Serum thyroid hormones levels are significantly decreased in septic neonates with poor outcome.

The aim of this prospective study was to investigate the effects of thyroid hormone levels on the sepsis criteria and mortality in septic newborns. This study was performed at the Firat University Hospital Neonatal Intensive Care Unit. A group of septic newborns and a control group of healthy non-infected newborns were evaluated. Blood samples were obtained at onset from septic and healthy newborns and at 10th day of the antibiotic therapy from only septic newborns, and thereafter serum total T(3) (TT(3)), total T(4) (TT(4)), and TSH levels were determined. A total of 292 newborns were included in the study. Serum TT(3) levels at onset and at 10th day of the antibiotic therapy were 163.8±63.4 and 178.3±33.1 ng/dl, TT(4) levels were 6.9±2.2 and 11.0±2.6 mg/ml, and TSH levels were 3.8±2.1 and 4.0±2.5 µU/ml, respectively in septic newborns. Serum TT3 levels were 180.3±47.6 ng/dl, TT(4) levels were 10.9±2.3 mg/ml, and TSH levels were 4.1±2.2 µU/ml in healthy newborns. Serum TT(3), TT(4) levels of septic newborns were significantly decreased with respect to those of healthy newborns at onset and serum TT(4) levels was increased significantly after antibiotic therapy. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of septic newborns and a healthy group. Our findings suggest that before and after treatment of neonatal sepsis a significant change is realized in thyroid hormone levels.

Oxidant and antioxidant levels in preterm newborns with idiopathic hyperbilirubinaemia.

OBJECTIVES: Newborns, particularly preterm infants, have limited antioxidant protective capacity. The organism's defence system against reactive oxygen species including vitamins A, E and C, trace element selenium (Se) and enzymes, such as catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) are essential components of the antioxidant system against the oxidative injury to the cellular membranes of erythrocytes. In this study, our aim was to compare the oxidant nitric oxide (total plasma nitrite level as an indicator of nitric oxide (NO)), antioxidant vitamins and selenium and erythrocyte antioxidant enzymes in premature babies with hyperbilirubinaemia with healthy preterms. METHODS: Twenty preterm infants with newborn jaundice were included in the study group, while 15 preterm infants without jaundice were enrolled in the control group. We evaluated the mean plasma levels of, respectively, the total nitrite as an indicator of NO, bilirubin, vitamins A, E, C and selenium, and the activity of erythrocyte antioxidant enzymes such as CAT, SOD and GSH-Px of preterm infants with idiopathic hyperbilirubinaemia and compared to those of the control group. RESULTS: The mean plasma total nitrite and total serum bilirubin levels and blood reticulocyte counts of the study group were found to be significantly higher than those of the control group (P < 0.001, P < 0.001 and P < 0.05, respectively). Furthermore, the activity of erythrocyte antioxidant enzymes (all P < 0.001) and the mean plasma levels of the antioxidant vitamins A, E, and C (P < 0.05, P < 0.05 and P < 0.001, respectively) and selenium (P < 0.001) of the study group were all found to be significantly lower than those of the control group. CONCLUSION: We hypothesize that low antioxidants in pretem babies may predispose them to increased oxidative stress, and cause hyperbilirubinaemia.

Long-term neurological outcome of acute encephalitis.

To understand the viral etiology of acute childhood encephalitis in Elazig, Eastern Turkey, 36 children aged between 4 months and 14 years who were treated in a regional medical center between January 1995 and June 1999 were studied. Viral etiology was identified in 16 of 34 (47.1 per cent) cases and the most frequently detected pathogens was mumps (seven cases, 20.6 per cent). No specific etiology was found in 18 (52.9 per cent) cases. Among the survivors, mental and/or focal neurological deficits persisted in 18 (52.9 per cent). Two children died and 32 survived, of whom 16 were left with no neurological sequel, 10 had persistent neurological sequel, and eight recovered with some degree of handicap. Improvement in the general health and sanitation of the population, and the universal use and development of new vaccination will significantly reduce the incidence of viral encephalitis.

Prune-belly syndrome associated with extra-abdominal abnormalities in a 7-year-old boy.

Prune-belly syndrome (PBS) is an association of abdominal wall deficiency, genitourinary anomalies, and in males, cryptorchidism. Other congenital anomalies are associated with PBS, particularly musculoskeletal deformities and gastrointestinal tract anomalies. In this report, a seven-year-old boy with PBS had mega cisterna magna variant, microcornea, aortic stenosis with bicuspid aortic valves, cholelithiasis, and Hirschsprung's disease. Coexistence of these abnormalities with PBS supports the concept of PBS being caused by an early disturbance of not only mesodermal development but also of the other germ layers. There was maternal ingestion of drugs in the 1st month of gestation. All cases with PBS should be evaluated thoroughly for extra-abdominal abnormalities resulting from disturbances of ectodermal and endodermal development. Even though disturbances related to ectodermal and endodermal development may be asymptomatic, early diagnosis of the disturbances may help in preventing possible future problems.

Nipple and areola diameter in Turkish pubertal girls.

The nipple and areola diameter of 498 girls aged 8-17 years were studied with the aim of finding measurable criteria for sexual maturation, including breast and pubic hair development during female puberty. All measurements were made holding a transparent ruler on both sides by the same observer. The smaller of the two measurements was used in the analysis. Significantly nipple and areola development occurred between breast stages B1 (2.56 and 14.35 mm), B2 (3.32 and 20.26 mm), B3 (5.21 and 28.84 mm), and B4 (6.28 and 32.03 mm). The nipple and areola diameter were also significantly greater in pubic hair stage (PH)3 (5.05 and 25.24 mm) with respect to PH2 and PH1 (3.46, 2.62 mm and 19.32, 15.37 mm, respectively), in PH5 (6.79 and 35.62 mm) with respect to PH4 (6.55 and 32.56 mm). A significant increase in nipple and areola diameter occurs between premenarchal girls and girls older than 0-2 years postmenarche. Sexual maturation staging by nipple size and by areola size appears to be feasible for female adolescent. However, staging by nipple size does not appear to be feasible for B4 and B5 stage, because the incremental gradations are small.

Omphalitis in term and preterm appropriate for gestational age and small for gestational age infants.

To determine whether there is a difference on the historical and clinical characteristics of omphalitis among term and preterm appropriate for gestational age (AGA) and small for gestational age (SGA) infants, we prospectively investigated 85 newborns with bacteriologically proved omphalitis. Study groups were based on gestational age and being SGA. Preterm AGA infants had significantly lower mean age and neutrophil counts. Risk factors such as septic delivery including unplanned home delivery, and bacterial spectrum were similar in the groups. Staphylococcus aureus and Escherichia coli were the most frequent micro-organisms. Mortality rates for the study groups were similar and overall case fatality rate was 13 per cent. Immunological immaturity of preterm newborns may explain the earlier occurrence age of omphalitis and lower absolute neutrophil count. The following features such as early-onset infection, septic delivery including unplanned home delivery and abnormal temperature may be considered as determinants of poor prognosis. However, further studies are needed.

Pubertal development of Turkish boys in Elazig, eastern Turkey.

Data on pubertal development in 462 healthy, well-developed schoolboys from the cross-sectional study in Elazig, Eastern Turkey, are reported. Genital and pubic hair development are classified according to Marshall and Tanner, and Winter criteria. The initiation of genital development (the onset of puberty) was 11.6 +/- 0.15 (mean +/- SEM) years and that of pubic hair development was 12.2 +/- 0.16 years. The completion of genital and pubic hair development occurred at the same age, namely at 15.7 +/- 0.11 years. On average the genitalia and pubic hair reached the adult stage 4.2 and 3.6 years after they began to develop, respectively. As a general comment Eastern Turkish boys' pubertal data are in good agreement with English, North American and South African data.

Low levels of selenium in mothers and their newborns in pregnancies with a neural tube defect.

OBJECTIVE: Very few data are presented in the literature about selenium (Se) in human fetal development. The aim of this paper was to study the relationship between maternal and neonatal Se status and neural tube defects (NTDs). PATIENTS AND METHODS: Serum and hair samples were obtained from 20 nonpregnant women, 32 healthy mothers with normal newborns, and 28 mothers who had a newborn with NTD, and their newborns at delivery. Serum Se levels, as ng/mL, and hair Se levels, as microgram/g, were determined on a Perkin-Elmer 1000 spectrophotometer (United Kingdom) by fluorometry. RESULTS: The mean maternal serum and hair Se concentrations in the NTD group (42.9 +/- 1.75 ng/mL, 277 +/- 7.73 ng/g, respectively) were significantly lower than those of the control healthy mothers (50.2 +/- 2.35 ng/mL, 300 +/- 6.10 ng/g, respectively) and the nonpregnant women (58.1 +/- 3.12 ng/mL, 315 +/- 7.64 ng/g, respectively). A significant decrease in concentrations of Se in serum and hair was observed in newborns with a NTD (26.0 +/- 1.55 ng/mL, 181 +/- 3.71 ng/g, respectively) compared with healthy newborns (32.6 +/- 1.70 ng/mL, 204 +/- 4.43 ng/g, respectively). CONCLUSIONS: Maternal Se deficiency during pregnancy was thought to be one of the factors responsible for NTDs. However, the lowered serum and hair Se concentrations may be secondary manifestations of an abnormal pregnancy and did not contribute to its production. More studies on maternal Se status during the antenatal period, especially early gestation and neonatal Se status including normal newborns and NTD infants, are needed.

Prune-belly syndrome associated with omphalocele in a female newborn.

The authors report on a female newborn with prune-belly syndrome (PBS) in association with omphalocele. This case raises the total of omphalocele associated with PBS to seven. The authors suggest that this case lends support to the concept of PBS being caused by an early disturbance of mesodermal development in both the abdominal wall and the urinary tract.

Maternal carriage and neonatal colonisation of group B streptococci in labour are uncommon in Turkey.

Group B streptococcus infection is an important cause of neonatal morbidity and mortality. We studied 114 women and their newborns to determine the relationship between maternal carriage and neonatal group B streptococcal colonisation. Rectal, cervical and vaginal swabs were taken at delivery. Within a few minutes of birth, swab specimens were also taken from throat, ear, umbilicus, conjunctiva and skin of the newborns. Group B streptococcus was isolated in 10 (8.7%) of the 114 pregnant women studied and in five (4.3%) of the 114 newborns. Vertical transmission rate was found to be 50%. Neonatal group B streptococcus colonisation has not reached a high level in Turkey, and consequently does not warrant intrapartum screening at the moment.