Ayşe Engin Arısoy

Cord Blood Cardiac Troponin I as an Early Predictor of Short-Term Outcome in Perinatal Hypoxia

BACKGROUND In most perinatal-hypoxia survivors, myocardial dysfunction can be reversed with appropriate inotropic support and oxygenation. The main problem related to outcome is cerebral damage. OBJECTIVE We tested the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of severity of cerebral damage and mortality in intrauterine hypoxia. METHODS Venous and arterial cord blood samples were collected at delivery from 54 consecutive newborns with hypoxic-ischemic encephalopathy and from 50 consecutive healthy controls. Arterial blood gas analysis was performed and levels of cTnI, creatine kinase and creatine kinase-MB in venous cord blood were measured. The same serum parameters were also measured on the 3rd and 7th day of life. RESULTS Infants with hypoxia had a significantly higher cord blood cTnI levels than controls (p < 0.0001). Cord blood and 3rd and 7th day serum cTnI values showed a significant increase with severity of HIE (p < 0.0001). In non-survivors cord blood cTnI levels were significantly higher than the survivors (5.9 ng/ml, range 2.1-12.8, and 1.6 ng/ml, range 0.4-5.8, respectively; p < 0.0001). Receiver-operator curve analysis revealed cord cTnI as the most sensitive factor for predicting early death (area under curve = 0.956; SE: 0.028; 95% CI: 0.9-1.01). Cord blood cTnI of 4.6 ng/ml was identified as the optimal cut-off level for predicting serious risk of early mortality. CONCLUSION The results suggest that significant elevation of cord cTnI is an excellent early predictor of severity of hypoxic-ischemic encephalopathy and mortality in term infants.

Concentrations of toxic metals and trace elements in the meconium of newborns from an industrial city.

Objective: To investigate fetal exposure to toxic metals [lead (Pb), cadmium (Cd)] and fetal levels of trace elements [zinc (Zn), copper (Cu), and iron (Fe)] in newborns from an industrial city. Relationships between meconium mineral contents and parental occupation and location of residence were also tested. Method: The meconium mineral contents of 117 healthy newborn infants were measured by flame atomic absorption spectrophotometer. Results: The median concentrations (interquartile range) of toxic metals and trace elements in the meconium were as follows: Pb: 46.5 (1,399) µg/g dry weight (wt), Cd: 2.3 (55.6) µg/g dry wt; Zn: 234 (3,049) µg/g dry wt; Cu: 11.8 (818.7) µg/g dry wt, and Fe 105 (2,980) µg/g dry wt. All the meconium samples contained both toxic metals and trace elements. The proportions of trace elements in the meconium samples with concentration higher than 100 µg/g dry wt of the substances tested were Zn 90%, Cu 64%, and Fe 53%. There were significantly positive correlations between the concentrations of toxic metals and trace elements. Also there were positive correlations between the levels of Zn, Fe, and parental occupations, and between the level of Fe and location of residence of the parents (proximity to the petroleum refinery or the dye industries). Conclusion: All the meconium samples were positive for toxic metals, and thus may reflect environmental pollution in the city. The occupation environments and the location of the family residence are linked with levels of trace elements in meconium.

The effect of blood gas and Apgar score on cord blood cardiac troponin I.

OBJECTIVES The aims of this study were to (a) establish a reference range for cardiac troponin I (cTnI) in the cord blood of healthy infants, and (b) investigate the effect of Apgar score, cord blood gas, gestational age, and creatine kinase (CK) and creatine kinase MB (CK-MB) fraction levels on cord blood cTnI levels. METHODS 112 perinatal hypoxic and 84 control newborns without perinatal hypoxia were enrolled in this study. Cord blood samples were collected from the babies for arterial blood gas analysis, cTnI, CK and CK-MB measurements. Gestational age, birth weight, sex, Apgar score and history of fetal distress were recorded. Hypoxic ischemic encephalopathy (HIE) group, hypoxic but without HIE group and control groups were identified according to clinical observations during the first 72 h in the newborn unit. RESULTS HIE and perinatal hypoxic without HIE groups had a significantly higher cord blood cTnI level according to the control group (1.8 ng/mL (0-13), 0 ng/ml (0-1.1) and 0 ng/ml (0-0.3) respectively). Cord blood cTnI level did not have a correlation with birth weight and gestational age (r = -0.02, p > 0.05 and r = 0.08, p > 0.05 respectively). Cord blood cTnI level also had a negative correlation with pH, bicarbonate, base deficit, and Apgar score (r = -0.40, p < 0.001; r = -0.39 p < 0.001; r = -0.45 p < 0.001; r = -0.41, p < 0.001) respectively). Cord blood cTnI level showed a positive correlation with CK and CK-MB levels (r = 0.45, p < 0.001 and r = 0.37, p < 0.001 respectively). Receiver operator curve analysis revealed that the most sensitive factor for prediction of perinatal hypoxia is cord cTnI value [area under curve = 0.929]. The optimal cut-off value of cord cTnI was 0.35 ng/ml for hypoxia. CONCLUSION cTnI levels in the cord blood are not affected by gestational age and birth weight. cTnI together with CK and CK-MB has been found to be elevated in hypoxic infants compared to normal infants. Therefore cTnI may be an indicator for perinatal hypoxia in neonates.

The effect of IVF pregnancies on mortality and morbidity in tertiary unit

BackgroundThere are several studies that have shown an increased risk of premature birth and developmental abnormalities with in vitro fertilization (IVF); however, the data on preterm mortality and morbidity are limited.AimOur aim is to investigate whether IVF had an effect on the mortality and morbidity in neonates admitted to the neonatal intensive care unit.MethodsA total of 940 term and preterm babies who were admitted to the intensive care unit over a period of 2 years were enrolled. Of these, 121 babies were born after IVF and 810 were born after a natural conception and 9 were born after ovulation induction. Of these, 112 preterm babies were born after IVF and 405 preterm babies were born after a natural conception.ResultsIn the IVF group, the gestational age and birth weight were significantly lower than in the non-IVF group. Additionally, in the IVF group, multiple births were significantly higher than in the non-IVF group. IVF pregnancies increase preterm delivery but did not increase preterm mortality, and preterm morbidity did not differ among groups, except for intraventricular hemorrhage (IVH). Gestational age was shown to be the primary risk factor for IVH using a logistic regression analysis. Also when newborns at gestational age <32 weeks were compared using regression analysis, gestational age was the major risk factor for IVH.ConclusionIVF appears to be associated with premature delivery and the known risks associated with prematurity.

Evaluation of lung function on impulse oscillometry in preschool children born late preterm.

There is a paucity of data on lung physiology in late‐preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term‐born children.

Functional pulmonary atresia in newborn with normal intracardiac anatomy: Successful treatment with inhaled nitric oxide and pulmonary vasodilators.

Functional pulmonary atresia is characterized by a structurally normal pulmonary valve that does not open during right ventricular ejection. It is usually associated with Ebsteins anomaly, Uhls anomaly, neonatal Marfan syndrome and tricuspid valve dysplasia. However, functional pulmonary atresia is rarely reported in newborn with anatomically normal heart. We report a newborn with functional pulmonary atresia who had normal intracardiac anatomy, who responded to treatment with nitric oxide and other vasodilator therapy successfully.

Neonatal sepsis and simple minor neurological dysfunction

This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low‐birthweight newborns followed until preschool age.

Evaluation of lung function in preschool children born late‐preterm with impulse oscillometry

There is a paucity of data on lung physiology in late‐preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term‐born children.

Acute renal failure SNAPPE and mortality

Background:  The aim of the present study was to determine, using the score for neonatal acute physiology and perinatal extension II (SNAPPE‐II), whether there is an association with acute renal failure (ARF) and whether it is possible to identify newborns at risk for ARF prior to a rise in creatinine in newborns.

Effects of passive smoking on lung function tests in preschool children born late-preterm: a preventable health priority

Abstract Objective: Late-preterm delivery is known to be associated with potential adverse effects on lung development. Passive smoking may result in alterations of pulmonary function in infants born late-preterm. Impulse oscillometry (IOS) is a noninvasive, rapid, and practicable technique that can assess lung function. This study aimed to evaluate the effect of passive smoking on lung function tests in preschool children born late-preterm using IOS. Methods: The study population consisted of a total of 139 children between 3 and 7 years of age born late-preterm who were being followed-up at our outpatient unit at the time of study period. Late-preterms were subcategorized according to presence or absence of exposure to passive smoking (PS). Those with and without exposure to passive smoking were referred to as PS group (56.1%, n = 78) and non-PS group (43.9%, n = 61), respectively. Resistance (R5–R20), reactance (X5–X20), and resonant frequency were measured by impulse oscillometry (IOS) at 5–20 Hz. Results: Median R5-R20 and Z5 were significantly higher and median X10 was significantly lower in PS group compared to non-PS group (p < .05). Conclusions: This study demonstrated that passive smoking significantly increases peripheral airway resistance and seems to adversely affect lung function in children born late-preterm.