Özgül Salihoğlu

Objective: Feeding difficulties are common in neonates with cleft palate with or without cleft lip (CP/L) and may delay breastfeeding initiation. This study aimed to evaluate feeding outcomes and practical bedside feeding strategies in neonates with CP/L managed in a tertiary hospital. Methods: This retrospective case series included neonates with CP/L hospitalized in a tertiary neonatal intensive care unit (NICU) between January 2020 and April 2026. Demographic characteristics, cleft type, associated anomalies, respiratory support requirements, feeding methods, time to first breastfeeding, time to full enteral feeding, hospitalization duration, discharge weight, and feeding outcomes at discharge were reviewed. Results: Twelve neonates with CP/L were included. Complete cleft palate was the most common anomaly (n = 7, 58%). One infant with trisomy 18 died before enteral feeding was established and was excluded from discharge feeding analyses. Among the remaining 11 infants, the median time to first breastfeeding was 2 days (range, 2–25 days), the median time to full enteral feeding was 6 days (range, 2–39 days), and the median length of hospitalization was 10 days (range, 7–65 days). Feeding tolerance was satisfactory in 10 of 11 surviving infants. At discharge, 9 infants were receiving breastfeeding either exclusively or with bottle feeding. Delayed transition to oral feeding was mainly observed in syndromic infants and those requiring respiratory support. Conclusion: In this cohort, many nonsyndromic neonates with CP/L achieved successful oral feeding with simple bedside feeding strategies and breastfeeding support. Within the limitations of this case series, routine reliance on specialized feeding devices was not necessary to achieve oral feeding in most nonsyndromic infants.

Term macrosomic newborns (≥ 4000 g) born between 37 and 42 weeks of gestation face greater risks of early neonatal morbidity and mortality than term infants with appropriate birth weights. Our study aimed to evaluate these outcomes specifically in term macrosomic newborns. From January 2022 to June 2023, we included singleton live-born infants with a birth weight ≥ 2500 g who were delivered at 37-42 weeks of gestation. The study group consisted of newborns with a birth weight ≥ 4000 g, while the control group was comprised of newborns with a birth weight of 2500-3999 g. Clinical and demographic data were prospectively collected from patient records and stored in an electronic database. Our study revealed a macrosomia frequency of 4.09% (43/1052). We identified a statistically significant positive correlation between maternal prepregnancy weight and neonatal birth weight (p < 0.05). Systolic and diastolic blood pressures were notably higher in the study group during the initial 15 min after birth (p < 0.05). Blood glucose levels decreased significantly in the study group during the first hour after birth (p < 0.01). History of lack of prenatal follow-up (66.6%) and cephalopelvic disproportion were significantly more prevalent in the macrosomic group (p < 0.05). No significant disparities concerning other morbidities were observed between the groups (p > 0.05). No mortality was documented in our study. We found that maternal prepregnancy weight demonstrated a statistically significant positive correlation with neonatal birth weight. Additionally, we noted a decrease in blood sugar levels during the first hour of life as birth weight increased, with significantly lower levels in the macrosomic group than in the control group. Furthermore, noninvasive arterial systolic/diastolic blood pressures measured within the first 15 min after birth in the delivery room were significantly higher in the macrosomic group than in the control group.

This study evaluated clinical, laboratory, and ultrasonographic factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. This retrospective cohort study included 96 neonates hospitalized for unexplained hyperbilirubinemia requiring phototherapy. UTI was defined by pyuria (>5 WBC/high-power field) and growth of a single uropathogen (≥50,000 CFU/mL) from catheterized urine samples. Neonates were classified as UTI-positive (n = 30) or UTI-negative (n = 66). Demographic characteristics, bilirubin levels, inflammatory markers, and renal ultrasonography findings were compared. UTI was diagnosed in 31.2% of neonates. Bilirubin levels, white blood cell counts, and C- reactive protein concentrations did not differ between groups. Pathological renal ultrasonography findings were significantly more frequent in the UTI group and were independently associated with UTI (odds ratio 4.62; 95% CI 1.39-15.40). Renal ultrasonography findings are strongly associated with UTI in hospitalized neonates with unexplained hyperbilirubinemia and may serve as a useful adjunctive evaluation tool in this high-risk population.

Neonatal cerebral venous sinus thrombosis is a rare but severe condition. We report a preterm neonate presenting with apnea who subsequently developed focal neurological deficits. While conventional anterior fontanelle ultrasonography was unremarkable, point‐of‐care mastoid fontanelle ultrasonography demonstrated markedly reduced venous flow in the right transverse sinus, raising suspicion of thrombosis. The diagnosis was confirmed by magnetic resonance imaging with venography. Serial bedside mastoid fontanelle ultrasonography enabled noninvasive monitoring of thrombus regression during anticoagulant therapy, with findings concordant with MRI/MRV. This case highlights the diagnostic and follow‐up value of point‐of‐care mastoid fontanelle ultrasonography as a complementary bedside tool in neonatal CVST.

Objective Therapeutic hypothermia (TH) reduces mortality in neonatal hypoxic-ischemic encephalopathy (HIE), yet nearly half of treated infants suffer adverse outcomes. This study aimed to define the “Hypothermia Resistance” phenotype by characterizing the 4-day trajectories of multi-organ dysfunction and identifying the physiological signals associated with severe MRI injury. Study design This retrospective cohort study included 24 term neonates with moderate-to-severe HIE treated with whole-body hypothermia. Patients were stratified into “Responder” (n = 18) and “Resistant” (n = 6) phenotypes based on systemic recovery patterns. Serial biomarkers (Lactate, Creatinine, AST, Platelets) were analyzed daily from Day 1 to Day 4. The primary outcome was brain injury severity on MRI assessed by the Weeke score. Results Admission characteristics and Day 1 biomarkers were comparable between groups. However, trajectories diverged significantly by Day 3 (72 h). The Resistant phenotype was characterized by a failure to clear systemic dysfunction, manifesting as persistent renal impairment (Median Creatinine: 1.39 vs 0.65 mg/dL; p < 0.01) and worsening thrombocytopenia (Median Platelets: 114 vs 190 × 10³/µL; p < 0.05) at 72 h. This “Day 3 Cliff” profile (Creatinine >1.0 mg/dL combined with Platelets <120 × 10³/µL) was strongly associated with severe MRI injury (diffusion restriction in basal ganglia/thalamus). Conclusion Physiological recovery during cooling is a dynamic process. Persistent multi-organ dysfunction on Day 3 constitutes a “Hypothermia Resistance” profile that serves as a robust surrogate marker for ineffective neuroprotection, distinct from early severity markers.

Objective: This study aims to establish the incidence of non-thyroidal illness syndrome (NTIS) in newborns and investigate its potential impact on neonatal outcomes. Additionally, by identifying the risk factors associated with the development of NTIS, this study aims to deepen the understanding of the condition. Materials and Methods: A total of 337 patients in the neonatal intensive care unit were studied retrospectively. Data on demographic and clinical characteristics, including gestational age, birth weight, head circumference, height, Apgar score, SNAPPE score, presence of congenital anomalies, mode of delivery, respiratory support, and duration of hospitalization, were collected. All patients underwent measurement of TSH and free T4 levels. Results: The study found that 4.5% of patients were diagnosed with NTIS. Patients with NTIS had higher rates of preterm delivery. NTIS patients exhibited lower gestational age, birth weight, head circumference, height, and Apgar scores than non-NTIS patients. NTIS patients had significantly more extended hospital stays, but no differences in mechanical ventilation duration or SNAPPE scores were obtained. Conclusions: This study indicates that thyroid dysfunction can occur in critically ill newborns, highlighting the necessity of evaluating thyroid function in this demographic.

Aim: To assess the effect of postnatal weight gain characteristics and multiple risk factors on treatment-required retinopathy of prematurity. Methods: The medical records of preterm infants who were followed up for retinopathy of prematurity in a tertiary referral center were retrospectively reviewed. Infants were grouped as Treatment(-) (retinal maturation without treatment) and Treatment(+) (treatment required). Retinopathy of prematurity findings, weight gain and weight gain rates at the 4th and 6th weeks, and clinical features were noted. The best cut-off points for the weight gain and weight gain rate were assessed with the area under the receiver operating characteristic curve. Risk factors were determined by the logistic regression model. Results: Twenty-eight of 201 preterm infants (13.5%) were in the treatment (+) group. Birth weight, gestational age, weight gain, and weight gain rate at the 4th and 6th weeks were lower, the duration of oxygen therapy and hospitalization was longer, and a history of bronchopulmonary dysplasia, necrotizing enterocolitis, prolonged mechanical ventilation, and erythrocyte transfusion was more common in the treatment (+) group (p

Objective: Eight newborns diagnosed with prenatal substance abuse were evaluated for the clinical course of neonatal abstinence syndrome depending on the type of substances used by their mothers during pregnancy. Material and Methods: A retrospective study of neonates with prenatal substance abuse admitted to our tertiary care university hospital’s Neonatal Intensive Care Unit (NICU) was conducted between February 2022 and March 2023. Demographic data, withdrawal symptoms, need for pharmacological treatment, and duration of hospitalization were collected. Newborns exposed to substances were divided into two groups: opioid and non-opioid (methamphetamine, Bonsai, marijuana). Results: Eight infants were included in the study. Four cases (50%) were in the group exposed to opioids. Pregnant users of opioids were older (28±6.73) than non-opioid substance users (21±4.83). The mean birth weight of newborns exposed to opioids (2541 g) was lower than that of the non-opioid group (3020 g). The average length of hospital stay was longer in the opioid group (34 days) compared to the non-opioid group (10 days). All newborns exposed to substances were born preterm (<37 gestational weeks). Withdrawal symptoms were observed in all cases in the opioid group and three cases in the non-opioid group to varying degrees. Medical treatment was required in three out of the seven cases with withdrawal symptoms. All patients requiring treatment were in the opioid group. All infants were discharged in good health. Conclusion: Substance exposure during the prenatal period is a significant cause of preterm birth in neonates. Many of these substances can cause varying degrees of withdrawal syndrome in newborns. Replacement therapies used during pregnancy containing heroin and naloxone can lead to a more severe, prolonged, and treatment-requiring neonatal withdrawal syndrome than other substances. In cases where morphine and methadone are unavailable, the symptoms of withdrawal syndrome can be managed with phenobarbital. It is crucial to monitor all newborns with prenatal exposure to substances early because it allows for appropriate intervention and treatment.

Using pain scales helps nurses in making early diagnoses and in assessing and managing pain symptoms and findings when developing a nursing care plan. To determine the validity and reliability of the Turkish form of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). Prospective study conducted in Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. 145 newborns in the 26th to 42nd gestational weeks that were receiving treatment and care in the neonatal intensive care unit were included in this study. A total of 1740 pain assessments were made by two independent observers on these 145 newborns. The research data was collected using a newborn description form, NIAPAS and the Neonatal Infant Pain Scale (NIPS). The scope validity index of NIAPAS was found to be between 0.90 and 1.00 and its Cronbach's alpha coefficient was 0.914. Correlations between characteristics and total scores (r = 0.20-0.82) were found to be sufficiently high. In an assessment on concurrency validity, there was a strong positive relationship between NIAPAS and NIPS scores (r = 0.73-0.82; P < 0.000). From kappa analysis (0.73-0.99) and intraclass correlation (r = 0.75-0.96), it was determined that there was concordance between the observers. NIAPAS was found to be a valid and reliable scale for evaluating acute pain in newborns.