Objective To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. Study design A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. Results At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). Conclusions In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. Trial registration ClinicalTrials.gov: NCT01958320.

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Differences in achievement of target saturation level were influenced by multiple factors (birth way, probe location, maternal smoking and umbilical blood gas pH) in the delivery room during resuscitation of preterm babies.

Purpose: To determine the demographic and clinical characteristics of newborn patients who underwent lacrimal probing surgical intervention with or without the marsupialization of intranasal cysts as the primary management for dacryocystocele treatment. Methods: Data from the medical charts of 350 infants who underwent lacrimal probing surgery due to nasolacrimal duct obstruction were reviewed retrospectively. Ten newborn patients with a naive diagnosis of congenital dacryocystocele were included in the study. Congenital dacryocystocele diagnosis was based on a triad of swelling in the inner canthal region, a bluish appearance, and epiphora. Lacrimal probing surgery accompanied by nasal endoscopy was planned for all patients as the first treatment option. Results: The mean age of the patients was 24.90 ± 7.15 days, with a range of 6–85 days. A total of 10 patients were included, comprising seven females and three males. The mean postoperative follow-up period was 38.7 ± 24.41 months. Five patients had left, four patients had right, and one patient had bilateral dacryocystocele. Seven eyes of the six patients had uncomplicated dacryocystocele, while the remaining patients had dacryocystocele with complications of dacryocystitis and/or preseptal cellulitis. All patients had intranasal cysts. All patients underwent one session of lacrimal probing surgery under general anesthesia; all with successful outcomes. Four patients with additional dacryocystocele-associated complications underwent combined intranasal marsupialization of the cyst wall. Discussion: Lacrimal probing surgery ± intranasal marsupialization of the cyst wall as a first treatment option can be effective for both congenital dacryocystocele and/or congenital dacryocystocele plus associated complications and provide complete resolution of dacryocystocele-related symptoms.

The aim of this study was to evaluate risk factors used for the assessment of neonatal hypoglycemia and to examine the follow-up outcomes observed in the first 48 hours of postnatal life. Methods: The records of infants born between 2015 and 2017 (3 years) at Şişli Hamidiye Etfal Training and Research Hospital who had a blood glucose level test performed within the first 24 hours after birth and who had follow-up results for 48 hours were included in the study. Data of gestational age; birth weight; gender; antenatal, natal and postnatal characteristics; blood glucose measurement method and time during the first 48 hours postpartum; glucose values and follow-up; nutritional status; and the need for hospitalization due to a low blood glucose value were recorded. Groups were created based on data of a diabetic mother, small for gestational age (SGA), large for gestational age (LGA), late preterm birth (34-36+6/7 gestational weeks), fetal distress, and feeding intolerance. Blood glucose measurement values and reasons for hypoglycemia and assessment were compared in subgroups. Results: The data of 9480 infants were reviewed and included in the study. It was determined that blood levels were checked in 28.7% (n=2720). The mean birth weight and gestational age of the infants was 3143±804 g and 37.7±2.5 weeks, respectively. In the study group, 54.7% were male, and 57.5% were delivered via cesarean section. The most frequent factors prompting blood glucose measurement were LGA status (25.9%), prematurity (18%), transient tachypnea (17.3%), and SGA status (11.6%). Results revealed that the blood glucose values of 2009 (73.9%) infants were within normal limits, and there was no further monitoring of blood glucose level during the first 48 hours. In 711 (26.1%), a low blood glucose level finding led to follow-up assessment. The incidence of hospitalization with a preliminary diagnosis of hypoglycemia was 2.5% (n=67). Subgroup analysis indicated that at the first hour, the mean blood glucose value of the patients with multiple factors that were risks for hypoglycemia suggesting further evaluation was lower than those with transient tachypnea and fetal distress (p<0.001), and the mean blood glucose value of premature and LGA neonates were significantly lower than the infants of diabetic mothers at the sixth hour (p<0.001). Conclusion: In the postnatal period, the rate of monitoring blood glucose levels in newborn babies was found to be 28.7% and the most commonly predicted risk factor was LGA babies. The frequency of postpartum hospitalization due to hypoglycemia was found to be 2.5%, and blood sugar levels were lower in the first hour in groups with multiple causes.

ÖZETPrematüre retinopatisi gelişim sıklığı ve etki eden risk faktörlerinin değerlendirilmesi Amaç: Çalışmamızda hastanemiz yenidoğan yoğun bakım ünitesinde yatan çok düşük doğum ağırlıklı bebeklerde prematüre retinopatisi (ROP) gelişim sıklığının belirlenmesi ve ROP gelişimi ile ilişkili etmenlerin araştırılması amaçlandı. Gereç ve Yöntem: Hastanemizde 1 Ocak 2007-31 Aralık 2011 tarihleri arasında izlenen ve doğum ağırlığı 1500 gram altında olan 246 bebek retrospektif olarak değerlendirildi. Prematüre retinopatisi gelişiminde etkili olan faktörler incelendi. Bulgular: Bu hastaların 55'inde (%22.4) ROP tanısı konuldu. Ortalama gebelik süresi; ROP tanısı alan bebeklerde 28.0±2.3 hafta olup gebelik haftası azaldıkça ROP gelişme riskinin anlamlı olarak arttığı görüldü (p: 0.011). Prematüre retinopatisi saptanan 55 bebeğin, 29'u (%52.7) Evre 1, 17'si (%30.9) Evre 2, 8'i (%14.6) Evre 3 ve 1'i (%1.8) Evre 5 ROP olarak izlendi. ROP gelişimi ile PDA, ileri evre NEK (evre 2-3), sepsis, BPD varlığı ve transfüze olma sıklığı arasında istatistiksel olarak anlamlı birliktelik saptandı (p değerleri sırasıyla; p=0.0001, p=0.004, p=0.003, p=0.0001 ve p=0.002). Mekanik ventilasyon, CPAP uygulaması, surfaktan uygulaması arasında ilişki saptanmadı. Annede hipertansiyon, diabet, preeklampsi, annenin sigara kullanımı, yaş ortalaması ve doğum şekli gibi faktörlerin ROP ile ilişkisi saptanmadı. Prematüre retinopatisi saptanan 55 olgunun 9'unda (%16.4) Evre≥3 ROP saptanarak lazer fotokoagülasyon tedavisi uygulandı ve bu olguların birinde (%1.8) kalıcı görme kaybı gelişti. Sonuç: Dünyada edinsel görme kaybının ikinci en sık nedeni olan ROP'un multifaktöriyel etmenlerle geliştiği ve sıklığı azaltmak için düşük doğum tartılı bebeklerin bu etkenler göz önüne alınarak irdelenmesi gerektiğini düşünüyoruz Anahtar kelimeler: Yenidoğan, retinopati, prematüre, lazer fotokoagulasyon ABSTRACT Evaluation of incidence and effective risk factors in development of retinopathy of prematurityObjective: The object of the study is to determine the frequency and associated factors in development of ROP at very low birth weight infants born in our hospital and hospitalized in neonatal intensive care unit. Material and Method: 246 babies born and followed up in our hospital between January 2007 and December 2011 and had birth weight < 1500 g were evaluated retrospectively. Effective factors on development of retinopaty of prematurity were evaluated. Results: Of these patients, 55 (22.4%) were diagnosed with ROP. The mean gestational age in babies diagnosed as ROP was 28.3±2.3 weeks and we found that with decreasing gestational age risk of development of ROP increased (p: 0.011). Of 55 patients with diagnosis of ROP; 29 (%52.7) were followed up with stage 1, 17 (%30.9) were at stage 2, 8 (%14.6) were at stage 3 and 1 patient was (%1.8) at stage 5. We detected statistically significant correlation between development of ROP and PDA, advanced stage of NEC (stage 2-3), sepsis, presence of BPD (p values respectively; p=0.0001, p=0.004, p=0.003, p=0.0001 and p=0.002...