Ultrasonography Causes Agitation and Pain Leading to Hemodynamic Disturbance in Neonates: A Prospective Observational Study

Background: Ultrasonography is widely used in neonatological practice and studies investigating the hemodynamic effects of various treatment protocols or clinical situations. On the other hand, pain causes changes in the cardiovascular system; so, in the case of ultrasonography leading to pain in neonates, it may cause hemodynamic alterations. In this prospective study, we evaluate whether ultrasonographic application causes pain and changes in the hemodynamic system. Methods: Newborns undergoing ultrasonographic examination were enrolled in the study. Vital signs, cerebral and mesenteric tissue oxygenation (StO2) levels, and middle cerebral artery (MCA) Doppler measurements were recorded, and NPASS scores were calculated before and after ultrasonography. Results: We enrolled 39 patients in the study. After ultrasonography, Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores were significantly higher (p 2, diastolic and systolic blood pressure; p = 0.03; p p p p = 0.02, p = 0.03, respectively) were altered. Cerebral (p = 0.008) and mesenteric (p = 0.039) StO2 levels were significantly lower in the whole study group, MCA end-diastolic velocity decreased (p = 0.02), and the resistive index (p = 0.03) increased in patients whose NPASS score was >7 after ultrasonography. Conclusions: This study is the first to show that ultrasonography may cause pain in newborn patients, and alters vital signs and hemodynamic parameters. Therefore, precautions should be taken to protect newborn babies from pain during ultrasound applications, as they are already exposed to many noxious stimuli. Furthermore, pain scores should be considered in studies using ultrasonography and evaluating hemodynamic parameters to increase the reliability of the studies

Thyroid Storm Complicating Pregnancy, A Case Report and Management

The incidence of hyperthyroidism in pregnancy is between 0,05 % and 0,2%. Graves disease is the most common cause of hyperthyroidism in pregnancy. Decrease in Thyroid Stimulating Hormone(TSH) levels and increase in free thyroxine levels are used for diagnosis of thyrotoxicosis. If hyperthyroidism is not treated during pregnancy, these pregnancies are prone to both maternal and fetal complications. Here we present a case of thyrotoxicosis with some maternal and fetal complications. 37 year old woman ,G4P2A1 with 28 - 29 weeks of pregnancy admitted to our clinic with complaints of back pain, painful uterine contractions and low pelvic pressure. Her blood pressure was 200/120mmHg, pulse rate was 120/min. She had tremor and exolphtalmic eyes, diffuse edema on legs. On suspect of hyperthyroidism she was told to uncover her neck. A diffuse goiter on neck was examined. Her thyroid hormones were sent for control. Thyroid hormone levels were TSH:0,009 uIU/ml, Free T3 :17,2 pg/ml (2-4,4),Free T4:>6 ng/ml (0,9-1,7). On emergency consultation, she had the diagnosis of Basedow Graves complicated with thyroid storm and undertaken to emergency treatment. Her blood glucose levels were checked four times in a day regularly and she had fasting blood glucose levels >120mg/dl and postbrandial blood glucose levels >200mg/dl and with the diagnosis of gestational diabetes, she has been started on ınsuline therapy. After 3 months of treatment, she gave birth to 2700gr, 44cm, Apgar 7-8 fetus. Postpartum no maternal or fetal complications were seen. Postpartum at the first week the baby had hyperthyroidism symptoms with the placental transport of autoantibodies, therefore breast feeding was stopped and checked for hormone levels regularly. The baby is now under control for the possibility of expected hypothyroidism. In uncontrolled hyperthyroidism, preeclampsia, premature birth, abruptio placenta, intrauterine growth retardation, fetal hyperthyroidism, stillbirth rates increase. These complication rates fall with the treatment of hyperthyroidism. Not only IUGR, we think gestational diabetes mellitus and macrosomic or LGA(large for gestational age) fetus could be one of the results of hyperthyroidism and high metabolic state in pregnancy. Hyperthyroidism in pregnancy is more frequent in our country and may mimic many pregnancy related conditions and should be differentiated and managed carefully

Turkish Validity Reliability of the Pediatric Peripheral Intravenous Infiltration Scale and Its Adaptation to Newborns

Aim: The aim of this study is to determine the Turkish validity reliability and newborns’ adaptation to Pediatric Peripheral Intravenous Infiltration Scale. Materials and Methods: This study is methodological and was conducted on 54 newborns with the simultaneous evaluation of two observers. Each infant was monitored 8 times with hourly observations from when the vein path was changed, and a total of 864 observational outcomes were assessed with scale. SPSS program was used for statistical evaluations. Results: A total of 54 newborns were taken into the study and the proportions of cases at each care level in neonatal intensive care unit were similar (level 1: 16 patients, level 2: 23 patients, level 3: 15 patients (p=0.348). The most commonly used fluid was found to be dextrose 10% in 63%, and total parenteral nutritional fluid in 26%. The newborns’ postnatal age was median 3 days (minimum: 1, maximum: 27). A total of 864 observations were made for 8 hours and in the 35% (n=19) of 54 babies, the vein pathway was changed after the first observation. 69% of the infants whose vascular accesses were changed, were identified in the first stage (1 point), 25% in the second stage (2 points), and vascular accesses were renewed. The Krippendorff’s alpha reliability coefficient showing the integration between the two evaluators was 1.00 (p<0.001). This result shows “full agreement” between the two evaluators. Intra-class correlation coefficient showing reliability between measurements was r=0.99 (p<0.001). This coefficient also indicates that the measurements are highly reliable. Conclusion: Intravenous infiltration and extravasations are preventable complications in neonates and should be assessed with the aid of a scale at regular intervals. Pediatric Peripheral Intravenous Infiltration Scale can be used in newborns and also in Turkish

Malondialdehyde Level in the Cord Blood of Newborn Infants

Objective: In this study, we aim to demonstrate that measurement of the malondialdehyde (MDA) level in the umbilical cord blood of newborn infants born via cesarean section (C/S) and normal vaginal delivery (NVD) is indicative of oxidative stress during the perinatal period. Methods: The study was conducted at Bakirkoy Training and Research Hospital between January 2006 and April 2006 on 15 newborns born via elective C/S, 15 newborns born via emergency C/S, and 15 newborns born via normal vaginal delivery. Complete blood count, total bilirubin, glucose, creatinine phosphokinase (CPK), uric acid, iron, blood gas, and malondialdehyde levels were measured in the umbilical cord blood Findings: Malondialdehyde levels in the umbilical cord blood in the emergency C/S and NVD groups were found to be statistically and significantly higher than those in the elective C/S group. In the emergency C/S group, it was determined that the malondialdehyde level increased as the oxygen saturation of the umbilical cord blood increased. In the NVD group, a positive correlation was detected between the total bilirubin and malondialdehyde levels in the umbilical cord blood. In the emergency C/S group, the malondialdehyde level was recorded to be high in the infants with high level of uric acid in the umbilical cord blood. Conclusion: We concluded that the malondialdehyde level in umbilical cord blood could serve as an indication of perinatal oxidative stress and that it could thus help in preventing permanent damage

Serum zinc levels in children of 0–24 months diagnosed with pneumonia admitted to our clinic

Aim: We have planned to study the relationship between zinc (Zn) plasma levels, as well as pneumonia criteria, and zinc in healthy children younger than 2 years of age compared to pediatric patients diagnosed with pneumonia and admitted to a hospital. Materials and methods: The study enrolled 25 patients of 0-24 months referring to our hospital's pediatric clinic, who were then diagnosed with bronchopneumonia based on the World Health Organization diagnostic criteria and admitted to suckling children clinic due to inability to receive out-patient treatment, and 10 healthy children of the same age group, whose physical examinations revealed no pathological findings. Results: There was no difference between the groups in terms of age and gender distribution (p> 0.05). The control group included in the study showed a significantly higher mean duration of breast milk intake compared to the patient groups (p<0.001). WBC values obtained from the patient group was significantly higher than that of the control group (p<0.001). Zn and iron (Fe) values as determined in the control group enrolled in the study were significantly higher compared to the patient group (p<0.01). Mean total protein in the control group was found to be significantly higher versus that of the patient groups (p<0.05). With regard to the r values of correlation coefficients of the subjects enrolled in the study, a slightly positive correlation was observed between Zn levels and iron levels (r=0.457). Conclusion: It was concluded that infections, particularly pneumonia, which present a serious issue both in our country and developing countries, may be developed more commonly among children with zinc deficiency

Neonatology oxidative status in preterm infants with premature preterm rupture of membranes and fetal inflammatuar response syndrome

The aim of this study, to determine an index of oxidative stress index in preterm infants less than 34 weeks gestational age with premature preterm rupture of membrane (PPROM) and fetal inflammatory response syndrome (FIRS). Methods: This study was designed as a prospective study. Fifty-one premature infants less than 35 weeks of gestational age were included in the study. The umbilical cord blood concentrations of IL-6, TAC (total antioxidant capacity) and PON-1 (paraoxonase-1) levels and TOS (total oxidative stress) were studied. The oxidative stress index (OSI = TAC/TOS) was calculated in all of prematüre infants. PPROM was defined as rupture of membranes at least 24 hours before the onset of labor. FIRS was defined by an umbilical cord IL-6 level greater than 11 pg/mL. Premature infants included in the study were divided into 4 groups. Group 1 included preterm infants without FIRS and with PPROM (n = 16), while Group 2 included preterm infants without PPROM and with FIRS (n = 9), Group 3 consisted of premature infants with PPROM and FIRS (n = 21) and Group 4 included premature infants without PPROM or FIRS (n = 5). Results: Umbilical cord TOS level was found to be higher in the preterm infants without FIRS and with PPROM (36.1 μmol H2O2 Equiv./L) compared to the preterm infants without PPROM or FIRS (11.9 μmol H2O2 Equiv./L) (p = 0.03). Umbilical cord PON-1 level was found to be lower in the preterms without FIRS and with PPROM (32 U/L), preterms without PPROM and with FIRS (30. 3 U/L) and the preterm infants with both PPROM and FIRS (48.6 U/L) compared to the preterm infants having no PPROM or FIRS (85.6 U/L) (p = 0.001). Conclusion: High pro-oxidant capacity was found in PPROM and low antioxidant capacity in PPROM and FIRS