The role of tumor necrosis factor-alpha -308 G/A and transforming growth factor-beta 1 -915 G/C polymorphisms in childhood idiopathic thrombocytopenic purpura

Objective: To increase our understanding of the etiology of idiopathic thrombocytopenic purpura (ITP) some cytokine gene polymorphisms were analyzed for susceptibility to the disease. The aim of this study was to investigate the role of tumor necrosis factor-alpha (TNF-α) -308 G/A and transforming growth factor-beta 1 (TGF-β1) –915 G/C polymorphisms in the development and clinical progression of childhood ITP.Materials and Methods: In all, 50 pediatric patients with ITP (25 with acute ITP and 25 with chronic ITP) and 48 healthy controls were investigated via LightCycler® PCR analysis for TNF-α -308 G/A and TGF-β1 -915 G/C polymorphisms.Results: The frequency of TNF-α -308 G/A polymorphism was 20%, 16%, and 22.9% in the acute ITP patients, chronic ITP patients, and controls, respectively (p>0.05). The frequency of TGF-β1 -915 G/C polymorphism was 16%, 8%, and 8.3% in the acute ITP patients, chronic ITP patients, and controls, respectively (p>0.05). The risk of developing ITP and clinical progression were not associated with TNF-α -308 G/A (OR: 0.738, 95% CI: 0.275-1.981, and OR: 0.762, 95% CI: 0.179-3.249) or TGF-β1 -915 G/C (OR: 1.5, 95% CI: 0.396-5.685, and OR: 0.457, 95% CI: 0.076-2.755) polymorphisms. Conclusion: The frequency of TNF-α -308 G/A and TGF-β1 -915 G/C polymorphisms did not differ between pediatric ITP patients and healthy controls, and these polymorphisms were not associated with susceptibility to the development and clinical progression of the disease

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS: The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS: The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HİE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION: The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether [removed

A Successful Whole Body Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy During an ECMO Run in a Newborn

Data regarding the safety of using therapeutic hypothermia (TH) with extracorporeal membrane oxygenation (ECMO) in neonates with both hypoxic ischemic encephalopathy (HIE), and respiratory failure are lacking. TH is not associated with an increased incidence of hemostatic complications, but hypothermia may impair coagulation. Herein, we report a case of a newborn who had meconium aspiration syndrome and HIE and underwent both TH and ECMO. He did not have any bleeding or circuit complications, and mortality as short-term outcome along with well-neurodevelopmental outcome

The role of tumor necrosis factor-alpha -308 G/A and transforming growth factor-beta 1 -915 G/C polymorphisms in childhood idiopathic thrombocytopenic purpura

Abstract Objective: To increase our understanding of the etiology of idiopathic thrombocytopenic purpura (ITP) some cytokine gene polymorphisms were analyzed for susceptibility to the disease. The aim of this study was to investigate the role of tumor necrosis factor-alpha (TNF-α) -308 G/A and transforming growth factor-beta

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

Histopathologic investigation of the protective effects of omega-3 fatty acids against boric acid-induced injury in kidney and testis tissue

Objective: In this study, it was aimed to evaluate the effects of boric acid on rat kidney and testis tissues histopathologically. Secondly, the protective effects of omega-3 fatty acid against boric acid-induced renal and testicular toxicity were investigated. Methods: 32 wistar albino rats were divided into 4 groups as follows: Control, Omega-3 (400 mg/kg/day for 10 days), Boric acid (375 mg/kg/day for 10 days) and Boric acid+omega-3 (both drugs same dosage for same day). Kidney and testis tissues were evaluated using a scoring system based on the extent of certain histopathological changes. Results: In histopathological examination, boric acid caused significant degeneration in both testis and kidney tissues. Most evident findings were glomerular shrinkage and necrosis, hemorrhage and tubular cell degeneration in kidneys, and exfoliation of seminiferous tubule cells, detachement of epithelium from basement membrane, decreased cellularity and degeneration in epithelial cells in testis tissues. Omega-3 administration significantly attenuated these changes. Conclusion: To our literature search, this is the first study reporting protective effects of omega-3 fatty acid against boric-acid-induced testicular and renal injury

Neonatal jaundice: Recommendations for follow-up and treatment

Neonatal jaundice due to hyperbilirubinemia is a common and mostly a harmless problem. However, there is a risk of acute bilirubin encephalopathy and kernicterus, which are rare but can cause permanent neurological damage. In 2022, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for neonatal hyperbilirubinemia in newborns who are at least 35 weeks gestational age. The 2022 AAP guideline incorporates updated phototherapy and exchange transfusion nomograms that feature higher bilirubin thresholds than previous guidelines, and includes risk assessments for escalation-of-care, which is a new definition, universal bilirubin screening procedures, and neurotoxicity risk factors that no longer consider race as a risk factor. It is necessary to exercise caution and consult with local experts when adapting the updated guideline in low- and middle-income countries due to potential lack of resources for screening, follow-up, and treatment

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

The impact of treatment options on neurodevelopmental status of neonates with jaundice requiring exchange transfusion

Giriş: Yenidoğan sarılığında kan değişimi, yaşamsal önemde ancak riskleri olan girişimsel bir işlemdir. Kan değişimi gerektirecek hiperbilirubinemi gelişiminin önlenmesi öncelikli yaklaşımdır. Çalışmamızda şiddetli hiperbilirubinemide, kan değişimi risk faktörleri ve ileri dönem nörogelişimsel durumun araştırılması amaçlanmıştır. Gereç ve Yöntem: Total serum bilirubin değeri Amerikan Pediatri Akademisi rehberine göre kan değişimi sınırında veya sınırın üstünde, 35 ve üstü gestasyonel hafta doğumlu 104 yenidoğan çalışmaya dahil edildi. Olguların 12-36 ayındayken ulaşılabilen 65’ine Gelişimi İzleme ve Destekleme Rehberi uygulandı. Kan değişimi uygulanan ve uygulanmayanlar sosyodemografik özellikler, risk faktörleri, etiyoloji, tedavi süreçleri ve ileri dönem nörogelişimsel durum açılarından karşılaştırıldı. Bulgular: Kan değişimi olguların %18,3’ünde uygulandı. Başvuru total serum bilirubin ve bilirubin/albümin oranı yüksekliği kan değişimi riskini arttıran temel değişkenlerdi. Kan değişimi riskini artıran eşik değerler, total serum bilirubinde 26,43 mg/dl ve bilirubin albümin oranında 7,43 mg/g saptandı. Sarılık etiyolojisinde ilk üç sırada; hemolitik hastalık, dehidratasyon ve erken anne sütü sarılığı ile prematürelik saptandı. Etiyolojilerle tedavi şekilleri arasında anlamlı ilişki bulunmadı. Postnatal 96 saatten sonra hastaneye başvuranların istatistiksel anlamlı yüsek bilirubinle (≥25 mg/dl) yattığı görüldü. On iki-otuz altı ayında değerlendirilen 65 olgunun %13,8’inde farklı alanlarda gelişimsel gecikme saptandı. Başvuru zamanı, tedavi şekilleri, total serum bilirubin ve bilirubin albümin oranıyla nörogelişimsel durum arasında anlamlı farklılık saptanmadı. Sonuç: Kan değişimi için başlıca risk faktörleri yüksek total serum bilirubin ve bilirubin albümin oranı bulundu. Hastaneye geç başvuranların daha sıklıkla ciddi hiperbilirubinemiyle yatması, taburculuk öncesi riskli grubun saptanması temel yaklaşımının önemini vurgulamaktadır. Ciddi hiperbilirubinemili olgular gelişimsel gecikmeler için riskli sayılmalı, düzenli izlem ve erken tanıyla müdahale fırsatları kaçırılmamalıdır.Introduction: Though predicting the emerging hyperbiluribinemia is the rational approach, timely exchange transfusion in significant neonatal hyperbilirubinemia is vital. The aim of this study is to evaluate the socio-demographic and clinical characteristics of newborns with significant hyperbilirubinemia, to evaluate risk factors for exchange transfusion and long-term neurodevelopmental status. Materials and Methods: Newborns who were admitted with bilirubin levels above the excahge transfusion thresholds (American Academy of Pediatrics, guideline 2004) total 104 cases were enrolled to the study. A total of 65 cases at 12-36 months were evaluated with Guide for Monitoring Child Development. The clinical and demographic characteristics, risk factors, treatment modalities, etiology of the groups and long-term neurodevelopmental status were compared between the groups with and without exchange transfusion, Results: Exchange transfusion was performed in 19 (18.3%) patients. Main factors that increase the risk of exchange transfusion were bilirubin level and bilirubin/albumin ratio. Cut-off bilirubin level and bilirubin/albumin ratio which increase the risk for exchage transfusion were 26.43mg/dl and 7.43mg/g respectively. The underlying etiologies were hemolytic disease (29.8%), dehydration and breast milk jaundice (28.8%), prematurity (26.9%). Late comers (postnatal >96 hours) were more likely to have bilirubin level ≥25 mg/dl. Development delays were detected in 13.8% of 65 cases. Conclusions: Admission bilirubin level and the ratio of bilirubin to albumin was among the factors that increase the risk of exchange transfusion. Late admission with significant hyperbiluribinemia may be prevented by identification of neonates at risk for developing significant hyperbilirubinemia before discharge or early in follow-up