Accidental ingestion of 3% hydrogen peroxide in the neonatal period.

Hydrogen peroxide (H2O2) is an oxidizing agent. High concentrations of H2O2 are used in the chemical industry, and 3% concentrations are used in household disinfectants. Severe H2O2 toxicity occurs with a 35% concentration. After poisoning with H2O2, corrosive damage occurs. We describe a 3-day-old male who ingested H2O2 accidentally and was treated with supportive care. Hydrogen peroxide intoxication usually occurs in adults accidentally. This is the first report of a newborn case of H2O2 ingestion.

Supraventricular tachycardia after respiratory syncytial virus infection in a newborn.

Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections in newborn infants. RSV can cause cardiac arrhythmias. We present a case of a term newborn with supraventricular tachycardia that developed during RSV infection and was successfully treated with amiodarone. RSV infection increases the risk of cardiac arrhythmia due to its course and the agents used in the treatment; therefore, close cardiac monitoring is required.

Massive upper gastrointestinal bleeding due to a gastric ulcer in a newborn.

Usually, swallowing of maternal blood is the cause of bloody vomiting in healthy term newborns. Other reported causes include gastritis, esophagitis, gastric ulcer, and duodenal ulcer. We report a newborn girl born by cesarean at 372/7 weeks who had hematemesis on postnatal day 1 and hematochezia on day 2. An erythrocyte transfusion was given on day 3. Gastroscopy performed on day 4 showed multiple gastric ulcers. Antacid treatment was given. On day 12, the newborn had a good general condition and stable vital signs and was discharged. Gastric ulcer needs to be considered as the etiology of hematemesis in healthy term newborns.

The propre-save study: effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants.

OBJECTIVE: To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. STUDY DESIGN: A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2). RESULTS: The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P < .001). The times to reach full enteral feeding were faster (P < .001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6). CONCLUSIONS: In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.

Is higher 25-hydroxyvitamin D level preventive for respiratory distress syndrome in preterm infants?

OBJECTIVE: The objective of this study was to investigate the relationship between cord blood 25-hydroxyvitamin D (25(OH)D) levels and respiratory distress syndrome (RDS) development in preterm infants. STUDY DESIGN: Between January 2012 and January 2013, 81 preterm infants, gestational age below 32 weeks, were prospectively enrolled into the study. Cord bloods of these newborns were tested for 25(OH)D levels. Low level was defined as ≤ 15 ng/mL (Group 1) and normal level as > 15 ng/mL (Group 2). Patients in Group 1 were also divided further into two subgroups as severe deficiency (Group 1a, ≤ 5 ng/mL) and mild deficiency (Group 1b, 5-15 ng/mL). RESULTS: In this study, 57 infants had low 25(OH)D levels (Group 1, median 8.0 ng/mL [interquartile range, IQR, 5-10]; Group 2, median 21 ng/mL [IQR, 19-24.7]). RDS rate was significantly higher in Group 1a (n = 18, 32.7%) and Group 1b (n = 34, 61.8%) compared with Group 2 (n = 3, 5.4%) (p = 0.001). There were no difference of having RDS between Group 1a (94.7%) and Group1b (89.5) (p = 0.512). Multivariate analysis showed that higher 25(OH)D level can be preventive for the development of RDS (odds ratio, 0.6; 95% confidence interval (0.5-0.8); p = 0.001). CONCLUSION: Lower cord blood 25(OH)D levels might be associated with increased risk of RDS in preterm infants with very low birth weight.

Management of postoperative pulmonary hypertension by inhaled nitric oxide in a newborn with congenital diaphragmatic hernia.

Postero-lateral congenital diaphragmatic hernia (CDH) is a life threatening anomaly characterized by diaphragmatic defect and intrathoracic herniation of abdominal viscera. In patients with CDH, the lungs are hypoplastic and persistent pulmonary hypertension develops in most cases. Although, inhaled nitric oxide (iNO) results in a reduction in pulmonary hypertension with improvement in oxygenation, its benefit in the patients with CDH remains controversial. In this report, the authors present successful management of postoperative pulmonary hypertension by iNO in a newborn with CDH.

The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial.

OBJECTIVE: To compare the effect of two lipid emulsions on the development of retinopathy of prematurity in very low birth weight infants. DESIGN: Randomized controlled study. PATIENTS AND METHODS: Eighty very low birth weight infants receiving parenteral nutrition from the first day of life were evaluated. One of the two lipid emulsions were used in the study infants: Group 1 (n=40) received fish-oil based lipid emulsion (SmofLipid®) and Group 2 (n=40) soybean oil based lipid emulsion (Intralipid®). MAIN OUTCOME MEASURES: The development of retinopathy of prematurity and the need for laser photocoagulation were assessed. RESULTS: The maternal and perinatal characteristics were similar in both groups. The median (range) duration of parenteral nutrition [14days (10-28) vs 14 (10-21)] and hospitalization [34days (20-64) vs 34 (21-53)] did not differ between the groups. Laboratory data including complete blood count, triglyceride level, liver and kidney function tests recorded before and after parenteral nutrition also did not differ between the two groups. In Group 1, two patients (5.0%) and in Group 2, 13 patients (32.5%) were diagnosed with retinopathy of prematurity (OR: 9.1, 95% CI 1.9-43.8, p=0.004). One patient in each group needed laser photocoagulation, without significant difference. Multivariate analysis showed that only receiving fish-oil emulsion in parenteral nutrition decreased the risk of development of retinopathy of prematurity [OR: 0.76, 95% CI (0.06-0.911), p=0.04]. CONCLUSIONS: Premature infants with very low birth weight receiving an intravenous fat emulsion containing fish oil developed less retinopathy of prematurity.