This study aims at evaluating the influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in prematurity. All preterm babies were divided into two groups, including Group 1 with "open PDA" and Group 2 with "closed PDA". The variables of platelet count, mean platelet volume, platelet mass index, and platelet function were analyzed and compared between two groups of patients to identify the factors that significantly influenced spontaneous closure of ductus arteriosus. Twenty-four patients were in the "open PDA" group, whereas 36 patients were in the "closed PDA" group. Mean GA and BW were 27.6 ± 1.8 (23.1-30.4) and 28 ± 1.6 (23.4-30.6) weeks and 1009 ± 270 (585-1480) g and 1035 ± 298 (505-1500) g in "open PDA" and "closed PDA" groups, respectively (p > 0.05). The incidence of "Collagen-ADP > 130 s" was significantly higher in the "open PDA" group, and the levels of hemoglobin and hematocrit were significantly lower in the "open PDA" group (p < 0.05). Multivariate logistic regression analysis showed that respiratory distress syndrome (OR: 9, CI: 1.5-51.8) and collagen-ADP > 130 s (OR: 5.7 CI: 1.55-21.3) are two independent factors associated with ductal patency. This is the first study in the English literature providing evidence of the influence of platelet dysfunction on the spontaneous closure of ductus arteriosus in prematurity. Longer collagen-ADP duration is identified as a risk factor of ductal closure.

Decision making to transfer a late preterm or term neonate with the diagnosis of transient tachypnea of the newborn (TTN) to an intensive care unit for respiratory support is a challenge for caregivers in level one and two NICUs. The aim of this study was to identify "practical bedside clinical clues" that may help to predict the severity of disease and need for respiratory support in patients with the diagnosis of TTN. Newborns having the diagnosis of TTN were classified into two groups according to the intensity of the respiratory support. Infants receiving only supplemental oxygen and infants requiring nasal continuous positive airway pressure or mechanical ventilation constituted group 1 (mild) and group 2 (severe), respectively. Demographic, clinical and laboratory characteristics were compared between the two groups. Patients in group 2 had lower gestational age, higher Silverman and Richardson scores, longer mean duration of oxygen support and hospitalization. A positive correlation was found between subcostal and xiphoid retractions, asynchrony in chest-abdomen movements, arterial pH < 7.30, ratio of PaO 2 / % inspired O 2 < 1.2 and need of respiratory support (p < 0.05). We suggest that simple scores can help physicians to get a good sense of a given baby's likelihood of deterioration.

Introduction: Health care-associated infection (HCAI) is a serious problem of neonatal intensive care units (NICUs) which is related to morbidity, mortality and increased cost of medical care. This study aimed to determine the incidence of HCAI in a tertiary NICU and identify the risk factors. Methodology: This prospective cohort study was conducted between July 1, 2011 and June 30, 2012. All newborns admitted to the NICU except for those who died or were discharged within 48 hours after admission were included. The definitions of Centers for Disease Control and Prevention (CDC) were used to diagnose specific types of infections. The incidence, causative organisms, risk factors and mortality of HCAIs were evaluated. Results: Among 352 newborns, a total of 60 HCAI episodes were evaluated in 37 (10.5%) of the patients over 5,212 patient-days. The overall incidence of HCAI was 17%, and the rate was 11.5/1,000 patient-days. Blood stream infection (BSI) was the most common HCAI (n = 42, 70%). In a multivariable logistic regression analysis, the presence of a central venous catheter/umbilical catheter (CVC/UC), the presence of a urinary catheter, and gestational age (< 32 weeks of gestation) were identified as significant independent risk factors. Gram-negative pathogens were the most common isolates. The overall mortality rate was 4%. The HCAI-related mortality rate was 10.8%. Conclusions: Patient care quality can be improved with surveillance of HCAI. The incidence and rate of HCAI in our NICU were found to be higher than international reports with a direct impact on mortality of preterm infants.

Introduction: The most important purpose in neonatal pain management is to minimize the pain felt by newborns and to help the newborn cope with pain. This study planned to examine the effects of two non-pharmacological methods, using pacifiers or maternal holding, on neonates’ pain admitted to the outpatient clinic (OC) and hospitalized in the Neonatal Intensive Care Unit (NICU). Material and Methods: Ninety newborns (30 used pacifiers, 30 maternal holding,30 control) who applied to the OC and 60 newborns (30 used pacifiers, 30 control) admitted to the NICU were prospectively included in this study. The Neonatal Infant Pain Scale (NIPS) was used to evaluate behavioral responses to pain perception. Physiological parameters of newborns and their durations of crying were also evaluated. Results: When the NIPS scores were analyzed in OC group during and after the procedure, the lowest score was found in the group using pacifiers (p<0.001). As for the NICU patients, both during and after the procedure, NIPS scores were found to be significantly lower in the pacifier users (p<0.001). It was observed that giving pacifiers and mathernal holding had positive effects on physiological parameters and duration of crying in OC patients (p<0.05). No significant difference in the NIPS score was found between OC and NICU group. Conclusion: This study showed that giving pacifiers and maternal holding during the procedure of blood sampling decreased the NIPS score, restored the changes in physiological parameters and decreased the duration of crying.

Background: Passive smoking exposure is an important public health problem that causes pneumonia, bronchiolitis, bronchopneumonia, asthma formation and exacerbation, middle ear inflammation, tooth decay, growth retardation and development in children.Objectives: In this study, it was aimed to evaluate passive smokers objectively by cotinine level in urine.Method: Eighty children with at least one active smoker at home and 80 children who were not active smoker at home were admitted to the Ankara Education and Research Hospital . Parents were asked a questionnaire to the sociodemographic characteristics of their children and their families, the habits of smoking and the illnesses they had in a year. To assess passive smoking exposures, the first urine of children was collected and the level of cotinine, the main metabolite of nicotine in the urine, was measured using the solid phase competitive chemiluminescence immunoassay method on the Immulite 2000 Analyzer. A cut-off value of 10 ng / ml was obtained for diagnosis of passive smoking. Patients with cotinine levels above this value were assessed as "exposed to passive smoking".Results: In passive smoking exposures, the number of illnesses and wheezing has increased in the last year. The preterm birth and wheezing frequency of the smokers were significantly higher in the pregnant women (p <0, 05). Median cotinine level was found to be 10 ng / ml in the passive smoking group but median cotinine level was found to be 20,8 ng / ml in the cigarette group (p <0,01). The group with only mother smokers had significantly increased incidence of tooth decay compared with other groups (p <0.05). No relationship was found between birth weigth of infant and smoking behaviour during pregnancy (p=0,53), however the frequency of prematurity was found to be higher (p=0.03).The cotinine level of 68.7% of patients in the passive smoking group and 25% of the control group was above the threshold value of 10 ng / ml. The most sensitive and specific threshold level of cotinine was found as 14.75 ng/ml. Conclusions: Our study showed that 25% of children who do not smoke at home are exposed to passive smoking. This finding suggests that families are biased towards reporting smoking cessation alongside their sick children and those children are also exposed to cigarette smoke in out-of-home settings.