Perinatal and somatic growth properties of preterm babies born from spontaneous and in vitro fertilization multiple pregnancies.

AIM: The objective of this study was to examine perinatal and neonatal properties of preterm infants with a corrected age of 24-36 months who were born as a result of spontaneous and in vitro fertilization multiple pregnancies, to interrogate somatic growth properties of these infants and evaluate the factors which had an impact by comparing groups. MATERIAL AND METHODS: A total of 125 children with a birth weight below 2 500 g and a gestational age below the 37(th) gestational week 60 of whom were born as a result of in vitro fertilization multiple pregnancies and 65 of whom were born as a result of spontaneous multiple pregnancies were included in the study. Maternal age and morbidity, early rupture of membranes, birth weigth, gestational week, gender, APGAR score, hospitalization reasons in the neonatal period, requirement for intensive care, frequency of congenital anomaly, outpatient follow-up status, rehospitalization and socioeconomic levels were interrogated in the patients. Detailed physical examination and current height, weight and head circumference measurements were performed and the findings were placed in the growth curves of Neyzi et al. Ethics committee approval was received for this study from the ethics committee of Bakirköy Gynecology Obstetrics and Pediatrics Education and Research Hospital (12.10.2010; no:305). RESULTS: The rate of cesarean section, mean maternal age, the rate of chronic disease in the mother and the rate of maternal disease which occured during pregnancy were significantly higher in the in vitro fertilization group (p<0.05). While no difference was found in mean gestational age, birth weight, rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization, APGAR score in the 5(th) minute was significantly higher in the in vitro fertilization group. The socioeconomical score was not different between the groups, but the in vitro fertilization group presented more regularly for outpatient follow-up visits. Height, head circumference measurements and mean current weight were found to be significantly higher in the in vitro fertilization group (p<0.05). CONCLUSION: The fact that there was no difference in the rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization was attributed to the fact that the study and control groups were composed of only multiple pregnancies and preterms.

An unusual cause of bilateral scrotal abscess in a preterm infant: Candida albicans.

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

Neonatal Bartter syndrome and unilateral ectopic renal cyst as new renal causes of hydrops fetalis: two case reports and review of the literature.

Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings.

Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome.

OBJECTIVE: We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. MATERIALS AND METHODS: All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS: Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION: A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.

Prevalence and distribution of congenital abnormalities in Turkey: differences between the prenatal and postnatal periods.

The aim of this study was to determine the distribution of cases associated with congenital abnormalities during the following three periods: pregnancy, birth, and the neonatal period. This was a retrospective study of cases between 2002 and 2006. All abnormal pregnancies, elective terminations of pregnancies, stillbirths, and births with congenital abnormalities managed in the Neonatology Unit were classified based on the above distribution scheme. During the 5-year study period, 1906 cases with congenital abnormalities were recruited, as follows: 640 prenatally detected and terminated cases, with most abnormalities related to the central nervous system, chromosomes, and urogenital system (56.7%, 12.7%, and 8.9%, respectively); 712 neonates with congenital abnormalities (congenital heart disease [49.2%], central nervous system abnormalities [14.7%], and urogenital system abnormalities [12.9%]); and hospital stillbirths, of which 34.2% had malformations (220 prenatal cases [34.4%] had multiple abnormalities, whereas 188 liveborn cases [26.4%] had multiple abnormalities). The congenital abnormalities rate between 2002 and 2006 was 2.07%. Systematic screening for fetal anomalies is the primary means for identification of affected pregnancies.

Fetal-neonatal ovarian cysts--their monitoring and management: retrospective evaluation of 20 cases and review of the literature.

OBJECTIVE: Neonatal ovarian cysts (NOC) are usually self-limiting structures. However, large or complex cysts may lead to severe complications. A standard guide to management, treatment and follow-up of NOC is not yet available. The aim of this study was to evaluate retrospectively the records of NOC patients from two medical centers. METHODS: A total of 20 newborns with NOC were included in the study. The size and localization of the cyst, the age, the signs and symptoms at presentation, and the possible maternal and fetal-neonatal etiologic factors were recorded. Follow-up procedures and treatment modalities were evaluated. RESULTS: The mean age at diagnosis was 34 gestational weeks. The cysts (mean size 53±15 mm) were predominantly in the right ovary (75%) and were evaluated as large cysts in 16 (80%) of the patients. In 5 of the patients with large cysts and in 1 of the 4 patients with small cysts, the cysts were evaluated as complex cysts. Torsion of the ovary was detected in five (25%) cases and these cases were treated surgically. Patients with simple cysts were closely followed by ultrasonography until the cysts disappeared. CONCLUSION: To date, there is no precise guide for the monitoring and treatment of NOCs. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. In our NOC series, it has been possible to apply a non-invasive follow-up program and minimally invasive surgical procedures.

An unusual cause of bilateral scrotal abscess in a preterm infant: Candida albicans

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome

OBJECTIVE: We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. Materials and METHODS: All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS: Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000 g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION: A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.