The Importance of Imaging in the Diagnosis of Rectus Femoris Pyomyositis in a 35Day-Old-Infant

Pyomyositis affecting the muscles around the hip may present with characteristics similar to those bof septic arthritis, which are challenging to diagnose due to their rare and vague presentation. Herein, we present a 35-day-old –male nfant with fever, restriction of hip and right limp movement and magnetic resonance imaging finding indicating rectus femoris pyomyositis

Bilateral Transverse (Bowdler) Fibular Spurs with Hypophosphatasia in an Adolescent Girl

Hypophosphatasia is a clinically heterogeneous inheritable disorder characterized by defective bone mineralization and the deficiency of serum and tissue liver/bone/kidney alkaline phosphatase activities. Due to the mineralization defect of the bones, various skeletal findings can be radiologically observed in hypophosphatasia. Bowing and Bowdler spurs of long bones are the characteristic findings. The Bowdler spurs reported on in the previous pertinent literature were observed in the perinatal aged patients and these lesions have rarely involved adolescents. We herein report on a 14-year-old girl with fibular Bowdler spurs

Effects of cord blood vitamin D levels on the risk of neonatal sepsis in premature infants

PurposeVitamin D plays a key role in immune function. Vitamin D deficiency may play a role in the pathogenesis of infections, and low levels of circulating vitamin D are strongly associated with infectious diseases. In this study, we aimed to evaluate the effects of low vitamin D levels in cord blood on neonatal sepsis in preterm infants.MethodsOne hundred seventeen premature infants with gestational age of <37 weeks were enrolled. In the present study, severe vitamin D deficiency (group 1) was defined as a 25-hydroxyvitamin D (25(OH)D) concentration <5 ng/mL; vitamin D insufficiency (group 2), 25(OH)D concentration ≥5 ng/mL and <15 ng/mL; and vitamin D sufficiency (group 3), 25(OH)D concentration ≥15 ng/mL.ResultsSixty-three percent of the infants had deficient levels of cord blood vitamin D (group 1), 24% had insufficient levels (group 2), and 13% were found to have sufficient levels (group 3). The rate of neonatal sepsis was higher in group 2 than in groups 1 and 3.ConclusionThere was no significant relationship between the cord blood vitamin D levels and the risk of neonatal sepsis in premature infants

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

Efficacy and Safety of Nebulized Recombinant Human DNase as Rescue Treatment for Persistent Atelectasis in Newborns: Case-series

Aim: To evaluate the efficacy and safety of using recombinant human DNase (rhDNase) in diminishing persistent atelectasis unresponsive to conventional treatment and mucus plugging in newborns with insufficient ability to clear thick and purulent airway secretions. Methods: Twelve newborns (10 preterms), who did not respond to conventional methods, received rhDNase nebulized therapy at a dose of 1.25 mg over a 15-minute period, twice a day (2 hours between the doses) for up to 3 days. The application of the drug was continued for up to 3 days or until the improvement of atelectasis. After a-three-day therapy, if atelectasis did not improve, a single dose (1.25 mg) of the same drug in liquid form was administered endotracheally. Clinical (respiration rate, requirement for oxygen concentration) and radiological response (chest x-ray scoring), duration of the treatment, recurrence of atelectasis and requirement for additional therapy were evaluated. Results: Ten out of 12 patients showed rapid clinical and radiological improvement after nebulized treatment. Two patients who did not respond to the three-day regimen received a single dose of the drug endotracheally and both recovered completely. Six patients did not require completion of three day regimen for radiological recovery. Chest x-ray scores and respiratory parameters showed significant improvement after the treatment. The respective median (range) values before and after treatment were 4 (1-5) and 0 (0-4) points for chest x-ray scores, 66 (60-78) and 49 (44-64) breaths/min for respiratory rates, and 45% (35-64) and 30% (21-40) for oxygen requirement. Comparison of pCO2 before (median, 56 mm Hg; range, 46-64) and after treatment (median, 41 mm Hg; range 38-58) in 7 patients showed significant improvement. Conclusion: In a large series of newborns to receive rhDNase and we demonstrated the usefulness of rhDNase as a mucolytic agent in treating newborns with persistent atelectasis who do not respond to other treatments

Evaluation of risk factors for necrotizing enterocolitis in preterm infants

Giriş: Bu çalışmada nekrotizan enterokolit (NEK) gelişiminde anne, bebek ve bebek bakımı ile ilişkili faktörlerin etkilerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Doğum haftası ≤32 ve doğum ağırlığı ≤1500 gram olan hastalar çalışmaya dâhil edildi. Maternal demografik özellikler ve gebelik öyküsü, antenatal ve natal takipteki problemler, antenatal steroid tedavisi, doğum şekli (NVY, C/S), ve bebeğin doğum öyküsü kayıt edildi. NEK tanısından önce prematüre bebeğe uygulanan ventilasyon tedavisinin süresi ve transfüzyon sayıları kayıt edildi. Çalışmaya evre 2 ve evre 3 NEK olguları alındı. Bulgular: Beş yüz otuz iki hastadan 61’ine (%11,4) NEK tanısı konuldu ve çalışma grubu olarak belirlendi. 60 hasta kontrol grubu olarak seçildi. Çalışma ve kontrol grubu arasında demografik özellikler, APGAR skoru, resüsitasyon gereksinimi ve antenatal steroid kullanımı açısından farklılık bulunmadı. NEK’li hastalarda ventilatörde kalım süresinin (p=0,037) ve eritrosit süspansiyonu transfüzyon sıklığının daha fazla olduğu görüldü (p=0,032). Antenatal steroid kullanımının evre 2 NEK’li hastalarda daha fazla olduğu (p=0,011), evre 3 olanlarda ventilatörde kalım süresinin daha fazla olduğu bulundu (p=0,020). NEK’li hastalarda mortalite oranı %31,1 olarak saptandı. Ölen hastaların %84’ünde evre 3 NEK olduğu, doğum ağırlığı ve haftalarının daha düşük olduğu görüldü. NEK grubunda respiratuvar distress sendromu (RDS) (p=0,02); RDS ve patent duktus arteriosus (PDA) birlikteliği daha fazla olduğu (p=0,03), intrakranial kanamanın (‹KK) evre 3 NEK’te fazla olduğu (p=0,034) saptandı. Evre 3 NEK’li olgularda RDS, PDA ve ‹KK birlikteliği daha fazla bulundu (p=0,006). Evre 3 NEK’li hastaların annelerinde kronik hipertansiyon (p=0,003), eklampsi (p=0,034) ve infeksiyon (p=0,011) sıklığının fazla olduğu görüldü. Sonuç: Bu çalışmada antenatal, natal ve postnatal faktörlerin NEK gelişiminde önemli rol oynadığı gösterilmiş olup, bu faktörlere yönelik alınacak önlemlerle hastalığın sıklığının azaltılabileceği önerilmiştir.Introduction: In the present study, it was aimed to evaluate the effects of the maternal and infantile factors and factors associated with the care of the infants in the development of necrotizing enterocolitis (NEC). Materials and Method: Infants with ≤32 weeks of gestational age and ≤1500 grams of birth weight were included in the study. Maternal demographic characteristics and pregnancy history, antenatal and postnatal follow-up problems, antenatal steroid treatment, modes of delivery (NVY, C/S), and the babies’ birth history were recorded. The duration of ventilation treatment and the number of transfusions applied before the diagnosis of NEC in premature infants were recorded. Patients with stage II and stage III NEC were included in the study. Results: Sixty one of 532 patients (11,4%) were diagnosed as NEC and allocated in the study group. Sixty patients were enrolled as the control group. There were no differences between both groups with respect to demographic characteristics, APGAR score, need for resuscitation and antenatal steroid treatment. The duration of ventilation treatment (p=0.037) and the frequency of red blood cell transfusion (p=0.032) were considered to be higher in the NEC group. Antenatal steroid administration was higher in patients with stage 2 NEC (p=0.011), but the duration of ventilation treatment was higher in those with stage 3 (p=0.020). The mortality rate was 31.1% in the patients with NEC. It was observed that 83% of patients who died had stage 3 NEC and a lower birth weight and gestational age. Respiratory distress syndrome (RDS) (p=0.02), togetherness of RDS and patent ductus arteriosus (PDA) were higher in the NEC group (p=0.03), and more intracranial hemorrhage (ICH) was detected at stage 3 NEC (p=0.034). RDS, PDA and ‹CH were frequently determined together in patients with stage 3 NEC (p=0.006). Chronic hypertension (p=0.003), eclampsia (p=0.034), and infection (p=0.011) were found to be more frequent in the mother of the patients with stage 3 NEC. Conclusion: In the present study, antenatal, natal and postnatal factors were shown to play an important role in the development of NEC, and if proposed measures to be taken, these factors may reduce the incidence of the disease

An Unusual Case of Heteropagus: Autosite With a Complex Cardiac Malformation

Asymmetrical form of conjoined twinning (heteropagus) is an extremely rare event with an incidence of 1–2 million live births. The incomplete component of heteropagus, namely, parasite, usually consists of rudimentary organs. Therefore, the autosite component of heteropagus can be separated successfully. A wide spectrum of associated congenital cardiac malformations, which are usually minor, has been described in autosites. However, a single-ventricle heart anomaly in the autosite has been reported in a very few cases. We report an unusual case of heteropagus with a complex cardiac malformation. To the best of our knowledge, this is the third heteropagus case in the literature with a single-ventricle heart in the autosite

A Comparison of Slow Infusion Intermittent Feeding versus Gravity Feeding in Preterm Infants: A Randomized Controlled Trial

Background: The transition to full enteral feeding is important for ensuring adequate growth in preterm infants. Aims: The aim of this study was to investigate the effects of two different intermittent feeding methods on the transition to full enteral feeding in preterm infants. Study design: A prospective, randomized controlled study was conducted in a neonatology and perinatology center. Subjects: Preterm infants with a gestational age between 24 + 0/7 and 31 + 6/7 were included in this study. They were divided into two groups: the SIF (slow infusion feeding) group and the IBF (intermittent bolus feeding) group. In the SIF group, feed volumes were administered over one hour using an infusion pump through an orogastric tube, with feeding occurring every three hours. The IBF group received enteral feeding using a gravity-based technique with a syringe through an orogastric tube, completed within 10 to 30 min. Outcome measures: The primary outcome was the achievement of full enteral feeding and the occurrence of feeding intolerance. Results: A total of 103 infants were enrolled in the study (50 in SIF and 53 in IBF). The time to achieve full enteral feeding did not differ significantly between the two groups (p = 0.20). The SIF group had significantly fewer occurrences in which gastric residual volume exceeded 50% (p = 0.01). Moreover, the SIF group had a significantly shorter duration of non-per-oral (NPO) status than the IBF group (p = 0.03). Conclusions: It is our contention that the use of the SIF method as an alternative feeding method is appropriate for infants with feeding intolerance and those at high risk of feeding intolerance

Comparison of Three Different Administration Positions for Intratracheal Beractant in Preterm Newborns with Respiratory Distress Syndrome

The aim of this study was to compare the efficacy and adverse effects of various intratracheal beractant administration positions in preterm newborns with respiratory distress syndrome. Methods: This study was performed on preterm newborns with respiratory distress syndrome. The inclusion criteria were being between 26 weeks and 32 weeks of gestational age, having a birth weight between 600 g and 1500 g, having received clinical and radiological confirmation for the diagnosis of respiratory distress syndrome (RDS) within 3 hours of life, having been born in one of the centers where the study was carried out, and having fractions of inspired oxygen (FiO2) ≥ 0.40 to maintain oxygen saturation by pulse oximeter at 88–96%. Beractant was administered in four positions to Group I newborns, in two positions to Group II, and in neutral position to Group III. Results: Groups I and II consisted of 42 preterm infants in each whereas Group III included 41 preterm infants. No significant differences were detected among the groups with regards to maternal and neonatal risk factors. Groups were also similar in terms of the following complications: patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH), chronic lung disease (CLD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), death within the first 3 days of life, death within the first 28 days of life, and rehospitalization within 1 month after discharge. Neither any statistically significant differences among the parameters related with surfactant administration, nor any significant statistical differences among the FiO2 levels and the saturation levels before and after the first surfactant administration among the groups were determined. Conclusion: In terms of efficacy and side effects, no important difference was observed between the recommended four position beractant application, the two position administration, and the neutral position