Nuriye Tarakçı

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.

Successful Treatment of Atrial Flutter with Propafenone and Synchronized Cardioversion in a Newborn

To the Editor : Atrial Flutter (AF) is a rare but potentially lethal arrhythmia. It’s characterized by a rapid regular atrial rate (300–600 bpm), accompanied by varying degrees of AV block [1]. It’s often associated with serious complications such as congestive heart failure, fetal hydrops and neurological damage [1–3]. Propafenone hydrochloride is a class IC antiarrhythmic agent which has been shown to be highly effective in the treatment of supraventricular and ventricular arrhythmias [4]. A newborn, born at 34 wk gestation presented with atrial flutter. Postnatal evaluation confirmed an irregular cardiac rhythm at rate of 210 beats/min. An ECG revealed supraventricular tachycardia with a rate of 220/min. Echocardiographic evaluation revealed pulmonary hypertension with a 40 mmHg gradient of tricuspid valve regurgitation and showed the absence of structural heart disease. Initially, adenosine was administered to the patient and an ECG showed typical AF waves (Fig. 1a), with 3:1 blocked atrioventricular conduction (atrial rate of 320/min and a ventricular rate of 107/min) (Fig. 1b). Amiodarone was administered which failed to convert the flutter. So, synchronized cardioversion was attempted with 3 joules (1.4 J/kg) and sinus rhythm was restored. However, AF restarted after 6 h and synchronized cardioversion with 3 joules was required four times intermittently during 2 d period. Sinus rhythm was not restored with all these treatments and propafenone at a dose of 10 mg/kg/d was started. Although the patient’s ventricular rate was 120– 130/min, AF 2/1 block were reverted to atrial tachycardia. Following increased dosage of propafenon (20 mg/kg/d), sinus rhythm was restored, with no recurrence. During the three months of follow-up period with oral propafenone, no recurrence has been observed. In the present case, propafenone has been found to be an effective medication after the fourth cardioversion in maintaining sinus rhythm. Also, multiple repeated synchronized cardioversions with an energy of 1.4 J/kg were found to be safe for the newborn.

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.

Neonatal septicemia in tertiary hospitals in Konya, Turkey

DOI: 10.4328/JCAM.5774 Received: 19.02.2018 Accepted: 04.03.2018 Published Online: 09.03.2018 Printed: 01.05.2018 J Clin Anal Med 2018;9(3): 187-91 Corresponding Author: Nuriye Tarakcı, Department of Neonatology, Dr. Faruk SukanWomen andChildren’s Diseases Hospital, 42060 Konya, Turkey. T.: +90 3322380931 F.: +90 3322376025 E-Mail: nuriyetarakci@hotmail.com ORCID ID: 0000-0003-2444-4724 Abstract Aim: Neonatal sepsis is one of the leading causes of mortality and morbidity in the developing world. The present study aims to determine the incidence and risk factors of neonatal sepsis in a single center over a four-year period. Material and Method: This is a retrospective study of all cases of culture-proven neonatal sepsis admitted in the neonatal intensive care unit of a single center between January 2013 and December 2016. Clinical features, risk factors, microbiological and biochemical results, and mortality rates were recorded. Associations between risk factors and mortality were investigated. Results: The prevalence rate of neonatal sepsis was 2.7 per 1000 live births (94/30545) and 9.3 per 1000 neonatal admissions (94/10133). Low birth weight (≤ 2500g) was recorded in 79 (84%) neonates with sepsis. There was at least one risk factor in all cases. Gram-negative bacteria were more frequently isolated than gram-positive bacteria (63.8% (60/94) vs. 29.7% (28/94)). Klebsiella pneumonia was predominant in both early-onset sepsis and late-onset sepsis (53% (16/30), 29.7% (19/64) respectively). Late-onset sepsis episodes attributed to Klebsiella pneumonia were associated with the highest sepsis-related mortality (41.7%). Discussion: Klebsiella pneumonia was found to be the most common agent in neonatal sepsis and responsible for sepsis-related mortality in this study. Prevalence of neonatal sepsis, its pathogens and risk factors differ in different parts of the world. Region-specific strategies to prevent new infections should be encouraged.

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.