Neurodevelopmental Outcome of Infants with Transient Hypothyroxinemia of Prematurity in a Newborn Intensive Care Unit

Objective: The aim of this study was to evaluate neurological development of infants with transient premature hypothyroxinemia (THOP). Methods: This prospective study included newborns who were born between 28-36 weeks of gestation (GW) and were admitted to the neonatal intensive care unit. Newborns exposed to maternal thyroid disease, or with severe intracranial problems, and congenital anomalies were excluded. Infants with THOP were the study group and those without THOP formed the control group. The study group was subdivided into those receiving levothyroxine replacement (5 µg/kg/day) and those who were untreated. Neonatal demographics, and morbidities, including respiratory distress syndrome, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were evaluated. The Ages and Stages Questionnaire (ASQ) and ASQ:Social-Emotional (ASQ:SE) developmental screening tests were administered to the entire study population at the corrected age of two years. Results: Seventy infants were included in this study, 40 of whom had THOP. The mean GW was 34.4±3.8 weeks in the study group and 37.2±2.3 weeks in controls (p=0.69). Mean overall birth weight was 1640±428 g. Levothyroxine replacement was started in 12/40 infants (30%). The groups were similar in terms of demographic characteristics. Rates of BPD and ROP were higher in the treated group (p=0.01). ASQ and ASQ:SE results did not differ between groups (p=0.75), nor did these scores differ between infants with THOP who did or did not receive levothyroxine (p=0.14). Conclusion: Although levothyroxine replacement therapy was associated with increased rates of BPD and ROP, this treatment did not appear to improve long-term neurological outcomes in this small group of infants with THOP. Prospective controlled studies with much larger sample sizes are needed to clarify the role of levothyroxine replacement in THOP.

Bronchopulmonary dysplasia and wnt pathway-associated single nucleotide polymorphisms.

AIM: Genetic variants contribute to the pathogenesis of bronchopulmonary dysplasia (BPD). The aim of this study is to evaluate the association of 45 SNPs with BPD susceptibility in a Turkish premature infant cohort. METHODS: Infants with gestational age <32 weeks were included. Patients were divided into BPD or no-BPD groups according to oxygen need at 28 days of life, and stratified according to the severity of BPD. We genotyped 45 SNPs, previously identified as BPD risk factors, in 192 infants. RESULTS: A total of eight SNPs were associated with BPD risk at allele level, two of which (rs4883955 on KLF12 and rs9953270 on CHST9) were also associated at the genotype level. Functional relationship maps suggested an interaction between five of these genes, converging on WNT5A, a member of the WNT pathway known to be implicated in BPD pathogenesis. Dysfunctional CHST9 and KLF12 variants may contribute to BPD pathogenesis through an interaction with WNT5A. CONCLUSIONS: We suggest investigating the role of SNPs on different genes which are in relation with the Wnt pathway in BPD pathogenesis. We identified eight SNPs as risk factors for BPD in this study. In-silico functional maps show an interaction of the genes harboring these SNPs with the WNT pathway, supporting its role in BPD pathogenesis. TRIAL REGISTRATION: NCT03467828. IMPACT: It is known that genetic factors may contribute to the development of BPD in preterm infants. Further studies are required to identify specific genes that play a role in the BPD pathway to evaluate them as a target for therapeutic interventions. Our study shows an association of BPD predisposition with certain polymorphisms on MBL2, NFKBIA, CEP170, MAGI2, and VEGFA genes at allele level and polymorphisms on CHST9 and KLF12 genes at both allele and genotype level. In-silico functional mapping shows a functional relationship of these five genes with WNT5A, suggesting that Wnt pathway disruption may play a role in BPD pathogenesis.

Treatment of COVID-19 patients with quercetin: a prospective, single center, randomized, controlled trial.

Scientific research continues on new preventive and therapeutic strategies against severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). So far, there is no proven curative treatment, and a valid alternative therapeutic approach needs to be developed. This study is designed to evaluate the effect of quercetin in COVID-19 treatment. This was a single-centre, prospective randomized controlled cohort study. Routine care versus QCB (quercetin, vitamin C, bromelain) supplementation was compared between 429 patients with at least one chronic disease and moderate-to-severe respiratory symptoms. Demographic features, signs, laboratory results and drug administration data of patients were recorded. The endpoint was that QCB supplementation was continued throughout the follow-up period from study baseline to discharge, intubation, or death. The most common complaints at the time of hospital admission were fatigue (62.4%), cough (61.1%), anorexia (57%), thirst (53.7%), respiratory distress (51%) and chills (48.3%). The decrease in CRP and ferritin levels was higher in the QCB group (all Ps were < 0.05). In the QCB group, the increase in platelet and lymphocyte counts was higher (all Ps were < 0.05). QCB did not reduce the risk of events during follow-up. Adjustments for statistically significant parameters, including the lung stage, use of favipiravir and presence of comorbidity did not change the results. While there was no difference between the groups in terms of event frequency, the QCB group had more advanced pulmonary findings. QCB supplement is shown to have a positive effect on laboratory recovery. While there was no difference between the groups in terms of event frequency, QCB supplement group had more advanced pulmonar findings, and QCB supplement is shown to have a positive effect on laboratory recovery/results. Therefore, we conclude that further studies involving different doses and plasma level measurements are required to reveal the dose/response relationship and bioavailability of QCB for a better understanding of the role of QCB in the treatment of SARS CoV-2.

The possible effect of pentoxifylline on development and severity of retinopathy of prematurity.

BACKGROUND AND AIM: Retinopathy of prematurity (ROP) is the major ocular problem of preterm infants that occurs with abnormal proliferation of immature retinal vessels. Although pentoxifylline (PTX) was reported to inhibit vasculogenesis and neovascularization in experimental studies, there is no clinical data about the effects of PTX treatment on the development and severity of ROP. This clinical study aimed to investigate the possible effects of PTX on the development of ROP. MATERIALS AND METHODS: A single-centre retrospective study was conducted including preterm infants who were hospitalised in the neonatal intensive care unit between 2015-2017 years. Infants were divided into two groups in terms of PTX administration for adjuvant therapy, as PTX and non-PTX groups. RESULTS: A total of 211 infants were included in the study [gestational age 29 (27-31) weeks, birth weight 1140 (960-1340) g]. From these, 97 infants (46%) were given PTX treatment. The two groups were similar in terms of demographic data and baseline clinical characteristics. Any stage of ROP was detected in 47.4% of infants in the PTX group, which was significantly higher than those in the non-PTX group (27.2%) (p = 0.002). The incidence of advanced-stage ROP in the PTX group (10.3%) was also higher than in the non-PTX group (2.6%) (p = 0.021). Repeated usage of PTX was not found to be related to the development of ROP (p = 0.059). The time of PTX administration was similar between the ROP and no-ROP groups (median; one vs one week, p = 0.825). Surfactant therapy, duration of hospital stay, and PTX treatment were found as significant risk factors for ROP in the logistic regression analysis. CONCLUSIONS: In contrast to the experimental studies and also promising results of PTX treatment in some neonatal morbidities, it may be associated with increased incidence and stage of ROP.

Isolated Asymptomatic Pulmonary Artery Sling in a Preterm Neonate.

Pulmonary artery sling is an uncommon entity in the neonatal period. It is defined as an abnormally originated left pulmonary artery arising from the posterior aspect of right pulmonary artery. Because of the associated structures in this region, mostly originating from sixth aortic arch, tracheobronchial anomalies and congenital heart defects, it frequently accompanies the pulmonary artery sling. Etiology of pulmonary artery sling has not been determined to date. Surgical correction is necessary even for asymptomatic cases because of the high mortality. Postoperative mortality is commonly associated with airway defects. Therefore, prompt diagnosis and timely intervention decrease the morbidity and mortality. We, herein, present a case of a neonate with isolated pulmonary artery sling un-associated with their developmental anomalies. Antenatal history was positive for maternal hypothyroidism, for which she was taking L-thyroxine. To the best of our knowledge, this is the first pulmonary artery sling case accompanied by maternal hypothyroidism. Key Words: Pulmonary artery sling, Neonate, Hypothyroidism.

The utility of amniotic fluid pH and electrolytes for prediction of neonatal respiratory disorders.

Background: Amniotic fluid (AF) is a complex structure with a changing content by gestation. Lower genomic expression of Na channels in airways was shown to be associated with respiratory distress syndrome (RDS). The aim of this study was to determine the possible role of amniotic fluid pH and electrolytes for prediction of neonatal respiratory morbidities.Methods: This was a prospective controlled cohort study. During C-section, 1 ml of AF was aspirated before incision of membranes. AF pH and electrolytes were analyzed by blood gas analyzer. Maternal and neonatal demographic features and clinical outcomes, respiratory morbidities were all recorded.Results: AF Na and K values were significantly higher in all infants with respiratory morbidities compared with those who did not develop respiratory findings. AF Na value was significantly higher in preterm neonates with RDS as well as in term neonates with transient tachypnea of the newborn (TTN). AF pH did not show any significant difference for prediction of respiratory morbidities in term and preterm infants.Conclusion: This is the first study that reported the value of AF Na and K levels for prediction of respiratory morbidities in term and preterm infants. However, further studies including larger number of infants are required to confirm the role of AF analysis to predict neonatal respiratory morbidities. Randomized controlled trial (RCT) number: NCT02813954.

Urgent surgical management of congenital intracranial hemangiopericytoma in a preterm neonate.

Hemangiopericytoma is a rare mesenchymal tumor originating from capillary pericytes, known as Zimmermann pericytes. The adult form is not uncommon and generally malignant but tumor is found rarely in children. Here we describe an intracranial hemangiopericytoma in a preterm newborn whose had the tumor resected successfully shortly after birth.

Neonatal atrial flutter: Three cases and review of the literature.

Yilmaz-Semerci S, Bornaun H, Kurnaz D, Cebeci B, Babayigit A, Büyükkale G, Çetinkaya M. Neonatal atrial flutter: Three cases and review of the literature. Turk J Pediatr 2018; 60: 306-309. Atrial flutter (AFl) is known to be a seldom type of fetal and neonatal arrhythmia. Although it could end in severe morbidities such as hydrops fetalis or even death, with early prenatal diagnosis and prompt therapeutic approaches the majority of AFl cases show good prognosis. Neonatal AFl might be resistant to first step therapies. Therefore, secondary agents like flecainide, amiodarone, sotalol and cardioversion, if required, could be influent in perinatal tachyarrhythmia. In addition, close follow-up even after discharge is very important to keep all follow-up appointments. Herein, we present three cases of fetal/neonatal AFl in light of the literature and discuss the characteristics, diagnosis and treatment options.

A rare case of cephalothoracopagus janiceps conjoined twins.

Yilmaz-Semerci S, Güzelbey T, Kurnaz D, Kalkan S, Çetinkaya M. A rare case of cephalothoracopagus janiceps conjoined twins. Turk J Pediatr 2018; 60: 751-754. Conjoined twins represent a rare phenomenon of a monochorionic monoamniotic twin. Five types of conjoined twins have been described and thoracocephalopagus was reported to be seen with an incidence of 1 in 3 million. The etiology has not been elucidated yet. Therefore, more data is required to understand this entity better. Herein, we report a case of thoracocephalopagus.

Wickerhamomyces anomalus blood stream infection in a term newborn with pneumonia.

Yilmaz-Semerci S, Demirel G, Tastekin A. Wickerhamomyces anomalus blood stream infection in a term newborn with pneumonia. Turk J Pediatr 2017; 59: 349-351. The incidence of invasive candidiasis is high in neonates admitted to neonatal intensive care unit and is associated with significant morbidity and mortality rates. Candida albicans is the most common fungal agent pathogenic to neonates but invasive fungal infections caused by uncommon fungi have increased in recent years. Wickerhamomyces anomalus is a very rare pathogen causing blood stream infection in neonates, which has reportedly caused only few cases in the literature. Here we report a case of blood stream infection caused by a fungal agent Wickerhamomyces anomalus in a term male infant.