Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial.

OBJECTIVE: Preterm infants have high zinc (Zn) requirements and are generally believed to be in a negative Zn balance in the early period of life. In this study, we aimed to investigate the effect of high-dose Zn supplementation in very low birth weight (VLBW: infants with birth weight < 1.5 kg) infants on feeding intolerance and development of mortality and/or morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). STUDY DESIGN: This is a prospective randomized trial. VLBW preterm infants with gestational age of <32 weeks were randomly allocated on the seventh day of life to receive extra amount of supplemental Zn along with the enteral feedings (9 + 3 mg), besides regular low-dose supplementation (3 mg), from enrollment until discharge. Outcome measures were feeding intolerance, NEC (stage ≥ 2), LOS, and mortality. RESULTS: A total of 195 infants (97 from study group and 98 from control group) were analyzed. A total of 46 (47.4%) infants in the study group and 64 (65.3%) infants in the control group ended up with feeding intolerance (p = 0.012). NEC was observed in 11 infants (11.2%) in the control group and only 1 infant (1%) in the study group (p = 0.003). There was a negative correlation between high-dose Zn supplementation and number of culture-proven LOS episodes (p = 0.041). This significance was also present for clinical sepsis, being higher in the control group (p = 0.029). No relationship between high-dose Zn supplementation and mortality and other morbidities (hemodynamically significant patent ductus arteriosus, bronchopulmonary dysplasia, retinopathy of prematurity, and severe intraventricular hemorrhage) was observed. CONCLUSION: Zn supplementation for VLBW infants is found to be effective to decrease feeding intolerance, NEC, and LOS episodes in this vulnerable population. Current data support the supplementation of VLBW infants with higher than regular dose of Zn. KEY POINTS: · Higher dose of Zn supplementation is shown to be a beneficial intervention in VLBW infants.. · Zn may decrease feeding intolerance, sepsis or NEC.. · Higher than regular dose of Zn seems to be safe..

A Comparison of Slow Infusion Intermittent Feeding versus Gravity Feeding in Preterm Infants: A Randomized Controlled Trial.

BACKGROUND: The transition to full enteral feeding is important for ensuring adequate growth in preterm infants. AIMS: The aim of this study was to investigate the effects of two different intermittent feeding methods on the transition to full enteral feeding in preterm infants. STUDY DESIGN: A prospective, randomized controlled study was conducted in a neonatology and perinatology center. SUBJECTS: Preterm infants with a gestational age between 24 + 0/7 and 31 + 6/7 were included in this study. They were divided into two groups: the SIF (slow infusion feeding) group and the IBF (intermittent bolus feeding) group. In the SIF group, feed volumes were administered over one hour using an infusion pump through an orogastric tube, with feeding occurring every three hours. The IBF group received enteral feeding using a gravity-based technique with a syringe through an orogastric tube, completed within 10 to 30 min. OUTCOME MEASURES: The primary outcome was the achievement of full enteral feeding and the occurrence of feeding intolerance. RESULTS: A total of 103 infants were enrolled in the study (50 in SIF and 53 in IBF). The time to achieve full enteral feeding did not differ significantly between the two groups (p = 0.20). The SIF group had significantly fewer occurrences in which gastric residual volume exceeded 50% (p = 0.01). Moreover, the SIF group had a significantly shorter duration of non-per-oral (NPO) status than the IBF group (p = 0.03). CONCLUSIONS: It is our contention that the use of the SIF method as an alternative feeding method is appropriate for infants with feeding intolerance and those at high risk of feeding intolerance.

The effect of spousal support on distress experienced during pregnancy in COVID-19 pandemic: Sample of Türkiye.

We conducted this study with 147 volunteer pregnant women to determine the effect of spousal support on the stress experienced during pregnancy during the COVID-19 pandemic period. We determined that the prenatal stress level of the pregnant women was low (15.34 ± 7.07), they were not at risk for distress, and the spousal support level was high (74.58 ± 8.78). We found that the rate of spousal support was 0.897 times higher for women who did not experience distress. Due to the stay-at-home rule during the pandemic, couples had to be together at home, which caused high spousal support, and we found that women's stress levels were lower.

A Multicenter Study of Genotype Variation/Demographic Patterns in 2475 Individuals Including 1444 Cases With Breast Cancer in Turkey.

Objective: Breast cancer (BC) is the most common cancer type in women and may be inherited, mostly in an autosomal dominant pattern. The clinical diagnosis of BC relies on the published diagnostic criteria, and analysis of two genes, BRCA1 and BRCA2, which are strongly associated with BC, are included in these criteria. The aim of this study was to compare BC index cases with non-BC individuals in terms of genotype and diagnostic features to investigate the genotype/demographic information association. Materials and Methods: Mutational analyses for the BRCA1/BRCA2 genes was performed in 2475 individuals between 2013-2022 from collaborative centers across Turkey, of whom 1444 with BC were designated as index cases. Results: Overall, mutations were identified in 17% (421/2475), while the percentage of mutation carriers in cases of BC was similar, 16.6% (239/1444). BRCA1/BRCA2 gene mutations were detected in 17.8% (131/737) of familial cases and 12% (78/549) of sporadic cases. Mutations in BRCA1 were found in 4.9%, whereas 12% were in BRCA2 (p<0.05). Meta-analyses were performed to compare these results with other studies of Mediterranean-region populations. Conclusion: Patients with BRCA2 mutations were significantly more common than those with BRCA1 mutations. In sporadic cases, there was a lower proportion with BRCA1/BRCA2 variants, as expected, and these results were consistent with the data of Mediterranean-region populations. However, the present study, because of the large sample size, revealed more robust findings than previous studies. These findings may be helpful in facilitating the clinical management of BC for both familial and non-familial cases.

Factors affecting birth satisfaction of women in Turkey: A cross-sectional study.

OBJECTIVE: Whether the method of birth affects the factors that contribute to the birth satisfaction of women is controversial. But, the importance of positive birth experience perception in perinatal care is increasing. This study aimed to examine women's birth satisfaction and the affecting factors in a university hospital. METHODS: This descriptive and cross-sectional study was conducted with 404 women in the gynecology and obstetrics clinic of a university hospital between January and April 2017. Data were collected using a Personal Information Form and the Scale for Measuring Maternal Satisfaction in Birth. Two versions of the scale were used for women who had cesarean birth and who had vaginal birth. The data were analyzed using the Independent Groups t-test, ANOVA, and the Bonferroni test which was performed to determine the group causing a difference. FINDINGS: There was no overall statistical difference between normal birth and cesarean birth groups in terms of total satisfaction level (p>0.05). The level of satisfaction from the healthcare team and respect for privacy was higher in women who had normal birth whereas the level of satisfaction from comforting and hospital room was higher in those who had cesarean birth. The findings of this study demonstrated that the factors affecting birth satisfaction were the desire for pregnancy, induction application, planned birth method, and type of anesthesia. IMPLICATIONS FOR PRACTICE: Determining the parameters that affect the birth satisfaction of women is of great importance in terms of increasing the quality of maternal care. Health professionals should raise awareness about the effects of normal and cesarean delivery practices and decisions regarding pregnancy request and delivery type on birth satisfaction.

Quality of life and sexual function after abdominal versus laparoscopic hysterectomy: a prospective study.

BACKGROUND: This study aimed to evaluate the quality of life (QoL) and sexual function of women who underwent total abdominal hysterectomy and total laparoscopic hysterectomy. METHODS: In this prospective cohort study, a total of 121 patients who underwent total abdominal hysterectomy (N.=65) and total laparoscopic hysterectomy (N.=56) operations for benign indications were included. Sociodemographic features, obstetric histories, and clinical characteristics of the patients were noted. Quality of life assessment was conducted with the World Health Organization Quality of Life-BREF questionnaire, which has five domains: overall quality of life + health, physical health, psychological health, social relationships, and environment. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction Scale with subscales of infrequency, non-communication, avoidance, non-sensuality, dissatisfaction, vaginismus, and anorgasmia. The patients were asked to fill in both questionnaires before the operation and six months after the operation. RESULTS: Of the 121 patients, 104 of them completed the postoperative surveys. In the total laparoscopic hysterectomy group, the individual improvements of the overall quality of life + health physical, and psychological health domains were statistically higher than the total abdominal hysterectomy group. In terms of sexual function, the total abdominal hysterectomy group had worse avoidance, non-sensuality, dissatisfaction, and vaginismus subscale scores and total score both in the preoperative and postoperative period compared to the total laparoscopic hysterectomy group. However, the individual differences and the number of patients exhibiting sexual dysfunction before and after surgery were not statistically significant in both groups. CONCLUSIONS: Laparoscopic hysterectomy was superior to abdominal hysterectomy in improving the quality of life of the patients. Both abdominal and laparoscopic hysterectomies were not found to affect female sexuality.

Prolonged minimal enteral nutrition versus early feeding advancements in preterm infants with birth weight ≤1250 g: a prospective randomized trial.

OBJECTIVE: To determine the effect of two different feeding strategies on time to achieve full enteral feeding and the incidence of feeding intolerance in preterm infants with birth weight ≤1250 g. METHODS: A prospective randomized trial (NCT02913677) conducted at a tertiary level neonatal intensive care unit. Preterm infants with birth weight ≤1250 g were randomly allocated to either prolonged minimal enteral nutrition (MEN) in which feed volumes were not increased for five days or early feeding advancement groups in which feed volumes were advanced by 20-25 ml/kg/d until 150 ml/kg/d feed volume was achieved. The primary outcomes were time to reach full enteral feeding sustained for 72 h and incidence of feeding intolerance. RESULTS: A total of 199 infants (99 in prolonged MEN and 100 in early feeding advancement groups) were involved in the study. No statistically significant differences were observed in time to achieve full enteral feeding and feeding intolerance. Daily weight gain (19 versus 16 g; p < .001) was significantly higher in prolonged MEN group. There were no significant differences in weight percentiles and z-scores at discharge. Duration of hospitalization was comparable between the groups. The overall incidence of late onset sepsis and culture proven sepsis was similar in both groups (p = .92 and p = .22, respectively). Incidence of necrotizing enterocolitis (NEC) was 5% in early feeding advancement group, whereas no case of NEC was observed in prolonged MEN group (p = .06). CONCLUSIONS: Prolonged MEN is not associated with a delay in time to achieve full enteral feedings. It may even provide an advantage for development of NEC in extremely low birth weight infants. TRIAL REGISTRATION: Clinical Trials.gov: NCT02913677.

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial.

BACKGROUND: The aim of this study was to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to the frequency of central-line-associated bloodstream infection (CLABSI), catheter-related bloodstream infection, primary bloodstream infection, and catheter colonization in critically ill pediatric patients with short-term central venous catheters. METHODS: Children who were admitted to the pediatric intensive care unit of a tertiary institution between May 2018 and December 2019 and received placement of a short-term central venous catheter were included in this single-center randomized controlled trial. Patients were grouped according to the type of catheter fixation applied. RESULTS: A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters (amounting to a collective total of 4,993 catheter days), were included in the study. The CHG-impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 vs 7.59 per 1,000 catheter days; hazard ratio (HR): 0.93, P = 0.76), catheter related bloodstream infection (3.82 vs 4.18 per 1,000 catheter days; HR: 0.98; P = 0.98), and primary bloodstream infection (2.54 vs 3.42 catheter days; HR: 0.79; P = 0.67). The CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 vs 7.59 per 1,000 catheter days; HR: 0.40; P = 0.04). In both groups, the most frequent microorganisms isolated in CLABSI or catheter colonization were Gram-positive bacteria (the majority were coagulase-negative staphylococci). CONCLUSIONS: The use of CHG-impregnated dressing does not decrease CLABSI incidence in critically ill pediatric patients but it significantly reduced catheter colonization. Coagulase-negative staphylococci were the most common microorganisms causing CLABSI or catheter colonization.

Complementary and Alternative Medicine Attitudes of Gynecologic Patients: Experience in a Tertiary Clinic.

OBJECTIVE: To evaluate the knowledge, attitudes, and behaviors regarding complementary and alternative medicine methods of patients who were admitted to gynecology outpatient clinics. METHODS: In the present survey, a questionnaire on complementary and alternative medicine practices was applied on 1,000 women (ages between 18 and 83 years old) who were admitted to the gynecology outpatient clinic of a tertiary maternity hospital. Demographic features and knowledge, attitudes, and behaviors about these methods were inquired in face-to-face interviews. RESULTS: While 80.7% of the total participants thought that complementary and alternative medicine was beneficial, only 37.5% of them had used these methods previously. The rate of prior knowledge on this subject was of 59.7% and the source of information was physicians for 8.5% of the patients. However, 72.4% of all participants wanted to obtain information on these methods and 93.7% wanted to be informed by physicians. In the decision tree model, having knowledge about complementary and alternative medicine was the most effective factor determining its use (p < 0.001). Phytotherapy was found to be the most used method, with 91.4%. The most preferred plant was onion (18.9%), and the most common reasons for herbal use were stress (15.4%) and fatigue (15.2%). CONCLUSION: More than one-third of the patients who applied to the gynecology outpatient clinics used one of the complementary and alternative medicine methods at least once. As gynecologists and obstetricians, we need to be more knowledgeable about these methods to provide correct guidance to our patients for accessing accurate and effective information.

OBJETIVO: Avaliar o conhecimento, as atitudes e os comportamentos em relação aos métodos de medicina complementar e alternativa de pacientes internadas em ambulatórios de ginecologia. MéTODOS: Na presente pesquisa, um questionário sobre práticas de medicina complementar e alternativa foi aplicado a 1.000 mulheres (idades entre 18 e 83 anos) que foram admitidas nos ambulatórios de ginecologia de uma maternidade terciária. Características demográficas e conhecimento, atitudes e comportamentos sobre esses métodos foram investigados em entrevistas pessoais. RESULTADOS: Enquanto 80,7% do total de participantes achavam que a medicina complementar e alternativa era benéfica, apenas 37,5% deles haviam usado esses métodos anteriormente. A taxa de conhecimento prévio sobre o assunto foi de 59,7% e a fonte de informação foi médica para 8,5% dos pacientes. No entanto, 72,4% de todos os participantes queriam obter informações sobre esses métodos e 93,7% queriam ser informados por médicos. No modelo de árvore de decisão, ter conhecimento sobre medicina complementar e alternativa foi o fator mais eficaz para determinar seu uso (p < 0,001). A fitoterapia foi o método mais utilizado, com 91,4%. A planta preferida foi a cebola (18,9%), e os motivos mais comuns para o uso de ervas foram estresse (15,4%) e fadiga (15,2%). CONCLUSãO: Mais de um terço das pacientes que se inscreveram no ambulatório de ginecologia utilizaram um dos métodos de medicina complementar e alternativa pelo menos uma vez. Como ginecologistas e obstetras, precisamos ter mais conhecimento sobre estes métodos a fim de fornecer orientações corretas aos nossos pacientes para o acesso a informações precisas e eficazes.

The effect of antioxidants in Ehrlich Ascites Cancer.

A fundamental goal in molecular oncology is to unravel the underlying mechanisms which cause the cell transformation. In line with this approach, genome-wide functional screening approaches have revealed exciting insights into heterogeneous nature of cancer. Rapidly expanding horizons of research have unraveled myriad of pathways which play instrumental role in carcinogenesis and metastasis. Oxidative stress has also been reported to be significantly involved in cancer onset and progression. In line with this approach, oxidative stress modulating chemicals have always been sharply divided into antioxidants and oxidative stress-inducing agents. Conceptual and experimental advancements have enabled us to critically analyze full potential of these two different groups of chemicals in cancer chemoprevention. Different antioxidants are currently being analyzed in different phases of clinical trials. Although it has been reported in the literature that antioxidant supplements reduce tumor cells in some tumors or cause volume reduction in solid tumor sizes, there is no definite consensus. Therefore, an antioxidant supplement guideline based on more detailed clinical research and as a result of these is needed to achieve the best care for cancer patients and to avoid risky treatments for cancer patients.

Complementary and Alternative Medicine Attitudes of Gynecologic Patients: Experience in a Tertiary Clinic / Atitudes de pacientes ginecológicos em medicina alternativa e complementar: Experiência em uma clínica terciária

Abstract Objective To evaluate the knowledge, attitudes, and behaviors regarding complementary and alternative medicine methods of patients who were admitted to gynecology outpatient clinics. Methods In the present survey, a questionnaire on complementary and alternative medicine practices was applied on 1,000 women (ages between 18 and 83 years old) who were admitted to the gynecology outpatient clinic of a tertiarymaternity hospital. Demographic features and knowledge, attitudes, and behaviors about these methods were inquired in face-to-face interviews. Results While 80.7% of the total participants thought that complementary and alternative medicine was beneficial, only 37.5% of them had used these methods previously. The rate of prior knowledge on this subject was of 59.7% and the source of information was physicians for 8.5% of the patients. However, 72.4% of all participants wanted to obtain information on these methods and 93.7% wanted to be informed by physicians. In the decision tree model, having knowledge about complementary and alternative medicine was the most effective factor determining its use (p<0.001). Phytotherapy was found to be the most used method, with 91.4%. The most preferred plant was onion (18.9%), and the most common reasons for herbal use were stress (15.4%) and fatigue (15.2%). Conclusion More than one-third of the patients who applied to the gynecology outpatient clinics used one of the complementary and alternativemedicine methods at least once. As gynecologists and obstetricians, we need to be more knowledgeable about these methods to provide correct guidance to our patients for accessing accurate and effective information.

Resumo Objetivo Avaliar o conhecimento, as atitudes e os comportamentos em relação aos métodos de medicina complementar e alternativa de pacientes internadas em ambulatórios de ginecologia. Métodos Na presente pesquisa, um questionário sobre práticas de medicina complementar e alternativa foi aplicado a 1.000 mulheres (idades entre 18 e 83 anos) que foram admitidas nos ambulatórios de ginecologia de uma maternidade terciária. Características demográficas e conhecimento, atitudes e comportamentos sobre esses métodos foram investigados em entrevistas pessoais. Resultados Enquanto 80,7% do total de participantes achavam que a medicina complementar e alternativa era benéfica, apenas 37,5% deles haviam usado esses métodos anteriormente. A taxa de conhecimento prévio sobre o assunto foi de 59,7% e a fonte de informação foi médica para 8,5% dos pacientes. No entanto, 72,4% de todos os participantes queriam obter informações sobre esses métodos e 93,7% queriam ser informados por médicos. No modelo de árvore de decisão, ter conhecimento sobre medicina complementar e alternativa foi o fator mais eficaz para determinar seu uso (p<0,001). A fitoterapia foi o método mais utilizado, com 91,4%. A planta preferida foi a cebola (18,9%), e osmotivos mais comuns para o uso de ervas foram estresse (15,4%) e fadiga (15,2%). Conclusão Mais de um terço das pacientes que se inscreveram no ambulatório de ginecologia utilizaram um dos métodos de medicina complementar e alternativa pelo menos uma vez. Como ginecologistas e obstetras, precisamos ter mais conhecimento sobre estes métodos a fimde fornecer orientações corretas aos nossos pacientes para o acesso a informações precisas e eficazes.

Comparison of Cradle Hold Versus Football Hold Breastfeeding Positions after Cesarean Section in Primiparous Mothers.

Objective: To compare cradle hold and football hold breastfeeding positions in terms of their effects on incision pain, breastfeeding success, and patient satisfaction among primiparous breastfeeding women after cesarean section. Materials and Methods: Sixty-seven breastfeeding primiparous women who underwent cesarean section were included in this crossover study. The women were instructed to use two different breastfeeding positions sequentially and change in pain intensity before and after each session were questioned. At the end of each session breastfeeding success (using LATCH breastfeeding charting system) and maternal satisfaction were assessed. In addition, mother's most preferred position was asked at the time of discharge. Results: A statistically significant increase was found in incisional pain score after breastfeeding with cradle hold position (p < 0.001), whereas no such change was observed in association with football hold position (p = 1.000). In contrast, total LATCH score was significantly better with cradle hold position when compared with football hold position (8.7 ± 1.1 versus 8.0 ± 1.1, respectively; p < 0.001). The two positions were similar in terms of maternal satisfaction scores (p = 0.082). Majority of the mothers (74.6%) preferred cradle hold position at the time of discharge. Conclusions: Although cradle hold position was associated with increased incision pain, it provided better breastfeeding experience and was more commonly preferred, which may be attributed to lesser familiarity with the latter position. Prenatal training should be provided to mothers on all breastfeeding positions. Further studies with larger sample size are warranted to better understand the relationships between incision pain after cesarean section, breastfeeding positions, and breastfeeding success.

Acute Kidney Injury in Neonates with Perinatal Asphyxia Receiving Therapeutic Hypothermia.

OBJECTIVE: To assess the incidence and severity of acute kidney injury (AKI) and evaluate risk factors that predict AKI in asphyxiated infants receiving therapeutic hypothermia. STUDY DESIGN: Infants ≥36 weeks' gestation diagnosed with moderate-to-severe perinatal asphyxia and received therapeutic hypothermia were reviewed retrospectively (n = 166). Modified Acute Kidney Injury Network criteria were used to diagnose AKI. The results of infants with AKI were compared with the infants who did not develop AKI. RESULTS: AKI developed in 49 (29.5%) infants, of whom 22 had stage I, 13 had stage II, and 14 had stage III AKI. The overall mortality rate was 15.7% and was significantly higher in infants with AKI when compared with infants without AKI (41 vs. 5%; p < 0.001). Asystole at birth (p = 0.044), placental abruption (p = 0.041), outborn status (p = 0.041), need for vasopressor support (p = 0.031), increased bleeding tendency (p = 0.031), initial lactate level (p = 0.015), and 12-hour lactate level (p = 0.029) were independent risk factors for the development of AKI. Receiver operating characteristic curve analysis demonstrated a good predictive value for initial lactate level (>15 mmol/L), with 69% sensitivity (95% CI: 55-82) and 82% specificity (95% CI: 74-89), and for 12-hour lactate level (>6 mmol/L), with 83.7% sensitivity (95% CI: 70-93) and 73.5% specificity (95% CI: 64.5-81), to predict AKI. CONCLUSION: AKI is still a common complication of perinatal asphyxia despite treatment with therapeutic hypothermia. Identification of risk factors associated with the development of AKI in asphyxiated infants would be potentially beneficial to reduce morbidity and mortality. Besides perinatal risk factors, initial and 12-hour lactate concentrations can be used for the early prediction of AKI.

Is Nasal Septum-Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study.

OBJECTIVE: Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum-tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth. STUDY DESIGN: Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2). RESULTS: A total of 167 infants (22-42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group). CONCLUSION: The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth.

Comparing the novel microstream and the traditional mainstream method of end-tidal CO2 monitoring with respect to PaCO2 as gold standard in intubated critically ill children.

The objective of this study was to evaluate a novel microstream method by comparison with PaCO2 and the more standard mainstream capnometer in intubated pediatric patients. We hypothesized that the novel microstream method would superior compared to the traditional mainstream method in predicting PaCO2. This was a prospective single-center comparative study. The study was carried out on 174 subjects with a total of 1338 values for each method. Data were collected prospectively from mainstream and microstream capnometer simultaneously and compared with PaCO2 results. Although both mainstream PetCO2 (mainPetCO2) and microstream PetCO2 (microPetCO2) were moderately correlated (r = 0.63 and r = 0.68, respectively) with PaCO2 values, mainPetCO2 was in better agreement with PaCO2 in all subjects (bias ± precision values of 3.8 ± 8.9 and 7.3 ± 8.2 mmHg, respectively). In those with severe pulmonary disease, the mainPetCO2 and microPetCO2 methods were highly correlated with PaCO2 (r = 0.80 and r = 0.81, respectively); however, the biases of both methods increased (14.8 ± 9.1 mmHg and 16.2 ± 9.0 mmHg, respectively). In cases with increased physiologic dead space ventilation, the agreement levels of mainPetCO2 and microPetCO2 methods became distorted (bias ± precision values of 20.9 ± 11.2 and 25.0 ± 11.8 mm Hg, respectively) even though mainPetCO2 and microPetCO2 were highly correlated (r = 0.78 and r = 0.78, respectively). It was found that the novel microstream capnometer method for PetCO2 measurements provided no superiority to the traditional mainstream method. Both capnometer methods may be useful in predicting the trend of PaCO2 due to significant correlations with the gold standard measurement in cases with severe pulmonary disease or increased physiological dead space -despite reduced accuracy.

Effect of withholding feeds on transfusion-related acute gut injury in preterm infants: a pilot randomized controlled trial.

Background: Several retrospective studies have reported an increase in necrotizing enterocolitis (NEC) during the 48 h following red blood cell (RBC) transfusion. Whether withholding enteral feeding during transfusion decreases the risk of transfusion-associated acute gut injury (TRAGI) in preterm infants is unclear.Study design and methods: In this pilot study, 112 preterm infants with gestational age ≤32 weeks and/or birth weight ≤1500 g were randomly assigned to withholding (NPO) or continuance of feeding (FED) during RBC transfusion. Primary outcome measure was development of NEC (stage ≥ 2) within 72 h of a transfusion and the change in abdominal circumference.Results: One hundred fifty-four transfusion episodes (74 NPO and 80 FED) were analyzed. Demographic characteristics were found to be similar in both groups. There was no difference in rates of NEC (0 versus 3.4%; p = .49) between the NPO and FED groups. The incidence of feeding intolerance was higher in the FED group; however, it was statistically insignificant (1.9 versus 6.8%, p = .36). Abdominal circumference remained similar in both groups in all three consecutive days following transfusion (p>.05).Conclusion: This pilot study does not support withholding feedings during transfusion but is not adequately powered to test the hypothesis that NPO decreases NEC rates. Adequately powered well-designed multicenter trials are still required.

Severe neonatal hyperbilirubinemia in the southeast region of Turkey

Background/aim: Severe neonatal hyperbilirubinemia is an important cause of morbidity and mortality in developing countries. The aim was to assess etiologic reasons for development of severe hyperbilirubinemia and define risk factors for exchange transfusion and acute bilirubin encephalopathy (ABE) in Sanliurfa located in the southeast region of Turkey. Materials and methods: An observational cohort study included 115 infants with ≥35 weeks of gestation admitted with diagnosis of severe hyperbilirubinemia in a period of 18 months. Potential risk factors associated with exchange transfusion and development of ABE were analyzed. Results: Among 115 infants, 67 (58.3%) received exchange transfusion and 45 (39.1%) developed ABE. Rh isoimmunization (OR: 24.6, 95% CI = 2.2­271, P = 0.009), glucose-6-phosphate dehydrogenase deficiency (G6PD) (OR: 21.1, 95% CI = 1.8­238.4, P = 0.01), early discharge (OR: 14.4, 95% CI = 4.2­48.9, P ≤ 0.001), and male sex (OR: 4.3, 95% CI = 1.3­14.1, P = 0.02) were independently associated with an increased risk for exchange transfusion. Being a refugee (OR: 6.8, 95% CI = 1.8­25.8, P = 0.005) and G6PD deficiency (OR: 9.9, 95% CI = 1.3­71.9, P = 0.02) were associated with development of ABE. Conclusion: Early discharge, Rh isoimmunization, and G6PD deficiency are significant risk factors for severe hyperbilirubinemia and exchange transfusion. Prevention of early hospital discharges, family education to increase awareness for hazardous effects of hyperbilirubinemia, and early follow-up visits after discharge would reduce the disease burden.

Neuropeptide Y Levels in Children and Adolescents with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in adolescence, however, the etiology has not been described. Neuropeptide Y (NPY) is one potential factor that may be involved in the etiology of ADHD. The goal of this study was to evaluate NPY levels in children with ADHD and compare the findings to healthy controls. METHODS: Forty-eight ADHD patients and 40 healthy controls were included in this study. The age range of ADHD patients was 6 to 16 years. All patients were diagnosed according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). RESULTS: The NPY levels of children with ADHD were compared to healthy controls but were not significantly different (t (86)= -0.887,  p= 0.378). NPY levels were similar (F= 0.191, p= 0.826) between ADHD presentations, and included 8 children with predominantly hyperactive-impulsive type (14.3%), 14 children with predominantly inattentive type (30.4%), and 26 children with a combined type (55.4%). There was also no difference between ADHD patients using medical treatment, ADHD patients not using medical treatment, and control subjects in terms of NPY levels (F= 0.572, p= 0.566). There was a significant positive correlation between age and NPY levels in the ADHD group (r= 0.349, p= 0.015). CONCLUSION: This study demonstrated that the NPY levels of ADHD subjects were not different than those of controls. Future studies with homogeneous phenotypes and a larger sample population are needed.

Drug exposure in early pregnancy might be related to the effects of increased maternal progesterone in implantation period.

AIM: This short communication aims to evaluate the relation in between drug exposure time and early pregnancy regarding gestational weeks. METHODS: The study covers the referrals made to the Department of Pharmacology for a teratogenic consultation in a 3-year period. From the recordings of pregnant women, the last menstrual period and the starting date of medication were used to determine the time of prescription with regard to gestational weeks. RESULTS: In all of the three years, potentially teratogenic medication was prescribed more frequently in the 3rd, 4th and 5th gestational weeks (in between 15-35 days of pregnancy). Approximately 75% of the pregnant women in the study were prescribed with drugs, most frequently with analgesics, antibiotics, gastrointestinal drugs and antidepressants, in these gestational weeks. CONCLUSIONS: The timing of prescriptions in early pregnancy frequently coincides with the increased levels of maternal progesterone in implantation period. Progesterone may lead to negative mood symptoms of an increased pain perception, anxiety, irritability and aggression in some of the pregnant women and therefore causes an increased stress condition which in turn may result in pain, infection and inflammation in the individual. Taking the frequently used medications into consideration, the reason for prescriptions in this period might be related to the symptoms originating from the effects of progesterone. Future studies are needed to better demonstrate this association of drug exposure and effects of maternal progesterone in early pregnancy.

Multi-dose vitamin d supplementation in stable very preterm infants: Prospective randomized trial response to three different vitamin D supplementation doses.

BACKGROUND: Preterm newborns are born with lower vitamin D stores. Although vitamin D supplementation is recommended there is no consensus regarding the adequate dose of supplementation for preterm infants. AIMS: To assess the effect of three different doses of vitamin D supplementation (400, 800 and 1000IU/d) in preterm infants ≤32weeks gestation on the prevalence of vitamin D deficiency and 25(OH) D levels at 36weeks postmenstrual age (PMA). STUDY DESIGN: Prospective randomized trial. SUBJECTS: 121 preterm infants with gestational age of 24-32weeks were randomly allocated to receive 400, 800 or 1000IU/d vitamin D. OUTCOME MEASURES: Serum concentration of 25(OH) D and the prevalence of vitamin D deficiency at 36weeks PMA. Vitamin D deficiency was defined as serum 25(OH) D concentrations <20ng/ml. RESULTS: Of the 121 infants 72% had deficient vitamin D levels before supplementation. The average 25(OH) vitamin D concentrations at 36weeks PMA were significantly higher in 800IU (40±21.4ng/ml) and 1000IU group (43±18.9ng/ml) when compared to 400IU group (29.4±13ng/ml). The prevalence of vitamin D deficiency (2.5 vs 22.5; RR: 0.09; CI:0.01-0.74) and insufficiency (30 vs 57.5; RR:0.32; CI:0.13-0.80) was significantly lower in 1000IU group when compared to 400IU group at 36weeks PMA. CONCLUSION: 1000IU/d of vitamin D supplementation in preterm infants ≤32weeks gestation age effectively decreases the prevalence of vitamin D deficiency and leads to higher concentrations of 25(OH) vitamin D at 36weeks PMA TRIAL REGISTRATION: Clinical Trials.gov: NCT02941185.