Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants.

BACKGROUND: To evaluate the efficacy of serial mean platelet volume (MPV) measurements in diagnosis and followup of sepsis and to compare its effectiveness with C-reactive protein (CRP) and interleukin-6 (IL-6) in sepsis. METHODS: Preterm infants, whose gestational age and weight were matched to each other, were grouped as control (n = 100) and sepsis (n = 91). Platelet indices (MPV, PDW, platelet count), CRP, and IL-6 levels were measured for the control group and on the day of diagnosis (1st day), 3rd, and 7th days of the sepsis group. RESULTS: There were significant differences between the control and sepsis group in terms of platelet count and MPV/PDW levels (p < 0.05). No significant changes were found in either platelet count or MPV and PDW of infants between early and late onset sepsis, nor between culture proven and non proven sepsis, nor among different infectious agents (gram positive/negative and fungal infections) (p > 0.05). Additionally, non-survivors with sepsis had higher levels of MPV and PDW during sepsis episodes on consecutive days (p < 0.05), in contrast to lower platelet counts in non-survivors (p < 0.05). Moreover, a positive correlation was found between MPV and IL-6 and CRP. A MPV value of 10.35 fL was identified as the cut off value in patients probably resulting in sepsis with a sensitivity of 97.8% and specificity of 78.7% (AUC = 0.949; p < 0.001), and a MPV value of 10.75 fL was determined as the cut off value in patients possibly resulting in death at diagnosis with a sensitivity of 95.2% and a specificity of 84.9% (AUC = 0.944; p < 0.001). CONCLUSIONS: The mean platelet volume can be used in addition to CRP and IL-6 at both diagnosis and follow-up of sepsis and the response of antimicrobial treatment.

N-acetylcysteine may prevent severe intestinal damage in necrotizing enterocolitis.

OBJECTIVE: The aim of this study was to evaluate the preventive effect of N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in an experimental rat model. MATERIAL AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups: NEC, NEC + NAC, and control. Necrotizing enterocolitis was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. Pups in the NEC + NAC group were administered NAC at a dose of 150 mg/kg daily by intraperitoneal route from the first day until the last day of the study. All pups were killed on the fifth day. Proximal colon and ileum were excised for histopathologic, immunohistochemical (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and caspase-3, caspase-8, caspase-9), and biochemical evaluation, including xanthine oxidase, total antioxidant status, total oxidant status, malondialdehyde, and myeloperoxidase activities. RESULTS: The pups in the NEC + NAC group had better clinical sickness scores compared with those in the NEC group (P < .05). In histopathologic and apoptosis evaluations (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and immunohistochemical evaluation for caspase-3 and caspase-9), the severity of bowel damage was significantly less in the NEC + NAC group compared with the NEC group (P < .01). Tissue malondialdehyde, myeloperoxidase, xanthine oxidase levels, and total oxidant status were significantly decreased in the NEC + NAC group, whereas total antioxidant status (TAS) was significantly increased in the NEC + NAC group (P < .01). CONCLUSION: N-acetylcysteine therapy significantly reduced the severity of intestinal damage in NEC.

Mesenchymal stem cell therapy in necrotizing enterocolitis: a rat study.

We evaluated the potential therapeutic use of exogenous human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in an experimental rat model of necrotizing enterocolitis (NEC). Thirty-six newborn Sprague-Dawley rats were randomly divided into three groups: NEC, NEC + hBM-MSC, and a control (control and control + hBM-MSC). NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. After NEC was induced, iron-labeled hBM-MSCs were administered by intraperitoneal injection. All pups were killed on the fourth day following injection, and the terminal ileum was excised for a histopathological and immunohistochemical evaluation. The pups in the NEC + hBM-MSC group showed significant weight gains and improvements in their clinical sickness scores (p < 0.01). Bowel damage severity observed in the histopathological evaluation was significantly lower in the NEC + hBM-MSC group than that in the NEC group (p = 0.012). The number of MSCs homing to the bowel was significantly higher in the NEC + hBM-MSC group than that in the control + hBM-MSC group. In conclusion, this is the first study that has evaluated the effectiveness of hBM-MSCs in a neonatal rat NEC model. MSCs reduced histopathological damage significantly.

C5a, a complement activation product, is a useful marker in predicting the severity of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal emergency, predominantly affecting low-birth weight, premature infants. Early clinical signs of NEC are nonspecific and the laboratory findings are not fully reliable. Its severe morbidities and rapid progression require the application of new biomarkers for early diagnosis and intervention. The complement activation product, C5a (anaphylatoxin) has been reported to be a contributing factor leading to mesenteric ischemia/reperfusion injury which is a predisposing factor in the pathogenesis of NEC. Therefore, our aim was to evaluate the efficacy of serial C5a measurements in the diagnosis and follow-up of NEC. Preterm infants, whose gestational age and weight matched each other, were grouped as controls (n = 23) and NEC (n = 22). Serum levels of C5a, serum amyloid-A (SAA), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were measured on the third day of life for the control group and on the day of diagnosis (1st day), 3rd and 7th days of the NEC group. C5a, SSA, CRP, and IL-6 levels were significantly higher in the NEC patients compared to the control group (P < 0.05) in the follow-up. Additionally, serum levels of C5a were found to be more accurate than the other parameters for the prediction of death and requirement for surgery at the time of diagnosis (P < 0.05). In conclusion, C5a may be useful as a new marker for both diagnosis and follow-up of infants with NEC in combination with clinical and radiographical findings.

Nifedipine for the treatment of preterm labor in twin and singleton pregnancies.

PURPOSE: To investigate the outcomes of singleton and twin pregnancies that were complicated by spontaneous preterm labor and received nifedipine tocolysis. METHODS: We identified the following subjects from a computerized, hospital database: 58 singleton and 32 twin pregnancies that were between 24 and 34 weeks of gestation, admitted for spontaneous preterm labor without rupture of the membranes, and receiving tocolysis with nifedipine. Data were analyzed using the Chi-square test, the Mann-Whitney test, and the Kaplan-Meier survival analysis. RESULTS: Spontaneous, preterm delivery occurred in 31.1% cases of singleton and 81.3% of twin pregnancies. Although the 22% of the mothers of twins did not have cervical changes upon admission, 37% of twins were delivered within 48 h. Mean for delivery weeks from admission to 36 weeks was significantly less for twin than it was for singleton gestations (32.3 ± 1.0 vs. 35.0 ± 0.5 weeks, respectively; Mantel-Cox X (2) = 41.118; p < 0.001). The maternal side effects were not significantly different between the groups. No serious cardiovascular complication had been found in either group. CONCLUSIONS: Tocolysis with nifedipine is effective and safe for use in both singleton and twin gestations.

Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies.

PURPOSE: To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. METHODS: The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. RESULTS: Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. CONCLUSIONS: Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice.

In this study, we aimed to make a comparison between chromosomal effects caused by conventional phototherapy and intensive phototherapy in jaundiced newborns. The study group included 83 newborns with gestation age of > or =35 weeks, and on days 3-10 after birth. Newborns were divided into four groups on the basis of total serum bilirubin (TSB) levels upon admission and need for phototherapy. The intensive group (n=19) consisted of newborns who received light-emitting diode (LED) phototherapy, the conventional group (n=23) consisted of newborns who received conventional phototherapy, the jaundiced control group (n=21) consisted of newborns whose TSB levels were higher than 10mg/dL (average = 13.7 + /-1.5 mg/dL) on admission and who did not receive phototherapy, and the non-jaundiced control group (n=20) consisted of newborns whose TSB levels were less than 5 mg/dl (average = 3.6 +/- 0.8 mg/dL). TSB level of the intensive group at admission was 20.2 +/- 1.3 mg/dL, whereas the level of conventional group was 19.6 +/- 1.5 mg/dL. Blood samples were taken from all infants on admission to determine sister chromatid exchange (SCE1) frequency. Blood sampling was repeated on discharge (SCE2) of infants who had received phototherapy. Demographic information, hospitalization details and the rate of decline in TSB were recorded, and frequencies of SCE1 and SCE2 were compared. There was no difference in demographic information among the four groups. SCE1 frequencies in 50 metaphases were evaluated in the intensive, conventional, jaundiced control and non-jaundiced control groups, and the SCE1 frequency was determined as 9.37/cell, 9.54/cell, 9.23/cell and 6.17/cell, respectively. The SCE1 frequency of the jaundiced groups (intensive, conventional and newborns-with-jaundice control group) was significantly higher than that in the non-jaundiced control group (p = 0.001). There was no significant difference between the intensive group and the conventional group in SCE2 frequency (13.5/cell vs. 13.55/cell, p = 0.39). SCE2 frequency was higher than SCE1 frequency in both the intensive and conventional groups (p = 0.001). A strong correlation was found between admission TSB and SCE1 frequency (p = 0.001; r = 0.79). The rate of decline in TSB was higher in the intensive group compared with the conventional group (0.26mg/(dLh) vs. 0.14 mg/(dLh); p = 0.001). We found that intensive and conventional phototherapies similarly increase SCE frequency in newborns. There was a strong, positive correlation between the TSB-on-admission level and SCE1 frequency. In the light of this study, we may conclude that intensive and conventional phototherapies may have an effect on chromosomes in jaundiced newborns. TSB levels higher than 10mg/dL are, too, reported hazardous on chromosomes. Further studies are warranted to elucidate this relationship.

Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases.

OBJECTIVES: This study was carried out to assess the incidence, presenting complaints, risk factors, and methods for prevention of hypernatremic dehydration among term and near-term breastfeeding infants. METHODS: We retrospectively evaluated term and near-term (> or =35 weeks of gestation) neonates admitted to our neonatology department, during a four-year period with serum sodium concentrations of > or =146 mEq/L. A detailed maternal and infant history and examination including presenting complaints, risk factors, feeding problems, and weight loss, if present, were registered. RESULTS: Among 1150 neonates admitted to our unit, 64 (5.6%) had serum sodium concentrations of >145 mEq/L, in whom 43 of them had sodium concentrations of >149 mEq/L. The most common presenting complaint was jaundice in 30 patients (48%). Forty-one (95%) of the 43 patients described a more than 7% weight loss and there was a positive correlation between serum sodium and urea and creatinine concentrations, and a negative correlation between serum sodium and glucose concentrations in these patients (p < 0.05). There was no difference between patients with sodium >149 mEq/L and <149 mEq/L with respect to maternal age, parity, educational level, hospital stay, type of delivery, and anesthesia and also with respect to seasons (p > 0.05). CONCLUSIONS: Weight loss in an infant of greater than 7% from birth weight increases the risk of hypernatremia, a weight loss limit that is lower than the previously reported 10%. This indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible interventions to correct problems and improve milk production and transfer.

Feasibility of neonatal hearing screening program with two-stage transient otoacoustic emissions in Turkey.

BACKGROUND: The objective of this study was to investigate the incidence of hearing loss in neonates and evaluate the feasibility of a two-stage Transient Evoked Otoacoustic Emission (TEOAE) screening test. Maternal concerns about hearing screening were also studied. METHODS: Neonatal intensive care patients and well babies were screened using a two-stage TEOAE test, which was followed by an Auditory Brainstem Response (ABR) test for those babies who failed the first test twice. RESULTS: In total, 711 neonates were screened. At the end of the two TEOAE tests, the cumulative pass rate was 99.3% and false-positive rate was 0.3%. Five neonates (0.7%) were referred for the ABR test. Sensorineural hearing loss was found in three of them (0.4%). Of these three neonates, one was from the well baby nursery and two were from the NICU population. Families generally welcomed the screening program, with no refusals. Positive test results have not caused important maternal concerns. CONCLUSIONS: Congenital hearing impairment is a prevalent disease in Turkey. The two-stage TEOAE program is suitable for the neonatal hearing screening program. In general, hearing screening tests do not cause notable maternal concerns.

An unusual cutaneous lesion as the presenting sign of spinal dysraphism in a preterm infant.

We present a preterm female infant with an unusual vascular nevus on the lumbosacral and gluteal regions. Our clinical diagnosis was probable twin nevus, with a blanched nevus adjacent to a telangiectatic nevus, later complicated by ulceration. Ultrasonography and magnetic resonance imaging of the lumbosacral region revealed that her conus medullaris level was at L4 and the spinal cord was tethered by an intraspinal lipoma, without evidence of a hemangioma. We could not find any literature reporting the association of twin nevus with spinal dysraphism.

Selective inhibition of nitric oxide in hypoxic-ischemic brain model in newborn rats: is it an explanation for the protective role of erythropoietin?

Erythropoietin (Epo) exerts neuroprotection against neuronal death induced by ischemia and hypoxia in vitro and in vivo. Recent studies suggest that the neuroprotective effects of Epo may depend upon different mechanisms, including the inhibition of nitric oxide (NO). We recently demonstrated that Epo exerts neuroprotection in a model of neonatal hypoxic-ischemic brain damage. In the present study, we directly determined whether systemic administration of recombinant Epo modulates cerebral NO production in a neonatal rat model of hypoxic-ischemic brain injury. Seven-day-old Wistar rat pups were subjected to left carotid artery occlusion followed by 2.5 h of hypoxic exposure. Brain nitrite levels were evaluated in both hemispheres (carotid ligated or nonligated) by Griess reagent 72 h after the hypoxic-ischemic insult. Our results show that hypoxic-ischemic insult results a significant increase in NO production as compared with NO levels in hypoxic hemispheres and control animals. A single dose of Epo treatment (1,000 U/kg i.p.) significantly decreased NO overproduction in the hypoxic-ischemic hemisphere, whereas no significant change appeared in hypoxia alone or in controls. These data suggest that the selective inhibitory effect of Epo on NO overproduction could have a neuroprotective effect in neonatal hypoxic-ischemic brain injury.