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

Evaluation of Fetal Central Nervous System Anomalies; Perinatology Council Data of a Reference Center

INTRODUCTION: Central nervous system (CNS) anomalies are the second most common congenital malformations detected during antenatal period. Rates of prenatal diagnosis are aroung 96% in anencephaly, but drops down to approximately 14 % in migration anomalies.We aimed to determine the frequency and features of CNS anomalies evaluated in the perinatology council of our hospital where high-risk pregnancies were discussed and also to emphasize the importance of antenatal diagnosis. METHODS: Pregnant women, with a CNS anomaly detected in their fetus, who were evaluated between January 2019-December 2019 in the perinatology council of Tepecik Training and Research Hospital were included in the study. Retrospectively, the records of the cases were examined, prenatal, and maternal risk factors at the time of council session, the council decision and the results were recorded. Statistical analyzes were done using SPSS 20.0 program. RESULTS: Data of 1272 pregnant women were evaluated in the study, and 261 cases (20.5%) with CNS anomalies were detected. A total of 129 pregnant women were excluded from the study because follow-up of these patients were not realized in our center or they didn't give birth yet.. Totally, 132 pregnant women were included in the study. The mean maternal age was 26.99+-6.50 (14-42) years, the mean gestational age was 22.63+-7.08 (10.4-38.6) weeks. Most common CNS anomalies detected were neural tube defects (n=54; 40%), hydrocephalus/ventriculomegaly (n=36; 27%), migration defects (n=21; 15%) and cerebellar malformations (n=9; 6%). Termination of pregnancy was decided for 29.8% (n=78) of pregnant women, but realized only for 62 pregnancies. Among pregnancies which were decided to be continued due to the fact that gestational week was 22 weeks or more (n=51), had fetuses with neural tube defects (n=25; 50%) and hydrocephalus/ventriculomegaly (n=36; 27%) with poor prognosis. DISCUSSION AND CONCLUSION: As the anomalies with high morbidity and mortality were referred to our hospital after the 22nd gestational week, termination option could not be offered to these pregnancies. High-risk pregnancies should be directed to perinatology centers in the early period so that this option can be presented to the family, appropriate follow-up and treatment of life-compatible ones

Evaluation of prolonged pain in preterm infants with pneumothorax using heart rate variability analysis and EDIN (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) scores

Purpose The EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) and heart rate variability has been used for the evaluation of prolonged pain. The aim of our study was to assess the value of the newborn infant parasympathetic evaluation (NIPE) index and EDIN scale for the evaluation of prolonged pain in preterm infants with chest tube placement due to pneumothorax. Methods This prospective observational study assessed prolonged pain in preterm infants with a gestational age between 33 and 35 weeks undergoing installation of chest tubes. Prolonged pain was assessed using the EDIN scale and NIPE index. Results There was a significant correlation between the EDIN scale and NIPE index (r=-0.590, P=0.003). Prolonged pain is significantly more severe in the first 6 hours following chest tube installation (NIPE index: 60 [50–86] vs. 68 [45–89], P<0.002; EDIN score: 8 [7–11] vs. 6 [4–8], P<0.001). Conclusion Prolonged pain can be accurately assessed with the EDIN scale and NIPE index. However, evaluation with the EDIN scale is time-consuming. The NIPE index can provide instantaneous assessment of prolonged and continuous pain

A Multicentered Study on Epidemiologic and Clinical Characteristics of 37 Neonates With Community-acquired COVID-19

Can, Emrah/0000-0002-2163-6564; Reis, AlessanRSS/0000-0001-8486-7469WOS: 000573923900002PubMed: 32932329Background: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. Methods: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. Results: Thirty-seven symptomatic neonates were included. the most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1-35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1-8.6] vs. 5.8 [0.3-69.2]p= 0.002, 11.9 [10.1-17.2] vs. 15.2 [11.7-18.0]p= 0.01, respectively) or who were severe/critical (1.0 [0.01-8.6] vs. 4.5 [0.1-69.2]p= 0.01, 11.7 [10.1-13.9] vs. 15.0 [11.7-18.0]p= 0.001, respectively). Conclusions: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.Turkish Neonatal SocietyThe Turkish Neonatal Society funded the online registration system of the study. Funders had no role in study design, data collection, data analysis and interpretation, writing of the report, and decision to publish of the article. the corresponding author has full access to all the data in the study and takes final responsibility for the decision to submit for publication. All authors approved the final version of the manuscript. M.K.K. wrote the first draft of the manuscript, no honorarium, grant, or other form of payment was given to anyone to produce the manuscript. To the best of our knowledge, no conflict of interest, financial or other, exists. There are no prior publications or submissions with any overlapping information, including studies and patients

Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5-28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17-21.71), tachypnea (OR: 26.5, 95% CI: 9.59-73.19), and chest retractions (OR: 27.5, 95% CI: 5.96-126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%. Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course

HIV Pozitif Gebeliklerde Seçilen Doğum Şeklinin,Doğum Süresinin ve Doğum Travayı TakibininFetal Bulaş Açısından Perinatal vePostnatal Sonuçlarının Değerlendirilmesi

Giriş: İnsan immün yetmezlik virüsü (HIV); dünyada ilk olarak 1981 yılında tanımlanmış olup, ülkemizde ise ilk vaka 1985 yılında görülmüştür.1985 yılında toplam üç olan vaka sayısı, 30 Haziran 2019 itibariyle toplam 21.988’dir. HIV bulaş yolları ele alındığında, halen tüm HIV vakalarının%48.6‘sının bulaş yolu bilinememektedir. Bu durum %1’lik gibi oldukça düşük oranlarda bildirilen anneden bebeğe bulaşın gerçekte daha da yüksekoranlarda olabileceğini düşündürmektedir.Gereç ve Yöntemler: Bu çalışmada hastanemizde doğum yapan HIV pozitif anneden doğan bebeklerin perinatal öykülerinin ve laboratuvar özelliklerinin incelenmesi amaçlanmıştır. Hastanemizde 2009-2019 yılları arasında doğum yapan HIV ile enfekte anne bebeklerinin perinatal öyküleri velaboratuvar özellikleri geriye dönük olarak incelenmiş, HIV enfeksiyonunave gebelik seyrine ait bilgiler, bulunabildiği kadarıyla tıbbi kayıtlardan eldeedilmiştir. Bulgular: HIV ile enfekte anneden doğan 15 bebeğin (%60 erkek, %40 kız)annelerinin 2’sine (%13.3) gebelikten önce, 7’sine (%46.7) gebelik sırasında,6’sına (%40) ise doğum sırasında HIV tanısı koyulduğu belirlendi. 8 annenin(%53.3) gebelik sırasında antiretroviral tedavi aldığı, 2 (%13.3) gebenin normal spontan doğum ile doğum yaptığı saptandı. Normal spontan doğumile doğan bebeklerden birine zidovudin profilaksisi başlanmış ve izlemindebebeğin sekiz haftalık profilaksi sonrasında HIV viral yükünün halen negatifolduğu görülerek profilaksisi kesilmiş, diğer bebek ise anne tarafından izinsiz olarak götürülmüştür. Göç İdaresi ile iletişime geçilmiş ancak anne ve bebeğe ulaşılamamıştır. 3 (%20) gebede erken membran rüptürü öyküsü saptanırken, en uzun travay süresi de 16 saat olarak belirlendi. 11 (%73.3) gebedoğum sırasında intravenöz zidovudin tedavisi ve 13 (%86.6) bebek antiretroviral profilaksi almıştı. HIV viral yükü bakılmış olan 11 bebeğin biri hariçdiğerlerinin viral yükü negatif saptanmıştır. HIV viral yükü pozitif (300.000kopya/mL) olan olgu 38. gestasyon haftasında sezaryen ile doğmuş olup,annesi doğum sırasında tanı almış, doğum sonrası hastaya üçlü (zidovudin,lamivudin, nevirapin) antiretroviral profilaksi başlanmıştı.Sonuç: Türkiye’de HIV enfeksiyonu çok sık görülmemekle birlikte, olgu sayısı yıllar içinde giderek artmaktadır. HIV’in anneden bebeğe perinatal geçişi,doğum öncesi, sırası ve sonrasında alınacak önlemler ile azaltılabilir. Özellikle, gebelikte HIV enfeksiyonu tanısının geç konulmaması ya da atlanmamasısağlanmalı ve HIV ile enfekte gebelerin takibi HIV konusunda uzman merkezlerce yapılmalıdır.Objective: Human immunodeficiency virus (HIV) was first described in1981 in the world, and the first case in our country was seen in 1985. Thetotal number of cases is 21.988 as of 30 June 2019, which was 3 in 1985.Considering the transmission routes of HIV positive cases in our country,the rate of transmission from mother to baby seems to be 1%, but it is likely that this ratio will be higher if 48.6% of all cases are not known.Material and Methods: In this study, perinatal histories and laboratoryfeatures of babies born from HIV-positive mothers are planned to be analyzed retrospectively. As far as possible information on HIV infection andthe course of pregnancy has been obtained from the medical records andthe perinatal history and laboratory features of HIV-infected mother’s babies who delivered between 2009 and 2019 at our hospital were analyzedretrospectively Results: Fifteen infants’ (60% male, 40% female) mothers were diagnosedin 2 (13.3%) before pregnancy, 7 (46.7%) of the mothers during pregnancy,and 6 (40%) of the mothers during delivery. It was ascertained that eightmothers (53.3%) received antiretroviral treatment during pregnancy and 2(13.3%) mothers delivered by normal spontaneous vaginal route. Zidovudine prophylaxis was started in one of the babies born with a normal spontaneous vaginal route, and the HIV virus load was still negative after eightweeks of prophylaxis and the prophylaxis was discontinued, the other babywas taken by the mother without permission. Premature membrane rupture was detected in three (20%) pregnant women, and the longest labortime was 16 hours. Eleven (73.3%) pregnant women received intravenouszidovudine therapy and 13 (86.6%) babies received antiretroviral prophylaxis. The viral load of the others was negative except one of the 11 babieswhose HIV viral load was examined. The patient with a positive HIV viralload (300.000 copies/mL) was born by cesarean at 38 weeks of gestationand her mother was diagnosed during delivery and triple antiretroviralprophylaxis (zidovudine, lamivudine, nevirapine) was started on to baby.Conclusion: Although HIV prevalence is not high in Turkey, the number ofcases has been increasing over the years. Perinatal transmission of the HIVvirus from mother to baby can be reduced by measures to be taken before,during and after birth. In particular, it should be ensured that HIV infectionis not diagnosed late or missed during pregnancy, and HIV-infected pregnant women should be followed up by centers which specialized in HIV