The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

Objective: The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. Methods: This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). Results: A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Conclusion: Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

Effect of kangaroo mother care on cerebral oxygenation, physiological parameters, and comfort levels in late-premature infants: A randomized controlled trial.

OBJECTIVE: To measure the effects kangaroo mother care (KMC) on the regional cerebral oxygen saturation (rSO2) measured with near-infrared spectroscopy (NIRS) in premature infants and to study the physiological stability and comfort of the infants during such interventions. DESIGN: This was a prospective, single-centered, single-blind, 2-arm, parallel-group randomized controlled trial conducted. SETTINGS: The study was carried out in a tertiary neonatal intensive care unit in Medical Faculty Hospital in Konya/Turkey. PARTICIPANTS: Premature infants born between 24 and 36+6 weeks. Participants were randomly assigned to one of two groups: kangaroo care (n = 20) and control groups (n = 20). The rSO2, oxygen saturation (%SpO2), heart rate (HR), respiratory rate, body temperature, and comfort levels of the infants were evaluated in three stages. FINDINGS: In the 60th min measurement of the intervention group, rSO2, body temperature, heart rate, respiratory rate, and, comfort level, the comfort level was found to be higher and significant in the 30th and 60th min measurements (p < 0.001). In the intervention group, the rSO2 (p < 0.001), body temperature (p < 0.001), HR (p < 0.001), SpO2 (p < 0.001), respiratory rate (p < 0.001), and comfort levels (p < 0.001) scores with the control group and the group × time interaction was significant. KEY CONCLUSIONS: KMC moderately increased the rSO2 levels and also created a moderate effect size on the physiological parameters and comfort levels of the newborns, which implicates its short-term benefits for premature infants. PRACTICE IMPLICATIONS: KMC may be beneficial in stabilizing rSO2 and physiological parameters and increasing comfort in premature infants. The trial was registered in ClinicalTrials.gov (identifier: NCT04725435).

Effects of the storage of breast milk at different temperatures on total antioxidant capacity, total oxidant status, and paraoxonase-1 level.

Konak M, Minici M, Tarakçi N, Altunhan H, Toker A, Örs R. Effects of the storage of breast milk at different temperatures on total antioxidant capacity, total oxidant status, and paraoxonase-1 level. Turk J Pediatr 2019; 61: 1-6. Breast milk is a well-balanced ideal nutritional source with high bioavailability for infants. As being a fresh, biological and dynamic product, changes in the breast milk during these storage periods have been the subject of ongoing research. This study aims to evaluate total antioxidant capacity (TAC), total oxidant status (TOS), and paraoxonase-1 (PON-1) levels of fresh and freezestored breast milk. Ten cc of breast milk was obtained from the mothers as the days between 10 and 15 in the morning within a 1-hour period. TAC, TOS, and PON-1 levels were evaluated in the fresh breast milk. Collected breast milk samples were divided into two groups for storage at -20°C or -80°C. Stored samples were tested for TAC, TOS, and PON-1 levels after 72 hours. The highest TAC level was detected in fresh breast milk (p < 0.05). The TOS levels of fresh breast milk showed a statistically significant reduction in rate after storage. The TOS levels at -20°C and -80°C were significantly lower at -80°C (p < 0.05). Our study results show that oxidant and antioxidant activities are at the maximum level in the fresh breast milk. In terms of antioxidant status the effect of freezing temperatures hasn`t been determined. We conclude that it is more convenient to store the breast milk at -80°C than to store at -20°C in terms of preserving the storage TOS level.

Short-term results of patients with neural tube defects followed-up in the Konya region, Turkey.

BACKGROUND: Additional congenital anomalies have often been found in patients with neural tube defect (NTD). We aimed to find out the clinical features, short term prognosis, treatment approaches, and systemic anomalies of NTD patients in the Konya region. METHOD: A total of 186 newborn babies with NTD were retrospectively included in the study and all were assessed in detail for congenital anomalies and clinical features. RESULTS: When the application month of the patients was examined, it was seen that the most frequent month was July. Of 186 babies, 101(54.3%) had meningomyelocele, 53 (28.5%) had meningocele, 13 (7.0%) had encephalocele, 16 (8.6%) had spina bifida occulta, and 4 (2.1%) had anencephaly. Of these patients, 97 (52.2%) were male and 89 (47.8%) were female. Hydrocephalus was an almost constant finding and was found in 140 (75.3%) patients. 51 (27.4%) patients had congenital heart disease (CHD). The most common CHD was atrial septal defect 22.3%. Orthopedic anomaly was detected in 51 (27.4%) patients, nephrological anomaly was found in 47 (25.3%) of the cases, congenital hypothyroidism was diagnosed in 14 (7.5%) patients with NTD. The mortality rate of patients diagnosed with NTD was 7.5%. The rates of premature delivery and consanguinity between parents were higher in patients with NTD. CONCLUSIONS: Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with NTD, and these anomalies significantly increase their morbidity and mortality. All newborn babies with NTD should be screened for additional congenital anomalies and evaluated with more organized, multidisciplinary methods.

Total antioxidant, total oxidant and serum paraoxonase levels according to lipid administration method in parenterally fed premature infants.

OBJECTIVE: The aim of our study was to determine whether lipid solutions delivered separately or in mixture with total parenteral nutrition (TPN) solutions effect the balance between oxidant and antioxidant levels in premature infants. METHODS: A total of 60 preterm newborns who were delivered at their 30-34 gestational weeks and received TPN were included in the study. Premature newborns were randomized into two groups based on the delivery method of the lipid solution, separately (Group 1) or in mixture with TPN solutions (Group 2). Total antioxidant status (TAS), total oxidant status (TOS) and paraoxonase (PON-1) levels were analyzed in both blood samples, and oxidative stress index (OSI) was also calculated. RESULTS: Thirty cases from both groups were included in the study. Statistically significant decrease in the level of TAS and increase in the level of PON-1 were detected at 72 h of TPN therapy in both groups (p < 0.05). Statistically significant decrease in both TOS and OSI levels were observed in Group 2 (p < 0.05). In association with these findings, any statistically significant intergroup difference was not detected in both parameters regarding oxidant balance (p > 0.05). CONCLUSION: Our study showed that according to lipid administration method any difference for oxidant-antioxidant balance was not detected.

The protective effects of different treatments on rat salivary glands after radiotherapy.

This study was aimed to evaluate the efficacy of treatment modalities for minimizing salivary gland damage caused by radiotherapy. Forty rats were divided into five groups. Group 1 had no irradiation or any treatment. Group 2 underwent only 15 Gy single dose radiotherapy. N-acetylcysteine, dexamethasone, hyperbaric oxygen treatment were given, respectively to the group 3, 4 and 5 for 5 days. 15 Gy single dose radiotherapy was applied to the group 3, 4 and 5 on the second day. Pyknosis, lysis, and vacuolization were examined in ductal cells and pyknosis, lysis, vacuolization, inflammation and collective duct damage in acinar cells. Dexamethasone and hyperbaric oxygen did not prove to have a positive effect on acinar and ductal cell. N-acetylcysteine-applied group had statistically significantly lower amount of damage. We determined that the decrease of ductal and acinar cell damage in parotid glands of N-acetylcysteine-applied rats was more distinct and statistically.

Fully automated simultaneous umbilical arteriovenous exchange transfusion in term and late preterm infants with neonatal hyperbilirubinemia.

OBJECTIVES: The purpose of this study was to compare the efficacy and safety of two different catheterization techniques of exchange transfusion (ET) used in the therapy of newborn jaundice: fully automated two-way ET technique and the classical one-way ET. PATIENTS AND METHODS: The study included babies at gestational age of >34 weeks. In total, 107 ETs were performed on 86 babies. Totally, the umbilical vein (UV) group included 54 babies having undergone 69 ETs and the UV/UA group included 32 babies having undergone 38 ETs. RESULTS: The declines in bilirubin levels right after ET (p = 0.018) and 8 h after ET (p = 0.014) were higher in the fully automated UV/UA technique than in the classical UV technique. Furthermore, the duration of intensive phototherapy following ET was shorter in the UV/UA method than in the UV method (p = 0.003). There was no difference between the two methods in terms of ET-associated complications (p = 0.927). CONCLUSIONS: In neonatal hyperbilirubinemia, ET with fully automated UV/UA technique is more efficient than the classical ET technique, causing no additional side-effects. It is also more physiological than the classical technique, since it minimizes the fluctuations in the blood volume and intravascular pressure during ET.

Birth weight and gestational age in newborns exposed to maternal obsessive-compulsive disorder.

We examined the impact of maternal obsessive-compulsive disorder (OCD) on gestational age and birth weight of infants. The sample included 63 mothers (28 patient and 35 controls). OCD and other psychiatric diagnoses were determined with a structured clinical interview. Birth weight and gestational age were lower in the newborns exposed to maternal OCD compared to ones who were not exposed. The results suggest that maternal OCD may negatively affect fetal weight growth and gestational duration.

Total antioxidant and total oxidant states, and serum paraoxonase-1 in neonatal sepsis.

BACKGROUND: Paraoxonase-1 (PON-1) is an enzyme with a glycoprotein structure that depends on calcium and which is located in serum high-density lipoprotein (HDL). The aim of this study was to evaluate PON-1, and oxidant/antioxidant state, before and after treatment for neonatal sepsis, and to determine the usability of PON-1 in neonatal sepsis treatment. METHODS: A total of 35 neonatal sepsis patients and 35 healthy controls were included in the study. Activity of PON-1, total oxidant state (TOS) and total antioxidant state (TAS) were measured and oxidative stress index (OSI) was calculated. RESULTS: In the neonatal sepsis patients, pre-treatment TAS, TOS and OSI were significantly higher than the post-treatment levels (P < 0.0001, P < 0.0001 and P < 0.0001, respectively), and PON-1 was significantly lower (P < 0.0001). Similarly, pre-treatment TAS, TOS and OSI in the sepsis group were also significantly higher than in the control group (P < 0.0001, P < 0.0001 and P < 0.0001, respectively) and PON-1 was significantly lower (P < 0.0001). Post-treatment TAS in the sepsis group was significantly higher than in the control group (P = 0.009), whereas post-treatment TOS, OSI and PON-1 in the sepsis group were not significantly different to the control group (P = 0.078, P = 0.597 and P = 0.086, respectively). CONCLUSION: Low serum PON-1 was found in neonatal sepsis. Serum PON-1 is thought to be a useful biomarker to evaluate the effectiveness of treatment and recovery in neonatal sepsis.

Total oxidant, antioxidant, and paraoxonase levels in babies born to pre-eclamptic mothers.

AIM: The aim of this study was to investigate the oxidant-antioxidant status in babies born to pre-eclamptic mothers (BBPM). MATERIAL AND METHODS: The paraoxonase (PON)-1, total antioxidant status (TAS), and total oxidant status (TOS) levels were measured in the cord blood and venous blood (7th day) of BBPM (n = 31) and babies born to normotensive mothers (n = 25). RESULTS: The PON-1 and TOS levels in the cord blood and venous blood on the 7th day were not significantly different between the two groups; however, the cord blood TAS levels were higher in BBPM (P = 0.001), and the TAS levels in the venous blood were higher in the control group (P = 0.021). Furthermore, the cord blood PON-1 levels of babies born to severely pre-eclamptic mothers (n = 18) were higher than those of babies born to moderately pre-eclamptic mothers (n = 13) (P = 0.042). There were no differences in the cord blood TAS and TOS levels and venous blood PON-1, TAS, and TOS levels between babies born to severely and moderately pre-eclamptic mothers. CONCLUSION: The increased TAS levels found in the cord blood of BBPM indicate that the fetus is protected against oxidative damage caused by increased oxidative stress in the mother. To the best of our knowledge, this is the first study in the published work investigating PON-1 levels in BBPM.

Successful use of topical "Ankaferd Blood Stopper" for repetitive bleedings in an infant with infantile hemangioma.

Infantile hemangioma (IH) is the most common vascular tumor of childhood. A major feature of this tumor is rapid growth during a proliferation phase in the first year of life, followed by contraction through a slow involution phase. Several complications may emerge during this course. Bleeding at the site of the lesion and infection are the most common complications. 'Ankaferd Blood Stopper' (ABS) is a hemostatic agent produced as a mixture of five separate plant extracts. Provision of hemostasis by ABS is independent from coagulation factors and the standard coagulation cascade. Furthermore, ABS has an antimicrobial effect. In this article, we have presented a seven-year-old infant with IH on the lower lip who had been admitted with the symptoms of frequent bleedings and infection, and who was successfully treated with topical ABS in terms of control of bleeding and infection. To the best of our knowledge, this is the first reported case of IH that has been treated with ABS for bleeding.

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey.

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.

Anogenital distance in Turkish newborns.

OBJECTIVE: Anogenital distances are considered to be a sensitive indicator of external genitalia exposure to factors such as anti-androgens, and/or endocrine distruptors during the prenatal period. Exposure to such factors can lead to changes in the anogenital measurements (AGM) of newborn infants. These measurements can be used to predict masculinization of the external genitalia in healthy newborns. The goal of this study was to determine normal values for AGM in Turkish newborns of both genders. METHODS: One hundred fifteen female and 135 male term newborns with no congenital defects were included in this study. A well-trained observer measured the anogenital distance by using a sliding Caliper graduated in millimeters. Anogenital distance was measured from the center of the anus to the posterior convergence of the fourchette in females and from the center of the anus to the junction of the smooth perineal skin with the base of the scrotum in males. RESULTS: Anogenital distance in males and females was 23±0.6 mm and 10.3±0.2 mm, respectively. There were significant differences in anogenital distance values between male and female newborns (p<0.05). CONCLUSION: The findings of this study provide data that can be used as reference standards with regard to AGM of the posterior genital structures in Turkish male and female newborns. These data will also serve in postnatal evaluations to determine the effects of prenatal exposures to factors affecting development of genitalia.

Hartnup disease masked by kwashiorkor.

This report describes an 11-month old girl with Hartnup disease presenting with kwashiorkor and acrodermatitis enteropathica-like skin lesions but free of other clinical findings. This case with kwashiorkor had acrodermatitis enteropathica-like desquamative skin eruption. Since zinc level was in the normal range, investigation for a metabolic disorder was considered, and Hartnup disease was diagnosed.