Effects of Saccharomyces boulardii on neonatal hyperbilirubinemia: a randomized controlled trial

OBJECTIVE

Since probiotics modulate intestinal functions and enterohepatic circulation; they might have an effect on neonatal hyperbilirubinemia treatment. The objective of this study was to investigate the efficacy of Saccharomyces boulardii supplementation on hyperbilirubinemia.

STUDY DESIGN

A prospective, double-blind, placebo controlled trial was performed on 35 to 42 gestational weeks' neonates. They were randomized either to receive feeding supplementation with S. boulardii 125 mg every 12 hours or placebo during phototherapy. Serum bilirubin levels were measured at 0, 24th, 48th, 72nd, and 96th hour of phototherapy.

RESULTS

A total of 119 infants (61 in the control group and 58 in the study group) were enrolled. The duration of phototherapy (2 [1-3] vs. 2 [1-3], p: 0.22) was not different between groups. The levels of bilirubin during phototherapy ([24th hour; 14.1 {12.8-15.7} vs. 13.5 {12.4-14.9}, p: 0.085]; [48th hour; 14.1 {12-15.3} vs. 13.4 {12.4-14.5}, p: 0.41]; [72nd hour; 13.9 {12.2-15.6} vs. 13.5 {12.5-14.5}, p: 0.41]; [96th hour; 14.7 {11.4-15.5} vs. 13.4 {10.7-14.1}, p: 0.24]) or the duration of rebound phototherapy (1 [1-1] vs. 1.5 [1-2], p: 0.40) were lower in the study group than in the controls, but none of the values were statistically significant.

CONCLUSION

S. boulardii did not influence the clinical course of hyperbilirubinemia significantly.

Oral versus intravenous paracetamol: which is better in closure of patent ductus arteriosus in very low birth weight infants?

OBJECTIVES

To compare the efficacy of oral and intravenous paracetamol for closure of hemodynamically significant patent ductus arteriosus (HSPDA) in very low birth weight (VLBW) preterm infants.

METHODS

Eighteen VLBW infants with HSPDA treated with either intravenous (n = 10) or oral (n = 8) paracetamol at 60 mg/kg/d for three consecutive days were analysed retrospectively. Ductal closure rate and evaluation of liver function tests were the major outcomes.

RESULTS

After two courses of treatment, HSPDA closure rate was higher in oral paracetamol group than that in the intravenous paracetamol group (88% versus 70%), but it was not statistically significant (p = 0.588). Liver function tests were normal after the treatment.

CONCLUSION

Although it was not statistically significant, the cumulative closure rates were higher in oral paracetamol group than those in the intravenous group. Larger trials are needed to confirm these data.

One-year clinical outcome after laser treatment for retinopathy of prematurity at a tertiary center in Turkey

The purpose of the study is to evaluate the clinical outcome of laser photocoagulation (LPC) in the treatment of retinopathy of prematurity (ROP) at a referral hospital in Turkey. In this retrospective study, a chart review of infants who underwent LPC for ROP between June 2011 and June 2013 was done. Clinical and demographic characteristics, laser parameters, anatomic, and refractive outcomes were evaluated. Totally 113 infants (202 eyes) were enrolled in the study. Of the 202 eyes, 29 eyes had threshold ROP, 141 eyes had prethreshold ROP, and 32 eyes had aggressive posterior ROP (APROP) at initial interventions. The mean gestational age (GA) was 28.13 ± 1.99 weeks (range between 24 and 33 weeks), the mean birth weight (BW) was 1,147.77 ± 341.77 g (range between 530 and 2,000 g) and the mean postmenstrual age (PMA) at first laser treatment time was 35.79 ± 1.74 weeks (range between 33 and 39 weeks). The mean number of laser spots (NLS) applied for each eye was 1,358.05 ± 369.91. Eyes with APROP had higher number of NLS than eyes with threshold ROP and prethreshold ROP (P < 0.01). Anatomic outcome was favorable for 171 eyes (84.7 %) at the end of the 1-year follow-up. Refractive data were available for 56 infants (100 eyes). The mean refractive error was 0.00 ± 2.48D SE. The incidence of high myopia (>5D) and strabismus was 2 and 14.3 %, respectively. Laser photocoagulation is an effective therapy for ROP. Early and appropriate laser treatment improves the clinical outcome of the disease.

Effect of laser photocoagulation on plasma levels of VEGF-A, VEGFR-2, and Tie2 in infants with retinopathy of prematurity

PURPOSE

To report the baseline plasma levels of vascular endothelial growth factor-A (VEGF-A), soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) and soluble Tie2 in infants with treatment-requiring retinopathy of prematurity (ROP) and to investigate the effect of laser treatment on the plasma levels.

METHODS

Blood samples were collected from infants with prethreshold type 1 ROP before, 1 day after, and 1 week after confluent laser photocoagulation. Enzyme-linked immunosorbent assay procedure was used to determine plasma VEGF-A, sVEGFR-2, and sTie2 levels.

RESULTS

A total of 48 eyes of 30 infants were included. The mean postconceptional age at which laser photocoagulation was performed was 37.5 ± 2.9 weeks. The mean number of laser spots applied to each eye was 1,480 ± 420. Regression of active retinopathy occurred within 1 week of treatment in all cases. Baseline plasma VEGF-A, sVEGFR-2, and sTie2 levels did not differ between unilateral and bilateral and also zone I and zone II disease. A significantly progressive decrease was observed in plasma VEGF-A, sVEGFR-2, and sTie2 levels at 1 day and 1 week after laser photocoagulation.

CONCLUSIONS

Plasma levels of VEGF-A, sVEGFR-2, and sTie2 decreased significantly in our patients after laser treatment; however, because of the variability in the measurements, further studies evaluating the clinical value of these angiogenic factors in patients with treatment-requiring ROP are necessary.

Palivizumab prophylaxis: does it have any influence on the growth and development of the infants?

AIM

To evaluate the rehospitalization rates of premature infants who received palivizumab prophylaxis and its influence on the growth and development of these infants.

METHODS

Infants with a gestational age of less than 32 weeks were randomized to receive prophylaxis with palivizumab (study group) or nothing (control group). Nasal swab samples were obtained monthly in all cases and also in case of infection and hospitalization. At the corrected age of 18 months Guide for Monitoring Child Development (GMCD) was administered to all patients and anthropometric indices were evaluated.

RESULTS

The study was completed with 39 infants in the study group and 40 infants in the control group. Incidence of hospitalization due to respiratory syncitial virus (RSV) was found to be significantly lower in the study group both at the year of prophylaxis and in the following year (p = 0.001, odds ratio 1.32 [1.11-1.57]). There were no significant differences in terms of anthropometric indices or GMCD tests between the groups at the corrected age of 18 months.

CONCLUSION

Palivizumab reduced the incidence of lower respiratory tract infections and hospitalizations due to RSV both in the year of prophylaxis and in the following year. However, this decrease did not have any impact on the development of infants.

Value of twelfth hour bilirubin level in predicting significant hyperbilirubinemia in preterm infants

BACKGROUND

As hyperbilirubinemia is a significant cause of brain injury, it is important to predict the cases who are at risk. Data for preterm infants are scarce. The aim of this study is to predict significant hyperbilirubinemia in preterm infants by measuring capillary bilirubin at 12th hour of life.

METHODS

One hundred and fifty neonates born ≤ 35 weeks were included in the study. They were categorized into two groups according to their birth weights (group 1: 1,000 - 1,499 g; group 2: 1,500 - 2,000 g). Their bilirubin levels were measured at 12th hour and daily thereafter for 5 days. Risk nomograms were generated based on their bilirubin measurements and postnatal ages. On the age-specific percentile-based nomogram, the zone above the 90th percentile was determined as high risk and those below the fifth percentile as low risk. Infants who had bilirubin levels over the limits defined according to their postnatal ages and birth weights were accepted to have significant hyperbilirubinemia and received phototherapy and predictive value of the 12th hour bilirubin was asssessed.

RESULTS

Fifty-four of 57 infants (94.7%) in group 1 and 75/93 infants (80.7%) in group 2 received phototherapy. Capillary bilirubin levels of 3.55 mg/dL and 4.55 mg/dL for group 1 and group 2 measured at the 12th hour of life had the highest sensitivity, negative and positive predictive value to predict the neonates who will develop significant hyperbilirubinemia.

CONCLUSION

Bilirubin levels of preterm infants should be monitored closely. More attention should be paid to the ones who had 12th hour bilirubin level above the cutoff values.

Nomograms of cerebellar vermis height and transverse cerebellar diameter in appropriate-for-gestational-age neonates

BACKGROUND

Evaluation of cerebellar morphology and measurement of its biometric parameters such as cerebellar vermis height and transverse cerebellar diameter may assist the neonatologist in monitoring cerebellar growth and development and detect abnormalities resulting from malformations, hemorrhage or ischemic infarction.

AIM

The aim of this study was to establish nomograms of cerebellar vermis height and transverse cerebellar diameter at birth in appropriate-for-gestational-age neonates by using cranial ultrasonography.

STUDY DESIGN

A cross-sectional observational study. Appropriate-for-gestational-age neonates were evaluated with cranial ultrasonography by the same neonatal sonographer.

SUBJECTS

Healthy appropriate-for-gestational-age neonates born between 26 and 42 weeks of gestation in their first postnatal 24 h.

OUTCOME MEASURES

Cranial sonographic measurements included cerebellar vermis height measured midsagitally from anterior fontanelle and transverse cerebellar diameter measured coronally from mastoid fontanelle. Measurements were taken for each gestational age between 26 and 42 weeks and nomograms were constructed.

RESULTS

Three hundred twenty-one consecutively born appropriate-for-gestational-age neonates (163 females and 158 males) were studied. A linear growth function was observed between vermis height and gestational age and between transverse cerebellar diameter and gestational age.

CONCLUSION

Nomograms of cerebellar vermis height and transverse cerebellar diameter against gestational age at birth in appropriate-for-gestational-age neonates have been constructed. This can help the neonatologist to assess variations from the normal during ongoing cerebellar growth and development and to diagnose cerebellar anomalies.

Efficacy of Saccharomyces boulardii on necrotizing enterocolitis or sepsis in very low birth weight infants: a randomised controlled trial

BACKGROUND

Probiotics have strain specific effects and the effects of fungi in preventing diseases in preterm infants have been investigated poorly. Saccharomyces boulardii is a yeast which acts both as a probiotic and a polyamine producer.

AIM

The objective of this study was to investigate the efficacy of S. boulardii in preventing necrotizing enterocolitis (NEC) or sepsis in very low birth weight infants.

STUDY DESIGN AND SUBJECTS

A prospective, double blind, placebo controlled trial was conducted in preterm infants (≤ 32 GWs, ≤ 1500 g birth weight). They were randomized either to receive feeding supplementation with S. boulardii 50 mg/kg every 12 h or placebo, starting with the first feed until discharged.

OUTCOME MEASURES

Necrotizing enterocolitis (NEC) or sepsis and NEC or death.

RESULTS

Birth weight and gestational age of the study (n = 104) and the control (n = 104) groups were 1126 ± 232 vs 1162 ± 216 g and 28.8 ± 2.2 vs 28.7 ± 2.1 weeks, respectively. Neither the incidence of stage ≥ 2 NEC or death nor stage ≥ 2 NEC or late onset culture proven sepsis was significantly lower in the study group when compared with the control group (9.6% vs 7.7%, p = 0.62; 28.8% vs 23%, p = 0.34). Time to reach 100 mL/kg/day of enteral feeding (11.9 ± 7 vs 12.6 ± 7 days, p = 0.37) was not different between the groups.

CONCLUSIONS

Saccharomyces boulardii did not decrease the incidence of NEC or sepsis.

The effect of phototherapy on fecal calprotectin levels

OBJECTIVE

Fetal calprotectin levels increase in the early stages of necrotizing enterocolitis. Although the effects of several factors on fetal calprotectin have been studied, the effect of phototherapy is not known. In this study, we analyzed the effect of phototherapy on fetal calprotectin levels.

METHODS

Ninety breast-fed newborns (46 male, 44 female) who were hospitalized for indirect hyperbilirubinemia and treated with phototherapy were included to the study. Forty-two of them were term and 44 of them were preterm. Newborns treated with phototherapy (n = 53) constituted the phototherapy group (29 preterm, 24 term) and 37 newborns who did not receive phototherapy (19 preterm, 18 term) constituted the control group. Fecal samples were collected 24 hours after phototherapy had been started. Fecal samples (100 mg) were weighed with sensitive scales and preserved at -80°C after buffering with a special solution. All samples were studied at the same time with a fecal calprotectin kit by using enzyme-linked immunosorbent assay.

RESULTS

There were no statistically significant difference between fecal calprotectin levels of term and preterm babies who received phototherapy and babies who did not receive phototherapy.

CONCLUSION

There was no effect of 24-hour phototherapy on fecal calprotectin levels in preterm and term newborns.

Use of cefoperazone/sulbactam in neonates

BACKGROUND

Neonates are at high risk for nosocomial infections due to multidrug-resistant pathogens. The use of β-lactamase inhibitors in combination with β-lactam antibiotics broadens the antimicrobial spectrum. Cefoperazone/sulbactam is used in children but there are limited data on its usage in neonates. The purpose of the present study was therefore to evaluate the use of cefoperazone/sulbactam in the treatment of neonatal infections caused by multidrug-resistant pathogens.

METHODS

The records of neonates who were hospitalized and who received cefoperazone/sulbactam were reviewed.

RESULTS

There were 90 infants who received cefoperazone/sulbactam. A pathogen could be isolated in 41 (45.6%) of the infants. In total, 17.1% of isolated pathogens were resistant to cefoperazone/sulbactam. Side-effects were seen in four of the infants. Two infants had cholestasis, one infant had neutropenia and one had superinfection with candida.

CONCLUSION

Cefoperazone/sulbactam can be used in the treatment of nosocomial infections caused by multidrug-resistant pathogens in neonates.

Alkaline phosphatase as an early marker of hemolysis in newborns

BACKGROUND

Early diagnosis and appropriate management of neonatal hyperbilirubinemia are very important in order to prevent bilirubin encephalopathy and kernicterus. Several diagnostic tests may be used for this purpose, including bilirubin level itself. The aim of the present study was to investigate whether serum alkaline phosphatase (ALP), which is an intracellular enzyme found abundantly in red blood cells, could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns.

METHODS

A total of 100 babies were evaluated, starting from the sixth hour after birth, and serum ALP and bilirubin levels were analyzed.

RESULTS

ALP levels were significantly higher in babies requiring therapy such as phototherapy or exchange transfusion (247.01 ± 67.44 IU/L vs 154.25 ± 56.07 IU/L). ALP levels rose significantly with rising total bilirubin level.

CONCLUSION

ALP levels at the sixth hour of life may be a significant predictor of developing hemolysis and hyperbilirubinemia requiring treatment.

Resistin levels in preterms: are they influenced by fetal inflammatory course?

OBJECTIVE

Many different factors are involved in the pathogenesis of preterm deliveries and among them maternal or perinatal infections and inflammatory response have the major role. Researches were carried out about resistin, which is thought to have a role in inflammatory cytokine cycle and it was shown to be associated with growth in neonates. However, no research has been carried out showing its relationship with inflammation in neonates. In this study, we aimed to evaluate the resistin levels in premature neonates and the effect of events such as preterm prelabour rupture of the membranes (PPROMs) and the use of antenatal steroids on these levels.

STUDY DESIGN

The study included 118 preterm neonates. Their medical data together with their mothers' were recorded. Serum resistin levels together with interleukin (IL)-6, C-reactive protein (CRP) and procalcitonin were evaluated in the first 2 h of life.

RESULT

Mean gestational age and birth weight of babies included in the study were 29.6 ± 2.7 weeks and 1306.4 ± 393.4 g, respectively. Babies with PPROMs had significantly higher levels of resistin ((n=30); 70.7 (7.8 to 568.4) ng ml(-1)) than babies without PPROM ((n=88); 25.9 (5.5 to 528.9) ng ml(-1)) (P=0.005), and the babies of mothers who received antenatal steroids had significantly lower resistin levels ((n=44); 20.8 (5.5 to 159.9) ng ml(-1)) than the babies of mothers who did not ((n=66); 34.6 (7.2 to 568.4) ng ml(-1)) (P=0.015). There were significant correlations between resistin and IL-6 levels and between IL-6 and procalcitonin and CRP levels in babies whose mothers did not receive antenatal steroids. However, no correlation was found between these parameters in babies whose mothers received antenatal steroids.

CONCLUSION

Preterm delivery and PPROM involve complex cascade of events including inflammation, and steroids are potent anti-inflammatory agents. Elevated resistin levels in babies with PPROM and suppressed levels in babies whose mothers received antenatal steroids reported in this study might have been observed as a result of the effects of fetal inflammation on resistin levels.

Bilateral diaphragmatic defect and associated multiple anomalies

Although congenital diaphragmatic hernia is one of the most common congenital anomalies, complete bilateral agenesis of the diaphragm is a very rare congenital malformation and frequently associated with other major anomalies. We report a case of bilateral diaphragmatic agenesis associated with major congenital anomalies. A 2,240-g male infant was born at 35 weeks of gestation to a 34-year-old mother with a history of minimal prenatal care. Polyhydramnios was reported on prenatal level 1 scan. The patient experienced early respiratory distress requiring intubation. Apgar scores were 2/1/1 at 1, 5 and 20 minutes, respectively, and efforts to resuscitate him were unsuccessful. He died at 2 hours of age. Autopsy revealed bilateral diaphragmatic agenesis associated with right pulmonary hypoplasia, left pulmonary agenesis, multiple cardiac abnormalities and gallbladder agenesis. Cytogenetic studies showed normal male karyotype. Bilateral agenesis of the diaphragm is a life-threatening malformation. Survival of these infants often depends on cardiopulmonary function. Bilateral agenesis of the diaphragm associated with gallbladder and unilateral pulmonary agenesis is a rare entity, and its clinical significance needs further investigation.

Pleural effusion: a rare complication of hepatitis A

Hepatitis A (HAV) infection, which is the most common form of hepatitis in the paediatric age group and which sometimes has a fulminant course, is endemic in Turkey, constituting one of the country's important health problems. Pleural effusion also represents a rare benign complication of acute HAV infections. We describe here a case of Hepatitis A who developed pleural effusion.

Effects of human milk fortifier on the antimicrobial properties of human milk

OBJECTIVE

To evaluate the effects of addition of human milk (HM) fortifier and iron on the anti-infective properties of HM.

STUDY DESIGN

HM samples were collected from 28 lactating mothers who delivered prematurely, within the first week of post-natal life. HM fortifier Eoprotin was used. The effects of this fortifier against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans were evaluated using a filter paper method. The measurements were repeated with pure HM, fortified HM and iron-added HM.

RESULTS

HM inhibited the growth of S. aureus, E. coli, P. aeruginosa and Candida. Addition of HM fortifier did not result in any significant difference on this effect. The addition of iron to HM reduced antimicrobial effect against all three bacteria and the Candida.

CONCLUSION

Premature HM has strong antimicrobial activity and addition of the milk fortifier Eoprotin does not change this effect, but addition of iron reduces this antimicrobial activity.

Relationship of Tel Hashomer criteria and Mediterranean fever gene mutations in a cohort of Turkish familial Mediterranean fever patients

OBJECTIVE

To evaluate the frequency of 5 mutations and their relationship with the Tel Hashomer criteria in 85 FMF patients.

METHODS

We looked for mutations in the Mediterranean fever (MEFV) gene in 84 consecutive patients who admitted to the Department of Medical Genetics of Afyon Kocatepe University, with a variable (from high to low) clinical suspicion of FMF. By using polymerase chain reaction and Hybridization-ELISA methods, 5 mutations (M694V, M694I, V726A, M680I and E148Q) have been studied between December 2002 and January 2005.

RESULTS

We detected homozygote mutations in 12 patients (25.3%) and heterozygote mutations in 23 patients (48.9%) out of 47 patients with high clinical suspicion of FMF using Tel Hashomer criteria. In 12 patients (25.3%), no mutation was detected despite the clinical diagnosis of FMF was likely according to the Tel Hashomer clinical criteria. On the other hand, we detected homozygote mutations in 2 patients (5.4%) and heterozygote mutations in 17 patients (45.9%) out of 37 patients with low clinical suspicion of FMF using Tel Hashomer criteria. In 18 out of 37 patients (48.6%) in this group no mutation was detected.

CONCLUSION

In patients with high or low clinical suspicion of diagnosis of FMF according to Tel Hashomer criteria, the frequency of homozygote patients was significantly higher than the frequency of patients with no mutation, but it was not higher than the frequency of heterozygote patients.

Delay in diagnosis of hypopituitarism after traumatic head injury: a case report and review of the literature

Neuroendocrine complications are among important and frequently missed complications of traumatic brain injury. Hypopituitarism, the partial or complete insufficiency of anterior pituitary secretion may be underrecognized due to its subtle clinical manifestations in traumatic patients. We report a case of 14.5-year-old girl who was admitted due to growth failure and had been diagnosed to have multiple hypophyseal hormone deficiency including thyroid-stimulating hormone, gonadotropins, adrenocorticotropin hormone which developed years after traumatic head injury.

Isoniazid and hypoglycaemia in a premature infant

Severe hypoglycaemia requiring more than 20 mg/kg per minute glucose infusion was seen in a premature infant. The infant was born to a woman with active tuberculosis, and she was on prophylactic isoniazid. Discontinuation of isoniazid resulted in prompt recovery of hypoglycaemia. Further pharmacological studies may be needed to establish a cause and effect relationship.

Intrauterine growth curves for Turkish infants born between 25 and 42 weeks of gestation

Intrauterine growth curves should be specific to each population and are needed for the Turkish population. An analysis of birthweight, crown-heel length, and head circumference in newborns between 25 and 42 weeks of gestational age was made. A total of 2481 babies were evaluated. Mean, standard deviation, and percentile values were calculated for each gestational age and smoothed curves were obtained for each parameter. In our country, the use of these new curves is more appropriate than those obtained in other countries.

Transient Tachypnea of the Newborn (TTN): A Role for Polymorphisms of Surfactant Protein B (SP-B) Encoding Gene?

BACKGROUND

Transient tachypnea of the newborn (TTN) is usually a benign self-limiting respiratory disorder in the immediate neonatal period. The lipophilic surfactant-associated protein B (SP-B) was demonstrated to be the most relevant structural component of the surfactant system for immediate postnatal pulmonary adaptation. We hypothesized genetic variations of surfactant protein B (heterozygous 121 ins 2 mutation er intron 4 polymorphisms) to be related to TTN.

PATIENTS AND METHOD

We screened genomic DNA of 83 healthy term neonates (gestational age: 39 (37 - 41) completed weeks [median and range]; birth weight: 3325 +/- 541 grams [mean +/- SD]) and 75 infants presenting with TTN (gestational age: 38 (37 - 41) completed wecks [median and range]; birth weight: 3091 +/- 435 grams [mean +/- SD]) by means of PCR-amplification, fragment length and sequence analysis. TTN was diagnosed an the basis of the clinical signs with respiratory rate > 60 breaths/minute, fraction of inspired oxygen > 0.21, and characteristic radiographic findings within less than 24 hours after birth. Newborns with any infection, pulmonary or cardiac congenital malformations, postnatal asphyxia and infants born to diabetic mothers were excluded.

RESULTS

In TTN-group the frequency of male infants (68.4 % versus 44.6 %, p < 0.05) and caeserian section were significantly higher (68.4 % versus 30.1 %, p < 0.05). We did not find any statistical difference in frequency of intron 4 variations between controls and TTN-group (8.4 % versus 10.7 %). None of the infants were heterozygous for the 121ins2 SP-B mutation.

CONCLUSIONS

WC conclude polymorphisms of intron 4 and heterozygous 121 ins 2 mutation not to associated with TTN.