Early neonatal outcomes in infants of mothers with organ transplantation under immunosuppressive treatment.

BACKGROUND: This study aimed to examine early clinical and laboratory findings in infants born to mothers who had organ transplants and received immunosuppressive treatment. METHODS: Between 2016 and 2023, the study examined infants of mothers who underwent organ transplantation and were receiving immunosuppressive treatment, and followed at the Department of Neonatology at Akdeniz University. Demographic, clinical, and laboratory characteristics of mothers and infants were recorded. On the first day of life, complete blood count values were examined, as well as potassium levels on the first, third, and seventh days, and creatinine levels on the third and seventh days. The tacrolimus blood level was calculated by taking the average of the tacrolimus blood values of the mother measured during the pregnancy. The infants were evaluated for any potential morbidities caused by intrauterine immunosuppressive drug exposure. RESULTS: The study included 21 mothers (some with multiple pregnancies) and 27 infants. According to the findings of this study, 74% of these infants were born premature, 67% had low birth weight, and all were delivered via cesarean section. Prematurity was associated with the morbidities found in the infants. In the early period, lymphopenia was detected in 37%, neutropenia in 25.9%, thrombocytopenia in 11.1%, hyperkalemia in 18.5%, and creatinine elevation in 7.4%, all of which returned to normal within a few days. There was no significant relationship between maternal tacrolimus blood levels and infant potassium and creatinine levels. CONCLUSION: Apart from an increased risk of prematurity, low birth weight, and cesarean delivery, no effects were observed in these infants during the early period. However, long-term follow-up is necessary to monitor for any potential morbidities.

Miracles of science: Birth after uterus transplantation.

AIM: The concept of regaining childbearing ability via uterus transplantation (UTx) motivates many infertile women to pursue giving birth to their own children. This article provides insight into maternal and neonatal outcomes of the procedure globally and facilitates quality of care in related medical fields. METHODS: The authors searched ISI Web of Science, MEDLINE, non-PubMed-indexed journals, and common search engines to identify peer-review publications and unpublished sources in scientific reference databases. RESULTS: The feasibility of the procedure has been proven with 46 healthy children in 88 procedures so far. Success relies upon dedicated teamwork involving transplantation surgery, obstetrics and reproductive medicine, neonatology, pediatrics, psychology, and bioethics. However, challenges exist owing to donor, recipient, and fetus. Fetal growth in genetically foreign uterine allograft with altered feto-maternal interface and vascular anatomy, immunosuppressive exposure, lack of graft innervation leading to "unable-to-feel" uterine contractions and conception via assisted reproductive technology create notable risks during pregnancy. Significant portion of women are complicated by at least one or more obstetric problems. Preeclampsia, gestational hypertension and diabetes mellitus, elevated kidney indices, and preterm delivery are common complications. CONCLUSIONS: UTx has short- and long-term satisfying outcome. Advancements in the post-transplant management would undoubtedly lead this experimental procedure into mainstream clinical practice in the near future. However, both women and children of UTx need special consideration due to prematurity-related neonatal problems and the long-term effects of transplant pregnancy. Notable health risks for the recipient and fetus should be discussed with potential candidates for UTx.

Neonatal Resuscitation Practices in Turkey: A Survey of the Turkish Neonatal Society and the Union of European Neonatal and Perinatal Societies.

OBJECTIVE: Optimal care in the delivery room is important to decrease neonatal morbidity and mortality. We aimed to evaluate neonatal resuscitation practices in Turkish centers. MATERIALS AND METHODS: A cross-sectional survey consisted of a 91-item questionnaire focused on delivery room practices in neonatal resuscitation and was sent to 50 Turkish centers. Hospitals with <2500 and those with ≥2500 births/year were compared. RESULTS: In 2018, approximately 240 000 births occurred at participating hospitals with a median of 2630 births/year. Participating hospitals were able to provide nasal continuous-positiveairway-pressure/high-flow nasal cannula, mechanical ventilation, high-frequency oscillatory ventilation, inhaled nitric oxide, and therapeutic hypothermia similarly. Antenatal counseling was routinely performed on parents at 56% of all centers. A resuscitation team was present at 72% of deliveries. Umbilical cord management for both term and preterm infants was similar between centers. The rate of delayed cord clamping was approximately 60% in term and late preterm infants. Thermal management for preterm infants (<32 weeks) was similar. Hospitals had appropriate equipment with similar rates of interventions and management, except conti nuous-positive-airway-pressure and positive-end-expiratory-pressure levels (cmH2O) used in preterm infants (P = .021, and P = .032). Ethical and educational aspects were also similar. CONCLUSIONS: This survey provided information on neonatal resuscitation practices in a sample of hospitals from all regions of Turkey and allowed us to see weaknesses in some fields. Although adherence to the guidelines was high among centers, further implementations are required in the areas of antenatal counseling, cord management, and circulation assessment in the delivery room.

Specific Granule Deficiency Due To Novel Homozygote SMARCD2 Variant.

Background: Specific granule deficiency (SGD) is a rare immunodeficiency associated with CCAT/enhancer-binding protein epsilon (CEBPE) gene variants. It can cause severe recurrent infections and is lethal without successful stem cell transplantation. Few cases with SGD of both type 1 and type 2 have been described in the literature. In this study, we present the first report of a case with a novel homozygous c.511 C > T (p.Gln171Ter) mutation in the SMARCD2 gene of SGD type 2, which was successfully treated with bone marrow transplantation. Case: A male infant presented to our neonatal intensive care unit on the second day of life with an icteric appearance and mild hypotonia. He was evaluated for immunodeficiency as the cause of delayed cord separation and refractory neutropenia. At 6 weeks of age, SGD type 2 with a new variant was diagnosed and successfully treated by bone marrow transplantation. Conclusion: SGD is an immunodeficiency disease that is quite rare. However, we believe that SGD diagnosis and associated new variants can be detected more frequently with the widespread use of all whole-exome sequencing techniques.

Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant.

OBJECTIVE: To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor. BACKGROUND: Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor. METHODS: Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume. RESULTS: Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g. CONCLUSIONS: Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies.

Enterocolitis necrosante: análisis retrospectivo de 1428 recién nacidos prematuros en una unidad de cuidados intensivos neonatales de nivel III durante un período de cuatro años / Developing necrotizing enterocolitis: retrospective analysis of 1428 preterm infants at a level-III neonatal intensive care unit over a four years period

Objetivo. Investigar la frecuencia de la enterocolitis necrosante (ECN) en prematuros y evaluar los factores de riesgo asociados con su aparición y progresión a perforación intestinal.Métodos. Cohorte retrospectiva de prematuros hospitalizados entre 2015 y 2018. Las características perinatales, clínicas, nutricionales y de laboratorio se analizaron con SPSS-23, y los factores de riesgo mediante una regresión logística.Resultados. En 1428 neonatos, la tasa de ECN fue del 18,28 %. La concepción por reproducción asistida, la cesárea y los corticoesteroides posnatales se asociaron con ECN (OR: 4,056; IC del 95 %: 2,810-5,854; OR: 1,961; IC del 95 %: 1,321-2,910; OR: 6,422; IC del 95 %: 4,327-9,530). El momento de la primera alimentación enteral se asoció con ECN, pero no con perforación intestinal (p < 0,001; p = 0,604). De 261 pacientes con ECN, 47 (18 %) tuvieron perforación intestinal. El momento de la primera alimentación enteral y el ductus persistente con repercusión hemodinámica fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal. (OR: 6,515; IC del 95 %: 5,011-8,470; OR: 4,715; IC del 95 %: 2,717-8,183; OR: 2,748; IC del 95 %: 1,100-6,866). La mortalidad fue del 9 %. La ECN aumentó el riesgo de mortalidad 2,192 veces (IC del 95 %: 1,469-3,271); en perforación intestinal, el riesgo aumentó 11,527 veces (IC del 95 %: 6,293-21,115).Conclusión. El conducto arterial persistente y el retraso en la primera nutrición enteral fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal.

Aim. To investigate NEC frequency in premature infants and assess risk factors associated with disease-onset and progression to intestinal perforation.Methods. Retrospective cohort in preterm neonates hospitalized between 2015 and 2018. Perinatal characteristics, clinical features, nutritional data and laboratory outcome were analyzed using SPSS-23 statistical package. Logistic regression was performed to analyze associated risk factors.Results. In 1428 neonates, the rate of developing NEC was 18.28 %. Conception with assisted reproductive technology, cesearean section and postnatal-steroids were associated with NEC (OR: 4.056, 95 % CI: 2.810-5.854, OR: 1.961, 95 % CI: 1.321-2.910, OR: 6.422; 95 % CI: 4.327-9.530).Timing of first enteral feeding was associated to developing NEC, but not to intestinal perforation (p < 0.001, p = 0.604). Forty-seven of 261 NEC patients (18 %) have developed intestinal perforation. Antenatal steroids showed to reduce severe consequences (p = 0.001). Timing of first enteral feeding and hemodynamically significant PDA were predisposing factors for NEC and low 5-minutes Apgar score for intestinal perforation. (OR: 6.515; 95 % CI: 5.011-8.470; OR: 4.715; 95 % CI: 2.717-8.183; OR: 2.748; 95 % CI: 1.100-6.866).Mortality was 9 %. Developing NEC increased risk of mortality by 2.192 times (95 % CI: 1.469-3.271); in intestinal perforation, mortality risk increased to 11.527 (95 % CI: 6.293-21.115).Conclusion. NEC frequency was 18.28 %. Intestinal perforation occurred in 18 % of NEC patients. PDA and delay in first enteral nutrition were predisposing factors for acquiring NEC and low 5-minutes Apgar scores for intestinal perforation

Developing necrotizing enterocolitis: retrospective analysis of 1428 preterm infants at a level-III neonatal intensive care unit over a four years period. / Enterocolitis necrosante: análisis retrospectivo de 1428 recién nacidos prematuros en una unidad de cuidados intensivos neonatales de nivel III durante un período de cuatro años.

AIM: To investigate NEC frequency in premature infants and assess risk factors associated with disease-onset and progression to intestinal perforation. METHODS: Retrospective cohort in preterm neonates hospitalized between 2015 and 2018. Perinatal characteristics, clinical features, nutritional data and laboratory outcome were analyzed using SPSS-23 statistical package. Logistic regression was performed to analyze associated risk factors. RESULTS: In 1428 neonates, the rate of developing NEC was 18.28 %. Conception with assisted reproductive technology, cesearean section and postnatal-steroids were associated with NEC (OR: 4.056, 95 % CI: 2.810-5.854, OR: 1.961, 95 % CI: 1.321-2.910, OR: 6.422; 95 % CI: 4.327-9.530). Timing of first enteral feeding was associated to developing NEC, but not to intestinal perforation (p < 0.001, p = 0.604). Forty-seven of 261 NEC patients (18 %) have developed intestinal perforation. Antenatal steroids showed to reduce severe consequences (p = 0.001). Timing of first enteral feeding and hemodynamically significant PDA were predisposing factors for NEC and low 5-minutes Apgar score for intestinal perforation. (OR: 6.515; 95 % CI: 5.011-8.470; OR: 4.715; 95 % CI: 2.717-8.183; OR: 2.748; 95 % CI: 1.100-6.866). Mortality was 9 %. Developing NEC increased risk of mortality by 2.192 times (95 % CI: 1.469- 3.271); in intestinal perforation, mortality risk increased to 11.527 (95 % CI: 6.293-21.115). CONCLUSION: NEC frequency was 18.28 %. Intestinal perforation occurred in 18 % of NEC patients. PDA and delay in first enteral nutrition were predisposing factors for acquiring NEC and low 5-minutes Apgar scores for intestinal perforation.

Objetivo. Investigar la frecuencia de la enterocolitis necrosante (ECN) en prematuros y evaluar los factores de riesgo asociados con su aparición y progresión a perforación intestinal. Métodos. Cohorte retrospectiva de prematuros hospitalizados entre 2015 y 2018. Las características perinatales, clínicas, nutricionales y de laboratorio se analizaron con SPSS-23, y los factores de riesgo mediante una regresión logística. Resultados. En 1428 neonatos, la tasa de ECN fue del 18,28 %. La concepción por reproducción asistida, la cesárea y los corticoesteroides posnatales se asociaron con ECN (OR: 4,056; IC del 95 %: 2,810-5,854; OR: 1,961; IC del 95 %: 1,321-2,910; OR: 6,422; IC del 95 %: 4,327-9,530). El momento de la primera alimentación enteral se asoció con ECN, pero no con perforación intestinal (p < 0,001; p = 0,604). De 261 pacientes con ECN, 47 (18 %) tuvieron perforación intestinal. El momento de la primera alimentación enteral y el ductus persistente con repercusión hemodinámica fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal. (OR: 6,515; IC del 95 %: 5,011-8,470; OR: 4,715; IC del 95 %: 2,717- 8,183; OR: 2,748; IC del 95 %: 1,100-6,866). La mortalidad fue del 9 %. La ECN aumentó el riesgo de mortalidad 2,192 veces (IC del 95 %: 1,469-3,271); en perforación intestinal, el riesgo aumentó 11,527 veces (IC del 95 %: 6,293-21,115). Conclusión. El conducto arterial persistente y el retraso en la primera nutrición enteral fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal.

Mortality Caused by Late-onset Sepsis in Very Low Birth Weight Infants: Risk Analysis and the Performance of Diagnostic Tools.

OBJECTIVE: To assess the risk on late-onset sepsis attributed mortality in very low birth weight (VLBW) infants.    Study Design: Observational study. PLACE AND DURATION OF STUDY: Level-III Neonatal Intensive Care Unit, Istinye University, Antalya Medical Park Hospital, Turkey, between January 2014 and December 2018. METHODOLOGY: Perinatal characteristics and clinical features of 198 septic preterm neonates were evaluated to predict sepsis-attributed mortality. ROC analysis was employed to drive optimal-cutoffs for laboratory parameters and logistic regression to calculate mortality risk factors using SPSS version-22 and MedCalc software. RESULTS: Mean gestational age was 28.91 ±2.67 weeks. Umbilical catheterisation was the principal risk factor for culture-positive sepsis (OR 2.860, 95%CI: 1.232-6.639). Outborn infants were more likely to deliver surfactant and longer intubation (p=0.013, and p=0.005, respectively), manifested frequent BPD (p=0.014), and at greater risk of proven sepsis and mortality (OR: 1.796, 95%CI: 1.011-3.191; OR: 1.950, 95%CI: 1.002-3.794). Low Apgar scores necrotising enterocolitis (NEC) and prolonged intubation were independent risk factors for mortality (OR: 13.840, 95%CI: 6.384-30.005; OR: 5.410, 95%CI: 2.113-13.849; OR: 10.037, 95%CI: 4.700-21.434). An increase in high-sensitivity C-reactive protein (hsCRP)-ratio >6.08-fold afforded good sensitivity and specificity (AUC: 0.914; sensitivity: 89.36%, specificity: 86.09%). Logistic regression of various combinations has shown a >6.08-fold change in hsCRP-ratio over 24-hours and platelet counts <88x109/L optimally predicted mortality (OR: 27.983, 95%CI: 9.704-80.697). CONCLUSION: Low Apgar scores, NEC and prolonged intubation are independent risk factors for mortality of VLBW infants. Birth in level III-IV NICUs featuring special neonatal care, avoidance of prolonged intubation, and timely prediction of fatal sepsis using hsCRP ratio and platelets could prevent sepsis-related mortality. Key Words: Sepsis, Very low birth weight, Infant formality, Apgar score.

Risk prediction using a neonatal therapeutic intervention scoring system in VLBW and ELBW preterm infants.

BACKGROUND: The Neonatal Therapeutic Intervention Scoring System (NTISS) is a therapy-based severity-of-illness index, The aim of the present study was to evaluate whether: (i) NTISS can predict the severity of illness with the same accuracy both in very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants, using all parameters; and (ii) the performance of NTISS can be increased by using only the significant variables. METHODS: All inborns <1500 g, and all outborns <1500 g transferred in the first 12 h of postnatal life, were included. NTISS using 63 variables was assessed for all infants at the 24th hour. Predictive performance for the overall variables was assessed using area under the curve (AUC) for group 1 (500-1499 g), 2 (1000-1499 g) and 3 (500-999 g). Variables with good prediction were identified for each group and a second AUC was assessed using only sensitive variables. Receiver operating characteristic (ROC) curve area for all variables was compared with the ROC area for sensitive variables. RESULTS: A total of 364 preterm infants fulfilled the eligibility criteria. The AUC of groups 1, 2 and 3 with all variables were 0.851; 0.834 and 0.749, respectively. The number of parameters with good prediction was 33 in group 1, 30 in group 2 and 18 in group 3. The AUC for sensitive variables was 0.848 in group 1; 0.821 in group 2 and 0.823 in group 3. When compared, increase in the description of outcome was significant only for group 3 patients (P = 0.02). CONCLUSION: NTISS using all parameters seems to be less predictive in ELBW infants. It is probably related to the use of some interventions, done as a routine procedure in almost all ELBW preterm infants, therefore NTISS may be modified according to birthweight in order to obtain a more sensitive prediction.

Maternal origin and clinical findings in a case with trisomy 22.

We report a newborn girl with multiple congenital anomalies whose chromosomal analysis showed complete trisomy 22. Her phenotype included microcephaly, epicanthus, hypertelorism, micrognathia, cleft palate, microtia, and preauricular tag. She died in the 24th post-natal hour. Trisomy 22 was shown by fluorescence in situ hybridization technique and the parental origin of the extra chromosome was found to be maternal by DNA microsatellite marker analysis of chromosome 22. Postmortem examination revealed the presence of atrioseptal defect and stasis in the biliary canals. We believe that this patient will contribute to the literature both by clinical findings and short life span associated with maternal origin of extra chromosome 22.

CMV seroconversion in pregnants and the incidence of congenital CMV infection.

In this study, it was aimed to determine the ratio of CMV seroconversion in pregnant women, the prevalence of maternal CMV infection and also the incidence of congenital CMV infection in their newborns in the Antalya region of Turkey. During a one-year period, CMV-specific IgG and IgM were determined in all (n: 1027) pregnant women admitted at 8 to 20 weeks of gestation, an according to the presence or absence of anti CMV-IgM and CMV-IgG, pregnant women were classified as seropositive, seronegative and having maternal CMV infection. Differentiation of primary and recurrent CMV infection in women with both CMV-IgM (+) and CMV-IgG (+) antibody was determined by the avidity index (AI) of anti-CMV IgG. Ultrasonographic examination was done and amniocentesis was performed at 21 to 23 weeks of gestation in pregnants with primary infection. CMV DNA was investigated in the amniotic fluid by quantitative polymerase chain reaction (qPCR). Pregnants with recurrent infection were followed only by ultrasonography for the presence of fetal abnormalities. Neonates born to mothers with CMV infection were examined for the findings of congenital CMV infection and screened for anti- CMV-IgM, CMV DNA and CMV antigenemia in the first two weeks of life. The rate of seropositivity was found as 98.5% and the rate of seronegativity as 1.5% in pregnant women. The prevalence of maternal CMV infection was found as 1.2% and among these pregnant women, the incidence of primary and recurrent maternal CMV infection was 0.3% (3 women) and 0.8% (12 women), respectively. Congenital CMV infection was detected in one of the newborns born to mothers with primary infection while no infection was detected in any of the newborns of mothers with recurrent CMV infection, so the incidence of congenital CMV infection was found as 0.1% and the rate of intrauterine infection following the primary maternal infection was 33%. In conclusion, seroprevalence rate of CMV in pregnants is high and most (66%) infections are recurrent maternal CMV infection in our region. Thus, it does not seem to be cost-effective to screen all pregnant women for CMV infection, as in the other countries with high seropositivity rate.

Hydrocephalus after intraventricular hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting.

BACKGROUND: Intraventricular hemorrhage and posthemorrhagic hydrocephalus are common causes of neonatal morbidity and mortality among preterm and low-birth weight infants (PT-LBWIs). Clinical management of posthemorrhagic hydrocephalus (PHH) is difficult and not well standardized. In this study, we aimed to determine the incidence of hydrocephalus after intraventricular hemorrhage (IVH) and the associated risk factors for ventriculoperitoneal (V-P) shunting in PT-LBWIs. We also aimed to identify the medical-care practices for these babies. METHODS: We reviewed the medical records of 42 babies with IVH diagnosed by cranial ultrasonography (classification of Papile et al, J Pediatr 1978;92:529-34). We compared 11 babies who required a V-P shunt with the 31 control subjects who did not require a V-P shunt or who died before discharge with respect to risk factors involved in V-P shunting. Maternal, perinatal, and neonatal risk factors, and therapies for IVH and PHH were studied as the V-P shunt-associated risk factors. RESULTS: The mean gestational age studied was 28.9 +/- 2.7 weeks, and the mean birth weight was 1164 +/- 391 g. This study revealed an incidence of 26% of PHH in PT-LBWIs with IVH. The most important risk factor for V-P shunt was found to be the severity of IVH (P < .05). Late gestational age and the time of IVH were found to be significant as well (P < .05). The length of hospitalization was found to be longer in patients with V-P shunt (P < .05). Therapies used for IVH and/or PHH were not significant as a risk factor for V-P shunt. In addition, the mortality rate was found to be 38% for all patients with IVH. CONCLUSION: Intraventricular hemorrhage in PT-LBWIs remains a significant problem, particularly when it is associated with PHH leading to long-term neurological impairment and decreased survival rate.

Unilateral pulmonary agenesis associated with colloidal goiter in a newborn: a case report.

Unilateral pulmonary agenesis is a very rare developmental malformation that is often associated with other anomalies. It can be asymptomatic or present with respiratory symptoms. Our case is a female newborn infant who had been taken to the hospital suffering from difficulty in breathing at the first day of birth. The baby died at the age of three days due to respiratory failure. On autopsy examination and its histopathological evaluation, we detected right pulmonary agenesis and colloidal goiter. According to the literature, pulmonary agenesis is associated with other anomalies including esophageal atresia, tracheal stenosis, musculoskeletal anomalies, DiGeorge syndrome and cardiovascular malformations such as septal defects, patent ductus arteriosus and total anomalous pulmonary venous return. To our knowledge, this is the first case of pulmonary agenesis associated with colloidal goiter.