The Use of Acute Peritoneal Dialysis in Critically Ill Newborns.

BACKGROUND To evaluate the efficacy, complications, and mortality rate of acute peritoneal dialysis (APD) in critically ill newborns. MATERIAL AND METHODS The study included 31 newborns treated in our center between May 2012 and December 2014. RESULTS The mean birth weight, duration of peritoneal dialysis, and gestational age of the patients were determined as 2155.2 ± 032.2 g (580-3900 g), 4 days (1-20 days), and 34 weeks (24-40 weeks), respectively. The main reasons for APD were sepsis (35.5%), postoperative cardiac surgery (16%), hypoxic ischemic encephalopathy (13%), salting of the newborn (9.7%), congenital metabolic disorders (6.1%), congenital renal diseases (6.5%), nonimmune hydrops fetalis (6.5%), and acute kidney injury (AKI) due to severe dehydration (3.2%). APD-related complications were observed in 48.4% of the patients. The complications encountered were catheter leakages in nine patients, catheter obstruction in three patients, peritonitis in two patients, and intestinal perforation in one patient. The general mortality rate was 54.8%, however, the mortality rate in premature newborns was 81.3%. CONCLUSIONS APD can be an effective, simple, safe, and important therapy for renal replacement in many neonatal diseases and it can be an appropriate treatment, where necessary, for newborns. Although it may cause some complications, they are not common. However, it should be used carefully, especially in premature newborns who are vulnerable and have a high mortality risk. The recommendation of APD therapy in such cases needs to be verified by further studies in larger patient populations.

Factors affecting infection development after meningomyelocele repair in newborns and the efficacy of antibiotic prophylaxis.

AIM: The purpose of this study was to evaluate the clinical and surgical variables that may be associated with wound infection and meningitis/ventriculoperitoneal (VP) shunt infection in newborns diagnosed with meningomyelocele (MMC), as well as the efficacy of antibiotic prophylaxis in reducing these complications. MATERIAL AND METHODS: The data of 91 neonates diagnosed with MMC, who underwent surgical intervention between May 2012 and December 2014, were retrospectively evaluated. Multivariant logistic regression analysis was used to determine the possible clinical and neurosurgical variables associated with meningitis/VP shunt infection and surgical wound infection. Spearman's test was performed for the correlation analysis. RESULTS: Following MMC closure, of the 91 neonates, 18 (16.4%) developed meningitis/shunt infection and 12 (11%) developed surgical wound infection. The operation time was not a significant independent risk factor for the development of meningitis (RR 0.618 [0.199-1.922], p = 0.406). Open neural placodes that were not covered by any pseudomembrane (myeloschisis), external ventricular drainage (EVD) use, and flap transposition were determined as significant relative risk factors for the development of meningitis (RR 8.655 [2.329-32.157], p = 0.001; RR 9.404 [1.183-74.743], p = 0.034; RR 8.125 [2.496-26.448], p = 0.001; and RR 3.150 [1.963-10.308], p = 0.048, respectively). Deep surgical wound infection was not correlated with the operation time or wound surface area. However, there was an intermediate but very significant positive correlation between meningitis and cerebrospinal fluid (CSF) leakage, length of hospitalization, and flap transposition (r = 0.377, 0.420, 0.357, and 0.503, respectively; for all values, p < 0.001). CONCLUSIONS: There was no association between MMC closure and development of infection. Since it carries a high risk for the development of meningitis, the EVD system should be avoided unless necessary. Routine prophylactic antibiotic use did not reduce the infection risk in MMC repair surgery. Thus, antibiotics should not be used if there are no risk factors predisposing to infection.

A new enema for treatment of intussusception with hydrostatic reduction: Olive oil.

OBJECTIVES: Intussusception is routinely treated using ultrasound-guided hydrostatic reduction (USGHR) with normal saline in our paediatric surgery department. With this study, olive oil was added to normal saline in ultrasound-guided reduction of intussusception. MATERIALS AND METHODS: Forty patients who were diagnosed and treated for intussusception in Van Yuzuncu Yil University Faculty of Medicine Pediatric Surgery Department from March 2017 to May 2017 were included in the study. During this retrospective study, randomly chosen 20 patients that treated with USGHR using normal saline were marked as Group 1. Moreover, 20 patients that treated with USGHR using a mixture of olive oil and saline (10% olive oil 90% normal saline) were marked as Group 2. Patients' age, gender, symptoms, treatment techniques, complications and hospitalisation periods were retrospectively noted. RESULTS: Forty patients were included in the study. In Group 1, 14 patients were treated in the first session, 4 patients were treated in the second session and 2 patients required laparotomy. Mean reduction time in this group was 15 min mean fluid volume used in each reduction was 80 ml/kg and mean hospitalisation period was 38 h. In Group 2, 19 patients were treated in the first session, and only 1 patient required a second session. Mean reduction time was 12 min, used fluid volume was 58 ml/kg for each reduction and hospitalisation period was 24 h. CONCLUSION: The average volume of fluid used for reduction, average reduction time, numbers of recurrent reductions and hospitalisation were less when a mixture of olive oil and normal saline were used in comparison with when normal saline was used alone to reduction the intussusception under ultrasound guidance. Using olive oil mixed with normal saline as a new enema fluid is likely to increase the success rate of ultrasound-guided reduction of intussusception.

A Single-Center Experience of CNS Anomalies or Neural Tube Defects in Patients With Jarcho-Levin Syndrome.

Jarcho-Levin syndrome (JLS) is a genetic disorder characterized by distinct malformations of the ribs and vertebrae, and/or other associated abnormalities such as neural tube defect, Arnold-Chiari malformation, renal and urinary abnormalities, hydrocephalus, congenital cardiac abnormalities, and extremity malformations. The study included 12 cases at 37-42 weeks of gestation and diagnosed to have had Jarcho-Levin syndrome, Arnold-Chiari malformation, and meningmyelocele. All cases of Jarcho-Levin syndrome had Arnold-Chiari type 2 malformation; there was corpus callosum dysgenesis in 6, lumbosacral meningmyelocele in 6, lumbal meningmyelocele in 3, thoracal meningmyelocele in 3, and holoprosencephaly in 1 of the cases. With this article, the authors underline the neurologic abnormalities accompanying Jarcho-Levin syndrome and that each of these abnormalities is a component of Jarcho-Levin syndrome.

Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus?

BACKGROUND: The purpose of this study was to evaluate whether or not platelet mass contributes to closure of patent ductus arteriosus (PDA) in premature newborns. STUDY DESIGN AND SUBJECTS: This retrospective study included 115 preterm newborns with hemodynamically significant PDA (hPDA) and 120 newborns without PDA. The newborns' platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were noted from their files and the platelet mass (platelet count plus MPV/10(3)) was calculated. Patients with congenital abnormality, persistent pulmonary hypertension or sepsis were not included in the study. RESULTS: Platelet count and PDW were found to not be risk factors for closure of hPDA (p > 0.05), but both high platelet mass (OR 1.25; 95% CI 1.12-1.41) and MPV (OR 1.87; 95% CI 2.52-3.85) were determined to be independent risk factors for hPDA. CONCLUSIONS: Platelet mass may be a more significant indicator than platelet count of closure of hPDA in preterm newborns.

A Rare Cause of Persistent Pulmonary Hypertension Resistant to Therapy in The Newborn: Short-Rib Polydactyly Syndrome.

Short-rib polydactyly syndrome is an autosomal recessively inherited lethal skeletal dysplasia. The syndrome is characterized by marked narrow fetal thorax, short extremities, micromelia, cleft palate/lip, polydactyly, cardiac and renal abnormalities, and genital malformations. In cases with pulmonary hypoplasia, persistent pulmonary hypertension of the newborn can develop. In this paper, we present a term newborn with persistent pulmonary hypertension of the newborn, which has developed secondary to short-rib polydactyly syndrome and was resistant to therapy with inhaled nitric oxide and oral sildenafil.