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Anemia of prematurity is common in very low birth weight premature infants. Treatment of this disorder includes red blood cell transfusions. Recombinant erythropoietin treatment failed to decrease transfusions in the first few weeks of life;anemia in this period of life may be related to the frequent blood withdrawals. Donor reduction programs, safe transfusion methods, and restrictive transfusion protocols have decreased the infectious complications of transfusions. Long-term neurodevelopmental outcomes in newborns with asymptomatic anemia are also controversial. Therefore, more restrictive transfusion guidelines should be used during this period. Preventing or limiting blood loss by phlebotomies should be the first goal. Iron deficiency anemia in these babies is common in the infancy period;therefore, periodic screening until 18 months of age is required. [ABSTRACT FROM AUTHOR]

Background: An iron regulatory peptide hormone, hepcidin, is also part of the innate immune system and is strongly induced during infections and inflammation. The aim of the present study was to determine serum levels of the 60 aa pro-hormone form of hepcidin (pro-hepcidin) in full-term and preterm newborns with sepsis and to determine the possible relationships between pro-hepcidin levels and serum iron and complete blood count parameters. Methods: Fifteen preterm newborns with sepsis, 17 healthy preterm, six full-term newborns with sepsis and 16 healthy full-term newborns were included the study. Blood samples were collected from patients with sepsis at the time of clinical diagnosis. Each blood sample was analyzed for complete blood count, serum iron and ferritin concentrations, iron-binding capacity, and pro-hepcidin level. Results: The mean serum pro-hepcidin level (mean ± SD) in preterm neonates with sepsis and in healthy preterm newborns was 565.4 ± 519.5 ng/mL and 279.8 ± 227.6 ng/mL, respectively ( P < 0.05). The mean serum pro-hepcidin level in full-term newborns with sepsis and in healthy full-term neonates was 981.4 ± 415.4 ng/mL and 482 ± 371.9 ng/mL, respectively ( P < 0.05). Although the mean serum ferritin levels in the two groups with sepsis were higher when compared with the healthy groups, the difference was not statistically significant in full-term newborns. No statistically significant correlations were found between serum pro-hepcidin levels and any other parameters in each group. Conclusions: Serum pro-hepcidin levels were higher in newborns with sepsis (either premature or full-term) than they were in healthy newborns at the time of clinical diagnosis. [ABSTRACT FROM AUTHOR]

Transient myeloproliferative disorder is a self limiting disorder characterized by leukocytosis with the presence of megakaryoblasts in the peripheral blood and bone marrow, anemia, thrombocytopenia, and organomegaly. It occurs in approximately 10% of newborn infants with Down syndrome. Hepatic fibrosis is seen in the severe form of transient myeloproliferative disorder with Down syndrome that is characterized by diffuse intralobular sinusoidal fibrosis and extramedullary hematopoesis. We describe a patient with hydrops fetalis, Down syndrome, and transient myeloproliferative disorder. We suggest that patients with the severe form of transient myeloproliferative disorder should be examined for hepatic fibrosis. [ABSTRACT FROM AUTHOR]

Background. The pathogenetic mechanisms of hepatic injury in perinatal asphyxia (PNA) are similar to those in ischemic hepatitis, yet liver involvement is currently not considered a component of multi-organ failure in PNA. Methods. A retrospective study was done on 56 newborns with PNA. Hepatocyte injury was diagnosed based on elevated serum alanine transaminase level (>00 U/L, twice upper normal) with subsequent normalization. Results and conclusions. Twenty-two of the patients had hepatocyte injury. Fetal distress, thrombocytopenia, convulsions, pathologic findings on imaging of the central nervous system, and a high rate of intrauterine growth retardation were the factors significantly associated with hepatocyte injury. This damage was also associated with high mortality. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine what proportion of newborns admitted with idiopathic non-hemolytic hyperbilirubinemia exhibit severe weight loss and hypernatremia. Methods: The prospective study involved 115 infants >48 h old who were admitted with jaundice between July 2002 and July 2003, and had unconjugated bilirubin levels >12 mg/dL. Premature babies (gestational age <37 weeks) and those with hemolytic jaundice and other pathologic causes of non-hemolytic jaundice were excluded. Postnatal age (days) at admission, bodyweight at admission, weight change since birth (percentage weight loss calculated at admission) and mode of feeding (breast-feeding, formula feeding, mixed feeding) were recorded. Severe weight loss was defined in babies who showed >10% weight loss or had not regained enough to reach birthweight by postnatal day 10. Serum Na levels and breast-milk Na levels were also measured. Results: Twenty-eight (33%) of the 86 newborns with idiopathic hyperbilirubinemia in the study exhibited severe weight loss. Almost all the 86 babies were exclusively breast-fed, and 10 babies (12%) had severe weight loss combined with hypernatremia. The group with severe weight loss and hypernatremia had higher breast-milk Na levels than the other infants. Conclusion: The results indicate that a large proportion of babies with non-hemolytic jaundice have severe weight loss, and that breast-fed newborns with the combination of weight loss and hypernatremia may present with non-hemolytic jaundice. [ABSTRACT FROM AUTHOR]

Acute renal failure (ARF) is a common problem in the neonatal intensive care unit (NICU). In most cases, ARF is associated with a primary condition such as sepsis, metabolic diseases, perinatal asphyxia and/or prematurity. This retrospective study investigated the course of illness, therapeutic interventions, early prognosis and risk factors associated with development of ARF in the neonatal period. A total of 1311 neonates were treated in our NICU during the 42-month study period, and 45 of these babies had ARF. This condition was defined as serum creatinine level above 1.5 mg/dL despite normal maternal renal function. The data collected for each ARF case were contributing condition, cause and clinical course of ARF, gestational age and birth weight, age at the time of diagnosis, treatment, presence of perinatal risk factors and need for mechanical ventilation. The frequency of ARF in the NICU during the study period was 3.4%. Premature newborns constituted 31.1% of the cases. The mean birth weight in the group was 2863 ± 1082 g, and the mean age at diagnosis was 6.2 ± 7.4 days. The causes of ARF were categorized as prerenal in 29 patients (64.4%), renal in 14 patients (31.1%) and postrenal in 2 patients (4.4%). Forty-seven percent of the cases were nonoliguric ARF. Asphyxia was the most common condition that contributed to ARF (40.0%), followed by sepsis/metabolic disease (22.2%) and feeding problems (17.8%). Therapeutic interventions were supportive in 77.8% of the cases, and dialysis was required in the other 22.2%. The mortality rate in the 45 ARF cases was 24.4%. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were associated with significantly increased mortality (p < 0.05). There were no statistical correlations between mortality rate and perinatal risk factors, oliguria, prematurity or blood urea nitrogen and creatinine levels. The study showed that, at our institution, ARF in the neonatal period is frequently associated with preventable conditions, specifically asphyxia, sepsis and feeding problems. Supportive therapy is effective in most cases of neonatal ARF. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were identified as indicators of poor prognosis in these infants. Early recognition of risk factors and rapid effective treatment of contributing conditions will reduce mortality in neonatal ARF. [ABSTRACT FROM AUTHOR]

Congenital leukemia is rare, and is frequently diagnosed as a form of acute myeloid leukemia at, or immediately after birth. Some infections, viral in particular, can mimic clinical signs and/or laboratory findings of congenital leukemia. This is the first documented case of candidemia resembling leukemia. [ABSTRACT FROM AUTHOR]

Presents the case of a newborn with hemolytic disease of the newborn developed severe hyponatremia after intravenous immunoglobulin therapy. Determination of the blood groups of the mother and baby; Utilization of a Wells-Brookfield cone-plate viscometer in determining the plasma viscosity; Performance of partial exchange transfusion with serum physiologic solution.

Presents a letter to the editor commenting on an article published in the periodical "Annals of Tropical Paediatrics" concerning breastfeeding malnutrition and hypernatremia.

Premature constriction of the fetal ductus arteriosus has been described with long-term indomethacin therapy, but not in fetuses who have been exposed to the drug for less than 72 hours. The sensitivity of the ductus to extended indomethacin tocolysis increases with advancing gestational age. For this reason, it is recommended that indomethacin not be used beyond 31 weeks of gestation. In the present case the gestational age of the patient was 27 weeks and the period of indomethacin exposure was only 16 hours. Our observations of pulmonary hypertension in this case suggest that administration of indomethacin even hours before delivery can significantly affect the ductus arteriosus and the pulmonary vasculature. [ABSTRACT FROM AUTHOR]

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

Aim: To investigate the effects of delayed cord clamping (DCC) on peripheral hematopoietic progenitor cells (HPCs) and hematological parameters in premature infants (<32 weeks) during the neonatal period. Methods: This was a prospective, randomized, and controlled, single-center study. Prior to delivery, 21 infants were randomly assigned to immediate cord clamping (ICC) at 5-10 s and 21 infants to DCC at 30-45 s. One milliliter blood sample was taken in the first 30 min of life. HPCs were measured by three-color flow cytometry using monoclonal antibodies. Results: There were no significant differences between groups in either maternal or neonatal demographics. All HPC counts were higher in the ICC group, but the difference was not significant. CD34+ cell counts were 45.3±36.6/μL in the ICC and 33.2±26.6/μL in the DCC group (P=0.33); multi-potent progenitor cell counts were 43.2±35/μL in the ICC and 31.1±26.6/μL in the DCC group (P=0.28); and hematopoietic stem cell counts were 2.1±2.1/μL in the ICC and 2.1±3.1/μL in the DCC group (P=0.66). Conclusion: Contrary to our expectation, all HPC counts were lower in the DCC group. [ABSTRACT FROM AUTHOR]

Vitamin D plays a central role in calcium and phosphate homeostasis, and it is essential for the proper development and maintenance of bone. Recent studies show that vitamin D is effective for different tissue functions in addition to bone metabolism. The study group was comprised of 101 healthy newborn infants with a gestational age of 38 weeks or more. Umbilical cord 25 (OH) D levels were measured. Newborns were divided into two groups according to the 25(OH) D levels (<12 ng/ml and >12 ng/ml). Thirty-one percent of these newborn infants had severe deficiency. There were no differences between the groups according to the mother's education, clothing style, home condition, profession, gestational age, vitamin D supplementation, newborn's gender, and birth weight. [ABSTRACT FROM AUTHOR]

A recently isolated peptide hormone, hepcidin, is thought to be the principal regulator of iron homeostasis. Hepcidin acts by limiting intestinal iron absorption and promoting iron retention in reticuloendothelial cells. Its precursor peptide form is called pro-hepcidin. The aims of this study were to determine serum pro-hepcidin levels in healthy preterm and term newborns, and to assess possible relationships between pro-hepcidin and serum iron, serum ferritin, and transferrin. A serum sample was collected from each of 26 healthy preterm (gestational age [ABSTRACT FROM AUTHOR]

Summary This study investigated bilirubin levels in 282 1-month-old, healthy, term infants from the Adana region in southern Turkey. Total bilirubin was >5 mg/dl in 20.2% of the infants and >10 mg/dl in 6% of the group. Thyroid function and levels of alanine aminotransferase, aspartate aminotransferase and glucose6-phosphate dehydrogenase were determined in babies with bilirubin levels >5 mg/dl. The results were normal in all but one case, an infant with a bilirubin level of >10 mg/dl and glucose-6-phosphate dehydrogenase deficiency. The results indicate that in this population a 5-mg/dl cut-off level for further investigation would mean that 20% of all infants would require further evaluation. This is not cost-effective. Based on our findings, we suggest that the cut-off level for investigating prolonged jaundice in term, 1-month-old, healthy infants in the Turkish population should be >5 mg/dl. [ABSTRACT FROM AUTHOR]

This article presents the case of a female newborn with irritability, increased tonus, jitteriness, and eating difficulties who was referred to our institution. Her mother had been taking fluoxetine (20 mg daily) during the second and third trimesters of her pregnancy. The infant's signs began on the first day after birth and persisted for 6 weeks. Extensive investigations excluded infective, genetic, and metabolic causes, and a provisional diagnosis of fluoxetine withdrawal was made. There have been few reports of neonatal complications following maternal fluoxetine hydrochloride treatment. According to these, signs occurred within a few days after birth and lasted up to 4 weeks. To our knowledge, our patient demonstrated the longest duration of signs reported to date. We recommend that physicians be aware of these complications in newborns after fetal exposure in utero to selective serotonin reuptake inhibitors. These neonates should be followed-up closely for adverse signs during the first days of life so that signs can be recognized and treated if necessary. [ABSTRACT FROM AUTHOR]

Objective: Early neonatal sepsis and respiratory distress syndrome lead to neonatal mortality in preterm infants during the first days of life. The objectives of this study were to identify whether spot urine albumin/creatinine ratio is an early diagnostic indicator of early neonatal sepsis and respiratory distress syndrome in preterm infants. Material and Methods: This was a prospective longitudinal analysis of 126 preterm infants born at less than 34 weeks of gestation. In this study, we evaluated serum concentrations of albumin, creatinine, C-reactive protein (CRP) and spot urine albumin/creatinine ratio on the first, third and seventh day of life. We also investigated the association of these parameters with early neonatal sepsis and respiratory distress syndrome in preterm infants during the first days of life. Results: There was a statistically significant difference between spot urine albumin/creatinine ratio and early neonatal sepsis group in the first and seventh day of life (p=0.01). Urinary albumin/creatinine ratios were not statistically significant in the respiratory distress syndrome group. Serum albumin concentrations and spot urine albumin/creatinine ratio were not correlated during the first days of life. There was also no relationship between gestational age, birth weight and spot urine albumin/creatinine ratio during the first days of life. Conclusion: Our results suggest that spot urine albumin/creatinine ratio during the early postnatal period can identify early neonatal sepsis in preterm infants. [ABSTRACT FROM AUTHOR]

Highlights • To date there have only few methods available for assessing Moro response objectively. • This study differs from other studies from the new application that measures Moro response and latency interval with video monitorization and accelerometer. • We believe that the evaluation of Moro reflex with an objective method may be a guide for early diagnosis of neurodevelopmental disorders and also may prevent long term complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze maternal and neonatal interleukin 6 (IL-6) (-174 G/C) polymorphism and to determine effect on preterm birth and neonatal morbidity.Study Design: One hundred and sixty-four mothers (100 term births, 64 preterm births) and 183 newborn infants who were 100 healthy term and 83 preterm babies followed in newborn intensive care units were evaluated. PCR-RFLP was performed for IL-6 (-174 G/C) genotyping.Results: The rate of GG genotype in mothers of term and preterm infants were 54% (n = 54/100), 75% (n = 48/64), respectively (p > .05) and the rate of GC + CC genotype was 46% (n = 46/100) and 25% (n = 16/64) in mothers giving term and preterm birth (PTB), respectively (p < .05). Additionally, the rate of GG genotype was 65% (n = 65/100) and 81.9% (n = 68/83) in term infants and preterm infants, respectively. GC + CC genotype was 35% (n = 35/100) in term infants and 18.1% (n = 15/83) in preterm infants (p < .05). The effect of IL-6 (-174) GC + CC genotype on PTB was statistically significant.Conclusion: The IL-6 174 G/C gene polymorphism was significantly different between mothers who were giving to term and preterm birth. The presence of polymorphism is protective against preterm birth and was not associated with neonatal outcome. [ABSTRACT FROM AUTHOR]

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

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

Describes the cases of five babies who presented with severe hyperbilirubinemia in the first two weeks of life and were diagnosed with congenital hypothyroidism. Serum concentrations of thyroxine and thyrotropin; Symptoms of hypothyroidism.

Attachment is defined as the emotional tie that a baby forms between itself and those who care for it, in order to keep an adult closer, thereby obtaining safety and security. Infantile colic has been defined as paroxysmal uncontrollable crying in an otherwise healthy infant less than three months of age, with more than three hours of crying per day on more than three days a week and for more than three weeks. We aimed to investigate whether there is a relationship between maternal attachment and infantile colic. The study was carried out at the Başkent University Department of Pediatrics. To evaluate maternal bonding, the Maternal Attachment Inventory was administered to 58 mothers of babies with infantile colic and 60 mothers of babies without infantile colic. The infantile colic rate was higher in female infants and in infants of mothers with a history of problematic pregnancy. In this study, no significant relationship was found between infantile colic and maternal bonding. [ABSTRACT FROM AUTHOR]

Background: Inferior vena cava (IVC) oxygen saturation as an indicator of mixed venous oxygenation may be valuable for understanding postnatal adaptations in newborn infants. It is unknown how this parameter progresses in critically ill premature infants. Aims: To investigate IVC oxygen saturation during the first three days of life in preterm infants with and without patent ductus arteriosus (PDA). Study Design: Case-control study. Methods: Twenty-seven preterm infants were admitted to the Neonatal Intensive Care. Preterm infants with umbilical venous catheterization were included in the study. Six umbilical venous blood gas values were obtained from each infant during the first 72 hours of life. Preterm infants in the study were divided into two groups. Haemodynamically significant PDA was diagnosed by echocardiography in 11 (41%) infants before the 72nd hour of life in the study group and ibuprofen treatment was started, whereas 16 (59%) infants who didn't have haemodynamically significant PDA were included in the control group. Results: In the entire group, the highest value of mean IVC oxygen saturation was 79.9% at the first measurement and the lowest was 64.8% at the 72nd hour. Inferior vena cava oxygen saturations were significantly different between the study and control groups. Posthoc analysis revealed that the first and 36th hour measurements made the difference (p=0.01). Conclusion: Inferior vena cava oxygen saturation was found to be significantly different between preterm infants with and without PDA. Further studies are needed to understand the effect of foetal shunts on venous oxygenation during postnatal adaptation in newborn infants. [ABSTRACT FROM AUTHOR]

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

Patent ductus arteriosus (PDA) may be associated with increased morbidityin premature infants. Diagnosis and treatment of hemodynamically significant ductus arteriosus is important. In this study, we investigated the predictive role of carina angle on chest X-ray in the diagnosis of PDA. Twenty-two premature infants with gestational age of less than 32 weeks were enrolled into this study during the period from October 2009 to June 2010 at the Neonatal Intensive Care Unit of Başkent University Hospital. We compared the carina angle of 10 patients who had hemodynamically significant PDA with 12 patients who had no PDA. Carina angle measurement was repeated after PDA treatment. The hemodynamically significant PDA group had a significantly wider carina angle (94.6±6.0°) compared to the no ductus group(81.1+9.1°; p<0.05). The predictive role of carina angle in the diagnosis of PDA was assessed by receiver operating characteristic (ROC) curve (area under the curve (AUC) =0.096; p=0.001). The cut-off value of carina angle was 91°, with a sensitivity of 83% and specificity of 80%. We observed significant reduction in the carina angle measurement after the treatment(p=0.001). Measurement of carina angle is a quite simple and effective method of assessing PDA. Carina angle may provide information about PDA when echocardiography cannot be done for the diagnosis. [ABSTRACT FROM AUTHOR]

Objective To evaluate the diagnostic potential of resistin in sepsis and to compare results with C-reactive protein (CRP) in infants < 32 weeks of gestation. Study Design A total of 64 infants were prospectively included in the study. Blood samples were collected for basal CRP and resistin within the first hour of life. When sepsis was suspected, samples were collected for CRP and resistin before the treatment was started (pretreatment CRP and resistin). On the third day of sepsis, CRP and resistin levels were measured for evaluating the treatment response (follow-up CRP and followup resistin). Culture-proven septic patients were divided into groups according to early or late-onset sepsis (EOS and LOS) and gram-negative or gram-positive sepsis (GNS and GPS). Results Pretreatment and follow-up resistin levels were significantly higher than basal resistin levels in both EOS and LOS groups (p < 0.01), with a positive correlation with CRP levels. To predict the GNS and GPS area under curve, values of pretreatment CRP and resistin were 0.714 and 0.984, respectively (p = 0.039). Conclusion Resistin had a superior potential to that of CRP in the diagnosis of sepsis in preterm infants. Resistin may be used as an early marker for sepsis in premature infants. [ABSTRACT FROM AUTHOR]

Ecevit A, İnce DA, Hanta D, Kurt A, Harman A, Özkiraz S, Gülcan H, Tarcan A. (Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey). Comparing the complications of ultrasoundguided versus percutaneously inserted central venous catheters in newborn infants in the neonatal intensive care unit. Çocuk Sağlığı ve Hastalıkları Dergisi 2013; 56: 12-19. We compared the complications of ultrasound (US)-guided versus percutaneously inserted central venous catheters in newborn infants in the Neonatal Intensive Care Unit (NICU). We retrospectively reviewed the records of full-term and preterm neonates who needed US-guided and percutaneously inserted central venous catheters (PICCs). They were divided into two groups. Newborn infants in the first group had US-guided catheters, while the second group had PICCs. We compared catheter complications between the two patient groups. Sixty-six patients were enrolled, with 36 patients in Group 1 and 30 patients in Group 2. Mean gestational age was 30.3 weeks in Group 1 and 27.9 weeks in Group 2. Mean birth weight was 1653.72 g in Group 1 and 945.67 g in Group 2. There was a significant difference (p<0.001) between the two groups. Duration of indwelling catheter (mean) was 21.61 days in Group 1 and 8.36 days in Group 2, and there was a significant difference (p<0.001) between the two groups. Catheter-related infection was found in 9 patients in Group 1 and in 1 patient in Group 2. There were no differences between the two groups regarding respiratory arrest in attempts at insertion of catheter and bleeding from catheter. We compared the complications of US-guided central venous catheters and peripherally inserted central venous catheters in newborn infants who were observed in the NICU. This retrospective study showed that US-guided central venous catheters used in high-risk hospitalized patients were associated with a much higher rate of catheter-related bloodstream infections (25% versus 0.3%) than with peripherally inserted central venous catheters. [ABSTRACT FROM AUTHOR]

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

Vitamin D is important for calcium homeostasis, muscle, and bone health. It has also immunomodulatory capacities in vivo and in vitro. Regulatory T cells (Treg) have been found to suppress a number of T cell-mediated immune disorders, including allergic responses and autoimmune diseases. This study aimed to investigate the correlation between 25-hydroxyvitamin D (25(OH)D) levels and the regulatory T cells in cord blood. The study group is comprised of 101 full-term newborn infants. Umbilical cord 25(OH)D levels and number and percentage of T lymphocyte, T helper, and Treg cells were measured. Infants were grouped according to 25-hydroxyvitamin D levels (25(OH)D <12 ng/ml and 25(OH)D >12 ng/ml) (converting factor of 25OHD level into SI unit, 2.6). Severe vitamin D deficiency (25(OH)D <12 ng/ml) was observed in 32% of the infants. There was no significant correlation between 25-hydroxyvitamin D levels and T cell number and percentages. There were also no significant differences in white blood cell, total lymphocyte count, T helper, and Treg cell percentage and number between groups. These results suggest that the serum level of 25-hydroxyvitamin D is not crucially involved in the correlation between vitamin D status and T cell regulation in cord blood. [ABSTRACT FROM AUTHOR]

Acid-base disturbances have been usually evaluated with the traditional Henderson-Hasselbach method and Stewart's physiochemical approach by quantifying anions of tissue acids (TA). It is hypothesized that an increase in tissue acids during metabolic acidosis would cause a compensatory decrease in the plasma chloride (Cl) relative to sodium (Cl-Na ratio) in order to preserve electroneutral balance. Therefore, we aimed to investigate the use of Cl-Na ratio as a bedside tool to evaluate the identifying raised TA in neonates as an alternative to complex calculations of Stewart's physiochemical approach. This retrospective study was conducted between January 2008 and December 2009. Infants were included in the study when blood gas analysis reveals a metabolic acidosis; pH <7.25 and sHCO concentration was <22 mEq/L. The Cl-Na ratio, sodium-chloride difference (Diff), anion gap (AG), albumin-corrected AG (AG), strong ion difference (SID), unmeasured anions (UMA), and TA were calculated at each episode of metabolic acidosis. A total of 105 metabolic acidosis episodes occurred in 59 infants during follow-up. Hypochloremic metabolic acidosis occurred in 17 (16%) of samples, and all had increased TA. The dominant component of TA was UMA rather than lactate. There was a negative correlation between the Cl-Na ratio and SID, AG, UMA, and TA. Also, there was a positive correlation between Diff and SID, AG, UMA, and TA. Base deficit and actual bicarbonate performed poorly in identifying the TA. In conclusion, our study suggested that Diff and Cl-Na ratio are simple and fast, and may be an alternative method to complex Stewart's physiochemical approach in identifying raised UMA and TA in critically ill neonates. [ABSTRACT FROM AUTHOR]

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

Objective: To discuss the relationship between fetal hyperechogenic bowel, absence of end diastolic flow in umbilical artery with Doppler ultrasound and necrotizing enterocolitis in extremely low birth weight and intrauterine growth restriction infants during early neonatal period. Case: We presented 3 cases with intrauterine growth restricted, extremely-low-birth-weight who had absence of end diastolic flow in umbilical artery and hyperechogenic bowel before delivery and developed necrotizing enterocolitis during the early postnatal period. Conclusion: Hyperechogenic bowel in cases with severe intrauterine growth restriction can be an important finding along with absent or reversed end diastolic flow to make a necrotizing enterocolitis in early neonatal period. [ABSTRACT FROM AUTHOR]

Objective: Intrahepatic cholestasis of pregnancy is a clinical syndrome, characterized by maternal pruritus and biochemical cholestasis. Epidemiologic surveys show significant regional differences in the incidence of intrahepatic cholestasis of pregnancy. In this study, we evaluated the frequency of intrahepatic cholestasis of pregnancy and perinatal/neonatal outcomes in our hospital. Methods: Twenty patients with intrahepatic cholestasis of pregnancy and their 22 newborn babies (3 twins), and one intrauterine exitus with unknown etiology were included in this retrospective analysis. Ursodeoxycholic acid was given to 50%of intrahepatic cholestasis of pregnancy patients. Fifteen (65.2%) of the newborn babies were ⩽37 weeks. Eight (34.7%) of newborns had transient respiratory support, 2 with continuous positive airway prssure. None of the babies had diagnosed respiratory distress syndrome, thus none of them required surfactant. One case of intrauterine exitus has occured with unknown etiology. Results: We conducted a retrospective study about frequency and perinatal outcome of pregnancies complicated by intrahepatic cholestasis of pregnancy between June 2007-August 2010 at Baskent University Ankara Hospital. Perinatal/neonatal outcomes were retrospectively studied by medical chart review. Conclusion: In our study intrahepatic cholestasis of pregnancy was present in 1.4% of pregnancies, that was similar to the European population. Increased risk of preterm delivery and respiratory distress syndrome were reported in literature, in our study group, none of the babies had RDS or other serious neonatal complications of preterm labor despite high rate of preterm birth rate and rather high levels of maternal serum bile acid levels. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is a multifactorial disease of preterm infants that is characterized by airway injury, inflammation, and parenchymal remodeling. Extravascular fibrin deposits in septae and alveoli due to the altered fibrin turnover are the pathological hallmarks of BPD that strongly indicates the importance of the imbalance in the competing activities of coagulation and fibrinolysis. Activation of the coagulation cascade leads to intraalveolar fibrin deposition in many inflammatory pulmonary disorders. Increased fibrin formation or decreased fibrinolysis may cause extravascular fibrin deposition. We evaluated the association between FXIII-Val34Leu, FVII-323 del/ins, and transforming growth factor β1 ( TGF-β 1) (915G/T) gene polymorphisms in patients with BPD. The study group consisted of 98 preterm infants with BPD. Ninety-four of the 192 preterm neonates were without BPD and sampled for the control group. Restriction fragment size analyses were performed by examining digested PCR products for FXIII-Val34Leu, FVII-323 del/ins, and TGF-β 1 (915G/C) genotypes. No significant associations were found between FXIII-Val34Leu, FVII-323 del/ins, TGF-β 1 (915G/C) gene polymorphisms and BPD phenotype in our population. Further studies with other genes are required for the identification of molecular predisposing factors for BPD that may help in the development of new treatments and hence might allow for targeting of this treatment to a “high-risk” subgroup, reducing unnecessary exposure to potentially harmful therapies. [ABSTRACT FROM AUTHOR]

The goal of this study was to determine whether there was an association between perinatal risk factors of prematurity and vestibular evoked myogenic potentials (VEMPs). A prospective case-control trial was designed. Fifty preterm newborns (100 ears) with a gestational age <37 weeks were included. The control group consisted of 20 healthy term infants (40 ears). VEMP recordings were performed, and mean latencies of p13 were calculated in all study subjects. Multivariable logistic regression was used to investigate the influence of perinatal variables on abnormal VEMP responses. VEMPs were elicited in all term infants (40 ears). In preterm infants, the responses were normal in 71 ears, delayed in 24 and absent in 5. There was a significant difference between abnormal VEMP rates for preterm and term infants (p < 0.001). Asphyxia (OR = 13.985, p = 0.048) and time of VEMP test (OR = 0.865, p = 0.038) were related to abnormal VEMP responses. There was no association between delayed VEMPs and gestational age, birth weight, hemoglobin and bilirubin levels, phototherapy, intracranial hemorrhage, convulsions, sepsis, ototoxic drugs, transfusion, mechanical ventilation, retinopathy of prematurity, bronchopulmonary dysplasia and respiratory distress syndrome. These results suggest a delay in the maturation of VEMPs in premature infants. Asphyxia was the most important risk factor for abnormal VEMP responses in preterm infants. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Summary: Objective: Auditory and vestibular functions have critical importance in infancy because they may affect motor and mental development. We aimed to determine the normal values of the vestibular evoked myogenic potential (VEMP) parameters to provide a reference for further research regarding the early diagnosis of vestibular dysfunction in newborns. Methods: Twenty-four term newborns (12 girls, 12 boys), with birth weights greater than 2500g and Apgar scores higher than 7 at 1min, were studied. Tympanometry, auditory-evoked brainstem responses, transient-evoked otoacoustic emissions, and VEMP recordings were assessed in all subjects during fourth week after birth. Results: All newborns passed the audiologic evaluation, and biphasic waveforms of the VEMP were obtained in all 48 tested ears. Mean latencies of p13, n23, and p13–n23 intervals were 13.7±1.1, 20.5±1.6, and 7.1±2.1ms, respectively. The mean amplitude value was 22.6±18.4μV. There were no significant differences in latency values or amplitudes with regard to sex or side of ear tested in newborns. Conclusions: VEMP may easily be used for early evaluation of vestibular dysfunction in newborns. Because results may differ owing to test techniques and age, every laboratory should have its own normal values. [Copyright &y& Elsevier]

This study was undertaken to determine the frequency and investigate the etiology of extreme hyperbilirubinemia (total serum bilirubin [TSB] ≥25 mg/dL [428 μmol/L]) in newborns admitted to a neonatal intensive care unit in southern Turkey. The charts of 93 term and near-term infants admitted with TSB levels of 25 mg/dL (428 μmol/L) or greater in the first 30 days after birth were retrospectively reviewed. During the 4.5-year study period, 774 infants were admitted to our unit with neonatal jaundice. Ninety-three (12%) of these infants had TSB levels of 25 mg/dL (428 μmol/L) or greater. The mean TSB level in the 93 cases was 30.1 ± 5.7 mg/dL (514.7 ± 97.5 μmol/L), and the peak levels ranged from 25.0 to 57.4 mg/dL (428–981.5 μmol/L). Thirty-three (35.5%) of the 93 babies had TSB levels of 30 mg/dL (513 μmol/L) or greater. Eighty-nine of 93 infants were being exclusively breast-fed. Nineteen babies were isoimmunized, 7 were bacteremic, 2 of the 39 babies tested for glucose-6-phosphate dehydrogenase had this enzyme deficiency, and 1 of the 71 infants tested for thyroid function had hypothyroidism. No cause for extreme hyperbilirubinemia was found in 61 (65.6%) cases. [ABSTRACT FROM AUTHOR]

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

Langerhans cell histiocytosis is characterized by a clonal proliferation of activated Langerhans cells. Langerhans cell histiocytosis can be localized (congenital self-healing reticulohistiocytosis-CSHR) or associated with dissemination and organ dysfunction. Absence of extracutaneous involvement as well as spontaneous resolution are essential for a definitive diagnosis of CSHR. Spontaneous resolution of the lesions does not preclude the possibility of relapse, either in the skin or at extracutaneous sites. Relapses involving the skin, mucosa, bone, and pituitary have been reported. Here we present a CSHR case who has atachycardia attack due to atrioventricular disassociation on following visits. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis is characterized by a clonal proliferation of activated Langerhans cells. Langerhans cell histiocytosis can be localized (congenital self-healing reticulohistiocytosis-CSHR) or associated with dissemination and organ dysfunction. Absence of extracutaneous involvement as well as spontaneous resolution are essential for a definitive diagnosis of CSHR. Spontaneous resolution of the lesions does not preclude the possibility of relapse, either in the skin or at extracutaneous sites. Relapses involving the skin, mucosa, bone, and pituitary have been reported. Here we present a CSHR case who has atachycardia attack due to atrioventricular disassociation on following visits. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about bilateral posterior subcapsular cataracts after inhaled budesonide therapy for bronchopulmonary dysplasia.

The article presents a case study of a two-day-old male who was born with gallbladder mud and stone. It describes the patient's condition whose mother had used high dose flaxseed oil capsules during pregnancy for seven months. It examines the possible causes of the formation of fetal gallbladder stones including smoking during pregnancy. The patient received phototherapy for indirect hyperbilirubinemia and was discharged from the hospital at 7-days-old without gallstones.