Nutritional effects on auditory brainstem maturation in healthy term infants.

OBJECTIVE: To assess the effects of dietary long chain polyunsaturated fatty acid (LCPUFA) supplementation on auditory brainstem maturation of healthy term newborns during the first 16 weeks of life by measuring brainstem auditory evoked potentials (BAEPs). DESIGN: Throughout the 16 week study period, infants in the formula A group (n = 28) were assigned to be fed exclusively with the same formula supplemented with DHA, and infants in the formula B group (n = 26) were assigned to receive only a DHA unsupplemented but otherwise similar formula. During the study period, the first 26 consecutive infants to be fed exclusively on their mother's milk for at least the first 16 weeks of life were chosen as the control group. BAEP measurements were performed twice: at the first and 16th week of age. RESULTS: There were no significant differences among the study and control groups in the BAEP measurements performed at the study entry. At 16 weeks of age, all absolute wave and interpeak latencies in the study and control groups had significantly decreased. The decreases were significantly greater in the formula A and control groups than in the formula B group. CONCLUSIONS: Infants fed on human milk or a formula supplemented with LCPUFAs during the first 16 weeks of life show more rapid BAEP maturation than infants fed on a standard formula. Although the clinical importance and long term effects of these findings remain to be determined, routine supplementation of formulas with LCPUFAs should be considered.

Intermittent versus continuous sertraline therapy in the treatment of premenstrual dysphoric disorders.

OBJECTIVE: Premenstrual dysphoric disorder (PMDD) is a combination of mood disturbances and physical symptoms that reduce the quality of individual life and the functionality of the individual. Many women do not consider the complaints arising in the luteal phase of the menstrual cycle as a psychiatric disorder and, thus, do not seek treatment. Those who take their complaints to doctors usually apply to gynecology clinics. The aim of the present study is to analyze the psychiatric disorders observed in patients with PMDD and to compare the continuous and intermittent administration of sertraline. MATERIALS AND METHODS: PMDD was investigated in the patients admitted to the Gynecology Clinic of the Medical School of Fatih University. The patients were asked to fill out forms designed in accordance with PMDD diagnosis criteria as defined in DSM IV. RESULTS: Among the 267 patients who filled out the forms, 162 (60.7%) were PMDD positive. Of the PMDD-positive patients, 133 accepted a psychiatric interview; 36 (27%) of them had depression, obsessive-compulsive disorder, anxiety and somatoform disorders as an accompanying disorder. Out of 162 PMDD-positive patients 94 accepted medical treatment; 71 patients were given sertraline on a continuous basis, and 23 patients took sertraline intermittently in the luteal phase of the cycle. Because of side effects, 44 (62%) of the continuous therapy and 22 (96%) of the intermittent therapy group stopped medication. At the end of 6-month follow-up, continuous use of sertraline was found to be significantly more tolerated than intermittent therapy in the treatment of PMDD (chi2 = 7.88, p = 0.005). CONCLUSION: In patients with the symptoms of PMDD, psychiatric evaluation should be encouraged by gynecology clinics, and continuous administration of sertraline should be the choice because of patients' greater acceptance of the therapy.

Neonatal diabetes mellitus: patient report and review of the literature.

A female infant born at 33 weeks gestation to a gestationally diabetic mother developed apnea and respiratory distress at 6 hours of age. Laboratory investigation demonstrated persistent hyperglycemia, and the patient was treated with continuous intravenous and subsequent subcutaneous insulin therapy. Detailed laboratory investigation to reveal the etiology of hyperglycemia and further endocrine evaluation were not significant. The baby's insulin requirement has continued thereafter, and she is being followed up in an outpatient clinic still under insulin therapy at 18 months of age. Neonatal diabetes mellitus should be considered in the differential diagnosis of neonatal hyperglycemia, and it may develop in newborns born to diabetic mothers, as well as neonatal hypoglycemia. Insulin treatment with close blood glucose monitoring is essential as long as hyperglycemia persists since neonatal diabetes mellitus may be either transient or permanent and it is not possible to differentiate these two outcomes before 18 months of age.

Fiberoptic phototherapy versus conventional daylight phototherapy for hyperbilirubinemia of term newborns.

The efficacy and wavelengths of fiberoptic phototherapy and conventional daylight phototherapy were compared in a relatively larger series of term newborns with nonhemolytic and significant hyperbilirubinemia than reported in previous studies. One hundred and nine term newborns were randomly assigned to receive either fiberoptic phototherapy on a fiberoptic phototherapy pad or overhead conventional phototherapy consisting of five daylight fluorescent lamps. Although the average spectral irradiance measured during the study period was significantly greater in the fiberoptic phototherapy group (9.2+/-1.2 microW/cm2/nm vs 7.1+/-1.1 microW/cm2/mm, p < 0.05), conventional phototherapy was significantly more effective in decreasing bilirubin levels: the duration of exposure to phototherapy was significantly shorter (49.4+/-14.4 hours vs 61+/-13.1 hours, p < 0.05), and overall bilirubin decline rate as mg/dl/h and percent/h was significantly greater in the conventional phototherapy group (0.15+/-0.06 mg/dl/h vs 0.11+/-0.05 mg/dl/h, and 0.81+/-0.34 percent/h vs 0.60+/-0.28 percent/h, p < 0.05). There were four failures of phototherapy in the fiberoptic phototherapy group whereas no phototherapy failure was observed in the conventional phototherapy group (p < 0.05). The emission spectrum of the daylight fluorescent lamp revealed a broad emission between the violet and red spectra with tiny narrow peak emission bands in 405 nm, 436 nm, 546 nm and 577 nm, while a broad emission through the blue and green wavelengths (mainly in the green spectrum) without any peak emissions was detected in the tungsten-halogen lamp of the fiberoptic phototherapy system. Conventional phototherapy with daylight fluorescent lamps should be preferred to fiberoptic phototherapy administered with fiberoptic phototherapy and in the treatment of term newborns with nonhemolytic hyperbilirubinemia.

Thoracic ectopic kidney in a child: a case report.

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. It is usually asymptomatic and discovered incidentally on a routine chest radiography. We report a thoracic ectopic kidney in a 19-month-old boy, which initially presented as a well demarcated mass at the base of the right lung on chest x-ray. Intravenous pyelography (IVP) and thoraco-abdominal computed tomography (CT) demonstrated a normal functioning transdiaphragmatic thoracic ectopic right kidney, but technetium-99m DTPA and DMSA scintigraphy demonstrated pelvic stasis. We hereby discuss the features of congenital thoracic ectopic kidney and review the literature. Although it is extremely rare, thoracic ectopic kidney should be considered in differential diagnosis of a mass with a well demarcated superior margin in the lower part of the thorax, and renal scintigraphy must be performed even if CT and IVP results are normal.

The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns.

OBJECTIVE: The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life. METHODOLOGY: A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of >/=17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia. RESULTS: No newborns had a serum total bilirubin level of >/=17 mg/dL in the first 72 hours of life. Sixty of 498 cases (12.05%) had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not develop significant hyperbilirubinemia on each of the first 5 days' measurements. Of the 206 newborns who had a serum bilirubin level of >/=6 mg/dL in the first 24 hours, 54 (26.21%) developed significant hyperbilirubinemia, whereas only 6 of the 292 newborns (2.05%) who had a serum bilirubin level of <6 mg/dL on the first day developed significant hyperbilirubinemia. A mean serum bilirubin level of >/=6 mg/dL on the first day had the highest sensitivity (90%). At this critical serum bilirubin value, the negative predictive value was very high (97.9%) and the positive predictive value was fairly low (26.2%). Furthermore, because no cases with a serum bilirubin level of <6 mg/dL in the first 24 hours of life required a subsequent phototherapy treatment and because all of those infants requiring a phototherapy treatment with serum bilirubin levels of >/=20 mg/dL were just among the cases whose first-day bilirubin levels were >/=6 mg/dL, the critical bilirubin level of 6 mg/dL on the first day made it possible, with the highest (100%) sensitivity and negative predictive value, to definitely predict all of the infants who would have a bilirubin level of >20 mg/dL, requiring a phototherapy treatment later during the first days of life. CONCLUSIONS: A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life.

Is a standard protocol necessary for oscillometric blood pressure measurement in term newborns?

OBJECTIVE: The necessity of taking only one randomized blood pressure measurement or averaging three repeated measurements and, the effects of various stages of the restful state and body position on blood pressure measurements obtained with the oscillometric technique were investigated in 138 healthy term newborns. METHODS: The Athena oscillometer was used to measure blood pressure. Three successive measurements with a 5-min interval were made in each of two positions, prone and supine, in random order 30 min after the last feeding if newborns were in very quiet or quiet sleep. During routine recording of vital signs, another (single) measurement was obtained before feeding the infant regardless of the body position of the newborn, provided that they were not struggling, crying or moving. RESULTS: For all systolic, diastolic and mean blood pressures measured, there were no significant differences among either prone, supine and single measurements or among three successive measurements in each position. CONCLUSIONS: We conclude that, in the routine care of term newborns, blood pressure measurements with the oscillometric technique may be made without the need of a special position or sleep state, provided that the measurements are made with an appropriate sized cuff in the absence of struggling, crying and movement of the newborn. Taking only one randomized measurement under these conditions would be enough and practical in daily newborn care practice instead of repeating and averaging many measurements.

Severe intrauterine growth retardation, aged facial appearance, and congenital heart disease in a newborn with Johanson-Blizzard syndrome.

We report a female newborn with Johanson-Blizzard syndrome associated with extreme intrauterine growth retardation, aged facial appearance, and atrial septal defect. Other features are microcephaly, prominent veins over the scalp, alopecia over the vertex, wide-open fontanelle, high forehead, antimongoloid slant, edematous eyelids, the absence of eyebrows and eyelashes, beaked nose with alae nasi, low-set ears, thin lips, and micrognathia. Investigations revealed deafness and congenital hypothyroidism. We believe that this association of severe intrauterine growth retardation and congenital heart disease represents the components of this syndrome.

Double versus single phototherapy in term newborns with significant hyperbilirubinemia.

The efficacy of double phototherapy, in the form of conventional phototherapy with special blue light plus fiberoptic phototherapy, was compared with conventional phototherapy consisting of special blue lamps alone in a relatively larger series of term newborns with significant hyperbilirubinemia. During the study period the sum of the average spectral irradiances in the double phototherapy group was significantly higher than that of the single phototherapy group (p < 0.05). Phototherapy was effective in decreasing bilirubin levels in both groups, but the response was greater in the double phototherapy group; the duration of exposure to phototherapy was significantly shorter (31.2 +/- 8.5 vs. 38.98 +/- 14.7 h, p < 0.05), and the overall bilirubin decline rate as mumol/l/h and per cent/h was significantly greater in the double phototherapy group (4.1 +/- 1.37 vs. 3.3 +/- 0.86 mumol/l/h, and 1.29 +/- 0.38 vs. 1.02 +/- 0.44 per cent/h, p < 0.05). In phototherapy treatment of term newborns with significant hyperbilirubinemia, double phototherapy provided more rapid and effective bilirubin reduction than conventional phototherapy alone due to higher spectral irradiance and larger body surface area exposed to phototherapy. The value of double phototherapy in the treatment of newborns with hemolytic hyperbilirubinemia remains to be determined.

The role of erythrocyte protoporphyrin in the diagnosis of iron deficiency anemia of children.

The values of erythrocyte protoporphyrin, ferritin and mean corpuscular volume (MCV) measurements in diagnosing iron deficiency anemia were investigated in 72 iron deficient and in 25 healthy control infants. Receiver operator curve, sensitivity and specificity of erythrocyte protoporphyrin, ferritin and mean corpuscular volume were compared between the study and control groups. In the study group mean corpuscular volume, hemoglobin and ferritin concentrations were significantly lower, and erythrocyte protoporphyrin was significantly higher when compared to the control group. In the iron deficient study group, erythrocyte protoporphyrin was the most sensitive test and ferritin was the most specific test, whereas ferritin was the most diagnostic test and mean corpuscular volume was the least diagnostic test. A significant correlation between erythrocyte protoporphyrin and hemoglobin values was determined. We conclude that erythrocyte protoporphyrin is a more sensitive but less specific test than ferritin, and it can be used as a first-line diagnostic test in the evaluation of iron deficiency and in diagnosing iron deficiency anemia in infants.

Comparison of the efficacy of conventional special blue light phototherapy and fiberoptic phototherapy in the management of neonatal hyperbilirubinaemia.

The efficacy and usefulness of two types of phototherapy differing in the source, wavelength and irradiance of the light, conventional phototherapy consisting of special blue light and fiberoptic phototherapy, were compared in a relatively larger series of term newborns with non-haemolytic and more significant hyperbilirubinaemia than those in previous studies. In total, 108 newborns were allocated sequentially to receive either conventional phototherapy consisting of five special blue lamps or fiberoptic phototherapy. The average spectral irradiance measured at the skin surface level of newborns during the study period was significantly greater in the conventional phototherapy group. The special blue lamp of the conventional phototherapy unit had an emission spectrum almost identical to the bilirubin absorption spectrum, whereas the tungsten-halogen lamp of the fiberoptic phototherapy had a broad emission through the blue and green wavelengths (mainly in the green spectrum). Phototherapy was more effective in the conventional phototherapy group; the duration of exposure to phototherapy (h) was significantly shorter, and the overall bilirubin decline rate (as micromol/l/h and %/h) was significantly greater in the conventional phototherapy group. According to the nursing personnel, fiberoptic phototherapy was more comfortable than the conventional phototherapy frame because of the easier accessibility and handling of the infants during phototherapy. They complained of giddiness, nausea, glare, temporary blurring of vision and difficulty in detecting the skin colour changes of newborns with the blue light of the conventional phototherapy unit. Conventional phototherapy consisting of special blue fluorescent lamps with approximately twofold higher irradiance and an emission spectrum almost identical to the bilirubin absorption spectrum is preferable to fiberoptic phototherapy in the standard treatment of term newborns with non-haemolytic hyperbilirubinaemia.

High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice.

A controlled study was conducted to assess the role of high-dose i.v. immunoglobulin (HDIVIG) therapy in neonatal immune haemolytic jaundice. Patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinaemia (>204 mmol l(-1)), positive direct antiglobulin test and high reticulocyte count (> or =10%) were randomly assigned to receive either conventional phototherapy alone or phototherapy with high-dose i.v. immunoglobulin (1 g kg(-1), over 4 h) as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded 290 mmol l(-1) and increased by more than 17 mmol l(-1) per h despite both treatment manoeuvres. Eight of 58 patients in the HDIVIG group required exchange transfusions, whereas it became necessary in 22 of 58 patients in the control group (p<0.001). The durations of phototherapy and hospitalization in terms of hours were significantly shorter in the HDIVIG group (p<0.05). No side effects of HDIVIG therapy were observed. In conclusion, HDIVIG therapy in newborns with ABO or Rh haemolytic diseases reduces haemolysis, serum bilirubin levels and the need for blood exchange transfusion, a procedure which has potential complications and carries a risk of mortality.

Bruce treadmill test in healthy Turkish children: endurance time, heart rate, blood pressure and electrocardiographic changes.

Heart rate, systolic and diastolic blood pressure and electrocardiographic changes were studied in 80 healthy children during treadmill exercise with Bruce protocol. Mean duration of exercise in boys increased from 10.01 +/- 1.61 minutes at age four to six years with a mean body surface area of 0.75 +/- 0.06 m2, to 17.86 +/- 2.66 minutes at age 13 to 15 years with a mean body surface area of 1.48 +/- 0.10 m2. Mean endurance time in girls increased from 11.06 +/- 1.92 minutes at age four to six years with a mean body surface area of 0.76 +/- 0.08 m2, to 15.69 +/- 2.23 minutes at age 13 to 15 years with a mean body surface area of 1.41 +/- 0.07 m2. Mean maximal heart rate was 193.38 +/- 10.89 beats/minute in boys and 196.78 +/- 10.99 beats/minute in girls. The maximum level of systolic blood pressure attained at peak exercise was lower in girls. Although data of healthy Turkish children including mean endurance time, heart rate and blood pressure responses to exercise were consistent with the results from several countries using the Bruce protocol, mean maximal heart rates for all groups were slightly higher than those obtained with the Balke protocol. The data obtained from this study offers age- and size-appropriate normal data in both sexes in healthy Turkish children and may be used as reference values during treadmill exercise.

Measurement of bone mineral density by dual energy X-ray absorptiometry in preterm infants fed human milk or formula.

UNLABELLED: Bone mineralization of healthy preterm infants fed human milk were compared with that of similar fed preterm formula. Bone mineralization was studied by dual energy X-ray absorptiometry in 43 preterm infants divided into two groups; 21 preterm infants were fed with maternal breast milk and 22 preterm infants with a preterm formula containing 70 mg calcium and 35 mg phosphorus per decilitre. CONCLUSION: Preterm infants fed breast milk had lower bone mineral density than the preterm formula-fed group. Fortifying preterm human milk with calcium and phosphorus will improve bone mineralization in preterm infants.

Variable clinical expression of Holt-Oram syndrome in three generations.

Holt-Oram syndrome is a distinct autosomal dominant entity presenting with upper limb defects and cardiac abnormality. No correlation between the severity of the heart and the limb defects has been established. Here we report variable clinical expression of Holt-Oram syndrome in three generations. The grandfather presented with typical upper limb defects: phocomelia of arms with three digits on each hand, congenital heart defect and narrow shoulders. His son manifested cardiac conduction disturbance with no congenital heart or skeletal defect. The granddaughter showed ventricular septal defect and moderate radial deviations of both hands with no obvious hypoplasia of the extremities. Clinical data of the presented family suggests lack of penetrance with respect to skeletal and structural cardiac abnormalities in the Holt-Oram syndrome.

[Acquired cytomegalovirus infection in infants. A case successfully treated with ganciclovir]. / Infection acquise par cytomégalovirus chez le nourrisson. Un cas traité avec succès par le ganciclovir.

BACKGROUND: Congenital cytomegalovirus infection is a severe condition. When acquired after birth prognosis is less severe although sensorial sequelae and risks justify treatment. CASE REPORT: A 2.5 year old infant with hepatitis due to cytomegalovirus infection acquired after birth was treated with intravenous ganciclovir (7.5 mg/kg b.i.d for 2 weeks then 10 mg/kg three times a week for 2 months. No side effect or toxicity was observed and the patient recovered without sequellae. DISCUSSION: In our experience, in addition to severe and symptomatic congenital cytomegalovirus infections, ganciclovir can be used in the treatment of less severe symptomatic acquired cytomegalovirus in infants.

[Changes in the maxillary sinus wall after the Caldwell-Luc intervention. An experimental study]. / Alteraciones de la pared ósea del seno maxilar tras la intervención de Caldwell-Luc. Estudio experimental.

Inferior nasoantral windows, with and without radical surgical removal of the maxillary sinus mucosa, were studied in ten New Zealand white rabbits. Surgical removal of the mucosa and the Caldwell-Luc operation were performed. After three months, the sinus cavity was smaller, the medial wall was retracted and the inner curtain was disturbed, and small antrostomies had closed.

[Disturbances in mucociliary clearance after maxillary sinus surgery. Experimental study]. / Alteración del flujo mucociliar en la cirugía del seno maxilar. Estudio experimental.

The effect of inferior nasoantral windows on mucociliary clearance, with or without radical surgical removal of the maxillary sinus mucosa, was evaluated in five New Zealand white rabbits. Mucociliary clearance was analyzed using India ink as a marker and observing its distribution and flow rate. Partial and radical surgical removal of the mucosa, nasoantral windows, and the Caldwell-Luc operation were performed and mucociliary transport was studied. After three months, mucociliary clearance was conserved after partial resection of the sinus mucosa and absent after radical mucosal resection.