BackgroundThe emergence of infections related to multidrug-resistant Gram-negative bacilli (MDR-GNB) reintroduced the use of colistin, an antibiotic that was previously abandoned due to adverse effects. However, because of its limited use in neonatal intensive care units, there is very little data about the effectiveness and safety of colistin in children and newborns. In this study, which will be the largest case study in the literature, we aimed to evaluate the effectiveness and safety of colistin in full-term and preterm newborns.Material/MethodsThe study included patients admitted into 2 level 3 neonatal intensive care units between January 2013 and June 2015. The medical records of patients diagnosed with sepsis, meningitis, pneumonia, and urinary tract infection based on the diagnostic culture results and treated with colistin were analyzed retrospectively. The patients whose infections were not verified were excluded from the study.ResultsThe study included 65 patients (18 term, 47 preterm). The most frequently isolated pathogens were Klebsiella pneumoniae and Acinetobacter baumannii followed by Pseudomonas aeruginosa and Enterobacter cloacae. Mean colistin treatment time was 15±3.5 days. All patients treated with colistin were being treated with at least 1 other antibiotic. While a complete clinical response was achieved in 51 (72.3%) patients, 14 (21.5%) patients died during treatment. Four (7.7%) patients died during as a result of another infection. Three patients developed renal toxicity, another 3 patients had seizures, and apnea was observed in 3 patients.ConclusionsColistin was found to be effective and safe for treatment of MDR-GNB infections in preterms and infants with very low birth weight. Given the severity of the infection, the adverse effects of colistin were at acceptable levels.

Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period. Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss the clinical features of neonatal infection with N. meningitidis in relation to the literature (analysis of a 97-year period). CASE REPORTO ur case, a 10-day-old male patient, was born by normal spontaneous delivery at term with a weight of 3,380 g. During pregnancy, his mother was regularly followed up. The natal history was unremarkable. He was breastfed and discharged without any problems on postnatal day 2. The neonate was admitted to the neonatal intensive care unit due to fever and difficulty breathing. An initial physical examination of the patient revealed cutis marmorata. He was hypotonic in general and exhibited poor sucking. The results of cardiovascular and respiratory examinations were normal. The patient did not exhibit organomegaly or eruptions. The capillary filling time was 2 s. The patient's initial vital findings were as follows: axillary temperature, 38.8°C; heart rate, 190/min; respiratory rate, 55/min; and arterial blood pressure, 100/60 mm Hg. The admittance weight of the neonate was 3,530 Ϯ 150 g. The results of a complete blood count and serum biochemical analysis did not reveal any abnormalities. The patient's C-reactive protein level was normal (0.2 mg/dl).A urinalysis and chest X-ray were normal. A peripheral blood smear revealed that the immature/total neutrophil ratio was 0.3. An analysis of arterial blood gases revealed both respiratory and metabolic acidosis.Blood and urine culture samples were obtained. The patient was diagnosed with sepsis and respiratory insufficiency based on the clinical and laboratory findings. He was intubated and given respiratory support with mechanical ventilation in SIMV (simultaneous intermittent mandatory ventilation) mode. Ampicillin (100 mg/kg of body weight/day) and cefotaxime (100 mg/kg/day) were administered. Intravenous fluid was given at an infusion rate of 150 ml/kg/day. Cranial, abdominal, and urinary ultrasound investigations done during clinical follow-up were evaluated as normal.To rule out meningitis, a lumbar puncture was done; the cerebrospinal fluid (CSF) biochemistry did not reveal any abnormalities.During the second hour of hospitalization in the intensive care unit, the patient's capillary filling time was found to be increased (5 s), and hypotension and bradycardia developed; thus, he was given a 10-ml/kg bolus of physiological serum twice. Because the patient's hypotension persisted, dopamine (10 g/kg/min) and dobutamine (10 g/kg/min) were given. However, during the fifth hour of admittance, a generalized purpuric eruption (Fig. 1) that enlarged and began to coalesce developed. Laboratory testing revealed leukopenia and thrombocytopenia, prolonged coagulation, and a rise in the C-reactive protein level (3.5 mg/dl). Vitamin K (1 mg) and fresh frozen plasma (15 ml/kg) we...

nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

Amaç: Hastanemiz yenidoğan kliniğinde yatırılarak izlenen ve izlem sırasında kaybedilen bebeklerin demografik özelliklerinin sunulması amaçlanmıştır. Gereç ve Yöntem: Yenidoğan Kliniğimizde beş yıllık süre içerisinde (1 Ocak 2007-31 Aralık 2011), kaybedilen bebeklerin kayıtları retrospektif olarak incelenerek; neonatal mortalite oranları, perinatalmaternal risk faktörleri ve ölüm nedenleri belirlendi. Bulgular: Çalışma süresince kliniğimize yatan hasta sayısı 5491 iken bu bebeklerin 167'si kaybedildi ve mortalite oranı %3,04 olarak saptandı. Kaybedilen bebeklerin %15,6'sı ilk 24 saat içerisinde, %74,9'u ise ilk 7 gün içerisinde kaybedilmişti. Kaybedilen bebeklerin %46,8'i kız, %53,2'si erkek idi. Akraba evliliği sıklığı %28,1 ve anne yaşı <19yaş olma oranı %2,3 ve >35 yaş olma oranı %14,3 olarak belirlendi. Kaybedilen bebeklerin %61,6'sı 37 gebelik haftasının altında, %29,9'u 28 gebelik haftası ve altında doğmuştu. Doğum ağırlığına göre ise %37,1'i 1000 g altında ve %64,6'sı 2500 g altında idi. En sık saptanan yenidoğan ölüm nedenleri; respiratuar distres sendromu ve immatürite %24,6, neonatal sepsis %14,9 ve konjenital anomaliler %10,2 olarak belirlendi. Diğer nedenler ise sırasıyla; perinatal asfiksi %9, diğer solunum problemleri (pnömotoraks, mekonyum aspirasyon sendromu, konjenital diyafragma hernisi v.b) %9, siyanotik konjenital kalp hastalığı %8,4, metabolik hastalıklar %7,7, intraventriküler kanama %7,7, nekrotizan enterokolit %3,6 ve diğer nedenler %4,9 olarak belirlendi. Sonuç: Yenidoğan bebeklerin ölüm nedenleri arasında immatürite ve konjenital anomaliler günümüzde önemli bir sıklıkta yer almaktadır. Bebeklerin önlenebilir ölüm nedenlerinin saptanarak bunları azaltmaya yönelik çabalar yenidoğan bebeklerin ölüm oranlarını azaltmada belirli oranda faydalı olacaktır.

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Context Limited data are available on the exact incidence of disorders of sex development (DSD) with genital ambiguity at birth. Objective To determine frequency of ambiguous genitalia in newborns. Design Prospective multicenter study. Setting Three tertiary care hospitals. Patients or Other Participants All 14,177 babies born during the study period were included. Main Outcome Measures All newborns were examined at birth; data on weeks of gestation, birth weight, and length were collected. A structured questionnaire was used for data collection. Quigley and Prader scales were used for phenotypic grading. Clinical and genetic investigations were performed. Results Eighteen babies with ambiguous genitalia were found among 14,177 newborns (1.3/1000). Fifteen newborns had 46,XY DSD, one had 46,XX congenital adrenal hyperplasia, and one had 45,X/46,XY mixed gonadal dysgenesis. Karyotype analysis was not done in one baby who died in the neonatal period. The ratio of prematurity was higher in the DSD group (44% vs 11%; P < 0.001) and the ratio of small for gestational age was also higher in the DSD group (22% vs 5%; P = 0.007). Eight babies with DSD had mothers who had additional medical conditions, such as preeclampsia, depression, insulin resistance, and gestational diabetes mellitus. Conclusion The frequency of ambiguous genitalia was higher than in previous studies, but, as with any experiment, the finding should be met with caution because this study was conducted in tertiary care hospitals. In addition, lower birth weight in the DSD group supports the hypothesis that early placental dysfunction might be important in the etiology of male genital anomalies.

BackgroundWe aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement.MethodsThe study was planned cross-sectional to be carried out between April–May 2015 in Turkey. A questionnaire form that determined the participants’ opinions and practices concerning vitamin D supplement was completed via face-to-face interview.ResultsA total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) (p = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%).ConclusionsThe present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health.

Amaç: Preeklampsinin çok düşük doğum ağırlıklı bebeklerin erken dönemdeki morbidite ve mortalite oranları üzerine etkisini araştırmak.