Gülsüm Kadıoğlu Şimşek

Background: This retrospective study investigated blood product transfusions and neonatal morbidity and mortality in preterm infants with birth weights <1500 g and gestational ages <32 weeks. Study design and methods: We conducted a retrospective cohort study of 291 preterm infants admitted to our neonatal intensive care unit between January 2020 and December 2022. Data were collected on transfusion exposure, including packed red blood cells (RBC), fresh frozen plasma (FFP), and platelets. Clinical outcomes included mortality and major neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Univariate analyses were performed, followed by multivariable logistic regression to adjust for confounding factors including birth weight and gestational age. Results: 80% of infants received RBC transfusion, 37.8% received FFP, and 16.1% received platelets. Transfused infants had lower gestational ages and birth weights. RBC, FFP, and platelet transfusions were associated with higher rates of BPD, IVH, NEC, and mortality in univariate analyses. In multivariable analysis, birth weight alone predicted mortality, suggesting extreme prematurity and illness severity were primary drivers. RBC transfusion independently predicted NEC and BPD, while FFP and platelet transfusions were linked to BPD. Total transfusions correlated with higher BPD, NEC, and mortality rates. Early transfusions were linked to impaired survival. Discussion: These findings suggest transfusions may not be independently associated with mortality, but may instead reflect underlying illness severity. However, they remain associated with serious morbidities in extremely preterm infants. The results emphasize the importance of judicious transfusion practices, evidence‐based thresholds, and research to clarify potential causal relationships.

Background: Red cell distribution width (RDW) and the RDW-to-platelet ratio (RPR) have emerged as readily available hematologic markers reflecting systemic inflammation in neonates with hypoxic–ischemic encephalopathy (HIE); however, their early postnatal trajectories across the clinical spectrum of HIE remain insufficiently characterized. Methods: This retrospective cohort study included 229 term or near-term infants diagnosed with HIE. Among them, 166 infants received therapeutic hypothermia, whereas 63 infants who did not undergo cooling served as the reference group. RDW and RPR values were measured at birth and at 72 h of life (after completion of cooling in the hypothermia group). Results: In the reference group, RDW values significantly decreased at 72 h, reflecting normal postnatal hematologic adaptation. In contrast, the hypothermia group demonstrated a blunted decline, with RDW levels remaining relatively stable over the first 72 h, consistent with a blunted early postnatal RDW decline. RPR values showed a mild, non-significant upward trend during the first 72 h of life; however, exploratory analyses suggested an association between higher RPR levels and increasing HIE severity. Conclusions: Across the spectrum of hypoxic–ischemic encephalopathy, RDW demonstrated a blunted postnatal decline, whereas RPR showed a mild, non-significant increase during the early neonatal period. These readily available hematologic markers may provide complementary insights into early systemic inflammatory and hematologic responses in HIE. Prospective multicenter studies are needed to determine their prognostic value and relationship with clinical and neurodevelopmental outcomes.

Aim: We aimed to investigate the effect of “Baby Friendly NICU” practice on exclusive breastfeeding rates following discharge in very preterm infants. Background: The Baby-Friendly Hospital Initiative (BFHI) is a global program launched by the World Health Organization (WHO) and UNICEF. Methods: The feeding technique, type of nutrition (breastfeeding, formula, mixed) and anthropometric measurements of the very preterm infants (≤32 gestational weeks) were recorded for every month following discharge up to corrected 6 months of age. Exclusive breastfeeding rates were compared between 2 periods before “Baby Friendly NICU” practice (group 1) and after (group 2). Results: Data of 252 infants, 135 in group 1 and 117 in group 2 were analyzed. Exclusive formula feeding rates decreased by 6 months age in group 2 (46 vs. 32%, P = .02); however, exclusively breastfeeding rates did not changed significantly (20% vs. 29%, P = .14). Conclusion: Baby friendly NICU practices significantly decreased formula feeding rates at 6 months; however, it did not have an effect on exclusive breastfeeding rates at any time point during follow-up probably due to small sample size.

Objective: Therapeutic hypothermia is the standard neuroprotective treatment for neonates with hypoxic-ischemic encephalopathy (HIE). However, neurodevelopmental outcomes may still vary depending on the severity of encephalopathy. This study aimed to evaluate two-year neurodevelopmental outcomes in infants with HIE treated with therapeutic hypothermia and compare outcomes between Stage 2 and Stage 3 cases classified according to the Sarnat & Sarnat staging system. Material and Methods: We conducted a retrospective cross-sectional study including 138 infants born at ≥35 weeks of gestation who were diagnosed with HIE and received therapeutic hypothermia in a Level III NICU between January 2016 and December 2017. Neurodevelopment was assessed at 24 months using the Bayley Scales of Infant and Toddler Development-II (BSID-II), focusing on Mental Development Index (MDI) and Psychomotor Development Index (PDI) scores. Results: Infants in the Stage 3 group required significantly more respiratory support, had a higher frequency of aEEG abnormalities, and more often received anticonvulsant therapy (p=0.020, p<0.001 and p<0.001, respectively). The Stage 3 group had significantly lower mean MDI and PDI scores (84±10 and 71±11, respectively) than the Stage 2 group (89±17 and 94±18; p=0.049 and p=0.001). Neurodevelopmental impairment was more prevalent in Stage 3 patients (36.5% vs. 17.3%, p=0.012). Conclusion: Despite uniform application of therapeutic hypothermia, neurodevelopmental outcomes at 24 months differ significantly by HIE severity. These findings highlight the importance of timely intervention, individualized follow-up, and the need for additional strategies in managing severe HIE cases.

Objectives: This study aims to identify risk factors and clinical markers for refractory patent ductus arteriosus to the initial medical treatment and determine appropriate treatment strategies. The goal is to define the newborns who will respond to treatment and to prevent patients from adverse effects of medical or surgical treatment of patent ductus arteriosus. Methods: Preterm infants with hemodynamically significant patent ductus arteriosus and whose gestational age was under 30 weeks were retrospectively evaluated. Infants who responded to the initial medical treatment (paracetamol or ibuprofen) were compared to those non-responders. Neonatal characteristics and comorbidities were compared between the groups. Results: Data from a total of 91 infants were analyzed. The mean gestational age was 27±1.9 weeks vs. 26±1.9 weeks (P=0.10), and birth weight was 1,056±290 vs. 974±318 g (P=0.61), respectively in responder and refractory groups. Success rates for patients treated with paracetamol (n=49) were 57.4%, while for those treated with ibuprofen (n=42), it was 42.6% (P=0.47). Echocardiographic findings such as ductal size 2.48±0.69 vs. 2.55±0.66 mm (P=0.75), and left atrium/aortic root ratio 1.73±0.4 vs. 1.64±0.25, (P=0.14) were also comparable. Incidence of severe intraventricular hemorrhage (22.7% vs 4.3%, P=0.009) and periventricular leukomalacia was significantly higher in the refractory group (53.1% vs. 22.2%, P=0.008). Conclusions: Combining multiple risk factors into a clinical decision-making model or algorithm could enhance the predictive accuracy of treatment response. Moreover, ongoing monitoring and tailored treatment adjustments based on individual responses and side effects are crucial for effectively managing patent ductus arteriosus in preterm infants.

Objective: To evaluate the incidence of thin catheter surfactant administration (TCA) failure and compare short and long‐term neonatal outcomes who failed TCA or did not.Design: Single‐center retrospective cohort study. Infants between 25 and 30 weeks of gestational age with respiratory distress syndrome and receiving 200 mg/kg poractant alfa via thin catheter administration were included. TCA failure was defined as the need for early mechanical ventilation (< 72 h). Infants were divided into two groups those who failed TCA or those who did not.Results: The TCA failure rate was 24.6%. Initial oxygen requirement (0.39% vs. 0.36%) and the number of small for gestational age infants were significantly higher in the TCA failure group (15% vs. 7.9%). Infants who failed TCA had a higher pneumothorax (6.7% vs. 1.1%, p = 0.03), BPD (15% vs.5.5%, p = 0.02), late‐onset sepsis (36.7% vs. 18%, p = 0.04), retinopathy of prematurity rates (11.7% vs. 3.3%, p = 0.02) and an increased duration of respiratory support. However, Bayley Scales of Infant Development II scores were comparable between groups at 18 and 26 months of corrected age.Conclusion: Infants who fail TCA are at increased risk for short‐term complications despite favourable long‐term neurodevelopmental outcomes. Identifying infants at risk of TCA failure may help early prevention of morbidities and individualise their management.

Objective This study aimed to assess the performance of the relatively new hematological marker delta neutrophil index (DNI) and other inflammatory markers in proven sepsis of the very preterm infant. Methods Infants with a gestational age of 0.05). The proven sepsis group had higher DNI (median 7.1% [range: 0.1–74] vs. 0.6% [range: 0.1–24.7%], p < 0.01], C-reactive protein (CRP; median 5 [range: 1–38] mg/L vs. 1 [range: 1–15] mg/L, p < 0.001), interleukin-6 (median 620 [range: 6.9–5,500] pg/mL vs. 42.2 [range: 2.2–5500] pg/mL, p < 0.01), and procalcitonin (median 6.2 [range: 0.26–86] µg/L vs. 0.6 [range: 0.06–25.7] µg/L, p = 0.002). According to receiver operating characteristic curve analysis, interleukin-6 had the highest area under the curve (AUC) at 0.74 (95% CI: 0.60–0.88, p < 0.01). The AUC values were 0.73 (95% CI: 0.59–0.88, p = 0.01) for procalcitonin, 0.62 (95% CI: 0.44–0.80, p = 0.18) for DNI, and 0.66 (95% CI: 0.50–0.82, p = 0.05) for CRP. Conclusion The DNI showed a statistically significant elevation in infants with proven sepsis; however, its diagnostic performance was lower than that of interleukin-6, CRP, and procalcitonin. Although the results are encouraging in determining the utility of DNI in predicting LOS in preterm infants, further research is needed to validate its predictive value, specifically in this population.

Objective: There is an ongoing debate about the best and comfortable way to administer surfactant. We hypothesized that uninterrupted respiratory support and continuous PEEP implementation while instilling surfactant via endotracheal tube (ETT) with side port will result in higher regional cerebral tissue oxygenation (rcSO2) and the alterations in cerebral hemodynamics will be minimal. Methods: Preterm infants who required intubation in the delivery room and/or in the first 24 hours of life with gestational age <32 were enrolled. Patients were intubated either via conventional ETT or ETT with side port (Vygon®) with appropriate sizes. Following NICU admission a NIRS probe placed on the forehead and each infant were monitored with NIRS.In conventional ETT group, patients separated from the ventilator while surfactant was instilled. In ETT with side port group respiratory support was not interrupted during instillation. Heart rate, oxygen saturations, rcSO2, cerebral fractional tissue oxygen extraction (cFTOE) and blood pressures were recorded. Results: A total of 46 infants analyzed. Surfactant was instilled with conventional ETT in 23 and ETT with side port in 23 infants. Birthweights (1037±238 vs 1152±277g) and gestational ages (28±2.3 vs 29±1.6weeks) did not differ between groups. During instillation of surfactant, rcSO2 levels [61.5 (49-90) vs 70 (48-85)] and cFTOE levels 0.28 (0.10-0.44) vs 0.23 (0.03-0.44)] were similar (p=0.58 and 0.82 respectively). Conclusion: Interruption of respiratory support during surfactant instillation did not significantly alter the cerebral tissue oxygenation. These results did not support our hypothesis possibly due to small sample size and should be confirmed with further studies.

Purpose: Cardiovascular dysfunction is common in hypoxic-ischemic encephalopathy (HIE), which is one of the leading causes of multi-organ failure in neonates. We aimed to assess troponin I and creatine kinase myocardial band (CK-MB) levels, inotropic score (IS) in HIE patients, and their associations with HIE staging and mortality. Method: The medical records of all HIE infants admitted to our unit between 2016 and 2018 were retrospectively analyzed. Demographic characteristics of the infants, seizures, anticonvulsive therapies, maximum inotrope doses, and the derived IS (dopamine dose [µg/kg/min] + dobutamine dose [µg/kg/min] + 100 × epinephrine dose [µg/kg/min]) and CK-MB and troponin-I levels obtained in the first six hours of life were compared according to HIE staging. Comparisons between survivors and non-survivors were made. Results: The study included data from 195 patients. Twenty-five patients were classified as stage 3, 116 as stage 2, and 54 as stage 1 HIE. Median Troponin-I, CK-MB level, and IS significantly differed by HIE staging (p < 0.01). The deceased infants had significantly higher median troponin I level [0.36 (0.02-3) vs. 0.16 (0.01–1.1) ng/ml; p = 0.006], median IS [20 (5-120) vs. 5 (5–10); p < 0.001], however, CK-MB values were comparable with survivors [129 (51–300) vs. 60.7 (31–300) ng/ml; p = 0.57]. The area under the curve was 0.93 for IS and 0.81 for Troponin I to predict mortality. Conclusion: Troponin I, CK-MB, and IS could be successfully used as disease severity markers in HIE furthermore, troponin I and IS, are good predictors of mortality. These results need to be confirmed with larger prospective multi-center studies.