Search

Background:Cyanotic CHD is a life-threatening condition that presents with low oxygen saturation in the newborn period. Hypoxemia might cause alterations in the metabolic pathways. In the present study, we aimed to evaluate the early postnatal amino acid and carnitine/acylcarnitine profiles of newborn infants with cyanotic CHD.Methods:A single centre case-control study was conducted. Twenty-seven patients with cyanotic CHD and 54 healthy newborn controls were enrolled. As part of the neonatal screening programme, results of amino acid and carnitine/acylcarnitine were recorded and compared between groups.Results:Twenty-seven neonates with cyanotic CHD and 54 healthy newborns as controls were enrolled in the study. Cyanotic CHD neonates had higher levels of alanine, phenylalanine, leucine/isoleucine, citrulline, ornithine, C5, C5-OH; but lower levels of C3, C10, C12, C14, C14:1, C16, C16.1, C18, C5-DC, C6-DC, C16-OH, C16:1-OH when compared with the healthy controls.Conclusion:This study showed that there are differences between patients with cyanotic CHD and healthy controls in terms of postnatal amino acid and carnitine/acylcarnitine profiles.

Background:The effect of prenatal diagnosis on prognosis in patients with transposition of the great arteries is not clear. In this study, we compared the outcomes after arterial switch operation.Methods:Outcome of 112 patients who had arterial switch operation in the neonatal period were analysed. The patients were divided into two groups: those who had prenatal diagnosis (Group 1; n = 34) and those who did not (Group 2; n = 78). The patients were also classified based on their diagnosis: simple transposition, transposition with ventricular septal defect and/or aortic arch hypoplasia, and Taussig–Bing anomaly.Results:In Group 1, the C-section delivery rate was higher (82% vs. 44%; p = 0.004), and it was observed that patients in Group 1 were more often intubated upon admission to the neonatal ICU (38% vs. 9%; p = 0.005). No differences were found between the two groups in terms of operation time, cardiopulmonary bypass time, post-operative invasive respiratory support duration, or extracorporeal membrane oxygenation support. It was observed that those who had Taussig–Bing anomaly had a higher mortality.Conclusions:Timely treatment have a positive effect on neonatal mortality and morbidity. That’s why all families with prenatal diagnosis of critical CHD should be recommended to have the delivery in a tertiary care hospital. Although it could not be demonstrated in this study, prenatal diagnosis has a potential to improve surgical results especially in countries or cities, which does not have enough resources for transfer and surgical units. Further efforts are needed to improve prenatal screening programmes.

Acute kidney injury (AKI) is a common complication of congenital heart diseases (CHDs) after cardiac surgery. This study aimed to define the frequency and critical course, risk factors and short-term outcomes of AKI in postoperative CHD neonates. Postoperatively followed term CHD newborn infants were enrolled in the study. Infants with congenital anomalies of the urinary tract and other major congenital anomalies were excluded. Neonatal modified KDIGO criteria were used to assess AKI. A total of 199 postoperatively followed newborn infants were included in the study. Acute kidney injury was detected in 71 (35.6%) patients. Of these patients, 24 (33.8%) were in stage 1, 14 (19.7%) in stage 2, and 33 (46.5%) in stage 3. Acute kidney injury occurred within the first week (median 1 day [IQR 1–2 days]) of cardiac surgery in 93% of the patients. The duration of invasive respiratory support and extracorporeal membrane oxygenation (ECMO) and mortality were significantly higher in stage 3 patients. Higher vasoactive-inotropic score (OR, 1.02; 95% CI, 1.0–1.04; p = 0.008) and receiving ECMO (OR, 7.9; 95% CI, 2.6–24.4; p = 0.001) were associated with risk for the development of AKI. The mortality rate was 52.1% in the AKI (+) patients, and having AKI (OR 7.1; 95% CI, 3.5–14.18) was significantly associated with mortality. Acute kidney injury, a common early complication after critical neonatal CHD cardiac surgery, is associated with increased morbidity and mortality. Stage 3 AKI is associated with significantly higher mortality rates.

A complete sternal cleft is a very rare congenital anomaly causing severe respiratory compromise. Surgical reconstruction options are limited, particularly in low birth weight newborns. Herein, we report a case of low birth weight premature newborn with a complete sternal cleft and its surgical treatment.

T cell receptor excision circles (TRECs) and kappa-deleting excision circles (KRECs) are DNA fragments potentially indicative of T and B cell development, respectively. Recent thymic emigrants (RTEs) are a subset of peripheral cells that may also represent thymic function. Here, we investigated TREC/KREC copy numbers by quantitative real-time PCR in the peripheral blood of patients with primary immunodeficiencies (PIDs, n = 145) and that of healthy controls (HCs, n = 86) and assessed the correlation between RTEs and TREC copy numbers. We found that TREC copy numbers were significantly lower in children and adults with PIDs (P < .0001 and P < .002, respectively) as compared with their respective age-matched HCs. A moderate correlation was observed between TREC copies and RTE numbers among children with PID (r = .5114, P < .01), whereas no significant correlation was detected between RTE values and TREC content in the HCs (r = .0205, P = .9208). Additionally, we determined TREC and KREC copy numbers in DNA isolated from the Guthrie cards of 200 newborns and showed that this method is applicable to DNA isolated from both peripheral blood samples and dried blood spots, with the two sample types showing comparable TREC and KREC values. We further showed that RTE values are not always reliable markers of T cell output. Although additional confirmatory studies with larger cohorts are needed, our results provide thresholds for TREC/KREC copy numbers for different age groups. 34951041

We have read the paper by Leung 'The younger the milder clinical course of COVID-19: Even in newborns?' with interest.1 In the article, it was emphasized a severe disease course in neonates compared to the pediatric age group (1 months- 2 years of age) and possible mechanisms for severity in neonatal paeriod was discussed. As the number of people affected by this new coronavirus (SARS-CoV-2) infections, higher number of newborns have been reported.

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

Introduction: The exact definition of small-for-gestational-age (SGA) infant is still controversial among clinicians. In this study, we aimed to understand which definition is better in terms of establishing both early postnatal problems and growth. In this way, we compared early neonatal problems and infancy growth of term infants with birth weight (BW) < -2 SDS and with BW between 10th percentile (−1.28 SDS) and −2 SDS.Methods: A single center retrospective cohort study was conducted. Preterm infants, multiple gestations and newborns with any congenital anomalies were excluded from the study. Study group was defined as Group 1 (n = 37), infants BW < −2.00 SDS; Group 2 (n = 129), between −1.28 and −2.00 SDS; and Group 3 (n = 137), randomly selected newborns with optimal-for-gestational-age (BW between −0.67 and +0.67 SDS) as a control group.Results: The incidence of severe hypoglycemia was highest in Group 1 (%10.8) and Group 2 and 3 had similar rates of severe hypoglycemia (0.8 and 0.7%, respectively). The incidence of polycythemia was 5.4% in Group 1 and was significantly higher than Group 3 (0.0%) while it was 2.3% in Group 2. Short stature (length < −2 SDS) ratio at the age of 1 and 2 years were similar in each group. Overweight/obesity ratio at the age of 1 were 9.5, 20.8 and 16.7% in each group, respectively (p = 0.509).Conclusion: This study was planned as a pilot study to determine potential differences in the problems of hypoglycemia, polycythemia, and growth according to the differences in definition. Short term disturbances such as hypoglycemia and polycythemia are found to be higher in infants with a BW SDS below −2. From this point of view, of course, it will not be possible to change the routine applications immediately, however this study will be an initiative for discussions by making long-term studies.

Aim: To evaluate the adverse effects of noise on hearing. Methods: Thirty-two infants that had been admitted to neonatal intensive care unit (NICU) and 25 healthy controls were included in this study. Noise levels were recorded continously during the hospitalization period. Results: All healthy controls passed the hearing screening tests before discharge and on the sixth-month follow up. Hospitalized infants had lower "Distortion Product Auto Acoustic Emission Signal Noise Ratio" (DPOAE SNR) amplitudes (dB) at five frequencies (1001, 1501, 3003, 4004, 6006 Hz in both ears). DPOAE fail rates at 1001 Hz and 1501 Hz were higher than in hospitalized infants (81.8% and 50.0% vs 20.0% and 4.0%). Infants who failed the test at 1001 and 1501 Hz were exposed to noise above the recommended maximum level for longer periods of time. Conclusion: Hearing tests performed at sixth-months of life were adversely affected in NICU graduates.

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

Aim To evaluate the relationship between serum 25-hydroxy vitamin D, 25 (OH) D, levels and retinopathy of prematurity. Methods and Results Serum 25 (OH) D levels were measured in 97 very low birth weight infants, prior to vitamin D supplementation. The development of retinopathy of prematurity and its treatment requirement were evaluated. At follow-up, retinopathy of prematurity developed in 71 (73.2%) infants. Serum 25 (OH) D levels were significantly lower in infants with retinopathy of prematurity than ones without retinopathy of prematurity ( P Conclusion Lower 25 (OH) D levels in the first days of life may be related to retinopathy of prematurity development and treatment requirement in premature infants.

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV +VG and PSV+ VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV + VG or PSV + VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV +VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV + VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1 beta in the tracheal aspirates increased during both modes. CONCLUSION: PSV + VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV + VG. Therefore, PSV + VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.

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.

Purpose: To present the clinical features of the eyelid nodules observed in a newly determined dermatologic disorder, idiopathic facial aseptic granuloma (IFAG), and to compare them with children having acute hordeolum and chalazion. Methods: Duration of the lesion, localization, presence of coexisting facial nodules, management strategies, and response time to topical/oral antibiotics were retrospectively reviewed in 50 children with IFAG, acute hordeolum, or chalazion. Results: Fourteen children with one or more IFAG nodules on their eyelids, 28 children with one or more acute hordeolum, and 8 children with one or more chalazion were examined. Children with IFAG on their eyelids and face presented earlier than children with acute hordeolum ( P = .006). The duration of this lesion was similar among patients with IFAG on their eyelids and acute hordeolum ( P = .53). Duration of the lesion and treatment response time were shorter in children with IFAG on their eyelids and face ( P = .004) than in those with IFAG on their eyelids ( P = .013). The lesions of patients with chalazion had a longer duration compared to those with IFAG on their eyelids ( P = .005), IFAG on their eyelids and face ( P < .001), and acute hordeolum ( P = .04). Twenty patients with acute hordeolum recovered after topical antibiotics and had a similar treatment response time to those with IFAG on their eyelids and face ( P = .06) and those with IFAG on their eyelids ( P = .16). Conclusions: IFAG should be considered in the differential diagnosis of painless eyelid nodules in children. Because IFAG on the eyelids has many overlapping features with hordeola/chalazia, its differentiation may be difficult in the absence of accompanying facial granulomas. Chronic subepidermal eyelid nodules resembling skin abscess should alert clinicians for IFAG. Because IFAG responds well to oral clarithromycin, unnecessary surgical interventions should be avoided in these cases. [ J Pediatr Ophthalmol Strabismus . 2016;53(4):206–211.]

Purpose To evaluate the relationship between serum neutrophil-to-lymphocyte ratio (NLR) and development of retinopathy of prematurity (ROP). Methods Infants with a gestational age of ≤32 week were screened for ROP. Complete blood cell, high-sensitivity C-reactive protein, and interleukin 6 levels of subjects were measured within the first 24 hours of life. The NLR was calculated by dividing neutrophil count by lymphocyte count. The association between other risk factors and the development of ROP were analyzed using univariate analysis and multivariate logistic regression analysis. Results A total of 100 infants were included: 80 with ROP and 20 without ROP. The NLR values differed significantly between the ROP group (median, 0.67; interquartile range, 0.38-1.09) and non-ROP group (median, 0.32; interquartile range, 0.22-0.79; P = 0.02). The lymphocyte count in the ROP group (4.01 ± 1.89) compared to that of the non-ROP group (5.69 ± 2.16) was significantly lower ( P = 0.001). In multivariate analysis, lymphocyte count remained an independent predictor of ROP (OR = 0.599; 95% CI, 0.430-0.836; P = 0.003). Conclusions The NLR seems not to be an independent predictor of development of ROP. Lymphocyte count is inversely associated with ROP.

In this study, we aimed to investigate the additive effect of mesenchymal stem cells (MSC) and defibrotide (DFT) in a rat model of femoral arterial thrombosis.Thirty Sprague Dawley rats were included. An arterial thrombosis model by ferric chloride (FeCl3) was developed in the left femoral artery. The rats were equally assigned to 5 groups: Group 1-Sham-operated (without arterial injury); Group 2-Phosphate buffered saline (PBS) injected; Group 3-MSC; Group 4-DFT; Group 5-MSC + DFT. All had two intraperitoneal injections of 0.5 ml: the 1st injection was 4 h after the procedure and the 2nd one 48 h after the 1st injection. The rats were sacrificed 7 days after the 2nd injection.Although the use of human bone marrow-derived (hBM) hBM-MSC or DFT alone enabled partial resolution of the thrombus, combining them resulted in near-complete resolution. Neovascularization was two-fold better in hBM-MSC + DFT treated rats (11.6 ± 2.4 channels) compared with the hBM-MSC (3.8 ± 2.7 channels) and DFT groups (5.5 ± 1.8 channels) (P0.0001 and P= 0.002, respectively).The combined use of hBM-MSC and DFT in a rat model of arterial thrombosis showed additive effect resulting in near-complete resolution of the thrombus.El objetivo de este estudio consistió en investigar el efecto aditivo de las células madre mesenquimales (MSC, por sus siglas en inglés) y del defibrótido (DFT) en un modelo de trombosis arterial femoral en ratas.Se incluyeron 30 ratas Sprague Dawley. Se desarrolló un modelo de trombosis arterial mediante cloruro de hierro (FeCl3) en la arteria femoral izquierda. Las ratas se asignaron equitativamente en cinco grupos: grupo 1, intervención quirúrgica simulada (sin lesión arterial); grupo 2, inyección de solución salina tamponada con fosfato (PBS); grupo 3, MSC; grupo 4, DFT; grupo 5, MSC + DFT. Todas las ratas recibieron dos inyecciones intraperitoneales de 0,5 ml: la primera se administró 4 horas después del procedimiento y la segunda 48 horas después de la primera. Se sacrificó a las ratas siete días después de la segunda inyección.Aunque el uso por separado de MSC derivadas de médula ósea humana (hBM-MSC) o de DFT permitió una resolución parcial del trombo, la combinación de ambos tuvo como resultado la resolución casi completa. La neovascularización fue doblemente mejor en las ratas tratadas con hBM-MSC + DFT (11,6 ± 2,4 canales) en comparación con los grupos asignados por separado a hBM-MSC (3,8 ± 2,7 canales) y DFT (5,5 ± 1,8 canales) (P0,0001 y P= 0,002, respectivamente).El uso combinado de hBM-MSC y DFT en un modelo de trombosis arterial en ratas mostró que el efecto aditivo tuvo como resultado la resolución casi completa del trombo.

Objective To determine the changes in serum C-reactive protein (CRP) levels during therapeutic hypothermia. Study Design Between January 2011 and June 2013, 133 hypoxic-ischemic encephalopathy patients being followed up in the neonatal intensive care unit of Dr. Sami Ulus Maternity and Children's Hospital are prospectively evaluated. Group 1; patients that received therapeutic hypothermia (n = 74) and group 2; patients that did not required therapeutic hypothermia (n = 59). All the patients underwent serial complete blood cell count and CRP assessments; blood cultures were obtained from all the cases at the time of admission and when CRP levels were elevated. Results Positive blood cultures were encountered in five cases (6.7%) in group 1 while no blood culture–proven septicemia was encountered in group 2. The CRP levels elevated gradually reaching a peak level on the 4th day and then decreased during the therapeutic hypothermia in patients with no blood culture–proven septicemia in group 1. The CRP levels showed statistically significant changes reaching a peak level on the 7th day in patients with blood culture–proven septicemia in group 2. Also, the CRP levels showed no alteration with time in group 2. Conclusion Therapeutic hypothermia itself might be associated with CRP elevation rather than an actual infection.

UNLABELLED Cardiac rhabdomyoma is the most common primary cardiac tumor, is considered to be a hamartoma of developing cardiac myocytes. Cardiac rhabdomyoma is associated with tuberous sclerosis complex (TSC) in 50-86% of cases. Mutations in TSC-1/TSC-2 genes result in increased mammalian target of rapamycin (mTOR) pathway activation responsible for the hamartomatous lesions of tuberous sclerosis complex. Therapy with mTOR inhibitors is currently under investigation as a treatment option for tumors associated with TSC. In this report we present a case with multiple symptomatic rhabdomyomas associated with tuberous sclerosis complex, deemed to be ineligible for surgical removal, treated with everolimus (mTOR inhibitor). CONCLUSION As we observed in our patient, in cases with inoperable symptomatic rhabdomyomas associated with TSC, everolimus, an mTOR inhibitor, may be the treatment of choice, which should be confirmed with additional studies.

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.

OBJECTIVES: The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). METHODS: A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage ≥2), length of NICU stay, and death. RESULTS: A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture-proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14–36] vs 32 days [20–44], P = .07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). CONCLUSIONS: Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death.

We aimed to report newborns with thrombosis and needed fibrinolytic treatment.This was a retrospective study conducted on 27 newborns with thrombosis followed-up in a neonatal intensive care unit between December 2007 and December 2012. The patients were divided into two groups according to treatment protocol; Group 1 (n = 15): recombinant tissue-type plasminogen activator (r-tPA) and Group 2 (n = 12): streptokinase (STK). The groups were compared in terms of the efficacy and complications of the treatments.In Group 1, flow restoration was complete in nine (60%) patients, partial in two (13.3%), and absent in four (26.7%). In Group 2, flow restoration was complete in seven (58.3%) patients, partial in three (25%), and absent in two (16.0%). The incidence of complete/partial recovery was similar in the groups. There was no difference between the two groups with regard to the duration of thrombus resolution. Fibrinolytic treatment was terminated in seven patients (46.7%) in Group 1, while in three patients (25%) in Group 2 due to the complications. The most common complications were minor or major bleedings. There was no statistically significant difference with regard to all bleedings complications between the two groups (P = .08), although the incidence of skin hemorrhages was higher in Group 1 (P = .007). There was no significant difference between the mortality rates.Even though the use of STK is not further recommended because of its potential undesirable side effects in newborns, its efficacy and safety appears to be similar to those of r-tPA.

Objective The objective of the study was to evaluate the effects of exogenous surfactant on respiratory indices in term infants with respiratory failure. Methods Consecutive 18 mechanically ventilated term infants, who received a single dose of exogenous surfactant were retrospectively included into the study. The respiratory outcome of surfactant rescue therapy was evaluated by comparing respiratory indices before and six hours after surfactant administration. Findings Median oxygenation index (OI), mean alveolar pressure (MAP) and fraction of inspired oxygen (FiO2) values were significantly decreased (P

Background Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as “delayed transition”, others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. Methods Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. Results Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. Conclusion PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.

In addition to its nutritional benefits, human milk also has bioactive elements. Limited immunological functions of newborns are supported and altered by the immunological elements of mother milk. Chemokines are of importance among these immune factors. Interleukin-8 (IL-8) has been demonstrated in mother's milk, and its receptors, CXC chemokine receptors (CXCR)-1 and CXCR-2, were detected on cells, responsible for immunological reactions and mammary glandular cells. The soluble forms of these receptors are yet to be described in human milk. In this study, it was aimed to assess the IL-8 levels and the concentrations of its receptors in colostrum and mature mother's milk in regard to preterm and term delivery. The results of this study indicated a decline in IL-8 levels with the lactation stage, but no difference was observed between term and preterm mother's milk. Regarding the CXCR-1 and CXCR-2, the concentrations of these receptors were similar in both colostrum and mature milk. Furthermore, there was not any significant difference between term and preterm mother's milk. In conclusion, this is the first study to investigate the concentrations of CXCR-1 and CXCR-2 with the levels of IL-8 in colostrum and mature human milk of term and preterm newborns. The alterations in IL-8 levels were similar in some of the studies reported. CXCR-1 and CXCR-2 levels did not demonstrate any significant difference. Further studies are required to investigate the soluble forms of these receptors and their relation to IL-8 with larger cohort.

Retinopathy of prematurity (ROP) is a preventable cause of blindness in the neonatal period. The incidence of ROP has been on the rise due to the increasing number of viable premature infants in neonatal intensive care units. The importance of omega-3 (n–3) polyunsaturated fatty acids (PUFAs) has been shown in fetal and neonatal development, especially for brain and retinal tissues. Favorable effects of omega-3 (n–3) fatty acids in diabetic retinopathy and macular degeneration in adults have been shown but the underlying mechanism is still unclear. It is known that n–3 reduces the pathologic neovascularization and slows down the progression. Experimental findings support this data however, there are a few clinical trials assessing the effects of n–3 on ROP development. In this chapter; the possible association with n–3 and ROP development is discussed.

Aim: The aim of this study was to assess cerebral and peripheral oxygenation, by using near infrared spectroscopy (NIRS) and microcirculation by using side stream dark field (SDF) imaging in newborns with polycythemia before and after partial exchange transfusion (PET) therapy to investigate treatment effect on tissue oxygenation and microcirculation. Methods: Polycythemic newborns with venous haematocrit (Htc) >70% or ≥65% with symptoms were included. NIRS measurements for cerebral and peripheral oxygenation and SDF recordings for microcirculatory flow assessment were obtained before and after PET. Fractional tissue oxygen extraction (FTOE) was calculated based on tissue oxygenation index and oxygen saturation. Wilcoxon test was used for statistical analysis. Results: Fifteen newborns were included. Cerebral tissue oxygenation index, microvascular flow index and % of vessels with hyperdynamic flow increased after PET; median (range): 61.27 (51.36–61.87) versus 64.54 (54.1–74.38), 2.74 (2.46–3) versus 3.22 (2.64–3.75) and 0 (0–2.8) versus 3 (0–99.3), respectively. Whereas cerebral fractional tissue oxygen extraction (CFTOE), % of vessels with sluggish flow decreased after treatment; 0.36 (0.22–0.44) versus 0.31 (0.17–0.46), 1.4 (0–69) versus 0 (0–0.9), respectively. Peripheral oxygenation was unchanged. Conclusion: Partial exchange transfusion improves microcirculation in polycythemic newborns. Cerebral oxygenation increases and cFTOE decreases suggesting increased blood flow. Microvascular flow increases possibly representing reactive hyperperfusion after hemodilution. Whether these effects are beneficial require further research.

Uzm. Dr. Banu Aydin, Babur Cad. Altindag, Ankara, Turkiye Tel. 0505 591 24 40 Email. b_ay_yz@yahoo.com Gelis Tarihi: 08.10.2013 • Kabul Tarihi: 12.02.2014 ABSTRACT Vomiting of infants may result from an ineffi caciously functioning gastroesophageal junction or it may be associated with numerous serious diseases. Segmental bulbus dilatation of duodenum is a very rare gastrointestinal system pathology that can trigger vomiting by causing either motility disorder or gastroesophageal refl ux. In the case here presented, endoscopic examination showed a severely dilated bulbus duodeni with decreased motility. In contrast with the previous cases reported in literature, the condition was treated medically with success.

Background/aim: It has been suggested that plasma KL-6 increases in premature infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the predictive values of KL-6 in BPD. Materials and methods: The study was performed in preterm neonates with birthweight ≤1500 g and gestational age ≤32 weeks. Plasma KL-6 levels were measured on postnatal days 1, 7, and 14. Results: BPD was identified in eight of the 28 study infants. On postnatal days 1 and 7, plasma KL-6 levels were similar in infants with BPD [on day 1: 8.9 (7.5-17.8) U/mL and on day 7: 16.8 (10.5-47.7) U/mL] and without BPD [on day 1: 10.8 (9.4-17.2) U/mL and on day 7: 12.9 (5.8-19.3) U/mL] (P = 0.38 and P = 0.13, respectively). On day 14, KL-6 levels were significantly higher in infants with BPD [155.2 (15.3-545.6) U/mL] than they were in infants without BPD [7.9 (7.7-15.6) U/mL] (P = 0.001). The best predictor was KL-6 levels on postnatal day 14 (area under the ROC curve = 0.88; range 0.75-1.0; P = 0.002). At this point, KL-6 level of 59.7 U/mL showed a specificity of 90.0% and negative predictive value of 85.7% for BPD. Conclusion: High plasma KL-6 levels on postnatal day 14 in premature infants may predict the development of BPD.

Acute compartment syndrome of the forearm in newborns is often misdiagnosed and can be disastrous if left untreated. Here, we report a full-term infant of a diabetic mother with underlying heterozygosity for MTHFR C677T and A1298C alleles. A spontaneous thrombosis occurred in the left axillary artery immediately after birth. The patient responded well to anticoagulant (heparin) and thrombolytic (tissue plasminogen activator) agents. After reperfusion of the extremity, acute compartment syndrome developed. Emergent fasciotomy was performed. In this case, effective collaboration between pediatricians and orthopedic surgeons resulted in salvage of the extremity, with good clinical and functional results.

A premature baby who was hospitalized with the diagnosis of sepsis was treated with diode laser photocoagulation for aggressive posterior retinopathy of prematurity. Diffuse corneal ectasia and corneal hydrops developed in the right eye, and hyphema and corneal hydrops developed on the left eye on postoperative day 12. The patient died because of cardiovascular collapse and hemodynamic instability. Sepsis may be a contributory factor to the clinical susceptibility of the patient for the postoperative corneal effects of the laser. This situation has not been previously reported in the literature. [ Ophthalmic Surg Lasers Imaging Retina . 2015;46:984–985.]

Background: Nutrition of very low-birth-weight newborns is important for a good physical and neurologic outcome. Body composition assessment, together with anthropometric measurements, is considered necessary to monitor adequate nutrition and growth. Objectives of this study were to assess body fat changes in newborns

To determine the association between serum 25-hydroxy vitamin D [25(OH)D] levels and acute respiratory tract infections (ALRTI) in newborns.The study group consisted of 30 term newborns with ALRTI who were admitted to our neonatal intensive care unit. Controls were 30 healthy newborns with the same age as the study group. Newborns and their mothers were tested for serum 25(OH)D levels, with a low level defined as ≤15 ng/mL.The groups were similar in gestational week, birthweight, postnatal age and gender. Forty-three of the 60 infants (including study and control) had low 25(OH)D levels. The median 25(OH)D levels were lower [9.5 ng/mL (IQR = 7.9-12.2)] in the study group than those of the control group [15.5 ng/mL (IQR: 12-18)] (p = 0.0001). The median serum 25(OH)D levels in the mothers of the study group were also lower than those in the mothers of the control group [11.6 ng/mL (IQR = 9.4-15.8) and 17.3 ng/mL (IQR = 13.7-20.6), respectively] (p = 0.0001).Lower blood 25(OH)D levels might be associated with increased risk of ALRTI in term newborn babies. Appropriate vitamin D supplementation during pregnancy and early childhood may enhance newborns' respiratory health.