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Bronchopulmonary dysplasia (BPD) survivors from the surfactant era were evaluated by echocardiography in a few studies and no significant difference were found between BPD and non-BPD children. In this study, we evaluated these children with myocardial performance index (MPI), which was obtained by tissue Doppler echocardiography (TDE) in addition to the conventional methods. Fifteen children with BPD who did not have any cardiopulmonary symptoms at the time of the study were examined. All children were studied with M-mode, two-dimensional and DE. Pulmonary artery systolic pressures (PAPs) were estimated from tricuspid regurgitant velocity, and MPI for both ventricles were obtained by TDE. Results were compared with those of term- born, age- and sex-matched control children. While the variables obtained by M-mode and DE did not differ between the groups, the right and left ventricular MPI were found to be significantly higher in the BPD grou compared with the control group (mean right ventricular MPI 0.48±0.04 vs. 0.41±0.05; mean left ventricular MPI 0.47±0.05 vs. 0.39±0.06). In addition, mean PAPs values of the patients were found to be significantly higher tha those of the controls (30.4±6.9 mmHg vs 23.3±5.3 mmHg), and there was a positive correlation between PAPs and right ventricular MPI values in the BPD group (r=0.5). While routine echocardiographic examinations revealed no difference between the groups, MPI measurements by TDE technique yielded significantly higher values in the BPD group. To this extent, our stud is the first to show that survivors of BPD may, in fact, have a subclinica ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Fetal malnutrition is an important risk factor for both early and late neonatal outcome and adult diseases. In this study, we aimed to investigate the incidence and characteristics of fetal malnutrition and its impacts on early neonatal morbidity and mortality in preterm infants by using the clinical assessment of nutritional status score (CANSCORE). Preterm infants whose gestational ages were between 28-34 weeks were included in the study. Detailed prenatal and natal history, anthropometric measurements, and intrauterine growth status were defined, and CANSCORE was applied to all infants. Infants were separated into two groups according to total score as malnourished (total score <25) and well nourished (total score ≥25). Early and late neonatal morbidities, which were observed during the clinical progress, were noted in all infants. A total of 93 preterm infants were enrolled in the study. The incidence of fetal malnutrition was 54.8% (n=51) in all infants. The incidences of maternal hypertension and preeclampsia, oligohydramnios and disturbed umbilical artery Doppler flow in the prenatal period and the incidences of neonatal hypoglycemia, polycythemia, feeding intolerance, and necrotizing enterocolitis in the postnatal period were significantly higher in preterm infants with fetal malnutrition. Fetal malnutrition contributes significantly to many early and late neonatal morbidities in preterm infants, and it should be identified in every preterm infant in the first days of life for predicting neonatal outcome, even though they are appropriately grown. [ABSTRACT FROM AUTHOR]

Adenosine is produced in the inflammed and damaged lung where it plays roles in the regulation of inflammation and tissue remodeling. Adenosine deaminase (ADA) is an enzyme responsible for the degradation of adenosine. Our aim was to compare the levels of ADA between infants with and without respiratory distress syndrome (RDS) and to determine the relationship between plasma ADA levels and bronchopulmonary dysplasia (BPD). One-hundred and twenty-five premature infants who were admitted to our neonatal intensive care unit were included in the study. Eighty-one of these infants with RDS were study group and the other 44 infants without RDS served as controls. Blood collection was made in the first day of life at the end of 24th-h and was used for laboratory testing. In the RDS group, mean ADA level was 25.5 (±±4.5) U/l, and in controls it was 26.3 (±±5.7) U/l. There was no statistically significant difference ( p == 0.326) in these groups although there was a statistically difference of ADA levels between BPD (34.5 ±± 5.2 U/l) and non-BPD (24.6 ±± 4.1) patients ( p == 0.001). There was also a positive relationship between ADA levels and severity of BPD ( r == ++ 0.845, p == 0.01). Perinatal inflammation is the key mechanism of BPD. ADA level in early postnatal life is elevated in infants with BPD and may be related with perinatal inflammation. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the diagnostic sensitivity and specificity of C-reactive protein (CRP) and procalcitonin (PCT) in neonates who were born after preterm premature rupture of membranes (PPROM) and compare these with interleukin-6 (IL-6). The study involved 74 preterm neonates who were born after PPROM. IL-6, CRP, complete blood count and leukocyte ratios, and PCT levels were measured in the 1st day of life, and CRP, PCT, and blood counts were repeated on the 3rd day of life. Seventy-four infants with PPROM were divided into two groups according to the development of sepsis and infection (Group 1: sepsis, n=32; Group 2: no sepsis, n=42). There were no significant differences between these groups with respect to gestational age, birthweight and duration of membrane rupture. There were significant differences between the two groups in the 1st day CRP (Group 1:0.85 ± 1.36 mg/dl, Group 2:0.23 ± 0.25 mg/dl; p=0.016), 1st day PCT (Group 1:7.2± 7.6 ng/ml, Group 2, 1.6± 4.0 ng/ml; p<0.001), an 3rd day PCT (Group 1:9.01± 11.5 ng/ml, Group 2:1.34 ± 1.35 ng/m p=0.001) and IL-6 (Group 1:80.7 ± 67.2 pg/ml, Group 2:3.4 ± 3.5 ng/m p<0.001) levels. CRP levels were not significantly different between Group 1 (1.2 ± 1.7 mg/dl) and Group 2 (0.58± 1.1 mg/dl) on the 3rd day of life (p=0.059). CRP levels on the 1st day of life had a cut-off value of 0.72 mg/dl with a sensitivity and specificity of 56% and 58%, respectively. CRP levels on the 3rd day had a cut-off level of 0.78 mg/dl with 60% sensitivity and 63070 specificity. PCT levels had a cut-off level of 1.74 ng/ml with 76% sensitivity and 85% specificity on the 1st day of life, and of 1.8 with 89% sensitivity and 86% specificity on the 3rd day of life. Statistical analysis revealed that the cut-off value of 7.6 pg/ml for IL-6 had a 93% sensitivity and 96.70% specificity. Interleukin (IL)-6 is the most reliable marker for the detection of early-onset sepsis in preterm neonates with PPROM. Early PCT levels seemed to be more sensitive than early CRP in this population. [ABSTRACT FROM AUTHOR]

Ponderal index (PI) is a weight-height related parameter that is mainly used to assess the pattern of fetal growth in small-for-gestational age infants. We aimed to use PI for large-for-gestational age (LGA) infants who were born to diabetic or non-diabetic mothers, in order to predict the fetal growth pattern. One hundred sixty-six LGA infants born at the Department of Obstetrics, Hacettepe University Hospital, Ankara, Turkey were included in the study. The PI was calculated by using the following formula: PI = weight. (g) x 100/(height, cm)³ Sixty-seven (40%) of these infants were born to diabetic mothers. Maternal age, maternal weight and maternal weight gain during pregnancy were similar in the diabetic and non-diabetic groups. Mean birthweight, height and head circumference were similar in both groups, but median PI of infants of diabetic mothers was significantly higher than of infants of non-diabetic mothers (3.02 and 2.89, respectively, p<0.05). Fetal growth was different between LGA infants of diabetic and non-diabetic mothers, and PI provided useful information on the proportionality of fetal growth in LGA infants. [ABSTRACT FROM AUTHOR]

Although the etiology is not clear, neonatal neutropenia is frequently seen in infants of preeclamptic mothers in the first week of life. Bronchopulmonary dysplasia is a chronic pulmonary morbidity that is associated with fetal and neonatal inflammation and neutrophil activation. In this study, we aimed to investigate the relation between absolute neutrophil count and subsequent development of bronchopulmonary dysplasia in infants of preeclamptic mothers. Between January 2003 and December 2007, 84 infants of preeclamptic mothers and 91 controls who were born and admitted to Hacettepe University İhsan Doğramacı Children's Hospital Neonatal Intensive Care Unit were included in the study. Complete blood count including white blood cell and differential count and peripheral blood smears were noted from hospital records in all infants. Mean gestational age was 30.2 ± 1.7 weeks in the preeclamptic group and 30.7 ± 1.8 in the control group, while the mean birth weights were 1035 ± 177 g and 1042 ± 149 g, respectively. There were statistically significant differences between the two groups with respect to white blood cell, absolute neutrophil and platelet counts (p<0.05). There was a positive correlation between white blood cell count, absolute neutrophil count and the development of bronchopulmonary dysplasia (white blood cell count odds ratio [OR]: 3.5, 95% confidence interval [CI]: 1.8-8.8; absolute neutrophil count OR: 2.6, 95% CI: 1.2-6.3). Neonatal neutropenia, which is frequently seen in infants of preeclamptic mothers, may prevent the development of bronchopulmonary dysplasia. Increased white blood cell count may reflect a risk factor for the development of bronchopulmonary dysplasia but this should be tested in prospective studies. [ABSTRACT FROM AUTHOR]

Pertussis, or whooping cough, a highly contagious disease caused by Bordetella pertussis, is making a comeback globally and nationally in spite of reasonable vaccination coverage. Worldwide, there have been increasing reports of Bordetella pertussis infection among adolescents and adults, but the peak incidence and highest mortality occur among infants. We report a 19-day-old female infant presenting with progressive respiratory failure. The mother was the only familial contact who complained of mild cough. However, occasional apneic episodes with cyanosis and peripheral lymphocytosis prompted us to examine the presence of Bordetella pertussis, which remains a significant cause of morbidity and mortality in unimmunized infants. Understanding the source of pertussis transmission to infants may provide new approaches to prevent pertussis in the most vulnerable infants. Various potential strategies have been reviewed or recommended in countries with the aim of better protecting infants against pertussis. Public health measures to prevent the disease could be strengthened and booster vaccinations against pertussis considered. [ABSTRACT FROM AUTHOR]

Genetic polymorphisms in the gene that codes for endothelial nitric oxide synthase (eNOS) have been associated with less nitric oxide availability and with various cardiovascular diseases in humans. The objective of this study was to analyze the genotype distributions and allele frequencies for the Glu298Asp (G894T) and T(-786)C polymorphisms of the eNOS gene among neonates with respiratory distress in comparison to healthy control subjects. Fifty premature neonates with respiratory distress and 55 neonates without any respiratory problem were included in the study. Genomic DNA from all the neonates was analyzed by polymerase chain reaction. A polymerase chain reaction-restriction fragment length polymorphism analysis of eNOS gene polymorphisms was performed, and the results were compared. There were no significant differences between the groups regarding either genotype distributions or the allele frequencies for the Glu298Asp and T(-786)C polymorphisms. These results suggest that eNOS Glu298Asp and T(-786)C polymorphisms are not associated with development of respiratory distress. [ABSTRACT FROM AUTHOR]

Placental chorioangioma and thrombosis of an umbilical vein varix are rare etiologic factors of non-immune hydrops fetalis. Herein, we report a patient who had hydrops fetalis associated with placental chorioangioma and thrombosis of an umbilical vein varix. This is the first report of coexistence of non-immune hydrops fetalis with placental chorioangioma and thrombosis of an umbilical vein varix. [ABSTRACT FROM AUTHOR]

Aim: To determine lipid peroxide concentrations in the first 10 days of life.Methods: Malondialdehyde concentrations were investigated in neonates with or without hyperbilirubinaemia during the first 10 days of life.Results: Serum malondialdehyde concentrations were higher in infants with hyperbilirubinaemia than in controls. A positive correlation was found between malondialdehyde and bilirubin concentrations in the study group. When the study group was categorised according to the presence of haemolysis, a significant correlation was found between malondialdehyde and bilirubin concentrations in those infants with hyperbilirubinaemia due to haemolysis. There was no such correlation in those without haemolysis.Conclusion: Exchange transfusion rapidly produces variable changes in pro-oxidant and antioxidant plasma concentrations in neonates, which may be responsible for free radical metabolism. The fall in malondialdehyde concentration is probably directly related to its exogenous removal by exchange transfusion. [ABSTRACT FROM AUTHOR]

Arginine is an essential amino acid in the fetus and neonate and is a conditionally essential nutrient for adults. As a precursor for the synthesis of nitric oxide (NO) and other molecules that have enormous biologic importance and as a stimulant to the production of growth hormone, L-arginine plays versatile key roles in nutrition, immunodefense and metabolism. The objectives of this study were to investigate whether there is a relationship between morbidity, mortality, and plasma arginine levels, and to determine whether long-term arginine-supplemented enteral nutrition affects morbidity, mortality, hospital stay, and growth parameters in premature infants with birth weight ≤1500 g and gestational age ≤34 weeks. In this placebo-controlled study, 53 preterm infants with a birth weight of ≤1500 g and gestational age ≤34 weeks were prospectively, randomly assigned to receive enterally supplemental L-arginine (250 mg/kg per day, study group; n=27) or sterile water (placebo) (control group; n=26). Nine infants from the study group and nine infants from the control group were lost to follow-up; 18 infants from the study group and 17 infants from the control group completed the study. Blood samples for plasma arginine levels on the 1st and 15th days of life and at the postconceptional 40th week were collected. Growth parameters (weight, length, head circumference, right upper arm mid-circumference and right thigh mid-circumference) were measured on the 1st and 15th days of life and at the postconceptional 40th week. Arginine supplementation was discontinued at the end of the postconceptional 40th week. There were no significant differences in growth parameters on the 15th day and at the postconceptional 40th week between the study and control groups. There was no relationship between plasma arginine levels on the 1st day, 15th day, and at the postconceptional 40th week and either synchronized growth parameters or morbidity and mortality in all infants. There was also no difference between the supplemented group and control group in terms of incidence of morbidity and mortality. We concluded that arginine supplementation by enteral route alone in premature infants does not affect the growth parameters, morbidity or mortality. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is one of the most important chronic morbidities of very low birth weight infants and is associated with significant comorbidities and high risk of mortality both in the neonatal intensive care unit (NICU) and long-term follow-up periods. In our country, there are few studies related with the characteristics of short- and long-term follow-up of infants with BPD. In this study, we aimed to define the demographic and clinical characteristics of infants with BPD in the last 10 years in our hospital, retrospectively. In the last 10 years, the incidence of BPD among very low birth weight infants was found to be 21.1% in our NICU. One hundred cases could be included in the study, and among them, 26 (26%) were mild BPD, 59 (59%) were moderate BPD and 15 (15%) were severe BPD according to the severity of the disease. The mean gestational age of the cases was 28.6±1.8 (25.4-34.8) weeks, while the mean birth weight was 1087±288 (600-2060) g. The number of male infants was higher than of females (61, 61%), and 85 (85%) cases were found to receive aggressive resuscitation at birth. On admission to NICU, 45% (n=45) of the cases were hypothermic and 76% (n=76) were hypotensive in the first 24 hours of life. During the NICU period, 69% (n=69) of the cases were found to develop respiratory distress syndrome, while 53% (n=53) developed pneumonia, 62% (n=62) patent ductus arteriosus, 33% (n=33) necrotizing enterocolitis, 67% (n=67) neonatal sepsis, 44% (n=44) intraventricular hemorrhage, and 34% (n=34) retinopathy of prematurity. Ten cases (10%) died during the NICU period. Home oxygen therapy was initiated in 69 (76.7%) of the discharged cases. Hypoxia, hypercarbia and hypocarbia in arterial blood gas analysis in the first three days of life were found to be the most important risk factors for the development of severe BPD. Fifty cases could be evaluated at corrected age of 12-24 months during the long-term follow-up. Of these, 11 (22%) had growth failure, 8 (16%) had cerebral palsy, 12 (24%) had severe retinopathy of prematurity, and 9 (18%) had hearing impairment. Rehospitalization rate was 47.8% (n=43) among discharged patients. The majority of the rehospitalized patients (18, 23.4%) had pneumonia, acute bronchiolitis (12, 15.6%) and sepsis (8, 10.4%). In conclusion, the short- and long-term management of BPD is complicated and requires a multidisciplinary approach. In our country, multicenter studies are needed to obtain comprehensive data about short- and long-term follow-up of infants with BPD. [ABSTRACT FROM AUTHOR]

Chryseobacterium meningosepticum is a gram-negative bacterium, which is pathogenic for preterm infants and immunocompromised adults, especially in intensive care units. This study is a documentation of an outbreak in a neonatal intensive care unit (NICU) and demonstrates the outcome and prognosis of infected infants. A total of 16 infants infected by C. meningosepticum during a one-year period were included in the study. The source of the bacteria could not be explained clearly but the environment and respiratory equipment were the most probable sources. Pneumonia was the most important complication because of its association with a high mortality rate (60%). Hydrocephalus occurred in three patients and resulted in severe neurologic sequelae. We concluded that C. meningosepticum is a fulminant microorganism that spreads rapidly as an outbreak in NICUs and causes serious complications such as pneumonia, meningitis, hydrocephalus, and long-term morbidities. [ABSTRACT FROM AUTHOR]

Perinatal mortality statistics are important indicators of the quality of the perinatal health care system on an institutional or national basis and are necessary for the identification of the problems and implementation of preventive measures in the perinatal health care system. However, perinatal mortality statistics on an institutional or national basis are inadequate in Turkey. In this study, we aimed to make a comprehensive perinatal mortality analysis of the 2001-2006 period in our tertiary care university hospital and to compare results with previous reports of our institution. The Perinatal Mortality Study Group prospectively analyzed the perinatal mortality cases regularly each month. The study group was composed of stillbirths including intrauterine and intrapartum deaths, pregnancy terminations and early neonatal deaths occuring after 22 completed weeks of gestation until the end of the 7th day of postnatal life or in cases with a birth weight of at least 500 g. The definitions of the World Health Organization were used for the calculation of perinatal, stillbirth and early neonatal mortality rates. Wigglesworth and de Galan-Roosen "fundamental" perinatal mortality classifications were used for the distribution of the cases. During the study period, 353 perinatal mortality cases were identified. Of these, 219 (62%) were stillbirth (28.3% intrauterine death, 7.4% intrapartum death and 26.3% pregnancy terminations) and 134 (38%) were early neonatal deaths. The distribution of cases according to Wigglesworth classification was as follows: intrauterine deaths 10.8%, congenital malformations 35.5%, prematurity 25.2%, perinatal asphyxia 12.5%, and special causes 15.9%. According to de Galan-Roosen "fundamental" classification, 0.6% trauma, 2.8% infection, 9.0% placenta-cord pathology, 3.1% maternal immune system pathology, 36.3% congenital malformations, 25.2% prematurity, and 13.0% unclassified cases were identified. Mean stillbirth rate was 21.9‰, while early neonatal mortality rate was 13.7‰ and perinatal mortality rate was 35.3‰ for the whole study period. In spite of a progressive decline in all mortality rates from 2001-2004, an approximately 1.5-2.8-fold increase was detected from 2005-2006. The ratio of stillbirths to total births increased from 1.6% in 2004 to 2.9% in 2006, and the ratio of early neonatal deaths to live births increased from 0.7% in 2004 to 1.8% in 2006. The analysis of the causes of early neonatal mortality showed a four-fold increase in prematurity from 0.3% in 2004 to 1.2% in 2005-2006 but similar rates of congenital malformations, perinatal asphyxia and special causes between the two periods. In our hospital, prematurity rate ranged between 19.2-24.6% during the 2001-2006 period.However, the ratio of very premature infants (gestational age <28 weeks) increased approximately two-fold from 4.4% in 2004 to 8.2-9.6% in 2005-2006. It is concluded that the perinatal mortality rate, which declined during from 2001-2004, showed an increase due mostly to increased early neonatal mortality rate and then stillbirth rate. The increased ratios of high-risk very premature infants among live births and of intrauterine deaths and pregnancy terminations among total births due to late referral seem to be the most important factors contributing to increased early neonatal mortality and stillbirth rates. [ABSTRACT FROM AUTHOR]

Gestational age of a newborn infant can be determined by the last menstrual period of the mother, early prenatal obstetric ultrasonography and postnatal scoring systems based on examination of physical and neuromuscular maturation of the newborn infant. However, gestational age is already accurately known in pregnancies conceived with assisted reproductive technologies such as in vitro fertilization, intracytoplasmic sperm injection (ICSI), ovulation induction, and in utero insemination. The aim of this study was to determine the accuracy and validity of the New Ballard Score in newborn infants born from ICSI pregnancies in which gestational ages were accurately known. Between June 2005 and November 2007, we examined 430 newborns born from ICSI pregnancies at Hacettepe University Hospital. Gestational ages of the subjects ranged from 23 to 40 weeks and 3 days. The correlation coefficient between the real gestational ages and gestational ages determined by New Ballard Score was 0.98 and regression line was linear (y=0.73+0.97x). The greatest correlation between the real gestational ages and gestational ages determined by the New Ballard Score was found in newborn infants younger than 28 weeks of gestational age (r=0.91, p<0.001) when all infants were divided into different gestational age groups. A statistically significant positive correlation between the real gestational ages and gestational ages determined by the New Ballard Score was found in singleton and multiple pregnancies (singleton: r=0.98, p<.0.001; multiple pregnancies: r=0.97, p<0.001). There was a statistically significant positive correlation between real gestational ages and gestational ages determined by the New Ballard Score in infants of hypertensive, diabetic and advanced aged mothers (infants of hypertensive mothers: r=0.95, p<0.001; infants of diabetic mothers: r=0.97, p<0.001; infants of advanced aged mothers: r=0.97, p<0.001). It was concluded that the New Ballard Score is a valid and accurate gestational age assessment tool for the entire newborn infant population. [ABSTRACT FROM AUTHOR]