Im Akin

Oral Lactoferrin to Prevent Nosocomial Sepsis and Necrotizing Enterocolitis of Premature Neonates and Effect on T-Regulatory Cells

OBJECTIVE Lactoferrin (LF) is effective in the prevention of sepsis in very low birth weight (VLBW) neonates. T-regulatory cells (Tregs) are important subsets of T lymphocytes that control pathogen-specific immune responses and are essential for intestinal immune homoeostasis. The aim of the present study is to determine whether oral LF at a dosage of 200 mg/d reduces nosocomial sepsis episodes and necrotizing enterocolitis (NEC) in premature infants and to evaluate the possible effects of LF on Treg levels. STUDY DESIGN In this prospective, placebo-controlled, double-blind, randomized trial, infants either VLBW or born before 32 weeks were assigned to receive either placebo (n = 25), or 200 mg LF (n = 25) daily throughout hospitalization. Episodes of culture proven nosocomial sepsis and NEC were recorded. The level of FOXP3 + CD4 + CD25hi lymphocytes was studied by flow cytometry at birth and discharge. A third comparison was made with healthy term neonates (n = 16). RESULTS Fewer sepsis episodes were observed in LF-treated infants (4.4 vs. 17.3/1,000 patient days, p = 0.007) with none developing NEC, without statistical significance. Treg levels at birth and discharge were similar, while preterm infants showed significantly lower levels than term controls. However, individual increases in Treg levels were higher in the LF group. CONCLUSION LF prophylaxis reduced nosocomial sepsis episodes. Treg levels in preterm infants were lower than in term infants and an increase of Treg levels under LF prophylaxis was observed. Increase in Treg levels can be the mechanism for protective effects of LF on nosocomial sepsis.

Effects of umbilical cord milking on the need for packed red blood cell transfusions and early neonatal hemodynamic adaptation in preterm infants born ≤1500 g: a prospective, randomized, controlled trial.

Objective: The aim of this study was to evaluate the effects of umbilical cord milking (UCM) on the need for packed red blood cell (PRBC) transfusion and hematologic and hemodynamic parameters in very-low–birth-weight infants. Methods: The infants were randomized into 2 groups: group 1 (UCM) and group 2 (control). The primary outcome was the number of PRBC transfusions during the first 35 days of life. The secondary outcome measures were the hemodynamic variables during the first 24 hours of life. Results: A total of 44 infants were included with 22 infants in each group. Two of 21 infants in group 1 and 4 of 21 infants in group 2 received transfusion in the first 3 days of life (P=0.384). The number and volume of PRBC transfusions were similar in both groups. However, the levels of hemoglobin (Hb) at the first and 24th hour of life were significantly higher in group 1. Phlebotomy volume was found as a statistically significant risk factor for the need for PRBC transfusion (P=0.005). Conclusions: UCM in delivery room results in a higher Hb level in the first day of life. In these groups of infants, phlebotomy losses may impact the transfusion need.

Clinical characteristics of recessive and dominant congenital hyperinsulinism due to mutation(s) in the ABCC8/KCNJ11 genes encoding the ATP-sensitive potasium channel in the pancreatic beta cell

Abstract Background: Recessive mutations in ABCC8/KCNJ11 of β-cell KATP channel generally cause severe medically unresponsive hyperinsulinemic hypoglycemia (HH). Rarer dominant mutations in these genes have been described that mostly cause milder, medically responsive congenital hyperinsulinism. Rarer dominant mutations in these genes have been described that mostly cause milder, medically responsive congenital hyperinsulinism. To date the phenotype of patients with dominant mutations seems to be different from those with recessive mutations as the majority of patients are responsive to diazoxide therapy. Controversy exists on whether these dominant ABCC8 or KCNJ11 genes mutations predispose to diabetes mellitus in adulthood or not. Subjects: We report the clinical and genetic characteristics of five patients with neonatal HH, three had recessively inherited KATP channel mutations and two with a dominantly acting mutation. As a result of failure to medical therapy, patients with recessive KATP channel mutations underwent a near total pancreatectomy. Two siblings with a novel dominant mutation showed good response to medical treatment. Although the HH remitted in early infancy, they became diabetic at the prepubertal age. Their mother, maternal aunt and maternal grandfather had the same mutation without any medical history of neonatal HH. Conclusion: The clinical presentation of our two patients with a dominant ABCC8 mutation was milder than that of patients with the resessive form of the disease as they responded well to medical management.

The association between cord hormones and transient tachypnea of newborn in late preterm and term neonates who were delivered by cesarean section

Abstract Objective: Failure of adequate and timely clearance of fetal lung fluid has been implicated in transient tachypnea of the newborn (TTN). There has been lack of human data on the association between endocrinological adaptation and fetal lung fluid clearance. Although TTN development in term or late preterm newborns delivered by cesarean section (CS) is well known, whether stress hormones levels at birth contribute to it or not is not known. The aim of the study was to assess the possible association between low adrenocorticothrophic hormone (ACTH), cortisol and free triiodothyronin (fT3) levels at birth and TTN in late preterm and term infants. Study design: We compared cord blood concentrations of epinephrine, cortisol, ACTH, fT4, fT3 and thyroid stimulating hormone in two groups of term and late pretrem infants born by CS: those who developed TTN and a comparison group without respiratory distress. Results: While there were no significant demographic differences between patient and control groups, cord ACTH, cortisol and fT3 were significantly lower and epinephrine was higher in infants developing TTN (p < 0.05). Conclusions: Lower cord levels of cortisol, ACTH and fT3 in patients with TTN may indicate the possible relation of these hormones in fetal lung fluid clearance and postnatal pulmonary adaptation through their modulatory effect on epithelial sodium channel and Na-K-ATPase.

Perinatal risk factors and mode of delivery associated with mortality in very low birth weight infants.

Abstract Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting. Methods: Medical records of 241 live-born VLBW infants (≤1500 g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated. Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750 g (p = 0.000 and p = 0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve = 0.792, 95% CI: 0.719–0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality. Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.

Hand intubation of a tiny neonate with a large obstructive mass in the oral cavity.

with airway obstruction caused by rhabdomyosarcoma of the tongue. Br J Anaesth 1999; 83: 951–955. 4 Holm-Knudsen R, Eriksen K, Rasmussen LS. Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway. Pediatr Anesth 2005; 15: 839–845. 5 Thomas ML, McEwan A. The anaesthetic management of a case of Kawasaki’s disease (mucocutaneous lymph nose syndrome) and Beckwith–Weidemann syndrome presenting with a bleeding tongue. Paediatr Anaesth 1998; 8: 500–502. 6 Thompson BM, Welna JO, Kasperbauer JL et al. Childhood airway manifestations of lymphangioma: a case report. AANA J 2004; 72: 280–283.

Is autologous cord blood transfusion effective and safe in preterm infants

Beril Altaş Yavuz1, Emel Okulu2, Saadet Arsan2, İlke Mungan Akın3, Begüm Atasay2, Ömer Erdeve2 1Department of Pediatrics, Farabi Hospital, Konya, 2Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara,3Department of Neonatology, Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey. E-mail: emelokulu@gmail.com Received: 28th December 2016, Revised: 14th February 2017, Accepted 20th February 2017

Respiratory Distress and Management Strategies in the Newborn

Approximately 10% of neonates require respiratory support immediately after delivery due to transitional problems or respiratory disorders, and up to 1% of neonates are in need of resuscitation. Respiratory distress is the most frequent cause of neonatal intensive care unit (NICU) admission, and the individual management strategies should be the main task in NICUs for these infants. Regardless of the cause, if not recognized and managed in advance, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. This chapter explores the evaluation and differential diagno‐ sis of respiratory distress in neonates and presents an update on management strategies according to the protocol of Ankara University Children’s Hospital Neonatal Inten‐ sive Care Unit.

Secondary Bacteremia A Serious Complication of Rotavirus Gastroenteritis in Neonates

Rotavirus infections are the common cause of gastroenteritis in infants and young children. Particularly affected are children between 6 months and 2 years of age, after which resistance to clinical infections develops. Neonates and infants younger than 3 months are usually asymptomatically infected. Hospital outbreaks of rotaviral disease are well documented in developed countries. High prevalences of subclinical infections are commonly reported among neonates in nurseries, but outbreaks of clinical disease in neonates are reported less frequently. Secondary enterobacterial bacteremia after rotavirus gastroenteritis have been reported in previously healthy children. Although the exact mechanism is unknown, it is believed that infected enterocytes become more vulnerable to bacterial invasion as a result of intestinal epithelium damage caused by rotavirus. Here, we present 2 cases of bacteremia occurred following an outbreak of rotavirus enteritis.

1797 Do Non-Invasive Ventilatory Strategies Work in Micro-Premature Infants who are at the Limits of Viability?

Aim To evaluate the non-invasive ventilatory support in micro-premature infants who are at the limits of viability. Methods This prospective cohort study from January-2009 to December 2011 included infants born before 26 weeks’. During resuscitation, stabilisation and transport infants were ventilated with a T-piece resuscitator, and all received prophylactic surfactant at a dose of 100 mg/kg. If respiratory drive was present, infants were extubated to NCPAP. The demographic and clinical features of the infants were assessed. Results Twenty-four infants born during the study period. Antenatal steroid rate was 16.7%. Mean gestational age(GA) and birth weight(BW) were 24.3±0.9 weeks, and 660.2±125.5 g, respectively. The presence of premature rupture of membranes and chorioamnionitis rate was 54%. Only five(21%) of 24 infants could be extubated to NCPAP, and three of these five were intubated in first 3-days. Only two(8.3%) infants succeeded on NCPAP, and the GAs’ were 24.6 and 25.1 weeks, the BWs’ were 1010 and 730 g. The rate of NEC, PDA, İVH and pulmonary hemorrhage were 29%, 36%, 36% and 21%, respectively in infants who survived more than 2 days. The overall mortality rate was 92%, the duration of hospitalization was between one and 137 days. Conclusion In our study, it has been seen that NCPAP may not be an effective ventilation strategy in premature infants who are at the limits of viability. The high proportion of chorioamnionitis in this group may affect the ventilation and the following problems. These babies are needed to be care at very special settings.