THE INFLUENCE OF TIME OF DIAGNOSIS ON NEURODEVELOPMENTAL OUTCOMES OF COMPLICATED MONOCHORIONIC PREGNANCIES

neonates. Methods: Retrospective cohort study of neonates born and investigated for cholestasis at 2 co-located neonatal and children facilities from January 2013 to December 2017. Results: 139 neonates with cholestasis were identified. BA and intestinal-failure associated liver-disease (IFALD) was the most prevalent cause of NC in term (18%) and preterm (66%) cohorts, respectively. Incidence of BA was higher in term (1:6) than preterm (1:50) cohorts. (OR 10.29; P = 0.0024). Higher birth weight, acholic stool, absent or abnormal gallbladder on ultrasound was associated with BA while gestational age ≤32 weeks, total parenteral nutrition ≥14 days, and low albumin were associated with non-BA. In predicting BA, nondraining HIDA demonstrated a lower specificity (73% vs 90%) and lower PPV (25% vs 78%) in preterm compared to term neonates. Conclusions: Etiologies of cholestasis among preterm neonates differ from those in term neonates and NC in preterm neonates may not warrant extensive evaluations for exclusion for BA. Pre-existing diagnostic approach to NC should be modified for preterm cohort, taking into accounts of the prevalence for each etiology, potential predictors and cost-efficiency.


THE INFLUENCE OF TIME OF DIAGNOSIS ON NEURODEVELOPMENTAL OUTCOMES OF COMPLICATED MONOCHORIONIC PREGNANCIES
Longhurst E 1 , Smoleniec J 2 , Stack J 3 1 University of New South Wales, Sydney, Australia, 2 Liverpool Hospital, Sydney, Australia, 3 Liverpool Hospital, Sydney, Australia Email: z5075764@ad.unsw.edu.au Background: There is a paucity of data regarding the relationship between time of diagnosis of monochorionic twins with complications and the neurodevelopmental outcomes of these twins.
Methods: A prospective cohort study was conducted, comparing the neurodevelopmental outcomes of pre and post 28 week diagnosis of monochorionic complications. The study analysed the data of monochorionic twin pregnancies diagnosed at Liverpool Hospital, from 2009 until 2018. Outcomes were compared using independent samples t-tests, Chi-square analysis and the Fisher's Exact Test.
Results: Significant differences in motor and language outcomes were observed between the pre and post 28 week groups; of 44.74% and 21.40% respectively. Categorical analysis revealed significance for motor outcomes between the pre and post 28 week groups (P = 0.016), and language outcomes in the numerical group (P = 0.009). Both results had higher neurodevelopmental means for the post 28 week group.
Conclusions: The post 28 week group was shown to perform better neurodevelopmentally than the pre 28 week group in language and motor outcomes. This confirms the justification of regular monitoring of monochorionic pregnancies.

OUTCOMES FOLLOWING CHANGES TO DELIVERY ROOM (DR) PRACTICES IN PRETERM INFANTS <29 WEEKS
Lowe K 1 , Maheshwari R 1,2 , Shah D 1 , 2 , Luig M 1 , Wright A 1 , Marceau J 1 , Baird J 1 , Jani P 1,2 1 NICU, Westmead Hospital, Westmead, Australia, 2 The University of Sydney, Sydney, Australia Email: Krista.Lowe@health.nsw.gov.au Background: Based on the neonatal intensive care unit's outcomes from ePREM72 CPI group and NSW NICUS reporting, we identified following aims to improve clinical care for preterm infants <29 weeks 1. To improve senior medical staff (Neonatologist &/ Neonatal Fellow) presence at birth and 2. Use of colorimetric CO 2 detector for early identification of upper airway obstruction during non-invasive respiratory support.
Methods: Plan-Do-Study-Act (PDSA) methodology was used throughout this CPI project. All inborn births < 29 weeks at Westmead Hospital 18 months before and after the implementation of changes were included. The CPI group performed staff education sessions on the changes to resuscitation practice, use of end tidal carbon dioxide detector with non-invasive respiratory support for early recognition of airway obstruction, instituting appropriate trouble shooting for non-response to positive pressure ventilation, early commencement of heated humidified gases and senior medical staff presence to oversee resuscitation.
Results: Statistically significant improvement in senior medical staff presence (56% to 76%, P = 0.005), overall reduction in DR intubation rates (73 to 54%, P = 0.0114), reduction in DR intubation rates for ≥ 26 wks (66% to 43%, P = 0.0117) were observed. A clinically important, but statistically non-significant improvement in proportion of infants with normocarbia on admission blood gas (56% to 67%) and reduction in proportion of infants with hypocarbia (23% to 18%) was observed.
Conclusions: Following implementation of changes to delivery room practices, we have demonstrated that using end tidal colorimetric CO 2 detector is associated with reduction in the need for DR intubation as well as a trend towards reduction in hypocarbia upon admission.

INVESTIGATING THE LONG-TERM BEHAVIOURAL AND NEUROCHEMICAL IMPACT OF IN-UTERO METHADONE EXPOSURE
Lum JS 1,2 , Bird KM 1,2 , Wilkie J 1,2 , Millard SJ 1,2 , Newell KA 1,2 , Wright IM 1,2 1 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia, 2 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia Email: jlum@uow.edu.au Background: Methadone is the most common Opioid Replacement Therapy in pregnancy. Methadone transverses the placenta, exposing the fetus at a critical period of neurodevelopment. Clinical studies indicate in-utero opioid exposure adversely affects neurocognitive parameters, particularly adolescent academic performance. Here we describe the neurobehavioural impact of in-utero methadone exposure on adolescent offspring in a newly developed, clinically relevant rodent model.

Methods:
Female adult Sprague-Dawley rats were treated with vehicle (0.2% saccharin) or methadone (30 mg/kg/day) two weeks prior to conception, throughout gestation and lactation. Adolescent offspring (postnatal days 35-45) underwent behavioural assessments, including open-field testing (OFT), novel object recognition (NOR) and rewarded T-maze alternation tasks. Furthermore, hippocampal BDNF protein levels were quantified.
Results: Methadone-exposed offspring exhibited altered patterns of exploratory behaviour, despite showing no difference of total locomotor activity in the OFT. Furthermore, methadoneexposed offspring displayed recognition memory deficits in the NOR task, in addition to learning deficits during T-maze tasks, exhibiting an increased percentage of incorrect entries during the training period and increased number of training sessions to acquire the task. In addition, methadone-exposed offspring exhibited reduced hippocampal BNDF expression.
Conclusions: These findings suggest that prenatal methadone exposure produces detrimental effects on cognitive processes in adolescent offspring, similar to clinical findings. These behavioural findings are associated with reduced BDNF levels, which is critical for neurocognitive function. The present findings are an essential first step to understanding the neurobiological alterations underpinning in-utero methadone exposure and this model provides a platform to assess potential alternative approaches for improved maternal and/or neonatal care.