S Unal

Bone mineral density in childhood obesity.

There are several metabolic and hormonal disturbances in childhood obesity. The purpose of this study was to determine the relationship between childhood obesity and bone mineral density (BMD). We studied BMD in 37 obese children and in 37 non-obese children. BMD was measured at L2-L4 level by using dual energy X-ray absorptiometry. BMD was significantly related to age, height and weight. The mean BMD in the obese children and control group was 0.655 +/- 0.175 and 0.626 +/- 0.159 g/cm2, respectively, without any statistically significant difference (p>0.05). There was no correlation between BMD values and osteocalcin or calcitonin levels. According to Tanners pubertal staging, the mean BMD of pubertal obese children was higher than that of prepubertal obese children. BMD of the pubertal obese children was significantly higher than that of the pubertal control group (p<0.05). Girls had higher mean BMD values than boys. In conclusion, our results show that BMD is not influenced by obesity in children but higher values in puberty were observed in obese children which may due to hormonal changes.

Hypernatremic dehydration in the newborn period and long-term follow up.

Background: Hypernatremic dehydration due to inadequate fluid intake can be a significant problem during the neonatal period and thereafter. The objective of the present study was to evaluate the term newborn infants admitted to Gazi University Hospital neonatal intensive care unit (NICU) for hypernatremic dehydration between June 2001 and June 2003 and compare the results with those of the literature search performed via MEDLINE for infants with the same diagnosis.

Impact of phototherapy on vasoactive mediators: NO and VEGF in the newborn

Abstract Aim: The objective of this study was to evaluate the effects of close and remote phototherapy on serum nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels as well as on body temperature heart rate and blood pressure in neonates of different gestational ages. Patients and method: Term (gestational age ≥37 weeks) and preterm neonates (GA <37 weeks) with hyperbilirubinemia requiring phototherapy were included in the study. All patients except for the ones in incubators were randomized to receive either close phototherapy (15 cm above the patient) or remote phototherapy (30–45 cm above patient). Body temperature, heart rate and blood pressure were measured before treatment, six hours into treatment and one hour after cessation of treatment. Blood samples for NO and VEGF measurements were also taken at the same times. Results: Sixty-one term newborns and 37 preterm newborns were included in the study. Patients were distributed into four groups according to the dose of treatment together with gestational age, i.e. term close and remote photoherapy groups (n=29, n=32, respectively), preterm close and remote photoherapy groups (n=10, n=27, respectively). Body temperature increased significantly with phototherapy in all groups but was not at hyperthermia level. Heart rate increased in all groups except for term newborns in the remote phototherapy group and blood pressure decreased in term infants but was unchanged in preterms. None of these changes were at the level of tachycardia or hypotension for a newborn. Phototherapy did not result in elevation of NO or VEGF levels. Conclusion: This study showed that in our group of patients close or remote phototherapy caused some body temperature, heart rate and blood pressure changes that were not clinically significant and did not result in increased levels of NO or VEGF, which are well known vasodilator mediators.

The effects of delivery route and anesthesia type on early postnatal weight loss in newborns: the role of vasoactive hormones

Abstract Objective: To investigate the effects of delivery route and maternal anesthesia type and the roles of vasoactive hormones on early postnatal weight loss in term newborns. Methods: Ninety-four term infants delivered vaginally (group 1, n=31), cesarean section (C/S) with general anesthesia (GA) (group 2, n=29), and C/S with epidural anesthesia (EA) (group 3, n=34) were included in this study. All infants were weighed at birth and on the second day of life and intravenous (IV) fluid infused to the mothers for the last 6 h prior to delivery was recorded. Serum electrolytes, osmolality, N-terminal proANP (NT-proANP), brain natriuretic peptide (BNP), aldosterone and plasma antidiuretic hormone (ADH) concentrations were measured at cord blood and on the second day of life. Results: Our research showed that postnatal weight loss of infants was higher in C/S than vaginal deliveries (5.7% vs. 1.3%) (p<0.0001) and in EA group than GA group (6.8% vs. 4.3%) (p<0.0001). Postnatal weight losses were correlated with IV fluid volume infused to the mothers for the last 6 h prior to delivery (R=0.814, p=0.000) and with serum NT-proANP (R=0.418, p=0.000), BNP (R=0.454, p=0.000), and ADH (R=0.509, p=0.000) but not with aldosterone concentrations (p>0.05). Conclusion: Large amounts of IV fluid given to the mothers who were applied EA prior to the delivery affect their offsprings’ postnatal weight loss via certain vasoactive hormones.

Prevalence of iron deficiency at the first age of the infants hospitalized in neonatal period

Iron deficiency (ID) is a global health problem. We aimed to determine the prevalence of ID at the first year of life in infants who were hospitalized in our neonatal intensive care unit (NICU) and investigate the effects of various factors on iron status. One year follow-up data of 219 infants who were discharged from NICU was retrospectively evaluated. ID anemia and ID without anemia were detected in fifteen infants (6.8%) and five (2.3%) infants, respectively. We concluded that, due to prophylactic iron treatment and close follow-up, hospitalization in neonatal period did not have any adverse effect on iron status at first year of life.

PO-0768 Evaluation Of Ventilatory Parameters, Short And Long Term Morbidities In Preterms Ventilated With Either Psv+vg Or Simv+vg

Introduction Volume guarantee (VG) ventilation is frequently used for newborns, mostly combined with SIMV or A/C modes. Aim of this study was to compare effect of SIMV+VG or PSV+VG ventilation on ventilatory and laboratory parameters and clinical findings. Patients and methods Preterms with RDS < 34thgestational age (GA)requiring mechanical ventilation in the first 12 h were randomised to either SIMV+VG or PSV+VG after surfactant treatment. Patients were ventilated with Draeger Babylog 8000+. Set and measured ventilatory parameters were downloaded by Babyview® software for 72 h unless extubation or need for HFO ventilation occurred. Actual peak inspiratory pressure (PIP), set and measured tidal volume (TV), mean airway pressure (MAP) and FiO2 were analysed. If measured TV percentage was between 80–120% of set TV, it was considered appropriate. Results 42 patients (21 PSV+VG, 21 SIMV+VG) were enrolled. Median GA were 29 weeks and BW were 980,0 and 870,0 gr in each group. Demographic characteristics were similar. ‘Appropriate TV’ was higher in PSV+VG group. PIP, MAP and FiO2 were similar in two groups. Hypocarbia, hypercarbia, hyperoxemia and hypoxemia incidences were not different. PSV+VG group were less tachycardic than SIMV+VG group. Acute and chronic prematurity problems including chronic lung disease (CLD) defined as oxygen requirement at 36th GA were not different. Conclusion PSV+VG was associated with higher ‘appropriate TV’ without any adverse effects and similar CLD occurence. These findings can support the beneficial use of PSV+VG which is more physiologic due to better inspiratory – expiratory synchrony.

PO-0609 Disseminated Renal Vein Thrombosis May Begin In Utero

Introduction Renal vein thrombosis (RVT) in neonates is a rare condition that carries low mortality but high morbidity. Aetiology isn’t fully understood; predisposing factors are dehydratation, sepsis, asphyxia, polycythemia, maternal diabetes, traumatic delivery, congenital renal vein defects, umblical catheterisation, prothrombotic conditions. Case presentation 36 week baby was born by C/S to 32 year-old, gravida 2 mother. The only prenatal risk was gestational diabetes. She was born early because of fetal distress. Evaluation of the infant for jaundice revealed left flank mass and edematous left leg in the second day of life. No effusion was detected in the joints of hip and knee. Lower extremity doppler USG was normal. Abdominal USG showed enlarged left kidney. Doppler USG showed thrombus in the inferior venae cavae, extending to left renal vein, main iliac veins, right external iliac vein. Right renal vein drained to retroperitoneal collaterals. Abdominal tomography confirmed USG. Retrospectively antenatal history revealed enlarged left kidney determined by USG performed right before birth. Based on retroperitoneal collaterals and prenatal USG we think RVT probably began in utero. There was no evidence of sagittal sinus thrombosis. The neonate was treated with LMWH. The results of clotting studies of mother were normal; heterozygot mutation of factor V Leiden and MTHFR gene were found in the baby. Follow-up renal scan at 3 months documented a non-functioning left kidney. Conclusion In neonatal period; when renal vein thrombosis and disseminated thrombosis is detected in the absence of other risk factors, prothrombotic conditions should be searched.

PO-0735 Nasal Hfov With Binasal Prongs Is Effective And Feasable In Elbw Newborns

Introduction Noninvasive ventilation with nasal CPAP (n-CPAP), or nasalintermittant positive pressure ventilation (n-IPPV) is becoming standard ofcare in preterm. Limited experience has been reported withnasal high frequency oscillatory ventilation (n-HFOV). We present 2 newbornstreated by n-HFOV applied with binasal prongs (Ram cannula Neotech) and DraegerBabylog 8000+ ventilator. Cases 1. A 900 gr. 28 weeks gestation infant was intubated, given surfactant and ventilated by volume guarantee pressure-support ventilation for RDS. On 2nd day HFOV was started due to worsening respiratory status. On 11th day patient was extubated to n-HFOV and continued for 4 days followed by n-IPPV/n-CPAP. 2. A 830 gr. 28 weeks gestation infant was resuscitated in the delivery room. RDS and pulmonary interstitial emphysema was detected on radiography and surfactant was given. At 12 h pneumothorax occurred necessitating thoracal tube insertion and HFOV. Conventional ventilation was tried several times without success. HFOV continued for 46 days then baby was extubated to n-HFOV. Patient required reintubation after 4 days due to sepsis. Abstract PO-0735 Table 1 Respiratory support and blood gas data of 2 patients are presented. Case 1 Case 2 HFO nHFO 4 h nHFO 24 h HFO nHFO 4 h nHFO 24 h PH 7.27 7.31 7.25 7.32 7.24 7.26 PCO2 53 47.5 45.7 30.8 35.5 36.6 PO2 63.5 61.7 100 58.8 67 59.1 FiO2 27 50 30 30 30 30 Amplitude 70 100 100 85 85 85 MAP 10 13 13 10 10 10 Conclusion n-HFOV with binasal prongs could be an alternative for preterms after prolonged HFOV.

O-027 Microcirculation Within The First Minutes And First 24 Hours Of Life In Healthy Term Newborns

Background and aims Microcirculation is important to ensure adequate tissue oxygenation and nutrient delivery. Clinical findings, perfusion index (PI) measurements are used to assess microcirculation. Side stream dark field (SDF) imaging is a noninvasive method of assessing microcirculation by means of a videomicroscope. This study aimed to assess microcirculation in healthy term newborns born either by spontaneous vaginal delivery (SVD) or caesarean section (C/S). Methods The assessments were done within the first 30 min of life (T0) and repeated at the 24th hour of life (T1). Microcirculation was assessed from axillary skin by using SDF technique with Microscan device where total and perfused vessel density (TVD, PVD) and microvascular flow index (MFI) were calculated, as well as by using microcirculation score (MS) based on capillary refill time, skin colour and warmth and PI measured by Masimo Radical7 pulse oxymeter. Vital signs were also recorded. Nonparametric tests were used for statistical analysis. Results Twelve newborns born by SVD and 25 newborns born C/S were included. The mean, SD, median values for temperature, TVD, PVD, MFI, MS, and PI at T0 and T1 are as follows; T0: Temp:36 ± 0,44(36,1), TVD: 18,79 ± 1,49(18,81), PVD: 18,73 ± 1,5(18,81), MFI: 3,07 ± 0,25(3), MS: 2,14 ± 1,36(2), PI: 1,84 ± 0,97(1,75). T1: Temp:37,1 ± 0,26(37,1), TVD: 18,93 ± 2,1(18,73), PVD: 18,9 ± 2,13(18,73), MFI: 3,17 ± 0,32(3,1), MS:1,65 ± 0,48(2), PI: 1,9 ± 0,8(2). Temperature was significantly and MFI was slightly higher at T1 compared to T0 (p = 0,001 and p = 0, 04). No difference was observed between SVD or C/S groups or at different times within the same group. Conclusions Peripheral microcirculation in general is not affected by mode of delivery in term healthy newborns and doesn’t seem to change significantly within the first 24 h of life.

1075 Risk Factors for Posthemorrhagic Hydrocephalus in a Neonatal Intensive Care Unit

Background and aim Post-hemorrhagic hydrocephalus (PHH) is one of the most serious complications of intraventricular hemorrhage (IVH) in a newborn. Causes are multifactorial including genetical, pre and postnatal complications. Conditions assosciated with hydrocephalus following IVH were investigated. Methods Charts of patients admitted to the neonatal intensive care unit (NICU) over last 5 years were investigated retrospectively, newborns with grade 3–4 IVH were analyzed for risk factors in the perinatal and neonatal period. Ones with and without hydrocephalus were compared. Results are expressed as median and range and percentage where required. Results 24 newborns were diagnosed with IVH, 9 of whom developed hydrocephalus. Most significant risk factors are shown in table 1. Abstract 1075 Table 1 Female(%) Male (%) PPV in DR (%) Asidosis (%) Hypercarbia (%) Hypotension (%) Pneumothorax (%) Low Plt (%) PHH (+)n=9 44 56 44 78 78 78 11 66 PHH (-)n=16 31 69 32 37 44 44 25 62 Hypotension, asidosis, were more frequent in the PHH group. GA, BW, Apgar scores, lowest-highest CO2, Crib score are shown in table 2. Abstract 1075 Table 2 GA (w) BW (g) Crib Score 1st min Apgar 5th min Apgar Lowest CO2 (mmHg) Highest CO2 (mmHg) PHH (+)n=9 31 (26–38) 1715 (866–3330) 3 (0–14) 7 (1–9) 9 (6–10) 29 (18–59) 117 (84–187) PHH (-)n=16 34 (24–40) 1820 (660–4000) 2.5 (0–11) 7 (1–9) 9 (3–10) 28 (16–43) 65 (31–180) p 0.2 0.44 0.5 0.6 0.8 0.8 0.044 Highest CO2 in the first 10 days of life was significantly higher in the PHH group (p=0.044). Conclusion PHH remains to be one of the most severe complications of IVH. In this small group of patients, high CO2 levels, hypotension seem to be important risk factors.