Comparison of cut and intact cord milking regarding cerebral oxygenation, hemodynamic and hematological adaptation of term infants.

OBJECTIVE: Although both delayed umbilical cord clamping and intact umbilical cord milking (I-UCM) provide the effective placental transfusion at birth, these procedures may not be used in neonates needing resuscitation. The aim of this study is to investigate the effect of cut umbilical cord milking (C-UCM), which permits resuscitation during an immediate transition period (ITP). METHODS: Sixty-two healthy term infants were randomly divided into C-UCM and I-UCM groups at birth. Approximately 30-cm length of cord was milked towards the baby 2-4 times within 20 seconds after birth in both C-UCM and I-UCM groups while the umbilical cord was cut in the former, and intact in the latter. Heart rate, arterial oxygen saturation (SpO2), cerebral regional oxygen saturation (crSO2) (2nd-15th min), blood pressure (BP) (within 15-30 min), residual placental blood volume (RPBV), and hemoglobin levels (at the sixth hour) were monitored during ITP. RESULTS: There were no significant differences in terms of mean gestational age (w) [(39.0 ± 1.2) versus (38.8 ± 1.1)], birth weight (g) [(3351.45 ± 254.30) versus (3256.94 ± 285.52)], Apgar scores at the 5th min (10 ± 0 versus 10 ± 0), first breathing time (sec) (5.4 ± 3.8 versus 5.7 ± 4.1), SpO2, crSO2, BP (mmHg) [(52.9 ± 6.9) versus (51.8 ± 5.7)], hemoglobin levels (g/dl) [(17.7 ± 1.8) versus (18.4 ± 1.4)], and RPBV (ml/kg) [(23.9 ± 4.7) versus (22.9 ± 5.4)] between C-UCM and I-UCM groups (p > .05). CONCLUSION: This study showed that C-UCM is as effective as I-UCM on cerebral oxygenation, hemodynamic and hematological adaptation of term infants in ITP. We suggest that C-UCM can provide additional placental transfusion in term neonates exposed to early cord clamping.

Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society.

OBJECTIVE: To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. MATERIAL AND METHODS: A prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived. RESULTS: Data from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. CONCLUSION: The present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

Retinopathy of Prematurity in Triplets.

OBJECTIVES: To investigate the incidence, severity and risk factors of retinopathy of prematurity (ROP) in triplets. MATERIALS AND METHODS: The medical records of consecutive premature triplets who had been screened for ROP in a single maternity hospital were analyzed and presence and severity of ROP; birth weight, gender, gestational age of the infant; route of delivery and the mode of conception were recorded. RESULTS: A total of 54 triplets (40 males, 14 females) who were screened for ROP between March 2010 and February 2013 were recruited for the study. All triplets were delivered by Caesarean section and 36 (66.7%) were born following an assisted conception. During follow-up, seven (13%) of the infants developed ROP of any stage and two (3.7%) required laser photocoagulation. The mean gestational age of triplets with ROP was 27.6±1.5 (27-31) weeks whereas it was 32.0±1.5 (30-34) weeks in those without ROP (p=0.002). The mean birth weights of triplets with and without ROP were 1290.0±295.2 (970-1600) g and 1667.5±222.2 (1130-1960) g, respectively (p<0.001). The presence of ROP was not associated with gender (p=0.358) or mode of conception (p=0.674). CONCLUSION: ROP in triplets seems to be mainly related to low gestational age and low birth weight. Further prospective randomized studies are necessary to demonstrate risk factors of ROP in triplets and to determine if and how gemelarity plays a role in the development of ROP.

A newborn with widespread skin lesions and extremity anomalies.

A variety of diseases can cause vesicular or pustular eruptions in newborns. A thorough clinical history and physical exam provide important clues for differential diagnosis. Goltz syndrome, also known as focal dermal hypoplasia, is a rare genodermatosis and generally diagnosed by the presence of the characteristic skin lesions. We present an infant with aplasia cutis, atrophic skin lesions, syndactyly and eye abnormalities who was diagnosed with Goltz syndrome soon after birth. Goltz syndrome should be considered in differential diagnosis of hypoplastic or aplastic skin lesions in neonates in the presence of skeletal or ophthalmic anomalies.

Effects of phototherapy using different light sources on oxidant and antioxidant status of neonates with jaundice.

BACKGROUND/AIM: Neonates have limited antioxidant protective capacity. It has recently been demonstrated that phototherapy used for treatment of neonatal jaundice produces oxidative stress. Various phototherapy devices using different light sources are available for phototherapy. We aimed to investigate the effects of phototherapy applied with different light sources on the global oxidant/antioxidant status in neonates. METHODS: Term and late-preterm (≥35 weeks) newborn infants hospitalized to receive phototherapy for non-hemolytic jaundice in the 2-9 days of life were enrolled. Infants who received conventional phototherapy with fluorescent lamps were defined as group 1, intensive light emitting diode (LED) phototherapy as group 2, and fiberoptic phototherapy as group 3. The serum total antioxidant capacity (TAC) and total oxidant status (TOS) were measured before and 24 h after phototherapy. Oxidative stress index (OSI) was calculated. RESULTS: Twenty nine patients were included in each group. At the beginning of phototherapy serum TAC, TOS and OSI levels were similar in all groups. After phototherapy serum TAC decreased significantly in all three groups (p < 0.001). Total oxidant status increased significantly in group 1 (p < 0.001) and group 2 (p = 0.001) whereas a statistically insignificant increase was observed in group 3 (p = 0.057). After phototherapy OSI increased significantly in group 1 (p < 0.001), group 2 (p = 0.001), and group 3 (p = 0.038). CONCLUSION: As indicated by increased OSI, oxidant/antioxidant balance is disturbed in favor of oxidants after blue fluorescent light, LED and fiberoptic phototherapy.

Erythema annulare centrifugum as the presenting sign of Pseudomonas aeruginosa sepsis in a newborn.

We report a case of erythema annulare centrifugum (EAC) with neonatal onset. The patient presented on the fourth day of life with erythematous papules that enlarged centrifugally to form annular or policyclic plaques on anterior surface of trunk and legs without signs of systemic toxicity. Subsequently, she developed sepsis and disseminated intravascular coagulation and died on the sixth day of life. Blood culture grew Pseudomonas aeruginosa. The coexistence of P. aeruginosa sepsis with the clinical appearance of erythema annulare centrifugum strongly suggests a pathogenetic effect of the microorganism on the skin eruption. To the best of our knowledge, this is the first report of EAC with P. aeruginosa sepsis in a newborn.

An unusual localization of the umbilicus in a neonate.

We report the case of a male neonate with a low-set umbilicus. Physical examination revealed an appropriately grown term infant with no unusual findings, except ectopically placed umbilical cord at the level of the bladder in the hypogastric zone. The infant underwent detailed investigations that revealed no associated malformation. To the best of our knowledge, this is the first case with very distinct localization of the umbilicus without any congenital abnormalities.