Objective: To evaluate the impact of maternal obesity on maternal, perinatal, and early neonatal outcomes. Methods: This retrospective cohort was conducted in a tertiary care university hospital between 2017 and 2021 in Istanbul. Women with a first-trimester body mass index (BMI) of >30.0 kg/m(2) were included in the maternal obesity group, and their maternal, perinatal clinical characteristics, and neonatal outcomes at the early postnatal period were compared with the age- and neonatal sex-matched non-obese control group (BMI <30.0 kg/m(2)). Results: The study included 1252 mother-infant dyads, with 626 infants in each group. In terms of pregnancy complications, maternal obesity was significantly associated with higher rates of both pregestational and gestational hypertension and diabetes mellitus (all p<0.001), and increased cesarean delivery rates (p<0.001). Infants born to obese mothers had significantly higher birth weight and higher rates of being large for gestational age (LGA) (p<0.001). These infants also demonstrated higher neonatal intensive care unit admission rates (p<0.001) compared with infants born to non-obese mothers. Early neonatal metabolic complications, including early formula supplementation (p<0.001), hypoglycemia (p = 0.02), and hypernatremia (p = 0.005), were significantly more frequent in the maternal obesity group. Conclusions: Maternal obesity is associated with adverse maternal, perinatal, and early neonatal outcomes, including delivery mode, postnatal neonatal metabolic adaptation, and early feeding difficulties. Early identification of highrisk pregnancies, individualized antenatal care, and structured postnatal feeding support may help reduce preventable maternal and neonatal complications.

Importance:Cerebral oximetry monitoring in the first 72 hours after birth has not been shown to reduce death or severe brain injury at 36 weeks' postmenstrual age in extremely preterm infants. The long-term effects remain uncertain. Objective:To determine whether treatment guided by cerebral oximetry monitoring during the first 72 hours after birth reduces the risk of death or longer-term neurodevelopmental outcomes at 2 years' corrected age, compared with usual care. Design, Setting, and Participants:In the phase 3 Safeguarding the Brain of Our Smallest Children (SafeBoosC-III) randomized clinical trial, we compared treatment guided by cerebral oximetry monitoring with usual care for the first 72 hours after birth. Seventy sites across 17 countries randomized 1601 infants within 6 hours of birth. Infants from 56 sites participated in this follow-up. Blinded assessors evaluated outcomes using a predefined 3-tier data model combining formal clinical assessments, parental questionnaires, and informal assessments. Data were analyzed from October to December 2024. Interventions:Treatment guided by cerebral oximetry monitoring for the first 72 hours after birth vs usual care. Main Outcomes and Measures:The coprimary outcomes were as follows: (1) death or moderate or severe neurodevelopmental disability and (2) Bayley cognitive composite score, both assessed at approximately 2 years' corrected age. Results:A total of 1438 infants (mean [SD] age, 26.0 [1.3] weeks; 758 male [52.7%]) participated in this follow-up study. Participants were followed up from October 2021 to October 2024. Death or moderate or severe neurodevelopmental disability occurred in 292 of 620 infants (47.1%) in the cerebral oximetry group compared with 321 of 669 infants (48.0%) in the usual-care group (relative risk with cerebral oximetry, 0.96; 97.5% CI, 0.85-1.07; P = .45). The mean (SD) Bayley cognitive score was 92.8 (17.0) in the cerebral oximetry group compared with 93.2 (17.3) in the usual-care group (mean difference with cerebral oximetry, -0.14; 97.5% CI, -3.24 to 2.96; P = .92). Conclusions and Relevance:In extremely preterm infants, treatment guided by cerebral oximetry monitoring compared with usual care for the first 72 hours after birth did not result in a lower incidence of death or moderate or severe neurodevelopmental disability nor higher Bayley cognitive scores at 2 years' corrected age. The routine use of cerebral oximetry monitoring during the first 72 hours after birth in extremely preterm infants to reduce neurodevelopmental disability was not supported by this trial. Trial Registration:ClinicalTrials.gov Identifier: NCT05134116.

Prevention of hyperbilirubinemia, among common reasons for outpatient visits and hospital readmissions during the neonatal period, depends on early diagnosis and effective treatment. Thus, discovering novel indices and parameters to predict severe hyperbilirubinemia is critical. The presence of hemolysis risk factors in newborns is not a prerequisite for treatment in most cases. We aimed to seek the role of a novel index (Çapa index), developed using umbilical cord blood carboxyhemoglobin (COHb) and total bilirubin levels, in predicting severe hyperbilirubinemia in the early neonatal period. In total, 290 term neonates were included in the present study, of which 171 were direct antiglobulin test positive with A, B, and O blood group system and/or rhesus factor incompatibility, and 119 were healthy controls without blood group incompatibility, sepsis, asphyxia, respiratory problems, pathologic weight loss, congenital anomaly, or need of intensive care. Çapa index was calculated by multiplying COHb (%) and total bilirubin (mg/dL) levels in umbilical cord blood and compared between the groups to predict its role in treatment requirements. COHb, bilirubin, and Çapa index were higher in the disease group than in healthy controls. In the disease group, cord blood bilirubin levels in the neonates needing phototherapy (PT) were unexpectedly significantly lower. In contrast, the COHb and Çapa index were higher than the ones without a need for treatment. In the disease group, the Çapa index had a significant predictive value in estimating PT requirements (area under the curve = 0.94). Standard hemolysis criteria have limited predictive value in the progression of hyperbilirubinemia. Çapa index, calculated as a practical biochemical index using umbilical cord blood COHb and bilirubin levels, can be a promising parameter in predicting severe hyperbilirubinemia and PT requirements in neonates.

Objectives: A special group of stem cells with multipotent and immunomodulatory properties are mesenchymal stem cells (MSCs). Many modulatory factors are thought to mediate immunomodulatory properties of MSCs. One of these modulatory factors is thought to be HLA-G, one of human leukocyte antigens (HLA). This study aimed to compare HLA-G levels in both stimulated and unstimulated of peripheral blood mononuclear cell (PBMC) cultures with "cord blood-MSC" (CB-MSC) and "Wharton's jelly-MSC" (WJ-MSC) at different rates and different incubation periods. Methods: WJ-MSCs were obtained by explant method, and CB-MSCs using Ficoll-paque. They were characterized by flow cytometry. MSCs and PBMCs were directly co-cultured for 24 and 72 h at 1:5 and 1:10, respectively. After incubations, the media were collected and HLA-G levels were measured by ELISA. Results: In the unstimulated group, the highest HLA-G level was found in the PBMC:WJ-MSC-72-1:5 group, while the lowest HLA-G level was found in the PBMC:CB-MSC-72-1:5. When 24-1:5 and 72-1:5 groups were examined, the HLA-G level decreased significantly in CB-MSC groups compared to WJ-MSC, while it increased significantly in the 24-1:10 and 72-1:10 groups (p<0.05). In stimulated groups, the highest HLA-G level was observed in the PBMC:CB-MSC-24-1:5. Conclusions: Our study aimed to evaluate the immunomodulatory effect of MSCs via HLA-G molecule. HLA-G levels changed with different incubation times of two different MSC sources. In this study, we suggest that MSCs as a cell therapy, in particular for immune system-related disease, may be a preliminary in vitro approach to evaluate the immunomodulatory effect via HLA-G.

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by skeletal muscle weakness, caused by antibodies targeting acetylcholine receptors (AChRs) at the neuromuscular junction. Acetylcholine receptor (AChR) antibodies can cross the placenta, affecting the fetus and leading to transient neonatal myasthenia gravis (TNMG) in 10-20% of newborns. Symptoms such as weak cry, feeding difficulties, respiratory distress, and hypotonia may be observed in affected infants. Objectives: The present study aims to evaluate the clinical outcomes in infants born to mothers diagnosed with MG. Methods: This retrospective cohort study included infants born to mothers with MG over a 15-year period. Maternal MG disease activity, pregnancy-related complications, and neonatal findings were reviewed from hospital records. The clinical characteristics of infants who developed transient neonatal MG were evaluated. Results: A total of 25 infants born to mothers diagnosed with MG were included in the study. The mean age of the mothers was 36.5 +/- 6.7 (19-44) years, and 17 (68%) of the mothers were primigravid. Fourteen mothers (56%) had undergone thymectomy before pregnancy, and 21 (84%) were receiving medical treatment [prednisolone, intravenous immunoglobulin (IVIG), pyridostigmine]. Twenty-two pregnancies (88%) resulted in cesarean delivery. Among the infants, whose mean gestational age (GA) was 38.41 +/- 1 weeks, 15 (60%) were female, and the mean birth weight was 3088 +/- 512 (2000-4030) grams. Three infants (12%) were small for GA, and two (8%) were large for GA. None of the infants required resuscitation in the delivery room, and the median length of hospital stay was 3 (3-15) days. One (4%) infant required invasive and 2 (8%) required non-invasive mechanical ventilation. Two of them (8%) developed poor feeding and hypotonia. The infant who required invasive mechanical ventilation was treated with pyridostigmine. Symptoms of transient neonatal MG began to improve by the second day of treatment. The treatment was completed within 10 days for the infant. No infant deaths occurred. Conclusions: Transient neonatal MG may present with a range of clinical manifestations, from mild hypotonia to severe respiratory failure. Appropriate clinical monitoring and treatment of pregnant women and close clinical observation of the infants may improve neonatal outcomes.

Objectives: To define the safe weight loss percentile threshold for the development of hypernatremia by using the "early weight loss nomograms." Methods: This retrospective study included exclusively breastfed healthy neonates over 36 weeks' of gestation. (n = 450). Daily percentage points of weight loss were plotted on the "early weight loss nomograms for exclusively breastfed neonates." The presence of hypernatremia was checked if infants lost ≥5% of their birth weight. Hypernatremia was classified as mild, moderate, or severe. The relation of weight loss rates and percentiles to development of hypernatremia was assessed. Results: The mean gestational age was 38.6 ± 1.3 (36.0-42.3) weeks; the mean birth weight was 3,200 ± 482 g. The mean total weight loss percentage before discharge was 5.9% ± 1.6% (0.5%-17%). The weight loss percentages within first 24 hours were similar in infants born via cesarean section or vaginal delivery (6% ± 1.6% vs. 5.4% ± 1.7%). Mild or moderate hypernatremia developed in 145 infants (32.2%). ROC analyses showed that weight loss of ≥5.5% could predict the development of hypernatremia (AUC = 0.665) and weight loss of ≥7% could predict the development of moderate hypernatremia (AUC = 0.915). Weight loss percentile of ≥75 could also predict the development of hypernatremia with 73% sensitivity and 46% specificity (AUC = 0.622). Conclusion: To the best of our knowledge, this is the first study to evaluate the relationship between weight loss nomogram percentiles and the development of hypernatremia. Even if the weight loss is within the defined acceptable normal ranges and percentiles, hypernatremia may develop if the weight loss is greater than the 75th percentile values.

Çocuklarda insan immün yetmezlik virüsü [human immunodeficiency virus (HIV)] enfeksiyonunun en yaygın bulaş yolu perinatal bulaştır. Anneden bebeğe gebelik, doğum ve emzirme sırasında HIV enfeksiyonu bulaşabilir. Bu çalışmada HIV ile enfekte annelerden doğan bebek ve annelere ait özelliklerin, perinatal HIV geçişini önlemek için uygulanan yöntem ve sonuçlarının değerlendirilmesi amaçlanmıştır. Üçüncü basamak bir hastane olan merkezimizde Ocak 2007-Aralık 2024 tarihleri arasında izlenen HIV ile enfekte anneden doğan bebeklerin verileri retrospektif olarak incelenmiştir. Bebeklerin demografik ve perinatal bilgileri, anne sütü alma durumu, uygulanan antiretroviral (ARV) profilaksi, konjenital anomali varlığı, ebeveynlerinin HIV enfeksiyonu, annelerin HIV enfeksiyonuna ve gebelik seyrine ait özellikleri kaydedilmiştir. Çalışmadaki HIV ile enfekte anneden doğan 120 bebeğin %54.2 (n= 65)'si erkek olarak belirlenmiştir. Bu olguların %62.5 (n= 75)'i diğer merkezlerden yönlendirilmiştir. On dokuz (%15.8) olgunun preterm ve 11 olgunun (%9.2) gestasyonel yaşa göre küçük doğduğu belirlenmiştir. Olguların 91 (%75.8)'inin sezaryen ile doğduğu tespit edilmiştir. İki olguda (%1.7) konjenital kardiyak anomali saptanmıştır. Annelerin 70 (%58.3)'i gebelikten önce, 40 (%33.3)'ı gebelik sırasında ve 10 (%8.3)'u doğumda tanı almıştır. Annelerin çoğunluğunun (%59.2) 20-30 yaş aralığında ve %26.7'sinin yabancı uyruklu olduğu belirlenmiştir. Annelerin 70 (%58.3)'ine gebelik öncesinde, 30 (%25)'una gebelik sırasında ARV tedavi başlanmıştır. Annelerin %73.3 (n= 88)'ünün son trimesterde HIV-1 RNA değeri < 20 kopya/mL ve %82.5 (n= 99)'inin CD4 sayısı ≥ 200 hücre/mm3 olarak değerlendirilmiştir. Olguların 82 (%68.3)'si düşük riskli anne bebeği, 38 (%31.7)'i yüksek riskli anne bebeği olarak belirlenmiştir. Yüksek riskli olmasına rağmen 15 olgu ilaç temininde yaşanan problemler nedeniyle sadece zidovudin profilaksisi almıştır. Dış merkezlerden yönlendirilen beş bebeğin geç başvuruları nedeniyle (3, 5, 2, 3, 29. gün) uygun profilaksileri almaları sağlanamamıştır. Doksan dört olguya (%78.3) 4-6 haftadan itibaren kotrimoksazol profilaksisi uygulanmıştır. Olgulardan dördünün (%3.1) izleminde HIV-RNA değerleri pozitif saptanmıştır. Bu dört olguda; annelerinin gebelik takipleri düzenli yapılamamış, doğum sonrası süreçte ARV profilaksileri yüksek riskli anne bebeği olmalarına rağmen uygun olarak başlanamamıştır. Etkili önlemlerle perinatal HIV bulaşmasını azaltmak ve ortadan kaldırmak mümkündür. Bu çalışma, sevk edilen bebeklerin yaşadığı sorunların tespitiyle bu konuda daha fazla eğitim yapılması ve yenidoğana uygulanacak profilaktik ilaçların yenidoğan formülasyonuna uygun temin edilmesinin önemini gözler önüne sermektedir.

Hyperbaric oxygen therapy (HBOT) administers oxygen under high pressure, mainly for decompression illness, carbon monoxide intoxication, wound healing, infections, and acute peripheral arterial ischaemia. There has been limited use in newborn infants. This case series aims to highlight the potential role of HBOT in management of rare and challenging conditions encountered in the neonatal period. Although HBOT is widely available, its application in newborns remains limited and not well established. We present three neonatal cases: acute peripheral ischaemia; vascular compromise due to thrombosis and compartment syndrome; and a non-healing surgical wound following omphalocele repair. We aim to emphasise the potential clinical benefit and discuss the safety profile of HBOT in select life or limb threatening neonatal pathologies. These cases demonstrate that HBOT, when use as an adjunctive therapy, may contribute to tissue salvage and overall improved outcomes in critically ill neonates. Our intention is to raise awareness and contribute to the limited literature regarding neonatal HBOT, particularly in contexts where usual treatment options are insufficient.

The most common route of transmission of human immunodeficiency virus (HIV) in children is perinatal transmission. HIV can be transmitted from mother to baby during pregnancy, delivery and breastfeeding. This study aimed to evaluate the characteristics of mothers and babies born to HIV-infected mothers and the methods applied to prevent perinatal HIV transmission and their outcomes. Data of babies born to HIV-infected mothers who were followed up at our tertiary hospital between January 2007 and December 2024 were retrospectively analyzed. Demographic and perinatal information of the patients, breastfeeding status, antiretroviral (ARV) prophylaxis, presence of congenital anomalies, HIV infection of the parents, characteristics of the mothers regarding HIV infection and pregnancy course were recorded. In our study, 65 of the 120 (54.2%) babies born to HIV-infected mothers were male. Of the patients, 62.5% (n= 75) were referred from other centers. Nineteen (15.8%) cases were born preterm and 11 (9.2%) cases were born small for gestational age. Ninety-one (75.8%) of the cases were born via cesarean section. Congenital cardiac anomalies were detected in two (1.7%). It was observed that 70 (58.3%) of the mothers were diagnosed before pregnancy, 40 (33.3%) during pregnancy and 10 (8.3%) at birth. The majority of mothers (59.2%) were between the ages of 20-30 and 26.7% were foreign nationals. ARV treatment was initiated in 70 (58.3%) of the mothers prior to pregnancy and in 30 (25%) during pregnancy. Of the mothers, 73.3% (n= 88) had HIV-1 RNA values < 20 copies/mL and 82.5% (n= 99) had CD4 counts >= 200 cells/mm(3) in the last trimester. Of these cases, 82 (68.3%) were infants of low-risk mothers and 38 (31.7%) were infants of high-risk mothers. Despite being high risk, 15 cases received only zidovudine prophylaxis due to problems in drug supply. Appropriate prophylaxis could not be provided to five babies referred from external centers due to their late applications (days 3, 5, 2, 3, 29). HIV-RNA values were positive in the follow-up of four (3.1%) of our cases. It is possible to reduce and eliminate perinatal HIV transmission by using effective measures. This study highlights the importance of identifying the problems experienced by referred babies, providing more education on this issue and providing prophylactic drugs that are suitable for newborn formulation.

INTRODUCTION:Non-invasive monitoring techniques have been used more commonly in neonatal clinical practice. The aim of this study was to evaluate the role of lung near-infrared spectroscopy (NIRS) for determination of the severity of Respiratory Distress Syndrome (RDS) and the requirement of surfactant therapy in preterm infants. METHODS:A total of 60 preterm infants with RDS were evaluated in terms of the requirement of surfactant therapy, as surfactant group (SG) or no-surfactant group (CG). Lung NIRS (L-NIRS), including both basal (bL-rSO2) and apex (aL-rSO2) lung oxygenation monitoring, was performed. RESULTS:The mean bL-rSO2 values before surfactant treatment were significantly lower in SG (83 ± 10%) than CG (89 ± 5%), (p < 0.01). The mean bL-rSO2 levels of 85% were found to significantly predict early surfactant requirement with 57% sensitivity and 73% specificity (p = 0.02). The mean bL-rSO2 values in the first 4 h were found to be significantly lower in SG who required repeated surfactant (all p < 0.05). CONCLUSIONS:L-NIRS ≤ 85% values at NICU admission may be used for determination of surfactant therapy in RDS. In addition, lower mean basal L-NIRS values in the first 4 h of life can also be used to guide repeated doses of surfactant. L-NIRS, either alone or in combination with other methods may be used for management of preterm infants with RDS after confirmation of our results by larger clinical studies.

INTRODUCTION:Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of childbearing age. SLE is associated with many maternal and neonatal morbidities. The aim of this study was to evaluate the neonatal outcomes of infants born to mothers with SLE. METHODS:This retrospective cohort study included data on 57 Turkish mother-infant pairs over a 10-year period. Demographic data of the newborns and the presence of neonatal morbidities such as cardiovascular, hematological involvement, and congenital anomalies were the primary outcomes of the study. RESULTS:The median maternal age and gestational age at delivery were 30 (22-43) years and 37.6 (24.1-40.9) weeks, respectively. Thirteen (22.8%) of the mothers were primigravid and 59.6% (n = 34) of the deliveries were by cesarean section. Anti-Ro, anti-La, and anti-dsDNA autoantibodies were present in 38.6% (n = 22) of the mothers. Only one woman developed pre-eclampsia. Nine (15.8%) of the newborns were preterm, 8 (14%) were intrauterine growth restricted. The mean birth weight of the infants was 2846 (675-4240) grams. Three infants (5.2%) required resuscitation in the delivery room. One infant (1.8%) developed a complete atrioventricular block and 1 (1.8%) had esophageal atresia. None of the infants developed the typical rash of neonatal lupus. CONCLUSIONS:SLE is an important systemic disease that can complicate pregnancy and neonatal outcomes. Optimal multidisciplinary antenatal care of the mother is essential to improve maternal and fetal outcomes.

BackgroundMeasurement of regional pulmonary oxygen saturation by near-infrared spectroscopy is a novel monitorization method. This study aimed to determine the early regional pulmonary oxygen saturations in neonates with respiratory distress.MethodsThis observational study was conducted at the delivery room in infants above 35 weeks of gestation who developed respiratory distress immediately after birth. Preductal oxygen saturation (Covidien Nellcor (R)) and regional oxygen saturations of both apical (raSO2) and basal regions (rbSO2) of right lung were measured (Covidien INVOS (R)) within the first 15 min of life and compared to those of healthy neonates.ResultsOf the 165 infants included to the study, 15 were late preterm and 55 developed respiratory distress. Infants with respiratory distress had significantly lower gestational age and birth weight. Regional pulmonary oxygenations at both apex and basal lung areas were positively correlated with SpO2 in all infants. The rbSO2 was significantly lower than raSO2 until 10th minute of life regardless of respiratory distress. The fractionized tissue oxygen extraction of both apical and basal lung areas was significantly higher in infants with respiratory distress until 5th minute of life.ConclusionThis study is one of the pioneer studies evaluating the early pulmonary oxygenation values of infants with respiratory distress. Oxygenation of apical lung regions are better than basal areas. Higher fractionized tissue oxygen extraction showed the impaired pulmonary perfusion in infants with respiratory distress.

Objective: To evaluate patients who underwent acute and chronic peritoneal dialysis under the age of one one in terms of etiology, complications, and prognosis over 20 years and to compare the results between the first and last 10 years of acute and chronic peritoneal dialysis. Material and Method: Seventy-four peritoneal dialysis patients under the age of one in the Division of Pediatric Nephrology and Neonatal Intensive Care Unit of our hospital between January 2002 and December 2023 were evaluated retrospectively. The patients were divided into two groups: patients admitted in the 2002-2013 period (Group I) and patients admitted in the 2013-2023 period (Group II). Patients in Group I and Group II were compared in terms of acute and chronic peritoneal dialysis etiology, complications, and prognosis. Result: Forty-four of the patients (60%) were newborns, and the remaining 30 were infants (40%). There were 39 patients in Group I and 35 patients in Group II. There was no difference between Group I and Group II for acute dialysis in terms of neonatal and infant diagnoses, infectious and non-infectious complications, and prognosis (p>0.05). There was no difference between Group I and Group II in terms of neonatal and infant diagnoses, infectious and non-infectious complications, and infant prognosis (p>0.05). There was no death in the newborns in Group II and patient survival was higher than in the newborns in Group I (p=0.019). Conclusion: Peritoneal dialysis is the most commonly used method for renal replacement therapy in children facing both acute and chronic renal failure. In the last decade, despite high-quality care in the neonatal care unit, positive technological developments and effective management of PD, the most common infectious complication was still peritonitis, and the non-infectious complication was dialysate leakage, as in the previous 10 years.

BACKGROUND:The objectives were to evaluate the descriptive features of newborns with a diagnosis of Rhesus (Rh) hemolytic disease, to determine the morbidity and mortality rates, to evaluate the treatment methods and the factors affecting treatment requirements and clinical outcomes during a ten-year period at a tertiary center. METHODS:Newborn infants who had a positive direct Coombs test and/or had a history of intrauterine transfusion (IUT) due to Rh hemolytic disease were included. The data regarding the prenatal, natal and postnatal periods were collected from hospital records. RESULTS:A total of 260 neonates were included of which 51.2% were female. The mean ± standard deviation gestational age was 36.9 ± 2.7 weeks. The rate of preterm birth was 41.2%. Of 257 mothers whose obstetric medical history could be accessed, 87.2% were multigravida, whereas 76.3% were multiparous. Among mothers who had a reliable history of anti-D immunoglobulin prophylaxis (n=191), 51.3% had not received anti-D immunoglobulin prophylaxis in their previous pregnancies. The antenatal transfusion rate was 31.7% and the frequency of hydrops fetalis was 8.8%. While combined exchange transfusion (ET) and phototherapy (PT) was performed in 15.4% of the babies, the majority either needed phototherapy only (51.1%) or no treatment (33.5%). The mortality rate was 3.8 % (n = 10), and nine babies out of these 10 were those with severe hydrops fetalis. CONCLUSION:This study showed that Rh hemolytic disease is still a major problem in developing countries. Multiple comorbidities may occur in addition to life threatening complications, including hydrops fetalis, anemia and severe hyperbilirubinemia. High rates of multiparity and low rates of anti-D immunoglobulin prophylaxis are potential barriers for the eradication of the disease. It should be remembered that Rh hemolytic disease is a preventable disease in the presence of appropriate antenatal follow-up and care facilities.

Objective Mydriatic eye drops used for retinopathy of prematurity (ROP) examination can cause systemic effects, and there are case reports of serious adverse effects in the literature. In this prospective study, we aimed to evaluate the early hemodynamic effects of mydriatic eye drops to understand the possible mechanisms of adverse effects. Study Design Between December 2018 and March 2019, preterm babies less than 32 gestational weeks and who underwent ophthalmologic examination in our unit were included. The vital signs (heart rate, respiratory rate, oxygen saturation [SpO2], and blood pressure values), cerebral and mesenteric tissue saturation by near-infrared spectroscopy (NIRS), and left ventricular functions of infants were recorded before and after applying mydriatic eye drops (2.5% phenylephrine and 0.5% tropicamide). The data were compared statistically. Strict adherence to prevent systemic absorption of the eye drops was applied. Results Thirty-two mydriasis procedures were evaluated in 26 patients. The mean gestational age was 28.5 ± 1.7 weeks, and the mean birth weight was 943 ± 233 g. There were no significant differences in terms of vital signs of infants including heart rate, blood pressure, and oxygen saturation [SpO2] levels before and after eye-drop application. In addition, NIRS values showed no significant differences between before and after measurements. No significant differences were detected at echocardiographic evaluation performed before and after mydriatic administration. No adverse reaction was observed in the study population during the study. Conclusion This is the first study that evaluated the early hemodynamic effects of mydriatic eye drops used for ROP screening by vital signs, NIRS, and echocardiographic evaluation. Mydriatic eye drops have no significant effect on early hemodynamic parameters including vital signs, NIRS, and echocardiographic findings in preterm infants. We suggest that a cautious approach for avoiding the systemic absorption of these agents may prevent the possible early systemic effects in this high-risk population. Key Points

Background: The human gut microbiota is an extensive population of microorganisms, and it shows significant variations between periods of optimal health and periods of illness. Vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are both pathogenic agents (BPAs) that can colonize in the gut after dysbiosis of microbiotal composition following antibiotic treatment. Methods: This study aimed to investigate the impact of antibiotics on the microbiotal composition of the gut. For this purpose, the first pass meconiums of 20 patients and the first rectal swabs containing BPAs of the same patients after antibiotic treatment were studied using next-generation sequencing-based 16S rRNA gene analysis. The V1–V9 region of 16S rRNA was sequenced with Oxford Nanopore. Results: Twenty-five phyla were detected in the meconiums, and 12 of them were absent after antibiotic treatment. The four most prevalent phyla in meconiums were Bacillota, Pseudomonadota, Bacteroidota, and Actinomycetota. Only the relative abundance of Pseudomonadota was increased, while a significant decrease was observed in the other three phyla (p < 0.05). A significant decrease was observed in alpha-diversity in rectal swabs containing BPAs versus meconiums (p = 0.00408), whereas an increased variance was observed in beta-diversity in all samples (p < 0.05). As a result of a LEfSe analysis, Pseudomonadota was found to have a higher relative abundance in rectal swabs, and Bacillota was significantly higher in the meconiums of the twins. Conclusions: Our study strongly verified the relationship between the administration of antibiotics, dysbiosis, and colonization of BPAs in the infants’ gut microbiota. Further research would be beneficial and needed, comprising the natural development process of the infants’ gut microbiota.

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.

Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes. Study Design The clinical and laboratory data of 40 women and neonates evaluated retrospectively. Results This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease. Conclusion Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support.