Sule Yigit

Birthweight Discordance in Twins and the Risk of Being Heavier for Respiratory Distress Syndrome

Twin pregnancies are becoming common as a result of increased assisted reproduction. Studies have shown that the smaller twin of a pair is at greater risk of morbidity and mortality. Our aim was to determine if there is a relation between birth-weight discordancy and neonatal morbidity and mortality and to test the occurrence of respiratory distress syndrome (RDS) in discordant twins. For 5 years all twins admitted to our intensive care unit were included in the study. Discordance was calculated as the difference between twins weights divided by the heavier weight. Diagnosis of RDS was made by typical clinical and radiographic methods. Multiple logistic regression was performed with gender, weight order and birth order as the independent variables and RDS as the dependent variable. Two hundred and sixty-six twin pairs with a mean gestation of 33 weeks and a mean birth-weight of 1890 g were evaluated. Multiple logistic regression revealed that being the heavier twin was a more important risk factor for RDS (odds ratio 4.5; 95% confidence interval 2.2-9.2) than being the male or second-born twin. Based on neonatal outcomes a birth-weight discordance equal or greater than 20% in twin pairs was accepted as the discordance criterion. Discordant and concordant groups were statistically different in neonatal mortality, necrotizing enterocolitis, polycytemia and hypoglycemia. Our data demonstrated that being the heavier twin is a risk factor for RDS and a birth-weight difference of 20% or more in twin pairs should be accepted as discordance.

Comparison between oscillometric and invasive blood pressure measurements in critically ill premature infants.

Aim:u2002 Blood pressure (BP) measurement techniques in neonates generally involve noninvasive measurements with a cuff (oscillometric) or invasive measurements through an arterial catheter. The aim of this study was to determine the reliability of the noninvasive oscillometric method in critically ill preterm infants when results were compared with the invasive technique.

A Rare Galactosemia Complication: Vitreous Hemorrhage

Galactosemia is a secondary glycosylation disorder characterized by galactose deficiency of glycoproteins and glycolipids. Abnormal glycosylation of coagulation factors and evidence of liver disease are associated with coagulopathy in galactosemic infants. We report a case of a neonate with galactosemia presenting with bilateral vitreous hemorrhage (VH). During the follow-up, hemorrhage in the right eye resolved; however, it persisted in the left eye. Vitrectomy was planned for the left eye. In addition to cataract, VH is another ophthalmic finding in galactosemia with serious sequelae such as amblyopia. Serious complications of coagulopathy in galactosemic infants can be prevented with early diagnosis and prompt treatment. Inclusion of galactosemia in the neonatal screening program offers an opportunity to prevent early severe symptoms.

Plasma carnitine levels in preterm infants with respiratory distress syndrome

Abstractu2002 Background :u2002Antenatal carnitine administration has been shown to induce fetal lung maturity by increasing pulmonary surfactant in animal and human studies. In this study, the aim was to investigate the status of carnitine in maternal and neonatal plasma of preterm infants with respiratory distress syndrome (RDS) in the first hours of life.

Plasma Ionized Magnesium Levelsin Neonatal Respir atory Distress Syndrome

Measurement of ionized magnesium (IMg) provides an accurate assessment of the free form of Mg, which is the physiologically active form and is most reflective of the biologically active and not easily measurable intracellular Mg fraction. Plasma levels of IMg were measured by ion-selective electrode method in premature newborns with respiratory distress syndrome (RDS), and relationships and correlations between IMg levels and various demographic, prognostic and laboratory characteristics were investigated by comparing the premature newborns with (study group; n = 19) and without RDS (control group; n = 20) in the present study. The values of the postnatal arterial pH and base excess and plasma IMg levels were significantly different between the study and control groups, and the number of newborns with any morbidity was significantly higher in the study group. Within the study group there were significant negative correlations between the plasma IMg levels and the values of the umbilical cord arterial pH (r = -0.621, p = 0.005) and base excess (r = -0.746, p = 0.001), and the value of the postnatal arterial base excess (r = -0.585, p = 0.008). The newborns who died later had higher plasma IMg levels than those who survived (0.89 +/- 0.45 vs. 0.63 +/- 0.24 mmol/l, p = 0.026). These findings suggest that increase of plasma IMg may be due to extracellular movement of Mg, which is a principally intracellular ion, as a result of acidosis, hypoxia and probable cellular injury during the early course of RDS. The exact pathophysiological mechanism responsible for IMg increase, and whether determination of plasma IMg level, including umbilical cord blood IMg measurement, can be used as an early or predictive indicator of RDS in the diagnosis remain to be determined in further large-scale studies.

Container type and bactericidal activity of human milk during refrigerated storage.

Background: Refrigeration of human milk has been recommended for its short-term storage. It has been shown that some nutritional, immunological, and bioactive properties and bactericidal activity of human milk can be altered during refrigeration. Pyrex bottles and polyethylene bags are 2 commonly used containers for human milk storage. Objective: The aim of this study was to compare the association between storage container type on the bactericidal activity of human milk for different durations of refrigeration (fresh, and at 24 and 48 hours). Methods: Forty-four samples of human milk were collected from 22 lactating mothers. Two samples of breast milk (approximately 10 mL each) were obtained by manual expression from each mother. One was collected directly into sterile Pyrex bottles and the other into polyethylene bags. One mL of human milk from each container was processed immediately after arrival to the laboratory. The remaining human milk was kept in the Pyrex and polyethylene containers at 4°C until analysis at 24 and 48 hours. The bactericidal activity of each sample was studied. A strain of Escherichia coli ATCC 25922 was used to determine the bactericidal effect of human milk. Results: Bactericidal activity was significantly reduced in milk samples stored in polyethylene bags compared to those stored in Pyrex bottles when milk samples were stored at 4°C for 24 and 48 hours (P < .05). Conclusion: Short-term storage of human milk in Pyrex bottles is more appropriate than polyethylene bags for preserving its bactericidal activity against E coli.

Oxidant and antioxidant status in neonatal proven and clinical sepsis according to selenium status

Selenium is a trace element required for the functioning of the immune system. Neonatal sepsis is a serious condition leading to morbidity and mortality in neonates worldwide. The purpose of this study was to measure selenium and plasma selenoprotein P (SePP), selenoenzyme activity, and alterations in oxidant/antioxidant status with immune biomarkers in neonates with clinical (nu2009=u200927) and proven neonatal sepsis (nu2009=u200925).

Lead and Mercury Levels in Preterm Infants Before and After Blood Transfusions

Very low birth weight (VLBW) infants usually receive packed red blood cell unit (pRBC) transfusions. Heavy metal transfer via pRBCs is not widely discussed before. This study aimed to determine pre-/post-transfusion erythrocyte lead and mercury levels in infants and to correlate these levels to heavy metal concentrations in pRBCs. VLBW infants (nu2009=u200980), needing pRBC transfusion for the first time, were enrolled. Erythrocyte heavy metal levels were determined in pre-/post-transfusion blood samples and also in pRBC units. Mean lead and mercury levels in the pRBCs were found to be 16.3u2009±u200910.8 and 3.75u2009±u20093.23xa0μg/L, respectively. Of the infants, 69.7% received lead above reference dose. Erythrocyte lead levels increased significantly after transfusions (10.6u2009±u200910.3 vs. 13u2009±u20098.5, pu2009<u20090.05) with significant correlated to amount of lead within pRBCs (ru2009=u20090.28). Mean pre-/post-transfusion erythrocyte mercury levels were 3.28u2009±u20093.08 and 3.5u2009±u20092.83xa0μg/L, respectively (pu2009>u20090.05). There was a significant correlation between mean difference of mercury levels after transfusion and amount of mercury delivered by pRBCs (ru2009=u20090.28). Infants can be subject to high levels of lead and mercury through pRBC transfusions.