Successful percutaneous removal of broken umbilical vein catheter in a very low-birth-weight preterm infant.

A 28-week-old preterm infant with a birth weight of 1250 g had a broken segment of umbilical vein catheter (UVC) lodged in the right atrium. It was observed that a 7-cm fragment of catheter had migrated to the right atrium through the inferior vena cava. The catheter was successfully retrieved by fluoroscopically guided percutaneous cardiac catheterization, using a cobra catheter and snare wire, without complication. Fracture and embolization of UVC is a rare but serious complication. Presently described was a case of fractured and embolized UVC in a very low-birth-weight preterm infant, and its successful retrieval via percutaneous endovascular approach.

Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants.

OBJECTIVE: To study the efficacy of early high doses parenteral nutrition (PN) versus early low dose with progressive increments PN regimens, we performed a prospective randomized study in very low birth-weight infants. STUDY DESIGN: Forty-one appropriate gestational age preterm infants with birth weights ranging from 750-1500 g were randomly assigned into two groups. In Group 1, infants started on 3.0 g/kg/day amino acids (AA) and 3 g/kg/day of 20% lipid; in Group 2, AA and lipid were started on 1 g/kg/day, and advanced over 3 days to a maximum 3 g/kg/day. Blood samples were obtained for AA concentrations before starting of the PN, and at the 7th and 14th days. RESULTS: The mean (±SD) birth weight was 1335 g (240), gestational age was 29.7 weeks (1.7) of the study group. The mean body weight and head circumference was similar in the Group 1 and Group 2 at the 14th postnatal days. There was no difference in the blood levels of triglyceride, blood urea nitrogen, creatinine, ammonia, lactat and bicarbonate in the two groups. There was no significant difference in the concentrations of AA except for arginine and asparagine. On day 14, the mean arginine concentrations were significantly higher and asparagine concentrations were lower in Group 2. CONCLUSION: Although earlier more aggressive administration of AA and fat is not associated with any significant metabolic abnormalities, growth rates and plasma AA concentrations of the infants were similar to infants who AA and lipid given lower in the first day of life.

Percutaneously inserted central catheters in the newborns: a center's experience in Turkey.

OBJECTIVE: To evaluate the success rate of insertion of percutaneously inserted central catheters (PICCs) and their duration; and the short- and long-term complications in the neonatal period. STUDY DESIGN: We did a prospective collection and analysis of the data of all infants who underwent PICC placement from January 2005 and through January 2007. During this period there were 139 PICCs inserted in a total of 124 infants. The data of all infants were compiled, including birth weight, gestational age, diagnosis, type of catheter, site of catheter placement, reason for catheter removal, duration of use of the catheter, and the rate of complications. RESULTS: The success rate of PICC insertion was 88.5% with the upper extremity being the most frequently used site. The mean duration of PICC treatment was 11.9 +/- 6.3 days. PICCs were removed electively for 72 times (54.1%) and due to catheter-related complications for 61 times (45.9%). The main complication rate was the mechanical occlusion (12.7%). There were no statistically significant differences in the number of complication rates according to the insertion site, the position of the catheter tip, or the size of the catheter. CONCLUSION: Our initial experience with PICCs is that their use provides life-saving therapy, they are easily inserted and they are convenient. Mechanical complications were the common reason for removal and we did not see complications more serious.

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.

Idiopathic congenital chylothorax presented with severe hydrops and treated with octreotide in term newborn.

Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. Morbidity of congenital chylothorax (CC) is high, and prognosis is very poor if chylothorax is associated with hydrops fetalis. The optimal treatment of CC has not been defined. Conservative treatment (low-fat high-protein diets with medium chain triglycerides, total parenteral nutrition, pleural drainage) and surgical intervention are performed. However, there is little experience with the use of octreotide therapy in this condition. We report a newborn with CC presented with severe non-immune hydrops and chylothorax resistant to mainly conservative treatment. The patient improved rapidly and the chylothorax disappeared with use of continuous administration of octreotide (10 microg/kg/per hour).

Acute osteomyelitis of the iliac bone presenting with gluteal syndrome in a newborn.

Acute osteomyelitis in neonates, although rare, represents a diagnostic and therapeutic challenge. We herein report an extremely rare case of congenital nonsyphilitic iliac bone osteomyelitis caused by methicilline-sensitive Staphylococcus aureus and presenting with gluteal syndrome in a near-term infant. To our knowledge, this represents the second report with iliac osteomyelitis and the first report with gluteal syndrome in neonatal period. A high index of suspicion is necessary to make an early diagnosis. Early diagnosis is essential to prevent catastrophic sequelae in such cases. We report this case because of its unusual clinical presentation and rarity.

Incontinentia pigmenti mimicking a herpes simplex virus infection in the newborn.

INTRODUCTION: Incontinentia pigmenti is a rare, X-linked dominant multisystem genodermatosis that presents at or soon after birth with characteristic cutaneous signs. The main features occur in the skin where a blistering rash occurs in the newborn period, followed by the blisters becoming raised-like warts. After the skin, the central nervous system is the next most affected system. CASE REPORT: We report a female infant who was born with vesicular eruptions who was initially thought to have congenital herpes simplex virus infection. CONCLUSION: This case report emphasises that incontinentia pigmenti should be included in the differential diagnosis of cutaneous blistering lesions and central nervous system involvement in neonates.

Neurological aspects of tuberous sclerosis in relation to MRI/MR spectroscopy findings in children with epilepsy.

Our aim was to evaluate the relationship between the neurological outcome of tuberous sclerosis complex (TSC) and the findings obtained from both cranial magnetic resonance imaging (MRI) and single voxel proton spectroscopy (SVPS). MRIs of 13 children who met the diagnostic criteria for TSC were taken. Eleven of these children also underwent a prospective analysis of SVPS. Fisher's exact test and Mann-Whitney U test were used, where applicable, to detect any signs of the imaging data that would indicate poor outcome, or in other words, poor seizure control and/ or high degree of mental retardation. Poor seizure control was seen in eight of the patients and multiple seizure types in seven. Mental retardation was severe in six patients and mild/moderate in seven. MRI revealed multiple bilateral tubers and subependymal nodules (13/13), confluence of tubers (8/13), subcortical linear heterotopias (7/13), gyral cores (3/13) and cortical atrophy (3/13). SVPS findings of tubers were characterized by decreased NAA/Cr (1.43 +/- 0.33, p<0.001), increased Cho/Cr (0.91 +/- 0.082, p< 0.05) and mI/Cr (0.97 +/- 0.19, p<0.01) ratios when compared with those of the control group. Lactate peak was detected in six patients. Unfavorable outcome in TSC can be predicted with the help of the following: multiple seizure types, a number of confluent appearances of the tubers and cortical atrophy. SVPS could be a useful clue to understand the pathophysiologic function of the tubers, especially in children with refractory epilepsy along with TSC.

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.