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Elgendy MM, Cortez J, Saker F, Acun C, Matar RB, Mohamed MA, Aly H. Acute kidney injury in infants with hypoxic-ischemic encephalopathy. Pediatr Nephrol 2024; 39:1271-1277. [PMID: 37947899 DOI: 10.1007/s00467-023-06214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND This study aimed to investigate the prevalence of acute kidney injury (AKI) in infants with varying degrees of hypoxic-ischemic encephalopathy (HIE) and its associated outcomes, including mortality and length of stay (LOS). METHODS The study used the National Inpatient Sample (NIS) dataset from 2010 to 2018. Regression analysis was used to control confounding variables. RESULTS Of 31,220,784 infants included in the study, 30,130 (0.1%) had HIE. The prevalence of AKI was significantly higher in infants with HIE (9.0%) compared to those without (0.04%), with an adjusted odds ratio (aOR) of 77.6 (CI:70.1-85.7, p < 0.001), with the highest prevalence of AKI in infants with severe HIE (19.7%), aOR:130 (CI: 107-159), p < 0.001). Infants with AKI had a higher mortality rate compared to those without AKI in those diagnosed with any degree of HIE (28.9% vs. 8.8%), aOR 3.5 (CI: 3.2-3.9, p < 0.001), particularly among those with severe HIE, aOR:1.4 (1.2-1.6, p < 0.001). CONCLUSIONS HIE is associated with an increased prevalence of AKI. Infants with severe HIE had the highest prevalence of AKI and associated mortality. The study highlights the need for close monitoring and early detection of AKI in infants with HIE, particularly those with severe HIE, to ameliorate the associated adverse outcomes.
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Affiliation(s)
- Marwa M Elgendy
- Department of Pediatrics & Neonatology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
| | - Josef Cortez
- Division of Neonatology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Firas Saker
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Ceyda Acun
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Raed Bou Matar
- Center for Pediatric Nephrology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Mohamed A Mohamed
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
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Abramsky R, Acun C, Alt J, Aly H, Arad N, Baak LM, Bakalar D, Balasingham T, Bammler T, Benders MJNL, Benitez D, Boni E, Boylan G, Campbell E, Castri P, Chandrashekar P, Chavez-Valdez R, Chen M, Chiodin E, Comstock B, Damien J, Damien J, de Vries LS, de Vries L, Dickman J, Doucette L, Duckworth E, Duckworth E, Echeverria-Palacio C, El Jalbout R, El-Dib M, Elshibiny H, Flock D, Gallagher A, Gasperoni E, Glass H, Harteman JC, Harvey-Jones K, Hazan I, Heagerty P, Inder T, Jantzie L, Juul S, Karnati S, Kute N, Lacaille H, Lange F, Lemmers PMA, Liu W, Llaguno N, Magalhães M, Mambule I, Marandyuk B, Marks K, Martin LJ, Massaro A, Mathieson S, Mathieson S, McCaul MC, Meehan C, Meledin I, Menna E, Menzato F, Mintoft A, Mitra S, Nakimuli A, Nanyunya C, Norris G, Northington FJ, Numis A, O'Reilly JJ, Ortiz S, Padiyar S, Paquette N, Parmeggiani L, Patrizi S, Pavlidis E, Pellegrin S, Penn AA, Petitpas L, Pinchefsky E, Ponta A, Puthuraya JPS, Rais R, Robertson NJ, Rodrigues D, Salandin M, Salzbank J, Sánchez L, Schalij N, Serrano-Tabares C, Shany E, Staffler A, Steggerda S, Tachtsidis I, Tann C, Tataranno ML, Trabatti C, Tremblay J, Tromp S, Tucker K, Turnbill V, Vacher CM, van Bel F, van der Aa NE, Van Meurs K, Van Steenis A, van Wyk L, Vannasing P, Variane G, Verma V, Voldal E, Wagenaar N, Wu Y, Wustoff C. Proceedings of the 14th International Newborn Brain Conference: Neonatal Neurocritical Care, seizures, and continuous aEEG and /or EEG monitoring. J Neonatal Perinatal Med 2023; 16:S33-S62. [PMID: 37599542 DOI: 10.3233/npm-239003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
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Acun C, Karnati S, Padiyar S, Puthuraya S, Aly H, Mohamed M. Trends of neonatal hypoxic-ischemic encephalopathy prevalence and associated risk factors in the United States, 2010 to 2018. Am J Obstet Gynecol 2022; 227:751.e1-751.e10. [PMID: 35690081 DOI: 10.1016/j.ajog.2022.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite recent advances in perinatal care, neonatal hypoxic-ischemic encephalopathy remains one of the most common causes of neonatal morbidity and mortality. The trends for prevalence and mortality of neonatal hypoxic-ischemic encephalopathy have not been examined in the era of therapeutic hypothermia in the United States. OBJECTIVE This study aimed to determine (1) the overall and gestational age-specific (35-36, ≥37, and >42 weeks) trends of hypoxic-ischemic encephalopathy prevalence and use of therapeutic hypothermia, (2) the trends of mortality in association with hypoxic-ischemic encephalopathy, (3) the confounding variables associated with hypoxic-ischemic encephalopathy, and (4) the clinical outcomes of neonates with hypoxic-ischemic encephalopathy. STUDY DESIGN This study used National Inpatient Sample datasets from 2010 to 2018. Moreover, the study included infants with a gestational age of ≥35 weeks with a documented hypoxic-ischemic encephalopathy diagnosis (mild, moderate, severe, or unspecified). We calculated trends in hypoxic-ischemic encephalopathy prevalence and the use of therapeutic hypothermia using chi-squared testing. Furthermore, this study used logistic regression models to control for confounders. RESULTS A total of 32,180,617 infants were included, of which 31,249,100 were term (gestational age of ≥37 weeks) and 931,517 were late preterm (gestational age of 35-36 weeks). Hypoxic-ischemic encephalopathy prevalence slightly increased from 0.093% in 2010-2012 to 0.097% in 2016-2018 (P=.01) in term infants and did not significantly change in late preterm infants (P=.20). There were 6235 term infants (20.8%) and 449 late preterm infants (21.1%) with hypoxic-ischemic encephalopathy who were managed with therapeutic hypothermia. The use of therapeutic hypothermia in both term and late preterm infants has increased over the years (P<.01). The mortality rate with hypoxic-ischemic encephalopathy decreased over time from 11.5% to 12.3% between 2010 to 2012, and from 8.3% to 10.6% betweenn 2016 to 2018 (P<.01). The factors with the strongest association with hypoxic-ischemic encephalopathy were placental infarction or insufficiency (odds ratio, 144; 95% confidence interval, 134-157), placental abruption (odds ratio, 101; 95% confidence interval, 91-112), cord prolapse (odds ratio, 74; 95% confidence interval, 65-84), and maternal anemia (odds ratio, 26; 95% confidence interval, 20-37). CONCLUSION Hypoxic-ischemic encephalopathy prevalence in neonates essentially remained the same at 1 per 1000 live births. The use of therapeutic hypothermia increased, and the mortality rate decreased in infants with hypoxic-ischemic encephalopathy. The identification of hypoxic-ischemic encephalopathy-associated factors should promote increased vigilance to optimize newborn outcomes.
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Affiliation(s)
- Ceyda Acun
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH.
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Swetha Padiyar
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Mohamed Mohamed
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
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Ruikka JL, Acun C, Karnati S. Entrapped peripherally inserted central catheter due to fibrin sheath in a neonate with noninvasive extraction and review of literature. J Neonatal Perinatal Med 2021; 15:383-386. [PMID: 34719444 DOI: 10.3233/npm-210830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripherally inserted central catheter line entrapment is a rare complication in the neonatal intensive care unit and only a small number of cases have been reported. While studies have suggested recommendations for removal, there is still a need for surgical intervention in some cases. This is a case of a premature infant with long term peripherally inserted central catheter line placement with fibrin sheath formation that required multiple attempts before successful noninvasive removal and a review of the cases with difficult peripherally inserted central catheter removal in newborns.
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Affiliation(s)
- J L Ruikka
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - C Acun
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - S Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Acun C, Baker A, Brown LS, Iglesia KA, Sisman J. Peripherally inserted central cathether migration in neonates: Incidence, timing and risk factors. J Neonatal Perinatal Med 2021; 14:411-417. [PMID: 33459671 DOI: 10.3233/npm-200684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND PICC line use is a common practice in neonatal units, but it is associated with various complications. Catheter migration is the most common complication in neonates. Periodic imaging is recommended to monitor the tip position of the PICCs, but the optimal frequency is undetermined. The incidence, timing and risk factors that are associated with PICC migration have not been fully investigated beyond 24 hrs in neonates. The aim of the study was to determine the incidence, timing and risk factors that are associated with peripherally inserted central venous catheter (PICC) migration in neonates. METHODS This was a single center, retrospective study of 168 PICCs placed in 141 neonates in the neonatal intensive care unit (NICU) between 2015 and 2016. The incidence of catheter migration was determined radiographically at 12-24 hrs and every third day after insertion until it was removed. RESULTS Overall incidence of PICC migration was 28%and most commonly was detected within the first three days after PICC placement (83%). The incidence of PICC migration was higher in males. The PICC migration was associated with difficulty advancing the PICC at the time of insertion and PICC dressing change. CONCLUSION Serial evaluation of PICC placement in neonates is required to maintain proper position. Based on our experience in our unit, we recommend periodic imaging at 12-24 hrs and on the third day after PICC placement as most migration occurred within three days after insertion.
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Affiliation(s)
- C Acun
- Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - A Baker
- THR Dallas Hospital, Dallas, TX, USA
| | - L S Brown
- Health System Research, Parkland Health and Hospital System, Dallas, TX, USA
| | - K A Iglesia
- Pediatric Radiology, Cook Children's Hospital, Fort Worth, TX, USA
| | - J Sisman
- Pediatrics, UTSW, Dallas, TX, USA
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Acun C, Nusairat L, Kadri A, Nusairat A, Yeaney N, Abu Shaweesh J, Aly H. Pneumothorax prevalence and mortality per gestational age in the newborn. Pediatr Pulmonol 2021; 56:2583-2588. [PMID: 34002954 DOI: 10.1002/ppul.25454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pneumothorax (PTX) in newborns is a life-threatening condition associated with high morbidity and mortality especially in premature infants. The frequency of PTX in neonates at different gestational ages (GA) and its impact on neonatal mortality have not been quantified. We aimed to determine: (1) the prevalence of PTX in neonates at different GA from ≤24 to ≥37 weeks, (2) the impact of PTX on mortality per GA, and (3) the impact of PTX on the length of stay (LOS) per GA. METHODS The national Kids' Inpatient Database for the years of 2006-2012 were used. We included all infants admitted to the hospital with a documented GA and International Classification of Disease 9 code of PTX. Bivariate and multivariate analyses were conducted and odds ratios (OR) were calculated. RESULTS A total of 10,625,036 infants were included; of them 3665 infants (0.034%) had a diagnosis of PTX, with highest prevalence at ≤24 weeks GA (0.67%), and lowest at term (0.02%). The overall mortality rate of patients with PTX was 8.8%, and greater in preterm (16.3%) versus term infants (2.7%). The association of mortality with PTX was greatest at GA of 29-32 weeks (OR = 8.55; 95% confidence interval: 6.56-11.13). Infants who survived until discharge had a median of 2-12 days longer LOS depending on GA category. CONCLUSIONS The prevalence of PTX peaks in infants less than 24 weeks, however, its impact on mortality is greatest at 29-32 weeks. PTX is associated with longer LOS in survivors.
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Affiliation(s)
- Ceyda Acun
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Leen Nusairat
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Amer Kadri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aseel Nusairat
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Natalie Yeaney
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Jalal Abu Shaweesh
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA
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Affiliation(s)
- Asra Tanveer
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
| | - Elsie Lee
- Department of Pathology, The George Washington University Medical Center, Washington, DC, USA
| | - Mohamed Mohamed
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
| | - An Massaro
- Department of Neonatology, The Children’s National Medical Center, Washington, DC, USA
| | - Tarek Hammad
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
| | - Hany Aly
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
| | - Ceyda Acun
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
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Keiser J, Aly H, Acun C. Late-onset group B streptococcus infection in a preterm neonate. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-2010-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John Keiser
- Department of Pathology, The George Washington University Medical Center, Washington, DC, USA
| | - Hany Aly
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
| | - Ceyda Acun
- Department of Newborn Services, The George Washington University Medical Center, Washington, DC, USA
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Abstract
OBJECTIVE We aimed to compare clinical presentation and risk factors associated with the development of pneumothorax among newborns of different birth weight (BW) categories. METHODS We collected clinical and respiratory data on all newborns diagnosed with pneumothorax over a 10-year period. Infants were classified into two groups with BW ≥ 2500 g and <2500 g. RESULTS From 13,811 infants, we identified 77 with pneumothorax (BW ≥ 2500 g in 33 and BW <2500 g in 44 infants). The prevalence of pneumothorax in the two BW categories was 0.27% and 2.5%, respectively. Infants with BW ≥ 2500 g were diagnosed with neumothorax at a median age of 5.5 h, and mostly (70%) did not require intubation. Infants with BW <2500 g were diagnosed with pneumothorax at a median age of 34 h, presenting with hypercarbia and increased requirement for supplemental oxygen. The majority of these infants (89%) received mechanical ventilation after pneumothorax. When compared to matched controls, there was a lower proportion of African-American infants in the pneumothorax group (48% versus 73%, p = 0.029) and a higher rate of bronchopulmonary dysplasia (30% versus 7%, p = 0.004). CONCLUSIONS Onset, presentation and management of pneumothorax varied according to BW. Preterm infants with pneumothorax are at increased risk for developing bronchopulmonary dysplasia.
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Affiliation(s)
- Hany Aly
- Department of Neonatology, The George Washington University and the Children's National Medical Center , Washington, DC , USA
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Acun C, Erdem LO, Söğüt A, Erdem CZ, Tomaç N, Gündoğdu S, Cavuldak S. Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study. ACTA ACUST UNITED AC 2013; 24:25-31. [PMID: 15005963 DOI: 10.1179/027249304225013349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20-30-minute periods, for 5-14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4-9 days of ceftriaxone therapy, and resolved completely 7-19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.
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Affiliation(s)
- Ceyda Acun
- Department of Pediatrics, Faculty of Medicine, Karaelmas University, Zonguldak, Turkey.
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Nesterenko TH, Acun C, Mohamed MA, Mohamed AN, Karcher D, Larsen J, Aly H. Is it a safe practice to administer oxygen during uncomplicated delivery: a randomized controlled trial? Early Hum Dev 2012; 88:677-81. [PMID: 22445187 DOI: 10.1016/j.earlhumdev.2012.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 02/10/2012] [Accepted: 02/11/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Newborns exposed to oxygen suffer from an oxidative stress with significant alterations in the concentrations of superoxide dismutase (SOD) and glutathione (GSSG). OBJECTIVE To investigate the biological and clinical effects of oxygen administration to delivering mothers. METHODS We conducted a randomized, double-blinded, controlled trial on a cohort of delivering women (n=56) with an uncomplicated term pregnancy. Women were randomly assigned to one of two groups: Oxygen group or Room Air group. The Oxygen group received 100% oxygen (2l/min) via nasal cannula for at least 30 min before delivery. Subjects in the Room Air group were connected to a nasal cannula while on room air. Concentrations of SOD (μg/g of Hb) and GSSG (μM/ml) were measured in maternal and umbilical cord blood. Bivariate and multivariate analyses were used to compare the two groups using the SAS system. RESULTS Maternal SOD and GSSG did not differ between the two groups at baseline or after delivery. Concentrations of SOD and GSSG in umbilical cord blood did not differ between groups. More infants in Oxygen Group required delivery room resuscitation (20% vs. 0%, P=0.03). This difference could not be explained by mode of delivery, infant sex, or other confounders. CONCLUSIONS Maternal exposure to oxygen during delivery is not associated with changes in umbilical cord SOD or GSSG. Further studies are needed to explore mechanisms responsible for the need of resuscitation in the oxygen group.
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Affiliation(s)
- Tetyana H Nesterenko
- Department of Neonatology, George Washington University and Children's National Medical Center, 900 23rd Street NW, Washington, DC 20037, United States
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Abstract
Robinow syndrome (also named "fetal face syndrome") includes a series of anomalies including mesomelic brachymelia, bifid terminal phalanges of the hands and feet, abnormalities of vertebrae and ribs, and hypoplastic external genitalia. A midline cleft of the lower lip and mandible is an extremely rare maxillofacial deformity. Seventy cases have so far been described to our knowledge. We report a patient with Robinow syndrome and midline cleft of the lower lip and mandible and describe the reconstruction of these anomalies. We propose that this anomaly should be added to the range of malformations associated with the syndrome.
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Affiliation(s)
- Eksal Kargi
- Departments of Plastic and Reconstructive Surgery, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey.
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Leonard D, Koca R, Acun C, Cinar S, Estürk E, Ustündag G, Herron S, Butterfly MM, Zenel JA. Visual diagnosis: three infants who have perioral and acral skin lesions. Pediatr Rev 2007; 28:312-8. [PMID: 17670956 DOI: 10.1542/pir.28-8-312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Douglas Leonard
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore, USA
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Acun C, Ustundag G, Sogut A, Koca R, Numanoglu G. Visual diagnosis: a child who has acute onset of unusual skin lesions and edema. Pediatr Rev 2006; 27:e71-4. [PMID: 17079503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Ceyda Acun
- Department of Pediatrics, Karaelmas University, School of Medicine, Zonguldak, Turkey
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Tanriverdi HA, Acun C, Ustundag G, Barut A, Tekin IO, Ustundag Y. Investigation of human colostrum Helicobacter pylori IgA content in lactating women. Eur J Obstet Gynecol Reprod Biol 2006; 124:58-60. [PMID: 16051420 DOI: 10.1016/j.ejogrb.2005.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 01/30/2005] [Accepted: 02/18/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective was to investigate the colostral H. pylori-specific IgA content in a sample of the female population in Turkey where a high endemicity for H. pylori has always been reported. MATERIALS AND METHODS One hundred and sixty-one pregnant women with positive serum H. pylori IgG antibody at the time of the last trimester were enrolled into the study. During the initial postpartum 24h, we obtained colostrum samples from each mother to test the presence and concentration of H. pylori-specific IgA. Breast milk antibody concentrations of H. pylori were measured by commercial ELISA tests. Sample absorbance/cut-off absorbance (s/c) ratio was used for semiquantitative interpretation. Ratios >1.1 were considered positive, ratios < or =1.1 negative. The statistical significance was tested by the Mann-Whitney U-test, and p < 0.05 was regarded as statistically significant. RESULTS At least 2 ml of colostrum was obtained and analyzed (mean volume 2.5+/-0.45 ml). The results indicated the absence of H. pylori-specific IgA in 64 colostral samples (39.8%). However, the rest of the women (n = 97; 60.2%) had a mean H. pylori-specific IgA s/c ratio of 4.31+/-2.51 (range 1.2-10.3) in their colostral milk samples. The mean gestational age at the time of delivery was 38 weeks and 5 days, and the mean birth weight was 3, 224+/-433 g (range 4, 300-1, 940 g). Gestational age at birth and mode of delivery were not correlated with the colostral-specific IgA levels. CONCLUSIONS Most of the lactating women (60.2%), who were seropositive for H. pylori, had some IgA in their colostral milk. Colostral milk theoretically can decrease H. pylori and perhaps many other enteric infections, whether or not it contains H. pylori-specific IgA. Therefore, breastfeeding is of utmost importance for neonates and should be encouraged. The H. pylori-specific IgA antibody concentration of colostral milk should be investigated in large-scale prospective studies for its effectiveness in the protection against neonatal transmission of this infection.
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Affiliation(s)
- Hamit Alper Tanriverdi
- Department of Obstetrics and Gynecology, Karaelmas University, Medical School, 67600 Kozlu, Zonguldak, Turkey.
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Tomac N, Demirel F, Acun C, Ayoglu F. Prevalence and risk factors for childhood asthma in Zonguldak, Turkey. Allergy Asthma Proc 2005; 26:397-402. [PMID: 16450575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Prevalence of asthma and other allergic diseases varies between different regions throughout the world. The aim of this study was to determine the prevalence of asthma and allergies and some risk factors for asthma in schoolchildren, aged between 6 and 16 years old, in Zonguldak, Turkey. We prepared 1500 questionnaires according to the International Study of Asthma and Allergies in Childhood criteria and distributed them in schools, to be completed at home by parents. Appropriately completed 1349 questionnaires, including complementary questions for risk factors, were taken into consideration. Data for air-pollutant levels of sulfurdioxide (SO2) and total suspended particles were obtained also. The prevalence of current wheezing symptoms was 9.6% in children aged between 13 and 16 years old and 11.2% in the total sample. In terms of physician-diagnosed asthma, allergic rhinitis, and eczema, the prevalences were 4.9, 37.7, and 13.2%, respectively. A family history of allergy, diagnosis, or symptoms of allergic rhinitis and bronchitis (age range, 6-9 years) and male gender were found to be significant predictors for asthma symptoms with adjusted odds ratios of 2.089, 0.336, 4.707, 1.652, and 0.599, respectively. Strongly positive correlation between number of symptomatic asthmatic patients and air pollution levels for SO2 (r = 0.864; p = 0.001) and total suspended particles (r = 0.891; p = 0.001) were observed also. The prevalence of asthma is high in Zonguldak, Turkey, and there is a strong correlation between air pollution and asthma symptoms. Allergy in the first-degree relatives, diagnosis of bronchitis and allergic rhinitis, age, and male gender are more important than the other factors in predicting asthma.
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Affiliation(s)
- Nazan Tomac
- Department of Pediatric Allergy, Zonguldak Karaelmas University, Zonguldak, Turkey
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Acun C, Tomac N, Ermis B, Onk G. Effects of inhaled corticosteroids on growth in asthmatic children: a comparison of fluticasone propionate with budesonide. Allergy Asthma Proc 2005; 26:204-6. [PMID: 16119035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In asthmatic children inhaled corticosteroids are widely used. However, there are some concerns about the systemic adverse effects of these drugs, especially in the growing child. We performed this prospective study in order to compare the effects of 400 microg/day of budesonide (BUD) and 250 microg/day of fluticasone propionate (FP) on growth in prepubertal (aged 4-11.5 years), moderate persisting asthmatic children. One hundred patients (51 boys and 49 girls), who were randomized into two groups, were recruited for the study. The first group was treated with BUD, 2X 200 microg/day, and the second group was treated with FP, 2X 125 microg/day, by using a medium-size volume-spacer metered-dose inhaler. Growth in children with asthma who were treated by inhaled corticosteroids was calculated by growth velocity over a 12-month period. Comparisons between treatment groups were calculated by t-test and chi-square test. There were no significant differences between BUD and FP groups for sex, age, first height, and growth velocity. Moderate persisting, prepubertal asthmatic children treated with 250 microg/day of FP appeared to have no different linear growth than those children who received 400 microg/day of BUD.
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Affiliation(s)
- Ceyda Acun
- Department of Pediatrics, Karaelmas University, Faculty Of Medicine, Zonguldak, Turkey
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Sogut A, Altin R, Uzun L, Ugur MB, Tomac N, Acun C, Kart L, Can G. Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3--11-year-old Turkish children. Pediatr Pulmonol 2005; 39:251-6. [PMID: 15668932 DOI: 10.1002/ppul.20179] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our objective was to investigate the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in 3-11-year-old Turkish children. A cross-sectional study was conducted in Zonguldak, northwestern Turkey. Symptomatic children were identified by using a self-administered questionnaire and were classified into three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children were invited to undergo polysomnography (PSG). Nine hundred fifty-four children (79.5%) were nonsnorers, 205 (17.2%) were occasional snorers, and 39 (3.3%) were habitual snorers. There was no significant relationship between gender and habitual snoring (male, 3.4%; female, 3.1%; P > 0.05; odds ratio (OR), 1.13; 95% confidence interval (CI), 0.59-2.14). There was a statistically significant relationship between habitual snoring and allergic rhinitis (OR, 4.23; 95% CI, 2.14-8.35). Four children who snored every night, and who had apnea spells and/or troubled sleep, underwent adenoidectomy and/or tonsillectomy before polysomnographic evaluation because of clinical detoriation. Twenty-eight of 39 children with habitual snoring participated in PSG evaluation. PSG revealed that 11 children (0.9% of the total population) had OSAS. When 4 operated children were added to these 28 children, we found the minimum prevalence of OSAS to be 1.3% in our study group. There was a significant correlation between OSAS and troubled sleeping (P <0.001; OR, 4.37; 95% CI, 1.33-14.3). We found the prevalence of habitual snoring to be 3.3% in Turkish children by using self-administered questionnaires. Allergic rhinitis was significantly correlated with habitual snoring. Minimum estimated prevalence of OSAS was found to be 1.3%.
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Affiliation(s)
- Ayhan Sogut
- Department of Pediatrics, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey
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Bayar A, Acun C, Dursun A, Verhoeven N, Bonafé L, Keser S, Superti-Furga A. Metaphyseal enchondrodysplasia with 2-hydroxy-glutaric aciduria: observation of a third case and further delineation. Clin Dysmorphol 2005; 14:7-11. [PMID: 15602086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In the course of evaluating a 17 months old boy with waddling gait and swollen joints, we found generalized, severe ossification defects in the metaphyses of his long bones. The differential diagnosis included nutritional or genetic rickets, metaphyseal dysplasia, and enchondrodysplasia. Calcium, phosphate and alkaline phosphatase were normal, while targeted analysis of urinary organic acids repeatedly revealed excretion of 2-hydroxy-glutaric acid. Thus, this child appears to have an unusual combination of findings described in just two other patients so far, a girl and a boy, and called 'spondyloenchondrodysplasia with D-2-hydroxy-glutaric aciduria'. These three cases are similar in terms of severe metaphyseal lesions, mild vertebral involvement, and presence of 2-hydroxy-glutaric acid in the urine. We consider this a radiographically and biochemically distinct entity, for which we suggest the name of 'metaphyseal enchondrodysplasia with 2-hydroxy-glutaric aciduria'.
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Affiliation(s)
- Ahmet Bayar
- Department of Orthopaedics and Traumatology, Zonguldak Karaelmas University, Turkey Department of Paediatrics, Zonguldak Karaelmas University, Turkey Department of Medical Genetics, Zonguldak Karaelmas University, Turkey Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, the Netherlands Department of Paediatrics, University Hospital, Lausanne, Switzerland
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Affiliation(s)
- Ceyda Acun
- Department of Pediatrics, Zonguldak Karaelmas University, Faculty of Medicine, Turkey.
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Sogut A, Acun C, Aydin K, Tomac N, Tomsac N, Demirel F, Aktuglu C. Isovaleric acidaemia: cranial CT and MRI findings. Pediatr Radiol 2004; 34:160-2. [PMID: 14534755 DOI: 10.1007/s00247-003-1049-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 07/22/2003] [Accepted: 07/29/2003] [Indexed: 10/26/2022]
Abstract
Isovaleric acidaemia is an inborn error of leucine metabolism due to deficiency of isovaleryl-CoA dehydrogenase, which results in accumulation of isovaleric acid in body fluids. There are acute and chronic-intermittent forms of the disease. We present the cranial CT and MRI findings of a 19-month-old girl with the chronic-intermittent form of isovaleric acidaemia. She presented with severe metabolic acidosis, hyperglycaemia, glycosuria, ketonuria and acute encephalopathy. Cranial CT revealed bilateral hypodensity of the globi pallidi. MRI showed signal changes in the globi pallidi and corticospinal tracts of the mesencephalon, which were hypointense on T1-weighted and hyperintense on T2-weighted images.
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Affiliation(s)
- Ayhan Sogut
- Department of Paediatrics, Karaelmas University, Zonguldak, Turkey
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Demirel F, Ozer T, Gürel A, Acun C, Ozdemir H, Tomaç N, Unalacak M. Effect of iodine supplementation on goiter prevalence among the pediatric population in a severely iodine deficient area. J Pediatr Endocrinol Metab 2004; 17:73-6. [PMID: 14960024 DOI: 10.1515/jpem.2004.17.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated goiter status and urinary iodine excretion (UIC) of 304 school-children (7-12 years old) 3 years after a law was passed for mandatory production of iodinated salt in an area previously characterized by severe iodine deficiency in Zonguldak, a mountainous city in the West Black Sea region in Turkey. We examined all the children for goiter by palpation, measured sonographic thyroid volumes (STV) and UIC. Eighty-two percent of families had been using iodinated salt. UIC was above 100 microg/l in 71.2% of the children and median UIC was sufficient (143.5 microg/l). The prevalence of goiter was lower at ultrasound (14.6%) than by palpation (19.4%). Median STV values were within recommended normal limits at all ages. Although Zonguldak had been a highly endemic region, it became mildly endemic 3 years after mandatory iodination of salt, with decrease of goiter prevalence.
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Affiliation(s)
- Fatma Demirel
- Department of Pediatrics, Karaelmas University School of Medicine, Zonguldak, Turkey.
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