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Background/aim Acute kidney injury (AKI) is a serious morbidity in premature neonates. The aim of this study was to determine the incidence of AKI and to evaluate its impact on morbidity and mortality in very premature infants. Materials and methods This retrospective cohort study was conducted in the neonatal intensive care unit (NICU). A total of 410 preterm infants who were born before 32 gestational weeks were screened and 318 were included in this analysis. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria. Results The incidence of AKI was 32.1% (102/318). Regression analyses revealed that lower gestational age, vasopressor use, and hemodynamically significant patent ductus arteriosus were significantly associated with an increased risk for AKI. After adjustment for potential confounders, those with AKI had a higher risk of death before 36 weeks of corrected gestational age (adjusted hazard ratio: 3.02, 95% confidence interval 1.47– 6.22). Additionally, the AKI group had a higher rate of bronchopulmonary dysplasia (BPD) (46% vs. 24%, p < 0.001) and longer hospital stay with a mean difference of 38 days. Conclusion AKI is common in very premature neonates and associated with higher mortality, longer hospital stay, and BPD. Identification of risk factors and preventive strategies for AKI may improve the outcomes in this vulnerable population.

To identify the incidence of and risk factors for acute kidney injury (AKI) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to evaluate its association with neonatal outcomes.A total of 78 newborns with confirmed PPHN admitted to the neonatal intensive care unit of a university hospital between 2016 and 2020 were retrospectively analyzed. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria.Of 78 PPHN infants, AKI was found in 29.5% (23/78). Multivariate analysis indicated that male sex (OR 3.43 95% CI 1.03-11.48, p=0.04) and severe PPHN (OR 5.67 95% CI 1.55- 20.68, p0.01) were independently associated with increased risk for AKI. Infants with AKI had significantly higher mortality rate than infants without AKI (43.5% vs. 9.1%, p0.01). Mortality rates in stage 1, stage 2 and stage 3 AKI were similar (36.4%, 57.1%, and 40%, respectively, p=0.68). Among survivors, AKI infants had significantly longer mechanical ventilation and lenght of stay than infants without AKI.In infants with PPHN, AKI is a common complication and is associated with increased mortality, and longer mechanical ventilation and lenght of stay. Careful monitoring of kidney function in infants with PPHN, especially in males and those who had severe PPHN can help to improve patient outcomes.Yenidoğanın persistan pulmoner hipertansiyonu (PPHN) olan yenidoğanlarda akut böbrek hasarı (ABH) insidansını ve risk faktörlerini belirlemek, ve yenidoğan sonuçları ile ilişkisini değerlendirmek.2016-2020 yılları arasında bir üniversite hastanesinin yenidoğan yoğun bakım ünitesine yatırılan doğrulanmış PPHN’si olan 78 yenidoğan retrospektif olarak incelendi. ABH tanısı, modifiye neonatal Kidney Disease: Improving Global Outcomes (KDIGO) kriterlerine göre konuldu.78 PPHN bebeğinin %29.5’inde (23/78) ABH saptandı. Çok değişkenli analiz, erkek cinsiyetin (OR 3,43 %95 CI 1,03-11,48, p=0,04) ve şiddetli PPHN’nin (OR 5,67 %95 CI 1,55- 20,68, p0,01) bağımsız olarak ABH riskinde artış ile ilişkili olduğunu gösterdi. ABH olan bebeklerde ölüm oranı ABH olmayanlara göre anlamlı olarak daha yüksekti (%43,5’e karşı %9,1, p0,01). Evre 1, Evre 2 ve Evre 3 ABH’deki ölüm oranları benzerdi (sırasıyla, %36,4, %57,1 ve %40, p=0,68). Hayatta kalanlar arasında, ABH olan bebeklerin mekanik ventilator ve hastanede yatış süreleri, ABH olmayan bebeklere göre daha uzun idi.PPHN’li bebeklerde ABH yaygın bir komplikasyondur ve artan mortalite, daha uzun mekanik ventilasyon ve hastanede kalış süresi ile ilişkilidir. PPHN’li bebeklerde, özellikle erkeklerde ve şiddetli PPHN’si olanlarda böbrek fonksiyonunun dikkatli bir şekilde izlenmesi hasta sonuçlarını iyileştirmeye yardımcı olabilir.

Background/Aim: Antenatal magnesium sulfate (MgSO4) treatment is widely used for fetal neuroprotection in women at risk of preterm delivery. Possible adverse effects of MgSO4 include respiratory depression and delay in closure of ductus arteriosus by antagonism of calcium channels. The aim of this study was to investigate the effects of antenatal MgSO4 exposure on cardiorespiratory complications during the early neonatal period in premature infants.Methods: A retrospective cohort study was performed on 340 preterm infants born between 23 and 32 weeks of gestational age. Patients were divided into two groups according to antenatal MgSO4 exposure: The MgSO4 group (n=186) and the no-MgSO4 group (n=154). Outcomes were acute cardiorespiratory events (intubation at birth, respiratory support, and hypotension in first day of life), and hemodynamically significant patent ductus arteriosus (HsPDA).Results: Mothers in the MgSO4 group were more likely to have preeclampsia and antenatal steroid treatment, while their infants were younger in gestation and weighed less (P

Aim: The aim of this study was to determine the rates of healthcare associated infections (HAIs) and device associated healthcare associated infections (DA-HAIs) as well as the rates of invasive device utilization in a neonatal intensive care unit (NICU); and to compare findings with national and international reports. Materials and methods: A total of 1984 patients who admitted to NICU between January 2016 and December 2018 were enrolled. We retrospectively analysed patient’s characteristics, etiologic pathogens and antibiotic susceptibility, mortality from medical charts and infection control committee surveillance reports. Infections were defined using the standart Centers for Disease Control and Prevention criteria. Results: During the 3-year period, total 98 HAI cases 69 of which were DA-HAI were detected. The overall incidence of HAIs was 4.9% and rate was 3.7 per 1000 patient days. The most common HAI was blood stream infection (BSI) (n=64, 65.3%) of those 52 were central line-associated (CLA). The CLA-BSI rate was 8.6 per 1000 central line days with central line utilization ratio of 0.22. Ventilator associated pneumonia (VAP) rate was 5.1 per 1000 ventilator days with ventilator utilization ratio of 0.12. The most common pathogens were Klebsiella pneumonia. (38.9%), Staphylococcus epidermidis (22.1%) and Candida spp. (11.6%). The overall mortality rate was 3%. The HAI-related mortality rate was 9.2%. Conclusion: Our findings highlight the importance of an surveillance approach in the NICU setting. HAI rates were lower than the rates reported from developing countries. However, with device utilization rates similar to those in developed countries our HAI rates were higher than that of the developed countries. Continous monitoring and implementation of necessary precautions are essential to decrease the rates of HAIs.

Infants who are born at 34This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57, 95% CI 0.35-0.94) and transient tachypnea of newborn (aOR 0.48, 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64, 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery and duration of hospitalization.Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.

To investigate the incidence of perinatal features and neonatal morbidities in migrant mothers in comparison with native Turkish mothers.A retrospective analysis was conducted using the medical records of 89 infants born to Syrian immigrants and 89 infants born to native Turkish mothers who were consecutively admitted to the neonatal intensive care unit of our hospital between 2015 and 2019. Statistical analyses were used to compare demographic data and perinatal and neonatal outcomes between the two groups.Compared to Turkish mothers, Syrian mothers were significantly younger and adolescent pregnancy rate was significantly higher (p0.01). The rates of multiple pregnancy, consanguineous marriage, and prolonged premature membrane rupture were also significantly higher in Syrian mothers (p0.05). The incidence rates of congenital anomalies, respiratory distress syndrome, transient tachypnea of newborn pneumonia/bronchiolitis, sepsis, jaundice, and feeding problems were the same for infants born to Syrian and Turkish mothers (p0.05). In addition, the two groups did not differ with respect to gestational week at birth, birth weight, sex, types of delivery, Apgar score, duration of hospital stay, and incidence of infant mortality (p0.05).The immigrant status negatively affects perinatal and neonatal outcomes. However, the incidence rates of infant mortality and neonatal morbidity did not differ between infants born to Syrian and those born to Turkish mothers. This may be due to the recent improvements in the of overall health status of migrant women or of those migrants living in Turkey being able to have access to increased prenatal and postnatal period policies of mother-child health services which have been successfully implemented.Göçmen anne bebeklerinde perinatal özelliklerin ve neonatal morbiditelerin görülme sıklığının araştırılması, Türk anne bebekleriyle karşılaştırılması.Hastanemizde 2015-2019 yılları arasında yenidoğan yoğun bakım ünitesine yatan 89 Suriyeli anne bebekleri ile aynı dönemde ardışık yatan 89 Türk anne bebeklerinin verileri retrospektif olarak dosya kayıtlarından elde edildi. İki grup arasında demografik data, perinatal ve neonatal sonuçlar karşılaştırmak için istatistiksel analiz yapıldı.Suriyeli annelerin yaş ortalaması anlamlı olarak daha düşük, adölesan gebelik oranı anlamlı olarak daha yüksekti (p0,01). Suriyeli annelerde çoğul gebelik, akraba evliliği ve uzamış erken membran rüptürü görülme oranı da Türk annelere göre istatistiksel olarak anlamlı derecede daha yüksek saptandı (p0,05). Konjenital anomaliler, respiratuvar distress sendromu, yenidoğanın geçici takipnesi pnömoni/bronşiolit, sepsis, sarılık ve beslenme problemi insidansı Suriyeli ve Türk annelerden doğan bebeklerde benzerdi. Bunun yanında, gestasyon haftası, doğum ağırlığı, cinsiyet, doğum şekli, düşük Apgar skoru, hastanede yatış süresi ve mortalite görülme sıklığı açısından Suriyeli anne bebekleri ile Türk anne bebekleri arasında anlamlı farklılık görülmedi (p0,05).Göçmen statüsü perinatal ve neonatal sonuçları olumsuz etkileyen bir faktördür. Bununla birlikte, Suriyeli anne bebeklerinde mortalite ve neonatal morbidite görülme sıklığı Türk anne bebeklerine göre belirgin bir farklılık göstermemektedir. Bu, son dönemde göçmenlerin sağlığının genel bir iyileşmesinden veya Türkiye’de yaşayan göçmen kadınların doğum öncesi ve sonrası dönemlerinde anne-çocuk sağlığı hizmetlerine erişebilirliği artıran politikaların başarılı bir şekilde uygulanmasından kaynaklanıyor olabilir.

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...

Amaç: Hipoksik iskemik ensefalopati (HİE) yenidoğanlarda ciddi bir problem olup nöromüsküler disfonksiyon ve ölümle ilişkilidir. Bu çalışmada neonatal HİE için potansiyel risk faktörlerini araştırmak amaçlanmıştır.Yöntem: 2015–2020 yıllarında yenidoğan yoğun bakım ünitemizde yatan bebekler üzerinde retrospektif bir vaka–kontrol çalışması gerçekleştirildi. Vaka grubu ≥36 gebelik haftasında doğan ve HİE tanısı alan bebeklerden oluşturuldu. Her vaka için, HİE’si olmayan, gestasyonel yaş bakımından eşlenik 4 bebek seçildi ve kontrol grubuna dahil edildi. Gruplar maternal demografik özellikler, gebelik özellikleri ve doğumla ilgili faktörler bakımından karşılaştırıldı.Bulgular: Çalışma 75 HİE’li bebek ve 300 kontrol içerdi. Tek değişkenli analizde nulliparite, antenatal bakım geçmişi, gebelik sırasında tıbbi komplikasyon, uzun süreli zor doğum, anormal fetal kalp hızı, doğum şekli, ve akut doğum komplikasyonları HİE ile anlamlı olarak ilişkili bulundu. Çok değişkenli lojistik analizde antenatal bakım eksikliği, anormal fetal kalp hızı (FKH) ve akut doğum komplikasyonu neonatal HİE ile ilişkili en güçlü faktörler idi.Sonuç: Bulgularımız antenatal bakım eksikliği, anormal FKH ve akut doğum komplikasyonlarının HİE gelişimi için risk faktörü olduğunu göstermiştir. Gebelerin yeterli antenatal bakım almalarını sağlamak ve gerekli obstetrik önlemleri uygulamak HİE insidansını azaltmaya yardımcı olabilir., Aim: Hypoxic ischemic encephalopathy (HIE) is a serious condition in neonates and is associated with neuromuscular dysfunction and death. In this study, we aimed to investigate potential risk factors for neonatal HIE.Methods: A retrospective case–control study was conducted on infants admitted to our neonatal intensive care unit between 2015 and 2020. Infants born at ≥36 weeks of gestation and diagnosed with HIE were included in the case group. For each case, 4 gestational agematched infants without HIE were selected and included in the control group. The groups were compared in terms of maternal demographic characteristics, pregnancy characteristics, and birth-related factors.Results: The study included 75 infants with HIE and 300 controls. Nulliparity, history of antenatal care, medical complications during pregnancy, prolonged difficult birth, abnormal fetal heart rate, mode of delivery, and acute birth complications were found to be significantly associated with HIE in univariate analysis. In multivariate logistic analysis, the lack of antenatal care, abnormal fetal heart rate (FHR), and acute birth complication were the strongest factors associated with neonatal HIE.Conclusion: Our findings demonstrated that the lack of antenatal care, abnormal FHR, and acute birth complications were risk factors for the development of HIE. Ensuring that pregnant women receive adequate antenatal care and applying necessary obstetric measures may help to reduce the HIE incidence.

Aim: This study aimed to compare platelet indices between late preterm and term newborns, and to analyze their relationship with perinatal conditions. Materials and Methods: Ninety-eight late preterm and 102 term newborns admitted to the neonatal intensive care unit 2018 and 2020 were retrospectively evaluated. Platelet indices including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) were measured in blood samples taken on the first day of life.Results: There was no significant difference in the PLT, MPV, PCT, and PDW values between late preterm and term newborns. In late preterm newborns, multivariable analysis showed that maternal hypertension was significantly related to lower PLT (p=0.001). In term newborns, multivariable analysis showed that being small for gestational age (SGA), male sex and maternal hypertension were significantly related to lower PLT (p, Amaç: Bu çalışmanın amacı geç preterm yenidoğanlar ve term yenidoğanlarda trombosit indekslerini karşılaştırmak ve perinatal faktörlerle ilişkisini incelemektir. Gereç ve Yöntemler: 2018-2020 yılları arasında akademik bir merkezin Yenidoğan Yoğun Bakım Ünitesine kabul edilen 98 geç preterm ve 102 term yenidoğan retrospektif olarak değerlendirildi. Yaşamın ilk gününde alınan kan örneklerinde trombosit sayısı (PLT), ortalama trombosit hacmi (MPV), plateletkrit (PCT) ve trombosit dağılım genişliği (PDW) dahil olmak üzere trombosit indeksleri ölçüldü.Bulgular: Geç prematüre ve term yenidoğanlar arasında PLT, MPV, PCT ve PDW değerleri açısından anlamlı fark yoktu. Geç prematüre yenidoğanlarda, çok değişkenli analiz, maternal hipertansiyonun düşük PLT ile anlamlı şekilde ilişkili olduğunu gösterdi (p=0.001). Term yenidoğanlarda, çok değişkenli analiz, gebelik yaşına küçük (SGA) olmak, erkek cinsiyet ve maternal hipertansiyonun düşük PLT ile anlamlı şekilde ilişkili olduğunu gösterdi (sırasıyla p

Objective The aim of this study was to identify the effects of antenatal steroids (ANS) on acute kidney injury (AKI) in very low birth weight (VLBW) preterm infants. Study design We performed a retrospective cohort study of VLBW infants admitted to a tertiary-care neonatal intensive care unit between January 2016 and June 2019. Infants were divided into no ANS, partial ANS, and complete ANS groups. Serum creatinine (SCr) levels and rates of AKI during the first 2 weeks of life were compared. Results During the study period, 335 infants met our inclusion criteria. Among no, partial, and complete ANS groups, there were significant differences in rates of stages 2 and 3 AKI (17, 11, and 6%, respectively). Logistic regression analysis revealed that complete ANS course was associated with lower rates of AKI (odds ratio [OR] = 0.41 95% confidence interval [CI]: 0.20-0.83) and stages 2 and 3 AKI (OR = 0.205 95% CI: 0.075-0.563) compared with no ANS. Infants in complete ANS group had significantly lower SCr at 72 hours of life and at discharge, SCr peak was compared with infants in no ANS group. Conclusion In VLBW infants, complete ANS exposure may be associated with improved renal function and decreased risk for AKI compared with no ANS. Key points · The effects of antenatal steroid treatment on renal function in preterm infants are not clear.. · A complete course of antenatal steroid decreases the risk for acute kidney injury in preterm infants.. · Infants who are not exposed to antenatal steroids need closer observation of their renal function..

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

Background: Hypoglycemia is low blood glucose level that may negatively affect neurological and developmental prognosis. The American Academy of Pediatrics (AAP), Committee on Fetus and Newborn defined the safe glucose concentrations in the 2011 guideline for newborns at risk for hypoglycemia. This study aimed to investigate the incidence and associated risk factors for hypoglycemia in newborn infants having risk and to assess compliance with the AAP guideline. Methods: According to 2011 AAP guideline for hypoglycemia, the newborns at risk for hypoglycemia included in this study were divided to four groups [infant of diabetic mother (IDM), large-for-gestational-age (LGA) infants, small-for-gestational-age (SGA) infants, and late preterm infants (LPI)]. Results: Of the 207 newborn infants, there were 12 cases in IDM group (5.7%), 79 cases in LGA group (38.1%), 66 cases in SGA group (31.8%) and 50 cases in LPI group (24.1%). The incidences of hypoglycemia in these four groups were 2 (16.6%), 10 (12.7%), 8 (12.2%) and 17 (34%), respectively. Although the gender, delivery method, birth weight and 5-min Apgar score at 5-min were not found to be associated with hypoglycemia (P > 0.05), lower gestational age was determined to be associated with higher incidence of hypoglycemia (P = 0.02). Median first feeding time was 55 min and time between first nutrition and blood glucose measurement was 30 min in all cases. Conclusion: Highest risk for hypoglycemia in early postnatal period was present especially in LPI group. Our compliance levels with the AAP guideline was found to be satisfactory. Key words: Neonatal hypoglycemia, Incidence, Risk factors, American academy of pediatrics guideline, Breastfeeding, Blood glucose checking, Newborn

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.

Morgagni hernia (MH) is the least common type of congenital diaphragmatic hernias. Although its course is often asymptomatic, it may be associated with various respiratory and gastrointestinal symptoms. We describe 7 children with MH during a 5-year period in three pediatric centers in Turkey. All children had acute or chronic respiratory symptoms; cough was the most frequent. The diagnosis was made by posterior-anterior (PA) and lateral chest X-rays. The PA chest X-rays showed a homogenous mass in 2 and a gas-filled cystic image in 3 children in the right cardiophrenic angle. A retrocardiac homogeneous density in one child, and bilateral consolidation in lower lung areas in another child were also seen. All lateral chest X-rays showed gas-filled bowel loops above the diaphragm. The diagnosis was confirmed by barium-contrast radiograph. Four patients had five additional anomalies, i.e., ventricular septal defect, right inguinal hernia, congenital hip dislocation, pectus carinatum, and obstruction of the uretero-pelvic junction. All of the hernias were repaired by an abdominal approach. There were no complications or recurrences during follow-up. In conclusion, MH should be considered in the differential diagnosis of cases of long-standing respiratory symptoms and/or when an unexplained radiological image, especially on the right cardiophrenic area, is present.