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Cyclopentolate is widely used in ophthalmology for its intense mydriatic and cycloplegic activity. Systemic side effects have been described in both adults and children. Myoclonic seizure is a rare side effect of eye drops that are used in eye examinations. We report herein a case of convulsion in a three-month-old girl following cyclopentolate hydrochloride and phenylephrine hydrochloride eye drops, which were used in advance of ophthalmoscopy for examination of retinopathy of prematurity (ROP). Physicians should be aware of the uncommon systemic side effects of cyclopentolate, and drops should be used in appropriate dosages. [ABSTRACT FROM AUTHOR]

Congenital cystic eye is a rare defect of the developing eye. Sometimes it has been seen together with intracranial anomaly. This case report represents a patient with cystic eye and cerebral loss, who was diagnosed prenatally. [ABSTRACT FROM AUTHOR]

As a case presented in this article neonatal abstinence syndrome (NAS) occurs following prenatal opioid exposure. These drugs have been associated with numerous obstetrical complications including intrauterine growth restriction, placental abruption, preterm delivery, stillbirth, and maternal death. NAS is characterized by signs and symptoms indicating central nervous system hyperirritability and autonomic nervous system, gastrointestinal tract. Symptoms of NAS typcall occurs following prenatal opioid exposure 48-72 hours post-birth. Blood, hair, urine or meconium confirmation may assist the diagnosis of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS. Scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. [ABSTRACT FROM AUTHOR]

Fetal pleural effusion is a rare abnormality that results from accumulation of fluid in the chest cavity. It is an uncommon anomaly which can be associated with structural malformations, inflammatory or iatrogenic problems, genetic syndromes or fetal hydrops. Early development of pleural effusion is usually associated with fetal hydrops and carries a poor prognosis. In this article, a newborn with Down syndrome and isolated pleural effusion is presented. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) poisoning can be seen especially in winter months. Diagnosis is very difficult in the neonatal period based on signs and findings. In this article, we report a case of a neonate who received hyperbaric oxygen therapy because of the high level of carboxyhemoglobin (COHb) which was diagnosed as CO poisoning in family members. [ABSTRACT FROM AUTHOR]

• Endocrine disrupting chemicals (Bisphenol A and phthalates) were detected in almost all cord blood samples. • Cord blood bisphenol-A levels were inversely associated with stretched penile length of newborns. • Cord blood bisphenol-A levels were positively associated with cord blood estradiol levels. • Cord blood di-2-ethylhexyl phthalate levels were significantly and inversely correlated with the anogenital index of male newborns. Bisphenol A (BPA) and phthalates can adversely affect the fetal development. However, observational studies on the effects of these chemicals on fetal male reproductive system are still limited. A hundred of umbilical cord blood samples were analyzed for the levels of BPA, di-2-ethylhexyl phthalate (DEHP), mono-2-ethylhexyl phthalate (MEHP), and sex hormones. After birth, male newborns underwent physical examination that included measurements of anogenital distance, stretched penile length (SPL), and penile width. BPA, DEHP and MEHP levels were detectable in ≈99% of cord blood samples. In covariate-adjusted models, cord blood BPA levels were inversely associated with SPL of newborns and positively associated with cord blood estradiol levels. In addition, there was a significant inverse relationship between cord blood DEHP levels and anogenital distance index of newborn males. Our results suggest that in utero BPA and DEHP exposure exerted adverse effects on fetal male reproductive development and cord blood estradiol levels. [ABSTRACT FROM AUTHOR]

Purpose: Vanished twin (VT) has been associated with poor perinatal outcomes. Our research aimed to investigate the outcomes of pregnancies with vanished twin and its possible association with methylenetetrahydrofolate reductase (MTHFR) polymorphisms.Methods: This study consisted of 30 of 38 VT pregnancies (group 1, VT group), 109 singletons (group 2), 70 spontaneous twins (group 3), and 101 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) twins (group 4).Results: Most patients in group 1 (28/30) were tested for MTHFR genes (C677T or A1298C polymorphisms). Eight of the 38 pregnancies with VT (21.1%) resulted in miscarriage. The prevalence of "2 or more pregnancy losses" in the "obstetric history" in group 1 was higher (23.3%) than those in the other groups (p = 0.007, χ2 = 17.8). The allelic frequencies of MTHFR 677 and MTHFR 1298 in group 1 were 0.268 and 0.429, respectively (higher than those in healthy population). The median birthweights in groups 1, 2, 3, and 4 were 2940, 3200, 2300, and 2095 g, respectively. The prevalence of respiratory distress syndrome was significantly higher in the IVF/ICSI twin pregnancy group (p < 0.001, χ2 = 21.2). Early pregnancy loss and the presence of "2 or more miscarriages" in the obstetric history of pregnancies with VT were more frequent.Conclusion: The coincidence of VT and MTHFR polymorphisms might play an incidental or factual role in this connection. [ABSTRACT FROM AUTHOR]

Although Patau syndrome (Trisomy 13) was first reported cytogenetically in 1960 by Patau, the clinical description of this syndrome dates back as early as 1657 in Bartholin writings. Patau syndrome (Trisomy 13) is a rare chromosomal disorder with an incidence of 1 in 16.000 live births. Trisomy 13 is the third most common autosomal trisomy after trisomy 21 (Down syndrome) and trisomy 18 (Edward syndrome). Most of the cases are due to skull and facial abnormalities; heart, kidney malformations; and/or other physical and mental abnormalities. Most cases are lost in the first days of life, mostly due to severe cardiac anomalies. In this clinical report, a newborn with Patau syndrome with the finding of acalvaria is presented. [ABSTRACT FROM AUTHOR]

The most common cause of immune hydrops fetalis is Rhesus immunization. Due to closely monitored pregnancies and anti-D immune prophylaxis during pregnancy in developed countries, the frequency of hydrops fetalis secondary to Rh immunization has decreased and subgroup incompatibility has gained importance. Kell subgroup is the most common subgroup and anti-Kell antibodies are one of the common causes of fetal and neonatal immune hydrops and anemia. This paper will be presenting two cases of immune hydrops fetalis caused by Kell subgroup incompatibility. [ABSTRACT FROM AUTHOR]

Goldenhar's syndrome is a rare disease characterized by dermal epibulbar tumors, periauricular appendices, malformation of the ears, and vertebral anomalies. In addition to craniofacial anomalies, patients may present cardiac, genitourinary, skeletal and central nervous system malformations. Multiple genetic and environmental factors play a role in the etiology of the syndrome and maternal diabetes is also thought to be related. Herein, we present an infant of a diabetic mother, getting a diagnosis of Goldenhar syndrome in the newborn period with characteristic clinical and radiological findings. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to investigate and compare the efficacy of the new leukocyte parameters mean neutrophil and monocyte volume (MNV, MMV), conductivity (MNC, MMC), scattering (MNS, MMS) and volume distribution width (NDW, MDW) with serum C-reactive protein (CRP), procalcitonin (PC) and interleukin (IL)-6 in the diagnosis of neonatal sepsis. Methods A total of 227 newborns (132 boys, 95 girls) were analyzed. There were 116 infants in the sepsis group (proven sepsis, n = 40; clinical sepsis, n = 76) and 111 in the control group. Venous blood samples were collected from infants at the time of diagnosis and complete blood count, peripheral blood smear, blood cultures, CRP, PC, IL-6 and MNV, MMV, MNC, MMC, MNS, MMS, NDW, and MDW were analyzed. Results MNV, NDW, MMV and, MDW were higher in infants with sepsis than in controls ( P < 0.05 for all). MNS was lower in the patients with sepsis ( P = 0.002). There was no significant difference between the sepsis and control groups in terms of MNC, MMC and MMS. Conclusion Although the predictive value of leukocyte parameters including neutrophil and monocyte volume, conductivity, scattering and volume distribution width in the diagnosis of neonatal sepsis was lower than that of CRP, PC and IL-6, some of these new parameters may be useful in the differential diagnosis of newborn sepsis, along with the other screening tools. In particular, MNV seems to be the most useful parameter with the highest specificity; also, the importance of PC in the diagnosis of early onset sepsis was confirmed. [ABSTRACT FROM AUTHOR]

Septic arthritis and osteomyelitis are serious disorders in neonates. These disorders in neonate differ from their counterparts in older children. The newborn infant may be less capable of responding to infection owing to immunologic deficiencies. Septic arthritis in the neonate are usually due to a blood borne spread of infection to joints. Because of these conditions and paucity of signs and symptoms, diagnoses are difficult in neonates. The aim of this study was screening bacteriological features of neonatal septic arthritis, signify the clinical and pathological differences between neonates and older children and discuss the treatment of septic arthritis. This retrospective study was carried out at the Hacettepe University İhsan Doğramacı Children's Hospital. A total of 13 newborn aged between 10 and 29 days were included the study group. We studied to document the etiological, diagnostic, clinical and therapeutic differences of septic arthritis in neonates. We also discuss the literature review with the experience of our neonatal intensive care unit. Early diagnosis and correct treatment of septic arthrit in neonate is very important in regards to morbidity and mortality. [ABSTRACT FROM AUTHOR]

Gastroschisis is a rare congenital anomaly. In this disease, the abdominal organs are found to be outside due to abdominal anterior wall defect. Environmental, familial, genetic and multifactorial factors are being accused in the pathogenesis of the disease. The exact cause of the disease is unknown yet. In this article, a newborn patient with gastroschisis born from nonconsangineous parents, who had a history of gastroschisis in his family is presented. [ABSTRACT FROM AUTHOR]

Congenital cystic adenomatoid malformation (CCAM) is a congenital hamartomatous lesion of the lung, characterized by aberrant proliferation of terminal bronchioles together with various cystic and solid structures. This entity was renamed recently as congenital pulmonary airway malformations (CPAM). Ultrasonography is the chief modality for prenatal diagnosis between 16-32 weeks of pregnancy. Polyhydramnios, hydrops, pulmonary hypoplasia, and mediastinal shift can also be detected synchronously. In this study, we evaluated retrospectively the records of infants prenatally diagnosed with CPAM who were hospitalized between 2001 and 2012 in Hacettepe University Ihsan Dogramaci Children's Hospital, Neonatal Intensive Care Unit. Prenatal diagnosis and postnatal outcome were compared. In the last 10 years, nine neonates were born with a prenatal CPAM diagnosis. 66.7% of the infants were asymptomatic. Complications such as polyhydramnios, hydrops, pulmonary hypoplasia, and mediastinal shift were not observed in any of the cases. The mean follow-up period was 3±3.7 years; two cases dropped out in the long-term follow-up. Postnatally, two cases were diagnosed with pulmonary sequestration (22.2%), one with CCAM type 1 (11.1%), one with thymic cyst (11.1%), one with bronchogenic cyst (11.1%), and one with congenital lobar emphysema (11.1%). Spontaneous resolution of the cysts was observed in two cases. As a result of recurrent pneumonia, lobectomy was performed in one case; it was diagnosed pathologically as CCAM type I. There was no mortality. In conclusion, although discrepancies exist between antenatal and postnatal diagnoses, ultrasonography has an important role in both the diagnosis and management of CPAM. [ABSTRACT FROM AUTHOR]

Adenovirus pneumonia, while common in infancy and childhood, is rarely documented and may be fatal in the neonatal period. Clinical manifestations include conjunctivitis, upper and lower respiratory diseases, gastroenteritis, and hemorrhagic cystitis. Diagnosis is confirmed by serologic tests, polymerase chain reaction (PCR) and adenovirus antigen detection. There is no specific therapy for adenovirus infections, although possible benefits have been demonstrated with ribavirin, vidarabine and ganciclovir. A nine-day-old female newborn required hospitalization because of pneumonia. in the follow-up, pneumonia progressed to acute respiratory distress syndrome and severe pulmonary hypertension. Although surfactant replacement therapy and mechanical ventilation were performed for the pneumonia, and sildenafil, iloprost and magnesium sulphate therapies were administered for the pulmonary hypertension, the infant died with pulmonary hemorrhage on the 9th day of admission. Postmortem pathologic examination revealed adenoviral pneumonia and severe secondary pulmonary hypertension. Adenovirus should be considered in the etiology of severe sepsis and resistant pneumonia in neonates. [ABSTRACT FROM AUTHOR]

Aim: Blood pressure (BP) measurement techniques in neonates generally involve noninvasive measurements with a cuff (oscillometric) or invasive measurements through an arterial catheter. The aim of this study was to determine the reliability of the noninvasive oscillometric method in critically ill preterm infants when results were compared with the invasive technique. Method: Twenty-seven premature infants with a mean birth weight of 1138 ± 552 g were enrolled in the prospective study. Invasive and noninvasive mean arterial pressure (MAP) levels were recorded simultaneously at each measurement in all patients. Low or lower range mean invasive MAP values (MAP ≤30) were evaluated separately as we aimed to assess the value of noninvasive measurements in hypotensive sick premature infants. Results: Totally, 431 paired BP measurements were taken during the first week of life. There was no statistically significant difference between invasive and noninvasive readings. However, noninvasive measurements were found significantly higher compared with invasive measurements in the presence of hypotension (p < 0.05). Conclusion: This study showed good agreement between oscillometric and invasive readings in critically ill premature infants, and further, comparable mean MAP values were found with the two methods. However, the accuracy of the oscillometric BP measurement technique fails in preterm infants with BP within the lower limits. [ABSTRACT FROM AUTHOR]

Intrauterine torsion of testes (IUTT) is a very rare condition. It can cause anorchia in bilateral cases. IUTT is almost exclusively extravaginal. It may result from the interplay between a hyperactive cremaster reflex and the failure of adequate in-utero fixation of the tunica vaginalis to the scrotal wall. Controversy in treatment continues regarding the urgency for surgical exploration as well as the need for contralateral testis fixation. Here, we present a two-day-old infant who was admitted to the neonatology department with a solid, firm and immobile mass in the right scrotum. The infant was diagnosed as IUTT after surgery. The necessity of contralateral testis fixation was discussed and performed after one month of follow-up. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is one of the most important chronic morbidities of very low birth weight infants and is associated with significant comorbidities and high risk of mortality both in the neonatal intensive care unit (NICU) and long-term follow-up periods. In our country, there are few studies related with the characteristics of short- and long-term follow-up of infants with BPD. In this study, we aimed to define the demographic and clinical characteristics of infants with BPD in the last 10 years in our hospital, retrospectively. In the last 10 years, the incidence of BPD among very low birth weight infants was found to be 21.1% in our NICU. One hundred cases could be included in the study, and among them, 26 (26%) were mild BPD, 59 (59%) were moderate BPD and 15 (15%) were severe BPD according to the severity of the disease. The mean gestational age of the cases was 28.6±1.8 (25.4-34.8) weeks, while the mean birth weight was 1087±288 (600-2060) g. The number of male infants was higher than of females (61, 61%), and 85 (85%) cases were found to receive aggressive resuscitation at birth. On admission to NICU, 45% (n=45) of the cases were hypothermic and 76% (n=76) were hypotensive in the first 24 hours of life. During the NICU period, 69% (n=69) of the cases were found to develop respiratory distress syndrome, while 53% (n=53) developed pneumonia, 62% (n=62) patent ductus arteriosus, 33% (n=33) necrotizing enterocolitis, 67% (n=67) neonatal sepsis, 44% (n=44) intraventricular hemorrhage, and 34% (n=34) retinopathy of prematurity. Ten cases (10%) died during the NICU period. Home oxygen therapy was initiated in 69 (76.7%) of the discharged cases. Hypoxia, hypercarbia and hypocarbia in arterial blood gas analysis in the first three days of life were found to be the most important risk factors for the development of severe BPD. Fifty cases could be evaluated at corrected age of 12-24 months during the long-term follow-up. Of these, 11 (22%) had growth failure, 8 (16%) had cerebral palsy, 12 (24%) had severe retinopathy of prematurity, and 9 (18%) had hearing impairment. Rehospitalization rate was 47.8% (n=43) among discharged patients. The majority of the rehospitalized patients (18, 23.4%) had pneumonia, acute bronchiolitis (12, 15.6%) and sepsis (8, 10.4%). In conclusion, the short- and long-term management of BPD is complicated and requires a multidisciplinary approach. In our country, multicenter studies are needed to obtain comprehensive data about short- and long-term follow-up of infants with BPD. [ABSTRACT FROM AUTHOR]

Chryseobacterium meningosepticum is a gram-negative bacterium, which is pathogenic for preterm infants and immunocompromised adults, especially in intensive care units. This study is a documentation of an outbreak in a neonatal intensive care unit (NICU) and demonstrates the outcome and prognosis of infected infants. A total of 16 infants infected by C. meningosepticum during a one-year period were included in the study. The source of the bacteria could not be explained clearly but the environment and respiratory equipment were the most probable sources. Pneumonia was the most important complication because of its association with a high mortality rate (60%). Hydrocephalus occurred in three patients and resulted in severe neurologic sequelae. We concluded that C. meningosepticum is a fulminant microorganism that spreads rapidly as an outbreak in NICUs and causes serious complications such as pneumonia, meningitis, hydrocephalus, and long-term morbidities. [ABSTRACT FROM AUTHOR]

Perinatal mortality statistics are important indicators of the quality of the perinatal health care system on an institutional or national basis and are necessary for the identification of the problems and implementation of preventive measures in the perinatal health care system. However, perinatal mortality statistics on an institutional or national basis are inadequate in Turkey. In this study, we aimed to make a comprehensive perinatal mortality analysis of the 2001-2006 period in our tertiary care university hospital and to compare results with previous reports of our institution. The Perinatal Mortality Study Group prospectively analyzed the perinatal mortality cases regularly each month. The study group was composed of stillbirths including intrauterine and intrapartum deaths, pregnancy terminations and early neonatal deaths occuring after 22 completed weeks of gestation until the end of the 7th day of postnatal life or in cases with a birth weight of at least 500 g. The definitions of the World Health Organization were used for the calculation of perinatal, stillbirth and early neonatal mortality rates. Wigglesworth and de Galan-Roosen "fundamental" perinatal mortality classifications were used for the distribution of the cases. During the study period, 353 perinatal mortality cases were identified. Of these, 219 (62%) were stillbirth (28.3% intrauterine death, 7.4% intrapartum death and 26.3% pregnancy terminations) and 134 (38%) were early neonatal deaths. The distribution of cases according to Wigglesworth classification was as follows: intrauterine deaths 10.8%, congenital malformations 35.5%, prematurity 25.2%, perinatal asphyxia 12.5%, and special causes 15.9%. According to de Galan-Roosen "fundamental" classification, 0.6% trauma, 2.8% infection, 9.0% placenta-cord pathology, 3.1% maternal immune system pathology, 36.3% congenital malformations, 25.2% prematurity, and 13.0% unclassified cases were identified. Mean stillbirth rate was 21.9‰, while early neonatal mortality rate was 13.7‰ and perinatal mortality rate was 35.3‰ for the whole study period. In spite of a progressive decline in all mortality rates from 2001-2004, an approximately 1.5-2.8-fold increase was detected from 2005-2006. The ratio of stillbirths to total births increased from 1.6% in 2004 to 2.9% in 2006, and the ratio of early neonatal deaths to live births increased from 0.7% in 2004 to 1.8% in 2006. The analysis of the causes of early neonatal mortality showed a four-fold increase in prematurity from 0.3% in 2004 to 1.2% in 2005-2006 but similar rates of congenital malformations, perinatal asphyxia and special causes between the two periods. In our hospital, prematurity rate ranged between 19.2-24.6% during the 2001-2006 period.However, the ratio of very premature infants (gestational age <28 weeks) increased approximately two-fold from 4.4% in 2004 to 8.2-9.6% in 2005-2006. It is concluded that the perinatal mortality rate, which declined during from 2001-2004, showed an increase due mostly to increased early neonatal mortality rate and then stillbirth rate. The increased ratios of high-risk very premature infants among live births and of intrauterine deaths and pregnancy terminations among total births due to late referral seem to be the most important factors contributing to increased early neonatal mortality and stillbirth rates. [ABSTRACT FROM AUTHOR]

Although the etiology is not clear, neonatal neutropenia is frequently seen in infants of preeclamptic mothers in the first week of life. Bronchopulmonary dysplasia is a chronic pulmonary morbidity that is associated with fetal and neonatal inflammation and neutrophil activation. In this study, we aimed to investigate the relation between absolute neutrophil count and subsequent development of bronchopulmonary dysplasia in infants of preeclamptic mothers. Between January 2003 and December 2007, 84 infants of preeclamptic mothers and 91 controls who were born and admitted to Hacettepe University İhsan Doğramacı Children's Hospital Neonatal Intensive Care Unit were included in the study. Complete blood count including white blood cell and differential count and peripheral blood smears were noted from hospital records in all infants. Mean gestational age was 30.2 ± 1.7 weeks in the preeclamptic group and 30.7 ± 1.8 in the control group, while the mean birth weights were 1035 ± 177 g and 1042 ± 149 g, respectively. There were statistically significant differences between the two groups with respect to white blood cell, absolute neutrophil and platelet counts (p<0.05). There was a positive correlation between white blood cell count, absolute neutrophil count and the development of bronchopulmonary dysplasia (white blood cell count odds ratio [OR]: 3.5, 95% confidence interval [CI]: 1.8-8.8; absolute neutrophil count OR: 2.6, 95% CI: 1.2-6.3). Neonatal neutropenia, which is frequently seen in infants of preeclamptic mothers, may prevent the development of bronchopulmonary dysplasia. Increased white blood cell count may reflect a risk factor for the development of bronchopulmonary dysplasia but this should be tested in prospective studies. [ABSTRACT FROM AUTHOR]

Gestational age of a newborn infant can be determined by the last menstrual period of the mother, early prenatal obstetric ultrasonography and postnatal scoring systems based on examination of physical and neuromuscular maturation of the newborn infant. However, gestational age is already accurately known in pregnancies conceived with assisted reproductive technologies such as in vitro fertilization, intracytoplasmic sperm injection (ICSI), ovulation induction, and in utero insemination. The aim of this study was to determine the accuracy and validity of the New Ballard Score in newborn infants born from ICSI pregnancies in which gestational ages were accurately known. Between June 2005 and November 2007, we examined 430 newborns born from ICSI pregnancies at Hacettepe University Hospital. Gestational ages of the subjects ranged from 23 to 40 weeks and 3 days. The correlation coefficient between the real gestational ages and gestational ages determined by New Ballard Score was 0.98 and regression line was linear (y=0.73+0.97x). The greatest correlation between the real gestational ages and gestational ages determined by the New Ballard Score was found in newborn infants younger than 28 weeks of gestational age (r=0.91, p<0.001) when all infants were divided into different gestational age groups. A statistically significant positive correlation between the real gestational ages and gestational ages determined by the New Ballard Score was found in singleton and multiple pregnancies (singleton: r=0.98, p<.0.001; multiple pregnancies: r=0.97, p<0.001). There was a statistically significant positive correlation between real gestational ages and gestational ages determined by the New Ballard Score in infants of hypertensive, diabetic and advanced aged mothers (infants of hypertensive mothers: r=0.95, p<0.001; infants of diabetic mothers: r=0.97, p<0.001; infants of advanced aged mothers: r=0.97, p<0.001). It was concluded that the New Ballard Score is a valid and accurate gestational age assessment tool for the entire newborn infant population. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate retrospectively the patients born in our hospital with neural tube defects. We investigated the demographic, prenatal, natal and postnatal features, familial risk factors, physical and radiological findings, and accompanying diseases of 45 (19 females, 26 males) patients. Incidence of neural tube defects in our hospital was shown to be higher than previous studies in our country. Meningomyelocele was seen in 42 (93%) of 45 patients, while meningocele was seen in three (7%) of 45 patients. Arnold-Chiari malformation type 2 was shown in 30 (71%) of 42 patients and Arnold-Chiari malformation type 1 was shown in only one (2%) of 42 patients. Neurologic and/or other findings were more frequently seen in patients with proximal spina bifida. We emphasize the reasons for the high incidence of spina bifida, methods of prevention and the importance of periconceptional folic acid administration. [ABSTRACT FROM AUTHOR]

Arginine is an essential amino acid in the fetus and neonate and is a conditionally essential nutrient for adults. As a precursor for the synthesis of nitric oxide (NO) and other molecules that have enormous biologic importance and as a stimulant to the production of growth hormone, L-arginine plays versatile key roles in nutrition, immunodefense and metabolism. The objectives of this study were to investigate whether there is a relationship between morbidity, mortality, and plasma arginine levels, and to determine whether long-term arginine-supplemented enteral nutrition affects morbidity, mortality, hospital stay, and growth parameters in premature infants with birth weight ≤1500 g and gestational age ≤34 weeks. In this placebo-controlled study, 53 preterm infants with a birth weight of ≤1500 g and gestational age ≤34 weeks were prospectively, randomly assigned to receive enterally supplemental L-arginine (250 mg/kg per day, study group; n=27) or sterile water (placebo) (control group; n=26). Nine infants from the study group and nine infants from the control group were lost to follow-up; 18 infants from the study group and 17 infants from the control group completed the study. Blood samples for plasma arginine levels on the 1st and 15th days of life and at the postconceptional 40th week were collected. Growth parameters (weight, length, head circumference, right upper arm mid-circumference and right thigh mid-circumference) were measured on the 1st and 15th days of life and at the postconceptional 40th week. Arginine supplementation was discontinued at the end of the postconceptional 40th week. There were no significant differences in growth parameters on the 15th day and at the postconceptional 40th week between the study and control groups. There was no relationship between plasma arginine levels on the 1st day, 15th day, and at the postconceptional 40th week and either synchronized growth parameters or morbidity and mortality in all infants. There was also no difference between the supplemented group and control group in terms of incidence of morbidity and mortality. We concluded that arginine supplementation by enteral route alone in premature infants does not affect the growth parameters, morbidity or mortality. [ABSTRACT FROM AUTHOR]

Objective: To compare perinatal outcomes in spontaneous twins compared with those conceived by intracytoplasmic sperm injection (ICSI). Design: Retrospective case-control study. Patients: Cases consisted of 274 intracytoplasmic sperm injection twins, controls were 348 naturally conceived twins delivered between 1999 and 2003 in a tertiary hospital. Main outcome measures: Birth weight, gestational age at birth, cesarean delivery rate, perinatal mortality and morbidity, congenital anomalies, gestational diabetes and pregnancy induced hypertension. Results: Preterm deliveries (76.6% vs. 64.1% <37 weeks and 19.7% vs. 13.2% <32 weeks) and low birth weight (73% vs. 60.3% <2500 g and 19.7% vs. 12.6% <1500 g) were significantly higher in the ICSI group compared with controls. Gestational diabetes mellitus (8% vs. 2.9%) and cesarean deliveries (95.2% vs. 77.6%) were more common in cases compared with the control group. There was a significantly higher rate of perinatal morbidity (16.4% vs. 7.8%) and mortality (8% vs. 2.6%) in ICSI twins. The incidence of congenital malformations diagnosed at birth was higher in cases (4.4%) compared with controls (0.9%) but the difference was not significant when adjusted for maternal age. Conclusion: Perinatal outcomes of twins after ICSI treatment are less optimal than naturally conceived twins. [ABSTRACT FROM AUTHOR]

Multisystem pseudohypoaldosteronism (PHA) is a rare autosomal recessive aldosterone unresponsiveness syndrome that results from mutations in the genes encoding epithelial sodium channel (ENaC) subunitsα,β andγ. In this study we examined three PHA patients to identify mutations responsible for PHA with different clinical presentations.All three patients presented uniformly with symptoms of severe salt-loss during the first week of life and were hospitalized for up to a year. Beyond infancy, one of the patients showed mild renal salt loss and had no lower respiratory tract infections until 8 years of age, while the other patients continue with a severe course.We sequenced the complete coding regions and intron–exon junctions of the genes encodingα,β andγ subunits of ENaC for all patients. The results revealed that the mild case represents a novel compound heterozygote including a missense (Gly327Cys) mutation in theαENaC gene. Sequences of relatives over three generations confirmed that the missense mutation co-segregates with PHA. This mutation was not found in 60 control subjects. The other patients with severe PHA had two homozygous mutations, a novel deletion mutation in exon 8 of theαENaC gene and a splice site mutation in intron 12 of theβENaC gene. Most of the PHA-causing mutations appear in theαENaC gene located on chromosome 12 rather than in theβ andγENaC genes located tandemly on chromosome 16. However, the frequency of sequence variants in patients and control subjects showed no difference between genes.Severe PHA cases are associated with mutations leading to absence of normal-lengthα,β orγENaC, while a mild case has been found to be associated with a missense mutation inαENaC. The predominance of PHA-causing mutations in theαENaC gene may be related to the function of this subunit. [ABSTRACT FROM AUTHOR]

Airway obstruction and feeding difficulties are the major issues in patients with Pierre-Robin sequence. Managing airway problems is challenging for both pediatricians and plastic and reconstructive surgeons. The main causes of airway obstruction are micrognathia and glossoptosis. Numerous therapeutic maneuvers have been used to stabilize the upper airway in these patients, such as prone positioning, tracheotomy and tongue-lip adhesions. However, high complication rates, long duration of hospitalization, ineffective airway management, and feeding difficulties are the disadvantages of these techniques. Mandibular distraction osteogenesis is an effective treatment to avoid tracheotomy and provide effective feeding in carefully selected Pierre-Robin sequence neonates. Here, we present a neonate with micrognathia and glossoptosis, who was treated with mandibular distraction, and we aimed to discuss the treatment modalities for airway management in patients with Pierre-Robin sequence. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is the most common cause of neurogenic hypotony in early infancy. The disease consists of four forms: type 0, type 1, type 2, and type 3, according to the age of onset, clinic severity and prognosis. SMA type 0 is the rarest and the most fatal type of the disease. SMA causes profound hypotony, severe weakness and often fatal restrictive pulmonary disease. The most common selective features of SMA type 0 are reduced fetal movements, severe weakness including of respiratory muscles and hypotony at birth, and fatal prognosis. To emphasize the importance of the distinctive diagnosis of the hypotonic newborn with respiratory distress, we present a rare SMA type 0 case with fetal hypokinesia, severe weakness including respiratory muscles requiring ventilator support at birth, arthrogryposis multiplex congenita (AMC), and deletions on exons 7 and 8 on Survival of Motor Neuron gene (SMN1). [ABSTRACT FROM AUTHOR]

Caffeine is frequently used for the treatment of apnea in preterm babies. Its mechanism of action includes not only antagonism of adenosine receptors on central nervous system but also an increase in electrical activity of the diaphragm. Caffeine's direct effect on diaphragm was investigated via electromyography, but ultrasound has not been used to show visible changes in muscles after the treatment before. Therefore, we aimed to assess the effect of caffeine on diaphragmatic function through ultrasonographic examination. It was a prospective observational study. Fifty-six participants receiving nasal continuous positive airway pressure with less than or equal to 32 weeks' gestational age born were enrolled. Diaphragmatic thickness, amplitude of excursion, and velocity of movement were measured before and within 5 minutes after caffeine loading dose and compared to each other. The protocol was registered with ClinicalTrials.gov Identifier NCT04483492. Diaphragmatic thicknesses and diaphragmatic velocity of movement did not differ after the treatment. However, amplitude of excursion of the diaphragm was found significantly higher after caffeine loading dose (8.7 mm, 10mm, respectively, P < .05). Diaphragm excursion increased after caffeine treatment in preterm babies, and this finding was potentially supported the direct effect of the caffeine on diaphragm. Another important finding of this study is that it reinforces the utility of ultrasonography in assessing diaphragmatic function in preterm infants.

Aim: To develop models that predict the presence of medication errors (MEs) (prescription, preparation, administration, and monitoring) using machine learning in NICU patients. Design: Prospective, observational cohort study randomized with machine learning (ML) algorithms. Setting: A 22-bed capacity NICU in Ankara, Turkey, between February 2020 and July 2021. Results: A total of 11,908 medication orders (28.9 orders/patient) for 412 NICU patients (5.53 drugs/patient/day) who received 2,280 prescriptions over 32,925 patient days were analyzed. At least one physician-related ME and nurse-related ME were found in 174 (42.2%) and 235 (57.0%) of the patients, respectively. The parameters that had the highest correlation with ME occurrence and subsequently included in the model were: total number of drugs, anti-infective drugs, nervous system drugs, 5-min APGAR score, postnatal age, alimentary tract and metabolism drugs, and respiratory system drugs as patient-related parameters, and weekly working hours of nurses, weekly working hours of physicians, and number of nurses' monthly shifts as care provider-related parameters. The obtained model showed high performance to predict ME (AUC: 0.920; 95% CI: 0.876-0.970) presence and is accessible online (http://softmed.hacettepe.edu.tr/NEO-DEER&#95;Medication&#95;Error/). Conclusion: This is the first developed and validated model to predict the presence of ME using work environment and pharmacotherapy parameters with high-performance ML algorithms in NICU patients. This approach and the current model hold the promise of implementation of targeted/precision screening to prevent MEs in neonates. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04899960., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yalçın, Kaşıkcı, Çelik, Allegaert, Demirkan, Yiğit and Yurdakök.)

Hospitalized newborns have an increased risk of malnutrition and, especially preterm infants, often experience malnutrition-related extrauterine growth restriction (EUGR). The aim of this study was to predict the discharge weight and the presence of weight gain at discharge with machine learning (ML) algorithms. The demographic and clinical parameters were used to develop the models using fivefold cross-validation in the software-R with a neonatal nutritional screening tool (NNST). A total of 512 NICU patients were prospectively included in the study. Length of hospital stay (LOS), parenteral nutrition treatment (PN), postnatal age (PNA), surgery, and sodium were the most important variables in predicting the presence of weight gain at discharge with a random forest classification (AUROC:0.847). The AUROC of NNST-Plus, which was improved by adding LOS, PN, PNA, surgery, and sodium to NNST, increased by 16.5%. In addition, weight at admission, LOS, gestation-adjusted age at admission (> 40 weeks), sex, gestational age, birth weight, PNA, SGA, complications of labor and delivery, multiple birth, serum creatinine, and PN treatment were the most important variables in predicting discharge weight with an elastic net regression (R 2  = 0.748). This is the first study on the early prediction of EUGR with promising clinical performance based on ML algorithms. It is estimated that the incidence of EUGR can be improved with the implementation of this ML-based web tool ( http://www.softmed.hacettepe.edu.tr/NEO-DEER/ ) in clinical practice., (© 2023. The Author(s).)

Background: Critically ill neonates are at greater risk for adverse drug reactions (ADRs). The differentiation of ADRs from reactions associated with organ dysfunction/immaturity or genetic variability is difficult., Methods: In this prospective cohort study, each ADR was assessed using newborn-specific severity and probability scales by the clinical pharmacist. Subsequently, a machine learning-based risk score was designed to predict ADR presence in neonates., Results: In 98/412 (23.8%) of (56.3%; male) neonates included, 187 ADRs (0.42 ADR/patient) were determined related to 49 different drugs (37.12%). Drugs identified as high risk were enoxaparin, dexmedetomidine, vinblastine, dornase alfa, etoposide/carboplatin and prednisolone. The independent variables included in the risk score to predict ADR presence, according to the random forest importance criterion, were: systemic hormones (2 points), cardiovascular drugs (3 points), diseases of the circulatory system (1 point), nervous system drugs (1 point), and parenteral nutrition treatment (1 point), (cut-off value: 3 points). This risk score correctly classified 91.1% of the observations in the test set (c-index: 0.914)., Conclusions: Using the high-performing risk score specific to neonates, it is expected that high-risk neonatal ADRs can be determined and prevented before they occur. Moreover, the awareness of clinicians of these drugs can be improved with this web-tool, and mitigation strategies (change of drug, dose, treatment duration, etc.) can be considered, based on a benefit-harm relationship for suspected drugs with a newborn-centered approach.

Aims: Evidence for drug-drug interactions (DDIs) that may cause age-dependent differences in the incidence and severity of adverse drug reactions (ADRs) in newborns is sparse. We aimed to develop machine learning (ML) algorithms that predict DDI presence by integrating each DDI, which is objectively evaluated with the scales in a risk matrix (probability + severity). Methods: This double-center, prospective randomized cohort study included neonates admitted to the neonatal intensive care unit in a tertiary referral hospital during the 17-month study period. Drugs were classified by the Anatomical Therapeutic Chemical (ATC) classification and assessed for potential and clinically relevant DDIs to risk analyses with the Drug Interaction Probability Scale (DIPS, causal probability) and the Lexicomp ® DDI (severity) database. Results: A total of 412 neonates (median (interquartile range) gestational age of 37 (4) weeks) were included with 32,925 patient days, 131 different medications, and 11,908 medication orders. Overall, at least one potential DDI was observed in 125 (30.4%) of the patients (2.6 potential DDI/patient). A total of 38 of these 125 patients had clinically relevant DDIs causing adverse drug reactions (2.0 clinical DDI/patient). The vast majority of these DDIs (90.66%) were assessed to be at moderate risk. The performance of the ML algorithms that predicts of the presence of relevant DDI was as follows: accuracy 0.944 (95% CI 0.888-0.972), sensitivity 0.892 (95% CI 0.769-0.962), F1 score 0.904, and AUC 0.929 (95% CI 0.874-0.983). Conclusions: In clinical practice, it is expected that optimization in treatment can be achieved with the implementation of this high-performance web tool, created to predict DDIs before they occur with a newborn-centered approach.

Background: The use of non-invasive ventilation methods in neonatal intensive care units has been increasing in recent years. Non-invasive ventilation techniques are lung preserving methods and they reduce the risk of volutrauma, barotrauma, and atelectotrauma., Methods: The effect of heated humidified high-flow nasal cannula (HHHFNC), continuous positive airway pressure (CPAP), nasal intermittent positive-pressure ventilation (NIPPV), and nasal high-frequency oscillation ventilation (NHFOV) were compared in preterm infants with respiratory distress., Results: Between December 2015 and February 2017, a total of 76 preterm infants (gestational age < 32 weeks) with respiratory distress were enrolled in this study. Of the patients, 20 received HHHFNC, while 20 received nasal CPAP (NCPAP), 19 received NIPPV, and 17 received NHFOV for respiratory support. The primary outcome was intubation requirement during non-invasive respiratory support. The secondary outcome included duration of non-invasive ventilation, air leak syndrome, abdominal distension, intraventricular hemorrhage, necrotizing enterocolitis (NEC), nasal injury, increased secretions, agitation, and mortality rate. The intubation ratio was higher in the NCPAP (40%) and NHFOV (29.4%) groups when compared with the NIPPV (10.5%) and HHHFNC (11.8%) groups. More nasal injury had developed in the NIPPV (78.9%) and NHFOV (82.4%) groups when compared with the NCPAP (40%) and HHHFNC (35%) groups. Moreover, the viscous secretion that blocked the cannulas was higher in NIPPV (78.9%) and NHFOV (76.5%) groups than NCPAP (25%) and HHHFNC (40%) groups. There were no significant differences in the duration of non-invasive ventilation methods, abdominal distension, NEC, air leak syndrome or mortality in the 4 groups., Conclusions: The NIPPV and HHHFNC methods can be useful as a primary mode of respiratory support for respiratory distress. However, doctors need to be careful with regard to the complications that may develop.

Background: The aim of the current study was to demonstrate the neonatal outcomes of infants born to mothers with early-onset preeclampsia (EP) and late-onset preeclampsia (LP), and compare the neonatal outcomes before and after 34 weeks of gestation in EP group., Methods: In this retrospective study, we evaluated preeclamptic mother and child pairs who were followedup at Hacettepe University Hospital between the years 2010 and 2017. The pregnant women were classified as having EP if diagnosed before 34 weeks of gestation (n=91) and LP if diagnosed after 34 weeks of gestation (n=34). The women in the EP group were further divided into subgroups according to the gestational week at birth, including those who gave birth before 34 weeks of gestation (early birth; n=57) and after 34 weeks of gestation (late birth; n=34). Necessary clinical and demographic data were withdrawn from the electronic registry and patient files., Results: Neonates in the EP/late birth subgroup had significantly lower gestational age and birthweight. Small for gestational age (SGA) frequency was higher in the early-onset subgroup born after 34 weeks` gestation compared to the late-onset preeclampsia group (p= 0,016). The incidence of neutropenia was significantly higher in the EP/late birth subgroup than in the LP group (p= 0.002). After correcting for gestational week and birth weight, neutrophil count was still significantly lower in the EP/late birth subgroup (p= 0.002). EP/late birth subgroup and LP group had comparable outcomes regardless of neutrophil count and SGA rate., Conclusions: Close follow up and postponing delivery in stable and appropriate pregnant women with preeclampsia would be beneficial for neonates.

Since early intervention is important in risky infants, it is also important to identify developmental problem as early as possible. There are various assessment methods for this. One of them is the General movements assessment (GMs), and the other one is the Bayley Scales of Infants and Toddler Developmental, third edition (Bayley-III). The present study aimed to compare the neurodevelopmental outcomes and Bayley-III scores at the age of 1.5-2 years with fidgety GMs. One hundred and twenty-six infants (57 females, 69 males) were assessed by the GMs at the corrected 3-5 months and also by the Bayley-III at the age of 1.5-2 years. According to the GMs, 21 infants exhibited the absence of fidgety movements, six infants exhibited abnormal fidgety movements, and 99 infants exhibited normal fidgety movements. According to the Bayley-III, 19 infants` motor scores, 13 infants` language scores, and 18 infants` cognitive scores were low (-2SD). Various neurodevelopmental problems were identified in 25.4% of the infants. As a result, although in the present study the Bayley-III underestimates the rates of motor impairment, it was found to be moderately compatible with the GMs at 3-5 months (r= 0.4, p < 0.001). However, the GMs were better than the Bayley-III in predicting neurodevelopmental outcomes at the age of 1.5-2. Although the Bayley-III and GMs may be valuable tools for estimating the later outcomes of infants, care should be taken while interpreting their results.