A rare case of acute cerebellitis due to enterovirus treated with therapeutic plasma exchange: Case report and review of the literature.

BACKGROUND: Acute cerebellitis is a rare complication of pediatric infections. There are many reports that viral infections lead to neurological manifestations, including acute cerebellitis. METHODS: A retrospective chart review was conducted for pediatric patients diagnosed with enterovirus cerebellitis between 2000 and 2024. The methods involved reviewing clinical and radiological records and assessing the treatment methods. RESULTS: Case Report We present the case of a 4-year-old immunocompetent child who initially presented with acute encephalopathy followed by truncal ataxia, and eventually received a diagnosis of postinfectious cerebellitis. Enterovirus real-time polymerase chain reaction were positive in the nasopharyngeal swab. Therapeutic plasma exchange (TPE) was started due to neurological deterioration despite IVIG treatment. She improved significantly with TPE, and methylprednisolone treatment and was discharged in good health status. The patient is being followed up as neurologically normal. CONCLUSION: Acute cerebellitis associated with enterovirus is a rare pediatric disorder. Early diagnosis and treatment with TPE in this severe case is thought to be preventive for the potentially fatal complications.

Angiotensin (1-7) peptide replacement therapy with plasma transfusion in COVID-19.

AIM: To determine whether convalescent angiotensin (1-7) peptide replacement therapy with plasma (peptide plasma) transfusion can be beneficial in the treatment of critically ill patients with severe coronavirus 2 (SARS-CoV-2) infection. STUDY DESIGN: Case series of 9 critically ill patients with laboratory-confirmed COVID-19 who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment. Peptide plasma: Plasma with angiotensin (1-7) content 8-10 times higher than healthy plasma donors was obtained from suitable donors. Peptide plasma transfusion was applied to 9 patients whose clinical status and/or laboratory profile deteriorated and who needed intensive care for 2 days. RESULTS: In our COVID-19 cases, favipiravir, low molecular weight heparin treatment, which is included in the treatment protocol of the ministry of health, was started. Nine patients with oxygen saturation of 93% and below despite nasal oxygen support, whose clinical and/or laboratory deteriorated, were identified. The youngest of the cases was 36 years old, and the oldest patient was 85 years old. 6 of the 9 cases had male gender. 3 cases had been smoking for more than 10 years. 4 cases had at least one chronic disease. In all of our cases, SARS CoV2 lung involvement was bilateral and peptide plasma therapy was administered in cases when oxygen saturation was 93% and below despite nasal oxygen support of 5 liters/minute and above, and intensive care was required. Although it was not reflected in the laboratory parameters in the early period, 8 patients whose saturations improved with treatment were discharged without the need for intensive care. However, a similar response was not obtained in one case. Oxygen requirement increased gradually and, he died in intensive care process. An increase of the platelet count was observed in all cases following the peptide plasma treatment. CONCLUSION: In this preliminary case series of 9 critically ill patients with COVID-19, administration of plasma containing angiotensin (1-7) was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

Hepatic Abscesses in Preterm Infants: Report of Three Cases and Review of the Literature.

PURPOSE: Hepatic abscess is a rare but potentially fatal entity in neonates. The aim of this study was to provide valuable data for diagnosis, management and prevention of hepatic abscess in preterm infants. METHODS: A retrospective chart review was made for patients diagnosed with hepatic abscesses between 2012 and 2015. Methods included clinical and radiological review of records and evaluation of potential risk factors. RESULTS: A total of three infants with hepatic abscesses were identified. All of them had low birth weight and low gestational age. Predisposing factors included prematurity, late sepsis, umbilical catheterization, necrotizing enterocolitis and previous antibiotic therapy. Isolated organisms from blood included Staphylococcus spp. in two cases and Pseudomonas spp. in one case. To the best of our knowledge, this is the first preterm case of hepatic abscess caused by Pseudomonas aeruginosa in the literature. All patients responded well to antibiotic therapy alone, and no interventional drainage was required. CONCLUSION: We suggest evaluating all preterm neonates who have severe sepsis and/or necrotizing enterocolitis signs and who do not respond to prolonged antibiotic therapy with detailed abdominal ultrasound for possible hepatic abscesses as early diagnosis, and treatment favors prognosis.

Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature.

With advances in medical sciences, an increase in survival rates of low birth weight; increased incidence in use of catheter and antibiotics, and total parenteral nutrition are reported, therefore, the rate of fungal infections in late and very late onset neonatal sepsis have increased. Although fungal endocarditis rarely occur in newborns, it has a high morbidity and mortality. Antifungal therapy is often insufficient in cases who develop fungal endocarditis and surgical treatment is not preferred due to its difficulty and high mortality. Herein, fungal endocarditis in a preterm newborn treated with single-dose recombinant tissue plasminogen activator in addition to antifungal therapy is presented and relevant literature has been reviewed. The vegetation completely disappeared following treatment and no complication was observed.

Subconjunctival hemorrhage in the newborn: Experience of a tertiary care hospital.

OBJECTIVE: The aim of this study is to determine the incidence and characteristics of newborns with subconjunctival hemorrhage (SCH). METHODS: In our study, patient files of term infants referred to the study hospital's ophthalmology clinic in 2018-19 were analyzed. Demographic data of infants including gestational week, birth weight, gender, and head circumference were all recorded. The frequency of SCH detection was evaluated depending on delivery type. Demographic data of infants with and without retinal hemorrhage (RH) were compared. RESULTS: A total of 172 eyes of 86 infants were included in study. Forty-two (48.8%) of 86 neonates were male, and 44 (51.2%) were female. Mean gestational week was 38.62±1.1. SCH was detected in 31.4% (27) in the right eye, 36% (31) in the left eye, and 32.6% (28) in both eyes. The diagnosis was made at the mean of 3.74 days (range 1-20). Mean birth weight was found as 3621.1±453.3 g, head circumference as 35.4±1.3 cm, height as 50.7±2 cm, and chest circumference as 33.6±1.4 cm. Mean Apgar score in 1st min was 7.1±0.4; 5th min was 9. About 11.6% (10) of the mothers were nulliparous, and 88.4% (76) were multiparous. It was found that 79 of the deliveries were vaginal and seven with cesarean section. RH was not detected in any of the infants born with cesarean section. CONCLUSION: SCH and RH were more common in infants born vaginally. If SCH is detected, a fundus examination should be performed to not miss possible RH.

The possible association between neonatal morbidities and amniotic fluid pH and electrolyte levels in infants of preeclamptic mothers.

BACKGROUND: Preeclampsia is a pregnancy-specific syndrome associated with increased perinatal mortality characterized by hypertension and proteinuria. An increasing number of studies have been published on the effect of preeclampsia on neonatal morbidities. However, there is no study regarding the possible effect of preeclampsia on amniotic fluid pH and electrolytes. The aim of this study was to determine the possible role of amniotic fluid pH and electrolytes for the prediction of and/or association with preeclampsia and neonatal morbidities. METHODS: This was a prospective, case-control study. During cesarean section (C/S), 1 ml of amniotic fluid was aspirated before incision of membranes. Amniotic fluid pH and electrolytes were analyzed by blood gas machine and biochemistry laboratory concurrently. Maternal and neonatal demographic features and clinical outcomes, presence of respiratory morbidities were all recorded. RESULTS: Amniotic fluid pH, sodium and gestational age were found to be independent risk factors for preeclampsia. Subgroup analysis revealed that in early onset preeclampsia group mechanical ventilation duration, duration of 02 therapy, sepsis and intrauterine growth retardation (IUGR) were higher than infants in control group born before 32 gestational weeks. Also, in the early onset preeclampsia group pH and potassium were higher compared with the control group. CONCLUSIONS: To the best of our knowledge, this is the first study that reported the value of amniotic fluid electrolyte analysis for the prediction of preeclampsia and neonatal morbidities in term and preterm infants. However, more studies including a larger number of infants are required to confirm the role of amniotic fluid analysis to predict preeclampsia and/or neonatal morbidities.

SIMPLE: A Novel Scoring System for Predicting Hemodynamically Significant Patent Ductus Arteriosus Without Echocardiographic Evaluation in Extremely Low Birth Weight Infants.

Aim: To develop a novel clinical scoring system for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in extremely low birth weight (ELBW) infants. Methods: A prospective observational study was conducted among ELBW infants born in the study center during a 6-month period. Fourteen items were selected on a literature review basis and weighed by severity on an arbitrary 1-4 scale, the sum of which represented the Scoring preterm Infants for PDA cLinically without Echocardiographic evaluation (SIMPLE) score. The SIMPLE scores were compared at several time points during the first 3 days of life between two groups of patients: those with an hsPDA at echocardiography and those without. Results: A total of 48 ELBW infants were enrolled, of which 30 infants developed hsPDA. The SIMPLE scores of the infants with hsPDA were significantly greater than those of the infants who did not develop hsPDA. Cut-off SIMPLE scores that were significantly associated with detection of symptomatic hsPDA at each evaluation time point were identified. Conclusions: SIMPLE is the first scoring system that depends on the risk factors and clinical findings of ELBW infants for early prediction of hsPDA. It is simple, objective and easy to perform, and it does not require any additional tests and/or echocardiographic evaluation. We suggest that SIMPLE can be used as a screening tool for determining the need for echocardiographic evaluation in ELBW infants in order to minimize the number of unnecessary pediatric cardiology consultations.

Angioedema Associated With Nebulized Recombinant Human DNase in a Preterm Infant: Case Report.

Pulmonary atelectasis leads to difficulties in weaning of the neonates from mechanical ventilation. The management of persistent atelectasis in neonates constitutes a common challenge for physicians. Several reports suggested Recombinant human DNase (rhDNase) as a beneficial therapy for neonates with persistent atelectasis by reducing mucous viscosity. No adverse effect associated with rhDNase treatment was reported in neonates. Herein, we report probable adverse reactions associated with rhDNase use in a preterm infant. Therefore, we suggest that clinicians must be aware of this reaction in neonates and should carefully follow up these infants for the development of adverse reactions. We think that more clinical experience and data are needed to define its tolerability and adverse effect profile in neonates.

Neonatal Appendicitis as a Rare Cause of Intestinal Perforation in a Preterm Neonate.

Intestinal perforation or inflammation due to appendicitis is rarely encountered in the neonatal period. The diagnosis may be delayed due to the lack of specific clinical symptoms and its rarity in this patient population. Early surgical treatment is the main treatment strategy with a good prognosis. However, delayed diagnosis may result in complications and even death. Herein, we describe a late preterm female neonate without any risk factors who had a diagnosis of perforated appendicitis at postnatal day 5. To the authors' knowledge, this case represents the earliest presentation of neonatal perforated appendicitis elucidated by prompt diagnostic laparotomy. Neonatal appendicitis should be considered in the differential diagnosis of infants with abdominal clinical findings.