Nilgün Koksal - Academia.edu (original) (raw)

Papers by Nilgün Koksal

Research paper thumbnail of Konjenital Diyafragma Hernisi: On Yıllık Tek Merkez Sonuçları

Güncel Pediatri, 2017

GIRIŞ ve AMAC: Konjenital diyafragma hernisi (KDH) yuksek mortalite ve uzun donem morbiditeler il... more GIRIŞ ve AMAC: Konjenital diyafragma hernisi (KDH) yuksek mortalite ve uzun donem morbiditeler ile iliskili nadir bir anomalidir. Bu calismanin amaci unitemizde KDH tanisi ile takip edilen hastalarin demografik, klinik ozelliklerini, uygulanan tedavi ve sonuclarini tanimlamaktir. YONTEM ve GERECLER: : Bu calismada Uludag Universitesi Tip Fakultesi yenidogan yogun bakim unitesinde KDH tanisi ile tedavi goren hastalar retrospektif olarak taranmistir. Ocak 2007 ile Aralik 2016 arasinda unitemizde tedavi goren hastalarin medikal kayitlari incelenmistir. Hastalarin demografik ve dogum ozellikleri, pulmoner hipertansiyon durumlari, karaciger ve mide herniasyonlari, ek konjenital anomalileri, mekanik ventilasyon sekilleri degerlendirilmistir. BULGULAR: : Calisma periyodu boyunca KDH nedeniyle tedavi goren 40 hasta calismaya alinmistir. Tum hastalar icinde olum orani %67.5 (27/40) olarak gerceklesmistir. Dusuk dogum agirligi, dusuk gestasyonel hafta, dusuk APGAR skorlari ve baslangicta yuks...

Research paper thumbnail of Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants

Türk Pediatri Arşivi, 2019

Ductus arteriosus is a physiologic phenomenon in utero and it closes spontaneously in term babies... more Ductus arteriosus is a physiologic phenomenon in utero and it closes spontaneously in term babies. The closure is problematic in preterm infants due to the intrinsic properties of the preterm ductus arteriosus tissue. Although patent ductus arteriosus has been reported to be associated with many adverse outcomes in this population, treatment has not led to a decrease in outcomes such as bronchopulmonary dysplasia. Treatment modalities also have their own risks and restrictions. The aim of the "Turkish Neonatal Society guidelines for the management of patent ductus arteriosus in preterm babies" is to standardize the diagnosis and treatment of patent ductus arteriosus in preterm infants by combining the current scientific data and the resources of our country.

Research paper thumbnail of Prematüre Bebeklerde Erken Agresif Total Parenteral Nütrisyonun Biyokimyasal Parametreler Üzerine Etkileri

Güncel Pediatri, 2019

GIRIŞ ve AMAC: Premature bebeklerde yuksek miktarda proteinin ilk gun baslanmasi ile buyume ve no... more GIRIŞ ve AMAC: Premature bebeklerde yuksek miktarda proteinin ilk gun baslanmasi ile buyume ve noromotor gelisimin olumlu etkilendigi bildirilmistir. Ancak yuksek protein miktarinin biyokimyasal parametreler uzerine etkisi tam olarak bilinmemektedir. Bu calismada premature bebeklerde dusuk ve yuksek doz protein uygulamasinin biyokimyasal parametreler uzerine olan etkisinin arastirilmasi amaclanmistir. YONTEM ve GERECLER: Bu retrospektif calismaya 34 hafta ve altinda dogan premature bebekler dahil edildi. Olgular dusuk (DP; ilk gun 1 g/kg/gun, gunluk 1 g arttirarak maksimum 3 g/kg/gun) ve yuksek protein (YP; ilk gun 3 g/kg/gun, maksimum 3,5-4 g/kg/gun) alimlarina gore iki gruba ayrilarak antenatal ve postanatal ozellikler, biyokimyasal sonuclar ve buyume gelismeleri bakimindan karsilastirildi. BULGULAR: YP grubunda 264, DP grubunda 100 olmak uzere calismaya toplam 364 hasta alindi. Biyokimyasal belirtecler bakimindan gruplar karsilastirildiginda; YP grubundaki olgularda kan ure azotu...

Research paper thumbnail of The Turkish Journal of Pediatrics 2008; 50: 581-584 Case Report Neonatal myiasis: a case report

Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myia... more Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myiasis is a rare condition and there are few reports about this subject. In this article, we report a 12-day-old female neonate who was referred to us due to larvae in her eyes and ears. She was infected with Lucilia spp. larvae and was treated with proper antibiotics. Key words: myiasis, aural, ocular, neonate, Lucilia. Myiasis is defined as the invasion of live mammalian tissue by the larvae of dipteran flies for feeding on the host organs and body fluids. The fly may also drop its eggs while in flight on the skin, wounds or natural openings of an immobile person. Myiasis that produce larvae can affect cutaneous tissue, body cavities and body organs1,2. The extent of the disease and host immune response depend on the fly

Research paper thumbnail of The Turkish Journal of Pediatrics 2008; 50: 581-584 Case Report Neonatal myiasis: a case report

Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myia... more Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myiasis is a rare condition and there are few reports about this subject. In this article, we report a 12-day-old female neonate who was referred to us due to larvae in her eyes and ears. She was infected with Lucilia spp. larvae and was treated with proper antibiotics. Key words: myiasis, aural, ocular, neonate, Lucilia. Myiasis is defined as the invasion of live mammalian tissue by the larvae of dipteran flies for feeding on the host organs and body fluids. The fly may also drop its eggs while in flight on the skin, wounds or natural openings of an immobile person. Myiasis that produce larvae can affect cutaneous tissue, body cavities and body organs1,2. The extent of the disease and host immune response depend on the fly

Research paper thumbnail of Effects of Early Aggressive Total Parenteral Nutrition on Biochemical Parameters Outcome in Preterm Infants

Güncel Pediatri, 2019

INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively... more INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants. METHODS: Premature infants born ≤34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth. RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge DISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.

Research paper thumbnail of Effects of Early Aggressive Total Parenteral Nutrition on Biochemical Parameters Outcome in Preterm Infants

Güncel Pediatri, 2019

INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively... more INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants. METHODS: Premature infants born ≤34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth. RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge DISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.

Research paper thumbnail of Insulin-Like Growth Factor-1 and Morbidities of Prematurity: Bronchopulmonary Dysplasia, Retinopathy of Prematurity, Intraventricular Hemorrhage and Necrotizing Enterocolitis

Güncel Pediatri, 2019

GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli ... more GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli bir büyüme faktörüdür. Prematüre doğum sonrası serum IGF-1 düzeyleri hızlıca düşmekte intrauterin dönemden daha da düşük seviyelerde kalabilmektedir. Bu çalışmada serum IGF-1 düzeylerinin, bronkopulmoner displazi (BPD), prematüre retinopatisi (PR), intraventriküler kanama (İVK) ve nekrotizan enterokolit (NEK) gibi prematüre morbiditeleri ile ilişkisinin olup olmadığı ve morbiditeleri ön görmede belirteç olarak kullanıp kullanılamayacağı araştırılmıştır.

Research paper thumbnail of Insulin-Like Growth Factor-1 and Morbidities of Prematurity: Bronchopulmonary Dysplasia, Retinopathy of Prematurity, Intraventricular Hemorrhage and Necrotizing Enterocolitis

Güncel Pediatri, 2019

GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli ... more GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli bir büyüme faktörüdür. Prematüre doğum sonrası serum IGF-1 düzeyleri hızlıca düşmekte intrauterin dönemden daha da düşük seviyelerde kalabilmektedir. Bu çalışmada serum IGF-1 düzeylerinin, bronkopulmoner displazi (BPD), prematüre retinopatisi (PR), intraventriküler kanama (İVK) ve nekrotizan enterokolit (NEK) gibi prematüre morbiditeleri ile ilişkisinin olup olmadığı ve morbiditeleri ön görmede belirteç olarak kullanıp kullanılamayacağı araştırılmıştır.

Research paper thumbnail of The Problems of Late Preterm Infants in Neonatal Period

Güncel Pediatri, 2018

GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç ... more GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç preterm" terimi kullanılmaktadır. Prematüre doğumların büyük bir kısmını "geç preterm" bebekler oluşturmaktadırlar. Antropometrik ölçümleri term bebeklere yakın olmasına rağmen artmış mortalite ve morbidite riskleri vardır. Bu çalışmada üçüncü basamak hastanedeki geç preterm doğumların erken dönem sorunlarını incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmada 3. basamak referans hastanesinde 01/01/2016-31/12/2016 tarihleri arasında doğan 210 geç preterm bebek, retrospektif olarak incelenmiştir. BULGULAR: Bir yıllık sürede gerçekleşen doğumların, %20,1'i geç preterm olarak saptandı ve tüm prematüre doğumların %65'i geç pretermlerden oluşmaktaydı. Geç preterm bebeklerin %58'inin yenidoğan yoğun bakım ünitesine yatışı gerekti. En sık yatış nedenlerinin geçici takipne (%31,1), konjenital anomali (%18,8) ve tedavi gerektiren sarılık (%16,3) olduğu görüldü. Düşük gestasyonel hafta ve sezaryan doğum varlığı, yatış gereken hastalarda istatistiksel olarak anlamlı oranda yüksek saptandı. Mortalite oranı %2,7 olup, konjenital anomali varlığında (%30,43'e %0,53, p<0,001) ve erkek cinsiyette (%87,5'e %12,5, p=0,033) bu oranının arttığı görüldü. TARTIŞMA ve SONUÇ: Geç preterm bebeklerin artmış mortalite ve morbidite risklerine rağmen, bu haftalardaki endikasyonsuz sezaryan doğumlar devam etmektedir. Anne yanında izleme alınan geç preterm bebekler solunum sorunları, beslenme sorunları, hiperbilirubinemi, hipoglisemi ve hipotermi açısından yakın takip edilmelidir.

Research paper thumbnail of The Problems of Late Preterm Infants in Neonatal Period

Güncel Pediatri, 2018

GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç ... more GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç preterm" terimi kullanılmaktadır. Prematüre doğumların büyük bir kısmını "geç preterm" bebekler oluşturmaktadırlar. Antropometrik ölçümleri term bebeklere yakın olmasına rağmen artmış mortalite ve morbidite riskleri vardır. Bu çalışmada üçüncü basamak hastanedeki geç preterm doğumların erken dönem sorunlarını incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmada 3. basamak referans hastanesinde 01/01/2016-31/12/2016 tarihleri arasında doğan 210 geç preterm bebek, retrospektif olarak incelenmiştir. BULGULAR: Bir yıllık sürede gerçekleşen doğumların, %20,1'i geç preterm olarak saptandı ve tüm prematüre doğumların %65'i geç pretermlerden oluşmaktaydı. Geç preterm bebeklerin %58'inin yenidoğan yoğun bakım ünitesine yatışı gerekti. En sık yatış nedenlerinin geçici takipne (%31,1), konjenital anomali (%18,8) ve tedavi gerektiren sarılık (%16,3) olduğu görüldü. Düşük gestasyonel hafta ve sezaryan doğum varlığı, yatış gereken hastalarda istatistiksel olarak anlamlı oranda yüksek saptandı. Mortalite oranı %2,7 olup, konjenital anomali varlığında (%30,43'e %0,53, p<0,001) ve erkek cinsiyette (%87,5'e %12,5, p=0,033) bu oranının arttığı görüldü. TARTIŞMA ve SONUÇ: Geç preterm bebeklerin artmış mortalite ve morbidite risklerine rağmen, bu haftalardaki endikasyonsuz sezaryan doğumlar devam etmektedir. Anne yanında izleme alınan geç preterm bebekler solunum sorunları, beslenme sorunları, hiperbilirubinemi, hipoglisemi ve hipotermi açısından yakın takip edilmelidir.

Research paper thumbnail of Low serum igf-1 and increased cytokine levels in tracheal aspirate samples are associated with bronchopulmonary dysplasia

The Turkish Journal of Pediatrics, 2017

Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is stil... more Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is still the most frequently seen long-term complication in preterm infants. The aim of this prospective study is to investigate the association between the development of BPD and serial measurements of IGF-1 levels and their relationship with levels of IGF-1 and cytokine in tracheal aspirate fluids. A total of 40 premature infants, born at a gestational age of ≤ 32 weeks, were enrolled in the study. On postnatal day-1, 3, 7, 21 and 28 serum IGF-1 levels and IGF-1 levels, IL-6, IL-8, IL-10 and TNF-alpha levels in tracheal aspirate fluid samples of intubated cases were examined. Mean gestational age of 40 patients included in the study was 29.41 ± 2.23 weeks, and their mean birth weight was 1,256.85 ± 311.48 g. BPD was detected in 35% of cases. Mean gestational week and birth weight of the cases that developed BPD were 30 ± 3 weeks and 1,150 ± 295 g, respectively. Serum IGF-1 levels on postnatal day-1, 3, 7, 21 and 28 in cases who developed BPD were significantly lower when compared with those without BPD (p < 0.01). Levels of IL-6, IL-8, IL-10, and TNF-alpha in tracheal aspirate samples were significantly higher in cases with BPD compared to those without BPD (p<0.05). IGF-1 levels in tracheal aspirate fluid samples did not differ significantly based on the presence of BPD (p>0.05). Severity of BPD was associated with decreased serum IGF-1 levels and increased cytokine levels in tracheal aspirate samples.

Research paper thumbnail of Low serum igf-1 and increased cytokine levels in tracheal aspirate samples are associated with bronchopulmonary dysplasia

The Turkish Journal of Pediatrics, 2017

Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is stil... more Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is still the most frequently seen long-term complication in preterm infants. The aim of this prospective study is to investigate the association between the development of BPD and serial measurements of IGF-1 levels and their relationship with levels of IGF-1 and cytokine in tracheal aspirate fluids. A total of 40 premature infants, born at a gestational age of ≤ 32 weeks, were enrolled in the study. On postnatal day-1, 3, 7, 21 and 28 serum IGF-1 levels and IGF-1 levels, IL-6, IL-8, IL-10 and TNF-alpha levels in tracheal aspirate fluid samples of intubated cases were examined. Mean gestational age of 40 patients included in the study was 29.41 ± 2.23 weeks, and their mean birth weight was 1,256.85 ± 311.48 g. BPD was detected in 35% of cases. Mean gestational week and birth weight of the cases that developed BPD were 30 ± 3 weeks and 1,150 ± 295 g, respectively. Serum IGF-1 levels on postnatal day-1, 3, 7, 21 and 28 in cases who developed BPD were significantly lower when compared with those without BPD (p < 0.01). Levels of IL-6, IL-8, IL-10, and TNF-alpha in tracheal aspirate samples were significantly higher in cases with BPD compared to those without BPD (p<0.05). IGF-1 levels in tracheal aspirate fluid samples did not differ significantly based on the presence of BPD (p>0.05). Severity of BPD was associated with decreased serum IGF-1 levels and increased cytokine levels in tracheal aspirate samples.

Research paper thumbnail of The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants

Pakistan Journal of Medical Sciences, 2019

Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neon... more Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neonatal outcomes in premature infants. Methods: The study included preterm infants born at gestational age ≤32 weeks in a tertiary university hospital between January 2016 and January 2017. The study group consisted of infants born from mothers with preeclampsia (Group-1), and the control group consisted of infants born from normotensive mothers (Group-2). Demographic characteristics and clinical outcomes of the infants were recorded. IL-6, IL-8, IL-10, and TNF-α cytokine levels were measured from umbilical cord blood samples. Results: A total of 108 infants were included in the study, of which 34 were in the Group-1 and 74 in the Group-2. Gestational ages (29 vs 30 weeks) of the infants in both groups were similar. There was no significant difference between the cytokine levels of infants with and without preeclampsia. The rate of small for gestational age, retinopathy of prematurity, intr...

Research paper thumbnail of The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants

Pakistan Journal of Medical Sciences, 2019

Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neon... more Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neonatal outcomes in premature infants. Methods: The study included preterm infants born at gestational age ≤32 weeks in a tertiary university hospital between January 2016 and January 2017. The study group consisted of infants born from mothers with preeclampsia (Group-1), and the control group consisted of infants born from normotensive mothers (Group-2). Demographic characteristics and clinical outcomes of the infants were recorded. IL-6, IL-8, IL-10, and TNF-α cytokine levels were measured from umbilical cord blood samples. Results: A total of 108 infants were included in the study, of which 34 were in the Group-1 and 74 in the Group-2. Gestational ages (29 vs 30 weeks) of the infants in both groups were similar. There was no significant difference between the cytokine levels of infants with and without preeclampsia. The rate of small for gestational age, retinopathy of prematurity, intr...

Research paper thumbnail of The effectiveness of serum amyloid a for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

The Turkish Journal of Pediatrics, 2019

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with paren... more The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its' effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants (<34 weeks' gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Research paper thumbnail of The effectiveness of serum amyloid a for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

The Turkish Journal of Pediatrics, 2019

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with paren... more The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its' effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants (<34 weeks' gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Research paper thumbnail of Yenidoğanlarda Mikafungin Kullanımı Sonuçları

Mikrobiyoloji Bulteni, 2019

İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin... more İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin prognozunu iyileştirmek için mantar enfeksiyonlarının önlenmesi ve tedavisi çok önemlidir. Yenidoğanlarda invaziv mantar enfeksiyonlarının tedavisinde ilk seçenek olan flukonazol ve amfoterisin B kullanımının nefrotoksisite, hepatotoksisite ve dirençli suşlar nedeniyle mümkün olmadığı durumlarda en son geliştirilen antifungal ilaç sınıfı olan ekinokandinlerden mikafungin kullanılmaktadır. Mikafunginin yenidoğanlarda kullanımı yeni olup, santral sinir sistemine etkili olan yüksek dozlardaki kullanım tecrübesi sınırlıdır. Bu çalışmada, üçüncü düzey yoğun bakım ünitesinde retrospektif olarak 24 aylık süre içerisinde (2016-2017) yenidoğan yoğun bakımındaki yatışları süresince kültür kanıtlı veya olası invaziv mantar enfeksiyonu tedavisi için mikafungin kullanılan hastaların elektronik dosyalarını incelenmek amaçlanmıştır. Çalışmaya 10 prematüre, 5 term bebek olmak üzere toplam 15 hasta dahil edilmiştir. Hastaların ortalama doğum ağrılığı 1732 ± 999 g ve ortalama gestasyon yaşı 32.2 ± 5.8 hafta olarak belirlenmiştir. Tüm hastalarda uzun süre yoğun bakım yatışı ve invaziv kandidoz enfeksiyonu riskini arttıran faktörler tespit edilmiştir. Bu risk faktörlerinin hastalardaki sıklığına baktığımızda en sıkla, hastaların hepsinde mevcut olan santral venöz kateter ve çoklu antibiyotik kullanımı saptanırken, diğerleri sırasıyla entübasyon, total parenteral nutrisyon kullanımı ve cerrahi işlem uygulaması olarak gözlenmiştir. Dört hastanın kültüründe mantar üremesi olmuştur. Hastalardan izole edilen Candida türleri Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis olarak saptanmıştır. Mikafungin tedavisine başlanan hastalardan sekizi öncesinde amfoterisin B, üçü flukonazol tedavisi almaktayken dört hasta ise herhangi bir antifungal tedavi almamıştır. Mikafungin başlama zamanı ortalama 29.9 ± 16.6 gün olarak belirlenmiştir. Mikafungin kullanım süreleri de ortalama 22.4 ± 11.2 gün olarak gerçekleşmiştir. İzlemde ise hiçbir hastada mikafungin kullanımına bağlı olarak elektrolit bozukluğu veya karaciğer fonksiyon testlerinde bozukluk görülmemiştir. Sonuç olarak flukonazol veya amfoterisin B kullanımına bağlı karaciğer ve böbrek fonksiyonları bozulan veya daha önceden bozuk olan yenidoğan hastalarda ve dirençli Candida suşlarının neden olduğu yenidoğanın kültür kanıtlı ve olası invaziv Candida enfeksiyonlarının tedavisinde yüksek doz (10 mg/kg/gün) mikafungin güvenli ve etkin bir tedavi seçeneği olabileceği düşünülmüştür.

Research paper thumbnail of Yenidoğanlarda Mikafungin Kullanımı Sonuçları

Mikrobiyoloji Bulteni, 2019

İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin... more İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin prognozunu iyileştirmek için mantar enfeksiyonlarının önlenmesi ve tedavisi çok önemlidir. Yenidoğanlarda invaziv mantar enfeksiyonlarının tedavisinde ilk seçenek olan flukonazol ve amfoterisin B kullanımının nefrotoksisite, hepatotoksisite ve dirençli suşlar nedeniyle mümkün olmadığı durumlarda en son geliştirilen antifungal ilaç sınıfı olan ekinokandinlerden mikafungin kullanılmaktadır. Mikafunginin yenidoğanlarda kullanımı yeni olup, santral sinir sistemine etkili olan yüksek dozlardaki kullanım tecrübesi sınırlıdır. Bu çalışmada, üçüncü düzey yoğun bakım ünitesinde retrospektif olarak 24 aylık süre içerisinde (2016-2017) yenidoğan yoğun bakımındaki yatışları süresince kültür kanıtlı veya olası invaziv mantar enfeksiyonu tedavisi için mikafungin kullanılan hastaların elektronik dosyalarını incelenmek amaçlanmıştır. Çalışmaya 10 prematüre, 5 term bebek olmak üzere toplam 15 hasta dahil edilmiştir. Hastaların ortalama doğum ağrılığı 1732 ± 999 g ve ortalama gestasyon yaşı 32.2 ± 5.8 hafta olarak belirlenmiştir. Tüm hastalarda uzun süre yoğun bakım yatışı ve invaziv kandidoz enfeksiyonu riskini arttıran faktörler tespit edilmiştir. Bu risk faktörlerinin hastalardaki sıklığına baktığımızda en sıkla, hastaların hepsinde mevcut olan santral venöz kateter ve çoklu antibiyotik kullanımı saptanırken, diğerleri sırasıyla entübasyon, total parenteral nutrisyon kullanımı ve cerrahi işlem uygulaması olarak gözlenmiştir. Dört hastanın kültüründe mantar üremesi olmuştur. Hastalardan izole edilen Candida türleri Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis olarak saptanmıştır. Mikafungin tedavisine başlanan hastalardan sekizi öncesinde amfoterisin B, üçü flukonazol tedavisi almaktayken dört hasta ise herhangi bir antifungal tedavi almamıştır. Mikafungin başlama zamanı ortalama 29.9 ± 16.6 gün olarak belirlenmiştir. Mikafungin kullanım süreleri de ortalama 22.4 ± 11.2 gün olarak gerçekleşmiştir. İzlemde ise hiçbir hastada mikafungin kullanımına bağlı olarak elektrolit bozukluğu veya karaciğer fonksiyon testlerinde bozukluk görülmemiştir. Sonuç olarak flukonazol veya amfoterisin B kullanımına bağlı karaciğer ve böbrek fonksiyonları bozulan veya daha önceden bozuk olan yenidoğan hastalarda ve dirençli Candida suşlarının neden olduğu yenidoğanın kültür kanıtlı ve olası invaziv Candida enfeksiyonlarının tedavisinde yüksek doz (10 mg/kg/gün) mikafungin güvenli ve etkin bir tedavi seçeneği olabileceği düşünülmüştür.

Research paper thumbnail of Aluminum exposure in premature babies related to total parenteral nutrition and treatments

The Turkish Journal of Pediatrics, 2018

This study aimed to measure aluminum contamination of parenteral nutrition (PN) solutions and alu... more This study aimed to measure aluminum contamination of parenteral nutrition (PN) solutions and aluminum contents of parenteral products given to newborn infants for nutrition or treatment. In this study, the aluminum content of the first products used to prepare PN solutions for premature neonates, of the final parenteral products prepared therefrom, and of the parenteral drugs frequently used in newborn units was measured using the inductively coupled plasma mass spectrometry. The aluminum contamination of all parenteral nutritional products evaluated, except for one, was detected to be over the recommended doses. Of all the first products analyzed within the scope of the study, trace-element preparation, preparation containing fat-soluble vitamins, 20% dextrose solution, calcium gluconate ampoule and sodium phosphate ampoule indicated high aluminum contamination. The total aluminum content of the prepared final products was identified to be at least 40% higher than the total aluminum content of the ingredients added to the compound. Accordingly, the minimum amount of aluminum content was measured as 233 μg/kg/day in nutrition solutions prepared for a baby weighing 1,000 g. Contamination was detected in 9 of the 18 drugs evaluated. This study indicated that the rate of aluminum exposure of the premature babies receiving parental nutrition is still much higher than the safe doses recommended as 5 μg/kg/day by the FDA. Products with lower aluminum content should be preferred in the care of premature infants.

Research paper thumbnail of Konjenital Diyafragma Hernisi: On Yıllık Tek Merkez Sonuçları

Güncel Pediatri, 2017

GIRIŞ ve AMAC: Konjenital diyafragma hernisi (KDH) yuksek mortalite ve uzun donem morbiditeler il... more GIRIŞ ve AMAC: Konjenital diyafragma hernisi (KDH) yuksek mortalite ve uzun donem morbiditeler ile iliskili nadir bir anomalidir. Bu calismanin amaci unitemizde KDH tanisi ile takip edilen hastalarin demografik, klinik ozelliklerini, uygulanan tedavi ve sonuclarini tanimlamaktir. YONTEM ve GERECLER: : Bu calismada Uludag Universitesi Tip Fakultesi yenidogan yogun bakim unitesinde KDH tanisi ile tedavi goren hastalar retrospektif olarak taranmistir. Ocak 2007 ile Aralik 2016 arasinda unitemizde tedavi goren hastalarin medikal kayitlari incelenmistir. Hastalarin demografik ve dogum ozellikleri, pulmoner hipertansiyon durumlari, karaciger ve mide herniasyonlari, ek konjenital anomalileri, mekanik ventilasyon sekilleri degerlendirilmistir. BULGULAR: : Calisma periyodu boyunca KDH nedeniyle tedavi goren 40 hasta calismaya alinmistir. Tum hastalar icinde olum orani %67.5 (27/40) olarak gerceklesmistir. Dusuk dogum agirligi, dusuk gestasyonel hafta, dusuk APGAR skorlari ve baslangicta yuks...

Research paper thumbnail of Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants

Türk Pediatri Arşivi, 2019

Ductus arteriosus is a physiologic phenomenon in utero and it closes spontaneously in term babies... more Ductus arteriosus is a physiologic phenomenon in utero and it closes spontaneously in term babies. The closure is problematic in preterm infants due to the intrinsic properties of the preterm ductus arteriosus tissue. Although patent ductus arteriosus has been reported to be associated with many adverse outcomes in this population, treatment has not led to a decrease in outcomes such as bronchopulmonary dysplasia. Treatment modalities also have their own risks and restrictions. The aim of the "Turkish Neonatal Society guidelines for the management of patent ductus arteriosus in preterm babies" is to standardize the diagnosis and treatment of patent ductus arteriosus in preterm infants by combining the current scientific data and the resources of our country.

Research paper thumbnail of Prematüre Bebeklerde Erken Agresif Total Parenteral Nütrisyonun Biyokimyasal Parametreler Üzerine Etkileri

Güncel Pediatri, 2019

GIRIŞ ve AMAC: Premature bebeklerde yuksek miktarda proteinin ilk gun baslanmasi ile buyume ve no... more GIRIŞ ve AMAC: Premature bebeklerde yuksek miktarda proteinin ilk gun baslanmasi ile buyume ve noromotor gelisimin olumlu etkilendigi bildirilmistir. Ancak yuksek protein miktarinin biyokimyasal parametreler uzerine etkisi tam olarak bilinmemektedir. Bu calismada premature bebeklerde dusuk ve yuksek doz protein uygulamasinin biyokimyasal parametreler uzerine olan etkisinin arastirilmasi amaclanmistir. YONTEM ve GERECLER: Bu retrospektif calismaya 34 hafta ve altinda dogan premature bebekler dahil edildi. Olgular dusuk (DP; ilk gun 1 g/kg/gun, gunluk 1 g arttirarak maksimum 3 g/kg/gun) ve yuksek protein (YP; ilk gun 3 g/kg/gun, maksimum 3,5-4 g/kg/gun) alimlarina gore iki gruba ayrilarak antenatal ve postanatal ozellikler, biyokimyasal sonuclar ve buyume gelismeleri bakimindan karsilastirildi. BULGULAR: YP grubunda 264, DP grubunda 100 olmak uzere calismaya toplam 364 hasta alindi. Biyokimyasal belirtecler bakimindan gruplar karsilastirildiginda; YP grubundaki olgularda kan ure azotu...

Research paper thumbnail of The Turkish Journal of Pediatrics 2008; 50: 581-584 Case Report Neonatal myiasis: a case report

Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myia... more Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myiasis is a rare condition and there are few reports about this subject. In this article, we report a 12-day-old female neonate who was referred to us due to larvae in her eyes and ears. She was infected with Lucilia spp. larvae and was treated with proper antibiotics. Key words: myiasis, aural, ocular, neonate, Lucilia. Myiasis is defined as the invasion of live mammalian tissue by the larvae of dipteran flies for feeding on the host organs and body fluids. The fly may also drop its eggs while in flight on the skin, wounds or natural openings of an immobile person. Myiasis that produce larvae can affect cutaneous tissue, body cavities and body organs1,2. The extent of the disease and host immune response depend on the fly

Research paper thumbnail of The Turkish Journal of Pediatrics 2008; 50: 581-584 Case Report Neonatal myiasis: a case report

Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myia... more Myiasis is a disease caused by fly larvae. Although adult cases have been reported, neonatal myiasis is a rare condition and there are few reports about this subject. In this article, we report a 12-day-old female neonate who was referred to us due to larvae in her eyes and ears. She was infected with Lucilia spp. larvae and was treated with proper antibiotics. Key words: myiasis, aural, ocular, neonate, Lucilia. Myiasis is defined as the invasion of live mammalian tissue by the larvae of dipteran flies for feeding on the host organs and body fluids. The fly may also drop its eggs while in flight on the skin, wounds or natural openings of an immobile person. Myiasis that produce larvae can affect cutaneous tissue, body cavities and body organs1,2. The extent of the disease and host immune response depend on the fly

Research paper thumbnail of Effects of Early Aggressive Total Parenteral Nutrition on Biochemical Parameters Outcome in Preterm Infants

Güncel Pediatri, 2019

INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively... more INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants. METHODS: Premature infants born ≤34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth. RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge DISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.

Research paper thumbnail of Effects of Early Aggressive Total Parenteral Nutrition on Biochemical Parameters Outcome in Preterm Infants

Güncel Pediatri, 2019

INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively... more INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants. METHODS: Premature infants born ≤34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth. RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge DISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.

Research paper thumbnail of Insulin-Like Growth Factor-1 and Morbidities of Prematurity: Bronchopulmonary Dysplasia, Retinopathy of Prematurity, Intraventricular Hemorrhage and Necrotizing Enterocolitis

Güncel Pediatri, 2019

GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli ... more GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli bir büyüme faktörüdür. Prematüre doğum sonrası serum IGF-1 düzeyleri hızlıca düşmekte intrauterin dönemden daha da düşük seviyelerde kalabilmektedir. Bu çalışmada serum IGF-1 düzeylerinin, bronkopulmoner displazi (BPD), prematüre retinopatisi (PR), intraventriküler kanama (İVK) ve nekrotizan enterokolit (NEK) gibi prematüre morbiditeleri ile ilişkisinin olup olmadığı ve morbiditeleri ön görmede belirteç olarak kullanıp kullanılamayacağı araştırılmıştır.

Research paper thumbnail of Insulin-Like Growth Factor-1 and Morbidities of Prematurity: Bronchopulmonary Dysplasia, Retinopathy of Prematurity, Intraventricular Hemorrhage and Necrotizing Enterocolitis

Güncel Pediatri, 2019

GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli ... more GİRİŞ ve AMAÇ: İnsulin benzeri büyüme faktörü-1 (IGF-1) fetal ve postnatal dönemde etkili önemli bir büyüme faktörüdür. Prematüre doğum sonrası serum IGF-1 düzeyleri hızlıca düşmekte intrauterin dönemden daha da düşük seviyelerde kalabilmektedir. Bu çalışmada serum IGF-1 düzeylerinin, bronkopulmoner displazi (BPD), prematüre retinopatisi (PR), intraventriküler kanama (İVK) ve nekrotizan enterokolit (NEK) gibi prematüre morbiditeleri ile ilişkisinin olup olmadığı ve morbiditeleri ön görmede belirteç olarak kullanıp kullanılamayacağı araştırılmıştır.

Research paper thumbnail of The Problems of Late Preterm Infants in Neonatal Period

Güncel Pediatri, 2018

GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç ... more GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç preterm" terimi kullanılmaktadır. Prematüre doğumların büyük bir kısmını "geç preterm" bebekler oluşturmaktadırlar. Antropometrik ölçümleri term bebeklere yakın olmasına rağmen artmış mortalite ve morbidite riskleri vardır. Bu çalışmada üçüncü basamak hastanedeki geç preterm doğumların erken dönem sorunlarını incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmada 3. basamak referans hastanesinde 01/01/2016-31/12/2016 tarihleri arasında doğan 210 geç preterm bebek, retrospektif olarak incelenmiştir. BULGULAR: Bir yıllık sürede gerçekleşen doğumların, %20,1'i geç preterm olarak saptandı ve tüm prematüre doğumların %65'i geç pretermlerden oluşmaktaydı. Geç preterm bebeklerin %58'inin yenidoğan yoğun bakım ünitesine yatışı gerekti. En sık yatış nedenlerinin geçici takipne (%31,1), konjenital anomali (%18,8) ve tedavi gerektiren sarılık (%16,3) olduğu görüldü. Düşük gestasyonel hafta ve sezaryan doğum varlığı, yatış gereken hastalarda istatistiksel olarak anlamlı oranda yüksek saptandı. Mortalite oranı %2,7 olup, konjenital anomali varlığında (%30,43'e %0,53, p<0,001) ve erkek cinsiyette (%87,5'e %12,5, p=0,033) bu oranının arttığı görüldü. TARTIŞMA ve SONUÇ: Geç preterm bebeklerin artmış mortalite ve morbidite risklerine rağmen, bu haftalardaki endikasyonsuz sezaryan doğumlar devam etmektedir. Anne yanında izleme alınan geç preterm bebekler solunum sorunları, beslenme sorunları, hiperbilirubinemi, hipoglisemi ve hipotermi açısından yakın takip edilmelidir.

Research paper thumbnail of The Problems of Late Preterm Infants in Neonatal Period

Güncel Pediatri, 2018

GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç ... more GİRİŞ ve AMAÇ: Prematüre doğumların 34 0/7 ve 36 6/7 gebelik haftası arasında olanları için "geç preterm" terimi kullanılmaktadır. Prematüre doğumların büyük bir kısmını "geç preterm" bebekler oluşturmaktadırlar. Antropometrik ölçümleri term bebeklere yakın olmasına rağmen artmış mortalite ve morbidite riskleri vardır. Bu çalışmada üçüncü basamak hastanedeki geç preterm doğumların erken dönem sorunlarını incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmada 3. basamak referans hastanesinde 01/01/2016-31/12/2016 tarihleri arasında doğan 210 geç preterm bebek, retrospektif olarak incelenmiştir. BULGULAR: Bir yıllık sürede gerçekleşen doğumların, %20,1'i geç preterm olarak saptandı ve tüm prematüre doğumların %65'i geç pretermlerden oluşmaktaydı. Geç preterm bebeklerin %58'inin yenidoğan yoğun bakım ünitesine yatışı gerekti. En sık yatış nedenlerinin geçici takipne (%31,1), konjenital anomali (%18,8) ve tedavi gerektiren sarılık (%16,3) olduğu görüldü. Düşük gestasyonel hafta ve sezaryan doğum varlığı, yatış gereken hastalarda istatistiksel olarak anlamlı oranda yüksek saptandı. Mortalite oranı %2,7 olup, konjenital anomali varlığında (%30,43'e %0,53, p<0,001) ve erkek cinsiyette (%87,5'e %12,5, p=0,033) bu oranının arttığı görüldü. TARTIŞMA ve SONUÇ: Geç preterm bebeklerin artmış mortalite ve morbidite risklerine rağmen, bu haftalardaki endikasyonsuz sezaryan doğumlar devam etmektedir. Anne yanında izleme alınan geç preterm bebekler solunum sorunları, beslenme sorunları, hiperbilirubinemi, hipoglisemi ve hipotermi açısından yakın takip edilmelidir.

Research paper thumbnail of Low serum igf-1 and increased cytokine levels in tracheal aspirate samples are associated with bronchopulmonary dysplasia

The Turkish Journal of Pediatrics, 2017

Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is stil... more Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is still the most frequently seen long-term complication in preterm infants. The aim of this prospective study is to investigate the association between the development of BPD and serial measurements of IGF-1 levels and their relationship with levels of IGF-1 and cytokine in tracheal aspirate fluids. A total of 40 premature infants, born at a gestational age of ≤ 32 weeks, were enrolled in the study. On postnatal day-1, 3, 7, 21 and 28 serum IGF-1 levels and IGF-1 levels, IL-6, IL-8, IL-10 and TNF-alpha levels in tracheal aspirate fluid samples of intubated cases were examined. Mean gestational age of 40 patients included in the study was 29.41 ± 2.23 weeks, and their mean birth weight was 1,256.85 ± 311.48 g. BPD was detected in 35% of cases. Mean gestational week and birth weight of the cases that developed BPD were 30 ± 3 weeks and 1,150 ± 295 g, respectively. Serum IGF-1 levels on postnatal day-1, 3, 7, 21 and 28 in cases who developed BPD were significantly lower when compared with those without BPD (p < 0.01). Levels of IL-6, IL-8, IL-10, and TNF-alpha in tracheal aspirate samples were significantly higher in cases with BPD compared to those without BPD (p<0.05). IGF-1 levels in tracheal aspirate fluid samples did not differ significantly based on the presence of BPD (p>0.05). Severity of BPD was associated with decreased serum IGF-1 levels and increased cytokine levels in tracheal aspirate samples.

Research paper thumbnail of Low serum igf-1 and increased cytokine levels in tracheal aspirate samples are associated with bronchopulmonary dysplasia

The Turkish Journal of Pediatrics, 2017

Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is stil... more Despite developments in the perinatal and neonatal care, bronchopulmonary dysplasia (BPD) is still the most frequently seen long-term complication in preterm infants. The aim of this prospective study is to investigate the association between the development of BPD and serial measurements of IGF-1 levels and their relationship with levels of IGF-1 and cytokine in tracheal aspirate fluids. A total of 40 premature infants, born at a gestational age of ≤ 32 weeks, were enrolled in the study. On postnatal day-1, 3, 7, 21 and 28 serum IGF-1 levels and IGF-1 levels, IL-6, IL-8, IL-10 and TNF-alpha levels in tracheal aspirate fluid samples of intubated cases were examined. Mean gestational age of 40 patients included in the study was 29.41 ± 2.23 weeks, and their mean birth weight was 1,256.85 ± 311.48 g. BPD was detected in 35% of cases. Mean gestational week and birth weight of the cases that developed BPD were 30 ± 3 weeks and 1,150 ± 295 g, respectively. Serum IGF-1 levels on postnatal day-1, 3, 7, 21 and 28 in cases who developed BPD were significantly lower when compared with those without BPD (p < 0.01). Levels of IL-6, IL-8, IL-10, and TNF-alpha in tracheal aspirate samples were significantly higher in cases with BPD compared to those without BPD (p<0.05). IGF-1 levels in tracheal aspirate fluid samples did not differ significantly based on the presence of BPD (p>0.05). Severity of BPD was associated with decreased serum IGF-1 levels and increased cytokine levels in tracheal aspirate samples.

Research paper thumbnail of The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants

Pakistan Journal of Medical Sciences, 2019

Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neon... more Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neonatal outcomes in premature infants. Methods: The study included preterm infants born at gestational age ≤32 weeks in a tertiary university hospital between January 2016 and January 2017. The study group consisted of infants born from mothers with preeclampsia (Group-1), and the control group consisted of infants born from normotensive mothers (Group-2). Demographic characteristics and clinical outcomes of the infants were recorded. IL-6, IL-8, IL-10, and TNF-α cytokine levels were measured from umbilical cord blood samples. Results: A total of 108 infants were included in the study, of which 34 were in the Group-1 and 74 in the Group-2. Gestational ages (29 vs 30 weeks) of the infants in both groups were similar. There was no significant difference between the cytokine levels of infants with and without preeclampsia. The rate of small for gestational age, retinopathy of prematurity, intr...

Research paper thumbnail of The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants

Pakistan Journal of Medical Sciences, 2019

Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neon... more Objective: To investigate the effects of maternal preeclampsia on inflammatory cytokines and neonatal outcomes in premature infants. Methods: The study included preterm infants born at gestational age ≤32 weeks in a tertiary university hospital between January 2016 and January 2017. The study group consisted of infants born from mothers with preeclampsia (Group-1), and the control group consisted of infants born from normotensive mothers (Group-2). Demographic characteristics and clinical outcomes of the infants were recorded. IL-6, IL-8, IL-10, and TNF-α cytokine levels were measured from umbilical cord blood samples. Results: A total of 108 infants were included in the study, of which 34 were in the Group-1 and 74 in the Group-2. Gestational ages (29 vs 30 weeks) of the infants in both groups were similar. There was no significant difference between the cytokine levels of infants with and without preeclampsia. The rate of small for gestational age, retinopathy of prematurity, intr...

Research paper thumbnail of The effectiveness of serum amyloid a for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

The Turkish Journal of Pediatrics, 2019

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with paren... more The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its' effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants (<34 weeks' gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Research paper thumbnail of The effectiveness of serum amyloid a for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

The Turkish Journal of Pediatrics, 2019

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with paren... more The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its' effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants (<34 weeks' gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

Research paper thumbnail of Yenidoğanlarda Mikafungin Kullanımı Sonuçları

Mikrobiyoloji Bulteni, 2019

İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin... more İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin prognozunu iyileştirmek için mantar enfeksiyonlarının önlenmesi ve tedavisi çok önemlidir. Yenidoğanlarda invaziv mantar enfeksiyonlarının tedavisinde ilk seçenek olan flukonazol ve amfoterisin B kullanımının nefrotoksisite, hepatotoksisite ve dirençli suşlar nedeniyle mümkün olmadığı durumlarda en son geliştirilen antifungal ilaç sınıfı olan ekinokandinlerden mikafungin kullanılmaktadır. Mikafunginin yenidoğanlarda kullanımı yeni olup, santral sinir sistemine etkili olan yüksek dozlardaki kullanım tecrübesi sınırlıdır. Bu çalışmada, üçüncü düzey yoğun bakım ünitesinde retrospektif olarak 24 aylık süre içerisinde (2016-2017) yenidoğan yoğun bakımındaki yatışları süresince kültür kanıtlı veya olası invaziv mantar enfeksiyonu tedavisi için mikafungin kullanılan hastaların elektronik dosyalarını incelenmek amaçlanmıştır. Çalışmaya 10 prematüre, 5 term bebek olmak üzere toplam 15 hasta dahil edilmiştir. Hastaların ortalama doğum ağrılığı 1732 ± 999 g ve ortalama gestasyon yaşı 32.2 ± 5.8 hafta olarak belirlenmiştir. Tüm hastalarda uzun süre yoğun bakım yatışı ve invaziv kandidoz enfeksiyonu riskini arttıran faktörler tespit edilmiştir. Bu risk faktörlerinin hastalardaki sıklığına baktığımızda en sıkla, hastaların hepsinde mevcut olan santral venöz kateter ve çoklu antibiyotik kullanımı saptanırken, diğerleri sırasıyla entübasyon, total parenteral nutrisyon kullanımı ve cerrahi işlem uygulaması olarak gözlenmiştir. Dört hastanın kültüründe mantar üremesi olmuştur. Hastalardan izole edilen Candida türleri Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis olarak saptanmıştır. Mikafungin tedavisine başlanan hastalardan sekizi öncesinde amfoterisin B, üçü flukonazol tedavisi almaktayken dört hasta ise herhangi bir antifungal tedavi almamıştır. Mikafungin başlama zamanı ortalama 29.9 ± 16.6 gün olarak belirlenmiştir. Mikafungin kullanım süreleri de ortalama 22.4 ± 11.2 gün olarak gerçekleşmiştir. İzlemde ise hiçbir hastada mikafungin kullanımına bağlı olarak elektrolit bozukluğu veya karaciğer fonksiyon testlerinde bozukluk görülmemiştir. Sonuç olarak flukonazol veya amfoterisin B kullanımına bağlı karaciğer ve böbrek fonksiyonları bozulan veya daha önceden bozuk olan yenidoğan hastalarda ve dirençli Candida suşlarının neden olduğu yenidoğanın kültür kanıtlı ve olası invaziv Candida enfeksiyonlarının tedavisinde yüksek doz (10 mg/kg/gün) mikafungin güvenli ve etkin bir tedavi seçeneği olabileceği düşünülmüştür.

Research paper thumbnail of Yenidoğanlarda Mikafungin Kullanımı Sonuçları

Mikrobiyoloji Bulteni, 2019

İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin... more İnvaziv kandidoz prematüre yenidoğanlarda yaygın ve ciddi bir enfeksiyondur. Prematüre bebeklerin prognozunu iyileştirmek için mantar enfeksiyonlarının önlenmesi ve tedavisi çok önemlidir. Yenidoğanlarda invaziv mantar enfeksiyonlarının tedavisinde ilk seçenek olan flukonazol ve amfoterisin B kullanımının nefrotoksisite, hepatotoksisite ve dirençli suşlar nedeniyle mümkün olmadığı durumlarda en son geliştirilen antifungal ilaç sınıfı olan ekinokandinlerden mikafungin kullanılmaktadır. Mikafunginin yenidoğanlarda kullanımı yeni olup, santral sinir sistemine etkili olan yüksek dozlardaki kullanım tecrübesi sınırlıdır. Bu çalışmada, üçüncü düzey yoğun bakım ünitesinde retrospektif olarak 24 aylık süre içerisinde (2016-2017) yenidoğan yoğun bakımındaki yatışları süresince kültür kanıtlı veya olası invaziv mantar enfeksiyonu tedavisi için mikafungin kullanılan hastaların elektronik dosyalarını incelenmek amaçlanmıştır. Çalışmaya 10 prematüre, 5 term bebek olmak üzere toplam 15 hasta dahil edilmiştir. Hastaların ortalama doğum ağrılığı 1732 ± 999 g ve ortalama gestasyon yaşı 32.2 ± 5.8 hafta olarak belirlenmiştir. Tüm hastalarda uzun süre yoğun bakım yatışı ve invaziv kandidoz enfeksiyonu riskini arttıran faktörler tespit edilmiştir. Bu risk faktörlerinin hastalardaki sıklığına baktığımızda en sıkla, hastaların hepsinde mevcut olan santral venöz kateter ve çoklu antibiyotik kullanımı saptanırken, diğerleri sırasıyla entübasyon, total parenteral nutrisyon kullanımı ve cerrahi işlem uygulaması olarak gözlenmiştir. Dört hastanın kültüründe mantar üremesi olmuştur. Hastalardan izole edilen Candida türleri Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis olarak saptanmıştır. Mikafungin tedavisine başlanan hastalardan sekizi öncesinde amfoterisin B, üçü flukonazol tedavisi almaktayken dört hasta ise herhangi bir antifungal tedavi almamıştır. Mikafungin başlama zamanı ortalama 29.9 ± 16.6 gün olarak belirlenmiştir. Mikafungin kullanım süreleri de ortalama 22.4 ± 11.2 gün olarak gerçekleşmiştir. İzlemde ise hiçbir hastada mikafungin kullanımına bağlı olarak elektrolit bozukluğu veya karaciğer fonksiyon testlerinde bozukluk görülmemiştir. Sonuç olarak flukonazol veya amfoterisin B kullanımına bağlı karaciğer ve böbrek fonksiyonları bozulan veya daha önceden bozuk olan yenidoğan hastalarda ve dirençli Candida suşlarının neden olduğu yenidoğanın kültür kanıtlı ve olası invaziv Candida enfeksiyonlarının tedavisinde yüksek doz (10 mg/kg/gün) mikafungin güvenli ve etkin bir tedavi seçeneği olabileceği düşünülmüştür.

Research paper thumbnail of Aluminum exposure in premature babies related to total parenteral nutrition and treatments

The Turkish Journal of Pediatrics, 2018

This study aimed to measure aluminum contamination of parenteral nutrition (PN) solutions and alu... more This study aimed to measure aluminum contamination of parenteral nutrition (PN) solutions and aluminum contents of parenteral products given to newborn infants for nutrition or treatment. In this study, the aluminum content of the first products used to prepare PN solutions for premature neonates, of the final parenteral products prepared therefrom, and of the parenteral drugs frequently used in newborn units was measured using the inductively coupled plasma mass spectrometry. The aluminum contamination of all parenteral nutritional products evaluated, except for one, was detected to be over the recommended doses. Of all the first products analyzed within the scope of the study, trace-element preparation, preparation containing fat-soluble vitamins, 20% dextrose solution, calcium gluconate ampoule and sodium phosphate ampoule indicated high aluminum contamination. The total aluminum content of the prepared final products was identified to be at least 40% higher than the total aluminum content of the ingredients added to the compound. Accordingly, the minimum amount of aluminum content was measured as 233 μg/kg/day in nutrition solutions prepared for a baby weighing 1,000 g. Contamination was detected in 9 of the 18 drugs evaluated. This study indicated that the rate of aluminum exposure of the premature babies receiving parental nutrition is still much higher than the safe doses recommended as 5 μg/kg/day by the FDA. Products with lower aluminum content should be preferred in the care of premature infants.