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Background The purpose of this study was to estimate the current incidence of retinopathy of prematurity (ROP) and the need for treatment in preterm infants in Turkey. Methods The study included preterm infants who had been screened for ROP between 2011 and 2013 in 49 neonatal intensive care units. Infants with birth weight (BW) ≤1500 g or ≤32 weeks’ gestational age and those with BW >1500 g or >32 weeks’ GA with an unstable clinical course were included. The incidence of any ROP or severe ROP and treatment modalities were determined. Results The study population included 15 745 preterm infants: 11 803 (75%) with GA ≤32 weeks, and 3942 (25%) with GA >32 weeks. Overall, 30% were found to have any stage of ROP, and 5% had severe ROP. Severe ROP was diagnosed in 8.2% of infants with BW ≤1500 g and 0.6% of infants with BW >1500 g. Of all infants diagnosed with ROP, 16.5% needed laser photocoagulation, and 20 patients born at >32 weeks’ GA required this treatment modality. Vitroretinal surgery was performed in 28 infants with severe ROP: 23 with GA ≤28 weeks and 5 with GA 29–32 weeks. Conclusions The findings of our study have the important implication that more mature babies are at risk of severe ROP requiring treatment. An effective programme for detecting and treating ROP should be established in Turkey. Trial registration number orcid.org/0000-0002-1329-2167.

Background/aim Established reference values are critical for the interpretation of immunologic assessments. In particular, the proportion and absolute counts of T- and B- cell subpopulations are subject to change with age and ethnicity. We aimed to establish age- specific reference values for lymphocyte subsets using updated immunophenotyping panels. Materials and methods We studied a total of 297 healthy Turkish subjects aged 0 to 50 years, stratified into major age brackets in a cluster factor of 10 per age-group. The predetermined age intervals contained randomly allocated participants enrolled over a period of 6 months, who were homogenously distributed by sex. We analyzed a complete blood count test and simultaneously with detailed immunophenotyping enumerated the percent and absolute cell counts of lymphocyte subsets. Results The percentage and absolute counts of lymphocyte subsets show a marked surge across the age-span. T helper, T cytotoxic, and the natural killer cell numbers were increasing from birth until 6 months, followed by a gradual decrease thereafter. B cell numbers were rising until 2 years, followed by a gradual decrease for the upcoming years, accompanied by a steady expansion of unclass-switched- and class-switched- B cells. Conclusion We provide updated extensive reference intervals for lymphocyte subpopulations in Turkish people.

Aim: We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and therefrom, to clarify the clinical importance of routinely checking serum total bilirubin (STB) levels after the cessation of phototherapy and to define an optimal time to check STB levels for the detection of RHB. Materials and Methods: Term and late preterm babies who received phototherapy were included in this study. The demographic and clinical features, time of onset of jaundice, phototherapy time and results to determine the etiology of jaundice were recorded for all babies. Serum rebound bilirubin measurements were performed two times at 12 and at 24 hours after the cessation of phototherapy. The re-initiation of phototherapy according to the 12th and 24th hour STB levels was accepted as early rebound and late rebound, respectively. IBM SPSS 22 was used for statistical analyses. Results: Data was available for 110 infants. The rebound rate requiring phototherapy was 9.1% (n = 10) and all had a risk factor. Most of the babies (9/10) rebounded at the 12th hour after the termination of phototherapy. Hemolysis and prematurity were found to be statistically significant for RHB (p = 0.008; p = 0.048). Conclusion: Post-phototherapy bilirubin follow-up may be incorporated using a combined approach of individualization, evaluation of risk factors, and application of common sense before discharge. Our study showed that STB levels could be measured after the cessation of phototherapy, especially in patients with a risk factor, at the 12th hour before discharge. Randomized controlled studies with larger sample sizes are still needed for definitive recommendations.

Pneumomediastinum is an uncommon cause of neonatal respiratory distress and occurs in approximately 2.5 per 1000 live births. Although, the most common cause of pneumomediastinum is an underlying lung disease, it can be seen in newborns who undergo resuscitation during delivery without a predisposing factor. Initial diagnosis by chest X-ray can be difficult in some cases. The “spinnaker-sail sign” is an uncommon radiological appearance of pneumomediastinum. Careful conservative management can result with spontaneous resolution without long-term sequelae. In this case report, we present a neonate who developed pneumomediastinum.

As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of "European Guidelines for the Management of RDS" by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (c) 2019 S. Karger AG, Basel

Introduction: There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. Methodology: A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2–4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room and continuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases. Results: Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6–7] days) and the longest for group 3 (10 [7–12] days) and group 6 (10 [8–12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups. Conclusions: Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.

Objective: In our study, we aimed to evaluate the risk factors that influenced development of necrotizing enterocolitis (NEC) in preterm babies born at a gestational age below 32 weeks who were being followed up in our neonatal intensive core unit. Method: Babies who were born at a gestational age below 32 weeks in our hospital were evaluated in terms of perinatal (maternal hypertension/preeclampsia, antenatal Doppler US abnormality, intrauterine growth restriction, delayed/premature membrane rupture) and postnatal risk factors for the development of NEC. Demographic and clinical characteristics of the babies, in-hospital follow-up period, presence of respiratory distress, perinatal asphyxia, prsence of hemodynamically ptent ductus arteriosus, inotropic support, ventilator support, caffeine treatment, presence of central catheter, erythrocyte suspensio, nevidenced/clinical sepsis, and nutritional statis were recorded. IBM SPSS Statistics 21,0 program was used for statistical evaluation. Results: Eighty-five preterm babies were included in our study. The birth weighst and gestational weeks of the subjects were found to be 1190 (380-1650)gs and 29 (21-31) weeks, respectively. The birth weight and gestational week were found to be significantly lower in the subjects who developed necrotizing enterocolitis compared to the subjects who did not (p:0.005; p:0.035). The incidence of NEC was found to be 11.7% (n:10) in preterm babies. Doppler ultrasonography revealed abnormal findings in five of the subjects who developed NEC and in 12 of the subjects who did not develop NEC; this difference was statistically significant (p:0.002). Surgical laparotom, and surgical resection were performed in five infants. Penrose drain was inserted in one infant at bedside. The mean birth weight and gestational week of these cases were found to be significantly lower compared to the ones who did not require surgery (p:0.015; p:0.042). In 3.5% of the babies tranfusion-rlated NEC was detected. The mortaisty rote in infants who developed NEC was 40 percent. Conclusion: Especially premature babies with lower gestational week and and very low birth weight, whom cannot tolerate minimal enteral feeding, and have abnormal Doppler ultrasound findings or blood transfusion history should be monitored more carefully.

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (C) 2016 S. Karger AG, Basel

Background. Mycoplasma hominis is a well-known bacterium colonizing the genito-urinary tract. It may cause pneumonia, bacteremia, abscesses, chronic lung disease, and rarely meningitis during the newborn period. Case. A preterm infant with a birth weight of 885 grams was born at 27 weeks of gestation and had respiratory distress syndrome needing mechanical ventilation. Spontaneous intestinal perforation and grade four intraventricular hemorrhage was diagnosed on day three. Conclusion. M. hominis was accepted as the causative agent of meningitis in this case report.

Raoultella planticola is rarely associated with clinical infection, and a limited number of pediatric cases have been reported. Herein we report a case of bacteremia presumptively secondary to bilateral conjunctivitis in an infant caused by R. planticola which was successfully treated with piperacillin-tazobactam. It should be kept in mind that R. planticola can be a pathogen in pediatric age groups. (C) 2017 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license

Ozdemir H, Memisoglu A, Alp-Unkar Z, Arcagok B, Bilgen H, Turan S, Ozek E. Persistent hyperglycemia in a neonate: Is it a complication of therapeutic hypothermia? Turk J Pediatr 2017; 59: 193-196. The aim of this report is to present a newborn with persistent hyperglycemia requiring insulin therapy as a possible complication of therapeutic hypothermia. A term appropriate for gestational age (AGA) female infant, was born by emergency cesarean section due to abruption of placenta and was resuscitated and intubated in the delivery room. Whole body cooling was initiated according to standard cooling criteria. The patient`s blood glucose increased up to 250 mg/dl on a glucose perfusion rate of 6 mg/kg/min after the second day of cooling. Insulin therapy was started due to persistent hyperglycemia and continued for 17 days. As it has been reported in adults after therapeutic cooling, persistent hyperglycemia attributed to hypothermia can also complicate therapeutic hypothermia in neonates.

A 3100 g male appropriate for gestational age baby was born at 40 weeks to a healthy mother by normal spontaneous vaginal delivery. Apgar scores were 9 and 10 at the 1st and 5th minutes, respectively. Physical examination of the infant's respiratory system, cardiovascular system and his abdominal examination were normal; neurological examination revealed no abnormality. Suspicious syndromic facial appearance with modarete edema at the baby's lips and face was evident and he had bruising on the left nasolabial groove and on both cheeks. We aimed to emphasize the fact that facial edema due to soft tissue trauma seen in newborns born with face presentation may be misinterpreted as a sign of a syndrome. However, careful anamnesis, thorough physical examination, and close follow-up could ensure the diagnosis of birth trauma.

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report updated recommendations of a European Panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007 and 2010. This second update of the guidelines is based upon published evidence up to the end of 2012. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is still not clear if the benefit of repeated courses on respiratory outcomes outweighs the risk of adverse outcomes in the short and long term. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not completely clear. In addition, use of very early continuous positive airway pressure (CPAP) has altered the indications for prophylactic surfactant administration. Respiratory support in the form of mechanical ventilation may be lifesaving but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using non-invasive respiratory support such as CPAP. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of normal body temperature, proper fluid management, good nutritional support, appropriate management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion. Copyright (c) 2013 S. Karger AG, Basel

Rahnella aquatilisis an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organism’s natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused byRahnella aquatilisduring the treatment for ventilator associated pneumonia due toStenotrophomonas maltophiliawith ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. AlthoughR. aquatilisis one of thesaprophyticusorganisms, it may cause life-threatening infection in newborn.

Herein, we report two preterms with invasive candidiasis refractory to liposomal amphotericin B (AMB) treatment in spite of low MIC levels (MIC: 0.5 mcg/mL). Both of the patients’ blood cultures were persistently positive forC. parapsilosisdespite high therapeutic doses (AMB: 7 mg/kg per day). After starting voriconazole blood cultures became negative and both of the patients were treated successfully without any side effects. In conclusion, although it is not a standard treatment in neonatal patients, our limited experience with these patients suggests that voriconazole appears to be a safe antifungal agent to be used in critically ill preterm infants with persistent fungemia despite AMB treatment.

Aim.To investigate obstetric features of pregnant women with thyroid disorders and thyroid function tests of their newborn infants.Methods.Women with hypothyroidism and having anti-thyroglobulin (ATG) and anti-thyroid peroxidase (anti-TPO) antibodies were assigned as group I, women with hypothyroidism who did not have autoantibodies were assigned as group II, and women without thyroid problems were assigned as group III.Results.Pregnant women with autoimmune hypothyroidism (group I) had more preterm delivery and their babies needed more frequent neonatal intensive care unit (NICU) admission. In group I, one infant was diagnosed with compensated hypothyroidism and one infant had transient hyperthyrotropinemia. Five infants (23.8%) in group II had thyroid-stimulating hormone (TSH) levels >20 mIU/mL. Only two of them had TSH level >7 mIU/L at the 3rd postnatal week, and all had normal free T4 (FT4). Median maternal TSH level of these five infants with TSH >20 mIU/mL was 6.6 mIU/mL. In group III, six infants (6.5%) had TSH levels above >20 mIU/mL at the 1st postnatal week.Conclusion.Infants of mothers with thyroid problems are more likely to have elevated TSH and higher recall rate on neonatal thyroid screening. Women with thyroid disorders and their newborn infants should be followed closely for both obstetrical problems and for thyroid dysfunction.

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. These updated guidelines are based upon published evidence up to the end of 2009. Strong evidence exists for the role of a single course of antenatal steroids in RDS prevention, but the potential benefit and long-term safety of repeated courses are unclear. Many practices involved in preterm neonatal stabilisation at birth are not evidence-based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS, but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be lifesaving, but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure or nasal ventilation. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.