School age outcome in very low birth weight infants

Ioanna Antoniadou

School age outcome in very low birth weight infants

Ioanna Antoniadou

2008, Early Human Development

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Twenty seven (15.9%) had BPD, although only 9 (5.3%) had moderate/ severe BPD. Ophthalmologic evaluation was performed in 80 infants (47.1%), of whom 12 (15%) had ROP although only 2 (2.5%) had severe ROP. Thirty five (20.6%) had intraventricular hemorrhage and 8 (4.7%) had IVH = 3. The overall mortality was 11.2%. Conclusions Comparing with the literature, our results were similar in variables as prenatal care, antenatal steroids, C-section and surfactant administration. We had less newborns receiving any assisted ventilation, a lower incidence of comorbidities as NEC and acceptable results of BPD. Our ROP results are not very different from the literature, however we had a lower incidence of VLBW with ophthalmologic evaluation performed. The overall mortality was similar to other Units.

S38 Abstracts Twenty seven (15.9%) had BPD, although only 9 (5.3%) had moderate/ severe BPD. Ophthalmologic evaluation was performed in 80 infants (47.1%), of whom 12 (15%) had ROP although only 2 (2.5%) had severe ROP. Thirty five (20.6%) had intraventricular hemorrhage and 8 (4.7%) had IVH = 3. The overall mortality was 11.2%. Conclusions Comparing with the literature, our results were similar in variables as prenatal care, antenatal steroids, C-section and surfactant administration. We had less newborns receiving any assisted ventilation, a lower incidence of comorbidities as NEC and acceptable results of BPD. Our ROP results are not very different from the literature, however we had a lower incidence of VLBW with ophthalmologic evaluation performed. The overall mortality was similar to other Units. doi:10.1016/j.earlhumdev.2008.09.095 3 weeks. Oligohydramnios develops in the donor twin who progressively becomes anaemic, oliguric and hypovolemic whereas polydramnios develops in the recipient who becomes plethoric, polyuric and cardiomegalic. The severity of TTTS at initial diagnosis is staged as Quintero's classification on ultrasonography. TTTS causes high fetal loss rate, high perinatal mortality and high prevalence of preterm delivery. After discharge from hospital survivors may suffer neurological sequelae. Materials and methods This is a retrospective review of all the twin pairs born in our unit during the period January 2003 to December 2007. 120 twin pairs were admitted to our neonatology unit. Maternal data, antenatal ultrasound findings, obstetric complications and placental morphology were assessed. The diagnosis of TTTS was considered in monochorionic twins if any two of the following criteria were satisfied: 1) intertwin haemoglobin difference >5 g/dl; 2) intertwin birthweight difference >20%; 3) pallor in one twin and plethora in the other. Results Abstract UENPS.80 Successful treatment of congenital diaphragmatic hernia (CDH) associated with pancreatic hypoplasia — Case report Slavikova Helena⁎, Sanakova Petra, Stranak Zbynek, Feyereisl Jaroslav, Pycha Karel, Rygl Michal, Skaba Richard Institute for the Care of Mother and Child, Prague, Czech Republic Background and aim The occurrence of coexisting congenital diaphragmatic hernia (CDH) and pancreatic hypoplasia is extremely rare and is considered highly lethal. No case of successful treatment of congenital diaphragmatic hernia associated with pancreatic hypoplasia and serious diabetes mellitus has been published till present. The authors describe a term neonate with this association. Materials and methods Monochorionic twins were present in 12 pregnancies. TTTS was diagnosed prenatally by ultrasonography based on one monochorionic placental mass, absent twin peak sign, concordant external genitalias, thin interfetal septum, oligo-anhydramnios in the donor and polyhydramnios in the recipient. In two cases antenatal ultrasonography demonstrated the signs of TTTS but none satisfied the clinical criteria (Table 1). Conclusions The original neonatal criteria for TTTS have been abandoned because often criteria failed to apply although the prenatal ultrasound signs suggested the TTTS. Clinical manifestations may be less severe than reported in literature. It can be due to the extreme variability of clinical signs and to the close ultrasound surveillance dedicated to these at risk-pregnancies. The identification of TTTS improves with advances in ultrasound technology which let us discover “mild” TTTS. Table 1 Case study. Results History, course, magnetic resonance scan, biochemical analysis of pancreatic hypoplasia parameters, images from surgery and two year follow up are presented. Conclusions Survival of coexisting congenital diaphragmatic hernia (CDH) and pancreatic hypoplasia is extremely rare. We are presenting patientwith this association who was successfully treated. Increased PIAO A-REDF Reduced PIACM oligohydramnios IUGR plethora jaundice pallor anaemia I case report I born II born II case report I born II born + − − − − − + − + + − + − + − + + + + + − − − − + + + + + − + + − − + + doi:10.1016/j.earlhumdev.2008.09.097 doi:10.1016/j.earlhumdev.2008.09.096 Abstract UENPS.81 “Mild” twin–twin transfusion syndrome: Clinical report Maurizio Carta, Mario Giuffrè, Ettore Piro, Simona La Placa, Maria Caiozzo, Giovanni Moceri, Giovanni Corsello⁎ Dipartimento Materno Infantile — Università di Palermo, Palermo, Italy Abstract UENPS.82 School age outcome in very low birth weight infants Helen Bouza⁎,a, Elias Nellasa, Alexia Prassoulib, Fani Anatolitoua, Jasmin Sarafidouc, Marina Anagnostakoua, Ioanna Antoniadoub a “Aghia Sophia” Children's Hospital, Athens, Greece b Institute of Child Health, Athens, Greece c University of Thessali, Volos, Greece Background and aim Background and aim Twin–twin transfusion syndrome (TTTS) is a potentially serious midtrimester complication of monochorionic twin pregnancies. TTTS occurs in 15% of monochorionic pregnancies affecting 1 in 1600 babies. TTTS is due to unbalanced intertwin transfusion mediated by one or more unidirectional arteriovenous anastomoses in association with absent or significantly fewer bidirectional superficial anastomoses. Symptoms of TTTS may develop within 2– Very Low Birth Weight (VLBW) infants are at a high risk of presenting Learning and Psycho-emotional problems at school age. The purpose of this study was the detailed assessment of non handicapped VLBW children at school age, with standardized tools, in order to detect Learning, Emotional and Behavioral Problems. Abstracts S39 Materials and methods Results The children of the study are part of a longitudinal follow up of VLBW children born between 1997–1998. At the age of 4, 32 children were considered to be normal or having minor neurodevelopmental disabilities and were selected for the purpose of this study. The children were assessed at 8–9 years of age using the Wechsler Intelligence Scale for Children (WISC III), the Bender gestalt test and the Achenbach's Child Behavior Checklist, Parent's report (CBCL) and Teacher's report (TRF). A significantly higher concordance in MZ twins compared with DZ twins, was observed: MZ = 92.9%, DZ = 70.3%. This suggests that genetic factors play a role in the development of these respiratory infections even though a high DZ concordance underlines also a strong environmental effect. We also estimated an etiological model on 936 twins for which the following risk factors were available: birth weight, gender, zygosity, number of older siblings, maternal smoking, paternal smoking, pollution, maternal asthma, paternal asthma and intubation at birth. The outcome considered was a respiratory infection before the 2 years of age. A logistic regression model that kept into account for twin data was applied. Paternal smoking in the presence of children, maternal asthma, having more than 2 older siblings and having been intubated at birth represent significant risk factors. Results The WISC III test showed that the children in our cohort had better performance on Verbal scale/Verbal Comprehension and lower performance on Performance scale (p: 0.054) and perceptual organisation (p:0.05). There was a trend to lower scores in Visual Concentration, Aural and Visual Memory, with a significant deviation in Aural Concentration. The Bender test showed that 28.1% of the children had positive markers for learning difficulties, 81.3% for emotional difficulties and 56.3% had markers of organic dysfunction. CBCL behavior problems scales revealed that the incidence of children with internalizing, externalizing or total problems were not significantly different from the general population, however there is a higher incidence of children with some of the syndromes: a higher incidence of social problems and thought problems. The CBCL competence scales revealed a higher incidence of problems at the school performance scale. The TRF behavior problems scales revealed a higher incidence of children with somatic complaints. TRF competence scale revealed a higher incidence of problems in academic competence. There is also a higher incidence of problems in adaptive functioning related to problems in learning and mood. Conclusions The results show that even if a moderate genetic component is present and children of mothers with asthma have a higher risk of respiratory disease, prevention of environmental factors (i.e. paternal smoking) would help in reducing the incidence of these diseases. ITR and SIN will start the enrolment of the cohort of newborn twins with the goal of following them up during childhood. This longitudinal cohort will allow studies on heritability and gene-environment interaction for major neonatal and paediatric outcomes, as well as etiological studies on the entire cohort given the extensive information on prenatal and neonatal life of the twins and their DNA samples. doi:10.1016/j.earlhumdev.2008.09.099 Conclusions The incidence of problems at school age among VLBW children is high. It is important to assess those children during early school age and suggest at the proper time techniques to improve their skills or educational assistance. doi:10.1016/j.earlhumdev.2008.09.098 Abstract UENPS.83 The Italian longitudinal cohort of newborn twins: A research opportunity Sonia Brescianini⁎,a, Emanuela Meddaa, Guido Cocchib, Giovanni Corselloc, Mario De Curtisd, Paolo Ghirrie, Luigi Memof, Carla Arpinog, Maria Antonietta Stazia a CNESPS, Istituto Superiore di Sanità, Roma, Italy b Istituto Clinico di Pediatria Preventiva e Neonatologia, Alma Mater Studiorum — Università di Bologna, Bologna, Italy c Neonatologia e TIN, Istituto Materno Infantile, Università di Palermo, Palermo, Italy d Dipartimento di Scienze Ginecologiche, Perinatologia e Puericultura, Università di Roma “La Sapienza”, Ospedale Umberto I, Rome, Italy e Dipartimento di Neonatologia e TIN, Dipartimento di Pediatria, Università di Pisa, Pisa, Italy f U.O.C. di Pediatria, Neonatologia, Ospedale San Martino, Belluno, Italy g Dipartimento di Neuroscienze, Unita di Pediatria, Università di tor Vergata, Roma, Italy Background and aim Twins represent a unique model in genetic epidemiology to study the genetic and environmental effects and their interaction on complex traits. The key point is represented by the comparison between the phenotypic resemblance in monozygotic twins (MZ) and in dizygotic twins (DZ). This comparison yields to the estimation of heritability. The Italian Twin Register (ITR) and the Italian Neonatal Society (SIN) are launching a new project aiming at establishing a newborn twin cohort with the objective of estimating the heritability of health-related pediatric outcomes. Materials and methods With the aim of understanding the importance of genes and environment in explaining the total phenotypic variance of bronchitis and/or bronchopneumonia and/or bronchiolitis, concordance rates of MZ (185 pairs) and DZ pairs (351 pairs) were estimated and compared. Abstract UENPS.84 The incidence of late preterm deliveries in a new ue admitted country Mirela Anisoara Siminel⁎, Elena Coleta, Mihaela Gheonea University of Medicine and Pharmacy of Craiova, Craiova, Romania Background and aim The late preterm birth defined as the preterm delivery between 34/ 35 weeks of gestation and 36/37 weeks is one of the most common problem that we are dealing with in NICU. Because the increased clinical risk of late preterm infants versus full terms such as: persistent temperature instability, hypoglycemia, hyperbilirubinemia, respiratory distress, sepsis, feeding difficulties they require special care, more days of hospital stay and often readmission and so an increased cost of hospitalisation. The objective of this work was to find out if the incidences of preterm births have increased in the period that follows the admission of Romania in UE and why. Materials and methods Material and method: We have studied the late preterm infants born in our Neonatology Clinic in a comparative study for three years, last two years (2005–2006) before the admission of Romania in UE and one year (2007) after. The total number of preterm births was 912. Results Results: If the figures related to the birthweight: low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW) are quiet similar 2005/2006 with 2007, LBW ~ 76.5%, VLBW ~ 13.57%, ELBW10.05%, the figures related gestational age are different: from the total number of preterm birth the late preterm infants (LPI) were 714 (78.23%); in 2005-192 LPI (77.4%), 2006-190 LPI (77.23%) meanwhile in 2007-332 LPI (79.4%). The difference is made by the late preterm infants with intrauterine growth restriction (IUGR). Conclusions The incidence of late preterm birth is increased in 2007, with a semnificative percentage of late preterm infants with IUGR.

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