Enrico Zecca

Early changes of pulmonary mechanics to predict the severity of bronchopulmonary dysplasia in ventilated preterm infants

Objectives: To verify whether early pulmonary mechanics measurements are useful to predict subsequent bronchopulmonary dysplasia (BPD) and its severity. Methods: Pulmonary mechanics were studied at 3, 5, 7 and 10 days of age in 52 preterm infants with birth weight < 1250 g, affected by respiratory distress syndrome and ventilated for more than 72 h. Pulmonary function was assessed using a previously standardized method based on the measurement of airflow with a Fleisch OO pneumotachograph and airway pressure with a model P7D differential pressure transducer. At 28 days pulmonary outcome was classified into three groups: no BPD, mild BPD (oxygen dependency and hazy lung on X-ray) and severe BPD (oxygen dependency and Northway stage 3/4). Results: Of the 52 infants, 39 survived to 28 days: no BPD (11 infants), mild BPD (16 infants) and severe BPD (12 infants). The no-BPD group had significantly higher gestational age and birth weight, fewer males and a lower incidence of patent ductus arteriosus than both BPD groups, while no differences were detected between the BPD groups. Lung compliance was significantly higher in the mild-BPD group than in the severe-BPD group at 7 and 10 days of life (p < 0.01 and p < 0.001, respectively). The corresponding odds ratio confirmed that ventilated infants with lower lung compliance values had a significantly higher probability of developing severe BPD. Respiratory system resistance did not show any predictive value. Conclusions: Our findings indicate that low lung compliance values determined on the 7th and 10th days of life are a reliable predictive tool of the severity of later BPD.

Which Phototherapy System Is Most Effective in Lowering Serum Bilirubin in Very Preterm Infants

Objective: To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels in preterm infants. Methods: This randomized clinical trial enrolled 140 preterm infants with gestational age ≤30 weeks and presenting nonhemolytic hyperbilirubinemia. When total serum bilirubin level reached 6.0 mg/dl (102.6 µmol/l), eligible infants were randomly assigned to four study groups: conventional, fiberoptic Wallaby, fiberoptic Biliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion. Results: Our results confirm that fiberoptic phototherapy, both Wallaby and Biliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions. Conclusion: Our data suggest that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants.

1025 Screening and Management of Neonatal Jaundice by Transcutaneous Bilirubin

Objective: The aim of this study was to assess the validity of our previously developed skin bilirubin nomogram in predicting severe hyperbilirubinemia (> 17 mg/dl) in healthy term and late preterm newborns. Methods: This multicenter study was conducted from February 2009 to December 2009 in the well-baby nurseries of five centres of Rome. The predictive ability of the nomogram for transcutaneous bilirubin (TCB) values in the first 96 hours of life was prospectively assessed in 2167 neonates with gestational age ≥35 weeks. Skin bilirubin was measured with the Bilichek and serum bilirubin was contemporary assayed by a spectrophotometric method. 1074 neonates had more than one measurements giving a total of 3241 values. Results: The mean TSB values was 8,3 ± 3 mg/dl, while the mean TCB values was 9,5 ± 3,3 mg/dl. A sensitivity of 96,4% and a negative predictive value (NPV) of 99.9% were obtained with a single bilirubin determination applying the 75° percentile of our nomogram. Two consecutive TCB determinations identified all infants reaching TSB values > 17 mg/ dl (100 % of sensitivity and 100% of NPV). Conclusion: The 75° percentile of the skin bilirubin nomogram for the European population in the first 96 hours of life is able to predict all neonates at risk of severe hyperbilirubinemia. It is a reliable guide for intervention and follow-up, and allows a safe discharge from the hospital, also reducing a large number of blood samples.

398 Serum Levels of IL-6, IL-8 and IL-10 in Premature Newborns Treated with two Ventilatory Strategies: HFOV and sIMV.

Background/aim: Severity of pulmonary dysfunction and later development of chronic lung disease in preterm neonates depends on several factors, including oxygen administration and ventilatory strategies. Aim of this report is the comparison of the effects of high-frequency oscillatory ventilation (HFOV) versus synchronized intermittent mandatory ventilation (sIMV) on serum cytokine levels (IL-6, IL-8, IL-10) during the first week of life.Methods: Forty preterm neonates with RDS and gestational age (GA) < 30 weeks were randomly assigned to one of the two above-mentioned ventilation strategies within 30 minutes from birth: Group HFOV: N: 20; mean GA: 27.1±1.4 wks; mean birth weight (BW): 882 ±157 g. Group sIMV: N: 20; mean GA: 27.4 ± 1.2 wks; mean BW: 936 ± 285 g. At 1, 3 and 5 days, the babies were monitored by means of ventilator indices and three pro-inflammatory cytokines in sera.Results: No clinical or biochemical differences were observed at baseline. The neonates assigned to HFOV benefited from early and sustained improvement in gas exchange (significantly lower FiO2 and significantly higher a/A ratio) with earlier extubation, and showed a significant reduction (p<0.05) of serum IL-6, IL-8 and IL-10 over time, as compared to the neonates assigned to sIMV treatment. In addition, at days 3 and 5, the IL-6 levels were significantly lower in the HFOV group as compared to sIMV patients [median (range) values: 7 (1–47) pg/ml vs 20 (4–144) pg/ml respectively at day 3, and 6 (2–44) pg/ml vs 14 (5–145) pg/ml at day 5, p<0.05].Conclusions: The results of this randomized clinical trial support the hypothesis that early use of HFOV, combined with optimum volume strategy, has a beneficial effect, reducing serum levels of pro-inflammatory cytokines and consequently the acute phase leading to lung injury.

83 Intrahepatic Cholestasis of Pregnancy and Neonatal RDS: First Evidence of a Correlation

BACKGROUND Intrahepatic Cholestasis of Pregnancy (ICP) impairs the placental clearance of bile acids (BA) and has been associated with perinatal morbidity but no adverse outcomes have been reported in the newborn. We have recently supposed a causative role of ICP in 3 cases of respiratory distress syndrome (RDS) in near term neonates in which the most common etiologies were excluded. For this reason we conducted a retrospective cohort study to verify the association between ICP and RDS and to clarify the role of BA in the RDS occurrence.METHODS We took data from our Division database about all newborns born during the years 2000 - 2004. Infants with Apgars score < 7 at 5 minutes, any evidence of liver disease, major malformations or chromosomal aberrations were excluded from the study. Study neonates were 77 infants born from pregnancies complicated by the only ICP whereas control neonates were 427 infants born from pregnancy without any signs of ICP. In the ICP group we also studied maternal BA levels just before the delivery and neonatal BA levels during the first 24 hour of life.RESULTS Univariate analysis showed a double incidence of RDS among newborns from ICP pregnancies(28.6% vs. 14%; p < 0.001). In the multivariate analysis, after adjustment for gestational age, sex and rate of antenatal steroids, ICP still was a factor significantly associated to the occurrence of neonatal RDS.CONCLUSIONS This study demonstrates that ICP can play a significant role in the genesis of RDS in near term and mild preterm infants in which other causes are uncommon. BA can produce surfactant inactivation in the alveoli reverting the reaction of phospholipase A2. In the lungs. Prospective studies are needed to answer several open questions.

EARLY VERSUS LATE DEXAMETHASONE TO PREVENT CHRONIC LUNG DISEASE IN VENTILATOR-DEPENDENT PRETERM INFANTS

EARLY VERSUS LATE DEXAMETHASONE TO PREVENT CHRONIC LUNG DISEASE IN VENTILATOR-DEPENDENT PRETERM INFANTS