Hulya Bilgen

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.

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.

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.

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.

Effect of foremilk and hindmilk on simple procedural pain in newborns.

Abstract Background : Infants are exposed to painful stimuli during routine medical care in the first few days of life. The aim of the present study was to compare the effect of foremilk; hindmilk, which has been known to have more fat content than foremilk; and sterile water in reducing pain in newborns undergoing minor painful procedures.

Comparison of two doses of breast milk and sucrose during neonatal heel prick.

Background:  The aim of the present study was to test analgesic effects of double‐ versus single‐dose breast milk and compare this effect with efficacy of double‐ versus single‐dose sucrose in a group of healthy term newborns during heel prick blood sampling.

Treatment of systemic neonatal candidasis with fluconazole

In connection with continuous progress in neonatal intensive care units, candidemia is becoming an increasingly common problem and deserves attention. Ten cases of systemic neonatal candidiasis were diagnosed over a two-year period in our neonatal intensive care unit. Eight infants weighed less than 1,500 g and their gestational ages were under 34 weeks. The infection was associated with prolonged antibiotic therapy, hyperalimentation with intravenous fat emulsion in all and with tracheal intubation in eight cases. Three of our babies had a central venous, seven an arterial catheter. The nlean age at onset was 21.4~:7.11 (15-35 days). Hypoactivity, lethargy and poor feeding were the most common presentations. The Candida species isolated from blood were Candida parapsitests in five cases, Candida albicans in four and Candida pseudotropicalis in one case. Antifungal susceptibility of the isolates to amphotericin B and fluconazole was determined using macrodilution method following the NCCLS guidelines [1] (Table 1 ). Treatment of infections due to certain Candida species is challenging in neonates because of the lack of standardized susceptibility testing for fungi. The correlation between results of in vitro susceptibility and in vivo response to antifungal therapy is not clearly defined either [2]. Candida albicans is the most common cause of neonatal candidemia and this organism has been reported to be highly susceptible to fluconazole in adults [2]. Fluconazole is a new alternafive to amphotericin B and used more and more frequently in the treatment of neonatal candidemia [3, 4]. Little data is available on its use in very low birth weight babies. Nine of our prema, ture neonates received fluconazole (6 mg/kg/d, single intravenous infusion) with good clinical response. No adverse effect attributable to fluconazole therapy was noted. One patient with high MIC of fluconazole (MOO rag/l) did not clinically respond with persistent positive blood cultures to 6 mg/kg/d fluconazole during two weeks of treatment. In this case in vitro resistance of C. albicans to fluconazole predicted lack of in vivo activity of the drug and the treatment was continued with amphotericin B. Based on our observation we think that fluconazole is a good alternative to amphotericin B. Identifying the Candida species and determining MIC values may be useful adjuncts in planning the treatment of neonatal candidemia. However, more cases are required to enable a comment on the correlation of in vitro susceptibility and in rive activity of the antifungals used in neonates. H. Bilgen, E. Ozek, V. Korten, B. Ener, D. Motbay Table 1: MIC values for Candida species.

Ductal closure with intravenous paracetamol: a new approach to patent ductus arteriosus treatment

Abstract Objectives: Indomethacin and ibuprofen are commonly used in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). These drugs are associated with serious adverse events, including gastrointestinal perforation, renal failure and bleeding. The role of paracetamol has been proposed for the treatment of PDA. Methods: We report a series of 11 neonates (birth weight: 415–1580 g; gestational age: 23–30.3 weeks) who were treated with paracetamol for a hsPDA. Neonates with hsPDA were treated with paracetamol in the presence of contraindications to ibuprofen or indomethacin. The condition of significant PDA was defined by the presence of at least one of the following criteria: internal ductal diameter # 1.4 mm/kg body weight, left atrium (LA)-to-aortic (Ao) root ratio > 1.4, unrestrictive pulsatile transductal flow, reverse or absent diastolic flow in the descending aorta along with clinical findings. Intravenous (IV) paracetamol was given at doses 15 mg/kg every 6 h for three days. Results: Successful ductal closure was achieved in 10 out of 11 babies (90.9%). No adverse or side effects were observed during the treatment. Conclusions: On the basis of these results, paracetamol could be considered as a promising and safe therapy for the treatment of PDA in preterm infants.

Comparison of three neonatal pain scales during minor painful procedures

Objective. There is no single or widely accepted method to define pain in neonates. The aim of this study was to compare three different neonatal pain scales in the estimation of the pain response to minor painful stimuli in healthy term neonates. Method. Thirty healthy neonates were included in the study. Video recordings of infants during heel prick blood sampling were evaluated by two observers according to the Neonatal Infant Pain Scale (NIPS), the Neonatal Facial Coding System (NFCS), and the Douleur Aiguë du Nouveau-né (DAN). Crying times of infants were recorded, and the correlation between the three pain scales and crying time was calculated. The pain scores and inter-observer variability were analyzed. Results. The highest correlation between the crying time and each of the three different neonatal pain scales was found for NIPS (r = 0.74, p<0.001), while similar results were found for the DAN scale (r = 0.67, p <0.001) and the NFCS (r = 0.67, p<0.001). Inter-observer variability was similar for the three scales (NFCS r = 0.95; DAN r = 0.97; NIPS r = 0.96). NFCS had a coefficient of variation (CV) of 59.8 ± 32.2%. The DAN scale and NIPS had similar CV values (41.5 ± 26.1% and 43.2 ± 31.6%, respectively), but these values were significantly lower than that of NFCS. Conclusion. All three scales provided comparable results, with a slight difference favoring NIPS. Therefore, NIPS can be used to evaluate pain during minor painful procedures in neonates.

Transcutaneous measurement of hyperbilirubinaemia: comparison of the Minolta jaundice meter and the Ingram icterometer.

The effectiveness of two different non-invasive transcutaneous bilirubin measurement devices was compared with serum bilirubin levels in 96 healthy newborns. Transcutaneous measurements were obtained with the Minolta Air Shields jaundice meter and the Ingram icterometer and serum bilirubin levels were determined by a direct spectrophotometric method (Bilitron 444). A linear correlation existed between serum bilirubin values and the readings on both the Minolta jaundice meter (r = 0.83) and the Ingram icterometer (r = 0.78). The Kappa coefficient was 0.66. the sensitivity, specificity and positive and negative predictive values were 100%, 56%, 33% and 100% for the Minolta jaundice meter and 100%, 48%, 29% and 100% for the Ingram icterometer, respectively. The high sensitivity and negative predictive value of both devices render them suitable for screening neonatal hyperbilirubinaemia. However, because of its low cost, the Ingram icterometer is preferable to the more complex and expensive Minolta jaundice meter, especially in countries with a high birth rate, such as Turkey.