Amaç: Orta/geç preterm doğan 11-12 yaşındaki çocukların nörogelişimsel sonuçlarını ve okul başarısını araştırmayı ve prognozu etkileyen risk faktörlerini belirlemeyi amaçladık. Hastalar ve Yöntem: Yenidoğan yoğun bakım ünitesinde Ocak 2004-Aralık 2004 tarihleri arasında izlenen orta ila geç preterm bebekler çalışmaya dahil edildi; çocuklar 2016 yılında hastanemiz pediatri polikliniğinde muayene edildi. Perinatal ve neonatal dönem öyküleri hastane veri tabanından elde edildi. Somatik büyüme özellikleri yorumlandı. Nörogelişim, Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R) ölçeği kullanılarak değerlendirildi. Pediatrik Semptom Kontrol Listesi (PSC) uygulandı. Sosyoekonomik düzeyin nörogelişimsel sonuç üzerindeki etkisi incelendi. Okul performansı karne notları kullanılarak değerlendirildi. Bulgular: Yaş ortalaması 11.6 olan 41 çocuk değerlendirildi. Somatik büyüme ile ilişkili risk faktörleri anne yaşı (>35 yaş), fetal distres ve patent duktus arteriyozus idi. Sepsis, sözel zekada bir azalma ile ilişkilendirildi; periventriküler lökomalazi hem sözel hem de performans zekası üzerinde olumsuz etkilere sahipti. Sosyoekonomik düzey, performans ve tam ölçekli zeka ile orta düzeyde bir korelasyon gösterdi. PSC puanı pozitif olan çocukların zeka bölümü anlamlı olarak daha düşüktü. Sonuç: Orta ila geç preterm bebekler, beynin tam olgunlaşmaması ve doğum sorunları nedeniyle hem nörolojik hem de gelişimsel olarak geride kalmaktadır. Erken prematüre bebeklere benzer şekilde, bu çocuklar uzun süre izlenmelidir; aile desteği, rehabilitasyon ve özel eğitim ihtiyaçları karşılanmalıdır.

We aimed to compare the rate of morbidity and mortality of late preterm and term infants during hospitalization in the third-level neonatal intensive care unit (NICU).743 late preterm and 489 term infants who were born and followed up in the third level NICU were evaluated retrospectively.The birth weight, mode of delivery, gestational week, gender, duration of hospitalization, problems in neonatal and post-discharge period, and rate of mortality were investigated.The rate of mortality and morbidity were compared between the groups.Respiratory distress syndrome (RDS) was the most common (40.3%) cause of hospitalization.The rate of necrotizing enterocolitis, RDS and bronchopulmonary dysplasia was significantly higher in late preterms.Sixty-two (8.3%) of the late preterms and 88 (18%) of the term babies died.Congenital anomalies (55%) were the major cause of mortality in the term group, whereas RDS (35%), surgical interventions, long-term hospitalization, and infection were the main causes of mortality in the late preterm group.The high mortality rate in our study was because our study included only the babies hospitalized in the 3 rd level NICU.It must be kept in mind that late preterms experience most of the problems of ongoing prematurity; therefore, they should not be delivered unless there is absolute obstetric and/or fetal indication.

Amaç: ABO hemolitik hastalık yenidoğan döneminde en sık görülen alloimmün hemolitik hastalıktır. Hemolitik hastalıklara bağlı gelişen sarılık varlığında geleneksel tedavi yöntemleri fototerapi ve kan değişimi olmakla birlikte hemolizin önlenmesi için intravenöz immunglobulin G (IVIG) tedavisi de kullanılmaktadır. Bu çalışma ile ABO hemolitik hastalığı olan yenidoğan bebeklerde IVIG kullanımının klinik sonuçalar üzerine etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Gebelik yaşı 37 hafta ve üzerinde, direkt coombs testi pozitif olan, indirekt hiperbilirubinemi nedeniyle fototerapi tedavisi başlanan 192 bebek çalışmaya dahil edildi. Enzim eksikliği (G6PD), polisitemi, viseral kanama, sefal hematom, patolojik tartı kaybı, metabolik hastalık ve sepsis şüphesi olan bebekler çalışmaya alınmadı. Bebekler sadece fototerapi alan ve fototerapi tedavisine ek IVIG tedavisi alan bebekler olarak iki grupta retrospektif olarak incelendi. Bulgular: Bebeklerin ortalama gebelik yaşları ve doğum tartıları benzerdi. IVIG uygulanan bebeklerde fototerapi ve hastanede yatış süreleri anlamlı olarak uzun, doğumdaki hemoglobin ve hematokrit değerlerine göre taburculuk değerlerinde gözlenen düşme (Δ Hemoglobin ve Δ Hematokrit) IVIG uygulanmayan gruba göre anlamlı olarak yüksek bulundu. Hemoliz bulguları devam ettiği için tekrar doz IVIG tedavisi alan bebeklerde ise en yüksek bilirubin düzeyleri ve toplam fototerapi süresi açısından tek doz IVIG tedavisi alan gruba göre anlamlı fark saptanmadı. Tartışma: Bu çalışma ile yenidoğanların ABO hemolitik hastalığında fototerapi tedavisine ek olarak IVIG kullanımının hemolizi önlemediği, fototerapi ve hastanede yatış süresini kısaltmadığı gösterilmiş, tekrarlanan dozlarda IVIG uygulamasının klinik etki olarak tek doz IVIG uygulamasından üstün olmadığı saptanmıştır. ABO hemolitik hastalığa bağlı gelişen indirekt hiperbilirubinemi tedavisinde halen ilk tercih etkin uygulanan fototerapi olmalıdır. ABO hemolitik hastalıkta IVIG kullanımını önermek için geniş hasta sayılı prospektif çalışmalara ihtiyaç vardır.

Objective: The ABO hemolytic disease is the most common alloimmune hemolytic disease in the neonatal period. The conventional treatment strategies for indirect hyperbilirubinemia caused by hemolysis are phototherapy and exchange transfusion. IVIG can also be used to prevent hemolysis. This study aimed to evaluate the efficacy of IVIG use in infants with ABO hemolytic disease. Materials and Method: Infants with gestational age >37 weeks, with a positive direct Coombs test, and having phototherapy for indirect hyperbilirubinemia were included in the study (n=192). Enzyme deficiency (G6PD), polycythemia, visceral hemorrhage, pathological weight loss and septicemia were the exclusion criteria. The newborn infants were reviewed retrospectively in two groups as the only phototherapy group and the phototherapy and IVIG group. Results: The mean gestational age and birth weight of the infants were similar between groups. The hospital stay and phototherapy duration were significantly longer and hemoglobin decrease from birth to discharge was significantly higher in the phototherapy and IVIG group. There was no difference found between the infants who received one dose or recurrent doses of IVIG in terms of highest bilirubin level and total phototherapy duration. Conclusion: This study showed that IVIG use in ABO hemolytic disease of newborns in addition to phototherapy neither prevents hemolysis nor decreases phototherapy duration and hospital stay. Recurrent doses of IVIG treatment have no clinical benefit over single dose IVIG treatment. The first choice of treatment should be an effective phototherapy in indirect hyperbilirubinemia due to ABO hemolytic disease. Further larger prospective studies are needed to assess the IVIG use in ABO hemolytic disease.

OBJECTIVES The rehospitalization frequency/indications of low birth weight (LBW) preterms and the effect of rehospitalization on growth and neurodevelopment were investigated. METHODS LBW preterms discharged from NICU were prospectively followed until the corrected age of 1 year. Infants rehospitalized after discharge were defined as the study group and those not rehospitalized as the control group. The frequency, duration and etiology of rehospitalization were investigated and the effects of neonatal complications, surgery and socio-demographic status on rehospitalization were assessed. RESULTS The study and the control group included 113 and 217 infants, respectively. Infants in the study group were rehospitalized 247 times in total. Rehospitalization was significantly higher in the male gender (39.7% vs. 28.9%, p < 0.05). Hyperbilirubinemia-anemia, anemia-surgery and pulmonary-other infections were the most common indications for rehospitalization in the 0-14 days, 15 days to 2 months and 2-12 months, respectively. Intrauterine growth had no impact on rehospitalization. Somatic growth and neurodevelopment were significantly delayed in the study group (p < 0.05). CONCLUSION Birth weight and gestational week are the most important determinants of rehospitalization. Rehospitalized preterm infants have significant deficits in both somatic growth and neurodevelopment despite high-quality follow-up care.

Aims Evaluate somatic growth and neurodevelopmental outcome of late and moderate preterms at 11–12 years of age, research the effect of perinatal, neonatal, socioeconomic and cultural risk factors. Methods Modarate and late preterms monitored in Bakirkoy Obstetrics and Paediatrics Training and Research Hospital between the dates January and December 2004 were included in this study. Mother’s age, chronic diseases, premature rupture of membrans, placenta patologies, Apgar score were examined as perinatal risk factors. Duration of admission in intensive care unit, respiratory problems, intracranial haemorrhage, periventricular leukomalacia, sepsis, necrotizing enterocolitis, retinopathy of prematurity were assessed as neonatal morbidities. Full physical and detailed neurologic examination was performed on every patient. PEDS test, which examines families’ concerns about their children and PSC test examining behaviour problems were also performed. Wisc-r test was used to calculate verbal, performance and full scale intelligence quotient, Report grades were used to evaluate school performance, socioeconomic level was determined through a poll. Results We examined 41 children (18 girls, 23 boys), mean age was 11,6 years. 5 cases (12,2%) were below tenth height percentile, 10 (24,4%) were below tenth weight percentile. Perinatal risk factors were not associated with verbal or numerical intelligence. As for neonatal morbidites; sepsis was associated with verbal intelligence, periventricular leukomalacia had a negative impact on verbal, performance and full scale intelligence. Socioeconomic level showed medium positive correlation with numerical and full scale intelligence. Children with concerned parents had significantly lower verbal, performance and full scale intelligence quotient, cases with a positive PSC score had a similar outcome. Girls had a better school performance, nevertheless there was no significant difference in intelligence quotient between two genders. As major neurologic deficits, three cases had mental retardation (Wisc-r score<70), one case was blind in one eye. Cases with major neurologic deficit had a lower full scale intelligence quotient and school performance. Conclusions Modarate and late preterms have a higher risk than terms in terms of somatic growth and neurodevelopment. Consequently, long term follow-up of moderate and late preterms, like early preterms, is crucial for early diagnosis, treatment and rehabilitation

Acute scrotal abscess is a rare condition in neonates. Most of these abscesses were reported to be unilateral and caused by Staphylococcus and Salmonella spp. Herein, we report a bilateral scrotal abscess in a preterm infant and Candida albicans was isolated from the scrotal fluid culture. To our knowledge, this is the first bilateral scrotal abscess in a preterm infant caused by C. albicans. Therefore, this organism must be suspected in differential diagnosis of acute scrotal abscess in neonates, especially in preterm infants.

SummARY Objective: To evaluate the frequency of necrotizing enterocolitis, intrinsic risk factors associated with newborns and mothers, and effects of these factors on the development of NEC and related mortality in our newborn intensive care unit. Material and Methods: Three hundred and thirty two newborns admitted to our intensive care unit with the diagnosis of NEC between January 2002 and August 2010 were evaluated retrospectively.

Objective The aim of this study was to evaluate the value of tubulary phosphorus reabsorption (TPR) ratio in diagnosis of osteopenia of prematurity. Methods This prospective study was performed between June 2009 and March 2011 and premature infants < 32 weeks of gestation and/or < 1500 gram were included. Maternal and neonatal demographic data were all recorded. The plasma Ca, P, ALP and 25-OH vitamin D levels of mothers and infants were evaluated. The neonatal morbidities, duration of hospitalizati, on and total parenteral nutrition were also recorded. Infants were evaluated at postnatal 40th week. Bone mineralization was assesed by plasma Ca, P, ALP, urea, creatinine and GGT levels in combination with femur X-ray. Also, urine was collected to determine urinary Ca and P levels and tubulary phosphate reabsorption was calculated. Results No significant differences were detected between infants with and without osteopenia of prematurity in terms of maternal biochemical values. On the postnatal 40th week, infants with TPR>95% had significantly higher ALP and lower P levels compared with those who had lower TPR. The sensitivity, specificity, positive predictive value and negative predictive value of TPR ratio in diagnosis of prematurity of osteopenia were found to be 27.2%, 82.7%, 17.1% and 89.6%, respectively. Conclusion In conclusion, TPR ratio can be used as an ancillary diagnostic marker in addition to primary diagnostic tests in diagnosis of prematurity of osteopenia.

Approximately 10% of neonates with Down syndrome may develop a form of megakaryoblastic leukemia that usually disappear spontaneously during the first months of the life. Although it seems to have a benign course, it may also be lethal and severe in some cases, especially in the form of hydrops and/or cardiopulmonary failure. Herein, we report a male infant with Down syndrome who was admitted with respiratory distress due to severe pericardial effusion leading to pericardial tamponade in the first 2 weeks of life. Pericardiosentesis and pericardial tube replacement in combination with steroid therapy was performed. He responded well to these therapies and his leukemia resolved on the fourth month of life. This case suggests that severe pericardial effusion and pericardial tamponade may be life-threatening complications of transient leukemia of Down syndrome and also it may be managed successfully with appropriate treatments.

Objective The aim of this study was to compare the somatic and neurodevelopmental outcomes of small and late preterm infants and also to determine the prenatal, natal and postnatal factors affecting these outcomes. Methods A total of 163 infants that were born < 32 weeks of gestation (small preterms, control group) and 240 infants born >32 weeks of gestation (late preterms, study group) were included to this prospective study. All infants were evaluated at postnatal 42 weeks. Neurodevelopmental outcomes of these infants were evaluated with neurological examination and Denver II Developmental Screening Test. Also somatic evaluation including the determination of the length according to Turkish children percentilles was also performed. Results The major neurological sequele ratio was significantly higher in small preterm infants (13.9%) compared with the late preterms (2.4%). Apgar scores at 5 minute, need of resuscitation in delivery room and male gender were all significantly associated with an increased risk of adverse neurological outcomes. Also presence of neonatal morbidities including neonatal hypoglycemia, sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage greater than stage III were also abnormal Denver results. Somatic growth failure was detected in 2% and 4.9% of the late and small preterm infants. Conclusion Small preterm infants might have significantly higher abnormal neurodevelopmental outcomes compared with late preterms. However, late preterm infants might be routinely followed-up for somatic growth and also neurodevelopmental outcomes.