Search

Background: The human gut microbiota is an extensive population of microorganisms, and it shows significant variations between periods of optimal health and periods of illness. Vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are both pathogenic agents (BPAs) that can colonize in the gut after dysbiosis of microbiotal composition following antibiotic treatment. Methods: This study aimed to investigate the impact of antibiotics on the microbiotal composition of the gut. For this purpose, the first pass meconiums of 20 patients and the first rectal swabs containing BPAs of the same patients after antibiotic treatment were studied using next-generation sequencing-based 16S rRNA gene analysis. The V1–V9 region of 16S rRNA was sequenced with Oxford Nanopore. Results: Twenty-five phyla were detected in the meconiums, and 12 of them were absent after antibiotic treatment. The four most prevalent phyla in meconiums were Bacillota, Pseudomonadota, Bacteroidota, and Actinomycetota. Only the relative abundance of Pseudomonadota was increased, while a significant decrease was observed in the other three phyla (p < 0.05). A significant decrease was observed in alpha-diversity in rectal swabs containing BPAs versus meconiums (p = 0.00408), whereas an increased variance was observed in beta-diversity in all samples (p < 0.05). As a result of a LEfSe analysis, Pseudomonadota was found to have a higher relative abundance in rectal swabs, and Bacillota was significantly higher in the meconiums of the twins. Conclusions: Our study strongly verified the relationship between the administration of antibiotics, dysbiosis, and colonization of BPAs in the infants' gut microbiota. Further research would be beneficial and needed, comprising the natural development process of the infants' gut microbiota. [ABSTRACT FROM AUTHOR]

Purpose: Neonatal hypoglycemia (NH) is frequent in neonatology practice. This study aimed to evaluate the regional cerebral tissue oxygenation and cerebral blood flow in neonates who developed NH immediately after birth. Methods: This prospective study included infants who developed NH (n=50) and the control healthy term neonates (n=50). Infants with NH are monitored in terms of continuous regional cerebral tissue oxygenation (rcSO2) via near-infrared spectroscopy (NIRS) during the first 24 hours of life. Middle cerebral artery (MCA) blood flow was evaluated by doppler ultrasound at the first and 24 hours of life. The pulsatility index (PI) was measured to assess cerebral vascular resistance. Results: The mean gestational age, birth weights and hemoglobin levels of infants were similar. The mean rcSO2 was continuously higher and fractional tissue oxygen extraction (FTOE) was lower in infants with NH. The mean MCA PI values at the first and 24th hours of life were significantly higher in NH. Conclusions: This study shows that cerebral perfusion was impaired in infants with NH. They had higher rcSO2, lower FTOE values and increased PI compared to healthy term infants. We suggest that increased PI may reflect increased vascular resistance and higher rcSO2 values associated with increased cerebral perfusion as a compensatory auto-regulatory response mechanism. Significantly lower FTOE values may dedicate decreased cerebral tissue oxygen extraction resulting from impaired cerebral perfusion even in the presence of auto-regulatory mechanisms. Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion. [ABSTRACT FROM AUTHOR]

Objective: The ABO hemolytic disease is the most common alloimmune hemolytic disease in the neonatal period. The conventional treatment strategies for indirect hyperbilirubinemia caused by hemolysis are phototherapy and exchange transfusion. IVIG can also be used to prevent hemolysis. This study aimed to evaluate the efficacy of IVIG use in infants with ABO hemolytic disease. Materials and Method: Infants with gestational age >37 weeks, with a positive direct Coombs test, and having phototherapy for indirect hyperbilirubinemia were included in the study (n=192). Enzyme deficiency (G6PD), polycythemia, visceral hemorrhage, pathological weight loss and septicemia were the exclusion criteria. The newborn infants were reviewed retrospectively in two groups as the only phototherapy group and the phototherapy and IVIG group. Results: The mean gestational age and birth weight of the infants were similar between groups. The hospital stay and phototherapy duration were significantly longer and hemoglobin decrease from birth to discharge was significantly higher in the phototherapy and IVIG group. There was no difference found between the infants who received one dose or recurrent doses of IVIG in terms of highest bilirubin level and total phototherapy duration. Conclusion: This study showed that IVIG use in ABO hemolytic disease of newborns in addition to phototherapy neither prevents hemolysis nor decreases phototherapy duration and hospital stay. Recurrent doses of IVIG treatment have no clinical benefit over single dose IVIG treatment. The first choice of treatment should be an effective phototherapy in indirect hyperbilirubinemia due to ABO hemolytic disease. Further larger prospective studies are needed to assess the IVIG use in ABO hemolytic disease. [ABSTRACT FROM AUTHOR]

Objective: Persistent pulmonary hypertension of the newborn (PPHN) is a serious clinical condition that developed through the persistence of high pulmonary vascular resistance during the transition period and results in severe morbidities and mortality. This study aims to determine the risk factors for developing PPHN and to evaluate the prognosis, morbidities, and mortality. Materials and Method: This retrospective study was conducted between January 2017 and January 2019. Hospital records of infants who needed neonatal intensive care were evaluated retrospectively in terms of etiological causes of PPHN, clinical prognosis of neonates, morbidities, and mortality rates. Results: A total of 29,650 infants were born during the 2-year study period, 920 of whom were admitted to a neonatal intensive care unit, of which 50 developed PPHN. Of the infants who developed PPHN, 66% were preterm and 52% were female. The most common etiology related to developing PPHN is congenital pneumonia (65%) in term infants and respiratory distress syndrome (100%) in preterm infants. The second most common etiology is perinatal asphyxia for both term and preterm infants. Morbidities such as patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia were higher in the preterm group, with mortality rates also being significantly higher in preterm infants. Conclusion: Persistent pulmonary hypertension of the newborn is a serious clinical condition that may result in high neonatal mortality even when appropriate cardiopulmonary support is given. Mortality and mortality-related morbidities are thought to be able to be decreased by defining the risk factors for developing PPHN. [ABSTRACT FROM AUTHOR]

While optimal antenatal care is provided for the mother to improve survival of newborn babies, appropriate should be given to the babies. The most important time period in delivery room management is the first minute which is named as "first golden minute". Within this period, body temperature of the baby should be checked, patency of its airway, its respiratory and heart rate should be assesed, first breath should be initiated in case of need, and saturation must be measured objectively using a pulse oximeter. Excessive and unnecessary use of oxygen should be prevented by considering targeted saturation values which are determined according to the time passed after birth. Recent studies showed that 30-60 seconds delay in umbilical cord clamping time will lead to higher hemoglobin concentrations and iron stores in newborns. Preterm babies who may need ventilatory support should be put on continuous positive airway pressure (CPAP) even from the first breath which will decrease the need for intubation and surfactant administration. Prophylactic administration of surfactant in preterm newborns is being abandoned today, surfactant should only be given to preterm newborns in need. Nowadays, less invasive administration of surfactant (LISA) is being tested. If resuscitation is needed oxygen support should be started with 21% saturated oxygen in newborns at or above 35th gestational age. If the gestational age is less than 35th weeks, 21-30% saturated oxygen should be given at the beginning then, oxygen support should be increased up to targeted saturation levels in a controlled manner. [ABSTRACT FROM AUTHOR]

Hyperprolactinemia is a rare disease in childhood which can originate from pituitary adenomas. Sixteen years old girl was admitted with complaints of amenorrhea and galactorrhea from left breast. On physical examination thyroid gland was nonpalpable and galactorrhea from left breast is detected. Laboratory evaluations revealed that, Thyroid Stimulating Hormone (TSH)=3.13 uIU/ml (0.5-5 uIU/ml), free T4=0.73 ng/dl (0.71-1.85 ng/dl), Follicule Stimulating Hormone (FSH)=10.7 mIU/ml (4-13 mIU/ml, follicular phase), Luteinising Hormone (LH)=8.45 mIU/ml, Prolaktin=227.9 ng/mL (5.18-26.53 ng/ml). Pituitary magnetic resonance imaging showed a macroadenoma about 20x15 mm extending to optic chiasm, enlarging sellaturcica and obliterating suprasellarcisterna. Serum levels of cortisole =14 mcg/dl (<20 mcg/dl), growth hormone=2.86 mIU/ml (0-20 mIU/ml), Adrenocorticotropic Hormone (ACTH)=24.7 pg/ml (0-100 pg/ml). There was no bitemporal defect in visual area examination. On neurosurgical consultation,there was no neccesity for surgical intervention and cabergoline treatment was initiated. Galactorrhea was resolved on the second day of treatment,and prolactin level decreased to 14.84 ng/ml on 7th day. Pituitary magnetic resonance imaging showed shrinkage in size of adenoma on 20th day. In conclusion, medical treatment of prolactinoma in childhood may have satisfying response; so that medical treatment should be tried before surgical intervention. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Child / Çocuk Dergisi is the property of Journal of Child and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Optimal care in the delivery room is important to decrease neonatal morbidity and mortality. We aimed to evaluate neonatal resuscitation practices in Turkish centers., Materials and Methods: A cross-sectional survey consisted of a 91-item questionnaire focused on delivery room practices in neonatal resuscitation and was sent to 50 Turkish centers. Hospitals with <2500 and those with ≥2500 births/year were compared., Results: In 2018, approximately 240 000 births occurred at participating hospitals with a median of 2630 births/year. Participating hospitals were able to provide nasal continuous-positiveairway-pressure/high-flow nasal cannula, mechanical ventilation, high-frequency oscillatory ventilation, inhaled nitric oxide, and therapeutic hypothermia similarly. Antenatal counseling was routinely performed on parents at 56% of all centers. A resuscitation team was present at 72% of deliveries. Umbilical cord management for both term and preterm infants was similar between centers. The rate of delayed cord clamping was approximately 60% in term and late preterm infants. Thermal management for preterm infants (<32 weeks) was similar. Hospitals had appropriate equipment with similar rates of interventions and management, except conti nuous-positive-airway-pressure and positive-end-expiratory-pressure levels (cmH2O) used in preterm infants (P = .021, and P = .032). Ethical and educational aspects were also similar., Conclusions: This survey provided information on neonatal resuscitation practices in a sample of hospitals from all regions of Turkey and allowed us to see weaknesses in some fields. Although adherence to the guidelines was high among centers, further implementations are required in the areas of antenatal counseling, cord management, and circulation assessment in the delivery room.