Adrenal congestion in perinatal hypoxia: Sonographic assessment and relationship with hypoxic ischemic encephalopathy.

BACKGROUND: During hypoxia, blood flow to the brain, myocardium, and adrenal glands is preserved or even increased to maintain homeostasis. Adrenal congestion occurs when venous return remains insufficient. Several different ultrasound measurements of adrenal glands in neonates have been reported in the literature. However, there is no data related on adrenal gland size in neonates with perinatal hypoxia. AIMS: To evaluate the adrenal congestion using by ultrasound (US) measurements in perinatal hypoxia, and to reveal the relationship of adrenal congestion with hypoxic-ischemic encephalopathy (HIE) grades and magnetic resonance imaging (MRI) findings. STUDY DESIGN: Prospective cohort study. SUBJECTS: Infants with perinatal hypoxia who met therapeutic hypothermia criteria and were being cooled were included in the present study. The control group was established from healthy neonates admitted to our center during the recruitment. OUTCOME MEASURES: The gland area was measured by tracing, and both the corpus and crura widths were measured. RESULTS: We reported adrenal gland area data of 110 newborns with HIE and compared them with 56 normal neonates. The adrenal size was significantly higher in the HIE group than in the control group (p<0,01). The frequency of adrenal congestion was 72.7% based on the selected cut-off values. The adrenal gland measurements were increased in the patients with perinatal hypoxia than those of the controls. CONCLUSIONS: In the systemic evaluation of newborns with perinatal hypoxia, additional care should be taken regarding adrenal congestion. The measurement of adrenal size with 2D US will help us to diagnose or confirm adrenal congestion and possible hemorrhagic changes. The morphological data and cut-off values given in our study will be useful for neonatologists and pediatric radiologists to evaluate the patient while managing perinatal hypoxia.

The efficacy of oral motor interventions on feeding outcomes in newborns with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

BACKGROUND: Feeding difficulties continue to be a serious problem in newborns with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). The aim of this study was to investigate the efficacy of oral motor interventions (OMI) on feeding outcomes in neonates with HIE/TH. METHODS: This was a prospective randomised control study conducted between January 2022 and September 2022. Premature Infant Oral Motor Intervention (PIOMI) was used as OMI. Newborns with HIE/TH, who underwent PIOMI, constituted the study group, and newborns, who did not receive any feeding exercise, constituted the control group. Transition time to full oral feeding (FOF) was determined as the time between initiation of tube feeding and full oral breastfeeding or bottle feeding. The day per oral (PO) feeding was started was specified as PO first, the day the infants could take half of the volume of the feedings by mouth was PO half, and the day the infants could take all the feedings by mouth was PO full. RESULTS: There were 50 neonates in each group. Time to FOF was significantly shorter in the study group than in the control group in all stages of HIE/TH (P= 0.008 for stage 1, and < 0.001 for stage 2 and 3 HIE). However, times to PO first, PO half, PO full and discharge were shorter in the study group than in the control group only in the neonates with stage 3 HIE (P= 0.003, 0.014, 0.013, 0.042, respectively). CONCLUSIONS: The PIOMI, which could be named as `HIE-OMI` in our study, is an effective intervention in shortening the transition time to FOF in neonates with all stages of HIE undergoing TH. In addition, `HIEOMI` shortens the length of hospital stay, and improves feeding outcomes in neonates with severe HIE/TH.

Serum vitamin D levels in children with recurrent otitis media.

The aims of this study were to evaluate serum vitamin D levels in cases of recurrent otitis media and investigate the effect of vitamin D therapy on the risk of re-occurrence of the disease. This prospective study was performed by comparing serum vitamin D levels in children with recurrent otitis media and healthy children. Eighty-four children between 1 and 5 years of age and diagnosed with recurrent otitis media were enrolled as the study group. One hundred-and-eight healthy children with similar demographic characteristics were enrolled as the control group. Patients were divided into groups according to their serum 25(OH) vitamin D levels. In patients with low initial serum vitamin D levels, vitamin D therapy was administered in addition to conventional treatment for otitis media. Mean serum 25(OH) vitamin D level in the study group was 11.4 ± 9.8 ng/mL Serum 25(OH) vitamin D levels were below 20 ng/mL in 69 % (n = 58) of cases in this group. In the control group, mean serum 25(OH) vitamin D level was 29.2 ± 13.9 ng/mL and was below 20 ng/mL in 30 % (n = 32) of cases. Comparison of serum 25(OH) vitamin D levels and PTH in the study and control groups revealed a statistically significant difference (p < 0.05). Treatment was initiated in cases diagnosed with vitamin D deficiency, and patients were followed up in due course. The only episodes detected over the course of 1-year follow-up were one attack in five patients and two attacks in two. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as otitis media.