1
Results Hyperthyrotiropinemia was detected in 31 (43.1%) out of 73 patients in whom thyroid functions were measured. Iodine deficiency was detected in 9 out of 25 patients, and two patients had hypothyroidism. Hypoplasia of thyroid was detected in 14 out of 33 patients. Median level of TSH in 73 patients was 14.95 mU/l (0.08127.7 mU/l), the mean FT4 level was 13.3±4.3 pmol/l, and the mean FT3 was 2.6±1.0 pg/ml, and the median thyroglobulin level was 58.23 ng/ml (4.43510.86 ng/ml) in 57 patients, the mean iodine level in urine was 13.53±12.77 μ/dl in 25 patients. Transcranial and renal ultrasonography revealed abnormal results in 7 (21.2%) in 33 patients and 6 (16.2%) in 37 patients, respectively. Of the 62 patients, 60 had congenital heart diseases. The most common lesions were patent foramen ovale (56.5%), patent ductus arteriosus (50%), ventricular septal defect (32.3%), followed by atrial septal defect (27.4%), endocardial cushion defect (12.9%). There was no statistical correlation between the coexistence of cardiovascular or cranial and renal diseases, and hyperthyrotiropinemia. Conclusions Thyroid dysfunction is common in patients with Down syndrome. Thus neonatal screening of thyroid function tests should be performed to prevent further intellectual deterioration and improve overall development. In neonatal period, hyperthyrotiropinemia should be kept in mind and periodical evalution should be made. doi:10.1016/j.earlhumdev.2010.09.303 PP-249. Supporting parents after newborn death Gabriela Magyarova, Alica Bystricka, Klaudia Demova, Frantisek Bauer Clinic of Neonatology, Faculty Hospital Nove Zamky, Slovakia Aim The approach to bereaving parents and relatives has been and most likely will remain a subject of discussions within the neonatal community. This article is presenting our approach (i.e. Neonatal of University Hospital Nove Zamky, one of five tertiary centers in Slovak Republic) It is trying to emphasize few issues we find important over the years. Case presentation All NICU staff is being trained to deal with bereaving parents, part of it is learning the stages of grieving process. The whole aim is focused on appropriate start and correct timing of this start of the grieving process. This is to avoid pathological processing of grieving. It is essential of involvement of the whole family including siblings, in some cases grandparents, depending on the family dynamics. The staff is also trained the correct communication, phrases to uses and even phrases that need to be avoided. The concept is considering the necessity of interventions in final stages of life, always taking into account the pain, comfort and dignity of the patient. Understandably, during final stages the presence of relatives is always important. Finally, article deals with the details of memory package, importance of future communication and support to bereaving relatives as well as our own staff. The entire concept is adapted to religious and cultural needs of each family. Conclusion An ethical approach to parents of critically ill newborns is still an actual problem. In our daily practice there are still some reserves that should be eliminated. Parents need communication with empathic staff who identify and accept their feelings and support and facilitate their normal grief process. Despite a lot of achievements in intensive neonatal care, there are also failures. Our care has to reflect humanity and dignity. doi:10.1016/j.earlhumdev.2010.09.304 PP-250. Hypoxic-ischemic enteropathy: A proposal for a new definition and classification Ayse Korkmaz, Neslihan Yurtman, Sule Yigit, Murat Yurdakok, Gulsevin Tekinalp Hacettepe University İhsan Doğramacı Children's Hospital Neonatology Unit, Turkey Aim Necrotizing enterocolitis (NEC) is a multifactorial disease which intestinal ischemia is a contributing factor in the pathogenesis although the time, duration and mechanism of ischemia is unclear. However, in infants with prenatal abnormal fetal Doppler velocime- try, the existenceof intestinal ischemiahas been proven by demonstration of postnatal disturbed superior mesenteric artery hemodynamics indicating persistent redistribution of regional blood flow. These infants have an increased risk of gastrointestinal problems and NEC-likeclinical picture very early in the first days of life. We aimed to define this specific clinical picture as hypoxic- ischemic enteropathy(HIE) and to create a staging system. Materials and methods The study was conducted retrospectively covering the period 20052009. Preterm infants presenting gastrointestinal problems or NEC-likeclinical picture in the first three days of life before the introduction of enteral feedings or only during minimal enteral nutrition (group A) were compared demographically and clinically with preterm infants who developed NEC after the first week of life and the initiation of enteral feedings (group B). Prenatal Doppler velocimetry abnormalities, time of first meconium passage, demographic, clinical and radiographic findings were noted in each infant. Results A total of 77 preterm infants were included in the study and of these 48 (62.3%) developed gastrointestinal problems in the first three days of life before the initiation of enteral feedings (group A), while 29 (37.7%) developed NEC (group B) after the first week of life. The frequencies of prenatal Doppler velocimetry abnormalities, small-for-gestational infants and delayed meconium passage after 48 h of life were significantly greater in group A than in group B. Conclusions We propose to use the term HIEto define infants who are mostly intrauterine-growth restricted with prenatal hemodynamic distur- bances and very early postnatal gastrointestinal problems such as feeding intolerance, disturbed gut motility and NEC-likeclinical picture. Stage 1 HIE includes the above clinical characteristics while Stage 2 and 3 are similar with NEC stages 2 and 3. doi:10.1016/j.earlhumdev.2010.09.305 Abstracts S116

PP-249. Supporting parents after newborn death

Embed Size (px)

Citation preview

Results

Hyperthyrotiropinemiawas detected in 31 (43.1%) out of 73 patientsin whom thyroid functions were measured. Iodine deficiency wasdetected in 9 out of 25 patients, and two patients had hypothyroidism.Hypoplasia of thyroidwasdetected in 14 outof 33patients.Median levelof TSH in 73 patients was 14.95 mU/l (0.08–127.7 mU/l), the mean FT4level was 13.3±4.3 pmol/l, and the mean FT3 was 2.6±1.0 pg/ml, andthemedian thyroglobulin level was 58.23 ng/ml (4.43–510.86 ng/ml) in57 patients, the mean iodine level in urine was 13.53±12.77 μ/dl in 25patients. Transcranial and renal ultrasonography revealed abnormalresults in 7 (21.2%) in 33 patients and 6 (16.2%) in 37 patients,respectively. Of the 62 patients, 60 had congenital heart diseases. Themost common lesionswere patent foramenovale (56.5%), patent ductusarteriosus (50%), ventricular septal defect (32.3%), followed by atrialseptal defect (27.4%), endocardial cushion defect (12.9%). There was nostatistical correlation between the coexistence of cardiovascular orcranial and renal diseases, and hyperthyrotiropinemia.

Conclusions

Thyroid dysfunction is common in patients with Down syndrome.Thus neonatal screening of thyroid function tests should beperformed to prevent further intellectual deterioration and improveoverall development. In neonatal period, hyperthyrotiropinemiashould be kept in mind and periodical evalution should be made.

doi:10.1016/j.earlhumdev.2010.09.303

PP-249. Supporting parents after newborn death

Gabriela Magyarova, Alica Bystricka, Klaudia Demova, Frantisek BauerClinic of Neonatology, Faculty Hospital Nove Zamky, Slovakia

Aim

The approach to bereaving parents and relatives has been andmost likely will remain a subject of discussions within the neonatalcommunity. This article is presenting our approach (i.e. Neonatal ofUniversity Hospital Nove Zamky, one of five tertiary centers in SlovakRepublic) It is trying to emphasize few issues we find important overthe years.

Case presentation

All NICU staff is being trained to deal with bereaving parents, part ofit is learning the stages of grieving process. Thewhole aim is focused onappropriate start and correct timing of this start of the grieving process.This is to avoid pathological processing of grieving. It is essential ofinvolvement of the whole family including siblings, in some casesgrandparents, depending on the family dynamics. The staff is alsotrained the correct communication, phrases to uses and even phrasesthat need to be avoided. The concept is considering the necessity ofinterventions in final stages of life, always taking into account the pain,comfort and dignity of the patient. Understandably, during final stagesthe presence of relatives is always important. Finally, article deals withthe details of memory package, importance of future communicationand support to bereaving relatives as well as our own staff. The entireconcept is adapted to religious and cultural needs of each family.

Conclusion

An ethical approach to parents of critically ill newborns is still anactual problem. In our daily practice there are still some reserves that

should be eliminated. Parents need communication with empathicstaff who identify and accept their feelings and support and facilitatetheir normal grief process. Despite a lot of achievements in intensiveneonatal care, there are also failures. Our care has to reflect humanityand dignity.

doi:10.1016/j.earlhumdev.2010.09.304

PP-250. Hypoxic-ischemic enteropathy: A proposal for a newdefinition and classification

Ayse Korkmaz, Neslihan Yurtman, Sule Yigit,Murat Yurdakok, Gulsevin TekinalpHacettepe University İhsan Doğramacı Children's Hospital NeonatologyUnit, Turkey

Aim

Necrotizing enterocolitis (NEC) is a multifactorial disease whichintestinal ischemia is a contributing factor in the pathogenesisalthough the time, duration and mechanism of ischemia is unclear.However, in infants with prenatal abnormal fetal Doppler velocime-try, the “existence” of “intestinal ischemia” has been proven bydemonstration of postnatal disturbed superior mesenteric arteryhemodynamics indicating persistent redistribution of regional bloodflow. These infants have an increased risk of gastrointestinalproblems and “NEC-like”clinical picture very early in the first daysof life. We aimed to define this specific clinical picture as “hypoxic-ischemic enteropathy” (HIE) and to create a staging system.

Materials and methods

The study was conducted retrospectively covering the period2005–2009. Preterm infants presenting gastrointestinal problemsor “NEC-like” clinical picture in the first three days of life beforethe introduction of enteral feedings or only during minimal enteralnutrition (group A) were compared demographically and clinicallywith preterm infants who developed NEC after the first week oflife and the initiation of enteral feedings (group B). PrenatalDoppler velocimetry abnormalities, time of first meconium passage,demographic, clinical and radiographic findings were noted in eachinfant.

Results

A total of 77 preterm infants were included in the study and ofthese 48 (62.3%) developed gastrointestinal problems in the firstthree days of life before the initiation of enteral feedings (group A),while 29 (37.7%) developed NEC (group B) after the first week of life.The frequencies of prenatal Doppler velocimetry abnormalities,small-for-gestational infants and delayed meconium passage after48 h of life were significantly greater in group A than in group B.

Conclusions

We propose to use the term “HIE” to define infants who are mostlyintrauterine-growth restricted with prenatal hemodynamic distur-bances and very early postnatal gastrointestinal problems such asfeeding intolerance, disturbed gut motility and “NEC-like” clinicalpicture. Stage 1 HIE includes the above clinical characteristics whileStage 2 and 3 are similar with NEC stages 2 and 3.

doi:10.1016/j.earlhumdev.2010.09.305

AbstractsS116