Secondary Gains of Strategies to Prevent COVID-19 Infection in Neonatal Intensive Care Unit: Has the Frequency of Healthcare-Associated Infections Decreased?

OBJECTIVE: To compare the frequency and distribution of healthcare-associated infections (HAI) in the neonatal intensive care unit (NICU) during COVID-19 infection. METHODS: We compared all cases hospitalized in the NICU and diagnosed with HAIs between 1 March - 1 September 2019 (pre-COVID-19 pandemic) and 1 March - 1 September 2020 (during the COVID-19 pandemic). RESULTS: We evaluated a total of 957 babies, 427 babies in the pre-COVID-19 period and 530 babies during the COVID-19 pandemic. HAIs were determined in 47 patients (60 attacks) and 39 patients (44 attacks) in the pre-COVID-19 period and during the COVID-19 period, respectively. HAIs incidence density (per1000 hospitalization days) was found 5.43 in pre-COVID-19 period and 4.87 in COVID-19 period. During the COVID-19 period, there was a significant decrease in the HAI incidence density and bloodstream infection (P = 0.009). CONCLUSIONS: COVID-19 infection prevention strategies helped reduce the frequency of HAIs especially in bloodstream infection in NICU.

A Displaced Mass in the Abdomen, Torsioned Ovary Cyst.

Ovarian cysts are one of the most common pathologies in the infancy period. Approximately 15% of intraabdominal masses seen in this period are genital origined and one-third of these masses are ovarian cysts. The incidence of ovarian cysts has been reported as 1 in 2500 live births. The most common complications in ovarian cysts are torsion and bleeding. Fetal ovarian cysts usually regress spontaneously in complicated cysts; laparoscopic or open surgery can be applied. A female infant with a diagnosis of intraabdominal cystic mass, suspicion of duodenal atresia, and mesenteric cyst made based on a prenatal ultrasonographic imaging was hospitalized in the neonatal intensive care unit for examination and treatment. The abdominal ultrasonography revealed a cystic lesion in the lower left quadrant. The patient was evaluated with abdominal CT for detailed evaluation 1 day later and revealed a cystic lesion in the right upper quadrant. The displacement of the cystic mass conducted the differential diagnosis in favor of mesenteric cyst and ovarian torsion. Laparoscopic surgery was performed for examination and treatment. It was observed that the left ovary was torsioned and displaced. Ovarian cysts are the most frequently observed masses among prenatal cystic masses in female fetuses. It should be kept in mind that cystic masses detected in the prenatal period may often be ovarian cysts and that these cysts can be displaced in the abdomen while torsion, and a treatment plan should be determined according to the clinical findings of the patient.

The long-term impacts of preterm birth and associated morbidities on bone health in preschool children: a prospective cross-sectional study from Turkey.

OBJECTIVE: To evaluate the impact of preterm birth on bone health in preschool children. METHODS: A total of 166 preschool children (aged 7-8 years) born preterm (n = 86, <37-week gestation) and at term (n = 80, ≥37 weeks of gestation) in our hospital were included in this prospective cross-sectional study. Data on antenatal, perinatal, and early postnatal characteristics and maternal obstetric history were obtained from medical records. Bone densitometry data including total bone mineral content (BMC), bone mineral density (BMD; total, lumbar, and femoral), z-scores, and bone loss were collected for each participant. RESULTS: Current height, weight, and BMI values were significantly lower in the preterm group (p < .001). Serum calcium, phosphorus and alkaline phosphatase (ALP) levels did not differ among groups, whereas VitD3 levels were significantly higher in the preterm group (p = .039). The mean total BMC, total BMD, lumbar (L2-L4) BMD, femur BMD, total z-score, and L2-L4 z-score values were significantly lower for the preterm group, whereas the total, lumbar, and femoral bone loss were significantly higher (p < .001), regardless of the severity of prematurity. Intraventricular hemorrhage (IVH) and retinopathy were significantly associated with lower total BMC (p = .004, p = .012, respectively). Fortified breastfeeding was associated with lumbar bone loss (p = .043), and formula feeding was associated with both femur and lumbar bone loss (p = .006, p = .012, respectively). CONCLUSIONS: Our findings revealed long-term adverse effects of preterm birth on bone health, with significantly lower anthropometric values (weight, height, and BMI), lower scores for total BMC, BMD (total, lumbar, femoral), and z-scores (total, femur), along with higher bone loss (total, lumbar, femoral) and higher rates of osteopenia and osteoporosis in preschool children born preterm (whether moderate or very preterm) compared with those born at term. Exclusive breastfeeding appears to reduce the likelihood of long-term bone loss in preterm infants.

Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience.

OBJECTIVE: The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF). METHODS: All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study. RESULTS: The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases. CONCLUSION: The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.

Hemolytic Anemia Due To Anti-c Incompatibility in The Newborn Period: A Case Report.

Hemolytic disease of the fetus and newborn is a disease that is caused by maternal alloantibodies to the fetus. In the literature, the frequency of hemolytic disease of the newborn due to Rh (D) sensitization decreased inversely with the increase in the use of anti-D gammaglobulin. However, the importance of minor blood group incompatibilities has increased in the etiology. Clinical presentation in patients with minor blood group incompatibility may vary from subclinical hemolysis findings to active hemolysis and hyperbilirubinemia requiring blood exchange. In this case study, we present a patient with hemolytic anemia due to anti-c antibody incompatibility.

COVID-19 Management in Newborn Babies in the Light of Recent Data: Breastfeeding, Rooming-in and Clinical Symptoms.

COVID-19 infection proceeds to spread rapidly, it has affected approximately 22 million people and resulted in 770.000 deaths worldwide so far (18 August 2020). The effect of COVID-19 infection on newborn babies still remains unclear. There is limited data regarding the effect of the virus in fetal life and among neonates after birth. Due to insufficient data, an ideal management method or treatment and follow-up guideline for disease in newborn babies cannot be established. In the recent three studies with the highest number of cases, it is reported that mothers who had COVID-19 infection in the last trimester, can breastfeed their babies if they comply with the appropriate hygiene and transmission prevention rules. It is also reported that pregnant women who got infected during pregnancy, have higher rates of maternal mortality, preterm birth frequency and cesarean delivery. Moreover it is asserted that vertical transmisson of the virus is possible and the babies who have community-acquired COVID-19 infection after birth often have symptoms of fever, hypoxemia, cough, tachypnea, less frequently feeding difficulty, retraction, ral, nasal congestion and exanthema. Topics as; its transmission via vaginal secretions during vaginal delivery, presence of the virus in breast milk and whether it has a teratogenic effect in intrauterine period, have not been fully explained. In this study, it is aimed to review the studies on newborn babies with COVID-19 infection and to compile the epidemic data, clinical findings, diagnosis and current information recommended for treatment. Although there is a limited number of published data on babies of mothers who had COVID-19 infection in the last period of pregnancy and babies who had infection in the neonatal period, the effects of the virus on the fetus in the early period of pregnancy and the long-term problems of newborn babies remain unknown.

Midterm Neuromotor Development Results of Preterm Babies less than 34 Weeks Gestational Age.

OBJECTIVES: This study aimed to evaluate the neuromotor development of premature babies and to determine the risk factors affecting neuromotor development in the middle time (3 years). METHODS: All babies with ≤34 weeks gestational age and born between 2011-2014 and hospitalized in our neonatal clinic were included in this study. Prenatal, perinatal and postnatal features of the babies were recorded. Consent was obtained from the families who had an outpatient follow-up and agreed to participate in this study. Neurological examination and Denver II Developmental Screening Test (DDST-II) were applied to babies and their results were recorded. Factors affecting neurodevelopment were evaluated. RESULTS: Complete data for 96 of the study infant were obtained. Fifty (52.1%) of the cases were female. The mean birth weight was 1542±518 grams. The mean corrected age was 20.9±10.7 months at the time of the examination. It was found cerebral palsy in 11 babies (11.5%) with the neurological examination and developmental retardation in 15 babies (15.6%) with DDST-II. Low birth weight, a gestational period of 25-26 weeks, Apgar score at 5th minute <7 were found to be the main risk factors for cerebral palsy and abnormal DDST-II result (p<0.05). In babies with abnormal neurological examination, the frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage were found to be high (p<0.05), and in babies with abnormal DDST-II results the frequency of respiratory distress syndrome, bronchopulmonary dysplasia and sepsis were found to be high (p<0.05). CONCLUSION: In our study, abnormal neurological examination rate was found 11.5% in preterm infants with gestational age ≤34 weeks, and the rate of abnormal DDST-II was found 15.6%. The main factors affecting neuromotor development were gestational week, birth weight and 5th minute Apgar score. The frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage in babies with abnormal neurological examination, and the frequency of respiratory distress, bronchopulmonary dysplasia and sepsis were found to be high in babies with abnormal DDST-II.

Effect of Prematurity on Foveal Development in Early School-Age Children.

PURPOSE: To evaluate the foveal development in preterm children with optical coherence tomography and OCT angiography. DESIGN: Retrospective cohort study. METHODS: This study included children aged 6-8 years who were born prematurely and who did not receive retinopathy treatment. They were evaluated between September 2018 and July 2019, categorized according to gestational age (GA) (group I: GA ≤30 weeks; group II: GA between 31 and 34 weeks), and compared with full-term children (group III). Central foveal thickness (CFT), inner retinal thickness (IRT), outer retinal thickness (ORT), subfoveal choroidal thickness (CT), temporal and nasal CT, foveal avascular zone (FAZ) diameter, and vessel densities of superficial (SCP-VD) and deep capillary plexuses (DCP-VD) of the foveal and parafoveal areas were examined in detail. RESULTS: The study included 126 eyes of 63 patients (group I: 40 eyes; group II: 46 eyes; and group III: 40 eyes). In group I, CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD were significantly greater than those in the other groups, and temporal CT and FAZ diameter were significantly lower (P < .05). GA showed a significant negative correlation with CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD and a significant positive correlation with subfoveal CT, temporal and nasal CT, and FAZ diameter (P < .05). CONCLUSION: The morphological and vascular foveal structures in early school-age children who were born premature were different from those of full-term children. These differences were correlated with GA and more pronounced in those with GA of ≤30 weeks.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents.

BACKGROUND Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents. MATERIAL AND METHODS A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded. RESULTS Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%). CONCLUSIONS In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Frequency of Ambiguous Genitalia in 14,177 Newborns in Turkey.

CONTEXT: Limited data are available on the exact incidence of disorders of sex development (DSD) with genital ambiguity at birth. OBJECTIVE: To determine frequency of ambiguous genitalia in newborns. DESIGN: Prospective multicenter study. SETTING: Three tertiary care hospitals. PATIENTS OR OTHER PARTICIPANTS: All 14,177 babies born during the study period were included. MAIN OUTCOME MEASURES: All newborns were examined at birth; data on weeks of gestation, birth weight, and length were collected. A structured questionnaire was used for data collection. Quigley and Prader scales were used for phenotypic grading. Clinical and genetic investigations were performed. RESULTS: Eighteen babies with ambiguous genitalia were found among 14,177 newborns (1.3/1000). Fifteen newborns had 46,XY DSD, one had 46,XX congenital adrenal hyperplasia, and one had 45,X/46,XY mixed gonadal dysgenesis. Karyotype analysis was not done in one baby who died in the neonatal period. The ratio of prematurity was higher in the DSD group (44% vs 11%; P < 0.001) and the ratio of small for gestational age was also higher in the DSD group (22% vs 5%; P = 0.007). Eight babies with DSD had mothers who had additional medical conditions, such as preeclampsia, depression, insulin resistance, and gestational diabetes mellitus. CONCLUSION: The frequency of ambiguous genitalia was higher than in previous studies, but, as with any experiment, the finding should be met with caution because this study was conducted in tertiary care hospitals. In addition, lower birth weight in the DSD group supports the hypothesis that early placental dysfunction might be important in the etiology of male genital anomalies.

Risk Factor Assessment and the Incidence of Neonatal Hypoglycemia in the Postnatal Period.

OBJECTIVES: The aim of this study was to evaluate risk factors used for the assessment of neonatal hypoglycemia and to examine the follow-up outcomes observed in the first 48 hours of postnatal life. METHODS: The records of infants born between 2015 and 2017 (3 years) at Sisli Hamidiye Etfal Training and Research Hospital who had a blood glucose level test performed within the first 24 hours after birth and who had follow-up results for 48 hours were included in the study. Data of gestational age; birth weight; gender; antenatal, natal and postnatal characteristics; blood glucose measurement method and time during the first 48 hours postpartum; glucose values and follow-up; nutritional status; and the need for hospitalization due to a low blood glucose value were recorded. Groups were created based on data of a diabetic mother, small for gestational age (SGA), large for gestational age (LGA), late preterm birth (34-36+6/7 gestational weeks), fetal distress, and feeding intolerance. Blood glucose measurement values and reasons for hypoglycemia and assessment were compared in subgroups. RESULTS: The data of 9480 infants were reviewed and included in the study. It was determined that blood levels were checked in 28.7% (n=2720). The mean birth weight and gestational age of the infants was 3143±804 g and 37.7±2.5 weeks, respectively. In the study group, 54.7% were male, and 57.5% were delivered via cesarean section. The most frequent factors prompting blood glucose measurement were LGA status (25.9%), prematurity (18%), transient tachypnea (17.3%), and SGA status (11.6%). Results revealed that the blood glucose values of 2009 (73.9%) infants were within normal limits, and there was no further monitoring of blood glucose level during the first 48 hours. In 711 (26.1%), a low blood glucose level finding led to follow-up assessment. The incidence of hospitalization with a preliminary diagnosis of hypoglycemia was 2.5% (n=67). Subgroup analysis indicated that at the first hour, the mean blood glucose value of the patients with multiple factors that were risks for hypoglycemia suggesting further evaluation was lower than those with transient tachypnea and fetal distress (p<0.001), and the mean blood glucose value of premature and LGA neonates were significantly lower than the infants of diabetic mothers at the sixth hour (p<0.001). CONCLUSION: In the postnatal period, the rate of monitoring blood glucose levels in newborn babies was found to be 28.7% and the most commonly predicted risk factor was LGA babies. The frequency of postpartum hospitalization due to hypoglycemia was found to be 2.5%, and blood sugar levels were lower in the first hour in groups with multiple causes.

A Case Report: Neonatal Torsional Ovarian Cyst.

The majority of abdominal masses detected in the neonatal period are benign (85%) and usually originate in the urinary tract (50%), genital system (15%), gastrointestinal system (15%), or the hepatobiliary tract (5%). Ovarian cysts comprise one-third of the masses with a genital origin. Presently described is a case of an ovarian cyst that developed during the antenatal period and transformed into a hemorrhagic cystic mass as a result of torsion. A female infant born at 37 weeks of gestation with the prediagnosis of nephroma was admitted to the neonatal intensive care unit. Abdominal ultrasonography revealed a smooth cystic mass approximately 50x45x35 mm in size in the left upper quadrant that was not associated with the kidney. Magnetic resonance imaging revealed a 55x44x49-mm cystic mass in the left adnexal region containing multiple septations that were not enhanced with contrast material, and the mass was then interpreted as a hemorrhagic fetal ovarian cyst. The left ovary, compromised by 2 full torsions, was removed during a laparoscopy performed on the postnatal seventh day. The infant was subsequently discharged without complications. It should be kept in mind that cystic masses detected in the prenatal period may be of ovarian origin. An appropriate follow-up and treatment should be planned according to the size of the ovarian cyst and the clinical findings.

Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome.

AIMS: To compare the effect of early nasal intermittent positive pressure ventilation (nIPPV) and nasal continuous positive airway pressure (nCPAP) in terms of the need for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants born between 24 and 32 gestational weeks. METHODS: This is a randomized, controlled, prospective, single-centered study. Forty-two infants were randomized to nIPPV and 42 comparable infants to nCPAP (birth weight 1356 ± 295 and 1359 ± 246 g and gestational age 29.2 ± 1.7 and 29.4 ± 1.5 weeks, respectively). RESULTS: The need for endotracheal intubation and invasive mechanical ventilation was significantly lower in the nIPPV group than the nCPAP group (11.9% and 40.5%, respectively, p < 0.05). There were no differences in the duration of total nasal respiratory support, duration of invasive mechanical ventilation, bronchopulmonary dysplasia or other early morbidities. CONCLUSION: nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

Urticaria due to Urtica dioica in a neonate.

Urticaria is one of the most common dermatoses during the childhood, but it is very rare in the neonates. A 17-day-old infant with a generalized urticaria was admitted to our pediatric emergency unit. The mother of the infant reported having applied water boiled with stinging nettle (Urtica dioica) onto her nipples twice a day (before and after each breastfeeding) for 2 days in order to heal her nipple cracks. Serum total immunoglobulin E (IgE) and specific IgE levels for stinging nettle were high in the infant and the mother. The rashes began to regress within the first day of the hospitalization and disappeared completely on the second day without treatment. The skin prick test with the water boiled with stinging nettle was positive for the infant with significant induration, but not for the mother. Conclusion Reporting the first urticaria case in newborns due to stinging nettle, the authors suggest that breastfeeding mothers should always consult a physician before using skincare products.