[Show abstract][Hide abstract] ABSTRACT: Introduction Noninvasive ventilation with nasal CPAP (n-CPAP), or nasalintermittant positive pressure ventilation (n-IPPV) is becoming standard ofcare in preterm. Limited experience has been reported withnasal high frequency oscillatory ventilation (n-HFOV). We present 2 newbornstreated by n-HFOV applied with binasal prongs (Ram cannula Neotech) and DraegerBabylog 8000+ ventilator.
Cases 1. A 900 gr. 28 weeks gestation infant was intubated, given surfactant and ventilated by volume guarantee pressure-support ventilation for RDS. On 2nd day HFOV was started due to worsening respiratory status. On 11th day patient was extubated to n-HFOV and continued for 4 days followed by n-IPPV/n-CPAP.
2. A 830 gr. 28 weeks gestation infant was resuscitated in the delivery room. RDS and pulmonary interstitial emphysema was detected on radiography and surfactant was given. At 12 h pneumothorax occurred necessitating thoracal tube insertion and HFOV. Conventional ventilation was tried several times without success. HFOV continued for 46 days then baby was extubated to n-HFOV. Patient required reintubation after 4 days due to sepsis.
Conclusion n-HFOV with binasal prongs could be an alternative for preterms after prolonged HFOV.
Archives of Disease in Childhood 10/2014; 99(Suppl 2):A496-A496. DOI:10.1136/archdischild-2014-307384.1375 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Near infrared spectroscopy (NIRS) is evolving into a clinical monitorization method providing information regarding not only cerebral but abdominal or renal tissue oxygenation (rSO2) as well. Fractional tissue oxygen extraction (FTOE) is calculated from NIRS measurements and arterial haemoglobin oxygen saturation (SpO2) measured by pulse oxymeter. Multichannel NIRS devices maybe very helpful in newborns with multisystem problems enabling realtime simultaneous measurements of rSO2 from different parts of the body. Pulse oxymeter integrated into a multichannel NIRS device provides simultaneous SpO2 monitoring making FTOE calculations more accurate and easier.
Methods Three term newborns; 2 undergoing therapeutic hypothermia for hypoxic ischaemic encephalopathy grade II, 1 with critical pulmonary stenosis before and after cardiac surgery were monitored by multichannel NIRS (Sensmart X-100, NONIN, USA) device including cerebral, abdominal, renal rSO2 and SpO2 probes. FTOE was calculated using the equation; (SpO2-rSO2)/SpO2.
Results Duration of monitorization and rSO2 and FTOE values of different body sites are presented in table with mean±SD.
Discussion Longterm simultaneous monitoring of tissue oxygenation in brain, abdomen and kidneys is useful while following newborns with multisystem problems requiring hypothermia or circulatory medications to titrate the treatment accordingly. NIRS device with integrated pulse oxymeter maybe helpful for realtime calculation of FTOE to assess hemodynamics.
Archives of Disease in Childhood 10/2014; 99(Suppl 2):A409-A410. DOI:10.1136/archdischild-2014-307384.1140 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 ± 1.3 days in Group I and 2.27 ± 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 ± 2.2 days in Group I and 3.53 ± 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 ± 1.5 days and 2.73 ± 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn’t decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.
Indian Journal of Hematology and Blood Transfusion 03/2014; 30(1). DOI:10.1007/s12288-012-0186-3 · 0.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Newborns are exposed to a considerable number of painful stimuli. This study is aimed to investigate the effects of 30% glucose solution and nonnutritive sucking on pain perception during venipuncture. Twenty-five term infants were randomized as receiving 30% dextrose (group 1) or sterile water (group 2). Neonatal Infant Pain Scale scores, skin conductance algesimeter recordings, and near-infrared spectroscopy measurements were recorded during the procedure. Neonatal Infant Pain Scale and skin conductance algesimeter results were decreased in both groups from that during venipuncture to after the procedure. Group 1 had lower Neonatal Infant Pain Scale scores compared with group 2 after venipuncture, different from the skin conductance algesimeter, where no difference was observed between groups. In group 1, cerebral blood volume increased after venipuncture. Glucose does not attenuate the Neonatal Infant Pain Scale score and skin conductance algesimeter index during venipuncture, but it leads to a lower Neonatal Infant Pain Scale score after venipuncture unlike the skin conductance algesimeter index, which was not lowered.
[Show abstract][Hide abstract] ABSTRACT: Gamma-glutamyltransferase (GGT) is commonly measured in newborn infants as a sensitive liver function test, however reference ranges mostly based on early studies including relatively small number of patients. The aim of this study was to emphasise recently changed GGT values due to changed newborns profile admitted to neonatal intensive care units (NICU) and establish new cross-sectional reference ranges for the serum GGT levels in a cohort of neonates between 26 and 42 weeks gestational age in one center.
From January 1, 2010 to December 31, 2012 liver function tests including serum GGT measurement were performed in 705 newborns who were admitted to NICU due to different etiologies at Gazi University School of Medicine Hospital, Ankara, Turkey. Infants with Apgar score <8 on 5th minutes, any metabolic or liver disease, cholestasis, congenital infection, culture proven sepsis, elevated serum aminotransferases, who treated with phenobarbital were excluded. Clinical and laboratory data of 583 neonates was analysed retrospectively. GGT was measured by enzymatic method by Abbott Architect C16000 autoanalyser. Mean, 2.5th and 97.5th percentiles were used to express the reference range data.
Four hundred sixty one GGT values of 200 preterm infants and 501 GGT values of 383 term infants during the first 28 days after birth were analysed. Serum GGT levels of preterm infants in the first 7 days and between 8-28 days after delivery were (mean ± SD; 141.81 ± 88.56 U/L and 131.17 ± 85.53 U/L) similar with term infants (139.90 ± 86.46 U/L and 144.56 ± 86.51 U/L) respectively (p = 0.649 and p = 0.087). Serum GGT levels were found to be significantly higher in male infants (145.98 ± 93.68 U/L) than females (132.18 ± 78.97 U/L) (p = 0.035) and infants born vaginally (152.24 ± 90.71 U/L) had also higher serum GGT activity than those born by cesarean section (135.38 ± 85.37 U/L) (p = 0.005).
A new reference range for serum GGT levels which higher than previous reference values can identify neonates with actually abnormal results and prevent unnecessary interventions.
Journal of pediatric gastroenterology and nutrition 08/2013; DOI:10.1097/MPG.0b013e3182a907f2 · 2.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of a newborn with severe respiratory distress since birth with two giant intrathoracic and separate eneteric duplication cysts in right hemithorax. On day 19, the intrathoracic cysts were removed, and the baby was discharged on his 22nd day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This report is the first case of two isolated, separated and giant right intrathoracic gastric duplication cysts in literature. The diagnostic values of radiological evaluation and surgical and pathological management for precise diagnosis are discussed.
Scottish medical journal 08/2013; 58(3):e28-30. DOI:10.1177/0036933013482662 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perinatal asphyxia is an important cause of neonatal morbidity and mortality. Hypothermia is an effective treatment of neonatal hypoxic-ischemic encephalopathy in infants. Cold agglutination is a primary or acquired autoimmune disease that involves autoantibodies that lead to hemagglutination at low temperatures lower than that of the body. In this case the importance of cold agglutinins during therapeutic hypothermia is presented.
The Indian Journal of Pediatrics 12/2012; 80(11). DOI:10.1007/s12098-012-0941-3 · 0.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and Aim Neonatal Intensive Care Unit (NICU) is a noisy environment in which infants can be exposed to high noise levels. The aim of the study is to evaluate the adverse effects of noise on hearing and, neurological outcomes of NICU graduates at six months of age.
Methods Thirty two infants that had been admitted to Gazi University Hospital NICU and 25 healthy controls, were included in the study. Noise levels were recorded continously during hospitalization period. TEOAE, DPOAE and ABR tests were used to assess hearing. Neurological outcome was assessed with Bayley II Infant Development Scale.
Results The median period of noise exposure above 45 dB, was 50.1% of the entire hospitalization period. Levels exceeding 45 dB were mostly below 124 Hz. Major source of noise was traced back to the incubators. All patients passed the hearing screening tests before discharge. On the sixth month follow up; hospitalized infants had lower DPOAE SNR amplitudes (dB) at five frequencies including 1001, 1501, 3003, 4004, 6006 Hz in both ears. DPOAE fail rates at 1001 Hz and 1501 Hz were higher in hospitalized infants (p=0.001). Positive correlation between noise exposure and duration of hospitalization was determined. Infants who failed at 1001 and 1501 Hz had similar Bayley II Infant Development Scale scores and there were no difference between groups.
Conclusion Major noise source in NICU was found to be the incubators. Although hearing loss was not detected in any infants, hearing tests at sixth months of life were adversely affected.
Archives of Disease in Childhood 10/2012; 97(Suppl 2):A365-A366. DOI:10.1136/archdischild-2012-302724.1280 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Preterm children experience a high prevalence of long-term serious cognitive defects. Fetuses of 23 weeks of gestational age are now viable. Subsequent physiological stress can seriously disrupt the maturational processes that lay down this arthitecture. The ensuing abnormalities in brain may then contribute to the long term cogntive deficits. We aimed to measure regional brain volumes on the magnetic resonance imaging of prematurely born 9-year-old children and group matched term children. Nineteen nine year old preterm children and 21 term children recruited for the study. All subjectswent under the volumetric magnetic resonance imaging. In the neurocognitive assessment, it was observed that preterm children had impairments in visuospatial functioning, three- dimensional thought ability, data processing andlearning speed, executive function, complicated executive attention, perseveration, working memory, abstract thinking, installation replacement, focused attention. Volumes of serebellum, right and left caudate nucleus, right and left putamen, right and left globus pallidus. Right and left hypocampus and corpus callosum were significantly smaller in preterm children. There was a correlation between serebellar volume and executivefunction, harmony in social life, importance given to attentionand detail, visuospatial disorder and verbal IQ, hypocampal volume and attention, arithmetics, verbal and performance IQ, bilateral caudate nucleus volume and full scale IQ score, vocabulary and speech skills, time in event processing, three dimensional thinking and verbal IQ scores. Our data indicate that preterm birth is associated with regionally specific, long term reductions in brain volume, in turn lead to poorer cognitive outcome.
Archives of Disease in Childhood 10/2012; 97(Suppl 2):A358-A358. DOI:10.1136/archdischild-2012-302724.1252 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Iron deficiency (ID) is a global health problem. We aimed to determine the prevalence of ID at the first year of life in infants who were hospitalized in our neonatal intensive care unit (NICU) and investigate the effects of various factors on iron status. One year follow-up data of 219 infants who were discharged from NICU was retrospectively evaluated. ID anemia and ID without anemia were detected in fifteen infants (6.8%) and five (2.3%) infants, respectively. We concluded that, due to prophylactic iron treatment and close follow-up, hospitalization in neonatal period did not have any adverse effect on iron status at first year of life.
[Show abstract][Hide abstract] ABSTRACT: Total parenteral nutrition (TPN) is a revolution in neonatal intensive care unit (NICU) care, but this therapy is not without problems. A 35-week-old, 1300 g female infant was transferred to our NICU because of bilious vomiting and feeding problems. When enteral feeding was started again, a severe condition similar to the previous one developed. On the 24th day, the patient underwent surgery with a diagnosis of Hirschprung's disease. One week before surgery, the parenteral solutions were composed without vitamins because intravenous vitamin supplements suitable for infants were not available. Thereafter, the patient suffered from severe hypoglycaemia, and sepsis started to develop, accompanied by a large anion gap and metabolic acidosis which is severe lactic acidosis refractory to massive doses of bicarbonate. The acidosis improved significantly when the patient was treated with thiamin. Although TPN is life saving in the NICU, meticulous attention must be paid while treating a patient with TPN, and all possible nutrients should be provided. In this report, a case of a preterm newborn requiring a prolonged period of TPN and complicated by serious lactic acidosis is presented and discussed.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to determine language levels in twins and singletons born after at least 34 weeks gestation and without identifiable neurological abnormality and to evaluate whether in vitro fertilization (IVF) affects language development in twin pregnancies.
A prospective study of a large cohort of all children born between 1 January 2001 and 31 December 2003 was carried out at Gazi University Hospital. All live-born twin pairs in which both twins survived were identified, and a comparable sample of families with pairs of singletons were chosen. The Stanford-Binet Intelligence Scale Form and the translated Turkish form of the Peabody Picture Vocabulary Test were completed at 60 months.
Even after excluding the most premature twins and those with diagnosable neurological damage, twins performed worse than singletons on language development tests. Twin girls had better scores than twin boys. A statistically significant difference was found between the scores of term and preterm twins. No significant difference was noted when compared according to birth order. Appropriate for gestational age (AGA) twins did better than small for gestational age (SGA) twins in the test scores. All twin girls did not differ from singleton girls, but all twin boys performed worse than singleton boys. Term twins had similar results with term singletons, but preterm twins had lower scores than preterm singletons. SGA singletons had better scores than SGA twins, while AGA twins and singletons did not differ. When the children were compared with regard to method of conception, IVF children had significantly lower scores on the tests than those in the spontaneous conception group.
It is hoped that the present findings could lead to a more precise assessment of children for speech impairment and, above all, to more efficient preventive intervention. Whatever mechanisms are involved, the present results indicate that twins born as a result of IVF, are at a disadvantage in terms of language development in comparison with spontaneously conceived twins.
Pediatrics International 07/2011; 53(6):944-9. DOI:10.1111/j.1442-200X.2011.03425.x · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.
This was a retrospective study of LGA infants of ≥36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006-2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student's t test were used for comparing variables.
Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045).
The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.
World Journal of Pediatrics 06/2011; 8(2):136-9. DOI:10.1007/s12519-011-0291-7 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess cerebral and peripheral oxygenation, by using near infrared spectroscopy (NIRS) and microcirculation by using side stream dark field (SDF) imaging in newborns with polycythemia before and after partial exchange transfusion (PET) therapy to investigate treatment effect on tissue oxygenation and microcirculation.
Polycythemic newborns with venous haematocrit (Htc) >70% or ≥65% with symptoms were included. NIRS measurements for cerebral and peripheral oxygenation and SDF recordings for microcirculatory flow assessment were obtained before and after PET. Fractional tissue oxygen extraction (FTOE) was calculated based on tissue oxygenation index and oxygen saturation. Wilcoxon test was used for statistical analysis.
Fifteen newborns were included. Cerebral tissue oxygenation index, microvascular flow index and % of vessels with hyperdynamic flow increased after PET; median (range): 61.27 (51.36-61.87) versus 64.54 (54.1-74.38), 2.74 (2.46-3) versus 3.22 (2.64-3.75) and 0 (0-2.8) versus 3 (0-99.3), respectively. Whereas cerebral fractional tissue oxygen extraction (CFTOE), % of vessels with sluggish flow decreased after treatment; 0.36 (0.22-0.44) versus 0.31 (0.17-0.46), 1.4 (0-69) versus 0 (0-0.9), respectively. Peripheral oxygenation was unchanged.
Partial exchange transfusion improves microcirculation in polycythemic newborns. Cerebral oxygenation increases and cFTOE decreases suggesting increased blood flow. Microvascular flow increases possibly representing reactive hyperperfusion after hemodilution. Whether these effects are beneficial require further research.
[Show abstract][Hide abstract] ABSTRACT: Congenital cystic adenomatoid malformation (CCAM) is a rare bronchopulmonary malformation characterized by loss of the normal pulmonary tissue. CCAM may be frequently associated with cardiac and renal anomalies. Rarely, CCAM may be seen with chromosome abnormalities. This is the first reported neonatal case of prenatally detected CCAM and postnatally diagnosed trisomy 13.
The Turkish journal of pediatrics 05/2011; 53(3):337-41. · 0.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of delivery route and maternal anesthesia type and the roles of vasoactive hormones on early postnatal weight loss in term newborns.
Ninety-four term infants delivered vaginally (group 1, n=31), cesarean section (C/S) with general anesthesia (GA) (group 2, n=29), and C/S with epidural anesthesia (EA) (group 3, n=34) were included in this study. All infants were weighed at birth and on the second day of life and intravenous (IV) fluid infused to the mothers for the last 6 h prior to delivery was recorded. Serum electrolytes, osmolality, N-terminal proANP (NT-proANP), brain natriuretic peptide (BNP), aldosterone and plasma antidiuretic hormone (ADH) concentrations were measured at cord blood and on the second day of life.
Our research showed that postnatal weight loss of infants was higher in C/S than vaginal deliveries (5.7% vs. 1.3%) (p < 0.0001) and in EA group than GA group (6.8% vs. 4.3%) (p < 0.0001). Postnatal weight losses were correlated with IV fluid volume infused to the mothers for the last 6 h prior to delivery (R = 0.814, p = 0.000) and with serum NT-proANP (R = 0.418, p = 0.000), BNP (R = 0.454, p = 0.000), and ADH (R = 0.509, p = 0.000) but not with aldosterone concentrations (p > 0.05).
Large amounts of IV fluid given to the mothers who were applied EA prior to the delivery affect their offsprings' postnatal weight loss via certain vasoactive hormones.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to report our experience with intravenous voriconazole therapy in the treatment of persistent Candida septicemia in very low birth weight (VLBW) neonates. Candidiasis was defined if an infant had a positive blood culture. Ten VLBW newborns developed Candida sepsis, and candidemia persisted in 6 of them despite 3 to 21 days of antifungal therapy with amphotericin B, either conventional or liposomal, and fluconazole. After the addition of voriconazole, clearance of Candida was achieved within 3-7 days of treatment. Antifungal therapy combination with liposomal amphotericin B and voriconazole was continued for at least two weeks after two negative cultures 48 hours apart. We conclude that considering the hazardous effects of Candida infections in preterm newborns, voriconazole can be added to the treatment of fungal sepsis in newborns who still have persistent candidemia despite conventional antifungal management. More clinical information is needed before voriconazole can be used as a first-line drug in antifungal therapy in newborns.
The Turkish journal of pediatrics 01/2011; 53(1):19-26. · 0.43 Impact Factor