Esin Okman

To evaluate cerebral Doppler ultrasonography parameters for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in very premature infan

Background: Exposure to environmental pollutants, especially endocrine-disrupting chemicals, disproportionately affects vulnerable populations like pregnant women, lactating mothers, and preterm infants. This study aimed to assess the detection patterns of DiNP-, DEP-, and DEHP-related metabolites in maternal urine and breast milk, examine agreement between matrices, and explore maternal factors associated with phthalate exposure. Methods: Fifty-five mothers who delivered at ≤32 gestational weeks and whose infants were hospitalized in the Neonatal Intensive Care Unit (NICU) were enrolled. Breast milk and urine samples were analyzed using a validated isotope-dilution LC–MS/MS method. Urinary phthalate metabolite concentrations were adjusted for specific gravity. Linear mixed-effects models with a random intercept for mother were used to examine associations between urinary and breast milk phthalate metabolite concentrations, assess temporal changes, and evaluate the influence of breast milk lipid content. Results: DEHP and DiNP metabolites were detected in nearly all maternal urine samples. Breast milk contained predominantly primary metabolites (MEHP and MiNP), while secondary oxidative metabolites were rarely detected. Urine concentrations consistently exceeded breast milk concentrations. Urinary and breast milk phthalate concentrations were not correlated across sampling periods, indicating limited matrix concordance. Conclusions: Mothers of very preterm infants experience sustained phthalate exposure in the postpartum period; however, limited metabolite transfer to breast milk indicates that maternal urine remains the preferred biomonitoring matrix for assessing systemic phthalate exposure. Breast milk phthalate profiles exhibit compound-specific temporal changes and appear largely independent of concurrent urinary exposure biomarkers.

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.

Breastfeeding is universally recognized as the optimal method of infant feeding, as well as preventing various adverse conditions for the mother-baby dyad. Despite the established importance of breastfeeding, achieving breastfeeding success still remains a difficult challenge influenced by clinical, psychological, social, and systemic factors. This chapter explores the concept of breastfeeding success: (1) from initiation rates to exclusivity and duration; (2) maternal satisfaction, health, and infant conditions; (3) psychosocial influences such as family support and cultural attitudes; and (4) the critical role of health systems, policy frameworks, and community-based interventions in promoting breastfeeding continuity. Strategies to enhance breastfeeding outcomes and common barriers encountered by mothers are highlighted. A multidimensional, integrated approach is necessary to improve global breastfeeding success rates.

Aim: This prospective study aimed to assess the accuracy and agreement of two transcutaneous bilirubin (TcB) devices—BiliCare and MBJ20—compared with serum total bilirubin (STB) in neonates with jaundice. Methods: Eighty‐eight infants born at ≥ 34 weeks of gestation were included. TcB was measured from the auricle using BiliCare and from the sternum using MBJ20, concurrently with STB testing. Results: The median gestational age was 38 weeks and mean birth weight was 3108 g; 39% were delivered by cesarean section and 49% were male. Mean bilirubin levels were 14.6 mg/dL (MBJ20), 12.9 mg/dL (BiliCare), and 14.4 mg/dL (STB). Both devices showed strong correlation with STB (MBJ20: r = 0.756, BiliCare: r = 0.772; p < 0.001). Mean differences from STB were −0.12 mg/dL for MBJ20 and 1.54 mg/dL for BiliCare. BiliCare showed higher predictive accuracy (AUC = 0.814) than MBJ20 (AUC = 0.751). Optimal TcB cutoff values were 14.2 mg/dL (BiliCare) and 15.6 mg/dL (MBJ20). Regression analysis showed no significant bias for either device. Based on STB measurements, 15% of the infants required phototherapy (PT). Conclusion: Both devices provide reliable noninvasive screening though BiliCare has a better accuracy in predicting the need for PT.

Background/Objectives: Endocrine-disrupting chemicals (EDCs) are exogenous substances that interfere with hormone regulation, leading to adverse health outcomes. Despite the wide use of EDCs in daily products like plastics, personal care items, and food packaging, public awareness remains low. Pregnant women and new mothers are particularly vulnerable, as exposure to EDCs during early life stages can have long-term health impacts. This cross-sectional, questionnaire-based study aimed to assess the awareness of EDCs among pregnant women and new mothers at a maternity hospital. Methods: This cross-sectional study was conducted in a tertiary care hospital between January and August 2022. A questionnaire based on the Mutualités Libres/AIM 2020 survey was used to assess awareness of EDCs among pregnant and postpartum women. The original survey was adapted culturally and linguistically for the Turkish population through translation and expert review. The questionnaire included sections on sociodemographics, habits, knowledge, information sources, healthcare, readiness for change, expectations, and attitudes. Results: The results showed that 59.2% of participants were unfamiliar with EDCs, and many lacked awareness of the associated health risks, including cancers, infertility, and developmental disorders in children. A significant portion of respondents had never heard of bisphenol A (BPA) or phthalates, while awareness of parabens was relatively higher. Conclusions: The study concluded that increasing awareness of EDCs is essential for fostering informed avoidance behaviors, especially in vulnerable populations like pregnant women and new mothers. Public health campaigns and healthcare provider involvement are crucial for enhancing awareness and reducing the health risks associated with EDCs.

Background/aim: The prediction of adverse conditions in the preterm neonatal brain might be improved by cerebral monitoring using combined measures of cerebral function, including oxygenation and blood flow parameters. To perform the consecutive measurements of the resistive index (RI) from the anterior cerebral artery (ACA) within the first week of life and to evaluate the association of these measurements with cerebral oxygen saturation (Csat) detected by near-infrared spectroscopy (NIRS). Materials and methods: This prospective cohort study enrolled very preterm infants, <32 weeks of gestational age, admitted to a tertiary neonatal intensive care unit. Csat levels were continuously monitored using NIRS for 72 h after birth. ACA RI measurements were obtained on the first, third, and seventh days of life by using transcranial Doppler ultrasound. These measurements were also compared between infants with and without unfavorable outcomes, including severe intraventricular hemorrhage (IVH) and early mortality. Results: A total of 96 preterm infants with Csat and ACA RI measurements were analyzed. Age at birth was 28.3 ± 1.9 weeks and birth weight was 1090 ± 305 g. The mean Csat of the infants was 77.1% ± 8.2% during the first 72 h of life. Mean ACA RI values were 0.76 ± 0.10, 0.75 ± 0.08, and 0.77 ± 0.08 on the first, third, and seventh days of life, respectively. RI on the first day of life was significantly higher in infants delivered by cesarian section than in those delivered vaginally (0.77 vs. 0.69; p = 0.017). Infants who died earlier had significantly higher ACA RI values on the first day than infants who survived beyond the first 7 postnatal days (0.83 vs. 0.76; p < 0.001). Conclusions: There was no association between ACA RI and Csat in the early period of life. ACA RI values on the first postnatal day might be significant for predicting early mortality in very preterm infants.

Objective: Breast milk is the best nutrient for newborns due to its rich dietary content, immunological factors, ease of accessibility, and affordability. Given the fact that adolescent birth rate in Turkey is high, this study examines the effects of adolescent motherhood with regard to macronutrient contents in breast milk. Study Design: We collected colostrum samples from mothers staying at our hospital. Gestational ages were ≥37 weeks. Demographic characteristics of the patients were registered. The MIRIS (Mid-Infrared Human Milk Analyzer) device was operated to analyze breast milk, adopting a spectroscopy method for measurements. Protein, fat, carbohydrate, and energy levels of the hindmilk samples were measured; thus, study groups were compared. Results: The study included 224 mothers, of whom 49 were adolescents and 125 were adults. Maternal weight and maternal body mass index, weight gain during pregnancy, mode of delivery and gestational age, as well as birth weight and gender of the infants were similar. As breast milk contents were compared, we found out that fat content levels in the colostrum of adolescent mothers were significantly higher, with respect to the other group. Protein and carbohydrate levels were lower in adolescents, even if they were not statistically significant. There was no difference between the groups in terms of energy levels. Conclusion: Adolescent motherhood may have negative influences on infant welfare. However, in terms of breast milk content quality, adult mothers are not superior to adolescents.

Background: Preeclampsia remains among the leading causes of maternal and perinatal morbidity and mortality worldwide. This study aimed to evaluate the macronutrient content of colostrum in mothers with preeclampsia. Materials and Methods: Women who delivered by cesarean section at ≤37 weeks of gestation were included in the study. Fresh colostrum samples were collected by manual expression on postpartum days 2 and 4 and were analyzed using a mid-infrared human milk analyzer. Demographic characteristics of the patients were recorded. The protein, fat, carbohydrate, and energy composition of the milk samples were compared between mothers with and without preeclampsia. Results: A total of 58 colostrum samples (25 preeclampsia, 33 nonpreeclampsia) were analyzed. The median gestational age of the infants was similar in both groups (32 versus 33 weeks; p > 0.05). There were also no differences between the groups in terms of maternal age, maternal body mass index, maternal weight gain during pregnancy, and infant gender. Median protein, fat, and carbohydrate levels in the colostrum of the preeclamptic mothers were 2.2, 2.1, and 6.3 g/dL, respectively, compared with 1.8, 2.4, and 6.2 g/dL in the nonpreeclamptic mothers, respectively. Although the colostrum of preeclamptic mothers had higher protein content and lower fat content, the difference was not statistically significant. Carbohydrate and energy contents were similar in both groups. Conclusions: The presence of preeclampsia does not cause a significant change in the macronutrient composition of mother's milk. Analyses of micronutrients at different lactation stages in larger samples are needed.