Novel useful markers for follow-up of necrotizing enterocolitis: endocan and interleukin-33.

Objectives: To ascertain the diagnostic value of endocan and interleukin (IL)-33 in infants with necrotizing enterocolitis (NEC) and to compare their effectiveness with C-reactive protein (CRP) and interleukin-6 (IL-6).Methods: Eighty-four preterm infants including control (n = 42) and NEC (n = 42) were eligible. Blood samples were obtained from infants in the NEC for the assessment of CRP, IL-6, endocan, and IL-33 serum levels at the time of diagnosis (first day), at the third and seventh days of NEC. Endocan, IL-33, CRP, and IL-6 serum levels were measured at the 14th day of life in the control group.Results: Serum levels of endocan, IL-33, CRP, and IL-6 were significantly higher in the NEC group compared to the control group at the first, third, and seventh days (p < .05). IL-33 and endocan levels continued to rise in the consequent days in patients with stage III NEC (p < .05). Serum endocan and IL-33 levels gradually increased in patients who underwent surgery (p < .05). Serum endocan levels were higher in patients with stage III NEC than those in the stage II NEC at the diagnosis.Conclusions: Serum levels of IL-33 and endocan can be used as markers in the diagnosis and follow-up of NEC.

Preeclampsia is an independent risk factor for spontaneous intestinal perforation in very preterm infants.

BACKGROUND: Spontaneous intestinal perforation (SIP) is an important surgical emergency in preterm infants. AIMS: To evaluate the effect of maternal preeclampsia on development of SIP in premature infants. STUDY DESIGN: Retrospective observational study in a large tertiary neonatal intensive care unit. SUBJECTS: The preterm infants of ≤32 weeks of gestational age and birthweight ≤1500 g who were hospitalized were enrolled. OUTCOME MEASURES: The primary outcome was to determine the association between preeclampsia and SIP. RESULTS: A total of 22 infants had SIP diagnosis. The incidence of SIP in infants born to preeclamptic mothers (6.2%) was significantly higher compared with those born to normotensive mothers (0.2%). In multinominal logistic regression model, preeclampsia was found to be an independent risk factor of SIP with an odds ratio of 13.5 (95% confidence interval 2.82-65.1). CONCLUSIONS: Maternal preeclampsia seemed to be an independent risk factor for development of SIP in premature infants.

Four neonates with giant ovarian cysts: difficulties in diagnosis and decision making process.

OBJECTIVE: Ovarian cysts compose most of the intraabdominal cysts in fetal period. Most of them regress spontaneously at intrauterine or postnatal period. The cysts that are complicated and do not regress are excised generally. METHODS: Here we report a case series that consists of four newborns having giant (≥ 10 cm) ovarian cysts. All of the patients were term infants and followed for ovarian cysts in intrauterine period. RESULTS: Patients were operated on 5, 11, 28, 47th days, respectively. Three patients had unilateral cysts (two right, one left) and one had bilateral cysts. One of the four patients had bilateral ovarian cysts, 100 × 95 mm in diameter on the left and 50 × 55 mm on the right, which was torsioned. CONCLUSION: The risk of complications is higher in bilateral cysts even they are smaller, and early surgical intervention should be done to these patients. During the operation of one of the patients, we detected the cyst at the opposite side that was shown by ultrasonography. Since the size of the mass is large, detecting the correct origin of the cyst is important for the selection of appropriate surgical approach.

Total oxidant status and oxidative stress are increased in infants with necrotizing enterocolitis.

BACKGROUND: Oxidative stress has been implicated in the pathogenesis of necrotizing enterocolitis (NEC). In this study, we compared the global oxidant/antioxidant status by measuring total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) in preterm infants with NEC and with control preterms. METHODS: Forty-one preterm neonates with NEC (stage 1 [group 1; n = 23] and stages 2 and 3 [group 2; n = 18]) and age-matched 36 healthy preterm controls (group 3) were included in this study. Blood samples were obtained both at the time of NEC diagnosis and 72 hours after for the evaluation of TAC and TOS. Serum levels of TAC, TOS, and OSI in patients with NEC were compared with controls. RESULTS: Demographic characteristics were comparable in all 3 groups. Preterm neonates in group 2 (with stages 2 and 3 NEC) had the highest TOS levels and OSI (P < .001 vs both groups 1 and 3). There was no difference in TAC levels among the groups (P = .26). CONCLUSIONS: Our findings demonstrated that although TAC levels were similar in all 3 groups, oxidant stress mechanisms were activated in preterm neonates with definite NEC (stages 2 and 3 NEC). Premature neonates with increased levels of TOS and OSI were associated with severity of NEC.

Serum intestinal fatty acid binding protein level for early diagnosis and prediction of severity of necrotizing enterocolitis.

BACKGROUND/AIM: Intestinal fatty acid binding protein (I-FABP) is found within cells at the tip of the intestinal villi, an area commonly injured in necrotizing enterocolitis (NEC). In this study, we aimed to investigate the value of serum I-FABP in early diagnosis and predicting severity of NEC. METHODS: This prospective study was conducted between April 2009 and November 2009. The preterm infants with suspected NEC were included in the study. These infants were divided into two groups according to their final diagnoses; Group 1: Stage 1 NEC and Group 2: Stages 2-3 NEC (Group 2a: Stage 2 NEC, Group 2b: Stage 3 NEC). Healthy preterms were assigned to control group (Group 3). Serial blood samples were obtained from the patients at symptom onset, 24h and 72 h later. One blood sample was taken from the controls. Serum I-FABP levels were compared among the groups. RESULTS: Initial serum I-FABP concentrations were 324.0±165.8 pg/ml, 764.7±465.1 pg/ml, and 360.2±439.5 pg/ml in Group 1, Group 2a, and Group 2b, respectively, and all were significantly higher than those of the control group (76.9±115.9 pg/ml) (p<0.001). The serum I-FABP levels gradually decreased from the onset of the disease to 72nd hour in Group 1 and Group 2a (p=0.001). In Group 2b I-FABP concentrations slightly decreased at 24th hour of the disease and increased thereafter, but the difference was not significant (p=0.06). CONCLUSION: Serial measurements of I-FABP levels may be a useful marker for early diagnosis and prediction of disease severity in NEC.

Dramatical recovery of a mechanical ventilatory dependent extremely low birth weight premature infant after Nissen fundoplication.

Gastroesophageal reflux disease (GERD) is a well-recognized condition in neonatal period. It is common in preterm infants, clinical spectrum is wide and the management may be difficult. Nissen fundoplication operation is well established as effective treatment for GERD in most children intractable to medical therapy, but its role in neonates is less clear and its effect in premature infants is not well established. Here, we report a case of a premature infant, who had severe respiratory system problems that needed mechanical ventilation despite all medical therapy, and demonstrate dramatical clinical and radiological improvement as a result of Nissen fundoplication surgery.

Enterocutaneous fistula secondary to purpura fulminans in a preterm infant.

Enterocutaneous fistula in newborns and preterms is a well-recognized complication after necrotizing enterocolitis and abdominal surgical procedures/percutaneous interventions. However, to our knowledge, enterocutaneous fistula associated with purpura fulminans has not been reported before. Herein we report a preterm infant with purpura fulminans who developed cutaneous necrotic lesions on anterior abdominal wall. Adherence of necrotic abdominal skin to the adjacent intestinal wall resulted in enterocutaneous fistula. The patient was treated conservatively with bowel rest and antibiotics. The fistula was surgically closed 2 months later.