Background:
Hyperglycaemia is common in extremely preterm (EP) neonates <28 weeks gestation. A mean blood glucose (BSL) ≥10 mmol/L in the first 3 days of age is associated with a 15-fold increase in risk of mortality.

Objective:
Following introduction of new Parenteral nutrition (PN) with a 12% glucose concentration in our network in 2022, we aimed to review if this led to more EP infants needing insulin.

Methods:
Retrospective study on EP infants requiring insulin between day 2-4 admitted to our regional level 3 NICU over 6 months in 2022. The historic control group A was EP infants requiring insulin on previous PN formulation admitted in 2020. Additional control group B was EP infants in 2022 who did not require insulin.

Results:
In 2022, 17/39 EP infants needed insulin (44%) as opposed to 8/29 infants from 2020 (38%). There was no difference in the demographic details between the study and historic control groups, while the control B infants were of higher gestational age and birth weight (Table 1). The subject group had higher mean BSL levels on day 2 when compared to other groups, despite similar GIR being delivered to all the groups.

Conclusion:
The increase in the number of admissions of EP babies in 2022 could have led to an increased insulin use. Despite higher day 2 BSL in study group, the higher concentration of glucose in the new PN doesn’t appear to increase insulin usage. Further effects on the nutritional benefits of new PN needs to be studied.

Background:
Gestational diabetes may cause cardiac complications in the neonate. A study comparing 40 infants of mothers with gestational diabetes with 40 controls demonstrated changes in myocardial function and in pulmonary vascular resistance. Elevated levels of insulin may induce these changes however there are scarce data correlating cord blood biomarkers of maternal glycemic control with severity of myocardial dysfunction. Levels of cord blood insulin, IGF-1 and c-peptide have been shown to correlate with neonatal complications in infants of diabetic mothers.
Objective:
To examine the correlation between cord blood biomarkers of glycemic control and myocardial function.
Methods:
Diabetic and non-diabetic pregnant women at term gestation were recruited prior to delivery. Cord blood insulin, c-peptide, cortisol, IGF-1 and HgA1C were taken from all participants. Postnatal blood glucose levels were drawn only in infants of diabetic mothers. Echocardiograms were performed in all participants before discharge.
Results:
There were 16 newborns with gestational diabetes (2 insulin controlled, one oral medication, and the rest diet-controlled), and 15 controls. Echocardiograms ranged between 17-73 hours of life. No significant differences were found between the groups in maternal and neonatal characteristics and in cord blood levels of biomarkers, and no hypoglycemic episodes were recorded in the gestational diabetes group, probably reflecting a well-controlled diabetic population. No significant differences were found in all the echocardiographic measurements including LV and RV function, and indicators of pulmonary vascular resistance.
Conclusions:
In well-controlled diabetic mothers, neonatal myocardial function was comparable to controls. Larger studies are needed to validate this finding.

Objective: To examine the perspectives and opinions of neonatologists in Israel regarding the resuscitation of newborns at 22-24 weeks' gestation and how they respond to parental preferences. Additionally, we aimed to identify the factors that influence physicians' decision-making process and determine the extent to which their decisions align with the national clinical guidelines.
Study design: Descriptive and correlative study using a 47-questions online questionnaire.
Results: Ninety out of the 127 neonatologist in Israel responded. 74%, 50%, and 16% of respondents believe that resuscitation and full treatment at birth is contrary to the best interests of infants born at 22-, 23-, and 24-weeks’ gestation, respectively. Respondents' decisions on resuscitation showed significant variation and did not consistently align with either the national clinical guidelines or the perception of what is in the best interest of the newborns. Gender, experience, country of birth and religiosity were all associated with treatment decisions. Personal values and concerns about legal risk were believed to affect decision-making.
Conclusion: There was significant variation observed among neonatologists in Israel regarding the management at the delivery room for infants at 22 to 24 weeks' gestation, with a notable emphasis on respecting the parents’ wishes. The national guidelines do not completely encompass this wide range of approaches. Country's guidelines should reflect the existing range of opinions, possibly through a broad survey of caregivers before setting the guidelines and recommendations.

Background:
Home phototherapy for low-risk, jaundiced neonates with hyperbilirubinemia is accepted as safe1-4. However, little information is available for the relative efficacy of new multidirectional LED phototherapy technology. We compare bili-hut™ (Little Sparrows Technologies, Inc.) vs. bili-bed (Medela, Inc), for hyperbilirubinemia treatment of term, breastfed infants.

Objective :
Our hypothesis, based on preliminary data, is that the bili-hut™ lowers bilirubin more rapidly, decreasing phototherapy time and nursing hours required.

Methods:
All eligible infants were offered enrollment, with participants randomized to receive treatment with bili-hut™ or BiliBed. Inclusion criteria are: term gestation (37-42 weeks), exclusive breastfeeding, and low medical/neurological risk. Initial bilirubin is drawn within eight hours of initiation of treatment and is checked 8 to 12 hours after therapy, and every 12 hours thereafter until levels are acceptable. The final level is drawn 8 to 12 hours after phototherapy is discontinued.

Results:
12 participants have completed treatment, 7 for bili-hut and 5 for the BiliBed. For bili-hut, the average treatment time is 14.8 hours, with a range of 6.7 to 23.5 hours. For the BiliBed, the average treatment time is 28.5 hours, with a range of 11.8 to 50.4 hours. No negative side effects of treatment have been perceived with either method.

Conclusion:
Preliminary data suggest the bili-hut™ enables more rapid treatment of low-risk neonates. The efficacy of bili-hut™ for low risk infants suggests that it should also be evaluated for higher-risk populations at home and in hospital settings.

Background: New diagnostic, treatment protocols and modern respiratory support have significantly improved survival rates of the extremely preterm infants (EP).
Objective: To identify perinatal factors associated with increased risk of death in EP.
Method: Methods: All surviving EP (born at ≤28 weeks of gestation) cared for in our tertiary neonatal intensive care unit between January, 1 2010 and December, 31 2020 were included. Perinatal maternal and neonatal data, data related to neonatal care, treatment, and complications were prospectively collected in the database of our unit. Data of surviving EP were compared to data of EP that died before discharge from the maternity hospital. Statistical analysis was performed using IBM SPSS Statistics 23.0, p <0.05 being considered statistically significant.
Results: 277 EP were included in the study, 94 of them died (33.9%). Comparative analysis of survivors to EP that died showed that lower gestational age, birth weight, Apgar scores at 1 and 5 minutes, higher oxygen need during resuscitation at birth, at 1, 18 and 24 hours of life, higher pressures on CPAP, lower temperature and pH at NICU admission, higher levels of creatinine during the first three days of life were associated with significantly increased risk of death (p<0.05).
Conclusion: Most of the factors identified in association with risk of death in EP in our study are related to birth status, resuscitation, and stabilization in the first hours of life, indicating areas to target for further improvement of neonatal intensive care of EP.

Background
Hypoxic-ischemic encephalopathy (HIE) is considered a major cause of cerebral palsy (CP) in moderately or severely asphyxiated newborns. Until now, therapeutic hypothermia (TH) for HIE has been the only effective treatment to prevent the onset of CP. We conducted a phase I trial of TH and autologous cord blood stem cell therapy in six patients with HIE to confirm its safety and feasibility.
Objective
To verify the stability and safety of the transport of cord blood and cord blood stem cell preparations necessary for treatment.
Methods
Cord blood samples were transported for a test run at 6-10°C for approximately 5 hours. Cells were isolated by SEPAX2, CD34 was measured by flow cytometry, and cell number and viability were determined. Bacterial contamination was confirmed by Gram staining, and the cell solution was prepared for transport after isolation. The isolated cord blood stem cell preparations were also tested for quality by performing a test run at 6-10°C for approximately 5 hours, as was the case with cord blood.
–Transport of cord blood and cord blood stem cell preparations for approximately 5 hours at 6-10°C had no particular effect on the number of viable cells, recovery rate, or CD34 viability before and after land transfer.
Conclusion
The stability and safety of the land transport of cord blood and cord blood stem cell preparations required for the treatment was confirmed, and it was thought that autologous cord blood stem cell therapy for HIE could be implemented at more medical institutions.

Hemodynamic monitoring plays a crucial role in the management of critically ill neonates, enabling early detection and intervention for hemodynamic instability. However, establishing a hemodynamics program within a neonatal unit can be challenging, particularly without the necessary support from the administration. This poster highlights challenges we are facing when attempting to implement such a program in our unit.

This challenges include limited financial resources, lack of awareness among administrators regarding the significance of hemodynamic monitoring, insufficient staffing, inadequate equipment, and limited training and education opportunities for healthcare professionals. These factors hinder the implementation and sustainability of a comprehensive hemodynamics program, ultimately impacting the quality of care provided to critically ill neonates.
Beyond the technical and financial aspects, cultural and organizational challenges arise. Adapting to a new program requires changes in institutional culture, workflow, and standard practices. Overcoming the resistance to change, fostering a culture of collaboration, and aligning the program's objectives with the overall institutional goals are paramount to success.

In conclusion, successful establishment of a hemodynamics program in a neonatal unit requires the active involvement and support of the administration. Addressing the identified challenges is crucial to ensure optimal patient outcomes and improve neonatal care. Increasing awareness, allocating of adequate resources, appropriate staffing, provision of necessary equipment, and ongoing training and education for healthcare professionals are perfect ways to help ahemodynamics program thrive.

Background: COVID-19 vaccine given during pregnancy is safe and effective and is not associated with premature delivery or perinatal complications. However, the effect on premature infants is unknown.
Objective: Therefore, this study aims to determine the effect of maternal COVID-19 vaccine on postnatal outcome in premature infants.
Methods: This is a single centre retrospective case-control study of premature infants born before 35 weeks gestation. Infants born to mothers who received SARS-CoV-2 vaccine during pregnancy were compared to infants born to non-vaccinated mothers. Prenatal and postnatal characteristics and postnatal complications were compared between the groups.
Results: 78 infants born to vaccinated mothers were matched with infants born to non-vaccinated mothers. No increase in postnatal complications was observed in the vaccinated group. In this group, respiratory distress syndrome (RDS) and the need of respiratory support were less frequent (P=0.02, P=0.002, respectively) and maternal vaccine had a protective effect on RDS [adjustable OR 0.38 (0.17-0.85), P = 0.02].
Conclusion: We demonstrated that maternal SARS-CoV-2 vaccine is not associated with postnatal adverse effect in premature infants and potentially has a protective effect on RDS and the need for respiratory support. Fetuses exposed to intrauterine mild hypoxemia and mild inflammation have accelerated lung maturation and less RDS. We cautiously speculate that SARS-CoV-2 vaccine could induce a mild inflammatory reaction and thus result in acceleration of lung maturation. These findings might suggest that COVID-19 vaccine is safe in high-risk pregnancies for premature delivery. Further studies are needed to confirm our findings and the biological mechanism.