Derya Büyükkayhan

Increased Aortic Intima-Media Thickness Is Related to Lipid Profile in Newborns with Intrauterine Growth Restriction

Background and Aim: Low birth-weight is known to be associated with an increase in cardiovascular risk similar to that seen with major environmental risk factors, such as cigarette smoking or hypertension. Much epidemiological evidence has linked low birth-weight with hypertriglyceridaemia. Method: We measured aortic wall thickness by ultrasonography and lipid profile in 40 newborn babies with intrauterine growth restriction and 40 controls. Results: Maximum and mean aortic intima-media thickness were significantly higher in the babies with intrauterine growth retardation (0.58 ± 0.06, 0.52 ± 0.03 mm, respectively) than in controls (0.44 ± 0.05, 0.40 ± 0.03 mm, p < 0.0001, p < 0.0001, respectively), more so after adjustment for birth-weight (maximum intima-media thickness: 0.23 ± 0.03 mm/kg vs. 0.12 ± 0.02 mm/kg, p < 0.0001; mean intima-media thickness: 0.21 ± 0.02 mm/kg vs. 0.11 ± 0.01 mm/kg, p < 0·0001). Serum triglyceride levels were significantly higher in the intrauterine growth retardation group (48.9 ± 14.8 mg/dl) compared with the control group (32.5 ± 9.8 mg/dl, p < 0.0001). The mean body mass index, prepregnancy weight, weight gain during pregnancy, maternal LDL cholesterol level and, height of the mothers were significantly lower in the intrauterine growth retardation group compared with the control group. For maximum aIMT, significant associations included the ponderal index (p = <0.01), length (p = 0.01) and serum triglyceride levels of infants (p = 0.02). Conclusion: Newborn babies with growth restriction have significant maximum aortic thickening with hypertriglyceridaemia, suggesting that prenatal events might predispose to later cardiovascular risk.

Brucellosis with pulmonary involvement in a premature infant.

Abstract Congenital brucellosis is rare. A premature infant with transplacentally acquired congenital brucellosis and pulmonary involvement is described.

Effect of antenatal betamethasone use on adrenal gland size and endogenous cortisol and 17-hydroxyprogesterone in preterm neonates.

AIM To assess the effect of antenatal betamethasone use on adrenal gland size and adrenal hormones in preterm neonates who had gestational ages of 27-36 weeks. INFANTS AND METHODS Sixty-six neonates divided into two groups: betamethasone group, whose mothers received betamethasone 12 mg two times 24 h apart, and no betamethasone group, whose mothers did not receive any steroid agent during the antenatal period. Serum 17-hydroxyprogesterone (17-OHP) levels and cortisol levels were measured during the first six hours of life. In addition, adrenal gland length and width were determined on the first day of life. Hormone tests and ultrasonographic evaluation were repeated on the fifth day of life. RESULTS We found statistically significant reductions in 17-OHP and cortisol levels at birth in corticosteroid-exposed neonates (p < 0.05). There was no significant difference between the study groups with regard to adrenal gland length and width (p > 0.05). CONCLUSIONS This study demonstrates that betamethasone use in preterm neonates reduces endogenous 17-OHP and cortisol levels; however, it has no effect on adrenal gland size.

Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: a pilot study

Abstract Both intravenous administration of immunglobulin (IVIG) and exchange transfusion (ET) have been used for treatment of neonatal sepsis. No studies have compared ET with IVIG in neonates. Aim: The aim of the study was to investigate serial IgG and IgM serum levels in two groups of septic infants treated with either IVIG or ET as adjuvant therapy. Results: A total of 88 infants with sepsis and gestational ages ranging from 32 to <37 weeks were enrolled consecutively. The effect of ET with fresh, whole blood and IVIG on immunoglobulin G and M levels was monitored over a 24-hour period. ET was performed on 33 infants, 33 infants received IVIG and 22 infants served as controls. There were nine deaths (27%) in the IVIG group, seven (21%) in the ET group and nine (41%) in the control group (p>0.05). IgG levels rose significantly 12 hours after administration of IVIG (p<0.01). There were no differences between the initial and 24-hour IgG levels in the IVIG group. IgG levels did not change significantly in the ET and control groups. IgM levels rose significantly 12 hours after ET and elevated IgM levels persisted for over 24 hours.

Complete Penoscrotal Transposition Associated with Aortic Stenosis in a Newborn

A newborn boy was admitted to our hospital at the age of 18 hours with an imperforate anus. The infant was born to non-consanguineous healthy parents at term by normal delivery after an uneventful pregnancy. There was no family history of malformations. Physical examination of the infant revealed the presence of complete transposition of the scrotum and penis, perineal hypospadias, anal atresia and bilateral club feet. Dysplastic left kidney and hypoplastic right kidney were observed on ultrasonography. Atrial septal defect, ventricular septal defect and subaortic stenosis were demonstrated by echocardigraphy. Chromosome analysis documented karyotype 46,XY. Parental karyotypes were normal. He had a sigmoid diverting colostomy because of high anal atresia. Unfortunately he died of cardiac failure after operation. In conclusion; we reported a newborn infant in whom complete penoscrotal transposition was accompanied by subaortic stenosis, which has not been reported previously.

Holt-Oram syndrome in two generations with translocation t(9;15)(p12;q11.2).

Ann Saudi Med 28(3) May-June 2008 www.saudiannals.net 209 Holt-Oram syndrome (HOS), first described by Holt and Oram in 1960,1 is transmitted in an autosomal dominant mode of inheritance that is highly penetrant, with variable expression and characterized by upper limb anomalies that are always present, including mainly preaxial ray and congenital heart defects and/or cardiac conduction anomalies (OMIM 142900). The clinical manifestations vary and range from subclinical radiographic findings to overt, life-threatening disease. HOS occurs in approximately 1:100 000 live births; 85 percent of cases are attributed to new mutations in the TBX5 gene.2 The upper limb anomalies may be unilateral or bilateral and involve structures derived from the embryonic radial ray, typically the radial, carpal, and thenar bones. Aplasia, hypoplasia, fusion, and anomalous development of these structures produce a wide spectrum of phenotypes, including triphalangeal or absent thumbs, foreshortened arms, and phocomelia. They affect preferentially the left rather than the right side without affecting the lower limbs at any time.3 The formation of a limb involves numerous genes.3 Between the fourth and sixth weeks of fetal development primary limb and heart differentiation occurs. In this condition, skeletal anomalies always affect the upper limbs. The lower limbs are not affected in HOS. The appearance of the upper limb buds before the lower limb buds may explain the preferential involvement of the upper limbs seen in this syndrome.4 In the majority of cases, cardiac defects like atrial septal defects or ventricular septal defects are found. More complex cardiovascular abnormalities such as tetralogy of Fallot or isolated pulmonary arterial hypoplasia are rare.1,5-9 The gene locus for HOS has been mapped to chromosome 12q24.1 and mutations of the TBX5 gene have been identified as the underlying gene defect. TBX5 is a member of the T-box transcription factor family and members of the T-box family of transcription factors regulate a variety of developmental Holt-Oram syndrome in two generations with translocation t(9;15)(p12;q11.2)