Possible role of asymmetric dimethylarginine (ADMA) in prediction of perinatal outcome in preeclampsia and fetal growth retardation related to preeclampsia

Objective: The objective of this study is to investigate maternal serum and neonatal umbilical cord asymmetric dimethylarginine (ADMA) levels in prediction of perinatal prognosis in pregnancies with preeclampsia (PE) and fetal intrauterine growth retardation (IUGR) accompanying PE (PE?+?IUGR).

Methods: Maternal serum ADMA (msADMA) and neonatal umbilical cord ADMA (ucADMA) levels were studied from 34 patients with PE, 25 patients with PE?+?IUGR, and 30 healthy pregnant controls in this prospective case–control study. Umbilical artery Doppler indices of fetuses, birth weights, Apgar scores, umbilical artery pH measurements of neonates, and admissions to neonatal intensive care unit (NICU) were recorded.

Results: Median msADMA was significantly higher in PE and PE?+?IUGR groups (p?=?0.024 and p?=?0.011, respectively), and ucADMA was significantly higher in PE and PE?+?IUGR groups than the control group (p?=?0.029 and p?=?0.018, respectively). Median msADMA and ucADMA levels were significantly higher in the PE?+?IUGR group than the PE group (p?=?0.019 and 0.021, respectively). ucADMA levels did not correlate with fetal umbilical arterial blood flow neither in the PE nor in the PE?+?IUGR group (p?=?0.518 and p?=?0.892, respectively). None was related with neonatal umbilical artery pH or NICU admission rates.

Conclusions: msADMA and ucADMA correlated with severity of PE. msADMA and ucADMA failed to predict perinatal outcome in patients with PE and PE?+?IUGR.     

Preterm meconium-stained amniotic fluid is an ominous sign for the development of chorioamnionitis and for in utero cord compression

Purpose: Meconium-stained amniotic fluid (MSAF) is rarely observed in preterm pregnancies, and its clinical significance is undetermined. We evaluated the correlation between MSAF and obstetrical and perinatal complications prior to 34 weeks’ gestation.

Materials and methods: Pregnancies complicated with MSAF between 24 and 34 weeks of gestation were compared with same gestational age-matched controls. The variables measured were: obstetrical complications: clinical chorioamnionitis, Intrahepatic Cohlestasis of Pregnancy – ICP, Intra Uterine Growth Restriction – IUGR, preeclampsia, gestational diabetes; nonobstetrical complications; and perinatal complications: cord around neck/body, Apgar <7 at 5?min, cord pH, Neonatal Intensive Care Unit – NICU admission, complications during NICU hospitalization, and composite outcome.

Results: Higher incidence of clinical chorioamnionitis (15% versus 4.3%; p?=?0.041) and higher incidence of cord around the neck/body were found in the MSAF group in comparison with the clear AF group (27.4% versus 18.4%; p?=?0.04). No significant differences between the study’s groups were found in nonobstetrical complications or other perinatal complications investigated in our study.

Conclusion: MSAF in preterm pregnancy is an ominous sign for the occurrence of chorioamnionitis and for in utero cord compression. Therefore, MSAF in preterm pregnancies should be considered as a non-reassuring sign.     

Evaluation of the coronary arteries in the foetus and newborn and their physiologic significance

Abstract

Objective: To review the current literature addressing the visualisation and clinical applicability of coronary artery blood flow in various foetal and neonatal settings.

Method: We reviewed original research papers, commentaries and review articles which studied the usefulness of coronary flow assessments in the growth restricted foetus, healthy neonates and neonates with clinical conditions such as asphyxia, congenital heart disease and post-surgical duct ligation myocardial failure.

Results: Relevant literature showed that visualisation of coronary blood flow in growth restricted foetuses is considered an ominous sign and identifies a subgroup of foetuses with a poorer foetal and neonatal outcome. A direct relationship between coronary blood flow and echocardiographic parameters in healthy term infants was noted. These assessments also provided useful information in infants with heart disease and perinatal asphyxia. Coronary perfusion has been noted as an important haemodynamic marker in the peri-operative evaluation of preterm infants undergoing surgical duct ligation.

Conclusions: The available literature suggests that these assessments play an important role in improving the understanding of the underlying clinical physiology of the disease process in both the foetus and the newborn. Future research should focus on the evolution of coronary blood flow in clinical situations such as hypotension and inotropic support.     

Population-based study on antenatal corticosteroid treatment in preterm small for gestational age and non-small for gestational age twin infants

Objectives: To assess the associations between antenatal corticosteroid use (ACU), mortality and severe morbidities in preterm, twin neonates and compare these between small for gestational age (SGA) and non-SGA twins.

Materials and methods: Population-based study using data collected by the Israel National Very Low Birth Weight infant database from 1995 to 2012, comprising twin infants of 24–31 weeks' gestation, without major malformations. Univariate and multivariable logistic regression analyses were performed.

Results: Among the 6195 study twin infants, 784 were SGA. Among SGA neonates, ACU were associated with decreased mortality (23.9% vs. 39.2%, p?p?=?0.0015), similar to the effect in non-SGA neonates (mortality 13.0% vs. 24.5%, p?p?P_interaction?=?0.69. Composite adverse outcome risk was also reduced in SGA (OR?=?0.78, 95% CI 0.50–1.23) and non-SGA groups (OR?=?0.78, 95% CI 0.65–0.95), P_interaction?=?0.95.

Conclusions: ACU should be considered in all mothers with twin gestation, at risk for preterm delivery at 24–31 weeks, in order to improve perinatal outcome.     

Neuronal apoptosis in the neonates born to preeclamptic mothers

Abstract

Objective: Preeclampsia may result in uteroplacental insufficiency and chronic intrauterine fetal distress. The aim of this study is to address this issue investigating neuronal apoptosis in an experimental model of preeclampsia and to evaluate the neurological outcome of the perinatal asphyxia in the neonates born to preeclamptic mother.

Materials and methods: Two out of four pregnant Sprague–Dawley rats (preeclamptic group) were given water containing 1.8% NaCl on gestation day 15 and 22 in order to establish the model of preeclampsia whereas other two (non-preeclamptic group) received normal diet. A model of perinatal asphyxia was established on the postnatal 7th day to one preeclamptic and one non-preeclamptic dam. Overall 23 pups born to overall four dams were decapitated to assess neuronal apoptosis by the TUNEL assay.

Results: The number of apoptotic neuronal cells was significantly higher in the preeclampsia groups in comparison with the control group (p?=?0.006 and p?=?0.006, respectively). It was also significantly higher in the asphyctic/non-preeclamptic group than the count in the control group (p?=?0.01). There was also significant difference between both asphyctic groups (p?=?0.003).

Conclusion: We conclude that preeclampsia causes small babies for the gestational age and cerebral hypoplasia. Both preeclampsia and perinatal asphyxia can cause increased neuronal apoptosis in the neonatal brains. However, the prognosis for neurological outcome is much worse when the perinatal asphyxia occurs in newborns born to preeclamptic mothers.     

Placental histologic patterns and neonatal seizure,in preterm premature rupture of membrane

Objective: To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM).

Methods: We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery.

Results: Mean gestational age at membrane rupture was 29.5?±?3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p?=?0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1?min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242–20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617–34.653).

Conclusions: Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.     

Maternal asthma: pregnancy course and outcome

Objective: To evaluate the association between maternal asthma and perinatal outcome.

Study design: In this retrospective population-based cohort study, all pregnancies between 1991 and 2014 in a tertiary medical center, were included. Multiple pregnancies and congenital malformations were excluded. Pregnancy course and outcomes were compared between women with and without asthma, and multivariable generalized estimating equations were used to control for confounders.

Results: During the study period, 243,363 deliveries met the inclusion criteria, 1.35% of which (n?=?3283) occurred in women diagnosed with asthma. Multiple perinatal complications were found to be associated with maternal asthma, including hypertensive disorders, preterm delivery, and cesarean delivery. However, no significant differences between the groups were noted in neonatal outcomes, including perinatal mortality rates and low Apgar scores. In the regression model, maternal asthma was noted as an independent risk factor for preterm delivery, hypertensive disorders of pregnancy, and cesarean delivery (aOR?=?1.21, 95%CI 1.1–1.4, p?=?.007; aOR?=?1.35, 95%CI 1.2–1.6, p?p?Conclusions: Maternal asthma is associated with an increased risk for adverse pregnancy outcome. This association remains significant while controlling for variables considered to coexist with maternal asthma. Nevertheless, perinatal outcome is generally favorable.     

Linoleic and arachidonic acid in perinatal asphyxia and prematurity

Objectives. Long-chain polyunsaturated fatty acids (LC-PUFA) are important for fetal and infant growth and development. The effects of prematurity and perinatal asphyxia on the levels of linoleic acid (LA) and arachidonic acid (AA) in plasma and red blood cell (RBC) membranes were investigated.

Methods. Fifty-five neonates were studied: 18 full term neonates with perinatal asphyxia (group A), nine preterm neonates (group B), and 28 healthy term neonates (group C). Non-esterified and total levels of LA and AA in plasma and RBC membranes were estimated using gas chromatography within the first day of life. Malondialdehyde (MDA) levels were measured using the thiobarbituric acid (TBA) reactivity method.

Results. Compared to group C, statistically significant lower levels of plasma free and total AA and free LA were observed in group A, whereas statistically significant higher levels of RBC total LA and AA were observed in RBC membranes of group B. A negative correlation between MDA and LC-PUFA levels was found.

Conclusion. Perinatal asphyxia is associated with a reduction in LC-PUFA levels, most likely as a result of increased oxidative stress. Premature infants soon after birth have higher LC-PUFA levels than term neonates, probably reflecting the overall metabolic activity and/or intrauterine transport of LC-PUFA.     

Vaginal delivery or cesarean section at term breech delivery – chance or risk?

Aim: The aim of the study was to examine maternal age, parity, and estimated neonatal birth weight (BW) depending on the mode of a full-term breech presentation (BP) birth delivery and neonatal outcomes.

Material and methods: One hundred and forty-six singleton term breech presentation pregnancies were included in a retrospective study conducted at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in Belgrade in 2013. Statistical analysis: Student's-t test, χ² likelihood ratio, and the Fisher's exact test. The level of statistical significance was set at p?<0.05.

Results: An ECS was the most common mode of delivery in (81.2%) nulliparous older than 35 years and most of the neonates (66.67%) with an estimated birth weight (BW) above 3500 grams were delivered by elective cesarean section (ECS). Perinatal asphyxia remained increased in the successful vaginal delivery (SVD) group (23.8%) compared with the urgent CS (UCS) group (13.3%) (p?=?0.035). Birth asphyxia was the most common in neonates were delivered by SVD (23.8%). There were no cases of perinatal deaths.

Conclusion: ECS remained the recommended mode of breech term delivery in nulliparous women older than 35 years, as well as in neonates with an estimated BW above 3500 grams.     

Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: a retrospective population-based cohort study

Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34–36?+?6/7 weeks), accounting for 60–70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries.

Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n?=?242,286), spontaneous (n?=?10,063), and medically indicated (n?=?4833) late preterm deliveries.

Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p?Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.     

Neurodevelopment in preterm infants with and without placenta-related intrauterine growth restriction and its relation to perinatal and postnatal factors

Objective: Intrauterine-growth restriction is associated with impaired neurodevelopment. However, studies on early childhood neurodevelopment of premature infants with placenta-related intrauterine-growth restriction (IUGR) are scarce and heterogeneous. We aimed to analyze the impact of placenta-related IUGR on preschool age neurodevelopment in preterm infants, and to ascertain which prenatal and postnatal factors influence neurodevelopment in these infants.

Methods: Prospective cohorts study: 48 placenta-related IUGR premature infants and 25 matched non-IUGR premature infants (mean gestational age: 31.4 and 31.6 weeks, respectively). Preschool neurodevelopment assessment with cognitive Bayley Scales III and with ASQ-III surveys (age interval: 34.07–42.50 months). Inter-cohort result comparison. Analysis of perinatal and environmental factors associated with impaired neurodevelopment in both cohorts.

Results: No statistically significant neurodevelopment differences were observed at preschool age between both preterm cohorts. Multivariate analysis of perinatal and environmental factors showed daycare, breastfeeding, higher parental educational level, and absence of severe neonatal morbidity to be associated with a lower risk of altered neurodevelopment at preschool age.

Conclusions: Placenta-related IUGR does not have a significant impact on preschool neurodevelopment in our preterm patients. Instead, post-natal positive environmental factors such as parental educational level, breastfeeding, and daycare attendance make a difference towards an improvement in neurodevelopment in these infants.     

Male disadvantage for neonatal complications of term infants,especially in small-for-gestational age neonates

Abstract

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.

Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.

Results: 37?342 singleton neonates were born ≥37 weeks’ gestation. 19?112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.

Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.     

Risk factors for necrotizing enterocolitis in very preterm infants: a case–control study in southwest China

Objective: The objective of this study is to investigate perinatal risk factors for necrotizing enterocolitis (NEC) in very preterm infants.

Methods: This retrospective study included all preterm infants with a gestational age <32 weeks attending our institution from 2013 to 2016. The NEC group comprised patients with NEC enrolled according to the inclusion criteria. Controls were selected from the database and were matched for gender, gestational age, and birth weight. Enumeration data are expressed as percentages (%) and were compared using the χ² test. Quantitative data are expressed as the mean (standard deviation) and were compared using Student’s t-test. Conditional logistic regression analyses were performed to identify the factors significantly associated with NEC.

Results: During the study period, 945 very preterm infants were admitted to the neonatal intensive care unit, of whom 46 (4.87%) acquired NEC. A total of 33 cases were enrolled in the NEC group, and 33 controls were selected from the database. Univariate analyses revealed significant differences between groups in the incidence of maternal placenta previa, neonatal infection symptoms, septicemia, and intravenous aminophylline administration (p?p?=?.043) and intravenous aminophylline (OR?=?4.922, p?=?.035) with NEC.

Conclusion: Neonatal septicemia and intravenous aminophylline use are risk factors associated with NEC development in very preterm infants.     

Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia? – a randomized controlled trial

Objective: The objective of this study is to evaluate whether therapeutic hypothermia reduces the incidence of acute kidney injury (AKI) among term neonates perinatal asphyxia.

Methods: This randomized controlled trial conducted in a tertiary care teaching hospital, south India included 120 term neonates with perinatal asphyxia who were randomized to receive either therapeutic hypothermia or standard supportive care. Renal parameters of neonates in both the groups were monitored and AKI was ascertained as per Acute Kidney Injury Network criteria.

Results: The incidence of AKI was less in therapeutic hypothermia group compared to standard treatment group (32% versus 60%, p?<?0.05). The incidence of Stages 1, 2, and 3 AKI was 22%, 5%, and 5% in therapeutic hypothermia group compared with 52%, 5%, and 3%, respectively, in the standard treatment group. The mortality was less in therapeutic hypothermia group compared with the standard treatment group (26% versus 50%, p?<?0.05).

Conclusion: Therapeutic hypothermia reduces the incidence and severity of AKI among term neonates with perinatal asphyxia.     

Outcome of preterm infants born to overweight and obese mothers†

Objectives: To evaluate perinatal morbidity and mortality among preterm neonates who were born to overweight and obese mothers compared to preterm neonates who were born to mothers with normal pre-pregnancy body mass index (BMI).

Methods: Retrospective recordings of medical charts of 110 preterm infants born to overweight (n?=?68) and obese (n?=?42) mothers at gestational age (GA) 28–34 weeks, as well as 110 controls matched for GA and birth weight. All infants were born at the Sheba Medical Center between 2007 and 2014. Data regarding maternal pre-pregnancy weight and height were recorded, as well as maternal and neonatal complications and feeding methods.

Results: Obese mothers had more pregnancy-induced hypertension (52.4% versus 21.4%, p = 0.006) and caesarean section deliveries (81% versus 52.4%, p = 0.018). Overweight mothers had more gestational diabetes (20.6% versus 2.9%, p = 0.001). The study and control groups were similar on all neonatal outcome parameters. No differences between the groups were recorded throughout hospitalization with respect to Apgar score, respiratory distress and support, hypotension, cardiac manifestations, brain pathologies, infection, feeding type and total hospitalization days.

Conclusions: Although the maternal complications are greater among obese and overweight women, it seems that preterm infants born to these women are not at increased risk for neonatal complications.     

Ultrasound measurement of fetal adrenal gland in fetuses with intrauterine growth restriction,an early predictive method for adverse outcomes

Objectives: Comparing the sonographic measurements of fetal adrenal gland in pregnancies with intrauterine growth restriction (IUGR) versus healthy controls and to assess whether the changes in adrenal gland measurements could predict adverse pregnancy outcomes in IUGR fetuses.

Methods: This prospective cohort study evaluated 97 pregnant women (48 with IUGR pregnancies and 49 healthy controls) during their third gestational trimester. All mothers underwent two dimensional ultrasonography of the fetal adrenal gland, and the fetal zone in transverse, sagittal, and coronal planes. Adrenal gland volume (AGV) and fetal zone volume (FZV) were calculated and corrected (c) for fetal weight. The mothers were then followed until delivery.

Results: Fetuses in the IUGR group had larger corrected adrenal gland volume (c_AGV) and smaller corrected fetal zone volume (c_FZV) compared to the fetuses in the control groups (p?p?Conclusions: Third trimester fetal adrenal gland sonography could potentially be used as an easy noninvasive method for identifying those IUGR fetuses who might have poorer outcomes.     

The association between histological chorioamnionitis,funisitis and neonatal outcome in women with preterm prelabor rupture of membranes

Abstract

Objective: To determine the impact of histological chorioamnionitis (HCA) and funisitis on neonatal outcome in preterm prelabor rupture of membranes (PPROM) pregnancies.

Methods: Women with PPROM between 24?+?0 to 36?+?6 weeks of gestation, admitted to the Department of Obstetrics and Gynecology at the University Hospital Hradec Kralove in the Czech Republic, between July 2008 and October 2010, were enrolled in the study (n?=?231).

Results: The incidence of early-onset sepsis (EOS) differed significantly in neonates born to women with and without HCA, after adjustment for gestational age (11% versus 1%, p?=?0.011). The incidence of EOS in neonates was also significantly different, after adjustment for gestational age, in cases with and without funisitis (18% versus 4%, p?=?0.002). The same was also found for retinopathy of prematurity (ROP) cases with and without funisitis (23% versus 4%, p?=?0.014), after adjustment for gestational age.

Conclusions: HCA and funisitis increase the risk of adverse perinatal outcome in PPROM pregnancies.     

Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants

Objective: To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia.

Method: Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis.

Results: Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR]?=?1.61), gestational age (OR?=?0.68), gestational diabetes (OR?=?0.22), macrosomia (OR?=?4.87), small for gestational age neonate [SGA] (OR?=?6.83) and admission cervical dilation (OR?=?0.79). For intrapartum factors, only cesarean section (OR?=?1.57) and last cervical dilation (OR?=?0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR?=?4.18), gentamycin/clindamycin in labor (OR?=?5.35), gestational age (OR?=?0.59) and macrosomia (OR?=?5.62).

Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions.

Conclusion: Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.     

Serum levels and ApaI polymorphism of insulin-like growth factor 2 on intrauterine growth restriction infants

Purpose: The aim of our study was to evaluate the IGF2 and IGF2R plasmatic level and IGF2-ApaI polymorphism on infants with intrauterine growth restriction (IUGR).

Materials and methods: A transversal study was conducted at the Neonatology Ward of the Gynecology Clinic I, Emergency Hospital Cluj-Napoca on neonates with IUGR who were discharged during June 2014 and June 2015. The serum levels of IGF2 and IGF2R were obtained by using ELISA method and IGF2-ApaI polymorphism by taking PCR-RFLP analysis.

Results: Forty infants with IUGR and 21 infants of appropriate gestational age (AGA) were evaluated. The serum levels of IGF2 proved higher on the A/G genotype when the IUGR group was compared with AGA (p value?=?.048). The G allele proved significantly more frequent in both the IUGR and the AGA group compared with the A allele (p?p value?>?.3). The A/G genotype proved significantly more frequent on term infants compared with preterm infants (p value?=?.039).

Conclusions: The infant with IUGR has a higher serum level of IGF2 if has A/G IGF2-ApaI genotype and higher values of IGF2R if it has the A/A genotype.     

An evaluation of hearing in infants administered with colistin in the premature neonatal intensive care unit

Aim: The aim of this study was to investigate the effects of colistin on hearing by evaluating the otoacoustic emission tests and clinical auditory brainstem responses in preterm infants treated with colistin in the neonatal intensive care unit.

Method: The study included 30 neonates (male: n?=?16, female: n?=?14) born before 37?weeks who were admitted to the Neonatal Intensive Care Unit at the Kahramanmaras Sutcu Imam Medical Faculty between January 2014 and January 2015 and who were treated with colistin during their time in intensive care because of infection. A control group was formed consisting of 30 preterm infants (male: n?=?18, female: n?=?12) with no additional disease born in the hospital during the same period. Following an ear, nose and throat examination the distortion product otoacoustic emission test, transient evoked otoacoustic emission and clinical auditory brainstem response tests were applied to all 60 patients.

Results: The otoacoustic emission responses obtained from the control group were positive and clinical auditory brainstem responses up to 15?dB were obtained. In the colistin group negative otoacoustic emission responses were obtained in two patients unilaterally and in one patient bilaterally and loss was observed at the thresholds in the clinical auditory brainstem response test. Significantly prolonged fifth wave latency was observed in the colistin group compared to the control group for the clinical auditory brainstem response at 15?dB.

Conclusions: Given that the study results showed unilateral hearing loss in two patients and bilateral hearing loss in one as well as latency at 15?dB, hearing tests to check for ototoxicity are recommended for patients given colistin.