Selmin Koklu

Increased Aortic Intima-Media Thickness Is Related to Lipid Profile in Newborns with Intrauterine Growth Restriction

Background and Aim: Low birth-weight is known to be associated with an increase in cardiovascular risk similar to that seen with major environmental risk factors, such as cigarette smoking or hypertension. Much epidemiological evidence has linked low birth-weight with hypertriglyceridaemia. Method: We measured aortic wall thickness by ultrasonography and lipid profile in 40 newborn babies with intrauterine growth restriction and 40 controls. Results: Maximum and mean aortic intima-media thickness were significantly higher in the babies with intrauterine growth retardation (0.58 ± 0.06, 0.52 ± 0.03 mm, respectively) than in controls (0.44 ± 0.05, 0.40 ± 0.03 mm, p < 0.0001, p < 0.0001, respectively), more so after adjustment for birth-weight (maximum intima-media thickness: 0.23 ± 0.03 mm/kg vs. 0.12 ± 0.02 mm/kg, p < 0.0001; mean intima-media thickness: 0.21 ± 0.02 mm/kg vs. 0.11 ± 0.01 mm/kg, p < 0·0001). Serum triglyceride levels were significantly higher in the intrauterine growth retardation group (48.9 ± 14.8 mg/dl) compared with the control group (32.5 ± 9.8 mg/dl, p < 0.0001). The mean body mass index, prepregnancy weight, weight gain during pregnancy, maternal LDL cholesterol level and, height of the mothers were significantly lower in the intrauterine growth retardation group compared with the control group. For maximum aIMT, significant associations included the ponderal index (p = <0.01), length (p = 0.01) and serum triglyceride levels of infants (p = 0.02). Conclusion: Newborn babies with growth restriction have significant maximum aortic thickening with hypertriglyceridaemia, suggesting that prenatal events might predispose to later cardiovascular risk.

Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life

Aim: To measure serial cardiac troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life.

The Relationship between Birth Weight Leptin and Bone Mineral Status in Newborn Infants

Background: The positive relationship between fat mass, bone mass and leptin has been shown in fetal mouse cartilage/bone. It has been shown that umbilical venous leptin predicts both the size of the neonatal skeleton and its estimated volumetric mineral density. Aims: This study investigates how birth weight and bone mineralization correlate with leptin levels. In addition, we aimed to determine the predictive value of anthropometrics measurements and gender on variability in bone mineral status. Methods: Umbilical cord venous blood samples were obtained at the delivery from 100 term newborn infants. Forty of the newborn infants had birth weights appropriate for gestational age (AGA), 30 were small for gestational age (SGA) and 30 were large for gestational age (LGA). Data were acquired using the whole body dual energy X-ray obsorptiometry scanner in the first 24 h after birth. Results: Leptin concentrations were higher in LGA (36.6 ±12.0 ng/ml; p < 0.0001), but lower in SGA (11.7 ± 5.6 ng/ml; p < 0.001) than in AGA infants (20.3 ± 7.6 ng/ml). Whole body bone mineral density and whole body bone mineral content were higher in LGA babies (0.442 ± 0.025 g/cm2, 71.6 ± 9.0 g, p < 0.01, p < 0.001, respectively) but lower in SGA (0.381 ± 0.027 g/cm2, 29.1 ± 9.1 g, p < 0.001, p < 0.001, respectively) than in AGA babies (0.426 ± 0.022 g/cm2, 53.7 ± 9.6 g, respectively). The percentage of whole body bone mineral content was lower in SGA (1.3 ± 0.3) than in AGA (1.6 ± 0.2, p < 0.001) and LGA (1.7 ± 0.2, p < 0.001). In stepwise linear regression analyses models; leptin is not found related to the bone indices. Conclusion: Our study does not provide support for the hypothesis that leptin may play a major role in the regulation of bone metabolism in the developing skeleton.

Brucellosis with pulmonary involvement in a premature infant.

Abstract Congenital brucellosis is rare. A premature infant with transplacentally acquired congenital brucellosis and pulmonary involvement is described.

Levetiracetam-Induced Anaphylaxis in a Neonate

BACKGROUND Neonatal seizures are often refractory to treatment with initial antiseizure medications. Clinicians turn to agents such as levetiracetam despite the paucity of published data regarding its safety, tolerability, or efficacy in the neonatal population. PATIENT PRESENTATION We describe a neonate who developed anaphylactic shock developing after receiving intravenous levetiracetam. RESULTS This is the first neonate to develop anaphylactic shock due to intravenous administration of levetiracetam. CONCLUSION Clinicians should be aware of this potentially fatal adverse effect occurring with intravenous levetiracetam in newborns.

Antimeasles antibodies in preterm infants during early infancy in Turkey

Abstract Aim: To measure maternally derived measles antibodies in sera of premature infants at birth and seropositivity rates in early infancy in a rural area of central Turkey. Methods: 65 premature and 24 full-term infants born in Erciyes University Hospital and their mothers were recruited to a longitudinal, prospective study. The infants were divided into three groups by gestational age: group A, <33 weeks; group B, 33–37 weeks; group C, >37 weeks. For specific analyses, the groups were subdivided into groups A1, B1 and C1 (infants of naturally immunised mothers) and A2, B2 and C2 (infants of vaccinated mothers). Blood samples were obtained from mothers and infants after delivery. The infants were re-evaluated at 2, 4 and 6 months of age. Results: Of 25 mothers, 20.3% were seronegative for measles antibodies. Twenty of the mothers had not been vaccinated. The percentages of seronegative infants at birth were 24.2% (n=8), 12.5% (n=4) and 0% (n=0) in groups A, B and C, respectively. No infants were seronegative at birth in A1, B1 or C1. Mean levels of antimeasles antibodies in all naturally immunised mothers were significantly higher than in vaccinated mothers. Antibody levels in all infants decreased rapidly with increasing age. Gestational age at birth [β=0.179, t=3.359, 95% confidence interval (CI) 0.0001–0.0001, p<0.05], birthweight (β=0.637, t=9.691, 95% CI 0.057–0.086, p<0.05) and maternal naturally immunised status (β=0.168, t=2.825, 95% CI 0.002–0.014, p<0.05) were significantly associated with antibody levels after birth. In all groups of naturally immunised mothers, the percentages of seronegative infants were significantly lower than in vaccinated mothers at birth and at 2, 4 and 6 months of age. Conclusion: The current recommendation to immunise all infants at 9 months of age might require revision for premature infants, especially those whose mothers have vaccination-induced immunity.

Adrenal Haemorrhage with Cholestasis and Adrenal Crisis in a Newborn of a Diabetic Mother

The large hyperaemic foetal adrenal gland is vulnerable to vascular damage. This may occur in the neonatal period as a consequence of difficult labour, or its aetiology may not be apparent. The spectrum of presentation is considerable, ranging from asymptomatic to severe life-threatening intra-abdominal haemorrhage. The presentation of adrenal insufficiency may be delayed but the regenerative capacity of the adrenal is great, and most adrenal haemorrhage is not associated with significantly impaired function. Some reports showed that cholestatic hepatopathy with congenital hypopituitarism reversed by hydrocortisone treatment is considered in the context of the endocrine syndrome, probably as a consequence of the adrenal failure. We describe a case of bilateral adrenal haemorrhage with hepatitis syndrome and persistent hypoglycaemia in a newborn male with striking features of neonatal cholestasis and adrenal crisis.

Anaphylactic shock due to vitamin K in a newborn and review of literature

Abstract Newborn infants are born with an immature innate immunity. They are less likely to develop anaphylaxis since their immune system is weaker than older infants and children. There are only a few reports of side effects after vitamin K injection in neonates although prophylaxis against hemorrhagic disease of the newborn with this drug has been in routine practice in all over the world for many years. We herein report a case of anaphylactic shock developing after the intramuscular administration of vitamin K1 in a newborn. To our knowledge, this patient is the first case of neonatal anaphylactic shock developing due to intramuscular administration of vitamin K1. We suggest the clinicians should be aware of this possibility of potentially fatal adverse effect occurring with intramuscular administration of vitamin K1.

Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn

Abstract Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85–90% pancreatectomy was performed and histological “diffuse nesidioblastosis” was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia.

Onychomycosis in a premature infant caused by Candida parapsilosis.

Abstract:  We report onychomycosis caused by Candida parapsilosis in a 35‐day‐old premature infant. To our knowledge, this represents the youngest instance of an isolated lesion of the nail plate without involvement of glabrous skin, caused by C. parapsilosis in this age group to be reported in the literature.