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Abstract Body

Familial hypercholesterolemia is one of the most common genetic diseases that leads to premature atherosclerosis. We investigated endothelial function in children with heterozygous familial hypercholesterolemia in order to detect the first signs of endothelial inflammation in non-invasive ways.

In 57 children with heterozygous familial hypercholesterolemia (Group 1), endothelial function was studied by measuring levels of nitric oxide (NO), endothelin and hypersensitive C-reactive protein (hsCRP). All secondary causes that could lead to a change in these indicators were excluded. No children from Group 1 were ever treated by statins or other lipid-lowering therapy. Results were compared with a group of children comparable in age and sex (Group 2). Average age of Group 1 was 9 years old ±2 months, Group 2 is 9 years old ±3 months. Average lipid values in Group 1: total cholesterol (TH) - 7.2 ± 0.9 mmol / L, low density lipoproteins (LDL) - 4.7 ± 0.7 mmol / L, triglycerides and high density lipoproteins (HDL) corresponded to normal. Group 2 average lipids: TH - 4.2 ± 0.7 mmol / L, LDL - 2.3 ± 0.4 mmol / L, the level of triglycerides and (HDL) corresponded to normal.

Results: The results in Group 1 were: NO 66.15 ± 1.19 μmol / L, endothelin 0.418 ± 0.121 pmol / L, hsCRP 0.25 ± 0.1 mg / dl.They showed in Group 2: NO 39.15 ± 0.15 μmol / L, endothelin 0.231 ± 0.05 pmol / L, hsCRP 0.11 ± 0.2 mg / dl.The results in group 1 were significantly higher and lower in terms of indicators, respectively: endothelin and hypersensitive reactive protein.

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Background: Electrical impedance tomography (EIT) has been proposed as a solution to the lack of bedside methods of measuring pulmonary blood in infants. This study aimed to determine if the cardiac-related signal (CRS) measured with EIT was due to pulmonary blood volume changes by addressing two limitations of the EIT CRS in three distinct biological models: 1) potential of CRS artefact from in-phase cardiac motion, 2) the large ventilation EIT signal masking CRS.

Methods: Study A: 10 ml/kg saline was administered into the right atrium of instrumented lambs (n=6) during protocolised apnoea with normal cardiac output, and then during asystole (immediately after pentobarbitone) as part of another study. Study B: During a sustained inflation (SI) (no ventilation) at birth in preterm lambs (n=12). Study C: In stable infants with a Blalock-Taussig (BT) shunt (n=4), Bidirectional cavopulmonary connection (BCPC) (n=3) and normal pulmonary circulation (n=6). EIT signals were filtered to the cardiac-domain, non-lung regions excluded and pulsatile blood volume during systole and diastole calculated.

Results: Study A: There was a significant fall in CRS-impedance within lung regions with saline whether the heart was beating or in asystole (p<0.0001 ANOVA). Study B: Diastolic pulsatile volume increased, and systolic volume decreased, during aeration (p<0.0001, linear regression). Study C: CRS identified the highly pulsatile BT shunt in the right ventral third of the lung, and CRS beat-to-beat amplitude was lower in the less pulsatile BCPC.

Conclusions: EIT can detect physiological events associated with regional blood volume change, demonstrating a clinical and research potential.

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Background: Vital signs are not routinely used in the Manchester Triage System (MTS). We aimed to develop and validate vital sign based MTS discriminators to improve the triage of children at the emergency department (ED).

Methods: The TrIAGE project is a prospective observational study based on electronic health record data in five European EDs (Netherlands (n=2), United Kingdom, Austria, and Portugal). In the current study, we included 117,438 consecutive children <16 years who presented during the study period (2012-2015). We derived new discriminators based on heart rate, respiratory rate, and capillary refill for relevant subgroups of MTS flowcharts, and with optimal cut-offs. The outcome measure was a 3-category reference standard (high/intermediate/low urgency) based on mortality at the ED, immediate lifesaving interventions, disposition and resource use.

Results: We identified six new discriminators for children <1 year and ≥1 year: “Abnormal heart rate”, “Very abnormal respiratory rate” and “Abnormal respiratory rate”, that provide additional value to specific subgroups of MTS flowcharts. Application of the modified MTS reclassified 744 patients (2.5%). Sensitivity increased from 0.66 (95%CI 0.60-0.72) to 0.71 (0.66-0.75) for high urgency patients and from 0.67 (0.54-0.76) to 0.70 (0.58-0.80) for high and intermediate urgency patients, at the cost of an acceptable decrease in specificity of 0.90 (0.86-0.93) to 0.89 (0.85-0.92) for high, and 0.66 (0.52-0.78) to 0.63 (0.50-0.75) for high and intermediate urgency patients. Overall performance improved (R² 0.199 versus 0.204).

Conclusions: New vital signs based discriminators lead to a small but relevant increase in performance and should be implemented in the MTS.

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Background and Aims:

Early detection of cognitive disability is difficult, and reliant on surrogate measurements of developmental progression. We aimed to assess the domain specific, concurrent validity, and the predictive ability of both the ASQ3 and the BSID-III to predict cognitive outcome at school age.

Methods:

Within a large observational birth cohort study, a nested cohort of children were assessed using both the ASQ-3 and BSID-III at 24 months, and again at 5 years using the Kaufmann brief IQ test.

Results:

At 24 months 278 children were assessed; mean(SD) BW 3445(506)grammes, M:F ratio=52:48. The ASQ-3 had reasonable predictive ability (sensitivity:specificity;AUROC) of same domain delay for motor (50%:76.89%;0.634, p = 0.007) and language (23%:100%;0.614, p=0.017) skills at two years, but poor ability to predict cognitive delay on the BSID-III (17.2%/98.8%;0.580, p=0.158).

204/278 children returned at 5 years. ASQ-3 domains of language and cognition were weakly correlated with verbal (R² 0.021, p-value 0.039) and non-verbal IQ respectively (R² 0.022, p-value 0.035). BSID-III domains of language and cognition showed better correlation with verbal and non-verbal IQ (R², p-value=0.189, <0.001 and 0.117, <0.001 respectively). For both assessments the ability to predict non-verbal IQ<1SD below population mean at 5 years was poor (ASQ; sensitivity 0%, specificity 98.5%), (BSID-III; sensitivity 20%, specificity 93%).

Conclusions:

The cognitive scales of the ASQ-3 had poor sensitivity in detecting an abnormal BSID-III cognitive score at 24 months. Both the ASQ-3 and the BSID-III have poor ability to predict cognitive delay at school age.

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Background and Aims

Delayed cord clamping (DCC) improves early stability of neonates. We explored the feasibility and safety of extended DCC with active stabilisation followed by maternal-infant delivery room cuddles (DRC).

Methods

Observational study of infants <32 weeks’ gestational age (GA), following the introduction of Lifestart^TM stabilisation trolley and delivery room support package, including cardiorespiratory monitoring and humidified respiratory support. A prolonged period of DCC was encouraged, followed by fully monitored DRC.

Results

The study included 84 infants (August 2018-December 2019) with median GA 29 weeks (interquartile range, IQR, 27-31); median birth weight 1115 g (IQR 912-1393 g). DCC > 60 s (n=61, 73%; median 120 s, IQR 80-150), with respiratory support during DCC in 66% of patients. No differences in maternal variables in DCC vs non-DCC infants, except general anaesthesia (p=0.03). DCC vs non-DCC infants had earlier development of spontaneous respiration (p<0.01), higher Apgar scores (1 and 5 min; p<0.01), more DRC (77 vs 48%, p=0.012), higher Hb (p=0.015) and fewer blood transfusions (p=0.04) <48 hours. No differences in maximum bilirubin, major IVH, PDA, NEC, BPD, ROP or mortality. DRC infants (n=58, p=0.012), had significantly fewer blood transfusions (p<0.01), intubations (p<0.01), inotropes (p<0.01), major IVH (p=0.04) and NEC (p=0.03) than non-DRC infants. There were no hypothermic infants, median admission temperature 36.9^oC (IQR 36.6-37.3^oC).

Conclusions

Stabilisation with intact cord and extended DCC, followed by DRC, can be safely delivered to extremely preterm infants and is associated with improved clinical stability.