Secondary Gains of Strategies to Prevent COVID-19 Infection in Neonatal Intensive Care Unit: Has the Frequency of Healthcare-Associated Infections Decreased?

OBJECTIVE: To compare the frequency and distribution of healthcare-associated infections (HAI) in the neonatal intensive care unit (NICU) during COVID-19 infection. METHODS: We compared all cases hospitalized in the NICU and diagnosed with HAIs between 1 March - 1 September 2019 (pre-COVID-19 pandemic) and 1 March - 1 September 2020 (during the COVID-19 pandemic). RESULTS: We evaluated a total of 957 babies, 427 babies in the pre-COVID-19 period and 530 babies during the COVID-19 pandemic. HAIs were determined in 47 patients (60 attacks) and 39 patients (44 attacks) in the pre-COVID-19 period and during the COVID-19 period, respectively. HAIs incidence density (per1000 hospitalization days) was found 5.43 in pre-COVID-19 period and 4.87 in COVID-19 period. During the COVID-19 period, there was a significant decrease in the HAI incidence density and bloodstream infection (P = 0.009). CONCLUSIONS: COVID-19 infection prevention strategies helped reduce the frequency of HAIs especially in bloodstream infection in NICU.

Effect of sleeping position on cardiac output, pulmonary pressure, and superior vena cava flow in healthy term infants.

BACKGROUND: Although the mechanism of action in newborns is unknown, sleep positioning is associated with many pathophysiological events. This study aimed to compare the effects of supine and prone sleeping positions on cardiac output (CO), systolic pulmonary arterial pressure (SPAP), and superior vena cava (SVC) flow in healthy newborns. METHODS: In the first 24-72 h of life, 40 healthy term newborns born in the same hospital were included in this prospective, cross-sectional, observational study. CO, SVC flow, and SPAP values of newborns in the supine and prone sleeping positions were calculated using echocardiographic examination. The measurements were statistically compared. RESULTS: In the supine sleeping position, CO, SVC flow, and SPAP were 235.00 (193.07-283.30) ml/kg/min, 92.80 (77.82-121.87) ml/kg/min, and 27.85 (24.70-30.48) mmHg. In the prone sleeping position, CO, SVC flow, and SPAP were measured as 195.35 (166.00-229.40) ml/kg/min, 67.25 (51.82-96.66) ml/kg/min, 31.60 (28.45-37.20) mmHg, respectively. Depending on sleeping position, these variables were significantly different between the groups. CONCLUSION: SVC flow and CO decreased in the prone sleeping position compared to the supine sleeping position in healthy newborns, whereas SPAP increased. The different hemodynamic effects of sleeping position on the cardiac, pulmonary, and nervous systems should be considered as flow and pressure changes are important in newborns.

Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience.

OBJECTIVE: The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF). METHODS: All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study. RESULTS: The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases. CONCLUSION: The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.

Effect of Prematurity on Foveal Development in Early School-Age Children.

PURPOSE: To evaluate the foveal development in preterm children with optical coherence tomography and OCT angiography. DESIGN: Retrospective cohort study. METHODS: This study included children aged 6-8 years who were born prematurely and who did not receive retinopathy treatment. They were evaluated between September 2018 and July 2019, categorized according to gestational age (GA) (group I: GA ≤30 weeks; group II: GA between 31 and 34 weeks), and compared with full-term children (group III). Central foveal thickness (CFT), inner retinal thickness (IRT), outer retinal thickness (ORT), subfoveal choroidal thickness (CT), temporal and nasal CT, foveal avascular zone (FAZ) diameter, and vessel densities of superficial (SCP-VD) and deep capillary plexuses (DCP-VD) of the foveal and parafoveal areas were examined in detail. RESULTS: The study included 126 eyes of 63 patients (group I: 40 eyes; group II: 46 eyes; and group III: 40 eyes). In group I, CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD were significantly greater than those in the other groups, and temporal CT and FAZ diameter were significantly lower (P < .05). GA showed a significant negative correlation with CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD and a significant positive correlation with subfoveal CT, temporal and nasal CT, and FAZ diameter (P < .05). CONCLUSION: The morphological and vascular foveal structures in early school-age children who were born premature were different from those of full-term children. These differences were correlated with GA and more pronounced in those with GA of ≤30 weeks.

Retinopathy screening results of late-preterm infants born at 32-35 weeks of gestational age.

PURPOSE: The aim of this retrospective, nonrandomized, observational clinical study was to evaluate the screening results for retinopathy of prematurity (ROP) of late-preterm infants born at 32-35 weeks gestational age (GA). METHODS: Retinopathy screening data of late-preterm infants were evaluated between January 2015 and September 2018. The zones and stages of ROP development were classified according to the International ROP Committee criteria. Patients were categorized into four groups according to GA: 32 < 33 weeks GA, 33 < 34 weeks GA, 34 < 35 weeks GA, and 35 < 36 weeks GA. The rates of development of any stage of ROP or severe ROP (requiring treatment) were recorded. RESULTS: The study included 543 infants: 139 (25.4%) in 32 < 33 weeks GA, 127 (23.6%) in 33 < 34 weeks GA, 162 (30.2%) in 34 < 35 weeks GA, and 115 (20.8%) in 35 < 36 weeks GA. Different stages of ROP developed in 29 infants (20.9%) in 32 < 33 weeks GA, 19 infants (15%) in 33 < 34 weeks GA, 17 infants (10.5%) in 34 < 35 weeks GA, and 6 infants (5.2%) in 35 < 36 weeks GA. Treatment was required for 14 infants (2.6%) due to severe ROP: 7 (5%) in 32 < 33 weeks GA, 3 (2.4%) in 33 < 34 weeks GA, and 4 (2.5%) in 34 < 35 weeks GA. No treatment was required in 35 < 36 weeks GA. CONCLUSION: Late-preterm infants must be screened for ROP, especially those born in developing countries. Although rates of ROP development decrease as GA increases, infants born at 34 weeks of GA or younger, regardless of birth weight, should be examined at least once for ROP.

Evaluation of Treatment Models in the Treatment of Retinopathy of Prematurity.

OBJECTIVES: This study aims to evaluate the treatment modalities applied for retinopathy of prematurity (ROP) and to determine the efficacy and results of treatment modalities. METHODS: Premature babies, who needed treatment for ROP and followed-up in the Neonatal Intensive Care Unit (NICU) of our hospital or external centers, were retrospectively evaluated between January 2012 and January 2017. According to the criteria determined by the International ROP committee, the zones and stages of the cases were recorded. In this study, patients were evaluated in three groups. Group 1: plus disease with any stage in zone 1, group 2: plus disease in zone 2, together with stage 2 or 3, group 3: classified as aggressive posterior retinopathy (APROP). The birth weight, gestational age, treatment weeks and treatments that were administered were recorded. Regression in plus disease, macular dragging and retinal detachment did not develop were evaluated as successful treatment. RESULTS: 1746 preterm babies were examined. 65 (3.7%) preterm babies were included in this study, 31 female and 34 male. 126 eyes of preterm babies were intervened. The mean birth weight was 1159 (535-2200) grams, and the mean gestational age was 28.4±2.5 (24-34) weeks. Group 1 had 33 eyes (26.1%), group 2 had 71 eyes (56.3%), and group 3 had 22 eyes (17.4%). 94 eyes (74.6%) were treated once, 26 eyes (20.6%) were treated twice, 6 eyes (4.8%) received treatment three times. The first treatment was applied at 36±2.4 (32-41) weeks. The first treatment was performed with intravitreal bevacizumab (IVB) in 75.8% of group 1 and 95.5% of group 3, and with diode laser photocoagulation (LPC) in 78.9% of group 2. There was a significant correlation between birth week and birth weight and first treatment week. Re-treatment was applied to 32,8% in LPC group and 19.2% in the IVB group due to recurrence. 5 eyes which were applied LPC+IVB did not need any re-treatment. Stage 4a retinal detachment developed in both eyes of 1 patient from group 1. Macular traction was developed in 2 eyes of 1 patient in group 2. After the treatments, success in 122 eyes (96.8%) was obtained. CONCLUSION: ROP can be controlled by convenient and effective treatment. Although conventional LPC is still the first treatment option for ROP, IVB alone or combination with LPC is a highly effective treatment option for zone 1 disease and APROP. IVB reduces the number of ROP treatments.

Neonatal Diabetes Mellitus.

Neonatal diabetes is a rare cause of hyperglycemia in the neonatal period. It is caused by mutations in genes that encode proteins playing critical roles in normal functions of pancreatic beta cells. Neonatal diabetes is divided into temporary and permanent subtypes. Treatment is based on the correction of fluid-electrolyte disturbances and hyperglycemia. Patients respond to insulin or sulfonylurea treatment according to the mutation type. Close glucose monitoring and education of caregivers about diabetes are vital.

Acute kidney injury in a single neonatal intensive care unit in Turkey.

BACKGROUND: Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity. METHODS: Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function. RESULTS: The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI. CONCLUSIONS: Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

Effect of neonatal sepsis on the development of allergies and asthma in later childhood.

BACKGROUND: Exposure to large amounts of endotoxins and other bacterial products in early childhood may protect against the development of allergic diseases later in childhood. The aim of this study was to investigate the effects of neonatal sepsis on subsequent development of asthma, allergic rhinitis, and atopic dermatitis in children. METHODS: We recruited 85 children (mean age 48.67 +/- 12.88 months) who had been hospitalized for sepsis in their neonatal period and their siblings (n = 85) as controls (mean age 61.81 +/- 21.34 months) to investigate the prevalences of asthma, atopic dermatitis and allergic rhinitis. After asking the questions in the International Study of Asthma and Allergies in Children (ISAAC) questionnaires to the parents, total IgE levels in sera were measured and skin prick tests were performed. RESULTS: Children with neonatal sepsis had lower total IgE levels and less sensitivity to Dermatophagoides pteronyssinus than controls (25.9 vs. 9.4%, p = 0.003). In addition, wheeze ever, wheeze in the last 12 months, physician-diagnosed asthma, and use of asthma drugs were less common in these subjects. Prevalences of allergic rhinitis and atopic dermatitis were equal in both groups. CONCLUSION: Exposure to severe infections such as sepsis in the neonatal period may decrease sensitization to environmental allergens and prevalence of asthma in later childhood.