[Show abstract][Hide abstract] ABSTRACT: Background/aim: The aim of this study was to report the gestational age (GA) and birth weight (BW) distribution of premature babies who needed treatment for retinopathy of prematurity (ROP) and to assess the timing of the treatment. Materials and methods: The records of 9008 infants who were screened for ROP were examined and 556 infants who underwent laser therapy for ROP were reviewed. Sex, GA, BW, postnatal age, and postmenstrual (PM) age at the time of laser therapy were recorded. The babies were classified as in-born (Group 1) and out-born infants (Group 2). Results: The mean GA was 27.3 weeks (range: 22–33 weeks) and the mean BW was 991.1 g (range: 520–2160 g). Of the treated infants, 7.0% were born later than 32 weeks and 8.3% were born over 1500 g. The mean postnatal age was 9.48 weeks (range: 5–22 weeks) and the mean PM age was 36.72 weeks (range: 29–48 weeks) at the time of treatment. Mean BWs and GAs were significantly higher and the mean postnatal age at the time of laser therapy was significantly earlier in Group 2. Conclusion: Infants with severe ROP had a wider range of BWs and GAs compared to those from developed countries and earlier treatment was needed for out-born infants.
Preview · Article · Jan 2016 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Objective: Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants.Methods: This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test.Result: Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement.Conclusions: In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.
No preview · Article · Dec 2015 · Journal of Maternal-Fetal and Neonatal Medicine
[Show abstract][Hide abstract] ABSTRACT: Objective To compare the effectiveness of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive-pressure ventilation (NIPPV) as the initial respiratory support within the minimally invasive surfactant therapy (MIST) approach in preterm infants with respiratory distress syndrome.
Design Prospective, randomised controlled study.
Setting Tertiary neonatal intensive care unit.
Patients and interventions This study enrolled 200 preterm infants with a gestational age of 26–32 weeks who showed signs of respiratory distress but did not require intubation in the delivery room. Surfactant therapy was performed using the MIST approach in the patients who met the criteria for surfactant administration.
Main outcome measures The primary outcomes were a need for intubation within the first 72 h of life and a surfactant requirement.
Results The infants in the study displayed similar characteristics at birth. Fewer infants in the NIPPV group required surfactant therapy (38% vs 60%; p=0.002) or invasive ventilation during the first 72 h of life (13% vs 29%; p=0.005), and NIPPV reduced the rate of moderate-to-severe bronchopulmonary dysplasia (BPD) (7% vs 16%; p=0.046). Multivariate logistic regression analysis showed that NIPPV support (OR: 0.36, 95% CI 0.17 to 0.76; p=0.008) and higher gestational age (OR: 0.76, 95% CI 0.59 to 0.98; p=0.041) reduced the need for invasive ventilation within the first 72 h of life. Surfactant requirement was also decreased with NIPPV support (OR: 0.39, 95% CI 0.22 to 0.71; p=0.002). However, there was no impact on BPD, based on the multivariate analysis.
Conclusions In infants born at 26–32 weeks’ gestation, NIPPV reduced the need for invasive ventilation and the surfactant requirement within the MIST approach.
Trial registration number ClinicalTrials.gov under identifier NCT01741129.
No preview · Article · Nov 2015 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract] ABSTRACT: Lamotrigine (LTG) is a widely used second-generation antiepileptic drug for long-term therapy of epileptic patients. Although LTG monotherapy during pregnancy is assumed to be relatively safe, teratogenic effects related to LTG has been reported previously. The presence of fetal malformations and maternal drug-induced lupus erythematosus concurrently in a pregnant women using LTG have not been reported before. We herein report a term infant with coarctation of aorta and ventricular septal defect, who was born to a mother treated with LTG for epilepsy before conception and throughout pregnancy. The mother was diagnosed with drug-induced lupus erythematosus at the 36th gestational week, and the symptoms resolved after discontinuation of the drug. Fetal cardiac anomalies should be searched in mothers who were exposed to LTG during pregnancy.
No preview · Article · Sep 2015 · American journal of therapeutics
[Show abstract][Hide abstract] ABSTRACT: Objective:
Transient tachypnea of the newborn (TTN) results from inadequate neonatal lung fluid clearance. Low-dose dopamine induces natriuresis in the kidneys and it has been assumed that, at this low dosage, dopamine increases renal perfusion in critically ill patients. Medium doses have positive inotropic and chronotropic effects via increased β-receptor activation. Recent studies have demonstrated that dopamine stimulates the clearance of pulmonary edema. Furthermore, β-adrenergic agonists regulate Na+ channels and Na-K-ATPase activity in the pulmonary epithelium. This study investigated the effect of dopamine at different dosages on TTN treatment.
A prospective controlled study examined 60 infants with TTN older than 34 weeks of gestation who required at least 24 h of O2 and nasal continuous positive airway pressure (nCPAP) treatment. The infants were randomized into three groups of 20: controls, infants treated with low-dose dopamine (3 μg/kg/min), and infants treated with a medium dose (5 μg/kg/min). The control and study groups were compared in terms of the requirement for mechanical ventilation, and the durations of nCPAP, oxygen requirement, and hospitalization.
The requirement for mechanical ventilation, and durations of nCPAP, oxygen requirement, and hospitalization did not differ significantly among the three groups (P=0.54, 0.16 and 0.11, respectively).
Dopamine treatment in low-moderate doses does not improve the outcome in TTN. Thus, further studies in this area are needed.
No preview · Article · Sep 2015 · Journal of Perinatal Medicine
[Show abstract][Hide abstract] ABSTRACT: Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants.
Preterm newborns with a gestational age of <32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group.
Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own.
Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development.
No preview · Article · Apr 2015 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
[Show abstract][Hide abstract] ABSTRACT: Objective: Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants. Methods: Preterm newborns with a gestational age of <32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group. Results: Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own. Conclusion: Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development.
[Show abstract][Hide abstract] ABSTRACT: Objective Our objective was to determine the neurodevelopmental outcome at 18–24 months’ of corrected age (CA) in preterm infants with severe intraventricular haemorrhage (IVH).
Methods This was a retrospective cohort study of all preterm infants who were <37 weeks’ gestation, had Grade 3–4 IVH. A comprehensive assessment including hearing, vision, neurological and developmental evaluation with Bayley Scales of Infant Development, Second edition (BSID II) was performed by the experienced researchers at 18 to 24 months’ CA.
Results A total of 138 were diagnosed as severe IVH (Grade 3–4). Median Apgar score (p < 0.01) and resuscitation at birth (p < 0.01) were significantly different for group 1, group 2 and group 3. The use of catheterization, need for mechanical ventilation, need for phototherapy, retinopathy of premature and bronchopulmonary dysplasia were significantly higher in-group 1 compared to group 2 and 3 (p < 0.001, p < 0.001, p < 0.01, p < 0.01 and p = 0.014 respectively). The duration of hospitalisation and mortality rates consistent with the degree of prematurity and were significantly higher in-group 1 compared to group 2 and 3 (p = 0.03 and p = 0.01). Among the long-term outcomes; the rates of CP and NDI did not differ between the groups (p = 0.68 and p = 0.068).
Conclusion Our results demonstrated that long-term outcomes of preterm infants did not differ between the groups classified according to the birth weight at 2 years of age. This has leaded to the conclusion that severe IVH is alone represents a significant risk factor for poor neurodevelopmental outcome in this already high-risk population.
No preview · Article · Oct 2014 · Archives of Disease in Childhood
[Show abstract][Hide abstract] ABSTRACT: Background and aims Compared with term infants, late preterm infants have higher risks for morbidities such as respiratory distress, hypothermia, hypoglycemia, hyperbilirubinemia and feeding difficulty. The aim of this study to investigate incidence and clinical characteristics of feeding difficulty in late preterm infants.
Methods A total of 426 infants were enrolled. We evaluated the clinical and demographic characteristics and feeding difficulty of late preterm infants.
Results 54 infants had feeding difficulty. There were no differences in gestational age and birth weight among the groups. Mean intolerance day was 2.3 ± 1.2 days. Compared infants with feeding intolerance and non-feeding intolerance full enteral feeding time 8 ± 2.3 days and 5.2 ± 1.7 days, respectively (p < 0.001). Feeding with breast milk rates was similar between the groups. Prokinetic use in the feeding intolerance group was 46% (n = 25). Subgroup analysis between prokinetic users and non-users there were no differences in full enteral feeding time and duration of parenteral nutrition.
Conclusions Late preterm infants should be followed closely for the complications such as feeding difficulty.
Preview · Article · Oct 2014 · Archives of Disease in Childhood
[Show abstract][Hide abstract] ABSTRACT: We report an infant who developed encephalopathy within the first 3 days of life. He had persistent hiccups that progressed to deep coma 72 hours after admission. The sepsis parameters and cerebrospinal fluid examination (CSF) were normal. The metabolic evaluation confirmed hyperammonemia, and hypercitrullinemia. The ratio of CSF/plasma glycine concentration was normal. This did not agree with our initial diagnosis of nonketotic hyperglycinemia where hiccups is present more often. Neonatal onset of argininosuccinic acid synthetase deficiency (ASD; citrullinemia) should be brought in mind in the differential diagnosis of encephalopathy in association with hiccups in the neonatal period suggesting inborn errors of metabolism.
No preview · Article · Oct 2014 · Archivos argentinos de pediatría
[Show abstract][Hide abstract] ABSTRACT: Background and aims Neonatal sepsis remains an important and potentially life-threatening clinical syndrome and a major cause of neonatal mortality and morbidity, particularly in preterm infants. The aim of this study to investigate whether values of base excess before the onset of clinical signs and symptoms of sepsis indicate infection in the early diagnosis of neonatal sepsis.
Methods A total of 118 infants were enrolled. The infants were classified into two groups: group 1 (sepsis, n = 49) and group 2 (control, n = 69). Blood gas analysis investigated for screening of neonatal sepsis.
Results A total of 49 infants with neonatal sepsis and 69 healthy controls were enrolled. A comparison of markers of sepsis revealed C-reactive protein, interleukin-6 level to be significantly higher and pH, pCO2, HCO3 and base excess values to be significantly lower in newborns with sepsis compared healthy controls (p < 0.01). The optimum cut-off value in the diagnosis of neonatal sepsis was found to be -5 mmol/L for base excess. Sensitivity, specificity, positive predictive value and negative predictive value of this base excess cut-off for neonatal sepsis were 75, 91, 86 and 84% respectively.
Conclusions This is the first study to determine the relationship between the decrease value of base excess and early stage of neonatal sepsis. If the value of base excess <-5 mmol/L without an underlying another reason, may need close follow up of infants for neonatal sepsis and it may help early diagnosis.
Full-text · Article · Oct 2014 · Archives of Disease in Childhood
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective: The aim of this study was to compare the efficacy of orally administered Lactobacillus reuteri (L. reuteri) versus nystatin in prevention of fungal colonization and invasive candidiasis in very low birth weight infants. Methods: A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1500 g. Patients were randomized into two groups, to receive L. reuteri or nystatin. Skin and stool cultures were performed once a week for colonization and blood cultures for invasive infections. The trial was registered to ClinicalTrials.gov under identifier NCT01531192. Results: A total of 300 preterm infants were enrolled (n=150, for each group). Gastrointestinal colonization and skin colonization rates were not significantly different between the groups (18.7% vs. 16%, p=0.54 and 14% vs. 12%, p=0.6, respectively). Invasive candidiasis was detected in two patients of the probiotic group and one patient of the antifungal group. Proven sepsis, feeding intolerance, and duration of hospitalization were significantly lower in the probiotics group than in the antifungal group. Conclusions: Prophylactic L. reuteri supplementation is as effective as nystatin, and more effective in reducing the incidence of proven sepsis in addition to its favorable effect on feeding intolerance.
No preview · Article · Sep 2014 · Journal of Maternal-Fetal and Neonatal Medicine
[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy and safety of oral paracetamol and oral ibuprofen for the pharmacological closure of patent ductus arteriosus (PDA) in preterm infants.
This prospective, randomized, controlled study enrolled 90 preterm infants with gestational age ≤30 weeks, birthweight ≤1250 g, and postnatal age 48 to 96 hours who had echocardiographically confirmed significant PDA. Each enrolled patient received either oral paracetamol (15 mg/kg every 6 hours for 3 days) or oral ibuprofen (initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 hours).
Spontaneous closure rate for the entire study group was 54%. After the first course of treatment, the PDA closed in 31 (77.5%) of the patients assigned to the oral ibuprofen group vs 29 (72.5%) of those enrolled in the oral paracetamol group (P = .6). The reopening rate was higher in the paracetamol group than in the ibuprofen group, but the reopening rates were not statistically different (24.1% [7 of 29] vs 16.1% [5 of 31]; P = .43). The cumulative closure rates after the second course of drugs were high in both groups. Only 2 patient (2.5%) in the paracetamol group and 3 patients (5%) in the ibuprofen group required surgical ligation.
This randomized, controlled clinical study compared oral paracetamol with ibuprofen in preterm infants and demonstrated that paracetamol may be a medical alternative in the management of PDA.
No preview · Article · Dec 2013 · The Journal of pediatrics
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of oral Lactobacillus reuteri (L reuteri) first on the incidence and severity of Necrotising enterocolitis (NEC) and second on sepsis.
Prospective randomised controlled study.
Tertiary neonatal intensive care unit.
Preterm infants with a gestational age of ≤32 weeks and a birth weight of ≤1500 g were included (n=400). Infants in the first group were given 100 million CFU/day (5 drops) of lyophilised L reuteri (DSM 17938) mixed in breast milk or formula, starting from first feeding until discharge. Participants in the control group were given a placebo.
To determine and compare the frequency of NEC and/or death after 7 days, frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay.
There was no statistically significant difference between groups in terms of frequency of NEC stage ≥2 (4% vs 5%; p=0.63) or overall NEC or mortality rates (10% vs 13.5%; p=0.27). Frequency of proven sepsis was significantly lower in the probiotic group compared to the control group (6.5% vs 12.5%; p=0.041). A significant difference was also observed with regard to rates of feeding intolerance (28% vs 39.5%; p=0.015) and duration of hospital stay (38 (10-131) vs 46 (10-180) days; p=0.022).
Our results show that oral L reuteri does not seem to affect the overall rates of NEC and/or death in preterm infants followed up in the neonatal intensive care unit, and significant reductions were observed in the frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay.
Full-text · Article · Dec 2013 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract] ABSTRACT: Objective
To determine the risk factors associated with lower respiratory tract infections (LRTI) related hospitalizations in preterm infants receiving palivizumab throughout the high season for respiratory syncytial virus (RSV) infection.
Premature infants who were commenced on palivizumab prophylaxis during the RSV season were included in the study following parental consent. Information on demographic, social, prenatal and postnatal clinical characteristics was recorded and risk factors associated with hospitalization were evaluated for each patient.
While 234 participants (Group 1, 92.8%) did not require hospitalization during the study period, 18 patients (Group 2, 7.2%) were hospitalized at least once for LRTI during the RSV season. The rate of moderate-severe bronchopulmonary dysplasia (BPD) was significantly higher in group 2 compared to group 1 (38.9% vs 16.2%; P=0.016). Of the 18 infants who were hospitalized, 6 (33.3%) tested positive for RSV while the remaining 12 patients (66.7%) were negative for RSV. Odds ratio (OR) analysis of several risk factors revealed the presence of BPD (OR: 3.28; 95%CI: 1.19-9), being from a family with low socioeconomic status (OR: 3.64; 95%CI 1.08-12.3) to be associated with a higher likelihood of LRTI-related hospitalization.
Our data demonstrated that RSV is an important LRTI agent and cause of hospitalization especially in preterm infants with additional risks such as BPD, gestational age of <28 weeks and low socioeconomic status. We suggest that improving care conditions and decreased BPD with prematurity would help in prevention of LRTI hospitalization.
Full-text · Article · Dec 2013 · Iranian Journal of Pediatrics