Eren Özek

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. These updated guidelines are based upon published evidence up to the end of 2009. Strong evidence exists for the role of a single course of antenatal steroids in RDS prevention, but the potential benefit and long-term safety of repeated courses are unclear. Many practices involved in preterm neonatal stabilisation at birth are not evidence-based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS, but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be lifesaving, but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure or nasal ventilation. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.

Comparison of sucrose and human milk on pain response in newborns

Abstract The aim of this study was to compare the analgesic effect of 2 ml 25% sucrose and human milk in a group of healthy term newborns. Healthy infants (n = 102) were randomly allocated to receive one of three solutions (sucrose, human milk, sterile water) 2 min prior to taking a heel prick blood sample. The median values of crying time, recovery time and percentage change in heart rate at 1, 2 and 3 min were recorded in response to the heel prick. Median crying times were 36, 52, and 62 s in the sucrose, placebo and human milk groups, respectively (P = 0.0009). In the sucrose group, there was a significant reduction in crying time compared to human milk and placebo groups. Similarly, the median recovery time in the sucrose group (72 s) was shorter than that in the human milk (112 s) and placebo groups (124 s) (P = 0.004). The percentage change in heart rate at 1, 2 and 3 min was also significantly lower in the sucrose group (P = 0.008, P = 0.01, P = 0.002 at 1, 2, and 3 min respectively). Conclusion The orosensorial antinociceptive effect of human milk is not as effective as an analgesic as a 25% sucrose solution.

Mothers’ postpartum psychological adjustment and infantile colic

Background: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. Aim:: To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. Methods: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. Results: Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS ⩾13. The mean EPDS of the mothers whose infants had infantile colic (10.2±6.0) was significantly higher than that of the mothers of infants without colic (6.3±4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. Conclusion: Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update.

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles.

Aim:  Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers.

Percentiles of oxygen saturations in healthy term newborns in the first minutes of life

The aim of this study was to establish the reference values of preductal oxygen saturation (SpO2) in healthy infants immediately after birth. SpO2 recordings of 200 term neonates (vaginal group;n=150 and cesarean group;n=50) with regular respiratory pattern were evaluated. The median SpO2 values in the first, fifth and tenth minutes were 71, 92, and 98% in vaginal deliveries and 70, 79, and 96% in cesarean deliveries, respectively. SpO2 was significantly lower in the cesarean group at any time after the first minute of life (p<0.0001). The time needed to reach a SpO2>90% was three times longer in cesarean deliveries. Healthy neonates are poorly saturated immediately after birth. The duration to reach a SpO2>90% was longer in infants born by cesarean deliveries.

Pichia anomala fungaemia in immunocompromised children.

Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow‐up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy.

Noise levels in neonatal intensive care unit and use of sound absorbing panel in the isolette

OBJECTIVE The purposes of this study were to measure the noise level of a busy neonatal intensive care unit (NICU) and to determine the effect of sound absorbing panel (SAP) on the level of noise inside the isolette. METHODS The sound pressure levels (SPL) of background noise, baby crying, alarms and closing of isolettes door/portholes were measured by a 2235-Brüel&Kjaer Sound Level Meter. Readings were repeated after applying SAP (3D pyramidal shaped open cell polyurethane foam) to the three lateral walls and ceiling of the isolette. RESULTS The median SPL of background noise inside the NICU was 56dBA and it decreased to 47dBA inside the isolette. The median SPL of monitor alarms and baby crying inside the isolette were not different than SPL measured under radiant warmer (p>0.05). With SAP, the median SPL of temperature alarm inside the isolette decreased significantly from 82 to 72dBA, monitor alarm from 64 to 56dBA, porthole closing from 81 to 74dBA, and isolette door closing from 80 to 68dBA (p<0.01). There was a significant reduction in the noise produced by baby crying when SAP was used in the isolette (79dBA vs 69dBA, respectively) (p<0.0001). There was also significant attenuation effect of panel on the environmental noise. CONCLUSIONS The noise level in our NICU is significantly above the universally recommended levels. Being inside the isolette protects infants from noise sources produced outside the isolette. However, very high noises are produced inside the isolette as well. Sound absorbing panel can be a simple solution and it attenuated the noise levels inside the isolette.

Pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis.

The authors present a case of pleomorphic xanthoastrocytoma that occurred in a 14-year-old boy with von Recklinghausens neurofibromatosis. The circumscribed turmor with a cystic component was located in the medial right temporal lobe. The designation of pleomorphic xanthoastrocytoma has been suggested for this neoplasm on the basis of its unique histological features. These include positive glial fibrillary acidic protein staining.

Quantitative ultrasound and biochemical parameters for the assessment of osteopenia in preterm infants

Objective. Our study aimed to evaluate the feasibility of quantitative ultrasound (QUS) evaluation in osteopenia of prematurity and to compare the results to biochemical parameters. Methods. QUS assessment of bone was performed at the end of the first postnatal week and at term-corrected age (CA) in premature infants (N = 30) and within the first week in full-term infants (N = 25). On the same day of measurement of QUS, the serum calcium, phosphorus (inorganic), and alkaline phosphatase (ALP) activity were measured in the preterm infants. Results. The median of tibia z score at term-CA in premature infants was significantly lower compared to that of first postnatal week (−1 and 0.4, respectively; p < 0.0001) and it was also lower than that of term-matched controls (0.0; p = 0.001). Preterm infants at term-CA had lower weights and lengths in comparison to term infants. The median ALP value was 585 IU/L at the first postnatal week and 703 IU/L at term-CA in preterm infants (p = 0.003). The median tibia z score of infants with ALP ≥900 IU/L was significantly lower than that of the infants with ALP <900 IU/L (−1.4 vs. 0.1; p = 0.001). An inverse correlation was found between ALP levels and tibia z score at term-CA in preterm infants (rho = −0.61, p = 0.01). Conclusions. Bone density of preterm infants at term-CA was lower than that at first postnatal week. Serum ALP levels increased during the first postnatal weeks. The tibia z scores were correlated to serum ALP levels. QUS is a good screening tool for the detection of osteopenia.