Georgios Mitsiakos

Neuromotor Outcomes in Infants With Bronchopulmonary Dysplasia

We examine the neuromotor outcomes of preterm infants with bronchopulmonary dysplasia. Two hundred and nineteen infants (gestational age, ≤ 32 weeks; birth weight, ≤ 1500 g) were studied. Neuromotor development was assessed using the Hammersmith Infant Neurological Examination. All potential risk factors associated with neuromotor scores (P < 0.015) were included in the generalized linear model (multiple linear regression) to determine if bronchopulmonary dysplasia had an independent relationship with neuromotor scores. Infants with severe bronchopulmonary dysplasia had lower global scores at ages 6 and 12 months. After adjustment for confounding factors, scores of infants with severe bronchopulmonary dysplasia were reduced by 13.2 units, whereas scores for those with periventricular leukomalacia were reduced by 11.1 units, at age 6 months. At age 12 months, scores for those with periventricular leukomalacia were reduced by 11.9 units. Duration of hospital stay reduced scores by 0.1 for each additional day increase in hospital. Bronchopulmonary dysplasia constitutes a major cause of poor neuromotor outcomes at age 6 months, but improvements in motor outcomes occur over time.

Neurological Outcome in Preterm Small for Gestational Age Infants Compared to Appropriate for Gestational Age Preterm at the Age of 18 Months: A Prospective Study

The aim of this study was to investigate the neurological outcome of premature small for gestational age infants at the corrected age of 18 months by the Hammersmith Infant Neurological Examination. A prospective trial was conducted comparing 41 preterm infants being small for gestational age with 41 appropriate for gestational age infants. Birth weight was significantly lower in small for gestational age infants compared with appropriate for gestational age infants (1724.6 ± 433 versus 1221 ± 328 g). There were no significant differences regarding the median gestational age and Apgar scores. Median global scores differ significantly between both groups: 75 (47-78) versus 76 (72-78) for the small for gestational age and appropriate for gestational age infants, respectively. Both groups had optimal scores. In conclusion, although the small for gestational age group scored lower in the Hammersmith Infant Neurological Examination, median global score in both groups was within optimal range.

Predicting Response to rFVIIa in Neonates With Intractable Bleeding or Severe Coagulation Disturbances

Background: To date, clinical experience with recombinant factor VIIa (rFVIIa) in neonates is rather limited because of the lack of controlled studies. &Agr;im: The objective of this study was to present further experience from our center with regard to the use of rFVIIa in newborns with severe bleeding or coagulopathy resistant to conventional therapy and to determine factors affecting the clinical outcome. Methodology: We performed a retrospective data analysis of 29 neonates with intractable bleeding or severe coagulation disturbances. All patients received 100 &mgr;g/kg of rFVIIa per dose bolus intravenously (maximum of 23 doses), as rescue procedure after other interventions had failed to achieve hemostasis. Results: Fourteen neonates survived (group A), whereas 15 died (group B). There was no difference in birth weight, gestational age, and bleeding site and causes between the 2 groups. In the neonates who survived, rFVIIa had been administered earlier in the disease process (<24 h of beginning of bleeding) compared with those who died (P=0.009). In all 29 neonates, international normalized ratio was directly restored (from 2.99±1.4 before rFVIIa administration to 1.6±1.1 afterward, P<0.001) and prothrombin time and activated partial thromboplastin time were significantly decreased after administration of rFVIIa (from 28 to 16.4 and from 180 to 67, respectively; P=0.001 and 0.05, respectively). Blood products administered were significantly less in group A than in group B, as time from the beginning of bleeding to the administration of rFVIIa was significantly less in group A than in group B. Neither acute adverse events nor thromboembolic complications were observed. Conclusions: In this neonatal group with intractable bleeding and/or severe coagulation disturbances, rFVIIa was more effective in early intervention as rescue therapy, without any adverse events in all neonates. Upon failure to achieve hemostasis with initial administration of blood products, fast intervention with rFVIIa could be considered in neonates with serious bleeding and coagulation disorders.

Intraventricular Hemorrhage and Platelet Indices in Extremely Premature Neonates.

Intraventricular hemorrhage (IVH) is a multifactorial disorder, the most important risk factors of which are prematurity and low birth weight. Disturbances in cerebral blood flow, inherent fragility of the germinal matrix vasculature, and platelet/coagulation disturbances are the 3 major pathogenic mechanisms. In this context, we investigated the role of platelet indices and several maternal and neonatal characteristics in the development of IVH through a retrospective cohort analysis of 130 extremely premature neonates, 24% of whom presented with severe IVH. There was a significant difference in platelet counts between the IVH and the control group on the first day of life (P=0.046). Presence of IVH was linked with lower birth weight (P=0.006) and lower gestational age (P=0.001). Platelet count on the first day of life was positively correlated with survival (P=0.001) and, along with platelet mass, was indicative of the worst IVH grade recorded for each neonate (P=0.002 and 0.007, respectively). Prolonged prothrombin time was also correlated with IVH (P<0.001), but factor analysis supported no prominent role. Maternal medications seem to play a minor role as well. In conclusion, IVH in extremely premature infants cannot be solely explained by platelet parameters, and further studies are required to determine the relationships between IVH, platelet indices, and outcomes.

Platelet Mass Predicts Intracranial Hemorrhage in Neonates With Gram-negative Sepsis

Neonatal sepsis due to gram-negative bacteria is associated with severe hemorrhagic conditions, such as intracranial hemorrhage (ICH). The aim of the study was to investigate the significance of platelet (PLT) count and platelet mass (PM) in predicting promptly neonatal ICH. Demographics, species, PLT, PM, ICH, and outcome for neonates with gram-negative sepsis for the period 2005 to 2012 were retrospectively recorded. Eighty-four infants were enrolled with median gestational age 30 weeks, median birthweight 1481.5 g, and median age at sepsis diagnosis 23 days. The most frequently isolated bacteria were Enterobacter spp. (38.1%). ICH occurred in 16 neonates (19%), whereas the mortality rate was 25% (21 neonates). The median PLT count and PM at days 1, 2, and 3 after diagnosis of gram-negative sepsis was significantly associated with the presence of ICH. Regression analysis revealed the cutoff predictive value of 355 fL/nL for the PM at day 3 (area under the curve: 75, sensitivity 90%, P=0.002). PM levels could play an important role in predicting the occurrence of ICH in high-risk neonates.

Prevalence, causes and mental health impact of workplace bullying in the Neonatal Intensive Care Unit environment

Objectives The aim of this study is to examine the prevalence, to report barriers and mental health impact of bullying behaviours and to analyse whether psychological support at work could affect victims of bullying in the healthcare workplace. Design Self-administered questionnaire survey. Setting 20 in total neonatal intensive care units in 17 hospitals in Greece. Participants 398 healthcare professionals (doctors, nurses). Main outcome measures The questionnaire included information on demographic data, Negative Act Questionnaire-Revised (NAQ-R) behaviour scale, data on sources of bullying, perpetrators profile, causal factors, actions taken and reasons for not reporting bullying, psychological support and 12-item General Health Questionnaire (GHQ-12) scores to investigate psychological distress. Results Prevalence of bullying measured by the NAQ-R was 53.1% for doctors and 53.6% for nurses. Victims of bullying differed from non-bullied in terms of gender and job experience, among demographic data. Crude NAQ-R score was found higher for female, young and inexperienced employees. Of those respondents who experienced bullying 44.9% self-labelled themselves as victims. Witnessing bullying of others was found 83.2%. Perpetrators were mainly females 45–64 years old, most likely being a supervisor/senior colleague. Common reasons for not reporting bullying was self-dealing and fear of consequences. Bullying was attributed to personality trait and management. Those who were bullied, self-labelled as a victim and witnessed bullying of others had higher GHQ-12 score. Moreover, psychological support at work had a favour effect on victims of bullying. Conclusions Prevalence of bullying and witnessing were found extremely high, while half of victims did not consider themselves as sufferers. The mental health impact on victims and witnesses was severe and support at work was necessary to ensure good mental health status among employees.

Congenital intestinal lymphangiectasia. A case report

Congenital intestinal lymphangiectasia, first described by Waldmann et al. in 1961, is a rare congenital malformation of the lymphatics, presented with generalized edema, hypoproteinemia and lymphopenia. Diagnosis is based on endoscopy findings and pathology. We present here a case of a male neonate, second child of an indigenous woman, delivered by caesarean section. Prenatally, multiple cystic abdominal masses were identified by ultrasound. The patient was treated successfully with enterectomy and anastomosis. Histopathology revealed primary intestinal lymphangiectasia with no features of malignancy. Intestinal lymphangiectasia is a rare pathology, which should be differentiated while exploring abdominal masses, hypoproteinemia and edema especially in neonates.

Newborns as potential organ donors: a new perspective?

Demand for organ donation is increasing over the years in all age groups leading search for alternative sources. Donation pool expansion in newborns necessitates new approaches specifically for brain and circulatory death definition. The “dead donor rule” (the donor must be dead before organ removal starts) remains the cornerstone for organ procurement. Brain death definition and time determination of circulatory death need to be uniformly accepted by the scientific community. Technical advances, uniform protocols for death determination and new proceedings in surgical field can maximize donation pool along with establishment of end-of-life care standard procedures and persistent support of the family. Newborns can serve as multivisceral donors in the near future to meet the increasing demand for organs in this age group.

PO-0422 Evaluation Of Cerebral Perfusion In Small For Gestational Age Neonates In The First Postnatal Week Using Colour Doppler Sonography

Background and aims Small for gestational age neonates (SGA) living in conditions of chronic hypoxia during fetal life may develop different autoregulation mechanisms in cerebral perfusion in order to maintain oxygen delivery to the brain in comparison to appropriate for gestational age (AGA) neonates. The aim of the current study was to estimate brain perfusion in SGA neonates during first postnatal week with the use of colour Doppler sonography. Patients/methods Transcranial Doppler sonography from the temporal acoustic window was performed bilaterally with CX50 PHILIPS device using S8–3 transducer in the first, third and seventh day of life of SGA neonates with mean gestational age 31.6 ± 2.2w and to comparable AGA ones. Recorded parameters were Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Mean Velocity (MV), Pulsatility Index (PI) and Resistance Index (RI) in middle cerebral artery MCA. Results 26 SGA and 26 matched for GA control AGA neonates were prospectively enrolled with statistically significant difference in birth weight (1.201, 9 ± 369.1 vs 1.805, 3 ± 431.7, p < 0.0001), in head circumference (27.4 ± 2.8 vs 30.0 ± 2.4, p = 0.01) and haemoglobin in first postnatal day (17.7 ± 1.7 vs 15.9 ± 1.6, p < 0.0001). Fetal Doppler were pathological in 6 SGA neonates. Doppler study showed a gradual increase in PSV and MV during the first week bilaterally in both groups with statistically significant difference between them in MV in the third day (Right p = 0.017, Left p = 0.05). EDV in right MCA was also found higher in SGA neonates in the second measurement (p = 0.04). No statistically significant differences were found in the resume parameters. Conclusion Increased brain metabolism in the first postnatal days is responsible for the observed augmentation of cerebral perfusion in order to maintain the balance between oxygen delivery and consumption. It seems that SGA neonates manage to develop compensatory mechanisms probably with an increase of their brain perfusion.

PO-0423 Differences In Cerebral Oxygenation And Perfusion Of Sga Neonates According To Gestational Age During The First Postnatal Week

Background and aims Low birth weight in conjuction with the immature autoregulation mechanisms noted in preterm neonates may influence brain perfusion and consequently the neurodevelopmental outcome. The aim of this study was to assess the potential variations in brain oxygenation and perfusion in SGA neonates of different gestational age during the first postnatal week with the use of Near Infrared Spectroscopy (NIRS). Patients/methods SGA neonates born at 28–32 weeks and 32+1–36 weeks respectively consisted the two study groups. Three measurements of forty minutes each were performed with NIRO-200 NX instrument in the first, third and seventh day of life. Tissue oxygenation index (TOI), fraction tissue oxygen extraction (FTOE) and tissue haemoglobin index (THI) were the recorded parameters. Results 38 neonates were prospectively enrolled; 12 were born at 28–32 weeks gestation and 26 at 32+1–36 weeks. Mean birth weight and head circumference were 1.062 ± 265 vs 1.656 ± 401 and 26.0 ± 2.5 vs 30.4 ± 1.8 respectively in the study populations. Haemoglobin in the first day didn’t show any significant difference between the two subgroups (16.4 vs 17.8). NIRS monitoring found higher FTOE at the right side in more preterm SGA neonates (p = 0.018) in the first postnatal day. All the other parameters were similar in the two groups. Abstract PO-0423 Table 1 Comparison of brain oxygenation and perfusion between SGA neonates with different gestational age 1st measurement 2nd measurement 3rd measurement 28–32w 32–36w 28–32w 32–36w 28–32w 32–36w TOI right 68.34 ± 9.48 74.06 ± 7.45 72.75 ± 6.49 72.33 ± 6.60 69.97 ± 9.31 70.24 ± 8.70 TOI left 67.80 ± 8.49 73.24 ± 8.56 69.62 ± 11.37 71.32 ± 6.30 70.86 ± 7.50 71.19 ± 7.51 FTOE right 0.31 ± 0.10 0.24 ± 0.09 0.22 ± 0.07 0.27 ± 0.06 0.30 ± 0.10 0.28 ± 0.09 FTOE left 0.30 ± 0.10 0.26 ± 0.10 0.25 ± 0.12 0.27 ± 0.06 0.30 ± 0.07 0.28 ± 0.08 THI right 1.81 ± 0.81 1.18 ± 0.98 1.23 ± 0.47 1.33 ± 0.8 1.71 ± 1.13 1.22 ± 0.50 THI left 1.10 ± 0.55 1.38 ± 0.78 1.56 ± 1.05 1.36 ± 1.06 1.25 ± 0.73 1.62 ± 1.00 Conclusion It seems there aren’t significant differences in cerebral oxygenation and perfusion between SGA neonates of different gestational age during the first postnatal week.