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Acute otitis media (AOM) is one of the most frequent infections in children. It is a burden due to its increased associated doctor visits, antibiotic needs, increased surgery, and potential contribution to hearing and speech complications. Acute otitis media has been shown in all ages but is mostly found in infants and young children. The attack rate for AOM peaks between 6 and 18 months of age. In the United States (US), nearly 80% of children less than 2 years of age have at least one episode of AOM annually, and most continue to have episodes through age 5 years [1].

WOS: 000484450300023, PubMed ID: 31236036, Hyperglycemia has become an important risk factor for mortality and morbidity in the neonatal period, especially with increased survival rates of very low birth weight neonates. Hyperglycemia in the neonatal period develops as a result of various mechanisms including iatrogenic causes, inability to supress hepatic glucose production, insulin resistance or glucose intolerance, specifically in preterm neonates. Initiation of parenteral or enteral feeding in the early period in preterm babies increases insulin production and sensitivity. The plasma glucose is targeted to be kept between 70 and 150 mg/dL in the newborn baby. While a blood glucose value above 150 mg/dL is defined as hyperglycemia, blood glucose values measured with an interval of 4 hours of >180-200 mg/dL and +2 glucosuria require treatment. Although glucose infusion rate is reduced in treatment, use of insulin is recommended, if two blood glucose values measured with an interval of 4 hours are >250 mg/dL and glucosuria is present in two separate urine samples.

Neonatal infections are a major cause of morbidity and mortality in the first month of life, especially in developing countries. Despite advances in neonatology, neonatal infections still haves clinical importance because of nonspecific signs and symptoms, no perfect diagnostic marker, and interference with non-infectious diseases of newborns. Diagnosis is typically made by clinical and laboratory findings. Empiric antibiotic therapy should be started in a newborn with signs and symptoms of infection after cultures are taken according to the time of the signs and symptoms, risk factors, admission from community or hospital, focus of infection, and antibiotic susceptibility estimation. Treatment should be continued according to clinical findings and culture results. Intrapartum antibiotic prophylaxis, proper hand washing, aseptic techniques for invasive procedures, appropriate neonatal intensive care unit design, isolation procedures, and especially breast milk use are needed to prevent infections. The use of diagnosis and treatment protocols increases clinical success.Yenidoğan enfeksiyonları gelişmekte olan ülkeler başta olmak üzere yaşamın ilk ayı içerisinde önemli bir morbidite ve mortalite nedenidir. Yenidoğan alanında yaşanan gelişmelere rağmen özgül belirti ve bulgularının olmaması, tanı koyacak mükemmel bir belirtecin bulunmaması ve yenidoğan dönemine ait enfeksiyon dışı klinik tablolar ile karışabilmesi nedeniyle klinik önemi devam etmektedir. Klinik ve laboratuvar bulguları birlikte değerlendirilerek tanı konulmaktadır. Enfeksiyon düşündüren belirti ve bulguların olduğu bebekte kültür örnekleri alınır alınmaz belirti ve bulguların başlama zamanı, etkenin edinildiği ortam ve varsa enfeksiyon odağına ilişkin bilgiler temelinde, olası etkenler ya da riskler ile olası antibiyotik duyarlığına göre ampirik antibiyotik tedavisi başlanmalı ve kültür sonuçları, klinik izlem ve gerektiğinde tekrarlanan laboratuvar tetkikleri ışığında tedavi değişikliği planlanmalıdır. Enfeksiyonların önlenmesi için intrapartum profilaksi, el yıkama, girişimlerde aseptik tekniklerin kullanılması, yoğun bakım biriminin uygun düzenlenmesi, izolasyon önlemleri ve özellikle anne sütü kullanımı önem taşımaktadır. Tanı ve tedavi protokollerinin kullanımı başarıyı artırmaktadır.

Objective: Surfactant administration is usually performed by endotracheal intubation under mechanical ventilation. Less invasive surfactant administration (LISA) technique has became widespread in recent years, in order to prevent the risk of barotrauma and volutrauma caused by mechanical ventilation and intubation. The aim of this prospective study is to evaluate the effectiveness of surfactant administration via a thin catheter during spontaneous breathing on NIPPV and to compare with INSURE method. Method: Seventy-eight preterm infants who were born at university hospital with less than 34 weeks of gestational age and who received surfactant therapy were enrolled. The intratracheal administration of poractant alfa (CUROSURF®) was performed using umbilical catheters in LISA group (n= 42). INSURE group had 36 infants who were intubated, received surfactant then extubated and placed on NIPPV. Results: There were no statistically significant differences between two groups in terms of intubation in the first 72 hours and re-administration of surfactant, the duration of NIPPV and the occurence of pneumothorax, pulmonary hemorrhage, patent ductus arteriosus, intraventricular hemorrhage, early onset neonatal sepsis, necrotising enterocolitis, bronchopulmonary dsyplasia and mortality (p>0.05). The pCO2 values decreased faster in LISA group when compared to INSURE group and this difference was statistically significant (p

Late-preterm delivery is known to be associated with potential adverse effects on lung development. Passive smoking may result in alterations of pulmonary function in infants born late-preterm. Impulse oscillometry (IOS) is a noninvasive, rapid, and practicable technique that can assess lung function. This study aimed to evaluate the effect of passive smoking on lung function tests in preschool children born late-preterm using IOS.The study population consisted of a total of 139 children between 3 and 7 years of age born late-preterm who were being followed-up at our outpatient unit at the time of study period. Late-preterms were subcategorized according to presence or absence of exposure to passive smoking (PS). Those with and without exposure to passive smoking were referred to as PS group (56.1%, n = 78) and non-PS group (43.9%, n = 61), respectively. Resistance (R5-R20), reactance (X5-X20), and resonant frequency were measured by impulse oscillometry (IOS) at 5-20 Hz.Median R5-R20 and Z5 were significantly higher and median X10 was significantly lower in PS group compared to non-PS group (p .05).This study demonstrated that passive smoking significantly increases peripheral airway resistance and seems to adversely affect lung function in children born late-preterm.

Background This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low-birthweight newborns followed until preschool age. Methods This was a prospective longitudinal study. Children with birthweight

Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30Hipoglisemi, uzun sürmesi ve tekrarlaması durumunda nörolojik zedelenme riski nedeniyle, yenidoğanın en önemli ve en sık metabolik sorunlarından birisidir. Bu nedenle, hipoglisemi riski taşıyan yenidoğanlar, doğum sonrası hemen beslenmeli ve beslenme sonrası 30. dakikadan itibaren 2-3 saat aralıklarla kan glukozuna bakılmalıdır. Hipoglisemi eşik değerleri, ilk 24 saat için belirtisi olanlarda 40 mg/dL, belirtisiz olanlarda 0 - 4 saatte 25 mg/dL, 4-24 saat aralığında 35 mg/dL, 24 saatten sonra 50 mg/ dL, 48 saatten sonra ise 60 mg/dL olarak kabul edilebilir. Tarama hastabaşı test çubukları ile yapılmalı, sınıra yakın değerlerde, laboratuvar yöntemi ile doğrulama yapılırken, gerekliyse tedavi başlanmalıdır. Tedavi ile ulaşılması hedeflenen düzeyler, beslenme öncesi postnatal ilk 48 saatte 50 mg/dL, 48 saatten sonra riskli olanlarda 60 mg/dL, kalıcı hipoglisemili olgularda ise 70 mg/dL’nin üstü olarak kabul edilebilir. Kan glukozu eşik değerin altında olan ve beslenme ile yükseltilemeyen durumlarda, 6-8 mg/kg/dk glukoz infüzyonu başlanmalı, belirti eşlik etmesi durumunda ise 2 ml/kg %10 dekstroz minibolus eşlik etmelidir. Hedef düzeye ulaşılamaması durumunda artışlar ve beslenme ile stabilizasyonun sağlanması durumunda azaltmalar 2 mg/kg/dk olarak yapılmalı, infüzyon hızının 3-5 mg/kg/dk’ye inmesi durumunda ise infüzyon sonlandırılmalıdır. Gerekliyse ayırıcı tanı açısından kan örnekleri hipoglisemi sırasında alınmalı ve araştırma, enteral beslenen bebeklerde 6 saatlik beslenmeme periyodu sonrasında, parenteral infüzyon alanlarda ise plazma glukozunun50 mg/dL olduğu herhangi bir zamanda yapılır. İnfüzyonları sonlandırılan riskli gruptaki hipoglisemik bebekler, plazma glukoz düzeyleri beslenme öncesi iki kez hedef düzeylerde saptanması durumunda, kalıcı, ciddi ya da dirençli hipoglisemili bebekler ise, plazma glukoz düzeyleri 6 saatlik açlık sonrası60 mg/dL olması durumunda taburcu edilebilirler.

Background There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. Methods Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5–20 Hz, resistance (R5–R20), reactance (X5–X20), impedans (Z5) and resonant frequency were measured on IOS. Results Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P

Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute after feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL after 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/ min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/ kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is 60 mg/dL following a 6-hour fast. © 2018 by Turkish Pediatric Association.

AIM The aim of this study was to evaluate the pulmonary functions of preschool children born late-preterm. MATERIAL AND METHODS Children aged between 3-7 years who were born at 340/7-366/7 weeks' gestation represented the target sample. Patients with a diagnosis of congenital cardiac, pulmonary and/or muscle diseases were excluded. Respiratory symptoms were evaluated using the modified asthma predictive index and International Study of Asthma and Allergies in Childhood criteria for children aged under and over 6 years, respectively. Skin prick tests were performed. Age-matched healthy controls were chosen according to the criteria proposed by the American Thoracic Society. Lung functions were evaluated using impulse oscillometry study in both groups. Data were recorded in the SPSS program. RESULTS A total of 139 late-preterms and 75 healthy controls participated in the study. The mean gestational week of the late-preterms was 35.3±0.9 weeks. The main admission diagnosis to neonatal intensive care unit was respiratory distress. In the postdischarge period, 54.1% were hospitalized for pulmonary infections at least once, and 57.8% were passive smoking currently. Aeroallergen sensitivity was detected as 25.8% in the late-preterm group; 34.5% and 15.1% were diagnosed as having asthma and non-asthmatic atopy, respectively. Impulse oscillometry study parameters of R5, R10, and Z5 were higher and X10 and X15 were lower in late-preterms than in controls (p

Background: The aim of the present study was to determine, using the score for neonatal acute physiology and perinatal extension II (SNAPPE-II), whether there is an association with acute renal failure (ARF) and whether it is possible to identify newborns at risk for ARF prior to a rise in creatinine in newborns. Methods: Information on postnatal risk factors and SNAPPE-II on the first day of life (non-ARF group, n = 475; ARF group, n = 78) were collected. Renal failure was defined as serum creatinine level >1 mg/dL and >1.3 mg/dL (for 333 weeks and

Objective: To evaluate the effect of domperidone use on corrected QT interval in premature infants. Study Design: A prospective study of premature infants receiving domperidone was included in this study. A baseline electrocardiogram was obtained just before and 3, 7 and 14 days after initiation of domperidone. Corrected QT was considered prolonged if it exceeded the upper limit for age. Result: A total of 40 premature infants were enrolled in this study. The mean birth weight of 1109±332 g, mean gestational age of 28.8±2.4 years and mean age at the onset of domperidone were 32.8±2 days. No difference in corrected QT interval was observed between just before and 3, 7 and 14 days after the start of the treatment. Two infants had corrected QT interval prolongation without any clinical side effect that resolved spontaneously. Conclusion: Our experience suggests that domperidone administered cautiously in modest doses does not result in arrhythmias or conduction defects in premature infants statistically. Additional data are needed to give optimal advice regarding the safety of domperidone treatment in premature infants.

Objective: To investigate fetal exposure to toxic metals [lead (Pb), cadmium (Cd)] and fetal levels of trace elements [zinc (Zn), copper (Cu), and iron (Fe)] in newborns from an industrial city. Relationships between meconium mineral contents and parental occupation and location of residence were also tested. Method: The meconium mineral contents of 117 healthy newborn infants were measured by flame atomic absorption spectrophotometer. Results: The median concentrations (interquartile range) of toxic metals and trace elements in the meconium were as follows: Pb: 46.5 (1,399) µg/g dry weight (wt), Cd: 2.3 (55.6) µg/g dry wt; Zn: 234 (3,049) µg/g dry wt; Cu: 11.8 (818.7) µg/g dry wt, and Fe 105 (2,980) µg/g dry wt. All the meconium samples contained both toxic metals and trace elements. The proportions of trace elements in the meconium samples with concentration higher than 100 µg/g dry wt of the substances tested were Zn 90%, Cu 64%, and Fe 53%. There were significantly positive correlations between the concentrations of toxic metals and trace elements. Also there were positive correlations between the levels of Zn, Fe, and parental occupations, and between the level of Fe and location of residence of the parents (proximity to the petroleum refinery or the dye industries). Conclusion: All the meconium samples were positive for toxic metals, and thus may reflect environmental pollution in the city. The occupation environments and the location of the family residence are linked with levels of trace elements in meconium.

Objectives: The aims of this study were to (a) establish a reference range for cardiac troponin I (cTnI) in the cord blood of healthy infants, and (b) investigate the effect of Apgar score, cord blood gas, gestational age, and creatine kinase (CK) and creatine kinase MB (CK-MB) fraction levels on cord blood cTnI levels. Methods: 112 perinatal hypoxic and 84 control newborns without perinatal hypoxia were enrolled in this study. Cord blood samples were collected from the babies for arterial blood gas analysis, cTnI, CK and CK-MB measurements. Gestational age, birth weight, sex, Apgar score and history of fetal distress were recorded. Hypoxic ischemic encephalopathy (HIE) group, hypoxic but without HIE group and control groups were identified according to clinical observations during the first 72 h in the newborn unit. Results: HIE and perinatal hypoxic without HIE groups had a significantly higher cord blood cTnI level according to the control group (1.8 ng/mL (0–13), 0 ng/ml (0–1.1) and 0 ng/ml (0–0.3) respectively). Cord blood cTnI level did not have a correlation with birth weight and gestational age (r = 70.02, p 4 0.05 and r = 0.08, p 4 0.05 respectively). Cord blood cTnI level also had a negative correlation with pH, bicarbonate, base deficit, and Apgar score (r = 70.40, p 5 0.001; r = 70.39 p 5 0.001; r = 70.45 p 5 0.001; r = 70.41, p 5 0.001) respectively). Cord blood cTnI level showed a positive correlation with CK and CK-MB levels (r = 0.45, p 5 0.001 and r = 0.37, p 5 0.001 respectively). Receiver operator curve analysis revealed that the most sensitive factor for prediction of perinatal hypoxia is cord cTnI value [area under curve = 0.929]. The optimal cut-off value of cord cTnI was 0.35 ng/ml for hypoxia. Conclusion: cTnI levels in the cord blood are not affected by gestational age and birth weight. cTnI together with CK and CK-MB has been found to be elevated in hypoxic infants compared to normal infants. Therefore cTnI may be an indicator for perinatal hypoxia in neonates.

Background: In most perinatal-hypoxia survivors, myocardial dysfunction can be reversed with appropriate inotropic support and oxygenation. The main problem related to outcome is cerebral damage. Objective: We tested the hypothesis that cardiac troponin I (cTnl), a known marker of myocardial injury, is also an early predictor of severity of cerebral damage and mortality in intrauterine hypoxia. Methods: Venous and arterial cord blood samples were collected at delivery from 54 consecutive newborns with hypoxic-ischemic encephalopathy and from 50 consecutive healthy controls. Arterial blood gas analysis was performed and levels of cTnl, creatine kinase and creatine kinase-MB in venous cord blood were measured. The same serum parameters were also measured on the 3rd and 7th day of life. Results: Infants with hypoxia had a significantly higher cord blood cTnl levels than controls (p < 0.0001). Cord blood and 3rd and 7th day serum cTnl values showed a significant increase with severity of HIE (p < 0.0001). In non-survivors cord blood cTnl levels were significantly higher than the survivors (5.9 ng/ml, range 2.1-12.8, and 1.6 ng/ml, range 0.4-5.8, respectively; p < 0.0001). Receiver-operator curve analysis revealed cord cTnl as the most sensitive factor for predicting early death (area under curve = 0.956; SE: 0.028; 95% Cl: 0.9-1.01). Cord blood cTnl of 4.6 ng/ml was identified as the optimal cut-off level for predicting serious risk of early mortality. Conclusion: The results suggest that significant elevation of cord cTnl is an excellent early predictor of severity of hypoxic-ischemic encephalopathy and mortality in term infants.

Amaç: Yenidoğanlarda göbek veni kateterizasyonu ile ilişkili ritm bozuklukları olgu sunumları ile sınırlıdır Bu çalışma erken doğmuş bebeklerde göbek ven kateterizasyonunun aritmi ve kalp hızı değişkenliği üzerindeki etkisini araştırmak amacıyla yapılmıştır. Gereç ve Yöntem: Çalışma erken doğmuş bebeklerden oluşan iki grupta yapılmıştır Grup I: Göbek ven kateteri takılı olan 26 bebek; grup II: göbek ven kateteri takılı olmayan 26 bebekten oluşmaktadır Bütün bebeklerin cinsiyet doğum haftası doğum kilosu ve klinik değerlendirme puanları SNAP II ve SNAPPE II kaydedildi Bebeklerin hepsine 24 saatlik Holter elektrokardiyografi takıldı Kalp hızı değişkenliği zaman alanlı ve frekans alanlı değişkenler kullanılarak çalışıldı.Bulgular: Çalışmaya alınan bebeklerin ortalama doğum haftası grup 1 rsquo;de 30 63 plusmn;2 67 grup 2 rsquo;de ise 31 60 plusmn;2 45 idi Gruplar arasında doğum haftası doğum ağırlığı SNAP II ve SNAPPE II puanları arasında istatistiksel olarak anlamlı fark saptanmadı Aritmi açısından karşılaştırıldığında iki grup arasında istatistiksel olarak fark bulunmadı Atriyal erken vuru grup 1 rsquo;de 11 hastada 42 3 grup 2 rsquo;de 7 hastada 26 9 saptandı Ventriküler erken vuru grup 1 rsquo;de 3 hastada 11 5 grup 2 rsquo;de bir hastada saptandı Sinüs taşikardisi ise sadece grup 1 rsquo;de yer alan üç hastada bulundu Kalp hızı değişkenliği iki grup arasında istatistiksel olarak farklı bulunmadı.Çıkarımlar: Çalışmamızda göbek ven kateterinin erken doğmuş yenidoğanlar da aritmi veya kalp hızı değişkenliği üzerinde anlamlı bir etkisinin olmadığı gösterilmiştir., Aim: Cardiac rhythm abnormalities associated with umbilical venous catheters in newborns are limited to anecdotal case reports The present study intended to evaluate association between umbilical venous catheter arrhythmic potential and changes in heart rate variability Material and Method: The study consisted of two groups; 26 preterm newborns with a umbilical venous catheter group 1 and 26 control group without group 2 The following parameters were recorded prospectively: gender gestation at birth birth weight and clinical assessment scores SNAP II and SNAPPE II Holter recordings were fitted in all newborns The heart rate variability study was performed by utilizing time domain and frequency domain analyses Results: The study population consisted of group 1 30 63 plusmn;2 67 weeks of gestation and group 2 31 60 plusmn;2 45 weeks of gestation There was no statistical difference between the two groups for gestational age birth weight SNAP II and SNAPPE II scores When compared for arrhythmia there was no statistical difference in any parameters between the two study groups Premature atrial contraction was noted in 11 babies 42 3 in group 1 and in 7 babies 26 9 in group 2 Premature ventricular contraction was noted in 3 babies 11 5 in group 1 and in one baby in group 2 Sinus tachycardia detected in 3 patients in only the group 1 None of the heart rate variability parameters were found to be statistically different between the two groups Conclusions: Our study reassuringly demonstrated that umbilical venous catheter does not have any significant effect on arrhythmia or heart rate variability in preterm newborns Turk Arch Ped 2013; 48: 131 7

It has been reported that gentamicin causes natriuresis, magnesuria and calciuria in neonates. The aim of this study was to determine the acute effects of trough and peak levels of gentamicin on the values of serum creatinine (SCr), urine albumin/urine creatinine (UA/UCr), fractional excretion of sodium and potassium (FENa, FEK) and urine calcium/urine creatinine (UCa/UCr) in preterm neonates treated with gentamicin for suspected infection. Baseline levels of serum and urine Cr, Na and K and urine albumin and Ca levels together with trough and peak gentamicin levels were measured in 61 preterm neonates at the start of the therapy, on the day of the third gentamicin dose and 48–72 h after the cessation of the gentamicin therapy. Therapeutic trough and peak levels were recorded in 56 (91.8%) and 39 (63.9%) of the preterm neonates, respectively, whereas high trough (>2 mg/dl) and peak (>9.99 mg/dl) levels were recorded in five (8.1%) and 11 (18%) of the 61 preterm neonates, respectively. Trough and peak levels of gentamicin were positively correlated with SCr, UA/UCr, FENa, FEK and UCa/UCr values. The UA/UCr, FENa and UCa/UCr values recorded during treatment were statistically significantly different from sub-therapeutic, therapeutic and high peak gentamicin levels. Gentamicin was found to have a serum peak level-dependent microalbuminuric, natriuric and calciuric effect in preterm neonates. Based on these results, we suggest that when the monitoring of serum gentamicin levels is not possible, the monitoring of UA/UCr, FENa and UCa/UCr can be useful as a noninvasive alternative.

Theaim of this study is to evaluate the lung function by using the oscillometric method in TTN at the pre-school age. Meterials and methods Childrenwho were born over a gestational age of 35 weeks and followed at our clinicwith the diagnosis of TTN in the 2005–2008 period defined as the study groupand children have no respiratory diseases are defined as the control group. Thedemographic features of the patient group, neonatal characteristics and followup data, maternal features were recorded. After physical examination andquestioning of respiratory symptoms, pulmonary function tests of patients whowere admitted to study performed with the by Impulse Oscillometry device. Results Total 62 patient were included thestudy, 31 of them were in the patient group and 31 were in the control group. There weren’t any statistically significantdifference among the two groups for the mean X values (X5, X10, X15, X20), meanR values (R5, R10, R15, R20) and mean impedance (Z5) value at he IOS study. Conclusion In our study, respiratory functions of preschool agechildren who had TTN diagnosis duringthe newborn period found similar with the respiratory functions of healtychildren. In our knowledge, this is the first study evaluating the long termeffects of TTN to the pulmonary functions by examining respiratory functionswith impulse oscillometry.

Background and aims Surgical site infections after median sternotomy and repair of congenital heart diseases are rare but have a high morbidity and mortality in paediatric patients. These patients may require repeated surgical procedures including sternal debridement. We present a case who had chronic Escherichia coli surgical site infection and mediastinitis after complete repair of tetralogy of Fallot. Methods A 2.7-year-old boy who underwent an uneventful surgical total correction procedure for tetralogy of Fallot 9 months before, was referred to our centre because of fever and swelling on sternal incision. Infective endocarditis was ruled out by echocardiographic examination. After ampicillin/sulbactam and clindamycin treatment, the abscess spontaneously drained. Cultures were positive for ESBL-producing E. coli . He had sternal debridement, appropriate antibiotic therapy and was discharged from hospital. Results Six months later, he was admitted because of effluent from sternal incision scar. MRI of mediastinum revealed a deep sternal wound infection. ESBL-positive E. coli was isolated in cultures taken from the suppurative effluent. Mediastinitis was confirmed by exploratory sternotomy. Cultures of blood and mediastinal swabs were positive for the same organism. The child had an uneventful recovery after the surgical and medical treatment. Conclusions Mediastinitis should also be considered in patients with sternal wound infections after heart surgery. Aggresive surgical and medical treatment is essential.

Background: There are several studies that have shown an increased risk of premature birth and developmental abnormalities with in vitro fertilization (IVF); however, the data on preterm mortality and morbidity are limited. Aim: Our aim is to investigate whether IVF had an effect on the mortality and morbidity in neonates admitted to the neonatal intensive care unit. Methods: A total of 940 term and preterm babies who were admitted to the intensive care unit over a period of 2 years were enrolled. Of these, 121 babies were born after IVF and 810 were born after a natural conception and 9 were born after ovulation induction. Of these, 112 preterm babies were born after IVF and 405 preterm babies were born after a natural conception. Results: In the IVF group, the gestational age and birth weight were significantly lower than in the non-IVF group. Additionally, in the IVF group, multiple births were significantly higher than in the non-IVF group. IVF pregnancies increase preterm delivery but did not increase preterm mortality, and preterm morbidity did not differ among groups, except for intraventricular hemorrhage (IVH). Gestational age was shown to be the primary risk factor for IVH using a logistic regression analysis. Also when newborns at gestational age

Functional pulmonary atresia is characterized by a structurally normal pulmonary valve that does not open during right ventricular ejection. It is usually associated with Ebstein′s anomaly, Uhl′s anomaly, neonatal Marfan syndrome and tricuspid valve dysplasia. However, functional pulmonary atresia is rarely reported in newborn with anatomically normal heart. We report a newborn with functional pulmonary atresia who had normal intracardiac anatomy, who responded to treatment with nitric oxide and other vasodilator therapy successfully.

The major and minor neurodevelopmental morbidities among premature infants become an important issue because of the increase in the number of surviving premature newborns, especially in the smaller gestational age group. The aim of this study was to examine the neuromotor outcome of the premature newborns at 4–6 years of age born with very low birth weight and to investigate the risk factors associated with this outcome. The present study was conducted in 70 very low birth weight children born during april 2004 and june 2007. The neuromotor status of 68 children were evaluated according to Touwen. The hospital records of the children were scanned for various risk factors. Three cases were already diagnosed and followed as CP. The remaining 65 children did not meet the criteria for CP. According to Touwen examination 28 (%41.2) children were considered as normal, 35 (%51.5) had simple minor neurological dysfunction, 2 (%2.9) had complex minor neurological dysfunction. 35 children with minor neurological dysfunction and 28 children with normal neuromotor status were compared for some risk factors. The children with minor neurological dysfunction had significantly lower Apgar score, their hosipitalization period was longer and the diagnosis rate of clinical (%73.5; %25) and culture proven sepsis (%47.1; %10.7) was higher in this group. Sepsis was significantly associated with adverse neurological outcome. The prevention of neonatal sepsis in NICU9s will increase the chance for healthy neurological development.

The major and minor neurodevelopmental morbidities among premature infants become an important issue because of the increase in the number of surviving premature newborns. The Aim of this study was to examine the cognitive, neuromotor, emotional and behavioral outcomes of the premature newborns at 4–6 years of age born with very low birth weight and to investigate the relationship between neuromotor and neurocognitive development. The neuromotor status of 68 children were evaluated according to Touwen neurological examination, 64 children were assessed using Stanford-Binet and Peabody Picture Vocabulary Test, 65 children using Strength and Difficulties Questionnaire and Vineland Adaptive Behavior Scale. Three cases were already diagnosed and followed as CP. According to Touwen examination 28 (%41.2) children were normal, 35 (%51.5) had simple minor neurological dysfunction (MND), 2 (%2.9) had complex MND. The mean IQ score was 90.1±10.9. The rate of hyperactivity, behavioral problems and emotional problems were in order %60, %33.8 and %53.8. The children were diagnosed as having a delay of 14.9±10.6 month for conducting, 10.6±8.6 month for daily activities, 10.7±11.5 month for social competence and a delay of 6.3±10.2 month for motor behavior. The cognitive and neuropsychological results of the 35 children with MND and 28 children with normal neuromotor status were compared. The children with MND had significanly lower mean IQ score, more delay for motor behavior and they were more hyperactive. Majority of the children who were considered as normal had cognitive impairment, language, behavior/emotional and neuromotor problems in various degrees.