Lung ultrasound in the evaluation of pulmonary edema in newborns with critical congenital heart disease.

BACKGROUND: Newborns with critical congenital heart disease (CCHD) with increased pulmonary blood flow (PBF) are at high risk for congestive heart failure. In this study, we aimed to evaluate the presence and degree of pulmonary edema in newborns with CCHD using lung ultrasound (LUS) during the perioperative period. METHODS: Prospective clinical trial, 44 newborn patients with CCHD were evaluated in this prospective clinical trial. LUS was repeatedly performed to determine the course of pulmonary edema during the perioperative period. LUS was performed simultaneously with chest radiography (CXR), which was the main part of patient management. The primary outcome of this study was to identify whether a correlation existed between LUS and CXR findings. The secondary outcomes were to determine the relationship between LUS and the need for respiratory support, diuretic use, vasoactive inotropic score (VIS), and pro-B-type natriuretic peptide (pro-BNP) levels during the perioperative period. RESULTS: The mean gestational age of the patients was 38.3 ± 1.7 weeks, with a mean birth weight of 3026 ± 432 g. In the preoperative period, both LUS and CXR images were consistent with clinical signs of pulmonary edema. On the first postoperative day, pulmonary edema increased compared to the preoperative period but gradually decreased by the 6th day of surgery (p < 0.05). Positive correlations were observed between the LUS and CXR findings at all study points (p < 0.05). The LUS findings exhibited trends parallel to those of VIS, serum pro-BNP levels, need for respiratory support, and diuretic requirements. As expected, these trends were more pronounced in CCHDs where PBF increased. CONCLUSION: In CCHD, serial lung ultrasound (LUS) assessments, particularly in cases with increased PBF, can provide valuable guidance for managing patients during the perioperative period.

Renal artery flow alterations in neonates with hypoxic ischemic encephalopathy.

BACKGROUND: To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life. METHODS: Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life. RESULTS: Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2. CONCLUSIONS: Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties.

Neonatal Outcomes of Critical Congenital Heart Defects: A Multicenter Epidemiological Study of Turkish Neonatal Society : Neonatal Outcomes of CCHD.

Critical congenital heart disease (CCHD) is one of the leading causes of neonatal and infant mortality. We aimed to elucidate the epidemiology, spectrum, and outcome of neonatal CCHD in Türkiye. This was a multicenter epidemiological study of neonates with CCHD conducted from October 2021 to November 2022 at national tertiary health centers. Data from 488 neonatal CCHD patients from nine centers were entered into the Trials-Network online registry system during the study period. Transposition of great arteria was the most common neonatal CHD, accounting for 19.5% of all cases. Sixty-three (12.9%) patients had extra-cardiac congenital anomalies. A total of 325 patients underwent cardiac surgery. Aortic arch repair (29.5%), arterial switch (25.5%), and modified Blalock-Taussig shunt (13.2%). Overall, in-hospital mortality was 20.1% with postoperative mortality of 19.6%. Multivariate analysis showed that the need of prostaglandin E1 before intervention, higher VIS (> 17.5), the presence of major postoperative complications, and the need for early postoperative extracorporeal membrane oxygenation were the main risk factors for mortality. The mortality rate of CCHD in our country remains high, although it varies by health center. Further research needs to be conducted to determine long-term outcomes for this vulnerable population.

Mesenchymal stem cell application in a newborn with severe intraventricular hemorrhage and respiratory distress.

In this case, we present a patient with respiratory distress syndrome, pulmonary interstitial lung disease, and grade 4 intraventricular hemorrhage, in which we applied mesenchymal stem cells simultaneously by intraventricular, intravenous, and intratracheal routes.

The Effects of Thyroid Hormone Levels on Patent Ductus Arteriosus Closure in Newborns.

Objective: Although the role of thyroid hormones in functional and anatomical closure of patent ductus arteriosus (PDA) is well known, their effects on the medical or surgical closure of PDA in newborns remain unclear. This study aimed to assess the correlation between thyroid function tests and PDA closure through medical or surgical interventions in newborns. Methods: This retrospective study was conducted on 65 newborns diagnosed with hemodynamically significant PDA (hs-PDA), with a premature rate of 81.5% (n=53). The subjects were divided into two groups according to the nature of the ductal closure as medically responsive "MR-PDA" or surgically treated "ST-PDA". The groups were compared in terms of thyroid hormone levels and other clinical parameters. Results: Thirty-three (51%) of all 65 patients had PDA and responded to medical treatment. Gestational week, birth weight, and mode of delivery were similar between the medical and surgical treatment groups (p>0.05). Free thyroxine levels were significantly lower in the MR-PDA group than in the ST-PDA group (p=0.01). Conclusions: Because hs-PDA is associated with increased morbidity and mortality in the neonatal period, especially in premature infants, we hypothesize that thyroid hormone levels may play a role in the closure of hs-PDA.

Ultrasonographic evaluation of endotracheal tube position in newborns with CHD.

Many studies have been conducted to determine the most reliable technique for evaluating the position of the endotracheal tube in patients receiving mechanical ventilation support. In this study, we aimed to determine the endotracheal tube position by ultrasonography in intubated patients with a diagnosis of critical CHD followed in the neonatal ICU. METHODS: In this prospective observational clinical study, we performed point-of-care ultrasound for endotracheal tube localisation in 65 intubated newborns with critical CHD. After routine radiography, each patient underwent point-of-care ultrasound examination with a portable ultrasonography device for endotracheal tube end-carina measurement. Endotracheal tube end-carina measurements on chest radiographs were compared with ultrasound images. RESULTS: The mean gestational age and birth weight were 37.8 ± 2.19 weeks and 2888 ± 595 g, respectively. Ultrasound images were obtained after an average of 2.08 ± 1.6 hours from the radiographs. The average ultrasound time allocated to each patient was 5 minutes. The mean endotracheal tube tip-to-carina distance on chest X-ray and ultrasound were optimally 1.33 ± 0.64 cm and 1.43 ± 0.67 cm, respectively. There was no significant difference between chest X-ray and ultrasound measurements in endotracheal tube end-carina distance values evaluated by the Bland-Altman method (mean difference 0.10 cm, p = 0.068). There was a linear correlation between the endotracheal tube tip-carina distance in ultrasound and radiography evaluation (r2 = 0.60, p < 0.001). CONCLUSION: It has been concluded that critical CHDs are frequently accompanied by vascular anomalies, and the endotracheal tube tip-carina distance measurement can be used by determining the carina section as a guide point in the ultrasonographic evaluation of the endotracheal tube location in this patient population.

How does COVID-19 affect maternal and neonatal outcomes?

OBJECTIVES: In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. METHODS: We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. RESULTS: COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. CONCLUSIONS: Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality.

Evaluation of Newborns Diagnosed with COVID-19: A Single-Center Experience.

OBJECTIVE: The causative agent of the severe acute respiratory syndrome is a new type of coronavirus infection called coronavirus disease-2019 (COVID-19) which has spread around the world. COVID-19 is thought to rarely affect infants, so pandemic planning focuses on adults. This study aimed to share our 1-year experience with COVID-19-positive newborns in a tertiary neonatal intensive care unit (NICU). STUDY DESIGN: Hospitalized newborns after a reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were evaluated in this retrospective, cohort study between March 2020 and March 2021. The clinical course, laboratory tests, imaging studies, and outcomes of affected newborns were collected from medical records. RESULTS: Eleven COVID-19-diagnosed newborns were analyzed in our study. Four (36.6%) patients had contact with a COVID-19-positive individual in their families. The main symptoms were fever (81.8%), hypoxemia (63.6%), and tachypnea (63.6%). Bacterial coinfection was identified in two newborns. Aortic coarctation was detected as an accompanied disease by a newborn who was referred to our hospital with a suspicion of congenital heart disease and two patients had a bacterial coinfection. We did not detect any cases of neonatal multisystem inflammatory syndrome. All patients were discharged in good health. None of the newborns had any complications and repeated infection with another variant during the first-year follow-up. CONCLUSION: Contrary to popular belief, newborns are a sensitive age group for COVID-19 and need a high rate of hospitalization. Congenital heart diseases and coinfections should not be overlooked in COVID-19-infected newborns. The acquired immunity due to COVID-19 infection protects newborns from recurrent COVID-19 infections in their first year of life. The absence of COVID-19-positive individual in the family in most cases suggests that PCR-negative adults may also play a role in the transmission of the disease. KEY POINTS: · COVID-19 is still a pandemic all over the world.. · COVID-19 is dangerous for newborns.. · PCR-negative adults may also play a role in the transmission of the disease to the newborn..

Efficiency of Lung Ultrasonography in the Diagnosis and Follow-up of Viral Pneumonia in Newborn.

OBJECTIVE: Lung ultrasonography (LUS) is a useful method for diagnosis of lung diseases such as respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax in the neonatal period. LUS has become an important tool in the diagnosis and follow-up of lung diseases. LUS is easy to apply at the bedside and is a practical and low-cost method for diagnosing pneumonia. STUDY DESIGN: This study was conducted in neonatal intensive care unit of Dr. Sami Ulus Obstetrics, Children's Health and Diseases Training and Research Hospital. From September 2019 to April 2020, 50 patients who were diagnosed with viral pneumonia were included in the study. Also, 24 patients with sepsis-related respiratory failure were included in the study as a control group. LUS was performed at the bedside three times, by a single expert, once each before treatment for diagnosis, on discharge, and after discharge in outpatient clinic control. RESULTS: Before treatment, LUS findings were lung consolidation with air bronchograms (50/50), pleural line abnormalities (35/50), B-pattern (25/50), disappearance of lung sliding (21/50), lung pulse (5/50), and pleural effusion (9/50). During discharge, we found significant changes: lung consolidation with air bronchograms (6/50), pleural line abnormalities (7/50), B-pattern (12/50), and pleural effusion (1/50) (p < 0.05). Outpatient clinic control LUS findings were lung consolidation with air bronchograms (0/50), pleural line abnormalities (0/50), B-pattern (0/50), disappearance of lung sliding (0/50), and pleural effusion (0/50) (p < 0.05). Also, B-pattern image, disappearance of lung sliding, and pleural line abnormalities were higher in control group (p < 0.05). CONCLUSION: Ultrasound gives no hazard, and the application of bedside ultrasonography is comfortable for the patients. Pneumonia is a serious infection in the neonatal period. Repeated chest radiography may be required depending on the clinical condition of the patient with pneumonia. This study focuses on adequacy of LUS in neonatal pneumonia. KEY POINTS: · Lung ultrasound is a practical and low-cost method in diagnosing pneumonia.. · Neonatal pneumonia is a very important cause of morbidity and mortality in NICU.. · We can evaluate neonatal pneumonia with combination of clinical presentations and LUS findings..

A Case of Congenital Glucose Galactose Malabsorption with a New Mutation in the SLC5A1 Gene.

Congenital glucose-galactose malabsorption (CGGM) is an autosomal recessive disorder originating from an abnormal transporter mechanism in the intestines. It was sourced from a mutation in the SLC5A1 gene, which encodes a sodium-dependent glucose transporter. Here we report a 2-day-old girl with CGGM who presented with severe hypernatremic dehydration due to diarrhea beginning in the first hours of life. Mutation analysis revealed a novel homozygous mutation NM_000343.3 c.127G > A (p.Gly43Arg) in the SLC5A1 gene. Since CGGM can cause fatal diarrhea in the early neonatal period, timely diagnosis of the disease seems to be essential.

Diagnostic Value of the Systemic Immune-Inflammation Index in Newborns with Urinary Tract Infection.

OBJECTIVE: Aim of this study is to investigate the diagnostic role of the systemic immune-inflammation index (SII; neutrophil × platelet [PLT]/lymphocyte) in the prediction of renal involvement in newborns with urinary tract infection (UTI). STUDY DESIGN: We conducted a retrospective cohort study among 117 newborns with a gestational age greater than 35 weeks and hospitalized in the NICU. Laboratory values obtained from blood samples taken before the initiation of antibiotics were evaluated for renal function tests, complete blood count, and acute phase reactants. The ratios of platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR), and SII were calculated. The patients were divided into two main groups according to the presence of urinary tract pathology in ultrasonography (US): group 1, UTI with renal involvement (n = 43) and group 2, UTI without renal involvement (n = 74). Predictive values of different tests were compared. RESULTS: The mean white blood cell, PLT, mean PLT volume, and neutrophile counts were higher, while lymphocyte counts were significantly lower in group 1 than those of group 2. Interleukin 6 (IL-6; pg/mL; IL-6), C-reactive protein (CRP; mg/L), NLR, PLR, and SII values were also higher in group 1. Receiver operating characteristics curve showed that SII, CRP, IL-6, PLR, and NLR have a predictive ability to discriminate renal involvement from normal renal findings in newborns with UTI. The SII produced an area under curve of 0.75 (72% sensitivity and 60.8% specificity). To define renal involvement, the cut-off values of SII, CRP, IL-6, PLR, and NLR were 217, 3.06, 23, 65.5, and 0.60, respectively. CONCLUSION: Our results showed that SII might be used as an additional parameter in the prediction of renal involvement in newborns with UTIs. Further studies are required. KEY POINTS: · Most UTIs in newborns present with upper UTI rather than simple cystitis.. · Some inflammatory markers can be used for the diagnosis of UTIs.. · SII may be useful in the prediction of urinary tract infections..

Therapeutic Role of Astaxanthin and Resveratrol in an Experimental Rat Model of Supraceliac Aortic Ischemia-Reperfusion.

OBJECTIVE: The aim of the study is to investigate the therapeutic effects of astaxanthin (AST) and resveratrol (RVT) on multiorgan damage in an animal model of the supraceliac aortic ischemia-reperfusion (I/R). METHODS: In this study, 28 rats (n = 7/group), 200 to 250 g in weight, were randomized to four groups (1: Sham, 2: Control + I/R, 3: AST + I/R, and 4: RVT + I/R). Following the abdominal incision, aortic dissection was performed in the sham group without injury. Other groups underwent I/R injury via supraceliac aortic clamping (20 minutes) and reperfusion. The rats were administered olive oil (3 mL/kg) orally for 2 weeks before and 1 week after the laparotomy. Additionally, oral AST (10 mg/kg) or RVT (50 mg/kg) was given to the study groups. All rats were sacrificed on the 3rd week of the experiment after blood samples were taken for analysis. Multiple rat tissues were removed. RESULTS: We found that RVT increased total antioxidant status (TAS) and superoxide dismutase (SOD) levels, and decreased total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), and malondialdehyde (MDA) levels, while AST increased the levels of TAS, decreased TNF-α, MDA, TOS, and OSI (p <0.05). Pathological investigations of the rat tissues revealed that both AST and RVT ameliorated tissue damage and apoptosis. CONCLUSION: Our study suggests that AST and RVT might show therapeutic effects against oxidative tissue damage and apoptosis in an animal model of aortic I/R. Further studies are required. KEY POINTS: · Major congenital heart diseases are at high risk of multiorgan damage.. · Re-establishment of blood flow may result in ischemia-reperfusion (I/R) injury.. · Astaxanthin and resveratrol may have therapeutic effects against I/R injury..

Role of systemic immune-inflammatory index in early diagnosis of sepsis in newborns with CHD.

OBJECTIVE: Congenital heart diseases (CHD) are the most common causes of birth defects that have increased the risk of infections. Neonatal sepsis is a life-threatening condition and early diagnosis can be life-saving. We aimed to evaluate the potential role of the systemic immune-inflammatory index in the early diagnosis of neonatal sepsis. METHODS: A retrospective cohort study was conducted on 166 newborns with a diagnosis of neonatal sepsis who were admitted to our hospital with CHD between January 2017 and June 2021. Haematological indices including neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammatory index were calculated for all patients at the time of diagnosis of neonatal sepsis (sepsis). The sepsis values of these indices were compared with the admission values (pre-sepsis) of the patients. RESULTS: The mean gestational age and birth weight of the patients were 38.36 ± 1.42 weeks and 3057.75 ± 484.68 g. It was found that absolute neutrophil count, systemic immune-inflammatory index, neutrophil/lymphocyte ratio, but not platelet/lymphocyte ratio were significantly increased at the time of sepsis. The receiver operating characteristic curve showed that systemic immune-inflammatory index, neutrophil/lymphocyte ratio, and absolute neutrophil count have predictive ability to define neonatal sepsis among newborns with CHD. The systemic immune-inflammatory index produced an area under the curve receiver operating characteristic curve of 0.76 (70% sensitivity, 70.5% specificity). To discriminate neonatal sepsis, the cut-off values of systemic immune-inflammatory index, neutrophil/lymphocyte ratio, and absolute neutrophil count were 517.19, 2.62, and 9210/mm3, respectively. CONCLUSION: As an easily accessible and reliable indicator, systemic immune-inflammatory index may be used in combination with the other parameters in the early diagnosis of neonatal sepsis.

Protective role of melatonin and spirulina in aortic occlusion-reperfusion model in rats.

The aim of this experiment was to investigate the role of melatonin and spirulina on multiorgan damage induced by ischemia/reperfusion injury (IR) in a rat model. A total of 32 male rats weighing 200-220 g were allocated into 4 groups (n = 8/group) (Sham, Control-IR [CIR], Melatonin-IR [MIR], and Spirulina-IR [SIR]). Sham group underwent midline laparotomy and dissection of the aorta without injury. In other groups, an IR model was established by clamping (ischemia) and releasing (reperfusion) the abdominal aorta at the supraceliac level for 20 min. All rats were given 3 ml/kg of distilled water by gavage for 14 days before and 7 days after the experiment. The treatment groups received either melatonin (50 mg/kg) or spirulina (50 mg/kg) by the same route. On the 21st day of the experiment, the rats were sacrificed. We found that melatonin and spirulina ameliorated the effects of IR at different levels of significance (ranging from p = .01 to p < .001), increasing total antioxidant capacity (TAC) and superoxide dismutase levels, and decreasing total oxidant status, oxidative stress index (OSI), myeloperoxidase, tumor necrosis factor-alfa and malondialdehyde levels. When compared MIR and SIR groups, only TAC and OSI levels did differ in favor of melatonin between the groups (p < .05). Histopathological and immunohistochemical examinations showed that melatonin and spirulina similarly reduced IR-related tissue damage and apoptosis. We concluded that melatonin and spirulina may have a protective role against oxidative tissue damage and apoptosis in the abdominal aortic IR animal model. PRACTICAL APPLICATIONS: Coarctation of aorta (CoA) and interrupted aortic arch (IAA) are serious cardiac defects with high morbidity and mortality if not diagnosed and treated early in life. Restoration of blood flow in CoA or IAA through prostaglandin E1 infusion, angioplasty or surgery can cause ischemia/reperfusion (IR) injury. This reperfusion period may be complicated IR injury at remote organs. It may be beneficial to increase antioxidant capacity in preventing stress-induced tissue damage. Melatonin and spirulina are agents with strong antioxidant properties. In this animal research, protective role of these products on multiorgan damage induced by IR was investigated for the first time. We found that both melatonin and spirulina ameliorate the effects of IR to varying degrees. This study provides evidence that melatonin and spirulina may have preventive effects on oxidative tissue damage and apoptosis in the abdominal aortic IR animal model.

Lactobacillus rhamnosus Sepsis Associated with Probiotic Therapy in a Term Infant with Congenital Heart Disease.

BACKGROUND: Congenital heart diseases (CHD) are the most common birth defects. Necrotizing enterocolitis (NEC) is an important cause of morbidity and mortality in premature infants, and probiotics can be used to protect NEC. CASE REPORT: We present a term infant with aortic coarctation who developed sepsis with Lactobacillus rhamnosus GG after probiotic use, successfully treated with ampicillin. The baby unfortunately died of acute cardiac arrest on the 90th day of life. CONCLUSION: Probiotic-associated sepsis may develop in infants with various risk factors such as central catheterization, long-term mechanical ventilation and in those at risk for NEC.

The Serum Levels of Asymmetric Dimethylarginine, Vascular Endothelial Growth Factor, and Insulin-Like Growth Factor-1 in Preterms with Retinopathy of Prematurity.

Objective:To determine the serum levels of asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1) in preterms with retinopathy of prematurity (ROP). Materials and Methods: We included 37 preterm infants. The first blood samples were obtained within the first 5 days of life and repeated at the time of the first ophthalmologic examination for ROP. The levels of ADMA, IGF-1, and VEGF were measured in all samples. Results: ROP was detected in 12 of the subjects (32.4%). We categorized the subjects as non-ROP (Group 1; n = 25), untreated ROP (Group 2; n = 7), and treated ROP (Group 3; n = 5) according to the eye findings. There were no significant differences among the groups for serum levels of ADMA, VEGF, and IGF-1 at the first sampling. Conclusion: We did not find any differences in terms of serum ADMA, IGF-1, and VEGF levels in preterm infants with or without ROP.

Thiol-Disulfide Homeostasis in Neonatal Patients with Urinary Tract Infection.

OBJECTIVE: Urinary tract infection (UTI) is a disease that can cause significant complications in the neonatal period. The thiol-disulfide homeostasis is one of the important antioxidant defense mechanisms. The purpose of this study is to show the relationship between UTI and thiol-disulfide homeostasis in newborns. STUDY DESIGN: In this prospective study, 40 newborns with UTI and 40 healthy controls were included. Thiol-disulfide tests (disulfide, native thiol, and total thiol levels) and septic screening tests were performed before and after antibiotherapy in UTI group. The control group was selected from healthy newborns who applied to the outpatient clinic. RESULTS: The C-reactive protein and interleukin-6 levels were higher, while native thiol and native thiol/total thiol ratio were significantly lower in pretreatment group compared with posttreatment and control group. Also, the levels of disulfide, ischemia modified albumin, disulfide/native thiol ratio, and disulfide/total thiol ratio were higher in pretreatment group compared with posttreatment group. CONCLUSION: The thiol-disulfide homeostasis is an important indicator of oxidative stress during infections. It is valuable to be detected with small amounts of serum in newborns. These molecules can be used to support the diagnosis of UTI in the newborn. Further studies are needed to define the role of thiol-disulfide homeostasis in the UTI of newborn. KEY POINTS: · The thiol-disulfide homeostasis can be an important indicator of oxidative stress during infections such as UTI.. · The thiol-disulfide homeostasis of newborn is valuable to be detected with small amounts of serum in neonatal period.. · Laboratory tests such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are not significantly different in UTIs..

Is it necessary to give calcium infusion during the exchange transfusion in newborns?

OBJECTIVES: We aimed to evaluate total serum calcium (TSC) and ionized serum calcium (ISC) levels and their effects on clinical outcomes in neonates underwent exchange transfusion (ET). METHOD: In this study, the data of newborn infants who underwent ET due to hyperbilirubinemia in a third level neonatal intensive care unit (NICU) were retrospectively analyzed. The patients were monitored by electrocardiogram during ET. Cardiac and respiratory rates, peripheral oxygen saturation, blood pressure values ​​and clinical findings as convulsion, tremor, hypertonia, laryngospasm, cyanosis and apnea were recorded in ET observation forms. The infants with no symptoms of hypocalcemia during the procedure were not routinely given IV calcium gluconate. TSC and ISC measured at the beginning, at the end and 24 h after the end of ET were evaluated retrospectively. RESULTS: Data of 36 newborn patients were evaluated. Median gestational age was 39 (35-40) weeks, mean birthweight was 2840 ± 841 (mean ± SD) grams. During the ET, desaturation was observed in five patients(13.9 %), sinus bradycardia in six(16.7 %), tachypnea in two(5.5 %), sinus tachycardia in one(2.8 %), and rare ventricular extrasystoles in one(2.8 %). Hypocalcaemia was not detected in any of the patients at the beginning of ET. Hypocalcemia was observed in two cases (5.5 %) at the end of ET. There was no statistically significant difference between the TSC and ISC levels at the beginning of ET, at the end and at the end of 24 h. CONCLUSION: As a result, routine intravenous (IV) calcium administration seems to be unnecessary provided that vital signs and neurological status are closely monitored during ET.

The role of thiol-disulfide homeostasis in neonatal sepsis.

BACKGROUND AND AIM: The thiol-disulfide homeostasis is essential for the body to maintain effective antioxidant defense mechanisms. We aimed to show the relationship between sepsis and thiol-disulfide homeostasis in newborns. MATERIALS AND METHODS: In this prospective study, 66 newborns with sepsis (group 1) and 51 healthy controls (group 2) were included. In group 1, 53 newborns were diagnosed as clinical sepsis (group 1a) and 13 as definite sepsis (group 1b). The study has two time points; the day of diagnosis (step 1) and three days after the treatment (step 2). At step 1, group 1 and group 2 were compared for thiol-disulfide homeostasis as well as inflammatory markers. At step 2, the same laboratory tests were repeated only in group 1. RESULTS: At step 1, the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were higher, while native thiol and total thiol levels were lower in group 1 compared to controls. Serum disulfide/total thiol ratio was also significantly higher in group 1. When analyzed for subgroups of group 1, demonstration of microorganism did not affect the serum thiol levels. Within group 1, at step 2, although CRP and IL-6 levels were significantly lowered compared to step 1, we did not observe significant changes in thiol-disulfide parameters. CONCLUSIONS: The thiol-disulfide homeostasis may have a role in the pathogenesis of sepsis in newborns. The related parameters might be new markers for the diagnosis of sepsis in newborn patients. Further studies are needed to define the role of thiol-disulfide homeostasis in the course of neonatal sepsis.