Ufuk Cakir

An intention to achieve better postnatal in-hospital-growth for preterm infants: Adjustable protein fortification of human milk

OBJECTIVEnWe assessed the effect of human milk (HM) fortification with extra protein supplement by an adjustable protein fortification method according to the weekly blood urea nitrogen (BUN) levels on growth in hospitalized preterm infants.nnnMETHODnA prospective observational intervention study in 58 preterms born ≤32 weeks of gestation and fed with breast milk was conducted. Preterms who were given a commercial HM fortifier which provides an additional protein of 0.8 g/3 scales according to the standard feeding strategy served as a historical control group. Infants who were given extra protein in addition to the HM fortifier with another commercial protein supplement which provides an additional protein of 2.2g/1 scale comprised the intervention group. Additional protein supplementation was adjusted according to BUN levels weekly in the intervention group. Weight gain velocities (g/kg/day), length, head circumferences (HC) gain velocities (mm/day) and daily growth indexes for weight, height and HC (percentage per day) were calculated.nnnRESULTSnThe median amount of daily enteral protein intake [4 (3.4-4.6) vs. 2.78 (2.1-3.1) g/kg/day, p < 0.0001] was significantly higher in the interventional group. Length (p = 0.008) and HC (p < 0.0001) gain velocities were significantly higher in the intervention group. Daily growth indexes for weight (2.2% vs. 1.8%, p = 0.026), for length (0.4% vs. 0.3%, p = 0.027) and for HC (0.48% vs. 0.36% per day, p = 0.003) were significantly higher in the intervention group.nnnCONCLUSIONnA higher protein intake by adjustable protein fortification method without energy or volume change leads to improved postnatal in-hospital-growth in very low birth weight infants.

Efficacy and safety of intravenous colistin in preterm infants with nosocomial sepsis caused by Acinetobacter baumannii.

OBJECTIVESnTo describe the efficacy of intravenous colistin on clinical and microbiological outcomes in preterm infants with nosocomial sepsis in neonatal intensive care unit (NICU) and define adverse events observed with this treatment.nnnMETHODSnThe records of preterm infants who received colistin with or without positive cultures in the NICU were retrospectively reviewed. Patients were evaluated for response to therapy and side effects.nnnRESULTSnA total of 21 preterm infants with medians of 28 weeks (23-36) gestational age and 870 g (620-2,650) birth weight were included. The median duration and dose of colistin therapy were 9 days (3-26) and 3 mg/kg/d (2-5). Recovery rate in patients including all with/without positive culture was 81% (17/21). Microbiological clearance by colistin was 69% (9/13). The major side effect observed was acute kidney injury (19%). At least 24% of infants required electrolyte supplementation during the colistin therapy. Magnesium levels were significantly lower at the end of the colistin therapy (p < 0.001). Acute kidney injury and electrolyte disturbances including hypomagnesemia were reversible in all surviving patients.nnnCONCLUSIONnWe suggest that renal function tests and serum electrolytes should be monitored closely and replaced in case of any need during the colistin therapy in preterm infants.

Outcome of the Respiratory Syncytial Virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study

Abstract Aim: To determine the incidence and outcomes of respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (ALRI) including morbidity, nosocomial infection and mortality among newborn infants who were admitted to the neonatal intensive care units (NICUs). Methods: A multicenter, prospective study was conducted in newborns who were hospitalized with community acquired or nosocomial RSV infection in 44 NICUs throughout Turkey. Newborns with ALRI were screened for RSV infection by Respi-Strip®-test. Main outcome measures were the incidence of RSV-associated admissions in the NICUs and morbidity, mortality and epidemics results related to these admissions. Findings: The incidence of RSV infection was 1.24% (n: 250) and RSV infection constituted 19.6% of all ALRI hospitalizations, 226 newborns (90.4%) had community-acquired whereas 24 (9.6%) patients had nosocomial RSV infection in the NICUs. Of the 250 newborns, 171 (68.4%) were full-term infants, 183 (73.2%) had a BW >2500u2009g. RSV-related mortality rate was 1.2%. Four NICUs reported seven outbreaks on different months, which could be eliminated by palivizumab prophylaxis in one NICU. Conclusion: RSV-associated ALRI both in preterm and term infants accounts an important percent of hospitalizations in the season, and may threat other high-risk patients in the NICU.

Impact of Prophylactic Continuous Positive Airway Pressure on Transient Tachypnea of the Newborn and Neonatal Intensive Care Admission in Newborns Delivered by Elective Cesarean Section.

OBJECTIVEnThis study aims to evaluate the effect of the prophylactic continuous positive airway pressure (CPAP) administration in the delivery room to newborns who were delivered by elective cesarean section (CS).nnnSTUDY DESIGNnInborn infants with gestational age between 34(0/7) to 38(6/7) and born by elective CS were prospectively randomized to receive either prophylactic CPAP for 20 minutes via face mask or standardized care without CPAP in the delivery room. Primary outcomes were the incidence of transient tachypnea of the newborn (TTN) and neonatal intensive care unit (NICU) admission due to respiratory distress.nnnRESULTSnA total of 259 infants with a mean gestational age of 37.7u2009±u20090.8 weeks and birth weight of 3,244u2009±u2009477u2009g were included. A total of 134 infants received prophylactic CPAP and 125 received control standard care. The rate of NICU admission was significantly lower in prophylactic CPAP group (pu2009=u20090.045). Although the rate of TTN was lower in the prophylactic CPAP group, the difference was not statistically significant (pu2009=u20090.059). The rate of NICU admission due to respiratory distress was significantly higher in late-preterm cohort than early-term cohort (pu2009<u20090.0001).nnnCONCLUSIONnProphylactic CPAP administration decreases the rate of NICU admission without any side effect in late-preterm and early-term infants delivered by elective CS.

Influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in the prematurity

BACKGROUNDnThis study aims at evaluating the influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in prematurity.nnnMETHODSnAll preterm babies were divided into two groups, including Group 1 with open PDA and Group 2 with closed PDA. The variables of platelet count, mean platelet volume, platelet mass index, and platelet function were analyzed and compared between two groups of patients to identify the factors that significantly influenced spontaneous closure of ductus arteriosus.nnnRESULTSnTwenty-four patients were in the open PDA group, whereas 36 patients were in the closed PDA group. Mean GA and BW were 27.6xa0±xa01.8 (23.1-30.4) and 28xa0±xa01.6 (23.4-30.6) weeks and 1009xa0±xa0270 (585-1480) g and 1035xa0±xa0298 (505-1500) g in open PDA and closed PDA groups, respectively (pxa0>xa00.05). The incidence of Collagen-ADPxa0>xa0130xa0s was significantly higher in the open PDA group, and the levels of hemoglobin and hematocrit were significantly lower in the open PDA group (pxa0<xa00.05). Multivariate logistic regression analysis showed that respiratory distress syndrome (OR: 9, CI: 1.5-51.8) and collagen-ADPxa0>xa0130xa0s (OR: 5.7 CI: 1.55-21.3) are two independent factors associated with ductal patency.nnnCONCLUSIONnThis is the first study in the English literature providing evidence of the influence of platelet dysfunction on the spontaneous closure of ductus arteriosus in prematurity. Longer collagen-ADP duration is identified as a risk factor of ductal closure.

The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns

Abstract Introduction: Almost 95% of the platelet transfusions (PTs) conducted in the neonatal intensive care unit (NICU) are prophylactic transfusions. Guidelines for prophylactic PTs are based on platelet counts, but not on platelet functions. Nowadays, in order to reduce unnecessary transfusions, utilizing platelet mass index (PMI) was investigated. The aim of study is to find out whether PTs performed in our NICU during last 2 years were in accordance with the current guideline and to evaluate whether the frequency of PTs should be reduced if PMI was considered. Methods: Forty-three infants who received 96 prophylactic PTs were enrolled in the study. The guideline utilized in our NICU advocate keeping the platelet count: (a) >100u2009000 in pre/post-operative, (b) >50u2009000 in unstable and (c) >20u2009000 in stable patients. According to PMI criteria, PT should be performed if PMI: (a) <800 in pre/post-operative, (b)<400 in unstable and (c) <160 in stable patients. Results: In all, 53.2% of PTs should not be given if the decision was in accordance with the current guideline. If decision for every PT was made according to the current guideline and taking PMI into consideration, an additional 11.5% reduction in total PTs could be achived. Conclusion: We suggest that better compliance with the new guidelines which take platelet functions into account may yield lower transfusion rate, lower costs and better conservation of blood bank resources.

Serum Endocan Level as a Predictive Marker for Hemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight İnfants

Background Diagnosis and treatment of patent ductus arteriosus (PDA) in premature infants is still an important problem for clinicians. Echocardiography is the gold standard for determination of PDA based on clinical and hemodynamic significance. Clinical decision making may be aided by measuring circulating biomarkers such as natriuretic and endothelial propeptides. We aimed to investigate the significance of serum endocan and B‐type natriuretic peptide (BNP) in the diagnosis and follow‐up of hemodynamically significant PDA (hsPDA) in very low birth weight infants. Materials and Methods In this study, 84 premature infants with gestation age less than 32 weeks were included. Forty‐two premature infants with hsPDA were determined as the study group and 42 premature infants without PDA were assigned as the control group. Blood samples were collected and analyzed for serum endocan and pro‐BNP levels. Results Serum levels of pro‐BNP and endocan in the study group at the time of diagnosis of PDA were found to be significantly higher than the control group, and the levels decreased significantly after medication. Multivariate regression analysis showed that birth weight and the presence of PDA were significantly correlated with serum endocan levels. The cutoff values of pro‐BNP and endocan for PDA prediction were 290 pg/mL and 506 ng/mL, respectively. Conclusion Endocan and pro‐BNP assays have clinical importance in the diagnosis, initiation therapy, and follow response to therapy in very low birth weight infants with hsPDA.

Comparison of Three Different Administration Positions for Intratracheal Beractant in Preterm Newborns with Respiratory Distress Syndrome

BACKGROUNDnThe aim of this study was to compare the efficacy and adverse effects of various intratracheal beractant administration positions in preterm newborns with respiratory distress syndrome.nnnMETHODSnThis study was performed on preterm newborns with respiratory distress syndrome. The inclusion criteria were being between 26 weeks and 32 weeks of gestational age, having a birth weight between 600 g and 1500 g, having received clinical and radiological confirmation for the diagnosis of respiratory distress syndrome (RDS) within 3 hours of life, having been born in one of the centers where the study was carried out, and having fractions of inspired oxygen (FiO2) ≥ 0.40 to maintain oxygen saturation by pulse oximeter at 88-96%. Beractant was administered in four positions to Group I newborns, in two positions to Group II, and in neutral position to Group III.nnnRESULTSnGroups I and II consisted of 42 preterm infants in each whereas Group III included 41 preterm infants. No significant differences were detected among the groups with regards to maternal and neonatal risk factors. Groups were also similar in terms of the following complications: patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH), chronic lung disease (CLD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), death within the first 3 days of life, death within the first 28 days of life, and rehospitalization within 1 month after discharge. Neither any statistically significant differences among the parameters related with surfactant administration, nor any significant statistical differences among the FiO2 levels and the saturation levels before and after the first surfactant administration among the groups were determined.nnnCONCLUSIONnIn terms of efficacy and side effects, no important difference was observed between the recommended four position beractant application, the two position administration, and the neutral position.

Evaluation of Thyroid Functions in Very Low Birth Weight Preterm Infants

Amac: Konjenital hipotiroidizm (KH) dunya capinda zihinsel engelligin onlenebilir ve onde gelen nedenidir. Konjenital hipotiroidi prevalansi yaklasik 1/3000’dir. Hipotiroidi, ozellikle hasta olanlarda olmak uzere prematurelerde term bebeklere gore daha siktir. Calismamizda cok dusuk dogum agirlikli (CDDA; <1500g) olan hastalarda KH sikligini saptamayi amacladik. Gerec ve Yontemler: Calisma 52 aylik donem boyunca yatan CDDA bebeklerin tibbi kayitlarinin retrospektif olarak degerlendirilmesi neticesinde gerceklestirildi. Ilk yatistan sonra 5 gunden uzun yasayan hastalarin tiroid fonksiyon testleri (TFT), [serbest tiroksin (sT4), tiroid stimulan hormon (TSH)] kayit edildi. Anormal sonucu olan hastalarin kontrol TFT sonuclarina gore hastalar alt gruplara ayrildi. KH grubuna tiroid hormon takviyesi yapildi. Bulgular: Calismaya 5. gunde alinan TFT sonucu elde edilebilen 581 hasta dahil edildi. Yetmisdokuz hastadan alinan ilk TFT anormal, ikinci kontrolde 26 hastanin TFT degerleri anormal olmasi nedeniyle KH tanisi konularak tiroid hormon takviyesi verildi. Cok dusuk dogum agirlikli yenidoganlarda KH orani %4.4 (1/23) olarak tespit edildi. Ayrica KH olan hastalarin gebelik haftalari, dogum agirligi anlamli olarak daha dusuk (sirasiyla p<0,00, p=0,037), kiz cinsiyet orani daha yuksek (p=0.017) bulunmustur. Sonuc: Konjenital hipotiroidi orani CDDA prematurelerde daha dusuk gebelik haftasi ve dogum agirligi ile kiz cinsiyette yuksek bulunmustur. Prematurelerde tiroid fonksiyon bozuklugu yaygin olarak izlenmektedir. Ozellikle prematurelerde norogelisimsel sonuclar dusunuldugunde tiroid fonksiyon testlerinin tekrari KH’yi tespit etme acisindan onemlidir.

Ginger (Zingiber officinale Roscoe) for the treatment and prevention of necrotizing enterocolitis

ETHNOPHARMACOLOGICAL RELEVANCEnNecrotizing enterocolitis (NEC) is the most important gastrointestinal emergency affecting especially preterm infants and causes severe morbidities and mortality. However, there is no cure. Oxidant stress, inflammation, apoptosis, as well as prematurity are believed to responsible in the pathogenesis of the disease. Ginger and its compounds have anti-inflammatory, antimicrobial, anti-oxidant properties and immunomodulatory, cytoprotective/regenerative actions.nnnAIM OF THE STUDYnThis study aimed to evaluate the beneficial effects of ginger on the intestinal damage in an experimental rat model of NEC.nnnMATERIALS AND METHODSnThirty newborn Wistar rats were divided into three groups: NEC, NEC +u202fginger and control in this experimental study. NEC was induced by injection of intraperitoneal lipopolysaccharide, feeding with enteral formula, hypoxia-hyperoxia and cold stress exposure. The pups in the NEC +u202fginger group were orally administered ginger at a dose of 1000u202fmg/kg/day. Proximal colon and ileum were excised. Histopathological, immunohistochemical (TUNEL for apoptosis, caspase 3 and 8) and biochemical assays including xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malonaldehyde (MDA) and myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin1β (IL-1β), and interleukin 6 (IL-6) activity were evaluated.nnnRESULTSnCompared with the NEC group, the rat pups in the NEC +u202fginger group had better clinical disease scores and weight gain (pu202f<u202f0.05). Macroscopic evaluation, Histopathologic and apoptosis assessment (TUNEL, caspase 3 and 8) releaved that severity of intestinal damage were significantly lower in the NEC +u202fginger group (pu202f<u202f0.05). The levels of TNF-α, IL-1β and IL-6 in the ginger treated group were significantly decreased (Pu202f<u202f0.05). The GSH-Px and SOD levels of the ginger treated group were significantly preserved in the NEC +u202fginger group (pu202f<u202f0.05). The tissue XO, MDA and MPO levels of the NEC +u202fginger group were significantly lower than those in the NEC group (Pu202f<u202f0.05).nnnCONCLUSIONnGinger therapy efficiently ameliorated the severity of intestinal damage in NEC and may be a promising treatment option.