Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso / Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report. / Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

A Previously Healthy Premature Infant Treated With Thrombolytic Therapy for Life-threatening Pulmonary Artery Thrombosis.

Pulmonary artery thrombosis is rarely reported in preterm neonates. Although treatment of neonatal thrombosis remains controversial, thrombolytic agents must be considered when the thrombosis is life threatening. We herein present a case of a preterm newborn with pulmonary artery thrombosis accompanied by acute-onset respiratory failure and cyanotic congenital heart disease. The thrombosis was successfully treated using tissue plasminogen activator. In conclusion, the thrombolytic therapy should be considered in treatment of patients in whom the thrombosis completely occludes the pulmonary arteries.

[The role of serum interleukin-6 and C-reactive protein levels for differentiating aetiology of neonatal sepsis]. / Función de la concentración sérica de interleucina 6 y proteína C-reactiva para diferenciar la etiología de la septicemia neonatal.

INTRODUCTION: In our clinical practice, we observed high interleukin-6 (IL-6) levels in gram-negative sepsis. OBJECTIVE: To investigate the relationship between IL-6 and C-reactive protein (CRP) levels and early determination of neonatal sepsis of gram-negative or gram-positive aetiology. POPULATION AND METHODS: White blood cell count, IL-6 and CRP levels were compared among different groups. RESULTS: Gram-negative, gram-positive and fungal infection groups consisted of 73, 82 and 15 patients, respectively. The optimal cut-off levels of IL-6 between gram-negative and gram-positive fungal infection groups were 202 and 57 pg/ml. The fungal infection group had higher CRP levels than gram-negative and positive infection groups. CONCLUSIONS: To our knowledge, this is the largest reported study aiming at determining of IL-6 cut-off levels to differentiate neonatal sepsis aetiology. Gram-negative microorganisms led to 10 fold higher IL-6 production. The evaluation of IL-6 and CRP is useful to diagnose and also differentiate neonatal sepsis aetiology.

Introducción. En la práctica clínica, hemos observado una concentración elevada de interleucina 6 (IL-6) en los casos de septicemia por gramnegativos. Objetivo. Investigar la relación entre las concentraciones de IL-6 y proteína C-reactiva (PCR) y la determinación temprana de la septicemia neonatal por gramnegativos o grampositivos. Población y métodos. Se compararon el recuento de leucocitos y las concentraciones de IL-6 y PCR entre los distintos grupos. Resultados. Los grupos de infección por gramnegativos, infección por grampositivos y micosis estaban formados por 73, 82 y 15 pacientes, respectivamente. Los valores de corte ideales de IL-6 entre el grupo de infección por gramnegativos y el de infección por grampositivos y el de micosis eran 202 pg/ml y 57 pg/ml, respectivamente. En el grupo de micosis se observaron concentraciones de PCR más altas que en los grupos de infección por gramnegativos e infección por grampositivos. Conclusiones. Hasta donde sabemos, este es el estudio de mayor envergadura notificado con el objetivo de determinar los valores de corte de IL-6 para diferenciar la etiología de la septicemia neonatal. Los microorganismos gramnegativos provocaron una producción de IL-6 diez veces mayor. La evaluación de IL-6 y PCR resulta útil para diagnosticar, y asimismo diferenciar, la etiología de la septicemia neonatal

Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit.

BACKGROUND: Retinopathy of prematurity (ROP) is a significant cause of childhood blindness. AIM: The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU). PATIENTS AND METHODS: Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia. RESULTS: We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 µg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time. CONCLUSIONS: Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists.

Reference values of serum cystatin C in very low-birthweight premature infants.

AIM: To determine reference values for cystatin C (CysC) and its correlation with creatinine (Cr), gestational age, birthweight and maternal Cr status in very low-birthweight (VLBW) preterm infants. METHOD: The study included 113 VLBW premature infants (<1500 g) of ≤ 32 gestational week. Serum Cr and CysC of the infant and serum Cr of the mother were analysed. RESULTS: The mean level of CysC was 1.77 ± 0.38 mg/L on day 1 and 1.61 ± 0.37 mg/L on day 3, and the decrease was statistically significant. There was a significant correlation only between maternal Cr and first-day Cr values and negative correlations between Cr and gestational age and birthweight on third day. Creatinine was not correlated with CysC both on day 1 (r = -0.077, p = 0.417) and day 3 (r = 0.132, p = 0.164). CONCLUSION: Here, we report the reference ranges for CysC and Cr on first and third day in VLBW infants. CysC concentrations significantly decrease by day 3 compared with day 1 and are independent of gestational week, birthweight and maternal renal function status in VLBW preterm infants.

Effects of different pulmonary surfactants in the prevention of postoperative intraabdominal adhesion formation.

BACKGROUND: After abdominal surgery, the formation of postoperative adhesion is a serious problem. The aim of the study is to evaluate the efficacy of 2 different pulmonary surfactants, poractant and beractant, on adhesion prevention in an experimental model. MATERIALS AND METHODS: An experimental intraabdominal adhesion model was created in 18 adult female rats by cecal abrasion. The rats were randomly assigned to 3 groups. Group I received no further treatment, whereas groups II and III received intraperitoneal poractant and beractant, respectively, before closing the incision. On the 15th postoperative day, all rats underwent relaparotomy, intraabdominal adhesions were scored macroscopically according to Canbaz scoring system, and the cecum in each animal was evaluated microscopically. RESULTS: The median adhesion scores of group II and III rats were significantly lower when compared with group I (P = .02). Group III had a lower median adhesion score than did group II, but this did not reach significance (P > .05). CONCLUSION: These observations suggest that intraperitoneal instillation of both pulmonary surfactants is associated with lower adhesion scores, higher adhesion-free cases, and improved histologic findings.

Automated determination of neutrophil VCS parameters in diagnosis and treatment efficacy of neonatal sepsis.

INTRODUCTION: The Coulter LH780 hematology analyzer can evaluate mean neutrophil volume (MNV), conductivity (MNC), scatter (MNS), and distribution width (DW). We sought to investigate the value of volume, conductivity, and scatter (VCS) parameters in diagnosis and treatment efficacy of neonatal sepsis. RESULTS: We observed significant increases in MNV, volume distribution width (VDW), conductivity distribution width (CDW), and significant decreases in MNC and MNS in septic newborns. There were significant decreases in MNV, VDW, and CDW, whereas MNC and MNS increased at the end of the treatment. Gram-negative sepsis caused higher MNV and VDW than Gram-positive sepsis. DISCUSSION: This is the largest reported study seeking to determine cutoff levels of neutrophil VCS parameters in diagnosis of sepsis, and the first study in the evaluation of treatment efficacy and the effects of sepsis onset time and birth weight. We suggest that neutrophil VCS parameters and their DWs are useful both for early diagnosis and evaluation of treatment efficacy in neonatal sepsis without requirement for any extra blood collection. METHODS: Peripheral blood samples from 304 newborns, 206 in group I (76 proven and 130 clinical sepsis) and 98 in group II (control group), were studied on diagnosis, 3rd day, and at the end of the treatment.

Rare clinical entity Perlman syndrome: is cholestasis a new finding?

Perlman syndrome is a rare syndrome characterized by polyhydramnios, fetal overgrowth, facial dysmorphism, visceromegaly, nephroblastomatosis and predisposition to Wilms tumor. Here we report on a newborn with a prenatal history of polyhydramnios who presented with nephromegaly, hypotonia, macrosomia, facial dysmorphism, cholestasis and characteristic ultrasonographic and computed tomographic appearances of renal abnormalities that are observed with Perlman syndrome. Perlman syndrome is a rare entity with a high neonatal mortality rate. This is the first case in which cholestasis has been observed. Close follow-up should be carried out for early detection of Wilms tumor.

Comparison of total oxidant/antioxidant status in unconjugated hyperbilirubinemia of newborn before and after conventional and LED phototherapy: A prospective randomized controlled trial.

PURPOSE: We evaluated and compared the oxidant and antioxidant status of hyperbilirubinemic infants before and after the two forms of phototherapy: conventional and LED phototherapy, in order to identify the optimal treatment method. METHOD: Thirty newborns exposed to conventional (Group I) phototherapy and 30 infants exposed to LED phototherapy (Group II) were studied. The serum total antioxidant capacity (TAC) and the total oxidant status (TOS) were assessed by EREL's method. RESULTS: There were no statistically significant differences in TAC or TOS levels between Group I and Group II prior to phototherapy, and no statistically significant difference in TAC levels between the two groups after phototherapy; however, TOS levels were significantly lower in Group II compared to Group I after phototherapy. Oxidative stress index (OSI) increased after conventional phototherapy (p < 0.05) CONCLUSION: The increase in TOS following conventional phototherapy was not not observed following LED phototherapy. This difference should be considered when using phototherapy.