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Introduction: Congenital CMV is a leading cause of hearing loss and intellectual disability. In the US, 1 in 150 newborns are estimated to have cCMV, however, most infants have no clinically detectable symptoms. Identification of infants with cCMV can facilitate early detection of CMV-associated hearing loss and provide timely interventions. Dried blood spots, the only samples used in newborn screening (NBS), do not have sensitivity whereas saliva and urine have high sensitivity. Due to lack of infrastructure for transport of saliva to NBS labs, the test will likely be performed in hospitals pre-discharge – similar to bilirubin, hearing screening, and pulse oximetry.

Methods: CMV sequences published by Boppana and custom sequences for internal control were used. Heaters and sensors were integrated into a disposable digital microfluidic cartridge to enable ultra-rapid amplification of target DNA sequences using polymerase chain reaction (PCR). Reaction droplets (containing sample, master mix, primers, probes, and lambda DNA) were subjected to 50 cycles including denaturing (95°C) and extension (60°C) stages. Saliva samples from newborns were run on the cartridge.

Results: On-cartridge droplet dispensing, reagent mixing, and PCR was completed in 8 min with some positive samples showing amplification within 4 min. Rapid PCR method compares well with the gold standard laboratory method. Figure shows PCR from 6 CMV patient samples amplified while the 2 normal samples did not.

Conclusions: Ultra-rapid and fully automated PCR can accelerate adoption of near-patient testing for cCMV circumventing the necessity to setup infrastructure to transport saliva samples.

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Background: Admission to the Neonatal Unit (NNU) is a stressful experience for any parent. Psychological distress, including symptoms of Post-traumatic Stress Disorder (PTSD), have short and long-term consequences for parent and infant. Identifying those at risk and understanding the contributing factors to psychological distress will influence interventions and improve psychological wellbeing.

Aim: To assess the psychological wellbeing of parents of infants admitted to the NNU.

Method: A prospective cohort study was designed in which 182 parents (56 fathers, 126 mothers) with an infant admitted to the NNU completed a questionnaire, which incorporated the Perinatal-Posttraumatic Stress Disorder Questionnaire (PPQ) and Parental Stressor Scale: NICU (PSS:NICU). Infant factors were identified using the Maternal & New-born Clinical Management System.

Results: 61.8% (n=110) were considered high risk (PPQ total >19) for developing clinically significant PTSD. Mothers had significantly higher PPQ scores (p = 0.012) compared to fathers. Mean parental stress, travel time, admission length, self-reported mental health, and associated behaviours were positively correlated with PPQ scores. Parental Stress (p<0.001), total associated behaviours (p<0.002), and travel time (p = 0.04) were significant risk factors for clinically significant PTSD symptomatology.

Conclusion: Significant psychological distress was identified amongst both mothers and fathers of infants admitted to the NNU, irrespective of socio-demographic factors and gestational age. Parental stress, related behaviours and increased travel time were significant risk factors for clinically significant PPQ scores. Interventions should focus on reducing parental stress associated with the NNU, and facilitating parents whom may have increased stress due to living further from the NNU.

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Post haemorrhagic ventricular dilatation (PHVD) is a complication that occurs in up to one third of preterm infants with severe germinal matrix-intraventricular haemorrhage (GM-IVH) and is known to have a negative impact on neurodevelopmental outcome. Advances in neuroimaging provide a unique opportunity to study the neonatal brain and measuring ventricular volume through 3D ultrasonography (3D US) could have a potential role in the controversial approach to PHVD. Ventricular volume can be estimated accurately through manual delineation of the ventricular contour which correlates well with ventricular volume as measured by magnetic resonance imaging. Automatic segmentation software could improve ventricular volume estimation as it would significantly reduce the processing time needed for manual segmentation. In this study, we train a convolutional neural network (CNN) for automatic segmentation of 3D US. We then evaluate and validate the network in preterm infants with PHVD. A total of 152 serial 3D US from 10 VLBWI with PHVD were analysed. The method was validated with the Dice similarity coefficient (DSC) and the intra-class coefficient (ICC), of 0.8 and 0.944 respectively. To further understand the potential clinical use of ventricular volume, we review in detail the temporal evolution of one patient and the complex anatomy of a dilated ventricular system after GMH-IVH with parenchymal involvement.

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BACKGROUND AND AIMS

Feeding intolerance (FI) is one of the hardest challenges for neonatologists. A standard protocol to evaluate feeding intolerance and guide clinical decision making is still lacking resulting in uneven management. A novel protocol for the evaluation of FI in preterm infants was realized in our Neonatal Intensive Care Unit (NICU). Aim of this study is to evaluate the effects of the application of a standardized protocol on the time to reach Full Enteral Feeding (FEF).

METHODS

A novel protocol for the evaluation of FI was realized reviewing available literature (Fig.1). All preterm infants with a gestational age ≥ 25 week and < 30 week, on non-invasive ventilation support within 5 days from birth and admitted to the NICU of Sant’Anna Hospital – Turin in 2019 were exposed to the novel protocol and compared with a historical control group of infants admitted in 2018. Primary endpoint was the time to reach FEF.

RESULTS

Fifty-three infants were exposed to the novel protocol and compared to 60 not exposed controls. The main result of the study was the reduction of the time to reach FEF observed in the exposed group (23.68 ± 13.45 vs 29.31 ± 13.76 days; p=0.03) (Fig. 2).

CONCLUSIONS

The implementation of the new protocol for the assessment of FI was associated to a reduction in the time to reach FEF. If this data will be confirmed by future controlled trials the protocol could be validated and widespread in clinical practise.

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Background and aims: Congenital heart defects (CHD) are the most common group of congenital malformations. With advanced testing - such as microarray and Next Generation Sequencing (NGS) - applied into routine clinical practice, more genetic anomalies may be detected in infants with CHDs.

The study aims to investigate the association between the congenital heart defects and genetic anomalies.

Methods: A retrospective observational study included all infants with a recorded new diagnosis of CHD born between 01/01/2016 and 31/12/2018, from a single tertiary neonatal intensive care unit. The data were recorded from electronic patient records. For analytic purposes, CHD cases were divided into 4 categories: critical, serious, significant or non-significant types.

Results: 315 infants were identified, of which 16 were excluded due either to a lack of follow-up or death from non-cardiac causes, making classification impossible. Significantly more infants with critical (94%) or serious (82%) CHD underwent relevant genetic testing than the infants with significant (57%) or non-significant (18%) CHD (p <0.0001). Diagnostic yield was not significantly different between categories, but for the whole cohort showed a positive linear correlation with the number of other congenital abnormalities of the infant (R² = 0.93, p<0.01).

Conclusions: In our cohort, around one-third of the infants with critical and serious heart conditions had underlying genetic defects. The infants with critical and serious heart defects needing surgery or intervention within one year of birth are often tested for underlying genetic defects. Genetic testing is strongly indicated in infants with CHD accompanied by other congenital abnormalities.

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Mesenteric hypoperfusion (MH) is one of the main risk factors of necrotizing enterocolitis (NEC) in neonates with ductus-dependent congenital heart diseases (dd-CHD). Aim: evaluation of postoperative MH effect on feeding intolerance in neonates undergoing cardiac surgery.

Methods. Forty term neonates with dd-CHD who had undergone cardiac surgery within two weeks of life were included. Doppler flow velocimetry in mesenteric arteries was performed at 1-4 days after surgery. Fourteen neonates underwent palliative surgery and had MH (group I). Twenty six neonates with d-transposition of great arteries underwent radical surgery, without MH (group II).

Results. NEC IIA incidence after surgery was higher in group I (28.6% vs 15.4%, p>0.05). Neonates with NEC IIA in group II had longer inotropic support (4-11 vs 1-3 days, p=0.02) than ones in group I. There was no incidence of NEC III. Maximal vasoactive-inotropic score 0-24 hours postoperatively in group II correlated with oral feeding start, time of reaching 100 kcal/kg/day (r=0.7). Six neonates with MH still needed gavage feeding after 1 month postoperatively (p<0.01). Group I had lower volume and calorie content of enteral nutrition on days 15, 21 postoperatively (p<0.05). Negative weight gain by 1 month was more often in group I (35.7% vs 15.4%, p>0.05). All neonates had low frequency of fortified breast milk (7.5%), preterm formula (15%) feeding.

Conclusion. Neonates with MH after cardiac surgery had increased frequency of NEC and were more difficult to achieve appropriate volume, calorie content of enteral nutrition. Energy-enriched enteral nutrition might be considered in neonates with MH.

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Background: In 2018, we established the Early Neurodevelopment Clinic (ENC) based on recent evidence-based guidelines for the early diagnosis of cerebral palsy (CP) in high-risk infants. In this study, we aimed to characterise the infants presenting to ENC and determine the rate of CP diagnosis.

Methods: This study analysed data from high-risk infants who attended ENC between May 2019 and April 2020. Neuroimaging reports were reviewed, and Prechtl’s General Movement Assessment and Hammersmith Infant Neurological Examination (HINE) performed. Infants were diagnosed as having typical development, delayed development, high-risk of CP or CP at the time of clinic attendance.

Results: Ninety-six high-risk infants attended ENC over the study period. Sixty-eight (71%) infants were born extremely preterm or extremely low birth weight, and 28 (29%) were infants born at other gestations with evidence of moderate to severe brain injury. Infants attended clinic at a median corrected age of 13.4 (12.9 – 14.0) weeks. Cranial ultrasound was performed in 94 (97.9%) infants, and 48 (51.1%) had an abnormality present. MRI brain was performed in 75 (78.1%) infants and 50 (66.7%) had an abnormality present. The median (IQR) HINE of infants with typical development, delayed development, high-risk of CP or CP was 60.0 (56.3 – 63.0), 50.0 (45.0 – 52.0), 45.5 (40.8 – 47.5) and 34 (26.8 – 45) respectively. Of the seventeen infants who had “absent” fidgety general movements, 16 were diagnosed with CP or high-risk of CP.

Conclusions: Implementation of recent evidence-based guidelines allowed for early diagnosis of CP within the first few months of life and appropriate referral of infants.