Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases.

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID-19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID-19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID-19 were evaluated. Twenty-six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID-19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Neurodevelopmental outcomes of very low birth weight preterm infants treated with poractant alfa versus beractant for respiratory distress syndrome.

BACKGROUND: Some controlled trials have shown significant differences in short-term clinical outcomes between poractant alfa and beractant in infants with respiratory distress syndrome (RDS). There is, however, no study showing the differences in long-term outcomes with these treatments. AIM: To determine and compare the neurodevelopmental outcomes of preterm infants with RDS treated with poractant alfa or beractant at 2 years of age. METHODS: This was a prospective, longitudinal, single-center cohort study of infants born at ≤ 1,500 g and/or ≤ 32 weeks between 2008 and 2009 who received either poractant alfa (n = 113) or beractant (n = 102) for RDS. Neurological and developmental assessments were performed at a corrected age of 18 to 24 months. RESULTS: About 33 of 113 infants (29.2%) in the poractant alfa group had neurodevelopmental impairment compared with 36 of 102 (35.2%) in the beractant group, and the results did not differ between the groups (p = 0.339). Similarly, no significant difference was found in the percentage of infants with cerebral palsy (11.5 vs. 16.7%, respectively; p = 0.275). CONCLUSION: Our findings suggest that poractant alfa and beractant are similar in terms of neurodevelopmental outcomes when used for the treatment of RDS in preterm infants.

Postnatal oral hydrocortisone in treatment of bronchopulmonary dysplasia: an observational study.

INTRODUCTION: The aim of our study was to determine whether hydrocortisone even at low dose could be an effective and safe alternative treatment for bronchopulmonary dysplasia. MATERIALS AND METHODS: This prospective pilot study was conducted in a tertiary referral neonatal intensive care unit placed in Ankara Zekai Tahir Burak Maternity Teaching Hospital. Preterm babies (> 32 week gestational age or > 1500 g birth weight) who were ventilator dependent approximately at or beyond three weeks of age (defined as rescue treatment) or were oxygen dependent on postmenstrual 36th week without evidence of any infection (defined as bronchopulmonary dysplasia treatment) were enrolled in the study. Hydrocortisone was used orally in an initial dose of 1 mg/kg twice a daily for a week and then the dose was tapered by 10-20% every other day regarding to clinical response. RESULTS: A total of 90 infants were enrolled in this study. After hydrocortisone treatment only 3 (3.4%) patients were still on respiratory support. When safety of the drug was evaluated 8 (8.8%) infants had early complications of hydrocortisone treatment. CONCLUSION: To the best of our knowledge this study is the first trial in the literature along with the hydrocortisone dose and the initiation time in treatment of bronchopulmonary displasia.

Neurodevelopmental outcome among multiples and singletons: a regional neonatal intensive care unit's experience in Turkey.

OBJECTIVE: The aim of this study was to compare the neurodevelopmental outcome at 12-18 months' corrected age between multiples and singleton preterm infants. METHODS: We designed a prospective study of preterm infants (≤32 weeks gestation) born and hospitalized in the neonatal intensive care unit between November 2008 and November 2009, whose assessments were performed at 12-18 months' corrected age. Neurodevelopmental impairment was defined as the presence of any one of the following: moderate or severe cerebral palsy, severe bilateral hearing loss or bilateral blindness, mental developmental index score, or psychomotor developmental index score less than 70. Results were compared for both multiples and singleton infants. RESULTS: One hundred and fifty-nine multiples and 211 singleton infants were assessed at 12-18 months' corrected age. The neurodevelopmental outcome including all parameters at 12-18 months' corrected age in multiples was not significantly different from singleton preterm infants. CONCLUSIONS: Multiple gestation in preterm infants is not associated with an increased risk of neurodevelopmental impairment at 12-18 months' corrected age compared with singleton preterm infants. For further information, long term and high participation in neurodevelopmental follow-up and evaluation at pre-school age will be needed.

Serum ibuprofen levels of extremely preterm infants treated prophylactically with oral ibuprofen to prevent patent ductus arteriosus.

AIM: The aim of this study was to explore the effects of early oral ibuprofen administration on the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) and define the association between serum ibuprofen levels and ductal closure. METHOD: Preterm infants with a gestational age of <28 weeks and/or birth weight of <1,000 g were randomized either to the intervention (ibuprofen prophylaxis) or control group. The intervention group received oral ibuprofen 10 mg/kg within 12-24 h after birth followed by 5 mg/kg at 24 and 48 h. Serum ibuprofen levels after the treatment were analyzed in the intervention group, and the incidence of hsPDA and complication rates were compared between two groups. RESULTS: Nineteen infants who received one course (three doses) of prophylactic ibuprofen in the intervention group and 17 infants in the control group who underwent an echocardiographic examination on the fourth day of life were analyzed. hsPDA was observed in five (26 %) infants in the intervention group and ten (58 %) infants in the control group (p = 0.09). In the intervention group two infants experienced gastrointestinal bleeding two infants had spontaneous intestinal perforation, and two infants developed acute kidney failure. Mean serum ibuprofen level was 28.7 ± 16.9 mg/L in the intervention group, and there was no correlation between ibuprofen level obtained on the fourth day and ductal closure. CONCLUSION: Oral ibuprofen prophylaxis reduces the rates of hsPDA even it is not statistically significant. The ductal closure rate did not correlate with serum ibuprofen levels. Due to high prevalence of adverse events observed, our data do not support the use of oral ibuprofen for prophylaxis of hsPDA.

Umbilical artery intima-media and wall thickness in infants of diabetic mothers.

BACKGROUND: Large for gestational age (LAG) neonates who had been exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing the metabolic syndrome. This can be explained by exposure to high glucose and insulin levels in utero which alter fetal adaptation and programming. OBJECTIVES: The aim of the study was to evaluate the onset of preclinical atherosclerosis in utero. METHODS: We measured umbilical artery wall thickness (ruWT) in the third trimester by obstetric ultrasound and umbilical artery intima-media thickness (uIMT) in pathologic specimens of umbilical cords obtained shortly after delivery and investigated the relation between these measurements and serum insulin level and C-peptide level in cord blood and assessed insulin resistance with the homeostasis model assessment of insulin resistance (HOMA-IR) in infants of diabetic mothers (IDMs), i.e. the study group, which was divided into a large for gestational age group (LGA)-IDM group and an appropriate for gestational age group (AGA)-IDM group and compared with a control group. RESULTS: The LGA-IDM group had significantly higher insulin (p < 0.001), C-peptide (p = 0.018) and HOMA-IR levels (p < 0.001) compared with the AGA-IDM and control groups. The LGA-IDM group had significantly larger ruWT (p = 0.013) and uIMT (p < 0.001) compared with the AGA-IDM and the control groups. The LGA-IDM group had increased uIMT and ruWT that correlated with the severity of maternal hyperglycemia. CONCLUSIONS: Measurement of ruWT in the third trimester is feasible, reproducible and strongly correlated with pathological serum insulin, C-peptide in cord blood and HOMA-IR levels.

Implementación de habitaciones individuales en la unidad de cuidados intensivos neonatales / Individual-room in the neonatal intensive care unit

La separación de las madres de sus bebés prematuros durante su internación en cuidados intensivos neonatales interrumpe la continuidad de la atención y disminuye su calidad, debido al aumento de la ansiedad y el estrés, y origina problemas en el neurodesarrollo y en la conducta a largo plazo. La atención centrada en la familia es un enfoque para la planificación, ejecución y evaluación de la asistencia sanitaria que se basa en la colaboración entre los profesionales de la salud y las familias de los pacientes. Luego de observar que el enfoque clásico no logra fomentar el desarrollo neurológico de los niños y la interacción madre-hijo, este método modifica el diseño de unidades, y propone nuevas disposiciones para satisfacer las necesidades de los neonatos, sus familias y los profesionales de la salud. En esta revisión se discuten la importancia de la atención centrada en la familia en la unidad de cuidados intensivos neonatales y los efectos de este enfoque sobre los diseños de dichas unidades

Implementación de habitaciones individuales en la unidad de cuidados intensivos neonatales / Individual-room in the neonatal intensive care unit

La separación de las madres de sus bebés prematuros durante su internación en cuidados intensivos neonatales interrumpe la continuidad de la atención y disminuye su calidad, debido al aumento de la ansiedad y el estrés, y origina problemas en el neurodesarrollo y en la conducta a largo plazo. La atención centrada en la familia es un enfoque para la planificación, ejecución y evaluación de la asistencia sanitaria que se basa en la colaboración entre los profesionales de la salud y las familias de los pacientes. Luego de observar que el enfoque clásico no logra fomentar el desarrollo neurológico de los niños y la interacción madre-hijo, este método modifica el diseño de unidades, y propone nuevas disposiciones para satisfacer las necesidades de los neonatos, sus familias y los profesionales de la salud. En esta revisión se discuten la importancia de la atención centrada en la familia en la unidad de cuidados intensivos neonatales y los efectos de este enfoque sobre los diseños de dichas unidades (AU)

Evaluation of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy.

Specific immunotherapy (SIT) is one of the treatment modalities recomended for the management of asthma and allergic rhinitis by international guidelines. A potential benefit of immunotherapy (IT) is to prevent the development of sensitisation to new allergens. There is stil no conclusion on this subject. One hundred twenty-two children 8-18 years old with intermittent asthma, with or without allergic rhinitis, all of whom were monosensitised to house dust mite (HDM) were selected. Sixty two of these children accepted to receive SIT with HDM extract for 4 years and the remaining 60 did not accept SIT and were treated with asthma medications only. This second group of children served as the control group. At the end of the 4-year study period, 36 of the 53 patients (67.9%) in the SIT group showed no new sensitizations, compared to 38 of 52 (73.0%) in the control group (p = 0.141). The most frequent new sensitizations at the end of the study were pollens, grasses and olive polen, followed by animal dander, alternaria and cockroach. In conclusion, SIT may not prevent the onset of new sensitizations in asthmatic children monosensitized to house dust mites. Further investigation is required to clarify the immunologic mechanisms and other factors by which SIT reduces or not the development of new sensitizations in monosensitized children.

Serum sickness-like syndrome after immunoglobulin M-enriched polyclonal immunoglobulin.

Medication reactions, infectious etiologies, graft vs. host disease, serum sickness, and serum sickness-like reaction are the most common conditions that cause skin fever and rashes in immunosuppressed patients. In addition to this long list of diseases, severity of the primary disease and deterioration in the patient's health status can make the diagnosis difficult. Furthermore, cutaneous and histological similarities in these mentioned conditions can be confounding. Here, we present a 16-year-old male patient with acute myeloid leukemia suffering from skin rashes and fever that appeared following a chemotherapy course leading to bone marrow suppression. We aim to discuss the differential diagnosis and share the diagnostic challenges that we already have experienced after immunoglobulin M-enriched polyclonal immunoglobulin.