Emrah Can

Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants

The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth. During the early postnatal period, protein intake must be sufficient to achieve normal postnatal growth in extremely low‐birthweight infants. The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at <34 gestational weeks (GW) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity (ROP).

Acute kidney injury in a single neonatal intensive care unit in Turkey.

BackgroundAlthough advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity.MethodsOf 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function.ResultsThe prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI.ConclusionsPrenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

A Comparison of Different Methods of Temperature Measurements in Sick Newborns

We aimed to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT), infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) measurements with traditional axillary glass mercury thermometer (AGMT) for intermittent temperature measurement in sick newborns. A prospective, descriptive and comparative study in which five different types of thermometer readings were performed sequentially for 3 days. A total of 1989 measurements were collected from 663 newborns. DAT and ITT measurements correlated most closely to AGMT (r = 0.94). The correlation coefficent for IFST and RGMT were 0.74 and 0.87, respectively. The mean differences for DAT, ITT, RGMT and IFST were +0.02°C, +0.03°C, +0.25°C and +0.55°C, respectively. There were not any clinical differences (defined as a mean difference of 0.2°C) between both mean AGMT&DAT and AGMT&ITT measurements. Our study suggests that tympanic thermometer measurement could be used as an acceptable and practical method for sick newborn in neonatal units.

Clinical Characteristics of Neonatal Meningomyelocele Cases and Effect of Operation Time on Mortality and Morbidity

Objective: We aimed to evaluate the clinical features, short-term prognosis, and effect of operation time on mortality and morbidity in neonates with meningomyelocele. Methods: This prospective study was conducted between January 2006 and December 2008. Clinical features, defective area, existence of additional anomalies, operation time, and morbidity and mortality data were recorded. The effectof operation time on mortality and morbidity was evaluated. Results: Patients (n = 28) were assessed during the study period. Mean birth weight, height, and head circumference were found to be 3,160 ± 582 g, 46.2 ± 3.3 cm, and 36.7 ± 4.1 cm, respectively. None of the mothers received folate supplementation. Hydrocephaly (n = 13), pes equinovarus (n = 4), pelvicalyceal ectasia (n = 4), acetabular dysplasia (n = 2), Chiari II malformation (n = 2), and hydronephrosis (n = 2) accounted for additional anomalies. The mean postnatal age for surgical operation was 3.2 ± 2.8 days; mean length of hospital stay was 10.2 ± 9.7 days. The cases operated after 72 h were hospitalized longer, received antibiotherapies for a longer duration and had higher total complication rates (p = 0.04, 0.02, and 0.01, respectively). Conclusion: Surgical operation of patients with meningomyelocele within 72 h after delivery significantly reduces not only the duration of hospitalization and antibiotic usage, but also complication rates.

Delivery room blood pressure percentiles of healthy, singleton, liveborn neonates

Background:  Arterial blood pressure (BP) is one of the four vital signs that reflect cardiovascular status in neonates. The present study aimed to obtain BP percentiles among healthy, singleton, liveborn neonates between 34 and 43 weeks of gestation who were less than 1 h old.

Healthcare-associated Infections in a Neonatal Intensive Care Unit in Turkey.

ObjectiveTo determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit.DesignProspective, cohort.SettingA 38-bed, teaching, referral, neonatal intensive-care unit.ParticipantsAll patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours.MethodsThe study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis.ResultsThe incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively.ConclusionsAntenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.

Oxygen saturation of healthy term neonates during the first 30 minutes of life.

The purpose of this study was to document the oxygen saturation (SpO2), general physical signs and laboratory characteristics during the first 30 min of life.

Relationship Between Oxygen Saturation and Umbilical Cord pH Immediately After Birth

BACKGROUND The aim of this study is to determine the relationship between oxygen saturation (SpO(2)) by pulse oximetry levels and umbilical cord arterial pH values in healthy newborns during the first 15 minutes of life. METHODS The study was performed with healthy term, appropriate-for-gestational-age newborn infants. The infants were divided in two groups: umbilical cord arterial blood pH value ≤7.19 (group 1) and >7.19 (group 2); SpO(2) levels during the first 15 minutes of life were compared between groups. RESULTS The study was completed with 129 infants (33 in group 1 and 96 in group 2). A significant correlation was found between first-measured preductal and postductal SpO(2) levels by pulse oximetry and umbilical cord arterial pH values ([r²:0.72(0.62 -0.79); p < 0.001] and [r²:0.32(0.25 - 0.54); p < 0.001], respectively). In group 1, infants had lower SpO(2) levels at both preductal and postductal measurements during the first 11 minutes of life and time to reach ≥90% SpO(2) level was longer compared with infants in group 2. CONCLUSION Determination of umbilical arterial blood pH values, in addition to clinical findings and oxygen saturation measurements, might be helpful in deciding the concentration of oxygen and whether or not to continue oxygen supplementation in the delivery room.

The evaluation of polycythemic newborns: efficacy of partial exchange transfusion

Objectives. To evaluate the clinical characteristics and risk factors of symptomatic and asymptomatic polycythemic neonates performed partial exchange transfusion (PET) and to determine the time of resolution of symptoms and effect of PET on short-term morbidity. Methods. This prospective cohort study was conducted with symptomatic (hematocrit; Hct >65% plus a clinical symptom) and asymptomatic (Hct level >70% without any symptoms) neonates who underwent PET due to polycythemia. Results. Among the patients performed PET, 43 (69.3%) were symptomatic and 19 (30.7%) asymptomatic. Persistent pulmonary hypertension and minor problems like hypoglycemia, hypocalcemia, hyperbilirubinemia, and thrombocytopenia improved in all patients within 24 h, 2.5 ± 1.0, 3.1 ± 1.4, 56.2 ± 16.9, and 53.5 ± 10.5 h, respectively, after PET (in except one symptomatic neonate with hypoglycemia). In symptomatic group, in three patients with suspected necrotizing enterocolitis (NEC) prior to PET stage IIa NEC developed. No other clinical and ultrasonographic findings were observed after PET. Conclusions. Early morbidities, due to polycythemia may be reversed with PET within a short time. PET did not increase or cause any complications except NEC. The issue that either NEC was a sign of polycythemia or a complication of PET could not be definitely outlined.

Acute osteomyelitis of the iliac bone presenting with gluteal syndrome in a newborn

Acute osteomyelitis in neonates, although rare, represents a diagnostic and therapeutic challenge. We herein report an extremely rare case of congenital nonsyphilitic iliac bone osteomyelitis caused by methicilline-sensitive Staphylococcus aureus and presenting with gluteal syndrome in a near-term infant. To our knowledge, this represents the second report with iliac osteomyelitis and the first report with gluteal syndrome in neonatal period. A high index of suspicion is necessary to make an early diagnosis. Early diagnosis is essential to prevent catastrophic sequelae in such cases. We report this case because of its unusual clinical presentation and rarity.