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Objectives: To evaluate the clinical characteristics, complication rates, and predictors of adverse outcomes related to peripherally inserted central catheters (PICC) in newborns over a seven-year period in a tertiary neonatal intensive care unit (NICU). Materials and Methods: This retrospective observational study included all neonates who underwent their first PICC placement between January 2017 and January 2024 in a single tertiary NICU. Demographic, clinical, and procedural data were collected, including birth weight, gestational age, catheter type, insertion site, dwell time, and reason for removal. Primary outcomes were PICC-related complications and catheter dwell time. Statistical analyses included chi-square or Fisher’s exact tests, Student’s t-test or ANOVA, and multivariable logistic regression to identify independent predictors of complications. Results: A total of 610 PICCs were evaluated. The mean gestational age was 31.0 ± 4.7 weeks, and the mean birth weight was 1579 ± 870 g. The majority of catheters (96.1%) terminated at the central location, with a mean dwell time of 12.9 ± 9.0 days. The most common removal reason was completion of therapy (60.3%), followed by mechanical complications (36.7%) and suspected infection (14.6%). Overall complication rate was 34.9%. In multivariable analysis, birth weight > 1000 g was associated with a lower risk of complications compared to <1000 g (1000–1500 g: OR 0.35, 95% CI 0.22–0.56; 1500–2000 g: OR 0.29, 0.15–0.54; >2000 g: OR 0.44, 0.21–0.92). Midline (OR 4.16, 1.76–9.83) and peripheral (OR 3.51, 1.82–6.76) terminations carried higher risk compared to central terminations. Use of antimicrobial-impregnated catheters reduced complication risk (OR 0.44, 0.26–0.74), while temporal vein insertion increased it (OR 4.14, 1.23–13.86). Conclusions: Low birth weight (<1000 g) and non-central catheter tip location are significant predictors of PICC-related complications in neonates, while antimicrobial-impregnated catheters have a protective effect. Targeted preventive strategies, strict adherence to insertion and maintenance bundles, and careful patient selection are recommended to improve outcomes in NICU patients.

Background: The aim was to describe reference values of oxygen saturation (SpO2) and heart rate (HR) in preterm infants immediately after birth. Methods: The preterm (< 35 gestational age) infants who did not require any intervention were included in the study. The recordings were taken by pulse oximetry during the first 15 minutes of life. Results: Totally 151 infants were analyzed. At 1 minute, the median (IQR) preductal SpO2 and HR were 61% (57 - 66) and 100 (90 - 107.3) bpm, rising at 5, 10 and 15 minutes to 80% (75 - 84) and 155 (142 - 164) bpm, 90% (88 - 92) and 155 (150 - 160) bpm, 96% (94 - 98) and 155 (149 - 162) bpm respectively. Conclusions: Oxygen saturation levels of preterm infants in delivery room are lower than reported in NRP guidelines. Clinicians who use pulse oximetry in HR follow up of premature babies should know HR may be < 100 bpm in first minutes of life and should avoid unnecessary positive pressure ventilation.

AimThe aim of this study was to evaluate the efficacy of CRP/Albumin ratio in predicting the need for surgical treatment and mortality in preterms whose gestational age <32 weeks with NEC.Material and MethodIn our study, infants between 1–28 days of gestation with a gestational age <32 weeks who were admitted to the neonatal clinic between January 1, 2015 and October 1, 2022 and diagnosed with NEC were included. General patients demographics, epidemiologics, clinical and laboratory parameters were recorded. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal predictive values of CAR.ResultsOf the 81 patients, 54% had a birth weight of ≤1000 g and 49% were born at ≤28 weeks of gestation. Twent-one (26%) patients were operated for NEC and the mortality rate was 31%. CRP/ALB ratio of ≥0,73 on day 2 [AUC 0,67 (95% CI 0,54–0,81); p=0,009] and ≥1,66 on day 3 [(AUC 0,66 (95% CI (0,53–0,79); p = 0,014] of NEC diagnosis found to be statistically significant in predicting for surgery. CRP/ALB ratio of ≥2,88 on day 1 [(AUC 0,69 (95% CI 0,57–0,82); p=0,002], CRP/ALB ratio of ≥3,15 on day 2 [(AUC 0,78 (95% CI 0,67–0,89); p<0,001], and CRP/ALB ratio of ≥1,72 on day 3 [(AUC 0,76 (95% CI 0,65–0,88); p=0,001] was found a significantly good predictive value for mortality. We showed that patients with NEC stage 2–3 were 23 times more likely to undergo surgery than patients with NEC stage 1 and hyponatremia, gestational week and length of hospital stay also affected mortality.ConclusionsC-reactive protein/albumin ratio is an useful and easily measured parameter with a good sensitivity in predicting the need for surgical treatment and mortality in necrotizing enterocolitis.

AimPain awareness in the neonatal clinic is a medical and ethical problem that has become increasingly important in recent years. Exposure to repetitive painful procedures in the newborn, during the period when the brain develops rapidly and stress perception systems are organized, causes excessive neural activity and somatosensory changes. This situation can cause neurodevelopmental and behavioral problems in the long term. Objective scoring systems such as PIPP, N-PASS, COMFORTneo, CRIES are used in the evaluation of pain in newborns. In this study, we aimed primarily to evaluate pain awareness in healthcare professionals working in the neonatal clinic, and secondarily to determine the trainings to be provided and the precautions to be taken on this subject.Material and MethodOur study was planned as single-centered and prospective. The questions used in the evaluation were created according to pain guidelines. It was conducted with 40 questions in 3 categories: demographic data, pain awareness and precautions. Surveys were created via Google forms. Our study was approved by the Sisli Hamidiye Etfal Clinical Research Ethics Commission.Results124 healthcare professionals participated in our study. 102 (84%) of the participants were women, 78 (63%) were doctors and 46 (37%) were nurses. When the answers were assessed, 95% of the participants stated that they knew that the newborn feels pain, 96% of them evaluated vascular access procedures as a painful procedure, 56% did not know how to use pain scales, and 14% stated that they were inadequate regarding pain-related measures (figure 1).Abstract OP-086 Figure 1Sharing some data through the pain awareness assessment survey.ConclusionsIn the neonatal unit, although there is pain awareness through the patients treated, all employees should receive repetitive training on pain, and clinic-based pain guides and algorithms should be developed in addition to general guides.

AimAcute appendicitis in newborns is rare and can be fatal. The incidence of the disease is reported as 0.04%-0.2%. Because neonatal appendicitis does not have any specific clinical findings, it is considered as an exclusion diagnosis. Appendix perforation is a common complication in diagnosed patients with a high mortality rate and its treatment is surgery. In our study, our neonatal appendicitis case, who came to our emergency department on the 8th postnatal day with bilious vomiting, circulatory dysfunction, and shock, is presented with a literature review.Material and MethodA female newborn with Down syndrome was admitted to our emergency department with the complaint of fekaloid vomiting and deterioration in her condition (figure 1). It was learned that she was brought to hospital because she had abdominal distension and intermittent vomiting for about 2 days, and there was no urine output for the last 24 hours. While no distal air passage was observed in the patient‘s standing direct abdominal radiograph, an abdominal computed tomography scan was performed upon the preliminary diagnosis of ileus, and the diagnosis was confirmed.Abstract OP-114 Figure 1The patient‘s fecaloid vomiting at the emergency department admission and perforated appendicitis seen during the operation.ResultsThe patient, who was taken into operation after consulting with the pediatric surgeon, was evaluated as perforated neonatal appendicitis (figure 1).ConclusionsRecent publications regarding neonatal appendicitis are generally written on isolated cases. Large case series can rarely be collected. A total of 141 cases were reported in the literature between 1905 and 2000. Although neonatal appendicitis occurs at the same rate in premature and term babies, the mortality rate was reported to be 28% in a study published in 2003. Diagnostic tools are also limited in neonatal appendicitis. X-ray gives clear information after perforation. Computed tomography can provide specific findings in patients. In the management, classical laparotomy and peritoneal lavage are performed. The most important management issue in these patients is early diagnosis and treatment with the least amount of invasive procedures.

Abstract Context Limited data are available on the exact incidence of disorders of sex development (DSD) with genital ambiguity at birth. Objective To determine frequency of ambiguous genitalia in newborns. Design Prospective multicenter study. Setting Three tertiary care hospitals. Patients or Other Participants All 14,177 babies born during the study period were included. Main Outcome Measures All newborns were examined at birth; data on weeks of gestation, birth weight, and length were collected. A structured questionnaire was used for data collection. Quigley and Prader scales were used for phenotypic grading. Clinical and genetic investigations were performed. Results Eighteen babies with ambiguous genitalia were found among 14,177 newborns (1.3/1000). Fifteen newborns had 46,XY DSD, one had 46,XX congenital adrenal hyperplasia, and one had 45,X/46,XY mixed gonadal dysgenesis. Karyotype analysis was not done in one baby who died in the neonatal period. The ratio of prematurity was higher in the DSD group (44% vs 11%; P < 0.001) and the ratio of small for gestational age was also higher in the DSD group (22% vs 5%; P = 0.007). Eight babies with DSD had mothers who had additional medical conditions, such as preeclampsia, depression, insulin resistance, and gestational diabetes mellitus. Conclusion The frequency of ambiguous genitalia was higher than in previous studies, but, as with any experiment, the finding should be met with caution because this study was conducted in tertiary care hospitals. In addition, lower birth weight in the DSD group supports the hypothesis that early placental dysfunction might be important in the etiology of male genital anomalies.

Background We aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement. Methods The study was planned cross-sectional to be carried out between April–May 2015 in Turkey. A questionnaire form that determined the participants’ opinions and practices concerning vitamin D supplement was completed via face-to-face interview. Results A total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) ( p  = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%). Conclusions The present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health.

Urticaria is one of the most common dermatoses during the childhood, but it is very rare in the neonates. A 17-day-old infant with a generalized urticaria was admitted to our pediatric emergency unit. The mother of the infant reported having applied water boiled with stinging nettle ( Urtica dioica ) onto her nipples twice a day (before and after each breastfeeding) for 2 days in order to heal her nipple cracks. Serum total immunoglobulin E (IgE) and specific IgE levels for stinging nettle were high in the infant and the mother. The rashes began to regress within the first day of the hospitalization and disappeared completely on the second day without treatment. The skin prick test with the water boiled with stinging nettle was positive for the infant with significant induration, but not for the mother. Conclusion Reporting the first urticaria case in newborns due to stinging nettle, the authors suggest that breastfeeding mothers should always consult a physician before using skincare products.