Neonatal Examination Research Articles

Health Services' Profile Introduced to under Five Rural Egyptian Children: A Cross-Sectional Study

Background: Children under 5 years of age represent 11.1% of total Egyptians with a mortality rate of 22/1000 live births in 2013. Family health centers are the first gates that provide them with health services. This study aimed to evaluate the health care services introduced to under 5 children in one of the rural family health centers in Egypt called Shawa family health center (SFHC) during 2012-2013. Subjects and Methods: This is a cross sectional descriptive and analytic study, conducted in SFHC, and included two phases. Phase I: Records of births, antenatal care, immunization, wellbaby and sick child visits to the clinic for the year 2012 were reviewed. Phase II: Data were collected using a structured pretested questionnaire. Findings: Antenatal care coverage rate was 57.8% of the visits, while neonatal examination accounted for 98.6%. Thyroid screening rate was 94.5%, while immunization coverage rate was 98.9%. No vitamin A supplementation was provided. The commonest health problems among this age group of children were respiratory tract infection (67.9%) and gastrointestinal problems (15.2%); 11.3% gastroenteritis and 3.9% parasitic infestation. The mean age of participating mothers was 26±2.4 years, 89% of them were < 35 years of age, 97% were currently married, 75% Original Research Article El-Khawaga and Abdel-Wahab; BJMMR, 6(6):597-605, 2015; Article no.BJMMR.2015.237 598 were of secondary or lower educational level and 91% belonged to families that have income < 1200 Egyptian pound / month. Over 80% of the mothers were satisfied with the service they received. Younger mothers, of income <1200 Egyptian pound /month and having greater than a secondary education were significantly more satisfied. Conclusion: SFHC fulfills most services recommended for children under 5 years of age. However there is shortage in some other services (e.g. low rates of antenatal and natal care, reluctance in application of integrated management of childhood illness (IMCI) program and non documentation of health education activities).

Clinical Risk Index for Babies (CRIB II) Scoring System in Prediction of Mortality in Premature Babies.

Clinical Risk Index for Babies scoring system (CRIB II) score is a recently developed tool to predict initial risk of mortality amongst low birth weight babies, the utility of which is scarce in many developing countries. To assess the efficiency of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies admitted to neonatal intensive care unit (NICU) at a tertiary care facility Kasr El-Aini paediatric hospital, Cairo, Egypt. Prospective cohort study design where 113 neonates, admitted during the first 24 hours to the NICU of Kasr El-Aini Hospital, from November 2013 till May 2014 were included. On admission, history taking, neonatal examination, arterial blood gas analysis and variables of CRIB II score were done. Subjects were followed up from admission till discharge or death. Male to female ratio was 1.1:1. Gestational age ranged from 25-32 weeks, the birth weight ranged from 700-1500 gm with mean of 1134.5 (± 202). CRIB II score ranged from 1-19 with a mean of 9.9 (± 4.0). The total mortality in the included cohort was 34.5% (31/113). Significant positive correlations were found between gestational age, birth weight, temperature, excess base, CRIB II score and the occurrence of mortality and with progressive increase in mortality with increasing CRIB II score (p=0.001). CRIB II score ≥ 11, gestational age ≤ 28 and birth weight ≤ 1100 were all found to be significantly associated with neonatal mortality. Area under ROC curve for CRIB II, gestational age and birth weight were found to be (0.968, 0.900 and 0.834) respectively. CRIB II score with cutoff point of ≥ 11 was the most sensitive (94.9%) with the predictive value (74.0%) and specificity (82.4%) compared to birth weight and gestational age. CRIB II score showed good calibration to predict neonatal mortality as demonstrated with Hosmer-lemeshow goodness of fit test (p= 0.952). CRIB II score is a valid tool of initial risk assessment in LBW, predicting outcome more accurately than birth weight or gestational age alone. It is easily applicable and should replace the traditional models as predictor of neonatal outcome.

Amniotic band syndrome: Case report

Amniotic band syndrome (ABS) is a group of rare congenital abnormalities caused by wrapping of parts of the foetus by fibrous amniotic bands during intrauterine life. Objective: To emphasise the importance of a timely diagnostic and therapeutic approach to the patient. Materials and Methods: We used medical records of a hospitalized newborn at the Clinic for Children's Internal Diseases Nis. We applied a descriptive method. Case report: A male newborn, delivered in the 33rd week of gestation, APGAR SCORE 7/8, birth weight 1550g, birth length 43 cm, one day old. The newborn child was transferred from the Gynaecological Clinic Nis to the Clinic for Children's Internal Diseases Nis. The child had suspected infection, respiratory distress syndrome and congenital malformations of limbs with either lacking or deformed hand phalanges. The baby was born by Caesarean section because of the umbilical cord prolapse. The newborn started breeding following a short reanimation. Prenatal ultrasound proved no abnormalities of the foetus. At admission, the newborn had normal physiological findings except for conductivities in both eyes, a lack of some hand phalanges and weaker primitive reflex response. Radiological findings of the hands indicated the absence or reduced size of the individual phalanges, deformities of the head and diaphysis of some hand phalanges of both hands, as well as the presence of soft tissue shadow in the region of the distal phalange of the third finger of the left hand. A paediatric surgeon confirmed the presence of Amniotic band syndrome after physical examination and radiological findings. Cytogenetic study found a normal male karyotype. The presence of abnormalities of other organ systems was excluded with cardiology, nephrology and neonatal examination. Conclusion: We need to think about the Amniotic band syndrome when the infant has visible congenital abnormalities. Ultrasound prenatal diagnosis is very important, but not always sufficiently sensitive in detecting small abnormalities. A multidisciplinary approach is also important in both diagnosis and treatment, depending on the clinical picture.

Imperforate Hymen Presenting with Massive Hematometra and Hematocolpos: A Case Report

Background: Imperforate hymen is the commonest congenital anomaly that causes closure of the vagina. Ideally, diagnosis should be made early during fetal and neonatal examinations to prevent symptomatic presentations of its complications at puberty. Case report: We report a case of a 15-year-old girl who presented with delayed menarche, eight-month history of cyclic abdominal pain, and a three-week history of lower abdominal swelling. A doctor prescribed anthelmintic and analgesic drugs to her a month ago before she was verbally referred to ESUT Teaching Hospital, Enugu. The development of her secondary sexual characteristics was normal for her age. A 20 cm-sized suprapubic mass, and a bulging pinkishimperforate hymen were found on examination. Her transabdominal ultrasound revealed massive hematometra and hematocolpos. She had virginity-preserving hymenotomy and evacuation of about 1000 mls of accumulated coffee-colored menstrual blood. Conclusion: Clinicians should have high index of suspicion of imperforate hymen when assessing cases of delayed menarche with cyclic lower abdominal pain to prevent the consequences of its delayed treatment like massive hematometra and hematocolpos.

Newborn Electrocardiography as a Screening Method for Long-QT Syndrome

Prolongation of the QT interval is the cause of about 10% cases of sudden infant death syndrome (SIDS) in newborns but it is also responsible for about 5% of sudden deaths in adults. LQTS is associated with life threatening arrhythmias such us torsade de pointes ventricular tachycardia or ventricular fibrillation (VF) leading to sudden death. Congenital causes (channelopathies) of LQTS are associated to mutations with different hereditary pattern according affected gene but it has been proven that several drugs and electrolytic alterations can significantly increase the QT interval. However, the cost-effectiveness of neonatal electrocardiographic (EKG) screening has been questioned and despite studies made in newborns there is still no consensus about the best moment to make and electrocardiographic screening. Previous studies demonstrate that newborns with QTc values over 470 msec often normalize by themselves in the first month of life. However in some cases these values remain high after first months of life. These cases are more frequently in determinate ethnics (Maghreb, Morocco and India-Pakistan). These races could be linked to cardiac electrical alterations with a hereditary pattern of variable penetrance. An EKG performed in the first month of life will allow the early identification of still asymptomatic infants with LQTS and also infants with some correctable congenital heart defects (CHD) not recognized by routine neonatal examinations. Appropriate therapy will prevent unnecessary deaths in infants, children, and young adults. At the light of this literature review we could assess that neonatal electrocardiographic screening is highly cost-effective and it may permit the early identification of infants at risk for SIDS.

Routine Use of Pulse Oximetry in the Newborn to Detect Critical Congenital Heart Disease

Critical Congenital Heart Disease’s (CCHD’s) are potentially life-threatening cardiac abnormalities where the systemic or pulmonary circulation is dependent on a patent ductus arteriosus and include those with duct-dependent pulmonary blood flow, inter-circulatory mixing, and systemic hypoperfusion. The seven main CCHD’s screening targets for neonatal pulse oximetry are hypoplastic left heart syndrome, pulmonary atresia (with intact ventricular septum), Tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia and truncus arteriosus. Early diagnosis improves outcomes. Systematic review and metaanalysis of pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies revealed that the overall sensitivity was 76.5% and specificity was 99.9%. The false-positive rate was low when it was done after 24 hours from birth [1]. The American Heart Association and the American Academy of Pediatrics suggest that routine pulse oximetry done on asymptomatic newborns after 24 hours of life but before discharge may detect critical CHD, incurs very low cost, and there is a low risk of harm [2]. European studies suggest that screening is cost-effective in identifying newborns with CCHD [3,4]. Over half of babies discharged with CHD detected in the first year of life were discharged from the hospital with a normal routine neonatal examination and the 6 week exam missed one-third of the patients [5]. In many countries, births are not attended and infants are discharged within hours of birth without medical evaluation by a qualified practioner. CCHD’s will go undetected in this setting.

Effectiveness of pulse-oximetry in addition to routine neonatal examination in detection of congenital heart disease in asymptomatic newborns

Objective: To assess the feasibility and effectiveness of pulse-oximetry as a screening tool in the detection of critical congenital heart disease (CCHD) in newborns.Methods: Post-natal babies born between 01/01/2007–31/12/2009 were eligible. Post-ductal pulse-oximetry was performed using Nellcor® NPB 40 pulse oximeter with reusable OXI-A/N saturation probe. Saturations ≥95% were deemed normal. If saturations were <95%, an echocardiogram was done. The regional paediatric cardiology database and death records identified babies later diagnosed with CCHD.Results: 6329/9613 eligible babies were studied and pulse-oximetry was performed at a mean age of 28 hours (range 6–72 hours). Fourteen babies had saturations <95%. CCHD was diagnosed in 7/14 babies; 4/7 had no clinical signs. Of the remaining 7 babies, 3 had non-critical but significant CHD and 4 had an undiagnosed respiratory illness or sepsis. All babies with low saturations had identifiable pathologies. One baby with normal saturations was later diagnosed with transposition of the great arteries. The sensitivity and specificity of identifying an unwell baby was 93.3% and 100% respectively; the sensitivity and specificity of identifying CCHD was 87.5% and 99.8% respectively. Clinical examination alone would have missed 4/7 (57%) of these.Conclusion: Pulse-oximetry is safe, acceptable, non-invasive and effective. Our study supports the routine use of pulse oximetry as part of the newborn check.

O-036 Hearing Loss By Week Of Gestation And Categories Of Birth Weight In Very Preterm Neonates: A Population-based Study

Background and aims Studies have shown an association between Neonatal hearing loss (NHL) and preterm birth and low birth weight, but the prevalence of NHL more specific within these categories is not known. Aim of this study is to present the risk of NHL by week of gestation and categories of birth weight in an nationwide cohort of neonates born Methods Results of the two-stage Automated Auditory Brainstem Response (AABR) Universal Newborn Hearing Screening Program in Dutch neonatal intensive care units and diagnostic examination were centrally registered between October 1998 and December 2012 and included in this study. NHL was defined as impaired when the neonates’ conventional Auditory Brainstem Response (ABR) level exceeded 35 dB in one (unilateral) or two (bilateral) ears at diagnostic examination. Birth weight was stratified into Results In total 18,564 neonates with a gestational age between 24.0 and 31.9 weeks were eligible for this study. Logistic regression analyses revealed significant associations between gestational age, birth weight and both unilateral and bilateral NHL (all p Conclusions Gestational age and birth weight are independently associated with NHL in a dose-response relationship. This information can be used to gain insight into health and related costs associated with very preterm births.

PO-0445 Neurobehavioral Assessment Of Late Preterm And Full-term Infants: A Preliminary Study

Neonatal neurobehavioral examinations describe newborn’s behavioural repertoire and observable responses to environmental stimulus. This study aimed to evaluate the neurobehavioral of healthy late preterm and full-term infants using Neonatal Neurobehavioral Assessment Preterm Infant (NAPI). We hypothesised that NAPI can detect neurobehavioral differences between healthy late preterm and full-term infant. In this prospective cross-sectional study, infants born with 36 weeks gestational age (GA) (6 days) and 37 weeks GA (6 days) in a tertiary health care institution of Sao Paulo state, Brazil were assessed 24 h after birth, using NAPI. Newborns with malformations, genetics syndromes, neurological impairment, infections and ventilation assistance were excluded. NAPI was conducted only by one expert examiner, in the same place, and always one hour before feeding. The study was approved by the Ethics Committee and all mothers assigned the informed consent form. For the preliminary analysis was considered p ≤ 0,05. Twenty babies (age: 36,5 ± 0,6; birth weight: 2,764 ± 558,16; gender: 70% male and 30% female) had the scores compared by age (36/37 weeks GA) not showing significantly difference: scarf sign (p = 0,685), motor and vigour development (p = 0,758), popliteal angle (p = 0,712), alertness and orientation (p = 0,939), irritability (0,816), cry quality (p = 0,669) and percent asleep (p = 0,248). In this preliminary study we verified that neurobehavioral performances are similar, suggesting that for this population NAPI is not sensitive to detect subtle changes. However, more patients need to be included to confirm our findings.

PO-0105 Early Onset Constipation - What Are The Lessons Learnt?

Background and aims Constipation developing at Aims Evaluate the outcome of EOC and role of rectal biopsy. Methods We reviewed all children diagnosed as EOC between 2008–2013 referred to the Gastroenterology clinic. We analysed 31 case notes and recorded their demographics, investigations and outcome. Results Of 31 children, 61% female, all caucasian except one mixed race. Age of onset reported as since birth in 61% and 1–5 months in 39%. 14/31 children were referred for rectal biopsy when clinically suspected to have HD. 3 were positive (all preterm) and 1 anteriorly placed anus missed on routine neonatal examination. The need for further investigation was driven by red flag symptoms. Passing meconium was delayed in only 8%. Children on hydrolysed milk prior to referral reported no benefit. All were treated with 1/2 laxatives and intermittent suppository. Over 4–12 months 65% fully recovered, (4 underwent surgery) and 13% were controlled with medication. Conclusion EOC is common and has significant impact on the QoL for infant and carer. No association between delayed meconium and HD was noted. The importance of vigilance for diagnosing HD especially in pre-terms must be stressed, also educating trainees about abnormally placed anus. Change in hydrolysed formulae may not be an option but support, advice and medication is the key to success.

Spectrum of diseases diagnosed on bone marrow examination of 285 infants in a single tertiary care center

ObjectivesBone marrow (BM) aspiration and trephine biopsy is one of the most valuable procedures in the evaluation of hematological disorders. There is a shortage of published literature regarding the indications, procedure, and outcome of bone marrow examination (BME) in neonates and infants. The aim of the present study is to analyze the common indications of performing BME and to assess the spectrum of disorders diagnosed from BM of neonates and infants.MethodsA retrospective analysis of BMEs performed in infants over a period of 5 years, between 2009 and 2013 was done.Results and discussionA total of 297 BME were performed on 285 infants, which constitutes 10.3% of pediatric BME procedures during the same period. In our institute, BME is routinely performed by trained pathologists from posterior superior iliac spine in children including infants and neonates with an overall sample adequacy of 97%. Evaluation of cytopenias and suspicion of storage disorder were the most common indications for BME procedure, while acute leukemias and storage disorders were the most common diagnoses offered in infant BM.ConclusionsPosterior superior iliac spine is a good site of BME in neonates and infants. BM trephine biopsy is a difficult procedure in this age group, however remains indispensable in situations where an infiltrative pathology is suspected. BME not only helps to make specific diagnoses but should also be used as an extremely valuable, quick, and economically viable procedure to exclude major hematological disorders including certain forms of storage disorder and hematological malignancy in this age group.

Core Concepts: Neonatal Neurological Examination

The neurological examination is an important tool in the evaluation of a newborn, helping to establish a diagnosis, and providing prognostic information. Neurological disorders may be apparent before birth or appear during the course of the neonatal period. The neonatal neurological examination varies by gestational age and state, which makes the examination a changing and dynamic process. This article reviews the essentials of the neonatal neurological examination, the presence of examination findings based on gestational age, normal and abnormal physical examination findings, and how the examination helps to identify various disorders.

The prevalence of coronavirus in fecal samples of neonatal calf diarrhea using electron microscopic examination

BACKGROUND:Neonatal calf diarrhea (NCD), also known ascalf scours, is caused by viruses, bacteria, and parasites.Coronavirus is one of the important causes of NCD syndrome.Electron microcopy has been used for demonstration of virusesin fecal samples of diarrheic calves since 1969. OBJECTIVES:The aim of this study was to determine the prevalence ofcoronavirus in fecal samples of neonatal calf diarrhea usingelectron microcopy examination of fecal samples. METHODS:For the purpose of this study, a total of 100 cases (under 2 monthsof age) of diarrheic calves from 25 commercial farms in fourdistricts of East Azerbaijan province of Iran were used. FreshFecal samples using sterile swab were collected from every calfwith clinical diarrhea. All samples were transferred into a sterilecontainer and then were sent to the laboratory to be kept in -20oCfreezer until examination. Electron microscopic examinationwas applied to all fecal samples. Chi-square test was used toanalyze the data. RESULTS:According to the results of this study,coronavirus was present in 15% of cases and a significantdifference was found between the prevalence rate and theseasons (p<0.05). The highest prevalence was recorded in winter(28%) and the least prevalence was seen in summer (4%). Therewas not any significant difference in both age groups anddifferent districts according to the prevalence rate of infection.CONCLUSIONS: Neonatal calf diarrhea is a multi-etiologicalsyndrome. Among the viral diarrhea, bovine coronavirus is oneof the major causes of this syndrome. For detection ofcoronavirus in feces, electron microscope examination is a goldstandard diagnostic technique. It seems that coronavirus can beconsidered as one of the important etiologies of neonatal calfdiarrhea in east Azerbaijan of Iran.

Formulation and stability study of a pediatric 2% phenylephrine hydrochloride eye drop solution

We present formulation and stability evaluation of a 2% (w/v) phenylephrine hydrochloride biocompatible eye drop solution, routinely prepared in hospital pharmacy under aseptic conditions, for retinal examination of neonates and premature infants. Eye drop solution was formulated by dissolution of phenylephrine hydrochloride and disodium hydrogen phosphate as buffering agent in sterile water for injection and sodium chloride for injection as isotonic agent. The previous solution was sterile filtered through under aseptic conditions, in an iso class 5 air quality clean room under horizontal laminar airflow hood. Physical stability (visual inspection, osmolality measurements), chemical stability (pH measurement, phenylephrine assay by liquid chromatography coupled with an ultra-high resolution and accurate mass) and sterility evaluation of phenylephrine eye drop solution stored at ambient temperature were studied during 60 days. The formulated eye drop solution had a pH of 6.90±0.05 and an osmolality of 285±2 mOsm/kg. Throughout the 60 days study the solutions remained clear without any precipitation or color modification, sterility was maintained, pH and osmolality were not significantly modified and no significant loss of product was detected using liquid chromatography coupled with an ultra-high resolution and accurate mass instrument suggesting the lack of degradation. These results indicate that 2% phenylephrine hydrochloride eye drop solutions were physically, chemically and microbiologically stable for at least 60 days when stored in type I amber glass vials at room temperature, allowing the compounding of higher batch sizes.

Motricidad fetal durante el segundo trimestre de gestación: estudio ecográfico longitudinal

IntroductionThe aim of this research is to contribute to knowledge of the normal spontaneous motor behavior of the human fetus during the second trimester of pregnancy. This study focuses on five patterns of spontaneous fetal movement: startle (S), axo-rhizomelic rhythmia (ARR), axial stretching (AS), general movement (GM), and diaphragmatic contraction (DC). MethodsA cohort of 13 subjects was followed up using 2D obstetrical ultrasound images at 12, 16, 20, and 24 weeks of gestation. As inclusion criteria, neonatal neurological examination and general movements after eutocic delivery at term were normal in all of the subjects, and their neuromotor and cognitive development until the end of pre-school age were also normal. ResultsAll these five motor patterns are present at the beginning of the 2nd gestational trimester, but their quantitative and qualitative traits are diverse according to gestational ages. The phasic, isolated or rhythmically repeated movements, S and ARR, are prominent at 12 and 16 weeks of gestation, and then their presence gradually diminishes. By contrast, tonic and complex AS and GM movements increase their presence and quality at 20 and 24 weeks. RAR constitute a particular periodic motor pattern not described in previous literature. Moreover, the incidence of DC is progressive throughout the trimester, in clusters of 2-6 arrhythmic and irregular beats. Fetal heart rate increases during fetal motor active periods. ConclusionsAll five normal behavioral patterns observed in the ultrasounds reflect the progressive tuning of motor generators in human nervous system during mid-pregnancy.

Frequency of retinopathy of prematurity in premature neonates with a birth weight below 1500 grams and a gestational age less than 32 weeks: a study from a tertiary care hospital in a lower-middle income country….

IntroductionRetinopathy of prematurity (ROP) is a treatable cause of blindness in neonates. In Pakistan, ROP is often not recognized early because screening and treatment programs are not yet in place in most neonatal units, even in tertiary care hospitals. It is hoped that this report will help inform medical professionals of the magnitude of the problem and help to design appropriate management strategies.ObjectivesThe aim was to determine the frequency of ROP in premature and very low birth weight (BW) neonates (BW<1500 g and gestational age (GA) <32 weeks).Study DesignCross-sectional study.Study SettingNeonatal intensive care unit (NICU) of a tertiary care hospital in Karachi, Pakistan.Study DurationFrom June 2009 to May 2010.Subjects and MethodsNeonates with a Birth weight (BW) <1500 g and Gestational Age (GA) <32 weeks who were admitted to the NICU and received an eye examination, or were referred for a ROP eye examination as an outpatient, were included in the study. GA was estimated from intrauterine ultrasound findings. Neonates with major congenital malformations, syndromes or congenital cataracts or tumors of the eyes, and those that died before the eye examination or did not attend the out patients department for an eye examination, were excluded. The neonatal eye examination was performed by a trained ophthalmologist at 4 or 6 weeks of age.ResultsOut of 86 neonates, ROP was identified in nine neonates (10.5%) at the first eye examination. ROP was significantly associated with BW (P = 0.037), GA (P = 0.033), and chronological age (P<0.001).Conclusionswe identified ROP in 10.5% of neonates at first eye examination. Significant associations between ROP and a GA<32 weeks and a BW<1500 g were also observed.we also stress that serial follow-up of neonates at risk for ROP is important when making a final diagnosis.

Evaluation of somatosensory cortical processing in extremely preterm infants at term with MEG and EEG

ObjectivePrior studies on extremely preterm infants have reported long-term prognostic value of absent secondary somatosensory cortex (SII) responses in magnetoencephalography (MEG) at term. The present work (i) further examines the potential added value of SII responses in neonatal neurological evaluation of preterm infants, and (ii) tests whether SII responses are detectable in routine neonatal electroencephalogram complemented with median nerve stimulation (EEG-SEP). MethodsAltogether 29 infants born <28 gestational weeks underwent MEG, MRI, and neonatal neurological examination at term age, and Hempel neurological examination at 2-years corrected age. Term-age EEG-SEP was available for seven infants. ResultsWhile in neonatal neurological examination severely abnormal finding predicted unfavorable outcome in 2/2 infants, outcome was unfavorable also in 3/9 (33%) moderately abnormal and in 5/18 (28%) mildly abnormal/normal infants. Of these eight infants four had unilaterally absent SII responses in MEG, compared with only two of the 24 infants with favorable outcome. Furthermore, SII responses (when present in MEG) were also usually detectable in EEG-SEP. ConclusionsComplementing clinical EEG recording with SEP holds promise for valuable extension of neonatal neurophysiological assessment. SignificanceMultimodal study of EEG and sensory evoked responses is informative, safe, and cheap, and it can be readily performed at bedside.

The passage of meconium alone is not a sign of correctly positioned anus

Objective: The aim of this study is to determine the consequences of delayed presentation of anorectal malformations and emphasize the causes of delayed diagnosis of these malformations.Methods: We retrospectively reviewed 54 neonatal patients with a diagnosis of anorectal malformations. Group 1 consisted of 35 patients diagnosed within the first 48 h of life and Group 2 included 19 patients diagnosed after 48 h of life.Results: Obstructive symptoms at the time of diagnosis, overall complications and the mean postoperative hospitalization period in Group 2 were markedly higher than that of Group 1. A comprehensive neonatal examination within the first 48 h of life was performed in 32 (91.4%) patients in Group 1 and 5 (26.3%) of the patients in Group 2 (p < 0.001).Conclusions: The passage of meconium is not the only sign of correctly positioned anus. A careful physical examination and awareness of this anomaly are of great importance in making a timely diagnosis of anorectal malformations.

Systemic Effects of Ophthalmic Cyclopentolate on Body Weight in Neonatal Mice

Background: Cyclopentolate is standardly used in ophthalmologic examinations of neonates to facilitate screening for retinopathy of prematurity. Reports of systemic effects have raised concerns of an increased risk of feeding intolerance after the examinations. Objectives: The goal of this study was to evaluate systemic concentrations of cyclopentolate after ophthalmic administration, as well as assess changes in weight as an indirect measure of alteration in feeding. Methods: Neonatal mice were randomized into three groups to simulate a neonatal model for ophthalmic medication administration. The cyclopentolate group received a one-time administration of tetracaine, cyclopentolate, and phenylephrine ophthalmologic solutions in accordance with the protocol used at the children's hospital. The placebo group received the same ophthalmic drop administration, except for normal saline in place of cyclopentolate, and the control group received no ophthalmic drops and minimal handling. Daily weights and serum samples to measure systemic concentrations of cyclopentolate post-ophthalmic administration were assessed at baseline and for 7 days following drop administration. Results: Analysis of serum levels demonstrated detectability of systemic cyclopentolate after ophthalmic administration as early as 30 min (86 ng/ml), 1 h (60 ng/ml), and 24 h (6.2 ng/ml). There were also differences in weight gained on following ophthalmic administration observed between the cyclopentolate group and placebo group, with the cyclopentolate group weighing significantly less on days 3 and 7 (p = 0.02). Conclusions: Results indicate cyclopentolate is absorbed systemically and instillation of cyclopentolate decreases weight gain in neonatal mice compared to placebo. These preclinical findings provide rationale for further studies in neonatal patients.

The Investigation of Patients with Congenital Heart Disease Monitored at Neonatal Intensive Care Unit of Gaziantep Children’s Hospital

The Investigation of Patients with Congenital Heart Disease Monitored at Neonatal Intensive Care Unit of Gaziantep Children’s Hospital Objective: To evaluate retrospectively the relative frequencies, risk factors and diagnostic clues of congenital heart disease in newborns at our neonatal intensive care unit. Materials and Methods: Among 2005 cases who were admitted to the Gaziantep Children’s Hospital Neonatal Intensive Care Unit between January 2012-December 2012, 21 newborns with congenital heart disease were evaluated retrospectively. Results: The prevalence of congenital heart disease was 1.04 %. Heart murmur was the main reason for requesting cardiology consultation in newborns diagnosed as congenital heart disease. The relative percentages of acyanotic and cyanotic heart defects were 62, and 38 percent, respectively. The most frequently detected acyanotic and cyanotic defects were atrioventricular septal defect and tetralogy of Fallot with a prevalence of 23.3 % and 9.5 %, respectively. Besides, 71.5 % of the newborns with congenital heart disease were mature and 28.5 of them premature. Besides, 66.6 % of the newborns diagnosed as congenital heart disease were hospitalized because of respiratory distress. Mean mother age was found as 24.2 (17-41) years. Parents of 43 % of the patients had a history of consanguineous marriage. In the follow-up, surgical treatment were recomended for 8 patients. Three patients passed away before cardiac surgery because of cardiac failure. Conclusion: The prevalence of congenital heart disease in newborns at the neonatal intensive care unit is higher than that in all live births. Careful cardiac examination of neonates hospitalized in intensive care unit is important due to different cardiac hemodynamics even in the absence of significant cardiac findings.