Turkish Neonatal Society guideline on the safe transport of newborn.

The rational presentation form of perinatal care in developed countries is evaluated within the regionalization program. Neonatal transport is the main step for the regionalization of perinatal care. It is a very important factor for reducing neonatal mortality and morbidity, especially in developing countries. Neonatal transport is a system integrity that includes more than one essential matter. Neonatal transport requires special hardware and serious organization because it can be a caused of mortality and morbidity in its own right. This guideline deals with the transport of newborn infants (definitions, personnel, technical equipment, stabilization conditions, special medical conditions, communication), and the current situation in our country and standard approaches. It should not be forgotten that changes in public space will also change the approach and that every baby should be evaluated within himself or special conditions.

Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants.

OBJECTIVE: The correct timing and technique of neural tube defect (NTD) repairs significantly decrease the morbidity and mortality of NTD cases. However, infections related to the surgery are still common. We investigated the effects of topical rifampin combined with routine prophylaxis in newborns with open NTDs. METHODS: This retrospective study included 86 patients who had undergone NTD surgery. The experimental group comprised 30 patients who were started on topical rifampin before surgery, and the control group comprised 56 patients who were not administered topical rifampin. Surgical site infections (SSIs) and meningitis/ventriculoperitoneal (VP) shunt infections that developed within 6 months after the surgical intervention were evaluated. RESULTS: In the postoperative period, meningitis/VP shunt infections and SSIs were observed in 6.7% and 3.3%, respectively, of the experimental group treated with topical rifampin. Meningitis/VP shunt infections and SSIs were observed in 37.5% and 21.4%, respectively, of the control group. External ventricular drainage and not using topical rifampin were identified as important relative risk (RR) factors for meningitis/VP shunt infections (RR 19.28, 95% confidence interval [CI] [3.53, 105.33], P = 0.001; RR 18.10, 95% CI [2.38, 137.68], P = 0.005). A flap transposition, cerebrospinal fluid leaks, and not using topical rifampin were identified as RR factors for SSIs (RR 22.21, 95% CI [4.81, 102.47], P < 0.001; RR 13.04, 95% CI [1.22, 139.33], P = 0.034; RR 7.09, 95% CI [1.12, 53.99], P = 0.042). We did not observe any local or systemic side effects resulting from the use of rifampin. CONCLUSIONS: The use of topical rifampin is an easy and effective method for reducing SSIs and meningitis/VP shunt infections related to NTD surgery.

Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study.

OBJECTIVE: Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants. METHODS: All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assessment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) ≥ grade III). RESULTS: Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH ≥ grade III when compared to the LS treatment group. CONCLUSIONS: ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.

The importance of administration of early surfactant and nasal continuous positive airway pressure in newborns with respiratory distress syndrome.

AIM: Mechanical ventilation is an invasive method and causes to important problems in the respiratory tract and lung parenchyma. The objective of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. MATERIAL AND METHODS: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was administered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). RESULTS: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p>0.05). The mean hospitalization time in the patients in the study group was 24.4±17.8 days, whereas the mean time of nCPAP was 28.4 (4-120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dysplasia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was found to be statistically significantly shorter compared to the control group (p<0.05). CONCLUSIONS: In our study, it was observed that administration of early surfactant and nCPAP in treatment of preterm newborns with a diagnosis of RDS markedly decreased the lenght of stay on mechanical ventilation, but had no significant impact on morbidity and mortality.

Spectrophotometric analysis in umbilical cords of infants with meconium aspiration syndrome.

We compared spectrophotometric analysis of the umbilical cords of infants with meconium aspiration syndrome (MAS) or with meconium-stained amniotic fluid (MSAF) and healthy infants. In a prospective study, 15 infants with MAS and 37 infants with MSAF were enrolled. Twenty healthy infants formed a control group. The absorption peak of umbilical cords with meconium was significantly higher in the infants with MAS or MSAF than in controls. Spectrophotometric analysis of the umbilical cords with meconium may be useful to identify developed neonates with MAS or MSAF.

Neonatal brucellosis and breast milk.

In this case report the authors present an extremely low birth weight premature infant with neonatal brucellosis whose mother had been treated for brucellosis during pregnancy. Infant developed mild respiratory distress syndrome soon after birth. At 2nd wk of postnatal age findings of bronchopulmonary dysplasia were evident and she and her mother were diagnosed to have brucellosis at the same time. After commencement of antibrucellosis therapy and nonspesific treatment for bronchopulmonary dysplasia, infant was completely cured of the symptoms related to both brucellosis and bronchopulmonary dysplasia. The results of the present case and a review of the literature have let to conclude that Brucella might have role in development of prematurity and bronchoplumonary dysplasia. Since discovery of brucella bacilli in early periods of 20th century, fetotoxicity of brucella bacilli seems to increase gradually suggesting an increasing virulance of the bacilli or vanishing host defense of human beings.

Evaluation of oxidant and antioxidant status in infants with hyperbilirubinemia and kernicterus.

OBJECTIVE: The objective of the present study was to determine oxidant and antioxidant status in infants with hyperbilirubinemia and/or kernicterus and to find whether there is a relationship between bilirubin level and oxidant/antioxidant status. PATIENTS: The study includes 69 full-term newborns (neonates with hyperbilirubinemia needing phototherapy [Group 1, n = 36] and neonates with kernicterus [Group 2, n = 33]) and 25 age-matched healthy newborn. RESULTS: Plasma total antioxidant capacity (TAC) and serum total oxidant status (TOS) were significantly higher in Groups 1 and 2 than the control group. There was a significant difference between Group 1 and control cases for malondialdehyde (MDA; p < 0.001). Total free sulfhydryl group (TTHI) values were significantly elevated in Group 1 compared to Group 2 and control cases. Correlation analysis showed that the correlation between total bilirubin (TB) and TAC, TOS, MDA and oxidative stress index may be expressed by a quadratic curve. After phototherapy, a statistically significant increase in nitrite level was observed. CONCLUSION: We demonstrated that the relationship between serum TB and antioxidants and oxidative stress could be expressed by a quadratic correlation curve.

TAR syndrome and esophagial atresia: a concomitant or variant condition?

Thrombocytopenia with absent radii (TAR) is rare cause of neonatal thrombocytopenia. TAR syndrome and esophageal atresia with tracheoesophageal fistula has been reported in only two cases in literature. Our case was the first in literature with unilateral TAR syndrome and bilateral absence of thumbs accompanying EA.

Global fibrinolytic capacity in neonatal sepsis.

In this study, we studied global fibrinolytic capacity (GFC) in newborn infants with sepsis. Sixty-one newborn infants, admitted to neonatal intensive care unit at Yuzuncu Yil University Hospital were enrolled in this study. White blood cell count, immature (I) / mature (M) neutrophil ratios, prothrombin time, and d-dimer levels were significantly higher in patient group than those of control group (P < .05). We found GFC to be significantly lower in the patient group compared to the control group (P < .05). The GFC value was negatively correlated to the Tollner scores but this correlation was not statistically significant (r = -.267, P = .095). Our findings showed that GFC decreases in severe neonatal sepsis; therefore, we suggest that GFC may be used for prognosis or in the early prediction of severe sepsis rather than the diagnosis of neonatal sepsis.

Necrotizing fasciitis caused by Staphylococcus epidermidis in a neonate with extremely low birthweight.

Necrotizing fasciitis (NF) is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. The initial skin presentation ranges from minimal rash to cellulites. The lesions subsequently spread rapidly. Even with appropriate medical and surgical therapy, the mortality rate in NF is more than 50%. In cases of neonates, mortality rate is higher than that ratio. High index of suspicion, prompt aggressive surgery, appropriate antibiotics and supportive care are the mainstays of management in the newborn infant with NF. Herein, we report a case of invasive and mortal NF caused by Staphylococcus epidermidis in an infant with extremely low birthweight.

A 3-day-old boy with a right preauricular swelling.

A 3-day-old boy was admitted for right preauricular swelling. Examination showed a toxic looking neonate with poor neonatal reflexes. There was erythema and swelling of 4 × 3 cm at the level of the right cheek. Laboratory investigation pointed to a bacterial infection. With parenteral antibiotics, the lesion resolved completely.

DNA-positive, IgM-negative symptomatic congenital cytomegalovirus infection: two case reports.

The characteristics of two newborns that had clinical symptoms of congenital cytomegalovirus have been presented here, whose CMV-DNA was found to be positive by the PCR method, despite serological analysis being negative for CMV IgM. In conclusion, when congenital CMV infection is suspected in newborns, it should not be forgotten that the sensitivity of serological CMV IgM assay is 70% and other methods such as CMV-DNA analysis should be performed in case of negative test results.

Does residual amniotic fluid after preterm premature rupture of membranes have an effect on perinatal outcomes? 12 years experience of a tertiary care center.

OBJECTIVE: To review our experience with preterm premature rupture of membranes at a tertiary-care hospital in Turkey to determine whether the amount of residual amniotic fluid after rupture has prognostic value for adverse maternal and fetal outcomes. METHODS: We reviewed the medical records of 191 pregnant women with gestational ages between 24 and 34 weeks at the time of rupture of the amniotic membrane and of their babies delivered in our hospital between January 1996 and September 2008. On the basis of amniotic fluid index (AFI) values recorded at the time of admission, patients were categorized into two groups: those with an AFI < 50 mm (n = 119) and those with an AFI > 50 mm (n = 72). RESULTS: The patients with high gravidity (4-8) were more prevalent in the group with an AFI < 50 mm (37 vs. 23.6%), while nulliparous women were more common in the group with an AFI > 50 mm (44.4 vs. 30.2%) (P < 0.05). Seventy-two percent of the cesarean sections performed due to nonreassuring fetal status were in the group with an AFI < 50 mm (P < 0.01). In 71.4% of the cases with a 5 min Apgar score < or = 7, AFI was less than 50 mm (P < 0.01). AFI < 50 mm was present in 65, 70.8, 76.7, and 73.1% of the pregnancies complicated by chorioamnionitis, respiratory distress syndrome, composite neonatal morbidity, and neonatal death, respectively (P < 0.05). CONCLUSIONS: A residual AFI < 50 mm after preterm PROM between 24 and 34 weeks of gestation, which is mostly seen in grand multiparous women in Eastern Turkey, may be a valuable prognostic variable for anticipating adverse maternal and neonatal outcomes.

Severe hypernatremia in newborns due to salting.

The aim of this study was to evaluate the etiology, clinical, and laboratory findings and prognostic features of life-threatening hypernatremic newborns secondary to salting. Ten severely hypernatremic newborns (four females) with a mean age of 6.5 +/- 2.6 days were followed up. Nine of them were full term, and one was preterm. It was noticeable that 60% of them were small for gestational age. In the laboratory investigation, five uremias were detected. It was interesting to find in the etiologic history that 40% of the patients had been salted just after birth. Twenty percent of them had also hyperbilirubinemia and kernicterus, 20% had neonatal convulsion, and 50% had dehydration. Two of the hypernatremic newborns died during the study; the others were followed up. One case had spasticity and developmental disability at the 3rd month, and another one had developmental disability at the 6th month of ages. As a conclusion, although salting of newborns is not so frequent, it could be seen in rural places of our country, and this may be one of the reasons for serious hypernatremia in newborns whose skin integrity have not been formed completely. These cases should be treated carefully.

Brachial plexus paralysis due to giant cavernous hemangioma with Kasabach-Merritt syndrome: successful management with interferon alpha.

Giant hemangiomas are rare in newborn babies and may cause some life-threatening complications such as congestive heart failure and coagulopathies including severe thrombocytopenia, microangiopathic hemolytic anemia and bleeding such as Kasabach-Merritt syndrome. We have presented here one infant case with a right lower brachial plexus paralysis due to giant hemangioma treated successfully with interferon alpha and have discussed the treatment. This is the first case of Kasabach-Merritt syndrome associated with a right lower brachial plexus paralysis treated with interferon in the literature to our knowledge. The administration of interferon-alpha might be indicated as a therapy for severe, life-threatening and giant hemangiomas such as Kasabach-Merritt syndrome, especially when there is resistance to steroid. However, more extensive data and new patients are needed to clarify this issue.

Prevalence of Helicobacter pylori in children and their family members in a district in Turkey.

The aim of this study was to determine the prevalence of Helicobacter pylori among children and their family members and to evaluate some epidemiologic characteristics. The study included 275 children, aged 1-15 year(s), suffering from different gastrointestinal complaints. Blood serology and stool antigen testing were used for the diagnosis of infection due to H. pylori. Sixty-five (23.6%) of the 275 children were positive for H. pylori, and this positivity had a significantly increasing correlation with age (p<0.001). H. pylori-associated infection was observed among 45 (69.2%) and 17 (8%) mothers in the H. pylori-infected and non-infected groups respectively (p<0.0001). Most children and their families infected with H. pylori were living in an urban area. The findings suggest that infection due to H. pylori is a problem for this district area, and all children having any gastrointestinal complaints should be examined whether H. pylori was prevalent among their family members.

Newborn infant with hemophagocytic lymphohistiocytosis and generalized skin eruptions.

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease resulting from abnormal proliferation of histiocytes in tissues and organs. The incidence of HLH is 1:50,000-300,000. Cutaneous eruptions have been reported in 6-65% of the cases. It's important to differentiate the eruptions from other systemic diseases. We present an infant with prominent skin manifestations of HLH. On the 11th day of life, she was admitted to our hospital with complaint of a generalized rash that had started the previous day. The eruptions consisted of irregularly shaped maculopapular erythematous rash and purpura. Bone marrow aspiration on the 25th day of life revealed hemophagocytosis with increased macrophages and histiocytes, consistent with HLH. Treatment was started with dexamethasone followed by induction chemotherapy with etoposide. All skin manifestations resolved in a few days. Although the clinical features are nonspecific, HLH should be kept in mind as an accompanying disease in neonates presenting with skin eruptions.

Four children with colchicine poisoning.

Colchicine poisoning is a rare event. It is characterized by multiorgan involvement and by poor prognosis associated with overdose. In this article we present four children with colchicine poisoning to emphasize that colchicine poisoning has a large spectrum in childhood. The children's ages ranged between 1 year and 3.5 years. The ingested dosage of colchicine was between 0.37 and 1.72 mg/kg. Most of the findings of colchicine poisoning such as gastrointestinal symptoms, hepatotoxicity, cardiotoxicity, bone marrow suppression, hypocalcaemia and hair loss were diagnosed in our patients. Two children receiving 0.37 mg/kg and 1 mg/kg colchicine and admitted 13 and 19 hours after poisoning, respectively, died. Our findings suggest that in addition to amounts of the drug, mortality was also related to the duration between drug ingestion and admission to hospital.