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.

Highest risk for hypoglycemia in early postnatal period was present especially in LPI group. Our compliance levels with the AAP guideline was found to be satisfactory.

Objective: It was aimed to define the main risk factors that affect mortality in infants with critical congenital heart disease (CHD). Material and Methods: We analyzed data from 105 infants with critical CHD underwent cardiovascular intervention at a tertiary neonatal intensive care unit (NICU) between September 2010 and January 2012. Demographic data, clinical findings (before and after intervention), type of intervention, and intervention risk score according to Risk Adjustment in Congenital Heart Surgery (RACHS-1) classification were evaluated. Results: The mean age at cardiovascular intervention was 15.2±11.8 days. Transcatheter interventions were performed in 29 patients (27.6%). Seventy-six patients (72.4%) underwent cardiovascular surgery. At post-interventional period, the rates of low cardiac output, pneumonia, and sepsis were significantly higher among patients underwent surgical intervention. Length of NICU stay was also longer among them. Overall mortality rate was 35.2% (n=37). Mortality was significantly lower in infants underwent transcatheter intervention. Univariate analyses showed that nonsurvivors differed from survivors in terms of gestational age, prematurity, the presence of associated disorder, pre-interventional need of mechanical ventilation, need of inotropic support, the presence of pulmonary hypertension and sepsis, requirement of cardiovascular surgery, age at intervention, and RACHS-1 score. Multivariate analysis showed that higher RACHS-1 score was associated with mortality (OR: 4.5, 95% CI (1.5-13.1), p=0.005) while higher gestational age was a preventive factor (OR: 0.6, 95% CI (0.5-0.9), p=0.01). Conclusion: Our study indicates that lower gestational age and severity of the disease seem to be most possible risk factors for mortality among infants with critical CHD.

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) (þ). 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 Z 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p Z 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p Z 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.

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