Relationship between thyroid hormone levels and transient tachypnea of the newborn in late-preterm, early-term, and term infants.

PURPOSE: We aimed to investigate the association between thyroid hormone levels and transient tachypnea of the newborn (TTN) among late-preterm, early-term, and term infants admitted to neonatal intensive care unit (NICU). MATERIALS AND METHOD: In the current retrospective study, neonates admitted to the NICU due to TTN were assigned to the TTN group (n = 404). Healthy neonates who were followed up in the well-baby nursery comprised the control group (n = 7335). Infants were grouped by gestational age into late-preterm (34-366 weeks), early-term (37-386 weeks), and term subgroups (39-416 weeks). Serum levels of thyroid-stimulating hormone (TSH) and thyroxin (T4) were determined from venipuncture samples taken at least 48 hours after birth. The relationship between thyroid hormone levels and the need for NICU admission for TTN was compared between groups. RESULTS: Compared to control infants, term neonates with TTN had significantly higher TSH levels, whereas late-preterm and early-term neonates with TTN had significantly lower T4 levels. Birth weight and mode of delivery had no effect on NICU admission for TTN. CONCLUSIONS: Infants admitted to NICU due to TTN had significantly different thyroid hormone levels with differences depending on gestational age.

Evaluation of coagulation tests before newborn circumcision: is it necessary?

Evaluation of coagulation parameters prior to newborn circumcision is routinely performed in many countries. However, the value of this screening in predicting the bleeding risk is unknown. The aim of this study was to evaluate the correlation between the preoperative prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT) and excessive bleeding after the circumcision in term, healthy newborns without family history of coagulopathy. The medical records of healthy, full term newborns born at VKV American Hospital, in Istanbul, Turkey, between 2009 and 2012 who were circumcised within the first week of life, were reviewed retrospectively. The data for family history of coagulopathy, clinical sign(s) of bleeding during and/or after delivery, preoperative PT, aPTT levels and the amount of bleeding after circumcision were gathered. The most recent medical records of the patients' were also reviewed for any possible, lately diagnosed bleeding disorder. A total of 450 newborns met the above criteria. None had a family history of bleeding disorder or clinical bleeding. A total of 158 (35%) newborns had an aPTT result greater than 54.5 s, 269 (59%) had PT result greater than 15.9 s and 72 (16%) had international normalized ratio result greater than 1.62. Neither of the patients with prolonged PT and/or aPTT had prolonged or excessive bleeding. The evaluation of PT and aPTT before elective newborn circumcision is not necessary in the absence of clinical bleeding or a family history of bleeding disorder. It is rather a habit in general practice and possibly a result of defensive medicine.

Transmission of methicillin-sensitive Staphylococcus aureus to a preterm infant through breast milk.

UNLABELLED: Contrary to traditional belief, breast milk is not a sterile fluid, even in healthy women. Breast milk may contain pathogenic bacteria that could cause serious infections especially in premature infants. There is no recommendation to evaluate breast milk routinely for pathogenic bacteria. However discontinuation of breastfeeding is not recommended even the mother had mastitis, because it is believed this will not pose a risk to infant. This is the report of a premature infant born at the 32nd gestational week who was readmitted to neonatal intensive care unit with late-onset Staphylococcus aureus sepsis. While searching for the transmission route of the infection, the breast milk was assessed. Although the mother did not have any symptoms of breast inflammation, S. aureus isolates, genetically 99% similar to those from the infant blood samples, were documented in the breast milk. CONCLUSION: Breast milk may contain pathogenic bacteria, even when expressed, stored and transported properly. When evaluating the source of a S. aureus infection in preterm infants, breast milk might be the source of the infection, even if the mother has no sign of mastitis.

Investigating the effect of black tea consumption during pregnancy on the oxidant/antioxidant status of breastmilk.

OBJECTIVE: Black tea is associated with antioxidant properties. The objective of this study was to investigate the effect of the amount of black tea consumption during pregnancy on the oxidant/antioxidant status of breastmilk. SUBJECTS AND METHODS: Breastmilk was obtained from 30 mothers and analyzed for lipid peroxidation based on levels of malondialdehyde (MDA) and of reduced glutathione (GSH). In a survey completed by all participants, daily black tea consumption during the pregnancy was reported. RESULTS: No correlation was found between the amount of black tea consumed and levels of MDA (p=0.401) and/or GSH (p=0.473). The results of this study indicate that consumption of varying amounts of black tea does not affect the oxidant/antioxidant status of breastmilk. CONCLUSIONS: The insensitivity of breastmilk to antioxidant contributions by black tea reflects the capacity of breastmilk to be resistant to the myriad of factors that otherwise affect a pregnant woman.

Frequency of ABO and rhesus blood groups among neonates born at a private hospital in Istanbul.

In this study we used gel centrifugation to determine the frequency and sex distribution of ABO and Rh blood group antigens among 4,656 neonates (2,317 males, 2,339 females) born at a private hospital in Istanbul. Group A Rh+ was the most frequent blood type and AB Rh- was the least frequent. Female neonates had a higher frequency of Rh+ blood than male neonates. Group A blood was detected most frequently followed by group O, group B, and group AB. Sex was not significantly associated with blood type. These results fall within the range of previously reported blood type frequencies for Turkey. Our data allow the creation of a blood bank database for the hospital.

Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy.

Munchausen syndrome by proxy is a kind of child abuse in which affected children are often hospitalized for long periods and endure repetitive, painful and expensive diagnostic attempts. We present herein two toxicologically confirmed cases of Munchausen syndrome by proxy. Case 1 is a 16-month-old male who had fever, peripheral cyanosis, tremor, and reported cardiac arrest. Symptoms recurred in the hospital when the mother administered fluids. Toxicology detected 3.5 ng/ml mercury (Hg) in the fluid and 9.4 microg Hg/g creatinine in the urine. Case 2 is a 14-year-old female who had irregular blood findings and multiple hospitalizations. Serum analysis detected warfarin. Both mothers were transferred to psychiatric care. Munchausen syndrome by proxy should be suspected when clinical/laboratory findings are negative, illness descriptions are inconsistent, and frequent hospitalization yields no diagnosis. Psychiatric evaluation and toxicological analysis are recommended.

Umbilical cord serum erythropoietin levels and maternal smoking in pregnancy.

OBJECTIVE: To evaluate the effect of maternal smoking during pregnancy on levels of umbilical cord erythropoietin. METHODS: Erythropoietin levels were measured in umbilical cord sera of 60 newborns who were delivered vaginally at term. There were 20 (33%) smoking and 40 (67%) nonsmoking mothers. RESULTS: Mean cord serum erythropoietin levels were significantly lower in the nonsmokers (nonsmokers, 24 ± 9 IU/L; smokers, 61 ± 46 IU/L; P < .001). There was a significant positive correlation between the number of cigarettes smoked per day and cord serum erythropoietin levels (r, 0.58; P ≤ .05). CONCLUSIONS: Smoking during pregnancy is associated with increased levels of umbilical cord erythropoietin at birth. This may indicate a risk of fetal hypoxia and growth restriction. Education and encouragement of cessation of smoking during pregnancy are important to avoid associated fetal and maternal morbidity and mortality.

The relationship between mother narrative style and child memory.

BACKGROUND: The question of whether children and infants have memory capabilities similar to adults has long been of interest. Until recently, it was thought that compared to adults, infants have very limited memory processing abilities. Knowledge about factors affecting a child's memory abilities can help families (specifically mothers) behave in a manner that best benefits their children in language and memory skills. The present study examines one factor that may underlie a child's memory capabilities; namely the mother's narrative style. METHODS: Convenience sampling was used to select participants. Forty healthy children (mean age of 31.55 months, range 25-37 months) and their mothers were entered into the study. All participants were native Turkish speakers, from similar socioeconomic status backgrounds. Memory was assessed by a modified version of the Magic Shrinking Machine. Narrative style was assessed by the mother "reading" a Frog Story; a picture book with no words in it. Children were then grouped according to their mother's level of narrative style. Children's language skills were measured via the Turkish form of the CDI (Communicative Development Inventory) which was translated to Turkish as TIGE. RESULTS: To explore the relationships between mothers' narrative styles and children's memory and language skills and between children's language skills and memory capabilities, linear regressions were run. There were no significant correlations among any comparisons (P > 0.05). CONCLUSIONS: Children's language skills do not improve according to their mothers' narrative styles, and children do not show better memory abilities when mothers use more words and longer sentences. In order to have a better understanding of these relationships, future research that includes several more variables is needed. KEYWORDS: Child; Mother; Memory; Narrative style.

How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: estrogen only, betamethasone only, and combination estrogen and betamethasone.

Labial adhesion is a common finding in prepubertal girls. Traditionally, topical estrogen cream application has been the choice of conservative treatment, however, topical betamethasone treatment has also recently been employed with some success. In this retrospective study, we analysed 131 children with labial adhesions. Eleven of 71 (15.4%) patients were treated successfully with topical estrogen cream only, and 5 of 32 (15.6%) patients were treated successfully with betamethasone cream only. We successfully treated 5 of 28 (28.5%) patients with a combination of estrogen and betamethasone creams. The mean time of treatment for each regimen of therapy was 4 weeks. There was no significance between the single-therapy estrogen and single-therapy betamethasone groups (P = 1.00), between single-therapy estrogen and the combination therapy (P = .16), and the single therapy betamethasone to combination therapy (P = .35) groups. There was also no significant difference between combination estrogen and betamethasone therapy and the combined data of the single therapies (relative risk 1.85; 95% confidence interval 0.89-3.89; P =.11). For the treatment of prepubertal labial adhesions, topical estrogen and betamethasone creams were found to have similar success rates, with limited satisfactory results. The combination therapy was mildly more efficacious than each of the single therapies but was not found to be statistically significant. Surgical separation is recommended if conservative treatment fails.

Therapeutic combination of sildenafil and iloprost in a preterm neonate with pulmonary hypertension.

While new pharmacological approaches have been demonstrated to effectively manage PH in adults, few reports have addressed PH treatment in neonates and infants. This case report describes the successful management of severe PH secondary to bronchopulmonary dysplasia, respiratory syncytial virus infection, and hypoxia in a preterm 4-month-old with the long-term use of orally administered sildenafil and inhaled iloprost.

Electronic media use by children in families of high socioeconomic level and familial factors.

The aim of this research was to describe electronic media access and use among children aged 6 months to 15 years and to identify familial factors. Data was collected with a questionnaire from 724 parents of children seen in the pediatric outpatient clinic of a private hospital while they awaited examination. Questions included electronic media ownership at home or in the child's bedroom, household habits of electronic media use, educational and occupational status of parents, smoking and alcohol consumption at home, and family income. The top three electronic media devices present at home were television, computer and DVD. On a typical day, 32% of children watched television for approximately less than 1 hour, 36% for 2 hours and 22% for 3 hours. Mean television viewing time was 1.89 +/- 0.76 hours. Nearly 12% of parents spent less than 30 minutes with their children, whereas 28% spent 1 hour, and 59% more than 1 hour. Older children spent more time watching television than the younger ones. Forty-six percent of children used computer and the internet at home on a typical day. Almost 20% of children also had a television in their bedroom and spent more time watching television than those without a television in their bedroom, and the ratio increased by age (one-fifth of 3-5-year olds, one-fourth of 6-10-year-olds and half of 11-15-year-olds, on average). The present study provides data for the education and counselling of parents about the use of electronic media by children and it will contribute to increasing the awareness and sensitivity of the population by drawing attention to the subject.

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study.

BACKGROUND: Kawasaki disease (KD) is an acute, self-limiting vasculitis of unknown etiology. The incidence of KD is increasing world wide. However, the epidemiological data for KD in Turkey has not been well described. OBJECTIVE: To describe the demographic, clinical, and laboratory features of children with KD who were diagnosed and managed in the American Hospital, Istanbul, Turkey. METHOD: Patients with KD were retrospectively identified from the hospital discharge records between 2002 and 2010. Atypical cases of KD were excluded. A standardized form was used to collect demographic data, clinical information, echocardiography and laboratory results. RESULTS: Thirty-five patients with KD, with a mean age of 2.5 + 1.9 years, were identified. Eighty-five point seven per cent of patients were under 5 years of age. A seasonal pattern favouring the winter months was noticed. In addition to fever and bilateral conjunctival injection, changes in the oral cavity and lips were the most commonly detected clinical signs in our cases. Coronary artery abnormalities were detected in nine patients. The majority of our patients had started treatment with intravenous immunoglobulin in the first 10 days of the onset of fever, and only one patient required systemic steroids for intravenous immunoglobulin-resistant KD. The coronary artery abnormalities resolved in all nine patients within 8 months. CONCLUSION: This study is the most comprehensive series of children from Turkey with KD included in Medline. As adult-onset ischemic heart disease may be due to KD in childhood, further prospective clinical investigations are needed to understand the epidemiology, management and long-term follow-up of the disease.

An evaluation of children with Kawasaki disease in Istanbul: a retrospective follow-up study

BACKGROUND: Kawasaki disease (KD) is an acute, self-limiting vasculitis of unknown etiology. The incidence of KD is increasing world wide. However, the epidemiological data for KD in Turkey has not been well described. OBJECTIVE: To describe the demographic, clinical, and laboratory features of children with KD who were diagnosed and managed in the American Hospital, Istanbul, Turkey. METHOD: Patients with KD were retrospectively identified from the hospital discharge records between 2002 and 2010. Atypical cases of KD were excluded. A standardized form was used to collect demographic data, clinical information, echocardiography and laboratory results. RESULTS: Thirty-five patients with KD, with a mean age of 2.5 + 1.9 years, were identified. Eighty-five point seven per cent of patients were under 5 years of age. A seasonal pattern favouring the winter months was noticed. In addition to fever and bilateral conjunctival injection, changes in the oral cavity and lips were the most commonly detected clinical signs in our cases. Coronary artery abnormalities were detected in nine patients. The majority of our patients had started treatment with intravenous immunoglobulin in the first 10 days of the onset of fever, and only one patient required systemic steroids for intravenous immunoglobulin-resistant KD. The coronary artery abnormalities resolved in all nine patients within 8 months. CONCLUSION: This study is the most comprehensive series of children from Turkey with KD included in Medline. As adult-onset ischemic heart disease may be due to KD in childhood, further prospective clinical investigations are needed to understand the epidemiology, management and long-term follow-up of the disease.

Successful treatment of massive gastrointestinal hemorrhage in acute biphenotypic leukemia with recombinant factor VIIa (NovoSeven).

Acute biphenotypic leukemia is a very rare malignancy of childhood. Hemorrhage is a frequent complication of these patients. An 18-year-old-male with acute biphenotypic leukemia developed massive gastrointestinal bleeding that was thought to be due to thrombocytopenia during chemotherapy-induced pancytopenia and did not respond to conventional therapy. Although the prothrombin time and the partial thromboplastin time were within normal limits, inspired by the success in thrombocytopenia and platelet function disorders we decided to use recombinant activated factor VII (rFVIIa) as a last resort. After using a single dose (65 microg/kg) of rFVIIa on the fifth day of bleeding, the bleeding ceased immediately. rFVIIa may be a novel therapeutic alternative in leukemia or chemotherapy-associated massive bleeding.

Successful medical management of neutropenic enterocolitis (typhlitis) in a child with acute lymphoblastic leukemia.

We report a case of acute lymphoblastic leukemia that was complicated by neutropenic enterocolitis (typhlitis) during the initial period of remission-induction chemotherapy. The patient's clinical symptoms resolved after aggressive treatment with intravenous fluids and electrolytes, nasogastric decompression, bowel rest, total parenteral nutrition, broad-spectrum antibiotics, and granulocyte colony-stimulating factor. Netropenic enterocolitis should always be considered in neutropenic leukemic children with the triad of fever, vomiting, and abdominal pain. Gastrointestinal hemorrhage may also accompany the symptoms described above. Plain roentgenogram, ultrasonography and computed tomography of the abdomen are helpful for making the diagnosis of this clinical condition. Early recognition and proper medical management of neutropenic enterocolitis may prevent the need for surgical intervention, and/or be life-saving.

Acute Monoblastic Leukemia as a Second Malignancy After Doxorubicin and Cisplatin Treatment for Osteosarcoma.

Secondary or therapy-related acute myeloid leukemia (t-AML) occurs as a complication of various chemotherapy regimens. In pediatric age group, leukemia as a second malignancy after osteosarcoma treatment with doxorubicin and cisplatin is relatively rare. A 15-year-old girl was admitted to our hospital with signs and symptoms of leukemia. She had been treated one-year earlier with doxorubicin and cisplatin for osteosarcoma of the left femur. The patient was diagnosed with acute monoblastic leukemia on the basis of bone marrow examination and immunophenotype analysis. There were no cytogenetic abnormalities. The patient's father had been diagnosed with pelvic chondrosarcoma, which suggested a familial susceptibility to cancer. We interpreted this as a rare case of t- AML with normal cytogenetic analysis, and believe the disease was induced by the addition of platinum compounds to a regimen including topoisomerase II inhibitors.