Transfusion-associated graft-versus-host disease following exchange transfusion in a newborn.
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Exchange Transfusion, Whole Blood↗
Biomedical subjects
H Ozkan
Publications and source records attributed to H Ozkan.
Platelet activation during the early neonatal period.
The first week of life is a time when hereditary or more frequently acquired factors lead to some important differences in the hemostatic mechanism of the newborn. It has been well known that ill neonates are prone to both hemorrhage and thrombosis. The aim of this study was to answer the question of whether there is a difference in platelet activation in healthy neonates during the first days of life that may contribute to both hemorrhage and thrombosis in the presence of additional pathologic insults. Platelet activation was determined with flow cytometry using monoclonal antibodies in 63 healthy children (29 neonates, 17 infants, and 17 older children). There was no significant difference in platelet activation among these three age groups (p > 0.05). In addition, platelet activation did not show any significant relationship to age, sex, mode of delivery, or blood bilirubin concentration (p > 0.05). It has been previously reported that platelet activation occurs at the time of birth. We could not find any evidence that healthy newborns during the first 3 days of life exhibit increased platelet activation. Further studies on platelet activation in ill neonates will help to clarify whether platelet activation plays a role in the pathogenesis of thrombotic and/or hemorrhagic disorders.
Antibodies, Monoclonal↗
Urinary enzyme changes in newborns with unconjugated hyperbilirubinemia.
Various changes in renal function caused by unconjugated hyperbilirubinemia in newborns have been suggested in previous reports. Disclosing an injury in renal tubulus epithelium is feasible by measurement of urinary enzymes. Thus, renal function tests and urinary enzymes in 25 terms newborns with unconjugated hyperbilirubinemia were evaluated before and after phototherapy. Ten healthy term newborns without hyperbilirubinemia formed the control group. Mean values of the variables obtained before and after phototherapy in the study group and in the controls were, respectively: urine osmolality (osm/kg H2O): 0.147 +/- 0.009, 0.174 +/- 0.011, and 0.153 +/- 0.018; endogenous creatinine clearance (mL/min per 1.73 m2): 45.7 +/- 2.15, 46.0 +/- 1.6 and 46.7 +/- 3.9; fractional excretion of sodium (%): 1.27 +/- 0.30, 0.79 +/- 0.19 and 1.24 +/- 0.07; tubular phosphorus reabsorption (%): 85.8 +/- 3.3, 87.8 +/- 2.8 and 86.6 +/- 1.7; urinary N-acetyl-beta-D glucosaminidase/creatinine (IU/mg): 0.617 +/- 0.226, 0.574 +/- 0.214 and 0.619 +/- 0.210; fractional excretion of alkaline phosphatase (%): 0.422 +/- 0.103, 1.001 +/- 0.374 and 0.596 +/- 0.201; fractional excretion of lactic dehydrogenase (LDH; %): 0.102 +/- 0.019, 0.121 +/- 0.023 and 0.119 +/- 0.041; fractional excretion of AST (%): 0.433 +/- 0.127, 0.530 +/- 0.113 and 0.502 +/- 0.074; fractional excretion of alanine aminotransferase (ALT; %) 0.856 +/- 0.413, 1.619 +/- 1.076 and 1.066 +/- 0.366. No significant difference was found between these values before and after phototherapy in the study group, or between the values before phototherapy in hyperbilirubinemic neonates and in the control group. In conclusion, unconjugated hyperbilirubinemia up to a serum level of 18.4 mg/dL in term neonates does not seem to result in injury of normal tubulus epithelium as shown by urinary enzyme levels.
Alanine Transaminase↗
Urinary nitrite excretion in low birth weight neonates with systemic inflammatory response syndrome.
Increased nitric oxide (NO) levels are thought to play an important role in the pathophysiology of the systemic inflammatory response syndrome (SIRS) which is caused by disseminated vascular endothelial damage. Clinical studies have shown that urinary nitrite (NO2-) and nitrate (NO3-) excretions can be utilized as indexes of NO formation. The SIRS and NO relationship was investigated in 15 neonates with SIRS, gestational age 32.5 +/- 4.4 weeks and weight 1,737 +/- 753 g. The control group comprised 18 neonates with a gestational age of 32.8 +/- 3.5 weeks and a weight of 1,778 +/- 538 g. There was no significant difference in birth weights and gestational ages between the two groups (p > 0.05 and p > 0.05). The urinary nitrite levels obtained in the subjects were normalized for urinary creatinine concentrations. The mean urinary nitrite levels in the control group neonates were found to be 4.22 +/- 1.8 micromol/mmol creatinine on the 1st day, 4.09 +/- 2.28 on the 2nd, 3.62 +/- 1.6 on the 3rd, and 4.01 +/- 1.12 micromol/mmol creatinine on the 7th day. There were no statistically significant differences between these levels (p > 0.05). We determined urinary levels of nitrite in neonates in the study group within the first 24 h of SIRS symptoms and found these levels (18.35 +/- 11.16 micromol nitrite/mmol creatinine) to be elevated as compared with those of the control subjects on the 7th day of life (p < 0.0005). In conclusion, urinary nitrite excretion is significantly elevated in neonates with SIRS due to septic events, and these results suggest that NO might play a part in SIRS.
Birth Weight↗
Multiple-dose activated charcoal in an accidental vancomycin overdose.
BACKGROUND: Multiple-dose activated charcoal may enhance the enterocapillary clearance of vancomycin. CASE REPORT: A 17-day-old female neonate born with congenital meningomyelocele and Arnold-Chiari malformation was iatrogenically overdosed with a 500 mg intravenous bolus of vancomycin during a shunt operation. The Red Man's Syndrome developed within minutes, characterized by sudden hypotension, skin rash and cyanosis. Serum vancomycin level at one hour after the injection was 165.7 micrograms/mL, as measured by an enzyme immunoassay method (EMIT). Multiple dose activated charcoal, 1 g/kg, was first given five hours after injection, and continued every four hours for 12 doses. The half-life of vancomycin during charcoal administration was calculated to be 9.4 h or less than the reported 13.4-33.7 h half-life in normal neonates. The neonate's renal function tests and brainstem auditory responses remained normal. CONCLUSIONS: Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimination half-life of vancomycin.
Anti-Bacterial Agents↗
Clinical usefulness of a new miniscope in the diagnosis of pancreatic disease.
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Catheterization↗
Relationship between serum unconjugated bilirubin levels and the autofluorescence of white blood cells in neonatal jaundice.
In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes, monocytes and neutrophils exposed to different unconjugated bilirubin concentrations and investigated the relationship between these parameters. Different unconjugated bilirubin concentrations were prepared from a newborn serum with an unconjugated bilirubin concentration of 800 m mumol/l. The same concentrations of unconjugated bilirubin have been prepared from pure bilirubin. 10 microliters of cord blood were incubated at room temperature for 15 min with 90-microliter solutions with different bilirubin concentrations prepared from both serum and pure bilirubin. After incubation, cells were washed three times with PBS, erythrocytes were lysed by lysing buffer and run through flow cytometry immediately. Autofluorescence was measured by recording mean fluorescence channels for lymphocytes, monocytes and neutrophils. There was a good correlation between serum concentrations of unconjugated bilirubin that cells were exposed to and the autofluorescence intensity of neutrophils (r = 0.904, p < 0.005), monocytes (r = 0.759, p < 0.05) and lymphocytes (r = 0.766, p < 0.01). Results obtained with pure bilirubin were also similar. Autofluorescence emitted by lymphocytes was lower than that of monocytes (p < 0.01) or neutrophils (p < 0.0005).
Bilirubin↗
Nutrition, immunity and infections: T lymphocyte subpopulations in protein--energy malnutrition.
Protein energy malnutrition (PEM) is one of the most frequent causes of secondary immune deficiency states. Alterations either in cellular or humoral immune mechanisms increase the susceptibility to infections in the malnourished organism. Infections aggravate the interrelationship of malnutrition to immune deficiency and infections, resulting in future adverse effects of malnutrition on humoral and cellular immune systems, IgG, IgM, IgA, C3, and T lymphocyte subpopulations were identified in 29 patients with PEM and 15 healthy infants serving as the control group, ranging between 3 and 24 months of age. Patients with PEM demonstrated elevated levels of IgG, IgM and IgA when compared to the control group (P < 0.01, P < 0.01, P < 0.01), C3 levels were significantly lower than the values of the control group (P < 0.01).
Antibodies, Monoclonal↗
Cholelithiasis in cervico-oculo-acoustic (Wildervanck's) syndrome.
An unusual case of cholelithiasis in an 18-month-old boy with cervico-oculo-acoustic (Wildervanck's) syndrome is presented. Our patient had Duane's retraction syndrome, Klippel-Feil anomaly and congenital deafness. To our knowledge this is the first case in which a probable association between cholelithiasis and Wildervanck's syndrome has been recorded. On the other hand, the presence of mutual malformations and anomalies such as scoliosis, ventricular septal defect, ectopic kidney, hydrocephalus, hypoplastic thumb and growth retardation seems to suggest that Wildervanck's syndrome is a clinical variant of Klippel-Feil sequence.
Abnormalities, Multiple↗
Low-dose sultamicillin oral suspension in the treatment of mild to moderate paediatric infections in Turkey.
A total of 101 children (47 males, 54 females; age range, 3 months-16 years) with mild to moderate upper or lower respiratory tract infections, or skin and soft tissue infections entered a clinical study conducted at two centres in Izmir, Turkey. The children received a mean daily dose of 25 mg/kg sultamicillin oral suspension administered as two equal doses approximately 12 h apart. In total, 100 children met all requirements for evaluability and were included in the clinical efficacy assessment, and 49 children were evaluated for bacteriological efficacy. Clinical cure was reported by the investigators in 93 patients, improvement in six and failure in only one. The bacteriological eradication rate of isolated pathogens was 100%. Of the 101 patients evaluated for drug safety, four experienced adverse drug-related or possibly drug-related reactions. All side-effects were gastro-intestinal and diarrhoea was reported in three patients. No discontinuation of therapy was reported, nor were any significant laboratory abnormalities recorded.
Administration, Oral↗
Giant lymphoid hamartoma of mediastinum (Castleman's disease).
The giant lymphoid hamartoma is known as a rare, benign, large, solitary, encapsulated mass of lymphoid tissue. It frequently involves mediastinum or pulmonary hilum. It may also occur in other various locations. Few of the patients may have general symptoms. The disease has been divided into two variants according to microscopic structure. These are hyaline vascular type and plasma-cell type. The hyaline vascular type is benign but the plasma-cell type meets malignancy criteria, so that the plasma-cell type has been subject to discussion whether it is suited to chemotherapy or not. Our case was a 55-year-old male with persistent cough. There was a mass having a size of 6 centimeters on left pulmonary hilum on chest radiograph. Left thoracotomy was performed and a hilar lymphoid mass removed. The biopsy finding was "hyaline vascular type giant lymphoid hamartoma". No other therapy was done. Patient is well six months after the operation.
Castleman Disease↗
The effect of phototherapy on total phospholipid levels of red cell membrane in jaundiced neonates.
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Erythrocyte Membrane↗
Assessment of clinical impact and predisposing factors for neonatal thrombocytopenia.
Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of thrombocytopenia and the underlying primary pathology process play an important role in reducing the risk of severe complications and mortality. We performed a 2-year prospective study of 643 neonates admitted to our neonatology unit to determine the frequency, predisposing factors, and clinical impact of thrombocytopenia. Thrombocytopenia developed in 18.2% of the preterm neonates and 0.8% of the term neonates. Prematurity, sepsis, hypoxia, intrauterine growth retardation, and disseminated intravascular coagulation were identified as predisposing factors for thrombocytopenia. The incidence of complications and mortality were higher in thrombocytopenic infants. Especially the prognosis was worse in cases who had mucosal hemorrhage, without a relation with the degree of thrombocytopenia. The thrombocytopenia occurred by day 2 in 43% of the infants, and resolved by day 8 in 61%. The platelet count nadir occurred by day 2. Since thrombocytopenic infants are at greater risk for bleeding, and the thrombocytopenia itself may have contributed to the high mortality, predisposing factors such as prematurity, infections, hypoxia must be eliminated by providing better care, giving adequate hygiene of both mother and the baby during the prenatal, natal, and neonatal period.
Causality↗
Breast milk versus infant formulas: effects on intestinal blood flow in neonates.
The differences between breast milk and infant formulas have been a popular subject of many recent studies. Most concern the chemical and biological characteristics of breast milk and infant formulas, but little work has been done about hemodynamic changes in the splanchnic circulation. In term neonates (n = 22) we evaluated the effect of breast milk, adapted cow's milk formula, and nucleotide supplemented cow's milk formula on intestinal blood flow. To determine the blood flow velocity and estimate volume flow, pulsed Doppler ultrasound of the superior mesenteric artery (SMA) was performed prefeeding and 15, 45, and 90 minutes following feeding. When pre- and postprandial blood flow features of babies were compared among in their groups according to nutrition post prandial blood flow velocity and volume flow were increased significantly over baseline in all three groups. While there was no significant difference between the postprandial blood flow parameters of the breast milk and adapted cow's milk formula-fed groups, the nucleotide supplemented cow's milk formula-fed group had significantly higher postprandial blood flow velocity and volume flow.
Humans↗
Kawasaki syndrome.
Kawasaki syndrome, also known as mucocutaneous lymph node syndrome, is an acute vasculitis of infants and young children. We describe a four-year-old girl who presented with fever, a diffuse erythematous maculopapular rash, bilateral nonpurulent bulbar conjunctivitis, dry, red, fissured lips, a tongue with a strawberry "appearance", an erythematous pharynx, indurative erythema, and edema and desquamation of the face, hands and feet. She probably developed mitral valve prolapse during the course of the disease. The diagnosis of Kawasaki syndrome was arrived at by excluding other diseases and by the presence of all the clinical criteria for Kawasaki syndrome. Since this syndrome is rarely encountered in Turkey, this case is presented and the literature regarding the syndrome is reviewed.
Aspirin↗
Oculocerebral hypopigmentation syndrome (Cross syndrome).
A typical case of Cross syndrome with hypopigmentation, mental and psychomotor retardation, spasticity, bilateral optic atrophy and dental defects in a three-year-old boy is presented. The clinical features of this rare syndrome are discussed.
Albinism, Oculocutaneous↗
A case of common truncus arteriosus with rare cardiac abnormalities.
Truncus arteriosus communis is a well-known, congenital, cardiac abnormality. In this report, we describe a very rare variant in which the truncus arose from the right ventricle, the atrial and ventricular septa were intact, the left ventricle was hypoplastic and the small right atrium was draining to the truncus arteriosus through a fibrose tunnel-like connection.
Heart Ventricles↗