The umbilical cord alpha-fetoprotein levels for predicting hyperbilirubinemia in term neonates.

OBJECTIVE: The aim of this study was to investigate the possible relationship between cord bloodalpha-fetoprotein (AFP) level and development of subsequent neonatal hyperbilirubinemia. STUDY DESIGN: The term newborns born between March 2005 and October 2005 were included in the study. Infants with Coombs-positive ABO and/or Rh incompatibility and/or hemolytic jaundice, asphyxia, congenital anomaly and signs of bleeding were excluded from the study. Cord blood AFP levels were measured in 504 full term newborns in this period. Infants were followed-up for possible neonatal hyperbilirubinemia. The capillary bilirubin level (CBL) was examined expeditiously in newborns developing jaundice and in other infants at the time discharge while the screening test was being performed. RESULTS: The mean umbilical cord AFP level was 49.1 ± 44.9 mg/L (range 1.1-396.2 mg/L), mean CBL was 5.8 ± 3.1 mg/dL (range 1-19.4 mg/dL), and the mean bilirubin detection time was 37 ± 23.2 hours (range 12-144 h) of age. Although a significant positive correlation was found between umbilical cord AFP and CBL levels, it was weak (r = 0.187, p < 0.001). Comparison of AFP levels in terms of bilirubin percentile values appropriate for postnatal age also showed a significant weak positive correlation (r = 0.113, p < 0.001). CONCLUSION: The umbilical cord AFP levels may not be used as a strong predictor for the determination of newborns at risk for hyperbilirubinemia.

Morbidity in early adulthood among low-risk very low birth weight children in Turkey: a preliminary study.

The objective of this study was to assess low-risk very low birth weight (VLBW) children, before the era of modern neonatal intensive care in Turkey, during adolescence. Forty-one VLBW adolescents were compared with 40 adolescents who had normal birth weight. The physical and neuromotor development, educational achievement and psychosocial status were assessed at a mean age of 17 +/- 1.6 years. VLBW adolescents were shorter than normal birth weight adolescents (p = 0.01). A major neurological abnormality (cerebral palsy) was seen in 12% and a minor neurological abnormality (tremor, coordination, behavioral and speech disorders) in 17%. VLBW adolescents had higher rates of visual problems (56% vs. 5%). School failure was present in 27%. There were no differences in behavioral problems or quality of life between the two groups, but VLBW adolescents did have a lower self-esteem score. Neurodevelopment and growth sequelae were a significant problem in VLBW adolescents. As early intervention might help to prevent or ameliorate potential problems, long-term follow-up is essential.

Vein of Galen aneurysmal malformation: prenatal diagnosis and early endovascular management.

A prenatally diagnosed patient was referred to our hospital at 35 weeks of gestation. Antenatal ultrasonography demonstrated cardiomegaly and aneurysm of the vein of Galen. A 3,290 g male baby was delivered by elective cesarean section at 37 weeks of gestation. Physical examination was remarkable for tachypnea, hyperdynamic precordium with a continuous murmur, cranial bruit and bounding carotid pulses. Magnetic resonance angiography confirmed vein of Galen aneurysmal malformation and demonstrated the vessels feeding the aneurysm. Postnatal management included aggressive medical treatment of cardiac failure and transarterial embolization of the vessels feeding the aneurysm at 3 days of age. Posthemorrhagic hydrocephalus developed after embolization, and a ventriculo-peritoneal shunt was placed at 29 days of age. Presently, the patient is 4 years of age and has no neurological abnormality at follow-up. Vein of Galen aneurysmal malformations can cause severe morbidity and mortality in neonates. However, careful obstetric follow-up and early postnatal endovascular treatment of these malformations may lead to a favorable outcome.

Neonatal hyperbilirubinemia and G71R mutation of the UGT1A1 gene in Turkish patients.

OBJECTIVE: Nonphysiologic hyperbilirubinemia of unexplained cause is prevalent among Turkish newborns, suggesting that there might be genetic risk factors in this population. Mutation of the UGT1A1 gene, glycine to arginine at codon 71 (G71R), is related to the development of neonatal jaundice in East Asian populations but the frequency of this mutation is rare among Caucasian populations. There are insufficient data on the G71R mutation in Turkish newborns with hyperbilirubinemia. The aim of this study was to investigate the genotypic distribution of the G71R mutation and its relationship with nonphysiologic hyperbilirubinemia of unexplained cause in Turkish newborns. METHODS: Polymerase chain reaction, restriction fragment length polymorphism and agarose gel electrophoresis techniques were used for detection of G71R mutation in 109 newborn infants: 39 with hyperbilirubinemia and 70 without hyperbilirubinemia. RESULTS: The genotypic distribution for the mutation was 70 G/G, 32 A/G, 7 A/A genotypes and the mutated allele frequency was 0.22. The frequency of G71R mutation was 33.3 % (n = 13) A/G, 7.7% (n = 3) A/A in the hyperbilirubinemia group and 27.1% (n = 19) A/R, 5% (n = 4) A/A in the nonhyperbilirubinemia group. The difference between the groups was not statistically significant. CONCLUSIONS: Our results suggest that G71R mutation of UGT1A1 is not rare; however, an association between G71R mutation and hyperbilirubinemia of unexplained cause has not been shown in Turkish newborns.

Cord blood cardiac troponin T and nonprotein-bound iron levels in newborns of mild pre-eclamptic mothers.

BACKGROUND: In hypoxic newborns, cardiac troponin T (cTnT) was shown to be an indicator of cardiac damage and increased levels of nonprotein-bound iron (NPBI), an indicator of increased free radical production and perinatal brain damage. OBJECTIVE: The aim of this study was to determine cord blood cTnT and NPBI levels in neonates of mild pre-eclamptic mothers. METHODS: The study included 50 babies of mild pre-eclamptic mothers and 50 babies of healthy mothers. cTnT and NPBI levels were measured in cord blood. RESULTS: The mean gestational age in the pre-eclamptic and healthy groups were 36.1 +/- 3.5 and 38.1 +/- 1.9 weeks, mean birth weights were 2,456 +/- 945 and 3,059 +/- 493 g. Cord blood median cTnT level was significantly higher in the pre-eclamptic group (0.024 vs. 0.015 ng/ml). Serum cTnT in the 95th percentile was 0.047 ng/ml in the healthy group. cTnT levels of preterm babies in the pre-eclamptic group was found to be significantly higher compared to term babies in the control group (0.038 vs. 0.013 ng/ml). It could not be demonstrated whether there is a statistically significant relation between cTnT levels and respiratory distress, gestation, type of delivery, sex and birth weight. The median NPBI level was higher in the control group (3.26 vs. 1.86 micromol/l). CONCLUSIONS: Increased levels of cTnT may be a biochemical marker of cardiac involvement in babies of mild pre-eclamptic mothers. In this study, no correlation was found between cTnT levels and NPBI levels.

Neonatal psoas abscess simulating septic arthritis of the hip: a case report and review of the literature.

We report a newborn infant with psoas abscess caused by methicillin-sensitive Staphylococcus aureus. He was referred to our hospital with a history of hospital admission for hip septic arthritis without clinical improvement, and presented limited left hip motion, swelling on the groin and pain. A magnetic resonance imaging study revealed an abscess of the left psoas muscle. Surgical drainage and antibiotic treatment resulted in full recovery.

Catch-up growth in appropriate- or small-for-gestational age preterm infants.

The aim was to evaluate postnatal growth of preterm infants in childhood and to determine factors that have an effect on catch-up growth (CUG). Ninety-six (42F, 54M) preterm born children with a gestational age of 32.6+/-2.9 weeks and birth weight of 1815+/-668 g were evaluated at age 4.7+/-1.1 years. Preterm children with birth weight and/or length below 10th percentile were accepted as small-for-gestational age (SGA) and those above as appropriate-for-gestational age (AGA). Height SDS was similar (-0.5+/-1.0) in preterm AGA and SGA children. Both groups had low body mass index (BMI) SDS (-0.6+/-1.4 and -1.0+/-1.5, respectively). Of the preterm SGA children, 65.8% showed a CUG in height and 3.8% catch- down growth. These rates were 24.6% and 33.5% in preterm AGA children. CUG in height was best explained by birth length and mother's height and CUG in weight by birth weight and mother's weight. In conclusion, although most of the preterm SGA children show CUG, they reach a compromised height in childhood. A number of preterm AGA children show a catch-down growth.

Elevated ghrelin levels in preterm born children during prepubertal ages and relationship with catch-up growth.

BACKGROUND: Ghrelin, the natural ligand of the GH secretagogue receptor, has potent orexigenic effect. Ghrelin levels are negatively associated with insulin secretion, increased in anorexia, and reduced in obesity. Increased ghrelin levels may be associated with early postnatal growth in preterm born children. OBJECTIVE: Aim of this study was to evaluate ghrelin and insulin levels at prepubertal ages in preterm born children born appropriate for gestational age (AGA) or small for gestational age (SGA) and relationships with catch-up growth (CUG) in a prospective cross-sectional study. METHODS: Eighty-four preterm born children grouped as preterm SGA (n=28) and preterm AGA (n=56) were evaluated at age 4.7+/-0.2 and 4.7+/-0.1 years with respect to their ghrelin and insulin levels. Their data were compared with that of body mass index matched term SGA (n=35) and term AGA (n=44) children of age 4.6+/-0.2 and 3.8+/-0.1 years. All children had height appropriate for their target height. CUG was defined as the difference between birth size and recent size and expressed as Delta height and Delta weight SDS. RESULTS: Preterm SGA and preterm AGA children had similar ghrelin levels (1717.0+/-166.9 and 1656.5+/-103.8 pg/ml), although Delta height and Delta weight SDS in preterm SGA were significantly higher than in preterm AGA children (P<0.001). Ghrelin levels in both preterm groups were higher than term SGA (469.2+/-132.5 pg/ml) and term AGA children (659.6+/-143.3 pg/ml; P<0.001 for all). Delta Height and Delta weight SDS of the term SGA children were similar to that of preterm SGA children. Ghrelin did not have correlation with CUG but had inverse correlation with recent anthropometric indices. Insulin was significantly higher in term SGA children than other groups (P<0.001). CONCLUSIONS: Preterm children have higher ghrelin levels at prepubertal ages regardless of the magnitude of their CUG. Term SGA children, on the other hand, behave differently and have lower ghrelin levels than preterm children at prepubertal ages, which may be related to elevated insulin levels in this group.

A rare and preventable cause of respiratory insufficiency: ingestion of benzalkonium chloride.

Caustic agents stored in ordinary containers can be ingested by children. These materials should be stored in soft distinctive bottles and in safe places. The probability of ingestion of a caustic agent is low in the newborn period, and caustic burns have been reported infrequently. In this case study, a newborn baby with severe respiratory insufficiency after ingestion of benzalkonium chloride is reported.

Analgesia in preterm newborns: the comparative effects of sucrose and glucose.

The aim of this study was to evaluate the effectiveness of different oral carbohydrate solutions for alleviation of pain in healthy preterm babies. Thirty-one preterm infants who were having blood drawn by heel prick were given 2 ml of solution A (20% sucrose), solution B (20% glucose) or solution C (placebo, sterile water) into the mouth, 2 min before lancing. Behavioural responses to this painful stimulus were measured by duration of crying and facial expressions (Neonatal Facial Coding System, NFCS) and physiological responses were measured by heart rate (HR), respiratory rate (RR), and oxygen saturation changes (SaO(2)). Infants had a mean birth weight (+/-SD) of 1,401 g (406), gestational age of 30.5 weeks (2.7); at the time of the procedure the postmenstrual age was 32.3 weeks (1.5). There was no significant difference in the time spent squeezing the heel between the three groups (P = 0.669). After the heel prick of both the sucrose and glucose groups the duration of first cry and total crying time was significantly reduced (P = 0.005 and P = 0.007). When the babies received placebo they showed a significantly higher NFCS score at 4 and 5 min after the heel prick (P = 0.009 and 0.046 respectively). Following painful stimulus HR increased significantly in the first 3 min compared with baseline, and at the first minute the mean of the HR was found to be significantly higher in the placebo group than in the sucrose and glucose groups (P = 0.007). We concluded that both sucrose and glucose administered orally before a heel prick reduce the pain response in preterm infants.