Effect of delivery mode on admission to neonatal intensive care unit in healthy singleton pregnancies.

Objective: The aim of this study was to evaluate the short-term results of perinatal health in vaginal and cesarean deliveries and the indications for admission to the neonatal intensive care unit (NICU) in terms of healthy singleton pregnancies. Materials and Methods: In this study, 300 pregnant women who gave birth in our tertiary hospital was included. The records of newborns admitted to the NICU of these pregnant women were reviewed between January 1, 2019 and January 1, 2021. Durations of newborn hospitalizations and problems encountered during admission were recorded. The results were statistically evaluated. Results: There was no significant difference between vaginal delivery and cesarean section groups in terms of the indications for admission to the NICU of term low-risk pregnant women (p=0.91, p=0.17). A higher admission in the NICU was found in the early term group. The early term group required more respiratory support compared to the full term group (p=0.02). When the groups were compared in terms of IV fluid treatment support, hypoglycemia or feeding difficulty, and jaundice requiring phototherapy, no significant difference was found. Conclusion: Withlimited data available for admission indications to the NICU of newborns born from term pregnancies, we found that the mode of delivery affects hospitalization indications of newborns, need for support, and Apgar scores. Early term delivery is associated with higher rates of neonatal morbidity and admission to the NICU. Better maternal care and prevention of factors that may lead to preterm birth will provide the prevention and management of these problems.

A novel scoring system (YASHMA) predicting brain injury in asphyxiated newborns.

BACKGROUND: Hypoxic-ischemic encephalopathy is a complication of adverse intrapartum events and birth asphyxia resulting in brain injury and mortality in late preterm and term newborns. OBJECTIVES: In this study, we aimed to predict brain damage on magnetic resonance imaging (MRI) with a new scoring system. METHODS: Yieldly And Scorable Holistic Measuring of Asphyxia (YASHMA) is generated for detection of brain injury in asphyxiated newborns. Total scores were calculated according to scores of birth weight, gestation weeks, APGAR scores at first and fifth minutes, aEEG patterns and epileptic status of patients. The major outcome of the scoring system was to determine correlation between poor scores and neonatal brain injury detected on MRI. RESULTS: In hypothermia group with brain injury, low gestational weeks and lowest APGAR scores, abnormal aEEG findings were statistically different from others. YASHMA scores were statistically significant with high sensitivity, specificity, AUC and 95% confidence interval values. CONCLUSIONS: YASHMA scoring system is feasible and can be suggestive for detecting brain injury in low-income countries.

Multi-dose vitamin d supplementation in stable very preterm infants: Prospective randomized trial response to three different vitamin D supplementation doses.

BACKGROUND: Preterm newborns are born with lower vitamin D stores. Although vitamin D supplementation is recommended there is no consensus regarding the adequate dose of supplementation for preterm infants. AIMS: To assess the effect of three different doses of vitamin D supplementation (400, 800 and 1000IU/d) in preterm infants ≤32weeks gestation on the prevalence of vitamin D deficiency and 25(OH) D levels at 36weeks postmenstrual age (PMA). STUDY DESIGN: Prospective randomized trial. SUBJECTS: 121 preterm infants with gestational age of 24-32weeks were randomly allocated to receive 400, 800 or 1000IU/d vitamin D. OUTCOME MEASURES: Serum concentration of 25(OH) D and the prevalence of vitamin D deficiency at 36weeks PMA. Vitamin D deficiency was defined as serum 25(OH) D concentrations <20ng/ml. RESULTS: Of the 121 infants 72% had deficient vitamin D levels before supplementation. The average 25(OH) vitamin D concentrations at 36weeks PMA were significantly higher in 800IU (40±21.4ng/ml) and 1000IU group (43±18.9ng/ml) when compared to 400IU group (29.4±13ng/ml). The prevalence of vitamin D deficiency (2.5 vs 22.5; RR: 0.09; CI:0.01-0.74) and insufficiency (30 vs 57.5; RR:0.32; CI:0.13-0.80) was significantly lower in 1000IU group when compared to 400IU group at 36weeks PMA. CONCLUSION: 1000IU/d of vitamin D supplementation in preterm infants ≤32weeks gestation age effectively decreases the prevalence of vitamin D deficiency and leads to higher concentrations of 25(OH) vitamin D at 36weeks PMA TRIAL REGISTRATION: Clinical Trials.gov: NCT02941185.

Impact of oral probiotics on neurodevelopmental outcomes in preterm infants.

OBJECTIVE: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC). METHODS: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18-24 months' corrected age. RESULTS: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups. CONCLUSION: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18-24 months' corrected age.

Protective effects of melatonin therapy in model for neonatal hyperoxic lung injury.

CONTEXT: Bronchopulmonary dysplasia (BPD) is a common outcome of premature birth. Currently, no effective preventive therapy is available for BPD, but the major role of O2 toxicity in the development of BPD has gained attention, particularly for developing new antioxidants for prevention. The major protective mechanism of melatonin (MT) includes free-radical scavenging activity and activation of the cyclooxygenase-prostoglandin enzyme system. OBJECTIVE: The aim of this study was to evaluate the effects of MT on cytoprotection and healing in a model of hyperoxic lung injury in newborn rats. METHODS: This is a case-control study design. SETTING: The study occurred at the Gulhane Military Medical Academy in Ankara, Turkey. INTERVENTION: A total of 60 newborn pups from dated, Sprague-Dawley, pregnant rats were divided equally into 3 groups as follows: (1) control group, (2) hyperoxia-exposed group, and (3) hyperoxia-exposed plus MT-treated group (MT group). Hyperoxia was performed by placing these pups in an oxygen chamber for 14 d during which oxygen was continuously delivered. OUTCOME MEASURES: At the end of the 14 d, lung specimens were collected and evaluation of the lamellar-body count and determination of histopathological scores were performed. Also, the activities of superoxide dysmutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) were assessed. RESULTS: The histopathological scores of the MT group were significantly lower than those of the hyperoxia-exposed group. The mean lamellar-protein and radial-alveolar counts in the MT group were found to be significantly higher than those of the hyperoxia-exposed group. Also, SOD and GSH-Px levels were significantly higher and MDA levels were significantly lower in the MT group compared with the hyperoxia-exposed group. CONCLUSION: MT therapy was found to have a protective effect in a model for hyperoxic lung injury in neonatal rats. Therefore, the research team suggests that MT therapy may be used for prevention of BPD in preterm infants after confirmation of this data by future clinical studies.

Effect of mode of delivery on macronutrient content of breast milk.

OBJECTIVE: To determine the effect of delivery type on macronutrient content of colostral milk. MATERIALS AND METHODS: The study was conducted at Zekai Tahir Burak Maternity Teaching Hospital. Colostral milk samples from term lactating mothers who gave birth by vaginal or cesarean delivery (CD) were obtained on the 2nd postpartum day. Milk protein, fat, carbohydrate (CHO) and energy levels were measured by using a mid-infrared human milk analyzer. RESULTS: A total of 204 term lactating mothers were recruited to the study; 111 mothers gave birth by vaginal route and 93 mothers by CD. Protein levels were statistically lower in colostral milk of mothers after CD compared to mothers who delivered vaginally (median 2.4 (range 0.3-6.4) g/dl versus 3 (0.5-6.3) g/dl, respectively; p = 0.036). Colostral fat, CHO and energy levels were similar between groups. In linear regression analysis, CD and maternal age were independently associated with lower protein content in colostrum. CONCLUSION: Vaginal delivery is associated with higher colostrum protein content. Hormonal activity induced by labor pain and uterine contractions might account for the alterations in the protein composition of human milk to facilitate optimal development of important physiologic functions in newborns.

Protective effects of colchicine in an experimental model of necrotizing enterocolitis in neonatal rats.

BACKGROUND: The pathophysiology of necrotizing enterocolitis (NEC) includes the massive production of endogenous cytokines with exaggerated activation of inflammatory pathways. Colchicine has been used as an anti-inflammatory agent. The aim of this study was to investigate the possible beneficial effects of colchicine in a neonatal rat model of NEC. MATERIALS AND METHODS: We randomly divided rat pups into three groups: a control group, a saline-treated NEC group, and a colchicine-treated NEC group. We induced NEC by hyperosmolar enteral formula feeding and exposure to hypoxia/reoxygenation after cold stress. Intestinal samples were harvested for biochemical and histopathologic analyses. RESULTS: The grade of intestinal injury of pups in the saline-treated NEC group was significantly higher than in the control and colchicine-treated groups (P < 0.001 and 0.003, respectively). The median level of intestinal malondialdehyde was significantly higher in the saline-treated NEC group compared with the control group (P = 0.006) or the colchicine-treated NEC group (P = 0.015). We observed significantly higher activity levels of intestinal superoxide dismutase and glutathione peroxidase in the colchicine-treated NEC group compared with the saline-treated NEC group (P = 0.033 and 0.030, respectively). The tissue levels of tumor necrosis factor-α and interleukin-1ß were significantly higher in the saline-treated NEC group compared with the colchicine-treated NEC group (P < 0.001 and 0.003, respectively). CONCLUSIONS: We observed that in this model of NEC, colchicine had favorable effects on intestinal histologic and biochemical changes.

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.

Human milk fortification with differing amounts of fortifier and its association with growth and metabolic responses in preterm infants.

BACKGROUND: Fortification of human milk (HM) is a common clinical practice to adapt breast milk to the nutritional needs of very low birth weight (VLBW) infants. The optimal method for HM fortification remains to be determined, and a variety of protocols are currently used in neonatal intensive care units. OBJECTIVE: It is believed that standard fortification is insufficient to meet the needs of VLBW infants. Therefore, we designed a randomized prospective study that investigated the effects of varying levels of blind fortification on short-term growth and metabolic responses of preterm infants. METHODS: Eligible infants were randomized into 3 groups: standard fortification (SF), moderate fortification (MF), and aggressive fortification (AF). Short-term growth, feeding intolerance, and urea, calcium, phosphorus, and alkaline phosphatase levels were assessed. RESULTS: There were 26, 29, and 29 infants in the SF, MF, and AF groups, respectively. The baseline characteristics of the groups were similar. Daily weight gain and length at discharge did not differ among the groups; however, head circumference was significantly higher in the MF and AF groups compared with the SF group. Urea, calcium, phosphorus, and alkaline phosphatase levels were similar between the groups. CONCLUSION: We demonstrated that blind fortification of HM, even with higher amounts than recommended by manufacturers, did not cause any measured adverse effects on the metabolic response of preterm infants. Anthropometric measurements (except head circumference) were not different between the different dosages of fortification.

CDP-choline reduces severity of intestinal injury in a neonatal rat model of necrotizing enterocolitis.

BACKGROUND: Cytidine 5'-diphosphocholine (CDP-choline) is an endogenous intermediate in the biosynthesis of phosphatidylcholine, a contributor to the mucosal defense of the intestine. The aim of this study was to evaluate the possible cytoprotective effect of CDP-choline treatment on intestinal cell damage, membrane phospholipid content, inflammation, and apoptosis in a neonatal rat model of necrotizing enterocolitis (NEC). METHODS: We divided a total of 30 newborn pups into three groups: control, NEC, and NEC + CDP-choline. We induced NEC by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. We administered CDP-choline intraperitoneally at 300 mg/kg/d for 3 d starting from the first day of life. We evaluated apoptosis macroscopically and histopathologically in combination with proinflammatory cytokines in the gut samples. Moreover, we determined membrane phospholipid levels as well as activities of xanthine oxidase, superoxide dismutase, glutathione peroxidase, and myeloperoxidase enzymes and the malondialdehyde content of intestinal tissue. RESULTS: Mean clinical sickness score, macroscopic gut assessment score, and intestinal injury score were significantly improved, whereas mean apoptosis score and caspase-3 levels were significantly reduced in pups in the NEC + CDP-choline group compared with the NEC group. Tissue proinflammatory cytokine (interleukin-1ß, interleukin-6, and tumor necrosis factor-α) levels as well as tissue malondialdehyde content and myeloperoxidase activities were reduced, whereas glutathione peroxidase and superoxide dismutase activities were preserved in the NEC + CDP-choline group. In addition, NEC damage reduced intestinal tissue membrane phospholipids, whereas CDP-choline significantly enhanced total phospholipid and phosphatidylcholine levels. Long-term follow-up in additional experiments revealed increased body weight, decreased clinical sickness scores, and enhanced survival in CDP-choline-receiving versus saline-receiving pups with NEC lesions. CONCLUSIONS: Our study reports, for the first time, beneficial effects of CDP-choline treatment on intestinal injury in a neonatal rat model of NEC. Our data suggest that CDP-choline may be used as an effective therapeutic agent to prevent NEC.

Beneficial effects of Nigella sativa oil on intestinal damage in necrotizing enterocolitis.

AIM: The aim of this study was to determine the beneficial effects of Nigella sativa oil (NSO) on rats with necrotizing enterocolitis (NEC). MATERIAL AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into three groups as NEC, NEC + NSO, and control. NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia and cold stress. Pups in the NEC + NSO group were administered NOS at a dose of 2 ml/kg daily by intraperitoneal route from the first day until the end of the study. Proximal colon and ileum were excised for histopathologic, apoptosis (TUNEL) and biochemical evaluation, including xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malonaldehyde (MDA), and myeloperoxdase (MPO) activities. RESULTS: Pups in the NEC + NOS group had better clinical sickness scores and weight gain compared to the NEC group (p < 0.05). In the macroscopic assessment, histopathologic and apoptosis evaluation (TUNEL), severity of bowel damage was significantly lower in the NEC + NOS group compared to the NEC group (p < 0.05). Tissue GSH-Px and SOD levels were significantly preserved in the NEC + NSO group (p < 0.05), whereas, tissue MDA, MPO levels of the NEC + NSO group were significantly lower than those in the NEC group (p < 0.05). CONCLUSION: NSO significantly reduced the severity of intestinal damage in NEC.

Blood L-arginine levels in early respiratory distress syndrome.

L-arginine is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Our aim was to compare the levels of L-arginine between infants with respiratory distress syndrome and infants without respiratory distress syndrome and to determine the relationship between plasma L-arginine concentrations and severity of disease. Thirty premature infants who were admitted to our neonatal intensive care unit were included the study. Seventeen of these infants with respiratory distress syndrome were study group and the other 13 infants without respiratory distress syndrome served as controls. Blood collection was made before any treatment or intervention given to infants and tandem mass spectrometry was used for laboratory testing. In the respiratory distress syndrome group mean L-arginine level was 33.0 (+/- 11.5) mM/l, and in controls it was 79.0 (+/- 23) mM/l. This difference was statistically significant (P < 0.05). There was a reverse relationship between L-arginine levels and oxygenation index (r = 0.732, P = 0.001). If level of L-arginine is low or insufficient in respiratory distress syndrome patients' nitric oxide level would decrease in pulmonary circulation and results increased pulmonary resistance and severity of respiratory distress syndrome. We concluded that L-arginine levels are low in patients with rspiratory distress syndrome and for further investigations, supplementation of respiratory distress syndrome patients with L-arginine may decrease disease severity.