By MEHMET FATİH DEVECİ, HATİCE TURGUT, MERAL ALAGÖZ, et al., Published on 01/01/22

Healthcare-associated bacterial conjunctivitis is an underrecognized yet preventable infection in neonatal intensive care units (NICUs). This study aimed to determine the incidence, risk factors, microbiological profile, and treatment approaches of healthcare-associated bacterial conjunctivitis in neonates. This descriptive, cross-sectional study included neonates diagnosed with bacterial conjunctivitis and followed in the NICU between January 2019 and January 2024. Pathogens were identified by MALDI-TOF MS and antimicrobial susceptibility determined using VITEK 2 according to EUCAST breakpoints. During the five-year period, 104 (2.5%) of 4107 neonates admitted to the NICU developed healthcare-associated bacterial conjunctivitis. Of the pathogens isolated in cultures, 70.2% were Gram-positive bacteria, with coagulase-negative staphylococci being the most common (52.9%), followed by Staphylococcus aureus, Klebsiella pneumoniae, and Serratia marcescens. Empirical treatment consisted of 0.3% topical gentamicin eye drops. In resistant cases, fortified vancomycin drops (32.7%), 0.5% moxifloxacin (4.8%), or 0.3% tobramycin (1.9%) eye drops were administered according to antibiogram results. Compared with Gram-positive infections, Gram-negative conjunctivitis was associated with longer durations of intubation, orogastric feeding, and hospitalization. These findings indicate a predominance of Gram-positive pathogens in NICU-acquired neonatal conjunctivitis, while Gram-negative infections confer greater clinical burden. Fortified antibiotic eye drops are an effective treatment option for resistant cases in high-risk newborns.

Necrotizing enterocolitis (NEC) is a severe and often catastrophic gastrointestinal emergency that predominantly affects neonates, especially those born prematurely, and is associated with high rates of morbidity and mortality. Despite its significant clinical impact, the precise etiology and molecular pathogenesis of NEC remain incompletely understood. In this study, we conducted global transcriptomic profiling using high-throughput RNA sequencing in 11 premature neonates diagnosed with NEC, following rigorous inclusion and exclusion criteria. Compared to healthy controls, we identified 1,204 differentially expressed genes (DEGs), including 636 upregulated and 568 downregulated transcripts. Notably, genes involved in hypoxia-induced apoptosis (e.g., HIF1 AAS3, HIF1 AAS1), the caspase cascade (BCL2, BCL6, CASP5, CASP7), and inflammation (IL1RAP, IL6ST, TNFAIP3, TNFRSF10 A, TLR6, TLR10) were significantly upregulated. In contrast, IL18, a key modulator of inflammatory responses, was downregulated. Interestingly, several genes encoding selenoproteins (GPX1, GPX4, SELENON, SELENOM, SELENOF, SELENOW, SELENOT) were also downregulated, suggesting molecular evidence of selenium deficiency. Gene ontology and pathway enrichment analyses revealed widespread dysregulation in pathways related to hypoxia response, systemic inflammation, coagulation, antimicrobial defense, mitochondrial function, autophagy, selenium metabolism, and apoptosis. Collectively, our findings provide novel insights into the molecular underpinnings of NEC in premature infants and suggest that systemic hypoxia, oxidative stress, selenium deficiency, and programmed cell death contribute significantly to its pathogenesis.

Background: Preterm birth may result in persistent alterations in peripheral airway development. We aimed to compare impulse oscillometry (IOS) parameters between school-aged children born preterm and healthy term-born controls and to investigate factors associated with peripheral airway dysfunction. Methods: This cross-sectional comparative study included 46 children born at ≤32 weeks of gestation and 40 independently recruited healthy term-born controls. IOS parameters, including R5, R20, R5–R20, X5, X20, AX, and Fres, were assessed. Multivariable linear regression was used to evaluate whether between-group differences persisted after adjustment for anthropometric measures. Results: Children born preterm had significantly higher R5 (0.75 vs. 0.48 kPa·s/L), R5–R20 (0.37 vs. 0.19 kPa·s/L), and AX (2.93 vs. 1.41 kPa/L) than controls (all p = 0.001), whereas R20, X5, X20, and Fres did not differ significantly. R5–R20 was the most frequently abnormal IOS parameter in the preterm group (34.8%). After adjustment for age, height z-score, and weight z-score, prematurity remained significantly associated with higher R5 (p = 0.005), R5–R20 (p < 0.001), and AX (p = 0.002). No significant associations were identified between R5–R20 and gestational age, bronchopulmonary dysplasia, mechanical ventilation, or other evaluated neonatal characteristics. Conclusions: School-aged children born preterm exhibit persistent differences in peripheral airway mechanics that are not explained by anthropometric differences. IOS may provide a useful complementary tool for long-term respiratory assessment after preterm birth.

Objective: Despite improved neonatal survival among very preterm infants, health problems affecting various organ systems may persist in the long term. The aim of this study was to determine the burden of morbidity and multimorbidity documented by 7–8 years of age among children born at ≤32 weeks’ gestation and to investigate the perinatal and neonatal factors associated with these outcomes. Methods: A single-center observational cohort study included 63 children born at ≤32 weeks’ gestation and assessed at 7–8 years of age. Perinatal and neonatal data were obtained retrospectively from medical records. Long-term health outcomes were assessed across five morbidity domains: respiratory, neurological/neurodevelopmental, sensory, growth-related, and educational/behavioral. The co-occurrence of two or more morbidity domains was defined as multimorbidity. Results: The median gestational age was 30 weeks (Q1–Q3, 28–32 weeks), and the birth weight was 1.23 kg (Q1–Q3, 0.9–1.65 kg). At least one morbidity was identified in 69.8% of the children, whilst 38.1% had morbidity involving two or more domains. The most common comorbidities were educational/behavioral (58.7%) and respiratory (42.9%). Neurological/neurodevelopmental morbidity was 31.7%, whilst sensory and growth-related morbidities accounted for 28.6%. Growth-related morbidity was associated with lower birth weight (p = 0.006) and being small for gestational age (SGA) (p < 0.001). Neurological/neurodevelopmental morbidity was associated with chorioamnionitis (p = 0.03), longer duration of CPAP (p = 0.04) and oxygen therapy (p = 0.01), as well as neonatal sepsis (p = 0.03). Conclusions: In this cohort, morbidities documented by 7–8 years of age occurred across multiple domains, with conditions in two or more domains co-occurring in a considerable proportion of children born at ≤32 weeks’ gestation. These findings support multidimensional long-term follow-up, while recognizing the heterogeneity of the 25–32-week gestational-age range.

Background: Neonatal septic arthritis is a rare but potentially devastating infection that can present with subtle clinical signs and rapidly progress to joint destruction, osteomyelitis, and permanent sequelae. We aimed to describe the clinical and microbiological characteristics, imaging findings, management, and follow-up outcomes of neonatal septic arthritis patients and to report ultrasonography (US) and magnetic resonance imaging (MRI) findings within the same cohort. Methods: This retrospective observational study was conducted in a tertiary neonatal intensive care unit and included neonates who were diagnosed with septic arthritis between January 2016 and December 2025. Demographic, clinical, laboratory, microbiological, imaging, treatment, and outcome data were systematically obtained from medical records. The diagnosis was based on compatible clinical findings supported by laboratory and/or microbiological evidence, with imaging used to support diagnosis and guide management. Results: Twelve neonates were included. The median gestational age was 36.5 weeks (26–40), and the median birth weight was 2435 g. The median symptom onset was 22 days of life. The hip (n = 4) and knee (n = 4) were most commonly affected. Pseudoparalysis and swelling were the most frequent findings. Synovial cultures were positive in 10/12 (Staphylococcus aureus, n = 7; methicillin-resistant Staphylococcus aureus (MRSA), n = 3), and blood cultures were positive in 6/12. US detected joint effusion in 33% of the patients, whereas MRI revealed inflammatory changes in all the patients. Concomitant osteomyelitis occurred in 5/12 patients. Orthopedic sequelae developed in 6/12; no mortality was observed. Conclusions: Neonatal septic arthritis is associated with a substantial risk of osteomyelitis and early sequelae. Delayed recognition may worsen outcomes. Normal ultrasonographic findings should not exclude the diagnosis when clinical suspicion persists, and MRI may provide complementary information for timely management.