Sinan Uslu

Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants

The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth. During the early postnatal period, protein intake must be sufficient to achieve normal postnatal growth in extremely low‐birthweight infants. The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at <34 gestational weeks (GW) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity (ROP).

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.

Neonatal Infection with Neisseria meningitidis: Analysis of a 97-Year Period Plus Case Study

ABSTRACT Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period. Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss the clinical features of neonatal infection with N. meningitidis in relation to the literature (analysis of a 97-year period).

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.

Relationship Between Oxygen Saturation and Umbilical Cord pH Immediately After Birth

BACKGROUND The aim of this study is to determine the relationship between oxygen saturation (SpO(2)) by pulse oximetry levels and umbilical cord arterial pH values in healthy newborns during the first 15 minutes of life. METHODS The study was performed with healthy term, appropriate-for-gestational-age newborn infants. The infants were divided in two groups: umbilical cord arterial blood pH value ≤7.19 (group 1) and >7.19 (group 2); SpO(2) levels during the first 15 minutes of life were compared between groups. RESULTS The study was completed with 129 infants (33 in group 1 and 96 in group 2). A significant correlation was found between first-measured preductal and postductal SpO(2) levels by pulse oximetry and umbilical cord arterial pH values ([r²:0.72(0.62 -0.79); p < 0.001] and [r²:0.32(0.25 - 0.54); p < 0.001], respectively). In group 1, infants had lower SpO(2) levels at both preductal and postductal measurements during the first 11 minutes of life and time to reach ≥90% SpO(2) level was longer compared with infants in group 2. CONCLUSION Determination of umbilical arterial blood pH values, in addition to clinical findings and oxygen saturation measurements, might be helpful in deciding the concentration of oxygen and whether or not to continue oxygen supplementation in the delivery room.

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.

Spontaneous Remission in Congenital Leukemia AML-M1 with Pericardial Effusion

Congenital leukemia is a very rare malignancy of childhood with a poor prognosis. The incidence is nearly 1 in 5 million live births. The majority of cases are acute myeloblastic leukemia with trisomy. Clinical manifestations are usually leukocytosis, petechia, ecchymosis, cutaneous nodules, hepatosplenomegaly and central nervous system symptoms. 23-days old girl was presented with complaints of maculopapular dermatitis and hepatosplenomegaly diagnosed as AML M1. During the follow-up period massive pericardial effusion was detected. This case is presented due to emphasize the rare association of pericardial effusion with congenital leukemia without trisomy and spontaneous remission of leukemia that was occasionally appear in the literature.

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.

Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000–2006

Aim:  The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates.