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Objective: A Disintegrin and Metalloproteinase with Thrombospondin-9 (ADAMTS-9), one of the ADAMTS enzymes, is expressed in all fetal tissues, unlike other ADAMTS enzymes, and is thus thought to play a role in fetal development. In this context, the objective of this study is to investigate the relationship between ADAMTS-9 activity and the development of congenital heart diseases (CHD) with a view to using ADAMTS-9 level as a biomarker for CHDs., Study Design: Newborns diagnosed with CHD and healthy newborns were included in the study as the CHD and control groups, respectively. Gestational age, maternal age, and mode of delivery information pertaining to the mothers and Apgar score and birthweight information pertaining to the newborns were recorded. Blood samples were taken from all newborns to determine their ADAMTS-9 levels in the first 24 hours of life., Results: Fifty-eight newborns with CHD and 46 healthy newborns were included in the study. Median ADAMTS-9 levels were 46.57 (interquartile range [IQR]: 33.31 [min: 26.92, max: 124.25]) and 23.36 (IQR: 5.48 [min: 11.7, max: 37.71]) ng/mL in the CHD and control groups, respectively. ADAMTS-9 levels in the CHD group were statistically significantly higher than in the control group ( p  = 0.000). ADAMTS-9 levels of the CHD and control groups were analyzed by the receiver operating characteristics curve. The area under the curve value for ADAMTS-9 levels of >27.86 ng/mL as the cut-off value for predicting the development of CHD in newborns was 0.836 (95% confidence interval [CI]: 0.753-0.900, p  = 0.0001). ADAMTS-9 levels of >27.86 ng/mL were determined to predict the development of CHD in newborns with a sensitivity of 77.78% (95% CI: 65.5-87.38) and a specificity of 84.78% (95% CI: 71.1-93.60)., Conclusion: In conclusion, it was found that the serum ADAMTS-9 levels were significantly higher in newborns with CHD than in healthy newborns. In parallel, ADAMTS-9 levels above a certain cut-off value were associated with CHD., Key Points: · ADAMTS-9 is expressed in fetal tissues.. · Its level increases in congenital heart diseases.. · It can be used as a biochemical marker in diagnosis.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: It is not yet known whether systemic inflammatory indices affect the development of respiratory distress syndrome (RDS) in premature infants. We aimed to evaluate the relationship between systemic inflammatory indices obtained on the first day of life and the development of RDS in premature infants., Study Design: Premature infants with gestational age of ≤32 weeks were included in the study. Six systemic inflammatory indices involving neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were measured in the first 1 hour after birth and compared in premature infants with and without RDS., Results: A total of 931 premature infants, 579 infants in the RDS group and 352 infants in the non-RDS group, were included in the study. MLR, PLR, and SIRI values were similar between the groups ( p  > 0.05 for all parameters). NLR, PIV, and SII values in the RDS group were significantly higher than those in the non-RDS group ( p  = 0.005, p  = 0.011, and p  < 0.001, respectively). In the predictivity of RDS, the AUC value of SII was 0.842 and the cut-off value was ≥78.200. Multiple logistic analysis showed that a higher level of SII (≥78.2) was independently associated with RDS (odds ratio: 3.03, 95% confidence interval: 1.761-5.301)., Conclusion: Our results demonstrated that a higher SII level (≥78.2) may be a predictor for the development of RDS in premature infants with gestational age of ≤32 weeks., Key Points: · It is not yet known whether systemic inflammatory indices affect the development of RDS.. · Our results demonstrated high SII levels may be a predictor for the development of RDS.. · SII may provide an advantage as a low-cost, easy-to-detect, useful and powerful parameter in RDS.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: This study aimed to ascertain the effects of astaxanthin (ASX) in an experimental necrotizing enterocolitis (NEC) model using rat pups., Study Design: Forty-two pups born from five Wistar albino rats were randomly divided into three groups as the control group, NEC + placebo (saline), and NEC + ASX. Pups in the NEC + ASX group were given 100 mg/kg/day oral ASX from day 1 to day 4 of the study. Saline of 2 mL/kg was given to the NEC + placebo group. Histopathological, immunohistochemical (caspase-3), and biochemical evaluations including the total antioxidant status (TAS), total oxidant status (TOS), superoxide dismutase (SOD), glutathione (GSH), lipid hydroperoxide (LPO), 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation protein products (AOPP), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and nuclear factor erythroid 2-related factor 2 (Nfr-2) activities were all performed., Results: A better survival rate and weight gain were demonstrated in the NEC + ASX group ( p  < 0.05). In the histopathological evaluation, the severity of intestinal damage was significantly reduced in the NEC + ASX group, as well as decreased apoptosis (enzyme-linked immunosorbent assay [ELISA] for caspase-3; p  = 0.001). The biochemical analyses of intestinal tissue TOS, oxidative stress index (OSI; TOS/TAS), IL-1β, LPO, 8-OHdG, AOPP, caspase-3 ( p  < 0.001 for all), and TNF-α and MPO ( p  = 0.001 for both parameters) levels were lower in the NEC + ASX group than in the NEC + placebo group. Nrf-2, TAS, GSH, and SOD levels were higher in the NEC + ASX group than in the NEC + placebo group ( p  = 0.001, 0.001, <0.001, and 0.01, respectively)., Conclusion: ASX treatment has been shown to effectively reduce the severity of intestinal damage in NEC due to its antioxidant, anti-inflammatory, and antiapoptotic properties., Key Points: · NEC causes extremely high morbidity and mortality, as well as many complications.. · We investigated the effectiveness of ASX in the experimental NEC model created in rat pups.. · First study examining the effect of ASX on the experimental NEC rat model.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Structured light plethysmography (SLP) is a novel and noncontact respiratory assessment technique. It provides tidal breathing measurement in patients difficult to cooperate. In this study, we aimed to determine data for tidal breathing parameters measured by SLP in newborns., Study Design: Infants between 2 and 5 days of life without having any respiratory symptoms were eligible for this observational study. In total, 5 minutes of tidal breathing was recorded using SLP (Thora-3Di, PneumaCare Ltd, Cambridge, U.K.) in each infant. Various tidal breathing parameters including timing indices, flow-based parameters, and regional parameters were obtained from SLP data., Results: A total of 57 infants underwent measurements in the study. Evaluable recordings from 42 term and 11 late preterm infants were analyzed. Median gestational age and birthweight of the infants were 38 (37-39) weeks and 3,195 (2,790-3,585) g, respectively. In terms of flow-based parameters, "tidal inspiratory flow at 50% of inspiratory volume divided by tidal expiratory flow at 50% of expiratory volume" was 1.29 (1.13-1.53). Relative contribution of the thorax to each breath in percentage was measured as 38.67 (28.21-43.60). Median values of left-right hemithoracic asynchrony and thoraco-abdominal asynchrony were 6.92 (5.35-9.04) and 17.96 (12.98-36.44) degrees in the study population, respectively. There were no differences in tidal breathing parameters except "hemithoracic asynchrony" between term and late preterm infants. Hemithoracic asynchrony was significantly lower in term neonates than late preterms., Conclusion: SLP was found to be feasible to obtain measures of tidal breathing parameters in newborns and it could be performed successfully even in the first days of life., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Antenatal magnesium sulfate (MgSO 4 ) treatment is associated with reduced risk of cerebral palsy in preterm infants. We aimed to investigate whether this treatment leads to any alterations on cerebral hemodynamics which could be detected by near-infrared spectroscopy (NIRS) readings in early postnatal life., Study Design: Infants with gestational ages (GAs) ≤ 32 weeks were divided into two groups regarding their exposure to antenatal neuroprotective MgSO 4 treatment or not. NIRS monitoring was performed to all infants, and readings were recorded for 2 hours each day during the first 3 days of life. The primary aim was to compare regional cerebral oxygen saturation (rcSO 2 ) and cerebral fractional tissue oxygen extraction (cFTOE) between the groups., Results: Sixty-six infants were exposed to antenatal MgSO 4 , while 64 of them did not. GA and birth weight were significantly lower in the treatment group ( p  < 0.01). No difference was observed in rcSO 2 and cFTOE levels in the first, second, and the third days of life ( p  > 0.05). An insignificant reduction in severe intraventricular hemorrhage rates was observed (8 vs. 15%, p  = 0.24)., Conclusion: We could not demonstrate any effect on cerebral oxygenation of preterm infants in early postnatal life that could be attributed to antenatal neuroprotective MgSO 4 treatment. Future studies are warranted to clarify the exact underlying mechanisms of neuroprotection., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: There is insufficient study of the association of blood groups with neonatal diseases. The aim of this study was to evaluate the blood groups associated with sepsis and blood groups in preterm infants., Study Design: This retrospective study was conducted between January 1, 2010 and November 31, 2018 in the neonatal intensive care unit (NICU). This study was done in single-center tertiary NICU. Infants born at gestational age (GA) <32 weeks with birth weight (BW) <1,500 g were included in the study., Results: A total of 2,548 infants were included. The culture-proven sepsis ratio (30.2%) was the lowest in the O blood group and the highest in the AB blood group (37.5%) ( p  = 0.045). Meningitis ratio (6.5%) was significantly higher, and hospital stay (64.1 ± 33.9 days) was significantly longer in B blood group (respectively, p  = 0.005, p  < 0.001). In the AB blood group, GA (27.68 ± 1.12 weeks) was the lowest and early onset sepsis (EOS) (40.1%) and mortality (28.9%) ratio were found to be statistically higher ( p  < 0.001 for all groups). The AB group was significantly related to higher frequency of EOS (odds ratio [OR] = 2.93, 95% confidence interval [CI] = 1.68-5.12, p  = 0.000), in addition to mortality (OR = 1.1, 95% CI = 0.55-2.19, p  = 0.001). The O group was found to be associated with lower risk of late onset sepsis (LOS) (OR = 1.67, 95% CI = 1.06-3.058, p  = 0.003) according to the model with corrected risk factor including GA, BW, and time of hospitalization., Conclusion: Our study was the first study showing a relationship between certain blood groups and EOS/LOS in premature infants as well as meningitis., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: We investigated the relationship of serum potassium (K + ) and ionized calcium (iCa 2+ ) levels with the persistence of ductus arteriosus., Study Design: This retrospective cohort study included infants with birth weight < 1,500 g and gestational age < 32 weeks. Serum K + and iCa 2+ levels at the 1st and 48th hour of life were measured from samples. The difference between the two levels was calculated for both serum K + (ΔK + ) and iCa 2+ (ΔCa 2+ ). These values were compared between hemodynamically significant patent ductus arteriosus (hsPDA) and non-hsPDA., Results: Of 1,322 hospitalized preterm nonates, 1,196 were included in the study. Mean serum K + levels at the 1st and 48th hour were higher and iCa 2+ levels at the 1st and 48th hour were lower in hsPDA and non-hsPDA, respectively ( p  < 0.001). Ionized ΔCa 2+ (-0.06 ± 0.13 vs. -0.02 ± 0.12 mmol/L) was higher in hsPDA ( p  < 0.001)., Conclusion: We demonstrated that serum K + and iCa 2+ level might play a role in ductal constriction., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: The aim of this study was to assess the utility of early postnatal platelet indices in the prediction of hemodynamically significant patent ductus arteriosus (hsPDA) and its response to pharmacological treatment in preterm infants., Study Design: The medical records of 971 infants with gestational age < 30 weeks and birth weight < 1,500 g were analyzed retrospectively. Infants with hsPDA comprised the study group and those without hsPDA comprised the control group. Complete blood count results were recorded, and red cell distribution width-to-platelet ratio (RPR) and platelet mass were calculated., Results: A total of 481 infants, 169 in the hsPDA group and 312 in the control group, were included. In terms of platelet indices, the hsPDA group showed significantly lower mean platelet volume (MPV) and platelet mass, whereas RPR was significantly higher ( p  < 0.05, respectively). Multiple logistic regression analysis showed that RDS (relative ratio [RR]: 2.39; 95% confidence interval [CI]: 1.45-3.93; p  < 0.001), MPV < 7.85 (RR: 3.71; 95% CI: 2.29-6.01; p  < 0.001), and RPR > 0.070 (RR: 5.33; 95% CI: 3.28-8.65; p  < 0.001) were independent risk factors for hsPDA., Conclusion: Low MPV and platelet mass and high RPR in the first hours of life are risk factors for hsPDA and hsPDA refractive to pharmacological treatment with ibuprofen in preterm infants., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants., Study Design: Our study was conducted between January 2013 and December 2017. Premature infants with birth weight <1,500 g and gestational age <32 weeks were included in the study. Serum osmolality was compared between infants with hemodynamically significant PDA (hsPDA) and non-hsPDA., Results: During the study period, 799 patients were evaluated. Mean serum osmolality levels were higher in the "hsPDA" group (297 ± 10.9 vs. 292 ± 8.3 mOsm/L) ( p  = 0.001). The area under the curve for osmolality was 0.582 ( p  = 0.0006, 95% confidence interval: 0.541-0.622) at the time of diagnosis for predicting hsPDA, with a cutoff value for osmolality of 300 mOsm/L., Conclusion: Serum osmolality may be recognized as an important contributing factor for ductal patency especially among extremely preterm infants who are most likely to have hsPDA in the early days of life., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Competing Interests: Conflict of Interest: None.

Aim  This study aims to evaluate hypoxia/ischemia and oxidant stress, and negative neurodevelopmental outcomes in small-for-gestational-age (SGA) infants. Material and Methods  Two study groups were established as SGA and appropriate-for-gestational-age (AGA) infants. SGA infants were allocated asymmetric and symmetric SGA infants. Serum levels of neuron-specific enolase (NSE), ischemia-modified albumin (IMA), malondialdehyde (MDA), total antioxidant capacity (TAC), and total oxidant status (TOS) were determined and oxidative stress indexes (OSI) were calculated in all groups. Results  Overall, 83 infants were diagnosed SGA, and 85 infants were determined AGA. TOS and OSI levels were significantly higher and TAC levels were significantly lower in SGA group ( p  < 0.05). MDA and IMA levels were significantly higher in SGA group ( p  < 0.05). NSE levels in SGA infants were significantly higher ( p  < 0.05). NSE and IMA were significantly higher in symmetric SGA infants ( p  < 0.05). TOS, OSI, MDA, TAC levels were not significantly different in SGA infants with abnormal neurological findings ( p  > 0.05); NSE and IMA levels were significantly higher in SGA group with abnormal neurological findings ( p  < 0.05). Conclusion  SGA infants expose to hypoxia and oxidative stress led to neuronal damage. We suggest that in addition to NSE, IMA blood levels might be a sensitive novel marker for predicting the severity of neuronal damage., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Aim: The aim of the article is to evaluate ischemia-modified albumin (IMA) levels in infants with transient tachypnea of the newborn (TTN) and to find out its relation to the disease severity. Patients and, Methods: Infants with > 37 weeks of gestation, without any respiratory and cardiac symptoms and without any maternal health problems, and diagnosed as TTN were allocated as the study group. Patients with obvious retractions, grunting, hypercarbia (Pco 2 > 60 mm Hg) or hypoxia (oxygen saturation < 88% with Fio 2 of 0.60) were managed with nasal continuous positive airway pressure (CPAP). During the postnatal 0 to 24 hours, blood samples were collected in 2 mL for IMA., Results: A total of 47 patients were diagnosed TTN, and allocated as the study group. Of the 47 patients, 43 patients without respiratory symptoms were enrolled as the control group. IMA levels in TTN were found to be significantly higher (p < 0.05). In addition, IMA levels were significantly increased in the nasal CPAP group versus supplemental oxygen therapy groups (p < 0.05). IMA levels were determined to be significantly higher in the > 3 days of oxygen therapy group (p < 0.05). IMA levels with a cutoff point of 0.87 ABSU, sensitivity of 81.1% and specificity of 69.8% predicted TTN (area under the curve [AUC] = 0.85; p < 0.05). IMA levels with > 0.98 ABSU, 78% sensitivity, and 86% specificity indicated the prediction of CPAP requirement (AUC = 0.86; p < 0.05)., Conclusion: IMA levels were significantly higher in infants with diagnosed TTN. Therefore, IMA may be used as a new marker for predicting TTN and disease severity., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)