Initiated Research Articles

Docosahexaenoic acid and the brain- what is its role?

Docosahexaenoic acid (DHA) is a 22-carbon omega 3 PUFA highly enriched in the neuronal cell membranes and rod outer segment membranes. When DHA is depleted from these cell membranes it is replaced nearly quantitatively by a 22-carbon omega 6 PUFA, docosapentaenoic acid, which has similar, but less potent, biophysical and physiological properties to DHA. It is speculated that omega 6-docosapentaenoic acid is a buffer to prevent the possible catastrophic effects of DHA depletion on brain and visual function. The primary insult from the loss of DHA from cell membrane glycerophospholipids, and replacement by omega 6-docosapentaenoic acid, is on the flexibility/compression of the membrane lipids which affects the optimal function of integral membrane proteins (receptors, voltage-gated ion channels and enzymes). This leads to effects on second messenger systems, and subsequently affects neurotransmitter concentrations due to 'weakened' signals from the initiating receptors. Remembering there are more than 80 billion neurones and many times more synaptic connections between neurons, a very small loss of "efficiency" in signal due to altered properties of membrane proteins would likely result in meaningful changes in brain and visual function. Additionally, impairment of neurotransmission could be due, in part, to sub-optimal brain energy metabolism (glucose entry into the brain), which is significantly reduced in omega 3 deficiency. Many studies report that dietary omega 3 deficiency results in changes in learning, coping with stress, behavioural changes, and responses in visual function. It is thus concluded that DHA is an essential fatty acid for optimal neuronal function.

Salt intake assessed by spot urine samples initiated in the physical examination population in Hunan, China

Background and Objectives: Excessive salt intake is a major public health problem in several countries, especially in China. However, few people are aware of their salt intake. The purpose of this study is to carry out salt intake test in routine physical examination, and to explore the salt intake of different populations and their correlation with diet. Methods and Study Design: Spot urine sample was collected to test urinary sodium and creatinine excretions for each participant recruited from physical examinations at the Third Xiangya Hospital. The Tanaka formula was used to estimate 24-h urinary sodium excretion, which reflects salt intake. In addition to physical and laboratory examination, information including personal details, health-related habits, and self-reported disease histories was obtained from the National Physical Examination Questionnaire. Results: In total, 26,406 people completed the salt intake evaluation. After data cleansing, the average salt intake was 8.39±1.80 g/d. Male, middle-aged, overweight and obese, hypertensive, and dyslipidaemic populations, as well as those with non-cardiovascular diseases were more likely to have excessive salt intake. Dietary sources had an effect on salt intake. Salt intake was lower in those who consumed more milk and fruit (both p and p trend＜0.01) but was higher in those who consumed more lean meat (both p and p trend＜0.05), fatty meat (both p and p trend＜0.01) and animal organs (both p and p trend＜0.01). Conclusions: The results showed that the salt intake in this population far surpasses the recommended amount. We strongly recommend salt intake assessment as routine test into physical examination center.

Early Larval Development and Annual Gametogenesis of the Brooding Oyster Ostrea circumpicta (Pilsbry, 1904) in the Shallow Subtidal Benthic Ecosystem in Jeju Island, Off the South Coast of Korea.

The subtropical brooding oyster Ostrea (= Striostrea) circumpicta (Pilsbry, 1904) occurs at high density in the shallow, subtidal, rocky bottom in Jeju Island, off the south coast of Korea, where the sea surface temperature and salinity varies annually from 13 to 25°C and 30 to 33 ppt, respectively. In this study, the annual gametogenesis and early larval development of O. circumpicta was examined, using histology and scanning electron microscopy (SEM). Histology indicated that the females and males initiated gonial mitosis in September, shortly after sexual resting in August. In December, ripe eggs first appeared in the follicles, and most of the females exhibited fully mature oocytes in May, as the water temperature reached 17 to 18°C. Spawning females were dominant in June and July, when the trochophore and strait- hinged veliger larvae were also identified in the branchial chambers, their size ranging from 111 to 130 μm and 135-205 μm in diameter, respectively. The veliger larvae in the brooding chamber exhibited a well- developed velum and digestive tract, suggesting that the larvae are engaged in feeding in the branchial chamber. Unlike other marine bivalves in temperate coastal ecosystems, O. circumpicta has a long period of gonad maturation and a short resting phase. It has been believed that such a long period of reproductive maturation is associated with a low level of food in the environment and the comparatively large size of the oocytes, which may require a relatively longer time to accumulate necessary nutrients to produce large eggs in a food-poor environment.

How Should We Select Patients for Blood Pressure–Lowering Treatment?

Should treatment to lower blood pressure (BP) be initiated based on baseline BP, overall cardiovascular (CV) risk, or a combination of the two? In a

Prognostic factors in patients with acute kidney injury requiring continuous renal replacement therapy

Objective To identify prognostic factors for mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods A retrospective study was conducted in 138 patients with initiated CRRT due to AKI who were admitted to the Emergency Intensive Care Unit of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2012 to December 2016. According to whether these patients survived after 28 days, they were divided into the death group (58 cases) and survived group (80 cases). Demographic and clinical parameters were retrieved and compared between the two groups. Logistic multivariate regression analysis was performed to determine the risk factors related to mortality. Results Of the 138 patients included, 58 patients (42.0%) died after 28 days. Patients in the death group were older, more likely to be male, had a higher score on the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), higher serum lactate level and lower serum creatinine level on admission, higher prevalence of coronary artery disease, and were more likely to be mechanically ventilated or treated with vasopressors. Multivariate logistic regression analysis revealed that age (OR=1.064, 95%CI: 1.022-1.108, P=0.002), APACHEⅡ score (OR=1.127, 95%CI: 1.003-1.265, P=0.044), mechanical ventilation (OR=7.432, 95%CI: 2.183-25.308, P=0.001) and use of vasopressors (OR=24.558, 95%CI: 7.651-78.825, P<0.01) were independent risk factors for mortality. Conclusions Older age, higher APACHEⅡ score, mechanical ventilation and use of vasopressors are risk factors for mortality in EICU patients with acute kidney injury requiring CRRT. Key words: Acute kidney injury; Continuous renal replacement therapy; Prognosis; ICU; Risk factors

The Difference of Two Application Methods (Manual and Electronic) and Their Effect on the Personality Metrics Psychometric Properties: A Structural Equation Model

This study aimed to compare the psychometric properties between two methods in the application of personality metrics (manual and electronic). To achieve this aim, researchers used the power of personality scale prepared by Alwalidi and Arnout (2016), which consists of (90) items distributed equally over six dimensions, each dimension consists of (15) items. This scale was applied to a sample consisted of (200) male and female students from Zagazig University, their ages ranged between 19 to 25 years. The researchers used the design of repeated measurements in the application of the procedures of the scale two forms (manual and electronic) on a sample of (200) students, was divided into two groups, by (100) students in each group according to the form of the scale (manual or electronic) the respondent receives the two forms, in a different order from one group to another. The psychometric properties related to the items represented by (item discrimination, and the validity of the items) and the psychometric properties related to the scale represented by (reliability) were calculated. The study found that the electronic application method was superior to the manual application method. Therefore the results recommend using the electronic method of application when initiating the construction or application of personal metrics.

Clinical characteristics and nursing of lower extremity deep vein thrombosis in elderly patients in Intensive Care Unit of Neurology Department

Objective To analyze the clinical characteristics of lower extremity deep venous thrombosis (DVT) in elderly patients in Intensive Care Unit (ICU) of Neurology Department, and to provide evidence for early implementation of preventive strategies. Methods Totally 229 patients who were admitted to the ICU of Neurology Department in a hospital from March 2017 to October 2018 were collected as the participants of the study and divided into the elderly group (age≥60 years) and non-elderly group (age<60 years) according to their ages. Self-designed questionnaire was used to collect the patients' general information, relevant factors of the lower extremity DVT, and information of commonly seen problems in elderly population such as history of hypertension and diabetes. SPSS 22.0 was used for data analysis. Results Among the 229 patients, 97 were diagnosed as lower extremity DVT, the incidence was 42.4%. Among them, the number of lower extremity DVT in the elderly group was 62, and the incidence was 57.4%, while the number in the non-elderly group was 35, and the incidence was 28.9%, and there was statistically significant difference between the two groups (P 0.05) , and the main type of DVT was intramuscular venous thrombosis. Conclusions Ischemic cerebrovascular disease, high level fibrinogen accompanied by hypertension, diabetes mellitus and heart disease are the main factors of DVT formation in the lower extremity of elderly patients in ICU of Neurology Department. Reducing hormone use is the protective factor of DVT prevention in lower extremities. Neurological ICU needs to pay early attention to the occurrence of DVT in the lower extremities of the elderly, especially the intramuscular venous thrombosis. Early prevention and interventions should be initiated to reduce the incidence of DVT in the lower extremities of elderly patients in Neurological ICU. Key words: Venous thrombosis; Lower extremity; Department of Neurology; Intensive Care Unit

IDENTIFICATION OF CANDIDA SPECIES IN DIABETIC PATIENTS WITH COATED TONGUE

Background: Coated tongue is a condition in which the dorsum of the tongue is covered by a white layer containing food debris or microorganisms such as Candida species (Candida spp). Factor that can influence coated tongue including a condition such as Diabetes mellitus which often reduce the production of saliva and initiate the increase of Candida spp in number. Objective: to determine various species of Candida spp. in the saliva of Diabetes mellitus patients with coated tongue as a preliminary condition to detect oral candidiasis. Methods: Coated tongue examination was performed by evaluating the lesion visually or using tongue scraper. Salivary collection was performed using oral rinse concentrate method. Saliva samples were inoculated in Chromogenic Agar to identify Candida spp. by examining the colour and the form of colony. Results: Eight samples (88.8%) were identified as C. albicans while C. parapsilosis was presented in 5 samples (66.6%) and C. tropicalis in 2 samples (22.2%). Overall, C. albicans is the most common Candida spp. that found in oral cavity. Candida spp. as normal flora in the oral cavity could be pathogen if the body's immune system decreases. In this study, there was a slight difference between Candida spp. found in the saliva of Diabetes mellitus patients compared to the control group. Conclusions: Candida spp. that identified in Diabetes mellitus patients with coated tongue are C.albicans, C. glabrata, and C. tropicalis.

Influence of breed on behavioral preferences of pigs

Behavioral preferences of Duroc and Pietrain piglets aged 2.5 – 5.5 months were explored. An experimental ground equipped with different types of toys for stimulation of play behavior was established, which piglets could access at any time. No significant differences were observed in the piglets’ activity related to consumption of food and water. The statistical data showed that social activity of Duroc piglets was significantly higher than that of Pietrain breed as they were more aggressive and initiated fights. However, with time (i.e. at the end of the experiment) the aggression level went down due to settlement of hierarchical relations among the piglets and introduction of toys to stimulate play behaviour. No significant differences were observed in frequencies of piglets’ visitation to the experimental ground and duration of their stay in it. The piglets preferred toys allowing for digging activity. Overall, Duroc piglets engaged with various play motivators significantly more than those of Pietrain breed.

Low-Dose Aspirin for Preventing Preeclampsia: What's the Optimal Strategy?

Daily low-dose aspirin initiated before 16 weeks of pregnancy can lower the occurrence of preeclampsia — but who should receive this treatment? In a

Reduction of Overwork Time of Nurses by Innovation of Nursing Records Using Structured Clinical Knowledge.

Hospitalization expenses account for a high rate of national medical care expenditure in Japan. The Japanese national medical care expenditure was 42 trillion 364.4 billion yen in 2015, in which hospitalization expenses were 15 trillion 575.2 billion yen (36.8%). Therefore, it is necessary to take measures to reduce hospitalization expenses. The total ratio of the labor cost of physicians and nurses accounted for about 1/3 of all expenditures of general hospitals in 2015. Moreover, the personnel cost of nurses accounted for about 1/5 of all expenditure, showing that the personnel cost of nurses is an element with a large influence on hospital management. The objective of this study was to develop a methodology to reduce the overtime work of nurses accounting for a large rate of personnel expenses by focusing on overtime work, a personnel expense-increasing factor, aiming at hospital cost reduction. First, the cause of overtime work, planning, and recording by nurses were analyzed and an IT application increasing the quality and efficiency of the work was developed. Then, fees for the use and maintenance of the IT system meeting the following conditions were set as a strategy to introduce the system: (1) 50% reduction of the overtime work of nurses and (2) fees 50% or lower than the reduced payment for overtime work. This IT application was introduced to the heads and directors of nursing of 5 hospitals and the strategy was proposed. All heads and directors highly evaluated the system and responded to initiate the process for the introduction. It was suggested that the methodology to reduce the overtime work of nurses proposed by this study is useful and feasible.

Effectiveness and feasibility of early essential newborn care during term cesarean section

Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P 0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS. Key words: Cesarean section; Maternal-child nursing; Neonatal nursing; Feasibility studies

Effect of highly active antiretroviral therapy on growth and development of infants and children

Objective To investigate the effect of high active antiretroviral therapy (HAART) on growth and development of infants born to pregnant women infected with human immunodeficiency virus (HIV) and the effect on blocking mother to children transmission. Methods Totally 165 pregnant women diagnosed with HIV infection from May 2006 to May 2017 and their 169 infants, including four pairs of twins were enrolled, and 82 infants born to HIV negative pregnant women in the same period were enrolled as control. All of the pregnant women in the experimental group were administrated with HAART when HIV antibody test was positive. The delivery intervention and artificial feeding were carried out as well. The weight, height, hemoglobin (Hb), serum iron and serum calcium level of infants at birth, 12 months and six years old were monitored and compared between the two groups. Apgar scores of newborns and intelligence tests at six-year-old were also recorded. Statistical analysis was performed by t test. Results Pregnant women were generally in good conditions and well tolerated to the drugs. There were no significant differences in neonatal Apgar scores, body weight, body length, Hb, serum iron, serum calcium and CD4+ T lymphocyte count between HIV positive experimental group and control group (t =-1.27, -1.12, -3.41, -5.62, -0.89, -3.02 and-0.74, respectively, all P>0.05). At the age of 12 months, there were no significant differences in body weight, length, Hb, serum iron, serum calcium and CD4+ T lymphocyte count between the two groups (t = 1.02, 1.41, 1.32, 1.03, 0.89 and 1.06, respectively, all P > 0.05). At the age of six years, there were no significant differences in all indexes between the two groups (t= 1.02, 0.87, 1.58, 1.03, 0.92 and 2.07, respectively, all P > 0.05). Intelligence assessment was performed in 78 children of the experimental group and 45 children of the control group at the age of six years, and there was no significant difference between the two groups ((89.7±12.5) score vs (91.2±13.7) score, t=1.67, P=0.43). All the children in the experimental group were positive for HIV antibody at birth, and six cases were positive for HIV RNA who were diagnosed with neonatal HIV infection. HAART was initiated for the six cases, while HIV antibody tests were still positive until the age of 18 months after HAART. The rest of the children′s HIV antibody tests became negative with the mother to children tramsission rate of 3.55% (6/169). Conclusion HAART could not only block mother to children tramsission of HIV, but also has no effect on growth and intellectual development of children during the observation period. Key words: Antiretroviral therapy, highly active; Human immunodeficiency virus; Child; Growth and development

Implementation of quality management systems in public health: The experience of the Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School

Introduction-Objective: Assessing the quality of health service provision at a Department level is difficult and needs to be documented. Documentation is achieved by certification. In spite of the increasing trend for more specialized quality standards, ISO 9001:2015 is the most widespread one. The Directorate of the Department of Urology of the University General Hospital of Heraklion, in cooperation with the Hospital Administration proceeded to study/ install the quality management system (QMS) according to ISO 9001:2015 for the provision by the Department of Urology and its Special Units (Non-Invasive Urology-Lithotripsy & Cystoscopy-Urodynamics) of diagnostic, therapeutic and nursing services as well as for the production of scientific work, research activity and provision of educational services. The procedure was implemented in July 2017 through the Special Account for Research of the University of Crete; using funds from a specific program set up for the development of the Department of Urology. To the best of our knowledge, this is the first case of certification of a Urological Department in a Public Hospital in Greece. The purpose of this study is to present the initial experience/results from the implementation of a QMS according to ISO 9001:2015 at our Department. Material and Methods: The procedure was initiated by providing medical-nursing and administrative staff with self-assessment questionnaires and special forms for problem-filling and improvement suggestions. All forms were filled in anonymously. All data gathered were processed by our quality management consultant. The results were presented to the parties involved in an open meeting at the Department and formed the basis for the QMS design. Through a 12-month strenuous workout with meetings about every 15 days, a QMS consisting of 14 procedures, two working instructions, 17 forms, and 13 administrative nursing protocols was set up. The system included 24 forms provided by the Ministry of Health and 29 clinical nursing protocols issued by the local Health Region. The staff was systematically trained in keeping them up and, with suggestions/ corrective actions the QMS was improved. Results: Through patient satisfaction questionnaires, the Department was rated with 9.1/10 (reception/stay), 9.8/10 (medical follow up), 9.3/10 (nursing care) and 9.2/10 (general service). With the implementation of the QMS, quality indicators related to medical-nursing care (drop-fall rates, fever rates, admission severity-related mortality, etc.) are monitored. Through staff meetings the progress of indicators is presented and actions are being taken aiming at improvements. The operation of the Department has been parameterized and co-perception has been conquered. By implementing a QMS, future goals have also been set: a) Higher staff participation rate problems/suggestions for improvement recording, b) Monitoring achievement of research objectives through standardized procedures, c) Higher satisfaction score achievement, d) Certification according to EN 15224, in order to introduce the of clinical risk concept by adopting scientifically registered protocols in daily diagnostic/ therapeutic practice. Conclusions: Certification of the QMS of a Urological Department in a Public Hospital is difficult but feasible. It can be successful despite organizational-technical difficulties/lack of resources. The benefits are many, such as enhancing organizational structure efficiency and improving communication within/outside the hospital.

Assessment of the Degree of Cure of the Composite Adhesive at Different Time Intervals after Initiating the Curing: An in vitro Study:

Assessment of the Degree of Cure of the Composite Adhesive at Different Time Intervals after Initiating the Curing: An in vitro Study:

Clinical practice value of hematological inflammation biomarkers in nasopharyngeal carcinoma

Inflammation promotes tumor initiate, progress, invade and metastasize. Hematological inflammation biomarkers in nasopharyngeal carcinoma (peripheral blood neurtrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index and C-creative protein) are the expressions of inflammation in the progress of nasopharyngeal carcinoma. The information of prognosis can be obtained by testing the hematological inflammation biomarkers in nasopharyngeal carcinoma patients. These biomarkers are the supplement for the current prognosis predictive indices and they can be used to guide the clinical practice, which will provide more ideas. Key words: Nasopharyngeal neoplasms; Prognosis; Hematological inflammation biomarker

Dupilumab-Associated Acquired Hemophilia A in an Elderly Male With Severe Eczema

This is a case of an 80-year-old Caucasian male with no personal or family history of coagulopathy, who was admitted for new onset painless hematuria followed by skin and significant deep soft tissue hemorrhage, with resultant anemia requiring blood transfusions. The hematuria started 1 week after he received an initial dose of subcutaneous injection of dupilumab for the treatment of refractory eczema. Few days later, he had spontaneous bruising on the tongue, anterior neck, right arm and entire left lower extremity in the absence of trauma and strenuous physical activity. His hemoglobin dropped to 7.2 g/dL from a baseline of 15.0 g/dL. Laboratory tests revealed a prolonged partial thromboplastin time, reduced factor VIII activity, and presence of factor VIII inhibitors. Three units of packed red blood cells were transfused and oral prednisone 1 mg/kg daily was initiated. His hemoglobin stabilized. No further bleeding was noted and the ecchymoses gradually resolved. J Med Cases. 2019;10(7):206-208 doi: https://doi.org/10.14740/jmc3336

Cohort profile: Famenin Brucellosis Cohort Study.

To achieve preventive and controlling activities of Brucellosis, we aimed this study as the first prospective cohort survey on brucellosis in Iran. This cohort in different phases from 2016 until 2020 going to investigate about brucella infection in selected population of Famenin, a city located in Hamadan province, west of Iran. A prospective cohort study. At the first phase of study, Famenin inhabitants including urban and rural people were studied during September to December in 2016. All identified household's people referred to specified health centers and clinically visited. Blood sampling was done, then these subjects were joined and the follow-up was initiated. At the next step, taken blood samples were examined using Wright kits and 2ME test for diagnosis the seroprevalence of brucellosis. Participants will be followed up for next years to examine clinical profiles of brucellosis and complete investigation about the main risk factors to reach strategies to control and reduce human and animal brucellosis. In the first phase, according to statistical analysis, 3363 persons including 47clusters were enrolled and considered for future studies. All participants were interviewed and demographic questioners were successfully completed. Finally, 2367 blood samples were entered in serology analysis. The seroprevalence of brucellosis based on serologic titers of Wright and 2ME test was 6.59% (95% CI: 5.62%: 7.66%) and 3.46 %( 95% CI: 2.72%: 4.20%) respectively. In the first phase, an extensive range of data and information were collected as the basic data for following phases of the cohort.

Servo-Controlled versus Protocol Driven Therapeutic Body Cooling on Transport

Background: Early initiation of therapeutic hypothermia (TH) for the treatment of Hypoxic Ischemic Encephalopathy (HIE) in term newborns has shown to improve outcomes. Many infants require transport into tertiary hospitals. The Tecotherm-Neo provides servo-controlled cooling compared to protocol driven use of various cooling agents. SMART Aim: By January, 2017, a protocol to recognize, initiate, and therapeutically cool infants during transport using the Tecotherm will be developed and implemented with a target temperature goal of 33-34° Celsius. Setting: Our NICU is a 71 bed Level 3 NICU that services a 100-mile …

Role of Donor Milk Supplementation in Newborn Nursery Level 1 in Improving Exclusive Breastfeeding Rate at Six Months of Life

Background and Aim: Despite the American Academy of Pediatrics’ (AAP) endorsement of the Baby Friendly Hospital Initiative ten steps to optimize breastfeeding, a percentage of newborns in the level one nursery ends up using formula for medical reasons including hypoglycemia, hyperbilirubinemia, weight loss greater than 8% or ineffective breastfeeding. Improving exclusive breastfeeding rates requires efforts in initiating exclusive breastfeeding in the postpartum hospital stay. Therefore, we introduced donor milk to newborns who needed nutritional supplements for medical reasons. We aimed to determine the benefits of Pasteurized Donor Human Milk supplement …