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Background: We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. Methods: We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF. Results: Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37–40) weeks and 3245 (2715–3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1–5) and 6 (4–7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r, P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001). Conclusion: Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.

Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock.Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents.The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p 0.001), followed by the VIS48 (0.802, p 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p 0.001, β = 14.7, 95% confidence interval [4.7-45.9]).We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.Neonatal sepsis is still one of the most important causes of mortality and morbidity in the neonatal period, and it is also a significant public health problem. Researchers have been looking for reliable biomarkers and scoring systems to detect neonatal sepsis and predict outcomes. The vasoactive inotropic score has been validated and found to be useful for predicting mortality in septic shock in adults and children and newborns who underwent cardiac surgeries. However, there are no neonatal sepsis data. In this retrospective study, we showed that a maximal vasoactive inotropic score of 20 or greater is an easy, noninvasive and useful tool to determine the poor outcome.

Purpose: To determine whether being small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) affected the sensitivity and specificity of Postnatal Growth and Retinopathy of Prematurity (G-ROP) model. Methods: We applied the G-ROP criteria, except hydrocephalus, for prematures retrospectively. The infants were divided into three subgroups according to birth weight percentiles (SGA, AGA, LGA), and the performance of the G-ROP criteria was tested for each group by calculating sensitivity and specificity for any stage retinopathy of prematurity (ROP) and severe ROP. Severe ROP was defined as ROP needing treatment. Results: Three hundred and ninety neonates screened for ROP were included. The gestational age and birth weight of the neonates were 29.3±2.9 weeks and 1302.9±416 g, respectively. There were 41 (10.5%) SGA, 312 (80%) AGA and 37 (9.5%) LGA neonates. The sensitivity of the model for any ROP was 67.8%, 66.7%, 73.2%, 55.6% for all of the patients in the study, SGA, AGA, and LGA neonates, respectively. The sensitivity of the model for severe ROP in all group and for each subgroup was 100%. The specificity of the model for any ROP was 65.9%, 70.6%, 87.7%, 90% for all of the patients, SGA, AGA, and LGA neonates, respectively. The specificity for severe ROP was 46.4%, 50%, 44%, 63.6% for all of the patients, SGA, AGA, and LGA neonates, respectively.Conclusion: The sensitivity and specificity of the G-ROP model in SGA infants were similar with the whole group, but was different between SGA, AGA and LGA neonates. Although the model did not miss any severe ROP, the specificity of the model for severe ROP was found low.

Objective This study aimed to determine the accuracy of neonatal lung ultrasound (LUS) in predicting the need for surfactant therapy compared with chest X-ray (CXR) in preterm infants. Study Design A prospective double-blind study was conducted in infants with a gestational age Results Among 45 preterm infants, the median (interquartile range [IQR]) LUS score was 4 (2–8) in the mild RDS group, whereas it was 10 (IQR: 9–12) in the severe RDS group (p Conclusion The LUS score in preterm infants accurately predicts the severity of RDS, the need for surfactant and CPAP failure. The routine use of LUS can decrease the frequency of CXRs in the neonatal intensive care units. Key Points

Objectives: This study aimed to investigate the underlying causes and outcomes of less than 1500 g birth weight infants who underwent acute peritoneal dialysis (PD). Methods: Case records of infants with birthweight less than 1500 g from January 2015 to June 2018 were reviewed. Results: The median (range) birth weight and gestational age of the patients were 720 g (555–1055) and 26 weeks (23–27.5), respectively. Underlying factors for the development of acute kidney injury (AKI) were patent ductus arteriosus (PDA) (15 patients), necrotizing enterocolitis (NEC) (10 patients), sepsis (7 patients), asphyxia (2 patients) and hydrops fetalis (2 patients). Multifunctional 10 F flexible catheter was used for the procedure. Median PD onset time was 7 days (4.5–13.5) and median PD duration was 3 days (1.5–3.5). Overall mortality rate was 81 % (n=17). Conclusions: Despite high overall mortality, PD is technically feasible in very low birthweight (VLBW) and extremely low birthweight (ELBW) neonates using a multifunctional catheter.

Background: Vitamin D and its receptor (VDR) have important roles in perinatal lung development. The objective of this study was to investigate the possible association between VDR FokI and TaqI po...

Objectives To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. Methods Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. Results Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p Conclusions If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.

Fetal development is adversely affected in infants of diabetic mothers. Poorly controlled diabetes in these mothers increases the incidence of congenital anomalies. The most common congenital anomalies are congenital heart disease, caudal regression syndrome, and central nervous system anomalies. The mortality rate of infants of diabetic mothers with cardiac malformations is higher. Jarcho–Levin syndrome, also known as spondylocostal dysostosis (SCD), is a rare genetic disorder with an unknown cause that manifests with respiratory failure, multiple spines, ribs, and other abnormalities. Here is a case of SCD with multiple congenital anomalies in the infant of a diabetic mother presented.

The aim of this study is to evaluate whether the platelet mass in the first 24 h of life is effective on closure of patent ductus arteriosus (PDA) or not.Preterm infants with a gestational age of 32 weeks, hospitalized at a tertiary neonatal intensive care unit (NICU) and requiring medical treatment (intravenous or oral ibuprofen) for hemodinamically significant PDA (hsPDA) were enrolled in this study. The patients were divided into two groups after first course of pharmacologic treatment according to closure of PDA (Group 1: PDA closure, Group 2: PDA without closure). Groups were compared in terms of demographics findings, morbidities, platelet measurements like counts, mean platelet volume (MPV) and platelet mass (platelet count × mean platelet volume).The study included 77 preterm newborns in Group 1, and 30 preterms in Group 2. There were no differences in birth weight, gestational age, gender and maternal risk factors between the study groups. The mean platelet count in the first postnatal blood count was in Group 1: 211.3 ± 89.2 × 10(3)/mm(3) and in Group 2: 216.5 ± 26 × 10(3)/mm(3), respectively (p = 0.783). The mean platelet volumes (MPV) were similar in both groups (p = 0.535). No statistically significant difference between platelet mass values was detected (Group 1: 1811 ± 884 fl/nl, Group 2: 1868 ± 717 fl/nl) (p = 0.753).Our data suggest that platelet count, MPV and platelet mass did not affect the closure of hsPDA with ibuprofen.

Objective: Viruses are demonstrated to be an uncommon etiologic agent of early and late pneumonia. In this study we aimed to investigate the safety and affectivity of oseltamivir use for viral pneumonia in newborns. Methods: This was a retrospective study conducted in a single tertiary neonatal intensive care unit between September 2009 and April 2013. Demographic, clinical and laboratory data before and after treatment, duration of hospitalization, time of clinical improvement were recorded. Results: During the study period, a total of 69 newborn cases who were treated by oseltamivir for H1N1 swine flu (n=12) or suspicious influenza (n=57) were evaluated. Mean birth weight and gestational age were 3100±601 grams and 37.9±1.8 weeks, respectively. On admission, median postnatal age was 20.6 (7-47) days. Oseltamivir, along with supportive care, was administered as 3.0 mg/kg/dose twice a day for 5 days according to the recommendations of Food and Drug Administration (FDA). The median time of initiation of oseltamivir was 2.3 days (1-4) after admission and the median hospitalization day was 10.4 days (5-22). No adverse effects associated with oseltamivir were observed and all patients were discharged after full recovery. Conclusion: Oseltamivir use in addition to supportive therapy seems to be safe and effective in newborns with severe viral pneumonia.

To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU).From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study.During the study period, the incidence of non-benign NA was 0.7 % (n = 55/7880). The mean age at diagnosis was 16.7 ± 1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia.Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.

Objective To determine the clinical spectrum of hemolytic disease due to irregular blood subgroup incompatibility in hospitalized neonates. Study Design The medical records of the all hospitalized newborn patients diagnosed with indirect hyperbilirubinemia due to subgroup incompatibility in Kell, C, c, E, and e systems were included in the study. Data from 106 newborns with hemolytic jaundice due to irregular blood subgroups were retrospectively evaluated, and clinical and laboratory findings were compared between patients . The treatment modalities given to the patients of each subgroup types and the laboratory findings and treatment modalities of the cases according to Coombs tests results were also analyzed. Fetal affection of the hemolysis and also fetal losses due to irregular red-cell alloimmunization were not detected in prenatal course, as there was no follow-up of these pregnancies. Results The mean postnatal hospitalizing age was 6.1 ± 5.2 days after birth. The mean total bilirubin level and the mean hemoglobin value on hospitalization were 343.7 ± 63.3 µmol/L (=20.1 ± 3.7 mg/dL) and 14.9 ± 3.4 g/dL, respectively. Of 106 patients identified with irregular subgroup incompatibility, 40 infants (37.7%) were associated with C, 22 (20.8%) with c, 30 (28.3%) with E, 9 (8.5%) with e, and 5 (4.7%) with Kell subgroup system. Positive Coombs tests (either direct and/or indirect) occurred in 28.3% of the study cases. Hydrops fetalis was determined in 5 of 106 neonates (4.7%). Twenty-two of 106 (20.8%) patients required total exchange transfusion. Positive Coombs test in cases required total exchange transfusion was 63.6%. Conclusion Our data expose the magnitude and spectrum of the potential developing severe hemolytic disease and immune hydrops due to irregular subgroup incompatibility. Minor group antibody screening is recommended both in the mother and the high-risk infants with hyperbilirubinemia and hemolytic disease of the newborn.

Crisponi syndrome is an infrequently described disorder with autosomal recessive trait. It is characterized by extensive muscular contractions in the face after even minimal stimuli or crying, hypertonia, opisthotonus, camptodactyly, and typical facial features. Muscle contractions attenuate during rest or when the infant calms down. As a recently described new disease, Crisponi syndrome may be confused with epileptic manifestations. Most of the patients die in the first months of life due to hyperthermia and feeding problems. Recently, it has been demonstrated that mutations of the CRLF1 gene ‘cytokine receptor-like factor 1’ are associated with Crisponi syndrome. Here, we present a newborn diagnosed with Crisponi syndrome and report a novel homozygous CFRL1 gene mutation.

Objective The objective of this study was to compare the perfusion index (PI) variability in premature infants with respiratory distress syndrome (RDS) following administration of two different natural surfactant preparations. Study design This was a prospective study on 92 preterm infants with RDS. Patients were randomized into two groups. Group 1 ( n = 46) received beractant; Group 2 ( n = 46) received poractant alfa. Oxygen saturation, PI, and heart rate were measured by Masimo Rainbow SET Radical-7 pulse oximeter (Masimo Corp., Irvine, CA) before and after surfactant. The effects of the two treatment regimens on PI and oxygenation were compared. Results Repeated doses were more needed in beractant group ( p = 0.04). Median oxygenation index (OI) before surfactant were similar, but improvement in OI was more prominent at 6th hour of surfactant in Group 2 ( p = 0.001). Both groups had similar preductal PI values before surfactant. PI was higher at 6th hour of surfactant in Group 2 ( p = 0.001). Pulmonary hemorrhage, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, and mortality were more frequent in infants whose PI values lower than 0.7 within the first 5 days of life ( p = 0.001). Conclusion Poractant alfa resulted in more prominent improvement in PI and OI. Low PI values measured at early postnatal period may predict poor clinical outcome in preterm infants with RDS.

Background The aim of this study was to evaluate the features and outcome of classic galactosemia diagnosed in the neonatal period. Methods A retrospective study was carried out on 22 newborns with classic galactosemia who were followed-up in a tertiary neonatal intensive care unit from January 2005 to January 2011. Results During the study period, 22 (18 boys, 4 girls) newborns were diagnosed with classic galactosemia. The median gestational age was 38 weeks (31 - 42) with a median age of 13 (3 - 23) days on admission. Major presenting symptoms were hepatomegaly (n = 22, 100%), jaundice [n = 19, 86%; including (n = 14, 63%) indirect and (n = 8, 36%) direct hyperbilirubinemia], vomiting (n = 17, 77%), and nuclear cataract (n = 15, 68%). Liver dysfunction (n = 22, 100%), Escherichia coli sepsis (n = 10), purpura fulminans (n = 1), hemophagocytosis (n = 1), and long QT syndrome (n = 1) were also noted. Cataract resolved in 11 (73%) patients with galactose-restricted diet in the first months. Four patients were operated for cataracts. Neurodevelopmental evaluation showed mild psychomotor retardation in one patient, learning disabilities in five, and developmental delay in three. None died from galactosemia or its complications. Patients who were diagnosed before 17 days did not require cataract operation. Conclusions Early diagnosis of galactosemia and treatment with a galactose-restricted diet could partially prevent and recover complications of the disease, but not all of them. Cataracts can develop even in the first few weeks of life. Early diagnosis seems important in the prevention of severe cataracts. Therefore, newborn screening for galactosemia should improve morbidity.

Congenital anomalies are one of the important reasons of mortality and morbidity in newborns. The aim of this study is to determine the incidence, distribution and the mortality of the congenital anomalies in a single neonatal intensive care unit (NICU) from Turkey.A retrospective analysis was performed between 2005 and 2012 in NICU using a computerized database. Variables including the type of anomaly, antenatal and postnatal history, gestational age, birth weight, consanguinity and other demographic, clinical and related laboratory variables were extracted from the computerized database using ICD-10 codes. Congenital anomalies were classified according to involved organ systems and also classified as single and multiple anomalies.A total of 1024 newborns with congenital anomaly (CA) (13.7%) were identified among the 7450 hospitalized newborns in NICU. The most affected system was the cardiovascular system (68.8%). Most of the anomalies (67.1%) were single anomalies. Of all, 59.4% had single major, 7.7% had single minor, 9% had single major plus single minor, 18.4% had multiple major and 2% had multiple minor anomalies. On the other hand, 96.3, 1.9, 0.1 and 1.7% of the newborns had malformation, deformation, disruption and dysplasia, respectively. Chromosomal analysis was only performed 24.8% of the newborns with CA and among them, 65.3% of these were in normal limits. The most frequently detected chromosomal abnormality was trisomy 21. Overall, mortality rate was 15.5% among the newborns with CA.In conclusion, the most common and mortal CA was cardio-vascular malformations in our hospital. The overall prevalence of cardio-vascular malformations among the newborn was higher than previously reported studies in Turkey. Further, studies with larger sample size are needed to determine CA in Turkey.

To determine the role of mean platelet volume (MPV) and uric acid levels in the diagnosis of neonatal sepsis (NS). A total of 146 newborns with suspected NS were prospectively included in the study and infants without NS (n = 142) were assigned as controls. The patients were divided into three groups: Group I (n = 64): clinical NS, Group II (n = 82): culture-proven NS, and Group III (n = 142): healthy controls. The patients in Group II had the highest C-reactive protein (CRP) levels (54.6 ± 5.4 mg/L), lowest platelet counts (199,329 ± 135,952/mm3) and lowest uric acid levels (2.6 ± 1.8 mg/dL) when compared to Groups I and III (p

Crisponi syndrome is an infrequently described disorder with autosomal recessive trait. It is characterized by extensive muscular contractions in the face after even minimal stimuli or crying, hypertonia, opisthotonus, camptodactyly, and typical facial features. Muscle contractions attenuate during rest or when the infant calms down. As a recently described new disease, Crisponi syndrome may be confused with epileptic manifestations. Most of the patients die in the first months of life due to hyperthermia and feeding problems. Recently, it has been demonstrated that mutations of the CRLF1 gene 'cytokine receptor-like factor 1' are associated with Crisponi syndrome. Here, we present a newborn diagnosed with Crisponi syndrome and report a novel homozygous CFRL1 gene mutation.

Human infection by Brevundimonas vesicularis is very rare, especially in children. A 29-week-old neonate is reported who developed early neonatal sepsis owing to B. vesicularis complicated by persistent meningitis and lymphadenopathy. B. vesicularis may be an emerging pathogen in neonatal infection.

Congenital isolated pleural effusion, a non-specific accumulation of fluid in the pleural space, is an uncommon anomaly which can be associated with structural malformations, inflammatory or iatrogenic problems, genetic syndromes or fetal hydrops. Here, we present two neonates with isolated congenital pleural effusion, one of which was associated with Down syndrome and the other with empyema and bloodstream infection caused by Burkholderia gladioli septicemia. We wanted to discuss the diagnosis and management of this rare clinical entity.

To report infections caused by Brevundimonas vesicularis and the treatment regimens administered based on antibiotic studies of this Gram-negative bacterium in the neonatal period.Eight hospitalized neonates with positive blood cultures for Brevundimonas spp. were studied. Demographic data, clinical and laboratory findings, nutritional regimens, presence of primary disease, and the antibiotic regimens administered during the treatment of these neonates were noted. Antimicrobial susceptibility tests were performed on isolates of the positive cultures.Four neonates were preterm, and four were full-term infants. The underlying diseases--with the exception of being a neonate--were congenital heart disease (4 patients), respiratory distress syndrome (2), multiple congenital cerebral anomalies (1), and meconium aspiration syndrome (1). Septicemia was observed in all eight patients, while three also had concurrent meningitis. Multidrug resistance to the antimicrobials, including piperacillin-tazobactam, ceftazidime, and aztreonam, were identified in all eight infants; however, susceptibility to amikacin and imipenem was retained. All study patients responded to the antibiotic treatments and subsequent cultures were sterile. One patient died due to other causes.We consider that until larger series are available, B. vesicularis should be regarded as virulent. Consequently, in this era of multi-resistant Gram-negative bacteria, serious B. vesicularis infections in neonates should be treated with a broad-spectrum agent, such as third-generation cephalosporin until the results of susceptibility testing are available. Our case reports demonstrate that the susceptibility of this organism to all aminoglycosides and third-generation cephalosporin is not uniform, but that most of the isolates are susceptible to imipenem. More treatment experience and more exact results from antimicrobial susceptibility testing are required to improve on present treatment regimens for invasive B. vesicularis infections.

We report early and successful enzymatic debridement using collagenase application to pinna in a preterm neonate. Collagenase clostridiopeptidase A should be kept in mind not only for the removal of eschar but also for avoidance of the progression of necrotic tissue in neonates.

There are few reports on pandemic swine influenza A (H1N1) virus infection in very young infants. We aimed to discuss the clinical characteristics and management of the H1N1 influenza infection in very young infants. Clinical characteristics of ten infants diagnosed with H1N1 influenza virus infection during the 2009 outbreak season in a tertiary neonatal intensive care unit were evaluated. The diagnosis was confirmed by testing of respiratory samples with pandemic H1N1 influenza specific real-time PCR assay. Of the 46 patients with fever or respiratory problems, ten (22%) were diagnosed with H1N1 influenza virus infection during the 2009 (October–December) peak outbreak season. All infants including the preterms were admitted from home, seven (70%) were full-term and three (30%) were preterm. Median age of the patients at admission was 24.5 days. Fever and cough were the most common symptoms. Apnea was the initial symptoms in three patients. Two patients required oxygen support, one of which, a preterm baby, had been mechanically ventilated for 2 days. Mean duration of hospitalization was 7.8 ± 4.9 days. Chest radiography revealed radio-opacities on both lung fields in six patients. In addition, two patients had co-infection. All patients with proven infection were given oseltamivir medication. Recovery was achieved in all patients with no residual deficits or side effects from the antiviral oseltamivir treatment. The H1N1 influenza virus infection in very young infants appears to be mild to moderate in severity. The outcomes of the infants may be influenced by antiviral therapy. Treatment with antiviral oseltamivir appears to have no major adverse effects.

Despite advances in the neonatal care, hypoxic ischemic encephalopathy in late preterm and term infants remains an important cause of morbidity and mortality. There is lack of data on the application of therapeutic hypothermia in the existence of severe skin lesions. Epidermolysis bullosa is a rare group of inherited conditions which causes blisters in skin and mucosal membranes. In this report, the authors describe a successful whole-body hypothermia treatment of severe hypoxic ischemic encephalopathy in a term newborn with dystrophic epidermolysis bullosa. They observed that therapeutic hypothermia may also be given in newborns with dystrophic epidermolysis bullosa without any complications.

Background and Aim Infantile colic (IC) is a common behavioural syndrome within the first 3 months of life. We aimed to compare the effectiveness of Lactobacillus reuteri (L.reuteri) and herbal drop combined with baby massage on IC and to evaluate the relationship with postpartum depression and anxiety. Methods Wessel Criteria were used for the diagnosis of IC in otherwise healty newborns. Patients were randomized into three groups: Group-1: L. Reuteri DSM17938 (BioGaia AB, Stockholm, Sweden), Group-2: Herbal drop (Babs, BerkoAB, Istanbul, Turkey), Group-3: Sterile water. All groups had baby massage. Infants crying episodes, feeding and stooling characteristics, growth, weight gain were noted weekly. Emotional structures of mother’s behaviour were evaluated before and at 2nd month with Edinburgh postpartum depression scale (EPDS) and State Trait Anxiety Inventory (STAI) tests. Results Seventy-four infants and their mothers completed the trial: 25 in the probiotic group, 24 in herbal drop, and 25 in placebo group. There was no difference between groups in demographic and clinical characteristics. The male rate was 62.2% (n=46). Crying times(minutes/day) at admission were similar (Group1: 348±37, Group2: 353±30, Group3: 346±28, p=0.67). A significant decrease in crying times were seen at 3.week in group1 (Group1: 35±9.8, Group2: 300±32.2, Group3: 188±40, p=0.001). The weight gain at this time was in group1 better, too (p =0.001). High EPDS and STAI scores decreased significantly after treatment in group1 at 2 month (p= 0.001). No adverse effects were reported in our groups. Conclusion The emotional structure and anxiety level of mothers affects the behaviour of infants. L. reuteri, reduced the crying episodes, mothers anxiety and postpartum depression and can be used in treatment of infantile colic.

Background and Aims Congenital heart diseases (CHD) are the most common life-threatening anomalies with significant morbidity and mortality in newborns. The aim of this study was to evaluate perfusion index variability (PI) and pro-Brain Natriuretic Peptide (NT-proBNP) levels before and after cardiac interventions. Methods A prospective study was performed on hospitalized newborns diagnosed with CHD. Oxygen saturation (SaO 2 ), PI, heart rate and serum NT-proBNP levels were obtained before and 6 th hour after cardiac interventions (catheterization or surgery) in all patients, by using Masimo Rainbow SET Radica l7 Monitor (Masimo Corp., Irvine, CA, USA). Duration of mechanical ventilation, morbidity and mortality rates were documented. Results Thirty-four CHD diagnosed newborns were included. Pulmonary atresia (20.6%), aortic coarctation (14.7%), and transposition of great arteries (11.82%) are the most common diagnoses. Median (IQR) birth weight and gestational age were 3250g (2450–4300) and 38weeks (38–42) respectively. Fifty-eight percent of newborns were male. Rapidly rising of oxygen saturations and PI values after cardiac interventions were observed in all patients (SaO 2 %, before: 79±6.6, after: 87.9±2.9, p=0.001) (PI before: 0.4±0.1, after: 1.1±0.2, p=0.001). A significant decrease in NT-proBNP levels (pg/mL) were seen after therapeutic interventions too(before: 1547±629, after: 911±262, p=0.001). Six patients (17.6%) required surgical intervention. The median (IQR) day of mechanical ventilation was 7days (2–21). Proven sepsis (n=8.23%), chronic lung disease (n=5.14%), pulmonary hemorrhage (n=4,%11), and pneumothorax(n=3.8%) are the most detected complications. Mortality rate was 20% (n=5). Conclusion Peripheral tissues are sensitive to alterations in perfusion. PI monitoring of these tissues could be an early marker of hypoperfusion. PI has significantly improved in correlation with SpO2 after therapeutic interventions. Assessment of PI and NT-proBNP values could be used by monitoring peripheral tissues in critically ill newborns with CHD.

It is well known that fetuses exposed in utero to anticonvulsants may have an increased risk of congenital malformation, estimated at between two to seven times greater than the general population ...

We report early and successful enzymatic debridement using collagenase application to pinna in a preterm neonate. Collagenase clostridiopeptidase A should be kept in mind not only for the removal of eschar but also for avoidance of the progression of necrotic tissue in neonates.

Background and Aims The perfusion index (PI); is an easy, non-invasive technique for the assessment of peripheral perfusion. The aim of this study was to determine the peripheral PI reference values and PI variability of clinically and hemodynamically stable newborns during the first five days. Method Pre- (right hand) and postductal (foot) PI values were recorded on the sixth hours, first, second, third and fifth day of 241 newborns life with the new generation pulse oximeter [MASIMO Rad 7 Oximeter, USA]. Results A total of 241 newborns (196 term, 45 preterm) were included in the study. The average gestation age of all newborns was 38.4±2.0 weeks and birth weight was 3204±566 grams. According to the analysis of repeated measurements of term and preterm groups within the first 5 days, PI values of right hand and foot did not vary. However, right hand PI values were significantly higher than foot PI values (p Conclusion The peripheral perfusion of stable newborns did not vary significantly during the first five days. It was considered, higher PI value of term newborns compared to preterm newborns, is the result of early adaptation in the microvascular blood flow. PI values obtained from stable newborns may be guiding for further studies planned on various diseases associated with impaired perfusion.

Background and Aim Researches to identify markers with high sensitivity and specificity in the diagnosis of neonatal sepsis are being held in parallel to recent advances in neonatology. In this study, we aimed to determine predictive values of MPV in the diagnosis of neonatal sepsis. Methods All infants diagnosed with clinical sepsis according to clinical and laboratory findings were included in this prospective study. Blood samples for hemoglobin, hematocrit, number of leukocyte, absolute neutrophyl count (ANC), number of platelet, MPV, CRP, blood culture were obtained from each patient within the first 24 hours of hospitalization. Patients who have positive culture results were accepted as proven sepsis. Patients were separated into three groups as proven sepsis (n=82) (Group-1), clinical sepsis (n=64) (Group-2) and control group (n=142) (Group-3). Results Group-1 CRP levels were higher (p=0.001) and number of platelets were lower (p=0.001) compared with other two groups. Leukocyte, ANC and MPV values were significantly high in Group-1 and Group-2 compared with Group 3 and there was no difference between Group-1 and Group-2 (p=0.001). Negative correlation was observed between MPV and platelet levels (r= –0.24, p=0.001) whereas positive correlation was observed between MPV and CRP levels (r=0.26, p=0.001). It was noted that for CRP- Specificity 82%, sensitivity 92%, negative predictive value (NPV) 83%, positive predictive value (PPV) 91%, and for MPV- Specificity 54%, sensitivity 82%, NPV 63%, PPV 76%. Conclusion High serum MPV levels in addition to CRP levels may be helpful in the diagnosis of newborns suspected to have sepsis.

Background & aim Congenital heart malformation (CHM) is one of the most frequent and important abnormalities in newborns. In this study we retrospectively analyzed the frequency and distribution of the congenital heart diseases in our NICU. Method Newborns hospitalized in NICU between 2005 and 2011 were retrospectively analyzed. Gestational age, birth weight, consanguinity, type of congenital heart disease extracted from the computerized database. CHMswere classified as follows; left-to-right shunt, obstructive, cyanotic with decreased pulmonary flow, cyanotic with increased pulmonary flow and others. Results A total of 706 newborns were diagnosed as congenital heart disease during 7-year study period among the 7450 admission (9.5%). Consanguinity rate was 22.3% and 30.4% of these were first degree relatives. 42.7%, 17.3%, 13%, 11.6% were left-to-right shunt, obstructive, cyanotic with decreased pulmonary flow, cyanotic with increased pulmonary flow and others, respectively. Most frequent heart malformations were ASD (25.5%), VSD (12.6%), Aortic coarctation (10.8%), PDA (9.5%), TGA (8.8%), pulmonary atresia (8.2%), AVSD (4.1%), hypoplastic left heart (3.8%), pulmonary stenosis (3.1%), TOF (2.5%). 37 % of the newborns had at least one congenital malformation in other organ systems. Conclusion ASD, VSD and aortic coarctation were most common congenital heart disease followed in our NICU.

Background & Aim: It is known that wet lung syndrome and pulmonary maladaptation are more frequent in infants delivered by cesarean section while the effect of mode of delivery on RDS is unknown. In this study, we analyzed the effect of the mode of delivery on RDS outcome in very low birth weight (VLBW) neonates. Methods Data of all the VLBW neonates with respiratory distress syndrome (RDS) between 2007 and 2012 was retrospectively analyzed. Gestational age, gender, birth weight, mode of delivery, necrotizing enterocolitis (NEC), intracranial bleeding (ICH), patent ductus arteriosus (PDA), retinopaty of prematurity (ROP), broncopulmonary dysplasia (BPD) were noted. Results A total of 186 newborns were diagnosed as VLBW neonates with RDS among the 5980 neonates hospitalized in NICU. Mean birth weight and gestational age were 1058±261 grams and 28±2.7 weeks, respectively. Cesarean delivery rate was 62.7%. There were no differences with respect to birth weight, gestational age and gender between mode of delivery. There was no significant relationship between the NEC, PDA, ROP, BPD and mode of delivery. Also no significant relationship between the mode of delivery and mortality was determined. On the other hand, ICH was significantly higher in neonates delivered vaginally (48% vs. 31%, p Conclusion Mode of delivery has no effect on the mortality and morbidity of RDS in VLBW neonates but ICH was significantly higher in normal vaginal delivery group. Therefore, mode of delivery should be decided on the basis of obstetrical indications.

Objective The aim of this study was to determine accurate and validated z-score equations for the normal values of coronary diameters adjusted with growth changes of the neonates by testing three different time periods. Methods Echocardiography was performed on 200 healthy neonates at birth, one and six months of ages. Several regression models for the left (LCA) and right coronary artery (RCA) diameters were tested with weight, height, body surface area and aortic annulus diameter. Reliable standards for the coronary artery diameters for healthy newborns by determining z-score equations with appropriate statistical validations were established. Results The coronary diameters on birth measurements were strongly correlated with birth weight, height, surface area and the diameter of the aortic annulus (Pearson’s R>0.8, all p Conclusion We present a new set of equations for neonatal z-score calculation on the basis of a large number of healthy neonates on three different time period consisting of birth, one and six month of ages. It is clear with this study that the growth in caliber of the coronary arteries is definite and progressive during postnatal time.

Background and Aim Congenital malformations are one of the important reasons of mortality and morbidity in newborns. The aim of this study is to give the frequency and distribution of the congenital malformation in a neonatal intensive care unit from Turkey. Method A retrospective analysis of congenital abnormalities in singleton births was performed to identify frequency, types, combined congenital abnormalities and distribution of malformation in newborns over a 7 year period. Congenital malformations were classified according to involved organ systems and also classed as single and multiple malformations. Result 1024 newborns with congenital malformations (13.7%) were identified among the 7450 hospitalized newborns in neonatal intensive care unit (NICU). Mean birth weight was 2988±648gr, mean gestational age was 37.9±2.5 weeks. Consanguinity rate was 22.3%. Prenatal diagnosis rate was 11%. The most affected system was the cardiovascular system (68.8%). Most of the malformations (69.6%) were single malformations while 20.4% of the newborns had multiple major and 8.4% of the newborns had multiple minor malformations. On the other hand, 1.4%, 0.1% and 1.6% of the newborns had deformation, disruption and displasia, respectively. Chromosomal analysis was only performed 24.8% and 65.3% of them were in normal limits. The most frequently detected chromosomal abnormality was Trisomy 21. Overall mortality rate was 15.5% among the newborns with congenital malformations. Conclusion The most common congenital malformation was cardio-vascular malformations in our hospital. Preventing and prenatal diagnosis of congenital malformations may help to reduce perinatal mortality and morbidity.Therefore, each country should establish its own national database for prevention and management of congenital malformations.

Background and Aim Congenital malformations and chromosomal abnormalities are important problems for the neonatal morbidity and mortality especially in well developed countries. In this study we investigated the prevalence and distribution of the chromosomal abnormalities in our NICU. Method Chromosomal abnormalities identified between 2008 and 2012 were retrospectively analyzed. Also, demographic features and concomitant congenital malformations were also collected. Cytogenetic analysis was performed on peripheral blood of newborns by standard chromosomal analysis methods. According to our hospital protocols, newborns with more than one major malformation or with 1 major plus 2 minor abnormalities were scheduled for chromosomal abnormalities. Results During the study period, 431 chromosomal analyses (3.2%) were performed among the 5170 hospitalized newborns. 78.4% of the cases had normal chromosomal karyotype. Consanguinity rate was 27.9%. Major chromosomal abnormality rate was 1.8%. Frequency of chromosomal abnormalities were as follows; Trisomy 21 13.5% (n=58), trisomy 18 2.3% (n=10), trisomy 13 1.2% (n=5), 45 XO 0.5% (n=2) and other chromosomal abnormalities were 4.2% (n=18). Congenital heart abnormalities (85.9%), cranio-fascial abnormalities (44.6%) and genito-urinary anomalies (16.9%) were most common concomittant malformations. Cardiovascular abnormalities were most common malformations in newborns with trisomy 21. Conclusion Frequency and distribution of the chromosomal abnormalities in our NICU were similar compering with other populational studies. Trisomy 21 was most common chromosomal abnormality. Newborns with malformations in more than two organ system should be investigated chromosomally as well.