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Bu calismanin konusu 19. asirda yasamis muelliflerden biri olan Ca‘fer b. Ebu Bekir b. Ca‘fer el-Lebeni’nin, Suleymaniye Kutuphanesi Haci Mahmud Efendi Koleksiyonunda 1007 numarada “Tombeki1 sisesindeki su ile abdest câiz olup olmadigi” ismiyle kayitli olan risâlesinin metin ve muhteva yonunden tetkik edilmesidir. Calismamizda Ca‘fer el-Lebeni’nin hayati, ilmi kisiligi ve yazdigi eserler hakkinda bilgi verilmis, kendisine sorulan tombeki sisesindeki su ile abdest almanin câiz olup olmadigi sorusuna dair verdigi olumlu cevabi delilleriyle birlikte aciklanmistir.

Background Decreased renal blood flow plays a vital role in the etiology of acute kidney injury (AKI). In this study, we aim to investigate the role of renal regional oxygen saturation (rSO2 ) reductions in predicting AKI in the first 24 hours of life. Methods One-hundred premature babies with a gestational age of ≤32 weeks were included. Renal and cerebral rSO2 s were monitored for 24 hours by near-infrared spectroscopy (NIRS). Infants were followed up for the first 7 days for the diagnosis of AKI. Results Infants' median gestational age was 29 (23-32) weeks, and their birth weight was 1192 ± 355 g. It was found that the renal rSO2 values were lower in the first 24 hours of life in patients who developed AKI, and this decrease was statistically significant in the first 6 hours of life. Conclusion The low renal rSO2 values in the early hours of life in premature babies may have a role in predicting AKI.

Hemolytic disease of the fetus and newborn can cause hydrops and intrauterine death due to fetal anemia. Immunoglobulin and plasmapheresis have been used to defer blood transfusions to later gestational ages and treat fetal anemia in patients who were immunized early in pregnancy, with different success.

Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 ± 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn infant, and the incidence varies between 3% and 15% in neonatal intensive care units (NICU). It has a high risk of mortality and both short- and long-term morbidity which severely impacts the quality of life in the survivors. Lack of specific clinical and laboratory findings makes early diagnosis difficult for the clinician and sometimes results in overtreatment for feeding intolerance which is quite frequent in preterms and can easily be confused with NEC. The fact that there are many definitions and presentations of NEC even complicates the management. This review aims to summarize the guideline of the Turkish Neonatal Society for diagnosis, treatment, and prevention of NEC for the clinician taking care of preterms. Etiopathogenesis and various clinical pictures of NEC, as well as diagnostic methods, are defined. Treatment and prognosis are discussed in detail with reference to current literature and preventive strategies are summarized based on evidence. Finally, the approach to baby presenting with suspected NEC is summarized in an algorithm.

IMPORTANCE The benefits of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome are uncertain.OBJECTIVE To examine the effect of selective application of MIST at a low fraction of inspired oxygen threshold on survival without bronchopulmonary dysplasia (BPD).DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial including 485 preterm infants with a gestational age of 25 to 28 weeks who were supported with continuous positive airway pressure (CPAP) and required a fraction of inspired oxygen of 0.30 or greater within 6 hours of birth. The trial was conducted at 33 tertiary-level neonatal intensive care units around the world, with blinding of the clinicians and outcome assessors. Enrollment took place between December 16, 2011, and March 26, 2020; follow-up was completed on December 2, 2020.INTERVENTIONS Infants were randomized to the MIST group (n = 241) and received exogenous surfactant (200 mg/kg of poractant alfa) via a thin catheter or to the control group (n = 244) and received a sham (control) treatment; CPAP was continued thereafter in both groups unless specified intubation criteria were met.MAIN OUTCOMES AND MEASURES The primary outcome was the composite of death or physiological BPD assessed at 36 weeks' postmenstrual age. The components of the primary outcome (death prior to 36 weeks' postmenstrual age and BPD at 36 weeks' postmenstrual age) also were considered separately.RESULTS Among the 485 infants randomized (median gestational age, 27.3 weeks; 241 [49.7%] female), all completed follow-up. Death or BPD occurred in 105 infants (43.6%) in the MIST group and 121 (49.6%) in the control group (risk difference [RD], -63% [95% CI, -14.2% to 1.6%); relative risk [RR], 0.87 [95% CI, 0.74 to 1.03]; P = .10). Incidence of death before 36 weeks' postmenstrual age did not differ significantly between groups (24 [10.0%) in MIST vs 19 [7.8%) in control; RD, 2.1% [95% CI, -3.6% to 7.8%); RR, 1.27 [95% CI, 0.63 to 2.57]; P = .51), but incidence of BPD in survivors to 36 weeks' postmenstrual age was lower in the MIST group (81/217 [37.3%] vs 102/225 [45.3%) in the control group; RD, -7.8% [95% CI, -14.9% to -0.7%); RR. 0.83 [95% CI, 0.70 to 0.98]; P = .03). Serious adverse events occurred in 10.3% of infants in the MIST group and 11.1% in the control group.CONCLUSIONS AND RELEVANCE Among preterm infants with respiratory distress syndrome supported with CPAP, minimally invasive surfactant therapy compared with sham (control) treatment did not significantly reduce the incidence of the composite outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age. However, given the statistical uncertainty reflected in the 95% CI, a clinically important effect cannot be excluded. (C) 2021 American Medical Association. All rights reserved.

Portable X-rays remain one of the most frequently used diagnostic procedures in neonatal intensive care units (NICU). Premature infants are more sensitive to radiation-induced harmful effects. Dangers from diagnostic radiation can occur with stochastic effects. We aimed to determine the radiation exposure in premature infants and staff and determine the scattering during X-ray examinations in the NICU. In this prospective study, dosimeters were placed on premature infants who were ≤1,250 g at birth and ≤30 weeks of gestational age who stayed in the NICU for at least 4 weeks. The doses were measured at each X-ray examination during their stay. The measurements of the nurses and the doctors in the NICU were also performed with dosimeters over the 1-month period. Other dosimeters were placed in certain areas outside the incubator and the results were obtained after 1 month. The mean radiation exposure of the 10 premature infants, monitored with dosimeters, was 3.65 ± 2.44 mGy. The mean skin dose of the six staff was 0.087 ± 0.0998 mSV. The mean scattered dose was 67.9 ± 26.5 µGy. Relatively high exposures were observed in 90% of the patients and two staff. The radiation exposure levels of premature infants and staff may need to be monitored continuously.· The premature infants are exposed to radiation due to the bedside X-rays.. · The radiation exposure levels of premature infants and staff may need to be monitored continuously.. · Measures and alternative methods to reduce radiation exposure should be encouraged..

Introduction: This study aimed to determine the association between serum mannose-binding lectin (MBL) levels, gene polymorphisms and late-onset sepsis (LOS) in preterm infants. Methods: Infants with

Invasive candidiasis is a common and serious infection in premature newborns. Preventing and treating fungal infections is very important to improve the prognosis of premature infants. Fluconazole and amphotericin B are used as the first choice in the treatment of invasive fungal infections of the newborns. In some cases, fluconazole and amphotericin B cannot be used due to nephrotoxicity, hepatotoxicity or resistant strains. Micafungin, which is among recently developed echinocandins, is the drug of choice in these cases. The use of micafungin in newborns is new and there is a limited experience about the effect of high dose usage in the central nervous system. The aim of this study was to evaluate the electronic files of patients who used micafungin for the treatment of culture-proven or possible invasive fungal infection during their hospital stay in the neonatal intensive care unit during a 24-month period (2016-2017) in the third-level intensive care unit. A total of 15 patients (10 premature and 5 term babies) were included in the study. The mean birth weight of the patients was 1732 ± 999 g and the mean gestational age was 32.2 ± 5.8 weeks. All patients had long-term intensive care and increased risk of invasive candidiasis infection. Central venous catheterization and multiple antibiotics usage were the most common risk factors in these patients. The other risk factors included intubation, total parenteral nutritional use and surgical procedure application. Candida species were isolated from the cultures of four patients. Candida species isolated from patients were Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis. The mean time for onset of micafungin was 29.9 ± 16.6 days. Mean duration of micafungin therapy was 22.4 ± 11.2 days. Eight patients received amphotericin B, three patients received fluconazole therapy and four patients did not receive any antifungal therapy before the onset of micafungin. None of these patients had an abnormal kidney or liver function tests due to micafungin use. As a conclusion, high dose (10 mg/kg/day) micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections that were caused by refractory Candida strains, and in the case of nephrotoxicity and hepatotoxicity.

Objective Caffeine treatment is routinely used in premature infants to prevent development of apnea and bronchopulmonary dysplasia. Although a limited number of studies have reported that early caffeine treatment may cause development of necrotizing enterocolitis (NEC) by reducing mesenteric blood flow, this issue is still under discussion. The aim of this study is to investigate the possible effect of different onset times of early caffeine treatment on mesenteric tissue oxygen saturation and NEC development in premature infants. Study Design A total of 87 preterm infants with ≤1,250-g birth weight (BW) was included in this prospective study. The cases were randomized as group 1 (first 24 hours) and group 2 (72nd hour) caffeine treatment groups and monitored by near-infrared spectroscopy (NIRS) for 72 hours from the time of admission until cerebral, renal, and mesenteric tissue oxygen saturations (rSO2) were recorded. The cases were followed-up to the 40th week in terms of NEC and other neonatal morbidities. Results A total of 87 infants were included in the study, including 45 in group 1 and 42 in group 2. The groups were similar in terms of demographic characteristics. The incidence of NEC in group 1 (20%) was higher in comparison to group 2 (9%). The mesenteric rSO2 values in the first 72 hours of group 1 were lower than those of group 2. Low gestational week, BW, and late onset of enteral feeding were found to be other significant risk factors for NEC. Conclusion In this study, mesenteric tissue oxygenation was lower, and NEC was higher in group 1. Mesenteric rSO2 measurements may be useful in predicting the development of NEC in patients receiving early caffeine therapy. Key Points

Objective Respiratory syncytial virus (RSV) is one of the most prevalent causes of lower respiratory tract infection (LRTI). The primary objective of this study is to provide the risk modelling of confirmed RSV infection in children who were born preterm at 29 to 35 weeks of gestational age and presented with LRTI. Study Design This prospective, multicenter study was performed between October 2015 and March 2017. Premature infants born with gestational age between 29 and 35 weeks that were ≤2 years of age at the beginning of the RSV season and admitted to the hospital with clinical findings of LRTI during the season were included. RSV-positive and -negative infants were compared in terms of demographic features, risk factors, and requirement of hospitalization. Results RSV positive group was lower than RSV negative group and ratio of ≤3 months age at admission was significant higher in RSV (+) group. RSV-positive infants were found to be significantly born during or 3 months prior to RSV season. The rate and duration of hospitalization and need for mechanical ventilation were significantly higher in RSV positive infants. The rate and duration of hospitalization in RSV positive patients was related to the chronological age. Conclusion This study showed that preterm infants with RSV-associated LRTI significantly needed more hospitalization, intensive care admission, and mechanical ventilation. In addition need of hospitalization and duration of hospitalization were significant higher in ≤3 months of age. Therefore, we suggest the importance of palivizumab prophylaxis in infants ≤ 3 months chronological age, especially during the RSV season.

Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 ± 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.

Introduction: We investigated the association between low 25-hydroxyvitamin D (25-OHD) levels and late-onset sepsis (LOS) in preterm infants (

Aim Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion. Material and methods Premature infants (≤32 gestational weeks) who were hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files. Results Ninety-six patients whose complete data could be reached were enrolled in the study. The mean gestational age of the patients was found as 29±2 weeks and the mean birth weight was 1353±369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of the cases of portal vein thrombose were complete occlusion and eight were partial occlusion. All patients with complete occlusion and six patients with partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31±13.8 days. Thrombosis disappeared in 7-120 days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation. Conclusion Portal vein thrombosis which has a significant place among the causes of portal hypertension in childhood, is mostly asymptomatic in the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications.

AIM To determine the role of serum insulin-like growth factor-1 levels in the development of retinopathy of prematurity, which is a major cause of childhood blindness worldwide. MATERIAL AND METHODS We prospectively studied newborn infants born at a postmenstrual age of

Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neonatal outcomes in premature infants. Methods: The study included preterm infants born at gestational age ≤32 weeks in a tertiary university hospital between January 2016 and January 2017. The study group consisted of infants born from mothers with preeclampsia (Group-1), and the control group consisted of infants born from normotensive mothers (Group-2). Demographic characteristics and clinical outcomes of the infants were recorded. IL-6, IL-8, IL-10, and TNF-α cytokine levels were measured from umbilical cord blood samples. Results: A total of 108 infants were included in the study, of which 34 were in the Group-1 and 74 in the Group-2. Gestational ages (29 vs 30 weeks) of the infants in both groups were similar. There was no significant difference between the cytokine levels of infants with and without preeclampsia. The rate of small for gestational age, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, neutropenia, and thrombocytopenia were significantly higher at the infants with preeclampsia. Conclusion: Maternal preeclampsia leads to an increase at the neonatal morbidities in premature infants without causing a significant alteration at the cytokine levels in cord blood. doi: https://doi.org/10.12669/pjms.36.2.1316 How to cite this:Cakir SC, Dorum BA, Koksal N, Ozkan H. The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants. Pak J Med Sci. 2020;36(2):26-31. doi: https://doi.org/10.12669/pjms.36.2.1316 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods: Retrospective cohort study was performed with prematurely (

Insulin-like growth factor-1 (IGF-1) is important for fetal and postnatal development. After premature births, serum IGF-1 concentrations rapidly decrease and can stay at much lower levels than during the intrauterine period. In this study, we aimed to ascertain whether IGF-1 is associated with morbidities of prematurity such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), and is a useful predictor of these diseases.METHODS: We enrolled newborn infants born at a postmenstrual age of ≤32 weeks in this prospective observational cohort study. Serum IGF-1 levels were measured serially in blood samples on the 1st, 3rd, 7th, 21st, and 28th day.RESULTS: A total of 93 infants were enrolled in the study. All these infants had the following characteristics at birth: weight 1236.11±354.06 g, and gestational age 29.43±2.10 weeks. All of the IGF-1 levels were significantly lower in the group which developed BPD or ROP (p, GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli bir büyüme faktörüdür. Prematüre doğum sonrası serum IGF-1 düzeyleri hızlıca düşmekte intrauterin dönemden daha da düşük seviyelerde kalabilmektedir. Bu çalışmada serum IGF-1 düzeylerinin, bronkopulmoner displazi (BPD), prematüre retinopatisi (PR), intraventriküler kanama (İVK) ve nekrotizan enterokolit (NEK) gibi prematüre morbiditeleri ile ilişkisinin olup olmadığı ve morbiditeleri ön görmede belirteç olarak kullanıp kullanılamayacağı araştırılmıştır.YÖNTEM ve GEREÇLER: Bu ileriye yönelik, gözlemsel çalışmaya, doğum yaşı ≤32 hafta olan prematüre bebekler alındı. Bebeklerin yaşamların 1, 3, 7, 21 ve 28. günlerinde serum IGF-1 düzeyleri ölçüldü. Neonatal morbiditeler açısından izlemleri yapıldı.BULGULAR: Çalışmaya toplam 93 bebek alındı. Bebeklerin ortalama doğum ağırlığı 1236,11±354,06 gr, ortalama doğum yaşları 29,43±2,10 hafta idi. BPD ve PR gelişen bebeklerin serum IGF-1 değerleri, gelişmeyenlere göre anlamlı olarak düşük saptandı. İVK ve NEK gelişen hastalarda ise IGF-1 düzeyleri açısından gelişmeyenlere göre anlamlı fark saptanmadı.TARTIŞMA ve SONUÇ: Prematüre bebeklerde BPD ve PR gelişimi ile ilk 4 haftadaki düşük IGF-1 düzeyleri arasında belirgin ilişki mevcuttur.

Invasive candidiasis is a common and serious infection in premature newborns. Preventing and treating fungal infections is very important to improve the prognosis of premature infants. Fluconazole and amphotericin B are used as the first choice in the treatment of invasive fungal infections of the newborns. In some cases, fluconazole and amphotericin B cannot be used due to nephrotoxicity, hepatotoxicity or resistant strains. Micafungin, which is among recently developed echinocandins, is the drug of choice in these cases. The use of micafungin in newborns is new and there is a limited experience about the effect of high dose usage in the central nervous system. The aim of this study was to evaluate the electronic files of patients who used micafungin for the treatment of culture-proven or possible invasive fungal infection during their hospital stay in the neonatal intensive care unit during a 24-month period (2016-2017) in the third-level intensive care unit. A total of 15 patients (10 premature and 5 term babies) were included in the study. The mean birth weight of the patients was 1732 ± 999 g and the mean gestational age was 32.2 ± 5.8 weeks. All patients had long-term intensive care and increased risk of invasive candidiasis infection. Central venous catheterization and multiple antibiotics usage were the most common risk factors in these patients. The other risk factors included intubation, total parenteral nutritional use and surgical procedure application. Candida species were isolated from the cultures of four patients. Candida species isolated from patients were Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis. The mean time for onset of micafungin was 29.9 ± 16.6 days. Mean duration of micafungin therapy was 22.4 ± 11.2 days. Eight patients received amphotericin B, three patients received fluconazole therapy and four patients did not receive any antifungal therapy before the onset of micafungin. None of these patients had an abnormal kidney or liver function tests due to micafungin use. As a conclusion, high dose (10 mg/kg/day) micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections that were caused by refractory Candida strains, and in the case of nephrotoxicity and hepatotoxicity.

Objective: To assess the short- and long-term effects of the adjustable fortification (ADJ) regimen on growth parameters in premature infants and to evaluate the amount of protein supplements given to reach the targeted blood urea nitrogen (BUN) levels. Methods: In this retrospective study, preterm babies who were born at ≤32 weeks gestational age and fed with human milk, were evaluated in two groups. Infants in Group-I were fed only standard fortification (STD). Infants in Group-II were fed the ADJ regimen. The study was conducted between 2011 and 2016. Results: There were 123 infants in the STD group and 119 in the ADJ group. The mean gestational age of the patients in Group-I was 29.7±1.8 weeks, and mean birth weight was 1266.1±347.1 g. The mean gestational age of the patients in Group-II was 29.5±1.9 weeks, and the mean birth weight was 1217.5±345.5 g. The daily increase in weight and weekly increase in HC were significantly higher in the ADJ group infants. Weight and HC of infants in the ADJ group were significantly higher at 40 weeks. At one year corrected age, weight, length, and HC measurements of both groups were similar. In Group-II, 63% of patients required additional protein supplementation up to 1.6 g/day to achieve the target BUN levels. Conclusion: A higher protein intake through the ADJ regimen improves the physical growth rate of premature infants in the NICU and after discharge. However, sometimes, the targeted growth and BUN values ​​cannot be achieved despite the administration of protein at the recommended increased doses. Increasing protein supplementation up to 1.6 g/day is safe, feasible, and beneficial for these infants. How to cite this:Dorum BA, Ozkan H, Cakir SC, Koksal N, Sen GE. What should be the protein target for adjustable Human Milk fortification in premature infants? Pak J Med Sci. 2019;35(1):277-281. doi: https://doi.org/10.12669/pjms.35.1.337 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: Mannose-binding lectin, which belongs to the collectin family, is an acute-phase reactant that activates the complement system. This study aimed to investigate the effect of MBL2 gene polymorphism on short-term outcomes in preterm infants. Method: Infants of

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.

Background Necrotizing enterocolitis (NEC) is an important cause of morbidity and mortality in preterm infants. There is limited data about the role of mesenteric oxygenation status during the first enteral feeding. Therefore, the aim of this study was to determine the mesenteric tissue oxygen saturation values before, during and after the first enteral feeding and to evaluate the effect of these values on the development of NEC in preterm infants. Methods A total of 105 preterm babies with ≤ 32 gestational weeks were included in this prospective study. The continuous monitoring of the mesenteric tissue oxygenation status was performed before, during and 3 hours after the first feeding by near-infrared spectroscopy (NIRS). Results The mean gestational week and birth weight of the study group were 28.8±2.1 weeks, and 1215±387 g, respectively. The first enteral feeding was started at 2.4±1.4 days with breast milk in 85% of infants. A total of 12 infants (11.4%) developed NEC (66% stage II, 34% stage III). The mean mesenteric tissue oxygen saturation levels of the infants that developed NEC were significantly lower both before and one hour after feeding (56.1±3.4 vs. 34±8.8, and 47.4±3.3 vs 37.8±10.9, respectively) compared with infants that did not develop NEC. Conclusions Lower mesenteric tissue oxygenation values measured before, and one hour after enteral feeding was associated with NEC development. We suggest that lower mesenteric tissue oxygenation during continuous monitoring of first enteral feeding may be used to predict NEC development during follow-up.

Giriş: Prematüre bebeklerde tiroid fonksiyon testlerindeki TFT bozukluğun sıklığı, etiyolojisi ve morbiditelerle ilişkisinin belirlenmesi.Gereç ve Yöntem: Bu çalışmaya Ocak 2009 ve Ocak 2012 yılları arasında Uludağ Üniversitesi yenidoğan yoğun bakım ünitesinde yatarak tedavi görmüş olan toplam 139 prematüre bebek alındı. Hastaların prenatal, natal ve postnatal özellikleri ve alınmış olan TFT değerleri kaydedildi. Tüm hastaların yaşamın 1. ve 3. haftasında TFT çalışıldı. Tiroid stimülan hormon TSH düzeyi 10 IU/L üzerindeki değerler yüksek kabul edildi. Serbest T3 ve T4 değerleri laboratuvar sınırları göz önüne alınarak değerlendirildi. Hipotiroidi tanısı olan ve olmayan tüm hastaların poliklinik izlemlerinden 6, 12 ve 18. aylardaki tartı, boy ve baş çevresi ölçümleri değerlendirmeleri kaydedildi.Bulgular: Çalışmamızda 41 hastanın %24 TFT’sinde anormallik tespit edilmiş olup olguların 22’sinde %53,6 geçici TSH yüksekliği, 9’unda %22 primer hipotiroidi, 9’unda %22 nontiroidal hastalık ve 1’inde %2,4 geçici hipotiroksinemi izlendi. Tiroid fonksiyon bozukluğu olan hastalarda respiratuvar distres sendromu sıklığı anlamlı derecede yüksek saptandı p=0,007 . Annesinde hipotiroidi olan bebeklerde tiroid fonksiyon bozukluğu oranı maternal hipotiroidi olmayan bebeklere göre anlamlı derecede yüksek saptandı p=0,049 . TFT’de bozukluk olan grupta 18. aydaki baş çevresi ortalaması TFT normal gruba kıyasla anlamlı olarak düşüktü p=0,047 .Sonuç: Prematürelerde tiroid fonksiyon bozukluğu sık görülen bir morbiditedir ve nöromotor gelişim açısından önemlidir. Maternal tiroid fonksiyon bozukluğu bebeklerde tiroid testlerinde bozulmaya yol açabilir. Tüm prematüre bebeklerde TFT’lerinde çalışılmalı ve hipotiroidi tedavi edilmelidir. Prematürelerde iyot maruziyetinin azaltılması TFT bozukluğu ve geçici hipotiroidi oranını azaltabilir, Introduction: To determine the rate, etiology and morbidity association of disorders of thyroid function tests TFTs in premature babies.Materials and Methods: A total of 139 premature babies who were admitted to Uludag University Faculty of Medicine Hospital Neonatal Intensive Care Unit between January 2009 and January 2012 were included in this study. Prenatal, natal and postnatal characteristics along with TFTs results were recorded. TFTs were performed for all patients in the first and third weeks of life. Thyroid stimulation hormone TSH values of >10 IU/L was considered elevated. Free T3 and T4 levels were evaluated according to laboratory cut-off values. Weight, height and head circumference values of all individuals with and without the diagnosis of hypothyroidism on the 6th, 12th, and 18th months of their polyclinic follow-ups Results: Abnormal TFTs were detected in 41 24% patients. Twenty two patients 53% had transient TSH elevation, 9 22% had primary hypothyroidism, 9 22% had non-thyroidal disease and 1 2.4% had transient hypothyroxinemia. Among morbidities, respiratory distress syndrome rate was found to be significantly higher in patients with thyroid function disorders p=0.007 . The rate of thyroid function disorders in patients with mothers with hypothyroidism was significantly more frequent compared to patients without maternal hypothyroidism p=0.049 . The mean head circumference in 18 month was significantly lower in patients with abnormal TFTs p=0.047 . Conclusions: Thyroid function disorders are common morbidities in premature babies and are important for neuromotor development. Maternal thyroid function disorder can lead to impairment of TFTs in infants. Thyroid function tests should be performed in all premature babies and hypotyhroidism should be treated. Avoidance of iodine exposure in premature infants can reduce the rate of abnormal TFTs and transient hypothyroidism.

Background & objective Preterm infants need nutritional and medical requirements in accordance with the physiologic maturity at birth and maintaining optimal postnatal corporal and cerebral growth is one of the main targets of medical caregivers. However, only a few strategies exist to improve the outcomes of infants in a pathogen-rich and nutrient-poor neonatal intensive care unit environment. In this pilot study, we hypothesize that synbiotics may enhance brain growth, which is reflected indirectly by an increase in head circumference through several signalling molecules. Methods A pilot study was conducted in preterm infants with a gestational age of ≤32 weeks and a birth weight of ≤1500 grams at neonatal intensive care unit of Uludag Univeristy Medical Faculty (NICU) for one-year period. Following the randomization of the infants, a prepared commercial synbiotic solution containing multi-combined probiotics and prebiotics was administered enterally to the study group. Results The odds of a patient having a lower body weight and head circumference below the 10th percentile were significantly lower in the probiotic group (p=0.001, p=0.03, respectively). Moreover, the infants in the synbiotics group had a more optimal head circumference (between the 50th and 90th percentiles, p=0.001). Conclusions Our results show that if we can maintain optimal gut microbiota, we might achieve better neuro-development via the beneficial effects of synbiotics on cytokines, neurotransmitters, and the cellular immunity of the nervous system. Further investigational models are needed to demonstrate the beneficial effects of synbiotics on the central nervous system.

Parenteral nutrition (PN) has been widely used in preterm infants. The lipid solutions used for PN, however, are associated with oxidative stress and morbidity. The aim of this study was to compare the effectiveness of a new-generation lipid emulsion (SMOFLipid) and olive-oil based lipid emulsion for prevention of PN-associated oxidative damage.Preterm infants 32 weeks of gestational age were included in this prospective randomized study. All infants were randomized to SMOFlipid or olive-oil based lipid emulsion (ClinOleic). Lipid peroxidation products were evaluated in all infants. In addition, total antioxidant capacity (TAC), and both pro- and anti-inflammatory cytokines were studied at days 0, 7 and 14.A total of 89 infants (SMOFlipid, n = 42; ClinOleic, n = 47) were enrolled. TAC was higher in the SMOFlipid group compared with the ClinOleic group at all time points, and the difference on day 7 was statistically significant. Although the anti-inflammatory cytokine interleukin-10 was higher in the SMOFlipid group, this difference was not significant. Bronchopulmonary dysplasia (BPD) was lower in the SMOFlipid group (14.1%) than in the ClinOleic group (31.2%), but this finding was non-significant p 0.05. The rate of severe BPD was significantly lower in the SMOFlipid group.To our best of knowledge, this is the first study to suggest that SMOFlipid might decrease oxidative damage and oxidative-stress-associated morbidity compared with olive oil-based emulsion in preterm infants.

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Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce Dr. Ipek Guney Varal, Uludag Universitesi Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Neonatoloji Bilim Dali, Bursa, Turkiye Tel.: +90 532 341 33 89 E-posta: ibettyg@yahoo.com Ge lis ta ri hi/Re cei ved: 07.01.2014 Ka bul ta ri hi/ Ac cep ted: 22.03.2014 1Uludag Universitesi Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Neonatoloji Bilim Dali, Bursa, Turkiye 2Uludag Universitesi Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Pediatrik Kardiyoloji Bilim Dali, Bursa, Turkiye 3Uludag Universitesi Tip Fakultesi, Radyoloji Anabilim Dali, Pediatrik Radyoloji Bilim Dali, Bursa, Turkiye Ipek Guney Varal1, Nilgun Koksal1, Hilal Ozkan1, Ozlem Bostan2, Onur Bagci1, Fahrettin Uysal2, Zeynep Yazici3, Pelin Dogan1

Background The aim of this study was to determine the causative agents in early, late- and very late-onset sepsis in preterm infants. The demographic features, risk factors, clinical and laboratory findings in sepsis types were also defined. Methods A total of 151 preterm infants with culture-proven neonatal sepsis were enrolled in this prospective study. The infants were classified into three groups with regard to the onset of sepsis: early onset sepsis (EOS), late-onset sepsis (LOS) and very late-onset sepsis (VLOS). A sepsis screen including whole blood count, blood smear, infection markers and cultures was performed before initiating antibiotic therapy. Results EOS, LOS and VLOS groups consisted of 23, 86 and 42 infants, respectively. Coagulase-negative staphylococci (CONS) was the most common organism in all sepsis groups. The main factors associated with EOS included presence of premature rupture of membranes, antibiotic use in pregnancy and choriamnionitis. Previous antibiotic use was the main factor associated with LOS, while low birthweight was the main factor in infants with VLOS. Although mortality rate due to Gram-negative bacteria and fungi was higher, CONS was an important cause of mortality in infants with LOS and VLOS. Conclusions CONS was found to be the most common causative organism in three sepsis types in preterm neonates. Although the mortality rate due to CONS was lower in EOS, it was an important cause of mortality in LOS and VLOS. CONS seems to be the main pathogen in neonatal sepsis in developing countries, as in developed countries.

İstanbullu K, Köksal N, Çetinkaya M, Özkan H, Yakut T, Karkucak M, Doğan H. The potential utility of real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal sepsis. Turk J Pediatr 2019; 61: 493-499. The purpose of this study was to evaluate the efficacy of real-time polymerase chain reaction (PCR) of the 16S rRNA gene in diagnosis of neonatal sepsis and compare it with conventional blood culture. A total of 150 infants were enrolled in this prospective study. The infants were classified into two groups: sepsis group (n=100) and control group (n=50). Blood samples for complete blood count, C-reactive protein, procalcitonin, serum-amyloid A, blood culture and PCR were obtained before initiating antibiotic treatment. Eight specific probes were used to perform PCR analysis for detection of 8 different microorganisms. The positivity rates of blood culture and PCR were found as 11% and 3%, respectively. The diagnosis of neonatal sepsis by PCR revealed a 16.6 % sensitivity, 97.8 % specificity, 33.3% positive predictive value and 94.8% negative predictive value compared with the blood culture. This study showed a low sensitivity of PCR of the 16S rRNA gene in the diagnosis of neonatal sepsis. This may be associated with the identification of rare microorganisms in the blood culture that were not included to PCR analysis. Implementation of all suspectible microorganisms into PCR assay may increase the sensitivity of 16S rRNA gene PCR in diagnosis of neonatal sepsis.

Ozkan H, Koksal N, Dogan P, Guney-Varal I, Bagci O, Ozgur T. The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its` effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants ( < 34 weeks` gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Pentalogy of Cantrell is characterized by the presence of five major congenital defects involving the abdominal wall, pericardium, diaphragm, lower sternum and various cardiac abnormalities. This rare syndrome was described by Cantrell in 1958 and it has poor prognosis. We report here a case of class I Cantrell syndrome and our aim is to share difficulties experienced and review the related literature.

Sacrococcygeal teratoma (SCT) is rarely associated with syndromes. We report a female newborn with a prenatal diagnosis of small sacrococcygeal teratoma and postnatally diagnosed as having trisomy 13. The sacrococcygeal teratoma was excised. It was reported as mature teratoma. The child succumbed to sepsis postoperatively.

Congenital short oesophagus and with intrathoracic development of the stomach is a rare developmental anomaly of the gastrointestinal system. Knowledge regarding its aetiology and management is limited. We report a case in which, in addition to short oesophagus and intrathoracic stomach, an encephalocele was identified during the antenatal period. After the postpartum examination, encephalocele, split notochord malformation, midline localized liver and congenital short oesophagus were confirmed. The report of this case adds to the body of knowledge on this rare condition.

Background Necrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in preterm infants. Aims To evaluate the effect of maternal preeclampsia on the development and severity of NEC in premature infants. Study design Prospective observational study in a tertiary neonatal intensive care unit. Subjects The preterm infants of ≤ 37 gestational age who were consecutively hospitalized were enrolled. The study group contained preterm infants born to a preeclamptic mother and the comparison group contained preterm infants born to a normotensive mother. Outcome measures The primary outcome was to determine the association between preeclampsia and NEC. Results A total of 88 infants had NEC diagnosis. The incidence of NEC in infants born to preeclamptic mothers (22.9%) was significantly higher compared with those born to normotensive mothers (14.6%). According to NEC stages, NEC was more advanced in preeclamptic mother infants. NEC developed significantly earlier in infants with NEC in the study group. The duration of NEC was also significantly longer in infants born to preeclamptic mothers. In multiple logistic regression model, preeclampsia was found to be predictive of NEC with an odds ratio of 1.74 (95% confidence interval 0.64–0.92). Conclusions Maternal preeclampsia may be an important risk factor for the development of NEC in premature infants as NEC incidence and severity of NEC were found to be significantly higher in premature infants born to preeclamptic mothers. The onset of NEC was significantly earlier and duration of NEC was longer in these infants.

Osteofibrous dysplasia is a rare and benign disease that originates from the tibia or fibula. The symptoms of osteofibrous dysplasia include painless enlargement and bowing of the tibia and pain occurring in the presence of pathological fracture. Herein a male infant who was admitted with redness and swelling on the right leg and diagnosed as pathological tibia fracture due to left tibia osteofibrous dysplasia on the third day of life was presented. To our knowledge, this is the earliest presentation of osteofibrous dysplasia with a pathological fracture in a neonate. Therefore, it must be suspected in neonatal bone fractures.

Aim: Nosocomial infections (NI) in a neonatal intensive care unit (NICU) and neonatal clinic were evaluated during a one-year-period. Material and Method: 314 newborns were investigated for nosocomial infections. Local ethics committee approval was given for this study. Nosocomial infections was defined using the CDC criteria. Results: Nosocomial infections developed in 53% of 127 patients (58% with culture positivity) in the NICU and in 2.6% of 187 patients (all with a negative culture) in the neonatal clinic. In total, (NICU plus neonatal clinic), NI developed in 23% of hosptalized patients. Nosocomial infections rate was 42.3% and in terms of patient days, NI rate was 14/1000 patient-day. When evaluated separately, NI developed in 53.5% of patients admitted in NICU and in 2.6% of neonatal clinic patients. Also, NI rates were 17.9/1000 patient-day in NICU and 1.6/1000 patient-day in the neonatal clinic. Patients with NI stayed at the hospital for 73.6 +/- 47.8 day in NICU and for 16.0 +/- 6.7 day in the neonatal clinic. Nosocomial infections developed on the 29.4 +/- 30.9(th) d in NICU and on the 7.6 +/- 2.9(th) day in the neonatal clinic. In NICU, in terms of 128 NI episodes, the NI related mortality was 8.5%. 16.1% (n: 11) of the patients with NI died. They died on the 56.7 +/- 50.2(nd) day of admission and on the 25.8 +/- 10.2(nd) day second after NI diagnosis. There was no mortality in neonatal clinic patients. Conclusions: Our NI rates were slightly higher than the developed countries and lower than the developing countries. Bir yılda, Yenidoğan Yoğun Bakım Birimi (YYBB) ve Yenidoğan Kliniği’ne yatan hastalarda gelişen hastane enfeksiyonları (HE) incelendi. Gereç ve Yöntem: Hastane enfeksiyonları Centers for Diseases Control and Prevention (CDC) ölçütlerine göre tanımlandı. Çalışma için Uludağ Üniversitesi Tıp Fakültesi Etik Kurul onayı alındı (04 Mart 2008 tarih ve 2008-5/12 sayılı etik kurul yazısı). Bulgular: Yenidoğan YBB’de yatan 127 hastanın %53’ünde (%58,5’i kültür pozitif), Yenidoğan Kliniği’nde yatan 187 hastanın %2,6’sında (hepsi kültür negatif) HE gelişti. Yenidoğan YBB ve Yenidoğan Kliniği’nde toplam %23 hastada HE gelişti, HE hızı %42,3, yatış gününe göre HE oranı ise 14/1000 hasta günü olarak bulundu. Hastane enfeksiyonları oranı YYBB’de 17,9, Yenidoğan Kliniği’nde 1,6/1000 hasta günü bulundu. Hastane enfeksiyonları olan hastalar, YYBB’de 73,6±47,8 gün, Yenidoğan Kliniği’nde 16,0±6,7 gün yattı. Hastane enfeksiyonları tanısı, YYBB’sinde hastaneye yatışlarının ortalama 29,4±30,9. gününde, Yenidoğan Kliniği’nde 7,6±2,9 gününde konuldu. Yenidoğan YBB’de 128 HE atağında atak ilişkili ölüm oranı %8,5 idi. Hastane enfeksiyonları saptanan 68 hastanın 11’i (%16,1) kaybedildi. Hastane enfeksiyonları tanısı alan hastalar, Yenidoğan YBB’de ortalama yatışının 56,7±50,2. gününde kaybedildi. Hastane enfeksiyonları tanısı konulduktan sonraki ortalama ölüm günü; YYBB’de 25,8±10,2 gün olarak saptandı. Yenidoğan Kliniği’nde HE gelişen hastalarda ölüm saptanmadı. Çıkarımlar: Kliniğimizde Yenidoğan YBB ve Yenidoğan Kliniği’ndeki HE’leri gelişmiş ülkelere göre biraz yüksek, gelişmekte olan ülkelere göre daha düşük saptandı.

Background: Although a variety of different lipid emulsions with varying fatty acid contents have been developed, there are some concerns about the administration of these lipid emulsions because of potential adverse effects, including oxidative stress-related morbidity. The aim of the present study was to evaluate and compare the effects of the standard soybean oil-based and olive oil-based i.v. lipid emulsions (ILE) on oxidative stress, determined by total antioxidant capacity (TAC), and to investigate the safety of the use of these two emulsions in terms of biochemical indices. Methods: In this prospective study, premature infants were randomly assigned to two groups, each group consisting of 32 patients who received parenteral ILE of either 20% olive oil or 20% soybean oil. They were given ILE for 7 days and then were evaluated with regard to TAC. Results: No statistically significant difference was observed between the groups in terms of routine biochemical parameters. TAC for both groups on day 7 was significantly lower compared with that on day 0. Although the decrease in TAC within 7 days of ILE administration was greater in the soybean group compared with that in the olive oil group, it was not statistically significant. Conclusions: Olive oil-based ILE exhibit similar antioxidant activity and can be used as an alternative to soybean oil-based ILE. TAC significantly decreased in infants following administration of either lipid emulsion, and premature infants tolerated either ILE well, both biochemically and clinically.

Valproic acid (VPA) is a teratogenic drug used in pregnant women for the treatment of epilepsy and mood disorders. Fetal valproate syndrome (FVS) is characterized by a number of abnormalities associated with VPA exposure in utero including neural tube defects, congenital heart defects, limb defects, genitourinary defects, brain, eye and respiratory anomalies, and abdominal wall defects. Complex cardiac defect and trigonocephaly have rarely been reported and multicystic dysplastic kidney has never been detected in FVS. We here report a female infant who was born to a mother with a history of low-dose VPA monotherapy (250 mg/day) during pregnancy and who had presented with a combination of unilateral multicystic dysplastic kidney, multicomplex cardiac defect including severe coarctation of aorta, Ebstein anomaly, secundum atrial septal defect, mesocardia along with trigonocephaly due to metopic craniosynostosis, typical facial appearance and limb defects. To our knowledge, this is the first case presented with multicystic dysplastic kidney, complex cardiac defect, trigonocephaly and other limb and facial defects because of exposure to very low-dose VPA monotherapy (250 mg/day) in utero. We conclude that VPA must be used very cautiously in pregnant women even as monotherapy and in low doses to prevent major congenital defects.

The purpose of this study was to evaluate the efficacy of serial serum amyloid A (SAA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants. A total of 144 infants were enrolled in this observational study. The infants were classified into three groups: group 1 (infants with NEC and sepsis), group 2 (infants with sepsis), and group 3 (no sepsis and NEC, control group). Data including serial whole blood count (WBC), SAA measurements that were obtained at the initial work-up of NEC and/or sepsis episode (0 day), at 24, 48 h, 7, and 10 day were evaluated. In addition, initial and serial follow-up abdominal radiographies were obtained. A total of 50 infants were diagnosed NEC. Mean SAA values (43.2 +/- A 47.5 mg/dl) of infants in group 1 at 0 h were significantly higher than those in group 2 and group 3. The percentage of infants with abnormal SAA levels was significantly higher in group 1 compared with that in group 2 at 24 h. In addition, the percentage of infants with abnormal SAA levels was slightly but not statistically higher in stage 2 and stage 3 NEC group compared with that stage 1 NEC at 0, 24, 48 h. SAA levels started to decline at 48 h of onset through day 10. The cut-off value for SAA for differentiating NEC from sepsis was 23.2 mg/dl. SAA may be recognized as an accurate laboratory marker in addition to clinical and radiographic findings for NEC diagnosis. It can also be used for determining the severity of NEC and response to therapy in infants with NEC.