Maria Stamatin

High-dose phenobarbital or erythropoietin for the treatment of perinatal asphyxia in term newborns

The aim of this study was to compare two neuroprotective strategies to supportive care in the treatment of perinatal asphyxia.

Pulse Oximetry During the First 24 Hours as a Screening Tool For Congenital Heart Defects

Abstract Introduction: Although screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged. Aim: To assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD. Material and Methods: In this prospective study, all infants born in “Cuza Voda” Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD. Results: 5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD. Conclusion: Routine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.

The Role of Follow-up in Monitoring the Outcomes of Prematurity in a Cohort of Romanian Infants.

Background: The rate of preterm births in Romania is one of the highest among European countries. However, there is little information regarding the ways in which premature birth affects the outcome in Romanian preterm infants. Aims: To investigate the effects of early developmental intervention after discharge from the hospital on motor and cognitive development in preterm infants. Study Design: Longitudinal observational study. Methods: We performed the Amiel-Tison neurologic evaluation at discharge and the Bayley Scales of Infant Development from 3 to 24 months. Based on these evaluations, an outcome score was formulated. Results: Between 2007 and 2010, 1157 of 2793 premature infants were included into the study. There was a negative correlation between the number of evaluations and the risk of developing neurologic sequelae (p<0.001). The correlation analysis demonstrated a significant association between the final category of risk at the end of the follow up program and the degree of compliance (p<0.01). At 24 months evaluation, there was a correlation between the low gestational age and the risk of developing severe neurologic sequelae (p<0.001). Conclusion: This study shows the importance of follow up program in decreasing the risk of developing neurologic sequelae in preterm infants.

OC-82 The role of cerebral and splanhnic saturation for the outcome of newborns with necrotizing enterocolitis

Near-infrared spectroscopy (NIRS) to measure somatic and cerebral saturations is increasingly used in Neonatal Intensive Care Units for the monitoring of various conditions, including congenital heart defects, renal disease or intestinal conditions. Splanchnic saturation is used for predicting impending necrotizing enterocolitis (NEC), but its’ fluctuations make it rather difficult to analyse. The Somatic-Cerebral Oxygenation Ratio (SCOR) has been developed recently to monitor healthy term and preterm infants as well as sick children as a more stable measurement of overall oxygenation. Material and methods We conducted a prospective study over three years (2014–2016) on 61 newborns, 38 preterm infants with clinical signs of NEC and 23 infants used as control group. We simultaneously measured cerebral and splanchnic saturations through NIRS. We calculated the Receiver Operating Characteristics Curve for all the parameters, in order to assess their value as predictive factors for NEC. Results The preterm infants who developed NEC had a mean gestational age of 31 weeks (IQR=27–33 weeks) and a mean birth weight of 1311 grams (IQR 900–1850). Splanchnic saturations had values between 15% and 69% in infants with NEC and 54%–88% in infants without NEC, with statistically significant differences between the two groups (p<<<0.01). Cerebral saturations had values between 15% and 85% in infants with NEC and 62%–95% in infants without NEC, also with significant differences (p<<<0.01). SCOR had values of 0.25–1.03 when NEC was diagnosed and 0.61–1.16 when NEC was absent (p<<<0.01). The area under the curve (AUC) is 0.914 for splanchnic saturation, 0.840 for cerebral saturation and 0.747 for SCOR (p<<<0.01). Conclusions SCOR is significantly different in infants with and without NEC. Both its’ sensitivity and specificity are lower than those of splanchnic saturation, but SCOR can be preferred in the clinical settings due to its’ smaller variations.

OC-81 Umbilical cord ghrelin levels in newborns with intrauterine growth restriction

Ghrelin is a hormone produced in the gastrointestinal tract which functions in the hypothalamus as an appetite-regulating neuropeptide. It has been linked to inducing appetite and various feeding behaviours. Because of this, ghrelin is involved in the metabolic pathway of the ‘thrifty phenotype’, a condition in which the infant with intrauterine growth restriction (IUGR) develops obesity and metabolic syndrome later in life. Ghrelin is composed of two molecular forms, the acylated and the non-acylated ghrelin (NA-Ghr), which modulate each other’s activity. We aimed to ascertain the values in the umbilical cord blood of NA-Ghr in infants with IUGR and their correlation with anthropometrical parameters at birth. Material and methods We performed a prospective comparative study on two groups of newborns, 19 with IUGR and 20 without IUGR, born between March and July 2016 in the Cuza-Voda Clinical Hospital of Obstetrics and Gynaecology. We collected cord blood samples and we analysed them through ELISA in order to determine NA-Ghr. Data was then interpreted in order to establish correlations between the values we obtained and anthropometrical parameters at birth. The statistical significance was established at p=0.05. Results The two lots were comparable regarding gestational age, but there were significant statistical differences regarding birth weight, length, ponderal index, head and chest circumferences. NA-Ghr had values of 103 pg/ml (0–474 pg/ml) in the study group and 118.6 pg/ml (8.74–293) in the control group, with significant statistical differences (p=0.0003). NA-Ghr is directly correlated with birth weight (p=0.001), length (p=0.01), head circumference (p=0.0001) and chest circumference (p=0.0001), but it is not correlated with gestational age (p=0.087). Conclusion NA-Ghr has lower mean values in newborns with IUGR, although it has a greater variability. Its’ role in the neonatal period is poorly understood. More studies are needed to compare these values with total ghrelin, acylated ghrelin and to monitor the dynamics of these hormones during infancy.

Correlations Among Parental and Neonatal Anthropometric Parameters, Feeding Practices and Infant Obesity

Background and aims Infant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child. Our study aims to describe the characteristics of a group of macrosomic newborns, in relation to the mothers’ weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay. Patients and methods We conducted a retrospective study on 179 newborns with birth weights >4000 grams, born over a period of three months (March–May) in 6 large maternity hospitals in Romania. Results the newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%). Conclusion Macrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge.

Physician Attitudes in Romania toward Withholding and Withdrawal of Intensive Care for Infants with Very Poor Prognosis

OBJECTIVE The purpose of this study was to examine the attitudes of Romanian physicians toward withholding and withdrawing intensive care for infants whose prognosis is very poor. METHODS A survey tool was developed by the authors and completed by participants in the annual meeting of the Neonatology Association of Romania. RESULTS The majority of respondents attempt resuscitation of all live-born infants, have never stopped resuscitation at birth while the infant was still alive, and have never stopped respiratory support because of poor prognosis. Nearly all respondents were uncomfortable talking with parents about withholding or withdrawing intensive care, and they were also uncomfortable talking to the parents about the death of their infant. CONCLUSIONS Romanian physicians are uniformly reluctant to withhold or withdraw intensive care for infants, even those with very poor prognosis. In addition, physicians are very uncomfortable talking with parents about limiting or stopping support and talking about the death of an infant. Educational programs targeting the communication of difficult topics with parents have the potential to decrease the discomfort experienced by physicians in conversing with parents about their childs poor prognosis or death.

1104 Long-Term Outcome of Term Newborns with Perinatal Asphyxia - Predictive Factors

Perinatal asphyxia represents the second most important cause of death in the NICU and an important source of neurologic long-time sequelae. Aim To identify long-term predictive factors for neurologic sequelae in term newborns with perinatal asphyxia. Material and Methods We conducted a prospective study on 67 term newborns with perinatal asphyxia, admitted to our NICU between 2010–2011. The following parameters were followed: Apgar scores at 1, 5, 10 minutes, cord blood pH, neurologic disorders, creatine-kinase (CK), lactate dehydrogenase (LDH), total antioxidant status (TAS) at 4, 12, 24, 48, 72 hours and 7 days, follow-up after discharge until 18 months of age. Results Incidence of perinatal asphyxia in the NICU was 3.76%. Mean Apgar score at 1 minute was 3.58 and at 5 minutes 5.33, thus indicating the efficiency of resuscitation. Mean blood cord pH was 7.04. During the first 12 hours of life, all newborns had neurologic disorders. After the first 72 hours, this aspect was only present in 53.7% of the newborns. TAS was lowest at 12 hours (0.92 mmol/L), not reaching normal values at any moment. Survival was 91.04% and was correlated with ph (p=0.012), CK (p=0.04), LDH (p=0.02), but not TAS (p=0.063). Neurologic sequelae decreased progressively, reaching 10.45% (n=7) at 18 months. CK and LDH were predictive for sequelae (p=0.01), but not the Apgar score or TAS (p=0.08). Conclusion Routine determinations for blood cord pH, CK and LDH can become valuable markers of long-term outcome for newborns with perinatal asphyxia, while TAS remains for further research.