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Abstract Body

Background. High dose erythropoietin (Epo) is neuroprotective in preclinical models of neonatal brain injury and in a meta-analysis of 4 phase II clinical trials, but the safety and potential benefits of such treatment for extremely preterm infants have not been established.

Methods. 941 infants 24-0/7 to 27-6/7 weeks’ gestation were randomized, and 936 subjects received Epo (n=476) or placebo (n=460) in a double-blinded manner. Enrollment and initial treatment with Epo or placebo occurred within 24 hours after birth. Study drug (Epo 1000 U/kg or placebo) was given intravenously every 48 hours for 6 doses, followed by 400 U/kg/dose Epo or sham injections three times a week through 32 weeks postmenstrual age (PMA). The primary endpoint was death or severe neurodevelopmental impairment (NDI) at 22-26 months PMA. Severe NDI was considered as the presence of severe cerebral palsy or Bayley Motor or Cognitive Composite Score < 70. Serious adverse events (SAEs) were prospectively collected and tabulated by treatment group.

Results. There was no statistically significant difference in the combined outcome of death or severe NDI between treatment groups. There were no clinically meaningful or statistically significant differences in SAEs or co-morbidities of prematurity including retinopathy of prematurity, intracranial hemorrhage, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia or death. Epo-treated infants received fewer transfusions and had fewer unique donor exposures than placebo-treated infants.

Conclusions. High dose Epo treatment of extremely preterm infants administered from 24 hours of birth through 32 weeks PMA is safe, but did not confer neuroprotection at two years.

ClinicalTrials.gov NCT01378273

Abstract Body

Background:
ABO blood group incompatibility occurs in 15-20% of all pregnancies and 10% of those develop hemolytic disease. Transcutaneous bilirubin screening use is increasing but still not widespread

Aims:

To compare neonatal outcomes of DCT positive and DCT negative infants born to blood group O positive mothers

To evaluate the effect of neonatal blood group on the severity of hemolysis and neonatal jaundice due to maternal-fetal ABO incompatibility

To investigate the value of transcutaneous bilirubin measurement and first serum bilirubin in predicting the development of significant hyperbilirubinemia later in the first few days in infants with ABO incompatibility

Methodology:
One year retrospective review of infants with blood group A and B positive born to Blood

group O positive mothers with gestational age of > 33 wks. at birth.

Conclusion :

 There were significant difference in the incidence and severity of hyperbilirubinemia and hemolysis between DCT negative and positive infants

 Infants with blood group B positive had more severe hemolysis as evidenced by need for PT, IVIG therapy and the duration of hospital stay

 Estimation of TCB after birth is useful in predicting which infants will develop severe hyperbilirubinemia

Abstract Body

Background and aims

Extremely preterm infants often develop anemia due to frequent blood sampling and need blood transfusions. Umbilical cord blood (UCB) differs from adult blood by higher levels fetal hemoglobin (HbF). When neonates receive blood transfusion from adult donors, there is an increased risk for prematurity associated diseases e.g. bronchopulmonary dysplasia and retinopathy of prematurity. To use UCB with higher levels of HbF for transfusions instead of blood from adult donors might improve outcome. The aim was to develop an optimized type of blood-component consisting of UCB derived erythrocytes(EUC) intended for transfusion into neonates.

Methods

UCB was collected from healthy newborns after clamping of the cord through cannulation of the umbilical vein. UCB diluted(SAGM 1:1) was filtered and processed by a bottom-top bag-system using a Smartpress(Macopharma). EUCs were analyzed in different series for: sterility(BactAlert), leukoreduktion(Leukocount (FACSLyrics), HbF(HPLC,Variant II)Hb, EVF(CelldynSapphire), erythrocyte morphology(light microscopy) and hemolysis (Hemoque,Plasma/lowHb).

Results

EUCs in respective series were: negative sterility test (n=9), leucocytes <1.0 x 106/ EUC unit (n=30), mean value of HbF=77 % of total hemoglobin variants (n=6), mean value of Hb=198 g/L (n=12), EVF= 0.59 % (n=12). 7 days after processing hemolysis in EUCs were 0.19% (n=8) and after 14 days 0.50% (n=7). The morphology of EUCs (n=4) was similar compared to the morphology of adult erythrocytes (n=4) a day 1.

Conclusions

UCB can be successfully and safely processed into EUC intended for optimized blood transfusions into neonates. The obtained results for EUC are in alignment with quality standards for adult erythrocyte blood components.

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Background and aims

At birth, fetal hemoglobin (HbF) is more abundant in preterm compared to term neonates. The aim of this study was to investigate the potential association of HbF with arterial oxygen saturation (SpO2), heart rate (HR), cerebral-tissue-oxygen-saturation (crSO2), and fractional-tissue-oxygen-extraction (FTOE) during the immediate postnatal transition.

Methods

Retrospective data analysis was performed on healthy neonates monitored for SpO2 and ECG, and additionally for crSO2 by near infrared spectroscopy, during the first 15 minutes after birth. A routine blood gas analysis included HbF measurement in all patients. FTOE was calculated from the measured SpO2 and crSO2. Correlations of total blood hemoglobin (Hb), HbF, and percentage of HbF (FHbF) with SpO2, HR, crSO2, and FTOE in each minute were performed for both term and preterm neonates.

Results

Ninety-two term (38,7±0,8 weeks´ gestation) and 19 preterm neonates (34,3±1,4 weeks´ gestation) were included. The two patient groups showed a statistically significant difference in FHbF and HbF, but no difference in Hb. There were no significant correlations between FHbF, HbF, and Hb with HR or SpO2 in both groups. In term neonates, there were no correlations between HbF and crSO2 or FTOE. In preterm neonates, however, a significant positive correlation was observed between HbF and crSO2 (2^nd to 5^th minute), whereas HbF was negatively correlated with FTOE (2^nd to 3^rd minute).

Conclusions

In term neonates, HbF did not correlate with cerebral oxygenation; however, in preterm neonates, increased HbF was associated with increased crSO2 and decreased FTOE, especially in the first minutes after birth.

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Background: Circulatory impairment treatment during transitional circulation remains controversial. In a pilot trial on circulatory impairment, Dobutamine (Db) group showed a trends towards improved short-term clinical outcomes vs placebo (PL) group (J Pediatr 2015).

Objective: The purpose of this study is to report on the long-term outcome of the infants observed for superior vena cava flow (SVC) patterns early after birth and included in an intervention study if SVC flow <41 ml/k/min.

Methods: Among the 126 infants <31 weeks of gestation prospectively scanned from birth, 28 presented low SVC flow within the first 24 hours after birth and received Db (n=16) or PL (n=12). Follow up of survivors included motor assessment and Bayley Scales II or III at 2 years, and the Reynolds Intellectual Assessment Scale at 6 years. Neurodevelopmental impairment (NDI) was defined as: cerebral palsy (Gross Motor Function Classification System ≥ level 2), or a cognitive function score < -2 standard deviations; or moderate or severe hearing or visual impairment. Db group, PL group and normal-flow group were compared.

Results: Eighteen infants died (Db 5; PL 2; normal-flow group 11, p=0.1). Follow up in survivors was accomplished in 80% and 55% of the cohort at 2 years and 6 years, respectively. No significant difference in the combined outcome (mortality or NDI) was found between the groups (42% Db, 36% PL, 30% normal-flow group).

Conclusions: This exploratory analysis did not show any difference in the long-term outcome of infants according to SVC flow patterns or its treatment early after birth.

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Background and aims: The knowledge about critical congenital heart disease (CCHD), placental pathology, and brain abnormalities is scarce. We aim to determine the prevalence of placental pathology in pregnancies complicated by CCHD, and the association with brain volume and -injury.

Methods: Placentas from term singleton pregnancies complicated by fetal CCHD were prospectively collected and analyzed. We excluded cases with known genetic abnormalities and maternal comorbidity. Available postnatal, preoperative magnetic resonance imaging (MRI) was scored for brain injury. A three-dimensionally automated segmentation pipeline was applied to determine postnatal total brain volumes (TBV).

Results: We included a total of 55 cases. Mean gestational age at birth, birth weight, and birth weight z score were 39 weeks (±1.3 weeks), 3235 g (±506.8 g), and -0.19 (± 0.89), respectively. Placental analyses revealed maternal vascular malperfusion (MVM) in 50.9%, inflammatory lesions in 41.8%, fetal hypoxia in 39.2%, delayed maturation in 25.5%, and chorangiosis in 18.2%. Placental weight was <10th percentile in 27.3% and was associated with MVM and perivillous fibrin deposition. Postnatal MRI was available in 37 neonates (mean age: 4.7 days). In cases with MVM, postnatal TBVs were significantly lower (p=0.014) and subdural hemorrhages occurred more often (p=0.031).

Conclusions: Placental pathology frequently occurs in CCHD and is associated with decreased postnatal brain volume and -injury. Our results strengthen the importance of further research into the placenta-heart-brain axis, which might help in development of neuroprotective interventions in the last trimester of pregnancy.