Ozge Aydemir

Screening for Retinopathy of Prematurity in a Large Tertiary Neonatal Intensive Care Unit in Turkey: Frequency and Risk Factors

Purpose: We aimed to determine applicable guidelines for screening of retinopathy of prematurity (ROP), and evaluate the contribution of risk factors for severe ROP. Methods: A prospective cohort study of neonates with a gestational age (GA) < 34 weeks or birth weight < 2000g who were admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary level hospital was conducted. The study group was classified into three groups according to eye examination findings as no ROP, mild ROP and severe ROP. Results: Of the 700 neonates screened, the frequencies of ROP for any stage and severe ROP were 32.7% and 3.1%, respectively. Laser photocoagulation was needed in 9.6% of neonates with ROP. None of the neonates with a GA ≥ 31 weeks required treatment. Any ROP was detected in 199 (53.6%) of the babies < 32 weeks (n = 371), 22 (5.9%) of whom were treated with laser photocoagulation. Independent risk factors for severe ROP in babies < 32 weeks GA were birth weight, duration of mechanical ventilation and patent ductus arteriosus (PDA). Conclusion: This is the largest prospective cohort study including infants younger than 34 weeks GA from Turkey. Our data which belongs to the last 1-year period shows lower incidence of severe ROP when compared to previous reports from Turkey. According to our data, screening babies smaller than 32 weeks GA or 1500g birth weight seems reasonable. In the presence of long duration of mechanical ventilation and PDA, screening should be intensified.

Umbilical Artery Intima-Media and Wall Thickness in Infants of Diabetic Mothers

Background: Large for gestational age (LAG) neonates who had been exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing the metabolic syndrome. This can be explained by exposure to high glucose and insulin levels in utero which alter fetal adaptation and programming. Objectives: The aim of the study was to evaluate the onset of preclinical atherosclerosis in utero. Methods: We measured umbilical artery wall thickness (ruWT) in the third trimester by obstetric ultrasound and umbilical artery intima-media thickness (uIMT) in pathologic specimens of umbilical cords obtained shortly after delivery and investigated the relation between these measurements and serum insulin level and C-peptide level in cord blood and assessed insulin resistance with the homeostasis model assessment of insulin resistance (HOMA-IR) in infants of diabetic mothers (IDMs), i.e. the study group, which was divided into a large for gestational age group (LGA)-IDM group and an appropriate for gestational age group (AGA)-IDM group and compared with a control group. Results: The LGA-IDM group had significantly higher insulin (p < 0.001), C-peptide (p = 0.018) and HOMA-IR levels (p < 0.001) compared with the AGA-IDM and control groups. The LGA-IDM group had significantly larger ruWT (p = 0.013) and uIMT (p < 0.001) compared with the AGA-IDM and the control groups. The LGA-IDM group had increased uIMT and ruWT that correlated with the severity of maternal hyperglycemia. Conclusions: Measurement of ruWT in the third trimester is feasible, reproducible and strongly correlated with pathological serum insulin, C-peptide in cord blood and HOMA-IR levels.

Umbilical cord oxidative stress in infants of diabetic mothers and its relation to maternal hyperglycemia

Abstract Aims: There is growing body of evidence that oxidative stress plays an important role in the pathogenesis of diabetes mellitus (DM) and in development of maternal and fetal complications of diabetic pregnancies. The aim of the present study was to investigate total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) in infants of diabetic mothers (IDM) and to reveal the influence of maternal hyperglycemia on these parameters. Methods: A prospective controlled study was conducted between March 2010 and November 2010. Umbilical cord blood was taken from IDM and controls for TAC and TOS measurement, and OSI was calculated. IDM were divided into two groups, either of mothers treated with insulin during pregnancy or of those treated with a carbohydrate-restricted diet. Results: Thirty-six IDM and 14 infants born to non-diabetic mothers were enrolled. Infants of insulin-treated mothers (group 1) and infants of mothers managed with a carbohydrate-restricted diet (group 2) had significantly higher TOS (p<0.001 and p=0.001, respectively) and OSI (p<0.001 and p=0.001, respectively) levels compared to controls. However, TAC levels were similar in all three groups. Maternal HbA1cvalues were correlated to TOS (p<0.001, r=0.694) and OSI (p<0.001, r=0.683). Conclusions: Oxidative stress is increased in IDM, and a significant relation exists between the degree of maternal hyperglycemia in pregnancy and oxidative stress in the newborn at birth.

Renal Immaturity Mimicking Chronic Renal Failure in an Infant Born at 22 Weeks Gestational Age

Abstract Glomerular function shows a progression directly correlated to gestational age (GA) and postnatal age in preterm infants. In preterms, glomerular filtration rate (GFR) is significantly lower than in term infants, and it matures more slowly in the postnatal period. In infants with very low GA, due to decreased GFR, normalization of serum creatinine values may be prolonged during recovery from acute renal failure (ARF). Herein, we report an extremely premature infant with high creatinine values from third week up to third month of life which normalized thereafter mimicking chronic renal failure.

1293 Umbilical Artery Intima-Media and Wall Thickness in Infants of Diabetic Mothers and its Relation to Maternal Hyperglycemia

Background Children who are large for gestational age at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing metabolic syndrome. This can be explained by exposure to high glucose and insulin levels in utero causing altered fetal adaptation and changes in normal fetal programming. Objectives The aim of the study was to evaluate preclinical atherosclerosis begins in utero. Methods We measured the umbilical artery wall thickness (ruWT) in the third trimester by obstetric ultrasound and umbilical artery intima media thickness (uIMT) in pathologic specimens of the umbilical cords obtained shortly after delivery and we investigated the relation between the these measurements and serum insulin, c-peptide level in cord blood and homeostasis model assessment of insulin resistance (HOMA-IR) in infants of diabetic mother (IDM). Study group divided into two groups as; large for gestational age (LGA)/IDM group, appropriate for gestational age (AGA)/IDM group and compared with control group. Results The LGA/IDM group had significantly higher insulin (p<0.001), c-peptides (p=0.018) and HOMA-IR levels (p<0.001) compared to AGA/IDM group and controls. LGA/IDM group had significantly higher ruWT(p=0.013) and uIMT (p<0.001) values compared to AGA/IDM group and controls. LGA/IDM group has increased umbilical artery intima-media and wall thickness which correlates with severity of maternal hyperglycemia. Conclusions Measurement of ruWT in third trimester is feasible, reproducible and strongly correlated with pathological measurements.