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Background: Thyroid hormone dysregulation is a well-recognized consequence of cardiopulmonary bypass (CPB), particularly in neonates undergoing congenital heart surgery. Triiodothyronine (T3) plays a crucial role in maintaining cardiovascular stability, and an early decline in serum levels may adversely impact clinical outcomes. This study aimed to evaluate perioperative thyroid hormone changes and their association with morbidity and mortality. Methods: We retrospectively analyzed 132 neonates who underwent congenital cardiac surgery with CPB between January 2021 and June 2024. Serum free T3 (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured preoperatively and within one hour after admission to the cardiac intensive care unit. Demographic, clinical, and surgical variables were recorded. Associations between thyroid hormone levels and postoperative outcomes, including in-hospital mortality, ventilation duration, vasoactive-inotropic score (VIS), and length of stay, were assessed using correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis. Results: Postoperatively, both FT3 and TSH levels declined significantly (p < 0.01), while FT4 levels remained unchanged. Lower postoperative FT3 levels were negatively correlated with prolonged invasive mechanical ventilation (rho = −0.196, p = 0.029) and longer hospital stay (rho = −0.183, p = 0.042). Overall mortality was 7.6% (n = 10). Non-survivors had significantly lower postoperative FT3 levels compared with survivors (p = 0.001). In multivariable logistic regression, postoperative FT3 was independently associated with mortality (OR = 0.22, 95% CI 0.05–1.03, p = 0.048). ROC analysis demonstrated good predictive performance of postoperative FT3 for mortality (AUC = 0.818), with an optimal cutoff of 2.17 pg/mL (sensitivity 72%, specificity 70%). Conclusions: Early postoperative suppression of FT3 is common after CPB in neonates and is independently associated with increased mortality and adverse short-term outcomes. Early assessment of thyroid function, particularly FT3, may provide valuable prognostic information and aid in risk stratification in this high-risk population.

The aim of the study was to examine and compare hepatitis A seropositivity in children. The study included patients aged 0-18 years who presented to our hospital and were examined for hepatitis A virus serology between 2009 and 2018. Patients were separated into 2 groups: those who presented before (group I) or after (group II) September 2012, when the mandatory hepatitis A vaccination program came into effect in Turkey. In total, 34 809 patients were evaluated: 20 111 (57.8%) males and 14 698 (42.2%) females, with a mean age of 8.2 ± 5.3 years. Anti-hepatitis A virus immunoglobulin M positivity was observed in 3.3% of patients, most often in January and from January to April when the region experiences more rainfall. Anti-hepatitis A virus immunoglobulin M positivity decreased dramatically in group II compared to group I (0.26% vs. 7.42%, P < .001). Anti-hepatitis A virus immunoglobulin G positivity was observed in 53.8% of all patients. A statistically significant increase was determined in anti-hepatitis A virus immunoglobulin G seropositivity in group II compared to group I (81.9% vs. 42.1%, P < .001). Hepatitis A virus infection in Turkey decreased dramatically following improvements to infrastructure and sanitation and implementation of the vaccination program. This study is the most comprehensive report of hepatitis A seropositivity in Turkey to date.

Double-chambered left ventricle (DCLV) is a rare congenital abnormality in which the left ventricle is divided into two separate chambers by a septum or anomalous muscular structure. The chambers are observed mostly parallel to each other without stenosis, and less frequently in a superior-inferior arrangement. An asymptomatic girl is presented here who was diagnosed with DCLV on echocardiographic examination that was performed for the evaluation of cardiac murmur detected by a pediatrician. She has been followed up without treatment.

The objectives of the study were to assess folate deficiency in patients with classic galactosemia, and to determine whether folic acid supplementation has an effect on galactose-1-phosphate uridyltransferase enzyme activity. Sixty-one newborn infants diagnosed with classic galactosemia between 2010 and 2017 were retrospectively evaluated. Within this group, 48 patients with Q188R homozygous mutation alone were enrolled into the study. Serum folate concentration was studied using chemiluminescence; and in folate deficient patients, galactose-1-phosphate uridyltransferase measurements before and after folic acid supplementation (100 mg/day folic acid for 30 days) were performed using an enzymatic calorimetric measurement technique based on kinetics. The serum folate level was low ( < 4 ng/ml) in 12 patients (25%). The galactose-1-phosphate uridyltransferase enzyme activity after folic acid supplementation was significantly higher than the values before folic acid supplementation (1.00±0.19 U/g Hb vs. 0.74±0.23 U/g Hb, p < 0.05); but was still less than the normal levels. Folate deficiency, most likely due to poor dietary intake, may develop in pediatric patients with classical galactosemia, and folic acid should be supplemented. Folic acid supplementation appears to have a low, but statistically significant, effect on galactose-1-phosphate uridyltransferase enzyme activity, but comprehensive research is needed to clarify whether there is any clinical significance.

Hypoxic-ischemic encephalopathy (HIE) continues to be a predominant cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) is the only method with proven neuroprotective effects, and the aim of this study was to evaluate the short-term results of patients treated with TH. Demographic, clinical characteristics, laboratory and aEEG results of patients who received TH treatment with a diagnosis of Stage II or Stage III HIE according to modified Sarnat staging in the Neonatal Intensive Care Unit were analyzed retrospectively. A total of 101 patients were included in the study. The mean gestational age of the patients was 38.8±1.5 weeks, the mean birth weight was 3215±499.5 g, and 40.6% were female. According to the modified Sarnat staging, 50.5% of the patients were evaluated as Stage II, and the others as Stage III HIE. The most common peripartum risk factors were meconium delivery (25.7%) and prolonged or difficult labor (20.7%). Mortality rates in patients with Stage II and Stage III HIE were 5.9% and 26%, respectively. In one of the patients who died, the 6th-hour aEEG background activity was moderately abnormal, and in 15 patients there was a severely abnormal voltage pattern. Acute kidney injury was found to be the most effective factor in mortality. In our study, it was concluded that the mortality rate of newborns diagnosed with Stage III HIE was higher, the biggest impact factor on mortality was acute kidney injury, and 6th-hour voltage activity in aEEG monitoring was useful in predicting prognosis.

Background: Congenital heart disease (CHD) refers to malformations of the heart or great vessels that occur during the intrauterine period. Critical CHD refers to heart conditions that require medical intervention or surgical procedures in the early stages of life. Methods: In this retrospective cohort study, newborns aged 0 to 28 days who were admitted to the Neonatal Intensive Care Unit and the Pediatric Cardiovascular Surgery Clinic of our hospital with a diagnosis of critical CHD between January 2019 and September 2024 were evaluated. Results: Among 160 patients, 52 (32.5%) had a prenatal diagnosis. Overall mortality was significantly higher in the prenatally diagnosed group compared to the postnatally diagnosed group (51.9% vs. 19.5%, p < 0.001). However, in the subgroup of patients with hypoplastic left heart syndrome (HLHS), pulmonary atresia (PA), or aortic arch anomalies (n = 67), prenatal diagnosis was associated with significantly lower mortality (38.9% vs. 68.8%, p = 0.018). Multivariate logistic regression identified prenatal diagnosis (OR 3.11, 95% CI 1.37–7.06), presence of the above high-risk lesions (OR 3.29, 95% CI 1.25–8.67), and lower birth weight (per 1 kg, OR 2.09, 95% CI 1.13–3.88) as independent predictors of mortality. Conclusions: In this cohort, the overall higher mortality among prenatally diagnosed patients reflects a higher proportion of complex lesions (e.g., HLHS) in that group. Nevertheless, within the high-risk subgroup of HLHS, PA, and aortic arch anomalies, prenatal diagnosis was associated with a significant survival benefit. These findings suggest that the impact of prenatal diagnosis on mortality is lesion-specific and confounded by disease severity. Future multicenter prospective studies with larger, homogeneous populations are needed to clarify the true effect of prenatal diagnosis on outcomes.

Several recent studies have reported that toxic metabolites accumulated in the body as a product of inborn errors of metabolism (IEM) are eliminated more rapidly with continuous venovenous hemodiafiltration (CVVHDF) than with peritoneal dialysis (PD). However, there is still uncertainty about the impacts of dialysis modalities on the short-term outcome. Here, it was aimed to investigate the effects of dialysis modalities on the short-term outcome. This retrospective study included 40 newborn infants who underwent PD (29 patients) or CVVHDF (11 patients) due to inborn errors of metabolism at a tertiary centre, between June 2013 and March 2018. The outcomes and the potential effects of the dialysis modality were evaluated. Of 40 patients, 21 were urea cycle defect, 14 were organic academia, and 5 were maple syrup urine disease. The median 50% reduction time of toxic metabolites were shorter in patients treated with CVVHDF (p < 0.05). Catheter blockage was the most common complication observed in PD group (24.1%), whereas in CVVHDF group hypotension and filter blockage were more common. There was no significant difference in mortality between dialysis groups (38% vs. 45.4%, p > 0.05). In patients with hyperammonaemia, duration of plasma ammonia > 200 μg/dL was the most important factor influencing mortality (OR 1.05, CI 1.01–1.09, p = 0.007).Conclusion: This study showed that CVVHDF is more efficient than PD to rapidly eliminate toxic metabolites caused by IEM in newborn infants, but not in improving survival.What is Known:•Toxic metabolites are eliminated more rapidly with CVVHDF than with PD.•Higher complication rates were reported with rigid peritoneal catheters in PD and catheter blockage in CVVHDF.What is New:•Prolonged duration of plasma ammonia levels above a safe limit (200 μg/dL) was associated with increased mortality.•Lower catheter-related complication rates may have been associated with the use of Tenckhoff catheters in PD and the use of right internal jugular vein in CVVHDF.

We aimed to evaluate the demographic, clinical, and laboratory findings and the management of newborns with hypernatremic dehydration (HDH). A total of 85 term newborns with serum sodium (Na) levels higher than 145 mEq/L who admitted to our hospital between January 2011 and December 2018 were included in this study. Among all cases, 54.1% were female infants with the mean birth weight, weight loss ratio, and median age at diagnosis of 3095 ± 540 g, 13.6 ± 10%, and 8 (2-24) days, respectively. The most common presenting complaints were breastfeeding difficulties (90.5%), fever (63.5%), decreased urination (43.5%), jaundice (22.3%), and convulsion (15.3%). The mean sodium and potassium, and median blood urea and creatinine levels on admission were 167.9 ± 13.4 mEq/L, 5.4 ± 2.8 mmol/L, 213 mg/dL (11-476 mg/dL), and 2.4 mg/dL (0.52-9.96 mg/dL), respectively. There was metabolic acidosis in 67% and acute renal failure in 74.4% of patients, while peritoneal dialysis was performed in 12 of them. There was a positive correlation between weight loss ratio and admission age, serum urea, and creatinine levels; there was a negative correlation between weight loss and blood pH. Eight patients died (9.4%). In our study, serum urea, creatinine, potassium, metabolic acidosis levels, convulsion, and dialysis requirements at the time of admission of the newborns with HDH were found to be higher in those who died compared to those who survived. Convulsion was a presenting complaint, and it was also observed during the treatment.

Background: Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure. We aimed to compare the effect, success, and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants. Methods: We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021. These patients underwent balloon aortic valvuloplasty, balloon coarctation angioplasty, ductal stenting, diagnostic procedures for aortic arch pathologies, and modified Blalock-Taussig in-shunt intervention. Patients were divided into two groups: femoral puncture (group = 1) and carotid cut-down (CC, group = 2). Results: Seventy-two catheterization procedures were performed in 64 patients; 32 (44.4%) were performed via the femoral approach and 40 (55.6%) were performed via the carotid approach. Sixteen (22.2%) procedures were diagnostic and 56 (77.8%) procedures were interventional. CC was performed in 13 (32.5%) patients with failed femoral intervention. Patients in the CC group had shorter durations of procedure, vascular access, and anesthesia, compared with the femoral access group (80.9 and 116.2 min, p = 0.001; 12.9 and 22.5 min, p = 0.001; 140.9 and 166.6 min,p = 0.001, respectively). Patients who underwent CC had fewer complications than did patients in the femoral access group (2.5% and 21.8%, respectively; p = 0.01); larger sheats were used in CC patients (p = 0.028).Conclusion: The carotid artery can be successfully used as a primary catheterization route, particularly in patients with small body weight and patients who require rapid vascular access, or stenting of the vertical duct.

In this study, we aimed to compare the femoral route and the carotid artery route in terms of procedural success of ductal stent implantation in patients with ductdependent pulmonary blood flow. The study included 51 patients with duct-dependent pulmonary circulation who underwent ductal stent implantation upon their admission to our clinic between July 2017 and March 2021. In total, 23 patients (group I) underwent ductal stent implantation via the femoral route, while the remaining 28 (group II) underwent the procedure via the carotid artery. The groups were compared in terms of procedural success, time, post-procedural blood pH, lactate levels, and complications. Duct morphology was observed in group 1 as follows: type 1 in 12 patients, type 3 in 8, type 2 in 2, and type 6 in 1 patient. In group 2, 26 patients had type 3, 1 had type 2, and 1 had type 6. The tortuosity index of the patients in group 1 was 1 in 8 patients, 2 in 8 patients, and 3 in 7 patients, while in group 2, it was 1 in 5 patients, 2 in 15 patients, and 3 in 8 patients. The success rate was 69.6% (16/26) in group I and 93.5% (29/31) in group II (P=.030). The cumulative success rate was 88.2% (45/51). The procedural durations were 78.2 ± 34.1 and 52.1 ± 22.0 minutes in group I and group II, respectively (P=.002). The mean blood pH values upon the completion of the procedure were 7.26 ± 0.1 and 7.33 ± 0.0 in group I and group II, respectively (P=.038). The mean post-procedural lactate levels were 2.8 mmol/L and 2.3 mmol/L in group I and group II, respectively (P=.038). The 2 groups did not show any differences in terms of procedural complications. The carotid artery route can be preferred, especially in vertical and tortuous ductus arteriosus, as it is associated with a high success rate and a short procedural time, as well as a better metabolic condition after the procedure.