Evrim Alyamac Dizdar

Low platelet count is associated with ductus arteriosus patency in preterm newborns.

BACKGROUND/AIMnTo determine whether there is an association between platelet counts and patent ductus arteriosus (PDA) incidence and/or closure in preterm newborns.nnnSTUDY DESIGN AND SUBJECTSnPremature infants with hemodynamically significant PDA (n=154) and a control group without PDA (n=207) who were hospitalized in the NICU were retrospectively evaluated. Platelet counts and other platelet indices including mean platelet volume (MPV) and platelet distribution width (PDW) of the infants in both groups during the first 3 days of life were recorded. Ibuprofen was started in infants with hemodynamically significant PDA and echocardiography was repeated 48 h thereafter to assess the closure of ductus.nnnRESULTSnMedian gestational age and birth weight of the infants with PDA were 28 (range 26-29) weeks and 1060 (range 892-1250) g respectively. Platelet counts were significantly lower in the patient group than in the control group (p<0.001). Multivariate analysis including gestational age, presence of RDS, presence of thrombocytopenia and PDW showed that hemodynamically significant PDA was independently associated with platelet count <150,000 (OR=2.13, 95% CI 1.26-3.61; p=0.005), high PDW (>17) (OR=2.68, 95% CI 1.41-5.09; p=0.003) and the presence of RDS (OR=2.25, 95% CI 1.41-3.59; p=0.001). Baseline platelet counts of the infants in whom ductus closed or persisted after ibuprofen treatment were similar.nnnCONCLUSIONSnPDA was associated with low platelet count and high PDW but not with other platelet indices in preterm infants. We could not show an association between platelet counts and persistence or closure after medical treatment.

Effect of mode of delivery on macronutrient content of breast milk

Abstract Objective: To determine the effect of delivery type on macronutrient content of colostral milk. Materials and methods: The study was conducted at Zekai Tahir Burak Maternity Teaching Hospital. Colostral milk samples from term lactating mothers who gave birth by vaginal or cesarean delivery (CD) were obtained on the 2nd postpartum day. Milk protein, fat, carbohydrate (CHO) and energy levels were measured by using a mid-infrared human milk analyzer. Results: A total of 204 term lactating mothers were recruited to the study; 111 mothers gave birth by vaginal route and 93 mothers by CD. Protein levels were statistically lower in colostral milk of mothers after CD compared to mothers who delivered vaginally (median 2.4 (range 0.3–6.4) g/dl versus 3 (0.5–6.3) g/dl, respectively; pu2009=u20090.036). Colostral fat, CHO and energy levels were similar between groups. In linear regression analysis, CD and maternal age were independently associated with lower protein content in colostrum. Conclusion: Vaginal delivery is associated with higher colostrum protein content. Hormonal activity induced by labor pain and uterine contractions might account for the alterations in the protein composition of human milk to facilitate optimal development of important physiologic functions in newborns.

The effect of lactational mastitis on the macronutrient content of breast milk

AIMSnMastitis in lactating mothers reduces milk production and alters the cellular composition of milk. Changes occurring in the mammary gland during the inflammatory response are believed to increase the permeability of the blood-milk barrier. This study examined the effect of mastitis during lactation on the macronutrient content of breast milk.nnnMETHODSnThe study was conducted at Zekai Tahir Burak Maternity Teaching Hospital. Transitional breast milk samples were obtained from term lactating mothers with or without mastitis. Milk protein, fat, carbohydrate, and energy levels were measured using a mid-infrared human milk analyzer.nnnRESULTSnThe study recruited 30 term lactating mothers: 15 mothers diagnosed with mastitis and 15 healthy mothers. The characteristics of the mothers in both groups were similar. Fat, carbohydrate, and energy levels were statistically lower in the milk samples of mothers with mastitis compared with the mothers without mastitis.nnnCONCLUSIONnLactational mastitis was associated with lower breast milk fat, carbohydrate, and energy levels. The local inflammatory response induced by cytokines and increased blood-milk barrier permeability might account for the changes in the fat, carbohydrate, and energy levels of human milk.

Enterocutaneous fistula secondary to purpura fulminans in a preterm infant.

Enterocutaneous fistula in newborns and preterms is a well-recognized complication after necrotizing enterocolitis and abdominal surgical procedures/percutaneous interventions. However, to our knowledge, enterocutaneous fistula associated with purpura fulminans has not been reported before. Herein we report a preterm infant with purpura fulminans who developed cutaneous necrotic lesions on anterior abdominal wall. Adherence of necrotic abdominal skin to the adjacent intestinal wall resulted in enterocutaneous fistula. The patient was treated conservatively with bowel rest and antibiotics. The fistula was surgically closed 2 months later.

Does Circadian Variation of Mothers Affect Macronutrients of Breast Milk

Objective To determine the within‐day variation of fat, protein, and carbohydrate content of breast milk. Methods The study was conducted at Zekai Tahir Burak Maternity Teaching Hospital between April 2013 and January 2014. We obtained milk samples from lactating mothers of hospitalized infants through hand expression after breast‐feeding or pumping three times a day. A mid‐infrared human milk analyzer was used for measuring the macronutrient contents of breast milk samples. Results Lactating mothers of 52 infants (30 preterm, 22 term) were recruited to the study. No significant difference was found in protein, fat, and carbohydrate content of milk samples throughout the day. We compared within‐day variation of macronutrients of transitional and mature milk, milk samples from the mothers of preterm and term infants, and samples collected by either hand expression or pumping. We did not find a significant difference between the groups. Conclusion Absence of circadian variations in lipid, carbohydrate, and protein content of breast milk in our study may be related to ethnic differences, maternal nutritional status, different milk content measurement technique, and population characteristics.

Intraventricular hemorrhage and oral ibuprofen in very low birth weight preterm infants

To the Editor: We read with interest the report by Brunner et al, which showed an association between a moderately low platelet count between 50 and 99 10/L, treatment of patent ductus arteriosus (PDA) with cyclooxygenase inhibitors, and intraventricular hemorrhage (IVH) in preterm infantswith a gestational age of <32 weeks. We evaluated the effect of platelet count on the severity of IVH among 325 very low birth weight preterm infants with IVH, of whom 25 had severe IVH (grade 3-4). Platelet counts were significantly lower in preterm infants with severe IVH than in these with mild IVH (grade 12) on the first day and on the day of cranial ultrasound examination (P = .035 and .003, respectively). Of 325 infants with IVH, 135 had received oral ibuprofen for the treatment of significant PDA. Oral ibuprofen treatment did not significantly increase the severity of IVH in very low birth weight infants who had a moderately low platelet count between 50 and 150 10/L (P = .095). We propose that contradictory results in the study of Brunner et al and our study might be secondary to the use of different form of ibuprofen (either intravenous or oral) or indomethacine. Second, platelet function rather than count might be more important for IVH. Infants with severe IVH have poorer neurodevelopmental outcome than those with milder IVH, and increased severity of IVH is associated with increased mortality and morbidity. Although we did not show any association between a moderately lowplatelet count, treatment of PDAwith oral ibuprofen, and severity of IVH, caution should be taken when using cyclooxygenase inhibitors in the treatment of PDA.