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Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants

Objective: To study the efficacy of early high doses parenteral nutrition (PN) versus early low dose with progressive increments PN regimens, we performed a prospective randomized study in very low birth-weight infants. Study design: Forty-one appropriate gestational age preterm infants with birth weights ranging from 750–1500 g were randomly assigned into two groups. In Group 1, infants started on 3.0 g/kg/day amino acids (AA) and 3 g/kg/day of 20% lipid; in Group 2, AA and lipid were started on 1 g/kg/day, and advanced over 3 days to a maximum 3 g/kg/day. Blood samples were obtained for AA concentrations before starting of the PN, and at the 7th and 14th days. Results: The mean (±SD) birth weight was 1335 g (240), gestational age was 29.7 weeks (1.7) of the study group. The mean body weight and head circumference was similar in the Group 1 and Group 2 at the 14th postnatal days. There was no difference in the blood levels of triglyceride, blood urea nitrogen, creatinine, ammonia, lactat and bicarbonate in the two groups. There was no significant difference in the concentrations of AA except for arginine and asparagine. On day 14, the mean arginine concentrations were significantly higher and asparagine concentrations were lower in Group 2. Conclusion: Although earlier more aggressive administration of AA and fat is not associated with any significant metabolic abnormalities, growth rates and plasma AA concentrations of the infants were similar to infants who AA and lipid given lower in the first day of life.

Idiopathic congenital chylothorax presented with severe hydrops and treated with octreotide in term newborn

Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. Morbidity of congenital chylothorax (CC) is high, and prognosis is very poor if chylothorax is associated with hydrops fetalis. The optimal treatment of CC has not been defined. Conservative treatment (low-fat high-protein diets with medium chain triglycerides, total parenteral nutrition, pleural drainage) and surgical intervention are performed. However, there is little experience with the use of octreotide therapy in this condition. We report a newborn with CC presented with severe non-immune hydrops and chylothorax resistant to mainly conservative treatment. The patient improved rapidly and the chylothorax disappeared with use of continuous administration of octreotide (10 μg/kg/per hour).

Incontinentia pigmenti mimicking a herpes simplex virus infection in the newborn.

IntroductionIncontinentia pigmenti is a rare, X-linked dominant multisystem genodermatosis that presents at or soon after birth with characteristic cutaneous signs. The main features occur in the skin where a blistering rash occurs in the newborn period, followed by the blisters becoming raised-like warts. After the skin, the central nervous system is the next most affected system.Case reportWe report a female infant who was born with vesicular eruptions who was initially thought to have congenital herpes simplex virus infection.ConclusionThis case report emphasises that incontinentia pigmenti should be included in the differential diagnosis of cutaneous blistering lesions and central nervous system involvement in neonates.

Neurological aspects of tuberous sclerosis in relation to MRI/MR spectroscopy findings in children with epilepsy.

Abstract Our aim was to evaluate the relationship between the neurological outcome of tuberous sclerosis complex (TSC) and the findings obtained from both cranial magnetic resonance imaging (MRI) and single voxel proton spectroscopy (SVPS). MRIs of 13 children who met the diagnostic criteria for TSC were taken. Eleven of these children also underwent a prospective analysis of SVPS. Fishers exact test and Mann-Whitney U test were used, where applicable, to detect any signs of the imaging data that would indicate poor outcome, or in other words, poor seizure control and/ or high degree of mental retardation. Poor seizure control was seen in eight of the patients and multiple seizure types in seven. Mental retardation was severe in six patients and mild/moderate in seven. MRI revealed multiple bilateral tubers and subependymal nodules (13/13), confluence of tubers (8/13), subcortical linear heterotopias (7/13), gyral cores (3/13) and cortical atrophy (3/13). SVPS findings of tubers were characterized by decreased NAA/Cr (1.43 ± 0.33, p<0.001), increased Cho/Cr (0.91 ± 0.082, p< 0.05) and mI/Cr (0.97 ± 0.19, p<0.01) ratios when compared with those of the control group. Lactate peak was detected in six patients. Unfavorable outcome in TSC can be predicted with the help of the following: multiple seizure types, a number of confluent appearances of the tubers and cortical atrophy. SVPS could be a useful clue to understand the pathophysiologic function of the tubers, especially in children with refractory epilepsy along with TSC.

Percutaneously inserted central catheters in the newborns: A center's experience in Turkey

Objective. To evaluate the success rate of insertion of percutaneously inserted central catheters (PICCs) and their duration; and the short- and long-term complications in the neonatal period. Study design. We did a prospective collection and analysis of the data of all infants who underwent PICC placement from January 2005 and through January 2007. During this period there were 139 PICCs inserted in a total of 124 infants. The data of all infants were compiled, including birth weight, gestational age, diagnosis, type of catheter, site of catheter placement, reason for catheter removal, duration of use of the catheter, and the rate of complications. Results. The success rate of PICC insertion was 88.5% with the upper extremity being the most frequently used site. The mean duration of PICC treatment was 11.9 ± 6.3 days. PICCs were removed electively for 72 times (54.1%) and due to catheter-related complications for 61 times (45.9%). The main complication rate was the mechanical occlusion (12.7%). There were no statistically significant differences in the number of complication rates according to the insertion site, the position of the catheter tip, or the size of the catheter. Conclusion. Our initial experience with PICCs is that their use provides life-saving therapy, they are easily inserted and they are convenient. Mechanical complications were the common reason for removal and we did not see complications more serious.