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Background and Aim Infantile colic (IC) is a common behavioural syndrome within the first 3 months of life. We aimed to compare the effectiveness of Lactobacillus reuteri (L.reuteri) and herbal drop combined with baby massage on IC and to evaluate the relationship with postpartum depression and anxiety. Methods Wessel Criteria were used for the diagnosis of IC in otherwise healty newborns. Patients were randomized into three groups: Group-1: L. Reuteri DSM17938 (BioGaia AB, Stockholm, Sweden), Group-2: Herbal drop (Babs, BerkoAB, Istanbul, Turkey), Group-3: Sterile water. All groups had baby massage. Infants crying episodes, feeding and stooling characteristics, growth, weight gain were noted weekly. Emotional structures of mother’s behaviour were evaluated before and at 2nd month with Edinburgh postpartum depression scale (EPDS) and State Trait Anxiety Inventory (STAI) tests. Results Seventy-four infants and their mothers completed the trial: 25 in the probiotic group, 24 in herbal drop, and 25 in placebo group. There was no difference between groups in demographic and clinical characteristics. The male rate was 62.2% (n=46). Crying times(minutes/day) at admission were similar (Group1: 348±37, Group2: 353±30, Group3: 346±28, p=0.67). A significant decrease in crying times were seen at 3.week in group1 (Group1: 35±9.8, Group2: 300±32.2, Group3: 188±40, p=0.001). The weight gain at this time was in group1 better, too (p =0.001). High EPDS and STAI scores decreased significantly after treatment in group1 at 2 month (p= 0.001). No adverse effects were reported in our groups. Conclusion The emotional structure and anxiety level of mothers affects the behaviour of infants. L. reuteri, reduced the crying episodes, mothers anxiety and postpartum depression and can be used in treatment of infantile colic.

Background and Aims Congenital heart diseases (CHD) are the most common life-threatening anomalies with significant morbidity and mortality in newborns. The aim of this study was to evaluate perfusion index variability (PI) and pro-Brain Natriuretic Peptide (NT-proBNP) levels before and after cardiac interventions. Methods A prospective study was performed on hospitalized newborns diagnosed with CHD. Oxygen saturation (SaO 2 ), PI, heart rate and serum NT-proBNP levels were obtained before and 6 th hour after cardiac interventions (catheterization or surgery) in all patients, by using Masimo Rainbow SET Radica l7 Monitor (Masimo Corp., Irvine, CA, USA). Duration of mechanical ventilation, morbidity and mortality rates were documented. Results Thirty-four CHD diagnosed newborns were included. Pulmonary atresia (20.6%), aortic coarctation (14.7%), and transposition of great arteries (11.82%) are the most common diagnoses. Median (IQR) birth weight and gestational age were 3250g (2450–4300) and 38weeks (38–42) respectively. Fifty-eight percent of newborns were male. Rapidly rising of oxygen saturations and PI values after cardiac interventions were observed in all patients (SaO 2 %, before: 79±6.6, after: 87.9±2.9, p=0.001) (PI before: 0.4±0.1, after: 1.1±0.2, p=0.001). A significant decrease in NT-proBNP levels (pg/mL) were seen after therapeutic interventions too(before: 1547±629, after: 911±262, p=0.001). Six patients (17.6%) required surgical intervention. The median (IQR) day of mechanical ventilation was 7days (2–21). Proven sepsis (n=8.23%), chronic lung disease (n=5.14%), pulmonary hemorrhage (n=4,%11), and pneumothorax(n=3.8%) are the most detected complications. Mortality rate was 20% (n=5). Conclusion Peripheral tissues are sensitive to alterations in perfusion. PI monitoring of these tissues could be an early marker of hypoperfusion. PI has significantly improved in correlation with SpO2 after therapeutic interventions. Assessment of PI and NT-proBNP values could be used by monitoring peripheral tissues in critically ill newborns with CHD.

Background and Aims The perfusion index (PI); is an easy, non-invasive technique for the assessment of peripheral perfusion. The aim of this study was to determine the peripheral PI reference values and PI variability of clinically and hemodynamically stable newborns during the first five days. Method Pre- (right hand) and postductal (foot) PI values were recorded on the sixth hours, first, second, third and fifth day of 241 newborns life with the new generation pulse oximeter [MASIMO Rad 7 Oximeter, USA]. Results A total of 241 newborns (196 term, 45 preterm) were included in the study. The average gestation age of all newborns was 38.4±2.0 weeks and birth weight was 3204±566 grams. According to the analysis of repeated measurements of term and preterm groups within the first 5 days, PI values of right hand and foot did not vary. However, right hand PI values were significantly higher than foot PI values (p Conclusion The peripheral perfusion of stable newborns did not vary significantly during the first five days. It was considered, higher PI value of term newborns compared to preterm newborns, is the result of early adaptation in the microvascular blood flow. PI values obtained from stable newborns may be guiding for further studies planned on various diseases associated with impaired perfusion.

Background and Aim Researches to identify markers with high sensitivity and specificity in the diagnosis of neonatal sepsis are being held in parallel to recent advances in neonatology. In this study, we aimed to determine predictive values of MPV in the diagnosis of neonatal sepsis. Methods All infants diagnosed with clinical sepsis according to clinical and laboratory findings were included in this prospective study. Blood samples for hemoglobin, hematocrit, number of leukocyte, absolute neutrophyl count (ANC), number of platelet, MPV, CRP, blood culture were obtained from each patient within the first 24 hours of hospitalization. Patients who have positive culture results were accepted as proven sepsis. Patients were separated into three groups as proven sepsis (n=82) (Group-1), clinical sepsis (n=64) (Group-2) and control group (n=142) (Group-3). Results Group-1 CRP levels were higher (p=0.001) and number of platelets were lower (p=0.001) compared with other two groups. Leukocyte, ANC and MPV values were significantly high in Group-1 and Group-2 compared with Group 3 and there was no difference between Group-1 and Group-2 (p=0.001). Negative correlation was observed between MPV and platelet levels (r= –0.24, p=0.001) whereas positive correlation was observed between MPV and CRP levels (r=0.26, p=0.001). It was noted that for CRP- Specificity 82%, sensitivity 92%, negative predictive value (NPV) 83%, positive predictive value (PPV) 91%, and for MPV- Specificity 54%, sensitivity 82%, NPV 63%, PPV 76%. Conclusion High serum MPV levels in addition to CRP levels may be helpful in the diagnosis of newborns suspected to have sepsis.

Background & aim Congenital heart malformation (CHM) is one of the most frequent and important abnormalities in newborns. In this study we retrospectively analyzed the frequency and distribution of the congenital heart diseases in our NICU. Method Newborns hospitalized in NICU between 2005 and 2011 were retrospectively analyzed. Gestational age, birth weight, consanguinity, type of congenital heart disease extracted from the computerized database. CHMswere classified as follows; left-to-right shunt, obstructive, cyanotic with decreased pulmonary flow, cyanotic with increased pulmonary flow and others. Results A total of 706 newborns were diagnosed as congenital heart disease during 7-year study period among the 7450 admission (9.5%). Consanguinity rate was 22.3% and 30.4% of these were first degree relatives. 42.7%, 17.3%, 13%, 11.6% were left-to-right shunt, obstructive, cyanotic with decreased pulmonary flow, cyanotic with increased pulmonary flow and others, respectively. Most frequent heart malformations were ASD (25.5%), VSD (12.6%), Aortic coarctation (10.8%), PDA (9.5%), TGA (8.8%), pulmonary atresia (8.2%), AVSD (4.1%), hypoplastic left heart (3.8%), pulmonary stenosis (3.1%), TOF (2.5%). 37 % of the newborns had at least one congenital malformation in other organ systems. Conclusion ASD, VSD and aortic coarctation were most common congenital heart disease followed in our NICU.

Background & Aim: It is known that wet lung syndrome and pulmonary maladaptation are more frequent in infants delivered by cesarean section while the effect of mode of delivery on RDS is unknown. In this study, we analyzed the effect of the mode of delivery on RDS outcome in very low birth weight (VLBW) neonates. Methods Data of all the VLBW neonates with respiratory distress syndrome (RDS) between 2007 and 2012 was retrospectively analyzed. Gestational age, gender, birth weight, mode of delivery, necrotizing enterocolitis (NEC), intracranial bleeding (ICH), patent ductus arteriosus (PDA), retinopaty of prematurity (ROP), broncopulmonary dysplasia (BPD) were noted. Results A total of 186 newborns were diagnosed as VLBW neonates with RDS among the 5980 neonates hospitalized in NICU. Mean birth weight and gestational age were 1058±261 grams and 28±2.7 weeks, respectively. Cesarean delivery rate was 62.7%. There were no differences with respect to birth weight, gestational age and gender between mode of delivery. There was no significant relationship between the NEC, PDA, ROP, BPD and mode of delivery. Also no significant relationship between the mode of delivery and mortality was determined. On the other hand, ICH was significantly higher in neonates delivered vaginally (48% vs. 31%, p Conclusion Mode of delivery has no effect on the mortality and morbidity of RDS in VLBW neonates but ICH was significantly higher in normal vaginal delivery group. Therefore, mode of delivery should be decided on the basis of obstetrical indications.

Objective The aim of this study was to determine accurate and validated z-score equations for the normal values of coronary diameters adjusted with growth changes of the neonates by testing three different time periods. Methods Echocardiography was performed on 200 healthy neonates at birth, one and six months of ages. Several regression models for the left (LCA) and right coronary artery (RCA) diameters were tested with weight, height, body surface area and aortic annulus diameter. Reliable standards for the coronary artery diameters for healthy newborns by determining z-score equations with appropriate statistical validations were established. Results The coronary diameters on birth measurements were strongly correlated with birth weight, height, surface area and the diameter of the aortic annulus (Pearson’s R>0.8, all p Conclusion We present a new set of equations for neonatal z-score calculation on the basis of a large number of healthy neonates on three different time period consisting of birth, one and six month of ages. It is clear with this study that the growth in caliber of the coronary arteries is definite and progressive during postnatal time.

Background and Aim Congenital malformations are one of the important reasons of mortality and morbidity in newborns. The aim of this study is to give the frequency and distribution of the congenital malformation in a neonatal intensive care unit from Turkey. Method A retrospective analysis of congenital abnormalities in singleton births was performed to identify frequency, types, combined congenital abnormalities and distribution of malformation in newborns over a 7 year period. Congenital malformations were classified according to involved organ systems and also classed as single and multiple malformations. Result 1024 newborns with congenital malformations (13.7%) were identified among the 7450 hospitalized newborns in neonatal intensive care unit (NICU). Mean birth weight was 2988±648gr, mean gestational age was 37.9±2.5 weeks. Consanguinity rate was 22.3%. Prenatal diagnosis rate was 11%. The most affected system was the cardiovascular system (68.8%). Most of the malformations (69.6%) were single malformations while 20.4% of the newborns had multiple major and 8.4% of the newborns had multiple minor malformations. On the other hand, 1.4%, 0.1% and 1.6% of the newborns had deformation, disruption and displasia, respectively. Chromosomal analysis was only performed 24.8% and 65.3% of them were in normal limits. The most frequently detected chromosomal abnormality was Trisomy 21. Overall mortality rate was 15.5% among the newborns with congenital malformations. Conclusion The most common congenital malformation was cardio-vascular malformations in our hospital. Preventing and prenatal diagnosis of congenital malformations may help to reduce perinatal mortality and morbidity.Therefore, each country should establish its own national database for prevention and management of congenital malformations.

Background and Aim Congenital malformations and chromosomal abnormalities are important problems for the neonatal morbidity and mortality especially in well developed countries. In this study we investigated the prevalence and distribution of the chromosomal abnormalities in our NICU. Method Chromosomal abnormalities identified between 2008 and 2012 were retrospectively analyzed. Also, demographic features and concomitant congenital malformations were also collected. Cytogenetic analysis was performed on peripheral blood of newborns by standard chromosomal analysis methods. According to our hospital protocols, newborns with more than one major malformation or with 1 major plus 2 minor abnormalities were scheduled for chromosomal abnormalities. Results During the study period, 431 chromosomal analyses (3.2%) were performed among the 5170 hospitalized newborns. 78.4% of the cases had normal chromosomal karyotype. Consanguinity rate was 27.9%. Major chromosomal abnormality rate was 1.8%. Frequency of chromosomal abnormalities were as follows; Trisomy 21 13.5% (n=58), trisomy 18 2.3% (n=10), trisomy 13 1.2% (n=5), 45 XO 0.5% (n=2) and other chromosomal abnormalities were 4.2% (n=18). Congenital heart abnormalities (85.9%), cranio-fascial abnormalities (44.6%) and genito-urinary anomalies (16.9%) were most common concomittant malformations. Cardiovascular abnormalities were most common malformations in newborns with trisomy 21. Conclusion Frequency and distribution of the chromosomal abnormalities in our NICU were similar compering with other populational studies. Trisomy 21 was most common chromosomal abnormality. Newborns with malformations in more than two organ system should be investigated chromosomally as well.