Sibel Özbek

Fetal-neonatal ovarian cysts--their monitoring and management: retrospective evaluation of 20 cases and review of the literature.

Objective: Neonatal ovarian cysts (NOC) are usually self-limiting structures. However, large or complex cysts may lead to severe complications. A standard guide to management, treatment and follow-up of NOC is not yet available. The aim of this study was to evaluate retrospectively the records of NOC patients from two medical centers. Methods: A total of 20 newborns with NOC were included in the study. The size and localization of the cyst, the age, the signs and symptoms at presentation, and the possible maternal and fetal-neonatal etiologic factors were recorded. Follow-up procedures and treatment modalities were evaluated. Results: The mean age at diagnosis was 34 gestational weeks. The cysts (mean size 53±15 mm) were predominantly in the right ovary (75%) and were evaluated as large cysts in 16 (80%) of the patients. In 5 of the patients with large cysts and in 1 of the 4 patients with small cysts, the cysts were evaluated as complex cysts. Torsion of the ovary was detected in five (25%) cases and these cases were treated surgically. Patients with simple cysts were closely followed by ultrasonography until the cysts disappeared. Conclusion: To date, there is no precise guide for the monitoring and treatment of NOCs. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. In our NOC series, it has been possible to apply a non-invasive follow-up program and minimally invasive surgical procedures. Conflict of interest:None declared.

Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome

OBJECTIVE We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. MATERIALS AND METHODS All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.

Prevalence and distribution of congenital abnormalities in Turkey: differences between the prenatal and postnatal periods.

The aim of this study was to determine the distribution of cases associated with congenital abnormalities during the following three periods: pregnancy, birth, and the neonatal period. This was a retrospective study of cases between 2002 and 2006. All abnormal pregnancies, elective terminations of pregnancies, stillbirths, and births with congenital abnormalities managed in the Neonatology Unit were classified based on the above distribution scheme. During the 5‐year study period, 1906 cases with congenital abnormalities were recruited, as follows: 640 prenatally detected and terminated cases, with most abnormalities related to the central nervous system, chromosomes, and urogenital system (56.7%, 12.7%, and 8.9%, respectively); 712 neonates with congenital abnormalities (congenital heart disease [49.2%], central nervous system abnormalities [14.7%], and urogenital system abnormalities [12.9%]); and hospital stillbirths, of which 34.2% had malformations (220 prenatal cases [34.4%] had multiple abnormalities, whereas 188 liveborn cases [26.4%] had multiple abnormalities). The congenital abnormalities rate between 2002 and 2006 was 2.07%. Systematic screening for fetal anomalies is the primary means for identification of affected pregnancies.

Perinatal and somatic growth properties of preterm babies born from spontaneous and in vitro fertilization multiple pregnancies.

AIM The objective of this study was to examine perinatal and neonatal properties of preterm infants with a corrected age of 24-36 months who were born as a result of spontaneous and in vitro fertilization multiple pregnancies, to interrogate somatic growth properties of these infants and evaluate the factors which had an impact by comparing groups. MATERIAL AND METHODS A total of 125 children with a birth weight below 2 500 g and a gestational age below the 37(th) gestational week 60 of whom were born as a result of in vitro fertilization multiple pregnancies and 65 of whom were born as a result of spontaneous multiple pregnancies were included in the study. Maternal age and morbidity, early rupture of membranes, birth weigth, gestational week, gender, APGAR score, hospitalization reasons in the neonatal period, requirement for intensive care, frequency of congenital anomaly, outpatient follow-up status, rehospitalization and socioeconomic levels were interrogated in the patients. Detailed physical examination and current height, weight and head circumference measurements were performed and the findings were placed in the growth curves of Neyzi et al. Ethics committee approval was received for this study from the ethics committee of Bakırköy Gynecology Obstetrics and Pediatrics Education and Research Hospital (12.10.2010; no:305). RESULTS The rate of cesarean section, mean maternal age, the rate of chronic disease in the mother and the rate of maternal disease which occured during pregnancy were significantly higher in the in vitro fertilization group (p<0.05). While no difference was found in mean gestational age, birth weight, rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization, APGAR score in the 5(th) minute was significantly higher in the in vitro fertilization group. The socioeconomical score was not different between the groups, but the in vitro fertilization group presented more regularly for outpatient follow-up visits. Height, head circumference measurements and mean current weight were found to be significantly higher in the in vitro fertilization group (p<0.05). CONCLUSION The fact that there was no difference in the rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization was attributed to the fact that the study and control groups were composed of only multiple pregnancies and preterms.

Neonatal Bartter syndrome and unilateral ectopic renal cyst as new renal causes of hydrops fetalis: two case reports and review of the literature.

Abstract Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings.

Necrotizing Enterocolitis; An Important Morbidity In Premature Infants: Results of A 9 Year Study

SummARY Objective: To evaluate the frequency of necrotizing enterocolitis, intrinsic risk factors associated with newborns and mothers, and effects of these factors on the development of NEC and related mortality in our newborn intensive care unit. Material and Methods: Three hundred and thirty two newborns admitted to our intensive care unit with the diagnosis of NEC between January 2002 and August 2010 were evaluated retrospectively.

An unusual cause of bilateral scrotal abscess in a preterm infant: Candida albicans

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

Erken doğmuş bebeklerde osteopeni sıklığı ve etiolojik risk etmenlerinin geriye dönük olarak değerlendirilmesi Orijinal Araştırma

Aim: Osteopenia is an important morbidity of very low birth weight nbsp; infants In this study we aimed to appreciate the frequancy of osteopenia the ethiological factors and the clinical and laboratory findings of osteopenia in our clinic nbsp; Material and Method: The records of preterm infants who were admitted from January 2004 to December 2006 with the diagnosis of osteopenia were reviewed Clinical data and information about these infants were assessed according to the data base of our clinic and the files of cases The gestational age sexuality birth weight clinical findings and laboratory findings of our cases were recorded This was a retrospective medical chart review Results: Out of a total of 3691 cases 113 were diagnosed as osteopenia The incidence was 3 1 94 cases 83 were pretems with lt;32 gestational age and 91 of them had lt;1250 gr birth weights Respiratory dystress 39 mild and nbsp; 47 severe was the most common initial complaint of these preterm infants and among these cases 73 had been supported by ventilation 42 cases received steroid treatment because of bronchopulmonary dysplasia 50 of the cases were diagnosed at the age of 15 30 days postnatally The cases who were symptomatic comprised 50 of the total number and thorax deformities were the major manifestations Also in 4 cases femurfracture was identified As the evidence of bone undermineralisation increased ALP and decreased P levels were the mostly determined laboratory findings nbsp; Conclusions: The incidence of osteopenia of prematurity in our clinic was determined as 3 1 nbsp; wich was lower than that reported in the literature The incidences of osteopenia among nbsp; infants born before 32 week of gestational age and with lt;1000 gr birth weight were respectively 22 5 nbsp; and 18 4 The pathogenesis of disease is multifactorial Respiratory dystress syndrome nbsp; ventilation support steroid treatment for bronchopulmonary dysplasia sepsis necrotizing enterocolitis total parenteral nutrition prolonged hospitalization were confirmed as common ethiological factors Turk Arch Ped 2009; 44: 18 22 Key words: Bronchopulmonary dysplasia BPD respiratory dystress syndrome RDS steroid treatment very low birth weight preterm

Evaluation of maternal measles antibody titers and response to the measles vaccination at the age of 9 months in preterm infants

An analysis of lower seroconversion rates and decreased vaccine efficacy, probably due to immature states of immune systems, was conducted by the Turkish Ministry of Health to propose a new strategy of vaccination against measles (at the age of 12 months by ROR vaccine instead of a measles vaccine at the age of 9 months). In this study, we aimed at evaluating whether this strategy, which has been followed by most of the developed countries, was justified for term and especially preterm infants by evaluating their maternal measles antibodies (MMA) titration and seropositivity rate at the age of 9 months and also their responses to measles vaccination at that age. A prevaccination venous blood sample was taken just before the vaccination and postvaccination blood samples 8–10 weeks after the vaccination by 0.5 ml Schwarz-strain live-attenuated measles vaccine (Pasteur, Paris, France). Measles Ig G kits (Gull RBU-100, Gull Lab. Salt Lake City, Utah) were used to study the measles antibody titers. The mean value of reference serum and the serum samples with REU (relative Elisa unit) values greater than 1 were accepted as positive. The characteristics and results for three groups are presented in Table 1. While no significant difference was found between the prevaccination values of group I and II, a statistical significance was detected for group I versus group III. Postvaccination values had a statistical significance for group I and II versus group III. For all groups, the differences between prevaccination and postvaccination mean REU values were found to be significantly higher. MMA seropositivity rates at the age of 9 months were 4.5% in group I, 19% in group II, and 21% in group III. In one of our previous studies, although no significant difference was detected between the maternal REU values in preterm and term groups, the cord blood samples showed a lower titer of mean REU values in preterm infants [2]. At 6 months, seronegativity increased to 86% and 74% for premature infants born at gestational ages ≤32 weeks and >32 weeks, respectively. WHO reports that the ideal timing for vaccination is the age when the MMA seropositivity rate drops under 5% in the population, in order to get a satisfactory response to the vaccination [1]. The results of this study were in favor of the new measles vaccination strategy at the age of 12 months in our country. But our results would suggest continuing to vaccinate group I babies who were born before 32 weeks of gestational age, but not later than the age of 9 months. This suggestion is especially valid in developed countries where most of the mothers are immunized by vaccination. Since passively acquired maternal measles antibodies might be expected to be lower among infants whose maternal immunity is vaccineEur J Pediatr (2007) 166:1181–1182 DOI 10.1007/s00431-006-0361-3

Yenidoğan Yoğun Bakım Ünitesinde Umbilikal Kateter Kullanımına Bağlı Sepsis Sıklığı

Ocak 1993 Ekim 1995 tarihleri arasinda yenidogan unitemizde yatirilan ve umbilikal kateter takilmasi gereken 170 yenidoganda katetere bagli sepsis sikligi retrospeklif olarak degerlendirildi Unitemizde solunum sorunu olan bu nedenle yardimci ventilasyon gerektiren kan degisimi uygulanan ve 1250 gr altindaki parenteral sivi verilmesi gerekli tum yenidoganlara umbilikal kateter takilmaktadir Kateter takilan hastalarin 63 unu solunum sorunu olan yenidoganlar olusturuyordu; hastalarin 21 ine 1250 gr altinda olduklari icin parenteral beslenme amaciyla kateter takildi Kateterin takili oldugu donemde hastalardan duzenli hemokultur alinarak infeksiyon acisindan izlendi; periferik venden alinan kulturde ureme saptandiginda veya klinik ve laboratuar bulgulari ile desteklendiginde sepsis tanisi konuldu Sepsis sikligi umblikal arter ve ven kateteri takilan olgularda sirasiyla 29 ve 16 5 bulundu Enfeksiyon etkeni olarak en sik klebsiella pneumonia ve staphylococcus epidermidis saptandi Umbilikal arter ve ven kateteri takilan olgular kateterizasyon suresine gore sinirlandirildiginda bes gunden uzun sureli kateterizasyonun enfeksiyon sikligini anlamli olarak arttirdigi goruldu p lt;0 05 Anahtar kelimeler: Umbilikal Kateter Septisemi Yenidogan