INAC 2016 Abstracts

Transcription

INAC 2016 Abstracts

INAC 2016 Abstracts
1
Whole Body Cooling (WBC) for Short Term Outcomes in Newborns with Asphyxial Encephalopathy
(CNAEST study): A Pilot Feasibility Study.
Govind Benakatti, Dattatray Inamdar, M M Karva, L H Bidari, Laxmi Hadalagi, Sandeep
Harsangi
Dr. Bidari's Ashwini Institute of Child Health and Researh Centre, India
Background and Aims
Limited studies have assessed the survival outcome of WBC. Moreover, studies from resource limited
settings are very much lacking and few available studies have failed to show the benefits of WBC in similar
manner with studies from developed nations. Various reasons are cited for this contradictory result. To
resolve this controversy and to study the effect of WBC on mortality and short term outcomes, we conducted
this pilot feasibility study in neonates with moderate to severe asphyxial encephalopathy in NICU of tertiary
care pediatric teaching hospital.
Methods
We followed TOBY trial protocol in newborns with ≥36 weeks of gestation with moderate to severe
asphyxial encephalopathy admitted within 6 hours of birth. The aEEG was continuously monitored for brain
activity, seizures and progress of encephalopathy. Predefined adverse effect profiles (acid-base, renal
functions, coagulation, cardiovascular profile) were monitored at 24-hourly intervals. Neonates remained in
cooling protocol for 72 hours and/or any predefined adverse effect occurred. MRI was done in all survived
neonates at discharge. Neonates were divided into three groups based on cooling initiation time as; groupA(0-2 hours), group-B(2-4 hours), and group-C(4-6 hours). Primary outcome was survival rate. Secondary
outcomes were; improvement in encephalopathy severity in aEEG and MRI.
Results
Fifty neonates were enrolled. 62%(n=31) had moderate and 38%(n=19) had severe encephalopathy.
Mean(±SD) age at cooling initiation was 3.78±1.8 hours and mean(±SD) duration of cooling was
66.8±9.6hours. Mortality was 50%. Group-A showed ‘threefold’ lesser mortality (27%vs.69%; P=0.030)
(OR 5.3; 95%C.I.1.1-27.8) and higher rate of improvement to mild/no encephalopathy (91% vs.16%;
P0.001). There was positive correlation between early cooling initiation with lesser brain injury on MRI
(Spearman’s co-efficient value:0.47; P=0.089).
Conclusions
WBC showed survival benefit and improved neurological outcome in neonates at time of discharge in
resource limited settings, provided initiated early, preferably within two hours of birth.
2
Magnesium Sulfate for Fetal Neuroprotection: Correlation between Maternal and Infant Serum
Magnesium Concentrations
IRIS MORAG, Iris Morag, Daniel Yakubovich, Michal Simchen, Tzipi Strauss
The Edmond and Lily Safra Children Hospital ant Chaim Sheba Medical Center, Israel
Aim
To determine the correlation between maternal and infant serum Mg concentration among preterm infants
exposed to MgSO4 for neuroprotection.
Methods
A total of 60 infants born at 32 weeks gestational age and exposed to MgSO4 for neuroprotection were
enrolled. The correlation between maternal serum Mg concentration (mMgC) drawn at 48 hours prior to
birth and infant serum Mg concentrations (iMgC) drawn immediately after birth was assessed. Additional
factors such as total Mg treatment dose, interval between treatment initiation, treatment discontinuation and
birth, as well as other maternal and infant characteristics were assessed as possible contributors.
Results
Complete data were available for 60 mother-infant dyads. Mean infant gestational age was 28.8 + 2.23
weeks. Median and interquartile range (IQR) of total MgSO4 dose, mMgC and iMgC were 45g (25-88), 5
(4-5) and 4 (3-4) mg/dL respectively. Maternal Mg concentration and iMgC correlated significantly (r=.433
p=.001). In multiple regression analysis duration between first loading and birth (b=-.031 p=.004) and
female gender (b=.412 p=.029) also correlated with iMgC.
Conclusion
Serum magnesium concentration in preterm infants treated for neuroprotection correlates with mMgC. This
correlation may serve as a non-invasive tool for estimation of fetal Mg concentration in exposed fetuses
during maternal treatment.
3
Dunstan Baby Language Efficacy in Decreasing the Parenting Stress Levels of Housewives with 0-2
Month Old Infants vs. Standard Care Using a Quasi-Experimental Study Design
Angelica Marie Pineda, Roza Clara Pineda, Henry Pinos, Loubelle Rirao, Rogelio Jr.
Rivera, Karen Angelica Rodil, Mary Christine Roque, Raiza Jane Sabate, Sandy Sanchez,
Jose Lorenzo Santos, Joshua Santos
Universiry of the East Ramon Magsaysay Memorial Medical Center, Philippines
Literature shows that infant distress and care giving can be sources of stress of primary care givers,
especially for first time mothers. The researchers wanted to determine whether Dunstan Baby Language
(DBL) is efficacious in decreasing parenting stress among these primiparous women with 0-2 month infants
over those utilizing standard newborn care.
This research utilized a quasi-experimental approach, where 18 participants were gathered and divided into
control (standard care) and experimental (DBL) groups. Descriptive statistics were used in the interpretation
of the demographics, while a repeated measures mixed model was used for the Parental Stress Scale (PSS)
results.
A total of 27 participants were enrolled in the study. The experimental group had 18 participants, with a
subsequent loss to follow up of 9, while the control group had 9 participants. These participants had babies
with a mean age of 1 month in the experimental group, and 2 months in the control group. An apparent
decrease was noted in the Time 1 to Time 2 and the Time 2 to Time 3 PSS scores in the experimental group,
as opposed to the control group having minimal changes in their PSS mean scores, but p-values failed to
demonstrate any significant difference among them (p-values ranged from 0.053-0.415).
Use of DBL among newborn babies led to decreased parenting stress levels among primiparous mothers as
reflected in the downward trend of PSS mean scores during the observation period. However, the difference
was not statistically significant versus the standard newborn care.
4
Etiology of Hydrops Fetalis at the Philippine General Hospital: a Retrospective Study
Michelle Abadingo, Maria Melanie Liberty Alcausin
University of the Philippines-Philippine General Hospital, Philippines
Introduction
Hydrops fetalis (HF) is defined as accumulation of fluid in 2 or more fetal compartments. HF is a diagnosis
with significant morbidity and mortality. An epidemiologic profile of HF in the local population is needed to
identify possible etiologic factors. This study aimed to identify common etiologic causes of HF in the
Philippine General Hospital (PGH).
Methodology
This is a retrospective review of hydrops fetalis cases delivered at the PGH from January 1, 2010 to
December 31, 2014. Fifty-eight (58) medical charts of patients, obtained from the Medical Records Section
of the PGH,were reviewed
Results
The median gestational age at birth was 31 (range 21-40) weeks. There were 19 identified cases (32%) of
stillbirth. Of the 32 patients born alive, 30 (93.75%) died in the immediate neonatal period. The etiologies of
HF were identified in 12 cases, which included hematologic anomalies (n=5), cardiac anomalies (n=3),
infectious problems (n=3) and congenital tumor (n=1). Aside from the 2 confirmed cases of alpha
thalassemia, 15 cases presented with microcytic, hypochromic anemia on complete blood count (CBC). The
cause of HF was not confirmed in the remaining 47 (80%) cases. There was a lack of laboratory work-ups
done.
Conclusion
It is important to fully investigate the causes of HF to aid in the proper management, counselling and
treatment planning.Further work-up must be done for mothers presenting with microcytic, hypochromic
anemia This is an important and common feature of alpha thalassemia which is a major cause of hydrops
fetalis in Southeast Asian countries.
Keywords: Hydrops fetalis, etiology, fetal outcome
5
Effect of Topical Emollients in the Prevention of Nosocomial Sepsis in Neonates:
A Randomized Controlled Trial
Ari Hidayat, Jennie Wong, Marxengel L. Asinas, Pamela Bandelaria
Background
Topical emollients have been introduced as one of the possible strategies to reduce nosocomial infections in
the Neonatal Intensive Care Unit (NICU). Topical application of sunflower seed oil and virgin coconut oil
that may augment the function of the skin barrier as a strategy for reducing risk of nosocomial sepsis and
improving survival rates in Neonatal Intensive Care Unit tertiary government hospital will be evaluated in
this study.
Objectives
To compare the effect of topical application of sunflower oil and virgin coconut oil in the prevention of
nosocomial infection among newborns in Neonatal Intensive Care Unit Tertiary Government Hospital.
Design
Double blind randomized controlled trial
Setting
Neonatal Intensive Care Unit in a Tertiary Government Hospital
Subjects
A total of 116 neonates were included in this study. The inclusion criteria were all admitted neonates at the
NICU on the first day of life with one of risk factors for nosocomial sepsis (low birth weight, prematurity,
required mechanical ventilation, invasive procedures, administration of parenteral fluids, and used of stock
solutions). Exclusion criteria were neonates with poor APGAR score, Ballard score less than 28 week,
presence of a major congenital anomaly, required major surgical procedure, neonates or mother with known
immunodeficiency; and birthweight less than 1000 grams
Methods
Subjects were randomly assigned to group SO (received daily topical applications of sunflower seed oil plus
conventional therapy), VCO (receive daily topical applications of virgin coconut oil plus conventional
therapy) and Co served as control (with no topical applications, but given conventional therapy). Outcome
parameters such as nosocomial sepsis, mortality rates, survival rate, length of hospital stay, skin condition
and adverse effect were compared in all groups.
Results
There was homogeneity of baseline demographic and clinical profile between three groups. No adverse
effects or allergic reaction were observed from the treatment groups. The incidence of nosocomial sepsis
among the sunflower oil group was 9.6 times less likely compared to that of control group (p value 0.005)
and this was statistically significant. Sunflower oil group was 5.7 times more likely to survive compared to
that of control group (p value 0.005, significant) and 3.4 times more likely to survive compared to the virgin
coconut oil group (p-value 0.052, borderline significant). Sunflower oil group had a significantly higher
survival curve compared to virgin coconut oil group (p value 0.019) and control (p value 0.001). There was
no significant difference in the length of stay between the three groups (p-value =0.505). The skin condition
in treatment group had a positive change in the skin condition compared to that of control, however, these
was not statistically significant (p value ≥0.05).
Conclusion
Topical sunflower oil has statistically significant reduction in the incidence of nosocomial sepsis and
mortality rates among NICU admitted neonates in Tertiary government Hospital. Both sunflower oil group
and virgin coconut oil group have no adverse effects or allergic reaction.
6
Impact and Outcomes of Prenatal Diagnosis of Congenital Heart Disease in Kosovo Single Centre
Experience
Ramush Bejiqi1, Ragip Retkoceri1, Hana Bejiqi2, Lindita Kryeziu2, Arber Retkoceri1, Rinor
Bejiqi2, Naim Zeka, Naim Zeka1, Abdurrahim Geguri, Abdurrahim Geguri1, Abdurrahim
Geguri, Armend Vuçiterna, Armend Vuçiterna1
1
University Clinicla Centre of Kosovo, Kosovo
2
Mean Centre of Family Medicine, Kosovo
Introduction
With high prevalence congenital heart anomalies (CHA) are the most common congenital disorders in
newborn and leading factor in neonatal death. Improving FE in Kosovo as the youngest country in Europe
with still high natality and mortality rate in early detection of heart anomalies, contributes in planning
delivery as in-utero transport abroad Kosovo, trying to reduce mortality as a consequence of HA.
Aim of presentation
is to present impact of prenatal diagnosis and postnatal treating foetuses and children with complex CHA in
Kosovo as a country with limited human and technical resources.
Methods
retrospectively we analysed medical reports and data, obtained from the FE,
Results
During this period January 2114 and December 2015 FE in 1413 pregnancies were performed (mean 1.5);
the age of gestation was from 14 to 32 weeks (mean 23 weeks). Of them 264 were pregnant with twins
(12.5%), and 13 pregnancies (0.6%) were with three foetuses (all from IVF). Indication for FE where all
multiple pregnancies, in 514 other indication was actual obstetric findings, in 218 was positive history, in
123 infection and use of medication during the pregnancy and, in 399 pregnancies indication was age of
parents, diabetes or self-initiative for FE. In 243 pregnancies (11.55) CHA was registered, where 68 have
been complex. Of them 22 were with complete atrioventricular canal, 17 where with hypoplastic left heart
syndrome, 12 with tricuspid atresia, and 17 where with tetralogy of Fallot or double outlet right ventricle.
From 68 pregnancies with CHA, despite advice to continue the pregnancy only 9 continue pregnancy (all
were with multiple foetuses where other one was health).
Conclusion
Despite the application of FE and accurate diagnosis most pregnant women interrupted pregnancy as a
consequence of CHA. Situation exacerbates the fact of lack of paediatric cardiac surgery services on
Kosovo.
7
Familial Recurrence of Congenital Heart Defects in Norway
Kristoffer Brodwall1,2, Elisabeth Leirgul2,4, Gottfried Greve1,3,4, Stein Emil Vollset2,5,
Grethe S. Tell2,5, Henrik Holmstrøm6, Nina Øyen2,7
1
Haukeland University Hospital, Norway
2
University of Bergen
3
University of Bergen, Norway
4
5
Norwegian Institute of Public Health, Oman
6
Oslo University Hospital, Norway
7
Background
Congenital heart defects (CHD) constitute the largest group of congenital malformations. Most cases occur
without any known etiologic cause, and the majority of affected families contain only one person with CHD,
but prevalence of CHD is increased for children being born into families already affected. In this study, the
recurrence risk ratio of CHD in Norway is described.
Material and methods
All births from 1994 through 2009 were identified in the Medical Birth Registry of Norway, with
information on CHD supplemented from clinical and administrative registers. Pairs of relatives were
established using the unique personal identification number. Familial recurrence risk ratio (RRR) was
calculated using CHD status in the older person as exposure and CHD status in the younger person as
outcome.
Results
Among 954,355 births 1994-2009 CHD was diagnosed in 13,081 (birth prevalence 137.1 per 10,000). We
were able to link 950,970 mother-child pairs, 938,699 father-child pairs, 466,307 pairs of full siblings,
including 17,181 pairs of twins, triplets or quadruplets, 51,964 pairs of maternal half siblings, and 55,490
pairs of paternal half siblings. CHD diagnosis was found in the mother in 1,182 of the births and in the father
in 927 of the births.
Overall RRR for CHD was 4.6 (95% confidence interval (CI) 4.2-4.9). By type of relationship, the motherto-child RRR was 7.8 (95% CI 6.6-9.3), father-to-child RRR was 1.9 (95% CI 1.3-2.8), same-sex twin RRR
was 13.4 (95% CI 11.2-15.9), unlike-sex twin RRR was 13.6 (95% CI 10.5-17.7), sibling (excluding twins)
RRR was 3.1 (95% CI 2.7-3.5), maternal half-sibling RRR was 1.6 (95% CI 1.0-2.7), and paternal halfsibling RRR was 1.3 (95% CI 0.8-2.3).
Conclusions
Recurrence risk ratio of CHD in families is high, especially between twins and from mother to child,
suggesting that significant familial risk factors for CHD are carried by the mother.
8
Empirical Cost Benefit Analysis of Investing in Neonatal Health Care in India. Are Neonatal Mortality
Related Sustainable Development Goals (SDGs) Acheivable?
Ramesh Vidavalur
Assistant Professor in Clinical Pediatrics, Weill Cornell Medical College/Cayuga Medical
Center, USA
Background
India accounts for 25% of global neonatal deaths with 26 million births annually. It is in the midst of
epidemiological and health transition wherein factors like urbanization and migration; changing lifestyles;
sustained economic growth have enormous impact on maternal and child health.
Objective
To determine temporal trends of neonatal mortality and cost effectiveness of investing in newborn health in
India.
Methods
Country specific data from global burden of disease study (GBD 2013), Institute of Health Metrics and
Evaluation was used. Descriptive statistics were used to analyze the data.
Results
There is 50% reduction in NMR in last 25 years (1990-2015) at annual rate of reduction (ARR) of -2.8%. In
order to achieve neonatal related SDG by the year 2030, the ARR needs to double at -5.5%. The total
number of disability adjusted life years (DALYs) lost to neonatal causes is 53.7 million. Lost income to
disability alone, at 10 years of productive life with discounted GDP at 50%, is 26 billion dollars, contributing
to loss of 1.5% of total GDP (1.87 trillion). It costs approximately USD 1.2 to avert loss of one DALY from
neonatal causes through NICU intervention, assuming cost of NICU care is USD 112 (Prinja et al, 2013) per
infant. Nationwide, if we spend USD10 for every delivery on neonatal care, cost per life saved/disability
averted is USD420.
Conclusion
Considering economic benefits and impact on GDP, it is time to increase current per capita public health
expenditure to focus on maternal child health to reap the economic benefits of a country. High quality
antenatal care; timely, quality obstetric care coupled with improved neonatal care in primary and secondary
public healthcare facilities for below poverty population via accountable universal healthcare funding
programs to overcome existing physical, economic and cultural barriers is needed to save most vulnerable
newborns.
9
Management of Adams-Oliver Syndrome in Twins
Adnan Bajraktarevic1, Alisa Abduzaimovic2, Sajra Uzicanin3, Ismet Suljevic4, Velma
Selmanovic5
1
Public Health Institution of Health Center Sarajevo, Bosnia and Herzegovina
2
Biochemistry Laboratory Tesanj, Bosnia and Herzegovina
3
Pediatrics Clinic Sarajevo, Bosnia and Herzegovina
4
Clinical Medical Center Sarajevo, Bosnia and Herzegovina
5
Genetic Institution of Canton Sarajevo, Bosnia and Herzegovina
Introduction
Adams-Oliver syndrome has a wide spectrum of physical anomalies ranging from characteristic aplasia cutis
congenita, transverse limb defects, and cutis marmorata telangiectica to extensive lethal anomalies. The
prevalence is unknown. Adams-Oliver syndrome can have different inheritance patterns. Adams-Oliver
syndrome is an extremely rare inherited disorder .
Objective
The long term prognosis of Adams Oliver Syndrome is not described adequately due to the limited number
of cases reported worldwide and limited extended follow-up of affected individuals.
Methods
Authors described a girl with moderate Adams-Oliver syndrome whose brother was also mildly affected.
Their mother had hypoplastic forth and fifth toes, thought to represent very mild expression of the syndrome.
The clinical diagnosis of Adams-Oliver Syndrome is made based on 2 major criteria.
Results
Adams-Oliver syndrome is diagnosed by the presence of features typically associated with the syndrome. In
both infants, twins with Adams-Oliver syndrome, congenital scalp defects are present at birth and it include
multiple hairless scarred areas. Both infants with Adams-Oliver syndrome also exhibit malformations of the
toes and feet. Girl has an associated heart defect that is present at birth as a congenital heart defect such as
ventricular septal defects, but boy has no change of heart.
Conclusions
Adams-Oliver syndrome can have different inheritance patterns. Treatment is symptomatic and is largely
dependent on the severity of the symptoms of the syndrome.The risk for two carrier parents to both pass the
defective gene and have an affected child is 25% with each pregnancy. The risk to have a child who is a
carrier like the parents is 50% with each pregnancy.
10
Improving Breastfeeding in Saudi Arabia: The Baby Friendly Hospital Initiative
Cynthia Mosher, Abdullah Sarkar, Alaa AbouBakr, Reem Hamadah, Asma Alhoulan, Yosra
AlMakadma, Tehreem Khan, Abdurahman Al-Hamdani, Abiola Senok
Alfaisal University, Saudi Arabia
Background
The Baby Friendly Hospital Initiative (BFHI), is a global effort aimed at promoting and supporting
breastfeeding. This study aimed to examine the implementation of the BFHI program in Saudi Arabia and
assess its efficacy in increasing duration of exclusive breastfeeding.
Methodology
This prospective, longitudinal study was carried out between December 2013 and September 2015 at a two
healthcare facilities (BFHI and a non-BFHI) in Riyadh, Saudi Arabia. Randomly selected women at 36-40
weeks gestation receiving antenatal care at the hospitals were enrolled. Questionnaires were administered
prenatally, one, three and six month postnatal to collect data on demographics, infant feeding, education and
support. A separate questionnaire was administered to staff to assess maternity staff practices.
Results
Breastfeeding education and encouragement was higher at the BFHI-practicing hospital (93.3%) compared
to the non-BFHI hospital (48.2%); p
Conclusion
This is the first known study to assess the effectiveness of BFHI implementation in Saudi Arabia. While
BFHI implementation is demonstrating a degree of success, there are weaknesses that can be improved
through strict compliance with BFHI practices.
11
Severe Congenital Enzymatic Defects of Pyruvate Kinase Deficiency in Newborns
Adnan Bajraktarevic1, Alisa Abduzaimovic2, Dragica Abduzaimovic2, Adela Tunjic3, Ismet
Suljevic4, Velma Selmanovic5
1
2
3
4
Clinical Medical Center Sarajevo, Bosnia and Herzegovina
5
Introduction
Pyruvate kinase deficiency is inherited in an autosomal-recessive manner. The gene is located on
chromosome 1 (1q21) in the most cases. Treatment is usually effective in reducing the severity of the
symptoms. Persons with severe disease usually have onset in the neonatal period or infancy.
Objective
Pyruvate kinase deficiency is the second most common cause of enzyme-deficient hemolytic anemia,
following G6PD deficiency.
Methods
Authors described three case in newborns durig six years of period 2010-2015. A diagnosis of pyruvate
kinase deficiency is favored based on a negative Coombs test result, blood group setups, and a peripheral
blood film examination that demonstrates no spherocytes but reveals contracted, shrunken, spiculated red
cells of the pyruvate kinase deficiency. The minimal tests required to guide the investigation of pyruvate
kinase deficiency include the following:complete blood count , differential blood count, reticulocyte count,
serum bilirubin level study and peripheral blood film examination. A precise diagnosis of pyruvate kinase
deficiency depends on the detection of the deficient enzyme. Enzyme assays, as well as deoxyribonucleic
acid DNA analysis with a polymerase chain reaction PCR assay.
Results
Morbidity and mortality correlate with disease severity and usually depend on complications. Complications
without therapy associated with pyruvate kinase deficiency include the following: jaundince, sudden
worsening of anemia associated with viral infections and heart failure. The hematocrit valueof three cases in
pyruvate kinase deficiency ranges from 19-27. Erythrocytes were usually normochromic and normocytic.
High reticulocyte counts may raise the mean cell volume, giving the impression that the anemia is
macrocytic. The reticulocyte count in pyruvate kinase deficiency were increasing number by 8-10%. Two
children die during infancy, but only one newborn had survived until 2016.
Conclusions
Morbidity and mortality correlate with disease severity and usually depend on complications. Splenectomy is
indicated only for patients with severe anemia but onlz for older ages. Severe disease is usually treated with
blood transfusions. Severe forms of the disease are mostly symptomatic during early newborn period and
often hidrops fetalis.
12
Four Cases Ivemark Syndrome During Last Fifteen Years with Heart Failure in Neonate
Adnan Bajraktarevic1, Alisa Abduzaimovic2, Zijo Begic3, Velma Selmanovic4
2
3
4
1
Background
Asplenia with heart failure, also known as Ivemark syndrome and right atrial isomerism. These uncommon
congenital disorders are characterized by defects in the heart, spleen and paired organs such as the lungs and
kidneys. Situs inversus is the mirror image of situs solitus in toto.
Objective
Infants with Ivemark syndrome often have several heart defects that are present at birth as congenital heart
defects due to the failure of normal right-left asymmetry.
Methods
During the last fifteen years from 2001 to 2015, the authors have described seven cases of situs inversus in
newborns. Of these seven infants had four heart defects. In addition to echocardiography in the neonatal
period after birth, authors have used fetal echocardiography in pregnant mothers. These are Ivermark
findings ultrasound were confirmed by CT scan or MRI scan.
Results
Heart defects with inversion organs in children were in 4 (57.1%) newborns. From 4 children one died (25%)
in the first 30 days of life and another, within one year of age (25%). So far, two (50%) survived three or
more years. Both children after cardiac operation successfully, one child once a second child twice, both in
the newborn period.
Conclusions
Newborns who have asplenia as part of heterotaxy syndromes, often have increased mortality and morbidity
related to extrasplenic abnormalities in neonatal period. Right isomerism is usually associated with asplenia,
Ivermark syndrome with heart failure. The right and left sides of the heart are different and have different
functions.
13
Evaluation of Efficacy and Safety of Home Phototherapy Unit for the Management of Neonatal
Jaundice in the Hospital Setting
Ashwani Bhatia, Ashwani Bhatia, Pratibha Agarwal, Victor Samuel Rajadurai
KK Women's and Children's Hospital, Singapore
introduction:
A prospective randomized case-controlled study in the hospital setting was conducted to evaluate the
feasibility, efficacy and safety of the home phototherapy unit [PEP Bed] before the same can be
recommended for home use.
Methods:
Term and late preterm neonates [35 weeks or more], weighing 2000 grams to 4000 grams at birth with onset
of jaundice between day 2 to day 7 of life and needing single blue phototherapy as per our hospital protocol
[Clinical Pathway for Neonatal Jaundice] were randomized for conventional phototherapy and home
phototherapy during the period of November 2011 to April 2012.
Results:
Thirty-eight (38) neonates received conventional phototherapy in the control group and thirty-three (35)
neonates received PEPBed phototherapy in the study group. Babies in both the groups were comparable with
respect to their mean birth weights, mean gestational age, mean maternal age, ethnicity, mode of delivery
and feeding pattern. Mean age and mean serum bilirubin level at the start of phototherapy as well as bilirubin
at the end of phototherapy were comparable in both the groups The rate of decline in serum bilirubin was
slightly higher in the PEP Bed group [3.04 µmoles/L/hour] as compared to the decline in control group [2.74
µmoles/L/hour], but this was statistically insignificant [P value - 0.226]. Similarly the duration of
phototherapy was slightly shorter in the PEP Bed group [30.5 hours (± 9.14)] as compared to the duration in
the control group [34.05 (± 10.99) hours] but this too was statistically insignificant [P value- 0.147].
Conclusion
Phototherapy given by PEPBed devise is feasible, safe and effective and can be recommended as an option
of home phototherapy in a selected group of jaundiced neonates.
14
Adverse Events Related to Ibuprofen Treatment of Patent Ductus Arteriosus in Premature Neonates
Daouda Ndour1, Hocine Bouamari1, Frank Plaisant1, Julien BERTHILLER2, Olivier Claris1,
Kim An NGUYEN1
1
Hospices civils de Lyon/Lyon 1 University/Femme Mere Enfant Hospital, France
2
Hospices civils de Lyon/Lyon 1 University/Femme Mere Enfant Hospital, France
Objective
to describe gastrointestinal perforation and other adverse drug events (ADE) associated with ibuprofen use to
treat patent ductus arteriosus (PDA) in premature neonates
Method
We retrospectively evaluated electronic patient medical record from all neonates treated with ibuprofen for
PDA during 5 years in a French neonatal intensive care unit (NICU). Full chart review and targeted triggers
were used to detect ADE. Categorical variables were compared using Chi 2 test or exact Fisher test.
Quantitative variables were compared using Student t test. Logistic regression was conducted using a
univariate model, and with a multivariate model to explore the risk factors associated with ADE.
Result
Of 227 neonates included with a mean gestational age (GA) of 27 weeks (24-33), 12 (5%) have presented
intestinal perforation and 7 necrotizing enterocolitis (3%). The time between the last administration of
ibuprofen and the occurrence of perforation varied between 0 and 6 days. The perforation occurred more
frequently in less than 27 weeks GA and under 1000g of birth weight; OR 0.14; IC 95% 0.03 - 0.66, p = 0.01
and 0.68 (0.18 - 2.58), p = 0.57 respectively. Other observed ADE were acute renal failure (25 infants, 11%),
thrombocytopenia (5 infants, 2%)
Conclusion
Ibuprofen is the molecule of choice for the treatment of premature ductus arteriosus but it is also associated
with ADE including gastrointestinal perforations that occur in the smaller and less mature infants.
15
The Effect of Umbilical Cord Milking On Hemodynamic Status of Preterm Infants: A Randomized
Controlled Trial
Walid El-Naggar1, David Simpson1, Arif Hussain1, Anthony Armson2, Linda Dodds1,
Andrew Warrren1, Robin Whyte1, Douglas McMillan1
1
Dalhousie University, Canada
2
Background
Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the
alternative, cord milking, have not been fully evaluated.
Objective
To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as
compared with immediate cord clamping (ICC).
Method
Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks’ gestation
were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth.
The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC)
flow. Neonatal care staff, echocardiographer and interpreter were blind to the randomization. Analysis was
by intention to treat.
Results
A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November
2011-2014). There were no statistically significant differences in maternal demographic and antenatal
variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g.
38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC
flow, cardiac outputs or neonatal morbidities [table1].
Conclusions
There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity
between preterm infants who received CM and those who received ICC. More research is needed before
routine cord milking can be recommended for very preterm infants.
16
Analgesic and Sedative Drug Use in Post-Surgery in a French NICU
Claire Adela Benhamed1, Frank Plaisant1, Benjamin Riche2, Muriel Rabilloud2, Olivier
Claris1, Kim An NGUYEN1
1
Hospices civils de Lyon/Femme Mère Enfant Hospital/Lyon 1 University, France
2
Hospices civils de Lyon/Lyon 1 University/CNRS-UMR 5558, France
Objective
This study aimed to describe the pattern of analgesic and sedative drugs use and the adverse drug reactions in
a neonatal intensive care unit (NICU)
Method
Demographic characteristics, prescriptions, and pain scores were recorded and analyzed for 168 infants after
their surgery, included consecutively between January 2012 and June 2013 in a NICU
Results
There was no acute and prolonged pain assessment in 21% and 36% of infants respectively on the first day.
The weekly average scores post-surgery were 2/15 for EDIN (prolonged pain scale) and 1.6/10 for DAN
(acute pain scale). The rates of pain control were 88% for EDIN and 72% for DAN. The most prescribed
opiate drug was fentanyl (98 patients; 58%) with an average dose of 1.8 mcg/kg/hour. Midazolam was used
in 95 patients (56%), with an average dose of 35 mcg/kg/hour. Bolus represented 7% of the total dose for
both drugs. The same doses were used in term and preterm neonates. Of 118 patients receiving fentanyl
and/or midazolam, 40% presented an urinary retention, 24% a weaning syndrome requiring a treatment by
morphine per os. Paracetamol (in 155 patients, 92%) and nalbuphine (in 55 patients, 33%) were the other
medications most prescribed.
Conclusion
The off-label use of fentanyl and midazolam was necessary to treat pain after surgery in NICU. The
assessment of pain should be done for all neonates to optimize their treatment. Further research on analgesic
and sedative medicine in the vulnerable neonate would be necessary to harmonize practices and reduce
adverse drug reactions
17
Assessment of Endotracheal Tube Position After Oral Intubation in the Neonate
Sahin Takci, Seyma Unuvar, Deniz Anuk-Ince
Gaziosmanpasa University School of Medicine, Turkey
Introduction The correct position of the endotracheal tube (ETT) tip is midtracheal region. Previously
Tochen described and American Academy of Pediatrics recommends the 7-8-9 rule to determine the depth of
ETT insertion. Although this rule is widely used in neonatal practice, accumulating data regarding its
accuracy are lacking in the literature. The aim of this study is to determine the accuracy of this method in our
neonatal cohort and to determine the factors related to malposition. Methods The data of infants’ requiring
oral intubation were recruited retrospectively from March 2013 to December 2014. The initial ETT depth of
insertion was calculated using actual weight in the 7-8-9 rule. Additional corrections were also performed
after auscultation. Midtracheal position was defined as the point halfway between the inferior clavicle and
carina on a chest radiograph. The initial depth was compared to the ideal depth (midtracheal region). The
distance of the initial and ideal depth was calculated and divided to the midtracheal distance. The ideal
proportion was zero according to this calculation. Demographic variables, intubation time, intubation place
were noted. Results 160 neonates were enrolled the study. Mean gestational age was 32.2±4.4 weeks and
weight was 1989±829 grams. The ETT tip was lower than the ideal depth in 51 (31.9%) infants and it was
higher in 109 (68.1) infants. The mean proportion of the difference between the initial depth and ideal depth
and midtracheal distance was 0.39 ± 0.17, 0.35 ± 0.30, 0.46 ± 0.38 and 0.23 ± 0.19 in infants weighing 1000
grams and less, 1001 to 2000 grams, 2001 to 3000 grams and 3001 to 4000 grams respectively (p0.05). The
difference between 2001-3000 grams and 3001-4000 grams group was statistically significant. Conclusion
Infants weighting 3001 to 4000 grams were more accurately intubated than infants were 2001 to 3000 grams.
18
Late Neonatal Sepsis Cases in an Third Level Neonatal Intensive Care Unit
Sahin Takci1, Buket Seyyah Altuntas1, Ergul Sonmezgoz1, Ali Gul1, Deniz Anuk-Ince2
1
Gaziosmanpasa University School of Medicine, Turkey
2
Baskent University School of Medicine, Turkey
Introduction
Neonatal sepsis is an important cause of neonatal morbidity and mortality. Efforts to reduce infections
involve active infection control measures, conducting surveillance analysis and knowledge of the prevailing
flora responsible for sepsis in each unit. In the present analysis short term outcome of the infants with late
onset sepsis were evaluated. Methods Late onset sepsis cases were retrospectively evaluated in the third level
neonatal intensive care unit. The C-reactive protein (CRP), immature/total neutrophil ratio in the peripheral
blood smear, absolute neutrophil count, other hematologic parameters including platelet count, mean platelet
volume and conjugated bilirubin levels were analysed on the time of the sepsis diagnosed. Results Seventy
six (6.3%) of 1210 infants in NICU diagnosed with late onset sepsis between December 2014 to January
2016. Mean gestational age and birth weight were 33.2 ± 4.8 weeks and 2044 ± 1031grams. Eight (10.5%)
infants were died during NICU follow up. Gram negative microorganisms were responsible for sepsis in 29
infants where as 46 infants were gram positive. The most common microorganism is coagulase negative
staphylococcus, and then Klebsiella spp, Staphylococcus aureus followed. Although the results did not reach
statistically significant level; CRP, I/T ratio, conjugated bilirubin levels tented to be higher, platelet levels
were lower in gram negative microorganism in comparison with gram positives. Mortality rate was 17.9% in
gram negative microorganisms and 6.4% in gram positive microorganisms (p0.05)
Conclusion
Knowledge of the prevailing microorganisms responsible for sepsis in each NICU and monitoring the flora
changes seen in time is important for optimal management of late onset sepsis.
19
Transcutaneous Bilirubin Nomogram Representative of Israeli Population Predicts
Hyperbilirubinemia
Ruben Bromiker1,2, Avi Goldberg2, Michael Kaplan1,2
1
Shaare Zedek Medical Center, Israel
2
Hebrew University, Israel
Background
Ethnic differences in neonatal hyperbilirubinemia incidence suggest it may be prudent for different
population groups to construct specific transcutaneous bilirubin (TcB) nomograms.
Objective
We constructed a TcB nomogram representative of the Israeli population and studied the risk of
hyperbilirubinemia per percentile category.
Design/Methods
Newborns 36 wk gestation were tested daily for TcB , using Drager JM-103 devices, during birth
hospitalization. TcB readings were analyzed for percentiles in 6 hourly epochs and divided into 4 risk groups
akin to the Bhutani et al bilirubin nomogram. Each infant was assigned to a risk group according to that
infant`s highest TcB. The risk of hyperbilirubinemia, defined as receiving phototherapy according to AAP
(2004) guidelines, was calculated for each risk group relative to that 40th percentile, and further refined with
ROC analysis.
Results
3303 measurements on 1059 consecutive newborns contributed to the nomogram. Subgroups comprised
Ashkenazi Jews (46.4%), Sephardic Jews (27%), mixed Ashkenazi/Sephardic (17%), Arab (8.2%) and
Ethiopian Jewish (1.4%).
Risk of phototherapy increased progressively with risk grouping (Table).
The area under the ROC curve using the various risk groupings as predictive cutoffs was 0.85%,(95%
confidence interval 0.83 to 0.87, p0.0001). The optimal risk for discriminating the need for phototherapy was
41-75th percentile group,(sensitivity 93.33, specificity 59.47).
Conclusions
In a TcB nomogram representative of the Israeli population, the risk of phototherapy increased progressively
with increasing percentile group. Newborns in the 76-95thth, and especially 95th percentile groups, are at high
risk for phototherapy and should be closely monitored.
20
Do We Need an Intubation-Skilled Person in all High risk deliveries?
Ali Almudeer, Walid Elnaggar, Douglas Macmillan, O O'Connell
21
Beyond the Hospital Setting: The Longer-Term Impact on Parents of Infants Born Prematurely
Gary Heard, Gary Heard
Whitley College University of Divinity, Australia
The lifetime care of premature babies beyond discharge from the hospital rests with the parents. In an
original exploration of the experience of parents in the wake of their child’s extremely premature birth,
using grounded theory analysis of interactions between parents of premature infants on a support network
over a seven year period, potential long-term impacts of premature birth on the parents are identified which
are not reflected in any other literature. The potential for the experience to be intense and profoundly
disruptive for many parents is articulated in four major areas where there is potentially a long-term impact on
the parent(s) which impact their capacity as parents and the resources available to them.
This research reveals potential for parents to be impacted beyond the time of discharge from hospital in:

Social relationships, and therefore social support

Emotional capacities,

Understanding of their own identity, and

Relationship with their child.
Concern for parent wellbeing is underlined when considered in light of the prevailing body of evidence
which demonstrates that the outcomes for extremely premature children are lower than their term
counterparts on almost every measure. To parent a child born at the extreme end of prematurity is to assume
responsibility for a child who, on the weight of evidence, is likely to need greater support and care across a
broad range of spectra, for a period far in excess of the time spent within the NICU. Understanding the
longer-term impact on parents of a child born at the extreme ends of prematurity is a first step towards
shaping the care for parents in the NICU such that the transitions back to home are less disruptive in the
parental journey and in preparation for life in the home.

Bio: Gary Heard completed his PhD research on the impact of parents who have extremely
premature infants, and is currently Academic Dean at Whitley College in the University of Divinity.
He also serves as locum chaplain at Melbourne’s Royal Children’s Hospital.
22
Should RSV Prophylaxis Indications Be Narrowed? A Single Tertiary Center Experience in Israel
Itai G ross1, Yael Weintraub1, Abu Ahmad Wiessam1,2, Sinan Abu-Leil3, Benjamin Bar-Oz3,
Smadar Eventov-Friedman3
1
Hadassah and and Hebrew University Medical Center Ein Kerem, Israel
2
2Hadassah School of Public Health and Community Medicine University. Hebrew
University, Israel
3
Hadassah and Hebrew University Medical Centers, Israel
Background
The updated guidelines for palivizumab prophylaxis for the prevention of RSV hospitalization published in
2014 by the AAP have narrowed dramatically the indications for treatment. In Israel, of ~16,000 annual
preterm deliveries, about 2/3 of infants are born at late prematurity, 340/7 to 366/7 weeks. Since 2014 the
national recommendations for RSV prophylaxis include all infants born up to 346/7 weeks` gestation.
Objective
To identify the prevalence and severity of RSV infection among preterm infants (PI) born up to 34 0/7 weeks`
gestation compared with late preterm infants (LPTI) and term infants (TI).
Methods:
Data of all children aged 0-14 years hospitalized with PCR positive RSV in a single tertiary center from
2010 and 2014 were collected. 793 children were included: 637 TI, 105 LPTI and 50 PI. The incidence of
hospitalization due to RSV infection, was compared between the 3 groups as well as the clinical course,
including intensive care unit (ICU) hospitalization, length of hospitalization and co-infection with other
respiratory viruses.
Results:
Hospitalization rate due to RSV infection was 5.2%, 3.5% and 1.3% among PI, LPTI and TI, respectively.
Hospitalization in ICU was 24%, 7.6%, 3% among PI, LPTI and TI, respectively (P0.05). Length of
hospitalization was almost 3 times higher among PI - 12.3% compared to TI – 4.4% and was significantly
higher than LPTI – 5.7% (P 0.05). Gender, co-infection with other respiratory viruses and age at
hospitalization due to RSV infection was not significantly different.
Conclusion
RSV infection is still a major cause of morbidity among children born prematurely including LPTI, even
after RSV prophylaxis. Our results do not support the current AAP guidelines. Further local studies are
needed to optimize the prophylaxis approach for both PI and LPTI.
23
Saliva versus Urine Selective Screening to Diagnose Congenital Cytomegalovirus Infection in a
Targeted Neonatal Population
Smadar Eventov-Friedman, Sinan Abu-Leil, Orit Caplan, Aliza Lifshitz, Dana Wolf,
Benjamin Bar-Oz
Hadassah and Hebrew University Medical Centers, Israel
Background
Urine is traditionally considered as the gold-standard sample for the detection of congenital cytomegalovirus
(CMV) infection. Although universal neonatal screening has been suggested as means for timely
identification and treatment, overall, this approach has not been practically implemented, partially due to the
difficulties in obtaining fresh urine samples from newborns. Recently, the clinical utility of saliva real time
(RT)-PCR has been suggested in universal screening studies.
Objective
To determine the efficiency of saliva RT-PCR versus urine culture in the targeted screening of neonates at
risk for having congenital CMV infection and validate an efficient screening algorithm.
Methods
Between 01/2014 and 06/2015, 633 pairs of urine and saliva samples, obtained within the first 10 days of life
from clinically-suspected neonates, were prospectively examined for CMV infection by RT-PCR in saliva
and urine culture. Discordant results were further examined by urine RT-PCR. Included were neonates with
suspected maternal infection during pregnancy, intra uterine growth restriction, thrombocytopenia, and
failure in neonatal hearing screening.
Results:
Of 633 urine-saliva pairs examined, 51(8.1%, 95%CI±2.1%, 5.6%-10.2%) were positive by saliva RT-PCR
and 26 (4.1%, 95%CI±1.5%, 2.6%-5.6%) were positive by urine culture. The calculated measures for saliva
efficiency in the studied population were: sensitivity, 96.2% (25/26), specificity, 95.7% (581/607), positive
predictive value (PPV), 49.0% (25/51), and negative predictive value (NPV) 99.8% (581/582).
Conclusions
Saliva RT-PCR assay is a highly sensitive and feasible method for targeted screening of clinically-suspected
neonates. A diagnostic algorithm based on initial saliva RT-PCR screening with subsequent confirmation of
positive results by urine testing was consequently instituted.
24
Quality Improvement Intervention with Bubble CPAP Improves Respiratory Outcomes in Preterm
Infants
Beatrice Stefanescu1, Christa Sala2, Andrei Stefanescu3
1
University of New Mexico, USA
2
Vanderbilt University, USA
3
Harvard University, USA
Background
Very low birthweight (VLBW) infants are at high risk for respiratory failure after birth. Bubble nasal
continuous positive airway pressure (BNCPAP) with selective surfactant administration has been shown to
be a safe alternative to traditional therapies including routine intubation, surfactant delivery, and mechanical
ventilation.
Objective
To determine the impact on respiratory outcomes one year after introduction of a standardized BNCPAP
protocol in VLBW infants.
Design/Methods
Non-standardized respiratory management for VLBW infants, born between 26-30 weeks gestation, was
replaced in October 2014 by a three-pronged respiratory bundle that included: 1) administration of BNCPAP
with first breath to support functional residual capacity in the delivery room, 2) strict guidelines for
surfactant administration, 3) continued BNCAP until 32 weeks postmenstrual age. Outcomes examined were
the proportion of infants receiving mechanical ventilation, days on mechanical ventilation, proportion of
infants with chronic lung disease (CLD), and the proportion of infants with oxygen dependency at discharge.
Outcomes were compared to all VLBW infants born in the year prior to implementation. Group differences
in outcomes were assessed using chi square, student’s t and log rank tests.
Results
There were 84 patients in the control group and 98 in the BNCPAP group. Compared to controls, infants in
the BNCPAP group were less likely to be intubated during hospitalization (77 vs 28% p0.01). BNCPAP
group infants who received ventilation spent less time on mechanical ventilation than those in the control
group (median 0 vs 3 days; log rank test p 0.001). A significantly smaller proportion of infants had CLD
with intervention (43 vs 18%, p0.01) and dependency on supplemental oxygen at discharge (16 vs 30%,
p=0.0.03).
Conclusion
Supporting VLBW infants with BNCPAP from first breath to 32 weeks PMA was associated with important
benefits including decreased rates of early intubation, reduced time on mechanical ventilation, and decreased
rates of BPD.
25
Role of Formula Feeds/Intravenous Fluids in Reducing Non Asphyxial Acute Renal Failure Rates
During Summer Months - Prospective Interventional Study
sandeep harshangi, basavaraj patil
M R Medical college, India
Objective
To evaluate the role of breast feeding & formula feeds/intravenous fluids in decreasing the incidence of non
asphyxial acute renal failure(ARF) during summer months (April, May 2014).
Methods
Initial study was done to know the non asphyxial ARF rates during summer months of 2013 in our nursery.
The intervention done was (done in 2014 summer) - Intravenous fluids/formula feeds along with exclusive
breast feeding was given to all nursery babies during the 1st 3days of life.
ARF was defined as blood urea nitrogen (BUN) 20mg/dl or creatinine level more than 1.5mg/dl for at least
24-48 hours along with urine output 1ml/Kg/hr.
Discussion
This is an interventional study done to show the decrease in incidence of ARF in our hospital in the peak
summer months of April and May 2013 and 2014.
The Incidence of ARF in nursery attached to Basaveshwara and Sangameshwar Hospital in Gulbarga was
14.5%, which is higher than the national standards of 1-8%1-5. But this has decreased in the year 2014 with
incidence being only 5.8%.
The mean ambient ward temperature was 40-42οC during the study months of both the years.
Conclusion
Our study shows that environmental factors play an important role in neonatal wellbeing and early
interventions and prompt addressal of feeding issues leads to reduction in non asphyxial acute renal failure
rates and thus improving outcomes.
The intervention need to be region specific due to environmental factors and demography as shown in our
study and there is a need for policy change to be brought in to address these issues.
26
Perfusion Index as a Screening Tool for Patent Ductus Arteriosus
Itamar Nitzan1, Cathy Hamerman1, Daniel Fink2, Meir Nitzan3, Robert Koppell4, Ruben
Bromiker1
1
2
3
jerusalem college of technology, Israel
4
cohen medical center long island, USA
Background
Hemodynamically Significant Patent Ductus Arteriosus (HSPDA) is of clinical interest in preterm neonates.
Perfusion Index (PI) is the percent of the change in the amount of light that passes through the tissue
between systole and diastole as measured by photoplethysmography. PI reflects peripheral perfusion and,
may be a screening tool for HSPDA.
Methods
Preductal and postductal PI were measured in preterm neonates (GA 24-34 weeks) who had
echocardiography performed to assess ductal status . Ductal status was defined as HSPDA (including:
hemodynamically significant and borderline hemodynamically significant) or closed.
Results
19 neonates with HSPDA and 22 with closed ducts were assessed. There were no differences in GA, BW or
day of life (DOL) between the groups
PI was higher in neonates with HSPDA. When divided into subgroups by postnatal age, this difference is
significant only after DOL 8 . [Table1].
In neonates after 8 days of life a cutoff of 1.7 postductal PI will have 77% sensitivity and 95% specificity in
predicting hemodynamic significance. A cutoff of 1.34 will have 92% sensitivity and 68% specificity (by
ROC curve analysis).
Discussion
PI is higher in neonates with HSPDA than in normal neonates, the difference is most significant after one
week, when pulmonary resistance decline. Higher PI probably does not reflect better perfusion but rather
lower diastolic blood volume due to retrograde diastolic flow, that affects both preductal and postductal
arteries.
Conclusion
In neonates older than one week, PI can be a screening tool for HSPDA.
27
Innovations in Mucus Extractor for Better Neonatal Resuscitation Outcomes
Saurabh Vyas
Country Newborn Consultant Ekam Foundation, India
Chairperson INA WNC 2015, India
National Faculty NEST NTS NHS Trust, UK
National Faculty NNF DSC, India
Abstract accepted EAP Congress and Master Course 2015, Norway
Best Individual Category Award World Breast Feeding Week 2013, India
National Faculty IAP AAP NRP, India
National Faculty NNF FBNC Training, India
Member NNF Accreditation Committee, India
Affiliations
Chairperson INA WNC India 2015, National Faculty NEST NTS NHS Trust London , National Faculty
NNF DSC , Abstract accepted EAP Congress and Master Course Oslo Norway 2015, Best Individual
Category Award World Breast Feeding Week 2013 by BPNI, National Faculty IAP AAP NRP , National
Faculty NNF FBNC Training , Member NNF Accreditation Committee .
Background
Mucus Extractor is very important for Neonatal Resuscitation. There are many cost effective innovative
changes that can make it more effective and useful for better Neonatal Resuscitation outcomes.
Objective
Make Mucus Extractor user friendly with some Cost Effective Innovations in renaming and design for
improved Neonatal Resuscitation Outcomes.
Setting
Mucus Extractor in Neonatal Resuscitation .
Subjects and interventions
Rename Mucus Extractor as Meconium Extractor.
Make the Mucus Extractor base more solid and heavy.
Make a limiting knob at 5cm and a mark at 5cm and 2cm with different bold color codes.
Make arrows for direction of suctioning.
Results
Renaming it as Meconium Extractor in place of Mucus Extractor will limit routine suctioning.
Sometimes during suction by a fresher, meconium is being aspirated in mouth due to horizontal position of
Mucus Extractor increasing risk of HIV transmission. By giving a solid and heavy base to Mucus Extractor it
will remain in vertical position at all times even if unsupported.
Making a limiting knob at 5cm will restrict its depth of insertion. Mark at 5cm and 2cm with different bold
color codes will make it more user friendly for the depth of insertion in mouth and nose.
Arrows regarding direction of suctioning will make it helpful for beginners using Mucus Extractor.
Conclusion
All these cost effective innovative measures will make Mucus Extractor more user friendly and will lead to
improved Neonatal Resuscitation outcomes.
Keywords
Mucus Extractor; Neonatal Resuscitation.
28
Impact of Kangaroo Mother Care on Cerebral Blood Flow of Preterm Infants
afaf korraa, Afaf Korraa, Ragaa AbdelSalam
Al Azhar University
Kangaroo mother care (KMC) has been used to improve the care of preterms . However, very little is known
about cerebral hemodynamics responses in preterm infants during KMC intervention. The aim of this study
is to evaluate the changes of cerebral blood flow in middle cerebral artery, before and after a 30 minute
application of kangaroo mother care in stable preterm infants. Methods It is a prospective comparative study.
Cerebral blood flow paremeters were measured with Doppler ultrasonography in one middle cerebral artery.
Sixty preterm stable infants were assessed before and after 30 min KMC. CBF indices were assessed in
different positions before KMC, forty neonates in supine position and 20 in vertical suspension (baby is held
vertically away from the skin of his mother). Other dependent variables heart rate and mean arterial blood
pressure and Spo2 were also studied before and after KMC. Results The mean gestational age of the infants
was (32.95±2.23 weeks), and mean birth weight was (1600-2400 gm). Comparing CBF indices before and
after KMC has shown a significant decrease in PI & RI after 30 min. KMC, the mean values were (2.0 ±
0.43 vs 1.68 ± 0.33 & 0.81 ± 0.05 vs 0.76 ± 0.06 respectively P 0.05*) with mean difference (0.32 & 95% CI
0.042-0.41 & 0.05 & 95% CI 0.04 to 0.06 respectively P 0.05*) and increase in end diastolic velocity &
mean velocity 30min of KMC (10.97±4.63 vs. 15.39 ± 5.66 P 0.05*& 25.66 ± 10.74 vs. 32.86 ± 11.47
P 0.05* ) with mean difference (- 4.42 & 95% CI -5.67 to -3.18 and -7.21 & 95% CI - 9.41 to 5.00
respectively). These changes indicate improvement in cerebral blood flow. No correlation has been found
between CBF parameters and studied vital signs or SpO2. Conclusion Kangaroo mother care improves
cerebral blood flow, thus it might influence the structure and functioning to preterm infant`s brain. Key
words kangaroo mother care, premature infants , cerebral blood flow
29
Variation in Reporting of Neonatal Nutritional Research: Time for a Standardised Reporting
Framework
Frank Bloomfield1,5, Frank Bloomfield, Nick Embleton, Nick Embleton2, Hans van
Goudoever3, Hans van Goudoever, Bill Hay, Bill Hay4, Barbara Cormack1,5, Barbara
Cormack
1
University of Auckland, New Zealand
2
Newcastle Hospitals NHS Foundation Trust, UK
3
Emma Children’s Hospital/AMC, Netherlands
4
University of Colorado School of Medicine, USA
5
National Women's Health, Auckland City Hospital, New Zealand
Background
Nutrition in early life in preterm babies is a key determinant of optimal growth and long-term health. Despite
much research, the optimum intakes of both energy and protein remain unknown, resulting in wide variation
in nutritional management, intakes and growth internationally. Progress towards determining what these
optimal intakes should be is hindered by the wide variation in how nutritional intakes and growth outcomes
are reported amongst studies.
Methods
We searched MEDLINE and the Web of Science for randomised controlled trials or observational studies
published between 2008-15 that compared ~ 3 vs. 4 g/Kg.d protein for preterm babies in the first month after
birth, a relatively narrow scope of research in which consistency of reporting might be expected.
Results
22 studies were reviewed. Twelve did not cite the breast-milk reference or figures used to calculate nutrient
intakes. Eight specified composition figures but cited 8 different references and used figures ranging from 64
to 80 kcal and 0.8 to 2.4 g protein per 100 ml breast-milk. Growth Z-scores were reported in 15 studies using
15 different datasets. Seven of the fourteen studies that reported weight velocity did not report how this was
calculated; three different methods were used in the remaining seven. There was also variation in statistical
methods and reporting of other growth outcomes.
Conclusions
Standardisation in neonatal nutrition research is essential to improve the quality and usefulness of clinical
trials and enable true meta-analysis of the results. We propose the StRONNG Checklist – Standardised
Reporting Of Neonatal Nutrition and Growth – to improve the quality and usefulness of reporting neonatal
nutritional studies and to facilitate meta-analysis.
30
Somatic-Cerebral Oxygenation Ratio – Predictive Factor for Necrotizing Enterocolitis
Andreea Avasiloaiei1, Elena Hanganu1, Mihaela Moscalu2, Maria Stamatin1
1
"Gr.T.Popa" University of Medicine and Pharmacy, Romania
2
"Gr.T.Popa" University of Medicine and Pharmacy, Romania
Somatic and cerebral saturations are increasingly used in Neonatal Intensive Care Units for the monitoring of
various conditions, including congenital heart disease, renal or intestinal conditions. Splanchnic saturation is
used for impending necrotizing enterocolitis (NEC), but its’ fluctuations make it a difficult parameter to
analyze. Recently, the Somatic-Cerebral Oxygenation Ratio (SCOR) has been monitored both in healthy
term and preterm infants and in sick children as a more stable measurement of overall oxygenation.
We conducted a prospective study over 18 months (January 2014-June 2015) on 43 newborns, 20 preterm
with abdominal distension or feeding intolerance and 23 term infants used as control group. We
simultaneously measured cerebral and splanchnic saturations through near-infrared spectroscopy. We
calculated the Receiver Operating characteristics Curve for all the parameters, in order to assess their value
as predictive factors for NEC.
Results
The infants in our group had a mean gestational age of 35.5 (+/- 5.3 SD) weeks and a mean birth weight of
2500 (+/- 1121 SD) grams. Splanchnic saturations had values between 28% and 74% in infants with NEC
and 54-88% in infants without NEC, with statistically significant differences between the two groups
(p0.01). Cerebral saturations had values between 45% and 81% in infants with NEC and 62-95% in infants
without NEC, also with significant differences (p0.01). SCOR had values of 0.35-1.27 when NEC was
diagnosed and 0.61-1.16 when NEC was absent (p=0.002). The area under the curve (AUC) is 0.925 for the
splanchnic saturation, 0.866 for the cerebral saturation and 0.81 for SCOR (p0.05).
Conclusions
SCOR is significantly different in infants with and without NEC. Its’ value as a predictive factor is lower
than the value of splanchnic saturation, but SCOR can be preferred in the clinical settings due to its’ smaller
variations.
31
The Effect of an Exclusive Human Milk Diet (EHMD) on the Incidence of Necrotizing Enterocolitis
(NEC) in the US: An Updated Epidemiological Evaluation
Martin Lee1, David Rechtman2, Alan Lucas3
1
Prolacta Bioscience, USA
2
Prolacta Bioscience, USA
3
University College, London, UK
Background
Clinical trials investigating a exclusively human milk based diet (EHMD) in premature infants born at less
than 1,250g birthweight have shown that this approach results in an about two-thirds lower incidence of
NEC (medical and surgical. Consequently a number of hospitals in the US have instituted this protocol on a
routine basis for these infants. The repeatability and persistence of this effect in routine practice remained an
open question.
Method
Several NICUs collected and reported data on the incidence of NEC both pre and post the introduction of the
EHMD. We reviewed and collated these results, and simultaneously investigated whether any reduction in
NEC can be attributed to a general population decline rather than the nutritional intervention.
Results
In the previously published randomized controlled trials, overall NEC rates were reduced from 17.4% to 6%;
surgical NEC was reduced from 12% to 1.2%. Seven independent pre/post cohort studies (N=2,194) have
shown similar relative reductions. The weighted average of the percent reduction in overall NEC across these
studies was ~73.3%. When the statistical significance of all of these studies is considered (based Fisher’s
method), the likelihood of the overall results of these studies being due to chance is approximately 0.0001.
An evaluation of NEC rates from the Vermont-Oxford Network database over the period 2008–2014 for
infants born under 1,250g bodyweight N~264,000) indicated that overall NEC rates fell from 8.9% to 6.9%,
about a 22% decline. However, across the shorter timeframe of the evaluated studies, this decline is closer to
15%.
Conclusion
The effect of an EHMD on the reduction in NEC rates far exceeds the overall decline in the incidence of this
morbidity, and is overwhelmingly associated with that diet. Moreover, the widespread introduction of this
diet may itself be responsible for part of this decline.
32
Role of Urinary Tract Infection in Neonatal Pathological Unconjugated Hyperbilirubinemia
Ajay Kumar1, Mohammed Uvaise S2, Mukta Mantan2, C P Baveja3
1
Maulana Azad Medical College, India
2
3
Objective
American Academy of Pediatrics recommends investigating for urinary tract infection (UTI) in neonates
with conjugated hyperbilirubinemia, but UTI may be associated with unconjugated hyperbilirubinemia also.
Study Design: Hospital based prospective cohort study. Setting: Referral Neonatal Unit of teaching hospital.
Participants and Intervention: One hundred consecutive neonates with gestational age more than or equal to
35 weeks with indirect hyperbilirubinemia in the pathological range. Study subjects treated with
phototherapy (and exchange transfusion) and neonates with UTI treated with antibiotics also.
Outcome Measures
Primary: Presence of UTI confirmed by positive urine culture. Secondary: i) Positive leukocyte esterase (LE)
and nitrite reactions ii) Significant pyuria iii) Rate of fall of bilirubin in neonates treated for UTI. Results:
Seven (7%) neonates had positive urine culture growth (UTI group) while remaining 93 babies constituted
non UTI group. In the UTI group, urine dipstick analysis revealed a positive LE reaction in 6 neonates
(85.7%) and 5 out of 7 (71.4%) babies had a positive Nitrite reaction. Significant pyuria was present in 4 of
these 7 neonates (57.1%). The median (range) total serum bilirubin at enrollment in the Non UTI group was
20.70 (11-53) mg/dL and in the UTI group 23.20 (17-26) mg/dL (P=0.665). In Non UTI group, 25 neonates
had Acute Bilirubin Encephalopathy and 23 neonates required double volume exchange transfusion for
hyperbilirubinemia. The median (range) duration of phototherapy in the remaining seventy neonates in the
Non UTI group was 39 (15-117) hours and in the UTI group it was 36 (21-100) hours (P=0.943) with a
median (range) rate of fall of bilirubin of 0.17 (0.01-0.5) mg/dL/h and 0.27 (0.05-0.42) mg/dL/h respectively
(P=0.172).
Conclusion
Treatment of UTI with antibiotics in neonates with pathological unconjugated hyperbilirubinemia results in
decreased Acute Bilirubin Encephalopathy and lower requirement of exchange transfusion for jaundice
treatment. Key Words: Conjugated, Culture, Jaundice, Urine
33
A Randomized Controlled Trial of Comparying Minimally Invasive Surfactant Therapy (mist) with
Intubation, Surfactant Administration and Extubation (insure) in Preterm Infants
Harmesh Singh
Dayanand Medical College and Hospital, India
Background
Many preterm babies with respiratory distress syndrome (RDS) due Therapeutic Hypothermia: Effect on
respiratory condition in neonatesbeing managed on continuous positive airway pressure (CPAP) may
require intubation for surfactant administration. Intubation may result in certain deleterious consequences in
such babies.
There is emerging evidence of new techniques of minimally invasive surfactant therapy using alternative
devices to avoid intubation. Hence this study was carried out with following aims.
Aims and objectives
Primary objective:
To compare the need for mechanical ventilation within 72 hours of therapy.
Secondary objectives:
To compare:

Duration of CPAP therapy.

Duration of oxygen support

Duration of hospital stay
Methods
Study sample: 56 neonates were initially enrolled as per eligibility Study design: Open label Randomized
Controlled Trial Randomization: Randomization was done by computer generated random sequence
number.One group received Minimally Invasive Surfactant Therapy (MIST) via 16G Angiocath (Desilet,
Vygon) and the second group was given INSURE (Intubation, Surfactant delivery and Extubation).The data
was analyzed by Stata corp 11.1, Fischer/Chi square test.
Results
There was no statistically significant difference in the need for mechanical ventilation within 72 hours of
surfactant administration between the two groups. Duration of requirement of CPAP was significantly less in
MIST group (p=0008).80 5 babies of INSURE group required oxygen for 7-28 days as compared to 24 5 in
MIST group. (p=0.000).Hospital stay was significantly shorter (p=0.0004) in MIST group than in INSURE
group.(more than 14 days in 325 and 76% respectively).
Conclusions
Minimally invasive surfactant therapy is feasible and has advantages as compared to INSURE therapy.
Key Words.
Surfactant therapy
Preterm infants
Minimal invasive
INSURE technique
34
Special Care Of Infants Conceived by In Vitro Fertilization
Silvia Maria Stoicescu, Octaviana Cristea, Nuti Daniela Oprescu
" Carol Davila” University of Medicine and Pharmacy, Romania
Assisted reproduction technologies (ART) are used worldwide for infertility treatment associated with
multiple pregnancies. Children conceived after ART procedure have a 7% rate of severe genetic defects such
as: major birth defects.
Key words
in vitro fertilization, multiple pregnancies, and prematurity, genetic defects
Objective
Assessment of special neonatal care of infants conceived by in vitro fertilization -IVF ; identifying neonatal
IVF pathology and associated costs.
Material and method
The retrospective study was performed over the period from the1st of January 2011 - 22nd of April 2016 on
newborns conceived by in vitro fertilization within the Neonatology Department of “AlessandrescuRusescu” National Institute for Mother and Child Health, Bucharest , Romania. We analyzed the observation
sheets of IVF infants admitted to NICU and the medical maternal investigations during the pregnancy.
Results
IVF pregnancies recorded a constant growth (1.28% in 2011 vs. 2.49% in 2016). Between January 1 st, ,2011
and April 22nd , 2016 there were recorded 326 newborns conceived by IVF. 62.2% were preterm infants
and 37.7% at term. 60.12% of all IVF infants were born as part of a twin pair and 13.8% as part of higherorder multiple pregnancies . Admission to the NICU is required not only for the specific pathology of
prematures but also for the genetic disease and imprinting disorders( Down syndrome, Silver –Russell),
congenital malformations such as pulmonary hypoplasia, diaphragmatic hernia, agenesis of the corpus
callosum.
Conclusions
Although these specific pregnancies are monitored, complications can occur at any time. IVF pregnancies
generate newborns who often require special long-term care in NICU, which triggers high costs.
35
INAC 2016 E-Poster
36
Oral Zinc Supplementation in Neonatal Hyperbilirubinemia: A Meta-Analysis
Background:
Hyperbilirubinemia may cause bilirubin encephalopathy which adversely affects brain development. Zinc
has been suggested to have a role in preventing hyperbilirubinemia and bilirubin encephalopathy.
Objectives:
To assess the effects of zinc in reducing the incidence and need for phototherapy in neonatal
hyperbilirubinemia its adverse effects.
Search methods:
Medline, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials
(CENTRAL) were searched. Hand search in various search engines was done.
Selection criteria:
Randomized controlled trials of any zinc supplements given at least 10 mg/day, administered to newborns
≥35 weeks of gestation at risk of hyperbilirubinemia. The primary outcomes were the incidence of
hyperbilirubinemia, proportion of newborns requiring phototherapy, and the duration of phototherapy.
Secondary outcomes include the ratio needing exchange transfusion, incidence of bilirubin encephalopathy,
length of hospital stay, number of deaths, and adverse effects observed.
Data collection and analysis:
Two review authors independently assessed eligibility and trial quality and extracted data. Statistical analysis
was carried out using Review Manager 5.3 (RevMan).
Main results:
Four trials contributed data. All studies were high-quality trials with overall low risk of bias. Oral zinc
supplementation has no significant effect in reducing the incidence of neonatal hyperbilirubinemia (RR 1.09;
95% CI 0.75-1.59). It did not show any significant benefit in reducing the phototherapy requirement in
patients with jaundice (RR 1.02; 95% CI 0.70-1.48). The duration of phototherapy is significantly shorter in
patients receiving zinc supplements (MD -16.69; 95% CI -25.09 to -8.30) but pooled data showed
heterogeneity. Adverse events were not significantly different between zinc and placebo. These include
diarrhea (RR 1.67; 95% CI 0.50-5.59), vomiting (RR 0.86; 95% CI 0.31-2.37), skin rashes (RR 1.22; 95% CI
0.31-4.90), and crying.
Authors`
Conclusions:
Zinc administered to newborns ≥35 weeks of gestation has not been shown to decrease the incidence of
hyperbilirubinemia nor the proportion of patients requiring phototherapy but may potentially shorten the
duration of such intervention.
37
Review of Premature Care at Monkole Hospital during the Last Ten Years (Kinshasa- D.R. Congo)
Gisèle Kazadi Tshiama, Gisèle Kazadi, Léon Tshilolo, Jordy Mafema
Monkole Hospital, Congo, Democratic Republic of the
Problematic:
Preterm birth contributes greatly to aggravate neonatal mortality in our country.
Aim and methodology:
To determine the etiology, prognosis and management of preterm in our country, a retrospective study from
January 2004 to August 2014 was initiated at Monkole Hospital.
Results:
A total of 5914 newborns were followed including 322 preterm infants, 57 of preterms were transferred.
Factors influencing the occurrence of prematurity were dysgravidie (21%), the twins (19%), young maternal
age (15%), infection (11%). The gestational age of preterm infants was less than 32 weeks in 38.3% and the
average weight of all was 1760 grams. The clinic was marked by respiratory distress, metabolic syndrome,
bleeding and infection.
Of the 322 premature infants, 84 (25.4%) had died with a mortality rate higher 36 (63%) in the group
transferred. Other prognostic factors were the Apgar score
Conclusion:
The authors discuss risk factors related to the local context and action to reduce morbidity and premature
mortality.
38
Factors Associated with Breast Milk Feeding of Very Preterm Infants from Birth to Six Month
Corrected Age
IRIS MORAG, Iris Morag, Ayala Maayan-Metzger, Tzipi Strauss
The Edmond and Lily Safra Children Hospital ant Chaim Sheba Medical Center, Israel
Objectives:
To investigate factors that may affect breast milk feeding (BMF) practice among very preterm infants.
Methods:
Infants born before 32 weeks gestational age (GA) and monitored up to 6 months corrected age (CA) were
included in this retrospective study. Feeding method was assessed at day of life 14, 36 weeks GA, 6 weeks
after home discharge and 6 months CA. Multivariable logistic regression analysis was used to examine
which factors were associated with BMF initiation at time point 1 and cessation at time points 2-4.
Results:
Out of 181 infants who qualified for the study, 146 (81%) initiated BMF, of them 80% exclusively. At time
points 2-4, 130 (71.8%), 87 (48%) and 36 (19.9%) infants respectively continued BMF. Multivariate analysis
revealed that initiation of BMF was more common with younger GA and higher level of maternal education.
Discontinuation of BMF at six weeks post discharge was more common with failure to exclusively BMF at
day 14. Cessation of BMF at 6 months CA was associated with birth at 28 weeks.
Conclusion:
Successful BMF can be commenced and maintained throughout hospitalization in the majority of very
preterm infants. Despite a significant dropout that occurs within several weeks after discharge, mothers of
infants of lower gestational age attempt greater efforts in providing BMF even after discharge. Exclusive
BMF at day of life14 is associated with BMF continuation after discharge.
39
Neonatal risks in Newborns from Assisted Reproductive Technology versus Natural conception.
Nadia Kasdallah1,2, Alaeddine Bouani2, Hakima Kbaier1,2, Hatem Ben Salem1,2, Ben
Daamar Hamdi2, Dorra Falleh2, Sonia Blibech1,2, Mohamed Douagi1,2
1
Military Hospital of Tunis, Tunisia
2
University Tunis El Manar/Faculty of Medecine of Tunis, Tunisia
Background and aims
It is well known that assisted reproductive technology (ART) increase the risk of multiple births, but the
debate about increased neonatal risks, especially birth defects in newborns is still a subject of debate. We
aim to compare the neonatal outcome of newborns from ART with newborns naturally conceived.
Methods
It was a 15-years retrospective and descriptive study comparing neonatal outcome of 285 newborns from
ART (ART group) and 221 newborns naturally conceived (Control group).
Results
In the ART group, rates of prematurity and low birth weight were respectively 64,9% and 68%. They were
statistically significantly higher than control group (p0.05).
The rate of birth defects was statistically significantly higher in ART group (13.6 %) then in Control group
(5.4%), (p0.002). In ART group, birth defects were major in 69.3%, cardiac defects were noted in 46%.
Birth defects were associated with ICSI in 48.7%. In ART and malformed newborns, birth defects were
lethal in 20.5 % and associated with major handicap in 17.8%.
Conclusions
This study support the hypothesis of increased neonatal risks in newborns from ART in term of prematurity,
low birth defect and birth defects comparatively with newborns naturally conceived. The relationship
between birth defect and ART remain poorly understood. Further etiological studies are required to explain
the exact mechanisms underlying these risks.
40
Newborn from Assisted Reproductive Technology. A First Tunisian Study.
Nadia Kasdallah, Hakima Kbaier, Hatem Ben Salem, Ines Trabelsi, Dorra Falleh, Sonia
Blibech, Mohamed Douagi
Background:
Assisted reproductive technology (ART) it raises a great debate about the potential risks of congenital
malformations in newborn.
Object:
This study compare the risk of congenital malformations in infants conceived with ART and those naturally
conceived.
Methods:
This is a retrospective descriptive and comparative case- report study, concerning 285 neonates born from
ART. Control group included 221 spontaneous neonates.
Results:
Rate of prematurity and low birth weight in ART group were respectively 64,9% and 68%.The overall rate
of birth defects in newborn from ART was 13.6 % versus 5.4% in controls: (OR= 2.76). It was mainly major
defects (69.3 %). The majority of defects were noticed with ICSI. Multiple malformations, cardiac and
orthopedic malformations were the most frequent. Isolated neurological abnormalities were observed in 2
newborns and one stillborn: complete agenesis of the corpus callosum, spina bifida. Two isolated
gastrointestinal malformations were observed. The evolution was fatal for 11 newborns from ART. Death
was directly attributable to the malformation in 8 newborns. A major handicap was noted in 5 among the 21
survivors malformed.
Conclusion:
The association between birth defects and ART reported in the literature has been confirmed by our results.
Although the exact mechanisms underlying this relationship remain poorly understood.
41
Left Hand Acheiria in 3 Newborns within a Period of 3 Months During the year 2011 in Fallujah
General Hospital
Samira Alaani1, Samira Alaani, Abdulkadir Abdulkareem Miri'e, Samira Alaani 1,
Abdulkadir Abdulkareem Miri'e 26
Fallujah general hospital, Iraq
We present 3 sporadic cases of congenital left hand Acheiria, a rare congenital defect, In one case (male),
left hand Acheiria is associated with left radial hemimelia , in the other 2 cases (both are females) ,there is
only congenital absence of left hand ( Acheiria) ,with completely normal left forearm & other 3 limbs. The
absence of any contributory family or drug history and the normal chromosomal study in the 3 cases lead us
to the belief that their occurrence may be linked to environmental contamination. To the best of our
knowledge,
there
is
dearth
of
information
on
these
anomalies
in
the
literatures,
&
their
management
remains
achallenge.
Keywords:
Acheiria, Hemimelia, Fallujah General Hospital
the literatures, & their management remains achallenge.
Keywords: Acheiria, Hemimelia, Fallujah General Hospital
42
Enhancing Neonatal Survivals: What can we do today?
Subhashchandra Daga, Achla Daga, Sameer Mhatre, Vaishali Ghane
Pacific Medical College &Hospital, India
Background:
Neonatal deaths account for 44% of the world’s under-5 child mortality. Over half of all neonatal deaths
globally occur in preterm babies. Therefore; improving care of a preterm baby is particularly important to
reduce under-five mortality.
Aim:
To spell out components of care of preterm/low birth weight babies at first level health facility and at first
referral unit (FRU) in low resource settings.
Methods:
We have analysed weight-wise survivals at two hospitals attached to medical colleges; J.J. Hospital, Mumbai
(JJ) and General Hospital, Talegaon (GH) and, at Rural Hospital, Dahanu (RH). There were three tiers of
interventions: T1) warmth; feeding and antibiotics, when indicated, T2) improved care at birth and increased
oxygen availability, T3) use of dopamine or its equivalent. JJ went through all these stages one-after-another;
GH had T1; T2 &T3 in one go. The RH had T1&T2.
Results:
50-55% VLBW babies survived at JJ by providing T1 during 1978-84. This percentage increased to 56-58%,
when T2 was added (1984-89). For babies with birth weight 1500-2000 g, the moderately low birth weight
category (MLBW), the corresponding figures were 56-58% and 84-86%. The same interventions led to
statistically significant decline in MLBW (1500-2000 g) and VLBW categories at GH (2010-13). RH (198792) achieved better survival rates in VLBW (61.5%) and MLBW (92.5%) categories with identical
interventions (TI&T2) and less staff.
Conclusion:
Based on our results, we suggest that in resource limited settings, the first level health facility may be able to
give T1 to short-stay babies, that weigh more than 1500 g and, that have no respiratory distress. The FRU
may be able to give T1&T2 to MLBW babies, with or without respiratory distress, and VLBW babies
without respiratory distress.
43
Enhancing Use of Donor Milk in Neonatal Intensive Care Unit: A Developing country perspective; an
interventional study
Subhashchandra Daga, Nilesh Naktode, Anushree Borhade, Savita Gavali
MIMER Medical College, India
Purpose
This is an effort to overcome difficulties in collection; short term storage and administration of donor human
milk with limited resources.
Objective
To replace 75% of formula feeds (FF) by donor human milk (DHM) feeds in first 3 days of life among
neonates admitted to the Neonatal Intensive Care Unit (NICU).
Methods
This was a prospective interventional study conducted at NICU of the MIMER medical college, Talegaon
Dabhade between December 2013 and August 2014. Participants were all the neonates (n=168) admitted
during the study period. Expressed DHM was administered within 2-3 hours of manual expression without
refrigeration or pasteurization. After expression, DHM was left standing in a covered stainless steel container
at room temperature. Prospective entries of 2 hourly feeds were made in the feeding charts for first 3 days of
life (36 entries). Main outcome measure was % replacement of FF.
Results
Of the total number of 6027 feeds charted, 4136 (68.6%) were human milk feeds and the rest, 1891(31.4%),
were formula feeds. Thus, 68.6% FF were replaced by DHM.
Conclusion
A simple low cost method was effective in replacing a significant proportion of FF by DHM in the first three
days of life for neonates.
44
Evaluation of Developmental Status of Pemature Infants Aged 4 to 12 Months with History of
Admission in NICU
Kambiz Keshavarz, Reza Abasi, Mohammad Zoladl, Atoosa Rezakhani, Arjang Rezakhani
Yasuj University of Medical Sciences, Iran
Backgrounds & aim:
Screening and early diagnosis of developmental delay in high risk children are obligatory. Premature
neonates with history of prolonged admission in neonate intensive care unit (NICU) are prone to more
developmental disorders in comparison with normal population. ASQ or age scaled questionnaire is a simple
method for early diagnosis of developmental delay in children.
Methods:
80 infants aged 4,6, and 12 months with a history of prematurity and prolonged admission in NICU entered
the study. ASQ including information in 5 main fields of development containing communication, fine and
gross motor status, personal-social and problem solving were completed for them. After collecting the data,
they underwent statistical analysis.
Results:
The average birth weight of the infants was 1734.37+/- 445.50 gram. 10% of them in the field of
communication, 30% in gross motor,27.5 % in fine motor,23.8% in problem solving state and 23.8% in field
of personal-social behavior had abnormal results. Sex, receiving surfactant, age of mother and breast feeding
didn’t have any effect on this situation.
Conclusion:
A considerable number of premature infants with history of prolonged admission in NICU have at least delay
in one filed of development. These findings suggest more attention and observation for these infants in order
to detec at early stage of any developmental delay and start rehabilitation.
Key words: ASQ, Developmental delay, premature infants
45
Evaluation of Neonatal Sepsis Causative Agents and Empirical Antibiotic Susceptibilities used in
Perinatology Division, Cipto Mangunkusumo National Hospital, Year 2011-2015
Charisha Nadia, R. Adhi Teguh Perma Iskandar
Perinatology Division, Ciptomangunkusumo National Hospital, Indonesia
Background:
Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing
world.1,2 Daily use of empirical antibiotic in neonatal sepsis should be based on the locally previous blood
culture and antibiotic sensitivity test results.2
Objective:
To evaluate susceptibilities of empirical antibiotic used daily in Perinatology Division, Cipto
Mangunkusumo National Hospital (RSCM) from the year 2011 to 2015 according to the most bacteria
causing sepsis neonatal.
Methods:
Retrospective study using positive blood culture results and antibiotic sensitivity test data taken from
Bacterial and Antibiotics Susceptibility Profile in Perinatology Division, RSCM, from 2011 until 2015.
Results:
There are 5065 blood cultures from infants with suspected neonatal sepsis since 2011-2015. Positive blood
culture results fluctuate from year to year, with a range of 17.9% to 28.1%.
From the blood cultures obtained since 2011 to 2015, gram-negative bacteria Acinetobacter baumannii is the
leading cause of neonatal sepsis in the ward. The second most common cause is Gram-positive bacteria,
Staphylococcus epidermidis.
There are a decreased sensitivity to the first, second, and third line antibiotic to most bacterias causing
neonatal sepsis from 2011 until 2015. In 2015, Acinetobacter baumannii and Staphylococcus epidermidis as
the most common cause of neonatal sepsis in the ward, have a low sensitivity level (60%) for the first,
second, and third line antibiotics.
Conclusions:
In general, daily empirical antibiotic therapy in perinatology ward has decreasing level of sensitivity to most
bacteria that cause neonatal sepsis year by year. We need regular surveillance of the organism pattern and
antibiotic sensitivity level as a basis for revised empirical neonatal sepsis therapy guidelines.
46
Demographic and Clinical Profile of Congenital Anomalies in a Tertiary Government Hospital, a 1year Retrospective Study
jenna angela rubio, Carlos Nunez, Jr.
Ospital Ng Maynila Medical Center, Philippines
Background:
Multiple congenital anomalies belong to the top causes of neonatal death in South East Asia Region with an
estimated 4% mortality rate. In the Philippines, birth defect has been on the top 10 cause of mortality.
Objectives:
This study aims to describe the clinico-demographic profile and to determine the proportion of all live births
with congenital anomalies delivered from January to December of 2014. The anomalies were categorized by
system; socio-demographic profile, maternal profile and neonatal profile was described, and the outcome
was noted.
Methodology:
A descriptive retrospective study. All live births in a tertiary government hospital from January to December
2014 who were reported to have major structural and functional congenital anomalies were included.
Medical records of all live births from January to December 2014 were retrieved and reviewed.
Results:
There were a total of 3,918 live births and 54 (1.38%) were noted to have at least 1 congenital anomaly.
Majority had single anomaly and the top organ systems involved are genital organ, cleft lip and cleft palate
and central nervous system. The most commonly encountered major anomaly was cleft lip and cleft palate,
followed by neural tube defect as a group. More than half were male and more than two-thirds were born
term, and majority of which survived. More than half of the total live births have normal birth weight and
majority was appropriate for gestational age. Almost two-thirds of live births survived and were sent home.
There were a total of 19 (35.1%) who expired.
Conclusion:
The proportion of birth defects in a tertiary government hospital in Manila, Philippines is 1.38%. However,
the proportion rate obtained in this study may not reflect the true situation in the general population. Regular
antenatal checkup and prenatal folic acid supplementation may help reduce the incidence of congenital
anomalies.
47
Safety and Efficacy of Ibuprofen in Preterms
Maria Chona Badillo, Victor Samuel Rajadurai
KK Womens and Children Hospital, Singapore
Introduction:
Indomethacin is the standard treatment in Patent Ductus Arteriosus (PDA). Ibuprofen is as effective as
Indomethacin in PDA closure .There are limited studies with regards to safety and efficacy of oral and
Intravenous Ibuprofen in Preterm Infants.
Objective:
This study was done to determine the safety and efficacy of Ibuprofen in treatment of PDA among preterms.
Study Design:
This is a retrospective cohort study conducted in KK Women’s and Children Hospital, Singapore
Methodology:
Included in the study were 138 very low birthweight infants born on March 1, 2010 to December 31, 2014
studied. Intravenous Ibuprofen was given to 107 subjects while 31 were given orally. The major outcomes
were time to PDA closure and drug-related complications.
Result:
Sixteen preterms who were given oral Ibuprofen had constricted PDA and 14 infants had closed PDA. With
IV Ibuprofen, 49 babies had constricted PDA and 55 babies had closed PDA. There was no statistical
difference with regards to constriction and PDA closure compared to nil effect (p=0.9).The median time to
constrict or close PDA is shorter in IV Ibuprofen (23 days) compared to oral (34 days) (log rank 0.01).
Among the 24 preterm infants who underwent PDA ligation, 2 received oral Ibuprofen (6.4%) while 22
received IV routed (20.6%). There were no difference in the overall GI adverse effects, necrotizing
enterocolitis and spontaneous intestinal perforation between the 2 groups.
Conclusion:
Both Intravenous and oral Ibuprofen are effective in treating PDA but the time to closure is faster with IV
Ibuprofen. There was no difference in the occurrence of surgical NEC or SIP among the 2 groups.
48
Management of Group B Streptococcus in Neonates at a Regional West Australian Hospital
Elaine Sanderson
Rockingham General Hospital, Australia
Currently there is no clear consensus on the management of infants born to GBS positive mothers who did
not receive antibiotics in a timely fashion in Western Australia. Most neonates seem to be given antibiotics
regardless of clinical appearance with the risks including side effects and antibiotic resistance. There is a
need to assess whether all neonates of untreated GBS positive mothers require antibiotics post-delivery or
whether there is a role for careful observation.
49
To Assess the Accuracy of Umbilical Cord Blood Gas In Determining Severity of Newborn Condition
Bader Kordi, Noha Nemiri
Hamad Hospital, Qatar
Introduction:
Umbilical cord blood gas and acid-base assessments are the most objective determinations of the fetal
metabolic condition at the moment of birth.. We conducted this study to assess how accurate the umbilical
cord gas parameters are in determining the outcome of the new born
Methods:
The cord gas data of all high-risk deliveries during 2013 in the Women‘s Hospital of Hamad Medical
Corporation Qatar were collected. Maternal Data include parity, illness, nationality, together with the
indication of cord gas sampling were gathered. Neonatal data includes gestational age weight combined with
the Apgar score. The outcome of both the mother and new born was recorded.
Results
A total number of deliveries during the study period were 15,000 cases. Of these high-risk deliveries, cord
sampling was carried out in 1042 cases. When combining all elements of cord gas done, the percentage of
severe cases was 15.3% with 11% of these babies needs NICU admission. Babies with cord PH
Conclusion
The cord gas is significantly correlating more with the baby Apgar score at one minute rather than 5 minutes.
The outcome is affected by the severity of the cord gas
Keywords
Cord gas, indication, and outcome
50
Meconium Contaminated Amniotic Fluid Leading to Intestinal Wall thickness affects the Functional
Outcome of Abdominal Wall Defects
Melanie Kapapa1, Tersa Rieg2, Doris Henne-Bruns1, Alexandre Serra1
1
University Hospital Ulm, Germany
2
Klinikum Heidenheim, Germany
Intestines exposed to amniotic fluid lead to an inflammatory fibrotic layer with thickening of intestinal wall,
falling motility and potentially leading to intestinal lumen obstruction. The optimal time of delivery in
gastroschisis neonates is crucial to reduce direct exposure to amniotic fluid contaminated with meconium,
which is evidenced by less problems in omphalocele newborns.
Data regarding the color of amniotic fluid, surgical complications, ICU duration stay, and number of
operations, clinical abnormalities, postsurgical complications and postoperative nutrition were collected from
medical records and surgery reports. Data were compared to omphalocele patients and to standardized, agematched normal control population accepting a significance level of 95% (p0,05).
Newborns with meconium contaminated amniotic fluid had significantly more often thickened bowel loops,
resulting in less primary abdominal wall closures. More operations in these patients until complete closure
were significantly more often required due to fibrin-covered bowels loops, necessity of gut resection or an
ileostomy. Additionally, patients with fibrin-covered intestines required further surgical treatment
significantly more often, because of intestinal obstruction. In short-time follow-up, ICU stay was
significantly longer in these patients due to longer mechanical ventilation requierements, significantly
extended parenteral nutrition and delayed oral nutrition begin. Notably, these results were independent of
gestational age, but always associated to the color of amniotic fluid.
The primary prognostic parameter of short-term outcome was the intensity of intestinal wall damage at the
time of surgery. In gastroschisis meconium contaminated amniotic fluid was directly associated to fibrin
covered bowels, leading to lower rate of primarily abdominal wall closures and poor postoperative outcome
with longer periods of mechanical ventilation, delayed oral feeding and prolonged parenteral nutrition. We
strongly recommend that the delivery be optimized by assessing the intestinal wall thickness with ultrasound
and inducing labor upon the first signs of damage to the intestines, regardless of the gestational age.
51
The Influence of Pregnancy and External Risk Factors on the Incidence of Abdominal Wall Defects
Melanie Kapapa1, Teresa Rieg2, Doris Henne-Bruns3, Alexandre Serra1
1
University Hospital, Germany
2
Klinikum Heidenheim, Germany
3
University Hospital, Germany
Background:
We analysed retrospectively abdominal wall defect (AWD) patients over a 10-year period hypothesizing that
external risk and pregnancy factors lead to increasing AWD.
Methods:
Data regarding pregnancy history, life-habits, proximity to waste or nuclear repositories or exposure to
chemical/ physical agents. 41 families participated in this study; 63.6% gastroschisis (GS) and 36.3%
omphalocele (OC). Data were compared to age-matched control population using the chi-square, the
Kruskal-Wallis and the Fisher exact test accepting a confidence interval of 95% (p0,05). Statistics performed
by using SigmaStat® (Systat Software Inc., CA).
Results: Mothers of AWD children used significantly more medications. Gastroschisis mothers (GM) were
significantly younger than Omphalocele mothers (OM) and 50% had changed their dietary habit. In GM
mothers via ultrasound significantly more dilated bowel loops and increased number of amniotic fluid
exchanges were detected. Conversely, the incidence of omphalocele increased significantly after hormonal
treatment, in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), whose mothers took less
folic acid prophylaxis. GS mothers significantly increased intake of dairy products and vegetables and they
suffered more often from immune-associated diseases.
Conclusions:
We confirmed maternal age and lifestyle-associated risk factors like changes dietary habits for GS and
increasing incidence of OC after prenatal hormonal treatment, IVF or ICSI.
52
Metabolic Analysis of Preterm Birth in Nigeria
Chinyere Ezeaka1, Scott Oltman2, Kelli Ryckman2, Nancy Weathers2, Bruce Bendell2,
Osayame Ekhaguere3, Azeez Butali2
1
Lagos University Teaching Hospital, Nigeria
2
University of Iowa, USA
3
Children's Hospital of Philadelphia, USA
Background
Several studies suggest that biomarkers of amino acid and fatty acid metabolism are important in identifying
pregnancies that end in preterm delivery. Few studies have examined these metabolites in developing
countries where both nutritional deficits and preterm birth risk is high.
Objective
To identify distinct metabolic profiles for preterm and term births in Nigeria.
Methods
Anti-partum maternal blood samples from 5 Nigerian women who delivered prematurely (34-36 weeks) and
10 controls (≥37 weeks) were analyzed for 42 metabolites (9 amino acids, free carnitine, 29 acylcarnitines,
citrate, succinylacetone, and acetylsalicylic acid) using tandem mass spectrometry. Principal Components
Analysis (PCA) was used to elucidate the metabolic differences between preterm and term birth and then
plotted on axes made up of the two principal components (PCs) explaining the largest proportions of
variance.
Results
The barycenter of preterm metabolite measurements was positively correlated with the first PC as opposed to
the barycenter of term measurements. The 1st PC explains approximately 37.7% of the variance in the data,
and has high positive correlations (≥0.80) with phenylalanine, free carnitine, and long-chain acylcarnitines
including C6, C12, C14:1 C16, C18, C18:1, and C18:2. This suggest acylcarnitines may be important in the
differentiation of preterm and term births in Nigeria. Additionally, there was a non-significant difference
between the barycenter of preterm measurements and the barycenter of term measurements in relation to the
second PC which accounts for 15.6% of the variance in the data and is primarily correlated with the
metabolites citrate and alanine.
Conclusion
Long-chain acylcarnitines and free carnitine may occur in pregnancies that will end in preterm birth. The
lack of statistical significance may be explained by small sample size. Further studies are needed to validate
these results and determine if interventions targeting long-chain fatty acid metabolism could be effective in
this population.
53
Early Newborn-Onset of Congenital Thrombotic Thrombocytopenic Purpura, with Unusual Features:
a Case Report.
Nadia Kasdallah1, Hamdi Ben Daamar1, Hatem Ben Salem1, Hakima Kbaier1, Sonia
Blibech1, Sawsen Bouzidi1, Brahim Nsiri1, Monia Ben Khaled2, Mohamed Bejaoui2,
Mohamed Douagi1
1
Military Hospital of Tunis., Tunisia
3
National Bone Marrow Transplant Center, Tunisia
Background and aim
Although most cases of neonatal thrombocytopenia are dominated by infections, other less common causes
should be precociously considered in some unusual situations to improve patient outcome. Genetic
deficiency of ADAMTS13 or Upshaw–Schulman syndrome (USS) is a very rare cause of neonatal
thrombocytopenia. The typically reported features of USS in neonates are jaundice with hyperbilirubinemia,
thrombocytopenia and /or combs negative hemolytic anemia, and an increased creatinine. We aimed to
report an original case of USS with unusual onset and features.
Case report:
A full term newborn was admitted for moderate repiratory distress. At 4 hours of live, he presented DIC with
diffuse hemorrhage, cerebral damage and hemorrhagic shock contrasting with moderate thrombocytopenia.
Theses complications were initially considered us related to early onset E coli maternofetal infection. The
patient recovered after treatment with antibiotics, plasma infusion, and platelet transfusion. Then, repeated
episodes of thrombocytopenia, resistant to platelet transfusions occur. The discrepancy between the severity
of the neonatal hemorrhagic syndrome and thrombocytopenia, recurrence and resistance to symptomatic
treatment suggested hereditary thrombotic thrombocytopenic purpura. Correction of thrombocytopenia was
obtained by FFP transfusions and had a dual diagnostic and therapeutic interest. Analysis of the plasma Von
Willebrand factor-cleaving metalloprotease, ADAMTS13, revealed low protease activity in the patient and
confirmed the clinical suspicion.
Conclusion: In this original report, USS was masked by disseminated intravascular coagulation (DIC) early
neonatal infectious cause. In neonates, infectious thrombocytopenia or DIC should not mask the diagnosis.
USS should be early considered face to unusual severity of hemorrhage contrasting with common biological
data, and recurrence of thrombocytopenia.
54
The Impact of an Interactive Educational Programme on Saudi Paediatric Nurses` Knowledge,
Attitudes, Beliefs, and Perceived Barriers to Optimal Post-Operative Pain Management
Nahar AlReshidi1, Tony Long2, Angela Darvill3
1
University of Salford, UK
2
University of Salford, UK
3
Senior Lecturer in Children’s Nursing, University of Huddersfield
Background
Post-operative pain management has been researched extensively, but it fails to receive the same attention
from paediatric nurses in Saudi Arabia. Practices are not evidence-based, but there is a willingness to
improve. The factors to be addressed in this study had not been considered together in any study, and each in
turn is supported by only minimal evidence of variable quality. No work of significance had been undertaken
in the context of Saudi Arabia or other Gulf nations
Aims
To test the impact of an interactive postoperative pain management education programme for paediatric
nurses
Study Design
A non-equivalent groups, pre-test post-test design was used. A sample of 229 paediatric nurses working in
surgical units in Hail region hospitals was recruited and completed four questionnaires on three occasions,
before the intervention, and at 1and 3 months after.
The intervention was an interactive educational programme on DVD with explanations, exercises, video
presentations and self-check games.
Results
There was significant improvement in participants` knowledge and attitudes. Perception of barriers to
effective pain management reduced, while self-efficacy improved. No improvement was found in perception
about children’s pain.
Conclusion
This study will improve pain management for children following surgery. It will prompt the use of an
alternative, digital, interactive education programme in Saudi Arabia
55
Association of Educational Level of the Mother With the Birth Weight of Hospitalized Newborns in
the NICU
Elena Polycarpou1, Elena Papamichael1, Elena Polycarpou1, Michalis Talias2, Christina
Karaoli1
1
Archibishop Makarios III hospital, Cyprus
2
Open Univercity of Cyprus, Cyprus
Objective
We investigated the correlation between the educational level of the mother with the birth weight (BW) of
hospitalized newborns in the only tertiary Neonatal Intensive Care Unit in Cyprus. Material and Methods:
The study was conducted in the Neonatal Intensive Care Unit (NICU) where all newborns in the country in
need of intensive care are hospitalized during the period March 2013-March 2014. The study included
526/640 premature neonates (82.2%). 312 male (54.60%) and 259 female newborns (45.40%). Educational
level: Mothers elementary-school graduates (M1) n: 67 (10,5%), high school graduates (M2) n: 210 (32,8%),
College/University graduates (M3) 281 (43.9%). We investigated whether there is a correlation between the
educational level of mothers and the birth weight of hospitalized newborns. Neonates were classified into
three groups: small for gestational age neonates (SGA), appropriate for gestational age (AGA) and large for
gestational age (LGA) according to their birth weight. Results: M1 Group: AGA 45 (69,2%), SGA 18 infants
(27.7%) and LGA 2 (3,1%). M2 Group: AGA 151 (74,4%), SGA 43 (21,2%) and LGA 9 (4,4%). M3 Group:
AGA 184 (71,3%), SGA 62 (24,0%) and LGA 12 (4,7%). Statistical analysis showed a proportionately
higher rate of SGA newborns in the M1 compared to M2 and M3 but the difference was not statistically
significant.
Conclusions
There appears to be a positive effect of the higher level of education of mothers on the birth of AGA
newborns in Cyprus. Our results are compatible with other international reports. Larger studies are needed to
support our results.
56
Breastfeeding and Maternal Educational Level: Presentation of the Current Trend in the Neonatal
Intensive Care Unit (NICU) of Arch. Makarios III Hospital
Elena Polycarpou1, Elena Papamichael1, Michalis Talias2, Christina Karaoli1
1
2
Objective
The record of breast milk administration in the NICU hospitalized neonates and the trend in relation to the
educational level of their mothers. Our NICU hosts all hospitalized preterm neonates nationwide. Materials
and methods: The study lasted for the period March 2013-March 2014 and involved 531 infants. The data
collection was done by filling out standardized questionnaires which were completed by the researcher in
collaboration with parents. The educational level of mothers was recorded as follows: elementary-school
graduate mothers(M1), high school graduates (M2) ,College-University graduates (M3). The educational
level of the mother was associated with the administration exclusively of breast milk, mixed feeding and
exclusively formula milk for premature neonates.
Results
Data from 531/640 hospitalized neonates 83% were collected. 312 male (54.60%) and 259 female neonates
(45.40%) were included. The educational level of mothers was: M1 n: 67 (10,5%), M2 n: 210 32,8%, M3
281 43,9%. The analysis showed: I. Breastmilk 120/531, M1 9/67, M2 41/201, M3 70/263 II. Formula milk
for premature neonates 148/531, M1 28/67, M2 62/201, M3 56/263 III. Mixed nutrition 263/531, M1 28 / 67,
M2 98/201, M3 137/263 Mothers in M1 group give their babies exclusively breast milk in extremely low
degree. Mothers M2 give exclusively breast milk more than the mothers M1 but less than M3. M3 mothers
have the highest rates of exclusive breast milk delivery (p=0,001) while clearly there is a larger percentage of
the choice of a mixed diet versus exclusive administration of formula than in the other groups of mothers.
Conclusions
The prevailing trend in our NICU is an increase in the exclusive administration of breastmilk in neonates
born to mothers with a higher educational level.
57
Association of the Educational Level of the Mothers of the Hospitalized Preterm Neonates with the
Degree of Prematurity
Elena Polycarpou1, Elena Papamichael1, Michalis Talias2, Christina Karaoli1
1
2
Objective
Although the literature recognizes the positive correlation between low socio-economic / educational level
and infant health level, evidence is not clear. The purpose of this study is to investigate the correlation of the
educational level of the mother with the degree of prematurity. Materials and Methods: The study was
conducted in the Neonatal Intensive Care Unit of Archibishop Makarios Hospital from March 2013 till
March 2014. During that period of time, 312 male (54.60%) and 259 female newborns (45.40%) were
hospitalized in our NICU. The educational level of mothers was recorded as follows: elementary-school
graduates (M1) n: 67 (10,5%), high school graduates (M2) n: 210 (32,8%), College- University graduates
(M3) 281 (43.9%). We investigated whether there is a correlation between the educational level of mothers
and the gestational age of hospitalized newborns. Results: Mothers M1 gave birth to 0 infants 24-26 weeks
of gestational age (GA) (0%), 5 27-29 (7.5%), 13 30-32 (19.4%), 25 33-36 (37.3%), 21 37 -40 (31.3%) and 3
40-42 (4.5%). Mothers M2 gave birth to 4 neonates 24-26 weeks (2.0%), 13 27 - 29 (6.3%), 24 30-32
(11.7%) 99 33-36 (48.3%), 60 37-40 (29.3%) and 5 40-42 (2.4%). Mothers M3 gave birth to 4 neonates 2426 weeks (1.5%), 18 27- 29 (6.8%), 40 30-32 (15.0%), 118 33-36 (44.4%), 79 37-40 (29.7%) and 7 40-42
(2.6%). M1 mothers appear to give birth to more premature neonates than M2 and M3 mothers but the
difference is not statistically significant.
Conclusions
The educational level of the mother appears to correlate with the degree of prematurity of newborns. In our
NICU the better-educated mothers give birth to greater gestational age newborns. Larger studies are needed
to support our results.
58
Malrotation and Intestinal Volvulus in a 29.5 Weeks of Gestation Premature Newborn, A Case Report
Mario Blancas, Alejandro Moguel, Ruben Martinez, Samuel Fernandez, Jose Iglesias,
Bernardez Isabel
Hospital Español de Mexico, Mexico
Intestinal malrotation refers to an abnormal or incomplete rotation of the intestine during the embryogenesis
period. Most of them are asymptomatic, only 1 out of 6000 new borns have any symptoms. On the other
hand the volvulus occurs when a small portion of the intestine turns around it´s own base. It is not common
to see volvulus during the neonatal period, when it happens it comes along with high rates of mortality, and
should be treated as a serious complication.
We present the case of a masculine newborn of 29.5 weeks of gestation, with the following perinatal history,
son of a 35 year old mother, previously healthy, with threatened abortion during the first trimester and
premature rupture of membranes with uterine activity at 29.3 weeks of gestation. The pregnancy is
interrupted by a cesarean section. Obtaining a masculine product with poor respiratory effort, Apgar score
7/9 weight of 1500 grams and height of 41.5 cm.
The product is taken to the NICU and diagnosed with hyaline membrane syndrome, early neonatal sepsis and
disseminate intravascular coagulation, 24 hours after bird that patient presents increasing of abdominal
perimeter and clinical findings compatible with intestinal perforation. After performing an open laparotomy,
we found intestinal malrotation, volvulus and 2 intestinal perforations in the terminal ileum, therefore an
intestinal resection along with an ileostomy is performed. After staying for 53 days in the intensive care unit
the newborn is discharged with 37.3 corrected weeks of gestation and a weight of 2310 grams.
The prevalence and incidence of this pathologies presented at the same time in a preterm newborn is very
low, in this cases the key for a favorable result is the early diagnosis and surgical treatment.
59
Neonatal Resuscitation Knowledge and Practice among Pediatric Residents in Jeddah, Saudi Arabia.
Jubara Alallah1, Yara Kano2, Abrar Fatani2, Ghofran Aljehani2
King Abdullah International Medical Research Center / King Saud bin Abdulaziz
University for Health Sciences, Neonatology Section, Pediatric Department, king Abdulaziz
Medical City, National Guard health Affair, Saudi Arabia
2
King Abdulaziz University , Jeddah, Kingdom of Saudi Arabia., Saudi Arabia
1
Introduction:
Neonatal asphyxia is considered as one of the major factors leading to neonatal death.
About 10% of newborns need some assistance at birth. Therefore all health care providers who participate in
the delivery should have the knowledge and the skills to perform neonatal resuscitation when needed
.Neonatal intensive care rotation is a core element of the Pediatric residency program, during the 4 years
training they should spend 24 week in the NICU and cover delivery room. But training in neonatal
resuscitation and the NRP course is not a prerequisite for the resident and exposure to the course is variable.
Objectives
This study estimated and compared the knowledge of junior and senior pediatric residents in the neonatal
resuscitation guidelines .We determined the frequency of resuscitation intervention in clinical setting and
evaluated the effectiveness of NRP to improve the confidence of the pediatric residents.
Methods
A cross-sectional study was conducted among 123 pediatric residents in the eight certified pediatric
residency program hospitals in Jeddah, Saudi Arabia. Knowledge was assessed using self-structured
questionnaire. The questionnaire consisted of 38 multiple-choice questions. SPSS version 21 was used for
the analysis. Chi-square test was used to compare the mean percentage of correct responses between
different variables. A P value less than 0.05 was considered significant.
Results
The average score of the residents` knowledge was 36.85 (n=116). No significant difference between the
knowledge scores of seniors and juniors (p=.410).A significant improvement in the level of confidence
among the residents who took the NRP ( P=.000) .there was A significant improvement in the level of
confidence among the residents who resuscitate more babies.(p=.004)
Conclusion
While the Pediatric residents` knowledge on neonatal resuscitation guidelines appears to be poor, the
Neonatal Resuscitation Program was found to be effective in improving the confidence level of the pediatric
residents. The need for the NRP as an essential prerequisite in the Pediatric residency program is highly
required.
60
Breastfeeding Very Low Birthweight Babies
Andreja Tekauc Golob, Saša Kostanjevec
University Clinical Center Maribor, Slovenia
Background
Mothers of very low birthweight (VLBW) preterm infants, encounter a variety of unique breastfeeding
barriers and challenges that result in a decreased rate of breastfeeding compared to term infants.
In neonatal intensive care units (NICU), further educational efforts are needed to address the specific
breastfeeding needs of parents with preterm infants.
Methods
A retrospective analysis of the breastfeeding rate in VLBW babies at discharge from Maribor University
Centre for the period 1.1.2011 – 31.8.2014 was performed. The breastfeeding rate according to birthweight
and gestational age was analysed. We compared the results with those of the previous five-year retrospective
analysis and with the current knowledge on breastfeeding of VLBW preterms in the literature.
Results
Of the 93 VLBW babies born in Maribor University Centre, 12.9% were exclusively breastfed, 4.3%
received only mothers’ milk, 10.8% were partially breastfed, 34.4% received both mothers’ milk and
formula and 37.6% were fed only with formula at discharge. Comparison with the previous 5-year analysis
shows a decrease in the number of formula-fed babies (29.3% / 43%).
Conclusions
Most VLBW babies are not breastfed at discharge. The results confirm that additional efforts can increase
the rate of successfully breastfed VLBW babies. Mothers of VLBW babies face many problems in
breastfeeding, and healthcare professionals should offer individualized care and support. International Board
Certified Lactation Consultants (IBCLC) are of great help.
Key words:/h3
Benefits of breastfeeding, very low birth weight babies, discharge from maternity hospital
61
Risk factors of sepsis and septic shock in Very Low Birth Weight Neonates: A single centre
retrospective analysis
Ankita Sharma1, Sangeeta Choudhury1, Poonam Singh2, Anup Thakur2, Neelam Kler2, Parul
Chugh1, Manvinder Ghalaut3
1
Sir Ganga Ram Hospital, India
2
Sir Ganga Ram Hospital, India
3
M. D. University, India
Background: Neonatal sepsis in very low birth weight (VLBW) infants leads to high morbidity and
mortality. Risk factors for sepsis in these infants may vary depending on level of care.
Design: Retrospective study
Objectives
Determining potential risk factors leading to development of late onset sepsis
Ascertaining high mortality rate factors
Setting
Level IIIB Neonatal Intensive Care Unit (NICU), Sir Ganga Ram Hospital (SGRH), New Delhi, India.
Subjects
VLBW (≤1500 grams) infants admitted at NICU, Department of Neonatalogy, SGRH, during the period of
January 2014 to December 2015 (2 years) were assessed.
Results
A total of 265 VLBW infants (both extramural and intramural) were included in the study. 57 of 265 infants
(21.5%) developed culture-positive sepsis with an associated mortality at 47.4%. Mean birth weight of
infants diagnosed with sepsis was 1060±240 grams and those without sepsis were 1155±235 grams.
Significant (p0.001) clinical presentations correlating with sepsis were desaturation (87.77%), shock
(56.1%), feed intolerance (56.1%), hyperglycemia (47.4%), meningitis (14.0%) and necrotizing enterocolitis
(17.5%). Independent factors associated with culture positive sepsis, as identified by multivariate analysis
using logistic regression were invasive ventilation (OR 4.6, CI 2.5-8.8), prior antibiotic exposure (OR 3.3, CI
1.8-6.1) and time to reach 100 ml/kg feed (OR 1.1, CI 1.1-1.2).
Further our study showed 70.2% (40/57) VLBW infants progressed to septic shock with an associated
mortality at 67.5% (p0.001). Dosage of inotrope (20.7% vs 79.3%; single vs two and more) for management
of septic shock did not show significance outcome improvement in terms of lowering mortality.
Conclusion:
Invasive ventilation, prolonged time to reach full feeds and prior antibiotic exposure are significant risk
factors associated with sepsis. Additionally, increased mortality due to septic shock needs further
deliberations and management.

Keywords: Very low birth weight, Sepsis, Septic shock.
62
Local Epidemiology of Blood Stream Infections in Neonates Admitted to a Neonatal Intensive Care
Unit in Ghana
Alhassan Abdul-Mumin1, Abass Abdul-Karim2, Tania Condurache3, George Rodgers3, Dan
Steward3, Imran Ravji4
1
Tamale Teaching Hospital, Ghana
2
Ghana Health Service, Ghana
3
University of Louisville, USA
4
United Nations Children Fund, Ghana
Introduction
Neonatal sepsis (NS) is among the most common causes of neonatal mortality globally. In resource-limited
settings, it is usually diagnosed clinically and managed empirically, as routine septic workup is not feasible.
This blind therapy can lead to poly-pharmacy and emergence of resistant strains in Neonatal Intensive Care
Unit (NICU) settings. A study in Accra (Ghana) has shown a shift from Gram-positive (GP) to Gramnegative (GN) organisms, with significant resistance to ampicillin and gentamicin.
Objective
To determine the local epidemiology of NS and antibiotic sensitivity patterns in our institution.
Methods
Successive patients admitted to the NICU were recruited to this prospective cohort study. Demographic,
clinical information were recorded. Blood culture samples were collected with aseptic techniques, after
seeking parental informed consent. Enrolled patients were followed clinically through completion of
antibiotics and discharge.
Results
Of the 39 patients recruited so far, the male: female ratio was 1.17; the mean age was 5.5 days, with 77%
aged ≤7 days on admission. Spontaneous vaginal delivery occurred in 71% and 94.9% of deliveries occurred
in a hospital. Common presenting complaints were fever (48.7%), poor feeding (33.8%), dyspnea (30.3%),
and jaundice (12.8%), and umbilical cord problems (10.2%). Initial diagnoses on admission were NS
(30.8%); asphyxia (10.3%); seizures, jaundice and prematurity (7.7 % each). A pathogenic organism was
isolated in 48.7% of the cultures sampled. E.coli (36.8%) and Klebsiella spp(31.6%) were the most common
isolates. Only 2/19 isolates were sensitive to ampicillin. AB modification was done in 6 of the patients. Mean
antibiotics treatment was 5.6 days.
Conclusions

GN organisms predominated among the isolates in our NICU

Majority of the isolates were resistant to ampicillin and gentamicin, which are the first line
antibiotics used in our setting.

Adequate identification of organisms and antibiotic susceptibilities will help to create a valid
protocol for adequate empiric antibiotic coverage.
63
Ultrasonographic Dimensions of Thyroid Gland in Healthy Term Neonates
Nilufer Guzoglu1, Ayse Tandircioglu1, Sevinc Odabası Gunes2, Ayca Torel Ergur2, Didem
Aliefendioglu1
1
University of Kırıkkale, Medicine School of Kirikkale, Turkey
2
University of Kırıkkale, Medicine School of Kirikkale, Turkey
Background and objectives
Measurement of the thyroid gland size is required when the thyroid function test is abnormal. For this
reason, reference values of the thyroid gland size are essential. The reference values can vary among
different geographic regions. Therefore, in this study we aimed that determining normal reference ranges in
healthy term newborn in our region.
Method
In this study, records of 270 newborns who attended to our hospital between January 2013 and December
2015 were evaluated retrospectively. Inclusion criteria were (1) gestational age between 37-42 weeks, (2)
healthy newborn except mildly jaundiced, (3) having normal thyroid function test. Newborns who have
maternal thyroid disease, congenital disorder, small for gestational age and, large for gestational age were
excluded from the study. Measurements had been performed by an expert radiologist between on day 5 and
20.
Results:
136 newborns were enrolled in the study. Mean gestational age and mean birth weight were 3274 ± 321
grams and 39 ± 1 weeks, respectively. 51% of the newborns was girl. For all babies, median and range of
total thyroid volume values were 0.62 ml (0.14 -1.62). 10, 25, 50, 75 and 90th percentile values were 0.31,
0.46, 0.62, 0.93 and 1.18, respectively.
Conclusion
We believe that determined thyroid volume reference values can help to show deviation in cases of the
assessment of thyroid size.
64
Rapid Success of Povidone-iodine Pleurodesis for Refractory Congenital Chylothorax : a Case Report
and Litterature Review.
Nadia Kasdallah1,2, Hakima Kbaier1,2, Hatem Ben Salem1,2, Neila Moualhi2, Nada
Missaoui2, Sonia Blibech1,2, Mohamed Douagi1,2
1
2
University Tunis El Manar, Tunisia
Background and aims
Povidone iodine (PVI) pleurodesis is commonly used in adult. However, the use of this procedure to
perform chemical pleurodesis in the management of congenital chylothorax is still nonconsensual. We
aimed to report a new case of refractory congenital chylothorax (CCT) managed with PVI pleurodesis with
iterature review.
Methods
We report a case of refractoy CCT managed with Povidone-iodine 4% pleurodesis with a review of
literature.
Results
In a full term female neonate, with refractory congenital chylothorax chemical pleurodesis was performed
at day 16 of life: one intrapleural instillation of 5ml PVI 4% was carried out with rapid success (48 hours )
and no side effects nine months later. Biologic functions spatially renal, thyroid tests stilled normal before
and after instillation. The analysis of 18 cases reported in Medeline and our observation provided the
following data: this procedure was successful without side effects in 11/19 cases. Severe side effects were
reported in four patients with high risks before procedure: extremely low birth weight and premature infant,
diffuse lymphangectasia, renal involvement, extensive deep central veins thrombosis.
Conclusions
PVI pleurodesis seems to be an effective and inoffensive means for management of refractory congenital
chylothorax and may represent a good alternative to surgery. Nevertheless, severe adverse effects are
possible in hard situations that need to been excluded. Randomized studies on large neonatal population are
required to precise: the risks and benefits of this procedure, the timing and the modalities of its realization
(duration of intervention, dilution and dosage of PVI) according to the patient`s field (gestational age, weight
and associated morbidity).
65
A Comparative Study on the Temperature Recording By Infrared Thermometer and Axillary
Electronic Thermometer
Wendy Mills, Varghese Abraham
Christian Hospital Chhatarpur, India
Measuring temperature is an essential part of nursing care and has been widely accepted as an indication of a
patient’s clinical condition. There are various ways and methods to measure the temperature and each has
their own advantages and disadvantages. The present study is done in Special Newborn Care Unit of
Christian Hospital Chhatarpur, India to compare the temperature recording in different part of the body using
electronic axillary and infrared thermometer(Multifunctional Infrared thermometer PC808). After getting
IRB and ethics committiee aproval a specially trained neonatal intensive care nurse measured the
temperature at axilla by electronic thermometer, and in forehead, chest, abdomen and foot by the Infrared
Thermometer (IRT) for each neonates with in a span of 5minutes. The results were entered in Microsoft
excel and analysed by standard deviation and mean. Atotal of 25 sample were collected of which 18(75%)
were preterm, 5(20%) post dated and the 5% were term. The mean temperature by axillary measurement was
36.9±0.52 where as the IRT head, IRT Chest and IRT abdomen were 36.9±0.42, 36.9±0.42 and 37.4±0.46
respectively. The most acurate measurement of IRT is from the forehead and it has the least variation from
the axillary temperature measurement by electronic thermometer.
66
Outcome of Premature under 28 Gestational Age in the Neonatal Resuscitation and Intensive Care
Unit of the Military Hospital of Tunis between 2008 and 2015.
Nadia Kasdallah, Dorra Falleh, Hakima Kbayer, Hatem Ben Salem, Hamdi Ben Daamar,
sonia Blibech, Mohamed Doagi
Background and aims
Extreme preterm (EP) infant have a high risk of morbidity and mortality. Survivor are often impaired
physically, and/or cognitively. Further, the health needs of these infants can be extensive, both in terms of
neonatal intensive care and for some, lifelong support. We aimed to analyze the outcome in short and
medium term of EP supported in our unit in order to develop a thoughtful management strategy.
Methods
It was a 8-years descriptive and prospective study (2008-2015). Perinatal characteristics, mortality and,
morbidity of all EP at birth and for medium term were analyzed.
Results
We identified 64 EP, 20% of EP were intubated in the delivery room. The average term was 25 GA
(gestational age). The mean birth weight was 940 gr. Morbidity was represented as follows: hyaline
membrane disease in 58%, transient respiratory distress in 31%, and infectious alveolitis in 3%. Assisted
ventilation was used in 75%. Hemodynamic disorders wee noted in 56% of EP. The rate of maternal-fetal
and nosocomial infections were 23% and 44% respectively. Neurological damage affected 21% of EP. The
rate of ulcerative enterocolitis necrotizing was 9,3%. The overall survival rate was 21%. The average length
of stay for survivors was 61 days. The lowest weight and term in survivors were respectively 25 GA and 860
gr.
We observed high rates of mortality and morbidity in EP but being improved. Several aspects are still to
promote in particular the management of risk pregnancies and neonatal reanimation of this high-risk
population.
67
Congenital Brain Tumor: Three Cases Reports
Nadia Kasdallah1,2, Dora Fallah1,2, Ben Daamar Hamdi1, Hakima Kbaier1,2, Hatem Ben
salem1,2, Sonia Blibech1,2, Bouani Alaa1,2, Neyla Mouelhi1,2, Mohamed Douagi1,2
1
2
Faculty of Medecine of Tunis, Tunisia
Background and aims
Congenital brain tumors (CBTs), defined as tumors presenting within 60 days after birth, are extremely rare
and account for only 0.5 to 4% of all pediatric brain tumors. Even after several investigations have been
performed, a clear direction for diagnosis and treatment of fetal intracranial tumors is still lacking. We
reviewed the cases of CBTs managed in our unit.
Methods
A 15-year retrospective study of the cases of CBTs hospitalized in our unit was performed. Clinical,
radiological with magnetic resonance imaging, histopathological findings and outcome were analyzed.
Results
We identified three cases of CBT diagnosed in two male and one female infant. The diagnosis was
performed in postnatal period for the three cases. CBT was revealed by refractory status epilepticus at day
one of life for first newborn, delayed walking for the second newborn (at 20 months) and bulging fontanels
at two months of life for the third newborn. Clinical outcome in the first case with pilocytic astrocytoma
grade I diagnosis resulted in vegetative state after delayed resection of the tumor (8 months). The second
patient with ependymoma grade II underwent successful resection of the tumor and is still alive with
concentration disorders. In the third case with infantile desmoplastic astrocytoma grade I diagnosis, surgery
was successfully performed at two months 26 days of life.
Conclusion
This study sheds light on the difficulty of prenatal diagnosis, neonatal diagnostic, histological, prognostic,
and therapeutic characteristics of CBTs. Further studies are needed to clarify its clinical characteristics and
establish recommendations for management.
68
Neonatal Bacterial Meningitis at a University Hospital in Southern Thailand
Sirinthip Kittivisuit, Anucha Thatrimontrichai, Waricha Janjindamai, Supaporn
Dissaneewate, Gunlawadee Maneenil
Prince of Songkla University, Thailand
Background
Meningitis is a serious neonatal infection with a poor neurodevelopmental outcome. There is limited
information about the incidence, type of organism and outcomes in developing countries.
Methods
We performed a retrospective study in a Thai neonatal intensive care unit to compare the characteristics and
outcomes in neonatal meningitis between period 1 (1991-2002) and period 2 (2003-2014).
Results
Over 24 years, the number of patients, episodes and pathogenic organisms of neonatal meningitis were 46,
54 and 62, respectively. The incidence of neonatal meningitis was 0.37 cases per 1,000 live births and 0.52%
of NICU-admitted neonates. The case fatality rate was 21.7% (10/46). Median (IQR) gestational age (GA)
and birthweight (BW) were 35 (7) weeks and 2,045 (1,208) g. Case fatality rate was 21.7%. In period 2,
significantly lower GA (P = 0.006), BW (P = 0.02), current weight (P = 0.001) and previous neurological
surgery (P = 0.02) were revealed at onset of meningitis than in period 1. Meningitis with bacteremia and
ventilator-associated pneumonia were found in 30% and 15% of cases, respectively. Within 48 hours of life,
no multidrug resistant (MDR) organisms were found (0/2); however, within 72 hours MDR was found in
44% (7/16). Acinetobacter baumannii was the most common causative organism (16%) and cause of death
(40%). In only one case, group B Streptococcus was the cause of meningitis and no cases of Listeria were
found.
Conclusions
Prematurity was a risk of meningitis in the recent period. Early onset meningitis should have a cut-off within
48 hours in high MDR areas.
Key Words: Acinetobacter baumannii, drug resistance, meningitis, newborn, neonatal intensive care
69
Cord Blood Pentraxin 3 in Fetal Macrosomia
Despina Briana1, Kleopatra Germanou1, Theodora Boutsikou1, Maria Boutsikou1, Nikolaos
Athanasopoulos1, Antonios Marmarinos2, Dimitrios Gourgiotis2, Ariadne MalamitsiPuchner1
1
National and Kapodistrian University of Athens, Greece
2
National and Kapodistrian University of Athens, Greece
Background
Fetal macrosomia is associated with activation of the immune system due to inflammation, which
predisposes to endothelial dysfunction and later cardiovascular complications. Pentraxin 3 (PTX3) is
released by macrophages, monocytes and endothelial cells, as a response to inflammatory stimuli. PTX3 is a
novel biochemical marker of inflammatory conditions, mainly involving the cardiovascular system.
Aim
To prospectively investigate cord blood PTX3 concentrations in large-for-gestational-age-(LGA), as
compared to appropriate-for-gestational-age-(AGA) pregnancies and associate them with a variety of
perinatal variables.
PTX3 concentrations were determined by ELISA in 80 cord blood samples of full-term singleton LGA
(n=40) and AGA (n=40) pregnancies. Neonates were classified as LGA or AGA based on customized birth
weight standards adjusted for significant determinants of fetal growth. No neonate presented with clinical or
laboratory evidence of infection.
Results
Cord blood PTX3 concentrations were similar in LGA and AGA pregnancies. However, in the macrosomic
group of infants, fetal PTX3 concentrations positively correlated with birth weight (r=0.416, p=0.008).
Furthermore, a positive association between cord blood PTX3 concentrations and gestational age was
recorded (r=0.229, p=0.041).
Conclusions
Cord blood PTX3 is probably not affected by fetal macrosomia. However, cord blood PTX3 up-regulation
with increasing birth weight in LGA pregnancies may probably indicate a predisposition to later
development of cardiovascular pathology in the severe cases of fetal macrosomia. The positive correlation
between gestational age and fetal PTX3 concentrations may possibly be attributed to the increased placental
expression of the protein, as pregnancy advances.
70
The Effect of Bosentan Therapy in Persistent Pulmonary Hypertension of the Newborn
Gunlawadee Maneenil, Anucha Thatrimontrichai, Waricha Janjindamai, Supaporn
Dissaneevate
Prince of Songkla University, Thailand
Background
Persistent pulmonary hypertension of the newborn (PPHN) is acute disorder of postnatal transition with
substantial morbidity and mortality. Inhaled nitric oxide (iNO) is the mainstay of therapy for PPHN;
however, some patients are unresponsive to iNO. Bosentan, an oral endothelin-1 receptor antagonist, reduces
pulmonary vascular resistance and hence may play a role in the treatment of PPHN.
Objective
To evaluate the effectiveness and safety of bosentan therapy in PPHN patients.
Study Design: Retrospective study. The data from medical records of newborns, diagnosed with PPHN and
had received oral bosentan from January 2013 - February 2016, were reviewed.
Results
40 neonates at a median gestation of 38 weeks were diagnosed with PPHN and received oral bosentan. The
median (IQR) age at the start of bosentan and the initial oxygen index (OI) were 27 (14.5-40.2) hours and
29.2 (13.4-40.1). The mean duration of bosentan therapy was 6.2±3.1 days. A significant improvement in OI
(P=0.002) and oxygen saturation (SpO2) (P0.001) was observed after 2 hours of treatment. 21 (52.5%)
neonates who received both iNO and bosentan (median OI 34.2; 29-42.6) and 19 (47.5%) neonates who
received bosentan alone (median OI 13; 9.8-30.9) had significantly decreased OI at 6 and 2 hours after
treatment, respectively (P=0.005 and P=0.01). No statistically significant difference was found in blood
pressure before and after bosentan treatment and there was no hepatic transaminitis in all neonates. Mortality
rate was 15% (6/40) and mean OI in the non-survivors group was 61.4.
Conclusions
Bosentan may be a safe and effective treatment for improving oxygenation in PPHN. In mild to moderate of
pulmonary hypertension where treatment with iNO is unavailable, oral bosentan can be an alternative
therapy option in the treatment of PPHN.
71
Comparison of the Neonatal Outcomes of Various Types of Bathing
Kotomi Yamaguchi, Marie Furuta
Kyoto University, Japan
Objectives
There are numerous methods of bathing infants, sponge and swaddle baths have been administered as
alternative methods to traditional bathing to keep newborns clean while reducing stressful exposure.
However, there is a lack of evidence as to whether various types of bathing have different effects on the
infants and whether those effects differ depending on the newborns’ clinical characteristics. The objective is
to compare the neonatal outcomes (efficacy and GBS infection etc) with various types of bathing (sponge,
swaddle and traditional immersion baths).
Method
We conducted a systematic review of randomized controlled trials and observational studies. We searched
multiple databases, including the CENTRAL, Ovid MEDLINE, PsycINFO, Embase and Maternity and
Infant Care. Search terms included newborn/newborns, infant/infants, skin care, bath/bathing and dry
technique. Only published papers written in English were included. Two reviewers independently assessed
the risk of bias in each study included in this review. One reviewer extracted data for analyses, which were
double-checked by the second reviewer.
Results
We searched 1,054 references in the databases. After screening titles and abstracts, we retrieved full texts for
forty-three papers. From these, five were finally included in our study, based on inclusion and exclusion
criteria. Although the outcomes measured varied accords studies, the results indicated that immersion baths
may be more beneficial than sponge baths in terms of maintaining a healthy body temperature for newborns.
However, interpreting the results requires caution because the methodological quality of the included studies
was poor. There was no evidence that the type of bathing had an effect on the risk of umbilical cord
infection.
Conclusions
We did not find enough high-quality evidence to examine whether different types of bathing have varying
effects on neonatal outcomes. Further research of high methodological quality will be required to inform
clinical practice.
72
The Prevalence and Hospital Burden of Glucose 6 Phosphatase Dehydrogenase (G6PD) Deficiency
Among Neonates Born in King Abdulaziz Medical City (KAMC-WR) in Jeddah, Saudi Arabia
Jubara Alallah1, Maria Al-Shaghab2, Sarah Sarah Dhaiban2, Rehab Fallatah2
1
King Abdullah International Medical Research Center, Saudi Arabia
2
King Abdulaziz university , Jeddah, Kingdom of Saudi Arabia., Saudi Arabia
Introduction
Glucose-6-phosphate dehydrogenase (G6PD) is an important enzyme for stabilizing red blood cell.1,2 G6PD
deficiency is the most common enzymopathy in the world; It is considered as a major risk factor for
kernicterus and other complications of hemolysis In previous studies in Saudi Arabia, the G6PD deficiency
prevalence was variable between 2 to 30.6%. Thus, the neonatal screen program for G6PD deficiency
became essential in very prevalent regions
Objectives
The aim of this study is to determine the prevalence of Glucose-6-Phosphatase Dehydrogenase (G6PD)
Deficiency & To examine the hospital course of G6PD deficient neonates in KAMC-WR, Jeddah.
Methods
Retrospective chart review of inborn neonates with G6PD deficiency from January 2010 through December
2014 at King Abdulaziz Medical City in Jeddah, Cord samples were collected as part of the standard
neonatal screening program. Out born neonates were excluded; maternal and neonatal data were collected
and analyzed using Statistical package IBM SPSS™ 21 (SPSS Inc., Chicago, Il, USA) .p-value of 0.05 was
considered statistically significant.
Result
During the five years study period 15,597 infants born, Total of 232 infants had G6PD deficiency, which
constitutes 1.48 % of the total screened population. 82.8 %were male.The mean gestational age was 39 wks,
and the mean birth weight was 2992 grams. 54%of the affected neonates requires phototherapy. Neonates
below 37 weeks, required early phototherapy intervention and longer duration, Preterm with G6PD
deficiency need a longer duration of phototherapy(70 hrs vs. 47 hrs, P0.001 ) and longer hospitalization (8
vs. 4 days, P0.001) Neonates with birth weight below 2.5 kg required treatment more than.
Conclusion
The prevalence of G6PD deficiency among inborn live neonates at KAMC-WR is 1.48%, Preterm with
G6PD deficiency develop jaundice earlier and need a longer duration of phototherapy and longer
hospitalization for jaundice. Early screening for jaundice is recommended for preterm neonates with G6PDd
in first 24 hours of life unless clinically indicated before.
73
Pediatrician`s Role in Prevention of Learning Disorder in Pre-School and School
1
Mojtaba Niazi1, Hoossein Noori2
Head of Clinic education and habilitation specific learning disorder, Iran
2
specific learning disorder Clinic, Iran
Recently the process of study and exploration of learning disorder had been developed remarkable. And
specialists’ concentration it more than past and they believe that specific learning disorder cause to become
low performance in necessary skills to maintain communicate and its result are social relationships disorder,
self esteem reduction, victim and low performance of child and student in different levels. However some
children have normal or high normal intelligence and also well hearing and vision sense but they can’t learn
educational subject by using of educational standard method so they were sent to education and habilitation
specific learning disorder centers by schools or consultors. At first these children have enough confidence to
educational improvement but gradually they understand other children are better than themselves in learning
aspects. And they feel that they are differ from others by passing few months of academic year. So their self
confidence become low. And they hate school and their parent force to children very much that the condition
become difficult because their parent aren’t well informed and these children parent and teachers compare
children with others unjustly or humiliating. Gradually children become depressed, anxious and victim. So
we can’t solve children problems roughly.
Therefore, pediatricians can help parents who are the first people on the move, or words delayed growth,
impaired cognitive skills (visual, auditory), visual memory weakness, impaired speech or language skills ....
Share with their children.
Ok we will discuss about definition,prevalence, classification, the goal of education and habilitation,
relationship between learning disorder with other science, clinical signs and specific approach treatmental for
learning disorder in this article.
74
A Review of Universal Antenatal Group B Streptococcus (GBS) Screening and Its Impact on Early
Onset Sepsis (EOS) In Neonates – The SGH Experience
Priyantha Edison, WB Poon, SKY Ho
Singapore General Hospital, Singapore
Background
Early-onset sepsis (EOS) continues to be a leading cause of neonatal morbidity and mortality with GBS
being a significant contributing pathogen. Universal antenatal screening for maternal GBS colonization and
intra partum antibiotic prophylaxis (IAP) have led to a reported decline in the burden of early onset GBS
disease (EOGBSD) worldwide. In SGH, the 2010 revised CDC recommendations were incorporated into a
revised EOS management algorithm in 2011. We aimed to evaluate the impact of universal GBS screening
on neonatal outcomes.
Methodology
A retrospective analysis of neonatal outcomes in the 2 years prior (Epoch 1) and 3 years post implementation
(Epoch 2) of universal antenatal GBS screening was done. All cases of EOS were reviewed.
Results
There were no cases of EOGBSD during the study period. The incidence of culture proven EOS in Epochs 1
and 2 were 0.03% and 0.09% respectively, observed predominantly among very preterm births with Gram
negative pathogens being the causative agent in 83% of the cases. In Epoch 2, there was a significant
reduction in the rate of congenital pneumonia in neonates born to GBS colonizers. However, there was a
significant increase in the rate of presumed EOS among neonates born to mothers with risk factors for sepsis.
Conclusion
The incidence of EOGBSD is very low in our population. EOS is a significant morbidity factor among very
preterm births and the majority is caused by gram negative pathogens. Adoption of the revised EOS
algorithm has contributed to an increase in the rate of neonates treated for presumed sepsis.
Key Words

early-onset sepsis (EOS);

group B Streptococcus (GBS)

universal screening
75
Antenatal and Postnatal Care Practices among Mothers in Rural Bangladesh
md Shahjahan
Daffodil International University (DIU), Bangladesh
Background
Proper utilization of antenatal and postnatal care helps to prevent complications and ensures better maternal
and child health in future. Although under-five mortality in South Asia including Bangladesh has reduced
substantially, the rate of neonatal mortality is still high. The study aims to identify factors associated with
practice of antenatal and/or postnatal care amongst mother of newborn from healthcare facility in selected
area of rural Bangladesh.
Methods
A community-based cross-sectional study was conducted among 360 representative samples of postnatal
mothers those were within their 42 days of delivery. The data were collected using semi-structured
questionnaire.
Results
About 14.2% of the respondents visited healthcare facility for 4 or more times to receive ANC. Though
higher proportion of mother delivered at home, 35.0% of the respondents experienced post-delivery
complications. Around 18% mothers received PNC from healthcare facility. Although many variables
revealed significant associations in bivariate analyses, few variables remained significant for ANCPNC
categories in multinomial logistic regression analysis. The likelihood of receiving either ANC or PNC (OR
=0.30, 95% CI =0.10-0.96) was significantly lower among mothers who had either no education or less
educated (1-5 years of schooling); and was found significantly higher for women who watched TV (OR =
2.79; 95% CI = 1.45 – 5.37); family income showed significant association for receiving both ANC and PNC
services as well.
Conclusion
Maternal care of newborn particularly PNC service is very poor in rural Bangladesh. Adequate antenatal and
postnatal care should be prioritized with the existing Maternal MCH facilities. Home visits of community
health workers could be an opportunity to enhance healthcare for the woman and newborn including
deliberation of specific health messages. Counseling could be integrated during ANC visits to increase the
postnatal care service further.
76
Osteogenesis Imperfecta – Case Presentation
Tanasescu Sonia1, ioana ciuca1, cristina dragomir2, simona muntean2, liviu pop1
1
University of Medicine and Pharmacy V. BabesTimisoara, Romania
2
Emergency County Hospital Timisoara, Romania
Osteogenesis imperfecta is a rare disease triggered by the occurrence of a genetic mutation in the genes
responsible for producing collagen. There are over 150 mutations, and the incidence is about 1 / 20,000.
After last classifications, there are 8 types of osteogenesis imperfecta, whose severity ranges from moderate
to severe or very severe with perinatal deaths.
The authors present the case of a 6 months old infant hospitalized for numerous fractures (at 2 months old –
radiocarpian fracture, at 5 ½ months old- left humerus fracture and at 6 months old - left shin median 1/3
incomplete fracture). Clinical examination reveals a cast device in the left leg. Paraclinic investigations: Xrays of the upper and lower limbs, lumbar spine bone reveals bone hypertransparency; osteodensitometry
reveals osteopenia. The ophthalmologic examination revealed sclera with normal aspect, transparent
crystalline; echocardiography reveals moderate tricuspid regurgitation. Based on clinical and laboratory
results the positive diagnosis is established: osteogenesis imperfecta and the treatment with bisphosphonates
was initiated. Under the treatment, the infant has not shown any fracture.
Keywords:osteogenesis, bisphosphonates ,fractures
77
Meilensteine der Motorischen Entwicklung – Eine Studie an Kindern im Ersten Lebensjahr
Heinz Krombholz, Angela Roth
State Institute of Early Childhood Research, Germany
Das Säuglings- und Kleinkindalter ist geprägt von raschen Entwicklungsprozessen, die sich in körperlichen
Veränderungen (Wachstum) und in der Erweiterung der motorischen Fertigkeiten und Kompetenzen zeigen.
Die wesentlichen Fertigkeiten im ersten Lebensjahr – hierzu gehören u. a. Kopf halten, sich umdrehen,
Krabbeln und sich Aufrichten – werden als „motorische Meilensteine“ bezeichnet. Zu diesen Meilensteine
existieren Entwicklungstabellen, anhand derer die individuelle Entwicklung eines Kindes beurteilt wird, sei
es durch Psychologen, Kinderärzte oder Eltern. Allerdings ist bei den vorliegenden Entwicklungstabellen
oftmals kaum nachvollziehbar, auf welchen empirischen Daten diese jeweils beruhen: Wann, wo und von
wem wurden die Daten erhoben? Wie groß war die Stichprobe und welche Zielkinder wurden für die
Untersuchung ausgewählt? Derzeit besteht der Verdacht, dass vorliegende Angaben zu den motorischen
Meilensteinen häufig veraltet sind und die Datenbasis nur gering ist. Ziel des Beitrages ist es, die Methoden
und Ergebnisse eines Forschungsprojekts zum Auftreten der wichtigsten motorischen Meilensteine
vorzustellen. Hierfür wurden junge Eltern aufgefordert (in Zeitschriften und Internetplattformen, die sich an
werdende und junge Eltern richten), die Entwicklung ihrer Kinder anhand eines Entwicklungskalenders, der
18 motorische Fertigkeiten umfasst, zu beobachten und zu registrieren. Dieses Einbeziehen von „Laien“ zur
wissenschaftlichen Datenerhebung ist zwar für die Entwicklungspsychologie eher ungewöhnlich, wird aber
vor allem in angelsächsischen Ländern bei biologischen Fragestellungen unter der Bezeichnung „citizen
science“ verschiedentlich angewandt. Seit 2013 beteiligen sich bundesweit mehr als 1600 Eltern an der
Online-Studie, Zwischenergebnisse liegen für 800 Kinder vor. Das Erfassen der individuellen
längsschnittlichen Entwicklung ermöglicht nicht nur die Ermittlung von Prozenträngen für das Erreichen der
Meilensteine, sondern auch die Analyse individueller Entwicklungsschritte und die Ermittlung von Faktoren,
die mit dem Entwicklungstempo zusammenhängen.
78
Impact of Prenatal Diagnosis in Surgical Congenital Anomalies in Albania
Ilirjana Bakalli
UHC" Mother Theresa", Albania
Introduction
Congenital anomalies are one of the main causes of perinatal mortality and morbidity, requiring in many
cases surgery. Prenatal diagnosis provide information that influences the prevalence of congenital anomalies
and perinatal care.
Aim
To assess if prenatal diagnosis has affected the prevalence of surgical congenital anomalies in our country
during 10 years (2006-2015) and to examine the trend of this pattern between the two periods: 1 st period
2006-2010 and 2nd period 2011-2015.
Methods
This is a retrospective study. Are included all children with Surgical Congenital Anomalies (SCA) admitted
at our PICU for surgical congenital anomalies during 2006-2015. (This is the only infantile surgery in
Albania) Live births are extracted from National Registry of Albania.
Results
During the study period, 334 SCA are admitted at our PICU (1.7% of all admissions). The prevalence of
SCA has been reduced from 1.14/1000 live births in the first period to 0.97/1000 live births in the second
period. Mortality rate also get down in the second period from 34% in 25.6%, near significance p=0.08;
95%CI(0.41÷1.06). The most important pathologies due to their higher incidence and mortality rate remain
the same in both periods but with a reduced prevalence in the second period: intestinal atresia from 0.29 to
0.18/1000 live births, esophageal atresia from 0.23 to 0.13/1000 live births, diaphragmal hernia from 0.13 to
0.08/1000 live births and laparoschisis from 0.08 to 0.05/1000 live births. We have to underline that 68.8%
of SCA come from regional zones of Albania, where prenatal diagnosis is not always possible, influencing
so in their presentation in time and the total mortality rate of these anomalies.
Conclusion
The pattern of SCA in our country hasn’t change, but prenatal diagnosis has influenced the prevalence of
surgical congenital anomalies and the prenatal care with an important reduction of mortality rate.
79
Concerns about the treatment of supraventricular tachycardia in neonates
Ilirjana Bakalli
Key words: neonat, amiodarone, supraventricular tachycardia.
Introduction
The most commonly presenting pathological tachycardia in the neonates is SVT (Supraventricular
Tachycardia). Immediate rate control is desired in the child who requires significant support. This life
threatening event at neonates necessitates a standard protocol for its management, dependent on the patient
stability at presentation. The use of intravenous amiodarone may quickly achieve rate control, but the safety
and efficacy of amiodarone in children and especially in neonates has not been established, due to the
presence of benzyl alcohol. Through our case report, we’d like to underline the risk of intravenous
amiodarone in neonates.
Case report
The child F.Sh, 29 days old, presents at our PICU with SVT and severe heart failure. (Heart rate - 280
beats/min, with reduced contractility in echocardiography – FS= 20%). We used Amiodarone to treat the
SVT, according the protocols (loading dose – 5 mg/kg two doses, followed by maintenance dose for 24
hours, to continue after with oral amiodarone). Thirty hours after the beginning of amiodarone treatment,
child developed a severe situation, with gasping respiration, generalized cyanosis, bradycardia, seizures and
cardiovascular collapse. Resuscitation has been done for more than 10 minutes. Clinical situation persisted
severe for other two days, with respiratory distress and neurologic involvement. We interrupted amiodarone
and added prednisolone in the treatment. After four days clinical situation was very good. He was discharged
from hospital after 7 days.
Conclusion
Through our case we would like to emphasize that intravenous amiodarone should be used with caution in
neonates and according the neonatal protocol for SVT, given that the presence of benzyl alcohol can cause
even fatal “gasping syndrome”.
80
Maternal Dietary Diversity and Risk of Low Birth Weight: Empirical Findings from India
Srinivas Goli, Deepti Singh
Jawaharlal Nehru University (JNU), India
Objectives India accounts for the highest proportion of low birth weight (LBW) babies born in the
developing world. Poor maternal nutrition during pregnancy has been associated with adverse infant health
outcomes, such as LBW. The aim of this paper was to assess the socio-economic factors influencing dietary
diversity among pregnant women and to investigate the association between maternal dietary diversity and
LBW among newborn babies. Methods and Materials The data for this analysis comes from a unique survey
that we conducted among 230 newly delivered women in an urban hospital setting in Uttar Pradesh, the
largest Indian state, which accounts for amongst the poorest maternal outcomes in India. Multivariate binary
logistic regression analysis points out low maternal education and economic status as being significant
factors influencing the poor dietary diversity among pregnant women. Result and Conclusion Specifically,
the prevalence of poor maternal dietary diversity was significantly less among the higher educated women
(25%, CI: 23.7-26.3, p0.05) compared to women with no education (41%, CI: 38.6- 43.2). The results also
show that women in the category of low dietary diversity had a significantly high proportion of LBW babies
(68%, 63.0- 72.1) in comparison to those with medium to high dietary diversity (47%, 43.5-50.5, p 0.05).
The findings suggest for improving maternal dietary diversity to reduce LBW babies in India.
81
Recurrent Neonatal Organophoshorus Poisoning
YUSUF PARVEZ
SENIOR SPECIALIST, United Arab Emirates
Organophosphorus poisoning in neonates is extremely rare and needs high index of suspicion to diagnose
it.Transplacental route is the most common mode of transmission,others being inhalation and ingestion;
either accidental or homicidal. The clinical manifestation often simulates that of sepsis andThe clinical
presentation is often confused with the features of sepsis like apnea, copious oral secretions, diarrhea,
letharginess, seizures. There may be recurrence of manifestations due to chronic exposure.The mainstay of
medical
therapy
in
organophosphate
poisoning
include
atropine, pralidoxime (2-PAM), and benzodiazepines (eg,diazepam)
Keywords- Apnea, Seizures, Sepsis.
82
Surfactant and Antenatal Steroid Use in New Era of RDS Treatment
Suada Heljic, Ismeta Kalkan, Sabina Terzic, Amra Cengic, Hajrija Maksic
University Clinical Center Sarajevo, Bosnia and Herzegovina
Background
The aim of this study was the comparison of survival rate in preterm infants with RDS treated with CPAP,
INSURE procedure and mechanical ventilation, depending on antenatal steroid use and surfactant
replacement.
Patients and methods
Investigation included preterm infants with respiratory distress syndrome (BW 1466,53 ± 498,04, GA 30,00
± 2,77) treated with CPAP (n=83) and INSURE procedure (n=35), and compared with infants treated with
mechanical ventilation (n=118) as a historical group. Survival rate depending on antenatal steroid therapy
and surfactant use is compared in both groups. \
Results
There is no statistical difference in birth weight, gestational age and sex distribution between CPAP,
INSURE i MV groups. There is statistical difference in survival rate (χ2 13,783, p0,05) between groups. In
CPAP and INSURE group, if their mothers received steroids antenatally, survival rate was 100%, if no,
survival rate was 89,12% and 94,44%, respectively. In MV group, if infants were treated with steroids
antenatally, survival rate was 76%, if no, 62,37% (χ2 43,565, p0,05). In CPAP group 32 infants (28,57%)
were not treated with surfactant; one, two or three doses of surfactant received 68 (60,71%), 8 (7,14%) and 4
(3,57%) infants respectively. In MV group 15 infants (19,48%) were not treated with surfactant; one, two or
three doses of surfactant received 41 (53,25%), 17 (22,08%) and 4 (5,19%) infants respectively (χ2 9,936,
p0,05).
Conclusion
Antenatal steroid use together with less aggressive treatment using CPAP and INSURE procedure show to
be the best strategy regarding survival of preterm infants with respiratory distress syndrome.
83
Comparison of Four Days Versus Seven Days of Antibiotic Therapy for Neonatal Pneumonia: A
Randomized Controlled Trial.
NB Mathur, Murugesan A
Pneumonia is the commonest form of neonatal infection contributing significantly to neonatal mortality. The
objective of the present study was to compare the effect of four days course versus seven days course of
antibiotic therapy in neonatal pneumonia on treatment success rate. All near term and term neonates
(gestation age 34 weeks ) with pneumonia, who had clinical remission by 48 hours of antibiotic treatment
were enrolled. Exclusion criteria comprised of birth through meconium stained amniotic fluid, positive blood
culture and associated meningitis. For a difference in success rate of 6% (for non inferiority trial) at 95%
confidence interval and power of 80 percent, 35 neonates were enrolled in each group. Pneumonia was
diagnosed on predefined clinical, radiological and laboratory grounds. Primary outcome parameter was
success rate defined by non recurrence of symptoms within 3 days of discharge. Secondary outcome
included morbidity rate up to 28 days after enrollment. The study was approved by the institutional ethics
committee and written informed consent was obtained.All cases of neonatal pneumonia who were
asymptomatic by 48 hours of antibiotic treatment were enrolled. The randomization sequence was generated
using random allocation software in variable blocks and concealed by placing the group allocation in sealed
opaque envelopes. Baseline variables including gender, age, weight, gestational age, clinical features, CRP
and Procalcitonin positivity were comparable in both groups. Success rate was 100% in both groups.
Duration of stay and duration of antibiotics was significantly lesser in the 4 day group. To conclude, a total
of 4 days of antibiotics was comparable to a total of 7 days of antibiotic thearapy with respect to success of
treatment and occurence of morbidity for 28 days following enrollment. Duration of antibiotics and hospital
stay was significantly less in the 4 day group.
84
Caring For the Newborn: Knowledge and Associations on Evidence-Based Practices at Community
Level among Sri Lankan Post-Natal Mothers
Sumudu Hewage1, Dhammica Rowel2
1
Post Graduate Institute of Medicine, University of Colombo, Sri Lanka
2
Family Health Bureau, Sri Lanka
Background:
Sri Lanka successfully reduced neonatal mortality to the lowest in South-East Asia. But morbidity remains
high, most of which could be prevented by simple, yet evidence-based interventions at both hospital and
home.
Objectives:
To assess maternal knowledge and factors associated with evidence based interventions on newborn care at
home among postnatal mothers.
Methods:
This hospital-based analytical cross-sectional study was done on consecutively selected 422 postnatal
mothers, at a tertiary care maternity hospital, following delivery of newborn. A pre-tested intervieweradministered questionnaire assessed mothers` knowledge on selected evidence-based newborn care
interventions recommended by WHO and UNICEF in their guidelines “Home visits for the newborn child: a
strategy to improve survival” (2009).
Descriptive data are presented as means, standard deviations and proportions. Inferential data are presented
as Odds Ratios and confidence intervals. Associations were assessed for significance by Chi Square and 95%
confidence intervals.
Results:
We achieved a response rate of 100%, reducing selection bias in the study. Mean age of study sample was
29.7 (SD=5.6) years. Most mothers (n=263;62.5%) delivered their second child. Mean score on overall
knowledge was 72.7%. Mothers were most knowledgeable in identification of danger signs (mean
score=81.3; SD=1.1), followed by immunization (mean score=77.3; SD=0.7) and breast feeding (mean
score=74.9; SD=1.7) Comparatively, knowledge was less on prevention of hypothermia (Mean score=60.0;
SD=1.1) and basic emergency care (mean score=47.2; SD=1.4). Higher level of knowledge was associated
with having more than one child, (p0.001; OR=0.2; 95%CI=0.1-0.4), mothers with secondary education
(p0.001; OR=4.2; 95%CI=1.9-9.1) and attending to antenatal parent-craft classes (p=0.002; OR=2.9;
95%CI=1.4-6.0).
Conclusions and recommendations:
Knowledge on prevention of hypothermia and basic emergency care should be delivered to mothers more
effectively by the national antenatal care program. Primi-parous and less educated mothers should be
focused more in the continuum of maternal and perinatal care to further improve newborn survival.
85
Oxidative Status in Premature Newborns Breastfed at Enriched or Not Enriched
HADDOUCHE MUSTAPHA1, SMAHI Chems-Eddine1, ARIBI MOURAD2
Universite Abou-Bekr Belkaid , Laboratoire de Biologie Moléculaie Appliquée et
Immunologie, Algeria
2
Université Abou-Bekr Belkaid , Laboratoire de Biologie Moléculaire Appliquée et
Immunologie, Algeria
1
Background
Evaluate the effect of fortification of human milk on oxidative status and growth of premature.
Material and Methods
The study population was composed of ten (10) preterm infants (breastfeeding) hospitalized in the Neonatal
EHS Tlemcen, Algeria, and twenty (20) controls (ten (10) preterm (artificial feeding) and ten (10) forward
(breastfeeding.)
Results: The plasma ORAC, CATALASE, levels were significantly decreased in new premature breast to
breast milk enriched ( 0RAC /0,234 ± 0,017, p=0.000) than in control ( new term borns 1,24 ± 0,113
),CATALASE/(1,351± 0.037)( 1.914±0.104 p=0.006) Additionally, serum concentrations of proteins were
significantly higher than premature new borns breast to breast milk enriched ( 79.827±5.074 ; 41.193±13.024
; p=0.000).
Conclusions:
Key Words: Oxidative status, premature new borns breastfed at enriched.
86
The Use of Pulse Oximetry in Term Newborns
Duska Miljanovic
Hospital „Sv. apostol Luka“, Bosnia and Herzegovina
Introduction:
Pulse oximetry is a method for percutaneous oxygen saturation (SpO2) measurement. In the delivery room it
is effective in assessment of the cardiopulmonary adaptation of healthy and asphyxic newborns.
Aim:
Measuring the SpO2 of term newborns in the first 20 minutes after birth and the time of achieving the
optimal saturation.
Methods:
The clinical data of 80 term neonates was prospectively evaluated. The newborns were divided in two
groups. Group 1 consisting of 50 healthy and Group 2 consisting of 30 asphyxic newborns of which 14 were
resuscitated with 100%O2 and 16 with room air (21%O2) by positive-pressure ventilation. The preductal
values of SpO2 obtained by pulse oximetry were analyzed continuously within the first 10 minutes after
birth, at 15 and 20 minute.The time to achieve SpO2≥90% was determined. In resuscitated newborns it was
the time to achieve optimal saturation depending on concentration of supplemental oxygen.
Results:
932 values of SpO2 were obtained. The median (min-max) SpO2 at 1,5,10,15,20 minutes were: 58% (3384%; n=52), 86% (72-94%; n=80), 96% (90-99%; n=80), 97% (91-100%; n=80), 98% (95-100%; n=80).
There were significant differences in average SpO2 values (p0.01) between healthy and asphyxic infants. For
the whole sample, the mean time to achieve SpO2 ≥90% was 7,08 minutes whereas 6,5 minutes for Group 1
and 8,0 minutes for Group 2.
The average time to reach an optimal saturation was 7.7 minutes in group receiving 21%O 2 versus 8.3
minutes in the group receiving 100%O2.
Conclusion:
Oxygen saturation increases gradually in the first minutes of life and slower in asphyxic than in healthy
newborns. Optimal saturation is reached faster in the group of newborns resuscitated with 21% than with
100% oxygen.
87
Retinopathy of Prematurity has Higher Frequency and Severity in Small-for-Gestational-Age than in
Appropriate-for-Gestational-Age very Preterm Infants
Aleksandra Matic1, Ivana Milojevic1, Zorka Grgic2
1
Institute for Child and Youth Health Care of Vojvodina, Serbia
2
Clinical Center of Vojvodina, Serbia
Introduction
Very preterm infants born as small-for-gestational-age (SGA) have higher mortality and morbidity
comparing to their appropriate-for-gestational-age (AGA) peers, including the risk for retinopathy of
prematurity (ROP).
Methods
Our sample consisted of all infants born from single pregnancies with gestation of 24 0/7 – 32 0/7 gestational
weeks in tertiary-care center of 2 million population region. Study period was 01.01.2011.-31.12.2013. The
very preterm infants who died during primary hospitalization or those born with congenital abnormalities,
chromosome abnormalities or prenatally acquired infections were excluded from the study. The sample was
divided into SGA and AGA group, depending on birth-weight percentiles of 10 or ≥ 10, respectively. Data
were collected about incidence and severity of ROP, as well as about relevant prenatal and postnatal risk
factors for ROP. Statistical analysis consisted of the Fischer`s exact test or Student t-test, and logistic
regression model for the significant risk factors.
Results
The study sample consisted of 184 very preterm infants, of which 65 were SGA and 119 AGA. Mean
gestations were 29.47 and 29.13 weeks, and mean birth weights were 969.69g and 1329.66g in SGA and
AGA group, respectively. ROP of any degree was diagnosed in 30 (46.15%) SGA and 29 (24.37%) AGA
infants and severe ROP demanding intervention in 16 (24.61%) SGA and 15 (12.6%) AGA infants. In both
cases, difference in incidence was statistically significant. After performing multivariate analysis with
significant risk factors (gestation, cesarean section, Apgar scores in the 1st and the 5th minute, respiratory
distress syndrome of 3-5 degree, endotracheal intubation, hypotension, red-blood cell transfusion), the
difference between the groups was still significant, with p=0,001, aOR 3,61 for ROP of any degree, and
p=0,025 and aOR 2,84 for severe ROP.
Conclusion
In our study of very preterm infants, being SGA represents higher risk for occurrence and severity of ROP.
88
Neonatal Abstinence Syndrome (NAS): Unborn Victims
Ashraf Hamdan
Mednax Medical Group, USA
NAS is a complex disorder defined as a constellation of behavioral and physiological signs and symptoms
that are remarkably similar despite marked differences in the properties of the causative agent.
There are two major types of NAS: NAS due to maternal use of substances that result in withdrawal
symptoms in the newborn and postnatal NAS secondary to abrupt discontinuation of opioid medications used
for pain in the newborn.
Maternal substance abuse is a preventable cause of mental, physical, and psychological problems in infants.
It has both medical and developmental consequences for the newborn, in addition to legal, health, and
economic consequences for the mother.
The incidence of NAS is difficult to determine because of unreliable histories of maternal drug abuse,
limited health provider skills in eliciting drug histories and diagnosing difficulties.
The large number of infants who suffer from NAS and the associated long-term morbidity mandate that
affected infants be accurately identified and their treatment and support should be optimized. A
multidisciplinary approach is essential including obstetricians, neonatologists, pediatricians, nurses,
nutritionists, mental health professionals, social workers, substance abuse counselors, and child development
specialists, at a minimum.
Primary treatment of NAS should be supportive. Pharmacologic therapy can prolong hospitalization and
exposes the infant to additional agents that are often not necessary. Pharmacotherapy for infants with more
severe NAS is necessary to allow them to feed, sleep, gain weight, and interact with caregivers.
Discharging otherwise healthy infant home once stable on treatment can reduce hospital stay and associated
costs. However, a safe discharge of the infant requires that support structures within the home and
community be available.
This lecture is a literature review to describe the impact of intrauterine drug exposure on the fetus and
newborn and to understand the pathophysiology, clinical picture and diagnosis of NAS.
89
Effect of Surfactant Therapy in near Term and Term Neonates with Severe Pneumonia : A
Randomized Controlled Trial
NB Mathur
Maulana Azad Medical College, New Delhi, India
Pneumonia is the commonest form of neonatal infection contributing significantly to neonatal mortality. The
objective of the present study was to evaluate the effect of surfactant therapy in near term and term neonates
with severe pneumonia requiring mechanical ventilation on pulmonary functions, ventilator settings and
duration of ventilation. The study was conducted in the Neonatal Intensive Care Unit of a tertiary teaching
hospital.All neonates with gestational age 34 weeks with pneumonia requiring mechanical ventilation
(Babylog 8000 )were enrolled. Exclusion criteria comprised of major congenital malformations and shock at
admission. Fifteen neonates were enrolled in each group. Pneumonia was diagnosed on predefined clinical,
radiological and laboratory grounds. Primary outcome parameter was pulmonary compliance (C) at 6 hours
of surfactant therapy. Secondary outcome included Airway Resistance (R), tidal volume (VT), minute
ventilation,(MV), arterial blood gases, ventilator settings and duration of ventilation. The study was
approved by the institutional ethics committee and written informed consent was obtained.All enrolled
neonates were randomized to receive or not receive natural bovine surfactant. The randomization sequence
was generated using random allocation software in variable blocks and concealed by placing the group
allocation in sealed opaque envelopes. Baseline variables including gender, age, weight, gestational
age,severity of respiratory distress, C,R, VT,MV, PaO2, and ventilator settings were similar in both groups.
After 6 hours, C, VT, MV, and PaO2 were significantly higher (p0.05) and Peak Inspiratory Pressure, Mean
Airway Pressure, FiO2, and R significantly lower (p0.05) in the surfactant group. The duration of ventilation
was significantly lower in the surfactant group. To conclude, surfactant therapy in neonatal pneumonia
requiring ventilation was associated with significant increase in C, VT, MV, and PaO2, and reduction in
ventilator settings at 6 hours. Duration of ventilation was significantly reduced in the surfactant group.
90
Ring Chromosome 13, Case Report
Diana Suarez1, Diana Suarez1, Gabriel del Castillo2, Yoisse Velasco2
1
Universidad Libre- Seccional Cali, Colombia
2
Hospital Infantil Los Ángeles, Colombia
Background
Ring chromosome 13 syndrome accounts for one-fifth of the ring chromosomes compatible with life. The
estimated incidence is 1 in 58.000 live births. In most cases this chromosomal abnormality is a break in the
terminal arms of chromosome 13, with the resulting loss of genetic material.
Aim
To describe a case of ring chromosome 13 syndrome diagnosed at birth and its phenotype/genotype
correlation.
Materials and methods
A case report of a newborn with ring chromosome 13 syndrome and a correlation of the phenotype/genotype.
Result
Diagnosis was confirmed by G-banding. In this case the phenotype correlated with loss of genetic material
critical area 13q34, corresponding to GroupI.
Conclusions
Ring chromosome 13 syndrome is a rare condition in our population, but must be taken into account in the
presence of a newborn phenotype as described here.
91
Extremely Preterm Infants Receiving Standard Neonatal Intensive care in the UK Receive very Low
Levels of AA, DHA and EPA
Laura de Rooy1,2, Simon C Dyall3, Hanady Hamdallah2
1
St George's University Hospital NHS Trust, UK
2
University of Roehampton, UK
3
Bournemouth University, UK
Omega-3 and omega-6 polyunsaturated fatty acids (PUFA’s) are essential for normal brain development.
Most brain fatty acid accretion occurs in the third trimester, and extremely preterm infants may therefore be
at risk of a functional deficit. The preterm infants’ diet may include parenteral nutrition, banked human milk,
maternal milk and formula milk.
24 infants 28 weeks gestation were recruited at a tertiary neonatal intensive care unit in London, UK, of
which 17 completed the study. Milk and parenteral lipid intakes were recorded for 6 weeks. Milk samples of
the infants’ majority intake were analysed at 6 time points, allowing estimates of fatty acid intakes. Intakes
were compared with the European Society for Paediatric Gastroenterology Hepatology and Nutrition
(ESPGHAN) guidelines and estimated accretion rates (Lapillonne and Jensen, 2009). Whole-blood fatty acid
levels were measured at the end of the study period. The relationships between mean intake and PUFA blood
levels were assessed by Pearson product-moment correlation coefficient.
Mean intakes of AA, DHA and EPA were below ESPGHAN guidelines, with AA intakes significantly below
guidance (p0.001). The amounts of AA and DHA available for accretion (28.6 (7.1) and 16.5 (4.9)
mg/kg/day, respectively) were significantly below estimated accretion rates (both p 0.001). The cumulative
deficit was 86.5% for AA, and 63.6% for DHA. There were significant correlations between mean DHA
intake and blood DHA levels (r = 0.704, P = 0.002), mean AA intake and blood AA levels (r = 0.568, P =
0.017) and mean EPA intake and blood EPA levels (r = 0.572, P = 0.016). This is the first study to establish
low omega-6 and omega-3 PUFA intakes for extremely preterm infants. Moreover, blood fatty acid levels
are shown to be a useful measure of intake, where establishing a sufficient consumption of these PUFA’s
could have clinical importance.
Lapillonne, A., Jensen, C. L., 2009. Reevaluation of the DHA requirement for the premature infant.
Prostaglandins Leukot Essent Fatty Acids 81, 143-150.
92
Neonatal Characteristics and Perinatal Complications in Neonates with Down Syndrome
Offra Engel2, Zivanit Ergaz-Shaltiel1, Ira Erlichman3, Yaron Naveh4, Michael S Schimmel4,
Ariel Tenenbaum2
1
Hadassah Medical Center, Israel
2
3
4
Shaare Zedek Medical center, Israel
Background
The annual rate of Down syndrome (DS) births in Jerusalem is stable, regardless of prenatal screening and
diagnostic measures. We aimed to evaluate our historical cohort for obstetrical characteristics and the
neonatal course and complications.
Methods
Computerized files and discharged letters of neonates with the diagnosis of DS born in the four main
hospitals in Jerusalem between the years 2000 to 2010 were reviewed and evaluated for maternal history and
primary neonatal hospitalization.
Results
Four hundred and three neonates were diagnosed with DS. The average maternal age was 35.6 years, 73%
were born via spontaneous vaginal delivery. In all gestational ages, the mean birth weight and head
circumference percentiles were significantly lower than the general population (p
Conclusions
DS Infants were small for date with relative reduced head circumference. Despite increased rate of
congenital anomalies and perinatal complications most of them were discharged home in a good medical
condition and exclusively breastfed.
93
The Incidence of Congenital Heart Disease Among Infants in Kolubara District, Serbia
Dragica Dimitrijevic, Marija Mladenovic, Svetlana Markovic, Selimir Spasic
General Hospital Valjevo, Serbia
Objective
Between countries there is a wide variation in congenital heart disease (CHD) detection rates depending of
type of lesion and level of diagnostic opportunity.
Aim: To investigate the incidence of CHD in infants in Kolubara district, Serbia
Methods
A retrospective study was performed using medical records of 7655 babies born during 6 year period, 20102015. We looked for those diagnosed with CHD during the first year of life, based on by clinical findings,
electrocardiography, chest X-ray, echocardiography and, for some, catheterization. Also, we searched for the
type of the lesion, genetic condition and other parameters that might point to the disease, such as
prematurity, twin pregnancy and in vitro fertilization (IVF). Finally, we compered our results with similar
studies.
Results
92 infant, 50 girls and 42 boys, 78.26% born in term, were diagnosed with CHD, and the incidence rate was
1.2%.Most of the disease were mild, and the distribution was made up of 36.4%children with ventricular
septal defect (VSD), 20.56% with atrial septal defect, 10.2% with patency of arterial duct, 6.5% with
pulmonary valve stenosis, and 3.7% with aortic coarctation. Also, among identified infants, we found two
with hypoplastic left heart syndrome, two with tetralogy Fallot, and one transposition of great arteries. Six
patients (6.52%) were diagnosed with syndromes, 4 with Down, one with Treacher – Collins, and one with
mutation in mitogen activated protein kinase. Most of our patients (89.13%) were from singleton pregnancy,
and 6.52% from IVF. Two third of them were diagnosed during first week of life. All results are in
agreement with similar studies.
Conclusion
The rates of specific CHD,both mild and severe and also the association with chromosome abnormalities are
generally comparable with those reported in similar studies. The most prevalent lesion was VSD. Early
detection of CHDs provides successfully treatment for those babies.
94
A Novel Therapeutic Strategy for Cerebral Palsy: Feasibility of Umbilical Cord Blood Stem Cells and
Umbilical Mesenchymal Stromal Cells
HARUO SHINTAKU, HARUO SHINTAKU, MAKOTO NABETANI
Objective
A novel therapeutic strategy for prevention of cerebral palsy (CP) has been initiated in Japan. Hypoxicischemic encephalopathy (HIE) occurs in 0.5-1.0 per one thousand newborns and leads to CP. Therapeutic
hypothermia (TH) improved mortality of newborns suffering with HIE, however it is not perfect therapy. We
already started umbilical cord (UC) blood stem cells (UCBSCs) therapy for neonatal HIE in addition to TH.
We also have been preparing to start a clinical trial of UC mesenchymal stromal cells (UC-MSCs) therapy
for patients who did not have a sufficient effect or did not take the UC blood.
Methods
UCBSCs collection will be restricted to mothers who have given prior written informed consent for
collection. UCBSCs was collected aseptically and non-cryopreserved autologous volume-reduced UCBSCs
(up to 3 doses adjusted for volume) will be prepared by using SEPAX. UC-MSCs were collected aseptically
from UC and isolated from the Wharton Jelly and cryopreserved after culture.
Results
UCB collection and infusion preparation in normal deliveries were as follows: (1) number of CD34 positive
cells was more than 90%, and survival rate of CD34-positive cells remained at 99% at 72 hours after
separation. (2) In the separation at SEPAX, to set on the machine, the minimum requirement of UCB volume
was 40 ml, and exclusion criteria must be set for clotting of UCB collected at the time because valid cell
separation and recovery becomes impossible. UC-MSCs have been defined and characterized as follows; (1)
abundant sources and ease of collection, storage, and transport; (2) little ethical controversy; (3)
multipotency to differentiate into various cell types; and (4) low immunogenicity with significant
immunosuppressive ability. However, it took several months for a preparation for clinical use.
Conclusions
Good results in UCBSCs collection and infusion preparation were obtained when compared to the results of
Cotten et al. (J Pediatr. 2014). UC-MSCs will be given the possibility of a treatment to patients who did not
take the UC blood.
95
Umbilical Cord Mesenchymal Stromal Cells
Haruo Shintaku1, Makoto Nabetani2, Takashi Hamazaki1, Satoshi Kusuda3, Masanori
Tamura4, Sinichi Watabe5, Yoshiaki Sato6, Masahiro Tsuji7, Akihiko Taguchi8, Hiroyuki
Ichiba9, Akira Oka10, Rintaro Mori11, Atsuko Taki12, Takeo Mukai13, Tokiko NagamuraInoue13
1
Osaka City University Graduate School of Medicine, Japan
2
Yodogawa Christian Hospital, Japan
3
Tokyo Women’s Medical University, Japan
4
Saitama Medical University, Japan
5
Kurashiki Central Hospital, Japan
6
Nagoya University Hospital, Japan
7
National Cerebral and Cardiovascular Center, Japan
8
Institute of Biomedical Research and Innovation, Japan
9
Osaka City General Hospital, Japan
10
The Tokyo University, Japan
11
National Center for Child Health and Development, Japan
12
Tokyo Medical and Dental University, Japan
13
University of Tokyo, Japan
Objective
We also have been preparing to start a clinical trial of UC mesenchymal stromal cells (UC-MSCs) therapy
for patients who did not have a sufficient effect or could not take the UC blood.
Methods
collection. UCBSCs was collected aseptically and prepared by using SEPAX. UC-MSCs were collected
aseptically and isolated from UC, and cryopreserved after culture. Infants admitted to the NICU of 6
hospitals in our research group will be eligible if they are ≥36 weeks’ gestational age and birth weight ≥1800
g with HIE and meet the cooling criteria.
Results
UCBSCs therapy for neonatal HIE in addition to TH was performed in 3 newborn patients. All of them have
survived from 3 months to 1 year. UC-MSCs have been defined and characterized as follows; (1) abundant
sources and ease of collection, storage, and transport; (2) little ethical controversy; (3) multipotency to
differentiate into various cell types; and (4) low immunogenicity with significant immunosuppressive ability.
Conclusions
Good results in combination therapy of UCBSCs and TH for newborn HIE were obtained in our 3 patients.
UC-MSCs therapy will give the possibility of treatment to patients who could not get UC blood.
96
New Approaches to the Treatment of Polycythemia in Newborns with Intrauterine Growth
Retardation (IUGR). Andreeva A.A. D.O.Otta Research Institute of Obstetrics and Gynecology
RAMS, St.-Petersburg , Russia
Anna Andreeva, Anna Andreeva
Polycythemia is observed every second child with IUGR, leading to disruption of the microcirculation in the
lungs, myocardial dysfunction, cerebral ischemia. The goal was to explore the efficacy of pentoxifylline for
the correction of polycythemia in newborns with IUGR. As the effectiveness of the treatment was used
method of assessing the functional state of erythrocytes with the help of small-angle light scattering. A total
of 25 newborns 36-40 weeks gestation with IUGR. The results showed that all the children in the first days
of life had clinical symptoms of disorders of the nervous system - CNS hyperexcitability syndrome.
According to the clinical blood test every baby had polycythemia (HGB - 22,6 ± 7,8; RBC - 6,3 ± 0,2; HCT 67,6 ± 2,5 ; MCV - 107,5 ± 1,5). Our research has shown that children with IUGR only 42% of red blood
cells have a good deformation activity, whereas normally 68% (p 0,001) was found that the functional
activity of erythrocytes decreased in polycythemia (R = - 0,6 (p0,001), and reducing the volume of red blood
cells (r = 0,5 (p0,01). The results showed that the lower the percentage of haemolysis of red blood cells, the
more severe neurological symptoms observed in children in the first days of life (R = - 0,92 (p0,05). For
treatment of polycythemia were treated with the drug pentoxifylline at a dose of 5 mg/kg of 10% glucose,
once a day at a rate of 5 ml/h the first three days. Control blood count showed the effectiveness of
pentoxifylline to politsetemii correction (HGB - 189,4 ± 6,2 (0,05); RBC - 5,4 ± 0,2 (p0,05); HCT - 67,6 ±
2,5 (p 0,001); MCV - 102,7 ± 0,9 (p0,01). Indicators of haemolysis of red blood cells after treatment
pentoksifilin – 53.2±0,66% (p0,05). Thus, we have shown the efficacy of pentoxifylline for the correction of
polycythemia in newborns with IUGR.
97
Campomelic Dysplasia in an Infant of Diabetic Mother: First Case Report
Ketaki Mukhopadhyay, Sutirtha Roy, Pradipprava Paria
West Bengal University of Health Sciences, India
Campomelic dysplasia is a rare, often lethal osteochondrodysplasia associated with skeletal malformations
and sex reversal. It occurs due to de novo mutations in SOX9 gene on chromosome 17. It is characterized by
bowed femora and tibiae, Pierre Robin sequence, hypoplastic scapulae, talipes equinovarus, hip dislocation,
male to female sex reversal and a high rate of neonatal mortality. A male newborn weighing 2700 grams was
born at 40 weeks of gestation to a mother suffering from gestational diabetes. Clinical and radiological
findings of Pierre Robin sequence, hypoplastic scapulae, congenital hip dislocation and bilateral bowed
femora confirmed this case as campomelic dysplasia. No sex reversal was present in this patient and he has
survived infancy. This is the first reported case of campomelic dysplasia in an infant of diabetic mother,
though it has previously been reported in acampomelic campomelic dysplasia(without bowing of limbs).
98
Can Repeated Attempts to Intubate Cause Gastric Perforation? – Case Report
Ramona Dumitru, Gopi Vemuri
Wythenshawe Hospital, UK
Gastric perforation in neonates is a rare surgical emergency and life-threatening condition with uncertain
etiology. Despite having high mortality rate, pathogenesis and etiology are greatly debated. Because of its
high mortality rate, it requires prompt recognition and urgent surgical intervention.
We report an interesting case of an incidental finding of gastric perforation in a premature neonate. A
preterm infant of 29 weeks (Twin1 of MCDA Twins) born via EMCS due to reversed EDF in twin brother.
Born in good condition, and need minimal intervention before admission to the neonatal unit. Chest X-ray
after admission shows a NGT in place and picture consistent of RDS. Initially started on CPAP, and as the
baby’s clinical condition worsened went on BiPAP and intubated at 22 hours of life. 4 attempts of intubation
by junior staff with 5th successful by Consultant. After starting ventilation, UAC/UVC were inserted and
position checked. Second X-ray indicated a good position for ETT, UVC and UAC as well as presence of air
under diaphragm (suggestive of perforation) confirmed by lateral decubitus X-ray.
Patient was tranferred and underwent surgical correction. During surgery, tiny perforation was noted on the
greater curvature of stomach which was repaired. Entire bowel normal. Enteral feeds started after 72 hours.
The particularity of this case is that its an incidental finding, probably within short time after occurance, with
tiny perforation which did not have time to cause the symproms described in the literature (abdominal
distension, feeding intolerance, respiratory distress, or poor activity). Therefore, we would like to emphasize,
as frequently seen in case reports from literature, that when repeated attempts of intubation are performed,
especially in premature babies gastric perforation seems to have a higher incidence. Secondly, as seen is this
case, a systematic review of an Xray is important as sometimes leads in „finding the unexpected”
99
Clavicle Fractures in Newborn – When Should we be Concerned? - Case Report
Ramona Dumitru, Muthu Yeshwanth
West Wales General Hospital, UK
Injury during birth is a recognised cause of neonatal morbidity and mortality. Fracture of the clavicle is
relatively common during a vaginal delivery and the incidence of fractured clavicle is between 0.4%-2.9% of
all newborns according to the latest studies Up to 40% of clavicle fractures remain undetected while the baby
is in hospital. Primary care health professionals will come across these undiagnosed clavicle fractures either
incidentally or following parental concerns for a lump over the clavicle or not moving the upper limb
properly. But when should we be concerned? When should a clavicle fracture should make us think also
about safeguarding?
We recently saw a case of a 4 days old newborn with a clavicle fracture which was detected during an
examination as referred for different condition. The baby was born via normal vaginal delivery, no history of
shoulder dystocia. Birth weight was 3.4kg. Baby had good movement of arms. Xray confirmed right-sided
clavicle facture. Baby had been discharged from hospital 48h prior and newborn examination was normal at
the time of discharge. Was it a missed clavicle fracture from birth or trauma occured while baby at home?
Should we be concerned or should we assume it was missed? In our case, the baby and the parents
underwent the safeguarding process, the police and social worker were involved but in the end it could not
be determined with certainty which was the cause of the fracture.
As the literature shows, the clavicle fractures are the most frequent both in the neonatal and in the childhood
period and most of the times the treatment is non-surgical. We strongly believe that if there is no obvious and
clear mechanism of occurrence, it is in the best interest of every child to be investigated in order to rule out
trauma.
100
Influence of Environment on Neonatal Renal Functions - Observational Study
basavaraj patil, sandeep harshangi, simy matthew
M R Medical college, India
Objective
To study the role of environmental factors in non asphyxial acute renal failure during summer months (April,
May 2013).
Methods
35 neonates out of 240, with fever, poor sucking and decreased urine output were admitted to the nursery
from April to May 2013 were evaluated for presence of ARF. ARF was defined as blood urea nitrogen
(BUN) 20mg/dl &/or creatinine level more than 1. 5mg/dl for at least 24-48 hours along with urine output
1ml/Kg/hr.
Results
35 out of 240 neonates (14.5%) had ARF; only 20% was oliguric. The mean gestation of neonates with ARF
was 38±2weeks (94%), males (71%). Factors including gestational age, weight, onset of sepsis, culture
positivity, associated meningitis, prior administration of nephrotoxic drugs, mode of delivery, establishment
of lactation, extramural or intramural were subjected to analysis for prediction of cause of ARF in neonates;
sepsis, atmospheric temp and poor feeding by LSCS mothers causing dehydration were found to be a major
predictor. ARF had recovered in 32 out of 35 neonates (91.4%); two babies succumbed to the disease, and 1
was referred to higher center.
Conclusion
General incidence of ARF in our study was high in the months of April and May (14.5%), 2013 when
compared to other studies (1-8%) and also when compared to 0 cases in the month of November and
December. This shows that seasonal variation like temperature and humidity has got an influence on ARF.
Non oliguric ARF was commoner than oliguric ARF. Aggressive management is needed for better outcome.
Dehydration and sepsis are a very important cause of non oliguric renal failure among neonates during
summer months which can be easily prevented by proper, adequate counselling of mothers by pediatricians.
101
Growth Velocity in Premature Babies Returning Home with Nasogastric Tubes in Situ Versus Those
Remaining in Hospital
Rhys Dore1, Frances O'Brien2
1
University of Oxford, UK
2
Oxford University Hospitals, UK
Background
The provision of feeds via nasogastric tubes is well established in neonatal units. The Home Tube Feeding
Programme teaches parents to manage these in order for premature babies to return home with the tubes in
situ. This hastens family bonding and reduces bed days per baby by about one week. Otherwise, maintaining
adequate growth velocity is a prime concern in premature babies to reduce the risk of adverse neurological
outcomes.
Objective
To review the growth velocity of babies on a home-feeding program during the period in which they would
otherwise be in hospital; and then to compare this to babies who could have returned home during this period
but
did
not
due
to
parental
choice.
Methods
Premature babies discharged from the neonatal unit in the past 26 months were included if home tube
feeding (n=115) or non-home tube feeding despite fulfilling criteria (n=81). Data were retrospectively
collected from a national neonatal database and patient records. Growth velocity was calculated for the week
post-discharge in those on the program, and the week pre-discharge for those not. Scores were compared
using
appropriate
statistical
analyses
with
Microsoft
Excel
and
SPSS.
Results
Growth velocity (g/kg/day) was higher in babies on home tube feeding than those not on the programme
(15.6±12.3 vs 10.4±6.2, p0.003). Baseline characteristics of gestation at birth, weight at birth and feeding
method (breast/formula/mixed) did not vary between the two groups (p=0.242, p=0.08, p=0.409
respectively).
Limitations
Only 62 of 115 notes from babies on home tube feeding could be retrieved. Also, multiple growth velocity
outliers
were
present
but
excluding
these
did
not
remove
significance.
Conclusion
Parents can be reassured that premature babies returning home early with nasogastric feeding tubes have a
slightly, yet significantly, higher growth velocity than their counterparts remaining in hospital.
102
Mouth Breath Problem in Childhood
Ekaterina Mirzabekyan1, Galina Tarasova2, Ekaterina Mirzabekyan4, Gunaj Ramazanova3
1
Federal Scientific Clinical Center of Otorhinolaryngology., Russia
Mouth breathing problem in childhood is still persist. Dentoalveolar anomalies (found in 42.7% of children)
together with nasal cavity and nasopharynx inflammatory diseases occupied the leading position among the
factors that determine it. The elimination of these reasons makes it possible to correct breathing type
formation that leads to harmonious facial profile development.
The purpose of our study was to develop the tactics of mouth breathing patients management.
Design
We examined 39 children aged 4 to 9 years with the presence of mouth breathing.
The examination included medical history, otorhinolaryngological and orthodontic examination, nasal cavity
and nasopharynx endoscopic examination, rhinomanometry and acoustic impedance measurement.
Results
Nasal breath possibility was completely preserved 25.6% of patients despite different malocclusion types
presence, which were often combined with a gothic palate.
28.2% of children had nasal cavity and nasopharynx diseases (including allergic) chronic inflammation in
combination with these anatomical regions architecture violation.
46.2% of the children have different types of occlusion disorders in combination with inflammatory changes
in nasal cavity and nasopharynx.
Patient management tactics included miogymnastics, respiratory gymnastics, nasal irrigation. In
malocclusion case - preortodontical trainers wearing. Monitoring of patients lasted from 3 to 12 months.
None of the children has not been assigned to surgery.
Upon completion of the study, mouth breath transition to the nasal type of breathing took place in 32
(82.1%) patients, in 6 children had a mixed type of breathing, and only one child remained mouth type of
breathing.
Conclusion
Orthodontist consultation should be included to child examination complex in case of mouth breath
presence. Joint ENT and orthodontic management with preortodontic trainers and conservative methods of
treatment use helps to restore nasal breathing without surgery.
103
Status Quo in Pediatric and Neonatal Simulation in the European German- Speaking Countries: The
DACHI Survey
Michael Wagner, Michael Wagner1, Ellen Heimberg2, Lukas P Mileder3, Alex Staffler4,
Angelika Berger1, Ruth M Löllgen5
1
Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Austria
2
Department for Pediatric Cardiology, Pulmonology, Intensive Care Medicine, Germany
3
Division of Neonatology, Austria
4
Division of Neonatology, Italy
5
Pediatric Emergency Department, Switzerland
Background
Simulation has acquired wide acceptance as an important component of education in health care. While the
simulated practice of important competencies in critical situations has been well established in most AngloSaxon countries, simulation training is still not established in many European countries.
The authors of this article and founding members of the Netzwerk Kindersimulation aimed to survey all
pediatric and neonatal health care institutions in Germany (D), Austria (A), Switzerland (CH) and South
Tyrol (I) (DACHI) on their current status of pediatric and neonatal simulation-based training (SBT). We
composed a online survey including 26 questions on the organization of SBT. The questionnaire was
validated according to established models including a pre-test and distributed electronically by the online
tool SurveyMonkey®.
Results
After dispatching a total of 474 surveys (n=359 in D, n=42 in A, n=66 in CH and n=7 in I) we achieved a
45.5% response rate, with 143 responders from D (39.8% in D), 36 from A (85.7% in A), 31 from CH
(46.9% in CH) and six from I (85.7% in I). In 62.5% of all surveyed institutions, SBT is already performed,
including standardized algorithm courses (87.2%), skill training (63.3%), and high fidelity simulation
training (58.1%). Only 16% of all inquired institutions actively conduct research in the area of simulation,
whereas 71% did express an interest. The most frequently stated impediments for establishing SBT were lack
of personnel (56.6%) and financial resources (61.8%).
Discussion and Conclusion
The results underline the presence of a previously unknown, strong interest in pediatric and neonatal
simulation in the DACHI region. Our findings provide an initial position for the advocacy and expansion of
simulation in pediatrics. This questionnaire will support a more effective collaboration among all simulation
enthusiasts in this region aiming to ultimately increase safety for children and neonates.
104
The Factor Associated to Oral Feeding Competency in Preterm infant
Putri Maharani Tristanita Marsubrin, Rinawati Rohsiswatmo, Oryza Sativa
Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
Background
Preterm infants experience oral feeding difficulties due to underdeveloped oral motor skills and lack of
coordination between sucking, swallowing, and respiration. Ability to oral feeding is one of maturity feeding
skill that had to be reached. Therefore, difficulty to achieve oral feeding leads to longer hospital stay and
higher
cost.
Aim
To
describe
Method
the
onset
of
oral
feeding
ability
and
its`
associated
factors.
A retrospective study was performed between October-December 2015 in Neonatology Unit, Department of
Pediatrics, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine,Universitas Indonesia, Jakarta,
Indonesia. The inclusion criteria was infants whom gestational age (GA) between 28-34 weeks. Subjects
were divided into 28-31 weeks GA (group A) and 32-34 weeks GA (group B). Those with congenital
anomaly were excluded.
Results
Thirty three subjects were included, mean GA was 31.3+1.9 weeks and mean birth weight (BW) was
1485+290.3 grams. The median onset to achieve full feed was 14(5-42) days in group A and 11.6(0-40) in
group B. While, mean onset to achieve oral feed was 35+9.8 days in group A and median was 25(1-65 days)
in group B. Mean hospital stay was 36.8+19.7 days in group A and 29.9+15.8 days in group B. There were
no correlation between enteral feeding(p=0.302), also patent ductus arrteriosus (PDA) (p=0.317) with onset
to achieve oral feeding. Correlation was found between sepsis (p=0.042), intraventricular hemorrhage (IVH)
(p=0,02), duration of oxygen therapy (p=0.001) with onset to achieve oral feeding. Onset to achieve oral
feeding was correlation with shortened hospital stay (p=0.000).
Conclusions
There are several concerning factors associated with the onset to achieve oral feeding, such as sepsis, IVH,
and duration of oxygen therapy.
105
Early Enteral Feeding and Incidence of Necrotizing Enterocolitis in Preterm Infant
putri maharani tristanita marsubrin, Rinawati Rohsiswatmo, Oryza Sativa
Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
Background
Early enteral feeding is still a challenge in management of premature infants, especially in very low birth
weight infants associated with small gestational of age. Necrotizing enterocolitis phobia (NEC phobia) often
hence neonatologists to advance the feeding to preterm infants.
Aim
To describe the incidence of NEC in early feeding and its correlation.
Method
A retrospective study was performed between October-December 2015 in Neonatology Unit, Department of
Pediatrics, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta,
Indonesia. The inclusion criteria was infants whom gestational age (GA) between 28-34 weeks. Subjects
were divided into 28-31 weeks and 32-34 weeks. Those with congenital anomaly were excluded. Early
enteral feeding was defined as giving enteral feeding within 24 hours, while after 24 hours was defined as
delay
enteral
feeding.
Results
33 subjects were included, the mean GA was 31.3+1.9 weeks and the mean birth weight (BW) was
1485+290.3 grams. Median onset of enteral feeding was 47(15-192) hours in 28-31 weeks GA group and
24(2-264) hours in 32-34 weeks GA group. Early enteral feeding was performed in 45.5% subjects. Fifty
percents subjects had delay enteral feeding due to gastric juice`s color changes. No incidence of NEC was
found in both groups. There was no correlation between giving early enteral feeding with sepsis (P=0.613),
but giving early feeding associated with shorter hospital stay (P=0.017) and onset to achieve full feed
(p=0.02).
Conclusion
No incidence of NEC is found in preterm infants receiving early enteral feeding. There is no correlation
between early enteral feeding with NEC.
106
Use of Passive Hypothermia Before the Installation of Selective Head Cooling Treatment in Moderate
to Severe Hypoxic-Ischemic Encephalopathy
Pablo Tietzsch, Alejandro Moguel, Saul Garza, Leonel Martinez, Jose Luis Ramirez, Jose
Iglesias, Isabel Bernardez
Hospital Español, Mexico
Hypoxic-ischemic encephalopathy is a source of high morbidity and mortality. Therapeutic hypothermia is
known to be a treatment approved for hypoxic-ischemic encephalopathy in late preterm and term infants,
hypothermia reduces brain energy utilization, decreasing free radical production and release of excitatory
neurotransmitters, these combined reduce neuronal apoptosis. This treatment significantly reduces
neurologic injury outcome. It has to be installed in the first 6 hours after birth. Our criteria for hypothermia,
includes neonates from 36 weeks gestation, weight higher than 1800 grams, ph 7.00 or lower within 60
minutes of birth and a base deficit 16 or higher, ventilation support for more than 10 minutes after birth,
APGAR score lower than 5 at 5 minutes, clinical data for moderate to severe encephalopathy, seizures,
lethargy, coma, hypotonia, abnormal reflexes, and abnormal suck.
This Study includes 2 cases in a private hospital in Mexico City, both with criteria for hypothermia therapy
and clinical data of either moderate or severe encephalopathy. We implemented passive hypothermia for 2 to
4 hours while waiting for the selective head cooling device to arrive, we started the decrease of core
temperature (34-35ºC) with cold blanquettes and shutting off the radiant warmer. We followed the protocol
for 72 hours of hypothermia with gradual warming, after getting to a normal temperature, the follow up in
both cases was with imaging, electroencephalographic studies, rehabilitation therapy and subsequent
evaluation till the age of 2 months with improvement in the prognosis in both cases.
In conclusion we observe that starting with a passive hypothermia has no adverse effects nor is
contraindicated in the use of hypothermia as treatment for moderate to severe encephalopathy in hospitals
that do count with the hypothermia device, in both cases we had an adequate evolution of our patients
proving it reduces cerebral injury and improves neurological outcome.
107
The Research About Genetic Mechanism of a Case of Mosaic of Trisomy 8 that has No Clinical
Symptoms
Peiqiong Li1, Fang Wang1, Jun Zhang2
1
Guangzhou Medical University, China
2
The Third Affiliated Hospital of Sun Yat-sen University
In our study, we found a rare case of abnormal chromosome number, the patient with a history of abortion
who has no obvious clinical symptoms. However, the peripheral blood karyotype of this case is 47, XX, +8.
So we carry out some research to find the cytogenetic and molecular genetic mechanisms of this rare case.
Objective
To explore the reasons of the patients with pure trisomy 8 in peripheral blood who has no obvious clinical
symptoms and source with these chromosome 8 ,as well as exploring whether there is randomly inactivated
by methylation regulation in these three chromosome 8 that make the patient normal.
Methods and results
The patient’s peripheral blood karyotype is 47，XX，+8; 2、The total DNA genotype for peripheral blood of
patients with is 47，XX，+8. What’s more, all these three chromosome 8 is different; 3、The total DNA
SNP amplification sequencing from the patient`s hair follicles, oral mucosa results showed that the two
organizations karyotype are 46, XX / 47, XX, +8; 4、The bisulfite sequencing results showed that the gene
EXT1 and GATA4 promoter CpG island from peripheral blood of patients was unmethylated.
Conclusions
1. Patient’s peripheral blood nucleated cells karyotype is 47, XX, +8, and the extra chromosome is due to the
first meiotic division separation; 2. Patient’s hair follicles and oral mucosa are mosaic of trisomy 8; 3. The
peripheral blood of patients with homozygous trisomy 8 who has no obvious clinical symptoms is not a
result of the the methylation regulation mechanism that make the additional chromosome 8 inactivation.
Key word: trisomy 8；mosaicism；genetic ；mechanism ； methylation
108
Therapeutic Hypothermia: Effect on Respiratory Condition in Neonates
Itamar Nitzan1, Shmuel Goldberg2, Cathy Hamerman1, Francis Mimouni1, Ruben Bromiker1
1
2
Background
Moderate Therapeutic Hypothermia (MTH) is used for neuroprotection in neonates with neonatal
encephalopathy. Hypothermia decreases metabolic requirements, cardiac output and respiratory rate, and
shifts the hemoglobin-oxygen dissociation curve leftward, towards higher affinity.
Methods
A retrospective study including all neonates treated with MTH (33.5° C) in the Neonatal Intensive Care Unit
(NICU) of the Shaare Zedek Medical Center (SZMC) Jerusalem, Israel, from January 2008 until September
2015. We collected data from NICU records on neonates respiratory and medical condition including:
Fraction of Inspired Oxygen (FIO2), arterial blood saturation as measured by pulse oximeter (SpO2) and
arterial blood saturation as measured by co oximeter (SaO2), from birth until 24 hours after rewarming.
Results
Thirty neonates’ records were evaluated. 12 neonates suffered respiratory deterioration (needed higher FIO 2
or respiratory support or had new onset desaturations with no change in the level of ventilatory assistance)
during the 24 hours after rewarming versus 3 with respiratory deterioration in the 24 hours before rewarming
(p=0.016). Despite higher FIO2 after rewarming, SpO2 declined from 96.9% (+2.9) before rewarming to
95.2% (+ 2.6) after rewarming (p0.001).
Discussion
Our study shows that neonates who underwent MTH require higher FiO2 and their SpO2 decrease after
rewarming. Possible explanations for these findings include: shifting of the hemoglobin-oxygen dissociation
curve towards higher affinity, and lower metabolic requirements and oxygen consumption during MTH. The
fact that more than third of the neonates clinically deteriorated after rewarming supports the second
explanation.
Conclusions
During MTH neonates have higher SpO2 and they require less oxygen. After rewarming the clinician should
expect, and monitor for possible respiratory deterioration.
These results raise the possibility of using MTH as an option for rescue treatment for respiratory
insufficiency unresponsive to conventional treatment. Further studies are needed to assess these conclusions.
109
Pulmonary Hemorrhage (PH) in Extremely Low Birth Weight (ELBW) Infants: Risk Factors and
Outcome.
VICTOR SAMUEL RAJADURAI, Sook Lin Loo, Jia Hui Lee, Pratibha Agarwal
KK Women's and Children's Hospital, Singapore, Singapore
Objective
To determine the incidence, risk factors and outcomes of ELBW infants who developed pulmonary
haemorrhage.
Study Design & Methods
Retrospective cohort study over a 5 years period (Jan 2011 – Dec 2015 ) of ELBW infants born in a tertiary
perinatal center.
PH was defined as the presence of frank red blood per endotracheal tube and associated with a need for
increased respiratory support. Clinical characteristics, morbidities and mortalities were compared between
infants with and without PH.
Results
Out of the 386 ELBW infants, 35(9%) had PH. Gestational age ≤ 25 weeks 26(74%) vs 143(41%) p0.0001
and birth weight ≤800g 28(80%) vs 192(54.7%) p0.005 were significantly higher in infants with PH.
Incidence of Respiratory distress syndrome (RDS) 28(80%) vs 162(46%) p 0.001, need for high frequency
oscillatory ventilation (HFOV) 31(89%) vs 117(33%) p 0.001, hypotension 22(63%) vs 90(26%) p 0.0001
and significant PDA 20(77%) vs 157(56%) p = 0.038 were also significantly higher in the PH group.
Antenatal steroid use, Apgar score ≤ 5 and incidence of SGA were not significantly different between the
groups. PH was associated with higher incidence of severe intraventricular hemorrhage (IVH) ≥ grade III
13(37%) vs 26(7.5%) and greater mortality 20(57%) 49(14.4%) p0.0001.
Conclusions
In extremely preterm infants the risk factors for developing PH were gestational age ≤ 25 weeks, birth
weight ≤ 800g and significant PDA. PH was associated with severe IVH and greater mortality.
110
Association of Extracellular Superoxide Dismutase with Respiratory Distress Syndrome and the
Development of Bronchopulmonary Dysplasia.
Przemyslaw Kicinski1, Krystyna Wyka2, Beata Malachowska2, Ewa Gulczynska1
1
Polish Mother’s Memorial Hospital - Research Institute, Poland
2
Medical University of Lodz, Poland
Aim
Assessment of the correlation between the serum extracellular superoxide dismutase (SOD3) concentration
and respiratory distress syndrome (RDS) and the development of bronchopulmonary dysplasia (BPD) in
infants born before 32 weeks of gestation with a birth weight ≤1500g.
The study involved 103 neonates born at the Polish Mother’s Memorial Hospital-Research Institute in the
years 2013-2014. Serum SOD3 level was determined in all infants on day 1 and 7 of life.
Results
Median gestational age was 28.9 weeks (IQR 27.4-30.1), whereas median birth weight 1100g (IQR 9501300). RDS was diagnosed in 100 infants: grade I in 23%, II in 61%, III in 15% and IV in 1%. No
association was found between the RDS grade of severity and SOD3 concentration on day 1 of life, R=0.18,
p=0.0675. Surfactant was administered in 71.8% of infants, to 16.2% of them it was administered twice. No
correlation was observed between the number of administered surfactant doses and the difference in SOD3
concentrations between day 7 and 1 of life, R= -0.06, p=0.5435. Neither was there noted the correlation
between RDS grade and the difference in SOD3 concentrations between day 7 and 1 of life, R= -0.13,
p=0.1882. On day 28 of life BPD was diagnosed in 49,5% of infants and it was not diagnosed in 50.5% of
them. No statistically significant correlation was detected between serum SOD3 concentration on day 1 and
7 of life and the development of BPD, respectively: p=0.3625 and p=0.4597.
Conclusions
The study did not demonstrate the association between the serum SOD3 concentration and the severity of
RDS and the risk for developing BPD. Neither was there a correlation between SOD3 concentration and the
number of administered surfactant doses.
111
The Role of Glutathione Peroxidase-1 and Selected Risk Factors in Necrotizing Enterocolitis in Very
Low Birth Weight Infants.
Przemyslaw Kicinski1, Krystyna Wyka2, Beata Malachowska2, Ewa Gulczynska1
1
Polish Mother’s Memorial Hospital - Research Institute, Poland
2
Medical University of Lodz, Poland
Aim
To assess the correlation between: the concentration of glutathione peroxidase-1 (GPx1) and selected risk
factors and the development of NEC in infants born before 32 weeks of gestation with a birth weight
≤1500g.
The study comprised 106 neonates born at the Polish Mother’s Memorial Hospital-Research Institute in the
years 2013-2014. NEC was diagnosed in 7 infants, the mean age at diagnosis was 20.4±10.4 day of life.
Serum GPx1 level was determined in all infants qualified for the study on day 1 and 7 of life.
Results
Median gestational age was 27.3 weeks (IQR 26.7-28.0) in the NEC group, whereas 29.0 weeks (IQR 27.430.1) in the group without NEC, p=0.0697. A statistically significant difference was found for the birth
weight between the investigated groups: 820g (IQR 700-1050) vs. 1140g (IQR 950-1300), p=0.0089. Among
the analyzed factors, a statistically significant difference between the analyzed groups was found for:
congenital infection 85.7 % vs. 36.7%, p=0.0149 and Apgar score at 1` 5.0 (IQR 5.0-6.0) vs. 6.0 (IQR 6.07.0), p=0.0055, Apgar score at 5` 6.0 (IQR 5.0-6.0) vs. 7.0 (IQR 6.0-7.0), p=0.0121, the severity of
respiratory distress syndrome (RDS) 2.0 (IQR 2.0-3.0) vs. 2.0 (IQR 1.0-2.0), p=0.0361. No statistically
significant correlation was found between serum GPx1 level on day 1 of life in the investigated groups
19.48ng/ml (IQR 15.76-49.67) vs. 16.52ng/ml (IQR 10.38-25.88), p=0.1435. However, on day 7 of life the
GPX1 level was statistically higher in the group with NEC as compared to that in the group without NEC,
respectively 28.27ng/ml (15.54-52.36) vs. 15.46ng/ml (IQR 10.38-22.08), p=0.0381.
Results
The study demonstrated statistically significantly higher GPx1 level on day 7 of life in the group with NEC.
Among the analyzed factors a statistically significant difference was observed for: the birth weight,
congenital infection, Apgar score at 1 `and 5` and the severity of respiratory distress syndrome.
112
Lower Gastointestinal Bleeding in Infants- Case Presentation
Tanasescu Sonia1, Ioana Ciuca1, Cristina Dragomir2, Simona Muntean2, Ioana Pacurar2,
Dorin Tanasescu3, Liviu Pop1
1
University of Medicine and Pharmacy Victor Babes Timisoara, Romania
2
3
Gastrointestinal hemorrhage is an emergency in pediatric pathology which may involve any part of the
gastrointestinal tract. The causes of digestive hemorrhage in infants vary from congenital or acquired
bleeding disorders due to allergies. Treatment in lower digestive hemorrhage should be gradually: evaluating
the bleeding, haemodynamic status of the infant, and a list of possible diseases.
The authors present two cases of lower digestive hemorrhage in infants aged between 1 and 5 months.
Case 1. Infant of 1 month old fed artificially coming from mother with a history of aspirin consumption in
late pregnancy is as normal stool consistency but mixed with fresh blood. Usual investigations revealed a
slightly increased APTT, the rest of the investigations including scintigraphy were normal.
Case 2. A five months old infant, artificially fed, with gastroesophageal reflux was hospitalized for vomiting
fresh blood (2 vomiting episodes) followed by a period of 2 weeks of streaked stool with blood. Paraclinic
investigations did not revealed anything pathological.
In the first case, the evolution was favorable after treatment with Ranitidine and Vitamin K injection, while
Case 2 was evolving slowly favorable with the extinction of lower gastrointestinal bleeding by replacing
food with highly hydrolyzed milk , representing a sample therapeutics for cow`s milk protein nonmediate Ig
E allergy.
Keywords: digestive hemorrhage, hemorrhagic disease, allergy to cow`s milk protein.
113
Cortisol, DHEA and DHEAS concentrations in claws collected by newborn dogs during the first 60
days of age: preliminary results
Maria Cristina Veronesi1, Barbara Bolis1, Marta Montillo2, Antonella Comin2
1
Università degli Studi di Milano, Italy
2
University of Udine, Italy
Despite the extremely high perinatal losses in dogs, canine perinatology remains mostly unknown because of
the difficult blood samples serial collection in newborns, and also because of ethical limitation. Coat and
claws can be collected without invasiveness and are suitable for long term retrospective measurement of
hormones accumulation, in dogs. Among several parameters, cortisol (C), dihydroepiandrosterone (DHEA)
and dihydroepiandrosterone sulphate (DHEAS) are crucial for the fetal to neonatal transition and for
neonatal adaptation. This study was aimed to preliminary investigate the cortisol, DHEA and DHEAS
concentrations in claws, collected without invasiveness in 7 newborn dogs at birth, and at 30 and 60 days of
age. Puppies, from a single litter, were born by elective Caesaeran section at term of a normal pregnancy. At
birth puppies were mature, viable, healthy and normal weighed; they remained healthy and with normal
development during the following 60 days. The claws of the four legs were trimmed at birth, and trimmed
again, collecting only the claws regrowth, after 30 and 60 days. For each sampling time, individual pool of
claws were stored until analysis by RIA. Cortisol decreased from 55.1±24.74 pg/mg at birth to 22.2±7.87
(p0.01) at 30 days, and to 9.1±3.36 at 60 days (p0.0001); DHEA decreased from 452±212.30 pg/mg at birth
to 195±252.04 at 30 days, and to 43±9.13 at 60 days (p0.01), while DHEAS decreased from 208±95.35
pg/mg at birth to 135±79.44 at 30 days, and to 45±13.98 at 60 days (p0.01). These results showed that the
highest accumulation occur during the second half of gestation, during the fetal development, but the still
high C, DHEA and DHEAS levels at 30 days, seems to suggest also a role of these hormones in the period of
long neonatal adaptation in the altricial-inept progeny typical of dogs.
114
Breastfeeding Children in the First Year of Life the Municipality of Niksic
Sanja Cizmovic1, S. Grubac1, B. Vucic2
1
General Hospital Niksic, Montenegro
2
Primary health care Niksic, Montenegro
Introduction
Breast milk is irreplaceable and invaluable nutrition in the first six months of life and after, when babies start
eating solids. Many scientific studies point to a lifelong benefits of breastfeeding past infancy. Breastfeeding
is the most beautiful and the strongest bond between a mother and a child.
Objective
To analyse breastfeeding rates in the first year of life in various stages of infancy period.
Materials and Methods
Randomly selected sample of 265 infants born from 2010 to 2012, with the total number of 2637 deliveries.
With all the examinees we analysed the length of exclusive breastfeeding as well as combining the breast
milk with formula.
Results
The rate of exclusively breastfed children in the first month of life was 69.8% or 185 children. In the third
month it was 47.9%, or 127 children. The number of exclusively breastfed children in the first six months
was 103, or 38.8%, and in the ninth month 88 children, or 33.2% was still breastfeeding along with the
intake of solids. By the end of the first year, the number of breastfed children was 69, or
26.03%.Breastfeeding and supplementing with formula was most common in the third month and was up to
28.19% and later decreased.
Conclusion
Exclusive breastfeeding rate was highest in the first month then it gradually decreased until the end of the
first year. It is of great importance to continue the work on the promotion of exclusive breastfeeding and
increase the breastfeeding rates.
115
Platelet Serotonin Level in Newborns with Intrauterine Growth Restriction
Nataliia Zvereva1, Yuliya Milyutina2
D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Russia
2
D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Russia
1
Serotonin plays an important role in the newbornsbrain morfo-functional development.
Platelets are the blood serotonin tank; there have the identical features to serotonin brain neurons (Oreland
L., Lesch K.P.).
We have studied the platelets serotonin level in newborns with intrauterine growth restriction (IUGR)
20 newborns with IUGR have been examined on the first day of life. The IUGR cause was the placental
insufficiency. The newborns gestational age was 37-40 weeks. Body weight - 2412,5±71,83 g, height
47,26±0,57 cm. The Apgar score was 7-8 points. The tone and reflexes were estimated with the C. AmielTison and S.A. Dargassies tables.
30 healthy term infants comprised the control group. Their gestational age was 38-40 weeks. Body weight 3542,6±75,09 g, height - 51,49±0,32 cm. The Apgar score was 7-9 points.
To detect the platelets serotonin level we have used the high-performance liquid chromatography with
electrochemical detection (with the column Reprosil 80 ODS-2, Germany and analytical cell - model 5100A
Coulochem II, ESA, USA).
The platelets serotonin level in IUGR newborns was 0,414±0,089 nmol / 10⁹ Tr against 1,017±0,158 nmol /
10⁹ Tr in the control group (Р 0,01).
It can be a consequence of the chronic intrauterine hypoxia and can define the central nervous system
development delay, that is shown in a tonic and reflex reactions formation delay and the cyclic organization
of a dream formation disturbance.
116
Umbilical Cord Mesenchymal Stromal Cells
Haruo Shintaku1, Haruo Shintaku1, Makoto Nabetani2, Takashi Hamazaki1, Satoshi
Kusuda3, Shinichi Watabe5, Masanori Tamura4, Masahiro Hayakawa6, Yoshiaki Sato6,
Masahiro Tuji7, Akihiko Taguchi8, Hiroyuki Ichiba9, Akira Oka10, Rintaro Mori11, Atsuko
Taki12, Takeo Mukai13, Tokiko Nagamura-Inoue13
1
Osaka City University Graduate School of Medicine, Japan
2
Yodogawa Christian Hospital, Japan
3
Tokyo Women’s Medical University, Japan
4
Saitama Medical University, Japan
5
Kurashiki Central Hospital, Japan
6
Nagoya University Hospital, Japan
7
National Cerebral and Cardiovascular Center, Japan
8
Institute of Biomedical Research and Innovation, Japan
9
Osaka City General Hospital, Japan
10
The Tokyo University, Japan
11
National Center for Child Health and Development, Japan
12
Tokyo Medical and Dental University, Japan
13
Institute of Medical Science, University of Tokyo, Japan
Objective
We also have started a basic to preclinical research of UC mesenchymal stromal cells (UC-MSCs) therapy
for patients who are not eligible for UC blood therapy.
Methods
collection. UCBSCs was collected aseptically and prepared by using SEPAX. UC-MSCs were aseptically
collected and isolated from UC and isolated from the Wharton Jelly and cryopreserved after culture. Infants
admitted to the NICU of 6 hospitals in our research group will be eligible if they are ≥36 weeks’ gestational
age and birth weight ≥1800 g with HIE and meet the cooling criteria.
Results
UCBSCs therapy for neonatal HIE in addition to TH was performed in 3 newborn patients. All of them have
survived from 3 months to 1 year. UC-MSCs demonstrated to have neurogenic differentiation in vitro with
persistent migration ability and significant anti-inflammation ability.
Conclusions
Good results in combination therapy of UCBSCs and TH for newborn HIE were obtained in our 3 patients.
UC-MSCs therapy may give the possibility of treatment to patients who could not take UC blood.
117
Prenatally diagnosed central nervous system (CNS) malformations: Fetal, neonatal and
neurodevelopmental outcome at 5 years of age
Odattil Geetha1, Yeo Seow Heong2, Victor Samuel Rajadurai1, Bhavani Sriram1
1
KK Women's and Children's Hospita, Singapore
2
KK Women's and Children's Hospital, Singapore
OBJECTIVE:
Objectives are

To study the fetal and neonatal outcomes of prenatally diagnosed CNS malformations.

To evaluate the neurodevelopmental outcome of the survivors at 5 years of age.
Methods
Maternal and neonatal records of prenatally diagnosed CNS malformations were retrospectively reviewed
over a 5-year period (January 2005 till December 2009). The relevant fetal and neonatal data were collected
from the database maintained by birth defect registry. The long term neurodevelopment data was obtained
from case records.
Results
There were 116 structural CNS malformations of which 80(68%) had termination of pregnancy or foetal
deaths. Anencephaly accounted for 37(46%) of the terminations. Out of the remaining 43(54%) cases,
17(40%) were neural tube defects, 7(16%) holoprosencephaly, 4(9%) agenesis of corpus callosum, 6(14%)
cerebellar lesions, 5(12%) posterior fossa lesions and 4(9%)others.
Out of the 36 total live births, 6 had anencephaly and all of them died. In addition there were 5(16%) other
deaths. Five (16%) infants needed ventilatory support and 5(16%) had surgical intervention during the
neonatal period. The five year neurodevelopmental outcome revealed 11(37%) children with global
developmental delay and they had moderate or severely disability. Their disorders were Arnold Chiari
malformations (2), holoprosencephaly (2), schizencephaly (2), Dandy-walker malformations (2),
hydrocephalus (2) and periventricular calcifications due to undetermined aetiology(1). Only 7(23%) children
had normal development and 7(23%) defaulted follow up.
Conclusion:
More than two-thirds of prenatally diagnosed CNS malformations underwent termination of pregnancy or
foetal deaths. More than one-third of survivors who were followed up had global delay and need for support
services.
118
Lead and Cadmium Content in Newborns with Impaired Kidney Function Due to Asphyxia
Andrii Loboda
Sumy State University, Ukraine
Such metals as lead (Pb) and cadmium (Cd) are ubiquitous persistent environmental toxicants known to
bioaccumulation in the human body. The main source for raising the level of heavy metals in the tissues of
newborn is transfer through the placenta to the fetus during pregnancy.
The aim of the investigation is explore the features of the content of toxic microelements (Pb and Cd) in
serum and erythrocytes of newborns with kidney injury due to asphyxia.
Investigation included 200 full-term newborns with the signs of renal injury: 100 neonates suffered severe
asphyxia, and 100 babies suffered moderate asphyxia. A comparison group comprised 20 healthy infants.
Blood was collected on the 1–2, 7–8 and 25-30 days of life. The electrolyte’s content in blood serum and
erythrocytes was determined by atomic absorption spectrophotometry.
Increased serum Pb content was typical for all newborns with impaired renal function due to asphyxia during
the neonatal period. For newborns with kidney injury due to asphyxia was typical relative hypercadmiemia,
which is stored during early neonatal period in case of severe asphyxia.
Newborns with kidney damage due to moderate asphyxia demonstrated on 25% (p0,05) higher level of Pb in
erythrocytes on 1-2 day of life relative to healthy children. This level was stable during remaining part of the
survey. Maximal concentrations of Pb in erythrocytes during 1 month of life were typical for newborns with
kidney damage due to severe asphyxia. Both groups of neonates demonstrated statistically high Cd
concentration in erythrocytes during early neonatal period and decrease its content (p0,05) to the end of
neonatal period.
For newborns with impaired renal function were typical high levels of Pb and Cd in blood serum during
early neonatal period in case of moderate asphyxia or predominantly during whole 1 month of life in case of
severe form.
119
Risk Factors for White Matter Abnormality in Extremely Preterm Infants with Neonatal Sepsis
Ju Sun Heo1,2, Ee-Kyung Kim1, So-Yeon Shim3, Seung Han Shin1, Han-Suk Kim1, JungHwan Choi1
1
Seoul National University College of Medicine, South Korea
2
CHA Gangnam Medical Center, CHA University School of Medicine, South Korea
3
Ewha Womans University School of Medicine, South Korea
Background
White matter abnormality (WMA) is an important type of lesion that can cause long-term
neurodevelopmental impairment in premature newborns. Systemic infection is a major upstream mechanism
for WMA. However, few reports have described the risk factors for WMA in the context of neonatal sepsis.
Our aim was to evaluate the risk factors for moderate-to-severe WMA in extremely preterm infants with
sepsis.
Methods
Sixty-three extremely preterm infants (gestational age 28 weeks) with culture-proven sepsis who underwent
brain magnetic resonance imaging prior to discharge between 2006 and 2013 were classified as having noneto-mild or moderate-to-severe WMA based on their WMA scores. Various risk factors for developing
moderate-to-severe WMA were then evaluated using multivariate logistic regression analysis.
Results
Fifty-five preterm infants (87.3%) had none-to-mild WMA, and 8 infants (12.7%) had moderate-to-severe
WMA. Using backward selection logistic regression, postmenstrual age (PMA) at sepsis diagnosis emerged
as a factor that was independently associated with moderate-to-severe WMA, and even after adjusting for
other known WMA risk factors, this significance persisted (Odd ratio: 0.616, 95% CI: 0.383-0.990, P =
0.045). In particular, the incidence of PMA at sepsis diagnosis 28 weeks was significantly higher in infants
with moderate-to-severe WMA (87.5 vs. 45.5%, P = 0.026), and WMA scores were significantly higher in
infants diagnosed with sepsis at PMA 28 weeks compared with other infants (mean ± standard deviation, 7.3
± 2.54 vs. 6.2 ± 1.46, P = 0.042).
Conclusions
PMA at sepsis diagnosis is an important risk factor for moderate-to-severe WMA in extremely preterm
infants with postnatal sepsis. Infants who suffer from sepsis at PMA 28 weeks are at increased risk for
developing moderate-to-severe WMA. To reduce the incidence of moderate-to-severe WMA, further
neuroprotective therapies are needed in infants diagnosed with sepsis at an early PMA, particularly for PMA
28 weeks.
120
Congenital Idiopathic Neonatal Cholestasis in a Patient with Down Syndrome-- A Case Report
---Dr.Mathew Kripail, Dr.Mohammed Abdel Latif, Dr.Asad Ur Rehman
MATHEW KRIPAIL
Down syndrome is associated with many anomalies affecting multiple organs. Down syndrome in a rare
cause of neonatal cholestasis, mostly associated with myeloproliferative disorders ,neonatal
hemochromatosis and bile duct paucity. The liver disease in these cases are very severe and fatal. We report
a case of idiopathic neonatal cholestasis that resolved spontaneously. The patient was a baby girl born at 37
weeks gestation by normal vaginal delivery to a mother G3P2 , 39 years old. Antenatal scan showedechogenic foci both ventricles and polyhydramnios. The baby was born with apgars 9 and 10 at 1 and 5
mins. Birth weight 3.1 kg (50%ile ), L=48(50%ile ) and HC=32cm(10%ile ). The physical features
consistent with trisomy 21. The patient was admitted on day 1 of life in with jaundice of 240/mmol ( OB set
up DCT negative, retics 12%) received intensive phototherapy, then normalized on day 3. Conjugated
fraction increased from day 4 of life , peak by day 7 -14 days -160 mmols (9.4mg/dl) for which extensive
workup was done Initial Hematological investigations CBC Hb 16 gm% platelets 57000 coagulations profile
within normal limits Thyroid Functions were normal LFT- peak ALT 430 IU AST 310 IU GGT 68 U/L
Serological tests - TORCH screen,HSV ,Hepatitis serology , Enterovirus PCR, Adenovius PCR, EBV PCR
were negative. Tandem Mass Specrometry , Tyrosinemia type 1 screening assay ---Negative , Urine organic
acids were normal Bile Acid metabolItes n ,GALACTOSE 1 PHOSPHTIDYL URIDYL TRANSFERASE
ACTIVITY - NORMAL ALPHA Fetoprotein- 67032ng/ml N ALPHA 1 ANTITRYPSIN - 1.50 g/l N Iron
Profile- done 3rd week- transferrin 1.95 gl. Iron 44 Serum FERRITIN –levels ranged from-1561- 4545
NORMAL BILIARY FUNCTION LIVER BIOPSY - evidence of acute cholestasis hepatitis and early iron
overload IN VIEW OF HIGH FERRITIN BIOPSY OF SALIVARY GLAND DONE--normal histology. No
iron deposits. The baby was managed conservatively – received Ursodeoxycholic acid .fat soluble vitamins
,fed with Elementary Formula . By 8 weeks the cholestasis improved and was discharged , and is doing well
on follow up.
121
Respiratory Morbidity in Small-for-Gestational-age Preterm Newborns According to Umbilical
Artery Doppler Findings
Aleksandra Matic2, Dusanka Subotic1, Andjelka Ristivojevic1, Nina Smiljanic3
1
Gynecological-obstetrics clinic, Clinical Centre of Vojvodina, Serbia
2
Institute for Child and Youth Health Care of Vojvodina, Serbia
3
Community Health Centre of Novi Sad, Serbia
Introduction
Abnormal umbilical artery (UA) doppler is a strong indicator of placental insufficiency, with increased
morbidity and mortality in newborns. Aim of our study was to compare mortality and respiratory morbidity
in small-for-gestational-age (SGA) preterm newborns from single pregnancies with and without pathological
UA doppler findings.
Methods
Retrospective study was conducted in the tertiary-care university clinic during the period 2011 - 2013.
Among SGA ( 10 birth-weight (BW) percentiles) singleton preterm newborns (gestation age from 27 0/7 to
36 6/7) whose mothers conducted prenatal doppler, we have found 56 newborns with pathological UA
doppler and 57 with normal UA doppler. The data about morbidity and respiratory problems were compared
between the groups.
Results
Mean gestation was 33.19 ± 0.31 weeks in normal UA doppler group and 32.39 ± 0.34 weeks in pathological
UA doppler group; the difference was not significant (p=0.09). Percentage of newborns with BW percentiles
3 was significantly higher in pathological UA group (33.33%:53.57%, p=0.03, OR 2.31). In pathological UA
doppler group there were significantly more often requirements for respiratory support - CPAP and/or
mechanical ventilation (36.84%:57.14%, p=0.032, OR 2.28), endotracheal intubation (15.8%:33.9%,
p=0.029, OR 2.74) and surfactant therapy (15.78%:32.14%, p= 0.045, OR 2.52). We did not find significant
difference between the groups in occurrence of pneumothorax (3:1, p= 0.36), pulmonary haemorrhage (3:0,
p=0.12) and bronchopulmonal dysplasia (4:2, p= 0.43. These results should be interpreted cautiously because
of the low frequency of these diseases in our study sample. Mortality was 4 (7.14%) in pathological UA
doppler and 3 (5.26%) in normal UA doppler group, and that was not significantly different (p=0.68).
Conclusion
In our sample of SGA preterm newborns, pathological umbilical artery doppler represents a risk factor for
increased requirements for respiratory support, endotracheal intubation and surfactant therapy.
122
Impact of Different Genotypes of CMV Infection in Neonates and Infants
Aneta Kozakova1, Kristina Kaluzova1, Jana Dornakova1, Krystof Tabery1, Ales Briksi2, Jana
Sumova2, Petra Chramostova2, Veronika Novakova2, Kveta Blahova3, Miroslav Zajac2,
Milos Cerny1, Petr Hubacek2
1
Department of Neonatology, Gynaecology and Obstetrics, Czech Republic
2
Laboratory of Virology, Department of Medical Microbiology, Czech Republic
3
Department of Paediatrics, Czech Republic
CMV genotypes influence the impact of the CMV infection on the developing fetus and neonates. Only
limited number of studies combined analysis of the glykoprotein B (gB), glykoprotein H (gH) and UL144 in
neonates and infants. Aim of the study was to find out various genotypes and clinical impact in Department
of Neonatology in Czech Republic. 592 biological samples were tested for presence of CMV infection
between 2002-2014. 456 whole blood samples, 94 urine samples and 42 other biological samples (most
frequently cerebrospinal fluid samples) were tested. Detection was performed by quantitative polymerase
chain reaction (PCR) technique. Retrospective CMV genotyping of gB1-4, gH1 and gH2 was performed
according to the published studies by real-time PCR detection and UL144 by sequencing. Median of CMV
detected load in whole peripheral blood was 6.42 CMV normalized viral copies (NVCs) (range 2.24-376.65
NVCs) and median of 7.5x10e3/ml CMV copies/ml of urine (range 5x10e2-8.1x10e6). CMV infection was
proved in 317 samples. Congenital CMV infection was detected in 13 cases. Median of follow-up time in 11
cases with congenital CMV infection was 6.25 years. 2 cases with congenital CMV infection showed
sensoneural hearing loss. Total genotyping with both glycoprotein B and H was performed in 68 cases.
UL144 sequence was obtained in 44 cases. Only glycoprotein B or H was detected in 9 cases.
Our study is focusing on the role of different CMV genotypes on complexity of human CMV infection,
tissue tropism and various clinical consequences. The results should help in assessment of different risks and
necessity
of
virostatic
treatment
in
particular
patients.
Supported by the project for conceptual development of research organization 00064203, Grant of the
ministry of Health of the Czech Republic grant of Internal Grant Agency of Ministry of Health of Czech
Republic NT/13691-4.
123
Continuous Glucose Monitoring in Infants of Diabetic Mothers
Kryštof Tabery1, Jana Dorňáková1, Kristýna Kalužová1, Aneta Kozáková1, Miloš Černý1,
Kateřina Štechová2
1
Department of Neonatology, University hospital Motol, Charles University, 2nd faculty of
Medicine, Czech Republic
2
Department of Internal medicine, University hospital Motol, Charles University, 2nd
faculty of Medicine, Czech Republic
Newborn infants of diabetic mothers are at a greatest risk of a neonatal hypoglycemia. Current state of art
screening of a hypoglycemia proposed by the American Asociation of Pediatrics is focused on a 1st 24 hours
and if a baby is normoglycemic screening ends on a 2nd day of life. New literary data suggest, that
hypoglycemias can firstly appear or re-occur later in neonatal period than first 48 hours even when fully fed.
The continous glucose monitoring (CGM) gives opportunity to monitor the glycemia without a need of a
frequent invasive sampling for prolonged period and also a rapid evaluation of a treatment. CGM had been
already acknowledged as realiable and safe in neborns. However exact meaning of this new data is yet to be
determined. We would like to present our data from the group of 30 newborns of diabetic mothers. We
administred the continous glucose senzor within hours after birth and monitored newborns up to a 6th day of
life. Our findings support the hypothesis of late hypoglycemias. Two newborns even had to be admitted to
the NICU for the compensation of the hypoglycemia on a 4th day of life. These hypoglycemias could have
passed unnoticed unless becoming severe with clinical symptomps. CGM could be next step in treating the
hypoglyceamia in the infants of diabetic mothers as well as other newborns in risk.
Supported by a development project of the Ministry of health for the research institution no. 00064203
(University hospital Motol.)
124
Including Roma Mothers in Healthcare to Their Newborns in Neonatal Intensive Care Unit
Snezhana Janchevska
PHO University Clinics of Gynecology and Obstetrics, Macedonia
During the neonatal intensive treatment, often newborn children are separated from their mothers, thus
deprived of the necessary contacts with the mother, kangaroo care, breastfeeding or feeding expressed breast
milk. Parents are worried, without of participation in neonatal care and with a feel to unnecessary. Neonatal
intensive care unit treatment attempts and practiced their own model to solve or mitigate the problem of
separation of the couple mothers-newborn child.
Goal of the study
Incorporating Roma mothers in healthcare to their newborns in neonatal intensive care across the parent΄s
education to antenatal care, expressed milk, Kangaroo care and breastfeeding.
Collected cohort during the period of five months, contents 36 examineers or 18 couples of mothers and
newborn infants of the Roma ethnic group, from different macedonian areas, born in the University Clinics
of Gynecology and Obstetrics in Skopje. Newborns are premature, small for gestational age, asphictic or
sick, 27-39 gestational weeks, with birth weight 920-3250 grams. We practice our Guidelines for expressed
breast milk and Kangaroo care. Mothers include in the internal human milk bank to pump breast milk.
Couples mothers-newborns take in the Kangaroo care sessions, each one of two hours, while the baby is in
stable clinical condition with body weight more than 1100 grams.
Results
Most of mothers (84.6 %) come from Skopje. They are from 17-27 years old and with primary or partial
education (84%). All mothers have incompletely prenatal controls and missed antenatal education. But,
100% of mothers accept expressed milk technic, Kangaroo care and breastfeeding. After discharge, 77% of
mothers continue to breastfeed. Only 5/18 couples don`t accept proposal from socio-economic reasons.
Disputation
Roma mothers and famillies have a tradition to breastfeed and take care about newborn babies. We
contribute to the humanization of neonatal intensive care and to better bonding between mother and baby.
125
Newborn with Nonimmune Hydrops Fetalis (Case Report )
ljubinka dragas1, danojla dakic2, lidija banjac3, rada rudanovic4, envera lekic5
1
doctor, Montenegro
2
doctor, Montenegro
3
doctor
4
doctor, Montenegro
5
doctor, Montenegro
Background
Hydrops fetalis is defined as the abnormal accumulation of fluid in body cavities: pleural, pericardial and
peritoneal and soft tissues. The basic problem in hydrops fetalis is an imbalalance in fluid homeostasis, with
more fluid accumulation than can be resorbed. In previous years most cases of hydrops were caused by
severe erytroblastosis fetalis secondary to Rh isoimmunization. Most cases of hydrops fetalis are now caused
by other conditions and are known as nonimmune hydrops. Case report: We present a female newborn born
with diffuse edema and ascites. A neonate born at 34 weeks′ gestation had a history of fetal hydropic
changes noticed on ultrasonography at 33 weeks′ gestation but supraventricular tachycardia (SVT) not
detected? On 13th day of life, tachycardia was developed and the patient received a dose of intravenous
adenosine without resulting, after that it was given a loading dose of amiodaron, followed by continuous
amiodaron resulting in decrease in heart rate.
We believe that the SVT occurred in the fetus and that they led to hydrops but not registered. SVT is the
most common and clinically significant form of sustained fetal tachyarrhytmia in pregnancy; depending on
duration and high rate variability heart failure and nonimmune hydrops may develop which are associated
with a high incidence of perinatal mortality.
Conclusions
Hydrops fetalis is a potentionally letal condition.The care given to a newborn with hydrops fetalis is always a
challenge for neonatologist. Key words: newborn, hydrops fetalis, supraventricular tachycardia
126
Diversity of Disorders Causing Neonatal Cholestasis - The Experience from the Pediatric Clinic UCC
Sarajevo
Hajrija Maksic, Sabina Terzić, Elmedina Mrkulić, Melika Melunović, Edina Kovač
Pediatric Clinic University Clinical Center of Sarajevo, Bosnia and Herzegovina
Background and objective
Differential diagnosis of neonatal cholestasis is extensive. It requires a step-wise approach, and early
recognition in order to ensure timely treatment and optimal prognosis. The aim of this study is to inform on
the prevalence and mortality of the diverse disorders causing neonatal cholestasis.
Methods
Clinical chemistry and causes of disease were retrospectively analyzed in 36 infants with neonatal
cholestasis during the last five years at the Pediatric Clinic UCC Sarajevo. Neonatal cholestasis was defined
as neonatal prolonged jaundice with conjugated hyperbilirubinemia when serum conjugated bilirubin
concentration greater than 1mg/dL (17.1 micromol/L) if the total serum bilirubin is 5.0 mg/dL (85.5
micromol/L).
Results
Altogether, 12 disorders causing neonatal cholestasis were identified. Seven children (19,4%) had biliary
atresia, seven children (19,4%) had cholestasis caused by the CMV, followed by idiopathic cases (22,2%),
cholestasis in preterm infants with sepsis (11,1%), Alagille syndrome, hypoplasia of gallbladder, biliary
sludge (all 11,1%) and others. Infants with biliary atresia were diagnosed at a mean age of 72 days, they
underwent Kasai portoenterostomy 78 days after birth. Two children had syndromic biliary atresia, died
before operation and two children died after surgery. No liver transplantation was successfully performed.
Conclusion
Neonatal cholestasis is a severe disorder associated with a high risk of complications in infancy and it
therefore requires urgent investigation in order to initiate life-saving therapy.
Keywords: neonatal cholestasis, biliary atresia, Kasai procedure.
127
Pathological States of Early Neonatal Period in Children Born After ICSI Application
Tetiana Stoieva, Vitalii Synenko, Svetlana Prokhorova, Nadezhda Lotysh, Roman Papinko,
Tetiana Bondarenko
The Odessa National Medical University, Ukraine
The relevance of the study is determined by rapid increasing number of children born as a result of assisted
reproductive technology (ART). There more than 12000 children were born with ART in Ukraine.
Purpose of research
to estimate the signs of pathology in children born as a result of ART at the early neonatal period.
This work analyses examination of 44 neonatal children born as a result of Intracytoplasmic Sperm Injection.
All children were treated at the Municipal Children Hospital.
Results
The analysis had revealed gestational age ranged from 29 to 41 weeks. Premature birth was observed in
(86.4±9.7) %. The number of children with low birth weight was (63.6±10.8) %.
Pathological states of children considering gestational age were analyzed. The children with the gestational
age below 34 weeks had the average body mass (1729.2±130.2)g, body length (41.7±2.1)cm. Respiratory
disorders (91.3%), hypoxic-ischemic encephalopathy (86.9%), intrauterine pneumonia (56.5%),
intraventricular hemorrhage (56.5%), hyperbilirubinemia (39.1%), congenital heart malformation (28.1%)
were identified. Most children with gestational age below 34 weeks were admitted to the intensive care unit.
The children with gestation age over 34 weeks had the average body weight (2483.0±581.0) g, body length
(47.5±2.9) cm. Hypoxic-ischemic encephalopathy (80.9%), delay of intrauterine development (38.1%),
hyperbilirubinemia (38.1%), intrauterine pneumonia (28.6%), intraventricular hemorrhage (19.1%),
congenital heart malformation (19.1%), convulsive syndrome (4.8%) were revealed.
Conclusion
The children born as a result of ICSI application have high rate of pathological states in the early neonatal
period. The frequency of neonatal pathology varies depending on the gestational age of child, the most
quantity of premature babies had two or more functional systems affected, moderate and severe disorders of
the central nervous and respiratory systems were diagnosed more often.
128
Evaluation of Postnatal Morbidity and Mortality of Surviving Co-Twin Following single-twin Death
Aslihan Abbasoglu, Aslihan Abbasoglu, Nihal Uysal, Ayse Celik, Ulas Tugcu, Filiz Yanık,
Aylin Tarcan
Baskent university, Turkey
İntroduction
İntrauterıne death of one fetus in a twin pregnancy is uncommen in the second or third trimester. Here we
report thepostnatal morbidity and mortality of surviving co- twin following single twin death
Methods
Birth records and patient files were evaluated retrospectively between 2008 and 2014 in Baskent University
Ankara Hospital. Demographics, gestational weeks, intrauterine demise week and neonatal morbidities were
recorded.
Results
9 of 247 dichorionic diamniotic twin gestations died in 2nd or 3rd trimester. Maternal risk factors and
neonatal morbidity and mortality results are shown in table 1. %33.3 of the newborns were term and did not
need NICU. %66.7 of the pregnancies were ended with preterm delivery.%55.5 newborns were girls. %77.7
of the newborns were twin gestations after medically assisted reproduction.
Conclusions
Single fetal death in a twin pregnancy is known to be a serious complication of pregnancy. It is a relatively
rare complication of multiple pregnancies but may carry with it an increased risk of perinatal morbidity and
mortality. For the surviving twin chorionicity and the gestational week of the intrauterin demise are the most
important risk factors.In our cases all twins were dichorionic and the most important problems were the
preterm delivery and its comorbidities
129
Reopening of PDA in Rremature Infants with VLBW and ELBW, Receiving Respiratory Support
VAP and CPAP
Crivceanscaia Larisa
IMSP IMsC
Prematurity is a multifactorial problem. In RM annually are born 90%, these children have respiratory
distress syndrom, requiring surfactant administration with need for implementation VAP or nasal CPAP
respiratory support on varying durations of time. The introduction of these care methods for premature
infants, have shown efficacy in all clinical trials, but remains a problem related to hemodynamic disorders in
these children conditioned by this ductus arteriosus functional.
Materials and methods: The study includes 73 premature babies with VLBW and ELBW, divided into 2
groups: 42 (57,5%) received noninvasive respiratory support (CPAP) and 31 (42,5%) noninvasive
respiratory support (VAP). Data were edited using T-Student test.
The goal to compare the incidence of the reopening DPA at premature bebies with VLBW and ELBW, wich
received respiratory support CPAP and VAP.
Results: From this study we obtained reopening of the PDA to16,6% receiving CPAP and 19,4% -to those
wich receive VAP (p0,05).
130
The Contribution of Genetically Determined Folate Status Disturbance in Reproductive Disorder and
Neonatal Pathologies
Zoia Rossokha1, Valeriy Pokhylko2, Tetyana Znamenska3, Valeriy Poltoropavlov4, Natalia
Gorovenko5
1
State Institution "Reference-centre for molecular diagnostics of Public Health Ministry of
Ukraine", Kjev, Ukraine, Ukraine
2
Higher State Educational Establishment of Ukraine “Ukrainian Medical Stomatological
Academy”, Ukraine
3
State University «Institute of pediatrics, obstetrics and gynecology NAMS in Ukraine»,
Kyiv, Ukraine, Ukraine
4
Higher State Educational Establishment of Ukraine “Ukrainian Medical Stomatological
Academy”, Poltava, Ukraine, Ukraine
5
National Medical Academy of Postgraduate Education named after P.L. Shupik, Kyiv,
Ukraine
Introduction
Folate status support is necessary for reproductive function. A variety of abnormalities in folate status
contribute to diseases risk in reproductive age and affect the neonates pathologoies. Folate status depends
from many factors, but the most important is the MTHFR gene polymorphism. In the presence of
unfavorable MTHFR gene variants are more frequently observed changes in folate status. The aim of this
study is to evaluate genetic disturbance of folate status in women with reproductive disorders, neonates and
its possible correction.
550 patients (primary and secondary infertility, premature birth) and 75 neonates (45 with perinatal asphyxia
and 30 clinically healthy) included in the study. Investigation was approved by the Ethics Committee. The
past history, folic acid status, MTHFR (C677T, A1298C) gene polymorphism were investigated. Statistical
analysis was determined using binary logistic regression (SPSS 17.0).
Results
MTHFR gene polymorphism in women with reproductive disorders had frequencies corresponding to
population distribution. Changes in folate status were identified in women with 677TT and 677CT genotypes
despite taking folic acid. 10% of patients with 677CT and 677TT genotypes had hyperhomocysteinemia,
15% of patients with these genotypes had increased folate level in serum and red blood cell. These patients
also used only folic acid. Patients with 677CT and 677TT genotypes that consumpted a multivitamin with
folic acid supplements had no abnormalities in folate metabolism. In neonates with perinatal asphyxia was
significantly reduced folic acid levels and significantly increased homocysteine levels compared with
clinically health neonates in the first days of life. Neonates with perinatal asphyxia had more frequently
677CT genotype.
Conclusion
Folate metabolism control should be used in carriers of 677TT and 677CT genotypes for timely correction.
The multivitamin (with folic acid) consumption during pregnancy is necessary for their sufficient
accumulation in fetuses and newborns, that will reduce the complication risk.
131
Is There Place to Change The Vitamin K Prophylactic Regime?
Ilirjana Bakalli
Introduction
With vitamin K prophylaxis, late vitamin K deficiency bleeding disease (VKDB) incidence has been
significantly reduced, even though it still remains a concern in the 21st century because in approximately
50% of cases it is presented with intracranial hemorrhage (ICH), a potentially life-threatening disorder. In
different parts of the world, various methods of vitamin K prophylaxis are practiced. In our country is used
the intramuscular prophylaxis. Through the incidence of late VKDB in our country we would like to discuss
about vitamin K prophylaxis.
Methods
Retrospective study. Are included all children with ICH due to late VKDB admitted at our PICU during 5
years (2011-2015). Criteria for late VKDB are based on the International Consensus.
Results
During these years, we noted a significant increased incidence of primary late VKDB in Albania, even
though according to our Neonatology recommendation, the prophylaxis with vitamin K is given 1 mg i/m, in
the first hour of life. Incidence of ICH varies from 18cases/100000 live births to 25 cases /100000 live births
and was associated sometimes with delayed diagnosis and poor prognosis: mortality rate was significantly
high 28.6 % with neurologic sequel in 14 % of cases. In front of this high incidence a lot of questions arise:
It was prophylaxis done correct? With correct prophylaxis is possible such a high incidence of bleeding? Do
we really have an increased incidence or is a better diagnosis? Is there place to change the prophylactic
regime? How should prophylaxis with vitamin K be done?
Conclusion
Late VKDB is still an important problem in our country. In our opinion vitamin K prophylaxis prevents the
classical form of hemorrhagic disease but to a lesser extent prevents late VKDB. Maybe in small countries,
where parenteral prophylaxis it isn’t done correct, we may use oral prophylaxis.
132
The Accuracy of Pulse Oximetry in Detecting Critical Congenital Heart Diseae Asymptomatc
Newborn
April Lorraine Hipolito, Karl Michael Reyes
St. Luke's Medical Center, QC, Philippines
Introduction
Critical congenital heart disease (CCHD) is a term used to describe newborns who have asymptomatic but
life threatening congenital heart disease. If left untreated, majority will not live past the first few weeks of
life. Screening with pulse oximetry can potentially identify asymptomatic infants with CCHD prior to
discharge.
Methods
Pulse oximetry (pre and post ductal) was performed on well, term newborns prior to discharge. A clinical
assessment and two-dimensional echocardiogram was performed on infants with positive screens. Patients
who tested negative for the pulse oximetry screening were followed up to a minimum of 2 months of age to
determine which of these infants presented with symptoms attributable to CCHD.
Results
Pulse oximetry screening was performed on 1,174 well, term newborns. Three patients tested positive for the
screen. Two were found to have transposition of the great arteries and the other was a false positive screen.
Of the 1,091 patients with negative results, 990 patients were followed-up and had no symptoms indicative
of CCHD. The measures of validity for this study were as follows: sensitivity of 100%, specificity of 99.9%,
positive predictive value of 66.67% and a negative predictive value of 100%.
Conclusion
Pulse oximetry is an accurate screening method for detecting CCHD in the target population. The sensitivity,
specificity and predictive values in this population group are acceptable and can be applied to the general
population.
133
Nadia Kasdallah1,2, Mouelhi Neila1,2, Alaeddine Bouani1,2, Kbaier Hakima1,2, Ben Salem
Hatem1,2, Blibech Sonia1,2, Douagi Mohamed1,2
1
Military Hospital of Tunis., Tunisia
2
University Tunis El Manar/Faculty of Medecine of Tunis/ Faculty of Medecine of Tunis,
Tunisia
Background and aims
Healthcare-associated infections (HAI), currently in middle of neonatal resuscitation, the most feared
pathology of the fact of the morbidity and the mortality associated. We aimed to analyze epidemiological,
clinical, and bacteriological data and outcome of HAI in our unit. We also recalled the interest of ecological
monitoring of germs for better prevention.
Methods
A one year retrospective study (1 January to 31 December 2015) of all cases of HAI identified in our unit.
Clinical, biological, bacteriological, therapeutic characteristics and outcome were analyzed.
Results
We identified 58 cases of newborns who had HAI. The prevalence of HAI was of 5%. The rate of
prematurity was 63.8% with an average term of 31 gestationnal weeks. The rate of low birth weight was
22.4%. Assisted ventilation was used in 48 cases (82.75%). The average duration of artificial ventilation was
four days. The HAI happened at an average of 4 days of hospitalization. We identified seven septicaemic
forms and one case of meningitis. The most frequently isolated bacteria were Klebsiella Pneumonia (41.4%)
followed by Acinetobacter baumanii (10.4%) and Pseudomonas Aeroginosa (7%). Central vascular catheters
were incriminated in four cases. The average length of stay was 18 days. The overall survival rate was
82.75%.
Conclusions
HAI are still a major problem in our neonatal intensive care unit. The emergence of enterobacteria multi
resistant must impose a best rationalization of antibiotics use and regularly control of the bacterial ecology
of our unit.
134
Study on Bacterial Contamination of Neonatal Intensive Care Units (NICU) and Antibiotics
Resistance Patterns in Isolated Bacteria in Hamadan Hospitals, west of Iran
Rasoul Yousefimashouf, Mina Momeni
Rsoul Yousefimashouf, Iran
Background
Many reports from all over the world indicade that multi-drug resistance in nosocomial organisms are
increasing.
Objectives
The objectives of this study were determination of antibiotics resistance patterns in bacteria isolated from
neonatal intensive care units (NICU) in Hamadan hospitals, west of Iran.
Methods
In this dtudy, 682 samples were randomly collected from different area including devices, apparatus,
physical surfaces and staffs, uniforms. The samples were inoculated in EMB and Blood agar by wet swabs
and transferred to medical laboratory for identification. 140 strains were selected and cultured on
Mulerhinton agar for antibiogram tests by Kirby-bauer method. The antibiotics disks were consisted of :
Erythromycin, vancomycin, tetracycline, ceftriaxone, cefataxime, penicillin, carbapenem, ampicillin,
methicillin, amikacin, gentamicin, sulfamethoxazole, nalidixic acid and ciprofloxacin.
Results
The average rate of bacterial contamination in NICU was 42.9%. The most contaminated parts, were the
staffs, uniforms (70.3%) and physical surfaces (58.4%) respectively. The most bacteria isolated were as
follow: Staphylococcus epidemidis, Staphylococcus aureus, Streptococcus faecium, Pseudomonas
aeroginosa, E.coli, Klebsiella, Enterobacter, Proteus, Acenetobacter. In this study, many different antibiotics
resistance patterns were obtained for strains isolated from intensive care units. In total, gram positive bactera
showed more resistance patterns, rather than gram negative bacteria. More than 80% of gram positive
bacteria were resistant to penicillin, ampicillin, tetracycline and gentamicin.
Conclusion
Our results showed the high drug resistance in strains isolated from NICU and considerable bacterial
contamination, it seems that sterilization and disinfection methods in hospitals were not performed correctly
and it should be controlled regularly by related authorities.
135
Study on Staphylococcus spp. Strains Isolated from Venous and Urinary Catheters in NICU of
Hamadan Hospitals, The West of Iran.
Rasoul Yousefimashouf1, Negin Molazadeh2
1
Hamadan University of Medical Sciences, Faculty of medicine, Iran
2
Hamadan University of Medical Sciences, Faculty of medicine, Iran
Background and aim
Staphylococcus coagulase negative strains are colonized on epiderm and distribute in environment and outer
bodies apparatus such as protez and intera-venous catheters. The aim of this study was the frequency of
Staphylococcus coagulase negative isolated from venous and catheters children hospitalized in NICU of
Hamadan hospitals and determination of antibiotics resistance patterns in Hamadan, the west of Iran .
Methods
We collected 108 samples randomly from patients who were hospitalized in NICU hospitals of Hamadan and
they needed to venous or urinary catheters. One specimen of each patient was taken and inoculated into
carrier transported media and transferred to bacteriology laboratory to identification of strains. Antibiogram
was performed by Kirby-Bauer method. Data was analyzed using SPSS 15 software.
Results
Out of 108 tested samples, 32.7% of patients had urinary catheter and 67.3% had venous catheter. 28% of
tested samples had positive culture. The positive cases were significantly found in those children who had
been used catheter more than 48 hours (P = 0.00). From the positive cases, Staphylococcus epidemidis
(40.4%), Acinetobacter baumannii (10.6%) and E. coli (8.5%) were the most common isolates. The most
rate of resistance of Staphylococcus epidemidis was against to erythromycin and ampicillin. The most rate of
sensitivty of E. coli was against to gentamicin and Psuedomonas aeruginosa to ciprofloxacin.
Conclusion
Our results showed the high contamination in used catheters particularly in those patients who needed to
catheter for long time. We also indicated the high drug resistance in strains isolated from catheters.
136
Trained Nurse Attending Deliveries Reduce the Number of Deaths Caused by Asphyxia in Maputo
Central Hospital
sonia Bandeira1, Sonia Bandeira1, Samira Weng2
1
Maputo Central Hospital, Mozambique
2
Ministy of Health of Mozambique, Mozambique
Introduction
About 4 million newborns die every year. Immediately after birth, 1 in 10 newborns need assistance to begin
breathing. In Mozambique, only 54% of newborns are assisted by skilled nurse at birth. In Maputo Central
Hospital, neonatal asphyxia is the 2nd cause of neonatal death. A qualified nurse in all deliveries can reduce
neonatal mortality in low resources countries./pre
Methodology and objective
This is a retrospective study in which a comparison is made between the term newborns with low APGAR
scores assisted by skilled nurse in 2014 (working only 8hours a day) and those assisted by non skilled nurse
in 2013. Objective: understand the impact of skilled nurse (trained in neonatal resuscitation) in delivery room
in neonatal mortality in Maputo Central Hospital, Mozambique./pre
Results
In 2013, 324 newborns had low APGAR with 52 deaths (16%); In 2014, 351 newborns had low Apgar and
29 deaths (8%). Neonates with congenital malformations were excluded.
Conclusion
Although the nurse was present in only 30% of all newborns with low Apgar scores, we observed a reduction
of neonatal deaths caused by asphyxia from 16% to 8%. This strategy can be applicable in low resources
sites to reduce neonatal mortality./pre
137
The Burden of Neonatal Hypoglycaemia
Emily Mullan, Helen Mactier
Princess Royal Maternity Hospital, UK
Hypoglycaemia is a common problem in neonatology and sustained hypoglycemia is thought to be
associated with long-term neurodevelopmental sequelae. Infants may be asymptomatic and awareness of
predisposing risk factors such as maternal diabetes allows targeted screening and prompt treatment. But how
much are we having to admit to the neonatal unit for management?
Aim
Describe the cohort of infants admitted to a single tertiary centre requiring management of neonatal
hypoglycaemia.
Method
Retrospective case note review for all admitted infants with a diagnosis of hypoglycaemia between 1/10/1330/9/14. Neonatal hypoglycaemia defined as blood glucose 2.5mmol/L.
Results
118 infants identified. Gestation ranged from 27+4-41+3weeks (median 36+5); 46% were term born. Birth
weight ranged from 580g–4710g (median 2477g). 20% were 91st centile. 66% were delivered by caesarian
section (18% elective; 48% emergency).
39 (33%) were direct admissions. Primary admission categories included prematurity, TTN and requirement
for prolonged resuscitation at delivery. 67% were admitted from postnatal wards; age at admission ranging
from 1-181 hours (average 16hrs). 31% of infants were reported as symptomatic, 18% of these having a
blood sugar 0.5mmol/L.Tachypnoea and `jittery` were the most commonly reported signs. Time to first feed
ranged from 9-900 minutes (median 68 minutes). Only 10 infants achieved first feed
27% were infants of mothers with diabetes. Co-mobidities included IV antibiotic administration for sepsis
risk factors (n=38), maternal labetalol (n=12) and hypothermia (n=11).
91% required nasogastric feeding; 63% required intravenous fluids, 49% of these were term infants. 15%
dextrose was required for 11 babies. Additional therapies included glucagon (n=7), diazoxide (n=4) and
thiazide (n=4). One infant was diagnosed with hyperinsulinism.
Conclusion
A high proportion of term infants are admitted for management of hypoglycaemia. Only 27% of admitted
infants were infants of mother with diabetes. These are an intensive population requiring active intervention.
Clinical detection of hypoglycaemia is low.
138
Neonatal Admission Temperatures: The Forgotten Patient
Francesca Ritchie, Sophie Springer, Nathalie DeVries
Palmerston North Hospital, New Zealand
Aims:
The 2016 RANZCOG Newborn Resuscitation Guideline states that admission temperatures to newborn units
are important predictors of outcomes and should be maintained between 36.5-37.5°C. Hypothermia is
associated with increased morbidity and mortality. This audit was done to check the admission temperatures
of babies in our local.Newborn.Unit.
Method:
Admission temperatures were assessed for all babies admitted to Palmerston North level 2A Neonatal Unit in
2015. Babies were excluded if they were more than 24hours old at admission, if it was a readmission, or if
the temperature at admission was not recorded. The total number of admissions were 499, after exclusion
criteria were applied this left 299. Ninety of the 499 babies were excluded for not having their admission
temperature recorded. We calculated the percentage of babies with low (under 36.5°C), normal (36.537.5°C) and high (over 37.5°C) admission temperatures for each of the different areas as outlined in the
results section below.
Results:
Thirty seven percent of babies had an admission temperature below the recommended 36.5°C. Prematurity
and low birth weight were associated with low admission temperatures. Delivery suite had the highest
percentage of cold babies per admission source even when adjusted for the confounder of gestation with 36%
of term babies being under 36.5°C at admission. Elective caesarian sections had the highest percentage of
cold babies per mode of delivery even when adjusted for gestation with 43% of term babies having an
admission temperature under 36.5°C. Low admission temperature was associated with longer admissions to
the unit irrespective of gestation, with term babies having an average stay of 56hrs if they had a normal
admission temperature and 90hours if they had a low admission temperature.
Conclusion:
These results show a high percentage of babies have a low admission temperature. As expected, prematurity
and low birth weights were associated with lower temperatures. Surprisingly, babies born in delivery suite
and babies born via elective caesarian sections had the highest percentage of low admission temperatures.
Low admission temperature was associated with admission stays nearly twice as long as normal admission
temperatures, indicating increased morbidity. This audit has shown significant concerns with babies from
delivery suite and with babies from elective caesarians and low admission temperature has been associated in
our newborn unit with increased morbidity. In response to this, our hospital protocol will be changed to
improve newborn temperatures.
139
Weak Correlation Between Urinary Kidney Injury Markers in Septic Neonates
Anna Tarko, Anna Suchojad, Aniceta Brzozowska, Małgorzata Majcherczyk, Iwona
Maruniak-Chudek
Medical University of Silesia, Faculty of Medicine in Katowice, Poland
Introduction
Urinary excretion of tubular injury markers, as example: NGAL, KIM1, IL18, is postulated as useful early
indicator of renal damage. Moreover, a measurement of the panel of biochemical parameters seems to be
better than of any single marker. The aim of the study, was to analyze the association between urinary levels
of kidney injury indicators in neonates hospitalized in Neonatal Intensive Care Unit.
Material and method
Urinary NGAL (uNGAL), KIM1 and IL18 concentrations were assessed in 140 neonates including 14
patients with AKI diagnosed based on pRIFLE criteria.
Results
In non-AKI group on the 1st, 2nd and 3rd day of observation median values of study parameters were as
followed: NGAL [49(24-120), 49(19-139) and 33(16-108) ng/ml,], KIM1 [0,67(0,29-0,12), 0,60(0,29-0,94)
and 0,57(0,26-0,85) ng/ml], IL18 [60(35-96), 54(35-99), and 55(36-101)pg/ml], respectively. The difference
between AKI and non-AKI group was statistically significant for uNGAL on the 3rd day and IL18 on the 1st
and 3rd day. There was a weak correlation between uNGAL and KIM1 on the 1stday(R=0,202; p=0,01) and
the 2nd day (R=0,288; p0,001); also between uNGAL and IL18 on the 1st day(R=0,149; p=0,05) and the 2nd
day (R=0,252; p0,01). There was no association between KIM1 and IL18. The positive correlation was
observed between the value of Apgar 5’ and concentration of IL18 on the 1st day, while inverse with
uNGAL. In addition, the severity of clinical status described by NTISS was reflected by increased values of
KIM1 and uNGAL. All markers were associated with serum CRP concentration.
Conclusions
In neonates treated in NICU the variability in urinary kidney injury markers is highly influenced by other
than kidney injury factors.
140
Subsequent Labor Abnormalities and Neonatal Outcomes Among Preterm Births with Prolonged
Latent Phase
Manuela Cucerea1, Manuela Cucerea, Marta Simon1, Bela Szabo1, Marcela Ungureanu2,
Raluca Marian1, Elena Moldovan1, Laura Mihaela Suciu1
1
University of Medicine and Pharmacy Tirgu Mures, Romania
2
University County Hospital Tirgu Mures, Romania
Aims
To examine the association of prolonged phase with cesarean risk, subsequent labor abnormalities and other
adverse neonatal outcome
Methods
a retrospective cohort analysis of 175 singleton preterm infants born at 24 to 36 weeks of gestation in one
tertiary level care academic hospital ( January 2014 through December 2015) with at least one ultrasound
cranial examination. Latency was divided into three intervals, and outcomes in the longer intervals were
compared with those infants who were delivered at
Results
Odds ratios and CIs for each latency interval that was controlled for counfounders that included gestational
age, antenatal steroid and antibiotic administration show a statistically decrease risk for cesarean section
from 1.5 [1.02-3.1], 1.4 [1.06-6.17] and 0.57 [0.25-0.72]; increase risk of low Apgar score at 5 minutes 0.36
[0.14-0.93], 1.4 [0.47-4.15] and 4.96 [1.09-22.54]
Conclusions
Prolonged latent phase is independently associated with decreased incidence of need for cesarean delivery,
depressed Apgar scores, and increased risk of ultrasound cranial abnormalities
141
Ductus Dependent Cardiopathies. Aproach and Evolution in a Neonatal Unit.
Reyes Roldan Lopez, Begoña Rodriguez Azor, Salvador Ariza Aranda, David Lopez
Martin1, Tamara Fernandez Ferrandez, Ana Isabel Valdivielso Martinez, Vanessa Maria
Schmitz, Enrique Salguero Garcia, Tomas Sanchez Tamayo
hospital Regional Universitario De Málaga, Spain
Congenital heart defects (CHD) are the most frequently admitted to neonatal critical care units (NICU)
congenital malformation. They require a quick diagnosis and treatment, specially ductus dependent defects
(DDC). Our objective is to describe the characteristics, management and complications of children with
DDC until discharge from our NICU. Our secondary aim is to evaluate possible evolution predictors. Side
effects described previously in the literature as associated with the use of prostaglandins were also registered.
Methods
A transversal study was performed, by clinical story revision of the children with DDC hospitalized in our
NICU in five years (2011-2015).
Results
We studied 48 patients (43,8% females), 18 with prenatal diagnosis (37,5%). 41 (85,4%) born at term and 7
(14,6%). 17 (35,4%) were born in our hospital and 31 (64,4%) came transferred from other hospitals. 25
where asymptomatic and 23 symptomatic (cyanosis or low cardiac output).
The most frequent DDC were great arteries transposition (16; 34,8%) and aortic flow changes (13; 28,2%). 8
(16,8%) associated non-cardiac major malformations.
All patients received prostaglandins, for an average 10.6 days (1-71). Vasoactive drugs (VAD) were needed
in 23 (47%). They needed central venous catheter for an average 12.25 days (1-71) and mechanical
ventilation (MV) for 4,8 days (0-71).
During admission, 24 (50%) had sepsis. 7 (15,6%) had digestive and 6 (12,8%) neurological disorders.
Cardiac surgery was performed (postoperative care in pediatric intensive care unit) in 29 (60,4%) and 6
(12,8%) died before surgery.
Children with prenatal diagnosis required less VAD (p=0.04), with longer treatment with prostaglandins
(p=0.012) and had less (NS, p=0.07) neurological disorders.
Conclusions
Children with DDC have an important morbimortality.
There may be side effects of prolonged treatment with prostaglandins, although new prospective studies are
still needed.
Prenatal diagnosis and birth in our hospital were associated with better outcome in our patients.
142
Prognosis of Newborn Pre-term from Mothers with Chorioamnionitis Histological
Ingrid Kandler1, Edna Maria de Albuquerque Diniz2, Fábio Gonçalves Coutinho3, Renata de
Souza da Silva1, Paulo Roberto Merçon Vargas1
1
Federal University of the Espírito Santo, Brazil
2
São Paulo University, Brazil
3
Postgraduate Institute Kandler Coutinho, Brazil
Introduction
Amniotic infection and chorioamnionitis (CAM) are determinants of maternal and perinatal infections,
parturition and birth preterm, morbidity and postnatal mortality. Although clinical, histopathological,
microbiological, biochemical and molecular methods can diagnose histologic CAM, remaining many cases
the clinical and epidemiology hidden because most neonatal deaths remains of sepsis, and this also leads
many sequels in newborns.
Objective
To investigate the relationship between histological CAM and prognosis PreTerm Newborn (PTN) in 2012 at
the University Hospital Cassiano Antonio de Moraes (HUCAM) in Vitória - ES, regarding the need for
oxygen therapy, early neonatal sepsis, perinatal asphyxia and death.
Method
We made a cross-sectional study, where all the placentas examined in 2012, in the Pathology Laboratory
HUCAM in Vitória, were analyzed together with the chart to the PTN and extracted data regarding the need
for oxygen therapy, early neonatal sepsis, perinatal asphyxia. The cases were categorized by gestational age,
perinatal outcome and positive placental histology to CAM.
Results
245 patients were chosen for the study, 94 (38.4%) were asymptomatic, 92 (37.5%) required oxygen therapy,
11 (4.5%) had neonatal early-onset sepsis, 10 (4.1%) had perinatal asphyxia, 27 (11%) died and 11 (4.5%)
with incomplete data. In the analysis of the placentas and 86.2% had negative histologic CAM and 13.8%
had positive CAM histological.
Conclusion
The number of placentas with histologic CAM was higher than the number of patients with early-onset
sepsis and birth asphyxia, similar to the number of patients who died. There is a worse prognosis ratio, that
is, perinatal asphyxia and neonatal sepsis in patients with positive placenta for histologic CAM, as the need
for oxygen therapy has no direct relationship with histologic CAM. Thus, we conclude that the placenta
present positive histologic CAM the PTN should be observed during 72h in the maternity ward for early
neonatal sepsis.
Keywords: histological chorioamnionitis, neonatal sepsis, perinatal asphyxia, oxygen therapy in the
newborn, prematurity.
143
399
E-Poster Presentations (Friday, July 17, 2015 16:30)
Poster
Miscellaneous
Implications of Studied Diseases In Neonatal Screening In The State Of Espírito Santo, Brazil, Before
And After Change Protocol Conjunctivitis Neonatal Prophylaxis
Ingrid Kandler1, Edna Maria de Albuquerque Diniz2, Fábio Gonçalves Coutinho3, Maria de
Fátima Caretta Martins4
1
2
São Paulo University, Brazil
3
4
State health department of the Espírito Santo, Brazil
Introduction
The National Neonatal Screening Program (PNTN) was implemented in order to develop actions aimed at
early diagnosis, treatment and monitoring of diseases in populations with a minimum age of zero to 30 days
of life. Better known as Guthrie Test, the test is performed with drops of blood taken from the heel of the
child on filter paper.
Objective
The objective of this study was to evaluate the incidence of diseases detected by neonatal screening test
before and after the change of neonatal conjunctivitis prophylaxis protocol.
Methods
We evaluated all the results of Guthrie Test of tests in all newborn of the State of Espírito Santo between the
years 2008 and 2012, the information was obtained from the Neonatal Screening Program database of the
State of Espírito Santo and examinations laboratory were performed in APAE-Victoria. Diseases that were
screened during the study period and were analyzed include: congenital hypothyroidism; PKU; sickle cell
anemia and cystic fibrosis before and after the exchange of Silver Nitrate drops by 1% povidone iodine drops
of 2.5% in 2010 to prevent neonatal conjunctivitis.
Results
The incidence of PKU have fallen for 1:10,000 cases to 0.2:10,000. The incidence for congenital
hypothyroidism had a increase 1.1:5000 cases 2:5000 cases, since the results of the incidence of sickle cell
anemia and hemoglobinopathies were 1.3:2500 cases to 1.0:2500 cases showing little variation in the
analyzed period, as the incidence of cystic fibrosis was 1.0: 12500 in 2009 rose to 1.9: 12,500 in 2010 and
then fell again and in 2012 the incidence was 1.0: 12500.
Conclusion
There was a reduction in phenylketonuria disease because information campaigns about the disease to the
population and genetic counseling for families with affected members and it was also found that there was a
large increase in the incidence of children with congenital hypothyroidism, hypothesizes that the change in
neonatal conjunctivitis protocol with povidone-iodine 2.5% can be a cause of neonatal hypothyroidism.
Keywords: phenylketonuria, sickle cell anemia, hemoglobinopathies, cystic fibrosis.
144
Is C-Reactive Protein Monitoring A Reliable Cost/Efficient Indicator For The Onset Of Infection In
Newborns With Congenital Heart Defects Treated With PGE1?
Marta Simon1,2, Szabina Vrincean1, Erzsebet Mathe1, Zsuzsanna Gall1, Laura M Suciu1,
Raluca Marian1, Carmen Gliga2, Monika Rusneac2, Manuela Camelia Cucerea1,2
1
University of Medicine and Pharmacy Tg.Mures, Romania
2
Mures County Emergency Hospital, Romania
Background
Ductus dependent congenital heart defects need PGE1 infusion in order to maintain the ductus permeability
until surgical repair can be done. In small centers this may last several weeks. Knowing the side effects of
the PGE1, the role of prostaglandins in inflammatory reactions and the risk for infection during prolonged
use of central catheters, one needs a reliable cost efficient method for early detection of a potential infection.
Materials and method
68 term infants with ductus dependent congenital heart defect with prolonged PGE1 administration were
screened for infections. Including criteria: term infants with no initial signs of infections, with good postnatal
adaptation, PGE1 infusion for more than 10days. Excluding criteria: prematures, premature rupture of
membranes, initial infiection, PGE1 infusion for less than 10days. C-reactive protein, CBC and differential,
cultures, temperature were monitored every 72h, or at the onset of a possible infection.
Results
PGE1 was administered for 10 to 42 days (mean 21,5days). 27(39.7%) cases positive cultures were obtained.
In 19(70.3%) of these cases CRP was elevated. We found elevated CRP in 26 cases, which associated
positive culture, left shift of WBC differential, and/or fever in 25 cases. Fever was present in 41 cases, in
13(31.7%) as a side effect of PGE1 infusion, cases without any other parameters of infection.
Conclusion
Monitoring the elevation of CRP proved to be a reliable and cost/efficient tool in predicting infections in
PGE1 receiving infants, being associated with at least one other infection pointing parameter in most of the
cases.
145
Analysis Hypothyroidism Congenital After Change Of Protocol Conjunctivitis Neonatal Prevention In
The State Of Espírito Santo, Brazil, In 2010
Ingrid Kandler1, Fábio Gonçalves Coutinho2, Luana Rabbi Bernardes3, Christina Cruz
Hegner4, Daniela Franco Lube4, Sarah Fardin de Oliveira4, Cristina Augusta Bravin4,
Terezinha Sarquis Cintra4, Samia Gourlart de Souza4
1
2
3
4
Association of Parents and Friends of people with cognitive disabilities (APAE)., Brazil
Introduction
The National Neonatal Screening Program ( PNTN ) , better known as Guthrie Test , makes the diagnosis of
congenital diseases such as congenital hypothyroidism that leads to several consequences, such as decreased
growth rate and mental retardation. In 2010 there was a change of conjunctivitis prophylaxis protocol due
neonatal high incidence of complications with the use of silver nitrate eye drops 1 % , because some studies
demostrarem fewer complications with the drops of povidone iodine 2.5% , it was changed.
Objective
To evaluate the number of confirmed cases of Congenital Hypothyroidism detected by neonatal screening
test, after the change of neonatal conjunctivitis prophylaxis protocol.
Method
We analyzed all medical records of patients with the Guthrie Test exam positive for congenital
hypothyroidism in the state of Espirito Santo in the period January 2011 to December 2012, data were
collected from the database information Neonatal Screening program of the state of Espírito Santo and the
tests were performed in APAE-Vitória, follow-up of patients up to 3 years age at the same institution.
Results
41 patients had abnormal tests for hypothyroidism in the 2011 and 2012 period prescribed, an increase of
86.4% over the period 2008 and 2009 when it was not used the eye drops of povidone-iodine 2.5%. After 3
years, 23 (56.1%) had a confirmed diagnosis, 5 (12.2%) had a transient hypothyroidism and 13 (31, 7%)
dropped out. The ultrasound analysis found that 23 (56.1%) had normal thyroid, 10 (24.4%) had thyroid with
reduced volume, 5 (12.2%) had thyroid with increased volume, 2 (4.9%) ectopic thyroid and 1 (2.4%)
thyroid agenesis.
Conclusion
Most patients had the diagnosis of hypothyroidism with 3 years of age, and of these cases the majority with
ultrasound normal thyroid reinforcing the hypothesis that the change in neonatal conjunctivitis protocol with
drops of 2.5% povidone-iodine it may be the cause of the increased incidence of hypothyroidism during the
neonatal period.
Keywords: neonatal screening, hypothyroidism, colirio povidone iodine 2.5%.
146
Perinatal Complications of Prematures ≤ 32 Weeks of Gestation: Inborn Vs Outborn. Experience of a
Regional IIIrd Level Center in Romania
Zaharie Gabriela1, Veronica Obada2, Monica Hasmasanu1, Ligia Blaga1, Tudor Pop1, Sorin
Andreica1, Diana Rusu2, Alexandru Zaharie3, Melinda Matyas1
1
University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Romania
2
County Emergency Hospital, Romania
3
University of Medicine Wien, Austria
Introduction and Aims
The paper aims to assess the perinatal complications of the inborn prematures ≤32 weeks of gestation versus
the outborn prematures transferred from lower level units to the regional center .
It is a retrospective study which takes place in Neonatology Department from County University Hospital
Cluj, Romania, between 2011-2013 . 193 premature infants under 32 SS were enrolled. 50 patients were
transferred from lower level units . All patients were admitted to NICU where were assessed: pH , CBC,
glucose,electrolites , GOT, GPT , bilirubin, CRP, BUN, creatinine, hemoculture.Was monitorized the
respiratory support, FiO2 and transfontanelar ultrasonography and echocardiography was performed.
Statistical data were processed in Statistics VII.
Informed consent was obtained for all patients.
Results
Characteristics of the groups were: inborns: GA = 29.44 ± 2.0016 weeks ; W= 1311.20 ± 380.57 ; for
outborns: GA=29.51± 2.12 SS ; W = 1318.105 ± 422,68g .
The severity of RDS was significantly higher at the transferred cases ; Silverman score 4.61±2.53 at inborn
and 5.41±2.81 at outborn (p= 0,00002).
The inborn patients received surfactant at 222.017 ± 604.382 minutes of live and outborn at 2491.89±
1425.000 minutes (p = 0.00).
The need of respiratory support : CPAP and mechanical ventilation was longer at outborn than inborns (p =
0.01).
Mechanical ventilation was applied longer for outborn patients than inborn ones .
Total enteral nutrition was delay at outborns than inborns 17.10±14.66 vs 11.70±9.85 days of live .
Bleedings were often in outborns : pulmonary hemorrhage (p=0.003),digestive hemorrhage (p=0.0001) and
cerebral hemorrhage (p=0.007).
Mortality rate was the same in both groups.
The GOT was significantly higher in the transfer group (p=0.003).
Conclusions
The severity of RDS was higher at outborn patients.
Bleedings were more often in the transferred patients( pulmonary, digestive and cerebral ) .
Total enteral nutrition was delay at outborns.
147
Comparative Assessment of Fetal Malnutrition In Preterm Newborns
Beatrice Ezenwa, Beatrice Ezenwa, Chinyere Ezeaka, Edna Iroha
Lagos University Teaching Hospital, Nigeria
Background
Fetal malnutrition is a risk factor for increased neonatal morbidities and mortalities worldwide. Its presence
and documentation at birth is essential for optimal management of the child. Body Mass Index(BMI) is the
tool of choice in determining body proportions and adiposity in children.
Objective
To assess the nutritional status of preterm newborns at birth using BMI and CANscore and to determine the
better indicator for FM in preterm newborns.
Methods
The study was carried out on consecutive, live born babies between 28 completed weeks through 36 weeks
gestation born at Lagos University Teaching Hospital, Lagos, Nigeria without any major congenital
abnormalities or severe perinatal illness. Birth weights and lengths were recorded for each infant at birth.
The BMI was calculated using the formula: [weight (kg)/ length (m)2]. BMI 10th centile using Brock’s chart
is considered as FM. PI was computed from the formula: [weight (g) / length3 (cm) X100]. A PI
Results
One hundred and forty preterm newborns were assessed. One hundred and eight (77%) were of LBW. BMI,
CANscore and PI identified 40.0%, 34.3% and 30.0% of the preterm newborns as FM. Out of the 56 FM
babies identified by BMI, CAN score and PI identified 33.9% and 51.8% of them respectively, as FM. Using
BMI as standard, PI was the most sensitive anthropometric index for detecting FM in preterm infants
compared to CANScore and this was statistically significant, p0.00.
Conclusion
FM is not exempt in preterm babies. BMI and PI are better identifiers of FM in preterm newborns compared
to CANScore
148
Factors Associated With Low Birth Weight in Term Newborns
Gamze Ozgurhan, Serdar Comert
Suleymaniye Maternity and Children’s Training and Research Hospital, Turkey
Background
Low birth weight (LBW), which is a major public health problem worldwide, is an important factor that
affects not only neonatal mortality, but also infant and childhood morbidity. Several maternal and socioeconomical factors can lead to LBW in newborns.
Objectives
To study maternal, neonatal and socio-economical factors in newborns born with LBW in our hospital and to
evaluate risk factors associated with LBW.
Design
Prospective and comparative study.
Method
Sixty newborns with LBW ( 2500 g) and 100 newborns with normal birth weight (2500-4000 g) as control
group were included in this study, all born in our hospital. A questionnaire including questions on maternal,
paternal and socio-economical factors was conducted as face-to-face interviews with mothers. Weight,
height and head circumference of all newborns were recorded. Using the data collected, these 2 groups were
then compared in terms of neonatal, maternal, paternal and socio-economical factors.
Results
Average birth weight, height and head circumference in LBW group were 2328±154,55 g, 47,22±1,72 cm
and 33,03±1,29 cm respectively. There was not any statistically significant difference in female/male ratio
between LBW group and control group. Statistically significant differences were observed between the 2
groups in smoking habits, number of antenatal care visits and presence of child mortalities under the age of 5
(p=0.014, p=0.04 and p=0.033 respectively). Socio-economic characteristics were not also found to be
statistically significantly different between the two groups.
Conclusion
Many factors have a role to play in the development of LBW. However, most important preventive actions
have been identified as improving the overall health conditions of mothers, prevention of smoking during
pregnancy and a providing sufficient number of antenatal care visits with high quality of service.
149
Effect of Oxytocin Augmentation of Labor and the Maternal and Neonatal Outcomes in a Secondary
Level Academic Perinatal Care Center
Laura Mihaela Suciu1, Marta Simon1, Rozalia Peti2, Mihaela Luca2, Dan Stefan Simpalean3,
Manuela Cucerea1
1
2
University County Hospital Tirgu Mures, Romania
3
Aims
To evaluate maternal and adverse neonatal effect of oxytocin given to mothers during labor Methods: A
retrospective cohort analysis of 1443 singleton infants born at 34 to 42 weeks of gestation in one secondary
level perinatal care center ( January to December, 2015). Mothers were divided into two groups, according to
the exposure to the oxytocin either for induction or augmentation of labor taking care of the inclusion and
exclusion criteria. Outcomes variables were cesarean delivery, need for neonatal resuscitation, thick
meconium, neonatal jaundice, birth related trauma, and polycythemia.
Results
The mean age of oxytocin group was 26.44 (±6.9) years while in control group was 25.68 (±4.2) years. OR
and CIs for oxytocin group was calculated and show a statistically significant decrease risks for cesarean
section OR 0.14 [0.005-0.45], and increase risk of birth related trauma OR 6.77 [2.08-22.56], neonatal
jaundice OR 1.27 [1.02-1.64]; thick meconium OR 0.95 [0.67-3.87], polycythemia OR 1.44 [1.2-2.78] and
successfully breast feeding OR1.3 [1.02-1.66]
Conclusions
The most commonly used drug for the induction and augmentation of labor is associated with adverse
neonatal outcome but not with cesarean risk.
150
Neonatal Resuscitation And Essentials Of Newborn Care: Delivering Neonatal Training In LowResource Settings
Alastair Stanley, Elizabeth Ledger, Toby Candler
Bristol Royal Hospital for Children, UK
Neonatal mortality accounts for 44% of under-5 mortality globally each year, with the majority of these
deaths occurring in sub-Saharan Africa. Improvements in neonatal outcomes in this setting can be achieved
without advanced or expensive technologies through training of local staff in neonatal resuscitation,
recognition of common neonatal problems, and the use of low-cost effective interventions such as Kangaroo
Care. The authors developed a two-day Neonatal Resuscitation and Essentials of Newborn Care course to
deliver this training to staff involved in neonatal care at hospitals in Ethiopia and Tanzania. The course used
a combination of lectures and clinical scenarios relating to neonatal resuscitation and the recognition and
management of neonatal sepsis, jaundice, hypothermia, feeding and hypoglycaemia. Candidates completed a
30-question true-false test at the beginning of the course to establish baseline knowledge, and again at the
end of the course by way of formal assessment and to quantify any improvements in knowledge. Formal
assessment also included a resuscitation scenario at the end of Day 1. Candidates were asked to complete
anonymous feedback to help improve the course in the future. A total of 93 staff, including doctors, nurses,
and medical assistants, completed both the initial and final test. 89% of candidates (n=83) improved their test
scores following completion of the course, with an increase in the median test score from 61% to 77% in
Ethiopia, and from 53% to 70% in Tanzania. Candidates who performed particularly well were invited to
complete a further day of training to be able to teach the course in order to train more healthcare workers. All
candidates reported feeling better able to perform neonatal resuscitation and manage neonatal problems after
attending the course. Delivering this course in low-resource settings improves both the knowledge and
confidence of healthcare workers with regards to neonatal resuscitation and care.
151
Relationship between BMI of Premature Newborn, Respiratory Distress, Early Neonatal Sepsis and
Death
Ingrid Kandler1, Fábio Gonçalves Coutinho2, Valmin Ramos Silva3
1
2
3
Medical School of Santa Casa de Misericórdia, Brazil
Introduction
External factors, that is, not intrinsic to the fetus result in restriction of asymmetric growth, which typically
begins at the end of the second trimester of pregnancy. Small reductions in nutrient and oxygen supply
hamper the growth of skeletal muscle and the deposition of glycogen and fat, but still allow bone growth and
continued brain.
Objective
To investigate the relationship between Premature Newborn (PTN) Body Mass Index (BMI) born in 2012 at
the University Hospital Cassiano Antonio Moraes (HUCAM) in Vitória - ES, regarding the need for oxygen
therapy, early neonatal sepsis and death,
Methods
Cross-sectional study, which were selected all born preterm in 2012, in HUCAM in Vitoria, ES, we
calculated the BMI of all preterm newborns and after we analyzed the medical records and extracted data
regarding the need for oxygen therapy, sepsis early neonatal and death. The cases were categorized
according to BMI in relation to gestational age and classified as malnourished, appropriate and obese and
after statistical calculation done seen the perinatal outcome.
Results
Among 189 preterm infants, 58 (31.5%) had a abnormal BMI, where 39 (21.2%) are obese and 19 (10.3%)
are malnourished. 52 (27.5%) had mechanical ventilation, 14 (7.4%) positive Rodwell score, 17 (9.0%) have
died and 40 (32.5%) had positive C-reactive protein. 6 BMI obtained PCR`s and positive scores at the same
time, where 4 (66.7%) is premature with normal BMI and 2 (33.3%) is premature with BMI in the range
obesity. 4 (100.0%) of children with mechanical ventilation have PCR and positive score. 5 (71.4%) of
children with PCR and positive score did not die and 2 (28.6%) died.
Conclusion
The logistic regression was not statistically significant in any association.Therefore no association between
BMI and changed the PCR and the score, so the calculation of the modified BMI does not play a risk factor
and not protection for preterm infants.
Keywords: Premature newborn BMI;Respiratory Distress;Early onset neonatal sepsis.
152
Congenital Heart Block in Neonatal Lupus
Fatemeh Tahghighi
Tehran University of Medical Sciences, Iran
Neonatal lupus erythematosus (NLE) is caused by the transplacental passage of maternal autoantibodies. The
presence of maternal anti-SSA/Ro and anti-SSB/La antibodies increases the risk of bearing infants with
NLE; rarely, NLE is due to maternal passage of U1-RNP antibodies. NLE has substantial associated
morbidity and mortality, particularly when the heart is affected. NLE may manifest as complete or
incomplete congenital heart block.In children who are severely affected, a pacemaker is frequently needed
because sudden cardiac death or heart failure may occur. Non-fluorinated steroids (prednisone, prednisolone
and methylprednisolone) are recommended only for maternal indications, not for prevention of CHB in antiRo/SSA-positive women. Fluorinated steroids (dexamethasone or bethametasone) are not metabolized by the
placenta and are available to the fetus in an active form. Routine prophylactic therapy with fluorinated
steroids is not recommended even in women who previously had children with CHB or skin rash since this
therapy has its own side-effects. Intravenous immunoglobulin had been used to prevent the development of
CHB and in some cases CHB recurred . At present, the only sure recommendation that can be made in these
women is that in the presence of reliable positivity for anti-Ro/SSA antibodies serial echocardiograms and
obstetric sonograms should be performed at least every 2 weeks starting from the 16th week of gestational
age: the goal is to detect early fetal abnormalities, such as premature atrial contractions or moderate
pericardial effusion, that might precede complete atrioventricular block and that might be a target of
preventive therapy. Fluorinated steroids should not be used in the absence of symptoms; in the presence of
alarming symptoms, using of them can be useful.
153
Acupressure at LI4 (Hegu) Point Prior to Heel Lancing for Pain Management at Healthy Term
Newborns
Aslihan Abbasoglu, Aslihan Abbasoglu, Safak Gucyetmez, Murat San
Gaziantep Cengiz Gokcek Maternity and Children's Hospital, Turkey
Introduction
Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Nonpharmacological strategies have actually become more important than pharmacological analgesic agents in
neonatal pain management. Acupressure is an ancient Chinese healing art. In this pain-relieving method, the
fingers are used to press key acupuncture points on the skin surface that stimulates the body’s regulatory
processes. We aimed to investigate the effect of acupressure at LI4 (Hegu) point prior to heel lancing as a
non-pharmacological intervention for procedural pain management in infants.
Methods
Twenty six term newborns who were undergoing heel lancing between postnatal days 3 to 8 as part of
routine neonatal screening were randomly assigned to the acupressure group or the oral sucrose group. In the
acupressure group, before the heel-lancing, acupressure was applied for 3 minutes simultaneously at LI4
(Hegu) point (On the dorsum of the hand, between the 1st and 2nd metacarpal bones, in the middle of the
2nd metacarpal bone on the radial side) .In the dextose group, each infant received 2 mL of 30% dextrose
orally via syringe 2 minutes prior to the heel lancing. Each baby’s behaviour was scored using the Neonatal
Infant Pain Scale (NIPS).
Results
There were no significant differences between the groups with respect to gestational age, birth weight, age at
time of procedure, weight at time of procedure (p0.05). The PIPP score in acupressure group was found 10.0
±2.08 and 9.85±2.19 in oral dextrose group (p0.05).
Conclusions
Our results indicate that applying acupressure at LI4 (Hegu) point point prior to heel lancing is as effective
as oral sucrose for reducing the discomfort of this procedure. Acupressure could be a promising nonpharmacological treatment modality for reducing pain in newborns.
154
Regional Tissue Oxygen Saturation In Newborns During Erythrocyte Transfusion Measured By
Near–Infrared Spectroscopy
Petja Fister, Domen Robek, Darja Paro-Panjan
University Medical Centre Ljubljana, Division of Pediatrics, Slovenia
Background and Aims
The tissue oxygen saturation (rSO2) depends on haemoglobin concentration and arterial oxygen saturation.
In anaemia the oxyform capacity of blood is diminished. Near–infrared spectroscopy (NIRS) might be an
additional nonivasive tool for establishing changes of tissue oxygen supply during transfusion. The purpose
was to evaluate changes in the regional rSO2 in newborns with anaemia during transfusion.
Methods
In a prospective study of 23 newborns with anaemia regional rSO2 was measured by NIRS (INVOS–
Cerebral/Somatic oximeter, 5100C Monitor, Somanetics, USA). The neonatal probes were placed on the left
and right forehead to measure brain rSO2 and lumbally to measure kidney rSO2. Because of anaemia 15
newborns received erythrocyte transfusion (T) and 8 exchange transfusion (ET). The regional rSO2 was
measured before, after the start, before the end and one hour after transfusions. The rSO2 measurements
were taken simultaneously at pre-set sampling rate of six seconds. Values were averaged over twenty
minutes with licensed version of Invos Analytics Tool.
Results
In both groups the rSO2 in the left and right brain and in the kidney were increasing from before, after the
start and before the end of the transfusion (p = 0.002, p = 0.047). In newborns with T the rSO2 stayed
elevated after the T. In newborns with ET the rSO2 after ET diminished to the values they had before the ET.
Conclusions
The rSO2 in the brain and the kidney was increasing in newborns with anaemia during transfusion.
Newborns with T were older when they received T, had lower haemoglobin, which rose significantly after T
with different adaptation mechanisms present. In applying new technologies for the assessment of decreased
ability of the circulating erythrocytes to meet the oxygen demands of tissues the regional rSO2 could be of a
value for potential use in newborns with anaemia.
155
Sy Zellweger- Unusual Presentation
Natasa Aluloska-Najdanovska1, Anet Papazovska1, Snezana Palcevska3, Velibor Tasic2
1
University Children Hospital, Macedonia
2
University Children Hospital, Macedonia
3
Clinical Hospital Adzibadem Sistina, Macedonia
Peroxisomal disorders are a group of genetically heterogeneous metabolic diseases that share dysfunction of
peroxisomes. The Zellweger spectrum disorders (ZSDs) are characterized by a generalized loss of
peroxisomal functions caused by deficient peroxisomal assembly. Zellweger syndrome (ZWS) is the most
common peroxisomal disorder to manifest itself in early infancy. Its incidence has been estimated to be 1 in
50,000-100,000. Clinical presentation and survival are heterogeneous.
Here we present 2 week old male affected by Zellweger syndrome with an unusual presentation. During the
regular fetal ultrasonography large polycystic kidneys were noted and nephrologic workout was suggested.
The baby was admitted to Neonatal Department suspected to have polycystic kidney disease. Clinical
features of severe hypotonia, facial appearance, redundant neck skin, ventricular septal defect, talipies
equinovarus, renal cystic disease suggested the possibility of Zellweger syndrome. The diagnosis was
confirmed by biochemical/metabolic assessment.
156
An 8-year review of major congenital abnormalities in a tertiary hospital in Lagos, Nigeria
Iretiola Fajolu1,2, Beatrice Ezenwa1,2, Patricia Akintan2, Veronica Ezeaka1,2
1
College of Medicine, University of Lagos., Nigeria
2
Lagos University Teaching Hospital, Idi-Araba, Nigeria
Background
Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of
neonatal mortality. They can also result in disability in majority of the survivors.
Objective
To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in
Lagos, Nigeria.
Methods
The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the
neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The
MCA were classified according to the 10th revision of the International Statistical Classification of Diseases
and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the
most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution.
Statistical analysis was based on systemic type, and neonatal outcome.
Results
Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total
births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an
increase in the yearly incidence from 2007-2014
The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system
(18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%)
infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the
study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group,
followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively.
Conclusion
The incidence of MCA in this study is high especially in the central nervous system. There was a steady
increase in the yearly incidence during the study period. The overall case fatality rate was also very high
with a high contribution to early neonatal deaths
157
Ways of Surfactant Administration and the Need of Mechanical Ventilation in Premature Born At 2430weeks Gestational Age
Marta Simon1,2, Erzsebet Mathe1, Szabina Vrincean1, Zsuzsanna Gall1, Laura M Suciu1,
Raluca Marian1, Monika Rusneac2, Carmen Gliga2, Manuela Camelia Cucerea1,2
1
University of Medicine and Pharmacy Tg.Mures, Romania
2
Mures County Emergency Hospital, Romania
Background
Respiratory distress syndrome due to surfactant deficiency and immature lung morphology, and also chronic
lung desease due to prolonged invasive ventilation remains the main pathology among prematures born
before 30 weeks gestational age. Recently new approaches to RDS like less invasive surfactant
administration (LISA) or intubation surfactant extubation (INSURE) followed by noninvasive ventilation
appeared to have better outcome.
In our retrospective study we analized the ventilation need and outcome of 43 prematures born at or before
30weeks gestational age, with respect on the surfactant administration and corticoprophylaxis.
Results
In our group mean gestational age was 27.3 weeks, mean birthweight 980.77g. 26 infants received surfactant
therapy in the first 2 hours of live, 16 of which had full corticoprophylaxy, 2 had only partial
corticoprophylaxy. 11 infants with both corticoprophylaxy and surfactant prophylaxy at birth via
LISA/INSURE method, with a mean gestational age of 28.18 weeks and mean birthweight of 979.09g 8 of
which needed ventilation for an average of 8.84days CPAP or SiPAP, 3needed intubation and conventional
ventilation. LISA without corticoprophylaxy was done in 5 cases, 3 of which needed conventional
ventilation.Therapeutic surfactant therapy was necessary in 10 prematures, with more invasive ventilation
modes- SIMV in all cases, in 4cases HFOV, for 7-38 days. Chronic lung desease was diagnosed in 4 infants,
all from the therapeutic surfactant and invasively ventilated group.
Conclusions
LISA/INSURE are less traumatic methods of surfactant administration, but it can be administered in well
selected group, with good respiratory effort, after alveolar recrutation, infants who benefit more of the
method are born at 27 weeks or after.
158
A Rare Case of Congenital Ranula in a Neonate
Snezana Palchevska1, Snezhana Palchevska1, Natasa Aluloska2, Mirjana Kocova3
1
Clinical Hospital Sistina Adzibadem, Skopje, Macedonia, Macedonia
2
University Children Hospital, Skopje, Macedonia, Macedonia
3
University Children Hospital, Skopje, Macedonia, Macedonia
Ranulas are cystic dilatations in the mouth floor. They are formed as a result of obstruction of one of the
sublingual salivary glands, leading to ducts proximal expansion to a musous retention cyst lined by salivary
duct epitelium, as seen neonates or mucous extravasation in the adjacent tissue forming a pseudo cyst that
lacks the epithelial lining. Ranula may be congenital or acquired. According to literature, oral ranulas are
most prevalent in females and the most common site for oral ranula is on the left side of the mouth floor.
Ranulas involving the ventral surface of the tongue are very rare, with sporadic cases reported in the world
literature, accounting for 2-8% of oral mucoceles. The dimensions range from 0,5 to 3,3 cm in diameter.
They are generally asymptomatic, although the large ones can cause aesthetic and functional problems.
Congenital ranula presenting in a newborn infant is a rarity with the incidence being estimated to be 0,74%
and thus there is a limited data published in the literature on the cited subject. We present a case of
symptomatic congenital ranula in a neonate, requiring surgical management. The physical examination,
lesion evolution and imaging are described, together with the surgical management, histopathology and
follow-up. Early clinical assessment, differential diagnosis and magnetic resonance imaging allow clinicians
to diagnose and treat this rare congenital condition with surgery in early infancy.
Key words: mucocele, congenital ranula, mouth, cystic dilatation
159
Prenatal Diagnosis of D Transposition of Great Arteries-Impact in Perinatal and Neonatal
Management
hajrije ismaili1,2, Hajrije Ismaili2
1
HPG23, Italy
2
HPG23, Italy
D-transposition of the great arteries is the most common cyanotic congenital heart defect to present in the 1st
week of life. A growing number of transposition of the great arteries is diagnosed before birth. Few studies
have evaluated the impact of prenatal diagnosis on perinatal management. Most patients with d-TGA/intact
ventricular septum are now successfully treated with prostaglandin E infusion, balloon atrial septostomy and
arterial switch operation in the first week of life.
Purpose of this study was double
Descriptive analysis of several parameters of the group involved in the study and analysis of the two
subgroups across different variables. First subgroup consists, whether were prenatally or postnatally
diagnosed, and second whether TGA was simple or complex.
Methods
We included patients with dTGA over a 4/year period from January 2012 to December 2015 in Papa
Giovanni XXIII Hospital, Bergamo. Charts for 43 patients were obtained and enrolled in study. Antenatal,
perinatal and neonatal variables were investigated. As statistic indicators were used: Structure, Percentage, P
value.
Results:
Our population of patient with TGA was divided into two cohorts study based on whether they were
prenatally or postnatal diagnosed. During study period, 16 patients(37.2%) were not diagnosed prenatally
and 27 patients (62.8%) were diagnosed prenatally. Among prenatally diagnosed patients(27), 23 were born
in HPG23,3 in OORBG-Bergamo, at an obstetric unit adjacent to our cardiac unit. . In prenatally diagnosed
patients, totally 27, 20 of them were born spontaneously and 7 were born by cesarean section. ASO was
performed at median of 8-14 days
Conclusions
Prenatal diagnosis of TGA, is an important factor that contributes in perinatal and neonatal management.
More efforts should be put on to increase prenatal diagnosis.
In our study, prenatal diagnosis didn’t alter the mode of delivery. It was offered planned and induction of
labor and deliveries were ended spontaneously in prenatally diagnosed patients.
Cesarean section was performed only for obstetric indications.
ASO was led according to recommendations.
Key words: Fetal echocardiography, Transposition of Great Arteries, Arterial switch operation.
160
Impairment of Brain Growth after Intraventricular Haemorrhage
Katharina Goeral1, Katharina Goeral, Bernd Schweiger3, Britta Hüning3, BM Hüning,
Gregor Kasprian2, Gregor Kasprian, Renate Fuiko, Renate Fuiko1, Ursula Felderhoff-Müser,
Angelika Berger, Monika Olischar, Ursula Felderhoff-Müser3, Angelika Berger1, Katrin
Klebermass-Schrehof, Bernd Schweiger, Monika Olischar1, Katrin Klebermass-Schrehof1
1
1, Austria
2
2, Austria
3
3, Germany
Background and aims
Brain biometry at term equivalent age has been shown to correlate with three-dimensional volumetric
measures and was recently used to study the degree of impaired brain growth in very preterm neonates. The
aim of the present study was to evaluate the additional impact of IVH on impaired brain growth.
Methods
Seventy-four preterm infants with IVH and Impaired brain growth was defined according to Kidokoro et al.
(increased IHD or small BPW pattern) and was evaluated by using one-dimensional measurements on MRI.
Interhemispheric distance (IHD) and biparietal width (BPW) were quantified. Z-Scores were calculated by
comparison to normative data of healthy age-matched controls published by either Garel (fetal MRI, data up
to 38 weeks gestation) or Nguyen Te Tich et al. (data at TEA).
Results
56.9% of neonates showed no parenchymal defect, 13.5% a localised and 16.2% an extensive parenchymal
defect
as
defined
by
Bassan
et
al.
IHD showed a mean Z-score of +1.9±2.0 and BPW a mean Z-score of -2.6±1.7. Summarised, 95.3% of
neonates showed some form of impaired brain growth (37.5% increased IHD and 92.2% small BPW pattern;
34.2% impaired brain growth according to both patterns).
Conclusions
Comparing our percentages of impaired brain growth to the cohort of 325 very preterm neonates studied by
Kidokoro et al., a comparable percentage of increased IHD, but a three-fold increase in the percentage of
small BPW pattern can be observed. This underlines the impact of IVH on brain growth.
161
Humeral pseudo aneurysm secondary a blood extraction.
Clinical case.
Natalia Ines Carrilho, Mercedes Almosni, Luciano Razetto, Laura Carbonell
Clínica Independencia, Argentina
Introduction
Humeral pseudo aneurysm is a rare entity, caused by extra vascular processes that damages the arterial wall.
The aetiology is variable, the most common cause is trauma, resulting in a disruption of the arterial wall and
secondarily in an aneurysm on the involved area. This type of aneurysms affect peripheral arteries, like in the
extremities. On physical examination a growing mass can be observed, pulsatile, on the affected area.
Complications are thrombosis, blockage or rupture of the aneurysm, therefore an early diagnosis and
treatment is important. The diagnosis includes: x-ray, Doppler ultrasound and MRI scan (magnetic
resonance). The recommended treatment is surgical repair with extreme-anastomosis and subsequent clinical
treatment in order to evaluate growth and functionality of the tracking member .
Objectives
To describe a pathology of iatrogenic origin with the aim of improving the security in the attention of
inewborns.
Clinical case
Patient of masculine sex, RNPT/APEG (36 weeks / 3675gr). He joined with 24 days of life to UCIN, derived
from pediatrics as since the first 4 days of life it presented a tumor at the third distal of the left arm. MSI
radiography was performed: without special features; ultrasound:hypoechoic image rounded with wall of
27,5 x 16 x 19mm with turbulent flow in its interior; Doppler ultrasound of the MSI: humeral artery at the
third distal with neck and sack image, turbulent flow, compatible with left brachial artery pseudo aneurysm.
He was evaluated by vascular surgery who realized a surgical treatment. He continues being monitored by
the paediatrics service.
Conclusion
The injury of the brachial artery is a rare complication of blood extraction and late diagnosis. Therefore the
emphasis should lie on a correct extraction technique as well as the thorough physical examination for
diagnosis and early intervention.
Bibliography:
Pediatria Surg Int (2004) 20:594-597. Arch Dis Child Fetal Neonatal Ed 2003 88:F152-F153
162
Neonatal Morbidity in Macrosomic Babies
Gamze Ozgurhan, Asuman Guney, Rabia Nur Temiz, Serdar Comert
Suleymaniye Maternity and Children’s Training and Research Hospital, Turkey
Purpose
Macrosomia is defined as birth weight over 4000 grams. Neonatal complications can be seen frequently in
macrosomic babies. In this study, we aim to compare macrosomic babies and AGA (appropriate for
gestational age) babies in terms of neonatal morbidity.
Methods
Maternal age, gravidity, parity, gestational diabetes, gestational hypertension, body mass index (BMI) before
pregnancy, weight gain during pregnancy, type of delivery, gestational age and sexuality of babies,
anthropometric measurements, incidence of birth trauma, Apgar score, respiratory distress score, presence of
metabolic problems as hypoglycemia, polycythemia, presence of hyperbilirubinemia, pathological weight
loss and requirement of hospitalization is evaluated prospectively and compared for each group. Windows
SPSS 22.0 program was used for statistical analysis and p
Results
A hundred macrosomic and 100 AGA baby were included in this study. Maternal age, macrosomic sibling
history, BMI before pregnancy, weight gain during pregnancy were significantly higher macrosomic group
(p=0.047, p=0.001, p=0.003, p=0.007 respectively). Gestational age of babies and (39.8, 39), rate of male
gender (70%, 49%) were also significantly higher in macrosomic group. First minute Apgar score was
significantly lower in macrosomic group but 5. Minute Apgar score was not significantly different between
two groups. Positive pressure ventilation application score was significantly higher in macrosomic group (p=
0.04). Clavicle fracture, caput succedaneum and ecchymosis rates were found to be significantly higher in
macrosomic group (p=0.004, p=0.005, p=0.022 respectively) but brachial plexus paralysis cephal hematoma
rates were not significantly different between two groups. Hypoglycemia and pathological weight loss were
significantly higher in macrosomic group (p=0.03, p=0.038 respectively) while other variables were not
significantly different between macrosomic and AGA groups.
Conclusion
High maternal age, macrosomic birth history, high BMI before pregnancy, more weight gain during
pregnancy and presence of gestational diabetes are risk factors for macrosomic birth. Birth trauma,
hypoglycemia and pathological weight loss were seen more frequently in macrosomic babies. For this
reason, after a careful physical examination, blood glucose levels and weight measurements should be
monitored closely.
163
Factors Affecting Breastfeeding in Late Preterm Infant
Maria Livia Ognean1, Corina Zgarcea1, Raluca Dumitra1, Oana Boanta1, Simona Kovacs2,
Ecaterina Olariu1, Doina Andreicut2
1
Clinical County Emergency Hospital, Romania
2
Clinical County Emergency Hospital, Romania
Introduction
Increased neonatal morbidity and mortality and more unfavorable outcomes have been associated with late
preterm birth. Breastfeeding difficulties and lower rates of breastfeeding were reported in late preterm
infants (LPI).
Aim
The authors aimed to evaluate possible risk factors for the lower rates of breastfeeding in LPI.
In a retrospective study the authors analyzed maternal and neonatal factors that may affect partial and
exclusive breastfeeding rates in the LPI (340-366 weeks gestation) born between 1 January 2013 and 31
December 2015 in the Maternity Hospital Sibiu. Maternal and neonatal characteristics, epidemiological and
clinical data were extracted from neonatal charts and comparatively analyzed between exclusively breastfed
LPI and those partially breastfed and formula fed LPI. Statistical analysis was performed using SPS for
Windows 10.0 and p was considered statistically significant if 0.05.
Results
The study group comprised 435 infants - 60 exclusively breastfed, 335 partially breastfed, and 40 formula
fed infants at discharge. When comparing the exclusively breastfed infants with those formula fed we found
that those fed exclusively with formula had significantly lower gestational age (p=0.043), birth weight
(p=0.000), Apgar scores at 1 minute (p=0.029), higher incidence of maternal fetal-infections (p=0.021: OR
1.94[ci95% 1.22-3.08]) and hospitalization length (p=0.002). Also, their mother were more often
multiparous (p=0.001), more often resident in rural areas (p=0.022), without prenatal care (p=0.001), less
educated (p=0.000). The comparison between exclusively breastfed LPI infants with those partially breastfed
showed no difference in gestational age and birth weight but exclusive breastfeeding was associated with
higher rates of anemia at birth (p=0.009), lower mean hemoglobin levels (p=0.012), increased rate and
duration of NICU hospitalization (p=0.034, p=0.012 respectively), and residence in urban areas (p=0.033).
Conclusions
Identification of factors that may affect breastfeeding rates may help professionals to implement effective
strategies or interventions for breastfeeding success in LPI infants.
164
Antenal Exposure to Magnesium Sulphate and the Risk of Spontaneous Intestinal Performance and
Necrotizing Enterocilitis in Very Peterm Neonates
Mohamed Ahmed1,2, Prakesh Shah2, Adel Mohamed2
1
Hospital for sick children, Canada
2
Mount Sinai Hospital, Canada
Background
Objective
To assess the risk of SIP and/or necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW)
infants exposed to MgSO4 antenatally.
Design
A retrospective cohort study was conducted using data from the Canadian Neonatal Network database.
Infants born
Result
Exposed (n=2055) and unexposed infants (n=2300) were compared. Demographic data and outcomes are in
[Table 1]. Results of multivariable regression analysis are in [Table 2].
Conclusion
Antenatal MgSo4 was not associated with NEC or SIP in ELBW infants including the subgroup of
165
Incidence of Extrauterine Growth Retardation and Related Factors in Preterm Infants
Sertac Arslanoglu2, Mehmet Emin Oguz1, Demet Terek1, Kıymet Celik1
1
Behcet Uz Children's Hospital, Turkey
2
İstanbul Medeniyet University, Turkey
Bacground/Scope
Despite advances in neonatal nutrition, extrauterine growth retardation (EUGR) for tiny preterm infants is
still a problem in the Neonatal Intensive Care Unit (NICU)s. EUGR is associated with important morbidities
including neurocognitive aoutcome. The aim of this study is to find out the incidence of EUGR and related
factors for preterm infants at a Level III NICU in the western coast of Turkey.
Methods
retrospective cohort study was planned with a duration of 18 months.Preterm infants admitted within the first
day of life and stayed at least 2 weeks at the NICU were included. EUGR was defined as growth below 10th
percentile at discharge. Demographic characteristics of mothers and infants, antenatal, natal risk factors, inhospital morbidities/procedures, growth and nutritional intakes were recorded. The incidence of EUGR along
with the possible associations between the nutritional, non-nutritional factors and EUGR development were
analysed using SPSS 20.0 Program for Windows.
Results
Out of 517 screened admissions, 110 preterm infants with a mean birth weight of 33.2 +- 2.2 weeks met the
inclusion criteria.While at birth only 15.5 % of the infants were SGA, EUGR rate was 45.9 % at the
discharge. EUGR development was associated with lower birth weight, sepsis, severe RDS and NEC, lower
fat intake in the first week .
Conclusion
EUGR continues to be a problem for preterm infants. The observed relationship between low fat intake and
EUGR might be partly due to our strategy of providing appropriately high protein intakes from the first
hours of life, but going slow for fat. The nutritional protocol was modified accordingly.
166
Hearing Loss and Associated Factors in VLBW Infants: Results from a Level III NICU at the
Anatolian Side of İstanbul
Sertac Arslanoglu1, Sibel Ozumut1, İlke Akın1, Ozgul Bulut1, Nuran Ustun1, Derya
Buyukkayhan1, Cemil Balaban2, Fahri Ovalı1
1
2
Background/Scope
The incidence of hearing loss is 0.3-2.2% in low birthweight and preterm infants. The aim of this study is to
find out the prevalence of permanent hearing loss and related factors in high risk preterm infants admitted to
our NICU and screened at discharge.
Methods
Preterm infants with a birthweight
Results
Out of the whole group admmitted to the NICU during the 3 years study period, 144 VLBW preterm infants
with a mean birth weight of 1227.2 g, a mean gestational age of 29.8 weeks met the inclusion criteria. The
rates for the use of an ototoxic drug, meningitis, mechanical ventilation longer than 5 and 10 days, and Grade
III IVH were 97.8, 2.7, 13.8, 5.5, and 2.7%, respectively. The permanent hearing loss was shown in only one
baby in the whole group (0.69%).
Conclusion
The prevalence of hearing loss was found to be lower than that reported for VLBW infants. Although it was
impossible to perform a correlation analysis for a single case, we speculate that low incidence of some risk
factors such as long mechanical ventilation days and Grade III IVH might partly explain this finding. This
paper presents here the first results of an ongoing study.
167
Congenital Tuberculosis After in Vitro Fertilization: Case Report
Veronica Mugarab-Samedi1, Kamran Yusuf1, Jack Rabi1, Salam Aljubouri1, Kyle Kurek2,
Polya Ninova1
1
University of Calgary, Canada
2
Alberta Children Hospital, Canada
Congenital tuberculosis is one of the rare manifestations of this dangerous disease. The diagnosis is usually
delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of
awareness of maternal disease prior to pregnancy. We report a case of congenital tuberculosis in an infant
born at 24 weeks of gestation to mother who presented with uncontrolled seizures during preterm labor.
Initial diagnosis was done by placental pathology that showed necrotizing granulomatous deciduitis and
subchorionitis with small aerobic non-motile bacilli inclusion and later confirmed by isolation of
Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Immediately after discovery of maternal
TB, infection diseases and TB services were contacted. Infant had full screening for TB including repeated
AFB culture of blood, CSF , endotracheal aspirates, gastric aspirates, urine and stools, and treatment for
tuberculosis with a four-drug regimen was started in both the mother and infant.
168

INAC 2016 Abstracts

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