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Purpose: Previous studies have reported that the conus medullaris (CM) is located between T12 and L2 in most adults, but no significant ascent has been observed during childhood. There is evidence that the normal position of the CM in an adult is acquired at birth in the majority of cases. Studies have shown that there are differences in CM levels in neonates. This situation causes problems for interventional procedures in the neonatal period. The aim of this study is to determine CM levels in preterm/term neonates using ultrasound (US). Materials and Methods: Newborn infants (gestational age: 24–43 weeks) admitted to the neonatal intensive care unit between March 2020 and June 2021 were evaluated for CM levels by the postnatal US. Infants with central nervous system abnormalities, dysmorphic features, somatic or various genetic diseases, or their parent’s refusal to participate were excluded from the study. Results: Of the 189 neonates infants included in our study, 85 (44.6%) were female, 104 (55.4%) were male, 139 (73.54%) were preterm (24–36 weeks), and 50 (26.46%) were term (37–42 weeks) neonates. As a result of the US performed on the first day of 189 neonates, CM levels, 31 (16.4%) were L1, 31 (16.4%) were L1-2, and 71 (37.6%) were L2. There is a strong correlation between birth weight and birth week (r 0.84). There is a negative relationship between birth weight and CM level (r -0,20), gestational age, and CM level (r -0,23). Conclusion: Conus medullaris level was negatively correlated with gestational age and increased with advancing gestational age. In addition, the CM level shows a slower rise at 28-40 weeks of postmenstrual age and reaches the normal level (L1-L2) in the neonatal period, as in adults. Knowing the level of the CM in the newborn period will ensure that spinal procedures such as lumbar puncture to be applied to the spinal region can be performed safely.
Objectives: This study aimed to examine whether infants with and without eye patches differ in terms of vital signs and clinical status after retinopathy of prematurity examination. Methods: Premature infants hospitalized in study center between June 2021-April 2022 were included. Group 1 is consisted of infants whose eyes were not closed after retinopathy of prematurity examination. Those infants whose eyes were closed eye-patches consisted of group 2. Vital signs were followed for 24 hours following the examination. Demographic, medical and follow-up data were all recorded prospectively. Vital signs were evaluated in accordance with birth week and weight. Pain score was evaluated by Neonatal Pain, Agitation, and Sedation Scale. Results: Pain scores were found to be lower in group 2 (p < 0.020). Although the systolic blood pressure, diastolic blood pressure, and mean blood pressure values of group 2 were found to be lower than group 1, they were within normal limits (all p < 0.05). Vomiting was not observed at all in Group 1 (p = 0.036). There was no significant difference between the groups in terms of fever, respiratory rate, heart rate, SpO2, and blood glucose values. Conclusions: This study showed that using an eye patch in infants after an eye examination reduces pain and increases comfort of infants. Although their pain scores are lower, taking necessary precautions are recommended for these patients in terms of vomiting. Thus, eye patches can be suggested as a non-pharmacological pain-reducing method after get advanced stagnation by the support of more studies with a larger number of participants.
Objectives: The aims of this study were to evaluate the demographic characteristics, risk factors, mortality rates, and laboratory findings of infants with fungal sepsis in the Neonatal Intensive Care Unit (NICU). Methods: This retrospective multicenter study included patients in NICU with Candida spp isolated in blood cultures between November 01, 2019, and September 01, 2022. The patients were evaluated in two groups as Group 1 infants with Candida albicans and Group 2 infants with Candida non-albicans positive blood cultures. Results: Candida infection was detected in blood cultures in 57 of 3450 patients admitted to the NICU. A total of 57 infants in- cluded in the study. Candida infection was determined 1.6% of infants in the study population, and 57% of them were extremely pre-term infants. There was no significant difference between the two groups in terms of laboratory data. Normal vaginal birth was determined at a higher rate in Group 1. In Group 2, length of hospital stay, duration of total parenteral nutrition (TPN), and mechanical ventilation (MV) were determined to be longer. The mortality due to Candida fungemia was determined as 35%, and of these patients, 65% had an additional medical condition. Conclusion: In accordance with the literature, this study showed that prolonged MV and longer TPN increased the incidence of fungal sepsis. Therefore, to decrease the fungal sepsis rate of NICU, shortening the hospital stay and effective screening programs are recommended.
Objective: Optimal care in the delivery room is important to decrease neonatal morbidity and mortality. We aimed to evaluate neonatal resuscitation practices in Turkish centers. Materials and Methods: A cross-sectional survey consisted of a 91-item questionnaire focused on delivery room practices in neonatal resuscitation and was sent to 50 Turkish centers. Hospitals with <2500 and those with ≥2500 births/year were compared. Results: In 2018, approximately 240 000 births occurred at participating hospitals with a median of 2630 births/year. Participating hospitals were able to provide nasal continuous-positive- airway-pressure/high-flow nasal cannula, mechanical ventilation, high-frequency oscillatory ventilation, inhaled nitric oxide, and therapeutic hypothermia similarly. Antenatal counseling was routinely performed on parents at 56% of all centers. A resuscitation team was present at 72% of deliveries. Umbilical cord management for both term and preterm infants was similar between centers. The rate of delayed cord clamping was approximately 60% in term and late preterm infants. Thermal management for preterm infants (<32 weeks) was similar. Hospitals had appropriate equipment with similar rates of interventions and management, except conti nuous-positive-airway-pressure and positive-end-expiratory-pressure levels (cmH2O) used in preterm infants (P = .021, and P = .032). Ethical and educational aspects were also similar. Conclusions: This survey provided information on neonatal resuscitation practices in a sam- ple of hospitals from all regions of Turkey and allowed us to see weaknesses in some fields. Although adherence to the guidelines was high among centers, further implementations are required in the areas of antenatal counseling, cord management, and circulation assessment in the delivery room.
Purpose: Urgent treatment in newborns with severe hyperbilirubinemia is the removal of bilirubin from the body by exchange transfusion (ET) as the main treatment modality. The aim of this study was to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two neonatal ıntensive care units (NICUs). Materials and Methods: The clinical data were collected of 28 newborns who had undergone rescue exchange transfusions after hospitalization with a diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital. Results: Evaluation was made of 28 newbons with a median serum bilirubin level on admission of 31.2 (20.3-36.8) mg/dL. The leading cause for exchange transfusion was hemolytic jaundice (67.8%), followed by inadequate feeding (14%). The most common cause of hyperbilirubinemia was Rh incompatibility. The reported rate of adverse events associated with exchange transfusion was 71%. The most common complications due to ET were thrombocytopenia and anemia. Four infants died after the ET therapy. Acute bilirubin encephalopathy (ABE) was detected in 39% of the newborns. Serum bilirubin and bilirubin/albumin ratios were found to be high in newborns with ABE. Conclusion: Newborns with severe hyperbilirubinemia, especially when related to hemolytic jaundice, may need rescue ET. As newborns with severe hyperbilirubinemia with a high bilirubin/albumin ratio are at risk of ABE, ET should be considered in these cases
The genetic cause of 46, XY disorder of sex development (DSD) still cannot be determined in about half of the cases. GATA-4 haploinsufficiency is one of the rare causes of DSD in genetic males (46, XY). Twenty-two cases with 46, XY DSD due to GATA-4 haploinsufficiency (nine missense variant, two copy number variation) have been previously reported. In these cases, the phenotype may range from a mild undervirilization to complete female external genitalia. The haploinsufficiency may be caused by a sequence variant or copy number variation (8p23 deletion). The aim of this study was to present two unrelated patients with DSD due to GATA- 4variants and to review the phenotypic and genotypic characteristics of DSD cases related to GATA-4 deficiency.
There is no reported case dealing with the relationship of polyhydramniosis and possible gastrointestinal dysmotility in fetuses with Freeman-Sheldon syndrome (FSS). A case report and literature review of FSS with gastrointestinal dysmotility in a premature newborn delivered due to polyhydramnios was presented. A male baby was born from a 24-year-old mother at 30 weeks of gestation due to polyhydramnios through an emergency cesarean section at a birth weight of 1,460 g. The diagnosis of FSS was considered with the clinical findings. It was also confirmed with the genetic screening, that is revealed a heterozygous likely pathogenic variant in the MYH3 gene. In dealing with FSS fetuses and newborns, perinatologists and neonatologists need to pay attention to the possibility of polyhydramnios due to impaired gastrointestinal motility in addition to other congenital malformations and continuing neonatal problems developed under the influence of gastrointestinal dysmotility.
Objective: Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns. Methods: Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels. Results: The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients. Conclusion: Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.
Introduction: Gastrointestinal perforations (GIPs) are problems with high mortality in the neonatal period. In the present study, the purpose was to share our experiences on GIPs in the neonatal period. Methods: A total of 28 patients who were followed up and treated in the Neonatal Intensive Care Unit between 2005 and 2020 were evaluated retrospectively with risk factors, characteristics, clinical and laboratory findings, and mortality rates. Results: There were a total of 16 male (57.1%) and 12 female (42.9%) patients 15 of whom were (53.6%) preterm, 13 (46.4%) were term. The mean birth weight was 2162±855 g. The most common cause of perforation was necrotizing enterocolitis with 16 cases. Perforation sides were jejunoileal in 17 cases, colon in eight cases, duodenum in two cases, and stomach in one case. A total of 12 of the cases (42.8%) were lost due to perforation. Statistically significant relations were detected between birth weight and gestational age and mortality. Discussion and Conclusion: GIPs appear as an important reason for mortality during the neonatal period. It is important to be careful because of perforation-related mortality in infants with low birth weight and low gestational age.
Background/aim: Limited research has focused explicitly on the association between neonatal jaundice and autism spectrum disorder (ASD), and inconclusive evidence exists in the literature within this framework. This study aimed specifically to investigate whether neonatal jaundice is a potential risk factor for ASD and whether there is a connection between the types of neonatal jaundice and the severity of ASD. Materials and method: This study involved 119 children with ASD [90 males (75.6%), 29 females (24.4%), mean age: 45.39 ± 11.29 months] and 133 healthy controls [100 males (75.2%), 33 females (24.8%), mean age: 46.92 ± 11.42 months]. Psychiatric disorders were diagnosed through the Diagnostic and Statistical Manual of Mental Disorders criteria. Childhood Autism Rating Scale (CARS) was used to assess the screening and diagnosis of autism. A specially prepared personal information sheet was employed to investigate sociodemographic characteristics and birth and clinical histories. Results: The rate of the history of jaundice and pathological jaundice requiring hospitalization and phototherapy were significantly higher in the ASD group compared to the controls. CARS total score and the mean scores of nearly all items were statistically higher in children with a history of pathological jaundice than those with a history of physiological jaundice. Conclusion: Neonatal jaundice, depends on its severity, seems to be one of the possible biological factors associated with subsequent development of and the severity of ASD. Establishing a causal relationship between neonatal jaundice and ASD by more comprehensive studies may contribute to alleviating of the severity of ASD for individuals at risk.Key words: Newborn, autism spectrum disorder, neonatal jaundice, phototherapy
Amaç: Tüm dünyada farklı mortalite ve morbidite oranlarına sahip olmasına rağmen, çocukluk çağı zehirlenmesi çocukluk sağlığı sorunları arasında önemli bir yere sahiptir. Sağlık harcamalarındaki artış, yatış süresi ve zehirlenmelerin neden olduğu iş gücü kaybı dikkate alındığında sorunun yalnızca tıbbi değil aynı zamanda sosyal boyutlarının da olduğunu göstermektedir.Yöntem: Hastanemize zehirlenme yakınması ile başvuran 1043 pediyatrik hastanın demografik verilerine ek olarak, başvuru öncesi müdahale, zehirlenme yeri, başvuru zamanı, ilaçlama süresi ve zehirlenme zamanı, zehirlenmeden sonra geçen süre, başvuru bulguları, hastanede kalma süresi, uygulanan tanı testleri ve tedavi yöntemleri prognozları ile retrospektif olarak değerlendirildi.Bulgular: Bin kırk üç olgunun %54,5’i kadındı. Yüz otuz dokuz intihar olgusunda ise kadın oranı %82’ye yükseldi. Zehirlenme nedenleri incelendiğinde, %47,2’si ilaçlara, %41,5’i sanayi ve %5,4’ü tarımsal ürüne, %2,7’si karbon monoksite, %2,6’sı gıdaya, %0,5’i bilinmeyen faktörlerle ve %0,2’si hayvan ısırıklarna bağlı meydana gelmişti. Başvuruda en sık görülen semptom %17 olguda kusma idi. Gastrik lavaj, aktif kömür, intravenöz sıvı rejimi (%33) en sık uygulanan tedavi idi. Üç ölüm olgusundan ikisi kolşisin, biri CO zehirlenmesi nedeniyle idi.Sonuç: Zehirlenmelerin tanı ve tedavisinde gelişme sevindirici olsa da, bu konudaki en doğru yaklaşım koruyucu önlemleri artırmak olacaktır. Bu standart önlemlere ek olarak, her ülke kendi epidemiyolojik çalışmasına uygun olarak öncelikler belirlemelidir. Ayrıca yüksek mortalite oranı (%22) gözönünde bulundurulursa, klinisyenlerin düşük dozlarda bile mortalite ile ilişkili olabilen kolşisin zehirlenmelerinin tanı ve tedavisinde daha dikkatli ve agresif olmalarını önerebiliriz
Background/aim: Most inborn metabolic diseases are diagnosed during the neonatal period. The accumulation of toxic metabolitesmay cause acute metabolic crisis with long-term neurological dysfunction and death. Renal replacement therapy (RRT) modalities allowthe efficient removal of toxic metabolites. In this study, we reviewed our experience with continuous venovenous hemodiafiltration(CVVHDF) as RRT for newborns with an inborn metabolic disease.Materials and methods: Patients diagnosed with an inborn metabolic disease and who received CVVHDF treatment at our neonatalintensive care unit between January 2014 and December 2017 were included in this study. Their demographic and clinical data werecollected, and the efficacy and safety of CVVHDF was evaluated.Results: A total of nine continuous RRT (CRRT) sessions as CVVHDF were performed in eight newborns with a diagnosis of urea cycledefect (n = 5), maple syrup urine disease (n = 2), or methylmalonic acidemia (n = 1). The mean age at admission was 10 ± 8.6 days(range: 3–28 days). The mean plasma levels of ammonium were 1120 ± 512.6 mg/dL and 227.5 ± 141.6 mg/dL before and at the endof the treatment, respectively. Plasma levels of leucine were 2053.5 ± 1282 μmol/L and 473.5 ± 7.8 μmol/L before and at the end of thetreatment, respectively. The CVVHDF duration was 32.3 ± 11.1 h (median: 37 h; range: 16–44 h), and the mean length of hospitalizationwas 14.6 ± 12.9 days. The mean duration of CVVHDF was 32.3 ± 11.1 h (range: 16–44 h). Circuit clotting was the most commonobserved complication (37.5%) and the survival rate was 50%. Among surviving patients, two developed severe and two developed mildmental and motor retardation.Conclusion: CVVHDF is a CRRT modality that can be used to treat newborns with an inborn metabolic disease. Early diagnosis,commencement of specific medical therapy, diet, and extracorporeal support, if needed, are likely to result in improved short and longtermoutcomes.
Background/aim: Extracorporeal membrane oxygenation (ECMO) is a form of life support for patients with respiratory failure, cardiacfailure, or both. The aim of this study was to evaluate neonates supported with ECMO and report our experience as a Turkish neonatalintensive care unit.Materials and methods: We retrospectively reviewed 11 newborn infants treated with ECMO at Ankara University for respiratory andcardiac failure. We reported the demographic, diagnostic, laboratory, and clinical data of the patients.Results: Eleven patients (9 male, 2 female) received ECMO support with a mean gestational age of 39.1 ± 1.6 weeks and mean birthweight of 3513 ± 506 g. Six patients received venoarterial (VA) ECMO and five patients received venovenous (VV) ECMO. Mean age atinitiation and duration of ECMO was 7.2 ± 7.4 days (2–24 days) and 10.4 ± 4.9 days (5–21 days), respectively. Mean oxygenation index(OI) before ECMO was 48.5 ± 5.7. ECMO was withdrawn from one patient due to severe brain injury. The survival rate for ECMO was73% and the survival rate to discharge was 64%, whereas the survival rate in congenital diaphragmatic hernia (CDH) cases was 40%.Conclusion: Our early results from ECMO for neonates are encouraging. Identification of patients for ECMO support and timelyreferral will offer a survival opportunity to complex neonatal cases.
Amaç: Çalışmada, yenidoğan yoğun bakım ünitesine alt solunum yolu enfeksiyonu nedeniyle yatırılan ve viral etken tespit edilen yenidoğanların epidemiyolojik ve klinik özelliklerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: 1 Ocak 2014-31 Aralık 2015 arasında alt solunum yolu enfeksiyonu nedeniyle yatırılan yenidoğanların özellikleri ve nazofarenjiyal aspirat örneklerinde PCR yöntemiyle saptanan viral etkenler araştırıldı. Konjenital kalp hastalığı, konjenital solunum yolları anomalisi, immün yetmezliği olan hastalar ile nozokomiyal kaynaklı viral enfeksiyonlar çalışmaya dahil edilmedi.Bulgular: Çalışma döneminde yatan toplam 1768 hastanın 81'i (%4.6) akut alt solunum yolu enfeksiyonu tanısı aldı, 56'sında (%69.1) viral etken izole edildi. En sık izole edilen etken respiratuvar sinsityal virüs (RSV)'di (%80.4, n=45), dört hastada (%7.1) RSV ile birlikte ikinci virüs izole edildi, 7 hastada (%12.5) RSV dışı virüs saptandı. Yatışlar en sık Şubat ve Ocak aylarında idi. Viral etken olarak RSV saptanan hasta grubunun hastaneye yatış gün ortancası (21 gün), RSV dışı virüs saptanan hasta grubuna (41 gün) göre anlamlı düşüktü (p=0.011). RSV ve RSV dışı virüslerin etken olduğu hasta gruplarında, hastaneye başvuru bulguları, başvurudaki laboratuvar bulguları, uygulanan solunum desteği açısından fark saptanmadı. Hastanede yatış süresi ortalaması tüm hasta grubunda 7.1±3.6 gün olup, RSV ve RSV koenfeksiyon grubunda, RSV dışı virüs saptanan gruba göre anlamlı olarak uzun idi (7.3±3.8 ve 4.8±3.1 gün, p=0.03). Kaybedilen hasta olmadı.Sonuç: Yoğun bakım ünitesine alt solunum yolu enfeksiyonu nedeniyle yatırılan yenidoğanlarda en sık izole edilen etken RSV'dir. RSV enfeksiyonuna bağlı hastane yatışları en sık Ocak-Şubat aylarında olup, daha erken postnatal günlerde gerçekleşmektedir. Yatış gerektiren yenidoğanlarda epidemiyolojik ve klinik faktörlerin bilinmesi engelleyici yaklaşımların geliştirilmesine olanak sağlayacaktır.

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