Pediatric Research | 2021
4th Congress of Joint European Neonatal Societies: Circulation and Haematology
Abstract
S COLLECTION 4 Congress of Joint European Neonatal Societies: Circulation and Haematology Pediatric Research _#####################_ ; https://doi.org/10.1038/s41390-021-01758-2 Date: 14–18 September 2021 Location: Virtual Meeting Sponsorship: Publication of this supplement was sponsored by MCA Events on behalf of the European Society of Paediatric Radiology (ESPR), Union of European Neonatal and Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI). All content was reviewed and selected by the Scientific Committee and selected abstract reviewers, which held full responsibility for the abstract selections. *Presenting author names have asterisks in the contributor lists. ID 57. Echocardiography-guided ductus arteriosus treatment: a randomized controlled trial on two prescription strategies to reduce the incidence of necrotizing enterocolitis María Carmen Bravo, Rebeca Sánchez-Salmador, María Teresa Moral-Pumarega, Manuela López-Azorín, Rocío Mosqueda-Peña, Izaskun Dorronsoro, Fernando Cabañas, María Jiménez, Adelina Pellicer La Paz University Hospital, Madrid, Spain, Doce Octubre University Hospital, Madrid, Spain, QuirónSalud University Hosptital, Madrid, Spain Background: Patent ductus arteriosus (PDA) approach remains controversial due to uncertainties about treatment benefits versus harms. We aim to evaluate whether a treatment scheme on echography-guided (EchoG) PDA closure (to reduce drug exposure) and 24-h-continuous ibuprofen infusion (24h-IB) (to reduce peak concentration of ibuprofen), compared to EchoG PDA closure plus conventional bolus ibuprofen treatment (bolus-IB), reduces severe bowel adverse event rate in infants below 33 weeks’ gestation with hemodynamically significant (hs) PDA. Methods: Multicentre, blinded randomized controlled trial. Infants with less than 28 weeks’ gestation underwent routine echocardiographic assessment between 18 to 72 h of birth; infants between 28 and 33 weeks were screened only in case PDA was suspected clinically. hsPDA was considered if ductal diameter was larger than 1.5 mm and indicators of pulmonary overflow, systemic hypoperfusion, or both were present. Results: One hundred forty-six infants (median gestational age 26 [25–28] weeks; median birth weight 881 [704–1100] g) were randomized to 24h-IB (n= 70) or bolus-IB (n= 76) study group at 86 (58–140) h from birth. Groups were comparable in terms of perinatal or neonatal relevant clinical data with the exception of higher prevalence of male sex in the bolus-IB group (p= 0.004). Treatment effectiveness was also similar with 53% (24h-IB) and 47% (bolus-IB) of the infants showing no ductal flow after ibuprofen treatment with similar total number of doses. Severe bowel adverse event rates were also similar [10% (24h-IB); 2.6% (bolus-IB), p= 0.1], although those in bolus-IB group reached full enteral nutrition earlier (p= 0.03). Postnatal age (p= 0.02) and peripheral SaO2 (p= 0.004) at treatment start, and pulmonary hemorrhage (0.03) before PDA treatment were associated to the development of severe bowel events independently of treatment group allocation. Conclusions: Ibuprofen intravenous continuous infusion compared to bolus infusion in preterm infants with hsPDA shows similar rates of success and does not reduce the prevalence of severe bowel events. Funding source: This study was supported by the Spanish Health Ministry (PI16/00644) and Mutua Madrileña Fundation (AP163272016). The authors did not receive any form of payment to perform the trial. ID 63. Impact of packed red blood cell transfusions on cerebral and somatic tissue oxygenation in premature infants with and without a patent ductus arteriosus Aisling Smith, Sean Armstrong, Eugene Dempsey, Afif EL-Khuffash The Rotunda Hospital, Dublin, Ireland, Cork University Maternity Hospital, Cork, Ireland Background: Packed red blood cell (PRBC) transfusions treat anaemia and support adequate cellular metabolism. The impact of PRBC transfusions on left ventricular (LV) afterload and pulmonary vascular resistance (PVR), cerebral and somatic regional tissue oxygenation (rSO2) in the context of a patent ductus arteriosus (PDA) warrants further investigation. Methods: Infants <32 weeks gestation who received a PRBC transfusion beyond the first 10 days of life were included. Each infant underwent a 24 h assessment of cerebral and somatic rSO2 and fractional tissue oxygen extraction (FTOE), commencing at the start of the transfusion. Echocardiography was carried out at baseline, 18 and 24 h post transfusion, to measure PVR, LV end systolic wall stress (ESWS) in addition to LV and right ventricular (RV) systolic strain. The impact of the presence of a PDA on cerebral and somatic rSO2/FTOE was assessed. Results: Thirty infants with a median [IQR] gestation and birth weight of 26.3 [24.8–28.0] weeks and 855 [659–1103] g were included. Baseline haemoglobin was 10.0 [9.3–10.5] g/dL. There was an increase in pulmonary artery acceleration time (48 ± 13 to 57 ± 16ms, p < 0.01) from baseline to 24 h post transfusion. LV ESWS did not change (378 ± 149 to 361 ± 132 dynes/cm, p= 0.67). There was no change in LV or RV strain over the study period (p > 0.05). Ten infants had a PDA (median diameter 2.1 [1.8–2.7]mm). Cerebral rSO2 increased in a similar manner in infants with and without a PDA following PRBC transfusion with a corresponding fall in cerebral FTOE (Figure). Although somatic rSO2 increased during the study period in the overall group, the rSO2 values were significantly lower in those with an open PDA at baseline and following transfusion compared to those with a closed PDA. There was a significant decrease in somatic FTOE following transfusion in the closed PDA group only (Figure). Conclusion: PRBC transfusion results in a fall in PVR without significant change in myocardial function or LV afterload. Cerebral oxygenation improved following transfusion regardless of PDA status. Somatic oxygenation improved to a greater extent in babies with a closed PDA. (ID 63) Cerebral and somatic rSO2 and FTOE