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BACKGROUND AND OBJECTIVE Leptin is produced by the human placenta besides adipose tissue and is suggested to be related to fetal growth. In order to find out whether multiple pregnancy is a factor affecting serum leptin levels, we compared neonatal serum leptin concentrations of twins and singleton newborns who were all appropriate for gestational age (AGA). INFANTS AND METHODS Thirty newborns were studied. Group 1 consisted of 15 infants from twin pregnancies and group 2 (control group) consisted of 15 infants from singleton pregnancies. Serum samples were taken at 24 hours following delivery and leptin concentrations were measured. RESULTS There were no significant differences in birth weight, gestational age and male/female ratio between infants of twin and single gestations. However, serum leptin concentrations of twins (mean +/- SEM: 1.13 +/- 0.35 ng/ml) were significantly lower than of the singleton infants (4.27 +/- 0.63 ng/ml) (p < 0.001). CONCLUSION Twin pregnancy might be a factor affecting serum leptin concentrations in newborn infants.

Backgraund and aim To evaluate and compare the morbidity and mortality of neonates born to pregnant women with positive and negative cervical cultures. Methods The demographic and clinical features of mothers included in this study, along with details of the microorganisms isolated on maternal cervical cultures and the number of days between a positive cervical culture and delivery were recorded. Neonates were stratified into two groups based on cervical culture results of their mothers - Group 1, positive cervical culture; Group 2, negative cervical culture. Results A total of 216 women who delivered 242 infants were included in the study. Group 1 consisted of 90 neonates while Group 2 had 152 newborns. Mean levels of the acute phase reactants, CRP and IL-6, obtained 6 hours after delivery were significantly higher in Group 1 compared to Group 2 (p Conclusions Women diagnosed with a high-risk pregnancy should be treated with antibiotics immediately after a positive cervical culture result, and delivery should be delayed until the success of antibitoic treatment can be evaluated. Early initiation of maternal antibiotic therapy is associated with shorther durations of hospital stay for newborns. Close follow-up of mothers with high risk pregnancies and extension of treatment duration are critical for determining prognosis in newborn infants.

Background and Aims Our aim was to determine the relationship between red blood cell transfusion and necrotizing enterocolitis (NEC) in all admitted very low birth weight (VLBW) infants with or without transfusion. Methods All VLBW neonates were categorized into five groups: subjects that developed NEC subjects that developed NEC > 48 hours after transfusion (n = 31); subjects that were never transfused but developed NEC, (n = 50); subjects that were transfused but did not develop NEC, (n = 250); and subjects that were neither transfused nor developed NEC (n = 301). Results A group of 647 infants were enrolled in the study. Mean gestational age and birth weight of the patients were 29±3.1 weeks and 1157±237 grams, respectively. The mean age at the onset of NEC in the NEC groups were 20±2.3 days, 12±3 days, and 11±2.6 days, respectively (P Conclusion In this study, we sought to evaluate all VLBW infants, whether they received a transfusion or not. We suggest that transfusion associated NEC exists, but many other factors influence this multifactorial disease. The age of NEC onset was later in transfused versus non-transfused patients, whereas the interval between transfusion and NEC was shorter.

Background and Aims The objective of this study was to determine whether use of a longer (1 in.) rather than astandard (5/8 in.) needle used for macrosomic neonates (birthweight over 4000 g) may affect antibodytiters after immunization against hepatitis B virus (HBV). Methods Fifty nine healthy infants were vaccinated at birth, 1, and 6 months of age with hepatitis Bvaccine, with follow up to 7 months of age. Infants were randomized into two groups according to needlelength of first vaccine at birth. First group vaccinated with standart needle length and other group receivedvaccine by longer needle length. Results Macrosomic infants who were immunized with a longer needle achieved significantly higher antibodytiters to hepatitis B surface antigen than standart needle length (median, 3890.2 vs 1311.7 mIU/mL, respectively; p=0.001). Conclusions Macrosomic neonates benefit from longer needle length with higher levels of antibody titersafter HBV vaccination.

Background and Aim Hypoxia and ischemia appear to play an important role in the pathogenesis of necrotizing enterocolitis (NEC) which is related to oxygen-derived free radical formation. This study was designed to evaluate the role of oxidative stress and potentially beneficial effects of N-acetylcysteine (NAC) in a neonatal rat model of NEC. Methods Thirty Wistar albino rat pups were randomly divided into 3 groups: group 1, control; group 2, NEC and saline; group 3, NEC and NAC treatment. NEC was induced by hyperosmolar enteral formula feeding and exposure to hypoxia after cold stress at 4 o C and oxygen. The pups were killed on the fourth day and their intestinal tissues were harvested for biochemical and histopathologic analysis. Results Mucosal injury scores and intestinal malondialdehyde levels in group 2 were found to be significantly higher than other groups ( p = p =0.018). Intestinal tissue TNF-α levels were significantly reduced with NAC treatment in group 3 compared to group 2 ( p Conclusions It is more likely that oxidative stress and inflammmatory mediators contributed to the pathogenesis of NEC and that NAC had a protective effect on intestinal injury through its antiinflammatory and antioxidant properties.

Purpose To identify the degree of perceived social support in mothers of hospitalized children in neonatal intensive care unit, and to assess in psychosocial aspects the relationship of the perceived social support with such variables as depression and anxiety level. Method A total of 50 mothers who have hospitalized infants in NICU, included in this study and the social support they perceived, and the their anxiety and depression levels were analyzed using “Multidimensional Scale of Perceived Social Support Scale” and Hospital Anxiety and Depression Scale (HAD scale), respectively. Results Perceptions of total social support and the social support provided by friends in the mothers increased as the infants’ birth weight decreased; the levels of total perceived social support and the perceived social support from families and spouses in the mothers getting pregnant with assisted conception techniques (ACT) were greater, compared with the mothers of spontaneous conception. The scores of total perceived social support and the perceived social support from families and spouses in depressed mothers were found to be lower than those in otherwise healthy mothers. Conclusion It was concluded in our study that the mothers of the hospitalized infants in the neonatal intensive care unit required social support provided especially by the spouses and the families, disclosing the relationship of inadequate perception of such supports with development of depression.

An infant was cleansed with 2% clorhexidine gluconate (CHG) because of repeated sepsis episodes from skin colonization. Asymptomatic hyperchloremia ensued, most likely associated with CHG therapy. Fourty-eight hours after CHG therapy withdrawal, serum chloride levels returned to normal. Hyperchloremia may be a reversible adverse effect of extensive use of CHG.

Ergotamine, an ergot alkaloid, used for the treatment and prevention of migraine attacks, is considered as a teratogenic drug and, therefore, should be avoided in pregnancy. Here, we report a newborn infant with unilateral renal agenesis, urethral atresia, and pulmonary hypoplasia associated with the use of ergotamine for the treatment of migraine attacks at early pregnancy. Genitourinary anomalies in association with ergotamine usage were rarely reported and this was the third case of renal agenesia in association with ergotamine usage in literature. We suggest that ergotamine teratogenicity may be dose dependent and should be avoided in pregnancy for the possibility of genitourinary anomalies.

Background: Therapeutic hypothermia provides up to 30% neuroprotection in moderate to severe hypoxic ischemic encephalopathy (HIE). Additional neuroprotection may be achieved by using concomitant pharmacologic neuroprotective agents. Aim: The aim was to evaluate the safety of concomitant neuroprotective therapy of therapeutic hypothermia and magnesium sulfate (MgSO 4 ) in the management of moderate and severe HIE in term and near‑term infants. Study Design: Multicenter double‑blind randomized controlled trial. Methodology: Term and near‑term newborn infants (≥35 weeks) with a clinical diagnosis of moderate or severe HIE were randomized to either Arm A (therapeutic hypothermia plus MgSO 4 ) or Arm B (therapeutic hypothermia plus placebo) using a net‑based randomization system. Both groups received, within 6 h of birth, standard hypothermia therapy (72 h of cooling to 33.5°C followed by slow rewarming over a period of 8 h) plus either MgSO 4 (250 mg/kg/dose ×3 doses) or placebo (normal saline). The groups were compared for short‑term predischarge adverse outcomes. Results: A total of 60 patients were randomized (29 in Arm A and 31 in Arm B). Both groups had similar baseline characteristics (P > 0.05) including severity of HIE. There were no differences in the short‑term adverse outcomes (death, seizures, thrombocytopenia, coagulopathy, renal failure, elevated liver function test’s, hypotension, intracranial hemorrhage, necrotizing enterocolitis, pulmonary hemorrhage, persistent pulmonary hypertension, and pulmonary air leak syndromes) between the two groups (P > 0.05). Conclusions: The combined use of therapeutic hypothermia and MgSO4 appears to be safe particularly with respect to maintaining normal blood pressure and coagulopathy. Long‑term survival and neurodevelopmental outcomes remain to be evaluated.

The study objective was to determine whether Ureaplasma respiratory tract colonization of preterm infants

Background and aims Meconium aspiration syndrome (MAS) is an important cause of severe respiratory failure in newborn infants. The aim of this study was to evaluate the efficacy of lung lavage with dilute porcine surfactant in ventilated infants with MAS. Methods In this prospective randomised controlled study ventilated infants with MAS with a gestational age ≥36, birth weight ≥2000 g included. Enrolled infants randomised into two groups; in group 1, two sequential 15 mL/kg aliquots of dilute porcine surfactant (Curosurf, Chiesi Farmaceutici S.p. A., Parma, Italy) with a phospholipid concentration of 5 mg/ml were instilled into the lung. In group 2, 100 mg/kg of porcine surfactant were administered as a bolus. Infants in both groups were evaluated and compared with regard to efficacy, morbidity and mortality. Results Fourteen infants were randomised. There were no significant differences between two groups in term of demographic characteristics. Median duration of respiratory support was longer in bolus surfactant group, although the difference was not statistically significant (2.2 vs. 7.2 days, p = 0.18). Similarly, duration of oxygen therapy and hospital stay length were shorter in lung lavage group but the difference was statistically insignificant (8.0 vs. 12.7 days, p = 0.32, 11 vs. 18.5 days p = 0.15, respectively). There were no differences in requirement for high frequency ventilation and nitric oxide between the groups. Conclusion Although it is not statistically significant, preliminary results show that lung lavage with dilute surfactant therapy shortens the duration of respiratory support and hospital stay length.

Background and aims Compared with term infants, late preterm infants have higher risks for morbidities such as respiratory distress, hypothermia, hypoglycemia, hyperbilirubinemia and feeding difficulty. The aim of this study to investigate incidence and clinical characteristics of feeding difficulty in late preterm infants. Methods A total of 426 infants were enrolled. We evaluated the clinical and demographic characteristics and feeding difficulty of late preterm infants. Results 54 infants had feeding difficulty. There were no differences in gestational age and birth weight among the groups. Mean intolerance day was 2.3 ± 1.2 days. Compared infants with feeding intolerance and non-feeding intolerance full enteral feeding time 8 ± 2.3 days and 5.2 ± 1.7 days, respectively (p Conclusions Late preterm infants should be followed closely for the complications such as feeding difficulty.

Background and aims Neonatal sepsis remains an important and potentially life-threatening clinical syndrome and a major cause of neonatal mortality and morbidity, particularly in preterm infants. The aim of this study to investigate whether values of base excess before the onset of clinical signs and symptoms of sepsis indicate infection in the early diagnosis of neonatal sepsis. Methods A total of 118 infants were enrolled. The infants were classified into two groups: group 1 (sepsis, n = 49) and group 2 (control, n = 69). Blood gas analysis investigated for screening of neonatal sepsis. Results A total of 49 infants with neonatal sepsis and 69 healthy controls were enrolled. A comparison of markers of sepsis revealed C-reactive protein, interleukin-6 level to be significantly higher and pH, pCO 2 , HCO 3 and base excess values to be significantly lower in newborns with sepsis compared healthy controls (p Conclusions This is the first study to determine the relationship between the decrease value of base excess and early stage of neonatal sepsis. If the value of base excess

Salbutamol is a beta-2 selective adrenoceptor agonist and is used extensively in the treatment of reversible obstructive airway disease of children [1]. The hypokalemic effect of salbutamol was investigated in adults with asthma and chronic renal failure [2-4]. We would like to draw attention to the successful treatment of hyperkalemia in 2 newborn infants

We readwith great interest the recent original article by Jo et al [1] published recently in this journal, which demonstrated that red cell distribution width (RDW) was associated with 28-day mortality in patients with severe sepsis and septic shock. The authors stated that RDW of nonsurvivors was higher than that of survivors in severe sepsis and septic shock, and there was a graded association between RDW and 28-day mortality. In addition, RDW had a relationship with the severity of the patients and was an independent prognostic factor of 28-day mortality in patients with severe sepsis and septic shock. Although experience about RDW as a prognostic factor is increasing, there is still a debate about it and no experience in pediatric population especially in newborn. We would like to present our experience related to RDW in neonatal sepsis. We evaluated the RDW values of 46 extremely low birth weight infants (birth weight b1000 g) with early sepsis. Sixteen (35%) of the infants were dead during this period. There was no statistically difference in both survivor and nonsurvivor groups with respect to sex, gestational age, birth weight, vaginal delivery rates, and Apgar 1’ andApgar5’ scores.Whenpatientsweredivided into 3groups according to RDW, the mortality rate did not change with increasing tertiles of RDW. The clinical risk index for babies (CRIB) scores did not change according to RDW tertiles. The authors stated that elevation of RDW in sepsis might be associated with inflammation. Proinflammatory cytokines such as tumor necrosis factor α, interleukin-6 (IL-6), and interleukin-1β could suppress red blood cell maturation and decrease the half-life of red blood cells. In our patients, IL-6 levels and also C-reactive protein levels were analyzed, and there was no correlation between IL-6 and C-reactive protein levels and RDW. Red cell distribution width could be elevated in any conditions in which red blood cell is produced ineffectively or increasingly destructed, which result in release of reticulocytes, and several possiblemechanisms have been suggested. Red cell distributionwidth does not predict the mortality in extremely low birth weight infants with early sepsis.

Objective Although neurodevelopmental outcomes for management of patent ductus arteriosus with intravenous indomethacin and ibuprofen are known, there has been lack of data on long term effects of oral ibuprofen in the literature. Method To assess the neurodevelopmental outcomes at 18–24 months’ corrected age, we conducted a prospective follow-up study of 99 infants with birth weight ≤1500 g and gestational age ≤32 weeks who recieved either oral or intravenous ibuprofen for patent ductus arteriosus.1) Moderate/severe cerebral palsy with functional deficits, 2) bilateral hearing loss and blindness in either eye, and 3) mental developmental index score or psychomotor index score less than 70 were defined as abnormal neurologic, neurosensory and cognitive outcomes, respectively. Results At 18–24 months’ corrected age, neurodevelopmental outcomes of 30 (60.0%) among 50 subjects who received oral ibuprofen were compared with 27 (55.1%) of 49 who received intravenous ibuprofen by certified and experienced examiners who were blinded to the groups. The results revealed that long term outcomes did not significantly differ among treatment regimes. Conclusion Preterm infants who were treated with oral ibuprofen for patent ductus arteriosus have similar neurological, neurosensory and cognitive outcomes with patients who recieved intravenous ibuprofen at 18–24 months’ corrected age.

Objective To evaluate the growth and neurodevelopmental outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotising 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. Neurodevelopmental assessment was done using the Bayley Scales of Infant Development II (BSID-II). The primary outcome was neurodevelopmental impairment at 18–24 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 were no significant difference in growth and neurodevelopmental outcomes between the two groups. Conclusion Oral probiotic administrated to VLBW infants to reduce the incidence and severity of NEC started with the first feed did not affect growth and neurodevelopmental outcomes at 18–24 months’ corrected age.

Aim Neonatal autopsies is a guide to explore the causes of the perinatal mortalities which is important marker for evaluation of the health policies. Multidisciplinary approach which includes obstetrician, pediatrician, pathologist and geneticist is required for the neonatal autopsies. We aimed to evaluate the neonatal autopsies in our center. Methods Thirty-eight neonatal autopsies performed between January 2009 and December 2010 were evaluated in respect to demographic characteristics, clinical and pathological diagnosis retrospectively. Results 7055 neonates were administered to our NICU between January 2009 and December 2010. 404 of the neonates passed away (5.7%). Only the 38 (9.4%) of the neonates’ parents give permission for autopsy. Of these neonates were 15 female (39%) and 23 male (61%). Sixty percent of these neonates were premature. Prematurity was higher in male neonates (p=0.001). Median gestational age was 32 (22–41) weeks. Median overall survival of the neonates were 4 (0–80) days. Eighty-three percent of the clinical diagnoses were correlated with the pathological diagnosis. Sixty percent of the clinical and pathological diagnoses were cardiovascular anomalies, diaphragmatic hernia, perinatal asphyxia and prematurity. Two neonates had pneumonia diagnosis by the autopsy. Only one of the neonate’s placenta had chorioamnionitis. Conclusion Neonatal autopsy rates should be increased to decrease the neonatal mortality rate in our country. Neonatal autopsies should be done with multidisciplinary approach and become prevalent and get more progress in our country.

Background and Aims Nasal continuous positive airway pressure (NCPAP) is widely used for the treatment of transient tachypnea of the newborn (TTN). In this study we hypothesized that the use of nasal intermittent mandatory ventilation (NIMV) may be well tolerated in TTN and we aimed to evaluate its efficacy in reducing the duration of respiratory distress compared with NCPAP in TTN. Methods This prospective, unblinded, randomized, controlled clinical trial was conducted in 40 eligible infants with a gestational age ≥37 weeks, and birth weight ≥2000 g who were hospitalized for TTN. Infants were randomized to either nonsynchronized NIMV (n=20) or NCPAP (n=20). The primary end point was the reduction of the duration of respiratory distress. Secondary end points were the duration and level of oxygen supplementation, the incidence of complications such as pneumothorax, pneumonia and respiratory failure requiring entubation. Results There was no significant difference in the demographic features of the groups. There were no significant difference in the duration of respiratory support (28.0±19.2 h vs 32.2±23.3 h, p=0.231), O 2 therapy (31.2±15.6 h vs 29.0±19.3 h, p=0.187), duration of TTN (67.6±36.5 h vs 63.3±39.1 h, p=0.480) and hospitalization (6.2±2.6 d vs 5.4±2.0 d, p=0.330) between the groups. The rate of complications were not significantly different between the groups. Conclusions Our study indicates that NIMV is well tolerated and as effective as NCPAP in the treatment of TTN.

Objective The aim of this study was to compare the neurodevelopmental outcome at 12–18 months’ corrected age between multiples and singleton preterm infants. Methods We designed a prospective study of preterm infants (≤32 weeks gestation) born and hospitalized in the neonatal intensive care unit between November 2008 and November 2009, whose assessments were performed at 12–18 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any one of the following: moderate or severe cerebral palsy, severe bilateral hearing loss or bilateral blindness, mental developmental index score or psychomotor developmental index score less than 70. Results were compared for both multiples and singleton infants. Results A hundred and fifty-nine multiples and 211 singleton infants were assessed at 12–18 months’ corrected age. The neurodevelopmental outcome including all parameters at 12–18 months’ corrected age in multiples was not significantly different from singleton preterm infants. Conclusions Multiple gestation in preterm infants is not associated with an increased risk of neurodevelopmental impairment at 12–18 months’ corrected age compared to singleton preterm infants. For further information long-term and high-participated neurodevelopmental follow-up and evaluation at pre-school age will be needed.

Objective The aim of the study is to compare the 2-year neurodevelopmental outcome of very low birth weight and/or very preterm infants followed with “medical home model” implemented in a big maternity hospital in Turkey with the primary health care. Methods We designed a prospective controlled study of infants born ≤32 week’s gestation and/or ≤1500 g and hospitalized. After discharge, intervention group were followed with in the concept of medical home model and control group were followed in the concept of primary standart health care. At 18–24 months’ of corrected age, the neurological examinations and the developmental assessments using the Bayley Scales of Infant Development-II were performed. Results The cerebral palsy rates in the intervention and control group were 10.6% (n=17) and 17.4% (n=27) respectively and the difference was not statistically significant (p=0.107). Whereas the rate of neurodevelopmental impairment in the intervention group was significantly lower than the control group (25% and 38, 7%; p=0.011). Conclusion We demonstrated that beginning a good follow-up process within the context of medical home model, efficient developmental support and performing guidance for early diagnose reduced the negative effects of VLBW and/or prematurity on neurodevelopmental impairment at 2 years of age.

Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). Mydriatic eye drops used for pupil dilatation while these examinations may be absorbed by nasopharyngeal mucosa and gastrointestinal system that may cause neurological and gastrointestinal side effects rarely. We aimed to evaluate the effect of mydriatic eye drops on cerebral and mesenteric tissue oxygenation by near infrared spectroscopy (NIRS), in very low birth weight (VLBW) infants. Eleven preterm infants with a gestational age of grade II), PDA, major congenital anomalies, major heart disease, infection, anemia, thyroid disease, acidosis, history of perinatal asphyxia and surgery, not feeding orally, were excluded the study. Cerebral and mesenteric tissue oxygenation were measured by NIRS probes that located forehead and umbilical region before and after the mydriatic eye drops. Eleven (6 female, 5 male) infants were included the study. The median gestational age, birth weight, postnatal age and body weight during examination were 29 weeks, 1190g, 39 days and 1700g, respectively. Before the mydriatic eye drops mean cerebral and mesenteric rSO2 were 63.0±7.6 and 54.9±10.1, respectively. After the eye drops mean cerebral and mesenteric SO2 were 60.0±10 and 51.7±9.9, respectively. Although the slightly decrease in oxygenation after mydriatic eye drops there were no statistically significant differences (p=0.6 and p=0.1). We believe that this difference may reach statistically significant levels in large study population.

Background Late preterm infants are physiologically and metabolically immature than term infants, and the incidence of late preterm birth is increasing. These infants have higher risks of medical complications such as respiratory distress, hypoglycemia, hyperbilirubinemia, sepsis, feeding difficulty and poor neurodevelopmental outcome than term infants. Objective We aimed to evaluate the clinical and demographic characteristics, and short-term outcomes and clinical course of late preterm infants who were admitted to our neonatal intensive care unit (NICU). Materials and method Data from NICU admissions of 605 late preterm and 1477 term infants in 1 year period between June 2010 and May 2011 were analyzed. Results Late preterm and total delivery numbers were 2004 and 18854. NICU admission rate of late preterm infants was 30%, respectively. Mean gestational week and birth weight were 35 1/7 w and 2352 g. Admission diagnosis were respiratory distress (46.5%), low birth weight (17.5%), jaundice (13.7%), polycythemia (8.1%), hypoglycemia(4%) and feeding difficulty (13.1%), and these morbidities’ rates were higher than term infants (p Conclusion We concluded that late preterm infants should be followed closely for these complications just after birth and preventive strategies should be put in practice.

Aim To investigate whether neurodevelopmental outcome at age one year might be different after early versus late rescue surfactant treatment in preterm infants. Methods In 54 preterm infants, having gestational age between 25–30 weeks who were enrolled in a controlled trial of early versus late selective surfactant treatment (45 vs. 70 min respectively), a standardized follow up of medical history, neurodevelopmental outcome using the Bayley Scales of Infant and Toddler Development, Second Edition at 9–12 months corrected age.scales were carried out. Results Median Mental developmental index (MDI) score was 107 for early group and 111 for late group. Median Psychomotor developmental index (PDI) score was 82 for early group and 93 for late group. Although median MDI and PDI scores were slightly higher in late poractant treatment group and neurodevelopmental impairment was higher in early rescue group than the late rescue group, this was not statistically significant. Conclusion Our results demostrated that both early and late poractant treatment had similiar effects on the neurodevelopmental outcomes of preterm infants with RDS. In terms of neurodevelopmental outcomes there is no obvious advantage of an immediate surfactant administration in preterm infants according to our results.

Background and Aim Vaspin is a visceral adipose tissue derived serin protease inhibitor which has an insulin sensitizing effect. It is correlated with insulin resistance and glucose metabolism and it improves glucose tolerance. Ou aim was to determine and compare serum vaspin and insulin concentrations in small-for-gestational age [SGA], appropriate-for-gestational age [AGA] and large- for-gestational age [LGA] infants at birth and fifth day of life. Methods Eighty-two neonates were divided into three groups, as SGA [n=22], AGA [n=30] and LGA [n=30]. Mothers age, gestational week, mode of delivery, maternal diseases like diabetes, preeclampsia and eclampsia were recorded. Blood for vaspin, insulin and glucose was collected from cord at birth and peripheric vein on the fifth day of life. Results At birth, there were no statistically significant difference in serum insulin concentrations between the three groups whereas cord serum vaspin concentrations were significantly higher in SGA group [χ2= 8,158 p Conclusion Cord vaspin levels are significantly higher in SGA neonates than AGA or LGA neonates. The fetal programming hypothesis proposes that many adulthood diseases originate through adaptation which the fetus makes when it is undernourished. High cord vaspin levels in SGA infants may be one of the adaptation for increased risk for adult metabolic diseases.

Hepatitis B virus (HBV) infection continues to be a serious global health problem. Primary prevention through immunization remains the most effective way of controlling the spread of HBV. HBV vaccines are immunogenic in newborns and infants, and provide high seroprotection. During the course of HBV vaccination, we observed that substantial number of term infants had elevated CRP values without sepsis. Therefore, we prospectively studied IL-6 and CRP responses to HBV immunization, seeking to demonstrate that immunization stimulates elevation of IL-6 and CRP levels without clinical detoriation, and that usually there is no need for antibiotic treatment. Subjects for the study were healty term infants without signs and symptoms of sepsis. IL-6, CRP, and white blood cell (WBC) levels were determined before immunization and 24 hours after immunization. Study population included 70 infants. Significant increases in CRP were seen 24 hr after vaccination (p=0.000). Although CRP levels of 22 infants (31.4%) at second evaluation were above the cut-off (4.82 mg/ml), none of these infants had clinical symptoms of sepsis. After 48–72 hours, CRP level of all patients normalized with no blood culture positivity. In conclusion, our study showed that HBV vaccine is highly immunogenic and responsible for CRP elevation in term infants without sepsis after first vaccination at birth. To the best of our knowledge this is the first study evaluating CRP response to HBV vaccine at birth in term infants. We suggest that this response should be encountered in differentiation of early neonatal sepsis to avoid unnecessary antibiotic use.

Backgraund and aim: The aim of this study was to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT) and infrared forehead skin thermometer (IFST) measurements made by mothers and physicians in healthy newborns. Methods The body temperature measurements of 120 healthy newborns were made on their 2nd day of life using DAT, RGMT and IFST, first by mothers followed by a designated physician. Correlation analysis was performed for the measurements obtained by mothers and the physician. The presence of a former child or children at home, the educational level of the mother and maternal age were also recorded. Results No correlation was observed between the measurements made by mothers and the physician using RGMT (R 2 =0.096). The temperatures measured by mothers and the physician showed a significant correlation when a DAT and IFST were used (R 2 =0.923, p 2 =0.916, p Conclusions Difficulty of use and interpretation make RGMTs less practical than DATs and IFST for use by mothers. Measurements with an IFST are obtained from a newborn’s forehead in a shorter length of time compared to DATs, which makes it a more practical option.

Background and Aims To determine reference values for cystatin C (CysC) and its correlation with creatinine (Cr), gestational age, birth weight and maternal Cr status in very low birth weight (VLBW) preterm infants. Aims The study included 113 VLBW premature infants ( Results The mean level of CysC was 1.77±0.38 mg/L on day 1 and 1.61±0.37 mg/L on day 3, and the decrease was statistically significant. There was a significant correlation only between maternal Cr and first-day Cr values and negative correlations between Cr and gestational age and birth weight on third day. Creatinine was not correlated with CysC both on day 1 (r= –0.077, p=0.417) and day 3 (r=0.132, p=0.164). The reference values of Cys C at birth are [median (3p-97p)]: 1.8 mg/dl (0.8–2.2) for 24–26 weeks, 1.8 mg/dl (1.51–3.19) for 26–28 weeks, 1.8 mg/dl (0.65–2.48) for 28–30 weeks and 1.79 mg/dl (0.68–2.31) for 30–32 weeks and at 3rd days are 1.5 mg/dl (0.54–2.0) for 24–26 weeks, 1.61 mg/dl (1.1–3.4) for 26–28 weeks, 1.7 mg/dl (0.56–2.3) for 28–30 weeks and 1.6 mg/dl (0.92–2.21) for 30–32 weeks. Conclusion CysC offer an important advantage in the measurement of renal functions independent from gestational age, birth weight and maternal Cr status in VLBW preterm infants.

Introduction Current hematology analysers can determine cell volume(V), conductivity for internal composition of cell(C) and light scatter for cytoplasmic granularity and nuclear structure(S) and standart deviations. Method We investigated these parameters in secreening of neonatal sepsis beyond the first day of life. We used LH780 hematological analyzer(Beckman Coulter, Fullerton, CA). We combined these parameters with interleukin-6(IL-6) and C-reactive protein(CRP), and developed models to diagnose sepsis by Effective Modelling of Moleculer Activity(EMMA). Results A total of 237 newborn, 61 proven sepsis, 108 clinical sepsis and 68 control, were enrolled the study. Mean neutrophil volume(MNV) and volume distribution width(VDW) were found to be statistically increased both in proven and clinical sepsis groups. We developed models using MNV, VDV, IL-6 and CRP. These models gave more sensitivity and specificity than usage of MNV, VDW, IL-6 and CRP alone. Conclusion We suggest to use combination of MNV and VDW with markers such as CRP and IL-6, and use diagnostic models created by using EMMA including these markers. Model 1: Sepsis= –1.17+0.015*[CRP]+0.009*[MNV]. Model 2: Sepsis= –1.35+0.0136*[CRP]+0.0074*[MNV]+0.0123* [VDW]. Model 3: Sepsis= –0.94+0.0043*[IL6]+0.011*[CRP]+0.0069*[MNV] Table 2. Test results and models’ performance of sepsis group Parameter Cut-off Sens Spec 95% Confidence Interval MNV (au) >157.1 78.64 81.63 0.807 to 0.890 VDW (au) >37.4 59.71 77.55 0.687 to 0.789 IL6 (pg/mL) >18 81.76 92.65 0.869 to 0.945 CRP (mg/dL) >7.5 71.57 98.53 0.852 to 0.928 Model 1 >0.3099 88.73 92.65 0.921 to 0.975 Model 2 >0.3615 87.75 92.65 0.912 to 0.970 Model 3 >0.2429 95.86 91.18 0.950 to 0.992

Partial exchange transfusion (PET) is traditionally suggested as treatment for neonates diagnosed with polycythemia. Nevertheless, late neurodevelopmental outcome of this treatment is controversial. We aimed to compare the neurodevelomental outcomes of the children who had history of neonatal polycythemia that treated with PET or not at 2 years old. Neonates who were hospitalized due to polycythemia between April 2009 and September 2009 included the study. Mental and psychomotor evaluations were performed using the Bayley Scales of Infant and Toddler Development Second Edition (BSID-II). The examiner was blinded to both group. 13 infants treated with PET and 21 not treated with PET were included the study. There were no statistically difference in respect to demographic and prenatal characteristics between groups. There were no statistically significant differences in immediate complication rates between groups, except indirect hyperbilirubinemia. Mental and psychomotor scores of the both groups were not statistically different. When the infants grouped into according to psychomotor scores (> 85 and ≤ 85) more infants who were not treated with PET had psychomotor scores ≤ 85 compared to the other group (p=0.03). More infants who were not treated with PET had psychomotor scores between 70 and 84. This means group who not treated with PET had more infants having mild psychomotor disability compared to other group. The main issue about the polycythemia treatment is late nerodevelopmental outcome. In our study, treatment with PET may protect the neonates with polycythemia from the late psychomotor disability.