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BACKGROUND This study was conducted to determine the effect of feeding in different positions on the gastric residual volume after feeding in preterm infants who initiated full enteral feeding. METHODS This quasi-experimental study was conducted with the hypothesis that testing the right lateral position leads to less gastric residual than left lateral position and the prone position leads to less gastric residual than the supine position. The data were collected in four stages from 35 preterm infants. Initially, the infants were positioned in supine position and were fed. After feeding, the infant rested in the supine position for 3 h. The stomach content was aspirated, and the volume of gastric residual was measured at the 60th, 120th, and 180th min after feeding. These steps are repeated in order of in the right lateral, left lateral, and prone position. Total gastric residual volume and type of enteral feeding were evaluated. RESULTS There was no significant difference among the positions in terms of the volume of gastric residuals in the measurements made at 60th (P = 9.552), 120th (P = .505), and 180th min (P = .430). When the amount of decrease in the gastric residual volumes was a significant difference between all measurement times in right lateral and prone positions (P < .001). CONCLUSION Although no significant difference was determined between the positions, the smallest residual volumes were determined in the right lateral and prone positions. The amount of decrease in residual volume was significant in right lateral and prone positions.

The Early Feeding Skills Assessment Tool (EFS) is a valid and reliable tool for evaluating preterm infants' oral feeding skills and readiness during the transition to oral feeding. There is currently no instrument with tested validity and reliability available to evaluate the oral feeding skills and readiness of preterm infants in Turkey. The aim of this study was to fill the need for such an instrument for use in the Turkish population by adapting and validating the EFS for the assessment of Turkish preterm infants during the transition to oral feeding.This methodological, cross-sectional study included 107 preterm infants. Validity of the EFS-Turkish was tested with linguistic, content, and construct validity analyses, and its reliability was tested using internal consistency and item analyses.A panel of experts confirmed the content validity of the items in the EFS-Turkish (content validity index = 0.97). Cronbach's alpha for the total instrument was 0.95, supporting its internal consistency reliability. Item-total correlations ranged from 0.58 to 0.83 (P.001). Confirmatory factor analysis confirmed the established EFS structure of 19 items and 5 factors. The tool demonstrated good model fit statistics (χ2/df = 2.24; P.001).The EFS-Turkish is a valid and reliable instrument for use in neonatal intensive care units to evaluate the feeding skills of preterm infants during the transition to oral feeding. The use of the EFS-Turkish is recommended to facilitate the safe and successful development of preterm infants' oral feeding skills and to plan evidence-based initiatives.

BACKGROUND Interpretation of the results of steroid hormone measurements is challenging at early infancy. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method provides a powerful tool for diagnosing steroidogenesis disorders. We aimed to develop normative data for a 14-steroid panel and four adrenal enzyme activity indices, determined by LC-MS/MS from 3 days to 6 months of age. METHODS Age- and sex-specific plasma steroid concentrations were calculated in 324 healthy full-term neonates and infants (151 females). Percentile curves were devised. Steroid ratios were evaluated as biomarkers of adrenal enzyme activities. The steroid profiles of four patients with adrenal enzyme deficiencies were included to test the diagnostic efficiency. RESULTS Nine steroids showed age, but none showed sex specificity. The concentrations of progestins and androgens were higher at 7-14 days than at 3-7 days. After the first month, adrenal androgen concentrations decreased significantly. Adrenal enzyme activities changed towards increasing cortisol over the first 6 months. There were several-fold differences in diagnostic steroids and related adrenal enzyme activity indices between the patients and the healthy group. CONCLUSIONS The majority of adrenal steroids show age-related variations in the neonatal period and early infancy. Our data will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis. IMPACT LC-MS/MS method is capable of quantitating numerous analytes simultaneously, which provides an integrated picture of adrenal steroidogenesis in a small amount of sample. The development of LC-MS/MS-based normative data of steroid hormones in healthy infants is crucial to differentiate physiologic alterations from steroidogenic defects during the first 3-6 months of infancy. Previous studies had limitations due to the small numbers of samples available by sex and by age groups. Our detailed normative data and percentile curves will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis without the need for further invasive testing.

BACKGROUND: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. METHODS: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. RESULTS: Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1-35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1-8.6] vs. 5.8 [0.3-69.2] p = 0.002, 11.9 [10.1-17.2] vs. 15.2 [11.7-18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01-8.6] vs. 4.5 [0.1-69.2] p = 0.01, 11.7 [10.1-13.9] vs. 15.0 [11.7-18.0] p = 0.001, respectively). CONCLUSIONS: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.

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.

Objectives: Preeclampsia is a major cause of maternal, fetal and neonatal morbidity and mortality. The aim of this study was to determine neonatal outcomes of premature infants born to preeclamptic mothers. Patients and Methods: Preterm infants ≤36 gestational age who were born to preeclamptic mothers and normotensive mothers were included in this study. Infant’s data including demographic characteristics, neonatal morbidities and mortalities were evaluated retrospectively. Results: Hundred and forty infants born to preeclamptic mothers (study group) and 144 infants born to normotensive mothers (control group) were included. No statistical difference was found between mean gestational age, birth weight, Apgar scores at 1 and 5 minutes, and in terms of sex ratio. Cesarean delivery, small gestational age and neutropenia rates were found significantly higher in the study group. Other neonatal morbidities such as necrotising enterocolitis and sepsis were also found higher in the study group but it was not statistically significant. Hospitalization and mortality rates were similar in both groups. Conclusions: Preeclampsia was associated with increased cesarean delivery, small gestational age and neutropenia. There were no significant differences between other morbidities and mortality of two groups. We think that prematurity is the main risk factor of morbidity and mortality regardless of concomitant.

Background/aim: We aimed to evaluate wheezing, bronchial asthma (BA), and atopy in premature infants at 2 years of age via a crosssectional study. Materials and methods: Premature infants at

Aim Some inborn errors of metabolism induce metabolic encephalopathy through accumulation of neurotoxic metabolites. Rapid elimination of these metabolites by peritoneal or extracorporeal dialysis is crucial to prevent neuronal damage or death. In this retrospective study, we evaluated the outcomes of nine neonates with metabolic crisis treated with peritoneal dialysis. Method Six neonates with hyperammonemic coma (four with organic acidemias, two with urea cycle disorders) and three with leucine accumulation due to maple syrup urine disease (MSUD) were managed with peritoneal dialysis in conjunction with dietary and pharmacological therapy. Results Three patients with organic acidemia survived. One of the patients was normal; others had moderate and severe neurological impairments. One neonate with organic acidemia and both neonates with urea cycle disorders died. Two of the three patients with MSUD survived without neurological impairment; the other had severe neurological damage and died at 9 months of age due to sepsis. Conclusion Theoretically, extracorporeal dialysis should be the first dialysis treatment of choice; however, this report demonstrates that peritoneal dialysis has a chance to prevent neurological damage in some patients. Therefore, in developing countries without extracorporeal dialysis opportunities, it can be still a life-saving procedure, if it is applied with skilled staff and standard procedures.

Teratomas, derived from pluripotent cells, are the most common neonatal tumors and are mainly located in the sacrococcygeal region or mediastinum [3]. They commonly present as large and deforming monstrous tumors with an incidence of 1 in 20,000 to 40,000 newborns. The lesion is usually life threatening due to airway obstruction, and their aetiology is uncertain. The head and neck localization comprises 2% to 9% of all teratomas. Most are very large and complex lesions containing solid and cystic areas. These lesions contain all three germ layers and may be composed of mature or immature elements. In the neonate, the presence of immature elements does not correlate with malignant potential, and most of these teratomas are benign [1, 3, 6, 12, 13]. We present a newborn with a giant head and neck mass visualised postnatally by cranial magnetic resonance imaging (MRI). The histopathological diagnosis made on the basis of excisional biopsy was mature teratoma. Total surgical resection was not possible due to massive invasion of airways and central nervous system (CNS) by the tumor. The clinical and radiological characteristics, as well as mortality, in this case of a teratoma are discussed.

Inadequate transfer of breast milk may cause hypernatremic dehydration in neonates and is a potentially devastating condition. This study aimed to assess the frequency risk factors complaints and complications of hypernatremia among hospitalized breastfed neonates at a neonatal tertiary care center in the Northeast of Turkey. Neonatal hypernatremia is a frequent reason for hospitalization in the newborn unit at the Turkish hospital. However as birth rates are excessive in this region it is compulsory to discharge babies without 24 hours of hospital care after birth. For this reason the pressing issue is the education of mothers on signs of successful breastfeeding.

Some inborn errors of metabolism induce metabolic encephalopathy through accumulation of neurotoxic metabolites. Rapid elimination of these metabolites by peritoneal or extracorporeal dialysis is crucial to prevent neuronal damage or death. In this retrospective study, we evaluated the outcomes of nine neonates with metabolic crisis treated with peritoneal dialysis.Six neonates with hyperammonemic coma (four with organic acidemias, two with urea cycle disorders) and three with leucine accumulation due to maple syrup urine disease (MSUD) were managed with peritoneal dialysis in conjunction with dietary and pharmacological therapy.Three patients with organic acidemia survived. One of the patients was normal; others had moderate and severe neurological impairments. One neonate with organic acidemia and both neonates with urea cycle disorders died. Two of the three patients with MSUD survived without neurological impairment; the other had severe neurological damage and died at 9 months of age due to sepsis.Theoretically, extracorporeal dialysis should be the first dialysis treatment of choice; however, this report demonstrates that peritoneal dialysis has a chance to prevent neurological damage in some patients. Therefore, in developing countries without extracorporeal dialysis opportunities, it can be still a life-saving procedure, if it is applied with skilled staff and standard procedures.

The objective of this study was to assess low-risk very low birth weight (VLBW) children, before the era of modern neonatal intensive care in Turkey, during adolescence. Forty-one VLBW adolescents were compared with 40 adolescents who had normal birth weight. The physical and neuromotor development, educational achievement and psychosocial status were assessed at a mean age of 17 +/- 1.6 years. VLBW adolescents were shorter than normal birth weight adolescents (p = 0.01). A major neurological abnormality (cerebral palsy) was seen in 12% and a minor neurological abnormality (tremor, coordination, behavioral and speech disorders) in 17%. VLBW adolescents had higher rates of visual problems (56% vs. 5%). School failure was present in 27%. There were no differences in behavioral problems or quality of life between the two groups, but VLBW adolescents did have a lower self-esteem score. Neurodevelopment and growth sequelae were a significant problem in VLBW adolescents. As early intervention might help to prevent or ameliorate potential problems, long-term follow-up is essential.

To investigate etiology, outcome and complications related to neonatal peritoneal dialysis (PD).Neonates treated with PD in our neonatal intensive care unit during 2007-2010 were analyzed retrospectively.Among 4036 hospitalized neonates; 20 neonates (0.5%) who underwent 21 cycles of PD [7 preterm, 13 term; 13 female, 7 male] were included. The mean birth weight was 2930.2 ± 720.6 g (1120-4570), mean gestational age was 37.5 ± 3.5 weeks (27-41). The etiologic disorders included inborn errors of metabolism (propionic acidemia, methylmalonic acidemia, citrullinemia, glutaric aciduria type 2, maple syrup urine disease, 10), or acute renal failure secondary to perinatal asphyxia (4), sepsis (2), prematurity (2), hypoplastic left heart syndrome (1), kernicterus (1). The complications included peritonitis (2), early leakage (4), hemorrhage (1), catheter removal (3) and occlusion (2). The mortality rate was 50%. The gestational ages and birth weights of surviving neonates were higher (p0.05). Among surviving neonates, chronic renal failure (1), severe (4) and moderate neuromotor impairment (2) developed within 4-43 months.PD, although invasive, is an effective therapy in neonates. The complexity and invasiveness of the procedure is probably responsible for high rate of complications and mortality. If appropriate catheter selection and technique in the placement should be done, PD might improve outcome.

Objective To investigate umbilical venous catheter (UVC) related thrombosis by Doppler echocardiographic evaluation of neonates infused with heparin or placebo. Methods We conducted a prospective study to determine UVC-related thrombosis in term and nearterm neonates. Heparin or placebo (0.5 IU/mL) was infused at a rate of 1 mL/hr to the study and control group. Doppler echocardiography was performed at 1, 3, and 5 days after UVC insertion. Results Forty-six neonates (63% males) with a mean gestational age of 38.2 ± 1.8 weeks, and a mean birth-weight of 2993 ± 563 grams were included. No UVC-related thrombosis was observed in the study group, which included 19 neonates. Among the 27 neonates in the control group, one neonate developed UVC-related thrombosis. There were no statistical differences between the groups for gestational age, birth weight, postnatal age, UVC duration, mortality, mechanical ventilation, and inotrope requirement, and hemagram or coagulation profile. The complications were as follows, mild pulmonary hemorrhage, 6.5% (3); leak-out, 4.3% (2); peritoneal leakage, 2.2% (1); occlusion, 2.2% (1); gastrointestinal findings, 6.5% (3); sepsis, 10.9% (5); and catheter-related thrombosis, 2.2% (1). Conclusion This study demonstrated that heparin infusion of 0.5 IU/mL through the UVC had no effect on catheter-related thrombosis in term and near-term neonates. Randomized controlled trials are necessary to conclusively evaluate the effect of heparin on UVC-related thrombosis.

Amaç: Wolff –Parkinson- White (WPW) elektrokardiyografik paterni saptanan çocuk hastaların demografik özellikleri, başvuru yakınmaları, elektrokardiyografik ve ekokardiyografik özellikleri ve tedavi yöntemleri değerlendirilmiştir. Materyal ve Yöntem: Bu çalışma tek bir merkezde ve üçüncü basamak araştırma hastanesinde 2009-2011 yılları arasında retrospektif olarak yapılmıştır. Yüzeyel EKG’ de WPW paterni saptanan 21 çocuk olgu (1 gün-15 yaş) çalışmaya dahil edildi. Hastalar asemptomatik veya Semptomatik olmak üzere iki gruba ayrıldı. Bulgular: Olguların çoğu (13 olgu, ortalama yaş: 6.0 yıl) tanı anında ve çalışma süresince asemptomatikti. Disritmi ile ilişkili semptomlar 8 olguda (ortalama yaş: 9.1 yıl) belirlendi. Gruplar arasında cinsiyet bakımından fark saptanmadı. Başvuru semptomları: dört olguda çarpıntı ve bir olguda senkop idi. Üç olgu Supraventriküler taşikardi atağı ile başvurdu ve SVT’li olguların tümünde intermittent tipte WPW paterni ve erkek cinsiyet predominansı saptandı. Ekokardiyografi ile yedi olguda mitral kapak prolapsusu, üç olguda hipertrofik kardiyomiyopati, bir olguda aort yetersizliği ve bir olguda Ebstein anomalisi saptandı. SVT ataklarında Amiodoron veya Adenozin ile başarılı tedavi sağlandı. Çalışma süresince olguların hiçbirisinde ani ölüm gözlenmedi. Sonuç: WPW elektrokardiyografik paterni tanısı alan çocuklara uygun tedavi uygulanmalıdır., Aims: To evaluate the children with electrocardiographic pattern of Wolff-Parkinson-White (WPW) and review their demographic features, presenting symptoms, electrocardiographic, echocardiographic findings, and management. Methods: The study was conducted in a single tertiary research hospital from 2009 to 2011, retrospectively. Twentyone children (1 day to 15 years) with a WPW pattern on surface ECG were included in this study. We classified patients into two groups as “Asymptomatic” and “Symptomatic Group”. Results: Most children were asymptomatic (13 cases, mean age: 6.0 years) at the diagnosis and during the study period. Symptoms related to dysrhtyhmia were recognized in 8 cases (mean age: 9.1 years) and most common in school age children. There were no gender predominance between two groups. The symptoms were palpitations in 4 cases and syncope in one case. Three cases presented with attack of supraventricular tachycardia (SVT). They also had intermittent nature of WPW and male predominance. Echocardiography revealed mitral valve prolapsus in 7, hypertrophic cardiomyopathy in 3, aortic regurgitation in 1 and Ebstein abnormality in 1 case. SVT were successfully treated with Amiodoron or Adenosine. No patient died suddenly during the study period.Conclusion: Children with electrocardiographic pattern of WPW should be recognized and managed properly

Objective. Infants with respiratory failure may require prolonged intubation. There is no consensus on the time of tracheotomy in neonates. Methods. We evaluated infants applied tracheotomy, time of procedure, and early complications in our neonatal intensive care unit (NICU) retrospectively from January 2012 to December 2013. Results. We identified 9 infants applied tracheotomy with gestational ages 34 to 41 weeks. Their diagnoses were hypotonic infant, subglottic stenosis, laryngeal cleft, neck mass, and chronic lung disease. Age on tracheotomy ranged from 4 to 10 weeks. Early complication ratio was 33.3% with minimal bleeding (1), air leak (1), and canal revision requirement (1). We discharged 7 infants, and 2 infants died in the NICU. Conclusion. Tracheotomy makes infant nursing easy for staff and families even at home. If carried out by a trained team, the procedure is safe and has low complication. When to apply tracheotomy should be individualized, and airway damage due to prolonged intubation versus risks of tracheotomy should be taken into consideration.