Content uploaded by Tze-Fun Lee
Author content
All content in this area was uploaded by Tze-Fun Lee on Jun 13, 2019
Content may be subject to copyright.
Abstracts
Paediatrics & Child Health, Vol. 23, No. S1 June/July 2018 e21
53
OUTCOMES IN EXTREMELY PREMATURE INFANTS WITH
TWIN-TWIN TRANSFUSION SYNDROME TREATED BY
LASER THERAPY
Julie Sommer1, Gabriel Altit2, Anne-Monique Nuyt1,
François Audibert3, Véronique Dorval1, Anie Lapointe1
1Department of Pediatrics, Division of Neonatology, CHU
Sainte-Justine, University of Montreal, Canada, 2Department of
Pediatrics, Division of Neonatology, Montreal Children’ Hospital,
McGill University, Canada, 3Department of Obstetrics and
Gynecology, CHU Sainte-Justine, University of Montreal, Canada
BACKGROUND: Twin pregnancies and fetal therapies are associated
with increased risk of preterm delivery. Limited literature exists on out-
comes for extremely preterm infants born in the context of a pregnancy
complicated with twin-twin transfusion syndrome (TTTS).
OBJECTIVES: To compare mortality of preterm newborns who
received laser therapy for TTTS to preterm controls born in the context
of a dichorionic-diamniotic (di-di) pregnancy. Secondary outcomes are:
short-term neonatal morbidities and neurodevelopmental measures at
18months of corrected gestational age (cGA).
DESIGN/METHODS: Case-control retrospective study of all twins
infant born <29 weeks of gestation between 2006 and 2015 at Sainte-
Justine Hospital. Preterm with TTTS and fetal laser therapy were com-
pared to preterm di-di twins. Survival analysis was done using Cox
proportional regression model.
RESULTS: Thirty-three preterms with TTTS (TTTS-laser group)
were compared to 101 preterms without TTTS (non-TTTS group).
Demographic data and comparisons for short-term morbidities are pre-
sented in Table1. TTTS status was not associated with increased mortal-
ity when adjusting for birth weight and antenatal steroids (Table2). No
differences were found for Bayley-3rd edition score, cerebral palsy, vision
impairment, hearing impairment and growth parameters at 18-month
cGA.
CONCLUSION: Extremely premature newborns exposed to fetal laser
therapy due to TTTS had similar survival and neurodevelopmental out-
comes compared to contemporaneous extremely preterm di-ditwins.
54
GLUTATHIONE ADDITION TO PARENTERAL NUTRITION
PREVENTS PULMONARY OXIDATIVE STRESS AND
HYPO-ALVEOLARIZATION IN NEWBORN GUINEA PIG
Jean-Claude Lavoie, Ibrahim Mohamed,1
1Department of Pediatrics, Université de Montréal
BACKGROUND: Parenteral nutrition (PN) is contaminated by per-
oxides, which induce oxidative stress (oxidized redox potential) and
hypoalveolarization in lungs of newborn animals. In human premature
newborns, PN is associated to an oxidized redox potential and to a
greater prevalence of bronchopulmonary dysplasia (BPD). Peroxides are
detoxied by glutathione that is decient in preterm infants.Hypothesis:
Improving glutathione level in premature infants prevents BPD develop-
ment caused by oxidative stress.
OBJECTIVES: Assess dose-response effect of glutathione added in PN
on alveolarization index and pulmonary redox potential of glutathione
(specic oxidative stress marker for peroxides) in newborn guinea pigs.
DESIGN/METHODS: At day 3 of life, through a jugular catheter,
guinea pigs (N=55) received PN (dextrose, amino acids, lipids, vitamins,
electrolytes) enriched in glutathione (0, 50, 120, 165, 270, 370, 650μg
GSSG/kg/d). GSSG was used rather than GSH because it has a better
stability in PN and similar efciency in vivo. Acontrol group (no manip-
ulation, fed by mouth) served as reference. After 4days, lungs were taken
for determination of GSH, GSSG, redox potential (capillary electropho-
resis) and alveolarization index (AI) (number of intercepts between a
1mm line and histological structures); higher is AI, higher is the num-
ber of alveoli. Data (mean±sem) from animals on PN were compared by
ANOVA, p<0.05.
RESULTS: There was no difference in the alveolarization index
between groups receiving doses ranging from 0 to 120μg/kg/d (25.9±0.6
intercepts/mm) and between those with doses ranging between 165 and
650μg/kg/d (30.5±0.6 intercepts/mm). However, the difference between
the lowest (0–120μg/kg/d) and the highest doses (165–650μg/kg/d) was
highly signicant (p<0.001). The control AI value was 29.4±1.2 inter-
cepts/mm. Increasing GSSG in PN has allowed a signicant (r2=0.47;
p<0.001) reduction of redox potential, from oxidized status of -205±2 in
PN without GSSG to -215±2 mV with the highest dose (650μg/kg/d);
control=-222±3 mV. GSSG in PN was also associated with a decreas-
ing GSSG values (r2=0.49; p<0.001), from 0.84±0.10 in PN without
GSSG to 0.38±0.06nmol/mg prot with the highest dose (650μg/kg/d);
control=0.35±0.07nmol/mg prot. There was no effect on GSH (mean
value of 29±1nmol/mg prot).
CONCLUSION: Addition of glutathione into PN prevents pulmonary
oxidative stress. The dose-response curve suggests a specic minimal dose
of GSSG to maintain the alveolar integrity. Lower doses were inefcient
whereas higher doses are unnecessary, as the index of alveolarization
reached a plateau with a mean value similar to that one observed in the
control group. This pre-clinical study brings basic data that will serve for
the clinical phase I-II study that we are starting soon.
55
USING DIFFERENT CHEST COMPRESSIONS AND
VENTILATION RATIOS (2:1, 3:1, 4:1) DURING NEONATAL
ASPHYXIA IN A PORCINE MODEL OF NEONATAL
RESUSCITATION – A RANDOMIZED CONTROLLED
ANIMAL TRIAL.
Matteo Pasquin, Po-Yin Cheung, Michael Wagner, Tze-Fun Lee,
Megan O’Reilly, Georg Schmolzer
BACKGROUND: The rationale for a compression to ventilation ratio
of 3:1 in neonates with primary hypoxic, hypercapnic cardiac arrest is
to emphasize the importance of ventilation; however, there are no pub-
lished studies testing this approach against alternative methods.
OBJECTIVES: To evaluate if using a 2:1 C:V ratio or a 4:1 C:V ratio
will improve ROSC compared to using a 3:1 C:V ratio.
DESIGN/METHODS: Term newborn piglets were anesthetized, intu-
bated, instrumented, and exposed to 40-min normocapnic hypoxia fol-
lowed by asphyxia. Asphyxia was achieved by clamping the endotracheal
tube until the piglet had asystole; at that time CPR was initiated. Piglets
were then randomized into 3 groups: 2:1 C:V ratio (n=8), 3:1 ratio (n=8),
4:1 C:V ratio (n=8), or a sham operated group. Atwo-step randomiza-
tion was used to reduce selection bias. After surgical instrumentation and
stabilization, a sequentially numbered, sealed brown envelope contain-
ing the allocation “sham” or “intervention” was opened (step one). The
sham-operated group had the same surgical protocol, stabilization, and
equivalent experimental periods without hypoxia and asphyxia. Only
Downloaded from https://academic.oup.com/pch/article-abstract/23/suppl_1/e21/4999507 by guest on 13 June 2019
Abstracts
e22 Paediatrics & Child Health, Vol. 23, No. S1 June/July 2018
piglets randomized to “intervention” underwent hypoxia and asphyxia.
Once the criteria for CPR were met, a second envelope containing the
allocations “2:1”,“3:1”,or “4:1”, was opened (step two). Cardiac function,
carotid blood ow, cerebral oxygenation, and respiratory parameters were
continuously recorded throughout the experiment.
RESULTS: The median (IQR) duration of asphyxia was similar between
the groups with 318 (194–576)sec, 255 (226–334)sec, 233 (169–395)
sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.68; oneway ANOVA with
Bonferroni). The median (IQR) time to ROSC was also similar between
groups 127 (82–210)sec, 96 (88–126)sec, 119 (83–256)sec for 2:1, 3:1,
4:1 C:V, respectively (p=0.67; oneway ANOVA with Bonferroni).
Overall, 8/8 in the 2:1 C:V ratio group, 7/8 in the 3:1 C:V ratio group,
and 7/8 in the 4:1 C:V ratio group survived.
CONCLUSION: There was no signicant difference in time to ROSC
for either chest compression technique during cardiopulmonary resusci-
tation in a porcine model of neonatal asphyxia.
56
GROWTH MINDSET MODERATES THE IMPACT OF
NEONATAL RESUSCITATION SKILL MAINTENANCE ON
PERFORMANCE IN A SIMULATION TRAINING VIDEO
GAME
Maria Cutumisu1,2, Matthew Brown3,2, Caroline Frayr2,
Georg Schmolzer2,4
1Department of Educational Psychology, Faculty of Education
University of Alberta, 2Centre for the Studies of Asphyxia and
Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital,
Edmonton, Alberta Health Services, Canada, 3Department of
Computing Science, University of Alberta, Edmonton, Canada,
4Department of Pediatrics, University of Alberta, Edmonton,
Canada
BACKGROUND: The Joint Commission on Accreditation of
Healthcare Organizations (2004) reporting on preventing infant death
and injury during delivery identied human errors during neonatal resus-
citation as responsible for more than two thirds of perinatal mortality and
morbidity. One of the main causes of human error in neonatal resuscita-
tion stems from a lack of practical learning experiences highlighted by
the neonatal training paradox of high-acuity, low-occurrence (HALO)
situations that arise infrequently. simulation-based medical education
(SBME) is resource and cost intensive, and not offered frequently enough
for development of competency and for supporting knowledge retention.
Therefore, other methods of training to improve knowledge retention
and decision-making are needed. We therefore developed a complemen-
tary tool to the physical SBME to improve knowledge retention during
neonatal resuscitation in the delivery room. Specically, we developed
a game-based neonatal resuscitation training simulator called RETAIN.
OBJECTIVES: We hypothesized that HCP playing the video game will
have an improved mindset and therefore an improved neonatal resusci-
tation performance.
DESIGN/METHODS: HCPs trained in NRP, including registered
nurses, respiratory therapists, neonatal nurse practitioners, neonatal con-
sultants, and neonatal fellows were recruited from the Royal Alexandra
Hospital, a tertiary NICU. Each participant was asked to complete a
pre-game questionnaire to obtain demographics (e.g. last Neonatal
Resuscitation Course (NRP)-course, years of experience) and assess their
neonatal resuscitation knowledge by completing a Resuscitation sce-
nario. Afterwards each participant played the RETAIN simulator, which
started with a tutorial before the actual three rounds and there was a
countdown for each of the rounds to simulate the stress of a real-world
scenario. After completion of the game each participant also completed
a Post-game questionnaire to assess the player’s mindset (e.g. How much
do you agree with the following statements? You can always change how
good you are at your job or You can get better at your job with practice)
using a Likert scale (1=Strongly Disagree to 5=Strongly agree).
RESULTS: We recruited 50 (45 females, 4 males, and 1 not reported)
HCP who were all NRP-trained and had completed a NRP refresher
course within the last 24months. Participants needed a mean (SD) 8.47
(8.66) minutes to complete the game. On average, participants reported
high levels of growth mindset (with scores ranging from seven to ten),
took their latest NRP course more than eight months prior to the current
study, and scored 93% in the game (32 was a perfect score). Interestingly,
participants who took the NRP course more recently made more mis-
takes in the simulation game. There was a signicant interaction of Last
NRP Course and Growth Mindset in predicting Number of Tries (b =.09,
S.E.=.04, beta=.32, t=2.25, p=.03), as well as a main effect for Last NRP
Course (b= -.08, S.E.=.04, beta=-.30, t=-2.04, p<.05). Thus, participants
who took an NRP course recently (i.e., within eight months), before the
current study, completed the game in signicantly fewer tries when they
endorsed more rather than less of a growth mindset. However, partici-
pants who endorsed more of a growth mindset performed similarly on the
game regardless of when they took the NRP course.
CONCLUSION: The study examined the relation between HCP task
performance and time elapsed since their latest NRP course and found
that growth mindset moderates this relation. Specically, HCP who took
the NRP course within the past eight months, those who endorsed a
higher growth mindset made fewer mistakes in a simulation game. Some
implications include growth mindset interventions and increased oppor-
tunities to practice skills in simulation sessions to help HCP achieve bet-
ter performance after taking a refresher NRP course.
57
CEREBRAL OXYGENATION AND PERIPHERAL OXIMETRY
IN EXTREMELY PRETERM INFANTS WITH PULMONARY
AND/OR CEREBRAL INTRAVENTRICULAR HEMORRHAGE
IN THE FIRST 72 HOURS OF LIFE
Thierry Beausoleil1,2, Marie Janaillac3, Keith Barrington3,2,
Marie-Josée Raboisson4, Oliver Karam5,6, Anie Lapointe3,
Mathieu Dehaes2,7
1Institute of Biomedical Engineering, University of Montreal,
Montreal, Canada, 2Research Centre, CHU Sainte-Justine,
Montreal, Canada, 3Department of Pediatrics, Division of
Neonatology, CHU Sainte-Justine and University of Montreal,
Montreal, Canada, 4Department of Cardiology, CHU Sainte-
Justine and University of Montreal, Montreal, Canada, 5Pediatric
Intensive Care Unit, Geneva University Hospital, Geneva,
Switzerland, 6Division of Pediatric Critical Care Medicine,
Children’s Hospital of Richmond at VCU, Richmond, VA, USA,
7Department of Radiology, Radio-oncology and Nuclear Medicine,
University of Montreal, Montreal, Canada
BACKGROUND: Extremely premature infants born <28 weeks of ges-
tation are at higher risk of pulmonary (PH) and cerebral intraventricular
(IVH) hemorrhage due to immature cardiovascular and transitioning
physiology. Non-invasive monitoring has the potential to detect early
abnormal circulation.
OBJECTIVES: To explore time-frequency relationships between cere-
bral oxygenation and peripheral oximetry.
DESIGN/METHODS: Near infrared spectroscopy cerebral regional
haemoglobin oxygen saturation (CrSO2), preductal peripheral perfu-
sion index (PI), heart rate (HR), capillary oxygen saturation (SpO2),
and blood pressure (BP) were monitored in the rst 72h of life. Patients
were grouped in infants with PH and/or IVH (n=8) and controls (n=10).
Signals were decomposed in wavelets allowing the analysis of localized
variations of power. This approach allowed to quantify the common
power and determine the duration of signicant cross-correlation, phase
and coherence between each pair of signals. Groups were compared with
Wilcoxon tests.
RESULTS: Figure 1 shows an example of CrSO2 and PI, and their
cross-correlation, phase (semblance) and coherence in a control (left
column) and a PH-IVH patient (right column). Durations of signicant
cross-correlation between CrSO2 and HR (p<0.01), and CrSO2 and SpO2
(p=0.02) were signicantly lower in PH-IVH infants compared to con-
trols. The duration of signicant anti-phase between CrSO2 and SpO2
(p=0.01) and the duration of signicant coherence between PI and BP
(p=0.03) were also signicantly lower in PH-IVH infants compared to
Downloaded from https://academic.oup.com/pch/article-abstract/23/suppl_1/e21/4999507 by guest on 13 June 2019