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Background: We aimed to determine the course of serum creatinine (sCr), serum cystatin C (sCysC) and urine cystatin C (uCysC) levels and calculate estimated glomerular filtration rate (eGFR) by using sCr- and sCysC-based formulas in preterm infants in the first 28 days of life. Methods: A total of 52 neonates were included in this prospective study. According to gestational age (GA), the neonates were divided into three groups. Group 1 composed of neonates who were born ≤28 weeks (n=15), group 2 and 3 consisted of infants who were born 29-31 weeks (n=16) and 32-34 weeks (n=21), respectively. Blood and urine samples were obtained at the 24-48 hours of life and then weekly until 28th day of life. sCr- and sCysC-based formulas were applied to determine the value and course of eGFR. Results: sCr level was negatively correlated with GA (r=-0.36, p=0.014) but not with BW (r=-0.15, p=0.31). While sCr levels showed significant variations in all study groups on day 7, day 14, and day 21 however, sCysC did not differ by GA at any time-points. All study groups had significantly different uCysC levels, except day 28. eGFR results calculated with sCr-based formula were detected to be closer to inulin. Conclusion: In preterm infants, sCr seemed to be a more reliable marker than sCysC to calculate eGFR. Moreover, in the same population, uCysC levels may reflect renal maturation more than sCysC.

Despite the development of new antiseizure drugs (ASDs), around one third of epilepsy patients become refractory to treatment or experience adverse events due to ASDs. Therefore, discovery of new ASDs and new therapy options are crucial to improve the quality of life. Herein, we report a 3-year-old child with multi-drug resistant epilepsy caused by perinatal asphyxia whose seizures were reduced by 90% after the introduction of ketogenic diet, vagal nerve stimulation (VNS) AspireSR (SR-seizure response) and oral cannabidiol.

Aim: For many years, colistin has not been considered a first-line treatment due to its toxic side effects. However, its use has recently been reevaluated as a last resort in the treatment of neonatal infections caused by multidrug-resistant (MDR) gram-negative bacteria (GNB). Accordingly, in this study we aimed to contribute to the literature by investigating the efficacy and nephrological effects of colistin use in neonates. Materials and Methods: The retrospective study was conducted in the neonatal intensive care unit of a tertiary university hospital between January 2015 and February 2019 and included 30 patients who received intravenous treatment with colistin for culture-proven hospital-acquired GNB infections. We analyzed the serum sodium, potassium, phosphate, calcium and magnesium levels, urea, creatinine, aspartate aminotransferase and alanine aminotransferase values, and urine outputs measured on the 1st, 3rd, and 10th days of treatment. Results: All patients were treated with colistin for at least 10 days (mean 16.07±3.22 days) and the treatment dose was 5 mg/kg per day. We observed a statistically significant difference between the 1st- and 10th-day urea, creatinine, calcium, magnesium, and urine output values (p˂0.05). Similarly, when we compared the measurements recorded on the 1st and 10th days of treatment, we found that the magnesium and calcium levels were significantly decreased (p=0.008 and p=0.038, respectively) while the urea, creatinine, and urine output values were significantly increased (p=0.027, p=0.022, p=0.001, respectively). Discussion and Conclusion: Colistin is an effective agent in the treatment of MDR-GNB infections in neonates. Neonates should be closely monitored for nephrotoxicity during treatment with colistin. The efficacy and safety of neonatal treatment with colistin should be investigated with further, larger-sample studies.

Aim: Vancomycin resistant enterococci (VRE) colonization is an important issue for healthcare recipients. The aim of this study is to determine the prevalence of VRE colonization in patients at the admission to the neonatal intensive care unit (NICU). Materials and Methods: In this retrospective study the medical records of patients who hospitalized to NICU between January 2010 to December 2019 were analyzed. At the admission, patients whose rectal cultures were detected as VRE colonization were evaluated for demographic characteristics for the risk factors of colonization. Results: One thousand three hundred twenty-three patients were admitted to our NICU from different centers were enrolled. Rectal VRE colonization was observed in 60 of 1323 (4.54%) patients. Sixty-five percent (39/60) of patients with rectal VRE colonization had no previous hospitalization history. Among these 60 patients 28 of them were admitted to our NICU in the first week of their life. Conclusion: Although hospitalization still remains an important risk factor for VRE colonization, we found that there is also a high rate of VRE colonization in newborns without a history of hospitalization or frequent outpatient admissions to pediatrics departments. That is a worrisome status that suggests that colonization may be developed in low risk areas of the hospital such as delivery room, operating room or recovery room.

Objective ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. Study Design This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. Results The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p Conclusion In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. Key Points

The birth weight (BW) for gestational age (GA) ensure a fair assessment of the nutritional status of small for gestational (SGA) infants. Ponderal index (PI) is used to identify wasting. This study aims to evaluate the association between PI values and short-term complications of term SGA infants and evaluate the reliability of PI. A total of 489 term SGA infants were included in this retrospective study. According to the PI values, the neonates were divided into three groups. Group 1 consisted of infants with low PI (PI < 10th percentile) (n=45), group 2 consisted of infants with appropriate PI (PI 10th-90th percentile) (n=405) and the ones with high PI (PI> 90th percentile) (n=39) constituted group 3. Demographic and clinical data of the mothers and neonates including clinical and laboratory assessments were collected and compared statistically. No difference was observed between the groups other than the incidence of hypoglycemia, jaundice requiring treatment and hospitalization rate, which were all significantly higher in low PI group than the group 2 and 3 (p=0.01, p=0.006 and p=0.04, respectively). None of the babies had severe morbidity or died.Conclusion: Although short-term complications were higher in term SGA infants with low PI, all term SGA infants should be defined as high-risk neonates and deserve special neonatal care and surveillance to prevent short-term complications.

Pandrug-resistant (PDR) bacterial infections in intensive care units are emerging as a severe problem. Therefore, new antibiotic options are urgently needed for the treatment of PDR infections in pediatric age groups, especially neonates. Herein, we report a 25 days old preterm neonate successfully treated with ceftazidime-avibactam due to a urinary tract infection caused by PDR Klebsiella pneumoniae. We aimed to describe our experiences about the safety and efficacy of ceftazidime-avibactam treatment.

Childhood obesity can cause hyperlipidemia and hepatic steatosis at early age and chronic disease complications in adult life. We aimed to evaluate the relationship between abdominal subcutaneous fat thickness (ASFT) and hepatic steatosis, serum lipid and transaminase levels in obese children.A retrospective study was conducted with children (aged 4-18 years) who presented to outpatient clinic due to obesity. Associations between ASFT as assessed by ultrasonography (US) and hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and serum lipid profile were evaluated.We identified 95 children, all of which were diagnosed as having hepatic steatosis; the most common type was grade 1 (73.6 %, n: 70), followed by grade 2 (21.1 %) and grade 3 (5.3 %). The mean values of midline and flank ASFT were measured as 38.48 ± 11.53 mm and 20.91 ± 8.00 mm in grade 1; 41.23 ± 10.03 and 19.84 ± 6.75 in grade 2 and 63.12 ± 12.08 and 23.22 ± 5.92 in grade 3 hepatic steatosis, respectively. Midline and flank ASFT correlated positively with triglycerides in grade 3 steatosis, while midline ASFT correlated with body mass index, total cholesterol, low-density lipoprotein cholesterol, and AST (r: 0.9; p: 0.037; r: 0.648, p: 0.001; r: 0.387, p: 0.001; r: 0.406, p: 0.001, r: 0.463, p: 0.001; respectively) in grade 1 steatosis.ASFT as assessed by US may be of predictive value for hyperlipidemia in grade 3 and for hypercholesterolemia in grade 1 hepatic steatosis in obese children.Introducción. La obesidad infantil puede causar hiperlipidemia y esteatosis hepática y complicaciones crónicas. Nuestro objetivo fue evaluar la relación entre el espesor de la grasa subcutánea abdominal (GSA) y la esteatosis hepática, las transaminasas y los lípidos séricos en niños obesos. Población y métodos. Estudio retrospectivo en niños (4-18 años) que acudieron a los consultorios externos. Se evaluaron las asociaciones entre el espesor de la GSA mediante ecografía y la esteatosis hepática, alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y el perfil lipídico sérico. Resultados. Se identificaron 95 niños con esteatosis hepática; el grado 1 fue el más frecuente (73,6 %, n: 70), seguido del grado 2 (21,1 %) y del 3 (5,3 %). El espesor medio (en mm) de la GSA de línea media y flancos fue 38,48 ± 11,53 y 20,91 ± 8,00 en grado 1; 41,23 ± 10,03 y 19,84 ± 6,75 en grado 2, y 63,12 ± 12,08 y 23,22 ± 5,92 en grado 3, respectivamente. El espesor de la GSA de línea media y flancos se correlacionó positivamente con triglicéridos en grado 3; el espesor de la GSA de línea media se correlacionó con el índice de masa corporal, colesterol total, colesterol LDL y AST (r: 0,9; p: 0,037; r: 0,648; p: 0,001; r: 0,387; p: 0,001; r: 0,406; p: 0,001; r: 0,463; p: 0,001; respectivamente) en grado 1. Conclusión. El espesor de la GSA mediante ecografía puede predecir hiperlipidemia en niños obesos con esteatosis hepática de grado 3 e hipercolesterolemia en grado 1.

OBJECTıVE: The aim of this study is to develop a scoring system for the prediction of intraventricular hemorrhage (IVH) in preterm infants in the first 7 days of life.A prospective, clinical study was conducted in Bahcesehir University, Medical Park Goztepe Hospital Neonatal Intensive Care Unit, with the enrollment of 144 preterm infants with gestational age between 24 and 34 weeks. All preterms were followed up for IVH after birth until the 4th week of life. The demographic characteristics and clinical risk factors were noted. Risk factors were analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrence of IVH within the first 7 days of life. The IVH scores were further applied prospectively to 89 preterm infants as validation cohort.Low gestational age (GA), low Apgar score, and having bleeding diathesis were the most important risk factors for IVH. According to these risk factors, a scoring system was developed for IVH ranged from 0 to 5. According to the risk ratios (RR) obtained from the logistic regression model, low GA (≤ 28 gestational week), presence of bleeding diathesis within 7 days, and low Apgar score increased the risk of IVH (RR = 3.32 for GA ≤ 28 gestational week, RR = 6.7 for presence of bleeding diathesis in 7th day, RR = 3 for having low Apgar score). The score was validated successfully in 89 infants. The area under ROC curve was 0.85 for derivation cohort and 0.807 for validation cohort. The predictive ability of the IVH score for derivation and validation cohort was calculated. The negative predictive values of a score less than 4 were 96.4 and 59.1%. CONCLUSıON: Concerning IVH-related sequelae which continue to be a major public health problem, we have developed a feasible predictive model for evaluating the risk for developing IVH for preterm infants in the first 7 days of life.

The postnatal growth and retinopathy of prematurity (G-ROP) study has proposed a new model for retinopathy of prematurity (ROP) prediction based on gestational age, birth weight and postnatal weight gain. The purpose of the current study is to assess the efficacy of the G-ROP model for predicting ROP among a Turkish cohort of premature infants. Records of infants who underwent ROP screening examinations between 2012 and 2019 were reviewed retrospectively. Infants with a documented ROP outcome and regular body weight measurements until day 40 of life were included. The G-ROP model was applied to the study group. The outcome measures were sensitivity and specificity of the model for detecting any stage ROP and treated ROP. A total of 242 infants were included. The G-ROP model identified 168 infants to be screened for ROP. The sensitivity was 88.3% for detecting any stage ROP and 91.2% for treated ROP. The specificity for any stage ROP and treated ROP was 51.7% and 34.1%, respectively. The incorporation of bronchopulmonary dysplasia to the model increased the sensitivity to 100% with 22.7% reduction in the number of screened infants. The G-ROP model is a simple and effective method for ROP prediction. However, in the current cohort, a small number of infants requiring treatment would be missed if G-ROP criteria were applied. The model may be modified with addition of bronchopulmonary dysplasia to detect all treatment requiring cases. Prospective studies among larger groups are necessary to assess the applicability of the modified model.

Purpose To determine macular thickness in 3- to 6-year-old children who were born preterm compared with age-matched controls born at term. Methods Children 36-72 months of age born ≤34 weeks and age-matched control children born at term were included in this prospective case–control study. Macular thickness measurements obtained using spectral domain optical coherence tomography were compared between groups and correlations of macular thickness were investigated in the preterm group. Results A total of 45 preterm children (median age, 57.7 months) and 44 controls (median, 56.1 months) were included. Central macula thickness (CMT) was significantly higher (P = 0.010) and perifoveal thickness was significantly lower (P = 0.029) in the preterm group compared with the control group. Moderate negative correlations of CMT with gestational age and birth weight were found in the preterm group. Best-corrected visual acuity was similar between groups and was not correlated with CMT in the preterm group. No significant difference in macular thickness was found between subjects who had retinopathy of prematurity and those who did not. Conclusions Compared with controls, children in the preterm group had thicker retinas at the central macula and thinner perifoveal retinas. These subtle alterations were not correlated with visual acuity and may be considered a reflection of prematurity.

Neonatal meningoencephalitis is a severe condition for the developing brain of a newborn. Radiologic findings of necrosis and liquefaction due to hemorrhagic meningoencephalitis may be confused with brain abcess. In this article, we report a neonate having liquefaction necrosis due to hemorrhagic meningoencephalitis mimicing intracranial abscess due to Proteus mirabilis. We would like to describe the clinical course and evolution of brain imaging and emphasize the importance of the serial MR imaging (MRI).

Background Meningomyelocele (MMC) is a condition that is originated by the fusion defect of the neural tube. It is a congenital anomaly and can be characterized by spinal cord defects and impaired skin integrity. It is very important to close the skin openings via three-dimensional artificial skin like construction for preventing infection and maintaining the healthy skin structure. Therefore, we aim to generate artificial skin like structures formed by the own cells of donor for treating the MMC-related skin disorder. Methods In this study, waste placental tissues were collected and decellularization process was applied. Decellularized and normal placental tissues were compared by immunohistochemistry (IHC). Donor’s own placental stem cells were seeded onto biological scaffold and were differentiated into skin related cell types. Finally, gene expressions were evaluated, and the structural integrity were analyzed with IHC. Tube formation assay was also performed for examining the angiogenesis formation of the tissue in order to evaluate the possibility of a healthy organ development. Results Characterization experiments proved that the decellularized skin preserved a normal skin 3D construction and vasculature along with significant ECM arrangements. The well-kept placental ECM scaffold was cytocompatible, supportive of mesenchymal cell types. Native organ related scaffold is expected to carry a huge influence in skin tissue engineering via delivering a niche for skin-based cells and even for stem/progenitor cells. Regarding to the data obtained from this study, in vivo investigation the skin-like structure in animal models is thought to be the next step as a future prospect. Conclusion This study is a reference investigation for skin engineering based on placental stem cells and biological scaffolds.

The early diagnosis of tuberous sclerosis complex (TSC), especially during the neonatal period is rare. If there is a family history, foetal cardiac masses diagnosed by foetal echocardiography, may suggest TSC. After the delivery, in the neonatal period, TSC should be rule out. We report a case who had TSC and diagnosed early in the neonatal period. We would like to describe the clinical features of TSC and emphasize the importance of early diagnosis.

Bronchiolitis is the most common cause of lower respiratory tract infection and hospitalization in infancy and some of the patients may require admission to Intensive Care Unit (ICU) due to severe form of the disease. The aim of this study was to determine the risk factors for ICU need. The study group was composed of 30 patients admitted to ICU with the diagnosis of bronchiolitis and 30 bronchiolitis patients that were treated in the regular ward at the same period were enrolled to the study as the control group. Clinical characteristics, laboratory and imaging data were collected and compared statistically. The mean age of the patients was 33.6 +/- 24.4 days and 202.8 +/- 179.8 days in the study and control groups respectively, p

Neonatal meningoencephalitis is a severe condition for the developing brain of a newborn. Radiologic findings of necrosis and liquefaction due to hemorrhagic meningoencephalitis may be confused with brain abcess. In this article, we report a neonate having liquefaction necrosis due to hemorrhagic meningoencephalitis mimicing intracranial abscess due to Proteus mirabilis. We would like to describe the clinical course and evolution of brain imaging and emphasize the importance of the serial MR imaging (MRI).

AIM: To detect the impact of insulin-like growth factor-1 (IGF-1) and other risk factors for the early prediction of retinopathy of prematurity (ROP) and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels. METHODS: The study was conducted with 127 preterm infants. IGF-1 levels in the 1st day of life, 1st, 2nd, 3rd and 4th week of life was analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrences of any stage ROP. A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated. RESULTS: Birth weights (BW), gestational weeks (GW) and the prevalence of breast milk consumption were lower, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were more frequent, the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP (P

Split notochord syndrome (SNS) is a very rare congenital anomaly. This report describes a male newborn with a neuroenteric cyst in the posterior mediastinum and multiple vertebrae anomalies presenting with respiratory failure and pulmonary hypertension. This report also discusses the embryological development and the etiologic theories of SNS.

Psödohipoaldosteronizm, aldosterona hedef organlarda direnç sonucu aşırı tuz kaybı, hiponatremi, hiperkalemi, metabolik asidoz ve hiperreninemik hiperaldosteronizm olarak tanımlanan nadir görülen bir hastalık grubudur. Olgu sunumunda postnatal 8. gününde dehidratasyon, hiperkalemi ve hiponatremi kliniği ile başvuran bir psödohipoaldosteronizm olgusu sunulması ve tedavisinin tartışılması amaçlanmıştır., Pseudohypoaldosteronism is a rare disease and develops as a result of resistance to aldosterone in target organs that causes excessive salt lost, hyponatremia, hyperkalemia, metabolic acidosis and hyperreninemia. An 8-day-old boy was transferred to our hospital because of dehydration, hyperkalemia and hyponatremia and was diagnosed pseudohypoaldosteronism. We aimed to discuss our case and the treatment of pseudohypoaldosteronism

Aim We aimed to evaluate nosocomial infection (NI) rate and antimicrobial susceptibilities of microorganisms causing NI in our Neonatal Intensive Care Unit (NICU). Material and method NI afflicting infants admitted to NICU of Bahcesehir University Goztepe Medicalpark Hospital between January 2012 and December 2012 were assessed using Centre For Disease Control And Prevention (CDC) criteria. Only culture-positive infants were enrolled. Results Of 328 infants, 49.1% were preterm. Thirty-five nosocomial infections occurred in 19 (6.4%) patients. Incidence density was 6.8/1000 patient-days. Attact rate per patient was 1.84. Two infants (10.5%) succumbed to death, one with a liver abscess due to Staphylococcus epidermidis, other with Candida albicans sepsis. Ventilator associated-pneumonia (VAP) rate (n = 4) 2.3/1000, sepsis rate (n = 19) 5.7/1000, UTI rate (n = 10) 1.5/1000, wound infection rate (n = 1) 0.1/1000, catheter infection rate (n = 2) 4/1000 and meningitis rate were (n = 1) 0.1/1000. Of 35 nosocomial agents 22 (62.8%) were gram negative (10 Klebsiella spp, 4 Enterobacter, 3 Acinetobacter, 3 E. coli, 2 Peudomonas), 10 (28.5%) were gram positive and 3 (8.6%) were Candida spp. All gram negatives were resistant to cephalosporins. Thirty-one percent of gram negative bacteria were resistant to carbapenems. Carbapenem-resistant gram negative agents were namely Acinetobacter baumanii complex, Pseudomonas aeruginosa and Enterobacter cloacea complex, All bacteria were susceptible to colistine. Conclusion ESBL positive and carbapenem-resistant gram negative bacteria are threats for NICU. It is of vital importance to implement reasonable antibiotherapy strategies and to propagate standart infection control measures.