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Giriş Erken neonatal sepsis ve solunum sıkıntısı sendromu, erken doğan bebeklerde yaşamın ilk günlerinde neonatal mortaliteye yol açmaktadır. Bu çalışmanın amacı, premature bebeklerde spot idrar albümin / kreatinin oranının erken neonatal sepsis ve solunum sıkıntısı sendromunun erken tanı göstergesi olup olmadığını belirlemektir. Yöntem 34. haftadan erken doğan 126 prematüre bebek prospektif olarak incelenmiştir.Bu çalışmada yaşamın birinci, üçüncü ve yedinci gününde serum albümin, kreatinin, C-reaktif protein (CRP) ve spot idrar albümin / kreatinin oranlarını değerlendirdik. Ayrıca bu parametrelerin, erken doğan bebeklerde yaşamın ilk günlerinde erken neonatal sepsis ve solunum sıkıntısı sendromu ile ilişkisini araştırdık. Bulgular Yaşamın ilk ve yedinci gününde spot idrar albümin / kreatinin oranı ile erken neonatal sepsis grubu arasında istatistiksel olarak anlamlı fark vardı (p = 0.01). Solunum sıkıntısı sendromu grubunda idrar albümin / kreatinin oranları istatistiksel olarak anlamlı değildi. Serum albümin konsantrasyonları ve spot idrar albümin / kreatinin oranı yaşamın ilk günlerinde korelasyon göstermemiştir. Ayrıca yaşamın ilk günlerinde gebelik yaşı, doğum ağırlığı ile spot idrar albümin / kreatinin oranı arasında ilişki yoktu. Sonuçlar Bulgularımız, Çalışmamız doğum sonrası erken dönemde spot idrar albümin / kreatinin oranının prematüre bebeklerde erken neonatal sepsisi tanımlayabildiğini göstermektedir.

The objective of this study is to investigate the effect of breast milk and sucrose on pain scores and perfusion index (PI) and to evaluate the alteration in pain and PI during retinopathy of prematurity (ROP) examination.This prospective randomized controlled study was conducted with preterm infants who were born in our hospital, hospitalized in the neonatal intensive care unit and whose gestational week was32 weeks and birth weight was1500 g. The preterm infants who would undergo ROP examination were allocated to three groups according to simple randomization method as follows: group 1: only local anesthetic eye drops, proparacaine HCl ophthalmic solution 0.5%, group 2: proparacaine HCl ophthalmic solution 0.5% plus breast milk, and group 3: proparacaine HCl ophthalmic solution 0.5% plus sucrose 24%. Postductal PI, transcutaneous oxygen saturation and heart rate (HR) values were measured before the eye examination (0), at the 30th, 60th, and 90th seconds (s) of the eye examination and 30 s after lasting of the examination in all infants. Pain was evaluated using Neonatal Infant Pain Scale (NIPS) during the examination.Fifty-one preterm neonates were prospectively enrolled into the study. The HR was higher during and after the examination in all infants according to before the examination (The present study indicates that alterations may be seen in PI during the ROP examination; in other words, peripheral tissue perfusion could be affected. We consider that eye examination is a very painful procedure, and administering breast milk, sucrose or local anesthetic is not sufficient for reducing pain.

Yenidoğan döneminde birleşik heterozigot Niemann-Pick Type C hastalığıNiemann-Pick Tip C hastalığı (NPC), esterifiye olmamış kolesterollerin lizozomlarda depolanması ile karekterize nörodejeneratif bir lizozomal depo hastalığıdır. Otozomal resesif kalıtılan bu hastalıktan NPC1 or NPC2 genleri sorumludur (1). Burada, kardeşi yenidoğan döneminde Niemann-Pick Tip C hastalığı tanısı alan ve NPC1 genetik analizi sonucunda birleşik heterozigot Niemann-Pick Tip C hastalığı saptanan yenidoğan olgusu sunuldu., Niemann-Pick Tip C hastalığı (NPC), esterifiye olmamış kolesterollerin lizozomlarda depolanması ile karekterize nörodejeneratif bir lizozomal depo hastalığıdır. Otozomal resesif kalıtılan bu hastalıktan NPC1 or NPC2 genleri sorumludur (1). Burada, kardeşi yenidoğan döneminde Niemann-Pick Tip C hastalığı tanısı alan ve NPC1 genetik analizi sonucunda birleşik heterozigot Niemann-Pick Tip C hastalığı saptanan yenidoğan olgusu sunuldu.

Giriş ve Amaç: Bu çalışmada, Başkent Üniversitesi Tıp Fakültesi Ankara Hastanesinde 1993-2016 yılları arasında organ nakli olan ve sonrasında gebelik nedeniyle izlenen annelerin bebeklerinin prenatal, natal ve postnatal izlem verilerinin retrospektif olarak değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmada 1993-2016 yılları arasında hastanemizde organ nakli yapılan ve organ nakli sonrasında takip edilen reproduktif yaştaki (15-49) 440 kadın hastanın dosyası incelendi. Organ nakli sonrası takip edilen 28 gebe çalışmaya dahil edildi. Maternal (tranplantasyon etiyolojisi, yaşı, nakil yaşı ve gebelik yaşı arasındaki süre, gebelik yaşı, zamanı ve türü, yardımcı üreme tekniği varlığı, gebelik süresince kullanılan ilaçlar ve dozları) ve neonatal (gebelik haftası, doğum ağırlığı, doğum salonu verileri, bebek antropometrik değerleri ile gebelik haftasına göre düşük (SGA), gebelik haftasına göre normal (AGA), gebelik haftasına göre fazla doğum ağırlıklı (LGA) bebek özellikleri ve doğum sonrası yenidoğan yoğun bakım-anne yanı izlem durumu değerlendirildi. İstatistiksel analizler SPSS paket programı kullanılarak yapıldı. Sürekli değişkenler ortalama ± standart sapma (SD) verildi. Kategorik değişkenler sıklık ve yüzdeler ile ifade edildi. Araştırma öncesi etik kurul izni alındı. Bulgular: Toplam 28 hastaya ait organ naklinin %71,4’ü (20/28) böbrek, %28,6’sı (8/28) karaciğer nakliydi. Organ nakillerinin %60,7’si (17/28) canlı, %39,3’ü (11/28) kadavradan nakildi. En sık görülen transplant etiyolojisi %21,9 ile glomerulonefrit idi. Gebeliklerin %78,6’sı (22/28) canlı doğum, % 21,4’ü (6/28) abortus ile sonuçlanmıştır. Bir kişide akut, iki kişide kronik rejeksiyon gözlenmiştir. En sık kullanılan tedavi protokolü %42,9 ile siklosporin+ prednizolon+ azatiyopurindir. Bebeklerin %40,9’u term, %40,9’u SGA, %59’u pretermdir. Bebeklerin 4’ünde (%18,1) RDS, 3’ünde (%13,6) prematüre retinopatisi (ROP), 1’inde (%4,5) NEK, 3 bebekte konjenital kalp hastalığı saptanmıştır. Bebeklerin %18,2’sinde resüsitasyon ihtiyacı olmuş, %45,4’ ü doğum sonrası anne yanına verilmiştir. Sonuç: Ülkemizdeki böbrek veya karaciğer nakli olmuş kadınların gebeliklerinden dünyaya gelen yenidoğan bebeklerin takibinde ortaya çıkan perinatal, neonatal morbidite ve mortaliteye ait sonuçların bilinmesi uygun yaklaşım açısından önem taşımaktadır.

Hyperbilirubinemia is one of the most widely seen cause of neonatal morbidity. Besides ABO and Rh isoimmunization, minor blood incompatibilities have been also been identified as the other causes of severe newborn jaundice. We report a newborn with indirect hyperbilirubinemia caused by minor blood group incompatibilities (P1, M, N, s and Duffy) whose hemolysis was successfully managed with intravenous immunoglobulin therapy. A thirty-two gestational weeks of preterm male baby became severely icteric on postnatal day 11, with a total bilirubin level of 14.66 mg/dl. Antibody screening tests revealed incompatibility on different minor groups (P1, M, N, s and Duffy (Fya ve Fyb)). On postnatal day thirteen, the level of bilirubin increased to 20.66 mg/dl although baby was under intensive phototherapy. After the administration of intravenous immunoglobulin and red blood cell transfusion, hemoglobin and total bilirubin levels became stabilised. Minor blood incompatibilities should be kept in mind during differential diagnosis of hemolytic anemia of the newborn. They share the same treatment algorithm with the other types hemolytic anemia. New studies revealed that intravenous immunoglobulin treatment in hemolytic anemia have some attractive and glamorous results. It should be seriously taken into consideration for treatment of minor blood incompatibilities.

Introduction: Most important factors in retinopathy of prematurity (ROP) are prematurity and oxygen toxicity although blood transfusions, insulin like growth factor-1 ( IGF-1), insulin like growth factor binding protein 3 (IGFBP-3) and vascular endothelial growth factor (VEGF) also have important roles. The objectives of this study were, to measure IGF-1 and IGFBP-3 levels in preterm newborns before and after blood transfusion and assess if the effect of transfusion in development of ROP is via these mediators, and to investigate whether IGF-1 and IGFBP-3 levels measured at 32 and 33 gestational age (GA) were different in preterm newborns with and without ROP. Material and Methods: Preterm newborns with gestational age ≤34 weeks were included and blood samples were obtained before and after red blood cell (RBC) transfusion. Results: Thirty newborns were included, 17 of whom had ROP ( stage 1: n=11, stage 2: n=5, stage 3: n=1). IGF-1 and IGFBP-3 levels did not change after RBC tranfusion. Excluding the patient with stage 3 ROP all ROP patients were referred as mild ROP. No difference was observed between IGF-1 and IGFBP-3 levels of the patients with and without mild ROP. Patients with mild ROP had significantly more number of transfusions. Conclusions: Erythrocyte transfusion increased the frequency of ROP, whereas IGFBP-3 and IGF-1 were not associated of ROP.

Beken, Serdar/0000-0002-8609-2684; BAS, AHMET YAGMUR/0000-0002-1329-2167; Bulbul, Ali/0000-0002-3510-3056; Karatekin, Guner/0000-0001-7112-0323, WOS: 000534242500056, PubMed: 31851725, Objective To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. Material and methods A prospective cohort study was performed between April 1, 2016 and April 30, 2017. the study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of.1500 g were collected for infants who survived. Results Data from 69 NICUs were obtained. the mean birth weight and gestational age were 1137 +/- 245 g and 29 +/- 2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. Conclusion the present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs., Turkish Neonatal Society [2-2016]; Turkish Neonatal Society, This study was supported by the Turkish Neonatal Society, http://www.neonatology.org.tr, number 2-2016, received by AYB. Turkish Neonatal Society funded the study's online registry system. the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

WOS: 000460493000010, PubMed: 30660088, …, Turkish Neonatology Society, This research was supported by Turkish Neonatology Society (grant).

Introduction: In this study, we aimed to investigate the frequency and clinical features of respiratory syncytial virus RSV infection among infants hospitalized with the diagnosis of lower respiratory tract infection.Materials and Methods: The study was conducted between 1 December 2012 and 1 March 2013 in our pediatric clinic. A total of 170 children between 1-24 months of age with lower respiratory tract infection were included. Their clinical and laboratory findings were analyzed retrospectively. The detection of RSV antigen was carried out by immunoassay method on nasopharyngeal swabbing samples.Results: RSV infection was determined in 37.1% of the patients. RSV + patients under the age of 6 months was statistically significantly higher than RSV - patients. In RSV + and RSV - patients there was no statistically significantly difference in gender, infiltration in chest radiography, C-reactive protein positivity

Turan O, Anuk-Ince D, Olcay L, Sezer T, Gulleroglu K, Yilmaz-Celik Z, Ecevit A. Neonatal cerebral sinovenous thrombosis: Two cases, two different gene polymorphisms and risk factors. Turk J Pediatr 2017; 59: 71-75. Cerebral sinovenous thrombosis (CSVT) is a rare disease in the neonatal period and also the greatest risk of neonatal mortality and morbidity. In this report, we presented two cases with CSVT and different risk factors. One of these cases had methylenetetrahydrofolate reductase (MTHFR) C677T homozygous polymorphism and the other case had both MTHFR A1298C homozygous polymorphism, plasminogen activator inhibitor-1 (PAI-1) 4G/ 5G polymorphism and elevated lipoprotein a. Early diagnosis and prompt initiation of therapy of neonatal CSVT may prevent neonatal mortality and poor long-term neurodevelopmental outcomes.

Aim: Respiratory distress syndrome (RDS) is a lung failure that starts after birth. Because of deficiency of surfactants in alveoli, this becomes one of the most important causes of morbidity and mortality in preterm neonates. In this study, we tried to compare the outcomes of two types of natural surfactant, derived from same animal and aimed to manage the anxiety of clinicians while they are choosing the most appropriate preparate for RDS treatment.Material and Methods: Newborns hospitalized in Baskent University Ankara Hospital Neonatal Intensive Care Unit between January 2017 and August 2018 and administrated with calfactant and beractant for RDS treatment were retrospectively examined.Results: A total of 57 neonates were enrolled into the study. It was indicated that 38 (66.7%) of neonates were administered beractant and 19 (33.3%) were administered calfactant. We did not find any significant difference between beractant and calfactant groups, according to their genders, gestational weeks, their intubation situations, the duration of the oxygen requirement, antibiotic usages and the durations of mechanical ventilation. It was determined that calfactant-administered neonates needed statistically more repeat dose, than those in the beractant group (p= 0.029). Conclusions: We examined two natural surfactant preparates derived from same animal. Calfactant which has some conflicting reports was newly introduced to our unit for RDS treatment. This study aimed to identify the most appropriate treatment modality for RDS. It would be more instructive to plan larger and more creative studies to examine possible differences among natural surfactant preparates.

Amaç: Bu çalışmanın amacı fetal ve erken postnatal serum endoglin düzeylerinin fetal büyümedeki rolünü ve maternal preeklampsinin endoglin düzeylerine olan ilişkisini araştırmaktır.Materyal ve Method: Bu çalışmaya 55 yenidoğan prospektif olarak çalışmaya dahil edildi ve 4 gruba ayrıldı:1)Normal gebelik ve gebelik haftasına göre düşük doğum ağırlıklı yenidoğanlar (n:13,small for gestational age:SGA) 2)normal gebelik ve gebelik haftasına göre fazla doğum ağırlıklı yenidoğanlar (n:19, large for gestational age:LGA) 3)Preeklamptik anneden doğan gebelik haftasına göre normal ağırlıklı yenidoğanlar (n:12, appropriate for gestational age:AGA)) 4)kontrol grup: preeklampsi ve herhangi bir hastalığı olmayan anneden doğan gebelik haftasına göre normal ağırlıklı yenidoğanlar (n:11).Kanlar umblikal kordondan ve postnatal 4.saatte periferal venden toplandı. Serum endoglin düzeyleri ELISA kit kullanılarak ölçüldü.Bulgular: Endoglin çalışılan tüm umblikal kord ve yenidoğan serumlarında saptandı. Fetal ve erken postnatal serum endoglin düzeyleri arasında SGA, LGA, preeklamptik ve kontrol grupları bakımından fark saptanmadı. Fetal ve erken postnatal serum endoglin düzeyleri SGA grupta AGA gruptan yüksek saptandı.Sonuçlar: Fetal ve erken postnatal serum endoglin düzeyleri yenidoğanlarda değişmemektedir. SGA yenidoğanlarda serum endoglin düzeyleri farklılık göstermektedir. Sonuçlarımız artan endoglin düzeylerinin SGA patofizyolojisinde rol oynayabileceğini düşündürmektedir.Normal ve komplike gebeliklerden doğan yenidoğanlarda endoglinin fetal büyümedeki rolünu belirlemek için geniş serili çalışmalara ihtiyaç vardır., Aim: The aim of the present study was to evaluate the role of fetal and early postnatal serum endoglin levels in fetal growth and to investigate the association between neonates of preeclamptic mothers and endoglin levels.Material and Methods: Fiftyfive neonates were prospectively enrolled into the study and divided into four groups: 1) Normal pregnancy and small for gestational age (SGA) neonates (n:13), 2) normal pregnancy and large for gestational age (LGA) neonates (n:19), 3) appropriate for gestational age (AGA) neonates of preeclamptic mothers (n:12), and 4) control group: AGA neonates born to mothers without preeclampsia or any other disease (n:11). Blood was collected from umbilical cords (UC) with both ends clamped, and from peripheral vein in the postnatal 4th hour. Serum endoglin levels were measured by employing an ELISA kit.Results: Endoglin was detectable in the serum of all studied umbilical cord and neonates. No statistically significant differences were found between fetal and early postnatal serum endoglin levels in SGA, LGA, preeclamptic and control groups. Fetal and early postnatal serum endoglin levels of SGA group were significantly higher than the values of AGA group.Conclusion: Fetal and early postnatal serum endoglin levels seem to be unchanged in neonates.We showed that SGA neonates are characterized by a alterations in serum endoglin levels.Our results suggest that increased endoglin levels may play a role in the pathophysiology of SGA. Further studies with larger patient series are required to determine the role of endoglin in fetal growth in normal neonates and in neonates born after a complicated pregnancy.

Background: The aim of the present study was to determine language levels in twins and singletons born after at least 34 weeks gestation and without identifiable neurological abnormality and to evaluate whether in vitro fertilization (IVF) affects language development in twin pregnancies. Methods: A prospective study of a large cohort of all children born between 1 January 2001 and 31 December 2003 was carried out at Gazi University Hospital. All live-born twin pairs in which both twins survived were identified, and a comparable sample of families with pairs of singletons were chosen. The Stanford–Binet Intelligence Scale Form and the translated Turkish form of the Peabody Picture Vocabulary Test were completed at 60 months. Results: Even after excluding the most premature twins and those with diagnosable neurological damage, twins performed worse than singletons on language development tests. Twin girls had better scores than twin boys. A statistically significant difference was found between the scores of term and preterm twins. No significant difference was noted when compared according to birth order. Appropriate for gestational age (AGA) twins did better than small for gestational age (SGA) twins in the test scores. All twin girls did not differ from singleton girls, but all twin boys performed worse than singleton boys. Term twins had similar results with term singletons, but preterm twins had lower scores than preterm singletons. SGA singletons had better scores than SGA twins, while AGA twins and singletons did not differ. When the children were compared with regard to method of conception, IVF children had significantly lower scores on the tests than those in the spontaneous conception group. Conclusion: It is hoped that the present findings could lead to a more precise assessment of children for speech impairment and, above all, to more efficient preventive intervention. Whatever mechanisms are involved, the present results indicate that twins born as a result of IVF, are at a disadvantage in terms of language development in comparison with spontaneously conceived twins.

Aim: The aim of this study was to assess cerebral and peripheral oxygenation, by using near infrared spectroscopy (NIRS) and microcirculation by using side stream dark field (SDF) imaging in newborns with polycythemia before and after partial exchange transfusion (PET) therapy to investigate treatment effect on tissue oxygenation and microcirculation. Methods: Polycythemic newborns with venous haematocrit (Htc) >70% or ≥65% with symptoms were included. NIRS measurements for cerebral and peripheral oxygenation and SDF recordings for microcirculatory flow assessment were obtained before and after PET. Fractional tissue oxygen extraction (FTOE) was calculated based on tissue oxygenation index and oxygen saturation. Wilcoxon test was used for statistical analysis. Results: Fifteen newborns were included. Cerebral tissue oxygenation index, microvascular flow index and % of vessels with hyperdynamic flow increased after PET; median (range): 61.27 (51.36–61.87) versus 64.54 (54.1–74.38), 2.74 (2.46–3) versus 3.22 (2.64–3.75) and 0 (0–2.8) versus 3 (0–99.3), respectively. Whereas cerebral fractional tissue oxygen extraction (CFTOE), % of vessels with sluggish flow decreased after treatment; 0.36 (0.22–0.44) versus 0.31 (0.17–0.46), 1.4 (0–69) versus 0 (0–0.9), respectively. Peripheral oxygenation was unchanged. Conclusion: Partial exchange transfusion improves microcirculation in polycythemic newborns. Cerebral oxygenation increases and cFTOE decreases suggesting increased blood flow. Microvascular flow increases possibly representing reactive hyperperfusion after hemodilution. Whether these effects are beneficial require further research.

Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce Dr. Ozden Turan, Okmeydani Egitim ve Arastirma Hastanesi, Yenidogan Yogun Bakim Unitesi, Istanbul, Turkiye Gsm: +90 532 202 25 50 E-posta: drozdentr@yahoo.com Ge lis ta ri hi/Re cei ved: 07.11.2013 Ka bul ta ri hi/ Ac cep ted: 19.12.2013 1Okmeydani Egitim ve Arastirma Hastanesi, Yenidogan Yogun Bakim Unitesi, Istanbul, Turkiye 2Bakirkoy Dr. Sadi Konuk Egitim ve Arastirma Hastanesi, Pediatrik Kardiyoloji Klinigi, Istanbul, Turkiye Ozden Turan1, Bedir Akyol2, Betul Gemici1, Berna Aksahin1, Soner Sazak1, Ziya Yurdakul1

Lipids are the main source of calories and considered very important in infant growth. We aimed to compare fatty acid composition of term and preterm breast milk. This is the first study that compares the fatty acid levels of preterm and term breast milk in Turkish women.Breast milk samples were obtained from mothers of term (n = 15) and preterm (n = 15) infants on postnatal days 3, 7, and 28. Fatty acid composition of human breast milk was determined longitudinally by gas-chromatography/mass spectrometry.There Were 31 fatty acids measured in the milk samples. In the first month, 17 fatty acid levels had significant differences. In group comparison, some fatty acids (C14:0, C16:0, C18:1 and C20:5) had significantly increased in the preterm group (P = 0.041, P = 0.046, P = 0.027, P = 0.033, respectively), whereas myristoleic acid (C14:1) and eicosanoic acid (C20:0) had significantly increased in the term group (P = 0.015, P = 0.048, respectively).Term and preterm milk have different compositions of fatty acids. Breast milk composition changes over time. As a general conclusion, breast milk provides the lipid requirements of infants.

Hairy polyp is a rare, benign tumor that frequently localizes in the nasopharynx and oropharynx. The embryogenesis of hairy polyp is not known precisely. The clinical profile can vary depending on the size and location of the tumor. In this report, we present a case with hairy polyp who was admitted with acute otitis media and completely recovered after spontaneous autoamputation.

The aim of this study was to see whether the scores of the Bayley Infant Neurodevelopmental Screener of 45 high-risk preterm infants (gestational age 26-37 wk) between the ages of 3 and 24 months predicted neurodevelopmental status at 7 to 10 years of age. Neurodevelopmental status of 45/122 preterm infants, grouped according to their gestational ages of 26 to 29, 30 to 32, and 33 to 37 weeks, were previously evaluated by Bayley Infant Neurodevelopmental Screener. The scores were categorized as low or high-moderate. Verbal and performance scores of Wechsler Intelligence Scale for Children–Revised (WISC-R) of those patients were assessed between 7 and 10 years. The patients with high-moderate-risk scores of Bayley Infant Neurodevelopmental Screener at all times, regardless of their gestational age, had lower performance, verbal, and total scores of WISC-R than those of who had low Bayley Infant Neurodevelopmental Screener risk scores. High-moderate risk score of Bayley Infant Neurodevelopmental Screener at 7 to 10, and 16 to 20 months, of all patients especially showed good prediction for identifying lower verbal and performance scales. For 7 to 10 months, verbal scale: positive predictive value = 92.3%, negative predictive value = 44.4%, sensitivity = 70.58%, and specificity = 80%; performance scale: positive predictive value = 100%, negative predictive value = 30%, sensitivity = 68.18%, and specificity = 100%. For 16 to 20 months, verbal scale: positive predictive value = 90%, negative predictive value = 37.5%, sensitivity = 64.3%, and specificity = 80%; performance scale: positive predictive value = 90%, negative predictive value = 12.5%, sensitivity = 56.3%, and specificity = 50%. Bayley Infant Neurodevelopmental Screener shows good prediction of later verbal and performance scores of Wechsler Intelligence Scale–Revised for Children as early as 7 to 10 months, which gives us the opportunity to start early intervention.

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

Kutis marmorata telenjiektatika konjenita (KMTK), nadir görülen, iyi huylu, sporadik etyolojisi bilinmeyen vasküler anomalidir. Genellikle doğumda görülürken, sonradan da ortaya çıkabilir. Tanı klinik bulgularla konulur. Burada sağ bacak ve ayakta, sırtta, sol el üzerinde ve kolda KMTK olan bir erkek yenidoğan olgusu sunuldu., Cutis marmorata telangiectatica congenita (CMTC) is a rare, benign, sporadic vascular abnormality of the skin of unknown aetiology. It is usually present at birth but may develop later on. Diagnosis of the disease is made clinically. We report a case of a male neonate with CMTC presented on the skin of the right leg and foot, back, left back hand and ar

Newborns are exposed to a considerable number of painful stimuli. This study is aimed to investigate the effects of 30% glucose solution and nonnutritive sucking on pain perception during venipuncture. Twenty-five term infants were randomized as receiving 30% dextrose (group 1) or sterile water (group 2). Neonatal Infant Pain Scale scores, skin conductance algesimeter recordings, and near-infrared spectroscopy measurements were recorded during the procedure. Neonatal Infant Pain Scale and skin conductance algesimeter results were decreased in both groups from that during venipuncture to after the procedure. Group 1 had lower Neonatal Infant Pain Scale scores compared with group 2 after venipuncture, different from the skin conductance algesimeter, where no difference was observed between groups. In group 1, cerebral blood volume increased after venipuncture. Glucose does not attenuate the Neonatal Infant Pain Scale score and skin conductance algesimeter index during venipuncture, but it leads to a lower Neonatal Infant Pain Scale score after venipuncture unlike the skin conductance algesimeter index, which was not lowered.

The aim of this retrospective study was to assess the need for additional enteral protein supplementation in preterm newborns with gestational age (GA) ≤32 weeks after full enteral feeds with either fortified breast milk (FBM) or preterm formula (PF) were reached, and to determine the effects of additional protein on physical and neurological development. After the standard early total parenteral nutrition (TPN) and reaching full enteral nutrition with 150-160 ml/kg/day, preterms were assessed for the requirement of additional protein based on serum blood urea nitrogen (BUN)/prealbumin levels. Additional enteral protein was given for BUN5 mg/dl and/or prealbumin ≤8 mg/dl with weekly assessments as per Neonatal Intensive Care Unit (NICU) protocol. Growth in the NICU and neurodevelopmental outcome at 18 months' corrected age (CA) were determined. There were 32 newborns in the non-supplemented group (Group 1) and 33 newborns in the supplemented group (Group 2). All newborns in Group 2 were on FBM. Weight gain and head growth were better and Bayley scores at 18 months' CA were higher in Group 2. Standard preterm nutrition with FBM may not be sufficient for preterms, and additional enteral protein supplementation may improve the physical growth rate in the NICU and result in better neurodevelopmental outcome at 18 months' CA.

Background Hypothermia is becoming a common treatment for newborns with hypoxic ischaemic encephalopathy. Cerebral metabolic effects have been studied extensively. However, acute effects on peripheral microcirculation are unknown. The effects of therapeutic hypothermia on peripheral microcirculation assessed by side-stream dark field (SDF) imaging technique are presented. Methods Peripheral microcirculation was assessed in seven newborns undergoing selective head-cooling treatment with SDF imaging video recordings during core temperature 34°C, and then after re-warming at 37°C, and also in seven control patients with rectal temperature 37°C. Microvascular flow index (MFI) and per cent of vessels with sluggish flow were determined by using appropriate software. Results Sluggish microcirculation was observed during hypothermia compared with controls. MFI and per cent of vessels with sluggish flow returned to normal after re-warming. Conclusions The results of this small group of newborns going through therapeutic hypothermia suggests that microcirculation is effected with this treatment. Whether this finding has other clinical impacts requires further research.

Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 +/- A 1.3 days in Group I and 2.27 +/- A 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 +/- A 2.2 days in Group I and 3.53 +/- A 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 +/- A 1.5 days and 2.73 +/- A 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn't decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.

Iron deficiency (ID) is a global health problem. We aimed to determine the prevalence of ID at the first year of life in infants who were hospitalized in our neonatal intensive care unit (NICU) and investigate the effects of various factors on iron status. One year follow-up data of 219 infants who were discharged from NICU was retrospectively evaluated. ID anemia and ID without anemia were detected in fifteen infants (6.8%) and five (2.3%) infants, respectively. We concluded that, due to prophylactic iron treatment and close follow-up, hospitalization in neonatal period did not have any adverse effect on iron status at first year of life. (C) 2012 Elsevier Ltd. All rights reserved.

Total parenteral nutrition (TPN) is a revolution in neonatal intensive care unit (NICU) care, but this therapy is not without problems. A 35-week-old, 1300 g female infant was transferred to our NICU because of bilious vomiting and feeding problems. When enteral feeding was started again, a severe condition similar to the previous one developed. On the 24th day, the patient underwent surgery with a diagnosis of Hirschprung's disease. One week before surgery, the parenteral solutions were composed without vitamins because intravenous vitamin supplements suitable for infants were not available. Thereafter, the patient suffered from severe hypoglycaemia, and sepsis started to develop, accompanied by a large anion gap and metabolic acidosis which is severe lactic acidosis refractory to massive doses of bicarbonate. The acidosis improved significantly when the patient was treated with thiamin. Although TPN is life saving in the NICU, meticulous attention must be paid while treating a patient with TPN, and all possible nutrients should be provided. In this report, a case of a preterm newborn requiring a prolonged period of TPN and complicated by serious lactic acidosis is presented and discussed.

Background/Aims: Vascular endothelial growth factor (VEGF) is a potent proangiogenic protein that activates VEGF receptor (VEGFR-1, VEGFR-2) tyrosine kinases expressed by vascular endothelial cells. A soluble truncated form of VEGFR-1 (sVEGFR-1) binds to VEGF as strongly as full-length VEGFR-1 and inhibits VEGF activity. sVEGFR-1 can be detected in mouse and human plasma but in human milk sVEGFR-1 has not been described previously. Methods: We measured sVEGFR-1 and VEGF in human milk and examined how the concentration varied with gestational age and the duration of lactation after birth. Human milk samples were collected from 29 mothers of preterm (38 weeks) infants at days 3, 7 and 28 postpartum. Results: The sVEGFR-1 and VEGF concentrations were greater in the human milk of mothers of preterm compared to term neonates (p < 0.05). Furthermore, the concentrations of sVEGFR-1 and VEGF were decreasing during postpartum days 3, 7 and 28. The concentration of sVEGFR-1 showed a positive correlation with the concentration of VEGF in human milk (r = 0.479 and p < 0.001). Conclusion: sVEGFR-1 is present in human milk and has a role in angiogenesis.

The management of giant omphalocele (GO) presents a major challenge to pediatric surgeons. Current treatment modalities may result in wound infection, fascial separation, and abdominal domain loss. We report a GO infant who required a delayed closure and was managed using sterile incision drape and polypropylene mesh.A 3080 g full-term female infant was born with a GO. The skin was dissected from the fascia circumferentially without opening the amniotic sac and the peritoneum. Subsequently, two polypropylene meshes of 10 x 10 cm in diameter were sutured to each other. Inner surface of the mesh silo was covered with sterile incision drape. This texture was sutured to the fascial margin. Then, the skin was sutured to the mesh and the silo was closed from the side and above. On the 4th day the reduction was started using thick sutures without anesthesia. This procedure was repeated on every 3rd day. When it came closer to the skin margins, constriction was performed using right angle clamps, each time placed 2 cm proximally to the previous sutures in a circular manner. Silo was removed easily and the skin, subcutaneous layers, and fascia were then approximated on the 42nd day.The postoperative course was uneventful and the infant was well with left inguinal hernia repaired in the 3rd month.The method we used can be performed at bedside and without the application of anesthesia, but should be tried on more patients to determine its effect.

Introduction: The aim of this study was to determine the normal position of the umbilicus so as to offer a guide to improve cosmetic results after the repair of congenital abdominal wall defects. Materials and Methods: The position of the umbilical center was determined in 187 neonates with respect to the xiphoid process, the center of the umbilicus and the pubis. The distance between the xiphoid process and the center of the umbilicus (XU), between the pubis and the center of the umbilicus (PU) and from the xiphoid process to the pubis (XP) were measured while the babies lay in a supine position. The PU: XU ratio was calculated based on these measurements. Results: Mean XP was 11.93 ± 1.40 cm, mean XU was 7.41 ± 1.08 cm and mean PU was 4.52 ± 0.70 (mean±SD). The PU:XU ratio was calculated as 0.61 ±0.12 (ratio±SD). Conclusion: We suggest that the PU:XU ratio should be 0.61 offering an ideal localization in umbilical reconstruction.

Nitric oxide (NO) and vascular endothelial growth factor (VEGF) are important mediators for hemodynamics and angiogenesis in the body. NO coming from endothelial cells and red blood cells is particularly effective in hypoxic vasodilation. VEGF has known effects on the induction of NO synthesis and is also known to be affected by blood product transfusions. The objectives of this study were to measure NO and VEGF levels before and after packed red blood cell (PRBC) transfusions.Blood was drawn from preterm newborns before and 30 min after PRBC transfusions and samples were used for NO and VEGF measurements. NO end products nitrite and nitrate were measured by modified Greiss method, VEGF levels measured by double sandwitch ELISA method. Vital signs including heart rate and blood pressure were also recorded.Thirty four newborns were included in the study and overall 54 transfusion episodes were assessed for mediator levels. No difference was observed between the mediator levels before and after PRBC transfusions. Vital signs were also unchanged.As there was no change in NO end product levels with PRBC transfusions, it might suggest that hypoxia was not severe enough to cause nitrite increase; however, other NO sources might still be active. VEGF levels were found to be unchanged and may reflect a delayed effect of transfusion on VEGF induction.

Background: Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus. Methods: This was a retrospective study of LGA infants of ≥36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 20062009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student's t test were used for comparing variables. Results: Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045). Conclusions: The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers. World J Pediatr 2012;8(2):136-139

Human milk is a complex biological fluid. It contains many nutrients, anti-infectious and biologically active substance. Human milk also contains many angiogenic polypeptides. We have determined four of these: Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), insulin-like growth factor-I (IGF-I) and platelet-derived growth factor (PDGF). The aim of this study was to compare the concentrations of VEGF, b-FGF, IGF-I and PDGF in human milk collected from mothers with preterm and term neonates. Human milk samples were collected from 29 mothers of preterm ( weeks) infants at days 3, 7 and 28 postpartum. Milk samples were analyzed for VEGF, b-FGF and PDGF by enzyme-linked immunosorbent assay and IGF-I was measured by radioimmunoassay method. Human milk levels of VEGF. IGF-I and b-FGF were significantly higher (p

To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (or=200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes.Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a valueor=200 mg/dL after 50-g test and were diagnosed to have GDM.Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT200 mg/dL.Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.

Enterocutaneous fistula (EF) in newborns and prematures is a well-recognized complication after necrotizing enterocolitis and other abdominal surgical procedures. Conservative management consists of bowel rest, antibiotics, wound care, and the administration of drugs that either reduce gastrointestinal motility or secretions. Octreotide decreases gastrointestinal secretions, inhibits or blocks the effects of gastrointestinal hormones, diminishes gut motility and thus reduces the flow through the fistula. We used octreotide and were able to report successful spontaneous closure of a fistula in our 2 neonatal patients, one a premature neonate with necrotizing enterocolitis (NEC) and the other with meconium peritonitis.

AIM The objective of this study was to evaluate the effects of close and remote phototherapy on serum nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels as well as on body temperature heart rate and blood pressure in neonates of different gestational ages. PATIENTS AND METHOD Term (gestational age > or = 37 weeks) and preterm neonates (GA < 37 weeks) with hyperbilirubinemia requiring phototherapy were included in the study. All patients except for the ones in incubators were randomized to receive either close phototherapy (15 cm above the patient) or remote phototherapy (30-45 cm above patient). Body temperature, heart rate and blood pressure were measured before treatment, six hours into treatment and one hour after cessation of treatment. Blood samples for NO and VEGF measurements were also taken at the same times. RESULTS Sixty-one term newborns and 37 preterm newborns were included in the study. Patients were distributed into four groups according to the dose of treatment together with gestational age, i.e. term close and remote photoherapy groups (n = 29, n = 32, respectively), preterm close and remote photoherapy groups (n=10, n=27, respectively). Body temperature increased significantly with phototherapy in all groups but was not at hyperthermia level. Heart rate increased in all groups except for term newborns in the remote phototherapy group and blood pressure decreased in term infants but was unchanged in preterms. None of these changes were at the level of tachycardia or hypotension for a newborn. Phototherapy did not result in elevation of NO or VEGF levels. CONCLUSION This study showed that in our group of patients close or remote phototherapy caused some body temperature, heart rate and blood pressure changes that were not clinically significant and did not result in increased levels of NO or VEGF, which are well known vasodilator mediators.

Background and Aim Sweet tasting solutions and non-nutritive sucking are strong pain reducers for newborns. This study aimed to investigate effects of 30% glucose solution and non-nutritive sucking on amplitude of pain perception with pain scale, stress detector and near infrared spectroscopy (NIRS) during and after venipuncture. Method Term newborns were randomised into two groups before venipuncture for bilirubin measurement. Group 1 received 30% dextrose, Group 2 received sterile water before venipuncture. Recordings of skin conductance algesimeter (SCA, Med-Storm Innovation, Norway) from foot and NIRS (NIRO 200 Hamamatsu, Japan) from head were obtained starting 7 minutes before venipuncture until 7 minutes after. PAIN scores were obtained during and 7 minutes after procedure. Non-nutritive sucking was provided throughout the study. Results 25 patients were included. Median PAIN scores were similar in both groups during venipuncture 5 (1–8) in Group 1, and 6 (1–10) in Group 2. Scores were decreased significantly seven minutes after procedure in both groups; as 1 (0–1) and 3 (1–3) in Group 1 and 2 respectively. In Group 1, cerebral blood volume (CBV) was increased from baseline after the procedure (p=0.008) however in Group 2 there was a decrease in CBV from baseline without statistical significance. Cerebral blood flow (CBF) was increased from baseline in both groups without statistical significance. SCA values were slightly increased from 0.23 to 0.29 in Group 1 and from 0.23 to 0.59 in Group 2. Conclusion Nonnutritive sucking and 30% glucose attenuate pain and stress responses during venipuncture however cerebral effects are open to investigation.

Background and Aim The neurodevelopmental pace of late preterms during the first 2 years has hardly been investigated. Our aim was to assess longitudional neurodevelopmental status of babies of gestational ages (GA) between 34–36 6/7 weeks (Group I), 37–40 weeks (Group II) with Bayley II Infant Development Scale (BAYLEY II) and neurologic examination done regularly and to correlate scores with the risk factors in neonatal intensive care units (NICU). Method 100 infants (Group I) 50 (Group II) were included in the study all had serial BAYLEY-II scores and neurologic examination done at the ages of 6, 9, 12, 18, 24 months. Results There were no difference between the total BAYLEY-II scores of the patients in both groups at all ages (p>0.05). However, the longitudional rate of change of the PDI and MDI scores of the two groups showed a different pattern. Between 6–9 months patients in group II had a higher rate of change of PDI scores than those of Group I (P Conclusion Knowing the rate of neurodevelopmental follow up of these patient group could be important when an early individualized management is needed.

Background and Aim Seizures in the neonatal period represent a neurological emergency but it is often challenging for the clinican to recognize it with only visual inspection. Our aim is to evaluate the use of amplitude integrated EEG (aEEG) as a prognostic tool in neonatal intensive care unit (NICU) patients with clinical seizures in the two years follow-up. Method Twenty-four infants with clinical seizures (Group I) and 67 infants with suspected seizure activity (Group II) were included in the study. All infants were monitored with aEEG at least 24 hours after the seizure activity were stopped. aEEG was analysed for background activity, sleep-wake cycle and seizure activity. All infants were followed up in our outpatient clinic had neurologic examination and Bayley II Infant Development Scale were done by the same neuropsychologist on the 6th, 12th, 15th and 18th months of age. Results Median gestational age of the infants were 36.0 weeks (261/7–413/7). There was no significant difference between groups regarding to Bayley scores. Mechanical ventilation, sepsis, inotrope use were more in Group I in which there were more critically ill infant. These critically ill infants tend to have lower Bayley scores in Group I. In Group I infants with normal background activity tend to have higher Bayley scores than those of whom had discontinuous, low valtage, burst supression activity. Conclusion aEEG helps management of infants with seizure activity allowing continuous long-term monitoring of brain functions. Continous background activity seems to be a good predictor of aEEG in infants with neonatal seizure.