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www.AJOG.org Doppler Assessment, Fetus, Neonatology, Prematurity Poster Session III

with SFLP, the survival was significantly lower for one or both twins(90% vs 33%, p�0.001) and survival of both twins (70% vs 33%,p�0.07). Of the remaining 4 pregnancies, 1 had amnioreduction; 2had radiofrequency ablation (RFA); and 1 was observed without treat-ment. The survival in the non-SFLP treated of one or both twins was3/4 (75%) and survival of both in 2/4 (50%).CONCLUSIONS: “Double barrel” PCI’s are a marker of high risk TTTS

ith complex vascular anatomy in which SFLP may be contraindi-ated. To improve fetal outcomes when “double barrel” PCIs are rec-gnized, we suggest initial diagnostic fetoscopy with amnioreductionnd/or RFA if no vascular equator can be defined. SFLP should beeserved for favorable vascular anatomy.

444 Perinatal outcomes in low risk and high risk congenitalulmonary airway malformations (CPAMs) as

ndicated by CPAM volume ratio (CVR)Zaria Murrell1, Foong-Yen Lim1, Sundeep Keswani1,

ounira Habli1, David Lewis2, Ronald Jaekle2,illiam Polzin1, Timothy Crombleholme1

1Cincinnati Children’s Hospital Medical Center, Cincinnati,H, 2University of Cincinnati, Cincinnati, OH

OBJECTIVE: CPAMs are bronchopulmonary malformations fre-uently identified on routine prenatal ultrasound. Complications re-

ated to rapid growth and mass effect in the chest include polyhydram-ios, pulmonary hypoplasia, and hydrops. Hydrops in CPAM issually fatal without intervention. Prenatal treatment options range

rom steroid administration, open fetal surgery, thoracoamniotichunting, or third trimester ex-utero intrapartum treatment by EXIT-o-resection. We reviewed a single center experience with CPAMs andhe impact on perinatal outcome.

STUDY DESIGN: A retrospective review from a single tertiary center ofall fetal CPAMs evaluated and treated from 2004 to 2010. Perinataloutcomes of all treatment paradigms for these cases were compared.RESULTS: One hundred five fetuses with CPAM were identified. 64/

05 (61%) were low risk fetuses (LRF as defined by CPAM volumeatio (CVR) �1.6 and no hydrops, mean CVR 0.71� 0.46) and 41/10539%) were high risk fetuses (HRF, as defined by CVR �1.6 and/orydrops, mean CVR 2.48� 1.20). Excluding patients that are stillregnant or had elective terminations: in the HRF group 35/41 (85%)eceived steroids with survival of 21/32 (65.6%); 26/41 (63%) wereydropic at presentation with survival of 13/25 (52%); 10/41 (24.4%)ad thoracoamniotic shunts with survival of 8/9 (88.9%), 4/41 (9.8%)nderwent EXIT to resection with survival of 4/4 (100%); and 4/419.8%) underwent open fetal surgery with a survival 0/4 (0%). In 15atients (12 LRF, 3 HRF) survival data was not available (either stillregnant or lost to follow-up). Excluding these patients, the overallurvival in the LRF was 51/52 (98%) and HRF was 26/38 (68%).

CONCLUSIONS: In fetuses diagnosed with CPAM, neonatal survival isxcellent in low risk fetuses (98%). Even in high risk fetuses, survivalf 68%, or 52% if hydrops is already present, can be acheived withggressive treatment with a combination of steroids, thoracoamniotichunts, open fetal surgery, or EXIT-to-resection as appropriate.

445 Serum glial fibrillary acidic protein levelsre significantly elevated in preterm neonatesith neurologic morbidity and mortality

Amanda Stewart1, Christopher Ennen1, Frances Northington1,illiam Savage1, Allen Everett1, Ernest Graham1

1Johns Hopkins School of Medicine, Baltimore, MDOBJECTIVE: Preterm infants are at increased risk for neurologic com-

lications and may benefit from early intervention. However, intra-artum fetal monitoring and neonatal brain imaging cannot rapidly

dentify them. Glial fibrillary acidic protein(GFAP) is a cytoskeletalntermediate filament protein found in the brain that is specific to

ifferentiated astrocytes and is only released after cell death. Our ob- i

Supplem

jective is to determine if serum GFAP levels change during the firstweek of life in preterm neonates with neurologic injury.STUDY DESIGN: This is a case-control study of neonates born at 23-34

eeks gestation admitted to a single university neonatal intensive carenit (NICU) from 5/09-5/10. Neonates with major congenital orhromosomal abnormalities were excluded. Cord blood was collectednd discard serum was obtained upon NICU admission (day 0) andays 1-4 of life. Cases with neurologic injury were gestational ageatched to the subsequent neonate admitted without neurologic in-

ury. Neurologic injury was determined by the presence of intraven-ricular hemorrhage (IVH), periventricular leukomalacia (PVL), neo-atal seizures, or hypoxic ischemic encephalopathy (HIE).

RESULTS: During the study period, there were 20 neonates with neu-ologic injury. Cases and controls did not differ in birth weight1065�498, 993�377 grams, p�0.19) or incidence of cesarean deliv-ry (75%, 65%, p�0.75). Compared to controls, cases had signifi-antly elevated GFAP levels on admission to the NICU and after 2 anddays of life (Figure). Serum GFAP levels were significantly elevated

n neonates with: IVH (n�14) after day 3-4 of life, PVL (n�9) andIE (n�4) after days 2-4 of life, seizures (n�7) after days 0, and 2-4 of

ife, and death (n�3) at days 0-4 of life.CONCLUSIONS: Serum GFAP during the first week of life is significantlylevated in preterm neonates with neurologic injury. The most se-erely affected neonates have higher levels at earlier days of life. SerumFAP may be a useful biomarker to identify neurologically injuredreterm neonates that would benefit from early intervention.

Figure 1

446 Neonatal intraventricular hemorrhage is associatedith early onset PROM and near-term IUGR

Angie Jelin1, Yvonne W. Cheng1, Aaron Caughey2

1University of California, San Francisco, San Francisco, CA,2Oregon Health & Science University, Portland, OROBJECTIVE: To evaluate the risk factors associated with neonatal intra-entricular hemorrhage.

STUDY DESIGN: A retrospective cohort of 246,337 preterm infants de-livered in California was stratified by gestational age and assessed forthe presence or absence of neonatal intraventricular hemorrhage(IVH). 5,812, 15,563, 30,770, and 194,192 were delivered between24-27, 28-31, 32-33 and 34-37 weeks respectively. There were a total of820 cases of intraventricular hemorrhage. Cases of IVH were thenanalyzed by etiology of delivery (preterm premature rupture of mem-branes (PROM), and preeclampsia) and coexisting outcomes intra-uterine growth retardation (IUGR) and chorioamnionitis (Chorio)were compared to infants delivered due to spontaneous preterm la-bor. Multivariate logistic regression was used to analyze the associa-tion between IVH and preeclampsia, PPROM, IUGR, and chorioam-nionitis, controlling for potential confounders.RESULTS: Infants delivered due to early onset PPROM or delivered

ear term with IUGR were more likely to suffer from IVH (Table 1).CONCLUSIONS: Neonatal outcomes are known to differ by etiology of

elivery and coexisting conditions. In the case of our study, IVH wasssociated with early delivery due to PROM and near-term delivery of

nfants with IUGR. Interestingly, there was not a significant increase

ent to JANUARY 2011 American Journal of Obstetrics & Gynecology S179