Hyperbilirubinemia is an important health problem in newborns. The most common causes are Rh and ABO incompatibility, hemolytic anemias, enzyme deficiencies, sepsis, hypothyroidism, pyloric stenosis and breast-milk jaundice. Adrenal hemorrhage is a rare cause of hyperbilirubinemia in the neonate. We present a six-day-old newborn with hyperbilirubinemia and suprarenal hematoma who was born at home without assistance of healthcare personnel. Adrenal hematoma should also be considered in the differential diagnosis of hyperbilirubinemia, particularly in newborns that experienced a difficult delivery.

Hyperbilirubinemia is an important health problem in newborns. The most common causes are Rh and ABO incompatibility, hemolytic anemias, enzyme deficiencies, sepsis, hypothyroidism, pyloric stenosis and breast-milk jaundice. Adrenal hemorrhage is a rare cause of hyperbilirubinemia in the neonate. We present a six-day-old newborn with hyperbilirubinemia and suprarenal hematoma who was born at home without assistance of healthcare personnel. Adrenal hematoma should also be considered in the differential diagnosis of hyperbilirubinemia, particularly in newborns that experienced a difficult delivery.

This study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 +/- 533 g. The mean age at admission was 4.47 +/- 2.22 days, and the mean bilirubin level was 35.0 +/- 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.

This study aimed to review the etiology, clinical - laboratory features and mortality rate of term 80 neonates with perinatal asphyxia admitted to our neonatal unit between January 2005-April 2006. The sex distribution was 24 (%30) female and 56 (% 70) male. The mean gestational age was 38.6±1.3 weeks and weight 3156±561 gram. Of the patients % 46.25 were delivered with a cesarean section and % 53.75 with spontaneous vaginal delivery. The etiologic factors for hypoxic ischemic encephalopathy were % 31.25 force delivery, meconium aspiration, and % 66.25 preeclampsia, eclampsia and diabetic mother’s infant. The distribution of patients according to HIE statging system (Sarnat&Sarnat) were as follows: 33 patients (% 41.25) in stage 1, 20 (% 25) in stage 2 and 27 (% 33.75 in stage 3. Seizures were observed in % 33.75 of patients. The mean duration of hospital stay was 10.6±7.7 days for the surviving patients and 4.2±3.4 days for patients who died. Except from central nervous system, liver and kidney were the most involved organs.Perinatal asphyxia remains to be leading cause of neonatal mortality. Hypoxic ischemic encephalopathy is a common newborn problem and cause important mortality and morbidity where low-social –cultural –education conditions with in regions.

Dicle Universitesi T›p Fakultesi Cocuk Sa¤l›¤› ve Hastal›klar› Anabilim Dal›, Cocuk Sa¤l›¤› ve Hastal›klar› Uzman› 2) Dicle Universitesi T›p Fakultesi Cocuk Sa¤l›¤› ve Hastal›klar› Anabilim Dal›, Cocuk Sa¤l›¤› ve Hastal›klar› Uzman›, Prof. Dr. 3) Dicle Universitesi T›p Fakultesi Aile Hekimli¤i Anabilim Dal›, Aile Hekimli¤i Uzman›, Yard. Doc. Dr. 4) Dicle Universitesi T›p Fakultesi Aile Hekimli¤i Anabilim Dal›, Aile Hekimli¤i Uzman› Girifl

Congenital diaphragmatic hernia is associated with a high degree of morbidity and mortality. It may be diagnosed antenatally by Ultrasonografi. Postnatal survival rate significantly increases by means of appropriate management. Three cases presented in this report were without a prenatal diagnosis. One of the cases has right side congenital diaphragmatic hernia while other two cases have left side ones. None of them could survive for postnatal 8 hours. In our report, we aimed to remind that survival of these cases may be increased if disease is detected prenatally and the labor is realized in centers where neonatologist, pediatric surgeon and required equipment are present.

SUMMARY The harlequin fetus, a severe variant of ichthyosis, occurs rarely, and these babies die within the first few days of life. Early retinoid therapy may improve the disorder and help increase survival rates. The exact cause of the sudden infant death syndrome of the suckling is not known and the incidence approximately is 0.1-0.3 %. In general, these babies looked well and healthy at the time of the sleeping but were found dead in their bed in the morning. We report a harlequin fetus with sudden infant death syndrome.

ÖZET Bu çalışmada 2005 Ocak 2006 Nisan tarihleri arasında Yenidoğan ünitemizde izlenen ve hipoksik iskemik ensefalopati (HİE) tanısı konulan 80 term hastanın etyoloji, klinik, laboratuvar özellikleri ve mortalite oranları retrospektif olarak incelendi Hastaların 24 (% 30)’ü kız, 56 (% 70’i)’sı erkek idi. Gestasyonel yaş ortalaması 38.6 ± 1,3 hafta ve ortalama doğum ağırlığı 3156±561gram idi. Hastaların 37 (% 46.25)’si sezaryen, 43 (% 53.75)’ü ise normal vaginal yolla, 8 (% 10)’i evde ve 72 (% 90)’si ise hastanede doğmuştu. Hastalarımızın % 31.25’inde zor doğum, mekonyumlu doğum, müdahaleli doğum gibi doğuma ait nedenler, % 66.25’inde preeklampsi veya eklampsi, diabet gibi gebeliğe ait nedenler saptandı. Hipoksik iskemik ensefalopati Sarnat&Sarnat’a göre 33 hasta (41.25) Evre 1, 20 hasta (% 25) Evre 2, 27 hasta ise (% 33.75) Evre 3 olarak değerlendirildi. Hastaların % 33.75’inde konvulziyon gözlendi. Hastanede kalım süresi yaşayanlarda ortalama 10.6±7.7 gün ve ölenlerde ise 4.2±3.4 gün idi. Santral sinir sistemi dışındaki organ tutulumları içinde en çok etkilenen organ karaciğer ve böbrek idi ve mortalite oranı % 30 olarak saptandı. Perinatal asfiksi neonatal mortalitenin halen en önemli nedenlerinden biri olarak devam etmektedir. Özellikle sosyo-kültürel ve eğitim düzeyinin düşük olduğu bölgelerde hipoksik iskemik ensefalopati mortalite ve morbidite açısından önemli bir sağlık sorunu olarak gözlenmektedir. Anahtar Kelimeler: Hipoksik İskemik Ensefalopati, Yenidoğan, Term

Neonatal hyperbilirubinemia is a common newborn problem and may cause important mortality and morbidity when early recognition and appropriate management was not made. In this study we aimed to asses the etiology of hyperbilirubinemia in 56 neonates who had exchange transfusion. Of patients 64% were male and 36% were female. Mean age of admission was 6.4  2.5 days and mean total bilirubin level was 3811,9 mg/dl. The cause of hyperbilirubinemia was ABO incompatibility in 34%, Rh incompatibility in 21.4%, glucose-6-phospatase deficiency in 9%, intrauterine growth restriction in 5%, sepsis in 4%, hypothyroidism in 3.6%, minor blood group incompatibility in 1.8%, cephal hematoma in 1.8%, diabetic mother’s child in 1.8% of patients. Exchange transfusion was made once in 86% and twice in 14% of patients.

T applications of colchicine have widened to include familial Mediterranean fever, primary biliary cirrhosis, liver cirrhosis, Behcet’s syndrome, recurrent pericarditis, and scleroderma.1 Colchicine poisoning is uncommon, but its mortality is rather high. Within 30-120 minutes following its ingestion, it is rapidly absorbed from the gastrointestinal tract leading to multiple complications. A 2-year-old girl was admitted to our hospital with complaints of a sudden onset of abdominal pain and vomiting. Drug poisoning was suspected, and family members were questioned accordingly. Her father had been diagnosed with gout and he was using colchicine dispert (0.5 mg) dragees. Detailed history revealed an accidental ingestion of almost 25 dragees of colchicine dispert 2 hours before her admission. Upon admission, she was pale and agitated. Her blood pressure was 95/55 mm/Hg, axillary temperature was 36.8OC, heart rate was 136 beats per minute, and respiratory rate was 34 breaths per minute. Her weight was 10 kg (3-10 percentiles) and height was 85 cm (25-50 percentiles). Abdominal auscultation revealed increased intestinal sounds. The rest of her physical examination was unremarkable. Whole blood count revealed the following: 60.4000 leukocytes/mm3, 13.4 g/dl hemoglobin (Hb), and 436.000/mm3 thrombocytes. On laboratory evaluation, a moderately increased aspartate aminotransferase (106 IU/mL) levels was found. C-reactive protein, erythrocyte sedimentation rate, serum sodium and potassium, urea, creatinine, calcium, and phosphorus levels were normal. Gastric lavage was performed and 1 g/kg of activated charcoal was orally administered. On the second day of hospitalization, she developed tachycardia, with a heart rate of 180 beats per minute. Electrocardiography revealed sinus tachycardia, and digoxin was administered. Echocardiography was normal. Vomiting and diarrhea persisted. Serum sodium and potassium levels decreased to 113 mmol/L and 3 mmol/L. In order to correct the fluid and electrolyte imbalance, intravenous fluid administration was initiated (3000 ml/m2/day, 1/5 isotonic saline in 5% dextrose solution, 3% NaCl solution). On the third day, severe thrombocytopenia (23.000/mm3), leukopenia (2500/mm3), and anemia (8.3 g/dL) were detected, but no bleeding, petechiae, ecchymoses, or hyperthermia developed. On the second week, total alopecia developed (Figure 1). Her abdominal pain, vomiting, and diarrhea were resolved during the first week, biochemical and hematological values returned to normal within 10 days. She was discharged on the following 13 days of treatment at the hospital. Her follow-up as an outpatient lasted for 10 months and it was uneventful. The clinical manifestations of colchicine toxicity can be broadly divided into 4 stages. The first stage is characterized by severe gastrointestinal symptoms such as, nausea, vomiting, diarrhea, abdominal distention, and abdominal pain besides leukocytosis. These symptoms develop within the first 4 to 8 hours following ingestion. At the second stage, usually between the second and eight days of poisoning, cardiorespiratory collapse and multiorgan failure occur. Colchicine induces adult respiratory distress syndrome, myocardial toxicity, and rhabdomyolysis. At the third stage, bone marrow suppression, and as a result, pancytopenia develops. The fourth stage is characterized by a rebound leukocytosis, and a total body alopecia occurring from day 10 onwards, which recovers over a period of several weeks. In the present case, gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain, and leukocytosis developed on the first day. On the second day, hyponatremia, hypokalemia, and hypovolemia developed due to vomiting and diarrhea, resulting in heart failure. On the third day, pancytopenia occurred. On day 10, clinical and laboratory findings improved, and on the 13th day, she was discharged Clinical Notes

Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal care unit of our hospital from April 2005 to February 2006.The number of VLBW admissions to the our neonatal care unit was 91, fourty one percent female and %49 were male. The mean birth weight was 1191±261 g and gestational age was 29±2.4 weeks. The mortality rate was 37.3 %. Antenatal steroids had been given to only 8% of mothers. The most important maternal risk factors were preeclampsia/eclampsia 30%, premature rupture of membranes 13%, hemorhage 8%. Respiratory distress syndrome was diagnosed 47%, surfactant was given to 40% of these infants. The major causes of death were sepsis, respiratuar distres syndrome, and extreme prematurity.Compared with reports from other developed NICU, VLBW infants at our center had higher mortality rates. We conclude that, the major cause of high mortality rate depends on low-social –cultural –education conditions associated with insufficient prenatal care, neonatal care and inaccurate neonatal transport in our region.

Digoxin is one of the most commonly used positive inotropic agent. Digitalis toxicity may occur easily because of digoxin has a narrow therapeutic window. Digitalis toxicity may result during treatment with digoxin or from accidental overdose of digoxin. An elevated serum level of digoxin (>2ng/ml) is likely to be associated with toxicity, overdose of digoxin (>5ng/ml) may lead to life-threatening arrhythmias. A 14-days old newborn with VSD, which had been prescribed the droplet form of digoxin but given the tablet form by the drugstore, was diagnosed as digitalis toxicity and hospitalized to our clinic. His mother expressed that she had given two tablets mashed with spoon and diluted. Bradycardia and grade 3/6 pansystolic murmur was determined in physical examination. Digoxin level in serum was >5 ng/ml and there was third degree atrioventricular block in ECG findings. The case has been presented to emphasize the importance of better evaluation of digoxin indications and making families of the patients conscious of the usage of digoxin.

The objective of this study was to determine the prevalence and spectrum of cardiovascular malformations in live-born preterm infants. Two hundred and four preterm infants (122 male; 82 female) whose gestational ages were 24-34 (31.1±2.2) weeks and were hospitalized in the Neonatology Service of Dicle University Medical Faculty, from April 2004 to April 2005, were enrolled to the study. Within two days after the patient’s hospitalization, cardiovascular malformations were investigated by the echocardiographic examination. Cardiovascular malformations were present at 99 (48.5%) of 204 preterm infants who enrolled to the study. The frequencies of the cardiovascular malformations among the preterms were %36.3 patent ductus arteriosus, %5.4 ventricular septal defect, %3.9 atrial septal defect, %0.98 pulmonary stenosis, %0.98 atrial septal aneurysm with patent foramen ovale, %0.49 atrioventricular septal defect, %0.49 tetralogy of Fallot.

Lymphoma is the second common malign disease in childhood in our country. A total of 29 NHL patients between 1999 and 2005 were retrospectively reviewed in this study. Twentythree patients were boy and six were girl. The most frequent symptoms were abdominal mass (20 patients) and abdominal pain (15 patients). Four patients underwent laparatomy due to intussuception and the diagnosis of NHL was made intraoperatively. Six patients had associated with mediastinal mass and three had mass on jaw. The mean LDH value was 574 U/L, while 43% of patients had a LDH level of greater than 500 U/L. Microscopic evaluation revealed B-cell Burkitt’s lymphoma in 20 patients, lymphblastic lymphoma in five patients, and large cell lymphoma in four patients. Of the 23 patients who accepted treatment, 20 received NHL-BFM 90, two received ALL-BFM and one received LSA2-L2 protocol treatment. A lymphoblastic lymphoma patient who received LSA2-L2 treatment died at the sixth month of the treatment. One patient was under the treatment during the study period. Fifteen patients were followed for a mean period of 24.8 months. The remaining seven patients lost the follow. Of these 15 patients, 14 recevied final treatment were inremition during the follow period, while one patient was failed to treatment.