National guidelines for delivery room management.

The following guideline is designed to give recommendations for the routine care of all neonates immediately after delivery, and the resuscitation and delivery room approach of all high-risk infants in light of recent literature. The guideline has been prepared as three different parts. The first part is about routine procedures that have to be performed to all healthy term and preterm infants in delivery room care. The second part summaries the basic principles of resusucitation including the latest changes that were mentioned in the International Liaison Committee on Resuscitation (ILCOR)-2015 guideline. Recommendations about the delivery room management of rare clinical conditions have been discussed in the last part. The social, medical conditions, and the resourses of Turkey have also been taken into consideration in its preparation. We hope it will be useful for all pediatricians and neonatologists for use as a essential guideline in delivery room care.

Analysis of serum γ-glutamyl transferase levels in neonatal intensive care unit patients.

OBJECTIVES: Gamma-glutamyl transferase (GGT) is commonly measured in newborn infants as a sensitive liver function test; however, reference ranges are mostly based on early studies, including relatively small number of patients. The aim of this study was to emphasise recently changed GGT values because of changed newborns profile admitted to neonatal intensive care units (NICUs) and establish new cross-sectional reference ranges for the serum GGT levels in a cohort of neonates between 26 and 42 weeks' gestational age in 1 centre. METHODS: From January 1, 2010 to December 31, 2012, liver function tests including serum GGT measurements were performed in 705 newborns who were admitted to NICUs because of different aetiologies at Gazi University School of Medicine Hospital, Ankara, Turkey. Infants with Apgar score <8 at the fifth minute, any metabolic or liver disease, cholestasis, congenital infection, culture-proven sepsis, elevated serum aminotransferases, and who were treated with phenobarbital were excluded. Clinical and laboratory data of 583 neonates were analysed retrospectively. GGT was measured by enzymatic method using the Abbott Architect C16000 autoanalyser. Mean, 2.5th, and 97.5th percentiles were used to express the reference range data. RESULTS: Four hundred sixty-one GGT values of 200 preterm infants and 501 GGT values of 383 term infants during the first 28 days after birth were analysed. Serum GGT levels of preterm infants in the first 7 days and between 8 and 28 days after delivery were (mean±standard deviation; 141.81±88.56 U/L and 131.17±85.53 U/L) similar to term infants (139.90±86.46 U/L and 144.56±86.51 U/L), respectively (P=0.649 and P=0.087). Serum GGT levels were found to be significantly higher in male infants (no need of query) (145.98±93.68 U/L) than female infants (132.18±78.97 U/L) (P=0.035), and infants born vaginally (152.24±90.71 U/L) also had higher serum GGT activity than those born by caesarean section (135.38±85.37 U/L) (P=0.005). CONCLUSIONS: A new reference range for serum GGT levels that is higher than previous reference values can identify neonates with truly abnormal results and prevent unnecessary interventions.

Combination antifungal therapy with voriconazole for persistent candidemia in very low birth weight neonates.

The purpose of this article is to report our experience with intravenous voriconazole therapy in the treatment of persistent Candida septicemia in very low birth weight (VLBW) neonates. Candidiasis was defined if an infant had a positive blood culture. Ten VLBW newborns developed Candida sepsis, and candidemia persisted in 6 of them despite 3 to 21 days of antifungal therapy with amphotericin B, either conventional or liposomal, and fluconazole. After the addition of voriconazole, clearance of Candida was achieved within 3-7 days of treatment. Antifungal therapy combination with liposomal amphotericin B and voriconazole was continued for at least two weeks after two negative cultures 48 hours apart. We conclude that considering the hazardous effects of Candida infections in preterm newborns, voriconazole can be added to the treatment of fungal sepsis in newborns who still have persistent candidemia despite conventional antifungal management. More clinical information is needed before voriconazole can be used as a first-line drug in antifungal therapy in newborns.

Maternal and umbilical venous adrenomedullin and nitric oxide levels in intrauterine growth restriction.

OBJECTIVE: To verify whether adrenomedullin (AM) and nitric oxide (NO) concentrations are changed in the maternal and fetal circulation in pregnancies complicated by intrauterine growth restriction (IUGR) compared to normal pregnancies, and to determine any relationship between them. METHODS: Forty-six small for gestational age (SGA) and 34 appropriate for gestational age (AGA) infants were included in the study. Umbilical and maternal venous AM and NO concentrations were determined. RESULTS: Umbilical NO concentrations in SGA infants (mean +/- SD; 176.2 +/- 75.8 micromol/L) were significantly greater than in AGA infants (143.4 +/- 39.2 micromol/L) (p = 0.015). However, umbilical AM concentrations were similar in SGA and AGA infants with 14.2 +/- 4.4 pmol/mL and 14.5 +/- 6.2 pmol/mL, respectively (p > 0.05). There was no relationship between NO and AM levels in umbilical blood (r = 0.09, p = 0.40). No difference was found between either AM or NO levels in the maternal plasma of the two groups. CONCLUSIONS: We suggest that NO is increased in the fetoplacental circulation in SGA infants probably as a response to decreased blood flow, whereas AM is not. Additionally, increased NO in the fetoplacental circulation was found to be independent from AM secretion.

Serum atrial natriuretic peptide levels in infants with transient tachypnea of the newborn.

OBJECTIVE: The mechanisms responsible for lung liquid clearance during the neonatal period result in switching of the lung epithelium from net secretion to net absorption following birth and driven by active Na(+) absorption. Transient tachypnea of the newborn (TTN) is known as the most common consequence of inadequate neonatal lung liquid clearance. It has been reported that alveolar type II cells behaved as a target for atrial natriuretic peptide (ANP) which inhibits the amiloride-sensitive Na-channel activity. The objective of this study is to investigate serum ANP concentrations in infants with TTN. METHODS: Fourteen newborn infants who were diagnosed with TTN (gestational age; 35.6 +/- 2.0 weeks) and twenty healthy neonates (gestational age; 36.3 +/- 2.2 weeks) were included in the study. Serum pro ANP concentrations were measured by ELISA using Biomedica GmbH (AUSTRIA) proANP kit on the 4th and 72nd hours of life. RESULTS: The mean serum pro ANP concentration was 2996 fmol/ml at 4 and 2694 fmol/ml at 72 hours of age for the infants with TTN and mean serum pro ANP concentrations of healthy infants found 3301 fmol/ml (p = 0.34) and 3204 fmol/ml (p = 0.04), respectively. CONCLUSION: It is concluded that serum ANP concentrations decreased in infants with TTN.

Resuscitation failure due to Fraser syndrome in a newborn undiagnosed in the prenatal period.

Long segment laryngo-tracheal atresia is rare, and is usually incompatible with life in neonates. We report a case of an infant with Fraser syndrome that had not been diagnosed in the prenatal period who presented with impossible intubation due to severe long segment laryngeal atresia in the delivery room. Antenatal diagnostic features of Fraser syndrome and emergency airway management are discussed.

Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?

Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheterization in the newborn. Most complications from central venous catheters are related to incorrect position of the catheter and it is emphasized to confirm the position of the catheter tip after placement in order to avoid possible complications. We present an unusual complication of cardiac tamponade because of umbilical venous catheterization in a term newborn which is extremely rare with correct location of the catheter tip at the junction of inferior vena cava and right atrium. We suggest that correct position never guarantees uneventful catheterization in the newborn. In any infant with a central venous catheter in situ who deteriorates clinically, pericardial effusion/cardiac tamponade must be considered and appropriate action taken.

Serum leptin levels in twins and singleton newborns.

BACKGROUND AND OBJECTIVE: Leptin is produced by the human placenta besides adipose tissue and is suggested to be related to fetal growth. In order to find out whether multiple pregnancy is a factor affecting serum leptin levels, we compared neonatal serum leptin concentrations of twins and singleton newborns who were all appropriate for gestational age (AGA). INFANTS AND METHODS: Thirty newborns were studied. Group 1 consisted of 15 infants from twin pregnancies and group 2 (control group) consisted of 15 infants from singleton pregnancies. Serum samples were taken at 24 hours following delivery and leptin concentrations were measured. RESULTS: There were no significant differences in birth weight, gestational age and male/female ratio between infants of twin and single gestations. However, serum leptin concentrations of twins (mean +/- SEM: 1.13 +/- 0.35 ng/ml) were significantly lower than of the singleton infants (4.27 +/- 0.63 ng/ml) (p < 0.001). CONCLUSION: Twin pregnancy might be a factor affecting serum leptin concentrations in newborn infants.