Evaluation of the Effectiveness of Systemic Inflammatory Indices in the Diagnosis of Respiratory Distress Syndrome in Preterm with Gestational Age of ≤32 Weeks.

OBJECTIVE: It is not yet known whether systemic inflammatory indices affect the development of respiratory distress syndrome (RDS) in premature infants. We aimed to evaluate the relationship between systemic inflammatory indices obtained on the first day of life and the development of RDS in premature infants. STUDY DESIGN: Premature infants with gestational age of ≤32 weeks were included in the study. Six systemic inflammatory indices involving neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were measured in the first 1 hour after birth and compared in premature infants with and without RDS. RESULTS: A total of 931 premature infants, 579 infants in the RDS group and 352 infants in the non-RDS group, were included in the study. MLR, PLR, and SIRI values were similar between the groups (p > 0.05 for all parameters). NLR, PIV, and SII values in the RDS group were significantly higher than those in the non-RDS group (p = 0.005, p = 0.011, and p < 0.001, respectively). In the predictivity of RDS, the AUC value of SII was 0.842 and the cut-off value was ≥78.200. Multiple logistic analysis showed that a higher level of SII (≥78.2) was independently associated with RDS (odds ratio: 3.03, 95% confidence interval: 1.761-5.301). CONCLUSION: Our results demonstrated that a higher SII level (≥78.2) may be a predictor for the development of RDS in premature infants with gestational age of ≤32 weeks. KEY POINTS: · It is not yet known whether systemic inflammatory indices affect the development of RDS.. · Our results demonstrated high SII levels may be a predictor for the development of RDS.. · SII may provide an advantage as a low-cost, easy-to-detect, useful and powerful parameter in RDS..

Serum ADAMTS-9 Level in Newborn Babies with Congenital Heart Disease.

OBJECTIVE: A Disintegrin and Metalloproteinase with Thrombospondin-9 (ADAMTS-9), one of the ADAMTS enzymes, is expressed in all fetal tissues, unlike other ADAMTS enzymes, and is thus thought to play a role in fetal development. In this context, the objective of this study is to investigate the relationship between ADAMTS-9 activity and the development of congenital heart diseases (CHD) with a view to using ADAMTS-9 level as a biomarker for CHDs. STUDY DESIGN: Newborns diagnosed with CHD and healthy newborns were included in the study as the CHD and control groups, respectively. Gestational age, maternal age, and mode of delivery information pertaining to the mothers and Apgar score and birthweight information pertaining to the newborns were recorded. Blood samples were taken from all newborns to determine their ADAMTS-9 levels in the first 24 hours of life. RESULTS: Fifty-eight newborns with CHD and 46 healthy newborns were included in the study. Median ADAMTS-9 levels were 46.57 (interquartile range [IQR]: 33.31 [min: 26.92, max: 124.25]) and 23.36 (IQR: 5.48 [min: 11.7, max: 37.71]) ng/mL in the CHD and control groups, respectively. ADAMTS-9 levels in the CHD group were statistically significantly higher than in the control group (p = 0.000). ADAMTS-9 levels of the CHD and control groups were analyzed by the receiver operating characteristics curve. The area under the curve value for ADAMTS-9 levels of >27.86 ng/mL as the cut-off value for predicting the development of CHD in newborns was 0.836 (95% confidence interval [CI]: 0.753-0.900, p = 0.0001). ADAMTS-9 levels of >27.86 ng/mL were determined to predict the development of CHD in newborns with a sensitivity of 77.78% (95% CI: 65.5-87.38) and a specificity of 84.78% (95% CI: 71.1-93.60). CONCLUSION: In conclusion, it was found that the serum ADAMTS-9 levels were significantly higher in newborns with CHD than in healthy newborns. In parallel, ADAMTS-9 levels above a certain cut-off value were associated with CHD. KEY POINTS: · ADAMTS-9 is expressed in fetal tissues.. · Its level increases in congenital heart diseases.. · It can be used as a biochemical marker in diagnosis..

Glucocorticoids in a Neonatal Hyperoxic Lung Injury Model: Pulmonary and Neurotoxic effects.

BACKGROUND: We aimed to compare the effect of dexamethasone (Dex), hydrocortisone (Hc), and methylprednisolone (Mpz) at equivalent doses on somatic growth, lung healing, and neurotoxicity in a hyperoxic rat model. We hypothesized that Mpz and Hc would be superior to Dex with less neurotoxicity by exerting similar therapeutic efficacy on the injured lung. METHODS: Neonatal rats were randomized to control, bronchopulmonary dysplasia (BPD), Dex, Hc, and Mpz groups. All drugs were administered daily following day 15 over 7 days. Histopathological and immunohistochemical analyses of the lung and brain were performed on day 22. RESULTS: All types had much the same impact on lung repair. Oxidative markers in the lung were similar in the steroid groups. While nuclear factor erythroid 2-related factor and heat-shock protein 70 dropped following steroid treatment, no difference was noted in other biochemical markers in the brain between the study groups. Apoptotic activity and neuron loss in the parietal cortex and hippocampus were noted utmost in Dex, but alike in other BPD groups. CONCLUSIONS: Mpz does not appear to be superior to Dex or Hc in terms of pulmonary outcomes and oxidative damage in the brain, but safer than Dex regarding apoptotic neuron loss. IMPACT: This is the first study that compared the pulmonary efficacy and neurotoxic effects of Dex, Hc, and Mpz simultaneously in an established BPD model. This study adds to the literature on the importance of possible antioxidant and protective effects of glucocorticoid therapy in an oxidative stress-exposed brain. Mpz ended up with no more additional neuron loss or apoptosis risk by having interchangeable effects with others for the treatment of established BPD. Mpz and Hc seem safe as a rescue therapy in terms of adverse outcomes for established BPD in which lung and brain tissue is already impaired.

Two Useful Umbilical Biomarkers for Therapeutic Hypothermia Decision in Patients with Hypoxic Ischemic Encephalopathy with Perinatal Asphyxia: Netrin-1 and Neuron Specific Enolase.

Hypoxic-ischemic encephalopathy (HIE) has a high risk of mortality in addition to serious neurological damage. In this study, we investigated the values of umbilical cord netrin-1 (NT-1) and neuron specific enolase (NSE) levels in the early diagnosis of HIE stage II/III induced by neonatal asphyxia.In the study group, infants with gestational age ≥ 36 weeks who were diagnosed with HIE II/III were included. NT-1 and NSE levels were measured from the umbilical cord immediately after birth. Results were compared between HIE II/III and the healthy control group. Cutoff values for serum NT-1 and NSE were determined with receiver-operating characteristics curves and the area under the curve (AUC) was used to determine the diagnostic value of NT-1 and NSE levels in infants diagnosed with HIE II/III.NT-1 (358.3 ± 108.3 pg/mL) and NSE (52.97 ± 17.8 ng/mL) levels in the cord blood in the HIE group were significantly higher (p = .030, p = .001, respectively) than cord blood values in the control group (NT-1 (275.1 ± 84.6 pg/mL) and NSE (28.7 ± 16.3 ng/mL)). NT-1 cutoff value for HIE was 292.3 pg/mL and 34.7 ng/mL for NSE (AUC: 990, sensitivity: 94%, specificity 100% and AUC: 1.0, sensitivity: 100% vs. specificity 100%, respectively).NT-1 and NSE represent candidate biomarkers with high reliability in the prediction in newborns with moderate-to-severe HIE.

Comparison of the effect of continuous and standard intermittent bolus paracetamol infusion on patent ductus arteriosus.

The aim of this study was to evaluate the effect of paracetamol on patent ductus arteriosus (PDA) closure and clinical outcomes in preterm infants when used as standard intermittent bolus and continuous intravenous (IV) infusion. Preterm neonates with birth weight (BW) ≤ 1500 g and gestational age (GA) ≤ 30 weeks were included in this study. During the study period, IV paracetamol therapy was given to all infants with hemodynamically significant patent ductus arteriosus (hsPDA). The patients were divided into the standard IV intermittent bolus infusion group and the continuous IV infusion group. Standard IV intermittent bolus paracetamol therapy was administered in the form of 15-mg/kg doses as 1-h infusions every 6 h for 5 days, while continuous IV paracetamol infusion therapy was administered as a 60-mg/kg/day dose continuously for 5 days. During the study period, 247 patients were evaluated, of which a total of 137 patients with hsPDA were included. There were no significant differences between the intermittent bolus and continuous infusion groups in terms of mean GA or BW. The continuous paracetamol infusion group had significantly higher rates of PDA-related morbidities, multiple paracetamol courses, and PDA ligation procedure compared with the standard intermittent bolus group.Conclusion: Our results were the first in the literature to compare IV paracetamol infusion regimens for PDA. Our results indicate that standard intermittent bolus infusion is still the most appropriate IV paracetamol regimen for the treatment of PDA.Trial registration: ClinicalTrials.gov Identifier: NCT04469413 What is Known: • Paracetamol has been proposed for the treatment of patent ductus arteriosus in preterm neonates. • There is no consensus on the duration and form of administration of paracetamol in hsPDA, and the information on this issue is insufficient. What is New: • Our study was the first in the literature to compare IV paracetamol infusion regimens for PDA. • Standard intravenous intermittent bolus paracetamol infusion was more effective in pharmacologic PDA closure compared with continuous intravenous paracetamol infusion and was associated with lower rates of PDA-related BPD, NEC, and need for ligation.

An Unknown Risk Factor for Sepsis in Very Low Birth Weight Preterms: ABO Blood Groups (BGaPS Study).

OBJECTIVE: There is insufficient study of the association of blood groups with neonatal diseases. The aim of this study was to evaluate the blood groups associated with sepsis and blood groups in preterm infants. STUDY DESIGN: This retrospective study was conducted between January 1, 2010 and November 31, 2018 in the neonatal intensive care unit (NICU). This study was done in single-center tertiary NICU. Infants born at gestational age (GA) <32 weeks with birth weight (BW) <1,500 g were included in the study. RESULTS: A total of 2,548 infants were included. The culture-proven sepsis ratio (30.2%) was the lowest in the O blood group and the highest in the AB blood group (37.5%) (p = 0.045). Meningitis ratio (6.5%) was significantly higher, and hospital stay (64.1 ± 33.9 days) was significantly longer in B blood group (respectively, p = 0.005, p < 0.001). In the AB blood group, GA (27.68 ± 1.12 weeks) was the lowest and early onset sepsis (EOS) (40.1%) and mortality (28.9%) ratio were found to be statistically higher (p < 0.001 for all groups). The AB group was significantly related to higher frequency of EOS (odds ratio [OR] = 2.93, 95% confidence interval [CI] = 1.68-5.12, p = 0.000), in addition to mortality (OR = 1.1, 95% CI = 0.55-2.19, p = 0.001). The O group was found to be associated with lower risk of late onset sepsis (LOS) (OR = 1.67, 95% CI = 1.06-3.058, p = 0.003) according to the model with corrected risk factor including GA, BW, and time of hospitalization. CONCLUSION: Our study was the first study showing a relationship between certain blood groups and EOS/LOS in premature infants as well as meningitis.

Case Report of Severe COVID-19 Pneumonia in a Term Newborn.

Coronavirus disease (COVID-19) has been shown to affect all age groups. The data in the literature usually admit a milder form of disease in infants and newborns than adults. COVID-19 is rarely seen in newborns and an urgent diagnosis should be made in any suspicious situation. A 6-day-old female newborn was admitted to our hospital with fever and dyspnea without cough. A rapid reverse-transcription polymerase chain reaction COVID-19 showed a positive result. Chest computed tomography revealed bilateral and widespread pulmonary involvement. After support therapy, the newborn was successfully discharged. We should carefully consider the new type of coronavirus as an agent for pneumonia in newborns with fever and dyspnea together with non-symptomatic family history. Our case was one of the interesting reported cases of severe pneumonia presenting in the perinatal period.

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.

Do Calcium and Potassium Levels Influence Ductal Patency in Preterm Infants?

OBJECTIVE: We investigated the relationship of serum potassium (K+) and ionized calcium (iCa2+) levels with the persistence of ductus arteriosus. STUDY DESIGN: This retrospective cohort study included infants with birth weight < 1,500 g and gestational age < 32 weeks. Serum K+ and iCa2+ levels at the 1st and 48th hour of life were measured from samples. The difference between the two levels was calculated for both serum K+ (ΔK+) and iCa2+ (ΔCa2+). These values were compared between hemodynamically significant patent ductus arteriosus (hsPDA) and non-hsPDA. RESULTS: Of 1,322 hospitalized preterm nonates, 1,196 were included in the study. Mean serum K+ levels at the 1st and 48th hour were higher and iCa2+ levels at the 1st and 48th hour were lower in hsPDA and non-hsPDA, respectively (p < 0.001). Ionized ΔCa2+ (-0.06 ± 0.13 vs. -0.02 ± 0.12 mmol/L) was higher in hsPDA (p < 0.001). CONCLUSION: We demonstrated that serum K+ and iCa2+ level might play a role in ductal constriction.

A Mystery of Patent Ductus Arteriosus and Serum Osmolality in Preterm Infants.

OBJECTIVE: Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. STUDY DESIGN: Our study was conducted between January 2013 and December 2017. Premature infants with birth weight <1,500 g and gestational age <32 weeks were included in the study. Serum osmolality was compared between infants with hemodynamically significant PDA (hsPDA) and non-hsPDA. RESULTS: During the study period, 799 patients were evaluated. Mean serum osmolality levels were higher in the "hsPDA" group (297 ± 10.9 vs. 292 ± 8.3 mOsm/L) (p = 0.001). The area under the curve for osmolality was 0.582 (p = 0.0006, 95% confidence interval: 0.541-0.622) at the time of diagnosis for predicting hsPDA, with a cutoff value for osmolality of 300 mOsm/L. CONCLUSION: Serum osmolality may be recognized as an important contributing factor for ductal patency especially among extremely preterm infants who are most likely to have hsPDA in the early days of life.

A promising, novel index in the diagnosis and follow-up of patent ductus arteriosus: Red cell distribution width-to-platelet ratio.

BACKGROUND: The role of red cell distribution width-to-platelet ratio (RPR) has not previously been mentioned in reports on patent ductus arteriosus (PDA). Our objective was to evaluate whether RPR would have a role in the diagnosis and/or prediction of pharmacological closure of PDA. METHODS: Preterm infants' gestational age ≤30 weeks and ≤1500 g who were given first ibuprofen treatment in the first week of life for hemodynamically significant PDA (hsPDA) were included in the study. The patients were matched for gestational age, birthweight, and sex. Patients were subdivided into two groups based on the response to medical treatment (open and closed PDA). Hemogram parameters were recorded before and after medical therapy. Groups were compared with regard to demographic and clinical characteristics and for three sequential hematological parameters. RPR was calculated. Patients with sepsis, anemia, perinatal asphyxia, and congenital/chromosomal anomaly were not included in the study. RESULTS: A total of 112 infants had medically treated hsPDA. Of those, ductus closed in 70 neonates (closed PDA). A total of 96 infants constituted the control group. Mean gestational age and birthweight of the patients were 28.9 ± 2.4 weeks and 1207 ± 372 g. While RPR was significantly increased, PCT was lower in both hsPDA and open PDA groups (P < 0.05 and P < 0.05, respectively). In multivariate analysis, high RPR (OR 3.3, 95% CI 1.438-5.872, P < 0.05) and RDS (OR 2.9, 95% CI 1.903-4.811, P < 0.01) were detected as independent risk factors for hsPDA. CONCLUSION: Red cell distribution width-to-platelet ratio and PCT may be promising supportive tools for the diagnosis and prediction of pharmacotherapy success.

Ginger ( Zingiber officinale ) prevents severe damage to the lungs due to hyperoxia and inflammation

Background/aim: Hyperoxia- and inflammation-induced lung injury is an important cause of the development of bronchopulmonary dysplasia (BPD) in premature infants. We aimed to ascertain the beneficial effects of ginger ( Zingiber officinale ) on rat pups exposed to hyperoxia and inflammation. Materials and methods: Thirty-six newborn Wistar rats were randomly divided into 3 groups as the hyperoxia (95% O 2 ) + lipopolysaccharide (LPS) group, the hyperoxia + LPS + ginger-treated group, and the control/no treatment group (21% O 2 ). Pups in the hyperoxia + LPS + ginger group were administered oral ginger at a dose of 1000 mg/kg daily during the study period. Histopathologic, immunochemical (SMA and lamellar body), and biochemical evaluations including total antioxidant status (TAS), total oxidant status (TOS), malondialdehyde (MDA), myeloperoxidase (MPO), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), interleukin-6 (IL-6), and caspase-3 activities were performed. Results: Better weight gain and survival rates were shown in the hyperoxia + LPS + ginger group (P < 0.05). In the histopathologic and immunochemical evaluation, severity of lung damage was significantly reduced in the hyperoxia + LPS + ginger group, as well as decreased apoptosis (ELISA for caspase-3) (P < 0.05). Tissue TAS levels were significantly protected, and TOS, MDA, and MPO levels were significantly lower in the hyperoxia + LPS + ginger group (P < 0.05). Tissue TNF-α, IL-1ß, and IL-6 concentrations were significantly decreased in the ginger-treated group (P < 0.05). Conclusion: Ginger efficiently reduced the lung damage and protected the lungs from severe damage due to hyperoxia and inflammation. Therefore, ginger may be an alternative option for the treatment of BPD.

Impact of Prophylactic Continuous Positive Airway Pressure on Transient Tachypnea of the Newborn and Neonatal Intensive Care Admission in Newborns Delivered by Elective Cesarean Section.

OBJECTIVE: This study aims to evaluate the effect of the prophylactic continuous positive airway pressure (CPAP) administration in the delivery room to newborns who were delivered by elective cesarean section (CS). STUDY DESIGN: Inborn infants with gestational age between 34(0/7) to 38(6/7) and born by elective CS were prospectively randomized to receive either prophylactic CPAP for 20 minutes via face mask or standardized care without CPAP in the delivery room. Primary outcomes were the incidence of transient tachypnea of the newborn (TTN) and neonatal intensive care unit (NICU) admission due to respiratory distress. RESULTS: A total of 259 infants with a mean gestational age of 37.7 ± 0.8 weeks and birth weight of 3,244 ± 477 g were included. A total of 134 infants received prophylactic CPAP and 125 received control standard care. The rate of NICU admission was significantly lower in prophylactic CPAP group (p = 0.045). Although the rate of TTN was lower in the prophylactic CPAP group, the difference was not statistically significant (p = 0.059). The rate of NICU admission due to respiratory distress was significantly higher in late-preterm cohort than early-term cohort (p < 0.0001). CONCLUSION: Prophylactic CPAP administration decreases the rate of NICU admission without any side effect in late-preterm and early-term infants delivered by elective CS.

Efficacy and safety of intravenous colistin in preterm infants with nosocomial sepsis caused by Acinetobacter baumannii.

OBJECTIVES: To describe the efficacy of intravenous colistin on clinical and microbiological outcomes in preterm infants with nosocomial sepsis in neonatal intensive care unit (NICU) and define adverse events observed with this treatment. METHODS: The records of preterm infants who received colistin with or without positive cultures in the NICU were retrospectively reviewed. Patients were evaluated for response to therapy and side effects. RESULTS: A total of 21 preterm infants with medians of 28 weeks (23-36) gestational age and 870 g (620-2,650) birth weight were included. The median duration and dose of colistin therapy were 9 days (3-26) and 3 mg/kg/d (2-5). Recovery rate in patients including all with/without positive culture was 81% (17/21). Microbiological clearance by colistin was 69% (9/13). The major side effect observed was acute kidney injury (19%). At least 24% of infants required electrolyte supplementation during the colistin therapy. Magnesium levels were significantly lower at the end of the colistin therapy (p < 0.001). Acute kidney injury and electrolyte disturbances including hypomagnesemia were reversible in all surviving patients. CONCLUSION: We suggest that renal function tests and serum electrolytes should be monitored closely and replaced in case of any need during the colistin therapy in preterm infants.

A novel useful marker in the early discrimination of transient hyperthyrotropinemia/hypothyroxinemia and congenital hypothyroidism in preterm infants: thyroid-stimulating hormone/free thyroxine ratio.

OBJECTIVES: Transient hyperthyrotropinemia/transient hypothyroxinaemia and congenital hypothyroidism (CH) have completely different treatment and clinical outcomes. However, a powerful, highly sensitive and cost-effective marker for the differentiation of these clinical entities in the early postnatal period is not available. Therefore, we aimed to test the potential, early predictive, diagnostic power of the thyroid-stimulating hormone (TSH)/free thyroxine (fT4) ratio for differentiation of the two clinical entities in the early period of life. METHODS: TSH and fT4 levels were recorded on the postnatal day 7 of premature infants<32 weeks of gestational age. TSH/fT4 ratio was calculated. The significance degree of TSH/fT4 ratio was analyzed for the differentiation of transient hyperthyrotropinemia or transient hypothyroxinaemia and CH. RESULTS: The study included 1,204 preterm infants<32 weeks of gestational age. Of the 1,204 infants, 978 (81.2 %) had normal thyroid function. Eighty-eight infants (7.3 %) were diagnosed with CH and 138 (11.5 %) with transient hyperthyrotropinemia or transient hypothyroxinemia. Initial TSH/fT4 ratio>4.8 was found to be an early diagnostic warning sign with high power in favor of transient hyperthyrotropinemia or transient hypothyroxinemia (AUC value: 0.947) and TSH/fT4 ratio>12.5 (AUC value: 0.999) was found to be an early diagnostic warning sign with high power in favor of CH (p=0.0001). CONCLUSIONS: We found for the first time that the TSH/fT4 ratio can be used for the early differentiation of transient hyperthyrotropinemia/transient hypothyroxinaemia and CH in preterm infants without additional cost and with high power.

Evaluation of beneficial effects of dexpanthenol on hypoxic-ischemic encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) is a cause of serious morbidity and mortality in newborns. Dexpanthenol, which is metabolized into D-pantothenic acid, has antioxidant and other potentially therapeutic properties. We examined some effects of dexpanthenol on the brains of week-old rat pups with HIE induced by obstruction of the right carotid artery followed by keeping in 8% O2 for 2 hours. Dexpanthenol (500 mg/kg) was administered intraperitoneally to 16 of 32 pups with HIE. Protein, DNA, and lipid oxidation degradation products were assayed and hippocampal and cortical cell apoptosis and neuronal cell numbers were evaluated in stained sections. Dexpanthenol application reduced oxidative stress and inflammation. TNF-α and IL-6 cytokine levels in HIE also decreased with dexpanthenol treatment. The numbers of caspase-3 positive cells in the dentate gyrus and CA1/CA2/CA3 regions of the hippocampus was lower, and apoptosis was decreased in the dexpanthenol-treated animals. These findings suggest possible clinical applications of dexpanthenol in human HIE.

Acquired bartter-like syndrome associated with colistin use in a preterm infant.

Acquired Bartter-like syndrome (BLS), characterized by hypokalemic metabolic alkalosis, hypomagnesemia, hypocalcemia, and normal kidney function, can be induced by diuretics or antibiotics. It is a very rare condition and only anecdotal cases mostly in adults were reported. Although tubulopathy associated with colistin was reported in adults, to the best of our knowledge, colistin-associated BLS neither in adults nor in children has been reported in the literature. We here report a-28-week, 740 g female preterm infant who developed BLS just after colistin treatment for Acinetobacter baumannii infection and recovered few days after the drug cessation, and discuss the possible association of colistin and tubulopathy. More research on colistin pharmacokinetics and pharmacodynamics in critically ill patients and preterm infants is needed to guide adequate colistin dosing at the least toxicity.

Evaluation of the efficacy of systemic inflammatory indices in determining mortality in very low birth weight infants.

OBJECTIVE: In our study, we aimed to investigate whether systemic inflammatory indices could be an indicator of mortality in very low birth weight (<1,500 g) preterm infants. METHODS: Very low birth weight preterm infants were included in our study, and patient data were recorded retrospectively. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, pan-immune-inflammation value, and systemic inflammation response index were calculated and recorded. The survivors and infants who died were compared for systemic inflammatory indices. RESULTS: A total of 1,243 very low birth weight infants were included in the study. Of the patients, 1,034 survived and 209 died. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, pan-immune-inflammation value, systemic immune-inflammation index, and systemic inflammation response index were found to be statistically significantly lower in the mortality group than those in the survivor group (p=0.039, p=0.001, p<0.001, p<0.001, p<0.001, and p=0.002, respectively). According to the receiver operating curve analysis, systemic immune-inflammation index with the highest area under the curve (0.844) was found to be the most effective systemic inflammatory indices in predicting mortality with a cutoff level of ≤28.87 (p=0.0001). Multiple regression analysis showed that a lower level of systemic immune-inflammation index (≤28.87) was independently associated with mortality (OR: 1.677, 95%CI 1.061-2.685, p=0.001). CONCLUSION: We have shown that low systemic immune-inflammation index value in very low birth weight preterm infants may be a novel systemic inflammatory index that can be used to predict mortality.

Role of Systemic Inflammatory Indices in the Prediction of Moderate to Severe Bronchopulmonary Dysplasia in Preterm Infants.

INTRODUCTION: The role of systemic inflammatory indices in the diagnosis of bronchopulmonary dysplasia (BPD) is unknown. The aim of the study was to determine the possible clinical utility of systemic inflammatory indices in the prediction of moderate to severe BPD. METHODS: Premature infants<32 weeks of gestational age were included in the study. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were calculated at birth and at the time of diagnosis of BPD (at 36th weeks of postmenstrual age). The patients were divided into two groups as no or mild BPD and moderate or severe BPD. RESULTS: A total of 1146 infants were included in the study, 957 in Group 1 and 189 in Group 2. The SIRI value was significantly higher in moderate or severe BPD both at birth and at the 36th week of postmenstrual age (p<0.001 and p<0.001, respectively). The AUC value of SIRI was 0.809 and the cut-off value was>0.98 in the predictivity of BPD at birth. The AUC value of SIRI was 0.842 and the cut-off value was>1.33 for the diagnosis of BPD at 36th week of postmenstrual age. After multiple logistic regression analysis, SIRI was shown to be a significant parameter for the diagnosis of BPD (OR 2.847, 95% CI 1.557-4.875). CONCLUSIONS: SIRI may be a useful biomarker for predicting moderate to severe BPD and a marker of clinical importance in the follow-up of infants with BPD.