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INTRODUCTION: Insulin-like growth factor-1 (IGF-1) is important for fetal and postnatal development. After premature births, serum IGF-1 concentrations rapidly decrease and can stay at much lower levels than during the intrauterine period. In this study, we aimed to ascertain whether IGF-1 is associated with morbidities of prematurity such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), and is a useful predictor of these diseases. METHODS: We enrolled newborn infants born at a postmenstrual age of ≤32 weeks in this prospective observational cohort study. Serum IGF-1 levels were measured serially in blood samples on the 1st, 3rd, 7th, 21st, and 28th day. RESULTS: A total of 93 infants were enrolled in the study. All these infants had the following characteristics at birth: weight 1236.11±354.06 g, and gestational age 29.43±2.10 weeks. All of the IGF-1 levels were significantly lower in the group which developed BPD or ROP (p<0.001). The patients who developed IVH and NEC also had lower IGF-1 levels. DISCUSSION and CONCLUSION: Strong correlations have been found between low serum IGF-1 levels during the first four weeks and development of BPD and ROP. [ABSTRACT FROM AUTHOR]

In 2016, the cases formerly known as "Apparent life-threatening events" (ALTE) have been renamed to "Brief Resolved Unexplained Events" (BRUE) by the American Academy of Pediatrics. The diagnosis of BRUE in infants is made when infants experience: a brief episode, that is resolved, which remains unexplained after the history and physical examination, and includes an event characterized by cyanosis or pallor; absent, decreased, or irregular breathing; marked change in tone; or altered level of responsiveness. Low and high-risk events can be identified epidemiologically. To be designated lower risk, the following criteria should be met; older than 60 days with birth at >32 weeks gestation, no previous event, a duration less than 1 minute, no need for resuscitation by trained medical personnel and no concerning historical features or physical examination findings. Low-risk events do not require hospitalization, further research, or home monitoring. Conversely, infants with high-risk events should be admitted to hospital and monitored. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate babies diagnosed as congenital heart disease in terms of frequency, risk factors and prognosis and to determine the issues to be covered to reduce the mortality in these patients in the scope of the literature. Materials and Methods: Ninety-nine patients diagnosed as congenital heart disease were enrolled among 1.175 patients who were admitted to neonatal intensive care unit in Uludağ University Hospital between January 2008 and January 2013. Results: Fifty-four patients (54.5%) of 99 cases included in the study were male and 45 (45.5%) cases were female. Of cases, 82.9% were term and mean birth weight was 3.142±592 gr. Most common diagnosis was transposition of great arteries seen in 14 cases (14.1%), followed by complete atrioventricular septal defect and aortic hypoplasia, 11 cases for each. Mortality rate was 35.3% (35 of 99 patients) and mean time of death was 22 days. Antenatal diagnosis rate was 55.6% (55 of 99 patients). Conclusions: It appears to be two major issues to address in order to reduce the mortality in congenital heart defects. Firstly, rate of proper follow-up in pregnancies and prenatal diagnosis must be increased. Secondly, these patients must be operated in the exact appropriate time by exclusive congenital heart surgeons, and subsequently managed by experienced post-operative care staff. Therefore, establishment of regional cardiac surgery/intensive care units and referral of all congenital heart defects to these centers would be ideal. In order to reduce the mortality and morbidity of congenital heart defects, these issues must be covered by the Ministry of Health and necessary initiatives must be established as urgently as possible. [ABSTRACT FROM AUTHOR]

Congenital heart tumors are very rare and the most common type is the rhabdomyoma. Frequency during autopsy is between 0.027-0.08%. Moreover 51-86% of these tumors are associated with tuberosclerosis. Also hamartomas might accompany, particularly on the central nervous system and skin, kidney, liver, lung and heart. In this paper, two cases diagnosed with tuberculosis who showed rhabdomyomas in fetal echocardiography in the antenatal period and were seen to have tubers in cranial magnetic resonance (MR) postnatally, are presented. [ABSTRACT FROM AUTHOR]

The mechanism and causes of sudden infant death syndrome (SIDS) is still remains its mystery. The pathophysiology of SIDS is not clear. Sleeping in prone position is thought to contribute to pathophysiology. Schwartz was the first physician suggesting that SIDS can be associated with heart and autonomic nervous system. Congenital long QT syndrome may trigger SIDS by causing ventricular tachycardia. Normal cardiac rhythm is regulated by ion channels and specific proteins, but genetical analyses clearly demonstrated that 5 ion channel genes were responsible for rare arrhythmias. The infections, fever and sleeping in prone position can increase the risk of long QT syndrome in babies having mutations in cardiac ion channels. In this review we tried to draw attention to SIDS as an important cause of death in childhood period and association of SIDS with long QT syndrome which is not necessarily noticed by physicians. [ABSTRACT FROM AUTHOR]

Background: Although a variety of different lipid emulsions with varying fatty acid contents have been developed, there are some concerns about the administration of these lipid emulsions because of potential adverse effects, including oxidative stress-related morbidity. The aim of the present study was to evaluate and compare the effects of the standard soybean oil-based and olive oil-based i.v. lipid emulsions (ILE) on oxidative stress, determined by total antioxidant capacity (TAC), and to investigate the safety of the use of these two emulsions in terms of biochemical indices. Methods: In this prospective study, premature infants were randomly assigned to two groups, each group consisting of 32 patients who received parenteral ILE of either 20% olive oil or 20% soybean oil. They were given ILE for 7 days and then were evaluated with regard to TAC. Results: No statistically significant difference was observed between the groups in terms of routine biochemical parameters. TAC for both groups on day 7 was significantly lower compared with that on day 0. Although the decrease in TAC within 7 days of ILE administration was greater in the soybean group compared with that in the olive oil group, it was not statistically significant. Conclusions: Olive oil-based ILE exhibit similar antioxidant activity and can be used as an alternative to soybean oil-based ILE. TAC significantly decreased in infants following administration of either lipid emulsion, and premature infants tolerated either ILE well, both biochemically and clinically. [ABSTRACT FROM AUTHOR]

Although there are no official recommendations for specific nutrient intakes in premature infants after hospital discharge, it is agreed that the goal should be to achieve the body composition and rate of growth of that of a normal fetus of the same postmenstrual age during the entire first year of life. Close monitoring of growth during hospital stay and after discharge is recommended to enable the provision of adequate nutrition support. Measurements of length and head circumference, in addition to weight, must be used to identify those preterm infants with poor growth that may need additional nutrition support. Infants with an appropriate weight for postconceptional age at discharge should be breast-fed when possible. Infants discharged with a subnormal weight for postconceptional age are at increased risk of long-term growth failure, and the human milk they consume should be supplemented, for example, with a human milk fortifier to provide an adequate nutrient supply. If formula-fed, such infants should receive special postdischarge formula with high contents of protein, minerals and trace elements as well as an long-chain polyunsaturated fatty acid supply, until about 52 weeks postconceptional age. Continued growth monitoring is required to adapt feeding choices to the needs of individual infants and to avoid underfeeding or overfeeding. [ABSTRACT FROM AUTHOR]

Aim: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in premature infants who were treated with oxygen and positive pressure ventilation. Although there are recent advances in neonatal care, it has been still the most common long term complication in preterm infants. The aim of this study was to evaluate infants who developed BPD throughout the clinical course of hospitalisation and to determine BPD frequency and also the risk factors associated with BPD. Materials and Method: A total of 276 infants who admitted to neonatal intensive care unit between January 2005 and January 2006 were included to this study. The infants with and without BPD were compared according to characteristic features and risk factors. Results: The mean gestational age and birth weight of all infants were 31±3.1(range, 24-36) weeks, and1607±610 (range, 500-4000) gram, respectively. BPD was diagnosed in 30% (84/276) of all infants. The mean gestational age and birth weight of infants with BPD were 30±3 (range, 24-36) weeks, and 1171±423 (range, 530-3700) gram, respectively. The 36% (31/84) of infants were smaller than 28 gestational age and 41.9% (26/84) were smaller than 1000 gram. Gestational age and birth weight were found to be the most important risk factors for development of BPD, and BPD risk increased as the gestational age and birth weight decreased. The duration of mechanical ventilation in infants with BPD and without BPD were found to be 40±4.3 days and, 17±2 days, respectively and this difference was found to be statistically significant (p<0.05). Similarly, the duration of oxygen therapy was found to be statistically higher in infants with BPD compared with the infants without BPD (p<0.05). Also, respiratory distress syndrome, intraventricular hemorrhage, chorioamnionitis in mother, prolonged total parenteral nutrition, and frequent blood transfusion were also other risk factors that were significantly associated with development of BPD. Conclusion: The risk for BPD is multifactorial. It was observed that the most important risk factors for BPD were prematurity, low birth weight, mechanical ventilation and prolonged oxygen therapy. Preventing small gestational age and low birth weight prematurity, decreasing the duration of mechanical ventilation and also to give minimum oxygen supply in premature infants. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the association between serum insulin like growth factor I (IGF-I) and retinopathy of prematurity (ROP). Materials and Method: We prospectively studied the newborn infants born at a postmenstrual age of <34 weeks between November 2006 and May 2007. ROP was classified according to the international classification of ROP. Total 33 infants were enrolled in the study. Serum IGF-I levels were studied after birth and weekly until discharge from the hospital. Results: Among the 33 infants, 36% had retinopathy of prematurity. Lower birth weight or younger gestational age were associated with the higher ROP development rate. The difference in the mean serum IGF-1 levels in the ROP group was found to be statistical significant when compared with the non-ROP group (p=0.03). There was no statistically significant relationship between the serum IGF-I levels which measured weekly and the development of ROP. Conclusion: In conclusion, low mean IGF-I levels in preterm infants are associated with the development of ROP. [ABSTRACT FROM AUTHOR]

Neurocutaneous melanosis (NCM) is rare and is characterized by the proliferation of melanocytes in the central nervous system. A 6-day-old infant boy was referred to our department with giant congenital melanocytic nevi and convulsions. On physical examination the patient had a giant black-brown pigmented nevus covering his face, neck, scalp, shoulders, back, chest, and abdomen. Numerous satellite lesions were noted on the face, neck, and upper extremities. In the right bulbar conjunctiva, a brown plaque was present. Magnetic resonance imaging (MRI) showed hyperintense areas in the brain on short repetition time/short echo time sequences, compatible with intraparenchymal melanin deposits. No leptomeningeal abnormality was seen. Further investigation also revealed agenesis of the right kidney and transposition of the great arteries. Transposition of the great arteries, which has never been reported in NCM, may be an incidental finding. We present a case of NCM associated with agenesis of the right kidney and transposition of the great arteries. [ABSTRACT FROM AUTHOR]

Introduction: In this study, it was aimed to evaluate the incidence, density and reciprocal relationships of Health Care Associated Infections (HCAIs) detected in the Pediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) in Bursa Uludag University Faculty of Medicine Hospital as a general perspective. Materials and Methods: In this study, data of 91 PICU and 158 NICU patients who developed HCAIs between 2012-2018 years, taking into account the criteria of the Centers for Disease Control and Prevention (CDC) 2015 and the Turkish National Hospital Infections Surveillance Network (UHESA) 2017, were retrospectively analyzed. Results: The HCAIs rate was higher in NICU (9.6% vs 14.9%; respectively, p <0.001), but the infection density was lower (9.9 versus 7.8/1000 patient days, p=0.061). Stay of length for all patients in NICU was found to be longer (19.1 days vs 9.7 days; p <0.001), and the median length of stay with HCAIs in PICU and in NICU was 41.5 days versus 49 days respectively (p=0.1). The median time of HCAIs diagnosis was 17 days in PICU vs 15 days in NICU, p=0.6). In NICU, according to birth weight, HCAIs rates and infection densities were 7.8% and 2.7/1000 patient-days in <750 g patients; 23.2% and 6.2/1000 patient-days in 751-1000 g patients, 6.1% and 4.9 patient-days in 1001-1500 g patients, 44.7% and 9.2/1000 patient-days in 1501-2500 g patients, and %24.6 and 13.8/1000 patient-days in >2501 g patients. HCAIs rates were found to be higher in babies with >1501 g. Conclusions: There may be differences in the rates and prevention strategies in PICU and NICU and continuous and high quality maintenance is important for infection control measures. [ABSTRACT FROM AUTHOR]

Introduction: The seizure is one of the most common neurological problems in neonatal intensive care units (NICU). Its frequency and etiology differ between preterm and term babies. This study aimed to investigate the properties, causes, response to treatment, and prognostic factors of neonatal seizures in term and preterm babies. Materials and Methods: The files of patients with a diagnosis of neonatal seizure in the NICU between 01/01/2014 and 01/09/2019 were analyzed retrospectively. Gross motor function classification, hearing test results and epilepsy rates were examined for neurological outcomes. Results: A total of 86 patients (43 preterm and 43 term infants) were included in this study. The most common etiological factors were hypoxic-ischemic encephalopathy (HIE) (35%) in term infants and intraventricular hemorrhage (IVH) in preterm infants (54%). The most common seizure type was subtle seizures in preterm babies and clonic seizures in term babies. The first seizure day was more on the first day and between the 4-7 days in term babies and after seventh days in preterm babies (p <0.05). The onset time of seizures in preterm babies was more after seven days at IVH, and on the first day at HIE (p<0.05). Status epilepticus frequency is higher in preterm (30%) than term (9.3%) (p = 0.015). The response rate to phenobarbital treatment was 71% in term infants and 50% in preterm infants (p = 0.06). According to the criteria (death, epilepsy, hearing loss, autism and gross motor function scale> 2) in our study, the poor prognosis rates were (52%) in term infants and (75%) in preterm infants (p = 0.051). Conclusion: In the etiology of neonatal seizures, IVH in preterm infants and HIE in term infants were the first. The neurological outcomes of patients who had convulsions in the neonatal period should be followed closely. [ABSTRACT FROM AUTHOR]

Introduction: Patent ductus arteriosus (PDA) causes a substantial increase in morbidities in premature babies by causing changes in organ perfusion. Various echocardiographic parameters are used to diagnose PDA and determine whether it is hemodynamically significant (HsPDA). This study aimed to investigate the role of tissue oxygen saturation in the first 24 hours in predicting HsPDA in high-risk premature babies who received respiratory support because of respiratory distress syndrome. Materials and Methods: In this prospective, observational study, cerebral, renal, and mesenteric regional tissue oxygen saturation levels were monitored by near infrared spectroscopy (NIRS) for the first 24 hours of the lives of preterm babies at ≤ 28 weeks of gestation. The NIRS data of babies with and without HsPDA as diagnosed by echocardiographic examination were compared. Results: Eighty-one premature babies who had HsPDA were included in the study. In the control group 51 premature babies who had not HsPDA were evaluated. The median ± standard deviation (SD) gestational age of the babies included in the study was 26.9 ± 1 weeks, and the mean ± SD birth weight was 880 ± 218 g. Renal and mesenteric NIRS measurements during follow-up were lower in babies with versus without HsPDA, but the difference was not statistically significant. Conclusion: Low renal and mesenteric stO2 values detected on the first day of life in high-risk infants may be associated with HsPDA. More studies are needed to reveal the effects of HsDPA on organs in these vulnerable babies with NIRS monitoring. [ABSTRACT FROM AUTHOR]

Sacrococcygeal teratoma (SCT) is rarely associated with syndromes. We report a female newborn with a prenatal diagnosis of small sacrococcygeal teratoma and postnatally diagnosed as having trisomy 13. The sacrococcygeal teratoma was excised. It was reported as mature teratoma. The child succumbed to sepsis postoperatively. [ABSTRACT FROM AUTHOR]

Gastro-esophageal reflux (GER) is one of the common problems of neonatal intensive care units. Although this condition does not always need to be treated, it occasionally causes clinically serious consequences. Initial management is medical; however, in some cases surgery might be required. A premature neonate with birth weight of 1370 grams was managed in our ICU. The patient was mechanical ventilator dependent due to GER. The patient needed Nissen fundoplication for successfully weaning off the ventilator. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the efficacy of serial serum amyloid A (SAA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants.Methods: A total of 144 infants were enrolled in this observational study. The infants were classified into three groups: group 1 (infants with NEC and sepsis), group 2 (infants with sepsis), and group 3 (no sepsis and NEC, control group). Data including serial whole blood count (WBC), SAA measurements that were obtained at the initial work-up of NEC and/or sepsis episode (0 day), at 24, 48 h, 7, and 10 day were evaluated. In addition, initial and serial follow-up abdominal radiographies were obtained.Results: A total of 50 infants were diagnosed NEC. Mean SAA values (43.2 +/- 47.5 mg/dl) of infants in group 1 at 0 h were significantly higher than those in group 2 and group 3. The percentage of infants with abnormal SAA levels was significantly higher in group 1 compared with that in group 2 at 24 h. In addition, the percentage of infants with abnormal SAA levels was slightly but not statistically higher in stage 2 and stage 3 NEC group compared with that stage 1 NEC at 0, 24, 48 h. SAA levels started to decline at 48 h of onset through day 10. The cut-off value for SAA for differentiating NEC from sepsis was 23.2 mg/dl.Conclusion: SAA may be recognized as an accurate laboratory marker in addition to clinical and radiographic findings for NEC diagnosis. It can also be used for determining the severity of NEC and response to therapy in infants with NEC. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The "late preterm" term is used for premature births between 34 0/7 and 36 6/7 gestational week. Most premature babies are "late preterm" babies. Although anthropometric measurements are close to term infants, there is increased risk of mortality and morbidity. In this study, we aimed to investigate in the neonatal period problems of late preterm labor in the tertiary referral hospital. METHODS: In this study, 210 late preterm infants born between 01/01/2016-31/12/2016 in the tertiary referral hospital were retrospectively examined. RESULTS: Twenty percent of births in one year were detected as late preterm, and 65% of all premature births were of late preterm. Fifty eight percent of late preterm infants were admitted to the neonatal intensive care unit. The most frequent causes of hospitalization were transient tachypnea (31.1%), congenital anomaly (18.8%) and jaundice requiring treatment (16.3%). Low gestational week and cesarean birth were statistically significantly higher in patients requiring hospitalization. The mortality rate was 2.7%, and increased in the presence of congenital anomalies (30.43%, 0.53%, p <0.001) and male gender (87.5%, 12.5%, p = 0.033). DISCUSSION and CONCLUSION: Despite the increased mortality and morbidity risks of late preterm infants, cesarean births without indications are still continuing in these weeks. Late preterm infants who are followed up with mother care should be followed closely for respiratory problems, nutritional problems, hyperbilirubinemia, hypoglycemia and hypothermia. [ABSTRACT FROM AUTHOR]

Introduction: The aim in this study was to investigate the role of vitamin B12 deficiency in neonatal hyperbilirubinemia. Materials and Methods: Term newborns who were breastfed and with hyperbilirubinemia were included in this prospective study. Those with hyperbilirubinemia were assigned to a patient group, and those without hyperbilirubinemia were assigned to a control group. The vitamin B12 levels of all newborns and their mothers were checked. Results: A total of 154 newborns were included in the study. Vitamin B12 deficiency was significantly higher in the patient group in comparison to the control group. Similarly, vitamin B12 levels of mothers were significantly lower in the patient group. The mean bilirubin level and phototherapy need were found to be significantly higher in patients with vitamin B12 deficiency. Conclusion: This study showed that vitamin B12 deficiency in the mother is related to vitamin B12 deficiency in the newborn, which significantly leads to neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. In this study, it was aimed to examine the microbiological factors, biochemical and clinical characteristics of neonatal meningitis cases, to reveal the risk factors, and to investigate the effect on the morbidities associated with meningitis in the first year of life. Materials and Methods: The files of patients diagnosed with meningitis in the level 3 Neonatal Intensive Care Unit between January 2010 and December 2015 were retrospectively analyzed. Results: There were 118 patients diagnosed with meningitis. The median gestational age of the patients was 32 weeks (24-40 weeks), and the median birth weight was 1987 grams (690-5020 grams). Most of the meningitis patients (n=106, 90%) were with late sepsis. The diagnosis day of those with poor prognosis was found to be greater [9.7 (2-28) days to 15.5 (3-138) days, p=0.03]. Cerebrospinal fluid (CSF) leukocytes were significantly higher in term babies with abnormal cranial magnetic resonance imaging (MRI) findings (p=0.037) and loss in hearing tests (p=0.045). CSF sugar levels were significantly lower in preterm babies with neuromotor retardation (p=0.001), history of seizures (p=0.003), abnormal cranial MRI findings (p=0.008) and hearing loss (p=0.005). Conclusion: In the long term, a significant number of cases with neonatal meningitis have neuromotor retarda-tion and hearing problems. Factors that can be used as predictors for poor neurological development; late-onset day, increased CSF leukocyte in all babies, and decreased CSF sugar in preterm babies. [ABSTRACT FROM AUTHOR]

Aim: To determine the role of serum insulin-like growth factor-1 levels in the development of retinopathy of prematurity, which is a major cause of childhood blindness worldwide. Material and Methods: We prospectively studied newborn infants born at a postmenstrual age of <32 weeks and birth weights <1 500 gr, between January 1st, 2015, and December 31st, 2015. A total of 40 infants were enrolled in the study. The retinal examination time was determined in accordance with the American Academy of Pediatrics recommendations for retinopathy of prematurity screening and follow- up. Retinopathy of prematurity was classified according to the international classification of retinopathy of prematurity. Serum Insulin like growth factor 1 levels were measured serially in blood samples on the 1st, 3rd, 7th, 21st, and 28th day. Results: Among the 40 infants, 11 (27.5%) constituted the retinopathy of prematurity group and 29 comprised the non-retinopathy of prematurity group. In the retinopathy of prematurity group, the mean gestational age and birth weight was significantly lower. The demographic features of the study cohort were similar. The duration of mechanical ventilation was significantly greater in the retinopathy of prematurity group compared with the non-retinopathy of prematurity group (p=0.036). In terms of neonatal morbidities such as respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, and necrotizing enterocolitis, no differences were detected between the groups. The mean serum insulin- like growth factor-1 levels in retinopathy of prematurity group were significantly lower than those in the non-retinopathy of prematurity group at each time point (1st, 3rd, 7th, 21st, and 28th day of postnatal life) (p=0.001). Conclusions: This study demonstrated the low serum insulin-like growth factor-1 levels was associated with retinopathy of prematurity development. [ABSTRACT FROM AUTHOR]

Introduction: To determine the rate, etiology and morbidity association of disorders of thyroid function tests (TFTs) in premature babies. Materials and Methods: A total of 139 premature babies who were admitted to Uludag University Faculty of Medicine Hospital Neonatal Intensive Care Unit between January 2009 and January 2012 were included in this study. Prenatal, natal and postnatal characteristics along with TFTs results were recorded. TFTs were performed for all patients in the first and third weeks of life. Thyroid stimulation hormone (TSH) values of >10 IU/L was considered elevated. Free T3 and T4 levels were evaluated according to laboratory cut-off values. Weight, height and head circumference values of all individuals with and without the diagnosis of hypothyroidism on the 6th, 12th, and 18th months of their polyclinic follow-ups. Results: Abnormal TFTs were detected in 41 (24%) patients. Twenty two patients (53%) had transient TSH elevation, 9 (22%) had primary hypothyroidism, 9 (22%) had non-thyroidal disease and 1 (2.4%) had transient hypothyroxinemia. Among morbidities, respiratory distress syndrome rate was found to be significantly higher in patients with thyroid function disorders (p=0.007). The rate of thyroid function disorders in patients with mothers with hypothyroidism was significantly more frequent compared to patients without maternal hypothyroidism (p=0.049). The mean head circumference in 18 month was significantly lower in patients with abnormal TFTs (p=0.047). Conclusions: Thyroid function disorders are common morbidities in premature babies and are important for neuromotor development. Maternal thyroid function disorder can lead to impairment of TFTs in infants. Thyroid function tests should be performed in all premature babies and hypotyhroidism should be treated. Avoidance of iodine exposure in premature infants can reduce the rate of abnormal TFTs and transient hypothyroidism. [ABSTRACT FROM AUTHOR]

Valproic acid (VPA) is a teratogenic drug used in pregnant women for the treatment of epilepsy and mood disorders. Fetal valproate syndrome (FVS) is characterized by a number of abnormalities associated with VPA exposure in utero including neural tube defects, congenital heart defects, limb defects, genitourinary defects, brain, eye and respiratory anomalies, and abdominal wall defects. Complex cardiac defect and trigonocephaly have rarely been reported and multicystic dysplastic kidney has never been detected in FVS. We here report a female infant who was born to a mother with a history of low-dose VPA monotherapy (250 mg/day) during pregnancy and who had presented with a combination of unilateral multicystic dysplastic kidney, multicomplex cardiac defect including severe coarctation of aorta, Ebstein anomaly, secundum atrial septal defect, mesocardia along with trigonocephaly due to metopic craniosynostosis, typical facial appearance and limb defects. To our knowledge, this is the first case presented with multicystic dysplastic kidney, complex cardiac defect, trigonocephaly and other limb and facial defects because of exposure to very low-dose VPA monotherapy (250 mg/day) in utero. We conclude that VPA must be used very cautiously in pregnant women even as monotherapy and in low doses to prevent major congenital defects. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the cardiac function in premature infants born to preeclamptic mothers and its clinical consequences. Methods: This was a prospective observational cohort study performed in a tertiary neonatal intensive care unit. Fifty-three premature infants born to preeclamptic mothers comprising the study group were evaluated and compared with 42 premature infants born to normotensive mothers (control group). Relationship between echocardiographic measures and neonatal morbidity were assessed as the main outcome measures. Results: Left ventricle end-diastolic dimension (LVEDD), peak flow velocities during early diastole (peak E wave), peak flow velocities during atrial contraction (peak A wave), and peak E/A ratio were significantly lower in the study group. Within the study group, these parameters were also significantly lower in infants with respiratory problems. LVEDD was significantly smaller in preeclamptic infants with intrauterine growth retardation (IUGR). Conclusion: Left ventricle diastolic dysfunction (LVDD) was detected in premature infants born to preeclamptic mothers in the first week after delivery. LVDD was associated with higher incidence of respiratory problems, transient tachypnea of the newborn, longer duration of oxygen requirement, and IUGR. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the characteristic features and both early and late term prognosis of premature infants who were followed-up with NEC in the neonatal intensive care unit. Materials and Method: A total of 50 premature infants less than 34 gestational weeks with NEC between January 2005 and December 2009 were included to this study and the characteristic features, clinical and laboratory findings, and prognosis of these infants were evaluated. Results: In this study, 15 infants (30%) had stage 1, 21 infants (42%) had stage 2 and 14 infants (28%) had stage 3 NEC. The incidence of NEC was 7.5% (20/568). The mean gestational age and birth weight of infants who developed NEC were 29±2.2 weeks and 1142±300 grams, respectively. The mean onset of NEC was 18.5±8.1 days. There was hypoxic birth history in 64% of infants and the ratio of breastfed infants was 54%. There was a positive blood culture in 36% of infants with NEC. Surgery was performed in 8 infants with stage 3 NEC, whereas the other infants responded well to medical treatment. The mortality rate was 12% and feeding problems and malabsorption were found to be the most common early and late term problems in infants who survived. Conclusions: NEC is one of the serious problems in premature infants. The mortality and frequency of NEC was decreased with the improvements in the Neonatal Intensive Care. The most important etiological factors were prematurity, hypoxia and enteral feeding. [ABSTRACT FROM AUTHOR]

Objective. Only limited studies with conflicting results are available on neonatal morbidity and mortality in infants born to preeclamptic mothers. The objective of this study was to evaluate neonatal morbidity and mortality in premature infants born to preeclamptic mothers. Methods. Premature infants who were admitted to Uludag University, School of Medicine, Neonatal Intensive Care Unit between June 2006 and December 2007 were included in this study. The infants were evaluated according to their demographic characteristics and neonatal morbidities. Results. Fifty-one infants born to preeclamptic mothers (study group) and 33 gestational age- and gender-matched infants born to normotensive mothers (control group) were included in this study. No statistical difference was found between the two groups in terms of demographic characteristics. However, frequency of neutropenia, duration of mechanical ventilation, and neonatal sepsis rates were found to be significantly higher in the study group compared with those of the control group. Although the rates of other neonatal morbidities such as bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and necrotising enterocolitis were found to be higher in the study group, the difference was not statistically significant. Mortality rates were also found to be similar in both groups. Conclusions. The infants born to preeclamptic mothers had significantly higher rates of neutropenia and sepsis. There were no significant difference in terms of other neonatal morbidities and neonatal mortality between the study and the control group. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the neonates with Rh hemolytic disease according to the severity of hemolytic disease (slight, moderate and severe) and the presence of intrauterine transfusion (IUT) for necessity of postnatal exchange transfusion or phototherapy application and severity of neonatal anemia. Materials and Method: The neonates admitted to Neonatal Intensive Care Unit with Rhesus hemolytic disease between January 2000 and November 2008 were included in this retrospective study. Cord blood hemoglobine and bilirubin levels, reticulocyte count, maximum bilirubin level, number of intrauterine transfusion, duration of phototherapy, requirement of postnatal exchange transfusion or redblood cell transfusions were all recorded. Results: A total of 44 neonates were included in the study. The mean gestational age and birth weight of infants were 37.6±0.3 week and 3031±53 g, respectively. Slight, moderate and severe hemolytic disease was determined in 13 (29.5%), 13 (29.5%) and 18 (41%) of infants, respectively. IUT was performed in 12 infants (27%) and 9 of them (75%) had severe hemolytic disease and this ratio was significantly higher compared with the infants without IUT. Similarly, requirement of postnatal exchange transfusi- on was also higher in infants who had IUT compared with the infants who did not have IUT. No significant difference was determined between infants with and without IUT in terms of duration of phototherapy, maximum bilirubin levels and transfusion requirement. Conclusion: The incidence of severe hemolytic disease and postnatal exchange requirement were significantly higher in infants with IUT compared with the infants without IUT. Therefore, it is concluded that if Rhesus hemolytic disease is severe in utero, it may present as severe hemolytic disease in the postnatal period. [ABSTRACT FROM AUTHOR]

Lamotrigine (LTG) has been used in epilepsia patients for treatment of partial seizures. It can cross the placenta and there are limited data about its use in pregnancy and foetal adverse effects. Extremity and cardiac malformations, dysmorphic facial appearance, coanal atresia and upper respiratory and gastrointestinal anomalies have been reported because of LTG use in pregnancy. Oxcarbazepine (OXC) is one of the new antiepileptic agents. Although the drug and its metabolites can easily pass from placenta to the foetus, available data suggest that it can be safely used during pregnancy because no teratogenicity has been reported. One infant with atrial septal defect and patent ductus arteriosus due to use of LTG and OXC in pregnancy has been reported in literature. Here, we report a female infant with micrognatia, low-set ears, facial dysmorphism and unilateral radius aplasia born to a mother who used LTG 100 mg/day and OXC 1200 mg/day during pregnancy for seizures. To our knowledge, this is the first major anomaly case associated with the combined use of these drugs. This case can provide useful data about the teratogenicity of LTG and OXC combination therapy. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the etiology in neonates admitted with prolonged jaundice. Materials and Method: Neonates with prolonged jaundice were included to this prospective study designed between January 2007 and December 2007. Prolonged jaundice was defined as total bilirubin level >5 mg/dL in newborns older than 14 days of age. After detailed history and physical examination, blood tests including blood groups of baby and mother, total, direct and indirect bilirubin, complete blood count (CBC), blood smear, reticulocyte count, Coombs test, serum aspartat transaminase (AST) level, serum alanin transaminase (ALT) level, viral markers, thyroid function tests, and glucose-6 phosphate dehydrogenase (G-6 PD) level and routine urine analysis with urine culture were performed in all newborns. Results: A total of 154 neonates were enrolled to the study. The most frequent cause of prolonged jaundice was breast milk jaundice (53%). It was followed by urinary tract infections and clinical sepsis (29%), hemolytic causes due to blood group incompetency (10%) and congenital hypothyroidism (8%). However, there were no significant differences between etiology and mean bilirubin levels. Conclusion: It is important to determine the etiology and to plan therapy according to etiology is important in newborns with prolonged jaundice. Breast milk jaundice, urinary tract infection and sepsis, hypothyroidism and hemolytic causes must be considered as the main etiology in newborns with prolonged jaundice. [ABSTRACT FROM AUTHOR]

Background: The incidence of congenital hypothyroidism (CH) is expected to be elevated in iodine-deficient areas. In this study, the authors aimed to determine the incidence of transient and permanent CH in a large city which is known to be in the zone of moderate iodine deficiency. Methods: Newborn babies in Bursa, Turkey, were screened by measurement of serum thyroid-stimulating hormone (TSH) obtained by heel prick. The babies who had a serum TSH >20 mIU/L were recalled for measurement of T4 and TSH in venous serum. Results: A total of 11 770 newborns were screened over a period of 9 years. The incidence of CH was found to be 1/840. However, after excluding the transient cases, permanent CH was diagnosed in 1/2354. It was impossible to distinguish transient patients from permanent CH by initial laboratory tests ( P > 0.05). The estimated power of the study in determining the incidence of CH in the population was 90% ( P < 0.05). Conclusion: The authors conclude that the incidence of CH is very high in their population which warrants a country-wide neonatal screening program. Since transient cases cannot be distinguished and untreated transient hypothyroidism may also cause mental retardation, treatment must be started as early as possible with frequent monitoring to optimize the outcome and identify the transient patients. [ABSTRACT FROM AUTHOR]

Aim: Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion. Material and Methods: Premature infants (≤32 gestational weeks) who were hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files. Results: Ninety-six patients whose complete data could be reached were enrolled in the study. The mean gestational age of the patients was found as 29±2 weeks and the mean birth weight was 1353±369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of the cases of portal vein thrombose were complete occlusion and eight were partial occlusion. All patients with complete occlusion and six patients with partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31±13.8 days. Thrombosis disappeared in 7-120 days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation. Conclusion: Portal vein thrombosis which has a significant place among the causes of portal hypertension in childhood, is mostly asymptomatic in the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Neural tube defects (NTD) are one of the most common congenital anomalies of the newborns. The incidence of NTD in Turkey is 3/1000. Various types of NTD appear depending on the part affected by the closure of the neural tube. The etiology of NTD is multifactorial, and a significant portion of them can be prevented by folic acid supplementation. Patients with NTD need long-term medical, surgical and care support. METHODS: In this study, antenatal, natal and postnatal characteristics of NTD patients who were admitted to the NICU between 2013-2017 were examined retrospectively. RESULTS: Twenty-nine NTD patients were included in this study. Sixteen (55%) of the patients were male and 13 (45%) were female. Mean gestational age was 37.5±1.97 weeks, mean birth weight was 3050±703.29 grams. Six patients had the following maternal risk factors for NTD development: diabetes, obesity, smoking, and the use of valproic acid. None of the patients used preconceptional folic acid. Of the NTD, 23 were meningomyelocele, 1 was meningocele, 3 were encephalomyelocele, 1 was encephalocele, and 1 was acrania. NTD was the most common at the lumbosacral region (n=10) and the other regions were lomber (n=8), thoracic (n=5), occipital (n=4) and cervical (n=1). While the complete loss of leg movements was seen in eleven of the patients, partial loss was seen in nine of them. The lesion level was higher than L4 in all of those with complete motor dysfunction and in 4 (44%) with partial motor dysfunction. Meningomyelocele sacs were ruptured in seven patients. Shunt procedures were required in 18 of 19 patients with hydrocephalus. Shunt placement and meningomyelocele operations were performed simultaneously in 11 patients. DISCUSSION and CONCLUSION: The preventable etiologic risk factors of NTDs should be known especially by the parents who are considering having a child. [ABSTRACT FROM AUTHOR]

Introductıon: Congenital diaphragmatic hernia (CDH) is a rare abnormality with high mortality and long-term comorbid conditions. Our aim, in this paper, was to describe demographics and birth characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution. Methods: The present study represents a retrospective cohort study of neonates with CDH who were treated at Uludag University Medical Faculty, Neonatal intensive care unit, Bursa. We identified the medical records of all patients with CDH who were admitted for treatment to our neonatal intensive care unit from January 2007 to December 2016. We reviewed the medical, surgical records, demographics and birth characteristics. We also recorded presence of pulmonary hypertension, whether or not the liver and, stomach also herniated into the thorax, other associated congenital malformations, and type of mechanical ventilation. Results: Forty patients were included in this study. The overall mortality was 67.5% (27/40). Survival for those who had surgical correction of CDH was 61% (13/21). Low birth weight, low gestational age, low APGAR scores and, high oxygen need at baseline was found to be associated with mortality, in patients with CDH. Among survivors, the median duration of hospitalization was 23 (14--35) days. Chronic gastrointestinal, pulmonary disorders and, failure to thrive were the most comorbid conditions after discharge. Dıscussıon And Conclusıon: KDH still has high mortality and morbidity. The birth of patients with prenatal diagnosis at appropriate centers will increase their chances of successful intervention. [ABSTRACT FROM AUTHOR]

Abstract: Because of the teratogenicity data in rats, it is recommended that women treated with imatinib should be aware of the potential teratogenicity of imatinib and effective contraception should be used during imatinib therapy to prevent pregnancy. We describe successful pregnancy and delivery, without any congenital anomaly, in a patient with CML under treatment of imatinib. The fetus had been exposed to imatinib for 8 weeks. The patient remained off treatment during gestation and cytogenetic relapse of CML (5 months after discontinuation of imatinib therapy) developed at seventh month of gestation. [Copyright &y& Elsevier]