BackgroundThe emergence of infections related to multidrug-resistant Gram-negative bacilli (MDR-GNB) reintroduced the use of colistin, an antibiotic that was previously abandoned due to adverse effects. However, because of its limited use in neonatal intensive care units, there is very little data about the effectiveness and safety of colistin in children and newborns. In this study, which will be the largest case study in the literature, we aimed to evaluate the effectiveness and safety of colistin in full-term and preterm newborns.Material/MethodsThe study included patients admitted into 2 level 3 neonatal intensive care units between January 2013 and June 2015. The medical records of patients diagnosed with sepsis, meningitis, pneumonia, and urinary tract infection based on the diagnostic culture results and treated with colistin were analyzed retrospectively. The patients whose infections were not verified were excluded from the study.ResultsThe study included 65 patients (18 term, 47 preterm). The most frequently isolated pathogens were Klebsiella pneumoniae and Acinetobacter baumannii followed by Pseudomonas aeruginosa and Enterobacter cloacae. Mean colistin treatment time was 15±3.5 days. All patients treated with colistin were being treated with at least 1 other antibiotic. While a complete clinical response was achieved in 51 (72.3%) patients, 14 (21.5%) patients died during treatment. Four (7.7%) patients died during as a result of another infection. Three patients developed renal toxicity, another 3 patients had seizures, and apnea was observed in 3 patients.ConclusionsColistin was found to be effective and safe for treatment of MDR-GNB infections in preterms and infants with very low birth weight. Given the severity of the infection, the adverse effects of colistin were at acceptable levels.

ObjectiveTo investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey.Material and methodsA prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived.ResultsData from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers.ConclusionThe present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

This study compares NT proBNP and troponin T levels in umbilical cord arterial blood and postnatal echocardiographic findings for infants of gestational and pregestational diabetic mothers and macrosomic infants. Twenty-seven infants of pregestational diabetic mothers, 61 infants of gestational diabetic mothers and 37 macrosomic infants of nondiabetic mothers were prospectively enrolled in this study along with a control group of 58 healthy infants of mothers without any pregestational or gestational disorders as the control group. All enrollees were born after 34 weeks of gestation. For this study, umbilical cord blood was drawn during delivery to determine NT proBNP and troponin T levels. Echocardiography was performed 24-72 h after the delivery. Umbilical cord troponin T and NT proBNP levels were found to be higher in the diabetic and macrosomic groups than in the control group (all of them p < 0.001). NT proBNP levels were positively correlated with interventricular septum thickness in the pregestational and gestational infants of diabetic mothers groups (r = 0.564 and r = 0.560, respectively, p < 0.01). Both pregestational and gestational diabetic mothers were divided into two groups according to HbA1c levels in the third trimester as good (<6.1 %) and suboptimal (>6.1 %) metabolic control. In the good and suboptimal metabolic control diabetic groups, NT proBNP levels were also positively correlated with interventricular septum thickness (r = 0.536 and r = 0.576, respectively, p < 0.01). In the suboptimal metabolic control diabetic group, NT proBNP was only found to be positively correlated with the left ventricular mass index (r = 0.586, p < 0.01). While there was no correlation in the myocardial performance index between infants of diabetic mothers and the control group, the myocardial performance index of macrosomic infants was lower than that of the control group (p = 0.017). Cardiac biomarkers (NT proBNP and troponin T) were elevated in infants of diabetic mothers and macrosomic infants. While there was a positive correlation between NT proBNP levels and cardiac structure in infants of pregestational and gestational diabetic mothers, there was no relationship between NT proBNP levels and cardiac function.

SNAP-PE-II was a significant predictor of mortality in newborns with birthweight <1500 g compared with CRIB, and assessment of antenatal corticosteroid use in conjunction with SNAP-PE-II increased the accuracy of the prediction of mortality.

The aim of this study was to evaluate the influence of Bifidobacterium lactis and Hindiba inulin on feeding intolerance and weight gain in premature babies. Material and Methods: Eighty nine premature babies with the diagnosis of feeding intolerance were enrolled in the study. Study group had Bifidobacterium lactis (5x109 CFU) + Hindiba inulin (900 mg) (Maflor) per oral, while control group did not have any medication for feeding intolerance. Results: B. lactis ve H. inulin was continued for a mean of 10 days. Time of full enteral feeding and time of starting oral feeding were longer in study group and this was statistically significant. Although lower birth weight, longer total parenteral nutrition duration, later starting of oral feeding and longer duration for start of full enteral feeding in the study group, there was no statistical difference in weights of the babies at discharge time when compared with the control group. When the groups were compared according to weight gain, study group gained more weight and it was statistically significant. Although necrotizing enterocolitis was not significantly different between groups, babies in the study group diagnosed as in Stage 1 and did not worsen. 33.3% of the babies in the control group progressed to Stage 2. Conclusion: Probiotics and prebiotics might have positive effects due to higher weight gain especially >1500 g birth weight infants and not advancing necrotizing enterocolitis in the study group having B. Lactis and H. inulin. Amaç: Bu çalışmanın amacı prematüre bebeklerde beslenme intoleransı ve ağırlık artışı üzerine Bifidobakteryum laktis ve Hindiba inülini'nin etkisinin değerlendirilmesidir. Gereç ve Yöntem: Beslenme intoleransı tanısıyla izlenmekte olan 89 prematüre bebek bu çalışmaya alınmıştır. Çalışma grubundaki olgulara Bifidobakteriyum laktis (5x109 CFU) + Hindiba inülini (900 mg) (Maflor şase) oral yolla verilirken, kontrol grubundaki olgulara beslenme intolransı için herhangi bir tedavi verilmedi. Bulgular: Çalışma grubundaki olgulara B. Laktis ve Hindiba inülinine ortalama 10 gün devam edilmişti. Oral beslemeye başlama ve tam enteral beslenmeye geçiş zamanları çalışma grubunda daha uzundu ve istatistiksel açıdan anlamlı idi. Çalışma grubundaki olgularda daha düşük doğum tartısı, daha fazla sayıda yaşa göre düşük ağırlıklı olgu sayısı, daha uzun süre total parental nutrisyon almaları, oral beslenmeye daha geç başlama ve tam enteral beslenme geçiş zamanının daha uzun olmasına rağmen taburculuktaki kiloları karşılaştırıldığında kontrol grubu ile aralarında istatistiksel açıdan anlamlı fark yoktu. Gruplar kilo artışı yönünden karşılaştırıldığında çalışma grubundaki bebeklerin daha fazla kilo aldığı gözlendi ve bu sonuç istatistiksel açıdan anlamlı idi. Çalışmamızda nekrotizan enterokolit açısından gruplar arasında istatistiksel açıdan anlamlı fark yoktu. Ancak çalışma grubundaki olgular evre 1'de kalırken, kontrol grubundaki olguların %33.3'nün evre 2' ye ilerlediği gözlendi. Sonuç: Beslenme intoleransı olan prematüre bebeklerde B. laktis ve Hind...