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Backgroud and aims: Bronchopulmonary dysplasia (BPD) is one of the most important chronic complications of premature birth. Although long term effects of BPD are more commonly known by the well-defined pulmonary consequences, cardiovascular sequelae related to BPD have also been reported. In the post-surfactant era data on the cardiovascular changes in new BPD patients is limited. In this study we aimed to investigate the role of myocardial tissue Doppler echocardiography in detecting cardiac pathology in preschool BPD patients and to find out possible risk factors related to cardiovascular sequela. Methods Prematurely born children with BPD (N=21, 4 severe BPD, 3 moderate BPD and 14 mild BPD) and without BPD (N=20) at 2 to 4 years of age were enrolled to the study. Conventional and myocardial tissue Doppler echocardiography studies were performed. Results In conventional echocardiography; right ventricular fractional shortening, tricuspid E/A ratio, mitral late diastolic inflow velocity and pulmonary acceleration time were decreased; mitral E/A ratio, left and right ventricular myocardial performance indexes were increased in BPD group compared to controls. In myocardial tissue Doppler measurements; tricuspid annulus E′/A′ratio was decreased and interventricular septum systolic velocity was increased in BPD group. Low birth weight, disease severity and postnatal cumulative steroid dosage were related with echocardiographic changes. Conclusion BPD affects global cardiac performances up to 2 to 4 year of age with regard to birth weight, disease severity and cumulative steroid dosage. Myocardial tissue Doppler examination did not have additional value to conventional echocardiography in demonstration of these changes.

Background and aims Perfusion index (PI) shows real time changes in peripheric blood flow. Among critically ill infants, it predicts poor perfusion and the severity of the disease. Early diagnosis and treatment of PDA is important to prevent complications due hemodynamically significant patent ductus arteriosus (PDA). In this study, we aimed to compare the PI values of premature infants with and without hemodynamically significant PDA. Methods Forty one premature infants were evaluated with echocardiography at the postnatal days 0 and 3. Patients were grouped as: Group 1 (n=19): no - PDA; Group 2 (n=10) hemodynamically nonsignificant PDA; Group 3 (n=12) hemodynamically significant PDA. PI was measured during a quiet state at the postnatal days 0, 1, 2 and 3 by Masimo pulse oximeter. Clinical characteristics of the infants were recorded prospectively. Results All the study groups were similar with regard to birth weight (1473±51 grams) and gestational age (30±2.9 weeks). Group 3 had significantly lower day 0 PI values compared to Group 1 and 2 (p=0.008). PI values of Group 3 increased after ibuprofen treatment and became similar to Group 1 and 2 after PDA closure on the postnatal days 2 and 3. Conclusion PI values of infants with hemodynamically significant PDA were lower at postnatal day 0 and with ibuprofen treatment; PI values increased to levels of infants without significant PDA. Our data show that PI is an early and noninvasive parameter predicting poor perfusion and may be helpful in decision making for PDA closure.

Background and aims Vitamin D is considered as an important regulator of fetal lung development and innate immune system. Its functions involved in susceptibility and resistance to infections and pulmonary diseases may be important for the occurrence of bronchopulmonary dysplasia (BPD). The aim of the study was to investigate the relationship between Vitamin D receptor gene polymorphism and BPD in preterm infants. Methods Fok I, Bsm I, Apa I, and Taq I polymorphisms in the Vitamin D Receptor (VDR) gene were genotyped using restriction fragment length polymorphism in109 preterm infants (47 with BPD, 62 without BPD) born at gestational age ≤ 32 weeks and admitted to NICU at Ege University Hospital. Results The univariate analysis showed Ff (OR=3.937, p=0.022, 95% CI= 1.22–12.69) and ff (OR=5.238, p=0.004, 95% CI= 1.69–16.23) genotypes of Fok I polymorphism were associated with increased risk of BPD; whereas tt genotype of Taq 1 polymorphism; was associated with a protective effect against BPD (OR=0.30, p=0.04, 95% CI= 0.098–0.094). In a multivariate logistic regression analysis of the model including variant Fok1 genotype with significant PDA, clinical and culture proven sepsis, mechanical ventilation and surfactant treatment; variant Fok 1 genotype increased the risk of BPD (OR=4.115, CI=1.080–15.686, p=0.038) independent from these factors. Taq 1, Bsm 1 and Apa 1 polymorphisms did not have any effect in the same model. Conclusion Fok1 polymorphism was associated with increased frequency of BPD after adjusting for multiple confounders. VDR gene polymorphisms may be suitable for prediction of infants at high risk for BPD.

Background and Aims Abdominal compartment syndrome refers to multiorgan failure secondary to increased intraabdominal pressure and circulatory failure. Early diagnosis and treatment of this clinical syndrome resulting with high mortality in children is possible via intravesical pressure (IVP)measurements. Data on IVP is limited in newborns with increased abdominal pressure due to diseases like necrotizing enterocolitis (NEC). We aimed to investigate the predictive value of consecutive IVP measurements for diagnosis and outcome of NEC. Methods IVP was measured twice daily for 10 days in 61 premature infants below 1500 grams. Measurements of infants with and without NEC were compared. Results Infants were grouped as; Group 1: without NEC, Group 2: NEC medically treated, Group 3: operated for NEC. Group 1 had lower IVP values compared to infants with NEC (p=0.001). Group 2 and 3 had similiar IVP values (p=0.155). A 10% increase in the consecutive IVP measurements was valuable for predicting NEC. Infants who died due to NEC had higher IVP values compared to surviving infants with NEC (p=0.043). Conclusion IVP measurements may be helpful for the diagnosis of NEC. Mortality due to NEC in premature infants may also be predicted with high IVP values.

Background and Aims End tidal measurement of carbonmonoxide (CO) as a side product of hemoglobin turn over may be an indicator of bilirubin production and hemolysis. We aimed to evaluate the association of transcutaneus CO measurement and bilirubin levels in healthy term newborns as an alternative to end tidal CO. Methods A total number of 390 infants were recruited in the study. Infants who were born in our hospital (n=340) were followed by daily transcutaneus CO and capillary bilirubin measurements starting from birth to discharge. Remaning 50 infants were admitted for hyperbilirubinemia treatment after 72 hours of life. Transcutaneous CO measurements were done by Masimo pulse oxymeter. Results Capillary bilirubin and transcutaneus CO levels on 24 and 48 hours of life were positively correlated (Spearman correlation coefficients r =0.21 and 0.87 respectively, p values for both analyses r =0.41, p Conclusion Our data showed positive and statistically significant correlations between bilirubin and transcutaneous CO measurements not in only healthy term newborns but also in newborns with hyperbilirubinemia. Therefore transcutaneous CO measurement deserves attention in order to obtain threshold levels for prediction of severe hyperbilirubinemia.

Background and Aims Thromboelastogram (TEG) gives information about the coagulation cascade showing the combined effects of coagulation factors and thrombocyte functions. Thrombin Generation Assay (TGA) measures the time dependent changes of thrombin concentration. Standard values for newborns do not exist for TGA and TEG. We aimed to evaluate the effects of prematurity and vitamin K on hemostatis by TEG and TGA in addition to conventional methods. Methods Preterm (n=16) and term (n=36) infants who received routine vitamin K prophylaxis were evaluated with pt, inr, ptt, fibrinogen, TEG and TGA measurements performed from cord blood and venous blood obtained on day 3. Results Cord blood pt, inr, ptt and fibrinogen values were similar in both groups. TEG-R value was increased in preterm group showing delayed onset of coagulation compared to term group (p=0.003). Other TEG and TGA measurements were similar in cord blood. After vitamin K prophylaxis; pt and inr decreased, fibrinogen increased in preterm infants (p values; 0.032, 0.01 and 0.009, respectively). In term infants; ptt decreased, fibrinogen, TEG-R, TEG-MA and TGA-lag time increased after vitamin K (p values; 0.034, 0.001, Conclusion In cord blood analyses; preterm infants didn’t have a significant difference apart from a delay in coagulation. The cloth strength was increased in term infants after vitamin K. The lack of such improvement in preterm infants may be attributable to immature hepatic functions of the preterms. Preliminary data for standard values of TEG and TGA were obtained.

Background and Aims Bronchopulmonary dysplasia (BPD) is an important chronic respiratory morbidity of premature infants. Increased carboxyhemoglobin (COHb) levels have been reported for chronic obstructive pulmonary disease, systemic inflammatory response syndrome and acute respiratory distress syndrome and also for mortality in premature infants. COHb levels increases as a result of oxidative stress and inflammation. Changes of COHb levels by the measurement of transcutaneous COHb levels may be informative for continuing inflammation levels of BPD. We aimed to evaluate inflammatory process in BPD with transcutaneous COHb. Methods Twenty premature infants discharged from Ege University NICU with the diagnosis of BPD (Group 1), 20 premature infant without BPD (Group 2), 20 term healthy control (Group 3) infant were included in the study. Transcutanous COHb levels were measured with Masimo radical set device following three months after discharge. Antenatal and neonatal characteristics of infants were recorded. Results Mean transcutanous COHb levels were significantly higher in group 1 than group 2 (p=0.000) at postnatal age 0. Mean SpCO values after first three months of discharge were higher in group 1 than group 2 (p Conclusion Our data support the ongoing persistant chronic inflamatory process after discharge in infants with BPD. The long term multisystemic morbidity, inflammatory mass could be minimized with early diagnosis and preventive treatments. Further investigations are needed in larger populations for early prediction of BPD among the risk group.