Breast Milk Protein Percentiles According to Gestational and Postnatal Age: Could It Be Used as a New Alternative in Guided Fortification?

Human milk is the first choice for infant nutrition but it must be multinutrient fortified for optimum growth and neurodevelopment in preterm infants. However, there is no consensus on ideal fortification method. The authors aimed to generate the human-milk protein content percentiles during the first five postnatal weeks in four preterm groups (n = 108) with median gestational age of 32 (23-36) wk, who were fed adjustably fortified breast milk in the NICU between October 2011 and June 2013. Total 540 breast milk samples of mothers of 108 infants were weekly analyzed for protein intake. It was observed that the median human-milk protein levels decreased throughout the five postnatal weeks in all groups. None of the preterm infants was able to take the recommended daily protein intake with the fortification protocol of the authors' unit. Preterm human-milk protein charts can be used as a new practical individualized fortification guiding method instead of laborious targeted or adjustable approaches currently in use.

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study.

BACKGROUND: Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. METHODS: A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. RESULTS: The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005). CONCLUSIONS: Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.

Negative Effects of Noise on NICU Graduates' Cochlear Functions.

AIM: To evaluate the adverse effects of noise on hearing. Methods: Thirty-two infants that had been admitted to neonatal intensive care unit (NICU) and 25 healthy controls were included in this study. Noise levels were recorded continously during the hospitalization period. Results: All healthy controls passed the hearing screening tests before discharge and on the sixth-month follow up. Hospitalized infants had lower "Distortion Product Auto Acoustic Emission Signal Noise Ratio" (DPOAE SNR) amplitudes (dB) at five frequencies (1001, 1501, 3003, 4004, 6006 Hz in both ears). DPOAE fail rates at 1001 Hz and 1501 Hz were higher than in hospitalized infants (81.8% and 50.0% vs 20.0% and 4.0%). Infants who failed the test at 1001 and 1501 Hz were exposed to noise above the recommended maximum level for longer periods of time. Conclusion: Hearing tests performed at sixth-months of life were adversely affected in NICU graduates.

Neuroprotective effect of L-arginine in a neonatal rat model of hypoxic-ischemia.

Aim: The aim of the present study is to investigate the neuroprotective effects of l-Arginine (l-arg) in the seven-day-old rat hypoxia-ischemia model. Materials and methods: L-Arginine (n = 10) or saline (n = 8) was administered intraperitoneally to seven-day-old rats before hypoxia-ischemia. In addition, 18 seven-day-old rats were given l-Arginine (n = 10) or saline (n = 8) after hypoxic-ischemic insult. Neuronal apoptosis was investigated by terminal dUDP-biotin nick end-labeling (TUNEL) following three days of recovery. The ratios of right side numerical density to the sum of right and left sides' numerical densities (right apoptosis index) were calculated for every brain region in rats receiving l-arginine and they were compared with the vehicle groups. Results: Right side apoptosis indexes of the hippocampus (mean ± SD; 35.0 ± 16.1) and striatum (41.9 ± 16.0) were significantly decreased in the l-Arginine post-treatment groups when compared to vehicles (61.0 ± 17.0 and 62.4 ± 27.0 respectively) (p < 0.05). There was no significant difference in the right apoptosis indexes of the cortex between l-Arginine post-treated group and the vehicle group. There were also no significant differences between the right side apoptosis indexes of the l-Arginine pretreatment groups and those of the vehicle group in any of the three regions (p > 0.05). Conclusions: It is concluded that neuronal apoptosis due to hypoxic-ischemic injury may likely to be reduced by post-treatment of l-Arginine in the neonatal rat model and l-Arginine provides a new possibility for neuroprotective strategies based on NO production.

Effects of blood transfusion on regional tissue oxygenation in preterm newborns are dependent on the degree of anaemia.

AIM: Most of the preterm infants are transfused at least once during their stay in the neonatal intensive care unit (NICU). The aims of this study were to demonstrate if packed red blood cell (pRBC) transfusion modulates regional (cerebral, abdominal, renal) tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) and to demonstrate if we can use NIRS to guide transfusion decisions in neonates. METHODS: A multi-probe NIRS device was applied to anaemic preterm infants of gestational age <33 weeks for 30-60 min before and 24 h after pRBC transfusion. We evaluated the results separately in the subgroup with a pre-transfusion haemoglobin (Hb) < 8 g/dL. Cerebral, abdominal and renal tissue oxygen saturation (rSO2 ) and abdominal/cerebral, abdominal/renal and renal/cerebral rSO2 ratios before and 24 h after transfusion were compared. RESULTS: There was no significant difference in cerebral rSO2 and abdominal/renal rSO2 ratios before and 24 h after transfusion, but abdominal and renal rSO2 and abdominal/cerebral and renal/cerebral rSO2 ratios at the 24th h following transfusion increased significantly. This increase was observed in the subgroup with pre-transfusion Hb < 8 g/dL. Although statistically significant, the increase in renal oxygenation was within the limits of variability. CONCLUSIONS: The increase in tissue oxygenation in abdominal region after pRBC transfusion suggests decreased tissue oxygenation of intestines during severe anaemia despite cerebral oxygenation being maintained at that particular Hb level. The impact of the increase on renal oxygenation with pRBC transfusion is unclear and might need further investigation. Increase in abdominal rSO2 may cause reperfusion injury, oxidative damage and trigger necrotising enterocolitis.

Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.

BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. METHODS: Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV+VG or PSV+VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. RESULTS: The study enrolled 42 subjects. Clinical data were similar between groups. PSV+VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV+VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-1ß in the tracheal aspirates increased during both modes. CONCLUSION: PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV+VG. Therefore, PSV+VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.

Regional brain volume reduction and cognitive outcomes in preterm children at low risk at 9 years of age.

OBJECTIVE: More information is needed on "low-risk" preterm infants' neurological outcome so that they can be included in follow-up programs. A prospective study was performed to examine the regional brain volume changes compared to term children and to assess the relationship between the regional brain volumes to cognitive outcome of the low-risk preterm children at 9 years of age. PATIENTS: Subjects comprised 22 preterm children who were determined to be at low risk for neurodevelopmental deficits with a gestational age between 28 and 33 weeks without a major neonatal morbidity in the neonatal period and 24 age-matched term control children term and matched for age, sex, and parental educational and occupational status. METHODS: Regional volumetric analysis was performed for cerebellum, hippocampus, and corpus callosum area. Cognitive outcomes of both preterm and control subjects were assessed by Weschler Intelligence Scale for Children Revised (Turkish version), and attention and executive functions were assessed by Wisconsin Card Sorting Test and Stroop Test TBAG version. RESULTS: Low-risk preterm children showed regional brain volume reduction in cerebellum, hippocampus, and corpus callosum area and achieved statistical significance when compared with term control. When the groups were compared for all WISC-R subscale scores, preterm children at low risk had significantly lower scores on information, vocabulary, similarities, arithmetics, picture completion, block design, object assembly, and coding compared to children born at term. Preterm and term groups were compared on the Stroop Test for mistakes and corrections made on each card, the time spent for completing each card, and total mistakes and corrections. In the preterm group, we found a positive correlation between regional volumes with IQ, attention, and executive function scores. Additionally, a significant correlation was found between cerebellar volume and attention and executive function scores in the preterm group. CONCLUSION: Low-risk preterm children achieve lower scores in neurophysiological tests than children born at term. Preterm birth itself has a significant impact on regional brain volumes and cognitive outcome of children at 9 years of age. It is a risk factor for regional brain volume reductions in preterm children with low risk for neurodevelopmental deficits. The significant interaction between cerebellar volume reduction and executive function and attention may suggest that even in preterm children at low risk can have different trajectories in the growth and development of overall brain structure.

Impact of mode of delivery on skin microcirculation in term healthy newborns within the first day of life.

BACKGROUND: Microcirculation is an important component of hemodynamic physiology. It can be assessed simply by clinical scores or by a variety of techniques including sidestream dark field (SDF) imaging and peripheral perfusion index (PI) measurements. Mode of delivery may have affects on microcirculation during transitional period. The aim of this study was to compare skin microcirculation in newborns born via vaginal delivery (VD) or cesarian section (C/S). METHODS: Term healthy newborns not requiring NICU admission were included. Vital signs were recorded. Skin microcirculation was determined by clinical scoring including capillary refill time, skin color, warmth of extremities, by SDF imaging where capillary density and microvascular flow is determined and by PI measurements where pulsatile and nonpulsatile capillary flow is measured. Assessments were done at 30 min and 24 h of life. Results were compared between VD and C/S groups and overtime. RESULTS: There were 12 newborns in VD group and 25 newborns in C/S group. No difference was observed in microcirculation assessments between groups. However VD group had increased hyperdynamic flow overtime. CONCLUSION: In healthy term newborns microcirculation does not seem to be affected by mode of delivery, however results may differ in sick or preterm newborns.

Perfusion index assessment during transition period of newborns: an observational study.

BACKGROUND: Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as "delayed transition", others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. METHODS: Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. RESULTS: Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. CONCLUSION: PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.

Ileo-ileal intussusception in a premature neonate: an unusual cause of NEC in premature babies.

Intussusception is a rare entity in neonates. It may present with non-specific signs including abdominal distension, feeding intolerance, vomiting and bloody stools. Symptomatology is similar to Necrotizing Entero-Colitis (NEC). Ultrasound can help to establish early diagnosis in neonate. A 27-week preterm newborn was initially suspected as NEC based on abdominal distention, bilious vomiting, worsening clinical condition and dilated loops of bowel on X-ray, which turned out to be ileo-ileal intussusception. Diagnosis was made by ultrasound obtained for a palpable mass to rule out intra abdominal abscess and lack of improvement in clinical condition despite 5 days of conservative treatment. Surgery was performed consisting of removal of the necrotic intussusception area and end-to-end anastomosis and patient was discharged from hospital on day 60 of life. As a conclusion, pathological abdominal findings in preterm newborns can also be due to conditions other than NEC and ultrasound may be a useful tool for timely and accurate diagnosis.

The effects of breast milk storage and freezing procedure on interleukine-10 levels and total antioxidant activity.

OBJECTIVE: To compare interleukine-10 (IL-10) and total antioxidant capacity (TAC) levels after breast milk storage by studying premature and term mothers' colostrum and mature milk and by analyzing those levels relative to gestational week. METHODS: Fifty-four colostrum and mature breast milk samples were collected from both premature and term mothers. The samples were divided into three groups based on the time of analysis: fresh milk, at +4 °C for 72 h, and at -20 °C for 14 d. The IL-10 and TAC levels were measured quantitatively. RESULTS: Fresh colostrum and mature milk had similar IL-10 levels. Term mothers' fresh-colostrum TAC levels were higher than their mature milk. The mature milk of the premature mothers' had higher TAC levels than that of term mothers. Storage did not affect the IL-10 levels of breast milk, but fresh milk antioxidant capacity halved after 72 h and 14 d. Colostrum IL-10 and TAC levels did not correlate with gestational week. Mature milk IL-10 levels did not correlate with gestational week, but TAC levels negatively correlated with gestational week (r: -0.61: p < 0.01). CONCLUSIONS: The milk stored for 72 h at +4 °C and for 14 d at -20 °C did not maintain the same TAC levels as the fresh samples. This should be considered especially for sick infants who need more antioxidant capability in neonatal units.

Validity and reliability of the infant breastfeeding assessment tool, the mother baby assessment tool, and the LATCH scoring system.

AIM: We aimed to evaluate the validity and reliability of the Infant Breastfeeding Assessment Tool (IBFAT), the Mother Baby Assessment (MBA) Tool, and the LATCH scoring system. SUBJECTS AND METHODS: Mothers who delivered healthy, full-term infants in the Obstetrics & Gynecology Service of Gazi University, Ankara, Turkey, between December 2013 and January 2014 and their infants were included in the study. Forty-six randomly selected breastfeeding sessions were monitored and scored simultaneously by three researchers (Raters 1, 2, and 3) using LATCH, IBFAT, and the MBA Tool. Researchers put the score sheets in an envelope in order to hide them from each other. The compatibility of the scores given by three researchers was assessed by statistical methods. RESULTS: We found positive and significant correlation coefficients between 0.81 to 0.88 for the total MBA score, between 0.90 to 0.95 for the total IBFAT score, and between 0.85 to 0.91 for the total LATCH score. Correlation coefficients testing these three tools ranged from 0.71 to 0.88, with the minimum value being noted for the correlation between LATCH and IBFAT scores and the maximum value being noted for the correlation between LATCH and MBA scores. CONCLUSIONS: We found positive and significant correlations between researchers' scores for 46 observations using the three assessment tools. This study showed that these above-mentioned tools were compatible for the assessment of the efficiency of breastfeeding.

The prediction of later neurodevelopmental status of preterm infants at ages 7 to 10 years using the Bayley Infant Neurodevelopmental Screener.

The aim of this study was to see whether the scores of the Bayley Infant Neurodevelopmental Screener of 45 high-risk preterm infants (gestational age 26-37 wk) between the ages of 3 and 24 months predicted neurodevelopmental status at 7 to 10 years of age. Neurodevelopmental status of 45/122 preterm infants, grouped according to their gestational ages of 26 to 29, 30 to 32, and 33 to 37 weeks, were previously evaluated by Bayley Infant Neurodevelopmental Screener. The scores were categorized as low or high-moderate. Verbal and performance scores of Wechsler Intelligence Scale for Children-Revised (WISC-R) of those patients were assessed between 7 and 10 years. The patients with high-moderate-risk scores of Bayley Infant Neurodevelopmental Screener at all times, regardless of their gestational age, had lower performance, verbal, and total scores of WISC-R than those of who had low Bayley Infant Neurodevelopmental Screener risk scores. High-moderate risk score of Bayley Infant Neurodevelopmental Screener at 7 to 10, and 16 to 20 months, of all patients especially showed good prediction for identifying lower verbal and performance scales. For 7 to 10 months, verbal scale: positive predictive value = 92.3%, negative predictive value = 44.4%, sensitivity = 70.58%, and specificity = 80%; performance scale: positive predictive value = 100%, negative predictive value = 30%, sensitivity = 68.18%, and specificity = 100%. For 16 to 20 months, verbal scale: positive predictive value = 90%, negative predictive value = 37.5%, sensitivity = 64.3%, and specificity = 80%; performance scale: positive predictive value = 90%, negative predictive value = 12.5%, sensitivity = 56.3%, and specificity = 50%. Bayley Infant Neurodevelopmental Screener shows good prediction of later verbal and performance scores of Wechsler Intelligence Scale-Revised for Children as early as 7 to 10 months, which gives us the opportunity to start early intervention.

Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 ± 1.3 days in Group I and 2.27 ± 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 ± 2.2 days in Group I and 3.53 ± 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 ± 1.5 days and 2.73 ± 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn't decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.

Preterm ovarian hyperstimulation syndrome presented with vaginal bleeding: a case report.

Preterm ovarian hyperstimulation syndrome (POHS) is an uncommon disorder characterized by prematurity, hypogastric and upper leg swelling of various intensities, high serum estradiol and gonadotropin levels, and ovarian follicular cyst/cysts. In this paper, we present the first case of POHS presenting with vaginal bleeding. A female infant was born via spontaneous vaginal delivery at 25 weeks of gestation with a birth weight of 610 g. At 36 weeks of post-conception age, she developed breast enlargement, swelling of the clitoral hood, labia major and minor, hypogastrium and upper legs. Several weeks later, vaginal bleeding started and lasted 3 days. The vaginal bleeding continued to occur at monthly intervals. The elevated levels of gonadotropins and estrogens, vulvar swelling and cysts in both ovaries confirmed the diagnosis of preterm ovarian hyperstimulation syndrome.

Short- and long-term effects of individualized enteral protein supplementation in preterm newborns.

The aim of this retrospective study was to assess the need for additional enteral protein supplementation in preterm newborns with gestational age (GA) ≤32 weeks after full enteral feeds with either fortified breast milk (FBM) or preterm formula (PF) were reached, and to determine the effects of additional protein on physical and neurological development. After the standard early total parenteral nutrition (TPN) and reaching full enteral nutrition with 150-160 ml/kg/day, preterms were assessed for the requirement of additional protein based on serum blood urea nitrogen (BUN)/prealbumin levels. Additional enteral protein was given for BUN <5 mg/dl and/or prealbumin ≤8 mg/dl with weekly assessments as per Neonatal Intensive Care Unit (NICU) protocol. Growth in the NICU and neurodevelopmental outcome at 18 months' corrected age (CA) were determined. There were 32 newborns in the non-supplemented group (Group 1) and 33 newborns in the supplemented group (Group 2). All newborns in Group 2 were on FBM. Weight gain and head growth were better and Bayley scores at 18 months' CA were higher in Group 2. Standard preterm nutrition with FBM may not be sufficient for preterms, and additional enteral protein supplementation may improve the physical growth rate in the NICU and result in better neurodevelopmental outcome at 18 months' CA.

The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey.

Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was O positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification.

The importance of cold-reactive autoantibodies in an asphyxiated infant before therapeutic hypothermia.

Perinatal asphyxia is an important cause of neonatal morbidity and mortality. Hypothermia is an effective treatment of neonatal hypoxic-ischemic encephalopathy in infants. Cold agglutination is a primary or acquired autoimmune disease that involves autoantibodies that lead to hemagglutination at low temperatures lower than that of the body. In this case the importance of cold agglutinins during therapeutic hypothermia is presented.

Clinical use of fresh-frozen plasma in neonatal intensive care unit.

Recommendations for FFP use in neonates are based on a very limited amount of data, and not on well-designed randomized controlled trials. This retrospective study was performed to analyze our experience with FFP use in neonatal intensive care unit (NICU). From January 2006 until August 2011 a total of 80 neonates were identified as having been treated with FFP. The most common indication for FFP use was prolonged PT or aPTT, representing 32.8% of all usages of FFP. Following FFT treatment PT and aPTT normalized in 42% and 60% patients, respectively. Our results suggest that FFP were often used in acceptable indications in NICU.

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

BACKGROUND: Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus. METHODS: This was a retrospective study of LGA infants of ≥36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006-2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student's t test were used for comparing variables. RESULTS: Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045). CONCLUSIONS: The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.