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Congenital esophageal web is a very rare type of esophageal atresia (EA) and is considered as Type IV atresia in Kluth's classification. Type IV EA is further classified into subgroups according to the location of web and the presence of tracheoesophageal fistula (TEF). Herein, we present a newborn having Type IV1a EA who was initially suspected as isolated EA and has co-existing malrotation together with the review of the literature. A newborn having congenital esophageal web was admitted with antenatal ultrasonography revealing polyhydramnios, dilated stomach, and duodenum. Abdominal X-ray revealed a gasless abdomen suggesting isolated EA. The upper gastrointestinal series confirmed complete obstruction at the lower esophagus. Bronchoscopy performed excluding TEF. Laparotomy revealed intestinal malrotation and the absence of another GI webs. Gastrotomy was performed and mucosal web at GEJ was seen by pushing nasogastric catheter. Web excision and Ladd procedure were performed. Congenital esophageal web is an extremely rare type of esophageal anomaly that can be only classified in Kluth classification. A high index of suspicion is required for diagnosis especially in newborns with the gasless abdomen and esophageal obstruction at the level of GEJ. Preoperative bronchoscopy is mandatory to exclude an associating TEF. Surgical exploration via laparotomy is beneficial for exploring additional GIS anomalies.

Aims: Evidence for drug-drug interactions (DDIs) that may cause age-dependent differences in the incidence and severity of adverse drug reactions (ADRs) in newborns is sparse. We aimed to develop machine learning (ML) algorithms that predict DDI presence by integrating each DDI, which is objectively evaluated with the scales in a risk matrix (probability + severity). Methods: This double-center, prospective randomized cohort study included neonates admitted to the neonatal intensive care unit in a tertiary referral hospital during the 17-month study period. Drugs were classified by the Anatomical Therapeutic Chemical (ATC) classification and assessed for potential and clinically relevant DDIs to risk analyses with the Drug Interaction Probability Scale (DIPS, causal probability) and the Lexicomp® DDI (severity) database. Results: A total of 412 neonates (median (interquartile range) gestational age of 37 (4) weeks) were included with 32,925 patient days, 131 different medications, and 11,908 medication orders. Overall, at least one potential DDI was observed in 125 (30.4%) of the patients (2.6 potential DDI/patient). A total of 38 of these 125 patients had clinically relevant DDIs causing adverse drug reactions (2.0 clinical DDI/patient). The vast majority of these DDIs (90.66%) were assessed to be at moderate risk. The performance of the ML algorithms that predicts of the presence of relevant DDI was as follows: accuracy 0.944 (95% CI 0.888-0.972), sensitivity 0.892 (95% CI 0.769-0.962), F1 score 0.904, and AUC 0.929 (95% CI 0.874-0.983). Conclusions: In clinical practice, it is expected that optimization in treatment can be achieved with the implementation of this high-performance web tool, created to predict DDIs before they occur with a newborn-centered approach. ispartof: JOURNAL OF CLINICAL MEDICINE vol:11 issue:16 ispartof: location:Switzerland status: published

OBJECTIVE: Despite improvements in neonatal care, neonatal bacterial meningitis is still an emerging problem worldwide with high rates of mortality. The present study evaluates data on suspected- and culture-proven neonatal bacterial meningitis in the light of a single tertiary reference center experience in Turkey in comparison with the globe. STUDY DESIGN: In this retrospective cohort study newborns admitted to Hacettepe University Ihsan Dogramaci Children’s Hospital Neonatal Intensive Care Unit during a 5-year-period between April 2014-May 2019 and who underwent atraumatic lumbar puncture were included. RESULTS: Two hundred sixty-four patients fulfilled the inclusion criteria. Most common symptoms in all patients raised suspicion in favor of NBM and resulted in lumbar puncture were fever (34.5%, n=91), respiratory distress (31.1%, n=82), lethargy (31.1%, n=82), and apnea (26.1%, n=69). The incidence of culture-proven NBM among suspected patients was 5.7% (n=15/264); while the incidence is 3.1 per 1000 (15/4574) at all Neonatal Intensive Care Unit admissions. Respiratory distress (60.0%, n=9/15) and apnea (40.0%, n=6/15) were the most common symptoms in patients with NBM; which may be due to the predominance of premature newborns in the NBM group. The most common microorganisms in CSF cultures were coagulase-negative Staphylococci with Methicillin-resistant Staphylococcus epidermidis being most common among all. CONCLUSIONS: The present study underlines high rates of culture-proven neonatal bacterial meningitis among suspected newborns despite improvements in modern health care, which raises attention to careful evaluation of these patients and early administration of properly-selected antibiotics. Our incidence rates are in keeping with studies from the developed world.

BACKGROUND: The objective of this study is to evaluate the obstetric outcomes of pregnancies with congenital diaphragmatic hernia (CDH). METHODS: Fifty one pregnancies prenatally diagnosed with CDH at our institution between January 1, 2002 and August 31, 2018 were retrospectively evaluated. The pregnancies were divided into two groups according to neonatal survival. Demographic features, clinical characteristics and prognostic factors were compared between the neonatal survival (n = 16) and non-survival (n = 28) groups. Cut-off values of fetal lung area to head circumference ratio (LHR), observed/expected LHR (o/e LHR) and observed/expected total fetal lung volume (o/e TFLV) for neonatal survival were calculated. RESULTS: Thirty six (70.6%) and fifteen (29.4%) fetuses had left and right sided CDH respectively. Seven patients chose termination of their pregnancies (13.7%). Statistically significant differences were found between survival and non-survival groups in terms of parity, median gestational week at diagnosis, polyhydroamniosis rate, CDH type, stomach position, liver position, median LHR, o/e LHR, o/e TFLV, median 5th minute Apgar score and neonatal operation rate values (p values were 0.03

Objectives To demonstrate immature granulocyte (IG) count and delta neutrophil index (DNI) values (novel potential predictive marker for neonatal sepsis) for neonates. Methods This prospective controlled clinical study was consisted of 208 patients (77 in the study group and 131 in the control group) who were delivered between January 2016 and January 2018 at the Hacettepe University Neonatal Intensive Care Unit in Ankara, Turkey. In this study, we evaluated value of DNI in diagnosing neonatal sepsis by comparing the DNI values in culture positive septic neonates with healthy neonates. Results In our study, the median interquartile range (IQR = 25–75%) DNI was 0.1% (0.0–0.3%) in the control group and 1.5% (1.0–2.45%) in the sepsis group (p Conclusions Our findings indicated that the DNI counts are significant diagnostic biomarkers for neonatal sepsis. They may also have utility in determining the sepsis etiology (differentiating between gram-positive and gram-negative agents).

Introduction: Enterococci are microbiota microorganisms that normally have low virulence; however, under some conditions they may cause community-acquired urinary tract and even hospital-acquired s...

Chest X-ray (CXR) is commonly used as a first-line imaging method to determine the cause of respiratory distress in NICUs. The aim of the study was to retrospectively assess the decrease in the number of CXRs performed due to the use of lung ultrasonography on the first day of life for newborns with respiratory distress. Infants who were admitted to the NICU on the first day of life due to respiratory distress were enrolled in this study (ClinicalTrials.gov identifier NCT04722016) and divided into two groups: the study group (n = 104) included patients born between January 2019 and June 2020, and the historical control group (n = 73) included patients born between June 2017 and December 2018. As a first-line technique for lung imaging, only CXR had been used in the historical control group, whereas ultrasound had been preferred in the study group. The radiation dose to the newborns and the number of CXRs performed in the first day of life were compared between the two groups. Significant reductions in the number of CXRs performed and radiation exposure were observed in the study group. The radiation dose decreased from 5.54 to 4.47 µGy per baby when LUS was routinely used. The proportion of patients who underwent CXR decreased from 100 to 71.2%.Conclusion: We observed that using lung ultrasonography as a first-line evaluation method in neonates with respiratory distress decreased both the number of CXRs performed and radiation exposure. What is Known: • Chest X-ray is commonly used as a first line imaging method to diagnose the reason of respiratory distress in NICUs. • Lung ultrasound is a new diagnostic tool for lung imaging. What is New: • With the use of lung ultrasonography, radiation exposure of both newborns and healthcare workers can be reduced. • This retrospective study revealed that most of the babies with respiratory distress were treated without CXR.

Background Neural tube defects are a group of congenital malformations in which the spinal column is bifid as a result of failed closure of the embryonic neural tube. Although not common, they might be complicated with pelvic organ prolapse mostly due to abnormal innervation and the resulting atrophy of the pelvic floor musculature. Case In this case report we present a newborn with uterovaginal prolapse in the setting of meningomyelocele, in whom the prolapse of pelvic organs spontaneously ameliorated after surgical correction of meningomyelocele.

Amac: Yenidoganlarda vucut sicakliginin olcumu icin en cok aksiller ve timpanik olcumler kullanilmaktadir. Calismada, premature ve zamaninda dogmus yenidoganlarda, aksiller, timpanik ve rektal vucut sicakligi olcumlerini karsilastirmayi amacladik. Gerec ve Yontemler: Calisma Hacettepe Universitesi Ihsan Dogramaci Cocuk Hastanesi Yenidogan Yogun Bakim Unitesi’nde gerceklestirildi. Calismaya alinan 100 hastada 100 aksiller, 100 timpanik ve 100 rektal olcum yapildi. Farkli yontemlerle olculen vucut sicakligi degerleri karsilastirildi. Bulgular: Tum calisma grubunda rektal ve aksiller vucut sicakligi olcumleri arasinda kuvvetli (r: 0.74, p:0.000), rektal ve timpanik olcumler ile aksiller ve timpanik olcumler arasinda ise zayif korelasyon (r: 0.47 ve 0.59; p:0.000, p:0.000) saptandi. Sonuc: Zamaninda ve premature dogan bebeklerin vucut sicakligi izlemi en iyi aksiller olcumlerle yapilabilir.

The aim of this study is to evaluate the significance of renal pelvis aspiration (RPA) in the management of antenatal hydronephrosis (AHN). This study enrolled 15 AHN cases (one twin pregnancy) that necessitated RPA for AHN. Chromosomal abnormalities, gene disorders, and additional life-threatening congenital abnormalities were eliminated prior to intrauterine interventions. Urine analysis were performed for the evaluation of renal function. Normal renal function was observed in six neonates/infants (40%) (group 1), whereas impaired renal function and various type of urinary system anomalies were observed in 9 neonates/infants (60%) (group 2) during the short-term and longitudinal follow-up periods. There were statistically significant differences in the oligohydroamniosis rate, mean fetal urine sodium value, mean fetal urine β2-microglobulin, mean gestational week at birth, and mean birthweight values between the groups (P = 0.007, P < 0.001, P = 0.035, P < 0.001, and P = 0.001, respectively). Renal pelvis aspiration and urine analysis were substantial for the management of AHN in necessary cases. β2-microglobulin and sodium are clinically useful markers to detect the presence of severe renal damage due to obstructive uropathy and thus, important adjuvants in the proper selection of fetuses for further antenatal interventions.

Polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), and polycyclic aromatic hydrocarbons (PAHs) are endocrine-disrupting chemicals (EDCs). Their presence in the environment is particularly concerning in cases of fetal exposure, which is the most vulnerable period of life for both human and animals who share the same environment. Placenta, as a sample collected using noninvasive methods to screen EDCs, is a good indicator for potential fetal exposure. Although recent studies indicate that companion animal may correspond to human exposure, species-specific anatomo-morphological and metabolic differences are controversial. In this study, placenta samples of 60 women and 25 dogs living and giving birth within the same region were evaluated for the presence of PCB, OCP, PBDE, and PAH residues; where, socio-demographic factors were also assessed to identify the possible sources. Gas chromatography-mass spectrometry method was validated for the matrix, and among 45 screened and targeted pollutants, only 18 were found in human placentas. While the most frequently detected pollutants were DDTs, followed by PAHs and PCBs in decreasing order, the pollutants with the highest concentrations were PAHs, followed by PCBs and DDTs. Only five of the target contaminants were detected in the dog placentas. These results indicate that; as dogs have different bioaccumulation capacities and higher excretion rates than humans, the life-long effects of exposure to endocrine compound and possible consequences related to adverse health outcomes are expected to vary and concentrations cannot be directly correlated.

OBJECTIVE: To compare the presence of eosinophilia and basophilia between two groups with and without bronchopulmonary dysplasia in preterm infants and, to investigate whether there was a correlation between the bronchopulmonary dysplasia severity and degree of eosinophilia. STUDY DESIGN: In this retrospective cohort study, we have evaluated premature babies who were admitted between 2007 and 2017 to the Neonatal Intensive Care Unit of Hacettepe Hospital. Hospital records were scanned and 85 preterm infants diagnosed with bronchopulmonary dysplasia formed the study group while 89 babies without bronchopulmonary dysplasia formed the control group. Necessary demographic, neonatal, and laboratory data were withdrawn from the electronic registry and patient files. RESULTS: In the study group, there was a statistically significant difference in the severity of eosinophilia and basophilia in the first day, first week, second week, third week, and fourth week compared to the control group (p

Jaundice is a common problem and occurs as a result of the increase in bilirubin level in infants. Infants may be adversely affected by this situation. The aim of this study is to determine whether neonatal jaundice affects the movements and postures of 3- to 5-month-old infants with hyperbilirubinemia and the correlation of motor repertoire at the same age with bilirubin levels. The study group included 30 infants (9 girls, 21 boys) with hyperbilirubinemia and a control group of 30 infants (11 girls, 19 boys) with typical development without hyperbilirubinemia. The motor repertoires of the infants were evaluated through detailed general movement (GM) analysis using video recordings made at 9-17 weeks post-term. The infants with hyperbilirubinemia had lower motor optimality score and subcategory scores (including observed movement patterns, age-adequate movement repertoire, observed postural patterns, and movement character) compared with the control group. The fidgety movement scores decreased as bilirubin value increased in infants.Conclusion: Infants with hyperbilirubinemia had poorer motor repertoire when compared to a control group. For this reason, detailed GM analysis of these infants will predict probable neurodevelopmental problems and infants with needs can begin individualized early intervention suitable for movement repertoire and posture at the earliest time. What is Known: • GMs of infants with hyperbilirubinemia were previously described. • However, the motor repertoires of infants with hyperbilirubinemia were not described in detail. What is New: • Infants with hyperbilirubinemia had poorer motor repertoire when compared to peers. • This is important in determining the need for individualized early intervention.

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

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.El inesperado nacimiento prematuro de un infante pudiera afectar la formación de la afectividad de las díadas madre-niño. Este estudio longitudinal se propuso explorar los patrones de afectividad madre-infante de infantes nacidos muy prematuramente (VPT) e infantes prematuros (PT) comparados con sus compañeros nacidos dentro del término regular en un país no occidental. Se evaluaron los resultados de desarrollo neurológico de los infantes, la ansiedad y síntomas depresivos maternos, así como las características socio-demográficas, con el fin de explorar sus efectos sobre la afectividad. Dieciocho VPT 11 PT, 11 infantes nacidos dentro del término regular y sus madres participaron. Las observaciones de patrones de afectividad y evaluaciones de desarrollo neurológico se llevaron a cabo a los 18 y 24 meses de la edad corregida. Este estudio identificó un cambio en los patrones de afectividad de los infantes VPT a lo largo del tiempo, de tal manera que los infantes VPT tendieron a tener menos patrones de afectividad insegura con sus madres al final del período de infancia. Mientras que los puntajes de desarrollo motor y de lenguaje se asociaron con patrones de afectividad a los 18 meses, los modelos que predijeron los patrones de afectividad ya no eran significativos a los 24 meses. Por tanto, el cambio en los resultados de desarrollo de los infantes VPT y los patrones de afectividad a lo largo del tiempo sugieren que el nacimiento prematuro en sí no es necesariamente un factor de riesgo para desarrollar patrones de afectividad insegura, pero los retardos en el desarrollo pudieran ser responsables de patrones de afectividad insegura. Se sugiere que los esfuerzos para promover los resultados de desarrollo de infantes prematuros pudieran mejorar la afectividad madre-niño.Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and socio-demographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants’ developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.Longitudinale Veränderungen der Bindungsmuster von Frühgeborenen, die in einem nicht-westlichen Land geboren wurden Eine unerwartete Frühgeburt kann die Bindungsentwicklung in Mutter-Kind-Dyaden beeinflussen. Diese Längsschnittstudie zielte darauf ab, in einem nicht-westlichen Land Mutter-Kind-Bindungsmuster von sehr früh Geborenen (very preterm; VPT) und Frühgeborenen (preterm; PT) im Vergleich zu termingeborenen Gleichaltrigen zu untersuchen. Neurologische Entwicklungs-Outcomes der Säuglinge, mütterliche Angst- und Depressionssymptome sowie soziodemografische Merkmale wurden evaluiert, um deren Effekte auf die Bindung zu untersuchen. 18 VPT, 11 PT und 11 termingeborene Säuglinge sowie ihre Mütter nahmen teil. Im (korrigierten) Alter von 18 und 24 Monaten wurden Beobachtungen der Bindungsmuster und Beurteilungen der neurologischen Entwicklung durchgeführt. Diese Studie stellte eine Veränderung der Bindungsmuster von VPT-Säuglingen im Laufe der Zeit fest. VPT-Säuglinge wiesen am Ende des Säuglingsalters tendenziell weniger unsichere Bindungsmuster zu ihren Müttern auf. Während motorische und sprachliche Entwicklungs-Outcomes nach 18 Monaten mit Bindungsmustern assoziiert waren, waren Modelle, die Bindungsmuster vorhersagen, nach 24 Monaten nicht mehr signifikant. Daher weisen die Veränderungen, die sich im Laufe der Zeit in den Entwicklungs-Outcomes und Bindungsmustern von VPT-Säuglingen ergeben, darauf hin, dass eine Frühgeburt an sich nicht unbedingt ein Risikofaktor für die Entwicklung unsicherer Bindungsmuster ist. Entwicklungsverzögerungen können jedoch zu unsicheren Bindungsmustern führen. Bemühungen zur Förderung der Entwicklungs-Outcomes von Frühgeborenen könnten daher die Mutter-Kind-Bindung verbessern.非欧米諸国で生まれた早産児の愛着パターンの縦断的変化 予期せぬ早期の出産は、母子の愛着形成に影響を与える可能性がある。この縦断的研究は、非欧米諸国における非常に早産 (VPT) および早産 (PT) の乳児の母子愛着のパターンを、正期産児の母子と比較して調査することを目的とする。乳児の神経発達の結果、母親の不安と抑うつ症状、および社会人口統計学的特徴を評価して、愛着への影響を調査した。 18人のVPT、11人のPT、11人の正期産児とその母親が参加した。愛着パターンの観察と神経発達の評価は、修正18ヶ月と24ヶ月で行われた。この研究でVPT乳児の愛着パターンの経時変化が確認された。すなわち、乳児期の終わりにVPT乳児が母親に対して不安定型愛着パターンを示す割合は減る傾向を示した。運動と言語の発達スコアは18か月で愛着パターンに関連していたが、愛着パターンを予測するモデルは24か月でもはや有意ではなかった。したがってVPT乳児の発達転帰と愛着パターンの経時的な変化は、早産自体が必ずしも不安定型愛着パターンが発達する危険因子ではないことを示唆している。それでも、発達の遅れは不安定型愛着パターンを説明するかもしれない。早産児の発達転帰を促すための努力は、母子愛着を改善する可能性があると示唆される。.婴儿的意外早产可能影响母子二元依恋的形成。这项纵向研究旨在探讨非西方国家极早产 (VPT) 和早产 (PT) 婴儿与足月产同龄婴儿相比的母婴依恋模式。评估了婴儿的神经发育水平、产妇焦虑和抑郁症状以及社会人口统计学特征, 以探讨其对依恋的影响。18个VPT、11个PT、11个足月产婴儿及其母亲参加了评估。在矫正年龄的18个月和24个月时进行依恋模式观察和神经发育评估。这项研究发现, 随着时间的推移, VPT婴儿的依恋模式发生了变化, 从而使得VPT婴儿在婴儿期结束时与母亲的不安全依恋模式趋于减少。虽然在18个月时, 运动和语言发展得分与依恋模式相关, 但预测依恋模式的模型在24个月时不再显著。因此, VPT婴儿的发育水平和依恋模式随着时间推移发生的变化表明, 早产本身并不一定是不安全依恋模式发展的危险因素;但是, 发育迟缓可能会导致不安全的依恋模式。我们建议, 努力促进早产儿的发育水平可能会改善母子依恋。.التغيرات على المدى الطويل في أنماط التعلق عند الرضع الخدج المولودين في بلد غير غربي قد تؤثر الولادة المبكرة غير المتوقعة للرضيع على تكوين التعلق في ثنائيات الأم والطفل. تهدف هذه الدراسة الطولية إلى استكشاف أنماط تعلق الأم والرضيع للرضع الخدج جداً (VPT) والمبتسرين (PT) مقارنة بأقرانهم المولودين المكتملين في بلد غير غربي. تم تقييم نتائج النمو العصبي للرضع ، وقلق الأم وأعراض الاكتئاب ، والسمات الاجتماعية الديموغرافية لاستكشاف آثارها على التعلق. وشارك في ذلك ثمانية عشر من الرضع الخدج جداً و 11 من المبتسرين و11 من كاملي المدة مع أمهاتهم في فترة الرضاعة. وأجريت ملاحظات على أنماط التعلق وتقييمات النمو العصبي في عمر 18 و 24 شهرا. حددت هذه الدراسة تغيرًا في أنماط التعلق للرضع الخدج جداً بمرور الوقت بحيث أنهم يميلون إلى أن يكون لديهم أنماط تعلق أقل أمانًا مع أمهاتهم في نهاية فترة الرضاعة. في حين ارتبطت درجات النمو الحركي واللغوي بأنماط التعلق عند 18 شهرًا ، حيث لم تعد النماذج التي تتوقع أنماط التعلق ذات أهمية عند عمر 24 شهرًا. ولذلك، فإن التغيير في نتائج النمو وأنماط التعلق مع مرور الوقت يشير إلى أن الولادة المبتسرة نفسها ليست بالضرورة عامل خطر لتطوير أنماط التعلق غير الآمنة؛ ومع ذلك، فإن تأخرات النمو قد ترتبط بهذه الأنماط. وتشير هذه النتائج أن الجهود المبذولة لتعزيز نتائج النمو للرضع الخدج قد تحسن من تعلق الأم والطفل.

Infantile hypertrophic pyloric stenosis (IHPS) is one of the hallmark pediatric surgical diseases. However, its etiology remains incompletely understood. By systematically reviewing the literature, we aim to clarify the effect of the effect of occupational and environmental factors and role of nitric oxide (NO) metabolism in the etiopathogenesis of IHPS. The systematic review is drafted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). Systematic literature search will be performed for the period 2000 (Jan) to 2020 (Dec) in the databases: MEDLINE, EMBASE, PubMed. The systematic search will cover the literature in English and Turkish language and will be limited to studies on human subjects. Four investigators will independently search the databases (MEDLINE, EMBASE, PubMed) according to the defined search strategy. The full-text of the selected articles will be screened independently by four reviewers, against the inclusion criteria. Descriptive data will be extracted from each study regarding: study details, methods, participants, outcomes and calculations of association for potential further statistical analysis. If meta-analysis could not be undertaken, systematic approach to analyzing the findings of included multiple studies will be described. Heterogeneity will be assessed by quantifying the inconsistency across studies using I2 statistic. Statistical analysis will be performed using Comprehensive Meta-Analysis Version 3.0 software. The p values lower than 0.05 will be considered statistically significant for all analyses.

OBJECTIVE Assess the earliest time of LUS to guide surfactant therapy. STUDY DESIGN In this observational study (ClinicalTrials.gov Identifier NCT04544514), LUS was performed within 30 min and repeated at 1, 2, 4, and 6 h on preterm babies. White lung appearance was defined as type 1 group, whereas prevalence of lines B as type 2 and lines A as type 3. Ultrasound and radiographic findings were also compared to determine surfactant need. RESULTS Among 71 patients, 41 received surfactant therapy. In the first evaluation, 37 of them have been defined as type 1, whereas 4 of them have been as type 2 group. Type 3 group did not receive surfactant. Type 1 findings were superior to predict surfactant need and the predictive value was 100% at 2 h. CONCLUSION Even early LUS assessment at the first 20-30 min was more significant to predict surfactant need than x-ray. Presence of white lung appearance for 2 h indicates an absolute surfactant need.

Celik HT, Korkmaz A, Ozyuncu O, Yigit S, Yurdakok M. Maternal adipose tissue, antenatal steroids, and Respiratory Distress syndrome: complex relations. Turk J Pediatr 2019; 61: 859-866. The incidences of maternal obesity and obesity-related maternal, fetal and neonatal complications have increased considerably. Obese people may have lower, normal or increased fat mass independent from their body mass index. We aimed to investigate the relationships between antenatal steroid therapy and maternal body fat ratio for the risk of Respiratory distress syndrome (RDS) in preterm infants. Pregnant women and their newborn infants between 24-34 weeks of gestation, who received a full course of antenatal steroid therapy were included in the study. Mother`s body weight, body mass index (BMI), and body compositions (muscle, fat, water) were calculated using the bioelectrical impedance method 5 days after giving birth. Neonatal characteristics and respiratory outcomes were noted. A total of 42 mothers and their single premature infants were included in the study. Nineteen (45.2%) infants developed RDS (Group 1) while 23 (54.8%) infants did not develop RDS (Group 2). The mean body fat mass (kg), fat ratio (%), truncal fat mass (kg), and truncal fat ratio (%) were statistically significantly higher in Group 1 than in Group 2. The incidence of RDS was significantly higher in the group of mothers with a body fat ratio > 30.0% (n=15/24, 62.5%) when compared with the group of mothers with a body fat ratio ≤ 30% (n=4/18, 22.2%) (p=0.013). Maternal adipose tissue plays an important role and should be taken into consideration especially in obese women, before giving antenatal steroids to achieve positive effects of the therapy in preterm infants.

Backround: Primary glomerular diseases (PGD) may represent wide spectrum of clinical presentations and pathological findings depending on the histopathological type and the severity/stage of the disease. The severity of PGD-related nephrotic syndrome (NS) predicts pregnancy outcome. The aim of the study to assess whether PGD has any effect on pregnancy and fetal outcome, as well as the effect of pregnancy on PGD. Materials and Methods: Retrospectively, ten pregnant women (11 pregnancies) with PGDs at Hacettepe University were investigated in terms of their pregnancy outcomes. The histopathological diagnosis was focal segmental glomerulosclerosis (FSGS), FSGS superimposed on immunglobulin A (IgA) nephropathy, membrano-proliferative glomerulonephritis (MPGN), and minimal change disease (MCD). Results: Nearly all pregnancies were complicated by nephrotic "signs and symptoms" and NS to a certain extend (mild-moderate to severe forms) and all cases were delivered by cesarean section. Eight cases (72.7 %) were complicated with IUGR, fetal distress and preterm delivery. Conclusion: In this case series, the authors have demonstrated that PGD has an adverse impact on perinatal outcome.

Background The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups. Methods This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants’ corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age. Results Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers’ depression scores were inversely associated with cognitive development (p = 0.030, R2 = 0.080, B=-0.283) and mothers’ anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R2 = 0.108, B=-0.329) at the age of corrected 6 months old. Conclusions Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers’ depressive symptomatology and maternal anxious/ambivalent attachment.

Aim The aim of this study was to determine the frequency of feeding problems in premature infants and to investigate the relationship between growth, development and maternal depression. Methods The study included 58 premature infants who were admitted to the Developmental Pediatrics Clinic between February-August 2018. Feeding problems obtained from the mothers by a questionnaire were classified as problems with oral-motor function, feeding rejection and oral hypersensitivity problems. Maternal depression was assessed by the Edinburgh Postpartum Depression Scale. Prenatal, perinatal and postnatal risk factors were recorded from the family and the hospital records. A development evaluation was performed with the Denver II Development Screening Test (DDST-II). Results Demographic characteristics are summarized in table-1. Twenty-six of the patients (44.8%) had feeding rejection, 9 (15.5%) had problems with oral-motor function, 2 (3.4%) had oral hypersensitivity problems and 8 (13.8%) had multiple feeding problems. No relation was found between birth weight and feeding problems. Parameters that are significantly associated with feeding problems in patients are shown in table-2. In the developmental evaluation, 14 (24.1%) of the patients were found to be abnormal in DDST-II and 10 of these patients (71.4%) had feeding problems (p: 0.066). Conclusion Since the presence of feeding problems affect weight gain and feeding behaviors, it is important to identify and diagnose early risk factors. In particular, mother’s concerns about feeding problems of the child should be questioned and the mother should be evaluated for depression.

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.

Bronchopulmonary dysplasia is a chronic lung disease that develops in low-birth-weight infants as a result of mechanical ventilation and oxygen toxicity in the early neonatal period. In these patients, mechanical ventilation and oxygen support are needed for a long time. We already use antenatal steroid, ventilation techniques with minimal baro/volutrauma, postnatal steroid, and vitamin A to prevent the development of bronchopulmonary dysplasia. Mesenchymal stem cell treatment is another way to reduce or stop the pathophysiologic pathways in the development of bronchopulmonary dysplasia. Herein, we present mesenchymal stem cell treatment and its outcomes in twins who were born with a gestational age of 26 weeks and diagnosed as having bronchopulmonary dysplasia (the female twin was born with a birth weight of 750 g and the male twin was born with a birth weight of 930 g). These patients were followed up with clinical findings, chest radiography, and lung ultrasonography.

Background/Aim: The aim of the study was to compare echocardiographic parameters and the perfusion index (PI) and plethysmographic variability index (PVI) values obtained by routine pulse oximetry in the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA). Materials and Methods: This prospective study was conducted between 2016 and 2017 at the HacettepeUniversity Neonatal Intensive Care Unit. The study included premature neonates who had a birth weight below 1500 g. Patients were routinely monitored from the right wrist and right foot using a pulse oximeter (Masimo Radical-7® Pulse CO-Oximetry), and PI and PVI values were recorded. The difference between right-hand and right-leg PI values was calculated as the delta PI (ΔPI). A cardiologist blinded to the results evaluated the presence of patent ductus arteriosus (PDA) with echocardiography on postnatal days 1th, 3rd, and 7th. Results: Of the 66 preterm neonates included in the study, 23 had hsPDA. On postnatal day 1, the hsPDA group had a significantly greater ductal diameter, PDA/left pulmonary artery (LPA) ratio, and left ventricle (LA)/aortic (Ao) ratio (P

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

In this study, we aimed to demonstrate cord blood immature granulocyte (IG) count and delta neutrophil index (DNI) values for term neonates. This retrospective study consisted of 126 term newborns born between July 2017 and December 2017. Cord blood samples were collected during delivery and IG count together with DNI values were obtained. `Beckman Coulter DXH800 System Hematology Analyzer` was used for analysis and calculations. The median DNI value was found to be 1.0 (interquantile range(IQR) 0.5-1.8%) and the median gestational age at delivery was 38.4 (IQR 37.6-39.0) weeks. The median birth weight and IG count were 3250 (IQR 2955-3593) g and 66 (IQR 26.5-112.3)/mm3, respectively. In conclusion, we believe that determining the normal laboratory reference values of IG count or DNI, which are important potential diagnostic markers for neonatal sepsis, will contribute to future studies on the diagnosis of neonatal sepsis.

BACKGROUND Nasal obstruction may cause short- and long-term problems such as respiratory distress, cyanosis, apnea, difficulty during feeding, and failure to thrive during the newborn period; since newborns are obligatory nasal breathers. Compression effect of the nasal cannulas and prongs used during respiratory support and nasal aspiration applications to clear the airways of secretions may result in nasal synechiae and acquired iatrogenic nasal obstruction. CASE In this case report, we present a premature newborn with nasal synechiae secondary to long-term nasal continuous positive airway pressure (nasal CPAP) applications and routine upper airway nursing care. CONCLUSION Severe nasal damage may occur in premature newborns receiving prolonged nasal CPAP support. To prevent this upper airway care should be conducted as gently as possible in premature newborns.

Objective To evaluate “papillary thyroid carcinoma-pregnancy” interaction among cancer survivors. Material and methods The clinical records of 8 pregnant women who received treatment for papillary thyroid cancer before their pregnancy were evaluated. Clinical features, pregnancy/perinatal outcomes and high-risk factors were compared with 45 controls who were randomly assigned from the institutional perinatal medicine database. Results Patients in the cancer group were older than the control group (34.3 vs 29.8 years). The cesarean section rate was higher (62.5% vs 33.3%) and the APGAR scores at the 1st and 5th minutes were lower in the cancer group. Conclusion Management of pregnancies with papillary thyroid cancer treatment and follow-up requires a multidisciplinary approach with careful antenatal care and perinatal surveillance. Patients who have received papillary thyroid cancer treatment can safely undergo pregnancy.