Sinan Mahir Kayiran

Therapeutic combination of sildenafil and iloprost in a preterm neonate with pulmonary hypertension.

While new pharmacological approaches have been demonstrated to effectively manage PH in adults, few reports have addressed PH treatment in neonates and infants. This case report describes the successful management of severe PH secondary to bronchopulmonary dysplasia, respiratory syncytial virus infection, and hypoxia in a preterm 4‐month‐old with the long‐term use of orally administered sildenafil and inhaled iloprost. Pediatr. Pulmonol. 2011; 46:617–620.

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study.

BACKGROUND: Kawasaki disease (KD) is an acute, self‐limiting vasculitis of unknown etiology. The incidence of KD is increasing world wide. However, the epidemiological data for KD in Turkey has not been well described. OBJECTIVE: To describe the demographic, clinical, and laboratory features of children with KD who were diagnosed and managed in the American Hospital, Istanbul, Turkey. METHOD: Patients with KD were retrospectively identified from the hospital discharge records between 2002 and 2010. Atypical cases of KD were excluded. A standardized form was used to collect demographic data, clinical information, echocardiography and laboratory results. RESULTS: Thirty‐five patients with KD, with a mean age of 2.5±1.9 years, were identified. Eighty‐five point seven per cent of patients were under 5 years of age. A seasonal pattern favouring the winter months was noticed. In addition to fever and bilateral conjunctival injection, changes in the oral cavity and lips were the most commonly detected clinical signs in our cases. Coronary artery abnormalities were detected in nine patients. The majority of our patients had started treatment with intravenous immunoglobulin in the first 10 days of the onset of fever, and only one patient required systemic steroids for intravenous immunoglobulin‐resistant KD. The coronary artery abnormalities resolved in all nine patients within 8 months. CONCLUSION: This study is the most comprehensive series of children from Turkey with KD included in Medline. As adult‐onset ischemic heart disease may be due to KD in childhood, further prospective clinical investigations are needed to understand the epidemiology, management and long‐term follow‐up of the disease.

Umbilical Cord Serum Erythropoietin Levels and Maternal Smoking in Pregnancy

Objective. To evaluate the effect of maternal smoking during pregnancy on levels of umbilical cord erythropoietin. Methods. Erythropoietin levels were measured in umbilical cord sera of 60 newborns who were delivered vaginally at term. There were 20 (33%) smoking and 40 (67%) nonsmoking mothers. Results. Mean cord serum erythropoietin levels were significantly lower in the nonsmokers (nonsmokers, 24 ± 9 IU/L; smokers, 61 ± 46 IU/L; P < .001). There was a significant positive correlation between the number of cigarettes smoked per day and cord serum erythropoietin levels (r, 0.58; P ≤ .05). Conclusions. Smoking during pregnancy is associated with increased levels of umbilical cord erythropoietin at birth. This may indicate a risk of fetal hypoxia and growth restriction. Education and encouragement of cessation of smoking during pregnancy are important to avoid associated fetal and maternal morbidity and mortality.

Congenital epulis of the tongue: A case report and review of the literature

We report a case on a neonate with congenital epulis rarely detected on the anterior ventral surface of the tongue.

Inherited combined deficiency of proteins C and S.

To the Editor: Protein C (PC) is a vitamin K-dependent plasma protein that acts as a major inhibitor in the procoagulant system through proteolytically degrading activated Factor V and Factor VIII. Researchers have found over 160 different mutations of the PC gene that lead to the absence, or a defective form, of PC (1). Protein S (PS), another vitamin K-dependent protein, acts as a cofactor for PC. It is activated at the endothelial surface when thrombin binds to thrombomodulin (2). Isolated deficiencies of PC and PS are well known, but combined deficiency of these two proteins is a rare finding. A 6-month-old boy with congenital heart disease who was born to apparently healthy, second-degree-related parents was referred to our hospital for surgery. Cardiac catheterization was performed to confirm the diagnosis that had been obtained through echocardiography: right atrial isomerism, dextrocardia, complete atrioventricular septa1 defect, left-hand topology and pulmonary stenosis. However, despite heparinization of the lumen before the procedure, the catheterization needle filled with clotted blood, making it impossible to insert a guide wire even after several attempts. A coagulopathic disorder was suspected, and subsequent testing revealed the following (Table 1): prothrombin time 12.9 s (normal 10.7-1 3 s), activated partial thrombo-

Evaluation of coagulation tests before newborn circumcision: is it necessary?

Evaluation of coagulation parameters prior to newborn circumcision is routinely performed in many countries. However, the value of this screening in predicting the bleeding risk is unknown. The aim of this study was to evaluate the correlation between the preoperative prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT) and excessive bleeding after the circumcision in term, healthy newborns without family history of coagulopathy. The medical records of healthy, full term newborns born at VKV American Hospital, in Istanbul, Turkey, between 2009 and 2012 who were circumcised within the first week of life, were reviewed retrospectively. The data for family history of coagulopathy, clinical sign(s) of bleeding during and/or after delivery, preoperative PT, aPTT levels and the amount of bleeding after circumcision were gathered. The most recent medical records of the patients’ were also reviewed for any possible, lately diagnosed bleeding disorder. A total of 450 newborns met the above criteria. None had a family history of bleeding disorder or clinical bleeding. A total of 158 (35%) newborns had an aPTT result greater than 54.5 s, 269 (59%) had PT result greater than 15.9 s and 72 (16%) had international normalized ratio result greater than 1.62. Neither of the patients with prolonged PT and/or aPTT had prolonged or excessive bleeding. The evaluation of PT and aPTT before elective newborn circumcision is not necessary in the absence of clinical bleeding or a family history of bleeding disorder. It is rather a habit in general practice and possibly a result of defensive medicine.

Supernumerary intrathoracic rib

An 8-year-old afebrile boy presented with a 10-day history of runny nose and coughing, with no history of lung or other systemic disease and no sign of respiratory distress, tachypnoea or tachycardia. Chest radiography revealed that anterior portion of the right third rib was oriented caudally and ended mid-thorax (figure 1). A thick band extended from the anterior edge of the third rib to the anterior portion of the sixth rib, causing retraction of the attached pleura. Unenhanced helical thorax CT …

Successful Treatment of Arterial Thrombus in an Extremely Low-Birth-Weight Preterm Neonate

Arterial thromboembolism in the pediatric population frequently occurs secondary to arterial catheterization. Catheterization-related complications are more common in smaller and sicker infants, due to high prothrombotic activity, low levels of natural anticoagulants, and various fibrinolytic imbalances. Arterial thrombus management in neonates remains controversial. Recombinant tissue plasminogen activator is the most commonly used thrombolytic agent in children, however there is very little experience with recombinant tissue plasminogen activator therapy in small prematures, especially in the first week of life. This case study reports catheter-related femoral artery occlusion in an extremely low-birth-weight preterm infant. Despite continuous heparin infusion for 6 hours, no resolution of the thrombus was seen by clinicians. Heparin was stopped, and recombinant tissue plasminogen activator therapy enabled complete recovery from the thrombus. The risk of bleeding (including intracranial hemorrhage) with recombinant tissue plasminogen activator treatment, especially in small preterm neonates is unknown. However, in this extremely low-birth-weight preterm infant, recombinant tissue plasminogen activator therapy was effective, and limiting the infusion rate to ≤0.4 mg/kg/hour was safe.

Investigating the Effect of Black Tea Consumption During Pregnancy on the Oxidant/Antioxidant Status of Breastmilk

OBJECTIVE Black tea is associated with antioxidant properties. The objective of this study was to investigate the effect of the amount of black tea consumption during pregnancy on the oxidant/antioxidant status of breastmilk. SUBJECTS AND METHODS Breastmilk was obtained from 30 mothers and analyzed for lipid peroxidation based on levels of malondialdehyde (MDA) and of reduced glutathione (GSH). In a survey completed by all participants, daily black tea consumption during the pregnancy was reported. RESULTS No correlation was found between the amount of black tea consumed and levels of MDA (p=0.401) and/or GSH (p=0.473). The results of this study indicate that consumption of varying amounts of black tea does not affect the oxidant/antioxidant status of breastmilk. CONCLUSIONS The insensitivity of breastmilk to antioxidant contributions by black tea reflects the capacity of breastmilk to be resistant to the myriad of factors that otherwise affect a pregnant woman.

P171 Ponderal index in sga neonates

Introduction Small for gestational age (SGA) is defined as infants with a birth weight below the 10th percentile for gestational age. However, this definition does not differentiate SGA infants who are constitutionally small from those who are growth-restricted (FGR). The risk of mortality and morbidity is increased in infants with FGR. Ponderal index (PI) is a useful tool to detect FGR. Therefore, it is important to define PI of SGA infants and we aimed to determine the PI of SGA term infants born in our hospital. Material and methods This study included 3187 newborns who were born at or after 37 weeks’ of gestation at American Hospital, Istanbul, Turkey. Infants whose birth weight was below 10th percentile according to the growth curve of Turkish neonates were considered as SGA infants. PI of SGA infants were calculated according to the formula; [weight (in g) x 100] ÷ [length (in cm)]3. PI of SGA infants were plotted on the PI – gestational age curve. Statistical analyses were performed by SPSS 17.0. Results There were 107 (3.36%) SGA infants. 62 (57.9%) of them were female, and 45 (42.1%) of them were male. PI was in normal ranges (between 10–90p) in 85% (10–90p). In 7 neonates (6.5%) PI was above 90 p. In 8 neonates (7.5%) PI was below 3–10p and only 1 neonate (%0.9) had PI below 3p. None of them had severe morbidity or died. There was no correlation between PI and gestational age (spearman; r=0.027, p=0.78). Conclusion With normal growth, the PI increases gradually from 30 to 37 weeks gestation and then remains constant which is a finding compatible with our study as we also observed no correlation between PI and gestational age in this study. Only 9 SGA infants (8.4%) had fetal malnutrition among whom only one of them had severe wasting with no morbidity and mortality. It may be reasonable to evaluate only SGA infants with PI less than 10 p.