Rıdvan Duran

Proficiency and knowledge gained and retained by pediatric residents after neonatal resuscitation course

Background: In previous studies the efficacy of the Neonatal Resuscitation Program (NRP) was evaluated, demonstrating good retention of knowledge in the participants. The aim of the present study was to evaluate the knowledge and proficiency that pediatric residents gained and retained following NRP and to determine the necessity and timing of the refresher courses.

Factor V Leiden Mutation and Other Thrombophilia Markers in Childhood Ischemic Stroke

The aim of this study was to evaluate the association between ischemic childhood stroke and thrombophilia. The prevalence of thrombophilia risk factors in 30 unrelated children with ischemic stroke were compared with 33 age-matched control subjects. Patients and control group were tested for the presence of activated protein C (APC) resistance, antiphospholipid antibodies (APLA), increased factor VIII levels, and for the deficiency of protein C (PC), protein S (PS), and antithrombin. When APCR was detected in patients or in controls, factor V Leiden (FVL) mutation was also tested. Seventeen of 30 patients (56.6%) had at least one thrombophilia marker compared with only 5 of 33 control subjects (15.1%). Three children with ischemic stroke (10%) were affected with a combination of two or more thrombophilia markers whereas none of the children in the control group had a combination of risk factors. Seven of 30 children with ischemic stroke (23.3%) and one of 33 control subjects (3.03%) had APC resistance and in all of them FVL mutation were found. The prevalence of FVL mutation was higher among pediatric stroke patients than among control subjects (p < 0.05). None of the patients but one child from the control group (3.03%) had PS deficiency. Antithrombin and PC deficiencies and the presence of APLA and increased factor VIII levels were more frequent in the pediatric stroke patients than in controls but the difference was not statistically significant (p > 0.05). These data confirm that stroke in children is commonly associated with a combination of multiple risk factors and especially the prevalence of FVL mutation is increased in children with ischemic stroke compared with control subjects.

Comparison of temporal artery, mid‐forehead skin and axillary temperature recordings in preterm infants <1500 g of birthweight*

Aim:  Preterm infants are prone to temperature maintenance problems due to immature thermoregulatory mechanism and relatively large body surface area. The objective of the present study was to evaluate the performance of a new non‐invasive infrared thermometer applied to the mid‐forehead and temporal artery in comparison with axillary temperature recordings by mercury‐in‐glass thermometer, and to determine the discomfort caused by these procedures in preterm infants on incubator care.

Etiology of neonatal gastric perforations: review of 10 years' experience.

Background: Neonatal gastric perforation (NGP) is a rare event and its etiology is still controversial. Although it has previously been described as spontaneous, recently some risk factors have been reported to be associated with the development of NGP including prematurity and nasal ventilation. The purpose of the present paper was to report and discuss etiology, clinical features, and outcome of the authors’ NGP cases over a 10 year period.

Scalds in pediatric emergency department: a 5-year experience.

Scald injuries are the most common type of burn in childhood. The authors’ aim in this study was to determine the characteristics of scald burns and to identify clinical signs and symptoms which help to predict the indications for hospitalization after scalding burn injury. All patients were retrospectively evaluated according to gender, ages, cause of burn, burn size and depth, distribution of burn area, first aid given, management, and patient’s outcomes. The factors affecting indication for hospitalization were retrospectively analyzed in 165 patients, 95 males and 70 females aged 1 month to 13 years (mean 2.74 ± 2.44 years), with scalding burn injury. The most common cause of scald injuries were hot water (106 patients) or hot tea and coffee (39 patients). The mean percent of TBSA burned was 10.26 ± 7.26%. Sixty-nine patients had required hospitalization. In the multivariate logistic regression analyses, among study subjects, only age and TBSA were risk factors significantly correlated to hospitalization (P < .001, P < .01, respectively). Prevention of scald injuries will require a two-prolonged approach: educating families and changing the traditional methods of preparing soup, milk, and tea in Turkey and elsewhere. To create effective programs for preventing scald injuries, it is essential to consider ethnic, cultural, socioeconomic, and environmental factors based on these characteristics.

Ochrobactrum anthropi bacteremia in a preterm infant with meconium peritonitis

Ochrobactrum anthropi is a non-fermenting gram-negative rod that was identified as a pathogenic microorganism during the past decade. O. anthropi is extensively distributed in the environment, and has been found in hospital and environmental water sources. O. anthropi infection is rare in childhood. We report a case of O. anthropi bacteremia in a preterm infant with a peritoneal lavage catheter and meconium peritonitis.

A premature infant with h-type tracheoesophageal fistula demonstrated by scintigraphic technique.

Purpose: Congenital tracheoesophageal fistula (TEF) without esophageal atresia is commonly known as “H” type. This is extremely rare in infants. The rarity of the condition, its nonspecific symptomatology, and limitations in its demonstration by contrast radiology and endoscopy contribute to delays between first presentation and confirmation of the diagnosis. Our aim was to demonstrate a congenital H-type tracheoesophageal fistula by using Tc-99m sulfur colloid scintigraphy. Materials and Methods: A case report. Results: A preterm female infant was born by cesarean section at 34 weeks gestation. After many attempts of feeding, she developed apnea, resolving spontaneously, peroral cyanosis, pallor, hypersalivation, and abdominal distension, even when she was being fed by an orogastric tube. With this complex symptomatology, she was suspected to have an H-type TEF. Because of prematurity and recurrent respiratory problems of the infant and the high risk of aspiration of contrast material during a cineradiographic procedure, and also because of the invasive nature of the endoscopic procedure as well as the requirement of general anesthesia, the diagnosis was made by using Tc-99m sulfur colloid scintigraphy and confirmed at operation. Conclusion: Demonstrating a congenital H-type tracheoesophageal fistula by using radionuclide imaging is an easily applicable technique.

The relationship between leukemoid reaction and perinatal morbidity, mortality, and chorioamnionitis in low birth weight infants

OBJECTIVES Neonatal leukemoid reaction (NLR) is relatively rare and considered as a white blood cell (WBC) count ≥50×10(9)/l . The aim of this study was to investigate the association of NLR with neonatal morbidity and mortality and maternal chorioamnionitis in low birth weight infants. METHODS In this case-controlled retrospective study, the medical records of 1200 newborn infants with a birth weight <2500g admitted to the neonatal unit over a period of 5 years were reviewed. The infants who developed features of NLR (n=17, 1.4%) formed the study group, while the remainder without NLR, matched for gestational age and birth weight (n=123), formed the control group. A chart review was performed and salient demographic, clinical, and laboratory data abstracted. A statistical analysis was subsequently performed on this data. RESULTS The mean WBC and absolute neutrophil counts of infants with NLR were significantly higher than those in the control group. The peak time of NLR was at 7.9±3.6 (interquartile range (IQR) 1-30) days and on average it improved within 4.1±1.95 (IQR 2-9) days. It was noted that those infants with NLR were mostly born by vaginal delivery and their mothers had a higher rate of early rupture of the membranes and chorioamnionitis. NLR was associated with a 4-fold increase in sepsis, 20-fold increase in intraventricular hemorrhage, 54-fold increase in bronchopulmonary dysplasia, and 6-fold increase in mortality. In the study group, those infants whose mothers had chorioamnionitis had a higher rate of early rupture of the membranes and they developed sepsis and intraventricular hemorrhage more often than those whose mothers did not have clinical chorioamnionitis. CONCLUSIONS In low birth weight newborn infants, NLR is significantly associated with sepsis, intraventricular hemorrhage, bronchopulmonary dysplasia, and a high mortality rate. Also, those infants with NLR are more likely to be born to mothers with chorioamnionitis and they face sepsis and intraventricular hemorrhage more often.

CRANIAL MR VENOGRAPHY FINDINGS OF SEVERE HYPERNATREMIC DEHYDRATION IN ASSOCIATION WITH CEREBRAL VENOUS THROMBOSIS IN THE NEONATAL PERIOD

Severe neonatal hypernatremia is an important electrolyte disorder that has serious effects on the central nervous system, including brain edema, intracranial hemorrhage, hemorrhagic infarct, and thrombosis. Cerebral venous thrombosis is relatively rare in severe neonatal hypernatremic dehydration. The English literature contains only a few reports of the cranial radiological findings in severe neonatal hypernatremia. The authors report cranial MR venography findings of a newborn infant with severe hypernatremic dehydration. To the best of their knowledge, this is the first such report in the English literature.

Comparison of temporal artery, nasopharyngeal, and axillary temperature measurement during anesthesia in children

STUDY OBJECTIVE To evaluate the accuracy and precision of a new, noninvasive infrared thermometer applied to the temporal artery. DESIGN Prospective randomized study. SETTING Trakya University Hospital. PATIENTS 60 ASA physical status 1 and 2 children undergoing surgery. INTERVENTIONS During anesthesia, temperature measurements were recorded with three different techniques: temporal artery, nasopharynx, and axillary temperature. MEASUREMENTS Temperatures measured from the nasopharynx, temporal artery, and the axilla were recorded at 15-minute intervals for the first hour, then at 30-minute intervals until the completion of surgery. During each measurement, heart rate and midarterial pressure were recorded. MAIN RESULTS There were no statistically significant differences between temperatures recorded at the temporal artery and nasopharynx at 15, 30, 45, 60, 90, and 120 minutes, and the completion of surgery. Axillary temperatures were statistically lower than those recorded at the nasopharynx and the temporal artery (P < 0.001). Bland-Altman plots showed a correlation of temperature measurements between the temporal artery and nasopharyngeal methods. The axillary method had a lower correlation with the temporal artery and the nasopharyngeal methods. CONCLUSIONS The temporal artery thermometer is a substitute for the nasopharyngeal thermometer for core temperature measurement during anesthesia in children.