Do preterm infants with Bronchopulmonary dysplasia have a unique postnatal weight gain pattern?

Objectives To investigate the weight gain pattern of preterm infants with bronchopulmonary dysplasia (BPD) during the hospital stay using weekly weight assessment methods. Methods This single-center, retrospective, cohort study was carried out in Zekai Tahir Burak Maternal Health Education and Research Hospital between 2014 and 2018. One hundred fifty-one preterm infants <32 weeks of gestation and <1500 g of birth weight with BPD were compared to 251 babies without BPD in terms of weekly weight gain, standard deviation score (SDS), and fall in weight SDS till discharge. Results Mean body weight was significantly lower in babies with BPD in all weeks except postnatal week (PW) 8. The groups had similar daily weight gain between birth and discharge (p = .78). Infants with BPD had lower weight SDS on postnatal day (PD) 14 and 21, and discharge, however similar on PD 28. The fall in SDS between PW 4 and discharge was significantly higher in the BPD group. Infants with BPD had higher fall in weight SDS between birth and discharge (p = .022). Discharge weight SDS was associated with gestational age and weight SDS on PW 4 in the whole cohort. Conclusion Infants with BPD showed a unique and unsteady pattern of growth compromise during the NICU course, most explicitly in early postnatal life and between PD 28-discharge. Future studies should consider not only the early postnatal life but also the period after four weeks of life till discharge to design an optimal nutrition strategy and decent growth for preterm infants with BPD

Is there any association between the efficacy of imaging techniques and the age of the patient in the diagnosis of acute appendicitis?

Aim: In this study, we aimed to assess whether there is any difference between the time and effectiveness seen in the diagnostic stage of acute appendicitis when an appropriate imaging method is selected for the patients in different age groups. Materials and Methods: During the 6-month period between October 1, 2015, and April 1, 2016, we retrospectively reviewed the files of patients who visited our emergency clinic, which is a third-step emergency department of a university hospital, and who then underwent operations at our hospital. Patients were evaluated according to their age: Group 1, 40 years and younger; Group 2, 40-60 years; Group 3, 60 years and older. Results: In this study, 97 patients (59.1%) were male and 67 patients (40.9%) were female. Their ages ranged from 19 to 86 years (mean age, 36.7 +/- 14.7 years). The percentage of patients who underwent only ultrasonography (US) was 52.3% in the first age group, 39.5% in the second age group, and 0.0% in the third age group (p<0.0001). The rates of patients who underwent only computerized tomography (CT) were 15.3% in the first age group, 28.9% in the second age group, and 60% in the third age group (p<0.0001). There was a statistically significant difference between the sensitivities of CT and US by age group (p<0.001). Conclusion: We believe that US should be the first method to be preferred in young and uncomplicated cases and that CT should be preferred in elderly patients with atypical presentations

Does severity of being small for gestational age in very low birth weight infants affect mortality?

Amaç: Gestasyon yaşına göre küçük (SGA) olmanın klasik tanımı, pretermlerde değişik derecelerde büyüme kısıtlılığının olması durumunda yetersiz değerlendirmeye sebep olabilir. Bu çalışmada çok düşük doğum ağırlıklı bebeklerde (ÇDDA) ılımlı ya da ciddi düzeyde SGA olmanın mortalite üzerine etkinliğinin araştırılması amaçlandı. Yöntem: Bu retrospektif çalışmaya 2013-2017 tarihlerinde hastanemizde doğan doğum ağırlığı 20 persentil olanlar AGA olarak gruplandırıldı. Persentil belirlemede Fenton büyüme eğrisi kullanıldı. Bulgular: Çalışmada SGA, M-SGA ve AGA grubuna sırası ile 34, 46 ve 631 bebek dahil edildi. Çalışmaya dahil edilen bebeklerden SGA olan grupta medyan doğum ağırlığı 660 g (560-720), M-SGA grubunda 800 g (720-870), AGA grubunda 1,080 g (920-1245) (p20 percentile were grouped as AGA. Fenton growth curve was used to determine percentile. Results: In the study, 34, 46 and 631 babies were included in the SGA, M-SGA and AGA groups, respectively. The median birth weight was 660 g (560-720) in the SGA group, 800 g (720-870) in the M-SGA group and 1080 g (920-1245) in the AGA group (p<0.001). Mortality rates were higher in SGA (44.1%) and M-SGA (15.2%) groups than in AGA (11.9%) groups (p<0.001). In logistic regression analysis, early neonatal sepsis [Odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5-4.3], severe intraventricular bleeding (OR: 3.8, 95% CI: 2.08-6.77) and being SGA (OR: 7.08, 95% CI: 2.5-14.7) are found as independent risk factors for mortality. The presence of moderate SGA was not detected as an independent risk factor for mortality. Conclusion: SGA with accompanying prematurity involves more risk for morbidity and mortality. The presence of moderate SGA in very low birth weight infants may also increase mortality. Further studies are needed with new classifications prepared considering the severity of SGA

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

Background: Preterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves. Methods: We retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight 16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22–2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23–36.9), RDS (OR: 1.81, 95% CI: 1.16–2.83), LNS (OR: 2.29, 95% CI: 1.43–3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38–3.23). Conclusion: The growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up

The Impact of Combined Oral Sildenafil and Inhaled Nitric Oxide for Treating Persistent Pulmonary Hypertension of the Newborn: A Single Center Experience

Objective: We aimed to compare the effect of the combined therapy, sildenafil and inhaled nitric oxide with inhaled nitric oxide monotherapy for the treatment of Pulmonary Hypertension of the Newborn. Study Design: Newborn infants (gestational age greater than 34 weeks) who were diagnosed with pulmonary hypertension between December 2008 and 2010 were retrospectively evaluated. Group I (n=14) received monotherapy with inhaled nitric oxide and Group II (n=9) received combined therapy with inhaled nitric oxide and oral sildenafil. Primary outcome was to compare the duration of inhaled nitric oxide therapy between groups. Results: Demographic characteristics were similar between the groups. Combination therapy was associated with early weaning of inhaled nitric oxide (4.8±1.5 vs. 13.5±7.6 hours). The duration of inhaled nitric oxide therapy was slightly shorter in combined therapy group (75[24-125] vs. 109[24-210] hours), however, the difference was insignificant (p=0.2). The incidence of mortality and neonatal outcomes were similar between the groups (p>0.05). Conclusion: Combined therapy did not result in shorter duration of inhaled nitric oxide therapy. Further well designed and larger studies that will elucidate the benefits of combination therapies and optimal therapy whereinhaled nitric oxide is not available are warranted