Background

Transfusion of any blood product is a frequent procedure in Newborn Intensive Care Units (NICU). Vital signs are observed frequently throughout transfusion. However there are a few studies about vital sign monitoring frequency in patients receiving blood products.

Objectives

In this study we aimed to monitor temperature, arterial tension and heart rate of newborns receiving any type of blood products.

Methods

In this prospective study, vital signs on 0, 15.,45., 75.minutes and one hour after transfusion of eritrocyte, fresh frozen plasma and trombocyte were recorded prospectively. If any product is transfused more than once, only the vital signs in the first transfusion of the patient were recorded.

Results

In 2018, 860 newborns were hospitalized and 109 of them received 805 blood products; most of the patients were preterm (n:54/119), postoperative congenital heart disease (n:33/119) and congenital malformations (n:19/119). Vital signs during 209 blood products (111 eritrocyte, 60 FFP and 38 thrombocyte suspension) were recorded. Only there was a statistically significant, but clinically nonsignificant (0.1◦C) increase in body temperature after eritrocyte and FFP one hour after transfusion, (p= 0.033 ve p= 0.018). There were no complication such as rash, urticer, tachycardia, flushing, tremor and hypotension.

Conclusion

Conclusion: Blood products seem safe in newborns. They have no significant effect on vital signs. As monitors are used for monitoring newborns in NICUs, frequent monitoring by nurses may be reduced during transusion.

Background

Introduction: Seizures are the most common manifestation of neurologic compromise in the newborn period and often portend serious neurologic injury or dysfunction. Understandably, movements that mimic seizures during this period cause significant concern for parents and physicians alike and often prompt extensive diagnostic evaluation.

Objectives

Here we reported a newborn patient admitted to NICU with mistaken for refractory seizures.

Methods

Case: A term 15 days female neonate presented to NICU suggestive of abnormal movements of limbs noted over the preceding 2 days. She was born by spontaneous vaginal delivery with uneventful antenatal period. The baby was admitted with a diagnosis of refractory neonatal seizures in another hospital and was treated with oral phenobarbital unsuccesfully.

Ictal and interictal EEG and cranial USG did not reveal any abnormality. These findings helped us in establishing a diagnosis of benign neonatal sleep myoclonus. The baby continued to be active in the hospital. Anticonvulsants therapy was tapered gradually and baby was sent home. On follow up, the jerks steadily reduced in frequency and disappeared by 4 weeks of life.

Results

Discussion: Benign neonatal sleep myoclonus, a benign movement disorder that typically starts within the first 15 days of life, occurs during NREM sleep, and consists of intermittent repetitive jerks of the limbs at 2 to 3 per second.

Conclusion

Conclusion: Benign sleep myoclonus of infancy can be mistaken for neonatal seizures or even neonatal status epilepticus; the recognition of diagnosis is imperative to avoid unnecessary diagnostic studies and treatments.

Background

Early diagnosis of acute intracranial hypertension is essential for the optimal treatment. Opthalmic ultrasound measurement of optic nerve sheath diameter (ONSD) is an easy, portabl, noninvasive and a radiation free technique to determine increased intracranial pressure.

Objectives

The aim was to establish the normal values for ONSD in premature and mature newborns.

Methods

Newborns without intracranial pathology in NICUs and Obstetrics/ Gynecology Departments were included. ONSD were measured at a distance 2, 2.5 and 3 mm beyond the right optic nerve head in preterms and at 3 mm in term infants. Measurements were done by a pediatric intensive care fellow who expertise with point-of-care ultrasound.

Results

554 newborn infants (premature:253, mature:301) were included in the study. The mean ONSD of premature babies from 2, 2.5 and 3 mm were 0.32±0.03 cm (range 0.20-0.42 cm), 0.33±0.03 cm (range 0.22-0.45 cm) and 0.36±0.02 cm (range 0.29-0.45 cm), respectively. The mean ONSD from 3 mm behind the optic disc of mature babies was 0.40±0.027 cm (range 0.33-0.36 cm). There was no significant difference in ONSD between males and females. In the correlation analysis, a significant, strong and positive correlation was found between ONSD measurements from 2, 2.5 and 3 mm behind the optic disc and gestational age, actual weight, birth height and birth head circumference.

Conclusion

Our study is important in terms of being the largest series in the literatu defining the normal range of ONSD in newborns. The normal values reported by present study may be used for evaluating the ONSD of newborns with and without increased incracranial pressure.

Background

We present a case of aorticopulmonary window (APW) with aortic arch interruptions that developed giant pseudoaneurysm after surgery.

Objectives

Case

A 6-day-old baby was referred to hospital for surgery with the diagnosis of APW. The patient was intubated and mechanical ventilation was performed due to respiratory distress. The echocardiographic evaluation showed a wide APW, patent ductus arteriosus, transverse aortic hypoplasia, aortic arch interruption and pulmonary hypertension.

Methods

Prostaglandin infusion was started. At 12 days of age, the hypoplastic transverse arch and interrupted aortic arch were repaired with prosthetic material. APW was repaired, PDA was ligated. Candida albicans was produced in the blood culture in the preoperative period. Antifungal therapy was initiated. The echocardiogram on the 18th postoperative day revealed giant pseudo aneurysm in the aortic arch. CT angiography showed a pseudo aneurysm extending from the aortic isthmus to distal descending aorta with active bleeding and hematoma in posterior mediastinum. The patient underwent to urgent surgery on the same day. Control CT angiographic evaluation revealed no aneurysm in the transverse aorta and descending aorta.

Results

He was discharged 21th day after the second operation. Blood culture taken 1 month after the end of antifungal treatment was negative

Conclusion

Aortopulmonary window (APW) may be an isolated anomaly (simple) or associated with concomitant cardiovascular anomalies (complex). Mortality is almost always due to concomitant cardiovascular anomalies. One of the most common concomitant cardiovascular anomalies is an interrupted aortic arch. Our patient underwent re-operation because of fungal end arthritis after a successful adjustment surgery.

Background

Children requiring intensive care in the neonatal period have more fine motor injuries, learning difficulties, eating disorders and sleeping problems. Sleep disorder rate is about 10-30% in children who had no problem in newborn period.

Objectives

We aimed to investigate the rate of sleep disorder in children who were admitted to NICU during newborn period.

Methods

46 patients hospitalized in NICU and still followed in outpatient policlinic at Çukurova University were enrolled in to the study. Children's Sleep Habits Questionnaire was performed to evaluate sleep resistance, delay in fall into sleep, duration of sleep, sleep anxiety, parasomnia, midnight awakening and daily sleepiness

Results

Children were 6.64±1.18 (5-9) years old. They were healthy and had no neurological squeal. None of the parents complained about sleep disorders. However, 20 of the 46 (43.47%) children had sleep disorder (Sleep disorder group). 26 children had no sleep disorder (No Sleep Disorder group). There were no statistically difference between groups in terms of gestational age, birth weight, ventilator support, gender (p>0.05)

Conclusion

Although there are no significant difference between groups, sleep disorder rate is higher compared to normal population’s rates reported in the previous studies. Infants discharged from NICU should be under evaluation also for sleep disorder

Background

Newborns in NICUs experience many painful procedures. Nonpharmacological managements such as massage therapy and Kangaroo care are shown to reduce pain after procedures.

Objectives

In this study our aim was to compare the effect of oral 10% dextrose solution, 5 minutes of massage therapy and 5 minutes of Kangaroo care on NIPS scores after venipuncture in newborns.

Methods

Newborns with gestational age ≥34 weeks in NICU or rooming in with their mothers were randomly enrolled to one of three groups and a blinded investigator scored the pain using NIPS before and after the procedure.

Results

There were 27, 26 and 23 newborns in dextrose, massage and Kangaroo care, respectively. There were no statistically difference between groups in terms of gestational age, gender, birth weight, time of last feeding, feeding with mother milk/formula and venipuncture site. Pain scores were similar before and after venipuncture in groups (p> 0.05). After the procedure, infants with a score of 0-2 (no pain) included 40.7%, 46.2% and 43.5%; infants with a score of 3-4 (light- moderate pain) included 29.6%, 7.7% and 13% and infants with a score of 5-8 (severe pain) included 29.6%, 46.2% and 43.5% of the groups in dextrose, massage and Kangaroo care, respectively (p> 0.05). Although number of infants with severe pain score was lower in dextrose group, difference was statistically nonsignificant.

Conclusion

Although nonpharmacological methods were used, almost one third of the infants experienced severe pain. So our aim should be to decrease the number of invasive procedures in NICUs.

Background

Introduction: Seizures are the most common manifestation of neurologic compromise in the newborn period and often portend serious neurologic injury or dysfunction. Understandably, movements that mimic seizures during this period cause significant concern for parents and physicians alike and often prompt extensive diagnostic evaluation.

Objectives

Here we reported a newborn patient admitted to NICU with mistaken for refractory seizures.

Methods

Case: A term 15 days female neonate presented to NICU suggestive of abnormal movements of limbs noted over the preceding 2 days. She was born by spontaneous vaginal delivery with uneventful antenatal period. The baby was admitted with a diagnosis of refractory neonatal seizures in another hospital and was treated with oral phenobarbital unsuccesfully.

Ictal and interictal EEG and cranial USG did not reveal any abnormality. These findings helped us in establishing a diagnosis of benign neonatal sleep myoclonus. The baby continued to be active in the hospital. Anticonvulsants therapy was tapered gradually and baby was sent home. On follow up, the jerks steadily reduced in frequency and disappeared by 4 weeks of life.

Results

Discussion: Benign neonatal sleep myoclonus, a benign movement disorder that typically starts within the first 15 days of life, occurs during NREM sleep, and consists of intermittent repetitive jerks of the limbs at 2 to 3 per second.

Conclusion

Conclusion: Benign sleep myoclonus of infancy can be mistaken for neonatal seizures or even neonatal status epilepticus; the recognition of diagnosis is imperative to avoid unnecessary diagnostic studies and treatments.