Hulya Ozdemir

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.

Maternal Thyroid Dysfunction and Neonatal Thyroid Problems

Aim. To investigate obstetric features of pregnant women with thyroid disorders and thyroid function tests of their newborn infants. Methods. Women with hypothyroidism and having anti-thyroglobulin (ATG) and anti-thyroid peroxidase (anti-TPO) antibodies were assigned as group I, women with hypothyroidism who did not have autoantibodies were assigned as group II, and women without thyroid problems were assigned as group III. Results. Pregnant women with autoimmune hypothyroidism (group I) had more preterm delivery and their babies needed more frequent neonatal intensive care unit (NICU) admission. In group I, one infant was diagnosed with compensated hypothyroidism and one infant had transient hyperthyrotropinemia. Five infants (23.8%) in group II had thyroid-stimulating hormone (TSH) levels >20 mIU/mL. Only two of them had TSH level >7 mIU/L at the 3rd postnatal week, and all had normal free T4 (FT4). Median maternal TSH level of these five infants with TSH >20 mIU/mL was 6.6 mIU/mL. In group III, six infants (6.5%) had TSH levels above >20 mIU/mL at the 1st postnatal week. Conclusion. Infants of mothers with thyroid problems are more likely to have elevated TSH and higher recall rate on neonatal thyroid screening. Women with thyroid disorders and their newborn infants should be followed closely for both obstetrical problems and for thyroid dysfunction.

Comparative heel stick study showed that newborn infants who had undergone repeated painful procedures showed increased short-term pain responses

We evaluated the short‐term effect of repeated pain exposure on the pain responses of newborn infants using different pain assessment methods, as this area had been under‐researched.

Rahnella aquatilis Sepsis in a Premature Newborn

Rahnella aquatilis is an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organisms natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused by Rahnella aquatilis during the treatment for ventilator associated pneumonia due to Stenotrophomonas maltophilia with ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. Although R. aquatilis is one of the saprophyticus organisms, it may cause life-threatening infection in newborn.

Severe lactic acidosis in an extremely low birth weight infant due to thiamine deficiency

Abstract Background: In this case report, we present a preterm newborn with persistent lactic acidosis who received total parenteral nutrition (TPN) that lacked thiamine. Case presentation: A 28-week-old, 750 g female infant was born with an Apgar score of 8 at the 5th minute. Umbilical cord blood gas levels, including lactate level, were normal, and she was admitted to our neonatal intensive care unit (NICU). Achieving full enteral feeding was not possible due to gastric residues and abdominal distention, making the patient dependent on TPN during the first 2 weeks of life. An insidious increase in lactic acid levels and uncompensated metabolic acidosis were apparent from the 23rd day of life. Severe metabolic acidosis was persistent despite massive doses of bicarbonate. The acidosis resolved dramatically within 6 h when the patient was administered with thiamine. Conclusions: Although TPN is life saving in the NICU, meticulous attention must be paid to provide all essential macro- and micro-nutrients.

Delayed cord clamping in term large-for-gestational age infants: A prospective randomised study: Delayed cord clamping in term large-for-gestational age infants

To compare the post‐natal effects of delayed cord clamping (DCC) and early cord clamping (ECC) in term large‐for‐gestational age (LGA) infants.

Persistent hyperglycemia in a neonate: is it a complication of therapeutic hypothermia?

Özdemir H, Memişoğlu A, Alp-Unkar Z, Arcagök B, Bilgen H, Turan S, Özek E. Persistent hyperglycemia in a neonate: Is it a complication of therapeutic hypothermia? Turk J Pediatr 2017; 59: 193-196. The aim of this report is to present a newborn with persistent hyperglycemia requiring insulin therapy as a possible complication of therapeutic hypothermia. A term appropriate for gestational age (AGA) female infant, was born by emergency cesarean section due to abruption of placenta and was resuscitated and intubated in the delivery room. Whole body cooling was initiated according to standard cooling criteria. The patient`s blood glucose increased up to 250 mg/dl on a glucose perfusion rate of 6 mg/kg/min after the second day of cooling. Insulin therapy was started due to persistent hyperglycemia and continued for 17 days. As it has been reported in adults after therapeutic cooling, persistent hyperglycemia attributed to hypothermia can also complicate therapeutic hypothermia in neonates.

1287 Does Cord Seperation Time has an Effect on Omphalitis

Background and Aim There is still controversy regarding the optimal umbilical cord care and the relationship between cord separation and omphalitis. The aim of our study is to investigate the impact of different umbilical cord care practices on the cord seperation time and omphalitis. Methods We included 514 newborns and randomly randomized them into six groups (Group 1: dry care (n:72); groups 2 (n:69), groups 3 (n:69) and 4 (n:76): a single application of 70% alcohol, 4% chlorhexidine or povidon-iodine in the delivery room, groups 5 (n:73) and 6 (n:62): a single application of 70% alcohol or 4% chlorhexidine in the delivery room and continued until discharge) and 421 of them completed the study. Umbilical cord was examined on the 2nd day and between 5–7 days of life for the signs of omphalitis. Babies were followed up for one month and cord seperation time was recorded. Results Cord separation time was the shortest for group one (6.40 ±1.36 day) and the longest for groups 3 and 6 (9.57±3.12 days and 9.58±4.07 days) (p<0.001). Omphalitis was detected in eight patients (1.9%) and there was no significant difference between the groups. There was no relationship between umbilical cord separation time and incidence of umbilical cord infection (p>0.05). Conclusion Our study showed that the mean time of cord separation was significantly shorter (6.40±1.36 days) in the dry cord care group and the longest in both chlorhexidine groups. However, cord seperation time did not have an impact on the rate of omphalitis.

751 Are Infants of Diabetic Mothers More Prone to Iron Deficiency

Background Iron deficiency during the fetal and neonatal (perinatal) period can result in dysfunction of multiple organ systems, some of which might not recover despite iron rehabilitation. The aim of the study was to assess whether infants born to mothers with gestational diabetes (GDMs)and large for gestational age (LGA) infants are at higher risk for iron-deficiency compared to matched healthy term controls. Methods Infants born in Marmara University Hospital were enrolled. Infants of GDMs were assigned as group1 (n:22), LGA infants as group2 (n:17) and the control group was assigned as group3 (n:72). Blood samples for complete blood cell count, ferritin and serum transferrin receptor (sTfR) levels were obtained from cord blood. Blood hemoglobin, ferritin and sTfR levels were compared between the groups. Results Median head circumference, height and weight of infants born to GDMs and LGA infants were significantly higher than that of the control group. When infants of GDMs and LGA infants were compared, bodyweight and height were significantly higher in the LGAgroup. Nosignificant differences were found in head circumference values between the groups. In groups 1.2.3 cord blood median hemoglobin, ferritin and sTfRlevels were 17.2; 15.4; 16.0(gr/dl)(p=0.05), 179.7; 252.3; 225.7(µg/L) (p=0.456) and 5.22; 4.34; 3.42 (mg/L) (p=0.008) respectively. Hemoglobin levels were higher in the infants of GDMs but this reached only borderline significance(p=0.05). Serum ferritin levels were found to be lower and sTfR levels were found to be higher in the infants of GDMs. The median serum transferrin receptor concentration in the infants of GDMs was significantly higher than that of both the control group and the LGA group. However, the differences between the groups in terms of ferritin were not statistically significant. Conclusions Increased sTfR reflects tissue iron deficiency in children. Increased sTfR levels in infants of GDMs may indicate that they have an risk for iron deficiency. Optimal follow up is warranted in infants of GDMs to prevent perinatal iron deficiency and its consequences.