Neside Cetin

Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit.

The use of oral nystatin to prevent fungal colonisation and infection in neonates in the Neonatal Intensive Care Unit (NICU) is still an open question and not yet recommended as a standard of care. To determine whether prophylactic oral nystatin results in a decreased incidence of invasive candidiasis in the newborn infants, a total of 3991 infants were divided randomly into two groups. Group A infants (n = 1995), only those neonates who were identified as yeast carriers (oral moniliasis) were treated with oral nystatin. Group B infants, all neonates who were admitted to the unit received oral nystatin, was routinely administered three times a day. Group A was divided into groups A1 and A2 (who were treated only if identified as yeast carriers). Urine and rectal cultures were taken on admission and then weekly thereafter. There were 215 (14.2%), 27 (5.6%) and 36 (1.8%) patients positive for invasive candidiasis in groups A1, A2 and B respectively. Oral nystatin prophylaxis significantly reduced the invasive candidiasis (P = 0.004) in extremely low‐birth weight (ELBW) and very low‐birth weight (VLBW) infants. Prophylactic administration of oral nystatine to the ELBW and VLBW infants results in a decreased risk of invasive candidiasis.

Diagnostic Value of Troponin T in Neonates of Mild Pre-Eclamptic Mothers

The measurement of myocardial damage by newer, highly specific markers of myocardial damage is now possible, including cardiac structural proteins such as troponin T (TnT). In neonates of pre-eclamptic mothers, it identifies minor myocardial damage missed by other biochemical markers. The present study was designed to determine the diagnostic value of TnT concentrations in neonates of pre-eclamptic mothers. Fifteen neonates of pre-eclamptic mothers were studied (9 boys and 6 girls), and 17 healthy full-term neonates (9 boys and 8 girls) were selected as a control group. The serum TnT concentration in neonates of pre-eclamptic mothers (0.70 ng/ml) was significantly higher than that in the control group (0.10 ng/ml). In an echocardiographic study, the mean mitral peak velocity at an atrial contraction (A) value of 39 cm/s in neonates of pre-eclamptic mothers was significantly lower than that in the control group (53 cm/s), and the mean mitral peak velocity of early diastole to peak velocity of the atrial contraction (E/A) value (1.75) in neonates of pre-eclamptic mothers was significantly higher than that in the control subjects (1.23). In conclusion, our study demonstrated high levels of cardiac TnT, lower mitral A values and high mitral E/A values in neonates of pre-eclamptic mothers, presumably associated with mild myocardial damage in the neonates of pre-eclamptic mothers.

Septic arthritis in patients followed-up in neonatal intensive care unit

Background : Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children.

Case reports. Trichosporon mucoides infection in three premature newborns.

Summary. In the present study Trichosporon mucoides infections in 3 premature newborns are reported.

Antimeasles antibodies in preterm infants during early infancy in Turkey

Abstract Aim: To measure maternally derived measles antibodies in sera of premature infants at birth and seropositivity rates in early infancy in a rural area of central Turkey. Methods: 65 premature and 24 full-term infants born in Erciyes University Hospital and their mothers were recruited to a longitudinal, prospective study. The infants were divided into three groups by gestational age: group A, <33 weeks; group B, 33–37 weeks; group C, >37 weeks. For specific analyses, the groups were subdivided into groups A1, B1 and C1 (infants of naturally immunised mothers) and A2, B2 and C2 (infants of vaccinated mothers). Blood samples were obtained from mothers and infants after delivery. The infants were re-evaluated at 2, 4 and 6 months of age. Results: Of 25 mothers, 20.3% were seronegative for measles antibodies. Twenty of the mothers had not been vaccinated. The percentages of seronegative infants at birth were 24.2% (n=8), 12.5% (n=4) and 0% (n=0) in groups A, B and C, respectively. No infants were seronegative at birth in A1, B1 or C1. Mean levels of antimeasles antibodies in all naturally immunised mothers were significantly higher than in vaccinated mothers. Antibody levels in all infants decreased rapidly with increasing age. Gestational age at birth [β=0.179, t=3.359, 95% confidence interval (CI) 0.0001–0.0001, p<0.05], birthweight (β=0.637, t=9.691, 95% CI 0.057–0.086, p<0.05) and maternal naturally immunised status (β=0.168, t=2.825, 95% CI 0.002–0.014, p<0.05) were significantly associated with antibody levels after birth. In all groups of naturally immunised mothers, the percentages of seronegative infants were significantly lower than in vaccinated mothers at birth and at 2, 4 and 6 months of age. Conclusion: The current recommendation to immunise all infants at 9 months of age might require revision for premature infants, especially those whose mothers have vaccination-induced immunity.

Congenital Acute Lymphoblastic Leukemia: Report of a Case with Leukemia Cutis

Congenital leukemia is an extremely rare disease, diagnosed at birth or within the first month of life. Most of the neonatal cases reported have acute nonlymphoblastic (acute monoblastic or myelomonoblastic) leukemia, in contrast to the predominance of acute lymphoblastic leukemia found in later childhood. Acute lymphoblastic leukemia (ALL) may occur but is exceedingly rare, most often of B cell lineage, and with a worse prognosis than childhood ALL.1 Generally, cases present with marked leukocytosis, petechia, ecchymoses, and extramedullary involvement, with massive hepatosplenomegaly, cutaneous nodules, and central nervous system leukemia. The clinical findings of neonatal leukemia are variable. Often the disease is characterized by a rapid downhill course, but it may be unpredictable. Some neonates show signs of leukemia at birth and die shortly thereafter, while others appear normal following delivery but clinical and hematologic problems develop later. In a third group, leukemia is not discovered until the third to sixth week of life, with a history suggestive of hematologic abnormalities dating back a few weeks earlier.2 We describe a case of congenital pre–B-cell ALL in a newborn female baby with striking features of leukemia cutis.

Harlequin baby with ecthyma gangrenosum.

Abstract:  Pseudomonas aeruginosa bacteremia or sepsis often occurs in hospitals, affecting mainly children with underlying disease. Ecthyma gangrenosum is classically considered a pathognomonic sign of sepsis by P. aeruginosa. The harlequin baby, a severe variant of ichthyosis, occurs rarely, and these infants are at high risk of cutaneous infections and sepsis. We herein report a harlequin baby who developed ecthyma gangrenosum.

Neonatal uterine prolapse

A case of neonatal uterine prolapse, successfully treated by simple reduction and temporary suturing of the labia majora, is reported after follow-up for 3 years.

Congenital hypothyroidism associated with Rubinstein-Taybi syndrome

Rubinstein-Taybi syndrome is a genetic syndrome characterized by broad thumbs and big toes, growth retardation, mental deficiency and dysmorphic facies. We report the association of Rubinstien-Taybi syndrome with congenital hypothyroidism.

Transient proteinuria in an infant born to a mother with HELLP syndrome

Abstract. The syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) is a severe form of pre-eclampsia and eclampsia associated with poor maternal and neonatal outcome. We report here the case of an infant born to a mother with HELLP syndrome. The infant was initially diagnosed as having nephrotic syndrome but after a follow-up period of 25 days proteinuria and oedema had disappeared. Conclusion: to our knowledge, transient proteinuria with maternal HELLP syndrome has not been previously described in the literature.