Ahmet Yagmur Bas

Neonatal thrombo-embolism: risk factors, clinical features and outcome

Abstract Background: There are few data with respect to prothrombotic risk factors in neonates. Aim: To determine the associated risk factors, clinical features and outcome in newborn infants diagnosed with thrombo-embolism. Methods: Case records of 25 infants (17 full-term and eight preterm) diagnosed with thrombo-embolism between January 2005 and April 2008 in a neonatal intensive care unit were reviewed. Results: Of the 25 infants, 18 cases of venous (72%) and seven of arterial (28%) thrombo-embolism were recorded; in 18 it was associated with central catherisation. The sites of thrombosis were portal vein (15), right renal vein (one), right femoral vein (one), multiple veins (one), right femoral artery (3), right iliac artery (2), bilateral iliac and renal arteries (one) and left renal artery (one). Hereditary thrombotic mutations were detected in three patients and anticardiolipin antibody was detected in one, none of whom had been catheterised. The remaining three non-catheterised patients had perinatal risk factors. Venous catheter placement was undertaken in 12 patients (48%), eleven of whom had: umbilical venous catheterisation for exchange transfusion (9), partial exchange transfusion (one) and venous access (one), and one had femoral venous catheterisation for an angiographic study. Arterial catheterisation was undertaken in seven patients (28%) (one infant had both umbilical venous and arterial catheters) for angiographic studies (5) and blood sampling (2). Of the 18 catheterised patients (72%), thrombophilic studies were undertaken in 13 and none had abnormal results. Additional perinatal risk factors were present in 18 patients (72%) and included prematurity (8), congenital heart disease (8), septicaemia (5), dehydration (3), respiratory distress syndrome (3), polycythemia (2), meconium aspiration syndrome (one), pneumonia (one), maternal diabetes (one), necrotising enterocolitis (one) and perinatal asphyxia (one). Although most of the patients recovered after anticoagulant or fibrinolytic therapy, the five (20%) deaths were associated mainly with underlying diseases. Conclusion: The most important risk factor for thrombo-embolic events in neonates is placement of central catheters and some perinatal prothrombotic conditions. Nevertheless, hereditary or acquired thrombophilic risk factors may also be a cause of thrombo-embolism

Symptomatic omphalomesenteric duct remnants in children

Background:  The present study gathers a single institutional experience of symptomatic omphalomesenteric duct (OMD) remnants in children with an emphasis on the age and modes of presentation, the surgical intervention and the histopathological findings.

The effect of maternal number of births on oxidative and antioxidative systems in cord blood

Objective: The aim of this study is to evaluate the relationship between cord blood oxidative and antioxidative status and maternal parity number. Methods: Patients are grouped according to the maternal parity number: primiparous group (n = 36), multiparous group (n = 40), and grand multiparous group (n = 26). Cord blood samples are obtained in all subjects and assessed for total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI). The serum TAC and TOS were evaluated by using an automated colorimetric measurement method. Results: TAC levels are significantly higher and oxidative stress indicators are significantly lower in newborns of primiparous women compared to multiparous women p < 0.05 for all). TAC level is increased, whereas TOS and OSI levels are decreased in newborns of grand multiparous mothers compared to primiparous mothers. TAC level is significantly higher, whereas TOS and OSI levels are significantly lower in newborns of grand multiparous women compared to multiparous women (p < 0.05 for all). Conclusions: These results suggest a relation between higher maternal parity and increased oxidative stress and decreased antioxidant defense capacity. On the other hand, the compensatory mechanisms improve the antioxidant defense system in newborns of grand multiparous women and may prevent oxidative stress.

The Incidence and Risk Factors of Severe Retinopathy of Prematurity in Extremely Low Birth Weight Infants in Turkey

Background The aim of this study was to identify the incidence of severe retinopathy of prematurity (ROP) requiring laser treatment and the overall incidence of ROP in extremely low birth weight (ELBW) infants, and to evaluate the associated risk factors for developing severe ROP in ELBW infants in Turkey. Material/Methods This retrospective, case-control, tertiary care-hospital based study included 235 ELBW infants screened for ROP. The incidence of the onset of ROP and severe ROP requiring laser treatment were assessed. The relationship between various clinical risk factors, and the development of severe ROP and onset of ROP were analyzed using univariate analysis and multivariate logistic regression analysis. Results The overall incidence of any stage ROP and severe ROP requiring laser treatment in ELBW infants was 75.5% and 38.7%, respectively. Severe ROP requiring laser treatment in ELBW infants was significantly associated with various independent risk factors, including blood transfusion (P=0.002), gestational age at birth (P<0.001), gestational weight at birth (P=0.001), culture-proven sepsis (P=0.047). Conclusions The severity of ROP may increase as weight at birth and gestational age at birth decrease, and in those with culture-proven sepsis as well as in those that receive blood transfusion. Clinicians should be aware of the presence of these risk factors when treating ELBW premature infants. Early detection and prevention of sepsis and reducing the number of blood transfusions may decrease the incidence of severe ROP requiring laser treatment.

Bronchopulmonary dysplasia in very low birth weight infants

ObjectiveThe developments in newborn care have enabled many more very low birth weight premature infants to live. The aim of our study was to determine the risk factors for bronchopulmonary dysplasia (BPD) development by evaluating mild and moderate/severe BPD in extramural neonates with a birth weight <1501 g.MethodsA case-control study was conducted between January 1, 2004- December 31, 2006 at the Dr. Sami Ulus Children’s Hospital Neonatal Intensive Care Unit. Patients with BPD and without BPD were compared. Bronchopulmonary dysplasia was diagnosed and classified according to the Bancalari criteria. One-hundred and six (106) extramural premature infants with a birth weight <1501 g and admitted to the Neonatal Unit in the first three days of life and survived for more than 28 postnatal days were included. Patients with multiple congenital anomalies and complex cardiac pathologies were excluded. The maternal and neonatal risk factors, clinical features, mechanical ventilation treatment were compared. The principal risk factors for BPD development were analyzed and followed by logistic regression test.ResultsThe diagnosis was mild BPD in 27 of the 106 patients and moderate/severe BPD in 29. The incidence of BPD was 52.8%. Fifty of 106 patients had no BPD. Analysis of risk factors revealed that gestational age ≤28 weeks (p=0.019), birth weight ≤1000 g (p=0.007), hypothermia (p=0.003), acidosis (p=0.003) and hypotension (p=0.005) at admission, respiratory distress syndrome (RDS) ( p<0.001), mechanical ventilation therapy (p<0.001), surfactant therapy (p=0.005), higher amount of mean fluid therapy on 7th days (p=0.008), nosocomial infection (p<0.001), higher amount of mean packed red cell transfusions (p<0.001) and more than two packed red cell transfusions (p=0.033) were risk factors associated with the development of BPD. Multivariant logistic regression analysis showed acidosis at admission (OR 5.12, 95%CI 1.17–22.27, p=0.029), surfactant treatment (OR 7.53, 95%CI 2.14–26.45, p=0.002), nosocomial infections (OR 4.66, 95%CI 1.27–17.12, p=0.02) and PDA (OR 9.60, 95%CI 2.23–41.22, p=0.002) were risk factors increasing the severity of BPD.ConclusionThe most important risk factors for BPD development in our study were RDS and nosocomial infections while the presence of acidosis at admission, surfactant administration, nosocomial infections and the presence of PDA were the most important risk factors regarding BPD severity. Presence of acidosis at admission as a risk factor emphasized the importance of suitable transport conditions for premature infants.

Effects of phototherapy using different light sources on oxidant and antioxidant status of neonates with jaundice.

BACKGROUND/AIM Neonates have limited antioxidant protective capacity. It has recently been demonstrated that phototherapy used for treatment of neonatal jaundice produces oxidative stress. Various phototherapy devices using different light sources are available for phototherapy. We aimed to investigate the effects of phototherapy applied with different light sources on the global oxidant/antioxidant status in neonates. METHODS Term and late-preterm (≥35 weeks) newborn infants hospitalized to receive phototherapy for non-hemolytic jaundice in the 2-9 days of life were enrolled. Infants who received conventional phototherapy with fluorescent lamps were defined as group 1, intensive light emitting diode (LED) phototherapy as group 2, and fiberoptic phototherapy as group 3. The serum total antioxidant capacity (TAC) and total oxidant status (TOS) were measured before and 24 h after phototherapy. Oxidative stress index (OSI) was calculated. RESULTS Twenty nine patients were included in each group. At the beginning of phototherapy serum TAC, TOS and OSI levels were similar in all groups. After phototherapy serum TAC decreased significantly in all three groups (p < 0.001). Total oxidant status increased significantly in group 1 (p < 0.001) and group 2 (p = 0.001) whereas a statistically insignificant increase was observed in group 3 (p = 0.057). After phototherapy OSI increased significantly in group 1 (p < 0.001), group 2 (p = 0.001), and group 3 (p = 0.038). CONCLUSION As indicated by increased OSI, oxidant/antioxidant balance is disturbed in favor of oxidants after blue fluorescent light, LED and fiberoptic phototherapy.

Neonatal non-ketotic hyperglycinemia: report of five cases.

© 2008 Japan Pediatric Society Non-ketotic hyperglycinemia (NKH), also called glycine encephalopathy (OMIM 238300), is a rare autosomal recessive disorder of glycine metabolism. There are four forms of glycine encephalopathy: neonatal, infantile, transient, and late. 1 The neonatal form develops within days after birth with acute neurological deterioration, rapidly progressing to a coma and often to death. The few surviving patients suffer from severe mental and developmental retardation as well as convulsions. 1,2 The authors report fi ve new patients with neonatal NKH and discuss the clinical course and treatment modalities.

Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit.

BACKGROUND Retinopathy of prematurity (ROP) is a significant cause of childhood blindness. AIM The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU). PATIENTS AND METHODS Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia. RESULTS We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 μg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time. CONCLUSIONS Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists.

Risk of retinopathy of prematurity in small for gestational age premature infants

ObjectivesTo evaluate the incidence, risk factors and severity of retinopathy of prematurity in neonatal intensive care unit and to evaluate its relationship with gestational age.MethodsCohort study of neonates with gestational age ≤32 weeks or birthweight ≤1500g.ResultsOf the 495 neonates screened, 43 (8.7%) infants were small for gestational age; the frequency of severe retinopathy of prematurity was 5.8%. Sepsis and being small for gestational age were independent risk factors for severe retinopathy of prematurity.ConclusionsClinicians should be aware of the presence of presence of retinopathy of prematurity when caring for protein small for gestational age infants.

A case series of neonatal arrhythmias

Abstract Objective: Neonatal arrhythmias (NAs) are defined as abnormal heart rates in the neonatal period. They may occur as a result of various cardiovascular, systemic and metabolic problems. Methods: A retrospective chart review was performed on newborns who were diagnosed with NA during hospitalization in a neonatal intensive care unit (NICU), or who were admitted to the NICU because of an arrhythmia diagnosis in two NICUs in Turkey from May 2011 to June 2013. Results: Seventeen neonates with arrhythmias were identified. The incidence of NA was 0.4% and 0.3% in the two NICUs, and was 0.37% in the study population as a whole. Mean gestational age was 37 (29–40) weeks. Nine of the infants (53%) were diagnosed with fetal arrhythmia (FA) during the last week of gestation. The distribution of NA types was as follows: six (35%) supraventricular tachycardia (SVT), six (35%) premature atrial contractions (PACs), two (11%) premature ventricular contractions (PVCs), two (11%) multiple arrhythmias such as SVT + PAC and AV block + PVC, and one (5%) AV block. Wolff–Parkinson–White syndrome was present in one patient. An association of NA with congenital heart malformations was identified in five cases. Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and an occasional cause of infant mortality if undiagnosed and untreated. It is important for the physician to be aware of the etiology, development and natural history of arrhythmias in the fetal and neonatal period.