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Purpose: The aim of this article is to investigate the effect of large birth weight (LGA) on adverse neonatal outcomes, especially on the effect of stillbirth. Yet another hypothesis is; Increased adverse neonatal outcomes of infants whose birth weight is close to 90th percentile, but less than 90% (90-80%). In this study, our aim is to investigate and compare the adverse neonatal outcomes of infants whose birth weight is 90-80 percentile and to gain morbidity and mortality rate in our country's literature. Materials and Methods: A total of 7800 births and infant files were examined in a tertiary center within a year. A total of 3 groups were formed. 1) birth weight> 90% (LGA group), 2) birth weight 90-80% 3) birth weight 79-10% (control group). The comparison of maternal and neonatal outcomes between groups was made. Results: A total of 4286 patients met the study criteria; 234 were in the LGA group, 356 in the 80-90 percentile group and 3696 in the control group. Maternal age and cesarean delivery rate were highest in LGA group. The rate of admission to the neonatal unit was much higher than in the control group, similar in the LGA and 80-90 percentile groups. Mechanical ventilation was higher in LGA and 80- 90 percentile groups than in the control group. Neonatal sepsis, RDS and clavicle fracture rates were slightly higher in LGA and 80-90 percentile groups compared to control group, but this difference was not statistically significant. Conclusion: It was found that neonates who are between 80-90 percentiles in terms of birth weight have high morbidity and need for neonatal intensive care. [ABSTRACT FROM AUTHOR]

Palliative care is referred to as 'organization of end-of-life care' and describes a holistic and active care approach for the patient and family with physical, emotional, social and spiritual aspects. Pediatric palliative care has entered the global agenda and its use has started in pediatric hospitals in the 1990s. Pediatric palliative care is now also being used in some children with chronic and life-limiting or threatening conditions in our country. The survival rate of children has increased thanks to medical and technological developments and pediatric palliative care is now used more frequently in practice. The number of neonates requiring palliative care has also increased with decreasing neonatal mortality rates in recent years. Palliative care of the neonate with a life-limiting condition begins at the time of diagnosis, and continues during the child's life, at the moment of death and afterwards. Palliative care consists of the maintenance of an effective and comprehensive approach focusing on the newborn and his/her family. This article discusses the neonatal palliative care approach and the recommendations in practice. [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disease causing gender differentation disorder. 21-Hydroxylase deficiency comprises more than 90% of patients and leads to cortisol deficiency. Cortisol deficiency causes life threatining adrenal failure. The diagnosis could be missed and the disease may cause to death especially in male neonate and girls with virilised severely. After the CAH diagnosis, the management of disease is possible both medical and surgical. Therefore neonatal CAH screening program is performed in many developed countries. Both male and female infant death can be prevented as well as early medical/surgical intervention correct the problems without grow-up. Europe and American Societies of Pediatric Endocrinology recommend the neonatal CAH screening. Because of all these reason neonatal CAH screening is important and necessary in our country that has high prevalence of consanguineous marriage. [ABSTRACT FROM AUTHOR]

Multiple organ failure (MOF) is characterized by deterioration of more than one function from among respiratory, hepatic, renal, hematologic, and cardiac functions after sepsis, trauma, hypoxia, or other causes. This study included 88 newborn infants who had a history of delivery between 24-41 gestational weeks and were diagnosed with culture-positive sepsis at Baskent University Ankara and Adana hospitals from 2007 to 2011. Organ dysfunction, frequency of MOF, and the relation between MOF and causative microorganisms and mortality were investigated. Patients were divided into four groups according to the microorganism isolated in blood cultures. Twenty percent of newborns developed MOF after sepsis with a gram-positive bacterium except coagulase-negative staphylococcus. MOF frequencies were 36.8%, 100% and 20.8% for sepsis with gram-negative bacteria, fungus and coagulase-negative staphylococcus, respectively. Among these infection groups, statistically significant differences were observed between death rates, MOF development, cardiac, liver and hematologic failures, and disseminated intravascular coagulation. Mortality rates were not statistically significantly different between patients with and without MOF. Although sepsis and associated MOF is an important cause of morbidity and mortality during the neonatal period, in this study, MOF was observed most frequently in fungal sepsis, but this was not associated with a high mortality rate. [ABSTRACT FROM AUTHOR]

Objectives: Early diagnosis and treatment is essential in reducing mortality in newborns with pneumothorax. In this study, newborns with a diagnosis of pneumothorax in neonatal intensive care unit of our hospital were evaluated and aimed to increase the awareness of physicians. Methods: 12 cases with pneumothorax were evaluated retrospectively. The gender, birth weight, gestational age, mode of delivery, the presence of underlying disease, pneumothorax localization, implementation of the surfactant and mechanical ventilation and existence or absence of mortality were recorded. Results: During the study, pneumothorax was detected 12 patients. Male/female ratio was 1.4. Eight of the patients had born with cesarean delivery, the mean birth weight of cases was 2623±912 g and, 66.7% of cases were term babies. Pneumothorax was observed in the first week of life in all patients and it occurred spontaneously in 4 patients. The frequency of bilateral pneumothorax was 41.7%. For the treatment, closed tube drainage was performed in 9 patients. The overall mortality rate was 66.7%. Half of the patients who died had congenital anomalies such as diaphragmatic eventration (n=1), hydrocephalus (n=1), encephalocel (n=1), non-immune hydrops fetalis (n=1). Conclusion: Additional congenital anomalies, such as PDAs and persistent pulmonary hypertension were found to be effective on mortality in neonates with pneumothorax. Although, it is a life-threatening condition, the emergency treatment is life saving. Therefore, in patients with risk factors, keeping pneumothorax in mind is also the first step of the treatment. [ABSTRACT FROM AUTHOR]

Aim: With the increase in using assisted reproductive techniques (ART) the pregnancy rates complicated with prematurity and multiple gestation show a significant increase. The aim of the study is to evaluate the neonatal mortality, morbidity and short term prognosis in infants born after ART. Material and Method: Hundred twenty two newborns born after ART and admitted to our Neonatology Clinic between January to December 2007 were included. Patients' hospital records were evaluated retrospectively in terms of perinatal and neonatal medical data including congenital anomalies, neonatal mortality and morbidity related to complication of preterm birth such as chronic lung disease, intracranial hemorrhage, retinopathy of prematurity. The control group included all babies of normal pregnancy admitted to our Clinic in this period. Independent samples t-test and chi-square test were used for statistical analysis. Results: The study group included 123 ART babies. Prematurity rate was 95.6%, congenital anomaly 8.9% and mortality 20.3%. Of those, 90.2% showed a history of multiple pregnancy. In comparison with normal pregnancy, ART babies have lower birth weight, higher mortality and congenital anomaly rates. Conclusions: The pregnancies after ART carry higher risk of multiple pregnancy, low birth weight and congenital abnormality which play a role in increased neonatal mortality and morbidity rate. [ABSTRACT FROM AUTHOR]

Multiple births and related complications have increased with the widespread use of assisted reproductive techniques (ART) in recent years. The aim of this multicenter study of the Turkish Neonatal Society was to evaluate the effects of ART on neonatal morbidity and mortality in Turkey. Between February-December 2006, data from 18 different centers were prospectively collected and analyzed. Of the 6356 newborns recruited in this study, 793 infants (12.5%) were conceived with ART. Eighty-seven percent of the study population was singleton, 10.9% was twin and 1.4% was triplet. Sixty-two percent of the multiples were conceived with ART. Prematurity, multiple births and very low birth weight were more frequent in the ART group. The frequencies of neonatal intensive care unit (NICU) admissions and surfactant and mechanical ventilation along with morbidities such as intraventricular hemorrhage, patent ductus arteriosus, sepsis, and mortality were higher in ART infants. ART-induced pregnancies carry higher risks of neonatal morbidity and mortality. Couples considering ART should be informed about the possible maternal and neonatal risks of ART and multiple gestations. [ABSTRACT FROM AUTHOR]

Objective: This study was carried out to determine the relationship of infant mortality with socio-demographical characteristics and prenatal-natal service utility. Materials and Methods: The case control study was carried out in Konya province in 2007. The infants of whom provincial directorate of health was informed as dead during a year were the case group; the infants who were selected via one-to-one correspondence method, born alive and still live were the control group. Addresses of 541 infants were visited to gain the consent of mothers and information was collected via survey. Besides, infant and child monitoring forms, household determination form of the family, pregnant and puerperal monitoring forms were evaluated. Information about 444 cases and controls in total was gathered except for the ones that could not be reached due to various reasons. Results: Of 444 infants who were dead in a year in Konya province and whose families and records could be reached 57.0% were male, 43.0% female, and 64.4% were dead early neonatal, 7.9% late neonatal and 27.7% post neonatal. Of the mothers of the dead infants 4.1% were at age 18 and under, 14.6% at age 35 and over. Infant mortality was correlated with low birth weight, not paying home visits during pregnancy, 4 and more pregnancies, kin marriage and pregnancy gap being less than 2 years. No relationship between other demographical and fertility characteristics and infant death was determined. Result: It was found out that to develop the number and quality of monitoring in pregnancy, and to hinder consanguineous marriage and extreme fertility may decrease infant mortality. [ABSTRACT FROM AUTHOR]

Objectives: Premature rupture of membranes (PROM) effect neonatal mortality and morbidity. Maternal and perinatal outcomes of women with PROM between 36-42 weeks were examined in this study. Material-Methods: Fourty-two women with PROM between 36-42 weeks were taken into the study. Patients were followed by ultrasound, leukocyte count, erythrocyte sedimentation rate (ESR), presence of fever, C-Reactive Protein (CRP). Patients were delivered vaginally or by C-section after evaluation of maternal and fetal factors. Results: Percentage of PROM between 36-42 weeks was found 38.1 %. Mean age was 28.2 years. More than one cause were detected in etiology. The most frequent causes were; unexpected beginning of labour in 19 (45.2%) cases, breech presentation in 4 (9.5%), twin pregnancy in 3 (7.1%) and infection in 3 (7.1%) cases. Three cases had intrauterine growth retardation, 2 had previous C-section, 2 had fetal abnormality, 1 had polyhydramnios, 1 case with grandmultiparity and 1 had decolman placenta. There wasn't any cause in three cases. Mean delivery week was 37.5 weeks. Delivery was occurred in 12 hours in 22 (52.3%) cases, in 24 hours in 13 (30.9%) and in a week in 7 (16.6%) patients. 28 (%66,6) patients were delivered vaginally. Induction of labour with oxytocin was applied to 16 (%57.1) cases. Fourteen (%33.4) patients were delivered by cesarean section. PROM related any maternal morbidity and mortality weren.t seen .Mean birthweight was 2509 grams. Minimum and maximum birthweight were 1800 g and 4300 g respectively. During spontaneous follow-up one baby was died in utero due to meconium aspiration. The baby was at 39 weeks gestational age and 3700 g. Conclusion: Expectant management in term pregnants having PROM can increase fetal morbidity and mortality. To prevent these, careful follow up of patients during labor and induction of labor without any delay is important. [ABSTRACT FROM AUTHOR]

Acardiac twin is a seldom malformation monocorionic pregnancies with prevalance of 1%. Acardiac twin usually occurs due to abnormal placental vascular anastomosis. This anomally is always lethal for recipient and has high mortality for pump twin. Pump twin is structurely normal but heart failure may develop with cardiomegaly, pericardial and gleural effusion, ascites and polyhidramnios during pregnancy. The optimal management of acardiac twin is controversial. The aim of the surgery is to cut the blood flow to acardiac twin without harming the pump twin. We presented an acardiac ancephalic monocorionic twin case that is diagnosed at 16th weeks of pregnancy and succesful neonatal result with conservative approach. Conservative approaches may be better in the absence of poor prognostic factors. [ABSTRACT FROM AUTHOR]

Premature birth is an important obstetric problem associated with increased perinatal mortality and poor long-term outcomes. Properly-controlled studies have demonstrated no additional benefit of cesarean delivery in low-birthweight infants with vertex presentation. However, hazards of vaginal delivery seem to increase with decreasing birthweight below 1500 g. We do not have sufficient data to recommend cesarean delivery for all cases of preterm breech presentation. Nevertheless, cesarean section might be safer if estimated birthweight is less than 1500 g regardless of fetal presentation. Further investigations are needed on this controversial issue. [ABSTRACT FROM AUTHOR]