Dilek Coban

Body Weight, Length and Head Circumference at Birth in a Cohort of Turkish Newborns

Objective: Intrauterine growth references are primarily useful indicators in the assessment of the general health status of newborn infants. Although Lubchenco’s references are still used in many neonatal care units, we believe that there is a need for up-to-date intrauterine growth references specific for different populations. To develop gestational age-and gender-specific national references for birth weight, birth length and head circumference. Methods: Data were collected from neonatal records of perinatology services of eleven hospitals from January to December 2009. The anthropometry of a total of 4750 singleton live births born between 28 and 41 weeks of gestation were recorded. Means and standard deviations were calculated, and percentiles for each gender and gestational week were produced using the LMS program. The results were compared with US infants and also with local data. Results: Gestational age- and gender-specific 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentile values were produced. Comparison of the 10th, 50th and 90th percentile values showed that the boys were heavier and longer than the girls. Head circumference values were also higher in the boys. Proportions of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants in the sample were 10.1%, 79.1% and 10.8%, respectively. Conclusion: These gender- and gestational age-specific references will be of use in clinical practice and also for research purposes until more comprehensive, reliable and accessible national data pertaining to the intrauterine growth of Turkish infants are produced. Conflict of interest:None declared.

Post-Operative Subcutaneous Fat Necrosis in a Newborn: A Case Report

Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition of neonates and infants. The disorder is caused by generalized and local tissue hypoperfusion. The ScFN tends to improve spontaneously with or without some severe complications such as hypercalcemia. The ScFN may occur as iatrogenic after hypothermic surgical interventions. We present iatrogenic ScFN in a newborn with uncomplicated hypercalcemia due to cold exposure on operating table during at an umbilical cord hernia operation. To our knowledge, this is the first report of a patient in whom ScFN occurred during a commonly performed and relatively short-term “nonhypothermic” operation.

Pentraxin 3 concentrations of the mothers with preterm premature rupture of membranes and their neonates, and early neonatal outcome

Abstract Background: Pentraxin 3 (PTX3) is an acute phase reactant which has been used to detect intra-amniotic infections (IAI) in pregnancy, but the prognostic value of PTX3 concentrations on neonates has not been studied. We aimed to investigate the relationship between maternal PTX3–neonatal PTX3 concentrations and early neonatal outcome. Methods: The mothers diagnosed with preterm prelabor rupture of membranes (PPROM) (n = 28) and their preterm infants (n = 28) were included in the study. PTX3 concentrations were studied in plasma in the maternal peripheral blood and umbilical/peripheral vein in the neonates. The relationship between the mPTX3–nPTX3 concentrations and neonatal outcome were investigated using non-parametric tests and binary logistic regression analysis. Results: The mean mPTX3 concentration was 10.35 ± 7.82 μg/L. Ten (35.7%) of all mothers were within the normal range and 18 (64.3%) in high percentile (≥97.5 percentile). There was no relation between mPTX3 concentrations and clinical or histologic chorioamnionitis, latency of PPROM, and early neonatal outcome. Mean nPTX3 concentrations was 9.18 ± 7.83 μg/L and high nPTX3 concentrations were detected in five (17.8%) neonates. nPTX3 concentrations were inversely correlated with gestational age and correlated with rate of intraventricular hemorrhage (IVH) and mortality. Neonates with high nPTX3 concentrations also have lowered APGAR scores, increased rate of respiratory distress syndrome, clinical sepsis, IVH, necrotizing enterocolitis and prolonged NICU stay. Conclusion: High PTX3 concentrations of the newborns are associated with some worsened early neonatal outcome including lower gestational age at delivery, increased rate of IVH and mortality. Maternal PTX3 concentrations are not an adequate marker in defining clinical or histologic chorioamnionitis and early neonatal outcome.

Multiple Intraoral Teratoma in a Newborn Infant: Epignathus

Teratomas originating from the oral cavity are named as epignathus. It is a rare type of teratoma. An 11-day old male newborn was diagnosed with cleft palate and intraoral masses. The mass on the right side was protruding from the mouth. Another one on the left side was extending from the nasopharynx to the oropharynx. The diagnosis of mature teratoma was made based on the histopathological study of surgically excised masses. We desired to report on this case since multiple localized epignatus in a newborn with cleft palate has not been described yet in the literature.

Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia.

Abstract Vaginal delivery of the macrosomic fetus may result in hemorrhage of intra-abdominal organs. Mostly affected organs are the liver and adrenal glands. Hemorrhage of liver is usually occurs as a subcapsular hemorrhage and it is clinically presented an abdominal mass without symptoms of anemia. But intraparenchymal hemorrhage of liver is very rare and there is no sign of abdominal mass. However, in contrast to subcapsular hemorrhage, symptoms of anemia are rapidly developed in newborns. A macrosomic newborn by vaginal delivery at term. Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level falled from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass. Intraparenchymal hemorrhage in the sixth segment of liver and right adrenal hemorrhage were detected on the ultrasonographic scan. Hepatic function tests were normal in the whole follow-up period, and hemorrhage resolved within two weeks. Following months after discharge, adrenal hemorrhage also resolved without any complication. Hepatic hemorrhages, causing hemorrhagic anemia in neonates, usually occur in subcapsular form. Intraparenchymal hepatic hemorrhage should especially be considered in those newborns, which are rapidly developed symptoms of anemia without any abdominal mass.

Neonatal Episodic Hypoglycemia: A Finding of Valproic Acid Withdrawal

The treatment of epilepsy during pregnancy is a worldwide problem. Drugs need to be used to control seizures in the mothers. In utero, exposure to valproic acid (VPA) and phenytoin (PH) may cause congenital malformations and also withdrawal symptoms such as irritability, jitteriness and symptoms of hypoglycemia. We present here a newborn with episodic hypoglycemia due to in utero exposure to VPA and PH. The mother was diagnosed as having complex partial epilepsy and was treated with PH (200 mg/day) and VPA (600 mg/day). The offspring developed jitteriness on the second day of life. The infant was hypoglycemic (32 mg/dl). These findings were accepted as withdrawal symptoms, since serum levels of VPA and PH were 37.8 μg/ml (50−100 μg/ml) and 6.37 μg/dl (10−20 μg/ml), respectively. Measurement of blood glucose is important and should be carefully monitored in infants exposed to antiepileptics in utero. Conflict of interest:None declared.

Iodine Overload and Severe Hypothyroidism in Two Neonates

Iodine overload frequently leads to transient hyperthyrotropinemia or hypothyroidism, and rarely to hyperthyroidism in neonates. Iodine exposure can be prenatal, perinatal or postnatal. Herein we report two newborn infants who developed severe hypothyroidism due to iodine overload. The overloading was caused by excessive use of an iodinated antiseptic for umbilical care in the first case, and as a result of maternal exposure and through breast milk with a high iodine level in the second case. Presenting the two cases, we wanted to draw attention to these preventable causes of hypothyroidism in infants. Conflict of interest:None declared.

Poland anomaly and hydranencephaly: An unusual association.

Poland Anomaly and Hydranencephaly: An Unusual Association Dilek Coban,* Tamer Gunes, Mustafa Ali Akin, Mustafa Akcakus, and Ali Yikilmaz Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Erciyes University, Kayseri, Turkey Faculty of Medicine, Department of Neurosurgery, Erciyes University, Kayseri, Turkey Faculty of Medicine, Department of Radiology, Erciyes University, Kayseri, Turkey

Dandy-Walker Malformation: A Rare Association With Hypoparathyroidism

Dandy-Walker malformation is characterized by cystic dilatation of the fourth ventricle and an enlarged posterior cranial fossa with upward displacement of the tentorium, lateral sinuses, and torcular, with agenesis or hypoplasia of the cerebellar vermis. Dandy-Walker malformation occurs in approximately the 4th week of gestation and is associated with various abnormalities involving the cardiac, skeletal, genitourinary, and gastrointestinal systems. The parathyroid gland also forms in the 3rd and 4th gestational weeks. Reported here is the case of a male infant with Dandy-Walker malformation with ventricular and atrial septal defect, unilateral renal agenesis, and hypoparathyroidism. To our knowledge, this rare association with neural crest events during the development of Dandy-Walker malformation has not been reported previously.

Vancomycin Resistant Enterococci outbreak in neonatal unit and management of cases after discharge

Today, hospital infections with vancomycin resistant enterococci (VRE) in neonatal units have been seen with increasing frequency in recent yr. However, VRE colonized persons have greater risks for public health after discharge. We evaluated the risk factors in the prenatal and natal period of patients with VRE colonization and/or infection, as well as measures taken during VRE outbreak and after discharge occurring between the mo of February to April of 2009 in the Erciyes University, Neonatology Unit. VRE colonization and/or infection was detected in 26 (5.9%) of the 438 patients during time of outbreak. Enterococcus faecium was isolated in rectal swab cultures of all patients, and the type of glycopeptide resistance was VanA in all patients except one. Three of cases were term (11%), the remaining 23(89%) were preterm. E. faecium isolated from the blood culture in two patients. The history of mothers including prenatal risk factors and infant related risk factors were evaluated. The number of cases with VRE-positive was 15 (57%) on discharge and three of these patients were still colonized with VRE at re-hospitalization. The outbreak of VRE, experienced in our unit usually occurs in the manner of colonization. Prevention of colonization require reduction of the use of antibiotics in the perinatology and neonatology units, infection control measurements to be maximized.