Evaluation of Patients with Neonatal Thrombosis.

The aim of the study is to characterize acquired and genetic risk factors and to give an account of the hereditary thrombophilia panel in neonatal thrombosis. All newborns diagnosed with neonatal thrombosis in a level III NICU were included in this retrospective cohort study. A total of 1850 patients were admitted to the NICU during the 5-y period; and 11 patients were diagnosed with thrombosis (0.58%). The most common risk factors were central venous catheter placement, hypoxia and prematurity and related complications, and sepsis. Four patients were investigated regarding the inherited risk factors for thrombosis. In these 4 patients, homozygous A1298C alleles of MTHFR and heterozygous FXIIIV34L mutations; homozygous PAI-SERPINE1 and heterozygous MTHFRA1298C mutations; compound heterozygous mutations of MTHFRC677T and MTHFRA1298C; and compound heterozygous mutations of MTHFRC677T, MTHFRA1298C, and PAISERPINE1 were detected respectively. In conclusion, neonatal thrombosis is multifactorial; newborns with acquired risk factors may also have hereditary risk factors. TRIAL INFORMATION: ClinicalTrials.govIdentifier: NCT05367466.

General attitudes toward and awareness of vaccines among students at a university in Northern Cyprus.

Misinformation and movements against vaccines put public health at risk. This study investigated vaccine awareness and opinions on the anti-vaccination movement among students at three faculties of Eastern Mediterranean University. Data were collected by questionnaire. Exposure to anti-vaccination propaganda increased proportionally with the size of the cities where participants were born. In total, 88.6% of the participants declared that they planned to vaccinate their children, while those who did not cited various reasons including the belief that vaccines do not work, that vaccines are harmful, and that it is better to be infected naturally. 60.6% of participants reported that they would get vaccinated against SARS-CoV-2 if there was an effective vaccine. Meanwhile, 24.5% of participants were not sure whether would get vaccinated even if it were possible, 11.4% of participants stated that they would not vaccinate their children for a variety of reasons. These results are important, especially in the context of a pandemic, because students will become leaders in education, business, and media, and thus shape the thoughts and opinions of future generations. The anti-vaccination movement is building momentum, and is especially influential in big cities; therefore, it is vital to change our approach to informing students about vaccination.

Influence of Intensive Care Unit Enlightenment on Premature Infants on Functional Brain Maturation Assessed by Amplitude-Integrated Electroencephalograph.

OBJECTIVE: Amplitude-integrated electroencephalograph (aEEG) presents a valuable tool for functional brain maturation of preterm infants. However, the effect of enlightenment on functional brain maturation of premature infants has not been investigated. We aimed to do this with aEEG. STUDY DESIGN: A total of 32 infants, 30 to 35 gestational weeks, were involved in the study. They were randomly distributed into three groups in which different lighting protocols were applied. In group 1, the infants' incubators were covered for 24 hours. In group 2, the infants' incubators were open for 24 hours. In group 3, the infants' incubators were covered for 12 hours and open for another 12 hours. The infants are evaluated with aEEG recordings done on the 3rd (first measurement) and 10th days (second measurement) along with the Burdjalov scoring. Analysis of aEEG recordings was performed, based on sleep-wake cycles (SWCs), upper and lower margin amplitudes, narrowband and broadband of SWC, and bandwidth of SWC. RESULTS: At first, the narrowband lower amplitudes in group 1 were higher than those of the other groups (p = 0.042), but the difference was not significant in the second measurement (p = 0.110). The Burdjalov scores were higher in group 1 and group 3 on 10th day, though not statistically significant (p = 0.871). When the infants were re-evaluated according to the gestational weeks, the Burdjalov scores of the two groups less than 34 weeks (30-31 and 32-33 weeks) were similar, whereas 34 to 35 weeks were higher when compared with those of the two groups. CONCLUSION: The difference observed between groups in terms of narrowband lower amplitude in the first measurement may reflect the effect of intrauterine environment rather than enlightenment at the same gestational age because it was made on the third day. However, the fact that all groups have similar results on day 10 suggests that other factors in the intensive care setting may diminish the effect of enlightenment. Burdjalov scores are associated with maturation, and high scores found in the 34- to 35-week group suggest that the 34-week maturation might be a threshold for SWC and development in our group sample.

The association of early postnatal weight loss with outcome in extremely low birth weight infants.

BACKGROUND: To compare outcomes of extremely low birth weight (ELBW) infants having different weight losses in the first 3 days of life. METHODS: One hundred and twenty six ELBW infants were evaluated retrospectively for weight loss percentages on the third day of life compared to their birth weight. We examined the weight loss on the third day of life compared to the birth weight for the ELBW infants and tested its association with mortality and morbidities. The mortality was subgrouped as overall mortality and mortality in the first 7 days of life. The morbidities were patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). BPD was defined as need for supplemental oxygen at 36 weeks' postconceptional age. We grouped the infants into four quartiles according to weight loss percentage on the third day of life: Group 1 (Quartile 1), infants with weight loss of 0-3% of birth weight; Group 2 (Quartile 2); infants with weight loss of 3.1-7.5%, Group 3 (Quartile 3), infants with weight loss of 7.51-12%; and Group 4 (Quartile 4), infants with weight loss of more than 12%. The mortality and morbidities were analyzed according to these groups and other risk factors. RESULTS: Overall mortality and mortality in the first 7 days of life were significantly higher in Groups 1 (36% and 27%) and 4 (43% and 24%), compared to Groups 2 (10% and 10%) and 3 (18% and 9%), respectively. CONCLUSION: Weight loss less than 3% and more than 12% was significantly associated with an increase in mortality. There was a positive correlation between weight loss on the third day of life and IVH. CONCLUSION: Inappropriate weight loss in ELBW infants is associated with increased mortality and IVH. Appropriate weight loss can improve outcomes in this population.

Mean platelet volume/count and mortality in extremely low birth weight infants of preeclamptic mothers.

PURPOSE: To compare complete blood count (CBC) parameters in extremely low birth weight (ELBW) infants born to mothers with and without preeclampsia and to evaluate whether these parameters could be used to determine the prognosis of infants born to mothers with preeclampsia. METHOD: Thirty-eight infants of preeclamptic mothers (IPM) and 77 infants of non-preeclamptic mothers (INPM) were included in the study. The CBC parameters of ELBW infants were evaluated at the sixth hour of life. RESULTS: The mean hemoglobin level of the IPM group was higher than the INPM group (16.4±2.4 vs 15.3±2.4; p=0.02). The mean platelet count of the IPM Group was significantly lower than the INPM group (168±65 vs 206±78; p=0.008). Overall and 7th day of life survival of infants were not different between the groups, but there was a correlation between platelet count of the IPM group and mortality in the first 7 days of life and overall mortality (r=-0.38, p=0.023 and r=-0.36, p=0.029). A cut-off point of 0.4 had significant predictive value for mortality (sensitivity of 91%, specificity of 66%). CONCLUSION: Hemoglobin and platelet counts were statistically different in ELBW infants born to preeclamptic mothers compared with non-preeclamptic mothers. Although the survival was not different between the two groups, platelet count and MPV/platelet count ratio were significantly correlated with overall mortality and mortality in the first 7 days of life in infants of preeclamptic mothers.

Impact of oral probiotics on neurodevelopmental outcomes in preterm infants.

OBJECTIVE: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC). METHODS: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18-24 months' corrected age. RESULTS: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups. CONCLUSION: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18-24 months' corrected age.

Management of hyperbilirubinemia in preterm infants in Turkey.

BACKGROUND/AIM: Prematurity is a significant risk factor for developing unconjugated hyperbilirubinemia. This study investigated the current approach to managing hyperbilirubinemia in preterm newborns in Turkey. MATERIALS AND METHODS: A study-specific questionnaire on the management of jaundice in preterm infants was sent to 100 level III neonatal intensive care units in Turkey. RESULTS: Responses were obtained from 84 centers from all regions of Turkey. Of the centers, 75.3% used the Turkish Neonatology Society guidelines for deciding to start phototherapy, and 24.7% used different guidelines. The monitoring of bilirubin varied among the participants. Of the participants, 53.6% believed that prophylactic phototherapy was necessary if the infant's birth weight was below 1000 g. The participants reported 6 cases of kernicterus in preterm infants in recent years. CONCLUSION: There is no single standard approach for managing neonatal hyperbilirubinemia in preterm infants in Turkey. Prophylactic phototherapy for extremely low birth-weight infants might be added to the guidelines for Turkey.

Evaluation of bone metabolism in newborn twins using quantitative ultrasound and biochemical parameters.

Metabolic bone disease (MBD) is one of the important complications of prematurity. Early and adequate nutritional interventions may reduce the incidence and potential complications of MBD. The present study aimed to evaluate bone metabolism in twins via biochemical parameters and quantitative ultrasound (QUS) and to compare the results between twin pairs. Moreover, twin infants were evaluated in terms of potential risk factors likely to have impact on MBD. Forty-three pairs of twins were included in the study. Serum calcium, phosphorus, magnesium, and alkaline phosphatase concentrations were assessed and bone mineral density was measured using QUS (speed of sound, SOS) at postnatal 30 d. Co-twin with the higher birth weight was assigned to Group 1 (n = 36) and the other twin was assigned to Group 2 (n = 36). Birth weight and head circumference were significantly higher in the infants of Group 1 compared with Group 2. No significant difference was found among the groups in terms of gender, history of resuscitation, length of stay in intensive care unit (ICU) or in the incubator, duration of total parenteral nutrition (TPN), type of nutrition, vitamin D use, biochemical parameters, and the SOS value. The factors likely to affect SOS, including type of pregnancy, maternal drug use, gender of infant, birth weight, head circumference at birth, gestational week, length of stay at the ICU, duration of TPN, type of nutrition, resuscitation, vitamin D use, and levels of calcium, phosphorus, magnesium, and alkaline phosphatase were entered into the model. The phosphorus level and the maternal drug use were found to be the factors that significantly reduced SOS, whereas pregnancy after assisted reproductive techniques was found to be a significant enhancing factor.

Dopamine treatment does not need speed recovery of newborns from transient tachypnea.

OBJECTIVE: Transient tachypnea of the newborn (TTN) results from inadequate neonatal lung fluid clearance. Low-dose dopamine induces natriuresis in the kidneys and it has been assumed that, at this low dosage, dopamine increases renal perfusion in critically ill patients. Medium doses have positive inotropic and chronotropic effects via increased ß-receptor activation. Recent studies have demonstrated that dopamine stimulates the clearance of pulmonary edema. Furthermore, ß-adrenergic agonists regulate Na+ channels and Na-K-ATPase activity in the pulmonary epithelium. This study investigated the effect of dopamine at different dosages on TTN treatment. METHODS: A prospective controlled study examined 60 infants with TTN older than 34 weeks of gestation who required at least 24 h of O2 and nasal continuous positive airway pressure (nCPAP) treatment. The infants were randomized into three groups of 20: controls, infants treated with low-dose dopamine (3 µg/kg/min), and infants treated with a medium dose (5 µg/kg/min). The control and study groups were compared in terms of the requirement for mechanical ventilation, and the durations of nCPAP, oxygen requirement, and hospitalization. RESULTS: The requirement for mechanical ventilation, and durations of nCPAP, oxygen requirement, and hospitalization did not differ significantly among the three groups (P=0.54, 0.16 and 0.11, respectively). CONCLUSION: Dopamine treatment in low-moderate doses does not improve the outcome in TTN. Thus, further studies in this area are needed.

Rotura y desplazamiento de catéter arterial umbilical: obstrucción arterial bilateral en un prematuro de muy bajo peso al nacer / Rupture and displacement of umbilical arterial catheter: Bilateral arterial occlusion in a very low birth weight preterm

La canalización de los vasos umbilicales es un procedimiento frecuente en las unidades de cuidados intensivos neonatales, especialmente en los recién nacidos de muy bajo peso al nacer. Raras veces el catéter arterial umbilical se rompe; los fragmentos retenidos pueden provocar trombosis, infección, embolización distal e incluso la muerte. En este artículo, describimos el caso de un recién nacido con isquemia bilateral, clínicamente significativa, de las extremidades que se manifestó después de la extracción de un catéter arterial umbilical roto. Estaba recibiendo tratamiento vasodilatador junto con fibrinolíticos y anticoagulantes. La evolución fue favorable.

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

Rupture and displacement of umbilical arterial catheter: Bilateral arterial occlusion in a very low birth weight preterm.

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

Haemorrhagic pneumonia caused by Stenotrophomonas maltophilia in two newborns.

Invasive procedures and antibiotic treatment increase the risk of nosocomial infections in neonatal intensive care units. Early identification and appropriate treatment is important. Herein we report two cases of massive hemorrhagic pneumonia caused by Stenotrophomonas maltophilia. The first case was diagnosed with congenital pneumonia; a chest tube was inserted because of pneumothorax on the third day of life. The second case had been referred with respiratory distress syndrome, and bilateral pneumothorax was present on admission. Upon follow up, the cases' clinical condition worsened; acute respiratory distress syndrome and massive pulmonary haemorrhage developed. After Stenotrophomonas maltophilia was isolated in blood cultures, the cases were treated successfully using a combination of trimethoprim/sulfamethoxazole and fluoroquinolone.

Lactobacillus Reuteri for the prevention of necrotising enterocolitis in very low birthweight infants: a randomised controlled trial.

OBJECTIVE: To evaluate the effect of oral Lactobacillus reuteri (L reuteri) first on the incidence and severity of Necrotising enterocolitis (NEC) and second on sepsis. DESIGN: Prospective randomised controlled study. SETTING: Tertiary neonatal intensive care unit. PATIENTS AND INTERVENTIONS: Preterm infants with a gestational age of ≤32 weeks and a birth weight of ≤1500 g were included (n=400). Infants in the first group were given 100 million CFU/day (5 drops) of lyophilised L reuteri (DSM 17938) mixed in breast milk or formula, starting from first feeding until discharge. Participants in the control group were given a placebo. MAIN OUTCOME MEASURES: To determine and compare the frequency of NEC and/or death after 7 days, frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay. RESULTS: There was no statistically significant difference between groups in terms of frequency of NEC stage ≥2 (4% vs 5%; p=0.63) or overall NEC or mortality rates (10% vs 13.5%; p=0.27). Frequency of proven sepsis was significantly lower in the probiotic group compared to the control group (6.5% vs 12.5%; p=0.041). A significant difference was also observed with regard to rates of feeding intolerance (28% vs 39.5%; p=0.015) and duration of hospital stay (38 (10-131) vs 46 (10-180) days; p=0.022). CONCLUSIONS: Our results show that oral L reuteri does not seem to affect the overall rates of NEC and/or death in preterm infants followed up in the neonatal intensive care unit, and significant reductions were observed in the frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay. TRIAL REGISTRATION NUMBER: NCT01531179.

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.

An unusual cause of refractory persistent pulmonary hypertension of the newborn: anomalous origin of one pulmonary artery.

Persistent pulmonary hypertension of the newborn is a source of considerable mortality and morbidity. Anomalous origin of one pulmonary artery, an uncommon congenital cardiac malformation, is a rare cause of persistent pulmonary hypertension. Here, we report the case of a patient with an anomalous origin of one pulmonary artery from the innominate artery who presented with persistent pulmonary hypertension refractory to treatment.

Renal and mesenteric tissue oxygenation in preterm infants treated with oral ibuprofen.

BACKGROUND: Hemodynamically significant patent ductus arteriosus (PDA) is a common problem in preterm infants which often causes significant morbidities. Although PDA induces alterations in various tissue perfusion, there is scarce information about the effect of oral ibuprofen on hemodynamics of regional tissues. OBJECTIVE: To investigate, using near-infrared spectroscopy, the effect of oral ibuprofen on renal and mesenteric tissue oxygenation and oxygen extraction in preterm infants with a diagnosis of hemodynamically significant PDA. PATIENTS AND METHODS: Fifteen infants (gestational age <32 weeks) with the diagnosis of hemodynamically significant PDA treated with oral ibuprofen were monitored for near-infrared spectroscopy - determined renal and mesenteric oxygenation. The infants with PDA were matched for gestational age, postnatal age with infants without PDA, who served as control subjects. RESULTS: In infants with PDA, mean arterial blood pressure was significantly lower compared with the control infants [39.3 (range:36-54) versus 51 (range:43-66) mmHg, respectively; p < 0.001)]. There were no significant differences in regional oxygen saturation and fractional oxygen extraction of renal and mesenteric tissues in PDA and control infants (p > 0.05). And ibuprofen treatment did not negatively influence renal and mesenteric oxygenation and extraction in infants with PDA (p > 0.05). CONCLUSION: Renal and mesenteric tissue oxygenation and oxygen extraction were preserved in preterm infants with a diagnosis of hemodynamically significant PDA treated with oral ibuprofen.