Median Gestation Research Articles

Correlation of radiographic thoracic area and oxygenation impairment in bronchopulmonary dysplasia

We hypothesized that radiographically-assessed hyperinflation in bronchopulmonary dysplasia (BPD) is related to the degree of oxygenation impairment. Our objective was to explore the relation of chest radiographic thoracic area (CRTA) with right-to-left shunt, right shift of the oxyhemoglobin dissociation curve and ventilation/perfusion ratio (VA/Q) in infants with BPD. Twenty-two infants born at median (IQR) gestation of 26 (24–28) weeks with BPD were prospectively studied at 39 (30–69) days. Inspired oxygen (FiO2) was varied to obtain transcutaneous oxygen saturation (SpO2) values between 85 and 96%. Shunt, shift and VA/Q were derived by plotting and analysing pairs of SpO2 and FiO2. CRTA was measured by free hand-tracing the perimeter of the thoracic area in anterio–posterior chest radiographs. Median (IQR) shunt was 8 (1–14)%, shift was 13 (11–19)kPa and VA/Q 0.42 (0.30–0.48). Median (IQR) CRTA/kg was 2495 (1962–2838)mm2 and was significantly related to shift (r=0.674, p<0.001), VA/Q (r=−0.633, p<0.001), weight at study (r=−0.457, p=0.003) and day of life (r=−0.406, p=0.009), but not to shunt. CRTA in BPD is significantly related to oxygenation impairment as quantified by shift and VA/Q. CRTA can be used as a simple radiographic test to quantify BPD severity.

EP02.07: The metallome of human placenta in gestational diabetes mellitus

The knowledge of the “omics” and therefore also of metallomics of GDM appears to be a necessary task in order to gain information about the molecular causes of the disease. Placenta was chosen as an alternative target organ for the analysis of GDM metallome. This was a case-control study. Singleton pregnancies affected by GDM and controls were included at 30 weeks. Ultrasound examinations, clinical and metabolic data were collected. Placenta samples were collected near the umbilical cord after delivery and stored at −80 °C until analysis. Each placenta sample was analysed five times and was evaluated with inductively coupled plasma mass spectrometry (ICP-MS). The detection limit for each element was determined using the Voigtman procedure. There were 19 normal pregnancies and 28 affected by GDM. There were not demographic differences between groups. The diagnosis of GDM was performed at 24 weeks of gestation. Median gestation age at ultrasound scan was 30 weeks. Estimated fetal weight was higher, but not significantly, in women with GDM than controls (p 0.07). There were not differences in fetal wellbeing between the groups. Fasting plasma glucose and HbA1c were higher in GDM group at delivery (p < 0.05). Gestational age at delivery and birthweight were not different between the groups, while GDM placenta weight was significantly heavier (p < 0.001). The comparison of the elemental concentrations in GDM and controls evidenced that Cadmium had lower concentrations and Selenium higher concentrations in GDM placentas than in the control group. ICP-MS confirms the picture of the elemental composition of healthy placentas available in the literature. These results put the attention on two key elemental markers such Selenium and Cadmium for the diagnosis of GDM.

Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia

In adults with Staphylococcus aureus bacteraemia, short duration of effective antibiotic treatment is associated with increased risk of complications and recurrence. The optimum duration of treatment for neonates is unknown and practice varies widely. To relate the duration of treatment of neonatal S. aureus bacteraemia to prevention of complications and recurrence. Retrospective cohort study of confirmed S. aureus bacteraemia occurring over a 10 year period in two large tertiary neonatal units. Neonatal patients developing confirmed S. aureus bacteraemia between birth and discharge from the neonatal unit were identified from microbiology department records. Clinical details obtained from case notes included demographics, duration of antibiotics and clinical outcomes. Recurrence was determined from laboratory and clinical records. Adverse outcomes were related to duration of antibiotic therapy. A total of 90 infants had S. aureus bacteraemia, of which six were meticillin-resistant S. aureus (7%). Median gestation was 27 weeks (range: 23-41), birth weight 846 g (434-3840) and postnatal age 16 days (0-116). Adverse outcomes were found in 44%, with death in 8%. Median duration of appropriate antibiotics was 19 days (range: 0-54). There were no cases of recurrent bacteraemia after finishing antibiotics. There was no relationship between antibiotic duration and complications. Neonatal S. aureus bacteraemia mainly affected preterm neonates and had a significant morbidity and mortality. Recurrent bacteraemia was rare, irrespective of treatment duration. For neonatal unit patients with S. aureus bacteraemia, antibiotic therapy for 14 days in uncomplicated cases may be sufficient to prevent recurrence, with longer treatment justified if there is inadequate source control.

O24. Prediction of pre-eclampsia in obese nulliparous women

Introduction Obese women have an increased risk of pre-eclampsia and may have a distinct mechanism of disease due to factors associated with adiposity and insulin resistance. Objective To develop a prediction model for pre-eclampsia in obese women. Methods SCOPE was a prospective cohort study of 5690 primiparous women. We investigated whether in obese SCOPE participants (BMI ⩾ 30kg/m 2 ) clinical factors and biomarkers measured at 15 weeks gestation, and ultrasound parameters at 20 weeks gestation could predict pre-eclampsia (blood pressure ⩾ 140/90mmHg after 20 weeks' gestation with either proteinuria ⩾ 300mg/24hour urine or protein: creatinine ratio ⩾ 30mg/mmol or urine dipstick protein ⩾ ++ or any multisystem complication of pre-eclampsia). The variables of interest were selected based on a-priory hypothesis. Univariate logistic regression selected factors ( p Results 834 (14.7%) of the SCOPE participants comprised the study population for this analysis. Median BMI was 33.1kg/m 2 (IQR 31.3–36.1kg/m 2 ). Median gestation at delivery was 40 weeks (IQR 38–41 weeks) and median birth weight was 3520g (IQR 3150–3850g). 9.2% (77 cases) developed pre-eclampsia. Factors associated with pre-eclampsia in univariate analysis were family history of venous thromboembolism (VTE) or cerebrovascular accident (CVA) ( p ( p =0.029); hip circumference at 15 weeks ( p =0.020); HDL cholesterol ( p =0.003); adiponectin ( p =0.037); natriuretic peptide A (ANP) propeptide ( p =0.046); natriuretic peptide B (BNP) ( p =0.031); placental growth factor (PLGF) ( p 0.001) and abnormal uterine artery Doppler (UtA-RI) ( p =0.002). In multivariate analysis family history of VTE or CVA (OR 2.7; 95%CI 1.5–4.7); HDL cholesterol 50mg/dl (OR 2.7; 95%CI 1.5–5.1) and PLGF (per log unit) (OR 0.6; 95%CI 0.4–0.7) were selected by stepwise procedure. The final model had an area under (AU) ROC of 0.68 (95%CI 0.62–0.75). Detection rates were 25.9% and 53.2% for a false positive rate of 10% and 25%, respectively. Conclusion The factors associated with later onset of pre-eclampsia in obese women are mainly cardiovascular but have only a moderate predictive performance.

Lost without trace: oximetry signal dropout in preterm infants

Oxygen saturation (SpO2) signal dropout leaves caregivers without a reliable measure to guide oxygen therapy. We studied SpO2 dropout in preterm infants on continuous positive airway pressure, noting the SpO2...

Outcomes of Pregnancy After Bariatric Surgery

Maternal obesity is associated with increased risk of pregnancy complications such as gestational diabetes, stillbirth, preterm birth, and congenital malformations. While small studies have looked into the effect of prepregnancy bariatric surgery on gestational diabetes, these studies have been inconclusive and have not considered presurgery body mass index (BMI) as a confounder. Some systematic reviews have found a lower risk of neonatal complications after bariatric surgery but included heterogeneous studies with small sample sizes. Taking presurgery BMI into account, this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in women who have had bariatric surgery versus women who have not. This population-based study used data from Swedish registries nationwide, which include prenatal, obstetric, and neonatal records. Of 627,693 singleton pregnancies between 2006 and 2011, 670 were in women who had undergone bariatric surgery with presurgery weight documented. Up to 5 control pregnancies in obese women were matched for BMI, age, level of education, years, and smoking history for each pregnancy in the intervention cohort. For controls, weight during early pregnancy was used to calculate BMI. For the study group, BMI was calculated with weight and height measurements at the time of surgery. Outcomes included gestational diabetes, low birth weight, macrosomia, stillbirth, large- and small-for-gestational-age, preterm birth, neonatal death, and major congenital malformations detected during the first year of life. Gestational diabetes was diagnosed by a 2-hour plasma glucose level of 10.0 mmol/L or higher during a glucose tolerance test (with a 75-g loading dose) or a fasting plasma glucose level of 7.0 mmol/L or higher. In the study, 1.9% of the postsurgery pregnancies versus 6.8% of the control pregnancies had gestational diabetes (odds ratio, 0.25; 95% confidence interval [CI], 0.13–0.47; P < 0.001; Table 2). The median gestation time of the diagnosis was 32 weeks for both groups, considering women for whom the diagnosis date was available. The surgery cohort, compared with controls, was associated with an increased risk of small-for-gestational-age infants (15.6% vs 7.6%; odds ratio, 2.20; 95% CI, 1.64–2.95; P < 0.001) and increased risk for low birth weight, although that was not statistically significant (6.8% vs 4.5%; odds ratio, 1.34; 95% CI, 0.88–2.04; P = 0.17). Alternatively, the surgery group had a lower risk for large-for-gestational-age infants compared with the control group (8.6% vs 22.4%; odds ratio, 0.33; 95% CI, 0.24–0.44; P < 0.001) and lower risk of macrosomia (1.2% vs 9.5%; odds ratio, 0.11; 95% CI, 0.05–0.24; P < 0.001). There was no significant difference between the 2 groups in terms of risk of preterm birth (10.0% vs 7.5%; odds ratio, 1.28; 95% CI, 0.92–1.78; P = 0.15), nor in terms of congenital malformations. One limitation of this study was that nearly all (98%) of the surgery procedures were gastric bypass surgery, so it is not clear as to whether these findings apply to other types of bariatric surgery. While the study found that bariatric surgery was associated with reduced risks of large-for-gestational-age infants as well as gestational diabetes, bariatric surgery was also associated with increased odds of small-for-gestational age infants, so increased attention during these pregnancies is recommended.

Reasons for failure of prevention of mother-to-child HIV transmission in a rural South African district hospital.

Further reduction of mother-to-child transmission (MTCT) of HIV requires improved understanding of the reasons for MTCT. We reviewed maternal and infant case notes for HIV-positive infants diagnosed by polymerase chain reaction at Bethesda Hospital. Nineteen cases were analysed. Median gestation at first antenatal consultation (ANC) was 22.5 (interquartile range [IQR] 19.25–24). Eleven (57.9%) mothers were HIV positive at first ANC, whilst eight tested negative and later positive (2 antepartum, 6 postpartum). Median maternal CD4 was 408 cells/μL (IQR 318–531). Six (31.6%) received no antenatal antiretroviral therapy (ART) because they were diagnosed as HIV positive postpartum; 9 (47.3%) received antenatal ART and 3 (15.8%) were never initiated on ART. At 6 weeks postpartum, 5 infants (26.3%) were not on prophylactic nevirapine (NVP) because their mothers had not yet been diagnosed. Maternal seroconversion in pregnancy and breastfeeding, and possibly false-negative HIV tests, were important reasons for prevention of mother-to-child transmission (PMTCT) failure.

Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh

Importance Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. Objective To assess effects of antenatal multiple micronutrient vs iron–folic acid supplementation on 6-month infant mortality and adverse birth outcomes. Design, Setting, and Participants Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127 282 women; 44 567 became pregnant and were included in the analysis and delivered 28 516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). Interventions Women were provided supplements containing 15 micronutrients or iron–folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. Main Outcomes and Measures The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth ( Results Among the 22 405 pregnancies in the multiple micronutrient group and the 22 162 pregnancies in the iron–folic acid group, there were 14 374 and 14 142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron–folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non–statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P P Conclusions and Relevance In Bangladesh, antenatal multiple micronutrient compared with iron–folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non–statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. Trial Registration clinicaltrials.gov Identifier:NCT00860470

G109 Restricting visitors to the nicu significantly reduces nosocomial viral respiratory tract infections in babies

Introduction Recent data suggest 8–52% of babies on the NICU have evidence of a viral respiratory tract infection (VRTI) (Ronchi 2014, Bennett 2012). These studies, and our own data, indicate babies with VRTIs spend twice as long in hospital and have significantly worse respiratory outcomes such as chronic lung disease and the need for home oxygen. There is little evidence exploring ways of reducing these infections in the NICU. Our recent survey demonstrates significant variation in UK NICU visiting practices and isolation policies for babies with RVTIs. Aim To establish the impact of visitor restriction on the incidence of NICU VRTIs. Methods We performed a retrospective study of all admissions between 2007 and 2013 at two large UK tertiary NICUs (˜13,300 bed days/year). Normal visiting policy included parents, family and friends. During the periods November to April of 2009, 2010 and 2011, in response to the H1N1 pandemic, we restricted visiting to parents/carers only. No other variations in practice occurred. We identified all babies positive for VRTIs. We used a Poisson generalised additive model (GAM), factoring in workload intensity and incidence of community VRTIs, to calculate the impact of these 3 winter restriction periods compared with normal visiting. Results There were 100 PCR proven VRTIs in 93 babies during this period (˜16/yr). Rhinovirus (n = 71), RSV (n = 8) and H1N1 (n = 5) were the most common. The median gestation of infected babies was 29 weeks (IQR 26–34 Weeks) and 46% required an escalation of respiratory support. Two of five H1N1 positive babies died. The results from the GAM suggest there was a 39% reduction (P Conclusion This is the first study demonstrating a significant reduction in NICU VRTIs through restricting visiting practices. VRTIs are associated with significant neonatal respiratory morbidity and have short and long-term resource implications. We need to explore better ways of minimising the impact of VRTIs in this vulnerable population.

Using Measurements of Shunt and Ventilation-to-Perfusion Ratio to Quantify the Severity of Bronchopulmonary Dysplasia

Background: Classifying the severity of bronchopulmonary dysplasia (BPD) by continuous numerical variables would facilitate follow-up of disease progression and quantified analysis of disease determinants. Objectives: To non-invasively measure oxygenation impairment in BPD by the degree of right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and ventilation/perfusion (V_A/Q) inequality and to explore their relation with clinical parameters. Methods: Prospective cohort study of 24 infants with a median (interquartile range, IQR) gestation of 25 weeks (24-27) and a birth weight of 0.70 kg (0.63-0.93), studied at 36 days (30-66), at a postmenstrual age (PMA) of 33 weeks (29-36). Inspired oxygen (F_IO₂) was varied to obtain three to five transcutaneous oxygen saturation (SpO₂) values between 85 and 96%. Values of shunt, shift and V_A/Q were obtained by plotting the paired data of SpO₂ against F_IO₂ for each infant using a unique program. Right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and V_A/Q were measured in infants born <32 weeks PMA receiving oxygen at 28 days. Results: The median (IQR) shunt was 8% (0.3-16.5), shift 14.5 kPa (10.9-19.4) and V_A/Q 0.40 (0.30-0.48). Shunt, shift and V_A/Q were significantly related to gestational age (GA) at birth, PMA at study, weight at study and weight gain per week. Conclusions: Severity of pulmonary oxygenation impairment in BPD can be quantified at the cot-side by non-invasive measurement of shunt, shift and V_A/Q. Low GA at birth, low weight at birth and at the time of study and impaired weight gain are significantly associated with the severity of oxygen-exchange impairment in infants with BPD.

Variability in survival of very low birth weight neonates in hospitals of India.

This prospective cohort study was conducted to evaluate variability in mortality of very low birth weight (VLBW) neonates during their birth hospitalization in different hospitals of India. A liveborn neonate was eligible for inclusion in the study if it was born or admitted in a participating hospital between 1st January and 31st December 2012 and weighed 1500g or less at birth. Neonates were given clinical care as per standard protocols. Standardized neonatal mortality ratio (SNMR) was calculated as the ratio of the observed mortality to the expected mortality. Expected mortality rate for each unit was calculated by adjusting for various prognostic factors at the time of birth or admission in the participating unit. Among 1345 neonates [mean birth weight: 1168 ± 240g, median gestation: 30wk (IQR: 28-32)] enrolled in the study 199 (14.8%) died before hospital discharge. Although variation in inter-hospital SNMR was statistically insignificant (P 0.49), 95% CI of SNMR of most hospitals was broad reaching level of clinical significance on both sides of line of equivalence. This indicates the need to establish an ongoing quality-improvement collaborative network to identify and adopt clinical practices associated with decreased mortality.

Late medical therapy of patent ductus arteriosus using intravenous paracetamol

ObjectiveTo investigate the effect of late treatment with intravenous paracetamol on patent ductus arteriosus (PDA) closure prior to possible PDA ligation.MethodsA retrospective review of infants with a haemodynamically significant PDA,...

Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age?

Recent studies report high rates of thyroid disorders in pregnant women. However, the need for universal thyroid screening remains controversial. Our aim was to estimate the prevalence of thyroid dysfunction (TD) during pregnancy and to analyse the association with maternal age. We conducted a cross-sectional study in a referral centre in collaboration with the primary care units from April 2010 to March 2011. The study included 2509 consecutive pregnant women resident in an iodine-sufficient area, mean age 32 years (range 16-47) who were universally screened for TD in their first trimester (median gestation 8 weeks, range 4-13 weeks). Thyroid-stimulating hormone (TSH) and free T4 (FT4) were analysed during the first antenatal visit. We applied first trimester-specific population-based TSH and FT4 reference ranges. We identified 416 women with positive TD screening [16·6%, 95% confidence interval (95% CI) 15·1-18·0]. Of these, 47 had overt hypothyroidism (1·9%), 90 subclinical hypothyroidism (3·6%), 23 overt hyperthyroidism (0·9%), 20 subclinical hyperthyroidism (0·8%) and 236 had isolated hypothyroxinaemia (9·4%). Applying a logistic regression model, age ≥30 years was not associated with a higher risk of TD [odds ratio (OR) 0·85, 95% CI 0·67-1·08] or hypothyroidism (OR 0·72, 95% CI 0·50-1·06). TD affects one in six pregnant women in an iodine-sufficient population. Maternal age ≥30 years do not increase the risk of TD.

175-POS

Objectives As inflammation has been associated with preeclampsia in cross-sectional analyses, we examined the relationship between inflammatory markers and preeclampsia in early pregnancy. Methods We conducted a nested case-control study of 409 preeclamptic women and 297 normotensive controls with primiparous singleton pregnancies enrolled in the Danish National Birth Cohort at a median gestation of 16 weeks. Preeclampsia was defined by blood pressure ⩾140/90 mmHg and proteinuria ⩾3 g/24 h. Inflammatory markers included interleukin (IL)-6, IL-6 receptor, IL-4, IL-4 receptor, IL-5, IL-12, IL-2, TNF-alpha, TNF-beta, TNF-receptor, IL-1beta IL-1alpha IL-8, IL-10, IFN-gamma, IL-18, macrophage migration inhibitory factor (MIF), macrophage inflammatory protein (MIP), transforming growth factor-beta (TGF), and RANTES. We examined associations between inflammatory markers dichotomized by the limit of detection (LOD) and preeclampsia using logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Models were adjusted for body mass index (BMI) and smoking. Results Women with IL-6 (OR 1.44, 95% CI 1.03–2.03) and TNF-alpha (OR 1.54, 95% CI 1.06–2.23) levels above the LOD have significantly increased risk of preeclampsia. IL-1beta levels above the LOD showed a decreased risk of preeclampsia (OR 0.55, 95% CI 0.3–1.01). Conclusions Elevated inflammatory markers in early pregnancy may be markers of subclinical disease and/or may be involved in pathogenesis. As these relationships are complex future studies should explore cytokine clusters in preeclampsia risk. Disclosures B.D. Taylor: None. G. Tang: None. R.B. Ness: None. J. Olsen: None. D.M. Hougaard: None. K. Skogstrand: None. J.M. Roberts: None. C. Haggerty: None.

Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial.

Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes. Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5). Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P < .001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95% CI, 0.85-0.91; P < .001). In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. clinicaltrials.gov Identifier: NCT00860470.

Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series.

Milrinone has been proposed as an effective treatment for pulmonary hypertension (PH) and right ventricular (RV) dysfunction. We aimed to determine the effect of milrinone therapy on clinical and echocardiography parameters of PH in preterm infants with elevated pulmonary pressures. A retrospective case review was conducted on infants <32 weeks gestation who received milrinone for the treatment of PH and reduced RV function. Echocardiographic data were collected before and after treatment with milrinone, and serial clinical parameters were recorded over a 72h period. Seven infants met the inclusion criteria with a median gestation and birth weight of 27.3 weeks and 1140 g, respectively. Four infants had a diagnosis of pulmonary hypoplasia with PH, and three infants were recipients in twin-to-twin transfusion syndrome who also developed PH. Nitric oxide was used in six infants before commencement of milrinone. Milrinone was commenced at a dose of 0.33 μg kg(-1) min(-1) to 0.5 μg kg(-1) min(-1) and continued for a median duration of 70 h. Use of milrinone was associated with a fall in oxygenation index and inhaled nitric oxide dose. Following an initial fall in blood pressure over the first 6 h, there was an increase in blood pressure over the subsequent 72 h. Echocardiographic data demonstrated an increase in indicators of myocardial performance and PH. One infant died before discharge. This case series suggests that milrinone may be a useful therapy for premature infants with echocardiography findings of PH and/or RH dysfunction. This data support the need for a randomised control trial to confirm its efficacy.

Peak systolic to end diastolic flow velocity ratio is associated with ductal patency in infants below 32 weeks of gestation

BackgroundEarly diagnosis and effective treatment of the patent ductus arteriosus (PDA) in infants less than 32 weeks gestation remains contentious.ObjectiveTo determine which clinical and echocardiographic parameters are associated with PDA...

Pulmonary edema in pregnancy and the puerperium: a cohort study of 53 cases

To describe the etiology and obstetric outcome in women presenting with pulmonary edema during pregnancy and the puerperium. As a secondary objective, we evaluated the utility of echocardiography in the investigation and management of such women. Retrospective case note analysis of 53 cases of pulmonary edema that resulted in severe respiratory distress and admission to intensive care. The study population were women accessing obstetric care at a tertiary referral center in South Africa. Cases were classified as cardiac (6/53; 11%), hypertensive (44/53; 83%), or septic (3/53; 6%), depending on the underlying cause for pulmonary edema. There were significant differences in the mean ejection fraction at echocardiography for cardiac vs. non-cardiac groups (26% vs. 55%, P=0.0001), as well as the presence of valvular stenosis or regurgitation (5/6 vs. 8/30, P=0.016). Women in the non-cardiac group were more likely to present earlier and require earlier delivery than in the cardiac group (median gestation at delivery 35 weeks vs. 38 weeks, P=0.0106) and mothers in the cardiac group were more likely to die (2/6 vs. 1/47, P=0.031). Cesarean delivery was performed in 85% of cases. Hypertensive illness is the most common underlying etiology in the development of pulmonary edema. Transthoracic echocardiography is a non-invasive investigation that can be carried out at the bedside and is a useful diagnostic tool in pulmonary edema occurring in pregnancy and the puerperium. Knowledge of ejection fraction is an important diagnostic tool to differentiate the underlying causes and to guide management.

PO-0631 Review Of The Neonatal Community Outreach Team Service For Infants Discharged On Home Oxygen

Background The British Thoracic Society has outlined the care pathway for infants with chronic lung disease on home oxygen. Aim To review the service provided to the infants going home on oxygen, by the Neonatal Community Outreach Team (NCOT) at Heart of England NHS Trust. Methods NCOT patient notes, Badger database and Parent feedback responses were reviewed to evaluate the care provided to babies on home oxygen. Results During the 14 month study period, 25 babies on home oxygen were cared for in the community by NCOT. Their median gestation at birth was 27 weeks (23–36 weeks) and median birth weight was 865 grams (520–3180 grams). The median gestation at discharge was 40 weeks (35–64 weeks) with a median oxygen requirement of 0.1 litres/minute (0.02- 0.4 litres/minute). The median number of pre-discharge NCOT contacts was 2 (1–12) and post-discharge contacts 21 (7–36). The median number of post-discharge overnight oxygen saturation studies was 2 (1–7). During the study period, 20 babies came off oxygen with a median post-discharge time of 12 weeks (1–27 weeks). A respiratory syncitial virus vaccination program was successfully completed. The NCOT also facilitated a monthly ‘Little Stars’ parents meeting and advisory group. The NCOT service had a 100% satisfaction response on parent survey (75% responders). Conclusion NCOT have provided an excellent service in the community to babies on home oxygen enabling early discharge from neonatal unit whilst appropriately managing oxygen therapy in the community and providing family support and education.

O-008 Early Bifidobacterium Breve Bbg-001 To Prevent Necrotising Enterocolitis, Late-onset Sepsis And Death: The Pips Trial: Abstract O-008 Table 1

<h3>Background</h3> Interpretation of published trials of probiotics in preterm infants is complicated by the use of multiple bacterial strains and exclusion from some trials of babies at high-risk of complications. <h3>Objective</h3> To evaluate a single strain of <i>Bifidobacterium breve</i> in an unselected population of preterm infants. <h3>Methods</h3> Multi-centre double blind Randomised Placebo Controlled Trial of <i>Bifidobacterium breve </i>BBG-001, 2.1 to 5.3 × 10⁸ cfu daily, (<i>B breve</i>) in infants below 31w gestation randomised before 48h. Primary outcomes were necrotising enterocolitis (NEC) ≥Bell stage 2, late onset sepsis (LOS) and death. Results are presented by intention to treat adjusted for sex, gestation and randomisation within 24 h and allowing for clustering of multiples. <h3>Results</h3> 1310 infants were randomised, median gestation 28.0w, median birthweight 1010g and median age starting the intervention 44 h. No adverse events related to the intervention were reported. <h3>Conclusions</h3> This intervention was not associated with any advantage in this population of babies. This result highlights the need to assess the efficacy of different probiotic strains and challenges the validity of combining trials using different probiotic interventions in meta-analyses.