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    INAC 2014 abstracts INAC 2014 abstracts Document Transcript

    • 1
    • 2 Evidence Based SpO2 Monitoring: Targeting in Preterm Infants Augusto Sola President of Ibero-American Society of Neonatology (Siben), USA Oxygen is a neonatal health hazard. Three randomized clinical trials (RCT’s) studied SpO2 targeting in infants 28 weeks gestation using signal extraction technology oximeters (SET, Masimo, Irvine, Ca.). Two SpO2 targets were compared (85-89% vs 91-95%). In two RCT’s SpO2 85-89% was associated with increased mortality and SpO2 91%-95% with a higher incidence of severe retinopathy of prematurity (ROP). The other RCT revealed no differences in mortality or ROP between the two SpO2 targets. SpO2 of 85-89% cannot be recommended. SpO2 of 91-95% is a narrow target that can be associated with hyperoxia. Wider intermediate targets may be safer than 85-89% and 91-95%.
    • 3 Universal CCHD Screening Saves Lives: International Update in CCHD Screening Anne de-Wahl Granelli Heriot-Watt University, India 30% of the babies with critical congenital heart disease (CCHD) leave the newborn nurseries without a diagnosis. Five percent of them will die without a diagnosis, and 25% return with a circulatory collapse. In 2011, the US secretary of health recommended to add CCHD screening with pulse oximetry to the mandatory newborn tests. Several multicenter studies have concluded that this simple test reduces the risk significantly. The international progress of CCHD screening with pulse oximetry in USA, Europe and Asia will be shared with you.
    • 4 Clinical Matters and Discernment on Neonatal SpO2 Monitoring Augusto Sola President of Ibero-American Society of Neonatology (Siben), USA SpO2 in daily clinical practice will be presented to provide bedside neonatal care providers with tools to improve monitoring, clinical decision making and avoid undesired hazardous hypoxia and hyperoxia. There are many SpO2 monitors in the market. Signal extraction technology oximeters (SET, Masimo, Irvine, Ca) measure through motion and low perfusion and provide perfusion index. For resuscitation and continuous care of ill neonates several technical issues are of importance, including types of sensors used and their placement and other. SpO2 targets of 85-89% or of 91-95% are not ideal. Wider intermediate targets may be safer than both of them.
    • 5 Evidence Based Medicine: Advantages and Implementation of Screening for Critical Congenital Heart Disease Anne de-Wahl Granelli Heriot-Watt University, India The strategies for implementing CCHD screening with pulse oximetry were endorsed by AAP, ACC and AHA in 2011, and based on European research. The journey from identifying the problem, finding evidence based solution and implementing CCHD screening across Sweden will be shared. Pitfalls, obstacles and answers to the most common questions about implementing a CCHD screening program will be shared with you.
    • 6 Effect of Therapeutic Hypothermia on DNA Damage and Neurodevelopmental Outcome among Term Neonates with Perinatal Asphyxia: a Randomised Controlled Trial Bahubali Gane1 , Vishnu Bhat1 , Nandakumar S2 , Ramachandra Rao2 , Ramachandra Rao, Harichandrakumar K T3 1 Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), India 2 Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), India 3 Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), India Background: One of the mechanism by which therapeutic hypothermia acts is by reduction in oxidative stress-induced DNA damage. We studied the effect of therapeutic hypothermia on DNA damage with the help of comet assay (Olive tail moment) and oxidative stress by serum 8-hydroxy2-deoxyguanosine(8- OHdG). Objective: To study the effect of therapeutic hypothermia on oxidative stress-induced DNA damage and neuro developmental outcome in term babies with perinatal asphyxia. Methods: Babies were randomized into hypothermia and control group. Babies in the hypothermia group were cooled for the first 72 h after birth using cloth-covered gel packs. Target rectal temperature of 33–340 C was maintained for 72hours. Blood sample was collected before, at 36 h and after completion of therapeutic hypothermia (at 72 h) for DNA damage and oxidative stress assessment using comet assay & 8-hydroxy2-deoxyguanosine. Infants were followed up to 18 months and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII), Indian adoption of Bayley Scale Results: There were no significant differences in baseline parameters. After 72 h, the hypothermia group showed lower olive tail moment (12.88±2.14 arbitrary units) than the control group (22.16±5.26) (p0.05). 8- OHdG levels increased drastically in control group (1252.87±357.07) than the hypothermia group (757.03±198.49) (p0.05). Neurodevelopmental assessment at 18 months showed significantly low motor and mental developmental quotient in control than the hypothermia group. Conclusion: Therapeutic hypothermia reduces oxidative stress-induced DNA damage and improves neurodevelopmental outcome at 18 months in perinatal asphyxia.
    • 7 Neonatal Resuscitation- An All Wales Survey on Training of Junior Doctors Jaya Parasuraman Wales Deanery, UK Introduction: All junior doctors undertaking pediatrics rotation are expected to attend deliveries and provide at least the basic level of neonatal resuscitation. This is quite daunting especially to junior doctors at the foundation level. This survey looked into the training available to the junior doctors in neonatal resuscitation prior to and during their pediatrics rotation in the Welsh hospitals. Methods: Junior doctors doing their first pediatrics rotation requiring neonatal resuscitation were included in the survey. They include foundation level doctors (F1/F2), GP trainees, junior pediatric trainees (ST1/ST2) and trust grade doctors. The online-based survey was sent to them through Wales Deanery, local postgraduate centers, pediatric secretaries and WRCPCH Facebook page. The survey was conducted from December 2012 to April 2013. Results: 26 doctors responded to the survey from hospitals all over Wales. 26.9% of doctors were not aware that they had to provide neonatal resuscitation in their rotation. 88.5% of them have not attended Neonatal Life Support course. 24% of doctors did not receive formal training in neonatal resuscitation prior to attending deliveries. 40% of doctors attended 5 deliveries under supervision initially. A concerning 40% of juniors doctors have been put in a situation where they felt not competent in attending neonatal resuscitation independently. Conclusion: This survey has identified a gap in the neonatal resuscitation training provided to junior doctors. In response to this, a study day focusing on basic neonatal resuscitation is being set up for the junior doctors.
    • 8 Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy Ori Hochwald1 , Mohammed Jabr2 , Horacio Osiovich2 , Steven Miller3 , Patrick McNamara3 , Pascal Lavoie2 1 Rambam Medical Center, Israel 2 University of British Columbia, Canada 3 Hospital for Sick Children and the University of Toronto, Canada Background: Therapeutic hypothermia (TH) improves outcomes in newborns with perinatal hypoxic- ischemic encephalopathy (HIE) and is now the standard of care in neonatology. However, data are lacking on the hemodynamic effects of TH on the systemic and cerebral blood circulations in newborns. Objective: To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow and brain injury during whole-body TH. Study design: Sixteen newborns with moderate or severe hypoxic ischemic encephalopathy were studied using echocardiography during and immediately after TH. Measures were also compared with twelve healthy control newborns of similar post-natal age. Newborns undergoing TH also had a cerebral magnetic resonance imaging (MRI) as part of routine clinical care on post-natal day 3 to 4. Results: LVCO was markedly reduced (mean+/-SD: 126+/-38 mL/kg/min) during TH, whereas SVC flow was maintained within expected normal values (88+/- 27 mL/kg/min) such that SVC flow represented 70% of the LVCO. This reduction in LVCO during TH was mainly accounted by a reduction in heart rate (99 +/- 13 BPM versus 123 +/- 17 BPM; p0.001) compared to immediately post-warming in the context of myocardial dysfunction. Neonates with documented brain injury on MRI showed higher SVC flow pre- rewarming, compared to new borns without brain injury(p=0.013). Conclusion: Newborns with perinatal hypoxic-ischemic encephalopathy showed a preferential systemic-to- cerebral redistribution of cardiac blood flow during whole-body TH, which may reflect a lack of cerebral vascular adaptation in newborns with more severe brain injury.
    • 9 Incidence and Outcomes of Asphyxia in Term and Near-Term Infants Born in Public Hospital from a Low-Middle-Income Country Sithembiso Velaphi University of Witwatersrand, South Africa Background: Birth asphyxia is one of the common causes of mortality in neonates. Asphyxia incidence and outcomes in developing countries are not commonly reported. Objectives: To determine the incidence and outcomes of asphyxia at hospital discharge in a public hospital from a low-middle-income-country. Methods: This was a retrospective descriptive study. Records of neonates weighing ≥2000g who were admitted or died in delivery-room with a primary diagnosis of asphyxia (defined as need for bag mask ventilation and admission to NICU) were reviewed for maternal/infant characteristics, resuscitation and outcomes at hospital-discharge. Results: Among the 23035 total live-births per year, 21086 weighed ≥2000g of which 357 had a diagnosis of asphyxia, giving an incidence of 16.9/1000 live-births. Using other criteria to define asphyxia the incidence varied from 2.5 to 12.1/1000 live births. Resuscitation required was bag mask-ventilation only in 90%, while 7% and 3% also required chest-compressions and adrenalin respectively. Hypoxic-ischaemic- encephalopathy (HIE) Stage-I occurred in 131 (47%), Stage-II in 122 (43%) and Stage-III in 28 (10%) with mortality rates of 1.5%, 5.7% and 57% respectively. Infants who had Apgar score 5 at 10 minutes, required adrenalin or took more than 20 minutes to spontaneous breathing were more likely to die or have moderate to severe HIE with odds ratio of 19.13 (95% CI;5.66-66.89); 81.2 (95% CI; 13.17-647.7) and 27.9 (95% CI; 6.89-117.3) respectively. Conclusion: Incidence of asphyxia is high. Severe HIE is associated with high mortality. Apgar score 5 at 10 minutes, use of adrenalin and time-to-spontaneous-respiration may be useful in decision making where resources are limited.
    • 10 Helping Babies Breathe (HBB) Training in Remote Areas of China: Educational Impact of a Pilot Training Workshop Qing Yue1 , Tao Xu1 , Huishan Wang1 , Linmin Gong1 , Danhua Wang2 , Lixin Wang3 , Mei Jiang4 , Shiwen Xia5 , Tong Zhang1 1 National Center for Women and Children's Health,China CDC, China 2 Peking Union Medical Colledge Hospital, China 3 Global Care Women and Children's Hosipital, China 4 Beijing Obstetrics and Gynecology Hosipital, China 5 Hubei Province Women and Children's Health Care Hospital, China Background: Helping Babies Breathe (HBB) is an evidence-based educational program which teaches the simple and essential steps that effectively resuscitate the majority of infants not breathing at birth, aiming to reduce mortality from birth asphyxia. HBB could extend resuscitation training in resource-limited settings. Objective: To evaluate the training effectiveness of HBB program in remote areas of China, providing proposal and reference for expanding HBB program in future. Based on the HBB educational materials of American Academy of Pediatrics (APP), a two-day intensive training work was carried out by sufficient master trainers among 73 healthcare providers from county level hospitals of Tibet and Sichuan province in 2013. The neonatal resuscitation (NR) knowledge of trainees and their self-confidence to complete NR were evaluated and compared before and after training. Bag and mask ventilation skills and objective structured clinical examination (OSCE) Station A and Station B were assessed after the training. Methods: NR knowledge score improved from 12.43±3.50 to 15.86±1.60 after HBB training, with statistically significant difference (t=7.42, P0.001). NR confidence score improved from 2.15±1.01 to 3.38±0.80, with statistically significant difference (t=7.72, P0.001). 72.2% of 73 trainees mastered the whole 7 items on bag and mask ventilation skill after training, and 16.7% of trainees mastered 6 items of the skill. 92.3% of trainees passed the OSCE A assessment, 83.9% passed the OSCE B assessment, and 77.4% passed both assessments. Conclusions: Healthcare providers participating the HBB training can significantly improve their NR knowledge and confidence. More simulation trainings are needed for healthcare providers to master the practical bag and mask ventilation skills, and deal with complex clinical cases correctly.
    • 11 Egyptian Neonatal Network, Four-Year’s Experience Mohamed Reda Bassiouny, William Keenan, Amr Elshahed Egyptian Neonatal Network, Egypt The field of neonatology has been dramatically changed during the past decade. With these changes, it was not always clear what was the "best" practice. Evidence of this is seen in the wide variations in outcome and process indicators in the network database. There are many Neonatal networks all over the world e.g. Vermont Oxford Network, National Institute of Child Health and Human Development, Canadian Neonatal Network and European Neonatal Network. Egypt showed advancement in neonatal care provided in many NICUs. For evidence based neonatal care, continuous collaboration should be established between these Units. An Egyptian Neonatal Network (EGNN) is established 2010 in Egypt supported by Tempus Grant from EU to study our local problems . EGNN is not-for-profit organization whose mission is to improve the quality and safety of medical care for newborns and their families through a co-ordinated program of research, education and quality improvement projects. This can be achieved through: creating databases, conducting outcomes research, clinical trials and collaborative quality improvement. Since then 38 neonatal units have joined. They add more than 10,000 patient's records. The data were defined in advance. Also data has been verified and passed three phases of validation before analysis. A centre participating in EGNN can receive important benefits including: reports with feedback about its performance, opportunities to participate in collaborative quality improvement projects, research projects and clinical trials, the Network’s newsletter and notifications of annual meetings. This will facilitate audit – outcomes and resource use, research – clinical trials, health services, population health, translational research, quality improvement, professional guidelines, education and training, policy and resource allocation decisions, advocacy and international collaborations. The activities of EGNN will be displayed. All neonatal associations and Funding agents are invited to share and support EGNN and to extend their work to regional and international network.
    • 12 Comparison of Two Natural Surfactants for Pulmonary Hemorrhage in Very Low Birthweight Infants: a Randomised Controlled Trial Dilek Dilli, Şenol Bozdağ, Tülin Gökmen, Uğur Dilmen Zekai Tahir Burak Maternity and Teaching Hospital, Turkey Objective: To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low birthweight (VLBW) infants. Study design: A prospective randomised controlled trial were conducted on 42 infants who were divided into two groups; poractant alfa (n=21) and beractant (n=21). Primary outcome measure was oxygenation index (OI) calculated before and after surfactant. Results: In groups, the mean (SD) birthweight and gestational age were similar [1051g (236) vs 1074g (242), P=0.33] and [27.9 (2.3) vs 27.2 (2.3), P=0.89]. Although the mean OI increased after pulmonary hemorrhage compared to baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group [before pulmonary hemorrhage: 11.9, after pulmonary hemorrhage: 22.7, after surfactant: 14.6, P=0.003 vs before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, after surfactant: 12.8, P=0.02]. There was no significant difference between the groups for after surfactant OI values (P=0.59). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in groups. Conclusion: Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.
    • 13 Volume Guarantee Pressure Support Ventilation in Extremely Preterm Infants and Neurodevelopmental Outcome at 18 Months Beatrice Stefanescu1 , Naima Frewan2 , Chris Slaughter1 , Michael O'Shea2 1 Vanderbilt University School of Medicine, USA 2 Wake Forest University School of Medicine, USA Background: Compared to pressure-controlled ventilation, volume targeted ventilation is associated with decreased neonatal complications including the combined outcome of death or bronchopulmonary dysplasia. However, little is known about its effect on neurodevelopmental outcomes. Objective: We evaluated the hypothesis that as compared to pressure-controlled ventilation, volume targeted ventilation, increases survival without neurodevelopmental impairment in extremely preterm infants. Methods: We studied a cohort of extremely preterm infants (birth weight ≤ 1250 grams) managed with either volume guarantee pressure support ventilation (VGPSV; n=135) or pressure controlled ventilation (PCV; n=135). Infants were evaluated at 18 months adjusted age with a standardized neurological examination and the Bayley Scales of Infant Development-Third Edition (Figure 1). Logistic regression models were used to evaluate the association of ventilation mode and neurodevelopmental outcomes. Results: Infants in the VGPSV group had a shorter time on mechanical ventilation than infants in the PCV group (median time on mechanical ventilation was 11, and 23 days, respectively; log rank p value 0.01; Figure 2).
    • 14 Rates of pulmonary interstitial emphysema (OR 0.6, [0.4, 0.8]; p = 0.006), hypotension (OR 0.7, [0.5, 0.9]; p = 0.01), and mortality were lower among infants treated with VGPSV (OR 1.7, [1.01, 2.9]; p = 0.03). Seventy percent (155/221) of survivors were evaluated at 18 months adjusted age. No difference was found in the risk of the combined outcome of death or neurodevelopmental impairment (Table 1).
    • 15 Conclusion: Although VGPSV was associated with lower mortality and improved short-term outcomes, it was not associated with improved neurodevelopmental outcome. The lack of improvement in neurodevelopmental outcome among infants treated with volume ventilation might be attributable to improved survival of infants at particularly high risk of impairment.
    • 16 Surfactant replacement therapies; Poractant versus Beractant; 5 Years’ Experience of Ankara Training Research Hospital Hatice Tatar Aksoy1 , Serçin Taşar2 , İnci Arıkan2 , Yıldız Dallar Bilge2 1 Ankara Training and Research Hospital, Turkey 2 Ankara Training and Research Hospital, Turkey Background: Surfactant replacement in preterm infants with respiratory distress syndrome (RDS) has been a major therapeutic breakthrough. Surfactant also can be used in other. Objective: To evaluate indications of surfactant replacement therapies in a NICU of a research hospital and compare the outcomes of the usage of two different form (poractant vs beractant). Methods: In this retrospective trial, we evaluated the outcomes of 137 infants treated with surfactant in 5 Years period. 23 infants were treated with poractant, 114 infants were treated with beractant. Results: Mean gestational age and birth weight was not different between the groups (32 vs 32 weeks, 1972g vs 2000g, p=0.76 and p=0.9 respectively). The primary diagnosis was MAS in 27 patients and pneumonia in 4 patients and RDS in 82 patients in beractant group. In poractant group 4 patients had MAS, 18 patients had RDS and 1 had pneumonia. Median hospitalization time of the patients was shorter in poractant group but the difference was not statistically different (21,3 vs 23,9 days p=0.6). Median duration of mechanical respiratory support was not different between the groups (1,54 vs 3,12, p=0.3). Three patients had pneumothorax, four patients had pulmonary hemorrhage in beractant group. Mortality rate did not differ between the groups (%12 vs %22 p=0.43). Conclusion: Pneumothorax and pulmonary hemorrhage were not detected with poractant group. Median hospitalization time of the patients was shorter in poractant group but it is not statistically significant, this can be a result of the small sample size of the poractant group.
    • 17 Reference Ranges of Tidal Volume in Preterm Infants Supported with Continuous Positive Airway Pressure Qaasim Mian1,2 , Gerhard Pichler1,2,3 , Corinna Binder3 , Megan O'Reilly1,2 , Khalid Aziz1,2 , Berndt Urlesberger3 , Po-Yin Cheung1,2 , Georg Schmolzer1,2,3 1 Royal Alexandra Hospital, Canada 2 University of Alberta, Cambodia 3 Medical University, Austria Objective: To describe changes in tidal volume (VT) and their correlation to changes in oxygen saturation and heart rate in spontaneously breathing preterm infants immediately after birth. Study design: In this prospective observational two-center study a flow sensor was attached to the facemask of spontaneously breathing infants born at 37 weeks gestational age who received continuous positive airway pressure (CPAP) immediately after birth. Respiratory function, heart rate, and oxygen saturation were continuously recorded during spontaneous breathing Results: Fifty-five infants receiving mask CPAP in the delivery room with a mean (SD) gestational age 31 (3) weeks and birth weight 1647 (500) grams were included. CPAP was started at a median (IQR) 103 (56- 186) seconds after birth and was delivered for 269 (205-379) seconds. Median VT ranged between 4.2-5.8 mL/kg with the individual VT varied between 0.9 and 19.8 mL/kg. Overall, VT increased over the first few minutes after birth and decreased thereafter. The rise in saturation after birth lagged the published normal ranges for spontaneously breathing preterm infants without CPAP. Conclusions: The 50th centile for spontaneous VT in preterm infants during mask CPAP ranged from 4.2 to 5.8 mL/kg with wide individual variation in the first minutes after birth. Preterm babies requiring CPAP after birth may take longer to achieve so-called “normal” saturation targets.
    • 18 Using Mesenchymal Stem Cells to Treat Lung Injury: Effects in a Rat Model of Bronchopulmonary Dysplasia Megan O'Reilly1 , Marius Moebius1 , Farah Eaton1 , Lavinia Ionescu1 , Saima Rajabali1 , Rajesh Anthuvan1 , Arul Vadivel2 , Bernard Thebaud2 1 University of Alberta, Canada 2 Ottawa Hospital Research Institute, Canada Background: Many preterm infants develop a chronic lung disease known as bronchopulmonary dysplasia (BPD), which interrupts lung development and results in long-term pulmonary complications that reach into adulthood. Mesenchymal stem cells (MSCs) prevent lung injury in experimental BPD in newborn rats. Whether MSCs can restore normal lung growth after established lung injury is clinically relevant, but unknown. Aim: Determine if administration of MSCs offers any therapeutic benefit to the adult BPD lung. Methods: Experimental BPD was achieved by exposing newborn rats to 95%O2 from postnatal day 4-14. Animals were then housed in room air (RA) until adulthood. Controls were exposed to RA. MSCs were isolated from human umbilical cord and intratracheally administered to rats (1x106 cells/kg). Three time- points were investigated: MSC-treatment at 1, 3, and 6 months (mo) followed by harvest at 2, 5, and 8mo respectively. -exposed rats exhibited persistent lung injury characterized by arrested alveolar growth with airspace Results: Adult O2enlargement. MSC-treatment at 1 and 3mo partially attenuated injury, but not at 6mo. Lung function parameters were not significantly different between treatment groups at all ages. O2- exposed rats ran a shorter distance at 1 and 6mo, demonstrating lower exercise capacity, but not at 3mo. Exercise capacity was not significantly different after MSC treatment. Conclusions: Treatment of the adult BPD lung with MSCs has the potential to improve lung injury if administered at an early stage of adulthood. Further studies are required to determine if cell-based strategies can be optimized to achieve therapeutic benefit later in adulthood.
    • 19 Does Increasing Blood Sample Volume Improve the Yield of Blood Cultures in the Neonatal Intensive Care Unit? - A Prospective Controlled Trial Ruben Bromiker1 , Nurit Yakobi2 , Maskit Bar Meir3 1 Shaare Zedek Medical Center, Israel 2 Shaare Zedek Medical Center, Israel 3 Shaare Zedek Medical Center, Israel Background: Bacteremia is a frequent complication in neonatal intensive care units (NICU). Blood cultures are the gold standard for the diagnosis. It is a common practice to draw small blood volumes for culture from neonates in order to prevent anemia, however this might compromise the sensitivity of the test. We examined whether using 1 ml of blood in an single aerobic bottle would improve the yield as compared to the current practice of obtaining two samples of 0.5 ml of blood (aerobic and anerobic bottles). Methods: A prospective controlled study was conducted between December 2009 and September 2010 at the NICU of Shaare Zedek Medical Center, Jerusalem, Israel. Study samples were 1ml blood cultures in single aerobic bottle, while control samples (paired) were as described above in our current practice. Culture bottles were weighed before and after blood inoculation. Time to positivity (TTP) was also recorded Results: We obtained 706 complete culture sets from 519 patients. Pathogens grew in 72 cultures from 37 patients. From these 72 cases, isolation of organisms was significantly higher in the control group (94.4% versus 77.7%, McNemar's test, p = 0.012). TTP in 0.5ml and 1ml aerobic bottles was similar and significantly shorter compared with anaerobic bottles. Conclusions: Contrary to our hypothesis, increasing the blood culture volume to 1ml in a single aerobic bottle did not improve the yield of the test, nor did it shorten the time to positivity. The current NICU practice for obtaining cultures is validated.
    • 20 Usefulness of Pulse Oximetry Screening in the Newborns for Detecting Critical Congenital Heart Disease in Rural Hospital Amar Taksande Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, India Background: Congenital cardiovascular malformations are the most common category of birth defects and responsible for more deaths in the first twelve month of life. Critical congenital heart disease (CCHD) will be present in approximately one quarter of these children, which requires catheter or surgery intervention in the first year of life. Aim: To determine the accuracy of pulse oximetry screening for detecting clinically unrecognized CCHD in the newborns. Methods: Pulse oximetry was performed on clinically normal newborns at within 4hour of first day of life. If screening oxygen saturation (SpO2) was below 90%, echocardiography was then performed. Inclusion criteria: All newborns who wasadmitted in postnatal ward & NICU. Exclusion criteria: Out born babies and babies with a prenatal diagnosis of duct dependent circulation. Results: Pulse-oximetric screening was performed on 2100 clinically normal newborns. Low SpO2 (90%) was found in eight babies seven of them had CCHD, including three patient with TGA, two with tricuspid atresia, one with tetralogy of fallot and one with transposition of great vessels. A pulse oximetry cut-off value of below 90% for detecting CCHD showed 100% sensitivity, 99.95% specificity, 87.50% positive predictive value, 100% negative predictive value. Conclusions: Pulse oximetry is a safe, feasible test in addition to routine examination of newborn to improve the early diagnosis of CCHD in the newborn. If oxygen saturation in clinically normal newborns is below 90% at 4 hours of age, urgent echocardiography is suggested to rule out CCHD.
    • 21 Treatment Outcomes of Infants with Cyanotic Congenital Heart Disease Treated with Synbiotics Dilek Dilli, Banu Aydın, Aysegül Zenciroğlu, Elif Özyazıcı, Serdar Beken, Nurullah Okumuş Dr Sami Ulus Maternity and Children Research and Training Hospital, Turkey Objectives: The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). Methods: A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage =2), length of NICU stay, and death. Results: A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture- proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14–36] vs 32 days [20–44], P =.07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). Conculsions: Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death.
    • 22 The Effect of a Ductus Arteriosus on Left Ventricular wall Shortening, Size and Volume Changes Measured with Speckle Tracking Echocardiography Koert de Waal1,2 , Anil Lakkundi1,2 , Farrah Othman1 1 John Hunter Children's Hospital, Australia 2 Hunter Medical Research Institute, Australia Background: A ductus arteriosus causes increased preload to the left ventricle and can increase stroke volume (SV). Preload and contractility determine myocardial wall shortening, and wall shortening and left ventricular size determine SV. We explored the interaction between wall shortening and left ventricular size in preterm infants with a range of ductal diameters. Methods: Ductal diameter (DAd), left ventricular output (LVO) and apical 4 chamber clips were imaged and analysed using TomTec software. Global longitudinal strain (GLS) and strain rate (GLSR) as measurements of wall shortening normalised for the length of the wall are provided by the software. The software uses Simpson’s rule to calculate parameters of left ventricular size, such as end systolic volume (ESV) and end diastolic volume (EDV). Results: 124 measurements in 56 infants (median 28 weeks) were analysed. A ductus arteriosus was found in 88 measurements (median DAd 1.5 mm, range 0.5 to 3.2mm). With 0.5 mm increments in DAd, a gradual increase in GLS (-17.7 to -19.6%, p 0.01) and GLSR (-1.64 to -1.84s-1 , p 0.01) with a decrease in EDV (2.38 to 1.91ml, p 0.05) and ESV (0.71 to 0.56ml, p 0.05) and no significant change in SV (1.68 to 1.35ml, p 0.12) and LVO (337 to 363 ml/kg/min, p 0.37) was seen up to a DAd of 1.5 mm. With further increase in DAd, GLS and GLSR decreased (to -17.7% and -1.62s-1 , p 0.05) with an increase in EDV (to 3.21ml, p 0.05) and SV (to 2.62ml, p 0.05). Conclusions: Wall shortening increases and left ventricular size decreases with small increases in preload. With increasing preload, increased left ventricular size and decreased wall shortening was seen. A decrease in GLS and GLSR might be used as marker to indicate volume overload in infants with a ductus arteriosus.
    • 23 Life Threatening Signs and Treatment Interventions of Critical Congenital Heart Defects in Newborns Mary Wyckoff, Sandra Ellingson University of California Davis Medical Center, USA Understanding and identifying congenital heart disease can save the newborn infant’s life. Prenatal ultrasound technology may facilitate identification of underlying disease, but some infants may still present without this critical prenatal information. Without screening, some newborns with critical congenital heart defects (CCHDs) might be missed since the life-threatening signs of CCHD might not be evident before an infant is discharged from the hospital. Infants with CCHDs are at risk for significant morbidity or mortality early in life due to the closing of the ductus arteriosus and other physiologic changes. The CDC has implemented a newborn screening using pulse oximetry, which can identify some infants with critical congenital heart defects (CCHDs). CCHDs are structural heart defects that are generally associated with hypoxemia and may require cardiac catheterization and early surgical intervention to decrease mortality and morbidity. CCHDs represent about 25% of all congenital heart defects and the diagnostics screen for 7 primary targets including hypoplastic left heart syndrome, pulmonary atresia with intact septum, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus and 5 secondary targets coarctation of the aorta, double outlet right ventricle, Ebstein anomaly, interrupted aortic arch, and single ventricle. Treatment protocols will be discussed and case based scenarios will be used to present individual case identification. The guidelines and use of the bedside Near Infrared Spectroscopy (NIRS) for Infant Cerebral Function Monitoring will be provided including treatment protocols and interventions for monitoring.
    • 24 Growth Velocity and Early Brain Maturation in Extremely Preterm Infants after Exposure to Maternal Sounds Amir Lahav Brigham and Women's Hospital, Harvard Medical School, USA Preterm infants in the NICU are often deprived of language exposure that may be crucial for the initial wiring of their brain. Here we report several studies from our lab examining the effects of maternal speech sounds on early growth and postnatal brain development. Seventy six (N=76) preterm infants (25-33 wks GA) were randomly assigned to receive daily exposure to either biological recordings of their own mother's voice and heartbeat (treatment group) or routine hospital sounds (control group) throughout their hospital stay. Infants in the treatment group showed significantly improved weight gain velocity (p=0.001) and increased auditory cortex volume (p=0.05) at one month of age compared to control infants matched for sex, birth GA, birth weight, and illness severity scores. In addition, we show that exposure to maternal sounds significantly reduced the number of apnea and bradycardia episodes (p=0.03), suggesting the role of soothing maternal stimulation in improving cardiorespiratory stability and autonomic self-regulation. These results suggest that exposing preterm infants to maternal auditory stimulation soon after birth may improve growth and neurodevelopment in the early postnatal period. Further studies are needed to determine the development cascade of these effects on subsequent neurodevelopment.
    • 25 Continuous Glucose Monitoring in Preterm Newborns Enrico Zecca, Eloisa Tiberi, Alessandro Perri, Mirta Corsello, Francesco Cota, Costantino Romagnoli Catholic University of the Sacred heart, Italy We assessed feasibility and reliability of a new continuous glucose monitoring system (CGMS) in 20 preterm newborns with a mean gestational age of 32 weeks and a mean birth weight of 1350 g. A subcutaneous sensor connected to the CGMS was inserted within 24h of delivery. Data collected from CGMS were compared with those obtained by a glucometer. Therapeutic management followed the usual standards protocols. The mean duration of CGMS recordings was 137 h, with a total of 449 paired glucose measurements. The Bland Altman Analyses showed a mean (95% CI) difference of -6,8 (-37,4 to 23,8) mg/dl. The Clarke Error Grid (CEG) criteria for clinical significance were met (98% in zone A and B). Because zones in the CEG were defined for the management of adult or paediatric patients with diabetes, we then modified the CEG to adapt it to a population of newborns. Again, the CGMS performance met the criteria for clinical accuracy because we did not find any increase of measurements in zones C, D, and E which involve an inadequate management of hyperglycaemia or hypoglycaemia. Our experience shows that the new CGMS is a safe and clinically adequate method to estimate glucose levels in preterm infants. The new sensor was well tolerated and the wireless connection to the monitor allowed an easy nursing of the neonates. This CGMS can be useful to check glycemic trends and to detect episodes of hypo- or hyper- glycaemia that cannot be valuated with a standard glucose monitoring.
    • 26 Monitoring the Oxygen Status in Infants receiving Mechanical Ventilation by means of Transcranial Cerebral Oximetry Anna Simonova, Estrin Vladimir Research Institute of Obstetrics and Pediatrics, Russia Purpose: To investigate the efficacy of transcranial cerebral oximetry for the diagnosis and prevention of oxidative stress in newborns on mechanical ventilation.Methods: In step 1 examined 24 healthy infants born at 38-40 weeks of gestation , with Apgar 7-10 points , with birth weight 2500-3900 , in a state of sleep after feeding. All children measured oxygen saturation of cerebral tissue (SctL, SctR) at 1, 3 and 5 days after birth. In the future, the study included two groups of newborns on mechanical ventilation. Group 1 patients (n = 38) modes of ventilation and FiO2 were established under the control of cerebral oximetry. Group 2 patients (n =37) selection modes of mechanical ventilation and FiO2 was carried out under the control of pulse oximetry and oxygen tension in capillary blood ( pO2 ) ,excluding cerebral oximetry . All patients underwent determination of peroxides and protein oxidation products (AORR) in serum at 1, 5, 10 day. Results: The age norm of cerebral oximetry in healthy infants was in the left hemisphere of the brain 79,2 ± 4,06% (p 0,01), in the right hemisphere 84,89 ± 5,1% (p0,01 ) . In 1group of patients the mean respirable FiO2 of the blend was 21% in contrast to 55 % for group 2 patients. In group 1 was significantly ( p0,01) decreased the length of stay on mechanical ventilation ( from 9.4 to 5.6 days ) compared with group 2 patients .In group 1, the content of peroxides reduced 2 times, and oxidation products ofproteins (AORR) 3 fold compared to group 2 ( p 0.05). Conclusions: Monitoring the oxygen status using transcranial cerebral oximetry decreases FiO2 in the inspired mixture and does not cause the development of oxidative stress in newborns.
    • 27 Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk and Hospitalized, in a Secondary Hospital Montse Pons1 , A Bordoy1 , M Garcia2 , E Alemany1 1 Hospital Manacor, Spain 2 Hospital Manacor, Spain Objectives: To determine the incidence of hypoglycemia in babies identified as being at risk , and hospitalized for any reason ; and also to study the differences and characteristics between each group of patients. Study design: Retrospective study. We revised nurse chart of all the babies hospitalized for any reason in our hospital during 2012 and all babies identified as at risk for hypoglycemia (small, large, infant of a diabetic mother, late-preterm...) during 2012. Background: In clinical practice in Neonates Units, we routinely perform blood glucose screening in risk neonates; but the incidence is not well established in asymptomatic neonates, and there is no evidence that asymptomatic hypoglycemia has any relevant consequence in psychomotor development (2). The clinical management of babies at risk of hypoglycemia has also changed over the last decades, with improved methods for diagnosis, and a greater focus on early feeding and glucose monitoring. However, there are few recent data on the effects of these changes on the incidence of neonatal hypoglycemia. Our hypothesis is that we have very low incidence of neonatal hypoglycemia in our population (secondary hospital) compared with the results of incidence published in a recent paper (3), but it could be either because of the population (tertiary hospital) or depending on the definition of neonatal hypoglycemia is used. We present the results of the review of 348 patients, discuss the results and make recommendations based on our population characteristics.
    • 28 Analysis of Mortinatality Causes in Almaty in 2008-2011 Nyshangul Bozhbanbayeva, Tykaz Mustaphasade, Saule Dikanbayeva, Guljan Baigazieva, Indira Suleimenova Kazakh National Medical University named after S.D. Asfendiyarov, Kazakhstan The aim of the study was to conduct a perinatal audit with regards to the rate level and causes as a basis for the development of measures focused on reduction of perinatal and neonatal mortality. We conducted a retrospective analysis of 2760 mortality cases in Almaty during the period of 2008-2011. During the study of direct neonatal mortality cases (anatomopathological diagnosis) it was found that the leading position belongs to asphyxia (31.1%), second position to intrauterine pneumonia (27.5%), respiratory distress syndrome (20.5%), congenital malformations (14.9%), other (6.1%). The studies revealed that 1139 newborns died in the juvenile neonatal period and it amounted to 41.3% out of the whole number of mortality cases of 0-27 days old infants and stillborns. Out of the total number of stillborns and infants who died within the first 27 days, 605 newborns died within the late neonatal period which amounts to 21.9%. 1016 cases (36.8%) of stillbirths were registered. Of all cases of mortality in neonatal period there were 82.6% of preterm infants, 15.5% of full-term infants and 1.9% of post-term infants. Only 32.1% of infants with birth weight between 500 and 999 and 24.4% of infants with birth weight between 1000 and 1499 grams died. Among all stillbirths the majority of infants (74.4%) died in antenatal period, and 25.3 died in intranatal period. Thus, the analysis of postnatal deaths causes and risk factors (social and domestic conditions, woman's health, peculiarities of pregnancy and labors) has shown that all these factors in varying degree influence the state of a newborn child.
    • 29 Early Term: Are They Really Term? Bahubali Gane, Vishnu Bhat Jawaharlal Institute of Postgraduate Medical Education & Research, India Background: The babies born between 37 weeks (260 days) of gestation up to 38 completed weeks (274 days) are called early terms. We focus attention on a subcategory of term because there are increasing data that these births have higher morbidity and mortality. Aims: To study morbidity and mortality among early term babies during neonatal period. Methods: Total 400 babies were included in the study, 200 were early term and 200 full term. Single live born babies between 37 0/7 weeks to 38 6/7weeks wereincluded as cases after assessing the gestational age at birth based on maternal history and Extended Ballard’s score. The course of hospital stay and progress were monitored and recorded. One fullterm (39-42 weeks) baby of the same sex born immediately after the birth of earlyterms baby was taken as control. The babies were followed up till 28 days. Results: Early term babies had higher neonatal mortality than full term babies [Relative risk 5(CI: 1.1-22), P=0.03]. Early term babies had 13% higher mortality than term babies. Early term babies had significantly higher incidence of perinatal asphyxia [RR-3.7, P0.05], sepsis [RR-4, P0.05], transient tachypnea of newborn, necrotizing enterocolitis, neonatal hyperbilirubinemia. Mean duration of hospital stay was longer in early term babies. Early term babies had significantly higher readmission rate during neonatal period. Conclusion: Early term babies have higher mortality and morbidity when compared to term babies.
    • 30 Outcome for Newborn Babies in Regional Neonatal Intensive Care Unit in Iraq Raid Umran, Mayumi Iwakawa Al Zahra Teaching hospital, Iraq Objective: To document the number, disease pattern and outcome of patients admitted to a neonatal intensive care unit (NICU) at a high workload receiving requests from maternity units with 24,000 deliveries yearly. Design: Descriptive study Method: The study was conducted at a level II Care NICU at Al Zahra teaching hospital at Najaf, in Iraq, from January 2011 to August 2013. The data of all the admitted neonates were analyzed, delivery type, weight at the time of admission, sex, cause of admission and outcome. Results: Four thousands two hundreds seventy seven neonates were admitted during the study period, Neonatal mortality was 969 cases. Eighty-six % of death cases were premature (less than 2500g birth weight). The most common cause of death was respiratory distress syndrome, prematurity followed by Sepsis and birth asphyxia. Conclusions: This study identified overloads by maternity case volumes contributes high neonatal mortality, and mortality rate among infants with low birth weight was high. Attempts to prolong the pregnancy might improve the neonatal outcome considerably. Shortage of trained nursing staff and ethical issue for maternity would be discussed.
    • 31 A Divisive Set-up: the Problems Caused by the Separation of Medical and Surgical Neonatal Services Andrews Hannah University of Birmingham Medical School, UK Aims: This paper explores the impact of transferring neonates for surgery by using a sample from Birmingham, UK. The Women’s Hospital (BWH), houses a level 3 NICU but is 5.5 miles from the Birmingham Children’s Hospital (BCH) where surgery is carried out but there is no NICU. The separation of surgical and intensive care services is perceived to be having a negative impact. Method: Semi-structured parent interviews were carried out at BWH, between May and June 2013. The interviewees were a convenience sample of parents of preterm surgical neonates (mean birth weight 1293g (range: 890g-1910g)). Results: The interviews revealed that the separation of these services is detrimental to parental experiences and is compromising the consistency and level of neonatal care. Qualitative analysis of the interview transcripts has identified problem areas for improvement: neonatal nursing care, hygiene, equipment, breast milk, the NICU/PICU environment, communication, ownership and transport. Some of the suggestions for improvement were: surgeons to visit the NICU more frequently (where surgery could be performed), the (re)training of nurses with neonates and the need for clearer transfer/care plans including neonatal preferences (lighting, touching, noise) and parental needs (emotional and psychological). Conclusion: The ‘Birmingham-type’ set-up causes additional burden for parents and neonates. Listening to the parent feedback in this study could lay the groundwork for improving the situation at sites where surgery and NICU are not co-located. (This project was carried out by a fourth year medical student at the University of Birmingham Medical School)
    • 32 Solar Powered Portable Culture Incubator Vasantha Thavaraj1 , Brijesh Vashishth1 , Arti Kapil2 , Neeraj Kapur3 1 Indian concil Of Medical research,, India 2 All India Institute of Medical Scxiences, India 3 Widsons Scientific works Lid, India Background: The current rate of infant mortality in India is 47/1000, two thirds of which is due to neonatal mortality1 . Neonatal sepsis accounts for more than 50% of the neonatal mortality in India. Ideally the prompt culture of specimens –The results of the lab tests will help clinicians to institute. This will culminate in an overall decrease in morbidity and mortality related to sepsis/infections. In resource-limited countries, in rural communities, there is a distinct lack of (functional) culture facilities; therefore, these specimens would require to be transported to the nearest well-equipped culture laboratory for culturing causative organism, and its sensitivity to antimicrobials. Our main aim was to fabricate a portable culture incubator which could run on solar energy. Methods: Solar Powered Portable Culture Incubator has been fabricated .It has a culture compartment and the battery compartment. The Solar Powered Portable Culture Incubator is made of wood and can maintain a temperature of 35 ± 2º C on a dual system i.e. a battery which is charged through a solar module during daytime, and switches to normal electric power in the night time . During transportation the temperature within the incubator is maintained with a solar module installed on the rooftop of the vehicle. Findings: Sample of pus from an inpatient’s infected wound at a district hospital has been cultured. Blinded Blood agar plates streaked with bacteria and a control plate were cultured in the Solar Powered Portable Culture Incubator. The experiment plate grew bacterial colonies but the control plate did not grow any colonies. Interpretation: The Solar Powered Portable Culture Incubator will help in establishing mobile culture facilities at the district level or the sub-district level; therefore, there is a tremendous scope for this product in our health system in rural as well as urban settings.
    • 33 Neonatal Care without Ventilators: What is the Yield? Subhashchandra Daga MIMER Medical College, India Background: Basic neonatal care, administered through simple interventions, has potential to prevent a large number of newborn deaths in limited resource setting. Methods: First, we strengthened following interventions: provision of warmth, enteralfeeding and oxygen administration for babies with respiratory distress and antibiotics for babies at risk of sepsis.Soon inotropes and pulmonary vasodilators were introduced. Later, CPAP delivery was started using locally assembled unit. We “compared with self” the following outcome variables: Weight-wise mortality, excluding babies less than 1000 g, bed occupancy and hospital stay. Results: Change in mortality was as follows- 1000-1499 g: 54% to 26.6%,1500-1999 g: 13.6% to 12.2%, 2001-2500g: 2.8% to 3.4% and 2500g: 3% to 2.5%. Average bed occupancy changed from 13.7 to 14.5 per day and average hospital stay changed from 10.3 to 11.26 days per baby. Survivals in less than 1000 g category are negligible. Conclusions: A non-ventilatory care can substantially reduce neonatal mortality in all weight categories except 1000 g.
    • 34 Quality of Neonatal Health care in Kilimanjaro Region, Northeast Tanzania: Learning from Mothers' Experiences Bernard Mbwele Christian Social Service Commission, Tanzania, United Republic of Background: Neonatal mortality has remained stagnant 26 to 28 deaths per 1,000 live births in the last 3 years. The aim of the study was to assess mothers’ involvement, experiences, perception and satisfaction of neonatal care in the hospitals of Kilimanjaro region of Tanzania. Methods: A cross sectional study using qualitative and quantitative approaches in 112 semi-structured interviews from 14 health facilities. By Purposive sampling, mothers from Peripheral facilities and Referral Hospital were interviewed for detection of illness, care given to the baby and time spent by the health worker for care and treatment were studied. Results: 80 mothers were interviewed from 13 peripheral facilities and 32 mothers were interviewed at a zonal referral hospital of Kilimanjaro region. Majority of mothers 28 (87.5%) at the referral hospital were referred from the periphery with critical neonatal condition. From these 28, 12 of them (37.5%) assisted in raising a concern for further investigations. From the peripheral hospitals of the region 59 mothers (73.8%) noted neonatal problems and they assisted for attaining diagnosis after a showing a concern for a request for further investigations. 11 mothers (13.8%) were able to identify the baby’s diagnosis directly without any assistance, followed by 7 mothers (8.7%) who were told by a relative, and 3 mothers (3.7%) who were told of the problem by the doctor that their babies needed medical attention. 24 times mothers in the peripheral hospitals reported bad language like “I don’t have time to listen to you every day and every time.” 77 mothers in the periphery (90.6%) were not satisfied with the amount of time spent by doctors for their babies. Conclusion: Mothers of the neonates play great roles in identifying the illness of the newborn. Their involvement in Health care delivery and evaluation is of paramount importance.
    • 35 A Complete Model of Rural Newborn Care in a Developing Country Subhashchandra Daga MIMER Medical College, India State government of Maharashtra, started Rural Newborn care project in a tribal block. Newborn care had two components, the home care and the hospital care. Most births took place at home and deliveries were conducted by traditional birth attendants. Home care revolved around training of birth attendants in thermal care, resuscitation of a depressed baby, identification of a small baby and its safe transportation. The chain of caregivers included, birth attendant, link worker and nurse midwife. At community hospital, the doctors and nurses were trained to deliver special care to referred babies by fine tuning thermal protection, enteral feeding and administration of antibiotics and oxygen, when indicated. Guidelines for management were prepared in graphic form for easy understanding. Principles of newborn care may not be new but adaptation to local situation for the delivery of care was the key to success. Reduction in perinatal mortality, still-birth rate and early neonatal mortality at primary health center area, and weight-wise mortality at community hospital are testimony to it.
    • 36 Efficacy and Safety of Right Internal Jugular Vein Access Guided by Ultrasound in Low Birthweight Neonates Fernando Montes1 , Antonio Rodríguez-Taméz1 , Itzel Barreto-Arroyo1 , Adolfo Hernández-Garduño1 , Isaías Rodríguez-Balderrama1 , José Quero2 , Manuel de la O- Cavazos1 1 Hospital Universitario/ Universidad Autónoma de Nuevo León, Mexico 2 Universidad Autónoma de Madrid, Spain Introduction: The placement of an intravascular catheter is the most frequently invasive procedure performed in the NICU.The options include peripheral lines, umbilical catheters and PICC. Success in achieving these accesses depends on the size of the vessel and the skill of the person performing the procedure. Once you have exhausted these venous accesses, a central venous line is considered. Objective: Evaluate the efficacy and safety of right internal jugular vein (RIJV) access guided by ultrasound in low birthweight neonates. Material and Methods: We carried out a prospective, comparative, longitudinal study in patients less than 2500 g that required placement of a central venous catheter (CVC) by ultrasound in the RIJV. The study was developed in the NICU of the University Hospital in Monterrey, México. In all patients a vascular access had been ordered after having attempted the usual accesses without successfully entering a vein. The population was divided into three groups: low (LBWN, 1500-2500g), very low (VLBWN, 1000-1499g), and extremely low (ELBWN, 1000g) birthweight newborns. During a period of 29 months we included 100 neonates: 39% LBW, 33% VLBW, and 28% ELBW. Of these 53% were female. Mean weight 1352 g. An average of two attempts to puncture RIJV were made and mean duration of the procedure was 16.8 ± 6.7 minutes. A 4 Fr catheter was used. Success of the procedure was 94%. To accomplish this, one puncture was required in 50% of the population, and five in 95.7%. Success was 97% in VLWN, 92.9% ELWN, and 92.3% in LWN. Cannulation was not successful in 6% of cases with a hematoma being present in the puncture area in 5% of cases. Puncture of the carotid artery did not occur. Conclusions: Catherization of the RIJV guided by ultrasound is an effective procedure in different low birthweight neonate populations.
    • 37 Use of Tegaderm TM Dressing for Prevention of Hypernatremic Dehydration in ≤ 30 Weeks Preterm Newborns. Controlled Randomized Trial: Preliminary Results Valentina Cardiello, Valentina Cardiello, Mirta Corsello, Mirta Corsello, Simonetta Costa, Simonetta Costa, Francesco Cota, Francesco Cota, Teresa Pianini, Luca Maggio, Costantino Romagnoli, Enrico Zecca , "A. Gemelli" University Hospital , Catholic University of Rome School of Medicine,, Italy Hypernatremic dehydration is a severe complication of preterm newborn with reportedly highmorbility. The use of Tegaderm dressings, a polyurethane semi-permeable film, is useful in reducing transepidermal water loss. Aim of the Study: Early use of Tegaderm dressing in preterm newborns is useful in reducing incidence of hypernatremicdehydration? Materials and Methods: A controlled randomized trial was designed. All ≤ 30 weeks preterms who were born at our institution from September 1st 2012 to Agoust 10th 2013 were included. Babies with chromosomal syndromes, major malformations and congenital infectious diseases were excluded.Babies in group T received Tegaderm dressing, babies in group noT did notreceive Tegaderm. Hypernatremia was defined as serum Na 145 mEq/l and it wasthe primary endpoint for the study. The sample size to observe a reduction ofthe incidence of hypernatremia from 35% to 15% was 83 babies per group. Secondary outcomes were weight loss, time to regain neonatal weight, IVH, PDA, ROP, NEC,sepsis, and duration of hospital stay. Results: Thirty babies have been included in the T group and 31 babiesin the noT group. No significant differences have been observed in baseline demographics among the two groups. Incidence of hypernatremia in the T group is 26.7% vs 45.2% for the noT group (p 0.18); the maximum weight loss is 10.6% in the T group vs 14.7% (p 0.00191) and occurred on average at 4.4 ± 1.6 days in the T group vs 5.2 ± 1.5 days for the noT group (p 0.046); regain of neonatal weight occurred at 12 ± 3.8 days in the T group vs 14.9 ± 4 days for noT group (p 0.01729). Conclusions: Our results are preliminary. Tegaderm dressing is useful for reducing incidence of hypernatremic dehydrationand maximum weight loss in ≤ 30 weeks’ preterm newborns.
    • 38 Spectrum of Clinical Manifestations of Amniotic Band Syndrome- A 20 years of Experience Krishna Gopagondanahalli Revanna, Suresh Chandran KK Women's and Children's Hospital, Singapore Amniotic band syndrome (ABS) is a spectrum of asymmetrical congenital malformations causing defects in the limbs, head, faceand rarely in the trunk. Spectrum of clinical manifestations varies from simple constriction bands affecting the distal limbsto lethal malformations involving craniofacial and visceral organs. The aetiology of ABS is unclear. In 1930, Streeter described his intrinsic defect of germ plasm theory which fails to explain the variety and asymmetry of lesions involving structures formed embryologically at very different times and derived from different germ layers. Torpin’s theory (1968) of early amnion rupture sequence, leading to development of multiple mesoblastic fibrous strands from chorionic side of the amnion could explain most of the manifestations of ABS. The development of fibrous strands appear to cause damage to the foetus through malformation, deformation and disruption. The clinical manifestations vary from asymmetric annular bands typically causing constriction bands, syndactyly and amputation of limb/digits in severe forms. The multiple, polymorphic, and asymmetrical facial malformations may be due to swallowing of amniotic bands by the fetus. The more lethal malformations involving cranial and facial structures are acrania, anencephaly, and acalvaria. Limb-body wall complex is an example of severe ABS affecting the trunk and extremities. Antenatal diagnosis of most of the cranial vault anomalies seen in ABS can be made as early as 12 weeks with accuracy using high resolution ultrasonography, whereas constriction rings and digital often go undiagnosed. We report a case series with clinical manifestations of ABS of varying severity due to malformation, deformation and disruption studied over the past 20 years.
    • 39 A Retrospective Cohort Study of Infants Born with Meconium Peritonitis in a Tertiary Hospital in Singapore Chandran Suresh, Lee Samanta, Bhavani Sriram, Victor Samuel Rajadurai KK Women's and Children's Hospital, Singapore Meconium peritonitis (MP) is a rare prenatal condition defined as sterile chemical peritonitis resulting from intestinal perforation with leakage of meconium into the peritoneal cavity that may occur in-utero or soon after birth. A retrospective cohort study of fourteen infants with antenatal diagnosis of MP during the period from January 2004 to June 2013 was enrolled. The median gestational age and birth weight were 36 weeks and 2858 grams. Eight were premature infants (57%) ranging from 24 to 36 weeks. The earliest antenatal ultrasonographic (US) diagnosis was made at 19 weeks of pregnancy. Prenatal US findingswere fetal ascites (86%), intraperitoneal calcifications (43%), polyhydramnios (29%), echogenic bowel (21%), meconium pseudocyst (14%) and hydrops fetalis (7%). Two of our infants had normal fetal scan. Meconium pseudocyst was detected postnatally in 50% infants. In the neonatal period, abdominal distension (67%) and bilious aspirates (33%) were the most common manifestations. One infant in the study group remained asymptomatic and was managed conservatively. Plain X-ray of the abdomen showed intraperitoneal calcifications (93%), meconium pseudocyst (33%) and pneumoperitoneum (14%). Nine of the 14 infants(64%) underwent surgery while the rest of them were managed conservatively. Per-operatively ileal atresia and volvulus was found in43% and 14% of babies respectively. All the infants were tested negative for congenital infections and cystic fibrosis. Survival rate was 86% with no long-term morbidities. Two babies in study group died at 3 months of age following pneumonia and enterocolitis. Conclusion: Fetal ascites is the commonest antenatal US finding identified in this cohort of MP infants. Hence fetal ascites when detected as an isolated abnormality in the US scans, it is imperative to look for other radiographic features of MP. In babies with antenatal diagnosis of MP, management should be planned in a tertiary hospital for better survival and reduced morbidity.
    • 40 Neonatal Abstinence Syndrome Due To Dependency-Inducing Drugs- Our Experience With Methadone Treatment Vasiliki Sideri, Christiana Vliora, Anna Daskalaki, Panagioula Mexi-Bourna, Kleanthis Kleanthous, Soulioti Maria, Kyrkou Gianna, Nikos Bournas, Vasiliki Papaevangelou Attikon Hospital, Greece Aim: Our aim was to study methadone substitution-treatment of NAS caused by dependency-inducing substances. Method: We retrospectively studied NICU hospitalization charts of infants with NAS, during 2008-2013. Results: We admitted, over a five year period, 7 neonates (5 girls, 2 boys), born to mothers using dependency-inducing medications, during pregnancy. Three had been accepted in a rehab methadone program, while the rest were active drug-users, most of them abusing more than one substance. Hepatitis C was present in 71.5% of mothers. Delivery was through natural labor in 57%. Median pregnancy length was 39.2±1.7weeks, median birth weight 2765.7±516.12gr and median head circumference 33.5±1.7cm, while 2 neonates had IUGR. All of the aforementioned infants presented with NAS and were treated with oral methadone (except one, who was treated with phenobarbital). The majority (5/7) began substitution therapy on the 2nd day of life, with a modified Finnegan Neonatal Abstinence Score ranging from 9-15. The median length of methadone administration was 37.5±8.9days (29-56 days), while median hospitalization length was 49.6±7.2days (42-156 days). Maximum methadone dose was given between the 10th - 15th day of life, and once treatment was over no relapse occur. Excepting the case in which phenobarbital was administered and who subsequently developed seizures on the 13th day of life, there were no other complications either from NAS or the methadone administration. Brain ultrasound, auditory brainstem responses and otoacoustic emissions were normal in the entirety of patients. One infant was initially given TPN, while the rest received enteral feeding exhibiting adequate weight gain. Upon discharge all of the infants had normal growth and development. Conclusions: Methadone administration for treating NAS seems to be effective and safe. Of course a larger cohort needs to be studied.
    • 41 Solar Powered Baby/radiant warmer Installed at Neonatal Intensive Care Unit at Lok Nayak Hospital,New Delhi Vasantha Thavaraj1 , Sankara Sastry2 , Nav Nidhi Sharma3 , Siddharth Ramji4 1 Indian council of Medical Research, India 2 Solar Energy Centre, 9th Milestone, Institutional Area, Gurgaon- Faridabad Road, Gwalpahari,, India 3 Indian council of Medical research, India 4 Maulan Azad Medical College, India Background: The important health challenges before India is that India has a high Neonatal mortality (death within 28 days after birth), Infant mortality (death within one year). The Open care system of baby radiant warmer is presently being used in our health system in Level I (tertiary care hospitals) and Level II in Special care newborn unit (SCNU) , Neonatal stabilization Unit, New born care corner. Methods: A single open care system of infant radiant warmer with 400 watts of infra red heating element and an energy meter, with baby bassinet was installed in the NICU, in Lok Nayak Hospita. The radiant warmer was kept near the window so that the connection can be made easily with the panel in the roof. The Thermostatic skin servo control device regulates radiant heat. Details of the power plant used: 400W is the peak power during its full load operation. Accordingly the present PV system is designed for about 10 hours of working, the system consumes about 4kWh (or 4units) in a day. Therefore, the designed PV system is for approximate generation of 4 kWh of energy per day. Findings: The Solar powered Radiant warmer has been successfully installed Neonatal nursery, Lok Nayak Hospital and fully functional since 10-12-2012. The preliminary energy consumption study shows that PV panels of 1.2kWp can be connected to 2-3 radiant warmers. Interpretation: The Solar powered baby warmer is environment friendly. It can be used in Tertiary care hospitals and also in rural areas where power supply is erratic and where there is plenty of sunshine this product will help in the care of high risk infants in Level II.
    • 42 Non-invasive Study of the Gut Microbiota Profiles and Mucosal Cells Gene Expression Changes Caused byNeonatal Sepsis in Very Low Birth Weight (VLBW) Twins Maria Carmen Collado1 , Christine Bäuerl1 , Maria Cernada3,4 , Eva Serna2 , Maximo Vento3,4 , Gaspar Perez-Martinez1 1 IATA-CSIC, Spain 2 University of Valencia, Spain 3 Polytechnic University Hospital La Fe, Spain 4 Polytechnic University Hospital La Fe, Spain Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. The role of prenatal microbial contact and its role on health remains elusive. Distortions in the establishment of microbiota might increase the risk of infections. Understanding microbial colonization of the gut in prematurity status and host response may predict risk of late onset sepsis to guide future strategies. Then, our aim was to evaluate the impact of neonatal sepsis on microbiota composition by 16S pyrosequencing and also, the host response by whole genome microarray analysis of exfoliated epithelial cells in very low birth weight (VLBW) preterm twins and likely identification of biomarkers for early diagnostic through non-invasive techniques.Important differences were found in the fecal microbiota and transcriptomic response from exfoliated intestinal epithelial cells in preterm infants who developed sepsis compared their matched healthy twins. Lower levels of Bifidobacterium spp and higher levels of Enterobacteriaceae where found in sepsis than controls. By pyrosequencing, Proteobacteria phylum (Enterobacteriaceae family) was predominant in sepsis. PCoAs showed differences between sepsis and control groups and profiles were twin-pair and neonate-dependent. Transcriptomic analysis of epithelial cells rendered clearly different profiles in infants with sepsis than in their healthy twins. We identified 820 probe sets to be differentially expressed among septic infants and healthy controls. Our data show specific shifts on microbiome and gene expression genes which differentially separate the VLBW premature twins suffering sepsis from their matched control twins. The intestinal transcriptome in response to sepsis measured by the recovery of exfoliated cells in fecal samples represents a non-invasive tool which particularly in VLBW preterm infants minimizes any discomfort to the subject. Our research suggests the potential of microbiota modulation by use of probiotics and prebiotics in order to reduce the risk of sepsis.
    • 43 Regional Prospective Review Study of the Neonatal Infection Screening Methods Within the East of England Neonatal Network. Maria Chalia1 , Michele Upton2 1 Mid Essex Hospital NHS Trust, UK 2 East of England, UK Aim: To monitor the adaptation of the regional neonatal infection screening policy in clinical practice amongst the neonatal units in the East of England region. Background: Based on the existing policy, all babies should have surface swabs taken, following admission or transfer to a neonatal unit. Additionally, all babies on the unit should be screened on a weekly basis in order to detect the presence of Methicillin Resistant Staphylococcus Aureus and other resistant organisms. METHODS: The study period was between September 2012 and May 2013. All 17 neonatal units (level 1to 3) in the region were asked to participate. There was random selection of at least 10 neonates from each unit with a minimal length of stay of 10 days. RESULT: 15 neonatal units participated in the study. Data from 149 babies were selected. The mean gestational age at birth was 32+3 weeks. The mean birth weight was 1.8 kilograms. The median of their stay on the unit was 3 weeks. Pie 1-Origin of Admission
    • 44 Graph 1-Admission swabs
    • 45 Pie 2-Surface swabs
    • 46 Graph 2
    • 47 Graph 3 Conclusions: This study demonstrates that the regional infection screening policy has been well adapted, with 89% of cases having both admission and weekly swabs obtained. This positive and unified practice facilitates communication between units, especially when a neonatal transfer is required. In addition, it reinforces the significance of strong affiliation bonds required between level 1, 2 and referring, level 3 neonatal units within a geographically challenging region.
    • 48 Electrical Inhibition (EI) Of Human Preterm Uterine Contractions: Just Another Pretty Smooth Muscle Jeffrey Karsdon1 , William M Huang2 , Graham Gaylord Ashmead3 1 Unaffiliated, USA 2 New York Presbyterian Lower Manhattan Hospital, USA 3 St. Luke’s-Roosevelt Hospital Center, USA Background: Drugs controlling preterm uterine smooth muscle contractions are inefficient with systemic side effects. Objective: Use a weak electrical current to inhibit human preterm uterine smooth muscle contractions. Study Design: Rabbits and rats had intrauterine pressure (IUP) and/or electromyographic (EMG) activity measured. An electrical device gave EI via electrodes to the uteri. Other rats got EI via an electrode transvaginal catheter (TVC) placed near the cervix. EI was a bipolar constant current square wave. EI effect was determined by IUP values or rat, pup birth interval (BI). Women in preterm labor at 24-34 weeks gestation got EI via TVC while monitoring fetal heart rate (FHR). A fetal monitor (toco) measured contraction tension and frequency. Contraction frequency or peaks (P-P), were measured for 3 20 minute periods. A mixed-model analysis of variance estimated mean P-P for C1, E1, and C2 with the level of significance at 0.05. Results: Animal EI decreased IUP only in the study horn (fig. plate A, bottom), IUP and EMG (fig. plate B) and increased rat BI either directly or by TVC. Human EI decreased toco (fig. plate C, bottom) with P-P 23% slower than controls (p=0.0134) and no FHR changes (fig. plate C, top). In all species EI decreased smooth muscle tone (solid line fig. plates B and C). Conclusions: Comparing studies of the first human's and animals show EI may control preterm uterine smooth muscle and birth. EI may decease resting smooth muscle tone in certain neonatal pathologies e.g. ductus arteriosis and persistent pulmonary hypertension.
    • 49 Surfactant replacement therapies; Poractant versus Beractant; 5 Years’ Experience of Ankara Training Research Hospital Hatice Tatar Aksoy1 , Serçin Taşar2 , İnci Arıkan2 , Yıldız Dallar Bilge2 1 Ankara Training and Research Hospital, Turkey 2 Ankara Training and Research Hospital, Turkey Background: Surfactant replacement in preterm infants with respiratory distress syndrome (RDS) has been a major therapeutic breakthrough. Surfactant also can be used in other. Objective: To evaluate indications of surfactant replacement therapies in a NICU of a research hospital and compare the outcomes of the usage of two different form (poractant vs beractant). Methods: In this retrospective trial, we evaluated the outcomes of 137 infants treated with surfactant in 5 years period. 23 infants were treated with poractant, 114 infants were treated with beractant. Results: Mean gestational age and birth weight was not different between the groups (32 vs 32 weeks, 1972g vs 2000g, p=0.76 and p=0.9 respectively). The primary diagnosis was MAS in 27 patients and pneumonia in 4 patients and RDS in 82 patients in beractant group. In poractant group 4 patients had MAS, 18 patients had RDS and 1 had pneumonia. Median hospitalization time of the patients was shorter in poractant group but the difference was not statistically different (21,3 vs 23,9 days p=0.6). Median duration of mechanical respiratory support was not different between the groups (1,54 vs 3,12, p=0.3). poractant group. Three patients had pneumothorax, four patients had pulmonary hemorrhage in beractant group. Mortality rate did not differ between the groups (%12 vs %22 p=0.43). Conclusion: Pneumothorax and pulmonary hemorrhage were not detected with poractant group. Median hospitalization time of the patients was shorter in poractant group but it is not statistically significant, this can be a result of the small sample size of the poractant group.
    • 50 Maternal Speech Sounds Elicits Sustained Heart Rate Response in Preterm Newborns in the First Month of Life Amir Lahav, Katherine Rand Brigham and Women's Hospital, Harvard Medical School, USA Background: The preferential response to mother’s voice is well documented in the fetus and term newborn. However, the response of preterm neonates is much less understood and more difficult to interpret due to the intensive clinical care and range of medical complications that characterize this population. Aim: This study examined the physiological response to mother’s voice and its sustainability in the first month of life in extremely preterm infants. Methods: Heart rate changes were monitored over a period of three weeks in 20 preterm infants born between 25-32 weeks gestation. Using innovative bedside technology, heart rate data were obtained daily from the infant’s cardiac monitor during short periods of exposure to recorded maternal speech sounds played inside the incubator. Results: Exposure to mother’s voice elicited sustained changes in heart rate. During exposure periods, infants had significantly lower heart rate compared to matched periods of care without exposure on the same day (p.0001). This effect was demonstrated exclusively by all infants, irrespective of gestational age at birth, birth weight, age at testing, Apgar score, caffeine therapy, and respiratory support. Conclusion: Exposure to mother’s voice induced distinct physiological changes in heart rate in hospitalized preterm infants in first month of life. It is possible that mother’s voice may improve autonomic stability and promote relaxation in this population of newborns. Further studies are needed to illuminate the inner workings of the preterm response to mother’s voice and to determine its therapeutic implications for optimizing care practices and developmental outcomes.
    • 51 The Hemodynamic of Bichorionic Biamniotic Twins in Early Neonatal Period Olena Riga, Anastasia Senatorova, Margaret Gonchar, Alena Boychenko, Iryna Vasilyeva, Iryna Vasilyeva, Iryna Vasilyeva Kharkiv National Medical University, Ukraine Background: The multiple pregnancies are associated with placental dysfunction and pathology of early neonatal period. The objectives of study was to investigate central and cerebral hemodynamic in early neonatal period in bichorionic biamniotic twins. Material: Prospective case-control investigation of central and cerebral hemodynamic was performed in 62 twins (37 without intrauterine growth retardation (IGR) and 25 with IGR), and 48 singletons (25 without IGR and 23 with IGR). The routine sings of hemodynamic were investigated (PhilipsHD7 XEunit, the Netherlands).For comparison of multiple groups, Kruskal-Wallis ANOVA on program STATISTICA 7. Results: The pregnancy course in women with twins and singletons was not difference except increase rate of in vitro fertilization (p=0.0006), and cesarean section (p=0.001) multiple pregnancy. The third twins ware “near term infants”. There were significant difference in decreasing of Vmin (11 cm/s) at third day of life in twins with IGR comparing singletons and twins without IGR in medium cerebral artery. At this time registration of decreasing cardiac output (60±2.7%) was present with correlation on Vmin (r=0.68, p0.05). The twins and singletons had no difference in central hemodynamic regimen: 53.2% twins and 56.2% normokinetic, p=0.7547; 35.4% twins and 41.6% singletons hyperkinetic, p=0.5208; and 11.4% and 2.2% hypokinetic respectively, p=0.0706. There was correlation between resistance index in anterior cerebral artery and ductus arteriosus diameter (r=0.5, p0.05); systolic index and ductus arteriosus diameter (r=-0.45, p0.05), and ductus arteriosus functional period in days (r=-0.48, p0.05). Conclusions: We speculate about risk of brain ischemia in bichorionicbi amniotic twins with IGR on third day of life due to decrease of cardiac output (hypokinetic hemodynamic regimen) on decrease catecholamine labor stress in “near term” infants with premature brain autoregulation. The regimen of central hemodynamic depends on the diameter and its functional period.
    • 52 Infant Driven Feeding Protocol Robyn Foo1 , Woei Bing Poon2 1 Singapore General Hospital, Singapore 2 Singapore General Hospital, Singapore Feeding practices for preterm babies are often inconsistent amongst clinicians and based on historical practice rather than evidence. There is increasing evidence that Infant Driven Feeding (IDF) may result in improved neurodevelopmental outcome, earlier attainment of full oral feeding and shorter hospital stay. Barriers to providing such care include perceptions of increased workload as well as increased length of stay. The purpose of this study was to determine whether oral feeds that are systematically advanced based on an IDF protocol would (1) result in greater nursing satisfaction, and (2) was non-inferior in length of stay. 33 infants, less than 34 weeks gestation formed the intervention group. These infants were given early non- nutritive sucking stimulation and commenced on oral feeds only after showing consistent signs of alertness during scheduled 3 hourly gavage feeds. Feed advancement, managed by trained nurses, was based on the protocol. Nurses were also trained on feeding techniques and infant behavioural cues. A retrospective cohort of infants (n=293) formed the control group. These infants had feedings advanced according to standard, schedule-driven feeding. Qualitative information from nurses regarding perceived standard of care and competence with feeding were collected. Nurses surveyed felt the new protocol allowed them to provide better care. They also felt more competent in feeding and more confident of the infants’ feeding abilities before discharge. Infants in the intervention group (median gestation at discharge=37.9 weeks) did not differ significantly from controls (median 37.3 weeks) in the length of stay. No adverse outcomes such as aspiration pneumonia or feeding related NICU re-admission were found during the implementation period. IDF did not increase the length of stay, or increase adverse health outcomes. It also allows individualized, developmentally appropriate progression of feeds that is safe, with greater nursing satisfaction.
    • 53 “Eating’s not as important as Breathing!” – Multidisciplinary Collaborative Decision-Making in Infant Feeding Disorders Andrea Fourie University of the Witwatersrand, South Africa Infant feeding disorders have far reaching negative health, nutritional and respiratory consequences. Feeding also influences bonding, family participation and quality of life. Balance between these factors is crucial for appropriate feeding and reiterates the need for multidisciplinary collaborative decision-making in infants with disordered feeding. In South Africa, many health professionals are moving to the private-sector due to higher salaries and the lack of resources in state facilities. The influence of this on the standard of care is unknown. Two in-patient infant feeding teams were compared. Team A, a multi-disciplinary team, works in an under-resourced state hospital. Team B, a multidisciplinary team, works in a well-resourced private hospital. The frequency and nature of team discussions related to infants with feeding conditions was evaluated. This will be illustrated through the use of case studies. Team A met daily with at least 4 team members and the infant’s family present. Decision-making was collaborative with all opinions considered. The family’s focus was typically related to discharge and the social aspects of feeding, this was therefore prioritized when possible. Daily ward-rounds; team members employed by the hospital and the need for problem-solving due to lack of resources facilitated this decision-making process. Team B did not meet as a team and decisions were made unilaterally by the paediatrician/otolaryngologist without the team or family’s involvement. Management priorities were typically related to health considerations with less emphasis on social and quality of life factors. Team members rely on private payment and were not employed by the hospital resulting in logistical challenges in holding discussions. The under-resourced state-based team appeared to be adopting a balanced multidisciplinary, family-centered collaborative- decision making approach when managing infants with feeding problems, unlike the private hospital. This highlights that privatization in developed countries may not necessarily result in improved quality of care particularly with regards to infant feeding disorders.
    • 54 Comparison of Conventional Phototherapy with the Adjunct Use of Reflecting Surfaces (Aluminum Foil Curtains and White Cloth Curtains) in Reducing Bilirubin Levels among Term Neonates – a Single-Blind RCT Rumar Magaspi, Lucila M. Perez Ospital ng Makati, Philippines Objective: This study aims to determine the effectiveness of conventional phototherapy, conventional with aluminum foil curtains versus conventional with white cloth curtains with aluminum foil versus with white cloth curtains in lowering bilirubin among term neonates with hyperbilirubinemia. Design: Single blind randomized controlled trial. Setting: Ospital ng Makati – Tertiary Hospital Participants: Three hundred two term neonates (7 days old) with indirect hyperbilirubinemia and total serum bilirubin (TSB) levels 75th percentile were included. Interventions: Subjects were randomized into 3 groups: conventional phototherapy (control), with aluminum foil curtains (AF), and with white cloth (WC). TSB levels were taken every 24 hours until it eached low risk levels (75th percentile for age). Main Outcome Measures: The rate of decline of TSB from baseline after 24 hours phototherapy and duration of phototherapy needed to reach the low risk level. Two-tailed z test and post hoc Scheffe test were used with Intention to Treat Analysis. Results: The rate of decline in TSB levels after 24 hours of phototherapy was significantly higher in aluminum foil (12%) compared with white cloth (5%) and control (3%). The mean duration of phototherapy was significantly shorter with phototherapy using aluminum foil at 3.13+0.84 days compared with white cloth at 4.49 + 0.53 days, and conventional phototherapy alone at 6.70 + 0.59 days (p=0.000). No adverse effect was noted. Conclusion: Reflecting surfaces used with phototherapy are effective and safe. Aluminum foil curtains produced more significant benefits than white cloth curtains. Keywords: Aluminum foil curtains, white cloth curtains, phototherapy, total serum bilirubin
    • 55 Vaccination Pain Management and Effect of Breast Feeding, Sucking the Pacifier and Mother's Hug: a Randomized Control Trial Simin Taavoni1 , Shadab Shahali2 , Hamid Haghani3 1 Tehran University of Medical Sciences, Iran 2 Iran University of Medical Sciences, Iran 3 Iran University of Medical Sciences, Iran Infants’ vaccination pain management is very important and must be managed, with lowest side effect methods. The aim of this study was to examine pain relieving effect of breast-feeding, sucking pacifier or being in mother's hug during DPT vaccination. Methods: This controlled trial study, was performed on 152 (38 in each group) healthy term infants with 2- 4 months years old, whom was brought to the health centers in west of Tehran for DPT vaccination, their parents filled in informed consent. (Year 2008- 2010) By randomized collection infants divided to three intervention group (Breast feeding, Sucking pacifier and being in mothers hug, and each group had intervention 2 minutes before, during, and 15 seconds after the injection) and control group, whom lied on the examining bed as routine of clinics (38 infants in each group). Objective changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization to 15 second after it. Descriptive and inferential statistics (ANOVA and paired sample T test) were used. All ethical points were considered and approved by Research ethics committee of IUMS and registered in Iranian Registry of Clinical Trials (IRCT). Result: Equality of age, gender and the time of feeding prior to vaccination were controlled and there were no significant difference between 4 groups. There were significant differences in Behavioral Pain Scores of four groups. (P 0.0001) and routine group had highest pain score. Conclusions: Breast feeding is more analgesic than pacifier use with maternal holding and maternal holding with breast feeding or pacifier use is more analgesic than being in mother's hug. These three interventions are more analgesic than lying on the examining table. It is suggested to use these simple interventions during immunization injection. Acknowledgment: Received grant by Research department of Iran University of Medical Sciences.
    • 56 Predictors of Death in Neonates with Coagulase Negative Staph Infections Mohammad Khassawneh1 , Abdulrahman Almatari2 1 United Arab Emerate university, United Arab Emirates 2 King Fahad Medical city, Saudi Arabia Background: Neonatal sepsis is a major cause of mortality and morbidity in this population. Predictors of outcome in neonatal sepsis are helpful for physician for counseling and setting expectation. We aimed to compare clinical characteristics of patients with Coagulase-negative staphylococci (Cons) sepsis who died with those who survived their Neonatal Intensive Care Unit (NICU) hospitalization. Methods: Retrospectively all infants admitted to NICU with neonatal sepsis proven by blood culture with Cons during stay in the NICU of King Fahad Medical City, Saudi Arabia in 4 year period between January 2009-January 2012 were included. Demographic data and other clinical characteristics were used as predictor of survival. The chi-squared test or the Fisher's exact test will be used for categorical variables comparison. A p-value 0.05 was considered statistically significant. Results: Death was recorded in 5 of 13 (38.4%) infants with gastrointestinal perforation and versus 10 of 58 (17.2%) without GI perforation, p value 0.043, In 10 of 32 (31.3%) with low platelet compared with 5 of 49 (10.2%) in patients with normal platelet, p value 0.017. Death was recorded in 8 of 10 (80%) of infants who needed High Frequency ventilator (HFV) versus 7 out of 71(9.9%) of infants who did not require this respiratory support, p value was less than 0.001. Birth weight and being infected by methicillin resistant Cons were not predictive of death in this population. Conclusion: Needing HFV, presence of low platelet, GI perforation are predictor of death in patients with neonatal sepsis caused by Cons.
    • 57 Predictive Risk Factors for Infection of The Fetus and Newborn. Nyshangul Bozhbanbayeva, Tykaz Mustaphasade, Guljan Baigazieva, Indira Suleimenova, Maral Amantayeva Kazakh National Medical University named after S.D. Asfendiyarov, Kazakhstan The aim of the research was to investigate the prognostically significant risk factors for intrauterine infection of the fetus and newborn. We observed 462 infected children and their mothers admitted to the clinics in Almaty during the period of 2005-2010 years. The average age of mothers was equal to 30,6 ± 0,7 years. The control group consisted of 55 non-infected children and their mothers. There’s a coupling force between the examined factor and infection. High risk factors with the greatest coupling force (bonding force of 10 to 15) are: missed abortion in maternal history (15), premature birth (15), the stimulation generic activity (14.6) , pre-eclampsia (11.5) , premature rupture of membranes (11.5), the threat of miscarriage ( 8.0), chronical intrauterine hypoxia of fetus by ultrasound (8.0). Acute respiratory viral infection during the current pregnancy (6.6), pseudo erosion of vesical cervix (6.5), somatic pathology of the mother in the form of chronic bronchitis (6.5), chronical adnexitis (6.5), acute of chronical pyelonephritis (6.5), allergic diseases of the mother (6.5), weighed down obstetrical history in the form of spontaneous miscarriages (6.0), pathological course of pregnancy in the form of late gestosis (6.0), dark green color of the amniotic fluid (5.8) were included in the medium risk factors . The coupling force between infection and disease states such as chronic coleitis (4.5) over the mother, a chronic disease of the gastrointestinal tract (4.5), cardiovascular disease 4.4 ), and endocrine pathology (4.3) over the mother, uterine (3.5), a history of abortion (3.5), and premature detachment of the placenta (3.0) composed a group of low-risk factors. Thus, the identification of the above mentioned risk - factors should guide clinicians on the directional survey of women and their children against persistent infections.
    • 58 Reduction in Late-onset Sepsis Associated with the Implementation of a Package of Infection Prevention and Control Interventions Roopali Soni Leeds General Infirmary, UK Aims: This study was undertaken to compare the rate and type of late-onset blood stream infections before and after the introduction of a package of infection prevention and control interventions introduced in November 2009. Methods: A retrospective study of all patients with culture proven late-onset sepsis over a period of 12 months pre (1st November 2008 to 31st October 2009) and post (1st January 2010 to 31st December 2010) intervention was undertaken. The infection rates for the five years prior to and 1 year following the study period were also analysed. Results: A total of 101 patients met the study criteria. There was a significant (P0.05) reduction in infection rates following the interventions when comparison was made based on the episodes of infection (5.0% vs. 3.6%). Although not statistically significant, there was also a reduction in the number of infants with infection (5.5% vs. 4.0%) and the rate of catheter related sepsis (9.8 vs. 7.6). There was an elimination of MRSA, Candida and Pseudomonas infections following the interventions. This effect was however not sustained for more than 12-18 months following the interventions. VLBW (1.5Kg) infants, those born at or 25 weeks and those with central venous catheters were the most susceptible. Conclusions: There was a significant reduction in the episodes of late onset sepsis associated with the implementation of infection prevention strategies. This study adds to the increasing evidence to support infection prevention care packages on neonatal units. There is a need for continued efforts to maintain these practices.
    • 59 Non-invasive Study of the Gut Microbiota Profiles and Mucosal Cells Gene Expression Changes Caused byNeonatal Sepsis in Very Low Birth Weight (VLBW) Twins Maria Carmen Collado1 , Christine Bäuerl1 , Maria Cernada3,4 , Eva Serna2 , Maximo Vento3,4 , Gaspar Perez-Martinez1 1 IATA-CSIC, Spain 2 University of Valencia, Spain 3 Polytechnic University Hospital La Fe, Spain 4 Polytechnic University Hospital La Fe, Spain Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. The role of prenatal microbial contact and its role on health remains elusive. Distortions in the establishment of microbiota might increase the risk of infections. Understanding microbial colonization of the gut in prematurity status and host response may predict risk of late onset sepsis to guide future strategies. Then, our aim was to evaluate the impact of neonatal sepsis on microbiota composition by 16S pyrosequencing and also, the host response by whole genome microarray analysis of exfoliated epithelial cells in very low birth weight (VLBW) preterm twins and likely identification of biomarkers for early diagnostic through non-invasive techniques. Important differences were found in the fecal microbiota and transcriptomic response from exfoliated intestinal epithelial cells in preterm infants who developed sepsis compared their matched healthy twins. Lower levels of Bifidobacterium spp and higher levels of Enterobacteriaceae where found in sepsis than controls. By pyrosequencing, Proteobacteria phylum (Enterobacteriaceae family) was predominant in sepsis. PCoAs showed differences between sepsis and control groups and profiles were twin-pair and neonate-dependent. Transcriptomic analysis of epithelial cells rendered clearly different profiles in infants with sepsis than in their healthy twins. We identified 820 probe sets to be differentially expressed among septic infants and healthy controls. Our data show specific shifts on microbiome and gene expression genes which differentially separate the VLBW premature twins suffering sepsis from their matched control twins. The intestinal transcriptome in response to sepsis measured by the recovery of exfoliated cells in fecal samples represents a non-invasive tool which particularly in VLBW preterm infants minimizes any discomfort to the subject. Our research suggests the potential of microbiota modulation by use of probiotics and prebiotics in order to reduce the risk of sepsis.
    • 60 Clabsi Reduction With Strict Maintenance Care Bundle Junaid Khan, Junaid Khan, Junaid Khan Al-Rahba Hospital, United Arab Emirates Background: Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and incur excess costs. 80,000 CVC-related BSIs occur in U.S. hospital ICUs causing an estimated 28,000 deaths annually. Annual cost to the healthcare system $296 million-$2.3 billion (U.S.).The use of a central line insertion bundle has been shown to reduce the incidence of CLABSI. Maintenance care has been included in some studies of CLABSI, but this has not been studied independently of other interventions. Objective: Getting to zero CLABSI, a believable goal. Methods: Maintenance care was conducted by trained infection controlpersonals using device-day measurement methods. During the intervention period, nursing staff used a post insertion maintenance bundle consisting of —Daily assessment of catheter need —Review dressing integrity & cleanliness —Use closed system for infusion, blood sampling & medication administration —Assemble & connect infusion tubing using aseptic or sterile technique. —Use consistent tubing configuration —Disinfect injection port (Hub) with 2 % chlorhexidine or 70% alcohol for 15 seconds & allow to dry for 30 sec to 1 min. —Hand hygiene performed & clean gloves worn for catheter entry —Use prefilled, flush containing syringes —Staff empowered to stop the line in non-emergent procedure if sterility breached Results: During the pre-intervention period, there were 450 documented catheter-days and 2 CLABSIs ( Oct 2011-Oct 2012), for an incidence density of 5.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 400 catheter-days and 0 CLABSIs (Nov 2012-Oct 2013), for an incidence density of 0 per 1000 catheter-days. Our target is also 0 CLABSI catheter days/1000. Conclusion: This study demonstrates that implementation of a central venous catheter maintenance care bundle with CLABSI bundle of care was associated with a significant reduction in CLABSI. It is important to stress on maintenance care bundle and strict surveillance by trained personals needed. Maintenance care bundle can be modified according to the need. Key Words: Bacteremia; central venous catheterization; infection control; catheter-related infections; maintenance care bundle.
    • 61 Language Assessment and Outcomes of Very Premature Infants Betty Vohr Alpert Medical School of Brown University, USA Preterm infants are at increased risk for language delays that may persist to school age and adolescence. They have early delays in expressive and receptive language and delays in grammatical awareness, vocabulary acquisition and phonological awareness at school age. Factors related to speech & language delay including the immature brain, the injured brain, neonatal morbidities, the NICU environment and social and environmental risk factors will be presented. Both short term and long term language outcome studies and their relationship with brain volume and MRI findings along with evidence for recovery of language skills with increasing age will be reviewed. Outcomes of a very preterm cohort using a new tool, Language Environment Analysis digital language processor (LENA™), to assess the natural language environment in the NICU and at home will be presented. Our studies have shown that preterm infant 1250g have reciprocal vocalizations (conversation turns) 8 and 4 weeks prior to their due date and are significantly more likely to have conversation turns with their mother than with another adult (Pediatrics 2009). In addition, increased amount of parent talk with preterm infants in the NICU was associated with higher 7- and 18-month Bayley-III language and cognitive scores (Pediatrics 2014). These findings offer an opportunity for language intervention for preterm infants starting in the NICU.
    • 62 Mortality and Long-Term Sequelae from Childhood to Adulthood of Extremely Preterm or Tiny Survivors Lex Doyle Royal Women's Hospital, Australia University of Melbourne, Australia Murdoch Childrens Research Institute, Australia Survival rates for extremely preterm (28 weeks’ gestational age) or extremely low birthweight (birthweight 1000 g) infants have increased dramatically with the advent of successful techniques for assisting ventilation from the 1970s. However survivors remain at significant risk for a wide array of long-term morbidities, which are mostly inversely related to gestational age, and occur at much higher rates than in non-preterm controls. Neurodevelopmental impairments obvious in the early years include cerebral palsy, developmental delay, and sensory impairments such as visual and auditory deficits. Approximately 1-in-4 extremely preterm or very tiny survivors have substantial problems with thinking, hearing, walking, talking or seeing. Although the rates appear high, 4% of normal birthweight, non-preterm controls also have substantial neurodevelopmental disability. At young adulthood, extremely preterm subjects have only slightly lower rates of educational achievement, employment and independent living. Despite the high rates of neurodevelopmental disabilities, and educational and behavioural problems encountered during their early years, most subjects adapt to roles of adult functioning and do better than might have been anticipated. Other areas of ill-health for ex-preterm children into adulthood included more abnormalities in respiratory function, with variables reflecting airflow being substantially diminished compared with controls, particularly in those who had bronchopulmonary dysplasia in the newborn period. The blood pressure of preterm subjects is significantly higher than controls, which is not related to intrauterine growth restriction. Despite their small size at birth very tiny or preterm survivors tend to achieve adult heights consistent with their genetic potential. As mortality rates have fallen, the focus for perinatal interventions must be to develop strategies to reduce long-term morbidity. In addition, follow-up to middle age and later adulthood is warranted to determine the risks, especially for cardiovascular, respiratory and metabolic problems, and other lifestyle issues likely to be confronted by very preterm or tiny survivors.
    • 63 Neuroprotection for Very Preterm Babies – Are We Making any Progress? Lex Doyle Royal Women's Hospital, Australia University of Melbourne, Australia Murdoch Childrens Research Institute, Australia Survival rates for extremely preterm or tiny babies have increased dramatically with advances in perinatal and neonatal intensive care. However the rates of neurological impairments and disabilities are too high in survivors relative to term controls; major neurological disability rates in those 1000 g or 28 weeks are 4-5 times higher than in term controls. There are some recent advances, however, that improve the outcome, both short-term and long-term, for extremely preterm or tiny babies. Magnesium sulphate given to the mother just prior very preterm birth reduces the rate of cerebral palsy in survivors. Caffeine given to very tiny babies not only reduces several short term morbidities, such as a patent ductus arteriosus and bronchopulmonary dysplasia, it also reduces the rates of death or disability, cerebral palsy, and cognitive delay. Docosahexanoic acid, an omega-3 fatty acid important in brain function, given as a supplement to feeds in very preterm babies improves cognitive function, but mostly in girls and in those 1250 g birthweight. Avoidance of corticosteroids to prevent or treat bronchopulmonary dysplasia may improve long-term outcome. Developmental interventions after discharge home designed to improve baby cognitive and motor development have been shown to increase cognitive development over the pre-school years, however, the effect is no longer evident after the children start school. In summary, several recent interventions look promising in improving long-term outcomes for very preterm infants; however their effects when implemented into usual clinical practice must be determined.
    • 64 Grapple with Ethical Puzzles in the Critical Care: A Neonatologist Prospective Sulaiman Alsaad State of Kuwait, Kuwait Progress in neonatal care has significantly improved the prognosis and chances of survival of critically ill or extremely preterm neonates. However, in some situations, when the neonate’s death can only be briefly postponed at the price of severe suffering, or when survival is associated with unexpected disabilities and an intolerable life for the child and his/her parents, the application of the full support of recent neonatal intensive care may not be appropriate. In such circumstances the limitation of intensive treatments (withholding or withdrawing) and shift towards palliative care, can represent a more humane and reasonable alternative. Conflicts in values regarding life and death and our understanding about “quality of life” influence our opinions about what is happening with many babies in our NICUs. We must recognize that our values and opinions are our own, and are not necessarily held by others. We should also remember that our images of disabilities might be overly negative. A study of former extremely low birth-weight infants who are now in adulthood noted that even though they acknowledged limitations in cognitive and physical abilities, they did not report a lower health-related quality of life than their more healthy counterparts. It is difficult to watch parents who want “everything done” for an infant that we know is not going to survive. How do we support the parents and also advocate for the best interests of our patient? This is one of the most difficult situations we find ourselves in and one that is not easily resolved. What we consider futile treatment may not be so in the eyes of the parents. In presentation I will address the following: The role of communication and information exchange between the NICU team and parents ·Strategies for withdrawal/withholding of life support among neonate ·Influence of culture/religion and believes on difficult decisions with the NICU (In my culture parents want) ·The rights of an NICU kid (THE KARATE KID)
    • 65 Newborn Care in the Tamale Teaching Hospital, Northern Ghana- a 6 month Review Alhassan Abdul-mumin1,2 , Peter Kwarteng1 , Gladys Ponpuo1 1 Tamale Teaching Hospital, Ghana 2 University for Development Studies, Ghana Under- 5 mortality rate in Ghana is unacceptably high at 82/1000 live births. A neonatal mortality rate of 32/1000 live births, contribute substantially to about 40% of all under-5 deaths in the country. A wide regional variation is observed for both vital statistics with the Northern region of the country recording the highest deaths. Fortunately or unfortunately, many of these deaths are due to preventable causes. Driven by the herculean task of meeting the MDG 4 target of reducing under-5 mortality to 40/1000 live births by 2015, the country has rolled out many neonatal interventions recently but it is unlikely that the target will be met at the current pace of progress. Six month review of sick neonates admitted to the NICU of the Tamale Teaching Hospital in Northern Ghana, where new born care is in infantile stage, is presented. A total of 757 patients were admitted to the ward in the period under review. Out of these 74% were delivered in our hospital, 18% were from other health facilities and 12% were delivered at home. The most common diagnoses were prematurity/low birth weight (LBW) (36%), neonatal sepsis (25%) and birth asphyxia (17%). 136 deaths were recorded, 64%, 21% and 13% due to prematurity/LBW, birth asphyxia and sepsis respectively. These diagnoses together constituted 78% of all admissions and contributed to 98% of deaths. The mortality was 18% of admissions. In conclusion, neonatal deaths due largely to preventable conditions, contribute substantially to U-5 mortality and significant gains could be made towards reduction of these deaths if the right neonatal interventions are implemented appropriately. The disproportionately high premature/LBW deaths highlights the challenges faced in care of this group of neonates.
    • 66 2 years Follow Up of Intra-Abdominal Extravasation of TPN Causing Liver Necrosis in a Preterm Infant Rana Alia, Haytham Ali Leeds Teaching Hospitals NHS Trust, UK To our knowledge, this is the first case report describing the outcome of liver necrosis following TPN extravasation in a preterm infant. A 26 weeks gestation preterm boy was born spontaneously with a birth weight of 1.0 kg. As part of routine stabilization he had a UVC inserted soon after birth and it was used to infuse TPN from day 2. The tip of the UVC was at the junction of the left portal vein. On day 6 of life the baby deteriorated with abdominal distension, renal impairment and abnormal liver function. Initial clinical diagnosis was necrotising enterocolitis. Plain abdominal radiograph showed an area of translucency overlying the liver Figure [1]. An ultrasound scan showed moderate ascites and a cystic lesion overlying the liver containing debris Figure [2]. Chemical analysis and the physical appearance of the ascetic fluid confirmed TPN leak. The UVC was not faulty when it was examined by the manufacturer. However and given the position of the UVC tip on x rays, the possible explanation was of chemical erosion of the liver by TPN with subsequent rupture of the liver capsule and leak inside the peritoneal cavity. Acute rupture of the portal vessels by the tip of UVC was unlikely because of the insidious onset of symptoms over days and lack of clinical signs of acute blood loss. The baby was managed conservatively and he made quick recovery. Regular liver ultrasound scans showed cyst calcification and then regression in size Figure [3]. It disappeared by the age of 2 years. There was no portal hypertension.
    • 67 Assessment of Labial Angle via Goniometer and Oral Motor Reflexes in Preterm Infants: Comparison with Term Infants Deniz Anuk Ince1 , Ulas Tugcu1 , Ayse Ecevit1 , Abdullah Kurt1 , Aslıhan Abbasoglu1 , Mustafa Agah Tekindal2 , Aylin Tarcan1 1 Baskent University Faculty of Medicine, Turkey 2 Baskent University Faculty of Medicine, Turkey Introduction: Oral feeding is complex sensorimotor process that differs preterm and term infants. Our objective was to evaluate labial angle via goniometer (an instrument for measuring angles) and oral motor reflexes in preterm and healthy term infants. Methodology: Seventy-eight preterm infants between 27 and 36 weeks gestational age and 45 healthy full- term infants were investigated. Term infants were evaluated once during the first week of life, and preterm infants were evaluated weekly until they reached independent oral feeding at 38-40 weeks postmenstrual age (PMA). The exclusion criteria were major congenital abnormalities, craniofacial malformation, intracranial hemorrhage. Labial angle was measured via goniometer and volume of milk ingested and oral motor reflexes (sucking, rooting, transverse tounge) were evaluated. APGAR score at 1st and 5th minute, full enteral nutrition time, hospitalization duration and weight at discharge were recorded. Dependency of variables on postmenstrual age is investigated by independent t tests and Mann-Whitney U tests. Results: Assessment of labial angle in preterm infants compared to term, significant differences were observed in both right and left labial angle. Oral motor reflexes showed significant differences in preterm infants compared to term. Also preterm group presented significant differences when comparing first to the other evaluations on sucking, rooting and transverse tongue reflexes. Conclusions: The development of feeding skills requires sensorimotor integration of swallowing and respiration, normal muscle tone, posture and normal oral-motor development. This was the first study evaluating labial angle via goniometer in preterm infants. The use of goniometer may help to show performance of oral motor capacity and may be used in preterm infants during evaluation of feeding skills.
    • 68 Non-invasive Evaluation of Feeding Maturation via Swallowing Sound Recording in Preterm Infants: Comparison to Findings in Term Infants Deniz Anuk Ince1 , Ayse Ecevit1 , Banu Oskay Acar2 , Ahmet Saracoglu2 , Abdullah Kurt1 , Mustafa Agah Tekindal3 , Aylin Tarcan1 1 Baskent University Faculty of Medicine, Turkey 2 Kuartis Technology and Consulting, Turkey 3 Baskent University Faculty of Medicine, Turkey Aim: Our objective was to evaluate maturation of sucking and swallowing in preterm infants using a non- invasive method: assessment of swallowing sounds. Methodology: Fifty-two preterm infants between 27 and 36 weeks’ gestational age and 42 healthy full-term infants were investigated. Feeding performance was assessed based on swallowing data collected during 2- minute audio recordings that were captured via a digital stethoscope placed at the hyoid region. Term infants were evaluated once during the first week of life, and preterm infants were evaluated weekly until they reached independent oral feeding at 38-40 weeks postmenstrual age (PMA). A software program is implemented in order to automatically generate the following variables for each evaluation: total number of swallows (S), total number of rhythmic swallows (RS), total number of resting intervals (RI), average time between resting intervals (ATRI), average time between swallows (ATS), average time between rhythmic swallows (ATRS), maximum number of rhythmic swallows (MRS), and volume of milk ingested. Dependency of variables on postmenstrual age is investigated by independent t tests and Mann-Whitney U tests. Results: The preterm infants' VM and MRS reached 10th percentile at postmenstrual 34-35 weeks. In the preterm group, VM and MRS (p0.001) were positively correlated with PMA. At 38-40 weeks PMA, MRS for preterm infants was not significantly different from the term infants’ MRS. Conclusion: We have demonstrated that swallowing function improve with advancing postmenstrual age and reach term infants' reference values. Swallowing sound analysis may be used to assess feeding maturation in preterm infants during NICU follow-up.
    • 69 Effect of Facilities in Decreasing the Perinatal Mortality Rate in Misurata Teaching Hospital –LIBYA Bashir Ashur, Salima Alburke, Muktar Sadi, Ali Rajab Misrata Hospital, Libyan Arab Objectives: To measure the perinatal mortality rate (PNMR) , to identify risk factors of perinatal death and to compare it with previous results in misurata hospital. Patient and methods: A descriptive, retrospective study of hospital files records. From January 2012to December 2012, information was collected from admitted newborn in neonatal unit and the registration book at labour room including operating theatre. The information collected include, history, clinical examination, investigation, treatment and outcome. Results: The total number of delivery in misurata hospital were6520 births, include 36 stillbirth and 6474 were live births .48 babies died in the first week of life and 70% (34) of the first week death died in the first 24hours. The main reasons of admission to neonatal unit were preterm delivery, sepsis, meconium delivery, birth asphyxia, and congenital malformation. Perinatal mortality rate was 13/1000 total births (57% death in the first week of life and 43% still birth). The main causes of early neonatal deaths were RDS 45%, congenital malformation 18%, birth asphyxia 12.5%, CHD 10% and sepsis 6%. 12(25%) of death were full term and 36(75%) were PT, of these PT , 35% between 32- 36weeks gestation, 20% between 24- 28 weeks and 18% between 28- 32 weeks gestation.
    • 70 Customized Bubble Continuous Positive Airway Pressure at the National Hospital Abuja for the Treatment of Respiratory Distress Syndrome Lamidi Audu, Adekunle Otuneye, Mairami Amsa, Mariya Mukhtar-Yola, Lauretta Mshelia, Mercy Garu National Hospital Abuja, Nigeria Background: Prematurity accounts for 25% of neonatal mortality in Nigeria and respiratory distress syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. Objectives: To construct an affordable, easy and effective bubble cpap device for the treatment of Respiratory Distress Syndrome Method: At the neonatal unit of the National hospital, Abuja we assembled a circuit of tubing connecting a gas source (oxygen concentrator/cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-water-seal bottle to generate bubble CPAP. Result: The resultant device when activated by turning on the gas source results in an immediate and sustained improvement in tissue oxygenation (SPO2) and reduction in work of breathing (respiratory rate, chest recessions and grunting). The respiratory rate dropped from a mean (sd) value of 64.5(19.2)/min before commencement of CPAP to 54.9(11.6)/min one hour after. (p0.05).The corresponding values for mean SPO2 were 84(12)% and 95(6)% respectively (P0.05). Conclusion: This devise is inexpensive ($15/unit), requires minimal training to assemble and apply and can be used in both secondary and tertiary institutions. Its adoption nation-wide will ultimately reduce deaths from premature deliveries in Nigeria. Authors: Audu L I, Otuneye AT, Mukhtar MY, Mairami AB, Mshelia LJ, Garu M
    • 71 Clinical Approach to Cerebral Sinovenous Thrombosis in Newborn: Case Report Iva Bilic Cace1 , Irena Barbaric2 , Izidora Holjar Erlic3 , Branimir Peter1 1 University Hospital Centre Rijeka, Croatia 2 University Hospital Centre Rijeka, Croatia 3 University Hospital Centre Rijeka, Croatia Cerebral Sinovenous Thrombosis (CSVT) in the neonatal population is a relatively uncommon disorder. However, its current morbidity, mortality, and adverse neurodevelopmental sequelae emphasize the importance of establishing an early diagnosis and a proper therapeutic plan. Early signs and symptoms are often vague and unrecognized by the clinician. Cranial imaging study is often requested for reasons other than suspected CSVT and the finding of this condition is accidental. The active treatment of any underlying cause of CSVT is undoubtedly necessary; however, one must be prudent when commencing antithrombotic therapy. Question of treatment strategy of CSVT remains controversial. We present a case of CSVT in a term newborn with birth asphyxia, meconium aspiration syndrome and sepsis. Cranial magnetic resonance imaging (MRI) was requested due to the above mentioned diagnosis, and it revealed thrombosis of right transverse and sigmoid sinus. At that time, the child was in a good clinical condition, with normal neurological status. We decided not to introduce any medication and the expectative treatment was commenced. Seven days later second MRI was performed and previously noted CSVT confirmed. Since the child condition had not deteriorated he was discharged from the hospital. Six weeks later third and final MRI was performed and the result was astonishing- there were no signs of CSVT, and the finding was normal. This case of CSVT in a newborn previously suffering from birth asphyxia and neonatal sepsis emphasize the importance of proper clinical examination as a part of decision making process regarding treatment modalities.
    • 72 Potential Fatal Complication of a Percutaneous Central Venous Catheter with Long Term Sequelae in a Premature Neonate Maria Chalia, Maria Chalia, Ahmed Hassan Mid Essex Hospital NHS Trust, UK Background: Cardiac tamponade is a well recognized complication of percutaneous central venous catheters with high mortality rates. In that respect specific policies have been implemented regarding the insertion and care of such catheters. Objective: To alert clinicians for prompt recognition of a rare but not obsolete complication. To emphasize that long term sequelae can be expected. Methods: We present a case of premature male infant, 27+4 weeks of gestation at birth, with rapid clinical deterioration on day 12 of life after a previously uneventful course. Progressive pallor, tachycardia and increasing requirement for respiratory support were noted. There was subsequent unrecordable saturations and blood pressure which led to the prompt recognition of cardiogenic shock with possible correlation to the existing central catheter in the right upper limb, used for parenteral nutrition. [Chest X ray] Results: The infant was intubated and the infusion was discontinued. On site Echocardiogram confirmed the diagnosis of cardiac tamponade, following which a pericardiocentesis was performed.
    • 73 [Echocardiogram] 27 mls of fluid were aspirated and immediate clinical improvement was noted. On readmission to the paediatric ward at the corrected age of 2 months with an acute respiratory illness, a clot was identified at the superior vena cava to the right atrial junction on Echocardiogram. Still at the age of 6 months the clot persists and has not diminished in size. The baby is on aspirin, close paediatric and cardiac follow up. Conclusions: Prompt recognition of cardiac tamponade is crucial. Long term follow up is required and repeat Echocardiogram should be considered.
    • 74 Regional Prospective Review Study of the Neonatal Infection Screening Methods Within the East of England Neonatal Network. Maria Chalia1 , Michele Upton2 1 Mid Essex Hospital NHS Trust, UK 2 East of England, UK Aim: To monitor the adaptation of the regional neonatal infection screening policy in clinical practice amongst the neonatal units in the East of England region. Background: Based on the existing policy, all babies should have surface swabs taken, following admission or transfer to a neonatal unit. Additionally, all babies on the unit should be screened on a weekly basis in order to detect the presence of Methicillin Resistant Staphylococcus Aureus and other resistant organisms. Methods: The study period was between September 2012 and May 2013. All 17 neonatal units (level 1to 3) in the region were asked to participate. There was random selection of at least 10 neonates from each unit with a minimal length of stay of 10 days. Results: 15 neonatal units participated in the study. Data from 149 babies were selected. The mean gestational age at birth was 32+3 weeks. The mean birth weight was 1.8 kilograms. The median of their stay on the unit was 3 weeks. Pie 1-Origin of Admission
    • 75 Graph 1-Admission swabs
    • 76 Pie 2-Surface swabs
    • 77 Graph 2
    • 78 Graph 3 Conclusions: This study demonstrates that the regional infection screening policy has been well adapted, with 89% of cases having both admission and weekly swabs obtained. This positive and unified practice facilitates communication between units, especially when a neonatal transfer is required. In addition, it reinforces the significance of strong affiliation bonds required between level 1, 2 and referring, level 3 neonatal units within a geographically challenging region.
    • 79 The Efficacy of Table Sugar Solution as Snalgesia During Intradermal Injection of BCG Vaccine in healthy term Neonates Frances Jane Dago -Oc Background: Large numbers of studies have shown that orally administered sweet tasting solutions result in a significant reduction in behavioral pain responses during or following painful procedures compared with placebo in term neonates. Objective: To evaluate the efficacy and safety of table sugar solution as analgesia during intradermal injection of BCG vaccine in healthy term neonates. Setting: Private tertiary hospital in Cebu City. Methods: A total of 72 subjects were included in this randomized, double-blind, prospective study. Eligible neonates received either 2ml of table sugar solution or placebo given orally two minutes prior to intradermal injection. Neonates were observed for 30 seconds and assessed using the Neonatal Infant Pain Scale (NIPS). Scores of 0-3 indicate minimal or no pain. Scores 4 and above indicate moderate to severe pain. Result: There was no statistically significant difference on the demographic information of the neonates with regards to sex (P value 0.815= NS) age of gestation (P value 0.735 =NS) and birthweight (mean = 2,882.38±427.56, P value 0.439=NS). The mean NIPS of neonates treated with table sugar was 2.095 (SD ±1.872) and 4.5 (SD ±1.196) for neonates treated with placebo. There was statistically significant difference noted on NIPS between the two groups (p value 0.0000=S). Conclusion: There was a significant decrease in pain intensity based on NIPS score of newborns who underwent intradermal injection treated with sugar compared to those treated with placebo. This study showed that table sugar solution is a safe and effective analgesia during intradermal injection of BCG vaccine.
    • 80 The Influence of Fish-oil Lipid Emulsions on Retinopathy of Prematurity in Very Low Birthweight Infants: A Randomized Controlled Trial Serdar Beken1 , Dilek Dilli1 , Nurdan Dinlen Fettah1 , Emrah Utku Kabataş2 , Aysegül Zenciroğlu1 , Nurullah Okumuş1 1 Dr Sami Ulus Maternity and Children Research and Training Hospital, Turkey 2 Dr Sami Ulus Maternity and Children Research and Training Hospital, Turkey Objective: To compare the effect of two lipid emulsions on the development of retinopathy of prematurity in very low birth weight infants. Design: Randomized controlled study. Patients and methods: Eighty very low birth weight infants receiving parenteral nutrition from the first day of life were evaluated. One of the two lipid emulsions were used in the study infants: Group 1 (n = 40) received soybean oil based lipid emulsion (Intralipid®) and Group 2 (n = 40) fish-oil based lipid emulsion (SmofLipid®). Main outcome measures: Development of retinopathy of prematurity and the need for laser photocoagulation were assessed. Results: The maternal and perinatal characteristics were similar in both groups. The median (range) duration of parenteral nutrition [14 days (10-28) vs 14 (10-21)] and hospitalization [30 days (10-28) vs 34 (21-53)] did not differ between the groups. Laboratory data including complete blood count, triglyceride level, liver and kidney function tests recorded before and parenteral nutrition also did not differ between the two groups. In Group 1, two patients (5.0%) and in Group 2, 13 patients (32.5%) were diagnosed with retinopathy of prematurity (p=0.001). One patient in each group needed laser photocoagulation, without significant difference. Multivariate analysis showed that only receiving fish-oil emulsion in parenteral nutrition decreased the risk of development of retinopathy of prematurity. Conclusions: Fish-oil lipid emulsions may be preventive for development of retinopathy of prematurity in preterm infants requiring parenteral nutrition.
    • 81 Precision and Accuracy of Integrated Incubator Scale Versus Stand-Alone Scale Shaul Dollberg, Inbal Yarkoni, Laurence Mangel, Margarita Shlifer Tel Aviv Medical Center, Israel Background: Body weight is an important variable to follow preterm infants. The need to weigh the unstable preterm infant outside of the incubator have prompted incubator manufacturers to integrate weight scales to incubators. Objective: As a part of a patient safety evaluation we aimed to compare accuracy and precision of stand- alone weight scale to integrated scale. Design / Methods: Six stand-alone weight scales (Shekel LTD, Israel) and 11 integrated to Isolette 8000 (Drager, Germany) weight scales were used. We used a 1KG standard metal weight and stable infants weighting 1000 to 2500 g. Precision was evaluated by repeated weighting of the standard and of infants in each of the scales (triplicates). Accuracy was evaluated by comparing weight measurements of infants and standard in the stand alone and integrated scales. Data are mean of differences weight ± SD. Comparison of weights was by the Wilcoxon test. Results: Using the standard 1KG weight, as well as weighing infants, stand alone scales were very accurate and precise compared to the integrated scales. The stand alone scales were subsequently used as the gold standard. There were large discrepancies in weight measurements in both within integrated scales and between the integrated and the stand alone scales, with a difference if up to 9% of the infants' weight, a clinically significant difference. The mean difference between stand alone and integrated scales was also statistically significant (p=0.022) Conclusion: Stand-alone weight scales were more accurate and precise compared with integrated scales. We suggest to use caution and clinical judgment when using integrated scales for clinical decision making.
    • 82 The Crisis of PAN Resistant Bacteria: How to Know What to Prescribe Sandra Ellingson, Mary Wyckoff University of California Davis Medical Center, USA According to the WHO, high percentage of hospital-acquired infections is caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). Inappropriate and irrational use of antimicrobial medicines provides favorable conditions for resistant microorganisms to emerge, spread and persist. This presentation will provide an overview of the epidemiology of antimicrobial resistance on a global scale. Multi-drug resistant organisms are prevalent worldwide and these infections cause severe illness, especially in acute and chronically ill neonatal intensive care patient populations. Choosing appropriate antimicrobial therapy has become increasingly complex as more choices become available and resistant bacteria continue to evolve. Multiple factors affect the choice of agent, and resistance forces vary widely between clinical settings, patient populations, and geographic areas. This bacterial culture specific data will be used to demonstrate how to implement antibiograms into everyday prescriptive practice. Facilitating the understanding of the cellular mechanisms through which bacteria become resistant is vital for healthcare providers. Individual patient care practices affect resistance within patients and clinical environments. This research-based information and recommendations on how to manage the use of antimicrobial agents, minimize iatrogenic infections in the acutely-ill neonatal population, and responsibly care for patients, in an age of widespread bacterial resistance will enhance the individual’s knowledge base. Recommendations will include description of evidence-based guidelines from professional societies, as well as provision of multiple resources through which participants may further gain knowledge of the state of the science of this important topic.
    • 83 Cyclic Sleep Organization and Melatonin Production in Full Term Newborns with Intrauterine Growth Retardation Inna Evsyukova, Ol'ga Koval'chuk-Kovalevskaya, Natalia Maslyanyuk Ott Research Institute of Obstetrics and Gynecology RAMS, Russia The number of newborns with intrauterine growth retardation (IUGR) due to the unfavorable impact of chronic hypoxia in a pregnancy complicated by placental insufficiency has been on the rise in recent years. They are characterized by a high rate of neurological disorders not only in the perinatal period but also in subsequent years of life. Objective: to study cyclic sleep organization and melatonin production in full termnewborns with IUGR. Methods: Electropolygraphic sleep studies (EEG, ECG, EOG, respiration, motor activity) were conducted in 25 newborns: 15 with IUGR and 10 healthy (control group) on the fifth and sixthday of life. Melatonin (M) production was studied by determining the urinary level of the 6 sulfateoxymelatonin (6-SOMT) in the daytime and nighttime by means of ELISA (DRG Instruments,Germany). Results: In IUGR newborns duration of the sleep cycle was shortened (37.7 ± 1.5 min versus63.4 ±3.9 min; Р= 0.0003) at the expense of the orthodoxical phase (14.0 ±1.9 min versus 27.3 ± 1.7 min; Р= 0.04) and the paradoxical phase (23.6 ± 1.9 min versus 36.1 ± 2.3 minР= 0.0004).The disorder of the formation of cyclic sleep organization was in 10 IUGR newborns and associated with a considerable delay in the development of tonic and congenital reflex reactions. The urinary content of 6-SOMT in the infants with IUGR was considerably lower than in healthy newborns (14,1 versus 4,5±1,1ng/ml; Р 0.001). Conclusions: The sleep in IUGR newborns indicates the degree of intrauterine brain damage as a result of chronic hypoxia. The absence of cyclic sleep organization, the impaired formation of the paradoxical phase combined with retarded development of tonic and reflex reactions and low melatonin production give evidence of severe brain damage, which warrants combined therapy aimed at restoring and improving the impaired functions in the early neonatal period of infant life.
    • 84 Necrotizing Enterocolitis in Neonates Monitored by INVOS Olariu Gabriela, Olariu Laura2 , Tunescu Mihaela Clinical Unversitary Children Hospital Louis Turcanu, Romania Introduction: Congenital heart malformation is a risk factor for the development of necrotisingent rocolitis. Objective: Non-invasive monitoring by regional cerebral and somatic oximetry performed early in the newborn have led to identification of severe affections Material and Method: Regional somatic and cerebral oximetry monitoring by using INVOS device can be an indicator of regional ischemia. The first case is a term newborn, with birth weight 2850g. at 6 days of life develop neonatal shock, but cerebral and somatic oximetry monitoring had detected severe mesenteric ischemia Echocardiography reveals an congenital heart malformation-interrupted aortic arch type. The ratio between mesenteric and cerebral circulation was 0.38/ 0.24 predictive for necrotisingent erocolitis,witch had developed at 14 days of age. The second case is a premature with birth weight 820g, GA=26 weeks and monitored trough regional somatic / brain oximetry, with a lower ratio of 0.22 / 0.19, which has developed necrotizing enterocolitis in 4th day of life. Doppler cardiac ultrasound detected a tight aortic stenosis with a hypoplastic left ventricle, Discussion indicator of regional ischemia when is developing an ecrotisingenterocolitis, this report is predictive to a value below 0.75% is early detection of necrotising enterocolitisin Conclusion: Somatic / brain oxigenation below 0.75) is a predictive factor for to detect in the early stages necrotizingenterocolitis. Key Words: Necrotizing enterocolitis, INVOS, mesenteric ischemia
    • 85 Cerebral Doppler Flowmetry Changes At a Premature Newborn Olariu Gabriela1 , Olariu Sebastian1 , Tunescu Mihaela1 , Botiz Alina2 1 Clinic Hospital Municipal, Romania 2 Clinical Universytary Children Hospital Louis Turcanu, Romania Introduction: In premature infants with idiopathic respiratory distress syndrome has significant hemodynamic changes occur in the cerebral circulation, at birth and during the first three days of life Objective: The aim of the study was to assess early postnatal changes of Doppler sonographic parameters of blood flow in the cerebral artery occurring, during the first three days of life at a premature newborn whit severe RDS versus a healthy premature newborn. Material and Methods: Two premature newborn were enrolled into the study, one presenting severe idiopathic RDS, the other clinically healthy. Cerebral blood flow velocities (CBFV) in the cerebral were obtained at age of 2, 12, 24, 48 and 72 hours after birth. Measured parameters included the peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged mean velocity (TAMV). Doppler indices (DI) - resistance index (RI) and pulsatility index (PI). Each newborn required continuous monitoring of blood gases, Sat O2, HR, BP, temperature and weight. Discussion: In premature infants with severe RDS who need surfactant replacement therapy and mechanical ventilation, changes in blood pressure and patent ductus arteriosus (PDA), reveal brain changes related to ischemia and then reperfusion processes, there are changes of the values of IR and IP. Conclusion: Cerebral Doppler flowmetry provides a noninvasive method of cerebral circulation monitoring and establishing future therapeutic approach. Key Words: Cerebral doppler flowmetry, severe respiratory distress syndrome
    • 86 Abruptio Placentae Reflection Towards Neonatal Blood Components Snezhana Janchevska, Emilija Badeva Gajdova University Clinics of Gynecology and Obstetrics, Macedonia Abruptio placentae is a premature separation of the placenta from the uterus. Women with placental abruption, typically present with bleeding, uterine contractions, and fetal distress. Objective: Relationships between fetal distress provocated by abruptio placentae and neonates’ peripheral blood components dynamic in the start of postnatal life. Study design: Cohort collected 20 months, contents 93 neonates with mothers’ abruptio placentae and fetal distress. Babies were born by Cesarean Section in the University Clinics of Gynecology and Obstetrics. Premature newborns formed a first group, and near to term newborns second group. Blood components were determinated with a blood counter, immediately after birth, in the end of the first day and second day. Results: All pregnancies finished by Cesarean Section. 67,7% of newborns were with Apgar score more than 7. Others neonates were asphictic. The prevalence of anemia after birth was 15% (14/93). The prevalence of the neonatal neutrophilia was 62,3% (58/93), range 74%-86%, with out of significant diferences between two groups. The first control showed descending of neutrophils values, and second control confirmed normalizing, with out of antibiotics therapy. 11/93 babies had conatal infection. Conclusions: The presence of placental abruption has been associated with selected labor and fetal distress. Vaginal bleeding in placental abruption is follows to neonatal anemia. Neonatal neutrophilia a postpartum event which result from oxygen stress by placental abruption, what can produce a placental insufficient and fetus oxygen stress too. The baby’s answer is high number of neutrophils in peripheral blood. Poststress neutrophilia occurs rapidly and disappears shortly.
    • 87 A Severe Hemolytic Disease of the Newborn Caused by Anti-E Antibodies : A Case Report Mathew Kripail, Mohammed Abdel Latif, Asad Ur Rahman Sultan Qaboos University Hospital, Oman With the implementation of Rhesus D immunoprophylaxis, there has been a relative increase in non -Rh(D) alloimmunization causing Hemolytic Disease of Fetus and Newborn. We report a rare case of severe hemolytic disease of newborn in a neonate due to anti-E alloantibodies ,born to a mother who was Group B Rh positive. The mother 27 years old , gravida 2 para 1 at 38 weeks of gestation delivered vaginally a male baby with apgars 8 and 8 at 1 and 5 mins with a birth weight of 2.3 kg. She was an unbooked case in our hospital and her antenatal scans were normal. This baby was admitted for respiratory distress and pallor, developed hypotension, needed inotropic support and high frequency ventilation. Echocardiography revealed severe cardiac dysfunction with severe tricuspid regurgitation with evidence of near systemic pulmonary hypertension. Lab investigations demonstrated a severe anemia Hb 5.2 gm/dL, a severe hyperbilirubinemia total S. ilirubin 192 umols/L (11.3 mg/dL), reticulocytes 35%,and a positive Direct Antglobulin test . As there was no apparent cause of the hemolytic disease, antibody testing in mother showed the presence of Rh E antibodies. A double volume exchange transfusion was performed with anti Rh E negative cross matched blood, along with intensive phototherapy. The baby recovered fully and was discharged in a healthy condition on postnatal day nine. This case highlight the importance of routine antibody screening and if necessary antibody identification even in Rh (D) positive females. This is necessary to ensure timely availability of Antigen negative blood and reduce the effects on the newborn.
    • 88 Hypoplasia of Right Ventricle with Tricuspid Stenosis and Atrial Septal Defect Svetlana Krstevska Blazevska, Svetlana Krstevska Blazevska1 , Radica Muratovska2 , Svetlana Krstevska Blazevska 1 Clinical Hospital Acibadem Sistina, Macedonia 2 University Hospital for pediatric desease, Macedonia Background: Hypoplasia of the right ventricle (RV) is part of malformation such as pulmonary and tricuspid atresia and very rare is associated with atrial septal defect (ASD), tricuspid stenosis and/or other congenital heart disease. A few cases with isolated hypoplastic RV and ASD have been reported. Objective: To show the case of a female newborn with very severe form of small right ventricle with ASD and tricuspid stenosis, but normal pulmonary valve. The newborn was one day old, with generalized cyanosis and swelling, especially of the head and neck. The baby was oxygen-depending, with increased liver of 4 cm. The patient was on mechanical ventilation. Palliative surgery was not made; because of very sever general condition. The baby died when it was 40 days old. Diagnosis of congenital heart disease was made by echocardiogram and confirmed at autopsy. Methods: Diagnosis was confirmed by two-dimensional transthoracic echocardiography, chest x-ray, computed tomography and autopsy findings. Conclusion: Right ventricular hypoplasia with ASD and tricuspid stenosis is an uncommon abnormality. Severe forms of hypoplasia, usually presenting in early newborn period. Surgery for symptomatic patient should be palliative during first days of life. Without palliative surgery the newborn with hypoplastic right ventricle have no chance of survival. Screening for critical congenital disease is the most important in case of critical congenital heart disease.
    • 89 Improving Quality of Care and Patient Satisfaction by Better Communication between Neonatal Unit and Primary Care Uday Kumar Evelina London, UK Aim: To examine the quality of communication between the neonatal unit and primary care for babies transferred from neonatal unit to postnatal ward and subsequently home. To improve the quality of discharge summaries and by doing so decrease the re-admission rate and improve the level of patient satisfaction. Method: It was a retrospective study of all babies admitted to the neonatal unit in January 2013 who were transferred to postnatal ward and subsequently discharged home. Data was collection from SEND (Standardized Electronic Neonatal database) summaries, clinical notes and postnatal discharge summaries. Results: 17 babies were included in the study. 47% (8) babies needed significant input from the pediatric team in the post natal ward. 35 %( 6) babies were found to have inadequate communication with primary care about the care they had received during their hospital stay. Conclusion: Two separate discharge summaries were being generated for each baby for a single episode of care. Neither of these discharge summaries contained full information about the whole episode of care in hospital and there was a significant risk of important information getting missed. Recommendations: All babies transferred from neonatal unit to postnatal ward should be kept on the SEND database as transitional care babies until they are discharged home from postnatal ward. Discharge summaries will be initiated by the neonatal team and edited by the postnatal doctor at the time of discharge from postnatal ward. A single final summary will be sent to primary care.
    • 90 Islam and Resuscitation (D.N.R. Islamic Perspective) Bader Kurdi NICU, Hamad Medical Corporation, DOHA, Qatar Introduction: Religious and cultural issues often play a more vital role in decision making by parents and physicians than economic considerations, especially in Arab nations. Physicians are often reluctant to even broach the subject of DNR with parents, believing it will not be accepted, may cause a loss of trust in the physician, or “it is unfair to ask parents to be involved in the decision making process involving life and death”. This has led to a significant increase in the number of handicapped survivors, and to a shortage of intensive care beds Method: 2 Types of facilitation of death (DNR):1-Active facilitation of death: (Withdrawal of the therapy) when the doctor takes effective action to facilitate the death of the patient, such as stop mechanical ventilation 2-Passive facilitation of death: (No escalation of therapy) Where the doctor doesn’t take any effective steps to facilitate the death of the patient, but leaves the disease to take its occurs without any extra support if the patient deteriorated. We offer both ways of DNR for parent of 25 cases in the last 12 months. Result: After we explain to the parents about the prognosis of those cases and supply them with multiple Islamic fatwa regarding Islam and resuscitation 12 of them agreed to not be aggressive in the resuscitation if the condition of the patient deteriorated. Conclusion: The majority of scholars said that the treatment of patients is desirable (not a must) where there is a recovery.
    • 91 Incidence of Neural Tube Defects in a Highly Endogamous Society: Community Based Study Bader Kurdi, Abdulbari Bener HMC, Qatar Background: The incidence rates of Neural Tube Defects (NTD) in the Arabian region have been attributed to environmental, dietary and genetic factors. No previous study has been conducted in the State of Qatar to document the incidence and trends of NTD. Objective: The aim of this study is to determine the incidence of NTD over a 25 years period in the State of Qatar. Subject and methods: The study was based on study from 1985 to 2009 with a total of 285,008 newborns at Women’s Hospital in Qatar were screened for NTD. The study included was age, gender, ethnicity, parental consanguinity, and residential area. Results: The overall prevalence of neural tube defects and anencephaly were 28 and 12 per 10000 births, respectively. The prevalence of anencephaly was 11 and 12 per 10000 births in male and female newborns, respectively. There were 131 (42.1%) males and 180 (57.9%) female newborns. The rate of NTD was 8.99 per 10,000 and 12, 89 per 10.000 in male and female newborns respectively. This difference was significant (p0.001). The prevalence of anencephaly was 13.1/10000 in newborns with mothers aged 35 years. Consanguinity was seen in 36.7% of the parents. . The prevalence of NTD (total Meningomyelocele, M+hydrocephalus and Anencephaly) during the 25 years period was 10.9 per 10,000 births. Conclusion: The present study revealed that Qatar has a high incidence of NTD. High rates of consanguinity and lack of per conceptual folic acid intake among mothers were the main factors contributing to NTD incidence rates in Qatar.
    • 92 Creation of Follow-up System in Ukraine in Frame of National Project "New Life: New Quality of Maternity and Childhood Protection Tetiana Znamenska1 , Tetiana Kurilina1 , Olena Riga2 , Andrey Penkov3 1 SI "Institute of Paediatrics, Obstetrics & Gynaecology NAMS of Ukraine", Ukraine 2 Kharkiv National Medical University, Ukraine 3 Kharkiv Regional Specialized Orphanage 1, Ukraine Actions in frame of National project (2011-2014) -the audit of medical care for mother & newborns in region (different state of follow-up system) - Planning & financial substantiation in new perinatal center (27 regions –now 12 centers opened) - Reconstruction (follow-up unit) & purchase of equipment - Education & training of medical personnel (telecommunication – on-line training, training cycle in-site) Our investment of capital (the main target of new project) The manpower - Highly skilled medical staff (postgraduate pre-attestation cycle, guest training, national manual, national standards & guidelines) - Medical care oriented on patient - International standard of “friendly hospital” as mandatory conditions - Professional support: clinic-twin, training for administration Material resources - Up-to-date equipment - Innovation technology - comfort conditions for mother-child joint station - Assured & free provision with medicine and materials, instructions for early discharge, effective development Information support - The approaching of availability of medical care for population - The application of the best world practice in maternity & childhood protection - The formation of the motivation of healthy mode of life in population - The approaching of population with print information materials Prospects for follow-up and early intervention system as a standard care for preterm &sick infants - The creation of training center for follow-up units personnel - Revision of orders of Health ministry - Unification of psychological-medical tracking - Inclusion of follow-up program in medical education Expectation results - Creation of national electronic register of preterm & sick infants - decreasing of child abandonment - Standardization of follow-up system and program of early intervention - decreasing of the rate of all consequences of aggressive intensive care
    • 93 The Pharmacogenetic Approach in Prognosis of Dopamine Dose in the Neonatal Intensive Care Unit Svitlana Kyriachenko, Gorovenko Natalia, Rossokha Zoia State Institute of Genetic and Regenerative Medicine National Academy of Medical Sciences of Ukraine, Ukraine Introduction: Molecular medicine is the foundation in the development of new approaches to the determination of an individual dose of the drug in the patient’s treatment. This is particularly important in neonatology to avoid side effects. T-786C polymorphism of the eNOS gene influences on the production of the protein. Aim: The aim of this study was to evaluate the effect of T-786C polymorphism on the dose of dopamine required for therapeutic effect. Material and methods: We conducted study of 51 newborns (27 full-term and 24 premature newborns) with perinatal pathologies (perinatal hypoxic damage, respiratory failures, necrotizing enterocolitis, etc.). It was obtained the informed consent of the parents for the participation in this study. For the genotyping was used polymerase chain reaction followed by visualization on 2% agarose gels. Results: The dose of dopamine for newborns in the intensive care unit was 5,0-9,0 mcg/kg/min to achieve a therapeutic effect. The frequency of -786TT genotype in investigated newborns was 27,45%, -786CT – 52,94% -786CC – 19,60%, respectively. The average dose of dopamine depending on the genotype is shown in Table 1. Table 1. Drug hemodynamic support in newborns depending on the C-786T polymorphism Patients with -786CC genotype treated significantly lower dose of dopamine to achieve a therapeutic effect compared with -786CT (p0,05) and -786TT (p0,05) genotypes patients. Conclusion: Genetic testing is promising to determine the therapeutic dose of dopamine in patients of neonatal intensive care unit. -786TT Dopamine dose, mcg/kg/min 5,30+0,127,80+0,068,50+0,13
    • 94 New Approach to Prognosis of Development Risk of Severe Perinatal Pathology in the Newborns Svetlana Kyriachenko, Zoia Rossokha, Natalia Gorovenko, Gorovenko Natalia State Institute of Genetic and Regenerative Medicine National Academy of Medical Sciences of Ukraine, Ukraine Introduction: Genetic characteristics of newborns have an impact on the risk of perinatal pathologies and neonatal syndromes. Aim: This work was to evaluate the role of gene-gene interaction in the development of critical conditions in newborns. Material and Methods: We conducted case-control study included 245 newborns (116 full-term and 119 premature newborns) with perinatal pathologies (perinatal hypoxic damage, respira tory failures, necrotizing enterocolitis, neonatal jaundice, etc.) and 110 healthy full-term newborns. There were used polymerase chain reaction with further restriction fragments length polymorphism analyses. Statistical analysis of the results was performed using SPSS 17.0 and R-Studio. To visualize the obtained results we used classification and regression trees (CART) and ID3 algorithm. Results: We determined the association between DD, ID genotypes of ACE gene, 1166AC, 1166CC genotypes of AT2R1 gene, 308AG, 308GG of TNF-a gene, with increased development risk of perinatal pathology, perinatal hypoxic damage, RDS, NEC, neonatal jaundice. 677TT genotype of MTHFR gene was associated with reduced gestational age (prematurity) and the development risk of severe perinatal pathology. The statistical model with 83,2% predictive value was elaborated. The best model included ACE, AT2R1, TNF-a genes (fig.1). Figure 1. Gene-gene interaction for individual prognosis in newborns. Conclusion: It was shown that genetic analysis is promising approach for using in clinical practice. It may help to allocate the risk of perinatal pathologies and critical states.
    • 95 Arterial Blood Gas Sampling in Neonatal Intensive Care, King Faisal Hospital Ingabire Magera, Nambayisa Schadrack1 King Faisal Hospital, Rwanda An arterial blood gas (ABG) is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. ABG sampling provides valuable information on the acid-base balance at a specific point in the course of a patient's illness. It is the only reliable determination of ventilation success as evidenced by CO2 content. The purpose of the project was to improve the quality of health care by ensuring the skill and accuracy in ABG sampling; improve the accuracy of results in order to monitor the severity and progression of a documented disease process and to control the risks related to the ABG sampling technique. The population of this project consists of all nurses and doctors (GP) working in NICU. The data was obtained using a checklist for a period of three months (March to May 2012). The results showed that the performance of checking oxygen concentration, hand washing, and use of gloves during the procedure are decreased respectively to +21.8, +6.4 and +5.2%. ABG sampling technique improved. However, the performance related to the use of aseptic technique decreased to -1.9%.
    • 96 Nosocomial Infection in Neonatal Intensive Care, King Faisal Hospital Ingabire Magera, Kamagaju Josephine2 King Faisal Hospital, Rwanda Nosocomial infections are defined as those “Occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission and is manifested at least two (2) days post admission and within one (1) week post discharge. In King Faisal Hospital, Kigali (KFH, K) NICU, out of 60 neonates admitted between January to June 2009, 12 (20%) had Nosocomial infections as confirmed by blood culture. Out of 12 (100%) neonates with NI, 5 (42%) died due to NI during that period.
    • 97 The Safety and Effectiveness of Therapeutic Hypothermia in Neonates with Hypoxic Ischaemic Encephalopathy Jennifer Miah University of Liverpool, UK Background: Cooling has been used traditionally in many aspects of medical care. However the role of Hypothermia in neuro protection for neonatal Hypoxic Ischemic Encephalopathy has emerged as a more novel and non-invasive approach. Hypoxic Ischemic Encephalopathy is a syndrome consisting of debilitating neurological symptoms of which asphyxia is a common cause. Oxygen deprivation in the brain results in a cascade of biochemical events which leads to cell necrosis. The use of therapeutic hypothermia however has been shown to alter these biochemical processes. Clinically this may improve the outcome in newborn infants with HIE by reducing the extent of neurological damage and mortality. Objective: The purpose of this literature review was to ascertain the safety and effectiveness of therapeutic hypothermia in neonates with Hypoxic Ischaemic Encephalopathy. Method: A literature review was undertaken on randomised controlled trials which were obtained through electronic databases such as science direct and pubmed. Nine studies were critically appraised using the critical appraisal skills programme. Outcome measures included mortality, neurodevelopment defects and adverse effects. Results: All studies revealed that there were greater numbers of deaths or disability in neonates provided with conventional care compared to those given cooling. Adverse effects of therapeutic cooling were low. Importantly, neonates given therapeutic hypothermia suffered less neurodevelopment impairments. Conclusion: Neonates less than 6 hours of age with Hypoxic Ischemic Encephalopathy demonstrate greater clinical benefits from therapeutic hypothermia in contrast to standard treatment. Hypothermia has shown to be a safe technique in improving survival and neurodevelopment impairments among neonates meeting strict selection criteria. Therefore therapeutic hypothermia should be considered more strongly as part of the clinical care to newborns with HIE.
    • 98 The Impact of the Baby Friendly Hospital Initiative in Saudi Arabia Cynthia Mosher, Cynthia Mosher, Abdurahman Alhamdani, Asma Alhoulan, Reem Hamadah, Tehreem Khan, Yosra Almakadma, Alaa AbouBakr Hashem, Abdullah Sarkar, Abiola Senok Alfaisal University, Saudi Arabia Background: The Baby Friendly Hospital Initiative (BFHI) launched by the World Health Organization (WHO) is a global effort aimed at promoting and supporting breastfeeding and has been shown to be effective in increasing breastfeeding rates. The WHO recommends exclusive breastfeeding for six months. Although Saudi Arabia has one of the highest breastfeeding initiation rates (92%), this falls rapidly to only 10% within six months. Aim: To identify the factors that shape breastfeeding trends and assess the effectiveness of BFHI implementation in Saudi Arabia. Methodology: This prospective, longitudinal study was carried out at two-matched healthcare facilities in Riyadh (BFHI-practicing versus BFHI-non-practicing). Randomly selected women at 38-40 weeks gestation, of all education, nationalities and ages, were enrolled. Known contraindications to breastfeeding were excluded. Pre-tested questionnaires administered prenatally, one, three and six months postnatal collected data on demographics, infant feeding practices, breastfeeding education and support. Maternity staff practices were surveyed. Data was analyzed using SPSS software. Results: preliminary data analyses showed a significantly higher incidence of women receive breastfeeding education at the BFHI hospital (93.3% vs 48.2%). Formula marketing targeting non-BFHI hospital patients was found to be 24.1% vs 4.8% despite national policies restricting such activities. Hospital policies regarding visitation times were identified as a risk factor. More BFHI-hospital patients were exclusively breastfeeding at discharge (51.0% vs 30.1%) Conclusion: While BFHI implementation is demonstrating success, there are weaknesses. Improved compliance with BFHI practices and addressing hospital policies may have an even larger impact on breastfeeding rates. Implications: An extensive research of the literature has found no study published assessing the effectiveness of BFHI implementation in increasing breastfeeding rates in Saudi Arabia. Our study will be the first to make this assessment and will be the first source of information to the local and global scientific community and the public.
    • 99 Effects of Surfactant Replacement Therapy in Preterm Baby with Neonatal Respiratory Distress Syndrome Vesna Novakovic, Stojislav Konjevic, Veroslava Milosevic, Ana Blagojevic Pediatric Clinic,Clinical Center, Bosnia and Herzegovina Introduction: Respiratory distress syndrome (RDS) is a pulmonary insufficiency mostly premature newborns, caused pulmonary surfactant deficiency. As many as 50% of all neonatal deaths is the result of RDS. A revolution in the treatment of RDS entered is application of surfactant, which is the gold standard in the treatment, with significant reduction mortality and complications. Objective: The objective of this study was to investigate the effect of surfactant replacement therapy, survival rate, and mortality risk factors in premature neonates with RDS in the clinic. Methods: This study included 105 preterm infants with RDS, between 24 and 37 weeks gestation, were admitted in the Neonatal Intensive Care Unit (NICU) and received surfactant during 2010 -2013. Results: Overall, 62% (83/134) neonates who received surfactant survived. The higher efficacy of surfactant therapy was observed in neonates with gestational age of more than 28 weeks 82,8% (58/70), in those who received the surfactant during the first 2 hours of life (58.3%),in a dose greater than 100mg/kg (63,4%), and whose mother received steroid therapy before labor (42.3%).The highest mortality 60,9% (39/64) was the neonates gestational age below 28, and Apgar score of less than 5/7 (53.1%), and birth weight of less than 1000 g 67.9% (36/53).Significantly higher risk of dying was observed in neonates with one or more risk factor, prenatal asphyxia, air-leak say and pulmonary hemorrhage, intracranial hemorrhage gr III i IV and early et late sepsis. Conclusion: Early treatment with surfactant, in doses higher than 100 mg/kg body weight significantly reduces mortality of RDS Prevention of risk factors and antenatal administration steroids increases the efficiency of surfactant replacement therapy.
    • 100 Treatment Breathing Disorders of Infants with Respiratory Distress Syndrome Fayziev Otabek, Anvar Yusupov Taskent pediatric medical institute, Uzbekistan Aim: The study was to evaluate the effectiveness of the drug Surfactant composite in the treatment of acute respiratory disorders in the newborn respiratory distress syndrome. Materials and methods: We observed 30 children: 15 children a basic group and 15 control groups. All infants were treated with the treatment of RDS (antibiotic, infusion and symptomatic therapy, enteral or parenteral nutrition). In the study group received the drug, as well as Surfactant composite premature 1st day of life, with a gestational age ≤ 36 weeks, body weight ≥ 900g at birth. The drug is used pulmonary, every 12 hours for 2 days. Hemodynamic monitoring, chest x-ray pulse oximetry (HR, A / D and SpO2): Results: The results showed that the main group of children during treatment with the drug Surfactant composite were quickly reduce the value of the maximum inspiratory pressure (Pin) and frequency – controlled ventilation (VR), and the significant difference was noted already from 2 days up to and transfer of children at weaning. Baby’s core group quickly noted the positive dynamics in the clinical picture, and in some patients in the first, 3 - minutes after administration of the drug improved chest and holding of breath in the lungs, skin color, or disappear minimum marbling. On changes in children can also judge the dynamics parameters of mechanical ventilation, including the duration of mechanical ventilation and ventilation with the use of hyperoxic mixtures (FIO2 ≥ 0,3). Conclusion: Use of the drug Surfactant composite in the treatment of respiratory distress syndrome leads to a more dynamic performance improvement respiratory biomechanics allows faster start falling Pin, VR and 2 times quickly reach the level of nontoxic FIO2.
    • 101 Recurrent Air Leakage in Preterm Newborn Infants: When Surgical Approach Could be Decisive. A case report Albert Pi Compañó, Anna Tarragó Aregay, Rosario Estudillo Mora, Laura Ripoll Roca Vall d'Hebron Hospital, Spain Introduction: Pulmonary air leakage is a severe complication of pulmonary disease in newborn infants, especially in preterm ones, often associated to resuscitation, mechanical ventilation, administration of surfactant or during CPAP-treatment. Needle aspiration or thoracostomy solve the condition in most cases, nevertheless recurrence of air leakage can occur. Case Report: Female patient born at 25+1 weeks of gestation and birthweight 540 g because of a suspected chorioamnionitis. She required resuscitation in the delivery room by endotraqueal intubation and surfactant administration. During the first days of life she suffered from pulmonary collapse which was solved with high frequency ventilation and presented persistent ductus arteriosus that had to be surgically closured. At the10th day of life the infant presented sudden deterioration and right tension pneumothorax was diagnosed, so that, needle aspiration and placement of two drainage tubes were proceeded. She was put again on high frequency ventilation. Nevertheless, air-leakage persisted, althought mobilizing the drainages and needing continuous manual aspirations. A bronchopleural fistula was suspected, and a selective left main bronchus intubation was attempted, unsuccessfully. Rapid deterioration was observed leading to cardiopulmonary arrest that required advanced cardiopulmonary resuscitation. We decided that a surgical approach by thoracotomy had to be performed. Macroscopic examination under normal saline revealed an air outflow at the mediastinal side of the right lower lobe, which was sutured and surface sealed. Afterwards patient respiratory condition and so her clinical status improved progressively. Conclusions: Recurrent pneumothorax is an unusual condition, but the patient's survival depends on an appropriate treatment. When the patient’s intubated and connected to mechanical ventilation, a bronchopleural fistula has to be suspected. It’s important to assess and perform surgery at the appropriate time in order to avoid a deterioration which could be fatal. We conclude that surgical approach should be considered when the conventional treatment has proved insufficient.
    • 102 Hypotonia, Lethargy and Hepatic Failure: Leading Signs of New Case of Galactosemia Albert Pi Compañó, Anna Tarragó Aregay, Rosario Estudillo Mora, Laura Ripoll Roca Vall d'Hebron Hospital, Spain Introduction: Galactosemia is a rare autosomal recessive inherited metabolic disorder. Its defect cause congenital abnormalities due to galactose accumulation if mother had taken milk during pregnancy, as well as the intake of milk after delivery will cause a progressive deterioration. An early diagnosis is essential. Case Report: A 21-day-old Caucasian male newborn was referred to the hospital because of hypotonia, tendency to lethargy, vomiting, poor feeding and deterioration of his clinical state. The patient was breastfed since birth. Clinical examination revealed jaundice, hepatomegaly and septic appearance. Lab tests showed slightly elevated liver enzymes, coagulopathy and metabolic acidosis. Infectious screening, abdominal ultrasound and metabolic studies were performed. Oral intake was discontinued. Abdominal ultrasound pointed to hepato-renal syndrome. The patient showed clinical improvement after intravenous rehidratation, so diet was reinstated. A rapid deterioration was observed, and nil per os was indicated again. Tyrosinemia was suspected and patient received nitisinone for three days, until laboratory tests rule it out. Other infectious or deposit causes of hepatic disease were excluded. Galactosemia was also suspected. Funduscopy was performed, finding bilateral cataracts resembling an oil drop in both eyes, suggesting galactosemia. He was given a free-galactose diet, improving his clinical state. Laboratory and genetic tests confirmed the diagnosis, being the patient an homozygous carrier of the most common mutation. Conclusions: Although is an extremely unusual disorder, galactosemia should be taken into account in the differential diagnosis of neonatal hepatic disease, as the patient's outcome is largely dependent on early diagnosis and appropriate treatment, ensuring survival of the affected individual. It’s important to note that oral intake should not be initiated until metabolic disorders had been discarded, in order to avoid a deterioration which could be fatal. Nowadays, since few months ago, this disorder is included in all-neonates metabolic screening tests in our region.
    • 103 Exfoliative-toxin producing Staphylococcus Aureus Neonatal Infection: a Case report Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Rafael Barragán Milán1 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Introduction: Neonatal staphylococcal infection is a potentially serious infection in this age group according to their immunological immaturity, so early identification and establishment of therapeutic measures are very important. Nowadays is an extremely rare germ causing neonatal sepsis. The severity of disease in the neonatal period wides from a low grade onfalitis to fulminant septicemia with possible meningitis and death. We report a case which exemplifies some of the possible complications of the infection caused by this organism, so rare today as etiologic agent of neonatal sepsis. Case presentation: Shortly-life male term newborn resulting from normoevolutive gestation which was ended by emergency cesarean section for suspected clinical corioaminionitis and meconium-stained amniotic fluid, started difficulty breathing, hypoactivity and rejection of breast milk, being given treatment as early neonatal sepsis at first hours of life. Maternal cultures for group B streptococcus were negative. Within next hours, facial, truncal, axillary and inguinal eritrodermia appeared and some bullous elements of few mm of diameter as well, which rapidly progressed to wide areas of skin exfoliation, suspecting of staphylococcal scalded skin syndrome. Vancomycin was added to treatment. Rapid and progressive deterioration occurred, associating respiratory failure that required mechanical ventilation support, hemodynamic collapse and secondary pulmonary hypertension requiring administration of vasoactive drugs and nitric oxide. Afterwards, slowly gradual but progressive improvement was followed by satisfactory clinical outcome. Meticillin-sensitive S.aureus was reported from blood and external cultures. Conclusion: The purpose of this case report is to highlight the low incidence of exfoliative toxin-producing S.aureus as microorganism to cause sepsis and/or meningitis in neonatal period, and the presence in our case of septicemia and no clinical signs of local infection. Is noteworthy in our case the route of vertical transmission instead of horizontal acquisition as source of infection, being even more exceptional in our current environment.
    • 104 Neonatal Hyperekplexia Resistant To Clonazepam: A Difficult Challenge for Medical Treatment And Nurse Caring Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Ainhoa Rivero Pérez1 , Carmen Núñez García1 , Berta Barbosa Nogueira1 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Introduction: Neonatal hyperekplexia or startle disease is a congenital disease characterized by an intense jerk and hypertonia at the lowest stimulus (sounds, tactile stimuli or from internal origin), potentially causing laryngospasm and apnea, and subsequent neurological sequelae. Its very low prevalence turns the condition a rare and little-known disease. This case reflects the need of individualized care strategies in these patients, recommendations which have not been established in prior cases. Case Report: Proper weight and term neonate, with no family or obstetric history of interest except meconium stained amniotic fluid, presented generalized muscle hypertonia, cyanosis and hyperexcitability from first hours of life. Laboratory and metabolic tests of blood and CSF, ultrasound transfontanelar imaging and cranial MRI were found to be normal, showing the EEG mild paroxysmal activity, which does not appear in the posterior exam. Hyperekplexia was suspected and clonazepam was initiated, obtaining no response. Synergistic therapeutic trial with clobazam and clonazepam was begun, decreasing the number and intensity of crisis. Given this situation a plan of nursing care was outlined: reduction of environmental stimuli by attention to sound, light and approaching the neonate; careful manipulation and attention in routine care (grooming, feeding,...); single-room accommodation; Vigevano maneuvring; NGT-feeding during first months, and enabling parents participating and training them in the cares. Conclusions: Care-needing of this infant with severe resistant hyperkplexia to the initial medical treatment, forced to make a very individualized plan based on knowledge of life-threatening events presented in nursing care. Modification of the environment, careful attention to routine care, continuous monitoring, nurse training in salvation maneuvers (Vigevano) and active parents inclusion in cares, made possible to overcome risk situations and aminorate family stress, towards the improvement of the patient when finally partially- responded to medical treatment, and could be also useful in future cases.
    • 105 Neonatal Continuous Arterio-Venous Exsanguinotransfusion: Description Of The Procedure And Nursing Care Albert Pi Compañó2 , Anna Tarragó Aregay1 , Rosario Estudillo Mora1 , Laura Ripoll Roca1 1 Vall d'Hebron, Spain 2 Centro Médico Teknon, Spain Introduction: Exsanguinotransfusion is a technique that is used to maintain the serum bilirubin levels below neurotoxicity. It's indicated in cases of hyperbilirubinemia when phototherapy has failed and there is high risk of bilirubin encephalopathy , as well as in severe cases of anemia with cardiac dysfunction and death risk, DIC , etc. ... Justification: To explain what the exsanguinotransfusion is and what the procedure consists of for the improvement on nursing handling. Description: This technique involves the withdrawal of fractional parts of baby's blood and the replacement with donor's blood. To carry this out, usually umbilical artery is catheterized (newborn blood will go to wasting bag) and umbilical vein as well (donor blood will be administered). Two infusion pumps are needed, one for input and the other for output, using a closed circuit. It is a sterile procedure. Preparation of input circuit: the blood products infusion equipment is connected with donor blood bag and to the hotline system and once purged is connected to the umbilical venous catheter. Preparation of output circuit : using a two- lined pump system , the primary line is filled with heparinized serum and connected to bag of rejection and the secondary line is connected with umbilical artery catheter. The infusion and extraction rythm must always be the same, and therefore, both pumps started and stoped simultaneously. Nursing care consists of registering all process, volumes removed, controlling leakage, hemodynamic and gasometric monitoring and assessing warning signs of complications or disorders. Conclusions: The technique of automatic exsanguinotransfusion brings more precision, comfort, safety and sterility being more physiological than the manual method, thus avoiding possible infections or complications. It requires well-knowledge of nursing care in this technique because it is fundamental for assembling the procedure and controlling potential clinical disorders during process.
    • 106 Benefits of Breastfeeding and Exclusive Breastfeeding in the Newborn Focusing on Preterms Albert Pi i Compañó1 , Anna Aregay Tarragó2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Breastfeeding contains not only appropriate nutrients but also provides digestive enzymes, vitamins and minerals for optimal baby's needs and development in their first months of life. In addition it also contains antibodies that come from the mother and help the newborn fighting infections. It must be started, if not contraindicated, in the first hour of life, as it is considered that colostrums is the most complete food at that time, and should be extended to 6 months exclusively or more. Thus, it is especially beneficial in preterm babies because of its digestive properties which make breast milk the most well-tolerated for the preterm and also immature gut. Justification: The support given to mothers must be very important for the implementation of breastfeeding be complete and could be extended for more, and our aim is specially focused in preterm infants. Description: This can be seen from 31 weeks onwards, but even 28 weeks can breastfeed with help. It results in an increase of survival of babies born below 1500g. Mother’s chest will warm automatically if her baby is cold, and even cool baby if too hot. For premature they need mother even more to stabilize. Conclusion: It’s very important that nurses and health professionals we provide adequate information on the benefits of breastfeeding and support mothers solving their concerns and supporting in the technique, as it could suppose leaving or, on the contrary, succession breastfeeding. Breastfed infants are less prone to gastrointestinal and respiratory infections, allergies, constipation, and prevent long-term childhood obesity, diabetes, sudden death syndrome and caries. And more over in case of preterm delivery: the smaller the premature, the more they need their mother’s chest to stabilize even if they need medical technology as well.
    • 107 Importance of Breastmilk Banks when Mother’s Breastfeeding is not Possible: Best Alternative to Artificial Milk Formula Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Introduction: Breastmilk banks are specialized services aimed at promoting and supporting breastfeeding and responsible for providing donated human milk to patients who need it, ensuring its safety and quality. There is strong evidence on the benefits feeding infants with breast milk in short and long term. Milk banks: They collect, process, store and disperse breastmilk. They produce a safe product concerning the risk of infections transmission: strict control in the selection of the donor, pasteurization process of milk before dispensing it, strict microbiological tests before and after processing. Breastmilk from bank: Offers: - better digestive tolerance, - immunological protection against infectious diseases, -protection against necrotizing enterocolitis. Contains growth factors which: -protect the immature tissue, -promote gut maturation, - promote the recovering of tissues damaged by infections. Long-term effects: -best psychomotor development, - decreased cardiovascular risk factors. Indications: • Nutritional : - prematurity, - malabsorption syndrome, - some metabolic congenital errors, - postoperative nutrition. • Therapeutical: - infectious diseases, - immunodeficiencies, - organ transplantation, - chronical diseases. • Preventive: -necrotizing enterocolitis, - cow's milk protein allergy, - immunosuppressive therapy. Conclusions: Breastmilk processed in milk bank retains largely the nutritional and immunological properties of human milk which make it an irreplaceable product concerning feeding of the newborn. Milkbanks will raise awareness in society about the value of breastfeeding and enable research and development of techniques that collaborate in its maintenance worldwide.
    • 108 Nursing Care in Preterm Infants Posture Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Caring postural changes in preterm newborns is known as the set of activities serving to promote some concrete positions that will be beneficial for the neurodevelopment of the child. Justification: This poster aims to spread the effectiveness of nursing intervention in the process of early child evelopment through positional care. Focusing mainly on the maintenance of physiological flexion, midline orientation and containment in the nest, the physiological position the fetus still in the maternal uterus would enjoy. Description: Our proposal is focused on making both health careers and parents and relatives of infants admitted to the neonatal unit conscious on the subject, providing the basics of positional care, as well as the benefits and disadvantages of each type of decubitus. Similarly, to provide all them several items (such as yawning, facial expressions, concrete behaviors,..) so they know how to understand the signs and symptoms of comfort or discomfort that newborns have. Conclusion: Awareness of nurses about the behavior and physical signs of newborns show us is needed to be able to modify infant postures since there is evidence that postural patterns that remain for weeks and months influence the formation of neural connections and cerebral pathways of the infant.
    • 109 Nutrition in Infants with Congenital Heart Disease Albert Pi Compañó, Anna Tarragó Aregay, Rosario Estudillo Mora, Laura Ripoll Roca Centro Médico Teknon, Spain Introduction: Children born with congenital heart disease often have alterations in nutrition, an important problem that must be treated with a multidisciplinary assessment, which will ensure optimal growth and development allowing entering surgery on best conditions and decreasing risk of complications on surgery room and also during postoperative period avoiding for example risk of edema and capillary leak if plasma proteins are on good levels. Nutritional Management: Proper assessment of nutritional status: Detailed clinical findings and laboratory data. - Ensure an adequate calorie-protein intake, fluid and sodium restriction, and supplementation of vitamins and minerals, especially iron and calcium. Type of food depends on the age, functional status of gastrointestinal tract and heart disease. Promote breastfeeding whenever possible. - Gradually increase the caloric density, but without altering metabolic balance and avoiding increasing volume. Oral feeding is the route of choice, provided that hemodynamically be possible, although enteral nutrition almost always be necessary. - Parenteral nutrition is only indicated when inability to use gastrointestinal tract. Conclusion: With successful nutritional assessment and an adequate nutritional support, morbidity and mortality associated to malnutrition are avoided and it allows entering surgery in optimal condition and decreases postoperative complications.
    • 110 Importance of Breast Milk Banks when Mother’s Breastfeeding is not Possible: Best Alternative to Artificial Milk Formula Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Breast milk banks are specialized services aimed at promoting and supporting breastfeeding and responsible for providing donated human milk to patients who need it, ensuring its safety and quality. There is strong evidence on the benefits feeding infants with breast milk in short and long term. Milk banks: They collect, process, store and disperse breast milk. They produce a safe productconcerning the risk of infections transmission: strict control in the selectionof the donor, pasteurization process of milk before dispensing it, strictmicrobiological tests before and after processing. Breast milk from bank: Offers: - better digestive tolerance, - immunological protection againstinfectious diseases, -protection against necrotizing enterocolitis. Containsgrowth factors which: -protect the immature tissue, -promote gut maturation, -promote the recovering of tissues damaged by infections. Long-term effects:-best psychomotor development, - decreased cardiovascular risk factors.Indications: Nutritional: - prematurity, - malabsorption syndrome, - some metabolic congenital errors,- postoperative nutrition. Therapeutical: - infectious diseases, -immunodeficiencies, - organ transplantation, - chronical diseases.Preventive: -necrotizing enterocolitis,- cow's milk protein allergy, -immunosuppressive therapy. Conclusions: Breast milk processed in milk bank retains largely the nutritional and immunologicalproperties of human milk which make it an irreplaceable product concerningfeeding of the newborn. Milk banks will raise awareness in society about thevalue of breastfeeding and enable research and development of techniques thatcollaborate in its maintenance worldwide.
    • 111 Improved Handling of Withdrawal Syndrome of the Newborn Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: The withdrawal syndrome is one of the most prevalent NICU disorders because of use of sedation and analgesic drugs. An early diagnosis will affect prognosis, morbidity and staying in the unit. Justification: We believe that the introduction of supplementary tables a part from Finnegan score during the stay will contribute to improving the assessment of the syndrome, customizing cares for each infant. Description: In our NICUs, Finnegan score is tested every 6-12 hours to adjust the phenobarbital or morphine (Brompton solution) dose in each infant needing those drugs. Sometimes is found that children do not be well-adapted to the treatment dosage, causing a delay in weaning and thus, more stress, problems with feeding and disposal, and finally in their neurodevelopment. The Finnegan test was initially created for children whose mothers had a drug -an opioid- addiction, but was former generalized toall cases of withdrawal syndrome. The application of Wat-1 tables and the Cunliffe Score will help complementing the above, thus providing a proper handling of the newborn suffering withdrawal syndrome arising from use of sedation and analgesic drugs. Conclusions: Using of complementary scores to Finnegan test will help providing better individual attention to newborns needed and avoid potential complications arising from the treatment.
    • 112 Nutritional Needs during Pregnancy Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Pregnancy period requires a diet providing necessary energy and nutritional resources to maintain mother health, allow body metabolic changes experienced by the pregnant mother, and achieve optimal development and fetal growth. Nursing should have clear nutritional guidelines during pregnancy and must be well known, for transmission to pregnant patients whenever needed, raising their awareness of their relevance. Description: It has been estimated that in energy terms must be necessary during the second and third trimester up to 300 Kcal per day over the requirements before pregnancy. It is considered sufficient an intake of 2200 Kcal per day (with a standard deviation of 390Kcal), reaching to 2500 kcal – 2750 kcal per day during the fifth month of pregnancy. A good diet would be 5-6 meals / day, avoiding coffee, alcohol and carbonated drinks and resting semi sitting with feet up. Conclusions: In pregnancy and also during breastfeeding higher amounts of some nutrients are required, so nurses should propose and include in the pregnant diet all the basics, ensuring they are sufficient, and adapting it to her various tastes and habits: over 10 – 20 g of protein a day (total 100g/day), 20-30g/day of fat (better vegetable oil), sufficient carbohydrate diet, high starched and avoiding rapidly absorbed sugars, folate 400mcg/day, iron 25-30mg/day, calcium 1.200mg/day, magnesium 450mg/day, iodine 175mcg/day, and 10g/day of yeast specially in second trimester
    • 113 Nutritional Plan in Gestational Diabetes Mellitus Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Gestational diabetes is a risk factor for pregnant women and behaves health problems for the fetus. Diet is the mainstayof treatment, and is used to achieve therapeutic blood sugar levels and thus optimal metabolic control. Description: Gestational diabetes refers to intolerance to carbohydrates first recognized during pregnancy. The self-care plan includes first a nutrition plan. If this results not being enough, the addition of other therapeutic measures, such as mild exercise or insulin treatment would be considered. Nutrition plan design: 1) Assessment based on clinical history, physical findings, laboratory tests, nutritional habits and preferences and resources destined for food.2) Strategies for controlling carbohydrate intake, to romote nutritional habits that achieve glycemic goals, gaining weight reasonably and avoiding appearing of ketonuria. 3) Program subsequent follow-upvisits to avoid weight gain, control blood glucose levels and the ability ofthe pregnant patient to fulfill the meal plan. Conclusions: Once detected gestational diabetes is essential to implement the evidence of the benefits achieved with current dietary recommendations for their management and assessment, because with good metabolic control adapted to the physiological stage of pregnancy may reduce fetal morbidity and mortality.
    • 114 Giving Support to Neonatal Losses Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d’Hebron Hospital, Spain Introduction: Neonatal losses are situations in which the arrival of a new family member is lived with hope and enthusiasm towards this new future loved one and the fact that there occurs an unexpected death makes parents and relatives not easily accept them. Moreover, death is something that exists as a clinical failure and health staff tends to focus on other patients forgetting sometimes those parents, and coming up death in a surrounded environment by strange people performing procedures that they do not understand, isolated from their loved ones, becomes a fact without emotional support. Justification: Highlight the important role of nurses and nursing activities that will facilitate the duel of prenatal death, giving emotional support and caring, a part from the newborn, both the parents and the relatives to help assimilate the loss and prevent the emergence of future psychiatric disorders, giving some guidance on possible interventions and activities to do. Methodology: Description nursing activities aimed at facilitating bereavement of perinatal death following the lived experience of cases in our unit. Results: Analyzing our experience we have seen the importance of measures such as: - Encourage participation in decision making about the interruption of life support once the parents have realized and understood the situation and the future implications - Encourage parents to catch the baby during or after his death , - Prepare the baby to be seen, - Have time for the family to remain alone with the baby - Encourage parents to verbally express the memories of loss - Encourage the identification of the deepest fears about the loss. Conclusions: The grieving process may continue towards assimilation loss and reorganization of life or towards creating a more lasting mental impairment, which will set up a pathological dimension, being important the nursing role.
    • 115 Improving Handling of Withdrawal Syndrome in Newborns Anna Tarragó Aregay1 , Rosario Estudillo Mora1 , Laura Ripoll Roca1 , Albert Pi Compañó2 1 Vall d'Hebron Hospital, Spain 2 Centro Médico Teknon, Spain Introduction: The withdrawal syndrome is one of the most prevalent NICU disorders because of use of sedation and analgesic drugs. An early diagnosis will affect prognosis, morbidity and staying in the unit. Justification: We believe that the introduction of supplementary tables appart from Finnegan score during the stay will contribute to improving the assessment of the syndrome, customizing cares for each infant. Description: In our NICUs, Finnegan score is tested every 6-12 hours to adjust the phenobarbital or morphine (Brompton solution) dose in each infant needing those drugs. Sometimes is found that children do not be well-adapted to the treatment dosage, causing a delay in weaning and thus, more stress, problems with feeding and disposal, and finally in their neurodevelopment. The Finnegan test was initially created for children whose mothers had a drug -an opioid- addiction, but was former generalized to all cases of withdrawal syndrome. The application of Wat-1 tables and the Cunliffe Score will help complementing the above, thus providing a proper handling of the newborn suffering withdrawal syndrome arising from use of sedation and analgesic drugs. Conclusions: Using of complementary scores to Finnegan test will help providing better individual attention to newborns needed and avoid potential complications arising from the treatment.
    • 116 Nutritional Needs during Pregnancy Anna Tarragó Aregay1 , Rosario Estudillo Mora1 , Laura Ripoll Roca1 , Albert Pi Compañó2 1 Vall d'Hebron Hospital, Spain 2 Centro Médico Teknon, Spain Introduction: Pregnancy period requires a diet providing necessary energy and nutritional resources to maintain mother health, allow body metabolic changes experienced by the pregnant mother, and achieve optimal development and fetal growth. Nursing should have clear nutritional guidelines during pregnancy and must be well known, for transmission to pregnant patients whenever needed, raising their awareness of their relevance. Description: It has been estimated that in energy terms must be necessary during the second and third trimester up to 300 Kcal per day over the requirements before pregnancy. It is considered sufficient an intake of 2200 Kcal per day (with a standard deviation of 390Kcal), reaching to 2500 kcal – 2750 kcal per day during the fifth month of pregnancy. A good diet would be 5-6 meals / day, avoiding coffee, alcohol and carbonated drinks and resting in a semisitting position with legs up. Conclusions: In pregnancy and also during breastfeeding higher amounts of some nutrients are required, so nurses should propose and include in the pregnant diet all the basics, ensuring they are sufficient, and adapting it to her various tastes and habits: over 10 – 20 g of protein a day (total 100g/day), 20-30g/day of fat (better vegetable oil), sufficient carbohydrate diet, high starched and avoiding rapidly absorbed sugars, folate 400mcg/day, iron 25-30mg/day, calcium 1.200mg/day, magnesium 450mg/day, iodine 175mcg/day, and 10g/day of yeast specially in second trimester.
    • 117 After a Newborn Death is not the end: Giving Support to Neonatal Losses to avoid Pathological Parents Mental Dimension Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Introduction: Neonatal losses are situations in which the arrival of a new family member is lived with hope and enthusiasm towards this new future loved one and the fact that there occurs an unexpected death makes parents and relatives not easily accept them. Moreover, death is something that exists as a clinical failure and health staff tends to focus on other patients forgetting sometimes those parents, and coming up death in a surrounded environment by strange people performing procedures that they don't understand, isolated from their loved ones, becomes a fact without emotional support . Justification: Highlight physicians and nursing activities that will facilitate the duel of perinatal death, giving emotional support and caring, appart from the newborn, both the parents and the relatives to help assimilate the loss and prevent the emergence of future psychiatric disorders, giving some guidance on possible interventions and activities to do. Methodology: Description nursing activities aimed at facilitating bereavement of perinatal death following the lived experience of cases in our unit. Results: Analyzing our experience we have seen the importance of measures such as: - Encourage participation in decision making about the interruption of life support once the parents have realized and understood the situation and the future implications - Encourage parents to catch the baby during or after his death , - Prepare the baby to be seen, - Have time for the family to remain alone with the baby - Encourage parents to verbally express the memories of loss - Encourage the identification of the deepest fears about the loss. Conclusions: The grieving process may continue towards assimilation loss and reorganization of life, or instead, towards creating a more lasting mental impairment, which will set up a pathological dimension. To avoid the last, is important both nursing and physicians role after newborn death has occurred.
    • 118 Timing of Both Elective Inductions or Cesarean Deliveries and neonatal late Preterms and early Terms Outcomes: Two Populations at Risk Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Late preterm births (34 to 36 weeks) and earlyterm ones (37 to 38) have increased over the last decades in developed countries. Although with less risk than smaller preterm gestational age, recent publications show higher rates of mortality and morbidity for these groups, if compared with full term infants, both in the short and long term. The risk of mortality and morbidity increases with decreasing gestational age, with the lowest risk being at 39 weeks of gestation. So that, elective delivery before 39 completed weeks' gestation is inappropiate. Complications of late preterm or early term birth are related to immaturity of the different organs and systems. During the neonatal period, the most frequent complications are hyaline membrane disease, feeding problems and hypoglycemia in late preterms; and transient tachipnea and hyperbilirubinemia in both. In the long term, outcomes show that late preterms have an increased risk for developmental delay, academic and behavioral difficulties. While most complications are less frequent and less severe than extremely preterm infants, the large number of children that are born as late preterms or induced early terms represent a large population at risk. The purpose of this poster is to highlight the increase on mortality, morbidity and increased risk for short and long term development in this population, especially in late preterms. As newborn health professionals, we should make our obstetricians colleagues to be aware of the true risks of births in the near-term gestational ages: women assessing elective births before 39 completed weeks’ should be counseled regarding these outcomes and also those who contemplating elective induction before 39 weeks' gestation with an unfavorable cervix, regarding an increased rate of cesarean delivery. Hopefully, it may help obstetricians, neonatologists, pediatricians and midwives to pay attention to this young population at risk, trying to reduce their incidence.
    • 119 Whooping Cough (pertussis) Vaccination in Pregnancy: A New Indication Albert Pi Compañó1 , Anna Tarragó Aregay2 , Rosario Estudillo Mora2 , Laura Ripoll Roca2 1 Centro Médico Teknon, Spain 2 Vall d'Hebron Hospital, Spain Introduction: Pertussis (whooping cough) is an important cause of infant death worldwide and continues to be a public health concern even in countries with high vaccination coverage. Despite the last, the incidence of pertussis is increasing since 2010, including developed countries. Particularly alarming is the increase of pertussis in infants too young to be (fully) vaccinated because the highest morbidity and mortality is observed in this first months, when the risk of apparition of life-threatening complications as maligne pulmonary hypertension is higher. Furthermore, about 30 to 40% of babies who get pertussis catch it from their mother (when source was identified). Discussion: Recent publications show maternal vaccination offers the possibility to protect infants by getting vaccinated against pertussis when they are pregnant and creating protective antibodies passing some of them to the baby before birth via trasplacentaria. These antibodies provide short-term protection against pertussis in early life, from birth till immunity is induced by active vaccination at two months of life. The best time to get pregnant women vaccinated is between 27 and 36 weeks of pregnancy, with between 28 and 32 weeks the ideal time. Maternal vaccination studies with both whole-cell and a cellular pertussis vaccines have not shown serious adverse effects neither in mother nor child. Additional support for the efficacy of maternal vaccination comes from studies showing that transfer of antibodies confers protection against pertussis. Since October 2012 is recommended that pregnant women receive the Tdap vaccine during each pregnancy irrespective of prior history of receiving pertussis vaccine, replacing the original recommendation that pregnant women get the vaccine only if they had not previously received it. Conclusion: Maternal vaccination might be an effective way to decrease morbidity and mortality caused by pertussis in newborn babies.
    • 120 Nail Changes Among Very Low Birth Weight Babies – a Hospital Based Study Swealina Pradhan, Tanmay Padhi Veer surendra sai medical college burla, India Introduction: The diagnosis of neonatal nail disorders can be a sign of systemic disorders. It can reflect developmental defects as well as metabolic alterations. Although there have been studies on nail disorders among children, no data exists about their prevalence among very low birth weight babies. Aims and objective: To study nail changes among very low birth weight babies. So that we can rule out any systemic disorders and can find any developmental defect at earliest. Materials and methods: 100 consecutive patients admitted to a neonatal unit for very lowbirth weight were included in the study. A detailed history was recorded about demographic details of mother and child, obstetric course and presence of cutaneous and systemic disorders. Nails were examined clinically and digital photographs were taken. Dermatoscopy was done in selected cases. Results: Out of100, 36 patients had some abnormalities in their nail. Ingrowing toe nail with hypertrophy of lateral nail fold of big toes was the most common abnormality seen in 18 patients followed by hyperpigmentation of proximal nail folds which was found in 8 patients. Beau’s line, onychogryphosis and longitudinal pigmented bands were seen in 3 patients each. One patient had anonychia. Conclusion: Nail abnormalities are seen commonly among neonates who belong to the very low birthweight category. A routine examination of the nail apparatus in all such cases should be done so that an early diagnosis can be made about the presence of developmental and systemic abnormalities.
    • 121 Early-Onset Neonatal Sepsis: Group B Streptococcal Compared to E. Coli Disease Bettina Renoldner, Bettina Renoldner, Nora Hofer, Nora Hofer, Bernhard Resch, Bernhard Resch Medical University of Graz, Austria Objective: To compare perinatal, laboratory, and short-term follow-up data of neonates with early- onset sepsis (EOS) either due to group B streptococci (GBS) or E. coli infection. Retrospective cohort analysis of all neonates with culture proven GBS and E. coli EOS born between 1993 and 2011 and hospitalized at the NICU of the Medical University of Graz, Austria. Data were analyzed regarding perinatal, laboratory and short-term outcome data. Results: During the study period 100 neonates with EOS due to GBS and 11 neonates with E.coliinfection were hospitalized at our NICU. Perinatal and short-term outcome data differed between GBS and E. coli infection regarding gestational age (median 38 vs. 32 weeks, p=.005), birth weight (median 3095 vs. 1836 grams, p=.031), presence of hypothermia (0 vs. 18%, p=.009), duration of mechanical ventilation (4 vs. 8 days, p=.019), length of hospitalization (15 vs. 22 days, p=.039), presence of chorioamnionitis (18 vs. 46%, p=.041) and maternal fever (2 vs. 18%, p=.049). Mortality rates did not differ (6 vs. 18%, p=.180). Laboratory data regarding white blood cell count, IT-ratio, and CRP values were not different between groups within the first 72 hours of life. Conclusion: Main differences were due to higher rates of preterm birth in the E. coli group, clinical and laboratory characteristics differed marginally.
    • 122 Follow-up of Preterm and Term Infants up to Two Years in Kharkiv Regional Perinatal Center Olena Riga1 , Tetyana Znamenska2 , Tetyana Kurilina2 , Ganna Senatorova1 , Iryna Kondratova1 , Iryna Gordienko1 , Iryna Gordienko3 , Andrey Penkov3 , Ganna Kukuruza, Ganna Kukuruza4 1 Kharkiv National Medical University, Ukraine 2 SI Institute of Paediatrics, Obstetrics & Gynaecology, Ukraine 3 Kharkiv Spesialized regional orphanage, Ukraine 4 SI "IOZDP NAMS of Ukraine", Ukraine Background: The neurological complication and delay of development occur in 15-52% of preterm infants, and term infants with severe hypoxic ischemic injury. The follow-up system helps to determinate of early child delay development. Objective of study was a monitoring of development from birth to 24 month of high risk group. Methods: During 2012-2013 yrs the developmental assessment was performed in 112 infants (78 preterm and 34 term). There were used Albert scale AIIMS (gross motor) in infants to 12 mo old and and KID - RSDI scale (cognitive, fine motor, speech and language, social and adaptive development) in older. The medical problems have been estimated also. Results: The comorbidity of premature were following: retinopathy of newborn (6,4%); neurosensory deafness (3.8%), bronchopulmonary dysplasia with medical treatment requirement (5.1%). To 12 mo physical delay and motor delay of development had 29.4% of preterm and only 5.8% of term infants (p0,05). There was significant delay of motor development (-3-6 mo) in third preterm infants compare in term (-3 mo, 11.7%, p=0.0442). To 24 mo 23% preterm infants had delay of development and 17.6% of term infants at that in cognitive, social-emotional development. Mean cognitive delay in preterm was 3,1 mo; in term – 3,9 mo one (p0,05) by KID-RSDI. To 12 mo 5,1% of preterm infant had hemiplegic and tetraplegic cerebral palsy. The follow-up was perform only in 37.3% preterm and term needs infants from high risk group. The redirection to early interventional program was only in 19.6% high risk group infants. Conclusions: About third preterm infants, that had follow-up monitoring demonstrated delay of motor development at first year. The follow-up program involved only third needs infants and helps to make an early cerebral palsy diagnosis and cognitive delay in order to redirect to early interventional service.
    • 123 The Association of GSTT2B Gene Deletion Polymorphism with Prematurity and Low Weight in Ukrainian Neonates Zoia Rossokha1 , Svetlana Kyriachenko1 , Olena Kovalova2 , Valeriy Pochylko2 , Tetiana Znamenskaya3 , Natalia Gorovenko4 1 State institution “Reference centre for molecular diagnostic of Public Health Ministry of Ukraine”, Ukraine 2 Ukrainian Medical Dental Academy, Ukraine 3 State University «Institute of pediatrics, obstetrics and gynecology NAMS in Ukraine», Ukraine 4 National Medical Academy for post-graduate education named after P.L. Shupyk, Ukraine Introduction: Genetic testing may be useful for the risk evaluation of pathological conditions in neonates. Prediction of pathology will contribute to the development of new preventive measures. The existing data of the impact of important GSTT2B gene regulatory to reduced activity of the enzyme-isomer in the brain tissue in the presence of deletion polymorphism of this gene led to the aim of our work. Material and Methods: Molecular genetic testing was performed in 262 neonates, 191 neonates with critical condition (71 – full-term, 120 – preterm, gestational age 22-37 weeks, including those with extremely low birth weight) and 71 healthy full-term neonates (control group). Statistical analysis was performed using the program «SPSS17.0». Results: Preterm neonates had significantly increased frequency of the del/del genotype– 45,83%(χ2=4,09, OR=1,88 (95%CI:1,02-3,50), p0,05) and significantly decreased frequency of the del/N genotype–38,33% (χ2 = 4,18, OR=0,54 (95%CI:0,30-0,98), p0,05) compared to del/del - 30,98%, del/N - 53,52% in control group, respectively.The investigated genotypes had no impact on the severity and course of perinatal asphyxia, respiratory failures and organ disfunction. We found a significant correlation between GSTT2B gene polymorphism and low birth weight. The birth weight average was significantly lower in neonates with genotype del/del - 2868,80+42,30 compared to in neonates with genotype N/N- 3189,20+75,70 (p0,05). Conclusion: Further research is needed to identify other profile genes in prematurity and low birth weight. Genetic testing of fetal cells in the mother's whole blood can be provided, thus preventive measures for pregnant women may be created.
    • 124 The Protective Effect of Maternal Breast Milk in the Development of Necrotising Enterocolitis in Newborn Infants Mussa Sabiha University of Liverpool, UK Background: Necrotising Enterocolitis (NEC) is a highly lethal disease of the gastrointestinal tract in newborn infants, in particular those who are premature. Statistics from the National Institute of Child Health and Developmental Neonatal Multicenter ResearchNetwork established that 10% of infants born with low birthweights (1500g) are affected by the condition. Although a range of factors are thought to contribute to the pathophysiology of the disease, formula feeding, prematurity and ischaemia of the intestine are significant. However, an association has been found between breast milk and NEC, demonstrating a decrease in the incidence of the disease in newborn infants fed exclusively this. This is thought to be due to the protective factors, especially the immunological factors such as IgA, lysosymes and certain macrophages and lymphocytes. Aims: This literature review aims to determine whether breast milk plays a protective role in the development of NEC in newborn infants.To investigate whether the benefits of maternal breast milk outweigh formula or preterm milk. Methods: A range of procedures were implemented to search online databases and journals. Relevant articles on breast milk and its effect on NEC in neonates were sought, with inclusion and exclusion criteria applied. Four articles were chosen to critically appraise. Results: All four studies found that when breast milk was fed to neonates in comparison to those fed formula or preterm milk, the infants were less likely to acquire NEC. Conclusions: Maternal breast milk was found to be more effective than formula or preterm milk, as it offered the most resistance against NEC from developing, even when it was used as a supplement. There is enough evidence to conclude that maternal breast milk can be effectively used as a protector against NEC in neonates, reducing the incidence of this highly fatal disease.
    • 125 Lansoprazole in Preterm Infants with Gastroesophageal Reflux ; a Pilot Study Seung Han Shin, Hye Jeong Jin, Han-Suk Kim, Ee-Kyung Kim, Jung-Hwan Choi Seoul National University College of Medicine, South Korea Objectives: Recently, proton pump inhibitors have been increasingly used to treat preterm infants with gastroesophageal reflux. The primary objective of this pilot study was to evaluate efficacy of lansoprazole in preterm infants with gastroesophageal reflux. Methods: Five preterm infants with gastroesophageal reflux documented by 24 hour impedance-pH monitoring were enrolled. They were given lansoprazole 1mg/kg once daily for 14 days. During study period, additional 24 hour impedance-pH monitoring was conducted on baseline, day 5, day 10, and day 14. Results: Median (min, max) gestational age was 27+6 (25+0 , 31+3 ) weeks, and median birth weight was 1,390 (590, 1,740) grams. Postmenstrual age at study enroll was 35+6 (32+6 , 36+2 ) weeks, and weight at study enroll was 1,800 (1,710, 1,980) grams. Percent time esophageal pH 4 (mean ± SD) was 14.28 ± 18.67 at baseline, 5.28 ± 7.73 at day 5, 4.5 ± 6.39 at day 10 and 3.18 ± 2.38 at day 14. Composite score (Boix-Ochoa) was 42.46 ± 51.09 at baseline, 15.66 ± 22.43 at day 5, 5.36 ± 20.57 at day 10, and 10.18 ± 5.89 at day 14. Conclusions: For preterm infant with gastroesophageal reflux, lansoprazole could be an option for treatment. Further large-scale studies should be conducted to address the safety issue and symptom correlation as treatment outcome.
    • 126 Breastfeeding Difficulties in a Woman Affected by Mammary Neurofibromatosis Type-1 Vasiliki Sideri1 , Thomas Papalexandris1 , Panagioula Mexi-Bourna1 , Anna Daskalaki1 , Emmanouela Sdona, Eleni Kontaki1 , Sofia Spanou1 , Giannis Agouridakis1 , Kleopatra Chrelia1 , Eleni Alexiou2 , Vasiliki Papaevangelou1 1 Attikon Hosptial, Greece 2 Attikon Hospital, Greece Introduction: Neurofibromatosis (NF) type-1, also known as von Recklinghausen disease, is the most frequent form of NF, presenting a variety of skin lesions, such as café au lait spots and neurofibromas. Multiple neurofibromas affecting the mammary gland often disturb normal breastfeeding, through irritation of the lesions or nipple confusion. Methods: A 36 years old puerpera presented at the Attikon Hospital Breastfeeding Referring Center after having delivered a healthy term offspring, complaining difficulties in lactating, due to multiple neurofibromas around her nipple and areola bilaterally. At home feeding of the newborn with milk formula has already started, while lactation was suppressed. Neither efforts with breast pump, nor by digital squeezing evocated spontaneous milk dropping. Furthermore, during breastfeeding the newborn tended to confuse nipples with the surrounding neurofibromas. Mother was encouraged to restart breastfeeding, to use breast pump and silicon nursing pads, otherwise continue entirely bottle feeding. She was directed to a breast-surgeon specialist for further examination and she was addressed to her local breastfeeding-support team. Conclusion: Mammary neurofibromatosis is a rare condition, which is located mainly around the areola. Interferes with normal breastfeeding when these lesions get lacerated or confused with nipples. Lactation is supported by encouraging affected mothers to continue breastfeeding.
    • 127 Challenges in Coordination of Ventilator Treatment in Premature and Sick Newborns in a Norwegian Neonatal Intensive Care Unit (NICU) Marianne Trygg Solberg1,2 , Thor Willy Ruud Hansen3 , Ida Torun Bjørk1 1 Faculty of Medicine,University of Oslo, Norway 2 University College, Norway 3 Faculty of Medicine, University of Oslo, Norway Background and aims: Interprofessional collaboration in mechanically ventilated premature and sick newborn infants is essential to the quality of care, by reducing errors and length of stay. The quality of care could be improved by more effective interprofessional communication and coordination of ventilator treatment. In order to develop best practice in oxygenation and ventilation the aim of this study was to explore how physicians and nurses experienced their collaboration when working with oxygen and ventilator therapy. Method: This was a qualitative study using four focus groups during September - October 2012 at the NICU, Oslo University Hospital, RH, in Norway. The study included 20 participants, with varied background and experience. Three focus groups consisted of nurses, and one group of physicians. The focus group sessions lasted 60 minutes and were audiotaped and transcribed verbatim. Results: We found that physicians and nurses perceived collaboration regarding newborns on mechanical ventilation to be unsystematic and lacking in coordination. Both professions considered communication to be the most important element when collaborating, but nurses felt that they had few opportunities to discuss and formulate plans with physicians. This led to inadequate utilization of the medical and clinical expertise in the nursing staff. In the physicians’ opinions, the nurses had more education regarding ventilator treatment and lung function in premature and newborn infants than the house officers, who often made changes in the ventilator settings based on suggestions from the nurses. Nurses and physicians approached decision-making differently and there was limited flexibility and dynamics in allocation of responsibility between them. Conclusions: Findings from this study indicate that nurses and physicians may improve the quality of care by advancing their communication strategies, which includes the formulation of strategies and goals together, the development of skills that facilitate two-way communication, and the use of guidelines to coordinate ventilator treatment.
    • 128 Reducing Nuisance Alarms with Nellcor OxiMax N-600x SatSecondsTM alarm Settings during Oxygen Saturation Monitoring: Influence on Performance Beatrice Stefanescu1 , T Michael O'Shea2 , Fran Haury3 , Jeffrey Sigl4 , Minyi Lu4 , Waldemar Carlo5 1 Vanderbilt University School of Medicine, USA 2 Wake Forest University School of Medicine, USA 3 Covidien, USA 4 Covidien, USA 5 University of Alabama at Birmingham, USA Objective: The Nellcor OxiMax N-600x containing SatSecondsTM alarm management software was designed to assist clinicians in discriminating nuisance alarms from those that are clinically relevant. Instead of sounding an alarm the moment the oxygen saturation reading violates the upper or lower limit settings, a magnitude and duration of tolerance can be set. Our primary objective was to study the proportion of nuisance alarms relative to the proportion of clinically relevant alarms being filtered under four different SatSecondsTM alarm settings (i.e. 10, 25, 50, and 100) in the NICU environment. Methods: This is an observational prospective study of 50 infants cared for in three large NICUs. Infants were monitored for 4 continuous hours each by a study observer with the study monitor (a blinded and muted MAX-N sensor of a Nellcor OxiMax N-600x with a MAX-N sensor), in addition to standard multi- parameter monitors. Results: There were 6496 incidences of standard threshold-based SpO2 alarms during 195 hours of monitoring, with a mean duration of 12.7 sec. Half of all desaturations had a duration of 5 seconds or less and 75% had a duration of 10 seconds or less. SatSecondsTM reduced the total alarm number by 23, 31, 36, and 40% at SatSecondsTM settings of 10, 25, 50, and 100, respectively. The area under the curve (AUC) and 95% Confidence intervals (CI) for SatSecondsTM alarm settings when compared to nursing intervention were as follows: 0.61 (0.57-0.66) when the SatSecondsTM alarm setting was off, 0.63 (0.59-0.68) for 10 SatSecondsTM alarm setting, 0.64 (0.59-0.69) for 25 SatSecondsTM alarm
    • 129 setting, 0.64 (0.59-0.69) for 50 SatSecondsTM alarm setting, and 0.63 (0.58-0.68) for 100 SatSecondsTM alarm setting, respectively. Conclusion: The SatSecondsTM feature of the Nellcor OxiMax pulse oximeter reduced clinically insignificant interventions, however its specificity to nurse-identified desaturations events does not significantly improve with lengthening SatSecondsTM alarm settings.
    • 130 Role of Bedside Targeted Neonatal Echocardiography (fECHO) in the Neonatal Intensive Care Unit Zhen Han Tan, Woei Bing Poon Singapore General Hospital, Singapore Objective: To review the utility of bedside functional echocardiography (fECHO) in the clinical management in the neonatal intensive care unit (NICU) in terms of common indications, and its impact on clinical management and/or outcome. Methods: Retrospective cohort study of all patients admitted in the NICU between 1 January 2012 till 31 December 2012 who had a fECHO performed by a neonatologist. Results: A total of 40 neonates underwent 94 fECHO with a median of 2 scans per neonate. 87.5% were preterm neonates, with a median gestational age of 27 weeks. The indications included assessment of patent ductus arteriosus (PDA, n=69, 73%), pulmonary haemodynamics (n=18, 19%),central venous catheter tip position (n=4, 4%), volume status (n=2, 2%), and cardiac contraction (n=1, 1%). Following the fECHOs done for PDA assessment, non-steroidal anti-inflammatory drug treatment was initiated in 39%, fluid restriction in 6%, conservative management in 16%, and PDA was documented closed in 17% requiring no further treatment. The assessment of pulmonary haemodynamics allowed weaning of vasodilator therapy (inhaled nitric oxide/magnesium sulphate) in 44%, and respiratory support in 17%. Urgent cardiology review was required in 3 neonates – 1 had an incidental large pericardial effusion, 1 was a case of pulmonary atresia with intact ventricular septum in which the PDA was noted to be smaller, and the last case was that of a large ventricular septal defect with fluid overload. Conclusions: fECHO appears to be a useful tool in enhancing clinical care and decision making for critically ill neonates in the NICU.
    • 131 Kangaroo Mother Care Method While Performing Neonatal Invasive Procedures In NICU: Should We Separate Neonates From Their Mothers? Anna Tarragó Aregay1 , Albert Pi Compañó2 , Rosario Estudillo Mora1 , Laura Ripoll Roca1 1 Vall d'Hebron Hospital, Spain 2 Centro Médico Teknon, Spain Introduction: Kangaroo mother care (KMC) is the procedure whereby newborn babies skin makes contact with parents' skin promoting health and newborn neurodevelopment by achieving homeostasis regulation, favouring bonding with parents, and facilitating feeding. All this together will fire and wire circuits to brain making possible a healthy development. Justification: We believe that KMC shouldn't be not only for little periods, it should be as continuous as possible, and much broader, we don't believe that baby must be "stable" before KMC can start, so we think neither conventional mecanical ventilation nor carrying catheters or drainages have to by themselves be a contraindication, and going beyond, that some procedures could be done during KMC, such as weaning and extubation, taking a blood sample for an analysis, or getting peripheric venous accesses. We think preterm babies could stay unstable partly because they are denied the skin-to-skin contact that would make them stable. Heart rate, breathing and oxygen saturation, blood pressure and temperature all stabilize far faster on mum than when they are separated, as well baby crying decreases using less calories getting less hypoglycaemic. So that, we measured heart rate variability in full-term and preterm neonates holding in skin- to-skin contact with their mothers and staying alone during the interventions above, and also infants' behavior was observed and manually recorded according to a validated scale. We found a decrease in autonomic activity by registering low beating heart rates, and an early onset of quiet sleep when comparing both. Conclusion: From our experience we have seen wide acceptance of this method by parents when asked for during interventions. We propose KMC while performing some interventions in NICU whereby KMC decreases the load of stress, being able to influence their earliest development and May having a good effect on their development.
    • 132 Solar Powered Baby/radiant warmer Installed at Neonatal Intensive Care Unit at Lok Nayak Hospital, New Delhi Vasantha Thavaraj1 , Sankara Sastry2 , Nav Nidhi Sharma3 , Siddharth Ramji4 1 Indian council of Medical Research, India 2 Solar Energy Centre, 9th Milestone, Institutional Area, Gurgaon- Faridabad Road, Gwalpahari,, India 3 Indian council of Medical research, India 4 Maulan Azad Medical College, India Background: The important health challenges before India is that India has a high Neonatal mortality (death within 28 days after birth), Infant mortality (death within one year). The Open care system of baby radiant warmer is presently being used in our health system in Level I (tertiary care hospitals) and Level II in Special care newborn unit (SCNU) , Neonatal stabilization Unit, New born care corner. Methods: A single open care system of infant radiant warmer with 400 watts of infra red heating element and an energy meter , with baby bassinet was installed in the NICU,in Lok Nayak Hospital The radiant warmer was kept near the window so that the connection can be made easily with the panel in the roof. The Thermostatic skin servo control device regulates radiant heat. Details of the power plant used: 400W is the peak power during its full load operation. Accordingly the present PV system is designed for about 10 hours of working, the system consumes about 4kWh (or 4units) in a day. Therefore, the designed PV system is for approximate generation of 4 kWh of energy per day. Findings: The Solar powered Radiant warmer has been successfully installed Neonatal nursery, Lok Nayak Hospital and fully functional since 10-12-2012. The preliminary energy consumption study shows that PV panels of 1.2kWp can be connected to 2-3 radiant warmers. Interpretation: The Solar powered baby warmer is environment friendly. It can be used in Tertiary care hospitals and also in rural areas where power supply is erratic and where there is plenty of sunshine this product will help in the care of high risk infants in Level II .
    • 133 Intestinal Atresia and Prenatal findings. Our Experience of the Last Ten Years Cinzia Tripodi, Carmen Marrero, Roman Papoyán, Pedro Arango, Tania De Ganzo, Lorenzo Martin University Hospital Nuestra Señora de Candelaria, Spain Introduction: An atresia is a complete congenital obstruction of the lumen of a hollow viscus. Intestinal atresia is one of the most frequent causes of bowel obstruction in the newborn and can occur at any point in the gastrointestinal tract. The most common site is the small intestine (jejunum and ileum) with an incidence rate from one in 1500 to 12,000 births. The colon is the least affected site with an incidence of one in 40,000 live births. A typical clinical feature is abdominal distension while vomiting usually begins in the first 24 to 48 hours after birth. Intestinal atresia can be detected by prenatal ultrasounds examination with the presence of polyhydramnios or a dilated loop of bowel. Radiographic studies should be performed after birth to confirm the diagnosis. The treatment of intestinal atresia is surgical correction with a long-term survival that varies from 84 to 100%. Most of the mortality occurs in infants with associated medical conditions. Method: A retrospective, descriptive study of case series of the patients with intestinal atresia attended in University Hospital “Nuestra Señora de Candelaria” since 2002, January to 2013, December. Results: 8 patients included. 4 of them were premature infants. In 5 of them there was a prenatal suspicion. The most frequent clinical features were vomiting and abdominal distension. Theradiographic studies were helpful in the 100% of patients. 1 case of colonic atresia. All the children were operated, and 3 of them more than once. We experienced 3 deaths. Conclusions: Intestinal atresia should be suspected in a newborn with abdominal distension, bilious vomiting and failure to pass meconium. We think we experienced a mayor rate of mortality than other series due to associated medical conditions and the complexity of the lesions.
    • 134 Overview of Two Cases of Epidermolysis Bullosa in our Hospital Cinzia Tripodi, Dinesh Lalchandani, Pedro Arango, Garazi Castelar, Carmen Marrero, Lorenzo Martin University Hospital Nuestra Señora de Candelaria, USA Introduction: Epidermolysis bullosa comprises a clinically and genetically heterogeneous group of rare inherited disorders characterized by marked mechanical fragility of epithelial tissues with blistering and erosions following minor trauma. This illness is caused by mutations involving at least 18 genes encoding structural proteins within keratin intermediate filaments, focal adhesions, desmosome cell junctions and hemidesmosome attachment complexes, which form the intraepidermal adhesion and dermoepidermal anchoring complex within the basement membrane zone of the skin and mucosae. The prevalence of epidermolysis bullosa was estimated to be approximately 8 per million and the incidence 19 per million live births. Clinical cases: Case 1. A term newborn appropriate for gestational age, a physiological pregnancy and a vaginal delivery. During the physical examination, intraoral blisters with superficial erosions and more lesions in shoulders and thorax come out .New vesicles starts to spread all over his body in response to minimal frictional trauma. His father has been studied by Dermatology for blisters in pretibial region in his left leg. Case 2. A term newborn appropriate for gestational age, a physiological pregnancy and a vaginal delivery. He shows respiratory distress that disappears in a few hours, while blisters and erosions stat to be patent all over his body including oral mucosae. In both cases we consult with a dermatologist and a nutritionist as their mayor problems were pain control and appropriate nutritional support due to oral lesions. When solving that, we decide the discharge from the hospital and going on with a multidisciplinary study of the case. Conclusions: The management of these patients is largely supportive and involves a multidisciplinary team. Pain control is an important aspect together with the nutritional compromise. Disabling and severe complications would need specialty teams when they appear.
    • 135 Kasabach-Merritt Phenomenon And Kaposiform Hemangioendothelioma in A Neonate Sevim Unal, Hatice Tatar Aksoy, Deniz Gonulal, Derya Ozyoruk, H Ahmet Demir Ankara Research and Educational Hospital, Turkey Introduction: Kasabach-Merritt phenomenon (KMP) is a rare consumptive coagulopathy characterized by profound thrombocytopenia and hypofibrinogenemia occurring in association with vascular tumors, kaposiform hemangioendothelioma (KHE) and tufted angioma. Treatment remains challenging without consensus on the optimal medical management. We reported a neonate with KMP and KHE, also debated regarding the management. Case report: He was born by vaginal delivery at term with birth weight of 3600 g. There were extensive petechiae all over the body and a small lumbal mass supposed to be hematom at birth. The fresh-frozen plasma and thrombocyte suspension were transfused because of thrombocytopenia. He was transported to our hospital on 3rd day. Magnetic resonans imaging (MRI) revealed a giant lobulated heterogeneous 76x54x86 cm mass invading right vertebral muscles, subcutaneous adipose tissue, and extending into the inguinal region, forcing right kidney, bladder and abdominal aorta anteriorly, spreading into the spinal canal at this level. The boundaries of mass and both renal vascular structures were indistinguishable. The vena cava inferior and vertebral posterior elements were pressured by mass (Figure 1). We diagnosed disseminated intravascular coagulation (DIC) due to low fibrinogen and thrombocytes, increased PT, aPTT, and INR. He was supported by cryoprecipitate and fibrinogen concentrate. The mass proggressively enlarged due to hemorrhage into mass and transfused erithrocyte suspension betweenwhiles (Figure 2). Since malign clinical course and possible KHE, he was given pulse sterod, vincristine, actinomycin-D. We managed to control DIC and hypofibrinogenemia, but biopsy was not possible because of DIC. Discussion: KMP does not occur with common hemangioma. Rather it is associated with more aggressive KHE and rarely with other vascular neoplasms. We suspected KHE in our patient, due to malign clinical course and MRI findings. Variable response to current pharmacologic therapy underscores inadequate knowledge of the pathogenesis of thrombocytopenia in KHE. We presented our case as rarely diagnosed in neonates and acchievement in controlling both KMP and possible KHE with multidisciplinary approach.
    • 136 Perception and Practice of Kangaroo Mother Care after Discharge from Hospital in Kumasi, Ghana: A longitudinal Study Priscilla Wobil1 , Priscilla Wobil1 , Samuel Blay Nguah1 , Gyikua Plange-Rhule1,2 , Joy Lawn3 , Kate Kerber3 , Regina Obeng1 1 Komfo Anokye Teaching Hospital, Ghana 2 Kwame Nkrumah University of Science and Technology, Ghana 3 Save the Children, South Africa Kangaroo Mother Care (KMC) is life saving among low birth weight (LBW) babies. Little is known about mothers’ continued unsupervised practice after discharge from hospital. This study aimed to evaluate KMC practice in the community among mothers of LBW infants after discharge from hospital. A longitudinal study of 202 mothers and LBW neonates was conducted from November 2009 to May 2010. Mothers were interviewed about their knowledge, practice and community perceptions of KMC after discharge from hospital. A repeated measure logistic regression analysis was done to assess variability in the binary responses at the various follow up visits. At recruitment 23 (11.4%, 95%CI: 7.4 to 16.6%) mothers knew about KMC. At discharge over 95% thought KMC was beneficial to them and were willing to continue KMC at home, and recommend KMC to other mothers. At first follow up visit 99.5% were still practicing KMC. This proportion did not change significantly over the four weeks (OR: 1.4, 95%CI: 0.6 to 3.3, p-value: 0.333). Household chores and potentially negative community perceptions of KMC did not affect its practice with odds of 0.8 (95%CI: 0.5 to 1.2, p=0.282) and 1.0 (95%CI: 0.6 to 1.7, p=0.934) respectively. During the follow-up period the neonates gained 23.7 sg (95%CI: 22.6 g to 24.7 g) per day. Maternal knowledge of KMC was low at the outset. Once initiated mothers continued practicing KMC in hospital and at home with their infants gaining optimal weight. Continued KMC practice was not affected by perceived community attitudes.
    • 137 The Predictive Power of Serial Neonatal Therapeutic Intervention Scoring System Scores for Mortality in Very Low Birth Weight Infants Pei-Ling Wu1 , Pei-Lun Lee2 , Wei-Te Lee2 , Hsiu-Lin Chen2,3 1 Kaohsiung Medical University, Taiwan 2 Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan 3 Kaohsiung Medical University, Taiwan Background: The Neonatal Therapeutic Intervention Scoring System (NTISS) is used to indicate disease severity for neonates who need intensive care. We examined the ability of serial NTISS scores to predict mortality in very low birth weight (VLBW) preterm infants. Methods: We reviewed the medical records of all preterm infants who had a birth weight less than 1500 g and were admitted to a neonatal intensive care unit from 2007 to 2011. We calculated the NTISS scores at 24, 48 and 72 hours after admission and assessed the predictive power for mortality using receiver- operating characteristic curve and area under the curve (AUC) analysis. We also constructed a predictive model with gestational age, birth weight and NTISS scores to predict the possibility of mortality in these VLBW infants. Results: In total, 172 infants were enrolled into this study. Eighteen (10.5%) infants died in the seven days after birth. The AUC of the NTISS score was 0.913 at 24 hours, 0.955 at 48 hours, and 0.958 at 72 hours. However, there was no significant difference in overall average NTISS scores between 48 and 72 hours. The NTISS score at 48 hours was a better predictor of mortality than that at 24 hours after admission. Combined with gestational age, birth weight, and NTISS score at 48 hours, the birth weight had little contribution to the predictive power of mortality. The model with gestational age and NTISS score at 48 hours had better predictive power than NTISS score alone (AUC = 0.99). Conclusion: NTISS scores at 48 hours seemed to be an effective method to predict mortality in preterm infants whose birth weight was less than 1500 g. In addition, gestational age played a more important role in predicting mortality than birth weight.
    • 138 The Crisis of PAN Resistant Bacteria: How to Know What to Prescribe Mary Wyckoff, Sandra Ellingson UC Davis, USA According to the WHO, high percentage of hospital-acquired infections is caused by highly resistant bacteria such as methicillin-resistantStaphylococcus aureus (MRSA). Inappropriate and irrational use of antimicrobial medicines provides favorable conditions for resistant microorganisms to emerge, spread and persist. This presentation will provide an overview of the epidemiology of antimicrobial resistance on a global scale. Multi-drug resistant organisms are prevalent worldwide and theseinfections cause severe illness, especially in acute and chronically ill neonatal intensive care patient populations. Choosing appropriate antimicrobial therapy has become increasingly complex as more choices become available and resistant bacteria continue to evolve. Multiple factors affect the choice of agent, and resistance forces vary widely between clinical settings, patient populations, and geographic areas. This bacterial culture specific data will be used to demonstrate how to implement antibiograms into everyday prescriptive practice. Facilitating the understanding of the cellular mechanisms through which bacteria become resistant is vital for healthcare providers. Individual patient care practices affect resistance within patients and clinical environments. This research-based information and recommendations on how to manage the use of antimicrobial agents, minimize iatrogenic infections in the acutely-ill neonatal population, and responsibly care for patients, in an age of widespread bacterial resistance will enhance the individual’s knowledge base. Recommendations will include description of evidence-based guidelines from professional societies, as well as provision of multiple resources through which participants may further gain knowledge of the state of the science of this important topic.
    • 139 How Cool is Cool! Evidence Based Practice for Whole Body Hypothermia in Neonates Mary Wyckoff, Jennifer Solano, Sandra Ellingson UC Davis, USA Term infants who suffer hypoxic ischemic events due to acute perinatal asphyxia may suffer acute morbidity sequelae if immediate intervention does not occur, specifically within the first 6 hours of life. This is a tight timeline with respect to outreach and transport case scenarios. As a tertiary center for outreach facilities we have developed protocols and practice timelines to facilitate and initiate whole body hypothermia to decrease mortality and morbidity in this population. This presentation will encompass our treatment regimen inclusive of birth to intervention, from initiation of outreach transport call to initiation of treatment protocols. This presentation will encompass how to cool, sedation and analgesia for shivering, treatment for seizures, video recording of seizure activity and understanding the aEEG. The bedside aEEG has placed another evaluation tool for healthcare providers and facilitates further diagnostics, understanding this tool facilitates nurses at the bedside and their ability to intervene and prevent ongoing further devastation. Brain cooling has been shown to have a favorable effect on multiple pathways contributing to brain injury, including excitatory amino acids the cerebral energy state, cerebral blood flow and metabolism, nitric oxide production,and apoptosis. Brain cooling is effective in reducing the extent of brain injury when it is initiated in less than 6 hours of life. Whole-body cooling provides homogeneous cooling to all brain structures, including peripheral and central brain regions. The protocols developed will be presented including our experiences and outcomes. This presentation will provide the audience with detailed information on how to cool, anticipated outcomes, scoring evaluations and how to interpret the aEEG. Outcome data will also be presented. Further information on how to explain cooling to the families and facilitate understanding will be presented.
    • 140 Author Index A Abbasoglu, Aslıhan · 67 Abdel Latif, Mohammed · 87 Abdul-mumin, Alhassan · 65 AbouBakr Hashem, Alaa · 98 Agouridakis, Giannis · 126 Alburke, Salima · 69 Alemany, E · 27 Alexiou, Eleni · 126 Alhamdani, Abdurahman · 98 Alhoulan, Asma · 98 Ali, Haytham · 66 Alia, Rana · 66 Alina, Botiz · 85 Almakadma, Yosra · 98 Almatari, Abdulrahman · 56 Alsaad, Sulaiman · 64 Amantayeva, Maral · 57 Amsa, Mairami · 70 Anthuvan, Rajesh · 18 Anuk Ince, Deniz · 67, 68 Arango, Pedro · 133, 134 Aregay Tarragó, Anna · 106 Arıkan, İnci · 16, 49 Ashur, Bashir · 69 Audu, Lamidi · 70 Aydın, Banu · 21 Aziz, Khalid · 17 B Badeva Gajdova, Emilija · 86 Baigazieva, Guljan · 28, 57 Bar Meir, Maskit · 19 Barbaric, Irena · 71 Barbosa Nogueira, Berta · 104 Barragán Milán, Rafael · 103 Barreto-Arroyo, Itzel · 36 Bassiouny, Mohamed Reda · 11 Bäuerl, Christine · 42, 59 Beken, Serdar · 21, 80 Bener, Abdulbari · 91 Bhat, Vishnu · 6, 29 Bilic Cace, Iva · 71 Binder, Corinna · 17 Bjørk, Ida Torun · 127 Blagojevic, Ana · 99 Blay Nguah, Samuel · 136 Bordoy, A · 27 Bournas, Nikos · 40 Boychenko, Alena · 51 Bozdağ, Şenol · 12 Bozhbanbayeva, Nyshangul · 28, 57 Bromiker, Ruben · 19 C Cardiello, Valentina · 37 Carlo, Waldemar · 128 Castelar, Garazi · 134 Cernada, Maria · 42, 59 Chalia, Maria · 43, 72, 74 Chandran, Suresh · 38 Chen, Hsiu-Lin · 137 Cheung, Po-Yin · 17 Choi, Jung-Hwan · 125 Chrelia, Kleopatra · 126 Collado, Maria Carmen · 42, 59 Corsello, Mirta · 25, 37 Costa, Simonetta · 37 Cota, Francesco · 25, 37 D Daga, Subhashchandra · 33, 35 Dago -Oc, Frances Jane · 79 Dallar Bilge, Yıldız · 16, 49 Daskalaki, Anna · 40, 126 De Ganzo, Tania · 133 de la O-Cavazos, Manuel · 36 de Waal, Koert · 22 Demir, H Ahmet · 135 de-Wahl Granelli, Anne · 3, 5 Dikanbayeva, Saule · 28 Dilli, Dilek · 12, 21, 80 Dilmen, Uğur · 12 Dollberg, Shaul · 81 Doyle, Lex · 62, 63 E Eaton, Farah · 18 Ecevit, Ayse · 67, 68 Ellingson, Sandra · 23, 82, 138, 139 Elshahed, Amr · 11 Estudillo Mora, Rosario · 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 131 Evsyukova, Inna · 83 F Fettah, Nurdan Dinlen · 80 Foo, Robyn · 52 Fourie, Andrea · 53 Frewan, Naima · 13 G Gabriela, Olariu · 84, 85 Gane, Bahubali · 6, 29 Garcia, M · 27 Garu, Mercy · 70 Gaylord Ashmead, Graham · 48 Gianna, Kyrkou · 40 Gökmen, Tülin · 12 Gonchar, Margaret · 51 Gong, Linmin · 10 Gonulal, Deniz · 135 Gopagondanahalli Revanna, Krishna · 38 Gordienko, Iryna · 122 Gorovenko, Natalia · 94, 123 H Haghani, Hamid · 55
    • 141 Hamadah, Reem · 98 Hannah, Andrews · 31 Hansen, Thor Willy Ruud · 127 Hassan, Ahmed · 72 Haury, Fran · 128 Hernández-Garduño, Adolfo · 36 Hochwald, Ori · 8 Hofer, Nora · 121 Holjar Erlic, Izidora · 71 I Ionescu, Lavinia · 18 Iwakawa, Mayumi · 30 J Jabr, Mohammed · 8 Janchevska, Snezhana · 86 Jiang, Mei · 10 Jin, Hye Jeong · 125 Josephine, Kamagaju · 96 K K T, Harichandrakumar · 6 Kabataş, Emrah Utku · 80 Kapil, Arti · 32 Kapur, Neeraj · 32 Karsdon, Jeffrey · 48 Keenan, William · 11 Kerber, Kate · 136 Khan, Junaid · 60 Khan, Tehreem · 98 Khassawneh, Mohammad · 56 Kim, Ee-Kyung · 125 Kim, Han-Suk · 125 Kleanthous, Kleanthis · 40 Kondratova, Iryna · 122 Konjevic, Stojislav · 99 Kontaki, Eleni · 126 Koval'chuk-Kovalevskaya, Ol'ga · 83 Kovalova, Olena · 123 Kripail, Mathew · 87 Krstevska Blazevska, Svetlana · 88 Kukuruza, Ganna · 122 Kumar, Uday · 89 Kurdi, Bader · 90, 91 Kurilina, Tetiana · 92 Kurilina, Tetyana · 122 Kurt, Abdullah · 67, 68 Kwarteng, Peter · 65 Kyriachenko, Svetlana · 94, 123 Kyriachenko, Svitlana · 93 L Lahav, Amir · 24, 50 Lakkundi, Anil · 22 Lalchandani, Dinesh · 134 Laura, Olariu · 84 Lavoie, Pascal · 8 Lawn, Joy · 136 Lee, Pei-Lun · 137 Lee, Wei-Te · 137 Lu, Minyi · 128 M M Huang, William · 48 M. Perez, Lucila · 54 Magaspi, Rumar · 54 Magera, Ingabire · 95, 96 Maggio, Luca · 37 Mangel, Laurence · 81 Maria, Soulioti · 40 Marrero, Carmen · 133, 134 Martin, Lorenzo · 133, 134 Maslyanyuk, Natalia · 83 Mbwele, Bernard · 34 McNamara, Patrick · 8 Mexi-Bourna, Panagioula · 40, 126 Miah, Jennifer · 97 Mian, Qaasim · 17 Mihaela, Tunescu · 84, 85 Miller, Steven · 8 Milosevic, Veroslava · 99 Moebius, Marius · 18 Montes, Fernando · 36 Mosher, Cynthia · 98 Mshelia, Lauretta · 70 Mukhtar-Yola, Mariya · 70 Muratovska, Radica · 88 Mustaphasade, Tykaz · 28, 57 N Natalia, Gorovenko · 93, 94 novakovic, vesna · 99 Núñez García, Carmen · 104 O Obeng, Regina · 136 Okumuş, Nurullah · 21, 80 O'Reilly, Megan · 17, 18 O'Shea, Michael · 13 O'Shea, T Michael · 128 Osiovich, Horacio · 8 Oskay Acar, Banu · 68 Otabek, Fayziev · 100 Othman, Farrah · 22 Otuneye, Adekunle · 70 Özyazıcı, Elif · 21 Ozyoruk, Derya · 135 P Padhi, Tanmay · 120 Papaevangelou, Vasiliki · 40, 126 Papalexandris, Thomas · 126 Papoyán, Roman · 133 Parasuraman, Jaya · 7 Penkov, Andrey · 92, 122 Perez-Martinez, Gaspar · 42, 59 Perri, Alessandro · 25 Peter, Branimir · 71 Pi Compañó, Albert · 101, 102, 103, 104, 105, 107, 108, 109, 110, 111, 112, 113, 114 115, 116, 117, 118, 119, 131 Pianini, Teresa · 37 Pichler, Gerhard · 17 Plange-Rhule, Gyikua · 136 Pochylko, Valeriy · 123
    • 142 Ponpuo, Gladys · 65 Pons, Montse · 27 Poon, Woei Bing · 52, 130 Pradhan, Swealina · 120 Q Quero, José · 36 R Rajab, Ali · 69 Rajabali, Saima · 18 Ramji, Siddharth · 41, 132 Rand, Katherine · 50 Rao, Ramachandra · 6 Renoldner, Bettina · 121 Resch, Bernhard · 121 Riga, Olena · 51, 92, 122 Ripoll Roca, Laura · 101, 102, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 131 Rivero Pérez, Ainhoa · 104 Rodríguez-Balderrama, Isaías · 36 Rodríguez-Taméz, Antonio · 36 Romagnoli, Costantino · 25, 37 Rossokha, Zoia · 94, 123 S S, Nandakumar · 6 Sabiha, Mussa · 124 Sadi, Muktar · 69 Samanta, Lee · 39 Samuel Rajadurai, Victor · 39 Saracoglu, Ahmet · 68 Sarkar, Abdullah · 98 Sastry, Sankara · 41, 132 Schadrack, Nambayisa · 95 Schmolzer, Georg · 17 Sdona, Emmanouela · 126 Sebastian, Olariu · 85 Senatorova, Anastasia · 51 Senatorova, Ganna · 122 Senok, Abiola · 98 Serna, Eva · 42, 59 Shahali, Shadab · 55 Sharma, Nav Nidhi · 41, 132 Shin, Seung Han · 125 Shlifer, Margarita · 81 Sideri, Vasiliki · 40, 126 Sigl, Jeffrey · 128 Simonova, Anna · 26 Slaughter, Chris · 13 Sola, Augusto · 2, 4 Solano, Jennifer · 139 Solberg, Marianne Trygg · 127 Soni, Roopali · 58 Spanou, Sofia · 126 Sriram, Bhavani · 39 Stefanescu, Beatrice · 13, 128 Suleimenova, Indira · 28, 57 Suresh, Chandran · 39 T Taavoni, Simin · 55 Taksande, Amar · 20 Tan, Zhen Han · 130 Tarcan, Aylin · 67, 68 Tarragó Aregay, Anna · 101, 102, 103, 104, 105, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 131 Taşar, Serçin · 16, 49 Tatar Aksoy, Hatice · 16, 49, 135 Tekindal, Mustafa Agah · 67, 68 Thavaraj, Vasantha · 32, 41, 132 Thebaud, Bernard · 18 Tiberi, Eloisa · 25 Tripodi, Cinzia · 133, 134 Tugcu, Ulas · 67 U Umran, Raid · 30 Unal, Sevim · 135 Upton, Michele · 43, 74 Ur Rahman, Asad · 87 Urlesberger, Berndt · 17 V Vadivel, Arul · 18 Vashishth, Brijesh · 32 Vasilyeva, Iryna · 51 Velaphi, Sithembiso · 9 Vento, Maximo · 42, 59 Vladimir, Estrin · 26 Vliora, Christiana · 40 Vohr, Betty · 61 W Wang, Danhua · 10 Wang, Huishan · 10 Wang, Lixin · 10 Wobil, Priscilla · 136 Wu, Pei-Ling · 137 Wyckoff, Mary · 23, 82, 138, 139 X Xia, Shiwen · 10 Xu, Tao · 10 Y Yakobi, Nurit · 19 Yarkoni, Inbal · 81 Yue, Qing · 10 Yusupov, Anvar · 100 Z Zecca, Enrico · 25, 37 Zenciroğlu, Aysegül · 21, 80 Zhang, Tong · 10 Znamenska, Tetiana · 92 Znamenska, Tetyana · 122 Znamenskaya, Tetiana · 123 Zoia, Rossokha · 93
    • 143