A 3-year-old child with multi-drug resistant epilepsy responding to pharmacological and nonpharmacological treatments.

Introduction: Despite the development of new antiseizure drugs (ASDs), around one third of epilepsy patients become refractory to treatment or experience adverse events due to ASDs. Therefore, discovery of new ASDs and new therapy options are crucial to improve the quality of life. Herein, we report a 3-year-old child with multi-drug resistant epilepsy caused by perinatal asphyxia whose seizures were reduced by 90% after the introduction of ketogenic diet, vagal nerve stimulation (VNS) AspireSR (SR-seizure response) and oral cannabidiol.Case presentation: A 9-month-old female infant had a history of multidrug resistant epilepsy due to perinatal asphyxia. At admission, she was experiencing up to 20-25 seizures per day lasting for 2-3 minutes. In addition to antiseizure drugs (ASDs), she was put on ketogenic diet (KD), vagal nerve stimulation (VNS) aspire seizure response (AspireSR) was inserted and oral cannabidiol (CBD) was started sequentially. Using pharmacological and nonph armacological therapies, her seizures have been reduced by 90%.Conclusion: The concurrent use of pharmacological and nonpharmacological therapies may be beneficial to improve seizures in infants with multi- Furthermore, our patient is the youngest child inserted VNS AspireSR in Turkey.

General movements assessment and Alberta Infant Motor Scale in neurodevelopmental outcome of preterm infants.

AIM: We aimed to compare the General Movement Assessment (GMA) and the Alberta Infant Motor Scale (AIMS) in preterm infants for the prediction of cerebral palsy (CP) and neurodevelopmental delay (NDD). Additionally, we aimed to evaluate the diagnostic compatibility of the General Movement Optimality Score (GMOS), the Motor Optimality Score (MOS), and AIMS for detecting CP and NDD. METHOD: Seventy-five preterm infants with gestational age (GA) 24-37 weeks were enrolled. Group 1 was composed of infants with 24-28 GA (n = 22); groups 2 and 3 consisted of infants with 29-32 GA weeks (n = 23) and 33-37 GA (n = 30) weeks, respectively. The infants were assessed during the writhing period, the fidgety period, and at 6-12 months of corrected age with GMOS, MOS, and AIMS, respectively. RESULTS: In the writhing period, a cramped-synchronized pattern was observed in 17 (22%) infants, whereas a poor repertoire pattern was observed in 34 (45%) infants. In the fidgety period of the 63 infants, 29 (46%) presented with fidgety movements absent. The MOS and AIMS scores of the infants in group 1 were significantly lower than the other groups, which were statistically significant (p = 0.004, p˂0.001). High and positive compatibility (Kappa coefficient: 0.709; p = 0.001) was found between AIMS and GMOS scores and between AIMS and MOS scores (Kappa coefficient: 0.804; p < 0.001). In all groups, a statistically significant association was found between total GMOS scores (p = 0.003) and the presence of fidgety movements (p = 0.003). GMOS, MOS, and AIMS were found to be associated with CP and NDD (p < 0.001). CONCLUSION: GMA is an important tool for the prediction of CP and NDD. The combined use of GMOS, MOS, and AIMS may guide the clinical practice for the valid and reliable diagnosis of CP and NDD.

Positive Direct Antiglobulin Test: Is It a Risk Factor for Significant Hyperbilirubinemia in Neonates with ABO Incompatibility?

OBJECTIVE: ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. STUDY DESIGN: This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. RESULTS: The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p < 0.001) and the highest bilirubin level (study group: 12.7 ± 3.6 mg/dL, control group: 10.4 ± 4.2 mg/dL, p < 0.001) were higher in infants with positive DAT. A total of 37 (46.8%) infants in the study group and 83 (11.2%) infants in the control group received phototherapy (PT) in the nursery (p < 0.001). In neonates with positive DAT, direct bilirubin level, duration of hospitalization, and PT in the nursery were higher (p = 0.002, <0.001, and <0.001, respectively), whereas hemoglobin level was lower (p < 0.001). CONCLUSION: In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. KEY POINTS: · The clinical spectrum of ABO incompatibility varies widely.. · The ABO incompatibility with positive DAT are at greater risk for high bilirubin levels.. · Infants with blood group incompatibilities must be monitored closely..

Asociación entre el espesor de la grasa subcutánea abdominal y la esteatosis hepática, las enzimas hepáticas y los lípidos séricos en niños obesos / Association of abdominal subcutaneous fat thickness with hepatic steatosis, liver enzymes, and serum lipids in obese children

Introducción. La obesidad infantil puede causar hiperlipidemia y esteatosis hepática y complicaciones crónicas. Nuestro objetivo fue evaluar la relación entre el espesor de la grasa subcutánea abdominal (GSA) y la esteatosis hepática, las transaminasas y los lípidos séricos en niños obesos.Población y métodos. Estudio retrospectivo en niños (4-18 años) que acudieron a los consultorios externos. Se evaluaron las asociaciones entre el espesor de la GSA mediante ecografía y la esteatosis hepática, alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y el perfil lipídico sérico.Resultados. Se identificaron 95 niños con esteatosis hepática; el grado 1 fue el más frecuente (73,6 %, n: 70), seguido del grado 2 (21,1 %) y del 3 (5,3 %). El espesor medio (en mm) de la GSA de línea media y flancos fue 38,48 ± 11,53 y 20,91 ± 8,00 en grado 1; 41,23 ± 10,03 y 19,84 ± 6,75 en grado 2, y 63,12 ± 12,08 y 23,22 ± 5,92 en grado 3, respectivamente. El espesor de la GSA de línea media y flancos se correlacionó positivamente con triglicéridos en grado 3; el espesor de la GSA de línea media se correlacionó con el índice de masa corporal, colesterol total, colesterol LDL y AST (r: 0,9; p: 0,037; r: 0,648; p: 0,001; r: 0,387; p: 0,001; r: 0,406; p: 0,001; r: 0,463; p: 0,001; respectivamente) en grado 1.Conclusión. El espesor de la GSA mediante ecografía puede predecir hiperlipidemia en niños obesos con esteatosis hepática de grado 3 e hipercolesterolemia en grado 1.

Introduction. Childhood obesity can cause hyperlipidemia and hepatic steatosis at early age and chronic disease complications in adult life. We aimed to evaluate the relationship between abdominal subcutaneous fat thickness (ASFT) and hepatic steatosis, serum lipid and transaminase levels in obese children.Population and methods. A retrospective study was conducted with children (aged 4-18 years) who presented to outpatient clinic due to obesity. Associations between ASFT as assessed by ultrasonography (US) and hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and serum lipid profile were evaluated.Results. We identified 95 children, all of which were diagnosed as having hepatic steatosis; the most common type was grade 1 (73.6 %, n: 70), followed by grade 2 (21.1 %) and grade 3 (5.3 %). The mean values of midline and flank ASFT were measured as 38.48 ± 11.53 mm and 20.91 ± 8.00 mm in grade 1; 41.23 ± 10.03 and 19.84 ± 6.75 in grade 2 and 63.12 ± 12.08 and 23.22 ± 5.92 in grade 3 hepatic steatosis, respectively. Midline and flank ASFT correlated positively with triglycerides in grade 3 steatosis, while midline ASFT correlated with body mass index, total cholesterol, low-density lipoprotein cholesterol, and AST (r: 0.9; p: 0.037; r: 0.648, p: 0.001; r: 0.387, p: 0.001; r: 0.406, p: 0.001, r: 0.463, p: 0.001; respectively) in grade 1 steatosis.Conclusion. ASFT as assessed by US may be of predictive value for hyperlipidemia in grade 3 and for hypercholesterolemia in grade 1 hepatic steatosis in obese children.

Association of abdominal subcutaneous fat thickness with hepatic steatosis, liver enzymes, and serum lipids in obese children. / Asociación entre el espesor de la grasa subcutánea abdominal y la esteatosis hepática, las enzimas hepáticas y los lípidos séricos en niños obesos.

INTRODUCTION: Childhood obesity can cause hyperlipidemia and hepatic steatosis at early age and chronic disease complications in adult life. We aimed to evaluate the relationship between abdominal subcutaneous fat thickness (ASFT) and hepatic steatosis, serum lipid and transaminase levels in obese children. POPULATION AND METHODS: A retrospective study was conducted with children (aged 4-18 years) who presented to outpatient clinic due to obesity. Associations between ASFT as assessed by ultrasonography (US) and hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and serum lipid profile were evaluated. RESULTS: We identified 95 children, all of which were diagnosed as having hepatic steatosis; the most common type was grade 1 (73.6 %, n: 70), followed by grade 2 (21.1 %) and grade 3 (5.3 %). The mean values of midline and flank ASFT were measured as 38.48 ± 11.53 mm and 20.91 ± 8.00 mm in grade 1; 41.23 ± 10.03 and 19.84 ± 6.75 in grade 2 and 63.12 ± 12.08 and 23.22 ± 5.92 in grade 3 hepatic steatosis, respectively. Midline and flank ASFT correlated positively with triglycerides in grade 3 steatosis, while midline ASFT correlated with body mass index, total cholesterol, low-density lipoprotein cholesterol, and AST (r: 0.9; p: 0.037; r: 0.648, p: 0.001; r: 0.387, p: 0.001; r: 0.406, p: 0.001, r: 0.463, p: 0.001; respectively) in grade 1 steatosis. CONCLUSION: ASFT as assessed by US may be of predictive value for hyperlipidemia in grade 3 and for hypercholesterolemia in grade 1 hepatic steatosis in obese children.

Introducción. La obesidad infantil puede causar hiperlipidemia y esteatosis hepática y complicaciones crónicas. Nuestro objetivo fue evaluar la relación entre el espesor de la grasa subcutánea abdominal (GSA) y la esteatosis hepática, las transaminasas y los lípidos séricos en niños obesos. Población y métodos. Estudio retrospectivo en niños (4-18 años) que acudieron a los consultorios externos. Se evaluaron las asociaciones entre el espesor de la GSA mediante ecografía y la esteatosis hepática, alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y el perfil lipídico sérico. Resultados. Se identificaron 95 niños con esteatosis hepática; el grado 1 fue el más frecuente (73,6 %, n: 70), seguido del grado 2 (21,1 %) y del 3 (5,3 %). El espesor medio (en mm) de la GSA de línea media y flancos fue 38,48 ± 11,53 y 20,91 ± 8,00 en grado 1; 41,23 ± 10,03 y 19,84 ± 6,75 en grado 2, y 63,12 ± 12,08 y 23,22 ± 5,92 en grado 3, respectivamente. El espesor de la GSA de línea media y flancos se correlacionó positivamente con triglicéridos en grado 3; el espesor de la GSA de línea media se correlacionó con el índice de masa corporal, colesterol total, colesterol LDL y AST (r: 0,9; p: 0,037; r: 0,648; p: 0,001; r: 0,387; p: 0,001; r: 0,406; p: 0,001; r: 0,463; p: 0,001; respectivamente) en grado 1. Conclusión. El espesor de la GSA mediante ecografía puede predecir hiperlipidemia en niños obesos con esteatosis hepática de grado 3 e hipercolesterolemia en grado 1.

Successful Treatment of Pandrug-resistant Klebsiella pneumoniae Infection With Ceftazidime-avibactam in a Preterm Infant: A Case Report.

Pandrug-resistant (PDR) bacterial infections in intensive care units are emerging as a severe problem. Therefore, new antibiotic options are urgently needed for the treatment of PDR infections in pediatric age groups, especially neonates. Herein, we report a 25 days old preterm neonate successfully treated with ceftazidime-avibactam due to a urinary tract infection caused by PDR Klebsiella pneumoniae. We aimed to describe our experiences about the safety and efficacy of ceftazidime-avibactam treatment.

Assessment of the G-ROP study criteria for predicting retinopathy of prematurity: results from a tertiary centre in Turkey.

PURPOSE: The postnatal growth and retinopathy of prematurity (G-ROP) study has proposed a new model for retinopathy of prematurity (ROP) prediction based on gestational age, birth weight and postnatal weight gain. The purpose of the current study is to assess the efficacy of the G-ROP model for predicting ROP among a Turkish cohort of premature infants. METHODS: Records of infants who underwent ROP screening examinations between 2012 and 2019 were reviewed retrospectively. Infants with a documented ROP outcome and regular body weight measurements until day 40 of life were included. The G-ROP model was applied to the study group. The outcome measures were sensitivity and specificity of the model for detecting any stage ROP and treated ROP. RESULTS: A total of 242 infants were included. The G-ROP model identified 168 infants to be screened for ROP. The sensitivity was 88.3% for detecting any stage ROP and 91.2% for treated ROP. The specificity for any stage ROP and treated ROP was 51.7% and 34.1%, respectively. The incorporation of bronchopulmonary dysplasia to the model increased the sensitivity to 100% with 22.7% reduction in the number of screened infants. CONCLUSIONS: The G-ROP model is a simple and effective method for ROP prediction. However, in the current cohort, a small number of infants requiring treatment would be missed if G-ROP criteria were applied. The model may be modified with addition of bronchopulmonary dysplasia to detect all treatment requiring cases. Prospective studies among larger groups are necessary to assess the applicability of the modified model.

Macular thickness in children aged 3-6 years born preterm.

PURPOSE: To determine macular thickness in 3- to 6-year-old children who were born preterm compared with age-matched controls born at term. METHODS: Children 36-72 months of age born ≤34 weeks and age-matched control children born at term were included in this prospective case-control study. Macular thickness measurements obtained using spectral domain optical coherence tomography were compared between groups and correlations of macular thickness were investigated in the preterm group. RESULTS: A total of 45 preterm children (median age, 57.7 months) and 44 controls (median, 56.1 months) were included. Central macula thickness (CMT) was significantly higher (P = 0.010) and perifoveal thickness was significantly lower (P = 0.029) in the preterm group compared with the control group. Moderate negative correlations of CMT with gestational age and birth weight were found in the preterm group. Best-corrected visual acuity was similar between groups and was not correlated with CMT in the preterm group. No significant difference in macular thickness was found between subjects who had retinopathy of prematurity and those who did not. CONCLUSIONS: Compared with controls, children in the preterm group had thicker retinas at the central macula and thinner perifoveal retinas. These subtle alterations were not correlated with visual acuity and may be considered a reflection of prematurity.

In vitro artificial skin engineering by decellularized placental scaffold for secondary skin problems of meningomyelocele.

BACKGROUND: Meningomyelocele (MMC) is a condition that is originated by the fusion defect of the neural tube. It is a congenital anomaly and can be characterized by spinal cord defects and impaired skin integrity. It is very important to close the skin openings via three-dimensional artificial skin like construction for preventing infection and maintaining the healthy skin structure. Therefore, we aim to generate artificial skin like structures formed by the own cells of donor for treating the MMC-related skin disorder. METHODS: In this study, waste placental tissues were collected and decellularization process was applied. Decellularized and normal placental tissues were compared by immunohistochemistry (IHC). Donor's own placental stem cells were seeded onto biological scaffold and were differentiated into skin related cell types. Finally, gene expressions were evaluated, and the structural integrity were analyzed with IHC. Tube formation assay was also performed for examining the angiogenesis formation of the tissue in order to evaluate the possibility of a healthy organ development. RESULTS: Characterization experiments proved that the decellularized skin preserved a normal skin 3D construction and vasculature along with significant ECM arrangements. The well-kept placental ECM scaffold was cytocompatible, supportive of mesenchymal cell types. Native organ related scaffold is expected to carry a huge influence in skin tissue engineering via delivering a niche for skin-based cells and even for stem/progenitor cells. Regarding to the data obtained from this study, in vivo investigation the skin-like structure in animal models is thought to be the next step as a future prospect. CONCLUSION: This study is a reference investigation for skin engineering based on placental stem cells and biological scaffolds.

A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants.

OBJECTiVE: The aim of this study is to develop a scoring system for the prediction of intraventricular hemorrhage (IVH) in preterm infants in the first 7 days of life. METHODS: A prospective, clinical study was conducted in Bahcesehir University, Medical Park Goztepe Hospital Neonatal Intensive Care Unit, with the enrollment of 144 preterm infants with gestational age between 24 and 34 weeks. All preterms were followed up for IVH after birth until the 4th week of life. The demographic characteristics and clinical risk factors were noted. Risk factors were analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrence of IVH within the first 7 days of life. The IVH scores were further applied prospectively to 89 preterm infants as validation cohort. RESULTS: Low gestational age (GA), low Apgar score, and having bleeding diathesis were the most important risk factors for IVH. According to these risk factors, a scoring system was developed for IVH ranged from 0 to 5. According to the risk ratios (RR) obtained from the logistic regression model, low GA (≤ 28 gestational week), presence of bleeding diathesis within 7 days, and low Apgar score increased the risk of IVH (RR = 3.32 for GA ≤ 28 gestational week, RR = 6.7 for presence of bleeding diathesis in 7th day, RR = 3 for having low Apgar score). The score was validated successfully in 89 infants. The area under ROC curve was 0.85 for derivation cohort and 0.807 for validation cohort. The predictive ability of the IVH score for derivation and validation cohort was calculated. The negative predictive values of a score less than 4 were 96.4 and 59.1%. CONCLUSiON: Concerning IVH-related sequelae which continue to be a major public health problem, we have developed a feasible predictive model for evaluating the risk for developing IVH for preterm infants in the first 7 days of life.

A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels.

AIM: To detect the impact of insulin-like growth factor-1 (IGF-1) and other risk factors for the early prediction of retinopathy of prematurity (ROP) and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels. METHODS: The study was conducted with 127 preterm infants. IGF-1 levels in the 1st day of life, 1st, 2nd, 3rd and 4th week of life was analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrences of any stage ROP. A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated. RESULTS: Birth weights (BW), gestational weeks (GW) and the prevalence of breast milk consumption were lower, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were more frequent, the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP (P<0.05). Initial serum IGF-1 levels tended to be lower in newborns who developed ROP. Logistic regression analysis revealed that low BW (<1250 g), presence of intraventricular hemorrhage (IVH) and formula feeding increased the risk of ROP. Afterwards, the scoring system was validated on 107 infants. The negative predictive values of a score less than 4 were 84.3%, 74.7% and 79.8% while positive predictive values were 76.3%, 65.5% and 71.6% respectively. CONCLUSION: In addition to BW <1250 g and IVH, formula consumption was detected as a risk factor for the development of ROP. Breastfeeding is important for prevention of ROP in preterm infants.

A newborn with hemorrhagic meningoencephalitis due to Proteus mirabilis.

Neonatal meningoencephalitis is a severe condition for the developing brain of a newborn. Radiologic findings of necrosis and liquefaction due to hemorrhagic meningoencephalitis may be confused with brain abcess. In this article, we report a neonate having liquefaction necrosis due to hemorrhagic meningoencephalitis mimicing intracranial abscess due to Proteus mirabilis. We would like to describe the clinical course and evolution of brain imaging and emphasize the importance of the serial MR imaging (MRI).

Risk factors for intensive care need in children with bronchiolitis: A case-control study.

Bronchiolitis is the most common cause of lower respiratory tract infection and hospitalization in infancy and some of the patients may require admission to Intensive Care Unit (ICU) due to severe form of the disease. The aim of this study was to determine the risk factors for ICU need. The study group was composed of 30 patients admitted to ICU with the diagnosis of bronchiolitis and 30 bronchiolitis patients that were treated in the regular ward at the same period were enrolled to the study as the control group. Clinical characteristics, laboratory and imaging data were collected and compared statistically. The mean age of the patients was 33.6±24.4 days and 202.8±179.8 days in the study and control groups respectively, p < 0.001. The presence of tachypnea at admission (96% of patient group and 70% of control group; p=0.01), having oxygen saturation less than 92% (100% of patient group and 27% of control group; p < 0.001), having radiological findings of bronchopneumonia and positive result for respiratory syncytial virus were also found to be significantly different in the study and control groups (p < 0.05).

A case of split notochord syndrome: Presenting with respiratory failure in the neonatal period.

Split notochord syndrome (SNS) is a very rare congenital anomaly. This report describes a male newborn with a neuroenteric cyst in the posterior mediastinum and multiple vertebrae anomalies presenting with respiratory failure and pulmonary hypertension. This report also discusses the embryological development and the etiologic theories of SNS.