Objective: Hemodynamically significant PDA (hsPDA) is one of the most common problems in preterm infants. This study was conducted to investigate the effect of combined pharmacological (paracetamol + ibuprofen) therapy on monotherapy-resistant hsPDA in infants. Subject and methods: The study included infants with persistent hsPDA, unresponsive to monotherapy. Combined treatment (paracetamol + ibuprofen) was started as paracetamol at a dose of 15 mg/kg every 6 hours for 5 days, and ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours. Echocardiographic evaluation was performed at 2 days after the end of treatment. If hsPDA persisted after the combined treatment, a surgical PDA ligation was considered. Results: A total of 12 infants were enrolled and 9 infants (75%) with monotherapy-resistant PDA were successfully treated with combined therapy. In three patients, no response was obtained to the combined treatment so surgical ligation was applied. Conclusions: Combined therapy may be a useful treatment option for monotherapy-resistant hsPDA in preterm infants. Before surgical ligations, this combined therapy option should be considered.

Background: Neonatal acute respiratory distress syndrome (NARDS) is an important cause of hypoxemic respiratory failure. This study aimed to investigate the short-term effects of endotracheal surfactant and budesonide combination therapy on NARDS secondary to late-onset neonatal sepsis (LONS). Methods: This was a retrospective, cross-sectional, and observational study. Newborns with NARDS due to LONS who received endotracheal surfactant and budesonide combination therapy between August 2022 and September 2023 were included in this study. Oxygenation status before endotracheal surfactant and budesonide treatment were compared with the values obtained two hours after treatment. Results: Among 20 neonates, 10 (50%) were diagnosed with severe NARDS, and 10 (50%) were diagnosed with moderate NARDS. The mean corrected gestational age was 33.3±2.9 w when endotracheal surfactant and budesonide were administered to the neonates. The need for the fraction of inspired oxygen (0.75 [0.57-1.00]% vs. 0.55 [0.44-0.80]%; mean difference [MD]: 17.50%, 95% confidence interval [CI]: 14.99 to 22.50) and oxygen saturation index (OSI; 8.03 [4.98-13.94] vs. 4.71 [4.11-8.93]; MD: 2.23, 95% CI: 1.22 to 3.24) decreased (P=0.001 and P<0.001, respectively) after endotracheal surfactant and budesonide treatment. However, preductal oxygen saturation (SpO2 ; 93 [91-94]% vs. 95 [94-96]%; MD: -3.50%, 95% CI: -5.00 to -2.00) increased significantly after endotracheal surfactant and budesonide treatment when compared to pre-treatment values (P<0.001). Conclusion: The reduction in oxygen demand and OSI, along with an increase in SpO2 after treatment compared to pre-treatment values, suggests that endotracheal surfactant and budesonide combination therapy could be an effective option to improve oxygenation in NARDS secondary to LONS.

Pulmonary hemorrhage is an important cause of morbidity and mortality in premature infants. There are few studies on pulmonary hemorrhage and associated morbidities observed in premature. The aim o...

Objective: To determine the factors associated with the procalcitonin levels in newborns with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia (TH). Materials and Methods: The neonates, who had moderate/severe HIE and were treated with TH, were included. The neonates were arranged into 2 groups by procalcitonin (PCT) level after rewarming was completed. The neonates who had a procalcitonin level of < 2.5 ng/ml constituted Group 1 and the ones who had a procalcitonin level of ≥ 2.5 ng/ml constituted Group 2. Univariate and multivariate logistic regression was used to assess the factors related with PCT level. Results: The first group included 123 (87.9%) neonates and the second group included 17 (12.1%) neonates. The median gestational age was 38 (36-39) weeks and the mean birth weight was 3081.7 ± 552.8 grams. In group 2, the rates for severe HIE, cesarean section, antibiotic switch, convulsion, inotrope use and mortality were higher, and duration of hospitalization was longer, whereas Apgar scores were lower (P < .05). The risk of a high procalcitonin level was found to be 6-fold (95% CI 1.9-19.1) higher in severe HIE and 5.2-fold higher (95% CI 1.7-16) in cesarean delivery. Conclusion: In neonates with HIE/TH, high post-rewarming procalcitonin levels were related with severe HIE and cesarean delivery. Some other clinical and laboratory findings, which may reflect worse clinical status, were also associated with high procalcitonin levels. Cite this article as: Okbay Güneş A, Bozkaya A, Avlanmis ME. Factors associated with post-rewarming procalcitonin levels in newborns with hypoxic ischemic encephalopathy. Turk Arch Pediatr. 2024;59(4):404-409.

Objective: To evaluate the diagnostic and prognostic utility of the hemoglobin–albumin–lymphocyte–platelet (HALP) score and several systemic inflammatory indices derived from routine blood parameters—including the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), pan-immune inflammation value (PIV), and systemic inflammatory response index (SIRI)—for pathogen differentiation and clinical assessment in culture-proven late-onset neonatal sepsis (LOS). Methods: A retrospective analysis was conducted on a cohort of 150 neonates with culture-proven LOS. Systemic inflammatory indices were calculated at baseline (first week of life) and at the time of septic insult. The discriminative power of these indices was assessed via ROC curve analysis, with optimal cut-off points determined by the Youden Index. Risk stratification was performed using Odds Ratio (OR) modeling with 95% Confidence Intervals (CIs) to evaluate the predictive strength of each marker according to its respective threshold. Results: Diagnosis-phase assessments identified SII as the premier discriminator for microbiological etiology (AUC = 0.869; OR = 44.57), outperforming PLR and PIV. Although HALP demonstrated moderate efficacy in distinguishing pathogens, it lacked prognostic value regarding mortality. Conversely, SIRI displayed limited clinical utility, yielding the lowest predictive performance in our cohort. Conclusions: In neonatal sepsis, the HALP score provided additional clinical information when compared with several hematological inflammatory indices. Although HALP was not associated with mortality, prospective multicenter studies are needed to clarify the role of these cost-effective markers in pathogen differentiation and clinical assessment of LOS.

To demonstrate the role of thiol–disulfide balance (TDB) in chronic urticaria (CU) in children and to examine their relationship with disease activity to find out its value as a diagnostic biomarker. Our study is a prospective, case-control, single-center cross-sectional study. A total of 78 individuals were included. Thirty-nine patients with CU were compared with 39 healthy children with similar demographic characteristics. Serum native thiol (-SH), disulfide (SS), total thiol (-SH + -S-S-) (TT), and derived indices that constitute the thiol–disulfide balance were measured. The relationship between these parameters and the urticaria activation score (UAS) was evaluated. Appropriate statistical methods were used in comparisons between the two groups. Correlations were analyzed using Spearman's ρ. Diagnostic performance was assessed using ROC analysis. There was no significant difference when both the patient group and the control group were evaluated in terms of age and gender.(p>0.05). -SH and TT were Considerably lower in the CU group (-SH: 535.69±51.90 vs 613.23±90.92 µmol/L; TT: 650.63±55.38 vs 746.51±137.93 µmol/L; both p0.05). UAS was inversely associated with -SH (ρ=−0.389; p=0.009). IgE was positively correlated with TT (ρ=0.403; p=0.007) and SS (ρ=0.355; p=0.018); no significant association was observed with eosinophilia. ROC analysis revealed AUC=0.749 (SE=0.053; 95% CI 0.645–0.853; p<0.001), cut-off=676.38 µmol/L, sensitivity=0.717, and specificity=0.733 for TT; and AUC=0.729 (SE=0.055; 95% CI 0.622–0.837; p<0.001), cut-off=548.50 µmol/L, sensitivity=0.696, and specificity=0.689 for -SH. The remarkable decrease of the thiol pool (especially -SH and TT) in children with CU is consistent with an oxidative-antioxidative imbalance associated with disease activity and IgE levels. -SH and TT demonstrate statistically significant discrimination between CU and controls, and come forward as complementary biomarkers for clinical evaluation. However, a detailed comprehensive study including larger sample sizes and longitudinal analyses are needed to confirm the findings.