Effects of DDT and DDE on placental cholinergic receptors.

The placental cholinergic system; known as an important factor in intracellular metabolic activities, regulation of placental vascular tone, placental development, and neurotransmission; can be affected by persistent organic pesticides, particularly organochlorine pesticides(OCPs), which can influence various epigenetic regulations and molecular pathways. Although OCPs are legally prohibited, trace amounts of the persistent dichlorodiphenyltrichloroethane(DDT) are still found in the environment, making prenatal exposure inevitable. In this study, the effects of 2,4'-DDT and 4,4'-DDT; and its breakdown product 4,4'-DDE in the environment on placental cholinergic system were evaluated with regards to cholinergic genes. 40 human placentas were screened, where 42,50% (17 samples) were found to be positive for the tested compounds. Average concentrations were 10.44 µg/kg; 15.07 µg/kg and 189,42 µg/kg for 4,4'-DDE; 2,4'-DDT and 4,4'-DDT respectively. RNA-Seq results revealed 2396 differentially expressed genes in positive samples; while an increase in CHRM1,CHRNA1,CHRNG and CHRNA2 genes at 1.28, 1.49, 1.59 and 0.4 fold change were found(p<0028). The increase for CHRM1 was also confirmed in tissue samples with immunohistochemistry. In vitro assays using HTR8/SVneo cells; revealed an increase in mRNA expression of CHRM1, CHRM3 and CHRN1 in DDT and DDE treated groups; which was also confirmed through western blot assays. An increase in the expression of CHRM1,CHRNA1, CHRNG(p<0001) and CHRNA2(p<0,05) were found from the OCPs exposed and non exposed groups.The present study reveals that intrauterine exposure to DDT affects the placental cholinergic system mainly through increased expression of muscarinic receptors. This increase in receptor expression is expected to enhance the sensitivity of the placental cholinergic system to acetylcholine.

Outcomes of newborns with tracheostomy: single center experience.

BACKGROUND: Babies with severe bronchopulmonary dysplasia (BPD) are discharged with the support of a home-type mechanical ventilator, after opening a tracheostomy. In addition, although rare, tracheostomy is required in the neonatal period in congenital airway malformations. Early tracheostomy is appropriate to prevent complications due to prolonged intubation. We aimed to find the appropriate time for tracheostomy by examining the tracheostomy opening and closing times, complications and demographic characteristics of the patients, who were hospitalized and underwent tracheostomy in our neonatal intensive care unit. METHODS: This retrospective study involved infants admitted to the neonatal intensive care unit between January 2014 and 2019 and discharged following tracheostomy. Information acquired from hospital data was enrolled. The protocol was registered with ClinicalTrials.gov identifier NCT04497740. RESULTS: Twenty-six neonates with median 27.5 weeks gestational age and birth weight 885 gr were enrolled in the study. The mean opening time for tracheostomy was 54 ± 24 days, and the postmenstrual age (PMA) was 36 ± 3 weeks. The mean time to closure of tracheostomy in newborns with a tracheostomy was 387 ± 164 days. The duration of accidental decannulation developed as an early complication in 8 patients was mean 11 ± 8 days. Aspiration pneumonia in 2, subglottic stenosis in 5, accidental decannulation in 2, suprastomal collapse in 7, tracheocutaneous fistula in 8 and granulation tissue in 2 patients were found to be late complications, which occurred within median 90 days. CONCLUSIONS: If there is no evidence that breathing has improved and the patient is still using a mechanical ventilator at high pressures and high oxygen concentration, a tracheostomy placement should be considered within two months.

Does inhaled salbutamol before surfactant therapy have any beneficial effect?

Çelik HT, Yurdakök M, Korkmaz A, Yigit S. Does inhaled salbutamol before surfactant therapy have any beneficial effect? Turk J Pediatr 2018; 60: 669-674. Beta (ß)2 adrenergic receptors are present in alveolar type II cells. Previously, the beneficial effects of inhaled salbutamol treatment on respiratory outcomes were shown in premature infants with transient tachypnea of the newborn. We hypothesized that inhaled salbutamol would increase the effects of surfactant on oxygenation in premature infants with respiratory distress syndrome (RDS). Inhaled salbutamol (0.15 mg/kg) or normal saline solution (0.30 ml/ kg) was administered as a single dose by micropump nebulizer 10 minutes before the first dose of surfactant (Poractant alfa) treatment in 40 infants with gestational ages ranging from 26 to 36 weeks. The effects of salbutamol therapy were evaluated by determining the duration of respiratory support, number of doses of surfactant, respiratory rate, heart rate, fraction of inspired oxygen, and partial pressure of arterial oxygen before and after salbutamol nebulization. No statistically significant difference was detected between the two groups in duration of respiratory support, number of doses of surfactant, respiratory rate, fraction of inspired oxygen, or partial pressure of arterial oxygen. In this study, no significant effect of inhaled salbutamol treatment on the surfactant therapy in premature infants with RDS was detected.

Autoimmune hepatitis and pregnancy: report of two cases with different maternal outcomes.

Women of childbearing age with autoimmune hepatitis (AIH) are now able to get pregnant. The progress of the disease during pregnancy is not well clarified yet. The first pregnant woman had cirrhosis secondary to AIH, and she delivered by cesarean section. The patient had severe thrombocytopenia at the time of hospitalization. Unfortunately, she died due to massive thromboembolism at the 24th hour after delivery. The other patient had three recurrent abortions with a diagnosis of AIH. Low-dose low molecular weight heparin and low-dose acetylsalicylic acid along with low-dose prednisolone were administered during the course of the following pregnancies. The following pregnancies ended up with a living child. There is a high morbidity and mortality risk for both fetus and mother. Hepatic performance of the patients, thrombotic events, inflammatory disorders and autoimmune system activation must be the main concerns together with necessary precautions.

Efficacy of new leukocyte parameters versus serum C-reactive protein, procalcitonin, and interleukin-6 in the diagnosis of neonatal sepsis.

BACKGROUND: The aim of this study was to investigate and compare the efficacy of the new leukocyte parameters mean neutrophil and monocyte volume (MNV, MMV), conductivity (MNC, MMC), scattering (MNS, MMS) and volume distribution width (NDW, MDW) with serum C-reactive protein (CRP), procalcitonin (PC) and interleukin (IL)-6 in the diagnosis of neonatal sepsis. METHODS: A total of 227 newborns (132 boys, 95 girls) were analyzed. There were 116 infants in the sepsis group (proven sepsis, n = 40; clinical sepsis, n = 76) and 111 in the control group. Venous blood samples were collected from infants at the time of diagnosis and complete blood count, peripheral blood smear, blood cultures, CRP, PC, IL-6 and MNV, MMV, MNC, MMC, MNS, MMS, NDW, and MDW were analyzed. RESULTS: MNV, NDW, MMV and, MDW were higher in infants with sepsis than in controls (P < 0.05 for all). MNS was lower in the patients with sepsis (P = 0.002). There was no significant difference between the sepsis and control groups in terms of MNC, MMC and MMS. CONCLUSION: Although the predictive value of leukocyte parameters including neutrophil and monocyte volume, conductivity, scattering and volume distribution width in the diagnosis of neonatal sepsis was lower than that of CRP, PC and IL-6, some of these new parameters may be useful in the differential diagnosis of newborn sepsis, along with the other screening tools. In particular, MNV seems to be the most useful parameter with the highest specificity; also, the importance of PC in the diagnosis of early onset sepsis was confirmed.

Serum prohepcidin levels in premature newborns with oxygen radical diseases.

This study aimed to investigate the prohepcidin levels in premature newborns with oxygen radical diseases such as bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis and to compare these levels with those of healthy premature newborns. Eighty premature infants (25-34 weeks gestational age) were enrolled. The patient group was composed of 38 premature babies with oxygen radical diseases, and the control group consisted of 42 healthy premature newborns. Complete blood count, serum iron and ferritin concentrations, iron-binding capacity (IBC), transferrin and prohepcidin levels were measured. The mean ferritin and prohepcidin levels were higher in the patient group than in the control group (p = 0.038 and p = 0.022, respectively). No significant correlations were found between serum prohepcidin levels and iron parameters. We believe that this finding will contribute to a greater understanding of the etiopathogenesis of oxygen radical diseases. There is a need for future studies to explore the link between underlying inflammatory mechanisms and hepcidin in oxygen radical diseases.

Glucose-6-phosphate dehydrogenase deficiency in neonatal hyperbilirubinaemia: Hacettepe experience.

AIM: The aim of this study was to investigate the prevalence of glucose-6-phospate dehydrogenase (G6PD) deficiency in newborn infants with neonatal hyperbilirubinaemia and to compare the clinical features of G6PD-deficient and G6PD-normal newborn infants. METHODS: A total of 4906 term and preterm neonates with indirect hyperbilirubinaemia were retrospectively evaluated according to demographic, neonatal features, bilirubin levels, erythrocyte G6PD levels, other risk factors and treatments. RESULTS: Among 4906 newborn infants with indirect hyperbilirubinaemia, 55 (1.12%) neonates were G6PD-deficient. In our study, no statistically significant difference was detected between G6PD-deficient and G6PD-normal infants in relation to the time of onset of jaundice, bilirubin levels and duration of phototherapy. However, the incidence of exchange transfusion in G6PD-deficient infants was 16.4% while it was only 3.3% in G6PD normal infants (P < 0.05). CONCLUSION: Testing for G6PD must be ordered to all newborns who are receiving phototherapy and especially to those who are coming from the high incident geographical regions and less responsive to phototherapy.

Myoclonic seizure due to cyclopentolate eye drop in a preterm infant.

Cyclopentolate is widely used in ophthalmology for its intense mydriatic and cycloplegic activity. Systemic side effects have been described in both adults and children. Myoclonic seizure is a rare side effect of eye drops that are used in eye examinations. We report herein a case of convulsion in a three month- old girl following cyclopentolate hydrochloride and phenylephrine hydrochloride eye drops, which were used in advance of ophthalmoscopy for examination of retinopathy of prematurity (ROP). Physicians should be aware of the uncommon systemic side effects of cyclopentolate, and drops should be used in appropriate dosages.