Kadir Şerafettin Tekgündüz

Effect of abdomen massage for prevention of feeding intolerance in preterm infants

BackgroundThe aim of this study was to evaluate the efficacy of abdominal massage on feeding tolerance in stable preterm infants fed minimal enteral nutrition.MethodsThe study was conducted on a control-grouped pre-test, post-test quasi-experimental design at the neonatal intensive care unit of a university hospital in Turkey between March and July 2012. Abdominal massage was applied to the massage group subjects for 15 minutes, 2 times daily, before the subject was fed starting in the 5-day study period.ResultsThe study was conducted with 27 subjects, 14 in the massage group and 13 in the control group. When frequency of defecation measurements were analysed, the difference between the first day and last day of the study was not statistically significant in the massage group. However, when daily weight gain, frequency of vomiting, abdominal circumference and gastric residual volume excess measurements were analysed, the differences between the first day and last day of the study were statistically significant in the massage group.ConclusionsIn accordance with the results of the study, we suggest that nurses should apply abdominal massage twice a day as an intervention helping to prevent gastric residual volume excess and abdominal distension in enterally fed preterm infants.

Intravenous paracetamol with a lower dose is also effective for the treatment of patent ductus arteriosus in pre-term infants.

INTRODUCTION Haemodynamically significant patent ductus arteriosus is a significant cause of morbidity and mortality in pre-term infants. This retrospective study was conducted to investigate the usefulness of lower-dose paracetamol for the treatment of patent ductus arteriosus in pre-term infants. MATERIALS AND METHODS A total of 13 pre-term infants who received intravenous paracetamol because of contrindications or side effects to oral ibuprofen were retrospectively enrolled. In the first patient, the dose regimen was 15 mg/kg/dose, every 6 hours. As the patient developed significant elevation in transaminase levels, the dose was decreased to 10 mg/kg/dose, every 8 hours in the following 12 patients. Echocardiographic examination was conducted daily. In case of closure, it was repeated after 2 days and when needed thereafter in terms of reopening. RESULTS A total of 13 patients received intravenous paracetamol. Median gestational age was 29 weeks ranging from 24 to 31 weeks and birth weight was 950 g ranging from 470 to 1390 g. The median postnatal age at the first intravenous paracetamol dose was 3 days ranging from 2 to 9 days. In 10 of the 13 patients (76.9%), patent ductus arteriosus was closed at the median 2nd day of intravenous paracetamol ranging from 1 to 4 days. When the patient who developed hepatotoxicity was eliminated, the closure rate was found to be 83.3% (10/12). CONCLUSION Intravenous paracetamol may be a useful treatment option for the treatment of patent ductus arteriosus in pre-term infants with contrindication to ibuprofen. In our experience, lower-dose paracetamol is effective in closing the patent ductus arteriosus in 83.3% of the cases.

Maternal and cord blood vitamin D status in high-altitude pregnancy.

Abstract Objective: We aimed to explore the risk factors that may lead to vitamin D deficiency in pregnant women living in moderately high-altitude regions. Methods: The study was conducted prospectively between November 2012 and July 2013. City of Erzurum is located at an altitude of 1900–2200 m, north Turkey at 39°4′ latitude. Healthy mothers that gave birth after completing 37th week of their pregnancies and healthy neonates weighting >2500 g were included in the study. For 25-hydroxyvitamin D (25(OH)D) analyses venous blood samples of 2 ml were obtained from the umbilical cord and the mother. Questionnaires were developed covering the demographical characteristics and possible risk factors for mothers. Results: Totally 81 mothers and neonates were included into the study. The mean 25(OH)D level of mothers was 7.1 ± 6.5 ng/ml. It was noted that 45 (55.7%) mothers had severe deficiency. Multivariate linear regression analysis showed that the dressing style and the level of sunlight received by the house were independent factors affecting the level of 25(OH)D. Conclusion: Our findings showed that cultural factors had significant effects on vitamin D levels. We believe that appropriate dose of vitamin D prophylaxis should be administered to pregnant women, considering the risk factors as well as the geographical features.

May we use ibuprofen as doses against courses in the treatment of patent ductus arteriosus in premature infants

Abstract Objective: We aimed to investigate the efficacy of ibuprofen doses in closing patent ductus arteriosus (PDA) and the possibility of reducing drug-related complications by reducing dose number. Methods: We performed a prospective study with 60 premature infants (≤33 weeks) who were treated with enteral ibuprofen for hsPDA. Echocardiographic examinations were performed before each dose. Treatment was stopped when PDA was closed and patients were followed for reopening and complications. Results: Rates of closure were 28.3%, 44.1%, 54.1%, 36.3%, 42.8% and 50.0% with the 1st, 2nd, 3rd, 4th, 5th and 6th doses. No closure was observed with 7th, 8th and 9th doses. Reopening was observed only in patients whose PDA closed with the 1st (3.3%), 2nd (1.6%) and 3rd (1.6%) doses. PDA diameters were higher in patients who required >4 doses. Complications were rare (6.6%) but unrelated with dose number. Conclusions: We conclude that it is possible to minimize ibuprofen exposure and achieve high closure rates of PDA in premature infants by performing echocardiography before each dose. PDA diameter should be used to estimate the duration of treatment. This approach is not effective in reducing complication rates and must be performed in attention to reopening especially for the first three doses.

Prognostic value of amplitude-integrated electroencephalography in neonates with hypernatremic dehydration

Abstract Objectives: Hypernatremic dehydration in neonates is a condition that develops due to inadequate fluid intake and it may lead to cerebral damage. We aimed to determine whether there was an association between serum sodium levels on admission and aEEG patterns and prognosis, as well as any association between aEEG findings and survival rates and long-term prognosis. Method: The present study included all term infants hospitalized for hypernatremic dehydration in between January 2010 and May 2011. Infants were monitored by aEEG. At 2 years of age, we performed a detailed evaluation to assess the impact of hypernatremic dehydration on the neurodevelopmental outcome. Results: Twenty-one infants were admitted to the neonatal intensive care unit for hypernatremic dehydration. A correlation was found between increased serum sodium levels and aEEG abnormalities. Neurodevelopmental assessment was available for 17 of the 21 infants. The results revealed that hypernatremic dehydration did not adversely affect the long-term outcomes. Conclusion: The follow-up of newborns after discharge is key to determine the risks associated with hypernatremic dehydration. Our results suggest that hypernatremic dehydration had no impact on the long-term outcome. In addition, continuous aEEG monitoring could provide information regarding early prognosis and mortality.

Combined treatment with chlorhexidine and 0·9% saline in a newborn infant with an infected surgical wound

Newborns are more susceptible to infection; this makes proper wound care extremely important in them. Unfortunately, in spite of successful surgery, patients can die as a result of wound area infections. Herein, we report a case in which a combined therapy of chlorhexidine (a disinfectant) and saline (a cleansing agent used in wound care) was used effectively to treat the wound in a newborn infant with an antibiotic‐resistant, Gram‐negative, bacteria‐related surgical site infection.

Ecthyma gangrenosum in a preterm infant.

Dear Editors, Ecthyma gangrenosum (EG) is a rare infection that is characteristically seen in immunocompromised patients and presents as embolic lesions caused by Pseudomonas aeruginosa (1). This type of infection has distinct pathognomonic features along with a high mortality rate, but when recognised early, it can be successfully treated. The classic lesions associated with EG are composed of deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated and rolled-out edges (1,2). An infant born at the 28th gestational week with a birthweight of 1200 g was admitted to the neonatal intensive care unit of our facility because of a large teratoma in the sacrococcygeal region on the first postnatal day. A complete resection was performed on the third postnatal day, and the pathology results showed a grade three immature teratoma. Chemotherapy (cisplatin, bleomycin and etoposide) was started on the 24th postnatal day and continued for four cycles at 3-week intervals. When the patient reached the 60th postnatal day, which coincided with the end of the second course of chemotherapy, ulcerated lesions were found over the infant’s entire body (Figure 1). Blood and wound cultures were performed, and the results identified the presence of P. aeruginosa. Based on the antibiotic susceptibility of this bacterium, meropenem treatment was started, and a complete recovery was observed after 21 days of treatment. To date, very few cases of EG have been reported during the neonatal period (1–5). However, preterm infants are especially at risk because of their immature immune system (3). The chemotherapy treatment in conjunction with the infant’s prematurity facilitated the development of EG in our

The Use Of Low-dose Recombinant Tissue Plasminogen Activator To Treat A Preterm İnfant With An İntrauterine Spontaneous Arterial Thromboembolism

Neonatal thromboembolic events are rare, and only a few cases of intrauterine spontaneous arterial thromboembolisms have been reported in the literature. Thrombolytic therapy with recombinant tissue plasminogen activator is usually the preferred treatment because it has a short half-life, fewer systemic side effects, and a strong, specific affinity for fibrin. Protocols vary from center to center, but there is still no consensus regarding the proper dosage or treatment duration. Herein, we present the case of an intrauterine spontaneous arterial thromboembolism in a preterm infant that completely resolved after being treated with low-dose recombinant tissue plasminogen activator (0.02 mg/kg/h).

Is vitamin D deficiency alone sufficient to increase the incidence of neonatal sepsis

Dear Editor, We read with great interest the manuscript of Cizmeci et al. [1] entitled “Cord-blood 25-hydroxyvitamin D levels and risk of early-onset neonatal sepsis: a case– control study from a tertiary care center in Turkey.” In that study, out of the 83 infants, 40 were suspected of having early-onset neonatal sepsis (EONS) (study group) and 43 had no sepsis (control group).They reported that low cord blood 25-OHD status of <30 ng/ml and prematurity were associated with the occurrence of EONS. Furthermore, they mentioned that the stepwise regression analysis did not materially change the association of 25-OHD with the occurrence of EONS. They determined that the cord blood 25-OHD levels were found to be associated with an increased risk of EONS and also suggested that measures to increase vitamin D status during pregnancy may be effective for preventing EONS in neonates. 1,25-Dihydroxyvitamin D3 directly regulates antimicrobial peptide gene expression, thereby revealing the potential of its analogues in the treatment of opportunistic infections [3]. However, there is insufficient highquality evidence relating to the clinical effects of vitamin D supplementation during pregnancy [2]. We performed a prospective study that focused on maternal and cord blood vitamin D. The study included only healthy mothers who gave birth after completing the 37th week and healthy neonates with a birth weight of >2500 g. The mean vitamin D level of the neonates was 7.0±6.6 ng/ml. The subjects were divided into five groups according to their vitamin D levels (Table 1). We did not observe EONS in either of our study groups. In conclusion, if neonatal sepsis does not increase in healthy neonates with lower vitamin D levels, as in our study, then other factors associated with pregnancy might play a role in EONS. Therefore, we believe that further large, controlled, and randomized studies are needed to evaluate the role that vitamin D plays in EONS.

Protective effect of L-carnitine in a rat model of retinopathy of prematurity.

AIM To investigate the effects of L-carnitine (LC) on rats with oxygen-induced retinopathy. MATERIALS AND METHODS The study was conducted on 40 Sprague Dawley rat pups. The rat pups were randomly divided into 4 groups: group 1 (n = 10) the healthy control group with intraperitoneal 0.1 mL/day physiological saline injection; group 2 (n = 10), exposed to hyperoxygen, did not receive LC but received 0.1 mL/day physiological saline intraperitoneally; group 3 (n = 10), exposed to hyperoxygen and received 100 mg/kg/day LC intraperitoneally; group 4 (n = 10), exposed to hyperoxygen and received 200 mg/kg/ day LC intraperitoneally. After postnatal day 20, the rat pups were killed and an histological examination was performed on the eyes, in addition to the detection of plasma malondialdehyde (MDA) levels. RESULTS The retinal and choroidal histopathological changes due to hyperoxygen were less in group 3 and minimal in group 4 compared with group 2. Compared with the healthy control group, the increase in the MDA levels in group 2 was significant (P <0.05). Compared with group 2 there was a significant (P < 0.05) decrease in the MDA levels in groups 3 and 4. CONCLUSION LC has beneficial effects on oxygen-induced retinopathy in rats in terms of histopathological changes and MDA levels.