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Background and Aim Cardiac catheterization is an important diagnostic tool. In this study, the frequency and the factors affecting the development of thrombosis were prospectively evaluated in neonates who were subjected to diagnostic and interventional cardiac catheterization. Method 29 patients were enrolled in this study. Blood samples were taken for complete blood count, prothrombin, activated partial thromboplastin time, INR ratio, mutation of factor V Leiden, prothrombin 20210 A, MTHFR C667 and A1298 before the procedure. 50 U/kg bolus of heparin was infused during catheterization and 20 U/kg/hour infusion of heparin was given to patients with clinically suspected thrombosis. Doppler was performed in all patients within 6 hours after catheterization. Results Arterial catheterization in 16 cases, venous catheterization in 7 cases and both were applied in 6 cases. Arterial thrombosis in 7 patients and venous thrombosis in two patients was detected. It’s observed that infusion of 20U/kg/h heparin had no effect on the development of arterial thrombosis. On the development of arterial and venous thrombosis, patient age, gender, diagnosis, treatments received prior to catheterization, hemoglobin and platelet count, PT, aPTT and INR values and Factor V Leiden, prothrombin 20210 A, MTHFR C667, A1298 mutations were found as not impacting. Conclusion There are no exact protocols for the prevention of thrombosis during and after catheterization. In this study, 50 unit/kg heparine bolus during catheterization and 20 unit/kg/hour heparine infusion after catheterization did not prevent the development of thrombosis. Extensive studies are needed to determine the appropriate drugs and/or doses of preventive treatments.

Background and Aim It is previously claimed that probiotic and prebiotic use in premature infants prevents pathogenic bacterial colonization in the intestine and reduces morbidity and mortality. In this study, the effect of synbiotic (probiotic+prebiotic) use on morbidity and mortality in very low birth weight (VLBW) infants is evaluated. Methods Thirty-four VLBW infants were randomly assigned to receive either synbiotic [probiotic: Bifidobacterium lactis, 5x10 colony forming unit, 30mg + prebiotic: Chicory inulin, 900 mg (1 sachet/day Maflor®, Cidex), n=17] (Group-1) or placebo (n=17) (Group-2) from the first enteral feeding and throughout the hospitalization period. Results There was no significant difference regarding the sociodemographic features between groups. The time interval to reach enteral nutrition to 50 cc/kg/day was similar in both groups, whereas it took shorter time in Group-1 to reach 100/cc/day (p=0.02). Increased gastric residual (former feeding >50%) occurred less in Group-1 (p=0.002). There was no significant difference between groups in the rate of early clinical or culture proven sepsis, however late clinical sepsis rate and late culture proven sepsis in Group-1 was significantly lower (p=0.001, p=0.04). Synbiotic use reduced the risk of sepsis independently from gestational age and gender (p=0.03). Necrotizing enterocolitis (stage≥2) was significantly higher in Group-2 (p=0.001). The rate of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were lower in Group-1 (p=0.04, p=0.03). No difference was identified regarding mortality, actual weight during hospitalization and discharge between groups. Conclusion Introduction of synbiotics with the first enteral feeding can help to reduce feeding intolerance and morbidity in VLBW infants.

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

13/47), delivery type (normal/cesarean sections=7/29 vs. 17/30), maternal group B Streptococcus infection (pos=2/36 vs. 1/47). Comparing ELBW and VLBW groups (excluding dead babies): mechanical ventilation(MV) n=25/30 vs. 11/47 (p

Background: Glucose intolerance and insulin sensitivity in preadolescent children might predict the risk of developing type 2 diabetes mellitus in adult life in small for gestational age (SGA) children. We aimed to investi-gate whether reduced birthweight is related to low insulin sensitivity in preadolescence. Subjects and Methods: Twenty-five SGA children and 29 appropriate for gestational age children (AGA) children born between 1993 and 1994 were evaluated for insulin sensitivity in preadolescence. At the beginning of the study, body mass index (BMI) was calculated and an oral glucose tolerance test (OGTT) was performed. Blood samples to measure glucose and insulin were taken every 30 minutes during OGTT. Homeostasis of model assessment-insulin resistance (HOMA-IR) and composite index (CI) values were measured to assess insulin sen-sitivity. Results: On the OGTT, 120-minute glucose and insulin levels were higher in SGA than AGA children ( P =0.02 and P =0.001, respectively). Although there was no difference between HOMA-IR values, the mean CI value was lower in SGA than AGA children ( P =0.001). There was an inverse correlation between birthweight and 120-min-ute glucose concentrations (r=-0.30, P =0.02). This correlation was stronger between birthweight and 120-min-ute insulin concentrations (r=-0.50, P =0.001). BMI was positively correlated with 120-minute insulin (r=0.50, P =0.001). There was no relationship between HOMA-IR values and birth size, but the CI index was positively correlated with birthweight (r=0.40, P =0.002). Conclusions: Birthweight may be a predictive factor for insulin sensitivity and CI is more reliable than HOMA-IR to assess this sensitivity in preadolescence.

Warfarin, which is used for anticoagulant therapy, rarely produces congenital warfarin syndrome characterized with hypoplastic nose, stippled epiphyses, and skeletal abnormalities when ingested during pregnancy. Here, we present a male infant, whose mother was treated with warfarin because of a prosthetic heart valve replacement after rheumatic heart disease, with signs of warfarin embryopathy. The mother's first pregnancy at 12 weeks gestation resulted in abortus due to warfarin toxicity. Subsequently, she delivered two healthy girls after her treatment had changed to low molecular heparin during pregnancy periods. We want to emphasize that risk-benefit ratio should be well weighed by both obstetricians and cardiologists when considering warfarin therapy for a woman at childbearing age.

To compare a combined dose of ketamine and midazolam versus ketamine alone in the sedation of children requiring lumbar puncture.A randomized, controlled study, conducted between January 2004 and December 2006.The Pediatric Emergency Department (PED) at Ankara Training and Research Hospital, Turkey.A random sample of 99 children (59 boys, 40 girls) aged 2-14 years (mean age 6.5+/-3.7) undergoing lumbar puncture.Participants were randomized to receive intravenous (IV) ketamine only (1 mg/kg; IVK) (n=51) or ketamine plus midazolam (1 mg/kg ketamine+0.1 mg/kg midazolam; IVKM) (n=48).The mean time to sedation and adverse events.The mean time to sedation was significantly shorter in the IVKM group than the IVK group (2.6+/-1.1 and 3.4+/-1.7 min, respectively; P=0.01). The parental satisfaction was significantly higher in the IVKM group (P=0.001). Also the fasting time and recovery time did not differ between groups, nor was there a significant difference in nausea/vomiting between groups. Nightmares or crying spells were more common in the IVK group than in the IVKM group (P=0.04).We conclude that adding midazolam to ketamine did not increase the frequency of adverse events and that the combined sedative was superior to ketamine alone in terms of speed of sedation and parental satisfaction.