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. Study Design 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 neonatal intensive care unit admission a near-infrared spectroscopy (NIRS) probe was placed on the forehead and each infant was started to be 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 saturation, rcSO2, cerebral fractional tissue oxygen extraction (cFTOE), and blood pressures were recorded. Results A total of 46 infants were analyzed. Surfactant was instilled with conventional ETT in 23 and ETT with side port in 23 infants. Birth weights (1,037 ± 238 vs. 1,152 ± 277 g) and gestational ages (28 ± 2.3 vs. 29 ± 1.6 weeks) 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 and should be confirmed with further studies. Key Points

Infants who undergo cardiac surgery frequently have complications that may advance to multiple organ failure and result in mortality. This study aims to compare three different multiple organ dysfunction scoring systems: the Neonatal Multiple Organ Dysfunction (NEOMOD) score, the modified NEOMOD score, and the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in predicting postoperative 30-day mortality in neonates undergoing cardiac surgery. This retrospective cohort study was conducted between January 2019 and February 2021 in a single unit on neonates operated on due to congenital heart disease in the first 28 days of life. Patients who underwent off-pump surgeries were excluded from the study. The NEOMOD, modified NEOMOD, and PELOD-2 scores were calculated for each of the first 3 days following surgery. A total of 138 patients were included. All scores had satisfactory goodness-of-fit and at least good discriminative ability on each day. The modified NEOMOD score consistently demonstrated the best prediction among these three scores after the first day, reaching its peak performance on day 2 (area under curve: 0.824, CI: 0.75–0.89). Our findings suggest that NEOMOD and modified NEOMOD scores in the first 72 h could potentially serve as a predictor of mortality in this population.

Amaç: Yenidoğan yoğun bakım ünitesinde izlenen çok düşük doğum ağırlıklı bebeklerde idrar yolu enfeksiyonu riski artmaktadır. Çalışmamızda, yenidoğan yoğun bakım ünitesinde takip edildiği dönemde idrar yolu enfeksiyonu tanısı alan preterm bebeklerin risk faktörlerini, klinik bulgularını, eşlik eden üriner anomali varlığını, en sık izole edilen patojeni vurgulamayı amaçladık. Gereçler ve Yöntem: Ocak 2016 ve Aralık 2017 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde izlenen ve idrar yolu enfeksiyonu (İYE) tanısı alan 27 hasta retrospektif olarak incelendi. Bulgular: Çalışmaya alınan hastaların %52’si kız (n:14) , %48’i erkek idi (n:13). Ortalama gestasyon haftası 34 hafta; doğum ağırlığı ise 2330 gramdı. Hastaların tanı anındaki en sık semptomları sırasıyla beslenme intoleransı, ateş ve apne idi (sırasıyla, %41, %33, %22). İdrar örnekleri 26 hastada üretral kateterle, 1 hastada suprapubik aspirasyon ile alındı. Hastalarda ortalama postnatal 35. günde idrar yolu enfeksiyonu gelişti. En sık izole edilen etken patojen Klebsiella pneumonia (n:17, %63) iken; sıklık sırasına göre Escherichia coli, Enterobacter aerogenes, Entrerokok feacalis, Serratia fonticola diğer izole edilen mikroorganizmalar oldu. Eş zamanlı bakılan kan kültüründe üreme saptanmayan 21 (%78) hasta, izole İYE tanısı aldı. 2 hasta BOS kültüründe Klebsiella pneumonia üremesi olması nedeni ile menenjit tanısı aldı. Postnatal dönemde yapılan ultrasonografik değerlendirmede 2 hastada üriner patoloji saptandı. İzlemde hiçbir hastanın üriner enfeksiyonu tekrarlamadı. Sonuç: Yenidoğan yoğun bakım ünitesinde izlenen preterm bebeklerde idrar yolu enfeksiyonu sık görülmektedir. Klinik semptom varlığında veya geç neonatal sepsis tanısı düşünüldüğünde idrar kültürü geciktirilmeden alınmalıdır

Objectives This study aimed to compare the effects of volume guarantee (VG) combined with assist/control (AC) ventilation to AC alone on hypocarbia episodes and extubation success in infants born at or near term. Methods In this prospective cohort study, infants >34 weeks of gestation at birth, who were born in our hospital supported by synchronized, time-cycled, pressure limited, assist/control ventilation (AC) or assist-controlled VG mechanical ventilation (AC + VG) were included. After admission, infants received either AC or VG + AC using by Leoni Plus ventilator. The ventilation mode was left to the clinician. In the AC group, peak airway pressure was set clinically. In the VG + AC group, desired tidal volume was set at 5 mL/kg, with the ventilator adjusting peak inspiratory pressure to deliver this volume. The study was completed once the patient extubated. Results There were 35 patients in each group. Incidence of hypocarbia was lower in the VG + AC compared with AC (%17.1 and 22.8%, respectively) but statistically not significant. Out-of-range partial pressure of carbon dioxide (PCO2) levels were lower in the VG + AC group and it reached borderline statistical significance (p = 0.06). The median extubation time was 70 (42–110) hours in the VG + AC group, 89.5 (48.5–115.5) hours in the AC group, and it did not differ between groups (p = 0.47). Conclusion We found combining AC and VG ventilation compared with AC ventilation alone yielded similar hypocarbia episodes and extubation time for infants of >34 gestational weeks with borderline significance lower out-of-range PCO2 incidence. Key Points