Welcome to the 9th EAPS Congress Programme Scheduling

Background and Aims

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications.

Methods

Methods: This prospective, observational study recruited patients up to 60 weeks’ postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events.

Results

Results: Infants (n 5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm)

underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of

cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age

influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical

conditions, congenital anomalies, or both (relative risk [RR] 1.16; 95% confidence interval [CI], 1.04e1.28) and in those

requiring preoperative intensive support (RR 1.27; 95% CI, 1.15e1.41). Additional complications occurred in 16.3% of

patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7e3.7%). Co-occurrence of intraoperative hypotension,

hypoxaemia, and anaemia was associated with increased risk of morbidity (RR 3.56; 95% CI, 1.64e7.71) and

mortality (RR 19.80; 95% CI, 5.87e66.7).

Conclusions

Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue

oxygenation on patient’s outcome, highlight the need for more standardised perioperative management guidelines for

neonates and infants.

Abstract Body

Vaccines are preventing infections and disease and are each year averting millions of premature deaths. However, even though there is a public health need for vaccines against several more pathogens, both viruses and bacteria, many vaccine candidates are not pursued due to limited commercial potential. There have been calls for public private partnerships and collaboration to correct for this market failure. The devastating Ebola outbreak in three West African countries in 2014-15 provided an impetus for action. CEPI, the Coalition for Epidemic Preparedness Innovations, was established informed by the experiences from testing Ebola vaccines during the West African outbreak. CEPI prioritized three epidemic pathogens, Lassa, Nipah and MERS, as well as flexible vaccine platforms. This allowed CEPI to be among the early investors in COVID-19 vaccines. The COVID-19 pandemic led to unprecedented efforts in developing new viral vaccines. The success of the mRNA platforms has given us a new vaccine technology that can be used for other diseases. The pandemic has also provided a momentum for political deliberations on how the world can be better prepared for epidemics and cross border infectious threats.

Abstract Body

For 30 years, antenatal corticosteroids (ACS) have been the standard of care for women at risk of imminent preterm birth (PTB). Robust, high-certainty evidence indicates that timely administration of ACS before imminent PTB reduces the most significant adverse outcomes from PTB, regardless of resource setting.

Despite widespread global use of ACS, significant knowledge gaps surround their safety, long-term effects, optimal timing and dosage. Almost half of women given ACS give birth outside the “therapeutic window” and remain undelivered over 7 days later. The population offered ACS has expanded over time, and ranges from women at 22 to 38 weeks’ gestation, with singleton or multiple pregnancies, even when the absolute risk of impending delivery is relatively low. Additionally, most trials included in the recent Cochrane systematic review on ACS before PTB were undertaken over 25 years ago, during a different era of neonatal care. Overtreatment with ACS is a concern, as evidence emerges of risks of potentially unnecessary ACS exposure.

In this presentation, I will review the current evidence for the short- and long-term benefits and safety of ACS exposure for neonates and children. I will consider the major ongoing challenges surrounding ACS administration, and discuss potential strategies to overcome them.

Key findings from the “Co-OPT ACS cohort”, the largest international birth cohort to date comprising data on ACS exposure and on perinatal and childhood outcomes, will be discussed. This cohort was created by the Consortium for the Study of Pregnancy Treatments (Co-OPT) to address key research questions on ACS, through linkage and harmonisation of population-based data on mothers, babies and children. It contains 2.28 million pregnancies and babies from 3 continents; its large scale and international representation enables review of rare outcomes, such as perinatal mortality, and longitudinal follow-up allows comprehensive evaluation of neonatal and childhood outcomes associated with ACS.

Abstract Body

In the past few decades the neonatal community has achieved the gradual decrease of the threshold of viability and an increased survival of all extremely preterm infants. These events explain the rising incidence of chronic respiratory morbidity in these infants with immediate life-limiting effects and lifelong consequences in the survivors. Postnatal corticosteroids are commonly administered systemically to prevent and treat evolving or established bronchopulmonary dysplasia (BPD) in mechanically ventilated prematurely-born infants. Despite historical reservations and some reluctance to use systemic steroids in everyday clinical care, systemic corticosteroids administered late (after 7 days) have been proven to reduce neonatal mortality and BPD without increasing the risk of necrotising enterocolitis or the combined risk of death and cerebral palsy. In this session we will aim to summarise their intended mechanism of action and their numerous side effects focusing on the potential impact of these potent systemic agents on normal development. We will also review recent evidence that highlight an enhanced understanding of their mechanism of action. Finally we will attempt to summarise the current evidence with a view to answer three practical questions: Which agents have been studied and how do they differ in how they influence clinical outcomes? When are they best administered and are they less or more beneficial if given earlier or later in evolving BPD? How can they be administered and is some route more efficient than the others in reducing the incidence of respiratory morbidity without increasing the incidence of severe neurodevelopmental impairment?

Abstract Body

MIS-C was described during the first wave of the Covid-19 pandemic. Clinical features included features of systemic inflammation shared with Kawasaki disease in approximately half of patients, reduced left ventricular function requiring vasoactive support in approximately 75% of patients, coronary artery aneurysms in approximately 10% of patients, and gastrointestinal pain in most patients. Laboratory features included raised inflammatory markers, disordered coagulation and raised cardiac biomarkers. Most patients were respiratory PCR negative, but serum IgG positive for SARS-CoV-2. This, in addition to a time lag of approximately 4 weeks from peak SARS-CoV-2 transmission to peak MIS-C presentation, suggested that MIS-C was a post-infectious disease.

Immunologically, MIS-C is characterised by high numbers of activated immature neutrophils in peripheral blood, decreased antigen presentation, and widespread T and B cell lymphopaenia. B cells show a germinal centre independent B cell response. Some groups have suggested a role for auto-inflammation with the identification of self-reactive antibodies. Compelling data have identified a subset of activated T cells expressing specific T cell receptor sequences, which may be exploited to improve diagnosis of MIS-C and requires further investigation. Treatment includes intravenous IgG (IVIg), corticosteroids and monoclonal antibodies (to IL-1, IL-6 or TNF-alpha), and for differential diagnoses (e.g. toxic shock syndrome). There is no evidence of clinically important improvements in outcome between groups of children treated with IVIg, corticosteroids or both in propensity-score matched cohorts. Recent data suggest a decline in the incidence of MIS-C relative to SARS-CoV-2 infection in children; however, the Covid-19 pandemic continues to surprise us.

Abstract Body

Primary fetal lung and airway anomalies are rare. Recognition and understanding of these lesions has improved over the last decades mainly due to improvements in prenatal ultrasound. With the introduction of fetal therapy options an increasing number of children survive with larger and more severe forms of fetal pleural effusion (FPE), congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS). In this presentation I will discuss the current views on etiology and pathophysiology of fetal lung lesions, the various pre- and postnatal management options (including fetal interventions) and report on the perinatal and neonatal outcome as well as what is known on long-term outcome.

Abstract Body

The talk will cover the causes of acute decompensated heart failure in children including viral myocarditis focussing on early recognition, treatment and advanced mechanical circulatory support. The pitfalls in diagnosis, the challenges in recognition and management before ICU and the outcomes will be covered in detail with an opportunity for Q & A.