Predictive Value of Vasoactive-inotropic Score for Mortality in Newborns Undergoing Cardiac Surgery

Objective: Vasoactive-inotropic Score (VIS) was developed to quantify the amount ofinotropic support provided in the postoperative period. We investigated the predictive value of(VIS) for mortality in neonates with congenital heart disease (CHD). Study design:Prospective cohort. Patients: 119 newborns who underwent cardiac surgery. Setting:Tertiary NICU-CHD center of Ankara from November 2016 to January 2019. Intervention/Measurement: VIS values were calculated by a standard formula for the first 72postoperative hours, and the maximum score was recorded. Primary outcomes: Duration ofmechanical ventilation, NICU length of stay, and mortality. Results: At surgery, the median(IQR) age was 15 d (9-31). The patients were divided into two groups according to mortality;Group 1 (Non-survivors) (n=36) and Group 2 (Survivors) (n=83). Higher VIS score wascorrelated to longer duration of mechanical ventilation (P=0.009, r=0.33), and was higheramong patients who died (P=0.003). Area under the curve (AUC) was 0,83 (P<0.001, CI: 95%0.7-0.9) for VIS to identify mortality. At a cut-off value of 15.5, sensitivity and negativepredictive values of VIS for mortality were 73.6% and 85.3%, respectively. The higher VIS(>15.5) was independently associated with increased odds for mortality (OR: 8.1, 95% CI:1.8-35.7, P=0.005). Conclusions: In newborns with CHD, a higher VIS within 72 hours aftercardiac surgery is associated with increased duration of mechanical ventilation, and mortality.VIS may be useful for prediction of mortality at early postoperative period.

Efecto aditivo de las células madre mesenquimales y del defibrótido en un modelo de trombosis arterial en ratas / Additive effect of mesenchymal stem cells and defibrotide in an arterial rat thrombosis model

Introducción. El objetivo de este estudio consistió en investigar el efecto aditivo de las células madre mesenquimales (MSC, por sus siglas en inglés) y del defibrótido (DFT) en un modelo de trombosis arterial femoral en ratas. Métodos. Se incluyeron 30 ratas Sprague Dawley. Se desarrolló un modelo de trombosis arterial mediante cloruro de hierro (FeCl3) en la arteria femoral izquierda. Las ratas se asignaron equitativamente en cinco grupos: grupo 1, intervención quirúrgica simulada (sin lesión arterial); grupo 2, inyección de solución salina tamponada con fosfato (PBS); grupo 3, MSC; grupo 4, DFT; grupo 5, MSC + DFT. Todas las ratas recibieron dos inyecciones intraperitoneales de 0,5 ml: la primera se administró 4 horas después del procedimiento y la segunda 48 horas después de la primera. Se sacrificó a las ratas siete días después de la segunda inyección. Resultados. Aunque el uso por separado de MSC derivadas de médula ósea humana (hBM-MSC) o de DFT permitió una resolución parcial del trombo, la combinación de ambos tuvo como resultado la resolución casi completa. La neovascularización fue doblemente mejor en las ratas tratadas con hBM-MSC + DFT (11,6 ± 2,4 canales) en comparación con los grupos asignados por separado a hBM-MSC (3,8 ± 2,7 canales) y DFT (5,5 ± 1,8 canales) (P < 0,0001 y P= 0,002, respectivamente). Conclusión. El uso combinado de hBM-MSC y DFT en un modelo de trombosis arterial en ratas mostró que el efecto aditivo tuvo como resultado la resolución casi completa del trombo.

Background/aim. In this study, we aimed to investigate the additive effect of mesenchymal stem cells (MSC) and defibrotide (DFT) in a rat model of femoral arterial thrombosis. Methods. Thirty Sprague Dawley rats were included. An arterial thrombosis model by ferric chloride (FeCl3) was developed in the left femoral artery. The rats were equally assigned to 5 groups: Group 1-Sham-operated (without arterial injury); Group 2-Phosphate buffered saline (PBS) injected; Group 3-MSC; Group 4-DFT; Group 5-MSC + DFT. All had two intraperitoneal injections of 0.5 ml: the 1st injection was 4 h after the procedure and the 2nd one 48 h after the 1st injection. The rats were sacrificed 7 days after the 2nd injection. Results. Although the use of human bone marrow-derived (hBM) hBM-MSC or DFT alone enabled partial resolution of the thrombus, combining them resulted in near-complete resolution. Neovascularization was two-fold better in hBM-MSC + DFT treated rats (11.6 ± 2.4 channels) compared with the hBM-MSC (3.8 ± 2.7 channels) and DFT groups (5.5 ± 1.8 channels) (P < 0.0001 and P= 0.002, respectively). Conclusion. The combined use of hBM-MSC and DFT in a rat model of arterial thrombosis showed additive effect resulting in near-complete resolution of the thrombus.

Rotura y desplazamiento de catéter arterial umbilical: obstrucción arterial bilateral en un prematuro de muy bajo peso al nacer / Rupture and displacement of umbilical arterial catheter: Bilateral arterial occlusion in a very low birth weight preterm

La canalización de los vasos umbilicales es un procedimiento frecuente en las unidades de cuidados intensivos neonatales, especialmente en los recién nacidos de muy bajo peso al nacer. Raras veces el catéter arterial umbilical se rompe; los fragmentos retenidos pueden provocar trombosis, infección, embolización distal e incluso la muerte. En este artículo, describimos el caso de un recién nacido con isquemia bilateral, clínicamente significativa, de las extremidades que se manifestó después de la extracción de un catéter arterial umbilical roto. Estaba recibiendo tratamiento vasodilatador junto con fibrinolíticos y anticoagulantes. La evolución fue favorable.

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

Neurodevelopmental Evaluation of Very Low Birth Weight Infants with Sepsis at 18 to 24 Months’ Corrected Age.

In this cohort study, neurodevelopmental outcome of 20 of 24 surviving very low birth weight infants with sepsis followed-up between 2008 and 2009 was compared with 20 control (uninfected infants). We found that plasma interleukin-6 and C-reactive protein values were negatively correlated with mental developmental index scores (r= -0.33, P= 0.03 and r= -0.40, P= 0.01, respectively) at 18 to 24 months’ corrected age. The results of this study indicate that sepsis experienced in the neonatal period seems to be related to low mental developmental index scores at 18 to 24 months’ corrected age.

Neurodevelopmental Evaluation of Very Low Birth Weight Infants With Transient Hypothyroxinemia at Corrected Age of 18-24 Months.

Objective: To perform neurodevelopmental evaluation at 18 to 24 months’ corrected age in very low birth infants (VLBW) with transient hypothyroxinemia. Design: Cohort study. Setting: Maternity teaching hospital. Patients: Premature infants who were previously evaluated for thyroid hormone values in the first weeks of life were included. Intervention: Data of these infants who weighed ≤1500 g and ≤32 weeks of gestation were retrieved for the current study. Available subjects (n=56) were evaluated for neurodevelopmental status at 18 to 24 months of corrected age. Bayley Scales of Infant Development –Second Edition (BSID-II) was performed to define Mental developmental index (MDI) and Psychomotor developmental index (PDI). Results: The mean MDI and PDI scores were similar between the infants with and without transient hypothyroxinemia of prematurity (THOP) [79.9 ± 14.9 vs 70 ± 20.7, respectively (P=0.54); and 92.2 ± 16.4 vs 85.6 ± 18.9, respectively (P=0.68)]. After adjustment for gestational age and multiple prenatal, perinatal, and early and late neonatal variables, THOP was not associated with an increased risk of disabling cerebral palsy, or a reduction of MDI and PDI scores. Conclusions: THOP may not be an important cause of problems in neurologic and mental development detected at the age of 18 to 24 months’ corrected age.

Intravenous ketamine plus midazolam vs. intravenous ketamine for sedation in lumbar puncture: a randomized controlled trial.

OBJECTIVE: To compare a combined dose of ketamine and midazolam versus ketamine alone in the sedation of children requiring lumbar puncture. STUDY DESIGN: A randomized, controlled study, conducted between January 2004 and December 2006. SETTING: The Pediatric Emergency Department (PED) at Ankara Training and Research Hospital, Turkey. PARTICIPANTS: A random sample of 99 children (59 boys, 40 girls) aged 2-14 years (mean age 6.5+/-3.7) undergoing lumbar puncture. INTERVENTION: Participants were randomized to receive intravenous (IV) ketamine only (1 mg/kg; IVK) (n=51) or ketamine plus midazolam (1 mg/kg ketamine+0.1 mg/kg midazolam; IVKM) (n=48). MAIN OUTCOME MEASURES: The mean time to sedation and adverse events. RESULTS: The mean time to sedation was significantly shorter in the IVKM group than the IVK group (2.6+/-1.1 and 3.4+/-1.7 min, respectively; P=0.01). The parental satisfaction was significantly higher in the IVKM group (P=0.001). Also the fasting time and recovery time did not differ between groups, nor was there a significant difference in nausea/vomiting between groups. Nightmares or crying spells were more common in the IVK group than in the IVKM group (P=0.04). CONCLUSIONS: We conclude that adding midazolam to ketamine did not increase the frequency of adverse events and that the combined sedative was superior to ketamine alone in terms of speed of sedation and parental satisfaction.

Neu-Laxova syndrome in an appropriate for gestational age newborn.

Neu-Laxova syndrome is a rare lethal congenital disorder involving multiple systems. Intrauterine growth retardation, ichthyosis, microcephaly, abnormal facial findings, and limb contractures are its key features. We present a case of Neu-Laxova syndrome in a male appropriate for gestational age (AGA) newborn with characteristic features including ichthyosis, microcephaly, severe ectropion, rudimentary ears, eclabion, limb contractures, and hypoplastic genitalia. The patient was born at 38 weeks of gestation to consanguinous Turkish parents. The mother was a 20-year-old primi gravida with lack of prenatal follow-up. Therefore, the case was diagnosed postnatally, and he died 5 days later. Because of the autosomal recessive inheritance of Neu-Laxova syndrome, in countries with high rates of consanguineous marriage, such as Turkey, physicians have to know this syndrome, and serial prenatal ultrasound examinations with genetic counseling should be performed on pregnant women at high risk. To the best of our knowledge, this is the first case described in an AGA newborn.