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OBJECTIVE To investigate the effect of surgery time on prognosis of newborns with meningomyelocele. METHODS The records of neonates with meningomyelocele were retrospectively analyzed. Demographic and clinical characteristics as well as information, timing of surgery, and durations of hospital stay and antibiotic therapy were recorded. RESULTS The records of 30 babies were included in the final analysis. Overall, the mean gestational age was 37.7±2.7 weeks, with a mean birth weight of 2967±755 g and head circumference of 35.8±3.8 cm. In terms of localization, 46.6% of the meningomyeloceles were lumbosacral, 40% were lumbar, 10% were thoracolumbar and 3.3% were thoracal. The mean size of the meningomyelocele sacs was 4.33±1.2 cm. Newborns underwent surgery on average of 8.2±5.9 days after birth, with an overall mean duration of hospital stay of 30±25.1 days. Patients were divided into two groups based on timing of surgery (group 1, ≤5 days; group 2, >5 days), and comparisons between groups revealed that earlier surgery was associated with significantly shorter durations of hospital stay (p

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.

Objective To evaluate the growth and neurodevelopment outcomes of very low-birth-weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC). Study Design This prospective follow-up study was conducted in a cohort of VLBW preterm infants enrolled in a randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Growth outcomes included weight, length, and head circumference. Cognitive and neuromotor development were assessed by using the Bayley Scales of Infant Development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18 to 22 months' corrected age. Results A total of 221 infants completed the trial protocol. Of the 208 infants eligible for follow-up, 174 infants (86 in the probiotics group and 88 in the control group) were evaluated. There was no significant difference in growth and neurodevelopmental outcomes between the two groups. Conclusion Oral probiotic administered to VLBW infants to reduce the incidence and severity of NEC started with the first feed did not affect growth, neuromotor, neurosensory, and cognitive outcomes at 18 to 22 months' corrected age.

Transient tachypnea of the newborn (TTN) is a consequence of inadequate neonatal lung fluid clearance. Natriuretic peptides play an important role in the regulation of extracellular fluid volume. The aim of the study was to investigate the relation between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and TTN, and to find out its role in predicting disease severity.A prospective controlled study involving 67 infants with TTN and 33 controls ≥34 weeks gestational age was conducted. Study and control groups were compared for plasma NT-proBNP levels measured on the 6th, 24th, 72nd and 120th hours of life. Cardiac systolic functions were evaluated by echocardiography.NT-proBNP levels were significantly higher in neonates with TTN compared to controls at 6th, 24th, 72nd and 120th hours (p0.001). NT-proBNP levels at 24th and 72nd hours were significantly higher in infants with prolonged tachypnea (p=0.007 and p=0.03) and in those who required respiratory support (p=0.006 and p0.001). Tachypnea duration was correlated with NT-proBNP levels at 24h (r=0.41, p=0.001). At a cut-off value of 6575 pg/ml, NT-proBNP had a sensitivity of 85% and specificity of 64% to predict mechanical ventilation requirement. Cardiac systolic functions were normal in all TTN patients.Plasma NT-proBNP levels are increased in neonates with TTN. Measurement of plasma NT-proBNP can be useful for predicting infants who will have prolonged tachypnea and mechanical ventilation requirement.

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.

To document the practice of labour in water, to assess the effects of water immersion during labor and/or birth (labour stages 1, 2 and 3) on maternal, fetal and neonatal wellbeing and to compare the outcomes and safety with conventional vaginal deliveries and deliveries with epidural analgesia.Two-hundred and seven women electing for waterbirth (n=207) were compared with women having conventional vaginal deliveries (n=204) and vaginal deliveries with epidural analgesia (n=191). Demographic data, length of 1(st), 2(nd) and 3(rd) stage of labor, induction and episiotomy requirements, perineal trauma, apgar scores, NICU requirements and VAS scores were noted.The 1(st) stage of labor was shorter in waterbirths compared with vaginal delivery with epidural analgesia but the 2(nd) and 3(rd) stage of labor were shortest in patients having waterbirth compared with conventional vaginal delivery and vaginal delivery with epidural analgesia. Patients having waterbirth had less requirement for induction and episiotomy but had more perineal laceration. All women having waterbirths had reduced analgesia requirements and had lower scores on VAS. There was no difference in terms of NICU admission between the groups. Apgar scores were comparable in both groups. There were no neonatal deaths or neonatal infections during the study.The study demonstrates the advantages of labor in water in terms of reduction in 2(nd) and 3(rd) stage of labor, reduction in pain and obstetric intervention such as induction or amniotomy.Suda doğum pratiğinin dökümentasyonu ve doğum travayı ve/veya doğum eylemi (doğumun birinci, ikinci ve üçüncü evresi) sırasında maternal, fetal ve yenidoğan iyilik hali üzerine etkilerini değerlendirerek, sonuçları ve güvenirlilik açısından epidural analjezi ile vajinal doğum ve konvansiyonel vajinal doğum sonuçları ile kıyaslanması.Suda doğum yapan ikiyüzyedi (n=207) kadın, konvansiyonel vajinal doğum yapan (n=204) ve epidural analjezi ile vajinal doğum yapan (n=191) kadınlarla kıyaslandı. Hastaların demografik verileri, doğum eyleminin 1., 2. ve 3. evresinin uzunluğu, indüksiyon ve epizyotomi ihtiyacı, perine travması, yenidoğanın apgar skorlaması, yoğun bakım ihtiyacı ve VAS skorları değerlendirildi.Konvansiyonel vajinal doğum ve epidural analjezi ile vajinal doğum yapanlarla kıyaslandığında suda doğuranlarda, doğumun 1. evresi kısalmakla birlikte özellikle 2. ve 3. evrelerin çok kısalmış olduğu görüldü. Suda doğum yapan hastalarda oksitosin ihtiyacı belirgin olarak daha azdı, epizyotomi oranı da daha düşüktü fakat daha fazla perineal laserasyon saptandı. Suda doğum yapan kadınların hepsinde analjezi ihtiyacı azalmıştı ve VAS skorları düşüktü. Gruplar arasında yenidoğan yoğun bakım ihtiyacı açısından fark yoktu. Apgar skorları benzerdi. Çalışma dönemi boyunca hiç yenidoğan ölümü veya yenidoğan enfeksiyonu saptanmadı.

Subcutaneous fat necrosis is an inflammatory disorder of adipose tissue. Although patients need long-term follow-up to prevent hypercalcemia, the prognosis is generally favorable. We herein present a case of a newborn who developed subcutaneous fat necrosis–related hypercalcemia after hypothermia treatment for hypoxic ischemic encephalopathy. Widespread use of hypothermia treatment for hypoxic ischemic encephalopathy in the neonatal intensive care unit may increase the risk of developing subcutaneous fat necrosis and subsequently hypercalcemia. Great care should be taken to recognize skin findings early in newborns receiving hypothermia treatment, and those diagnosed with subcutaneous fat necrosis require close follow-up because they are at risk for developing hypercalcemia.

Intrauterine ischemia of the limbs is a rare condition involving thrombosis and ischemia of the extremities before birth. The clinical presentation depends on the extremity affected as well as the timing of thrombosis. Very few cases with extremity hypoperfusion and gangrene due to intrauterine thrombosis have been reported in the literature, and therefore there is no consensus on the optimal therapeutic strategy for such cases. Presented here is a case of a newborn with intrauterine brachial arterial thrombosis of the right upper extremity who was successfully treated by a combination of recombinant tissue plasminogen activator, enoxaparin and collagenase application followed by surgery.

Background: Bronchopulmonary dysplasia (BPD) is characterized by inflammation, fibrosis and mucosal necrosis, which leads to emphysematous coalescence of alveoli. Objective: We tested whether prophylaxis with colchicine , an anti-inflammatory, antioxidant and antifibrotic drug, would decrease the severity of lung injury in an animal model of BPD. Methods: Twenty-five rat pups were divided into three groups: control (n = 8), hyperoxia (n = 7), and hyperoxia + colchicine (n = 10). The hyperoxia groups were exposed to >95% oxygen from day 1 to 10 of life. On day 10, the animals were sacrificed and the lungs were processed for histology and biochemical analysis. Lung morphology was assessed by the mean linear intercept (MLI), a measure of alveolar size. The degree of lung inflammation and antioxidant capacity were assessed by quantifying lung homogenate tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels. Results: Colchicine significantly decreased lung damage as determined by the MLI in the hyperoxia groups (p < 0.01). The median level of lung MDA was significantly higher in the hyperoxia group compared with the control group (p < 0.05) and the colchicine-treated group (p < 0.05). Lung homogenate SOD and GSH-Px activities in the colchicine-treated group were significantly higher than in the hyperoxia group (p < 0.05). Furthermore, colchicine-treated pups had lower lung homogenate TNF-α and IL-1β levels compared with the hyperoxia group (p < 0.05). Conclusions: Colchicine has favorable effects on alveolarization as well as inflammation and oxidative stress markers in an animal model of BPD.

Introduction: While the routine administration of Rhesus immunoglobulin has significantly reduced the incidence of this type of alloimmunization, maternal alloimmunization to other red cell antigens continues to contribute to perinatal morbidity and mortality. Although the Kell antigen is found on the red cells of only 9% of the population, attention has increasingly been focused on Kell antibodies. Case Report: We present a case of fetal hydrops who was sonographically detected at 30th week of pregnancy. Antenatal tests for evaluation of fetal condition clearly showed the critical level of hemolytic disease but the baby was delivered prematurely due to fetal distress. The combination of anemia, reticulocytopenia, hydrops fetalis, and positive indirect Coombs test suggested Kell isoimmunization. The baby was treated by exchange transfusion with the Kell-negative packed red cell succesfully, and was discharged on postnatal 30th day. Conclusion: Here we describe a case of hydrops fetalis caused by Kell alloimmunization that was determined in postnatal period, and thus we plan to discuss the perinatal approach to the Kell immunization.

The Coulter LH780 hematology analyzer can evaluate mean neutrophil volume (MNV), conductivity (MNC), scatter (MNS), and distribution width (DW). We sought to investigate the value of volume, conductivity, and scatter (VCS) parameters in diagnosis and treatment efficacy of neonatal sepsis.We observed significant increases in MNV, volume distribution width (VDW), conductivity distribution width (CDW), and significant decreases in MNC and MNS in septic newborns. There were significant decreases in MNV, VDW, and CDW, whereas MNC and MNS increased at the end of the treatment. Gram-negative sepsis caused higher MNV and VDW than Gram-positive sepsis.This is the largest reported study seeking to determine cutoff levels of neutrophil VCS parameters in diagnosis of sepsis, and the first study in the evaluation of treatment efficacy and the effects of sepsis onset time and birth weight. We suggest that neutrophil VCS parameters and their DWs are useful both for early diagnosis and evaluation of treatment efficacy in neonatal sepsis without requirement for any extra blood collection.Peripheral blood samples from 304 newborns, 206 in group I (76 proven and 130 clinical sepsis) and 98 in group II (control group), were studied on diagnosis, 3rd day, and at the end of the treatment.

Background/Aim: To evaluate the association between the cortisol levels and clinical outcomes in preterm infants. Methods: Baseline adrenocorticotropic hormone (ACTH) and cortisol levels and ACTH-stimulated cortisol concentrations after low-dose synthetic ACTH (Synacthen®, 1 µg/kg) were measured in preterm infants Results: Ninety-eight preterm infants were enrolled. Median baseline cortisol and ACTH levels were 13.7 µg/dl (25th-75th percentile, 9.7-21.1 µg/dl) and 11.5 pg/ml (25th-75th percentile, 6.9-22.6 pg/ml), respectively. Median peak cortisol level after ACTH stimulation was 33.6 µg/dl (25th-75th percentile, 27.2-40.2 µg/dl). The prevalence of relative AI, defined as baseline cortisol Conclusion: Neither baseline nor ACTH-stimulated cortisol levels were associated with clinical outcomes in preterm infants. A significant proportion of preterm infants hospitalized in the neonatal unit fulfilled the criteria for relative AI; however, relative AI did not affect outcome.

OBJECTIVE: To evaluate the efficacy and safety of clarithromycin treatment in preventing bronchopulmonary dysplasia (BPD) in Ureaplasma urealyticum–positive preterm infants. PATIENTS AND METHODS: Nasopharyngeal swabs for U urealyticum culture were taken from infants with a birth weight between 750 and 1250 g in the first 3 postnatal days. Infants with a positive culture for U urealyticum were randomly assigned to 1 of 2 groups to receive either intravenous clarithromycin or placebo. All the patients were followed at least up to the 36th postmenstrual week. RESULTS: A total of 224 infants met the eligibility criteria of the study. Seventy-four (33%) infants had a positive culture for U urealyticum in the first 3 day cultures. The rate of BPD development was significantly higher in patients with U urealyticum positivity (15.9% vs 36.4%; P < .01). However, multivariate logistic regression analysis failed to reveal a significant association between the presence of U urealyticum and BPD development (odds ratio: 2.4 [95% confidence interval: 0.9–6.3]; P = .06). Clarithromycin treatment resulted in eradication of U urealyticum in 68.5% of the patients. The incidence of BPD was significantly lower in the clarithromycin group than in the placebo group (2.9% vs 36.4%; P < .001). Multivariate logistic regression analysis confirmed the independent preventive effect of clarithromycin for the development of BPD (odds ratio: 27.2 [95% confidence interval: 2.5–296.1]; P = .007). CONCLUSIONS: Clarithromycin treatment prevents development of BPD in preterm infants who are born at 750 to 1250 g and colonized with U urealyticum.

We aimed to determine applicable guidelines for screening of retinopathy of prematurity (ROP), and evaluate the contribution of risk factors for severe ROP.A prospective cohort study of neonates with a gestational age (GA)34 weeks or birth weight2000g who were admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary level hospital was conducted. The study group was classified into three groups according to eye examination findings as no ROP, mild ROP and severe ROP.Of the 700 neonates screened, the frequencies of ROP for any stage and severe ROP were 32.7% and 3.1%, respectively. Laser photocoagulation was needed in 9.6% of neonates with ROP. None of the neonates with a GA ≥ 31 weeks required treatment. Any ROP was detected in 199 (53.6%) of the babies32 weeks (n = 371), 22 (5.9%) of whom were treated with laser photocoagulation. Independent risk factors for severe ROP in babies32 weeks GA were birth weight, duration of mechanical ventilation and patent ductus arteriosus (PDA).This is the largest prospective cohort study including infants younger than 34 weeks GA from Turkey. Our data which belongs to the last 1-year period shows lower incidence of severe ROP when compared to previous reports from Turkey. According to our data, screening babies smaller than 32 weeks GA or 1500g birth weight seems reasonable. In the presence of long duration of mechanical ventilation and PDA, screening should be intensified.

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.

Our purpose was to reach the reasons of isolated low levels of maternal serum unconjugated estriol (uE3) levels (≤ 0.3 multiples of the median (MoM)) in the triple-marker screen with special emphasis on maternal diseases and medications used for them.Single center retrospective cross-sectional analysis. Of 13,367 non-smoking women with identified singleton pregnancies screened for triple test, during 3-year period (2007-2009), a group of women with isolated low serum uE3 levels (≤ 0.3 MoM) (n = 14) were selected as the study group.Of these 14 women, no one gave birth with ichthyosis. Five patients had, isolated very low uE3 levels (0.01 MoM). Of these women, one had umbilical cord knot, one was on corticosteroid and three were on propylthiouracil treatment. So, there was history of maternal drug intake in 28.5% of cases with isolated low uE3 (≤ 0.3 MoM). This rate increases to 80% in cases with very low uE3 levels (0.01 MoM).Maternal diseases and medications used during pregnancy can affect fetus and antenatal screening test results. This is important during counseling of patients and to perform the appropriate antenatal and postnatal evaluation of the mother and fetus with multidisciplinary approach.

Background Oxidative damage is important in the pathogenesis of respiratory distress syndrome (RDS). However, data on the effect of surfactant therapy on oxidative stress in vivo are limited. We aimed to evaluate the oxidant/antioxidant status in preterm infants with RDS via measurement of total antioxidant capacity (TAC) and total oxidant status (TOS), to determine the effect of surfactant on oxidant/antioxidant balance and to assess the association between TAC, TOS and clinical outcomes of the patients. Methods Sixty-nine infants with RDS were included. Blood samples for determining TAC and TOS were collected before and 48 h after surfactant treatment. TAC and TOS levels were analysed in serum. Patients were followed up until discharge or death. Results Post-surfactant TAC levels were significantly higher than pre-surfactant TAC levels ( P = 0.029). TAC/TOS ratio significantly increased after surfactant treatment ( P = 0.018). Infants Conclusions Oxidant–antioxidant balance shifts in favour of the antioxidant system after surfactant treatment. Lower TAC/TOS ratio in preterm infants may be associated with increased mortality.

Objective: The aim of this study was to compare and evaluate the efficacy of nebulized 3% hypertonic saline (HS) and recombinant human DNase (rhDNase) treatment for resolution of persistent atelectasis in newborns. Study design: Forty newborns (38 preterms) who did not respond to conventional treatment were enrolled to receive either nebulized 3% HS solution (n = 20) or rhDNase (n = 20) between September 2007 and March 2008. Clinical parameters, oxygen saturation and radiological response (chest X-ray scoring) were analyzed before and after administration of 3% HS or rhDNase. Results: The patients of the nebulized 3% HS solution group improved better chest X-ray scores parameters than the patients of the rhDNase group: chest X-ray scores were 5.1 ± 1.9 vs 4.8 ± 1.7 before treatment and 1.0 ± 0.8 vs 2.1 ± 1.4 after treatment (P

Fungal infections are increasingly frequent causes of neonatal sepsis (NS). This study examined the predictive value of the combined evaluation of the C-reactive protein (CRP) and interleukin-6 (IL-6) responses for differentiating fungal and bacterial aetiologies in patients with NS. From January to September 2007, neonates who were diagnosed with NS and had their CRP and IL-6 levels measured were selected. Based on their blood culture results, the neonates were divided into two groups: group of fungal sepsis (FS) and group of bacterial sepsis (BS). FS included 14 Candida albicans and one non-albicans Candida isolates and BS included five Klebsiella pneumoniae, three Pseudomonas aeruginosa, three Enterococcus faecalis, two coagulase-negative Staphylococcus species, one Enterococcus faecium and one Acinetobacter species. Significant differences were observed in the CRP (FS vs. BS: 28.10 ± 11.03 vs. 11.39 ± 2.94 mg l(-1), P = 0.026) and IL-6 (FS vs. BS: 38.60 ± 24.24 vs. 392.82 ± 102.46 ng l(-1), P = 0.000) levels between groups. The combined evaluation of the CRP and IL-6 responses better predicted the causative micro-organism in NS.

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918-1919 and 1957-1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries.

Introduction: Thrombosis is a rare but serious event in neonates. Perinatal risk factors associated with the developing hemostatic system increase the risk of thromboembolism. Treatment protocols vary between different centers. In this study, thrombosis and subsequent treatment were evaluated in 17 neonates hospitalized in a neonatal intensive care unit. This is the largest series reported to date. Method: From January 2007 to December 2009, thrombosis was diagnosed in 17 newborns hospitalized in a neonatal intensive care unit. Most were treated with recombinant tissue plasminogen activator (r-tPA) and enoxaparin as anticoagulant therapy. Results: Eleven courses of r-tPA therapy were administered to 10 patients. Sixteen patients received low-molecular-weight heparin (LMWH) treatment. None of the patients had hemorrhagic complications due to therapy. Recurrence was observed in 1 patient 1.5 months after the first course of r-tPA and retreatment was performed. A complete decrease in thrombus size was achieved in 9 patients and a partial decrease in 5 patients. One patient died before treatment was initiated; another died at the end of the first day of treatment and thus could not be evaluated. One patient who had a homozygous mutation for factor V Leiden did not respond to treatment and the extremity involved was amputated. Conclusions: Thrombosis in neonates is a multifactorial disorder. Treatment consisting of r-tPA and an anticoagulant was shown to be a safe and effective approach to clot dissolution in neonates.

Methylergonovine (MEV) is a semi-synthetic ergot alkaloid used in the prevention and control of postpartum hemorrhage. This report describes 12 newborns born on the same day in a local country hospital in Turkey and developed sepsis-like symptoms and encephalopathy within the first 6 h of life due to accidental administration of MEV instead of vitamin K in the delivery room. The major features of MEV poisoning were lethargy (41.7%), seizure (75.0%), feeding intolerance (66.6%), hypoventilation (58.3%), irritability (25%), and peripheral circulatory abnormalities (58.3%). As a conclusion, clinical findings of ergot toxicity in newborns cannot be distinguished from infectious disease or neonatal encephalopathy.

Invasive fungal infections are a major cause of morbidity and mortality in preterm infants. The authors conducted the first prospective, randomised controlled trial of nystatin compared with fluconazole for the prevention of fungal colonisation and invasive fungal infection in very low birth weight (VLBW) neonates.During a 12-month period, all VLBW neonates were assigned randomly to receive nystatin (1 ml suspension, 100 000 U/ml, every 8 h), fluconazole (3 mg/kg body weight, every third day) or placebo from birth until day 30 of life (day 45 for neonates weighing1000 g at birth). The authors performed weekly surveillance cultures and systemic fungal susceptibility testing.During the study period, 278 infants (fluconazole group, n=93; nystatin group, n=94; control group, n=91) weighing1500 g at birth were admitted. There were no differences in birth weight, gestation, gender or risk factors for fungal infection among the groups. Fungal colonisation occurred in 11.7% of the nystatin group and 10.8% of the fluconazole group, as compared with 42.9% of the control group. The incidence of invasive fungal infection was 4.3% in the nystatin group and 3.2% in the fluconazole group, as compared with 16.5% in the control group. There were no differences in fungal colonisation and invasive fungal infection between the nystatin and fluconazole groups.Prophylactic nystatin and fluconazole reduce the incidence of colonisation and invasive fungal infection in VLBW neonates. The authors believe that nystatin is an alternative to fluconazole, because nystatin is safe, inexpensive, well tolerated and effective.

Background: The objectives of this study were to determine the cord blood thyroid-stimulating hormone (TSH) and free T4 (FT4) levels in Turkish neonates and to determine whether these variables reveal iodine deficiency. Methods: We collected 818 cords from healthy mothers at parturition and measured levels of FT4 and TSH. We also measured cord blood FT4 and TSH levels in different stages of gestation and gender. We grouped the neonates according to cord serum TSH levels, either being less (Group A) or greater (Group B) than 10 mIU/L. Group A included 589 neonates (300 girls [51%] and 289 boys [49%]) and Group B included 229 neonates (105 girls [45%] and 124 boys [55%]). Results: The percentage of subjects with cord blood TSH 10 mIU/L was 72% and 28%, respectively. Although cord TSH levels in Group B were greater than those in Group A (P < 0.001), cord blood FT4 levels in Group B were lower than those in Group A (P < 0.05). There was no difference between both sex in terms of birthweight and maternal age. TSH and FT4 levels did not vary according to neonate sex during gestation, except for from week 37 to 41. TSH levels of male neonates at the 41st week of gestation were higher than those of female neonates (P < 0.05). There were no effects of birthweight on TSH and FT4 levels if the neonate was lighter than 2500 g at birth. TSH levels of male neonates were higher than those of female neonates when their birthweights were

Congenital localized absence of the skin (CLAS) has been observed in various subsets of inherited epidermolysis bullosa (EB). Pyloric atresia (PA) is a rare disorder that is associated with EB. Here, we describe three preterm male infants with PA, CLAS, and EB at birth, one of whom had multiple bullae and erosions on the stomach and pericardium. To the best of our knowledge, this is the first report of findings regarding a PA-EB-CLAS association.

Neonatal sepsis, characterized by systemic signs of infection in the first month of life, remains an important clinical syndrome. Despite advances in neonatology, it has high rates of mortality and morbidity. The combine or alone usage of interleukin‐6 (IL‐6) and C‐reactive protein (CRP) has recently been proven to be useful in the early diagnosis of sepsis in newborns. The study included 282 patients; there were 232 in Group I (170 proven and 62 clinical sepsis) and 50 in Group II (control group). The optimum cut‐off value in the diagnosis of neonatal sepsis was found to be 24.65 pg/ml for IL‐6 and 4.82 mg/l for CRP. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this IL‐6 cut‐off for neonatal sepsis were 72, 84, 95, and 42%, respectively. Sensitivity, specificity, PPV, and NPV of the CRP cut‐off for neonatal sepsis were 67, 97, 99, and 39%, respectively. The combination of IL‐6 (>24.65 pg/ml) and CRP (>4.82 mg/l) in the diagnosis of neonatal sepsis gave sensitivity, specificity, PPV, and NPV of 53, 100, 100, and 33%, respectively. To our knowledge, this is the largest reported study seeking to determine cut‐off levels for IL‐6 and CRP in the diagnosis of neonatal sepsis. In conclusion, we think that it is useful to evaluate IL‐6 and CRP, in combination, for the early diagnosis of neonatal sepsis. J. Clin. Lab. Anal. 24:407–412, 2010. © 2010 Wiley‐Liss, Inc.

In this study, we aimed to make a comparison between chromosomal effects caused by conventional phototherapy and intensive phototherapy in jaundiced newborns. The study group included 83 newborns with gestation age of ≥35 weeks, and on days 3–10 after birth. Newborns were divided into four groups on the basis of total serum bilirubin (TSB) levels upon admission and need for phototherapy. The intensive group (n = 19) consisted of newborns who received light-emitting diode (LED) phototherapy, the conventional group (n = 23) consisted of newborns who received conventional phototherapy, the jaundiced control group (n = 21) consisted of newborns whose TSB levels were higher than 10 mg/dL (average = 13.7 ± 1.5 mg/dL) on admission and who did not receive phototherapy, and the non-jaundiced control group (n = 20) consisted of newborns whose TSB levels were less than 5 mg/dl (average = 3.6 ± 0.8 mg/dL). TSB level of the intensive group at admission was 20.2 ± 1.3 mg/dL, whereas the level of conventional group was 19.6 ± 1.5 mg/dL. Blood samples were taken from all infants on admission to determine sister chromatid exchange (SCE1) frequency. Blood sampling was repeated on discharge (SCE2) of infants who had received phototherapy. Demographic information, hospitalization details and the rate of decline in TSB were recorded, and frequencies of SCE1 and SCE2 were compared. There was no difference in demographic information among the four groups. SCE1 frequencies in 50 metaphases were evaluated in the intensive, conventional, jaundiced control and non-jaundiced control groups, and the SCE1 frequency was determined as 9.37/cell, 9.54/cell, 9.23/cell and 6.17/cell, respectively. The SCE1 frequency of the jaundiced groups (intensive, conventional and newborns-with-jaundice control group) was significantly higher than that in the non-jaundiced control group (p = 0.001). There was no significant difference between the intensive group and the conventional group in SCE2 frequency (13.5/cell vs 13.55/cell, p = 0.39). SCE2 frequency was higher than SCE1 frequency in both the intensive and conventional groups (p = 0.001). A strong correlation was found between admission TSB and SCE1 frequency (p = 0.001; r = 0.79). The rate of decline in TSB was higher in the intensive group compared with the conventional group (0.26 mg/(dL h) vs 0.14 mg/(dL h); p = 0.001). We found that intensive and conventional phototherapies similarly increase SCE frequency in newborns. There was a strong, positive correlation between the TSB-on-admission level and SCE1 frequency. In the light of this study, we may conclude that intensive and conventional phototherapies may have an effect on chromosomes in jaundiced newborns. TSB levels higher than 10 mg/dL are, too, reported hazardous on chromosomes. Further studies are warranted to elucidate this relationship.

Background: Metabolic bone disease of prematurity is a common problem in preterm infants. The aim of the present paper was to measure the effect of vitamin D, in order to see the relation between vitamin D and urinary excretion of deoxypyridinoline (DPD), serum osteocalcin (OC), calcium (Ca), inorganic phosphorus (P), and alkaline phosphatase (ALP). Methods: Three different doses of vitamin D, 200 IU/kg (group 1, 11 infants), 400 IU/kg (group 2, 15 infants) and 800 IU/kg bodyweight/day (group 3, 11 infants), were administered to a total of 37 preterm infants between 15th day of birth until the 30th day of birth. Results: There were no significant differences in levels of serum Ca and P before and after vitamin D supplementation in all groups. Serum ALP levels were increased in all but significantly only in groups 1 and 3. Serum OC levels were also increased in each group by the treatment. Urinary DPD excretion was increased gradually by the increase in vitamin D intake, but it was significant only in group 3. Conclusion: High dose of vitamin D supplementation might accelerate bone turnover and increased urinary DPD levels might reflect increased bone resorption. To the best of the authors’ knowledge this is the first study comparing the effects of different vitamin D dose, by the means of urinary collagen cross-links, on bone turnover in preterm infants.

BACKGROUND: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. METHODS: We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. RESULTS: Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. CONCLUSION: These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.

Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrhage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosed by ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.

Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants.Preterm newborns with a gestational age of32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group.Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own.Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development.

Supraventricular tachycardia (SVT) is the most common sustained arrhythmia in neonates and infants. Presentation of SVT in the neonate is usually subtle and frequently complicated by congestive heart failure. Despite the widespread use of β2-agonists, their safety has been questioned. Several studies have reported an increased incidence of cardiac arrhythmias in patients treated with these agents, and other studies have found increased rates of cardiovascular death associated with the use of oral and nebulized β2-agonists such as salbutamol, which is used to treat bronchospasm in newborns with several diseases. Herein, we report a case of SVT following administration of nebulized salbutamol in a neonate.

Amaç: Yenidoğan döneminde özellikle cerrahi işlem ihtiyacı duyan, uzun süre parenteral beslenme (PB) kullanımına bağlı kolestaz gelişen olgularda standart tedaviye ek olarak verilen balık yağı içeren çok bileşenli ile standart lipid emülsiyonlarının (PLE) etkisini karşılaştırmak.Gereç ve Yöntem: Bu retrospektif çalışmaya yenidoğan yoğun bakım ünitesinde (YDYBÜ) Ocak 2011 – Şubat 2012 döneminde yatan, cerrahi operasyon geçirip 2 haftada ve daha uzun süreli PB ihtiyacı olup PB ilişkili kolestaz gelişen hastalar çalışmaya alındı. Hastalar Grup1, kolestazı olup standart kolestaz tedavisine ek olarak standart PLE (saf soya yağı içeren) verilen, Grup 2 ise ek olarak soya yağı, orta zincirli yağ asidi, zeytin ve balık yağı içeren çok bileşenli PLE verilen olmak üzere iki gruba ayrıldı. Hastaların YYBÜ’de izleminde kolestaz süreleri ve prognozları ile ilgili verileri karşılaştırıldı.Bulgular: Bu çalışmaya Grup 1 (n= 11) ve Grup 2 (n= 13)’de toplam 24 hasta dâhil edildi. Grup 1 ve 2 için ortalama gestasyonel yaşlar sırasıyla 36±4.3 ve 30.3±3.4 hafta, doğum ağırlıkları ortalama 2395±635 ve 1404 ±670 g idi. Doğum haftaları ve doğum ağırlığı arasında önemli istatistiksel farklılık vardı (sırasıyla p=0.047, p=0.03). Grupların gebelik haftası ve doğum ağırlıkları farklı olmasına rağmen, toplam beslenmeme süresi (Grup 1: 10±3.3 gün; Grup 2: 16.3±10.6 gün) ve total PB süreleri (Grup 1: 20±4.6 gün; Grup 2: 25.8±17 gün) ve mortalite oranları karşılaştırıldığında gruplar arasında önemli farklılık saptanmadı. Çok bileşenli PLE kullanımına bağlı kısa dönemde yan etki saptanmadı.Sonuç: Yapılan retrospektif çalışmada değerlendirmeye alınan hastaların demografik verileri arasında fark olmasına rağmen parenteral beslenme ilişkili kolestaz açısından daha riskli olan prematüre bebeklerin sonuçları term bebekler ile benzerdi. Bununla birlikte iki grup arasında balık yağı içeren çok bileşenli PLE’nin kolestaz ilaç tedavisine ek olarak kullanılmasının, standart PLE kullanılmasına göre ek katkı sağlamadığı gösterildi. Gruplar arasındaki farkların bu sonucu etkileyebileceğini düşünmekteyiz., Objective: To compare the effect of a multicomponent parenteral lipid emulsion (PLE) with a standard PLE in case of cholestasis induced by long-term use of parenteral nutrition (PN) in infants who need surgical procedures.Material and Method: We conducted a retrospective study in neonatal intensive care unit (NICU) between January 2011 and February 2012. The patients with surgical procedures and need for long-term PN (at least 2 weeks) at NICU were enrolled in the study. Group 1: given standard lipid emulsion, in addition to the standard treatment of cholestasis, Group 2: given multicomponent lipid emulsion (soybean oil, medium chain triglyceride, olive and lipid fish oil) in addition to the standard treatment of cholestasis. Period of cholestasis and prognosis data were compared during follow-up in NICU.Results: A total of 24 patients (Group 1 (n = 11) and Group 2 (n = 13)) were included in the study. Period of cholestasis were similar between groups. Despite the inequality between gestational age and birthweight among groups (gestational age 36±4.3 and 30.3±3.4 weeks and p=0,047, birth weight mean 2395±635 and 1404 ±670 g, p=0.03 , respectively Group 1 and 2), total non-feeding time (Group 1: 10 ± 3.3 days; Group 2: 16.3 ± 10.6 days) and total duration of PN (group 1: 20 ± 4.6 days; Group 2: 25.8 ± 17 days) and mortality rates were compared between the groups and there was no statistically difference. There were no short-term adverse effects identified due to the use of multi-component PLE.Conclusion: No additional contribution of multicomponent PLE than standard PLE to the treatment of cholestasis could be shown at our study. We think that inequality among groups may effect these results.

Objective To compare the effectiveness of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive-pressure ventilation (NIPPV) as the initial respiratory support within the minimally invasive surfactant therapy (MIST) approach in preterm infants with respiratory distress syndrome. Design Prospective, randomised controlled study. Setting Tertiary neonatal intensive care unit. Patients and interventions This study enrolled 200 preterm infants with a gestational age of 26–32 weeks who showed signs of respiratory distress but did not require intubation in the delivery room. Surfactant therapy was performed using the MIST approach in the patients who met the criteria for surfactant administration. Main outcome measures The primary outcomes were a need for intubation within the first 72 h of life and a surfactant requirement. Results The infants in the study displayed similar characteristics at birth. Fewer infants in the NIPPV group required surfactant therapy (38% vs 60%; p=0.002) or invasive ventilation during the first 72 h of life (13% vs 29%; p=0.005), and NIPPV reduced the rate of moderate-to-severe bronchopulmonary dysplasia (BPD) (7% vs 16%; p=0.046). Multivariate logistic regression analysis showed that NIPPV support (OR: 0.36, 95% CI 0.17 to 0.76; p=0.008) and higher gestational age (OR: 0.76, 95% CI 0.59 to 0.98; p=0.041) reduced the need for invasive ventilation within the first 72 h of life. Surfactant requirement was also decreased with NIPPV support (OR: 0.39, 95% CI 0.22 to 0.71; p=0.002). However, there was no impact on BPD, based on the multivariate analysis. Conclusions In infants born at 26–32 weeks’ gestation, NIPPV reduced the need for invasive ventilation and the surfactant requirement within the MIST approach. Trial registration number ClinicalTrials.gov under identifier NCT01741129.

In our clinical practice, we observed high interleukin-6 (IL-6) levels in gram-negative sepsis.To investigate the relationship between IL-6 and C-reactive protein (CRP) levels and early determination of neonatal sepsis of gram-negative or gram-positive aetiology.White blood cell count, IL-6 and CRP levels were compared among different groups.Gram-negative, gram-positive and fungal infection groups consisted of 73, 82 and 15 patients, respectively. The optimal cut-off levels of IL-6 between gram-negative and gram-positive fungal infection groups were 202 and 57 pg/ml. The fungal infection group had higher CRP levels than gram-negative and positive infection groups.To our knowledge, this is the largest reported study aiming at determining of IL-6 cut-off levels to differentiate neonatal sepsis aetiology. Gram-negative microorganisms led to 10 fold higher IL-6 production. The evaluation of IL-6 and CRP is useful to diagnose and also differentiate neonatal sepsis aetiology.Introducción. En la práctica clínica, hemos observado una concentración elevada de interleucina 6 (IL-6) en los casos de septicemia por gramnegativos. Objetivo. Investigar la relación entre las concentraciones de IL-6 y proteína C-reactiva (PCR) y la determinación temprana de la septicemia neonatal por gramnegativos o grampositivos. Población y métodos. Se compararon el recuento de leucocitos y las concentraciones de IL-6 y PCR entre los distintos grupos. Resultados. Los grupos de infección por gramnegativos, infección por grampositivos y micosis estaban formados por 73, 82 y 15 pacientes, respectivamente. Los valores de corte ideales de IL-6 entre el grupo de infección por gramnegativos y el de infección por grampositivos y el de micosis eran 202 pg/ml y 57 pg/ml, respectivamente. En el grupo de micosis se observaron concentraciones de PCR más altas que en los grupos de infección por gramnegativos e infección por grampositivos. Conclusiones. Hasta donde sabemos, este es el estudio de mayor envergadura notificado con el objetivo de determinar los valores de corte de IL-6 para diferenciar la etiología de la septicemia neonatal. Los microorganismos gramnegativos provocaron una producción de IL-6 diez veces mayor. La evaluación de IL-6 y PCR resulta útil para diagnosticar, y asimismo diferenciar, la etiología de la septicemia neonatal

Paraovarian cysts are assumed to be rare in childhood. This assumption is due to the fact that most patients with paraovarian cyst are asymptomatic unless complicated. Owing to the wide range of pathologies in differential diagnosis, preoperative diagnosis of paraovarian cyst presents a challenge. Herein is reported two cases of complicated paraovarian cyst in children.

Cytomegalovirus (CMV) may transmit perinatally or from breast milk. The risk for development of symptomatic CMV disease in very-low-birth-weight premature infants after transmission from maternal breast milk is not clear. There are scarce data in the literature about congenital CMV infection in multiple pregnancies, being mostly with twin gestations. Here we present a unique case of triplets with CMV infection transmitted via breast milk.

Hematemesis in a healthy newborn is most often caused by swallowed maternal blood. Maternal blood due to fibrocystic breast disease in human milk has not previously been reported in the literature. We report here a newborn case with hematemesis in which the mother had fibrocystic breast disease, and we want to emphasize this rare entity. Physicians should be aware of this rare condition, and fibrocystic breast disease of the mother should be included in the differential diagnosis of newborns with hematemesis.

Chemical pleurodesis with povidone-iodine has been used to treat congenital idiopathic chylothorax in neonates. We report successful use of povidone-iodine in an extremely premature infant to treat a pneumothorax that had persisted for more than one week despite high-frequency ventilation.

Atrial flatter yenidoğan ve bebeklerde nadir görülen bir aritmidir. Anne karnında, perinatal dönemde ve bebeklik süresince ortaya çıkabilir. Atriyal flatter, yenidoğanlarda sıklıkla asemptomatiktir. Atriyal flatterli yenidoğan hastaların % 20’si kalp yetmezliği tablosunda başvururken, hastaların çoğu asemptomatik taşikardi ile başvurmaktadırlar. Hastaları sinüs ritmine döndürmek için ilaç tedavisi, senkronize kardiyoversiyon, kalp pili gibi tedavi yöntemleri kullanılmaktadır. Çoğu olgu dijitalizasyon veya elektriksel kardiyoversiyon ile kolaylıkla sinüs ritmine döndürülebilir. Elektriksel kardiyoversiyon yenidoğanlardaki persistan atrial flatter için iyi bir tedavi yöntemidir. Elektriksel kardiyoversiyona cevap veren atriyal flatterli bir yenidoğan olgusunu sunduk., Atrial flutter is an uncommon arrhythmia in newborns and infants. It may manifest in the intrauterine, perinatal periods or during infancy. Newborns with atrial flutter are frequently asymptomatic, and in most patients it begins as asymptomatic tachycardia, although in up to 20% it may present with heart failure. Drugs, synchronized cardioversion or pacemakers are used for the conversion to sinus rhythm in these patients. In most cases, it is easily converted to sinus rhythm by electrical cardioversion or digitalization. Electrical cardioversion is a good treatment modality for neonates with sustained atrial flutter. We have presented a neonate with atrial flutter who responded to electrical cardioversion

Neonatal Health Service Improvement in the Last Decade in Turkey Turkiye’de Son Dekadda Yenidogan Saglik Hizmetlerindeki Duzelmeler Ugur Dilmen Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey In the assessment of the development levels of countries, one of the important indicators is the infant and the neonatal mortality. Every year, of the 130 million babies born in the world, four million of them are lost in the neonatal period. t has been reported that 41% of deaths under five years were in the neonatal period in 2008 (1.2). In Turkey until recently, mortality rate not parallel to economic level of our country has been sadness for the physicians and the (other staff dealing with children's health). Except a few of neighboring countries we had more negative figures than all. However, the recent studies show that in Turkey there is a significant decrease in; under five years, infant and neonatal mortality rates (Figure 1-3, Source: 2011 Istanbul University, Marmara University, Yildirim Beyazit University “Infant and Under-Five Mortality Survey 2012”, Other Years Turkey Public Health Institution).

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.

Pelvis is a rare location of the hematogeneous osteomyelitis during the newborn period. Successful cure of osteomyelitis during the newborn period is dependent on a fast and true diagnosis and on sufficient treatment. In this case report, iliac osteomyelitis of a newborn that was clinically suspected on the fifth day, was diagnosed radiologically and was found to be caused by methicillin-sensitive Staphylococcus aureus, is presented. According to our knowledge, this is the youngest osteomyelitis case in the literature and the third presented iliac osteomyelitis case of the newborn period.

Aim There has been no clear consensus of the appropriate positioning in preterm infants. We aimed to evaluate the changes of cerebral and mesenteric tissue oxygenation in three different positions, by near infrared spectroscopy (NIRS), in stable very low birth weight (VLBW) infants of postnatal > 30 days. Methods NIRS monitoring of cerebral and mesenteric tissue oxygenation in three different positions was performed in 29 stable preterm newborns in neonatal intensive care unit (NICU). The patients were observed in three different positions consecutively, each lasting for 4 h. The demographic features, cerebral and mesenteric tissue oxygenation with positional changes and feeding periods were recorded. Results Mean gestational age, mean birth weight and mean postnatal age of the patients were 27.6 ± 1.7 weeks, 1046 ± 308 g and 42.4 ± 15.7 days, respectively. There were no statistically significant differences in cerebral and mesenteric tissue regional SO2 values in each position (p = 0.954 and p = 0.151, respectively). The values of cerebral and mesenteric tissue regional SO2 before and after feeding did not show any statistically significant difference in each position. Conclusions Clinically stable very low birth weight infants are able to maintain a stable cerebral and mesenteric tissue oxygenation in different positions, both before and after feeding. Positional changes seem to be safe in VLBW stable infants and this influence should be considered in care of these patients in the NICU. Clinical Trials Identification Number: NCT01255189.