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Aim: To determine the reference values of strong ion difference (SID), effective SID (SIDe), unmeasured anions (UMA), tissue acids (TA), lactate and Chloride-Sodium (Cl-Na) ratio of umbilical cord blood, and to evaluate the impact of delivery mode on these parameters. Methods: This prospective study was performed on healthy term newborn infants that had normal progress throughout the first and second stages of labor during normal spontaneous delivery (NSD) and cesarean section (C/S). Immediately after birth, 1ml and 2 ml of umbilical venous cord blood samples were obtained for blood gas analysis and blood chemistry respectively. The Cl-Na ratio, anion gap (AG), albumin corrected AG (AGCorr), SID, SIDe, UMA and TA were calculated in NSD and C/S groups.. Results: A total of 181 healthy newborn infants were included the study. Fifty-one infants were delivered by NSD and 130 infants by C/S. The pH and PCO2 values were similar in both groups. The mode of delivery had a significant impact on the umbilical cord AG, AGCorr, SID, lactate, UMA, and TA levels. All these values were significantly higher in NSD than C/S group. Conclusion: Umbilical cord blood gas analysis is a common practice to evaluate fetal status at delivery. The calculation of blood gas parameters in perinatal problems according to Stewart’s method may lead further understanding how perinatal conditions of the mother influence the fetus and newborn infant.

Giriş Erken neonatal sepsis ve solunum sıkıntısı sendromu, erken doğan bebeklerde yaşamın ilk günlerinde neonatal mortaliteye yol açmaktadır. Bu çalışmanın amacı, premature bebeklerde spot idrar albümin / kreatinin oranının erken neonatal sepsis ve solunum sıkıntısı sendromunun erken tanı göstergesi olup olmadığını belirlemektir. Yöntem 34. haftadan erken doğan 126 prematüre bebek prospektif olarak incelenmiştir.Bu çalışmada yaşamın birinci, üçüncü ve yedinci gününde serum albümin, kreatinin, C-reaktif protein (CRP) ve spot idrar albümin / kreatinin oranlarını değerlendirdik. Ayrıca bu parametrelerin, erken doğan bebeklerde yaşamın ilk günlerinde erken neonatal sepsis ve solunum sıkıntısı sendromu ile ilişkisini araştırdık. Bulgular Yaşamın ilk ve yedinci gününde spot idrar albümin / kreatinin oranı ile erken neonatal sepsis grubu arasında istatistiksel olarak anlamlı fark vardı (p = 0.01). Solunum sıkıntısı sendromu grubunda idrar albümin / kreatinin oranları istatistiksel olarak anlamlı değildi. Serum albümin konsantrasyonları ve spot idrar albümin / kreatinin oranı yaşamın ilk günlerinde korelasyon göstermemiştir. Ayrıca yaşamın ilk günlerinde gebelik yaşı, doğum ağırlığı ile spot idrar albümin / kreatinin oranı arasında ilişki yoktu. Sonuçlar Bulgularımız, Çalışmamız doğum sonrası erken dönemde spot idrar albümin / kreatinin oranının prematüre bebeklerde erken neonatal sepsisi tanımlayabildiğini göstermektedir.

The objective of this study is to investigate the effect of breast milk and sucrose on pain scores and perfusion index (PI) and to evaluate the alteration in pain and PI during retinopathy of prematurity (ROP) examination.This prospective randomized controlled study was conducted with preterm infants who were born in our hospital, hospitalized in the neonatal intensive care unit and whose gestational week was32 weeks and birth weight was1500 g. The preterm infants who would undergo ROP examination were allocated to three groups according to simple randomization method as follows: group 1: only local anesthetic eye drops, proparacaine HCl ophthalmic solution 0.5%, group 2: proparacaine HCl ophthalmic solution 0.5% plus breast milk, and group 3: proparacaine HCl ophthalmic solution 0.5% plus sucrose 24%. Postductal PI, transcutaneous oxygen saturation and heart rate (HR) values were measured before the eye examination (0), at the 30th, 60th, and 90th seconds (s) of the eye examination and 30 s after lasting of the examination in all infants. Pain was evaluated using Neonatal Infant Pain Scale (NIPS) during the examination.Fifty-one preterm neonates were prospectively enrolled into the study. The HR was higher during and after the examination in all infants according to before the examination (The present study indicates that alterations may be seen in PI during the ROP examination; in other words, peripheral tissue perfusion could be affected. We consider that eye examination is a very painful procedure, and administering breast milk, sucrose or local anesthetic is not sufficient for reducing pain.

WOS: 000484450300023, PubMed ID: 31236036, Hyperglycemia has become an important risk factor for mortality and morbidity in the neonatal period, especially with increased survival rates of very low birth weight neonates. Hyperglycemia in the neonatal period develops as a result of various mechanisms including iatrogenic causes, inability to supress hepatic glucose production, insulin resistance or glucose intolerance, specifically in preterm neonates. Initiation of parenteral or enteral feeding in the early period in preterm babies increases insulin production and sensitivity. The plasma glucose is targeted to be kept between 70 and 150 mg/dL in the newborn baby. While a blood glucose value above 150 mg/dL is defined as hyperglycemia, blood glucose values measured with an interval of 4 hours of >180-200 mg/dL and +2 glucosuria require treatment. Although glucose infusion rate is reduced in treatment, use of insulin is recommended, if two blood glucose values measured with an interval of 4 hours are >250 mg/dL and glucosuria is present in two separate urine samples.

Yenidoğan döneminde birleşik heterozigot Niemann-Pick Type C hastalığıNiemann-Pick Tip C hastalığı (NPC), esterifiye olmamış kolesterollerin lizozomlarda depolanması ile karekterize nörodejeneratif bir lizozomal depo hastalığıdır. Otozomal resesif kalıtılan bu hastalıktan NPC1 or NPC2 genleri sorumludur (1). Burada, kardeşi yenidoğan döneminde Niemann-Pick Tip C hastalığı tanısı alan ve NPC1 genetik analizi sonucunda birleşik heterozigot Niemann-Pick Tip C hastalığı saptanan yenidoğan olgusu sunuldu., Niemann-Pick Tip C hastalığı (NPC), esterifiye olmamış kolesterollerin lizozomlarda depolanması ile karekterize nörodejeneratif bir lizozomal depo hastalığıdır. Otozomal resesif kalıtılan bu hastalıktan NPC1 or NPC2 genleri sorumludur (1). Burada, kardeşi yenidoğan döneminde Niemann-Pick Tip C hastalığı tanısı alan ve NPC1 genetik analizi sonucunda birleşik heterozigot Niemann-Pick Tip C hastalığı saptanan yenidoğan olgusu sunuldu.

Background: healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. Methods: a HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: the Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005). Conclusions: neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs., NA

This study aimed to compare the integrity of the efferent auditory pathways of newborns that had high hyperbilirubinemia levels and required treatment due to these and healthy newborns.Term-born (37 weeks or later) infants that were brought to the Newborn Polyclinic of the Başkent University Hospital were included in the study. The study included a total of 84 infants including healthy newborns (n = 42) and those that had jaundice and were receiving phototherapy (n = 42). After conducting a general otorhinolaryngology examination on all newborns included in the study, Transient Otoacoustic Emission (TEOAE) test was carried out in the absence and presence of contralateral noise. The obtained contralateral suppression values were compared between the two groups.In the TEOAE test, the responses obtained at 1 kHz in the newborns receiving phototherapy were found to be lower. The difference between the groups was significant (p = 0.038). The rates of suppression presence at 2 kHz, 2.8 kHz and total OAE were found significantly higher (p 0.05) in the group not receiving phototherapy. Among the phototherapy-receiving infants, the hyperbilirubinemia levels of the infants in whom suppression was obtained in the contralateral suppression test did not show a statistically significant difference in comparison to those in whom suppression was not obtained (p 0.05).Based on the obtained data, hyperbilirubinemia may have a disruptive effect on the efferent auditory system in newborns. Consequently, we are of the opinion that, in addition to hearing screening in risky newborn infants, a MOC suppression test would be useful.

Giriş ve Amaç: Bu çalışmada, Başkent Üniversitesi Tıp Fakültesi Ankara Hastanesinde 1993-2016 yılları arasında organ nakli olan ve sonrasında gebelik nedeniyle izlenen annelerin bebeklerinin prenatal, natal ve postnatal izlem verilerinin retrospektif olarak değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmada 1993-2016 yılları arasında hastanemizde organ nakli yapılan ve organ nakli sonrasında takip edilen reproduktif yaştaki (15-49) 440 kadın hastanın dosyası incelendi. Organ nakli sonrası takip edilen 28 gebe çalışmaya dahil edildi. Maternal (tranplantasyon etiyolojisi, yaşı, nakil yaşı ve gebelik yaşı arasındaki süre, gebelik yaşı, zamanı ve türü, yardımcı üreme tekniği varlığı, gebelik süresince kullanılan ilaçlar ve dozları) ve neonatal (gebelik haftası, doğum ağırlığı, doğum salonu verileri, bebek antropometrik değerleri ile gebelik haftasına göre düşük (SGA), gebelik haftasına göre normal (AGA), gebelik haftasına göre fazla doğum ağırlıklı (LGA) bebek özellikleri ve doğum sonrası yenidoğan yoğun bakım-anne yanı izlem durumu değerlendirildi. İstatistiksel analizler SPSS paket programı kullanılarak yapıldı. Sürekli değişkenler ortalama ± standart sapma (SD) verildi. Kategorik değişkenler sıklık ve yüzdeler ile ifade edildi. Araştırma öncesi etik kurul izni alındı. Bulgular: Toplam 28 hastaya ait organ naklinin %71,4’ü (20/28) böbrek, %28,6’sı (8/28) karaciğer nakliydi. Organ nakillerinin %60,7’si (17/28) canlı, %39,3’ü (11/28) kadavradan nakildi. En sık görülen transplant etiyolojisi %21,9 ile glomerulonefrit idi. Gebeliklerin %78,6’sı (22/28) canlı doğum, % 21,4’ü (6/28) abortus ile sonuçlanmıştır. Bir kişide akut, iki kişide kronik rejeksiyon gözlenmiştir. En sık kullanılan tedavi protokolü %42,9 ile siklosporin+ prednizolon+ azatiyopurindir. Bebeklerin %40,9’u term, %40,9’u SGA, %59’u pretermdir. Bebeklerin 4’ünde (%18,1) RDS, 3’ünde (%13,6) prematüre retinopatisi (ROP), 1’inde (%4,5) NEK, 3 bebekte konjenital kalp hastalığı saptanmıştır. Bebeklerin %18,2’sinde resüsitasyon ihtiyacı olmuş, %45,4’ ü doğum sonrası anne yanına verilmiştir. Sonuç: Ülkemizdeki böbrek veya karaciğer nakli olmuş kadınların gebeliklerinden dünyaya gelen yenidoğan bebeklerin takibinde ortaya çıkan perinatal, neonatal morbidite ve mortaliteye ait sonuçların bilinmesi uygun yaklaşım açısından önem taşımaktadır.

Hyperbilirubinemia is one of the most widely seen cause of neonatal morbidity. Besides ABO and Rh isoimmunization, minor blood incompatibilities have been also been identified as the other causes of severe newborn jaundice. We report a newborn with indirect hyperbilirubinemia caused by minor blood group incompatibilities (P1, M, N, s and Duffy) whose hemolysis was successfully managed with intravenous immunoglobulin therapy. A thirty-two gestational weeks of preterm male baby became severely icteric on postnatal day 11, with a total bilirubin level of 14.66 mg/dl. Antibody screening tests revealed incompatibility on different minor groups (P1, M, N, s and Duffy (Fya ve Fyb)). On postnatal day thirteen, the level of bilirubin increased to 20.66 mg/dl although baby was under intensive phototherapy. After the administration of intravenous immunoglobulin and red blood cell transfusion, hemoglobin and total bilirubin levels became stabilised. Minor blood incompatibilities should be kept in mind during differential diagnosis of hemolytic anemia of the newborn. They share the same treatment algorithm with the other types hemolytic anemia. New studies revealed that intravenous immunoglobulin treatment in hemolytic anemia have some attractive and glamorous results. It should be seriously taken into consideration for treatment of minor blood incompatibilities.

Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30Hipoglisemi, uzun sürmesi ve tekrarlaması durumunda nörolojik zedelenme riski nedeniyle, yenidoğanın en önemli ve en sık metabolik sorunlarından birisidir. Bu nedenle, hipoglisemi riski taşıyan yenidoğanlar, doğum sonrası hemen beslenmeli ve beslenme sonrası 30. dakikadan itibaren 2-3 saat aralıklarla kan glukozuna bakılmalıdır. Hipoglisemi eşik değerleri, ilk 24 saat için belirtisi olanlarda 40 mg/dL, belirtisiz olanlarda 0 - 4 saatte 25 mg/dL, 4-24 saat aralığında 35 mg/dL, 24 saatten sonra 50 mg/ dL, 48 saatten sonra ise 60 mg/dL olarak kabul edilebilir. Tarama hastabaşı test çubukları ile yapılmalı, sınıra yakın değerlerde, laboratuvar yöntemi ile doğrulama yapılırken, gerekliyse tedavi başlanmalıdır. Tedavi ile ulaşılması hedeflenen düzeyler, beslenme öncesi postnatal ilk 48 saatte 50 mg/dL, 48 saatten sonra riskli olanlarda 60 mg/dL, kalıcı hipoglisemili olgularda ise 70 mg/dL’nin üstü olarak kabul edilebilir. Kan glukozu eşik değerin altında olan ve beslenme ile yükseltilemeyen durumlarda, 6-8 mg/kg/dk glukoz infüzyonu başlanmalı, belirti eşlik etmesi durumunda ise 2 ml/kg %10 dekstroz minibolus eşlik etmelidir. Hedef düzeye ulaşılamaması durumunda artışlar ve beslenme ile stabilizasyonun sağlanması durumunda azaltmalar 2 mg/kg/dk olarak yapılmalı, infüzyon hızının 3-5 mg/kg/dk’ye inmesi durumunda ise infüzyon sonlandırılmalıdır. Gerekliyse ayırıcı tanı açısından kan örnekleri hipoglisemi sırasında alınmalı ve araştırma, enteral beslenen bebeklerde 6 saatlik beslenmeme periyodu sonrasında, parenteral infüzyon alanlarda ise plazma glukozunun50 mg/dL olduğu herhangi bir zamanda yapılır. İnfüzyonları sonlandırılan riskli gruptaki hipoglisemik bebekler, plazma glukoz düzeyleri beslenme öncesi iki kez hedef düzeylerde saptanması durumunda, kalıcı, ciddi ya da dirençli hipoglisemili bebekler ise, plazma glukoz düzeyleri 6 saatlik açlık sonrası60 mg/dL olması durumunda taburcu edilebilirler.

WOS: 000460493000010, PubMed: 30660088, …, Turkish Neonatology Society, This research was supported by Turkish Neonatology Society (grant).

WOS:000366239700006 PubMed: 26742308 OBJECTIVE: To identify how acupressure on the acupoint Yintang (EX-HN 3) impacts oxygen saturation, pulse rate, and peripheral perfusion in term-born infants without underlying disease. METHODS: Infants born between weeks 37 and 42 of gestation were included in this study. The polyclinic's neonatology room was noise-controlled and made half-dark to prevent the perfusion index from being confounded. A pulse oximeter was linked to the baby's left lower extremity. Acupressure was applied on Yintang (EX-HN 3) for 30 s clockwise, held for 30 s, and then acupressure was applied for another 30 s counterclockwise. The baby's SaO(2), pulse rate, and perfusion index were recorded for each minute before and after acupressure. RESULTS: When pre- and post-acupressure pulse rate values were compared, a significant decrease in pulse rate values after acupressure application was observed. When pre- and post-acupressure oxygen saturation values were compared, a significant increase in post-acupressure oxygen saturation was observed. In addition, peripheral perfusion increased significantly after acupressure. CONCLUSION: Acupressure application has been used in traditional medicine for many years. However, it is not yet widely used in modern medicine. This study shows the impact of acupressure on neonatal skin perfusion, oxygen saturation, and pulse rate. (C) 2015 JTCM. All rights reserved.

Context Acupressure is an ancient Chinese healing art. In this pain-relieving method, the fingers are used to press key acupuncture points on the skin surface that stimulates the body׳s regulatory processes. Objective The aim of this study was to investigate the effect of acupressure at Kun Lun (UB60) and Taixi (K3) points for pain management in preterm infants prior to heel lancing for blood collection. Design This was a prospective, randomized controlled study. Setting The study setting was the neonatal intensive care unit at Baskent University Hospital in Turkey. Patients A total of 32 preterm infants between 28 and 36 weeks׳ gestational age were randomly assigned to one of two groups: an acupressure group ( n = 16) or a control group ( n = 16). Intervention In the acupressure group, immediately before the heel prick, acupressure was applied for three minutes at UB60 and K3 points. Main Outcome Measures A behavioral pain score was determined using the Premature Infant Pain Profile (PIPP) scale. Results There were no significant differences between the groups with respect to gestational age, birth weight, sex, mode of delivery, age at time of procedure, weight at time of procedure, or PIPP score. Mean duration of procedure and mean duration of crying were both shorter in the acupressure group (both P = .001). Conclusions Applying acupressure at the BL60 and K3 points before heel lancing was associated with shorter procedural time and shorter duration of crying in preterm infants.

Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute after feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL after 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/ min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/ kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is 60 mg/dL following a 6-hour fast. © 2018 by Turkish Pediatric Association.

OBJECTIVE The aim of this study was to analyze maternal and neonatal interleukin 6 (IL-6) (-174 G/C) polymorphism and to determine effect on preterm birth and neonatal morbidity. STUDY DESIGN One hundred and sixty-four mothers (100 term births, 64 preterm births) and 183 newborn infants who were 100 healthy term and 83 preterm babies followed in newborn intensive care units were evaluated. PCR-RFLP was performed for IL-6 (-174 G/C) genotyping. RESULTS The rate of GG genotype in mothers of term and preterm infants were 54% (n = 54/100), 75% (n = 48/64), respectively (p > .05) and the rate of GC + CC genotype was 46% (n = 46/100) and 25% (n = 16/64) in mothers giving term and preterm birth (PTB), respectively (p

WOS: 000484450300016, PubMed ID: 31236029, Pain control is an important ethical issue to be considered and constitutes the basis of treatment in premature and term newborns. The inadequacy of pain control in these infants in neonatal intensive care units leads to neurodevelopmental and behavioral problems in the long term. For this reason, it is extremely important to raise awareness of the presence of pain in newborn infants, to reduce invasive procedures applied to infants as much as possible, and to minimize pain with non-pharmacologic or pharmacologic treatments when it is inevitable.

Turan O, Anuk-Ince D, Olcay L, Sezer T, Gulleroglu K, Yilmaz-Celik Z, Ecevit A. Neonatal cerebral sinovenous thrombosis: Two cases, two different gene polymorphisms and risk factors. Turk J Pediatr 2017; 59: 71-75. Cerebral sinovenous thrombosis (CSVT) is a rare disease in the neonatal period and also the greatest risk of neonatal mortality and morbidity. In this report, we presented two cases with CSVT and different risk factors. One of these cases had methylenetetrahydrofolate reductase (MTHFR) C677T homozygous polymorphism and the other case had both MTHFR A1298C homozygous polymorphism, plasminogen activator inhibitor-1 (PAI-1) 4G/ 5G polymorphism and elevated lipoprotein a. Early diagnosis and prompt initiation of therapy of neonatal CSVT may prevent neonatal mortality and poor long-term neurodevelopmental outcomes.

When conventional methods for treating complicated problems such as acute and chronic renal failure or metabolic diseases fail, the therapy of choice is peritoneal dialysis (PD) in neonatal period. However, in cases that involve technical difficulties, such as bulky lesions in the abdomen or complications from previous abdominal surgeries, it is not always possible to place a peritoneal catheter. In such situations, continuous venovenous hemodiafiltration (CVVHDF) can be effective. This case series presents our experience in 2013 with the administration of CVVHDF to four patients in our neonatal intensive care unit who could not undergo PD for various reasons.

Aim Despite extensive research, there is still controversy regarding the time at which sucking and swallowing functions mature in preterm infants. This study aimed to evaluate maturation using the noninvasive method of swallowing sound. Methods We compared 52 preterm infants of between 27 and 36 weeks' gestational age with a control group of 42 healthy full-term infants. Feeding performance was based on swallowing data collected during two-minute audio recordings. The following variables were generated for each evaluation: total number of swallows, total number of rhythmic swallows, total number of resting intervals, average time between resting intervals, average time between swallows, average time between rhythmic swallows, maximum number of rhythmic swallows and volume of milk ingested. The dependency of the variables on postmenstrual age was also investigated. Results The volume of milk ingested by the preterm infants and the maximum number of rhythmic swallows were positively correlated with postmenstrual age (PMA). The preterm infants reached the 10th percentile of the control infants at 34–35 weeks' PMA and were not significantly different from the control infants at 38–40 weeks' PMA. Conclusion Swallowing sound can be used to assess feeding maturation in preterm infants during neonatal intensive care unit follow-up.

Background:This study aimed to examine the differences between arterial and inferior caval vein oxygen saturation, fractional oxygen extraction, and the shunt index, which were calculated in the diagnosis of patent ductus arteriosus.Methods:Twenty-seven preterm infants were included in this study and were divided into two groups according to patent ductus arteriosus. Among them, 11 (41%) infants had haemodynamically significant patent ductus arteriosus and 16 (59%) did not have significant patent ductus arteriosus. Synchronous arterial and venous blood gases were measured during the first post-natal hours after the insertion of umbilical catheters. The differences between arterial and inferior caval vein oxygen saturation, inferior body fractional oxygen extraction, and the shunt index were calculated. Echocardiography was performed before the 72nd hour of life in a selected group of patients who had haemodynamically significant patent ductus arteriosus. Ibuprofen treatment was administered to patients with patent ductus arteriosus. Echocardiography was performed on the 72nd hour of life in preterm infants without any clinical suspicion of patent ductus arteriosus.Results:The early measured differences between arterial and inferior caval vein oxygen saturation and inferior body fractional oxygen extraction were found to be lower and the shunt index was found to be higher in the haemodynamically significant patent ductus arteriosus group than in the group without haemodynamically significant patent ductus arteriosus.Conclusion:We found that the shunt index, calculated in the first hours of life as ≥63%, predicted haemodynamically significant patent ductus arteriosus with a sensitivity of 78% and specificity of 82% in preterm newborns.

Background: The aim of this study was to determine the effects of severe hyperbilirubinemia on vestibular evoked myogenic potentials (VEMP). Methods: A prospective study was designed. Seventeen term infants who suffered from severe hyperbilirubinemia in the first 5 postnatal days of age were included in the study group. The control group consisted of 17 healthy term infants. Audiological evaluation was performed, including tympanometry and transient evoked otoacoustic emissions, and VEMP tests. Results: All newborns passed audiological evaluation. Biphasic waveforms of VEMP were obtained in all of the 34 infants who had been tested. Both latencies of p13 and n23 were significantly delayed in the severe hyperbilirubinemia group (P < 0.05). Conclusion: This pilot is the first study to show that severe hyperbilirubinemia causes delay in VEMP latencies. We suggest that severe hyperbilirubinemia might affect the vestibular nuclei or the integrity of the inferior vestibular nerve and vestibulospinal tract. Further studies need to explain the relation between hyperbilirubinemia and the vestibular system.

Aim: Respiratory distress syndrome (RDS) is a lung failure that starts after birth. Because of deficiency of surfactants in alveoli, this becomes one of the most important causes of morbidity and mortality in preterm neonates. In this study, we tried to compare the outcomes of two types of natural surfactant, derived from same animal and aimed to manage the anxiety of clinicians while they are choosing the most appropriate preparate for RDS treatment.Material and Methods: Newborns hospitalized in Baskent University Ankara Hospital Neonatal Intensive Care Unit between January 2017 and August 2018 and administrated with calfactant and beractant for RDS treatment were retrospectively examined.Results: A total of 57 neonates were enrolled into the study. It was indicated that 38 (66.7%) of neonates were administered beractant and 19 (33.3%) were administered calfactant. We did not find any significant difference between beractant and calfactant groups, according to their genders, gestational weeks, their intubation situations, the duration of the oxygen requirement, antibiotic usages and the durations of mechanical ventilation. It was determined that calfactant-administered neonates needed statistically more repeat dose, than those in the beractant group (p= 0.029). Conclusions: We examined two natural surfactant preparates derived from same animal. Calfactant which has some conflicting reports was newly introduced to our unit for RDS treatment. This study aimed to identify the most appropriate treatment modality for RDS. It would be more instructive to plan larger and more creative studies to examine possible differences among natural surfactant preparates.

WOS: 000361632500007, PubMed ID: 25792430, To date, no study has evaluated changes in oral labial angle as preterm infants mature. The main purpose of this study was to document goniometer measurements of the labial angle of the mouth in preterm infants, to assess changes with development, to compare to findings in healthy term infants, and also evaluate oral motor reflexes in these groups. Seventy-eight preterm infants and 45 healthy term infants were recruited for the prospective study. Labial angle was assessed via goniometer, and oral motor reflexes and the volume of milk ingested were evaluated. There was significant difference between term and preterm infants' labial angles (P < .01). The distribution of preterm infants' angles were similar to term infants' by 36 to 40 weeks' postmenstrual age. Goniometer measurements of the oral labial angle may reveal oral motor performance in preterm infants and may be relevant for feeding skills assessment in this group of infants.

Background Oral administration of probiotics in newborn preterm infants has been shown to be helpful, especially ın reducıng the incidence of necrotizing enterocolitis and overall mortality rates.Objective To evaluate the effect of probıotıc supplementation on ıntestınal colonization by antibiotic-resistant microorganisms in preterm infants receiving antibiotics in a neonatal intensive care unit (NICU).Methods The prospective, randomized trial was performed ın preterm infants who were hospitalized in the NICU at Baskent University Ankara Hospital between January 2011 and February 2012. A total of 51 infants were enrolled and randomly assigned to one of two groups: Group 1 (n=27) received probiotic therapy and Group 2 (n=24) did not receive probiotics. The probiotic used was Lactobacillus reuteri (Biogaia® AB, Sweden). Subjects underwent weekly nasal swab and stool cultures for a maxımum of 6 weeks, and at the tıme of dıscharge ıf thıs was prıor to 6 weeks. All posıtıve cultures were further tested for culture-specıfıc ıdentıfıcatıon and antıbıotıc suceptibility.Results A total of 607 cultures were evaluated. Posıtıve cultures were found ın 37.9% from Group 1 and 35.2% from Group 2. Intestınal colonızatıon by antıbıotıc-resıstant bacterıa dıd not sıgnıfıcantly dıffer between groups (P>0.05). Conclusions Oral supplementation with probiotics do not prevent the intestınal colonization of antibiotic-resistant microorganisms in preterm NICU patıents who receıved antıbıotıc treatment.

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The aim of this study was to determine the effects of adjuvant immunoglobulin M (IgM)-enriched intravenous immunoglobulin (IVIG) therapy on mortality rate, hematological variables and length of hospital stay in newborn infants with blood culture-proven sepsis. Demographic and clinical features and outcome measures of 63 newborn infants with blood culture-proven sepsis were documented retrospectively from the medical records. The patients were divided into two groups according to their treatment history. The patients in Group 1 received antibiotic therapy only and the patients in Group 2 received both antibiotic and adjuvant IgMenriched IVIG. The study revealed that mortality rates were 28.1% and 12.9% in Group 1 and Group 2, respectively. The mortality rate was lower in Group 2, but the difference between the two groups was not statistically significant (p=0.21). Coagulase-negative Staphylococcus was the most common type of bacteria isolated from the blood culture in both groups. When changing laboratory results were compared between the two groups, hemoglobin, leukocyte count and C-reactive protein levels were different during the first three days of antibiotic treatment. Our study revealed that if diagnosed at an early stage and treated aggressively with appropriate and effective antibiotics, adjuvant IgM-enriched IVIG treatment has no additional benefits in neonatal sepsis.

In neonatal medicine, it is important to assess tissue oxygenation due to hypoxia, as hyperoxia can have adverse effects. Usually, measurements of arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) are used for clinical decisions regarding oxygen therapy in neonates. However, this approach cannot explain the complete physiological economy of oxygen (1–3). Some recommend measuring venous oxygen to evaluate tissue perfusion and response to therapy (1, 3–8). Umbilical venous catheters are widely used in neonatal intensive care units for medication, fluid and nutrition administration. Mixed venous oxygenation can be measured by inserting an umbilical venous catheter into the inferior vena cava (IVC) (3). The advantages of measuring IVC oxygenation are not affected by atrial right-left shunting (3, 4). Monitoring of mixed venous oxygen saturation (Svo2) shows the residual oxygen after tissue oxygen extraction and also represents the combined sufficiency of arterial oxygen content, cardiac output and tissue oxygen consumption (2, 9, 10). Right atrial SvO2 was used for monitoring, in contrast to using SaO2 alone in an animal model (7). True mixed venous blood is derived from a pool of blood entering the pulmonary artery via the great veins in the chest. It contains blood that has passed through all systemic capillary beds capable of extracting oxygen, and is thoroughly mixed in the right ventricle (11). However, catheterization of the pulmonary artery or right atrium is hazardous for neonates and is not routinely applied (3, 12). Umbilical venous catheters are frequently used in neonatal intensive care units due to their lower complication rates. Umbilical venous catheterization is not affected by intracardiac shunting that leads to mixing of systemic and pulmonary venous blood (3, 4, 13). The measurement of venous oxygen saturation has been used in several studies of sepsis and septic shock, and during the perioperative period of major surgery because it shows major derangements in oxygen balance (13–16). Umbilical venous oxygen saturation pointed a great similarity to arterial oxygen saturation in some premature infants in our clinical practice that it was hypothesized as a sign of severe ductal shunt predicting patent ductus arteriosus (PDA). In this study, on the basis of this clinical observation, the course of IVC oxygen saturation was measured in preterm infants as an indicator of mixed venous oxygenation in the first three days of life; and differences between infants with and without PDA were investigated.

The aim of this study was to evaluate the relationship between neonatal mortality-morbidity and pregnancies with preterm premature rupture of membranes (PPROM), particularly those complicated by histologic chorioamnionitis (HCA), in preterm infants. A retrospective study was conducted on 58 preterm neonates born to 46 pregnant women with PPROM. Maternal characteristics, placental examination, and neonatal morbidity and mortality were analyzed. Of 1,392 deliveries, 46 (3.3%) pregnancies and 58 newborn infants were complicated with PPROM. HCA was present in 21 (1.5%) cases, and 15 of them were28 weeks of gestational age. In the HCA (+) group, 8/21(38%) neonates had 5-minute Apgar scores of5, 12/21 (57.1%) infants had patent ductus arteriosus (PDA), and 16/21 (76.1%) infants had respiratory distress syndrome (RDS). The latency period was significantly longer and the rate of chorioamnionitis and percentage of major neonatal morbidity and mortality were significantly higher in preterm infants with gestational age28 weeks. Respiratory distress syndrome, perinatal hypoxia and PDA were significantly associated with HCA in preterm infants.

Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves' disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves' disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves' disease associated pregnancies and management of newborns after birth.

Congenital hyperinsulinism is the most frequent cause of persistent hypoglycemia in infancy. We present the case of a preterm, large-for-gestation-age infant with congenital hyperinsulinism who was found to have a novel p.Q392H homozygous mutation in the ABCC8 gene. The patient had severe brain damage, despite early diagnosis and appropriate management. The new mutations may provide an understanding of the prognosis and treatment of the disease. In addition, the data will help the family make informed decisions about future pregnancies.

Multiple systemic risk factors are associated with retinopathy of prematurity (ROP). We analyzed the role of low weight gain (WG) to predict the development of stage 3+ ROP among preterm infants. This study included 126 newborns with birth weight ≤1500 g and gestational age32 weeks. Preterm newborn infants were divided into two groups according to severity of ROP as: preterm infants without ROP or mild ROP (Group 1) and preterm infants with stage 3+ ROP (Group 2). WG and WG proportion were measured at completed 4 and 6 weeks of life. The patients under the cut-off point according to receiver operating characteristic curve were classified as low WG patients. WG and WG proportion were significantly lower in Group 2 than in Group 1 at the 4th and 6th weeks of life. We concluded that low WG and WG proportion at the 4th and 6th weeks of life were predictive for the development of stage 3+ ROP. Preterm babies with low birth weight and low WG should be followed closely for severe ROP.

Purpose To evaluate the safety of peripherally inserted central venous catheters (PICCs) and their complications in critically ill premature neonates. Methods A retrospective collection of data of infants with very low birth weight (VLBW) who underwent PICC placement over a 2-year period. Gestational age, birth weight (BW), sex, site of catheter placement, reason for catheter removal, duration of the catheter use, proven sepsis, type of the reported organism and the rate of complications were collected. The infants were classified into two groups according to BWs: Group 1–-VLBW infants (BW between 1,000 and 1,500 g) and Group 2–-BW Results During the study period, 90 VLBW infants were admitted to the neonatal intensive care unit. PICCs were attempted in 71 patients. A PICC was successfully inserted into 62 patients (87.3%). Totally, 68 PICCs were inserted into 62 infants. PICCs placed in either the upper or the lower extremity have no differences in complication rates. The median time of catheter insertion was 10 (1-22) days for Group 1 and 16 (1-47) days for Group 2 (p=0.001). The median duration of PICCs was 9 (2-18) and 12.0 (3-30) days, respectively (p=0.012). There were no significant differences between groups for the reasons for removal (p=0.859). Conclusions PICCs are convenient for the administration of long course antibiotics and parenteral nutrition for both VLBW and ELBW infants. The risk of catheter complications did not increase in ELBW infants. Although the technique of insertion is easy and using PICCs has many benefits, serious and fatal complications may occur in premature neonates in critical states.

Recent investigations have shown that late preterm infants have increased risk for attention deficit hyperactivity disorder, neurosensory impairment, and emotional, behavior and learning problems. Vestibular evoked myogenic potential (VEMP) abnormality may partly contribute to these problems. Our aim was to measure VEMP in late preterm infants and to compare the findings between late preterm and term infants. Seventeen late preterm infants (mean gestational age: 35.11 weeks +/- 0.78) postnatal aged 8 weeks and 17 full-term (mean gestational age: 38.05 weeks +/- 0.96) infants postnatal aged 4 weeks underwent cervical (c)VEMP test without sedation. Mean latencies of p13 were calculated in all study subjects. cVEMPs were elicited in all late preterm and term infants. Mean latencies of p13 in late preterm and term infants were 14.53 and 13.34 ms, respectively. Mean latencies of n23 were determined as 23.18 ms and 19.92 ms for late preterm and term infants, respectively. There were statistically significant differences between late preterm and term infants for latency of p13 (p0.001) and latency of n23 (p0.000). Abnormal VEMP results might be related to a delay in the maturation of the sacculocollic pathways in late preterm infants.

Objective To evaluate analgesic effects of acupuncture in preterm neonates during minor painful procedures. Methods Ten preterm neonates requiring heel prick for blood gas analysis were enrolled in the study, which had a crossover design. Oxygen saturation, systolic and diastolic blood pressure, respiratory rate, heart rate, and crying duration were recorded before and after heel prick. Babies were given expressed breast milk before each procedure. Patients were randomly assigned to receive acupuncture or not, and the groups were crossed over on the following day, so that patients who had received acupuncture received only breast milk, and the previous breast milk only group received both acupuncture and breast milk. The neonatal infant pain scale (NIPS) was used for pain evaluation. Results Crying duration and NIPS pain scores during heel prick were lower in the neonates who had received acupuncture. Conclusion Acupuncture is an effective method for the treatment of pain in neonates.

In this study, the perinatal mortality is presented in 2009 compared to 1998. Changing patterns of the perinatal mortality rate (PNMR), the stillbirth rate (SBR), early neonatal mortality rate (ENMR) and the causes of the perinatal mortality in Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBH) were described. This is the largest maternity hospital of Ankara in the central Anatolian region of Turkey. The total deliveries were 22,777 and 18,567 in 1998 and 2009, respectively. PNMR was 27.7 per 1000, and SBR was 23.7 per 1000 total births. ENMR was 4 per 1000 in 1998. PNMR is 20.7 per 1000, and SBR was 16.3 per 1000 and ENMR was 4.6 per 1000 total births in 2009. It is important to know the causes of mortality. In this study, the causes of perinatal deaths were classified according to the Wigglesworth classification. Antepartum stillbirth (62.3%) was the most frequent cause in 1998. Perinatal asphyxia is the majority (46.6%) of the perinatal deaths in 2009. This study shows that even prenatal care is getting better, obstetric care as well as close follow-up throughout the intrapartum period and diminishing the preterm delivery rate is also important for preventing and reducing perinatal mortality.

Association between maternal-fetal proinflammatory cytokine genotype and preterm birth was studied. Isolated genomic DNA from maternal and cord blood samples of 100 preterm and 101 term labors were used for TNF alpha (-238G/A, -308G/A), IL-1 alpha (4845G/T), and IL-1 beta (-511C/T) genotyping. TNF alpha -238 GA genotype in term neonates was significantly higher than the premature neonates (p < 0.05). Maternal-fetal TNFa -238 heterozygosity was associated with term labor (p < 0.05). TNF alpha -308 GA and AA genotypes were associated with term labor (mothers and neonates, respectively; p < 0.05 and p < 0.001). The incidence of term labor was significantly increased in TNF alpha -308 GA genotype. If a -308GA carrier has a fetus with GG genotype, the incidence of preterm labor increases (p < 0.01). The 4845 T allele was significantly higher in preterm mothers and neonates (p < 0.001 and p < 0.001). The effect of maternal-fetal genotype for the pregnancy outcome reveals that maternal 4845GG and GT genotypes increase term labor incidence, whereas fetal 4845 TT genotype was a significant independent risk factor for preterm birth (p < 0.01). IL-1 beta -511 TT genotype was significantly higher in preterm neonates. The preterm labor risk was significantly increased in maternal -511 TT genotype and fetal CT genotypes, whereas with maternal -511 CT or TT genotypes or a -511 TT fetus, the incidence of term pregnancy increases (p < 0.01).

Hypoglycemia is the most common metabolic disorder that may cause neonatal encephalopathy and result in permanent brain injury.1 Prompt diagnosis is important as urgent treatment may change the progression of the disease and the future prognosis. Conventional MRI is useful to demonstrate the signal changes that are prominent on the occipital lobes; however, MRI may not show the pathology in the very early period. Diffusion-weighted-imaging (DWI) should be obtained prior to other sequences to show any early signal changes that are not visible on MRI. We report a 3-day-old baby who was admitted to the emergency room with the complaint of poor feeding and cyanosis. There was no problem perinatally, Apgar score was 10 on the first and fifth minutes, and the physical examination was normal at birth and when discharged from the hospital. At the time of admission, he had generalized seizures. The laboratory tests showed severe hypoglycemia, blood glucose level was 21 mg/dl (normal value 50-80 mg/dl). He was given 2cc/kg 10% dextrose, control blood glucose was 78 mg/dl and saturation was 95%. Fifteen minutes later, the blood glucose decreased again (32 mg/dl) and 100 cc/kg 10% dextrose was injected. Despite these injections, control glucose levels were 42, 47, and 57 mg/dl, and during the acute treatment, seizures repeated. Antiepileptic drugs were started (Phenobarbital 20mg/kg infusion and 5 mg/kg maintenance dose) and dextrose was continued. An MRI of the brain was performed after the cessation of the seizures. The conventional MRI was normal except for suspicious faint signal increase on the left occipital lobe. Fluid-attenuated inversion recovery (FLAIR) sequence showed no signal changes (Figure 1A). However, diffusion weighted MRI showed significant perirolandic and right occipital diffusion restriction, which was hyperintense on DWI and hypointense on apparent diffusion coefficient map (Figure 1B). The left occipital lobe was normal. An MR angiography was also normal ruling out any vascular occlusion. During follow-up, he did not have any more seizures and serum blood glucose was within normal range. Ten days later he was discharged with per oral Phenobarbital (2 × 9 mg) and Diazoxide (3 × 20 mg). An informed consent was obtained from his parents. Figure 1 Axial fluid-attenuated inversion-recovery image A) does not show any abnormal signal. Apparent coefficient map (ADC) shows B) restriction of diffusion on the right insula, posterior parietal, and left parietal lobes. Neonatal hypoglycemia is associated with corticospinal tract injury and adverse motor and cognitive outcomes.2 Infants who are small for gestational age, the smaller of the twins, babies of toxemic mothers, hypocalcemic, and polycythemic patients are at risk for hypoglycemia; however, there may not be an underlying cause at all times.3 Although it is not easy to distinguish hypoxic ischemic encephalopathy and hypoglycemic encephalopathy, various injury patterns in hypoglycemia are described based on MRI findings. Wong et al4 showed that selective posterior white matter and pulvinar edema were most predictive of clinical hypoglycemia, and no injury or a watershed pattern of injury was seen more often in severe hypoglycemia. The conventional MRI is good at showing increased signal on FLAIR or T2-weighted imaging; however, it may not be sensitive in the very early period. The DWI is also important as well as conventional techniques. Our case did not show any abnormal signal intensity on T2-weighted and FLAIR imaging on the regions that showed restriction of diffusion on the DWI. The DWI is not only necessary to distinguish vasogenic edema versus cytotoxic edema, but also leads to the diagnosis itself in case of normal conventional MRI findings. In conclusion, in neonates who are suspicious for hypoglycemic encephalopathy and have poor sedation, priority should be given to DWI before other sequences and the protocol should be organized accordingly.

Vitamin D is important for calcium homeostasis, muscle, and bone health. It has also immunomodulatory capacities in vivo and in vitro. Regulatory T cells (Treg) have been found to suppress a number of T cell-mediated immune disorders, including allergic responses and autoimmune diseases. This study aimed to investigate the correlation between 25-hydroxyvitamin D (25(OH)D) levels and the regulatory T cells in cord blood. The study group is comprised of 101 full-term newborn infants. Umbilical cord 25(OH)D levels and number and percentage of T lymphocyte, T helper, and Treg cells were measured. Infants were grouped according to 25-hydroxyvitamin D levels (25(OH)D12 ng/ml and 25(OH)D12 ng/ml) (converting factor of 25OHD level into SI unit, 2.6). Severe vitamin D deficiency (25(OH)D12 ng/ml) was observed in 32% of the infants. There was no significant correlation between 25-hydroxyvitamin D levels and T cell number and percentages. There were also no significant differences in white blood cell, total lymphocyte count, T helper, and Treg cell percentage and number between groups. These results suggest that the serum level of 25-hydroxyvitamin D is not crucially involved in the correlation between vitamin D status and T cell regulation in cord blood.

To understand the effect of prenatal chronic hypoxia on prohepcidin levels in term newborns.We determined prohepcidin (Pro-Hep) levels in both term appropriate-for-gestational age (AGA) and term small-for-gestational-age (SGA) infants. Uteroplacental insufficiency had exposed all SGA infants to chronic hypoxia. Serum samples were collected from nine full-term SGA infants. Samples were analyzed for complete blood count, serum iron and ferritin concentrations, iron-binding capacity, and prohepcidin levels.The mean serum Pro-Hep level was 156.4 ? 46.7 ng/ml for SGA infants and 482 ? 371.9 ng/ml for 16 healthy term AGA infants (historical controls); this difference was statistically significant. Statistical analyses revealed significant between-group differences for hemoglobin, hematocrit, mean corpuscular volume, red blood cell distribution width, and serum ferritin and Pro-Hep levels.This study showed that compared with AGA infants, Pro-Hep levels were lower in term SGA infants, suggesting that prenatal chronic hypoxia decreases Pro-Hep synthesis.

Hepcidin is a regulatory peptide hormone acts by limiting intestinal iron absorption and promoting iron retention. Determining the level of hepcidin in anemia of prematurity might be important in preventing iron overload. This study aimed to determine serum levels of prohepcidin in newborns with anemia of prematurity, to assess the effect of a single erythrocyte transfusion on serum prohepcidin levels, and to determine the possible relationships between prohepcidin levels and serum iron and complete blood count parameters. Nineteen premature newborns with anemia of prematurity who had been treated with erythrocyte transfusions were included in this study. Just before, and 48 hours after, each transfusion, venous blood samples were collected from patients. Serum prohepcidin levels before and after erythrocyte transfusion were 206.5+/-27.3 and 205.7+/-47.1 ng/mL, respectively; no statistically significant differences were found. No significant differences existed before or after transfusion regarding serum total iron and ferritin levels, iron-binding capacity, or mean corpuscular hemoglobin concentration. No significant correlations existed between serum prohepcidin levels and other parameters, either before or after transfusions. Our results showed that there were no statistically significant differences between serum prohepcidin levels before and after a single erythrocyte transfusion in premature newborns.