Ferda Özlü

Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit.

Aim:  To evaluate the role of electronic faucets in a newborn intensive care unit during a Pseudomonas aeruginosa outbreak.

A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey

Aim:  To report the incidence of healthcare‐associated infections (HAIs), site of infection and bacterial epidemiology in the Neonatal Intensive Care Unit in a university hospital in Adana, Turkey, between 2001 and 2006.

Barttin mutations in antenatal Bartter syndrome with sensorineural deafness

Case 1 The male patient had been born at 30 weeks of gestation (weight 1,360 g) to consanguineous parents. Pregnancy was complicated by severe polyhydramnios. Findings at his physical examination were normal except for a triangular face, large eyes, protruding ears, tachypnea and retractions. He rapidly developed renal salt wasting, hyper-reninemic hyperaldosteronism, hypokalemic metabolic alkalosis, and impaired renal function [creatinine (Crea) 1.5 mg/dl]. The diagnosis of antenatal Bartter syndrome (aBS) was suspected. On day 49 oral administration of indomethacin was started (2–3 mg/kg per day), which could not help to regulate serum potassium levels. Instead, upon indomethacin treatment, renal function further deteriorated (Crea 2.5 mg/dl). Therefore, indomethacin was stopped, and he was treated with spironolactone. Potassium need declined to 27 mEq/kg, and he was discharged after 140 days. He has unilateral sensorineural deafness detected by impaired brain stem evoked potentials and growth retardation. A homozygous mutation in the Barttin gene (BSND) leading to a loss of start codon was detected (Table 1). A similar mutation has been previously described [1].

A neonate with homozygous protein C deficiency with a homozygous Arg178Trp mutation.

Homozygous protein C deficiency affects approximately 1/400,000 to 1/1,000,000 live births. Homozygous protein C deficiency is associated with catastrophic and fatal purpura fulminans-like or thrombotic complications and disseminated intravascular coagulation. In the present patient, genetic study revealed Arg178Trp, a mutation found widely in European population; but this is the first case of homozygous Arg178Trp mutation who suffered from catastrophic purpura fulminans phenotype.

Polymorphism of the angiotensin-converting enzyme gene and angiotensin-converting enzyme activity in transient tachypnea of neonate and respiratory distress syndrome.

Background: Transient tachypnea of neonate (TTN) and respiratory distress syndrome (RDS) of the newborn are the most common cause of early respiratory distress in the immediate neonatal period. There is increasing evidence to support the role for the activation of the renin angiotensin system during acute lung injury. Objectives: The purpose of this study was to determine if there is a relationship between angiotensin-converting enzyme (ACE) I/D polymorphism, ACE activity and TTN and respiratory distress syndromes. Methods: Nineteen neonates with TTN, 20 neonates with RDS and 21 control infants are studied for ACE polymorphism and serum ACE activity. Results: Twenty six (43.3%) patients have DD polymorphism, 19 (31.7%) patients have ID polymorphism and 15 (25%) patients have II polymorphism. Serum ACE activity is 43.5 ± 1.8 (40–46) U/L in DD, 31.5 ± 2.3 (28–36) U/L in ID and 22.1± 2.1(19–46) U/L in II patient. Conclusions: The study could not find any difference in DD alleles and ACE activity between control group and TTN group. ACE polymorphism was not different between RDS group and control group in this study.

Are vital signs indicative for bacteremia in newborns

Abstract Objective: Neonatal systemic infection is a leading cause of morbidity and mortality both in industrialized and developing countries. The aim of this prospective study was to evaluate if vital signs had a predictive power in neonatal sepsis as an early marker. Methods: This study was designed as a matched case–control study. Vital signs were monitorized prior to infection in newborns that had healthcare-associated blood stream infection (BSI). Maximum and minimum values of the vital signs (blood pressure, heart rate, respiratory rate and temperature) of the babies at rest were recorded from the nurse observation charts five days prior to clinical sepsis and compared with vital signs of healthy, age-matched babies. Results: Maximum mean heart rates, respiratory rates and systolic blood pressure levels of the patients in BSI group were significantly higher than the control group in the past three days prior to clinical deterioration. Conclusion: Monitoring vital signs closely might be helpful in a newborn infant to define a BSI. In future, a respiratory and blood pressure predictive monitoring system such as heart rate variability index may be developed for newborn patients with sepsis.

Do all deliveries with elective caesarean section need paediatrician attendance

Aim: To determine whether paediatrician attendance to deliveries with elective caesarean section (CS) is really needed for term and also for preterm babies with 35–37 weeks gestational age. Methods: Singleton newborns ≥35 gestational weeks without any identified risk factor were evaluated for resuscitation steps prospectively after CS under regional and general anaesthesia. Results: 545 infants were included in the study. 150 (27.5%) of infants needed only supplemental oxygen and 23 (4.2%) neonates needed bag and mask ventilation. None of the babies needed cardiopulmonary resuscitation (CPR) (chest compression) or endotracheal tube insertion/epinephrine administration. More infants required supplemental oxygen and bag-mask ventilation in general anaesthesia delivery group compared to spinal/epidural anaesthesia group (35.5% vs. 24.4%, p = 0.29 for oxygen and 9.2 % vs. 2.3%, p < 0.0001 for bag-mask) The need for resuscitation steps was not statistically significantly different between neonates who were born in 35–37 gestational week and neonates who were born ≥38 week (p = 0.170 for supplementary oxygen, p = 0.442 for bag-mask ventilation). Conclusion: There is not increased risk for chest compression and entubation for infants ≥ 35 gestation weeks without antenatally identified risk factors born with elective CS either under regional or general anesthesia and only 4.2% of the babies needed bag-mask ventilation, so a health care personel who knows basic NRP may be sufficient in the clinics where it is easy to achieve an advanced skilled health care personel when needed.

Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy

Yapıcıoğlu-Yıldızdaş H, Ece Ü, Sucu M, Yurdakul G, Şimşek H, Özlü F. Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy. Turk J Pediatr 2017; 59: 724-727. Twin reversed arterial perfusion syndrome is mostly seen in monochorionic diamniotic twin pregnancies with an estimated incidence of 1/9500-11000 pregnancies. One of the twins is acardiac with various abnormalities especially with upper part of the body, and mortality is 100%. The other twin functions as a pump twin and mostly has polyhydramnios and heart failure; and mortality rate is high due to prematurity and heart failure. Herein we report a TRAP syndrome and the prognosis of pump twin who was born at 30 weeks gestational age.

A congenital soft tissue ewing sarcoma in a newborn patient

Akçalı M, Yapıcıoğlu H, Akay E, Özlü F, Kozanoğlu B, Erdoğan K, Gönlüşen G, Satar M. A congenital soft tissue Ewing sarcoma in a newborn patient. Turk J Pediatr 2017; 59: 76-79. < p < Congenital Ewing sarcoma is extremely rare. Here we present a newborn baby born with a mass on the left shoulder. Immunohistochemical staining showed congenital Ewing sarcoma. Chemotherapy and then surgical operation were planned, however the patient died before initiation of chemotherapy on the 30th day of life.

Corset Usage for Gastrointestinal and Respiratory Problems in a Newborn with Prune Belly Syndrome

Prune Belly syndrome (PBS), comprises a triad of anomalies that include abdominal wall flaccidity, urologic anomalies and bilateral cryptorchidism in males. The abdominal musculature hypoplasia predisposes to respiratory problems, respiratory infections secondary to impaired cough mechanism, and cause chronic constipation secondary to ineffective valsalva ability. Here, the authors present a newborn baby with Prune Belly syndrome who had respiratory and gastrointestinal problems which resolved after corset use. To the authors knowledge, this is the first case of corset usage in the treatment of PBS in a newborn infant.