Can the Side Effects of Mydriatics Be Reduced with the ROP-bundle Protocol?

Aim:The mydriatics that used for pupil-dilation in the examination of retinopathy-of-prematurity (ROP) may cause some side-effects in the neurological, gastrointestinal, cardiovascular systems by absorption from the nasal mucosa, cornea, conjunctiva, skin. In order to minimize these side-effects, it’s recommended to prepare mydriatics in appropriate concentrations, combinations, and to apply pressure on the naso-lacrimal canal by closing the eyes after the application. In this study, we aimed to evaluate the systemic side-effects in the early period of using 0.5% cyclopentolate-1% phenylephrine combination for pupil-dilatation before the ROP-examination and with the protocol we applied after drip in our unit.Materials and Methods:Thirty-three ROP examinations of 17 cases were included in the study, which was planned retrospectively. After instillation of eye drops containing 0.5% cyclopentolate-1% phenylephrine combination in accordance with our ROP-bundle-protocol, the eye was closed, pressure was applied to the naso-lacrimal canal for 1-2 minutes, and the excess part that had leaked into the skin was wiped off. Oxygen saturation (SaO2), the amount of oxygen given, blood pressure arterial (TA), heart rate were recorded before and after the drop at 10., 30., and 60. minutes. In addition, patients were followed up for 24 hours in dimensions of gastric-residue, distention, apnea and other side-effects.Results:The mean-week of gestation, body weight of 17 newborns, 35.3% (6) of whom were boys, 64.7% (11) of girls, were found to be 27.6±3 weeks, 1025±389 g, respectively. In 33 evaluations made before and after mydriatic in 17 cases; distension developed in two cases, apnea in one, and pallor of the skin in one patient. Although there was a statistically significant difference only in SaO2 and 60th minute systolic TA-measurements between pre- and post-treatment measurements, hemodynamic changes were not evaluated as clinically significant.Conclusion:In-order-to reduce the side-effects that may develop due to mydriatics, it’s necessary to standardize the practices before and after the ROP-examination, close follow-up of the cases after the ROP-examination in terms of early intervention

A Newborn with Congenital Mixed Phenotype Acute Leukemia After In Vitro Fertilization

Congenital leukemia is a rare disease. The majority of cases of this disease are acute myelogenous leukemia (AML). Congenital acute lymphoblastic leukemia (ALL) is rare and most often is of B cell lineage. Rarely, some cases have been designated biphenotypic or mixed phenotype acute leukemia (MPAL). Herein, we report a preterm newborn referred to us as a result of the appearance of blue-violaceous dermal nodules on her body at birth. She was a twin and the product of an in vitro fertilization (IVF) pregnancy. Physical examination showed jaundice, hepatosplenomegaly, and peripheral facial nerve palsy in addition to dermal nodules. Bone marrow aspiration showed 40% blasts of lymphoid lineage; skin biopsy and its immunohistochemistry revealed myeloblastic infiltration of the dermis. Cytogenetic analysis (46,XX), fluorescence in situ hybridization (FISH) analysis, and cranial magnetic resonance were normal. The patient was diagnosed with congenital MPAL, and an association between IVF and congenital leukemia was suggested

Congenital arterial thrombosis in newborn: A case report

Neonatal thrombosis is a serious event that can cause mortality or severe morbidity. Although catheters are the most common cause of neonatal thrombosis, spontaneous events can also occur. Arterial thrombosis is very rare and accounts for approximately half of all thrombotic events in neonates. Genetic prothrombotic risk factors may affect the occurence of neonatal thrombosis. In this report, a case of left brachial, radial, and ulnar arterial thrombosis associated with methylene-tetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphism heterozygosity is presented. Plasma homocysteine level and other prothrombotic components were normal. Standard heparin, aspirin, vitamin B12, B6 and folic acid were initiated for treatment. However, the left arm of the patient was amputated at the shoulder because its capillary stream could not be observed. We suggest that MTHFR gene C677T and A1298C polymorphism heterozygosity might be investigated in neonates with congenital arterial thrombosis in spite of normal serum homocysteine levels. © Trakya University Faculty of Medicine

Protective effects of carnosine, ginkgo biloba extract and clarithromycin on gastrointestinal system and oxidative stress and effect of clarithromycin on bacterial translocation in rats with hypoxia/reoxygenation-induced intestinal injury

Nekrotizan enterokolit (NEK), özellikle prematüre yenidoğanları etkileyen önemli bir gastrointestinal sorun ve prematürelerin önemli morbidite ve mortalite nedenidir. Bu çalışmada sıçan yavrularında hipoksi?reoksijenizasyon (H/R) modeli uygulanarak oluşturulan intestinal hasarda, H/R'den önce proflaktik uygulanan karnozin, ginkgo alkaloidi (EGb 761) ve klaritromisinin koruyucu etkileri araştırıldı. Bir günlük 35 adet Wistar albino türü sıçanlar randomize olarak kontrol, NEK, karnozin+NEK, EGb 761+NEK ve klaritromisin+NEK olmak üzere beş gruba ayrıldı. Karnozin+NEK, EGb 761+NEK ve klaritromisin+NEK gruplarına günlük olarak sırasıyla karnozin (250 mg/kg, ip), EGb 761 (100 mg/kg, po) ve klaritromisin (40 mg/kg, sc) üç gün süreyle verildi. Dördüncü günde, kontrol grubu dışındaki tüm sıçanlar hava geçirmez kapalı bir ortamda, önce 5 dk süreyle %100 CO2, hemen ardından 5 dk %100 oksijen solutularak, H/R yöntemiyle NEK modeli oluşturuldu. H/R'den en az 4 saat sonra tüm sıçanlar dekapite edildi. Histopatolojik ve biyokimyasal incelemeler için barsak doku örnekleri alındı. Barsak doku örneklerinden biyokimyasal olarak malonildialdehid (MDA), nitrik oksit (NO), catalase (CAT), glutatyon peroksidaz (GSH-Px) ve glutatyon (GSH) düzeyleri ölçüldü. Bakteriyel translokasyonu değerlendirmek için kontrol, NEK ve klaritromisin+NEK gruplarından steril olarak kan, mezenterik lenf nodu, karaciğer, dalak ve gayta kültürleri alındı. Çalışma sonunda, histopatolojik olarak en ağır hasarlanmanın NEK grubunda olduğu, karnozin ve klaritromisinin NEK'e karşı histopatolojik olarak belirgin koruyucu olduğu, ancak EGb 761'in etkisiz olduğu saptandı. Barsak dokusunda MDA ve NO düzeylerinin NEK'te belirgin arttığı, buna karşın GSH ve GSH-Px aktivitesinin belirgin azaldığı görüldü. Karnozin ve klaritromisinin MDA ve NO düzeylerini belirgin azalttığı, GSH-Px aktivitesini belirgin arttırdığı, ayrıca karnozinin GSH düzeyini de arttırdığı saptandı. EGb 761 biyokimyasal olarak etkisizdi. Bakteriyel translokasyon bakımından gruplar değerlendirildiğinde; NEK grubunda kan, mezenterik lenf nodu ve gayta kültürlerindeki üremelerin anlamlı olduğu, klaritromisinin mezenterik lenf nodunda bakteriyel translokasyonu önlediği saptandı. H/R ve bakteriyel translokasyonun NEK gelişiminde önemli risk faktörleri olduğu, klaritromisin ve karnozinin NEK'e karşı belirgin koruyucu etkilere sahip oldukları, ancak EGb 761'in oral yolla etkisiz olduğu sonucuna varıldıNecrotizing enterocolitis (NEC) is the most common gastrointestinal disorder and cause of morbidity and mortality in premature newborns. In this study, the protective effects of carnosine, ginkgo biloba extract (EGb 761) and clarithromycin were investigated in rats with hypoxia/reoxygenation (H/R) induced intestinal injury. One day old, 35 wistar-albino rat pups were randomly divided into five groups as control, H/R (NEC), carnosine+NEC, EGb 761+NEC and clarithromycin+NEC. Carnosine (250 mg/kg/d, intraperitoneally), EGb 761 (100 mg/kg/d, orally) and clarithromycin (40 mg/kg/d, subcutaneously) were administered for three days. On day four, all rats except for control group were placed into a chamber of 100% CO2 for five min, then they were reoxygenized with 100% O2 for the next five min. All rats were killed at least four hour after the H/R. Intestine tissue samples (ITSs) were extracted for histopathological connective tissue score (CTS) and biochemical examination. The levels of malonyldialdehyde (MDA), nitric-oxide (NO), catalase (CAT), glutathione-peroxidase (GSH-Px) and glutathione (GSH) were measured on ITSs. Cultures of blood, mesenteric lymph nodes (MLNs), liver, spleen and cecal contents were taken from the groups of the control, NEC and clarithromycin+NEC for evaluation of bacterial translocation (BT). At the end of the study, the NEC group had the worst CTS. Carnosine and clarithromycin had histopathologically significant protective effect on intestinal injury (p0.05). The levels of MDA and NO of ITSs were significantly increased, whereas GSH and GSH-Px activities of them were significantly decreased in the NEC group. While carnosine and clarithromycin significantly decreased the levels of MDA and NO, they increased the activity of GSH-Px (p<0.05). In addition, carnosine also increased the level of GSH (p<0.05). EGb 761 was biochemically unaffective. Significantly increase in BT of MLNs, cecal contents and blood was determined in the NEC group when compared with control group. It was determined that clarithromycin significantly reduced the BT of MLNs in the NEC (p<0.05). In conclusion, H/R and BT are the most important risk factors for NEC. Clarithromycin and carnosine have protective effect on intestinal injury in NEC however EGb 761 given orally has no protective effec

The Effects of Resveratrol on Hyperoxia-induced Lung Injury in Neonatal Rats

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that causes significant morbidity and mortality in premature infants. Inflammation and oxidative injury play an important role in the pathogenesis of BPD. Resveratrol is an antioxidant and anti-inflammatory agent. In this study, the histopathological and biochemical effects of resveratrol on a hyperoxia-induced lung injury model in newborn rats were investigated. Methods: The experiment was performed on newborn rat pups from the 3rd to 13th postnatal day and they were randomly divided into four groups: Group 1 (air-exposed + saline, n = 10), Group 2 (air-exposed + resveratrol, n = 11), Group 3 (hyperoxia-exposed + saline, n = 6) and Group 4 (hyperoxia-exposed + resveratrol, n = 7). Resveratrol was administered (30 mg/kg/day) intraperitoneally. The histopathological effects of resveratrol on lung tissue were assessed by alveolar surface area, fibrosis, and smooth muscle actin (SMA) score, and the biochemical effects on lung tissue were assessed by glutathione (GSH), superoxide dismutase (SOD), nitric oxide (NO), tumor necrosis factor-α (TNF-α), and nuclear factor kappa B (NF-κB) levels. Results: The alveolar surface area, fibrosis, SMA score, and NO levels were found to be significantly higher in Group 3 compared with Group 1 (p < 0.05). In addition, it was found that resveratrol treatment significantly reduced the SMA score and the NO and TNF-α levels, and increased the GSH and SOD levels in the hyperoxia group (p < 0.05). Conclusion: This experimental study showed that oxidative stress and NO contributed to the pathogenesis of hyperoxia-induced lung injury, and that resveratrol had a preventive effect on hyperoxic lung injury through its anti-inflammatory and antioxidant properties

Caffeine prevents bilirubin-induced cytotoxicity in cultured newborn rat astrocytes

Objective: Unconjugated bilirubin (UCB) may cause neurotoxicity in preterm neonates due to immaturity of UGT1A1 leading to bilirubin accumulation in the brain. Caffeine used in the treatment of apnea of prematurity was reported to decrease mechanical ventilation requirement, the frequencies of bronchopulmonary dysplasia, patent ductus arteriosus, cerebral palsy and neurodevelopmental disorders in very low birth weight infants. However, the effect of caffeine on hyperbilirubinemia was not yet clarified. Methods: We used astrocyte cell cultures obtained from 2-day-old Wistar albino rats via modified Cole and de Vellis method. UCB concentration toxic to 50% of astrocytes, and caffeine concentration increasing cell viability 100% were used in experiments. While no medication was applied to the control group, UCB (50 μM) and caffeine (100 μM) were applied to the bilirubin and caffeine groups for 24 h. Prophylactic and therapeutic caffeine groups were treated with caffeine 4 h before and after UCB exposure. The effects of caffeine were investigated in rat astrocytes exposed to UCB in terms of cell viability, apoptosis, antioxidant defense, proinflammatory cytokines, and Toll-like receptor (TLR)s. Results: Compared to the control group, UCB increased apoptosis, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, total nitrate/nitrite, and TLR4 levels, and decreased cell viability, catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) activities, glutathione, and TLR9 levels (for all p <.001). Conversely, prophylactic and therapeutic caffeine improved the detrimental effects of UCB. Conclusions: Caffeine seems encouraging for the prevention and treatment of bilirubin neurotoxicity in rats by means of its antiapoptotic, antioxidant, anti-inflammatory, anti-nitrosative, and anti-TLR-4 properties. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group

The effects of bosentan on hyperoxia-induced lung injury in neonatal rats

Background: Bronchopulmonary dysplasia (BPD) remains an important cause of morbidity and mortality in premature infants. There is currently no proven effective treatment modality for BPD, and inflammation and oxidative injury play an important role in the pathogenesis of this disease. This study investigated the histopathological and biochemical effects of bosentan, which is a non-specific endothelin receptor antagonist with known antioxidant and anti-inflammatory properties, on hyperoxia-induced lung injury (HILI) in neonatal rats. Methods: The experiment was performed on newborn rats from the 3rd to the 13th postnatal day. The rats were randomly divided into six groups: Group 1 (air-exposed + saline, n = 6); Group 2 (HILI, n = 8); Group 3 (air-exposed + bosentan, n = 7); Group 4 (HILI + saline, n = 7); Group 5 (HILI + early bosentan-treated group, n = 6), and Group 6 (HILI + late bosentan-treated group, n = 7). Bosentan was administered (30 mg/kg/day) intraperitoneally. The histopathological effects of bosentan on lung tissue were assessed by their alveolar surface area, fibrosis, and smooth muscle actin (SMA) scores, and the biochemical effects on lung tissue were assessed by interleukin-1 beta (IL-1β), IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α). Results: The alveolar surface area and fibrosis scores were found to be significantly higher in HILI groups compared with Group 1 (P < 0.01). The SMA scores in HILI groups were also significantly higher than Group 1 (P < 0.01). Bosentan treatment, especially late therapy, reduced all of these histopathological scores and the levels of IL-6 and TNF-α in the hyperoxia groups (P < 0.01). Conclusion: This experimental study showed that bosentan had a protective effect on hyperoxic lung injury through its anti-inflammatory properties. © 2019 Japan Pediatric Societ

Fetal sodium valproate exposure causes Baller-Gerold syndrome phenotype: Both phenotypes in the same family

Baller-Gerold syndrome (BGS) is characterized by craniosynostosis and preaxial upper-limb malformations, and it has an autosomal recessive inheritance. Valproate syndrome occurs after exposure to valproic acid in utero, and is characterized by trigonocephaly. Both syndromes can also present with other malformations. Herein, we report a female newborn and her brother who both had a history of fetal exposure to maternal anti-epileptic drugs, especially sodium valproate. On physical examination of the female patient, craniosynostosis, trigonocephaly, right radius aplasia and hypoplastic thumb, and cardiac and renal malformations were determined, and she was diagnosed with BGS phenotype. The brother's examination revealed trigonocephaly, polymastia and hypospadias, and he was diagnosed with valproate syndrome. Based on these patients, we aimed to add further evidence in the literature indicating that the use of sodium valproate alone and in combination with other anti-epileptic drugs throughout pregnancy can increase the risk of serious fetal congenital malformations depending on the doses