Sürdürülebilir Kalkınma Amaçları

• 3

• MakaleAçık Erişim2026Scopus SJRQ1/r/kostu/10341
  Evaluation of the frequency, risk factors and outcomes of ROP in preterm infants with a BW >1500 g or GA >32 weeks in Turkiye (TR-ROP 2) and medicolegal fears: a Turkish Neonatal Society multicentre study

  Bas, Ahmet Yagmur; Koc, Esin; Unal, Sezin; Hirfanoglu, Ibrahim Murat; Arslan, Zehra; Gundogdu, Semra; Iyigun, Fatma; Kale, Yusuf; Tanrıverdi, Sema; Mutlu, Birgul

  Background This study aimed to evaluate the prevalence and risk factors of retinopathy of prematurity (ROP) in preterm infants with a birth weight (BW)>1500 g or gestational age (GA) >32 weeks in Turkiye. Methods A prospective cohort study (TR-ROP 2) was conducted in 80 neonatal intensive care units between 30 September 2023 and 1 November 2024. Infants with a BW >1500 g or GA >32 weeks who had an unstable clinical course or were deemed at risk for ROP were included. The effect of medicolegal concerns on the decision to screen was also evaluated. Results The study included 4140 infants at risk for ROP development; 242 (5.8%) developed any stage of ROP, and 17 (0.4%) developed severe ROP requiring treatment. Risk factors independently associated with ROP included lower GA and BW, being small for GA, red blood cell transfusion, oxygen therapy >5 days, mechanical ventilation >1 day, early neonatal sepsis (ENS) with comorbidities or presence of ≥3 comorbidities (excluding ENS). Of those with BW ≥2000 g, 31.4% were screened for medicolegal reasons; 2.2% developed ROP, but none had severe ROP. Conclusions ROP in mature infants is rare but can occur in the presence of multiple risk factors. Medicolegal concerns may contribute to overscreening. Developing evidence-based, risk-adapted screening guidelines is essential to ensure appropriate care without unnecessary interventions.

  • 
  AtıfScopus3·OpenAlex3

  İncele
• MakaleAçık Erişim2026Scopus SJRQ1/r/kostu/10274
  Alternative diagnoses in neonates undergoing therapeutic hypothermia for presumed hypoxic–ischemic encephalopathy

  Donmez, Tugrul; Serce Pehlevan, Ozge; Gunlemez, Ayla

  Background – Early identification of hypoxic–ischemic encephalopathy (HIE) remains challenging during the first hours of life, and therapeutic hypothermia (TH) is often initiated before the underlying diagnosis can be established. Objective – The primary aim of this work is to compare the clinical characteristics, laboratory findings, and short-term outcomes of neonates treated with TH for presumed HIE according to their predominant underlying diagnosis. Methods – We retrospectively reviewed all neonates who received TH for suspected HIE between 2019 and 2023. Infants were categorized according to the predominant underlying diagnosis identified following comprehensive clinical, neurophysiological, neuroimaging, metabolic, genetic, and subspecialty evaluations. Demographic, clinical, neurologic, and laboratory parameters—including inflammation- and oxidative stress-related indices—were compared between groups. Results – Among 92 neonates treated with TH, nine (10%) were subsequently found to have non-hypoxic–ischemic etiologies of neonatal encephalopathy. Baseline neurological severity assessed by Sarnat staging and initial amplitude-integrated electroencephalography patterns did not differ between groups. However, infants in the non-HIE group demonstrated significantly higher rates of myocardial injury (77% vs. 22%, p < 0.001) and severe thrombocytopenia (66% vs. 25%, p = 0.016). These infants also had substantially longer hospitalizations [median (25P–75P): 28 (17–38) vs. 7 (5–11) days, p = 0.002] and higher mortality rates (55.6% vs. 6%, p = 0.001). The median day of death was earlier in the non-HIE group [median (25P–75P): 3 (1–57) vs. 16 (8–77) days; p = 0.30]. However, it was not statistically significant. Inflammatory and oxidative stress indices did not differ significantly between groups. Conclusion – Approximately 10% of neonates undergoing therapeutic hypothermia for presumed HIE were ultimately found to have non-hypoxic–ischemic causes of neonatal encephalopathy despite similar early neurologic presentations. These infants experienced greater systemic morbidity and poorer short-term outcomes. While the small and heterogeneous non-HIE cohort warrants cautious interpretation, disproportionately severe systemic manifestations—particularly myocardial injury and thrombocytopenia—may represent early clinical clues prompting broader diagnostic evaluation beyond hypoxic–ischemic injury.

  • 
  İncele
• MakaleAçık Erişim2025/r/kostu/10898
  Factors affecting mortality in cases of perinatal asphyxia treated with hypothermia; A 10-year experience: A retrospective cohort study

  Günlemez, Ayla; Dönmez, Tuğrul; Pehlevan, Ozge Serce

  Aim: Birth asphyxia and intrapartum brain injury can cause death or irreversible brain damage. The only known treatment that improves prognosis is therapeutic hypothermia. Our goal was to assess the parameters associated with death in newborns receiving therapeutic hypothermia. Materials and Methods: This retrospective cohort study was conducted in a neonatal intensive care unit (NICU) and included neonates who underwent therapeutic hypothermia due to perinatal asphyxia over 10 years. Patients were categorized into survivors and nonsurvivors based on their in-hospital outcomes. Demographic characteristics, clinical parameters, laboratory findings, and complications were retrieved from the patients’ medical records. Prognostic factors were compared between groups using appropriate statistical methods, and multivariate logistic regression was performed to identify independent predictors of mortality. Results: A total of 114 newborns treated with therapeutic hypothermia were analyzed, of whom 11 (9.6%) died due to perinatal asphyxia (PA). Non-survivors had significantly lower gestational ages (37±2 vs. 38.4±1.6 weeks, p=0.042), lower 5-minute Apgar scores (5 [1--5] vs. 5.5 [4--7], p=0.048), and higher cesarean delivery rates (81.8% vs. 41.7%, p=0.011). Severe findings on aEEG and Sarnat Stage III were more common among nonsurvivors (p<0.001 for both). Nonsurvivors also exhibited significantly lower admission rectal temperatures [33.8°C (32--36) vs. 35.8°C (34.5--36), p=0.023], higher rates of thrombocytopenia (81.8% vs. 42.7%, p=0.013), acute renal failure (90.9% vs. 39.8%, p=0.001), and cranial ultrasound abnormalities (27.3% vs. 3.9%, p=0.019). In the multivariate logistic regression analysis, only a lower rectal temperature at admission remained an independent predictor of mortality (OR: 1.520, 95% CI: 1.061--2.178, p = 0.023). Conclusion: Factors such as lower Apgar scores, acute renal failure, and hypothermia severity on admission are strongly associated with mortality. The early identification and management of these risk factors are critical for improving outcomes in neonates treated with therapeutic hypothermia.

  • 
  İncele
• Kitap BölümüYalnız künye2025/r/kostu/10721
  Antiepileptic Drugs

  Donmez, Tugrul

  The neonatal period is a critical phase for brain development, marked by rapid growth and increased vulnerability to neurological disorders. Neonatal epilepsy, characterized by recurrent, unprovoked seizures, presents a significant challenge due to its diverse etiologies, including genetic factors, congenital anomalies, infections, and metabolic disorders. This chapter provides a comprehensive overview of the causes, diagnostic methods, and management strategies for neonatal epilepsy. Genetic abnormalities, such as lissencephaly and Ohtahara syndrome, can lead to severe seizures, while congenital brain malformations and perinatal injuries contribute significantly to the condition. Prenatal and postnatal infections, including those in the TORCH complex, as well as metabolic imbalances such as hypoglycemia and hypocalcemia, also play crucial roles in seizure onset. Accurate diagnosis involves a multidisciplinary approach including clinical assessment, electroencephalography, imaging techniques, and metabolic tests. Treatment requires a careful balance of efficacy and safety, with medications such as phenobarbital, levetiracetam, and vigabatrin offering various benefits and risks. Management strategies must account for the neonate's unique physiological characteristics and developmental needs. Future directions in neonatal epilepsy treatment focus on advancing pharmacological therapies, exploring non-pharmacological interventions, and utilizing personalized medicine approaches. Ongoing research aims to improve treatment outcomes and minimize long-term developmental impacts for affected infants.

  İncele