Titration of betaine therapy to optimize therapy in an infant with 5,10-methylenetetrahydrofolate reductase deficiency

PubMed ID: 19434424Betaine therapy was given for 2 years to a 2- year-old boy with 5,10-methylenetetrahydrofolate reductase deficiency. Used as a methyl donor to lower homocysteine levels through methylation of methionine, betaine has been reported to be effective in treating homocystinuria. Satisfactory biochemical and clinical responses were obtained with the following regimen: betaine started in the newborn period at increasing doses to reach 1 g given six times a day. It is suggested that frequent administration of a moderate dose may provide clinical and biochemical benefit. © Springer-Verlag 2009

Development of intestinal flora in infancy and its effects on immune system [Bebeklikte barsak floras? gelişimi ve i·mmun sisteme etkileri]

Intestinal immune system, in which intestinal flora play an important role, can be programmed to be more efficient against infections as well as producing less allergic and autoimmune disorders. Beginning with the diet in pregnancy, then by vaginal delivery and human milk -with its synbiotic effect - maturation of healthy gastrointestinal flora in infants can be supported. Probiotics, prebiotics,and synbiotics may be helpful in reducing severe infectious complications such as necrotising enterocolitis in preterm infants and preventing allergic disorders in infants with a high risk of atopy due to their positive effects on the development of intestinal microflora

Probiotics in the prevention of necrotizing enterocolitis in preterm infants [Prematüre bebeklerde nekrotizan enterokolitten korunma amaci ile probiyotik kullanimi]

Development of a balanced intestinal flora is related with the mode of delivery and the diet within the first days. The newborn intestine is sterile, and diarrheal and other infections are frequent due to increased permeability, lack of secretory (s)IgA and immune experience. Flora, consisting of grampositive lactobacilli and Bifidobacteria due to vaginal birth and breast-feeding, positively contribute to the immune system and infant health. Among preterm infants, the development of healthy flora is delayed due to cesarean birth, lower chance of receiving human milk, colonizing pathogenic microorganisms of the intensive care unit, and antibiotics, and thus the risk of necrotizing enterocolitis is high. Evaluating the results of 16 studies in 2,842 preterm infants, the Cochrane metaanalysis 2011 showed that enteral probiotic supplementation decreased the incidence of severe necrotizing enterocolitis (stage 2 or more) and reduced all-cause mortality. No infection was observed with the supplemented organism

Fetal neonatal proinflammatory cytokine response-relation to perinatal brain and lung damage [Fetal ve neonatal proenflamatuar sitokin yaniti - perinatal beyin ve akciger zedelenmesi ile ilişkisi]

Perinatal infections are known to lead to preterm rupture of membranes and preterm labor. The role of proinflammatory cytokines has recently been understood in these pathologies. It has also been suggested that periventricular leucomalacia and intraventricular hemorrhage, both of which are frequently seen in preterm infants, are related to perinatal cytokine response, most prominently to IL-1, IL-6, IL-8 and TNF and fetal inflammmatory response may lead to brain damage and cerebral palsy in preterm infants. Even further spastic cerebral palsy in term infants is shown to be related to cytokine damage, and bacterial lipopolysaccharides sensitize the immature brain to hypoxic-ischemic insult. Lower scores in biophysical profile and depression and clinical asphyxia at birth may be the clinical symptoms of fetal inflammatory response. These patients are shown to have increased neonatal morbidity due to organ damage caused by increased cytokine response. Cytokines are also accused of in utero programming of the immature lung to increased postnatal inflammatory response and bronchopulmonary dysplasia in preterm infants. Prevention of perinatal infection and inflammation has crucial importance not only to prevent preterm delivery but also persistent brain and lung damage

Neonatal outcomes of assisted reproduction and multiple pregnancies [Yardimli üreme tekniklerinin neonatal mortalite ve morbidite üzerine etkileri]

Multiple births and related complications have increased with the widespread use of assisted reproductive techniques (ART) in recent years. The aim of this multicenter study of the Turkish Neonatal Society was to evaluate the effects of ART on neonatal morbidity and mortality in Turkey. Between February-December 2006, data from 18 different centers were prospectively collected and analyzed. Of the 6356 newborns recruited in this study, 793 infants (12.5%) were conceived with ART. Eighty-seven percent of the study population was singleton, 10.9% was twin and 1.4% was triplet. Sixty-two percent of the multiples were conceived with ART. Prematurity, multiple births and very low birth weight were more frequent in the ART group. The frequencies of neonatal intensive care unit (NICU) admissions and surfactant and mechanical ventilation along with morbidities such as intraventricular hemorrhage, patent ductus arteriosus, sepsis, and mortality were higher in ART infants. ART-induced pregnancies carry higher risks of neonatal morbidity and mortality. Couples considering ART should be informed about the possible maternal and neonatal risks of ART and multiple gestations

Meconium stained amniotic fluid: Antenatal, intrapartum, postnatal management:review [Mekonyum Boyal Amniyotik Sv: Antenatal, ntrapartum, Postnatal Yönetim]

Approximately 13o of all live births are complicated by meconium stained amniotic fluid and only 5o of neonates born through of them develop meconium aspiration syndrome (MAS). In case of meconium stained amniotic fluid and respiratory distress MAS should be ruled out. Meconium aspiration may occur in utero or in first a few inspirations. Chronic fetal hypoxia and acidosis may cause fetal gasping and meconium aspiration in utero. Respiratory distress may ta ke place by the aspiration of meconium stained amniotic fluid in the nasopharynx of normal new born. Severity criteria for MAS are also defined. Mild MAS is a disease that requires less than 40o oxygen for less than 48 hours, moderate MAS is disease that requires more than 40o oxygen for mo re than 48 hours with no air leak, and severe MAS is a disease that requires assisted ventilation for more than 48 hours and is often associated with persistent pulmonary hypertension. The principal of prenatal management is to consider mecoium stained amniotic fluid as a sign of fetal distress and to follow closely the other signs of fetal distress. Intrapartum suctioning is not very effective and if the infant is vigorous defined as strong respiratory efforts, good muscle tone and a heart rate grea ter than 100 bpm, intubation and tracheal aspiration is not necessary. Pharmacotherapy of MAS in dude sedation and analgesia, pulmonary care, antibiotics, anti inflammatory agents and pulmonary vasodilators, surfactant and surfactant lavage. Copyright © 2012 by Türki ye Klinikleri

Turkish neonatal society guideline on nutrition of the healthy term newborn [Türk neonatoloji derneği sağlıklı term bebeğin beslenmesi rehberi]

Research shows strong evidence that breastfeeding offers many health benefits for infants and mothers, as well as potential economic and environmental benefits for communities. The World Health Organization recommends breastfeeding exclusively for up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. © Copyright 2018 by Turkish Pediatric Association

The use of surfactant in the neonatal period- the known, those still under research and those need to be further investigated [Yenidogan döneminde sürfaktan kullani{dotless}mi{dotless}-bilinenler, halen araşti{dotless}ri{dotless}lanlar, araşti{dotless}ri{dotless}lmasi{dotless} gerekenler]

Respiratory distress syndrome is pulmoner insufficiency caused by the lack of surfactant and the main reason of morbidity and mortality in preterm infants. Mothers at high risk of preterm birth should be transferred to perinatal centers with experience for respiratory distress syndrome and antenatal steroids should be given before 35 weeks' of gestational age. Surfactant treatment should be applied to babies with or at high risk for respiratory distress syndrome. Prophylaxis should be given to infants of <26 weeks of gestational age and to infants requiring entubation in the delivery room. Nasal continuous positive airway pressure should be considered in infants with complete steroid treatment and without entubation need. Early surfactant may be given if entubation is performed during follow-up. Natural forms of surfactant should be preferred when needed. If the infant is stable, early extubation and non-invasive respiratory support should be considered. In this review, the recent studies' current data about surfactant treatment will be discussed. © 2014 by Turkish Pediatric Association