Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns.

OBJECTIVE: To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment. DESIGN: A prospective, controlled cohort analysis. SETTING: A tertiary level mother-child birth and health care center. PARTICIPANTS: Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period. METHODS: A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups. RESULTS: All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group. CONCLUSIONS: Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.

Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society.

OBJECTIVE: To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. MATERIAL AND METHODS: A prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived. RESULTS: Data from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. CONCLUSION: The present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

Transcutaneous Bilirubin Levels during the First Month of Life in Term and Late-preterm Newborns.

OBJECTIVE: We aimed to develop a transcutaneous bilirubin (TcB) nomogram for assessment of the risk of significant hyperbilirubinemia and prolonged jaundice during the first month of life in term and late-preterm Turkish newborns. METHODS: On the basis of the daily (3rd, 7th, 15th and 30th days) TcB measurements, 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles, and 5 percentile tracks were obtained. TcB measurements were made by a transcutaneous bilirubinometer (JaundiceDetector JH20-1C). RESULTS: We screened 729 healthy term and late-preterm Turkish infants 3-30 days old and developed a nomogram of TcB levels. TcB level was ≥5 mg/dl in 41.98% and 25.9% of infants at age 15.0 ± 2.1 days and 30.9 ± 2.6 days, respectively. The TcB measurement-based nomogram values of the 97th percentiles (cutoff values) at age 15.0 ± 2.1 and 30.9 ± 2.6 days were 11.4 (10.82-12.13) mg/dl and 10.0 (9.40-10.70) mg/dl, respectively. CONCLUSION: This nomogram can be used to determine the risk status of Turkish newborns regarding significant hyperbilirubinemia and prolonged jaundice on the basis of TcB measurement in the first month of life.

Reliable and powerful laboratory markers of cobalamin deficiency in the newborn: plasma and urinary methylmalonic acid.

BACKGROUND: Diagnosing cobalamin deficiency is critical, given the high prevalence of cobalamin deficiency particularly in developing countries. Measuring serum cobalamin levels is of limited diagnostic sensitivity, in other words its specificity and sensitivity are low. The present study investigated the changes in the levels of metabolic markers - plasma homocysteine, plasma methylmalonic acid (MMA) and urinary MMA - of cobalamin metabolism. METHODS: Plasma cobalamin and serum folic acid were studied in 206 pregnant women over the last four prenatal weeks. Plasma cobalamin, folic acid, homocysteine, MMA from umbilical cord blood and urinary MMA in newborns were studied. RESULTS: Plasma cobalamin values were low in 66% of the mothers. There was a positive correlation between maternal and neonatal plasma cobalamin values (r = 0.72, p < 0.001). B12 was strongly inversely associated with plasma MMA, urine MMA and plasma homocysteine. To predict cobalamin deficiency, sensitivities of plasma MMA, urinary MMA and homocysteine were 96.4%, 95.6% and 88.2%, respectively. And positive predictive values (PPV) were 96.2%, 96.9% and 86% for plasma MMA, urinary MMA and plasma homocysteine levels, respectively. CONCLUSION: Plasma MMA and urinary MMA B12 are the most robust markers of cobalamin deficiency. As a non-invasive method, urinary MMA is a sensitive method in demonstrating cobalamin deficiency in the newborn.

A rare entity: idiopathic priapism in a newborn and review of the literature.

Priapism is a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is an important medical condition, which requires evaluation and may require emergency management. This condition occurs very infrequently in paediatrics outside of the sickle-cell population and is exceedingly rare in newborns. The evaluation and management of neonatal priapism can be challenging for paediatricians, neonatologists and paediatric urologists alike given the lack of experience with this condition, its poorly understood pathophysiology and the absence of well-established guidelines. We present a case of idiopathic neonatal priapism because of its rarity and review of the literature.

Severe vitamin D deficiency among pregnant women and their newborns in Turkey.

OBJECTIVES: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey. METHODS: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers' age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels. RESULTS: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97 ± 3.27 ng/ml and 4.29 ± 2.44 ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p < 0.05). Ninety-five mothers had serum 25(OH)D3 below 20 ng/ml and all cord blood serum 25(OH)D3 levels were below 20 ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71 ± 1.88 and 5.2 ± 3.4 ng/ml, respectively, with a significant difference between them (p < 0.05). CONCLUSION: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.

Comparison of two transcutaneous bilirubinometers in term and near-term neonates.

PURPOSE: Determination of bilirubin levels is performed for many newborns in the first days of life, and several different transcutaneous bilirubinometers are available. We aimed to determine whether transcutaneous bilirubin measurement, as performed using Jaundice Detector JH20-1C, a new device, correlates with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. DESIGN AND SAMPLE: The study was performed on term or near-term newborn infants who underwent transcutaneous bilirubin measurements as part of their normal care. The study group consisted of 585 newborn infants with gestational ages ranging from 35 to 42 weeks, coming from an uneventful pregnancy. In this prospective study, bilirubin concentrations were determined with two different transcutaneous bilirubinometers. MAIN OUTCOME VARIABLE: In 585 infants, the correlation coefficient for Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was .965 (p < .0001). The mean (± standard deviation) difference between the Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was 0.26 ± 0.95 mg/dL. Results showed the Jaundice Detector JH20-1C to have an acceptable level of intradevice imprecision (r = .978, p < .0001, mean differences .0158 ± .871 mg/dL). RESULTS: Jaundice Detector JH20-1C showed the good performances of intradevice and interdevice imprecision in comparison with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. Jaundice Detector JH20-1C may be suitable for screening term or near-term newborn infants for jaundice in the well-baby nursery or maternity ward.

Fluconazole administration leading to anaphylactic shock in a preterm newborn.

Preterm infants, born with immature innate immunity, are less likely to develop anaphylaxis. Fluconazole prophylaxis during the first six weeks of life decreases invasive candidiasis in very low birth weight infants. Adverse effects of fluconazole are very rare. In this study, we report a newborn (a male, 26 weeks gestation and 900 g birth weight) who developed anaphylaxis after fluconazole administration. Hypotension and erythematous rash were present. We believe this to be the first anaphylaxis case in newborns caused by fluconazole in literature. Clinicians should be aware of the possibility of this potentially fatal adverse effect occurring with intravenous fluconazole.

Levetiracetam-induced anaphylaxis in a neonate.

BACKGROUND: Neonatal seizures are often refractory to treatment with initial antiseizure medications. Clinicians turn to agents such as levetiracetam despite the paucity of published data regarding its safety, tolerability, or efficacy in the neonatal population. PATIENT PRESENTATION: We describe a neonate who developed anaphylactic shock developing after receiving intravenous levetiracetam. RESULTS: This is the first neonate to develop anaphylactic shock due to intravenous administration of levetiracetam. CONCLUSION: Clinicians should be aware of this potentially fatal adverse effect occurring with intravenous levetiracetam in newborns.

Anaphylactic shock due to vitamin K in a newborn and review of literature.

Newborn infants are born with an immature innate immunity. They are less likely to develop anaphylaxis since their immune system is weaker than older infants and children. There are only a few reports of side effects after vitamin K injection in neonates although prophylaxis against hemorrhagic disease of the newborn with this drug has been in routine practice in all over the world for many years. We herein report a case of anaphylactic shock developing after the intramuscular administration of vitamin K1 in a newborn. To our knowledge, this patient is the first case of neonatal anaphylactic shock developing due to intramuscular administration of vitamin K1. We suggest the clinicians should be aware of this possibility of potentially fatal adverse effect occurring with intramuscular administration of vitamin K1.

Foot Skin Ischemic Necrosis following Heel Prick in a Newborn.

There are only a few reports on side effects after heel prick in neonates although heel prick has been performed all over the world for many years. The medicine staff had obtained only a drop of blood by pricking the baby's heel using a lancet without compressing the heel or foot to measure his blood glucose level 3 hours after birth. However he developed a severe and hemorrhagic skin reaction on his entire left foot, beginning 30 minutes after obtaining the drop of blood by pricking the baby's heel using a lancet. The lesion, which was treated with topical mupirocin and povidone-iodine solution daily, slowly decreased in size and had almost fully resolved within 3 weeks. He was healthy and 9 months old at the time of writing this paper. We herein report a case of foot skin ischemic necrosis following heel prick in a newborn. To our knowledge this patient is the first case of foot skin ischemic necrosis due to heel prick in newborns.

Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn.

Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85-90% pancreatectomy was performed and histological "diffuse nesidioblastosis" was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia.

Anaphylactic shock due to hepatitis B immunoglobulin in a newborn.

Hepatitis B immunoglobulin (HBIG) is administered for the passive immunisation of all infants born to HBsAg-positive mothers within 12 h of birth. Adverse effects of HBIG are very rare. In this study, we report a newborn (a female, 33 weeks' gestation and 2030 g birth weight) developing anaphylaxis after HBIG administration. The mother was a Hepatitis B virus (HBV) carrier. Hypotension and erythematous rash developed 7 min after HBIG administration. Reporting the first anaphylaxis case in newborns due to HBIG in literature, we suggest the condition be taken into account, and requisite precautions should be taken against this probable complication in the newborn.

The relationship between abdominal aortic intima-media thickness and lipid profile in neonates born to mothers with preeclampsia.

Neonates born to mothers with preeclampsia are known to be associated with lipid alterations that might increase the risk for cardiovascular disease in adult life. The aim of this study was to investigate the effect of preeclampsia on lipid metabolism, aortic intimamedia thickness (aIMT) and subsequent atherogenic risk in newborn infants. Aortic intima-media thickness was measured in 60 neonates of mothers with preeclampsia (group I; 30 neonates of mothers with preeclampsia and group II; 30 neonates of mothers with severe preeclampsia) and 30 healthy neonates (group III). Maternal and cord serum lipid profiles were determined in all groups. Mean abdominal aIMT measurements were higher in the neonates born to mothers with preeclampsia (group I; 0.36 +/- 0.03 mm and group II; 0.36 +/- 0.04 mm) compared with the control group (group III; 0.33 +/- 0.03 mm, p = 0.006). Serum triglyceride levels were significantly higher in the neonates born to mothers with preeclampsia (group I; 39.2 +/- 42.0 mg/dl and group II; 39.5 +/- 56.5 mg/dl) compared with the control group (group III; 14.9 +/- 18.8 mg/dl, p = 0,039). Serum HDL cholesterol levels were significantly lower in the neonates born to mothers with preeclampsia (group I; 17.3 +/- 12.3 mg/dl and group II; 17.1 +/- 12.8 mg/dl) compared with the control group (group III; 27.6 +/- 13.0 mg/dl, p = 0.002). In conclusion; neonates of mothers with preeclampsia have significantly higher aIMT with lipid alterations. This may play a role in the pathogenesis of atherosclerosis in adult life.

Nicolau syndrome induced by intramuscular vitamin K in a premature newborn.

INTRODUCTION: Nicolau syndrome (NS), also known as livedo-like dermatitis or embolia cutis medicamentosa, is a very rare complication of intramuscular and intraarticular injection of various drugs. CASE REPORT: We herein report a case of NS developing approximately 2 h after the intramuscular administration of vitamin K1 in an extremely low birth weight premature newborn. To our knowledge, this patient is the youngest case suffering from such a livedoid skin necrosis and the first case of neonatal NS developing due to intramuscular administration of vitamin K1.

Congenital cytomegalovirus infection associated with severe lung involvement in a preterm neonate: a causal relationship?

We report a preterm neonate with congenital cytomegalovirus (CMV) infection associated with severe lung involvement progressing to early chronic lung disease (CLD) and death. The present case represents the earliest and the most severe lung involvement depending on recurrent maternal CMV infection reported in the literature. Neonatal mortality and progression to early CLD should be considered in the list of possible neonatal sequelae resulting from recurrent maternal CMV infection.

Effect of antenatal betamethasone use on adrenal gland size and endogenous cortisol and 17-hydroxyprogesterone in preterm neonates.

AIM: To assess the effect of antenatal betamethasone use on adrenal gland size and adrenal hormones in preterm neonates who had gestational ages of 27-36 weeks. INFANTS AND METHODS: Sixty-six neonates divided into two groups: betamethasone group, whose mothers received betamethasone 12 mg two times 24 h apart, and no betamethasone group, whose mothers did not receive any steroid agent during the antenatal period. Serum 17-hydroxyprogesterone (17-OHP) levels and cortisol levels were measured during the first six hours of life. In addition, adrenal gland length and width were determined on the first day of life. Hormone tests and ultrasonographic evaluation were repeated on the fifth day of life. RESULTS: We found statistically significant reductions in 17-OHP and cortisol levels at birth in corticosteroid-exposed neonates (p < 0.05). There was no significant difference between the study groups with regard to adrenal gland length and width (p > 0.05). CONCLUSIONS: This study demonstrates that betamethasone use in preterm neonates reduces endogenous 17-OHP and cortisol levels; however, it has no effect on adrenal gland size.

Serum insulin-like growth factor-I (IGF-I), IGF-binding protein-3, and growth hormone levels in collodion babies: a case-control study.

AIM: Because growth failure occurs in many collodion babies, we investigated serum growth hormone (GH), insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels in collodion babies admitted to Gevher Nesibe Hospital, Kayseri, Turkey between 1999 and 2006. PATIENTS AND METHOD: The newborns diagnosed clinically as 'collodion baby' were included in the study group (group 1). Because collodion babies are usually born small for gestational age (SGA) and/or premature, a control group (group 2) was formed by selecting the first infant admitted immediately after each study infant who matched for gestational age (+/- 7 days) and birth weight (+/- 100 g). All infants' blood samples were collected within the first 2 h of life for measurements of serum GH, IGFBP-3 and IGF-I levels. RESULTS: Group 1 consisted of 23 collodion babies (13 males and 10 females) with gestational ages ranging from 32 to 42 weeks, and birth weights ranging from 1,300 to 3,600 g. Ten were born premature and 16 were SGA. Serum IGF-I and IGFBP-3 levels were lower but serum GH levels were higher in collodion babies than in controls. Birth weight was positively correlated with serum IGF-I (r = 0.310, p = 0.046) and IGFBP-3 (r = 0.389, p = 0.011) levels. Serum GH level was negatively correlated with birth weight (r = -0.376, p = 0.014), serum IGF-I (r = -0.567, p <0.001) and IGFBP-3 (r = -0.444, p = 0.003). CONCLUSION: Collodion babies had lower serum IGF-I and IGFBP-3 levels but higher serum GH levels than controls in the present case-control study. The underlying mechanism needs to be explored.