Sabahattin Ertuğrul

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey.

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.

Total antioxidant and total oxidant states, and serum paraoxonase‐1 in neonatal sepsis

Paraoxonase‐1 (PON‐1) is an enzyme with a glycoprotein structure that depends on calcium and which is located in serum high‐density lipoprotein (HDL). The aim of this study was to evaluate PON‐1, and oxidant/antioxidant state, before and after treatment for neonatal sepsis, and to determine the usability of PON‐1 in neonatal sepsis treatment.

Comparison of urinary neutrophil gelatinase-associated lipocalin, C-reactive protein and procalcitonin in the diagnosis of late onset sepsis in preterm newborns

Abstract Abstract Objective: We aimed to determine the value of uNGAL levels in the early diagnosis of late-onset sepsis in preterms, and to compare CRP and PCT. Materials and Methods: Preterm infants admitted to the NICU between the ages of 7 to 28 days, were divided into two groups: 24 cases with clinical sepsis (gestational age 32.88±1.45w) and 20 cases as the control group (gestational age 33±1.49w). Laboratory analyses (CBC, uNGAL, CRP and PCT measurements) were performed at the onset of treatment in the two groups. In the sepsis group, the patients were re-evaluated. Results: On the first and seventh days of treatment in the sepsis group, CRP (median: 25.09mg/L vs 8.63mg/L), PCT (median; 17.11ng/ml vs 1.39ng/ml) and uNGAL levels were determined as 45.69±18.37ng/ml, 7.89±4.19ng/ml, respectively. We found significant differences in CRP, PCT and uNGAL levels between the groups. On the seventh day of treatment, CRP, PCT and uNGAL levels were found to have significantly decreased.We found the sensitivity, specificity, positive and negative predictive values, respectively as: for CRP, 58.3%, 80%, 77.8% and 61.5%; for PCT, 91.7%, 75%, 81.5% and 88.2%; and for uNGAL, 91.7%, 100%, 100% and 90.9% Conclusion: Urinary NGAL seems to be a more sensitive and specific, reliable biomarker than serum CRP and PCT. We believe that unlike other biomarkers, uNGAL does not require a blood sample, non-invasive and non-sterile conditions, and with small amounts of urine collection in newborn sepsis it may be an ideal biomarker.

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.

Total Antioxidan Level, Total Oxidan Level and Serum Paraoxonase‐1 Levels in Neonatal Sepsis

Paraoxonase‐1 (PON‐1) is an enzyme with a glycoprotein structure that depends on calcium and which is located in serum high‐density lipoprotein (HDL). The aim of this study was to evaluate PON‐1, and oxidant/antioxidant state, before and after treatment for neonatal sepsis, and to determine the usability of PON‐1 in neonatal sepsis treatment.

Total oxidant, antioxidant, and paraoxonase levels in babies born to pre‐eclamptic mothers

The aim of this study was to investigate the oxidant‐antioxidant status in babies born to pre‐eclamptic mothers (BBPM).

Candida albicans menengitis in a newborn with classical galactosemia

Classical galactosemia is a rarely seen carbohydrate metabolism disorder. The frequency of sepsis significantly increases in patients with galactosemia. The most common agent causing sepsis is E. coli. Sepsis due to fungus in patients with galactosemia is rarely reported. Candida is an important cause of sepsis in newborn intensive care units especially in newborns with underlying risk factors such as prematurity and low birth weight. Although the most common etiologic agent of sepsis is E. coli in cases with galactosemia, it should be kept in mind that candida may also be causative agent of sepsis and meningitis in these patients even though there is no underlying risk factor. Also the clinical and laboratory findings of candidiasis may be obscure. For this reason, especially in newborn candida meningitis, the index of suspicion should be kept high for early diagnosis and treatment. In such patients cerebrospinal fluid analysis, culture and brain imaging should be done necessarily, because early diagnosis and treatment will be life saving. In this article we reported a galactosemia case with the diagnosis of meningitis and Candida albicans grown in his blood culture derived on the fourth day of admission to clinic.

Duktus Bağımlı Konjenital Kalp Hastalıklarında Oral Prostaglandin E1 Tedavisinin Değerlendirilmesi

Purpose: Intravenous prostaglandin E1 (PGE1) infusion is a treatment which has been proven to be effective in ductus dependent congenital heart disease. However, PGE1 is very expensive, needed continuous infusion and its supply is difficult by every center. When its long term use is necessary, these problems become more important. The aim of this study was to show whether oral PGE1could keep the ductus open or not till the supply of intravenous PGE1. Method: Ten patients, who were admitted to newborn intensive care unit with the diagnosis of ductus dependent congenital heart disease and received oral PGE1 till the supply of intravenous PGE1, were evaluated. The PO2 with the arterial blood gas analysis and SO2 levels with pulse oxymeter at skin were recorded before and after the administration of oral and intravenous PGE1. Results: The mean oral PGE1 initiation age was 5.5 hours (0.5-25), and mean administration period was 28 hours (18-46). It was observed that the PO2 and SO2 levels of patients measured 2 hours after the initiation of oral PGE1 were significantly increased compared to the levels before initiation of PGE1. The improvement in PO2 and SO2 levels continued till the initiation of intravenous PGE1. It was also observed that the PO2 and SO2 levels of patients measured 2 hours after the initiation of intravenous PGE1 were slightly increased compared to levels before initiation of intravenous PGE1. Conclusion: Although intravenous PGE1 is more effective than oral PGE1 in short term usage, oral PGE1 is also sufficiently effective in keeping the dustus open. For this reason until the intravenous PGE1 is supplied oral PGE1 may be used as an alternative treatment choice. We think that in long term use oral PGE1, which is cheaper and easy to use, could be used instead of intravenous PGE1 without need of admission to hospital and opening intravenous line. However for this further studies are needed to confirm this assumption.