Green synthesis of (S)-1-(furan-2-yl)propan-1-ol from asymmetric bioreduction of 1-(furan-2-yl)propan-1-one using whole-cell of Lactobacillus paracasei BD101.

Chiral heterocyclic alcohols are important precursors for production of pharmaceutical medicines and natural products. (S)-1-(furan-2-yl)propan-1-ol ((S)-2) can be used production of pyranone, which can be used in the synthesis of sugar analogues, antibiotics, tirantamycines, and anticancer drugs. The synthetic approaches for (S)-2, however, have substantial difficulties in terms of inadequate enantiomeric excess (ee) and gram scale synthesis. Moreover, the biocatalytic synthesis of (S)-2 is unknown until now. In this study, the synthesis of (S)-2 was carried out by performing the asymmetric bioreduction of 1-(furan-2-yl)propan-1-one (1) using the Lactobacillus paracasei BD101 biocatalyst obtained from boza, a grain-based fermented beverage. (S)-2 was obtained with >99% conversion, >99% ee, and 96% yield under the optimized conditions. Furthermore, in 50 h, 8.37 g of 1 was entirely transformed into (S)-2 on gram scale (96% isolated yield, 8.11 g). This is the first report on the high-gram scale biocatalyzed synthesis of enantiopure (S)-2. These data suggest that L. paracasei BD101 can be used to bioreduction of 1 in gram scale and efficiently produce (S)-2. Furthermore, these findings laid the base for future study into the biocatalytic production of (S)-2. It was particularly notable as it was the highest known to date optical purity of (S)-2 generated by asymmetric reduction using a biocatalyst. This work offers a productive environmentally friendly method for producing (S)-2 using biocatalysts.

Prolonged Tracheal Intubation and the Association Between Patent Ductus Arteriosus and Bronchopulmonary Dysplasia: A Secondary Analysis of the PDA-TOLERATE trial.

In the PDA-TOLERATE trial, persistent (even for several weeks) moderate to large patent ductus arteriosus (PDA) was not associated with an increased risk of BPD when the infant required <10 days of intubation. However, in infants requiring intubation for ≥10 days, prolonged PDA exposure (≥11 days) was associated with an increased risk of moderate/severe BPD.

The effect of umbilical cord blood spexin, free 25(OH) vitamin D3 and adipocytokine levels on intrauterine growth and anthropometric measurements in newborns.

Spexin is a newly described peptide and is known to reduce the uptake of long-chain fatty acids into adipocytes. The serum spexin levels of obese children between the ages of 12-18 are lower. The effect of serum spexin and free 25(OH) vitamin D3 levels on intrauterine development in newborns is unknown. Our aims is to evaluate the effects of spexin and adipocytokin levels in the cord blood of term newborn babies on the weight of the baby according to the gestation age (GA) and anthropometric measurement results. Babies who were born in our hospital and whose GA was ≥37 weeks were evaluated in three groups as appropriate for GA (AGA), small for GA (SGA) and large for GA (LGA). A total of 84 babies, including an equal number of infants in AGA, SGA and LGA groups, were included in the study. Spexin, leptin, active ghrelin, free 25(OH) vitamin D3, glucose, and insulin levels in the cord blood of infants were examined at birth. The results were compared according to GA and birth weight (BW). There was no statistically significant difference between groups in terms of mean spexin, active ghrelin, free 25(OH) vitamin D3, and insulin levels. The mean leptin level was significantly higher in LGA group than SGA and AGA groups (p 0.004). The mean spexin and leptin levels were higher in girls than in boys (respectively p value 0.029, 0.003). Although there is a significant positive correlation between BW, head circumference, height, umbilical circumference, umbilical circumference/height ratio and the mean leptin levels (p < 0.001), there was no significant correlation between mean spexin, active ghrelin, free 25 (OH) vitamin D3, insulin, and glucose levels. This study suggests that spexin may not have an effect on intrauterine development.

Acute rheumatic fever: 10-year single-center experience: clinical and laboratory findings, with subclinical carditis and treatment complications.

BACKGROUND: Acute rheumatic fever in childhood continues to cause serious morbidity despite all developments. The objective of this study was to evaluate the clinical and laboratory characteristics of patients with acute rheumatic fever and to determine the frequency of subclinical carditis and the side effects of the drugs used in the treatment. METHODS: The data of patients hospitalised between 2008 and 2018 with the diagnosis of acute rheumatic fever were included in the study. The relationship of gender and age with the frequency of major symptoms and the distribution of the drugs used in the treatment and their side effects were evaluated. RESULTS: Medical records of 102 patients with complete data were reviewed. 56.9% of the patients were male and the mean age was 10.7 ± 1.9 years. The most common distribution of complaints found were arthritis (51%), arthralgia (25.5%) and fever (16.7%). 10.8% of all patients (n = 11) were diagnosed subclinical carditis via echocardiographic evaluation. The frequency of carditis was higher in female patients with a borderline statistical significance (p = 0.05). However, there was no statistically significant difference between gender and arthritis (p = 0.22) and carditis (p > 0.05). Anti-congestive therapy was required in 22% and inotropic treatment was needed in 6.1% cases. Toxic hepatitis developed in four cases during the acetylsalicylic acid treatment. CONCLUSIONS: In a 10-year period, detection of subclinical carditis in 10.8% cases supported that echocardiography should be performed as a standard method for the diagnosis of acute rheumatic fever. Patients should be followed closely in terms of hepatic toxicity due to acetylsalicylic acid used in the treatment.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents.

BACKGROUND Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents. MATERIAL AND METHODS A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded. RESULTS Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%). CONCLUSIONS In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Lack of Equipoise in the PDA-TOLERATE Trial: A Comparison of Eligible Infants Enrolled in the Trial and Those Treated Outside the Trial.

The PDA: TO LEave it alone or Respond And Treat Early trial compared the effects of 2 strategies for treatment of patent ductus arteriosus (PDA) in infants <280/7 weeks of gestation; however 137 potentially eligible infants were not recruited and received treatment of their PDA outside the PDA-TOLERATE trial due to "lack-of-physician-equipoise" (LPE). Despite being less mature and needing more respiratory support, infants with LPE had lower rates of mortality than enrolled infants. Infants with LPE treated before day 6 had lower rates of late respiratory morbidity than infants with LPE treated ≥day 6. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.

PDA-TOLERATE Trial: An Exploratory Randomized Controlled Trial of Treatment of Moderate-to-Large Patent Ductus Arteriosus at 1 Week of Age.

OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. RESULTS: At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). CONCLUSIONS: In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.

Retinopathy screening results of late-preterm infants born at 32-35 weeks of gestational age.

PURPOSE: The aim of this retrospective, nonrandomized, observational clinical study was to evaluate the screening results for retinopathy of prematurity (ROP) of late-preterm infants born at 32-35 weeks gestational age (GA). METHODS: Retinopathy screening data of late-preterm infants were evaluated between January 2015 and September 2018. The zones and stages of ROP development were classified according to the International ROP Committee criteria. Patients were categorized into four groups according to GA: 32 < 33 weeks GA, 33 < 34 weeks GA, 34 < 35 weeks GA, and 35 < 36 weeks GA. The rates of development of any stage of ROP or severe ROP (requiring treatment) were recorded. RESULTS: The study included 543 infants: 139 (25.4%) in 32 < 33 weeks GA, 127 (23.6%) in 33 < 34 weeks GA, 162 (30.2%) in 34 < 35 weeks GA, and 115 (20.8%) in 35 < 36 weeks GA. Different stages of ROP developed in 29 infants (20.9%) in 32 < 33 weeks GA, 19 infants (15%) in 33 < 34 weeks GA, 17 infants (10.5%) in 34 < 35 weeks GA, and 6 infants (5.2%) in 35 < 36 weeks GA. Treatment was required for 14 infants (2.6%) due to severe ROP: 7 (5%) in 32 < 33 weeks GA, 3 (2.4%) in 33 < 34 weeks GA, and 4 (2.5%) in 34 < 35 weeks GA. No treatment was required in 35 < 36 weeks GA. CONCLUSION: Late-preterm infants must be screened for ROP, especially those born in developing countries. Although rates of ROP development decrease as GA increases, infants born at 34 weeks of GA or younger, regardless of birth weight, should be examined at least once for ROP.

Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome.

AIMS: To compare the effect of early nasal intermittent positive pressure ventilation (nIPPV) and nasal continuous positive airway pressure (nCPAP) in terms of the need for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants born between 24 and 32 gestational weeks. METHODS: This is a randomized, controlled, prospective, single-centered study. Forty-two infants were randomized to nIPPV and 42 comparable infants to nCPAP (birth weight 1356 ± 295 and 1359 ± 246 g and gestational age 29.2 ± 1.7 and 29.4 ± 1.5 weeks, respectively). RESULTS: The need for endotracheal intubation and invasive mechanical ventilation was significantly lower in the nIPPV group than the nCPAP group (11.9% and 40.5%, respectively, p < 0.05). There were no differences in the duration of total nasal respiratory support, duration of invasive mechanical ventilation, bronchopulmonary dysplasia or other early morbidities. CONCLUSION: nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

Turkish Validation of the Infiltration Scale in Infants.

PURPOSE: To test the validity and reliability of an infiltration scale in infants that was adapted for the pediatric population. DESIGN AND METHODS: The present study is an observational prospective study. The study was conducted in a NICU of a training and research hospital in Istanbul. Data were obtained from131 infants who were <4 kg. Language validity of the scale was tested by expert linguists. The comments of fourteen experts were taken for content validity. For reliability testing, three observers independently evaluated the scale. RESULTS: Infiltration developed in 28.72% of infants who were examined and grade 2 infiltration was detected at rate of 58%. The content validity index of the scale was 0.93. The Cronbach's alpha was calculated as 0.96 in the agreement of the three observer nurses' evaluations. A highly significant association was detected between the coherence of Cohen's kappa values and Intra-Class Correlation coefficient (ICC) (p < 0.01). CONCLUSIONS: The infiltration scale is a valid and reliable scale in infants. The validity and reliability of the scale has been verified and may be used in the identification of infiltration in infant gestational age between 24 and 39 weeks and weighing <4 kg. PRACTICE IMPLICATIONS: The infiltration scale for infants is a valid and reliable tool for monitoring catheter sites in the prevention of complications such as infiltration due to PIV therapy practices in neonatal intensive care units.

Risk assessment of trace metals in an extreme environment sediment: shallow, hypersaline, alkaline, and industrial Lake Acigöl, Denizli, Turkey.

The major and trace element component of 48 recent sediment samples in three distinct intervals (0-10, 10-20, and 20-30 cm) from Lake Acigöl is described to present the current contamination levels and grift structure of detrital and evaporate mineral patterns of these sediments in this extreme saline environment. The spatial and vertical concentrations of major oxides were not uniform in the each subsurface interval. However, similar spatial distribution patterns were observed for some major element couples, due mainly to the detrital and evaporate origin of these elements. A sequential extraction procedure including five distinct steps was also performed to determine the different bonds of trace elements in the < 60-µ particulate size of recent sediments. Eleven trace elements (Ni, Fe, Cd, Pb, Cu, Zn, As, Co, Cr, Al and Mn) in nine surface and subsurface sediment samples were analyzed with chemical partitioning procedures to determine the trace element percentage loads in these different sequential extraction phases. The obtained accuracy values via comparison of the bulk trace metal loads with the total loads of five extraction steps were satisfying for the Ni, Fe, Cd, Zn, and Co. While, bulk analysis results of the Cu, Ni, and V elements have good correlation with total organic matter, organic fraction of sequential extraction characterized by Cu, As, Cd, and Pb. Shallow Lake Acigöl sediment is characteristic with two different redox layer a) oxic upper level sediments, where trace metals are mobilized, b) reduced subsurface level, where the trace metals are precipitated.

Factors Affecting the Target Oxygen Saturation in the First Minutes of Life in Preterm Infants.

Background: The aim of this study was to describe the effect of factors on time to reach a pulse oxygen saturation (SpO2) level of 90% in preterm infants in the delivery room. Methods: Preterm (<35 gestational age) infants who did not require supplemental oxygen were included in the study. Continuous recordings were taken by pulse oximetry during the first 15 min of life. Results: Of 151 preterm infants, 79 (52.3%) were female and 126 (83.5%) were delivered by cesarean section. Target saturation level (≥90%) was achieved faster in preductal measurements. Mean times taken to have a preductal and postductal SpO2 level of 90% were significantly lower in preterm babies born by vaginal delivery, with umbilical arterial pH ≥ 7.20 and whose mothers were non-smokers during pregnancy. Conclusions: Differences in achievement of target saturation level were influenced by multiple factors (birth way, probe location, maternal smoking and umbilical blood gas pH) in the delivery room during resuscitation of preterm babies.

Determination of seasonal changes in wetlands using CHRIS/Proba Hyperspectral satellite images: A case study from Acigöl (Denizli), Turkey.

The changes in wetlands that occur through natural processes, as well as through industrialization and agricultural activities, are decreasing and even annihilating the living spaces of endemic species. Acigöl (Denizli, Turkey), which is a suitable habitat for flamingos (Phoenicopterus ruber), is a lake that is affected by seasonal anomalies as a result of being shallow. Acigöl, which is fed by precipitation, groundwater and the springs that occur along tectonic faults, has no water output other than evaporation and industrial activities. In addition to natural factors, it is important to determine the changes in the wetlands of Acig6l, where industrial salt is produced, in order to reveal the micro-ecological equilibrium, the relationship between climate and natural life, and regulation of industrial activities. Remote sensing tools are frequently used in determination of changes in wetlands. Changes in coastlines, water level and area covered by water are parameters that can be examined by remote sensing while investigating wetlands. In this study, the water-covered area was examined using remote sensing. Within the scope of this study, CHRIS/Proba Mode 2 (water bandset) hyperspectral satellite images, acquired on 9/17/2011 for the season and on 6/18/2012 - 6/19/2012 forwet season, were used in orderto present the seasonal changes in Acigöl, during one hydrogeological period. The processes of noise reduction, cloud screening, atmospheric correction, geometric correction, and identification of wetlands have been implemented on the CHRIS/Proba images. In determining the water-covered areas, the Normalized Difference Water Index (NDWI) was used. It was determined that W6 (560 nm) and W18 (1015 nm) and W2 (447 nm) and W18 (1015 nm) band combinations were most appropriate to be used in NDWI to demonstrate the water-land separation. Using Proba-NDWI image, it was established that an area of 27.4 km2 was covered with water during dry season, and 61.2 km2 was covered during wet season. The results indicated that; since the lake water area is directly affected by seasonal and annual climatic anomalies, water used by industrial facilities has to be drawn out of the lake in reasonable amount.

Neonatal infection with Neisseria meningitidis: analysis of a 97-year period plus case study.

Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period. Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss the clinical features of neonatal infection with N. meningitidis in relation to the literature (analysis of a 97-year period).

Evaluation of risk factors for development of severe hyperbilirubinemia in term and near term infants in Turkey.

OBJECTIVE: To determine clinical features, etiology and risk factors in term and near term newborns with severe hyperbilirubinemia. METHODS: During ten years period (2000 - 2009), infants of ≥ 35 gestational weeks who received phototherapy were evaluated retrospectively. The study population was divided into two groups and clinical features, etiology and risk factors were compared. Group 1 defined by those who had bilirubin level ≥25 mg/dl (severe hyperbilirubinemia) and group 2 defined by bilirubin level <25 mg/dl. RESULTS: During the study period 1335 babies were evaluated. Severe hyperbilirubinemia was found in 137 (10.3%) patients. Total serum bilirubin level was 29.7±4.7 mg/dl in group 1 and 18.9±3.5 mg/dl in group 2. Pathological weight loss, vaginal delivery and supplementary feeding were identified as significant risk factors for development of severe hyperbilirubinemia (p <0.001, p <0.001 and p = 0.04, respectively). The time at recognition of jaundice by family and postnatal age at admission were significantly higher in group 1. The ratios of previous sibling received phototherapy and being the second child or after were found higher in group 1. CONCLUSION: Pathological weight loss, vaginal delivery and supplementary feeding were determined as risk factors for development of severe hyperbilirubinemia. The newborns with severe hyperbilirubinemia had late recognition of jaundice and admission to hospital by their families.

Evaluation of Etiological Causes and Factors Affect Length of Hospitalization in Neonates Hospitalized with Lower Respiratory Tract Infection.

Objectives: This study aims to determine the risk factors by examining the sociodemographic characteristics of infants hospitalized in the neonatal intensive care unit (NICU) due to lower respiratory tract infection (LRTI), to determine the factors that affect the duration of hospitalization, and to determine the underlying microbial factors and evaluate them in the light of the literature. Methods: This study evaluated the data of newborns hospitalized with LTRI between 01 October 2022 and 31 March 2023. Demographic characteristics of the patients detected viral agents, duration of hospitalization and risk factors were recorded in the study form. Babies divided viral LRTI and non-viral LRTI, and then compared with each other. Additionally, the facts that might affect the duration of hospitalization were investigated. Results: The study included 57 babies. Viral agent was detected in 50.9% of the babies, the most frequently viral agent was respiratory syncytial virus (RSV) (48.2%). Other viral factors, in order of frequency; Adenovirus, SARS-CoV-2, Influenza A and B. There is no demographic difference between the viral agent positive and negative groups. The patients were evaluated according to length of hospitalization, it was seen that the hospital stay was longer in babies who were found to be viral positive and needed oxygen therapy (p=0.02, p=0.03, respectively). The male gender ratio was higher in the group with longer hospital stays, but this difference was not statistically significant. Although the rate of exclusive breastfeeding was higher in the group with a short hospitalization period, this difference was not statistically significant (p>0.05). Conclusion: RSV is currently the most frequently detected viral agent in lower respiratory tract infections in newborns. The hospital stay of babies diagnosed with RSV is longer than those with non-RSV viral agents. So struggling with RSV is important in preventing lower respiratory tract infections in newborns. It is necessary to develop a vaccine or immunoglobulin application against RSV infection not only for preterm babies but also for all newborn babies.

Knowledge, Attitudes and Practices of Pediatricians About COVID-19 Vaccination to Children.

Objectives: Achieving high vaccination rates is very important in the prevention of the coronavirus disease 2019 (COVID-19) as in other infectious diseases. This study aimed to evaluate pediatricians' knowledge, attitudes and behaviours about COVID-19 vaccination of children. Methods: Our single-center, descriptive, cross-sectional, prospective study was conducted between September 20, 2022 and November 30, 2022. The sample consisted of 350 physicians who agreed to fill out the questionnaire voluntarily. Participants were asked 21 questions about their sociodemographic data, knowledge about COVID-19 vaccination of children, attitudes and behaviours via Google Forms. Results: A total of 350 pediatricians, 72.6% of whom were women, participated in our study. 51.4% of the participants were working in a Training and Research Hospital, and 99.1% had received COVID-19 vaccination themselves. While 65.7% (n=230) of pediatricians recommended COVID-19 vaccination for all children, 27.7% (n=97) recommended it only for children in the risk group, and 6.6% (n=23) did not recommend COVID-19 vaccination for children. The most common reasons why pediatricians did not recommend the vaccine to all children were; 56.7% lack of sufficient clinical research on vaccination in children, 50% concerns about the long-term effects of the vaccine, 27.5% vaccine-related side effects. The most risk groups for which participants recommended vaccination were asthma (chronic lung disease) 84.6%, diabetes mellitus 72%, and immunodeficiency 69.7%. 68.9% of pediatricians knew that COVID-19 vaccine was used for children aged 12 years and older in Türkiye, and 60.9% thought that COVID-19 vaccine was safe for children. Those who thought that COVID-19 vaccine was safe for children were more likely to recommend the vaccine to children (p<0.001). When the answers given to the knowledge questions were analyzed, it was found that the knowledge level of those who did not recommend vaccination to children was lower than the others (p<0.001). Conclusion: In the present study, pediatricians mostly recommend COVID-19 vaccine to children. The vaccine safety and the level of knowledge about COVID-19 vaccine are effective factors in recommending the vaccine. Therefore, we conclude that trainings to be organized for pediatricians about COVID-19 vaccine will increase the rate of recommending COVID-19 vaccine to children.

A Rare Presentation of Homozygous Pathogenic Variant in MC2R Gene with Salt-Wasting Crisis in a Neonate.

Introduction: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disease resulting from isolated glucocorticoid deficiency or unresponsiveness to adrenocorticotropic hormone. Patients with FGD usually present in infancy or early childhood with hyperpigmentation, recurrent infections, and hypoglycemia. The salt-wasting crisis is rare. Case Presentation: A term female neonate was admitted to the neonatal intensive care unit due to respiratory distress. On physical examination, she had generalized hyperpigmentation. Initial laboratory work-up yielded normal serum electrolytes and glucose. Hyponatremia and hyperkalemia emerged on follow-up. The patient was diagnosed as having primary adrenal insufficiency (PAI) with elevated plasma adrenocorticotropin hormone and reduced cortisol levels and hydrocortisone. We started on oral sodium (5 mEq/kg/day) and fludrocortisone (FC) (0.2 mg/day) treatment to the patient. Ultrasonography revealed hypoplastic adrenal glands. Molecular genetic analysis revealed a previously reported homozygous pathogenic variant NM_000529.2: c.560delT (p.V187fs*29) in the MC2R gene. FC dose was tapered to 0.05 mg/day on the third month of life and was stopped at tenth months of age with maintenance of normal serum electrolytes and clinical findings. Conclusion: FGD due to MC2R gene mutation may rarely present with a salt-wasting crisis in the neonatal period. Identifying the causative gene with the pathogenic variant in PAI may serve to individualize a treatment plan.

Secondary Gains of Strategies to Prevent COVID-19 Infection in Neonatal Intensive Care Unit: Has the Frequency of Healthcare-Associated Infections Decreased?

OBJECTIVE: To compare the frequency and distribution of healthcare-associated infections (HAI) in the neonatal intensive care unit (NICU) during COVID-19 infection. METHODS: We compared all cases hospitalized in the NICU and diagnosed with HAIs between 1 March - 1 September 2019 (pre-COVID-19 pandemic) and 1 March - 1 September 2020 (during the COVID-19 pandemic). RESULTS: We evaluated a total of 957 babies, 427 babies in the pre-COVID-19 period and 530 babies during the COVID-19 pandemic. HAIs were determined in 47 patients (60 attacks) and 39 patients (44 attacks) in the pre-COVID-19 period and during the COVID-19 period, respectively. HAIs incidence density (per1000 hospitalization days) was found 5.43 in pre-COVID-19 period and 4.87 in COVID-19 period. During the COVID-19 period, there was a significant decrease in the HAI incidence density and bloodstream infection (P = 0.009). CONCLUSIONS: COVID-19 infection prevention strategies helped reduce the frequency of HAIs especially in bloodstream infection in NICU.

Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura.

This study aimed to evaluate the efficacy, cost, and effects of anti-D immunoglobulin (anti-D Ig), methylprednisolone, or intravenous immunoglobulin (IVIG) therapy on the development of chronic disease in children who are Rh-positive with diagnosed immune thrombocytopenic purpura (ITP). Children with newly diagnosed ITP and platelet count <20,000/mm(3) were prospectively randomized to treatment with anti-D Ig (50 µg/kg), methylprednisolone (2 mg/kg/day), or IVIG (0.4 g/kg/day, 5 days). Sixty children with a mean age of 6.7 years were divided into three equal groups. No difference was observed between platelet counts before treatment and on day 3 of treatment. However, platelet counts at day 7 were lower in the methylprednisolone group than in the IVIG group (P = 0.03). In the anti-D Ig group, hemoglobin and hematocrit levels were significantly lower at the end of treatment (P < 0.05). Chronic ITP developed in 30% of the anti-D Ig group, 35% of the methylprednisolone group, and 25% of the IVIG group, but no significant difference was noted among the groups. The cost analysis revealed that the mean cost of IVIG was 7.4 times higher than anti-D Ig and 10.9 times higher than methylprednisolone. In the treatment of ITP in childhood, one 50 µg/kg dose of anti-D Ig has similar effects to IVIG and methylprednisolone. Among patients who were treated with anti-D Ig, serious anemia was not observed, and the cost of treatment was less than that of IVIG treatment.