165: Serum biomarker glial fibrillary acidic protein in the identification of periventricular white matter injury in preterm neonates with intraventricular hemorrhage at birth

identification of periventricular white matter injury in preterm neonates with intraventricular hemorrhage at birth Christopher P. Wayock, Elisabeth Nigrini, William J. Savage, Jacky M. Jennings, Frances J. Northington, Allen D. Everett, Ernest Graham Johns Hopkins University School of Medicine, Department of Gynecology & Obstetrics, Division of Maternal-Fetal Medicine, Baltimore, MD, Johns Hopkins University School of Medicine, Department of PathologyTransfusion Medicine, Baltimore, MD, Johns Hopkins University School of Medicine, Departments of Pediatrics, Division of General Pediatrics and Adolescent Medicine; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD, Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Neonatology, Baltimore, MD, Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Cardiology, Baltimore, MD, Johns Hopkins University School of Medicine, Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Baltimore, MD OBJECTIVE: Premature neonates are at increased risk for both intraventricular hemorrhage (IVH) and periventricular white matter injury (PWMI). It is unclear which neonates with IVH will develop PWMI, which is associated with the subsequent development of cerebral palsy. Our objective is to determine if a serum biomarker can identify which neonates with IVH will develop PWMI. STUDY DESIGN: From 4/09-4/11 there were 49 neonates born between 23-34 weeks gestation diagnosed with IVH by head ultrasound performed on day of life 3 or 7. PWMI was diagnosed by head ultrasound performed at 2 months of life. A serum biomarker glial fibrillary acidic protein (GFAP) was measured in cord blood at the time of birth, in neonatal serum upon admission to the intensive care unit, and daily for the first 4 days of life. Neonates with IVH and PWMI (n 20) were compared to those with IVH alone(n 29) using t-tests, Chi-square and Fisher’s exact where appropriate. Logistic regression was used to measure the ability of GFAP to identify PWMI. RESULTS: Neonates with IVH & PWMI did not differ from those with IVH only in gestational age (26.6 / 2.7, 27.1 / 2.8 wks), birth weight (960 / 444, 952 / 366g) or incidence of cesarean delivery (60%, 48.3%). Umbilical arterial pH (7.22 / 0.2, 7.27 / 0.08) and base deficit (4.6 / 6.9 mM, 3.8 / 2.8 mM) did not differ, but those with IVH & PWMI had a significantly higher incidence of seizures (45%, 6.9%, p 0.004) and severe IVH (85%, 17.2%, p 0.0001). GFAP was significantly increased in those with IVH & PWMI on day of life 2-4 (p 0.04, 0.02, 0.02). Logistic regression showed that GFAP on day of life 4 predicted PWMI with sensitivity 41.2%, specificity 95.6%, PPV 87.5%, and NPV 68.6%. CONCLUSION: Among preterm neonates diagnosed with IVH by head ultrasound after birth, serum GFAP may identify neonates at risk for developing PWMI. Identifying these neonates during the first week of life, rather than on a head ultrasound performed at 2 months, could provide early prognostic information, assist in the triaging of these patients to investigational therapies, and help monitor the efficacy of therapy. 166 Does penile ring block anesthesia make a difference in pain response to Neonatal circumcision? Thomas Toussaint, Clones Lans, Douglas Sherlock, Joshua Fogel, Chaur-Dong Hsu Nassau University Medical Center, OBGYN, East Meadow, NY OBJECTIVE: To compare the use of oral sucrose (SUC) versus oral sucrose plus lidocaine ring block (SUC-RB) in the management of pain during neonatal circumcision. STUDY DESIGN: This is a retrospective review of 826 charts of newborns circumcised from January 1st 2008 to December 31st 2010 at our single medical center. Due to insufficient documentation, 35 charts were excluded. The charts were divided in two groups: SUC group where sucrose only was used for pain management during neonatal circumcision and SUC-RB group where 1% lidocaine ring block was added to the sucrose for pain management. Pain levels were recorded using the Neonatal Infant Pain Scale (NIPS) before the procedure, at 1 minute after starting the procedure, at 5 minutes after the procedure, and 30 minutes after the procedure. ANOVA, Pearson Chisquare test, and Fischers exact test were used for statistical analyses .Within groups, analyses were performed for each of the pain timepoints using the McNemar test. RESULTS: With regard to pain, the SUC group had a significantly greater percentage of pain than the SUC-RB group at both 1 minute (77.7% vs.69.4%; p 0.01) and 5 minutes (65.7% vs. 55.7%; p 0.004). There was no significant pain difference at 30 minutes. In the multivariate logistic regression analyses, those in the SUC group had significantly greater odds for pain at 1 minute than those in the SUC-RB group (OR: 2.02 vs. 1.45: p 0.03). No significant difference was noted at 5 minutes. There was a continuous significant decrease in pain percentage at 5 minutes and 30 minutes (p 0.001). CONCLUSION: Those in the SUC-RB group had significantly lower levels of pain at 1 minute. These findings suggest the addition of lidocaine ring block to oral sucrose is helpful to prevent pain in neonates undergoing circumcision.