Analysis of Grunting Sound in Infants for Predicting the Severity of Respiratory Distress Syndrome.

OBJECTIVE: Vocalizations from infants, particularly sounds associated with respiratory distress, are fundamental for observational scoring of respiratory tract issues. Listening to these infant sounds is a prevalent technique for decision-making in newborn intensive care units. Expiratory grunting, indicative of the severity and presence of potential conditions, is valuable, however, this evaluative method is subjective and prone to error. This study investigates the potential of computer-aided analysis to offer an objective scale for assessing the severity of respiratory tract problems, utilizing digital recordings of grunting sounds. METHODS: The original data set is formed with a total of 189 grunting sound segments collected from 38 infants. Multiple evaluation approaches were performed to reveal the relation between spectral characteristics of the recordings and the severity or existence of respiratory distress. RESULTS: Three spectral features were evaluated as prominently related to hospital stay duration and respiratory distress. The harmonic ratio of the recordings was graded as the most-related spectral feature that would characterize the severity. CONCLUSIONS: The potential of an innovative and objective grading approach is first investigated for replacing the human ear with a computer-aided evaluation system. The results are promising and the detected relation between expert ear-based scoring and harmonic ratio suggests that the spectral character of the grunting sounds would reflect the nature of respiratory conditions. Moreover, this study underlines those spectral features of digital grunting recordings that would be functional for automated prediction and decision-making.

Long-term effect of indomethacin on a rat model of neonatal hypoxia ischemic encephalopathy through behavioral tests.

BACKGROUND: Many medical experts prescribe indomethacin because of its anti-inflammatory, analgesic, tocolytic, and duct closure effects. This article presents an evaluation of the enduring impact of indomethacin on neonatal rats with hypoxic-ischemic (HI) insults, employing behavioral tests as a method of assessment. METHODS: The experiment was conducted on male Wistar-Albino rats weighing 10 to 15 g, aged between seven and 10 days. The rats were divided into three groups using a random allocation method as follows: hypoxic ischemic encephalopathy (HIE) group, HIE treated with indomethacin group (INDO), and Sham group. A left common carotid artery ligation and hypoxia model was applied in both the HIE and INDO groups. The INDO group was treated with 4 mg/kg intraperitoneal indomethacin every 24 h for 3 days, while the Sham and HIE groups were given dimethylsulfoxide (DMSO). After 72 h, five rats from each group were sacrificed and brain tissue samples were stained with 2,3,5-Triphenyltetrazolium chloride (TCC) for infarct-volume measurement. Seven rats from each group were taken to the behavioral laboratory in the sixth postnatal week (PND42) and six from each group were sacrificed for the Evans blue (EB) experiment for blood-brain barrier (BBB) integrity evaluation. The open field (OF) test and Morris water maze (MWM) tests were performed. After behavioral tests, brain tissue were obtained and stained with TCC to assess the infarct volume. RESULTS: The significant increase in the time spent in the central area and the frequency of crossing to the center in the INDO group compared with the HIE group indicated that indomethacin decreased anxiety-like behavior (p < 0.001, p < 0.05). However, the MWM test revealed that indomethacin did not positively affect learning and memory performance (p > 0.05). Additionally, indomethacin significantly reduced infarct volume and neuropathological grading in adolescence (p < 0.05), although not statistically significant in the early period. Moreover, the EB experiment demonstrated that indomethacin effectively increased BBB integrity (p < 0.05). CONCLUSIONS: In this study, we have shown for the first time that indomethacin treatment can reduce levels of anxiety-like behavior and enhance levels of exploratory behavior in a neonatal rat model with HIE. It is necessary to determine whether nonsteroidal anti-inflammatory agents, such as indomethacin, should be used for adjuvant therapy in newborns with HIE.

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy.

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS: The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS: The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HIE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION: The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.

Effect of whole body massage on pain scores of neonates during venous puncture and comparison with oral dextrose and Kangaroo care, a randomized controlled evaluator-blind clinical study.

OBJECTIVE: Newborns in NICUs experience many painful procedures. The aim of the study was to evaluate the effect of whole body massage therapy on pain scores during venipuncture and to compare with oral 10% dextrose and Kangaroo care. STUDY DESIGN: Newborns with gestational age ≥34 weeks were randomly enrolled to one of three groups: dextrose, massage and Kangaroo care and a blinded investigator scored the pain using NIPS before and during the procedure. RESULTS: There were 25, 26 and 23 newborns in dextrose, massage and Kangaroo care groups, respectively. Pain scores were similar before and during venipuncture in groups (p > 0.05). 36.5% of newborns (27/74) had severe pain scores. Number of newborns with no pain (score 0-2), moderate pain (score 3-4) and severe pain (score 5-7) were similar in each group. CONCLUSION: Massage, Kangaroo and oral 10% dextrose had similar effects on pain scores during venipuncture.

Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.

PURPOSE: The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. MATERIALS: From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. RESULTS: 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). CONCLUSION: Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.

Birth weight, head circumference, and length of newborns are unaffected by maternal levels of vitamin B12 and folate.

Vitamin B12, folate, and other micronutrients are essential for healthy growth. We hypothesized that there is a high prevalence of vitamin B12 deficiency in mothers and their newborns, and that blood serum vitamin B12 and folate levels may affect anthropometric measurements at birth. A total of 204 newborn babies and their 196 mothers were included. Blood samples of newborns and mothers were obtained for vitamin B12 (<200 pg/mL) and folate (<3 ng/mL) deficiencies. Additionally, iron and ferritin levels were measured. The mean gestational age and birth weight were 37.2 ± 2.6 (22.3-41) weeks and 3045 ± 770 (505-4525) g, respectively. All micronutrient levels in cord blood were higher than maternal levels (P = .001). A total of 96.3% of mothers and 64.5% of babies had vitamin B12 deficiency; 4% of mothers and none of the infants had folate deficiency. In total, 38.2% of mothers and 10.6% of infants had ferritin deficiency and 38.7% of mothers and 41.4% of newborns had iron deficiency. There was a negative correlation between cord vitamin B12 level and birth weight and head circumference (r = -0.21, P = .004 and r = -0.16, P = .036, respectively), whereas no correlation was found between maternal micronutrient status and anthropometric measurements of newborns. In conclusion, anthropometric measurements were unaffected by maternal levels, but vitamin B12 deficiency is very common in pregnant women and newborn babies. Mothers and their infants may benefit from early diagnosis and treatment. Awareness of vitamin B12 deficiency in pregnant women and newborns should be increased in Turkey.

Antiapoptotic Effects of Hydroxychloroquine on Hypoxic-Ischemic Injury in Neonatal Rat Brain: May Hydroxychloroquine Be an Adjuvant Theraphy?

OBJECTIVE: Hydroxychloroquine (HCQ) has immunomodulatory, antithrombotic, cardiovascular, antimicrobial, and antineoplastic effects. In this study, we aimed to investigate the antiapoptotic and immunomodulator effects of intraperitoneal HCQ on hypoxic-ischemic (HI) injury in newborn rats. STUDY DESIGN: Wistar albino rats, 7 to 10 days old, were randomly divided into three groups: hypoxic-ischemic encephalopathy (HIE) group, HIE treated with HCQ group, and Sham group. Left common carotid artery ligation and hypoxia model were performed in HIE and HCQ groups. The HCQ group was treated with 80 mg/kg intraperitoneal HCQ every 24 hours for 3 days, while Sham and HIE groups were given physiological saline. After 72 hours, rats were decapitated and brain tissues were stained with hematoxylin and eosin, TUNEL, and IL-1ß for histopathological grading and neuronal cell injury. RESULTS: Neuronal apoptosis was statistically lower in all neuroanatomical areas in the HCQ group compared with the HIE group. IL-1ß-stained areas were similar in both HCQ and HIE groups but significantly higher compared with the Sham group. Histopathological grading scores were found to be lower in the HCQ group on the left parietal cortex and hippocampus region. CONCLUSION: In this study, we have shown for the first time that HCQ treatment decreased apoptosis in HI newborn rat model in both hemispheres. HCQ may be a promising adjuvant therapy in neonatal HIE. KEY POINTS: · HCQ decreased neuronal apoptosis in the ischemic penumbra of the rat brain.. · HCQ attenuates hypoxia-ischemia-induced brain injury in neonatal rats.. · HCQ has no anti-inflammatory effect on HI injury..

The effect of different intravenous lipids on free bilirubin levels in premature infants.

BACKGROUND: Intravenous lipid emulsions are commonly used as a part of parenteral nutrition in premature infants. The potential bilirubin-displacing effects of high free fatty acid (FFA) levels during lipid infusions are known. Levels of free bilirubin (FB) predict the risk of bilirubin neurotoxicity more accurately than indirect serum bilirubin levels. In the present study, we decided to compare the effect of two different lipid solutions on free bilirubin and free fatty acids levels in premature infants. METHODS: Infants were grouped into two groups according to intravenous lipid preparations: Infants in Group 1 received lipid emulsion containing olive oil + soybean oil and Group 2 received containing olive oil + soybean oil + fish oil. The blood samples were gained when lipid intake was 3.5 g/kg/day and FFA and FB levels were analyzed. RESULTS: Serum FFA and FB levels were similar in groups (p = 0.26 and 0.69 respectively). There were significant correlation between serum FFA and FB levels in Group 1 (r = 0.74, p < 0.001) and in Group 2 (r = 0.92, p < 0.001). CONCLUSION: Both lipid preparations seem to have similar effects on free bilirubin and free fatty acid levels in premature newborns.

Coexistence of molybdenum cofactor deficiency type A and hypertrophic pyloric stenosis, a new case.

Molybdenum cofactor deficiency is a rare neurometabolic disease that is usually characterized by seizures, abnormal muscle tonus, developmental delay and poor nutrition, and is seen soon after birth. Pyloric stenosis causes serious vomiting in the first months of life. The presence of neurologic damage in molybdenum cofactor deficiency and possible abnormal innervations may cause pyloric stenosis; however, the pathogenesis is unclear. Pyloric stenosis with molybdenum cofactor deficiency has been described in two cases. Herein, we report the third case and suggest that hypertrophic pyloric stenosis should be kept in mind as a clinical manifestation of molybdenum cofactor deficiency.

Effect of Short-Term Morbidities, Risk Factors and Rate of Growth Failure in Very Low Birth Weight Preterms at Discharge.

BACKGROUND: Very low birth weight (VLBW) infants often demonstrate postnatal growth failure (PGF). We aimed to analyze incidence and risk factors for PGF in surviving VLBW infants hospitalized more than 28 days. MATERIALS AND METHODS: Fenton growth chart (2013) was used for Z-scores for birth weight (BW) and discharge weight. Infants with a decrease in their Z-scores at discharge >1 were considered as 'PGF group' and with a decrease >2 were considered as 'severe PGF group'. RESULTS: One hundred and forty-one of 148 (95.3%) infants had PGF, 88 of 141 (62.4%) had severe PGF. There were significant differences in gestational age, birth and discharge weight, and days to regain BW, age of first and full enteral feeding, duration of parenteral nutrition, lipid emulsions, intubation and hospitalization between groups (p < 0.05). Vasopressor treatment, nosocomial infection, patent ductus arteriosus and bronchopulmonary dysplasia rates were significantly higher in severe PGF group (p < 0.05). CONCLUSION: PGF remains a serious problem in our unit. All VLBW preterm infants should be followed for PGF.

Spontaneously resolved uterine prolapse in a neonate with spina bifida.

Yapicioglu Yildizdas H, Ece Ü, Bilen Yurdakul G, Kolagasigil E. Spontaneously resolved uterine prolapse in a neonate with spina bifida. Turk J Pediatr 2019; 61: 979-981. Neonatal uterine prolapse is rare and mostly due to spina bifida. It is probably due to abnormal innervation of levator ani and subsequent atrophy of the muscle in patients with spina bifida. Here we report a newborn patient with uterine prolapse after meningomyelocele operation. Foley catheter was used to manage uterine prolapse, however rectal prolapse occurred and catheter was pulled out. She was followed in an outpatient clinic without any management. She is now seven months old and had no uterine prolapse since the age of two months.

Non-persistent pesticides in breast milk in an agricultural area in Turkey.

BACKGROUND: Organophosphates, pythyreoids, carbamate pesticides and fungicides are heavily used in agriculture. They may have dangerous effects on newborn health especially on immune system and growth via prenatal transmission by placenta or postnatal transmission by breastfeeding. METHODS: In 2015, 144 non-persistent pesticides in 64 milk samples of 32 mothers were studied by OuEChERS method in liquid chromatography/tandem mass spectrometer in neonatal Intensive Care Unit in Adana, a city in Cukurova region which is an important agricultural area in Turkey. RESULTS: Pesticides were detected in milk samples of 11 mothers (34.3%) and 21 (32.8%) of milk samples. In five mothers, fungicides (in 5/10 samples propicanozole-PP, in 4/10 samples bromucanozole-BM), in five mothers, organophosphates (in 10/10 samples primyphosphomethyl-PPM), in one mother, both organophosphates and fungicide (in 1/2 samples PPM and in 1/2 samples buprimate) were detected. However, the estimated daily intakes (EDI) were less than acceptable daily intakes (ADI) for PPM, PP and BM, respectively. CONCLUSIONS: Although pesticides levels in human milk did not exceed the ADIs, we suggest monitoring pesticides in human breast milk especially for newborn health.

New biomarkers for antenatal infection: MICA and MICB gene expression in preterm babies.

The human major histocompatibility complex class I chain-related gene A and B (MICA and MICB) is one of the genes in chromosome 6. As MIC expression is inducible by heat, viral infection, inflammation and DNA damage, the molecules have been thought to be stress markers for the cells. We aimed to find the level of mRNA concentrations of MICA and MICB in neonates without any evidence of early onset infection.

Effects of two different lipid emulsions on antioxidant status, lipid peroxidation and parenteral nutrition- related cholestasis in premature babies, a randomized-controlled study.

BACKGROUND: Olive oil-soybean oil (OO/SO) based lipid emulsions (LE) lack ω-3 PUFAs eicosapentaenoic acid -EPA and docosahexaenoic acid- DHA, which have clinical benefits on inflammatory processes. Fish oil based LEs are good sources of DHA and EPA. Fish oil, MCT, Olive oil and Soya oil (FMOS) lipid is one of the fish oil containing LEs supplemented with high levels of α-tocopherol and lower levels of phytosterol compared to OO/SO lipid emulsions. We investigated the effects of OO/SO and FMOS lipid preparations on cholestasis, levels of antioxidant enzymes and lipid peroxidation. METHODS: Preterm neonates ≤32 gestational weeks age and/or ≤1500 g were randomly assigned to receive either FMOS or OO/SO in the first day of life. Catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx) and thiobarbituric acid reactive substances (TBARS) levels in the first day of life, 7th day of lipid use and 28th day of life were measured and cholestasis during parenteral nutrition was recorded. RESULTS: 34 and 33 patients were in FMOS and OO/SO lipid groups respectively. Although the TBARS levels were higher in the first day of life and 7th day of LEs in OO/SO lipid group (p=0.014 and p=0.022), on the 28th day of life TBARS level was similar and SOD level was higher (p=0.014) in OO/SO group. Cholestasis was significantly lower in FMOS lipid group (0% vs. 18.2%), (p=0.011) and neonates regained birth weight earlier (p=0.006). There was no significant difference in other morbidities. CONCLUSIONS: FMOS and OO/SO lipid emulsions have similar effects on lipid peroxidation on 28th day of life and on morbidities in short term period except for cholestasis.

Peritoneal dialysis in neonates: six years of single center experience

Background/aim: Peritoneal dialysis (PD) is generally considered the practical dialysis modality for neonates in the treatment of acute kidney injury (AKI) and metabolic disturbances. The aim of this study was to evaluate the indications, complications, and outcomes of PD between January 2011 and December 2016. Materials and methods: This study included all 56 neonates that underwent PD over six years in our neonatal intensive care unit (NICU). A retrospective chart review was performed for all patients in our institution. Results: The incidence of PD was 1.32% (56/4230 patients) during this period. Mean birth weight of the patients was 2267.77 ± 1060.63 (540­5050) g. Thirty-four (60.7%) patients were premature. Fourteen patients (25%) were in the postoperative period of cardiac surgery due to congenital cardiac defects, fourteen patients (25%) were diagnosed with metabolic diseases, one patient had hypoxic ischemic encephalopathy, and another patient had severe pulmonary hypertension. Conclusion: In the acute setting of a neonatal intensive care unit, PD performed in a neonate provides a technically simple method of steady fluid, solute removal, and correction of electrolyte abnormalities. A trocar catheter appears safe even in premature babies, and closed three-way stopcock system seems to be reliable at the bedside in NICUs.

Turkish Neonatal Society Guideline on fluid and electrolyte balance in the newborn.

Fluid and electrolyte balance and acid-base homeostasis are essential components of normal cellular and organ functions, both in the intrauterine and postnatal developmental period. Knowledge of physiologic changes and appropriate management are important aspects of neonatal intensive care. The aim is to ensure successful transition from the fetal to neonatal period and maintain a normal fluid-electrolyte and acid-base balance. In this paper, fluid and electrolyte requirements in the neonate, treatment of sodium and acid-base disorders on which some controversy exists, and also perioperative fluid-electrolyte management are reviewed.

The effects of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants.

AIM: To evaluate the effect of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants. MATERIAL AND METHODS: Seventy-four infants between 34 and 41 weeks of gestation were included in the study. Of these, 37 were umbilical cord clamped immediately after birth and the remaining 37 were clamped after waiting one minute. Babies were divided into two groups as term and preterm. The prenatal, natal, postnatal characteristics of the infants were recorded. Hematologic and lymphocyte subgroups were investigated in cord blood and venous blood at day 7. Lymphocyte subgroups were evaluated using flow cytometry. RESULTS: With the delay of cord clamping, the leucocytes count and the percentage of CD3+T lymphocytes in cord blood of preterm infants decreased and this decrease continued at day 7. On the contrary, CD19+B lymphocyte levels in the cord blood of preterm infants increased, and this increase continued at day 7. Also, the percentage of CD4+T lymphocytes of preterm infants decreased with the delay of cord clamping at day 7. There was no difference between groups for the rate of sepsis development. CONCLUSION: With the delay of cord clamping, the leucocytes count, the percentage of CD3+T, and CD4+T lymphocytes decreased, and the percentage of CD19+B lymphocytes increased in preterm infants. The delay in cord clamping time in term and preterm infants seems to have no impact on the rate of sepsis development. Larger series of studies are needed to assess the effect of these findings on the development of infection in late preterm infants who have delayed cord clamping.

Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy.

Yapicioglu-Yildizdas H, Ece Ü, Sucu M, Yurdakul G, Simsek H, Özlü F. Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy. Turk J Pediatr 2017; 59: 724-727. Twin reversed arterial perfusion syndrome is mostly seen in monochorionic diamniotic twin pregnancies with an estimated incidence of 1/9500-11000 pregnancies. One of the twins is acardiac with various abnormalities especially with upper part of the body, and mortality is 100%. The other twin functions as a pump twin and mostly has polyhydramnios and heart failure; and mortality rate is high due to prematurity and heart failure. Herein we report a TRAP syndrome and the prognosis of pump twin who was born at 30 weeks gestational age.

Withdrawal syndrome and hypomagnesaemia and in a newborn exposed to valproic acid and carbamazepine during pregnancy.

The usage of drugs during pregnancy affect the fetus and the newborn. In this report, we present findings from a newborn baby, whose mother was epileptic, and was under the treatment of valproic acid and carbamazepine during pregnancy. We have found symptoms of withdrawal syndrome, hyponatremia and feeding problem, which was most probably related to exposure to the mentioned drugs. We have also diagnosed hypomagnesaemia and atrial septal defect 4 milimeters in diameter. There are already many reports about the side effects of valproic acid and carbamazepine usage during pregnancy. To the best of our knowledge, hypomagnesaemia has not yet been reported as a side effect. We think that hypomagnesaemia is also related to the usage of antiepileptics.