The Diagnostic Value of Presepsin in Acute Appendicitis and Reference Ranges for Healthy Children.

OBJECTIVE: This study aimed to investigate the diagnostic value of presepsin, a new inflammatory marker for paediatric appendicitis, and to determine a reference range of presepsin for children. METHODS: This single-center prospective study was conducted in our paediatric emergency department between 1 February 2021 and 1 July 2021. Patients aged 0-18 years diagnosed with acute appendicitis, which was pathologically confirmed, and healthy volunteers in the same age group were included in the study. Serum presepsin levels were analysed using an enzyme-linked immunosorbent assay reader. In addition to presepsin, other acute-phase reactants, paediatric appendicitis scores and imaging methods were evaluated. RESULTS: There were 94 patients in the acute appendicitis group and 102 healthy volunteers in the control group. Median values were compared between the two groups, and no statistically significant differences were found (p = 0.544). In addition, no statistically signivficant differences in presepsin levels were found between the acute and perforated appendicitis groups (p = 0.344). The median (IQ1-IQ3) reference range for presepsin in healthy children was 0.9950 (0.7575-1.610) ng/mL. CONCLUSION: Presepsin is not a suitable marker for the diagnosis of acute appendicitis. We observed that serum presepsin levels were not elevated in paediatric appendicitis, which is a local infection, in contrast to previous studies.

Which Inotropic Drug, Dobutamine or Milrinone, Is Clinically More Effective in the Treatment of Postligation Cardiac Syndrome in Preterm Infants?

OBJECTIVE: This study aimed to detect which of the two main medicines suggested in the treatment of postligation cardiac syndrome (PLCS)-dobutamine or mirinone-possesses a more therapeutic effect. While doing this, clinicians are provided with a broader perspective on the treatment and follow-up of cases. The desire was to increase the treatability and monitor ability of the cases in question and hence their survivability. STUDY DESIGN: A retrospective review of a cohort of infants with PLCS was conducted between March 2012 and December 2018. In the treatment of infants with PLCS, dobutamine (dobutamine study group-DSG) or milrinone (milrinone study group-MSG) was used. The respiration, cardiac, echocardiography, and perfusion parameters of the cases were assessed both before and after ligation. Based on the data obtained, both the effects of the medicines on PLCS and the difference between their therapeutic effects were studied. The accuracy of prognostication was assessed with receiver operating characteristic analyses. RESULTS: PLCS was detected in 29 (34.1%) of 85 patent ductus arteriosus ligation cases in total. Of all the PLCS cases, 13 (44.8%) were treated with dobutamine and 16 (55.2%) with milrinone. It was observed that the effects of the medicines on the respiratory system and cardiovascular system manifested in the third and 6th hour, respectively. It was detected that both medicines had more effect on the systolic blood pressure (SBP) (area under the curve [AUC]: 0.997/0.996, p = 0.001/0.002) than on the diastolic blood pressure (AUC: 0.911/0.843, p = 0.032/0.046). CONCLUSION: Dobutamine and milrinone, two primary medicines that can be used in the treatment of cases with PLCS, possess similar therapeutic effects on this pathology. In addition, their postoperative therapeutic effects on the SBP are more in the foreground.

The relationship between immature platelet fraction and severity of acute bronchiolitis.

BACKGROUND AND OBJECTIVES: Acute bronchiolitis is one of the most common reasons for hospitalization in infants. Although patients with acute bronchiolitis generally have a good prognosis, death can also occur. In this study, we evaluate the immature platelet fraction (IPF) as an indicator of the severity of acute bronchiolitis. METHODS: In our study, 179 patients diagnosed with acute bronchiolitis were divided into three groups as mild (n: 48; 26.8%), moderate (n: 104; 58.10%) and severe (n: 27; 15.1%) bronchiolitis. There were 80 healthy children in the control group. The diagnostic capacity of IPF and hematological parameters (platelet distribution width (PDW), mean platelet volume (MPV), white blood cell count (WBC), and platelet count (PLT)) values to predict severity of acute bronchiolitis was evaluated using receiver operating characteristic (ROC) curves and their respective areas under the curves (AUCs) calculated with 95% confidence intervals. RESULTS: The IPF value of patients with acute bronchiolitis was significantly higher than the healthy group (p < 0.001). In addition, a positive correlation was observed between clinical severity of bronchiolitis and IPF. The ROC curve analysis indicated that the IPF cut-off point for predicting severity of acute bronchiolitis was > 3.2% (Sensitivity of 84%, specificity of 97%). We found that the AUCs for IPF, MPV, PDW, WBC and PLT were statistically significant for bronchiolitis relative to the healthy control group. The parameter with the greatest AUC value was IPF. CONCLUSION: The IPF may present for diagnosing and evaluating the clinical severity of acute bronchiolitis in children.

The efficacy of propranolol in very preterm infants at the risk of retinopathy of prematurity: Which newborn and when?

PURPOSE: Retinopathy of prematurity (ROP), a proliferative vitreoretinopathy resulting from the vascular disorder of the retina, is the most frequent cause of blindness in childhood. In our time, ROP in advanced stage, a serious problem in premature infants, has no other treatment more effective and with fewer side effects than laser photocoagulation (LPC) treatment, which narrows visual field. The search for methods with fewer side effects than LPC has increased in recent times for the treatment of ROP. We aimed to investigate the effects in question of propranolol on ROP in various stages (stages 1, 2, and 3 ROP). METHODS: This study is designed as a randomized, placebo-controlled, single-centered, double-blind clinical trial with parallel groups. A total of 126 very preterm infants, followed up in our unit from April 2011 to January 2013, were randomly selected and included in our study. They were separated into the groups of 0, 1, and 2 depending on their stage of ROP. In addition, all the patients were divided into control group (CG) and propranolol treatment group (PTG). While the cases in the CG were administered physiological saline solution, the cases in the PTG were administered propranolol (2 mg/kg/day) in the neovascularization phase (second phase) of the ROP. RESULTS: Propranolol given to the group of stage 0-1 ROP was observed to have had no effect on the level of statistical significance between the CG and PTG in terms of increase in ROP stages (p > 0.05). However, propranolol was found to be more useful in patients with stage 2 ROP (p < 0.05). CONCLUSION: When given in the neovascularization phase of the ROP, propranolol was found to be effective in the stage 2 (advanced stage) ROP patients but in stage 0-1 (early-stage) ROP patients, its efficacy was not sufficient.

Can Platelet Mass Index Be a Parameter to Predict Intraventricular Hemorrhage in Very-Low-Birth-Weight Newborns?

OBJECTIVE: Intraventricular hemorrhage (IVH) is an important problem in neonatal units not only in terms of its consequences but also its follow-up and the prediction of its emergence in newborns. In this study, we have compared platelet parameters such as platelet count (PC), mean platelet volume (MPV), and platelet mass index (PMI) in terms of IHV in very-low-birth-weight (VLBW) newborns. Thus, we have tried to determine platelet values to guide clinicians in both the prediction and follow-up of IVH. STUDY DESIGN: This is a retrospective, multicenter, and case-controlled study. In this study, 386 cases of VLBW newborns (below 1,500 g) and gestational age below 32 weeks, hospitalized and monitored between August 8, 2012, and April 7, 2018, were included. The platelet values of the cases on their 12th hour postpartum (PC1, MPV1, and PMI1) and the platelet values on days 5 to 7 (PC2, MPV2, and PMI2) were recorded in their study cards. A p-value of <0.05 was accepted as statistically significant. RESULTS: While there was no difference of PC1, MPV1, PMI1, PC2, or MPV2 values (p > 0.05), PMI2 values in the severe stage IVH group cases were found to be significantly lower compared with other platelet parameters (p < 0.05). CONCLUSION: PMI2 values can provide clinicians with important knowledge that may aid them in recognizing important pathologies such as IVH.

Platelet mass index can be a reliable marker in predicting the prognosis of retinopathy of prematurity in very preterm infants.

BACKGROUND: Retinopathy of prematurity (ROP) is a proliferative vitreoretinopathy resulting from vascular defect of the retina. The present study evaluates platelets, which are involved in VEGF storage, transport and release, and their functions with regard to the prognosis of the disease. The objective was to suggest a simple minimal invasive method that will facilitate the management of the disease and help clinicians in predicting the prognosis. METHODS: In this single center, retrospective, case-control study, we included a control group consisting of very preterm newborns (n = 83) at risk of ROP and a laser photocoagulation group including infants (n = 63) who received laser therapy during their follow-up examinations. The employed assessments included platelet counts and platelet mass index (PMI) which provide guidance in understanding platelet activity. In doing so, consideration was given to the first and second phases of ROP. The accuracy of prognostication was assessed with receiver operating characteristic analyses. RESULTS: The study groups did not differ statistically significantly by platelet count during the first and second phases of ROP (p > 0.05) nor were the PMI measurements statistically significantly different between the study groups during the first phase of the disease (p > 0.05). PMI values of the study groups, however, differed significantly in the second phase of ROP (p < 0.05). CONCLUSION: The present study found a significant difference between the two groups in PMI measurements which reflect increased VEGF levels during the neovascularization phase, which underlies the disease. This conclusion demonstrated that monitoring the PMI values in newborns at risk of ROP can be considered to be a minimally invasive method that by changing the retinal examination procedure in use today which is rather troublesome for both the physician and the newborn, can provide facilities in monitoring the disease for both the physician and the newborn.

A Study of the Relationship Between Cystatin C and Metabolic Bone Disease in Preterm Infants

OBJECTIVE: Cystatin C (CysC) is commonly used as a marker of renal failure in premature infants. The aim of this study was to investigate serum CysC levels in osteopenia of prematurity (OP) and determine whether CysC could be safely used as a marker of renal insufficiency in infants with OP. METHODS: Subjects were 50 preterm infants (≤32 gestational weeks). Calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) serum levels were measured in postnatal week nine, and bone density was measured concurrently by quantitative ultrasonography. Patients with a Z score of <-2 were considered to have OP. RESULTS: The mean serum CysC levels in preterm infants in postnatal week nine were 1.50±0.19 mg/L. Serum CysC levels were not correlated with speed of sound values, Z scores, serum Ca, P or ALP levels. Serum CysC levels were not significantly different between infants with OP [1.50 (1.35-1.61) mg/L] and in infants without OP [1.58 (1.28-1.70) mg/L]. CONCLUSION: The presence of OP does not affect the safety of CysC as a marker of renal insufficiency in preterm infants.

Short-term Refractive Effects of Propranolol Hydrochloride Prophylaxis on Retinopathy of Prematurity in Very Preterm Newborns.

PURPOSE: Retinopathy of prematurity (ROP) is one of the major problems of surviving premature infants with several ophthalmic morbidities such as increased risk of refractive errors, strabismus, and cortical visual impairment. Use of propranolol hydrochloride (PH) for the prevention of ROP is a new promising treatment modality. However, long-term effects are still to be defined. In our study, we aimed to investigate the short-term refractive effects of PH used for ROP prophylaxis in very preterm newborns. METHODS: This is a prospective, randomized, double-blind, placebo-controlled study. Very preterm newborns with a birthweight less than or equal to 1500 g and/or born prior to 32 gestational weeks were included in the study. The subjects were randomly divided into two groups: control group (CG, n = 37) given placebo and PH group (PHG, n = 34) given PH starting from 4 weeks after birth (27.1 ± 2.1 day). PHG patients received PH therapy for about 1 month (25.7 ± 7.8 day). Anthropometric measurements including weight, length, and head circumference were recorded before PH treatment (at birth) and during eye control (at corrected age). Cycloplegic refraction values were measured by retinoscopy at corrected age (CG: 10.3 ± 4.3 months, PHG: 11.4 ± 4.8 months). RESULTS: Anthropometric measurements including gestational age, weight, length, and head circumference were similar at birth and corrected age in both groups. The mean level of spherical refraction was significantly less hyperopic in the PHG than in the CG (CG: 1.37 ± 1.40 D, PHG: 0.37 ± 1.44 D) (p = 0.005). CONCLUSION: PH may lead to myopic shift by affecting the beta-adrenergic receptors in the choroid or ciliary body of the developing eye. Long-term refractive follow-up is required in order to elucidate the effects of PH on emmetropization process of these very preterm infants.

Effects of Lycopene in Hyperoxia-Induced Lung Injury in Newborn Rats.

The aim of this study was to evaluate the therapeutic effect of lycopene on a hyperoxia-induced lung injury model in rat pups. Full-term rat pups were included in the study 12-24 h after delivery. The pups were separated into 4 groups: normoxia control (NC), hyperoxia control (HC), hyperoxia + lycopene (HL), and normoxia lycopene (NL). The normoxia groups were housed in ambient air, and the hyperoxia groups in > 85% O2. HL and NL groups received 50 mg lycopene in oil/kg body weight/day delivered intraperitoneally (i.p.), the other groups received oil alone. On day 11, the rat pups were sacrificed and their lungs removed. Statistically significant injury was observed in all histological parameters measured (MLI, proliferating cell nuclear antigen (PCNA), and apoptosis) in the HC group (HC vs NC, p = 0.001). This injury could not be reversed with lycopene treatment (HC vs HL, 0.05; NC vs HL, p = 0.001). With hyperoxia, statistically significant decreases were observed in biochemical parameters in terms of SOD, MDA, and IL-6 values (HC vs NC: SOD, p = 0.02; MDA, p = 0.043; IL-6, p = 0.001). The use of lycopene did not provide any improvement in these values (HC vs HL, p > 0.05). Hyperoxia or lycopene had no effect on IL-1ß and GPx (p > 0.05). When comparing NC and NL groups, negative effects were observed in the group given lycopene in terms of MLI, PCNA, apoptosis, and IL-6 (all parameters, p = 0.001). We observed that 50 mg lycopene in oil/kg body weight/day given via i.p. had no curative effect on the hyperoxia-induced lung injury in newborn rats and may even induce adverse effects.

Evaluation of aortic intima-media thickness in newborns with Down syndrome.

BACKGROUND: Health care programs for children with Down syndrome (DS) help improve the overall outcome and quality of life of these children. It is therefore very important to focus on the most common and serious problems of these patients, such as congenital heart defects and cardiac problems, and to keep medical guidelines updated with regard to these problems. OBJECTIVES: The aim of this study was to evaluate aortic intima-media thickness (aIMT), lipid profiles and blood pressure in DS patients in comparison with a control group of ageand gender-matched neonates without DS. MATERIAL AND METHODS: Serum concentrations of lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride), blood pressure and abdominal aIMT were measured in newborns with DS, and compared with the measurements from ageand gender-matched newborns without DS. RESULTS: No statistically significant differences between the 2 groups of newborns were detected with respect to aIMT, lipid levels or blood pressure. CONCLUSIONS: This study represents the first investigation of aIMT - one of the most important indicators of atherosclerosis - in DS patients, but neither a significantly increased aIMT, nor any significant changes in lipid profiles or blood pressure were detected in this group of patients. Whether aIMT differs according to the type of congenital heart defect (such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, and atrioventricular septal defect) among DS patients remains to be determined in future studies.

Neonatal Endocrinologic Problems in Collodion Babies.

OBJECTIVES: To identify endocrinologic problems, particularly those concerning growth, in collodion babies (CBs). METHODS: Clinically identified newborn CBs were included in the study group (group 1). Because CBs are generally born premature, small for gestational age (SGA), or both, a control group matched to the study group in terms of gestational age and birthweight (group 2) was also established. Blood specimens were collected from both groups for thyroid function tests and to measure serum growth hormone (GH), insulinlike growth factor 1 (IGF-1) and IGF binding protein-3 (IGFBP-3) levels. RESULTS: Group 1 consisted of 42 CBs (25 male, 17 female) with gestational ages of 32 to 42 weeks and birthweights of 1,400 to 4,000 g. Twelve were assessed as premature and 17 as SGA. Serum IGF-1 and IGFBP-3 levels were lower and serum GH levels higher than in controls. Primary hypothyroidism was diagnosed in 10 patients in the study group, subclinical hypothyroidism in 2, and central hypothyroidism in 1. A statistically significant difference was determined between the groups in terms of primary hypothyroidism (p = 0.01). Serum GH levels were weakly negatively correlated with birthweight (correlation coefficient [r] = -0.32, p = 0.04) and serum IGF-1 (r = -0.38, p = 0.001) and IGFBP-3 (r = -0.36, p = 0.002) levels. CONCLUSION: Premature birth and SGA are common in CBs. GH levels are high and IGF-1 and IGFBP-3 levels low at birth as a sign of GH resistance in these patients. The greater prevalence of hypothyroidism in these children is also significant.

Thyroid status of iodine deficient newborn infants living in central region of Turkey: a pilot study.

BACKGROUND: Iodine deficiency (ID) during the fetal and neonatal periods can lead to neonatal hypothyroidism. This study was conducted to evaluate the effect of ID on the thyroid hormone level of newborns living in Turkey. METHODS: Between 1998 and 2013, 71 newborns with a urinary iodine concentration <100 µg/L were recruited into the study. Data on thyroid volume, free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroglobulin (Tg) were collected from all newborns, and on breast milk iodine from their mothers. Infants who were classified as having congenital hypothyroidism (TSH >40 mU/L and fT4 <8.5 pmol/L) were treated with levothyroxine (n=26, T group), while the remaining infants remained untreated (n=45, UT group). Thyroid hormones were subsequently measured 7-14 days later in a sub-sample of both treated and untreated infants. RESULTS: The average values at the time of admission were as follows [median (min-max)]. fT3: 5.0 (2.8-7.1) pmol/L, fT4: 7.7 (0.13-19.1) pmol/L, TSH: 75 (14-426) mU/L, Tg: 464 (226-1100) ng/mL, urinary iodine concentration (UIC): 30 (0-61) µg/L, breast milk iodine levels: 21 (10-150) µg/L, thyroid ultrasound (USG): 1.10 (0.24-1.95) mL for the T group; and fT3: 5.7 (1.7-12.7) pmol/L, fT4: 16.2 (9.9-33.5) pmol/L, TSH: 5.4 (0.63-41.8) mU/L, Tg: 171 (15-2124) ng/mL, UIC: 39 (0-90) µg/L, breast milk iodine levels: 47 (10-120) µg/L, thyroid USG: 0.75 (0.35-1.72) mL for the UT group. A significant difference was found between groups in respect to fT3, fT4, TSH and Tg levels. No significant difference in thyroid ultrasonography, UIC, and breast milk iodine levels was found between the two groups. The Tg levels of 50 out of 71 patients were measured, 40 (80%) of whom had Tg levels above the normal range (101 ng/mL). CONCLUSIONS: In our country, despite the use of iodized salt, congenital hypothyroidism due to ID remains a problem. The Tg level of newborns can be used as a good indicator of ID.

Protective effect of vitamin D against hyperoxia-induced lung injury in newborn rats.

INTRODUCTION: Preterm infants have risks of developing vitamin D deficiency. Thus we aimed to investigate the effect of vitamin D on hyperoxia-induced lung injury in newborn rats. METHODS: Full term rat pups were included in the study 12-24 hr after delivery. The pups were randomly divided into eight groups as follows: normoxia control group (NC), normoxia plus vitamin D group (ND1, 1 ng/gr/day vitamin D), normoxia plus vitamin D group (ND2, 3 ng/gr/day vitamin D), normoxia plus vitamin D group (ND3, 5 ng/gr/day vitamin D), hyperoxia control group (HC), hyperoxia plus vitamin D group (HD1, 1 ng/gr/day vitamin D), hyperoxia plus Vitamin D group (HD2, 3 ng/gr/day vitamin D), hyperoxia plus vitamin D group (HD3, 5 ng/gr/day vitamin D). The histopathological effects of vitamin D were assessed by alveolar surface area (with mean linear intercept (MLI) method), apoptosis index and proliferating cell nuclear antigen (PCNA) index. RESULTS: MLI values were significantly lower among three groups (HD1: 83.93 ± 1.95 µm, HD2: 81.76 ± 1.68 µm, and HD3: 82.33 ± 1.87 µm) when compared with HC group (92.98 ± 2.09 µm) (P = 0.001, P = 0.0004, P = 0.002, respectively). Apoptotic cell index were significantly lower among three treatment groups (HD1: 1.455 ± 0.153, HD2: 0.575 ± 0.079, and HD3: 0.700 ± 0.105) when compared with HC group (2.500 ± 0.263) (P = 0.001, P = 0.001, P = 0.001, respectively). Although PCNA positive cell index did not change in HD1 group (0.132 ± 0.008) (P > 0.05), there were significant increases in HD2 (0.277 ± 0.026) and HD3 (0.266 ± 0.018) group when compared with HC group (0.142 ± 0.010) (HD2 P = 0.001, HD3 P = 0.001). CONCLUSION: Vitamin D seems to protect hyperoxia-induced lung injury in newborn rats. Pediatr Pulmonol. 2017;52:69-76. © 2016 Wiley Periodicals, Inc.

The Efficacy of Propranolol in Retinopathy of Prematurity and its Correlation with the Platelet Mass Index.

PURPOSE: Retinopathy of Prematurity (ROP) is a proliferative vitreoretinopathy which is one of the most frequent causes of blindness in children. In an attempt to find a solution to this important problem in preterm children, the search for new, effective treatment modalities with fewer side effects is underway. In our study, which was planned for this reason, we aimed to investigate the effects of propranolol treatment applied to cases of ROP in various stages during the second phase (known as the neovascularization-hypoxia phase) and to determine the correlation of these effects with the platelet mass index (PMI). METHOD: A total of 171 preterm infants at risk of ROP were selected randomly for inclusion in the study. All of the patients were classified according to their stage of ROP and were divided into control and treatment groups. While the cases in the control group were administered physiological saline solution, those in the treatment group were administered propranolol in the period that corresponded to the second stage of the disease. The thrombocyte and PMI values in the first and second stages of each study group were recorded. RESULTS: A significant difference was found between the control and treatment groups of the stage 2 ROP study subjects. In the stage 2 ROP study group, no significant difference was detected between the control and treatment cases in terms of platelet counts in phase 1 or in the PMI values and the thrombolytic counts in phase 2. On the other hand, in phase 2 of the stage 2 ROP study subjects significant differences were detected between the control and treatment group in terms of PMI values. CONCLUSION: In the study, it was found in the stage 2 ROP study group that propranolol reduced the need for laser photocoagulation significantly. Also, in parallel to the efficacy of propranolol in this study group, a decrease was observed in PMI values.

Investigation of Rotavirus with Various Methods in Children with Acute Gastroenteritis and Determination of Its Molecular Epidemiology in Kayseri Province, Turkey.

BACKGROUND: In this study, the fresh stool samples from 254 children under 5 years of age with acute gastroenteritis which were delivered between October 2012 and December 2013 were collected. METHODS: In the stool samples, rotavirus antigens were investigated using two different immunochromatographic methods which are routinely used at different times, namely the RIDA® QUICK Rotavirus/Adenovirus Combi Test (R-Biopharm AG, Germany) and the Genx® Rotavirus Test (Diamed-Lab, Turkey), in addition to the Rotavirus Ag (Stool) ELISA (DRG, Germany) kit. The results were compared with reverse transcriptase PCR (RT-PCR). RESULTS: When the Genx® Rotavirus Test and RIDA® QUICK Rotavirus/Adenovirus Combi Test immunochromatographic methods were compared with RT-PCR, their sensitivity and specificity were found as 97.1%, 100%, and 80.4%, 72%, respectively. As to the Rotavirus Ag (Stool) ELISA method, on the other hand, its sensitivity was found to be 95.1% and its specificity was 86.5%. The most common genotype was G9P[8] (40%), which was followed by the G1P[8] (18.7%) and G3P[8] (9.6%) genotypes. CONCLUSION: Consequently, it was revealed that the sensitivity of ELISA and immunochromatographic methods, which provide results in a short time and are used in the investigation of rotavirus antigen, was high and their specificity was low; further studies to determine the distribution of G and P genotypes will contribute to establishing strategies for vaccine development for rotavirus in the world.

Effects of L-carnitine supplementation on respiratory distress syndrome development and prognosis in premature infants: A single blind randomized controlled trial.

The aim of the present study was to investigate the efficacy of L-carnitine therapy on the occurrence and prognosis of respiratory distress syndrome (RDS). A single blind, randomized controlled trial study was conducted on 130 infants with gestational ages of 28-36 weeks. Infants were assigned to experimental groups (groups 1 and 2) and control groups (groups 3 and 4). Groups 1 and 3 consisted of infants with RDS, and groups 2 and 4 groups were composed of infants without RDS. The experimental groups were treated with carnitine. No statistically significant differences in serum carnitine levels were detected between the study and the control groups on day 1 of treatment (P=0.06). However, on day 7 of treatment, serum carnitine levels in the experimental groups were significantly increased (P=0.02), as compared with the control groups. The surfactant requirement value, which is how many rounds of surfactant therapy were required, was 1.56±0.97 in group 1, and 2.12±0.99 in group 3 (P<0.001). The mean duration of mechanical ventilation required was 3.04±3.60 days in group 1, and 4.73±5.63 days in group 3 (P<0.001). The present results indicate that carnitine supplementation in premature infants with RDS may help to increase carnitine levels, thus decreasing the duration of mechanical ventilation and surfactant requirement.

A fatal case caused by massive honey bee stings.

Bee venom is a complex substance which acts in different ways; local or systemic anaphylaxis associated with IgE and direct toxic effects of the large volume of injected venom. We report a 10- year-old boy who was the vulnerable of 5989 honey bee attacks. To the best of our knowledge, this case had the ultimate number of honey bee stings in the literature, until now. He was admitted to pediatric intensive care unit after 3 hours of incident. Plasmapheresis was started to remove circulating venom that can cause many systemic side effects. Unfortunately, multiorgan failure developed on the 2nd day of admission due to severe hemolysis and rabdomyolysis. Additional therapies modalities, mechanical ventilation, hemodialysis, and antihypertensive drugs were added to the treatment during the disease process. Despite all of the treatments, the patient was failed on 12th day of hospitalization.

Investigation on malondialdehyde, S100B, and advanced oxidation protein product levels in significant hyperbilirubinemia and the effect of intensive phototherapy on these parameters.

BACKGROUND: The parameters of oxidative stress [advanced oxidation protein products (AOPPs), malondialdehyde (MDA), and S100B] and the effect of intensive phototherapy (PT) on these parameters have not been studied extensively in newborns with significant hyperbilirubinemia (SH). We aimed to measure the levels of MDA, S100B, and AOPPs in newborns with SH, and to compare newborns with healthy control newborns without hyperbilirubinemia on the basis of these parameters of oxidative stress. In addition, we investigated the effect of intensive PT on these parameters during the treatment of SH and report our findings for the first time in the literature. METHODS: The study was performed in newborns (n = 62) who underwent intensive PT because of SH. Newborns without jaundice constituted the control group (n = 30). Both groups were compared with respect to demographic characteristics and biochemical (laboratory) parameters including MDA, AOPPs, and S100B. MDA, AOPPs, and S100B were also compared before and after intensive PT in the PT group. In the study group, a correlation analysis of demographic characteristics; MDA, AOPP, and S100B values; and changes occurring in MDA, AOPPs, and S100B values due to the effect of intensive PT was performed. RESULTS: Serum total bilirubin, S100B, and MDA levels in the PT group before performing PT were significantly higher than those in the control group. In newborns receiving PT serum total bilirubin, MDA and AOPP levels decreased significantly after intensive PT. In correlation analysis, a statistically significant negative correlation was found only between the amount of bilirubin decrease with PT and AOPP levels after PT in the study group. CONCLUSION: Whether the significant decrease in MDA levels, which was higher prior to PT, is due to the decrease in serum bilirubin levels or due to the effect of intensive PT itself remains to be determined in further studies. The decrease in AOPP levels after PT implies that intensive PT has protective effects on oxidative stress.

A report of adenocarcinoma in situ and congenital pulmonary airway malformation in a three-day-old infant with a review of the literature.

Association between malignancy and congenital pulmonary airway malformation is a rare entity in childhood. Herein, we describe a three-day-old infant with respiratory distress and cystic lung lesion on her left lung. A lobectomy was performed at the age of three days, and the patient was diagnosed with congenital pulmonary airway malformation and adenocarcinoma in situ.