Ayse Sevim Gokalp

Acute effects of gentamicin on glomerular and tubular functions in preterm neonates

It has been reported that gentamicin causes natriuresis, magnesuria and calciuria in neonates. The aim of this study was to determine the acute effects of trough and peak levels of gentamicin on the values of serum creatinine (SCr), urine albumin/urine creatinine (UA/UCr), fractional excretion of sodium and potassium (FENa, FEK) and urine calcium/urine creatinine (UCa/UCr) in preterm neonates treated with gentamicin for suspected infection. Baseline levels of serum and urine Cr, Na and K and urine albumin and Ca levels together with trough and peak gentamicin levels were measured in 61 preterm neonates at the start of the therapy, on the day of the third gentamicin dose and 48–72xa0h after the cessation of the gentamicin therapy. Therapeutic trough and peak levels were recorded in 56 (91.8%) and 39 (63.9%) of the preterm neonates, respectively, whereas high trough (>2xa0mg/dl) and peak (>9.99xa0mg/dl) levels were recorded in five (8.1%) and 11 (18%) of the 61 preterm neonates, respectively. Trough and peak levels of gentamicin were positively correlated with SCr, UA/UCr, FENa, FEK and UCa/UCr values. The UA/UCr, FENa and UCa/UCr values recorded during treatment were statistically significantly different from sub-therapeutic, therapeutic and high peak gentamicin levels. Gentamicin was found to have a serum peak level-dependent microalbuminuric, natriuric and calciuric effect in preterm neonates. Based on these results, we suggest that when the monitoring of serum gentamicin levels is not possible, the monitoring of UA/UCr, FENa and UCa/UCr can be useful as a noninvasive alternative.

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

BACKGROUNDnIn most perinatal-hypoxia survivors, myocardial dysfunction can be reversed with appropriate inotropic support and oxygenation. The main problem related to outcome is cerebral damage.nnnOBJECTIVEnWe 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.nnnMETHODSnVenous 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.nnnRESULTSnInfants 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.nnnCONCLUSIONnThe results suggest that significant elevation of cord cTnI is an excellent early predictor of severity of hypoxic-ischemic encephalopathy and mortality in term infants.

Hemophilia-Specific Quality of Life Index (Haemo-QoL and Haem-A-QoL questionnaires) of children and adults: result of a single center from Turkey.

The aim of this study is to describe the health status, health care received, and their impact on the quality of life in patients with hemophilia. Patients with severe factor VIII or IX deficiency without inhibitors or other chronic disease were enrolled. Turkish version of the Hemophilia-Specific Quality of Life Index (Haemo-QoL) questionnaire was administered to the pediatric patients aged 4 to 16 years and Haem-A-QoL to the adult patients. Joints were evaluated according to the World Federation of Hemophilia (WFH) orthopedic joint scores.Thirty-nine children/adolescents and 31 adult patients were enrolled. Mean Haemo-QoL scores were 39.6 ± 15.0 for the children and mean Haem-A-QoL 47.4 ± 14.1 for the adult patients, respectively. Internal consistency reliability was generally sufficient. Total Cronbachs alpha coefficient was >.70 (range .77–.96) in all the age groups. Mean total WFH orthopedic joint scores were 1.83 ± 2.7, 4.9 ± 4.96, and 6.94 ± 6.15 in 4–7, 8–12, and 13–16-year-old groups, respectively. They were more impaired in the adult patients (16.23 ±14.12). These results show that the Turkish version of the Haemo-QoL and Haem-A-QoL are reliable instruments to measure the quality of life in the pediatric and adult patients with severe hemophilia. When compared to the Haemo-QoL scores of an international multicenter West European study of children, quality of life in the Turkish patients were more impaired in the subscales of physical health, feeling, view, school and sport, and treatment as well as more impaired WFH joint scores. The authors recommend primary factor prophylaxis and encouraging the patients to learn home treatment to improve joint scores and quality of life.

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

OBJECTIVESnThe 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.nnnMETHODSn112 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.nnnRESULTSnHIE 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.nnnCONCLUSIONncTnI 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.

Intrapleural streptokinase treatment in children with empyema

Our aim was to compare intrapleural streptokinase (SK) treatment and simple tube drainage in the treatment of children with complicated parapneumonic pleural effusion. A retrospective review of medical records included patient demographics, clinical presentation, biochemical and microbial studies of pleural effusion, radiographic evaluation of chest tube drainage, use of fibrinolytic agents and type of surgical intervention. During the 2.5-year period (1999–2002), 53 children (29 M, 24 F) with complicated parapneumonic effusions or empyema were identified. Closed tube drainage and antibiotic treatment were administered to patients with a diagnosis of complicated parapneumonic effusion (nu2009=u200924) until October 2000; after that time point, intrapleural streptokinase was added to this regimen (nu2009=u200929). The median age at the time of presentation was 2.5xa0years (range: 5xa0months-14.6xa0years). There were no significant differences in terms of clinical outcomes between the two groups. The average length of hospital stay was 19.1u2009±u20095.5 and 21.9u2009±u200911.2xa0days for the drainage and streptokinase groups, respectively; the time to afebrile state after admission was 5.8u2009±u20094.1 and 7.6u2009±u20097.5xa0days. The percentage of patients who eventually required surgical intervention was 8.3% for the drainage group and 20.6% for the streptokinase group. In conclusion, in the treatment of complicated parapneumonic effusions or empyema, the adjunctive treatment with intrapleural SK does not significantly reduce durations of fever, chest tube drainage and hospital stay, and the need for surgery, regardless of the stage of the disease, compared to simple closed tube drainage.

Effect of heavy metals in the meconium on preterm mortality: Preliminary study

There have been many studies that have investigated the risk factors of mortality in preterm infants, but none has shown an association between preterm mortality and exposure to heavy metals or trace elements. The aim of this study was therefore to measure the levels of toxic metals (lead, cadmium) and trace elements (zinc, iron, copper) in meconium samples and elucidate their association with preterm mortality.

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 2u2009years 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 <32u2009weeks 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.

Calciphylaxis due to poor compliance in a child with end stage renal disease: A case report

Calciphylaxis (calcific uremic arteriolopathy) is a vasculopathy that is often defined in patients due to renal failure, however, some patients with calciphylaxis do not show secondary or tertiary hyperparathyroidism. It results from mural calcification of arteries and arterioles in the deep dermis and subcutaneous adipose tissue, leading to vessel occlusion. The resulting ischemia may be so severe that infarction of the downstream tissue may develop, the most affected sites being the skin and subcutaneous adipose tissue. The regions of the body with thicker subcutaneous adipose tissue such as the breast, abdomen, thighs and buttocks may be more frequently affected. 1 The accepted concept is that reduced glomeruler filtration rate, even in the early stages of end-stage renal disease (ESRD), results in diminished renal phosphorus excretion and an increase in serum phosphorus concentration. The retained inorganic phosphorus combines with plasma calcium and the calcium × phosphate product with CaHPO4 concentration rise. 2 This leads to the stimulation of parathyroid hormone secretion and secondary hyperparathyroidism as well as the resorption of calcium and phosphorus from bone with resulting osteodystrophy and metastatic calcification. Cutaneous metastatic calcification was reported as long ago as 100 years. The lesions are quite characteristic, starting as areas of painful purple discoloration in the extremities that are plaquelike or nodular. They usually progress to necrotizing gangrenous areas and ulcerations. Some reports describe actual gangrene and self-amputation of digits or extremities. 3 In this case report, we present an 8-year-old girl who experienced cutaneous and widespread visceral calcifications due to poor compliance of her parents to the treatment of chronic renal failure. Case report

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.

Effect of number of BCG vaccination on tuberculin induration size

Aim:u2003 The aim of this study is to interpret purified protein derivative (PPD) induration sizes with respect to the number of Bacillus Calmette–Guérin (BCG) scars.