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    A case of diastrophic dysplasia associated with mega cysterna magna
    (Aves Yayincilik, Ibrahim Kara, 2007) Duran, Ridvan; Vatansever, Uelfet; Aladag, Nuekhet; Acunas, Betuel; Tuysuz, Beyhan
    Skeletal dysplasias comprise a large group of hereditary disorders characterized by abnormal growth, short stature and malformations and deformations of bone and cartilage. Diastrophic dysplasia is a skeletal-disorder characterized by short stature, foot and spinal deformities, hitchhiker's thumb and ear abnormalities. Internal organs develop normally. The physical examination of the newborn referred to our hospital for multiple abnormalities revealed a poor general condition with cyanosis, disproportionate short stature, large front fontanel, short neck, misshapen upper ear and 'cauliflower' deformity, cleft palate, hitchhiker's thumb, long and slim fingers except the thumb, proximally located toes, flexion contractures in the large joints, bilateral talipes equinovarus and left scrotal hernia. Mega cysterna magna was demonstrated in,the posterior fossa in the cranial tomography. With these clinical and radiological findings, the newborn was diagnosed as diastrophic dysplasia. The infant was discharged on day 19 after genetic counseling to the family and was to be followed up by the newborn outpatient clinic.
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    Etiology of neonatal gastric perforations
    (Wiley, 2007) Duran, Ridvan; Inan, Mustafa; Vatansever, Uelfet; Aladag, Nuekhet; Acunas, Betuel
    Background: Neonatal gastric perforation (NGP) is a rare event and its etiology is still controversial. Although it has previously been described as spontaneous, recently some risk factors have been reported to be associated with the development of NGP including prematurity and nasal ventilation. The purpose of the present paper was to report and discuss etiology, clinical features, and outcome of the authors' NGP cases over a 10 year period. Methods: Charts of five infants with NGP was reviewed in terms of gender, birthweight, gestational age, time of diagnosis, associated disease, site of perforation, type of surgery performed, and clinical outcome. Results: There were three boys and two girls with a mean birthweight and gestational age of 1650 g and 32 weeks, respectively. Three of them were premature. Mean perforation time was day 10 postnatally. Three infants had associated problems including prematurity, respiratory distress syndrome type 1, necrotizing enterocolitis, mechanical ventilator support, and one of them had tracheaesophageal fistula. Mothers of two out of these three infants had chorioamnionitis. One full-term infant received dexamethasone because of brain edema. Only one patient had no associated problem. Perforation occurred in the lesser curvature in three infants and in the greater curvature in two infants. Mortality rate was 60%. Conclusions: Contrary to previous literature, and similar to recent publications, it was found that essentially low-birthweight infants with tracheaesophageal fistula or chorioamnionitis and full-term babies on steroid therapy may have a risk for NGP, suggesting that an infant with contributing factors should be monitored more carefully for the development of NGP.
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    The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia
    (Elsevier Science Bv, 2008) Duran, Ridvan; Aladag, Nuekhet; Vatansever, Uelfet; Sut, Necdet; Acunas, Betuel
    Objective. Neonatal care provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality. Neonatal Resuscitation Program (NRP) courses had been held since 1996. The aim of this study was to evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia. Methods. This retrospective study comprised newborn infants who were born in hospitals at Trakya region of Turkey during the last 3 years and were diagnosed as perinatal asphyxia and were referred to our Neonatal Unit. Those patients who were referred before NRP course (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (post-training period) as Group 3. Chart review was performed with regard to gestational age, birth weight, Apgar scores, resuscitation type, stage of hypoxic ischemic encephalopathy (HIE), existence of meconium aspiration syndrome (MAS), progress of the disease, duration of hospitalization. Results. The study comprised 66 patients; 35 in Group 1, 18 in Group 2 and 13 in Group 3. The number of cases who had not been resuscitated was 10 in the pretraining period, 3 in the transition period and I in the post-training period which decreased significantly. The first minute Apgar scores in three groups were as follows; 2.08 +/- 1.2, 2.2 +/- 1.1 and 3.7 +/- 1.4, and this increase was statistically significant. The fifth minute Apgar scores also increased from 5.43 +/- 1.5 in the pretraining period to 6.5 +/- 1.9 in the post-training period, but this increase was not statistically significant. The number of patients with Stage I and 2 HIE decreased more in Group 3 (n = I I in Stage I HIE, n = 17 in Stage 2 HIE) compared to those in Group I (n = 7 in Stage I HIE, n = 5 in Stage 2 HIE) but the difference was not statistically significant. The duration of hospitalization decreased in post-training period (15.1 +/- 10.3 days in pretraining period, 12.0 +/- 8.9 days in transition period, 6.1 +/- 1.2 days in post-training period). Conclusions. After NRP courses, the number of patients with perinatal asphyxia and with no resuscitation and also the duration of hospitalization decreased significantly, whereas the first minute Apgar scores increased significantly. (c) 2007 Elsevier B.V. All rights reserved.
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    Proficiency and knowledge gained and retained by pediatric residents after neonatal resuscitation course
    (Wiley-Blackwell, 2008) Duran, Ridvan; Aladag, Nuekhet; Vatansever, Uelfet; Kucukugurluoglu, Yasemin; Sut, Necdet; Acunas, Betul
    Background: In previous studies the efficacy of the Neonatal Resuscitation Program (NRP) was evaluated, demonstrating good retention of knowledge in the participants. The aim of the present study was to evaluate the knowledge and proficiency that pediatric residents gained and retained following NRP and to determine the necessity and timing of the refresher courses. Methods: The study consisted of 42 pediatric residents who were divided into three groups. Group 1 included pediatric residents who attended the course 1 year previously (n = 18); group 2, 6 months previously (n = 12); and group 3 included those residents who had not attended the NRP previously (n = 12). A written test consisting of 100 questions was applied, and endotracheal intubation skill on a neonatal manikin was evaluated. Results: The percentage of correct answers of participants in groups 1 and 2 decreased similarly during the 6 month and 1 year time period following previous courses. After the new NRP the correct answers increased significantly in groups 1 and 2. The duration of intubation attempt was 17.8 +/- 6.0 s in group 1, 17.5 +/- 1.5 s in group 2, and 22.3 +/- 2.6 s in group 3 before the course and decreased after the course to 10.9 +/- 2.0 s in group 1, 10.3 +/- 1.5 s in group 2, and 11.7 +/- 1.6 s in group 3. The knowledge missing after 6 months and 1 year were similar, while intubation skill decreased after 1 year following the course. Conclusions: Due to worsening of test findings at 6 months after NRP, and deterioration of performance of intubation 1 year after NRP, it is suggested that a refresher course may be required every year.