A. Boët

Stroke volume and cardiac output evaluation by electrical cardiometry: accuracy and reference nomograms in hemodynamically stable preterm neonates

Objective:To investigate the accuracy of electrical cardiometry (EC) to measure stroke volume (SV) and cardiac output (CO) and to provide gestational age (GA) and birth weight (BW)-based reference data for SV and CO in hemodynamically stable preterm neonates.Study Design:Prospective observational blinded study. Paired measurements of SV and CO on stable preterm infants without any hemodynamic compromise were carried out using EC (SVEC) and echocardiography (SVECHO).Results:Seventy-nine preterm neonates (mean GA: 31±3.2 weeks) were enrolled. A good correlation was found for SV (r=0.743; P<0.0001) and CO (r=0.7; P<0.0001) measured by EC and echocardiography. These correlations remained significant after adjusting for GA, patent ductus arteriosus and type of respiratory support (SV: St.β=0.48, P<0.0001 and CO: St.β=0.69, P<0.0001). Mean biases (and variabilities) were −1.1 (from 0.7 to −2.9) ml and −0.21 (from 0.15 to −0.55) l min−1 for SV and CO, respectively. Local regression shows a tendency for EC to overestimate SV and CO especially at higher values (at about >2 ml and >0.4 l min−1, respectively). Coefficient of variation of SV was 48.9% and 52%, for EC and echocardiography. SV and CO rose with increasing GA and BW following an exponential equation (R2>0.8).Conclusion:Measuring SV and CO with EC in hemodynamically stable preterm infants shows good correlation and variability similar to that of echocardiography. A trend to overestimation exists at highest values, but it is unlikely to be clinically significant. Reference GA and BW-based nomograms for SV and CO are provided.

P6 Phrenic nerve palsy and Glenn anastomosis: One center 10 years experience

Introduction Diaphragmatic paralysis after cardiac surgery due to bilateral phrenic nerve palsy is an important complication especially in infants with Glenn procedure. The best pulmonary condition is a key factor for success in monoventricular palliative surgery. The response of the patient to phrenic nerve palsy may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Indeed, with a global incidence of 1.6% in most series, Glenn anastomosis appears to be one of the closed heart procedures of high risk of palsy.

PS-145 Preterm Infants Transportation Between Tertiary Care Centres (tcc) Within First Hours Of Life: Restrospective Cohort Study

Introduction Regionalization in perinatal care improved neonatal survival for 2 decades. Perinatal transport is known to be a bad prognostic factor for preterm neonates born in second level centres. No data exist for babies born in TCC who had to be transferred to other TTC. We evaluate short term clinical outcomes of preterm infants transferred between TCC. Methods We retrospectively analysed all neonates aged ≤32 weeks gestation transferred before 6 h of life from the South Paris University Hospitals to another TCC. Transfer was due to organisational problems. Control group consisted of neonates born the month before or after the cases and matched for gestational age, birth weight and CRIB-II. Simple linear and logistic regressions were used for analysis. Results We included 60 cases and 60 controls. The two groups were similar for basic clinical characteristics. No difference in clinical features (RDS, infection related respiratory failure, air leaks, hypotension) were present between the groups (Table 1). Early outcomes (IVH, periventricular leucomalacy, NEC, BPD and NICU stay) rates were not influenced by the transfer transport ((Table 1) Abstract PS-145 Table 1 Conclusions Perinatal transfer for preterm babies born in a TCC is not a negative prognostic factor. It is conceivable that optimal care in delivery room is a keystone for better outcome.

PS-021 Electrical Cardiometry Stroke Volume Evaluation In Nicu: Comparison With Functional Echocardiography

Background Evaluation of cardiac output in neonates might be difficult because of the complexity and risks of invasive classical procedures. New systems like electrical cardiometry (EC: Osypka Medical, Berlin, Germany and La Jolla, California, USA) have been proposed but few data are available in neonates. We investigated stroke volume (SV) using EC in term and preterm infants. Methods Eligible patients were neonates admitted to the NICU and undergoing echocardiography for any clinical reasons, without congenital heart disease. We measured SV with EC and echocardiography, within 10 min. Measurements were repeated 6 times by the same operator to calculate repeatability before and after echocardiography. Data have been compared with correlation and Bland-Altman analysis. Results 59 neonates were enrolled, allowing 150 paired measurements. Mean gestational age and birth weight were 33.9 ± 3.4 wks and 1988 ± 823 g, respectively. Results of Pearson correlation and Bland-Altman analysis for the whole population were (r = 0.611; p < 0.001) and (mean error [echo-EC] -1.35 mL [95% CI: -6.55 mL ± 3.85 ml]), respectively. Correlation is maintained even with PDA (r = 0.627; p < 0.001). Gestational age seems to do not influence the correlation between EC and echo (Partial correlation coefficient r = 0.36; p < 0.0001). Repeatability (coefficient of variation) was 46% for EC and 52% for echocardiography. There was no difference in SV measured by EC after 10 min (3.76 ± SD vs 3.78 ± SD; p = 0.56, Wilcoxon test). Conclusions EC is feasible, reproducible and quick. It could be an useful tool for continuous monitoring and haemodynamic evaluation in neonates. EC is particularly interesting for the clinical management of preterm neonates.

PO-0488 Non-invasive Haemodynamic Monitoring Using Electrical Cardiometry In Neonates During Respiratory Procedures

Background Electrical cardiometry (EC: Osypka Medical, Berlin, Germany and La Jolla, California, USA) is a new non-invasive technique for haemodynamic monitoring of neonates. No data are available for preterm babies during respiratory procedures, such as elective extubation or chest physiotherapy. We designed this study to clarify if these procedures have any haemodynamic consequences. Abstract PO-0488 Figure 1 Methods We assessed stroke volume (SV), cardiac output (CO), contractility index (ICON) and heart rate (HR) with EC before and after 5, 10, 15, 30 and 60 min from elective extubation or physiotherapy sessions with accelerated expiratory flow [Demont B et al , Physiotherapy 2007;93:12–16]. Functional echocardiography has been performed by the same operator before and after 60 min from the above-described respiratory procedures. Infants with congenital heart disease were not eligible. Results Eleven (for physiotherapy) and thirteen (for extubation) preterm infants were enrolled. Gestational age and birth weight were 29.2 ± 0.5 wks and 1313 ± 915 g, respectively. Fig.1 shows trends of SV, CO, ICON and HR before and after the procedures: no differences were noticed (p = 0.318 for SV; p = 0.559 for CO; p = 0.23 for ICON;p = 0.78 for HR, Friedman test). No differences were found analysing separately extubation and physiotherapy groups. Conclusions No haemodynamic changes are visible during elective extubation or chest physiotherapy in preterm infants. These preliminary results deserve further evaluation studying cerebral oxygenation with NIRS.

SFNP-17 - Purpura précoce en suite de couches : diagnostic et prise en charge

Nous rapportons le cas d’un nouveau-ne a terme presentant a H2: purpura, cephalhematome, hematome dos et palais sans autre signe, thrombopenie a 8000/mm3. Les causes infectieuses eliminees, il recoit 1 cure d’immunoglobulines (Ig), 3 culots plaquettaires sans efficacite, puis 2 culots HPA (Human Platelet Antigen) 1a negatifs montant le taux a 155000/mm3. Un phenotype maternel HPA-1a negatif et un cross match positif avec le pere diagnostiquent un allo antiHPA-1a (anti-Pla1) circulant. Il recevra plusieurs transfusions avant disparition des anticorps. Les thrombopenies allo-immunes signent la destruction des plaquettes fœtales des la 1ere grossesse par des allo-anticorps maternels (IgG transmises au foetus des 14SA) ciblant des antigenes plaquettaires fœtaux absents chez elle. Le titrage d’anticorps plaquettaires par MAIPA (Monoclonal Antibody Immobilisation of Platelet Antigen) et le genotypage HPA familial signent l’allo-immunisation, cause la plus frequente de thrombopenie neonatale dont 80% des cas sont dus a HPA-1a. Le traitement est base sur les transfusions de donneurs genotypes et les Ig parfois associees aux corticoides. Un suivi specialise des grossesses suivantes est necessaire. Des therapeutiques d’inhibition des anticorps par deglycogenisation sont prometteuses.

SFNP-19 - Infection tardive à streptocoque β-hémolytique du groupe B chez un ancien grand prématuré

Nous rapportons le cas d’un enfant ne a 29SA presentant a J29 un choc septique avec meningite purulente a streptocoque du groupe B (SGB) serotype III avec clone hypervirulent Sequence Type 17 compliquee d’un etat de mal convulsif. Apparaissent rapidement des lesions cerebrales avec ventriculite puis une hydrocephalie symptomatique : pose d’une derivation ventriculo-peritoneale avec occlusion necessitant une reprise chirurgicale. Le retour a domicile aura lieu a J91. Le SGB est une des 2 causes majeures de sepsis neonatal dont 30–40% de meningites notamment par le ST17 (75% des infections tardives et 81% des meningites en France et le serotype I (13%), et le IV aux USA. L’antibioprophylaxie per partum a permis de diminuer le taux d’infection precoce, a l’instar de l’E.coli, mais celui des infections tardives est constant (1,4‰ des naissances prematurees, 0,24‰ a terme) avec des formes moins severes. Les voies de contamination sont l’infection par le lait de mere surtout en presence d’une mastite (culture negative pour notre cas) avec recurrences possibles et la transmission horizontale par porteurs sains (famille, soignants). Les mesures preventives des recidives (arret allaitement, pasteurisation) sont discutees devant le taux de morbi-mortalite eleve (62% et 14%).

SFNP-18 - Iatrogénie fœtale : déni et problème de suivi de grossesse : le cas des sartans

Nous rapportons 2 complications graves dues aux antagonistes de l’angiotensine II (agtII : sartans). Le 1er cas est une enfant nee a 33SA pour RCIU et anamnios avec vessie non visualisee. L’adaptation a la vie extra uterine est mediocre avec detresse respiratoire severe, HTAP, anurie et hypotension. L’interrogatoire retrouve une prise d’olmesartan arrete a 29 SA. L’evolution, de part l’arret precoce, sera favorable avec cependant une insuffisance renale chronique moderee. Le 2eme cas est une enfant estimee a 36 SA, RCIU, nee en anamnios post deni de grossesse, avec traitement pendant toute celle-ci par valsartan. Elle presente une sequence de Potter avec anurie et hypoxie par hypoplasies renale et pulmonaire avec deces a J1. La prise aux 2 et 3eme trimestres de sartan entraine fœtopathies severes avec insuffisance renale par dysgenesie tubulaire, defaut d’ossification du crâne et hypoplasie pulmonaire (letalite superieure a 50%). Il s’agit d’un antagoniste specifique de l’agtll (systeme renine-angiotensine-aldosterone) actif sur le recepteur AT1 (protection contre inflammation, fibrose, apoptose), inhibant son effet vasoconstricteur, hypertenseur et natriuretique. Ce traitement contre-indique pendant la grossesse reste trop souvent prescrit chez des femmes en âge de procreer.

SFN CO-06 - Evaluation non invasive du débit cardiaque chez le nouveau-né : comparaison de la vélocimétrie électrique et de l’échographie cardiaque

L’evaluation du debit cardiaque en neonatologie est complexe et les procedures classiques sont risquees. La velocimetrie electrique (VE) est un systeme non invasif mais peu de donnees existent chez le nouveau-ne. Ce travail compare les valeurs du volume d’ejection (SV) mesure par VE et echographie cardiaque chez les enfants hospitalisees en reanimation neonatale par des mesures repetees de VE avant et apres echographie par le meme operateur. 32 enfants sont inclus permettant 53 mesures avec un âge gestationnel (AG) et un poids moyens de 29 SA et 1265g. Les correlations de Pearson et analyses de Bland Altman sur la cohorte retrouvent r= 0,499 (p La VEest facile, rapide et reproductible. Elle peut etre une aide precieuse a l’evaluation hemodynamique neonatale notamment chez le premature, surtout en absence de canal arteriel.

SFNP-10 - Evaluation non invasive de l’hémodynamique chez le nouveau-né au cours de manœuvres respiratoires.

La velocimetrie electrique (VE) est une nouvelle technique non invasive de monitorage hemodynamique. Il n’existe pas de donnees pour le moment chez les nouveau-nes au decours de procedures respiratoires comme l’extubation ou la kinesitherapie respiratoire. Le but de ce travail est de savoir si elles entrainent des modifications hemodynamiques. Pour cela dans notre population des nouveau-nes prematures on recueille le volume d’ejection (SV), debit cardiaque (DC), l’index de contractilite (ICON) et la frequence cardiaque (FC) avec la VE avant, apres et a 5, 10, 15, 30 et 60 minutes de l’extubation ou de manœuvres d’acceleration du flux expiratoire (AFE). 11 (AFE) et 13 (extubation) enfants sont inclus avec un âge gestationnel et un poids moyen de 29 SA et 1313g. Aucune difference entre les valeurs mesurees n’a ete relevee au decours des procedures d’AFE et d’extubation quel que soit le parametre (p=0.318 pour SV; p=0.559 DC; p=0.23 ICON; p=0.78 FC, tests de Friedman). Aucune difference n’est relevee en analysant separement les 2 groupes. Aucune modification hemodynamique n’est relevee dans notre cohorte de prematures. Ces resultats preliminaires meritent d’etre approfondis notamment par mesure specifique du debit cerebral par NIRS.