Placenta, Secret Witness of Infant Morbidities: The Relationship Between Placental Histology and Outcome of the Premature Infant

Objective: The microscopic and macroscopic features of the placenta can contribute to the clinical understanding of premature delivery. The aim of our study was to figure out the relationship between the histopathological findings of the placentas of premature deliveries and its effects on neonatal morbidity and mortality. Material and Method: The placentas of 284 singleton preterm infants with <35 weeks of gestation were examined. three groups created as the normal, chorioamnionitis and vasculopathy according to histopathological findings in placentas subjects. Results: The mean gestational age of the infants in the study group was 30.5 ± 3.2 weeks, and the mean birth weight was 1588 ± 581 g. The pathology was normal in ninety-six (33.8%), vasculopathy in 153 (53.9%) and chorioamnionitis in 35 (12.3%). The gestation age of the infants was lower in the chorioamnionitis group. Moreover, retinopathy of prematurity, early onset neonatal sepsis, and duration of respiratory support were found to be higher in the chorioamnionitis group. In the vasculopathy group, preeclampsia and small for gestational age were found to be significantly higher. Conclusion: Histopathological findings of the placentas from preterm deliveries provided important data in determining the etiology of preterm delivery and outcomes of infants. Infants delivered by mothers with chorioamnionitis were particularly found to be more preterm, and these preterm infants would have a longer hospital stay, higher respiratory support requirement, and more serious morbidities

Malformations and Neonatal Problems in Babies of Mothers with Epilepsy: What are the Possible Problems in Women with Epilepsy during Pregnancy?

Objectives:This study aims to investigate the effects of epilepsy and its treatment on maternal and fetal outcomes during pregnancy. Methods: This study was designed as a retrospective observational case-control study. One hundred sixty-nine pregnant women (PW) and their newborns were included. The study group consisted of PW with epilepsy (PWWE)(mean age: 27.6 years; n=89), and the control group comprised PW without epilepsy (mean age: 27.5 years; n=80). Results:In the PWWE, unintended pregnancy was found to be higher (p<0.001). Pregnancy complications and cesarean incidence were higher in the PWWE than in the control group. Time of birth was significantly earlier in the PWWE (p<0.01). No significant difference was found between the groups concerning birth weight, height, sex of infants, and the incidence of birth complications. In the postpartum sixth week visit, all mothers in the control group were nursing their infants, whereas 11.4% of the PWWE were not nursing their infants (n=10) (p<0.05). During the study, two mothers, and one baby with severe malformation died. The prevalence of major congenital malformations (MCMs) was found as 0% in the drug-free group, 5.7% in the mono therapy group, and 8.3% in the polytherapy group, respectively. Conclusion:Although the majority of the mothers with epilepsy have a healthy pregnancy and healthy baby, we found that the mortality rate and risk of experiencing serious problems in the perinatal and postnatal period were higher compared with the controls. Neonatal disorders and congenital malformations were more common in these infants. It is important that these patients should be followed up closely during the pre-conception, pregnancy, and postpartum periods, and infants should be followed up in tertiary neonatal intensive care units when necessary

Exhaled carbon monoxide levels and demographics of water-pipe smoking young at outdoor areas of water-pipe smoking cafes, in Ankara.

Background: Water-pipe smokers are exposed to several toxicants, including carbon monoxide (CO), causing potential health effects. Objectives: The aim of the study was to investigate demographic features and exhaled CO levels of water pipe smoking (WPS) young. Methods: The study was implemented at the outdoor areas of WPS cafes, in Ankara, in August. Demographic characteristics and exhaled CO levels of young were detected before and after one hour of WPS. Findings:. Mean exhaled CO levels before and after WPS were 1.4±1.2 ppm (min 0.1-max 5.6) and 9.4±5.3 ppm (min 3-max 25), respectively (p=0.001). Males and cigarette smokers had higher mean exhaled CO levels, before WPS (p=0.033 and p=0.001, respectively). A significant correlation was detected between duration of WPS and with exhaled CO levels before (p=0.005, r=0.363) and after WPS (p=0.039, r=0.270). In association with the rise in daily number of cigarettes, a rise in exhaled CO levels was detected after WPS (p=0.044, r=0.383). Conclusions: In Ankara, nearly half of WPS young are also cigarette smokers, are mostly students or unemployed, and WPS is perceived as a social event. Mean post-WPS levels were lower compared to previous studies, because study was conducted in the open and non-polluted air. Males, cigarette smokers and longer years of WPS practice are associated with higher mean exhaled CO levels, suggesting that these groups are subject to more health detriment risks caused by CO exposure. Large cohort studies, especially targeting high-risk groups are needed in understanding how to curb WPS and take environmental and policy controls

The Evaluation Of The Effects Of Passive Smoking On Children's Health With Detection Of Urine Cotinine Levels

Background: Passive smoking exposure is an important public health problem that causes pneumonia, bronchiolitis, bronchopneumonia, asthma formation and exacerbation, middle ear inflammation, tooth decay, growth retardation and development in children.Objectives: In this study, it was aimed to evaluate passive smokers objectively by cotinine level in urine.Method: Eighty children with at least one active smoker at home and 80 children who were not active smoker at home were admitted to the Ankara Education and Research Hospital . Parents were asked a questionnaire to the sociodemographic characteristics of their children and their families, the habits of smoking and the illnesses they had in a year. To assess passive smoking exposures, the first urine of children was collected and the level of cotinine, the main metabolite of nicotine in the urine, was measured using the solid phase competitive chemiluminescence immunoassay method on the Immulite 2000 Analyzer. A cut-off value of 10 ng / ml was obtained for diagnosis of passive smoking. Patients with cotinine levels above this value were assessed as "exposed to passive smoking".Results: In passive smoking exposures, the number of illnesses and wheezing has increased in the last year. The preterm birth and wheezing frequency of the smokers were significantly higher in the pregnant women (p &lt;0, 05). Median cotinine level was found to be 10 ng / ml in the passive smoking group but median cotinine level was found to be 20,8 ng / ml in the cigarette group (p &lt;0,01). The group with only mother smokers had significantly increased incidence of tooth decay compared with other groups (p &lt;0.05). No relationship was found between birth weigth of infant and smoking behaviour during pregnancy (p=0,53), however the frequency of prematurity was found to be higher  (p=0.03).The cotinine level of 68.7% of patients in the passive smoking group and 25% of the control group was above the threshold value of 10 ng / ml. The most sensitive and specific threshold level of cotinine was found as 14.75 ng/ml. Conclusions: Our study showed that 25% of children who do not smoke at home are exposed to passive smoking. This finding suggests that families are biased towards reporting smoking cessation alongside their sick children and those children are also exposed to cigarette smoke in out-of-home settings

Aquired cytomegalovirus ınfection of extremely low birth weight ınfant

Anne sütü, özellikle prematürelerde kazanılmış sitomegalovirüs (CMV) enfeksiyonu için majör kaynaktır ve anne sütünden kazanılan CMV enfeksiyonu seropozitif anne bebeklerinde görülmektedir. Türkiye’de annelerin çoğunluğunun seropozitif olmasına karşın prematüre bebeklerde yaşamı tehdit eden akkiz CMV enfeksiyonu yalnızca vaka sunumları şeklinde çok az olguda bildirilmektedir. Preterm semptomatik anne sütü kaynaklı CMV enfeksiyonunun tedavisi klinik bulguların ağırlığına göre yapılmalıdır. Postnatal 111. gününde menenjit-sepsis tanısı alan, anne sütünden kazanılan CMV enfeksiyonu tanımlanan ancak yaşamı tehdit eden çoklu organ yetmezliği gelişmemesi nedeniyle antiviral tedavi verilmeyen prematüre bir bebek literatür bilgileri eşliğinde sunulmuştur. Preterm bebeklerde etken saptanmayan sepsis kliniği, açıklanamayan trombositopeni, karaciğer enzim yüksekliği ve direkt bilirübinemi varlığında kazanılmış CMV enfeksiyonu akla getirilmelidir.Breast milk is a major source for acquired cytomegalovirus infection especially in premature infants and acquired CMV infection occurs in infants whose mothers were seropositive for CMV. Although most of mothers of premature infants are seropositive in Turkey, acquired life-threatening breast milk acquired CMV infection was reported occasionally. Treatment of preterm with symptomatic breast milk acquired CMV infection should be done according to the severity of clinical signs. In this report, a preterm case with a diagnosis of breast milkacquired CMV meningitis and sepsis without multiorgan failure on the 111th day of life, who did not require antiviral therapy was presented and discussed in the context of the acquired CMV literature. In preterm babies, when there is sepsis with no apparent causes, unexplained thrombocytopenia, elevated liver transaminases and direct hyperbilirubinemia acquired CMV infection should be suspected

Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return

Total anomalous pulmonary venous return (TAPVR) is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT) associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio

Neonatal Resuscitation Practices in Turkey: A Survey of the Turkish Neonatal Society and the Union of European Neonatal and Perinatal Societies

Objective: Optimal care in the delivery room is important to decrease neonatal morbidity and mortality. We aimed to evaluate neonatal resuscitation practices in Turkish centers. Materials and Methods: A cross-sectional survey consisted of a 91-item questionnaire focused on delivery room practices in neonatal resuscitation and was sent to 50 Turkish centers. Hospitals with <2500 and those with ≥2500 births/year were compared. Results: In 2018, approximately 240 000 births occurred at participating hospitals with a median of 2630 births/year. Participating hospitals were able to provide nasal continuous-positive- airway-pressure/high-flow nasal cannula, mechanical ventilation, high-frequency oscillatory ventilation, inhaled nitric oxide, and therapeutic hypothermia similarly. Antenatal counseling was routinely performed on parents at 56% of all centers. A resuscitation team was present at 72% of deliveries. Umbilical cord management for both term and preterm infants was similar between centers. The rate of delayed cord clamping was approximately 60% in term and late preterm infants. Thermal management for preterm infants (<32 weeks) was similar. Hospitals had appropriate equipment with similar rates of interventions and management, except conti nuous-positive-airway-pressure and positive-end-expiratory-pressure levels (cmH2O) used in preterm infants (P = .021, and P = .032). Ethical and educational aspects were also similar. Conclusions: This survey provided information on neonatal resuscitation practices in a sam- ple of hospitals from all regions of Turkey and allowed us to see weaknesses in some fields. Although adherence to the guidelines was high among centers, further implementations are required in the areas of antenatal counseling, cord management, and circulation assessment in the delivery room