Objective: In this study, we aimed to evaluate growth characteristics of preterms followed up in a neonatal intensive care unit (NICU) during adolescence. Methods: The preterms born in 2001-2002 who were followed up in the NICU of our hospital were examined in 2016. Data from the prenatal, natal, and postnatal periods, as well as at the 6-7 years, were obtained from a database with follow-up assessments during adolescence. Measures of growth (height, weight, body mass index), the percentile curves for Turkish children, and the target height formula were used in the assessment. Factors affecting growth, such as maternal problems and neonatal morbidities, were questioned. Results: Thirty-seven preterm babies (19 females and 18 males) were included in the study. The mean gestational age was 31.5 (28-34) weeks, and the birth weight was 1298 (820-1870) grams. Six newborns (17.6%), and three adolescents (8.1%) were below 3(rd) percentile for height. All cases had height percentiles within the normal range at 6-7 years of age. Twenty-six adolescents (70.3%) achieved the target height. Eleven premature (29.7%) during the neonatal period, one child (2.7%) during the school period, and one adolescent (3%) were below 3rd percentile for weight. During the neonatal period, one case for height and two cases for weight were above 90(th) percentiles. While, during school period, 6 cases for height, 2 cases for weight were above 90th percentiles; 1 case for height, 6 cases for weight were above 90th percentiles during adolescence. The frequency of obesity increased from 2.7% to 13.5% during adolescence. 90% of individuals below 3rd percentile of birth weight reached normal weight percentiles during adolescence. Prenatal, natal, and postnatal risk factors, as well as duration of breastfeeding, were not found to be effective in achieving the target height during school-age and adolescent periods. Conclusion: In this study, wefound that all cases had normal percentiles for height in the school period, but on the other hand, 8.1% cases were <3(rd) percentiles during adolescence. Also, the frequency of cases that were <3(rd) percentiles for weight was similar during the school period and adolescence. These results reflected that, while catch-up growth could be achieved during the school years, it was not achievable during adolescence. It demonstrates that the growth of individuals born preterm is a dynamic phenomenon.

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.

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.

The duodenum is the most frequently obstructed region of the gastrointestinal tract, an important cause of mortality and morbidity in neonatal period. The objective of the present study was to summarize the causes of early mortality and morbidity in infants with congenital duodenal obstruction (CDO). Data on a total of 94 patients with CDO diagnosed in our clinic, and treated surgically between January 1993 and December 2012, were studied retrospectively. Patients were divided into 3 groups in terms of diagnosis: annular pancreas (n = 45), duodenal atresia (n = 31), and duodenal web (n = 18). The groups were compared in terms of sex, birth weight, age at the time of operation, and morbidity and mortality rates. Of the patients, 54 were male and 40 female, and the mean birth weight was 2278 g (range, 1180–3400 g). The average age at the time of the operation was 6.96 days (range, 1–38 days). The time to full oral intake postoperatively was 10.32 days (range, 4–38 days). Additional anomalies were found in 61 cases (64.8%). Early morbidity was most commonly associated with an anastomosis problem. Early mortality occurred in 6 cases (6.4%), and the most common causes were sepsis and cardiac anomalies. Elimination of sepsis, cardiac anomalies, and anastomosis problems is critical to ensure continued reductions in infant mortality and morbidity caused by CDO.

Aim:The study aims to determine features, morbidities and mortality of adolescent pregnants and their hospitalized newborns in the neonatal period.Methods:Six hundred forty-one adolescent pregnants were enrolled and compared to 309 non-adolescent pregnants. Demographic characteristics of mothers and complications of delivery, demographic characteristics of newborns, morbidities, and mortality of infants admitted to hospital during neonatal period were recorded.Results:The mean age of adolescent and non-adolescent pregnants were 17.2±0.8 and 27.0±4.3 years, respectively. Education levels, being housewife, extramarital birth-giving, cesarean section rate, and twin pregnancy were higher in adolescent pregnants. The mean height, head circumference, and weight of newborns in adolescent pregnants were significantly lower. Even though neonatal mortality was similar in both pregnants, early neonatal morbidities were more common in adolescent pregnants. Duration and rate of hospitalization, and morbidities causing hospitalization during the neonatal period were similar in the babies of both pregnants. Among babies admitted to the neonatal intensive care unit, mortality rates were higher in babies born to non-adolescent mothers.Conclusion:Worse neonatal outcome of babies born to adolescent pregnants, and higher mortality in the neonatal period in non-adolescent pregnants were found. But characteristics and morbidities of babies hospitalized in the neonatal period were similar in both groups.

Objective: The aim of this study was to compare the physical growth features of preterms infants at early childhood and to evaluate the perinatal and postnatal risk factors that affect growth. Method: Somatic growth features including weight, height, and target height, of moderate-late and early preterm infants followed-up in our unit were evaluated at a mean age of 42 months. The effects of intrauterine growth characteristics (IUGC) on current growth as well as the effects of perinatal and early neonatal problems were investigated. Results: A total of 232 moderate-late preterm infants (Group I) (mean gestational age [GA]: 34.9±1.2 weeks) and 112 early preterms (Group II) (mean GA: 29.9±1.6 weeks) were evaluated. The ratio of retardation in height was 2.6 % and 6.3% in Group I and Group II, respectively. The rate of failure in achieving the target height was higher in Group II (3.9% vs 8%). Growth differences in terms of height and weight were not significantly different between the two groups (p>0.05). Severe intraventricular hemorrhage (IVH), hydrocephalus and invasive mechanical ventilation requirements negatively affected the growth in height and reaching the target height (p<0.05). Conclusion: The moderate-late and early preterm infants had similar growth features in terms of weight, height, and target height when evaluated at 42 months of age

Aim: This study aimed to evaluate the effects of maternal vitamin D deficiency on osteopenia of prematurity in very low birth weight premature infants. Methods:This study was conducted on 60 premature infants born before 32 weeks of gestation with a birth weight < 1,500 g.Infants whose mothers had a 25-hydroxycholecalciferol (25-OHD) level < 40 nmol/L were assigned to group 1 (n = 30), while those with a 25-OHD level ≥ 40 nmol/L were assigned to group 2 (n = 30).Serum calcium, phosphate, and alkaline phosphatase (ALP) levels were measured on the first postnatal day, and weekly during hospitalization.Tubular phosphate reabsorption (TRP), femoral radiographs, and serum urea, creatinine, calcium, phosphate, and ALP were evaluated after 40 weeks of gestation.Two values of ALP > 800 IU/L, at least 1 week apart, was considered diagnostic of osteopenia.Results: Osteopenia of prematurity was detected in five patients (16.7%) in group 1, and two patients (6.7%) in group 2. No statistically significant differences were found between the two groups, except for lower phosphate levels in group 1 (p = 0.04).Conclusions: Macro-mineral deficiencies could play a key role in the development of osteopenia of prematurity.Maternal vitamin D deficiencies can have a negative impact on bone metabolism and phosphate levels in infants.

Amaç: Bu çalışmada, 1000 gram ve altında doğan ve 3-5 yaşına gelmiş çocukların, Dünya Sağlık Örgütü Çocuk ve Ergenlerde Uluslararası İşlevsellik Sınıflaması (ICF-CY) sisteminde belirlenen alanlarda sorunla karşılaşma oranları araştırılarak ve hizmet ihtiyaçlarının belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Elli sekiz çocuğa okul öncesi dönemde fizik muayene ve ayrıntılı nörolojik inceleme yapıldı. Bu çocuklar perinatal ve sosyodemografik özellikler yönünden irdelenerek tüm çocuklara Vineland Uyum ve Davranış Ölçeği uygulanmıştır. Sonuçlar ICF-CY modeline uyarlanmıştır. Bulgular: Olgularımızın iletişim işlevselliğinde %20,6’sının, günlük yaşam becerilerine katılımında %12,1’inin, sosyalleşme işlevselliğinde %19’unun, hareket işlevselliğinde ise %29,3’ünün ciddi düzeyde sorun yaşadıkları saptanmıştır. Sadece 3 olguda ciddi düzeyde yaşla uyumlu olmayan davranış sorunu tanımlanmıştır. Hareket işlevselliğinin; öz bakım işlevselliğini, ev yaşamı etkinliklerine katılımı, sosyalleşme işlevselliğini, oyun ve boş zaman etkinliklerine katılımı, öğrenme ve problem çözme işlevselliğini anlamlı olarak etkilediği belirlenmiştir. Olgularımızın %22,4’ünün (13 olgu) yüksek seviyede özel eğitim desteğine ihtiyacı olduğu belirlenmiştir. Tartışma: Günümüzde yaşama şansları oldukça yüksek olan aşırı düşük doğum ağırlıklı prematürelerin işlevsellik, etkinlik, yaşama katılım ve hizmet ihtiyaçlarının saptanabilmesi için uzun dönem izlemleri çok önemlidir ve mutlaka ergenlik dönemine kadar devam ettirilmelidir.

Gereç ve Yöntemler: Bu retrospektif çalışma Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi Yenidoğan Yoğun Bakım Ünitesi (YDYBÜ) Düzey I-III’te bir yılda (1 Ocak 2010-31 Aralık 2010) yatırılan yenidoğanları kapsamaktadır. Risk faktörlerinin belirlenebilmesi için sepsis tanısı alan yenidoğanların özellikleri sepsis olmayanlar ile karşılaştırıldı. 2010 yılında sepsise neden olan etkenlerin dağılımı ve antibiyotik dirençleri önceki yıllar ile karşılaştırıldı.

Objective: Continuous surveillance is important to be informed on local epidemiology and cover organisms likely to cause sepsis in empirical therapy. We aimed to determine the characteristics of neonates with sepsis and etiological organisms in a single center. Material and Methods: This retrospective study included neonates admitted at level I-III units (NICU) in Kanuni Sultan Suleyman Training and Research Hospital during a one-year period (January 1st, 2010 to December 31st, 2010). The characteristics of neonates diagnosed as sepsis were compared to those without sepsis in order to determine risk factors. The distribution and resistance pattern of pathogens causing sepsis during 2010 were identified and compared with those of the previous years. Results: Among the 4703 patients treated in our NICU, 292 (6.2%) were diagnosed as culture proven sepsis [96 early- onset sepsis (EOS), 196 late-onset sepsis (LOS)]. Mean birth weight was 2304 +/- 1066.9 g (640-5250 g) and mean gestational age was 36 +/- 4.2 weeks (24-40 weeks). Preterm babies were infected four times more frequently than babies born at term [OR, 3.96 (95% CI, 3.10-5.06, p=0.001)]. Presence of central venous catheter, ventilation support, total parenteral nutrition, and prolonged hospitalization were other risk factors for sepsis development. Mortality from EOS was higher than that from LOS (19.8% vs. 4.1%, p=0.001). Coagulase negative staphylococci (CoNS) were the most commonly isolated pathogens in blood cultures of term neonates. Gram-negative bacilli [Klebsiella pneumoniae (18.4%), other GNB (27%)] were more common in preterm babies than term neonates. Resistance to penicillin and ampicillin were high in gram-positive bacteria. Ampicillin, gentamicin, cefotaxime, and carbapenem resistances in GNB were 63%, 36%, 33%, and 7.5%, respectively. Conclusion: Prematurity is a major risk factor for sepsis. During the years of 1997, 2005, 2007, and 2010, CoNS remained the most frequent pathogen. The relative proportion of gram-negative bacilli is substantial in preterm babies. Carbapenem resistance in GNB is worth consideration.

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

Objectives: The present studyaimed at evaluating factors affecting scar formation and tuberculin skin test (TST) response in Bacillus Calmette-Guerin (BCG) vaccinated infants.Methods: In the current study, 216 infants with gestational age (GA) of 26 to 40 weeks and birth weight of 730 g to 4590 g were included. The mean corrected age was 6.27 +/- 3.79 weeks, and the mean weight was 4442.4 +/- 1084.1 g (range 2100 - 7700 g) at the time of BCG vaccination. TST was applied at 8 to 16 weeks of vaccination. Factors affecting TST response and BCG scar formation were evaluated.Results: A scar response to BCG vaccination was found in 60%, 49.4%, and 59.7% of the infants with GA < 32 weeks, 33 to 36 weeks, and >= 37 weeks, respectively. Of the male infants 65% produced a scar compared to the 45% of the female infants (P = 0.014). The mean weight at the time of vaccination was significantly higher in infants with scar development than in those without scars (6976.94 g vs. 6455.68, P = 0.002). A tuberculin reaction was detected in 57% of the infants (80%, 54%, and 50% according to birth weight > 2500 g, 1500 - 2500 g, and < 1500 g, respectively) (P = 0.213). TST response rate was 67%, 55%, and 47% according to GA >= 37 w, 33 - 36 w, and <= 32 w, respectively (P = 0,020). In the present study, 68.4% of the cases with TST of 5 - 10 mm, and 100% of the cases with TST > 10 mmdeveloped scars >= 2mm(r = 0.360; P = 0.001).Conclusions: Prematurity or birth weight does not affect BCG scar formation. TST response is lower in preterm babies. The correlation between scar formation and TST response was too low to be interpreted as positive.

AIM The objective of this study was to examine perinatal and neonatal properties of preterm infants with a corrected age of 24-36 months who were born as a result of spontaneous and in vitro fertilization multiple pregnancies, to interrogate somatic growth properties of these infants and evaluate the factors which had an impact by comparing groups. MATERIAL AND METHODS A total of 125 children with a birth weight below 2 500 g and a gestational age below the 37(th) gestational week 60 of whom were born as a result of in vitro fertilization multiple pregnancies and 65 of whom were born as a result of spontaneous multiple pregnancies were included in the study. Maternal age and morbidity, early rupture of membranes, birth weigth, gestational week, gender, APGAR score, hospitalization reasons in the neonatal period, requirement for intensive care, frequency of congenital anomaly, outpatient follow-up status, rehospitalization and socioeconomic levels were interrogated in the patients. Detailed physical examination and current height, weight and head circumference measurements were performed and the findings were placed in the growth curves of Neyzi et al. Ethics committee approval was received for this study from the ethics committee of Bakırköy Gynecology Obstetrics and Pediatrics Education and Research Hospital (12.10.2010; no:305). RESULTS The rate of cesarean section, mean maternal age, the rate of chronic disease in the mother and the rate of maternal disease which occured during pregnancy were significantly higher in the in vitro fertilization group (p<0.05). While no difference was found in mean gestational age, birth weight, rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization, APGAR score in the 5(th) minute was significantly higher in the in vitro fertilization group. The socioeconomical score was not different between the groups, but the in vitro fertilization group presented more regularly for outpatient follow-up visits. Height, head circumference measurements and mean current weight were found to be significantly higher in the in vitro fertilization group (p<0.05). CONCLUSION The fact that there was no difference in the rate of hospitalization, time of hospitalization, frequency of follow-up in the intensive care unit, rates of congenital anomaly and rehospitalization was attributed to the fact that the study and control groups were composed of only multiple pregnancies and preterms.

Acute rheumatic fever (ARF) is an inflammatory collagenous tissue disease which shows its cardinal signs in joints, heart, skin and nervous system while affecting whole connective tissue system more or less. This study was conducted in order to investigate the clinical pattern and severity of ARF, echocardiographic findings and the course of the patients with heart valve involvement by studying the clinical and laboratory aspects of the patients diagnosed with ARF according to updated Jones criteria. The study included 214 patients diagnosed with ARF for the first time between January 2005 and May 2008. All patients were scanned with doppler echocardiography (ECHO) between certain intervals. Severity of carditis was grouped into 3 groups of mild, moderate and severe. The frequency of carditis was 57.9%, arthritis was 73.4%, chorea was 11.7% and erythema marginatum was 0.9% but no subcutaneous nodules. Recovery was observed in 22% of the cases of isolated aortic insufficiency (AI), 50% of the cases with isolated mitral insufficiency (MI) and 80% of the cases with mitral and aortic insufficiencies together (MI+AI). Recovery in isolated MI was significantly much more than recovery in isolated AI. However, recovery in AI was significantly much more than in MI in cases of mitral and aortic insufficiencies together. In conclusion, ARF is a cause of acquired and preventable heart disease and it can be reversed through right diagnosis and appropriate treatment. Isolated mitral insufficiency, isolated aortic insufficiency and both mitral and aortic insufficiency are observed during a valvular disease. Remission among valvular diseases are most commonly in those with mitral insufficiency and remissions in both mitral and aortic insufficiency occur most commonly in aortic ones. Regular prophylaxis is the key element for long term prevention of patients with ARF .

Cardiac rhabdomyoma often shows spontaneous regression and usually requires only close follow-up. However, patients with symptomatic inoperable rhabdomyomas may be candidates for everolimus treatment. Our patient had multiple inoperable cardiac rhabdomyomas causing serious left ventricle outflow-tract obstruction that showed a dramatic reduction in the size after everolimus therapy, a mammalian target of rapamycin (mTOR) inhibitor. After discontinuation of therapy, an increase in the diameter of masses occurred and everolimus was restarted. After 6 months of treatment, rhabdomyomas decreased in size and therapy was stopped. In conclusion, everolimus could be a possible novel therapy for neonates with clinically significant rhabdomyomas.

AIM:This study aimed to investigate the perinatal mortality rate with 37 864 deliveries which occured in two different periods in a single center, to compare the components of perinatal mortality and affecting factors with the results of the study related with perinatal mortality which we conducted in 1999 and to emphasize the precautions directed to reduce mortality rates.MATERIAL AND METHODS:All live births and stillbirths which occurred in Bakırköy Obstetrics and Pediatrics Training and Research Hospital between January 2007 and December 2007 were evaluated. The results were compared with the results of the study conducted in 1999. Newborns with a weight above five hundred grams and a gestational age above 22 weeks were enrolled in the study. The stillbirth rate, early neonatal mortality rate, late neonatal mortality rate, perinatal mortality rate and corrected perinatal mortality rate were calculated. Modified Wigglesworth Classification was used for evaluating the perinatal mortality and the subjects were examined in 7 groups. The characteristics belonging to the years of 2007 and 1999 were examined, the differences were recorded and the results were discussed. When the two periods were compared, it was observed that the perinatal mortality rate increased from 23.5‰ to 26‰.RESULT:When the causes were investigated, it was observed that the stillbirth rate was increased in 2007 (84%) and especially congenital anomalies had an important role in this increment. The early neonatal mortality rate declined from 0.8% in 1999 to 0.4% in 2007. It was found that especially the premature mortality rate (Group 3) and the mortality rate related with perinatal asphyxia (Group 4) were significantly decreased.CONCLUSION:The decrease in early neonatal mortality rate could be best explained by productive operation of the new neonatal intensive care unit which had been established after 2002.