Selma Aktas

Nasal HFOV with Binasal Cannula Appears Effective and Feasible in ELBW Newborns

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation.

The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey.

Maternal red-cell alloimmunization occurs when a womans immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was O positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification.

Skinfold Thickness of Preterm Newborns When They Become Late Preterm Infants

BACKGROUND Nutrition of very low-birth-weight newborns is important for a good physical and neurologic outcome. Body composition assessment, together with anthropometric measurements, is considered necessary to monitor adequate nutrition and growth. Objectives of this study were to assess body fat changes in newborns ≤32 weeks gestation by weekly skinfold thickness (SFT) measurements and to compare them with those of late preterm infants born at 34, 35, and 36 weeks once they reached 34, 35, and 36 weeks corrected age (CA). MATERIALS AND METHODS Preterm infants ≤32 weeks gestation had SFT measured from 4 body sites, including biceps, triceps, and subscapulary and suprailiac regions, by a Holtain caliper starting from 48 hours of age at weekly intervals until 34, 35, and 36 weeks CA. The measurements were compared with those of late preterm controls born at 34, 35, and 36 weeks gestation. RESULTS There were 37 preterm infants in the patient group. When reaching 34, 35, and 36 weeks CA, preterm infants had higher SFT values compared with controls in all body sites. Median and range of total SFT were 14.6 mm (9.6-18.9 mm) in patients and 11 mm (7.8-16.4 mm) in controls at 34 weeks CA, 15.5 mm (10.7-21.8 mm) in patients and 12.3 mm (7-17 mm) in controls at 35 weeks CA, and 16.4 mm (11.8-23.7 mm) in patients and 12.9 mm (7-17.8 mm) in controls at 36 weeks CA (P = .001 in all). No sex difference was observed at 34 and 35 weeks. CONCLUSION These results show that preterm infants start accumulating excess fat even from early weeks of life. Careful assessment of growth by tools other than simple anthropometric measurements is essential to avoid future complications.

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24–32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV+VG or PSV+VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV+VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV+VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1β in the tracheal aspirates increased during both modes. CONCLUSION: PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV+VG. Therefore, PSV+VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.

Impact of mode of delivery on skin microcirculation in term healthy newborns within the first day of life.

Abstract Background: Microcirculation is an important component of hemodynamic physiology. It can be assessed simply by clinical scores or by a variety of techniques including sidestream dark field (SDF) imaging and peripheral perfusion index (PI) measurements. Mode of delivery may have affects on microcirculation during transitional period. The aim of this study was to compare skin microcirculation in newborns born via vaginal delivery (VD) or cesarian section (C/S). Methods: Term healthy newborns not requiring NICU admission were included. Vital signs were recorded. Skin microcirculation was determined by clinical scoring including capillary refill time, skin color, warmth of extremities, by SDF imaging where capillary density and microvascular flow is determined and by PI measurements where pulsatile and nonpulsatile capillary flow is measured. Assessments were done at 30 min and 24 h of life. Results were compared between VD and C/S groups and overtime. Results: There were 12 newborns in VD group and 25 newborns in C/S group. No difference was observed in microcirculation assessments between groups. However VD group had increased hyperdynamic flow overtime. Conclusion: In healthy term newborns microcirculation does not seem to be affected by mode of delivery, however results may differ in sick or preterm newborns.

Functional brain maturation of prematurely born, growth discordant monochorionic twins assessed by aEEG.

The amplitude-integrated electroencephalogram (aEEG) is a simple and convenient tool for brain function monitoring. It is being more widely used in monitoring high risk neonates in neonatal intensive care units. Normal values and patterns for aEEG activity in preterm infants are still being developing. Here we report the functional brain maturation of preterm twin siblings with aEEG who were severely affected by fetal growth discordance. The aEEG records of growth retarded twin was compared with her appropriate for gestational age sibling in order to see if there is also a developmental discordance in the functional brain maturation of these twins.

Echocardiography may cause significant pain response in preterm infants

Abstract Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants. Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10 minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination. Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p = 0.000), respiratory rate (p = 0.000), diastolic blood pressure (p = 0.001) and oxygen saturation (p = 0.000) during the examination were significantly different than the values before and 10 minutes after the examination. Infants whose gestational age ≤32 weeks (n:20) have significantly higher NIPS scores (mean ± SEM = 3.3 ± 0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean ± SEM = 2.4 ± 0.2). Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.

Different presentations of cow`s milk protein allergy during neonatal period

Aktaş S, Ergenekon E, Ünal S, Türkyılmaz C, Hirfanoğlu İM, Atalay Y. Different presentations of Cows milk protein allergy during neonatal period. Turk J Pediatr 2017; 59: 322-328. Cow`s milk protein allergy (CMPA) is the most common cause of allergy occurring in the first year of life due to infant formula or breast-milk of mothers who are drinking cow`s milk or eating cows milk products. Most children with allergic colitis are symptomatic in the first months, usually by 4 weeks. There are rare cases whom were sensitized prenatally and demonstrated symptoms in the first week, even in the first 2 days of life. The most common clinical sign of CMPA is bloody stool in a well-appearing infant. Gross bloody stool or fecal occult blood are also the common signs of necrotizing enterocolitis (NEC), especially in preterm infants with systemic instability. The treatment options are totally different so the clinician has to be very careful evaluating the patient. We report 5 preterm cases of CMPA, two of whom were siblings. Two of them presented with massive bloody stools and 3 of them presented with abdominal distension and fecal occult blood all of which were initially considered as NEC. Literature review of 20 cases with similar history is summarized as well.

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.