Sadi Türkay

Intravenous Immunoglobulin in the Treatment of Salmonella Typhimurium Infections in Preterm Neonates

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. tymphimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 (P<.05); complications developed in 81.8% in group 1 and 16% in group 2 (P<0.01); mortality was 40.9% in group 1 and 12% in group 2 (P<.05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 (P<.01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.

Echocardiographic, morphologic, and geometric variations of the left ventricular outflow tract: possible role in the pathogenesis of discrete subaortic stenosis.

Although the clinical features and natural course of discrete subaortic stenosis (DSS) are well defined, the etiology remains speculative. The purpose of this study was to identify the echocardiographic, morphologic, and geometric variations of the left ventricular outflow tract associated with DSS in children and to determine whether these variations have a role in the pathogenesis of DSS. The aortoseptal angle (ASA), mitral-aortic valve separation (MAS), and the size of the aortic annulus were determined in two groups of children. Group 1 comprised 11 patients with isolated DSS, who were compared with an age- and body surface area- (BSA) matched healthy children (Group 1A, n: 20). Group 2 comprised 10 patients with DSS and ventricular septal defect (VSD). Group 2 was compared with an age- and BSA-matched patients with isolated perimembranous VSD (Group 2A, n: 22). Measurements were carried out from previously recorded echocar diographic studies. The ASA was steeper (119.3 ±6.1° vs 137.5 ±5.6°, p < 0.001), and the MAS was wider (6.1 ±1.6 vs 3.2 ±0.7 mm, p < 0.001) in patients with isolated DSS than in healthy control subjects. Similar differences were found between patients in Group 2 and Group 2A; the ASA was steeper (122.2 ±6.5° vs 141.3 ±5.0°, p< 0.001), and the MAS was wider (5.8 ±1.5 vs 3.8 ±1.1 mm, p < 0.001). The size of the aortic annulus was not different among the four study groups. Although the MAS was significantly wider in patients with DSS, there was significant overlap in MAS between patients and controls. However, if an ASA ≤ 130° was chosen as a predictive variable, it was found to be a highly sensitive, specific, and positive predictive marker for the development of DSS. This study demonstrates that DSS is associated with a steeper ASA, and a wider MAS, in patients with or without associated VSD. These morphologic abnormalities, especially a steeper ASA, may be risk factors for the development of DSS.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus

La gastroenteritis por rotavirus es la mas frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los ninos pequenos, ademas de deshidratacion grave y desequilibrios electroliticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatia, deshidratacion, desequilibrio electrolitico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infeccion habitual en nuestro pais (Turquia), con diversas manifestaciones clinicas, entre ellas, las convulsiones, que pueden verse no solo en los ninos con enfermedades neurologicas o sistemicas sino tambien en los ninos sanos. Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Yenidoğan Ünitemizde Takip Edilen Hastalar ve Gözlenen Özellikleri

The neonatal period constitutes the most important period of childhood since it has the highest rate of mortality In this study it has been aimed at investigating the distribution per year he most frequent problems congenital malformations and causes of death of 2999 neonates hospitalized in our Neonatology Unit between January 1986 and June 1995 Key words: Neonate Mortality

Bir Yenidoğanda Florokinolon Artropatisi

Florokinolonlar genis spektrumlu ve hucre ici penetrasyonu kuvvetli olan DNA replikasyonunu onleyen bakterisid etkili bir antibiyotik grubudur Uzun yillardir kinolonlara bagli kikirdak toksisitesi deneysel olarak immatur hayvanlarda ispatlanmis ve prepubertal hastalarda kullanim kontrendikasyonu yaratmis olmakla birlikte multirezistan Enterobacter cloace septisemili ve ventrikulitisli prematur yenidoganlarda basarili sonuclar elde edilmistir Bu makalede Cumhuriyet Universitesi Pediatri Bolumu Neonatoloji Unitesinde neonatal sepsis tanisi konan ve florokinolon ile tedavi edilen bir olgu sunulmustur Anahtar kelimeler: Florokinolonlar Artropati

Role of Lipid Peroxidation in Phototoxic Effects of Tin-Porphyrin in neonatal rats 17

Background: Metalloporphyrine are inhibitors of heme oxygenase enzyme. Tin-protoporphyrin (Sn-PP) is one such compound, which potently supress billirubin production. However Sn-PP is a potential pohotosensitizers and could react with ambient fluorescent lights or sunlight to lead to tissue damage. This effect of Sn-PP may be due to lipid peroxidation. Ain: We investigated the role of lipid peroxidation in Sn-PP mediated photoxicity. Methods: Twenty-two neonatal rats were administered intraperitoneal injections of 40μmol/kg of Sn-PP (4mM). Twelve of them were exposed to sunlight for 3 hours(Group I) and ten of them kept in the dark (Group II) Control group (ten rats) were given injections of equal volume of normal saline (Group III). Blood samples were analyzed for malondialdehyde (MDA) as indices of lipid peroxidation. Results: Mean MDA level was significantly increased in group I (1.4550±0.087) compared with group II(1.0978±0.080) and group III (1.0282±0.057). There was no significant difference in mean MDA level between group II and III (p>0 017)Conclusion: Lipid peroxidation can play a significant role in Sn-PP mediated phototoxicity in neonatal rats.

INTRAVENOUS IMMUNOGLOBULIN FOR TREATMENT OF SALMONELLA TYPHIMURIUM INFECTIONS IN PRETERM NEONATES

Preterm neonates are for more susceptible than term neonates to severe infections. We planned to determine the role of intravenous immunoglobulin (IVIG) administration in the preterm neonates with Salmonella typhimurium infections. 47 preterm neonates between 33-37 weeks of gestational age and 1170 to 2100 grams in weight were included in this study. All neonates had Salmonella typhimurium infection progressing with intestinal or extraintestinal involvement. The neonates divided into two groups at randomly. Both groups were treated with Cefoperuzone. Neonates in group I (n=22) did not receive IVIG. Neonates in group II(n=25) received IVIG at a dose of 500 mg/kg on the 1st,2nd,3rd and 8th day of infection. Blood samples were obtained before and after treatment for monitoring serum IgG.Bacteremia occurred in 7/22 (31.0 %) neonates who had not given IVIG and 2/25 (8%) neonates given IVIG, resulting in a statistically significant difference (p<0.05). Complications developed in 10/22 (81.8%) Group I and 4/25 (16%) Group II, the difference between two groups was significant (p<0.01). The mortality rate was 40.9 percent in Group I and 12.0 percent in group II; the difference was also significant (p<0.05). The durations of antimicrobial therapy and recovery were reduced in group II. The differences between group I and II were significant (p<0.01 and p<0.01). The eradication of Solmonela from intestine was evaluated, it was not different between the two groups within 3 months (p>0.05).We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S.typhimurium infections reduces the complications, mortality rate and the duration of therapy.