Severe Apnea in a Premature Infant after Accidental Vancomycin Overdose Responsive to Treatment with Exchange Transfusion

Background: Mostly seen toxicities following vancomycin are ototoxicity and nephrotoxicity. We here report a very low birth weight preterm neonate who developed severe episodes of apnea after accidental iatrogenic vancomycin overdose, responsive to treatment with double volume exchange transfusion. Case report: A preterm neonate weighing 1380 grams received two doses of 10-fold of the normal dose of vancomycin per kg in this age group. She developed sudden onset of frequent and severe episodes of apnea, which required noninvasive ventilation. Using fluorescence polarization immunoassay, serum vancomycin level was found to be 84 μg/mL 10 hours after the last dose. The patient underwent exchange transfusion. Apnea episodes terminated 12 hours after exchange transfusion. The blood level of vancomycin decreased from 84 μg/mL before exchange to 67 μg/mL immediately post-exchange and eventually to less than 1 μg/mL in 36th hour after exchange. Discussion: Target peak concentration of vancomycin in neonates is between 20 and 40 μg/mL and trough concentration ranges from 5 to 10 μg/mL. Peak serum concentration of our patient can be back extrapolated to be about 336 μg/mL which was higher than the target level. This high plasma levels of vancomycin might be the cause of apnea in our patient as evidenced in similar reports. Conclusion: Apnea is a potential sign of vancomycin overdose in neonates and infants treated with this antibiotic. Exchange transfusion is a potential effective treatment to rapidly resolve this unwanted complication

Evaluation of Endometrial Precancerous Lesions in Postmenopausal Obese Women - A High Risk Group?

Aim: To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women. Materials and Methods: Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group. Results: We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group. Conclusions: We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important

Nasal HFOV with Binasal Cannula Appears Effective and Feasible in ELBW Newborns.

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation

Different presentations of cow's milk protein allergy during neonatal period

Cow's milk protein allergy (CMPA) is the most common cause of allergy occurring in the first year of life due to infant formula or breast-milk of mothers who are drinking cow's milk or eating cow's milk products. Most children with allergic colitis are symptomatic in the first months, usually by 4 weeks. There are rare cases whom were sensitized prenatally and demonstrated symptoms in the first week, even in the first 2 days of life. The most common clinical sign of CMPA is bloody stool in a well-appearing infant. Gross bloody stool or fecal occult blood are also the common signs of necrotizing enterocolitis (NEC), especially in preterm infants with systemic instability. The treatment options are totally different so the clinician has to be very careful evaluating the patient. We report 5 preterm cases of CMPA, two of whom were siblings. Two of them presented with massive bloody stools and 3 of them presented with abdominal distension and fecal occult blood all of which were initially considered as NEC. Literature review of 20 cases with similar history is summarized as well

Nasal HFOV with Binasal Cannula Appears Effective and Feasible in ELBW Newborns

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation

Effects of a closed system suction connector on airway resistance in ventilated neonates

Background/aim: Increased airway resistance reduces the effectiveness of ventilation treatment. Endotracheal tubes (ETTs) and connectors contribute to resistance. However, the effect of a closed system suction (CSS) connector is not well known. We compared the in vivo resistance occurring with a CSS connector with that of the standard connector. Materials and methods: This prospective study was conducted at Gazi University Hospital's neonatal intensive care unit. Intubated neonates were studied for two cycles; each cycle contained two periods of ETT + connector pairs (15 min/period) as follows: cycle 1 {[}A: long ETT + standard connector; B: long ETT + CSS connector] and cycle 2 {[}C: shortened ETT + standard connector; D: shortened ETT + CSS connector]. Resistance of 40 breaths/period was averaged for each case, and the means were analyzed by Wilcoxon test for pairwise comparisons between standard and CSS connectors. As each case provided two cycle data, 16 cycle data were compared. Results: The CSS connector increased resistance by 13.8\% (range: 3.0\%-22.1\%) compared to the standard connector; P < 0.001. The resistance increase was similar between long {[}17.3\% (range: 3.0\%-17.7\%)] and shortened ETTs {[}15.3\% (range: 5.0\%-29.6\%)]; P = 0.834. Conclusion: CSS connectors were found to increase airway resistance in ventilated neonates. The contribution of CSS should be considered during ventilation, particularly in the presence of difficulty in providing sufficient tidal volume