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Purpose: We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings of the patients before and after closure., Methods: The study groups (107 preterm neonates under 34 gestational weeks) were classified as hemodynamically significant PDA (group 1), hemodynamically insignificant PDA with closure therapy (group 2), hemodynamically insignificant PDA without closure therapy (group 3), and no PDA group (group 4) based on the echocardiography. 6- and 10-region LUS scores were compared for each group., Results: There was a significant difference between groups 1 and 3 on first, third, and seventh days. In contrast, groups 1 and 2 had similar LUS scores on the first, third, and seventh days. There was a negative correlation between LUS scores on the first and third days and gestational age, birth weight, the first- and fifth-minute APGAR scores, and there was a positive correlation between aortic root to left atrium ratio, and PDA diameter/weight ratio., Conclusion: We observed that LUS scores in patients with hemodynamically insignificant PDA treated with closure therapy were similar to in patients with hemodynamically significant PDA. Thus, LUS score can have role in PDA closure in preterm neonates. However, more comprehensive studies are needed., (© 2024 Wiley Periodicals LLC.)

Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaraş earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment., Conclusions: Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT., What Is Known: •Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately., What Is New: •CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Vitamin B12, folate, and other micronutrients are essential for healthy growth. We hypothesized that there is a high prevalence of vitamin B12 deficiency in mothers and their newborns, and that blood serum vitamin B12 and folate levels may affect anthropometric measurements at birth. A total of 204 newborn babies and their 196 mothers were included. Blood samples of newborns and mothers were obtained for vitamin B12 (<200 pg/mL) and folate (<3 ng/mL) deficiencies. Additionally, iron and ferritin levels were measured. The mean gestational age and birth weight were 37.2 ± 2.6 (22.3-41) weeks and 3045 ± 770 (505-4525) g, respectively. All micronutrient levels in cord blood were higher than maternal levels (P = .001). A total of 96.3% of mothers and 64.5% of babies had vitamin B12 deficiency; 4% of mothers and none of the infants had folate deficiency. In total, 38.2% of mothers and 10.6% of infants had ferritin deficiency and 38.7% of mothers and 41.4% of newborns had iron deficiency. There was a negative correlation between cord vitamin B12 level and birth weight and head circumference (r = -0.21, P = .004 and r = -0.16, P = .036, respectively), whereas no correlation was found between maternal micronutrient status and anthropometric measurements of newborns. In conclusion, anthropometric measurements were unaffected by maternal levels, but vitamin B12 deficiency is very common in pregnant women and newborn babies. Mothers and their infants may benefit from early diagnosis and treatment. Awareness of vitamin B12 deficiency in pregnant women and newborns should be increased in Turkey., Competing Interests: Conflict of interest None declared., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: Intravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion., Materials and Methods: This study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2-3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared., Results: During the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups ( p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group ( p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group ( p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group ( p < 0.001 and p = 0.01, respectively)., Conclusion: In this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Okulu, Erdeve, Kilic, Olukman, Calkavur, Buyukkale, Cetinkaya, Ulubas, Demirel, Hanta, Ertugrul, Gultekin, Tuncer, Demir, Bilgin, Narli, Yildiz, Terek, Koroglu, Seren, Ozyazici, Ozdemir, Turgut, Narter, Akin, Ozyazici, Zenciroglu, Asker, Gokmen, Salihli, Bulbul, Zubarioglu, Atasay, Koc and Turkish Neonatal Society IVIG Study Group.)

Background: Very low birth weight (VLBW) infants often demonstrate postnatal growth failure (PGF). We aimed to analyze incidence and risk factors for PGF in surviving VLBW infants hospitalized more than 28 days., Materials and Methods: Fenton growth chart (2013) was used for Z-scores for birth weight (BW) and discharge weight. Infants with a decrease in their Z-scores at discharge >1 were considered as 'PGF group' and with a decrease >2 were considered as 'severe PGF group'., Results: One hundred and forty-one of 148 (95.3%) infants had PGF, 88 of 141 (62.4%) had severe PGF. There were significant differences in gestational age, birth and discharge weight, and days to regain BW, age of first and full enteral feeding, duration of parenteral nutrition, lipid emulsions, intubation and hospitalization between groups (p < 0.05). Vasopressor treatment, nosocomial infection, patent ductus arteriosus and bronchopulmonary dysplasia rates were significantly higher in severe PGF group (p < 0.05)., Conclusion: PGF remains a serious problem in our unit. All VLBW preterm infants should be followed for PGF., (© The Author(s) [2019]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The rational presentation form of perinatal care in developed countries is evaluated within the regionalization program. Neonatal transport is the main step for the regionalization of perinatal care. It is a very important factor for reducing neonatal mortality and morbidity, especially in developing countries. Neonatal transport is a system integrity that includes more than one essential matter. Neonatal transport requires special hardware and serious organization because it can be a caused of mortality and morbidity in its own right. This guideline deals with the transport of newborn infants (definitions, personnel, technical equipment, stabilization conditions, special medical conditions, communication), and the current situation in our country and standard approaches. It should not be forgotten that changes in public space will also change the approach and that every baby should be evaluated within himself or special conditions., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Aim: To evaluate the role of electronic faucets in a newborn intensive care unit during a Pseudomonas aeruginosa outbreak., Methods: After three patients had P. aeruginosa bacteremia, environmental cultures including those from patient rooms, incubator, ventilators, total parenteral nutrition solutions, disinfection solutions, electronic and hand-operated faucet filters/water samples after removing filters and staff hands were taken., Results: Only filters of electronic faucets and water samples after removing filters and one liquid hand soap showed P. aeruginosa (3-7 × 106 cfu/mL). We have removed the electronic faucets and new elbow-operated faucets were installed. Pulsed-field gel electrophoresis analysis of outbreak-blood culture isolates from two patients and isolates from electronic water faucets/one liquid hand soap indicated the presence of 90.7% genetically related subtype, probably from the same clone. Water cultures from new faucets were all clean after installation and after 7 months., Conclusion: We suggest that electronic faucets may be considered a potential risk for P. aeruginosa in hospitals, especially in high-risk units., (© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

In this study, we have prospectively recorded healthcare-associated infections (HAIs) in NICU and found incidence density as 18 infections per 1000 patient days. Of the infections, 51.3% was bacteriemia (BSI), and 45.1% was ventilator-associated pneumonia (VAP). Gram-negative microorganisms were predominant in VAP and Staphylococcus epidermidis was the leading microorganism (53.0% of BSIs) in BSIs. Multivariate logistic regression analysis showed the importance of hood O(2) use in days (RR: 1.3) and total parenteral nutrition use in days (RR: 1.09) for BSIs. Umbilical arterial catheterization in days (RR: 1.94), ventilator use in days (RR: 1.05), chest tube (RR: 12.55), orogastric feeding (RR: 3.32) and total parenteral nutrition in days (RR: 1.05) were found to be significantly associated with VAP. In conclusion, incidence density in our unit is high and Gram-negative rods are predominant similar to developing countries. These results strongly suggest improving measures of prevention and control of HAIs in the unit.

Aim: To report the incidence of healthcare-associated infections (HAIs), site of infection and bacterial epidemiology in the Neonatal Intensive Care Unit in a university hospital in Adana, Turkey, between 2001 and 2006., Methods: During these years, HAIs were collected by an active surveillance system., Results: Five hundred one of 2832 infants hospitalised more than 72 h had 1124 HAI. The HAI incidence and incidence density ranged between 14.1 and 29.7 infections/100 patients, and 10.9-17.3 infections/1000 patient days within the study period; 61.5% of HAIs were ventilator-associated infections; 26.2% were bloodstream infections; 3.5% were urinary tract infections; 3.5% were necrotising enterocolitis (Stages II and III) and 1.4% was meningitis. The most frequent pathogens were gram-negative pathogens (75.6% of all infections) followed by gram-positive micro-organisms (21.4%) and Candida species (3.0%). Birthweight, gestational age and Apgar scores were lower and overall mortality rate (32.9% vs. 19.7%) and number of inpatient days were higher in patients with HAIs (for all P<0.001) when compared with those who did not have HAIs. Furthermore, HAI rate was inversely related to birthweight (P<0.001)., Conclusion: In this study, the overall infection rate is high compared with developed countries and predominant micro-organisms are gram-negative enteric rods. These results strongly suggest the need for improving measures for prevention and control of HAIs in this hospital.

Classical neonatal diabetes mellitus is defined as hyperglycemia that occurs within the first month of life in term infants. It can be either permanent or transient. Cerebellar agenesis and permanent neonatal diabetes has been previously reported as a new autosomal recessive disorder. Pancreas Transcription Factor 1 Alpha (PTF1A) mutations have been related with this constellation of abnormalities. Here we report a new case of cerebellar agenesis and neonatal diabetes mellitus whose parents are PTF1A mutation carriers.

Homozygous protein C deficiency affects approximately 1/400,000 to 1/1,000,000 live births. Homozygous protein C deficiency is associated with catastrophic and fatal purpura fulminans-like or thrombotic complications and disseminated intravascular coagulation. In the present patient, genetic study revealed Arg178Trp, a mutation found widely in European population; but this is the first case of homozygous Arg178Trp mutation who suffered from catastrophic purpura fulminans phenotype.

Cardiac tumors are uncommon in neonates and most of them are histologically benign. The most common cardiac tumor in neonates and infants is rhabdomyoma. Malignant cardiac tumors are considerably rarer, and rhabdomyosarcoma (RMS) is the leading malignancy. To our knowledge, only one case of intrapericardial RMS was reported in the literature, in a seven-month-old baby. Here we present another newborn baby with intrapericardial RMS.

The purpose of this study was to determine cord blood cytokine levels and their relationship with morbidity and mortality in neonates with prolonged, premature rupture of membranes (PPROM). Forty two premature neonates of 29-35 weeks gestational age with PPROM exceeding 24 hours were considered as the PPROM group and simultaneously, 41 premature neonates without PPROM were considered as the control group. All the neonates were admitted to the Neonatology Unit for further evaluation of subsequent complications such as early neonatal sepsis, pneumonia, intraventicular haemorrhage (IVH), respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC) and chronic lung disease (CLD). Cord blood and mothers' blood samples were obtained during delivery in both groups and tested for IL-6, IL-8 and TNF-alpha levels. Twenty one percent of patients with PPROM had histological chorioamnionitis. The risk for developing early neonatal sepsis increased significantly in neonates whose mothers had histological chorioamnionitis (p < 0.05). There was a statistically significant relationship between PPROM and risk of developing NEC (p < 0.05); no significant increase was seen as regards early neonatal sepsis, IVH, RDS, pneumonia, or BPD. The mean IL-8 levels in cord blood and mothers' serum were significantly higher in the PPROM group (p < 0.001, p< 0.005). In addition, IL-6 levels found in mothers' serum were significantly higher than those found in the control group (p < 0.01). However, levels in cord blood were similar (p > 0.05). TNF-alpha levels were similar in both groups (p > 0.05). Neonates who developed NEC had higher IL-8 levels in their cord blood when compared to those without NEC (p < 0.05). In conclusion, the presence of PPROM increases the risk of chorioamnionitis. In addition, PPROM increases the risk of NEC, and patients who developed NEC had significantly higher cord blood IL-8 values. We may conclude that patients with PPROM and higher IL-8 levels in cord blood might be considered as at possible risk of NEC.

We report a case of 14-year-old male with local augmentation of varicella zoster exanthems on the forearm on which cast application was performed. After 1 week, the first varicella zoster exanthems began to appear on the left forearm under the cast and trunk, while lesions on the other forearm and extremities were very rare. We postulated that the local pressure and heat increased the number of exanthems.

This study was conducted in order to assess the normal range of subarachnoid space width in healthy term newborns. A total of 230 healthy newborns were evaluated within the first 28 days of life. Measurements were correlated with body weight, height and head circumference. Mean measurements for falx-cortex and craniocortical widths and the correlations are given in tables. Subarachnoid space widths increased as weight, height and head circumference increased and the correlation was statistically significant.

Objectives: We investigated the effect of human growth hormone (GH) on newborn rat brain superoxide dismutase, glutathione and malondialdehyde (MDA) levels in hypoxic-ischemic (H-I) newborn rats., Methods: Fourty-eight 7 days old newborn rats were randomized to a healthy (n: 15), H-I (n: 18) and GH administered H-I (GH-H-I, n: 15) group. Permanent, left common carotid ligation was performed in the H-I groups. In the GH-H-I group, 50 mg/kg human GH (Norditropin Simplex, Novo Nordisk A/S) was administered subcutaneously just before carotid artery ligation. Two hours after ligation, rats were subjected to 2 h of hypoxemia and then were decapitated. Right and left cerebral hemispheres (CHs) and cerebellum-brain stem (C-BS) were separated., Results: Glutathione levels of each region were not statistically different from each other in and between the groups. Superoxide dismutase levels were higher in C-BSs compared to CHs (for each comparison p < 0.01). CHs and C-BS MDA levels were similar in the control and H-I groups but MDA levels of both CHs of the GH-H-I group were significantly higher than the levels of the H-I group (p = 0.01; p = 0.024, respectively). Left CH MDA level of GH-H-I group was higher compared to left CH MDA of the control group (p = 0.045) while there was no difference between right CHs. In the GH-H-I group, left CH MDA level was higher than the C-BS (p = 0.03). MDA levels of the C-BSs did not differ between the groups (p > 0.05)., Conclusion: Although we have not evaluated the effect of GH histopathologically, increased lipid peroxidation especially in the H-I (left) hemisphere of the GH treated rats might suggest that GH treatment may be harmful in H-I encephalopathy., (Copyright 2006 S. Karger AG, Basel.)

Malignant ectomesenchymoma is a rare tumor reported in head-neck, abdomen and perineal regions. It consists of mesenchymal and neuroectodermal elements. In this tumor group, neoplastic cells are differentiated into neuronal cells. It also has at least one malignant mesenchymal element, generally rhabdomyosarcoma. In this report we present a neonate with ectomesenchymoma.

Pyruvate kinase (PK) plays a key role in erythrocytes, which obtain most of their energy from glycolysis. This study investigated erythrocyte energy metabolism in hypoxic newborns, measuring pyruvate kinase activity, kinetic, and ATP levels in hypoxia. Forty-nine babies who had cord pH value lower than 7.2 and Apgar scores lower than 7 in the first minute were accepted as the hypoxic group, and 48 babies who had cord pH value higher than 7.2 and an Apgar score higher than 7 in the first minute were taken as controls. The erythrocyte mean PK activity was found to be lower (16.9+/-8.5 [5.8-47.9] EU/gHb) in the hypoxic group than the control group (21.3+/-10.9 [3.9-44.3] EU/gHb) (p<.05). The mean ATP value of hypoxic group was higher (19.2+/-11.3 [3.9-37.6] mM) compared to control group (13.8+/-7.16 [3.9-28.7] mM). In the kinetic study, with different ADP concentrations in the control group, the substrate amount (Km) that is needed to reach the half-maximum of enzyme activity (Vmax=27.7 Eu/gHb) was found to be 2.70 mM, but it was 1.47 mM to reach Vmax (22.7 Eu/gHb) in the hypoxic group. Vmax was 41.67 Eu/gHb and Km was 8.33 mM in the control group at different PEP concentrations, whereas Vmax was 21.7 Eu/gHb and Km was 0.89 mM in the hypoxic group. Increase in the ATP level while ePK activity decreases, suggesting that glycolysis increases in hypoxia. In the kinetic study, the substrate amount needed for reaching the half-maximum of enzyme activity was less in the hypoxic group, probably suggests that pyruvate kinase increases glycolysis by increasing its affinity to the substrates. In this way, erythrocytes may gain the energy required for oxygen delivery to tissues and maintaining ion gradient. This arrangement possibly proceeds from sygmoidal structure of pyruvate kinase.