Evaluatıon of cochlear functıons and effects of noıse exposure ın babıes who were hospıtalızed ın Gazı Unıversıty Neonatal Intensıve Care Unıt

Gazi Üniversitesi Tıp Fakültesi (GÜTF) Yenidoğan Yoğun Bakım Ünitesinde (YDYBÜ) yatırılan prematüre ve miadında doğmuş bebeklerin yatışları boyunca maruz kaldıkları gürültünün frekans (Hertz) ve şiddetinin (desibel) belirlenmesi ile işitme ve nörolojik gelişimleri üzerine etkisini araştırmak amaçlanmıştır. YDYBÜ ne yatan 32 yenidoğan bebek ve kontrol amaçlı 25 sağlıklı bebek çalışmaya dahil edilmiştir. YDYBÜ‟nde yatan hastaların maruz kaldıkları gürültü yattıkları süre boyunca monitörize edilmiş, taburculuk öncesinde ve altıncı aylarında işitmelerini değerlendirmek amacıyla DPOAE ile TEOAE testleri yapılmış; nörolojik gelişlerini değerlendirmek amacıyla Bayley II gelişim testi uygulanmıştır. YDYBÜ‟de izlenen hastalarda ortalama 162,2 ± 134,9 saat kayıt yapılmıştır. Hastaların, AAP‟nin önerdiği üst sınır olan 45 dB üzerinde gürültüye yattıkları sürenin ortalama %50,1±13,9‟unda maruz kaldığı bulunmuştur. Hastaların hem 45 dB üzeri hem de 65 dB üzeri gürültüye en fazla küvöz motorunun neden olduğu 124 Hz ve altındaki frekanslarda maruz kaldığı bulunmuştur. YDYBÜ‟de izlenen bebeklerin taburculuk öncesi ve kontrol grubundaki bebeklerin de yenidoğan döneminde yapılan işitme tarama testleri TEOAE ve ABR‟den kalan yoktur. Ayrıca altıncı ayda yapılan işitme değerlendirmesi TEOAE ve DPOAE global değerlendirildiğinde işitme kaybı saptanmamıştır. DPOAE‟da test edilen 6 frekans ayrı ayrı incelendiğinde; hastanede yatan bebeklerin DPOAE SNR amplitüdleri (dB) ortalaması; hem sağ hem de sol kulakta 1001, 1501, 3003, 4004 ve 6006 Hz‟te kontrol grubuna göre daha düşük bulunmuştur. Ayrıca YDYBÜ‟de yatan bebeklerin testte 1001 Hz ve 1501 Hz‟de kontrol grubuna göre daha çok kaldığı saptanmıştır. YDYBÜ‟de yatan hastaların arasında testten kalanların 45 dB ve 65 dB üzeri gürültüye daha uzun süre maruz kaldıkları görülmüştür. Bu hastaların YDYBÜ‟de yatış süresi ile 45 dB üzeri maruz kalınan süre; 65 dB üzeri maruz kalınan süre; maruz kaldıkları ortalama gürültü arasında; maruz kaldıkları maksimum gürültü arasında aynı yönde korelasyon saptanmıştır. Bayley II gelişim testi puanları 1001 ve 1501 Hz‟te geçen ve kalan hastalar arasında fark bulunmamıştır. Sonuç olarak; YDYBÜ‟de gürültünün önerilenin üzerinde olduğu, gürültünün asıl kaynağının küvöz olduğu, bu hastaların işitme kayıpları olamamakla birlikte bazı frekanslarda işitme eşiklerinin yükseldiği saptanmıştır. YDYBÜ‟de önerilen ses düzeyinin genellikle aşıldığı ve bebeklerin uzun dönem işitmeleri üzerinde gürültünün olumsuz etki yarattığı saptanmıştır. Çalışmamız ünitemizin durumu konusunda farkındalığı arttırmış ve sonucunda gürültünün azaltılmasına yönelik düzenlemeler planlanmıştır.Thirty two infants that had been admitted to Gazi University Hospital, Neonatal Intensive Care Unit were included in this study. Thereafter, the ambiant noise exposure was determined via measurements of frequency (Hertz) and sound pressure levels (decibel). Our aim was to evaluate the adverse affects of noise on hearing and neurological outcomes. Noise levels were recorded continously during the hospitalization period. TEOAE, DPOAE and ABR tests were used to assess hearing. Hearing tests were performed before discharge and at sixth months of life. Neurological outcome was assessed with Bayley II Infant Development Scale. Noise levels were recorded during the hospitalization period and mean recording time was 162,2 ± 134,9 hours. At 50,1 ± 13,9 % of hospitalization period, infants were exposed to higher noise levels (above of 45 dB) than the recommended level stated by AAP. In spectral analysis of the noise, levels exceeding 45 dB and also 65 dB, were mostly below 124 Hz. Major source of the noise was traced back to the incubators. Before discharge from NICU all infants were screened for hearing loss. All patients passed the tests including TEOAE and ABR. On the sixth month follow up; TEOAE and DPOAE were performed and no hearing loss was detected again. Hospitalized infants had lower DPOAE SNR amplitudes (dB) at five frequencies including 1001, 1501, 3003, 4004, 6006 Hz. DPOAE pass rates at 1001 and 1501 Hz were significantly lower compared with healthy subjects. Infants who failed the test at 1001 and 1501 Hz, had been exposed to noise at longer periods of time, above the recommended level of 45 dB and 65 dB. We detected a positive correlation between noise exposure (above 45 dB, above 65 dB, mean noise level and maximum noise level) and duration of hospitalization. Infants who failed at 1001 and 1501 Hz had similiar Bayley II Infant Development Scale scores and there were no difference between groups. In conclusion, high noise levels above recommended levels were recorded at Gazi University Hospital NICU and the major noise source in NICU was found to be the incubators. Although hearing loss was not detected in any infants, hearing thresholds were increased at some frequencies. Ambient noise was mostly above recommended levels and this was thought to adversely affect the hearing tests performed at sixth months of life. This study increased the awareness of our NICU‟s physical condition and some arrangements should be planned to reduce noise levels

The Effects of Surfactant on Oxygenation in Term Infants with Respiratory Failure

Objective: The objective of the study was to evaluate the effects of exogenous surfactant on respiratory indices in term infants with respiratory failure. Methods: Consecutive 18 mechanically ventilated term infants, who received a single dose of exogenous surfactant were retrospectively included into the study. The respiratory outcome of surfactant rescue therapy was evaluated by comparing respiratory indices before and six hours after surfactant administration. Findings: Median oxygenation index (OI), mean alveolar pressure (MAP) and fraction of inspired oxygen (FiO2) values were significantly decreased (P<0.001); median arterial oxygen partial pressure (PaO2), arterial oxygen saturation (SaO2) and PaO2/FiO2 values were significantly increased six hours after surfactant treatment (P<0.001). Conclusion: Rescue therapy with surfactant was found to be effective in the improvement of early respiratory indices in term infants with respiratory failure

Oseltamivir use for viral pneumonia in newborns

Objective: Viruses are demonstrated to be an uncommon etiologic agent of early and late pneumonia. In this study we aimed to investigate the safety and affectivity of oseltamivir use for viral pneumonia in newborns. Methods: This was a retrospective study conducted in a single tertiary neonatal intensive care unit between September 2009 and April 2013. Demographic, clinical and laboratory data before and after treatment, duration of hospitalization, time of clinical improvement were recorded. Results: During the study period, a total of 69 newborn cases who were treated by oseltamivir for H1N1 swine flu (n=12) or suspicious influenza (n=57) were evaluated. Mean birth weight and gestational age were 3100±601 grams and 37.9±1.8 weeks, respectively. On admission, median postnatal age was 20.6 (7-47) days. Oseltamivir, along with supportive care, was administered as 3.0 mg/kg/dose twice a day for 5 days according to the recommendations of Food and Drug Administration (FDA). The median time of initiation of oseltamivir was 2.3 days (1-4) after admission and the median hospitalization day was 10.4 days (5-22). No adverse effects associated with oseltamivir were observed and all patients were discharged after full recovery. Conclusion: Oseltamivir use in addition to supportive therapy seems to be safe and effective in newborns with severe viral pneumonia

A new line method; A direct test in spinal muscular atrophy screening for DBS

Background: Nucleic acid-based assays provide an opportunity to screen for genetically encoded diseases like spinal muscular atrophy (SMA), before the onset of symptoms. Nowadays, such assays could be easily utilized as high-throughputs in SMA to detect a homozygous deletion of exon 7 of the survival motor neuron 1 gene (SMN1) that is responsible for >95% of SMA patients.Methods: We developed a new line method (NLM) as a direct real time PCR test procedure without nucleic acid extraction in dried blood spots (DBS) to screen for homozygous deletion of exon 7 of the SMN1 gene. Performance of this setup was evaluated on 580 DBS newborn samples and air dried 50 DBS from whole blood including 20 samples for homozygous deletion of the SMN1 gene detected earlier with MLPA.Results: We found all 580 newborn DBS samples as wild type. DBS prepared from 50 whole blood samples also including 20 affected people were correctly identified as homozygous deletions and 30 wild types of exon 7 of SMN1 as before with MLPA. When the MLPA method was taken as the gold standard, the sensitivity and specificity of the NLM test were found 100% for the detection of SMN1 exon 7 homozygous deletion.Conclusion: In the NLM, the total test duration has been reduced to less than 75 min without requiring any extra process such as DNA extraction step and sample plate preparation after the punching step. Thereby, newborn SMA screening with the NLM has gained an environmentally friendly feature with not requiring additional tedious steps.We thank all the newborns, patients and their family members who participated in this study, and we thank the SNP Biotechnology R ; D Ltd. team for their environmental friendly approach and work.We thank all the newborns, patients and their family members who participated in this study, and we thank the SNP Biotechnology Ramp;amp;D Ltd. team for their environmental friendly approach and work

Additive effect of mesenchymal stem cells and defibrotide in an arterial rat thrombosis model

Background/aim. In this study, we aimed to investigate the additive effect of mesenchymal stem cells (MSC) and defibrotide (DFT) in a rat model of femoral arterial thrombosis. Methods. Thirty Sprague Dawley rats were included. An arterial thrombosis model by ferric chloride (FeCl3) was developed in the left femoral artery. The rats were equally assigned to 5 groups: Group 1-Sham-operated (without arterial injury); Group 2-Phosphate buffered saline (PBS) injected; Group 3-MSC; Group 4-DFT; Group 5-MSC + DFT. All had two intraperitoneal injections of 0.5 ml: the 1st injection was 4 h after the procedure and the 2nd one 48 h after the 1st injection. The rats were sacrificed 7 days after the 2nd injection. Results. Although the use of human bone marrow-derived (hBM) hBM-MSC or DFT alone enabled partial resolution of the thrombus, combining them resulted in near-complete resolution. Neovascularization was two-fold better in hBM-MSC + DFT treated rats (11.6 +/- 2.4 channels) compared with the hBM-MSC (3.8 +/- 2.7 channels) and DFT groups (5.5 +/- 1.8 channels) (P < 0.0001 and P= 0.002, respectively). Conclusion. The combined use of hBM-MSC and DFT in a rat model of arterial thrombosis showed additive effect resulting in near-complete resolution of the thrombus

Perfusion index assessment during transition period of newborns: an observational study.

Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as "delayed transition", others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.

Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants

Grading the level of evidence of neonatal pharmacotherapy:midazolam and phenobarbital as examples

Background: Many drugs are used off-label or unlicensed in neonates. This does not mean they are used without evidence or knowledge. We aimed to apply and evaluate the Grading and Assessment of Pharmacokinetic–Pharmacodynamic Studies (GAPPS) scoring system for the level of evidence of two commonly used anti-epileptic drugs. Methods: Midazolam and phenobarbital as anti-epileptics were evaluated with a systematic literature search on neonatal pharmacokinetic (PK) and/or pharmacodynamic [PD, (amplitude-integrated) electroencephalography effect] studies. With the GAPPS system, two evaluators graded the current level of evidence. Inter-rater agreement was assessed for dosing evidence score (DES), quality of evidence (QoE), and strength of recommendation (REC). Results: Seventy-two studies were included. DES scores 4 and 9 were most frequently used for PK, and scores 0 and 1 for PD. Inter-rater agreements on DES, QoE, and REC ranged from moderate to very good. A final REC was provided for all PK studies, but only for 25% (midazolam) and 33% (phenobarbital) of PD studies. Conclusions: There is a reasonable level of evidence concerning midazolam and phenobarbital PK in neonates, although using a predefined target without integrated PK/PD evaluation. Further research is needed on midazolam use in term neonates with therapeutic hypothermia, and phenobarbital treatment in preterms. Impact: There is a reasonable level of evidence concerning pharmacotherapy of midazolam and phenobarbital in neonates. Most evidence is however based on PK studies, using a predefined target level or concentration range without integrated, combined PK/PD evaluation.Using the GAPPS system, final strength of recommendation could be provided for all PK studies, but only for 25% (midazolam) to 33% (phenobarbital) of PD studies.Due to the limited PK observations of midazolam in term neonates with therapeutic hypothermia, and of phenobarbital in preterm neonates these subgroups can be identified for further research.</p