Acute Peritoneal Dialysis in Premature Infants.

OBJECTIVE: This study aimed to investigate the underlying causes and outcomes of less than 1500 g birth weight infants who underwent acute peritoneal dialysis (PD). METHODS: Case records of infants with birthweight less than 1500 g from January 2015 to June 2018 were reviewed. RESULTS: The median (range) birth weight and gestational age of the patients were 720 g (555-1055) and 26 weeks (23-27.5), respectively. Underlying factors for the development of acute kidney injury (AKI) were patent ductus arteriosus (PDA) (15 patients), necrotizing enterocolitis (NEC) (10 patients), sepsis (7 patients), asphyxia (2 patients) and hydrops fetalis (2 patients). Multifunctional 10 F flexible catheter was used for the procedure. Median PD onset time was 7 days (4.5-13.5) and median PD duration was 3 days (1.5-3.5). Overall mortality rate was 81 % (n=17). CONCLUSIONS: Despite high overall mortality, PD is technically feasible in very low birthweight (VLBW) and extremely low birthweight (ELBW) neonates using a multifunctional catheter.

Is the First Postnatal Platelet Mass as an Indicator of Patent Ductus Arteriosus?

BACKGROUND: The aim of this study is to evaluate whether there is an association between the platelet mass and patent ductus arteriosus (PDA) closure in premature newborns. METHODS: Preterm infants (gestational age ≤33 weeks) with hemodynamically significant PDA (group 1, n = 178) and a control group of preterm infants without PDA (group 2, n = 211) were retrospectively evaluated between August 1, 2013 and July 30, 2015 in the neonatal intensive care unit (NICU). Platelet counts and platelet indices including mean platelet volume (MPV), and platelet mass (platelet count x mean platelet volume) in the first 24 hours of life, demographic findings and morbidities were recorded. RESULTS: No differences were observed in demographic findings between the study groups in terms of birth weight, gestational age, gender and maternal risk factors. The mean platelet count in the first postnatal hemogram in group 1 and group 2 were 189.43 ± 72.14 (X103 /mm3) and 206.86 ± 70.11(X103/mm3), respectively (P < 0.05). The MPV were similar in both groups (P > 0.05). Platelet mass values were 1443.70 ± 572.40 fL/nL in Group 1 and 1669.49 ± 1200.42 fL/nL in group 2. There was a statistically significant difference in platelet mass values between the two groups (P = 0.011). Multivariable analysis including presence of thrombocytopenia, MPV and platelet mass showed that hemodynamically significant PDA was not independently associated with platelet count <150 000 (OR = 1.001, 95% CI 0.980-1.023; P = 0.921), MPV (OR = 0.967, 95% CI 0.587-1.596; P = 0.897) or platelet mass (OR = 0.999, 95% CI 0.997-1.002; P = 0.681). The optimal cut-off value of platelet mass for patients with PDA was ≤1530.8 fL/nL (area under the curve [AUC]: 0.580), with sensitivity of 58% and specificity of 56.2% (P = 0.008). CONCLUSION: Our data suggest that platelet count, MPV, and platelet mass do not contribute to closure of PDA in premature newborns.

Neonatology oxidative status in preterm infants with premature preterm rupture of membranes and fetal inflammatuar response syndrome.

BACKGROUND: The aim of this study, to determine an index of oxidative stress index in preterm infants less than 34 weeks gestational age with premature preterm rupture of membrane (PPROM) and fetal inflammatory response syndrome (FIRS). METHODS: This study was designed as a prospective study. Fifty-one premature infants less than 35 weeks of gestational age were included in the study. The umbilical cord blood concentrations of IL-6, TAC (total antioxidant capacity) and PON-1 (paraoxonase-1) levels and TOS (total oxidative stress) were studied. The oxidative stress index (OSI = TAC/TOS) was calculated in all of prematüre infants. PPROM was defined as rupture of membranes at least 24 hours before the onset of labor. FIRS was defined by an umbilical cord IL-6 level greater than 11 pg/mL. Premature infants included in the study were divided into 4 groups. Group 1 included preterm infants without FIRS and with PPROM (n = 16), while Group 2 included preterm infants without PPROM and with FIRS (n = 9), Group 3 consisted of premature infants with PPROM and FIRS (n = 21) and Group 4 included premature infants without PPROM or FIRS (n = 5). RESULTS: Umbilical cord TOS level was found to be higher in the preterm infants without FIRS and with PPROM (36.1 µmol H2O2 Equiv./L) compared to the preterm infants without PPROM or FIRS (11.9 µmol H2O2 Equiv./L) (p = 0.03). Umbilical cord PON-1 level was found to be lower in the preterms without FIRS and with PPROM (32 U/L), preterms without PPROM and with FIRS (30. 3 U/L) and the preterm infants with both PPROM and FIRS (48.6 U/L) compared to the preterm infants having no PPROM or FIRS (85.6 U/L) (p = 0.001). CONCLUSION: High pro-oxidant capacity was found in PPROM and low antioxidant capacity in PPROM and FIRS.

Does platelet mass influence the effectiveness of ibuprofen treatment for patent ductus arteriosus in preterm infants?

OBJECTIVE: The aim of this study is to evaluate whether the platelet mass in the first 24 h of life is effective on closure of patent ductus arteriosus (PDA) or not. STUDY DESIGN: Preterm infants with a gestational age of < 32 weeks, hospitalized at a tertiary neonatal intensive care unit (NICU) and requiring medical treatment (intravenous or oral ibuprofen) for hemodinamically significant PDA (hsPDA) were enrolled in this study. The patients were divided into two groups after first course of pharmacologic treatment according to closure of PDA (Group 1: PDA closure, Group 2: PDA without closure). Groups were compared in terms of demographics findings, morbidities, platelet measurements like counts, mean platelet volume (MPV) and platelet mass (platelet count × mean platelet volume). RESULTS: The study included 77 preterm newborns in Group 1, and 30 preterms in Group 2. There were no differences in birth weight, gestational age, gender and maternal risk factors between the study groups. The mean platelet count in the first postnatal blood count was in Group 1: 211.3 ± 89.2 × 10(3)/mm(3) and in Group 2: 216.5 ± 26 × 10(3)/mm(3), respectively (p = 0.783). The mean platelet volumes (MPV) were similar in both groups (p = 0.535). No statistically significant difference between platelet mass values was detected (Group 1: 1811 ± 884 fl/nl, Group 2: 1868 ± 717 fl/nl) (p = 0.753). CONCLUSION: Our data suggest that platelet count, MPV and platelet mass did not affect the closure of hsPDA with ibuprofen.

Beneficial effects of methylene blue on the acute phase of corrosive esophageal burn in rats.

INTRODUCTION: The aim of the article is to investigate the beneficial effects of methylene blue (MB) on the acute phase of experimental corrosive esophageal burns. MATERIALS AND METHODS: A total of 21 male Sprague-Dawley rats were allocated into three groups with an equal number in each group. In Group 1 (control), the esophageal lumen was irrigated with saline. In Groups 2 (untreated) and 3 (MB treatment), the distal esophagus was burned with 30% NaOH solution. In Group 3, MB was applied locally on the distal esophageal lumen (30 mg/kg) 90 minutes after the burn. In all the groups, animals were humanely killed at the end of the 7th day. Distal esophageal specimens were obtained for histopathological and biochemical examinations. RESULTS: MB increased the tissue superoxide dismutase levels and the total antioxidant status, whereas it decreased the levels of the total oxidant status with significant attenuation of histopathological damage. CONCLUSION: MB might have reduced the tissue damage in corrosive esophagitis because of its antioxidant effects.

The effect of vascular endothelial growth factor overexpression in experimental necrotizing enterocolitis.

PURPOSE: Necrotizing enterocolitis (NEC) is a serious condition, predominantly observed in premature infants. We used an experimental NEC model to investigate the effects of vascular endothelial growth factor (VEGF) cloned into a plasmid. MATERIALS AND METHODS: Twenty-four newborn Wistar albino rats were randomized equally into three groups as follows: control, NEC and NEC+VEGF. NEC was induced by hyperosmolar enteral formula feeding, exposure to hypoxia/reoxygenation and cold stress. In the NEC+VEGF group, VEGF (1 µg) incorporated into plasmid (2 µg) was administered subcutaneously once daily for a total of 3 days starting on the first day of the NEC procedure. All rats were sacrificed on the 4th day of life, and the specimens were harvested for histopathological and biochemical examinations [including tissue oxidative stress (malondialdehyde and nitric oxide), inflammation (myeloperoxidase, interleukin-6 and tumor necrosis factor alpha) and apoptosis (caspase-3 activity) parameters]. RESULTS: In the NEC+VEGF group, tissue malondialdehyde, nitric oxide, interleukin-6, tumor necrosis factor alpha levels and caspase-3 activity were significantly decreased. In addition, the myeloperoxidase level was increased compared to that of the NEC group (p < 0.05). Histopathologically, VEGF overexpression enhanced angiogenesis, alleviated villous atrophy and tissue edema (p < 0.05). CONCLUSION: VEGF overexpression with plasmids seems to be a promising approach in the management of NEC.

Protective effect of dimethyl sulfoxide on stricture formation in corrosive esophageal burns in rats.

INTRODUCTION: The aim of this study was to investigate the effects of dimethyl sulfoxide (DMSO) on stricture formation in corrosive esophageal burns. MATERIALS AND METHODS: A total of 21 male rats were divided equally into three groups. In Group 1 (burn) and Group 2 (burn + DMSO) burns were induced in the distal esophagi with a 30% NaOH solution. In Group 3 (control), a saline solution was applied to the esophageal lumen. In Group 2, DMSO was administered intraperitoneally (3 mg/kg) 15 minutes after the burn was induced and then every 24 hours for 7 days. All rats were humanely killed at the end of Day 22. Distal esophagi were harvested for analysis. The stenosis index (SI) and histopathologic damage score were evaluated in addition to malondialdehyde (MDA), myeloperoxidase (MPO), nitric oxide (NO), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6) levels. RESULTS: DMSO significantly decreased the levels of MDA, NO, TNF-α, and IL-6 in the rats with burned esophagi. Furthermore, the SI and histopathologic scores decreased significantly in the burn + DMSO group relative to the burn group (p < 0.05). CONCLUSIONS: Our results suggest that DMSO can decrease the occurrence of stricture formation and could represent a beneficial alternative therapy for the treatment of corrosive esophagitis.

Impact of H. pylori on growth: is the infection or mucosal disease related to growth impairment?

BACKGROUND: Helicobacter pylori (H. pylori) has been recognized as one of the most common chronic bacterial infections in the world. Most children are colonized in early childhood, and the infection will last a lifetime unless the child is treated with appropriate antibiotics. AIM: To evaluate whether H. pylori infection has an influence on growth and whether the severity of endoscopic findings relates to the growth impairment. METHODS: We formed four groups based on the presence or absence of H. pylori infection and gastrointestinal complaints as follows: group I: RAP +/H. pylori+; group II: RAP +/H. pylori-; group III: RAP -/H. pylori+; group IV: RAP -/H. pylori-. The relationship between endoscopic appearances, histological severity of gastritis, and antral H. pylori density with growth parameters was evaluated. RESULTS: The BMI standard derivation scores of groups I and II were significantly lower than those of asymptomatic controls independent of their H. pylori status. A significant difference in height for age standard derivation scores was observed only between groups I and IV. When we compared the BMI and height for age standard derivation scores of group III and group IV combined with that of the endoscopically normal children in the recurrent abdominal pain group, there was no significant difference between the two groups. CONCLUSION: Recurrent abdominal pain associated with gastric mucosal injury plays a role in a decrease in BMI independent of H. pylori infection. However, if recurrent abdominal pain originates from H. pylori infection, it appears that linear growth is also affected.