Ali Ulas Tugcu

Acupressure at BL60 and K3 Points Before Heel Lancing in Preterm Infants

CONTEXT Acupressure is an ancient Chinese healing art. In this pain-relieving method, the fingers are used to press key acupuncture points on the skin surface that stimulates the body׳s regulatory processes. OBJECTIVE The aim of this study was to investigate the effect of acupressure at Kun Lun (UB60) and Taixi (K3) points for pain management in preterm infants prior to heel lancing for blood collection. DESIGN This was a prospective, randomized controlled study. SETTING The study setting was the neonatal intensive care unit at Baskent University Hospital in Turkey. PATIENTS A total of 32 preterm infants between 28 and 36 weeks׳ gestational age were randomly assigned to one of two groups: an acupressure group (n = 16) or a control group (n = 16). INTERVENTION In the acupressure group, immediately before the heel prick, acupressure was applied for three minutes at UB60 and K3 points. MAIN OUTCOME MEASURES A behavioral pain score was determined using the Premature Infant Pain Profile (PIPP) scale. RESULTS There were no significant differences between the groups with respect to gestational age, birth weight, sex, mode of delivery, age at time of procedure, weight at time of procedure, or PIPP score. Mean duration of procedure and mean duration of crying were both shorter in the acupressure group (both P = .001). CONCLUSIONS Applying acupressure at the BL60 and K3 points before heel lancing was associated with shorter procedural time and shorter duration of crying in preterm infants.

Laser acupuncture before heel lancing for pain management in healthy term newborns: a randomised controlled trial

Background Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Non-pharmacological strategies have currently become more important than pharmacological analgesic agents in neonatal pain management. Acupuncture is a new non-pharmacological method for preventing pain in newborns. Objective We aimed to investigate the effect of laser acupuncture (LA) at the Yintang point before heel lancing as a non-pharmacological intervention for procedural pain management in infants. Methods Forty-two term newborns, who were undergoing heel lancing between postnatal days 3 to 8 as part of routine neonatal screening, were randomly assigned to the LA group or the oral sucrose group. In the LA group, 2 min before the heel lancing, 0.3 J of energy was applied to the Yintang point using a Laser PREMIO-30 unit for 30 s. In the sucrose group, each infant received 0.5 mL of 24% sucrose orally via syringe 2 min before the heel lancing. Each babys behaviour was scored using the Neonatal Infant Pain Scale (NIPS), assessed blinded to group. Results There were no significant differences between the LA and oral sucrose groups with respect to means for gestational week of age at birth, birth weight, actual weight, or Apgar score. Mean procedure time was significantly shorter in the LA group; however, mean crying time was longer and NIPS score was lower compared to the oral sucrose group. Conclusions Our results indicate that 0.3 J of LA at the Yintang point before heel lancing is less effective than oral sucrose for reducing the discomfort of this procedure. Trial Registration Number KA14/09.

Evaluation of peripheral perfusion in term newborns before and after Yintang (EX-HN 3) massage.

OBJECTIVE To identify how acupressure on the acupoint Yintang (EX-HN 3) impacts oxygen saturation, pulse rate, and peripheral perfusion in term-born infants without underlying disease. METHODS Infants born between weeks 37 and 42 of gestation were included in this study. The polyclinics neonatology room was noise-controlled and made half-dark to prevent the perfusion index from being confounded. A pulse oximeter was linked to the babys left lower extremity. Acupressure was applied on Yintang (EX-HN 3) for 30 s clockwise, held for 30 s, and then acupressure was applied for another 30 s counterclockwise. The babys SaO2, pulse rate, and perfusion index were recorded for each minute before and after acupressure. RESULTS When pre- and post-acupressure pulse rate values were compared, a significant decrease in pulse rate values after acupressure application was observed. When pre- and post-acupressure oxygen saturation values were compared, a significant increase in post-acupressure oxygen saturation was observed. In addition, peripheral perfusion increased significantly after acupressure. CONCLUSION Acupressure application has been used in traditional medicine for many years. However, it is not yet widely used in modern medicine. This study shows the impact of acupressure on neonatal skin perfusion, oxygen saturation, and pulse rate.

Neonatal thyrotoxicosis with severe supraventricular tachycardia: case report and review of the literature.

Abstract Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves’ disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves’ disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves’ disease associated pregnancies and management of newborns after birth.

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.

Experience with continuous venovenous hemodiafiltration in four newborns: A case series and review of the literature

When conventional methods for treating complicated problems such as acute and chronic renal failure or metabolic diseases fail, the therapy of choice is peritoneal dialysis (PD) in neonatal period. However, in cases that involve technical difficulties, such as bulky lesions in the abdomen or complications from previous abdominal surgeries, it is not always possible to place a peritoneal catheter. In such situations, continuous venovenous hemodiafiltration (CVVHDF) can be effective. This case series presents our experience in 2013 with the administration of CVVHDF to four patients in our neonatal intensive care unit who could not undergo PD for various reasons.

PO-0513 The Influence Of Igm-enriched Immunoglobulin Therapy On Neonatal Mortality And Haematological Variables In Newborn Infant With Blood Culture-proven Sepsis

Background and aims The aim of this study is to determine the effects of adjuvant immunoglobulin M-enriched IVIG therapy on mortality rate, haematological variables and length of hospital stay in newborn infant with blood culture-proven sepsis. Methods Demographic and clinical features and outcome measures of 63 newborn infant with blood culture-proven sepsis were retrospectively documented from the medical records. The patients were divided into two groups according to their treatment history. The patients in Group 1 received antibiotic therapy only and the patients Group 2 received both antibiotic and adjuvant IgM-enriched IVIG. Results The study revealed that mortality rates were 28.1% and 12.9% in Group 1 and Group 2, respectively. The mortality rate was lower in group 2, but the difference between the two groups was not statistically significant (p = 0.21) Coagulase negative Staphylococcus was the most common type of bacteria isolated from blood culture in both groups. When compared changing of laboratory results in both groups, haemoglobin, leukocyte count and CRP levels were different between two groups during the first three days of antibiotic treatment. Conclusion Our study revealed that if diagnosed at an early stage and treated aggressively with appropriate and effective antibiotics, adjuvant IgM-enriched IVIG treatment have no additional benefits in neonatal sepsis.

PO-0666 Acupressure For Preterm Infants In Pain Relief

Background and aims Recent studies have shown that newborns remember and perceive the pain, and they have been shown to feel pain from intrauterine life. To avoid adverse effects of pharmacologic analgesic agents, non pharmacologic strategies to minimise neonatal procedural pain have been proposed. Acupressure is a complementary treatment that uses fingers and applies pressure to stimulate acupoints of the human body. We studied the analgesic effect of acupressure in preterm infants during heel prick blood draw. Methods This study was carried out in a tertiary care neonatal unit at the Baskent University in Turkey. 32 infants born before the age of 37 weeks, and who did not have sepsis, any metabolic or genetic disease, and did not receive any medication for sedation or analgesia were included. The experimental group was given both routine care and acupressure. The control group only underwent routine care. Kunlun point (EX-HN3) and Taixi point (K3) was kneaded for 3 min before the procedure. All babies were scored according to the Premature Infant Pain Profile (PIPP) by a second researcher. Results In both groups of infants enrolled in the study; gestational age, birth weight, postnatal day, the actual weights were similar (p > 0.05). The procedure time and crying time in the acupressure group was significantly lower than other group (p = 0.00). PIPP scores were not found different (p = 0,046). Conclusions In this study, applying acupressure did not change the PIPP score in preterm infants. More research should be done in different acupressure points for analgesic effect for preterm infants.

PO-0484 Neonatal Thyrotoxicosis With Severe Supraventricular Tachycardia: Case Report And Review Of The Literature

Background and aims Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves’ disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia. Case Report The female infant, who was born by ceasarean section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260–300 beats/minute, and electrocardiogram revealed ongoing supraventricular tachycardia. Sotalol was effective after two cardioversions in maintaining sinus rhytm. Our patient was diagnosed to have thyroid storm due to thyrotoxicosis. Intensive medical therapy was started with 10 mg/kg/day of propylthiouracil, 1 drop of Lugol’s iodine solution three times per day, 2 mg/kg/day propranolol, and 2 mg/kg/day of oral prednisolone. After the diagnosis of neonatal thyrotoxicosis, the mother in our case was found out to have hyperthyroidism with TSH: 0.035 µIU/mL (normal: 0.35- 4.94). She was immediately started methimasole treatment. Conclusions The purpose of presenting this patient is to emphasise the importance of prenatal care and follow-ups. Obstetricians, endocrinologists, and paediatricians need to work together for better management of Graves’ disease associated pregnancies.

PO-0716 Continuous Venovenous Hemodiafiltration Experience Of Four Newborns

Aim Conventional methods are the first treatment modalities of renal failure or metabolic diseases in newborns. If these modalities fail to treat, we start to use peritoneal dialysis (PD). Continuous venovenous hemodiafiltration (vvHDF) is used when PD can not be performed. Our continuous vvHDF experience of 4 patients in neonatal intensive care unit, is presented. Case1: A male term newborn infant, having mapple syrup urine disease with a high serum leucine value after PD could not be performed, vvHDF was successfully provided. He was discharged from our hospital on 34th postnatal day. Case2: A preterm newborn, having polycystic renal disease and could not use under PD and vvHDF was started on 13th postnatal day. He died due to ventilator associated pneumonia on 135th postnatal day. Case3: A term newborn, having “polycystic renal disease” and could not perform PD, was referred to our unit for continuous vvHDF administration on 3rd postnatal day. vvHDF application was continued until his 61st postnatal day. Case4: A term newborn was appealed to our emergency service, with dyspnea and supraventricular tachycardia was diagnosed on 13th postnatal day. After intervention, multiorgan failure developed in our patient. At his postnatal day 27, vvHDF was performed. The patient died because of ventilator associated pneumonia. Conclusion Continuous vvHDF application should be considered in the neonatal period, in cases where it is impossible to apply PD. Due to the technical difficulties in the neonatal period, such application is not common but it is also life saving.