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- Deirdre M. Murray (Ireland)
- Charles Christoph Roehr (United Kingdom)
MATERNAL HYPERTENSION DURING PREGNANCY IS ASSOCIATED WITH AN INCREASED RISK OF BRAIN ABNORMALITIES ON MRI AT TERM-EQUIVALENT AGE IN VERY PRETERM INFANTS
- Shipra Jain (United States of America)
Abstract
Abstract Body
Background: Studies of term infants with maternal hypertensive disorders of pregnancy (HDP) indicate poorer neurodevelopmental outcomes than those without HDP. Reported effects on very preterm (VPT) infants are inconsistent. Here we evaluate the effects of HDP on brain structural abnormalities in VPT infants using MRI at term-equivalent age.Objective: To evaluate the effects of HDP on brain injury in very preterm (VPT) infants using structural MRI at TEA.
Study design: This prospective, multicentric study enrolled 395 VPT infants between 2016-2019. Infants were imaged between 39-44 weeks postmenstrual age. Brain abnormality was assessed using the Kidokoro global brain abnormality score. Infants classified as HDP-exposed if mother had chronic or gestational hypertension/pre-eclampsia. Multivariable linear regression was performed controlling for histologic chorioamnionitis, antenatal steroids, magnesium sulfate, and sex to identify the independent effects of HDP on infant brain abnormality.
Results: Of 395 VPT infants, 42.5% were HDP-exposed. The two groups were statistically similar except for incidence of chorioamnionitis (HDP: 15.5%, non-HDP: 38.3%) and antenatal magnesium therapy (HDP: 88.7%, non-HDP: 80.6%). In unadjusted analyses, median Kidokoro scores between the groups were not significantly different. In multivariable analyses, HDP-exposed infants had significantly higher scores than those without HDP, independent of our confounders.
Conclusions: Maternal HDP is a significant risk factor for early brain abnormalities in VPT infants.
HIGHER PROPHYLACTIC PLATELET TRANSFUSION THRESHOLDS IN PRETERM INFANTS ARE ASSOCIATED WITH INCREASED ADVERSE OUTCOMES AT TWO YEARS CORRECTED AGE
- Carmel Maria Moore (Ireland)
Abstract
Background and Aims
In 2019 the PlaNeT-2/MATISSE multicentre randomised trial reported that a higher platelet transfusion threshold (50x109/L) in preterm neonates <34 weeks of gestation compared to a lower one (25 x109/L) was associated with significantly increased mortality or major bleeding. We now report on neurodevelopmental outcomes at two years corrected age.
Methods
Neurodevelopmental outcomes were assessed using formal assessment tools and/or parent reporting assessment. A favourable outcome was given if a child was alive at two years of age and did not have any of the following: cerebral palsy that impaired independent walking; cognitive impairment >2 standard deviations below the mean; severe seizure disorder; hearing impairment not corrected by hearing aids; or bilateral cortical visual impairment with no useful vision.
Results
Follow-up data were available for 92% (601 out of 653) eligible children. Of the 296 infants assigned to the higher threshold group, 147 (50%) infants died or survived with significant neurodevelopmental impairment, as compared with 120 (39%) of the 305 infants assigned to the lower threshold group (odds ratio 1.54, adjusted for gestational age and presence of intrauterine growth restriction as covariates, and centre adjusted using a random effect; 95% confidence interval, 1.09-2.17; P=0.017).
Conclusions
Neonates randomised to a higher platelet transfusion threshold of 50x109/L compared to 25 x109/L had a higher rate of death or significant neurodevelopmental impairment at two years corrected age. There is no evidence that prophylactic platelet transfusion reduces bleeding and increasing evidence that it causes harm which continues into childhood.
INTRODUCING HEART RATE VARIABILITY MONITORING COMBINED WITH BIOMARKER SCREENING INTO A LEVEL IV NICU: A PROSPECTIVE IMPLEMENTATION STUDY
- Serife Kurul (Netherlands)
Abstract
Background and Aims
Late-onset neonatal sepsis (LONS) is a major complication in preterm neonates. Early recognition, by means of heart rate variability (HRV) monitoring, could help to guide early therapy and thereby improve outcome. The aim of this study was to investigate the association between the implementation of a local HRV-monitoring guideline in a level-IV NICU on mortality, measures of sepsis severity, frequency of sepsis testing and antibiotic usage among very preterm neonates.
Methods
In January 2018 a guideline was implemented for early detection of LONS using HRV monitoring combined with determination of inflammatory biomarkers. Data on all patients admitted with a gestational age at birth of <32 weeks were reviewed in the period January 2016-June 2020 (n=1,135; n=515 pre-implementation, n=620 post-implementation)). Outcomes of interest were (sepsis-related) mortality, sepsis severity (neonatal sequential organ failure assessment (nSOFA)), sepsis testing and antibiotic usage. Differences before and after implementation of the guideline were assessed using logistic and linear regression analysis for binary and continuous outcomes respectively. All analyses were adjusted for gestational age and sex.
Results
Mortality within 10 days of a sepsis episode occurred in 39 (10.3%) and 34 (7.6%) episodes in the pre- and post-implementation period respectively (P=0.13). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P=0.01). We observed significantly more blood tests for determination of inflammatory biomarkers, but no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.
Conclusions
Implementing HRV monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in reduced sepsis severity, without an increased use of antibiotics or number of blood cultures.
EFFICACY AND SAFETY OF INTRAVENOUS-TO-ORAL SWITCH THERAPY IN NEONATES WITH A PROBABLE BACTERIAL INFECTION: RAIN STUDY
- Fleur M. Keij (Netherlands)
Abstract
Background and Aims
Neonatal intravenous-to-oral antibiotic switch therapy is not yet practiced in high-income settings due to uncertainties on exposure and safety. We therefore aimed to evaluate the efficacy and safety of an early intravenous-to-oral antibiotic switch compared to a full course of intravenous antibiotics in neonates with a probable bacterial infection.
Methods
We conducted a multicentre, randomised controlled, non-inferiority trial. Neonates (postmenstrual age >35+0 weeks, 0-28 days old) in whom prolonged antibiotic treatment was indicated because of a probable bacterial infection, were randomly assigned to switch to oral amoxicillin/clavulanic acid suspension (4:1; 75+18.75/mg/kg/day tid) or continue on intravenous antibiotics. Both groups were treated for seven days. The primary outcome was bacterial (re)infection within 28-days after treatment completion. Secondary outcomes included side effects and duration of hospitalization.
Results
From February 2018 until May 2021, 510 neonates were included: 255 were assigned to the oral and 255 to the intravenous treatment group. The (re)infection rate was 0.4% in both groups. There was no significant difference in reported side effects (50.0% vs. 44.8%). Median duration of hospitalization was significantly shorter in the oral treatment group (3.4 days vs. 6.8 days).
Conclusions
An early intravenous-to-oral antibiotic switch is not inferior to a full course of intravenous antibiotics in neonates with probable bacterial infection and is not associated with more adverse events. The use of oral antibiotics results in a significant shorter hospitalization.
SYSTEMATIC REVIEW, META-ANALYSIS AND EXTERNAL VALIDATION OF PREDICTION MODELS OF BRONCHOPULMONARY DYSPLASIA IN VERY PREMATURE INFANTS
- Tng Chang Kwok (United Kingdom)
Abstract
Background and Aims
Bronchopulmonary dysplasia (BPD) is a complex multifactorial prematurity-related respiratory disease requiring personalised care. Prediction models can identify high-risk infants for targeted preventative treatments. The study aims to assess published BPD prediction models to identify the most promising model for clinical practice and research.
Methods
Prediction models using predictors routinely assessed before two weeks of age in very premature infants were included. Two reviewers independently screened, assessed and extracted data from eligible studies. Meta-analysis of externally validated models was performed. Eligible models were externally validated in our retrospective national cohort of 62,864 very premature infants born between 2010-2017 in England and Wales.
Results
From the 7,628 records identified, 53 models were reported from 64 studies recruiting 274,107 infants. 35 (55%) studies recruited infants pre-2010; 39 (61%) were single-centre studies. 60 (94%) studies had high risk of analysis bias with calibration not assessed (55 (86%) studies) and small sample size (37 (58%) studies). Following meta-analysis of 22 BPD and 11 BPD/death composite models, the Laughon 2011 NICHD day one model was most promising in predicting BPD and death with fair discrimination (C-statistics 0.76 (95% CI 0.70–0.81) and good calibration (moderate evidence) (Figure 1). The six models externally validated in our national cohort had similar discrimination (C-statistics 0.70–0.90) but poor calibration (Figure 2).
Conclusions
BPD prediction models still lack external validation, calibration and impact assessment. Contemporary, validated, well-calibrated and dynamic models are needed to support clinical decision making in this high-risk population.