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Tracheomalacia (TM) is a disease that causes the airway obstruction of the tracheal lumen as a result of the structural disorder of the tracheal cartilage. We present a 4-month-old patient who developed ventilator depended TM after repair of esophageal atresia with tracheoesophageal fistula. Aortopexy and intraoperative flexible bronchoscopy were first performed via partial sternotomy in Turkey for this patient. He was weaned from ventilatory support and extubated at the first and discharged at the 8th post-operative day. Partial sternotomy is performed in the supine position, thus it allows for intraoperative flexible bronchoscopy permitting to check for the adequacy of the aortopexy.

Background: healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. Methods: a HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: the Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005). Conclusions: neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs., NA

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV +VG and PSV+ VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV + VG or PSV + VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV +VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV + VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1 beta in the tracheal aspirates increased during both modes. CONCLUSION: PSV + VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV + VG. Therefore, PSV + VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.

Objective: Nitric oxide plays a preventive role in the development of necrotizing enterocolitis. Oral nitrite and nitrate intake has gained importance with the discovery of the conversion of nitrite to nitric oxide in acidic medium out of the synthesis of nitric oxide from L-arginine. Objective of this study was to examine the breast milk concentrations of nitric oxide and asymmetric dimethylarginine which is a competitive inhibitor of nitric oxide and to compare these concentrations in terms of gestational age and maturity of breast milk. Study Design: Forty-one women were included in the study. Milk samples were collected from 3 groups of mothers as term, late preterm and preterm on the postpartum days 3, 7 and 28. Results: When breast milk concentrations of nitric oxide were compared according to the postnatal day of the milk independently from gestational age; nitric oxide concentration was higher in the colostrum than in the transition milk and mature milk (p=0,035; p=0,001; respectively). For the comparison of asymmetric dimethylarginine concentrations among these groups and days; no statistically significant difference was observed in terms of gestational age and maturity of the milk (p=0.865, p=0.115; respectively). Conclusion: The highest nitric oxide concentration was found in the colostrum, suggesting that colostrum is a valuable food for newborns. Plasma concentrations of asymmetric dimethylarginine were negatively correlated with nitric oxide and did not show a correlation with breast milk, suggesting that asymmetric dimethylargininedoesn’t make nitric oxide inhibition in breast milk.

Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants.Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination.Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p=0.000), respiratory rate (p=0.000), diastolic blood pressure (p=0.001) and oxygen saturation (p=0.000) during the examination were significantly different than the values before and 10minutes after the examination. Infants whose gestational age 32 weeks (n:20) have significantly higher NIPS scores (meanSEM=3.3 +/- 0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean +/- SEM=2.4 +/- 0.2).Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.

Background/aim: Increased airway resistance reduces the effectiveness of ventilation treatment. Endotracheal tubes (ETTs) and connectors contribute to resistance. However, the effect of a closed system suction (CSS) connector is not well known. We compared the in vivo resistance occurring with a CSS connector with that of the standard connector. Materials and methods: This prospective study was conducted at Gazi University Hospital's neonatal intensive care unit. Intubated neonates were studied for two cycles; each cycle contained two periods of ETT + connector pairs (15 min/period) as follows: cycle 1 [A: long ETT + standard connector; B: long ETT + CSS connector] and cycle 2 [C: shortened ETT + standard connector; D: shortened ETT + CSS connector]. Resistance of 40 breaths/period was averaged for each case, and the means were analyzed by Wilcoxon test for pairwise comparisons between standard and CSS connectors. As each case provided two cycle data, 16 cycle data were compared. Results: The CSS connector increased resistance by 13.8% (range: 3.0%-22.1%) compared to the standard connector; P < 0.001. The resistance increase was similar between long [17.3% (range: 3.0%-17.7%)] and shortened ETTs [15.3% (range: 5.0%-29.6%)]; P = 0.834. Conclusion: CSS connectors were found to increase airway resistance in ventilated neonates. The contribution of CSS should be considered during ventilation, particularly in the presence of difficulty in providing sufficient tidal volume.

AIM Most of the preterm infants are transfused at least once during their stay in the neonatal intensive care unit (NICU). The aims of this study were to demonstrate if packed red blood cell (pRBC) transfusion modulates regional (cerebral, abdominal, renal) tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) and to demonstrate if we can use NIRS to guide transfusion decisions in neonates. METHODS A multi-probe NIRS device was applied to anaemic preterm infants of gestational age

Aim: The aim of the present study is to investigate the neuroprotective effects of l-Arginine (l-arg) in the seven-day-old rat hypoxia-ischemia model. Materials and methods: L-Arginine (n = 10) or saline (n = 8) was administered intraperitoneally to seven-day-old rats before hypoxia-ischemia. In addition, 18 seven-day-old rats were given l-Arginine (n = 10) or saline (n = 8) after hypoxic-ischemic insult. Neuronal apoptosis was investigated by terminal dUDP-biotin nick end-labeling (TUNEL) following three days of recovery. The ratios of right side numerical density to the sum of right and left sides' numerical densities (right apoptosis index) were calculated for every brain region in rats receiving l-arginine and they were compared with the vehicle groups. Results: Right side apoptosis indexes of the hippocampus (mean +/- SD; 35.0 +/- 16.1) and striatum (41.9 +/- 16.0) were significantly decreased in the l-Arginine post-treatment groups when compared to vehicles (61.0 +/- 17.0 and 62.4 +/- 27.0 respectively) (p < 0.05). There was no significant difference in the right apoptosis indexes of the cortex between l-Arginine post-treated group and the vehicle group. There were also no significant differences between the right side apoptosis indexes of the l-Arginine pretreatment groups and those of the vehicle group in any of the three regions (p > 0.05). Conclusions: It is concluded that neuronal apoptosis due to hypoxic-ischemic injury may likely to be reduced by post-treatment of l-Arginine in the neonatal rat model and l-Arginine provides a new possibility for neuroprotective strategies based on NO production.

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

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

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation.

Aktaş S, Ergenekon E, Ünal S, Türkyılmaz C, Hirfanoğlu İM, Atalay Y. Different presentations of Cow's milk protein allergy during neonatal period. Turk J Pediatr 2017; 59: 322-328. Cow`s milk protein allergy (CMPA) is the most common cause of allergy occurring in the first year of life due to infant formula or breast-milk of mothers who are drinking cow`s milk or eating cow's milk products. Most children with allergic colitis are symptomatic in the first months, usually by 4 weeks. There are rare cases whom were sensitized prenatally and demonstrated symptoms in the first week, even in the first 2 days of life. The most common clinical sign of CMPA is bloody stool in a well-appearing infant. Gross bloody stool or fecal occult blood are also the common signs of necrotizing enterocolitis (NEC), especially in preterm infants with systemic instability. The treatment options are totally different so the clinician has to be very careful evaluating the patient. We report 5 preterm cases of CMPA, two of whom were siblings. Two of them presented with massive bloody stools and 3 of them presented with abdominal distension and fecal occult blood all of which were initially considered as NEC. Literature review of 20 cases with similar history is summarized as well.

Microcirculation is an important component of hemodynamic physiology. It can be assessed simply by clinical scores or by a variety of techniques including sidestream dark field (SDF) imaging and peripheral perfusion index (PI) measurements. Mode of delivery may have affects on microcirculation during transitional period. The aim of this study was to compare skin microcirculation in newborns born via vaginal delivery (VD) or cesarian section (C/S).Term healthy newborns not requiring NICU admission were included. Vital signs were recorded. Skin microcirculation was determined by clinical scoring including capillary refill time, skin color, warmth of extremities, by SDF imaging where capillary density and microvascular flow is determined and by PI measurements where pulsatile and nonpulsatile capillary flow is measured. Assessments were done at 30 min and 24 h of life. Results were compared between VD and C/S groups and overtime.There were 12 newborns in VD group and 25 newborns in C/S group. No difference was observed in microcirculation assessments between groups. However VD group had increased hyperdynamic flow overtime.In healthy term newborns microcirculation does not seem to be affected by mode of delivery, however results may differ in sick or preterm newborns.

To compare interleukine-10 (IL-10) and total antioxidant capacity (TAC) levels after breast milk storage by studying premature and term mothers’ colostrum and mature milk and by analyzing those levels relative to gestational week.Fifty-four colostrum and mature breast milk samples were collected from both premature and term mothers. The samples were divided into three groups based on the time of analysis: fresh milk, at +4 °C for 72 h, and at -20 °C for 14 d. The IL-10 and TAC levels were measured quantitatively.Fresh colostrum and mature milk had similar IL-10 levels. Term mothers’ fresh-colostrum TAC levels were higher than their mature milk. The mature milk of the premature mothers’ had higher TAC levels than that of term mothers. Storage did not affect the IL-10 levels of breast milk, but fresh milk antioxidant capacity halved after 72 h and 14 d. Colostrum IL-10 and TAC levels did not correlate with gestational week. Mature milk IL-10 levels did not correlate with gestational week, but TAC levels negatively correlated with gestational week (r: -0.61: p 0.01).The milk stored for 72 h at +4 °C and for 14 d at -20 °C did not maintain the same TAC levels as the fresh samples. This should be considered especially for sick infants who need more antioxidant capability in neonatal units.

The aim of this study was to investigate the effects of cisplatin and the protective role of acetyl l-carnitine against uterine tube toxicity. Twenty-four female Wistar albino rats were divided into four groups: control group was injected with saline (control); group 2 was injected with acetyl l-carnitine; group 3 was injected with cisplatin; and group 4 was pre-treated with acetyl l-carnitine before cisplatin intraperitoneal injection. According to our results, a significant weight loss was observed in rats from group 3. The thickness of the wall and epithelium of uterine tube were decreased in group 3 rats. We elaborate the protein expression of caspase in epithelium and stroma by IHC. We found that the expression of caspase and the number of TUNEL-positive cells were increased in group 3 rats compared to the other groups. In our study, we showed the protective role of acetyl l-carnitine against uterine tube toxicity caused by cisplatin.

Background Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as “delayed transition”, others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. Methods Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. Results Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. Conclusion PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.

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

Neonatal jaundice is the result of an imbalance between bilirubin production and elimination. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. Hemolysis has a significant role in bilirubin increase in newborns. Intrauterine is tolerated by the maternal metabolism in life. When hemolysis takes place, a decrease is accepted in the haptoglobin and hemopoexin blood levels binding hemoglobin in the environment. Therefore, it may be considered that haptoglobin and hemopoexin from the early period umbilical cord (C) blood in newborns may be an indicator in determining jaundice likely to develop in later stages. Babies were called to the control polyclinic in the third and fifth days. Eighty-four babies with normal term birth were included in the study. Gestational age of the mothers was 39.5 +/- 1.5 weeks in average. A significant negative correlation was found between the haptoglobin level from the UC taken during delivery and the bilirubin value in the fifth day (r=-0.345; P=0.001). The haptoglobin value from the blood of the UC can be used as a guiding indicator to demonstrate the future occurrence of jaundice in newborns. This way, the babies with high jaundice risk may be detected earlier and closer follow-up of these babies can be obtained. As a result, the haptoglobin level of the blood from the UC during delivery allows us to make an early prediction on whether neonatal jaundice will occur. J. Clin. Lab. Anal. 22:409-414, 2008. (C) 2008 Wiley-Liss, Inc.

Background: Nutrition of very low-birth-weight newborns is important for a good physical and neurologic outcome. Body composition assessment, together with anthropometric measurements, is considered necessary to monitor adequate nutrition and growth. Objectives of this study were to assess body fat changes in newborns

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

Aim: We aimed to evaluate the validity and reliability of the Infant Breastfeeding Assessment Tool (IBFAT), the Mother Baby Assessment (MBA) Tool, and the LATCH scoring system. Subjects and Methods: Mothers who delivered healthy, full-term infants in the Obstetrics & Gynecology Service of Gazi University, Ankara, Turkey, between December 2013 and January 2014 and their infants were included in the study. Forty-six randomly selected breastfeeding sessions were monitored and scored simultaneously by three researchers (Raters 1, 2, and 3) using LATCH, IBFAT, and the MBA Tool. Researchers put the score sheets in an envelope in order to hide them from each other. The compatibility of the scores given by three researchers was assessed by statistical methods. Results: We found positive and significant correlation coefficients between 0.81 to 0.88 for the total MBA score, between 0.90 to 0.95 for the total IBFAT score, and between 0.85 to 0.91 for the total LATCH score. Correlation coefficients testing these three tools ranged from 0.71 to 0.88, with the minimum value being noted for the correlation between LATCH and IBFAT scores and the maximum value being noted for the correlation between LATCH and MBA scores. Conclusions: We found positive and significant correlations between researchers' scores for 46 observations using the three assessment tools. This study showed that these above-mentioned tools were compatible for the assessment of the efficiency of breastfeeding.

Preterm ovarian hyperstimulation syndrome (POHS) is an uncommon disorder characterized by prematurity, hypogastric and upper leg swelling of various intensities, high serum estradiol and gonadotropin levels, and ovarian follicular cyst/cysts. In this paper, we present the first case of POHS presenting with vaginal bleeding. A female infant was born via spontaneous vaginal delivery at 25 weeks of gestation with a birth weight of 610 g. At 36 weeks of post-conception age, she developed breast enlargement, swelling of the clitoral hood, labia major and minor, hypogastrium and upper legs. Several weeks later, vaginal bleeding started and lasted 3 days. The vaginal bleeding continued to occur at monthly intervals. The elevated levels of gonadotropins and estrogens, vulvar swelling and cysts in both ovaries confirmed the diagnosis of preterm ovarian hyperstimulation syndrome.

Objectives:Gamma-glutamyl transferase (GGT) is commonly measured in newborn infants as a sensitive liver function test; however, reference ranges are mostly based on early studies, including relatively small number of patients. The aim of this study was to emphasise recently changed GGT values because of changed newborns profile admitted to neonatal intensive care units (NICUs) and establish new cross-sectional reference ranges for the serum GGT levels in a cohort of neonates between 26 and 42 weeks' gestational age in 1 centre.Methods:From January 1, 2010 to December 31, 2012, liver function tests including serum GGT measurements were performed in 705 newborns who were admitted to NICUs because of different aetiologies at Gazi University School of Medicine Hospital, Ankara, Turkey. Infants with Apgar score

Perinatal asphyxia is an important cause of neonatal morbidity and mortality. Hypothermia is an effective treatment of neonatal hypoxic-ischemic encephalopathy in infants. Cold agglutination is a primary or acquired autoimmune disease that involves autoantibodies that lead to hemagglutination at low temperatures lower than that of the body. In this case the importance of cold agglutinins during therapeutic hypothermia is presented.

Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was 0 positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification. (C) 2013 Elsevier Ltd. All rights reserved.

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

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

Recommendations for FFP use in neonates are based on a very limited amount of data, and not on well-designed randomized controlled trials. This retrospective study was performed to analyze our experience with FFP use in neonatal intensive care unit (NICU). From January 2006 until August 2011 a total of 80 neonates were identified as having been treated with FFP. The most common indication for FFP use was prolonged PT or aFTT, representing 32.8% of all usages of FFP. Following FFT treatment PT and aPTT normalized in 42% and 60% patients, respectively. Our results suggest that FFP were often used in acceptable indications in NICU. (C) 2012 Elsevier Ltd. All rights reserved.

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

To determine the preventative effect of caffeic acid phenethyl ester (CAPE) in necrotizing enterocolitis (NEC) in an experimental rat model of NEC.Thirty newborn Sprague-Dawley rats were randomly divided into three groups; as NEC, NEC + CAPE and control. NEC was induced by enteral formula feeding, subjected to hypoxia-hyperoxia and cold stress. Pups in the NEC + CAPE group were treated with CAPE at a dose of 30 mg/kg daily by intraperitoneal route from the first day to the end of the study. All pups were executed on the fourth day. Proximal colon and ileum were allocated for histopathologic and biochemical evaluation, including xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS), malonaldehyde (MDA) and myeloperoxidase (MPO) activities.The pups in the NEC + CAPE group had better histopathologic and apoptosis evaluations (TUNEL and caspase-9) and the severity of bowel damage was significantly lower in the NEC + CAPE group compared to the NEC group (P0.01). The clinical sickness scores and body weight in the NEC + CAPE group was significantly better compared to the NEC group (P0.05). Tissue MDA, MPO, XO levels and TOS were remarkably reduced in the NEC + CAPE group, however, TAS was significantly increased in the NEC + CAPE group (P0.05).Treatment with CAPE reduces the intestinal damage in NEC.

We evaluated the potential therapeutic use of exogenous human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in an experimental rat model of necrotizing enterocolitis (NEC). Thirty-six newborn Sprague Dawley rats were randomly divided into three groups: NEC, NEC + hBM-MSC, and a control (control and control + hBM-MSC). NEC was induced by enteral formula feeding, exposure to hypoxia hyperoxia, and cold stress. After NEC was induced, iron-labeled hBM-MSCs were administered by intraperitoneal injection. All pups were killed on the fourth day following injection, and the terminal ileum was excised for a histopathological and immunohistochemical evaluation. The pups in the NEC + hBM-MSC group showed significant weight gains and improvements in their clinical sickness scores (p < 0.01). Bowel damage severity observed in the histopathological evaluation was significantly lower in the NEC + hBM-MSC group than that in the NEC group (p = 0.012). The number of MSCs homing to the bowel was significantly higher in the NEC + hBM-MSC group than that in the control + hBM-MSC group. In conclusion, this is the first study that has evaluated the effectiveness of hBM-MSCs in a neonatal rat NEC model. MSCs reduced histopathological damage significantly. (Pediatr Res 70: 489-494, 2011)

The aim of this study was to evaluate the preventive effect of N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in an experimental rat model.Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups: NEC, NEC + NAC, and control. Necrotizing enterocolitis was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. Pups in the NEC + NAC group were administered NAC at a dose of 150 mg/kg daily by intraperitoneal route from the first day until the last day of the study. All pups were killed on the fifth day. Proximal colon and ileum were excised for histopathologic, immunohistochemical (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and caspase-3, caspase-8, caspase-9), and biochemical evaluation, including xanthine oxidase, total antioxidant status, total oxidant status, malondialdehyde, and myeloperoxidase activities.The pups in the NEC + NAC group had better clinical sickness scores compared with those in the NEC group (P.05). In histopathologic and apoptosis evaluations (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and immunohistochemical evaluation for caspase-3 and caspase-9), the severity of bowel damage was significantly less in the NEC + NAC group compared with the NEC group (P.01). Tissue malondialdehyde, myeloperoxidase, xanthine oxidase levels, and total oxidant status were significantly decreased in the NEC + NAC group, whereas total antioxidant status (TAS) was significantly increased in the NEC + NAC group (P.01).N-acetylcysteine therapy significantly reduced the severity of intestinal damage in NEC.

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

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

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

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

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

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

Objective To evaluate the association between glycemic levels with glucose loading test during pregnancy and maternal and perinatal outcomes. Methods Retrospective analysis of 2059 singleton pregnancies screened for gestational diabetes mellitus at Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2004 and December 2006 was conducted. Sensitivity and specificity of the 50 g glucose loading test was calculated for different cut-off values in our population. Maternal and perinatal outcomes in different groups with different results after screening test were compared. Results An increase in cut-off value from 140 to 145 mg/dl seems to be associated with a significant increase in specificity along with a tolerable decrease in sensitivity. A cut-off value of 147.5 mg/dl is associated with a higher specificity and a slightly lower sensitivity. However, the cut-off value 150 mg/dl seems to be associated with a significant decrease in sensitivity. As for the upper limit, a cut-off value of 180 mg/dl is associated with a 90% specificity and a cut-off value of 200 mg/dl is associated with a 99% specificity. A 100% specificity could be reached only after a cut-off value of 221 mg/dl. A GLT value of 180 mg/dl or higher was found to be associated with poor maternal and fetal outcomes, regardless of the result obtained after the diagnostic test. Conclusion Results obtained after 50 g GLT should be evaluated separately for each patient and the diagnostic test which is time-consuming, uncomfortable and expensive can be omitted up to a cut-off value of 147.5 mg/dl, especially for those patients with no risk factors. Besides, a GLT value of 180 mg/dl or higher proves the diagnostic test unnecessary as these patients are associated with unfavorable perinatal and fetal outcomes.

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

Background Early aggressive nutrition followed by enriched preterm style enteral feeding is considered the standard of care in neonatal intensive care units (NICU) and results in good neurological outcome. However there are concerns whether preterms accumulate excess fat during NICU stay. Aim Aim of this study was to compare skinfold thickness of preterms when they reached 35 weeks corrected age (CA) with that of 35 week born controls. Methods Appropriate for gestational age (AGA) preterms born ≤32 weeks gestational age (GA) had skinfold thickness measured from 5 body sites by using Holtain caliper at 35 weeks CA as well as weight, length, head circumference (HC) and ponderal index (PI), results were compared with gender matched AGA near term controls born at 35 weeks gestation with nonparametric tests. Data are expressed as median and range. Results 26 preterms (10 males GA:30.5 w (28–31), BW: 1500g (1040–1700)), 16 females GA:29 w (25–32), BW: 985g (610–1800)) were compared to 20 controls (10 males BW:2175g (1837–2356), 10 females BW: 2115g (1815–2362)).Skinfold thickness measured from triceps, biceps, subscapular, suprailiac and midtigh regions were significantly higher in patients compared to controls both in girls and boys (Figure 1.2). However weight, length, HC and PI were similar. Conclusion Enriched feeding with increased protein and calories is essential for preterms during NICU stay however the way we do it does not seem to lead to in utero body composition which is considered ideal.

Background and aim Post-hemorrhagic hydrocephalus (PHH) is one of the most serious complications of intraventricular hemorrhage (IVH) in a newborn. Causes are multifactorial including genetical, pre and postnatal complications. Conditions assosciated with hydrocephalus following IVH were investigated. Methods Charts of patients admitted to the neonatal intensive care unit (NICU) over last 5 years were investigated retrospectively, newborns with grade 3–4 IVH were analyzed for risk factors in the perinatal and neonatal period. Ones with and without hydrocephalus were compared. Results are expressed as median and range and percentage where required. Results 24 newborns were diagnosed with IVH, 9 of whom developed hydrocephalus. Most significant risk factors are shown in table 1. Hypotension, asidosis, were more frequent in the PHH group. GA, BW, Apgar scores, lowest-highest CO 2 , Crib score are shown in table 2. Highest CO 2 in the first 10 days of life was significantly higher in the PHH group (p=0.044). Conclusion PHH remains to be one of the most severe complications of IVH. In this small group of patients, high CO 2 levels, hypotension seem to be important risk factors.

Background and Aim Neonatal Intensive Care Unit (NICU) is a noisy environment in which infants can be exposed to high noise levels. The aim of the study is to evaluate the adverse effects of noise on hearing and, neurological outcomes of NICU graduates at six months of age. Methods Thirty two infants that had been admitted to Gazi University Hospital NICU and 25 healthy controls, were included in the study. Noise levels were recorded continously during hospitalization period. TEOAE, DPOAE and ABR tests were used to assess hearing. Neurological outcome was assessed with Bayley II Infant Development Scale. Results The median period of noise exposure above 45 dB, was 50.1% of the entire hospitalization period. Levels exceeding 45 dB were mostly below 124 Hz. Major source of noise was traced back to the incubators. All patients passed the hearing screening tests before discharge. On the sixth month follow up; hospitalized infants had lower DPOAE SNR amplitudes (dB) at five frequencies including 1001, 1501, 3003, 4004, 6006 Hz in both ears. DPOAE fail rates at 1001 Hz and 1501 Hz were higher in hospitalized infants (p=0.001). Positive correlation between noise exposure and duration of hospitalization was determined. Infants who failed at 1001 and 1501 Hz had similar Bayley II Infant Development Scale scores and there were no difference between groups. Conclusion Major noise source in NICU was found to be the incubators. Although hearing loss was not detected in any infants, hearing tests at sixth months of life were adversely affected.

Introduction Noninvasive ventilation with nasal CPAP (n-CPAP), or nasalintermittant positive pressure ventilation (n-IPPV) is becoming standard ofcare in preterm. Limited experience has been reported withnasal high frequency oscillatory ventilation (n-HFOV). We present 2 newbornstreated by n-HFOV applied with binasal prongs (Ram cannula Neotech) and DraegerBabylog 8000+ ventilator. Cases 1. A 900 gr. 28 weeks gestation infant was intubated, given surfactant and ventilated by volume guarantee pressure-support ventilation for RDS. On 2nd day HFOV was started due to worsening respiratory status. On 11th day patient was extubated to n-HFOV and continued for 4 days followed by n-IPPV/n-CPAP. 2. A 830 gr. 28 weeks gestation infant was resuscitated in the delivery room. RDS and pulmonary interstitial emphysema was detected on radiography and surfactant was given. At 12 h pneumothorax occurred necessitating thoracal tube insertion and HFOV. Conventional ventilation was tried several times without success. HFOV continued for 46 days then baby was extubated to n-HFOV. Patient required reintubation after 4 days due to sepsis. Conclusion n-HFOV with binasal prongs could be an alternative for preterms after prolonged HFOV.

Background and aims Microcirculation is important to ensure adequate tissue oxygenation and nutrient delivery. Clinical findings, perfusion index (PI) measurements are used to assess microcirculation. Side stream dark field (SDF) imaging is a noninvasive method of assessing microcirculation by means of a videomicroscope. This study aimed to assess microcirculation in healthy term newborns born either by spontaneous vaginal delivery (SVD) or caesarean section (C/S). Methods The assessments were done within the first 30 min of life (T0) and repeated at the 24th hour of life (T1). Microcirculation was assessed from axillary skin by using SDF technique with Microscan device where total and perfused vessel density (TVD, PVD) and microvascular flow index (MFI) were calculated, as well as by using microcirculation score (MS) based on capillary refill time, skin colour and warmth and PI measured by Masimo Radical7 pulse oxymeter. Vital signs were also recorded. Nonparametric tests were used for statistical analysis. Results Twelve newborns born by SVD and 25 newborns born C/S were included. The mean, SD, median values for temperature, TVD, PVD, MFI, MS, and PI at T0 and T1 are as follows; T0: Temp:36 ± 0,44(36,1), TVD: 18,79 ± 1,49(18,81), PVD: 18,73 ± 1,5(18,81), MFI: 3,07 ± 0,25(3), MS: 2,14 ± 1,36(2), PI: 1,84 ± 0,97(1,75). T1: Temp:37,1 ± 0,26(37,1), TVD: 18,93 ± 2,1(18,73), PVD: 18,9 ± 2,13(18,73), MFI: 3,17 ± 0,32(3,1), MS:1,65 ± 0,48(2), PI: 1,9 ± 0,8(2). Temperature was significantly and MFI was slightly higher at T1 compared to T0 (p = 0,001 and p = 0, 04). No difference was observed between SVD or C/S groups or at different times within the same group. Conclusions Peripheral microcirculation in general is not affected by mode of delivery in term healthy newborns and doesn’t seem to change significantly within the first 24 h of life.

Introduction Volume guarantee (VG) ventilation is frequently used for newborns, mostly combined with SIMV or A/C modes. Aim of this study was to compare effect of SIMV+VG or PSV+VG ventilation on ventilatory and laboratory parameters and clinical findings. Patients and methods Preterms with RDS 2 were analysed. If measured TV percentage was between 80–120% of set TV, it was considered appropriate. Results 42 patients (21 PSV+VG, 21 SIMV+VG) were enrolled. Median GA were 29 weeks and BW were 980,0 and 870,0 gr in each group. Demographic characteristics were similar. ‘Appropriate TV’ was higher in PSV+VG group. PIP, MAP and FiO 2 were similar in two groups. Hypocarbia, hypercarbia, hyperoxemia and hypoxemia incidences were not different. PSV+VG group were less tachycardic than SIMV+VG group. Acute and chronic prematurity problems including chronic lung disease (CLD) defined as oxygen requirement at 36th GA were not different. Conclusion PSV+VG was associated with higher ‘appropriate TV’ without any adverse effects and similar CLD occurence. These findings can support the beneficial use of PSV+VG which is more physiologic due to better inspiratory – expiratory synchrony.