Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

PREGNANCY IN CANCER SURVIVORS; EXPERIENCE OF A SINGLE TERTIARY CENTER

Objective: To investigate obstetric and perinatal outcomes among pregnant female survivors of adolescent and young adult cancers

How do platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio change in women with preterm premature rupture of membranes, and threaten preterm labour?

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.The aim of the study was to investigate peripheral blood platelets, neutrophils and lymphocytes counts in women with preterm premature rupture of membranes (PPROM) and threatened preterm labour (TPL) compared with gestation-matched controls in order to learn how they change. This study was conducted on 60 women with PPROM, 50 women with TPL and 47 healthy pregnant women. Laboratory parameters (including complete blood count, C-reactive protein (CRP)) of all the participants were recorded. The neutrophil-to-lymphocyte ratio (NLR) values were significantly higher in PPROM group than TPL group and healthy control group (6.1 ± 3.9, 4.4 ± 1.7, 4.4 ± 2.2, p =.007, p =.018, respectively). At a cut-off level of 5.14, NLR accurately predicted occurrence of neonatal sepsis (AUC = 0.717 (95% confidence interval 0.610–0.824), p =.001) with sensitivity and specificity rates of 69.7% and 72.0%, respectively. In the management of the patients with PPROM, NLR can be used as a more cost-effective method than other blood parameters that require the use of a kit.IMPACT STATEMENTWhat is already known on this subject? There is only one study in the literature evaluating blood count parameters (such as platelet-to-lymphocyte ratio (PLR), NLR) in PPROM pregnancies. That study demonstrated PLR and NLR were both higher in the PPROM group. What do the results of this study add? The present study demonstrates that only NLR is higher in the PPROM group. Furthermore, we have also demonstrated distinctively that NLR can predict occurrence of neonatal sepsis. What are the implications of these findings for clinical practice and/or further research? High values of NLR may be useful for predicting adverse outcomes in PPROM and TPL patients as a cost-effective method. Further studies are needed to determine whether these parameters can be used to predict if a pregnant woman who is at risk of preterm labour will result in adverse perinatal outcome

Modified myocardial performance index and its prognostic significance for adverse perinatal outcome in early and late onset fetal growth restriction

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.Objective: To compare the fetal modified myocardial performance index (Mod-MPI) in appropriately grown, early (EO) and late onset (LO) fetal growth restricted (FGR) fetuses and to assess its prognostic significance for adverse perinatal outcome. Study design: In a prospective case-control study, Mod-MPI was performed in 22 and 51 fetuses with EO and LO-FGR fetuses, respectively. Mod-MPI values of FGR fetuses were compared against gestation-matched controls (34 for EO-, and 32 for LO-FGR, respectively). Correlation testing related with poor perinatal outcomes were performed. Results: Incidences of pathologic uterine artery Doppler rate, cesarean section rate, 5-min Apgar score < 7, neonatal intensive care unit (NICU) admission and perinatal mortality were significantly higher in the EO-FGR group (p <.001). There was a decrease in Mod-MPI with gestational age in the normal (Pearson’s r = 0.401, p <.001), and growth-restricted fetuses (Pearson’s r = 0.248, p =.034). Mean Mod-MPI values were significantly higher in both EO- and LO-FGR group than gestation-matched controls (p <.001). There was no significant correlation between Mod-MPI values and perinatal deaths (Pearson’s r = 0.004, p =.987) and 5-min Apgar score < 7 (Pearson’s r = 0.391, p =.088) in the EO-FGR fetuses. There was a significant negative correlation between Mod-MPI values and cerebroplacental ratio (CPR) values (Pearson’s r = −0.288, p =.041); however no significant correlation between Mod-MPI values and 5-min Apgar score< 7, and fetal distress during labor (Pearson’s r = 0.149, p = 0.297) in the LO-FGR fetuses was noted. Conclusion: EO and LO-FGR fetuses have significantly higher Mod-MPI values, demonstrating prenatal cardiac dysfunction. Evaluating Mod-MPI is not so effective in predicting poor perinatal outcome in both EO and LO-FGR fetuses

Fetal cerebral and cardiac hemodynamics in postdate pregnancy

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.Objective: We aimed to determine the fetal cerebro-placental Doppler indices and modified myocardial performance index (Mod-myocardial performance index (MPI)) in this homogenous group of postdated pregnancies. Methods: A total of 92 singleton pregnant women were included in this prospective study. The study involved three groups; full term control (Group 1, n = 42, 39 0/7 to 40 6/7 week’ gestation), late term (Group 2, n = 34, 41 0/7 to 41 6/7 week’ gestation) and post term (Group 3, n = 16, ≥ 42 0/7 weeks’ gestation). Each participant underwent a Doppler assessment of the fetal umbilical artery (UA), middle cerebral artery (MCA), Mod-MPI. We determined the correlation of the Doppler indices and mod-MPI in patients with unfavorable outcome. Results: MCA pulcatility indices (PI), cerebroplacental ratio (CPR) values were significantly higher in the control group than those in the late-term and post-term groups (Group 1: 1.63 ± 0.3, Group 2: 1.27 ± 0.51, Group 3: 1.13 ± 0.22, respectively, p <.001). The Mod-MPI was significantly higher in the late-term and post-term groups than in the control group (Group 1:0.38 ± 0.1, Group 2: 0.59 ± 0.09, Group 3: 0.60 ± 0.08, respectively, p <.001. MCA PI and CPR were only significantly lower in patients with unfavorable outcome). The threshold value for CPR levels for predicting unfavorable outcome in postdate pregnancies was calculated as 1.11 (area under curve [AUC] 0.762, confidence interval [CI] 0.575–0.95) with 72.7% sensitivity and 71.8% specificity. Conclusions: Fetal Mod-MPI does not differ in postdate pregnancies with favorable and unfavorable outcome. The monitorization of fetal well-being with CPR may help to clinicians to select patient for expectant management in postdate pregnancies

PREGNANCY OUTCOMES OF 115 CASES WITH MATERNAL HEART DISEASE

Objective: To evaluate the outcomes of pregnancies with maternal heart disease

Fetal left ventricular modified myocardial performance index and renal artery pulsatility index in pregnancies with isolated oligohydramnios before 37 weeks of gestation

Objective: The aim was to evaluate fetal left modified myocardial performance index (Mod-MPI) and renal artery Doppler parameters in fetuses with isolated oligohydramnios and a normal amount of amniotic fluid

BREAST CANCER DURING PREGNANCY: THE OBSTETRIC AND PERINATAL OUTCOMES OF 11 CASES

Objective: The aim of this paper is to present 11 cases of patients diagnosed with breast cancer during pregnancy and their perinatal outcomes

Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey

Purpose To evaluate the distribution and the obstetric outcomes of pregnancies with different types of rheumatic diseases managed in our unit