The D-dimer reference intervals in healty term newborns.

OBJECTIVE: To determine the D-dimer reference intervals in the neonatal period. MATERIALS AND METHODS: The research had been carried out in the obstetrics and gynecology clinic and neonatal outpatient clinic of a third level hospital. Healthy term newborns aged between 1 and 28 days were enrolled in the study. Venous blood samples were collected from peripheral veins in all babies and D-dimer, prothrombin time, activated partial thromboplastin time and platelet counts were measured. Reference intervals for D-dimer in the neonatal period were determined using 2.5th and 97.5th percentile values. RESULTS: A hundred and thirty four newborns (71 boys, 63 girls) were enrolled in the study. Mean D-dimer levels of infants aged 1-28 days was 1.74 ± 1.88 mg/L (reference range; 0.25-2.81 mg/L). D-dimer levels were between 2.44 and 2.45 mg/L, 1.71-1.76 mg/L, 1.26-0.89 mg/L and 0.88-0.66 mg/L in the first, second, thirth and fourth week of life,respectively. D-dimer values inversely correlated with postnatal age (r:-0.3, p < 0.001). However, it remained above adult levels even in the last week. There was no statistically significant difference between the D-dimer levels of girls (1.93 ± 2.06 mg/L) and of boys (1.57 ± 1.71 mg/L). DISCUSSION: In this study, D-dimer levels in the neonatal period were found to be higher than adult levels stated in the literature. D-dimer levels gradually decreased overtime in the first month. It would be appropriate to use age-specific reference values in the evaluation of D dimer levels in the neonatal period.

Midstream Clean-Catch Urine Culture Obtained by Stimulation Technique versus Catheter Specimen Urine Culture for Urinary Tract Infections in Newborns: A Paired Comparison of Urine Collection Methods.

OBJECTIVE: The group of Herreros Fernández developed a new, safe, quick, and successful technique for collecting midstream clean-catch urine(MS-CCU) in newborns based on bladder stimulation and lumbar paravertebral massage maneuvers. The purpose of this study was to compare the contamination rates of catheter specimen urine (CSU) and MS-CCU by a lumbar/sacral stimulation technique in newborns. MATERIALS AND METHODS: Full-term newborns ranging in age from 2 to 28 days who needed an investigation for a presumed urinary tract infection (UTI) were included in the study. Two samples, MS-CCU by lumbar/sacral stimulation technique and CSU, were collected consecutively for each patient. Suitable samples were obtained from 90 patients. RESULTS: The contamination rate in MS-CCU cultures (n = 24/90, 26.66%) was higher than in CSU cultures (n = 9/90, 10%), and the difference was statistically significant (p = 0.039). Thirteen patients had UTI according to both samples (14.14%). In urine analysis, while there was no statistically significant difference in bacteriuria (p = 0.61) and nitrite positivity (p = 0.14) between patients with and without UTI, pyuria (p = 0.01) and leukocyte esterase positivity (p = 0.01) were higher in patients with UTI, and the difference was statistically significant. CONCLUSION: The contamination rate in MS-CCU cultures was two and a half times greater than in the CSU culture samples. Thus, MS-CCU cannot replace the catheter for the diagnosis of UTI.

Perfusion index assessment during transition period of newborns: an observational study.

BACKGROUND: Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as "delayed transition", others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. METHODS: Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. RESULTS: Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. CONCLUSION: PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.

Midstream clean-catch urine collection in newborns: a randomized controlled study.

UNLABELLED: We aimed to evaluate a recently defined technique based on bladder stimulation and paravertebral lumbar massage maneuvers in collecting a midstream clean-catch urine sample in newborns. A total of 127 term newborns were randomly assigned either to the experimental group or the control group. Twenty-five minutes after feeding, the genital and perineal areas of the babies were cleaned. The babies were held under the armpits with legs dangling. Bladder stimulation and lumbar paravertebral massage maneuvers were only applied to the babies in the experimental group. Success was defined as collection of a urine sample within 5 min of starting the stimulation maneuvers in the experimental group and of holding under the armpits in the control group. The success rate of urine collection was significantly higher in the experimental group (78%) than in the control group (33%; p < 0.001). The median time (interquartile range) for sample collection was 60 s (64.5 s) in the experimental group and 300 s (95 s) in the control group (p < 0.0001). Contamination rates were similar in both groups (p = 0.770). CONCLUSION: We suggest that bladder stimulation and lumbar paravertebral massage is a safe, quick, and effective way of collecting midstream clean-catch urine in newborns.

The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey.

Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was O positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification.

Platelet usage trends in a tertiary care hospital - Could it be less and less expensive?

Major bleeding is a life threatening complication of severe thrombocytopenia. The aim of this study was to find out the indications and the threshold for platelet transfusions in the pediatric patients of our hospital throughout 1 year. Records of the hospital's blood bank and the files of the patients were retrospectively reviewed. One hundred and four patients, between ages 0-18 years received 378 platelet units. Pretransfusion platelet counts were found to be significantly lower in hematology-oncology groups compared to other clinics (p<0.05). Single donor apheresis was found to be the major source of platelets in hematology (80.8%, n=147) and oncology (86.5%, n=45) clinics. There is a tendency for using apheresis products without proven superiority compared to platelet concentrates in terms of efficacy. This practice can be abandoned by continuous education.

Clinical use of fresh-frozen plasma in neonatal intensive care unit.

Recommendations for FFP use in neonates are based on a very limited amount of data, and not on well-designed randomized controlled trials. This retrospective study was performed to analyze our experience with FFP use in neonatal intensive care unit (NICU). From January 2006 until August 2011 a total of 80 neonates were identified as having been treated with FFP. The most common indication for FFP use was prolonged PT or aPTT, representing 32.8% of all usages of FFP. Following FFT treatment PT and aPTT normalized in 42% and 60% patients, respectively. Our results suggest that FFP were often used in acceptable indications in NICU.

Diagnostic accuracy of complete blood cell count and neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios for neonatal infection.

Background: Complete blood cell (CBC) counts and neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and platelet-to-lymphocyte ratios (PLR) are simple measurements that are conducted as part of routine diagnostic procedures. Objective: To determine the diagnostic importance, specificity, and sensitivity of these measurements for the diagnosis of neonatal infections and in discriminating between neonatal sepsis and various other infections. Methods: We conducted a retrospective study of data from a consecutive series of 232 neonatal patients admitted to Yildirim Beyazit University Yenimahalle Training and Research Hospital in Ankara for 2 years from 2016 to 2018. We included patients with a diagnosis of or clinically suspected infection, and healthy neonates were included as controls. Data included CBC counts, and bacterial culture results, considered the criterion standard for the diagnosis of neonatal sepsis. NLR, LMR, and PLR were calculated. We compared data using independent Student t and Mann-Whitney U tests and determined the sensitivity, specificity, and likelihood ratio (LHOR) of the characteristics for neonatal sepsis using receiver operating characteristic curve analyses. Results: We included data from 155 neonatal patients with a diagnosis or suspicion of infection and 77 healthy neonates. NLR was significantly higher in neonates with sepsis or fever due to dehydration (P < 0.001) than in neonates with other infections or healthy neonates. LMR was significantly higher in neonates with sepsis or viral infection than in those with other infections or healthy controls (P = 0.003). In neonates with early-onset sepsis (EOS), we found cut-off values of ≥4.79 [area under curve (AUC) 0.845, 95% confidence interval (CI) 0.76-0.93, LHOR 11.6, specificity 98.7%, sensitivity 15%] for NLR, ≥1.24 (AUC 0.295; CI 0.18-0.41, LHOR 1.02, specificity 2.6%, sensitivity 100%) for LMR, and ≥37.72 (AUC 0.268; CI 0.15-0.39, LHOR 0.86, specificity 7.8%, sensitivity 80%) for PLR. We found cut-off values of ≥4.94 (AUC 0.667; CI 0.56-0.77, LHOR 4.16, specificity 98.7%, sensitivity 5.4%) for NLR and ≥10.92 (AUC 0.384; CI 0.26-0.51, LHOR 6.24, specificity 98.7%, sensitivity 8.1%) for LMR in those with late-onset sepsis (LOS). Conclusions: CBCs, NLR, LMR, and PLR may be useful for the differential diagnosis of EOS and LOS, and neonates with sepsis from those with other infection. NLR may be a useful diagnostic test to identify neonatal patients with septicemia more quickly than other commonly used diagnostic tests such as blood cultures. NLR has high specificity and LHOR, but low sensitivity.

Effect of cord clamping time on neonatal vitamin B12, folate and urinary iodine concentration.

OBJECTIVES: The aim of this randomised study was to investigate whether early or late clamping of the cord influences the status of micro-elements and thyroid hormone levels in newborns. MATERIAL AND METHODS: The study participants were randomised into two groups: Group 1, in which cord clamping was performed within 10 s (n = 32) and Group 2, in which clamping was performed at the 60th second (n = 28). Sociodemographic parameters were recorded; maternal and neonatal levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulant hormone (TSH), urinary iodine concentration levels (UIC) folate and vitamin B12 were measured. RESULTS: Of the maternal and neonatal thyroid hormone values examined, a significant difference was determined between the groups only in respect of the FT4 and FT3 values of the newborns in the first 24 hours (p = 0.037, p = 0.009, respectively). The FT4 values in the first 24 hours were determined to be lower than normal in 15.6% (n: 5) of the newborns in Group 1 and in 0% of Group 2. The FT3 values in the first 24 hours were determined to be lower than normal in 62.5% (n: 20) of the newborns in Group 1 and in 28.5% of Group 2. Vitamin B12 values below the normal limit were determined at a significantly higher rate in Group 1 (p = 0.009). A statistically significant positive correlation was observed between the maternal and neonatal vitamin B12 levels (r: 0.334, p = 0.009). CONCLUSIONS: Late clamping of the umbilical cord may contribute to erythrocyte synthesis by allowing passage of vitamins such as B12 and folic acid to the newborn.

Does Interval between Breastfeeding and Heel Lance Affect the Perception of Pain in Newborns?

OBJECTIVE: To investigate whether the duration between breastfeeding and heel lance has an effect on babies' pain perception. STUDY DESIGN: A randomised trial. PLACE AND DURATION OF STUDY: Obstetrics & Gynecology Unit, Yenimahalle Training and Research Hospital, Ankara, Turkey between August 2019 and February 2020. METHODOLOGY: Healthy term newborns who were scheduled for a heel lance blood collection for newborn screening were included in the study. Healthy term babies were randomised into three groups, according to their heel lance time. The procedure was performed immediately after breastfeeding (group 1), one hour after breastfeeding (group 2), and two hours after breastfeeding (group 3). The magnitude of pain was measured by the neonatal pain, agitation and sedation scale (N-PASS) one minute before intervention, at the time of intervention, and at 1, 2 and 5 minutes after the intervention. Total crying times of the babies was recorded as well. RESULTS: Ninety-one babies were included in the study. The pain scores during heel lance and one and two minutes after heel lance were significantly higher in group 3 than in group 1 and group 2. Total crying time of the babies in group 3 was also significantly longer than the total crying time of the babies in group 1 and group 2. However, there was no significant difference between group 1 and 2 in terms of pain scores. CONCLUSION: The duration between breastfeeding and heel lance may influence the perception of pain in newborns. Keeping this period short, may reduce the perception of pain. Key Words: Breastfeeding, Breast milk, Newborn, Pain.

Is There Any Effect of Hyperbilirubinemia on Breastfeeding? If Any, at Which Level?

Objectives: We wanted to investigate whether hyperbilirubinemia (significant or physiological) has an effect on breastfeeding, milk intake, infant's wakefulness, and if any, which level of bilirubin affects breastfeeding. Materials and Methods: Healthy, term, and breastfed babies with significant hyperbilirubinemia who required phototherapy were included in the study (group 1, n = 71). In the neonatal outpatient clinic, a control group was formed from babies with physiological jaundice (group 2, n = 90). All infants were monitored during breastfeeding and breastfeeding was evaluated with breastfeeding assessment tools (IBFAT and LATCH) and milk intake was assessed by test scale. The same examinations were repeated after phototherapy when normal bilirubin levels were reached. Results: Milk intake, Infant Breastfeeding Assessment Tool (IBFAT) (IBFAT total score [IBFATT], IBFAT first item score [IBFAT1], IBFAT sixth item score [IBFAT6]), and LATCH scores were significantly lower in group 1 than the control group (p = 0.001). In group 1, the amount of milk intake, IBFAT and LATCH scores after phototherapy increased significantly compared to prephototherapy values (p = 0.001). Looking at the correlation matrix in the whole study group (groups 1 and 2) there were moderate but very significant negative correlations between bilirubin and milk intake (r = 0.32, p = 0.001), IBFATT (r = 0.47, p = 0.001), IBFAT1 (r = 0.57, p = 0.001), IBFAT6 (r = 0.65, p = 0.001), and LATCH scores (r = 0.49, p = 0.001). In the receiving operating characteristics analysis, the cutoff bilirubin value was found to be 12 mg/dL. Conclusion: Hyperbilirubinemia may have a negative effect on breastfeeding and milk intake. It appears that bilirubin levels above 12, including in babies with physiological jaundice, adversely affect breastfeeding.

Effect of Phototherapy on Peripheral Blood Cells in Hyperbilirubinemic Newborns.

This study was conducted to determine the neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, platelet/lymphocyte ratio; and to evaluate the effect of phototherapy on the peripheral blood cells in newborns with indirect hyperbilirubinemia. A total of 180 newborns consisting of 119 hyperbilirubinemic newborns, who received phototherapy; and 61 healthy newborns were included in the study. A statistically significant difference was present only between the patient group and healthy newborn white blood cell values after phototherapy. The differences found for pre-phototherapy neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio values were statistically significant, but no statistical significance was present for the values after phototherapy. These results suggest that phototherapy may have an effect on peripheral blood cells by directly decreasing both the cytokine and bilirubin levels. The decrease in neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio after phototherapy could potentially be used in the evaluation of phototherapy's effect on peripheral blood cells. New studies on this subject are, therefore, required. Key Words: Newborn, Phototherapy, Inflammation, Peripheral blood cells.

Knowledge, behavior, and awareness of neonatologists and anesthesiologists about oral complications of intubation and protection methods.

OBJECTIVES: This study aimed to assess awareness of anesthesiologists and neonatologists about oral complications occurring during and after the orotracheal intubation (OTI) in premature infants and their knowledge and behavior regarding protection methods from these complications in clinical practice. METHODS: This study included 94 neonatologists and 137 anesthesiologist. The final version of the questionnaire included 15 items in three main parts: (i) personal information; (ii) awareness about oral complications occurring during and after the OTI in premature infants; (iii) knowledge and behavior regarding protection methods from these complications in clinical practice. RESULTS: A total of 95.7% of neonatologists and 83.2% of anesthesiologists were aware of oral complications related to OTI. The most common complications the anesthesiologists encountered were oral, laryngeal, or pharyngeal region injuries (60.7%) and palatal groove (52.2%) for the neonatologists. The most preferred method for stabilization of the orotracheal intubation tube (OTT) was bonding to the perioral region with an adhesive tape (98.3%). The primary determining factor in the choice of OTT stabilization method was the ease of use (28.2%). A total of 23.8% of the participants were aware of the palatal stabilization device (PSD), whereas only 1.3% used it in their routine and 57.1% of them believed it can prevent complications. CONCLUSIONS: The results showed that neonatologists were more aware of the OTI-related oral complications than anesthesiologists. The knowledge of the participants regarding prevention of these complications is insufficient. Study participants believe in the efficacy of PSD but do not use it in clinical practice for a number of reasons.

Which Hand Position in Breastfeeding Is Better for Milk Intake: Palmar Grasp or Scissor Grasp? A Pilot Study.

Objectives: During breastfeeding, there are two natural hand positions used most often by the mother to introduce her breast to the baby (palmar grasp [C-hold position] and scissor grasp). In this study, we aimed to investigate whether the milk intake is affected by the hand position. Materials and Methods: Both healthy term breastfed infants and their mothers were included in the study. Each mother-baby dyad was monitored during two feeding periods (100 mother-baby dyads, 200 breastfeeding sessions). Mothers were asked to grasp their breasts differently (palmar or scissor grasp) in each breastfeeding session. Milk intake was determined by test weighing. Results: One hundred mother-baby dyads were included in the study. There was no statistically significant difference between scissor grasp (34.60 ± 22.16 mL) and palmar grasp (38.30 ± 27.37 mL) positions when evaluated in terms of milk intake (p = 0.13). When asked what position they prefer to breastfeed at home, the majority of them (56%) stated that they preferred scissor grasp positions. In terms of breastfeeding by hand position, there was a statistically significant difference (p = 0.003) between the mothers who received breastfeeding training during pregnancy (59.2% palmar grasp position, 40.8% scissor grasp position) and the mothers who had not (29.4% palmar grasp position, 70.6% scissor grasp position). Conclusions: Our study showed that there was no difference in milk intake between palmar grasp position and scissor grasp position. The mothers should be encouraged to use the hand position that is most natural and comfortable.

Effect of Phototherapy on Neutrophil VCS Parameters and White Blood Cells.

OBJECTIVE: To investigate the effect of phototherapy (PT) on WBC parameters and neutrophil volume, conductivity and scatter (VCS) parameters. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Keçiören Training and Research Hospital, Turkey, from October 2016 and January 2017. METHODOLOGY: Term newborns who had received PT for indirect hyperbilirubinemia were inducted. Total serum bilirubin, neutrophil, eosinophil, basophil, monocyte, lymphocyte counts, and neutrophil VCS parameters before and after PT were compared. RESULTS: The mean age of the neonates at admission was 6.05 ±3.7 days. The mean gestational age at the time of birth was 37.44 ±2.09 weeks. The mean duration of PT was 46.37 ±17.00 hours. PT was associated with a significant increase in eosinophil (p=0.039) and basophil counts (p=0.034), a significant decrease in leucocyte (p=0.036) and neutrophil counts (p=0.031). There was no significant change in monocyte (p=0.79) and lymphocyte counts (p=0.93). There was a significant decrease in neutrophil volume values and a significant increase in neutrophil scatter values after PT. There was no effect of PT on neutrophil conductivity values. CONCLUSION: PT affects some WBC components and neutrophil volume and scatter parameters. There is a need for further prospective clinical researches on this topic before starting to use neutrophil VCS parameters in the diagnosis of sepsis.

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV+VG or PSV+VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV+VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV+VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1ß in the tracheal aspirates increased during both modes. CONCLUSION: PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV+VG. Therefore, PSV+VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.

LATCH scores and milk intake in preterm and term infants: a prospective comparative study.

OBJECTIVES: We aimed to detect the breastmilk intake in preterm and term infants and to determine if the LATCH scoring system (latch; audible swallowing; type of nipple; comfort [breast/nipple]; hold [positioning]) could be helpful to denote that infants have taken enough breastmilk according to their postnatal age and weight. MATERIALS AND METHODS: Sixty-six breastfeeding sessions were monitored and scored simultaneously by using the LATCH scoring system. The weight of the 66 infants (33 preterm, 33 term) was measured before and after a breastfeeding session, and thereby milk intake by breastfeeding was determined. The expected amount of milk volume that infants should receive for each feeding session was calculated according to the postnatal age and weight. The breastmilk intake by breastfeeding was compared with LATCH scores and the expected milk volume for each feeding. RESULTS: We observed that 25 term infants (75.8%) took 100% of the expected milk volume for each feeding session, compared with two preterm infants (2.1%) (p=0.009). The median LATCH scores were 7.0 (minimum-maximum=5-9) in preterm babies and 9 (minimum-maximum=7-10) in term babies (p<0.0001). Term babies could consume 95.4% of the expected milk volume for each feeding session, whereas this ratio was only 45% in preterm babies. In each group, babies receiving a score of ≥7 took at least 50% of the expected milk volume for each feeding session. In each group, higher LATCH scores were associated with higher median intake, but the minimum and maximum intake for each LATCH score revealed marked variability. CONCLUSIONS: High LATCH scores (7-10) may be helpful to determine that infants take at least 50% of the expected breastmilk volume for each feeding in both preterm and term infants. However, LATCH scores cannot substitute for test weights in premature infants because of variability in minimum and maximum milk intake per LATCH score.

Ileo-ileal intussusception in a premature neonate: an unusual cause of NEC in premature babies.

Intussusception is a rare entity in neonates. It may present with non-specific signs including abdominal distension, feeding intolerance, vomiting and bloody stools. Symptomatology is similar to Necrotizing Entero-Colitis (NEC). Ultrasound can help to establish early diagnosis in neonate. A 27-week preterm newborn was initially suspected as NEC based on abdominal distention, bilious vomiting, worsening clinical condition and dilated loops of bowel on X-ray, which turned out to be ileo-ileal intussusception. Diagnosis was made by ultrasound obtained for a palpable mass to rule out intra abdominal abscess and lack of improvement in clinical condition despite 5 days of conservative treatment. Surgery was performed consisting of removal of the necrotic intussusception area and end-to-end anastomosis and patient was discharged from hospital on day 60 of life. As a conclusion, pathological abdominal findings in preterm newborns can also be due to conditions other than NEC and ultrasound may be a useful tool for timely and accurate diagnosis.

Unilateral Ectrodactyly in a Newborn with Trisomy 18 Syndrome: An Unusual Association.

The case of a newborn male with trisomy 18 syndrome, having bilateral syndactyly, aplasia and hypoplasia of the foot digits, unilateral ectrodactyly of the left foot and a prominently dorsiflexed hallux, clenched hand with overlapping fingers and general hypertonia, is presented. There are only 5 cases of trisomy 18 syndrome associated with ectrodactyly in the literature. We present a case of trisomy 18 syndrome with unilateral ectrodactyly of the left foot, which is an infrequent association.

Skinfold thickness of preterm newborns when they become late preterm infants.

BACKGROUND: Nutrition of very low-birth-weight newborns is important for a good physical and neurologic outcome. Body composition assessment, together with anthropometric measurements, is considered necessary to monitor adequate nutrition and growth. Objectives of this study were to assess body fat changes in newborns ≤32 weeks gestation by weekly skinfold thickness (SFT) measurements and to compare them with those of late preterm infants born at 34, 35, and 36 weeks once they reached 34, 35, and 36 weeks corrected age (CA). MATERIALS AND METHODS: Preterm infants ≤32 weeks gestation had SFT measured from 4 body sites, including biceps, triceps, and subscapulary and suprailiac regions, by a Holtain caliper starting from 48 hours of age at weekly intervals until 34, 35, and 36 weeks CA. The measurements were compared with those of late preterm controls born at 34, 35, and 36 weeks gestation. RESULTS: There were 37 preterm infants in the patient group. When reaching 34, 35, and 36 weeks CA, preterm infants had higher SFT values compared with controls in all body sites. Median and range of total SFT were 14.6 mm (9.6-18.9 mm) in patients and 11 mm (7.8-16.4 mm) in controls at 34 weeks CA, 15.5 mm (10.7-21.8 mm) in patients and 12.3 mm (7-17 mm) in controls at 35 weeks CA, and 16.4 mm (11.8-23.7 mm) in patients and 12.9 mm (7-17.8 mm) in controls at 36 weeks CA (P = .001 in all). No sex difference was observed at 34 and 35 weeks. CONCLUSION: These results show that preterm infants start accumulating excess fat even from early weeks of life. Careful assessment of growth by tools other than simple anthropometric measurements is essential to avoid future complications.