Objective: The impact of in utero exposure to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on neonatal health, particularly in the absence of active infection at delivery, remains incompletely understood. This study evaluated early neonatal outcomes and short-term follow-up among infants exposed to maternal Coronavirus Disease-2019 (COVID-19) during pregnancy, compared with unexposed neonates. Methods: This retrospective observational cohort study was conducted at Gazi University Faculty of Medicine Hospital, a tertiary university hospital with a Level IV NICU, between March 2020 and August 2021. Neonates who tested polymerase chain reaction (PCR)-negative at delivery and were born to mothers with PCR-confirmed SARS-CoV-2 infection during pregnancy were classified as exposed, while neonates born to mothers without a history of COVID-19 during pregnancy served as controls. Neonatal outcomes during hospitalization and at one-month follow-up were assessed. Results: A total of 196 neonates were included, of whom 112 were exposed in utero to maternal COVID-19. Neonatal intensive care unit (NICU) admission was more frequent among exposed infants [28.4% vs. 11.9%; relative risk (RR): 2.38, 95% confidence interval (CI): 1.25-4.54; p = 0.007]. In exposed neonates, hyperbilirubinemia requiring phototherapy occurred more frequently (38.8% vs. 22.2%; RR: 1.75, 95% CI: 1.08-2.85; p = 0.017), and the onset of jaundice occurred earlier [median (interquartile range) 3 (2-3) vs. 5.5 (3-8) days; p = 0.006]. Direct Coombs testing (performed in a clinically selected subset) showed similar overall positivity rates, but high-grade positivity (≥2+) occurred exclusively among exposed infants (p = 0.004). In trimester-specific analyses, second-trimester maternal infection was associated with a higher rate of neonatal endotracheal intubation than with first- or third-trimester exposure (10.0% vs. 0%; p = 0.034). No group differences were observed in early postnatal complications or rehospitalizations at one month. CONCLUSION: Resolved maternal SARS-CoV-2 infection during pregnancy was not associated with major adverse neonatal outcomes, but it was linked to more frequent NICU admissions, earlier onset of clinical jaundice, a higher incidence of hyperbilirubinemia requiring treatment, and distinct patterns of severity on the direct Coombs test, potentially consistent with altered immune or hematologic processes. A trimester-specific association with endotracheal intubation was observed and should be interpreted cautiously.

MiRNA 148a, which is associated with various biological processes such as immunity and cell differentiation, is one of the most abundant miRNAs in breast milk. This study aimed to determine the amount of miRNA 148a in different infant formulas, which are used for infants who cannot receive breast milk. The study analyzed 20 formulas, including stage one infant formulas (0-6 months of age), stage two follow-up formulas (6-12 months of age), stage three toddler formulas (above 12 months of age), and premature ones, analyzing miRNA 148a expression and qPCR miRNA gene expression, with significance set at p < 0.05. The expression levels of miRNA 148a in different infant formulas were compared, and no statistically significant difference was observed (p > 0.05). Also, there was no difference in relative miRNA 148a expression across formulas with and without probiotics (p > 0.05). Protein levels in probiotic formulas (0 month-1 year+) were positively correlated with relative miRNA 148a expression (p = 0.022). Although miRNA 148a expression has been shown to be present in formulas, it has been revealed that the amount is low compared to breast milk in line with the literature. In this direction, it is important to increase current data on the mechanisms of action of miRNAs in breast milk and the efforts to ensure that infant formulas reach a composition closest to breast milk in line with their biological effects.

BACKGROUND:Despite recommendations to limit the use of vancomycin for known resistant infections, it remains one of the most commonly prescribed antibiotics in neonatal intensive care units (NICUs). One of the most effective approaches to reducing unnecessary antibiotic exposure is through the implementation of antibiotic stewardship programmes (ASPs). AIM:The objective of this study was to evaluate the effectiveness of ASPs in reducing the use of vancomycin in neonates hospitalized in our NICU. METHODS:This study was a quasi-experimental single-centre study for a quality improvement (QI) initiative. Interventions were implemented to limit the use of vancomycin, including education of the neonatal intensive care team, standardization of vancomycin therapy, and prospective audit and feedback. The pre-intervention period was compared with the post-intervention period. FINDINGS:The initiation of vancomycin decreased from 166 times in the pre-intervention period to 71 times after stewardship implementations, representing a 57.2% reduction. Total vancomycin days of therapy per 1000 patient days gradually declined from 113 to 45 (60.2%) (P<0.001) during the study period. There was an increase in the Gram-positive growth in the culture of patients who were started on vancomycin (P=0.04). The number of patients receiving two or more courses of vancomycin treatment decreased by 85.7% (P=0.03). CONCLUSIONS:This study has demonstrated that implementing effective multi-disciplinary strategies can significantly reduce vancomycin exposure in the NICU. The application of ASP practices and management in the NICU is essential and achievable, without any increase in the duration of hospitalization or mortality rates.

Autosomal recessive congenital ichthyosis (ARCI) is a group of diseases presenting as collodion baby at birth. ARCI is categorized as Harlequin ichthyosis, lamellar ichthyosis, and non-bullous congenital ichthyosiform erythroderma (NBCIE), bathing suit icthyosis (BSI) and others. We describe the case of a male newborn with NBCIE whose whole exome sequencing revealed two variants of TGM1 gene (NM_000359.3) in a compound heterozygous state: c.790C>T (p.Arg264Trp) in exon 5 and c.2060G>A (p.Arg687His) in exon 13. In the literature, the Arg264Trp variant has been reported as homozygous or compound heterozygous with other variants in patients with BSI. In contrast, the Arg687His variant has been reported only as homozygous in patients with BSI. To the best of our knowledge, this is the first case whose two compound heterozygous variants, exhibiting the NBCIE phenotype, instead of the BSI.

BACKGROUND:Hyperbilirubinemia is a clinical picture frequently occurring in the neonatal period and may negatively affect the development of infants. AIMS:To evaluate term infants with hyperbilirubinemia in terms of both motor development and sensory processing skills and to compare them with their healthy peers without hyperbilirubinemia. STUDY DESIGN:A cross-sectional study. SUBJECTS:Children born at term, aged 10-18 months, with and without a history of hyperbilirubinemia were included in the study. OUTCOME MEASURES:After demographic information was recorded, motor development was evaluated with the Peabody Motor Development Scale-2 and sensory processing skills were evaluated with the Test of Sensory Function in Infant. RESULTS:A total of 42 children (mean ± SD age of the children 13.07 ± 1.47 months, 22 with hyperbilirubinemia and 20 without hyperbilirubinemia) were included in the study. A statistically significant difference was found in the gross motor (p = 0.02), fine motor (p = 0.03), and total motor (p = 0.017) development scores of the Peabody Motor Development Scale-2 and in the adaptive motor functions (p = 0.004), visual tactile integration (p < 0.001), and total scores (p = 0.004) of The Test of Sensory Function in Infant in favor of the control group. CONCLUSIONS:The motor and sensory processing skills of children born at term with hyperbilirubinemia may be negatively affected. Infants with hyperbilirubinemia should be evaluated from the early period not only in terms of motor but also sensory processing skills and should be supported with appropriate intervention programs.

Prematüre Bebeklerde İntraarteryel ve Osilometrik Kan

Abstract Background Researchers have attempted to automate the spontaneous movement assessment and have sought quantitative and objective methods over the past decade. The purpose of the study was to present a quantitative assessment method of spontaneous movement using center-of-pressure (COP) movement analysis. Methods A total of 101 infants were included in the study. The infants were placed in the supine position on the force plate with the cranial-caudal orientation. In this position, the recording of video and COP movement data were made simultaneously for 3 min. Video recordings were used to observe global and detailed general movement assessment (GMA), and COP time series data were used to obtain quantitative movement parameters. Results According to the global GMA, 13 infants displayed absent fidgety movements (FMs) and 88 infants displayed normal FMs. The binary logistic regression model indicated significant association between global GMA and COP movement parameters (chi-square = 20.817, p < 0.001). The sensitivity, specificity, and overall accuracy of this model were 85% (95% CI: 55–98), 83% (95% CI: 73–90), and 83% (95% CI: 74–90), respectively. The multiple linear regression model showed a significant association between detailed GMA (motor optimality score-revised/MOS-R) and COP movement parameters (F = 10.349, p < 0.001). The MOS-R total score was predicted with a standard error of approximately 1.8 points (6%). Conclusions The present study demonstrated the possible avenues for using COP movement analysis to objectively detect the absent FMs and MOS-R total score in clinical settings. Although the method presented in this study requires further validation, it may complement observational GMA and be clinically useful for infant screening purposes, particularly in clinical settings where access to expertise in observational GMA is not available.

Objective The research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly consists of adult patients, leaving its impact on children understudied. This study aims to investigate the correlations between viral load, clinical course, age, and Alpha variant (B.1.1.7) in children. Methods The study was conducted on children under the age of 18 years, who were admitted to Amasya University Sabuncuoglu Serefeddin Research and Training Hospital in Turkey between February and April 2021. ΔCt values, which were obtained by real-time polymerase chain reaction (PCR), were analyzed to estimate the viral loads of the patients. Alpha variant (B.1.1.7) positivity was determined by real-time PCR. Results There was no difference between estimated viral loads of different clinical courses (p > 0.05), or between asymptomatic and symptomatic patients (p > 0.05). Viral loads were found to decrease with increasing age (p = 0.002). Also, a higher rate of symptomatic disease was found in children under the age of 4 years (p < 0.05). Alpha variant (B.1.1.7) was not found to be associated with severe disease in children (p > 0.05). Conclusion Our results demonstrate higher viral loads and symptomatic disease in children under the age of 4 years. Alpha variant (B.1.1.7) was not found to be related to disease severity. There has not been a consensus on the vaccination of the pediatric population worldwide. More studies are needed to understand the viral kinetics of SARS-CoV-2 and its severity on children to build effective vaccination strategies in children as public health restrictions are eased.

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.

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) (& thorn;). 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.

Context: There are limited data in the literature about the relationship between neonatal seizures and subsequent epilepsy. Aims: This study aimed to identify the predictive value of perinatal factors, etiologies, electroencephalography (EEG), and cranial ultrasonography (USG) for future epilepsy after neonatal seizures. Materials and Methods: A total of 92 children with epilepsy who had seizures during their neonatal period were retrospectively evaluated whether the contribution of perinatal, natal, and postnatal risk factors confining clinical, laboratory, EEG, and imaging to subsequent epilepsy. Chi-square, uni, and multivariate logistic regression were applied to find out predictive factors for subsequent epilepsy. Results: The rate of epilepsy was 57.6 % during 1-6 years follow-up. Birth weight, Apgar scores at first and fifth minutes, resuscitation history, abnormal neurological examination, etiology, response to the treatment, abnormal EEG, or USG findings were the most important risk factors for future epilepsy in univariate analysis (P < 0.05). Furthermore, asphyxia, fifth minute Apgar scores, response to the treatment, USG, and EEG were independent predictors (P < 0.05) for subsequent epilepsy in multivariate logistic regression. No relationship was found between subsequent epilepsy and mode of delivery, seizure onset time, and seizure types (P > 0.05). Conclusion: Although there are recent promising and advanced techniques in neonatal intensive care units, asphyxia is still one of the most important risk factors for not only poor neurological conditions but also for future epilepsy after neonatal seizures. Apgar scores, treatment with multiple antiepileptic drugs, poor background EEG activity, and abnormal neuroimaging seem to have strong predictive values for developing subsequent epilepsy. Therefore, patients with a history of neonatal seizures should be closely followed up to decrease the risk of long-term outcomes and early detection of epilepsy.

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.

The following guideline is designed to give recommendations for the routine care of all neonates immediately after delivery, and the resuscitation and delivery room approach of all high-risk infants in light of recent literature. The guideline has been prepared as three different parts. The first part is about routine procedures that have to be performed to all healthy term and preterm infants in delivery room care. The second part summaries the basic principles of resusucitation including the latest changes that were mentioned in the International Liaison Committee on Resuscitation (ILCOR)-2015 guideline. Recommendations about the delivery room management of rare clinical conditions have been discussed in the last part. The social, medical conditions, and the resourses of Turkey have also been taken into consideration in its preparation. We hope it will be useful for all pediatricians and neonatologists for use as a essential guideline in delivery room care.

Introduction: Most important factors in retinopathy of prematurity (ROP) are prematurity and oxygen toxicity although blood transfusions, insulin like growth factor-1 ( IGF-1), insulin like growth factor binding protein 3 (IGFBP-3) and vascular endothelial growth factor (VEGF) also have important roles. The objectives of this study were, to measure IGF-1 and IGFBP-3 levels in preterm newborns before and after blood transfusion and assess if the effect of transfusion in development of ROP is via these mediators, and to investigate whether IGF-1 and IGFBP-3 levels measured at 32 and 33 gestational age (GA) were different in preterm newborns with and without ROP. Material and Methods: Preterm newborns with gestational age ≤34 weeks were included and blood samples were obtained before and after red blood cell (RBC) transfusion. Results: Thirty newborns were included, 17 of whom had ROP ( stage 1: n=11, stage 2: n=5, stage 3: n=1). IGF-1 and IGFBP-3 levels did not change after RBC tranfusion. Excluding the patient with stage 3 ROP all ROP patients were referred as mild ROP. No difference was observed between IGF-1 and IGFBP-3 levels of the patients with and without mild ROP. Patients with mild ROP had significantly more number of transfusions. Conclusions: Erythrocyte transfusion increased the frequency of ROP, whereas IGFBP-3 and IGF-1 were not associated of ROP.

AimMost 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. MethodsA multi-probe NIRS device was applied to anaemic preterm infants of gestational age <33weeks for 30-60min before and 24h 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 (rSO(2)) and abdominal/cerebral, abdominal/renal and renal/cerebral rSO(2) ratios before and 24h after transfusion were compared. ResultsThere was no significant difference in cerebral rSO(2) and abdominal/renal rSO(2) ratios before and 24h after transfusion, but abdominal and renal rSO(2) and abdominal/cerebral and renal/cerebral rSO(2) 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. ConclusionsThe 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 rSO(2) may cause reperfusion injury, oxidative damage and trigger necrotising enterocolitis.

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.