Predictive value of serum inflammatory markers in retinopathy of prematurity.

PURPOSE: To evaluate the relationship between the development of retinopathy of prematurity (ROP) and neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). MATERIAL AND METHODS: The medical records of 153 preterm infants born before the 34th week of gestation, were retrospectively reviewed. Complete blood cell (CBC) and C-reactive protein (CRP) results measured within the first 24 h of life were recorded. NLR, LMR and PLR were calculated by dividing neutrophil count by lymphocyte count, lymphocyte count by monocyte count, and platelet count by lymphocyte count, respectively. Analysis of possible risk factors related with ROP development was evaluated using logistic regression analysis. Results were compared between infants with and without ROP. RESULTS: A total of 153 infants, of which 64 (41.9%) with ROP and 89 (58.1%) without ROP, were included in the study. While lymphocyte count and LMR were found to be significantly lower in infants with ROP (p = 0.015 and p = 0.044), neutrophil count and NLR were found to be significantly higher (p = 0.021 and p = 0.046, respectively). No significant difference were observed in platelet and monocyte count and PLR (p = 0.808, p = 0.170 and p = 0.075, respectively). Multivariate logistic regression analysis revealed that gestational age, birth weight and NLR were major risk factors for the development of ROP (OR:0.59; p = 0.01, OR:1.00; p = 0.02 and OR: 2.56; p = 0.02, respectively). CONCLUSION: This study supports that, in addition to prematurity, NLR on the first postnatal day has a significant predictive value in ROP.

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.

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..

The effects of latency period in PPROM cases managed expectantly.

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 240/7-346/7 weeks of gestation.Material and method: The study group consisted of 206 patients at 240/7-346/7 weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 240/7-286/7, 290/7-316/7, and 320/7-346/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3-7 days, 8-13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO2/FiO2 ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3-7-day latency period group. Total complications were significantly lower in the 290/7-316/7 week PPROM group in which the latency period was ≥14 days, compared to those in 3-7 days and 8-13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3-7 days and 8-13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 240/7-286/7, and 11.0 days between weeks 290/7-316/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.

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.

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.

Impact of Feeding Interval on Time to Achieve Full Oral Feeding in Preterm Infants: A Randomized Trial.

BACKGROUND: Preterm infants are scheduled to receive total feeding amount in either 3-hour or 2-hour intervals. A gavage feeding may be required if the scheduled amount is not completed orally. Feedings every 2 hours are one-third smaller than feedings every 3 hours. Thus, if the volume of each feed is reduced by decreasing the feeding interval from 3 to 2 hours, the likelihood that the infant completes each volume orally increases, and the probability of requiring gavage feeding decreases. The impact of feeding with 2-hour or 3-hour intervals on time to achieve full oral feeding in preterm infants was investigated. METHODS: Infants on full enteral gavage feedings were randomized into 2 groups to receive feedings in either 3-hour or 2-hour intervals. The time to achieve full oral feeding and the duration of feeding transition from gavage to oral feedings were investigated. Data were presented as median (interquartile range). RESULTS: The study included 100 infants (gestational age: 29 [28-31] weeks, birth weight: 1205 [1040-1380] g) with 50 in each group. The postmenstrual age to achieve full oral feeding was 35 (35-37) weeks in the 3-hour-interval group and 35 (34-36) weeks in the 2-hour-interval group; P = 0.131. The duration of feeding transition was similar between groups. CONCLUSIONS: Feeding every 2 hours caused no improvement in the time to achieve full oral feeding. The 3-hour-interval feeding is appropriate for the neonatal units, where less handling of preterms and decreased workload of nurses are valuable.

The consequence of phototherapy exposure on oxidative stress status of expressed human milk.

OBJECTIVE: There exists evidence that phototherapy can disturb the oxidant/antioxidant balance in favor of oxidants. If phototherapy is continued during tube feeding in preterms, expressed human milk is subjected to phototherapy lights for about 20 min per feeding. We aimed to investigate the effects of phototherapy lights on oxidative/antioxidative status of expressed human milk. STUDY DESIGN: Milk samples of 50 healthy mothers were grouped as control and phototherapy and exposed to 20 min of day-light and phototherapy light, respectively. Total antioxidant capacity (mmol-Trolox equiv/L) and total oxidant status (mmol-H2O2/L) in expressed human milk samples were measured. RESULTS: Levels of antioxidant capacity of the expressed human milks in the phototherapy group were lower than those of the control group [mmol-Trolox equiv/L; median (interquartile-range): 1.30 (0.89-1.65) and 1.77 (1.51-2.06), p: < .001]. Levels of oxidant status were similar in both groups. CONCLUSION: We demonstrated that phototherapy decreased antioxidant capacity of expressed human milk without any alteration in oxidative status. We think that this observation is important for the care of very low birth weighted infants who have limited antioxidant capacity and are vulnerable to oxidative stress. It may be advisable either to turn off the phototherapy or cover the tube and syringe to preserve antioxidant capacity of human milk during simultaneous tube feeding and phototherapy treatment.

Evaluation of dynamic thiol-disulfide homeostasis in very low-birth-weighted preterms.

BACKGROUND: Thiols are organic compounds containing sulfhydryl groups which exert antioxidant effects via dynamic thiol-disulfide homeostasis. The shift towards disulfides indicates the presence of oxidative environment. Thiol-disulfide homeostasis has not been evaluated in neonates. We aimed to evaluate dynamic thiol-disulfide homeostasis in preterm infants. METHODS: Preterm infants with birth weight less than 1500 g (25-32 weeks of gestation) were included. Infants with major congenital anomaly, perinatal asphyxia, twin to twin transfusion and infants who were mechanically ventilated and nil by mouth for more than 3 days or fed with formula, had intraventricular hemorrhage ≥ grade 2 or sepsis, received blood/blood product transfusion or inotrope treatment and developed bronchopulmonary dysplasia or retinopathy of prematurity (≥ stage 3), and died were excluded thereafter. Serum thiol-disulfide homeostasis was evaluated for three times: (Baseline, first week, third week). Serum native thiol, total thiol and disulfide were measured (µmol/Lt), disulfide:native thiol, disulfide:total thiol, and native thiol:total thiol ratios were calculated. Wilcoxon's test was used to analyze the significance of change in measurements. Baseline results were analyzed for gender and mode of delivery. RESULTS: Eighty preterm infants [1255 (1080-1415) grams] were included. Baseline values were native thiol: 209.54 ± 41.83 µmol/L; total thiol: 251.70 ± 45.82 µmol/L; disulfide: 21.08 ± 7.43 µmol/Lt; disulfide:native thiol: 10.49 ± 4.62; disulfide:total thiol: 8.45 ± 2.93; native thiol:total thiol: 83.10 ± 5.87. Thiol levels increased in each measurement, disulfide and disulfide/thiol ratios increased in the first week, decreased in the third week, ratio of native/total thiol decreased in the first week, increased in the third week. No effect of gender or mode of delivery on baseline thiol-disulfide homeostasis was detected. CONCLUSIONS: The shift in the thiol-disulfide equilibrium towards disulfides in the first week can be attributed to subjection of infants to many oxidative insults. Furthermore, the thiol predominance in the third week could be explained by the decrease in oxidative events and increase in feeding as a supply of antioxidants. This study, displaying the levels of the dynamic thiol-disulfide homeostasis in preterm infants without obvious risks for increased oxidative stress, may provide acceptable range for thiol-disulfide homeostasis in recovering preterm infants.

The effect of the modes of delivery on the maternal and neonatal dynamic thiol-disulfide homeostasis.

Background: Thiols are organic compounds containing sulfhydryl groups which exert antioxidant effects via dynamic thiol-disulfide homeostasis. The shift towards disulfide indicates the presence of oxidative environment. The thiol-disulfide homeostasis has not been studied in different mode of delivery before. Aims: To investigate the effects of mode of parturition on the thiol-disulfide homeostasis in mothers and term infants. Study design: The participants were grouped according to the mode of their delivery: group vaginal delivery (VD, n = 40) and group cesarean section (C/S, n = 40). Three serum samples were collected: from mothers at the beginning of labor, from the cord blood (CB), and from the infants at the 24th hour after birth. The dynamic thiol-disulfide homeostasis in both groups were compared. Results: The levels of native-thiol and total-thiol in CB were significantly higher in VD group than those with C/S group. The levels of disulfide were higher in infants born by C/S compared with those born by VD. The disulfide-to-native thiol ratio, disulfide-to-total thiol ratio, and native thiol-to-total thiol ratio were similar between two groups. Conclusion: Our results showed that the dynamic thiol-disulfide homeostasis of the neonate was greatly influenced by the way of delivery and supported that vaginally delivered infants have less oxidative stress.

Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units.

BACKGROUND: To evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition. METHODS: A prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)≤1500 g or gestational age (GA)≤32 weeks and those with a BW>1500 g or GA>32 weeks with an unstable clinical course were included in the study. Predictors for the development of ROP were determined by logistic regression analyses. RESULTS: The TR-ROP study included 6115 infants: 4964 (81%) with a GA≤32 weeks and 1151 (19%) with a GA>32 weeks. Overall, 27% had any stage of ROP and 6.7% had severe ROP. A lower BW, smaller GA, total days on oxygen, late-onset sepsis, frequency of red blood cell transfusions and relative weight gain were identified as independent risk factors for severe ROP in infants with a BW≤1500 g. Of all infants, 414 needed treatment and 395 (95.4%) of the treated infants had a BW≤1500 g. Sixty-six (16%) of the treated infants did not fulfil the Early Treatment for Retinopathy of Prematurity requirements for treatment. CONCLUSIONS: Screening of infants with a GA≤34 weeks or a BW<1700 g appears to be appropriate in Turkey. Monitoring standards of neonatal care and conducting quality improvement projects across the country are recommended to improve neonatal outcomes in Turkish NICUs. TRIAL REGISTRATION NUMBER: NCT02814929, Results.

Retinopathy of prematurity in extremely premature infants: multiple births versus single births

Background/aim: This study aimed to compare the incidence of any stage of retinopathy of prematurity (ROP) and type 1 ROP between extremely preterm multiple- and single-birth infants. Materials and methods: In this retrospective study, we included extremely preterm infants who were ≤27 weeks of gestational age at birth. The screened infants were divided into two groups: single and multiple births. The incidence of any stage of ROP and type 1 ROP was compared between the groups. Results: This study included 301 infants; 225 were in the single-birth group and 76 were in multiple-birth group. The incidences of any stage of ROP and type 1 ROP among all infants were 70.7% (213 of 301) and 16.6% (50 of 301), respectively. Regression analysis showed that lower birth weight (OR = 0.99, P = 0.004) and longer length of stay in hospital (OR = 1.02, P = 0.002) were significantly correlated with any stage of ROP. Compared to single-birth infants, the risk of any stage of ROP and type 1 ROP did not statistically increase for multiple-birth infants (P > 0.05). Conclusion: This study showed that multiple birth had no significant correlation with ROP development in extremely preterm infants.

Increased ADMA levels are associated with poor pulmonary outcome in preterm neonates.

BACKGROUND: Nitric oxide (NO), synthesized from the amino acid L-arginine by the action of NO synthases (NOS), is a pulmonary vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. Preterm infants have higher plasma ADMA concentrations than term infants which could cause inhibition of NO synthesis and deterioration in pulmonary functions. We aimed to investigate the relationship between serum ADMA and L-arginine levels of preterm infants and respiratory distress syndrome (RDS), requirement of surfactant treatment, duration of mechanical ventilation, oxygen treatment, and development of bronchopulmonary dysplasia (BPD). METHODS: A prospective cohort study was conducted including 80 preterm infants born with gestational age (GA) ≤ 32 weeks and birth weight (BW) ≤ 1500 g. Blood samples were obtained from all infants immediately after birth, and at postnatal 28th day of age. The relationship of first-day serum ADMA and L-arginine levels and surfactant requirement, duration of mechanical ventilation, oxygen treatment was investigated. Serum ADMA and L-arginine levels at 1st and 28th days were compared at patients with and without BPD. The role of serum ADMA levels at postnatal 28th day of age to predict the requirement of oxygen at postmenstrual 36 weeks of age was also investigated. RESULTS: Eighty preterm infants (42 male, 38 female) were enrolled in the study. Mean BW and GA for the total cohort was 1144.81 ± 220.44 g and 28.3 ± 1.8 weeks, respectively. Sixty-one infants were diagnosed as RDS and 44 infants treated with surfactant. The first-day ADMA levels were significantly higher in infants with surfactant requirement (1.14 ± 0.23 versus 0.86 ± 0.37, p < 0.01). First-day L-arginine levels were lower in infants with surfactant requirement compared to infants without surfactant requirement (22.32 ± 2.33 versus 23.75 ± 2.42, p > 0.05) but not significantly. Serum ADMA and L-arginine concentrations at first day were not different among infants with and without BPD (p > 0.05). ADMA concentrations at 28th day was significantly higher in infants with BPD (1.00 ± 0.25 versus 0.81 ± 0.25, p < 0.05). The cutoff level of 0.875 µmol/L for ADMA at 28th day offered the best predictive value for oxygen requirement at postnatal 36 weeks of age with a sensitivity of 88% and a specificity of 54%. Conclusion: Serum ADMA and L-arginine levels are related to pulmonary morbidities in newborn. The results of this study show that increased ADMA levels are associated with poor pulmonary outcomes in preterm infants.

A Previously Healthy Premature Infant Treated With Thrombolytic Therapy for Life-threatening Pulmonary Artery Thrombosis.

Pulmonary artery thrombosis is rarely reported in preterm neonates. Although treatment of neonatal thrombosis remains controversial, thrombolytic agents must be considered when the thrombosis is life threatening. We herein present a case of a preterm newborn with pulmonary artery thrombosis accompanied by acute-onset respiratory failure and cyanotic congenital heart disease. The thrombosis was successfully treated using tissue plasminogen activator. In conclusion, the thrombolytic therapy should be considered in treatment of patients in whom the thrombosis completely occludes the pulmonary arteries.

Obstetric outcomes of isolated oligohydramnios during early-term, full-term and late-term periods and determination of optimal timing of delivery.

AIM: Our aim was to evaluate the obstetric outcomes of isolated oligohydramnios during the early-term, full-term, and late-term periods, and to determine the optimal timing of delivery. METHODS: A retrospective study was performed at a tertiary center. Isolated oligohydramnios cases were divided into early-term, full-term, and late-term groups. Evaluated outcomes were fetal birthweight, 5-min Apgar score < 7, meconium-stained amniotic fluid, neonatal intensive care unit admission, transient tachypnea of newborn (TTN), requirement of ventilator, newborn jaundice, mode of delivery, induction of labor, and undiagnosed small-for-gestational-age fetus before delivery. Composite outcome was defined as perinatal outcomes taken together (neonatal intensive care unit admission, TTN, requirement of ventilator, and newborn jaundice). RESULTS: The study period included 1213 cases of term isolated oligohydramnios. Within this cohort there were 347 early-term, 781 full-term and 85 late-term patients. The cesarean rate and the rate of newborn jaundice were higher in early-term cases (37.8% and 3.5%, respectively) than in full-term cases (30.1% and 0.9%, respectively). Meconium-stained amniotic fluid was higher in late-term than full-term cases. Timing of delivery did not affect occurrence of TTN, 5-min Apgar score < 7, ventilator requirement, or composite outcome. In total, 15-17% of isolated oligohydramnios cases involved undetected small-for-gestational-age fetuses. CONCLUSION: As this study was not a randomized controlled trial, a decisive conclusion may not be possible. However, until well-designed controlled studies are conducted, expectant management may be appropriate up to the full-term period and induction of labor may be appropriate management when the full-term period is reached.

Early-term delivery and adverse neonatal outcomes at a tertiary center in Turkey.

Early-term infants incur higher risks for neonatal morbidities compared to full-term infants. In this study, we investigated the neonatal morbidities in early-term infants admitted to a neonatal intensive care unit (NICU). Early-term (37 0/7 and 38 6/7 weeks of gestation) and full-term (39 0/7 and 41 6/7 weeks of gestation) infants born between January 2013 and December 2014 were enrolled in this study. Early-term deliveries accounted for 8,026 (25.7%) of all live births (n = 31,170). The admission rate of early-term infants to the NICU was 7.5%. The most common diagnoses were jaundice (44.2%) and respiratory distress (37.8%). The cesarean section and small-for-gestational-age rates were significantly higher in early-term infants (p < 0.001), as were the mean duration of hospital stay, prolonged hospitalization (> 5 days), and readmission rates (p< 0.05). Morbidities, including NICU admission, respiratory distress, jaundice, hypoglycemia, feeding difficulty, and dehydration, were also more common in early-term infants (p< 0.05). This is the first Turkish study to report on the association of early-term delivery with poor neonatal outcomes. These results should be evaluated by obstetricians when considering the timing of labor induction or planned cesarean delivery. They should also be considered by neonatologists, who need to be aware of the higher risk of neonatal morbidities.