Hematoma de la vaina de los rectos en un recién nacido macrosómico después de un parto distócico: A propósito de un caso / Rectus sheath hematoma in a macrosomie neonate following difficult delivery: Case report

La macrosomía es un factor de riesgo de traumatismos obstétricos y se asocia con morbimortalidad neonatal. El cefalohematoma y la fractura clavicular son los más frecuentes. Los traumatismos intrabdominales son poco frecuentes. El hematoma de la vaina de los rectos es una acumulación de sangre en la vaina del músculo recto mayor del abdomen. Se asocia con traumatismos, cirugías y tratamiento anticoagulante, en especial en los adultos y las personas de edad avanzada. En este artículo presentamos el caso de un recién nacido de sexo masculino con parto vaginal distócico. Durante el examen físico se observó un hematoma periumbilical de 1 x 1 cm y un cefalohematoma parietal de 1 x 1 cm. En la ecografía abdominal y la tomografía computada del abdomen se observó un hematoma de la vaina del recto derecho de 7 x 4 x 2 cm.

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.

Rectus sheath hematoma in a macrosomie neonate following difficult delivery. Case report. / Hematoma de la vaina de los rectos en un recién nacido macrosómico después de un parto distócico. A propósito de un caso.

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.

La macrosomía es un factor de riesgo de traumatismos obstétricos y se asocia con morbimortalidad neonatal. El cefalohematoma y la fractura clavicular son los más frecuentes. Los traumatismos intrabdominales son poco frecuentes. El hematoma de la vaina de los rectos es una acumulación de sangre en la vaina del músculo recto mayor del abdomen. Se asocia con traumatismos, cirugías y tratamiento anticoagulante, en especial en los adultos y las personas de edad avanzada. En este artículo presentamos el caso de un recién nacido de sexo masculino con parto vaginal distócico. Durante el examen físico se observó un hematoma periumbilical de 1 x 1 cm y un cefalohematoma parietal de 1 x 1 cm. En la ecografía abdominal y la tomografía computada del abdomen se observó un hematoma de la vaina del recto derecho de 7 x 4 x 2 cm.

Ocular findings on follow-up in children who received phototherapy for neonatal jaundice.

BACKGROUND: To evaluate the ocular findings in children between 3 and 5 years of age who had received phototherapy in the neonatal period and to investigate whether they had phototherapy-related permanent ocular damage clinically. METHODS: The phototherapy group (n = 57) consisted of children who had undergone phototherapy for at least 24 h, and the control group (n = 43) comprised children who had not received phototherapy. Ophthalmic examinations consisted of assessment of visual acuity, convergence near point, ocular movements, ocular alignment, dynamic retinoscopy, cycloplegic refraction and biomicroscopic examination of anterior segment and posterior segment (using a 90 D lens in the latest). RESULTS: All children were orthophoric and had normal eye movements. A significant difference was found between the phototherapy group and control group regarding convergence near point 3.0 (2.0-5.0) vs 3.0 (2.0-5.0) (p = 0.018), right cycloplegic spherical equivalent 1.0 (0.0-3.0) vs 0.75 (0.0-4.75) (p = 0.011) and left cycloplegic spherical equivalent 1.0 (0.075-3.0) vs 0.75 (0.0-5.25) (p = 0.006).The study groups were similar according to cycloplegic spherical and cylindrical refractions. However, no significant difference was found between the groups regarding the need for eye glasses. CONCLUSION: Although there were significant differences between the phototherapy and the control groups according to the convergence near point and right and the left eye cycloplegic spherical equivalent, the similarity between the groups regarding the need for eyeglasses suggested that difference was clinically insignificant.

Bone measurements of infants with hyperbilirubinemia by quantitative ultrasound: the influence of phototherapy.

OBJECTIVE: The purpose of the current study was to investigate the possible effects of phototherapy on bone status of term infants evaluated by measurement of tibial bone speed of sound (SOS). MATERIALS AND METHODS: The phototherapy group (n = 30) consisted of children who had undergone phototherapy for at least 24 h and the control group (n = 30) comprised children who had not received phototherapy. Blood samples were obtained from all infants for serum calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone and vitamin D concentrations. The left tibial quantitative ultrasound (QUS) measurements were performed using a commercial device. RESULTS: There was no statistically significant difference between phototherapy-exposed and nonexposed infants in terms of Ca, P, ALP, PTH and vitamin D levels. Comparison of bone SOS between the phototherapy-exposed and control group revealed no statistically difference. Also, no significant difference in Z-score for SOS was observed between those with or without exposure. CONCLUSION: The data of our study indicate that phototherapy treatment has no impact on bone status in the hyperbilirubinemic infants. Although there is no statistically significant evidence of an excess risk of bone damage following phototherapy, studies with larger sample sizes and longer duration of follow-up are needed to gain a better understanding of its effects.

Hemolytic Anemia and Heart Failure Caused by Anti-C and Anti-E Immunization.

Many different blood group systems, such as Rh, ABO, Kell, Kidd, Duffy, MNS, have been reported as causes of hemolytic disease of the newborn. Hemolysis due to minor blood group incompatibility in the fetus or newborn has been determined in isolated case reports. Here, we report a case of a patient who had received red cell transfusion due to severe Rh c and E incompatibility, leading to hemolytic anemia with heart failure. The mother and the baby were grouped B and B, respectively, both being positive for RhD antigen. The baby's blood group type was C+, c+, E+, e+, K-, while her mother's blood group type was C+, c-, E-, e+, K-. Our patient was diagnosed as Rh c and E incompatibility, leading to the hemolytic anemia. Minor blood group incompatibility should be considered in infants with prolonged jaundice and severe anemia, leading to heart failure.

Evaluation of bone metabolism in newborn twins using quantitative ultrasound and biochemical parameters.

Metabolic bone disease (MBD) is one of the important complications of prematurity. Early and adequate nutritional interventions may reduce the incidence and potential complications of MBD. The present study aimed to evaluate bone metabolism in twins via biochemical parameters and quantitative ultrasound (QUS) and to compare the results between twin pairs. Moreover, twin infants were evaluated in terms of potential risk factors likely to have impact on MBD. Forty-three pairs of twins were included in the study. Serum calcium, phosphorus, magnesium, and alkaline phosphatase concentrations were assessed and bone mineral density was measured using QUS (speed of sound, SOS) at postnatal 30 d. Co-twin with the higher birth weight was assigned to Group 1 (n = 36) and the other twin was assigned to Group 2 (n = 36). Birth weight and head circumference were significantly higher in the infants of Group 1 compared with Group 2. No significant difference was found among the groups in terms of gender, history of resuscitation, length of stay in intensive care unit (ICU) or in the incubator, duration of total parenteral nutrition (TPN), type of nutrition, vitamin D use, biochemical parameters, and the SOS value. The factors likely to affect SOS, including type of pregnancy, maternal drug use, gender of infant, birth weight, head circumference at birth, gestational week, length of stay at the ICU, duration of TPN, type of nutrition, resuscitation, vitamin D use, and levels of calcium, phosphorus, magnesium, and alkaline phosphatase were entered into the model. The phosphorus level and the maternal drug use were found to be the factors that significantly reduced SOS, whereas pregnancy after assisted reproductive techniques was found to be a significant enhancing factor.

Effects of neonatal sepsis on thrombocyte tests.

OBJECTIVE: Hemostatic disorders are common complications in sepsis, and coagulation abnormalities occur in almost all the septic patients. Thrombocytes have a key role in the pathogenesis of coagulation abnormalities in sepsis. This study aimed to investigate thrombocyte function disorders as a likely cause of hemorrhagic diathesis in patients with neonatal sepsis. MATERIAL AND METHODS: The study included 70 septic newborns (sepsis group) and 59 healthy newborns (control group). Blood samples were collected from the patients within the first 24 h of hospitalization. Thrombocyte aggregation and secretion tests were performed by optical aggregometry and lumi-aggregometry, respectively. Collagen (2 µg/mL), epinephrine (5 µM), standard (5 µM) and high (10 µM) doses of adenosine diphosphate (ADP), standard (1 unit) and high (4 units) doses of thrombin, ristocetin (1.25 mg/mL) and arachidonic acid (0.5 mM) were used as the agonists. RESULTS: The mean age of the septic newborns was significantly higher than that of the controls (6.78 ± 14.47 days versus 1.25 ± 1.17, p < 0.001). There was no difference between the groups regarding gender- and birth-related characteristics. No difference was observed between the groups regarding platelet count (293.37 ± 144.48 × 10(9)/L in the sepsis group and 254.22 ± 65.26 × 10(9)/L in the control group, p = 0.195). Platelet secretion induced by collagen, epinephrine, standard and high (10 µM) doses of ADP, or arachidonic acid and platelet aggregation induced by collagen, high-dose ADP, arachidonic acid, ristocetin or thrombin (1 unit) were significantly higher in the sepsis group than in the control group. CONCLUSION: Based on the results, we concluded that large-scale studies with recurrent tests performed in different periods of sepsis are needed.

Gaviscon and domperidon responsive apnea episodes associated with gastro-esophageal reflux disease in twins.

BACKGROUND: The possible pathophysiology of the relationship between gastro-esophageal reflux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. PATIENT'S FINDINGS: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy. CONCLUSION: Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.

Feeding an infant with high arched palate by high flow rate bottle nipple.

For infants with high arched palate, feeding is one of the most immediate challenges faced by parents and caretakers. General suggestions for feeding in infants with cleft palate may be adapted to infants with high arched palate. These include oral feeding facilitation techniques and special feeding tools. Here we present a newborn with a high arched palate and serious feeding problems who was fed easily by a large size and a large hole nipple, ordinarily used for infants older than 6 months, instead of specialized feeding equipment.

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.

Detection of cord blood hepcidin levels as a biomarker for early-onset neonatal sepsis.

Early-onset neonatal sepsis (EONS) continues to be a severe condition associated with a high mortality and morbidity. However, symptoms and laboratory markers of this serious condition are nonspecific and currently there are no available standard tests to provide perfect diagnostic accuracy. An early recognition and initiation of antimicrobial therapy are essential in order to prevent morbidity and mortality. Hepcidin, the key regulator of iron homeostasis, is also an acute-phase reactant, which has a critical role in inflammation and contributes to host defense by interfering with microorganism's access to iron. Since hepcidin expression is induced by interleukin-6 (IL-6), it also plays role in the innate immune system. Recently, endogenous expression of hepcidin by macrophages and neutrophils in response to bacterial pathogens confirmed its role in innate immunity. The clear link between the hepcidin molecule and innate immunity may be used for the detection of EONS. We hypothesized that an increased level of hepcidin in cord blood may be used as a reliable biological marker of EONS and designed a prospective cohort study to test this hypothesis and collected pilot data. Cord blood samples of all infants born between January 2009 and December 2010 at our university hospital were collected after parental consent and a total of 38 infants were enrolled in the study who fulfilled the sepsis criteria. The range of cord blood hepcidin was found to be significantly increased in newborns with EONS (min-max: 118.1-8400 ng/mL). To the best of our knowledge, this is the first study to investigate the pathophysiologic relevance of hepcidin in EONS and demonstrate increased levels of hepcidin in cord blood as an acute-phase reactant in response to sepsis.

Bohn's nodules: peculiar neonatal intraoral lesions mistaken for natal teeth.

Inclusion cysts of transient nature during the neonatal period are developmental lesions, which are seen in the oral cavity of the newborn infant. These lesions are classified into three subtypes according to their localizations. When noticed by the anxious parents on the gingival surfaces, they are often mistaken for natal teeth, which lead to seeking medical attention. Herein, we describe a newborn infant with Bohn's nodules to increase the awareness of the physicians to this benign, self-limiting lesion.

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.

Necrotizing enterocolitis in a newborn following intravenous immunoglobulin treatment for haemolytic disease.

ABO iso-immunization is the most frequent haemolytic disease of the newborn. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 hours of life in cases of haemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinaemic encephalopathy. Intravenous immunoglobulins (IVIG) are used to reduce exchange transfusion. Herein, we present a female newborn who was admitted to the NICU because of ABO immune haemolytic disease. After two courses of 1 g/kg of IVIG infusion, she developed necrotizing enterocolitis (NEC). Administration of IVIG to newborns with significant hyperbilirubinaemia due to ABO haemolytic disease should be cautiously administered and followed for complications.

[A rare cause of afebrile convulsion: rotavirus gastroenteritis]. / Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus.

Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus / A rare cause of afebrile convulsion: rotavirus gastroenteritis

La gastroenteritis por rotavirus es la más frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los niños pequeños, además de deshidratación grave y desequilibrios electrolíticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatía, deshidratación, desequilibrio electrolítico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infección habitual en nuestro país (Turquía), con diversas manifestaciones clínicas, entre ellas, las convulsiones, que pueden verse no sólo en los niños con enfermedades neurológicas o sistémicas sino también en los niños sanos.

Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Congenital hypothyroidism presenting with postpartum bradycardia.

Congenital hypothyroidism is a clinical condition characterized by lack of thyroid hormone because of thyroid gland developmental and thyroid hormone biosynthesis disorders. The most common cause of permanent hypothyroidism is congenital factors. Prompt diagnosis is critical. However, overt signs of hypothyroidism are rarely present at birth, and 95% of affected babies are asymptomatic. Hypoxemia, apnea, acidosis, increased intracranial pressure, vagal stimulus and central nerve system abnormalities represent the most common causes of bradycardia in the neonate. Bradycardia associated with congenital hypothyroidism is very rare. In this paper, a case of severe congenital hypothyroidism, induced by maternal blocker antibodies, who presented with bradycardia, is reported.

Children with food refusal: an assessment of parental eating attitudes and their styles of coping with stress.

BACKGROUND: In this study, we aimed to assess the eating attitudes and stress coping styles of parents whose children presented to the clinic complaining of food refusal. METHODS: The parents of 31 children aged ≥3 years, presented to the clinic with the complaint of food refusal. The control group consisted of 30 healthy children with no prior history of food refusal, and their parents. In both groups, birth features, body mass indexes (BMIs), eating attitudes and stress coping styles of the parents were assessed. The parents of both groups were studied, in part utilizing the eating attitudes test (EAT), and the coping styles of stress scale (CSSS). RESULTS: Our study found that body weights and BMI values of the fathers in the study group were significantly lower than fathers in the control group. There was no significant difference in EAT scores between the two groups; however, where the children's body weight and height for age percentile was under 25%, the parents had significantly lower EAT scores. When CSSS scores were assessed, the optimistic approach score of the mother and the self-confident score of the father were found to be significantly high in both groups. CONCLUSION: The parental perception and definition of eating problems does not necessarily indicate the presence of an eating disorder in a child. In fact, the eating attitudes of the fathers were related to the low percentile weight and height values of the children, and a child's food refusal was not dependent on the stress coping style used by the parent.

Infantile malignant osteopetrosis: a rare cause of neonatal hypocalcemia.

Infantile malignant osteopetrosis (IMO; OMIM 259700) is a rare inherited bone disease characterized by reduced or dysregulated activity of osteoclasts, resulting in generalized osteosclerosis. The disease usually presents within the first few months of life with anemia, hepatosplenomegaly, frontal bossing, nystagmus, blindness, deafness, and bone fractures. Children with IMO are at risk of developing hypocalcemia, with attendant tetanic seizures. We report the case of a baby boy who presented with neonatal hypocalcemia. Skeletal radiographs demonstrated sclerotic bones and a dense base of the skull with typical "space alien" face confirming the diagnosis of IMO. Pancytopenia developed at 2 months of age. Visual evoked potential showed severe bilateral optic nerve damage. Genetic mutation study revealed a new mutation in exon 13 of the TCIRG1 gene. Neonatal hypocalcemia can occur as result of IMO, which is easily missed out by clinicians. This causes delay in establishing the diagnosis and starting necessary treatment. Therefore, osteopetrosis should be kept in mind as a rare cause of neonatal hypocalcemia.