Pelin Doğan

The effect of early administration of combined multi-strain and multi-species probiotics on gastrointestinal morbidities and mortality in preterm infants: a randomized controlled trial in a tertiary care unit

Güney-Varal İ, Köksal N, Özkan H, Bağcı O, Doğan P. The effect of early administration of combined multi-strain and multi-species probiotics on gastrointestinal morbidities and mortality in preterm infants: A randomized controlled trial in a tertiary care unit. Turk J Pediatr 2017; 59: 13-19. Necrotizing enterocolitis (NEC) is a gastrointestinal emergency of the neonatal period. The aim of this study was to demonstrate the use of multistrain and multispecies probiotic on gastrointestinal morbidities and mortality. The study was organized as a randomized controlled, prospective study in premature infants (≤32 week and ≤1500 gram). The ready commercial preparations which contain multi-combined probiotics of Lactobacillus rhamnosus (4.1x10⁸ cfu) + Lactobacillus casei (8.2x10⁸ cfu) + Lactobacillus plantorum (4.1x10⁸ cfu) + Bifidobacterium animalis (4.1x10⁸ cfu) together with 383 mg of fructooligosaccharides and 100 mg of galactooligosaccharides as the prebiotic content, was administered enterally to the probiotic group (n=70); control group constituted of 40 preterms. Primary outcomes of the present study were ≥ Stage 2 NEC and the mortality. Secondary outcomes were culture-proven sepsis and days to reach full enteral feeding. All cases of NEC were seen in group 2 as 3.6% (n=4) of all infants. The mortality was found to be 1.4% (n=1) in Group 1 and 22.5% (n=9) in Group 2. The incidence of NEC and the mortality rate were found to be significantly lower in Group 1 (p=0.016, p=0.001, respectively). In Group 1, the NEC-related mortality rate and sepsis-related mortality rate were significantly lower than that of the control group (p=0.046, p=0.023). In this study, we showed that using probiotic strains in combined multistrain and multispecies forms at higher doses and for prolonged duration had positive effects on gastrointestinal complications, sepsis and mortality in premature infants.

Results of Thyroid Function Tests in Premature Infants

Oz Giris: Premature bebeklerde tiroid fonksiyon testlerindeki (TFT) bozuklugun sikligi, etiyolojisi ve morbiditelerle iliskisinin belirlenmesi. Gerec ve Yontem: Bu calismaya Ocak 2009 ve Ocak 2012 yillari arasinda Uludag Universitesi yenidogan yogun bakim unitesinde yatarak tedavi gormus olan toplam 139 premature bebek alindi. Hastalarin prenatal, natal ve postnatal ozellikleri ve alinmis olan TFT degerleri kaydedildi. Tum hastalarin yasamin 1. ve 3. haftasinda TFT calisildi. Tiroid stimulan hormon (TSH) duzeyi 10 IU/L uzerindeki degerler yuksek kabul edildi. Serbest T3 ve T4 degerleri laboratuvar sinirlari goz onune alinarak degerlendirildi. Hipotiroidi tanisi olan ve olmayan tum hastalarin poliklinik izlemlerinden 6, 12 ve 18. aylardaki tarti, boy ve bas cevresi olcumleri degerlendirmeleri kaydedildi. Bulgular: Calismamizda 41 hastanin (%24) TFT’sinde anormallik tespit edilmis olup olgularin 22’sinde (%53,6) gecici TSH yuksekligi, 9’unda (%22) primer hipotiroidi, 9’unda (%22) nontiroidal hastalik ve 1’inde (%2,4) gecici hipotiroksinemi izlendi. Tiroid fonksiyon bozuklugu olan hastalarda respiratuvar distres sendromu sikligi anlamli derecede yuksek saptandi (p=0,007). Annesinde hipotiroidi olan bebeklerde tiroid fonksiyon bozuklugu orani maternal hipotiroidi olmayan bebeklere gore anlamli derecede yuksek saptandi (p=0,049). TFT’de bozukluk olan grupta 18. aydaki bas cevresi ortalamasi TFT normal gruba kiyasla anlamli olarak dusuktu (p=0,047). Sonuc: Prematurelerde tiroid fonksiyon bozuklugu sik gorulen bir morbiditedir ve noromotor gelisim acisindan onemlidir. Maternal tiroid fonksiyon bozuklugu bebeklerde tiroid testlerinde bozulmaya yol acabilir. Tum premature bebeklerde TFT’lerinde calisilmali ve hipotiroidi tedavi edilmelidir. Prematurelerde iyot maruziyetinin azaltilmasi TFT bozuklugu ve gecici hipotiroidi oranini azaltabilir. Introduction: To determine the rate, etiology and morbidity association of disorders of thyroid function tests (TFTs) in premature babies. Materials and Methods: A total of 139 premature babies who were admitted to Uludag University Faculty of Medicine Hospital Neonatal Intensive Care Unit between January 2009 and January 2012 were included in this study. Prenatal, natal and postnatal characteristics along with TFTs results were recorded. TFTs were performed for all patients in the first and third weeks of life. Thyroid stimulation hormone (TSH) values of >10 IU/L was considered elevated. Free T3 and T4 levels were evaluated according to laboratory cut-off values. Weight, height and head circumference values of all individuals with and without the diagnosis of hypothyroidism on the 6th, 12th, and 18th months of their polyclinic follow-ups. Ya zis ma Ad re si/Ad dress for Cor res pon den ce: Dr. Onur Bagci, Uludag Universitesi Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Neonatoloji Bilim Dali, Bursa, Turkiye Tel.: +90 507 502 74 23 E-posta: onurbagci@hotmail.com Anah tar ke li me ler Iyot maruziyeti, hipotiroidi, tiroid fonksiyon testleri, prematurite

PS-042b Results Of Thyroid Function Tests In Premature Infants

Thyroid hormones are critical for normal growth and neurodevelopment. Abnormalities of thyroid functions tests (TFT) are frequently seen in premature infants, physiological hypothyroxinemia being the most common (70%). Clinical and subclinical hypothyroidism is common (0.3–2.5%) in woman who are in conceptional age or pregnant. Maternal hypothyroidism is known to have an adverse impact on the developing fetus. In this study we aim to identify the rate of abnormalities of TFT, its association with morbidities and impact on long term neurodevelopment. Material and method In this retrospective study, rate of abnormalities of TFT, its association with morbidities and neurodevelopment is investigated in 139 premature babies admitted to neonatal intensive care unit in Uludag Universitiy Medical Faculty between January 2009 and January 2012. Results Mean gestational weeks and birth weights of infants were 31.3 ± 2.9 weeks 1667 ±707 gr. Fourty one patients (24%) had TFT abnormality, 53.6% had transient TSH elevation, 22% had primary hypothyroidism, 22% had non-thyroidal disease and 2.4% had transient hypothyroxinemia. Fourty seven percent of SGA babies and, 26% of AGA babies had TFT abnormalities, difference was not statistically significant. Most common TFT abnormality was found to be transient TSH elevation in SGA and AGA babies. Mothers of 8 patients had maternal hypothyroidism. Five of these babies (63.5%) had TFT abnormality (p = 0.049). Mean head circumference in 18 months of age in normal TFT group was 46.3 cm ± 1.6 compared to babies with abnormal TFT whose mean head circumference was 45 cm ± 2.4 at the same age, difference was statistically significant. There were no statistically significant difference between groups for antropometric values in 6, 9, 12 moths and neurodevelopmental evaluation. Conclusion TFT abnormalities are frequent in prematüre babies and it is one of the most common causes of preventable mental retardation. In neonates, even transient hypothyroidism is associated with poor neurodevelopmental outcome, hence it must be treated urgently. As also detected in our study, maternal hypothyroidism is associated with increased neonatal hypothyroidism and these babies must be managed closely in postnatal period. Although not statistically significant, SGA babies were found to have increased rate of hypothyroidism. Further investigation with larger number of patients is necessary.