Inhaled beta-2 agonist salbutamol for the treatment of transient tachypnea of the newborn.

OBJECTIVE: To evaluate the efficacy of inhaled salbutamol, a beta-2 adrenergic agonist, for the treatment of transient tachypnea of the newborn (TTN) and to determine whether inhaled salbutamol is safe in newborn infants. STUDY DESIGN: Inhaled salbutamol or normal saline solution was administered to 54 infants with gestational ages ranging from 34 to 39 weeks and TTN. The response to salbutamol therapy was evaluated by determining respiratory rate, clinical score of TTN, level of respiratory support, and fraction of inspired oxygen before and at 30 minutes and 1 and 4 hours after salbutamol nebulization. RESULTS: Among the 54 infants with TTN, 32 received salbutamol and 22 received normal saline solution. After one dose, the salbutamol group showed significant improvements in respiratory rate, clinical score of TTN, fraction of inspired oxygen, and level of respiratory support (P < .05). After treatment, the mean pH, partial pressure of arterial oxygen, and partial pressure of arterial carbon dioxide values were better in the salbutamol group when compared with the placebo group (P < .05). Duration of hospitalization in the neonatal intensive care unit was also shorter for the salbutamol group (P < .05). CONCLUSION: Inhaled salbutamol treatment was effective with respect to both clinical and laboratory findings of TTN and without adverse events.

Ponderal index of large-for-gestational age infants: comparison between infants of diabetic and non-diabetic mothers.

Ponderal index (PI) is a weight-height related parameter that is mainly used to assess the pattern of fetal growth in small-for-gestational age infants. We aimed to use PI for large-for-gestational age (LGA) infants who were born to diabetic or non-diabetic mothers, in order to predict the fetal growth pattern. One hundred sixty-six LGA infants born at the Department of Obstetrics, Hacettepe University Hospital, Ankara, Turkey were included in the study. The PI was calculated by using the following formula: PI = weight (g) x 100/(height, cm)3. Sixty-seven (40%) of these infants were born to diabetic mothers. Maternal age, maternal weight and maternal weight gain during pregnancy were similar in the diabetic and non-diabetic groups. Mean birthweight, height and head circumference were similar in both groups, but median PI of infants of diabetic mothers was significantly higher than of infants of non-diabetic mothers (3.02 and 2.89, respectively, p < 0.05). Fetal growth was different between LGA infants of diabetic and non-diabetic mothers, and PI provided useful information on the proportionality of fetal growth in LGA infants.

Procalcitonin versus CRP as an early indicator of fetal infection in preterm premature rupture of membranes.

The aim of this study was to examine the diagnostic sensitivity and specificity of C-reactive protein (CRP) and procalcitonin (PCT) in neonates who were born after preterm premature rupture of membranes (PPROM) and compare these with interleukin-6 (IL-6). The study involved 74 preterm neonates who were born after PPROM. IL-6, CRP, complete blood count and leukocyte ratios, and PCT levels were measured in the 1st day of life, and CRP, PCT, and blood counts were repeated on the 3rd day of life. Seventy-four infants with PPROM were divided into two groups according to the development of sepsis and infection (Group 1: sepsis, n = 32; Group 2: no sepsis, n = 42). There were no significant differences between these groups with respect to gestational age, birthweight and duration of membrane rupture. There were significant differences between the two groups in the 1st day CRP (Group 1: 0.85 -/+ 1.36 mg/dl, Group 2: 0.23 +/- 0.25 mg/dl; p = 0.016), 1st day PCT (Group 1: 7.2 +/- 7.6 ng/ml, Group 2, 1.6 +/- 4.0 ng/ml; p < 0.001), and 3rd day PCT (Group 1: 9.01 +/-11.5 ng/ml, Group 2: 1.34 +/- 1.35 ng/ml; p = 0.001) and IL-6 (Group 1: 80.7 +/- 67.2 pg/ml, Group 2: 3.4 +/- 3.5 ng/ml; p < 0.001) levels. CRP levels were not significantly different between Group 1 (1.2 +/- 1.7 mg/dl) and Group 2 (0.58 +/- 1.1 mg/dl) on the 3rd day of life (p=0.059). CRP levels on the 1st day of life had a cut-off value of 0.72 mg/dl with a sensitivity and specificity of 56% and 58%, respectively. CRP levels on the 3rd day had a cut-off level of 0.78 mg/dl with 60% sensitivity and 63% specificity. PCT levels had a cut-off level of 1.74 ng/ml with 76% sensitivity and 85% specificity on the 1st day of life, and of 1.8 with 89% sensitivity and 86% specificity on the 3rd day of life. Statistical analysis revealed that the cut-off value of 7.6 pg/ml for IL-6 had a 93% sensitivity and 96.7% specificity. Interleukin (IL)-6 is the most reliable marker for the detection of early-onset sepsis in preterm neonates with PPROM. Early PCT levels seemed to be more sensitive than early CRP in this population.

Fetal malnutrition and its impacts on neonatal outcome in preterm infants.

Fetal malnutrition is an important risk factor for both early and late neonatal outcome and adult diseases. In this study, we aimed to investigate the incidence and characteristics of fetal malnutrition and its impacts on early neonatal morbidity and mortality in preterm infants by using the clinical assessment of nutritional status score (CANSCORE). Preterm infants whose gestational ages were between 28-34 weeks were included in the study. Detailed prenatal and natal history, anthropometric measurements, and intrauterine growth status were defined, and CANSCORE was applied to all infants. Infants were separated into two groups according to total score as malnourished (total score < 25) and well nourished (total score > or = 25). Early and late neonatal morbidities, which were observed during the clinical progress, were noted in all infants. A total of 93 preterm infants were enrolled in the study. The incidence of fetal malnutrition was 54.8% (n = 51) in all infants. The incidences of maternal hypertension and preeclampsia, oligohydramnios and disturbed umbilical artery Doppler flow in the prenatal period and the incidences of neonatal hypoglycemia, polycythemia, feeding intolerance, and necrotizing enterocolitis in the postnatal period were significantly higher in preterm infants with fetal malnutrition. Fetal malnutrition contributes significantly to many early and late neonatal morbidities in preterm infants, and it should be identified in every preterm infant in the first days of life for predicting neonatal outcome, even though they are appropriately grown.

Myocardial performance index by tissue Doppler in bronchopulmonary dysplasia survivors.

Bronchopulmonary dysplasia (BPD) survivors from the surfactant era were evaluated by echocardiography in a few studies and no significant differences were found between BPD and non-BPD children. In this study, we evaluated these children with myocardial performance index (MPI), which was obtained by tissue Doppler echocardiography (TDE) in addition to the conventional methods. Fifteen children with BPD who did not have any cardiopulmonary symptoms at the time of the study were examined. All children were studied with M-mode, two-dimensional and DE. Pulmonary artery systolic pressures (PAPs) were estimated from tricuspid regurgitant velocity, and MPI for both ventricles were obtained by TDE. Results were compared with those of term-born, age- and sex-matched control children. While the variables obtained by M-mode and DE did not differ between the groups, the right and left ventricular MPI were found to be significantly higher in the BPD group compared with the control group (mean right ventricular MPI 0.48 +/- 0.04 vs. 0.41 +/- 0.05; mean left ventricular MPI 0.47 +/- 0.05 vs. 0.39 +/- 0.06). In addition, mean PAPs values of the patients were found to be significantly higher than those of the controls (30.4 +/- 6.9 mmHg vs. 23.3 +/- 5.3 mmHg), and there was a positive correlation between PAPs and right ventricular MPI values in the BPD group (r = 0.5). While routine echocardiographic examinations revealed no difference between the groups, MPI measurements by TDE technique yielded significantly higher values in the BPD group. To this extent, our study is the first to show that survivors of BPD may, in fact, have a subclinical ventricular dysfunction.

Maternal pertussis is hazardous for a newborn: a case report.

Pertussis, or whooping cough, a highly contagious disease caused by Bordetella pertussis, is making a comeback globally and nationally in spite of reasonable vaccination coverage. Worldwide, there have been increasing reports of Bordetella pertussis infection among adolescents and adults, but the peak incidence and highest mortality occur among infants. We report a 19-day-old female infant presenting with progressive respiratory failure. The mother was the only familial contact who complained of mild cough. However, occasional apneic episodes with cyanosis and peripheral lymphocytosis prompted us to examine the presence of Bordetella pertussis, which remains a significant cause of morbidity and mortality in unimmunized infants. Understanding the source of pertussis transmission to infants may provide new approaches to prevent pertussis in the most vulnerable infants. Various potential strategies have been reviewed or recommended in countries with the aim of better protecting infants against pertussis. Public health measures to prevent the disease could be strengthened and booster vaccinations against pertussis considered.

Association between the Glu298Asp and T(-786)C polymorphisms of the endothelial nitric oxide synthase gene and respiratory distress in preterm neonates.

Genetic polymorphisms in the gene that codes for endothelial nitric oxide synthase (eNOS) have been associated with less nitric oxide availability and with various cardiovascular diseases in humans. The objective of this study was to analyze the genotype distributions and allele frequencies for the Glu298Asp (G894T) and T(-786)C polymorphisms of the eNOS gene among neonates with respiratory distress in comparison to healthy control subjects. Fifty premature neonates with respiratory distress and 55 neonates without any respiratory problem were included in the study. Genomic DNA from all the neonates was analyzed by polymerase chain reaction. A polymerase chain reaction-restriction fragment length polymorphism analysis of eNOS gene polymorphisms was performed, and the results were compared. There were no significant differences between the groups regarding either genotype distributions or the allele frequencies for the Glu298Asp and T(-786)C polymorphisms. These results suggest that eNOS Glu298Asp and T(-786)C polymorphisms are not associated with development of respiratory distress.

Does individual room implemented family-centered care contribute to mother-infant interaction in preterm deliveries necessitating neonatal intensive care unit hospitalization?

The aim of the study was to investigate the effect of individual room care in the neonatal intensive care unit (NICU) on the factors that influence mother-preterm infant interaction. Mothers in group I had hospitalization with their preterm infants in an individual room in the NICU. Mothers in group II were not hospitalized but had opportunity to visit their babies and spend time with them whenever they wanted. On the postdischarge third month, mothers were assessed for parental stress, postpartum depression, and perception of vulnerability. Although the mean depression, stress, and vulnerability scores were higher in group II, there was no significant difference between the groups (P > 0.05). Postpartum depression rate was more than double in group II, but this difference was not statistically significant (P = 0.06). Individual room care in the NICU cannot prevent maternal stress, postpartum depression, and perception of vulnerability related to having a high-risk preterm infant by itself alone.

Hydrops fetalis associated with chorioangioma and thrombosis of umbilical vein.

Placental chorioangioma and thrombosis of an umbilical vein varix are rare etiologic factors of non-immune hydrops fetalis. Herein, we report a patient who had hydrops fetalis associated with placental chorioangioma and thrombosis of an umbilical vein varix. This is the first report of coexistence of non-immune hydrops fetalis with placental chorioangioma and thrombosis of an umbilical vein varix.

Bone speed of sound curves of twin and singleton neonates.

AIM: To evaluate associations between prenatal risk factors, neonatal characteristics and bone development. METHODS: Tibial speed of sound (SOS) of 317 neonates whose gestational ages ranged between 25 and 41 weeks and birth weight between 580 and 4,350 g was measured using quantitative ultrasound. RESULTS: Bone SOS values correlated significantly with gestational age and birth weight. Small for gestational age (SGA) infants had higher bone SOS values than appropriate for gestational age (AGA) infants. Infants born to multiple pregnancies had lower SOS values than singleton infants so two separate bone SOS curves were made: for singleton infants born AGA (n = 152), and for infants of multiple pregnancies born AGA (n = 104). Infants of preeclamptic mothers had significantly higher SOS values than the infants of mothers without preeclampsia. CONCLUSION: This is the first study reporting bone SOS values of Turkish neonates. Prenatal risk factors, such as preeclampsia, multiple pregnancy, and being SGA, affect the bone development of the fetus.

Thrombin activatable fibrinolysis inhibitor activity (TAFIa) levels in neonates with meconium-stained amniotic fluid.

OBJECTIVE: Meconium-stained amniotic fluid (MSAF) is thought to be a sign of fetal hypoxia, which causes activation of coagulation and inhibition of fibrinolysis. Inflammation is also seen in MSAF. On the other hand, thrombin activatable fibrinolysis inhibitor (TAFI) is an inhibitor of fibrinolysis and a regulator of vascular inflammation. For this reason, in this study we aimed to evaluate the relation between hypoxia, fibrinolysis, and inflammation by determining the levels of TAFI activity (TAFIa) in MSAF where inflammation was also thought to have a role in the pathogenesis. METHODS: The MSAF group consisted of 22 neonates; 20 neonates served as the control group. Plasma TAFIa levels were evaluated in all neonates in the first six hours of life. RESULTS: TAFIa levels were significantly higher in the MSAF group when compared with the control group and the levels correlated negatively with cord blood pH levels. CONCLUSIONS: Increased TAFIa levels in neonates with MSAF might be due to hypoxia. Inflammation observed in MSAF may also play an additional role in increased TAFIa expression. Although no clinical complication that can be attributed to this increase was seen, one should be alert to the complications of depressed fibrinolysis that might be observed in these neonates.

Long-term enteral glutamine supplementation in very low birth weight infants: effects on growth parameters.

Enteral and parenteral glutamine supplementation in preterm infants has been shown to have some beneficial effects on neonatal morbidity and mortality, although the results are controversial. In this study, we aimed to determine if long-term glutamine-supplemented enteral nutrition affects growth parameters in very-low-birth-weight (VLBW) preterm infants. Preterm infants with a birth weight of < or = 1500 g were assigned to receive enteral glutamine supplementation (300 mg/kg/day) or placebo between 8-120 days (4 months) of life. At the end of each month, growth parameters [weight, length, head circumference, left upper mid-arm circumference (MAC) and left mid-thigh circumference (MTC)] were determined and enteral glutamine dose was adjusted according to the current weight. In VLBW infants (n = 69), the glutamine-supplemented group (n = 36) had significantly higher mean weight, length, head circumference, MAC and MTC than the control group (n=33) at the end of the fourth month. These findings suggest that long-term enteral glutamine supplementation may lead to significant improvements in growth in all body measures in VLBW infants, possibly in a time-dependent pattern.

ACE gene deletion/deletion polymorphism may be a protective factor for respiratory distress in preterm infants.

The objective in this study was to evaluate the angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism in premature infants with and without respiratory distress within the first 24 hours of life. Totally, 87 premature babies who were followed up in the neonatal unit were included in the study. Of these babies, 41 had respiratory distress, and constituted the patient group. The remaining 46 babies who did not have respiratory distress constituted the control group. Blood samples were obtained from the babies within the first few days of life prior to administration of any blood product. The ACE gene insertion (I) and deletion (D) polymorphism was investigated using polymerase chain reaction method. The I/I polymorphism was frequent in the patient group and the D/D polymorphism was frequent in the control group (p < 0.05). There was no relationship between the ACE gene polymorphism and hospital stay, ventilation or oxygen consumption duration of the patients. In addition, taking into consideration the gestational age, no association was found between ACE gene polymorphism and birth weights of the babies. The I/I genotype was considered a risk factor for pulmonary disorders in neonates as the I/I variant was more frequent in the neonates with respiratory distress than in healthy newborns. The ACE I/I genotype is associated with an increased risk of respiratory disorders among premature infants and the D/D genotype is a protective factor for respiratory disorders, but these infants with ACE D/D genotype might be at risk for the development of cardiovascular disorders later in life.

Evaluation of serum granulocyte colony stimulating factor levels in infants of preeclamptic mothers.

In this study we aimed to evaluate the relationship between serum granulocyte colony stimulating factor (G-CSF) levels and absolute neutrophil counts (ANC) in infants of preeclamptic mothers. The study group consisted of 31 infants of preeclamptic mothers while the control group consisted of 24 gestational age-adjusted infants of normotensive mothers. G-CSF levels were determined by enzyme-linked immunosorbent assay (ELISA). The mean G-CSF level was 981.8 +/- 1682.5 (25.7-5924) pg/ml in the study group and 770.8 +/- 1779 (18-8526) pg/ml in control group (p > 0.05). There was no correlation between G-CSF levels and absolute or total neutrophil counts on the 1st, 2nd and 7th days in infants of preeclamptic mothers. There were positive correlations between G-CSF levels and ANC on the 1st and 7th days of life in infants of normotensive mothers. Neutropenia developed in 42.3% of the study group and in 21.7% of the control group on the 1st day of life (p > 0.05). On the 2nd day, neutropenia was observed in 61.5% of the study group and 26.1% of the control group (p = 0.013). Serum G-CSF levels were not low in neutropenic babies of preeclamptic mothers. In contrast, higher G-CSF levels in neutropenic infants suggest impaired G-CSF response in infants of preeclamptic mothers.

Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography.

In this study, risk factors of developmental dysplasia of the hip (DDH) were evaluated. History, clinical examination and risk factors for DDH of the babies were recorded. The hips were evaluated with ultrasonography. Infantile hip ultrasonography is one of the best methods for screening of DDH. Ultrasonography is easy, repeatable and provides visualization of the cartilage part of the hip joint. Graf's method of infantile hip ultrasonography was used to evaluate the hip in this study. Both hips of 371 babies and 32 unilateral hips of 32 babies were included in the study. In 403 babies, 14 (3.4%) had DDH. There were 5 type IIB, 7 type IIC, 1 type D, and 1 type IV hips. Physiological immaturity was present in 81 hips (19% of babies). According to risk factor analysis, the only risk factor in unilateral analysis was presence of oligohydramnios (odd ratio-OR: 11.8, confidence interval-CI: 2.7-52.7). In correlation analysis, there was a correlation between female gender and swaddling. There was overall increase in DDH in female babies who were swaddled compared to those who were not. The results of this study showed that the most important risk factor was oligohydramnios for DDH. Swaddling and female gender increased the risk of the disease, but further studies in larger series are necessary for the confirmation of these results.

Birthweight discordance in twins and the risk of being heavier for respiratory distress syndrome.

Twin pregnancies are becoming common as a result of increased assisted reproduction. Studies have shown that the smaller twin of a pair is at greater risk of morbidity and mortality. Our aim was to determine if there is a relation between birth-weight discordancy and neonatal morbidity and mortality and to test the occurrence of respiratory distress syndrome (RDS) in discordant twins. For 5 years all twins admitted to our intensive care unit were included in the study. Discordance was calculated as the difference between twins' weights divided by the heavier weight. Diagnosis of RDS was made by typical clinical and radiographic methods. Multiple logistic regression was performed with gender, weight order and birth order as the independent variables and RDS as the dependent variable. Two hundred and sixty-six twin pairs with a mean gestation of 33 weeks and a mean birth-weight of 1890 g were evaluated. Multiple logistic regression revealed that being the heavier twin was a more important risk factor for RDS (odds ratio 4.5; 95% confidence interval 2.2-9.2) than being the male or second-born twin. Based on neonatal outcomes a birth-weight discordance equal or greater than 20% in twin pairs was accepted as the discordance criterion. Discordant and concordant groups were statistically different in neonatal mortality, necrotizing enterocolitis, polycytemia and hypoglycemia. Our data demonstrated that being the heavier twin is a risk factor for RDS and a birth-weight difference of 20% or more in twin pairs should be accepted as discordance.

Maternal risk factors associated with lead, mercury and cadmium levels in umbilical cord blood, breast milk and newborn hair.

OBJECTIVE: Lead (Pb), mercury (Hg) and cadmium (Cd) are environmental pollutants that are wide spread throughout the world. The present study aimed to investigate the level of exposure to Pb, Hg and Cd during the prenatal period, and the possible routes of maternal exposure to these toxic heavy metals. PARTICIPANTS: The study included 123 mothers and their newborns. Umbilical cord blood samples were collected immediately after delivery, and breast milk and newborn hair samples were collected between postpartum d 3 and 10. RESULTS: Among the 121 cord blood samples that were analyzed, Pb was present in 120 (99.2%) and the mean level was 1.66 ± 1.60 µg dL(-1) (range:

Blood L-arginine levels in early respiratory distress syndrome.

L-arginine is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Our aim was to compare the levels of L-arginine between infants with respiratory distress syndrome and infants without respiratory distress syndrome and to determine the relationship between plasma L-arginine concentrations and severity of disease. Thirty premature infants who were admitted to our neonatal intensive care unit were included the study. Seventeen of these infants with respiratory distress syndrome were study group and the other 13 infants without respiratory distress syndrome served as controls. Blood collection was made before any treatment or intervention given to infants and tandem mass spectrometry was used for laboratory testing. In the respiratory distress syndrome group mean L-arginine level was 33.0 (+/- 11.5) mM/l, and in controls it was 79.0 (+/- 23) mM/l. This difference was statistically significant (P < 0.05). There was a reverse relationship between L-arginine levels and oxygenation index (r = 0.732, P = 0.001). If level of L-arginine is low or insufficient in respiratory distress syndrome patients' nitric oxide level would decrease in pulmonary circulation and results increased pulmonary resistance and severity of respiratory distress syndrome. We concluded that L-arginine levels are low in patients with rspiratory distress syndrome and for further investigations, supplementation of respiratory distress syndrome patients with L-arginine may decrease disease severity.

Visceroatrial situs solitus with atrioventricular alignment discordance double outlet right ventricle and superoinferior ventricles: fetal and neonatal echocardiographic findings.

Visceroatrial situs, ventricular morphology, and atrioventricular and ventriculoarterial alignments can reliably be assessed with fetal echocardiography. We herein describe, to our knowledge, the first reported fetal echocardiographic diagnosis of a fetus with visceroatrial situs solitus, atrioventricular alignment discordance, double outlet right ventricle, and superoinferior ventricles of a 22-year-old gravida III para II woman with a previous history of intrauterine fetal death. She had been evaluated at another center and was referred to our unit because of the suspicion about her diagnosis and underwent fetal ultrasonographic evaluation at 39 weeks gestation. Neonatal echocardiographic evaluation and autopsy findings confirmed the diagnosis. Accordingly there was (solitus, L-loop ventricle, and anterior aorta) double outlet right ventricle, superoinferior ventricles with diminutive right ventricle, noncommitted trabecular ventricular septal defect, and pulmonary hypertension.