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In this clinical vignette, we describe a case of a patient with windsock-like posterior mitral annulus perforation at the site of annular calcification caused by infective endocarditis. Three-dimensional transesophageal images of the perforation resembling an "alien's mouth" are very striking for how 3-dimensional imaging can improve visualization of anatomy of the heart. (

Thoracic air leak syndromes (TALS) are very rare among the noninfectious pulmonary complications (PCs). They can either be idiopathic or have several risk factors such as allogeneic hematopoietic stem cell transplantation (allo-HSCT), graft versus host disease and rarely pulmonary aspergillosis. We present a 14-year-old girl with hypoplastic myelodysplastic syndrome who developed graft versus host disease on day 60, TALS on day 150, bronchiolitis obliterans syndrome on day 300, pulmonary aspergillosis on day 400 and COVID-19 pneumonia on day 575 after allo-HSCT. This is the first report of a child who developed these subsequent PCs after allo-HSCT. Therefore, the manifestations of these unfamiliar PCs like TALS and COVID-19 pneumonia, and concomitant pulmonary aspergillosis with management options are discussed.

Many factors and technical problems may alter the interpretation of electrocardiograms (ECGs). Infrequently, an artifact is considered to be the cause of ST-segment elevation, especially in asymptomatic patients. An important difference between true ST-segment elevation attributable to myocardial infarction and an artifact is that the baseline elevation in an artifact may begin before or after the onset of the QRS complex. When one encounters an abnormal ECG that exhibits suspicious wave contours and possibly only one completely normal limb lead, the diagnosis of arterial pulse artifact should be considered.

Background: probiotics and prebiotics have strain-specific effects on the host. Synbiotics, a mixture of probiotics and prebiotics, are proposed to have more beneficial effects on the host than either agent has alone. Purpose: we performed a randomized controlled trial to investigate the effect of Lactobacillus and Bifidobacterium together with oligosaccharides and lactoferrin on the development of necrotizing enterocolitis (NEC) or sepsis in very low birth weight neonates. Methods: neonates with a gestational age ≤32 weeks and birth weight ≤1,500 g were enrolled. The study group received a combination of synbiotics and lactoferrin, whereas the control group received 1 mL of distilled water as placebo starting with the first feed until discharge. The outcome measures were the incidence of NEC stage ≥2 or late-onset cultureproven sepsis and NEC stage ≥2 or death. Results: mean birth weight and gestational age of the study (n=104) and the control (n=104) groups were 1,197±235 g vs. 1,151±269 g and 29±1.9 vs. 28±2.2 weeks, respectively (P>0.05). Neither the incidence of NEC stage ≥2 or death, nor the incidence of NEC stage ≥2 or late-onset culture-proven sepsis differed between the study and control groups (5.8% vs. 5.9%, P=1; 26% vs. 21.2%, P=0.51). The only significant difference was the incidence of all stages of NEC (1.9% vs. 10.6%, P=0.019). Conclusion: the combination of synbiotics and lactoferrin did not reduce NEC severity, sepsis, or mortality., NA

The effective use of social media, which has become an indispensable tool for companies due to the advantages it has achieved in reaching the target group, has become an important issue. In this study, the feeds of Twitter users about competitors in the cosmetics, marketplace and electronic sectors and the feeds shared by the companies’ corporate Twitter accounts during February 2018 were analysed using Social Media Mining method. A success ranking was made by evaluating the measurement criteria of Twitter effectiveness consisting of number of tweets, tweet value, follower gain, number of responses, number of retweets and number of likes and it was determined that the most successful company was from cosmetics and the lowest ranked company was from electronic sector. In order to determine tweet value, Sentiment Analysis was carried out and the number of positive tweets was found to be higher for the cosmetics companies., Bu çalışmanın amacı farklı sektörlerde faaliyet gösteren lider rakip firmaların sosyal medya etkinliklerinin ölçülmesidir. Bu kapsamda, 2018 Şubat ayı boyunca Twitter kullanıcılarının kozmetik, pazaryeri ve elektronik sektöründe faaliyet gösteren rakip firmalar hakkında yaptıkları paylaşımlar ve bu firmaların kurumsal Twitter hesaplarından yapmış oldukları paylaşımlar Sosyal Medya Madenciliği yöntemi ile analiz edilmiştir. Firmalar hakkındaki tweet sayısı, tweet değeri (olumlu, olumsuz, nötr), takipçi kazanımı, yanıt sayısı, retweet sayısı ve beğeni sayısı başlıklarından oluşan Twitter etkinliğinin ölçüm kriterleri ele alınarak bir başarı sıralaması yapılmış ve en başarılı firmanın kozmetik, en düşük sıralamaya sahip firmanın ise elektronik sektöründen olduğu tespit edilmiştir. Tweet değerini saptayabilmek için Duygu Analizi gerçekleştirilmiştir ve olumlu tweet oranının kozmetik firmaları için daha fazla olduğu sonucuna ulaşılmıştır.

Veri madenciliği büyük veriden anlamlı bilgi çıkarma sürecidir. Çok yaygın uygulama alanı bulan veri madenciliği tekniği bu çalışmada bir e-ticaret web sitesine uygulanmıştır. Bu çalışmada internet üzerinden alışveriş yapan kişilerin profillerinin elde edilmesi ve hangi e-ticaret sitelerini bir arada kullandıklarının belirlenmesi amaçlanmıştır. Bu amaçla Birliktelik kuralları analizi uygulanmıştır. Destek, güven ve kaldıraç oranları ile hem web sitelerinin hem de tüketicilerin satın alma işlemi gerçekleştirdiği ürün kategorilerinin sıralama işlemleri gerçekleştirilmiştir. Uygulamada R programlama dili kullanılmış, analiz sonuçları Apriori ve Eclat algoritmaları ile elde edilmiştir.

Objective ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. Study Design This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. Results The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p Conclusion In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. Key Points

The birth weight (BW) for gestational age (GA) ensure a fair assessment of the nutritional status of small for gestational (SGA) infants. Ponderal index (PI) is used to identify wasting. This study aims to evaluate the association between PI values and short-term complications of term SGA infants and evaluate the reliability of PI. A total of 489 term SGA infants were included in this retrospective study. According to the PI values, the neonates were divided into three groups. Group 1 consisted of infants with low PI (PI < 10th percentile) (n=45), group 2 consisted of infants with appropriate PI (PI 10th-90th percentile) (n=405) and the ones with high PI (PI> 90th percentile) (n=39) constituted group 3. Demographic and clinical data of the mothers and neonates including clinical and laboratory assessments were collected and compared statistically. No difference was observed between the groups other than the incidence of hypoglycemia, jaundice requiring treatment and hospitalization rate, which were all significantly higher in low PI group than the group 2 and 3 (p=0.01, p=0.006 and p=0.04, respectively). None of the babies had severe morbidity or died.Conclusion: Although short-term complications were higher in term SGA infants with low PI, all term SGA infants should be defined as high-risk neonates and deserve special neonatal care and surveillance to prevent short-term complications.

To evaluate the correlation between total serum and transcutaneous bilirubin and to determine the reliability of transcutaneous bilirubinometry for screening and monitoring of neonatal jaundice among preterms. Ninety nine infants with gestational ages ≤34 weeks were prospectively enrolled. Babies were classified into three groups as; 24–28, 29–31, and 32–34 weeks. Total serum bilirubin and simultaneous transcutaneous bilirubin were measured before the onset of phototheraphy, during and at 24 h after discontinuing phototherapy. Total serum bilirubin significantly correlated with transcutaneous bilirubin in the whole cohort (r = 0.867, p

Bu çalışma, farklı sektörlerde faaliyet gösteren rakip firmaların Twitter verilerini analiz ederek, firmaların Twitter verilerinin firmalara göre anlamlı bir uyum gösterip göstermediğinin tespit edilmesini, firmaların Twitter’da paylaştıkları içeriklerin kümelenmesini ve hangi içerik kümesinin en fazla etkileşime yol açtığının belirlenmesini amaçlamaktadır. Bu kapsamda, 2017 yılı boyunca kozmetik, elektronik ve pazaryeri sektörlerinde faaliyet gösteren rakip firmalar tarafından paylaşılan Twitter verileri, Sosyal Medya Madenciliği süreci izlenerek analiz edilmiştir. Firmaların Twitter verilerinin firmalara göre anlamlı bir uyum gösterip göstermediği Uygunluk Analizi ile tespit edilmiştir. Firmaların Twitter paylaşımları ise Metin Madenciliği ön işleme metotlarından faydalanılarak “Özel Teklif”, “Yarışma & Etkinlik”, “Ürün”, “Sosyal”, “Destek & Geri Bildirim” ve “Özel Etkileşim” kategori başlıklarıyla kümelenmiştir. Firmaların elde ettikleri etkileşimlerin büyük bir çoğunluğunun azınlıktaki paylaşımlardan gelmesi sebebi ile hangi içerik kümesinin en fazla etkileşime yol açtığı Pareto İlkesi yardımı ile belirlenmiştir.

Objective: To determine if near-infrared spectroscopy (NIRS), which is easier to obtain than Doppler ultrasonography (USG), may be used in accordance with Doppler USG to provide additional data for assessment of organ blood flow velocities in preterm infants with hemodynamically significant PDA. Study design: Thirty-one infants who were treated with ibuprofen for closure of PDA were monitored continuously with NIRS. Cerebral, mesenteric, and renal arterial blood flow velocities were measured with Doppler USG before and after the treatment. Results: While cerebral, mesenteric, and renal fractional oxygen extraction (FTOE) measurements decreased significantly (p = .042, p < .001, p < .001, respectively), NIRS measurements (p = .016, p < .001, p < .001, respectively) and mean blood flow velocities (p = .003, p = .011, p = .002, respectively) increased significantly after the treatment. There was a significant correlation between pretreatment cerebral and mesenteric FTOE and resistive index (RI) values (r = 0.45, p = .01, and r = 0.46, p = .01, respectively). However, no correlation was observed between renal FTOE values and renal RI (r = 0.33, p = .06). Posttreatment cerebral, renal, and mesenteric FTOE values correlated positively with corresponding RI (r = 0.41, p = .02; r = 0.39, p = .02; r = 0.65, p < 01; respectively). Pretreatment and posttreatment cerebral, mesenteric, and renal FTOE values and arterial mean velocities were inversely correlated (pretreatment: r = 0.69, p < .01; r = 0.72, p < .01; r = 0.77, p < .01; posttreatment: r = 0.54, p = .01; r = 0.69, p < .01; r = 0.38, p = .01; respectively). Conclusion: As Doppler and NIRS measurements correlated significantly, we concluded that NIRS might be used in monitoring organ blood flow in preterm infants with PDA, which may provide additional data for management of this condition.

Nocardia spp is a gram-positive aerobic filamentous bacteria that causes pulmonary and systemic infections, especially in patients with immunosuppression or chronic lung diseases. It is rarely reported in children with cystic fibrosis. Macrophage activation syndrome is a life-threatening disease with an excessive inflammatory response usually triggered by infections. There are few reports in cystic fibrosis related to macrophage activation syndrome. Herein we report a child with cystic fibrosis who had macrophage activation syndrome due to Nocardia infection.

We aimed to investigate the association between thyroid hormone levels and transient tachypnea of the newborn (TTN) among late-preterm, early-term, and term infants admitted to neonatal intensive care unit (NICU).In the current retrospective study, neonates admitted to the NICU due to TTN were assigned to the TTN group (n = 404). Healthy neonates who were followed up in the well-baby nursery comprised the control group (n = 7335). Infants were grouped by gestational age into late-preterm (34-36Compared to control infants, term neonates with TTN had significantly higher TSH levels, whereas late-preterm and early-term neonates with TTN had significantly lower TInfants admitted to NICU due to TTN had significantly different thyroid hormone levels with differences depending on gestational age.

Adrenal incidentalomas (AIs) are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR), and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em) were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI), and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV) and right ventricular (RV) echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients.

To examine the prokinetic effect of clarithromycin in very low birth weight (VLBW) preterm infants.VLBW preterm infants who have not achieved half of the full enteral feeding in the second week of life were enrolled in the study. The infants enrolled in the study were randomized. Twenty infants received oral clarithromycin (7.5 mg/kg, twice a day) and 20 control infants did not receive any treatment.Full enteral feeding was attained earlier in the clarithromycin group than in the control group [7 (6-9) versus 9 (9-11) days, respectively; p .001]. Duration of parenteral nutrition and number of withheld feeds were significantly lower in the clarithromycin group (p = .013 and p .001, respectively). Parenteral nutrition-associated cholestasis (n = 1 versus 3, p = .1) and length of hospital stay (50 versus 59 median days, p = .1) tend to be lower in the clarithromycin group without any statistical significance. We observed no adverse effect of clarithromycin therapy.Clarithromycin treatment in VLBW preterm infants resulted in better toleration of enteral feeding. Larger randomized controlled trials are needed to establish routine use of clarithromycin in the treatment of feeding intolerance.

Jaundice is one of the most common problems in the newborn. It is generally accepted as a physiologic condition; most cases are benign and transient. However, in a small portion of jaundiced newborn infants, serum bilirubin concentrations increase to a level at which irreversible brain damage can occur. The timely diagnosis and management of severe hyperbilirubinemia is essential to prevent acute bilirubin encephalopathy and kernicterus. Kernicterus still occurs although it is almost always preventable. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy. Therefore, a system-based approach using the recommendations of this guideline should be implemented in all birthing facilities and continued in ambulatory care of the newborn infants. / Sarılık yenidoğan bebeklerde sık görüllen bulgulardan biridir. Normal fizyolojik bir durum olarak kabul edilir; genellikle selim, geçici bir durumdur. Ancak yenidoğanların küçük bir bölümünde geri dönüşümsüz ciddi beyin hasarı için tehdit oluşturabilen düzeylere erişebilir. Zamanında tanı konup tedavi edildiğinde akut bilirubin ensefalopatisi ve kernikterus önlenebilir. Kernikterus her zaman önlenebilir bir durum olmasına rağmen halen görülmektedir. Bu kılavuzun amacı ciddi hiperbilirubinemi sıklığını ve bilirubin ensefalopatisini azaltmaktır. Bundan dolayı bu kılavuzun önerilerinin tüm doğum yapılan kurumlarda ve taburcu etme sonrası izlemde kullanılmasını sağlamak önemlidir., NA

BACKGROUND The aim of this study was to evaluate the relationship between umbilical cord blood interleukin (IL)-6 concentration and preterm morbidity and mortality in premature infants born with fetal inflammatory response syndrome (FIRS). METHODS This prospective, observational study included 84 preterm infants with a gestational age of 24-36 weeks who had been admitted to the neonatal intensive care unit (NICU). FIRS was defined as umbilical cord blood IL-6 > 11 pg/mL. In premature infants with FIRS, morbidities (multiple organ failure [MOF], respiratory distress syndrome [RDS], patent ductus arteriosus, intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity) and death were evaluated. Critical umbilical cord blood IL-6 concentrations for the development of RDS, death, and for MOF were determined in premature infants with FIRS. RESULTS Fifty-two infants with IL-6 concentration > 11 pg/mL constituted the FIRS group. Thirty-two infants without FIRS served as a control group. RDS, MOF, and mortality were significantly higher in the FIRS group (P = 0.001, P = 0.001, and P = 0.005, respectively). Umbilical cord blood IL-6 concentration > 26.7 pg/mL in the FIRS group was found to be predictive of RDS, with 70% sensitivity and 85% specificity. Umbilical cord blood IL-6 concentration > 37.7 pg/mL was found to be predictive of death, with 78.6% sensitivity and 60% specificity. The predictive value of IL-6 for the development of MOF was 17.5 pg/mL, with 91% sensitivity and 66% specificity. CONCLUSIONS Umbilical cord blood IL-6 concentration > 26.7, 37.7, and 17.5 pg/mL in premature infants with FIRS was found to be predictive for RDS, death, and MOF, respectively.

Preterm birth rates are on the increase all over the world and continue to be an important cause for neonatal mortality and morbidity. Although clinical investigations and statistics have traditionally focused on premature infants born at a gestational age of 32 weeks or less, this increase is related to the increase in late preterm births and compared to term births, late preterms have increased risk of mortality and morbidity (1). National Institute of Child Health and Human Development (NICHHD) defines late preterm births as births between 340/7 to 366/7 weeks (2). These infants are usually considered to be developmentally and functionally as mature as term newborns and both obstetricians and neonatologists tend to consider these newborns to be protected from common perinatal problems. However, late preterm infants are more likely to develop problems such as respiratory distress, apnea, feeding intolerance, hyperbilirubinemia, hypoglycemia and hypothermia (3). Moreover, the prevalance of these problems may be different in each country. Therefore, determining the risk factors in these infants leads to more comprehensive preventive and treatment strategies. Late preterm infants who have potentially higher risk for morbidity and hospitalization require closer monitoring and follow-up. In order to understand their needs better, we aimed to analyse the rate of late preterm births among a large cohort of births and determine risk factors as well as mortality and short term outcomes.

The aim of this study is to evaluate cerebellar growth of preterm infants with intraventricular hemorrhage. Vermis height (VH) and transverse cerebellar diameter (TCD) were measured by cranial ultrasound in 18 preterm infants (26-30 weeks) with intraventricular hemorrhage (IVH) at first 3 days of life and at term equivalent age (TEA). IVH was diagnosed by ultrasonography and scaled in accordance with the definitions by Papile et al. Measurements were compared with 18 preterm (26-30 weeks) infants without IVH. Both VH and TCD of preterm infants with IVH were significantly lower than those of preterm ones without IVH at TEA (p

Objective: We investigated the effects of delayed and early clamping of the cord on the hematologic status of the baby at birth and at the end of second month.Methods: Umbilical cord of 74 babies were clamped in the first 30 s (Group 1) and 76 were clamped at 90–120 s (Group 2). Levels of hemoglobin, hematocrit, iron and ferritin were analyzed from the umbilical cord blood at birth and from the venous samples at the end of second month.Results: Hemoglobin, hematocrit, iron and ferritin levels of cord blood were similar in both groups. However, their levels other than ferritin were higher in Group 2 at the end of second month. Two babies had respiratory distress and twelve neonates received phototherapy in Group 2 whereas only five neonates received phototherapy in Group 1.Conclusion: Term babies to whom delayed cord clamping was performed had improved hematological parameters at the end of second month. Therefore, delaying cord clamping in these babies may be a favorible approach in preventing anemia.

WOS: 000362112100003 PubMed ID: 26196367 Exposure to the pressure experienced by higher birth weight babies during the intrauterine period might cause hip dysplasia. The aim of this study is to determine the effect of birth weight in newborns on hip ultrasonography when the paternal and maternal risk factors are excluded. A total of 701 babies born at 38-42 gestational weeks were included in the study. Hip ultrasonography was performed within 7 days following birth using the Graf technique in the babies without risk factors for developmental dysplasia of the hip. Images obtained were controlled with respect to conformity to the Graf method and angular measurements were performed. According to the and angle values obtained, type 1A and 1B hips were categorized as mature; type 2A hips were categorized as immature; and type 2C, D, 3A, 3B, and 4 hips were categorized as pathological hips. The results obtained were analyzed for the effect of birth weight on the angular values and hip typing. The birth weight of the babies was 338488 +/- 48241g (2030-6124g). It was determined that the birth weight had no effect on the values of and angles in the male babies (P=0.21, 0.76). It was determined that increasing birth weight decreased the angle value (P=0.001) and caused no difference in the angle value (P=0.057) in the female babies. It was found that birth weight had no effect on hip typing in both female and male babies (P=0.060, 0.22). Increases in birth weights caused decreases in ultrasonographic angles only in female babies.

To compare the blood flow velocities of superior mesenteric artery (SMA) before versus after clarithromycin treatment for feeding intolerance in very low-birth weight infants.A prospective study was conducted in a group of infant1500 g with feeding intolerance who received clarithromycin 7.5 mg/kg/dose bid. Before and at the third day of the clarithromycin therapy, SMA blood flow velocity was measured with Doppler ultrasound.SMA peak systolic velocity (PSV) and mean systolic velocity (MV) on the third day of the treatment was found significantly higher than the initial measurement (p = 0.013 and p = 0.027, respectively). End diastolic velocity of the SMA did not change with clarithromycin therapy (p = 0.113). There were no significant changes about pulsatility and resistive index of SMA with regard to clarithromycin therapy.Clarithromycin effects the splanchnic circulation. The rise in PSV and MV in SMA is remarkable. These results suggest that the splanchnic blood flow increases significantly after clarithromycin usage.

One of the most challenging aspects in the management of neonates with late-onset neonatal sepsis (LOS) is to make the diagnosis. Presepsin is a novel and promising marker of sepsis. The aim of this study was to assess the role of presepsin in the diagnosis of LOS in preterm infants.Forty-two premature newborns ≤32 weeks gestational age with a diagnosis of LOS were prospectively involved in the study. Forty gestational and postnatal age-matched infants without sepsis served as controls. Levels of presepsin, C-reactive protein, and procalcitonin were measured at enrollment and on the third and seventh days of sepsis.Initial presepsin levels in the LOS group were significantly higher than in the control group (1024 pg/mL, min-max: 295-8202; versus 530 pg/mL, min-max: 190-782; p 0.0001). The area under the receiver-operating curve for presepsin was 0.864. A presepsin value of 800.5 pg/mL was established as a cut-off value, with 67% sensitivity and 100% specificity. Presepsin levels gradually decreased during treatment.Presepsin can be used as a reliable biomarker for LOS and treatment response in preterm infants. However, we could not demonstrate the efficacy of presepsin for the detection of disease severity or prognosis.

The pathophysiologies of bronchopulmonary dysplasia (BPD) are inflammation, infection, tissue damage, angiogenesis defects and genetic susceptibility. Because of the role of the vitamin D binding protein (Gc globulin) on these factors, we investigated the relationship between Gc globulin polymorphisms and BPD. This case-control study was performed with 160 neonates (⩽32 gestational ages, ⩽1500 g). PCR DNA sequence analyses were used for GC gene rs4588 and rs7041 single-nucleotide polymorphisms. In the univariate analyses, it was observed that Gc2 was the only variant that was protective against BPD (Odd ratio (OR)=0.47, 95% coinfidence interval (CI)=0.24 to 0.89, P=0.020). In the multivariate analyses, Gc2 decreased the risk of disease (OR=0.15, 95% CI=0.029 to 0.79, P=0.026) independent of gestational age, birth weight, 5-min Appearance, Pulse, Grimace, Activity, and Respiration scores, respiratory distress syndrome and sepsis. The Gc2 variant was, after adjusting for confounders, associated with a decrease in the frequency of BPD. Our study adds Gc globulin to the list of candidate genes that potentially contribute to the etiology of the disease.

Background To investigate the efficacy and safety of recombinant human granulocyte colony-stimulating factor, recombinant human granulocyte-macrophage colony-stimulating factor (rhG-CSF) to treat sepsis in neutropenic preterm infants. Methods Fifty-six neutropenic preterm infants with suspected or culture-proven sepsis hospitalized in Zeynep Kamil Maternity and Children's Educational and Training Hospital, Kozyatagi/Istanbul, Turkey between January 2008 and January 2010 were enrolled. Patients were randomized either to receive rhG-CSF plus empirical antibiotics (Group I) or empirical antibiotics alone (Group II). Clinical features were recorded. Daily complete blood count was performed until neutropenia subsided. Data were analyzed using SPSS version 11.5. Results Thirty-three infants received rhG-CSF plus antibiotic treatment and 23 infants received antibiotic treatment. No drug-related adverse event was recorded. Absolute neutrophil count values were significantly higher on the 2 nd study day and 3 rd study day in Group I. Short-term mortality did not differ between the groups. Conclusion Treatment with rhG-CSF resulted in a more rapid recovery of ANC in neutropenic preterm infants. However, no reduction in short-term mortality was documented.

The aim of this study was to evaluate cerebellar growth of preterm infants. Vermis height and transverse cerebellar diameter were measured by cranial ultrasonography in 38 preterm infants (27-32 weeks) at birth and term equivalent age. Measurements were compared with 40 term appropriate-for-gestational-age infants. Preterms at term equivalent age had larger vermis height than term infants (2.39 ± 0.25 cm vs 2.25 ± 0.18 cm, P = .005), whereas no significant difference was found in the transverse cerebellar diameter (5.32 ± 0.38 cm vs 5.44 ± 0.23 cm, P = .13). Vermis height and transverse cerebellar diameter of appropriate-for-gestational-age preterm infants (n = 29) were found larger than small-for-gestational-age ones (n = 9). Vermis height and transverse cerebellar diameter at term equivalent age of appropriate-for-gestational-age preterm infants born before and after 29 weeks of age showed no significant difference. Cerebellar growth is preserved in extreme preterms. However, being small for gestational age may have deleterious effects on cerebellar development.

Objective This study aims to investigate the effects of antenatal magnesium sulfate on intestinal blood flow in preterm neonates. Study Design In this prospective case-match study, 25 preterm neonates exposed to magnesium sulfate antenatally were included (study group). Overall, 25 gestational age-matched neonates who had no exposure to magnesium constituted the control group. Serial daily Doppler flow measurements of superior mesenteric artery (SMA) were performed. The time to reach full feeds, first meconium passage were assessed. Presence of feeding intolerance or necrotizing enterocolitis was recorded. Results Blood flow velocities of SMA were not different between the groups during the first five postnatal days. However, SMA blood flow showed an increasing trend in the control group unlike the study group (control group, p < 0.001; study group, p = 0.29). There was no significant difference between the two groups regarding the time to reach full feeds or first meconium passage and presence of feeding intolerance. No case of necrotizing enterocolitis was seen. Conclusion Antenatal magnesium does not significantly affect intestinal blood flow, but it seems to attenuate the increasing trend of the intestinal blood flow in the early postnatal days. However, this study failed to show any impact of this finding on clinical outcomes., NA

A 2300 g female baby was born at 36+4 gestational age via caesarean section. Prenatal history was unremarkable. At 2 hours of age the baby was transferred to neonatal intensive care unit due to progressive respiratory distress and received poractant alfa as intubation-surfactant-extubation therapy after which FiO2 requirement decreased from 0.50 to 0.25. At 34 hours of age, while she was still on nasal continuous positive airway pressure (CPAP), she had sudden deterioration with retractions, desaturation and bradycardia. The infant was immediately intubated and put on high frequency oscillatory ventilation (HFOV) after which her oxygen saturations and heart rate stabilized.

Background: Thyroid function tests in neonates have been challenging to interpret because their levels are affected by several neonatal and delivery-related factors. The aim of the study was to evaluate reference values of thyroxine (T4) and thyrotropin (TSH) levels in different gestational age groups and to demonstrate the affect of perinatal factors on thyroid hormones. Methods: Medical records of 7616 neonates whose gestational age ranges between 34 and 42 weeks were analyzed retrospectively. Gender, mode of delivery, gestational age, postnatal age and birth weight were noted together with TSH and T4 levels. Results: Gestational age (r = 0.14, p < 0.001) and birth weight (r = 0.12, p < 0.001) had positive correlation with T4 levels, whereas they had no effect on TSH levels. Males had higher TSH and lower T4 levels (p = 0.001 for both) compared with females. T4 levels of babies born via vaginal delivery were lower than the ones born via cesarean section (p = 0.01). Multivariable analysis yielded gestational age as the only factor affecting T4 levels (p < 0.001). T4 and TSH levels based on 2.5-97.5 percentile cutoffs according to gestational age were presented. Conclusions: The thyroid hormone ranges given in this study can help pediatricians to interpret the thyroid hormone results with ease., NA

Amplitude-integrated encephalography (EEG) is frequently used in neonatal intensive care units to monitor brain functions. Its bedside application and easy interpretation are the most important features. Brain development of small for gestational age infants can be affected by intrauterine chronic hypoxia. The current study aimed to evaluate cerebral functions of small for gestational age infants by means of amplitude-integrated EEG. Thirty- to 34-week-old 22 small for gestational age and 27 appropriate for gestational age preterm infants were included in the study. The mode of delivery, gender, birth weight, and Apgar scores of the patients were recorded. Following middle cerebral artery mean velocity measurement with cranial Doppler at the 24th hour of birth, an amplitude-integrated EEG recording was performed on all infants, for a period of 4 to 24 hours. Small for gestational age infants had significantly higher middle cerebral artery mean velocity than appropriate for gestational age infants (21.09 ± 4.25 vs 17.8 ± 4.07; P = .029). The amplitude-integrated EEG recordings showed lower “lower border of quiet sleep” and total Burdjalov score in small for gestational age infants when compared with appropriate for gestational age infants (2.5 [1-3.25] µV vs 3 [2.75-4] µV; P = .04, 8 [6-10], 9 [9-11]; P = .04, respectively). Increased middle cerebral artery blood flow observed in small for gestational age infants might be a marker of chronic intrauterine hypoxia to which these infants were exposed. These infants demonstrated a more immature pattern of amplitude-integrated EEG.

Purpose To report the baseline plasma levels of vascular endothelial growth factor-A (VEGF-A), soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) and soluble Tie2 in infants with treatment-requiring retinopathy of prematurity (ROP) and to investigate the effect of laser treatment on the plasma levels. Methods Blood samples were collected from infants with prethreshold type 1 ROP before, 1 day after, and 1 week after confluent laser photocoagulation. Enzyme-linked immunosorbent assay procedure was used to determine plasma VEGF-A, sVEGFR-2, and sTie2 levels. Results A total of 48 eyes of 30 infants were included. The mean postconceptional age at which laser photocoagulation was performed was 37.5 ± 2.9 weeks. The mean number of laser spots applied to each eye was 1,480 ± 420. Regression of active retinopathy occurred within 1 week of treatment in all cases. Baseline plasma VEGF-A, sVEGFR-2, and sTie2 levels did not differ between unilateral and bilateral and also zone I and zone II disease. A significantly progressive decrease was observed in plasma VEGF-A, sVEGFR-2, and sTie2 levels at 1 day and 1 week after laser photocoagulation. Conclusions Plasma levels of VEGF-A, sVEGFR-2, and sTie2 decreased significantly in our patients after laser treatment; however, because of the variability in the measurements, further studies evaluating the clinical value of these angiogenic factors in patients with treatment-requiring ROP are necessary.

Vancomycin-resistant Enterococcus (VRE) colonisation can be controlled with strict adherence to infection control measures. We describe a VRE outbreak coincident with bacterial probiotic trial. Relationship between probiotic and VRE colonisation, and other possible risk factors were investigated.Two hundred and ten infants with gestational age less than 32 weeks had been randomised for a trial with probiotic preparation containing Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium lactis, fructooligosaccharide, galactooligosaccharide, colostrums and lactoferrin (NBL probiotic ATP®; Nobel, Istanbul, Turkey) between February 2012 and August 2013 when a VRE outbreak also took place. The existence of a relationship between this probiotic preparation and VRE colonisation was investigated.The begining and end of the outbreak were coincident with the beginning and end of the probiotic trial. Demographic and clinical features of neonates did not differ between VRE colonised (n = 94) and non-colonised infants (n = 116) except for vancomycin (p = 0.012) and probiotic (p 0.001) use.Probiotic and vancomycin exposure were significant risk factors for VRE colonisation. The acquisition and transfer of resistance genes of bacteria may be mediated by probiotics. Therefore, the safety of probiotics is a concern and should be investigated further.

WOS: 000332353600010 PubMed: 23820264 Background: Sepsis is an important cause of neonatal death and perinatal brain damage, particularly in preterm infants. It is thought that activation of the inflammatory cascade triggered by cytokine might play a role in the pathogenesis of sepsis. Recent evidence supports a role for resistin in inflammation. There are no data in the literature on resistin levels of premature newborns with sepsis, which can also cause inflammatory response. The objective of this study was to evaluate whether resistin can be used as an indicator in neonatal sepsis of preterm babies. Materials and methods: Forty-three premature newborns considered to have sepsis were included in the study. Forty-three gestational and postnatal age- and sex-matched premature newborns without premature prolonged rupture of membrane or sepsis served as controls. Results: The median resistin and interleukin-6 (IL-6) levels of the premature babies with sepsis were 85.9 ng/mL and 342.7 pg/mL, respectively, and were higher than those of the control group (29.9 ng/mL and 17.7 pg/mL, respectively). The sensitivity, specificity, positive, and negative predictive values for resistin were 73.7%, 45.8%, 68.3%, and 52.4%, respectively. Conclusion: Resistin levels were higher in premature newborns with sepsis and correlated with IL-6 levels, which is an indicator of neonatal sepsis. This suggests that resistin may also be used in the diagnosis of neonatal sepsis. However, it has limited value when compared with the other inflammatory markers including C-reactive protein, procalcitonin, and IL-6. Copyright (C) 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved. Mother and Child Health Foundation, Istanbul, Turkey This study was supported by the Mother and Child Health Foundation, Istanbul, Turkey.

Aim To evaluate the rehospitalization rates of premature infants who received palivizumab prophylaxis and its influence on the growth and development of these infants. Methods Infants with a gestational age of less than 32 weeks were randomized to receive prophylaxis with palivizumab (study group) or nothing (control group). Nasal swab samples were obtained monthly in all cases and also in case of infection and hospitalization. At the corrected age of 18 months Guide for Monitoring Child Development (GMCD) was administered to all patients and anthropometric indices were evaluated. Results The study was completed with 39 infants in the study group and 40 infants in the control group. Incidence of hospitalization due to respiratory syncitial virus (RSV) was found to be significantly lower in the study group both at the year of prophylaxis and in the following year (p = 0.001, odds ratio 1.32 [1.11–1.57]). There were no significant differences in terms of anthropometric indices or GMCD tests between the groups at the corrected age of 18 months. Conclusion Palivizumab reduced the incidence of lower respiratory tract infections and hospitalizations due to RSV both in the year of prophylaxis and in the following year. However, this decrease did not have any impact on the development of infants.

Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants.All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assessment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) ≥ grade III).Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH ≥ grade III when compared to the LS treatment group.ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.

WOS: 000287728400006 PubMed: 20689515 Objective: Many different factors are involved in the pathogenesis of preterm deliveries and among them maternal or perinatal infections and inflammatory response have the major role. Researches were carried out about resistin, which is thought to have a role in inflammatory cytokine cycle and it was shown to be associated with growth in neonates. However, no research has been carried out showing its relationship with inflammation in neonates. In this study, we aimed to evaluate the resistin levels in premature neonates and the effect of events such as preterm prelabour rupture of the membranes (PPROMs) and the use of antenatal steroids on these levels. Study Design: The study included 118 preterm neonates. Their medical data together with their mothers' were recorded. Serum resistin levels together with interleukin (IL)-6, C-reactive protein (CRP) and procalcitonin were evaluated in the first 2 h of life. Result: Mean gestational age and birth weight of babies included in the study were 29.6 +/- 2.7 weeks and 1306.4 +/- 393.4 g, respectively. Babies with PPROMs had significantly higher levels of resistin ((n = 30); 70.7 (7.8 to 568.4) ng ml(-1)) than babies without PPROM ((n = 88); 25.9 (5.5 to 528.9) ng ml(-1)) (P = 0.005), and the babies of mothers who received antenatal steroids had significantly lower resistin levels ((n = 44); 20.8 (5.5 to 159.9) ng ml(-1)) than the babies of mothers who did not ((n = 66); 34.6 (7.2 to 568.4) ng ml(-1)) (P = 0.015). There were significant correlations between resistin and IL-6 levels and between IL-6 and procalcitonin and CRP levels in babies whose mothers did not receive antenatal steroids. However, no correlation was found between these parameters in babies whose mothers received antenatal steroids. Conclusion: Preterm delivery and PPROM involve complex cascade of events including inflammation, and steroids are potent anti-inflammatory agents. Elevated resistin levels in babies with PPROM and suppressed levels in babies whose mothers received antenatal steroids reported in this study might have been observed as a result of the effects of fetal inflammation on resistin levels. Journal of Perinatology (2011) 31, 171-175; doi:10.1038/jp.2010.103; published online 5 August 2010 Mother and Child Health FoundationMother and Child Health Foundation This study was supported by the Mother and Child Health Foundation.

BACKGROUND: Vancomycin a frequently used antimicrobial for the treatment of late-onset neonatal sepsis. It can be infused either intermittently or continuously, however, there is no consensus on the optimal dosing regimen. AIM: To evaluate microbiological outcomes, clinical response and adverse events of vancomycin when administered via continuos intravenous infusion. METHODS: The files of preterm infants (