Objective This study aimed to determine the accuracy of neonatal lung ultrasound (LUS) in predicting the need for surfactant therapy compared with chest X-ray (CXR) in preterm infants. Study Design A prospective double-blind study was conducted in infants with a gestational age <34 weeks with respiratory distress syndrome (RDS) by evaluation with LUS and CXR on admission. Results Among 45 preterm infants, the median (interquartile range [IQR]) LUS score was 4 (2–8) in the mild RDS group, whereas it was 10 (IQR: 9–12) in the severe RDS group (p < 0.01). The LUS score showed a significant correlation with the need for total surfactant doses (ρ = 0.855; 95% confidence interval [CI]: 0.801–0.902; p < 0.001). A cut-off LUS score of four predicted the need for surfactant with 96% sensitivity and 100% specificity (area under the curve [AUC]: 1.00; 95% CI: 0.97–1.00; p < 0.01). LUS scores predicted continuous positive airway pressure (CPAP) failure accurately (AUC: 0.804; 95% CI: 0.673–0.935; p = 0.001). A significant correlation was observed between LUS scores and positive end-expiratory pressure levels (ρ = 0.782; p < 0.001). During the study period, the CXR number per infant with RDS decreased significantly when compared with preceding months (p < 0.001). The LUS score in the first day of life did not predict the development of bronchopulmonary dysplasia (AUC: 0.274; 95% CI: 0.053–0.495; p = 0.065). Conclusion The LUS score in preterm infants accurately predicts the severity of RDS, the need for surfactant and CPAP failure. The routine use of LUS can decrease the frequency of CXRs in the neonatal intensive care units. Key Points

Objective: This study examined systemic inflammatory indices and “Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) scores” in neonates with hypoxic–ischemic encephalopathy (HIE). Methods: A total of 43 neonates with moderate-to-severe HIE at 36 weeks’ gestation were assessed. Systemic inflammatory markers were measured before HT commenced within 0–6 h after birth and between 60 and 72 h during and after therapy or before adjusting for hypothermia. Results: Platelet counts, hemoglobin levels, and platelet indices in the HIE group were significantly lower at both time points (p = 0.001). Both the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) decreased in the HIE group after hypothermia therapy (p = 0.001). Seizures, PVL, and kidney injuries were associated with higher HALP scores. The AUCs of NLR, PLR, MLR, SII, SIRI, and platelet, neutrophil, monocyte, and lymphocyte Index (PIV) showed significant sensitivity and specified HIE, with area under the curve (AUC) values of 0.654, 0.751, 0.766, 0.700, 0.722, and 0.749, respectively. Conclusions: A significant difference in systemic inflammatory markers was found between the HIE and control groups after hypothermia treatment, with significant reductions in the MLR and NLR. These markers, particularly MLR, were significant predictors of adverse clinical outcomes including seizures, PVL, and kidney damage.

Background: To evaluate carboxyhemoglobin (COHb) levels in diagnosing late-onset sepsis (LOS) in preterm neonates. Methods: The records of culture-positive LOS in preterm neonates hospitalized in NICU from January 2017 to July 2022 were reviewed.COHb levels, C-reactive protein, procalcitonin, and neutrophil to lymphocyte ratio of septic preterm infants were compared to controls. Serial COHb levels measured within six hours before or 24h after blood culture sampling, three to seven days prior, and three to five days after starting antimicrobial therapy were retrieved from patient records. Results: The study included 77 blood-culture-positive preterm infants and 77 non-septic controls. During the LOS episode, the COHb values were found to be significantly increased (median: 1.8, IQR: 1.4-2.5) when compared to the control group (median: 1.2, IQR: 0.8-1.6) (p < 0.001). ROC analysis yielded an AUC of 0.714 for COHb (95% CI: 0.631-0.796, p1.5%, the test’s sensitivity was 64.94%, the specificity was 72.73%, the positive predictive value was 70.42%, and the negative predictive value was 67.47%.LOS led to a dramatic rise followed by a decrease after the initiation of the antimicrobial therapy [1.8 (1.4-2.5) ] vs. [1.45 (0.2-4)] p<0.001. Conclusion: COHb levels increased at the beginning of LOS, decreasing in response to antibiotics. When used in conjunction with other sepsis biomarkers, the variation of COHb can be important in evaluating a LOS episode in preterm infants. COHb can be utilized as a quick, bedside approach for detecting LOS in preterm neonates in NICUs.

Objective: To assess if systemic immune-inflammatory index (SII) has a diagnostic role for late-onset sepsis (LOS) in premature neonates. Patients and Methods: A single-center retrospective observational study including preterm infants with culture-proven LOS and controls was conducted between January 2017 and December 2022. SII was derived using complete blood count values acquired at the beginning of and three to five days before LOS. SII was compared between the LOS group and controls. Results: A total of 144 infants were included in the study. The SII values of the LOS group were found to be significantly increased in comparison to the control group [376.74 (11.11 – 15170) vs. 235.24 (46.83 – 1214.38) (median, min-max), P =0.018]. The SII values significantly increased when pre-sepsis and LOS values were compared [200.6 (0 – 1295.78) vs. 328.28 (0 – 14678, P

Objective: Multiple pregnancies are associated with an increased risk of adverse maternal and neonatal outcomes, especially those associated with prematurity. The purpose of this study was to assess the mortality and short-term morbidity of infants born from multiple pregnancies and hospitalized in neonatal intensive care units. Methods: The medical records of women who gave birth to multiple neonates over four-year period and their children were retrospectively analyzed. The study examined neonatal outcomes, specifically mortality, and short-term morbidity, during hospitalization. Results: The study included 220 neonates from 126 multiple pregnancies (three triplets and 123 twins). The preterm birth rate was 97%. Presentation anomalies, cesarean section rates, assisted reproductive techniques (ART), congenital anomalies, and antenatal corticosteroid administration were statistically higher in multiple births compared to singleton births. In multiple pregnancies, the rates of spontaneous, in-vitro fertilization, and intrauterine insemination were 73%, 21.5%, and 5.5%, respectively. There were 78.5% dichorionic diamniotic pregnancies, 14.5% monochorionic diamniotic pregnancies, 4.7% monochorionic monoamniotic pregnancies, and 2.3% trichorionic triamniotic pregnancies detected. Monochorionic pregnancies were associated with lower birth weight and longer duration of total parenteral nutrition (1808±548 vs. 1994±524g, p=0.02, and 12.6±9.9 vs. 8.3±7.1days, p=0.005, respectively). Significantly higher rates of monochorionic placentation, higher maternal age, and maternal disease frequency were observed in ART multiple pregnancies (p=0.001, p=0.01 and p=0.02, respectively. Birth order had no significant effect on perinatal outcomes. Male infants were discharged more frequently with the diagnosis of small for gestational age (32.5% vs. 14.5%, p=0.003). Fourteen infants were lost, including four in utero, six due to extreme prematurity, one due to Trisomy 18, three due to sepsis and necrotizing enterocolitis in the neonatal period. Conclusion: Multiple pregnancy and associated complications, especially prematurity and low birth weight, are increasing. Both antenatal and postnatal approaches need to be improved and specialized to improve neonatal outcomes.