Abdullah Kurt

Acupuncture in preterm babies during minor painful procedures.

OBJECTIVE To evaluate analgesic effects of acupuncture in preterm neonates during minor painful procedures. METHODS Ten preterm neonates requiring heel prick for blood gas analysis were enrolled in the study, which had a crossover design. Oxygen saturation, systolic and diastolic blood pressure, respiratory rate, heart rate, and crying duration were recorded before and after heel prick. Babies were given expressed breast milk before each procedure. Patients were randomly assigned to receive acupuncture or not, and the groups were crossed over on the following day, so that patients who had received acupuncture received only breast milk, and the previous breast milk only group received both acupuncture and breast milk. The neonatal infant pain scale (NIPS) was used for pain evaluation. RESULTS Crying duration and NIPS pain scores during heel prick were lower in the neonates who had received acupuncture. CONCLUSION Acupuncture is an effective method for the treatment of pain in neonates.

Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene

Abstract Congenital hyperinsulinism is the most frequent cause of persistent hypoglycemia in infancy. We present the case of a preterm, large-for-gestation-age infant with congenital hyperinsulinism who was found to have a novel p.Q392H homozygous mutation in the ABCC8 gene. The patient had severe brain damage, despite early diagnosis and appropriate management. The new mutations may provide an understanding of the prognosis and treatment of the disease. In addition, the data will help the family make informed decisions about future pregnancies.

Noninvasive evaluation of swallowing sound is an effective way of diagnosing feeding maturation in newborn infants

Despite extensive research, there is still controversy regarding the time at which sucking and swallowing functions mature in preterm infants. This study aimed to evaluate maturation using the noninvasive method of swallowing sound.

Dicephalic parapagus conjoined twins.

Sir, The incidence of conjoined twins is 1/50,000–1/ 100,000 but the true incidence is around one in 200,000 as 60% are stillborn or die shortly after birth [1]. The term parapagus means twins fused extensively side to side [2]. A 33-y-old pregnant woman, gravida 7, para 7, abortus 0 who had no prenatal medical evaluation went in to active labor at 38 wk of gestation by cesarean section. The conjoined twins were referred to the authors’ hospital at 30 h of life. The combined weight of the conjoined twins was 4,200 g. Clinical examination revealed two heads, a single thorax and abdomen, one rudimenter and two independent upper and lower limbs, one complemented genitalia and anus (Fig. 1). Thoracoabdominal magnetic resonance imaging revealed two sets of lungs but there was a fusion at the middle lung. The liver, pancreas, genitourinary tract were shared. Echocardiography showed cardiac fusion. Twin A (right sided) had atrioventricular septal defect, discordant ventriculoarterial connection and pulmonary stenosis and twin B (left sided) had single ventricle and the wall was shared with other’s heart. Due to complex cardiologic and physical features; surgeons agreed that surgical seperation was impossible. The twins are postnatal 42 d of life and are still followed-up in neonatal intensive care unit. Conjoined twinning is a rare complication of monozygotic twins. Also in our case, twins had two heads which is called dicephalic that usually accompanied single heart or fusion of the heart [3]. The main limiting factor is the degree of cardiovascular anomaly when considering seperation procedures and long-term survival [4]. In a study including 14 pairs of conjoined twins, surgical seperation was possible in only one pair, the remaining 13 pairs of twins survived less than one year [5]. The degree of cardiac fusion is predictive for the management. Surgical seperation is rarely successful in twins with united hearts, the survival usually depends on the severity of cardiac malfomation [3]. Prenatal follow-up, early and accurate diagnosis is important for the determination of severe malformation. Antenatal diagnosis can give a chance of organ sharing level for further management of pregnancy and give parents the option of termination.

Neonatal Outcomes of Pregnancy with Intrahepatic Cholestasis

Objective: Intrahepatic cholestasis of pregnancy is a clinical syndrome, characterized by maternal pruritus and biochemical cholestasis. Epidemiologic surveys show significant regional differences in the incidence of intrahepatic cholestasis of pregnancy. In this study, we evaluated the frequency of intrahepatic cholestasis of pregnancy and perinatal/neonatal outcomes in our hospital. Methods: Twenty patients with intrahepatic cholestasis of pregnancy and their 22 newborn babies (3 twins), and one intrauterine exitus with unknown etiology were included in this retrospective analysis. Ursodeoxycholic acid was given to 50%of intrahepatic cholestasis of pregnancy patients. Fifteen (65.2%) of the newborn babies were ≤37 weeks. Eight (34.7%) of newborns had transient respiratory support, 2 with continuous positive airway prssure. None of the babies had diagnosed respiratory distress syndrome, thus none of them required surfactant. One case of intrauterine exitus has occured with unknown etiology. Results: We conducted a retrospective study about frequency and perinatal outcome of pregnancies complicated by intrahepatic cholestasis of pregnancy between June 2007-August 2010 at Baskent University Ankara Hospital. Perinatal/neonatal outcomes were retrospectively studied by medical chart review. Conclusion: In our study intrahepatic cholestasis of pregnancy was present in 1.4% of pregnancies, that was similar to the European population. Increased risk of preterm delivery and respiratory distress syndrome were reported in literature, in our study group, none of the babies had RDS or other serious neonatal complications of preterm labor despite high rate of preterm birth rate and rather high levels of maternal serum bile acid levels.

Goniometer Measurements of Oral Labial Angle and Evaluation of Oral Motor Reflexes in Preterm Infants Comparison to Findings in Term Infants

To date, no study has evaluated changes in oral labial angle as preterm infants mature. The main purpose of this study was to document goniometer measurements of the labial angle of the mouth in preterm infants, to assess changes with development, to compare to findings in healthy term infants, and also evaluate oral motor reflexes in these groups. Seventy-eight preterm infants and 45 healthy term infants were recruited for the prospective study. Labial angle was assessed via goniometer, and oral motor reflexes and the volume of milk ingested were evaluated. There was significant difference between term and preterm infants’ labial angles (P < .01). The distribution of preterm infants’ angles were similar to term infants’ by 36 to 40 weeks’ postmenstrual age. Goniometer measurements of the oral labial angle may reveal oral motor performance in preterm infants and may be relevant for feeding skills assessment in this group of infants.

PO-0078 The Relationship Between Maternal And Neonatal 25(oh) Vitamin D Status

Background In this study we aimed to investigate the relationship between maternal and neonatal 25(OH)D levels. Methods The subjects were 58 mothers and their newborns who were born between February 2012 and April 2012. Blood specimens were obtained within 72 h of birth and from mothers. Serum 25(OH)D concentrations were measured. Vitamin D deficiency was defined as serum concentrations ≤20 ng/mL. Results The mean gestational age and birth weight of preterm infants were 33.06 ± 2.2 weeks and 2125.4 ± 546 g and for term infants were 38.84 ± 1 weeks and 3470.3 ± 451 g, respectively. Sociodemographic characteristics of mothers were not significantly different between groups. Twelve percent of infants born before 32 completed weeks, 16% infants born between 32–36 weeks and 28% of term infants had vitamin D deficiency. Vitamin D deficiency was found in 27% mothers of preterm infants and 42% mothers of term infants. Conclusion Vitamin D receptors plays an important role in calcium absorption and bone metabolism. In the literature there are reports that vitamin D deficiency during pregnancy had adverse gestational outcomes including risk of pre-eclampsia, gestational diabetes. The mean vitamin D levels were normal in infants whereas their mothers had low levels of vitamin D. When we consider that all mothers in the study received vitamin D supplements, we should give appropriate vitamin D prophylaxis during pregnancy. Also we should give adequate vitamin D supplementation to the infants without any delay.

1333 Clinical Manifestations of Urinary Tract Infections in Newborn Infants Admitted to Neonatal Intensive Care Unit

Background and Aims To determine the demography, clinical manifestations and the most common organism isolated of the urinary tract infection (UTI) in the newborn infants who were admitted to the neonatal intensive care unite (NICU). Methods Newborn infants diagnosed with UTI were investigated retrospectively, clinical and demographic characteristics of infants were collected from the medical records in the NICU. Urine cultures were obtained by suprapubic aspiration or urinary cathater. Results Fifty-one infants were included in this study. The mean (±SD) gestational age and weight of infants were 31.53±4.32 weeks, and 1724.90±902.21 g respectively. Male patients accounted for %56.9 of the study group. Infants born with cesarian section were %86.3. The median age for the urine culture was 31.53±4.3days. Klebsiella pneumania was the dominant microorganism isolated in 22 patients (43.13%), followed by Escherichia coli in 13 patients (25.4%). The most common presenting symptoms were vomitting in 39(76.5%) infants, desaturation in 34 (66.7%) infants, tachycardia in 31 (60.8%) infants, apnea in 21 (41.2%) infants and jaundice in 18 (35.3%) infants. Conclusions The incidence of UTI in newborn infants is 0.1–1% and it can be as high as 10% in low-birthweight and preterm babies. The presentation of UTI in the neonatal infants is non-specific and the most common clinical manifestations are vomitting, fever, enteral feeding intolerance, apnea and bradycardia. In this study, desaturation and tachycardia are also shown as presenting manifestations of UTI. Klebsiella pneumania was the dominant microorganism isolated in 22(43.13%) patients in our study.