INAC 2016 Abstracts

INAC 2016 Abstracts

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Whole Body Cooling (WBC) for Short Term Outcomes in Newborns with Asphyxial Encephalopathy (CNAEST study): A Pilot Feasibility Study. Govind Benakatti, Dattatray Inamdar, M M Karva, L H Bidari, Laxmi Hadalagi, Sandeep Harsangi Dr. Bidari's Ashwini Institute of Child Health and Researh Centre, India Background and Aims Limited studies have assessed the survival outcome of WBC. Moreover, studies from resource limited settings are very much lacking and few available studies have failed to show the benefits of WBC in similar manner with studies from developed nations. Various reasons are cited for this contradictory result. To resolve this controversy and to study the effect of WBC on mortality and short term outcomes, we conducted this pilot feasibility study in neonates with moderate to severe asphyxial encephalopathy in NICU of tertiary care pediatric teaching hospital. Methods We followed TOBY trial protocol in newborns with ≥36 weeks of gestation with moderate to severe asphyxial encephalopathy admitted within 6 hours of birth. The aEEG was continuously monitored for brain activity, seizures and progress of encephalopathy. Predefined adverse effect profiles (acid-base, renal functions, coagulation, cardiovascular profile) were monitored at 24-hourly intervals. Neonates remained in cooling protocol for 72 hours and/or any predefined adverse effect occurred. MRI was done in all survived neonates at discharge. Neonates were divided into three groups based on cooling initiation time as; groupA(0-2 hours), group-B(2-4 hours), and group-C(4-6 hours). Primary outcome was survival rate. Secondary outcomes were; improvement in encephalopathy severity in aEEG and MRI. Results Fifty neonates were enrolled. 62%(n=31) had moderate and 38%(n=19) had severe encephalopathy. Mean(±SD) age at cooling initiation was 3.78±1.8 hours and mean(±SD) duration of cooling was 66.8±9.6hours. Mortality was 50%. Group-A showed ‘threefold’ lesser mortality (27%vs.69%; P=0.030) (OR 5.3; 95%C.I.1.1-27.8) and higher rate of improvement to mild/no encephalopathy (91% vs.16%; P0.001). There was positive correlation between early cooling initiation with lesser brain injury on MRI (Spearman’s co-efficient value:0.47; P=0.089). Conclusions WBC showed survival benefit and improved neurological outcome in neonates at time of discharge in resource limited settings, provided initiated early, preferably within two hours of birth.

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Magnesium Sulfate for Fetal Neuroprotection: Correlation between Maternal and Infant Serum Magnesium Concentrations IRIS MORAG, Iris Morag, Daniel Yakubovich, Michal Simchen, Tzipi Strauss The Edmond and Lily Safra Children Hospital ant Chaim Sheba Medical Center, Israel Aim To determine the correlation between maternal and infant serum Mg concentration among preterm infants exposed to MgSO4 for neuroprotection. Methods A total of 60 infants born at 32 weeks gestational age and exposed to MgSO4 for neuroprotection were enrolled. The correlation between maternal serum Mg concentration (mMgC) drawn at 48 hours prior to birth and infant serum Mg concentrations (iMgC) drawn immediately after birth was assessed. Additional factors such as total Mg treatment dose, interval between treatment initiation, treatment discontinuation and birth, as well as other maternal and infant characteristics were assessed as possible contributors. Results Complete data were available for 60 mother-infant dyads. Mean infant gestational age was 28.8 + 2.23 weeks. Median and interquartile range (IQR) of total MgSO4 dose, mMgC and iMgC were 45g (25-88), 5 (4-5) and 4 (3-4) mg/dL respectively. Maternal Mg concentration and iMgC correlated significantly (r=.433 p=.001). In multiple regression analysis duration between first loading and birth (b=-.031 p=.004) and female gender (b=.412 p=.029) also correlated with iMgC. Conclusion Serum magnesium concentration in preterm infants treated for neuroprotection correlates with mMgC. This correlation may serve as a non-invasive tool for estimation of fetal Mg concentration in exposed fetuses during maternal treatment.

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Dunstan Baby Language Efficacy in Decreasing the Parenting Stress Levels of Housewives with 0-2 Month Old Infants vs. Standard Care Using a Quasi-Experimental Study Design Angelica Marie Pineda, Roza Clara Pineda, Henry Pinos, Loubelle Rirao, Rogelio Jr. Rivera, Karen Angelica Rodil, Mary Christine Roque, Raiza Jane Sabate, Sandy Sanchez, Jose Lorenzo Santos, Joshua Santos Universiry of the East Ramon Magsaysay Memorial Medical Center, Philippines Literature shows that infant distress and care giving can be sources of stress of primary care givers, especially for first time mothers. The researchers wanted to determine whether Dunstan Baby Language (DBL) is efficacious in decreasing parenting stress among these primiparous women with 0-2 month infants over those utilizing standard newborn care. This research utilized a quasi-experimental approach, where 18 participants were gathered and divided into control (standard care) and experimental (DBL) groups. Descriptive statistics were used in the interpretation of the demographics, while a repeated measures mixed model was used for the Parental Stress Scale (PSS) results. A total of 27 participants were enrolled in the study. The experimental group had 18 participants, with a subsequent loss to follow up of 9, while the control group had 9 participants. These participants had babies with a mean age of 1 month in the experimental group, and 2 months in the control group. An apparent decrease was noted in the Time 1 to Time 2 and the Time 2 to Time 3 PSS scores in the experimental group, as opposed to the control group having minimal changes in their PSS mean scores, but p-values failed to demonstrate any significant difference among them (p-values ranged from 0.053-0.415). Use of DBL among newborn babies led to decreased parenting stress levels among primiparous mothers as reflected in the downward trend of PSS mean scores during the observation period. However, the difference was not statistically significant versus the standard newborn care.

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Etiology of Hydrops Fetalis at the Philippine General Hospital: a Retrospective Study Michelle Abadingo, Maria Melanie Liberty Alcausin University of the Philippines-Philippine General Hospital, Philippines Introduction Hydrops fetalis (HF) is defined as accumulation of fluid in 2 or more fetal compartments. HF is a diagnosis with significant morbidity and mortality. An epidemiologic profile of HF in the local population is needed to identify possible etiologic factors. This study aimed to identify common etiologic causes of HF in the Philippine General Hospital (PGH). Methodology This is a retrospective review of hydrops fetalis cases delivered at the PGH from January 1, 2010 to December 31, 2014. Fifty-eight (58) medical charts of patients, obtained from the Medical Records Section of the PGH,were reviewed Results The median gestational age at birth was 31 (range 21-40) weeks. There were 19 identified cases (32%) of stillbirth. Of the 32 patients born alive, 30 (93.75%) died in the immediate neonatal period. The etiologies of HF were identified in 12 cases, which included hematologic anomalies (n=5), cardiac anomalies (n=3), infectious problems (n=3) and congenital tumor (n=1). Aside from the 2 confirmed cases of alpha thalassemia, 15 cases presented with microcytic, hypochromic anemia on complete blood count (CBC). The cause of HF was not confirmed in the remaining 47 (80%) cases. There was a lack of laboratory work-ups done. Conclusion It is important to fully investigate the causes of HF to aid in the proper management, counselling and treatment planning.Further work-up must be done for mothers presenting with microcytic, hypochromic anemia This is an important and common feature of alpha thalassemia which is a major cause of hydrops fetalis in Southeast Asian countries. Keywords: Hydrops fetalis, etiology, fetal outcome

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Effect of Topical Emollients in the Prevention of Nosocomial Sepsis in Neonates: A Randomized Controlled Trial Ari Hidayat, Jennie Wong, Marxengel L. Asinas, Pamela Bandelaria Background Topical emollients have been introduced as one of the possible strategies to reduce nosocomial infections in the Neonatal Intensive Care Unit (NICU). Topical application of sunflower seed oil and virgin coconut oil that may augment the function of the skin barrier as a strategy for reducing risk of nosocomial sepsis and improving survival rates in Neonatal Intensive Care Unit tertiary government hospital will be evaluated in this study. Objectives To compare the effect of topical application of sunflower oil and virgin coconut oil in the prevention of nosocomial infection among newborns in Neonatal Intensive Care Unit Tertiary Government Hospital. Design Double blind randomized controlled trial Setting Neonatal Intensive Care Unit in a Tertiary Government Hospital Subjects A total of 116 neonates were included in this study. The inclusion criteria were all admitted neonates at the NICU on the first day of life with one of risk factors for nosocomial sepsis (low birth weight, prematurity, required mechanical ventilation, invasive procedures, administration of parenteral fluids, and used of stock solutions). Exclusion criteria were neonates with poor APGAR score, Ballard score less than 28 week, presence of a major congenital anomaly, required major surgical procedure, neonates or mother with known immunodeficiency; and birthweight less than 1000 grams Methods Subjects were randomly assigned to group SO (received daily topical applications of sunflower seed oil plus conventional therapy), VCO (receive daily topical applications of virgin coconut oil plus conventional therapy) and Co served as control (with no topical applications, but given conventional therapy). Outcome parameters such as nosocomial sepsis, mortality rates, survival rate, length of hospital stay, skin condition and adverse effect were compared in all groups. Results There was homogeneity of baseline demographic and clinical profile between three groups. No adverse effects or allergic reaction were observed from the treatment groups. The incidence of nosocomial sepsis among the sunflower oil group was 9.6 times less likely compared to that of control group (p value 0.005) and this was statistically significant. Sunflower oil group was 5.7 times more likely to survive compared to that of control group (p value 0.005, significant) and 3.4 times more likely to survive compared to the virgin coconut oil group (p-value 0.052, borderline significant). Sunflower oil group had a significantly higher survival curve compared to virgin coconut oil group (p value 0.019) and control (p value 0.001). There was no significant difference in the length of stay between the three groups (p-value =0.505). The skin condition in treatment group had a positive change in the skin condition compared to that of control, however, these was not statistically significant (p value ≥0.05). Conclusion Topical sunflower oil has statistically significant reduction in the incidence of nosocomial sepsis and mortality rates among NICU admitted neonates in Tertiary government Hospital. Both sunflower oil group and virgin coconut oil group have no adverse effects or allergic reaction. 6

Impact and Outcomes of Prenatal Diagnosis of Congenital Heart Disease in Kosovo Single Centre Experience Ramush Bejiqi1, Ragip Retkoceri1, Hana Bejiqi2, Lindita Kryeziu2, Arber Retkoceri1, Rinor Bejiqi2, Naim Zeka, Naim Zeka1, Abdurrahim Geguri, Abdurrahim Geguri1, Abdurrahim Geguri, Armend Vuçiterna, Armend Vuçiterna1 1 University Clinicla Centre of Kosovo, Kosovo 2 Mean Centre of Family Medicine, Kosovo Introduction With high prevalence congenital heart anomalies (CHA) are the most common congenital disorders in newborn and leading factor in neonatal death. Improving FE in Kosovo as the youngest country in Europe with still high natality and mortality rate in early detection of heart anomalies, contributes in planning delivery as in-utero transport abroad Kosovo, trying to reduce mortality as a consequence of HA. Aim of presentation is to present impact of prenatal diagnosis and postnatal treating foetuses and children with complex CHA in Kosovo as a country with limited human and technical resources. Methods retrospectively we analysed medical reports and data, obtained from the FE, Results During this period January 2114 and December 2015 FE in 1413 pregnancies were performed (mean 1.5); the age of gestation was from 14 to 32 weeks (mean 23 weeks). Of them 264 were pregnant with twins (12.5%), and 13 pregnancies (0.6%) were with three foetuses (all from IVF). Indication for FE where all multiple pregnancies, in 514 other indication was actual obstetric findings, in 218 was positive history, in 123 infection and use of medication during the pregnancy and, in 399 pregnancies indication was age of parents, diabetes or self-initiative for FE. In 243 pregnancies (11.55) CHA was registered, where 68 have been complex. Of them 22 were with complete atrioventricular canal, 17 where with hypoplastic left heart syndrome, 12 with tricuspid atresia, and 17 where with tetralogy of Fallot or double outlet right ventricle. From 68 pregnancies with CHA, despite advice to continue the pregnancy only 9 continue pregnancy (all were with multiple foetuses where other one was health). Conclusion Despite the application of FE and accurate diagnosis most pregnant women interrupted pregnancy as a consequence of CHA. Situation exacerbates the fact of lack of paediatric cardiac surgery services on Kosovo.

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Familial Recurrence of Congenital Heart Defects in Norway Kristoffer Brodwall1,2, Elisabeth Leirgul2,4, Gottfried Greve1,3,4, Stein Emil Vollset2,5, Grethe S. Tell2,5, Henrik Holmstrøm6, Nina Øyen2,7 1 Haukeland University Hospital, Norway 2 University of Bergen 3 University of Bergen, Norway 4 Haukeland University Hospital, Norway 5 Norwegian Institute of Public Health, Oman 6 Oslo University Hospital, Norway 7 Haukeland University Hospital, Norway Background Congenital heart defects (CHD) constitute the largest group of congenital malformations. Most cases occur without any known etiologic cause, and the majority of affected families contain only one person with CHD, but prevalence of CHD is increased for children being born into families already affected. In this study, the recurrence risk ratio of CHD in Norway is described. Material and methods All births from 1994 through 2009 were identified in the Medical Birth Registry of Norway, with information on CHD supplemented from clinical and administrative registers. Pairs of relatives were established using the unique personal identification number. Familial recurrence risk ratio (RRR) was calculated using CHD status in the older person as exposure and CHD status in the younger person as outcome. Results Among 954,355 births 1994-2009 CHD was diagnosed in 13,081 (birth prevalence 137.1 per 10,000). We were able to link 950,970 mother-child pairs, 938,699 father-child pairs, 466,307 pairs of full siblings, including 17,181 pairs of twins, triplets or quadruplets, 51,964 pairs of maternal half siblings, and 55,490 pairs of paternal half siblings. CHD diagnosis was found in the mother in 1,182 of the births and in the father in 927 of the births. Overall RRR for CHD was 4.6 (95% confidence interval (CI) 4.2-4.9). By type of relationship, the motherto-child RRR was 7.8 (95% CI 6.6-9.3), father-to-child RRR was 1.9 (95% CI 1.3-2.8), same-sex twin RRR was 13.4 (95% CI 11.2-15.9), unlike-sex twin RRR was 13.6 (95% CI 10.5-17.7), sibling (excluding twins) RRR was 3.1 (95% CI 2.7-3.5), maternal half-sibling RRR was 1.6 (95% CI 1.0-2.7), and paternal halfsibling RRR was 1.3 (95% CI 0.8-2.3). Conclusions Recurrence risk ratio of CHD in families is high, especially between twins and from mother to child, suggesting that significant familial risk factors for CHD are carried by the mother.

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Empirical Cost Benefit Analysis of Investing in Neonatal Health Care in India. Are Neonatal Mortality Related Sustainable Development Goals (SDGs) Acheivable? Ramesh Vidavalur Assistant Professor in Clinical Pediatrics, Weill Cornell Medical College/Cayuga Medical Center, USA Background India accounts for 25% of global neonatal deaths with 26 million births annually. It is in the midst of epidemiological and health transition wherein factors like urbanization and migration; changing lifestyles; sustained economic growth have enormous impact on maternal and child health. Objective To determine temporal trends of neonatal mortality and cost effectiveness of investing in newborn health in India. Methods Country specific data from global burden of disease study (GBD 2013), Institute of Health Metrics and Evaluation was used. Descriptive statistics were used to analyze the data. Results There is 50% reduction in NMR in last 25 years (1990-2015) at annual rate of reduction (ARR) of -2.8%. In order to achieve neonatal related SDG by the year 2030, the ARR needs to double at -5.5%. The total number of disability adjusted life years (DALYs) lost to neonatal causes is 53.7 million. Lost income to disability alone, at 10 years of productive life with discounted GDP at 50%, is 26 billion dollars, contributing to loss of 1.5% of total GDP (1.87 trillion). It costs approximately USD 1.2 to avert loss of one DALY from neonatal causes through NICU intervention, assuming cost of NICU care is USD 112 (Prinja et al, 2013) per infant. Nationwide, if we spend USD10 for every delivery on neonatal care, cost per life saved/disability averted is USD420. Conclusion Considering economic benefits and impact on GDP, it is time to increase current per capita public health expenditure to focus on maternal child health to reap the economic benefits of a country. High quality antenatal care; timely, quality obstetric care coupled with improved neonatal care in primary and secondary public healthcare facilities for below poverty population via accountable universal healthcare funding programs to overcome existing physical, economic and cultural barriers is needed to save most vulnerable newborns.

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Management of Adams-Oliver Syndrome in Twins Adnan Bajraktarevic1, Alisa Abduzaimovic2, Sajra Uzicanin3, Ismet Suljevic4, Velma Selmanovic5 1 Public Health Institution of Health Center Sarajevo, Bosnia and Herzegovina 2 Biochemistry Laboratory Tesanj, Bosnia and Herzegovina 3 Pediatrics Clinic Sarajevo, Bosnia and Herzegovina 4 Clinical Medical Center Sarajevo, Bosnia and Herzegovina 5 Genetic Institution of Canton Sarajevo, Bosnia and Herzegovina Introduction Adams-Oliver syndrome has a wide spectrum of physical anomalies ranging from characteristic aplasia cutis congenita, transverse limb defects, and cutis marmorata telangiectica to extensive lethal anomalies. The prevalence is unknown. Adams-Oliver syndrome can have different inheritance patterns. Adams-Oliver syndrome is an extremely rare inherited disorder . Objective The long term prognosis of Adams Oliver Syndrome is not described adequately due to the limited number of cases reported worldwide and limited extended follow-up of affected individuals. Methods Authors described a girl with moderate Adams-Oliver syndrome whose brother was also mildly affected. Their mother had hypoplastic forth and fifth toes, thought to represent very mild expression of the syndrome. The clinical diagnosis of Adams-Oliver Syndrome is made based on 2 major criteria. Results Adams-Oliver syndrome is diagnosed by the presence of features typically associated with the syndrome. In both infants, twins with Adams-Oliver syndrome, congenital scalp defects are present at birth and it include multiple hairless scarred areas. Both infants with Adams-Oliver syndrome also exhibit malformations of the toes and feet. Girl has an associated heart defect that is present at birth as a congenital heart defect such as ventricular septal defects, but boy has no change of heart. Conclusions Adams-Oliver syndrome can have different inheritance patterns. Treatment is symptomatic and is largely dependent on the severity of the symptoms of the syndrome.The risk for two carrier parents to both pass the defective gene and have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy.

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Improving Breastfeeding in Saudi Arabia: The Baby Friendly Hospital Initiative Cynthia Mosher, Abdullah Sarkar, Alaa AbouBakr, Reem Hamadah, Asma Alhoulan, Yosra AlMakadma, Tehreem Khan, Abdurahman Al-Hamdani, Abiola Senok Alfaisal University, Saudi Arabia Background The Baby Friendly Hospital Initiative (BFHI), is a global effort aimed at promoting and supporting breastfeeding. This study aimed to examine the implementation of the BFHI program in Saudi Arabia and assess its efficacy in increasing duration of exclusive breastfeeding. Methodology This prospective, longitudinal study was carried out between December 2013 and September 2015 at a two healthcare facilities (BFHI and a non-BFHI) in Riyadh, Saudi Arabia. Randomly selected women at 36-40 weeks gestation receiving antenatal care at the hospitals were enrolled. Questionnaires were administered prenatally, one, three and six month postnatal to collect data on demographics, infant feeding, education and support. A separate questionnaire was administered to staff to assess maternity staff practices. Results Breastfeeding education and encouragement was higher at the BFHI-practicing hospital (93.3%) compared to the non-BFHI hospital (48.2%); p Conclusion This is the first known study to assess the effectiveness of BFHI implementation in Saudi Arabia. While BFHI implementation is demonstrating a degree of success, there are weaknesses that can be improved through strict compliance with BFHI practices.

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Severe Congenital Enzymatic Defects of Pyruvate Kinase Deficiency in Newborns Adnan Bajraktarevic1, Alisa Abduzaimovic2, Dragica Abduzaimovic2, Adela Tunjic3, Ismet Suljevic4, Velma Selmanovic5 1 Public Health Institution of Health Center Sarajevo, Bosnia and Herzegovina 2 Biochemistry Laboratory Tesanj, Bosnia and Herzegovina 3 Pediatrics Clinic Sarajevo, Bosnia and Herzegovina 4 Clinical Medical Center Sarajevo, Bosnia and Herzegovina 5 Genetic Institution of Canton Sarajevo, Bosnia and Herzegovina Introduction Pyruvate kinase deficiency is inherited in an autosomal-recessive manner. The gene is located on chromosome 1 (1q21) in the most cases. Treatment is usually effective in reducing the severity of the symptoms. Persons with severe disease usually have onset in the neonatal period or infancy. Objective Pyruvate kinase deficiency is the second most common cause of enzyme-deficient hemolytic anemia, following G6PD deficiency. Methods Authors described three case in newborns durig six years of period 2010-2015. A diagnosis of pyruvate kinase deficiency is favored based on a negative Coombs test result, blood group setups, and a peripheral blood film examination that demonstrates no spherocytes but reveals contracted, shrunken, spiculated red cells of the pyruvate kinase deficiency. The minimal tests required to guide the investigation of pyruvate kinase deficiency include the following:complete blood count , differential blood count, reticulocyte count, serum bilirubin level study and peripheral blood film examination. A precise diagnosis of pyruvate kinase deficiency depends on the detection of the deficient enzyme. Enzyme assays, as well as deoxyribonucleic acid DNA analysis with a polymerase chain reaction PCR assay. Results Morbidity and mortality correlate with disease severity and usually depend on complications. Complications without therapy associated with pyruvate kinase deficiency include the following: jaundince, sudden worsening of anemia associated with viral infections and heart failure. The hematocrit valueof three cases in pyruvate kinase deficiency ranges from 19-27. Erythrocytes were usually normochromic and normocytic. High reticulocyte counts may raise the mean cell volume, giving the impression that the anemia is macrocytic. The reticulocyte count in pyruvate kinase deficiency were increasing number by 8-10%. Two children die during infancy, but only one newborn had survived until 2016. Conclusions Morbidity and mortality correlate with disease severity and usually depend on complications. Splenectomy is indicated only for patients with severe anemia but onlz for older ages. Severe disease is usually treated with blood transfusions. Severe forms of the disease are mostly symptomatic during early newborn period and often hidrops fetalis.

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Four Cases Ivemark Syndrome During Last Fifteen Years with Heart Failure in Neonate Adnan Bajraktarevic1, Alisa Abduzaimovic2, Zijo Begic3, Velma Selmanovic4 Public Health Institution of Health Center Sarajevo, Bosnia and Herzegovina 2 Biochemistry Laboratory Tesanj, Bosnia and Herzegovina 3 Pediatrics Clinic Sarajevo, Bosnia and Herzegovina 4 Genetic Institution of Canton Sarajevo, Bosnia and Herzegovina

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Background Asplenia with heart failure, also known as Ivemark syndrome and right atrial isomerism. These uncommon congenital disorders are characterized by defects in the heart, spleen and paired organs such as the lungs and kidneys. Situs inversus is the mirror image of situs solitus in toto. Objective Infants with Ivemark syndrome often have several heart defects that are present at birth as congenital heart defects due to the failure of normal right-left asymmetry. Methods During the last fifteen years from 2001 to 2015, the authors have described seven cases of situs inversus in newborns. Of these seven infants had four heart defects. In addition to echocardiography in the neonatal period after birth, authors have used fetal echocardiography in pregnant mothers. These are Ivermark findings ultrasound were confirmed by CT scan or MRI scan. Results Heart defects with inversion organs in children were in 4 (57.1%) newborns. From 4 children one died (25%) in the first 30 days of life and another, within one year of age (25%). So far, two (50%) survived three or more years. Both children after cardiac operation successfully, one child once a second child twice, both in the newborn period. Conclusions Newborns who have asplenia as part of heterotaxy syndromes, often have increased mortality and morbidity related to extrasplenic abnormalities in neonatal period. Right isomerism is usually associated with asplenia, Ivermark syndrome with heart failure. The right and left sides of the heart are different and have different functions.

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Evaluation of Efficacy and Safety of Home Phototherapy Unit for the Management of Neonatal Jaundice in the Hospital Setting Ashwani Bhatia, Ashwani Bhatia, Pratibha Agarwal, Victor Samuel Rajadurai KK Women's and Children's Hospital, Singapore introduction: A prospective randomized case-controlled study in the hospital setting was conducted to evaluate the feasibility, efficacy and safety of the home phototherapy unit [PEP Bed] before the same can be recommended for home use. Methods: Term and late preterm neonates [35 weeks or more], weighing 2000 grams to 4000 grams at birth with onset of jaundice between day 2 to day 7 of life and needing single blue phototherapy as per our hospital protocol [Clinical Pathway for Neonatal Jaundice] were randomized for conventional phototherapy and home phototherapy during the period of November 2011 to April 2012. Results: Thirty-eight (38) neonates received conventional phototherapy in the control group and thirty-three (35) neonates received PEPBed phototherapy in the study group. Babies in both the groups were comparable with respect to their mean birth weights, mean gestational age, mean maternal age, ethnicity, mode of delivery and feeding pattern. Mean age and mean serum bilirubin level at the start of phototherapy as well as bilirubin at the end of phototherapy were comparable in both the groups The rate of decline in serum bilirubin was slightly higher in the PEP Bed group [3.04 µmoles/L/hour] as compared to the decline in control group [2.74 µmoles/L/hour], but this was statistically insignificant [P value - 0.226]. Similarly the duration of phototherapy was slightly shorter in the PEP Bed group [30.5 hours (± 9.14)] as compared to the duration in the control group [34.05 (± 10.99) hours] but this too was statistically insignificant [P value- 0.147]. Conclusion Phototherapy given by PEPBed devise is feasible, safe and effective and can be recommended as an option of home phototherapy in a selected group of jaundiced neonates.

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Adverse Events Related to Ibuprofen Treatment of Patent Ductus Arteriosus in Premature Neonates Daouda Ndour1, Hocine Bouamari1, Frank Plaisant1, Julien BERTHILLER2, Olivier Claris1, Kim An NGUYEN1 1 Hospices civils de Lyon/Lyon 1 University/Femme Mere Enfant Hospital, France 2 Hospices civils de Lyon/Lyon 1 University/Femme Mere Enfant Hospital, France Objective to describe gastrointestinal perforation and other adverse drug events (ADE) associated with ibuprofen use to treat patent ductus arteriosus (PDA) in premature neonates Method We retrospectively evaluated electronic patient medical record from all neonates treated with ibuprofen for PDA during 5 years in a French neonatal intensive care unit (NICU). Full chart review and targeted triggers were used to detect ADE. Categorical variables were compared using Chi 2 test or exact Fisher test. Quantitative variables were compared using Student t test. Logistic regression was conducted using a univariate model, and with a multivariate model to explore the risk factors associated with ADE. Result Of 227 neonates included with a mean gestational age (GA) of 27 weeks (24-33), 12 (5%) have presented intestinal perforation and 7 necrotizing enterocolitis (3%). The time between the last administration of ibuprofen and the occurrence of perforation varied between 0 and 6 days. The perforation occurred more frequently in less than 27 weeks GA and under 1000g of birth weight; OR 0.14; IC 95% 0.03 - 0.66, p = 0.01 and 0.68 (0.18 - 2.58), p = 0.57 respectively. Other observed ADE were acute renal failure (25 infants, 11%), thrombocytopenia (5 infants, 2%) Conclusion Ibuprofen is the molecule of choice for the treatment of premature ductus arteriosus but it is also associated with ADE including gastrointestinal perforations that occur in the smaller and less mature infants.

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The Effect of Umbilical Cord Milking On Hemodynamic Status of Preterm Infants: A Randomized Controlled Trial Walid El-Naggar1, David Simpson1, Arif Hussain1, Anthony Armson2, Linda Dodds1, Andrew Warrren1, Robin Whyte1, Douglas McMillan1 1 Dalhousie University, Canada 2 Dalhousie University, Canada Background Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the alternative, cord milking, have not been fully evaluated. Objective To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as compared with immediate cord clamping (ICC). Method Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks’ gestation were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth. The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC) flow. Neonatal care staff, echocardiographer and interpreter were blind to the randomization. Analysis was by intention to treat. Results A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November 2011-2014). There were no statistically significant differences in maternal demographic and antenatal variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g. 38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC flow, cardiac outputs or neonatal morbidities [table1].

Conclusions There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity between preterm infants who received CM and those who received ICC. More research is needed before routine cord milking can be recommended for very preterm infants. 16

Analgesic and Sedative Drug Use in Post-Surgery in a French NICU Claire Adela Benhamed1, Frank Plaisant1, Benjamin Riche2, Muriel Rabilloud2, Olivier Claris1, Kim An NGUYEN1 1 Hospices civils de Lyon/Femme Mère Enfant Hospital/Lyon 1 University, France 2 Hospices civils de Lyon/Lyon 1 University/CNRS-UMR 5558, France Objective This study aimed to describe the pattern of analgesic and sedative drugs use and the adverse drug reactions in a neonatal intensive care unit (NICU) Method Demographic characteristics, prescriptions, and pain scores were recorded and analyzed for 168 infants after their surgery, included consecutively between January 2012 and June 2013 in a NICU Results There was no acute and prolonged pain assessment in 21% and 36% of infants respectively on the first day. The weekly average scores post-surgery were 2/15 for EDIN (prolonged pain scale) and 1.6/10 for DAN (acute pain scale). The rates of pain control were 88% for EDIN and 72% for DAN. The most prescribed opiate drug was fentanyl (98 patients; 58%) with an average dose of 1.8 mcg/kg/hour. Midazolam was used in 95 patients (56%), with an average dose of 35 mcg/kg/hour. Bolus represented 7% of the total dose for both drugs. The same doses were used in term and preterm neonates. Of 118 patients receiving fentanyl and/or midazolam, 40% presented an urinary retention, 24% a weaning syndrome requiring a treatment by morphine per os. Paracetamol (in 155 patients, 92%) and nalbuphine (in 55 patients, 33%) were the other medications most prescribed. Conclusion The off-label use of fentanyl and midazolam was necessary to treat pain after surgery in NICU. The assessment of pain should be done for all neonates to optimize their treatment. Further research on analgesic and sedative medicine in the vulnerable neonate would be necessary to harmonize practices and reduce adverse drug reactions

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Assessment of Endotracheal Tube Position After Oral Intubation in the Neonate Sahin Takci, Seyma Unuvar, Deniz Anuk-Ince Gaziosmanpasa University School of Medicine, Turkey Introduction The correct position of the endotracheal tube (ETT) tip is midtracheal region. Previously Tochen described and American Academy of Pediatrics recommends the 7-8-9 rule to determine the depth of ETT insertion. Although this rule is widely used in neonatal practice, accumulating data regarding its accuracy are lacking in the literature. The aim of this study is to determine the accuracy of this method in our neonatal cohort and to determine the factors related to malposition. Methods The data of infants’ requiring oral intubation were recruited retrospectively from March 2013 to December 2014. The initial ETT depth of insertion was calculated using actual weight in the 7-8-9 rule. Additional corrections were also performed after auscultation. Midtracheal position was defined as the point halfway between the inferior clavicle and carina on a chest radiograph. The initial depth was compared to the ideal depth (midtracheal region). The distance of the initial and ideal depth was calculated and divided to the midtracheal distance. The ideal proportion was zero according to this calculation. Demographic variables, intubation time, intubation place were noted. Results 160 neonates were enrolled the study. Mean gestational age was 32.2±4.4 weeks and weight was 1989±829 grams. The ETT tip was lower than the ideal depth in 51 (31.9%) infants and it was higher in 109 (68.1) infants. The mean proportion of the difference between the initial depth and ideal depth and midtracheal distance was 0.39 ± 0.17, 0.35 ± 0.30, 0.46 ± 0.38 and 0.23 ± 0.19 in infants weighing 1000 grams and less, 1001 to 2000 grams, 2001 to 3000 grams and 3001 to 4000 grams respectively (p0.05). The difference between 2001-3000 grams and 3001-4000 grams group was statistically significant. Conclusion Infants weighting 3001 to 4000 grams were more accurately intubated than infants were 2001 to 3000 grams.

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Late Neonatal Sepsis Cases in an Third Level Neonatal Intensive Care Unit Sahin Takci1, Buket Seyyah Altuntas1, Ergul Sonmezgoz1, Ali Gul1, Deniz Anuk-Ince2 1 Gaziosmanpasa University School of Medicine, Turkey 2 Baskent University School of Medicine, Turkey Introduction Neonatal sepsis is an important cause of neonatal morbidity and mortality. Efforts to reduce infections involve active infection control measures, conducting surveillance analysis and knowledge of the prevailing flora responsible for sepsis in each unit. In the present analysis short term outcome of the infants with late onset sepsis were evaluated. Methods Late onset sepsis cases were retrospectively evaluated in the third level neonatal intensive care unit. The C-reactive protein (CRP), immature/total neutrophil ratio in the peripheral blood smear, absolute neutrophil count, other hematologic parameters including platelet count, mean platelet volume and conjugated bilirubin levels were analysed on the time of the sepsis diagnosed. Results Seventy six (6.3%) of 1210 infants in NICU diagnosed with late onset sepsis between December 2014 to January 2016. Mean gestational age and birth weight were 33.2 ± 4.8 weeks and 2044 ± 1031grams. Eight (10.5%) infants were died during NICU follow up. Gram negative microorganisms were responsible for sepsis in 29 infants where as 46 infants were gram positive. The most common microorganism is coagulase negative staphylococcus, and then Klebsiella spp, Staphylococcus aureus followed. Although the results did not reach statistically significant level; CRP, I/T ratio, conjugated bilirubin levels tented to be higher, platelet levels were lower in gram negative microorganism in comparison with gram positives. Mortality rate was 17.9% in gram negative microorganisms and 6.4% in gram positive microorganisms (p0.05) Conclusion Knowledge of the prevailing microorganisms responsible for sepsis in each NICU and monitoring the flora changes seen in time is important for optimal management of late onset sepsis.

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Transcutaneous Bilirubin Nomogram Representative of Israeli Population Predicts Hyperbilirubinemia Ruben Bromiker1,2, Avi Goldberg2, Michael Kaplan1,2 1 Shaare Zedek Medical Center, Israel 2 Hebrew University, Israel Background Ethnic differences in neonatal hyperbilirubinemia incidence suggest it may be prudent for different population groups to construct specific transcutaneous bilirubin (TcB) nomograms. Objective We constructed a TcB nomogram representative of the Israeli population and studied the risk of hyperbilirubinemia per percentile category. Design/Methods Newborns 36 wk gestation were tested daily for TcB , using Drager JM-103 devices, during birth hospitalization. TcB readings were analyzed for percentiles in 6 hourly epochs and divided into 4 risk groups akin to the Bhutani et al bilirubin nomogram. Each infant was assigned to a risk group according to that infant`s highest TcB. The risk of hyperbilirubinemia, defined as receiving phototherapy according to AAP (2004) guidelines, was calculated for each risk group relative to that 40th percentile, and further refined with ROC analysis. Results 3303 measurements on 1059 consecutive newborns contributed to the nomogram. Subgroups comprised Ashkenazi Jews (46.4%), Sephardic Jews (27%), mixed Ashkenazi/Sephardic (17%), Arab (8.2%) and Ethiopian Jewish (1.4%). Risk of phototherapy increased progressively with risk grouping (Table). The area under the ROC curve using the various risk groupings as predictive cutoffs was 0.85%,(95% confidence interval 0.83 to 0.87, p0.0001). The optimal risk for discriminating the need for phototherapy was 41-75th percentile group,(sensitivity 93.33, specificity 59.47). Conclusions In a TcB nomogram representative of the Israeli population, the risk of phototherapy increased progressively with increasing percentile group. Newborns in the 76-95thth, and especially 95th percentile groups, are at high risk for phototherapy and should be closely monitored.

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Do We Need an Intubation-Skilled Person in all High risk deliveries? Ali Almudeer, Walid Elnaggar, Douglas Macmillan, O O'Connell Dalhousie University, Canada

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Beyond the Hospital Setting: The Longer-Term Impact on Parents of Infants Born Prematurely Gary Heard, Gary Heard Whitley College University of Divinity, Australia The lifetime care of premature babies beyond discharge from the hospital rests with the parents. In an original exploration of the experience of parents in the wake of their child’s extremely premature birth, using grounded theory analysis of interactions between parents of premature infants on a support network over a seven year period, potential long-term impacts of premature birth on the parents are identified which are not reflected in any other literature. The potential for the experience to be intense and profoundly disruptive for many parents is articulated in four major areas where there is potentially a long-term impact on the parent(s) which impact their capacity as parents and the resources available to them. This research reveals potential for parents to be impacted beyond the time of discharge from hospital in: 

Social relationships, and therefore social support



Emotional capacities,



Understanding of their own identity, and



Relationship with their child.

Concern for parent wellbeing is underlined when considered in light of the prevailing body of evidence which demonstrates that the outcomes for extremely premature children are lower than their term counterparts on almost every measure. To parent a child born at the extreme end of prematurity is to assume responsibility for a child who, on the weight of evidence, is likely to need greater support and care across a broad range of spectra, for a period far in excess of the time spent within the NICU. Understanding the longer-term impact on parents of a child born at the extreme ends of prematurity is a first step towards shaping the care for parents in the NICU such that the transitions back to home are less disruptive in the parental journey and in preparation for life in the home.  Bio: Gary Heard completed his PhD research on the impact of parents who have extremely premature infants, and is currently Academic Dean at Whitley College in the University of Divinity. He also serves as locum chaplain at Melbourne’s Royal Children’s Hospital.

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Should RSV Prophylaxis Indications Be Narrowed? A Single Tertiary Center Experience in Israel Itai G ross1, Yael Weintraub1, Abu Ahmad Wiessam1,2, Sinan Abu-Leil3, Benjamin Bar-Oz3, Smadar Eventov-Friedman3 1 Hadassah and and Hebrew University Medical Center Ein Kerem, Israel 2 2Hadassah School of Public Health and Community Medicine University. Hebrew University, Israel 3 Hadassah and Hebrew University Medical Centers, Israel Background The updated guidelines for palivizumab prophylaxis for the prevention of RSV hospitalization published in 2014 by the AAP have narrowed dramatically the indications for treatment. In Israel, of ~16,000 annual preterm deliveries, about 2/3 of infants are born at late prematurity, 340/7 to 366/7 weeks. Since 2014 the national recommendations for RSV prophylaxis include all infants born up to 346/7 weeks` gestation. Objective To identify the prevalence and severity of RSV infection among preterm infants (PI) born up to 34 0/7 weeks` gestation compared with late preterm infants (LPTI) and term infants (TI). Methods: Data of all children aged 0-14 years hospitalized with PCR positive RSV in a single tertiary center from 2010 and 2014 were collected. 793 children were included: 637 TI, 105 LPTI and 50 PI. The incidence of hospitalization due to RSV infection, was compared between the 3 groups as well as the clinical course, including intensive care unit (ICU) hospitalization, length of hospitalization and co-infection with other respiratory viruses. Results: Hospitalization rate due to RSV infection was 5.2%, 3.5% and 1.3% among PI, LPTI and TI, respectively. Hospitalization in ICU was 24%, 7.6%, 3% among PI, LPTI and TI, respectively (P0.05). Length of hospitalization was almost 3 times higher among PI - 12.3% compared to TI – 4.4% and was significantly higher than LPTI – 5.7% (P 0.05). Gender, co-infection with other respiratory viruses and age at hospitalization due to RSV infection was not significantly different. Conclusion RSV infection is still a major cause of morbidity among children born prematurely including LPTI, even after RSV prophylaxis. Our results do not support the current AAP guidelines. Further local studies are needed to optimize the prophylaxis approach for both PI and LPTI.

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Saliva versus Urine Selective Screening to Diagnose Congenital Cytomegalovirus Infection in a Targeted Neonatal Population Smadar Eventov-Friedman, Sinan Abu-Leil, Orit Caplan, Aliza Lifshitz, Dana Wolf, Benjamin Bar-Oz Hadassah and Hebrew University Medical Centers, Israel Background Urine is traditionally considered as the gold-standard sample for the detection of congenital cytomegalovirus (CMV) infection. Although universal neonatal screening has been suggested as means for timely identification and treatment, overall, this approach has not been practically implemented, partially due to the difficulties in obtaining fresh urine samples from newborns. Recently, the clinical utility of saliva real time (RT)-PCR has been suggested in universal screening studies. Objective To determine the efficiency of saliva RT-PCR versus urine culture in the targeted screening of neonates at risk for having congenital CMV infection and validate an efficient screening algorithm. Methods Between 01/2014 and 06/2015, 633 pairs of urine and saliva samples, obtained within the first 10 days of life from clinically-suspected neonates, were prospectively examined for CMV infection by RT-PCR in saliva and urine culture. Discordant results were further examined by urine RT-PCR. Included were neonates with suspected maternal infection during pregnancy, intra uterine growth restriction, thrombocytopenia, and failure in neonatal hearing screening. Results: Of 633 urine-saliva pairs examined, 51(8.1%, 95%CI±2.1%, 5.6%-10.2%) were positive by saliva RT-PCR and 26 (4.1%, 95%CI±1.5%, 2.6%-5.6%) were positive by urine culture. The calculated measures for saliva efficiency in the studied population were: sensitivity, 96.2% (25/26), specificity, 95.7% (581/607), positive predictive value (PPV), 49.0% (25/51), and negative predictive value (NPV) 99.8% (581/582). Conclusions Saliva RT-PCR assay is a highly sensitive and feasible method for targeted screening of clinically-suspected neonates. A diagnostic algorithm based on initial saliva RT-PCR screening with subsequent confirmation of positive results by urine testing was consequently instituted.

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Quality Improvement Intervention with Bubble CPAP Improves Respiratory Outcomes in Preterm Infants Beatrice Stefanescu1, Christa Sala2, Andrei Stefanescu3 1 University of New Mexico, USA 2 Vanderbilt University, USA 3 Harvard University, USA Background Very low birthweight (VLBW) infants are at high risk for respiratory failure after birth. Bubble nasal continuous positive airway pressure (BNCPAP) with selective surfactant administration has been shown to be a safe alternative to traditional therapies including routine intubation, surfactant delivery, and mechanical ventilation. Objective To determine the impact on respiratory outcomes one year after introduction of a standardized BNCPAP protocol in VLBW infants. Design/Methods Non-standardized respiratory management for VLBW infants, born between 26-30 weeks gestation, was replaced in October 2014 by a three-pronged respiratory bundle that included: 1) administration of BNCPAP with first breath to support functional residual capacity in the delivery room, 2) strict guidelines for surfactant administration, 3) continued BNCAP until 32 weeks postmenstrual age. Outcomes examined were the proportion of infants receiving mechanical ventilation, days on mechanical ventilation, proportion of infants with chronic lung disease (CLD), and the proportion of infants with oxygen dependency at discharge. Outcomes were compared to all VLBW infants born in the year prior to implementation. Group differences in outcomes were assessed using chi square, student’s t and log rank tests. Results There were 84 patients in the control group and 98 in the BNCPAP group. Compared to controls, infants in the BNCPAP group were less likely to be intubated during hospitalization (77 vs 28% p0.01). BNCPAP group infants who received ventilation spent less time on mechanical ventilation than those in the control group (median 0 vs 3 days; log rank test p 0.001). A significantly smaller proportion of infants had CLD with intervention (43 vs 18%, p0.01) and dependency on supplemental oxygen at discharge (16 vs 30%, p=0.0.03). Conclusion Supporting VLBW infants with BNCPAP from first breath to 32 weeks PMA was associated with important benefits including decreased rates of early intubation, reduced time on mechanical ventilation, and decreased rates of BPD.

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Role of Formula Feeds/Intravenous Fluids in Reducing Non Asphyxial Acute Renal Failure Rates During Summer Months - Prospective Interventional Study sandeep harshangi, basavaraj patil M R Medical college, India Objective To evaluate the role of breast feeding & formula feeds/intravenous fluids in decreasing the incidence of non asphyxial acute renal failure(ARF) during summer months (April, May 2014). Methods Initial study was done to know the non asphyxial ARF rates during summer months of 2013 in our nursery. The intervention done was (done in 2014 summer) - Intravenous fluids/formula feeds along with exclusive breast feeding was given to all nursery babies during the 1st 3days of life. ARF was defined as blood urea nitrogen (BUN) 20mg/dl or creatinine level more than 1.5mg/dl for at least 24-48 hours along with urine output 1ml/Kg/hr. Discussion This is an interventional study done to show the decrease in incidence of ARF in our hospital in the peak summer months of April and May 2013 and 2014. The Incidence of ARF in nursery attached to Basaveshwara and Sangameshwar Hospital in Gulbarga was 14.5%, which is higher than the national standards of 1-8%1-5. But this has decreased in the year 2014 with incidence being only 5.8%. The mean ambient ward temperature was 40-42οC during the study months of both the years. Conclusion Our study shows that environmental factors play an important role in neonatal wellbeing and early interventions and prompt addressal of feeding issues leads to reduction in non asphyxial acute renal failure rates and thus improving outcomes. The intervention need to be region specific due to environmental factors and demography as shown in our study and there is a need for policy change to be brought in to address these issues.

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Perfusion Index as a Screening Tool for Patent Ductus Arteriosus Itamar Nitzan1, Cathy Hamerman1, Daniel Fink2, Meir Nitzan3, Robert Koppell4, Ruben Bromiker1 1 Shaare Zedek Medical Center, Israel 2 Shaare Zedek Medical Center, Israel 3 jerusalem college of technology, Israel 4 cohen medical center long island, USA Background Hemodynamically Significant Patent Ductus Arteriosus (HSPDA) is of clinical interest in preterm neonates. Perfusion Index (PI) is the percent of the change in the amount of light that passes through the tissue between systole and diastole as measured by photoplethysmography. PI reflects peripheral perfusion and, may be a screening tool for HSPDA. Methods Preductal and postductal PI were measured in preterm neonates (GA 24-34 weeks) who had echocardiography performed to assess ductal status . Ductal status was defined as HSPDA (including: hemodynamically significant and borderline hemodynamically significant) or closed. Results 19 neonates with HSPDA and 22 with closed ducts were assessed. There were no differences in GA, BW or day of life (DOL) between the groups PI was higher in neonates with HSPDA. When divided into subgroups by postnatal age, this difference is significant only after DOL 8 . [Table1]. In neonates after 8 days of life a cutoff of 1.7 postductal PI will have 77% sensitivity and 95% specificity in predicting hemodynamic significance. A cutoff of 1.34 will have 92% sensitivity and 68% specificity (by ROC curve analysis). Discussion PI is higher in neonates with HSPDA than in normal neonates, the difference is most significant after one week, when pulmonary resistance decline. Higher PI probably does not reflect better perfusion but rather lower diastolic blood volume due to retrograde diastolic flow, that affects both preductal and postductal arteries. Conclusion In neonates older than one week, PI can be a screening tool for HSPDA.

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Innovations in Mucus Extractor for Better Neonatal Resuscitation Outcomes Saurabh Vyas Country Newborn Consultant Ekam Foundation, India Chairperson INA WNC 2015, India National Faculty NEST NTS NHS Trust, UK National Faculty NNF DSC, India Abstract accepted EAP Congress and Master Course 2015, Norway Best Individual Category Award World Breast Feeding Week 2013, India National Faculty IAP AAP NRP, India National Faculty NNF FBNC Training, India Member NNF Accreditation Committee, India

Affiliations Chairperson INA WNC India 2015, National Faculty NEST NTS NHS Trust London , National Faculty NNF DSC , Abstract accepted EAP Congress and Master Course Oslo Norway 2015, Best Individual Category Award World Breast Feeding Week 2013 by BPNI, National Faculty IAP AAP NRP , National Faculty NNF FBNC Training , Member NNF Accreditation Committee . Background Mucus Extractor is very important for Neonatal Resuscitation. There are many cost effective innovative changes that can make it more effective and useful for better Neonatal Resuscitation outcomes. Objective Make Mucus Extractor user friendly with some Cost Effective Innovations in renaming and design for improved Neonatal Resuscitation Outcomes. Setting Mucus Extractor in Neonatal Resuscitation . Subjects and interventions Rename Mucus Extractor as Meconium Extractor. Make the Mucus Extractor base more solid and heavy. Make a limiting knob at 5cm and a mark at 5cm and 2cm with different bold color codes. Make arrows for direction of suctioning. Results Renaming it as Meconium Extractor in place of Mucus Extractor will limit routine suctioning. Sometimes during suction by a fresher, meconium is being aspirated in mouth due to horizontal position of Mucus Extractor increasing risk of HIV transmission. By giving a solid and heavy base to Mucus Extractor it will remain in vertical position at all times even if unsupported. Making a limiting knob at 5cm will restrict its depth of insertion. Mark at 5cm and 2cm with different bold color codes will make it more user friendly for the depth of insertion in mouth and nose. Arrows regarding direction of suctioning will make it helpful for beginners using Mucus Extractor. Conclusion All these cost effective innovative measures will make Mucus Extractor more user friendly and will lead to improved Neonatal Resuscitation outcomes. Keywords Mucus Extractor; Neonatal Resuscitation.

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Impact of Kangaroo Mother Care on Cerebral Blood Flow of Preterm Infants afaf korraa, Afaf Korraa, Ragaa AbdelSalam Al Azhar University Kangaroo mother care (KMC) has been used to improve the care of preterms . However, very little is known about cerebral hemodynamics responses in preterm infants during KMC intervention. The aim of this study is to evaluate the changes of cerebral blood flow in middle cerebral artery, before and after a 30 minute application of kangaroo mother care in stable preterm infants. Methods It is a prospective comparative study. Cerebral blood flow paremeters were measured with Doppler ultrasonography in one middle cerebral artery. Sixty preterm stable infants were assessed before and after 30 min KMC. CBF indices were assessed in different positions before KMC, forty neonates in supine position and 20 in vertical suspension (baby is held vertically away from the skin of his mother). Other dependent variables heart rate and mean arterial blood pressure and Spo2 were also studied before and after KMC. Results The mean gestational age of the infants was (32.95±2.23 weeks), and mean birth weight was (1600-2400 gm). Comparing CBF indices before and after KMC has shown a significant decrease in PI & RI after 30 min. KMC, the mean values were (2.0 ± 0.43 vs 1.68 ± 0.33 & 0.81 ± 0.05 vs 0.76 ± 0.06 respectively P  0.05*) with mean difference (0.32 & 95% CI 0.042-0.41 & 0.05 & 95% CI 0.04 to 0.06 respectively P  0.05*) and increase in end diastolic velocity & mean velocity 30min of KMC (10.97±4.63 vs. 15.39 ± 5.66 P  0.05*& 25.66 ± 10.74 vs. 32.86 ± 11.47 P  0.05* ) with mean difference (- 4.42 & 95% CI -5.67 to -3.18 and -7.21 & 95% CI - 9.41 to 5.00 respectively). These changes indicate improvement in cerebral blood flow. No correlation has been found between CBF parameters and studied vital signs or SpO2. Conclusion Kangaroo mother care improves cerebral blood flow, thus it might influence the structure and functioning to preterm infant`s brain. Key words kangaroo mother care, premature infants , cerebral blood flow

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Variation in Reporting of Neonatal Nutritional Research: Time for a Standardised Reporting Framework Frank Bloomfield1,5, Frank Bloomfield, Nick Embleton, Nick Embleton2, Hans van Goudoever3, Hans van Goudoever, Bill Hay, Bill Hay4, Barbara Cormack1,5, Barbara Cormack 1 University of Auckland, New Zealand 2 Newcastle Hospitals NHS Foundation Trust, UK 3 Emma Children’s Hospital/AMC, Netherlands 4 University of Colorado School of Medicine, USA 5 National Women's Health, Auckland City Hospital, New Zealand Background Nutrition in early life in preterm babies is a key determinant of optimal growth and long-term health. Despite much research, the optimum intakes of both energy and protein remain unknown, resulting in wide variation in nutritional management, intakes and growth internationally. Progress towards determining what these optimal intakes should be is hindered by the wide variation in how nutritional intakes and growth outcomes are reported amongst studies. Methods We searched MEDLINE and the Web of Science for randomised controlled trials or observational studies published between 2008-15 that compared ~ 3 vs. 4 g/Kg.d protein for preterm babies in the first month after birth, a relatively narrow scope of research in which consistency of reporting might be expected. Results 22 studies were reviewed. Twelve did not cite the breast-milk reference or figures used to calculate nutrient intakes. Eight specified composition figures but cited 8 different references and used figures ranging from 64 to 80 kcal and 0.8 to 2.4 g protein per 100 ml breast-milk. Growth Z-scores were reported in 15 studies using 15 different datasets. Seven of the fourteen studies that reported weight velocity did not report how this was calculated; three different methods were used in the remaining seven. There was also variation in statistical methods and reporting of other growth outcomes. Conclusions Standardisation in neonatal nutrition research is essential to improve the quality and usefulness of clinical trials and enable true meta-analysis of the results. We propose the StRONNG Checklist – Standardised Reporting Of Neonatal Nutrition and Growth – to improve the quality and usefulness of reporting neonatal nutritional studies and to facilitate meta-analysis.

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Somatic-Cerebral Oxygenation Ratio – Predictive Factor for Necrotizing Enterocolitis Andreea Avasiloaiei1, Elena Hanganu1, Mihaela Moscalu2, Maria Stamatin1 1 "Gr.T.Popa" University of Medicine and Pharmacy, Romania 2 "Gr.T.Popa" University of Medicine and Pharmacy, Romania Somatic and cerebral saturations are increasingly used in Neonatal Intensive Care Units for the monitoring of various conditions, including congenital heart disease, renal or intestinal conditions. Splanchnic saturation is used for impending necrotizing enterocolitis (NEC), but its’ fluctuations make it a difficult parameter to analyze. Recently, the Somatic-Cerebral Oxygenation Ratio (SCOR) has been monitored both in healthy term and preterm infants and in sick children as a more stable measurement of overall oxygenation. Material and methods We conducted a prospective study over 18 months (January 2014-June 2015) on 43 newborns, 20 preterm with abdominal distension or feeding intolerance and 23 term infants used as control group. We simultaneously measured cerebral and splanchnic saturations through near-infrared spectroscopy. We calculated the Receiver Operating characteristics Curve for all the parameters, in order to assess their value as predictive factors for NEC. Results The infants in our group had a mean gestational age of 35.5 (+/- 5.3 SD) weeks and a mean birth weight of 2500 (+/- 1121 SD) grams. Splanchnic saturations had values between 28% and 74% in infants with NEC and 54-88% in infants without NEC, with statistically significant differences between the two groups (p0.01). Cerebral saturations had values between 45% and 81% in infants with NEC and 62-95% in infants without NEC, also with significant differences (p0.01). SCOR had values of 0.35-1.27 when NEC was diagnosed and 0.61-1.16 when NEC was absent (p=0.002). The area under the curve (AUC) is 0.925 for the splanchnic saturation, 0.866 for the cerebral saturation and 0.81 for SCOR (p0.05). Conclusions SCOR is significantly different in infants with and without NEC. Its’ value as a predictive factor is lower than the value of splanchnic saturation, but SCOR can be preferred in the clinical settings due to its’ smaller variations.

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The Effect of an Exclusive Human Milk Diet (EHMD) on the Incidence of Necrotizing Enterocolitis (NEC) in the US: An Updated Epidemiological Evaluation Martin Lee1, David Rechtman2, Alan Lucas3 1 Prolacta Bioscience, USA 2 Prolacta Bioscience, USA 3 University College, London, UK Background Clinical trials investigating a exclusively human milk based diet (EHMD) in premature infants born at less than 1,250g birthweight have shown that this approach results in an about two-thirds lower incidence of NEC (medical and surgical. Consequently a number of hospitals in the US have instituted this protocol on a routine basis for these infants. The repeatability and persistence of this effect in routine practice remained an open question. Method Several NICUs collected and reported data on the incidence of NEC both pre and post the introduction of the EHMD. We reviewed and collated these results, and simultaneously investigated whether any reduction in NEC can be attributed to a general population decline rather than the nutritional intervention. Results In the previously published randomized controlled trials, overall NEC rates were reduced from 17.4% to 6%; surgical NEC was reduced from 12% to 1.2%. Seven independent pre/post cohort studies (N=2,194) have shown similar relative reductions. The weighted average of the percent reduction in overall NEC across these studies was ~73.3%. When the statistical significance of all of these studies is considered (based Fisher’s method), the likelihood of the overall results of these studies being due to chance is approximately 0.0001. An evaluation of NEC rates from the Vermont-Oxford Network database over the period 2008–2014 for infants born under 1,250g bodyweight N~264,000) indicated that overall NEC rates fell from 8.9% to 6.9%, about a 22% decline. However, across the shorter timeframe of the evaluated studies, this decline is closer to 15%. Conclusion The effect of an EHMD on the reduction in NEC rates far exceeds the overall decline in the incidence of this morbidity, and is overwhelmingly associated with that diet. Moreover, the widespread introduction of this diet may itself be responsible for part of this decline.

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Role of Urinary Tract Infection in Neonatal Pathological Unconjugated Hyperbilirubinemia Ajay Kumar1, Mohammed Uvaise S2, Mukta Mantan2, C P Baveja3 1 Maulana Azad Medical College, India 2 Maulana Azad Medical College, India 3 Maulana Azad Medical College, India Objective American Academy of Pediatrics recommends investigating for urinary tract infection (UTI) in neonates with conjugated hyperbilirubinemia, but UTI may be associated with unconjugated hyperbilirubinemia also. Study Design: Hospital based prospective cohort study. Setting: Referral Neonatal Unit of teaching hospital. Participants and Intervention: One hundred consecutive neonates with gestational age more than or equal to 35 weeks with indirect hyperbilirubinemia in the pathological range. Study subjects treated with phototherapy (and exchange transfusion) and neonates with UTI treated with antibiotics also. Outcome Measures Primary: Presence of UTI confirmed by positive urine culture. Secondary: i) Positive leukocyte esterase (LE) and nitrite reactions ii) Significant pyuria iii) Rate of fall of bilirubin in neonates treated for UTI. Results: Seven (7%) neonates had positive urine culture growth (UTI group) while remaining 93 babies constituted non UTI group. In the UTI group, urine dipstick analysis revealed a positive LE reaction in 6 neonates (85.7%) and 5 out of 7 (71.4%) babies had a positive Nitrite reaction. Significant pyuria was present in 4 of these 7 neonates (57.1%). The median (range) total serum bilirubin at enrollment in the Non UTI group was 20.70 (11-53) mg/dL and in the UTI group 23.20 (17-26) mg/dL (P=0.665). In Non UTI group, 25 neonates had Acute Bilirubin Encephalopathy and 23 neonates required double volume exchange transfusion for hyperbilirubinemia. The median (range) duration of phototherapy in the remaining seventy neonates in the Non UTI group was 39 (15-117) hours and in the UTI group it was 36 (21-100) hours (P=0.943) with a median (range) rate of fall of bilirubin of 0.17 (0.01-0.5) mg/dL/h and 0.27 (0.05-0.42) mg/dL/h respectively (P=0.172). Conclusion Treatment of UTI with antibiotics in neonates with pathological unconjugated hyperbilirubinemia results in decreased Acute Bilirubin Encephalopathy and lower requirement of exchange transfusion for jaundice treatment. Key Words: Conjugated, Culture, Jaundice, Urine

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A Randomized Controlled Trial of Comparying Minimally Invasive Surfactant Therapy (mist) with Intubation, Surfactant Administration and Extubation (insure) in Preterm Infants Harmesh Singh Dayanand Medical College and Hospital, India Background Many preterm babies with respiratory distress syndrome (RDS) due Therapeutic Hypothermia: Effect on respiratory condition in neonatesbeing managed on continuous positive airway pressure (CPAP) may require intubation for surfactant administration. Intubation may result in certain deleterious consequences in such babies. There is emerging evidence of new techniques of minimally invasive surfactant therapy using alternative devices to avoid intubation. Hence this study was carried out with following aims. Aims and objectives Primary objective: To compare the need for mechanical ventilation within 72 hours of therapy. Secondary objectives: To compare: 

Duration of CPAP therapy.



Duration of oxygen support



Duration of hospital stay

Methods Study sample: 56 neonates were initially enrolled as per eligibility Study design: Open label Randomized Controlled Trial Randomization: Randomization was done by computer generated random sequence number.One group received Minimally Invasive Surfactant Therapy (MIST) via 16G Angiocath (Desilet, Vygon) and the second group was given INSURE (Intubation, Surfactant delivery and Extubation).The data was analyzed by Stata corp 11.1, Fischer/Chi square test. Results There was no statistically significant difference in the need for mechanical ventilation within 72 hours of surfactant administration between the two groups. Duration of requirement of CPAP was significantly less in MIST group (p=0008).80 5 babies of INSURE group required oxygen for 7-28 days as compared to 24 5 in MIST group. (p=0.000).Hospital stay was significantly shorter (p=0.0004) in MIST group than in INSURE group.(more than 14 days in 325 and 76% respectively). Conclusions Minimally invasive surfactant therapy is feasible and has advantages as compared to INSURE therapy. Key Words. Surfactant therapy Preterm infants Minimal invasive INSURE technique

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Special Care Of Infants Conceived by In Vitro Fertilization Silvia Maria Stoicescu, Octaviana Cristea, Nuti Daniela Oprescu " Carol Davila” University of Medicine and Pharmacy, Romania Assisted reproduction technologies (ART) are used worldwide for infertility treatment associated with multiple pregnancies. Children conceived after ART procedure have a 7% rate of severe genetic defects such as: major birth defects. Key words

in vitro fertilization, multiple pregnancies, and prematurity, genetic defects

Objective Assessment of special neonatal care of infants conceived by in vitro fertilization -IVF ; identifying neonatal IVF pathology and associated costs. Material and method The retrospective study was performed over the period from the1st of January 2011 - 22nd of April 2016 on newborns conceived by in vitro fertilization within the Neonatology Department of “AlessandrescuRusescu” National Institute for Mother and Child Health, Bucharest , Romania. We analyzed the observation sheets of IVF infants admitted to NICU and the medical maternal investigations during the pregnancy. Results IVF pregnancies recorded a constant growth (1.28% in 2011 vs. 2.49% in 2016). Between January 1 st, ,2011 and April 22nd , 2016 there were recorded 326 newborns conceived by IVF. 62.2% were preterm infants and 37.7% at term. 60.12% of all IVF infants were born as part of a twin pair and 13.8% as part of higherorder multiple pregnancies . Admission to the NICU is required not only for the specific pathology of prematures but also for the genetic disease and imprinting disorders( Down syndrome, Silver –Russell), congenital malformations such as pulmonary hypoplasia, diaphragmatic hernia, agenesis of the corpus callosum. Conclusions Although these specific pregnancies are monitored, complications can occur at any time. IVF pregnancies generate newborns who often require special long-term care in NICU, which triggers high costs.

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INAC 2016 E-Poster

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Oral Zinc Supplementation in Neonatal Hyperbilirubinemia: A Meta-Analysis Background: Hyperbilirubinemia may cause bilirubin encephalopathy which adversely affects brain development. Zinc has been suggested to have a role in preventing hyperbilirubinemia and bilirubin encephalopathy. Objectives: To assess the effects of zinc in reducing the incidence and need for phototherapy in neonatal hyperbilirubinemia its adverse effects. Search methods: Medline, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Hand search in various search engines was done. Selection criteria: Randomized controlled trials of any zinc supplements given at least 10 mg/day, administered to newborns ≥35 weeks of gestation at risk of hyperbilirubinemia. The primary outcomes were the incidence of hyperbilirubinemia, proportion of newborns requiring phototherapy, and the duration of phototherapy. Secondary outcomes include the ratio needing exchange transfusion, incidence of bilirubin encephalopathy, length of hospital stay, number of deaths, and adverse effects observed. Data collection and analysis: Two review authors independently assessed eligibility and trial quality and extracted data. Statistical analysis was carried out using Review Manager 5.3 (RevMan). Main results: Four trials contributed data. All studies were high-quality trials with overall low risk of bias. Oral zinc supplementation has no significant effect in reducing the incidence of neonatal hyperbilirubinemia (RR 1.09; 95% CI 0.75-1.59). It did not show any significant benefit in reducing the phototherapy requirement in patients with jaundice (RR 1.02; 95% CI 0.70-1.48). The duration of phototherapy is significantly shorter in patients receiving zinc supplements (MD -16.69; 95% CI -25.09 to -8.30) but pooled data showed heterogeneity. Adverse events were not significantly different between zinc and placebo. These include diarrhea (RR 1.67; 95% CI 0.50-5.59), vomiting (RR 0.86; 95% CI 0.31-2.37), skin rashes (RR 1.22; 95% CI 0.31-4.90), and crying. Authors` Conclusions: Zinc administered to newborns ≥35 weeks of gestation has not been shown to decrease the incidence of hyperbilirubinemia nor the proportion of patients requiring phototherapy but may potentially shorten the duration of such intervention.

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Review of Premature Care at Monkole Hospital during the Last Ten Years (Kinshasa- D.R. Congo)

Gisèle Kazadi Tshiama, Gisèle Kazadi, Léon Tshilolo, Jordy Mafema Monkole Hospital, Congo, Democratic Republic of the Problematic: Preterm birth contributes greatly to aggravate neonatal mortality in our country. Aim and methodology: To determine the etiology, prognosis and management of preterm in our country, a retrospective study from January 2004 to August 2014 was initiated at Monkole Hospital. Results: A total of 5914 newborns were followed including 322 preterm infants, 57 of preterms were transferred. Factors influencing the occurrence of prematurity were dysgravidie (21%), the twins (19%), young maternal age (15%), infection (11%). The gestational age of preterm infants was less than 32 weeks in 38.3% and the average weight of all was 1760 grams. The clinic was marked by respiratory distress, metabolic syndrome, bleeding and infection. Of the 322 premature infants, 84 (25.4%) had died with a mortality rate higher 36 (63%) in the group transferred. Other prognostic factors were the Apgar score Conclusion: The authors discuss risk factors related to the local context and action to reduce morbidity and premature mortality.

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Factors Associated with Breast Milk Feeding of Very Preterm Infants from Birth to Six Month Corrected Age IRIS MORAG, Iris Morag, Ayala Maayan-Metzger, Tzipi Strauss The Edmond and Lily Safra Children Hospital ant Chaim Sheba Medical Center, Israel Objectives: To investigate factors that may affect breast milk feeding (BMF) practice among very preterm infants. Methods: Infants born before 32 weeks gestational age (GA) and monitored up to 6 months corrected age (CA) were included in this retrospective study. Feeding method was assessed at day of life 14, 36 weeks GA, 6 weeks after home discharge and 6 months CA. Multivariable logistic regression analysis was used to examine which factors were associated with BMF initiation at time point 1 and cessation at time points 2-4. Results: Out of 181 infants who qualified for the study, 146 (81%) initiated BMF, of them 80% exclusively. At time points 2-4, 130 (71.8%), 87 (48%) and 36 (19.9%) infants respectively continued BMF. Multivariate analysis revealed that initiation of BMF was more common with younger GA and higher level of maternal education. Discontinuation of BMF at six weeks post discharge was more common with failure to exclusively BMF at day 14. Cessation of BMF at 6 months CA was associated with birth at 28 weeks. Conclusion: Successful BMF can be commenced and maintained throughout hospitalization in the majority of very preterm infants. Despite a significant dropout that occurs within several weeks after discharge, mothers of infants of lower gestational age attempt greater efforts in providing BMF even after discharge. Exclusive BMF at day of life14 is associated with BMF continuation after discharge.

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Neonatal risks in Newborns from Assisted Reproductive Technology versus Natural conception.

Nadia Kasdallah1,2, Alaeddine Bouani2, Hakima Kbaier1,2, Hatem Ben Salem1,2, Ben Daamar Hamdi2, Dorra Falleh2, Sonia Blibech1,2, Mohamed Douagi1,2 1 Military Hospital of Tunis, Tunisia 2 University Tunis El Manar/Faculty of Medecine of Tunis, Tunisia Background and aims It is well known that assisted reproductive technology (ART) increase the risk of multiple births, but the debate about increased neonatal risks, especially birth defects in newborns is still a subject of debate. We aim to compare the neonatal outcome of newborns from ART with newborns naturally conceived. Methods It was a 15-years retrospective and descriptive study comparing neonatal outcome of 285 newborns from ART (ART group) and 221 newborns naturally conceived (Control group). Results In the ART group, rates of prematurity and low birth weight were respectively 64,9% and 68%. They were statistically significantly higher than control group (p0.05). The rate of birth defects was statistically significantly higher in ART group (13.6 %) then in Control group (5.4%), (p0.002). In ART group, birth defects were major in 69.3%, cardiac defects were noted in 46%. Birth defects were associated with ICSI in 48.7%. In ART and malformed newborns, birth defects were lethal in 20.5 % and associated with major handicap in 17.8%. Conclusions This study support the hypothesis of increased neonatal risks in newborns from ART in term of prematurity, low birth defect and birth defects comparatively with newborns naturally conceived. The relationship between birth defect and ART remain poorly understood. Further etiological studies are required to explain the exact mechanisms underlying these risks.

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Newborn from Assisted Reproductive Technology. A First Tunisian Study. Nadia Kasdallah, Hakima Kbaier, Hatem Ben Salem, Ines Trabelsi, Dorra Falleh, Sonia Blibech, Mohamed Douagi Military Hospital of Tunis, Tunisia Background: Assisted reproductive technology (ART) it raises a great debate about the potential risks of congenital malformations in newborn. Object: This study compare the risk of congenital malformations in infants conceived with ART and those naturally conceived. Methods: This is a retrospective descriptive and comparative case- report study, concerning 285 neonates born from ART. Control group included 221 spontaneous neonates. Results: Rate of prematurity and low birth weight in ART group were respectively 64,9% and 68%.The overall rate of birth defects in newborn from ART was 13.6 % versus 5.4% in controls: (OR= 2.76). It was mainly major defects (69.3 %). The majority of defects were noticed with ICSI. Multiple malformations, cardiac and orthopedic malformations were the most frequent. Isolated neurological abnormalities were observed in 2 newborns and one stillborn: complete agenesis of the corpus callosum, spina bifida. Two isolated gastrointestinal malformations were observed. The evolution was fatal for 11 newborns from ART. Death was directly attributable to the malformation in 8 newborns. A major handicap was noted in 5 among the 21 survivors malformed. Conclusion: The association between birth defects and ART reported in the literature has been confirmed by our results. Although the exact mechanisms underlying this relationship remain poorly understood.

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Left Hand Acheiria in 3 Newborns within a Period of 3 Months During the year 2011 in Fallujah General Hospital Samira Alaani1, Samira Alaani, Abdulkadir Abdulkareem Miri'e, Samira Alaani 1, Abdulkadir Abdulkareem Miri'e 26 Fallujah general hospital, Iraq We present 3 sporadic cases of congenital left hand Acheiria, a rare congenital defect, In one case (male), left hand Acheiria is associated with left radial hemimelia , in the other 2 cases (both are females) ,there is only congenital absence of left hand ( Acheiria) ,with completely normal left forearm & other 3 limbs. The absence of any contributory family or drug history and the normal chromosomal study in the 3 cases lead us to the belief that their occurrence may be linked to environmental contamination. To the best of our knowledge, there is dearth of information on these anomalies in the literatures, & their management remains achallenge. Keywords: Acheiria, Hemimelia, Fallujah General Hospital the literatures, & their management remains achallenge. Keywords: Acheiria, Hemimelia, Fallujah General Hospital

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Enhancing Neonatal Survivals: What can we do today? Subhashchandra Daga, Achla Daga, Sameer Mhatre, Vaishali Ghane Pacific Medical College &Hospital, India Background: Neonatal deaths account for 44% of the world’s under-5 child mortality. Over half of all neonatal deaths globally occur in preterm babies. Therefore; improving care of a preterm baby is particularly important to reduce under-five mortality. Aim: To spell out components of care of preterm/low birth weight babies at first level health facility and at first referral unit (FRU) in low resource settings. Methods: We have analysed weight-wise survivals at two hospitals attached to medical colleges; J.J. Hospital, Mumbai (JJ) and General Hospital, Talegaon (GH) and, at Rural Hospital, Dahanu (RH). There were three tiers of interventions: T1) warmth; feeding and antibiotics, when indicated, T2) improved care at birth and increased oxygen availability, T3) use of dopamine or its equivalent. JJ went through all these stages one-after-another; GH had T1; T2 &T3 in one go. The RH had T1&T2. Results: 50-55% VLBW babies survived at JJ by providing T1 during 1978-84. This percentage increased to 56-58%, when T2 was added (1984-89). For babies with birth weight 1500-2000 g, the moderately low birth weight category (MLBW), the corresponding figures were 56-58% and 84-86%. The same interventions led to statistically significant decline in MLBW (1500-2000 g) and VLBW categories at GH (2010-13). RH (198792) achieved better survival rates in VLBW (61.5%) and MLBW (92.5%) categories with identical interventions (TI&T2) and less staff. Conclusion: Based on our results, we suggest that in resource limited settings, the first level health facility may be able to give T1 to short-stay babies, that weigh more than 1500 g and, that have no respiratory distress. The FRU may be able to give T1&T2 to MLBW babies, with or without respiratory distress, and VLBW babies without respiratory distress.

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Enhancing Use of Donor Milk in Neonatal Intensive Care Unit: A Developing country perspective; an interventional study Subhashchandra Daga, Nilesh Naktode, Anushree Borhade, Savita Gavali MIMER Medical College, India Purpose This is an effort to overcome difficulties in collection; short term storage and administration of donor human milk with limited resources. Objective To replace 75% of formula feeds (FF) by donor human milk (DHM) feeds in first 3 days of life among neonates admitted to the Neonatal Intensive Care Unit (NICU). Methods This was a prospective interventional study conducted at NICU of the MIMER medical college, Talegaon Dabhade between December 2013 and August 2014. Participants were all the neonates (n=168) admitted during the study period. Expressed DHM was administered within 2-3 hours of manual expression without refrigeration or pasteurization. After expression, DHM was left standing in a covered stainless steel container at room temperature. Prospective entries of 2 hourly feeds were made in the feeding charts for first 3 days of life (36 entries). Main outcome measure was % replacement of FF. Results Of the total number of 6027 feeds charted, 4136 (68.6%) were human milk feeds and the rest, 1891(31.4%), were formula feeds. Thus, 68.6% FF were replaced by DHM. Conclusion A simple low cost method was effective in replacing a significant proportion of FF by DHM in the first three days of life for neonates.

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Evaluation of Developmental Status of Pemature Infants Aged 4 to 12 Months with History of Admission in NICU

Kambiz Keshavarz, Reza Abasi, Mohammad Zoladl, Atoosa Rezakhani, Arjang Rezakhani Yasuj University of Medical Sciences, Iran Backgrounds & aim: Screening and early diagnosis of developmental delay in high risk children are obligatory. Premature neonates with history of prolonged admission in neonate intensive care unit (NICU) are prone to more developmental disorders in comparison with normal population. ASQ or age scaled questionnaire is a simple method for early diagnosis of developmental delay in children. Methods: 80 infants aged 4,6, and 12 months with a history of prematurity and prolonged admission in NICU entered the study. ASQ including information in 5 main fields of development containing communication, fine and gross motor status, personal-social and problem solving were completed for them. After collecting the data, they underwent statistical analysis. Results: The average birth weight of the infants was 1734.37+/- 445.50 gram. 10% of them in the field of communication, 30% in gross motor,27.5 % in fine motor,23.8% in problem solving state and 23.8% in field of personal-social behavior had abnormal results. Sex, receiving surfactant, age of mother and breast feeding didn’t have any effect on this situation. Conclusion: A considerable number of premature infants with history of prolonged admission in NICU have at least delay in one filed of development. These findings suggest more attention and observation for these infants in order to detec at early stage of any developmental delay and start rehabilitation. Key words: ASQ, Developmental delay, premature infants

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Evaluation of Neonatal Sepsis Causative Agents and Empirical Antibiotic Susceptibilities used in Perinatology Division, Cipto Mangunkusumo National Hospital, Year 2011-2015 Charisha Nadia, R. Adhi Teguh Perma Iskandar Perinatology Division, Ciptomangunkusumo National Hospital, Indonesia Background: Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world.1,2 Daily use of empirical antibiotic in neonatal sepsis should be based on the locally previous blood culture and antibiotic sensitivity test results.2 Objective: To evaluate susceptibilities of empirical antibiotic used daily in Perinatology Division, Cipto Mangunkusumo National Hospital (RSCM) from the year 2011 to 2015 according to the most bacteria causing sepsis neonatal. Methods: Retrospective study using positive blood culture results and antibiotic sensitivity test data taken from Bacterial and Antibiotics Susceptibility Profile in Perinatology Division, RSCM, from 2011 until 2015. Results: There are 5065 blood cultures from infants with suspected neonatal sepsis since 2011-2015. Positive blood culture results fluctuate from year to year, with a range of 17.9% to 28.1%. From the blood cultures obtained since 2011 to 2015, gram-negative bacteria Acinetobacter baumannii is the leading cause of neonatal sepsis in the ward. The second most common cause is Gram-positive bacteria, Staphylococcus epidermidis. There are a decreased sensitivity to the first, second, and third line antibiotic to most bacterias causing neonatal sepsis from 2011 until 2015. In 2015, Acinetobacter baumannii and Staphylococcus epidermidis as the most common cause of neonatal sepsis in the ward, have a low sensitivity level (60%) for the first, second, and third line antibiotics. Conclusions: In general, daily empirical antibiotic therapy in perinatology ward has decreasing level of sensitivity to most bacteria that cause neonatal sepsis year by year. We need regular surveillance of the organism pattern and antibiotic sensitivity level as a basis for revised empirical neonatal sepsis therapy guidelines.

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Demographic and Clinical Profile of Congenital Anomalies in a Tertiary Government Hospital, a 1year Retrospective Study jenna angela rubio, Carlos Nunez, Jr. Ospital Ng Maynila Medical Center, Philippines Background: Multiple congenital anomalies belong to the top causes of neonatal death in South East Asia Region with an estimated 4% mortality rate. In the Philippines, birth defect has been on the top 10 cause of mortality. Objectives: This study aims to describe the clinico-demographic profile and to determine the proportion of all live births with congenital anomalies delivered from January to December of 2014. The anomalies were categorized by system; socio-demographic profile, maternal profile and neonatal profile was described, and the outcome was noted. Methodology: A descriptive retrospective study. All live births in a tertiary government hospital from January to December 2014 who were reported to have major structural and functional congenital anomalies were included. Medical records of all live births from January to December 2014 were retrieved and reviewed. Results: There were a total of 3,918 live births and 54 (1.38%) were noted to have at least 1 congenital anomaly. Majority had single anomaly and the top organ systems involved are genital organ, cleft lip and cleft palate and central nervous system. The most commonly encountered major anomaly was cleft lip and cleft palate, followed by neural tube defect as a group. More than half were male and more than two-thirds were born term, and majority of which survived. More than half of the total live births have normal birth weight and majority was appropriate for gestational age. Almost two-thirds of live births survived and were sent home. There were a total of 19 (35.1%) who expired. Conclusion: The proportion of birth defects in a tertiary government hospital in Manila, Philippines is 1.38%. However, the proportion rate obtained in this study may not reflect the true situation in the general population. Regular antenatal checkup and prenatal folic acid supplementation may help reduce the incidence of congenital anomalies.

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Safety and Efficacy of Ibuprofen in Preterms Maria Chona Badillo, Victor Samuel Rajadurai KK Womens and Children Hospital, Singapore Introduction: Indomethacin is the standard treatment in Patent Ductus Arteriosus (PDA). Ibuprofen is as effective as Indomethacin in PDA closure .There are limited studies with regards to safety and efficacy of oral and Intravenous Ibuprofen in Preterm Infants. Objective: This study was done to determine the safety and efficacy of Ibuprofen in treatment of PDA among preterms. Study Design: This is a retrospective cohort study conducted in KK Women’s and Children Hospital, Singapore Methodology: Included in the study were 138 very low birthweight infants born on March 1, 2010 to December 31, 2014 studied. Intravenous Ibuprofen was given to 107 subjects while 31 were given orally. The major outcomes were time to PDA closure and drug-related complications. Result: Sixteen preterms who were given oral Ibuprofen had constricted PDA and 14 infants had closed PDA. With IV Ibuprofen, 49 babies had constricted PDA and 55 babies had closed PDA. There was no statistical difference with regards to constriction and PDA closure compared to nil effect (p=0.9).The median time to constrict or close PDA is shorter in IV Ibuprofen (23 days) compared to oral (34 days) (log rank 0.01). Among the 24 preterm infants who underwent PDA ligation, 2 received oral Ibuprofen (6.4%) while 22 received IV routed (20.6%). There were no difference in the overall GI adverse effects, necrotizing enterocolitis and spontaneous intestinal perforation between the 2 groups. Conclusion: Both Intravenous and oral Ibuprofen are effective in treating PDA but the time to closure is faster with IV Ibuprofen. There was no difference in the occurrence of surgical NEC or SIP among the 2 groups.

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Management of Group B Streptococcus in Neonates at a Regional West Australian Hospital Elaine Sanderson Rockingham General Hospital, Australia Currently there is no clear consensus on the management of infants born to GBS positive mothers who did not receive antibiotics in a timely fashion in Western Australia. Most neonates seem to be given antibiotics regardless of clinical appearance with the risks including side effects and antibiotic resistance. There is a need to assess whether all neonates of untreated GBS positive mothers require antibiotics post-delivery or whether there is a role for careful observation.

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To Assess the Accuracy of Umbilical Cord Blood Gas In Determining Severity of Newborn Condition Bader Kordi, Noha Nemiri Hamad Hospital, Qatar Introduction: Umbilical cord blood gas and acid-base assessments are the most objective determinations of the fetal metabolic condition at the moment of birth.. We conducted this study to assess how accurate the umbilical cord gas parameters are in determining the outcome of the new born Methods: The cord gas data of all high-risk deliveries during 2013 in the Women‘s Hospital of Hamad Medical Corporation Qatar were collected. Maternal Data include parity, illness, nationality, together with the indication of cord gas sampling were gathered. Neonatal data includes gestational age weight combined with the Apgar score. The outcome of both the mother and new born was recorded. Results A total number of deliveries during the study period were 15,000 cases. Of these high-risk deliveries, cord sampling was carried out in 1042 cases. When combining all elements of cord gas done, the percentage of severe cases was 15.3% with 11% of these babies needs NICU admission. Babies with cord PH Conclusion The cord gas is significantly correlating more with the baby Apgar score at one minute rather than 5 minutes. The outcome is affected by the severity of the cord gas Keywords Cord gas, indication, and outcome

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Meconium Contaminated Amniotic Fluid Leading to Intestinal Wall thickness affects the Functional Outcome of Abdominal Wall Defects

Melanie Kapapa1, Tersa Rieg2, Doris Henne-Bruns1, Alexandre Serra1 1 University Hospital Ulm, Germany 2 Klinikum Heidenheim, Germany Intestines exposed to amniotic fluid lead to an inflammatory fibrotic layer with thickening of intestinal wall, falling motility and potentially leading to intestinal lumen obstruction. The optimal time of delivery in gastroschisis neonates is crucial to reduce direct exposure to amniotic fluid contaminated with meconium, which is evidenced by less problems in omphalocele newborns. Data regarding the color of amniotic fluid, surgical complications, ICU duration stay, and number of operations, clinical abnormalities, postsurgical complications and postoperative nutrition were collected from medical records and surgery reports. Data were compared to omphalocele patients and to standardized, agematched normal control population accepting a significance level of 95% (p0,05). Newborns with meconium contaminated amniotic fluid had significantly more often thickened bowel loops, resulting in less primary abdominal wall closures. More operations in these patients until complete closure were significantly more often required due to fibrin-covered bowels loops, necessity of gut resection or an ileostomy. Additionally, patients with fibrin-covered intestines required further surgical treatment significantly more often, because of intestinal obstruction. In short-time follow-up, ICU stay was significantly longer in these patients due to longer mechanical ventilation requierements, significantly extended parenteral nutrition and delayed oral nutrition begin. Notably, these results were independent of gestational age, but always associated to the color of amniotic fluid. The primary prognostic parameter of short-term outcome was the intensity of intestinal wall damage at the time of surgery. In gastroschisis meconium contaminated amniotic fluid was directly associated to fibrin covered bowels, leading to lower rate of primarily abdominal wall closures and poor postoperative outcome with longer periods of mechanical ventilation, delayed oral feeding and prolonged parenteral nutrition. We strongly recommend that the delivery be optimized by assessing the intestinal wall thickness with ultrasound and inducing labor upon the first signs of damage to the intestines, regardless of the gestational age.

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The Influence of Pregnancy and External Risk Factors on the Incidence of Abdominal Wall Defects Melanie Kapapa1, Teresa Rieg2, Doris Henne-Bruns3, Alexandre Serra1 1 University Hospital, Germany 2 Klinikum Heidenheim, Germany 3 University Hospital, Germany Background: We analysed retrospectively abdominal wall defect (AWD) patients over a 10-year period hypothesizing that external risk and pregnancy factors lead to increasing AWD. Methods: Data regarding pregnancy history, life-habits, proximity to waste or nuclear repositories or exposure to chemical/ physical agents. 41 families participated in this study; 63.6% gastroschisis (GS) and 36.3% omphalocele (OC). Data were compared to age-matched control population using the chi-square, the Kruskal-Wallis and the Fisher exact test accepting a confidence interval of 95% (p0,05). Statistics performed by using SigmaStat® (Systat Software Inc., CA). Results: Mothers of AWD children used significantly more medications. Gastroschisis mothers (GM) were significantly younger than Omphalocele mothers (OM) and 50% had changed their dietary habit. In GM mothers via ultrasound significantly more dilated bowel loops and increased number of amniotic fluid exchanges were detected. Conversely, the incidence of omphalocele increased significantly after hormonal treatment, in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), whose mothers took less folic acid prophylaxis. GS mothers significantly increased intake of dairy products and vegetables and they suffered more often from immune-associated diseases. Conclusions: We confirmed maternal age and lifestyle-associated risk factors like changes dietary habits for GS and increasing incidence of OC after prenatal hormonal treatment, IVF or ICSI.

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Metabolic Analysis of Preterm Birth in Nigeria Chinyere Ezeaka1, Scott Oltman2, Kelli Ryckman2, Nancy Weathers2, Bruce Bendell2, Osayame Ekhaguere3, Azeez Butali2 1 Lagos University Teaching Hospital, Nigeria 2 University of Iowa, USA 3 Children's Hospital of Philadelphia, USA Background Several studies suggest that biomarkers of amino acid and fatty acid metabolism are important in identifying pregnancies that end in preterm delivery. Few studies have examined these metabolites in developing countries where both nutritional deficits and preterm birth risk is high. Objective To identify distinct metabolic profiles for preterm and term births in Nigeria. Methods Anti-partum maternal blood samples from 5 Nigerian women who delivered prematurely (34-36 weeks) and 10 controls (≥37 weeks) were analyzed for 42 metabolites (9 amino acids, free carnitine, 29 acylcarnitines, citrate, succinylacetone, and acetylsalicylic acid) using tandem mass spectrometry. Principal Components Analysis (PCA) was used to elucidate the metabolic differences between preterm and term birth and then plotted on axes made up of the two principal components (PCs) explaining the largest proportions of variance. Results The barycenter of preterm metabolite measurements was positively correlated with the first PC as opposed to the barycenter of term measurements. The 1st PC explains approximately 37.7% of the variance in the data, and has high positive correlations (≥0.80) with phenylalanine, free carnitine, and long-chain acylcarnitines including C6, C12, C14:1 C16, C18, C18:1, and C18:2. This suggest acylcarnitines may be important in the differentiation of preterm and term births in Nigeria. Additionally, there was a non-significant difference between the barycenter of preterm measurements and the barycenter of term measurements in relation to the second PC which accounts for 15.6% of the variance in the data and is primarily correlated with the metabolites citrate and alanine. Conclusion Long-chain acylcarnitines and free carnitine may occur in pregnancies that will end in preterm birth. The lack of statistical significance may be explained by small sample size. Further studies are needed to validate these results and determine if interventions targeting long-chain fatty acid metabolism could be effective in this population.

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Early Newborn-Onset of Congenital Thrombotic Thrombocytopenic Purpura, with Unusual Features: a Case Report. Nadia Kasdallah1, Hamdi Ben Daamar1, Hatem Ben Salem1, Hakima Kbaier1, Sonia Blibech1, Sawsen Bouzidi1, Brahim Nsiri1, Monia Ben Khaled2, Mohamed Bejaoui2, Mohamed Douagi1 1 Military Hospital of Tunis., Tunisia 3 National Bone Marrow Transplant Center, Tunisia Background and aim Although most cases of neonatal thrombocytopenia are dominated by infections, other less common causes should be precociously considered in some unusual situations to improve patient outcome. Genetic deficiency of ADAMTS13 or Upshaw–Schulman syndrome (USS) is a very rare cause of neonatal thrombocytopenia. The typically reported features of USS in neonates are jaundice with hyperbilirubinemia, thrombocytopenia and /or combs negative hemolytic anemia, and an increased creatinine. We aimed to report an original case of USS with unusual onset and features. Case report: A full term newborn was admitted for moderate repiratory distress. At 4 hours of live, he presented DIC with diffuse hemorrhage, cerebral damage and hemorrhagic shock contrasting with moderate thrombocytopenia. Theses complications were initially considered us related to early onset E coli maternofetal infection. The patient recovered after treatment with antibiotics, plasma infusion, and platelet transfusion. Then, repeated episodes of thrombocytopenia, resistant to platelet transfusions occur. The discrepancy between the severity of the neonatal hemorrhagic syndrome and thrombocytopenia, recurrence and resistance to symptomatic treatment suggested hereditary thrombotic thrombocytopenic purpura. Correction of thrombocytopenia was obtained by FFP transfusions and had a dual diagnostic and therapeutic interest. Analysis of the plasma Von Willebrand factor-cleaving metalloprotease, ADAMTS13, revealed low protease activity in the patient and confirmed the clinical suspicion. Conclusion: In this original report, USS was masked by disseminated intravascular coagulation (DIC) early neonatal infectious cause. In neonates, infectious thrombocytopenia or DIC should not mask the diagnosis. USS should be early considered face to unusual severity of hemorrhage contrasting with common biological data, and recurrence of thrombocytopenia.

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The Impact of an Interactive Educational Programme on Saudi Paediatric Nurses` Knowledge, Attitudes, Beliefs, and Perceived Barriers to Optimal Post-Operative Pain Management Nahar AlReshidi1, Tony Long2, Angela Darvill3 1 University of Salford, UK 2 University of Salford, UK 3 Senior Lecturer in Children’s Nursing, University of Huddersfield Background Post-operative pain management has been researched extensively, but it fails to receive the same attention from paediatric nurses in Saudi Arabia. Practices are not evidence-based, but there is a willingness to improve. The factors to be addressed in this study had not been considered together in any study, and each in turn is supported by only minimal evidence of variable quality. No work of significance had been undertaken in the context of Saudi Arabia or other Gulf nations Aims To test the impact of an interactive postoperative pain management education programme for paediatric nurses Study Design A non-equivalent groups, pre-test post-test design was used. A sample of 229 paediatric nurses working in surgical units in Hail region hospitals was recruited and completed four questionnaires on three occasions, before the intervention, and at 1and 3 months after. The intervention was an interactive educational programme on DVD with explanations, exercises, video presentations and self-check games. Results There was significant improvement in participants` knowledge and attitudes. Perception of barriers to effective pain management reduced, while self-efficacy improved. No improvement was found in perception about children’s pain. Conclusion This study will improve pain management for children following surgery. It will prompt the use of an alternative, digital, interactive education programme in Saudi Arabia

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Association of Educational Level of the Mother With the Birth Weight of Hospitalized Newborns in the NICU Elena Polycarpou1, Elena Papamichael1, Elena Polycarpou1, Michalis Talias2, Christina Karaoli1 1 Archibishop Makarios III hospital, Cyprus 2 Open Univercity of Cyprus, Cyprus Objective We investigated the correlation between the educational level of the mother with the birth weight (BW) of hospitalized newborns in the only tertiary Neonatal Intensive Care Unit in Cyprus. Material and Methods: The study was conducted in the Neonatal Intensive Care Unit (NICU) where all newborns in the country in need of intensive care are hospitalized during the period March 2013-March 2014. The study included 526/640 premature neonates (82.2%). 312 male (54.60%) and 259 female newborns (45.40%). Educational level: Mothers elementary-school graduates (M1) n: 67 (10,5%), high school graduates (M2) n: 210 (32,8%), College/University graduates (M3) 281 (43.9%). We investigated whether there is a correlation between the educational level of mothers and the birth weight of hospitalized newborns. Neonates were classified into three groups: small for gestational age neonates (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) according to their birth weight. Results: M1 Group: AGA 45 (69,2%), SGA 18 infants (27.7%) and LGA 2 (3,1%). M2 Group: AGA 151 (74,4%), SGA 43 (21,2%) and LGA 9 (4,4%). M3 Group: AGA 184 (71,3%), SGA 62 (24,0%) and LGA 12 (4,7%). Statistical analysis showed a proportionately higher rate of SGA newborns in the M1 compared to M2 and M3 but the difference was not statistically significant. Conclusions There appears to be a positive effect of the higher level of education of mothers on the birth of AGA newborns in Cyprus. Our results are compatible with other international reports. Larger studies are needed to support our results.

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Breastfeeding and Maternal Educational Level: Presentation of the Current Trend in the Neonatal Intensive Care Unit (NICU) of Arch. Makarios III Hospital Elena Polycarpou1, Elena Papamichael1, Michalis Talias2, Christina Karaoli1 1 Archibishop Makarios III hospital, Cyprus 2 Open Univercity of Cyprus, Cyprus Objective The record of breast milk administration in the NICU hospitalized neonates and the trend in relation to the educational level of their mothers. Our NICU hosts all hospitalized preterm neonates nationwide. Materials and methods: The study lasted for the period March 2013-March 2014 and involved 531 infants. The data collection was done by filling out standardized questionnaires which were completed by the researcher in collaboration with parents. The educational level of mothers was recorded as follows: elementary-school graduate mothers(M1), high school graduates (M2) ,College-University graduates (M3). The educational level of the mother was associated with the administration exclusively of breast milk, mixed feeding and exclusively formula milk for premature neonates. Results Data from 531/640 hospitalized neonates 83% were collected. 312 male (54.60%) and 259 female neonates (45.40%) were included. The educational level of mothers was: M1 n: 67 (10,5%), M2 n: 210 32,8%, M3 281 43,9%. The analysis showed: I. Breastmilk 120/531, M1 9/67, M2 41/201, M3 70/263 II. Formula milk for premature neonates 148/531, M1 28/67, M2 62/201, M3 56/263 III. Mixed nutrition 263/531, M1 28 / 67, M2 98/201, M3 137/263 Mothers in M1 group give their babies exclusively breast milk in extremely low degree. Mothers M2 give exclusively breast milk more than the mothers M1 but less than M3. M3 mothers have the highest rates of exclusive breast milk delivery (p=0,001) while clearly there is a larger percentage of the choice of a mixed diet versus exclusive administration of formula than in the other groups of mothers. Conclusions The prevailing trend in our NICU is an increase in the exclusive administration of breastmilk in neonates born to mothers with a higher educational level.

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Association of the Educational Level of the Mothers of the Hospitalized Preterm Neonates with the Degree of Prematurity Elena Polycarpou1, Elena Papamichael1, Michalis Talias2, Christina Karaoli1 1 Archibishop Makarios III hospital, Cyprus 2 Open Univercity of Cyprus, Cyprus Objective Although the literature recognizes the positive correlation between low socio-economic / educational level and infant health level, evidence is not clear. The purpose of this study is to investigate the correlation of the educational level of the mother with the degree of prematurity. Materials and Methods: The study was conducted in the Neonatal Intensive Care Unit of Archibishop Makarios Hospital from March 2013 till March 2014. During that period of time, 312 male (54.60%) and 259 female newborns (45.40%) were hospitalized in our NICU. The educational level of mothers was recorded as follows: elementary-school graduates (M1) n: 67 (10,5%), high school graduates (M2) n: 210 (32,8%), College- University graduates (M3) 281 (43.9%). We investigated whether there is a correlation between the educational level of mothers and the gestational age of hospitalized newborns. Results: Mothers M1 gave birth to 0 infants 24-26 weeks of gestational age (GA) (0%), 5 27-29 (7.5%), 13 30-32 (19.4%), 25 33-36 (37.3%), 21 37 -40 (31.3%) and 3 40-42 (4.5%). Mothers M2 gave birth to 4 neonates 24-26 weeks (2.0%), 13 27 - 29 (6.3%), 24 30-32 (11.7%) 99 33-36 (48.3%), 60 37-40 (29.3%) and 5 40-42 (2.4%). Mothers M3 gave birth to 4 neonates 2426 weeks (1.5%), 18 27- 29 (6.8%), 40 30-32 (15.0%), 118 33-36 (44.4%), 79 37-40 (29.7%) and 7 40-42 (2.6%). M1 mothers appear to give birth to more premature neonates than M2 and M3 mothers but the difference is not statistically significant. Conclusions The educational level of the mother appears to correlate with the degree of prematurity of newborns. In our NICU the better-educated mothers give birth to greater gestational age newborns. Larger studies are needed to support our results.

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Malrotation and Intestinal Volvulus in a 29.5 Weeks of Gestation Premature Newborn, A Case Report

Mario Blancas, Alejandro Moguel, Ruben Martinez, Samuel Fernandez, Jose Iglesias, Bernardez Isabel Hospital Español de Mexico, Mexico Intestinal malrotation refers to an abnormal or incomplete rotation of the intestine during the embryogenesis period. Most of them are asymptomatic, only 1 out of 6000 new borns have any symptoms. On the other hand the volvulus occurs when a small portion of the intestine turns around it´s own base. It is not common to see volvulus during the neonatal period, when it happens it comes along with high rates of mortality, and should be treated as a serious complication. We present the case of a masculine newborn of 29.5 weeks of gestation, with the following perinatal history, son of a 35 year old mother, previously healthy, with threatened abortion during the first trimester and premature rupture of membranes with uterine activity at 29.3 weeks of gestation. The pregnancy is interrupted by a cesarean section. Obtaining a masculine product with poor respiratory effort, Apgar score 7/9 weight of 1500 grams and height of 41.5 cm. The product is taken to the NICU and diagnosed with hyaline membrane syndrome, early neonatal sepsis and disseminate intravascular coagulation, 24 hours after bird that patient presents increasing of abdominal perimeter and clinical findings compatible with intestinal perforation. After performing an open laparotomy, we found intestinal malrotation, volvulus and 2 intestinal perforations in the terminal ileum, therefore an intestinal resection along with an ileostomy is performed. After staying for 53 days in the intensive care unit the newborn is discharged with 37.3 corrected weeks of gestation and a weight of 2310 grams. The prevalence and incidence of this pathologies presented at the same time in a preterm newborn is very low, in this cases the key for a favorable result is the early diagnosis and surgical treatment.

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Neonatal Resuscitation Knowledge and Practice among Pediatric Residents in Jeddah, Saudi Arabia.

Jubara Alallah1, Yara Kano2, Abrar Fatani2, Ghofran Aljehani2 King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, Neonatology Section, Pediatric Department, king Abdulaziz Medical City, National Guard health Affair, Saudi Arabia 2 King Abdulaziz University , Jeddah, Kingdom of Saudi Arabia., Saudi Arabia 1

Introduction: Neonatal asphyxia is considered as one of the major factors leading to neonatal death. About 10% of newborns need some assistance at birth. Therefore all health care providers who participate in the delivery should have the knowledge and the skills to perform neonatal resuscitation when needed .Neonatal intensive care rotation is a core element of the Pediatric residency program, during the 4 years training they should spend 24 week in the NICU and cover delivery room. But training in neonatal resuscitation and the NRP course is not a prerequisite for the resident and exposure to the course is variable. Objectives This study estimated and compared the knowledge of junior and senior pediatric residents in the neonatal resuscitation guidelines .We determined the frequency of resuscitation intervention in clinical setting and evaluated the effectiveness of NRP to improve the confidence of the pediatric residents. Methods A cross-sectional study was conducted among 123 pediatric residents in the eight certified pediatric residency program hospitals in Jeddah, Saudi Arabia. Knowledge was assessed using self-structured questionnaire. The questionnaire consisted of 38 multiple-choice questions. SPSS version 21 was used for the analysis. Chi-square test was used to compare the mean percentage of correct responses between different variables. A P value less than 0.05 was considered significant. Results The average score of the residents` knowledge was 36.85 (n=116). No significant difference between the knowledge scores of seniors and juniors (p=.410).A significant improvement in the level of confidence among the residents who took the NRP ( P=.000) .there was A significant improvement in the level of confidence among the residents who resuscitate more babies.(p=.004) Conclusion While the Pediatric residents` knowledge on neonatal resuscitation guidelines appears to be poor, the Neonatal Resuscitation Program was found to be effective in improving the confidence level of the pediatric residents. The need for the NRP as an essential prerequisite in the Pediatric residency program is highly required.

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Breastfeeding Very Low Birthweight Babies Andreja Tekauc Golob, Saša Kostanjevec University Clinical Center Maribor, Slovenia Background Mothers of very low birthweight (VLBW) preterm infants, encounter a variety of unique breastfeeding barriers and challenges that result in a decreased rate of breastfeeding compared to term infants. In neonatal intensive care units (NICU), further educational efforts are needed to address the specific breastfeeding needs of parents with preterm infants. Methods A retrospective analysis of the breastfeeding rate in VLBW babies at discharge from Maribor University Centre for the period 1.1.2011 – 31.8.2014 was performed. The breastfeeding rate according to birthweight and gestational age was analysed. We compared the results with those of the previous five-year retrospective analysis and with the current knowledge on breastfeeding of VLBW preterms in the literature. Results Of the 93 VLBW babies born in Maribor University Centre, 12.9% were exclusively breastfed, 4.3% received only mothers’ milk, 10.8% were partially breastfed, 34.4% received both mothers’ milk and formula and 37.6% were fed only with formula at discharge. Comparison with the previous 5-year analysis shows a decrease in the number of formula-fed babies (29.3% / 43%). Conclusions Most VLBW babies are not breastfed at discharge. The results confirm that additional efforts can increase the rate of successfully breastfed VLBW babies. Mothers of VLBW babies face many problems in breastfeeding, and healthcare professionals should offer individualized care and support. International Board Certified Lactation Consultants (IBCLC) are of great help. Key words:/h3 Benefits of breastfeeding, very low birth weight babies, discharge from maternity hospital

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Risk factors of sepsis and septic shock in Very Low Birth Weight Neonates: A single centre retrospective analysis Ankita Sharma1, Sangeeta Choudhury1, Poonam Singh2, Anup Thakur2, Neelam Kler2, Parul Chugh1, Manvinder Ghalaut3 1 Sir Ganga Ram Hospital, India 2 Sir Ganga Ram Hospital, India 3 M. D. University, India Background: Neonatal sepsis in very low birth weight (VLBW) infants leads to high morbidity and mortality. Risk factors for sepsis in these infants may vary depending on level of care. Design: Retrospective study Objectives Determining potential risk factors leading to development of late onset sepsis Ascertaining high mortality rate factors Setting Level IIIB Neonatal Intensive Care Unit (NICU), Sir Ganga Ram Hospital (SGRH), New Delhi, India. Subjects VLBW (≤1500 grams) infants admitted at NICU, Department of Neonatalogy, SGRH, during the period of January 2014 to December 2015 (2 years) were assessed. Results A total of 265 VLBW infants (both extramural and intramural) were included in the study. 57 of 265 infants (21.5%) developed culture-positive sepsis with an associated mortality at 47.4%. Mean birth weight of infants diagnosed with sepsis was 1060±240 grams and those without sepsis were 1155±235 grams. Significant (p0.001) clinical presentations correlating with sepsis were desaturation (87.77%), shock (56.1%), feed intolerance (56.1%), hyperglycemia (47.4%), meningitis (14.0%) and necrotizing enterocolitis (17.5%). Independent factors associated with culture positive sepsis, as identified by multivariate analysis using logistic regression were invasive ventilation (OR 4.6, CI 2.5-8.8), prior antibiotic exposure (OR 3.3, CI 1.8-6.1) and time to reach 100 ml/kg feed (OR 1.1, CI 1.1-1.2). Further our study showed 70.2% (40/57) VLBW infants progressed to septic shock with an associated mortality at 67.5% (p0.001). Dosage of inotrope (20.7% vs 79.3%; single vs two and more) for management of septic shock did not show significance outcome improvement in terms of lowering mortality. Conclusion: Invasive ventilation, prolonged time to reach full feeds and prior antibiotic exposure are significant risk factors associated with sepsis. Additionally, increased mortality due to septic shock needs further deliberations and management. 

Keywords: Very low birth weight, Sepsis, Septic shock.

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Local Epidemiology of Blood Stream Infections in Neonates Admitted to a Neonatal Intensive Care Unit in Ghana Alhassan Abdul-Mumin1, Abass Abdul-Karim2, Tania Condurache3, George Rodgers3, Dan Steward3, Imran Ravji4 1 Tamale Teaching Hospital, Ghana 2 Ghana Health Service, Ghana 3 University of Louisville, USA 4 United Nations Children Fund, Ghana Introduction Neonatal sepsis (NS) is among the most common causes of neonatal mortality globally. In resource-limited settings, it is usually diagnosed clinically and managed empirically, as routine septic workup is not feasible. This blind therapy can lead to poly-pharmacy and emergence of resistant strains in Neonatal Intensive Care Unit (NICU) settings. A study in Accra (Ghana) has shown a shift from Gram-positive (GP) to Gramnegative (GN) organisms, with significant resistance to ampicillin and gentamicin. Objective To determine the local epidemiology of NS and antibiotic sensitivity patterns in our institution. Methods Successive patients admitted to the NICU were recruited to this prospective cohort study. Demographic, clinical information were recorded. Blood culture samples were collected with aseptic techniques, after seeking parental informed consent. Enrolled patients were followed clinically through completion of antibiotics and discharge. Results Of the 39 patients recruited so far, the male: female ratio was 1.17; the mean age was 5.5 days, with 77% aged ≤7 days on admission. Spontaneous vaginal delivery occurred in 71% and 94.9% of deliveries occurred in a hospital. Common presenting complaints were fever (48.7%), poor feeding (33.8%), dyspnea (30.3%), and jaundice (12.8%), and umbilical cord problems (10.2%). Initial diagnoses on admission were NS (30.8%); asphyxia (10.3%); seizures, jaundice and prematurity (7.7 % each). A pathogenic organism was isolated in 48.7% of the cultures sampled. E.coli (36.8%) and Klebsiella spp(31.6%) were the most common isolates. Only 2/19 isolates were sensitive to ampicillin. AB modification was done in 6 of the patients. Mean antibiotics treatment was 5.6 days. Conclusions



GN organisms predominated among the isolates in our NICU

 Majority of the isolates were resistant to ampicillin and gentamicin, which are the first line antibiotics used in our setting.  Adequate identification of organisms and antibiotic susceptibilities will help to create a valid protocol for adequate empiric antibiotic coverage.

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Ultrasonographic Dimensions of Thyroid Gland in Healthy Term Neonates Nilufer Guzoglu1, Ayse Tandircioglu1, Sevinc Odabası Gunes2, Ayca Torel Ergur2, Didem Aliefendioglu1 1 University of Kırıkkale, Medicine School of Kirikkale, Turkey 2 University of Kırıkkale, Medicine School of Kirikkale, Turkey Background and objectives Measurement of the thyroid gland size is required when the thyroid function test is abnormal. For this reason, reference values of the thyroid gland size are essential. The reference values can vary among different geographic regions. Therefore, in this study we aimed that determining normal reference ranges in healthy term newborn in our region. Method In this study, records of 270 newborns who attended to our hospital between January 2013 and December 2015 were evaluated retrospectively. Inclusion criteria were (1) gestational age between 37-42 weeks, (2) healthy newborn except mildly jaundiced, (3) having normal thyroid function test. Newborns who have maternal thyroid disease, congenital disorder, small for gestational age and, large for gestational age were excluded from the study. Measurements had been performed by an expert radiologist between on day 5 and 20. Results: 136 newborns were enrolled in the study. Mean gestational age and mean birth weight were 3274 ± 321 grams and 39 ± 1 weeks, respectively. 51% of the newborns was girl. For all babies, median and range of total thyroid volume values were 0.62 ml (0.14 -1.62). 10, 25, 50, 75 and 90th percentile values were 0.31, 0.46, 0.62, 0.93 and 1.18, respectively. Conclusion We believe that determined thyroid volume reference values can help to show deviation in cases of the assessment of thyroid size.

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Rapid Success of Povidone-iodine Pleurodesis for Refractory Congenital Chylothorax : a Case Report and Litterature Review. Nadia Kasdallah1,2, Hakima Kbaier1,2, Hatem Ben Salem1,2, Neila Moualhi2, Nada Missaoui2, Sonia Blibech1,2, Mohamed Douagi1,2 1 Military Hospital of Tunis, Tunisia 2 University Tunis El Manar, Tunisia Background and aims Povidone iodine (PVI) pleurodesis is commonly used in adult. However, the use of this procedure to perform chemical pleurodesis in the management of congenital chylothorax is still nonconsensual. We aimed to report a new case of refractory congenital chylothorax (CCT) managed with PVI pleurodesis with iterature review. Methods We report a case of refractoy CCT managed with Povidone-iodine 4% pleurodesis with a review of literature. Results In a full term female neonate, with refractory congenital chylothorax chemical pleurodesis was performed at day 16 of life: one intrapleural instillation of 5ml PVI 4% was carried out with rapid success (48 hours ) and no side effects nine months later. Biologic functions spatially renal, thyroid tests stilled normal before and after instillation. The analysis of 18 cases reported in Medeline and our observation provided the following data: this procedure was successful without side effects in 11/19 cases. Severe side effects were reported in four patients with high risks before procedure: extremely low birth weight and premature infant, diffuse lymphangectasia, renal involvement, extensive deep central veins thrombosis. Conclusions PVI pleurodesis seems to be an effective and inoffensive means for management of refractory congenital chylothorax and may represent a good alternative to surgery. Nevertheless, severe adverse effects are possible in hard situations that need to been excluded. Randomized studies on large neonatal population are required to precise: the risks and benefits of this procedure, the timing and the modalities of its realization (duration of intervention, dilution and dosage of PVI) according to the patient`s field (gestational age, weight and associated morbidity).

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A Comparative Study on the Temperature Recording By Infrared Thermometer and Axillary Electronic Thermometer Wendy Mills, Varghese Abraham Christian Hospital Chhatarpur, India Measuring temperature is an essential part of nursing care and has been widely accepted as an indication of a patient’s clinical condition. There are various ways and methods to measure the temperature and each has their own advantages and disadvantages. The present study is done in Special Newborn Care Unit of Christian Hospital Chhatarpur, India to compare the temperature recording in different part of the body using electronic axillary and infrared thermometer(Multifunctional Infrared thermometer PC808). After getting IRB and ethics committiee aproval a specially trained neonatal intensive care nurse measured the temperature at axilla by electronic thermometer, and in forehead, chest, abdomen and foot by the Infrared Thermometer (IRT) for each neonates with in a span of 5minutes. The results were entered in Microsoft excel and analysed by standard deviation and mean. Atotal of 25 sample were collected of which 18(75%) were preterm, 5(20%) post dated and the 5% were term. The mean temperature by axillary measurement was 36.9±0.52 where as the IRT head, IRT Chest and IRT abdomen were 36.9±0.42, 36.9±0.42 and 37.4±0.46 respectively. The most acurate measurement of IRT is from the forehead and it has the least variation from the axillary temperature measurement by electronic thermometer.

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Outcome of Premature under 28 Gestational Age in the Neonatal Resuscitation and Intensive Care Unit of the Military Hospital of Tunis between 2008 and 2015. Nadia Kasdallah, Dorra Falleh, Hakima Kbayer, Hatem Ben Salem, Hamdi Ben Daamar, sonia Blibech, Mohamed Doagi Military Hospital of Tunis, Tunisia Background and aims Extreme preterm (EP) infant have a high risk of morbidity and mortality. Survivor are often impaired physically, and/or cognitively. Further, the health needs of these infants can be extensive, both in terms of neonatal intensive care and for some, lifelong support. We aimed to analyze the outcome in short and medium term of EP supported in our unit in order to develop a thoughtful management strategy. Methods It was a 8-years descriptive and prospective study (2008-2015). Perinatal characteristics, mortality and, morbidity of all EP at birth and for medium term were analyzed. Results We identified 64 EP, 20% of EP were intubated in the delivery room. The average term was 25 GA (gestational age). The mean birth weight was 940 gr. Morbidity was represented as follows: hyaline membrane disease in 58%, transient respiratory distress in 31%, and infectious alveolitis in 3%. Assisted ventilation was used in 75%. Hemodynamic disorders wee noted in 56% of EP. The rate of maternal-fetal and nosocomial infections were 23% and 44% respectively. Neurological damage affected 21% of EP. The rate of ulcerative enterocolitis necrotizing was 9,3%. The overall survival rate was 21%. The average length of stay for survivors was 61 days. The lowest weight and term in survivors were respectively 25 GA and 860 gr. We observed high rates of mortality and morbidity in EP but being improved. Several aspects are still to promote in particular the management of risk pregnancies and neonatal reanimation of this high-risk population.

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Congenital Brain Tumor: Three Cases Reports Nadia Kasdallah1,2, Dora Fallah1,2, Ben Daamar Hamdi1, Hakima Kbaier1,2, Hatem Ben salem1,2, Sonia Blibech1,2, Bouani Alaa1,2, Neyla Mouelhi1,2, Mohamed Douagi1,2 1 Military Hospital of Tunis, Tunisia 2 Faculty of Medecine of Tunis, Tunisia Background and aims Congenital brain tumors (CBTs), defined as tumors presenting within 60 days after birth, are extremely rare and account for only 0.5 to 4% of all pediatric brain tumors. Even after several investigations have been performed, a clear direction for diagnosis and treatment of fetal intracranial tumors is still lacking. We reviewed the cases of CBTs managed in our unit. Methods A 15-year retrospective study of the cases of CBTs hospitalized in our unit was performed. Clinical, radiological with magnetic resonance imaging, histopathological findings and outcome were analyzed. Results We identified three cases of CBT diagnosed in two male and one female infant. The diagnosis was performed in postnatal period for the three cases. CBT was revealed by refractory status epilepticus at day one of life for first newborn, delayed walking for the second newborn (at 20 months) and bulging fontanels at two months of life for the third newborn. Clinical outcome in the first case with pilocytic astrocytoma grade I diagnosis resulted in vegetative state after delayed resection of the tumor (8 months). The second patient with ependymoma grade II underwent successful resection of the tumor and is still alive with concentration disorders. In the third case with infantile desmoplastic astrocytoma grade I diagnosis, surgery was successfully performed at two months 26 days of life. Conclusion This study sheds light on the difficulty of prenatal diagnosis, neonatal diagnostic, histological, prognostic, and therapeutic characteristics of CBTs. Further studies are needed to clarify its clinical characteristics and establish recommendations for management.

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Neonatal Bacterial Meningitis at a University Hospital in Southern Thailand Sirinthip Kittivisuit, Anucha Thatrimontrichai, Waricha Janjindamai, Supaporn Dissaneewate, Gunlawadee Maneenil Prince of Songkla University, Thailand Background Meningitis is a serious neonatal infection with a poor neurodevelopmental outcome. There is limited information about the incidence, type of organism and outcomes in developing countries. Methods We performed a retrospective study in a Thai neonatal intensive care unit to compare the characteristics and outcomes in neonatal meningitis between period 1 (1991-2002) and period 2 (2003-2014). Results Over 24 years, the number of patients, episodes and pathogenic organisms of neonatal meningitis were 46, 54 and 62, respectively. The incidence of neonatal meningitis was 0.37 cases per 1,000 live births and 0.52% of NICU-admitted neonates. The case fatality rate was 21.7% (10/46). Median (IQR) gestational age (GA) and birthweight (BW) were 35 (7) weeks and 2,045 (1,208) g. Case fatality rate was 21.7%. In period 2, significantly lower GA (P = 0.006), BW (P = 0.02), current weight (P = 0.001) and previous neurological surgery (P = 0.02) were revealed at onset of meningitis than in period 1. Meningitis with bacteremia and ventilator-associated pneumonia were found in 30% and 15% of cases, respectively. Within 48 hours of life, no multidrug resistant (MDR) organisms were found (0/2); however, within 72 hours MDR was found in 44% (7/16). Acinetobacter baumannii was the most common causative organism (16%) and cause of death (40%). In only one case, group B Streptococcus was the cause of meningitis and no cases of Listeria were found. Conclusions Prematurity was a risk of meningitis in the recent period. Early onset meningitis should have a cut-off within 48 hours in high MDR areas. Key Words: Acinetobacter baumannii, drug resistance, meningitis, newborn, neonatal intensive care

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Cord Blood Pentraxin 3 in Fetal Macrosomia Despina Briana1, Kleopatra Germanou1, Theodora Boutsikou1, Maria Boutsikou1, Nikolaos Athanasopoulos1, Antonios Marmarinos2, Dimitrios Gourgiotis2, Ariadne MalamitsiPuchner1 1 National and Kapodistrian University of Athens, Greece 2 National and Kapodistrian University of Athens, Greece Background Fetal macrosomia is associated with activation of the immune system due to inflammation, which predisposes to endothelial dysfunction and later cardiovascular complications. Pentraxin 3 (PTX3) is released by macrophages, monocytes and endothelial cells, as a response to inflammatory stimuli. PTX3 is a novel biochemical marker of inflammatory conditions, mainly involving the cardiovascular system. Aim To prospectively investigate cord blood PTX3 concentrations in large-for-gestational-age-(LGA), as compared to appropriate-for-gestational-age-(AGA) pregnancies and associate them with a variety of perinatal variables. Material and methods PTX3 concentrations were determined by ELISA in 80 cord blood samples of full-term singleton LGA (n=40) and AGA (n=40) pregnancies. Neonates were classified as LGA or AGA based on customized birth weight standards adjusted for significant determinants of fetal growth. No neonate presented with clinical or laboratory evidence of infection. Results Cord blood PTX3 concentrations were similar in LGA and AGA pregnancies. However, in the macrosomic group of infants, fetal PTX3 concentrations positively correlated with birth weight (r=0.416, p=0.008). Furthermore, a positive association between cord blood PTX3 concentrations and gestational age was recorded (r=0.229, p=0.041). Conclusions Cord blood PTX3 is probably not affected by fetal macrosomia. However, cord blood PTX3 up-regulation with increasing birth weight in LGA pregnancies may probably indicate a predisposition to later development of cardiovascular pathology in the severe cases of fetal macrosomia. The positive correlation between gestational age and fetal PTX3 concentrations may possibly be attributed to the increased placental expression of the protein, as pregnancy advances.

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The Effect of Bosentan Therapy in Persistent Pulmonary Hypertension of the Newborn Gunlawadee Maneenil, Anucha Thatrimontrichai, Waricha Janjindamai, Supaporn Dissaneevate Prince of Songkla University, Thailand Background Persistent pulmonary hypertension of the newborn (PPHN) is acute disorder of postnatal transition with substantial morbidity and mortality. Inhaled nitric oxide (iNO) is the mainstay of therapy for PPHN; however, some patients are unresponsive to iNO. Bosentan, an oral endothelin-1 receptor antagonist, reduces pulmonary vascular resistance and hence may play a role in the treatment of PPHN. Objective To evaluate the effectiveness and safety of bosentan therapy in PPHN patients. Study Design: Retrospective study. The data from medical records of newborns, diagnosed with PPHN and had received oral bosentan from January 2013 - February 2016, were reviewed. Results 40 neonates at a median gestation of 38 weeks were diagnosed with PPHN and received oral bosentan. The median (IQR) age at the start of bosentan and the initial oxygen index (OI) were 27 (14.5-40.2) hours and 29.2 (13.4-40.1). The mean duration of bosentan therapy was 6.2±3.1 days. A significant improvement in OI (P=0.002) and oxygen saturation (SpO2) (P0.001) was observed after 2 hours of treatment. 21 (52.5%) neonates who received both iNO and bosentan (median OI 34.2; 29-42.6) and 19 (47.5%) neonates who received bosentan alone (median OI 13; 9.8-30.9) had significantly decreased OI at 6 and 2 hours after treatment, respectively (P=0.005 and P=0.01). No statistically significant difference was found in blood pressure before and after bosentan treatment and there was no hepatic transaminitis in all neonates. Mortality rate was 15% (6/40) and mean OI in the non-survivors group was 61.4. Conclusions Bosentan may be a safe and effective treatment for improving oxygenation in PPHN. In mild to moderate of pulmonary hypertension where treatment with iNO is unavailable, oral bosentan can be an alternative therapy option in the treatment of PPHN.

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Comparison of the Neonatal Outcomes of Various Types of Bathing Kotomi Yamaguchi, Marie Furuta Kyoto University, Japan Objectives There are numerous methods of bathing infants, sponge and swaddle baths have been administered as alternative methods to traditional bathing to keep newborns clean while reducing stressful exposure. However, there is a lack of evidence as to whether various types of bathing have different effects on the infants and whether those effects differ depending on the newborns’ clinical characteristics. The objective is to compare the neonatal outcomes (efficacy and GBS infection etc) with various types of bathing (sponge, swaddle and traditional immersion baths). Method We conducted a systematic review of randomized controlled trials and observational studies. We searched multiple databases, including the CENTRAL, Ovid MEDLINE, PsycINFO, Embase and Maternity and Infant Care. Search terms included newborn/newborns, infant/infants, skin care, bath/bathing and dry technique. Only published papers written in English were included. Two reviewers independently assessed the risk of bias in each study included in this review. One reviewer extracted data for analyses, which were double-checked by the second reviewer. Results We searched 1,054 references in the databases. After screening titles and abstracts, we retrieved full texts for forty-three papers. From these, five were finally included in our study, based on inclusion and exclusion criteria. Although the outcomes measured varied accords studies, the results indicated that immersion baths may be more beneficial than sponge baths in terms of maintaining a healthy body temperature for newborns. However, interpreting the results requires caution because the methodological quality of the included studies was poor. There was no evidence that the type of bathing had an effect on the risk of umbilical cord infection. Conclusions We did not find enough high-quality evidence to examine whether different types of bathing have varying effects on neonatal outcomes. Further research of high methodological quality will be required to inform clinical practice.

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The Prevalence and Hospital Burden of Glucose 6 Phosphatase Dehydrogenase (G6PD) Deficiency Among Neonates Born in King Abdulaziz Medical City (KAMC-WR) in Jeddah, Saudi Arabia Jubara Alallah1, Maria Al-Shaghab2, Sarah Sarah Dhaiban2, Rehab Fallatah2 1 King Abdullah International Medical Research Center, Saudi Arabia 2 King Abdulaziz university , Jeddah, Kingdom of Saudi Arabia., Saudi Arabia Introduction Glucose-6-phosphate dehydrogenase (G6PD) is an important enzyme for stabilizing red blood cell.1,2 G6PD deficiency is the most common enzymopathy in the world; It is considered as a major risk factor for kernicterus and other complications of hemolysis In previous studies in Saudi Arabia, the G6PD deficiency prevalence was variable between 2 to 30.6%. Thus, the neonatal screen program for G6PD deficiency became essential in very prevalent regions Objectives The aim of this study is to determine the prevalence of Glucose-6-Phosphatase Dehydrogenase (G6PD) Deficiency & To examine the hospital course of G6PD deficient neonates in KAMC-WR, Jeddah. Methods Retrospective chart review of inborn neonates with G6PD deficiency from January 2010 through December 2014 at King Abdulaziz Medical City in Jeddah, Cord samples were collected as part of the standard neonatal screening program. Out born neonates were excluded; maternal and neonatal data were collected and analyzed using Statistical package IBM SPSS™ 21 (SPSS Inc., Chicago, Il, USA) .p-value of 0.05 was considered statistically significant. Result During the five years study period 15,597 infants born, Total of 232 infants had G6PD deficiency, which constitutes 1.48 % of the total screened population. 82.8 %were male.The mean gestational age was 39 wks, and the mean birth weight was 2992 grams. 54%of the affected neonates requires phototherapy. Neonates below 37 weeks, required early phototherapy intervention and longer duration, Preterm with G6PD deficiency need a longer duration of phototherapy(70 hrs vs. 47 hrs, P0.001 ) and longer hospitalization (8 vs. 4 days, P0.001) Neonates with birth weight below 2.5 kg required treatment more than. Conclusion The prevalence of G6PD deficiency among inborn live neonates at KAMC-WR is 1.48%, Preterm with G6PD deficiency develop jaundice earlier and need a longer duration of phototherapy and longer hospitalization for jaundice. Early screening for jaundice is recommended for preterm neonates with G6PDd in first 24 hours of life unless clinically indicated before.

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Pediatrician`s Role in Prevention of Learning Disorder in Pre-School and School 1

Mojtaba Niazi1, Hoossein Noori2 Head of Clinic education and habilitation specific learning disorder, Iran 2 specific learning disorder Clinic, Iran

Recently the process of study and exploration of learning disorder had been developed remarkable. And specialists’ concentration it more than past and they believe that specific learning disorder cause to become low performance in necessary skills to maintain communicate and its result are social relationships disorder, self esteem reduction, victim and low performance of child and student in different levels. However some children have normal or high normal intelligence and also well hearing and vision sense but they can’t learn educational subject by using of educational standard method so they were sent to education and habilitation specific learning disorder centers by schools or consultors. At first these children have enough confidence to educational improvement but gradually they understand other children are better than themselves in learning aspects. And they feel that they are differ from others by passing few months of academic year. So their self confidence become low. And they hate school and their parent force to children very much that the condition become difficult because their parent aren’t well informed and these children parent and teachers compare children with others unjustly or humiliating. Gradually children become depressed, anxious and victim. So we can’t solve children problems roughly. Therefore, pediatricians can help parents who are the first people on the move, or words delayed growth, impaired cognitive skills (visual, auditory), visual memory weakness, impaired speech or language skills .... Share with their children. Ok we will discuss about definition,prevalence, classification, the goal of education and habilitation, relationship between learning disorder with other science, clinical signs and specific approach treatmental for learning disorder in this article.

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A Review of Universal Antenatal Group B Streptococcus (GBS) Screening and Its Impact on Early Onset Sepsis (EOS) In Neonates – The SGH Experience Priyantha Edison, WB Poon, SKY Ho Singapore General Hospital, Singapore Background Early-onset sepsis (EOS) continues to be a leading cause of neonatal morbidity and mortality with GBS being a significant contributing pathogen. Universal antenatal screening for maternal GBS colonization and intra partum antibiotic prophylaxis (IAP) have led to a reported decline in the burden of early onset GBS disease (EOGBSD) worldwide. In SGH, the 2010 revised CDC recommendations were incorporated into a revised EOS management algorithm in 2011. We aimed to evaluate the impact of universal GBS screening on neonatal outcomes. Methodology A retrospective analysis of neonatal outcomes in the 2 years prior (Epoch 1) and 3 years post implementation (Epoch 2) of universal antenatal GBS screening was done. All cases of EOS were reviewed. Results There were no cases of EOGBSD during the study period. The incidence of culture proven EOS in Epochs 1 and 2 were 0.03% and 0.09% respectively, observed predominantly among very preterm births with Gram negative pathogens being the causative agent in 83% of the cases. In Epoch 2, there was a significant reduction in the rate of congenital pneumonia in neonates born to GBS colonizers. However, there was a significant increase in the rate of presumed EOS among neonates born to mothers with risk factors for sepsis. Conclusion The incidence of EOGBSD is very low in our population. EOS is a significant morbidity factor among very preterm births and the majority is caused by gram negative pathogens. Adoption of the revised EOS algorithm has contributed to an increase in the rate of neonates treated for presumed sepsis. Key Words 

early-onset sepsis (EOS);

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group B Streptococcus (GBS)

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universal screening

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Antenatal and Postnatal Care Practices among Mothers in Rural Bangladesh md Shahjahan Daffodil International University (DIU), Bangladesh Background Proper utilization of antenatal and postnatal care helps to prevent complications and ensures better maternal and child health in future. Although under-five mortality in South Asia including Bangladesh has reduced substantially, the rate of neonatal mortality is still high. The study aims to identify factors associated with practice of antenatal and/or postnatal care amongst mother of newborn from healthcare facility in selected area of rural Bangladesh. Methods A community-based cross-sectional study was conducted among 360 representative samples of postnatal mothers those were within their 42 days of delivery. The data were collected using semi-structured questionnaire. Results About 14.2% of the respondents visited healthcare facility for 4 or more times to receive ANC. Though higher proportion of mother delivered at home, 35.0% of the respondents experienced post-delivery complications. Around 18% mothers received PNC from healthcare facility. Although many variables revealed significant associations in bivariate analyses, few variables remained significant for ANCPNC categories in multinomial logistic regression analysis. The likelihood of receiving either ANC or PNC (OR =0.30, 95% CI =0.10-0.96) was significantly lower among mothers who had either no education or less educated (1-5 years of schooling); and was found significantly higher for women who watched TV (OR = 2.79; 95% CI = 1.45 – 5.37); family income showed significant association for receiving both ANC and PNC services as well. Conclusion Maternal care of newborn particularly PNC service is very poor in rural Bangladesh. Adequate antenatal and postnatal care should be prioritized with the existing Maternal MCH facilities. Home visits of community health workers could be an opportunity to enhance healthcare for the woman and newborn including deliberation of specific health messages. Counseling could be integrated during ANC visits to increase the postnatal care service further.

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Osteogenesis Imperfecta – Case Presentation Tanasescu Sonia1, ioana ciuca1, cristina dragomir2, simona muntean2, liviu pop1 1 University of Medicine and Pharmacy V. BabesTimisoara, Romania 2 Emergency County Hospital Timisoara, Romania Osteogenesis imperfecta is a rare disease triggered by the occurrence of a genetic mutation in the genes responsible for producing collagen. There are over 150 mutations, and the incidence is about 1 / 20,000. After last classifications, there are 8 types of osteogenesis imperfecta, whose severity ranges from moderate to severe or very severe with perinatal deaths. The authors present the case of a 6 months old infant hospitalized for numerous fractures (at 2 months old – radiocarpian fracture, at 5 ½ months old- left humerus fracture and at 6 months old - left shin median 1/3 incomplete fracture). Clinical examination reveals a cast device in the left leg. Paraclinic investigations: Xrays of the upper and lower limbs, lumbar spine bone reveals bone hypertransparency; osteodensitometry reveals osteopenia. The ophthalmologic examination revealed sclera with normal aspect, transparent crystalline; echocardiography reveals moderate tricuspid regurgitation. Based on clinical and laboratory results the positive diagnosis is established: osteogenesis imperfecta and the treatment with bisphosphonates was initiated. Under the treatment, the infant has not shown any fracture. Keywords:osteogenesis, bisphosphonates ,fractures

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Meilensteine der Motorischen Entwicklung – Eine Studie an Kindern im Ersten Lebensjahr Heinz Krombholz, Angela Roth State Institute of Early Childhood Research, Germany Das Säuglings- und Kleinkindalter ist geprägt von raschen Entwicklungsprozessen, die sich in körperlichen Veränderungen (Wachstum) und in der Erweiterung der motorischen Fertigkeiten und Kompetenzen zeigen. Die wesentlichen Fertigkeiten im ersten Lebensjahr – hierzu gehören u. a. Kopf halten, sich umdrehen, Krabbeln und sich Aufrichten – werden als „motorische Meilensteine“ bezeichnet. Zu diesen Meilensteine existieren Entwicklungstabellen, anhand derer die individuelle Entwicklung eines Kindes beurteilt wird, sei es durch Psychologen, Kinderärzte oder Eltern. Allerdings ist bei den vorliegenden Entwicklungstabellen oftmals kaum nachvollziehbar, auf welchen empirischen Daten diese jeweils beruhen: Wann, wo und von wem wurden die Daten erhoben? Wie groß war die Stichprobe und welche Zielkinder wurden für die Untersuchung ausgewählt? Derzeit besteht der Verdacht, dass vorliegende Angaben zu den motorischen Meilensteinen häufig veraltet sind und die Datenbasis nur gering ist. Ziel des Beitrages ist es, die Methoden und Ergebnisse eines Forschungsprojekts zum Auftreten der wichtigsten motorischen Meilensteine vorzustellen. Hierfür wurden junge Eltern aufgefordert (in Zeitschriften und Internetplattformen, die sich an werdende und junge Eltern richten), die Entwicklung ihrer Kinder anhand eines Entwicklungskalenders, der 18 motorische Fertigkeiten umfasst, zu beobachten und zu registrieren. Dieses Einbeziehen von „Laien“ zur wissenschaftlichen Datenerhebung ist zwar für die Entwicklungspsychologie eher ungewöhnlich, wird aber vor allem in angelsächsischen Ländern bei biologischen Fragestellungen unter der Bezeichnung „citizen science“ verschiedentlich angewandt. Seit 2013 beteiligen sich bundesweit mehr als 1600 Eltern an der Online-Studie, Zwischenergebnisse liegen für 800 Kinder vor. Das Erfassen der individuellen längsschnittlichen Entwicklung ermöglicht nicht nur die Ermittlung von Prozenträngen für das Erreichen der Meilensteine, sondern auch die Analyse individueller Entwicklungsschritte und die Ermittlung von Faktoren, die mit dem Entwicklungstempo zusammenhängen.

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Impact of Prenatal Diagnosis in Surgical Congenital Anomalies in Albania Ilirjana Bakalli UHC" Mother Theresa", Albania Introduction Congenital anomalies are one of the main causes of perinatal mortality and morbidity, requiring in many cases surgery. Prenatal diagnosis provide information that influences the prevalence of congenital anomalies and perinatal care. Aim To assess if prenatal diagnosis has affected the prevalence of surgical congenital anomalies in our country during 10 years (2006-2015) and to examine the trend of this pattern between the two periods: 1 st period 2006-2010 and 2nd period 2011-2015. Methods This is a retrospective study. Are included all children with Surgical Congenital Anomalies (SCA) admitted at our PICU for surgical congenital anomalies during 2006-2015. (This is the only infantile surgery in Albania) Live births are extracted from National Registry of Albania. Results During the study period, 334 SCA are admitted at our PICU (1.7% of all admissions). The prevalence of SCA has been reduced from 1.14/1000 live births in the first period to 0.97/1000 live births in the second period. Mortality rate also get down in the second period from 34% in 25.6%, near significance p=0.08; 95%CI(0.41÷1.06). The most important pathologies due to their higher incidence and mortality rate remain the same in both periods but with a reduced prevalence in the second period: intestinal atresia from 0.29 to 0.18/1000 live births, esophageal atresia from 0.23 to 0.13/1000 live births, diaphragmal hernia from 0.13 to 0.08/1000 live births and laparoschisis from 0.08 to 0.05/1000 live births. We have to underline that 68.8% of SCA come from regional zones of Albania, where prenatal diagnosis is not always possible, influencing so in their presentation in time and the total mortality rate of these anomalies. Conclusion The pattern of SCA in our country hasn’t change, but prenatal diagnosis has influenced the prevalence of surgical congenital anomalies and the prenatal care with an important reduction of mortality rate.

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Concerns about the treatment of supraventricular tachycardia in neonates Ilirjana Bakalli UHC" Mother Theresa", Albania Key words: neonat, amiodarone, supraventricular tachycardia. Introduction The most commonly presenting pathological tachycardia in the neonates is SVT (Supraventricular Tachycardia). Immediate rate control is desired in the child who requires significant support. This life threatening event at neonates necessitates a standard protocol for its management, dependent on the patient stability at presentation. The use of intravenous amiodarone may quickly achieve rate control, but the safety and efficacy of amiodarone in children and especially in neonates has not been established, due to the presence of benzyl alcohol. Through our case report, we’d like to underline the risk of intravenous amiodarone in neonates. Case report The child F.Sh, 29 days old, presents at our PICU with SVT and severe heart failure. (Heart rate - 280 beats/min, with reduced contractility in echocardiography – FS= 20%). We used Amiodarone to treat the SVT, according the protocols (loading dose – 5 mg/kg two doses, followed by maintenance dose for 24 hours, to continue after with oral amiodarone). Thirty hours after the beginning of amiodarone treatment, child developed a severe situation, with gasping respiration, generalized cyanosis, bradycardia, seizures and cardiovascular collapse. Resuscitation has been done for more than 10 minutes. Clinical situation persisted severe for other two days, with respiratory distress and neurologic involvement. We interrupted amiodarone and added prednisolone in the treatment. After four days clinical situation was very good. He was discharged from hospital after 7 days. Conclusion Through our case we would like to emphasize that intravenous amiodarone should be used with caution in neonates and according the neonatal protocol for SVT, given that the presence of benzyl alcohol can cause even fatal “gasping syndrome”.

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Maternal Dietary Diversity and Risk of Low Birth Weight: Empirical Findings from India Srinivas Goli, Deepti Singh Jawaharlal Nehru University (JNU), India Objectives India accounts for the highest proportion of low birth weight (LBW) babies born in the developing world. Poor maternal nutrition during pregnancy has been associated with adverse infant health outcomes, such as LBW. The aim of this paper was to assess the socio-economic factors influencing dietary diversity among pregnant women and to investigate the association between maternal dietary diversity and LBW among newborn babies. Methods and Materials The data for this analysis comes from a unique survey that we conducted among 230 newly delivered women in an urban hospital setting in Uttar Pradesh, the largest Indian state, which accounts for amongst the poorest maternal outcomes in India. Multivariate binary logistic regression analysis points out low maternal education and economic status as being significant factors influencing the poor dietary diversity among pregnant women. Result and Conclusion Specifically, the prevalence of poor maternal dietary diversity was significantly less among the higher educated women (25%, CI: 23.7-26.3, p0.05) compared to women with no education (41%, CI: 38.6- 43.2). The results also show that women in the category of low dietary diversity had a significantly high proportion of LBW babies (68%, 63.0- 72.1) in comparison to those with medium to high dietary diversity (47%, 43.5-50.5, p 0.05). The findings suggest for improving maternal dietary diversity to reduce LBW babies in India.

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Recurrent Neonatal Organophoshorus Poisoning YUSUF PARVEZ SENIOR SPECIALIST, United Arab Emirates Organophosphorus poisoning in neonates is extremely rare and needs high index of suspicion to diagnose it.Transplacental route is the most common mode of transmission,others being inhalation and ingestion; either accidental or homicidal. The clinical manifestation often simulates that of sepsis andThe clinical presentation is often confused with the features of sepsis like apnea, copious oral secretions, diarrhea, letharginess, seizures. There may be recurrence of manifestations due to chronic exposure.The mainstay of medical therapy in organophosphate poisoning include atropine, pralidoxime (2-PAM), and benzodiazepines (eg,diazepam) Keywords- Apnea, Seizures, Sepsis.

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Surfactant and Antenatal Steroid Use in New Era of RDS Treatment Suada Heljic, Ismeta Kalkan, Sabina Terzic, Amra Cengic, Hajrija Maksic University Clinical Center Sarajevo, Bosnia and Herzegovina Background The aim of this study was the comparison of survival rate in preterm infants with RDS treated with CPAP, INSURE procedure and mechanical ventilation, depending on antenatal steroid use and surfactant replacement. Patients and methods Investigation included preterm infants with respiratory distress syndrome (BW 1466,53 ± 498,04, GA 30,00 ± 2,77) treated with CPAP (n=83) and INSURE procedure (n=35), and compared with infants treated with mechanical ventilation (n=118) as a historical group. Survival rate depending on antenatal steroid therapy and surfactant use is compared in both groups. \ Results There is no statistical difference in birth weight, gestational age and sex distribution between CPAP, INSURE i MV groups. There is statistical difference in survival rate (χ2 13,783, p0,05) between groups. In CPAP and INSURE group, if their mothers received steroids antenatally, survival rate was 100%, if no, survival rate was 89,12% and 94,44%, respectively. In MV group, if infants were treated with steroids antenatally, survival rate was 76%, if no, 62,37% (χ2 43,565, p0,05). In CPAP group 32 infants (28,57%) were not treated with surfactant; one, two or three doses of surfactant received 68 (60,71%), 8 (7,14%) and 4 (3,57%) infants respectively. In MV group 15 infants (19,48%) were not treated with surfactant; one, two or three doses of surfactant received 41 (53,25%), 17 (22,08%) and 4 (5,19%) infants respectively (χ2 9,936, p0,05). Conclusion Antenatal steroid use together with less aggressive treatment using CPAP and INSURE procedure show to be the best strategy regarding survival of preterm infants with respiratory distress syndrome.

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Comparison of Four Days Versus Seven Days of Antibiotic Therapy for Neonatal Pneumonia: A Randomized Controlled Trial. NB Mathur, Murugesan A Maulana Azad Medical College, India Pneumonia is the commonest form of neonatal infection contributing significantly to neonatal mortality. The objective of the present study was to compare the effect of four days course versus seven days course of antibiotic therapy in neonatal pneumonia on treatment success rate. All near term and term neonates (gestation age 34 weeks ) with pneumonia, who had clinical remission by 48 hours of antibiotic treatment were enrolled. Exclusion criteria comprised of birth through meconium stained amniotic fluid, positive blood culture and associated meningitis. For a difference in success rate of 6% (for non inferiority trial) at 95% confidence interval and power of 80 percent, 35 neonates were enrolled in each group. Pneumonia was diagnosed on predefined clinical, radiological and laboratory grounds. Primary outcome parameter was success rate defined by non recurrence of symptoms within 3 days of discharge. Secondary outcome included morbidity rate up to 28 days after enrollment. The study was approved by the institutional ethics committee and written informed consent was obtained.All cases of neonatal pneumonia who were asymptomatic by 48 hours of antibiotic treatment were enrolled. The randomization sequence was generated using random allocation software in variable blocks and concealed by placing the group allocation in sealed opaque envelopes. Baseline variables including gender, age, weight, gestational age, clinical features, CRP and Procalcitonin positivity were comparable in both groups. Success rate was 100% in both groups. Duration of stay and duration of antibiotics was significantly lesser in the 4 day group. To conclude, a total of 4 days of antibiotics was comparable to a total of 7 days of antibiotic thearapy with respect to success of treatment and occurence of morbidity for 28 days following enrollment. Duration of antibiotics and hospital stay was significantly less in the 4 day group.

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Caring For the Newborn: Knowledge and Associations on Evidence-Based Practices at Community Level among Sri Lankan Post-Natal Mothers Sumudu Hewage1, Dhammica Rowel2 1 Post Graduate Institute of Medicine, University of Colombo, Sri Lanka 2 Family Health Bureau, Sri Lanka Background: Sri Lanka successfully reduced neonatal mortality to the lowest in South-East Asia. But morbidity remains high, most of which could be prevented by simple, yet evidence-based interventions at both hospital and home. Objectives: To assess maternal knowledge and factors associated with evidence based interventions on newborn care at home among postnatal mothers. Methods: This hospital-based analytical cross-sectional study was done on consecutively selected 422 postnatal mothers, at a tertiary care maternity hospital, following delivery of newborn. A pre-tested intervieweradministered questionnaire assessed mothers` knowledge on selected evidence-based newborn care interventions recommended by WHO and UNICEF in their guidelines “Home visits for the newborn child: a strategy to improve survival” (2009). Descriptive data are presented as means, standard deviations and proportions. Inferential data are presented as Odds Ratios and confidence intervals. Associations were assessed for significance by Chi Square and 95% confidence intervals. Results: We achieved a response rate of 100%, reducing selection bias in the study. Mean age of study sample was 29.7 (SD=5.6) years. Most mothers (n=263;62.5%) delivered their second child. Mean score on overall knowledge was 72.7%. Mothers were most knowledgeable in identification of danger signs (mean score=81.3; SD=1.1), followed by immunization (mean score=77.3; SD=0.7) and breast feeding (mean score=74.9; SD=1.7) Comparatively, knowledge was less on prevention of hypothermia (Mean score=60.0; SD=1.1) and basic emergency care (mean score=47.2; SD=1.4). Higher level of knowledge was associated with having more than one child, (p0.001; OR=0.2; 95%CI=0.1-0.4), mothers with secondary education (p0.001; OR=4.2; 95%CI=1.9-9.1) and attending to antenatal parent-craft classes (p=0.002; OR=2.9; 95%CI=1.4-6.0). Conclusions and recommendations: Knowledge on prevention of hypothermia and basic emergency care should be delivered to mothers more effectively by the national antenatal care program. Primi-parous and less educated mothers should be focused more in the continuum of maternal and perinatal care to further improve newborn survival.

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Oxidative Status in Premature Newborns Breastfed at Enriched or Not Enriched HADDOUCHE MUSTAPHA1, SMAHI Chems-Eddine1, ARIBI MOURAD2 Universite Abou-Bekr Belkaid , Laboratoire de Biologie Moléculaie Appliquée et Immunologie, Algeria 2 Université Abou-Bekr Belkaid , Laboratoire de Biologie Moléculaire Appliquée et Immunologie, Algeria 1

Background Evaluate the effect of fortification of human milk on oxidative status and growth of premature. Material and Methods The study population was composed of ten (10) preterm infants (breastfeeding) hospitalized in the Neonatal EHS Tlemcen, Algeria, and twenty (20) controls (ten (10) preterm (artificial feeding) and ten (10) forward (breastfeeding.) Results: The plasma ORAC, CATALASE, levels were significantly decreased in new premature breast to breast milk enriched ( 0RAC /0,234 ± 0,017, p=0.000) than in control ( new term borns 1,24 ± 0,113 ),CATALASE/(1,351± 0.037)( 1.914±0.104 p=0.006) Additionally, serum concentrations of proteins were significantly higher than premature new borns breast to breast milk enriched ( 79.827±5.074 ; 41.193±13.024 ; p=0.000). Conclusions: Key Words: Oxidative status, premature new borns breastfed at enriched.

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The Use of Pulse Oximetry in Term Newborns Duska Miljanovic Hospital „Sv. apostol Luka“, Bosnia and Herzegovina Introduction: Pulse oximetry is a method for percutaneous oxygen saturation (SpO2) measurement. In the delivery room it is effective in assessment of the cardiopulmonary adaptation of healthy and asphyxic newborns. Aim: Measuring the SpO2 of term newborns in the first 20 minutes after birth and the time of achieving the optimal saturation. Methods: The clinical data of 80 term neonates was prospectively evaluated. The newborns were divided in two groups. Group 1 consisting of 50 healthy and Group 2 consisting of 30 asphyxic newborns of which 14 were resuscitated with 100%O2 and 16 with room air (21%O2) by positive-pressure ventilation. The preductal values of SpO2 obtained by pulse oximetry were analyzed continuously within the first 10 minutes after birth, at 15 and 20 minute.The time to achieve SpO2≥90% was determined. In resuscitated newborns it was the time to achieve optimal saturation depending on concentration of supplemental oxygen. Results: 932 values of SpO2 were obtained. The median (min-max) SpO2 at 1,5,10,15,20 minutes were: 58% (3384%; n=52), 86% (72-94%; n=80), 96% (90-99%; n=80), 97% (91-100%; n=80), 98% (95-100%; n=80). There were significant differences in average SpO2 values (p0.01) between healthy and asphyxic infants. For the whole sample, the mean time to achieve SpO2 ≥90% was 7,08 minutes whereas 6,5 minutes for Group 1 and 8,0 minutes for Group 2. The average time to reach an optimal saturation was 7.7 minutes in group receiving 21%O 2 versus 8.3 minutes in the group receiving 100%O2. Conclusion: Oxygen saturation increases gradually in the first minutes of life and slower in asphyxic than in healthy newborns. Optimal saturation is reached faster in the group of newborns resuscitated with 21% than with 100% oxygen.

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Retinopathy of Prematurity has Higher Frequency and Severity in Small-for-Gestational-Age than in Appropriate-for-Gestational-Age very Preterm Infants Aleksandra Matic1, Ivana Milojevic1, Zorka Grgic2 1 Institute for Child and Youth Health Care of Vojvodina, Serbia 2 Clinical Center of Vojvodina, Serbia Introduction Very preterm infants born as small-for-gestational-age (SGA) have higher mortality and morbidity comparing to their appropriate-for-gestational-age (AGA) peers, including the risk for retinopathy of prematurity (ROP). Methods Our sample consisted of all infants born from single pregnancies with gestation of 24 0/7 – 32 0/7 gestational weeks in tertiary-care center of 2 million population region. Study period was 01.01.2011.-31.12.2013. The very preterm infants who died during primary hospitalization or those born with congenital abnormalities, chromosome abnormalities or prenatally acquired infections were excluded from the study. The sample was divided into SGA and AGA group, depending on birth-weight percentiles of 10 or ≥ 10, respectively. Data were collected about incidence and severity of ROP, as well as about relevant prenatal and postnatal risk factors for ROP. Statistical analysis consisted of the Fischer`s exact test or Student t-test, and logistic regression model for the significant risk factors. Results The study sample consisted of 184 very preterm infants, of which 65 were SGA and 119 AGA. Mean gestations were 29.47 and 29.13 weeks, and mean birth weights were 969.69g and 1329.66g in SGA and AGA group, respectively. ROP of any degree was diagnosed in 30 (46.15%) SGA and 29 (24.37%) AGA infants and severe ROP demanding intervention in 16 (24.61%) SGA and 15 (12.6%) AGA infants. In both cases, difference in incidence was statistically significant. After performing multivariate analysis with significant risk factors (gestation, cesarean section, Apgar scores in the 1st and the 5th minute, respiratory distress syndrome of 3-5 degree, endotracheal intubation, hypotension, red-blood cell transfusion), the difference between the groups was still significant, with p=0,001, aOR 3,61 for ROP of any degree, and p=0,025 and aOR 2,84 for severe ROP. Conclusion In our study of very preterm infants, being SGA represents higher risk for occurrence and severity of ROP.

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Neonatal Abstinence Syndrome (NAS): Unborn Victims Ashraf Hamdan Mednax Medical Group, USA NAS is a complex disorder defined as a constellation of behavioral and physiological signs and symptoms that are remarkably similar despite marked differences in the properties of the causative agent. There are two major types of NAS: NAS due to maternal use of substances that result in withdrawal symptoms in the newborn and postnatal NAS secondary to abrupt discontinuation of opioid medications used for pain in the newborn. Maternal substance abuse is a preventable cause of mental, physical, and psychological problems in infants. It has both medical and developmental consequences for the newborn, in addition to legal, health, and economic consequences for the mother. The incidence of NAS is difficult to determine because of unreliable histories of maternal drug abuse, limited health provider skills in eliciting drug histories and diagnosing difficulties. The large number of infants who suffer from NAS and the associated long-term morbidity mandate that affected infants be accurately identified and their treatment and support should be optimized. A multidisciplinary approach is essential including obstetricians, neonatologists, pediatricians, nurses, nutritionists, mental health professionals, social workers, substance abuse counselors, and child development specialists, at a minimum. Primary treatment of NAS should be supportive. Pharmacologic therapy can prolong hospitalization and exposes the infant to additional agents that are often not necessary. Pharmacotherapy for infants with more severe NAS is necessary to allow them to feed, sleep, gain weight, and interact with caregivers. Discharging otherwise healthy infant home once stable on treatment can reduce hospital stay and associated costs. However, a safe discharge of the infant requires that support structures within the home and community be available. This lecture is a literature review to describe the impact of intrauterine drug exposure on the fetus and newborn and to understand the pathophysiology, clinical picture and diagnosis of NAS.

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Effect of Surfactant Therapy in near Term and Term Neonates with Severe Pneumonia : A Randomized Controlled Trial NB Mathur Maulana Azad Medical College, New Delhi, India Pneumonia is the commonest form of neonatal infection contributing significantly to neonatal mortality. The objective of the present study was to evaluate the effect of surfactant therapy in near term and term neonates with severe pneumonia requiring mechanical ventilation on pulmonary functions, ventilator settings and duration of ventilation. The study was conducted in the Neonatal Intensive Care Unit of a tertiary teaching hospital.All neonates with gestational age 34 weeks with pneumonia requiring mechanical ventilation (Babylog 8000 )were enrolled. Exclusion criteria comprised of major congenital malformations and shock at admission. Fifteen neonates were enrolled in each group. Pneumonia was diagnosed on predefined clinical, radiological and laboratory grounds. Primary outcome parameter was pulmonary compliance (C) at 6 hours of surfactant therapy. Secondary outcome included Airway Resistance (R), tidal volume (VT), minute ventilation,(MV), arterial blood gases, ventilator settings and duration of ventilation. The study was approved by the institutional ethics committee and written informed consent was obtained.All enrolled neonates were randomized to receive or not receive natural bovine surfactant. The randomization sequence was generated using random allocation software in variable blocks and concealed by placing the group allocation in sealed opaque envelopes. Baseline variables including gender, age, weight, gestational age,severity of respiratory distress, C,R, VT,MV, PaO2, and ventilator settings were similar in both groups. After 6 hours, C, VT, MV, and PaO2 were significantly higher (p0.05) and Peak Inspiratory Pressure, Mean Airway Pressure, FiO2, and R significantly lower (p0.05) in the surfactant group. The duration of ventilation was significantly lower in the surfactant group. To conclude, surfactant therapy in neonatal pneumonia requiring ventilation was associated with significant increase in C, VT, MV, and PaO2, and reduction in ventilator settings at 6 hours. Duration of ventilation was significantly reduced in the surfactant group.

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Ring Chromosome 13, Case Report Diana Suarez1, Diana Suarez1, Gabriel del Castillo2, Yoisse Velasco2 1 Universidad Libre- Seccional Cali, Colombia 2 Hospital Infantil Los Ángeles, Colombia Background Ring chromosome 13 syndrome accounts for one-fifth of the ring chromosomes compatible with life. The estimated incidence is 1 in 58.000 live births. In most cases this chromosomal abnormality is a break in the terminal arms of chromosome 13, with the resulting loss of genetic material. Aim To describe a case of ring chromosome 13 syndrome diagnosed at birth and its phenotype/genotype correlation. Materials and methods A case report of a newborn with ring chromosome 13 syndrome and a correlation of the phenotype/genotype. Result Diagnosis was confirmed by G-banding. In this case the phenotype correlated with loss of genetic material critical area 13q34, corresponding to GroupI. Conclusions Ring chromosome 13 syndrome is a rare condition in our population, but must be taken into account in the presence of a newborn phenotype as described here.

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Extremely Preterm Infants Receiving Standard Neonatal Intensive care in the UK Receive very Low Levels of AA, DHA and EPA Laura de Rooy1,2, Simon C Dyall3, Hanady Hamdallah2 1 St George's University Hospital NHS Trust, UK 2 University of Roehampton, UK 3 Bournemouth University, UK Omega-3 and omega-6 polyunsaturated fatty acids (PUFA’s) are essential for normal brain development. Most brain fatty acid accretion occurs in the third trimester, and extremely preterm infants may therefore be at risk of a functional deficit. The preterm infants’ diet may include parenteral nutrition, banked human milk, maternal milk and formula milk. 24 infants 28 weeks gestation were recruited at a tertiary neonatal intensive care unit in London, UK, of which 17 completed the study. Milk and parenteral lipid intakes were recorded for 6 weeks. Milk samples of the infants’ majority intake were analysed at 6 time points, allowing estimates of fatty acid intakes. Intakes were compared with the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines and estimated accretion rates (Lapillonne and Jensen, 2009). Whole-blood fatty acid levels were measured at the end of the study period. The relationships between mean intake and PUFA blood levels were assessed by Pearson product-moment correlation coefficient. Mean intakes of AA, DHA and EPA were below ESPGHAN guidelines, with AA intakes significantly below guidance (p0.001). The amounts of AA and DHA available for accretion (28.6 (7.1) and 16.5 (4.9) mg/kg/day, respectively) were significantly below estimated accretion rates (both p 0.001). The cumulative deficit was 86.5% for AA, and 63.6% for DHA. There were significant correlations between mean DHA intake and blood DHA levels (r = 0.704, P = 0.002), mean AA intake and blood AA levels (r = 0.568, P = 0.017) and mean EPA intake and blood EPA levels (r = 0.572, P = 0.016). This is the first study to establish low omega-6 and omega-3 PUFA intakes for extremely preterm infants. Moreover, blood fatty acid levels are shown to be a useful measure of intake, where establishing a sufficient consumption of these PUFA’s could have clinical importance. Lapillonne, A., Jensen, C. L., 2009. Reevaluation of the DHA requirement for the premature infant. Prostaglandins Leukot Essent Fatty Acids 81, 143-150.

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Neonatal Characteristics and Perinatal Complications in Neonates with Down Syndrome Offra Engel2, Zivanit Ergaz-Shaltiel1, Ira Erlichman3, Yaron Naveh4, Michael S Schimmel4, Ariel Tenenbaum2 1 Hadassah Medical Center, Israel 2 Hadassah Medical Center, Israel 3 Hadassah Medical Center, Israel 4 Shaare Zedek Medical center, Israel Background The annual rate of Down syndrome (DS) births in Jerusalem is stable, regardless of prenatal screening and diagnostic measures. We aimed to evaluate our historical cohort for obstetrical characteristics and the neonatal course and complications. Methods Computerized files and discharged letters of neonates with the diagnosis of DS born in the four main hospitals in Jerusalem between the years 2000 to 2010 were reviewed and evaluated for maternal history and primary neonatal hospitalization. Results Four hundred and three neonates were diagnosed with DS. The average maternal age was 35.6 years, 73% were born via spontaneous vaginal delivery. In all gestational ages, the mean birth weight and head circumference percentiles were significantly lower than the general population (p Conclusions DS Infants were small for date with relative reduced head circumference. Despite increased rate of congenital anomalies and perinatal complications most of them were discharged home in a good medical condition and exclusively breastfed.

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The Incidence of Congenital Heart Disease Among Infants in Kolubara District, Serbia Dragica Dimitrijevic, Marija Mladenovic, Svetlana Markovic, Selimir Spasic General Hospital Valjevo, Serbia Objective Between countries there is a wide variation in congenital heart disease (CHD) detection rates depending of type of lesion and level of diagnostic opportunity. Aim: To investigate the incidence of CHD in infants in Kolubara district, Serbia Methods A retrospective study was performed using medical records of 7655 babies born during 6 year period, 20102015. We looked for those diagnosed with CHD during the first year of life, based on by clinical findings, electrocardiography, chest X-ray, echocardiography and, for some, catheterization. Also, we searched for the type of the lesion, genetic condition and other parameters that might point to the disease, such as prematurity, twin pregnancy and in vitro fertilization (IVF). Finally, we compered our results with similar studies. Results 92 infant, 50 girls and 42 boys, 78.26% born in term, were diagnosed with CHD, and the incidence rate was 1.2%.Most of the disease were mild, and the distribution was made up of 36.4%children with ventricular septal defect (VSD), 20.56% with atrial septal defect, 10.2% with patency of arterial duct, 6.5% with pulmonary valve stenosis, and 3.7% with aortic coarctation. Also, among identified infants, we found two with hypoplastic left heart syndrome, two with tetralogy Fallot, and one transposition of great arteries. Six patients (6.52%) were diagnosed with syndromes, 4 with Down, one with Treacher – Collins, and one with mutation in mitogen activated protein kinase. Most of our patients (89.13%) were from singleton pregnancy, and 6.52% from IVF. Two third of them were diagnosed during first week of life. All results are in agreement with similar studies. Conclusion The rates of specific CHD,both mild and severe and also the association with chromosome abnormalities are generally comparable with those reported in similar studies. The most prevalent lesion was VSD. Early detection of CHDs provides successfully treatment for those babies.

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A Novel Therapeutic Strategy for Cerebral Palsy: Feasibility of Umbilical Cord Blood Stem Cells and Umbilical Mesenchymal Stromal Cells HARUO SHINTAKU, HARUO SHINTAKU, MAKOTO NABETANI Objective A novel therapeutic strategy for prevention of cerebral palsy (CP) has been initiated in Japan. Hypoxicischemic encephalopathy (HIE) occurs in 0.5-1.0 per one thousand newborns and leads to CP. Therapeutic hypothermia (TH) improved mortality of newborns suffering with HIE, however it is not perfect therapy. We already started umbilical cord (UC) blood stem cells (UCBSCs) therapy for neonatal HIE in addition to TH. We also have been preparing to start a clinical trial of UC mesenchymal stromal cells (UC-MSCs) therapy for patients who did not have a sufficient effect or did not take the UC blood. Methods UCBSCs collection will be restricted to mothers who have given prior written informed consent for collection. UCBSCs was collected aseptically and non-cryopreserved autologous volume-reduced UCBSCs (up to 3 doses adjusted for volume) will be prepared by using SEPAX. UC-MSCs were collected aseptically from UC and isolated from the Wharton Jelly and cryopreserved after culture. Results UCB collection and infusion preparation in normal deliveries were as follows: (1) number of CD34 positive cells was more than 90%, and survival rate of CD34-positive cells remained at 99% at 72 hours after separation. (2) In the separation at SEPAX, to set on the machine, the minimum requirement of UCB volume was 40 ml, and exclusion criteria must be set for clotting of UCB collected at the time because valid cell separation and recovery becomes impossible. UC-MSCs have been defined and characterized as follows; (1) abundant sources and ease of collection, storage, and transport; (2) little ethical controversy; (3) multipotency to differentiate into various cell types; and (4) low immunogenicity with significant immunosuppressive ability. However, it took several months for a preparation for clinical use. Conclusions Good results in UCBSCs collection and infusion preparation were obtained when compared to the results of Cotten et al. (J Pediatr. 2014). UC-MSCs will be given the possibility of a treatment to patients who did not take the UC blood.

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A Novel Therapeutic Strategy for Cerebral Palsy: Feasibility of Umbilical Cord Blood Stem Cells and Umbilical Cord Mesenchymal Stromal Cells Haruo Shintaku1, Makoto Nabetani2, Takashi Hamazaki1, Satoshi Kusuda3, Masanori Tamura4, Sinichi Watabe5, Yoshiaki Sato6, Masahiro Tsuji7, Akihiko Taguchi8, Hiroyuki Ichiba9, Akira Oka10, Rintaro Mori11, Atsuko Taki12, Takeo Mukai13, Tokiko NagamuraInoue13 1 Osaka City University Graduate School of Medicine, Japan 2 Yodogawa Christian Hospital, Japan 3 Tokyo Women’s Medical University, Japan 4 Saitama Medical University, Japan 5 Kurashiki Central Hospital, Japan 6 Nagoya University Hospital, Japan 7 National Cerebral and Cardiovascular Center, Japan 8 Institute of Biomedical Research and Innovation, Japan 9 Osaka City General Hospital, Japan 10 The Tokyo University, Japan 11 National Center for Child Health and Development, Japan 12 Tokyo Medical and Dental University, Japan 13 University of Tokyo, Japan Objective A novel therapeutic strategy for prevention of cerebral palsy (CP) has been initiated in Japan. Hypoxicischemic encephalopathy (HIE) occurs in 0.5-1.0 per one thousand newborns and leads to CP. Therapeutic hypothermia (TH) improved mortality of newborns suffering with HIE, however it is not perfect therapy. We already started umbilical cord (UC) blood stem cells (UCBSCs) therapy for neonatal HIE in addition to TH. We also have been preparing to start a clinical trial of UC mesenchymal stromal cells (UC-MSCs) therapy for patients who did not have a sufficient effect or could not take the UC blood. Methods UCBSCs collection will be restricted to mothers who have given prior written informed consent for collection. UCBSCs was collected aseptically and prepared by using SEPAX. UC-MSCs were collected aseptically and isolated from UC, and cryopreserved after culture. Infants admitted to the NICU of 6 hospitals in our research group will be eligible if they are ≥36 weeks’ gestational age and birth weight ≥1800 g with HIE and meet the cooling criteria. Results UCBSCs therapy for neonatal HIE in addition to TH was performed in 3 newborn patients. All of them have survived from 3 months to 1 year. UC-MSCs have been defined and characterized as follows; (1) abundant sources and ease of collection, storage, and transport; (2) little ethical controversy; (3) multipotency to differentiate into various cell types; and (4) low immunogenicity with significant immunosuppressive ability. Conclusions Good results in combination therapy of UCBSCs and TH for newborn HIE were obtained in our 3 patients. UC-MSCs therapy will give the possibility of treatment to patients who could not get UC blood.

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New Approaches to the Treatment of Polycythemia in Newborns with Intrauterine Growth Retardation (IUGR). Andreeva A.A. D.O.Otta Research Institute of Obstetrics and Gynecology RAMS, St.-Petersburg , Russia Anna Andreeva, Anna Andreeva Polycythemia is observed every second child with IUGR, leading to disruption of the microcirculation in the lungs, myocardial dysfunction, cerebral ischemia. The goal was to explore the efficacy of pentoxifylline for the correction of polycythemia in newborns with IUGR. As the effectiveness of the treatment was used method of assessing the functional state of erythrocytes with the help of small-angle light scattering. A total of 25 newborns 36-40 weeks gestation with IUGR. The results showed that all the children in the first days of life had clinical symptoms of disorders of the nervous system - CNS hyperexcitability syndrome. According to the clinical blood test every baby had polycythemia (HGB - 22,6 ± 7,8; RBC - 6,3 ± 0,2; HCT 67,6 ± 2,5 ; MCV - 107,5 ± 1,5). Our research has shown that children with IUGR only 42% of red blood cells have a good deformation activity, whereas normally 68% (p 0,001) was found that the functional activity of erythrocytes decreased in polycythemia (R = - 0,6 (p0,001), and reducing the volume of red blood cells (r = 0,5 (p0,01). The results showed that the lower the percentage of haemolysis of red blood cells, the more severe neurological symptoms observed in children in the first days of life (R = - 0,92 (p0,05). For treatment of polycythemia were treated with the drug pentoxifylline at a dose of 5 mg/kg of 10% glucose, once a day at a rate of 5 ml/h the first three days. Control blood count showed the effectiveness of pentoxifylline to politsetemii correction (HGB - 189,4 ± 6,2 (0,05); RBC - 5,4 ± 0,2 (p0,05); HCT - 67,6 ± 2,5 (p 0,001); MCV - 102,7 ± 0,9 (p0,01). Indicators of haemolysis of red blood cells after treatment pentoksifilin – 53.2±0,66% (p0,05). Thus, we have shown the efficacy of pentoxifylline for the correction of polycythemia in newborns with IUGR.

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Campomelic Dysplasia in an Infant of Diabetic Mother: First Case Report Ketaki Mukhopadhyay, Sutirtha Roy, Pradipprava Paria West Bengal University of Health Sciences, India Campomelic dysplasia is a rare, often lethal osteochondrodysplasia associated with skeletal malformations and sex reversal. It occurs due to de novo mutations in SOX9 gene on chromosome 17. It is characterized by bowed femora and tibiae, Pierre Robin sequence, hypoplastic scapulae, talipes equinovarus, hip dislocation, male to female sex reversal and a high rate of neonatal mortality. A male newborn weighing 2700 grams was born at 40 weeks of gestation to a mother suffering from gestational diabetes. Clinical and radiological findings of Pierre Robin sequence, hypoplastic scapulae, congenital hip dislocation and bilateral bowed femora confirmed this case as campomelic dysplasia. No sex reversal was present in this patient and he has survived infancy. This is the first reported case of campomelic dysplasia in an infant of diabetic mother, though it has previously been reported in acampomelic campomelic dysplasia(without bowing of limbs).

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Can Repeated Attempts to Intubate Cause Gastric Perforation? – Case Report Ramona Dumitru, Gopi Vemuri Wythenshawe Hospital, UK Gastric perforation in neonates is a rare surgical emergency and life-threatening condition with uncertain etiology. Despite having high mortality rate, pathogenesis and etiology are greatly debated. Because of its high mortality rate, it requires prompt recognition and urgent surgical intervention. We report an interesting case of an incidental finding of gastric perforation in a premature neonate. A preterm infant of 29 weeks (Twin1 of MCDA Twins) born via EMCS due to reversed EDF in twin brother. Born in good condition, and need minimal intervention before admission to the neonatal unit. Chest X-ray after admission shows a NGT in place and picture consistent of RDS. Initially started on CPAP, and as the baby’s clinical condition worsened went on BiPAP and intubated at 22 hours of life. 4 attempts of intubation by junior staff with 5th successful by Consultant. After starting ventilation, UAC/UVC were inserted and position checked. Second X-ray indicated a good position for ETT, UVC and UAC as well as presence of air under diaphragm (suggestive of perforation) confirmed by lateral decubitus X-ray. Patient was tranferred and underwent surgical correction. During surgery, tiny perforation was noted on the greater curvature of stomach which was repaired. Entire bowel normal. Enteral feeds started after 72 hours. The particularity of this case is that its an incidental finding, probably within short time after occurance, with tiny perforation which did not have time to cause the symproms described in the literature (abdominal distension, feeding intolerance, respiratory distress, or poor activity). Therefore, we would like to emphasize, as frequently seen in case reports from literature, that when repeated attempts of intubation are performed, especially in premature babies gastric perforation seems to have a higher incidence. Secondly, as seen is this case, a systematic review of an Xray is important as sometimes leads in „finding the unexpected”

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Clavicle Fractures in Newborn – When Should we be Concerned? - Case Report Ramona Dumitru, Muthu Yeshwanth West Wales General Hospital, UK Injury during birth is a recognised cause of neonatal morbidity and mortality. Fracture of the clavicle is relatively common during a vaginal delivery and the incidence of fractured clavicle is between 0.4%-2.9% of all newborns according to the latest studies Up to 40% of clavicle fractures remain undetected while the baby is in hospital. Primary care health professionals will come across these undiagnosed clavicle fractures either incidentally or following parental concerns for a lump over the clavicle or not moving the upper limb properly. But when should we be concerned? When should a clavicle fracture should make us think also about safeguarding? We recently saw a case of a 4 days old newborn with a clavicle fracture which was detected during an examination as referred for different condition. The baby was born via normal vaginal delivery, no history of shoulder dystocia. Birth weight was 3.4kg. Baby had good movement of arms. Xray confirmed right-sided clavicle facture. Baby had been discharged from hospital 48h prior and newborn examination was normal at the time of discharge. Was it a missed clavicle fracture from birth or trauma occured while baby at home? Should we be concerned or should we assume it was missed? In our case, the baby and the parents underwent the safeguarding process, the police and social worker were involved but in the end it could not be determined with certainty which was the cause of the fracture. As the literature shows, the clavicle fractures are the most frequent both in the neonatal and in the childhood period and most of the times the treatment is non-surgical. We strongly believe that if there is no obvious and clear mechanism of occurrence, it is in the best interest of every child to be investigated in order to rule out trauma.

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Influence of Environment on Neonatal Renal Functions - Observational Study basavaraj patil, sandeep harshangi, simy matthew M R Medical college, India Objective To study the role of environmental factors in non asphyxial acute renal failure during summer months (April, May 2013). Methods 35 neonates out of 240, with fever, poor sucking and decreased urine output were admitted to the nursery from April to May 2013 were evaluated for presence of ARF. ARF was defined as blood urea nitrogen (BUN) 20mg/dl &/or creatinine level more than 1. 5mg/dl for at least 24-48 hours along with urine output 1ml/Kg/hr. Results 35 out of 240 neonates (14.5%) had ARF; only 20% was oliguric. The mean gestation of neonates with ARF was 38±2weeks (94%), males (71%). Factors including gestational age, weight, onset of sepsis, culture positivity, associated meningitis, prior administration of nephrotoxic drugs, mode of delivery, establishment of lactation, extramural or intramural were subjected to analysis for prediction of cause of ARF in neonates; sepsis, atmospheric temp and poor feeding by LSCS mothers causing dehydration were found to be a major predictor. ARF had recovered in 32 out of 35 neonates (91.4%); two babies succumbed to the disease, and 1 was referred to higher center. Conclusion General incidence of ARF in our study was high in the months of April and May (14.5%), 2013 when compared to other studies (1-8%) and also when compared to 0 cases in the month of November and December. This shows that seasonal variation like temperature and humidity has got an influence on ARF. Non oliguric ARF was commoner than oliguric ARF. Aggressive management is needed for better outcome. Dehydration and sepsis are a very important cause of non oliguric renal failure among neonates during summer months which can be easily prevented by proper, adequate counselling of mothers by pediatricians.

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Growth Velocity in Premature Babies Returning Home with Nasogastric Tubes in Situ Versus Those Remaining in Hospital Rhys Dore1, Frances O'Brien2 1 University of Oxford, UK 2 Oxford University Hospitals, UK Background The provision of feeds via nasogastric tubes is well established in neonatal units. The Home Tube Feeding Programme teaches parents to manage these in order for premature babies to return home with the tubes in situ. This hastens family bonding and reduces bed days per baby by about one week. Otherwise, maintaining adequate growth velocity is a prime concern in premature babies to reduce the risk of adverse neurological outcomes. Objective To review the growth velocity of babies on a home-feeding program during the period in which they would otherwise be in hospital; and then to compare this to babies who could have returned home during this period but did not due to parental choice. Methods Premature babies discharged from the neonatal unit in the past 26 months were included if home tube feeding (n=115) or non-home tube feeding despite fulfilling criteria (n=81). Data were retrospectively collected from a national neonatal database and patient records. Growth velocity was calculated for the week post-discharge in those on the program, and the week pre-discharge for those not. Scores were compared using appropriate statistical analyses with Microsoft Excel and SPSS. Results Growth velocity (g/kg/day) was higher in babies on home tube feeding than those not on the programme (15.6±12.3 vs 10.4±6.2, p0.003). Baseline characteristics of gestation at birth, weight at birth and feeding method (breast/formula/mixed) did not vary between the two groups (p=0.242, p=0.08, p=0.409 respectively). Limitations Only 62 of 115 notes from babies on home tube feeding could be retrieved. Also, multiple growth velocity outliers were present but excluding these did not remove significance. Conclusion Parents can be reassured that premature babies returning home early with nasogastric feeding tubes have a slightly, yet significantly, higher growth velocity than their counterparts remaining in hospital.

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Mouth Breath Problem in Childhood Ekaterina Mirzabekyan1, Galina Tarasova2, Ekaterina Mirzabekyan4, Gunaj Ramazanova3 1 Federal Scientific Clinical Center of Otorhinolaryngology., Russia Mouth breathing problem in childhood is still persist. Dentoalveolar anomalies (found in 42.7% of children) together with nasal cavity and nasopharynx inflammatory diseases occupied the leading position among the factors that determine it. The elimination of these reasons makes it possible to correct breathing type formation that leads to harmonious facial profile development. The purpose of our study was to develop the tactics of mouth breathing patients management. Design We examined 39 children aged 4 to 9 years with the presence of mouth breathing. The examination included medical history, otorhinolaryngological and orthodontic examination, nasal cavity and nasopharynx endoscopic examination, rhinomanometry and acoustic impedance measurement. Results Nasal breath possibility was completely preserved 25.6% of patients despite different malocclusion types presence, which were often combined with a gothic palate. 28.2% of children had nasal cavity and nasopharynx diseases (including allergic) chronic inflammation in combination with these anatomical regions architecture violation. 46.2% of the children have different types of occlusion disorders in combination with inflammatory changes in nasal cavity and nasopharynx. Patient management tactics included miogymnastics, respiratory gymnastics, nasal irrigation. In malocclusion case - preortodontical trainers wearing. Monitoring of patients lasted from 3 to 12 months. None of the children has not been assigned to surgery. Upon completion of the study, mouth breath transition to the nasal type of breathing took place in 32 (82.1%) patients, in 6 children had a mixed type of breathing, and only one child remained mouth type of breathing. Conclusion Orthodontist consultation should be included to child examination complex in case of mouth breath presence. Joint ENT and orthodontic management with preortodontic trainers and conservative methods of treatment use helps to restore nasal breathing without surgery.

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Status Quo in Pediatric and Neonatal Simulation in the European German- Speaking Countries: The DACHI Survey Michael Wagner, Michael Wagner1, Ellen Heimberg2, Lukas P Mileder3, Alex Staffler4, Angelika Berger1, Ruth M Löllgen5 1 Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Austria 2 Department for Pediatric Cardiology, Pulmonology, Intensive Care Medicine, Germany 3 Division of Neonatology, Austria 4 Division of Neonatology, Italy 5 Pediatric Emergency Department, Switzerland Background Simulation has acquired wide acceptance as an important component of education in health care. While the simulated practice of important competencies in critical situations has been well established in most AngloSaxon countries, simulation training is still not established in many European countries. Material and Methods The authors of this article and founding members of the Netzwerk Kindersimulation aimed to survey all pediatric and neonatal health care institutions in Germany (D), Austria (A), Switzerland (CH) and South Tyrol (I) (DACHI) on their current status of pediatric and neonatal simulation-based training (SBT). We composed a online survey including 26 questions on the organization of SBT. The questionnaire was validated according to established models including a pre-test and distributed electronically by the online tool SurveyMonkey®. Results After dispatching a total of 474 surveys (n=359 in D, n=42 in A, n=66 in CH and n=7 in I) we achieved a 45.5% response rate, with 143 responders from D (39.8% in D), 36 from A (85.7% in A), 31 from CH (46.9% in CH) and six from I (85.7% in I). In 62.5% of all surveyed institutions, SBT is already performed, including standardized algorithm courses (87.2%), skill training (63.3%), and high fidelity simulation training (58.1%). Only 16% of all inquired institutions actively conduct research in the area of simulation, whereas 71% did express an interest. The most frequently stated impediments for establishing SBT were lack of personnel (56.6%) and financial resources (61.8%). Discussion and Conclusion The results underline the presence of a previously unknown, strong interest in pediatric and neonatal simulation in the DACHI region. Our findings provide an initial position for the advocacy and expansion of simulation in pediatrics. This questionnaire will support a more effective collaboration among all simulation enthusiasts in this region aiming to ultimately increase safety for children and neonates.

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The Factor Associated to Oral Feeding Competency in Preterm infant Putri Maharani Tristanita Marsubrin, Rinawati Rohsiswatmo, Oryza Sativa Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia Background Preterm infants experience oral feeding difficulties due to underdeveloped oral motor skills and lack of coordination between sucking, swallowing, and respiration. Ability to oral feeding is one of maturity feeding skill that had to be reached. Therefore, difficulty to achieve oral feeding leads to longer hospital stay and higher cost. Aim To describe Method

the

onset

of

oral

feeding

ability

and

its`

associated

factors.

A retrospective study was performed between October-December 2015 in Neonatology Unit, Department of Pediatrics, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine,Universitas Indonesia, Jakarta, Indonesia. The inclusion criteria was infants whom gestational age (GA) between 28-34 weeks. Subjects were divided into 28-31 weeks GA (group A) and 32-34 weeks GA (group B). Those with congenital anomaly were excluded. Results Thirty three subjects were included, mean GA was 31.3+1.9 weeks and mean birth weight (BW) was 1485+290.3 grams. The median onset to achieve full feed was 14(5-42) days in group A and 11.6(0-40) in group B. While, mean onset to achieve oral feed was 35+9.8 days in group A and median was 25(1-65 days) in group B. Mean hospital stay was 36.8+19.7 days in group A and 29.9+15.8 days in group B. There were no correlation between enteral feeding(p=0.302), also patent ductus arrteriosus (PDA) (p=0.317) with onset to achieve oral feeding. Correlation was found between sepsis (p=0.042), intraventricular hemorrhage (IVH) (p=0,02), duration of oxygen therapy (p=0.001) with onset to achieve oral feeding. Onset to achieve oral feeding was correlation with shortened hospital stay (p=0.000). Conclusions There are several concerning factors associated with the onset to achieve oral feeding, such as sepsis, IVH, and duration of oxygen therapy.

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Early Enteral Feeding and Incidence of Necrotizing Enterocolitis in Preterm Infant putri maharani tristanita marsubrin, Rinawati Rohsiswatmo, Oryza Sativa Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia Background Early enteral feeding is still a challenge in management of premature infants, especially in very low birth weight infants associated with small gestational of age. Necrotizing enterocolitis phobia (NEC phobia) often hence neonatologists to advance the feeding to preterm infants. Aim To describe the incidence of NEC in early feeding and its correlation. Method A retrospective study was performed between October-December 2015 in Neonatology Unit, Department of Pediatrics, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. The inclusion criteria was infants whom gestational age (GA) between 28-34 weeks. Subjects were divided into 28-31 weeks and 32-34 weeks. Those with congenital anomaly were excluded. Early enteral feeding was defined as giving enteral feeding within 24 hours, while after 24 hours was defined as delay enteral feeding. Results 33 subjects were included, the mean GA was 31.3+1.9 weeks and the mean birth weight (BW) was 1485+290.3 grams. Median onset of enteral feeding was 47(15-192) hours in 28-31 weeks GA group and 24(2-264) hours in 32-34 weeks GA group. Early enteral feeding was performed in 45.5% subjects. Fifty percents subjects had delay enteral feeding due to gastric juice`s color changes. No incidence of NEC was found in both groups. There was no correlation between giving early enteral feeding with sepsis (P=0.613), but giving early feeding associated with shorter hospital stay (P=0.017) and onset to achieve full feed (p=0.02). Conclusion No incidence of NEC is found in preterm infants receiving early enteral feeding. There is no correlation between early enteral feeding with NEC.

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Use of Passive Hypothermia Before the Installation of Selective Head Cooling Treatment in Moderate to Severe Hypoxic-Ischemic Encephalopathy Pablo Tietzsch, Alejandro Moguel, Saul Garza, Leonel Martinez, Jose Luis Ramirez, Jose Iglesias, Isabel Bernardez Hospital Español, Mexico Hypoxic-ischemic encephalopathy is a source of high morbidity and mortality. Therapeutic hypothermia is known to be a treatment approved for hypoxic-ischemic encephalopathy in late preterm and term infants, hypothermia reduces brain energy utilization, decreasing free radical production and release of excitatory neurotransmitters, these combined reduce neuronal apoptosis. This treatment significantly reduces neurologic injury outcome. It has to be installed in the first 6 hours after birth. Our criteria for hypothermia, includes neonates from 36 weeks gestation, weight higher than 1800 grams, ph 7.00 or lower within 60 minutes of birth and a base deficit 16 or higher, ventilation support for more than 10 minutes after birth, APGAR score lower than 5 at 5 minutes, clinical data for moderate to severe encephalopathy, seizures, lethargy, coma, hypotonia, abnormal reflexes, and abnormal suck. This Study includes 2 cases in a private hospital in Mexico City, both with criteria for hypothermia therapy and clinical data of either moderate or severe encephalopathy. We implemented passive hypothermia for 2 to 4 hours while waiting for the selective head cooling device to arrive, we started the decrease of core temperature (34-35ºC) with cold blanquettes and shutting off the radiant warmer. We followed the protocol for 72 hours of hypothermia with gradual warming, after getting to a normal temperature, the follow up in both cases was with imaging, electroencephalographic studies, rehabilitation therapy and subsequent evaluation till the age of 2 months with improvement in the prognosis in both cases. In conclusion we observe that starting with a passive hypothermia has no adverse effects nor is contraindicated in the use of hypothermia as treatment for moderate to severe encephalopathy in hospitals that do count with the hypothermia device, in both cases we had an adequate evolution of our patients proving it reduces cerebral injury and improves neurological outcome.

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The Research About Genetic Mechanism of a Case of Mosaic of Trisomy 8 that has No Clinical Symptoms Peiqiong Li1, Fang Wang1, Jun Zhang2 1 Guangzhou Medical University, China 2 The Third Affiliated Hospital of Sun Yat-sen University In our study, we found a rare case of abnormal chromosome number, the patient with a history of abortion who has no obvious clinical symptoms. However, the peripheral blood karyotype of this case is 47, XX, +8. So we carry out some research to find the cytogenetic and molecular genetic mechanisms of this rare case. Objective To explore the reasons of the patients with pure trisomy 8 in peripheral blood who has no obvious clinical symptoms and source with these chromosome 8 ,as well as exploring whether there is randomly inactivated by methylation regulation in these three chromosome 8 that make the patient normal. Methods and results The patient’s peripheral blood karyotype is 47，XX，+8; 2、The total DNA genotype for peripheral blood of patients with is 47，XX，+8. What’s more, all these three chromosome 8 is different; 3、The total DNA SNP amplification sequencing from the patient`s hair follicles, oral mucosa results showed that the two organizations karyotype are 46, XX / 47, XX, +8; 4、The bisulfite sequencing results showed that the gene EXT1 and GATA4 promoter CpG island from peripheral blood of patients was unmethylated. Conclusions 1. Patient’s peripheral blood nucleated cells karyotype is 47, XX, +8, and the extra chromosome is due to the first meiotic division separation; 2. Patient’s hair follicles and oral mucosa are mosaic of trisomy 8; 3. The peripheral blood of patients with homozygous trisomy 8 who has no obvious clinical symptoms is not a result of the the methylation regulation mechanism that make the additional chromosome 8 inactivation. Key word: trisomy 8；mosaicism；genetic ；mechanism ； methylation

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Therapeutic Hypothermia: Effect on Respiratory Condition in Neonates Itamar Nitzan1, Shmuel Goldberg2, Cathy Hamerman1, Francis Mimouni1, Ruben Bromiker1 1 Shaare Zedek Medical Center, Israel 2 Shaare Zedek Medical Center, Israel Background Moderate Therapeutic Hypothermia (MTH) is used for neuroprotection in neonates with neonatal encephalopathy. Hypothermia decreases metabolic requirements, cardiac output and respiratory rate, and shifts the hemoglobin-oxygen dissociation curve leftward, towards higher affinity. Methods A retrospective study including all neonates treated with MTH (33.5° C) in the Neonatal Intensive Care Unit (NICU) of the Shaare Zedek Medical Center (SZMC) Jerusalem, Israel, from January 2008 until September 2015. We collected data from NICU records on neonates respiratory and medical condition including: Fraction of Inspired Oxygen (FIO2), arterial blood saturation as measured by pulse oximeter (SpO2) and arterial blood saturation as measured by co oximeter (SaO2), from birth until 24 hours after rewarming. Results Thirty neonates’ records were evaluated. 12 neonates suffered respiratory deterioration (needed higher FIO 2 or respiratory support or had new onset desaturations with no change in the level of ventilatory assistance) during the 24 hours after rewarming versus 3 with respiratory deterioration in the 24 hours before rewarming (p=0.016). Despite higher FIO2 after rewarming, SpO2 declined from 96.9% (+2.9) before rewarming to 95.2% (+ 2.6) after rewarming (p0.001). Discussion Our study shows that neonates who underwent MTH require higher FiO2 and their SpO2 decrease after rewarming. Possible explanations for these findings include: shifting of the hemoglobin-oxygen dissociation curve towards higher affinity, and lower metabolic requirements and oxygen consumption during MTH. The fact that more than third of the neonates clinically deteriorated after rewarming supports the second explanation. Conclusions During MTH neonates have higher SpO2 and they require less oxygen. After rewarming the clinician should expect, and monitor for possible respiratory deterioration. These results raise the possibility of using MTH as an option for rescue treatment for respiratory insufficiency unresponsive to conventional treatment. Further studies are needed to assess these conclusions.

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Pulmonary Hemorrhage (PH) in Extremely Low Birth Weight (ELBW) Infants: Risk Factors and Outcome. VICTOR SAMUEL RAJADURAI, Sook Lin Loo, Jia Hui Lee, Pratibha Agarwal KK Women's and Children's Hospital, Singapore, Singapore Objective To determine the incidence, risk factors and outcomes of ELBW infants who developed pulmonary haemorrhage. Study Design & Methods Retrospective cohort study over a 5 years period (Jan 2011 – Dec 2015 ) of ELBW infants born in a tertiary perinatal center. PH was defined as the presence of frank red blood per endotracheal tube and associated with a need for increased respiratory support. Clinical characteristics, morbidities and mortalities were compared between infants with and without PH. Results Out of the 386 ELBW infants, 35(9%) had PH. Gestational age ≤ 25 weeks 26(74%) vs 143(41%) p0.0001 and birth weight ≤800g 28(80%) vs 192(54.7%) p0.005 were significantly higher in infants with PH. Incidence of Respiratory distress syndrome (RDS) 28(80%) vs 162(46%) p 0.001, need for high frequency oscillatory ventilation (HFOV) 31(89%) vs 117(33%) p 0.001, hypotension 22(63%) vs 90(26%) p 0.0001 and significant PDA 20(77%) vs 157(56%) p = 0.038 were also significantly higher in the PH group. Antenatal steroid use, Apgar score ≤ 5 and incidence of SGA were not significantly different between the groups. PH was associated with higher incidence of severe intraventricular hemorrhage (IVH) ≥ grade III 13(37%) vs 26(7.5%) and greater mortality 20(57%) 49(14.4%) p0.0001. Conclusions In extremely preterm infants the risk factors for developing PH were gestational age ≤ 25 weeks, birth weight ≤ 800g and significant PDA. PH was associated with severe IVH and greater mortality.

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Association of Extracellular Superoxide Dismutase with Respiratory Distress Syndrome and the Development of Bronchopulmonary Dysplasia. Przemyslaw Kicinski1, Krystyna Wyka2, Beata Malachowska2, Ewa Gulczynska1 1 Polish Mother’s Memorial Hospital - Research Institute, Poland 2 Medical University of Lodz, Poland Aim Assessment of the correlation between the serum extracellular superoxide dismutase (SOD3) concentration and respiratory distress syndrome (RDS) and the development of bronchopulmonary dysplasia (BPD) in infants born before 32 weeks of gestation with a birth weight ≤1500g. Material and methods The study involved 103 neonates born at the Polish Mother’s Memorial Hospital-Research Institute in the years 2013-2014. Serum SOD3 level was determined in all infants on day 1 and 7 of life. Results Median gestational age was 28.9 weeks (IQR 27.4-30.1), whereas median birth weight 1100g (IQR 9501300). RDS was diagnosed in 100 infants: grade I in 23%, II in 61%, III in 15% and IV in 1%. No association was found between the RDS grade of severity and SOD3 concentration on day 1 of life, R=0.18, p=0.0675. Surfactant was administered in 71.8% of infants, to 16.2% of them it was administered twice. No correlation was observed between the number of administered surfactant doses and the difference in SOD3 concentrations between day 7 and 1 of life, R= -0.06, p=0.5435. Neither was there noted the correlation between RDS grade and the difference in SOD3 concentrations between day 7 and 1 of life, R= -0.13, p=0.1882. On day 28 of life BPD was diagnosed in 49,5% of infants and it was not diagnosed in 50.5% of them. No statistically significant correlation was detected between serum SOD3 concentration on day 1 and 7 of life and the development of BPD, respectively: p=0.3625 and p=0.4597. Conclusions The study did not demonstrate the association between the serum SOD3 concentration and the severity of RDS and the risk for developing BPD. Neither was there a correlation between SOD3 concentration and the number of administered surfactant doses.

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The Role of Glutathione Peroxidase-1 and Selected Risk Factors in Necrotizing Enterocolitis in Very Low Birth Weight Infants. Przemyslaw Kicinski1, Krystyna Wyka2, Beata Malachowska2, Ewa Gulczynska1 1 Polish Mother’s Memorial Hospital - Research Institute, Poland 2 Medical University of Lodz, Poland Aim To assess the correlation between: the concentration of glutathione peroxidase-1 (GPx1) and selected risk factors and the development of NEC in infants born before 32 weeks of gestation with a birth weight ≤1500g. Material and methods The study comprised 106 neonates born at the Polish Mother’s Memorial Hospital-Research Institute in the years 2013-2014. NEC was diagnosed in 7 infants, the mean age at diagnosis was 20.4±10.4 day of life. Serum GPx1 level was determined in all infants qualified for the study on day 1 and 7 of life. Results Median gestational age was 27.3 weeks (IQR 26.7-28.0) in the NEC group, whereas 29.0 weeks (IQR 27.430.1) in the group without NEC, p=0.0697. A statistically significant difference was found for the birth weight between the investigated groups: 820g (IQR 700-1050) vs. 1140g (IQR 950-1300), p=0.0089. Among the analyzed factors, a statistically significant difference between the analyzed groups was found for: congenital infection 85.7 % vs. 36.7%, p=0.0149 and Apgar score at 1` 5.0 (IQR 5.0-6.0) vs. 6.0 (IQR 6.07.0), p=0.0055, Apgar score at 5` 6.0 (IQR 5.0-6.0) vs. 7.0 (IQR 6.0-7.0), p=0.0121, the severity of respiratory distress syndrome (RDS) 2.0 (IQR 2.0-3.0) vs. 2.0 (IQR 1.0-2.0), p=0.0361. No statistically significant correlation was found between serum GPx1 level on day 1 of life in the investigated groups 19.48ng/ml (IQR 15.76-49.67) vs. 16.52ng/ml (IQR 10.38-25.88), p=0.1435. However, on day 7 of life the GPX1 level was statistically higher in the group with NEC as compared to that in the group without NEC, respectively 28.27ng/ml (15.54-52.36) vs. 15.46ng/ml (IQR 10.38-22.08), p=0.0381. Results The study demonstrated statistically significantly higher GPx1 level on day 7 of life in the group with NEC. Among the analyzed factors a statistically significant difference was observed for: the birth weight, congenital infection, Apgar score at 1 `and 5` and the severity of respiratory distress syndrome.

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Lower Gastointestinal Bleeding in Infants- Case Presentation Tanasescu Sonia1, Ioana Ciuca1, Cristina Dragomir2, Simona Muntean2, Ioana Pacurar2, Dorin Tanasescu3, Liviu Pop1 1 University of Medicine and Pharmacy Victor Babes Timisoara, Romania 2 Emergency County Hospital Timisoara, Romania 3 Emergency County Hospital Timisoara, Romania Gastrointestinal hemorrhage is an emergency in pediatric pathology which may involve any part of the gastrointestinal tract. The causes of digestive hemorrhage in infants vary from congenital or acquired bleeding disorders due to allergies. Treatment in lower digestive hemorrhage should be gradually: evaluating the bleeding, haemodynamic status of the infant, and a list of possible diseases. The authors present two cases of lower digestive hemorrhage in infants aged between 1 and 5 months. Case 1. Infant of 1 month old fed artificially coming from mother with a history of aspirin consumption in late pregnancy is as normal stool consistency but mixed with fresh blood. Usual investigations revealed a slightly increased APTT, the rest of the investigations including scintigraphy were normal. Case 2. A five months old infant, artificially fed, with gastroesophageal reflux was hospitalized for vomiting fresh blood (2 vomiting episodes) followed by a period of 2 weeks of streaked stool with blood. Paraclinic investigations did not revealed anything pathological. In the first case, the evolution was favorable after treatment with Ranitidine and Vitamin K injection, while Case 2 was evolving slowly favorable with the extinction of lower gastrointestinal bleeding by replacing food with highly hydrolyzed milk , representing a sample therapeutics for cow`s milk protein nonmediate Ig E allergy. Keywords: digestive hemorrhage, hemorrhagic disease, allergy to cow`s milk protein.

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Cortisol, DHEA and DHEAS concentrations in claws collected by newborn dogs during the first 60 days of age: preliminary results Maria Cristina Veronesi1, Barbara Bolis1, Marta Montillo2, Antonella Comin2 1 Università degli Studi di Milano, Italy 2 University of Udine, Italy Despite the extremely high perinatal losses in dogs, canine perinatology remains mostly unknown because of the difficult blood samples serial collection in newborns, and also because of ethical limitation. Coat and claws can be collected without invasiveness and are suitable for long term retrospective measurement of hormones accumulation, in dogs. Among several parameters, cortisol (C), dihydroepiandrosterone (DHEA) and dihydroepiandrosterone sulphate (DHEAS) are crucial for the fetal to neonatal transition and for neonatal adaptation. This study was aimed to preliminary investigate the cortisol, DHEA and DHEAS concentrations in claws, collected without invasiveness in 7 newborn dogs at birth, and at 30 and 60 days of age. Puppies, from a single litter, were born by elective Caesaeran section at term of a normal pregnancy. At birth puppies were mature, viable, healthy and normal weighed; they remained healthy and with normal development during the following 60 days. The claws of the four legs were trimmed at birth, and trimmed again, collecting only the claws regrowth, after 30 and 60 days. For each sampling time, individual pool of claws were stored until analysis by RIA. Cortisol decreased from 55.1±24.74 pg/mg at birth to 22.2±7.87 (p0.01) at 30 days, and to 9.1±3.36 at 60 days (p0.0001); DHEA decreased from 452±212.30 pg/mg at birth to 195±252.04 at 30 days, and to 43±9.13 at 60 days (p0.01), while DHEAS decreased from 208±95.35 pg/mg at birth to 135±79.44 at 30 days, and to 45±13.98 at 60 days (p0.01). These results showed that the highest accumulation occur during the second half of gestation, during the fetal development, but the still high C, DHEA and DHEAS levels at 30 days, seems to suggest also a role of these hormones in the period of long neonatal adaptation in the altricial-inept progeny typical of dogs.

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Breastfeeding Children in the First Year of Life the Municipality of Niksic Sanja Cizmovic1, S. Grubac1, B. Vucic2 1 General Hospital Niksic, Montenegro 2 Primary health care Niksic, Montenegro Introduction Breast milk is irreplaceable and invaluable nutrition in the first six months of life and after, when babies start eating solids. Many scientific studies point to a lifelong benefits of breastfeeding past infancy. Breastfeeding is the most beautiful and the strongest bond between a mother and a child. Objective To analyse breastfeeding rates in the first year of life in various stages of infancy period. Materials and Methods Randomly selected sample of 265 infants born from 2010 to 2012, with the total number of 2637 deliveries. With all the examinees we analysed the length of exclusive breastfeeding as well as combining the breast milk with formula. Results The rate of exclusively breastfed children in the first month of life was 69.8% or 185 children. In the third month it was 47.9%, or 127 children. The number of exclusively breastfed children in the first six months was 103, or 38.8%, and in the ninth month 88 children, or 33.2% was still breastfeeding along with the intake of solids. By the end of the first year, the number of breastfed children was 69, or 26.03%.Breastfeeding and supplementing with formula was most common in the third month and was up to 28.19% and later decreased. Conclusion Exclusive breastfeeding rate was highest in the first month then it gradually decreased until the end of the first year. It is of great importance to continue the work on the promotion of exclusive breastfeeding and increase the breastfeeding rates.

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Platelet Serotonin Level in Newborns with Intrauterine Growth Restriction Nataliia Zvereva1, Yuliya Milyutina2 D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Russia 2 D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Russia 1

Serotonin plays an important role in the newbornsbrain morfo-functional development. Platelets are the blood serotonin tank; there have the identical features to serotonin brain neurons (Oreland L., Lesch K.P.). We have studied the platelets serotonin level in newborns with intrauterine growth restriction (IUGR) 20 newborns with IUGR have been examined on the first day of life. The IUGR cause was the placental insufficiency. The newborns gestational age was 37-40 weeks. Body weight - 2412,5±71,83 g, height 47,26±0,57 cm. The Apgar score was 7-8 points. The tone and reflexes were estimated with the C. AmielTison and S.A. Dargassies tables. 30 healthy term infants comprised the control group. Their gestational age was 38-40 weeks. Body weight 3542,6±75,09 g, height - 51,49±0,32 cm. The Apgar score was 7-9 points. To detect the platelets serotonin level we have used the high-performance liquid chromatography with electrochemical detection (with the column Reprosil 80 ODS-2, Germany and analytical cell - model 5100A Coulochem II, ESA, USA). The platelets serotonin level in IUGR newborns was 0,414±0,089 nmol / 10⁹ Tr against 1,017±0,158 nmol / 10⁹ Tr in the control group (Р 0,01). It can be a consequence of the chronic intrauterine hypoxia and can define the central nervous system development delay, that is shown in a tonic and reflex reactions formation delay and the cyclic organization of a dream formation disturbance.

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A Novel Therapeutic Strategy for Cerebral Palsy: Feasibility of Umbilical Cord Blood Stem Cells and Umbilical Cord Mesenchymal Stromal Cells Haruo Shintaku1, Haruo Shintaku1, Makoto Nabetani2, Takashi Hamazaki1, Satoshi Kusuda3, Shinichi Watabe5, Masanori Tamura4, Masahiro Hayakawa6, Yoshiaki Sato6, Masahiro Tuji7, Akihiko Taguchi8, Hiroyuki Ichiba9, Akira Oka10, Rintaro Mori11, Atsuko Taki12, Takeo Mukai13, Tokiko Nagamura-Inoue13 1 Osaka City University Graduate School of Medicine, Japan 2 Yodogawa Christian Hospital, Japan 3 Tokyo Women’s Medical University, Japan 4 Saitama Medical University, Japan 5 Kurashiki Central Hospital, Japan 6 Nagoya University Hospital, Japan 7 National Cerebral and Cardiovascular Center, Japan 8 Institute of Biomedical Research and Innovation, Japan 9 Osaka City General Hospital, Japan 10 The Tokyo University, Japan 11 National Center for Child Health and Development, Japan 12 Tokyo Medical and Dental University, Japan 13 Institute of Medical Science, University of Tokyo, Japan Objective A novel therapeutic strategy for prevention of cerebral palsy (CP) has been initiated in Japan. Hypoxicischemic encephalopathy (HIE) occurs in 0.5-1.0 per one thousand newborns and leads to CP. Therapeutic hypothermia (TH) improved mortality of newborns suffering with HIE, however it is not perfect therapy. We already started umbilical cord (UC) blood stem cells (UCBSCs) therapy for neonatal HIE in addition to TH. We also have started a basic to preclinical research of UC mesenchymal stromal cells (UC-MSCs) therapy for patients who are not eligible for UC blood therapy. Methods UCBSCs collection will be restricted to mothers who have given prior written informed consent for collection. UCBSCs was collected aseptically and prepared by using SEPAX. UC-MSCs were aseptically collected and isolated from UC and isolated from the Wharton Jelly and cryopreserved after culture. Infants admitted to the NICU of 6 hospitals in our research group will be eligible if they are ≥36 weeks’ gestational age and birth weight ≥1800 g with HIE and meet the cooling criteria. Results UCBSCs therapy for neonatal HIE in addition to TH was performed in 3 newborn patients. All of them have survived from 3 months to 1 year. UC-MSCs demonstrated to have neurogenic differentiation in vitro with persistent migration ability and significant anti-inflammation ability. Conclusions Good results in combination therapy of UCBSCs and TH for newborn HIE were obtained in our 3 patients. UC-MSCs therapy may give the possibility of treatment to patients who could not take UC blood.

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Prenatally diagnosed central nervous system (CNS) malformations: Fetal, neonatal and neurodevelopmental outcome at 5 years of age Odattil Geetha1, Yeo Seow Heong2, Victor Samuel Rajadurai1, Bhavani Sriram1 1 KK Women's and Children's Hospita, Singapore 2 KK Women's and Children's Hospital, Singapore OBJECTIVE: Objectives are 

To study the fetal and neonatal outcomes of prenatally diagnosed CNS malformations.



To evaluate the neurodevelopmental outcome of the survivors at 5 years of age.

Methods Maternal and neonatal records of prenatally diagnosed CNS malformations were retrospectively reviewed over a 5-year period (January 2005 till December 2009). The relevant fetal and neonatal data were collected from the database maintained by birth defect registry. The long term neurodevelopment data was obtained from case records. Results There were 116 structural CNS malformations of which 80(68%) had termination of pregnancy or foetal deaths. Anencephaly accounted for 37(46%) of the terminations. Out of the remaining 43(54%) cases, 17(40%) were neural tube defects, 7(16%) holoprosencephaly, 4(9%) agenesis of corpus callosum, 6(14%) cerebellar lesions, 5(12%) posterior fossa lesions and 4(9%)others. Out of the 36 total live births, 6 had anencephaly and all of them died. In addition there were 5(16%) other deaths. Five (16%) infants needed ventilatory support and 5(16%) had surgical intervention during the neonatal period. The five year neurodevelopmental outcome revealed 11(37%) children with global developmental delay and they had moderate or severely disability. Their disorders were Arnold Chiari malformations (2), holoprosencephaly (2), schizencephaly (2), Dandy-walker malformations (2), hydrocephalus (2) and periventricular calcifications due to undetermined aetiology(1). Only 7(23%) children had normal development and 7(23%) defaulted follow up. Conclusion: More than two-thirds of prenatally diagnosed CNS malformations underwent termination of pregnancy or foetal deaths. More than one-third of survivors who were followed up had global delay and need for support services.

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Lead and Cadmium Content in Newborns with Impaired Kidney Function Due to Asphyxia Andrii Loboda Sumy State University, Ukraine Such metals as lead (Pb) and cadmium (Cd) are ubiquitous persistent environmental toxicants known to bioaccumulation in the human body. The main source for raising the level of heavy metals in the tissues of newborn is transfer through the placenta to the fetus during pregnancy. The aim of the investigation is explore the features of the content of toxic microelements (Pb and Cd) in serum and erythrocytes of newborns with kidney injury due to asphyxia. Investigation included 200 full-term newborns with the signs of renal injury: 100 neonates suffered severe asphyxia, and 100 babies suffered moderate asphyxia. A comparison group comprised 20 healthy infants. Blood was collected on the 1–2, 7–8 and 25-30 days of life. The electrolyte’s content in blood serum and erythrocytes was determined by atomic absorption spectrophotometry. Increased serum Pb content was typical for all newborns with impaired renal function due to asphyxia during the neonatal period. For newborns with kidney injury due to asphyxia was typical relative hypercadmiemia, which is stored during early neonatal period in case of severe asphyxia. Newborns with kidney damage due to moderate asphyxia demonstrated on 25% (p0,05) higher level of Pb in erythrocytes on 1-2 day of life relative to healthy children. This level was stable during remaining part of the survey. Maximal concentrations of Pb in erythrocytes during 1 month of life were typical for newborns with kidney damage due to severe asphyxia. Both groups of neonates demonstrated statistically high Cd concentration in erythrocytes during early neonatal period and decrease its content (p0,05) to the end of neonatal period. For newborns with impaired renal function were typical high levels of Pb and Cd in blood serum during early neonatal period in case of moderate asphyxia or predominantly during whole 1 month of life in case of severe form.

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Risk Factors for White Matter Abnormality in Extremely Preterm Infants with Neonatal Sepsis Ju Sun Heo1,2, Ee-Kyung Kim1, So-Yeon Shim3, Seung Han Shin1, Han-Suk Kim1, JungHwan Choi1 1 Seoul National University College of Medicine, South Korea 2 CHA Gangnam Medical Center, CHA University School of Medicine, South Korea 3 Ewha Womans University School of Medicine, South Korea Background White matter abnormality (WMA) is an important type of lesion that can cause long-term neurodevelopmental impairment in premature newborns. Systemic infection is a major upstream mechanism for WMA. However, few reports have described the risk factors for WMA in the context of neonatal sepsis. Our aim was to evaluate the risk factors for moderate-to-severe WMA in extremely preterm infants with sepsis. Methods Sixty-three extremely preterm infants (gestational age 28 weeks) with culture-proven sepsis who underwent brain magnetic resonance imaging prior to discharge between 2006 and 2013 were classified as having noneto-mild or moderate-to-severe WMA based on their WMA scores. Various risk factors for developing moderate-to-severe WMA were then evaluated using multivariate logistic regression analysis. Results Fifty-five preterm infants (87.3%) had none-to-mild WMA, and 8 infants (12.7%) had moderate-to-severe WMA. Using backward selection logistic regression, postmenstrual age (PMA) at sepsis diagnosis emerged as a factor that was independently associated with moderate-to-severe WMA, and even after adjusting for other known WMA risk factors, this significance persisted (Odd ratio: 0.616, 95% CI: 0.383-0.990, P = 0.045). In particular, the incidence of PMA at sepsis diagnosis 28 weeks was significantly higher in infants with moderate-to-severe WMA (87.5 vs. 45.5%, P = 0.026), and WMA scores were significantly higher in infants diagnosed with sepsis at PMA 28 weeks compared with other infants (mean ± standard deviation, 7.3 ± 2.54 vs. 6.2 ± 1.46, P = 0.042). Conclusions PMA at sepsis diagnosis is an important risk factor for moderate-to-severe WMA in extremely preterm infants with postnatal sepsis. Infants who suffer from sepsis at PMA 28 weeks are at increased risk for developing moderate-to-severe WMA. To reduce the incidence of moderate-to-severe WMA, further neuroprotective therapies are needed in infants diagnosed with sepsis at an early PMA, particularly for PMA 28 weeks.

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Congenital Idiopathic Neonatal Cholestasis in a Patient with Down Syndrome-- A Case Report ---Dr.Mathew Kripail, Dr.Mohammed Abdel Latif, Dr.Asad Ur Rehman MATHEW KRIPAIL Down syndrome is associated with many anomalies affecting multiple organs. Down syndrome in a rare cause of neonatal cholestasis, mostly associated with myeloproliferative disorders ,neonatal hemochromatosis and bile duct paucity. The liver disease in these cases are very severe and fatal. We report a case of idiopathic neonatal cholestasis that resolved spontaneously. The patient was a baby girl born at 37 weeks gestation by normal vaginal delivery to a mother G3P2 , 39 years old. Antenatal scan showedechogenic foci both ventricles and polyhydramnios. The baby was born with apgars 9 and 10 at 1 and 5 mins. Birth weight 3.1 kg (50%ile ), L=48(50%ile ) and HC=32cm(10%ile ). The physical features consistent with trisomy 21. The patient was admitted on day 1 of life in with jaundice of 240/mmol ( OB set up DCT negative, retics 12%) received intensive phototherapy, then normalized on day 3. Conjugated fraction increased from day 4 of life , peak by day 7 -14 days -160 mmols (9.4mg/dl) for which extensive workup was done Initial Hematological investigations CBC Hb 16 gm% platelets 57000 coagulations profile within normal limits Thyroid Functions were normal LFT- peak ALT 430 IU AST 310 IU GGT 68 U/L Serological tests - TORCH screen,HSV ,Hepatitis serology , Enterovirus PCR, Adenovius PCR, EBV PCR were negative. Tandem Mass Specrometry , Tyrosinemia type 1 screening assay ---Negative , Urine organic acids were normal Bile Acid metabolItes n ,GALACTOSE 1 PHOSPHTIDYL URIDYL TRANSFERASE ACTIVITY - NORMAL ALPHA Fetoprotein- 67032ng/ml N ALPHA 1 ANTITRYPSIN - 1.50 g/l N Iron Profile- done 3rd week- transferrin 1.95 gl. Iron 44 Serum FERRITIN –levels ranged from-1561- 4545 NORMAL BILIARY FUNCTION LIVER BIOPSY - evidence of acute cholestasis hepatitis and early iron overload IN VIEW OF HIGH FERRITIN BIOPSY OF SALIVARY GLAND DONE--normal histology. No iron deposits. The baby was managed conservatively – received Ursodeoxycholic acid .fat soluble vitamins ,fed with Elementary Formula . By 8 weeks the cholestasis improved and was discharged , and is doing well on follow up.

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Respiratory Morbidity in Small-for-Gestational-age Preterm Newborns According to Umbilical Artery Doppler Findings Aleksandra Matic2, Dusanka Subotic1, Andjelka Ristivojevic1, Nina Smiljanic3 1 Gynecological-obstetrics clinic, Clinical Centre of Vojvodina, Serbia 2 Institute for Child and Youth Health Care of Vojvodina, Serbia 3 Community Health Centre of Novi Sad, Serbia Introduction Abnormal umbilical artery (UA) doppler is a strong indicator of placental insufficiency, with increased morbidity and mortality in newborns. Aim of our study was to compare mortality and respiratory morbidity in small-for-gestational-age (SGA) preterm newborns from single pregnancies with and without pathological UA doppler findings. Methods Retrospective study was conducted in the tertiary-care university clinic during the period 2011 - 2013. Among SGA ( 10 birth-weight (BW) percentiles) singleton preterm newborns (gestation age from 27 0/7 to 36 6/7) whose mothers conducted prenatal doppler, we have found 56 newborns with pathological UA doppler and 57 with normal UA doppler. The data about morbidity and respiratory problems were compared between the groups. Results Mean gestation was 33.19 ± 0.31 weeks in normal UA doppler group and 32.39 ± 0.34 weeks in pathological UA doppler group; the difference was not significant (p=0.09). Percentage of newborns with BW percentiles 3 was significantly higher in pathological UA group (33.33%:53.57%, p=0.03, OR 2.31). In pathological UA doppler group there were significantly more often requirements for respiratory support - CPAP and/or mechanical ventilation (36.84%:57.14%, p=0.032, OR 2.28), endotracheal intubation (15.8%:33.9%, p=0.029, OR 2.74) and surfactant therapy (15.78%:32.14%, p= 0.045, OR 2.52). We did not find significant difference between the groups in occurrence of pneumothorax (3:1, p= 0.36), pulmonary haemorrhage (3:0, p=0.12) and bronchopulmonal dysplasia (4:2, p= 0.43. These results should be interpreted cautiously because of the low frequency of these diseases in our study sample. Mortality was 4 (7.14%) in pathological UA doppler and 3 (5.26%) in normal UA doppler group, and that was not significantly different (p=0.68). Conclusion In our sample of SGA preterm newborns, pathological umbilical artery doppler represents a risk factor for increased requirements for respiratory support, endotracheal intubation and surfactant therapy.

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Impact of Different Genotypes of CMV Infection in Neonates and Infants Aneta Kozakova1, Kristina Kaluzova1, Jana Dornakova1, Krystof Tabery1, Ales Briksi2, Jana Sumova2, Petra Chramostova2, Veronika Novakova2, Kveta Blahova3, Miroslav Zajac2, Milos Cerny1, Petr Hubacek2 1 Department of Neonatology, Gynaecology and Obstetrics, Czech Republic 2 Laboratory of Virology, Department of Medical Microbiology, Czech Republic 3 Department of Paediatrics, Czech Republic CMV genotypes influence the impact of the CMV infection on the developing fetus and neonates. Only limited number of studies combined analysis of the glykoprotein B (gB), glykoprotein H (gH) and UL144 in neonates and infants. Aim of the study was to find out various genotypes and clinical impact in Department of Neonatology in Czech Republic. 592 biological samples were tested for presence of CMV infection between 2002-2014. 456 whole blood samples, 94 urine samples and 42 other biological samples (most frequently cerebrospinal fluid samples) were tested. Detection was performed by quantitative polymerase chain reaction (PCR) technique. Retrospective CMV genotyping of gB1-4, gH1 and gH2 was performed according to the published studies by real-time PCR detection and UL144 by sequencing. Median of CMV detected load in whole peripheral blood was 6.42 CMV normalized viral copies (NVCs) (range 2.24-376.65 NVCs) and median of 7.5x10e3/ml CMV copies/ml of urine (range 5x10e2-8.1x10e6). CMV infection was proved in 317 samples. Congenital CMV infection was detected in 13 cases. Median of follow-up time in 11 cases with congenital CMV infection was 6.25 years. 2 cases with congenital CMV infection showed sensoneural hearing loss. Total genotyping with both glycoprotein B and H was performed in 68 cases. UL144 sequence was obtained in 44 cases. Only glycoprotein B or H was detected in 9 cases. Our study is focusing on the role of different CMV genotypes on complexity of human CMV infection, tissue tropism and various clinical consequences. The results should help in assessment of different risks and necessity of virostatic treatment in particular patients. Supported by the project for conceptual development of research organization 00064203, Grant of the ministry of Health of the Czech Republic grant of Internal Grant Agency of Ministry of Health of Czech Republic NT/13691-4.

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Continuous Glucose Monitoring in Infants of Diabetic Mothers Kryštof Tabery1, Jana Dorňáková1, Kristýna Kalužová1, Aneta Kozáková1, Miloš Černý1, Kateřina Štechová2 1 Department of Neonatology, University hospital Motol, Charles University, 2nd faculty of Medicine, Czech Republic 2 Department of Internal medicine, University hospital Motol, Charles University, 2nd faculty of Medicine, Czech Republic Newborn infants of diabetic mothers are at a greatest risk of a neonatal hypoglycemia. Current state of art screening of a hypoglycemia proposed by the American Asociation of Pediatrics is focused on a 1st 24 hours and if a baby is normoglycemic screening ends on a 2nd day of life. New literary data suggest, that hypoglycemias can firstly appear or re-occur later in neonatal period than first 48 hours even when fully fed. The continous glucose monitoring (CGM) gives opportunity to monitor the glycemia without a need of a frequent invasive sampling for prolonged period and also a rapid evaluation of a treatment. CGM had been already acknowledged as realiable and safe in neborns. However exact meaning of this new data is yet to be determined. We would like to present our data from the group of 30 newborns of diabetic mothers. We administred the continous glucose senzor within hours after birth and monitored newborns up to a 6th day of life. Our findings support the hypothesis of late hypoglycemias. Two newborns even had to be admitted to the NICU for the compensation of the hypoglycemia on a 4th day of life. These hypoglycemias could have passed unnoticed unless becoming severe with clinical symptomps. CGM could be next step in treating the hypoglyceamia in the infants of diabetic mothers as well as other newborns in risk. Supported by a development project of the Ministry of health for the research institution no. 00064203 (University hospital Motol.)

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Including Roma Mothers in Healthcare to Their Newborns in Neonatal Intensive Care Unit Snezhana Janchevska PHO University Clinics of Gynecology and Obstetrics, Macedonia During the neonatal intensive treatment, often newborn children are separated from their mothers, thus deprived of the necessary contacts with the mother, kangaroo care, breastfeeding or feeding expressed breast milk. Parents are worried, without of participation in neonatal care and with a feel to unnecessary. Neonatal intensive care unit treatment attempts and practiced their own model to solve or mitigate the problem of separation of the couple mothers-newborn child. Goal of the study Incorporating Roma mothers in healthcare to their newborns in neonatal intensive care across the parent΄s education to antenatal care, expressed milk, Kangaroo care and breastfeeding. Material and Methods Collected cohort during the period of five months, contents 36 examineers or 18 couples of mothers and newborn infants of the Roma ethnic group, from different macedonian areas, born in the University Clinics of Gynecology and Obstetrics in Skopje. Newborns are premature, small for gestational age, asphictic or sick, 27-39 gestational weeks, with birth weight 920-3250 grams. We practice our Guidelines for expressed breast milk and Kangaroo care. Mothers include in the internal human milk bank to pump breast milk. Couples mothers-newborns take in the Kangaroo care sessions, each one of two hours, while the baby is in stable clinical condition with body weight more than 1100 grams. Results Most of mothers (84.6 %) come from Skopje. They are from 17-27 years old and with primary or partial education (84%). All mothers have incompletely prenatal controls and missed antenatal education. But, 100% of mothers accept expressed milk technic, Kangaroo care and breastfeeding. After discharge, 77% of mothers continue to breastfeed. Only 5/18 couples don`t accept proposal from socio-economic reasons. Disputation Roma mothers and famillies have a tradition to breastfeed and take care about newborn babies. We contribute to the humanization of neonatal intensive care and to better bonding between mother and baby.

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Newborn with Nonimmune Hydrops Fetalis (Case Report ) ljubinka dragas1, danojla dakic2, lidija banjac3, rada rudanovic4, envera lekic5 1 doctor, Montenegro 2 doctor, Montenegro 3 doctor 4 doctor, Montenegro 5 doctor, Montenegro Background Hydrops fetalis is defined as the abnormal accumulation of fluid in body cavities: pleural, pericardial and peritoneal and soft tissues. The basic problem in hydrops fetalis is an imbalalance in fluid homeostasis, with more fluid accumulation than can be resorbed. In previous years most cases of hydrops were caused by severe erytroblastosis fetalis secondary to Rh isoimmunization. Most cases of hydrops fetalis are now caused by other conditions and are known as nonimmune hydrops. Case report: We present a female newborn born with diffuse edema and ascites. A neonate born at 34 weeks′ gestation had a history of fetal hydropic changes noticed on ultrasonography at 33 weeks′ gestation but supraventricular tachycardia (SVT) not detected? On 13th day of life, tachycardia was developed and the patient received a dose of intravenous adenosine without resulting, after that it was given a loading dose of amiodaron, followed by continuous amiodaron resulting in decrease in heart rate. We believe that the SVT occurred in the fetus and that they led to hydrops but not registered. SVT is the most common and clinically significant form of sustained fetal tachyarrhytmia in pregnancy; depending on duration and high rate variability heart failure and nonimmune hydrops may develop which are associated with a high incidence of perinatal mortality. Conclusions Hydrops fetalis is a potentionally letal condition.The care given to a newborn with hydrops fetalis is always a challenge for neonatologist. Key words: newborn, hydrops fetalis, supraventricular tachycardia

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Diversity of Disorders Causing Neonatal Cholestasis - The Experience from the Pediatric Clinic UCC Sarajevo Hajrija Maksic, Sabina Terzić, Elmedina Mrkulić, Melika Melunović, Edina Kovač Pediatric Clinic University Clinical Center of Sarajevo, Bosnia and Herzegovina Background and objective Differential diagnosis of neonatal cholestasis is extensive. It requires a step-wise approach, and early recognition in order to ensure timely treatment and optimal prognosis. The aim of this study is to inform on the prevalence and mortality of the diverse disorders causing neonatal cholestasis. Methods Clinical chemistry and causes of disease were retrospectively analyzed in 36 infants with neonatal cholestasis during the last five years at the Pediatric Clinic UCC Sarajevo. Neonatal cholestasis was defined as neonatal prolonged jaundice with conjugated hyperbilirubinemia when serum conjugated bilirubin concentration greater than 1mg/dL (17.1 micromol/L) if the total serum bilirubin is 5.0 mg/dL (85.5 micromol/L). Results Altogether, 12 disorders causing neonatal cholestasis were identified. Seven children (19,4%) had biliary atresia, seven children (19,4%) had cholestasis caused by the CMV, followed by idiopathic cases (22,2%), cholestasis in preterm infants with sepsis (11,1%), Alagille syndrome, hypoplasia of gallbladder, biliary sludge (all 11,1%) and others. Infants with biliary atresia were diagnosed at a mean age of 72 days, they underwent Kasai portoenterostomy 78 days after birth. Two children had syndromic biliary atresia, died before operation and two children died after surgery. No liver transplantation was successfully performed. Conclusion Neonatal cholestasis is a severe disorder associated with a high risk of complications in infancy and it therefore requires urgent investigation in order to initiate life-saving therapy. Keywords: neonatal cholestasis, biliary atresia, Kasai procedure.

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Pathological States of Early Neonatal Period in Children Born After ICSI Application Tetiana Stoieva, Vitalii Synenko, Svetlana Prokhorova, Nadezhda Lotysh, Roman Papinko, Tetiana Bondarenko The Odessa National Medical University, Ukraine The relevance of the study is determined by rapid increasing number of children born as a result of assisted reproductive technology (ART). There more than 12000 children were born with ART in Ukraine. Purpose of research to estimate the signs of pathology in children born as a result of ART at the early neonatal period. This work analyses examination of 44 neonatal children born as a result of Intracytoplasmic Sperm Injection. All children were treated at the Municipal Children Hospital. Results The analysis had revealed gestational age ranged from 29 to 41 weeks. Premature birth was observed in (86.4±9.7) %. The number of children with low birth weight was (63.6±10.8) %. Pathological states of children considering gestational age were analyzed. The children with the gestational age below 34 weeks had the average body mass (1729.2±130.2)g, body length (41.7±2.1)cm. Respiratory disorders (91.3%), hypoxic-ischemic encephalopathy (86.9%), intrauterine pneumonia (56.5%), intraventricular hemorrhage (56.5%), hyperbilirubinemia (39.1%), congenital heart malformation (28.1%) were identified. Most children with gestational age below 34 weeks were admitted to the intensive care unit. The children with gestation age over 34 weeks had the average body weight (2483.0±581.0) g, body length (47.5±2.9) cm. Hypoxic-ischemic encephalopathy (80.9%), delay of intrauterine development (38.1%), hyperbilirubinemia (38.1%), intrauterine pneumonia (28.6%), intraventricular hemorrhage (19.1%), congenital heart malformation (19.1%), convulsive syndrome (4.8%) were revealed. Conclusion The children born as a result of ICSI application have high rate of pathological states in the early neonatal period. The frequency of neonatal pathology varies depending on the gestational age of child, the most quantity of premature babies had two or more functional systems affected, moderate and severe disorders of the central nervous and respiratory systems were diagnosed more often.

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Evaluation of Postnatal Morbidity and Mortality of Surviving Co-Twin Following single-twin Death Aslihan Abbasoglu, Aslihan Abbasoglu, Nihal Uysal, Ayse Celik, Ulas Tugcu, Filiz Yanık, Aylin Tarcan Baskent university, Turkey İntroduction İntrauterıne death of one fetus in a twin pregnancy is uncommen in the second or third trimester. Here we report thepostnatal morbidity and mortality of surviving co- twin following single twin death Methods Birth records and patient files were evaluated retrospectively between 2008 and 2014 in Baskent University Ankara Hospital. Demographics, gestational weeks, intrauterine demise week and neonatal morbidities were recorded. Results 9 of 247 dichorionic diamniotic twin gestations died in 2nd or 3rd trimester. Maternal risk factors and neonatal morbidity and mortality results are shown in table 1. %33.3 of the newborns were term and did not need NICU. %66.7 of the pregnancies were ended with preterm delivery.%55.5 newborns were girls. %77.7 of the newborns were twin gestations after medically assisted reproduction. Conclusions Single fetal death in a twin pregnancy is known to be a serious complication of pregnancy. It is a relatively rare complication of multiple pregnancies but may carry with it an increased risk of perinatal morbidity and mortality. For the surviving twin chorionicity and the gestational week of the intrauterin demise are the most important risk factors.In our cases all twins were dichorionic and the most important problems were the preterm delivery and its comorbidities

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Reopening of PDA in Rremature Infants with VLBW and ELBW, Receiving Respiratory Support VAP and CPAP Crivceanscaia Larisa IMSP IMsC Prematurity is a multifactorial problem. In RM annually are born 90%, these children have respiratory distress syndrom, requiring surfactant administration with need for implementation VAP or nasal CPAP respiratory support on varying durations of time. The introduction of these care methods for premature infants, have shown efficacy in all clinical trials, but remains a problem related to hemodynamic disorders in these children conditioned by this ductus arteriosus functional. Materials and methods: The study includes 73 premature babies with VLBW and ELBW, divided into 2 groups: 42 (57,5%) received noninvasive respiratory support (CPAP) and 31 (42,5%) noninvasive respiratory support (VAP). Data were edited using T-Student test. The goal to compare the incidence of the reopening DPA at premature bebies with VLBW and ELBW, wich received respiratory support CPAP and VAP. Results: From this study we obtained reopening of the PDA to16,6% receiving CPAP and 19,4% -to those wich receive VAP (p0,05).

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The Contribution of Genetically Determined Folate Status Disturbance in Reproductive Disorder and Neonatal Pathologies Zoia Rossokha1, Valeriy Pokhylko2, Tetyana Znamenska3, Valeriy Poltoropavlov4, Natalia Gorovenko5 1 State Institution "Reference-centre for molecular diagnostics of Public Health Ministry of Ukraine", Kjev, Ukraine, Ukraine 2 Higher State Educational Establishment of Ukraine “Ukrainian Medical Stomatological Academy”, Ukraine 3 State University «Institute of pediatrics, obstetrics and gynecology NAMS in Ukraine», Kyiv, Ukraine, Ukraine 4 Higher State Educational Establishment of Ukraine “Ukrainian Medical Stomatological Academy”, Poltava, Ukraine, Ukraine 5 National Medical Academy of Postgraduate Education named after P.L. Shupik, Kyiv, Ukraine Introduction Folate status support is necessary for reproductive function. A variety of abnormalities in folate status contribute to diseases risk in reproductive age and affect the neonates pathologoies. Folate status depends from many factors, but the most important is the MTHFR gene polymorphism. In the presence of unfavorable MTHFR gene variants are more frequently observed changes in folate status. The aim of this study is to evaluate genetic disturbance of folate status in women with reproductive disorders, neonates and its possible correction. Materials and methods 550 patients (primary and secondary infertility, premature birth) and 75 neonates (45 with perinatal asphyxia and 30 clinically healthy) included in the study. Investigation was approved by the Ethics Committee. The past history, folic acid status, MTHFR (C677T, A1298C) gene polymorphism were investigated. Statistical analysis was determined using binary logistic regression (SPSS 17.0). Results MTHFR gene polymorphism in women with reproductive disorders had frequencies corresponding to population distribution. Changes in folate status were identified in women with 677TT and 677CT genotypes despite taking folic acid. 10% of patients with 677CT and 677TT genotypes had hyperhomocysteinemia, 15% of patients with these genotypes had increased folate level in serum and red blood cell. These patients also used only folic acid. Patients with 677CT and 677TT genotypes that consumpted a multivitamin with folic acid supplements had no abnormalities in folate metabolism. In neonates with perinatal asphyxia was significantly reduced folic acid levels and significantly increased homocysteine levels compared with clinically health neonates in the first days of life. Neonates with perinatal asphyxia had more frequently 677CT genotype. Conclusion Folate metabolism control should be used in carriers of 677TT and 677CT genotypes for timely correction. The multivitamin (with folic acid) consumption during pregnancy is necessary for their sufficient accumulation in fetuses and newborns, that will reduce the complication risk.

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Is There Place to Change The Vitamin K Prophylactic Regime? Ilirjana Bakalli UHC" Mother Theresa", Albania Introduction With vitamin K prophylaxis, late vitamin K deficiency bleeding disease (VKDB) incidence has been significantly reduced, even though it still remains a concern in the 21st century because in approximately 50% of cases it is presented with intracranial hemorrhage (ICH), a potentially life-threatening disorder. In different parts of the world, various methods of vitamin K prophylaxis are practiced. In our country is used the intramuscular prophylaxis. Through the incidence of late VKDB in our country we would like to discuss about vitamin K prophylaxis. Methods Retrospective study. Are included all children with ICH due to late VKDB admitted at our PICU during 5 years (2011-2015). Criteria for late VKDB are based on the International Consensus. Results During these years, we noted a significant increased incidence of primary late VKDB in Albania, even though according to our Neonatology recommendation, the prophylaxis with vitamin K is given 1 mg i/m, in the first hour of life. Incidence of ICH varies from 18cases/100000 live births to 25 cases /100000 live births and was associated sometimes with delayed diagnosis and poor prognosis: mortality rate was significantly high 28.6 % with neurologic sequel in 14 % of cases. In front of this high incidence a lot of questions arise: It was prophylaxis done correct? With correct prophylaxis is possible such a high incidence of bleeding? Do we really have an increased incidence or is a better diagnosis? Is there place to change the prophylactic regime? How should prophylaxis with vitamin K be done? Conclusion Late VKDB is still an important problem in our country. In our opinion vitamin K prophylaxis prevents the classical form of hemorrhagic disease but to a lesser extent prevents late VKDB. Maybe in small countries, where parenteral prophylaxis it isn’t done correct, we may use oral prophylaxis.

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The Accuracy of Pulse Oximetry in Detecting Critical Congenital Heart Diseae Asymptomatc Newborn April Lorraine Hipolito, Karl Michael Reyes St. Luke's Medical Center, QC, Philippines Introduction Critical congenital heart disease (CCHD) is a term used to describe newborns who have asymptomatic but life threatening congenital heart disease. If left untreated, majority will not live past the first few weeks of life. Screening with pulse oximetry can potentially identify asymptomatic infants with CCHD prior to discharge. Methods Pulse oximetry (pre and post ductal) was performed on well, term newborns prior to discharge. A clinical assessment and two-dimensional echocardiogram was performed on infants with positive screens. Patients who tested negative for the pulse oximetry screening were followed up to a minimum of 2 months of age to determine which of these infants presented with symptoms attributable to CCHD. Results Pulse oximetry screening was performed on 1,174 well, term newborns. Three patients tested positive for the screen. Two were found to have transposition of the great arteries and the other was a false positive screen. Of the 1,091 patients with negative results, 990 patients were followed-up and had no symptoms indicative of CCHD. The measures of validity for this study were as follows: sensitivity of 100%, specificity of 99.9%, positive predictive value of 66.67% and a negative predictive value of 100%. Conclusion Pulse oximetry is an accurate screening method for detecting CCHD in the target population. The sensitivity, specificity and predictive values in this population group are acceptable and can be applied to the general population.

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Nadia Kasdallah1,2, Mouelhi Neila1,2, Alaeddine Bouani1,2, Kbaier Hakima1,2, Ben Salem Hatem1,2, Blibech Sonia1,2, Douagi Mohamed1,2 1 Military Hospital of Tunis., Tunisia 2 University Tunis El Manar/Faculty of Medecine of Tunis/ Faculty of Medecine of Tunis, Tunisia Background and aims Healthcare-associated infections (HAI), currently in middle of neonatal resuscitation, the most feared pathology of the fact of the morbidity and the mortality associated. We aimed to analyze epidemiological, clinical, and bacteriological data and outcome of HAI in our unit. We also recalled the interest of ecological monitoring of germs for better prevention. Methods A one year retrospective study (1 January to 31 December 2015) of all cases of HAI identified in our unit. Clinical, biological, bacteriological, therapeutic characteristics and outcome were analyzed. Results We identified 58 cases of newborns who had HAI. The prevalence of HAI was of 5%. The rate of prematurity was 63.8% with an average term of 31 gestationnal weeks. The rate of low birth weight was 22.4%. Assisted ventilation was used in 48 cases (82.75%). The average duration of artificial ventilation was four days. The HAI happened at an average of 4 days of hospitalization. We identified seven septicaemic forms and one case of meningitis. The most frequently isolated bacteria were Klebsiella Pneumonia (41.4%) followed by Acinetobacter baumanii (10.4%) and Pseudomonas Aeroginosa (7%). Central vascular catheters were incriminated in four cases. The average length of stay was 18 days. The overall survival rate was 82.75%. Conclusions HAI are still a major problem in our neonatal intensive care unit. The emergence of enterobacteria multi resistant must impose a best rationalization of antibiotics use and regularly control of the bacterial ecology of our unit.

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Study on Bacterial Contamination of Neonatal Intensive Care Units (NICU) and Antibiotics Resistance Patterns in Isolated Bacteria in Hamadan Hospitals, west of Iran Rasoul Yousefimashouf, Mina Momeni Rsoul Yousefimashouf, Iran Background Many reports from all over the world indicade that multi-drug resistance in nosocomial organisms are increasing. Objectives The objectives of this study were determination of antibiotics resistance patterns in bacteria isolated from neonatal intensive care units (NICU) in Hamadan hospitals, west of Iran. Methods In this dtudy, 682 samples were randomly collected from different area including devices, apparatus, physical surfaces and staffs, uniforms. The samples were inoculated in EMB and Blood agar by wet swabs and transferred to medical laboratory for identification. 140 strains were selected and cultured on Mulerhinton agar for antibiogram tests by Kirby-bauer method. The antibiotics disks were consisted of : Erythromycin, vancomycin, tetracycline, ceftriaxone, cefataxime, penicillin, carbapenem, ampicillin, methicillin, amikacin, gentamicin, sulfamethoxazole, nalidixic acid and ciprofloxacin. Results The average rate of bacterial contamination in NICU was 42.9%. The most contaminated parts, were the staffs, uniforms (70.3%) and physical surfaces (58.4%) respectively. The most bacteria isolated were as follow: Staphylococcus epidemidis, Staphylococcus aureus, Streptococcus faecium, Pseudomonas aeroginosa, E.coli, Klebsiella, Enterobacter, Proteus, Acenetobacter. In this study, many different antibiotics resistance patterns were obtained for strains isolated from intensive care units. In total, gram positive bactera showed more resistance patterns, rather than gram negative bacteria. More than 80% of gram positive bacteria were resistant to penicillin, ampicillin, tetracycline and gentamicin. Conclusion Our results showed the high drug resistance in strains isolated from NICU and considerable bacterial contamination, it seems that sterilization and disinfection methods in hospitals were not performed correctly and it should be controlled regularly by related authorities.

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Study on Staphylococcus spp. Strains Isolated from Venous and Urinary Catheters in NICU of Hamadan Hospitals, The West of Iran.

Rasoul Yousefimashouf1, Negin Molazadeh2 1 Hamadan University of Medical Sciences, Faculty of medicine, Iran 2 Hamadan University of Medical Sciences, Faculty of medicine, Iran Background and aim Staphylococcus coagulase negative strains are colonized on epiderm and distribute in environment and outer bodies apparatus such as protez and intera-venous catheters. The aim of this study was the frequency of Staphylococcus coagulase negative isolated from venous and catheters children hospitalized in NICU of Hamadan hospitals and determination of antibiotics resistance patterns in Hamadan, the west of Iran . Methods We collected 108 samples randomly from patients who were hospitalized in NICU hospitals of Hamadan and they needed to venous or urinary catheters. One specimen of each patient was taken and inoculated into carrier transported media and transferred to bacteriology laboratory to identification of strains. Antibiogram was performed by Kirby-Bauer method. Data was analyzed using SPSS 15 software. Results Out of 108 tested samples, 32.7% of patients had urinary catheter and 67.3% had venous catheter. 28% of tested samples had positive culture. The positive cases were significantly found in those children who had been used catheter more than 48 hours (P = 0.00). From the positive cases, Staphylococcus epidemidis (40.4%), Acinetobacter baumannii (10.6%) and E. coli (8.5%) were the most common isolates. The most rate of resistance of Staphylococcus epidemidis was against to erythromycin and ampicillin. The most rate of sensitivty of E. coli was against to gentamicin and Psuedomonas aeruginosa to ciprofloxacin. Conclusion Our results showed the high contamination in used catheters particularly in those patients who needed to catheter for long time. We also indicated the high drug resistance in strains isolated from catheters.

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Trained Nurse Attending Deliveries Reduce the Number of Deaths Caused by Asphyxia in Maputo Central Hospital sonia Bandeira1, Sonia Bandeira1, Samira Weng2 1 Maputo Central Hospital, Mozambique 2 Ministy of Health of Mozambique, Mozambique Introduction About 4 million newborns die every year. Immediately after birth, 1 in 10 newborns need assistance to begin breathing. In Mozambique, only 54% of newborns are assisted by skilled nurse at birth. In Maputo Central Hospital, neonatal asphyxia is the 2nd cause of neonatal death. A qualified nurse in all deliveries can reduce neonatal mortality in low resources countries./pre Methodology and objective This is a retrospective study in which a comparison is made between the term newborns with low APGAR scores assisted by skilled nurse in 2014 (working only 8hours a day) and those assisted by non skilled nurse in 2013. Objective: understand the impact of skilled nurse (trained in neonatal resuscitation) in delivery room in neonatal mortality in Maputo Central Hospital, Mozambique./pre Results In 2013, 324 newborns had low APGAR with 52 deaths (16%); In 2014, 351 newborns had low Apgar and 29 deaths (8%). Neonates with congenital malformations were excluded. Conclusion Although the nurse was present in only 30% of all newborns with low Apgar scores, we observed a reduction of neonatal deaths caused by asphyxia from 16% to 8%. This strategy can be applicable in low resources sites to reduce neonatal mortality./pre

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The Burden of Neonatal Hypoglycaemia Emily Mullan, Helen Mactier Princess Royal Maternity Hospital, UK Hypoglycaemia is a common problem in neonatology and sustained hypoglycemia is thought to be associated with long-term neurodevelopmental sequelae. Infants may be asymptomatic and awareness of predisposing risk factors such as maternal diabetes allows targeted screening and prompt treatment. But how much are we having to admit to the neonatal unit for management? Aim Describe the cohort of infants admitted to a single tertiary centre requiring management of neonatal hypoglycaemia. Method Retrospective case note review for all admitted infants with a diagnosis of hypoglycaemia between 1/10/1330/9/14. Neonatal hypoglycaemia defined as blood glucose 2.5mmol/L. Results 118 infants identified. Gestation ranged from 27+4-41+3weeks (median 36+5); 46% were term born. Birth weight ranged from 580g–4710g (median 2477g). 20% were 91st centile. 66% were delivered by caesarian section (18% elective; 48% emergency). 39 (33%) were direct admissions. Primary admission categories included prematurity, TTN and requirement for prolonged resuscitation at delivery. 67% were admitted from postnatal wards; age at admission ranging from 1-181 hours (average 16hrs). 31% of infants were reported as symptomatic, 18% of these having a blood sugar 0.5mmol/L.Tachypnoea and `jittery` were the most commonly reported signs. Time to first feed ranged from 9-900 minutes (median 68 minutes). Only 10 infants achieved first feed 27% were infants of mothers with diabetes. Co-mobidities included IV antibiotic administration for sepsis risk factors (n=38), maternal labetalol (n=12) and hypothermia (n=11). 91% required nasogastric feeding; 63% required intravenous fluids, 49% of these were term infants. 15% dextrose was required for 11 babies. Additional therapies included glucagon (n=7), diazoxide (n=4) and thiazide (n=4). One infant was diagnosed with hyperinsulinism. Conclusion A high proportion of term infants are admitted for management of hypoglycaemia. Only 27% of admitted infants were infants of mother with diabetes. These are an intensive population requiring active intervention. Clinical detection of hypoglycaemia is low.

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Neonatal Admission Temperatures: The Forgotten Patient Francesca Ritchie, Sophie Springer, Nathalie DeVries Palmerston North Hospital, New Zealand Aims: The 2016 RANZCOG Newborn Resuscitation Guideline states that admission temperatures to newborn units are important predictors of outcomes and should be maintained between 36.5-37.5°C. Hypothermia is associated with increased morbidity and mortality. This audit was done to check the admission temperatures of babies in our local.Newborn.Unit. Method: Admission temperatures were assessed for all babies admitted to Palmerston North level 2A Neonatal Unit in 2015. Babies were excluded if they were more than 24hours old at admission, if it was a readmission, or if the temperature at admission was not recorded. The total number of admissions were 499, after exclusion criteria were applied this left 299. Ninety of the 499 babies were excluded for not having their admission temperature recorded. We calculated the percentage of babies with low (under 36.5°C), normal (36.537.5°C) and high (over 37.5°C) admission temperatures for each of the different areas as outlined in the results section below. Results: Thirty seven percent of babies had an admission temperature below the recommended 36.5°C. Prematurity and low birth weight were associated with low admission temperatures. Delivery suite had the highest percentage of cold babies per admission source even when adjusted for the confounder of gestation with 36% of term babies being under 36.5°C at admission. Elective caesarian sections had the highest percentage of cold babies per mode of delivery even when adjusted for gestation with 43% of term babies having an admission temperature under 36.5°C. Low admission temperature was associated with longer admissions to the unit irrespective of gestation, with term babies having an average stay of 56hrs if they had a normal admission temperature and 90hours if they had a low admission temperature. Conclusion: These results show a high percentage of babies have a low admission temperature. As expected, prematurity and low birth weights were associated with lower temperatures. Surprisingly, babies born in delivery suite and babies born via elective caesarian sections had the highest percentage of low admission temperatures. Low admission temperature was associated with admission stays nearly twice as long as normal admission temperatures, indicating increased morbidity. This audit has shown significant concerns with babies from delivery suite and with babies from elective caesarians and low admission temperature has been associated in our newborn unit with increased morbidity. In response to this, our hospital protocol will be changed to improve newborn temperatures.

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Weak Correlation Between Urinary Kidney Injury Markers in Septic Neonates Anna Tarko, Anna Suchojad, Aniceta Brzozowska, Małgorzata Majcherczyk, Iwona Maruniak-Chudek Medical University of Silesia, Faculty of Medicine in Katowice, Poland Introduction Urinary excretion of tubular injury markers, as example: NGAL, KIM1, IL18, is postulated as useful early indicator of renal damage. Moreover, a measurement of the panel of biochemical parameters seems to be better than of any single marker. The aim of the study, was to analyze the association between urinary levels of kidney injury indicators in neonates hospitalized in Neonatal Intensive Care Unit. Material and method Urinary NGAL (uNGAL), KIM1 and IL18 concentrations were assessed in 140 neonates including 14 patients with AKI diagnosed based on pRIFLE criteria. Results In non-AKI group on the 1st, 2nd and 3rd day of observation median values of study parameters were as followed: NGAL [49(24-120), 49(19-139) and 33(16-108) ng/ml,], KIM1 [0,67(0,29-0,12), 0,60(0,29-0,94) and 0,57(0,26-0,85) ng/ml], IL18 [60(35-96), 54(35-99), and 55(36-101)pg/ml], respectively. The difference between AKI and non-AKI group was statistically significant for uNGAL on the 3rd day and IL18 on the 1st and 3rd day. There was a weak correlation between uNGAL and KIM1 on the 1stday(R=0,202; p=0,01) and the 2nd day (R=0,288; p0,001); also between uNGAL and IL18 on the 1st day(R=0,149; p=0,05) and the 2nd day (R=0,252; p0,01). There was no association between KIM1 and IL18. The positive correlation was observed between the value of Apgar 5’ and concentration of IL18 on the 1st day, while inverse with uNGAL. In addition, the severity of clinical status described by NTISS was reflected by increased values of KIM1 and uNGAL. All markers were associated with serum CRP concentration. Conclusions In neonates treated in NICU the variability in urinary kidney injury markers is highly influenced by other than kidney injury factors.

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Subsequent Labor Abnormalities and Neonatal Outcomes Among Preterm Births with Prolonged Latent Phase Manuela Cucerea1, Manuela Cucerea, Marta Simon1, Bela Szabo1, Marcela Ungureanu2, Raluca Marian1, Elena Moldovan1, Laura Mihaela Suciu1 1 University of Medicine and Pharmacy Tirgu Mures, Romania 2 University County Hospital Tirgu Mures, Romania Aims To examine the association of prolonged phase with cesarean risk, subsequent labor abnormalities and other adverse neonatal outcome Methods a retrospective cohort analysis of 175 singleton preterm infants born at 24 to 36 weeks of gestation in one tertiary level care academic hospital ( January 2014 through December 2015) with at least one ultrasound cranial examination. Latency was divided into three intervals, and outcomes in the longer intervals were compared with those infants who were delivered at Results Odds ratios and CIs for each latency interval that was controlled for counfounders that included gestational age, antenatal steroid and antibiotic administration show a statistically decrease risk for cesarean section from 1.5 [1.02-3.1], 1.4 [1.06-6.17] and 0.57 [0.25-0.72]; increase risk of low Apgar score at 5 minutes 0.36 [0.14-0.93], 1.4 [0.47-4.15] and 4.96 [1.09-22.54] Conclusions Prolonged latent phase is independently associated with decreased incidence of need for cesarean delivery, depressed Apgar scores, and increased risk of ultrasound cranial abnormalities

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Ductus Dependent Cardiopathies. Aproach and Evolution in a Neonatal Unit. Reyes Roldan Lopez, Begoña Rodriguez Azor, Salvador Ariza Aranda, David Lopez Martin1, Tamara Fernandez Ferrandez, Ana Isabel Valdivielso Martinez, Vanessa Maria Schmitz, Enrique Salguero Garcia, Tomas Sanchez Tamayo hospital Regional Universitario De Málaga, Spain Congenital heart defects (CHD) are the most frequently admitted to neonatal critical care units (NICU) congenital malformation. They require a quick diagnosis and treatment, specially ductus dependent defects (DDC). Our objective is to describe the characteristics, management and complications of children with DDC until discharge from our NICU. Our secondary aim is to evaluate possible evolution predictors. Side effects described previously in the literature as associated with the use of prostaglandins were also registered. Methods A transversal study was performed, by clinical story revision of the children with DDC hospitalized in our NICU in five years (2011-2015). Results We studied 48 patients (43,8% females), 18 with prenatal diagnosis (37,5%). 41 (85,4%) born at term and 7 (14,6%). 17 (35,4%) were born in our hospital and 31 (64,4%) came transferred from other hospitals. 25 where asymptomatic and 23 symptomatic (cyanosis or low cardiac output). The most frequent DDC were great arteries transposition (16; 34,8%) and aortic flow changes (13; 28,2%). 8 (16,8%) associated non-cardiac major malformations. All patients received prostaglandins, for an average 10.6 days (1-71). Vasoactive drugs (VAD) were needed in 23 (47%). They needed central venous catheter for an average 12.25 days (1-71) and mechanical ventilation (MV) for 4,8 days (0-71). During admission, 24 (50%) had sepsis. 7 (15,6%) had digestive and 6 (12,8%) neurological disorders. Cardiac surgery was performed (postoperative care in pediatric intensive care unit) in 29 (60,4%) and 6 (12,8%) died before surgery. Children with prenatal diagnosis required less VAD (p=0.04), with longer treatment with prostaglandins (p=0.012) and had less (NS, p=0.07) neurological disorders. Conclusions Children with DDC have an important morbimortality. There may be side effects of prolonged treatment with prostaglandins, although new prospective studies are still needed. Prenatal diagnosis and birth in our hospital were associated with better outcome in our patients.

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Prognosis of Newborn Pre-term from Mothers with Chorioamnionitis Histological

Ingrid Kandler1, Edna Maria de Albuquerque Diniz2, Fábio Gonçalves Coutinho3, Renata de Souza da Silva1, Paulo Roberto Merçon Vargas1 1 Federal University of the Espírito Santo, Brazil 2 São Paulo University, Brazil 3 Postgraduate Institute Kandler Coutinho, Brazil Introduction Amniotic infection and chorioamnionitis (CAM) are determinants of maternal and perinatal infections, parturition and birth preterm, morbidity and postnatal mortality. Although clinical, histopathological, microbiological, biochemical and molecular methods can diagnose histologic CAM, remaining many cases the clinical and epidemiology hidden because most neonatal deaths remains of sepsis, and this also leads many sequels in newborns. Objective To investigate the relationship between histological CAM and prognosis PreTerm Newborn (PTN) in 2012 at the University Hospital Cassiano Antonio de Moraes (HUCAM) in Vitória - ES, regarding the need for oxygen therapy, early neonatal sepsis, perinatal asphyxia and death. Method We made a cross-sectional study, where all the placentas examined in 2012, in the Pathology Laboratory HUCAM in Vitória, were analyzed together with the chart to the PTN and extracted data regarding the need for oxygen therapy, early neonatal sepsis, perinatal asphyxia. The cases were categorized by gestational age, perinatal outcome and positive placental histology to CAM. Results 245 patients were chosen for the study, 94 (38.4%) were asymptomatic, 92 (37.5%) required oxygen therapy, 11 (4.5%) had neonatal early-onset sepsis, 10 (4.1%) had perinatal asphyxia, 27 (11%) died and 11 (4.5%) with incomplete data. In the analysis of the placentas and 86.2% had negative histologic CAM and 13.8% had positive CAM histological. Conclusion The number of placentas with histologic CAM was higher than the number of patients with early-onset sepsis and birth asphyxia, similar to the number of patients who died. There is a worse prognosis ratio, that is, perinatal asphyxia and neonatal sepsis in patients with positive placenta for histologic CAM, as the need for oxygen therapy has no direct relationship with histologic CAM. Thus, we conclude that the placenta present positive histologic CAM the PTN should be observed during 72h in the maternity ward for early neonatal sepsis. Keywords: histological chorioamnionitis, neonatal sepsis, perinatal asphyxia, oxygen therapy in the newborn, prematurity.

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399 E-Poster Presentations (Friday, July 17, 2015 16:30) Poster Miscellaneous Implications of Studied Diseases In Neonatal Screening In The State Of Espírito Santo, Brazil, Before And After Change Protocol Conjunctivitis Neonatal Prophylaxis Ingrid Kandler1, Edna Maria de Albuquerque Diniz2, Fábio Gonçalves Coutinho3, Maria de Fátima Caretta Martins4 1 Federal University of the Espírito Santo, Brazil 2 São Paulo University, Brazil 3 Postgraduate Institute Kandler Coutinho, Brazil 4 State health department of the Espírito Santo, Brazil Introduction The National Neonatal Screening Program (PNTN) was implemented in order to develop actions aimed at early diagnosis, treatment and monitoring of diseases in populations with a minimum age of zero to 30 days of life. Better known as Guthrie Test, the test is performed with drops of blood taken from the heel of the child on filter paper. Objective The objective of this study was to evaluate the incidence of diseases detected by neonatal screening test before and after the change of neonatal conjunctivitis prophylaxis protocol. Methods We evaluated all the results of Guthrie Test of tests in all newborn of the State of Espírito Santo between the years 2008 and 2012, the information was obtained from the Neonatal Screening Program database of the State of Espírito Santo and examinations laboratory were performed in APAE-Victoria. Diseases that were screened during the study period and were analyzed include: congenital hypothyroidism; PKU; sickle cell anemia and cystic fibrosis before and after the exchange of Silver Nitrate drops by 1% povidone iodine drops of 2.5% in 2010 to prevent neonatal conjunctivitis. Results The incidence of PKU have fallen for 1:10,000 cases to 0.2:10,000. The incidence for congenital hypothyroidism had a increase 1.1:5000 cases 2:5000 cases, since the results of the incidence of sickle cell anemia and hemoglobinopathies were 1.3:2500 cases to 1.0:2500 cases showing little variation in the analyzed period, as the incidence of cystic fibrosis was 1.0: 12500 in 2009 rose to 1.9: 12,500 in 2010 and then fell again and in 2012 the incidence was 1.0: 12500. Conclusion There was a reduction in phenylketonuria disease because information campaigns about the disease to the population and genetic counseling for families with affected members and it was also found that there was a large increase in the incidence of children with congenital hypothyroidism, hypothesizes that the change in neonatal conjunctivitis protocol with povidone-iodine 2.5% can be a cause of neonatal hypothyroidism. Keywords: phenylketonuria, sickle cell anemia, hemoglobinopathies, cystic fibrosis.

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Is C-Reactive Protein Monitoring A Reliable Cost/Efficient Indicator For The Onset Of Infection In Newborns With Congenital Heart Defects Treated With PGE1? Marta Simon1,2, Szabina Vrincean1, Erzsebet Mathe1, Zsuzsanna Gall1, Laura M Suciu1, Raluca Marian1, Carmen Gliga2, Monika Rusneac2, Manuela Camelia Cucerea1,2 1 University of Medicine and Pharmacy Tg.Mures, Romania 2 Mures County Emergency Hospital, Romania Background Ductus dependent congenital heart defects need PGE1 infusion in order to maintain the ductus permeability until surgical repair can be done. In small centers this may last several weeks. Knowing the side effects of the PGE1, the role of prostaglandins in inflammatory reactions and the risk for infection during prolonged use of central catheters, one needs a reliable cost efficient method for early detection of a potential infection. Materials and method 68 term infants with ductus dependent congenital heart defect with prolonged PGE1 administration were screened for infections. Including criteria: term infants with no initial signs of infections, with good postnatal adaptation, PGE1 infusion for more than 10days. Excluding criteria: prematures, premature rupture of membranes, initial infiection, PGE1 infusion for less than 10days. C-reactive protein, CBC and differential, cultures, temperature were monitored every 72h, or at the onset of a possible infection. Results PGE1 was administered for 10 to 42 days (mean 21,5days). 27(39.7%) cases positive cultures were obtained. In 19(70.3%) of these cases CRP was elevated. We found elevated CRP in 26 cases, which associated positive culture, left shift of WBC differential, and/or fever in 25 cases. Fever was present in 41 cases, in 13(31.7%) as a side effect of PGE1 infusion, cases without any other parameters of infection. Conclusion Monitoring the elevation of CRP proved to be a reliable and cost/efficient tool in predicting infections in PGE1 receiving infants, being associated with at least one other infection pointing parameter in most of the cases.

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Analysis Hypothyroidism Congenital After Change Of Protocol Conjunctivitis Neonatal Prevention In The State Of Espírito Santo, Brazil, In 2010 Ingrid Kandler1, Fábio Gonçalves Coutinho2, Luana Rabbi Bernardes3, Christina Cruz Hegner4, Daniela Franco Lube4, Sarah Fardin de Oliveira4, Cristina Augusta Bravin4, Terezinha Sarquis Cintra4, Samia Gourlart de Souza4 1 Federal University of the Espírito Santo, Brazil 2 Postgraduate Institute Kandler Coutinho, Brazil 3 Federal University of the Espírito Santo, Brazil 4 Association of Parents and Friends of people with cognitive disabilities (APAE)., Brazil Introduction The National Neonatal Screening Program ( PNTN ) , better known as Guthrie Test , makes the diagnosis of congenital diseases such as congenital hypothyroidism that leads to several consequences, such as decreased growth rate and mental retardation. In 2010 there was a change of conjunctivitis prophylaxis protocol due neonatal high incidence of complications with the use of silver nitrate eye drops 1 % , because some studies demostrarem fewer complications with the drops of povidone iodine 2.5% , it was changed. Objective To evaluate the number of confirmed cases of Congenital Hypothyroidism detected by neonatal screening test, after the change of neonatal conjunctivitis prophylaxis protocol. Method We analyzed all medical records of patients with the Guthrie Test exam positive for congenital hypothyroidism in the state of Espirito Santo in the period January 2011 to December 2012, data were collected from the database information Neonatal Screening program of the state of Espírito Santo and the tests were performed in APAE-Vitória, follow-up of patients up to 3 years age at the same institution. Results 41 patients had abnormal tests for hypothyroidism in the 2011 and 2012 period prescribed, an increase of 86.4% over the period 2008 and 2009 when it was not used the eye drops of povidone-iodine 2.5%. After 3 years, 23 (56.1%) had a confirmed diagnosis, 5 (12.2%) had a transient hypothyroidism and 13 (31, 7%) dropped out. The ultrasound analysis found that 23 (56.1%) had normal thyroid, 10 (24.4%) had thyroid with reduced volume, 5 (12.2%) had thyroid with increased volume, 2 (4.9%) ectopic thyroid and 1 (2.4%) thyroid agenesis. Conclusion Most patients had the diagnosis of hypothyroidism with 3 years of age, and of these cases the majority with ultrasound normal thyroid reinforcing the hypothesis that the change in neonatal conjunctivitis protocol with drops of 2.5% povidone-iodine it may be the cause of the increased incidence of hypothyroidism during the neonatal period. Keywords: neonatal screening, hypothyroidism, colirio povidone iodine 2.5%.

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Perinatal Complications of Prematures ≤ 32 Weeks of Gestation: Inborn Vs Outborn. Experience of a Regional IIIrd Level Center in Romania Zaharie Gabriela1, Veronica Obada2, Monica Hasmasanu1, Ligia Blaga1, Tudor Pop1, Sorin Andreica1, Diana Rusu2, Alexandru Zaharie3, Melinda Matyas1 1 University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Romania 2 County Emergency Hospital, Romania 3 University of Medicine Wien, Austria Introduction and Aims The paper aims to assess the perinatal complications of the inborn prematures ≤32 weeks of gestation versus the outborn prematures transferred from lower level units to the regional center . Material and Methods It is a retrospective study which takes place in Neonatology Department from County University Hospital Cluj, Romania, between 2011-2013 . 193 premature infants under 32 SS were enrolled. 50 patients were transferred from lower level units . All patients were admitted to NICU where were assessed: pH , CBC, glucose,electrolites , GOT, GPT , bilirubin, CRP, BUN, creatinine, hemoculture.Was monitorized the respiratory support, FiO2 and transfontanelar ultrasonography and echocardiography was performed. Statistical data were processed in Statistics VII. Informed consent was obtained for all patients. Results Characteristics of the groups were: inborns: GA = 29.44 ± 2.0016 weeks ; W= 1311.20 ± 380.57 ; for outborns: GA=29.51± 2.12 SS ; W = 1318.105 ± 422,68g . The severity of RDS was significantly higher at the transferred cases ; Silverman score 4.61±2.53 at inborn and 5.41±2.81 at outborn (p= 0,00002). The inborn patients received surfactant at 222.017 ± 604.382 minutes of live and outborn at 2491.89± 1425.000 minutes (p = 0.00). The need of respiratory support : CPAP and mechanical ventilation was longer at outborn than inborns (p = 0.01). Mechanical ventilation was applied longer for outborn patients than inborn ones . Total enteral nutrition was delay at outborns than inborns 17.10±14.66 vs 11.70±9.85 days of live . Bleedings were often in outborns : pulmonary hemorrhage (p=0.003),digestive hemorrhage (p=0.0001) and cerebral hemorrhage (p=0.007). Mortality rate was the same in both groups. The GOT was significantly higher in the transfer group (p=0.003). Conclusions The severity of RDS was higher at outborn patients. Bleedings were more often in the transferred patients( pulmonary, digestive and cerebral ) . Total enteral nutrition was delay at outborns.

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Comparative Assessment of Fetal Malnutrition In Preterm Newborns Beatrice Ezenwa, Beatrice Ezenwa, Chinyere Ezeaka, Edna Iroha Lagos University Teaching Hospital, Nigeria Background Fetal malnutrition is a risk factor for increased neonatal morbidities and mortalities worldwide. Its presence and documentation at birth is essential for optimal management of the child. Body Mass Index(BMI) is the tool of choice in determining body proportions and adiposity in children. Objective To assess the nutritional status of preterm newborns at birth using BMI and CANscore and to determine the better indicator for FM in preterm newborns. Methods The study was carried out on consecutive, live born babies between 28 completed weeks through 36 weeks gestation born at Lagos University Teaching Hospital, Lagos, Nigeria without any major congenital abnormalities or severe perinatal illness. Birth weights and lengths were recorded for each infant at birth. The BMI was calculated using the formula: [weight (kg)/ length (m)2]. BMI 10th centile using Brock’s chart is considered as FM. PI was computed from the formula: [weight (g) / length3 (cm) X100]. A PI Results One hundred and forty preterm newborns were assessed. One hundred and eight (77%) were of LBW. BMI, CANscore and PI identified 40.0%, 34.3% and 30.0% of the preterm newborns as FM. Out of the 56 FM babies identified by BMI, CAN score and PI identified 33.9% and 51.8% of them respectively, as FM. Using BMI as standard, PI was the most sensitive anthropometric index for detecting FM in preterm infants compared to CANScore and this was statistically significant, p0.00. Conclusion FM is not exempt in preterm babies. BMI and PI are better identifiers of FM in preterm newborns compared to CANScore

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Factors Associated With Low Birth Weight in Term Newborns Gamze Ozgurhan, Serdar Comert Suleymaniye Maternity and Children’s Training and Research Hospital, Turkey Background Low birth weight (LBW), which is a major public health problem worldwide, is an important factor that affects not only neonatal mortality, but also infant and childhood morbidity. Several maternal and socioeconomical factors can lead to LBW in newborns. Objectives To study maternal, neonatal and socio-economical factors in newborns born with LBW in our hospital and to evaluate risk factors associated with LBW. Design Prospective and comparative study. Method Sixty newborns with LBW ( 2500 g) and 100 newborns with normal birth weight (2500-4000 g) as control group were included in this study, all born in our hospital. A questionnaire including questions on maternal, paternal and socio-economical factors was conducted as face-to-face interviews with mothers. Weight, height and head circumference of all newborns were recorded. Using the data collected, these 2 groups were then compared in terms of neonatal, maternal, paternal and socio-economical factors. Results Average birth weight, height and head circumference in LBW group were 2328±154,55 g, 47,22±1,72 cm and 33,03±1,29 cm respectively. There was not any statistically significant difference in female/male ratio between LBW group and control group. Statistically significant differences were observed between the 2 groups in smoking habits, number of antenatal care visits and presence of child mortalities under the age of 5 (p=0.014, p=0.04 and p=0.033 respectively). Socio-economic characteristics were not also found to be statistically significantly different between the two groups. Conclusion Many factors have a role to play in the development of LBW. However, most important preventive actions have been identified as improving the overall health conditions of mothers, prevention of smoking during pregnancy and a providing sufficient number of antenatal care visits with high quality of service.

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Effect of Oxytocin Augmentation of Labor and the Maternal and Neonatal Outcomes in a Secondary Level Academic Perinatal Care Center Laura Mihaela Suciu1, Marta Simon1, Rozalia Peti2, Mihaela Luca2, Dan Stefan Simpalean3, Manuela Cucerea1 1 University of Medicine and Pharmacy Tirgu Mures, Romania 2 University County Hospital Tirgu Mures, Romania 3 University of Medicine and Pharmacy Tirgu Mures, Romania Aims To evaluate maternal and adverse neonatal effect of oxytocin given to mothers during labor Methods: A retrospective cohort analysis of 1443 singleton infants born at 34 to 42 weeks of gestation in one secondary level perinatal care center ( January to December, 2015). Mothers were divided into two groups, according to the exposure to the oxytocin either for induction or augmentation of labor taking care of the inclusion and exclusion criteria. Outcomes variables were cesarean delivery, need for neonatal resuscitation, thick meconium, neonatal jaundice, birth related trauma, and polycythemia. Results The mean age of oxytocin group was 26.44 (±6.9) years while in control group was 25.68 (±4.2) years. OR and CIs for oxytocin group was calculated and show a statistically significant decrease risks for cesarean section OR 0.14 [0.005-0.45], and increase risk of birth related trauma OR 6.77 [2.08-22.56], neonatal jaundice OR 1.27 [1.02-1.64]; thick meconium OR 0.95 [0.67-3.87], polycythemia OR 1.44 [1.2-2.78] and successfully breast feeding OR1.3 [1.02-1.66] Conclusions The most commonly used drug for the induction and augmentation of labor is associated with adverse neonatal outcome but not with cesarean risk.

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Neonatal Resuscitation And Essentials Of Newborn Care: Delivering Neonatal Training In LowResource Settings Alastair Stanley, Elizabeth Ledger, Toby Candler Bristol Royal Hospital for Children, UK Neonatal mortality accounts for 44% of under-5 mortality globally each year, with the majority of these deaths occurring in sub-Saharan Africa. Improvements in neonatal outcomes in this setting can be achieved without advanced or expensive technologies through training of local staff in neonatal resuscitation, recognition of common neonatal problems, and the use of low-cost effective interventions such as Kangaroo Care. The authors developed a two-day Neonatal Resuscitation and Essentials of Newborn Care course to deliver this training to staff involved in neonatal care at hospitals in Ethiopia and Tanzania. The course used a combination of lectures and clinical scenarios relating to neonatal resuscitation and the recognition and management of neonatal sepsis, jaundice, hypothermia, feeding and hypoglycaemia. Candidates completed a 30-question true-false test at the beginning of the course to establish baseline knowledge, and again at the end of the course by way of formal assessment and to quantify any improvements in knowledge. Formal assessment also included a resuscitation scenario at the end of Day 1. Candidates were asked to complete anonymous feedback to help improve the course in the future. A total of 93 staff, including doctors, nurses, and medical assistants, completed both the initial and final test. 89% of candidates (n=83) improved their test scores following completion of the course, with an increase in the median test score from 61% to 77% in Ethiopia, and from 53% to 70% in Tanzania. Candidates who performed particularly well were invited to complete a further day of training to be able to teach the course in order to train more healthcare workers. All candidates reported feeling better able to perform neonatal resuscitation and manage neonatal problems after attending the course. Delivering this course in low-resource settings improves both the knowledge and confidence of healthcare workers with regards to neonatal resuscitation and care.

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Relationship between BMI of Premature Newborn, Respiratory Distress, Early Neonatal Sepsis and Death

Ingrid Kandler1, Fábio Gonçalves Coutinho2, Valmin Ramos Silva3 1 Federal University of the Espírito Santo, Brazil 2 Postgraduate Institute Kandler Coutinho, Brazil 3 Medical School of Santa Casa de Misericórdia, Brazil Introduction External factors, that is, not intrinsic to the fetus result in restriction of asymmetric growth, which typically begins at the end of the second trimester of pregnancy. Small reductions in nutrient and oxygen supply hamper the growth of skeletal muscle and the deposition of glycogen and fat, but still allow bone growth and continued brain. Objective To investigate the relationship between Premature Newborn (PTN) Body Mass Index (BMI) born in 2012 at the University Hospital Cassiano Antonio Moraes (HUCAM) in Vitória - ES, regarding the need for oxygen therapy, early neonatal sepsis and death, Methods Cross-sectional study, which were selected all born preterm in 2012, in HUCAM in Vitoria, ES, we calculated the BMI of all preterm newborns and after we analyzed the medical records and extracted data regarding the need for oxygen therapy, sepsis early neonatal and death. The cases were categorized according to BMI in relation to gestational age and classified as malnourished, appropriate and obese and after statistical calculation done seen the perinatal outcome. Results Among 189 preterm infants, 58 (31.5%) had a abnormal BMI, where 39 (21.2%) are obese and 19 (10.3%) are malnourished. 52 (27.5%) had mechanical ventilation, 14 (7.4%) positive Rodwell score, 17 (9.0%) have died and 40 (32.5%) had positive C-reactive protein. 6 BMI obtained PCR`s and positive scores at the same time, where 4 (66.7%) is premature with normal BMI and 2 (33.3%) is premature with BMI in the range obesity. 4 (100.0%) of children with mechanical ventilation have PCR and positive score. 5 (71.4%) of children with PCR and positive score did not die and 2 (28.6%) died. Conclusion The logistic regression was not statistically significant in any association.Therefore no association between BMI and changed the PCR and the score, so the calculation of the modified BMI does not play a risk factor and not protection for preterm infants. Keywords: Premature newborn BMI;Respiratory Distress;Early onset neonatal sepsis.

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Congenital Heart Block in Neonatal Lupus Fatemeh Tahghighi Tehran University of Medical Sciences, Iran Neonatal lupus erythematosus (NLE) is caused by the transplacental passage of maternal autoantibodies. The presence of maternal anti-SSA/Ro and anti-SSB/La antibodies increases the risk of bearing infants with NLE; rarely, NLE is due to maternal passage of U1-RNP antibodies. NLE has substantial associated morbidity and mortality, particularly when the heart is affected. NLE may manifest as complete or incomplete congenital heart block.In children who are severely affected, a pacemaker is frequently needed because sudden cardiac death or heart failure may occur. Non-fluorinated steroids (prednisone, prednisolone and methylprednisolone) are recommended only for maternal indications, not for prevention of CHB in antiRo/SSA-positive women. Fluorinated steroids (dexamethasone or bethametasone) are not metabolized by the placenta and are available to the fetus in an active form. Routine prophylactic therapy with fluorinated steroids is not recommended even in women who previously had children with CHB or skin rash since this therapy has its own side-effects. Intravenous immunoglobulin had been used to prevent the development of CHB and in some cases CHB recurred . At present, the only sure recommendation that can be made in these women is that in the presence of reliable positivity for anti-Ro/SSA antibodies serial echocardiograms and obstetric sonograms should be performed at least every 2 weeks starting from the 16th week of gestational age: the goal is to detect early fetal abnormalities, such as premature atrial contractions or moderate pericardial effusion, that might precede complete atrioventricular block and that might be a target of preventive therapy. Fluorinated steroids should not be used in the absence of symptoms; in the presence of alarming symptoms, using of them can be useful.

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Acupressure at LI4 (Hegu) Point Prior to Heel Lancing for Pain Management at Healthy Term Newborns Aslihan Abbasoglu, Aslihan Abbasoglu, Safak Gucyetmez, Murat San Gaziantep Cengiz Gokcek Maternity and Children's Hospital, Turkey Introduction Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Nonpharmacological strategies have actually become more important than pharmacological analgesic agents in neonatal pain management. Acupressure is an ancient Chinese healing art. In this pain-relieving method, the fingers are used to press key acupuncture points on the skin surface that stimulates the body’s regulatory processes. We aimed to investigate the effect of acupressure at LI4 (Hegu) point prior to heel lancing as a non-pharmacological intervention for procedural pain management in infants. Methods Twenty six term newborns who were undergoing heel lancing between postnatal days 3 to 8 as part of routine neonatal screening were randomly assigned to the acupressure group or the oral sucrose group. In the acupressure group, before the heel-lancing, acupressure was applied for 3 minutes simultaneously at LI4 (Hegu) point (On the dorsum of the hand, between the 1st and 2nd metacarpal bones, in the middle of the 2nd metacarpal bone on the radial side) .In the dextose group, each infant received 2 mL of 30% dextrose orally via syringe 2 minutes prior to the heel lancing. Each baby’s behaviour was scored using the Neonatal Infant Pain Scale (NIPS). Results There were no significant differences between the groups with respect to gestational age, birth weight, age at time of procedure, weight at time of procedure (p0.05). The PIPP score in acupressure group was found 10.0 ±2.08 and 9.85±2.19 in oral dextrose group (p0.05). Conclusions Our results indicate that applying acupressure at LI4 (Hegu) point point prior to heel lancing is as effective as oral sucrose for reducing the discomfort of this procedure. Acupressure could be a promising nonpharmacological treatment modality for reducing pain in newborns.

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Regional Tissue Oxygen Saturation In Newborns During Erythrocyte Transfusion Measured By Near–Infrared Spectroscopy Petja Fister, Domen Robek, Darja Paro-Panjan University Medical Centre Ljubljana, Division of Pediatrics, Slovenia Background and Aims The tissue oxygen saturation (rSO2) depends on haemoglobin concentration and arterial oxygen saturation. In anaemia the oxyform capacity of blood is diminished. Near–infrared spectroscopy (NIRS) might be an additional nonivasive tool for establishing changes of tissue oxygen supply during transfusion. The purpose was to evaluate changes in the regional rSO2 in newborns with anaemia during transfusion. Methods In a prospective study of 23 newborns with anaemia regional rSO2 was measured by NIRS (INVOS– Cerebral/Somatic oximeter, 5100C Monitor, Somanetics, USA). The neonatal probes were placed on the left and right forehead to measure brain rSO2 and lumbally to measure kidney rSO2. Because of anaemia 15 newborns received erythrocyte transfusion (T) and 8 exchange transfusion (ET). The regional rSO2 was measured before, after the start, before the end and one hour after transfusions. The rSO2 measurements were taken simultaneously at pre-set sampling rate of six seconds. Values were averaged over twenty minutes with licensed version of Invos Analytics Tool. Results In both groups the rSO2 in the left and right brain and in the kidney were increasing from before, after the start and before the end of the transfusion (p = 0.002, p = 0.047). In newborns with T the rSO2 stayed elevated after the T. In newborns with ET the rSO2 after ET diminished to the values they had before the ET. Conclusions The rSO2 in the brain and the kidney was increasing in newborns with anaemia during transfusion. Newborns with T were older when they received T, had lower haemoglobin, which rose significantly after T with different adaptation mechanisms present. In applying new technologies for the assessment of decreased ability of the circulating erythrocytes to meet the oxygen demands of tissues the regional rSO2 could be of a value for potential use in newborns with anaemia.

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Sy Zellweger- Unusual Presentation Natasa Aluloska-Najdanovska1, Anet Papazovska1, Snezana Palcevska3, Velibor Tasic2 1 University Children Hospital, Macedonia 2 University Children Hospital, Macedonia 3 Clinical Hospital Adzibadem Sistina, Macedonia Peroxisomal disorders are a group of genetically heterogeneous metabolic diseases that share dysfunction of peroxisomes. The Zellweger spectrum disorders (ZSDs) are characterized by a generalized loss of peroxisomal functions caused by deficient peroxisomal assembly. Zellweger syndrome (ZWS) is the most common peroxisomal disorder to manifest itself in early infancy. Its incidence has been estimated to be 1 in 50,000-100,000. Clinical presentation and survival are heterogeneous. Here we present 2 week old male affected by Zellweger syndrome with an unusual presentation. During the regular fetal ultrasonography large polycystic kidneys were noted and nephrologic workout was suggested. The baby was admitted to Neonatal Department suspected to have polycystic kidney disease. Clinical features of severe hypotonia, facial appearance, redundant neck skin, ventricular septal defect, talipies equinovarus, renal cystic disease suggested the possibility of Zellweger syndrome. The diagnosis was confirmed by biochemical/metabolic assessment.

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An 8-year review of major congenital abnormalities in a tertiary hospital in Lagos, Nigeria Iretiola Fajolu1,2, Beatrice Ezenwa1,2, Patricia Akintan2, Veronica Ezeaka1,2 1 College of Medicine, University of Lagos., Nigeria 2 Lagos University Teaching Hospital, Idi-Araba, Nigeria Background Congenital abnormalities are defects present at birth and are increasingly becoming an important cause of neonatal mortality. They can also result in disability in majority of the survivors. Objective To describe the pattern and outcome of major congenital abnormalities (MCA) in a tertiary hospital in Lagos, Nigeria. Methods The labour ward and labour ward theatre delivery records and admission records of the in-born ward of the neonatal unit of a tertiary hospital were reviewed retrospectively from January 2007 to December 2014. The MCA were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, (ICD-10). Multiple abnormalities were counted once by the system with the most major anomaly. Abnormalities were grouped according to organ systems, sex and yearly distribution. Statistical analysis was based on systemic type, and neonatal outcome. Results Out of 14581 deliveries during the study period, 167 had MCA, giving an incidence of 11.5 per 1000 total births; 71 (42.5%) were females, 91 (54.5%) were male and 5(3.0%) had indeterminate sex. There was an increase in the yearly incidence from 2007-2014 The most frequent abnormalities were in the central nervous system (31.7%), musculoskeletal system (18.6%), complex congenital abnormalities group (15.5%) and urogenital system (11.4%). Fifty six (31.8%) infants died in the first week of life contributing 12.6% to the overall early neonatal mortality during the study period. Overall case fatality rate was 42.0%; case fatality was highest in the other abnormalities group, followed by chromosomal, cardiovascular and genitourinary system abnormalities respectively. Conclusion The incidence of MCA in this study is high especially in the central nervous system. There was a steady increase in the yearly incidence during the study period. The overall case fatality rate was also very high with a high contribution to early neonatal deaths

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Ways of Surfactant Administration and the Need of Mechanical Ventilation in Premature Born At 2430weeks Gestational Age Marta Simon1,2, Erzsebet Mathe1, Szabina Vrincean1, Zsuzsanna Gall1, Laura M Suciu1, Raluca Marian1, Monika Rusneac2, Carmen Gliga2, Manuela Camelia Cucerea1,2 1 University of Medicine and Pharmacy Tg.Mures, Romania 2 Mures County Emergency Hospital, Romania Background Respiratory distress syndrome due to surfactant deficiency and immature lung morphology, and also chronic lung desease due to prolonged invasive ventilation remains the main pathology among prematures born before 30 weeks gestational age. Recently new approaches to RDS like less invasive surfactant administration (LISA) or intubation surfactant extubation (INSURE) followed by noninvasive ventilation appeared to have better outcome. Materials and methods In our retrospective study we analized the ventilation need and outcome of 43 prematures born at or before 30weeks gestational age, with respect on the surfactant administration and corticoprophylaxis. Results In our group mean gestational age was 27.3 weeks, mean birthweight 980.77g. 26 infants received surfactant therapy in the first 2 hours of live, 16 of which had full corticoprophylaxy, 2 had only partial corticoprophylaxy. 11 infants with both corticoprophylaxy and surfactant prophylaxy at birth via LISA/INSURE method, with a mean gestational age of 28.18 weeks and mean birthweight of 979.09g 8 of which needed ventilation for an average of 8.84days CPAP or SiPAP, 3needed intubation and conventional ventilation. LISA without corticoprophylaxy was done in 5 cases, 3 of which needed conventional ventilation.Therapeutic surfactant therapy was necessary in 10 prematures, with more invasive ventilation modes- SIMV in all cases, in 4cases HFOV, for 7-38 days. Chronic lung desease was diagnosed in 4 infants, all from the therapeutic surfactant and invasively ventilated group. Conclusions LISA/INSURE are less traumatic methods of surfactant administration, but it can be administered in well selected group, with good respiratory effort, after alveolar recrutation, infants who benefit more of the method are born at 27 weeks or after.

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A Rare Case of Congenital Ranula in a Neonate Snezana Palchevska1, Snezhana Palchevska1, Natasa Aluloska2, Mirjana Kocova3 1 Clinical Hospital Sistina Adzibadem, Skopje, Macedonia, Macedonia 2 University Children Hospital, Skopje, Macedonia, Macedonia 3 University Children Hospital, Skopje, Macedonia, Macedonia Ranulas are cystic dilatations in the mouth floor. They are formed as a result of obstruction of one of the sublingual salivary glands, leading to ducts proximal expansion to a musous retention cyst lined by salivary duct epitelium, as seen neonates or mucous extravasation in the adjacent tissue forming a pseudo cyst that lacks the epithelial lining. Ranula may be congenital or acquired. According to literature, oral ranulas are most prevalent in females and the most common site for oral ranula is on the left side of the mouth floor. Ranulas involving the ventral surface of the tongue are very rare, with sporadic cases reported in the world literature, accounting for 2-8% of oral mucoceles. The dimensions range from 0,5 to 3,3 cm in diameter. They are generally asymptomatic, although the large ones can cause aesthetic and functional problems. Congenital ranula presenting in a newborn infant is a rarity with the incidence being estimated to be 0,74% and thus there is a limited data published in the literature on the cited subject. We present a case of symptomatic congenital ranula in a neonate, requiring surgical management. The physical examination, lesion evolution and imaging are described, together with the surgical management, histopathology and follow-up. Early clinical assessment, differential diagnosis and magnetic resonance imaging allow clinicians to diagnose and treat this rare congenital condition with surgery in early infancy. Key words: mucocele, congenital ranula, mouth, cystic dilatation

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Prenatal Diagnosis of D Transposition of Great Arteries-Impact in Perinatal and Neonatal Management

hajrije ismaili1,2, Hajrije Ismaili2 1 HPG23, Italy 2 HPG23, Italy D-transposition of the great arteries is the most common cyanotic congenital heart defect to present in the 1st week of life. A growing number of transposition of the great arteries is diagnosed before birth. Few studies have evaluated the impact of prenatal diagnosis on perinatal management. Most patients with d-TGA/intact ventricular septum are now successfully treated with prostaglandin E infusion, balloon atrial septostomy and arterial switch operation in the first week of life. Purpose of this study was double Descriptive analysis of several parameters of the group involved in the study and analysis of the two subgroups across different variables. First subgroup consists, whether were prenatally or postnatally diagnosed, and second whether TGA was simple or complex. Methods We included patients with dTGA over a 4/year period from January 2012 to December 2015 in Papa Giovanni XXIII Hospital, Bergamo. Charts for 43 patients were obtained and enrolled in study. Antenatal, perinatal and neonatal variables were investigated. As statistic indicators were used: Structure, Percentage, P value. Results: Our population of patient with TGA was divided into two cohorts study based on whether they were prenatally or postnatal diagnosed. During study period, 16 patients(37.2%) were not diagnosed prenatally and 27 patients (62.8%) were diagnosed prenatally. Among prenatally diagnosed patients(27), 23 were born in HPG23,3 in OORBG-Bergamo, at an obstetric unit adjacent to our cardiac unit. . In prenatally diagnosed patients, totally 27, 20 of them were born spontaneously and 7 were born by cesarean section. ASO was performed at median of 8-14 days Conclusions Prenatal diagnosis of TGA, is an important factor that contributes in perinatal and neonatal management. More efforts should be put on to increase prenatal diagnosis. In our study, prenatal diagnosis didn’t alter the mode of delivery. It was offered planned and induction of labor and deliveries were ended spontaneously in prenatally diagnosed patients. Cesarean section was performed only for obstetric indications. ASO was led according to recommendations. Key words: Fetal echocardiography, Transposition of Great Arteries, Arterial switch operation.

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Impairment of Brain Growth after Intraventricular Haemorrhage Katharina Goeral1, Katharina Goeral, Bernd Schweiger3, Britta Hüning3, BM Hüning, Gregor Kasprian2, Gregor Kasprian, Renate Fuiko, Renate Fuiko1, Ursula Felderhoff-Müser, Angelika Berger, Monika Olischar, Ursula Felderhoff-Müser3, Angelika Berger1, Katrin Klebermass-Schrehof, Bernd Schweiger, Monika Olischar1, Katrin Klebermass-Schrehof1 1 1, Austria 2 2, Austria 3 3, Germany Background and aims Brain biometry at term equivalent age has been shown to correlate with three-dimensional volumetric measures and was recently used to study the degree of impaired brain growth in very preterm neonates. The aim of the present study was to evaluate the additional impact of IVH on impaired brain growth. Methods Seventy-four preterm infants with IVH and Impaired brain growth was defined according to Kidokoro et al. (increased IHD or small BPW pattern) and was evaluated by using one-dimensional measurements on MRI. Interhemispheric distance (IHD) and biparietal width (BPW) were quantified. Z-Scores were calculated by comparison to normative data of healthy age-matched controls published by either Garel (fetal MRI, data up to 38 weeks gestation) or Nguyen Te Tich et al. (data at TEA). Results 56.9% of neonates showed no parenchymal defect, 13.5% a localised and 16.2% an extensive parenchymal defect as defined by Bassan et al. IHD showed a mean Z-score of +1.9±2.0 and BPW a mean Z-score of -2.6±1.7. Summarised, 95.3% of neonates showed some form of impaired brain growth (37.5% increased IHD and 92.2% small BPW pattern; 34.2% impaired brain growth according to both patterns). Conclusions Comparing our percentages of impaired brain growth to the cohort of 325 very preterm neonates studied by Kidokoro et al., a comparable percentage of increased IHD, but a three-fold increase in the percentage of small BPW pattern can be observed. This underlines the impact of IVH on brain growth.

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Humeral pseudo aneurysm secondary a blood extraction. Clinical case. Natalia Ines Carrilho, Mercedes Almosni, Luciano Razetto, Laura Carbonell Clínica Independencia, Argentina Introduction Humeral pseudo aneurysm is a rare entity, caused by extra vascular processes that damages the arterial wall. The aetiology is variable, the most common cause is trauma, resulting in a disruption of the arterial wall and secondarily in an aneurysm on the involved area. This type of aneurysms affect peripheral arteries, like in the extremities. On physical examination a growing mass can be observed, pulsatile, on the affected area. Complications are thrombosis, blockage or rupture of the aneurysm, therefore an early diagnosis and treatment is important. The diagnosis includes: x-ray, Doppler ultrasound and MRI scan (magnetic resonance). The recommended treatment is surgical repair with extreme-anastomosis and subsequent clinical treatment in order to evaluate growth and functionality of the tracking member . Objectives To describe a pathology of iatrogenic origin with the aim of improving the security in the attention of inewborns. Clinical case Patient of masculine sex, RNPT/APEG (36 weeks / 3675gr). He joined with 24 days of life to UCIN, derived from pediatrics as since the first 4 days of life it presented a tumor at the third distal of the left arm. MSI radiography was performed: without special features; ultrasound:hypoechoic image rounded with wall of 27,5 x 16 x 19mm with turbulent flow in its interior; Doppler ultrasound of the MSI: humeral artery at the third distal with neck and sack image, turbulent flow, compatible with left brachial artery pseudo aneurysm. He was evaluated by vascular surgery who realized a surgical treatment. He continues being monitored by the paediatrics service. Conclusion The injury of the brachial artery is a rare complication of blood extraction and late diagnosis. Therefore the emphasis should lie on a correct extraction technique as well as the thorough physical examination for diagnosis and early intervention. Bibliography: Pediatria Surg Int (2004) 20:594-597. Arch Dis Child Fetal Neonatal Ed 2003 88:F152-F153

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Neonatal Morbidity in Macrosomic Babies Gamze Ozgurhan, Asuman Guney, Rabia Nur Temiz, Serdar Comert Suleymaniye Maternity and Children’s Training and Research Hospital, Turkey Purpose Macrosomia is defined as birth weight over 4000 grams. Neonatal complications can be seen frequently in macrosomic babies. In this study, we aim to compare macrosomic babies and AGA (appropriate for gestational age) babies in terms of neonatal morbidity. Methods Maternal age, gravidity, parity, gestational diabetes, gestational hypertension, body mass index (BMI) before pregnancy, weight gain during pregnancy, type of delivery, gestational age and sexuality of babies, anthropometric measurements, incidence of birth trauma, Apgar score, respiratory distress score, presence of metabolic problems as hypoglycemia, polycythemia, presence of hyperbilirubinemia, pathological weight loss and requirement of hospitalization is evaluated prospectively and compared for each group. Windows SPSS 22.0 program was used for statistical analysis and p Results A hundred macrosomic and 100 AGA baby were included in this study. Maternal age, macrosomic sibling history, BMI before pregnancy, weight gain during pregnancy were significantly higher macrosomic group (p=0.047, p=0.001, p=0.003, p=0.007 respectively). Gestational age of babies and (39.8, 39), rate of male gender (70%, 49%) were also significantly higher in macrosomic group. First minute Apgar score was significantly lower in macrosomic group but 5. Minute Apgar score was not significantly different between two groups. Positive pressure ventilation application score was significantly higher in macrosomic group (p= 0.04). Clavicle fracture, caput succedaneum and ecchymosis rates were found to be significantly higher in macrosomic group (p=0.004, p=0.005, p=0.022 respectively) but brachial plexus paralysis cephal hematoma rates were not significantly different between two groups. Hypoglycemia and pathological weight loss were significantly higher in macrosomic group (p=0.03, p=0.038 respectively) while other variables were not significantly different between macrosomic and AGA groups. Conclusion High maternal age, macrosomic birth history, high BMI before pregnancy, more weight gain during pregnancy and presence of gestational diabetes are risk factors for macrosomic birth. Birth trauma, hypoglycemia and pathological weight loss were seen more frequently in macrosomic babies. For this reason, after a careful physical examination, blood glucose levels and weight measurements should be monitored closely.

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Factors Affecting Breastfeeding in Late Preterm Infant Maria Livia Ognean1, Corina Zgarcea1, Raluca Dumitra1, Oana Boanta1, Simona Kovacs2, Ecaterina Olariu1, Doina Andreicut2 1 Clinical County Emergency Hospital, Romania 2 Clinical County Emergency Hospital, Romania Introduction Increased neonatal morbidity and mortality and more unfavorable outcomes have been associated with late preterm birth. Breastfeeding difficulties and lower rates of breastfeeding were reported in late preterm infants (LPI). Aim The authors aimed to evaluate possible risk factors for the lower rates of breastfeeding in LPI. Material and methods In a retrospective study the authors analyzed maternal and neonatal factors that may affect partial and exclusive breastfeeding rates in the LPI (340-366 weeks gestation) born between 1 January 2013 and 31 December 2015 in the Maternity Hospital Sibiu. Maternal and neonatal characteristics, epidemiological and clinical data were extracted from neonatal charts and comparatively analyzed between exclusively breastfed LPI and those partially breastfed and formula fed LPI. Statistical analysis was performed using SPS for Windows 10.0 and p was considered statistically significant if 0.05. Results The study group comprised 435 infants - 60 exclusively breastfed, 335 partially breastfed, and 40 formula fed infants at discharge. When comparing the exclusively breastfed infants with those formula fed we found that those fed exclusively with formula had significantly lower gestational age (p=0.043), birth weight (p=0.000), Apgar scores at 1 minute (p=0.029), higher incidence of maternal fetal-infections (p=0.021: OR 1.94[ci95% 1.22-3.08]) and hospitalization length (p=0.002). Also, their mother were more often multiparous (p=0.001), more often resident in rural areas (p=0.022), without prenatal care (p=0.001), less educated (p=0.000). The comparison between exclusively breastfed LPI infants with those partially breastfed showed no difference in gestational age and birth weight but exclusive breastfeeding was associated with higher rates of anemia at birth (p=0.009), lower mean hemoglobin levels (p=0.012), increased rate and duration of NICU hospitalization (p=0.034, p=0.012 respectively), and residence in urban areas (p=0.033). Conclusions Identification of factors that may affect breastfeeding rates may help professionals to implement effective strategies or interventions for breastfeeding success in LPI infants.

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Antenal Exposure to Magnesium Sulphate and the Risk of Spontaneous Intestinal Performance and Necrotizing Enterocilitis in Very Peterm Neonates Mohamed Ahmed1,2, Prakesh Shah2, Adel Mohamed2 1 Hospital for sick children, Canada 2 Mount Sinai Hospital, Canada Background Objective To assess the risk of SIP and/or necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW) infants exposed to MgSO4 antenatally. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born Result Exposed (n=2055) and unexposed infants (n=2300) were compared. Demographic data and outcomes are in [Table 1]. Results of multivariable regression analysis are in [Table 2]. Conclusion Antenatal MgSo4 was not associated with NEC or SIP in ELBW infants including the subgroup of

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Incidence of Extrauterine Growth Retardation and Related Factors in Preterm Infants Sertac Arslanoglu2, Mehmet Emin Oguz1, Demet Terek1, Kıymet Celik1 1 Behcet Uz Children's Hospital, Turkey 2 İstanbul Medeniyet University, Turkey Bacground/Scope Despite advances in neonatal nutrition, extrauterine growth retardation (EUGR) for tiny preterm infants is still a problem in the Neonatal Intensive Care Unit (NICU)s. EUGR is associated with important morbidities including neurocognitive aoutcome. The aim of this study is to find out the incidence of EUGR and related factors for preterm infants at a Level III NICU in the western coast of Turkey. Methods retrospective cohort study was planned with a duration of 18 months.Preterm infants admitted within the first day of life and stayed at least 2 weeks at the NICU were included. EUGR was defined as growth below 10th percentile at discharge. Demographic characteristics of mothers and infants, antenatal, natal risk factors, inhospital morbidities/procedures, growth and nutritional intakes were recorded. The incidence of EUGR along with the possible associations between the nutritional, non-nutritional factors and EUGR development were analysed using SPSS 20.0 Program for Windows. Results Out of 517 screened admissions, 110 preterm infants with a mean birth weight of 33.2 +- 2.2 weeks met the inclusion criteria.While at birth only 15.5 % of the infants were SGA, EUGR rate was 45.9 % at the discharge. EUGR development was associated with lower birth weight, sepsis, severe RDS and NEC, lower fat intake in the first week . Conclusion EUGR continues to be a problem for preterm infants. The observed relationship between low fat intake and EUGR might be partly due to our strategy of providing appropriately high protein intakes from the first hours of life, but going slow for fat. The nutritional protocol was modified accordingly.

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Hearing Loss and Associated Factors in VLBW Infants: Results from a Level III NICU at the Anatolian Side of İstanbul Sertac Arslanoglu1, Sibel Ozumut1, İlke Akın1, Ozgul Bulut1, Nuran Ustun1, Derya Buyukkayhan1, Cemil Balaban2, Fahri Ovalı1 1 İstanbul Medeniyet University, Turkey 2 İstanbul Medeniyet University, Turkey Background/Scope The incidence of hearing loss is 0.3-2.2% in low birthweight and preterm infants. The aim of this study is to find out the prevalence of permanent hearing loss and related factors in high risk preterm infants admitted to our NICU and screened at discharge. Methods Preterm infants with a birthweight Results Out of the whole group admmitted to the NICU during the 3 years study period, 144 VLBW preterm infants with a mean birth weight of 1227.2 g, a mean gestational age of 29.8 weeks met the inclusion criteria. The rates for the use of an ototoxic drug, meningitis, mechanical ventilation longer than 5 and 10 days, and Grade III IVH were 97.8, 2.7, 13.8, 5.5, and 2.7%, respectively. The permanent hearing loss was shown in only one baby in the whole group (0.69%). Conclusion The prevalence of hearing loss was found to be lower than that reported for VLBW infants. Although it was impossible to perform a correlation analysis for a single case, we speculate that low incidence of some risk factors such as long mechanical ventilation days and Grade III IVH might partly explain this finding. This paper presents here the first results of an ongoing study.

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Congenital Tuberculosis After in Vitro Fertilization: Case Report Veronica Mugarab-Samedi1, Kamran Yusuf1, Jack Rabi1, Salam Aljubouri1, Kyle Kurek2, Polya Ninova1 1 University of Calgary, Canada 2 Alberta Children Hospital, Canada Congenital tuberculosis is one of the rare manifestations of this dangerous disease. The diagnosis is usually delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy. We report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to mother who presented with uncontrolled seizures during preterm labor. Initial diagnosis was done by placental pathology that showed necrotizing granulomatous deciduitis and subchorionitis with small aerobic non-motile bacilli inclusion and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Immediately after discovery of maternal TB, infection diseases and TB services were contacted. Infant had full screening for TB including repeated AFB culture of blood, CSF , endotracheal aspirates, gastric aspirates, urine and stools, and treatment for tuberculosis with a four-drug regimen was started in both the mother and infant.

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