Is high platelet distribution width in the first hours of life can predict hemodynamically significant patent ductus arteriosus in preterm newborns?

Aim: To determine whether there is any association between platelet indices within the first hours of life and hemodynamically significant patent ductus arteriosus (hsPDA) in preterm newborns. Patient and methods: A total of 100 preterm infants, gestational age <32 weeks and birth weight <1500 g were analyzed in the study. Complete blood counts obtained within the first 6 hours of life were evaluated for platelet parameters and compared for patent ductus arteriosus (PDA) status. Results: We included 50 infants with hsPDA and 50 controls. Mean gestational week of patients were 28.8 ± 2.4 weeks and mean birth weight of the patients were 1237.5 ± 406 g. Platelet distribution width (PDW) is higher in PDA group compared with the control group (p =.023). The cutoff value of PDW is 11.45 fL for hsPDA with 65% sensitivity and 66% specificity. The other blood parameters including platelet count, platelet mass, and mean platelet volume (MPV) were no statistically different between the two groups. Also, there was no association with the platelet count and the response to the medical therapy. Conclusions: There is no association between hsPDA and the platelet count, platelet mass or MPV in the first day of life. We determined that hsPDA patency was significantly associated with a higher first day PDW level, which is a more specific indicator of platelet activation than other platelet parameters

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Serum alpha fetoprotein levels in healthy infants less than one year of age

Tıpta Uzmanlık TeziAlfa-fetoprotein, fetal bir serum proteinidir. Çocukluk çağında önemli bir tümör belirteci olan alfa-fetoproteinin gebelikte, yenidoğanlarda ve süt çocukluğu döneminde patoloji olmaksızın yükselebildiği de vurgulanmaktadır. Çoğu kez alfa-fetoproteinin normal olarak mı, yoksa patolojik olarak mı yükseldiği konusunda çelişkiye düşülmekte ve ileri görüntüleme yöntemleri gibi pahalı ayırıcı tanı yöntemlerine başvurulmaktadır. Bir yaş altı dönemde alfa-fetoprotein değerlerinin normal aralığı iyi dökümante edilebilirse bu değerler aşıldığında patolojik durumun tanımlanması daha kolay olacaktır. Bu çalışmanın amacı bir yaş altı sağlıklı çocuklarda serum alfa-fetoprotein düzeylerinin yaşa göre normal değer aralıklarının belirlenmesidir. Kan örnekleri sağlıklı yenidoğan ve süt çocuklarından alındı. Süt çocukluğu dönemi: 1-2 ay, 3-6 ay, 7-9 ay ve 10-12 ay olarak gruplandırıldı. İstatistiksel olarak her dönemden 30 olgu rastgele olarak çalışmaya alındı ve cinsiyet dağılımının eşit olmasına dikkat edildi. Yüzelli olgu (75 erkek, 75 kız) değerlendirildi. Serum alfa-fetoprotein düzeyleri katı fazlı-iki yönlü kemilüminesan immünometrik tanısal yöntemi kullanılarak çalışıldı. Ortalama serum alfa-fetoprotein düzeyleri, yenidoğan döneminde 2-7 gün arasında 40609±17903 (8998-54000) ng/ml, 8-28 gün arasında 2140±2833 (65-10675) ng/ml, süt çocukluğu döneminde 2-3 ay arasında 600±700 (20-2711) ng/ml, 4-6 ay arasında 60±44 (5-202) ng/ml, 7-9 ay arasında 49±102 (4-480) ng/ml ve 10-12 ay arasında 16±7 (3-57) ng/ml olarak saptandı. Yaş arttıkça ortalama serum alfa-fetoprotein düzeylerinin azaldığı görüldü. Cinsiyetler arasında anlamlı fark saptanmadı. Sonuç olarak merkezimizde takip edilen sağlıklı yenidoğan ve süt çocukluğu döneminde serum alfa-fetoprotein normal sınırlarının geniş bir aralıkta olduğu görüldü. Bir yaş altı çocuklarda serum alfa-fetoprotein düzeylerini yükselten tümör ve tümör dışı nedenler araştırılırken sağlıklı çocuklardan elde ettiğimiz minimum ve maksimum değerlerin de gözönünde bulundurulması uygundur. Anahtar Kelimeler: Alfa-fetoprotein, normal sınır, yenidoğan, süt çocuğuAbstractAlpha-fetoprotein is a fetal serum protein. It is emphasized that alfa-fetoprotein is a significant tumor marker in childhood, however may increase in the absence of a pathology such as during pregnancy, neonatal period and infancy. It is frequently considered contradictory whether high levels of alfa-fetoprotein are due to a pathological condition or just normal finding and expensive procedures such as advanced screening techniques for differential diagnosis are performed. If the normal range of alfa-fetoprotein levels can be favorably documented for those infants less than one year of age, when these levels are exceeded, it would be easier to define the pathological condition. The aim of this study is to determine the normal range of serum alfa-fetoprotein levels in healthy children less than one year of age. Blood samples were collected from healthy newborns and infants. Infancy period was grouped as 1-2 months, 3-6 months, 7-9 months and 10-12 months of ages. From each group, 30 cases were randomly included in the study and sex distribution was equal. One hundred and fifty cases (75 males, 75 females) were enrolled. Serum alfa-fetoprotein levels were determined by a solid-phase, two-site chemiluminescent immünometric diagnostic assay. Mean serum alfa-fetoprotein levels were detected as 40609±17903(8998-54000) ng/ml between postnatal 0-7 days, 2140±2833 (65-10675) ng/ml between postnatal 8-28 days, and 600±700 (20-2711) ng/ml, 60±44 (5-202) ng/ml, 49±102 (4-480) ng/ml, 16±7 (3-57) ng/ml for 2-3 months, 4-6 months, 7-9 months and 10-12 months of infancy, respectively. There was a negative corelation between mean serum alfa-fetoprotein levels and postnatal age. There was no significant difference between and within the groups in terms of gender. In conclusion, normal levels of serum alfa-fetoprotein in healthy newborns and infants who were followed-up in our center demonstrated a wide range. Our data provided from healthy children less than one year of age, for minimum and maximum values of serum alfa-fetoprotein can be taken into consideration when evaluating the causes of tumors and non tumor etiologies that elevate serum alfa-fetoprotein levels. Key Words: Alpha-fetoprotein, normal range, newborn, infan

High flow nasal cannula versus nasal continuous positive airway pressure for primary respiratory support in preterm infants: A prospective randomized study

Objective b-This study compares high flow nasal cannula (HFNC) with nasal continuous positive airway pressure (nCPAP) within the first hour of life as the primary respiratory support in neonates of ≤32 weeks of gestational age. Study Design b-This prospective, randomized study was conducted in infants with a gestational age of ≤32 weeks who had spontaneous respiration. HFNC or nCPAP was used as a first line respiratory support after admission to intensive care unit. Primary outcome was primary treatment failure. Secondary outcomes were duration of noninvasive respiratory support and oxygen treatment, maximum FiO 2level, length of hospital stay, intubation rate, rates of respiratory distress syndrome, pneumothorax, and bronchopulmonary dysplasia. Subgroup analysis was performed for infants ≤28 weeks of gestational age. Results b-We enrolled 107 infants, 53 in HFNC and 54 to nCPAP group. There was no difference in primary outcome between the two groups. There was no difference between the groups in aspect of secondary outcomes. Conclusion b-HFNC and nCPAP have no significant differences as a primary mode of respiratory support in preterm infants, in the time to wean off the devices and oxygen support, respiratory distress syndrome and bronchopulmonary dysplasia incidence, hospitalization duration, and rates of complications of prematurity

A very rare cause of apnea in the neonatal period: Joubert syndrome

WOS: 000395220700017PubMed ID: 30204974

Laryngeal web associated with chromosome 22q11 deletion in a preterm infant

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Staphylococcal scalded skin syndrome in a preterm infant

WOS: 000418094200002A male infant was delivered by cesarean section at 26 weeks and 3 days gestational age and weighed 1020 grams. Apgar scores were 7 and 8 at 1st and 5th minutes, respectively. The baby was hospitalized for prematurity, and given one dose of surfactant therapy on the first day of life. Empirical ampicillin and gentamicin therapy was started on the first day of life and continued for ten days. He also received high-flow oxygen through nasal cannula. The patient had neither clinical nor culture-proven sepsis attacks. On the 25th day of his life, the patient developed diffuse blanching erythema which started around the nose followed by appearance of bullous lesions on the extremities, neck and upper back regions (Figure 1)

Urgent surgical management of congenital intracranial hemangiopericytoma in a preterm neonate

Hemangiopericytoma is a rare mesenchymal tumor originating from capillary pericytes, known as Zimmermann pericytes. The adult form is not uncommon and generally malignant but tumor is found rarely in children. Here we describe an intracranial hemangiopericytoma in a preterm newborn whose had the tumor resected successfully shortly after birth

Tularemia as a result of outdoor activities for children in the countryside

Aim: To investigate the features of a new tularemia outbreak that occurred in the Thrace region. Materials and methods: The research team visited the village after the identification of the index case. Serum and throat samples were taken from 41 villagers who were examined, and environmental samples were taken in order to identify the source of the outbreak. Culture, serology, and molecular methods were used to search for Francisella tularensis in these samples. Results: A total of 8 children were diagnosed with tularemia. The adults and all of the other children were seronegative for tularemia. All of the patients had a history of swimming in a pool filled with water from a local stream, and contact with stream water was calculated to increase the risk of developing the disease 9.3-fold. Polymerase chain reaction analysis was positive in a lymph node aspirate of the index case and in the home tap water of 3 patients as well as in the spring water and stream water in the village. Francisella tularensis could not be isolated from any culture of samples. Interestingly, the waterborne tularemia outbreak affected only children. Conclusion: Although tularemia has been not reported from Tekirdag Province for 74 years, the disease reemerged in the region due to the removal of hygienic measures. These clues may signify that the agent had maintained its presence in the region for many years