gestation in 10 study regions in 2003. Regions were Flanders in Belgium, theEastern Region of Denmark, 6 of 8 districts in the Ile-de-France region ofFrance, Hesse in Germany, Lazio in Italy, the Central-Eastern region of theNetherlands, the Wielkopolska/Lubuskie region in Poland, the Northernregion of Portugal and the Northern and former Trent regions of the UK.Inclusions were crossed-checked with birth registers. Outcomes includedterminations of pregnancy, stillbirths, neonatal deaths and respiratory andneurological morbidity (intraventricular hemorrhage (IVH) grade III and IV orcystic periventricular leukomalacia (PVL) and bronchopulmonary dysplasia(BPD)).

Results

The MOSAIC cohort included 7222 babies. Terminations of pregnancyconstituted 8.1% of the cohort, but ranged between 0.5% in the Polish studyregion to 17.5% in the French region. Therewere also large differences in rates ofintrapartum and labor ward deaths. In the Danish and German study regions,few babies 24–27 weeks of gestation died during labor or in the labor ward,while this proportion was much higher in the Dutch and French regions. In-hospital mortality after live birth, standardized for gestational age and sex, wasdoubled in high versus low mortality regions (18–20% versus 7–9%). Morbidityamong survivors varied significantly (IVH/PVL ranged from 2.6% to over 10% andBDP from 10.5 to 21.5%), but differed from mortality rankings.

Conclusions

Mortality and morbidity varied widely between European regions, raisingquestions about the differences in ethical decision making, medical practices andorganization of care that are responsible for these variations. Our results alsounderscore the importance of collecting data on all pregnancy outcomes andsuggest that substantial biasesmayexist in studies basedonlyonNICUadmissions.

doi:10.1016/j.earlhumdev.2008.09.376

Abstract UENPS.361Catastrophic haemorrhage due to vascular anomalies of the gut in apreterm neonate

Kumar Swamy⁎, Anu Paul, Brian Davies, Shailinder Singh, Dulip JayasingheNottingham University Hospital, Nottingham, United Kingdom

Background and aim

Catastrophic upper gastrointestinal bleed due to vascular anomalies hasnot previously been reported in a preterm neonate. We present such a case ina 26 week neonate on the 8th day of life. Conservative measures failed tostop the bleeding hence laparotomy was performed and a bleeding gastrichaemangioma was oversewn. At a subsequent laparotomy a partialgastrectomy was performed. Even at extreme prematurity, surgery is atreatment option for uncontrollable upper gastrointestinal bleeding.

Materials and methods

A baby girl, weighing 690 g, was born following 26 weeks of pregnancy.On day 8, she developed massive upper gastrointestinal bleed with a totalblood loss of about 64 mL/kg. At laparotomy the bleed was found to becoming from a gastric haemangioma occupying a large part of the anteriorstomach wall. The haemangioma was over sewn and stomach cavity waspacked with Surgicel. Four days postoperatively (day 12) she developedabdominal distension with free air on abdominal X-ray. She was taken backto theatre and was found to have gastric perforation at the site of herprevious surgery. The abnormal area of the stomach was excised in the formof a partial gastrectomy. Enteral feeds were started on day 23 and full NGfeeding was established by day 29.

Four weeks later (day 43), she suddenly deteriorated with overwhelmingnecrotising enterocolitis. Despite full resuscitation including a peritonealdrain she continued to deteriorate and died within a few hours.

A post mortem examination was performed and found to havenecrotising enterocolitis and foci of ectatic vascular spaces suggestingvascular malformation of the stomach and intestines.

Results

This case illustrates two points. Firstly, even at extreme pre-maturity,surgery should be considered for ongoing gastrointestinal bleeding. Secondlyat both operations the rest of the intestine was inspected externally andfurther lesions were not seen. Four weeks later, after her death, post mortemshowed multiple vascular malformations which may have led to necrotizingenterocolitis. This shows that either these lesions were small or not presentand had developed with growth.

Conclusions

Vascular anomaly of the gastrointestinal tract is a source of acute bloodloss but is a rare occurrence. It can arise in any part of the digestive system;however is extremely rare in neonates especially in a preterm neonate andnot many have been reported in literature.

This intraoperative photograph shows the stomach opened to reveal thevascular lesion with a single prolene stitch on the lesion.

doi:10.1016/j.earlhumdev.2008.09.377

Abstract UENPS.362Ethylglucuronide and ethylsulfate in meconium: New biomarkers ofgestational ethanol exposure?

Federica Vagnarelli⁎,c, Luca Morinia, Emilia Marcheib, Manuela Pellegrinib,Angelo Groppia, Cristiana Stramesia, Oscar Garcia-Algard,Roberta Pacificib, Simona PichinibaDepartment of Legal Medicine and Public Health, University of Pavia, Pavia,ItalybIstituto Superiore di Sanità, V.le Regina Elena 299, 00161, Rome, ItalycNICU, Arcispedale Santa Maria Nuova, Reggio Emilia, ItalydUnitad de Recerca Infància i Entorn (URIE), Paediatric Service, Hospital del Mar,Barcelona, Spain

Background and aim

In recent years, fatty acid ethyl esters (FAEEs) in meconium emerged asreliable, direct biological markers for establishing gestational alcoholexposure. Conversely, ethyl glucuronide (EtG) and ethyl sulfate (EtS), twoethanol metabolites already detected in blood, urine and hair have beennever investigated in this neonatal biological matrix.

We developed a sensitive and specific liquid chromatography-tandemmass spectrometric method which for the first time identified and quantifiedEtG and EtS in neonatal meconium.

Materials and methods

The validated method has been applied to analysis of specimens fromtwo different European study cohorts: Reggio Emilia (Italy) and Barcelona

Abstracts S145