Sema Tanriverdi

Serial Intravesical Pressure Measurements Can Predict the Presence and the Severity of Necrotizing Enterocolitis

BACKGROUND AND AIMS Necrotizing enterocolitis (NEC) which is accompanied with gastrointestinal ulceration and necrosis is one of the most important problems of preterm infants in neonatal intensive care unit (NICU). Increased intra-abdominal pressure (IAP) is detected among most of the pediatric patients hospitalized in intensive care unit and undergoing surgery or trauma. This pathology, namely, abdominal compartment syndrome, causes ischemia and hypoperfusion of abdominal organs. Recently, the effect of increased IAP on NEC is under focus and this increase is thought to be related with the onset of NEC by leading to intestinal ischemia and necrosis. In this study, we aimed to investigate if serial intravesical pressure (IVP) measurements as an indirect indicator of IAP may help to early diagnosis in NEC and to decision for surgery besides to predict the mortality of NEC. MATERIAL AND METHOD A total number of 61 preterm infants with a birth weight of ≤ 1,500 g hospitalized in NICU were included to the study. IVP values were measured by the same nurse twice daily during their hospitalization through urinary catheter. The IVP values of the preterm infants with and without NEC were compared. RESULTS Totally 61 premature infants included in the study were grouped as follows: group 0, the control group without NEC (n = 38); group 1, medically treated NEC patients (n = 14); and group 2, NEC patients undergoing surgery (n = 9). The median IVP measurements of group 0 were lower than the other groups (p = 0.001). No statistically significant difference in IVP measurements was detected between group 1 and group 2 (p = 0.155). A 10% of increase in IVP measurement was significant in predicting the development of NEC with consecutive serial measurements. The mean IVP measurements were higher in infants with NEC who died during their follow-up at NICU compared with NEC patients who survived (p = 0.043). CONCLUSION Serial IVP measurements may help for early diagnosis and surgery decision of NEC and high IVP levels also may predict mortality in cases with NEC.

The effect of inhaled nitric oxide therapy on thromboelastogram in newborns with persistent pulmonary hypertension.

Studies about the effects of inhaled nitric oxide (iNO) on bleeding time and platelet aggregation in newborns are limited in number and have inconclusive results. Thromboelastogram (TEG) shows the combined effects of coagulation factors and platelet functions. In this preliminary study, we aimed to evaluate the effects of iNO on coagulation using TEG in newborns with persistent pulmonary hypertension (PPH). TEG assays were performed in 10 term infants receiving iNO treatment for PPH and 32 healthy term infants. Samples of the iNO group were collected before and during iNO. Clot reaction time (R), clot kinetics (K), maximum amplitude (MA), and alpha angle were obtained from the TEG tracing. TEG-R values were statistically higher during iNO treatment (7.75 ± 3.34) when compared to the values before iNO (4.83 ± 1.38) and the healthy controls (3.75 ± 0.98). The alpha angle was lower in iNO treated infants at both periods (before iNO, 55.33 ± 8.58; during iNO, 42.90 ± 18.34) compared to the control group (64.95 ± 6.88). MA values before iNO treatment were the lowest (44.43 ± 14.09) and improved with the iNO treatment (48.40 ± 9.49) despite still being lower compared to the controls (53.67 ± 5.56). Conclusion: Both PPH and iNO may negatively effect in vitro coagulation tests. Therefore, newborns with PPH requiring iNO treatment should be closely monitored for coagulation problems.

Neonatal status epilepticus controlled with levetiracetam at Sturge Weber syndrome.

Sturge-Weber syndrome is a rare, sporadic, congenital neurocutaneous syndrome characterized by facial cutaneous vascular malformation, leptomeningeal angioma and eye abnormalities. Seizures develop during the first year of life, may become refractory to multiple anticonvulsants and status epilepticus may develop. A rare subtype of Sturge-Weber syndrome with bilateral facial vascular malformation, unilateral cerebral involvement and neonatal status epilepticus is reported here. Neonatal status epilepticus was successfully controlled with intravenous levetiracetam infusion.

Treatment of Congenital Complete Atrioventricular Heart Block With Permanent Epicardial Pacemaker in Neonatal Lupus Syndrome

Introduction: Neonatal lupus syndrome (NLS) is a passively acquired autoimmune condition due to the transplacental passage of maternal anti-Ro/SSA and anti-La/SSB antibodies in mothers with systemic lupus erythematosus (SLE), and congenital complete heart block (CHB) is its most serious manifestation. Skin and hepatic involvement may occur in later infancy. Case Presentation: A term infant with fetal bradycardia, detected at the 23rd gestational age, was diagnosed with CHB due to NLS and was successfully treated with a permanent epicardial pacemaker. The patient was reported here due to rarity of the procedure in neonatal period. Conclusions: Mothers with SLE should be screened and closely followed up during pregnancy for the development of fetal atrioventricular (AV) block.

Endoscopic evacuation of cerebellar hematoma in a term newborn.

Intracerebellar hemorrhage is very rare in term infants and only severe cases with massive intracranial hemorrhage, posthemorrhagic hydrocephalus and clinical deterioration due to increased intracranial pressure require neurosurgical evacuation. In recent adult studies endoscopic hematoma evacuation has been shown as a rapid, effective, and safe technique. A term newborn hospitalized for meconium aspiration syndrome showed hypertonia, jitteriness and abnormal amplitude integrated electroencephalogram findings. He was diagnosed with cerebellar hematoma which caused hydrocephalus by cranial magnetic resonance imaging (MRI). The hematoma was successfully evacuated neuroendoscopically as the first case in literature to our knowledge. Neurologic, a-EEG and MRI findings resolved.

285 Can Measurement of Intravesical Pressure be used for the Diagnosis and Follow up of Necrotizing Enterocolitis

Background and Aims Abdominal compartment syndrome refers to multiorgan failure secondary to increased intraabdominal pressure and circulatory failure. Early diagnosis and treatment of this clinical syndrome resulting with high mortality in children is possible via intravesical pressure (IVP)measurements. Data on IVP is limited in newborns with increased abdominal pressure due to diseases like necrotizing enterocolitis (NEC). We aimed to investigate the predictive value of consecutive IVP measurements for diagnosis and outcome of NEC. Methods IVP was measured twice daily for 10 days in 61 premature infants below 1500 grams. Measurements of infants with and without NEC were compared. Results Infants were grouped as; Group 1: without NEC, Group 2: NEC medically treated, Group 3: operated for NEC. Group 1 had lower IVP values compared to infants with NEC (p=0.001). Group 2 and 3 had similiar IVP values (p=0.155). A 10% increase in the consecutive IVP measurements was valuable for predicting NEC. Infants who died due to NEC had higher IVP values compared to surviving infants with NEC (p=0.043). Conclusion IVP measurements may be helpful for the diagnosis of NEC. Mortality due to NEC in premature infants may also be predicted with high IVP values.