Benign external hydrocephalus: a review, with emphasis on management

Benign external hydrocephalus in infants, characterized by macrocephaly and typical neuroimaging findings, is considered as a self-limiting condition and is therefore rarely treated. This review concerns all aspects of this condition: etiology, neuroimaging, symptoms and clinical findings, treatment, and outcome, with emphasis on management. The review is based on a systematic search in the Pubmed and Web of Science databases. The search covered various forms of hydrocephalus, extracerebral fluid, and macrocephaly. Studies reporting small children with idiopathic external hydrocephalus were included, mostly focusing on the studies reporting a long-term outcome. A total of 147 studies are included, the majority however with a limited methodological quality. Several theories regarding pathophysiology and various symptoms, signs, and clinical findings underscore the heterogeneity of the condition. Neuroimaging is important in the differentiation between external hydrocephalus and similar conditions. A transient delay of psychomotor development is commonly seen during childhood. A long-term outcome is scarcely reported, and the results are varying. Although most children with external hydrocephalus seem to do well both initially and in the long term, a substantial number of patients show temporary or permanent psychomotor delay. To verify that this truly is a benign condition, we suggest that future research on external hydrocephalus should focus on the long-term effects of surgical treatment as opposed to conservative management

Optimizing nurse capacity in a teaching hospital neonatal intensive care unit

PubMedID: 26729324Patients in intensive care units need special attention. Therefore, nurses are one of the most important resources in a neonatal intensive care unit. These nurses are required to have highly specialized training. The random number of patient arrivals, rejections, or transfers due to lack of capacity (such as nurse, equipment, bed etc.) and the random length of stays, make advanced knowledge of the optimal nurse a requirement, for levels of the unit behave as a stochastic process. This stochastic nature creates difficulties in finding optimal nurse staffing levels. In this paper, a stochastic approximation which is based on the required nurse: patient ratio and the number of patients in a neonatal intensive care unit of a teaching hospital, has been developed. First, a meta-model was built to generate simulation results under various numbers of nurses. Then, those experimented data were used to obtain the mathematical relationship between inputs (number of nurses at each level) and performance measures (admission number, occupation rate, and satisfaction rate) using statistical regression analysis. Finally, several integer nonlinear mathematical models were proposed to find optimal nurse capacity subject to the targeted levels on multiple performance measures. The proposed approximation was applied to a Neonatal Intensive Care Unit of a large hospital and the obtained results were investigated. © 2016, Springer Science+Business Media New York

Turkish Neonatal Society guideline on the safe transport of newborn [Türk Neonatoloji Derneği yenidoğan bebeğin güvenli nakli rehberi]

The rational presentation form of perinatal care in developed countries is evaluated within the regionalization program. Neonatal transport is the main step for the regionalization of perinatal care. It is a very important factor for reducing neonatal mortality and morbidity, especially in developing countries. Neonatal transport is a system integrity that includes more than one essential matter. Neonatal transport requires special hardware and serious organization because it can be a caused of mortality and morbidity in its own right. This guideline deals with the transport of newborn babies (definitions, personnel, technical equipment, stabilization conditions, special medical conditions, communication), and the current situation in our country and standard approaches. It should not be forgotten that changes in public space will also change the approach and that every baby should be evaluated within himself or special conditions. © Copyright 2018 by Turkish Pediatric Association

Infantile rhabdoid tumor mimicking hepatic hemangioendothelioma

PubMedID: 27072279[No abstract available

Intraventricular streptokinase for the treatment of posthaemorrhagic hydrocephalus of preterm

PubMedID: 12763331Posthaemorrhagic hydrocephalus following intraventricular haemorrhage is still one of the most serious complications of premature birth. Small premature babies are not suitable for shunt surgery because of high cerebrospinal fluid protein and risk of obstruction. For this reason there is a great need for alternative approaches for treatment of posthaemorrhagic hydrocephalus. The objective of this study was to investigate if intraventricular streptokinase treatment reduces the need for ventriculoperitoneal shunt in posthaemorrhagic hydrocephalus. A case-control trial was carried out in 12 premature babies with posthaemorrhagic hydrocephalus. Six of them were treated with intraventricular streptokinase and 6 premature babies were in the control group. While 5 babies in the study group needed ventriculoperitoneal shunt, 3 of the control patients needed shunt surgery. There were no rebleeding, ventriculitis or meningitis in either groups. In conclusion on the basis of our results we do not recommend routine use of intraventricular streptokinase in posthaemorrhagic hydrocephalus. © 2003 Elsevier Science Ltd. All rights reserved

A newborn infant with sternal malformation/vascular dysplasia association

PubMedID: 12017236Sternal malformation/vascular dysplasia complex was described by Hersch et al. in 1985. The principle findings include cleft of the sternum covered by an atrophic skin, a midline abdominal raphe and hemangiomatosis. The inheritance pattern seems to be sporadic. We report a newborn baby with sternal defect, cleft lip and palate, supraumbilical raphe and hemangiomas

Chromosome and p63 gene analysis of an infant with ectrodactyly-split hand and foot malformation

Aim: Split hand-split foot malformation (SHFM) results from central ray reduction and presents as median clefts of the hands and feet, syndactyly, aplasia or hypoplasia of the phalanges, metacarpals and metatarsals, which are frequently associated with other phenotypic abnormalities. We aimed to investigate the genetic pathway of SHFM in a child. Materials and methods: Cytogenetic and molecular genetic analysis was performed in a 10-day-old boy with split-syndactyly hand and flat-syndactyly foot. Results: We found a complex chromosomal rearrangement including breaks in 4q12, fragility in the 9q11-13 band region and 9qh+. Cytogenetic results agree with the literature findings. The mutation analysis of the p63 gene revealed no mutation. Conclusion: The phenotype of our patient may be due to variable expressivity and penetrance of the p63 gene and to other genetic factors, or the mutation can be located in the other 4 loci for SHFM. Additional minor modifying genes, which predispose to non-syndromic cleft palate, could also contribute to the expression of the cleft palate component of the EEC syndrome. © TÜBİTAK

Statistical analysis of patients' characteristics in neonatal intensive care units

PubMedID: 20703900The staff in the neonatal intensive care units is required to have highly specialized training and the using equipment in this unit is so expensive. The random number of arrivals, the rejections or transfers due to lack of capacity and the random length of stays, make the advance knowledge of the optimal staff; equipments and materials requirement for levels of the unit behaves as a stochastic process. In this paper, the number of arrivals, the rejections or transfers due to lack of capacity and the random length of stays in a neonatal intensive care unit of a university hospital has been statistically analyzed. The arrival patients are classified according to the levels based on the required nurse: patient ratio and gestation age. Important knowledge such as arrivals, transfers, gender and length of stays are analyzed. Finally, distribution functions for patients' arrivals, rejections and length of stays are obtained for each level in the unit. © 2009 Springer Science+Business Media, LLC

Maternal and neonatal effects of remifentanil used for endotracheal intubation in caesarean section [Sezaryenlerde endotrakeal entübasyon i·çin kullanilan remifentanilin anne ve yenidogandaki etkileri]

Aim: This prospective, randomised, double-blinded study was performed to compare intubating conditions, maternal and neonatal effects of remifentanil used for endotracheal intubation in caesarean section with succinylcholine. Materials and Methods: Following Faculty ethic committee approval and written informed consent of parturients, ninety-six parturient were assigned randomly to one of three groups. After intravenous administration of atropine 0.5 mg, anaesthesia was induced with thiopental sodium (5 mg kg-1) followed by remifentanil 2,5 µg kg-1 (Group R2) (n=32), remifentanil 3 µg kg-1 (Group R3) (n=32) over 60 seconds or succinylcholine 1.5 mg kg -1 (Group S) (n=32). Intubating conditions and haemodynamic parameters were recorded. Preoperatively and after umbilical cord clamping, maternal blood samples were taken to evaluate plasma renin, glucose, and cortisol, and neonatal umbilical cord blood samples were taken to evaluate blood gas values. New-borns' performance were assessed using APGAR and neuro adaptive capacity scores (NACS). Results: Intubation conditions were significantly better in group R3 and S than in group R2 (p<0.05). Heart rate and blood pressure values were found to be significantly lower in group R2 and R3 after induction of anaesthesia and at 1st, 2nd, 4th and 6th minutes after endotracheal intubation than in group S (p<0.05). Cortisole levels were significantly lower in group R2 and R3 after umbilical cord clamping than preoperative levels, whereas it was significantly higher in group S (p<0.05). Conclusion: When compared with succinylcholine; remifentanil (3 µg kg-1) led to similar intubating conditions, lower haemodynamic discrepancy, lower cortisol levels and NACSs at 15th minutes when it is used during endotracheal intubation for cesarean section delivery