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    Awareness or neglecting the diagnosis of cow milk protein allergy in the neonatal period
    (HEC Press, 2023) Vardar, Gonca; Ozdil, Mine; Tufekci, Sinan
    Background and Objectives: Cow milk protein allergy (CMPA) can mimic surgical disease, gastroenteritis, sepsis, and necrotizing enterocolitis in the neonatal period. For this reason, we aimed to evaluate the clinical features, differential diagnosis, and treatment methods of neonates with CMPA. Methods and Study Design: The charts of twenty-six breastfed full-term and preterm newborns presenting with CMPA between October 2018 and February 2021 were retrospectively reviewed. The clinical symptoms, laboratory findings, and methods used in diagnosis and treatment were analyzed. Results: CMPA was diagnosed in preterm infants 50% (n=13) at the same rate as in full-term infants 50% (n=13) between 32 to 38 weeks corrected age (median 36 weeks). Among patients with CMPA, 69.2% (n=18) had blood in the stool at the onset. Cow's Milk-related Symptom Score score was found to be significantly higher prior to diagnosis vs. after treatment with the cow milk protein-free mom’s milk diet [12(11-13) vs. 4(3-5), p<0.001]. Seventy-two hours after the commencement of the mothers’ elimination diet, macroscopic blood in stool disappeared in all patients except one patient. Oral food challenge (OFC) for the diagnosis of CMPA was carried out on all (n=26) neonates. Eosinophilia was seen in 46.2% of patients (n=12). The methemoglobin concentration was 1.1 to 1.5% (median 1.3%). Conclusions: CMPA should be kept in mind for well-appearing preterm and full-term infants suspected of necrotizing enterocolitis and gastroenteritis, respectively, presenting with bloody stool and eosinophilia. The use of OFC can be implemented since neonates were very well monitored in the neonatal intensive care unit. Treatment is possible by continuing breastfeeding. © 2023, Asia Pacific Journal of Clinical Nutrition. All Rights Reserved.
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    Awareness or neglecting the diagnosis of cow milk protein allergy in the neonatal period
    (H E C Press, Healthy Eating Club Pty Ltd, 2023) Vardar, Gonca; Ozdil, Mine; Tufekci, Sinan
    Background and Objectives: Cow milk protein allergy (CMPA) can mimic surgical disease, gastroenteritis, sepsis, and necrotizing enterocolitis in the neonatal period. For this reason, we aimed to evaluate the clinical features, differential diagnosis, and treatment methods of neonates with CMPA. Methods and Study Design: The charts of twenty-six breastfed full-term and preterm newborns presenting with CMPA between October 2018 and February 2021 were retrospectively reviewed. The clinical symptoms, laboratory findings, and methods used in diagnosis and treatment were analyzed. Results: CMPA was diagnosed in preterm infants 50% (n=13) at the same rate as in full-term infants 50% (n=13) between 32 to 38 weeks corrected age (median 36 weeks). Among patients with CMPA, 69.2% (n=18) had blood in the stool at the onset. Cow's Milk-related Symptom Score score was found to be significantly higher prior to diagnosis vs. after treatment with the cow milk protein-free mom's milk diet [12(11-13) vs. 4(3-5), p<0.001]. Seventy-two hours after the commencement of the mothers' elimination diet, macroscopic blood in stool disappeared in all patients except one patient. Oral food challenge (OFC) for the diagnosis of CMPA was carried out on all (n=26) neonates. Eosinophilia was seen in 46.2% of patients (n=12). The methemoglobin concentration was 1.1 to 1.5% (median 1.3%). Conclusions: CMPA should be kept in mind for well-appearing preterm and full-term infants suspected of necrotizing enterocolitis and gastroenteritis, respectively, presenting with bloody stool and eosinophilia. The use of OFC can be implemented since neonates were very well monitored in the neonatal intensive care unit. Treatment is possible by continuing breastfeeding.
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    Comparison of the Effectiveness of Single and Double Surface Light Emitting Diodes Phototherapy and Intensive Compact Fluorescent Phototherapy in the Treatment of Neonatal Hyperbilirubinemia
    (Galenos Publ House, 2023) Tufekci, Sinan; Tufekci, Bilge Sertel
    Aim: In newborns with extremely high serum total bilirubin levels, the phototherapy method that reduces serum total bilirubin levels most rapidly should be applied to reduce the need for exchange transfusions and thus prevent the development of acute and/or chronic bilirubin encephalopathy. The aim of this study was to compare the efficacy of single or double light-emitting diode (LED) and intensive compact fluorescent tube (CFT) phototherapy in the first 4 hours of treatment for hyperbilirubinemia.Methods: The study was a retrospective analysis of prospectively collected data, and designed as a single-center, cross-sectional study. Sixty newborns born between 35 and 42 weeks of gestation and treated with intensive phototherapy were included in the study. Total serum bilirubin (TSB) levels were measured 4 hours after the initiation of treatment in neonates who received LED or CFT phototherapy, and the efficacy of these methods was compared.Results: The rate of decline in TSB was 1.07 mg/dL/h in CFT, 0.74 mg/dL/h in double LED, and 0.44 mg/dL/h in single LED phototherapy. Compact fluorescent tube and double LED phototherapy were found to be more effective than single LED phototherapy (p<0.01,Conclusion: In neonates with hyperbilirubinemia, intensive CFT or double LED phototherapy in the first few hours of treatment may reduce the risk of bilirubin encephalopathy.
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    A Retrospective Analysis of the Neurological Evaluation of Cases With Neonatal Hypoglycemia
    (Springernature, 2022) Gurbuz, Gurkan; Gur, Selen; Tufekci, Sinan; Halis, Hulya
    Introduction Hypoglycemia is a common treatable metabolic disorder in the neonatal period. It can cause several neurological problems if untreated. In this study, the neurological outcomes of cases with hypoglycemia in the neonatal period were examined retrospectively, and the study aimed to determine risk factors and prognostic factors. Methods In this retrospective study, cases were followed in the pediatric neurology outpatient clinic between 2019 and 2022, and patients with a history of hypoglycemia in the neonatal period were enrolled and analyzed retrospectively. The laboratory studies and clinical findings of the cases were obtained from follow-up records from the pediatric neurology outpatient clinic retrospectively. Physical examination findings, hypoglycemia levels, and symptoms of hypoglycemia, if any, were obtained retrospectively from the discharge files of the patients. Results A total of 70 cases were included in the study. Twenty-eight were girls and 42 were boys. Forty of the cases were preterm. The number of asymptomatic cases was 38, and the number of symptomatic cases was 32. There was no significant difference in regard to the mean lowest serum glucose levels between symptomatic and asymptomatic cases. Thirty-three of the patients had neurological problems such as neuromotor developmental delay, cortical blindness, and epilepsy. Abnormal magnetic resonance imaging (MRI) findings were detected in 30 of the symptomatic cases and eight of the asymptomatic cases. The rate of neurological sequelae in asymptomatic cases was found to be significantly lower than in symptomatic cases. Conclusions Patients who have a symptomatic hypoglycemic period, maternal gestational problems, and abnormal MRI carry a high risk for neurological sequelae, and these findings indicate poor prognosis.