Follow-Up of Low Birth Weight Preterm Infants After Hospital Discharge: Incidence and Reasons for Rehospitalization.

OBJECTIVES: The rehospitalization frequency/indications of low birth weight (LBW) preterms and the effect of rehospitalization on growth and neurodevelopment were investigated. METHODS: LBW preterms discharged from NICU were prospectively followed until the corrected age of 1 year. Infants rehospitalized after discharge were defined as the study group and those not rehospitalized as the control group. The frequency, duration and etiology of rehospitalization were investigated and the effects of neonatal complications, surgery and socio-demographic status on rehospitalization were assessed. RESULTS: The study and the control group included 113 and 217 infants, respectively. Infants in the study group were rehospitalized 247 times in total. Rehospitalization was significantly higher in the male gender (39.7% vs. 28.9%, p < 0.05). Hyperbilirubinemia-anemia, anemia-surgery and pulmonary-other infections were the most common indications for rehospitalization in the 0-14 days, 15 days to 2 months and 2-12 months, respectively. Intrauterine growth had no impact on rehospitalization. Somatic growth and neurodevelopment were significantly delayed in the study group (p < 0.05). CONCLUSION: Birth weight and gestational week are the most important determinants of rehospitalization. Rehospitalized preterm infants have significant deficits in both somatic growth and neurodevelopment despite high-quality follow-up care.

Bronchopulmonary dysplasia frequency and risk factors in very low birth weight infants: A 3-year retrospective study.

OBJECTIVE: In this study, the relationship between the frequency of bronchopulmonary dysplasia, perinatal risk factors and other prematurity comorbidities were evaluated in very low birth weight infants. METHODS: A total of 872 very low birth weight infants' files were retrospectively reviewed. The effects of the clinical parameters, such as type of birth, small for gestational age, gender, antenatal steroids, early membrane rupture, chorioamnionitis, surfactant administration, respiratory distress syndrome, patent ductus arteriosus, apnea, early and late sepsis on the frequency of bronchopulmonary dysplasia, were evaluated by binary logistic regression analysis. RESULTS: The overall mortality rate was 20.9%. After the first 28-day mortality reduction, the total bronchopulmonary dysplasia frequency was found to be 20.1%. The odds ratio and 95% confidence intervals of the factors affecting the development of bronchopulmonary dysplasia were found to be as follows respectively: respiratory distress syndrome (OR 6.2, 95% CI 3.6-10.6, p<0.01), patent ductus arteriosus (OR 4.9, 95% Cl 2.4-9.9, p<0.01), apnea (OR 4.1, 95% CI 2.5-6.9, p<0.01), late sepsis (OR 2.7, 95% CI 1.6-4.5, p<0.01), early membrane rupture (OR 2.6, 95% Cl 1.2-5.5, p=0.01), and male gender (OR 1.6, 95% CI 1.0-2.7, p=0.04) was found. However, there was no effect of chorioamnionitis, antenatal steroids, small for gestational age, early sepsis and type of birth on bronchopulmonary dysplasia. CONCLUSION: Differently from the usual factors which are low birth weight and a gestational week, there was a significant but non-linear risk relationship between respiratory distress syndrome, patent ductus arteriosus, late sepsis, apnea, early membrane rupture, male gender and bronchopulmonary dysplasia.

Assesment of perinatal mortality in two different periods: results of a single center.

AIM: This study aimed to investigate the perinatal mortality rate with 37 864 deliveries which occured in two different periods in a single center, to compare the components of perinatal mortality and affecting factors with the results of the study related with perinatal mortality which we conducted in 1999 and to emphasize the precautions directed to reduce mortality rates. MATERIAL AND METHODS: All live births and stillbirths which occurred in Bakirköy Obstetrics and Pediatrics Training and Research Hospital between January 2007 and December 2007 were evaluated. The results were compared with the results of the study conducted in 1999. Newborns with a weight above five hundred grams and a gestational age above 22 weeks were enrolled in the study. The stillbirth rate, early neonatal mortality rate, late neonatal mortality rate, perinatal mortality rate and corrected perinatal mortality rate were calculated. Modified Wigglesworth Classification was used for evaluating the perinatal mortality and the subjects were examined in 7 groups. The characteristics belonging to the years of 2007 and 1999 were examined, the differences were recorded and the results were discussed. When the two periods were compared, it was observed that the perinatal mortality rate increased from 23.5‰ to 26‰. RESULT: When the causes were investigated, it was observed that the stillbirth rate was increased in 2007 (84%) and especially congenital anomalies had an important role in this increment. The early neonatal mortality rate declined from 0.8% in 1999 to 0.4% in 2007. It was found that especially the premature mortality rate (Group 3) and the mortality rate related with perinatal asphyxia (Group 4) were significantly decreased. CONCLUSION: The decrease in early neonatal mortality rate could be best explained by productive operation of the new neonatal intensive care unit which had been established after 2002.

Regression of Cardiac Rhabdomyomas in a Neonate after Everolimus Treatment.

Cardiac rhabdomyoma often shows spontaneous regression and usually requires only close follow-up. However, patients with symptomatic inoperable rhabdomyomas may be candidates for everolimus treatment. Our patient had multiple inoperable cardiac rhabdomyomas causing serious left ventricle outflow-tract obstruction that showed a dramatic reduction in the size after everolimus therapy, a mammalian target of rapamycin (mTOR) inhibitor. After discontinuation of therapy, an increase in the diameter of masses occurred and everolimus was restarted. After 6 months of treatment, rhabdomyomas decreased in size and therapy was stopped. In conclusion, everolimus could be a possible novel therapy for neonates with clinically significant rhabdomyomas.

Significance of silent carditis and investigation of follow-up signs in acute rheumatic fever.

AIM: This study aimed to demonstrate the importance of ECHO in the diagnosis and long-term follow-up of silent carditis. MATERIAL & METHODS: This study included 182 (157 arthritis; 25 chorea) patients out of 214 patients who had been diagnosed with acute rheumatic fever for the first time. All of the patients were scanned with ECHO between specific intervals. RESULTS: While there was no recovery observed in isolated aortic insufficiency during long-term follow-up, recovery in isolated mitral insufficiency was found. As the follow-up time of the mitral and aortic insufficiencies became longer, there was an increase in recovery in aortic insufficiency. CONCLUSION: Follow-up results of silent carditis support that ECHO should be among the major criteria used to diagnose rheumatic carditis.

Neurodevelopment of preterm infants born after in vitro fertilization and spontaneous multiple pregnancy.

BACKGROUND: The aim of this study was to compare perinatal, neonatal characteristics and neurodevelopmental prognosis of preterm infants born after in vitro fertilization (IVF) and spontaneous multiple pregnancy, and to evaluate the factors affecting neurodevelopmental outcome at 24-36 months. METHODS: A total of 125 preterm infants, 65 from spontaneous and 60 from IVF multiple pregnancy were evaluated in terms of neurodevelopmental outcome at the age of 24-36 months. Mean maternal age, chronic maternal disease, birthweight, gestational week, gender, APGAR score, neonatal intensive care unit admission, presence of congenital anomalies, referral to follow up, rehospitalization and socioeconomic status were investigated. Gross Motor Function Classification System and Denver II Developmental Screening Test were carried out. Local ethics committee approved the study (12.10.2010; no: 305). RESULTS: Mean maternal age, chronic maternal illness, pregnancy-related diseases, 5 min APGAR score, rate of cesarean delivery and referral to follow up were significantly higher in the IVF group (P < 0.05). Neurological examination identified increased muscle tone in two children (1.6%); only one infant in the IVF group had cerebral palsy. A total of 26 subjects (20.8%; spontaneous group, n =17, 26.2%; IVF group, n = 9, 15%) had abnormal Denver II findings, mostly in language (8.8%) and personal-social (8.0%) development. CONCLUSION: Morbidity, length of hospitalization and neurodevelopmental outcome of preterm infants born after spontaneous and IVF multiple pregnancy are similar. Delays in language and personal-social development were the most common neurodevelopmental abnormalities. Even within similar socioeconomic status, parents in the IVF group were more compliant with follow up.

School Performance and Neurodevelopment of Very Low Birth Weight Preterm Infants: First Report From Turkey.

Very low birth weight preterm infants are under significant risk of neurologic, developmental, and somatic problems. In this study, 90 infants born with a birth weight <1500 g and/or with a gestational age <32 weeks were evaluated after the first year of elementary school to assess neurodevelopment. The Wechsler Intelligence Scale for Children-Revised (WISC-R) test, Pediatric Symptom Checklist, and Parent Evaluation of Developmental Status were performed. Mental retardation, cerebral palsy, blindness, epilepsy, and posthemorrhagic hydrocephaly incidences were 14%, 7%, 2%, 5%, and 2%, respectively. The WISC-R score of 32 patients (35.5%) were below 85. Perinatal asphyxia, abnormal neurologic examination, and delayed or impaired speech correlated significantly with low WISC-R scores. Education and income of the father had positive impact on WISC-R scores (P = .042 and P = .026). Parents' concern and presence of cognitive problems were correlated (P = .026). Environmental factors, as well as the prevention of morbidity, affected school performance positively.

Assessment of the place of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity.

AIM: In this study, we aimed to investigate the utility of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity in addition to biochemical markers. MATERIALS AND METHOD: Premature babies with a gestational age of ≤32 weeks and/or a birth weight of ≤1 500 g who were hospitalized in the neonatal intensive care unit between June 2009 and March 2011 were included in the study. These babies were evaluated at the 40th gestational week and serum calcium, phosphorus, alkaline phosphatase, urea, creatinine, urinary calcium and phosphorus levels were measured and tubular reabsorption of phosphorus was determined. The subjects who had bone graphy findings and/or an alkaline phosphatase level of >400IU/L and a phosphorus value of <3.5 mg/dL were considered osteopenic. The levels of tubular reabsorption of phosphorus of the osteopenic patients were compared with the ones of the non-osteopenic patients. The study was initiated after obtaining ethics committee approval (date: 04.29.2009/213). RESULTS: During the study period, a total of 698 premature babies were hospitalized in our neonatology unit. A diagnosis of osteopenia of prematurity was made in 24 of 190 subjects who met the study criteria. The level of tubular reabsorption of phosphorus was compared with the serum calcium, phosphorus and alkaline phosphatase levels measured at the 40th gestational week and alkaline phosphatase was found to be significantly increased in the group with a high tubular reabsorption of phosphorus (≥%95). When the subjects with a phosphorus level of <3.5 mg/dL and an alkaline phosphatase level of >499 IU were compared with the newborns who were found to have a tubular reabsorption of phosphorus of ≥%95 for the objective of evaluating the specificity and sensitivity of tubular reabsorption of phosphorus, the sensitivity, specificity, positive predictive value and negative predictive value of tubular reabsorption of phosphorus in the diagnosis of osteopenia were found to be 27%, 82%, 17% and 89%, respectively. When the osteopenic and non-osteopenic patients were compared in terms of the levels of tubular reabsorption of phosphorus, no statistically significant difference was found. CONCLUSIONS: It was thought that it was not appropriate to use tubular reabsorption of phosphorus alone in the diagnosis of osteopenia of prematurity.

Diagnostic value of elevated CXCR4 and CXCL12 in neonatal sepsis.

OBJECTIVE: Neonatal sepsis remains a major cause of morbidity and mortality in newborns. The chemokine CXCL12 and its receptor CXCR4 are now known to play an important role in inflammatory states. However, it is unclear how chemokines respond to late-onset neonatal sepsis. METHODS: Patients were classified into the groups of septic and non-septic ones. Samples of venous blood were obtained from all septic and non-septic newborns at the beginning and within 48-72 h after initiation of treatment. Serum levels of CXCR4 and CXCL12 were measured. RESULTS: Concentrations of IL-6, CXCR4 and CXCL12 at the time of diagnosis were significantly higher in the septic neonates compared with the non-septic ones. Additionally, there were statistically significant differences in septic neonates between the first and the second levels of IL-6, CXCR4, CXCL12 and I/T ratio. ROC curve analyses revealed that IL-6, CXCR4, CXCL12 and I/T ratio resulted in significant AUC with respect to early identification of septic neonates. Univariate logistic regression analysis showed that increased IL-6, CXCR4 and CXCL12 were strong predictors of neonatal LOS. CONCLUSIONS: Serum CXCR4 and CXCL12 levels increase in septic neonates and that both chemokines decrease within 48-72 h of treatment. Serum concentrations of both chemokines represent promising novel biomarkers for neonatal sepsis.

Familial mediterranean Fever: diagnosing as early as 3 months of age.

Familial Mediterranean Fever is an autosomal recessive disease. Major symptoms of disease are recurrent fever accompanied by serositis attacks. The disease is usually diagnosed before 20 years of age. Symptoms related to FMF are noted when children become more verbal, usually after 2 years of age. In this case report, the youngest patient with the diagnosis of FMF is presented. She was consulted to pediatric rheumatology for the high acute phase response and fever. It was learned that her mother had recurrent swelling of her ankle joints. Mutation analysis was performed and two homozygous mutations (M694V and R202Q) were identified. She was diagnosed as FMF at 3 months of age and colchicine was started. She responded to colchicine. Her uncontrolled acute phase response declined gradually. This case was reported to point out the importance of early remembrance of autoinflammatory diseases even at very early ages especially at endemic countries.

Features of multiple pregnancies obtained by in vitro fertilization or spontaneously.

BACKGROUND: The aim of this study was to investigate the prognosis of infants born to multiple pregnancies obtained by in vitro fertilization (IVF) or spontaneously. METHODS: The records of multiple pregnancies in Bakirkoy Maternity and Children's Hospital between February 2008 and January 2009 were investigated. Maternal, perinatal and postnatal data of multiple pregnancies were evaluated. The congenital anomalies determined by physical examination and/or imaging studies in the prenatal, natal and postnatal period and the difference between groups in terms of morbidity and mortality were investigated as well. RESULTS: A total of 401 spontaneous multiple pregnancies and 128 IVF multiple pregnancies were included in the study. Rate of multiple pregnancies for live births and IVF rate were 3.8% and 0.79%, respectively. The mean maternal age was 30.1 years (21-43) in the IVF group and 27.9 years (13-43) in the spontaneous group (P < 0.05). The cesarean delivery rate was 100% in the IVF group and 78% in the spontaneous group (P = 0.002). Premature rupture of membranes rate was 9.8% in the IVF group and 3.6% in the spontaneous group (P < 0.05). CONCLUSIONS: Multiple pregnancies constitute an important health problem due to high perinatal risks and increased health costs. We found maternal age, premature rupture of membranes and cesarean delivery rate significantly high in the IVF group. No significant differences were found between spontaneous and IVF multiple pregnancies in terms of demographic features, hospitalization stay and rate, admission to neonatal intensive care unit, mortality and congenital malformation.

Efficacy of prophylactic fluconazole therapy in decreasing the incidence of Candida infections in extremely low birth weight preterm infants.

OBJECTIVE: Systemic fungal infections are major causes of morbidity and mortality, and are associated with significant neurodevelopmental impairment in premature infants. Our objective was to evaluate the efficacy of fluconazole prophylaxis in prevention of systemic fungal infections among preterm infants. STUDY DESIGN: This observational pre-post cohort study was performed in preterm infants with a birth weight of < 1,000 g who were given prophylactic fluconazole starting on the first postnatal day at a dose of 3 mg/kg twice a week. These infants were compared with preterm infants who were not given prophylaxis. RESULTS: Prophylaxis group consisted of 90 infants and control group consisted of 107 infants. Systemic fungal infection was observed in five patients (4.7%) in the control group while no fungal infection was detected in the prophylaxis group (p = 0.03). There were no significant differences between two groups in terms of demographic features, maternal and neonatal risk factors, and all-cause mortality rates. No adverse reactions were seen during the prophylaxis period. CONCLUSIONS: We suggest that intravenous fluconazole prophylaxis at a dose of 3 mg/kg twice a week is a safe and effective strategy for decreasing systemic fungal infections even in neonatal intensive care units with low rates of invasive Candida infection.

Perinatal and somatic growth properties of preterm babies born from spontaneous and in vitro fertilization multiple pregnancies.

AIM: The objective of this study was to examine perinatal and neonatal properties of preterm infants with a corrected age of 24-36 months who were born as a result of spontaneous and in vitro fertilization multiple pregnancies, to interrogate somatic growth properties of these infants and evaluate the factors which had an impact by comparing groups. MATERIAL AND METHODS: A total of 125 children with a birth weight below 2 500 g and a gestational age below the 37(th) gestational week 60 of whom were born as a result of in vitro fertilization multiple pregnancies and 65 of whom were born as a result of spontaneous multiple pregnancies were included in the study. Maternal age and morbidity, early rupture of membranes, birth weigth, gestational week, gender, APGAR score, hospitalization reasons in the neonatal period, requirement for intensive care, frequency of congenital anomaly, outpatient follow-up status, rehospitalization and socioeconomic levels were interrogated in the patients. Detailed physical examination and current height, weight and head circumference measurements were performed and the findings were placed in the growth curves of Neyzi et al. Ethics committee approval was received for this study from the ethics committee of Bakirköy Gynecology Obstetrics and Pediatrics Education and Research Hospital (12.10.2010; no:305). RESULTS: The rate of cesarean section, mean maternal age, the rate of chronic disease in the mother and the rate of maternal disease which occured during pregnancy were significantly higher in the in vitro fertilization group (p<0.05). While no difference was found in mean gestational age, birth weight, rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization, APGAR score in the 5(th) minute was significantly higher in the in vitro fertilization group. The socioeconomical score was not different between the groups, but the in vitro fertilization group presented more regularly for outpatient follow-up visits. Height, head circumference measurements and mean current weight were found to be significantly higher in the in vitro fertilization group (p<0.05). CONCLUSION: The fact that there was no difference in the rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization was attributed to the fact that the study and control groups were composed of only multiple pregnancies and preterms.

Evaluation of growth in very low birth weight preterm babies.

AIM: The aim of this study was to evaluate physical growth of very low birth weight (VLBW) preterm babies at a mean age of three years and to investigate the factors which affected growth. MATERIAL AND METHODS: The factors including maternal problems, prenatal problems, early neonatal problems, nutrition, familial socioeconomical status and presence of chronic disease which affected catch-up growth in terms of height and weight in VLBW infants followed up in the neonatal intensive care unit (NICU) of our hospital were examined. The target height formula was used in assessment of growht in height and the contribution of genetic properties was investigated. The points of the subjects on the growth curve were plotted according to the Percentile Curve of the Turkish Children prepared by Neyzi et al. The states of the subjects with and without intrauterine growth retardation (were compared. The study was intitiated after obtaining approval from the ethics committeee of our hospital (100/25.10.2005). RESULTS: One hundred and seventeen preterm babies (57 females and 60 males) with a mean adjusted age of 35.8±2.39 80 of whom were appropriate for gestational age (AGA), 28 of whom were symmetrical (small gestational age) SGA and 9 of whom were asymmetrical SGA were included in the study. The mean gestational age (GA) was found to be 31±2.16 weeks and the mean birth weight (BW) was found to be 1271±226 g. The mean current height was found to be 92.06±4.90 cm. The mean weight was found to be 12.98±1.94 kg. The mean target height was calculated to be 163.66±8.1 cm (157.20 cm for the girls and 170.20 cm for the boys). It was found that 15 preterm babies (12.8%) could not achieve the target height (girls: 6%, boys: 6.8%). The risk factors related with failure to achieve target height were found to include ventilator treatment, presence of chronic disease, advanced stage intracranial bleeding (ICB), posthemorrhagic hydrocephalus, absence of breastfeeding, failure to sit at the table with the family and malnutrition. The maternal age, early rupture of membranes (PROM), preeclampsia, smoking, early neonatal problems, gender, being AGA and SGA, gestational age, birth weight and socioeconomical level were statistically insignificant in terms of achieving target height (p>0.05). CONCLUSIONS: If very low birth weight preterm babies have no chronic disease and condition leading to neurodevelopmental retardation and if they are breastfed early and continuously (0-24 months), they can achieve catch-up growth similar to term babies. In examination of growth in terms of height, using target height may be more appropriate to shown the genetic potential.

Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome

OBJECTIVE: We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. Materials and METHODS: All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS: Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000 g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION: A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.

Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome.

OBJECTIVE: We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. MATERIALS AND METHODS: All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS: Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION: A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.

Balloon valvuloplasty for critical aortic stenosis in a fetus: a case report.

The mortality and morbidity of fetal aortic stenosis (AS) depend on the degree of the hemodynamic effects of the stenosis, and left ventricular (LV) adaptation, development and function during fetal life. In the case of critical AS, the development of hydrops and death in utero are well recognized entities. A 23-week gestation fetus was diagnosed with critical severe AS, cardiomegaly, a dilated LV with very poor contractility, and mitral regurgitation. There was a reversal of flow in the aortic arch through the ductus arteriosis and a reversed a-wave in the ductus venosus on Doppler examination. The fetus had hydrops with ascites, and massive scalp, face and skin edema. Fetal amniocentesis was normal. Aortic valvuloplasty was performed under general anesthesia and echocardiographic guidance. Pericardial effusion was not observed after the procedure. However, LV function could not be ameliorated and continued to diminish. There was no cardiac activity in the fetus two hours after the intervention. Aortic valvuloplasty in utero for AS is technically feasible. Mortality is mainly associated with technical errors, LV function, and the degree of endofibroelastosis in the effected fetuses.

An unusual cause of bilateral scrotal abscess in a preterm infant: Candida albicans

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

An unusual cause of bilateral scrotal abscess in a preterm infant: Candida albicans.

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

Neonatal Bartter syndrome and unilateral ectopic renal cyst as new renal causes of hydrops fetalis: two case reports and review of the literature.

Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings.