Archives of Perinatal Medicine 6(1), 50-62, 2000 Abstracts 

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Zakopane, 20-23 May 2000

A b s t r a c t s

Chorioamnionitis and the prognosis for VLBW infants

I. Macedo, J. Lima, T. Tomé, C. Soares, G. Gaspar, A. M. Valido

Matemidade Dr. Alfredo da Costa, Lisbon, Portugal

Objective: Checking the effects of chorioamnionitis on neonatal morbidity and mortality in very low birth weight (VLBW) preterm infants.

Limits of fetal viability

I. Macedo, J. Lima, T. Tomé, C. Soares, T. Costa, A. M. Valido

Matemidade Dr. Alfredo da Costa, Lisbon, Portugal

Objective: Mortality and neurodevelopmental morbidity among infants weighting less than 1001 g at birth and gestational age (GA) < 31 weeks, were analyzed to discuss the limit of viability in view of an aggressive approach.

Methods: A retrospective analysis of survival and neurodevelopmental outcome of 191 extremely low birth weight (ELBE) infants admitted to our NICU between 1994-98, was made. All data were processed and frequency analysis was accomplished by the SASS for Windows, version 9.0. A p level of 0.05 was taken to establish statistical significance.

Conclusion: These results suggest that our global outcome improved after 25 weeks GA, although we have verified an individual variation that can justify an individualized, aggressive approach.

Cord compression syndrome – clinical fact or fiction?

Mariusz Z. Skotnicki, Jan Urban

Department of Perinatology and Obstetrics, Medical Academy in Białystok

Many years of clinical observations of pregnancies complicated by oligohydramnios aroused our doubts regarding significance of the cord compression syndrome. We decided to use Doppler technique to check whether its notion really has influence on course of pregnancy. As determinant of oligohydramnios we took value of index of amnion fluid (AFI), according to Phellan, below 6. 5. The study was performed on 53 pregnant women: 33 with oligohydramnios and 20 with normohydramnios. The mean gestational age was: 40. 2 weeks (SD ± 0. 84, Me 40) and 39. 8(SD ± 2. 58, Me 41) and masses of newborn children were: 3750 g (SD ± 402 g) and 3190 g (SD ± 637 g). Systolic-to-diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) were estimated in the following vessels: 1) fetal arteries: middle cerebral artery (MCA), renal artery (RA) and descending aorta (AD), 2) maternal arteries: uterine artery (UTA) and arcuate artery (AA), 3) umbilical artery (UA) and 4) specific flow (SF) and transverse section field (TSF) of umbilical vein (UV).

Results are presented in table.

The influence of epidural analgesia

on the oxidative stress during labor

H. Billert, Z. Kruszyński, M. Kurpisz,

D. Szkutnik, K. Frąckowiak, D. Mielcarek

Department of Anesthesia in Obstetrics and Gynecology

University School of Medical Sciences, Poznań, Poland

Objective: Epidural analgesia is a safe and effective method of pain relief during labor, however some aspects of its pathophysiology, I. e. effects on labor, still remain controversial. It has been suggested that epidural analgesia may reduce oxidative stress during parturition. The aim of this study was to assess selective parameters of oxidative stress in parturients receiving epidural analgesia.

Results: There was a gradual decrease in both TBARS and xantine oxidase serum levels during labor under epidural analgesia (TBARS: before analgesia: 228.38 ± 207.10, after the first analgetic dose: 214.13 ± 124.25, at delivery: 135.00 ± 93.33 nM), however the observed differences failed to reach statistical significance.

Conclusion: We may conclude that epidural analgesia does not significantly influence the oxidative stress parameters in peripheral blood during labor.

under epidural analgesia

H. Billert, Z. Kruszyński, A. Warenik,

M. Kurpisz, B. Męczykalski, K. Rychlik

Department of Anesthesia in Obstetrics and Gynecology

University School of Medical Sciences, Poznań, Poland

Polymorphic genotypes of the angiotensin-converting enzyme

in severe pregnancy-induced hypertension

University of Medical Sciences, Poznań, Poland

University of Medical Sciences, Poznań, Poland

Introduction: In recent years the genetic background of pregnancy-induced hypertension (PIH) were intensively investigated. In the renin-angiotensin system (RAS) insertion/deletion (I/D) polymorphism of the gene coding for angiotensin-converting enzyme (ACE) was shown. The goal of the present study was to determine the role of the ACE alleles in the group of women with different PIH severity.

Results: ACE genotype frequencies are presented in table 1. We have detected statistical overrepresentation of DD genotype in the severe PIH group (p = 0.00005, O.R. = 7.3, 95%, C.L. 2.5-21.9, if compared to gestational hypertension, and p = 0.0024, O.R. = 3.97, 95% C.L. 1.46-11.18, if compared to the controls). Genotype frequencies were in agreement with Hardy-Weinberg equilibrium.

Table 1. ACE genotypes in the investigated groups

Conclusions: Significant overrepresentation of D alelle of ACE gene observed in the severe PIH group indicates the possible importance of this allele in the pathogenesis of PIH.

Birth asphyxia – diagnosis and handling

Ola Didrik Saugstad

Department of Pediatric Research, The National Hospital, Oslo, Norway

Birth asphyxia represents worldwide a huge problem and approximately 5% of the newly born need some kind of resuscitation at birth. The incidence of birth asphyxia is difficult to estimate but the WHO has calculated that approximately 1 million newborn infants die and a similar number develop sequelae following birth asphyxia. Hypoxic ischemic encephalopathy is registered in 2-b per 1000 births in the western world. The last years it has been clear that energy failure in the brain following birth asphyxia is biphasic. After a primary energy failure with a normalisation of the energy status a secondary energy failure develops after some hours often leading to long term damage. There is therefore a window for therapy between the primary and secondary energy failure. For this reason it is extemely important to develop optimal resuscitation procedures. Such procedures of the newborn are undergoing extensive changes. Up to recently the use of 100% oxygen was recommended by most guidelines. However, recent animal studies from our laboratory have shown that room air seems to be as efficient as 100% oxygen for newborn resuscitation, even in the presence of severe meconium aspiration. On this background the World Health Organization has changed their guidelines far basic newborn resuscitation stating that “additional oxygen is not necessary for basic resuscitation”(WHO 1997). Also The American Heart Association and American Academy of Pediatrics recently have changed their resuscitation guidelines. Regarding the use of 100% oxygen for newborn resuscitation they now state: “If assisted ventilation is required, 100% oxygen should be delivered by positive pressure ventilation ... If supplemental oxygen is not a available, resuscitation of the newly born infant should be initiated with positive pressure ventilation and room air.” These two organizations have as a goal to give priority to research concerning room air resuscitation the next years to come. Recent animal data indicate that Cerebral NO and oxygen radical production in neutrophils isolated from the cerebral circulation are elevated during 100% oxygen compared with room air resuscitation. A recent clinical study from Spain (Vento et al. 1999) found that newborn infants resuscitated with 100% oxygen when compared with room air resuscitated had significantly elevation of markers of oxidative stress as long as 4 weeks after birth. These results are highly surprising since it is known that median resuscitation time is 2 minutes only. Even a brief exposure to oxygen after birth therefore seems to trigger long term oxidative stress. Which consequences this may have we do not know. But there is an accumulating body of data showing that preterm infants subsequently developing chronic lung disease have signs of increased oxidative stress already a few hours after birth (Ogihara et al. 1999). Perhaps resuscitation of preterm infants with 100% oxygen triggers oxidative stress which may have long term implications for several organs? It is clear that oxygen radicals and oxidative stress play a role as second messengers and in signal transduction. Increased oxidative stress precipitated by resuscitation therefore might have long term consequences on growth and development. There is therefore a need for an extensive research program identifying and assessing each step of the resuscitation procedure.

Brain Power Doppler and velocimetry

in healthy and hypoxic neonates

Objectives: To evaluate whether neonatal cerebral blood flow differed in healthy and hypoxic neonates.

Material and methods: Power Doppler (PD) signals and velocimetry in middle cerebral (MCA) and anterior cerebral (ACA) arteries were recorded in 40 appropriate for gestational age healthy neonates and in 30 appropriate for gestational age hypoxic neonates. Recordings were performed after delivery and then after 12, 24, 48, 72 hours. PD signals were recorded in three different transverse and three different longitudinal plains of the brain. Fixed preinstalled PD system installations for neonatal brain were used during examinations. The images were recorded on S-VHS tape and transmitted to computer for analysis of pixel density, corresponding to cerebral blood flow.

Results: Neonatal cerebral PD signals in healthy neonates increased initially after birth, then decreased with time during the study. PD signals in hypoxic neonates were significantly higher and blood velocimetry in MCA and ACA showed lower cerebral vascular resistance than in the healthy neonates.

Conclusion: The results might suggest an increased blood flow in neonatal brain as a response to intra-uterine hypoxia.

Metabolic fuels in diabetic pregnancy

M. R. G. Carrapato, F. Marcelino

Maria Pia Children’s Hospital, Porto, Portugal

The 1989 St Vincent’s Declaration stated, as a 5-year goal, “...that the outcome of the diabetic pregnancy should approach that of non-diabetic pregnancies” and indeed, over the last 20 years, significant reductions in spontaneous abortions, stillbirths, congenital malformations and perinatal mortality have been achieved. However, recent reports have shown that even in western countries, spontaneous abortions may be as high as 17%, stillbirths rate to be 5-times greater, congenital malformations to range from 4 to10 times the usual rate, perinatal mortality to be 5-fold, neonatal mortality 15 times greater and that infant mortality might be trebled as the result of diabetic pregnancies.

It can be argued that these bad results are the consequences of poor medical and social care, from prior to conception to perinatal services and they most probably are. Nevertheless, even in the best series, corrected rates for diabetes-related malformations are considerably higher than the rest of the population and macrosomia poses a major problem, ranging from 20% in gestational diabetes to 35% or more in pre-existing diabetes. Again, it can be argued that good metabolic control has not been achieved or that good is not necessarily “optimal”. Alternatively, it can be put forward that there might be an abnormal genetic background contribution (and the evidence is pretty scanty) or that there might be other metabolic fuels besides glucose accounting for the aetiopathogenesis of both the congenital malformations and the macrosomia. Over the last 10 years there has been increasing evidence from animal and human studies to support the theory that in addition to sugars (glucose, galactose and mannose) other metabolic fuels such as ketones and deranged lipid peroxidation lead to “unbalanced” prostaglandin synthesis. Dietary supplementation of deficient substracts (arachidonic acid and myo-inositol), free oxygen radical scavenging enzymes and anti-oxidants have been shown, both in vivo and in vitro, to reduce the rate of malformation in the offspring of diabetic animals. Whether such strategies might be applicable to clinical practice remains a promising but open question.

Similarly, the same general principles of multfactorial pathomechanisms have been postulated for macrosomia including and ranging from ketone bodies, to free fatty acids, “selected” aminoacids with a conspicuous role for IGF1 and IGF2 at local level. Maternal insulin antibodies and insulin counter-regulatory hormones may, in addition, further contribute to the resulting macrosomia.

However, although some or all of these substracts may, per se or in synergy, play a significant role in the aetiopathogenesis of the congenital malformations and/or the macrosomia of the infant of the diabetic mother and whether dietary supplementation (or any other therapeutic approach) might hold a promise for the future, for the moment the priority should focus on preconceptional planning and strict glycaemic control throughout pregnancy.

Analysis of the risk factors of bronchopulmonary dysplasia

in neonates born in the Department of Neonatology

University of Medical Sciences in Poznań 1997-1999

Ewa Burchardt-Kroll, Marta Szymankiewicz, Janusz Gadzinowski

Chair and Department of Neonatology, University of Medical Sciences, Poznań, Poland

Bronchopulmonary dysplasia (BPD) becomes one of the most important problems in neonatal intensive care units. With the improvement of neonatal care and increase of survival rate in low-birth-weight newborns the total number of babies with BPD raises. Treatment of this disease is still very difficult and often unsuccessful. The aim of the study was the retrospective analysis of the risk factors of BPD as well as gestational age, birth weight, Apgar score, sex, antenatal steroids, mode of ventilation, duration of ventilation, severity of RDS, surfactant therapy and other.

Our material comprised of 121 newborns with BPD treated in the Department of Neonatology in Poznań in the period of years 1997-1999. Results of our study confirm the previous data that prematurity, low birth weight, male gender, loss of antenatal steroids and complications of mechanical ventilation are closely correlated with the high incidence of BPD. We state that the increasing rate of BPD during last three years is a result of higher rate of survivors in the group of low-birth-weight and very-low-birth-weight infants. We speculate that analysis of risk factors allows to change or modify the way of treatment and care to decrease the rate of BPD.

Effect of short-term morphine infusion

on premature infant pain profile (PIPP) and hemodynamics

There is an increasing awareness of the deleterious effects of pain in the term and preterm newborns. Use of sedations and analgesicsa are being advocated. However, there is a need to study the effectiveness of sedation and analgesia on PIPP and Hemodynamics in premature infants on assisted ventilation. We studied the effect of morphine infusion on premature neonatal responses to pain, blood pressure, heart rate and other clinical outcomes. Twenty two infants of gestational age of 26-35 wks, birth weight 810-2570 g, who were receiving mechanical ventilation were randomized into either, a) morphine treatment or b) control: no treatment group. All infants were assessed for pain profile using: PIPP and Comfort Scale prior to initiation of morphine infusion. Morphine was given first as a bolus 100 g/kg over 30 minutes than mainted at infusion rate of 20 g/kg/hr. It was continued for at least one day or for up to 5 days if necessary. PIMP score and Comfort Scale were assessed prior to the treatment, then at 6,12,24 hrs of age, heart rate, BP, and ventilatory parameters more frequently. The data are given below.

These observations indicate that short-term continuous morphine is safe and is effective in reducing PIPP score and is associated with lower morbidities. Further studies are indicated to assess the extent of the effectiveness in reducing morbidities such IVH.

Changes of birth structure in the Regional Hospital

in Brzeziny during the period 1987-1996

During the period 1987-1996, a continuous decrease of the number of births was observed. In 1996 the total number of births in Poland was 431211, which corresponded to a 30% decrease in comparison with the data of 1987. During the analysed period of time, from 1987 to 1996, 7096 babies were born in the Regional Hospital in Brzeziny. This comprised 2729 babies born to mothers living in urban areas, and 4364 born to mothers living in the country. In the period 1995-1996, the number of births fell by 56.7% in comparison with the period 1987-1988. For the group of mothers living in the towns, the decrease was 45.5% and was lower than the average, whereas for mothers living in the country it was higher and amounted to 62.2%. The significant reduction of number of births which occurred during the period 1987-1996 in rural communities is responsible for the dramatic fall of birth rate during that period. Another important tendency observed in that period is a reduction of difference between birth rates in urban and rural communities.

Comparison of maternal and neonatal morbidity

in forceps assisted, vacuum extraction

and spontaneous vaginal deliveries

B. Tekin, T. Senses, N. Tekin, H. Hassa

Osmangazi University Medical Faculty, Eskisehir, Turkey

Objective: From the starting point of observation of more frequent hyperbilirubinemia in neonates delivered by vacuum extraction we decided to compare neonatal and maternal morbidity in forceps assisted, vacuum extraction and spontaneous vaginal deliveries.

Materials and methods: Deliveries between January 1996 and April 2000 were evaluated retrospectively. Eleven forceps, eleven vacuum and twenty spontaneous vaginal deliveries with similar duration of labor and birthweights, all from similarly aged nulliparous women at term pregnancies are included in the study. These deliveries were compared with each other in terms of maternal injury, apgar scores, umbilical artery pH value, neonatal injury, duration of hospital stay of neonate, neonatal morbidity including hyperbilirubinemia. Results were evaluated with student t-test and chi-square test.

Results: There were no significant differences in ages of patients, duration of labor and pregnancy, presence or absence of oxytocin augmentation of labor between three groups. Indication for undergoing an operative delivery was mostly delayed second stage of labor. There was no significant difference in distribution of indication of operative delivery between two groups. Two operative groups were also similar when compared for soft tissue laceration except for the occurrence of a case of cervical laceration in vacuum group. Vacuum delivery group appeared to have a lower fifth minute apgar score than spontaneous vaginal delivery group and umbilical artery pH values were similar in three groups. There was no neonatal injury diagnosed in forceps group. Vacuum group had longer neonatal hospital stay than forceps group and detected hyperbilirubinemia was more frequent after vacuum deliveries.

Conclusion: We concluded that vacuum deliveries are not safer than forceps assisted deliveries in regard of neonatal and maternal morbidity. Neonates delivered by vacuum extraction should be closely observed for hyperbilirubinemia. These results must be supported by larger randomized prospective clinical trials.

Non-invasive fetal ECG: comparison of tracings

in uncomplicated pregnancies and in pregnancies

complicated by arrythmia

W. J. Ginda, W. Markwitz, M. Ropacka, G. H. Bręborowicz

Department of Perinatology and Gynecology, University School of Medical Sciences, Poznań, Poland

Objective: The aim of this study was to determine the differences in ECG recordings in uncomplicated pregnancies and in the fetuses, who developed arrythmia.

Material and methods: We analyzed 40 fetuses. Twenty of them manifested arrythmia and 20 present rythmic fetal heart rate pattern (GA 28-40 weeks). To obtain the ECG recordings we used non-invasive transabdominal recording system (FEMO system, Medco, Israel). Each patient was monitored 10 minutes. We analyzed two 2-minute sets of each 10-minute tracing. We studied number of fetal R peaks placed between 2 maternal R peaks as well as the average ECG complex. In both groups maternal pulse varied between 60-80 beats/min. Additionally we monitored the fetal status by means of ultrasound machine with color Doppler facilities. The chi square test was used to compare the results in both groups.

Results: In the group of arrythmias, predominantly 3 fetal R peaks were placed between two maternal R peaks. In both analyzed groups we did not observe any signs of cardiovascular insufficiency. The average complexes showed an enlargement of negative P wave in case with reverse end-diastolic flow in the umbilical artery (2 cases). The outcome was good in both groups and children did not require any treatment in neonatal period.

Conclusions: Fetal ECG seems to be an additional method useful in the diagnosis of fetal arrythmia. Analysis of the maternal and fetal R peaks pattern allows to distinguish between arrythmic and rythmic fetal heart rates. Severe blood flow disturbances in the umbilical artery are reflected in fetal ECG. The irregular fetal heart beats do not warrant an aggressive approach from a risk-benefit standpoint.

Fetal pulse oximetry and fetal heart rate tracings

in the second stage of labor

W. Markwitz, M. Ropacka, W. J. Ginda, G. H. Bręborowicz

Department of Perinatology and Gynecology, University School of Medical Sciences, Poznań, Poland

Objective: to compare the mean values of fetal oxygen saturation with fetal heart rate pattern in the second stage of labor (Melchior classification) and pH values from umbilical cord.

Material and methods: The study included 60 parturients in gestational age 37-42 weeks. Fetal oxygen saturation was recorded and averaged over the last 30 min of the second stage of labor. Simultaneously, fetal heart rate and uterine contractions were monitored. Fetal heart rate patterns were assessed according to Melchior’s classification. At birth, the cord acid-base parameters (pH) were calculated.

Conclusions: The mean values of fetal oxygen saturation over the last 30 min of labor significantly correlate with arterial pH values and with FHR abnormalities according to Melchior’s classification. Fetal oxygen saturation in the second stage of labor help us in distinguishing which pregnancies can be managed conservatively versus operatively.

Pulmonary venous blood flow in the third trimester

of pregnancy in uncomplicated pregnancy and in pregnancy

complicated by IUGR

M. Ropacka, W. Markwitz, W. Ginda, K. Hepner, G. H. Bręborowicz

Department of Perinatology and Gynecology, University School of Medical Sciences, Poznań, Poland

Objective: to describe blood flow velocity waveforms in fetal pulmonary veins in normally grown and growth-retarded fetuses in the third trimester.

Materials and methods: Doppler studies were performed in 80 normally grown fetuses and 48 growth-retarded fetuses between 30 and 42 weeks of gestation. A combined color-coded Doppler and two-dimensional real-time ultrasound were used. Pulsed Doppler flow velocity waveforms of pulmonary veins were obtained at the entrance into the left atrium from a transverse cross section of the fetal chest at the level of the cardiac four-chamber view. The subjects of analysis were: peak systolic (VS), peak diastolic (VD), end-diastolic velocities (VA), and time-averaged velocities (TAMX). Analysis was performed for two gestational intervals: 30-36 wks, 37-42 wks. For each interval following data were calculated and analyzed: mean value, standard deviation and correlation coefficient.

Results: The mean gestational age in the normally grown and growth retarded fetuses was 33.4 ± 1.3 weeks and 34.1 ± 1.7 weeks in the first analyzed interval and 38.3 ± 1.1 weeks and 38.0 ± 1.5 weeks in the second. In the first gestational interval the calculated mean values in both analyzed group were: VS = 0.23 ± 0.03 cm/s and 0.21 ± 0.09 cm/s, VD = 0.18 ± 0.04 cm/s and 0.16 ± 0.04 cm/s, VA = 0.08 ± 0.03 and 0.06 ± 0.02 cm/s, PIV = 1.03 ± 0.22 and 1.20 ± 0.22, TAMX = 0.18 ± 0.03 cm/s and 0.13 ± 0.05 cm/s, respectively. In the second analyzed gestational interval the obtained values for normally grown and growth retarded fetuses were: VS = 0.28 ± 0.07 cm/s and 0.27 ± 0.15 cm/s, VD = 0.23 ± 0.08 cm/s and 0.21 ± 0.06 cm/s, VA = 0.08 ± 0.05 cm/s and 0.07± 0.09 cm/s, PIV = 1.07 ± 0.25 and 1.19 ± 0.28, TAMX = 0.19 ± 0.05 cm/s and 0.17 ± 0.26 cm/s, respectively.

Conclusions: There were no statistically significant differences between normally grown and growth retarded fetuses in all analyzed indices in both gestational intervals. The pulmonary venous flow in growth retarded fetuses demonstrate the similar pattern to that observed in normally grown fetuses in the third trimester.

Index for acceptance of pregnancy by adolescent mothers

and risk of child rejection

Objectives: Pregnancy is a normal life event or transitional crisis. Each pregnant woman, specially teenage pregnancies may be going through this transitional period with psychological and emotional changes which have often been neglected. Poor adjustment to pregnancy affects the relationship between mother and child. It seems that exists correlation between acceptance of pregnancy and possibility of child rejection. The aim of this study was to evaluate the risk factors.

Material and Methods: 160 adolescent mothers were examined during the perinatal period using special questionnaire. Each questionnaire contained some items which were separate as index for acceptance of pregnancy. Each item was scored “0” or “1”, with higher scores representing a greater acceptance. Outcome of index items were calculated.

Results: Generally teens mothers had high results of index for acceptance of pregnancy. Lower scores were conected with items for social support. Our findings showed significant differences in the psychological and parenting needs of younger and older teens.

Conclusions: Pregnancy is serious life experience for teens. Social support is more important than self-acceptance of pregnancy. Social acceptance seems to be the main factor, which decreases the risk of child rejection. Acceptance of Pregnancy Index is good indication of emotional health in pregnancy.

Thyroid function impairment in preterm infants

– does it need more consideration?

Poland is the country of mild to moderate iodine deficiency. Thyroid function assessment at birth is based on TSH analysis. Considering the fact, that thyroid function is immature in preterm neonates, a variety of thyroid dysfunctions can be observed in this population. In most cases TSH is normal at the time, when screening test is performed.

The aim of this preeliminary study was: 1) To evaluate the incidence of hypothyroxinemia, sick euthyroid syndrome, transient hypothyroidism and hyperthyrotropinemia in premature neonates, 2) To estimate the usefulness of free hormones (FT4 and FT3) measurments as a screening tools in preterm babies, 3) To establish the uniform thyroid function screening program for very low birth weight infants. At present, we started step 1 and 2.

Material: consisted of 19 preterm infants with mean gestational age 30.5 weeks and a mean birth weight 1686 g. Among many medical problems, RDS was diagnosed in 53% of babies.

Methods: hormonal study included TSH, FT4, FT3 from cord blood, on day 7, 14 and at 4 weeks of age. Analyses were performed using AutoDelfia kits, by time-resolved fluoroimmunoassays.

Results: Mean TSH leveles were decreasing from assay to assay, mean FT4 did not differ significantly in each succeeiding sample. In 16% of infants on day 7 and in 20% on day 14, FT4 concentrations were below low limits for term neonates. Mean FT3 level from cord blood was lower than in adult in 85% of babies. On day 7, 63% of newborn had low FT3, and on day 14-33%. In two very very low birth weight infants sick euthyroid syndrome could be strongly suspected. The comparison between infants with RDS and non-RDS patients was performed. The only statistically significant difference was noted in relation to FT4 level on day 7, which was lower in sick neonates (12.5 pmol/l vs 16.1pmol/l; p = 0.03)

Speculations: This is preeliminary report, so we are not going to draw conclusions, but we can formulate the following speculations.1) Thyroid “transient” impairment affects preterm babies. 2) Free hormones should have a priority in evaluation of thyroid function in premature neonates. 3) Thyroid function screening test based only on once TSH assessment is not adequate for preterm infants. 4) Normal values for free hormones in infants born prematurely need to be established. This study will be continued.

Pulsatility index values for different sections

of the fetal middle cerebral artery in normal pregnancy

M. Bednarek, G. H. Bręborowicz

Department of Perinatology and Gynecology School of Medical Sciences, Poznań, Poland

The standard curves of pulsatility index (PI) in different segments of fetal middle cerebral artery (MCA): initial segment (M1) and subcortical segment (M2) were established.

98 normal pregnancies at 26 to 42 weeks of gestation were investigated with pulsed Doppler ultrasonography. Serial records of cerebral blood flow velocity waveforms were studied.

Our data indicate that the pulsatility index of the middle cerebral artery in the normal fetus has a parabolic pattern during pregnancy in both segments of MCA. The normal range of the PI of the MCA shows a peak near 28-32 weeks in M! and M2 segments (fig. 1). In subsequent gestational weeks the PI in both segments of the MCA decreases. After term M1 PI tends to stabilisation reflect or even slightly increases, when M2 PI still drops gradually. This finding can reflect a late pregnancy adaptation of fetal cerebral circulation for decreased oxygen supply via placenta to fetal brain. These data also indicate the importance of knowing exactly which cerebral vessel is being insonated, so that the color Doppler examination can be interpreted correctly.

Efficacy of inhalational nitric oxide therapy

in neonatal acute respiratory failure

Bogumi_a Stoińska, Jan L. Mazela, Hanna Szczapa-Krenz, Janusz Gadzinowski

Chair and Department of Neonatology, University of Medical Sciences, Poznań, Poland

Inhaled nitric oxide is a potent and selective pulmonary artery vasodilator. We studied the effects of nitric oxide inhalation in neonates with acute respiratory failure and pulmonary hypertension associated with various neonatal cardiopulmonary diseases.

Methods: Inhaled nitric oxide therapy was used in twenty neonates with acute respiratory failure and mean pulmonary arterial pressure (MPAP) above 45 mm Hg. There were monitored: invasive systemic arterial pressure, MPAP (color Doppler), oxygenation index (OI) and mean airway pressure (MAP) before and during nitric oxide treatment. SLE INOSYS-equipment was used to administer nitric oxide as inhalation. The loading dose of NO was 20 ppm for every patient whenever OI > 12.

Effect of surfactant lung lavage (SLL) in meconium

aspiration syndrome (MAS) on oxygenation

and duration of mechanical ventilation (MV)

K. Kowalska, M. Szymankiewicz, J. Gadzinowski, D. Vidyasagar*

Chair and Department of Neonatology, University of Medical Sciences, Poznań, Poland

*Division of Neonatology, University of Illinois at Chicago, Chicago, IL, USA

Surfactant lavage and surfactant application became a new tool in treatment of meconium aspiration syndrome (MAS) in neonates. The aim of our study was to evaluate an effect of SLL followed with surfactant administration on oxygenation and need for MV in severe MAS.

Results are presented in the Table below.

Conclusions: our pilot SLL study showed the benefit of this procedure in newborns with severe MAS. Comparing the findings from the period before SLL became a routine procedure in severe MAS we can state that the time of mechanical ventilation, time of NICU, and duration of hospitalization is currently shorter than before. The economic effect of this treatment will be analyzed in a future.

Is there a difference in perinatal outcome of multiple pregnancies

by IVF and by spontaneous conception?

Zdenek Hajek, Pavel Drbohlav, Lucia Haakova

Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic

We did a comparative study of patients who gave birth to twins conceived by in vitro fertilization and twins conceived spontaneously. Patients of the in vitro fertilization and embryo transfer (IVF-ET) group were older and more often primiparous than in the other group. In our study, the frequency of premature rupture of membranes (PROM) was twice as high in the IVF-ET group and the frequency of threatened abortion was three times as high, but the differences were not statistically significant. We did not find any differences in the incidence of maternal disease in pregnancy (preeclampsia, gestational diabetes mellitus, and hepatopathy). The frequency of threatened premature labor was the same in both groups. The rate of caesarean section in the IVF-ET group was statistically significantly higher in comparison with the group of spontaneous twins. This is associated with the broader indications for operative delivery in multiple pregnancies. The perinatal mortality rate was also the same in both groups, thus we can conclude that we did not find any differences in the perinatal outcome of twin pregnancies conceived by IVF-ET as compared with spontaneous twins.

Cardiac effects of beta-mimetics and calcium blockers

in preterm delivery prevention

Rafa£ Kocy£owski, Przemys£aw Korszun, Grzegorz H. BrÊborowicz

Department of Perinatology and Gynecology, School of Medical Sciences, Poznan, Poland

Objective: To study the effects of beta-mimetics and calcium blockers used in preterm delivery prevention on cardiac arrhythmias and heart rate variability (HRV).

Study design: 24-hour ECG Holter recordings were obtained for 15 healthy pregnant volunteers between 27-39 weeks after last period and 15 healthy pregnant women treated with preterm delivery risk. Cardiac arrhythmias (supraventricular and ventricular) and heart rate variability (HRV) were determined.

Results: Index LF:HF (low frequency: high frequency) of frequency-domain measures of heart rate variability was significantly higher in subjects with preterm delivery risk prevention. Supraventricular and ventricular arrhythmias did not differ and stayed within normal aged-related range.

Conclusions: Increased LH:HF index suggest altered autonomic modulation during tocolytic treatment with higher sympathetic component in HRV power spectrum. Calcium blockers seemed to be efficient in cardiac arrhythmia controlling.