Murat Yurdakök

Transient tachypnea of the newborn: what is new?

An infant born by cesarean delivery is at risk of having excessive pulmonary fluid which makes predisposition to transient tachypnea of the newborn (TTN), because fetal thorax compression during labor leads to the loss of large volumes liquid from the lungs. At birth, the pulmonary epithelium switches from predominantly facilitated Cl− secretion to predominantly active Na+ reabsorption with the increase expression epithelial Na+-channels (ENaC). Diminished activity or immaturity of this process may contribute to the development of TTN. Familial clustering of some TTN cases shows a genetic predisposition in the developing of this disorder. Antenatal glucocorticoids induce lung Na+ reabsorption by increasing the number and activity of channels even in hypoxia. Since a large release of fetal adrenaline occurs late in labor stimulating ENaC to start reabsorbing lung fluids, aerolized β-agonists may be used in the treatment. Genetic predisposition for β-adrenergic hyporesponsiveness may cause TTN in newborn period, and asthma/wheezing in older age groups. Although furosemide accelerates lung fluid resorption and cause pulmonary vasodilatation, oral or aerosolized furosemide cannot be recommended as treatment for TTN unless additional data become available.

Birthweight Discordance in Twins and the Risk of Being Heavier for Respiratory Distress Syndrome

Twin pregnancies are becoming common as a result of increased assisted reproduction. Studies have shown that the smaller twin of a pair is at greater risk of morbidity and mortality. Our aim was to determine if there is a relation between birth-weight discordancy and neonatal morbidity and mortality and to test the occurrence of respiratory distress syndrome (RDS) in discordant twins. For 5 years all twins admitted to our intensive care unit were included in the study. Discordance was calculated as the difference between twins weights divided by the heavier weight. Diagnosis of RDS was made by typical clinical and radiographic methods. Multiple logistic regression was performed with gender, weight order and birth order as the independent variables and RDS as the dependent variable. Two hundred and sixty-six twin pairs with a mean gestation of 33 weeks and a mean birth-weight of 1890 g were evaluated. Multiple logistic regression revealed that being the heavier twin was a more important risk factor for RDS (odds ratio 4.5; 95% confidence interval 2.2-9.2) than being the male or second-born twin. Based on neonatal outcomes a birth-weight discordance equal or greater than 20% in twin pairs was accepted as the discordance criterion. Discordant and concordant groups were statistically different in neonatal mortality, necrotizing enterocolitis, polycytemia and hypoglycemia. Our data demonstrated that being the heavier twin is a risk factor for RDS and a birth-weight difference of 20% or more in twin pairs should be accepted as discordance.

Acute gastric dilatation complicating the use of mydriatics in a preterm newborn

Abstract A 2-month-old girl who had been born at 27-weeks gestation was admitted for her screening examination for retinopathy of prematurity and given two drops each of cyclopentolate 0.5 % and phenylephrine 2.5 %. Approximately 2 h after completion of the examination, the infant had episodes of apnoea and vomiting. She was noted to be distended, and an abdominal radiograph demonstrated acute gastric dilatation. Apnoea, vomiting and distension resolved after 18 h and a repeat abdominal radiograph demonstrated resolution of the gastric dilatation.

Chemical Burn Caused by Topical Vinegar Application in a Newborn Infant

Abstract: Although there is increasing interest in “alternative medicine,” including nontraditional and homeopathic remedies, all around the world, they are not always safe and beneficial and may have adverse effects. We report a chemical burn caused by vinegar applied topically to lower body temperature in a febrile newborn and discuss briefly chemical skin burns caused by organic acids.

Comparison between oscillometric and invasive blood pressure measurements in critically ill premature infants.

Aim:u2002 Blood pressure (BP) measurement techniques in neonates generally involve noninvasive measurements with a cuff (oscillometric) or invasive measurements through an arterial catheter. The aim of this study was to determine the reliability of the noninvasive oscillometric method in critically ill preterm infants when results were compared with the invasive technique.

Use of recombinant human DNase in a premature infant with recurrent atelectasis

Presence of mucus-plugging and abundance of thickened pulmonary secretions in the neonatal period are risk factors for pulmonary infections and prolonged artificial ventilation. The viscoelastic properties of airway secretions was known to be largely due to the presence of highly polymerized DNA. 1 Recombinant human DNase (rhDNase) degrades highly viscosic DNA and was shown to be efficient in patients with cystic fibrosis (CF). 2,3 The use of rhDNase for the treatment of atelectasis in patients in the neonatal intensive care unit is a new concept, intended to liquefy the mucus when conventional therapies fail. 4 We present our experience with rhDNase use in a premature infant with recurrent atelectasis.

Molybdenum Cofactor Deficiency Presenting With Severe Metabolic Acidosis and Intracranial Hemorrhage

Molybdenum cofactor deficiency leads to combined deficiency of sulfite oxidase, xanthine dehydrogenase, and aldehyde oxidase enzyme activities. The major clinic symptom is intractable seizures seen soon after birth. No definite therapy is available. We report here a newborn with molybdenum cofactor deficiency—associated Dandy-Walker malformation who presented with severe lactic acidosis and intracranial hemorrhage. (J Child Neurol 2004; 19:155—157).

Urinary uric acid levels and discoloration of diapers in healthy neonates

Sirs, Uric acid, a weak organic acid with a pKa of 5.75, is the end product of dietary and endogenous purine metabolism [1]. The normal range of plasma urate values is dependent on the population and varies with sex, ethnic and anthropometric differences [2]. In diapers of newborn infants, deposits of pink or red uric acid crystals have long been observed, creating panic in the family because of confusing it with blood. The observation of pink or red uric acid crystals in diapers of some neonates and not in others has led us to investigate the factors that effect crystallization. The relationship between urinary uric acid concentration and color change in diapers has not been investigated. We designed a study to find out whether or not there is a correlation between urinary uric acid concentration and pink to red color changes in the diapers of neonates. Urinary uric acid concentrations and urine examinations were evaluated after the completion of 24 h of age in 100 physiologically stable newborn infants (Table 1). Infants born with perinatal complications, those having a urine pH of <5.5 or hematuria or pyuria were excluded. Caregivers and mothers were informed about the investigation, informed consent was given, and parents were asked to report any color changes in diapers to the pediatrician. Diapers were also examined by three residents in pediatrics at each visit (three times a day) for the presence of pink or red color until discharge. The observers did not know the results of the urine examination at the time. All of the infants were breastfed. Urine collections were obtained from each infant using an external collecting device (urine bag), which was applied after the completion of 24 h of life. Urine specimens were studied for uric acid and creatinine by sequential multiple autoanalyzer at 37 C, with standards supplied by the manufacturer (Autoanalyzer, P-Module, Hitachi). The accepted normal range in the booklet supplied by the manufacturer for urinary uric acid was 37–92 mg/dl. Urine samples were also analyzed for urine pH, density and examined microscopically for pyuria and hematuria automatically (UEF-100, USA). Statistical analyses were conducted using the SPSS version 10.0 for Windows. The chi-square test was used to examine the significance of uric acid concentrations below and above the cutoff level in color positive and color negative groups. The Mann-Whitney U test was used for comparison of the means and ratios between the groups. P values lower than 0.05 were considered significant. The mean and median urinary uric acid concentrations for the color positive group were 105.9€80.7 mg/dl and 101.50 mg/dl, and those of the color negative group were 74.4€70.4 mg/dl and 55.50 mg/dl (P=0.151). Pink or red color was seen in the diapers of 22 neonates. There were 11 newborns whose uric acid concentrations were above 92 mg/dl, the highest level of accepted uric acid concentration in urine, in the color positive group. In the color negative group, uric acid concentrations were below 92 mg/dl in 26 neonates and above 92 mg/dl in 52 (P=0.153). For male infants, we also determined no significant difference (P=0.09) (Table 1). The mean concentration of urinary uric acid in infants born by normal spontaneous vaginal delivery was 85.1€67.0 mg/dl and of neonates born by cesarean section, 87.0€77.0 mg/dl (P=0.928). Urine density ranged between 1,001 and 1,025 (median=1,008.5, moderate=1,010) and pH between 5.5 and 8.0 (median=6.0, moderate=6.0). Microscopic examinations of the infants included in the study were all normal. No correlation was found between color positive and negative groups and urine density or pH. In neonates high urinary uric acid excretion has been shown by various researchers [3, 4, 5]. Since we know from the report of Monkus et al. [5] that the peak uric acid S. K peli · M. Yurdak k · G. Kilinc · E. Bilgetekin Department of Neonatology, Hacettepe University Ihsan Dogramaci Children’s Hospital, Ankara, Turkey

CSF Erythrocyte Volume Analysis: A Simple Method for the Diagnosis of Traumatic Tap in Newborn Infants

An objective method to evaluate the erythrocytes in cerebrospinal fluid (CSF) in traumatic tap is described. In newborn infants with intracranial bleeding the CSF mean corpuscular volume (MCV) values are lower than the peripheral blood MCV, but in patients with traumatic tap, the CSF and blood MCV values are similar.

Plasma carnitine levels in preterm infants with respiratory distress syndrome

Abstractu2002 Background :u2002Antenatal carnitine administration has been shown to induce fetal lung maturity by increasing pulmonary surfactant in animal and human studies. In this study, the aim was to investigate the status of carnitine in maternal and neonatal plasma of preterm infants with respiratory distress syndrome (RDS) in the first hours of life.