Evaluation of premature newborn with patent ductus arteriosus

Prematüre bebeklerde, önemli soldan sağa şanta neden olan patent duktus arteriozus (PDA), artmış neonatal morbidite ve mortalite ile ilişkilidir. Bu çalışmada, hastanemiz yenidoğan yoğun bakım ünitesinde izlenen ve PDA tanısı alan prematüre bebekler özellikle PDA boyutunun prognoza etkisi açısından geriye dönük olarak değerlendirildi. GEREÇ ve YÖNTEM: 2005-2009 yılları arasında Adnan Menderes Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesi'nde toplam 407 prematüre bebek izlendi ve 33 bebekte hemodinamik olarak anlamlı PDA saptandı. PDA tanısı alan bebeklerin demografik verileri, klinik bulguları, tedaviye yanıtları ve gözlenen komplikasyonlar incelendi. BULGULAR: Ortalama gebelik yaşı 30,1±2,8 hafta ve ortalama doğum ağırlığı 1602±553 g idi. Prematüre bebeklerde semptomatik PDA %8,1 sıklıkta saptandı. Olguların %27'sinde PDA spontan kapandı (hepsinde PDA 2,5 mm'nin altındaydı). 24 bebeğe ibuprofen(19 intravenöz, 5 per oral) verildi, 13' ünde (%54) kapanma gözlendi. Cerrahi ligasyon, semptomatik PDA'lı olguların %12'sinde gerekti. PDA <2,5 mm olanlarda ligasyon gerekmedi, PDA ≥2,5 mm olanların %24'üne ligasyon uygulandı. Ligasyon yapılan bir olguda şilotoraks ve bir olguda da lokal enfeksiyon gözlendi. SONUÇ: Bu çalışmada PDA tanısı alan prematüre bebeklerin klinik izlemlerine etki eden faktörler incelenmiştir. PDA çapı <2,5 mm olanlarda prognozun daha iyi olduğu gözlenmiştir.OBJECTIVE: Patent ductus arteriosus (PDA) with significant left to right shunt is related to increased neonatal morbidity and mortality in premature babies. In this retrospective study, premature newborns with PDA followed in our unit were evaluated especially with regard to effect of PDA diameter on the outcome. MATERIALS and METHODS: Premature babies (n=407; gestational age <37 weeks) followed in Adnan Menderes University Faculty of Medicine NICU between years 2005-2009 were included in the study. Thirtythree of them with haemodynamically significant (hs) PDA were determined. Demographic data, clinical features, respond to therapy and complications were investigated. RESULTS: Mean gestational age was 30.1±2.8 weeks and mean birth weight was 1602±553 g. Symptomatic PDA incidence among premature babies was 8.1%. Spontaneous closure was observed in 27% of the cases (all had ductus diameter of <2.5 mm). Twenty-four babies were given ibuprofen (19 intravenously, 5 per oral), closure was obtained in 13 cases. Success rate of ibuprofen therapy was 54%. Surgical ligation was needed in 12% of the cases. None of the cases with <2.5 mm PDA required surgery, whereas surgical ligation was performed in 24% of cases with ≥2.5 mm PDA. Local infection in one case and chylothorax in another case were seen as surgical complications. CONCLUSION: Factors affecting the clinical outcome of premature infants suffering from PDA were investigated in this study. Better prognosis was seen when ductus diameter is <2.5 mm

Rare Birth Defects in Pregnancies of Women with Pregestational Diabetes: Absent Radius

Diabetes mellitus (DM) is an important disease that negatively affects fetal development and women with pregestational diabetes have an increased risk for adverse pregnancy outcomes, including a markedly increased risk for birth defects. In this report, a newborn with absent radius associated with pregestational diabetes was presented. A male newborn was born at 40th gestational week from a 20-year-old mother by cesarean section. The patient had shortness in the limbs, hypoplastic right thumb and flexion contracture at his right hand besides respiratory distress.To our knowledge, with this case report, we would like to share the second case of diabetic mother's infant with absent radius in the literature

A 22 q11.2 deletion case with multiorgan failure

The 22q11.2 deletion syndrome is a genetic disorder seen inone out of every 4,000-6000 live births. The effects of the deletion can include a variety of physical findings, such as heart problems, cleft palate, facial dysmorphism, tymic hypoplasia, hypocalcemia, immune deficiency, developmental issues, including learning difficulties. The case was the second born child of 33 year old healthy mother by Caesarian section at 37 weeks of gestation. Birth weight of the baby girlwas 3400 g. She was referred to our unit on her first day due to respiratory distress. She had diffuse edema, cutis marmoratus and low set ears. Her oral orifice was small and the mouth was pulled downward on one side while crying. She was tachypneic, grunting. She had cyanosis, retractions, nasal flaring and hepatomegaly. Femoral pulses were weak. She had hypocalcemia, metabolic acidosis, hyperuricemia, hyperkalemia, abnormal renal function tests. Thymic shadow was absent on chest x-ray. Thrombocytopenia and giant thrombocytes were seen on peripheral blood smear. PTH level was normal. Interrupted aortic arch type-B was detected by echocardiographic examination and prostoglandin infusion was started. 22q11.2 deletion was detected by FISH examination. Interrupted aortic arch cases may be present with metabolic acidosis, edema, hepatomegaly and multiorgan failure during newborn period. 22q11 deletion should be considered in interrupted aortic arch cases with accompanying features such as characteristic facial appearance, thymic aplasia, hypocalcemia, giant thrombocytes and surgical team should be informed

Highlights for the Research Involving the Lactation Period in Laboratory Rats

Lactation is an important period in newborn nutrition since nutritional factors in the early stagesof development have life-long impacts. Lactation provides various important long-lasting healthbenefits to the offspring. The lactation period, however, provides much more than just nutrients.The composition and quantity of nutrients in breast milk are not the only factors that can influence offsprings during breastfeeding. Maternal behaviors to nourish and protect her litters during lactation are also important in programing. The current study attempted to focus on specificcharacteristics of the breastfeeding period, such as changes in food consumption, mother’sweight, and the time dams spend lactating with or without pups. A deeper understanding of thiscritical period will allow for designing better pediatric models including maternal separation, artificial rearing, and studies covering maternal manipulations.Keywords: Lactation period, maternal care, milk, mother rats, newborn&nbsp;</p

Surfactant Protein D as a Novel Therapy for Periventricular Leukomalacia: Is It the Missing Piece of the Puzzle?

Activation of microglia with an inflammatory insult, which plays a central role in periventricular leukomalacia (PVL), results in premyelinating oligodendrocyte death via release of certain cytokines, reactive oxygen and nitrogen species. Toll-like receptor (TLR) 4 is necessary for lipopolysaccharide (LPS) induced oligodenrocyte injury in the CNS. Having an ability to bind TLR 2, 4, and LPS receptor CD14, surfactant protein D (spD) may be a promising agent to counteract the pathways associated with PVL. Supplementation of surfactant treatment with spD may be the key point in prevention of PVL by supression of inflammation and preventing damage to pre-OLs in a vulnerable premature brain operating through TLRs

Impact of Maternal Ketogenic Diet on NLRP3 Inflammasome Response in the Offspring Brain

The effects of maternal diet on the neuroimmune responses of the offspring remain to be elucidated. We investigated the impact of maternal ketogenic diet (KD) on the NLRP3 inflammasome response in the offspring’s brain. C57BL/6 female mice were randomly allocated into standard diet (SD) and ketogenic diet (KD) groups for 30 days. After mating, the presence of sperm in the vaginal smear was considered day 0 of pregnancy, and female mice continued their respective diets during pregnancy and the lactation period. Following birth, pups were further allocated into two groups and given either LPS or intraperitoneal saline on postnatal (PN) days 4, 5 and 6; they were sacrificed on PN11 or PN21. Neuronal densities were significantly lower globally in the KD group when compared to the SD group at PN11. Neuronal density in the prefrontal cortex (PFC) and dentate gyrus (DG) regions were also significantly lower in the KD group when compared to the SD group at PN21. Following administration of LPS, the decrease in the neuronal count was more prominent in the SD group when compared to the KD group in the PFC and DG regions at PN11 and PN21. NLRP3 and IL-1β were higher in the KD group than in the SD group at PN21 in the PFC, CA1 and DG regions, and were significantly lower in the DG region of the KD group especially when compared to the SD group following LPS. Results of our study reveal that maternal KD negatively affects the offspring’s brain in the mouse model. The effects of KD exhibited regional variations. On the other hand, in the presence of KD exposure, NLRP3 expression after LPS injection was lower in the DG and CA1 areas but not in the PFC when compared to SD group. Further experimental and clinical studies are warranted to elucidate the molecular mechanisms underlying the impact of antenatal KD exposure and regional discrepancies on the developing brain