Neopterin Levels and Indoleamine 2,3-Dioxygenase Activity as Biomarkers of Immune System Activation and Childhood Allergic Diseases.

BACKGROUND: Although Th2 immune activation is predominant in allergic diseases, neopterinlevels and indoleamine 2,3-dioxygenase (IDO)-1 activity (kynurenine:tryptophan ratio), which reflect Th1 immune activity, increase with interferon-gamma (IFN-γ) stimulation. We investigated neopterin, tryptophan, and kynurenine levels as biomarkersof the Th1 immune system activation and changes in IDO-1 activityin children with asthma, allergic rhinitis, and atopic dermatitis, as well as the relationship between these biomarkers and the total IgE level, age, and disease severity. METHODS: We divided 205 children (80 girls and 125 boys, four months to 17 years old) into four groups: controls, patients with asthma, patients with allergic rhinitis, and patients with atopic dermatitis. Peripheral venous blood samples were collected. Neopterin levels were determined by an enzyme immunoassay. Tryptophan and kynurenine levels were analyzed using HPLC. IDO-1 enzyme activity was calculated using tryptophan and kynurenine levels. IgE levels were measured. The Mann-Whitney U test, Kruskal-Wallis test, and Conover post-hoc method were used for statistical analysis. RESULTS: Neopterin, tryptophan, and kynurenine levels were higher and IgE levels and IDO-1 enzyme activity were lower in patients with asthma and allergic rhinitis than in controls (P<0.05). Patients with atopic dermatitis showed higher neopterin, tryptophan, and kynurenine levels, higher IDO-1 activity, and lower IgE levels thancontrols (P<0.05). CONCLUSIONS: The Th1/Th2 balance is disrupted in children with allergic diseases, concomitant with increased Th1-mediated immune response activation and reduced IgEproduction, which is promoted by Th2-type cytokines.

Sleep patterns of young children with newly diagnosed atopic dermatitis.

INTRODUCTION: Even though atopic dermatitis (AD) most often begins in the first year of life, it is not well known whether sleep disturbances occur following the onset of the disease or whether they develop later. AIM: To determine the sleep patterns of young children already diagnosed with AD in comparison to a control group by using a validated questionnaire, the Brief Infant Sleep Questionnaire (BISQ). MATERIAL AND METHODS: Forty-six children with a new diagnosis of AD and 60 healthy children, aged 3-36 months, participated in the study. Their sleep behaviors were assessed using the BISQ along with a structured sociodemographic data form. RESULTS: It was found that when compared with healthy children, children with AD did not have decreased daily total sleep duration (p = 0.1); however, it was found that they woke up more frequently at night (52.2% vs. 40%, p = 0.4) and they stayed awake significantly longer than 60 min when they woke up (41.3% vs. 11.7%, p < 0.05). In addition, mothers of children with AD reported that their children had three times as many sleep problems compared to the reports of mothers of healthy children. CONCLUSIONS: The findings of this study showed that sleep disturbance was more common in young children with already diagnosed AD, and the BISQ provided a practical way to assess the sleep patterns. The use of a screening tool to enable early identification and treatment of childhood sleep problems among patients with AD should be encouraged.

Cost-effectiveness of rotavirus vaccination in Turkey.

BACKGROUND/PURPOSE: Cost-effectiveness studies about rotavirus (RV) vaccination programs were performed in many countries due to the severe economic burden of RV infections. This study is an economic evaluation performed to assess the potential for introducing the RV vaccine to the Turkish National Immunization Program. METHODS: In this retrospective clinical study, the records and laboratory findings of a total of 4126 patients admitted to Turgut Ozal University Hospital, Ankara, Turkey with acute gastroenteritis were analyzed. A model described by Parashar et al. was used to obtain the annual episodes of diarrhea, hospitalization and outpatients visits in Turkey. Monovalent and pentavalent vaccination was assumed to protect in average 85% of RV acute gastroenteritis. All costs are expressed in 2012 United States (US) $, where US$1 equals 1.8 Turkish Liras (TL). Losses of labor costs were not taken into consideration. RESULTS: The vaccination program with 85% coverage was cost effective and cost saving compared to no vaccination. A projected birth cohort of 1.25 million children was followed until 5 years of age; a routine vaccination could potentially avert 210,994 cases of diarrhea treated in outpatient hospital facilities and 42,715 hospitalizations. The RV associated economic burden was obtained as US$17,909 million per year (US$14.33 per birth annually) in medical direct costs by using the national level of RV diarrhea disease burden estimates. For monovalent and pentavalent vaccination, assuming a cost of US$31.5 and US$38 per vaccine course, the cost of the vaccination program was estimated to be approximately US$37,878 million and US$45,475 million, respectively. CONCLUSION: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections.

The value of the clinical history for the diagnosis of immediate nonsteroidal anti-inflammatory drug hypersensitivity and safe alternative drugs in children.

BACKGROUND: Diagnosing hypersensitivity reactions that develop as a result of nonsteroidal anti-inflammatory drugs (NSAID) with a history is mostly misleading, and skin tests and/or provocation tests are needed for a definitive diagnosis. OBJECTIVE: To determine the frequency of actual NSAID hypersensitivity and whether there are any parameters in the history to predict NSAID hypersensitivity. In addition, to determine safe alternative drugs for children who are diagnosed with actual NSAID hypersensitivity. METHODS: Children with a history of NSAID hypersensitivity were evaluated by an allergist. Safe alternatives in children with a confirmed NSAID hypersensitivity were found by oral provocation tests. RESULTS: Sixty-four patients who were admitted with a suspicion of immediate-type reaction to NSAIDs were included in the study. The median age of the patients was 6 years old (range, 1-17 years), and 37 of the patients (57.8%) were boys. We performed skin tests for suspected NSAID in 35 patients (54.7%). Of these, two had positive results. Provocation tests were performed with 62 patients whose skin test results were negative or for whom skin tests were not available. During the provocation tests, 16 patients (25.8%) developed reactions. Low- and high-dose acetaminophen, nimesulide, and tolmetin sodium were used to find safe alternative drugs. Two patients developed reactions to high-dose acetaminophen but no reaction to nimesulide and tolmetin sodium. When statistically significant parameters were analyzed in a logistic regression model, the presence of multiple NSAIDs hypersensitivity in the patient history (odds ratio 26.6 [95% confidence interval, 1.47-481.63]; p = 0.026) and the emergence of a reaction within an hour (odds ratio 26.4 [95% confidence interval, 1.73-403.11]; p = 0.019) were found as the independent factors to predicted actual NSAID hypersensitivity. CONCLUSION: The emergence of a reaction within an hour of taking the drug and the presence of multiple NSAIDs hypersensitivity history increased the possibility of actual NSAID hypersensitivity. Nimesulide, low-dose acetaminophen, and tolmetin sodium could be used as safe alternative drugs in patients with multiple NSAIDs hypersensitivity.

Assessment of skills using a spacer device for a metered-dose inhaler and related independent predictive factors in caregivers of asthmatic preschool children.

BACKGROUND: The correct use of inhalation devices is essential for successful therapy. We aimed to evaluate the skills in the use of a spacer device with an metered-dose inhaler (MDI) and factors that influence this skill in asthmatic preschool children's caregivers. METHODS: The caregivers of 12-month-old to 72-month-old children were interviewed face-to-face and filled out questionnaires. To assess use of the spacer device, we asked the caregivers to verbally describe and demonstrate how they used the device. RESULTS: A total of 244 patients were included in the study, and 142 (58.2%) of the caregivers demonstrated every step for using the spacer device. The most frequently mistaken step was waiting for 30 seconds for the second puff after the first puff. When statistically significant and clinically important parameters were analyzed in a logistic regression model, the parameters satisfaction with the spacer device (odds ratio [OR] 29.9; 95% confidence interval [CI], 7.64 to 117.39; p < 0.001), a university graduate (OR 13.5; 95% CI, 3.36 to 54.8; p < 0.001), family monthly income of more than US$1500 (OR 5.3; 95% CI, 2.16 to 13.39; p < 0.001), device training provided by a clinical trainer (OR 12.3; 95% CI, 4.82 to 31.73; p < 0.001), regular follow-ups (OR 3.6; 95% CI, 1.57 to 8.47; p = 0.003), and the absence of a severe attack during the last year (OR 6.5; 95% CI, 2.64 to 16.43; p < 0.001) were found to be independent factors that affected the correct demonstration of the device. CONCLUSION: The factors most effective in the correct use of the MDI spacer device were satisfaction with the device, training having been given by a clinical trainer on this subject, and the caregiver being a university graduate.

The Platelet Parameters as Inflammatory Markers in Preschool Children with Atopic Eczema.

BACKGROUND: Mean platelet volume has been frequently used as an inflammatory marker in various diseases associated with inflammation. In this study, we compared platelet parameter levels between preschool children with and without atopic eczema (AE). METHODS: Preschool children with AE and age-matched healthy children were included in the study. Complete blood count was assessed in children with AE while platelet parameters were compared between children with and without AE. RESULTS: One hundred twenty eight pediatric patients (78 boys, mean age: 14 months) diagnosed with AE and 128 healthy patients (71 boys, mean age: 12 months ) were included in the study. There were no statistically significant differences between the genders (p = 0.375) and ages (p = 0.273) of both groups. WBC (p = 0.952), Hb (p = 0.370), MCV (p = 0.314) and RDW values (p = 0.124), and platelet counts (p = 0.198) of both groups were similar. In the AE group, while the MPV value was found to be higher (p = 0.003), mean PDW value (p = 0.025) and PLT/MPV ratio were found to be lower (p = 0.021). In addition, there was no correlation between the severity of AE and MPV (rho; 0.1, p = 0.257), PDW (rho; -0.1, p = 0.269) and PLT/MPV (rho; 0.07, p = 0.432) ratio. CONCLUSIONS: In patients with AE, as a sign of inflammation, PDW value and PLT/MPV ratio decrease while MPV value increases. This study has also shown that there is no association between the severity of AE and platelet parameters.

Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants.

BACKGROUND: To evaluate the efficacy of serial mean platelet volume (MPV) measurements in diagnosis and followup of sepsis and to compare its effectiveness with C-reactive protein (CRP) and interleukin-6 (IL-6) in sepsis. METHODS: Preterm infants, whose gestational age and weight were matched to each other, were grouped as control (n = 100) and sepsis (n = 91). Platelet indices (MPV, PDW, platelet count), CRP, and IL-6 levels were measured for the control group and on the day of diagnosis (1st day), 3rd, and 7th days of the sepsis group. RESULTS: There were significant differences between the control and sepsis group in terms of platelet count and MPV/PDW levels (p < 0.05). No significant changes were found in either platelet count or MPV and PDW of infants between early and late onset sepsis, nor between culture proven and non proven sepsis, nor among different infectious agents (gram positive/negative and fungal infections) (p > 0.05). Additionally, non-survivors with sepsis had higher levels of MPV and PDW during sepsis episodes on consecutive days (p < 0.05), in contrast to lower platelet counts in non-survivors (p < 0.05). Moreover, a positive correlation was found between MPV and IL-6 and CRP. A MPV value of 10.35 fL was identified as the cut off value in patients probably resulting in sepsis with a sensitivity of 97.8% and specificity of 78.7% (AUC = 0.949; p < 0.001), and a MPV value of 10.75 fL was determined as the cut off value in patients possibly resulting in death at diagnosis with a sensitivity of 95.2% and a specificity of 84.9% (AUC = 0.944; p < 0.001). CONCLUSIONS: The mean platelet volume can be used in addition to CRP and IL-6 at both diagnosis and follow-up of sepsis and the response of antimicrobial treatment.

Relationship between hypogammaglobulinemia and severity of atopic dermatitis.

BACKGROUND: Atopic dermatitis is an itchy, inflammatory, chronic, or chronically relapsing skin disease. The disease occurs in people who have an "atopic tendency" or may appear as a clinical sign of primary immunodeficiency. OBJECTIVES: To determine the relation between severity of atopic dermatitis and hypogammaglobulinemia. METHODS: One hundred sixty pediatric patients with atopic dermatitis (98 boys and 62 girls, 1-60 months old, median age 14.5 months) and 95 healthy children (57 boys and 38 girls, median age 16 months; control group) were included in the study. In patients with atopic dermatitis, the severity of disease was determined by the SCORing Atopic Dermatitis index. Serum immunoglobulin levels of all patients and children in the control group were measured by nephelometry on admission. RESULTS: The incidence of hypogammaglobulinemia was higher in patients with atopic dermatitis than in the control group (P = .009). The main reason for this difference was the low level of IgG in the atopic dermatitis group (P = .024). Analysis of the relation between hypogammaglobulinemia and the severity of atopic dermatitis showed no statistically significant difference between the group with mild to moderate atopic dermatitis and the group with severe atopic dermatitis with respect to hypogammaglobulinemia (P = .859), IgG (P = .068), IgA (P = .410), and IgM (P = .776) values. CONCLUSION: Hypogammaglobulinemia was more frequent in patients with atopic dermatitis compared with the control group, mostly owing to the low IgG level. Hypogammaglobulinemia is not associated with the severity of atopic dermatitis.

Pediatricians manage anaphylaxis poorly regardless of episode severity.

BACKGROUND: No information exists on how the knowledge or the practice of pediatricians regarding anaphylaxis episodes vary with episode severity. The aim of this study was to assess and compare pediatrician knowledge on the management of mild and severe anaphylaxis using clinical scenarios and to determine factors that affect their decisions. METHODS: A questionnaire consisting of eight questions on the diagnosis and management of anaphylaxis was distributed at two national congresses. A uniform answer box including possible response choices was given below each question, and respondents were asked to check the answers that they thought appropriate. The management of mild and severe anaphylaxis was examined using two clinical case scenarios involving initial treatment, monitoring, and discharge recommendations. RESULTS: Four hundred and ten questionnaires were analyzed. The percentage of pediatricians who correctly answered all questions on the management of mild and severe anaphylaxis scenarios was 11.3% and 3.2%, respectively. Pediatricians did significantly better with initial treatment, but they were less knowledgeable with respect to observation time and discharge criteria in the mild anaphylaxis case scenario compared with the severe one (both P < 0.001). Multiple logistic regression analysis identified only working in an emergency department or intensive care unit as significantly predicting correct diagnosis of anaphylaxis among pediatricians (P = 0.01, 95% confidence interval: 0.11-0.57). No pediatrician-related factors predicted physician knowledge on the management of anaphylaxis. CONCLUSIONS: Pediatricians have difficulty with different steps in managing mild and severe anaphylaxis. Their deficiencies in management may result in failure to prevent recurrences of mild anaphylaxis and may increase mortality in severe anaphylaxis.

Acquired atopic disease after liver transplantation in children; similarities to and differences from adults: a preliminary study.

OBJECTIVE: The aim of this study was to determine the similarities and differences in the frequency and follow-ups of newly diagnosed atopic diseases after liver transplantation in pediatric and adult patients. MATERIALS AND METHODS: Patients who underwent liver transplants between 2005 and 2013 and who are still alive were enrolled in the study. Patients who came for checkups filled out a survey evaluating atopic diseases. Those who had an atopic disease before transplantation were excluded from the study. RESULTS: A total of 165 patients were enrolled in this study; 114 (69.1%) were males and 29 (17.6%) were children. The average transplantation age was 40.8 (0.3-67) years, and the most frequent reason for transplantation was chronic viral hepatitis. In 22 patients, atopic diseases [allergic rhinitis in nine patients (5.5%), asthma in six patients (3.9%), atopic eczema in six patients (3.9%), food allergy in six patients (3.9%), and drug allergy in one patient (0.6%)] developed after transplantation. Atopic diseases after transplantation were more common in children (P=0.03). When the atopic diseases were examined on a case-by-case basis, there were no differences between children and adults with respect to asthma (P=0.284), allergic rhinitis (P=1.0), or atopic eczema (P=0.284), but food allergy (P=0.009) and peripheral eosinophilia (P=0.002) were more common in children. The periodicity of allergic diseases after transplantation (P=0.192) and total IgE levels (P=0.086) were similar. CONCLUSION: Atopic diseases developed after liver transplantation and had a greater impact on children than adults. Therefore, after undergoing liver transplantation, patients should be monitored closely for signs of atopic diseases.

Actitud de los pediatras sobre el uso de andadores para los bebés / Pediatricians' attitude about the use of infant walkers

Los andadores se utilizan frecuentemente a pesar de que su uso puede ocasionar lesiones. Se realizó una encuesta para obtener información sobre las actitudes y el abordaje de los pediatras respecto del uso de andadores. Se invitó a 247 pediatras que asistieron al 44° Congreso Turco de Pediatría y Europediatría (2008) a responder un cuestionario preparado por los autores. Se incluyeron en el análisis 226 cuestionarios respondidos en forma completa. La mediana de edad de los participantes (119 mujeres) fue de 39 años (29 a 58). De ellos, 4% recomendaban el uso de andadores, 32,3% dejaban la decisión a criterio de los padres y 63,7% no lo recomendaban. Ciento cinco habían tratado con anterioridad a un bebé que sufrió una lesión relacionada con el uso del andador; de ellos, 73,3% no recomendaron su uso y 57,1% opinaron que la producción y el uso de andadores deberían prohibirse. Conclusiones. El 4% de los pediatras encuestados recomiendan el uso de andadores para bebés y más del 30% dejan la decisión a los padres. Los pediatras que atendieron a un bebé que sufrió una lesión por el uso del andador fueron menos proclives a recomendarlo.

Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. Conclusions. Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Pediatricians' attitude about the use of infant walkers.

UNLABELLED: Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. CONCLUSIONS: Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Is PFAPA syndrome really a sporadic disorder or is it genetic?

Periodic fever syndromes are a group of disorders sharing similar symptoms, characterized primarily by regularly recurring fevers. PFAPA syndrome, one of the members of this group of disorders, is a clinical entity of unknown etiology which is frequently seen in the early childhood. Currently, the pathogenesis and the genetic basis of most of the disorders in the periodic fever spectrum are known, other than that of PFAPA syndrome. Although, classically PFAPA syndrome is known as a sporadic disease, we propose that it is not sporadic. We think that PFAPA syndrome may be an inherited disease and this hypothesis is supported by the clinical mimicry of PFAPA syndrome with other periodic fever syndromes with well-known genetic transmissions, frequent occurrence of the condition in members of the same family and emergence of common genetic mutations in the periodic fever syndrome spectrum. Moreover, our clinical observation that most of the patients diagnosed with PFAPA syndrome were of the same families strongly suggest a probable genetic transmission of this disorder. We have decided to discuss this hypothesis to contribute to the literature and assist our colleagues who are dealing with this commonly overlooked and often misdiagnosed disorder.

Management preferences of pediatricians in moderate and severe acute asthma.

OBJECTIVE: To assess and compare management preferences of physicians for moderate and severe acute asthma based on case scenarios and to determine the factors influencing their decisions. METHODS: A questionnaire based on the Global Initiative on Asthma (GINA) guideline and comprising eight questions on management of acute asthma was delivered to participants of two national pediatric congresses. Management of moderate and severe acute asthma cases was evaluated by two clinical case scenarios for estimation of acute attack severity, initial treatment, treatment after 1h, and discharge recommendations. A uniform answer box comprising the possible choices was provided just below the questions, and respondents were requested to tick the answers they thought was appropriate. RESULTS: Four-hundred and eighteen questionnaires were analyzed. All questions regarding moderate and severe acute asthma case scenarios were answered accurately by 15.8% and 17.0% of physicians, respectively. The initial treatment of moderate and severe cases was known by 100.0% and 78.2% of physicians, respectively. Knowledge of the appropriate plan for treatment after 1h was low both for moderate (45.0%) and severe attacks (35.4%). Discharge recommendations were adequate in 32.5% and 70.8% of physicians for moderate and severe attacks, respectively. Multiple logistic regression analysis revealed that working at a hospital with a continuing medical education program was the only significant predictor of a correct response to all questions regarding severe attacks (p = .04; 95%CI, 1.02-3.21). No predictors were found for information on moderate attacks. CONCLUSIONS: Pediatricians have difficulty in planning treatment after 1 hour both for moderate and severe asthma attacks. Postgraduate education programs that target physicians in hospitals without continuing medical education facilities may improve guideline adherence.

Serum transaminase elevation in children with rotavirus gastroenteritis: seven years' experience.

BACKGROUND: There are no studies on clinically significant transaminase elevation due to rotavirus gastroenteritis in the literature. Also, there are significant discrepancies among previous studies regarding the prevalence of increased serum transaminase levels in rotavirus infection. METHODS: Patients investigated for rotavirus by stool antigen testing, who were followed between January 2005 and May 2012, were retrospectively enrolled in this study. Patients were divided into 2 groups according to their rotavirus results: rotavirus-positive acute gastroenteritis (RPAG) and rotavirus-negative acute gastroenteritis (RNAG) groups. RESULTS: A total of 4317 children who presented with acute gastroenteritis were assessed. The study was completed with 642 patients who met the inclusion criteria. In the RPAG group (n = 272), elevated alanine aminotransferase (ALT) was found in 42 (15.4%) patients and elevated aspartate aminotransferase (AST) in 69 (25.4%), while in the RNAG group (n = 370), these numbers were 25 (6.8%) and 44 (11.9%), respectively. The elevated ALT and AST levels were found to be significantly higher in the RPAG group than in the RNAG group (both p < 0.001). The prevalence of elevated transaminase levels was found to be similar with respect to gastroenteritis severity score (p > 0.05). The high serum transaminase levels normalized uneventfully in all patients in the RPAG and RNAG groups during follow-up. CONCLUSIONS: In this study, our results clearly signify a liver influence in rotavirus infections. Therefore, rotavirus infections should be kept in mind when evaluating the aetiology of transaminase elevation in patients with acute gastroenteritis.

Comparison of brain apparent diffusion coefficient value in naturally and assisted conceived newborns.

BACKGROUND: Our aim was to assess the value of brain apparent diffusion coefficient (ADC) in Intra Cytoplasmic Sperm Injection (ICSI) and spontaneously conceived preterm singletons. METHODS: Twenty ICSI-conceived preterm singletons and 20 gestational age matched spontaneously conceived preterm singletons were studied. All subjects underwent diffusion-weighted imaging (DWI). The main outcome measure was the brain ADC value in the in ICSI-conceived and naturally conceived newborns. RESULTS: Children born after ICSI had an increased ADC value than the controls. The ADC values of ICSI-conceived singletons were higher than those of spontaneously conceived singletons at cerebellum, corpus striatum, frontal lobe, occipital lobe, and temporal lobe white matter. The mean Apgar score, birth weight, height, and head circumference of ICSI children were found to be similar to naturally conceived children. CONCLUSIONS: Measuring ADC value may be a promising marker in identifying neurological outcome of ICSI-conceived newborns.

Red cell distribution width (RDW) in the newborn: normative data.

AIM: To evaluate the normal range of red blood cell distribution width (RDW) in term and preterm newborns dependent on gestational age. MATERIAL AND METHODS: A total of 1,594 preterm and term neonates were admitted to our neonatology department. Infants were divided into two groups according to their gestational age. Group 1 consisted of infants with ≤34 weeks of gestation; group 2 consisted of infants with ≥35 weeks of gestation. Infants in Groups I and II were subdivided according to their gestational age. Gestational age, birth weight, sex, hemoglobin and hematocrit, MCV levels of all newborns were recorded, and RDW was compared between the groups. RESULTS: A total of 1,594 newbornswere enrolled in the study. Group 1 (≤34 weeks) consisted of 725 newborns and Group 2 (≥35 weeks) consisted of 869 newborns. The mean normal range of RDW in Group 1 was 17.8 ± 2.1 and of group II was 16.7 ± 1.6 (P<0.05). The normal range for RDW values at 32-34 weeks was higher than at 35-36 gestational weeks, and at 37-42 weeks (P = 0.002 and 0.003). CONCLUSION: RDW values at ≤34 weeks in newborns are higher than at ≥35 weeks. This may be useful in the differential diagnosis of neonatal hematologic diseases together with other red cell parameters.

Make-up of the epinephrine autoinjector: the effect on its use by untrained users.

BACKGROUND: Part of the problems related to proper use of the epinephrine autoinjector may be related to the design of the autoinjector itself. AIM: We investigated whether minor modifications in the design of the currently available epinephrine autoinjector ease its use and abrogate common use errors. METHODS: All interns other than those who had previously worked in allergy department in a medical school were invited to the study. Two identical epinephrine autoinjector trainers (Epipen trainer(®) ) were used, one of which was modified by changing the gray safety cap to red and placing a yellow arrow pointing to the black injection tip. A written and visual instruction sheet for each trainer was provided. Participants were asked to demonstrate the use of the Epipen trainer either with the original or with the modified one. They were scored and timed for their demonstration. RESULTS: Out of the 224 interns who were invited to participate, one hundred and sixty-four interns (73.2%) participated in the study. The number of participants correctly demonstrating the use of epinephrine autoinjectors was 22.6% and 65% in unmodified and modified trainer groups, respectively (p < 0.001). The mean time to administer trainers was 26.78 ± 10.6 and 15.88 ± 2.55 s; total median scores were 3.08 ± 1.48 and 4.47 ± 0.84 in unmodified and modified groups, respectively (p < 0.001 for both). Significantly fewer participants had presumptive unintentional injection injury while using modified (5%) compared with unmodified trainer (45.2%) (p < 0.001). CONCLUSION: Few and simple modifications in the design of epinephrine autoinjector were found effective in increasing its correct use and decreasing common use errors by untrained users. (Clinical trials identifier: NCT01217138).