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Objective: To identify maternal second and third trimester urine metabolomic biomarkers for the detection of fetal congenital heart defects (CHDs). Study design: This was a prospective study. Metabolomic analysis of randomly collected maternal urine was performed, comparing pregnancies with isolated, non-syndromic CHDs versus unaffected controls. Mass spectrometry (liquid chromatography and direct injection and tandem mass spectrometry, LC-MS-MS) as well as nuclear magnetic resonance spectrometry, ¹H NMR, were used to perform the analyses between 14 0/7 and 37 0/7 weeks gestation. A total of 36 CHD cases and 41 controls were compared. Predictive algorithms using urine markers alone or combined with, clinical and ultrasound (US) (four-chamber view) predictors were developed and compared. Results: A total of 222 metabolites were identified, of which 16 were overlapping between the two platforms. Twenty-three metabolite concentrations were found in significantly altered in CHD gestations on univariate analysis. The concentration of methionine was most significantly altered. A predictive algorithm combining metabolites (histamine, choline, glucose, formate, methionine, and carnitine) plus US four-chamber view achieved an AUC = 0.894; 95% CI, 0814-0.973 with a sensitivity of 83.8% and specificity of 87.8%. Enrichment pathway analysis identified several lipid related pathways that are dysregulated in CHD, including phospholipid biosynthesis, phosphatidylcholine biosynthesis, phosphatidylethanolamine biosynthesis, and fatty acid metabolism. This could be consistent with the increased risk of CHD in diabetic pregnancies. Conclusions: We report a novel, noninvasive approach, based on the analysis of maternal urine for isolated CHD detection. Further, the dysregulation of lipid- and folate metabolism appears to support prior data on the mechanism of CHD. [ABSTRACT FROM AUTHOR]

Objective: Maternal folic acid supplementation has been recommended prior to and during the first trimester of pregnancy to reduce the risk of infant neural tube defects. However, an uncertain relationship between folic acid supplementation during pregnancy and development of childhood asthma exists. Recent data show a methyl donor-rich diet could increase the risk of developing allergic airway disease through DNA methylation and aberrant gene transcription. This study evaluated the effect of folic acid supplementation during pregnancy on airway remodeling and allergic airway disease vulnerability in a mouse asthma model. Methods: BALB/c mice were divided into four groups according to gestational folic acid supplementation and postnatal ovalbumin (OVA) exposure: Group 1 (whole pregnancy folic acid supplementation + OVA-exposed group), Group 2 (first gestational week folic acid supplementation + OVA-exposed group), Group 3 (no folic acid supplementation + OVA-exposed group), and Group 4 (control group). Offspring were sacrificed on day 45 for immunohistological and ultrastructural tests. Results: In OVA challenged groups, folic acid supplementation led to a thicker epithelial and subepithelial smooth muscle layer than in the unsupplemented group. Moreover, folic acid supplementation during whole pregnancy (Group 1) was associated with a thicker epithelial and subepithelial smooth muscle layer than folic acid supplementation during the first week of pregnancy (Group 2), suggesting a duration-response relationship. Electron microscopic imaging revealed that structural changes including the loss of epithelial integrity, thickening of basement membrane, and subepithelial fibrosis were more prominent in the folic acid supplementation groups. Conclusions: This study suggested that maternal folic acid supplementation during pregnancy affects airway remodeling and increases the allergic responses induced by ovalbumin challenge in offspring. In addition, the effect size increased as the duration and cumulative dose increased. [ABSTRACT FROM AUTHOR]

Objective: To investigate Phosphorylated adenosine monophosphate activated protein kinase (AMPK) levels in healthy pregnant women and pregnant women with preeclampsia (PE).Methods: Twenty-eight women with mild-PE, 22 with severe-PE, and 30 normotensive controls were included in this cross-sectional study. The serum AMPK levels of these patients were analyzed. The patients were followed up to delivery.Results: No statistically significant difference was found between the groups for age, gravida, parity, and gestational age at the time the blood samples were obtained (p > .05). No significant difference between the group with mild-PE and the control group was found, while in the severe-PE group, serum AMPK levels were significantly higher relative to both the mild-PE and control groups (p < .001 and p < .001, respectively). No correlation was detected between serum AMPK levels and age, body mass index (BMI), and gestational age at the time the blood samples were collected. A negative correlation was found between AMPK levels and gestational week and birthweight at delivery, while a positive correlation was detected between systolic and diastolic blood pressures and AMPK levels.Conclusions: Serum AMPK was higher in patients with severe-PE compared with healthy pregnant women and patients with PE without severe features so it might be a new biomarker for the prediction of disease and its severity. [ABSTRACT FROM AUTHOR]

Purpose: Ischemia-modified albumin (IMA) is used to determine tissue hypoxia. We aimed to evaluate the serum IMA levels in preterm infants requiring transfusion due to anemia of prematurity, a clinical condition to cause tissue hypoxia.Materials and Methods: This prospective study was performed in Etlik Zubeyde Hanim Hospital, Turkey. Preterm infants with birth weight less than 1500 g and born between 25 and 32 weeks were included during assessment for anemia of prematurity. The transfused infants with anemia of prematurity formed the "transfusion group", the control group consisted of gender, gestational and postnatal age-matched infants without transfusion requirement. Serum samples of control group and pre-transfusion and post-transfusion samples of transfusion group were analyzed for IMA (ABS unit). Serum IMA levels were compared between control group and pre-transfusion samples of transfusion group and were also evaluated for the significance of change after transfusion.Results: Sixty-two infants were included (transfusion group: 31, control group: 31). The pretransfusion serum IMA levels were higher than that of infants in the control group [ABS unit; transfusion group; pre-transfusion: 1.00 (0.76-1.09) and control group: 0.81 (0.52?1.04); p = .03]. Serum IMA levels decreased significantly to 0.79 (0.59-0.95) after transfusion; p = .007. Infants with hematocrit higher than 30% had lower IMA levels [0.69 (0.54-0.96)] than infants with lower hematocrit [0.96 (0.75-1.05)]; p = .002.Conclusions: Clinicians may bear in mind that serum IMA levels could be utilized as a marker in deciding on erythrocyte transfusion in premature anemia. [ABSTRACT FROM AUTHOR]

Background: Periventricular leukomalacia (PVL) is the leading cause of neurocognitive deficits in children with prematurity. We previously hypothesized that surfactant protein D (SPD) with its ability to bind toll-like receptors may have a possible ameliorating effect in PVL. Methods: Three groups were defined as: LPS-administered and postnatal intranasal saline administered group, LPS-administered and postnatal intranasal SPD-treated group, and control group. Twenty-eight offspring rats were reared with their dams until their sacrifice for histological evaluation on day 7. Results: A significant loss of brain weight occurred in the LPS group compared with controls. The postnatal intranasal SPD treatment significantly reduced the number of TUNEL-positive cells in the periventricular white matter as compared with the LPS-treated group. Compared with the control group, LPS injection in the rat brain significantly reduced the MBP-positive staining. Postnatal SPD treatment greatly prevented LPS-stimulated loss of MBP staining. Conclusions: Present study demonstrated a neuroprotective effect of SPD in a rat model of PVL. Our results offer future implications towards increasing our understanding about multifactorial mechanisms underlying periventricular leukomalacia and developing plausible therapeutic strategies in order to prevent neurocognitive deficits in preterm infants. [ABSTRACT FROM PUBLISHER]

Objective: Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants.Methods: Preterm newborns with a gestational age of <32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group.Results: Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own.Conclusion: Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development. [ABSTRACT FROM AUTHOR]

Objective: To determine the serum tenascin-C (TN-C) levels in cases with mild and severe preeclampsia.Methods: Pregnant women were divided into three groups, namely healthy pregnants (Group 1, n = 20), pregnants with mild preeclampsia (Group 2, n = 20) and pregnants with severe preeclampsia (Group 3, n = 20). The groups were formed so as to match each other in terms of gestational week. From each pregnant woman, pre- and post-delivery blood samples were obtained to measure serum TN-C levels. The data were evaluated using the Kruskall-Wallis variance analysis. For the obtained values of p < 0.05, the groups were compared in pairs. A p value of < 0.017 was accepted as significant.Results: In Groups 1, 2 and 3, the prepartum TN-C levels were 5.02 ± 0.4 µg/ml, 12.8 ± 2.9 µg/ml and 33.8 ± 11.7 µg/ml, and in the postpartum TN-C levels were 4.7 ± 0.1 µg/ml, 11.7 ± 1.8 µg/ml and 50.6 ± 33.8 µg/ml, respectively. There was a significant difference between the groups in terms of the prepartum and postpartum TN-C levels (p < 0.017, Mann-Whitney U [MWU] test). There was also a significant difference in the prepartum TN-C levels between Groups 2 and 3 (p < 0.017, MWU test).Conclusions: The prepartum and postpartum TN-C levels were significantly higher in mild and severe preeclampsia than those in healthy pregnants. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to determine the neurodevelopmental outcome at 18–24 months’ of corrected age (CA) in preterm infants with severe intraventricular hemorrhage (IVH). Methods: This was a retrospective cohort study of all preterm infants who were <37 weeks’ gestation, had Grade 3–4 IVH, were admitted between January 2009 and December 2010 and discharged. The cohort was divided into three groups. Group 1 was defined as infants born with a birth weight (BW) less than 1000 g, group 2 was defined as infants born with a BW between 1000 and 1500 g and group 3 was defined as infants born with a BW between 1501 and 2500 g. Severe IVH was defined as the presence of grade 3–4 IVH on cranial ultrasound. Cranial ultrasound was performed in the first week of life and subsequently at weekly intervals by a radiologist. A comprehensive assessment including hearing, vision, neurological and developmental evaluation with Bayley Scales of Infant Development, Second edition was performed by the experienced researchers at 18–24 months’ CA. Neurodevelopmental impairment (NDI) was defined as at the presence of one or more of the following: cerebral palsy; Mental Developmental Index score lower than 70; Psychomotor Developmental Index score lower than 70; bilateral hearing impairment; or bilateral blindness. Results: From January 2009 to December 2010, a total of 138 infants were diagnosed as severe IVH (grade 3–4). Of them, 74 (71.1%) infants (group 1 = 31, group 2 = 29 and group 3 = 14 infants) completed the follow-up visit and evaluated at 18–24 months’ CA. Median Apgar score (p < 0.01) and resuscitation at birth (p < 0.01) were significantly different for groups 1–3. The use of catheterization, need for mechanical ventilation, need for phototherapy, retinopathy of premature and bronchopulmonary dysplasia were significantly higher in group 1 compared to groups 2 and 3 (p < 0.001,p < 0.001,p < 0.01,p < 0.01 andp = 0.014, respectively). The duration of hospitalization and mortality rates consistent with the degree of prematurity were significantly higher in group 1 compared to groups 2 and 3 (p = 0.03 andp = 0.01). Among the long-term outcomes, the rates of CP and NDI did not differ between the groups (p = 0.68 andp = 0.068). Conclusion: Our results demonstrated that long-term outcomes of preterm infants did not differ between the groups classified according to the BW at two years of age. This has leaded to the conclusion that severe IVH is alone represents a significant risk factor for poor neurodevelopmental outcome in this already high-risk population. [ABSTRACT FROM PUBLISHER]

Objective: The aim of this study was to compare the efficacy of orally administeredLactobacillus reuteri (L. reuteri)versus nystatin in prevention of fungal colonization and invasive candidiasis in very low birth weight infants. Methods: A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1500 g. Patients were randomized into two groups, to receiveL. reuterior nystatin. Skin and stool cultures were performed once a week for colonization and blood cultures for invasive infections. The trial was registered to ClinicalTrials.gov under identifier NCT01531192. Results: A total of 300 preterm infants were enrolled (n = 150, for each group). Gastrointestinal colonization and skin colonization rates were not significantly different between the groups (18.7% versus 16%,p = 0.54 and 14% versus 12%,p = 0.6, respectively). Invasive candidiasis was detected in two patients of the probiotic group and one patient of the antifungal group. Proven sepsis, feeding intolerance, and duration of hospitalization were significantly lower in the probiotics group than in the antifungal group. Conclusions: ProphylacticL. reuterisupplementation is as effective as nystatin, and more effective in reducing the incidence of proven sepsis in addition to its favorable effect on feeding intolerance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of dopamine on thyroid hormone tests and prolactin (PRL) and to assess requirement for L-thyroxin (LT4). Methods: The infants ( n = 102) were divided into three groups (Group 1; received no dopamine, Group 2 received ≤25 mg/kg cumulative dose and Group 3; received >25 mg/kg cumulative dose). Blood samples were taken at 6-8 days (timepoint 1), 13-15 days (timepoint 2), and 4-6 weeks of life (timepoint 3). Results: Respiratory distress syndrome was higher in group 2 and 3. Patnet ductus arteriosus was higher in group 3 than in groups 1 and 2. Duration and cumulative dose in group 3 were higher than group 2. There was no difference between thyroid hormones that were taken after stopping infusion at timepoint 3 among all groups. No therapy with LT4 was needed. PRL levels were higher at timepoint 1 in group 1 than compared to group 2 and 3 ( p < 0.05), and no difference between group 2 and 3 ( p > 0.05). This difference was disappeared at following timepoints. Conclusions: The release of TSH, FT3, FT4 and PRL were not inhibited and prophylactic thyroid hormone treatment was not required in VLBW infants receiving dopamine infusions. [ABSTRACT FROM AUTHOR]

Background: Spontaneous intestinal perforation (SIP) is an important surgical emergency in preterm infants. Aims: To evaluate the effect of maternal preeclampsia on development of SIP in premature infants. Study design: Retrospective observational study in a large tertiary neonatal intensive care unit. Subjects: The preterm infants of ⩽32 weeks of gestational age and birthweight ⩽1500g who were hospitalized were enrolled. Outcome measures: The primary outcome was to determine the association between preeclampsia and SIP. Results: A total of 22 infants had SIP diagnosis. The incidence of SIP in infants born to preeclamptic mothers (6.2%) was significantly higher compared with those born to normotensive mothers (0.2%). In multinominal logistic regression model, preeclampsia was found to be an independent risk factor of SIP with an odds ratio of 13.5 (95% confidence interval 2.82-65.1). Conclusions: Maternal preeclampsia seemed to be an independent risk factor for development of SIP in premature infants. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of delivery type on macronutrient content of colostral milk. Materials and methods: The study was conducted at Zekai Tahir Burak Maternity Teaching Hospital. Colostral milk samples from term lactating mothers who gave birth by vaginal or cesarean delivery (CD) were obtained on the 2nd postpartum day. Milk protein, fat, carbohydrate (CHO) and energy levels were measured by using a mid-infrared human milk analyzer. Results: A total of 204 term lactating mothers were recruited to the study; 111 mothers gave birth by vaginal route and 93 mothers by CD. Protein levels were statistically lower in colostral milk of mothers after CD compared to mothers who delivered vaginally (median 2.4 (range 0.3-6.4) g/dl versus 3 (0.5-6.3) g/dl, respectively; p = 0.036). Colostral fat, CHO and energy levels were similar between groups. In linear regression analysis, CD and maternal age were independently associated with lower protein content in colostrum. Conclusion: Vaginal delivery is associated with higher colostrum protein content. Hormonal activity induced by labor pain and uterine contractions might account for the alterations in the protein composition of human milk to facilitate optimal development of important physiologic functions in newborns. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether serum folic receptor α levels are changed in women whose previous pregnancies were complicated with neural tube defects (NTDs). Methods: This was a case-control study that included 41 women as the control group who had previously had at least one healthy pregnancy and 37 women as the study group who had a previous pregnancy complicated with NTDs. Blood samples were obtained from all of the participants six weeks after the termination of pregnancy or delivery of a baby. Serum folate receptor α concentrations were analyzed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Results: The mean concentrations of serum folate receptor α were significantly lower in the NTD cases compared to those in the control group ( p = 0.02). There was no significant difference in mean serum folate titers between the NTD cases and the control group ( p = 0.07). Conclusion: Low serum folic acid receptor α levels in the current study did not appear to be a regulatory marker of maternal folate homeostasis per se but rather a factor that contributed to the development of NTDs. [ABSTRACT FROM AUTHOR]

Background and objectives: Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants. Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III-IV) were analyzed. Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA ( n = 145) and without histological CA ( n = 136). Mean gestational age was 28.8 ± 2.6 weeks and 29.1 ± 2.5 weeks, and mean birth weight was 1138 ± 350 g and 1210 ± 299 g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis ( p = 0.007), PDA ( p = 0.003), IVH ( p = 0.03), and death ( p = 0.04). Conclusion: Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine whether inherited thrombophilia affects components of first trimester combined aneuploidy screening test. Method: A case-control study was performed between January 1st and December 31st 2011, at a tertiary referral hospital. Singleton pregnancies with inherited thrombophilia that underwent first trimester (11-13+6 week) combined aneuploidy screening test were included in the study. Pregnancy associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (fbHCG) and fetal nuchal translucency (NT) were compared between the study group and controls. Results: Within the study period, 15 881 women with singleton pregnancies had a combined first trimester aneuploidy screening test at our institution. Among these, 207 women met the inclusion criteria. A control group that comprised 625 women with similar gestational age was generated, using a 1:3 ratio. PAPP-A levels were significantly higher, whereas fbHCG levels and fetal NT measurements were lower in women with inherited thrombophilia ( p < 0.001). Conclusion: Our study suggested that PAPP-A, free b-HCG and NT MoM levels display alterations in women with inherited thrombophilia. Future trials are needed to assess the need for readjustment of risk in these patients. [ABSTRACT FROM AUTHOR]

Background: Hemodynamically significant patent ductus arteriosus (PDA) is a common problem in preterm infants which often causes significant morbidities. Although PDA induces alterations in various tissue perfusion, there is scarce information about the effect of oral ibuprofen on hemodynamics of regional tissues. Objective: To investigate, using near-infrared spectroscopy, the effect of oral ibuprofen on renal and mesenteric tissue oxygenation and oxygen extraction in preterm infants with a diagnosis of hemodynamically significant PDA. Patients and methods: Fifteen infants (gestational age <32 weeks) with the diagnosis of hemodynamically significant PDA treated with oral ibuprofen were monitored for near-infrared spectroscopy - determined renal and mesenteric oxygenation. The infants with PDA were matched for gestational age, postnatal age with infants without PDA, who served as control subjects. Results: In infants with PDA, mean arterial blood pressure was significantly lower compared with the control infants [39.3 (range:36-54) versus 51 (range:43-66) mmHg, respectively; p < 0.001)]. There were no significant differences in regional oxygen saturation and fractional oxygen extraction of renal and mesenteric tissues in PDA and control infants ( p > 0.05). And ibuprofen treatment did not negatively influence renal and mesenteric oxygenation and extraction in infants with PDA ( p > 0.05). Conclusion: Renal and mesenteric tissue oxygenation and oxygen extraction were preserved in preterm infants with a diagnosis of hemodynamically significant PDA treated with oral ibuprofen. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of oral clarithromycin versus placebo treatment in preventing feeding intolerance in very low birth weight (VLBW) infants. Study Design: A prospective, randomised controlled trial in which two groups of preterm infants (birth weight <1500 g) were randomised to clarithromycin (7.5 mg/kg/dose every 12 h) or placebo treatment. During the period, 38 infants, whose parents accepted participation, were enrolled in the study. Feeding intolerance and time to achieve full enteral feeding were considered as primary outcome measures. Results: Feeding intolerance was significantly longer in placebo than clarithromycin ( p = 0.031). Time to achieve full feeding after beginning the treatment was equal among the groups. Conclusion: This is the first randomised controlled study of clarithromycin and placebo treatment that compares the improvement of feeding intolerance in VLBW infants. Our findings indicate a dramatic improvement in feeding intolerance after oral clarithromycin treatment. But according to our results, clarithromycin-treated infants were not able to attain full enteral feeding more quickly than placebo. This may be due to prophylactic usage of clarithromycin. Significant differences might have resulted if only infants who had feeding intolerance were recruited. [ABSTRACT FROM AUTHOR]

The aim of the present study was to characterize the pharmacokinetic profile of oral ibuprofen on consecutive 3 d by trough serum levels, and if possible to define a cut-off level for ductal closure in preterm infants. The study enrolled 20 preterm infants with gestational age ≤30 weeks, birth weight <1250 g and hemodynamically significant patent ductus arteriosus (hsPDA). Patients received oral ibuprofen at an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. Patients were compared for serum ibuprofen levels in addition to their demographic and clinical data in case of their response to the treatment. hsPDA closed in 16 (80%) of the patients. Although mean ibuprofen levels on consecutive 3 d showed a plateau in general, ibuprofen serum levels on the first treatment day were statistically low in patients with unclosed hsPDA ( p = 0.003). The optimal cut-off value for serum ibuprofen level on the first treatment day was measured as 5.5 mg/l with 100% sensitivity and 93% specificity. Serum ibuprofen level on the first treatment day seems to be an important factor for a successful ductal closure. Target concentration approach by the evaluation of trough level may be applicable to real-time dosing strategy. [ABSTRACT FROM AUTHOR]

Aim: In this study, it is aimed to investigate total oxidant and antioxidant status of newborns and their breast milks. Methods: Totally, 184 infants who were born in our hospital were included in the study. Study group was divided into two main study groups, including term and preterm groups; main study groups were also divided into two sub-groups, AGA and SGA. TOS and TAC levels were measured in cord blood of all newborns and in mother milks. Groups were statistically compared with each other in terms of TOS, TAC and OSI levels. Results: The study included 92 preterm newborns (Group I) and 92 term newborns (Group II). TOS, TAC and OSI levels were found significantly higher in Group I than Group II ( p < 0.0001, p = 0.17, p < 0.0001, respectively). When sub-groups of Group I and Group II, namely TAGA, TSGA and PAGA and PSGA, were compared with each other. TOS and OSI levels were significantly higher and TAC levels were significantly lower in TSGA group relative to TAGA group ( p < 0.0001; p = 0.001; p < 0.0001, respectively). No statistically significant difference was found between Group I and Group II and between sub-groups of Group I and II with regards the TOC, TAC and OSI levels of mother milk. Conclusion: In preterm newborns and term SGA infants, total oxidant stress is increased and antioxidant capacity is low. No significant difference was found between mother milks of preterm and term AGA and SGA infants. [ABSTRACT FROM AUTHOR]

Compared with term infants, late preterm infants are immature physiologically and metabolically, and have higher risks for medical complications such as respiratory distress, hypoglycemia, hyperbilirubinemia, sepsis, feeding difficulty and poor neurodevelopmental outcomes. The incidence of late preterm birth is increasing. We evaluated the clinical and demographic characteristics, short-term outcomes and clinical courses of late preterm infants admitted to our neonatal intensive care unit (NICU). Data from NICU admissions of 605 late preterm and 1477 term infants in the 1-year period between June 2010 and May 2011 were analyzed. There were 2004 late preterm deliveries and 18,854 total deliveries. Of late preterm infants, 30% were admitted to the NICU. The mean gestational age and birth weight were 351/7 weeks and 2352 g, respectively. The admission diagnoses were respiratory distress (46.5%), low birth weight (17.5%), jaundice (13.7%), feeding difficulty (13.1%), polycythemia (8.1%) and hypoglycemia (4%); these morbidity rates were higher than those in term infants ( p < 0.001). The overall mean hospitalization period was 7.5 ± 9.1 days. The respective mortality and rehospitalization rates were 2.1% and 4.4%, which were higher than those for term infants ( p < 0.001). In conclusion, late preterm infants should be followed closely for the complications just after birth, and preventive strategies should be developed. [ABSTRACT FROM AUTHOR]

Objective: To analyze the relationship of obstetric complications and neonatal outcomes with the thrombophilic status of the mother-infant couples in case of demonstrated placental villous thrombosis in histopathological evaluation after delivery. Methods: Placentas of high-risk pregnancies, unexplained fetal loss or infants who needed neonatal intensive care unit (NICU) admission were collected at the time of delivery. Results: In a 6 months period, placental villous thrombosis was detected in 30 among 800 placentas. Half of the mothers had a bad obstetric outcome previously, such as at least one abortus or stillbirth. Eighteen neonates (60%) were premature. Seventy-five percent of the neonates ( n = 24) needed NICU admission and the mortality rate was 9.3 %. Five of the patients had congenital anomalies. Thrombophilic mutations could be evaluated in seven mothers-infant couples, all of whom had at least one positive mutation for thrombosis. Conclusions: Severe fetal vasculopathy appears to be a predisposing factor for adverse neonatal outcomes. Analyzing placentas will yield advantages as the same pathological process may repeat in subsequent pregnancies. Thrombophilic mutations should be evaluated to provide the etiology of the adverse outcome and to give prophylaxis for the future pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of fecal calprotectin in diagnosis and predicting severity of necrotizing enterocolitis (NEC) in preterm infants. Methods: A prospective controlled study was conducted including preterm infants with stage 2 to 3 NEC, and birth weight and gestational age-matched controls. Fecal samples were obtained both at the time of NEC diagnosis and 3-5 days later from the patients, and at similar postnatal age from controls. Results: Twenty-five infants with stage 2 to 3 NEC and 25 controls were enrolled. Median fecal calprotectin concentrations were 1,282 and 365 µg/g at diagnosis in infants with NEC and controls, respectively. Fecal calprotectin levels of infants with NEC were significantly higher than those of the control group both in the first and second samples. Although the fecal calprotectin levels gradually decreased from the time of diagnosis to the second sampling time in stage 2 NEC, in stage 3 NEC fecal calprotectin concentrations increased to a higher level. A fecal calprotectin value of 792 µg/g was found to be 76% sensitive and 92% specific for the diagnosis of definite NEC. Conclusion: Fecal calprotectin increases in infants with NEC and serial measurements may be useful as a noninvasive prognostic marker for progression of disease. [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]

Objective: Our purpose was to reach the reasons of isolated low levels of maternal serum unconjugated estriol (uE3) levels (≤0.3 multiples of the median (MoM)) in the triple-marker screen with special emphasis on maternal diseases and medications used for them. Methods: Single center retrospective cross-sectional analysis. Of 13,367 non-smoking women with identified singleton pregnancies screened for triple test, during 3-year period (2007-2009), a group of women with isolated low serum uE3 levels (≤0.3 MoM) ( n = 14) were selected as the study group. Results: Of these 14 women, no one gave birth with ichthyosis. Five patients had, isolated very low uE3 levels (<0.01 MoM). Of these women, one had umbilical cord knot, one was on corticosteroid and three were on propylthiouracil treatment. So, there was history of maternal drug intake in 28.5% of cases with isolated low uE3 (≤0.3 MoM). This rate increases to 80% in cases with very low uE3 levels (<0.01 MoM). Conclusions: Maternal diseases and medications used during pregnancy can affect fetus and antenatal screening test results. This is important during counseling of patients and to perform the appropriate antenatal and postnatal evaluation of the mother and fetus with multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Objective: To determine total antioxidant capacity and total oxidation status in fresh and freeze stored (at −80°C) breast milk during the stages of lactation. Methods: Samples of colostrum, transitional and mature milk were collected from 44 healthy women at 3, 8 and 30 days after birth. The total milk volume collected (6 ml) was divided in two aliquot parts: 3 ml for the fresh analysis which was done immediately after the extraction and 3 ml for storage under freezing conditions at −80°C for two months. The antioxidant status and oxidative stress of the fresh and stored breast milk were assessed via determination of total antioxidant capacity and total oxidation status. Results: Antioxidant capacity of transitional and mature milk decreased ( p = 0.0001, p = 0.028, respectively); however, antioxidant capacity of colostrum did not change by storage at −80°C ( p > 0.05). Total antioxidant capacity of fresh and stored breast milk significantly decreased during the stages of lactation ( p < 0.0001, p = 0.028, respectively). Total oxidation status showed no significant difference in fresh and stored breast milk during the stages of lactation ( p > 0.05). Conclusion: Freeze storage of breast milk at −80°C for two months seems not to be the optimal condition to preserve the antioxidant capacity of breast milk. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to investigate the possible neuroprotective and ameliorating effects of leptin treatment in hypoxic-ischemic injury induced neuronal cell death. Methods. Experimental groups in the study were: sham-operated group, leptin treated hypoxia-ischemia group, and vehicle treated hypoxia-ischemia group. In hypoxia-ischemia group, left common carotid artery was ligated permanently on the seventh postnatal day. Two hours after the procedure, hypoxia (92%% nitrogen and 8%% oxygen) was applied for 2.5 h. Leptin treatment was injected (intraperitoneally; i.p.) as a single dose immediately after the hypoxia period. Neuronal cell death, neuronal density, and leptin levels were evaluated in both hemispheres 72 h after the hypoxic-ischemic insult. Results. Compared with the hypoxic-ischemia group, the mean leptin levels were higher in the brains of the sham group for both hemispheres. The leptin treatment significantly diminished the number of 'apoptotic cells' in the hippocampal CA1, CA2, CA3, and gyrus dentatus regions in both hemispheres. Leptin treatment significantly preserved the number of neurons in both hemispheres, when compared with the vehicle treated group. Conclusion. We conclude that leptin treatment improves neuronal density and decreases apoptosis in the newborn rat with hypoxic-ischemic brain injury. [ABSTRACT FROM AUTHOR]

Objective. Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Invasive fungal infections are associated with significant morbidity and mortality among preterm infants cared for in the neonatal intensive care unit (NICU). Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the presence of any association between MBL gene polymorphism and nosocomial invasive fungal infection in preterm neonates. Methods. Codon 54 (B allele) polymorphism in exon 1 of the MBL gene was investigated in 31 patients diagnosed as nosocomial invasive fungal infection and 30 control preterm neonates. Results. AB genotype was determined in 26%% and 30%% of patient and control groups, respectively, and the difference was not statistically significant. AA genotype was determined in 74%% of the patient group and in 67%% of the control group, and the difference was not statistically significant. B allele frequency was not different significantly in the patient group (13%%) compared to the control group (18%%). Conclusions. In our study, no relationship was found between MBL codon 54 gene polymorphism and the risk of nosocomial invasive fungal infection in preterm neonates in NICU. [ABSTRACT FROM AUTHOR]

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918--1919 and 1957--1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries. [ABSTRACT FROM AUTHOR]

Objective: In the present study, the effects of povidone iodine (PI) used during Caesarean operations on maternal thyroid hormones and urine iodine levels in the infant and the mother were investigated. Design: Twenty-seven patients were allocated to the PI group I (Gr I), and 28 to the non-PI group (Group II). Maternal preoperative and 24th-h postoperative free T3 (fT3), freeT4 (fT4), TSH, and urine iodine levels were determined, as well as infant urine iodine values. Results: In both groups, fT3 levels before and after the operation were found to be reduced ( p < 0.01, p = 0.01, respectively). However, the decrease in fT3 was approximately 1.5-fold higher in Gr I than in Gr II. TSH levels increased significantly in Gr I ( p = 0.005). The urine iodine levels of the mothers increased 25% in Gr I, but only 2% in Gr II. Conclusions: The absorption of PI by the skin was found to lead to changes in fT3, TSH, and urine iodine excretion values in the mothers. The findings of this study of Caesarean operations, which have a short duration, might be a signal to be careful of thyroid hormone effects in operations lasting longer. [ABSTRACT FROM AUTHOR]

Background and objectives: Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in preterm infants. This case series was conducted to investigate the usefulness of paracetamol as a first choice for the treatment of PDA in preterm infants. Subjects and methods: Preterm infants were prospectively enrolled. Treatment with oral paracetamol was started at a dose of 15 mg/kg every 6 h for 3 d, with echocardiographic evaluation performed at the end of the treatment and 2 d after the treatment. Serum paracetamol levels were also evaluated for 24 h after the first dose to ensure the absorption and reaching the therapeutic level. Results: A total of six preterm infants were prospectively enrolled. Five infants with PDA were successfully treated with oral paracetamol. Only one patient did not respond to paracetamol treatment whereas another one received a second cure due to reopening of the ductus. Conclusion: Paracetamol may be a useful treatment option for the primer treatment of PDA in preterm infants. If paracetamol is shown to be effective in a large series, because of low risk of side effects, low cost and preparation is available in enteral form, it may be an advantageous alternative at PDA treatment. [ABSTRACT FROM AUTHOR]

Objective: Ovarian cysts compose most of the intraabdominal cysts in fetal period. Most of them regress spontaneously at intrauterine or postnatal period. The cysts that are complicated and do not regress are excised generally. Methods: Here we report a case series that consists of four newborns having giant (≥10 cm) ovarian cysts. All of the patients were term infants and followed for ovarian cysts in intrauterine period. Results: Patients were operated on 5, 11, 28, 47th days, respectively. Three patients had unilateral cysts (two right, one left) and one had bilateral cysts. One of the four patients had bilateral ovarian cysts, 100 × 95 mm in diameter on the left and 50 × 55 mm on the right, which was torsioned. Conclusion: The risk of complications is higher in bilateral cysts even they are smaller, and early surgical intervention should be done to these patients. During the operation of one of the patients, we detected the cyst at the opposite side that was shown by ultrasonography. Since the size of the mass is large, detecting the correct origin of the cyst is important for the selection of appropriate surgical approach. [ABSTRACT FROM AUTHOR]

Aim. Although the effect of adolescent pregnancy on perinatal mortality and morbidity is known, data on the neonatal hospitalization rate in these deliveries have not been reported. We aimed to assess the possible effects of adolescent pregnancies on the hospital outcomes of the newborns. Methods. Three hundred adolescent mothers under 17 years of age and their singleton newborns were enrolled in this retrospective study. The major outcomes of the study were the rates of prematurity and intrauterine growth retardation, and the admission rate of newborns to the neonatal intensive care unit. Results. Twenty-nine percent of the newborns were premature, and the intrauterine growth retardation rate was 1%%. Forty-one newborns (13.6%%), of whom 38 (92.6%%) were preterm, were admitted to the neonatal intensive care unit. The admission rate of the study population was higher than the overall newborn neonatal intensive care unit admission rate for our hospital of 9.7%% ( p < 0.05). Conclusion. The rates of prematurity and neonatal intensive care unit admission were higher in adolescent mothers. This study is the first to demonstrate that the high NICU admission rate was related to premature deliveries in this group. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Comparison of Lactobacillus reuteri (L. reuteri) and nystatin prophylaxis on Candida colonization and infection in very low birth weight infants" in the 2015 issue is presented.

A letter to the editor is presented in response to the article "The association of antenatal corticosteroids with neonatal hypoglycemia and hyperbilirubinemia" by K.E. Pettit.