The Effects of Thyroid Hormone Levels on Patent Ductus Arteriosus Closure in Newborns.

Objective: Although the role of thyroid hormones in functional and anatomical closure of patent ductus arteriosus (PDA) is well known, their effects on the medical or surgical closure of PDA in newborns remain unclear. This study aimed to assess the correlation between thyroid function tests and PDA closure through medical or surgical interventions in newborns. Methods: This retrospective study was conducted on 65 newborns diagnosed with hemodynamically significant PDA (hs-PDA), with a premature rate of 81.5% (n=53). The subjects were divided into two groups according to the nature of the ductal closure as medically responsive "MR-PDA" or surgically treated "ST-PDA". The groups were compared in terms of thyroid hormone levels and other clinical parameters. Results: Thirty-three (51%) of all 65 patients had PDA and responded to medical treatment. Gestational week, birth weight, and mode of delivery were similar between the medical and surgical treatment groups (p>0.05). Free thyroxine levels were significantly lower in the MR-PDA group than in the ST-PDA group (p=0.01). Conclusions: Because hs-PDA is associated with increased morbidity and mortality in the neonatal period, especially in premature infants, we hypothesize that thyroid hormone levels may play a role in the closure of hs-PDA.

Efficiency of Lung Ultrasonography in the Diagnosis and Follow-up of Viral Pneumonia in Newborn.

OBJECTIVE: Lung ultrasonography (LUS) is a useful method for diagnosis of lung diseases such as respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax in the neonatal period. LUS has become an important tool in the diagnosis and follow-up of lung diseases. LUS is easy to apply at the bedside and is a practical and low-cost method for diagnosing pneumonia. STUDY DESIGN: This study was conducted in neonatal intensive care unit of Dr. Sami Ulus Obstetrics, Children's Health and Diseases Training and Research Hospital. From September 2019 to April 2020, 50 patients who were diagnosed with viral pneumonia were included in the study. Also, 24 patients with sepsis-related respiratory failure were included in the study as a control group. LUS was performed at the bedside three times, by a single expert, once each before treatment for diagnosis, on discharge, and after discharge in outpatient clinic control. RESULTS: Before treatment, LUS findings were lung consolidation with air bronchograms (50/50), pleural line abnormalities (35/50), B-pattern (25/50), disappearance of lung sliding (21/50), lung pulse (5/50), and pleural effusion (9/50). During discharge, we found significant changes: lung consolidation with air bronchograms (6/50), pleural line abnormalities (7/50), B-pattern (12/50), and pleural effusion (1/50) (p < 0.05). Outpatient clinic control LUS findings were lung consolidation with air bronchograms (0/50), pleural line abnormalities (0/50), B-pattern (0/50), disappearance of lung sliding (0/50), and pleural effusion (0/50) (p < 0.05). Also, B-pattern image, disappearance of lung sliding, and pleural line abnormalities were higher in control group (p < 0.05). CONCLUSION: Ultrasound gives no hazard, and the application of bedside ultrasonography is comfortable for the patients. Pneumonia is a serious infection in the neonatal period. Repeated chest radiography may be required depending on the clinical condition of the patient with pneumonia. This study focuses on adequacy of LUS in neonatal pneumonia. KEY POINTS: · Lung ultrasound is a practical and low-cost method in diagnosing pneumonia.. · Neonatal pneumonia is a very important cause of morbidity and mortality in NICU.. · We can evaluate neonatal pneumonia with combination of clinical presentations and LUS findings..

Thiol-Disulfide Homeostasis in Neonatal Patients with Urinary Tract Infection.

OBJECTIVE: Urinary tract infection (UTI) is a disease that can cause significant complications in the neonatal period. The thiol-disulfide homeostasis is one of the important antioxidant defense mechanisms. The purpose of this study is to show the relationship between UTI and thiol-disulfide homeostasis in newborns. STUDY DESIGN: In this prospective study, 40 newborns with UTI and 40 healthy controls were included. Thiol-disulfide tests (disulfide, native thiol, and total thiol levels) and septic screening tests were performed before and after antibiotherapy in UTI group. The control group was selected from healthy newborns who applied to the outpatient clinic. RESULTS: The C-reactive protein and interleukin-6 levels were higher, while native thiol and native thiol/total thiol ratio were significantly lower in pretreatment group compared with posttreatment and control group. Also, the levels of disulfide, ischemia modified albumin, disulfide/native thiol ratio, and disulfide/total thiol ratio were higher in pretreatment group compared with posttreatment group. CONCLUSION: The thiol-disulfide homeostasis is an important indicator of oxidative stress during infections. It is valuable to be detected with small amounts of serum in newborns. These molecules can be used to support the diagnosis of UTI in the newborn. Further studies are needed to define the role of thiol-disulfide homeostasis in the UTI of newborn. KEY POINTS: · The thiol-disulfide homeostasis can be an important indicator of oxidative stress during infections such as UTI.. · The thiol-disulfide homeostasis of newborn is valuable to be detected with small amounts of serum in neonatal period.. · Laboratory tests such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are not significantly different in UTIs..

Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants.

BACKGROUND: The use of non-invasive ventilation methods in neonatal intensive care units has been increasing in recent years. Non-invasive ventilation techniques are lung preserving methods and they reduce the risk of volutrauma, barotrauma, and atelectotrauma. METHODS: The effect of heated humidified high-flow nasal cannula (HHHFNC), continuous positive airway pressure (CPAP), nasal intermittent positive-pressure ventilation (NIPPV), and nasal high-frequency oscillation ventilation (NHFOV) were compared in preterm infants with respiratory distress. RESULTS: Between December 2015 and February 2017, a total of 76 preterm infants (gestational age < 32 weeks) with respiratory distress were enrolled in this study. Of the patients, 20 received HHHFNC, while 20 received nasal CPAP (NCPAP), 19 received NIPPV, and 17 received NHFOV for respiratory support. The primary outcome was intubation requirement during non-invasive respiratory support. The secondary outcome included duration of non-invasive ventilation, air leak syndrome, abdominal distension, intraventricular hemorrhage, necrotizing enterocolitis (NEC), nasal injury, increased secretions, agitation, and mortality rate. The intubation ratio was higher in the NCPAP (40%) and NHFOV (29.4%) groups when compared with the NIPPV (10.5%) and HHHFNC (11.8%) groups. More nasal injury had developed in the NIPPV (78.9%) and NHFOV (82.4%) groups when compared with the NCPAP (40%) and HHHFNC (35%) groups. Moreover, the viscous secretion that blocked the cannulas was higher in NIPPV (78.9%) and NHFOV (76.5%) groups than NCPAP (25%) and HHHFNC (40%) groups. There were no significant differences in the duration of non-invasive ventilation methods, abdominal distension, NEC, air leak syndrome or mortality in the 4 groups. CONCLUSIONS: The NIPPV and HHHFNC methods can be useful as a primary mode of respiratory support for respiratory distress. However, doctors need to be careful with regard to the complications that may develop.

Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns.

Objectives: Lung ultrasonography has become an important tool in the diagnosis and follow-up of lung diseases in the newborn period in recent years. Lung diseases such as pneumonia, transient tachypnea of the newborn and respiratory distress syndrome (RDS) can be diagnosed with lung ultrasound. Lung USG is a simple, practical and low-cost method in diagnosing neonatal RDS.Methods: This study was performed in Hacettepe University Neonatal Intensive Care Unit From December 2015 to February 2017. Forty patients who were diagnosed as RDS and given surfactant [200 mg/kg poractant alfa (CUROSURF®, Chiesi, Italy) intratracheal Suspension] were included in the study. Lung ultrasonography was performed at the bedside by a single expert, once before surfactant treatment and three times after surfactant treatment. Post-treatment ultrasonographic examinations were carried out at 2, 4 and 6 h after surfactant treatment.Results: Before surfactant treatment, lung USG findings of patients were as follows: lung consolidation with air bronchograms (40/40), B-pattern (36/40), pleural line abnormalities (37/40), severe B-pattern (12/40) and disappearance of A-lines in all USG of patients. In the second hour of treatment, we did not see any valuable change or difference in lung USG findings of patients. The only change was the disappearance of air bronchograms and lung consolidation in five patients. Four hours after treatment we saw a reduction in lung consolidation in 14 patients, B-pattern had decreased in 15 patients, the appearance of A-lines and spared areas. But after 6 h, we started to see A-lines clearly, loss of B-pattern, an appearance of pleural line, and lung sliding in nearly all patients except three.Conclusion: Ultrasound is nonionizing and gives no hazard to the patient. Also, making it bedside is feasible and comfortable than other methods. Responsive and unresponsive patients to surfactant treatment can be determined in the early course of the disease and the cases needing re-treatment can be diagnosed easily by performing lung USG. This review focuses on ultrasonographic changes of the lung after surfactant treatment in premature newborns.

Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome.

INTRODUCTION: Lung ultrasonography (LUS) is a noninvasive bed-side test and increasingly used by clinicians in the management and follow-up of respiratory distress syndrome (RDS) in premature infants. OBJECTIVE: To compare the results of three natural surfactants according to LUS scores in premature infants with RDS. METHODS: This was a prospective study on 62 preterm infants (25-34 weeks) with RDS and receiving surfactant according to 2016 European guidelines. All patients underwent a clinical evaluation and chest X-ray at three study points; at the first hours of life (presurfactant), and at 6-12th hour (early postsurfactant) and 24th hour (late postsurfactant) of surfactant. Simultaneously fractional inspired oxygen (FiO2) need, arterial PaO2 values, Downes and LUS scores were noted. The patients were randomized into three groups; Group 1 (n = 23), poractant alpha; Group 2 (n = 20), beractant; and Group 3 (n = 19), calfactant. The groups were compared according to clinical, laboratory and radiological variables as well as LUS scores. RESULTS: Gestational age (p = .05), birthweight (p = .07), and SNAPPE-II scores (p = .57) were similar in three groups. Repeated dose need was the highest in Group 3 (p = .04). FiO2 need (p = .04) was the highest and PaO2 values (p = .03) were the lowest at late postsurfactant point in the same group. LUS scores were also the highest in Group 3 at this period (p = .02). Downes scores were similar in groups at all points (p > .05). NICU stay were similar in groups (p = .53). The durations of total oxygen supplementation, mechanical ventilation, and hospital stay were the same in groups (p > .05). CONCLUSIONS: In newborns with RDS, poractant alpha and beractant have similarly reduced oxygen need in accordance to the LUS findings. However, they seem to be superior compared to calfactant.

The clinical and radiological course of bronchopulmonary dysplasia in twins treated with mesenchymal stem cells and followed up using lung ultrasonography.

Bronchopulmonary dysplasia is a chronic lung disease that develops in low-birth-weight infants as a result of mechanical ventilation and oxygen toxicity in the early neonatal period. In these patients, mechanical ventilation and oxygen support are needed for a long time. We already use antenatal steroid, ventilation techniques with minimal baro/volutrauma, postnatal steroid, and vitamin A to prevent the development of bronchopulmonary dysplasia. Mesenchymal stem cell treatment is another way to reduce or stop the pathophysiologic pathways in the development of bronchopulmonary dysplasia. Herein, we present mesenchymal stem cell treatment and its outcomes in twins who were born with a gestational age of 26 weeks and diagnosed as having bronchopulmonary dysplasia (the female twin was born with a birth weight of 750 g and the male twin was born with a birth weight of 930 g). These patients were followed up with clinical findings, chest radiography, and lung ultrasonography.

Congenital heart defects: the 10-year experience at a single center.

Objective: We aimed to evaluate congenital heart disease (CHD) cases according to EUROCAT subgroup classification that were diagnosed during the prenatal period in our center.Methods: CHDs that were prenatally diagnosed using ultrasonography and confirmed by fetal echocardiography were reviewed over a 10-year period. Subgroup classification was finalized at the post-partum period in terms of the EUROCAT guide 1.3. Congenital heart defect subtypes and obstetric outcomes (gestational week at delivery, birth weight, gender, extracardiac structural abnormalities, karyotype results if performed) were analyzed.Results: The data of 180 cases with CHD were examined. Left ventricular outflow tract obstruction (LVOT) was the most common CHD subtype (57/180; 31.6%), which included 48, five, and four cases of hypoplastic left heart syndrome (HLHS), coarctation of the aorta, and aortic valve atresia/stenosis, respectively. Eighteen pregnancies were terminated; the most common CHD subtype among patients of terminated pregnancies was hypoplastic left heart syndrome (HLHS) (n = 7, 38.8%). The most common extracardiac malformations were a single umbilical artery, esophageal atresia, and situs inversus in our study group. Eighteen of the 96 (18.75%) neonates with CHD died during the neonatal period. The most common CHD subtype was HLHS (7/18; 38%) among the newborns who died after birth.Conclusion: Prenatal diagnosis of a CHD and subgroup classification is very important for clinical decision making, including prenatal management, recommendations for termination of the pregnancy, postnatal management of the patient, and for early referral to pediatric cardiology and cardiovascular surgery centers.

Influence of defect locations and nitrogen doping configurations on the mechanical properties of armchair graphene nanoribbons.

The effect of defect locations on the mechanical properties of armchair graphene nanoribbons (AGNRs) and the various configurations of nitrogen (N) doping on the mechanical properties of AGNRs were examined using molecular dynamics (MD) simulations. The variation of the Young's modulus (YM) and the ultimate tensile strength (UTS) of pyridinic-N, graphitic-N, and pyrrolic-N by increasing the concentration of N doping was investigated. The results of MD simulations show that the defect location has a significant effect on the UTS and failure strain (FS) of AGNRs in both vertical and horizontal directions. In the horizontal direction, variations of the UTS and FS are lower than in the vertical direction. On the other hand, the variations of the YM is almost similar in vertical and horizontal directions. The results of this work indicate that the UTS and FS of AGNRs are more sensitive than the YM of AGNRs for different defect directions. Pyridinic-N improves the mechanical properties of the defective AGNR and performs better YM and UTS values than the graphitic-N. Substitution N atoms, which are located at the defective sites and/or at the edges of AGNRs, are mechanically more favorable. Pyrrolic-N configuration has the lowest mechanical properties among the other configurations. Furthermore, pyrrolic-N with Stone-Wales-1 (SW-1) type of defect has higher mechanical properties than pyrrolic-N with Stone-Wales-2 (SW-2) type of defect.

Effects of the nitrogen doping configuration and site on the thermal conductivity of defective armchair graphene nanoribbons.

The influence of the nitrogen (N) doping configuration on the thermal conductivity (TC) of armchair graphene nanoribbons (AGNRs) of size 15.7 nm × 7.26 nm was investigated using classical molecular dynamics (MD) simulations with the optimized Tersoff potential at room temperature. The effect of changing the N-doping site in defects on the TC of AGNRs was also investigated in detail. The variations with N concentration of the TCs of AGNRs presenting graphitic N (quarternary N), pyridinic N, and pyrrolic N doping configurations were studied. Results of MD simulations showed that, among these three doping configurations, pyridinic N was associated with the highest TC, and pyrrolic N with the lowest TC. The highest TC values were obtained when the N dopant atoms were located at the edges and at defects in the AGNR. The presence of both pyrrolic N and Stone-Wales type 1 (SW-1) defects led to a higher TC than the presence of both pyrrolic N and SW-2 defects. Phonon-defect scattering was found to be influenced by changes in C-C bond orientation. SW-1 defects were found to exert a greater influence on the TC than graphitic N doping. Furthermore, the influence on the TC of the N-doping site location in SW-1 defects was examined. Doping the central sites of SW-1 defects was found to yield higher TC values than doping the edge sites of defects. Graphitic-N doping of the more central sites in a SW-1 defect led to a higher TC than the random graphitic-N doping of sites in a SW-1 defect.

Management and outcomes of cystic hygromas: experience of a tertiary center.

PURPOSE: Cystic hygroma (CH) is a fetal sonographic finding with an incidence of 1%. Chromosomal abnormalities and structural malformations are commonly related with CH. We aimed to describe our experience and determine the association between diagnosis of CH and adverse pregnancy outcome. METHODS: We retrospectively reviewed data of prenatal CH diagnoses over a ten-year period. Cases were evaluated for maternal age, gestational week at CH diagnosis, invasive procedure, karyotype result, associated abnormality and perinatal outcome. We categorized cases into two groups to understand the impact of maternal age on perinatal outcomes, and the cut-off was 35 years old. RESULTS: Totally 28 individuals were enrolled in the study. The median maternal age at birth was 27.5 years old, and 7 patients were over 35 years old. Karyotype results were available for all individuals, and 15 had an abnormal chromosome (53.5%). Five fetuses had structural abnormalities, and they were all observed within patients under 35 years old. Healthy fetuses (without any problem at antenatal screening and birth) were found to be only 14.3% in advanced maternal age (AMA) group and 33.3% in young mothers. CONCLUSIONS: Women with AMA and CH had a higher risk of having a baby with a chromosomal abnormality, as compared with younger women.