Effect of partially hydrolyzed synbiotic formula milk on weight gain of late preterm and term infants-a multicenter study.

Introduction: Data on the effectiveness of hydrolyzed infant formula containing both pre- and probiotics (synbiotic formula) on the growth of infants is still scarce. This retrospective study was designed to evaluate the effect of a partially hydrolyzed synbiotic formula on growth parameters and the possible occurrence of major gastrointestinal adverse events or morbidities in infants born via cesarean section (C-section) delivery. Methods: C-section-delivered term and late preterm infants who received either partially hydrolyzed synbiotic formula, standard formula, or maternal milk and followed at seven different hospitals from five different regions of Turkey, during a 1-year period with a minimum follow-up duration of 3 months were evaluated retrospectively. All the included infants were evaluated for their growth patterns and any kind of morbidity such as diarrhea, constipation, vomiting, infection, or history of hospitalization. Results: A total of 198 infants (73 in the human milk group, 61 in the standard formula group, and 64 in the partially hydrolyzed synbiotic formula group) reached the final analysis. The groups were similar regarding their demographic and perinatal characteristics. No difference was observed between the three groups regarding gastrointestinal major side effects. Growth velocities of the infants in the human milk and partially hydrolyzed synbiotic formula groups during the first month of life were similar whereas the weight gain of infants in the standard formula group was significantly less than these two groups (p < 0.001). Growth velocities were similar among the three groups between 1st and 3rd months of age. Discussion: A partially hydrolyzed synbiotic formula provided better weight gain in late-preterm and term infants who were delivered via C-section delivery compared to the standard formula during the first month of life. This weight gain was similar to the infants receiving exclusively human milk. This difference was not observed in length and head circumference gain. No difference was observed in any of the parameters during the 1st-3rd months of age. Specially formulated partially hydrolyzed synbiotic formulas may reverse at least some of the negative impacts of C-section delivery on the infant and help to provide better growth, especially during the early periods of life.

Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey.

Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment.

Effects of kangaroo mother care on feeding intolerance in preterm infants.

OBJECTIVE: Feeding intolerance (FI) is a common condition in preterm infants because they have an immature gastrointestinal tract. There are studies on the effects of the position on gastric residual volume (GRV) in preterm infants. Kangaroo mother care (KMC) may be an instrument for reducing FI by providing an upright position to infants. Moreover, numerous studies conducted with this therapeutic position applied by putting an infant on the mother's chest have indicated its positive effects on the infant's weight gain, growth and development, and vital signs. Therefore, this study aimed to reveal the impact of KMC on FI in preterm infants. METHODS: The population of the study, designed as a randomized trial, consisted of 168 preterm infants [KMC: 84, Standart Care (SC): 84] hospitalized in the neonatal intensive care unit of a university hospital between June and November 2020. Infants were randomly selected and divided into two groups. After the vital signs of the infants in both groups became stable, the infants were fed in the same position. KMC was applied to the infants in the intervention group for 1 h by preparing a suitable environment after feeding. Infants in the SC group were placed in the prone position after feeding. The GRVs of the infants in both groups were recorded on the Infant Follow-up Form before the next feeding. RESULTS: No statistically significant difference was detected between the groups upon comparing them in terms of demographic and clinical characteristics. The body temperatures and O2 saturations of the participants in the KMC group were statistically significantly higher, and their respiratory and heart rates were lower than the SC group. The transition time to full enteral feeding was statistically significantly shorter, and FI was experienced significantly less in the KMC group infants than in the SC group (p < 0.05). There was no statistically significant difference between the groups in terms of the infants' weight gain and length of hospital stay (p > 0.05). CONCLUSION: The present study demonstrated that KMC had a positive impact on FI in preterm infants. KMC is not only a safe care model providing the earliest contact between parents and infants but also a practice whose positive effect on the functioning of the digestive system in preterm infants we can use.

Combined (dual) drug therapy for the treatment of patent ductus arteriosus: last approach prior to ligation.

OBJECTIVE: We aimed to evaluate the efficacy of combined (ibuprofen+paracetamol) medical therapy in cases of persistent haemodynamically significant patent ductus arteriosus that are resistant to standard medical monotherapy (ibuprofen and/or paracetamol) in this retrospective multi-centre study. METHODS: The combined therapy included the administration of 15mg/kg/dose of paracetamol every 6 h for 3 days and ibuprofen at an initial dose of 10mg/kg/dose followed by 5 mg/kg/dose every 24 h. After 2 days following the administration of the last dose, the researchers evaluated the efficacy of combined treatment by conducting an echocardiographic examination. RESULTS: Of all 42 patients who received combined therapy, 37 (88.1%) patients exhibited closure of the haemodynamically significant patent ductus arteriosus without requiring surgical ligation. Patients who did not respond to combined therapy had a higher mean birth weight and gestational age compared to those who responded (p < 0.05). CONCLUSION: The researchers believe the success of ibuprofen and paracetamol in haemodynamically significant patent ductus arteriosus treatment may be due to their synergistic efficacy and inhibition of the prostaglandin synthesis pathway through different enzymes. The results of our retrospective trial suggest that combination therapy with paracetamol and ibuprofen can be attempted when monotherapy is unsuccessful in treating haemodynamically significant patent ductus arteriosus, especially in centres without a surgical department.

The effect of natural surfactants on the development of postoperative intraabdominal adhesion.

Background/aim: The development of postoperative adhesion after abdominal surgery is sometimes a severe problem. Our study investigates the effectiveness of exogenous surfactant application in preventing adhesion development in the experimental adhesion model. Materials and methods: This randomized-controlled interventional study was carried out in the animal laboratory of Kahramanmaras Sütçü Imam University between March 1 and March 31, 2020. An experimental intra-abdominal adhesion model was established in 24 adult female rats by cecal abrasion. Rats were randomly divided into four groups. Groups I, II, and III were taken intraperitoneally as beractant, poractant, and calfactant applied groups, respectively. Group IV was the control group. Relaparotomy was performed in all groups on the 15th postoperative day, and intra-abdominal adhesions were scored macroscopically according to the Canbaz scoring system. In addition, the cecal regions were evaluated microscopically and scored according to the Zühlke microscopic classification system. The scores of the groups were compared statistically. Results: The Zühlke adhesion development score was significantly lower in the exogenous surfactant applied groups. In addition, when the surfactant-applied groups were compared among themselves, it was seen that the adhesion score in the beractant group was significantly better than the other surfactant types (p < 0.01). Conclusion: Our study results showed that prophylactic intraperitoneal surfactant application significantly reduced postoperative adhesion development, particularly beractant.

Evaluation of thymic dimensions in patients with multisystem inflammatory syndrome.

BACKGROUND: Multisystem inflammatory syndrome (MIS-C) is the most important complication of COVID-19 in the pediatric population. Unfortunately, this problem is an unpredictable situation in patients with COVID-19. We aimed to evaluate the effects of MIS-C on thymus dimensions in pediatric patients. METHODS: We retrospectively analyzed the files of 368 pediatric patients aged 2-18 years, who were diagnosed with COVID-19. Computer Tomography (CT) images of 22 patients diagnosed with COVID-19 and 10 patients diagnosed with MIS-C were evaluated in detail by two board-certified radiologists. Eighteen age and sexmatched patients who applied to the emergency department of our hospital for any reason and had a CT scan for any reason were selected as the control group. The data of both groups were statistically compared. RESULTS: Considering the differences between the groups in terms of laboratory data, monocytes, hemoglobin, and platelet were significantly lower in the MIS-C group than the other groups. Procalcitonin, C- reactive protein, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proBNP levels were statistically significantly higher in the MIS-C group compared to the other groups Regarding the differences in thymus dimensions, thymus AP diameter, transverse diameter, length, thickness, and volume were significantly higher in the MIS-C group than in the other groups There was a significant positive correlation between the transverse diameter of the thymus and CRP, procalcitonin, pro-brain natriuretic peptide (proBNP), and NLR levels. CONCLUSIONS: Our study shows that thymus dimensions and acute phase reactants are higher in pediatric patients in the MIS-C group. Also, thymus transverse diameter, thymus thickness, and PLR values pose a risk for the development of MIS-C. More research is needed on the role of the thymus gland in the pathogenesis and diagnosis of MIS-C.

Evaluation of Pulmonary Functions After Discharge in Pediatric Patients with COVID-19: A Prospective Study.

Objectives: The aim of this study was to investigate the pulmonary function of pediatric patients with COVID-19 after recovery. Methods: Pediatric patients aged 5-18 years hospitalized with diagnoses of COVID-19 and discharged with recovery were included in this prospective study. Pulmonary function tests (PFTs) were performed through spirometry. Results: The patient group consisted of 34 children and the control group of 33. The forced vital capacity (FVC%) values of the control and patient groups were 110.62±11.71 and 94.21±13.68 (p<0.001), forced expiratory volume in the first second (FEV1%) values were 104.91±6.26 and 98.67±14.93 (p=0.032), FEV1/FVC% values were 108.50±8.81 and 101.06±24.89 (p=0.034), and forced expiratory flow (FEF) 25-75% values were 106.71±6.68 and 101.85±24.89, respectively (p=0.286). However, Spearman correlation analysis revealed moderate negative correlation between length of hospital stay and FEF 25-75% (r=-0.364, p=0.35). Conclusion: PFTs in pediatric patients after recovery from COVID-19 were abnormal in the present study. The results were significant in terms of the development of mixed-type lung disease. Further long- and short-term studies are now needed for a better understanding of the prognosis in these patients.

Haematological parameters predicting cardiac involvement in children with COVID-19 infection.

AIM: Haematological parameters obtained from the full blood count, such as neutrophil-to-lymphocyte ratio (NLR), are cost-effective tests which have been shown to be predictive of the prognosis of many diseases. We aimed to evaluate certain haematological parameters and cardiac biomarkers to test whether they could predict cardiac involvement by COVID-19 infection. METHODS: This retrospective study included patients aged 1 month to 18 years having a positive COVID-19 PCR test but no comorbidity, who were admitted to the paediatric emergency department between 15 March 2020 and 1 February 2021. RESULTS: There were 292 COVID-19 PCR-positive patients, 12 MIS-C patients and 70 healthy controls. A receiver operator characteristic curve analysis was performed to predict MIS-C in patients with COVID-19 infection. An NLR value of ≥5.03 could predict MIS-C with a sensitivity of 66.7% and a specificity of 91.6%; a proBNP value of ≥329.5 ng/L with a sensitivity of 91.7% and a specificity of 95.6%; a CKMB value of ≥2.95 µg/L with a sensitivity of 100% and a specificity of 77.7%; and a troponin-I value of ≥0.03 µg/L with a sensitivity of 75% and a specificity of 99.2%. A logistic regression analysis showed that an NLR value of ≥5.03 increased the risk of MIS-C 19.3 fold; a proBNP value of ≥329.5 ng/L increased the risk 238 fold; and a troponin-I value of ≥0.03 µg/L increased the risk 60 fold. CONCLUSIONS: At the time of admission, parameters such as proBNP, troponin-I and NLR can predict the development of MIS-C in COVID-19 patients with high sensitivity and specificity.

Severe multilobar lung echinococcosis with multiorgan involvement in a child.

Multilobar lung echinococcosis with multiorgan involvement is an extremely rare entity in pediatric populations. We would like to share an adolescent girl with very demonstrative postero-anterior chest X-ray and computed tomography images.

Evaluation of cases with infantile hemangioma requiring treatment.

AIM: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma.

Nosocomial Infections in Non-COVID-19 Pediatric Patients Prior to and During the Pandemic in a Pediatric Intensive Care Unit.

BACKGROUND: Nosocomial infections are a global threat to human health worldwide. AIM: This study aimed to investigate the change of nosocomial infection factors in equivalent historical periods in pediatric patients without COVID-19 before and during the pandemic in the pediatric intensive care unit. METHOD: The study was planned retrospectively. Data on hospital infection rates, incidence densities, invasive device-associated infections, infectious agents, comorbid diseases, and invasive procedures in non-COVID-19 pediatric patients were obtained from the medical records for the periods of April-September 2019 and April-September 2020 in the pediatric intensive care unit. Hand hygiene compliance rates of healthcare workers were evaluated. RESULTS: Prior to the pandemic, the number of patients was 332, comprising 2,377 patient days with a nosocomial infection rate of 5.12, and an incidence density of 7.15. During the pandemic, the number of patients was 221, comprising 2,260 patient days with a nosocomial infection rate of 4.52, and incidence density of 4.43. Prior to the pandemic, there were 28.80% cases of Klebsiella pneumoniae, 23.81% of Pseudomonas aeruginosa, 9.52% of Enterococcus faecium, and 4.76% of Enterococcus faecalis. During the pandemic, there were decreased 14.29% cases of Klebsiella pneumoniae while Pseudomonas aeruginosa, Enterococcus faecium, and Enterococcus faecalis was not seen. Prior to the pandemic, the hand hygiene compliance rate was 94.83%, and during the pandemic, it was found to be 99.44%. CONCLUSION: This study showed that the spread of bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa, vancomycin-resistant enterococci, and Stenotrophomonas maltophilia, which are a major public health threat, can be decreased by applying simple standard methods.

Respiratory problems in preterm infants with pulmonary hemorrhage.

AIM: Pulmonary hemorrhage is an important cause of morbidity and mortality in premature infants. There are few studies on pulmonary hemorrhage and associated morbidities observed in premature. The aim of this study was to investigate the possible relationship between pulmonary hemorrhage and respiratory problems in premature infants. MATERIAL AND METHOD: Premature infants aged 25-32 weeks who were born between January 2014 and January 2018 in the neonatal intensive care unit were included to the study. Of these premature infants, 28 were patients diagnosed as pulmonary hemorrhage and 56 were control cases with the same demographic characteristics without pulmonary hemorrhage. From the medical records of infants; clinical course characteristics such as duration of ventilation, duration of oxygen supplementation, hospital stay were detailed. The data was analyzed statistically. RESULTS: The duration of mechanical ventilation was significantly longer in the pulmonary bleeding group than in the control group (p: .001). There was a significant difference between the groups in terms of moderate and severe bronchopulmonary dysplasia (BPD) and the rate of BPD in the pulmonary hemorrhage group was higher than in the control group (17.2%-53.6%; p: .001). In addition, pulmonary hemorrhage group had significant patent ductus arteriosus (PDA) and preterm retinopathy (ROP) rate compared with control group. DISCUSSION: This study implicated that, pulmonary hemorrhage is related with respiratory morbidities in preterm infants such as BPD and prolonged respiratory support. At the same time, the other morbidities such as ROP prolonged hospitalization are higher in infants with pulmonary hemorrhage. CONCLUSION: In the follow-up of patients with pulmonary hemorrhage, defining respiratory problems and treatment and prophylaxis of comorbid conditions may be planned sooner.

Retinopathy of prematurity incidence and treatment modalities in moderate and late preterm infants: a study from two tertiary centers.

OBJECTIVE: The aim of this study was to evaluate the incidence, severity, and treatment modalities of retinopathy of prematurity (ROP) in moderate and late preterm infants with a gestational age (GA) >31 + 6 weeks. METHODS: ROP screening results of preterm infants with GA >31 + 6 weeks to 36 + 6 weeks between March 2013 and January 2019 were evaluated retrospectively. Infants were divided into 2 groups according to GA as 32-33 + 6 weeks (moderate preterm) and 34-36 + 6 weeks (late preterm). In these groups, any ROP and severe ROP (requiring treatment) development rates and ROP types and treatment modalities were evaluated. RESULTS: A total of 4156 preterm infants, 1875 (45.1%) female and 2281 (54.9%) male, were included. Overall, 1466 (35.2%) of the infants were moderate preterm and 2690 (64.8%) were late preterm. The incidences of any ROP and severe ROP were 22% and 2.5%, respectively. The rate of severe ROP was 5.3% in moderate preterm infants and 0.9% in late preterm infants. Significant correlations were determined between duration of hospital stay, birth weight (BW), and GA with ROP development (r = +0.415, r = -0.258, r = -0.199, respectively; p < 0.001 for all). Of 102 patients (2.5%) requiring treatment, 64 (62.7%) had laser, 34 (33.3%) had intravitreal bevacizumab (IVB), 2 (1.9%) had sequential IVB and laser, and 2 (1.9%) had vitreoretinal surgery. CONCLUSION: ROP seems to still be an important health problem in moderate and late preterm infants in our country according to data from screening high-risk preterm infants with a GA >31 + 6 weeks. In this cohort, ROP development correlates with GA, BW, and duration of hospitalization significantly.

The bedside practice of sonographic guided internal jugular vein access in critically ill premature infants.

BACKGROUND: Intrahospital transport, general anesthesia, and the prolonged duration of the central venous catheterization (CVC) in unfavorable conditions pose a significant risk to a critically-ill premature infant. We aimed to demonstrate a minimalized and safe manner of CVC in this patient population. METHODS: We worked on a prospective study in 51 critically-ill premature infants in which a 22 Gauge catheter was put in one of the central thoracic veins with the guidance of sonography as a bedside procedure. Of the patients, 27 (53%) were extremely premature, and 21 (41%) were extremely low birth weight infants (ELBW). The mean gestational age was 29±5 weeks, and the mean weight at the time of the procedure was 1655±1028 grams. While no anesthetic and sedative drugs were administered to ELBW infants during procedures, in the remainder of the cohort, procedures were carried out only under sedoanalgesia. RESULTS: Vascular access was achieved in 48 (94%) of the patients after a mean number of 1.47±0.75 attempts. Body heat loss of the patients at the end of the procedures was not statistically significant (P=0.164). However, ELBW infants lost their body heat significantly more than the rest of the cohort (P=0.032). We experienced clinically insignificant common carotid artery puncture in three patients and hemothorax in one patient. CONCLUSIONS: CVC of critically ill premature infants can be safely and successfully achieved in incubators using sonography guidance, protecting them from hypothermia and anesthetic drugs.

MIS-C with diarrhea complaint and acute kidney injury: A pediatric COVID-19 patient.

We present the case of a 3-month-old male infant patient who initially presented with severe dehydration with acute kidney injury secondary to COVID-19. Regarding the individual's previous history, the patient had congenital heart disease and was taking furosemide and captopril. The patient improved after initial hydration therapy. However, on the fourth day of hospitalization, the patient suddenly deteriorated and was found to have MIS-C. The patient's clinical course progressively worsened despite maximum support, and he died from severe MIS-C. We conclude that during the COVID-19 period, MIS-C is a serious health problem that should be considered in the differential diagnosis of patients with acute kidney injury.

Predictive value of cardiac markers in the prognosis of COVID-19 in children.

BACKGROUND AND AIM: Occasionally, children with COVID-19 may develop arrhythmia, myocarditis, and cardiogenic shock involving multisystemic inflammatory syndrome in children (MIS-C). This study aimed to identify the laboratory parameters that may predict early cardiovascular involvement in these patients. MATERIALS AND METHODS: Data of 320 pediatric patients, aged 0-18 years (average age, 10.46 ± 5.77 years; 156 female), with positive COVID-19 reverse transcription-polymerase chain reaction test and with cardiac biomarkers at the time of admission to the pediatric emergency department were retrospectively scanned. The age, sex, COVID-19-associated symptoms, pro-brain natriuretic peptide (proBNP), CK-MB, and troponin I levels of the patients were recorded. RESULTS: Fever was noted in 58.1% of the patients, cough in 29.7%, diarrhea in 7.8%, headache in 14.7%, sore throat in 17.8%, weakness in 17.8%, abdominal pain in 5%, loss of taste in 4.1%, loss of smell in 5.3%, nausea in 3.4%, vomiting in 3.8%, nasal discharge in 4.4%, muscle pain in 5%, and loss of appetite in 3.1%. The proBNP value ≥282 ng/L predicted the development of MIS-C with 100% sensitivity and 93% specificity [AUC: 0.985 (0.959-1), P < 0.001]; CK-MB value ≥2.95 with 80% sensitivity and 77.6% specificity [AUC: 0.792 (0.581-1), P = 0.026]; and troponin I value ≥0.03 with 60% sensitivity and 99.2% specificity [AUC: 0.794 (0.524-1)]. CONCLUSIONS: Cardiac markers (proBNP and troponin I), especially proBNP, could be used to detect early diagnosis of cardiac involvement and/or MIS-C in pediatric patients with COVID-19 and to predict related morbidity and mortality.

The protective effects of Anakinra in a neonatal rat model of necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) is a commonly seen life-threatening condition in newborns characterized by ischemic necrosis. This study aimed to investigate anakinra's effects, an interleukin-1 receptor antagonist, on oxidative stress, inflammation, and tissue necrosis in an NEC rat model. METHODS: Forty Wistar albino pups were divided into four groups randomly as follows; group 1, control group; group 2, anakinra-treated control group; group 3, NEC group; and group 4, NEC and anakinra treatment group. The rats were given hyperosmolar formula feeding, and they were exposed to hypoxia after cold stress at +4 °C and oxygen in order to create the NEC model. On the 4th day of the experiment, the pups were decapitated, and the intestinal tissues were resected for biochemical and histopathologic examination. RESULTS: Microscopic injury scores and apoptotic indexes were higher in group 3 than the control group (p < 0.001, p = 0.002, respectively), and there was a significant decrease after anakinra. Interleukin 1ß and caspase-3 levels increased with NEC and decreased significantly after administration of anakinra (p = 0.006, p = 0.004, respectively). Malondialdehyde and glutathione peroxidase levels also increased compared with the control group (p = 0.019, p = 0.002, respectively). DISCUSSION: In this experimental study, we found that anakinra had antiinflammatory and antioxidant effects and was protective against intestinal injury and apoptosis.