Background

Children requiring intensive care in the neonatal period have more fine motor injuries, learning difficulties, eating disorders and sleeping problems. Sleep disorder rate is about 10-30% in children who had no problem in newborn period.

Objectives

We aimed to investigate the rate of sleep disorder in children who were admitted to NICU during newborn period.

Methods

46 patients hospitalized in NICU and still followed in outpatient policlinic at Çukurova University were enrolled in to the study. Children's Sleep Habits Questionnaire was performed to evaluate sleep resistance, delay in fall into sleep, duration of sleep, sleep anxiety, parasomnia, midnight awakening and daily sleepiness

Results

Children were 6.64±1.18 (5-9) years old. They were healthy and had no neurological squeal. None of the parents complained about sleep disorders. However, 20 of the 46 (43.47%) children had sleep disorder (Sleep disorder group). 26 children had no sleep disorder (No Sleep Disorder group). There were no statistically difference between groups in terms of gestational age, birth weight, ventilator support, gender (p>0.05)

Conclusion

Although there are no significant difference between groups, sleep disorder rate is higher compared to normal population’s rates reported in the previous studies. Infants discharged from NICU should be under evaluation also for sleep disorder

Background

The Pediatric Early versus Late Parenteral Nutrition in Critical Illness (PEPaNIC) multicenter, randomized controlled trial (RCT) showed that withholding supplemental parenteral nutrition (PN) for up to one week in the pediatric intensive care unit (PICU) resulted in better outcomes [1,2] compared with initiating parenteral nutrition early on day one of admission to the PICU.

Objectives

This study investigates, two years after the PEPaNIC RCT, parent-reported Health-Related Quality of Life (HRQoL) of critically ill children compared with that of a healthy control group. Furthermore, effects of late-PN compared with early-PN during the first week in the PICU on long-term parent-reported HRQoL were examined. Parents’ own HRQoL was examined and was associated with the HRQoL they reported regarding their child.

Methods

All survivors of the 1440 children who participated in the RCT were approached for this 2-years follow-up. Patients were compared with 405 matched healthy children. Assessed outcomes comprised parent-reported HRQoL of the child and the parent. Measurements consisted of the parent-reported Infant Toddler Quality of Life Questionnaire (ITQOL, 0-3 years old), the parent-reported Child Health Questionnaire-Parent Form 50 (CHQ-PF50, 4-18 years old), and the parent-reported Health Utilities Index (HUI). For parents’ own HRQoL the self-reported Short Form Health Survey (SF-12) was used. To adjust for missing data, multiple data imputation by chained equations will be performed prior to univariable and multivariable linear and logistic regression analyses adjusted for risk factors.

Results

Analyses are planned at the end of January.

Conclusion

Conslusions will be presented at the conference.

Background

Children born ≤32 weeks have higher risk of motor and cognitive disabilities compared to peers born at term. Inflammation and glutamate excitotoxicity potentiate each other in preterm brain injuries. Genetic variants in these pathways may modify this risk.

Objectives

To test whether risk variants in the glutamate transporter (EAAT2-200/-181) and pro-inflammatory cytokines (TNFα-308, IL1ß-511, IL6-174) interact, predisposing preterm survivors with functional variants in both pathways to higher risk of impairment.

Methods

In the APIP cohort (n=309), we defined exposure as TNFα-308 (GG/GA/AA), IL1ß-511 (CC/CT/TT), IL6-174 (CC/CG/GG) and EAAT2-200 (CC/CA/AA)/-181 (AA/AC/CC); primary outcome as cerebral palsy (CP) at 2y; secondary outcomes as cystic periventricular leukomalacia (cPVL); movement and cognition assessments at 2y (Griffiths Scales) and 5y (Movement ABC; British Ability Scales, BAS). 202 children had data for CP, both EAAT2 variants and at least one cytokine variant.

Results

TNFα-308 was associated with both CP (p=0.04) and cPVL (p=0.05), with 3/10 children with AA risk genotype having these outcomes compared to 6/100 with GG. BAS score was 9 points lower with IL1ß-511 CC reference genotype (n=53) compared to CT (n=46) (p=0.02). BAS was weakly associated with EAAT2-200 (p=0.09), specifically the verbal ability subscale (p=0.03). IL1ß-511 was associated with the non-verbal reasoning subscale (p=0.003). There were no associations with the Griffiths and M-ABC scores, or with IL6-174. Our study was underpowered to assess interaction, due to rarity of both risk genotype combinations and CP.

Conclusion

This exploratory study suggests an association between neurodevelopmental outcomes in children born ≤32 weeks and pro-inflammatory/glutamatergic variants.

Background

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital cerebrovascular abnormality. Despite endovascular treatment and specialised perinatal intensive care management neurological sequelae are still high.

Objectives

To identify predictors of adverse neurodevelopmental outcome in VGAM newborns.

Methods

We retrospectively reviewed medical records of newborns with diagnosis of VGAM over the period 2006-2018. Clinical and radiological data were analyzed. Neurodevelopmental outcome was defined as good or poor using the Pediatric Stroke Recurrence and Recovery Questionnaire.

Results

We included 29 newborns (20 prenatal, 9 postnatal diagnosis) followed for a mean period of 37 months. Nine patients (31%) developed heart failure requiring intensive care support during the first 48 hours of life. Twenty three patients underwent endovascular treatment: 6 urgent procedures due to neonatal heart failure and 17 elective procedures (overall 39, 1 to 4 per patient); 7 patients (30%) experienced hemorragic or thrombotic complications.

Postnatal MRI showed cerebral damage in 46% and ventricular dilation in 64%; at last MRI rates were 69 and 42%, respectively. At follow up 44% of patients presented poor neurodevelopmental outcome.

In univariate analysis neither the degree of clinical severity at birth nor duration of intensive care support seem to be related to neurodevelopmental outcome. Brain damage at postnatal MRI was significantly related to poor outcome (p 0.02). In multivariate analysis ventricular dilation at last MRI was the only variable associated.

Conclusion

Early brain lesions and persistence of ventricular dilation at follow up could be considered predictors of poor neurodevelopmental outcome in newborns affected by VGAM.

Background

Rates of paediatric organ donation in the UK remain relatively low, despite public awareness campaigns. As of 2020, England will join the other nations of the UK with an “opt out” scheme for organ donation. However this will not include children, so it is worth considering what other factors may have affected paediatric organ donation rates after confirmation of brainstem death over time.

Objectives

To analyse the outcome of children with confirmed brain stem death, including organ donation rates, on a regional tertiary UK PICU between 2003 and 2017.

Methods

Data was obtained for children who were confirmed brainstem dead on PICU from the unit databases and clinical records at Bristol Royal Hospital for Children, UK, over two periods, 2003-2009 and 2010-2017, covering 15 years in total.

Results

48 children had brainstem death confirmed during their admission to PICU.

Organ donation rates improved during the latter period (12/33 [36%] vs 3/15 [20%]) but over a third of these children (17/48) could not become donors, as they underwent a Coroner’s post mortem.

Conclusion

Although organ donation rates may be improving, a significant proportion of children who were confirmed brain dead may not be offered as donors as they undergo Coroner’s post mortems. To improve paediatric donation rates further, consideration should be given to potential alternatives to full post mortem examinations.

Background

Accidental dislodgement of central venous catheters is a frequent complication in NICU and it often requires catheter replacement. Subcutaneously anchored sutureless devices (SAS) (Securacath) have been recently introduced in clinical practice for securement of different types of central catheters, but they have never been used in neonates.

Objectives

To evaluate safety and efficacy of SAS in neonates.

Methods

We adopted SAS for securement of all central venous catheters inserted in neonates via ultrasound-guided cannulation either of the brachio-cephalic vein (centrally inserted central catheters: CICC) or the femoral vein (femorally inserted central catheters: FICC).

Results

72 central catheters were inserted in 70 preterm and term neonates (3-4Fr power injectable polyurethane catheters; 62 CICC + 10 FICC) and they were all secured with SAS. Mean postmenstrual age at the time of insertion was 31 weeks (range 25 - 41 weeks) and mean weight was 1400 grams (range 580 - 4100 grams). SAS was easy to place in all cases. The median duration of the line was 5 weeks (range 10 days - 3 months). No accidental dislodgement of CICC or FICC was recorded. All SAS but one were left in place until elective removal of the catheter; only in one patient, early removal of SAS was necessary because of a skin ulcer caused by the device. In all patients, SAS removal was easy and uneventful, and it did not require any sedation or local anesthesia.

Conclusion

SAS was effective in preventing accidental catheter dislodgement in 100% of cases. Complications during insertion, maintenance and removal were negligible.

Background

Extremely low birth weight (ELBW) is an issue of growing importance because the increasing survival likelihood of premature babies.

Objectives

To evaluate the impact of the multiple birth on the oucome of ELBWNs.

Methods

One hundred and eighty-two ELBWNs were examined from the delivery to the discharge. The patients were divided in two groups: 1 – from single pregnancies, and 2 – twins. The twins were divided in two subgroups: 2a (from natural conception) and 2b (after in-vitro fertilization – IVF). The data of obstetric anamnesis, birth, mortality, morbidity and outcome at the discharge were compared. The data were calculated using software statistical packages STATGRAPHICS v. 4.0; SPSS v. 13.0 and EXCEL for Windows. The significance of the conclusions was fixed by p < 0.05.

Results

The twins were 35,7% of all ELBWNs, significantly often were delivered via Caesarean section (CS) and more rarely were prenatally infected compared to Group 1. In the neonatal period, Group 2 significantly more often suffered from anemia, intraventricular haemorrhage, persistent ductus arteriosus; required longer mechanical ventilation and later achieved optimal nutritive tolerance. After the neonatal period, they often suffered from residual cerebral damages, severe hypotrophy, required longer hospital stay and half of them were discharged with residual problems. The groups did not significantly differ according to the mortality.

Conclusion

According to our data, more than one third of ELBWNs were twins. The multiple birth is an independent factor which may cause ELBWNs-birth and may impact their long term outcome. IVF does not play a role in this outcome.

Background

Accidental dislodgement is a frequent complication of epicutaneo-caval catheters (ECC) in NICU. Recently, cyanoacrylate glue (CG) has been widely used for securing different types of central lines. However, data about its safety and effectiveness in the neonatal population are not yet available

Objectives

To evaluate safety and efficacy of CG as a securement strategy for ECC.

Methods

We applied CG (Hystoacryl, BBraun) on the exit site of all ECC inserted in our NICU in 2018: the exit site was also covered with transparent semipermeable dressing (TSD) (Tegaderm, 3M). The results were compared with an historical cohort of infants whose ECC were secured using sterile strips (SteriStrips, 3M) and the same type of TSD.

Results

In 2018, 134 ECC (1-2 Fr polyurethane catheters) were inserted in 92 preterm and term neonates and all of them were secured with CG + TSD; 124 ECC inserted in 80 preterm neonates in 2017 were used as controls. Mean postmenstrual age at the time of insertion was 29 weeks in both groups. The use of CG was not associated with any side effect. The incidence of accidental dislodgement was significantly reduced from 35% to 20% (p <0.007). CG was safe and easy to apply, and it yielded the additional advantage of being very effective in preventing any bleeding/oozing at the puncture site. Removal of CG was consistently easy and uneventful.

Conclusion

Securement of ECC with CG + TSD is completely safe and it is effective in reducing the risk of catheter dislodgement.

Background

High fecal calprotectin (FC) levels have been documented in term and preterm infants (PI).

Objectives

To determine FC levels in PI and to correlate them with clinical- biochemical sepsis and inflammatory intestinal disorders (necrotising enterocolitis or not).

Methods

prospective longitudinal observational study of PI ≤35s EG, from which stool samples were collected at 4, 8, 15, 30 days of life for FC determination (μg/g). Predominant breastfeeding was considered if more than 80% of the daily intake is breastfeeding.

Results

369 stool samples collected from 114 PI. Mean gestational age 30.26 (±2.38) weeks, birth weight 1376.90±429.16 grams. 76 pathological processes in 42 neonates (36.8% of PI). No differences according to feeding or gestational age.

Mean calprotectin in healthy PI is significantly lower than in the ones with diseases, being statistically significant differences between 4 and 30 days, between 4 and 15 and 8 and 15.

Conclusion

A high calprotectin mean was observed in all cases, being greater in the first 4 days of life significantly, with slight posterior decrease and stabilization during the first months. During intercurrent diseases, both systemic infections and intestinal distress, the FC rises before the onset of symptoms or the elevation of acute phase reactants and after the improvement remains elevated for 8-10 days. Its use as a predictor of digestive pathology in preterm infants is possible.

Background

There were few studies for follow-up in bone status in preterm infants during infancy although osteopenia of prematuirty earns attention..

Objectives

This study aims to measured tibial bone speed of sound (SOS) by quantitative ultrasound (QUS) to assess the bone status in very preterm infants at 1- year of corrected age (CA), and to determine what factors influence bone status at 1-year CA.

Methods

Very preterm infants (gestational age less than 32 weeks) admitted to neonatal intensive care unit (NICU) of Kaohsiung Medical University Hospital were enrolled. Bone SOS measured by QUS accompanied with the questionnaire about caring pattern on infants, measurements of body weight, and height has been performed at the left tibia within 1 week of birth, at 1-month CA and 1-year CA.

Results

This study consisted of 114 very preterm infants. Mean gestational age was 28 ± 1.9 weeks and mean birth weight was 1123 ± 323.1 grams. Tibial bone SOS at 1-month CA (2711.3 ± 178.8m/s) was significantly lower than at birth and 1-year CA. Multivariate analysis showed that bone SOS at 1-month CA positively and neonatal therapeutic intervention scoring system (NTISS) scores at admission to NICU negatively influencing tibial bone SOS in very preterm infants at 1-year CA.

Conclusion

This study revealed a decrease of tibial bone SOS at 1-month CA (i.e. osteopenia of prematurity) compared with SOS at birth in very preterm infants. Bone SOS at 1-month CA and NTISS at admission had influences on tibial bone SOS in very preterm infants at the first year of life.

Background

Large Patent Ductus Arteriosus (PDA) can cause significant haemodynamic problems to preterm infants. It can increase burden on pulmonary circulation which in turn increases work of breathing, leading to increased calorie consumption. Poor nutrition can lead to poor neurodevelopmental outcome and increases the risk of CLD.

Objectives

To review the PDA ligation in preterm infants and its link to the weight gain.

Methods

Retrospective observational study over a period of 10 years from Jan 2019 to Dec 2018. Data was collected from Badger database (Neonatal patient record database). Data on gestational age, birth weight, PDA ligation weight, discharge weight and oxygen requirement at 36 weeks were collected among the infants who required PDA ligation.

Results

18 preterm infants needed surgical PDA ligation during study period. The mean gestation at birth was 25 weeks. Mean birth weight was 650 grams. Mean gestational age for PDA ligation was 32 weeks with mean weight of 1060 grams. The mean discharge gestational age was 47.5 weeks with mean weight of 3230 grams.100% of the babies had a diagnosis of chronic lung disease at 36 weeks and 83% went home on oxygen. The mean growth rate before duct ligation 54.3 grams/week which increased to 167.3 grams/week after ligation.

Conclusion

The results show PDA ligation hasn’t had noticeable effect on babies as 100% were diagnosed were diagnosed with CLD at 36 weeks corrected gestational age with the majority discharge home on oxygen. However, growth rates have markedly increased. Babies with large PDA need more calorie requirement to have optimal growth.

Background

The ‘Barriers to feeding’ survey instrument is validated for adult ICU as a quality improvement tool.

Objectives

We aimed to undertake initial validation of the tool for the PICU setting.

Methods

The adult survey was reviewed and minor wording changes were made to make it understandable to a UK context. The electronic survey was sent to staff in a single large UK mixed cardiac and general PICU for testing with a free text question about any perceived pediatric barriers that were missing.

Results

64 questionnaires were returned (response rate 64/150 42%) by a mixture of nurses (81.8%) , medical staff (15%) and dieticians (3.2%) with 58/64 complete. Few respondents (10%) skipped any questions, and no one particular question was skipped. Mean scores for each survey item ranged from 2.08 to 5.08. There were 15 responses for missing items, these were categorised into four new items: Delays to preparing or obtaining non-standard enteral feeds; 2) Severe fluid restriction (especially post-operative cardiac surgery); 3) Lack of staff knowledge and support around breastfeeding mothers and 4) Conservative PICU feeding protocol.

Conclusion

Initial validation work has been successful, further qualitative work was done around layout and question wording, and translations into multiple languages are underway before being extended to examine barriers to enteral feeding internationally. This process will provide a valid quality improvement survey tool that PICUs can use to target improvement locally.