Deniz Anuk Ince

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.

Peripherally inserted central venous catheters in critically ill premature neonates

Purpose To evaluate the safety of peripherally inserted central venous catheters (PICCs) and their complications in critically ill premature neonates. Methods A retrospective collection of data of infants with very low birth weight (VLBW) who underwent PICC placement over a 2-year period. Gestational age, birth weight (BW), sex, site of catheter placement, reason for catheter removal, duration of the catheter use, proven sepsis, type of the reported organism and the rate of complications were collected. The infants were classified into two groups according to BWs: Group 1–-VLBW infants (BW between 1,000 and 1,500 g) and Group 2–-BW <1,000 g (extremely low birth weight, ELBW group). Results During the study period, 90 VLBW infants were admitted to the neonatal intensive care unit. PICCs were attempted in 71 patients. A PICC was successfully inserted into 62 patients (87.3%). Totally, 68 PICCs were inserted into 62 infants. PICCs placed in either the upper or the lower extremity have no differences in complication rates. The median time of catheter insertion was 10 (1-22) days for Group 1 and 16 (1-47) days for Group 2 (p=0.001). The median duration of PICCs was 9 (2-18) and 12.0 (3-30) days, respectively (p=0.012). There were no significant differences between groups for the reasons for removal (p=0.859). Conclusions PICCs are convenient for the administration of long course antibiotics and parenteral nutrition for both VLBW and ELBW infants. The risk of catheter complications did not increase in ELBW infants. Although the technique of insertion is easy and using PICCs has many benefits, serious and fatal complications may occur in premature neonates in critical states.

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.

The role of plasminogen activator inhibitor-1 and angiotensin-converting enzyme gene polymorphisms in bronchopulmonary dysplasia.

BACKGROUND Bronchopulmonary dysplasia (BPD) is a multifactorial disease of preterm infants that is characterized by airway injury, inflammation, and parencymal remodeling. Activation of the coagulation cascade leads to intraalveolar fibrin deposition in many inflammatory pulmonary disorders. Increased fibrin formation or decreased fibrinolysis may cause extravascular fibrin deposition. Extravascular fibrin deposits in septae and alveoli due to the altered fibrin turnover are the pathological hallmarks of BPD, which strongly indicate the importance of the imbalance in the competing activities of coagulation and fibrinolysis. OBJECTIVE We investigated the predictive value of variations in plasminogen activator inhibitor-1 (PAI-1) and angiotensin-converting enzyme (ACE) genes as molecular determinants for BPD in neonates. METHODS The study group comprised 98 preterm infants with BPD and a control group including 94 preterm infants without BPD. Restriction fragment size analyses were performed by visualizing digested polymerase chain reaction products for ACE and PAI-1 genotypes. RESULTS No significant associations were found between ACE, PAI-1 gene polymorphisms, and BPD phenotype in our population. CONCLUSIONS The two gene polymorphisms (PAI-1 and ACE) had no role in the development of BPD in our study. Further studies with other genes are required for the identification of molecular predisposing factors for BPD that may help in the development of new treatments.

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.

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.

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.

Çok düşük doğum ağırlıklı bir bebekte konjenital iktiyoz

Iktiyozlar klinik ve etiyolojik olarak hererojen derinin bir grup kalitsal keratinizasyon bozuklugudur. Yaygin cilt kurulugu, ciltte soyulma ve pullanma, bazen eritrodermi ve histopatolojik olarak hiperkeratoz ile karakterizedir. Iktiyozis vulgaris ve X’e bagli iktiyoz, iktiyozun en yaygin gorulen tipleridir. Konjenital iktiyozlar daha seyrek gorulur. Lameller iktiyoz, konjenital iktiyoziform eritrodermi ve harlequin iktiyozu konjenital iktiyozlar arasinda yer alir. Lamellar iktiyoz genelikle dogumda mevcuttur ya da kisa bir sure sonra baslar. Bebekler tum vucudu kaplayan parsomen kagidi benzeri yapisi olan seffaf bir membranla (kollodion zar) dogarlar. Dehidratasyon, sepsis, elektrolit dengesizligi ve pnomoni gibi komplikasyonlarin onlenmesi sag kalim acisindan buyuk onem tasir. Tedavideki temel amac sivi kaybinin onlenmesi, derinin nemlendirilmesi ve stratum korneumun yumusakliginin saglanmasidir. Sundugumuz olgumuzda klinik ozellikleri ile lameller iktiyoz tanisi konulan cok dusuk dogum agirlikli premature bebek sadece topikal ajanlarla basari ile tedavi edilmistir. Bu vaka nedeni ile konjenital iktiyozlu premature bebeklerin yenidogan yogum bakim unitesindeki bakimi gozden gecirilmistir.