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European Society for Paediatric Research Annual Meeting Abstracts Bilbao, Spain September 27–30, 2003

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European Society for Paediatric Research Annual Meeting Abstracts Bilbao, Spain September 27–30, 2003 0031-3998/03/5404-0557 PEDIATRIC RESEARCH Vol. 54, No. 4, 2003 Copyright © 2003 International Pediatric Research Foundation, Inc. Printed in U.S.A. EUROPEAN SOCIETY FOR PAEDIATRIC RESEARCH ANNUAL MEETING ABSTRACTS BILBAO, SPAIN SEPTEMBER 27–30, 2003 0008NEO 0011NEO PRESCHOOL OUTCOME IN CHILDREN BORN VERY PREMATURELY EFFICACY OF ERYTHROPOITIN IN PREMATURE INFANTS AND CARED FOR ACCORDING TO NIDCAP Adnan Amin, Daifulah Alzahrani Bjo¨rn Westrup1, Birgitta Bo¨hm1, Hugo Lagercrantz1, Karin Stjernqvist2 Alhada Military Hospital City:Taif, Saudi Arabia 1Neonatal Programme, Dept. of Woman and Child Health, Astrid Lindgren Children’s Hospital, Objective: To identify the effect of early of parentral recombinant human erythropoitin (r-HuEPO) Karolinska Institute, Stockholm, Sweden;2Depts. of Psychology and of Paediatrics, University of and iron administration on blood transfusion requirement of premature infants. Methods: In a Lund, Sweden City: Stockholm and Lund, Sweden controlled clinical trial conducted at the Neonatal Intensive Care Unit, Al-Hada Military Hospital, Background/aim: Care based on the Newborn Individualized Developmental Care and Assess- Taif, Kingdom of Saudi Arabia over a 16 month period. We assigned 20 very low birth weight infants ment Program (NIDCAP) has been reported to exert a positive impact on the development of (VLBW) with gestational age of (mean Ϯ SEM 28.4 Ϯ 0.5 weeks and birth weight of (mean Ϯ SEM prematurely born infants. The aim of the present investigation was to determine the effect of such care 1031 Ϯ 42 gm), to receive either intravenous (r-HuEPO 200 U/kg/day) and iron 1mg/kg/day or on the development at preschool age of children born with a gestational age of less than 32 weeks. conventional therapy over 21 days study period. Blood transfusion administration under goes a strict Method: All surviving infants intended to treat in a randomized controlled trial (11 in the NIDCAP protocol in our nursery. Results: During the three weeks study period, the hemoglobin and heamat- group and 15 in the control group) were examined at 66.3 (6.0) months corrected for prematurity, ocrit remained similar in the two groups while the reticulocyte counts were greater in the (r-HuEPO) mean (SD). In the assessment we employed the Wechsler Preschool and Primary Scale of Intelli- recipients on day 14.The number and volume of blood transfusions were similar in both groups. gence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement Conclusion: VLBW infants receive fewer blood transfusions than the number previously reported. ABC) for motor function, subtests of the NEPSY test battery for behavior, and the WHO definitions Strict pheloptomy and transfusion criteria could minimize the need r-HuEPO. of impairment, disability and handicap. Mann Whitney test was employed for the continuous variables and an exact logistic regression for the Odds Ratios, correcting for gender, gestational age, relative birthweight and levels of parental education. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] vs. the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) vs. 93.7 (26.8) or Performance IQ 94.3 (14.7) vs. 86.3 (24.8). The Odds Ratio (OR; 95% CI) survival without overall disability was 14.7 (0.8-Ͼ100) in favor of the NIDCAP group. The corresponding OR for surviving without mental retardation was 3.5 (0.7-Ͼ100) and for surviving without abnormal behavior 19.9 (1.1-Ͼ100). Conclusion: Although we could show a significant impact on the NIDCAP group only in the behavioral aspect of development there were tendencies in the same direction for general cognition and incidence of disability. 0009NEO 0012NEO PARENTERAL NUTRITION ASSOCIATED CHOLESTASIS(PNAC) IN LBW TITLE:ENDOTHELIAL ACTIVATION IN PRETERM INFANTS WITH CHO- NEONATES. RIOAMNIONITIS AND FUNISITIS Ran Namgung, Jae Il Shin, Min Soo Park, Chul Lee Author(s):D. Heinrich1, B.W. Kramer1, S. Seidenspinner1,A.Marx2, D. Berg3, P. Groneck3, Ch.P. Pediatrics, Yonsei University College of Medicine City: Seoul, Korea Speer1 Background/aims: PNAC, though multifactorial in etiology, may be associated with abnormal 1)Children’s Hospital, Univ. of Wuerzburg, 2) Department of Pathology, Univ. of Wuerzburg, 3) aminoacid (AA) intake, excess or deficiency, & an excess of Intralipid (IL). Prolonged administration Children’s Hospital of Cologne City: Wuerzburg and Cologne, Germany of IL in premature baboons resulted in steatosis, cholestasis (CH), & proliferation of bile ducts in the Aims: Chorioamnionitis and funisitis are associated with preterm labour and postnatal morbidity. Endothelial cell liver in a dose dependent manner. In neonates receiving PN, possible relationships between serum adhesion molecules play a crucial role in transmigration of leukocytes. E-selectin is involved in rolling whereas ICAM-1 direct bilirubin(DB) & AA or IL amounts have not been evaluated. We hypothesized that low birth and VCAM-1 are essential for adhesion. We investigated whether chorioamnionitis in preterm infants induced the weight (LBW) infants with CH would have received higher amount of AA or IL than those without expression and shedding of adhesion molecules in the umbilical cord and increased the concentrations of E-selectin, CH. Methods: Twenty two newborns with CH(ges. 29.8Ϯ1.6wk, bir wt 1298Ϯ217g) were compared ICAM-1, interleukin (IL)-1 beta, IL-6 and IL-8 in the cord blood. Methods: Immunohistochemistry was performed on with 22 without CH (29.5Ϯ1.7wk, 1286Ϯ363g). CH was defined as a direct bilirubin(DB) Ͼ2mg/dl.; paraffin-embedded umbilical cord sections. For E-selectin and VCAM-1 the positive cells per vessel were counted, for other causes of CH including primary liver disease or mechanical causes were excluded. In CH vs ICAM-1 the intensity of staining was measured by a four-step semi-quantitative scale. Concentrations of cytokines, non-CH, peak DB was higher(4.6Ϯ2.4 vs 1.2Ϯ0.2mg/dl, pϽ.0001), & PN dur was longer(36.5Ϯ1.4 E-selectin and ICAM-1 were measured by ELISA. The patients were divided into 3 groups according to histology: vs 19.2Ϯ9.8d, pϽ.0001). Clinical risk factors were analyzed by multiple logistic regression analysis, chorioamnionitis with funisitis (nϭ11; birth weight (BW) median 860g, 95% confidence interval (CI) 588-1516g; & amounts of AA & IL, average daily or total, were analyzed. Results: Dur of fasting & PN, gestational age (GA) median 26 wks, CI 22–31 wks), chorioamnionitis without funisitis (nϭ9; BW median 950g, CI (ϩ)C-reactive protein, feeding intolerance, average daily IL amount, total AA & total IL amount were 632-1704g; GA median 28 wks, CI 24–31 wks) and a control group without infection (nϭ12; BW median 865g, CI significantly associated with PNAC. Average daily AA amount was similar between groups, whereas 581-1596g; GA median 26 wks, CI 23–31 wks). Results: E-selectin expression on arterial and venous endothelium was average daily IL amount was significantly higher in CH vs non-CH(2.2Ϯ0.3 vs 1.8Ϯ0.4g/kg/d, restricted to 3 cases, all in the chorioamnionitis and funisitis group. VCAM-1 was detected in 8 out of 11 cases with pϭ0.002). Total AA & total IL amounts were significantly higher in CH vs non-CH, respectively(AA, chorioamnionitis and funisitis (median artery 1.3 pos. cells, CI 0–20.2 pos. cells), in 4 out of 9 cases with chorioam- 66.8Ϯ24.1 vs 35.6Ϯ21.2g/kg, pϽ.0001;IL, 81.2Ϯ29.1 vs 36.5Ϯ21.5, pϽ.0001). Serum peak DB was nionitis alone (median artery 0 pos. cells, CI 0–0.4 pos. cells; pϽ0.05) and in 1 out of 12 cases in the control group positively correlated with total AA amount [DBϭ0.865ϩ0.044xAA(g), rϭ.500, pϭ.0014], total IL (median artery 0 pos. cells, CI 0–0.4 pos. cells; pϽ0.005). The expression on the venous endothelium showed an identical amount [DBϭ0.204ϩ0.048xIL(g), rϭ.677, pϽ.0001], or average daily IL amount [DBϭ distribution between groups. ICAM-1 was expressed on the endothelium of all investigated vessels, but arterial expression -3.67ϩ3.36xIL(g/kg/d), rϭ.529, pϭ.0006]. Conclusions: Since serum DB increased with increasing was higher with chorioamnionitis and funisitis (median 2.5, CI 2.3–3.4) compared to chorioamnionitis alone (median 2.1, total infusion of AA or IL in a dose dependent manner, we suggest that cumulative toxicity of AA CI 1.6–2.5; pϽ0.001) or control group (median 2.0, CI 1.4–2.5; pϽ0.005). Similar expression patterns were found in the & IL may result in PNAC in LBW infants. We speculate that decreasing the cumulative load of AA venous endothelium, vascular walls and Wharton’s Jelly. The concentrations of soluble ICAM-1 and E-selectin in cord & IL could possibly attenuate severity of hepatic pathology in PNAC. blood were higher with chorioamnionitis and funisitis (median 242.3 ng/ml, CI 111.5–509.4 ng/ml and median 66.3 ng/ml, CI 27.1–245 ng/ml, respectively) than with chorioamnionitis alone (median 123.5 ng/ml, CI 98.2–206.3 ng/ml; pϽ0.005 and median 43.1 ng/ml, CI 14.8–117.3 ng/ml; pϭ0.05, respectively) or in the control group (median 116.3 ng/ml, CI 77.4–163.8 ng/ml; pϽ0.001 and median 19.1 ng/ml, CI 9.3–84.8 ng/ml; pϽ0.005, respectively). Similarly, concentrations of IL-1 beta, IL-6 and IL-8 were increased with chorioamnionitis and funisitis. Conclusion: Chorioam- nionitis alone did not cause an up-regulation of adhesion molecules or an increase in proinflammatory mediators. However, chorioamnionitis with funisitis resulted in systemic inflammation and endothelial activation with expression of E-selectin and VCAM-1 on the endothelium of vessels and up-regulation of ICAM-1 expression in all compartments of the umbilical cord.
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