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    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
    (BMJ Publishing Group, 2026) Bas, Ahmet Yagmur; Koc, Esin; Unal, Sezin; Hirfanoglu, Ibrahim Murat; Arslan, Zehra; Gundogdu, Semra; Iyigun, Fatma
    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. © Author(s) (or their employer(s)) 2026.
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    An Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosus
    (Frontiers Media Sa, 2020) Okulu, Emel; Erdeve, Omer; Arslan, Zehra; Demirel, Nihal; Kaya, Huseyin; Gokce, Ismail Kursad; Ertugrul, Sabahattin
    No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7)and 28(6/7)weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 +/- 1.4 weeks and 926 +/- 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (>= Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p> 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80,p= 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92,p= 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p= 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.