From national newborn guidelines to international consensus

Turkey recently showed a faster development in term of neonatal mortality when compared to other countries in similar position. A struggle against rarer and more challenging diseases started in the last years as neonatal mortality rate decreased, therefore, the number of patients who require follow-up for specific morbidities such very-low-birth-weight premature infants, congenital heart disease patients, and infants with inborn error of metabolism increased (1, 2). On the other hand, reduction in mortality rate has directed more attention to pregnancy follow-up, including recommendations on fetal care, early diagnosis of antenatal pathologies, and providing appropriate health services before the delivery (3). As the number of tertiary neonatal intensive care units increased in last ten years and neonatologists distributed more homogeneously throughout the country, many newborns with no chance of survival in the past can be transported to reference hospitals with the improved transport system and can survive nowadays. The spread of health care through the country has helped to ensure equality of opportunities, too (4).

The Turkish Neonatal Society has been developing national guidelines since 2014 in order to provide a national standard of care and scientific resources in the education of neonatologists. These guidelines are widely accepted nationwide and supported by the state health authority. The first guidelines were developed for the care of premature and sick term infants, but then upon the need, they have been enriched on different morbidities, intra-unit applications and rarer diseases.

New guidelines have been developed in contact with other disciplines then neonatology and this paid attention to make common statements with related disciplines. For example, similar recommendations have been made with perinatology societies for antenatal care, while consensus reports regarding ophthalmology and neonatal endocrinology have been established together with related associations. Turkey Retinopathy of Prematurity Guideline (in association with Turkish Ophthalmological Society) and five guidelines for neonatal endocrine problems (in association with Turkish Pediatric Endocrinology and Diabetes Society) have emerged through this cooperation.

In 2017, the Turkish Neonatal Society decided to update 22 guidelines that were created within 3 years’ effort and to publish them as separate articles. Reasons that led the society to publish them as articles are as follows:

1. In recent years, many studies about neonatology indexed from our country have been published in international reputable journals and attracted attention in the international scientific community. In international conferences, meetings, and congresses, Turkey’s scientific developments in this field have been appreciated and suggested as a model for many countries in the region.

2. In terms of health statistics, Turkey is located in a transition zone between high and middle-income countries (5). Therefore, the national statements to be established should be based on local studies and facilities. On the other hand, it will be able to form a model for Eastern European, Middle Eastern, and Caucasian countries on a scientific basis.

3. Turkey has been a country of immigration and emigration throughout history. On the other hand, although the rate of consanguineous marriage varies regionally, despite all developments, it did not fall below an average of 22%. These reasons make our country genetically rich in inherited diseases (6, 7). When rare diseases are concerned, many studies conducted in Europe show that patients originating from Turkey have an important place (8, 9).

For the reasons mentioned above, our guidelines that we have updated in order to provide a higher quality and standard of newborn intensive care in our country, have attracted our attention to have a potential for being an international reference. Therefore, we found it appropriate to publish our guidelines both in Turkish and English. We hope that the 22 guidelines you find in this issue of the Turkish Pediatrics Archive will help the neonatal health of our country, as well as the health of all newborns, starting from our region and reaching the world.