Using room air or 100% oxygen during neonatal resuscitation — Pilot study

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Abstracts

Abstract UENPS.43 Prevalence and risk factors of hearing loss in neonates admitted in a tertiary care centre using BAER

ments were taken. Samples of the umbilical cord blood were collected after birth and leptin concentration was analysed by standart RIA method.

Hariram Maralakunte⁎ Sagar Apollo Hospital Bangalore India, Bangalore, India

We stated significantly lower leptin level in prematures (6.88 + 6.49 ng/ml) comparing to mature children (13.8 + 9.81 ng/ml) (p < 0.01). Taking birth weight into account as a nutritional state criterium we affirm that the lowest leptin concentration was observed in <3000 g group (8, 41 + 6.07 ng/ml). The significantly highest level (p < 0.01) was observed in >4000 g group (20.52+ 12.83 ng/ml). Significantly higher (p < 0.05) leptin level was observed in female children (14.9 + 9.4 ng/ml vs 12.6 + 10.13 ng/ml). There were no differences in P.I. between premature and mature newborns. P.I. was significantly higher in male newborns. In the age of 6 and 12 months 86% of newborns with birth weight >90 percentile were still characterized by the same >90 body mass percentile.

Background and aim To determine the prevalence and assess related risk factors for hearing impairment among high risk neonates using Brainstem Auditory Evoked Response. Materials and methods All neonates admitted in the newborn intensive care unit for reasons like prematurity, perinatal asphyxia, sepsis, meningitis, in utero infections, respiratory distress requiring hood Oxygen or mechanical ventilation, hyperbilirubinemia (requiring phototherapy/exchange transfusion) and babies who stayed beyond 48 h in the NICU were included in the study. The screening procedure was performed by Brainstem Auditory Evoked Response (RMS Medulla 201, India).Exclusion criteria: Severe life threatening congenital anomalies. Results 208 neonates were enrolled in the study. Mean gestational age was 33 weeks, mean birth weight 1950 g; 114 neonates being male and 94 being female; 47 neonates exhibited abnormal BAER at 40 weeks corrected gestational age. Follow up examination of these 47 neonates at 4 months corrected age revealed that 12 infants had persistent hearing loss. (8 of these infants had bilateral pathologic BAER and remaining 4 had unilateral pathologic BAER.). Ex utero transfers, resuscitation at birth and aminoglycosides administration were identified as significant risk factors in our study. Conclusions Hearing screening in high risk population revealed a total of 5.8% with pathologic BAER. Significant risk factors were Ex utero transfers, resuscitation at birth and aminoglycoside administration. Other perinatal complications did not significantly influence screening results indicating improved perinatal handling in a neonatal population at risk for hearing disorders. Our study has highlighted that early referral to a tertiary care centre, judicious use of aminoglycosides and presence of trained personnel for every delivery might reduce the chances of hearing loss among high risk neonates. On the basis of this data, it is suggested that initial screening should be performed at 40 weeks corrected gestational age. BAER should be repeated at 4 months corrected age if the initial test is abnormal. Our study also concludes that neonatal hearing test is a must for all NICU graduates for early diagnosis. doi:10.1016/j.earlhumdev.2008.09.059

Results

Conclusions Both the small and the large birth weight are connected with similarly low and high leptinaemia. According to “fetal programming” theory large birth weight causes higher probability of patophysiological (especially obesity) disturbances. The risk of diabetes in future is also more often in these children. doi:10.1016/j.earlhumdev.2008.09.060

Abstract UENPS.45 Using room air or 100% oxygen during neonatal resuscitation — Pilot study Dariusz Pawel Madajczak⁎, Joanna Paulina Seliga, Maria Katarzyna Borszewska-Kornacka Department of Neonatology Warsaw Medical University, Warsaw, Poland Background and aim Traditionally neonatal resuscitation has been preformed with 100% oxygen. This management was never evidence based, but seemed logical having in mind that the main goal was to reverse fetal hypoxemia and acidosis. Moving further room air ventilation seems to be devoid side effects of free oxygen radicals. Materials and methods Our study included 83 neonates (45 term babes and 38 premature) born in the 2nd Department of Obstetrics and Gynecology and admitted to the Department of Neonatology Warsaw Medical University. The inclusion criteria were as follows: neonates with clinical signs of asphyxia requiring resuscitation after birth. Intervention

Abstract UENPS.44 Somatic parameters of the newborns in relationship to cord blood leptin concentration

Positive pressure ventilation provided by a self inflating bag or NeoPuff using room air or 100% oxygen. Evaluation

Jerzy Wojculewicz⁎,a, Hanna Jasiel-Wojculewiczb, Elzbieta Kolodziejczaka a Neonatal Department, Medical University, Gdansk, Poland b Department of Hypertension and Diabetology, Medical University, Gdansk, Poland

Apgar score evaluation in the 1st and 5th minute, cord pH comparison, and post stabilization capillary blood gases. Additionally incidence of Intraventricular Hemorrhage (IVH), Retinopathy of the Premature (ROP) and Bronchopulmonary Dysplasia (BPD) among preterm neonates were evaluated.

Background and aim Results The aim of the study was estimation of the leptin level in the umbilical cord blood in newborns in connection to their gestational age, gender and somatic parameters. Materials and methods A cohort of 301 newborns born between 01.01.04–30.06.05 in Neonatal Dept. Medical University of Gdansk was examined. Antropometric measure-

There was no statistical difference in the 5th minute Apgar among term neonates in all the both groups. There was a statistically significant higher increase pH among preterm neonates ventilated with room air. There was no difference between average post stabilization capillary blood gases in all the groups. We did not note ROP and BPD cases among preterm babies in both groups. In our study group we noted statistically significant higher risk of I° and II° of IVH among preterm babies ventilated with 100% oxygen.

Abstracts

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Conclusions

Background and aim

It is difficult to state, based on our material, that room air ventilation during resuscitation is beneficial for preterm neonates. Based on our results we can assume that the use of room air during resuscitation of term neonates is just as efficient as ventilation with 100% oxygen. Based on these conclusions we plan a randomized allocation concealed study.

The intrapartum acid-base status of the fetus is an important parameter to establish the relation between intrapartum events and neonatal condition. Umbilical cord blood gas analysis is a reliable way to determine the acid-base status of the fetus. Noninvasive monitoring of pCO2 and oxygen saturation (SpO2) can give idea about intrapartum status of the newborn. Aim: To evaluate the relation between SpO2, pulse rate (PR) and transcutaneous measurement of pCO2 (TcPCO2) in healthy term infants immediately after birth in delivery room.

doi:10.1016/j.earlhumdev.2008.09.061

Materials and methods Abstract UENPS.46 A newborn with generalized crusted papulonodular rash at birth A Hashimoto–Prietzke case Pablo Justich, Rodolfo Pedro Giniger⁎, Flavia Torielli, Rosmari Vazquez, Juana Rubio, Fransisco Chicano, María Teresa Guerin, Juan Antonio Carmona Clínica Virgen de la Vega, Murcia, Spain Background and aim Pathological skin lesions are rare disorders in the newborn period and red–brown papules specifically may present a diagnostic dilemma. Apart from primary skin disorders, the differential diagnosis includes infectious diseases, benign or malignant tumors and storage diseases. Materials and methods Report on one case. Results A full-term newborn, male, with widespread eruption since birth, consisting of multiple reddish-brown nodules, papulonodules, sometimes with ulcerations and scabs, concerning all the body, except for the mucous membranes, with a predilection for the face and thorax, without general abnormalities. Blood tests revealed no abnormalities and antibody titers of TORCH, varicella and syphilis were inconspicuous. Bacterial and viral cultures were also negative. X-rays of the chest and ultrasonography of the abdomen and brain were also normal. A biopsy and haematoxylin–eosin stain revealed dermal infiltration of pleomorphic histiocytes with eosinophilic ground-glass cytoplasm and round to bean-shaped nuclei. The histiocytic cells were positive for antibodies against S-100 protein and CD1a, but negative for anti-CD68. The clinical examination, histopathological data, immunohistochemistry, and the benign evolution during the following months with no particular treatment define the diagnosis of congenital selfhealing Langerhans' cell histiocytosis of Hashimoto–Pritzker (CSHLCH). Conclusions Generalized crusted papulonodular rash at birth may present a real challenge to the pediatrician and an important stress to their parents. Despite its impressive clinical presentation, CSHLCH is a benign condition. Careful evaluation for systemic disease such as the Letterer–Siwe disease must be performed at the time of diagnosis. As long as many questions remain unanswered and because of the apparent close relationship to malignant Langerhans cell histiocytosis, caution is indicated and long term follow-up of these patients is recommended. doi:10.1016/j.earlhumdev.2008.09.062

Abstract UENPS.47 Evaluation of a new transcutaneous measurement of PCO2 Tutku Ozdogan⁎,a, Sultan Kavuncuoglub, Yasemin Senela, Iskin Namdara, Guntulu Durana, Senay Dogana a Süleymaniye Maternity Hospital, Istanbul, Turkey b Bakirkoy Maternity Hospital, Istanbul, Turkey

In a prospective, nonrandomized study of 20 healthy term infants of uneventful pregnancies the new sensor for combined TcPCO2, pulse rate (PR) and SpO2 was tested. The V-Sign(tm) Sensor is a digital sensor for noninvasive and continuous monitoring of transcutaneous carbon dioxide partial pressure (PcCO2), oxygen saturation (SpO2), and pulse rate (PR). The SenTec Digital Monitor (SDM) is a lightweight (2.5 kg) stand alone monitor (SenTec AG, Therwil, Switzerland). For each baby one seperate sensor was applied by a resident after drying the baby and the values of SpO2, PR and TcPCO2 were recorded by a neonatologist at 5th, 10th and 15th minutes of birth in the delivery room. Results Fourteen infants were male, 6 were females. Mean birth weight of infants was 3351gr (2580–4220). All infants were born vaginally. Mean SpO2 value at 5th minute was 88.78% (73–100%), at 10th minute was 91% (75–100%), at 15th minute was 92.78% (77–100). Mean PR value at 5th minute was 155/min (132–180), at 10th minute was 149.8/min (130–166), at 15th minute was 146.3/min (126–161). Mean TcPCO2 value at 5th minute was 41 mm Hg (23–66.8), at 10th minute was 40.69 mm Hg (17–75.3), at 15th minute was 41.58 mm Hg (13.8–72). 5th min. TcPCO2 value was highly correlated with PR at 5th and 10th min(p = 0.004). TcPCO2 at 5th min. was not correlated with SpO2 at 5th min (p = 0.2). However 5th min. SpO2 value has no correlation with 5th min. PR (p = 0.6) which shows that TcPCO2 mesurement was more sensitive than SpO2 mesurement. Conclusions Early measurement of TcPCO2 value is more sensitive than SpO2 value to determine the neonatal condition. TcPCO2 can be used to measure intrapartum status of the newborn and comparing TcPCO2 with that of umbilical cord may be subject of another study. doi:10.1016/j.earlhumdev.2008.09.063

Abstract UENPS.48 Impact of diaphragmatic paralysis following surgical ligation of patent ductus arteriosus in very low birthweight infants Ming-Chou Chiang⁎, Reyin Lien, Ren-Huei Fu, Peng-Hong Yang Chang Gung Memorial Hospital, Taoyuan, Taiwan Background and aim Patent ductus arteriosus (PDA) is frequently seen in VLBW infants. Both hemodynamic aberrations caused by a PDA and treatment modalities for this condition may result in mortality and morbidity. Phrenic nerve injury is one of the complications of PDA ligation and will lead to diaphragmatic paralysis. Management of diaphragmatic paralysis in neonates is controversial. Besides, in the literature, little is focused on VLBW infants. The aim of this study is to justify different treatment modalities and to analyze clinical outcome among VLBW infants with diaphragmatic paralysis following surgical ligation of PDA. Materials and methods Medical records were retrospectively reviewed during the period from January 2003 to December 2007. The diagnosis was made either from the