Phototherapy-induced hypocalcemia and hypoparathyroidism in icteric term newborns.

OBJECTIVES: Phototherapy is demonstrated to cause hypocalcemia by decreasing melatonin levels and increasing cortisol levels. However, the relationship between parathyroid hormone (PTH) level and calcium has not been previously evaluated in patients receiving phototherapy. Our study aimed to evaluate the effect of phototherapy on ionized calcium (iCa), total calcium (tCa), corrected calcium (cCa), magnesium (Mg), phosphorus (P), 25-hydroxyvitamin D (25(OH)D), and PTH levels. METHODS: Infants who were born at term and received inpatient phototherapy for indirect hyperbilirubinemia were included in our study. The patients' gestational age, birth weight, and phototherapy durations were recorded. Total bilirubin, albumin, iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels before and after phototherapy were compared. Laboratory results were also compared between patients who received phototherapy for ≤24 h, 25-47 h, and ≥48 h. RESULTS: A total of 166 term infants were included in the study. The mean duration of phototherapy was 31.9 ± 9.2 h. Albumin levels before and after phototherapy were similar (p=0.246). However, there were significant decreases in iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels after phototherapy (p<0.001), while P level was significantly increased after phototherapy (p<0.001). In addition, P levels increased with >24 h of phototherapy, while iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels decreased significantly with ≥48 h of phototherapy (p=0.002, p=0.008, p=0.001, p=0.012, and p<0.001, respectively). CONCLUSIONS: This study demonstrates that PTH suppression is one of the causes of phototherapy-induced hypocalcemia.

Evaluation of the correlation of the new Ballard scoring with the ultrasonographic optical nerve sheath diameter and brain volume of preterm infants.

BACKGROUND: Optic nerve sheath diameter (ONSD) measurements with magnetic resonance imaging and ultrasonography in preterm infants are similar. AIM: We measured ultrasonographic ONSD and calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with gestational age, birth weight, head circumference, and new Ballard score. METHOD: This prospective study included preterm infants admitted to the neonatal intensive care unit without intracranial pathology. Two images per eye were obtained from a linear array ultrasound transducer placed on the patient's superior eyelid. The ONSD was measured 3 mm behind the globe. The brain was considered an ellipsoid, and estimated absolute brain volumes were calculated by subtracting the volumes of the two lateral ventricles from the total brain volumes. RESULTS: A total of 143 preterm infants (male 74, female 69) included in the study. The mean gestational age of the study population was 29.7 weeks (23-36), and the mean birth weight was 1390 g (500-2850). There was a significant difference in ONSD between the male and female gender. A significant, strong, and positive correlation was found between ONSD measurements and gestational age (r 0.901, p < 0.001), new Ballard score (r 0.946, p < 0.001), birth weight, head circumference, and brain volumes. CONCLUSION: Our results suggested that ONSD measurements are highly correlated with anthropometry, and it could be a promising bedside, non-invasive objective tool for the determination of exact gestational age postnatally along with the new Ballard score.

Diagnostic Role of Systemic Inflammatory Indices in Infants with Moderate-to-Severe Hypoxic Ischemic Encephalopathy.

BACKGROUND: When the newborn brain is exposed to hypoxia, as in hypoxic ischemic encephalopathy (HIE), it causes an inflammatory response. A wide variety of inflammatory markers are therefore used in the diagnosis of HIE. OBJECTIVE: We aimed to determine the diagnostic role of systemic inflammatory indices in infants with moderate-to-severe HIE. We have also investigated the effect of hypothermia treatment over those indices. STUDY DESIGN: A retrospective cohort study of infants suffering from moderate-to-severe HIE was conducted in a tertiary-level neonatal intensive care unit between September 2019 and March 2021. Systemic inflammatory indices including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated for infants with HIE and controls at baseline, and after therapeutic hypothermia in those with HIE. RESULTS: A total of 103 infants (53 in the HIE group and 50 in the control group) were included in the study. Median gestational ages (GA) were 39 (37-40) and 38 (37-39) weeks, and median birth weights (BW) were 3,165 (2,890-3,440) and 3,045 (2,850-3,460) g in the HIE and control groups, respectively. GA, BW, mode of delivery, and gender of infants were similar between the groups. Infants in the HIE group had significantly higher NLR (p = 0.001), SII (p = 0.001), PIV (p = 0.001), and SIRI (p = 0.004) values when compared with the control group. Those indices decreased significantly after hypothermia treatment in the HIE group. Areas under curve for NLR, PLR, MLR, SII, SIRI, and PIV to predict HIE were found to be 0.808, 0.597, 0.653, 0.763, 0.686, and 0.663, respectively. Cutoff values having a good ability to predict HIE for SII and NLR were 410 and 1.12. Elevated NLR level above 1.12 was found to be an independent predictor for HIE, as revealed by multivariate analyses. No associations were found between systemic inflammatory indices and amplitude-integrated electroencephalography (aEEG) patterns, presence of seizures, and death. CONCLUSION: Systemic inflammatory indices may represent reliable and readily available predictors of HIE risk. NLR seems to be an independent factor in diagnosing moderate-to-severe HIE. KEY POINTS: · Systemic inflammatory incides are readily calculated from the peripheral blood count.. · NLR is an independent and valuable factor in diagnosing moderate-to-severe hypoxic-ischemic encephalopathy.. · Systemic inflammatory incides might be feasible for diagnosing hypoxic-ischemic encephalopathy..

Comparison of the effect of continuous and standard intermittent bolus paracetamol infusion on patent ductus arteriosus.

The aim of this study was to evaluate the effect of paracetamol on patent ductus arteriosus (PDA) closure and clinical outcomes in preterm infants when used as standard intermittent bolus and continuous intravenous (IV) infusion. Preterm neonates with birth weight (BW) ≤ 1500 g and gestational age (GA) ≤ 30 weeks were included in this study. During the study period, IV paracetamol therapy was given to all infants with hemodynamically significant patent ductus arteriosus (hsPDA). The patients were divided into the standard IV intermittent bolus infusion group and the continuous IV infusion group. Standard IV intermittent bolus paracetamol therapy was administered in the form of 15-mg/kg doses as 1-h infusions every 6 h for 5 days, while continuous IV paracetamol infusion therapy was administered as a 60-mg/kg/day dose continuously for 5 days. During the study period, 247 patients were evaluated, of which a total of 137 patients with hsPDA were included. There were no significant differences between the intermittent bolus and continuous infusion groups in terms of mean GA or BW. The continuous paracetamol infusion group had significantly higher rates of PDA-related morbidities, multiple paracetamol courses, and PDA ligation procedure compared with the standard intermittent bolus group.Conclusion: Our results were the first in the literature to compare IV paracetamol infusion regimens for PDA. Our results indicate that standard intermittent bolus infusion is still the most appropriate IV paracetamol regimen for the treatment of PDA.Trial registration: ClinicalTrials.gov Identifier: NCT04469413 What is Known: • Paracetamol has been proposed for the treatment of patent ductus arteriosus in preterm neonates. • There is no consensus on the duration and form of administration of paracetamol in hsPDA, and the information on this issue is insufficient. What is New: • Our study was the first in the literature to compare IV paracetamol infusion regimens for PDA. • Standard intravenous intermittent bolus paracetamol infusion was more effective in pharmacologic PDA closure compared with continuous intravenous paracetamol infusion and was associated with lower rates of PDA-related BPD, NEC, and need for ligation.

Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus.

Introduction: Early rescue surfactant is the most effective way of administering surfactant but many infants still receive surfactant later. Our aim was to explore the association between timing of surfactant administration and the development of patent ductus arteriosus and other neonatal morbidities. Materials and method: This retrospective study analyzed 819 preterm infants under 30 weeks of gestational age and under 1,500 g. Results: Five hundred and ninety three infants received surfactant during the study period, of these 365 received it within 2 h of life (early group) and 228 received it after two h (late group). Patent ductus arteriosus was detected in 175 (48%) of the early group and 168 (74%) of the late group, p = 0.001. Multinominal logistic regression analysis demonstrated that receiving surfactant after 2 h of life has a OR 3.5 (2.2-5.64 95 % CI) and a p-value of 0.001 for developing patent ductus arteriosus. Conclusion: In this study population we observed that late surfactant administration is associated with increased risk of patent ductus arteriosus.