Comparative Outcomes of Levetiracetam and Phenobarbital Usage in the Treatment of Neonatal Seizures: A Retrospective Analysis.

OBJECTIVES AND AIM: The primary aim of this study was to conduct a comparative analysis of the safety and efficacy of levetiracetam (LEV) and phenobarbital (PB) as first-line treatments for neonatal seizure management. This study was designed to measure and compare the incidence of adverse effects and to determine the discharge and mortality rates associated with the use of these antiseizure medications (ASMs). Through this comparison, this research sought to provide insights to optimise care for neonates experiencing seizures. MATERIALS AND METHODS: This retrospective cohort study evaluated 104 neonates treated for seizures at Zeynep Kamil Hospital from 2015 to 2020 after excluding those on non-PB/LEV antiseizure medications. Seizures were characterised using electroencephalogram (EEG) and categorised according to aetiology and frequency. Treatment efficacy was gauged by seizure cessation, as confirmed using EEG. Adverse effects and demographic data were recorded. Statistical analyses were conducted using SPSS, employing the Shapiro-Wilk, independent t-test, Mann-Whitney U test, and chi-square test, with a significance threshold of p < 0.05. RESULTS: Overall, 104 neonates treated with first-line ASM were evaluated for efficacy; PB was administered in 68.26% of the cases, while LEV was utilised in 31.74%. The total complete response rate was 40.38%, with no significant difference between the PB and LEV groups (p = 0.309). The incidence rate ratios (IRRs) demonstrated that seizure frequency profoundly influenced treatment effectiveness, with IRRs of 2.09 for rare seizures, 3.25 for frequent seizures, and 4.01 for status epilepticus, indicating a higher treatment response rate with increasing seizure frequency. For second-line treatment, among a subset of 62 patients, PB had a slight, non-significant advantage over LEV, with an odds ratio of 1.09, suggesting a marginally better response to LEV. Adverse events were significantly more frequent in the PB group, affecting 19 of 67 neonates (28.36%), compared to only 2 of 71 neonates (2.82%) in the LEV group (p < 0.001). No significant difference was observed in the discharge rates between the two groups (PB, 67.61%; LEV, 75.76%; p = 0.674). Interestingly, the mortality rate was significantly higher in the LEV group (45.45%) than that in the PB group (22.54%; p = 0.045). CONCLUSION: This study underscores LEV's superior safety profile over PB in neonatal seizure management, evidenced by a significantly lower rate of adverse events. PB seems to be more effective in the second-line treatment of neonatal seizures. Despite the lack of significant differences in the discharge rates, the higher mortality rate associated with LEV warrants further investigation. These findings advocate the cautious selection of antiepileptic drugs in neonatal care, with a preference for LEV based on its safety profile.

The Effect of Breastfeeding Self-Efficacy on Infants' Weights and Breastfeeding Outcomes.

OBJECTIVE: The aim of this study was to investigate the effects of breastfeeding self-efficacy (BSE) and breastfeeding success (BFS) on infants' weight gain rates and breastfeeding outcomes. MATERIALS AND METHODS: Mothers were evaluated within the postpartum 72 hours with "Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF)" and "LATCH Scale." After 6 months, the mothers were called to learn the exclusive breastfeeding (EB) duration and the weight of the infants. RESULTS: Two hundred mother-infant couples were enrolled, 176 (88%) of them could be reached in the sixth month. The BSES-SF scores were positively correlated with LATCH scores (P = .0001). The EB rate in the sixth month was positively correlated with BFS but not correlated with BSE (r, P = .218, .004; .79, .297, respectively). The percentage of weight gain and the rate of weight percentile change of babies according to birth weight at the sixth month of age were negatively correlated with BSE (r = -0.226, -0.148, P = .003, .049, respectively) but not correlated with BFS. CONCLUSION: Higher BFS was associated with increased duration of EB in the first 6 months of life, and higher BSE was related to lower increase in the percentage of weight gain and a lower rate of weight percentile change of babies at 6 months of age.

The efficacy of oral motor interventions on feeding outcomes in newborns with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

BACKGROUND: Feeding difficulties continue to be a serious problem in newborns with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). The aim of this study was to investigate the efficacy of oral motor interventions (OMI) on feeding outcomes in neonates with HIE/TH. METHODS: This was a prospective randomised control study conducted between January 2022 and September 2022. Premature Infant Oral Motor Intervention (PIOMI) was used as OMI. Newborns with HIE/TH, who underwent PIOMI, constituted the study group, and newborns, who did not receive any feeding exercise, constituted the control group. Transition time to full oral feeding (FOF) was determined as the time between initiation of tube feeding and full oral breastfeeding or bottle feeding. The day per oral (PO) feeding was started was specified as PO first, the day the infants could take half of the volume of the feedings by mouth was PO half, and the day the infants could take all the feedings by mouth was PO full. RESULTS: There were 50 neonates in each group. Time to FOF was significantly shorter in the study group than in the control group in all stages of HIE/TH (P= 0.008 for stage 1, and < 0.001 for stage 2 and 3 HIE). However, times to PO first, PO half, PO full and discharge were shorter in the study group than in the control group only in the neonates with stage 3 HIE (P= 0.003, 0.014, 0.013, 0.042, respectively). CONCLUSIONS: The PIOMI, which could be named as `HIE-OMI` in our study, is an effective intervention in shortening the transition time to FOF in neonates with all stages of HIE undergoing TH. In addition, `HIEOMI` shortens the length of hospital stay, and improves feeding outcomes in neonates with severe HIE/TH.

Factors Associated with the Transition Time to Full Enteral Feeding in Newborns with Hypoxic Ischemic Encephalopathy.

BACKGROUND: We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. METHODS: We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF. RESULTS: Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37-40) weeks and 3245 (2715-3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1-5) and 6 (4-7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r,P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001). CONCLUSION: Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.

The Associations Between Lung Ultrasonography Scores in the First Day of Life and Clinical Outcomes.

OBJECTIVES: To investigate the role of lung ultrasonography (LU) in predicting noninvasive ventilation (NIV) failure and the relationship between lung ultrasonography scores (LUS) with clinical outcomes in neonatal respiratory failure (NRF). METHODS: A prospective, cross-sectional study was conducted in newborns with NRF who needed NIV and were evaluated by LU. The first LUS (LUS1) was calculated at 2-6 hours and the second (LUS2) at 12-24 hours of life. The patients were divided into NIV failure and NIV non-failure groups. The relationship between LUS and clinical outcomes was evaluated. RESULTS: Among 157 neonates, the median (interquartile range) of gestational week and birth weight were 37 weeks (34-39), and 2890 grams (2045-3435), respectively. The reasons for NRF were transient tachypnea of the newborn (n = 92, 58.6%), congenital pneumonia (n = 58, 36.9%), and respiratory distress syndrome (n = 7, 4.5%). The rate of NIV failure was 17.8% (n = 28). Both LUS1 and LUS2 were significantly higher in neonates with NIV failure compared to neonates with NIV non-failure (P = .001). A cutoff value of LUS1 ≥ 4 predicted NIV failure with 96% sensitivity and 63% specificity. There were positive correlations between LUS and PEEP values, IMV and total MV days, carbon dioxide values, length of hospital stay, and antibiotic days (ρLUS1 , P = .843, <.001; .474, <.001; .444, <.001; .258, .001; .212, .008; .270, <.001, respectively). CONCLUSIONS: Lung ultrasound scores were higher in neonates with NIV failure than with NIV non-failure group, and strongly correlated with end-expiratory pressure values. Lung ultrasound scores were found to be related with some of the clinical outcomes of the NRF, and this suggested that LUS could provide information about the prognosis of NRF.

Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit.

OBJECTIVES: To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. METHODS: Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. RESULTS: Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p<0.001). The EB rate between discharge and 30th day of life did not change between groups (CG:90%, SG1:89%, SG2:75.9; p=0.075). CONCLUSIONS: If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.

The relationship between cardiometabolic risks and vitamin D levels with the degree of obesity.

AIM: The aim of this study was to evaluate the cardiometabolic risk factors including vitamin D levels according to the degree of obesity in adolescents. MATERIAL AND METHODS: This is a retrospective cross-sectional study. A total of 363 overweight/obese adolescents aged between 11 and 18 years who were evaluated in our clinic from January 2012 to December 2015 were included in the study. The degree of obesity was calculated as the body mass index standard deviation. Hypertension, dyslipidemia, hyperinsulinemia, hyperglycemia, insulin resistance, and vitamin D deficiency were defined as cardiometabolic risk factors. Mann-Whitney U, Chi-square, Spearman and Pearson's correlation tests, and linear regressions analyses were used for statistical analyses. RESULTS: Of the 319 (n=319/363) adolescents, all of whose cardiometabolic risk factors were known, 267 (85.7%) had at least one cardiometabolic risk factor. The body mass index standard deviation had a positive correlation with the number of cardiometabolic risk factors (p<0.001). In the linear regression models in which sex and age were considered as covariates, an increase of one unit in the body mass index standard deviation led to an increase of 6.085 mm Hg in systolic blood pressure, 4.4 mm Hg in diastolic blood pressure, 1.59 points in HOMA-IR, 13% in insulin level, and a decrease of 2.16 ng/mL in vitamin D levels. CONCLUSION: In adolescents, the number of cardiometabolic risk factors increases as the degree of obesity increases. The determination of the severity of obesity can help to identify individuals at greater risk for higher blood pressure, impaired glucose metabolism, and lower serum vitamin D levels. On the other hand, the degree of obesity may not reflect the presence of abnormal lipid and glucose levels.