Hüseyin Altunhan

Procalcitonin measurement at 24 hours of age may be helpful in the prompt diagnosis of early-onset neonatal sepsis

BACKGROUND The clinical signs of early-onset neonatal sepsis (EONS) are nonspecific and indistinguishable from those of noninfectious disorders. The early diagnosis of EONS is difficult, but is essential to improve outcomes. The aim of this study was to determine the diagnostic value of procalcitonin (PCT) at birth and at 24h of age in the prompt diagnosis of EONS. METHODS The patient group consisted of neonates with a Töllner score of ≥ 10 or a Töllner score of 5-10 but with the presence of prolonged rupture of the membranes (> 18 h) or chorioamnionitis or maternal fever (n=171). The control group (n=89) comprised neonates admitted to the neonatal intensive care unit for different disease entities. Procalcitonin levels at birth (first) and at 24h of age (second) were measured for each neonate in both of the study groups. RESULTS There was no difference between the two groups in terms of gender, birth weight, or gestational age. The mean (min-max) first PCT level was 0.48 (0.07-3.48)ng/ml in the controls and 0.51 (0.09-28.6)ng/ml in patients. The mean (min-max) second PCT level was 1.72 (0.21-18.23)ng/ml in the controls and 16.17 (0.17-100)ng/ml in patients. There was no statistically significant difference in PCT levels between the patient and control groups at birth. However, at 24h of age, PCT levels were significantly higher in the patient group than in the control group (p<0.001). Serum PCT levels in controls at 24h of age were slightly increased compared to levels at birth, but as a normal reaction. PCT thresholds for the diagnosis of sepsis were 0.59 ng/ml at birth (sensitivity 48.7%, specificity 68.6%) and 5.38 ng/ml at 24h of life (sensitivity 83.3%, specificity 88.6%). CONCLUSIONS In EONS, PCT measurements at birth may initially be normal; a serial PCT measurement at 24h of age may be more helpful for an early diagnosis. During the first 24h of life PCT is a more sensitive marker of infection than C-reactive protein. Further studies are needed to confirm our findings.

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey.

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.

Comparing the efficacy of nebulizer recombinant human DNase and hypertonic saline as monotherapy and combined treatment in the treatment of persistent atelectasis in mechanically ventilated newborns

Background:  The purpose of the present study was to compare the cost‐effectiveness and efficacy of nebulizer recombinant human DNase (rhDNase) and hypertonic saline (HS) as monotherapy and combined treatment in neonatal atelectasis.

Serum ischemia-modified albumin and oxidized LDL in cord blood and serum of neonates born to pre-eclamptic mothers

We investigated oxidized low‐density lipoprotein (OxLDL) and ischemia‐modified albumin (IMA) in cord blood and neonatal blood of 7‐day‐old neonates born to pre‐eclamptic and normotensive healthy mothers.

Persistent Nasal Bleeding Due to Nasal CPAP Application in 2 Premature Newborns Successfully Treated With Topical “Ankaferd Blood Stopper”

Respiratory distress syndrome (RDS) is one of the most common causes of hospitalization of premature babies in newborn intensive care units. Nasal continuous positive airway pressure (CPAP) has been used widely for a long time in the treatment of RDS. Nasal bleeding due to nasal mucosal injury is not rare in the course of nasal CPAP application. Nasal bleeding can usually be controlled uneventfully with simple applications. However, to bring these bleedings under control can sometimes be difficult and time consuming. Furthermore, continuous bleeding can occlude the respiratory route by forming a plug. Ankaferd Blood Stopper (ABS) is a herbal product that can stop cutaneous, dental, and postoperational external bleeding in a few minutes. Herein, we wanted to share our experience in using topical ABS to control epistaxis that had appeared in 2 premature babies related to CPAP application, and which could not be controlled using conventional methods. Nasal CPAP was applied on 2 premature babies born at 30 and 32 weeks of gestation and hospitalized for RDS treatment. However, unilateral nasal bleeding began on the first and the third day of treatment, respectively. Nasal bleeding was attempted to be controlled using conventional methods (pressure on the nose, irrigation with hot water, topical vasoconstrictor agent application, etc), but bleeding could not be stopped. Thrombocyte counts and routine hemostasis tests of both babies were normal. Intramuscular vitamin K (0.5 mg) was administered at birth. Ankaferd blood stopper (Ankaferd Health Products Ltd, _ Istanbul, Turkey) was applied onto the bleeding nostrils of both babies as a topical spray form. Bleeding stopped in a few minutes following ABS application and did not recur. No systemic or local adverse effects were observed. Ankaferd blood stopper is a hemostatic agent consisting of 5 distinct herbal extracts named Urtica dioica, Vitis vinifera, Glycrrhiza glabra, Alpinia officinarum, and Thymus vulgaris. This product, which is used in traditional Turkish medicine, has been licensed by the Ministry of Health. There are many clinical and experimental studies proving its effect on controlling digestive tract, oral, nasal, and cutaneous bleedings, which show whether there they accompany any coagulation disorders. In published studies, it has been shown that this product has no serious adverse effects. Ankaferd blood stopper achieves hemostasis independently from coagulation factors and the classical coagulation cascade. It constitutes a structural network via interference with blood proteins, mainly with fibrinogen, and thus, it provides vital aggregation of erythrocytes. It can be used both for individuals with normal hemostasis and primary or secondary hemostasis disorders as it does not interfere with the cascade working upon coagulation factors. Based on our experience in these 2 cases, we can conclude that topical ABS application is a practical, effective, and safe hemostatic treatment modality. We believe that topical ABS application will create a novel treatment modality in superficial cutaneous and mucosal bleedings in newborns including premature babies.

Fully automated simultaneous umbilical arteriovenous exchange transfusion in term and late preterm infants with neonatal hyperbilirubinemia

Abstract Objectives: The purpose of this study was to compare the efficacy and safety of two different catheterization techniques of exchange transfusion (ET) used in the therapy of newborn jaundice: fully automated two-way ET technique and the classical one-way ET. Patients and methods: The study included babies at gestational age of >34 weeks. In total, 107 ETs were performed on 86 babies. Totally, the umbilical vein (UV) group included 54 babies having undergone 69 ETs and the UV/UA group included 32 babies having undergone 38 ETs. Results: The declines in bilirubin levels right after ET (p = 0.018) and 8 h after ET (p = 0.014) were higher in the fully automated UV/UA technique than in the classical UV technique. Furthermore, the duration of intensive phototherapy following ET was shorter in the UV/UA method than in the UV method (p = 0.003). There was no difference between the two methods in terms of ET-associated complications (p = 0.927). Conclusions: In neonatal hyperbilirubinemia, ET with fully automated UV/UA technique is more efficient than the classical ET technique, causing no additional side-effects. It is also more physiological than the classical technique, since it minimizes the fluctuations in the blood volume and intravascular pressure during ET.

The Delayed Diagnoses of Hypertrophic Pyloric Stenosis due to Hospitalization in Neonatal Intensive Care Unit: A Report of 5 Cases

Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric outlet obstruction in infants. It commonly requires surgery. Its incidence is 0.17-4.4 cases per 1,000 live births. The clinical findings of pyloric stenosis typically appear within three to five weeks after birth. Its most important clinical finding is non-bilious projectile vomiting. If its diagnosis is missed in early period, the most common finding is dehydration (with hypochloremic hypokalemic metabolic alkalosis). However the findings of HPS might be frequently masked in infants hospitalized for longer periods in neonatal intensive care unit. Because vomiting is the one of most common symptoms, it may be related to the different etiological factors of vomiting (congenital or genetic causes, NEC, sepsis, nutritional intolerance), blockage of projectile vomiting with gastric drainage by previously inserted indwelling orogastric/nasogastric catheter which prevents development of excessive gastric dilatation. The accurate diagnosis delays with elimination of severe alkalosis and electrolyte disorder and prevention of malnutrition with administered parenteral nutrition. Herein we would like to draw attention the delayed diagnosis of HPS in five neonatal cases who were hospitalized in the neonatal intensive care unit (nicu) for longer periods.

Congenital tuberculosis in premature twins after in vitro fertilisation

Genital tuberculosis is a major cause of infertility in countries where tuberculosis is endemic. With recent advances in assisted reproductive technology, women with tuberculous endometritis may become pregnant and ultimately have children with congenital tuberculosis. In vitro fertilisation represents a useful treatment for infertility. Congenital tuberculosis is a rare and severe, rapidly progressive, disease. Making an early diagnosis of congenital tuberculosis is difficult, because it can mimic many neonatal illnesses. To the best of our knowledge, we report the first cases of premature twins with congenital tuberculosis following in vitro fertilisation. After the diagnosis of genital tuberculosis in the mother, the twins were screened and diagnosed for tuberculosis. The twins dramatically improved after anti-tuberculosis therapy. We also wish to draw attention to the importance of searching for genital tuberculosis as the possible cause of congenital infection, even if the mother is asymptomatic.

Total antioxidant, total oxidant and serum paraoxonase levels according to lipid administration method in parenterally fed premature infants.

Abstract Objective: The aim of our study was to determine whether lipid solutions delivered separately or in mixture with total parenteral nutrition (TPN) solutions effect the balance between oxidant and antioxidant levels in premature infants. Methods: A total of 60 preterm newborns who were delivered at their 30–34 gestational weeks and received TPN were included in the study. Premature newborns were randomized into two groups based on the delivery method of the lipid solution, separately (Group 1) or in mixture with TPN solutions (Group 2). Total antioxidant status (TAS), total oxidant status (TOS) and paraoxonase (PON-1) levels were analyzed in both blood samples, and oxidative stress index (OSI) was also calculated. Results: Thirty cases from both groups were included in the study. Statistically significant decrease in the level of TAS and increase in the level of PON-1 were detected at 72 h of TPN therapy in both groups (p < 0.05). Statistically significant decrease in both TOS and OSI levels were observed in Group 2 (p < 0.05). In association with these findings, any statistically significant intergroup difference was not detected in both parameters regarding oxidant balance (p > 0.05). Conclusion: Our study showed that according to lipid administration method any difference for oxidant–antioxidant balance was not detected.

Premature Bebekte Pulmoner İnterstisyel Amfizem

Pulmoner interstisyel amfizem genellikle yenidoganlarda aralikli pozitif basincli ventilator izleminin bir komplikasyonu olarak gelisen peribronsial- perialveolar hava kacagi sendromudur. Havanin normal hava yollari disinda, peribronkovaskuler kilifin konnektif dokusu, interlobuler septa ve visseral plevrada birikmesidir. Siklikla yenidogan doneminde, ozellikle de respiratuar distres sendromu nedeniyle ventilator destegine ihtiyac duyan premature bebeklerde gorulur. Birincil tedavi yontemleri lateral dekubit pozisyonu, selektif bronsial entubasyon ve yuksek frekansli ventilasyondur. Ventilator destegi alan, solunum yetersizligi bulunan yenidoganlarda yuksek mortalite ve morbiditesinden dolayi pulmoner interstisyel amfizem akilda tutulmalidir. Burada yenidogan yogun bakim unitesindeki izleminin 9. gununde pulmoner interstisyel amfizem gelisen ileri derecede dusuk dogum agirlikli bebek hasta sunulmustur.