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To assess the impact of clinical neonatal seizures on outcome characteristics of preterm and term newborns with neonatal encephalopathy (NE).We designed a prospective comparative study with 53 babies (preterm neonates: 26 and term neonates: 27) with NE: group 1 (preterm neonates with seizures, n = 13), group 2 (preterm neonates without seizures, n = 13), group 3 (term neonates with seizures, n = 13) and group 4 (term neonates without seizures, n = 14). The functional outcome characteristics of the survivors were assessed by the Ankara Developmental Screening Inventory (ADSI) and the Guide for Monitoring Child Development (GMCD) at 12 months of age.Clinically defined acute symptomatic seizures were diagnosed with prompt conventional EEG / amplitude-integrated EEG in preterm (92.3%) and term neonates (81.4%) with etiology-specific diagnoses of NE. There were no differences between the study groups regarding seizure semiology and EEG characteristics. A primary adverse outcome was defined in 22 (41.5%) of the cohort. However, only 15.3% of infants had an unfavorable functional outcome with ADSI at 12 months. Among the survivors, there was no significant difference between the study groups regarding ADSI scores. The GMDC test revealed normal development in 50% of survivors with seizures in the preterm group and 83% in the term group.There was no significant difference between the characteristics of functional outcomes at 12 months in preterm and term neonates with NE for clinical seizures.

Objective: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome. TSC arises from mutations in either TSC1, at 9q34, or TSC2, at 16p13.3. Skin lesions, such as hypomelanotic macules, facial angiofibromas, shagreen patches, and ungual fibromas, are frequently seen in these patients. The present study aims to investigate clinical manifestations, molecular findings and phenotype-genotype correlations in 17 patients with TSC. Materials and Methods: TSC1 and TSC2 molecular analyses were performed on a next-generation sequencing platform (Illumina MiSeq). Variant interpretation was made in accordance with the American College of Medical Genetics 2015 recommendations. Results: Four patients carried a heterozygous mutation in TSC1, while the remaining seven carried mutations in TSC2. Three novel variants in TSC2 were defined. Sequencing failed to detect a mutation in six patients. in only one of these patients, multiplex ligation-dependent probe amplification (MLPA (R)) could be performed, and a large deletion in the TSC1 gene was detected. A wide spectrum of phenotypic features was noted throughout the study group. Dermatological findings were observed in almost all patients. Conclusion: in this study, in addition to the three novel mutations reported herein, the spectrum of TSC1 and TSC2 gene mutations and their phenotypes were reported.

GirişTıp eğitiminde program değerlendirme programların geliştirilmesi sürecinde rehberlik edecek verileri sağlar. Kullanılan değerlendirme araçlarının geçerli, güvenilir, düşük maliyetli olması ve öğrenci, eğitici, mezun vb gruplardan görüş almak için kullanılabilmesi beklenir.Program değerlendirme etkinlikleri, Ege Üniversitesi Tıp Fakültesi’nde 2001 yılında başlayan program geliştirme çalışmalarının önemli bir bileşeni olmuştur. Gereç ve YöntemGüncel öğrenci ve öğretim üyesi değerlendirme formlarıyla elde edilen sonuçların güvenirlik ve geçerliği, metodolojik tasarım tipinde bir çalışmayla değerlendirilmiştir. İç tutarlılık güvenirliğinin belirlenmesinde Cronbach alpha katsayısı hesaplanmıştır. Kapsam geçerliğini belirlemek için bir uzman panelinde madde kapsam geçerlilik oranları hesaplanmıştır. Yapı geçerliğinin belirlenmesi için açımlayıcı faktör analizi uygulanmıştır.Puanlayıcılar arası uyum (interrater agreement) ve puanlayıcılar arası güvenilirlik (interrater reliability) araştırılmıştır. Puanlayıcılar arası güvenilirliğe ilişkin sınıf içi korelasyon katsayısı (intraclass correlation coefficient) için iki yönlü karma etki modeli kullanılarak % 95 güven aralığında tutarlık araştırılmıştır. SonuçCronbach alpha değerlerinin İkinci ve Üçüncü Sınıf Blok Değerlendirme formunun iki faktörü dışında 0,7 üzerinde bulunması, güncellenen öğrenci ve öğretim üyesi değerlendirme formlarının sonuçlarıyla ilgili iç tutarlık güvenirliğini desteklemektedir. Yapı geçerliği analizinde öğrenci formları, İkinci ve Üçüncü Sınıf Blok Değerlendirme Formu dışında tek boyutlu, Öğretim Üyesi Değerlendirme Formu ise üç faktörlü yapıya sahip bulunmuştur.İkinci ve Üçüncü Sınıf Blok Değerlendirme formunda Faktör II, Öğretim Üyesi Blok ve Staj Değerlendirme Formunda ise Faktör III için puanlayıcılar arası uyum ve güvenilirlik katsayılarının kabul edilebilir düzeylerin altında olması bu boyutlar için yapılan ölçüme ilişkin güvenilirliği desteklememektedir.Bu çalışmanın sonuçları, EÜTF program değerlendirme sisteminde kullanılan güncel değerlendirme formlarıyla yapılan ölçümlerin geçerlik ve güvenirliğini destekleyen kanıtların yanı sıra, sonuçların yorum ve kullanımında dikkatli olunması gereken noktaları da ortaya koymuştur., Introduction Program evaluation in medical education provides data that guide the program development process. It is expected that evaluation instruments are valid, reliable and low-cost, and useful for obtaining opinions of different groups such as student, teacher or graduate. Program evaluation has been a crucial component of program development in Ege University School of Medicine since 2001. Materials and Methods In this methodological design type study, reliability and validity of the results, obtained by updated students’ and teachers’ evaluation forms, were assessed. Cronbach alpha coefficient was calculated for assessing internal consistency reliability. Item content validity ratios were calculated in an expert panel. Exploratory factor analysis was implemented for determining construct validity. Interrater agreement and interrater reliability related to interpretation and use of the judgments of different observers were analyzed. Consistency was examined by a two-way mixed-effect model at 95% confidence interval, for calculating the intraclass correlation coefficient (ICC) related to interrater reliability. ResultsCronbach alpha coefficients that were over 0,7, except for Second and Third Year Student Block Evaluation Form, corroborated the internal consistency reliability for updated student and teacher evaluation forms. In construct analysis, student forms, except the Second and Third Year Block Evaluation Form were found to have a one-dimension construct, while teacher forms were determined to have a three-dimensions construct.Reliability of measurement of Factor II of Second and Third Year Block Student Forms and Factor III of Teachers’ Evaluation Forms was not corroborated as the interrater agreement and reliability coefficients were below acceptable levels. Results of this study revealed the evidences that support the validity and reliability of measurements done by the current evaluation forms used in the program evaluation system of Ege University School of Medicine, and also detected the points to be paid attention while interpreting and using the results of the measurements.

BACGROUND The gastric residual check is routine procedure in neonatal intensive care units while increasing the amounts of feeds given via oro/nasogastric tubes as a precaution for necrotising entereocolitis and intestinal intolerance. However this time consuming procedure is mostly misleading and there is recently a tendency not to check prefeed residuals. METHODS We have changed our clinical protocol at the end of 2018 to increase the feeds without checking the residuals and investigated its effects on the incidence of intestinal intolerance, time to reach full feeds and growth parameters. RESULTS Comparing the results of 60 preterm infants < 35 weeks cared in previous years (2016-2017), 77 preterms cared in 2019 without routine residual checks have reached total feeds 6 days earlier (9,32 (±8,52), 15,32 (±12,98), p< 0.01) discharged 1 day earlier (41,72 (±28,73), 43,90 (±35,13), p = 091) and had higher weight (2832,17 (±520,40), 2534,15 (±451,84), p

Aim: A brief resolved unexplained event (BRUE) is characterized by sudden alterations in an infant’s breathing, color, tone, or responsiveness. the aim of this study was to evaluate the necessity of electroencephalography (EEG) in high-risk BRUE cases. Materials and Methods: Fifty-one patients’ cases were analyzed retrospectively. All of these patients were younger than 1 month so considered to be a high-risk group. the gestational week, the age of the patient, the duration of the event, the conditions related to the event, whether or not any intervention was needed, the type of intervention if done, if the event recurred, the number of recurrences, the state of consciousness during the event, respiratory pattern, muscle tone, sleeping position, suspicion of trauma, use of medication by mother and/ or baby and smoking exposure were evaluated in detail. Results: the mean age of the patients was 15.74±14.96 days, 31 (60.78%) were male and 20 (39.21%) were female. the mean gestational age was 37.64±2.35 weeks. the neurological examinations of the patients were evaluated as normal. EEG was performed in 36 (70.58%) of the 51 patients and only one patient had sharp waves in the left hemisphere central region. in 11 patients hospitalized with a preliminary diagnosis of BRUE, final diagnoses were found as congenital pyloric stenosis, dehydration, fetal myocarditis, patent ductus arteriosus, lower respiratory tract infection and gastroesophageal reflux. Conclusion: It would be more appropriate to plan the tests to be carried out in the high-risk BRUE group by evaluating many factors such as recurrence of the event, family history, and neurological examination findings. As a result, even in the high-risk BRUE group, it would be cost effective to perform an EEG if only the clinical cues are strongly suggestive for the diagnosis of epilepsy.

EgeUn###, Purpose: Feeding intolerance is one of the most frequent problems among preterm infants. These infants are fed with expressed breast milk or preterm formulas of which the temperature is not routinely measured. In this study, we aimed to examine the effects of feeds with warm milk versus room temperature milk in preterm infants. Materials and Methods: Infants with a birth weight 1,500g or gestational age 34 weeks were included in the study and assigned to two different feeding temperature groups (22-24 degrees C and 32-34 degrees C). Some infants in both groups were exclusively breast milk-fed, and some received breast milk and artificial milk (mixed feeding). Feeding tolerance of infants in both groups and the consequences were evaluated. Results: In total, 80 preterm infants (group 1 fed with milk at 22-24 degrees C, n=40; group 2 fed with milk at 32-34 degrees C, n=40) were prospectively included in the study. There was a slight decrease in gastric residual frequency in infants fed with breast milk in group 2. Apnea was significantly more frequent in group 1 (p=0.006), and these infants needed more anti-reflux treatment (p=0.013). Conclusion: According to our results, warming enteral feeds close to body temperature are encouraging especially due to the decrease in gastric residual frequency, apnea of prematurity, and need for anti-reflux treatment. More studies may confirm the positive effect of warm enteral feeds on feeding tolerance in preterm infants.

WOS: 000456986200010, PubMed ID: 29776787, Background: Approximately 25% of congenital heart diseases (CHD) are estimated to be critical and require an intervention. In this study, we aimed to investigate the additional value of peripheral perfusion index (PPI) measurements to pulse oximetry screening for critical CHD (CCHD). Methods: Infants born at Ege University Hospital between May 2013 and September 2015 were prospectively included in the study. In addition to physical examination, pre- and postductal oxygen saturations and PPI values were measured with a new generation pulse oximeter before discharge from the hospital. Results: A total of 3175 newborns (33 with an antenatal diagnosis of CCHD) were included in the study. With the combination of physical examination, pulse oximetry screening and peripheral perfusion index (PPI) measurements, all newborns with CCHD were detected in our study including three infants without an antenatal diagnosis in whom pulse oximetry screening was negative. Conclusion: PPI measurements may be valuable for early detection of obstructive left heart lesions where pulse oximetry screening has limitations in diagnosis. Copyright (C) 2018, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.

Sitomegalovirüs (CMV), konjenital enfeksiyonlar arasında en sık görülen ve çocuklarda ilerleyen yaşlarda nörosensöriyel sağırlık ve öğrenme güçlüklerine en sık yol açan etkendir. Konjenital CMV enfeksiyonunun (KCMV), değişik ülkelerde yapılan çalışmalarda, canlı doğumların yaklaşık olarak %0.15-2.2’sinde görüldüğü belirlenmiştir. Konjenital CMV enfeksiyonu olan bebeklerin çoğu, doğum sonrası asemptomatik olup bu dönemde ancak tarama testleri ile tanı konabilmektedir. Bu çalışmada, tükürükte CMV DNA varlığı gerçek zamanlı polimeraz zincir reaksiyonu (Rt-PCR) yöntemi kullanılarak konjenital CMV enfeksiyonu görülme sıklığının araştırılması ve hastalığa eşlik eden nörosensöriyel işitme kaybı değerlendirilmesi amaçlanmıştır. Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum (KHD) Kliniği’nde Ekim 2015-Ekim 2017 tarihleri arasında canlı doğan 1000 yenidoğandan, doğumu izleyen ilk yarım saat içerisinde kuru eküvyonla alınan tükürük örneğinde, CMV DNA, Rt-PCR ile (Abbott Molecular, ABD) araştırılmıştır. Pozitiflik saptanan yenidoğanların, konjenital CMV enfeksiyonu açısından doğrulanması için, olguların ilk 21 gün içerisinde alınan idrar veya kan örneklerinden aynı yöntemle CMV DNA araştırılmıştır. Çalışmaya alınan tüm bebeklerin işitme testleri de değerlendirilmiştir. Olguların 497 (%49.7)’si kız ve 503 (%50.3)’ü erkek, ortalama doğum ağırlığı 3116.81 g ve ortalama doğum haftası 37.61 hafta olarak bulunmuştur. Bin yenidoğanın tükürük örneklerinin 16 (%1.6)’sında CMV DNA pozitif olarak saptanmıştır. Tükürükte CMV DNA düşük pozitif saptanan diğer 14 olgunun idrar ve/veya kan örnekleri konjenital CMV enfeksiyonunu desteklememiştir. Pozitif saptanan olguların idrar ve/veya kan örneklerinde CMV DNA pozitifliği ile KCMV enfeksiyonu sadece ikisinde (%0.2) saptanmıştır. Konjenital CMV tanısı alan iki olgunun birinde nörosensöriyel işitme kaybı bulunmuş ve semptomatik hastalık olarak tanımlanmıştır. Diğer olgu ise asemptomatik olarak değerlendirilmiştir. Tükürük gibi, doğumun ilk saatlerinde noninvaziv bir yöntemle ve kolaylıkla alınan bu örnekte CMV DNA’nın saptanması konjenital CMV enfeksiyonu tanısı için önemlidir. Pozitif saptanan olgularda CMV DNA’nın kan veya idrarda da doğrulanması gerekir. Yenidoğan popülasyonunda tükürükte CMV DNA taraması ve başka bir örnekte pozitifliğin doğrulanması sonucunda bu çalışmada %0.2 oranında KCMV saptanmıştır. Yenidoğanda konjenital CMV enfeksiyonu kesin tanısının noninvaziv ve kolaylıkla alınan bir örnekle konması gelişebilecek sekellerin önlenmesi ve toplum sağlığı açısından önemlidir., Cytomegalovirus (CMV), is the most common cause among congenital infections and is the most seen etiology in long-term sensorineural hearing loss (SNHL) and neurological impairment. Congenital CMV infection (CCMV) was reported in 0.15-2.2% of live-borne neonates in studies from different countries. A significant proportion of infected infants are asymptomatic after birth and might only be detected by routine screening methods during the new born period. The aim of this study was to screen the saliva of live-born neonates with areal-time PCR based method for the detection of CCMV in our hospital. Saliva samples collected in half an hour after birth by dry dacron swabs and were evaluated for CMV DNA (Rt-PCR, Abbott Molecular USA) from 1000 babies born in Ege University Faculty of Medicine Hospital Obstetrics Clinic between October 2015-October 2017. For the confirmation of CCMV, saliva positive newborns were evaluated with the same method for CMV DNA from their urine or blood within 21 days. All newborns were screened for sensorineural hearing tests. Subjects were 497 girls (49.7%) and 503 boys (50.3%), with a mean weight of 3116.8 g and mean of 37.61 birth week. CMV DNA was positive in the saliva of 16 newborns (1.6%). Fourteen newborns were weakly positive for CMV DNA in their saliva and were not confirmed for CCMV infection. Congenital CMV was confirmed in only two (0.2%) with the CMV DNA results in urine and/or blood samples. One of the two newborns with CCMV was symptomatic and had a neurosensorial hearing loss. The other one was asymptomatic. Saliva samples, taken immediately after birth with a noninvasive and easy method for the detection of CMV DNA is very important for diagnosis of CCMV. Positive samples should be confirmed with CMV DNA in urine or blood samples of these newborns. In this study, detection of positivity in saliva samples that were confirmed with other samples of our newborn population for CCMV was 0.2%. The specific diagnosis for CCMV in newborns with a noninvasive and easy collecting sample is important to avoid sequelae and for public health concerns.

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth.Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2).Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of

Background Apoptosis that occurs after hypoxia/reoxygenation (H/R) has an important role in the pathogenesis of necrotizing enterocolitis (NEC). Telomerase activity, showing the regeneration capacity, may also be important in the recovery process. Therefore, we aimed to investigate the effects of insulin-like growth factor-1 (IGF-1) and erythropoietin (EPO) on apoptosis and telomerase activity in an H/R model. Methods Young mice were divided into four groups each containing ten Balb/c mice. Group 1 (H/R) were exposed to H/R; group 2 and group 3 were pretreated with IGF-1 and EPO, respectively, for 7 days before H/R. Group 4 served as control. Intestinal injury was evaluated by histological scoring and assessment of apoptosis was performed by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) test. Proapoptotic and antiapoptotic gene expressions and telomerase activity were analyzed by real-time PCR. Results IGF-1- and EPO-treated animals had decreased histological damage and apoptosis, confirmed by TUNEL test and caspase activity. Telomerase activity was increased in these animals in addition to increased expression of antiapoptotic genes. However, proapoptotic gene expressions were not statistically different. Conclusions The protective effects of IGF-1 and EPO in H/R damage may be through increased expression of antiapoptotic genes and increased telomerase activity, especially for IGF-1. Impact This is a comprehensive study measuring various variables, namely IGF-1, EPO, apoptosis, apoptotic and antiapoptotic genes, and telomerase activity in the NEC model. The intestinal protective effects of IGF-1 and EPO in H/R damage may occur through increased expression of antiapoptotic genes and increased telomerase activity. To the best of our knowledge, telomerase activity has not been investigated in the NEC model before. Regarding our results, novel strategies may be implemented for the early definitive diagnosis, robust preventive measures, and effective treatment modalities for NEC., Scientific and Technological Research Council of Turkey (TUBITAK), This study was granted by The Scientific and Technological Research Council of Turkey (TUBITAK).

Background/aim: Congenital heart disease (CHD) is the most common congenital malformation group and is the leading cause of newborn mortality in developed countries. Most of the infants with CHD develop preoperative or postoperative acute kidney injury (AKI). Acute kidney injury may develop before the serum creatinine rise and oliguria. Urinary biomarkers such as kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, and cystatin C may predict AKI in patients with critical CHD (CCHD) before the serum creatinine rise. In this study, we aimed to determine the AKI incidence among newborn patients with CCHD and investigate the predictivity of urinary biomarkers for AKI. Materials and methods: Newborns with a gestational age >34 weeks and birth weight >1500 g with a diagnosis of CCHD were enrolled in the study. Blood and urine samples were collected at birth, during the first 24–48 h, and in the preoperative and postoperative periods. Results: A total of 53 CCHD patients requiring surgery during the neonatal period were enrolled in the study. The 24–48 h KIM-1 levels of the cases with exitus were higher (P = 0.007). The 24–48 h cystatin C and preoperative NGAL levels were higher in patients with postoperative AKI (P = 0.02). Conclusion: In newborns with CCHD, high KIM-1 levels may predict mortality, whereas high cystatin C and preoperative NGAL levels may be indicative of AKI. These biomarkers deserve further investigation in larger study populations. Key words: Acute kidney injury, cardiovascular surgery, critical congenital heart disease, newborn, urinary biomarker

Aim:The aim of this study is to compare the efficiency of a new method called "finger feeding" with a well-known technique called syringe feeding for improving sucking skills and accelerating transition to breastfeeding in preterm infants. Materials and Methods:Totally 70 babies were included in this prospective randomized controlled study. Finger feeding method was applied in Group 1 (n = 35) and syringe feeding method was applied in Group 2 (n = 35). the COMFORTneo scale (CnS), oxygen saturation, pulse, respiratory rate, body temperature, amount of breast milk taken, and vomiting data were recorded before and after both applications. Hospitalization period and time elapsed for complete transition from both methods to breastfeeding were also recorded. Results:There was no statistical difference for birth weights, mean gestational age, and vital signs recorded before and after feeding between two groups. Predicted comfort and distress scores of Group 1 determined by the CnS were significantly lower than those of Group 2. This means that babies in the finger feeding group had better comfort than the those in Group 2 (p = 0.000). Time passed for transition to breastfeeding was significantly shorter than that in Group 2 (19.4 +/- 15.0 days versus 29.7 +/- 10.2 days,p = 0.000). Group 1 had lower amount of food leakage while feeding and their average weight gain at the end of 10th day was significantly higher (322.1 +/- 82.3 g versus 252 +/- 108.4 g,p = 0.004). They also were discharged earlier than Group 2 (25.8 +/- 17.4 days versus 35.9 +/- 13.0 days,p = 0.001). Conclusion:Finger feeding method is an effective way for increasing sucking abilities, accelerating transition to breastfeeding, and shortens duration of hospitalization in preterm infants.

Aim: Exogenous surfactant may be needed not only for Respiratory Distress syndrome (RDS) treatment; but also, in the management of other pulmonary diseases of infants. In this study, we aimed to investigate the impact of single versus multiple doses of surfactant therapy in pulmonary problems of preterm infants. Materials and Methods: In this study, preterm infants who needed surfactant treatment were retrospectively evaluated. Surfactant therapy for RDS were given as 200 mg/kg poractant or 100 mg/kg beractant and repeated with 100 mg/kg doses when needed later. Poractant or beractant (100 mg/kg) were given in the treatment of other pulmonary diseases. Results: Totally 64 preterm patients were recruited into this study. Patients in group 1 (43.8%) received a single dose of surfactant; whereas group 2 patients (56.2%) had more than one dose. Mean gestational age and birth weight of infants in group 2 were significantly lower than group 1 (p

WOS: 000423241000012, PubMed ID: 28832325, Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point) and 1988-1989 (2nd time point) were compared with the year 2008 (3rd time point). The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for high risk pregnancies are needed.

WOS: 000418709600009, Aim: Expressed breast milk is beneficial for infants in neonatal intensive care unit (NICU) when direct breastfeeding is not possible. Breast expression with manual or electric breast pumps is promoted for the initiation and maintenance of lactation in this critical period. In this study, we aimed to compare the efficacy and maternal comfort of sequential versus simultaneous breast expression in newly delivered mothers whose infants were admitted to NICU. Materials and Methods: Thirty five mothers were followed prospectively for milk expression either sequentially (n=21, group 1) or simultaneously (n=14, group 2) with breast pumps for 10 days. The total amount of milk expressed per day and per each period was recorded together with the duration of breast expression. The mothers' impressions about the easiness and comfort of the procedure, and their satisfaction with the amount of milk were evaluated with a questionnaire at the end of the study. Results: The amounts of expressed milk per day and per each expression period were similar in both groups. However, time spent for each expression period was significantly lower in the simultaneous breast expression group. Mothers in this group gave higher scores with regard to ease of use when compared to mothers in the sequential expression group (4.36 +/- 0.50 vs. 4.00 +/- 0.44, p=0.046). The mothers graded both methods with similar scores in all other parameters. Conclusion: Simultaneous breast expression is time saving while both simultaneous and sequential breast expression are similarly efficient for milk production, and both methods are helpful and tolerable in promoting breastfeeding for NICU mothers.

Respiratory distress syndrome is pulmoner insufficiency caused by the lack of surfactant and the main reason of morbidity and mortality in preterm infants. Mothers at high risk of preterm birth should be transferred to perinatal centers with experience for respiratory distress syndrome and ante-natal steroids should be given before 35 weeks’ of gestational age. Surfactant treatment should be applied to babies with or at high risk for respiratory distress syndrome. Prophylaxis should be given to infants of

Appropriate treatment of neonatal seizures with an effective therapy is important in reducing long-term neurologic disabilities. Sixty-seven neonates, who received intravenous (IV) levetiracetam (LEV) as first-line therapy for treating seizures between 2013 and 2017 were evaluated retrospectively to investigate the efficacy of LEV and its neurodevelopmental outcome at 12 months of age. Of the 67 neonates (44 preterm and 23 term babies) evaluated for seizures, 55 (82%) had a defined etiology. EEG confirmation was obtained in 36 (57.1%) of the neonates with clinical seizures. On the 7th day of the treatment (mean seizure control time 7.4 ± 15.1 days), LEV was effective as monotherapy in 43 (64%), whereas add-on therapy was required in 24 (36%) neonates. At the 1-year follow-up, 76% of infants achieved drug-free state, nine (18%) infants remained on LEV monotherapy and three (6%) needed add-on therapy. Neurodevelopmental outcome of the infants was assessed with Ankara Development Screening Inventory and results suggested favorable neurodevelopmental outcome in 69.7% of the infants with at the end of the 1-year follow-up with LEV monotherapy. In conclusion, this retrospective cross-sectional study demonstrated that IV LEV is an effective first-line therapy for treating neonatal clinical seizures and LEV monotherapy effect was sustained during the first year follow-up. © 2020, Belgian Neurological Society.

Objective: To determine the reference ranges of presepsin in term and preterm neonates without infection, with respect to gestational and postnatal age, within the first 28 days of life. Methods: A total of 144 neonates born at 24-42 weeks' gestation, including healthy term and preterm neonates without clinical signs or symptoms of infection, were included in this prospective observational study. Presepsin measurements included cord blood levels and serum levels on postnatal days 1, 3, 5, 7, 14, 21, and 28. Results: the presepsin values corresponding to the 10th percentile ranged from 240.8 pg/mL (on day 1) to 129.9 pg/mL (on day 28), whereas those corresponding to the 90th percentile ranged from 725.8 pg/mL (on day 1) to 471.6 pg/mL (on day 28). Significantly higher presepsin levels were observed in cesarean deliveries than in spontaneous deliveries (p: 0.012 to < 0.001), in gestational ages = 37 weeks (p: < 0.05 to < 0.001), and in cases with a maternal history of chorioamnionitis than in those without (p: < 0.05 to < 0.001). Conclusion: in conclusion, our findings revealed, for the first time, the reference ranges of presepsin in healthy term and preterm neonates without infection with respect to gestational and postnatal age, sex, and body weight. Presepsin levels within the first 28 days of life seem likely to be affected by the type of delivery, gestational and postnatal age, birth weight, and presence of respiratory distress syndrome or maternal chorioamnionitis.

Cytomegalovirus (CMV), is the most common cause among congenital infections and is the most seen etiology in long-term sensorineural hearing loss (SNHL) and neurological impairment. Congenital CMV infection (CCMV) was reported in 0.15-2.2% of live-borne neonates in studies from different countries. A significant proportion of infected infants are asymptomatic after birth and might only be detected by routine screening methods during the new born period. The aim of this study was to screen the saliva of live-born neonates with areal-time PCR based method for the detection of CCMV in our hospital. Saliva samples collected in half an hour after birth by dry dacron swabs and were evaluated for CMV DNA (Rt-PCR, Abbott Molecular USA) from 1000 babies born in Ege University Faculty of Medicine Hospital Obstetrics Clinic between October 2015-October 2017. For the confirmation of CCMV, saliva positive newborns were evaluated with the same method for CMV DNA from their urine or blood within 21 days. All newborns were screened for sensorineural hearing tests. Subjects were 497 girls (49.7%) and 503 boys (50.3%), with a mean weight of 3116.8 g and mean of 37.61 birth week. CMV DNA was positive in the saliva of 16 newborns (1.6%). Fourteen newborns were weakly positive for CMV DNA in their saliva and were not confirmed for CCMV infection. Congenital CMV was confirmed in only two (0.2%) with the CMV DNA results in urine and/or blood samples. One of the two newborns with CCMV was symptomatic and had a neurosensorial hearing loss. The other one was asymptomatic. Saliva samples, taken immediately after birth with a noninvasive and easy method for the detection of CMV DNA is very important for diagnosis of CCMV. Positive samples should be confirmed with CMV DNA in urine or blood samples of these newborns. In this study, detection of positivity in saliva samples that were confirmed with other samples of our newborn population for CCMV was 0.2%. The specific diagnosis for CCMV in newborns with a noninvasive and easy collecting sample is important to avoid sequelae and for public health concerns.

WOS: 000484450300012, PubMed ID: 31236025, Postnatal growth failure due to inappropriate and insufficient nutrition is a risk for preterm infants, especially for very-low-birth-weight or extremely-low-birth-weight infants. This extrauterine growth failure causes negative effects on long-term neurodevelopment. Early initiation of intensive parenteral nutrition with appropriate protein and energy supply is a nutritional emergency when enteral feeding cannot be achieved. This approach prevents protein catabolism and helps achievement of positive protein balance and postnatal growth. Protein, lipid, and glucose initiation with appropriate doses that reach timely goals constitute the major elements of parenteral nutrition. The transition to enteral nutrition with the mother's milk at the earliest convenience must be targeted in parenteral nutrition.

WOS: 000441766000024, PubMed ID: 30119594, Background/aim: Geographical distribution, ethnicity, and other socioeconomic factors may affect anthropometric measurements, and for that reason each society should determine their own measurements accounting for those factors. In this study, we aimed to determine the anthropometric measurements of healthy late preterm and term infants to compare the results with other national and international studies. Materials and methods: This sectional study was carried out among 1197 infants born with a gestational age of 35 weeks. Chest circumference, ear length, foot length, palmar length, middle finger length, philtrum distance, inner and outer canthal distances, and palpebral fissure length were measured in the first 24 h of life. Results: All measurements of late preterm infants were smaller than those of term infants (P < 0.05). Compared with male infants, the chest circumference, ear length, foot length, pahnar length, philtrum distance, and inner canthal distances of the female infants were lower (P < 0.05). No significant differences were found between male and female infants' middle finger length, outer canthal distance, and palpebral fissure length measurements. Percentile values for all measurements of 35-42-week male and female infants were described. Condusion: These measurements of male and female infants born between 35 and 42 weeks may be useful for early detection of syndromes by detecting anatomical abnormalities in our population.

WOS: 000429850300007, Aim: In the present study, the relationship between neonatal morbidity and cord vitamin D levels is investigated. Materials and Methods: Premature infants who were born before 32 weeks of gestation and admitted to our neonatal intensive care unit between January 2014 and January 2015 were included in the study. Vitamin D levels in the cord blood of infants were measured. Serum calcium, phosphorus and alkaline phosphatase levels were recorded in the first 24 hours. All neonates were followed up for neonatal morbidities until discharge. Results: The mean gestational age of the study subjects was 29.2 +/- 2.6 (23-32). The mean vitamin D level was 27.4 +/- 19.3 ng/mL (4-76). Fourteen (46.7%) infants had normal vitamin D levels; 2 infants (6.7%) had vitamin D insufficiency (20-30 ng/mL), 14 infants (46.7%) had vitamin D deficiency (< 20 ng/mL), and 7 infants had severe vitamin D deficiency (23.3%). In 60% of infants with intrauterine growth restriction had vitamin D deficiency of p< 0.05. Serum phosphorus levels on the first day of life were significantly lower in infants with vitamin D deficiency (p< 0.001). Conclusion: In more than half of the study population vitamin D deficiency was determined. Infants with intrauterine growth restriction had vitamin D deficiency in more than half of the cases. Low levels of phosphorus may be a marker of vitamin D deficiency in the first days of life.

WOS: 000484450300011, PubMed ID: 31236024, Early initiation of enteral feeding with the own mother's milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother's milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother' milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother's milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neuro developmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up.

WOS: 000219058200004, Aim: There are many risk factors that cause significant neurologic damage in term and preterm infants who need intensive care. For these patients brain injury prevention has become the main goal of modern neonatalogy. Observing brain functions with electroencephalography (EEG) in newborns may be helpful in determining patients who carry increased risk factors for neurologic morbidity. The aim of this study is to compare the results of the synchronous amplitude EEG (aEEG) and conventional EEG (cEEG) in cases with newborn encephalopathy. Materials and Methods: Fifty two newborns cases (27 term, 25 preterm) were included to Ege University, Faculty of Medicine Pediatrics Department Neonatal ICU with possible neurological risk, thus, with neonatal encephalopathy, neurologic disturbance, or severe respiratory distress syndrome (RDS). Amplitude EEG was performed for 24-48 hours. Amplitude EEG was assessed by a neonatalogist using Burdjalov scoring system. The results of simultaneously performed amplitude EEG and conventional EEG were compared. Results: The results of synchronous aEEG and cEEG were compared and there was significant difference between aEEG scores (between 0-13 points) and cEEG grade(grade 0-3) (p

Background The aim of this study was to investigate the relationship between plasma chitotriosidase activity, an inflammatory protein secreted mainly from macrophages, and neonatal morbidity and mortality in premature infants. Methods Cord blood chitotriosidase activity was studied in healthy control infants (53 term, group 1; 26 late preterm [33–37 gestational weeks], group 2) and 35 preterm infants (≤32 weeks; group 3). In group 3, consecutive samples at 3 h, 24 h, 72 h, 7 days, 14 days, and 36 weeks after conception were also analyzed. Group 3 was also evaluated for mortality, respiratory treatment and bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC). Results Cord blood chitotriosidase activity was positively correlated with gestational age and birthweight. SNAPPE-II score was correlated with chitotriosidase activity at 24 h. Consecutive chitotriosidase activity for group 3 was non-significantly higher in infants who died in the early neonatal period. Higher chitotriosidase activity was observed in mechanically ventilated infants than infants treated with non-invasive assisted ventilation. BPD, PDA, IVH and ROP, but not NEC, were related to higher chitotriosidase activity, being significant at some of the time points. Conclusion Neonatal stress such as invasive ventilation may create a risk for the development of BPD, PDA, IVH, and ROP by increasing macrophage activation in preterm infants as reflected in the higher chitotriosidase activity. High chitotriosidase activity may also be associated with disease severity and mortality.

WOS: 000429776500009, PubMed ID: 28969451, Brain abscess is a rare disease in childhood requiring prompt medical and/or surgical treatment. The objective was to review presentation, management, and outcome of brain abscess in children. We reviewed the clinical and radiological features and outcomes of 18 children (10 females, 8 males), with a median age of 48 months (range 1-182), that presented with brain abscesses and admitted to a tertiary pediatric infectious department between December 2010 and January 2017. One (5.5%) patient underwent craniotomy and 14 (77.7%) had burr hole aspirations. The most common localization was the frontal lobe (33.3%). The survival rate was 94.4%, and long-term neurological sequelae affected 27.7% of the patients. Empiric treatment choices require knowledge of common pathogens and local resistance. The most predominant infections were still upper respiratory infections. Clinicians may treat the children with appropriate choice and duration of antibiotic treatment for upper respiratory tract infections.

Konjenital sifiliz, Treponema pallidum ile enfekte olan annelerin prenatal dönemde düzenli izlem ve etkin tedavilerinin sağlanması, doğum sonrası bebeklerin hızla değerlendirilip erken tedavi edilmeleriyle önlenebilir. Burada annesi sifiliz tanısıyla yetersiz tedavi almış, makülopapüler döküntülerle başvuran maternal treponemal testi pozitif saptanarak erken konjenital sifiliz tanısıyla başarıyla tedavi edilen yenidoğan hasta sunulmaktadır., Congenital syphilis is preventable with proper antenatal follow-up and treatment of the pregnant woman infected with Treponema pallidum, and the rapid evaluation and early treatment of the newborns. Here we report a newborn with early congenital syphilis presenting with maculopapular rash and positive treponemal test born to an inadequately treated syphilitic mother.

WOS: 000418709600016, Hyperinsulinemic hypoglycemia (HH) is the most common reason for persistent and recurrent hypoglycemia in the neonatal and infancy periods. We presented a case diagnosed with HH on the first day of life and who underwent near-total pancreatectomy because of the unresponsiveness to the diazoxide treatment. Despite early diagnosis and management, complications developed due to hypoglycemia and surgery.

WOS: 000418537000015, Congenital syphilis is preventable with proper antenatal follow-up and treatment of the pregnant woman infected with Treponema pallidum, and the rapid evaluation and early treatment of the newborns. Here we report a newborn with early congenital syphilis presenting with maculopapular rash and positive treponemal test born to an inadequately treated syphilitic mother.

WOS: 000418709600012, Aim: Prematurity is an important health problem affecting all segments of society. In this study, we aimed to evaluate the level of awareness of prematurity and related problems. Materials and Methods: A questionnaire consisting of fifteen questions was administered to medical faculty students, pediatric residents, and to laypersons by face to face interviews. The questionnaire applied in the scope of the study had 8 open-ended questions and 7 "yes-no" questions. Results: Of the 150 people who answered the questionnaire, 92 were health workers and the remaining 54 were people from the public. The groups with and without health workers had a similar rate of awareness of the World Prematurity Awareness Day (58.7% vs. 58.6% respectively, p=0.30). All of the health care workers defined prematurity correctly while 89.7% of the laypersons gave the correct definition (p< 0.05). People from the public expected the survival of babies with higher birth weight and gestational age and this group was less informed about the short and long-term problems related to prematurity. In both groups, the awareness of physicians specializing in newborn care was low (17.4% vs. 13.8%, p=0.13). The level of awareness of the shortage of specialized physicians and nurses in neonatal care was significantly lower among laypersons than that of health care workers (p values < 0.05). Conclusion: Although our study population knew what prematurity was, they lacked knowledge about the complications of prematurity, and the quality and adequacy of the health care teams involved in the care of premature babies.

Studies about the effects of inhaled nitric oxide (iNO) on bleeding time and platelet aggregation in newborns are limited in number and have inconclusive results. Thromboelastogram (TEG) shows the combined effects of coagulation factors and platelet functions. In this preliminary study, we aimed to evaluate the effects of iNO on coagulation using TEG in newborns with persistent pulmonary hypertension (PPH). TEG assays were performed in 10 term infants receiving iNO treatment for PPH and 32 healthy term infants. Samples of the iNO group were collected before and during iNO. Clot reaction time (R), clot kinetics (K), maximum amplitude (MA), and alpha angle were obtained from the TEG tracing. TEG-R values were statistically higher during iNO treatment (7.75 ± 3.34) when compared to the values before iNO (4.83 ± 1.38) and the healthy controls (3.75 ± 0.98). The alpha angle was lower in iNO treated infants at both periods (before iNO, 55.33 ± 8.58; during iNO, 42.90 ± 18.34) compared to the control group (64.95 ± 6.88). MA values before iNO treatment were the lowest (44.43 ± 14.09) and improved with the iNO treatment (48.40 ± 9.49) despite still being lower compared to the controls (53.67 ± 5.56). Conclusion: Both PPH and iNO may negatively effect in vitro coagulation tests. Therefore, newborns with PPH requiring iNO treatment should be closely monitored for coagulation problems.

The Omenn syndrome is a form of severe combined immune deficiency that is inherited autosomal recessively and characterized by growth retardation, erythrodermia, lymphadenopathy, hepatosplenomegaly and severe recurrent infections. Although circulating T lymphocytes on the lymphocyte panel are normal, their functions are abnormal. On the other hand, circulating B lymphocytes are decreased or absent. Our case was a baby girl who was born to the second pregnancy of a 29-year-old mother on the 37th gestational week. She had a history of a sister’s death on the 51st day of life due to Omenn syndrome. There was no consanguinity between parents. Her physical examination was normal expect generalized exfoliative erythrodermia. Routine laboratory investigations revealed eosinophilia. X-ray, echocardiography, abdominal and transfontanel ultrasonography findings were normal. IgG was at the lowest boundaries of the normal values. IgA and IgM were low as well. While T lymphocytes were elevated, B lymphocytes were extremely low. The family had a history of a baby death with the homozygote RAG1 g.854C>T (p.Q248X) mutation and parents were heterozygote carriers of the same mutation. Our patient also had the same homozygote RAG1 g.854C>T mutation. Since the parents’ immunoglobulin levels and lymphocyte panels were normal, haploidentical stem cell transplantation from the father was performed. Unfortunately our patient passed away due to pulmonary infection on the posttransplantation 12th day. Genetic counseling has a great significance as untreated Omenn syndrome is fatal but the disorder is treatable with appropriate bone marrow or umbilical cord blood stem cell transplantion.

Sturge–Weber syndrome is a rare, sporadic, congenital neurocutaneous syndrome characterized by facial cutaneous vascular malformation, leptomeningeal angioma and eye abnormalities. Seizures develop during the first year of life, may become refractory to multiple anticonvulsants and status epilepticus may develop. A rare subtype of Sturge–Weber syndrome with bilateral facial vascular malformation, unilateral cerebral involvement and neonatal status epilepticus is reported here. Neonatal status epilepticus was successfully controlled with intravenous levetiracetam infusion.