The predictive significance of umbilical cord bilirubin and bilirubin/albumin ratio for neonatal jaundice in healthy term newborns.

BACKGROUND: The aim of this study is to determine the value of the questions asked in routine follow-up, the cord blood bilirubin (CBB) and bilirubin/albumin (B/A) ratio in estimating the risk of developing hyperbilirubinemia. METHODS: Term and healthy 217 newborns whose CBB and albumin could be obtained and whose needed to be measured bilirubin level at the 24thand 72nd hours of life were included. Nutrition, sex and nationality, consanguinity between parents, jaundice in the sibling (s), mother's medications were questioned. CBB and albumin, serum total bilirubin (STB), serum albumin and transcutaneous bilirubin (TcB) at the 24th and 72nd hours of life, were recorded. RESULTS: CBB and cord B/A ratio, STB and serum B/A ratio, and TcB at the 24th and 72nd hours were found to be higher in the babies who received the phototherapy (p < 0.001 for all). The moderate positive correlation (correlation coefficient 0.383) at the 24th hour and strong positive correlation (correlation coefficient 0.759) at the 72nd hour between STB and TcB measurements was detected. In estimating the need for phototherapy the sensitivity and specificity of CBB were 74.2% and 56.5%, the sensitivity and specifity of cord B/A was 74.2%, and 61.8%. The cut-off value of CBB in estimating the need for phototherapy is 1.8, and the cut-off value of the cord B/A ratio is 0.56. When the cut-off value is 1.8 for the CCB and the cord B/A ratio is 0.56, the positive predictive values are low, but the negative predictive values are significantly high (92.9% and 93.5%, respectively) in determining the need for phototherapy. DISCUSSION: CBB and B/A ratio are important in predicting the possibility of indirect hyperbilirubinemia (IHB) development. Babies should be followed closely in terms of IHB development when their CBB value is 1.8 mg/dL and above, and the cord blood B/A ratio is 0.56 and above.

Troponin T and NT ProBNP Levels in Gestational, Type 1 and Type 2 Diabetic Mothers and Macrosomic Infants.

This study compares NT proBNP and troponin T levels in umbilical cord arterial blood and postnatal echocardiographic findings for infants of gestational and pregestational diabetic mothers and macrosomic infants. Twenty-seven infants of pregestational diabetic mothers, 61 infants of gestational diabetic mothers and 37 macrosomic infants of nondiabetic mothers were prospectively enrolled in this study along with a control group of 58 healthy infants of mothers without any pregestational or gestational disorders as the control group. All enrollees were born after 34 weeks of gestation. For this study, umbilical cord blood was drawn during delivery to determine NT proBNP and troponin T levels. Echocardiography was performed 24-72 h after the delivery. Umbilical cord troponin T and NT proBNP levels were found to be higher in the diabetic and macrosomic groups than in the control group (all of them p < 0.001). NT proBNP levels were positively correlated with interventricular septum thickness in the pregestational and gestational infants of diabetic mothers groups (r = 0.564 and r = 0.560, respectively, p < 0.01). Both pregestational and gestational diabetic mothers were divided into two groups according to HbA1c levels in the third trimester as good (<6.1 %) and suboptimal (>6.1 %) metabolic control. In the good and suboptimal metabolic control diabetic groups, NT proBNP levels were also positively correlated with interventricular septum thickness (r = 0.536 and r = 0.576, respectively, p < 0.01). In the suboptimal metabolic control diabetic group, NT proBNP was only found to be positively correlated with the left ventricular mass index (r = 0.586, p < 0.01). While there was no correlation in the myocardial performance index between infants of diabetic mothers and the control group, the myocardial performance index of macrosomic infants was lower than that of the control group (p = 0.017). Cardiac biomarkers (NT proBNP and troponin T) were elevated in infants of diabetic mothers and macrosomic infants. While there was a positive correlation between NT proBNP levels and cardiac structure in infants of pregestational and gestational diabetic mothers, there was no relationship between NT proBNP levels and cardiac function.

Unusual cause of acute neurologic deficit in childhood: primary central nervous system vasculitis presenting with basilar arterial occlusion.

INTRODUCTION: Primary central nervous system (CNS) vasculitis of childhood is a rare disorder. The most common signs and symptoms are acute severe headache and focal neurologic deficit. It should be suspected in children who have an acquired neurologic deficit that remains unexplained after an initial basic evaluation. Diagnosis usually depends on brain magnetic resonance imaging and conventional angiography of cerebral vasculature. Stenosis is the most common angiographic finding and it usually affects the middle cerebral artery and its branches. Anterior and posterior circulation is rarely involved. CASE REPORT: In this report, we describe an 8-year-old boy who presented with vertebrobasilar insufficiency symptoms and primary CNS vasculitis diagnosis was made later.

Intracranial hemorrhages due to late-type vitamin K deficiency bleeding.

OBJECTS: Vitamin K deficiency bleeding (VKDB) represents a clinical picture characterized by bleedings due to insufficient levels of vitamin-K-dependent hemostatic factors. VKDB can be classified into three groups as early, classic, and late according to time of occurrence. Late-type VKDB has particular importance due to frequent intracranial hemorrhages that lead to high mortality and morbidity. In our study, we aimed to emphasize the importance of vitamin K prophylaxis in prevention of late-type VKDB. MATERIALS AND METHODS: Data of 12 infants treated for intracranial hemorrhage due to late-type VKDB in Baskent University Hospitals between June 1998 and June 2005 have been analyzed. RESULTS: The ages of patients ranged between 25 and 90 days. Five were born in the hospital and seven were born at home. None of the infants born at home received vitamin K prophylaxis. Hemorrhages were classified as intraparenchymal in 58.33%, subarachnoid in 50.00%, subdural in 50.00%, intraventricular in 41.66%, and epidural in 8.33% according to cranial computerized tomography findings. Surgery was performed in seven cases (58.33%). A total of six patients died (50.00%). Three of the deaths were from the surgery-performed group. CONCLUSION: All newborns should receive vitamin K prophylaxis to prevent bleeding due to vitamin K deficiency. Symptoms of any predisposing disease and warning bleeds must be noticed early and additional doses of vitamin K should be administered, if required.