Effect of Fluid Supplementation on Serum Bilirubin Level During Phototherapy of Exclusively Breastfed Term Infants with Hyperbilirubinemia

Aim:This study compared the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy.Materials and Methods:A randomized controlled study was carried out in the neonatal intensive care unit of Zeynep Kamil Maternity and Children Training and Research Hospital (Istanbul, Turkey) over a 4-month period. Fifty healthy term infants with hyperbilirubinemia were randomized to receive either solely breastmilk (n=25) or both breastmilk and intravenous fluid (n=25) during phototherapy.Results:There were no significant differences (p>0.05) in the mean birth weight, mean gestastional age, modes of delivery, mean time of admission age, mean serum osmolality, and hematocrit and reticulocyte count between the two groups. Similarly, there was no significant difference (p>0.05) in the mean indirect serum bilirubin level at the time of admission to the neonatal intensive care unit and at 4, 8, 12, 24, and 48 hours after commencement of phototherapy between the two groups. There was no significant difference (p>0.05) in the mean duration of phototherapy or in the median duration of hospitalization between the two groups.Conclusion:Based on our results, intravenous fluid support has no effect on the rate of decrease in serum bilirubin and decrease in duration of phototherapy in healthy term newborns with no dehydration. However, using the oral route avoided the need for intravenous cannula and their attendant complications. Insensible fluid loss is increased during phototherapy, so protection of hydration status with oral feeding is important for newborns

Effect of Fluid Supplementation on Serum Bilirubin Level During Phototherapy of Exclusively Breastfed Term Infants with Hyperbilirubinemia

Amaç:Bu çalışmada fototerapi alan term yenidoğanlara intravenöz veya oral sıvı desteği verilerek serum bilirubin seviyelerinin düşüş oranları karşılaştırılmıştır.Materyal ve Metot:Zeynep Kamil Kadın Doğum ve Çocuk Eğitim ve Araştırma Hastanesi'nin (İstanbul, Türkiye) yenidoğan yoğun bakım ünitesinde 4 aylık bir süre içinde gerçekleştirilmiş randomize kontrollü bir çalışmadır. Elli sağlıklı term bebek, hiperbilirübinemi nedeniyle fototerapi alırken sadece anne sütü (n=25) veya hem anne sütü hem de intravenöz sıvı (n=25) alacak şekilde randomize edildi.Bulgular:Her iki grup arasında doğum ağırlığı, gestasyonel yaş, doğum şekli, hastaneye kabul yaşı, serum osmolalitesi, hematokrit ve retikülosit sayısı ortalamaları açısından anlamlı fark yoktu (p>0,05). Benzer şekilde, yenidoğan yoğun bakım ünitesine başvuru sırasında ve fototerapi başladıktan sonraki 4, 8, 12, 24 ve48. saatlerde serum total bilirubin düzeyi ortalamaları her iki grup için karşılaştırıldığında anlamlı fark yoktu (p> 0,05). Fototerapi süresi ve hastanede kalış süresi ortalamaları karşılaştırıldığında iki grup arasında anlamlı fark yoktu (p>0,05).Sonuç:Elde ettiğimiz sonuçlara göre, dehidratasyonu olmayan sağlıklı yenidoğanlara intravenöz sıvı desteği verilmesi serum bilirubin düşüş oranı ve fototerapi süresi üzerinde etkili değildir. Bununla birlikte, oral yolun kullanılması, intravenöz kanül gereksinimi ve bunlara ilişkin komplikasyonlardan kaçınmayı sağladı. Fototerapi sırasında insensibl sıvı kaybı artacağından oral beslenme ile hidrasyonun korunması çok önemlidir.Aim:This study compared the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy. Materials and Methods:A randomized controlled study was carried out in the neonatal intensive care unit of Zeynep Kamil Maternity and Children Training and Research Hospital (Istanbul, Turkey) over a 4-month period. Fifty healthy term infants with hyperbilirubinemia were randomized to receive either solely breastmilk (n=25) or both breastmilk and intravenous fluid (n=25) during phototherapy. Results:There were no significant differences (p>0.05) in the mean birth weight, mean gestastional age, modes of delivery, mean time of admission age, mean serum osmolality, and hematocrit and reticulocyte count between the two groups. Similarly, there was no significant difference (p>0.05) in the mean indirect serum bilirubin level at the time of admission to the neonatal intensive care unit and at 4, 8, 12, 24, and 48 hours after commencement of phototherapy between the two groups. There was no significant difference (p>0.05) in the mean duration of phototherapy or in the median duration of hospitalization between the twogroups. Conclusion:Based on our results, intravenous fluid support has no effect on the rate of decrease in serum bilirubin and decrease in duration of phototherapy in healthy term newborns with no dehydration. However, using the oral route avoided the need for intravenous cannula and their attendant complications. Insensible fluid loss is increased during phototherapy, so protection of hydration status with oral feeding is important fornewborns

EWSR1(22q12) Translocation Positive Pediatric Adrenal Tumor with Loss of 1p, 11q, and Unbalanced Gain of 17q: Neuroblastoma or Ewing Sarcoma?

Background: Although neuroblastoma and Ewing sarcoma/Primitive neuroectodermal tumor are different clinical entities, they are both a member of small round blue cell tumors and can mimic each other's behavior in clinical and molecular aspects. Case report: A 3 year-old girl with an abdominal mass was found to have a small round blue cell tumor originating from the right adrenal gland. High level of neuron specific enolase, initial genetic test results (N-Myc amplification: negative, loss of 1p, 11q, and unbalanced gain of 17q) and characteristic radiological appearance of the tumor suggested a preliminary diagnosis of neuroblastoma but further analysis showed CD99 expression and presence of EWSR1 rearrangement, which are mostly observed in Ewing sarcoma. Conclusion: Adrenal gland tumors of childhood with complex immunophenotypic features requires distinguishing two discrete tumors in the small round blue cell tumor group, neuroblastoma and Ewing sarcoma. Although no exact diagnosis of the tumor was made, we reached a good response with neuroblastoma treatment protocol

The Efficacy and Safety of Procedural Sedoanalgesia with Midazolam and Ketamine in Pediatric Hematology

Objective: The aim of this study is to investigate the efficacy and safety of sedoanalgesia performed outside the operating room by pediatricians trained in advanced airway management and life support. Materials and Methods: Midazolam and ketamine were administered consecutively by intravenous route under cardiorespiratory monitoring for painful procedures of pediatric hematology. Results: A total of 115 patients had 237 sedoanalgesia sessions. Sedation time was 24.02±23.37 s and sedation success was 92.5% (Ramsay scores of ≥5). Patient satisfaction was high. The recovery time was 28.81±14.4 min. Although statistically significant (p<0.01) increases in systolic and diastolic blood pressure, heart rate, and respiratory rate were observed without clinical importance, they improved without any intervention. No severe adverse events were observed. Conclusion: Sedoanalgesia with intravenous midazolam and ketamine for pediatric hematology and oncology patients’ painful minor invasive procedures performed in an optimally equipped setting outside the operating room by pediatricians trained and certificated in advanced airway management and life support is effective and safe

Predictive value ofplatelet count and mean platelet volume in diagnosis oflate onset neonatal sepsis

Giriş ve Amaç: Bu çalışmamızda geç sepsis/i yenidoğanlarda, trombosit sayısı ve ortalama trombosit hacmini (MPV) 'i tayin ederekyenidoğanın geç sepsisinin erken tanısında değerini belirlemeyi amaçladık. Gereç ve yöntem: Çalışma, geç sepsis tanısıyla yatan, 5-28 günlük hastalar üzerinde retrospektif olarak yapıldı. Kontrol grubu herhangi bir sağlık problemi olmayan 40 hastadan (20 erkek, 20 kız), hasta grubu ise kan kültürlerinde üreme olan 19 kız, 21 erkek olmak üzere 40 hastadan oluşturuldu. Trombosit ve MPV değerleri hastaya antibiyotik başlanmadan hemen önce alındı. Trombosit ve MPV ölçümleri Badanan Couter hemogram sayıcısı ile yapıldı. İstatistiksel analizler için SPSS (Statistical Package for Social Sciences) for Windows 13.0 programı kullanıldı. Bu çalışma Göztepe Eğitim ve Araştırma Hastanesi etik komisyonunca onaylandı. Bulgular: Hasta grubu olgularının MPV düzeyleri kontrol grubuna göre anlamlı derecede yüksek bulunmuştur (p<O,Ol). Hasta grubunun trombosit değerleri ise kontrol grubuna göre anlamlı derecede düşük olarak bulundu (p<O, OJ). Trombosit sayısı için sensitivite% 82,5, spesifisite %100, pozitif tahmin değeri % 100 ve negatif tahmin değeri % 85,1 bulundu. MPV değerlendirmesinde sensitivite % 52,5; spesifisite %92,5; pozitiftahmin değeri % 87,5 ve negatiftahmin değeri% 66,1 olarak bulundu. Çıkarımlar: Özellikle hastane enfeksiyon/arına bağlı olarak gelişen geç sepsisin klinik bulgularının tam olarak ortaya çıkmadığı erken dönemde, trombosit sayısı ve MPV değerleri yol gösterici olabilir. Ancak yine de trombosit sayısı ve MPV' nin geç sepsis tanısında ve takibinde güvenilir olduğunu göstermek için diğer enfeksiyon belirteç/erini de içeren kıyaslamalı çalışmalara gereksinim vardır.Objective and Aim: The purpose of this study was to analyse the predictive value ofplatelet count and mean platelet volume in early diagnosis of Iate onset neonatal sepsis. Material and Method: The study is done retrospectively with 40 Iate onset sepsis subjects who had positive blood cultures and aged between 5-28 days old and 40 healthy subjects matchedfor age. Platelet and MPV levels are determined before antibiotics use. Platelet and MPV measurements are done with Backman Couter blood eel! counter. SPSS for Wındows 13. O software programme was usedfor statistical analysis. This study is approved by the ethics committee of the G&ouml;ztepe Hospital. Results: MPV levels are found significantly higher in study group than the control group (p&lt;O,OJ). Platelet count is found significantly lower in study group than the control group (p&lt;O, Ol). Sensitivity, specifity, positive predictive value and negative predictive value for pletelet count are found 82. 5%, 100%, 100% and 85.1% respectively. Sensitivity, specifity, positive predictive value and negative predictive value for MPV are found 52.5%, 92.5%, 87.5% and 66.1% respectively. Conclusions: Platelet count and MPV levels may have predictive value especially in early stages of nasocomial originated Iate onset neonatal sepsis. But comparetive studies with the other infectious markers are needed to mark the reliability of platelet count and MPV in diagnosis andfollow up ofIate onset neonatal sepsis

High Infection-Related Mortality in Pediatric Acute Myeloid Leukemia without Preventive Antibiotics and Antifungals: Retrospective Cohort Study of a Single Center from a Middle-Income Country

Objective: This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country. Materials and Methods: Infection-related mortality was evaluated retrospectively in 49 pediatric patients. Results: A total of 173 chemotherapy courses were administered as first-line chemotherapy. Four patients died during induction: one patient due to intracranial bleeding, two patients due to typhlitis, and one patient due to invasive fungal infection with pulmonary vascular invasion and massive bleeding. Another two patients died with resistant disease. During consolidation there were four infection-related deaths and one death due to cardiotoxicity. In first-line chemotherapy mortality was 22% (11/49); infection-related mortality was 14% (7/49). Event-free survival and overall survival at 6 years were 42.9% and 61.2% (95% CI: 44-76 and 66-99 months), respectively. Conclusion: Due to considerable infection-related deaths, antibacterial and mold-active antifungal prophylaxis may be tried during neutropenic periods in pediatric AML