Gülsevin Tekinalp

Exposure of newborns to aflatoxin M1 and B1 from mothers' breast milk in Ankara, Turkey

Aflatoxins (AFs) are important risks for human health due to their widespread presence in foods and environment. However, contamination risk of breast milk with different pollutants including AFs is high in todays life conditions. Since breast milk is a major nutrient for infants, feeding of infants with safe milk is essential. Therefore, the objective of this study was to determine the levels of AF M(1) and B(1) in breast milk samples collected from 75 mothers in Ankara, Turkey. AF M(1) and B(1) levels were investigated by high performance liquid chromatography (HPLC) with a fluorescence detector following an extraction procedure. The limit of detection was found to be 5 ng/l. Both AFs were detected in diverse degrees in all breast milk samples: The level of AF M(1) were in the ranges of 60.90-299.99 ng/l, and AF B(1) were in the ranges of 94.50-4123.80 ng/l. These results pointed out the exposure of mothers and neonates to AF M(1) and B(1), and the necessity of further research on mycotoxin contamination both in foods and biological fluids as well as protection strategies.

Determination of reference values for plasma cystatin C and comparison with creatinine in premature infants

Cystatin C (CysC) is a low-molecular-mass protein (13,343xa0dalton, 120 amino acids) belonging to the cystatin superfamily of reversible inhibitors of cysteine proteases. CysC appears to be eliminated from the circulation almost exclusively by glomerular filtration, which makes it a promising endogenous marker of renal function. CysC has been demonstrated to reflect glomerular filtration rate better than other low-molecular-weight proteins, including creatinine (Cr). We established reference values for serum CysC and compared them with Cr in 108 preterm infants by particle-enhanced nephelometric immunoassay. On the first day, serum CysC values ranged from 1.25 to 2.84xa0mg/L, significantly decreasing after 3xa0days of life. Cr levels determined simultaneously on the first day ranged from 0.05 to 1.12xa0mg/dl and were also significantly different from day 3 levels. Both CysC and Cr levels were independent of gender, birth weight, hemoglobin levels, and hydration state. Cr correlated negatively with gestational age (ru2009=u2009−0.25, pu2009=u20090.009), but not CysC. A significant correlation was found between CysC and Cr on day 1 (ru2009=u20090.21, pu2009=u20090.031), but no correlation was found according to day 3 blood samples (ru2009=u20090.19, pu2009=u20090.053). CysC is regarded as an alternative for assessing renal function in preterm neonates, but its advantages over Cr are not yet proven.

Vitamin D-deficiency rickets and myelofibrosis

This study was aimed at detecting the early appearance of myelofibrosis by bone marrow biopsy examination in children with vitamin D-deficiency rickets. Twelve children, aged 4 to 18 months, were evaluated. Only a minimal increase of the reticulin was shown in rachitic children without anemia in whom no other laboratory evidence of myelofibrosis was present. Early signs of myelofibrosis with increase of reticulin were present in rachitic infants with anemia. In patients of the same age with iron deficiency anemia, the bone marrow reticulin findings were normal. Bone marrow biopsy after successful treatment of rickets could be repeated in one patient with myelofibrosis; results indicated that the myelofibrosis with anemia associated with vitamin D-deficiency rickets is reversible by vitamin D treatment.

A case of Pearson syndrome associated with multiple renal cysts.

A 41-day-old infant who had severe metabolic acidosis, anemia, bleeding, hypoglycemia, and proximal tubulopathy was diagnosed with Pearson syndrome. Fibrosis in the liver, severe iron deposition in hepatocytes, and multiple renal cortical cysts were found on postmortem examination. Southern blot analysis of mitochondrial DNA obtained from peripheral blood revealed a heteroplasmic deletion of approximately 3.5 kilobases.

Interrupted aortic arch in a neonate: multidetector CT diagnosis

We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted aorta of a neonate. CTA is useful for evaluating malformations of the aortic arch, particularly in cases that cannot undergo conventional angiography or in which detailed information cannot be provided by echocardiography.

Incidence of phenylketonuria and hyperphenylalaninaemia in a sample of the Turkish newborn population

The incidence of hereditary aminoacidopathies has been determined and nationwide programmes focussed on the most common diseases have been set up in the USA and most of the European countries. Specifically, the programme for phenylketonuria (PKU, McKusick 26160) has been successful and has served as a model for the detection and preventive treatment of genetic diseases.

Inhaled Beta-2 Agonist Salbutamol for the Treatment of Transient Tachypnea of the Newborn

OBJECTIVEnTo evaluate the efficacy of inhaled salbutamol, a beta-2 adrenergic agonist, for the treatment of transient tachypnea of the newborn (TTN) and to determine whether inhaled salbutamol is safe in newborn infants.nnnSTUDY DESIGNnInhaled salbutamol or normal saline solution was administered to 54 infants with gestational ages ranging from 34 to 39 weeks and TTN. The response to salbutamol therapy was evaluated by determining respiratory rate, clinical score of TTN, level of respiratory support, and fraction of inspired oxygen before and at 30 minutes and 1 and 4 hours after salbutamol nebulization.nnnRESULTSnAmong the 54 infants with TTN, 32 received salbutamol and 22 received normal saline solution. After one dose, the salbutamol group showed significant improvements in respiratory rate, clinical score of TTN, fraction of inspired oxygen, and level of respiratory support (P < .05). After treatment, the mean pH, partial pressure of arterial oxygen, and partial pressure of arterial carbon dioxide values were better in the salbutamol group when compared with the placebo group (P < .05). Duration of hospitalization in the neonatal intensive care unit was also shorter for the salbutamol group (P < .05).nnnCONCLUSIONnInhaled salbutamol treatment was effective with respect to both clinical and laboratory findings of TTN and without adverse events.

Prenatal diagnosis of isolated non-compaction of the ventricular myocardium: Study of six cases

Background: Isolated non‐compaction of the ventricular myocardium (INVM) is characterized by prominent and excessive trabeculations in one or more ventricular wall segments, with deep intertrabecular recesses communicating directly with the ventricular cavities. Diagnosis of the disease is based on the 2‐D echocardiographic features. Despite the fact that many cases of INVM have been reported in children and adults since the initial description of the disease, it has been diagnosed in only a few fetuses up to now. Therefore, failure to diagnose on fetal echocardiography is probably more common. There are different opinions about diagnosis of INVM on fetal echocardiography.

Increased Fetal Iron Load in Rhesus Hemolytic Disease

There is little information about the iron overload caused by hemolysis in fetuses affected with rhesus hemolytic disease (RHD). The authors therefore studied the iron load in RHD by measuring cord blood ferritin levels in babies affected with RHD and gestational age- and weight-matched controls. Cord blood ferritin levels were higher in babies with RHD. Intrauterine transfusions did not affect the ferritin status of the babies with RHD and there was no correlation between hemoglobin and ferritin levels. The results indicate that there is an increased intrauterine iron load in babies with RHD, independent from intrauterine transfusions and rate of hemolysis.

Maternal risk factors associated with lead, mercury and cadmium levels in umbilical cord blood, breast milk and newborn hair.

Abstract Objective: Lead (Pb), mercury (Hg) and cadmium (Cd) are environmental pollutants that are wide spread throughout the world. The present study aimed to investigate the level of exposure to Pb, Hg and Cd during the prenatal period, and the possible routes of maternal exposure to these toxic heavy metals. Participants: The study included 123 mothers and their newborns. Umbilical cord blood samples were collected immediately after delivery, and breast milk and newborn hair samples were collected between postpartum d 3 and 10. Results: Among the 121 cord blood samples that were analyzed, Pb was present in 120 (99.2%) and the mean level was 1.66u2009±u20091.60u2009µgu2009dL−1 (range: <detection limit–12.50u2009µgu2009dL−1), whereas Hg was noted in only 2 (1.7%) (15.74 and 33.20u2009µgL−1) and Cd was detected in 24 (19.8%) (range: <u2009detection limit–6.71u2009µgL−1). The level of Pb in cord blood was ≥2u2009µgu2009dL−1 in 29% of the samples. Pb, Hg and Cd were detectable in all the newborn hair samples. Discussion: Among the 107 breast milk samples analyzed, 89 (83.2%) had a detectable level of Pb and the mean level was 14.56u2009±u200912.13u2009µgL−1. Detection rate of Cd in breast milk was higher in women who resided near to city waste disposal site. Detection rate of Cd in cord blood was significantly higher in the women who consumed ≥2 servings of fish weekly. Maternal exposure to environmental tobacco smoke (ETS) resulted in elevated levels of Pb and Cd in newborn hair samples. Conclusion: Most of the study samples had detectable levels of Pb, Hg and Cd, indicating that there was long-term maternal exposure prior to and during pregnancy, and a considerable number of the cord and breast milk samples had levels that exceeded the present accepted safety level.