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PP-303. Epidemiological and clinical features of the newborn infants with indirect hyperbilirubinemia
Abstracts
levels on admission. In group I exchange transfusion was performed to one patient (6%) and in group II to one patient (10%). In the control group none of the patients required exchange transfusion. Duration of LED phototherapy was 4.2 ± 0.8 days in group I, 4.5 ± 0.5 days in group II and 3.4 ± 0.6 days in group III (p < 0.05). Number of patients who required erythrocyte transfusion were one in group I, three in group II and none in group III respectively. None of the patients in three groups were rehospitalised.
S137
Conclusions Close follow-up of the newborns for IHB, especially those at high risk, could prevent development of the neurological sequelae.
doi:10.1016/j.earlhumdev.2010.09.359
Conclusions IVIG therapy, single or multiple, did not affect exchange transfusion rate and hospitalisation time in ABO hemolytic jaundice of newborn as we used LED phototherapy.
doi:10.1016/j.earlhumdev.2010.09.358
PP-304. The prevalence and prognostic significance of relative adrenal insufficiency in preterm infants Fatma Nur Sarı a, Suna Oguz a, Evrim Alyamac Dizdar a, Nesibe Andıranb, Omer Erdevea, Nurdan Urasa, Raziye Memik a, Ugur Dilmen a a Zekai Tahir Burak Maternity Teaching Hospital, Neonatal Intensive Care Unit, Turkey b Fatih University Faculty of Medicine, Department of Pediatric Endocrınology, Turkey
PP-303. Epidemiological and clinical features of the newborn infants with indirect hyperbilirubinemia
Aim
Nilay Hakan, Mustafa Aydın, Elif Calıskanozturk, Ayşegul Zenciroglu, Arzu Dursun, Nurullah Okumus Dr. Sami Ulus Maternity and Children's Hospital, Neonatology, Turkey
To evaluate the prevalence of relative adrenal insufficiency (AI) using the low dose adrenocorticotropic hormone (ACTH) stimulation test and assess the association of relative AI with clinical outcomes in preterm infants.
Aim
Materials and methods
To evaluate epidemiological and clinical features of newborns with indirect hyperbilirubinemia (IHB).
We measured ACTH, basal cortisol and ACTH-stimulated cortisol concentrations after low-dose synthetic ACTH (Synacthen®) (1 μg/ 1.73 m2) stimulation at 20th, 30th or 40th minute in preterm infants less than 37 weeks of gestational age between 5 and 7th days of life. The association of cortisol concentrations with the severity of illness measured by SNAPPE-II score and the clinical outcomes were examined. A random cortisol concentration <15 μg/dl, or <9 μg/dl increase in response to low dose ACTH stimulation was used to diagnose relative adrenal insufficiency.
Materials and methods This study consisted of all newborns that diagnosed with IHB between January 2006 and December 2008 in our neonatal intensive care unit (NICU). The data were extracted from medical records. Results
Results Among a total of 4692 patients admitted to NICU during study period, 1220 patients (26%) (1015 full-term, 356 preterm) were diagnosed with IHB. Of them, 732 (60%) were male, 488 (40%) were female. While in 112 patient (9.2%) jaundice appeared within first 24 h, in remaining (n:1108, 90.8%) it appeared after 24 h. While 936 patients (76.7%) fed only with breast milk, 268 (22%) fed with breast milk plus formula, 8 (0.7%) fed with formula, and 8 (0.7%) fed with cow milk. An underlying etiologic risk factor was present in 918 (75.3%) patients: blood group incompability (BGI) in 392 (32.3%) [268 (22%) ABO incompability, 80 (6.6%) Rh-D isoimmunisation, 16 (1.3%) subgroup incompability], prematurity in 356 (29.2%), and others in 170 patients (13.9%). In general, mean total bilirubin (TB) level at admission was 19.2 ± 4.8 mg/dl (3.9–36.1). There were no significant differences at mean TB levels in patients with Rh-D isoimmunisation, ABO and subgroup incompability, and the patients without BGI (p > 0.005). TB level was found higher in patients with positive direct Coombs test (n:84, 6.9%) (p < 0.002). Mean phototherapy duration was 2.3 ± 0.8 (1–5) days. While the patients breast milk fed received phototherapy for 2.3 days, the patients formula fed received it for 3.7 days (p = 0.005). In the patients undergone exchange transfusion (176/1220, 14.4%) etiologic risk factors were ABO incompability (n:64, 36.4%), Rh-D isoimmunisation (n:12, %6.8), and exaggerated physiological jaundice (n:84, 47.8%). Kernicterus findings were determined in four patients (4/20) on cranial MRI.
Ninety eight preterm infants were enrolled in the study. The median basal cortisol and ACTH value of all infants were 13.7 (9.7–21.1) μg/dl and 11.5 (6.9–22.6) pg/ml, respectively. Peak cortisol value was reached at 40th minute in 93, at 30th minute in 4 and at 20th minute in one infant. There was no correlation between SNAPPE-II scores and ACTH, basal or stimulated cortisol values. Basal cortisol levels were <15 μg/dl in 55 infants and cortisol increment was <9 μg/dl in 9 infants, yielding to 65% overall prevalence of relative AI. All of the infants with cortisol increment <9 μg/dl had basal cortisol values ≥15 μg/dl. The relative risk of death was significantly higher in infants with cortisol increment <9 μg/dl than the infants with cortisol increment ≥9 μg/dl. Conclusions Relative adrenal insufficiency is an important clinical entity and should be screened in critically ill preterm infants. High basal cortisol values cannot exclude relative adrenal insufficiency and low dose ACTH stimulation test should be performed. Cortisol increment less than 9 μg/ dl in response to ACTH stimulation was associated with increased mortality.
doi:10.1016/j.earlhumdev.2010.09.360
levels on admission. In group I exchange transfusion was performed to one patient (6%) and in group II to one patient (10%). In the control group none of the patients required exchange transfusion. Duration of LED phototherapy was 4.2 ± 0.8 days in group I, 4.5 ± 0.5 days in group II and 3.4 ± 0.6 days in group III (p < 0.05). Number of patients who required erythrocyte transfusion were one in group I, three in group II and none in group III respectively. None of the patients in three groups were rehospitalised.
S137
Conclusions Close follow-up of the newborns for IHB, especially those at high risk, could prevent development of the neurological sequelae.
doi:10.1016/j.earlhumdev.2010.09.359
Conclusions IVIG therapy, single or multiple, did not affect exchange transfusion rate and hospitalisation time in ABO hemolytic jaundice of newborn as we used LED phototherapy.
doi:10.1016/j.earlhumdev.2010.09.358
PP-304. The prevalence and prognostic significance of relative adrenal insufficiency in preterm infants Fatma Nur Sarı a, Suna Oguz a, Evrim Alyamac Dizdar a, Nesibe Andıranb, Omer Erdevea, Nurdan Urasa, Raziye Memik a, Ugur Dilmen a a Zekai Tahir Burak Maternity Teaching Hospital, Neonatal Intensive Care Unit, Turkey b Fatih University Faculty of Medicine, Department of Pediatric Endocrınology, Turkey
PP-303. Epidemiological and clinical features of the newborn infants with indirect hyperbilirubinemia
Aim
Nilay Hakan, Mustafa Aydın, Elif Calıskanozturk, Ayşegul Zenciroglu, Arzu Dursun, Nurullah Okumus Dr. Sami Ulus Maternity and Children's Hospital, Neonatology, Turkey
To evaluate the prevalence of relative adrenal insufficiency (AI) using the low dose adrenocorticotropic hormone (ACTH) stimulation test and assess the association of relative AI with clinical outcomes in preterm infants.
Aim
Materials and methods
To evaluate epidemiological and clinical features of newborns with indirect hyperbilirubinemia (IHB).
We measured ACTH, basal cortisol and ACTH-stimulated cortisol concentrations after low-dose synthetic ACTH (Synacthen®) (1 μg/ 1.73 m2) stimulation at 20th, 30th or 40th minute in preterm infants less than 37 weeks of gestational age between 5 and 7th days of life. The association of cortisol concentrations with the severity of illness measured by SNAPPE-II score and the clinical outcomes were examined. A random cortisol concentration <15 μg/dl, or <9 μg/dl increase in response to low dose ACTH stimulation was used to diagnose relative adrenal insufficiency.
Materials and methods This study consisted of all newborns that diagnosed with IHB between January 2006 and December 2008 in our neonatal intensive care unit (NICU). The data were extracted from medical records. Results
Results Among a total of 4692 patients admitted to NICU during study period, 1220 patients (26%) (1015 full-term, 356 preterm) were diagnosed with IHB. Of them, 732 (60%) were male, 488 (40%) were female. While in 112 patient (9.2%) jaundice appeared within first 24 h, in remaining (n:1108, 90.8%) it appeared after 24 h. While 936 patients (76.7%) fed only with breast milk, 268 (22%) fed with breast milk plus formula, 8 (0.7%) fed with formula, and 8 (0.7%) fed with cow milk. An underlying etiologic risk factor was present in 918 (75.3%) patients: blood group incompability (BGI) in 392 (32.3%) [268 (22%) ABO incompability, 80 (6.6%) Rh-D isoimmunisation, 16 (1.3%) subgroup incompability], prematurity in 356 (29.2%), and others in 170 patients (13.9%). In general, mean total bilirubin (TB) level at admission was 19.2 ± 4.8 mg/dl (3.9–36.1). There were no significant differences at mean TB levels in patients with Rh-D isoimmunisation, ABO and subgroup incompability, and the patients without BGI (p > 0.005). TB level was found higher in patients with positive direct Coombs test (n:84, 6.9%) (p < 0.002). Mean phototherapy duration was 2.3 ± 0.8 (1–5) days. While the patients breast milk fed received phototherapy for 2.3 days, the patients formula fed received it for 3.7 days (p = 0.005). In the patients undergone exchange transfusion (176/1220, 14.4%) etiologic risk factors were ABO incompability (n:64, 36.4%), Rh-D isoimmunisation (n:12, %6.8), and exaggerated physiological jaundice (n:84, 47.8%). Kernicterus findings were determined in four patients (4/20) on cranial MRI.
Ninety eight preterm infants were enrolled in the study. The median basal cortisol and ACTH value of all infants were 13.7 (9.7–21.1) μg/dl and 11.5 (6.9–22.6) pg/ml, respectively. Peak cortisol value was reached at 40th minute in 93, at 30th minute in 4 and at 20th minute in one infant. There was no correlation between SNAPPE-II scores and ACTH, basal or stimulated cortisol values. Basal cortisol levels were <15 μg/dl in 55 infants and cortisol increment was <9 μg/dl in 9 infants, yielding to 65% overall prevalence of relative AI. All of the infants with cortisol increment <9 μg/dl had basal cortisol values ≥15 μg/dl. The relative risk of death was significantly higher in infants with cortisol increment <9 μg/dl than the infants with cortisol increment ≥9 μg/dl. Conclusions Relative adrenal insufficiency is an important clinical entity and should be screened in critically ill preterm infants. High basal cortisol values cannot exclude relative adrenal insufficiency and low dose ACTH stimulation test should be performed. Cortisol increment less than 9 μg/ dl in response to ACTH stimulation was associated with increased mortality.
doi:10.1016/j.earlhumdev.2010.09.360