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BackgroundRespiratory distress syndrome (RDS) is the most common respiratory disease in premature infants. Exogenous natural surfactant preparations are used in the treatment of RDS. In recent years, it has become increasingly evident that surfactant plays an immunoregulatory role.ObjectivesThe aim of this study was to evaluate cytokine and chemokine response following three different regimens of natural surfactant treatment in preterm newborns with RDS.MethodsPremature newborns below 32 weeks of gestation who were intubated for RDS and given early surfactant rescue therapy were included in the study. Newborns were randomly divided into three groups and Beractant 100 mg/kg (B-100), Poractant alfa 100 mg/kg (Pα-100) and Poractant alfa 200 mg/kg (Pα-200) were administered intratracheally. Blood samples and transtracheal aspirates (TA) were collected just before and 4–6 h after the surfactant treatment. Total eosinophil count, inducible T Cell alpha chemoattractant (ITaC), macrophage inflammatory protein 3 beta (MIP3b), interleukins (IL) 5, 8, 9, 10, 13, immunoglobulin E (IgE), interferon gamma (IFN-γ), eotaxin and tumor necrosis factor beta-1 (TGF-β1) were measured from blood and tracheal aspirate samples.ResultsA total of 45 infants, 15 in each group, were included in the study. Mean gestational age, birth weight, antenatal, demographic and clinical characteristics of the study groups were similar. IFNγ concentration and eosinophil counts in TA decreased after surfactant replacement in all groups, especially in the infants treated with Pα-100 and Pα-200. Eotaxin, TGF beta and IL-8 concentrations in TA increased significantly in the infants treated with Pα-100 and Pα-200. IL-9 levels in TA decreased in the B-100 group but increased in the Pα-100 and Pα-200 groups. Blood levels of cytokines and chemokines showed significantly decreased levels of ITaC and MIP3b only in the B-100 group, but no significant change was observed in the Pα-100 and Pα-200 groups.ConclusionIn our study, the different immunomodulatory effects of natural surfactant preparations on newborn lung is proven. We found that Poractant α, one of the natural surfactant preparations, shifted the lung immune system toward TH2.

Cystic fibrosis (CF) is an autosomal recessive disease. The genetic transition occurs with CF transmembrane conductance regulator (CFTR) gene mutation. We aimed to determine the frequency of CF mutations and also new mutations in the CFTR gene in neonates with respiratory distress. Newborn babies hospitalized due to respiratory distress were included in the patient group. The control group consisted of infants who had no respiratory distress. The CFTR genes of both groups were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. A total of 40 patients (20 in the patient group and 20 in the control group) were evaluated. The CFTR gene analysis was normal in 16 neonates in the patient group, whereas in others: A46D (c.137C>A) (n = 1), D1312G (c.3935A>G) (n = 1), R117H (c.350G>A) (n = 1), S1426P (c.4276T>C) (n = 1) heterozygotes were detected; CFTR gene analysis was normal at 14 neonates in the control group, whereas in others: E1228G (c.3683A>G) (n = 1), E217G (c.650A>G) (n = 1), E632TfsX9 (c1894_1895delAG) (n = 1), I807M (c.2421 A>G) (n = 2), S573F (c.1718C>T) (n = 1) heterozygotes were detected. There was no significant difference in the patient and control groups’ CFTR gene analysis (p = 0.340). This study demonstrates the importance of CFTR gene analysis in asymptomatic newborn infants for follow-up and early diagnosis of CFTR-related disorders. In this study, a c.1894_1895delAG (E632TfsX9) heterozygous mutation detected in the CFTR gene in an asymptomatic newborn infant, was first encountered in the literature.

Hipoglisemi, yenidoğanın en sık metabolik sorunudur ve uzun sürmesi ya da sık tekrarlaması durumunda serebral zedelenmeye neden olabilir. Bu çalışmanın amacı doğum sonrası anne yanında izlenen ve risk faktörü olan yenidoğan bebeklerde hipoglisemi sıklığını belirlemek, hipoglisemi taramasının önemini ve hipoglisemiden korunmada da anne sütünün önemini vurgulamaktır. Gereç ve Yöntemler: Çalışmaya Mayıs 2020 ile Mayıs 2021 tarihleri arasında hastanemizde doğan ve anne yanında izlenen, risk faktörü olan yenidoğan bebekler alındı. Bebeklerde ilk kan glukozu, beslendikten 30 dakika sonra ölçüldü. Beslenme ile normoglisemik değerler elde edilmesi durumunda, ölçüm 2-3 saat aralıklarla ve beslenme öncesi olacak şekilde tekrarlandı, yaşamın 48. saatinde tarama sonlandırıldı. Hipoglisemi gelişen bebeklerle gelişmeyen bebekler demografik özellikleri, beslenme şekilleri ve kan glukoz değerleri açısındn karşılaştırıldılar. Bulgular: Çalışmaya risk faktörü olan ve hipoglisemi taraması yapılan 260 bebek alındı. Bu bebeklerin 109'u (%41,9) preterm bebek, 62'si (%23,8) diabetik anne bebeği (DAB), 32'si (%12,3) gebelik haftasına göre büyük bebek (LGA), 10'u (%3,8) gebelik haftasına göre küçük bebek (SGA) ve 47'si (%18,1) intrauterin büyüme kısıtlılığı (İUBK) olan bebeklerdi. Yapılan taramada 260 bebeğin 24'ünde (%9,2) hipoglisemi saptandı. Bebeklerin %78,5'inde ilk beslenme anne sütüyken, sonraki beslenmelerde sadece anne sütü ile beslenen bebeklerin oranının %50,8'e düştüğü görüldü. İzlem boyunca sadece anne sütü alan bebeklerde anlamlı olarak hipogliseminin daha az olduğu görüldü (p=0,003). Sonuç: Risk faktörü olan bebeklerin, özellikle de diabetik anne bebeklerinin doğum sonrası hipoglisemi taramalarının yapılması önemlidir. Hipoglisemi riski taşıyan bu bebeklerin, hipoglisemiden korumak için hem erken hem de geç dönemde sadece anne sütü ile beslenmeleri sağlanmalıdır.

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