Early Hemodynamic Effects of Mydriatic Eye Drops in Preterm Infants.

OBJECTIVE: Mydriatic eye drops used for retinopathy of prematurity (ROP) examination can cause systemic effects, and there are case reports of serious adverse effects in the literature. In this prospective study, we aimed to evaluate the early hemodynamic effects of mydriatic eye drops to understand the possible mechanisms of adverse effects. STUDY DESIGN: Between December 2018 and March 2019, preterm babies less than 32 gestational weeks and who underwent ophthalmologic examination in our unit were included. The vital signs (heart rate, respiratory rate, oxygen saturation [SpO2], and blood pressure values), cerebral and mesenteric tissue saturation by near-infrared spectroscopy (NIRS), and left ventricular functions of infants were recorded before and after applying mydriatic eye drops (2.5% phenylephrine and 0.5% tropicamide). The data were compared statistically. Strict adherence to prevent systemic absorption of the eye drops was applied. RESULTS: Thirty-two mydriasis procedures were evaluated in 26 patients. The mean gestational age was 28.5 ± 1.7 weeks, and the mean birth weight was 943 ± 233 g. There were no significant differences in terms of vital signs of infants including heart rate, blood pressure, and oxygen saturation [SpO2] levels before and after eye-drop application. In addition, NIRS values showed no significant differences between before and after measurements. No significant differences were detected at echocardiographic evaluation performed before and after mydriatic administration. No adverse reaction was observed in the study population during the study. CONCLUSION: This is the first study that evaluated the early hemodynamic effects of mydriatic eye drops used for ROP screening by vital signs, NIRS, and echocardiographic evaluation. Mydriatic eye drops have no significant effect on early hemodynamic parameters including vital signs, NIRS, and echocardiographic findings in preterm infants. We suggest that a cautious approach for avoiding the systemic absorption of these agents may prevent the possible early systemic effects in this high-risk population. KEY POINTS: · Mydriatic eye drops are commonly used for pupil dilatation before retinopathy of prematurity examination, and there are reports of serious adverse events caused by these drops.. · Due to the adverse events of eye drops, hemodynamic effects of these agents were investigated by clinical findings, near-infrared spectroscopy, and echocardiography.. · No significant early hemodynamic effect was observed so avoiding systemic effects may be prevented with precautions..

SIMPLE: A Novel Scoring System for Predicting Hemodynamically Significant Patent Ductus Arteriosus Without Echocardiographic Evaluation in Extremely Low Birth Weight Infants.

Aim: To develop a novel clinical scoring system for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in extremely low birth weight (ELBW) infants. Methods: A prospective observational study was conducted among ELBW infants born in the study center during a 6-month period. Fourteen items were selected on a literature review basis and weighed by severity on an arbitrary 1-4 scale, the sum of which represented the Scoring preterm Infants for PDA cLinically without Echocardiographic evaluation (SIMPLE) score. The SIMPLE scores were compared at several time points during the first 3 days of life between two groups of patients: those with an hsPDA at echocardiography and those without. Results: A total of 48 ELBW infants were enrolled, of which 30 infants developed hsPDA. The SIMPLE scores of the infants with hsPDA were significantly greater than those of the infants who did not develop hsPDA. Cut-off SIMPLE scores that were significantly associated with detection of symptomatic hsPDA at each evaluation time point were identified. Conclusions: SIMPLE is the first scoring system that depends on the risk factors and clinical findings of ELBW infants for early prediction of hsPDA. It is simple, objective and easy to perform, and it does not require any additional tests and/or echocardiographic evaluation. We suggest that SIMPLE can be used as a screening tool for determining the need for echocardiographic evaluation in ELBW infants in order to minimize the number of unnecessary pediatric cardiology consultations.

Congenital esophageal diverticulum in a very low birth weight infant: case report and review of literature.

BACKGROUND: A diverticulum is an outpouching of a tubular organ that is classified as congenital and acquired according to the involved layers of the gastrointestinal wall. Congenital true diverticulum has been very rarely seen in neonatal period and it is very difficult to diagnose it especially in premature infants. CASE: A male infant was born with birth weight of 1000 g at 28th gestational week, was hospitalized for prematurity and respiratory distress. During follow up intermittent CO2 retention was observed in blood gases. On the 17th day of hospitalization, esophageal dilatation was detected on X-ray and barium swallowed esophagram showed a saccular pouch on the distal esophagus. The patient was operated on 26th day of life and pathological specimen revealed true diverticulum of esophagus. The patient died due to respiratory failure and septic shock during hospitalization. CONCLUSION: To the best of our knowledge this case is the smallest and youngest preterm infant diagnosed with congenital esophageal diverticulum. Prolonged and intermittent CO2 retention such as in our case can be an atypical symptom of congenital diverticulum and it should be suspected in the differential diagnosis. Congenital esophageal diverticulum may be also seen in extremely preterm infants and can present with unusual symptoms.

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.

Angioedema Associated With Nebulized Recombinant Human DNase in a Preterm Infant: Case Report.

Pulmonary atelectasis leads to difficulties in weaning of the neonates from mechanical ventilation. The management of persistent atelectasis in neonates constitutes a common challenge for physicians. Several reports suggested Recombinant human DNase (rhDNase) as a beneficial therapy for neonates with persistent atelectasis by reducing mucous viscosity. No adverse effect associated with rhDNase treatment was reported in neonates. Herein, we report probable adverse reactions associated with rhDNase use in a preterm infant. Therefore, we suggest that clinicians must be aware of this reaction in neonates and should carefully follow up these infants for the development of adverse reactions. We think that more clinical experience and data are needed to define its tolerability and adverse effect profile in neonates.

Predictive Factors for Clinical Severity and Cardiopulmonary Arrest in Pediatric Electrical Injuries in Southeastern Turkey.

OBJECTIVE: An electrical injury (EI) is an emergency that causes high morbidity and mortality each year. The aim of this study was to define the epidemiological, clinical, and laboratory factors that might predict severe patients and cardiac arrest in pediatric EI cases. METHODS: All of the patients' medical files were reviewed retrospectively through a 2-year period for the demographic, clinical, and laboratory findings. The patients were classified into the severe injury group or the mild injury group. The SPSS (Chicago, Ill) software was used to analyze the data. RESULTS: Among the 38 patients, 18 patients (47.4%) were in the mild group, and 20 patients (52.6%) were in the severe group. Low-voltage injuries were observed in 35 (92.1%) of the patients. Most of the severe patients were injured with low voltage (75%) and in household settings (85%). Plug and sockets were the most observed source of the injuries in all of the patients, whereas water-related injuries were most prevalent in the severe group. The source of injury was different in the mild and severe groups (P = 0.009). In the severe group, 13 patients (34.2%) were resuscitated after cardiopulmonary arrest. In the multivariate analysis of the demographic data, the most predictive parameters for cardiac arrest and the clinical severity in EIs are the factors of electrical cables and water. CONCLUSIONS: Electrical injuries are a significant concern in the pediatric population. Our results showed that low voltage and household electricity could cause morbidity and mortality.

Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature.

PURPOSE: Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations. METHODS: VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded. RESULTS: A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%. CONCLUSION: Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.

Neonatal Appendicitis as a Rare Cause of Intestinal Perforation in a Preterm Neonate.

Intestinal perforation or inflammation due to appendicitis is rarely encountered in the neonatal period. The diagnosis may be delayed due to the lack of specific clinical symptoms and its rarity in this patient population. Early surgical treatment is the main treatment strategy with a good prognosis. However, delayed diagnosis may result in complications and even death. Herein, we describe a late preterm female neonate without any risk factors who had a diagnosis of perforated appendicitis at postnatal day 5. To the authors' knowledge, this case represents the earliest presentation of neonatal perforated appendicitis elucidated by prompt diagnostic laparotomy. Neonatal appendicitis should be considered in the differential diagnosis of infants with abdominal clinical findings.

Hepatic Abscesses in Preterm Infants: Report of Three Cases and Review of the Literature.

PURPOSE: Hepatic abscess is a rare but potentially fatal entity in neonates. The aim of this study was to provide valuable data for diagnosis, management and prevention of hepatic abscess in preterm infants. METHODS: A retrospective chart review was made for patients diagnosed with hepatic abscesses between 2012 and 2015. Methods included clinical and radiological review of records and evaluation of potential risk factors. RESULTS: A total of three infants with hepatic abscesses were identified. All of them had low birth weight and low gestational age. Predisposing factors included prematurity, late sepsis, umbilical catheterization, necrotizing enterocolitis and previous antibiotic therapy. Isolated organisms from blood included Staphylococcus spp. in two cases and Pseudomonas spp. in one case. To the best of our knowledge, this is the first preterm case of hepatic abscess caused by Pseudomonas aeruginosa in the literature. All patients responded well to antibiotic therapy alone, and no interventional drainage was required. CONCLUSION: We suggest evaluating all preterm neonates who have severe sepsis and/or necrotizing enterocolitis signs and who do not respond to prolonged antibiotic therapy with detailed abdominal ultrasound for possible hepatic abscesses as early diagnosis, and treatment favors prognosis.

Predictive Factors for Determining the Clinical Severity of Pediatric Scorpion Envenomation Cases in Southeastern Turkey.

OBJECTIVE: The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases. METHODS: The medical files of 41 scorpion envenomation cases were reviewed retrospectively. The cases were classified as mild-moderate or severe. The epidemiological, clinical, and laboratory findings of patients were recorded. RESULTS: There were 27 patients (65.9%) in the mild-moderate group and 14 patients (34.1%) in the severe group. The median age of all patients was 48 months. The most common systemic finding was cold extremities (41.5%). In all patients, the most commonly observed dysrhythmia was sinus tachycardia (34.1%). Two patients (4.9%) had pulseless ventricular tachycardia and died. Pulmonary edema and myocarditis were observed in 9 patients (22%). Median values of leukocyte and glucose levels were markedly increased in the severe group. Additionally, the mean thrombocyte level (540,857 ± 115,261 cells/mm(3)) in the severe group was significantly increased compared with the mild-moderate group (391,365 ± 150,017 cells/mm(3)). Thrombocyte levels exhibited a positive correlation with leukocyte and glucose values and a negative correlation with patient left ventricular ejection fraction. Multivariate analysis of laboratory parameters indicated that the most predictive factor for clinical severity is thrombocytosis (odds ratio 23.9; 95% CI: 1.6-353.5, P = .021). CONCLUSIONS: Although our results share some similarities with those of other reports, thrombocytosis was markedly increased in the severe group and served as the most predictive laboratory factor of clinical severity.

Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature.

With advances in medical sciences, an increase in survival rates of low birth weight; increased incidence in use of catheter and antibiotics, and total parenteral nutrition are reported, therefore, the rate of fungal infections in late and very late onset neonatal sepsis have increased. Although fungal endocarditis rarely occur in newborns, it has a high morbidity and mortality. Antifungal therapy is often insufficient in cases who develop fungal endocarditis and surgical treatment is not preferred due to its difficulty and high mortality. Herein, fungal endocarditis in a preterm newborn treated with single-dose recombinant tissue plasminogen activator in addition to antifungal therapy is presented and relevant literature has been reviewed. The vegetation completely disappeared following treatment and no complication was observed.