Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants.

BACKGROUND: To evaluate the efficacy of serial mean platelet volume (MPV) measurements in diagnosis and followup of sepsis and to compare its effectiveness with C-reactive protein (CRP) and interleukin-6 (IL-6) in sepsis. METHODS: Preterm infants, whose gestational age and weight were matched to each other, were grouped as control (n = 100) and sepsis (n = 91). Platelet indices (MPV, PDW, platelet count), CRP, and IL-6 levels were measured for the control group and on the day of diagnosis (1st day), 3rd, and 7th days of the sepsis group. RESULTS: There were significant differences between the control and sepsis group in terms of platelet count and MPV/PDW levels (p < 0.05). No significant changes were found in either platelet count or MPV and PDW of infants between early and late onset sepsis, nor between culture proven and non proven sepsis, nor among different infectious agents (gram positive/negative and fungal infections) (p > 0.05). Additionally, non-survivors with sepsis had higher levels of MPV and PDW during sepsis episodes on consecutive days (p < 0.05), in contrast to lower platelet counts in non-survivors (p < 0.05). Moreover, a positive correlation was found between MPV and IL-6 and CRP. A MPV value of 10.35 fL was identified as the cut off value in patients probably resulting in sepsis with a sensitivity of 97.8% and specificity of 78.7% (AUC = 0.949; p < 0.001), and a MPV value of 10.75 fL was determined as the cut off value in patients possibly resulting in death at diagnosis with a sensitivity of 95.2% and a specificity of 84.9% (AUC = 0.944; p < 0.001). CONCLUSIONS: The mean platelet volume can be used in addition to CRP and IL-6 at both diagnosis and follow-up of sepsis and the response of antimicrobial treatment.

Multiple epiphyseal dysplasia tip 5: Case report a rare skeletal dysplasia presenting with repetitive joint pain in children.

INTRODUCTION AND IMPORTANCE: Multiple epiphyseal dysplasia, which affects the epiphysis of long bones, can show autosomal dominant and autosomal recessive inheritance patterns (Ballhausen et al., 2003 [1]). The symptoms typically appear in childhood, although they sometimes do not show symptoms until adulthood. The goals of treatment in children are to prevent the early onset of osteoarthritis, improve function, and educate patients and their families about the natural history and genetic basis of the disease. Some patients present to the clinic with only non-healing and unidentified joint pain. Although multiple epiphyseal dysplasia type 5 is a rare disease with autosomal dominant inheritance in general, it can also be observed with de novo mutation, although very rarely, without a family history. CASE PRESENTATION: 7-years-old male patient was admitted to our orthopedics outpatient clinic with complaints of joint pain, fatigue, and pain in the knees and ankles that had lasted for about 3 years. He had epicanthus, left hemifacial microsomia, and metacarpophalangeal joint laxity. The arm was proportional to the body. In the laboratory, there was no obvious finding other than vitamin D deficiency. The epiphyses, especially in the ankle, were dysplasic on Xray. After genetic tests we detected multiple epiphyseal dysplasia type 5, with de novo mutation, without family histories. CLINICAL DISCUSSION: Multiple epiphyseal dysplasia type 5, which is usually an autosomal dominant disease (Ballhausen et al., 2003 [1]) characterized by normal height; it is seen due to heterozygous mutation of matrilin-3 gene (MATN3) at 2p24.1 location. Early-onset osteoarthritis, multiple epiphyseal dysplasia, arthralgia, small proximal femoral epiphyses, wide and short femoral neck, coxa vara, high greater trochanter, small, irregular epiphyses (distal femoral, proximal tibia, distal radius, distal ulna), mild metaphyseal irregularities (distal femoral, proximal tibia, proximal humeri, distal radius, distal ulna), genu valgum may accompany. In hands; small, irregular epiphyses (first metacarpal), delayed carpal ossification may be seen. Delayed tarsal ossification can be observed in the feet. On the other hand, some patients present to the clinic with only non-healing and unidentified joint pain. Although multiple epiphyseal dysplasia type 5 a rare disease with autosomal dominant inheritance in general, it can also be observed like our case with de novo mutation, although very rarely, without a family history. CONCLUSION: Multiple epiphyseal dysplasia type 5 is a rare disease. It should be kept in mind that skeletal dysplasia should also be evaluated, although it is rarely seen in patients with persistent joint pain. Thus, we can both slow down the progression with early diagnosis of the patient and minimize the early surgical requirements.

Mesenchymal stem cell therapy in necrotizing enterocolitis: a rat study.

We evaluated the potential therapeutic use of exogenous human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in an experimental rat model of necrotizing enterocolitis (NEC). Thirty-six newborn Sprague-Dawley rats were randomly divided into three groups: NEC, NEC + hBM-MSC, and a control (control and control + hBM-MSC). NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. After NEC was induced, iron-labeled hBM-MSCs were administered by intraperitoneal injection. All pups were killed on the fourth day following injection, and the terminal ileum was excised for a histopathological and immunohistochemical evaluation. The pups in the NEC + hBM-MSC group showed significant weight gains and improvements in their clinical sickness scores (p < 0.01). Bowel damage severity observed in the histopathological evaluation was significantly lower in the NEC + hBM-MSC group than that in the NEC group (p = 0.012). The number of MSCs homing to the bowel was significantly higher in the NEC + hBM-MSC group than that in the control + hBM-MSC group. In conclusion, this is the first study that has evaluated the effectiveness of hBM-MSCs in a neonatal rat NEC model. MSCs reduced histopathological damage significantly.

Red cell distribution width (RDW) in the newborn: normative data.

AIM: To evaluate the normal range of red blood cell distribution width (RDW) in term and preterm newborns dependent on gestational age. MATERIAL AND METHODS: A total of 1,594 preterm and term neonates were admitted to our neonatology department. Infants were divided into two groups according to their gestational age. Group 1 consisted of infants with ≤34 weeks of gestation; group 2 consisted of infants with ≥35 weeks of gestation. Infants in Groups I and II were subdivided according to their gestational age. Gestational age, birth weight, sex, hemoglobin and hematocrit, MCV levels of all newborns were recorded, and RDW was compared between the groups. RESULTS: A total of 1,594 newbornswere enrolled in the study. Group 1 (≤34 weeks) consisted of 725 newborns and Group 2 (≥35 weeks) consisted of 869 newborns. The mean normal range of RDW in Group 1 was 17.8 ± 2.1 and of group II was 16.7 ± 1.6 (P<0.05). The normal range for RDW values at 32-34 weeks was higher than at 35-36 gestational weeks, and at 37-42 weeks (P = 0.002 and 0.003). CONCLUSION: RDW values at ≤34 weeks in newborns are higher than at ≥35 weeks. This may be useful in the differential diagnosis of neonatal hematologic diseases together with other red cell parameters.

C5a, a complement activation product, is a useful marker in predicting the severity of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal emergency, predominantly affecting low-birth weight, premature infants. Early clinical signs of NEC are nonspecific and the laboratory findings are not fully reliable. Its severe morbidities and rapid progression require the application of new biomarkers for early diagnosis and intervention. The complement activation product, C5a (anaphylatoxin) has been reported to be a contributing factor leading to mesenteric ischemia/reperfusion injury which is a predisposing factor in the pathogenesis of NEC. Therefore, our aim was to evaluate the efficacy of serial C5a measurements in the diagnosis and follow-up of NEC. Preterm infants, whose gestational age and weight matched each other, were grouped as controls (n = 23) and NEC (n = 22). Serum levels of C5a, serum amyloid-A (SAA), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were measured on the third day of life for the control group and on the day of diagnosis (1st day), 3rd and 7th days of the NEC group. C5a, SSA, CRP, and IL-6 levels were significantly higher in the NEC patients compared to the control group (P < 0.05) in the follow-up. Additionally, serum levels of C5a were found to be more accurate than the other parameters for the prediction of death and requirement for surgery at the time of diagnosis (P < 0.05). In conclusion, C5a may be useful as a new marker for both diagnosis and follow-up of infants with NEC in combination with clinical and radiographical findings.

Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies.

PURPOSE: To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. METHODS: The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. RESULTS: Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. CONCLUSIONS: Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

Protective effects of caffeic acid phenethyl ester (CAPE) on intestinal damage in necrotizing enterocolitis.

OBJECTIVE: To determine the preventative effect of caffeic acid phenethyl ester (CAPE) in necrotizing enterocolitis (NEC) in an experimental rat model of NEC. MATERIALS AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into three groups; as NEC, NEC + CAPE and control. NEC was induced by enteral formula feeding, subjected to hypoxia-hyperoxia and cold stress. Pups in the NEC + CAPE group were treated with CAPE at a dose of 30 mg/kg daily by intraperitoneal route from the first day to the end of the study. All pups were executed on the fourth day. Proximal colon and ileum were allocated for histopathologic and biochemical evaluation, including xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS), malonaldehyde (MDA) and myeloperoxidase (MPO) activities. RESULTS: The pups in the NEC + CAPE group had better histopathologic and apoptosis evaluations (TUNEL and caspase-9) and the severity of bowel damage was significantly lower in the NEC + CAPE group compared to the NEC group (P < 0.01). The clinical sickness scores and body weight in the NEC + CAPE group was significantly better compared to the NEC group (P < 0.05). Tissue MDA, MPO, XO levels and TOS were remarkably reduced in the NEC + CAPE group, however, TAS was significantly increased in the NEC + CAPE group (P < 0.05). CONCLUSION: Treatment with CAPE reduces the intestinal damage in NEC.

Pneumococcal meningitis in the newborn period in a prevaccination era: a 10-year experience at a tertiary intensive care unit.

There are few data with respect to pneumococcal meningitis in neonates. Epidemiological aspects, clinical features and outcomes in newborn infants diagnosed with pneumococcal meningitis were evaluated in this study. Nineteen newborn infants in a neonatal intensive care unit diagnosed with culture-proven community-acquired bacterial meningitis between January 1999 and December 2008 were reviewed, and of them, eight patients were diagnosed as pneumococcal meningitis. Overall, among 10,186 hospitalized newborn infants, 132 community-acquired sepsis/meningitis cases (1.3%) were suspected, and blood cultures were performed in all, while cerebrospinal fluid (CSF) cultures could be performed in 124 cases. Rate of blood culture positivity was 45%. Nineteen (15.3%) of 124 were diagnosed as culture-proven community-acquired bacterial meningitis, which was confirmed by CSF growth. Eight (42.1%) of 19 had pneumococcal meningitis. In pneumococcal cases, abundant Gram-positive diplococci were seen on CSF smear and Streptococcus pneumoniae was isolated from CSF cultures. All isolates were susceptible to penicillin and third-generation cephalosporins. Irritability (n: 7), poor sucking (n: 7) and fever (n: 6) were the principal findings on the initial physical examination. Of all patients with pneumococcal meningitis, four were initially given cefotaxime plus amikacin treatment, and the remaining four were initially given cefotaxime plus ampicillin plus vancomycin. Antibiotic treatment in two patients was revised during their clinical course. Additionally, in three patients, vancomycin and ampicillin was discontinued on the third day when antibiogram of CSF cultures revealed penicillin sensitivity. Overall, mortality in pneumococcal meningitis was 50%. In the surviving patients, two had epilepsy, one sensorineural hearing loss, and two mental-motor retardation. Pneumococcal meningitis was the leading cause of community-acquired neonatal meningitis in our patients. Immunization against pneumococcal disease in developing countries would be beneficial for public health and for newborn infants.

Thrombocytosis associated with enoxaparin: A very rare cause in newborns.

Newborn infants are most vulnerable to the development of thrombosis because of the developing neonatal hemostatic system, perinatal risk factors and different types of medical conditions. Enoxaparin is the current anticoagulant of choice with advantages for the treatment of neonatal thrombosis. Thrombocytosis induced by enoxaparin has been reported as a rare adverse effect of this medication in adults. However, to our knowledge, in newborns there have been no reported cases to date of thrombocytosis induced by enoxaparin.

Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases.

OBJECTIVES: This study was carried out to assess the incidence, presenting complaints, risk factors, and methods for prevention of hypernatremic dehydration among term and near-term breastfeeding infants. METHODS: We retrospectively evaluated term and near-term (> or =35 weeks of gestation) neonates admitted to our neonatology department, during a four-year period with serum sodium concentrations of > or =146 mEq/L. A detailed maternal and infant history and examination including presenting complaints, risk factors, feeding problems, and weight loss, if present, were registered. RESULTS: Among 1150 neonates admitted to our unit, 64 (5.6%) had serum sodium concentrations of >145 mEq/L, in whom 43 of them had sodium concentrations of >149 mEq/L. The most common presenting complaint was jaundice in 30 patients (48%). Forty-one (95%) of the 43 patients described a more than 7% weight loss and there was a positive correlation between serum sodium and urea and creatinine concentrations, and a negative correlation between serum sodium and glucose concentrations in these patients (p < 0.05). There was no difference between patients with sodium >149 mEq/L and <149 mEq/L with respect to maternal age, parity, educational level, hospital stay, type of delivery, and anesthesia and also with respect to seasons (p > 0.05). CONCLUSIONS: Weight loss in an infant of greater than 7% from birth weight increases the risk of hypernatremia, a weight loss limit that is lower than the previously reported 10%. This indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible interventions to correct problems and improve milk production and transfer.

Soft tissue infections in children: a retrospective analysis of 242 hospitalized patients.

Pediatric soft tissue infections (STIs) are frequently seen disorders that represent one of the most common indications for antimicrobial therapy. We conducted a retrospective analysis of 242 patients who were hospitalized with STIs during the period from January 2000 to January 2004. The ages of the patients ranged from 1 month to 180 months (mean 44.33 +/- 36.92 months). The STIs were distributed as cellulitis in 96 (39.7%) patients, cervical lymphadenitis in 62 (25.6%), cervical abscess in 49 (20.2%), subcutaneous abscess in 25 (10.3%), pyomyositis in 6 (2.5%) and necrotizing fasciitis in 4 (1.6%). In 103 (42.2%) patients, a predisposing factor was found. Blood cultures yielded positive results in 18 (7.4%) cases. The responsible microorganisms were identified in 74 (30.6%) patients. The initial therapy consisted of ampicillin/sulbactam in 166 (68.6%) patients, ceftriaxone or cefotaxime in 58 (24.0%), and ceftriaxone plus clindamycin in 18 (7.4%). Surgical drainage was performed in 65 (86.7%) patients with abscesses. White blood cell count, C-reactive protein, and erythrocyte sedimentation rate returned to normal in mean periods of 3, 7 and 10 days, respectively. The mean duration of parenteral antibiotic therapy was 10 days, and the duration of treatment was found to increase with increasing C-reactive protein and erythrocyte sedimentation rate on admission (P = 0.001 and P < 0.001). Complications developed in 12 (4.8%) patients; there was no mortality.

The Effects of Inhaled ß-Adrenergic Agonists in Transient Tachypnea of the Newborn.

Aim. To investigate the efficacy of an inhaled ß-adrenergic agonists in transient tachypnea of the newborn (TTN). Method. We retrospectively analyzed a cohort of 51 term infants (Group 1) and 37 term infants (Group 2) monitored in the newborn intensive care unit diagnosed with TTN. Infants in Group 1 received humidified oxygen alone, and infants in Group 2 were administered the inhaled ß-2 agonist plus humidified oxygen. Results. TTN clinical respiratory assessment, respiratory rate, oxygen saturation values, need for supplemental oxygen therapy, blood gas PH, PO2, and duration of hospitalization were significantly improved in infants in Group 2 as compared with infants in Group 1 (P < .05). No statistically significant difference was observed with regard to blood glucose, potassium, heart rate, and PCO2 (P > .05). Conclusion. Inhaled ß-adrenergic agonist added to humidified oxygen was found to improve clinical and laboratory parameters. We believe that further studies should be conducted with larger groups to demonstrate the efficacy of ß-2 agonists in TTN patients.

Retinopathy of prematurity: incidence, risk factors, and evaluation of screening criteria.

BACKGROUND/AIM: The goal of this study was to investigate the incidence of retinopathy of prematurity (ROP) and the relationship between risk factors and disease in premature newborns in our neonatal intensive care unit. MATERIALS AND METHODS: A total of 219 premature subjects were retrospectively evaluated for retinopathy. Demographic information, clinical data, and risk factors were reviewed. RESULTS: The gestational ages of the infants included in the study ranged between 25 and 36 weeks, and the birth weights ranged between 670 and 4460 g. In this study, the incidence of ROP was 20.1% (44) in preterm infants: 16 had stage 1 (36.4%), 15 had stage 2 (34.1%), 11 had stage 3 (25%), 1 had stage 4 (2.3%), 1 had stage 5 (2.3%), and 6 had plus (+) disease (7.2%). The risk factors associated with the development of ROP included low birth weight, ventilation treatment, bronchopulmonary dysplasia, and maternal preeclampsia. The risk factors were analyzed with logistic regression analysis. The odds ratios were 5.952 (95% confidence interval [CI]: 2.030-17.447), 20.070 (95% CI: 4.213-95.600), 5.879 (1.916-18.037), and 3.200 (95% CI: 1.002-11.535), respectively. CONCLUSION: In this study, birth weight, ventilation treatment, bronchopulmonary dysplasia, and maternal preeclampsia were the most important risk factors for the development of ROP.

Smith-lemli-opitz syndrome: a case with annular pancreas.

Smith-Lemli-Opitz syndrome is an autosomal recessive disease of cholesterol metabolism. It is a multiple malformation syndrome with typical dysmorphic features such as bitemporal narrowing, ptosis, epicanthus, microcephaly, micrognathia, and cardiovascular, skeletal, urogenital, and gastrointestinal anomalies. This report presents a typical case of Smith-Lemli-Opitz syndrome with annular pancreas which is an unreported gastrointestinal abnormality.

Congenital hypothyroidism presenting with postpartum bradycardia.

Congenital hypothyroidism is a clinical condition characterized by lack of thyroid hormone because of thyroid gland developmental and thyroid hormone biosynthesis disorders. The most common cause of permanent hypothyroidism is congenital factors. Prompt diagnosis is critical. However, overt signs of hypothyroidism are rarely present at birth, and 95% of affected babies are asymptomatic. Hypoxemia, apnea, acidosis, increased intracranial pressure, vagal stimulus and central nerve system abnormalities represent the most common causes of bradycardia in the neonate. Bradycardia associated with congenital hypothyroidism is very rare. In this paper, a case of severe congenital hypothyroidism, induced by maternal blocker antibodies, who presented with bradycardia, is reported.

Protective Effects of Nigella sativa Oil in Hyperoxia-Induced Lung Injury.

BACKGROUND: Oxygen-induced lung injury is believed to lead to the development of bronchopulmonary dysplasia in premature infants. We have evaluated the beneficial effects of Nigella sativa oil (NSO) on rats with hyperoxia-induced lung injury. METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups as hyperoxia (95% O(2)), hyperoxia+NSO and control (21% O(2)). Pups in the hyperoxia+NSO group were administered intraperitoneal NSO at a dose of 4ml/kg daily during the study period. Histopathologic, immunochemical, and biochemical evaluations (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], malonaldehyde [MDA] and myeloperoxidase [MPO]) were performed. RESULTS: In the histopathologic and immunochemical evaluation, severity of lung damage was significantly lower in the hyperoxia+NOS group (P<.05). Tissue GSH-Px and SOD levels were significantly preserved, and MDA, MPO levels were significantly lower in the hyperoxia+NSO group (P<.05). CONCLUSION: NSO significantly reduced the severity of lung damage due to hyperoxia.

Separation anxiety disorder increases among neonatal intensive care unit graduates.

AIM: To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU). METHODS: A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group. RESULTS: We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU. CONCLUSION: The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.

Paediatric Halitosis and Helicobacter pylori Infection.

OBJECTIVE: To compare the presence of Helicobacter pylori (H. pylori) infection by stool antigen test in children with and without halitosis. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Fatih University Hospital, Ankara, Turkey, between December 2008 and June 2009. METHODOLOGY: Fifty-three patients aged between 3-15 years who presented to paediatrics outpatient clinic with halitosis and 55 healthy children aged between 4-15 years without halitosis were included in the study. Halitosis was confirmed with organoleptic test. Stool antigen test was performed in both groups. Intergroup proportions were compared using chisquare and Fisher exact tests with significance at p < 0.05. RESULTS: The H. pylori stool antigen test was positive in 11 out of 53 patients (20.8%) with halitosis and 12 of 55 healthy controls (21.8%). The rate of positive H. pylori stool antigen test results were similar between two groups (p > 0.05). Twoweeks eradication treatment was administered to 11 patients with H. pylori infection and halitosis. After treatment, the symptoms of 8 patients with halitosis (72.7%) completely resolved and persisted in 3 patients (27.3%). Seven of the 11 patients who were administered eradication treatment also had abdominal pain along with halitosis. Both symptoms completely resolved in all those patients after treatment. CONCLUSION: Although no statistically significant difference existed between the rate of H. pylori infections among those with and without halitosis. Eradication treatment was found beneficial in the treatment of children with halitosis and positive H. pylori stool antigen test.

N-acetylcysteine may prevent severe intestinal damage in necrotizing enterocolitis.

OBJECTIVE: The aim of this study was to evaluate the preventive effect of N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in an experimental rat model. MATERIAL AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups: NEC, NEC + NAC, and control. Necrotizing enterocolitis was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. Pups in the NEC + NAC group were administered NAC at a dose of 150 mg/kg daily by intraperitoneal route from the first day until the last day of the study. All pups were killed on the fifth day. Proximal colon and ileum were excised for histopathologic, immunohistochemical (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and caspase-3, caspase-8, caspase-9), and biochemical evaluation, including xanthine oxidase, total antioxidant status, total oxidant status, malondialdehyde, and myeloperoxidase activities. RESULTS: The pups in the NEC + NAC group had better clinical sickness scores compared with those in the NEC group (P < .05). In histopathologic and apoptosis evaluations (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and immunohistochemical evaluation for caspase-3 and caspase-9), the severity of bowel damage was significantly less in the NEC + NAC group compared with the NEC group (P < .01). Tissue malondialdehyde, myeloperoxidase, xanthine oxidase levels, and total oxidant status were significantly decreased in the NEC + NAC group, whereas total antioxidant status (TAS) was significantly increased in the NEC + NAC group (P < .01). CONCLUSION: N-acetylcysteine therapy significantly reduced the severity of intestinal damage in NEC.