Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation.

Cow`s milk protein allergy (CMPA) is the most common cause of allergy occurring in the first year of life due to infant formula or breast-milk of mothers who are drinking cow`s milk or eating cow's milk products. Most children with allergic colitis are symptomatic in the first months, usually by 4 weeks. There are rare cases whom were sensitized prenatally and demonstrated symptoms in the first week, even in the first 2 days of life. The most common clinical sign of CMPA is bloody stool in a well-appearing infant. Gross bloody stool or fecal occult blood are also the common signs of necrotizing enterocolitis (NEC), especially in preterm infants with systemic instability. The treatment options are totally different so the clinician has to be very careful evaluating the patient. We report 5 preterm cases of CMPA, two of whom were siblings. Two of them presented with massive bloody stools and 3 of them presented with abdominal distension and fecal occult blood all of which were initially considered as NEC. Literature review of 20 cases with similar history is summarized as well.

Objective We aimed to investigate whether cord blood bilirubin (CBB) level could be used to identify the newborns at a high risk of developing hyperbilirubinemia. Study Design Total and direct serum bilirubin level were evaluated from umbilical cord blood of newborns. We checked blood groups and Rh status of all mothers and determined blood groups and direct Coombs test (DC) of newborns born to mothers whose blood group was O type or Rh negative to determine the maternal–fetal blood group or Rh incompatibility. Results A total of 418 newborns were included, and phototherapy (PT) was required in 17 newborns. The cutoff value of CBB for predicting the occurrence of significant hyperbilirubinemia requiring PT was 1.67 mg/dL, with a sensitivity of 82% and specificity of 99%. The mean CBB level in babies receiving PT was 2.4 ± 0.9 mg/dL. When blood group, CBB level, DC, gender, and mode of delivery were assigned as possible risk factors, multıvariate analysis showed ABO, Rh incompatibility, and CBB level increased the risk of PT requirement. Conclusion CBB could be useful to determine newborns at a risk of developing hyperbilirubinemia and prevent developing severe complications due to delay in diagnosis.

Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants. Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10 minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination. Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p = 0.000), respiratory rate (p = 0.000), diastolic blood pressure (p = 0.001) and oxygen saturation (p = 0.000) during the examination were significantly different than the values before and 10 minutes after the examination. Infants whose gestational age ≤32 weeks (n:20) have significantly higher NIPS scores (mean ± SEM = 3.3 ± 0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean ± SEM = 2.4 ± 0.2). Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.

Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as “delayed transition”, others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN. Neonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN. Forty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature. PI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.