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Objective: Hypoxic-ischemic encephalopathy (HIE) is an acute and progressive encephalopathy resulting from perinatal asphyxia. Approximately 15% infants with neonatal HIE die, whereas 25% exhibit subsequent neurological disabilities. In this study, it was intended to compare effects of total body cooling treatment administered for hypoxic-ischemic encephalopathy on neurological and developmental findings obtained at 18-36 months. Material and Methods: Patients who have been hospitalized between 2013 and 2014 in Neonatal Intensive Care Unit with a diagnosis of hypoxic-ischemic encephalopathy and treated total body cooling were included. After discharge, neurological examinations of the patients were evaluated by developmental assessments with “Bayley Scales of Infant Development II” at 18-36 months. Results: Mean MDI score of 17 patients was 90.2±16.3, and mean PDI score was 93.8±17.3. MDI scores were < 70 in 11.8% (n = 2) of all cases, and PDI scores were < 70 in 5.9% (n=1) of all cases. In 5.9% (n=1) of all cases, deafness and cerebral palsy were detected. Developmental disorder were found in 17.6% (n=3) of all cases. Conclusion: The therapeutic hypothermia in newborns decreased mortality in moderate and severe HIE and improved neurodevelopmental outcomes at 18th month. In our study, early neurological and developmental problem rates after therapeutic hypothermia were found similar with the literature. However, long period follow-up is necessary to determine minor disorders in these patients.

Neonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes presenting within the first 6 months of life. INS gene promoter mutations have been shown to cause both remitting/relapsing and permanent NDM. We, herein, present three interesting patients with INS gene promoter mutations. Two cousins with an identical homozygous c.-331C > G mutation presented with NDM. The first cousin had nonremitting diabetes and still requires multidose insulin injections at the current age of 6.1 years. However, the other cousin's diabetes remitted at the age of 9 months, and she is still in remission at the age of 3 years with no medication or dietary intervention required (latest HbA1c was 4.9%). The third patient had NDM also due to a homozygous INS promoter c.-331C>A mutation. Her diabetes remitted at the age of 2 months and relapsed at the age of 2.6 years with severe diabetic ketoacidosis (DKA). Distinct clinical phenotype and relapse with severe DKA in one of the three cases suggest that INS promotor mutations can cause a heterogeneous phenotype and even cases exhibiting remission can relapse unpredictably. Therefore, as the age of relapse is unpredictable, close follow-up and family education on diabetes symptoms are essential for cases with remitting/relapsing diabetes due to INS gene mutations.

Aim:Neonatal bilirubin-induced neurologic dysfunction can present with a wide spectrum of symptoms from mild neurologic impairment to severe acute bilirubin encephalopathy. In this study, we aimed to determine the risk factors of unconjugated hyperbilirubinemia among hospitalized infants with serum total bilirubin levels ≥25 mg/dL and evaluate the effects of high serum bilirubin levels due to hemolysis on neurodevelopmental outcome at postnatal between 18 and 24 months.Materials and Methods:Thirty-six term infants were enrolled in the study. The patients were divided into two groups according to their condition of either hemolytic or nonhemolytic hyperbilirubinemia. Neurodevelopmental assessment with The Bayley scale of Infant Development-II at postnatal between 18 and 24 months was performed on all infants.Results:Fourteen infants (38.9%) were in the nonhemolytic group, while 22 (61.1%) were in the hemolytic group and there was no statistically significant difference between the groups in terms of the measured mean Mental Developmental index and Psychomotor Developmental index scores. All 4 patients who underwent exchange transfusion had subgroup incompatibility and their Psychomotor Developmental index scores were significantly lower (p

Background: Invasive procedures are increasingly used in neonatal intensive careunits. Umbilical catheters are frequently attached to preterm babies. The aimof this study is to determine the relationship and risk factors of umbilicalcatheters inserted in our clinic with portal vein thrombosis (PVT).Materials and Methods: We retrospectively evaluated preterm infantswith a gestational age of 32 weeks and below, who had a umbilical vein catheter(UVC) inserted in our neonatal intensive care unit between 01 October 2017 and31 December 2018, and who had a catheter inserted for at least 6 hours. UVCinserted cases were evaluated for portal venous doppler ultrasonograpy (USG)examination before discharge. Perinatal risk factors and properties related tocatheter were evaluated.Results:A total of 142 patients underwent UVC insertion. Doppler USG results of 118patients were achieved. In 15 (9.9%) cases, portal vein thrombosis was detectedby doppler USG. None of the patients with PVT had clinical findings. The meangestational age and birth weight were lower in patients with PVT. Thrombosiswas detected in the left branch of portal vein in 14 patients and thrombosis inthe main portal vein in one patient. In a patient with PVT, gestationaldiabetes was present in the mother. Patients with PVT had higher rates of lateneonatal sepsis and bronchopulmonary dysplasia, and the length ofhospitalization was longer. In this group, the low placement rate of thecatheter was higher, and the length of catheter stay was longer than othergroup.Conclusions: Umbilical vein catheterization is an important risk factor for thedevelopment of PVT. Especially low birth weight infants with UVC should beevaluated with portal doppler USG for PVT., Amaç: Yenidoğan yoğun bakım ünitelerinde giderek artan sıklıkta invazivgirişimler yapılmaktadır. Özellikle preterm bebeklere sıklıkla umblikal kateterlertakılmaktadır. Bu çalışmanın amacı kliniğimizde takılan umblikalkateterlerinportal ventrombozu (PVT) ile ilişkisini ve risk faktörlerinibelirleyebilmektir.Materyal vemetod: Retrospektif olarak 01Ekim 2017-31 Aralık 2018 tarihleri arasında kliniğimiz yenidoğan yoğun bakımünitesinde izlenen gestasyon yaşı 32 hafta ve altında olan, umblikal katetertakılan ve en az 6 saat boyunca kateter takılı olan preterm bebekler çalışmayadahil edildi. Umblikal ven kateteri (UVK) takılan hastaların taburculuk öncesiPVT açısından yapılan portal venöz doppler ultrasonografi (USG) sonuçları ileperinatal risk faktörleri ve kateter ile ilgili özellikler değerlendirildi.Bulgular: 142 hastaya UVK takıldı. 118 hastanın doppler USG sonucuna ulaşıldı. Onbeş (%9,9) hastada doppler USG ile PVT saptandı. PVT saptanan hastalarınhiçbirinde klinik bulgu yoktu. PVT saptanan hastaların ortalama gestasyon yaşıve doğum ağırlığı, PVT saptanmayan hastalardan daha düşüktü. On dört hastadaportal venin sol dalında tromboz saptanırken, bir hastada ana portal vende trombozsaptandı.Tromboz saptanan bir hastada annede gestasyonel diyabet mevcuttu. PVTsaptanan hastaların geç neonatal sepsis ve bronkopulmoner displazi oranlarıdaha yüksekti, hastanede yatış süresi daha uzundu. Yine bu grupta kateterinalçak yerleşim oranı daha fazla, kateter kalış süresi ise diğer gruba göre dahauzundu.Sonuç: Umblikal ven kateterizasyonu PVT gelişimi için önemli bir riskfaktörüdür. UVK takılan, özellikle düşük doğum ağırlıklı hastalar PVT açısındanportal doppler USG ile değerlendirilmelidir.

Objective: To determine the emotional, behavioral, and developmental problems and quality of life of children born as Term Small for Gestational Age (SGA) in the preschool period, and to compare them with children born as term appropiate for gestational age (AGA).Method: This study conducted as a prospective case control study. Term SGA babies who were followed up in the Neonatal Intensive Care Unit were taken in the study group, while babies born with term AGA were taken in the control group. All participants’ parents filled the Sociodemographic form, Child Behavior Checklist (CBCL) and Pediatric Quality of Life Scale (PedsQL) and were asked questions to complete the ADSI by expert psychologists.Results: 20 SGA (63 months ± 7 months) born term and 20 AGA (59 months ± 8 months) born term children were taken in the study group. There was no significant difference between the groups in terms of gestational age, gender, and age at the outpatient clinic. Social problems were significantly higher in the SGA group (p = 0.014). The school functionality score (SchFS) was found to be significantly lower in the SGA group (p

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth.Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2).Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of

BACKGROUND Many interventions have been designed to increase breast milk (BM) consumption among preterm and critical-term infants in neonatal units. The aim of this study was to determine the trends in the usage of BM in a neonatal unit and the risk factors for insufficient breast-milk feeding at discharge. METHODS This retrospective study included newborn infants who hospitalized in the neonatal unit during two periods in different years, a 15-month period in 2012-2013 and in 2017-2018. The primary outcomes were the availability of BM within 24 h after delivery and the status of infant feeding at discharge. RESULTS During two periods of the study, a total of 3,018 infants were included in the study. The rate of BM expression within the first 24 h after delivery was 92.9%, and it was found that the first period of the study, caesarean section delivery, very low birth weight, being first-time mother, and young maternal age were each independently associated with the delayed initiation of BM expression (P < 0.05). At discharge, 87.6% of the infants had been feeding with BM. Multiple births, the delayed initiation of BM expression, and the length of hospital stay were associated with inadequate BM feeding at discharge (P < 0.001). CONCLUSION This study showed that interventions supporting BM feeding, which have recently been carried out, made improvements to the initiation of BM expression among mothers whose babies were admitted to the neonatal unit, and in the rate of BM feeding among infants at discharge.

Fanconi Bickel Syndrome (FBS), also known as glycogen storage disease Type XI, is a rare autosomal recessive disorder. This syndrome has many different identified mutations and it is rarely diagnosed during the neonatal period. Our patient is a two-week old female newborn who was admitted to our hospital with fever and dehydration. Renal Fanconi Syndrome was diagnosed in the presence of polyuria, proteinuria, glycosuria, hyperchloremic metabolic acidosis with normal anion gap and positive urine anion gap, hyperuricemia, hypophosphatemia and an increased excretion of phosphorus in urine. A novel mutation, IVS8 homozygote g.24401-24406del6 in the GLUT2 gene was demonstrated by the Sanger method. The same mutation was detected as heterozygote in her parents. Although most of the affected infants have a consanguineous parentage history in the literature, our patient was born to non-consanguineous parents. Also, according to our knowledge, few FBS patients were diagnosed in the newborn period. Our patient was diagnosed with a novel mutation in her first month of life.

Hemolysis and jaundice related to Rh incompatibility in the neonatal period has decreased substantially due to the widespread use of anti-D gammaglobulin in recent years. Nevertheless, the rate of subgroup mismatch in the etiology of hemolytic diseases of the newborn has increased significantly. In this article an 8-day-old newborn infant with “c” subgroup incompatibility and presenting with severe anemia, in whom hemolysis could be controlled with intravenous immunoglobulin infusion and subgroup appropriate blood transfusion, has been presented. Scientific studies have demonstrated that the hemolytic disease of patients who don’t have major blood group incompatibility but carry anti-C antibodies can be rather serious. Therefore, subgroup mismatch should always be kept in mind for newborns presenting with severe hemolytic anemia, and transfusion or if necessary exchange transfusion should be provided with subgroup matched blood products.

WOS: 000410700000010, Urea cycle disorders are a group of diseases associated with hyperammonemia, which causes severe neurological sequelae, seizures and psychomotor retardation. In this study, six newborn cases diagnosed between 2010-2014 as citrullinemia Type I (four cases) and argininosuccinic aciduria (two cases) are presented in terms of clinical course and treatment responses.

Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p < 0,01), radiografías de tórax anormales (p < 0,01), requerimiento de atención en terapia intensiva (p < 0,01) y más días de oxigenoterapia (p < 0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p < 0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p < 0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal. Aim: To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others. Methods: The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others. Results: Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p< 0.01), abnormal chest radiography (p< 0.01), need for intensive care (p< 0.01), and duration of oxygen requirement (p< 0.01) but less fever on admission and duration of antibiotic use (for both, p< 0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p< 0.01). Conclusion: This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.

Aim: Preterm infants are often significantly underweight at the time of hospital discharge. Growth impairment during early infancy can have permanent detrimental effects. We aimed to evaluate the incidence and risk factors of postnatal growth restriction (PNGR) in preterm infants.Methods: This prospective study included 124 preterm infants in neonatal intensive care unit between January 2015 and June 2016.Results: Of 140 preterm infants screened, postnatal growth retardation was detected in 46 babies (37%). Low gestational age was independent risk factors for PNGR.Conclusion: Clinicians should be aware of the presence of this morbidity when caring for preterm infants and to provide optimal enteral nutrition.

Cutis marmorata telangiectatica congenita is a rare, benign, sporadic and cutaneous vascular disease. A newborn female baby whose mother was aged 29 years and used propylthiouracil during pregnancy was hospitalized because of varicose lesions on the skin of the lower extremity and on the back, which were present at birth. It was observed that the lesions did not disappear, although appropriate room temperature was provided. The patient was diagnosed as having cutis marmorata telangiectatica congenita and screened for additional anomalies. She had no additional anomalies, and she was discharged and monitored. At the postnatal sixth month, the cutaneous vascular lesions disappeared spontaneously. Cutis marmorata telangiectatica congenita, which is a rare condition, should be kept in mind in the differential diagnosis of physiologic cutis marmoratus, which occurs frequently in the neonatal period.

Elizabethkingia meningoseptica is a widespread gram-negative bacillus in the environment, but a rarely reported human pathogen presenting mostly as nosocomial infections. Advances in neonatal intensive care facilities and usage of sophisticated medical devices strengthen the invasive infectious potential of the microorganism. Clinical manifestations usually include primary bacteremia, meningitis, nosocomial pneumoniae, intravascular catheter-related bacteremia and gastrointestinal and biliary tract infections. Lack of improved diagnostic systems in resource constrained settings, might be a cause of underreporting of such infections. Discrimination between colonization and infection is quite difficult, and it has an unusual antibiotic susceptibility pattern. Therefore clinicians should pay special attention to accurate diagnosis in order to prevent mistreatment. Here we report three newborn cases with the diagnosis of E. meningoseptica infection and colopnization, with the aim of drawing attention to the diagnosis and management of this rare but lethal bacteria that is already present in the intensive care unit environment.Elizabethkingia meningoseptica es un bacilo gramnegativo ampliamente distribuido en la naturaleza pero poco frecuente en humanos que se presenta en infecciones intrahospitalarias. Los avances en las instalaciones de cuidados intensivos neonatales y el uso de dispositivos médicos sofisticados fortalecen la capacidad infecciosa invasiva del microorganismo. Las manifestaciones clínicas suelen incluir bacteriemia primaria, meningitis, neumonía intrahospitalaria, bacteriemia relacionada con el uso de catéteres intravasculares e infecciones gastrointestinales y de las vías biliares. Es posible que, en entornos con recursos limitados, la falta de sistemas de diagnóstico mejorados sea una de las causas por las que no se notifican todas esas infecciones. Resulta bastante difícil distinguir entre colonización e infección, y el patrón de sensibilidad a los antibióticos es diferente. Por consiguiente, los médicos deben realizar el diagnóstico preciso para así evitar el tratamiento incorrecto. En este artículo, describimos tres casos de recién nacidos con diagnóstico de infección y colonización por E. meningoseptica con el objetivo de destacar la importancia del diagnóstico y el tratamiento oportunos de esta bacteria poco frecuente pero letal que ya está presente en las unidades de cuidados intensivos.

To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others.The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others.Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p0.01), abnormal chest radiography (p0.01), need for intensive care (p0.01), and duration of oxygen requirement (p0.01) but less fever on admission and duration of antibiotic use (for both, p0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p0.01).This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p0,01), radiografías de tórax anormales (p0,01), requerimiento de atención en terapia intensiva (p0,01) y más días de oxigenoterapia (p0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal.

Serum bilirubin levels beyond the physiological limits, may lead to alterations in autonomic regulation in a newborn infant. Heart rate variability (HRV), is a noninvasive and quantitative marker of the activity of the autonomic nervous system (ANS). To date, few studies have demonstrated the undesirable effects of severe unconjugated hyperbilirubinemia (UHB) on autonomic functions, and only one study has used HRV as a marker of the autonomic activity. However, the relationship between altered cardiac autonomic functions and UHB by using the HRV derived from 24-hour Holter electrocardiography (ECG) recording has not been investigated previously.We aimed to assess whether a relationship exists between severe UHB and cardiac autonomic dysfunction by evaluating HRV via 24-hour Holter ECG recording.This single-center, prospective, case-control study was conducted on 50 full-term newborn infants with severe UHB requiring phototherapy and 50 healthy infants as controls. HRV assessment was performed by using 24-hour Holter ECG recording.There was no significant difference in terms of mean average heart rate, mean maximum heart rate and mean RR duration between the groups. However, mean minimum heart rate was significantly lower in the study group. When 24-hour time and frequency domain parameters were compared, time and frequency domain parameters rMSDD as well as high frequency (HF), which represent parasymphathetic activity, were significantly higher in the study group. Furthermore, low frequency to high frequency (LF/HF) ratio, that serves as an indicator of sympathovagal balance, was significantly lower in the study group.Severe UHB may cause cardiac autonomic dysfunction in favor of parasympathetic predominance in jaundiced neonates.