Retinopathy of prematurity in extremely low birth weight infants in Turkey

PURPOSE

This study was designed to determine the incidence rate of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants in the middle Black Sea region of Turkey.

METHODS

The charts of 1,719 preterm infants were reviewed between January 2003 and September 2011. Of them, 225 (13.1%) infants with birth weights of less than 1,000 g were enrolled in the study. ROP was classified according to the international classification of retinopathy.

RESULTS

Of the 225 ELBW infants, 47.6% had advanced ROP, 23.1% had mild ROP, and 29.3% did not have ROP; 30.2% infants required treatment. ROP was detected in 75.6% of multiple births versus 69.6% of singleton births; there were no significant differences between the two groups (P = .388).

CONCLUSION

Extremely premature infants with low gestational ages had high incidence rates of advanced ROP. Most ELBW infants require ROP treatment. In addition, increased survival of ELBW infants owing to advancements in neonatal care warrants the specialization of ophthalmologists in regard to improved diagnosis and treatment of ROP.

Screening for retinopathy of prematurity (ROP) in the middle Black Sea region of Turkey

This study was designed to determine the frequency of retinopathy of prematurity (ROP) and the effectiveness of the screening protocol in preterm infants for our country. With these objectives, the charts of 1000 preterm infants were reviewed in Ondokuz Mayis University, Department of Ophthalmology. ROP frequency, the effect of gestational age (GA) and birth weight (BW) and the effectiveness of the screening protocol were evaluated. In this study, ROP was observed in 30.8% of infants and not observed in 69.2% of infants. Threshold ROP was detected in 7.0%. The frequency of threshold ROP was 43.5%, 20.0%, 12.6%, and 8.8% in the infants with GA of < or = 26, 26-28, 29-30, and 31-32 weeks, respectively. Threshold ROP was not observed in babies born after 34 weeks. Treatment was required for 11% of the infants. ROP treatment requirement (11%) was limited to babies with GA of < 34 weeks of gestation. Incidence of ROP was inversely proportional with GA and BW. Treatment was not required when GA was > 34 weeks. A new ROP screening protocol is proposed for Turkey, which is: screening of preterm babies with GA of < 34 weeks and BW of < 1800 g.

Neonatal morbidity and mortality of late-preterm babies

OBJECTIVE

To analyze neonatal morbidity and mortality rates of late-preterms and to compare them with their term counterparts in a tertiary care unit in Turkey.

STUDY DESIGN

The study included 252 late-preterm newborns (34 0/7--36 6/7 weeks' gestational age), admitted to Neonatal Intensive Care Unit in the first 24 h of life between January 2005 and June 2007 and 252 newborns born in the same hospital in the same period of time. Babies with major congenital and/or chromosomal abnormalities were excluded.

RESULTS

The mortality rate was 2.3% in late-preterms. None of the term newborns died. Compared to terms, late-preterms were 11 times more likely to develop respiratory distress, 14 times more likely to have feeding problems, 11 times more likely to exhibit hypoglycemia, 3 times more likely to be readmitted and 2.5 times more likely to be rehospitalized. Late-prematurity, being large for gestational age, male gender, and cesarean delivery were significant risk factors for respiratory distress.

CONCLUSION

Late-preterms have significantly higher risk of morbidity and mortality compared with term newborns. Greater concern and attention is required for the care of this ignored, at-risk population.

Two cases of 9p deletion syndrome and a case of partial trisomy 8 and partial monosomy 9p

Two cases of 9p deletion syndrome anda case of partial trisomy 8 and partial monosomy 9p: We report 3 girls with mental retardation (MR), distinctive malformations of the skull and facial region, including trigonocephaly, small palpebral fissures, and unusually midface hypoplasia, congenital heart defects which are characteristics of monosomy 9p. We performed GTG banding and fluorescence in situ hybridization (FISH) method in all cases. By using cytogenetic methods, three terminal deletions of the short arm of the chromosome 9 were identified and in 2 patients the deletion was de novo, and one patient inherited deletion. FISH analysis showed 46,XX,del(9)(pter-p22).ish del(9)(pter-->p22) in two patients and 46,XX,-9,+der(9)t(8;9)(q24.3;p22)pat.ish der(9)t(8;9)(q24.3;p22)pat (305J7-T7x1,wcp8+,wcp9+) in the third patient. This report compares the symptoms and features of our patients with previously reported patients with a 9p deletion syndrome.

Tear secretion and ferning patterns among premature and full-term newborns

In this study, we aimed to assess the quality and quantity of tears among premature and term newborns. Tear ferning and Schirmer's tests were conducted over the first 10 days of life. Correlations between tear ferning patterns, Schirmer's scores, post-conceptional age, and birth weight were evaluated. Forty-six newborns (23 preterm, 23 term) were enrolled, with a mean post-conceptional age of 36.6 weeks and a mean weight of 2598.2 g. Mean total, basal and reflex Schirmer's test results were 13.5 mm, 6.7 mm and 6.8 mm, on the right and 14.0 mm, 7.1 mm and 6.9 mm on the left eye, respectively. Median ferning score was 2 (range 1-3) bilaterally. Schirmer scores were correlated with ferning capacity and post-conceptional age. Our study shows that newborns secrete moderate quantity, good quality tears. Ferning capacity, Schirmer scores and post-conceptional age are correlated.

Reference values of cord blood transferrin, ceruloplasmin, alpha-1 antitrypsin, prealbumin, and alpha-2 macroglobulin concentrations in healthy term newborns

Acute phase proteins are sensitive markers of tissue necrosis and inflammatory process. These markers may be especially useful in the neonatal period, in which mortality and morbidity rates are high, because fetus and baby are subjected to numerous metabolic, genetic, physiologic and environmental injuries such as neonatal asphyxia and septicemia. The purpose of the present study was to establish normal cord blood levels of some acute phase proteins in healthy term neonates. Umbilical cord blood was obtained at the time of vaginal delivery in 60 newborn infants (30 girls, 30 boys). Specific protein concentrations were measured by nephelometric assay. Transferrin, ceruloplasmin, alpha-1 antitrypsin, prealbumin, and alpha-2 macroglobulin concentrations [arithmetic mean (+/- SD)] were found to be 199.7 (+/- 34.6) mg/dl, 14.6 (+/- 4.0) mg/dl, 160.2 (+/- 23.6) mg/dl, 11.9 (+/- 2.2) mg/dl, and 284.6 (+/- 44.4) mg/dl, respectively. Prealbumin levels for girls [12.9 (+/- 2.2)] were found to be significantly higher than those of boys [10.9 (+/- 1.8)] (p < 0.001), while there were no significant differences between the other proteins. We conclude that these results may be used as reference values for the diagnosis of pathological conditions in newborns.

Does birth weight discordance in preterm twins affect neonatal outcome?

OBJECTIVE

To compare neonatal morbidity and mortality between hospitalized discordant and concordant preterm twin pairs.

STUDY DESIGN

This was a retrospective, hospital-based study of preterm twins, followed in neonatal intensive care unit. Twins were classified as discordant when the difference in birth weight was >15%. Morbidity and mortality rates were compared between discordant and concordant groups.

RESULTS

Of 136 preterm twins in the study, 54 were discordant and 82 were concordant. In discordant twins hypoglycemia and cesarean delivery rate was higher than concordant pairs. The mortality rate did not differ between concordant and discordant groups.

CONCLUSIONS

Hospitalized preterm discordant twin pairs have an increased risk of hypoglycemia compared to concordants. Discordant growth is not a risk factor for prolonged hospitalization and increased mortality.

An unusual cause of acute renal failure in a newborn: hydrometrocolpos

Here we report on an unusual cause of acute renal failure in a newborn: hydrometrocolpos due to imperforate hymen. Hymenotomy resolved all of the laboratory and clinical abnormalities of the patient and the baby was sent home healthy.

Severe hypothyroidism caused by hepatic hemangioendothelioma in an infant of a diabetic mother

Hemangioendotheliomas can express type 3 iodothyronine deiodinase and cause severe hypothyroidism. The risk of congenital malformations such as vertebral and cardiac abnormalities in infants of diabetic mothers is higher than in babies of healthy women. Here we report an infant of a diabetic mother with hypothyroidism caused by liver hemangioendothelioma. Consumptive hypothyroidism should be an indicator to search for a vascular tumor in infants. Supranormal doses of L-thyroxine might be required for normalization of thyroid function until the tumor involutes or is resected.

Timing of umbilical cord separation and neonatal intensive care unit practices

We investigated the effects of antibiotic and corticosteroid treatment of the mother close to birth and postnatal neonatal intensive care unit (NICU) practices such as phototherapy, parenteral nutrition, and antibiotic treatment of the infant on umbilical cord detachment time. The impact of dry cord care on risk of omphalitis in NICU patients was also investigated. Cord separation time was longer in preterm babies. Antenatal antibiotic and corticosteroid use did not affect cord detachment time. The use of postpartum antibiotics, parenteral nutrition, and phototherapy delayed cord separation. Among these, antibiotic treatment was the most effective factor. Dry cord care did not increase the risk of omphalitis in NICU patients in our series.

Hypoxic-ischemic encephalopathy: correlation of serial MRI and outcome

Twenty-four patients with hypoxic-ischemic encephalopathy were examined with serial magnetic resonance imaging up to 4 years of age. Magnetic resonance imaging studies were performed in the neonatal period, at the fourth month and the fourth year of age, and the findings were compared with the patients' neurodevelopmental outcome at the fourth year of age. Periventricular signal alterations and deep gray matter involvement were usually evident in the initial magnetic resonance imaging studies, and encephalomalacia, periventricular leukomalacia, and atrophy were the common findings on follow-up magnetic resonance imaging studies. In the patients with hypoxic-ischemic encephalopathy, some correlation between magnetic resonance imaging findings and neurodevelopmental outcome was recognized. The patients with deep gray matter involvement on the initial magnetic resonance imaging had a poor prognosis, and the ones with normal magnetic resonance imaging findings had a favorable neurodevelopmental outcome. On the follow-up magnetic resonance imaging findings, encephalomalacia and periventricular leukomalacia were associated with poor neurodevelopmental outcome. In predicting the neurologic outcome at 4 years of age, magnetic resonance imaging findings of the neonatal period had the highest negative predictive value, whereas magnetic resonance imaging findings at 4 months of age and 4 years of age had the highest positive predictive value.

Comparison of trimethoprim-sulfamethoxazole, cephadroxil and cefprozil as prophylaxis for recurrent urinary tract infections in children

The aim of this study was to compare the efficacy of prophylactic trimethoprim-sulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groups randomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months--one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.

Ciprofloxacin treatment in newborns with multi-drug-resistant nosocomial Pseudomonas infections

OBJECTIVES

To evaluate the efficacy and acute side effects of ciprofloxacin treatment in newborns who developed nosocomial Pseudomonas aeruginosa infection.

METHODS

Intravenous ciprofloxacin treatment was given to 30 newborns who developed nosocomial P. aeruginosa infection as proven by culture antibiogram results. Initial doses of 10 mg/kg/day were given and increased up to 40 mg/kg/day according to clinical response, laboratory and culture results. During therapy, complete white blood cell counts, urinalysis, liver and renal function tests were performed weekly. All patients were examined daily during treatment for possible symptoms of joint toxicity such as erythema and swelling. The patients were evaluated by general physical examination, with special attention to joints, 1 week after discharge.

RESULTS

Two of the patients (6.6%) died due to pseudomonas infection, but the bacteria were successfully eradicated in 28 patients (93.4%). Four patients died from other causes. No laboratory abnormality related to ciprofloxacin was observed during treatment. Swelling and hyperemia of the joints were not encountered during treatment and the 1-week period after discharge. Ciprofloxacin-resistant P. aeruginosa isolates were not grown during the study.

CONCLUSION

Ciprofloxacin treatment is effective in life-threatening multi-drug-resistant P. aeruginosa infections.

Thyroid function tests in preterm infants born to preeclamptic mothers with placental insufficiency

OBJECTIVE

Since preeclampsia causes placental insufficiency, it can be hypothesized that it decreases placental passage of thyroxine (T4) from mother to infant and thus may deepen the transient hypothyroxinemia seen in preterm infants after birth. The aim of this study was to compare thyroid function tests of preterm infants born to preeclamptic mothers with placental insufficiency with preterm infants born to mothers without placental insufficiency.

METHODS

Thirty-one preterm infants born to preeclamptic mothers with placental insufficiency were included in the study (group I) and 31 preterm infants born to mothers without placental insufficiency were included as the control group (group II). Thyroid hormone levels were assayed from blood samples obtained from the women before birth and thereafter from the infants at delivery (cord) and on the 1st, 3rd, 7th, and 21st days of life.

RESULTS

Cord blood triiodothyronine (T3), free T3 (FT3) and free thyroxine (FT4) levels in group I were lower than in group II, whereas thyrotropin (TSH) and thyroxine binding globulin (TBG) levels were higher. No statistical difference in hormone levels studied at postnatal 1st, 3rd, 7th, and 21st day was found between the two groups.

CONCLUSION

Low levels of thyroid hormones and high level of TSH in cord blood in premature infants born to preeclamptic mothers with placental insufficiency suggest intrauterine hypothyroidism. Increase in TSH and thyroid hormone concentrations after birth reveal that the hypothalamic-pituitary-thyroid axis is intact.

Low serum apolipoprotein AI levels in amyloidosis related to familial Mediterranean fever

Amyloidosis (A) related to familial Mediterranean fever (FMF) causes serious morbidity and mortality in children. Our study evaluates serum levels of apolipoprotein (Apo) AI, AII, B, and E and Apo AII/AI ratios as a non-invasive diagnostic tool for amyloidosis in children with FMF and FMF-A. Results were compared with those of patients with childhood nephrotic syndrome (NS) and healthy children (controls). Significantly lower serum levels of Apo AI (90.20+/-28.30 mg/dl) were documented in patients with FMF-A than in all other groups (FMF 126.89+/-51.07 mg/dl, NS 140.38+/-33.73 mg/dl, and controls 134.67+/-12.73 mg/dl) ( P<0.01). Diagnostic sensitivity, specificity, and predictive value for this test were 85%, 80%, and 85%, respectively. Apo AII/AI ratio results were essentially equal in all groups ( P>0.05). It is concluded that a decreased Apo AI serum level, but not Apo AII/AI ratio, is a useful, non-invasive test for the early diagnosis of FMF-A in children.

Neonatal tetanus in the middle Black Sea region of Turkey

We retrospectively analyzed 62 cases with neonatal tetanus (NT) seen in the Department of Pediatrics of Ondokuz Mayis University from 1989 to 2001. Epidemiological characteristics and prognostic factors on survival were investigated. We grouped the patients into two groups, the survivors and those who died. All patients were born in non-hygienic conditions, coming from rural regions. None of the mothers had been immunized against tetanus. The mortality rate was 40% (25 of 62 cases) and the only two poor prognostic factors on survival were age younger than five days at onset and the presence of fever. There was no significant difference between the two groups regarding the other known prognostic factors. Although the NT rate is declining, we must continue to protect against it by strictly enforcing preventive policies, especially in rural regions.

Meningitis due to Salmonella in preterm neonates

Meningitis due to Salmonella is a rare condition. Here we report seven cases with neonatal Salmonella meningitis diagnosed and treated in the Pediatric Neonatology Unit of Ondokuz Mayis University Faculty of Medicine between January 1985-February 2001. Five cases were cured with appropriate treatment; in two of them no neurological sequelae were seen. Of the remaining three, reversible hydrocephalus occurred in two cases and subdural empyema was found in one. Two patients died on the 30th and 40th days of hospitalization: one of them had hydrocephalus and the other ventriculitis. In this report we point out the importance of neonatal meningitis due to Salmonella serotypes, though it rarely occurs.

Pellagra: a sporadic pediatric case with a full triad of symptoms

Pellagra is clinically manifested by a photosensitive dermatitis, diarrhea, and dementia. The full triad of symptoms is usually not well developed in infants and children. We report a case of a 14-year-old boy with classic symptoms of pellagra. All his symptoms responded to treatment with nicotinic acid.

Reversible nephrotoxicity after overdose of colloidal bismuth subcitrate

Although toxicity due to acute and chronic use of bismuth salts is well known, nephrotoxicity after ingestion of colloidal bismuth has been reported in few cases so far. Here we report the first case of acute renal failure (ARF) due to colloidal bismuth subcitrate overdosage in childhood. A 2-year-old boy was admitted to the hospital 6 h after ingestion of 28 De-Nol tablets (colloidal bismuth subcitrate 8.4 g). On admission, physical examination was unremarkable and he showed no signs of encephalopathy. Initially gastric lavage was performed then appropriate fluid therapy was started. ARF associated with uremia and oliguria developed on day 2 and peritoneal dialysis therapy was prescribed on day 4 for 10 days. Blood and urine bismuth levels were 739 micrograms/l and 693 micrograms/l, respectively, 10 days after the pills had been taken. His urine volume gradually increased and plasma BUN and creatinine levels decreased during peritoneal dialysis. On day 20 post-admission, plasma BUN and creatinine were 14 mg/dl and 0.7 mg/dl, respectively. Blood bismuth levels were 96 micrograms/l on day 60 and 12 micrograms/l on day 105. Now the patient is well and has no problem. This case suggests that ARF may develop in children following colloidal bismuth subcitrate overdosage; the prognosis is good, and peritoneal dialysis may be useful in these cases.

Exchange transfusion treatment in a newborn with phenobarbital intoxication

A comatose, 14-day-old boy was referred to our emergency department (ED) after an overdose of phenobarbital, which was used for the treatment of long-standing jaundice. Plasma phenobarbital concentration was 112.4 microg/ml before treatment. One hour after giving albium transfusion, an exchange transfusion, which took about 45 minutes, was performed. Volume of exchange was 400 ml (volume of exchange (ml) = 2 x 85 ml/kg). After the exchange transfusion, the phenobarbital concentration decreased to 50.84 microg/ml. At clinical and laboratory follow-up, the patient recovered fully. This case suggests that exchange transfusion is an effective and successful treatment for phenobarbital intoxication in newborn.

Carpenter syndrome: report of two siblings

Carpenter syndrome consists of acrocephaly, soft tissue syndactyly, short fingers, preaxial polydactyly, congenital heart disease, hypogenitalism, cryptorchidism, obesity, umbilical hernia and mental retardation. Here we report two affected sibs (IQs were 80 and 93) presenting various cerebrospinal malformations, i.e. frontal lobe deformity, narrowed foramen magnum, hypoplastic posterior fossa, kinked spinal cord, and syrinx cavitation demonstrated by magnetic resonance imaging.

The prevalence of asthma and other allergic diseases in a province of Turkey

To document the prevalence of asthma and other allergic disorders among children, a questionnaire study involving 3,118 children aged six to 14 years was done. The overall prevalence of allergic diseases was 27.4 percent and the prevalence of each disorder was as follows: rhinitis 11 percent, asthma 10.2 percent, conjunctivitis 7.1 percent, and skin diseases 6.3 percent. Atopic diseases were reported most commonly among the families of children with allergic rhinitis. When compared with internal regions of Turkey, the prevalence of allergic diseases was found to be very high. It was concluded that allergic diseases are an important health problem among children in our region.

Amphotericin B in the treatment of candida meningitis in three neonates

Candidiasis is an opportunistic infection and may result in significant morbidity and mortality in neonates. Cerebral candidiasis is rare and usually associated with systemic candidiasis. Information concerning the toxicity and efficacy of antifungal therapy for neonates is limited. In this report, we present three neonates with candidiasis. All of the patients were premature with low birth weights, and received antibiotic therapy for one to four weeks before the onset of candidiasis. Candida albicans was isolated from cerebrospinal fluid cultures. Amphotericin B was given administered at an initial dose of 0.25 mg/kg/day intravenously (IV) and increased to a dosage of 2 mg/kg/day, and therapy was continued for three to four weeks. A transient and mild elevation in hepatic enzyme concentration was observed in two patients, and transient thrombocytopenia occurred in all of them.

Application of ice water to the face in initial treatment of supraventricular tachycardia

Supraventricular tachycardia (SVT) is a life-threatening dysrhythmia in childhood. Initial treatment includes classic vagal maneuvers, some pharmacological agents, cardioversion and application of ice water to the face. In this paper we report our results of ice water application to the face in SVT. The study included ten patients between the ages of seven days and 15 years who were admitted to our hospital with supraventricular tachycardia in the previous year. Ice water was applied to their faces for five seconds immediately and all of them were digitalized. This procedure was utilized in 28 out of 36 SVT attacks, and was found to be effective in restoring sinus rhythm on 27 of 28 occasions (96%). Tachycardia recurred a total of 18 times in three of the ten patients. There was no recurrence in six patients. No response was noted in only one patient. Application of ice water to the face is an easy, safe, effective and repeatable procedure in the initial treatment of supraventricular tachycardia.

Effects of ascaris infection on iron absorption in children

Twenty-six Ascaris-infected children and 21 control children (10 of whom had iron-deficiency anaemia) were subjected to haematological and oral iron absorption tests. The levels of oral iron absorption by the infected children and by the healthy controls were similar, whereas the level of absorption by the children with iron deficiency anaemia was relatively high. It therefore appears that Ascaris infection does not lead to iron malabsorption and iron deficiency anaemia in children.

A new neurocutaneous syndrome: nevus sebaceus syndrome

We describe a case of nevus sebaceus syndrome characterized by a linear sebaceous nevus, extending on the left half of the face from forehead to lower neck, including the auricle; alopecia on the temporoparietal region; generalized hypotonia; insufficiency of eyes in following moving objects and insufficiency in controlling the head; lipodermoid cysts in the left and right eyes; bilateral conjunctival masses; corneal vascularization in the right eye; coloboma of the left eyelid and right optic disc. This is a rare case of a sebaceous nevus occurring concomitantly with optical and central nervous system abnormalities.

[Rubella infection in low birth weight infants]

Rubella infection in low birth weight infant was investigated with enzyme-linked immunosorbent assay (ELISA). Thirty Low birth weight infants were included in this study. Seropositive reaction (both Ig G and Ig M) was found in four of the cases. One of the infants who showed hyperbilirubinemia, sepsis and Low birth weight and another case who had tracheoesophageal fistula died in three days. The other two cases which showed seropositive reaction are being followed up as healthy children. We reached the conclusion that Low birth weight may be related to asymptomatic intrauterine rubella infection.