Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization.

OBJECTIVE: This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. STUDY DESIGN: This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO-DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. RESULTS: Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. CONCLUSION: COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. KEY POINTS: · COHb levels do not predict the risk of developing severe hyperbilirubinemia in term neonates.. · COHb levels may predict that ABO incompatibility in early life.. · COHb levels did not prove to be superior to the direct coombs test..

Suspected or Proven Early-Onset Sepsis and NLR, PLR, and MPV Parameters in Neonates with Born through MSAF.

OBJECTIVE: It was aimed to determine the presence of early-onset sepsis in newborns born through meconium-stained amniotic fluid (MSAF) and to investigate the changes of blood parameters in these neonates. STUDY DESIGN: This cross-sectional observational study was performed with neonates born MSAF were divided into two groups as C-reactive protein (CRP) and procalcitonin (PCT) positive and negative group. RESULTS: A total of 3,096 neonates enrolled in this study, and of these 272 with MSAF (8.7%), 76 (27.9%) with neonates were Group I and 196 (72.1%) neonates were Group II. Group I had significantly higher CRP and PCT values and monocyte values significantly lower than Group II, but there were no statistically significant differences between other investigated blood count parameters. There was no association between the platelet, mean platelet volume (MPV), plateletcrit, platelet distribution width, neutrphil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and sepsis in neonates born MSAF. The following areas under the receiver operating characteristic curve were found, respectively: MPV was 0.49 (0.36-0.55), NLR was 0.54 (0.48-0.60), PLR was 0.53 (0.47-0.59), and MLR was 0.54 (0.48-0.60). CONCLUSION: MSAF might be a risk factor for early-onset sepsis in neonates. However, MPV, NLR, PLR, and MLR values cannot be helpful for the detection of suspected or proven early-onset neonatal sepsis in born MSAF neonates. KEY POINTS: · MSAF might be as a risk factor for EOS in neonates.. · CRP and procalcitonin values may help to be determined at EOS in asymtomatic neonates with MSAF.. · MPV, NLR, PLR, andMLR values do not seemto behelpful for the early detection of sepsis inmeconium-stained term neonates..

The value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) parameters in analysis with fetal malnutrition neonates.

Objective To assess the association between fetal malnutrition (FM) and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in singleton term appropriate for gestational age (AGA) neonates. Methods This cross-sectional observational study was performed with 4340 singleton, term AGA neonates without perinatal disease over a two-year period. Results A total of 4320 neonates were evaluated in this study. Those diagnosed with fetal malnutrition, 284 (6%) neonates, were compared with 150 healthy term AGA neonates. Gestational week, birth weight, birth height, head circumference, maternal age, last pregnancy weight, and status of income of the FM group were found to be lower when compared to the control group (P = 0.011). Low last pregnancy weight (P = 0.017) and low level of income (P = 0.042) were found to be factors that affect the presence of FM. The NLR and PLR were found to be significantly higher in the FM group compared with term AGA healthy controls. In correlation analyses, there was a negative correlation between the NLR and PLR with fetal nutritional status (P = 0.011 and P < 0.001, respectively). When the NLR level was taken as 4.51, the sensitivity and specificity of the test for FM were calculated as 81.2% and 80.8%, respectively [area under the receiver-operating characteristic curve (AUROC): 0.81]; when the PLR level was taken as 155.4, the sensitivity and specificity of the test for FM were calculated as 87.0% and 85.4%, respectively (AUROC: 0.94). Conclusion Cord-blood NLR and PLR negatively correlate with term FM AGA neonates.

The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis.

OBJECTIVE: The purpose of this study was to investigate the relationship between neonate early-onset sepsis (EOS) and the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) of term neonates. MATERIALS AND METHODS: This prospective observational study was conducted with term neonates diagnosed with EOS compared with 44 healthy controls. Exclusion criteria were prematurity, postmaturity, small or large for gestational age according to week of pregnancy, preeclampsia, gestational diabetes mellitus, chorioamnionitis, congenital major anomalies, and cyanotic congenital heart disease. RESULTS: A total of 122 term neonates were included in the study. Of these, 78 were diagnosed with EOS and 44 were healthy controls. Tachycardia and apnea with bradycardia were the most common clinical signs of the onset of EOS in neonates in the EOS group. This group had significantly higher neutrophil counts, axillary temperatures, NLRs, PLRs, C-reactive proteins, and procalcitonin levels compared with the control group. There was a positive association between neutrophil counts, NLR, and PLR in the EOS group. An NLR of 6.76 was determined as the predictive cutoff value of neonate EOS (sensitivity 97.4%; specificity 100%; area under the receiver-operating characteristic curve 0.99; P=0.001). A PLR of 94.05 was determined as the predictive cutoff value of neonate EOS (sensitivity 97.4; specificity 100%; area under the receiver-operating characteristic curve 0.93; P=0.001). CONCLUSIONS: NLRs and PLRs were positively correlated with EOS in term neonates, and these ratios can be used as diagnostic adjunct tests for neonate EOS workups.

Critical congenital heart disease screening with a pulse oximetry in neonates.

OBJECTIVE: To compare the results of pulse oximetry screening for critical congenital heart disease (CCHD) in newborn infants performed at <24 h and >24 h following. METHOD: Measurements were taken for each group at <24 h and >24 h following birth. Echocardiography was performed if the SpO2 readings remained abnormal results. RESULTS: A total of 4518 newborns were included in this prospective descriptive study. Of these, 2484 (60.3%) were delivered vaginally and 1685 (39.7%) by cesarean section. Median time points of the screening were 25.4 (25.3-25.5) vs. 17.3 (12.2-22.4) hours after birth. In 4109 infants screened 24 h after birth, the mean pre- and postductal oxygen saturations (SpO2) were 96.5±1.99 and 97.7±1.98, while 127 infants screened within 24 h of mean preductal and postductal SpO2 were 91.33±2.64 and 94.0±4.44. No CCHD was detected during the study period. Pulse oximetry screening was false positive for CCHD in 9 of 4109 infants (0.02%); of these, six infants were referred to pediatric cardiology and three cases were diagnosed as other significant, non-cardiac pathology. There were two cases with AVSD (atrioventricular septal defect, three cases with ventricular septal defect (VSD), and one case with patent ductus arteriosus (PDA). CONCLUSIONS: Saturation values are different between <24-h and >24-h neonates in pulse oximetry screening. The screening in this study identified infants with other important pathologies, this forms an added value as an assessment tool for newborn infants.

Central Hematocrit Levels in Fetal Malnourished Term Infants.

BACKROUND: Fetal malnutrition is especially important for common chronic diseases in adult life. They could potentially be prevented by achieving optimal fetal nutrition. OBJECTIVE: The aim of this study was to investigate hematocrit levels of malnourished, term, appropriate for gestational age (AGA) neonates. SUBJECTS AND METHODS: A total of 80 AGA neonates (between 10% and 90% percentiles interval according to birth week), born with spontaneous vaginal delivery between 37 and 42 weeks of gestation, detected by both last menstrual period and ultrasonography measurements, were included in the study. Neonates with fetal malnutrition constituted the study group and the control group consisted of well-nourished neonates. We analyzed central venous hematocrit levels obtained 4 hours after birth and maternal risk factors for both groups. RESULTS: Although there were no differences in gestational age, head circumference, maternal factors (gravidity, parity, abortions and curettage counts, maternal tobacco use, preeclampsia, hypertension, diabetes mellitus, gestational diabetes mellitus, and history of urinary tract infections), first minute APGAR scores, and sex, Clinical Assessment of Nutritional Status score was lower (29.91±2.87 vs. 21.25±1.65) and hematocrit levels were higher (51.33±2.740 vs. 59.53±5.094) in the fetal malnutrition group (P<0.0001). CONCLUSIONS: Central hematocrit levels in malnourished term AGA neonates were found significantly higher than well-nourished term AGA newborns.

Pentoxifylline Treatment of Very Low Birth Weight Neonates with Nosocomial Sepsis.

Objective The objective of this study was to assess the result of intravenous pentoxifylline as an adjunct to antibiotic therapy on mortality and morbidity in very low birth weight (VLBW) preterm neonates with nosocomial sepsis. Methods For the 18 VLBW preterm neonates, as an adjunct therapy to antibiotics regimens, pentoxifylline (5 mg/kg/h for 6 hours) was administered to premature infants with sepsis on 3 successive days. Clinical and laboratory parameters were recorded before and after treatment. Results Following pentoxifylline therapy, the immature-to-total neutrophil ratio and C-reactive protein (CRP) levels were significantly decreased, while the blood pH and base excess were significantly increased (p < 0.05). The axillary temperature, noninvasive blood pressure, hemoglobin, leukocyte, and thrombocyte values did not significantly differ after treatment (p > 0.05). Coagulase-negative staphylococci (CoNS) (32%), Streptococcus hominis (7.3%), Pseudomonas aeruginosa (5.3%), and Candida parapsilosis (3.1%) were identified in the blood cultures. There were no short-term morbidities (intraventricular hemorrhages, necrotizing enterocolitis, periventricular leukomalacia, and patent ductus arteriosus), no adverse effects, and no mortalities during or after the pentoxifylline therapy in the preterm neonate participants. Conclusion The CRP levels and heart rate both decreased, while the pH and base excess parameters of the blood gas analysis changed positively after pentoxifylline treatment in VLBW preterm neonates with nosocomial sepsis.

Pentoxifylline and Pentaglobin adjuvant therapies for neonatal nosocomial sepsis in neonates less than 1500g weight.

OBJECTIVE: To compare different support therapies in very low birth-weight preterm neonates with nosocomial sepsis. METHODS: This clinical pilot study was conducted at the Bagcilar Research and Training Hospital, Istanbul, Turkey, from September 2015 to November 2016. Preterm infants appropriately sized for a gestational age of < 32 weeks and < 1,500g were included in the study. Pentaglobin was initiated on the day of diagnosis of nosocomial sepsis to very low birth-weight preterm neonates as a support therapy in addition to antibiotics: 5 ml/kg per day of pentaglobin was infused over a four-hour period on three consecutive days. Pentoxifylline (5 mg/kg every 6 hours) was administered to premature infants with sepsis on three successive days. RESULTS: Of the 41 neonates, 19(46.3%) were girls and 22(53.7%) were boys. Vital signs, haematologic tables, peripheral blood smear left shift ratio, and blood-gas parameters did not differ significantly between the groups (p>0.05), but the C-reactive protein (mg/dl) values significantly decreased after pentoxifylline treatment (p<0.05). Coagulase-negative staphylococci were the most frequently isolated bacteria in the two groups (n=4; 19% vs. n=4; 20%). There was no difference in isolated microorganisms. There was no significant difference in intraventricular haemorrhage, necrotising enterocolitis, periventricular leukomalacia or symptomatic patent ductus arteriosus in the neonates when comparing the two groups and no systemic reactions were observed during adjuvant therapy in the preterm neonates (p>0.05). The total duration of hospitalisation was 49.46±13.52 days for the pentaglobin group and 44.21±11.1 days for the pentoxifylline group neonates. CONCLUSIONS: Pentoxifylline treatment for nosocomial sepsis decreased C-reactive protein levels and heart rate more than pentaglobin therapy.

Auditory neuropathy in late preterm infants treated with phototherapy for hyperbilirubinemia.

OBJECTIVE: To evaluate the prevalence of auditory neuropathy (AN) in late preterms treated with phototherapy for hyperbilirubinemia. DESIGN: Prospective observational study comprising late preterms treated with phototherapy for hyperbilirubinemia. Newborns were screened with combined transient-evoked otoacoustic emissions (TEOAEs) / automated auditory brainstem responses (AABR). Infants who failed screening underwent diagnostic (ABR). Infants were all re-evaluated with AABR at one year. STUDY SAMPLE: Eighty-five infants with a mean serum total bilirubin concentration of 22.3 ± 1.76 mg/dl; severe-hyperbilirubinemia (SH), and 102 infants with a mean serum total bilirubin concentration of 18.6 ± 1.26 mg/dl; non-severe hyperbilirubinemia (NSH) were included. RESULTS: From 85 late preterms with SH, six (7.1%) failed screening and underwent diagnostic ABR for six weeks. AN was diagnosed in two (2%) infants with SH. Four (3.9%) of the 102 controls with NSH demonstrated failure at TEOAE/AABR. No AN was diagnosed in the control group at the diagnostic ABR. No statistically significant difference was found between infants treated with phototherapy for SH and NSH with regard to AN/AD either in the postnatal period or at one year. No correlation was found between serum bilirubin levels and ABR latencies or thresholds. CONCLUSIONS: AN (2%) in late preterms treated with phototherapy for severe-hyperbilirubinemia was not higher than in those with non-severe hyperbilirubinemia.

Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura.

This study aimed to evaluate the efficacy, cost, and effects of anti-D immunoglobulin (anti-D Ig), methylprednisolone, or intravenous immunoglobulin (IVIG) therapy on the development of chronic disease in children who are Rh-positive with diagnosed immune thrombocytopenic purpura (ITP). Children with newly diagnosed ITP and platelet count <20,000/mm(3) were prospectively randomized to treatment with anti-D Ig (50 µg/kg), methylprednisolone (2 mg/kg/day), or IVIG (0.4 g/kg/day, 5 days). Sixty children with a mean age of 6.7 years were divided into three equal groups. No difference was observed between platelet counts before treatment and on day 3 of treatment. However, platelet counts at day 7 were lower in the methylprednisolone group than in the IVIG group (P = 0.03). In the anti-D Ig group, hemoglobin and hematocrit levels were significantly lower at the end of treatment (P < 0.05). Chronic ITP developed in 30% of the anti-D Ig group, 35% of the methylprednisolone group, and 25% of the IVIG group, but no significant difference was noted among the groups. The cost analysis revealed that the mean cost of IVIG was 7.4 times higher than anti-D Ig and 10.9 times higher than methylprednisolone. In the treatment of ITP in childhood, one 50 µg/kg dose of anti-D Ig has similar effects to IVIG and methylprednisolone. Among patients who were treated with anti-D Ig, serious anemia was not observed, and the cost of treatment was less than that of IVIG treatment.

Oxygen saturation of healthy term neonates during the first 30 minutes of life.

BACKGROUND: The purpose of this study was to document the oxygen saturation (SpO(2) ), general physical signs and laboratory characteristics during the first 30 min of life. METHODS: Forty healthy singleton full-term neonates delivered vaginally (n = 33) or by cesarean section (n = 7) were included in this prospective observational study. After delivery, the SpO(2) levels of the upper (right hand; 'preductal') and lower (dorsum of the right foot; 'postductal') extremities of the neonates lying on the servo-controlled radiant heater in the delivery room were measured simultaneously with oximeter probes (Oxiprobe BM-270) placed at 1, 5, 10, 15, 20, 25, and 30 min. The correlation between pre- and postductal SpO(2) level and different variables (vital signs, capillary refill time recorded at 1 and 15 min, cord pH and hemoglobin values, and Apgar scores at 1 and 5 min) was examined. RESULTS: The 1 min pre- and postductal SpO(2) were 82.3 ± 7.34% and 79.08 ± 8.16% (P > 0.05), respectively. The preductal values at 5, 10, and 15 min were statistically higher than the postductal values (89.73 ± 6.01%, 93.43 ± 4.06%, and 94.53 ± 3.19% vs 85.53 ± 6.92%, 89.9 ± 4.91%, 92.83 ± 3.92%, respectively). SpO(2) was the same regardless of the mode of delivery. No correlations were found between pre- and postductal SpO(2) and other variables. CONCLUSIONS: Oxygen saturation was not affected by mode of delivery, was independent of Apgar score, cord hemoglobin, cord pH, vital signs, and capillary refill time in the first few minutes of life, and did not reach 90% in the first 5 min of life in healthy full-term neonates.

Pentaglobin as an adjunct therapy in very low birthweight neonates with nosocomial sepsis.

OBJECTIVE: To evaluate the effect of pentaglobin treatment on clinical and laboratory parametres and the major morbidities in very low birthweight neonates with nosocomial sepsis before and after pentaglobin treatment. METHODS: The prospective interventional study was conducted from January 1 to December 31, 2010, at the neonatal intensive care unit (NICU) of the Bakirköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. Pentaglobin was initiated on the day of diagnosis of nosocomial sepsis to 13 pre-term neonates as a support therapy in addition to antibiotics; 5 ml/kg per day of pentaglobin was infused over a 4-hour period on 3 consecutive days. Clinical and laboratory parametres and major morbidities were recorded before and after pentaglobin treatment and compared using NCSS software. RESULTS: Of the total, 8 (66%) were females and 5 (40%) males. Following pentaglobin therapy, the immature-to-total neutrophil ratio and C-reactive protein levels were significantly decreased, and the capillary pH and base excess were significantly increased (p < 0.05). The axillary temperature, non-invasive blood pressure, haemoglobin, leukocyte, and thrombocyte values did not significantly differ before and after treatment (p > 0.05). Coagulase-negative staphylococci (n = 3; 23%), Klebsiella pneumoniae (n = 2; 15.3%), and Pseudomonas aeruginosa (n = 1; 7.7%) were identified in blood cultures. The presence of intraventricular haemorrhages, necrotising enterocolitis, periventricular leukomalacia, and patent ductus arteriosus was not changed following the treatment. Adverse effects and mortality were not observed during or after the therapy. CONCLUSION: Pentaglobin treatment of nosocomial sepsis could be used as an adjunct therapy without any adverse short-term reactions, even in very low birthweight pre-term infants.

Ankyloblepharon Filiforme Adnatum in a 3-day-old Neonate: A Case Report.

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly consisting of partial or complete fusion of the eyelid margins. It is usually isolated and benign, but its presence should alert the neonatologist as it may rarely be associated with other disorders. We present a case of a 3-day-old newborn presenting with isolated AFA at birth.

Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants.

BACKGROUND: The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth. During the early postnatal period, protein intake must be sufficient to achieve normal postnatal growth in extremely low-birthweight infants. The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at <34 gestational weeks (GW) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity (ROP). METHODS: Fifty-three neonates born at <34 GW and hospitalized in the neonatal intensive care unit (NICU) were included in this prospective study. They were randomly divided into two groups. Group 1 received aggressive parenteral nutrition (PN) (amino acids 3 g/kg per day and lipids 2 g/kg per day on first day of life). Group 2 received conventional PN (amino acids 1.5 g/kg per day and lipids 1 g/kg per day on first day of life). The anthropometric measurements, clinical outcomes and serum levels of insulin-like growth factor-I (IGF-I), IGF binding protein (IGFBP) and thyroid hormones were compared between groups. RESULTS: At 40 weeks of gestation, height, head circumference and serum IGF-I and IGFBP3 were statistically higher in the group receiving aggressive PN. Thyroid hormones were not affected by aggressive PN. The lower levels of IGF-I and IGFBP3 in the group receiving conventional PN were negatively correlated with development of ROP. CONCLUSION: Aggressive PN seems to positively affect neonates' anthropometric measurements at the 40th gestational week and the development of ROP. These effects may be related to high levels of IGF-I and IGFBP3.

Delivery room blood pressure percentiles of healthy, singleton, liveborn neonates.

BACKGROUND: Arterial blood pressure (BP) is one of the four vital signs that reflect cardiovascular status in neonates. The present study aimed to obtain BP percentiles among healthy, singleton, liveborn neonates between 34 and 43 weeks of gestation who were less than 1 h old. METHODS: BP measurements were taken after birth in supine-positioned neonates in the delivery room using an oscillometric device. A total of 982 well-nourished neonates who did not require resuscitation, were not fetally malnourished, were not admitted to the neonatal intensive care unit and were without obvious congenital abnormalities were included in the study. RESULTS: Sex- and type-of-delivery-specific 5th and 95th percentiles BP measurements were obtained for gestation. Mean BP values for systolic, diastolic and mean of term neonates were 63.98 ± 12.29 mmHg, 38.34 ± 11.06 mmHg and 49.32 ± 11.33 mmHg, and late preterm neonates were 61.80 ± 12.46 mmHg, 33.17 ± 9.97 mmHg and 46.52 ± 10.8 mmHg, respectively. There were weak but significant correlations between birthweight, birth length and head circumference and systolic, diastolic and mean arterial BP values (r = 0.20, r = 0.15 and r = 0.20, respectively, P < 0.001). Neonates who were delivered vaginally had higher mean BP values for systolic, diastolic and mean than neonates delivered by cesarean section (P < 0.05). Female neonates had higher systolic BP values than male neonates (P < 0.05). CONCLUSION: Data presented in this study include sex- and delivery-mode-specific BP percentile curves using an oscillometric method and serve as a valuable reference for physicians in dealing with the management of singleton, liveborn late preterm and term newborns in the delivery room intensive care.

New intrauterine growth percentiles: a hospital-based study in Istanbul, Turkey.

OBJECTIVE: To develop gender and gestation-specific growth percentiles for singleton live-born neonates and to compare new weight for age unisex percentiles with Lubchenco unisex percentiles. METHODS: Cross-sectional birth data were collected from the neonatal registry from January 2000 to April 2006 (n = 15.509). After exclusion, the sample included 15.112 neonates. RESULTS: Newly developed weight for age, charts were compared with Lubchenco unisex percentiles, 91.8% of the subjects were classified in the same way (Kappa = 0.74, P < 0.001). Small for gestational age (SGA) and large for gestational age (LGA) according to the Lubchenco percentiles differed from the new percentiles (Mc Nemar test, P < 0.001). The percentage of SGA neonates was underestimated by Lubcheno percentile (5.8% vs. 10.6%, respectively), whereas the percentage of LGA neonates was overestimated by Lubcheno percentile (10.3% vs. 9.3%, respectively). CONCLUSION: New growth chart for newborn delivered at different gestational ages have been established, which can be used to define SGA and LGA in Turkish neonates. Studies comparing the Lubchenco percentiles with new percentiles are needed.

Infantil Acute Hemorrhagic Edema in a Neonate: A Case Report.

Acute infantile hemorrhagic edema is a rare leukocytoclastic vasculitis with symptom triad of fever, large purpuric skin lesions, and edema. The major features are an ecchymotic purpura, an inflammatory edema of the limbs and face. It is a benign condition with a dramatic onset, resolves spontaneously and completely within 1-3 weeks, and is seen in children younger than 3 years of age. We would like to detail a newborn with acute infantile hemorrhagic edema, as it is a rare disease in childhood, especially in the neonatal period.

Oxygen saturation levels during the first minutes of life in healthy term neonates.

The oxygen support during neonatal resuscitation is not completely defined by evidence-based science. We, therefore, aimed to determine the oxygen saturation (SpO(2)) levels within the first 15 minutes of life and to evaluate the effect of delivery routes, gender and measurement sites on the mean time to reach preductal and postductal SpO(2) levels of 90% among healthy term neonates. The sensors were placed at the right hand for preductally and the left hand for postductally SpO(2) measurements. In this prospective observational study, 141 healthy term neonates were included. Seventy-one (50.3%) of the babies were female, and 77 (54.6%) were delivered by caesarean section. Mean gestational age was 38.8 ± 1.1 weeks and mean birth weight was 3,082 ± 425.7 g. Overall, it took 7.5 ± 2.8 and 9.5 ± 3.2 min to reach oxygen saturation levels ≥ 90% preductally and postductally, respectively. The lengths of time to reach ≥ 90% preductal and postductal SpO(2) levels were 6.9 ± 2.8 and 8.4 ± 3.2 min for vaginal delivery and 8.0 ± 2.8 and 10.4 ± 2.9 min for caesarean section, respectively. Thus, the time to reach SpO(2) levels ≥ 90% was prolonged in the postductal measurements and in the neonates born by caesarean section. Gender was found to have no effect on duration to reach 90% SpO(2) levels at both preductal and postductal measurements. The measurement site and the type of delivery must be taken into consideration when oxygen saturation was measured in term healthy newborn in delivery room immediately after birth.

A comparison of different methods of temperature measurements in sick newborns.

We aimed to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT), infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) measurements with traditional axillary glass mercury thermometer (AGMT) for intermittent temperature measurement in sick newborns. A prospective, descriptive and comparative study in which five different types of thermometer readings were performed sequentially for 3 days. A total of 1989 measurements were collected from 663 newborns. DAT and ITT measurements correlated most closely to AGMT (r = 0.94). The correlation coefficent for IFST and RGMT were 0.74 and 0.87, respectively. The mean differences for DAT, ITT, RGMT and IFST were +0.02°C, +0.03°C, +0.25°C and +0.55°C, respectively. There were not any clinical differences (defined as a mean difference of 0.2°C) between both mean AGMT&DAT and AGMT&ITT measurements. Our study suggests that tympanic thermometer measurement could be used as an acceptable and practical method for sick newborn in neonatal units.

Turkish validity and reliability of the COVERS pain scale.

OBJECTIVE: The objective of this study is to determine the Turkish validity and reliability of COVERS. METHODS: This study was conducted on 41 newborns as methodological design. The scales, such as newborn information form, COVERS, preterm infant pain profile (PIPP), and neonatal infant pain scale (NIPS), were used in the study. Validity (e.g., language, content concurrent, and construct) and internal consistency and inter-rater reliability of the scale were conducted. RESULTS: It was found that COVERS showed a high correlation with PIPP and NIPS, and the item-total correlation of COVERS was above 0.30 during and after heel lance procedure. The Cronbach's α values were 0.77 and 0.83 during and after heel lance procedure, respectively. The kappa values of the items of COVERS were between 0.38 and 0.78 during heel lance procedure. CONCLUSIONS: It was concluded in this study that there was a moderate correlation in intraclass correlation coefficients for scores of COVERS during both diaper change and heel lance procedures. It has been concluded that the scale is valid and reliable in 27-week-old and older newborns.