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Objective To investigate the effectivity of pentoxifylline (PTX) and immunoglobulin M (IgM)-enriched intravenous immunoglobulin (IVIG) therapy in the treatment of neonatal sepsis (NS), alone or in combination. Study design This was a prospective, double-blind, controlled study. Newborns with suspicion of sepsis were enrolled in the study. The patients were separated into four groups according to treatment protocol: Group 1 = placebo, Group 2 = pentoxifylline, Group 3 = IgM-enriched IVIG, and Group 4 = pentoxifylline + IgM-enriched IVIG. Blood samples were taken for C-reactive protein, interleukin-6, neutrophil CD64 expression, and tumor necrosis factor-alfa measurements immediately before treatment (1st day), and measurements were repeated on the 2nd and 4th days of the therapy. Results A total of 204 patients, 51 in each group, were recruited into the study. There were no significant differences for symptoms of sepsis among groups, except lethargy. No significant differences were observed among the groups according to laboratory data. Overall mortality rate was 8.8%. The rates of morbidities and mortality among study groups were similar. Conclusion PTX and IgM-enriched IVIG therapies, either alone or in combination, did not reduce the rates of morbidities and mortality in NS.

Objective: Viruses are demonstrated to be an uncommon etiologic agent of early and late pneumonia. In this study we aimed to investigate the safety and affectivity of oseltamivir use for viral pneumonia in newborns. Methods: This was a retrospective study conducted in a single tertiary neonatal intensive care unit between September 2009 and April 2013. Demographic, clinical and laboratory data before and after treatment, duration of hospitalization, time of clinical improvement were recorded. Results: During the study period, a total of 69 newborn cases who were treated by oseltamivir for H1N1 swine flu (n=12) or suspicious influenza (n=57) were evaluated. Mean birth weight and gestational age were 3100±601 grams and 37.9±1.8 weeks, respectively. On admission, median postnatal age was 20.6 (7-47) days. Oseltamivir, along with supportive care, was administered as 3.0 mg/kg/dose twice a day for 5 days according to the recommendations of Food and Drug Administration (FDA). The median time of initiation of oseltamivir was 2.3 days (1-4) after admission and the median hospitalization day was 10.4 days (5-22). No adverse effects associated with oseltamivir were observed and all patients were discharged after full recovery. Conclusion: Oseltamivir use in addition to supportive therapy seems to be safe and effective in newborns with severe viral pneumonia.

Objective: Newborns who suffer from jaundice and/or receive phototherapy (PT) are at a higher risk of developing asthma. In this study we aimed to investigate the relationship between bilirubin and peripheral eosinophil counts in newborns with severe hyperbilirubinemia needing PT. Methods: In this study, a retrospective analysis was performed on 306 newborns with severe hyperbilirubinemia with gestational age ≥35 weeks (Group 1) and the control group consisted of 295 age and gender-matched newborns (Group 2). Total serum bilirubin, hemoglobin, albumin, leucocyte and eosinophil counts before and after PT were recorded from medical charts. Findings : All the patients in Group 1 received phototherapy and 77 (25.2%) of them needed exchange transfusion (ET). Before receiving PT, the patients in Group 1 had lower levels of Hb and higher levels of total serum bilirubin and lymphocytes than those in Group 2 although there was no statistically significant difference with regard to peripheral eosinophil counts. Eosinophils were detected to be numerically lower in Group 1. Higher bilirubin subgroups had also lower eosinophil counts. The patients in Group 1 had lower levels of Hb, leucocyte, albumin and higher levels of eosinophil following PT. Conclusion: Peripheral eosinophil count may be affected by bilirubin levels and/or phototherapy. There is a need for further clinical research based on different models.

Background Newborn screening tests have been designed to identify infants with severe disorders that are relatively prevalent and treatable or controllable. Comparing to other countries, the incidence of these diseases are very high in Turkey where the rate of consanguineous marriage is high. Methods In this article, it is aimed to evaluate the development and organization of newborn screening programs in Turkey which include phenylketonuria, congenital hypothyroidism and biotinidase deficiency screenings. The point reached today, limitations of the program, expectations and projects for the future are discussed. Results Today, the point reached in screening programs of the country is appreciable. While the screening rate of the live born babies was 4,7% in 1987, this rate reached to 95% by 2008. Predicted target for newborn screening program at the strategic plan of Ministry of Health for 2010–2014 was to enhance this rate above 95% by the end of 2012. It seems that the envisaged goal has been reached. Conclusion National newborn screening program appears to be conducted successfully and extensively as a result of political determination and performance of health care workers who are in charge of this program. Nevertheless, limited numbers of the nutrition and metabolism clinics and specialists on these branches have caused some access difficulties, waste of time, and financial loss. Therefore, special planning to improve quality and the number of the clinics would be useful.

OBJECTIVES: The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). METHODS: A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage ≥2), length of NICU stay, and death. RESULTS: A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture-proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14–36] vs 32 days [20–44], P = .07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). CONCLUSIONS: Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death.

Objective: To assess the Turkish National Newborn Screening Programme (NNSP) for congenital hypothyroidism (CH). Retrospective study based on the data from NNSP. Methods: Since December 2006, a nationwide screening programme for CH has been conducted in Turkey by the Turkish Directorate of Public Health (TDPH) in cooperation with several institutions. We evaluated the database between January 2008 and July 2010 of this programme. According to the methodology of the NNSP, between three and five days of age (or at discharge from the hospital, if this occurs earlier) blood specimens were routinely collected from neonates on filter paper, by puncturing the heel. The accepted thyroid-stimulating hormone cut-off level for recall was 20 mU/L initially and 15 mU/L subsequently. The incidence of possible CH by years was reported. Results: During the evaluation period, 3223765 newborns were tested. The mean annual incidence of possible CH showed a gradual increase over the years (1:888 in 2008, 1:592 in 2009, and 1:469 in 2010). Regional differences were noted. Although the mean age of blood sampling did not change by years, the mean age at notification for suspected CH decreased from 19.2 to 15.7 days from 2008 to 2010. Conclusions: We reported the first assessment of NNSP in Turkey. An improvement in performance measures for the CH screening programme has been noted. Knowledge on incidence of confirmed CH is not yet available in the database. Conflict of interest:None declared.

We aimed to report newborns with thrombosis and needed fibrinolytic treatment.This was a retrospective study conducted on 27 newborns with thrombosis followed-up in a neonatal intensive care unit between December 2007 and December 2012. The patients were divided into two groups according to treatment protocol; Group 1 (n = 15): recombinant tissue-type plasminogen activator (r-tPA) and Group 2 (n = 12): streptokinase (STK). The groups were compared in terms of the efficacy and complications of the treatments.In Group 1, flow restoration was complete in nine (60%) patients, partial in two (13.3%), and absent in four (26.7%). In Group 2, flow restoration was complete in seven (58.3%) patients, partial in three (25%), and absent in two (16.0%). The incidence of complete/partial recovery was similar in the groups. There was no difference between the two groups with regard to the duration of thrombus resolution. Fibrinolytic treatment was terminated in seven patients (46.7%) in Group 1, while in three patients (25%) in Group 2 due to the complications. The most common complications were minor or major bleedings. There was no statistically significant difference with regard to all bleedings complications between the two groups (P = .08), although the incidence of skin hemorrhages was higher in Group 1 (P = .007). There was no significant difference between the mortality rates.Even though the use of STK is not further recommended because of its potential undesirable side effects in newborns, its efficacy and safety appears to be similar to those of r-tPA.

Prostaglandin E1 infusion is widely used to maintain patencyof ductus arteriosus in newborns with duct-dependentcongenital heart disease until surgery. ProstaglandinE1 is a lifesaving drug, but it has many side effects includingfever, apnea, bradycardia, hypotension, convulsion,edema, and cortical hyperostosis. The gastrointestinaltract has not been recognized as a major site of seriousadverse effects of prostaglandin E1 infusion, althoughdiarrhea is a well-recognized side effect that usually respondsto dose reduction. In this report, we present acase of intestinal intussusception presumably induced byprostaglandin therapy in a newborn with duct-dependentcongenital heart disease.Key words: Prostaglandin E1, newborn, gastrointestinal

To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU).From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study.During the study period, the incidence of non-benign NA was 0.7 % (n = 55/7880). The mean age at diagnosis was 16.7 ± 1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia.Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.

Objective: To investigate the role of interleukin-6 (IL-6) and C-reactive protein (CRP) in non-thyroidal illness (NTI) in premature infants. Methods: Serum levels of IL-6 and CRP, thyroid-stimulating hormone (TSH), total thyroxine (T4), free T4 (fT4), total triiodothyronine (T3), and free T3 (fT3) were determined at the 1st, 2nd and 4th weeks of postnatal life in 148 premature infants born before 33 weeks of gestation. Results: At the 1st week, serum T3 was negatively correlated with IL-6(r= -0.33, p= 0.001) and CRP (r= -0.17, p= 0.03). Serum T3 was negatively and more strongly correlated with IL-6 (r= -0.49, p= 0.001) and CRP (r=- 0.33,p= 0.03) at the 2nd week, at which time sepsis frequency and low T3 rates were the highest. At the 4th week, mortality rate was higher among infants with lower T3 levels. Conclusions: High IL-6 and CRP values related to neonatal sepsis might have a significant role in the pathogenesis of NTI in premature infants. Conflict of interest:None declared.

Objectives and aim IVF has become an efficient and widely used treatment for infertile couples, however, it is responsible for an increasing number of multifetal pregnancies and adverse neonatal outcomes. This study aimed to assess a health service utilization in one neonatal intensive care unit (NICU), as a response to the 2010 Turkish reproductive regulation requiring single embryo transfer (SET). Methods All assisted reproductive technology (ART) pregnancies delivered at Zekai Tahir Burak Maternity Teaching Hospital between February 2010 and October 2011 were included in this study. Subjects were divided into two groups: Group 1 consisted of infants conceived before the ART regulation, and born between February 2010 and October 2010, and Group 2 consisted of infants conceived after the ART regulation, and born between November 2010 and October 2011. Results Upon comparing the study groups, we observed a significant decrease in the incidence of multiple births in Group 2. The mean gestational age and mean birthweight were significantly higher in Group 2. The rates of prematurity and low birthweight, very low birthweight and extremely low birthweight infants were significantly lower in Group 2. Similarly, the rates of NICU admission, respiratory distress syndrome, necrotizing enterocolitis anemia and pneumonia/sepsis, and the need for respiratory support (mechanical ventilation and nasal continuous positive airway pressure) were significantly lower in Group 2. Conclusions According to our data, NICU utilization was reduced and the early post-natal outcomes of the babies were improved after the new Turkish regulation on ART imposing SET. However, multicenter studies are needed to generalize our results to the whole country.

To perform neurodevelopmental evaluation at 18 to 24 months’ corrected age in very low birth infants (VLBW) with transient hypothyroxinemia. Cohort study. Maternity teaching hospital. Premature infants who were previously evaluated for thyroid hormone values in the first weeks of life were included. Data of these infants who weighed ≤1500 g and ≤32 weeks of gestation were retrieved for the current study. Available subjects (n=56) were evaluated for neurodevelopmental status at 18 to 24 months of corrected age. Bayley Scales of Infant Development -Second Edition (BSID-II) was performed to define Mental developmental index (MDI) and Psychomotor developmental index (PDI). The mean MDI and PDI scores were similar between the infants with and without transient hypothyroxinemia of prematurity (THOP) [79.9 ± 14.9 vs 70 ± 20.7, respectively (P=0.54); and 92.2 ± 16.4 vs 85.6 ± 18.9, respectively (P=0.68)]. After adjustment for gestational age and multiple prenatal, perinatal, and early and late neonatal variables, THOP was not associated with an increased risk of disabling cerebral palsy, or a reduction of MDI and PDI scores. THOP may not be an important cause of problems in neurologic and mental development detected at the age of 18 to 24 months’ corrected age.

Background/aim: It has been suggested that plasma KL-6 increases in premature infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the predictive values of KL-6 in BPD. Materials and methods: The study was performed in preterm neonates with birthweight ≤1500 g and gestational age ≤32 weeks. Plasma KL-6 levels were measured on postnatal days 1, 7, and 14. Results: BPD was identified in eight of the 28 study infants. On postnatal days 1 and 7, plasma KL-6 levels were similar in infants with BPD [on day 1: 8.9 (7.5-17.8) U/mL and on day 7: 16.8 (10.5-47.7) U/mL] and without BPD [on day 1: 10.8 (9.4-17.2) U/mL and on day 7: 12.9 (5.8-19.3) U/mL] (P = 0.38 and P = 0.13, respectively). On day 14, KL-6 levels were significantly higher in infants with BPD [155.2 (15.3-545.6) U/mL] than they were in infants without BPD [7.9 (7.7-15.6) U/mL] (P = 0.001). The best predictor was KL-6 levels on postnatal day 14 (area under the ROC curve = 0.88; range 0.75-1.0; P = 0.002). At this point, KL-6 level of 59.7 U/mL showed a specificity of 90.0% and negative predictive value of 85.7% for BPD. Conclusion: High plasma KL-6 levels on postnatal day 14 in premature infants may predict the development of BPD.

Oxidative stress has been implicated in the pathogenesis of necrotizing enterocolitis (NEC). In this study, we compared the global oxidant/antioxidant status by measuring total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) in preterm infants with NEC and with control preterms.Forty-one preterm neonates with NEC (stage 1 [group 1; n = 23] and stages 2 and 3 [group 2; n = 18]) and age-matched 36 healthy preterm controls (group 3) were included in this study. Blood samples were obtained both at the time of NEC diagnosis and 72 hours after for the evaluation of TAC and TOS. Serum levels of TAC, TOS, and OSI in patients with NEC were compared with controls.Demographic characteristics were comparable in all 3 groups. Preterm neonates in group 2 (with stages 2 and 3 NEC) had the highest TOS levels and OSI (P.001 vs both groups 1 and 3). There was no difference in TAC levels among the groups (P = .26).Our findings demonstrated that although TAC levels were similar in all 3 groups, oxidant stress mechanisms were activated in preterm neonates with definite NEC (stages 2 and 3 NEC). Premature neonates with increased levels of TOS and OSI were associated with severity of NEC.

WOS: 000350022000007, PubMed ID: 25250785, …

Uzm. Dr. Banu Aydin, Babur Cad. Altindag, Ankara, Turkiye Tel. 0505 591 24 40 Email. b_ay_yz@yahoo.com Gelis Tarihi: 08.10.2013 • Kabul Tarihi: 12.02.2014 ABSTRACT Vomiting of infants may result from an ineffi caciously functioning gastroesophageal junction or it may be associated with numerous serious diseases. Segmental bulbus dilatation of duodenum is a very rare gastrointestinal system pathology that can trigger vomiting by causing either motility disorder or gastroesophageal refl ux. In the case here presented, endoscopic examination showed a severely dilated bulbus duodeni with decreased motility. In contrast with the previous cases reported in literature, the condition was treated medically with success.

Background: The purpose of the present paper was to examine whether low birth size is associated with reduced pulmonary function and increased atopic sensitization in preadolescence. Methods: A cohort of 25 small-for-gestational-age (SGA) infants and an age- and sex-matched comparison group of 29 appropriate-for-gestational-age (AGA) infants born in 1993/94 were studied in preadolescence. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and forced expiratory flow when 25–75% of FVC is expired (FEF25–75%) were measured using a spirometer. Atopic sensitization was assessed on serum total IgE levels and skin prick tests (SPT) to common allergens. Results: There were positive correlations among FEV1 (r = 0.30, P = 0.001), FVC (r = 0.20, P = 0.03), and FEF25–75% (r = 0.5, P = 0.001) and ponderal index (PI), although the FEV1/FVC ratio was not correlated with birth size. Mean value of serum total IgE was higher in SGA (106.0 ± 73.4 IU/mL) than AGA children (71.4 ± 67.1 IU/mL; P = 0.02). PI under 10th centile was associated with high IgE levels (P = 0.04, odds ratio, 3.2; 95%CI: 1.0–9.8). The overall prevalence of atopy was 14.8% and there was no significant difference between the groups (P > 0.05). Conclusion: Preadolescents who were born SGA with low birth size compared to controls had reduced pulmonary function. In preadolescence the prevalence of atopy is not higher in SGA than AGA children, although low PI at birth is associated with high IgE levels. Further follow up of this cohort is required to establish the pattern of pulmonary functions and atopic sensitizations in relation to birth size.

Objective To investigate glycohemoglobin (HbAIc) levels in adolescents without diabetes, attending to our Adolescent Day Care Clinic. Subjects and methods We studied on randomly selected 186 subjects aged between 9 and 18 years. HbA1c levels were measured in all subjects and those whose HbA1c levels >95th percentile were invited for oral glucose tolerance test (OGTT). Homeostasis of model assessment (HOMA-IR) value was used to define insulin resistance in subjects who underwent OGTT. Results The median age of all subjects was 11 (min 9–max 18) years and 50.5% were boys. The median HbA1c level was higher in boys (5.2%; min 4.4–max 6.2) than girls (5.0%; min 4.0–max 6.4) ( p = 0.001). Fasting glucose was positively correlated to HbA1c ( r = 0.26, p = 0.001). HOMA-IR values were >2.5 in six subjects and four of them were obese while two had impaired glucose tolerance. In multivariate analysis, it was observed that gender (boy) and high-fasting glucose levels were associated with high-HbA1c levels (OR 1.9, CI 95%: 1.0–3.4, p = 0.02 and OR 1.1, CI 95%: 1.0–1.1, p = 0.001, respectively). Conclusions We believe that routine HbA1c screening is not necessary for adolescents without diabetes. However screening may become desirable in the future at least for obese adolescents.

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

To determine the association between serum 25-hydroxy vitamin D [25(OH)D] levels and acute respiratory tract infections (ALRTI) in newborns.The study group consisted of 30 term newborns with ALRTI who were admitted to our neonatal intensive care unit. Controls were 30 healthy newborns with the same age as the study group. Newborns and their mothers were tested for serum 25(OH)D levels, with a low level defined as ≤15 ng/mL.The groups were similar in gestational week, birthweight, postnatal age and gender. Forty-three of the 60 infants (including study and control) had low 25(OH)D levels. The median 25(OH)D levels were lower [9.5 ng/mL (IQR = 7.9-12.2)] in the study group than those of the control group [15.5 ng/mL (IQR: 12-18)] (p = 0.0001). The median serum 25(OH)D levels in the mothers of the study group were also lower than those in the mothers of the control group [11.6 ng/mL (IQR = 9.4-15.8) and 17.3 ng/mL (IQR = 13.7-20.6), respectively] (p = 0.0001).Lower blood 25(OH)D levels might be associated with increased risk of ALRTI in term newborn babies. Appropriate vitamin D supplementation during pregnancy and early childhood may enhance newborns' respiratory health.

Umbilical vessel catheterization is a common procedure in Neonatal Intensive Care Units, especially in very low birthweight infants. Rarely, umbilical artery catheters break, and the retained fragments can cause thrombosis, infection, distal embolization, and even death. Herein, we describe a neonate with clinically significant bilateral limb ischemia developing after removal of a broken umbilical artery catheter. He was under vasodilator treatment in addition to fibrinolytic and anticoagulants. The evolution was favourable.

Jarcho-Levin sendromu anormal kostovertebral segmentasyon, “yengec seklinde” toraks kafesi gorunumune neden olan ve omurga yapisini etkileyen kostovertebral bileskede kostalarin bilateral komplet fuzyon defektleri ile karakterize konjenital bir sendromdur. Bu sendromun spondilotorasik ve spondilokostal dizostoz olmak uzere iki alt tipi vardir. Spondilotorasik tipte vertebra deformiteleri, spondilokostal tipte ise kosta anomalileri daha sik gozlenir. Jarcho-Levin sendromuna noral tup defektleri, kardiyak, renal ve gastrointestinal anomaliler eslik edebilir. Bu yazida meningomiyelosel ve hidrosefali eslik eden spondilotorasik tip Jarcho-Levin sendromu tanisi alan bir yenidogan olgu nadir gorulmesi nedeniyle literatur bilgileri isiginda sunuldu.

Hydrops fetalis is a serious condition which indicates poor prognosis for the affected fetus. Although the incidence of isoimmune hydrops fetalis has decreased markedly, nonimmune hydrops fetalis cases have been more frequently reported. Nonimmune-mediated hydrops can be caused by hemoglobinopathies. In this report we present a case of nonimmune hydrops fetalis caused by homozygous α-thalassemia. Because of the high incidence of the disease in our country, α-thalassemia should be investigated in all cases with nonimmune hydrops fetalis.None declared.Hidrops fetalis, etkilenen fetüste kötü prognoza işaret eden ciddi bir durumdur. İzoimmün hidrops fetalis görülme sıklığı belirgin olarak azalmakla birlikte, giderek daha fazla sayıda nonimmün hidrops fetalis olgusu rapor edilmektedir. Hemoglobinopatiler nonimmün aracılı hidropsa neden olabilir. Bu makalede, homozigot α-talasemiye bağlı gelişen bir nonimmün hidrops fetalis olgusu sunuldu. Ülkemizde insidansın yüksek olması nedeniyle nonimmünhidrops fetalisli tüm olgularda α-talasemi araştırılmalıdır.

Multiple pregnancies are characterized by significantly higher rates of intrauterine and perinatal morbidities and fetal death compared to singleton pregnancies. It is well known that the death of a co-twin during the second and third trimester can cause damage in the other fetus. Here we report two newborn cases presenting with renal failure probably caused by intrauterine death of their co-twins shortly before birth.

To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants.A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination. The control group (Group 2, n = 56) received the same volume of sterile water per oral with an opaque syringe. Primary outcome measurement was pain assessed by Premature Infant Pain Profile (PIPP) score. Secondary outcome measurements were tachycardia (180 bpm)/bradycardia (100 bpm), desaturations (85% for10 s), and crying time.The groups were similar for gestational age, birthweight or postnatal age at examination. The intervention group had a significantly lower mean PIPP score during eye examination, following insertion of the speculum [Group 1:12 (9-13) vs. Group 2:14 (13-15), p 0.001]. There were no significant differences between the groups with regard to crying time and the number of the patients with tachycardia/bradycardia and desaturation.Oral paracetamol modestly reduces pain scores during eye examinations. Further cross-over trials on dose and frequency of paracetamol and combination of pharmacological with non-pharmacological approaches and paracetamol alone as a single agent in significant pain reduction are needed.

Objective To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low-birth-weight (VLBW) infants. Study Design A prospective randomized controlled trial was conducted on 42 infants who were divided into two groups, poractant alfa ( n = 21) and beractant ( n = 21). Results In both the groups, the mean standard deviation (SD) birth-weight and gestational age were similar ( p = 0.33 and 0.89, respectively). Although, the mean oxygenation index (OI) increased after pulmonary hemorrhage compared with baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group (before hemorrhage: 11.9, after hemorrhage: 22.7, 1 hour of surfactant: 14.6, 8th hour of surfactant: 7.8, 24th hour of surfactant: 8.5, p = 0.007 vs. before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, 1 hour of surfactant: 12.8, 8th hour of surfactant: 12.8, 24th hour of surfactant: 9.7, p = 0.02). There was no significant difference between the groups for OI values at all time points ( p > 0.05). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in both the groups. Conclusion Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.

Objective The objective of this study was to investigate the relationship between cord blood 25-hydroxyvitamin D (25(OH)D) levels and respiratory distress syndrome (RDS) development in preterm infants. Study Design Between January 2012 and January 2013, 81 preterm infants, gestational age below 32 weeks, were prospectively enrolled into the study. Cord bloods of these newborns were tested for 25(OH)D levels. Low level was defined as ≤ 15 ng/mL (Group 1) and normal level as > 15 ng/mL (Group 2). Patients in Group 1 were also divided further into two subgroups as severe deficiency (Group 1a, ≤ 5 ng/mL) and mild deficiency (Group 1b, 5–15 ng/mL). Results In this study, 57 infants had low 25(OH)D levels (Group 1, median 8.0 ng/mL [interquartile range, IQR, 5–10]; Group 2, median 21 ng/mL [IQR, 19–24.7]). RDS rate was significantly higher in Group 1a ( n = 18, 32.7%) and Group 1b ( n = 34, 61.8%) compared with Group 2 ( n = 3, 5.4%) ( p = 0.001). There were no difference of having RDS between Group 1a (94.7%) and Group1b (89.5) ( p = 0.512). Multivariate analysis showed that higher 25(OH)D level can be preventive for the development of RDS (odds ratio, 0.6; 95% confidence interval (0.5–0.8); p = 0.001). Conclusion Lower cord blood 25(OH)D levels might be associated with increased risk of RDS in preterm infants with very low birth weight.

Hypoxic ischemic encephalopathy (HIE) is an important cause of permanent injury of central nervous system leading to neonatal death, cerebral palsy and developmental delay. Whole-body cooling therapy is the only effective treatment for HIE today. Subcutaneous fat necrosis during cooling period is rarely seen. A female newborn was born to 33-year-old gravida three parity two mother at 39 weeks of gestation by an emergent cesarean section due to fetal distress. The pregnancy course was complicated with gestational diabetes mellitus, mother received insulin therapy during the last trimester. On admission, she had abnormal neurological findings including hypotonia and absent neonatal reflexes. The patient was treated with postnatal hypothermia in the sixth hour of the method of whole body cooling. Forty-eight hours of treatment, subcutaneous fat necrosis was diagnosed and on the follow-up, the patient developed hypercalcemia and treated with pamidronate. Postnatal twenty-fifth day, patient was discharged with normal physical and neurological examination. Subcutaneous fat necrosis is a rare condition that can be seen during hypothermia period. Close monitoring of these patients because of hypercalcemia risk is important during follow-up., Hipoksik iskemik ensefalopati (HİE), neonatal ölüm, serebral palsi ve ileri dönemde gelişimsel gerilikle sonuçlanabilen merkezi sinir sisteminin kalıcı hasarının önemli bir sebebidir. Tüm vücut soğutma tedavisi HİE'de günümüzdeki tek etkin tedavi yöntemidir. Tüm vücut soğutmaya bağlı subkutan yağ nekrozu gelişimi nadir görülen bir yan etkidir. Otuz üç yaşındaki annenin 3. gebeliğinden 2. yaşayan olarak sezaryen ile 3500 gram olarak doğan kız bebek postnatal 4. saatinde solunum sıkıntısı, hipotonisite ve konvülsiyon nedeni ile yenidoğan yoğun bakım ünitesine (YYBÜ) kabul edildi. Öyküden, annenin gestasyonel diyabet nedeni ile gebelikte son trimesterde insülin tedavisi aldığı öğrenildi. YYBÜ'ne kabulde, hasta entübe, genel durumu kötü ve hipotonikti. Hastaya postnatal 6. saatinde tüm vücut soğutma yöntemiyle hipotermi tedavisi başlandı. Tedavinin 48. saatinde subkutan yağ nekrozu ile uyumlu lezyonları gelişen hastanın izlemde hiperkalsemisi gelişti ve pamidronat tedavisinden fayda gördü. Hasta genel durumu iyi, lezyonları iyileşmiş ve nörolojik muayenesi normal olarak postnatal 25. günde taburcu edildi. Hipotermi tedavisinin komplikasyonları arasında subkutan yağ nekrozu nadir görülen bir durumdur. Subkutan yağ nekrozu genellikle kendiliğinden iyileşen bir patoloji olmakla birlikte hiperkalsemi riski nedeniyle hastaların yakından izlenmesi önemlidir.

To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2).The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P.001). The times to reach full enteral feeding were faster (P.001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6).In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.

Aim: To determine the sociodemographic and behavioral characteristics of adolescents who attempt suicide and evaluate them by different scales. Materials and methods: The study was conducted with 116 adolescent suicide attempters and 98 age-matched healthy controls. Results: The mean age of all adolescents was 13.8 1.2 years, with ages ranging from 11 to 16 years. Of these adolescents, 82.7% were girls. The total Suicide Probability Scale score was negatively correlated with the total Reasons for Living Inventory (r =-0.42, P = 0.001) and positively correlated with the Problem Solving Inventory score, which is indicative of low problem-solving capabilities (r = 0.46, P = 0.001). Logistic regression analysis showed that higher suicidal probability scores among adolescents were associated with previous suicide attempts (P = 0.01, OR = 2.0, CI 95%: 1.0-3.5). Conclusion: The greater the Suicide Probability Scale score, the higher the probability of suicide and the lower the problem-solving capability. It is possible that having had a previous suicide attempt is the most important risk factor for a future suicide attempt. Cooperation among family, school, and psychological professionals may help reduce the attempted suicide rate, especially among female adolescents. - - - Amac: Ozkiyim girisiminde bulunan ergenlerin sosyodemografik ve davranissal ozelliklerinin belirlenmesi ile birlikte farkli olceklerle degerlendirilmeleri amaclandi. Yontem ve gerec: Calisma ozkiyim girisiminde bulunan 116 ergen ve benzer yastaki 98 saglikli denek uzerinde yapildi. Bulgular: Tum ergenlerin ortalama yasi 13,8 ± 1,2 yil olup yas araligi 11-16 yil arasinda idi. Olgularin % 82,7'si kiz idi. Intihar Olasiligi Olcegi skoru ile Yasami Surdurme Nedenleri envantari arasinda olumsuz yonde (r = -0,42; P = 0,001), problem cozme yetenegi dusuklugunun gostergesi olarak Problem Cozme Envanteri arasinda ise olumlu yonde bir iliski vardi (r = 0,46, P = 0,001). Logistik regresyon analizinde daha once ozkiyim girisiminde bulunulmasinin Intihar Olasigi Olcegi skorunu artirdigi gosterildi (P = 0,01; OR = 2,0; CI % 95: 1,0-3,5). Sonuc: Intihar olasigi Olcegi skoru arttikca intihar olasiligi artmakta ve problem cozme yetenegi azalmaktadir. Bir sonraki ozkiyim girisimi icin en onemli hazirlayici etmen daha once ozkiyim girisiminde bulunulmasidir. Aile, okul ve psikoloji uzmanlari arasindaki iletisim ozellikle kiz ergenler arasinda ozkiyim girisimini azaltmaya yardimci olabilir. Anahtar sozcukler: Ergen, ozkiyim girisimi, hazirlayici etmenler, olcekler

Hypoxic-ischemic encephalopathy (HIE) due to perinatal asphyxia remains an important cause of neonatal morbidity and mortality. The aim of this study was to investigate the predictive values of biochemical parameters, including serum creatine kinase (CK), lactate dehydrogenase (LDH), uric acid (UA), and lactate, in newborns with HIE. A total of 94 patients who were diagnosed with HIE were prospectively enrolled into the study. According to the Sarnat and Sarnat classification, 29 (30.9%) patients had Stage I, 36 (38.3%) Stage II, and 29 (30.9%) Stage III HIE. When CK, LDH, UA, and lactate were used together in order to determine the stage of HIE, specificity and sensitivity were calculated to be 87% and 94%, respectively. Measurement of serum CK, LDH, lactate, and UA levels together is a promising method in determining the stage of hypoxia in the laboratory before clinical manifestations occur so that hypothermia treatment can be initiated earlier.

Herbs have been used for centuries to prevent and control many diseases. The biggest challenge and problem is lack of information about the effect of herbs and its side effects. Thyme (thymus vulgaris) is a small shrubby plant with a strong, spicy taste, and odor. Thyme has carminative, diaphoretic, expectorant, sedative, antibacterial and antifungal properties. It also has antispasmodic effects; tea made by infusing the herb in water or thyme juice ready-to-use is traditionally frequently used for infantile colic in our country. A fourteen-day-old male newborn was admitted to the emergency department with severe respiratory distress. There was a history of 50 mL of thyme juice (added table sugar) ingestion given for his infantile colic two hours before admission. He had hypoglycemia, hyperuricemia, and lactic acidosis. Further investigation confirmed fructose 1-6 diphosphatase deficiency in the patient. We thought that lactic acidosis may have been triggered by fructose added to the thyme water to sweeten its taste. However, phenolic compounds of thyme juice may also cause acidosis.

BACKGROUND: Near drowning is the term for survival after suffocation caused by submersion in water or another fluid. Pulmonary insufficiency may develop insidiously or suddenly because of near drowning. AIM: We want to present a newborn case of acute respiratory distress syndrome caused by near drowning. CASE: A 26-day-old boy was brought to the emergency department because of severe respiratory distress. Two hours before admission, the baby suddenly slipped out his mother's hands and fell in the bathtub full of water while bathing. After initial resuscitation, he was transferred to the neonatal intensive care unit for mechanical ventilation. PaO2/FIO2 ratio was 97, with SaO2 of 84%. Bilateral heterogeneous densities were seen on his chest x-ray film. The baby was considered to have acute respiratory distress syndrome. Antibiotics were given to prevent infection. Because conventional therapy failed to improve oxygenation, a single dose of surfactant was tested via an intubation cannula. Four hours later, poractant alfa (Curosurf) administered repeatedly at the same dosage because of hypoxemia (PaO2/FIO2 ratio, 124; SaO2, 88%). Oxygen saturation was increased to more than 90% in 24 hours, which was maintained for 3 days when we were able to wean him from mechanical ventilation. After 7 days, the x-ray film showed considerable clearing of shadows. He was discharged home on the 15th day after full recovery. CONCLUSIONS: This case report describes a rapid and persistent improvement after 2 doses of surfactant in acute respiratory distress syndrome with severe oxygenation failure caused by near drowning in a newborn. Language: en

Objective The objective of this study was to compare the perfusion index (PI) variability in premature infants with respiratory distress syndrome (RDS) following administration of two different natural surfactant preparations. Study design This was a prospective study on 92 preterm infants with RDS. Patients were randomized into two groups. Group 1 ( n = 46) received beractant; Group 2 ( n = 46) received poractant alfa. Oxygen saturation, PI, and heart rate were measured by Masimo Rainbow SET Radical-7 pulse oximeter (Masimo Corp., Irvine, CA) before and after surfactant. The effects of the two treatment regimens on PI and oxygenation were compared. Results Repeated doses were more needed in beractant group ( p = 0.04). Median oxygenation index (OI) before surfactant were similar, but improvement in OI was more prominent at 6th hour of surfactant in Group 2 ( p = 0.001). Both groups had similar preductal PI values before surfactant. PI was higher at 6th hour of surfactant in Group 2 ( p = 0.001). Pulmonary hemorrhage, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, and mortality were more frequent in infants whose PI values lower than 0.7 within the first 5 days of life ( p = 0.001). Conclusion Poractant alfa resulted in more prominent improvement in PI and OI. Low PI values measured at early postnatal period may predict poor clinical outcome in preterm infants with RDS.

Newborns with jaundice requiring or not requiring phototherapy (PT) are at greater risk of developing asthma later in life. In this study, we investigated the effect of PT treatment on eosinophil and eosinophilic cationic protein (ECP) levels in newborns with severe hyperbilirubinemia. Thirty newborns diagnosed with severe hyperbilirubinemia and exposed to light-emitting diode (LED) PT were enrolled into the study. Total serum bilirubin (TSB) levels, complete blood count and serum ECP concentrations were measured before and after PT. TSB and hemoglobin (Hb) counts were lower after PT (p = 0.001). There was no difference between leukocyte, lymphocyte, neutrophil and platelet count before and after PT. Eosinophil levels were increased after PT, although not significantly. ECP levels were higher after PT (p = 0.006). It may be speculated that newborns treated with LED PT, increased ECP might play a role in developing allergic diseases later in life.

Cataract may cause visual loss especially in the newborn period if early and urgent intervention is not managed. Approximately 1/3 of cases are congenital, 1/3 are related with systemic diseases and the remaining 1/3 are idiopathic or sporadic. The prevalence of congenital cataract in developed countries is estimated as 1 - 3 per 10,000 live births. There are a number of medicines besides systemic and infectious diseases which may cause cataract. Linezolid is a member of the oxazolidinone antibiotic family which can be used in serious infections caused by vancomycin resistant E. faecium (VRE), methicillin resistant S. aureus (MRSA), methicillin resistant coagulase negative staphylococci and penicillin resistant S. pneumonia in infants and children. Side effects are reported as diarrhea, vomiting, headache, transaminase elevation, rashes and optic neuropathy. Herein, we report a preterm newborn who developed thrombocytopenia and bilateral cataracts during linezolid therapy and relieved one week after the discontinuation of the therapy.

Background Nosocomial blood stream infections (NBSI) are a significant hazard in health care facilities, exacting a tremendous toll and causing increased morbidity, mortality, and increased length of hospital stay and health care costs. Methods In this article, we report the results of a retrospective cohort study to describe the epidemiology of pseudomonas NBSI in infants admitted to one Turkish neonatal intensive care unit (NICU) during the 5-year period 2006-2010. In this period, Pseudomonas spp. were isolated from the blood cultures of 28 patients. Results Pseudomonas putida (n = 12) was a causative microorganism at 42.8% of these infants, while Pseudomonas aeruginosa (n = 9) was determined in 32%. Sixty-five percent (n = 18) of the infants were below 32 weeks. The median age at diagnosis was 7 days (4-16). Mechanical ventilation (> 48 hours) rate was 89.2% (n = 25) and umbilical catheterization rate (> 48 hours) was 29.2% (n = 9). Imipenem resistance was detected in 53.5% (n = 15) of all cases. Median length of hospital stay was 15 days (8-29) with a mortality rate of 28%. Five of the infants who died had associated disorders such as Di George syndrome, anal atresia, necrotizing enterocolitis, and respiratory distress syndrome. Conclusions We may say that pseudomonas infections are still an important cause of nosocomial sepsis and mortality in NICUs. Low birth weight and invasive procedures may be predisposing factors for pseudomonas infections. Mortality was associated with underlying disorders.

Jarcho-Levin syndrome is a congenital disorder characterized by abnormal vertebral segmenta-tion, defects affecting spine formation with complete bilateral fusion of the ribs at the costover-tebral junction producing a “crab-like” configuration of the thorax. This syndrome is composed of two subgroups: spondylothorasic and spondylocostal dysostosis. While vertebral deformities are frequent in spondylothorasic type, costal abnormalities are common in spondylocostal type. Jarcho-Levin syndrome may be associated with neural tube defects, cardiac, renal, and gastroin-testinal anomalies. In this report, a newborn diagnosed to be Spondylothorasic type Jarcho -Levin syndrome and associated with meningomyelocele and hydrocephalus was presented with litera-ture highlight because of its rarity.

Introduction: Respiratory syncytial virus (RSV) is a major cause of pneumonia in infants worldwide. We aimed to evaluate the clinical course of community-acquired RSV pneumonia in newborns hospitalized in neonatal intensive care unit. Materials and Methods: All the newborns diagnosed as pneumonia were prospectively evaluated for RSV infection between November 2010 and April 2011. Fifty-four specimens of nasopharyngeal secretions were tested in parallel with the RAT and the multiplex real time polymerase chain reaction (RT- PCR). Downes’ score was used to assess the disease severity in patients with pneumonia. Results: RAT has a sensitivity of 90% and a specificity of 78.5%, as the PCR technique target assay. Four of the patients with RSV pneumonia had secundum atrial septal defect (ASD) and all of four needed mechanical ventilation support. The first day Downes’ score was positively correlated with time of intravenous fluid requirement (p= 0.001, r= 0.48), total oxygen need (p= 0.000, r= 0.63), and re-enteral feeding (p= 0.001, r= 0.46). Blood pH (p= 0.031, r= 0.46) were negatively correlated with Downes’ score. The second day Downes’ score was higher in patients with ASD than those of without ASD (3.8 ± 2.6 vs. 2 ± 1.1, p= 0.01). The most possible risk factor for longer hospital stay was the higher second day Downes’ score (p= 0.02 OR: 1.9, CI 95% (1.1-3.2). All infants were discharged from hospital in a good health. Conclusion: RAT is sensitive and specific in detecting RSV infections in newborns. Physicians may use Downes’ score for evaluation of disease severity in infants with RSV pneumonia. In these patients, ASD has increased the disease severity.

Brucellosis is a zoonosis caused by ingestion of unpasteurized milk or other dairy products from infected animals or through close contact with their secretions. Human-to-human transmission, which is rare, has been reported in association with blood transfusion, bone marrow transplantation, transplacental or perinatal exposure, and breastfeeding. In the neonatal period, congenital brucellosis, which is an extremely rare condition, can lead to serious clinical consequences with a high morbidity and mortality rate. The case presented here is a premature baby born at 25 weeks' gestation to a mother suffering from severe oligohydramnios, premature rupture of membranes and untreated acute brucellosis. The baby had severe respiratory distress and radiological findings compatible with pulmonary infection. The blood cultures of the baby and the mother were positive for Brucella melitensis, supporting the diagnosis of brucellosis with presumed transplacental transmission.

No abstract available

Neu-Laxova syndrome is a rare lethal congenital disorder involving multiple systems. Intrauterine growth retardation, ichthyosis, microcephaly, abnormal facial findings, and limb contractures are its key features. We present a case of Neu-Laxova syndrome in a male appropriate for gestational age (AGA) newborn with characteristic features including ichthyosis, microcephaly, severe ectropion, rudimentary ears, eclabion, limb contractures, and hypoplastic genitalia. The patient was born at 38 weeks of gestation to consanguinous Turkish parents. The mother was a 20-year-old primi gravida with lack of prenatal follow-up. Therefore, the case was diagnosed postnatally, and he died 5 days later. Because of the autosomal recessive inheritance of Neu-Laxova syndrome, in countries with high rates of consanguineous marriage, such as Turkey, physicians have to know this syndrome, and serial prenatal ultrasound examinations with genetic counseling should be performed on pregnant women at high risk. To the best of our knowledge, this is the first case described in an AGA newborn.

Introduction Ammonia is an important chemical agent used in industry. Accidental inhalation of ammonia has resulted in upper airway and bronchoalveolar injury. If a large amount of ammonia is breathed, the agent can cause unconsciousness, shock and even death. Case In this article, we report a case of non-accidental poisoning in adolescence. The patient was a 14-year-old boy and working as an apprentice at a workshop of a jeweller. He had drunk some amount of diluted ammonia by the force of another, 18-year-old, male apprentice. This patient presented with ammonia intoxication symptoms culminating in coma. Conclusions We reported this case as an unusual ammonia poisoning seen in adolescence.

Background The aim of this study was to evaluate the features and outcome of classic galactosemia diagnosed in the neonatal period. Methods A retrospective study was carried out on 22 newborns with classic galactosemia who were followed-up in a tertiary neonatal intensive care unit from January 2005 to January 2011. Results During the study period, 22 (18 boys, 4 girls) newborns were diagnosed with classic galactosemia. The median gestational age was 38 weeks (31 - 42) with a median age of 13 (3 - 23) days on admission. Major presenting symptoms were hepatomegaly (n = 22, 100%), jaundice [n = 19, 86%; including (n = 14, 63%) indirect and (n = 8, 36%) direct hyperbilirubinemia], vomiting (n = 17, 77%), and nuclear cataract (n = 15, 68%). Liver dysfunction (n = 22, 100%), Escherichia coli sepsis (n = 10), purpura fulminans (n = 1), hemophagocytosis (n = 1), and long QT syndrome (n = 1) were also noted. Cataract resolved in 11 (73%) patients with galactose-restricted diet in the first months. Four patients were operated for cataracts. Neurodevelopmental evaluation showed mild psychomotor retardation in one patient, learning disabilities in five, and developmental delay in three. None died from galactosemia or its complications. Patients who were diagnosed before 17 days did not require cataract operation. Conclusions Early diagnosis of galactosemia and treatment with a galactose-restricted diet could partially prevent and recover complications of the disease, but not all of them. Cataracts can develop even in the first few weeks of life. Early diagnosis seems important in the prevention of severe cataracts. Therefore, newborn screening for galactosemia should improve morbidity.