Abstract UENPS.111Clinical significance of scpB gene based PCR test improving Streptococcusagalactiae carriage screening in pregnant women

Bartlomiej Wolski⁎,a, Rafal Adamczaka, Anna Studzinskab,Jolanta Zegarskaa, Wieslaw SzymanskiaaNicolaus Copernicus University in Torun, CM, Bydgoszcz, PolandbNicolaus Copernicus University, Torun, Poland

Background and aim

Streptococcus agalactiae is still the most frequent causative agent ofneonatal early-onset disease. Rapid identification of GBS-colonized womenon admission for delivery allows for an effective intrapartum antimicrobialprophylaxis.

We calculated sensitivity, specificity and predictive values of PCR assaytargeted an amplification GBS-specific region of deletion in scpB gene andcompared to culture method of GBS screening.

Materials and methods

A total number of 150 pregnant women were tested using rectovaginalswab samples for detection of GBS carriers by PCR andmicrobiologic culture—the “gold standard”. The PCR assay was targeted to amplification GBS-specificregion of deletion in scpB gene for C5a peptidase andwas realized according toDmitriev's and all protocol in our own modification. Results were obtainedafter 60 min.

Results

The sensitivity of the PCR assay was 97.7% and specificity was 93.5%.Positive predictive value for PCR was 85.7% and negative predictive valuewas 99%. GBS carriage estimated by PCR was 32.7% but in classicalmicrobiologic method was 28.7%. In 7 cases (4.7%) PCR test was positivebut culture of rectovaginal swab was negative. We found one woman withPCR negative and simultaneous positive verification in microbiologic test(0.7%).

Conclusions

The high positive predictive value and rapidity of PCR test to determineGBS status in the urgent intrapartum setting is the most useful benefitallowing for more accurate and effective intrapartum prophylaxis.

doi:10.1016/j.earlhumdev.2008.09.127

Abstract UENPS.11225 years of a neonatal intensive care unit — What has changed inneonatal surgery?

Ana Raquel Silva⁎, Carlos Mariz, Joaquim Monteiro, Gustavo Rocha,Hercilia Guimaraes, Jorge Correia-PintoHospital São João, Porto, Portugal

Background and aim

Through the last decades the surgical treatment of newborns hasexperienced an important progress. The improvements in neonatal surgeryare due, in large extension, to the multidisciplinarity of care in NeonatalIntensive Care Units, which involves Paediatric Surgeons, Neonatologists,Obstetricians, Paediatric Cardiologists, Anaesthesiologists, Radiologists,Nurses, Pharmaceuticals, among others. Advances in prenatal diagnosismade it possible for newborns in need of early surgical care, to be born inspecialized centres, allowing even the introduction of techniques performedby paediatric surgeons during delivery (EXIT procedure — ex uterointrapartum treatment). Also the progresses in ventilatory support andnutrition, especially with the wide use of parenteral nutrition, contributed toa significant increase in the survival of these newborns. Finally, the

implementation of surgical procedures increasingly less invasive has enabledthe reduction of surgical aggression and, with it, the morbidity.

Materials and methods

Comparison, in a perspective of historical evolution, of the number ofnewborns treated in the Neonatal Intensive Care Unit (NICU) of Hospital SãoJoão — Porto, with some standard surgical diseases, and their mortality rate,between the periods 1987–1993 and 2002–2008.

Conclusions

Unlike the number of newborns with gastrointestinal congenital malforma-tions,which remainedstable inbothperiods, therewas an increase in thenumberof newborns with gastroschisis, HDC and mainly NEC. The comparison betweenthe two periods clearly shows a decrease in the mortality rate in all pathologies.However, in infantswithNEC and CDH, this decline is less clear, which justifies anincreased effort in clinical approach, as well as in research studies.

Pathology Mortality

1987–1993 2002–2008n % N %

Gastroschisis 11/15 73 2/22 9Necrotizing enterocolitis (NEC) 4/9 44 7/29 24.1Congenital Diaphragmatic Hernia (CDH) 15/27 55 10/34 29.4Intestinal Atresia 18/33 55 3/33 9.1Esophageal Atresia 14/36 39 0/24 0Anorectal Malformation 4/21 19 1/22 4.5Meconial Ileus 3/7 43 1/9 11

doi:10.1016/j.earlhumdev.2008.09.128

Abstract UENPS.113Antinociceptive effect of exclusive breast feeding in healthy term infantsduring DPT vaccination

Amit Upadhyay⁎, Virendra Bahadur Singh, Shyam Kumar MishraLLRM Medical College, Meerut, India

Background and aim

Hypothesis

Exclusively breast-fed infants are more stable/developed neurologicallyas compared to partially breast-fed infants, and so they should have lowerpain scores at the time of vaccination.

Objective

To compare the antinociceptive effect of exclusive breast feeding andpartial breast-feeding in healthy term infants less than three months ofpostnatal ages, during DPT vaccination.

Materials and methods

Place of study

The present studywas carried out in the immunization clinic, DepartmentofPediatrics, LLRMMedical College, Meerut during September and October 2007.

Design

Prospective cohort, double blind study.

Sample size

In this study 35 cases in each group were required to attain a power of90% with a of 0.05. Primary outcome variable was the duration of cry aftervaccination.

AbstractsS50

Blinding

Blinding was done by video recording of entire events by using digitalvideo camera. Later, an observer who was blinded to the breast feeding statusof the baby, noted the crying duration and facial coding score at 1 and 3 minafter the DPT vaccination.

Statistical method

Analysis of continuous data with normal distribution was analyzed byStudent's t test. Categorical data was analyzed by “Chi-Square” test.

Results

Duration of cry was significantly lower in EBF babies (60.3±44.1 s) ascompared to PBF babies (102±55.4 s) (p<0.001). The duration of cry wasreduced by mean difference of 41.81 (95% confidence interval for mean:43.41 to 77.16) in the EBF group as compare to the PBF group. Modified FacialCoding Score (MFCS) was significantly lower in EBF infants at 1 min and3 min as compared to PBF (p<0.05). MFCS was same in both groupsimmediately after the needle insertion.

Conclusions

As compared to top milk fed infants, exclusively breast fed term infantsperceive lesser pain during vaccination.

doi:10.1016/j.earlhumdev.2008.09.129

Abstract UENPS.114Perinatal choline treatment reverse alcohol effect on neuronal migration

Yoav Littner⁎, Hitoshi KomuroThe Cleveland Clinic Foundation, Cleveland, United States

Background and aim

1% of all live births in the U.S. have some neurodevelopmental deficitsassociated with in utero alcohol exposure. One of the suggested mechanismsfor alcohol toxicity is impaired neuronal migration. When applied in vitro,alcohol, slows the migration of cerebellar granule cells. Since supplementa-tion with perinatal choline improves the neurodevelopmental outcome ofanimals exposed to alcohol, we examined cholines effects on migration ofalcohol exposed cerebellar granule cells. We aimed to test the hypothesisthat prenatal choline treatment can diminish ethanol toxicity on neuronalmigration.

Materials and methods

Microexplant Culture made from postnatal days 6–7 mouse cerebella wasplaced on dishes coated with poly-l-lysine with culture medium. After 2 h inan incubator, culture medium and culture medium with 40 mM of cholinechloride was added to each control and treatment dish respectively. Twentyhours after plating, dishes were transferred into a chamber of a micro-incubator. Using confocal microscope, the migration of granule cells wasrecorded. The cells were illuminated with a 488-nm wavelength light froman argon laser through an inverted microscope equipped with a 20×objective. Images of the cells were collected every 60 s for 30 min. Followingthe application of 100 mM of ethanol the images of the same cells werecollected in a similar way. The distance traveled by a migrating granule cellwas defined as the absolute value of the change in its position during theentire time-lapse session. Since isolated granule cells exhibit systematicfluctuations in their migration rate every 2–3 h, we averaged the dataobtained from at least 100 isolated granule cells. Statistical significancebetween experimental groups was tested by T-test.

Results

Both control and treatment group cells showed similar migration ratebefore alcohol was added to the culture (48.9 vs 53.8 m/h, P=0.2). In the

control cells, the addition of ethanol slowed the migration of granule cellsfrom 48.9 to 36.1 m/h (P=0.015). Following alcohol application, cells inthe treatment group also demonstrated a reduction in the rate of migration(53.8 vs 48.5 m/h, P=0.14), but to a lesser extent when compared withcontrol cells.

Conclusions

When exposed to alcohol, granule cells demonstrate a reduction inmigration. Choline supplementation has protective effect and reverse alcoholaction on granule cells migration.

doi:10.1016/j.earlhumdev.2008.09.130

Abstract UENPS.115A study of the efficacy for the new combined therapy with edaravone(free radical scavenger) and brain hypothermia in neonatal hypoxicischemic encephalopathy

Masaki Shimizu⁎

Saitama Children's Medical Center, Saitama, Japan

Background and aim

Brain hypothermia therapy (BHT) has been considered insufficient toprevent basal ganglia injury in severe HIE. In severe HIE, free radicals (FRs)has taken part in insult of neuronal cell. In this study, we hypothesized thatthe new combined therapy of Edaravone (free radical scavenger) and BHTsuppress the FRs acting and prevent the brain injury.

Aim is to examine the efficacy of the Edaravone treatment combined withBHT.

Materials and methods

Medical records of 20 HIE infants between 2001 and 2003 were reviewedand divided into two groups. Edaravone group (E group: 7 infants) treatedwith Edaravone and BHT. BHT group (13 infants) treated only BHT. All 20infants treated with selective head cooling within 6 h of birth with 34 °C. InE group, Edaravone was administered 0.5 mg/kg intravenously twice a dayfor 10 days. The therapeutic efficacy was evaluated with the head MRIfindings and neurological examination at 3 years follow-up. We obtained theconsent about BHT and the use of Edaravone from both group's parents. Thisstudy was approved by the institutional review board and the research ethicscommittee.

Results

All of 20 infants were followed until 3 years and 18 infants (E group 7infants; BHT group 11 infants) examined head MRI. The mean gestationalages and birth weights comparable between the E group and in the BHTgroup (39.3 weeks vs. 38.8 weeks; 2763.1 g vs. 2793.1 g). In E group,developmental evaluation revealed 5 infants had normal development,two infants had mild and severe disability. In BHT group, only two infantshad normal development, and 9 infants had severe disability and 2 infantswere dead. The MRI findings revealed the injury of the basal ganglia in oneinfant, and 6 infants showed normal findings in E group. In BHT group, 3infants had normal MRI findings and 8 infants revealed severe injury ofbrain.

Conclusions

FRs were released in large amounts between ischemia and reperfusion insevere HIE. In this study, the new combined therapy with Edaravone and BHTshowed stronger efficacy of prevention from brain injury than only BHT inHIE treatment. We are now conducting a randomized comparative study todetermine whether the combination therapy of Edaravone and BHT iseffective.

doi:10.1016/j.earlhumdev.2008.09.131

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