A neonatal septic arthritis case caused by klebsiella pneumoniae: A case report

Septic arthritis is encountered very rarely during the neonatal period and its diagnosis can delay because of atypical symptoms, thus it may lead to serious sequelae. The sequale can be prevented by early diagnosis and concomitant treatment. In neonates, pain can be experienced as a result of pseudoparalysis and of movement of the effected joints. A 17-day-old neonatal patient was brought to our hospital with complaint of unrest and then diagnosed with septic arthritis due to propagation of Klebsiella pneumoniae in joint fluid culture was represented because of the rarity of such a case. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Subgroup incompatibility due to anti-E In newborn: two case reports

Yenidoğanın hemolitik hastalığı, maternal eritrosit antikorlarının fetus eritrositlerini direkt etkilemesi sonucu görülen ağır bir durumdur. Çoğunlukla Rh ve ABO uygunsuzluğuna bağlı görülmekle birlikte, nadiren subgrup uyuşmazlığı nedeniyle de karşımıza çıkabilir. Subgrup uyuşmazlığında, hafif hiperbilirubinemiden kan değişimine ihtiyaç gösterecek kadar ciddi hemolitik reaksiyonlar görülebilmektedir. Biz bu yazıda, anti-E’ye bağlı yenidoğanın hemolitik hastalığı gelişen iki olgu sunduk. Birinci olgu, doğumdan sonra yoğun fototerapi ve intravenöz immunglobulin (İVİG) ile tedavi edildikten sonra taburcu edildi. Otuz üç günlükken ağır anemi ve sarılık ile yeniden hastanemize başvuran hastaya eritrosit transfüzyonu, fototerapi ve İVİG tedavisi uygulandı. İkinci olgu, postnatal ikinci gün total bilirubin 21 mg/dL ile hastanemize sevkedildi. Yoğun fototerapi ve İVİG verilen olgunun izleminde hemoliz komplikasyonu gelişmedi.Hemolytic disease of newborn is a severe disease, resulting from maternal red blood cell (RBC) alloantibodies directed against fetal RBCs. This is mostly due to Rh (D), ABO incompatibility and also rarely due to subgroup incompatibility. Mild hyperbilirubinemia to severe hemolytic reactions requiring exchange transfusion therapy can occur in subgroup incompatibility. In this article, we report two patients who developed hemolytic disease of the newborn due to anti-E. Case 1 was treated with intensive phototherapy and IVIG immediately after birth. This case was readmitted to the hospital at 33rd day of life because of jaundice and severe anemia and treated with IVIG, phototherapy and erythrocyte transfusion. Case 2 was referred to our hospital at postnatal second day because of total bilirubin levels of 21 mg/dL. This case was also treated with IVIG, intensive phototherapy and no any complications of hemolysis developed during clinical follow up

Anne sütüyle beslenen yenidoǧanlarda hipernatremik dehidratasyon

Introduction: Since it can cause life-threatening complications in newborns, diagnosis and treatment of hypernatremic dehydration associated with inadequate breastfeeding is important. Materials and Methods: Records of exclusively-breastfed newborns (37-42 weeks) with hypernatremic dehydration (serum Na ≥ 150mEq/L) admitted between 2006 and 2012 were reviewed retrospectively. Results: The mean gestational age, birth weight, weight loss, maternal age, and age at diagnosis of 26 newborns with hypernatremic dehydration were 38.8±1.1 weeks, 3292±458 gr, 13.5±5.5%, 27.6±4.9 years, and 3.9±3.5 days, respectively. The percentages of female patients, caesarean delivery, and primipar mothers were 57.6%, 61.6%, and 57.6% respectively. Admission complaints were fever (30.7%), poor feeding and jaundice (26.9%), restlessness and hypoactivity (7.6%). Hypernatremic dehydration frequency within first five days, in summer season, during hospitalization were 84.6%, 73%, and 42.3%, respectively. The mean serum BUN, creatinine, Na levels were found 45.6±64.1 mg/dl, 1.5±2.3 mg/dl, and 157±11.9 mEq/L, respectively. Of 26 mothers, 57.6% had received breastfeeding education and 84% had inadequate fluid intake. Among four patients with seizures, three had prerenal failure, one had renal failure requiring dialysis, and brain edema developed in one. Serum Na levels were higher in infants who were baby of primipar mother (p=0.002), born in another hospital (p=0.012), from young mothers (p=0.035), from mothers with no breastfeeding education (p=0.007), and with delayed hospital admission (p<0.01). Serum Na concentrations ≥160mEq/L were associated with complications (p<0.01). Serum Na levels were negatively correlated with maternal age (p=0.035) and positively correlated with (p=0.016) weight loss. Conclusions: Hypernatremic dehydration can be prevented in newborns by close monitoring of weight loss and by teaching successful breastfeeding techniques and signs of dehydration to the mothers within first week. © The Journal of Current Pediatrics, published by Galenos Publishing

Prematüre Apnesinde Kafein Tedavisi: Geleneksel Derleme

Prematüre apnesi, yenidoğan yoğun bakım ünitelerinde prema- türe bebeklerde sıklıkla karşılaşılan bir durum olup, solunumun 15-20 sn’den daha fazla durmas ı ya da daha k ısa süreli solunum kesintisine oksijen satürasyon düşüklüğü ve/veya bradikardinin eşlik etmesi olarak tanımlanır. Gebelik haftas ı 28’in altında doğan bebeklerin hemen tü- münde apne görülürken, gebelik haftas ı büyüdükçe apne s ıklığı azal- maktadır. Prematüre doğumun getirdiği nörolojik immatürite ile birlikte apne nedeniyle araya giren hipoksemi ve bradikardi ataklar ı, bu be- beklerde nörolojik hasarlanma riskini artırmakta ve uzun dönemde; se- rebral palsi, gelişimsel koordinasyon bozukluğu, bilişsel ve davranışsal bozukluklar, bronkopulmoner displazi ve prematüre retinopatisi gibi önemli morbiditelere neden olabilmektedir. Bu nedenle prematüre be- beklerde apne tanısı ve tedavisi önem arz etmekte, apnenin farmakolo- jik tedavisinde de ilk tercih olarak bir metilksantin türevi olan kafein yer almaktadır. Kafein, yapısal olarak adenozine benzemekte ve etkisi doza bağımlı olarak başlıca adenozin reseptörleri üzerinden olmaktadır. Ka- fein, prematüre apnesinde adenozin ile baskılanmış medüller solunum merkezi inhibisyonunu ortadan kaldırmakta, gama aminobütirik asit sa- lınımını önleyerek sinirsel uyarılmayı artırmakta, santral sinir sistemi- nin kan karbondioksit düzeylerine hassasiyeti artırmakta, böylece apneli bebeklerde solunumu uyarmakta ve devaml ılığını sağlamaktadır. Bu derlemede, prematüre bebeklerde apne tedavisinde ilk tercih olan ka- feinin etkisi, kimlere, ne zaman, hangi dozda ve ne kadar süre kullan- mamız gerekti ğiyle ilgili bilgiler, son literatür bilgileri ışığında verilmeye çalışılmıştır

Yenidoǧanda işitme tarama programi ve yönetimi

Congenital hearing loss (CHL) is one of the most common neurologic birth defect in the world. Over the years, developments in technique and instrumentation have significantly and positively altered the direction, accuracy, and success of neonatal hearing screening program. In this program, Otoacoustic emission (OAE) testing and/or automated auditory brainstem response (ABR) testing is used; however, there are very important differences between the two tests. While OAE testing reflects the status of the peripheral auditory system extending to the cochlear outer hair cells, ABR testing reflects the status of the peripheral auditory system, the eighth nerve, and the brainstem auditory pathway. Current universal neonatal hearing screening statistics indicate an overall hearing loss rate of 1-3/1000 live birth and 1-6/100% in the neonatal intensive care units. CHL rate is also 2.2/1000 live births in our country. An undiagnosed or delayed diagnosed hearing impairment may have serious effect on a child's language, social, emotional, cognitive, academic, and vocational development, significantly affecting the child's quality of life. Assessment of hearing loss in children is very important because early identification and appropriate intervention of hearing loss results in better development and educational outcomes. For this reason, all newborns should be screened by appropriate screening program (OAE and/or ABR) within first month of life. Those who do not pass screening should have a comprehensive audiological evaluation at no later than three months of age, and infants with confirmed hearing loss should receive appropriate intervention at no later than six months of age. Copyright © 2017 by Türkiye Klinikleri

Macrodactyly and proteus syndrome

Macrodactyly is a rare congenital, nonhereditary malformation presenting as an increased size of one or several digits of the hands or feet. Proteus syndrome, consisting of various clinical manifestations, is a congenital hamartomatous syndrome involving many organ systems and characterized mainly by hemihypertrophy, macrodactyly, exostoses, pigmentary nevi and subcutaneous tumors. In rare cases, the clinical manifestations of Proteus syndrome may be limited to acral tissue hypertophy. We report a case with Proteus syndrome restricted macrodactyly of one hand. The differential diagnosis with macrodactyly and other hamartomatous overgrowth syndromes is discussed. Kaynaklar

Electrophysiological assessment of the brain function in term SGA infants

Small for gestational age (SGA) infants are defined as babies having a birth weight below the 10th percentile for gestational age. A great number of studies have shown that children with SGA have an increased risk of impaired neurodevelopment. Electroencephalography (EEG) is an excellent method for measuring brain maturation in newborns. In this study, the effect of SGA on the maturation of cerebrocortical electrographic activity was investigated by the EEG and also analyzed with power spectral analysis. Serial EEGs were performed in 40 term SGAs, and 20 term appropriate for gestational age (AGA) infants in 1st week, 1st and 3rd month. Power spectral analysis was performed quantitatively in five channels (Fp1-C3, C3-O1, Fp2-C4, C4-O2, and Cz-C4 channels). Amplitude levels of the SGA group were significantly lower than the AGA group in all records. Delta frequency was the major frequency component in the groups. Delta frequency activities in the midline vertex region were decreased in the AGA group with increasing postconceptual age while the activities of the SGA group were increased. Contrarily, beta frequency activities in the midline vertex region were increased in the AGA group with increasing postconceptual age while these activities of the SGA group were decreased. Theta frequency activities in the fronto-central regions were lower in the SGA group. In terms of the vertex, k-complex, and sleep spindle, there was no difference between the two groups. We conclude that cerebrocortical electrophysiological maturation has been delayed in term SGA infants during the first three months of postnatal life. © 2009 Elsevier B.V

A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy

Methyldopa is known to cause the production of autoantibodies against red blood cells (RBCs), leading to a positive direct antiglobulin test (DAT) and hemolytic anemia. In about 20% of patients taking methyldopa, IgG autoantibodies develop against RBCs. However, most of the patients do not have hemolysis. A small percentage of such DAT-positive patients, about 2% of those taking methyldopa, develop an autoimmune hemolytic anemia (AIHA). The fact that the DAT is positive in the newborn with unconjugated hyperbilirubinemia is considered as an isoimmune hemolytic disease caused by blood group incompatibility. In this article, a newborn with jaundice and positive DAT without hemolysis is reported. Her mother had the history of taking methyldopa in her pregnancy. Thus, when newborns are detected with positive DAT and jaundice, without blood group incompatibility, mothers should be questioned regarding drugs used in their pregnancy