Should Ocular Hemorrhage Screening be Conducted in Newborns with Acidosis?

OBJECTIVE: Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis. STUDY DESIGN: Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed. RESULTS: Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH. CONCLUSION: Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation. KEY POINTS: · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..

The effect of oscillometric blood pressure measurement on pain response in preterm infants.

AIM: Preterm neonates are exposed to many painful procedures in neonatal intensive care units. This study aims to evaluate the effect of oscillometric blood pressure (BP) measurement on pain response in preterm infants. METHODS: This prospective study was performed over 4 months in a level III neonatal intensive care unit. Premature neonates whose gestational age was <34 weeks and postmenstrual age <36 weeks were included if they had no systemic diseases. BP measurement was performed on the right arm. The Premature Infant Pain Profile-Revised (PIPP-R) scores were evaluated three times before, during, and 10 min after BP measurement. RESULTS: During the 5-month period, 100 preterm neonates (53 male infants) were included in the study. Median birth weight and gestational age of the infants were 1148 (IQR: 1015-1300) g and 28 (IQR: 27-30) weeks, respectively. PIPP-R scores were found to be ≥7 in 34% of neonates. PIPP-R scores increased during BP measurement and decreased after. CONCLUSION: Our results demonstrated that oscillometric BP measurement which is generally accepted as a non-invasive tool for monitoring can produce mild pain in premature neonates of postmenstrual age <36 weeks.

Transcutaneous bilirubin measured on protected skin during phototherapy in term and preterm neonates.

BACKGROUND: Transcutaneous bilirubin (TCB) measurement is a simple, painless, and time-saving alternative for the assessment of TSB (total serum bilirubin) levels. However, TCB measurements obtained during phototherapy can yield inaccurate results. We evaluated the effectiveness of TCB measurements obtained from protected skin areas in patients who underwent phototherapy. METHODS: This prospective study included neonates delivered at a gestational age of ≥340/7 weeks. TCB measurements were performed at the forehead and the lower end of the sternum using a JM-105 device. Simultaneously, blood samples were collected to determine TSB levels. During phototherapy, the forehead was covered with a photo-opaque patch. TSB and TCB were measured before, during, at the end of, and after phototherapy. RESULTS: In total, 200 neonates, including 110 (55 %) term and 90 (45 %) late preterm infants, were enrolled. Of these neonates, 162 (81 %) were Turkish while 38 (19 %) were refugees from Syria and Iraq. Notably, no statistically significant differences were observed in the TSB and TCB values between the Turkish and refugee groups (p > 0.05). Bland-Altman analysis was conducted between the TCB values obtained from the covered forehead area and TSB values; the analysis revealed moderate, high, and excellent agreements for the first bilirubin measurement and at the end of phototherapy, before phototherapy, and for the second and rebound bilirubin measurements, respectively. Regarding intraclass correlation coefficients, values >0.95, 0.94-0.85, 0.84-0.70, and < 0.7 indicated perfect, high, moderate, and unacceptable compatibilities, respectively. Although a significant association was observed between pre-phototherapy TCB obtained from the sternum and TSB levels, no significant associations were observed during phototherapy. CONCLUSIONS: Our findings indicate that the consistency observed between TCB measurements obtained from the protected skin areas and TSB values can be used to monitor phototherapy effectiveness, particularly in late preterm/term infants and those with darker skin tones. Furthermore, this approach can aid in guiding decisions related to treatment termination, evaluating rebound bilirubin levels, minimizing costs, and providing a less invasive testing option.

Short-term outcomes of extremely low birth weight infants in a tertiary neonatal intensive care unit in Türkiye.

BACKGROUND: Advances in neonatal care have led to increased survival of extremely preterm infants. Extremely low-birth-weight (ELBW) infants, defined as infants weighing less than 1000 g at birth, constitute a significant portion of neonatal intensive care unit (NICU) patients. The aim of this study is to determine the mortality and short-term morbidities of ELBW infants and assess the risk factors related to mortality. METHODS: The medical records of ELBW neonates hospitalized in the NICU of a tertiary-level hospital between January 2017 and December 2021 were evaluated retrospectively. RESULTS: 616 ELBW (289 females and 327 males) infants were admitted to the NICU during the study period. Mean birth weight (BW) and gestational age (GA) for the total cohort were 725 ± 134 g (range 420-980 g) and 26.3 ± 2.1 weeks (range 22-31), respectively. The rate of survival to discharge was 54.5% (336/616) [33% for the infants with ≤750 g BW, 76% for the infants with 750-1000 g BW], and 45.2% of survived infants had no major neonatal morbidity at discharge. Independent risk factors for mortality of ELBW infants were asphyxia at birth, birth weight, respiratory distress syndrome, pulmonary hemorrhage, severe intraventricular hemorrhage, and meningitis. CONCLUSIONS: The incidence of mortality and morbidity was very high in ELBW infants, particularly for neonates born weighing less than 750 g in our study. We suggest that preventive and more effective treatment strategies are needed for improved outcomes in ELBW infants.

Multi-organ dysfunction in infants with acidosis at birth in the absence of moderate to severe hypoxic ischemic encephalopathy.

INTRODUCTION: Infants with perinatal asphyxia are at risk for organ failure aside from the brain, regardless of the severity of the asphyxial insult. We aimed to evaluate the presence of organ dysfunction other than the brain in newborns with moderate to severe acidosis at birth, in the absence of moderate to severe hypoxic ischemic encephalopathy. MATERIALS AND METHODS: Data of 2 years were retrospectively recorded. Late preterm and term infants admitted to the intensive care unit with ph < 7.10 and BE < -12 mmol/l in the first hour were included in the absence of moderate to severe hypoxic ischemic encephalopathy. Respiratory dysfunction, hepatic dysfunction, renal dysfunction, myocardial depression, gastrointestinal problems, hematologic system dysfunction, and circulatory failure were evaluated. RESULTS: Sixty-five infants were included [39 (37-40) weeks, 3040 (2655-3380) grams]. Fifty-six (86 %) infants had one or more dysfunction in any system [respiratory: 76.9 %, hepatic: 20.0 %, coagulation: 18.5 %, renal: 9.2 %, hematologic: 7.7 %, gastrointestinal: 3.0 %, and cardiac: 3.0 %]. Twenty infants had at least two affected systems. The incidence of coagulation dysfunctions was higher in the infants with severe acidosis (n = 25, ph < 7.00) than the infants with moderate acidosis (n = 40: pH = 7.00-7.10); 32 % vs 10 %; p = 0.03. CONCLUSIONS: Moderate to severe fetal acidosis is associated with the development of extra-cranial organ dysfunctions in infants who do not require therapeutic hypothermia. A monitoring protocol is needed for infants with mild asphyxia in order to identify and manage potential complications. Coagulation system should be carefully evaluated.

Can the triglyceride-glucose index predict insulin resistance in LGA newborns?

BACKGROUND: The aim of this study is to investigate the TyG index and TG/HDL-C ratio and their relationships with insulin resistance in LGA infants. METHODS: A prospective controlled study was conducted including 65 LGA and gestational age, gender-matched appropriate for gestational age (AGA) neonates. Serum TG, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), insulin and glucose levels were measured within two hours after birth, TyG index and HOMA-IR values were calculated. RESULTS: TyG index and TG/HDL- C ratio were higher in LGA neonates compared to AGA ones (p = 0.03; p = 0.00, respectively). Compared with AGA newborns, LGA newborns had higher levels of insulin and HOMA-IR (p = 0.00; p = 0.00, respectively). TyG index and TG/HDL-C ratio showed moderate correlation with HOMA-IR (r = 0.59 R2 = 0.35 p < 0.001; r = 0.5 R2 = 0.25 p < 0.001, respectively). CONCLUSiON: The results of this study show that LGA newborns have increased levels of TyG index and TG/HDL-C associated with insulin resistance.

Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry?

AIM: Bevacizumab may affect preterm infants' ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO. METHODS: Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70. RESULTS: LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (p<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, p<.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar (p > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (p<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups (p > .05). Moderate and severe developmental delays were similar between groups (p > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups, p > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups, p > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO (p > .05). Odds of NDI was not effected by ROP treatment type (p > .05). CONCLUSIONS: Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.

Umbilical Cord Separation Time and Influencing Factors in Very-Low-Birth-Weight Preterm Neonates.

OBJECTIVE: The average time for umbilical cord separation in term neonates is 7 to 10 days. Prematurity, phototherapy, prolonged duration of antibiotic treatment, and parenteral nutrition are other factors which were demonstrated to delay cord separation. In the previous studies including greater premature infants, the time of separation of the umbilical cord was shown to vary 2 to 3 weeks. We aimed to determine the cord separation time and associated factors in very-low-birth-weight (VLBW) infants. STUDY DESIGN: In this retrospective study, VLBW infants (birth weight [BW] <1,500 g, gestational age [GA] < 32 weeks) without umbilical catheterization were included. Specific cord care was not applied. The cord separation time, gender, mode of delivery, presence of sepsis, duration of antibiotic treatment, serum free thyroxine, free triiodothyronine (FT3), thyroid-stimulating hormone, lowest leukocyte, polymorphonuclear leukocytes (PMNLs), and platelet counts were recorded. RESULTS: The study included 130 infants (GA: 29 ± 2 weeks, BW: 1,196 ± 243 g). Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day of life. A positive correlation was demonstrated between duration of antibiotic treatment and cord separation time (p < 0.001, r: 0.505). Cord separation time did not differ regarding gender or mode of delivery. Corrected leukocyte count (p = 0.031, r: -0.190) and PMNL count (p = 0.022, r: -0.201), and serum FT3 level (p = 0.003, r: -0.261) were found to be negatively correlated with cord separation time. The cord separation time was found to be delayed in the presence of sepsis (with sepsis: 18 ± 7 days and without sepsis: 13 ± 3 days; p = 0.008). Sepsis was found to delay the cord separation time beyond second week (odds ratio = 6.30 [95% confidence interval: 2.37-15.62], p < 0.001). CONCLUSION: The 95th percentile for cord separation time was 22nd day. Sepsis might be either the reason or the consequence of delayed cord detachment. The exact contribution of low serum FT3 levels to the process of cord separation should be investigated in further studies. KEY POINTS: · Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day, in VLBW infants.. · Sepsis was found to delay the cord separation time by sixfold beyond second week.. · Serum free triiodothyronine level was negatively correlated with cord separation time..

Minor dysmorphic features in a patient with papillorenal syndrome: A Case Report.

Papillorenal syndrome, also known as renal coloboma syndrome, is characterised by congenital optic disc anomalies and renal abnormalities. Mutations in the PAX2 gene, which plays a critical role in embryogenesis, cause this syndrome. Other related anomalies are less commonly observed. To our knowledge, this is the first case reported in the literature in which Papillorenal syndrome accompanied various dysmorphic features.

Evaluation of radiologic evidence of metabolic bone disease in very low birth weight infants at fourth week of life.

AIM: The aim of this study is to determine the incidence of metabolic bone disease (MBD) and assess the risk factors for development radiologic evidence of MBD. METHODS: Preterm infants with gestational age ≤32 weeks and birth weight ≤1500 g were included in this prospective study. Metabolic bone disease was defined as hypophosphatemia (phosphorus levels <4 mg/dl), ALP levels >450 U/L, or radiologic findings of MBD at four weeks of age. RESULTS: The study included 254 infants (gestational age: 29 (27-30) weeks, birth weight: 1130 g (960-1300)). Metabolic bone disease was diagnosed in 96 patients (37%); 48 infants had only radiologic evidence of MBD, 24 infants had only biochemical diagnosis of MBD, and 24 infants had both radiologic evidence of MBD and biochemical diagnosis of MBD. CONCLUSIONS: Our results showed that radiologic evidence of MBD existed in some infants with normal biochemical results. That finding may guide further development of screening programs for MBD.

Comparison of placental α microglobulin-1 protein assay (Amnisure) with speculum examination for the diagnosis of premature preterm rupture of membranes (PPROM): a clinical evaluation.

In this study, we aimed to compare the clinical outcomes of Premature Preterm Rupture of Membranes (PPROM) cases diagnosed by classical speculum examination and by placental alpha microglobulin-1 protein (PAMG-1) assay. The medical records of all patients with singleton pregnancies that were diagnosed with PPROM were retrospectively reviewed. Singleton pregnancies with PPROM diagnosis that was confirmed either by direct visualisation of amniotic fluid leaking through the cervix or by placental alpha microglobulin-1 protein (PAMG-1) assay if no amniotic fluid leakage was documented were included in the study. Demographics, prenatal and postnatal characteristics were reviewed from the medical charts and were recorded. The study included 138 pregnancies with PPROM; 111 patients in clinical speculum examination group and 27 in PAMG-1 assay group. There were no significant differences in maternal and pregnancy characteristics between the clinical speculum examination and PAMG-1 assay groups. Foetal outcomes were comparable between clinical speculum examination and PAMG-1 assay groups. In the clinical speculum examination group, there were nine (8.1%) chorioamnionitis cases, however, there were no chorioamnionitis cases in the PAMG-1 assay group during the latency period (p = .21).Impact statementWhat is already known on this subject? Placental alpha microglobulin-1 protein assay uses immunochromatography method to detect trace amount of placental alpha microglobulin-1 protein in vaginal fluids and has high sensitivity and specificity for ROM diagnosis. However, to the best of our knowledge, the clinical outcome of ROM cases detected by classical speculum examination and by placental alpha microglobulin-1 protein assay has not been compared in the literature previously.What do the results of this study add? Although statistically insignificant, cases diagnosed by PAMG-1 assay had lower risk of chorioamnionitis during latency period.What are the implications of these findings for clinical practice and/or further research? Whether cases diagnosed by PAMG-1 assay represent a milder form of rupture of membranes than cases diagnosed by classical speculum examination group warrants further research.

The Turkish Neonatal Society proposal for the management of COVID-19 in the neonatal intensive care unit.

Due to immaturity of immune function and the possibility of mother-fetal vertical and aerosol transmissions, neonates are particularly susceptible to the new coronavirus (SARS-CoV-2). Perinatal-neonatal departments should cooperate closely and take integrated approaches, and neonatal intensive care units (NICU) should prepare emergency plans for the coronavirus disease 2019 (COVID-19) as far as possible, so as to ensure the optimal management and treatment of potential victims. During the epidemic of COVID-19, the emergency response plan for the NICU should be based on the actual situation, including diagnosis, isolation, and treatment, as well as available equipment and staffing, and take into account the psychosocial needs of the families and neonatal care staff. In this context of the COVID-19 pandemic, the Turkish Neonatal Society has proposed a protocol with the evidence available at the time of preparation to handle neonates with SARS-CoV-2 infections and outbreaks in NICUs. We hope that this proposal can provide valuable information so medical workers do not have to enter the battlefield alone. At this moment, sharing resources, experiences and lessons, regardless of who you are, is our only chance to win.

Survival of periviable infants: 5-year experience at a single center.

Objectives: The primary aim of the present study was to investigate the survival rates of periviable births in a referral Level III NICU center in Turkey; the secondary aim was to determine the perinatal and natal risk factors related to mortality.Methods: This retrospective cross-sectional study was conducted at the Neonatal Intensive Care Unit between 1 January 2011 and 31 December 2015. All live deliveries occurring from 22 0/7 weeks to 25 6/7 week of gestation were included in the study (total n = 165). We documented prenatal, natal, and postnatal clinical processes in each case and assessed morbidity, mortality, and factors related to long-term prognosis.Results: While none of the infants born at 22 weeks of gestation survived until discharge, the survival rates for those admitted to the NICU were 7.5% for infants born at 23 weeks, 29.1% at 24 weeks, and 43.5% at 25 weeks. A total of 46 survived (27.9%), and follow-up data beyond 12 months were available for 22. The prevalence of neurodevelopmental impairment or neurosensory impairment was inversely associated with gestational age.Conclusions: The most important risk factors associated with mortality in periviable infants were SNAPPE score, antenatal corticosteroid use, and gestational age.

Severe Anemia Is Associated with Intestinal Injury in Preterm Neonates.

OBJECTIVE: A temporal relationship has been reported between necrotizing enterocolitis, anemia, and red blood cell transfusion (RBCT) in preterm neonates. However, the mechanism underlying this association is not clearly defined. Intestinal (I-) and liver (L-) fatty acid binding proteins (FABPs) have been proposed as plasma markers for the detection of acute intestinal injury. This study aimed to investigate the effect of anemia and RBCT on intestinal injury in preterm neonates by measuring serum I-FABP and L-FABP levels. STUDY DESIGN: A prospective cohort study including preterm neonates with gestational age <32 weeks and/or birth weight <1,500 g and requiring erythrocyte transfusions for anemia after day 15 of life was conducted. Stable growing preterm infants with hemoglobin values ≥ 10 g/dL were taken as controls. I-FABP and L-FABP levels of the neonates with anemia were compared with levels of the control group. In addition, pretransfusion I-FABP and L-FABP levels of the neonates with anemia were compared with posttransfusion levels. RESULTS: In total, 39 infants transfused for anemia and 20 controls were enrolled. L-FABP levels were significantly higher in neonates with anemia compared with controls (p < 0.001), whereas I-FABP (p = 0.695) was not different. L-FABP and I-FABP levels were similar before and after transfusion in neonates with anemia. L-FABP levels before transfusion were negatively correlated with pretransfusion hemoglobin levels (p < 0.001). CONCLUSION: Anemia is associated with intestinal injury documented by increased L-FABP levels in preterm infants, and this injury is more severe with lower hemoglobin levels.

Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society.

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.

The Effects of Bilirubin and Phototherapy on Neonatal Thiol-Disulfide Homeostasis.

OBJECTIVE: To determinate the effects of bilirubin and phototherapy on oxidative stress in newborns. STUDY DESIGN: A case-control study. PLACE AND DURATION OF STUDY: Third level Newborn Intensive Care Unit, Ankara Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Turkey, from May to August 2017. METHODOLOGY: Blood samples of 62 term newborns were grouped as control, before and after phototherapy. Total and native thiol, disulfide and ischemia modified albumin values in expressed blood samples were measured. Disulfide-native thiol ratio, disulfide-total thiol ratio and native thiol-total thiol ratio values were computed. RESULTS: Bilirubin levels were positively correlated with native and total thiol levels and negatively correlated with ischemia modified albumin levels (r=0.409 p= 0.001, r= 0.328 p<0.009, r=-0.503 p<0.001). Native and total thiol levels of the control group were lower (p<0.001) and ischemia modified albumin levels were higher than those before and after phototherapy (p<0.001). In jaundiced newborns, native and total thiol values reduced after phototherapy, while IMA levels increased (p=0.001, p<0.001, p<0.001). CONCLUSION: Bilirubin showed antioxidant effect without increasing oxidative stress. Oxidative stress increased after phototherapy. This result was associated with decrease in bilirubin rather than oxidative effect of phototherapy.

Neonatal outcomes in Syrian and other refugees treated in a tertiary hospital in Turkey

Background/aim: Turkey accepts refugees from many countries, principally Syria. More than 2.7 million refugees live in Turkey.We evaluated the neonatal outcomes of refugees. Materials and methods: We retrospectively reviewed the clinical and demographic characteristics of refugee infants born in our hospital between August 2013 and September 2016. Results: Refugees (718 Syrian, 136 Iraqi, 32 Afghani, and 21 of other nationalities) accounted for 907 of 49,413 births. The mean refugee maternal age was lower than that of Turkish women, whereas the gestational age (GA) and birthweight were similar. Refugees required fewer cesarean sections but exhibited greater small- and large-for-GA rates (P < 0.05). Refugee and Turkish infant mortality rates did not differ significantly (0.8 vs. 0.4%). Eighty-nine (12.3%) refugee neonates and 6682 (13.5%) Turkish neonates were admitted to our neonatal intensive care unit (NICU). Jaundice and perinatal asphyxia were significantly more common in refugees, whereas respiratory distress syndrome, GA ≤32 weeks, and infant birthweight <2000 g were more common in Turkish infants. The total NICU admission cost of approximately 450,000 USD was paid by the Turkish government. Conclusion: The numbers of refugees and refugee births continue to grow. The Turkish people and government have provided medical, social, and economic support to date; international assistance is needed.

Effect of birth weight on retinopathy of prematurity in discordant twin pairs.

Purpose: Since twin pairs with discordance have equal gestational age (GA), discordant twins may constitute an appropriate group to investigate the specific effect that birth weight (BW) has on the development of retinopathy of prematurity (ROP). The present study aims to investigate the effect of BW on any and severe stages of ROP development in twin pairs. Methods: Fifty-two discordant twin pairs (104 preterms) born ≤32 gestational weeks, who were diagnosed with a minimum of 18% discordance between their BWs, were retrospectively analyzed. Twin pairs were separated into two groups based on the BW of each pair. The rate of any stage of ROP, Type 1 ROP, and perinatal risk factors were compared statistically among twin pairs. Results: The rate of any stage of ROP and Type 1 ROP was 24.0% and 4.8% in the whole group, respectively. A statistically significant difference was shown between lower and higher BW groups at any stage of ROP development (34.6% vs. 13.4%, P = 0.02). However, no difference was observed in Type 1 ROP development (7.7% vs. 1.9%, P = 0.17). No significant differences were found between twin pairs regarding neonatal morbidities. The number of small GA (SGA) infants in the smaller twin group was statistically higher than larger group and regression analysis showed that being SGA had significant correlation with any stage of ROP (odds ratio: 4.98, P = 0.02). Conclusion: This study showed that BW serves an effective role at any stage of ROP development in discordant twin pairs; however, no significant difference in terms of Type 1 ROP.

The value of delta neutrophil index in neonatal sepsis diagnosis, follow-up and mortality prediction.

BACKGROUND: The complete blood cell count (CBC) and peripheral blood smear were the most commonly ordered tests for the diagnosis of neonatal sepsis. Delta neutrophil index (DNI) shows leucocyte differentiation and calculated while CBC is performed. AIMS: We aimed to evaluate the value of DNI in neonatal sepsis. STUDY DESIGN: DNI was measured with Siemens Advia 2120 and 2120i devices. DNI was calculated as (neutrophil and eosinophil count in myeloperoxidase channel)-(polymorphonuclear leucocyte count in nuclear lobularity channel). RESULTS: Study population included 141 and 87 neonates in sepsis (110 proven, 31 clinical) and control groups. Demographic characters were similar between groups. Proven sepsis group had lower birthweight and higher late-onset sepsis rate than clinical sepsis and control groups. Median DNI (16.3 vs 1,4) and CRP (6.8 vs 0,03 mg/dl) were significantly higher in sepsis group. Proven sepsis group had significantly higher DNI level than clinical sepsis group (20.8 vs 9.1). Cut-off level of DNI was 4.6 with 85% sensitivity and 80% specificity. Cut-off level of CRP was 0.58 mg/dl with 81% sensitivity and 82% specificity. Combination of DNI and CRP gave 98% sensitivity and 76% specificity. Mortality rate in sepsis group was 39%. Median DNI level in patients with mortality was significantly higher (30.1 vs 9.6). Cut-off level of DNI for mortality prediction was 16.1 with 75% sensitivity and 65% specificity. Follow-up levels of DNI was significantly decreased in 6-10 days to normal levels (16.3 to 4.2). CONCLUSIONS: DNI was found to be useful in the diagnose, follow-up and mortality prediction of neonatal sepsis without extra blood to CBC.