Serdar Cömert

Acute kidney injury in a single neonatal intensive care unit in Turkey.

BackgroundAlthough advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity.MethodsOf 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function.ResultsThe prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI.ConclusionsPrenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

A Comparison of Different Methods of Temperature Measurements in Sick Newborns

We aimed to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT), infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) measurements with traditional axillary glass mercury thermometer (AGMT) for intermittent temperature measurement in sick newborns. A prospective, descriptive and comparative study in which five different types of thermometer readings were performed sequentially for 3 days. A total of 1989 measurements were collected from 663 newborns. DAT and ITT measurements correlated most closely to AGMT (r = 0.94). The correlation coefficent for IFST and RGMT were 0.74 and 0.87, respectively. The mean differences for DAT, ITT, RGMT and IFST were +0.02°C, +0.03°C, +0.25°C and +0.55°C, respectively. There were not any clinical differences (defined as a mean difference of 0.2°C) between both mean AGMT&DAT and AGMT&ITT measurements. Our study suggests that tympanic thermometer measurement could be used as an acceptable and practical method for sick newborn in neonatal units.

A Comparison of Magnesium Sulphate and Sildenafil in the Treatment of the Newborns with Persistent Pulmonary Hypertension: A Randomized Controlled Trial

The aim of this prospective, randomized and controlled study was to compare the clinical efficacy of intravenous magnesium sulfate (MgSO₄) and oral sildenafil therapies with persistent pulmonary hypertension of the newborn. A total of 34 infants in the MgSO₄ group and 31 infants in the sildenafil group completed the study. The time to reach the adequate clinical response [defined as oxygen index (OI) level of <15, a pulmonary artery pressure of < 20 mmHg) was significantly shorter in the sildenafil group (p = 0.002). Duration of mechanical ventilation was longer and the number of the patients requiring inotropic support was higher in the MgSO₄ group (p = 0.001 and p = 0.002, respectively). Although among two groups the difference in OI > 5 as speculated in our hypothesis could only be found at 36 h of the treatment, sildenafil was more effective than MgSO₄ in the treatment of persistent pulmonary hypertension of the newborns with regard to time to adequate clinical response, duration of mechanical ventilation and support requirement with inotropic agents.

Hypospadias in Istanbul: Incidence and risk factors

Background:  The aim of the present prospective study was to determine the incidence of hypospadias in newborns in one of the busiest teaching hospitals of Istanbul, and to investigate the risk factors.

Healthcare-associated Infections in a Neonatal Intensive Care Unit in Turkey.

ObjectiveTo determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit.DesignProspective, cohort.SettingA 38-bed, teaching, referral, neonatal intensive-care unit.ParticipantsAll patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours.MethodsThe study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis.ResultsThe incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively.ConclusionsAntenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.

Subacute Sclerosing Panencephalitis Presenting as Acute Disseminated Encephalomyelitis

Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis of childhood and young adolescence due to persistant measles virus infection of the central nervous system. In majority of cases onset occurs from 5–15 years of age.1 In a nonimmunized population the average onset is 8 years. Children with SSPE had experienced natural infection with the rubeola virus at an early age, half before age 2 years.2 SSPE generally occurs 5–10 years after measles infection. In the early stages of the disease behavioral and personality changes is followed by myoclonic jerks and convulsions. In late stages dementia, stupor and coma develops. Diagnosis is achieved by typical clinical findings, meales antibody titer increase in cerebrospinal fluid (CSF) and serum, high amplitude, slow, sharp waves in EEG. Prognosis is poor and death ensues in about 3 yr after the diagnosis. Here it is presented a 7-years-old boy with involuntary movements in both hands, drop attacks while walking, ataxia and stupor. Due to suggestive radiological and clinical findings and a history of recent mumps infection he was thought to have acute disseminated encephalomyelitis initially and given treatment. But due to clinical deterioration and detection of anti measles IgG in serum, and CSF, SSPE diagnosis was confirmed. With this SSPE case presenting initially as ADEM, the authors tried to emphasize that presentation of SSPE may clinically and radiologically beddiverse and a thorough differential diagnosis is mandatory for a definite diagnosis.

The evaluation of polycythemic newborns: efficacy of partial exchange transfusion

Objectives. To evaluate the clinical characteristics and risk factors of symptomatic and asymptomatic polycythemic neonates performed partial exchange transfusion (PET) and to determine the time of resolution of symptoms and effect of PET on short-term morbidity. Methods. This prospective cohort study was conducted with symptomatic (hematocrit; Hct >65% plus a clinical symptom) and asymptomatic (Hct level >70% without any symptoms) neonates who underwent PET due to polycythemia. Results. Among the patients performed PET, 43 (69.3%) were symptomatic and 19 (30.7%) asymptomatic. Persistent pulmonary hypertension and minor problems like hypoglycemia, hypocalcemia, hyperbilirubinemia, and thrombocytopenia improved in all patients within 24 h, 2.5 ± 1.0, 3.1 ± 1.4, 56.2 ± 16.9, and 53.5 ± 10.5 h, respectively, after PET (in except one symptomatic neonate with hypoglycemia). In symptomatic group, in three patients with suspected necrotizing enterocolitis (NEC) prior to PET stage IIa NEC developed. No other clinical and ultrasonographic findings were observed after PET. Conclusions. Early morbidities, due to polycythemia may be reversed with PET within a short time. PET did not increase or cause any complications except NEC. The issue that either NEC was a sign of polycythemia or a complication of PET could not be definitely outlined.

Hospital acquired bloodstream infections in neonatal intensive care unit

Bulgular: Bir y›ll›k süre içerisinde 807 hasta 72 saatten daha uzun süre yatt›. Kan kültüründe üreme say›s› 97 idi. Üreme olanlar›n %65,6’s› erken do¤mufl, %34,4’ü zaman›nda do¤mufl bebeklerdi. En s›k elde edilen mikrorganizmalar koagülaz negatif stafilokok ve Klebsiella pneumonia türüydü. Kan ak›m enfeksiyon h›z› 5,9:1000 gün, katetere ba¤l› kan ak›m› enfeksiyon h›z› 9,6:1000 gün, ventilatörle iliflkili pnömoni h›z› 13,8:1000 gün olarak bulundu. Gram pozitif mikroorganizmalarda glikopeptit direnci görülmedi. Hastane enfeksiyonu için hastane yat›fl süresi, mekanik ventilasyon ve kateter varl›¤›n›n anlaml› risk etmenleri oldu¤u saptand›. Kan kültüründe üreme olanlarda ölüm oran› %12,5 idi.

Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation

Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitted to neonatal intensive care unit and intubated due to severe respiratory insufficiency. He showed signs of severe pulmonary hypoplasia and his echocardiography revealed a cardiac dextroversion. The patient was relatively stabilized after four days under combined high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO). A corrective surgical intervention was sustained with dopamine, dobutamine, fentanyl and midazolam infusions. Ventilator settings were: 9 cmH2O MAP; 15-Hz frequency; 30 cmH2O amplitude and 55% FiO2. Venous-blood gas analysis indicated pH:7.38 pO2:36.2, pCO2:39.2 with SpO2:98%. We believe that HFOV and iNO combination is an effective alternative for the anesthetic management of CDH cases as it provides better gas exchange and less volutrauma.

Beta-ketothiolaz eksikliği: Olgu sunumu

Beta-ketothiolase deficiency is defect ofketone body and isoleucine metabolism. Mithocondrial acetoacetyl-CoA thiolase is responsible for the division of 2 methylacetoacetyl-CoA in isolasine methabolism, the formation of acetoacethyl-CoA in kethogenese and the division of acetoacetyl-CoA in ketolysis. This case was prepared to emphasize the importance of considering the Beta-ketotiolase deficiency for the diseases causing ketoacidosis which is resistant to the treatment.