Browsing by Author "Dorum, Bayram Ali"

Now showing 1 - 20 of 30

A comparison of chlorhexidine and povidone-iodine solutions in neonatal intensive care units
(Wiley, 2023-01) Küçüker, Hakan; Çakır, Salih Çağrı; Köksal, Nirgül; Özkan, Hilal; Kocael, Fatma; Dorum, Bayram Ali; Yıldırım, Cansu Sivrikaya; Çelebi, Solmaz; Hacımustafaoğlu, Mustafa; KÜÇÜKER, HAKAN; ÇAKIR, SALİH ÇAĞRI; KÖKSAL, FATMA NİRGÜL; ÖZKAN, HİLAL; KOCAEL, FATMA; SİVRİKAYA YILDIRIM, CANSU; ÇELEBİ, SOLMAZ; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Dorum, Bayram Ali; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0002-1636-5819; 0000-0001-5761-4757; 0000-0002-1787-6872; 0000-0003-4646-660X; 0000-0002-2823-8454; CZJ-5958-2022; HJZ-4508-2023; CZV-1969-2022; IGT-7005-2023; DXK-0792-2022; A-5375-2017; KGF-7434-2024; ENK-4130-2022; CTG-5805-2022
Background: Povidone-iodine (10%; PI) and 2% chlorhexidine in 70% isopropyl alcohol (CHG-IA) solutions are among the most widely used disinfectants in the neonatal intensive care units. This study compares the use of these disinfectants and helps decide which is superior to the other for neonatal use.Methods: All term and preterm infants born and hospitalized in Bursa Uludag University Hospital between July 2018-March 2020 were included. The infants were randomized into two disinfectant groups before birth. The application site was cleaned with the assigned disinfectant before intervention. The infants were screened for rates of neonatal sepsis, thyroid-stimulating hormone (TSH) levels, free thyroxine (fT4) levels, skin reactions to the assigned solution, and acute neurological side effects.Results: We enrolled 208 term and preterm infants (PI:104 vs. CHG-IA: 104) in the study. The prematurity rates were identical (PI: 74.0%; CHG-IA: 72.1%; p = 0.755). Neonatal sepsis rates among these groups were not statistically different (PI: 8.7%; CHG-IA: 4.8%; p = 0.406). The median TSH value of the PI group was high (4.05 mIU/L) in comparison with that of the CHG-IA group (3.09 mIU/L; p = 0.016). No cutaneous or neurological side effects were recorded in patients treated with CHG-IA solution.Conclusions: Although these two solutions were equally protective against infections, the CHG-IA solution was a better alternative to PI for neonatal use. Considering that the PI solution may be responsible for impaired thyroid function, the CHG-IA solution is a good alternative because it provides sufficient protection with a safer adverse effect profile.
Aluminum exposure in premature babies related to total parenteral nutrition and treatments
(Türk Pediatri Dergisi, 2018-07-01) Asut, Emre; Köksal, Nilgün; Dorum, Bayram Ali; Özkan, Hilal; Asut, Emre; KÖKSAL, FATMA NİRGÜL; Dorum, Bayram Ali; ÖZKAN, HİLAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Yenidoğan Bilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı; 0000-0002-2823-8454; A-5375-2017; AAG-8393-2021; HJH-3690-2023; JGS-7600-2023; JJY-3921-2023
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 mu g/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 mu g/kg/day by the FDA. Products with lower aluminum content should be preferred in the care of premature infants.
Aluminum exposure in premature babies related to total parenteral nutrition and treatments
(Turkish J Pediatrics, 2018-07-01) Asut, Emre; Köksal, Nilgün; Dorum, Bayram Ali; Özkan, Hilal; ÖZKAN, HİLAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neontoloji Anabilim Dalı.; 0000-0002-2823-8454; AAG-8393-2021; HJH-3690-2023; A-5375-2017
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 mu g/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 mu g/kg/day by the FDA. Products with lower aluminum content should be preferred in the care of premature infants.
BRUE - bebeklerde kısa süreli düzelen açıklanamayan olaylar
(Uludağ Üniversitesi, 2018) Dorum, Bayram Ali; Köksal, Nilgün; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.
Daha öncesinde “Açıkça yaşamı tehdit eden olaylar” “Apparent life-threatening events” (ALTE) olarak tanımlanan olgular, 2016 yılında, Amerikan Pediatri Akademisi tarafından “Kısa süreli düzelen açıklanamayan olaylar”-“Brief Resolved Unexplained Events” (BRUE) olarak yeniden isimlendirilmiştir. BRUE tanısı için; kısa süren, bu süre sonunda düzelen, öykü ve fizik muayene ile açıklanamayan bir olayın şu özelliklerden birini içermesi gerekir; siyanoz ya da solukluk; solunumun azalması, düzensizleşmesi yada olmaması; tonusta belirgin değişiklik; bilinç durumunda değişiklik. Böyle bir olayın düşük riskli mi yoksa yüksek riskli mi olduğu, epidemiyolojik olarak ortaya konmalıdır. Düşük riskli olarak değerlendirilmesi için şu kriterler karşılanmalıdır; doğumda ≥32 haftalık ve doğum sonrası yaşın 60 günün üzerinde olması, daha önce benzer bir olay olmaması, 1 dakikadan kısa sürmesi, eğitimli sağlık personeli tarafından canlandırmaya gerek duyulmaması ve herhangi bir öykü veya fizik muayene bulgusu saptanmaması. Düşük riskli olaylar, hastaneye yatırma, daha fazla araştırma veya ev monitorizasyonu gerektirmez. Aksine, yüksek riskli olayları olan bebekler hastaneye yatırılmalı, izlenmeli ve altta yatabilecek bir patoloji açısından incelenmelidir.
Brue - brief resolved unexplained events
(Galenos Yayincilik, 2018-01-01) Dorum, Bayram Ali; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı; 0000-0002-2823-8454; A-5375-2017; AAG-8393-2021
In 2016, the cases formerly known as "Apparent life-threatening events" (ALTE) have been renamed to "Brief Resolved Unexplained Events" (BRUE) by the American Academy of Pediatrics. The diagnosis of BRUE in infants is made when infants experience: a brief episode, that is resolved, which remains unexplained after the history and physical examination, and includes an event characterized by cyanosis or pallor; absent, decreased, or irregular breathing; marked change in tone; or altered level of responsiveness. Low and high-risk events can be identified epidemiologically. To be designated lower risk, the following criteria should be met; older than 60 days with birth at >= 32 weeks gestation, no previous event, a duration less than 1 minute, no need for resuscitation by trained medical personnel and no concerning historical features or physical examination findings. Low-risk events do not require hospitalization, further research, or home monitoring. Conversely, infants with high-risk events should be admitted to hospital and monitored.
Can tissue oxygen saturation levels in the first 24 hours predict the development of patent ductus arteriosus in premature babies with respiratory distress syndrome?
(Galenos Yayınevi, 2023-12-01) Dorum, Bayram Ali; Özkan, Hilal; Çetinkaya, Merih; Çakır, Salih Çağrı; Köksal, Nilgün; ÖZKAN, HİLAL; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; 0000-0001-5761-4757; JJY-3921-2023; HJZ-4508-2023; JGS-7600-2023
Introduction: Patent ductus arteriosus (PDA) causes a substantial increase in morbidities in premature babies by causing changes in organ perfusion. Various echocardiographic parameters are used to diagnose PDA and determine whether it is hemodynamically significant (HsPDA). This study aimed to investigate the role of tissue oxygen saturation in the first 24 hours in predicting HsPDA in high-risk premature babies who received respiratory support because of respiratory distress syndrome. Materials and Methods: In this prospective, observational study, cerebral, renal, and mesenteric regional tissue oxygen saturation levels were monitored by near infrared spectroscopy (NIRS) for the first 24 hours of the lives of preterm babies at <= 28 weeks of gestation. The NIRS data of babies with and without HsPDA as diagnosed by echocardiographic examination were compared. Results: Eighty-one premature babies who had HsPDA were included in the study. In the control group 51 premature babies who had not HsPDA were evaluated. The median standard deviation (SD) gestational age of the babies included in the study was 26.9 +/- 1 weeks, and the mean +/- SD birth weight was 880 +/- 218 g. Renal and mesenteric NIRS measurements during follow-up were lower in babies with versus without HsPDA, but the difference was not statistically significant. Conclusion: Low renal and mesenteric stO2 values detected on the first day of life in high-risk infants may be associated with HsPDA. More studies are needed to reveal the effects of HsDPA on organs in these vulnerable babies with NIRS monitoring.
Congenital diaphragmatic hernia: Ten-year single center results
(Galenos Yayıncılık, 2017-12-01) Dorum, Bayram Ali; Çakır, Salih Çağrı; Yakut, Uğur; Özkan, Hilal; Gürpınar, Arif Nuri; Köksal, Nilgün; Dorum, Bayram Ali; ÇAKIR, SALİH ÇAĞRI; Yakut, Uğur; ÖZKAN, HİLAL; GÜRPINAR, ARİF NURİ; Köksal, Nilgün; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatol Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0002-2823-8454; 0000-0001-5761-4757; A-5375-2017; HJZ-4508-2023; JSF-7437-2023; JRA-9088-2023; JIJ-4901-2023; JGS-7600-2023
Introduction: Congenital diaphragmatic hernia (CDH) is a rare abnormality with high mortality and long-term comorbid conditions. Our aim, in this paper, was to describe demographics and birth characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution.Methods: The present study represents a retrospective cohort study of neonates with CDH who were treated at Uludag University Medical Faculty, Neonatal intensive care unit, Bursa. We identified the medical records of all patients with CDH who were admitted for treatment to our neonatal intensive care unit from January 2007 to December 2016. We reviewed the medical, surgical records, demographics and birth characteristics. We also recorded presence of pulmonary hypertension, whether or not the liver and, stomach also herniated into the thorax, other associated congenital malformations, and type of mechanical ventilation.Results: Forty patients were included in this study. The overall mortality was 67.5% (27/40). Survival for those who had surgical correction of CDH was 61% (13/21). Low birth weight, low gestational age, low APGAR scores and, high oxygen need at baseline was found to be associated with mortality, in patients with CDH. Among survivors, the median duration of hospitalization was 23 (14-35) days. Chronic gastrointestinal, pulmonary disorders and, failure to thrive were the most comorbid conditions after discharge.Discussion And Conclusion: KDH still has high mortality and morbidity. The birth of patients with prenatal diagnosis at appropriate centers will increase their chances of successful intervention.
The danger awaiting premature babies: Portal vein thrombosis
(Türk Milli Pediatri Derneği, 2020-03-30) Çakır, Salih Çağrı; Özkan, Hilal; Dorum, Bayram Ali; Köksal, Nilgün; Kudretoğlu, Pınar; Baytan, Birol; Sezgin, Melike; Güneş, Adalet Meral; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Yenidoğan Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Hematolojisi Bilim Dalı.; 0000-0001-5761-4757; AAG-8393-2021; 57205555920; 16679325400; 37661266800; 7003323615; 57219225102; 6506622162; 55316683800; 24072843300
Aim: Umbilical venous catheters are frequently used in the neonatal period. The incidence of umbilical venous catheter-related thrombosis is between 1.3% and 43% in ultrasound scans. This study aimed to determine the incidence and risk of portal vein thrombosis in patients who were hospitalized in the neonatal intensive care unit and underwent umbilical venous catheter insertion. Material and Methods: Premature infants (<= 32 gestational weeks) who were hospitalized in a Level III neonatal intensive care unit and underwent umbilical vein catheter placement between 2016 and 2018, were included in the study. The demographic data, clinical risk factors for thrombosis, number of catheter days, catheter locations, times of detection of thrombosis using Doppler ultrasonography, treatment methods and durations, thrombosis follow-up and examinations were obtained retrospectively from the electronic patient files. Results: Ninety-six patients whose complete data could be reached were enrolled in the study. The mean gestational age of the patients was found as 29 +/- 2 weeks and the mean birth weight was 1353 +/- 369 g. Portal vein thrombosis was detected in 13.5% (n=13) of the patients. Five of the cases of portal vein thrombose were complete occlusion and eight were partial occlusion. All patients with complete occlusion and six patients with partial occlusion were treated with low-molecular-weight heparin for a mean duration of 31 +/- 13.8 days. Thrombosis disappeared in 7-120 days in all patients. A thrombophilia mutation was detected in six patients with thrombosis, four of whom had the PAI-1 4G / 5G mutation. Conclusion: Portal vein thrombosis which has a significant place among the causes of portal hypertension in childhood, is mostly asymptomatic in the neonatal period and cannot be recognized clinically. It is important to screen and follow up patients with umbilical vein catheters using Doppler ultrasonography in terms of PVT after catheter removal to prevent long-term complications.
The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants
(Professional Medical Publications, 2020-01) Çakır, Salih Çağrı; Dorum, Bayram Ali; Köksal, Nilgün; Özkan, Hilal; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0001-5761-4757; 0000-0002-2823-8454; HJZ-4508-2023; A-5375-2017; CZV-1969-2022; IGT-7005-2023; 57205555920; 37661266800; 15056452900; 16679325400
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, IL10, and TNF-alpha 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, intraventricular hemorrhage, necrotizing enterocolitis, neutropenia, and thrombocytopenia were significantly higher at the infants with preeclampsia. Conclusion: Maternal preeclampsia leads to an increase at the neonatal morbidities in premature infants without causing a significant alteration at the cytokine levels in cord blood.
Evaluation of risk and prognostic factors in neonatal meningitis
(Galenos Yayınevi, 2023-04-01) Parlakay, Gülşah; Çakır, Salih Çağrı; Dorum, Bayram Ali; Özkan, Hilal; Çelebi, Solmaz; Hacımustafaoğlu, Mustafa; Köksal, Nilgün; Parlakay, Gülşah; ÇAKIR, SALİH ÇAĞRI; Dorum, Bayram Ali; ÖZKAN, HİLAL; ÇELEBİ, SOLMAZ; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Enfeksiyon Hastalıkları Bilim Dalı.; 0000-0001-5761-4757; 0000-0002-2823-8454; 0000-0003-4646-660X; HJZ-4508-2023; A-5375-2017; JJW-4932-2023; JJY-3921-2023; JHN-1091-2023; CTG-5805-2022; JGS-7600-2023
Introduction: Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. In this study, it was aimed to examine the microbiological factors, biochemical and clinical characteristics of neonatal meningitis cases, to reveal the risk factors, and to investigate the effect on the morbidities associated with meningitis in the first year of life.Materials and Methods: The files of patients diagnosed with meningitis in the level 3 Neonatal Intensive Care Unit between January 2010 and December 2015 were retrospectively analyzed.Results: There were 118 patients diagnosed with meningitis. The median gestational age of the patients was 32 weeks (24-40 weeks), and the median birth weight was 1987 grams (690-5020 grams). Most of the meningitis patients (n=106, 90%) were with late sepsis. The diagnosis day of those with poor prognosis was found to be greater [9.7 (2-28) days to 15.5 (3-138) days, p=0.03]. Cerebrospinal fluid (CSF) leukocytes were significantly higher in term babies with abnormal cranial magnetic resonance imaging (MRI) findings (p=0.037) and loss in hearing tests (p=0.045). CSF sugar levels were significantly lower in preterm babies with neuromotor retardation (p=0.001), history of seizures (p=0.003), abnormal cranial MRI findings (p=0.008) and hearing loss (p=0.005).Conclusion: In the long term, a significant number of cases with neonatal meningitis have neuromotor retarda-tion and hearing problems. Factors that can be used as predictors for poor neurological development; late-onset day, increased CSF leukocyte in all babies, and decreased CSF sugar in preterm babies.
Geç pretermlerin erken dönem sorunları
(Uludağ Üniversitesi, 2018) Çakır, Salih Çağrı; Dorum, Bayram Ali; Köksal, Nilgün; Özkan, Hilal; Coşkun, Muzaffer; Özcan, Nur; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.
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.
İnsülin benzeri büyüme faktörü-1 ve premature morbiditeleri: Bronkopulmoner displazi, premature retinopatisi, intraventriküler kanama ve nekrotizan enterokolit
(Uludağ Üniversitesi, 2019) Dorum, Bayram Ali; Köksal, Nilgün; Özkan, Hilal; Çakır, Salih Çağrı; Yılmaz, Cansu; Özgür, Taner; Budak, Ferah; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmunoloji Anabilim Dalı/Neonatoloji Bilim Dalı.
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. YÖNTEM ve GEREÇLER: Bu ileriye yönelik, gözlemsel çalışmaya, doğum yaşı ≤32 hafta olan prematüre bebekler alındı. Bebeklerin yaşamların 1, 3, 7, 21 ve 28. günlerinde serum IGF-1 düzeyleri ölçüldü. Neonatal morbiditeler açısından izlemleri yapıldı. BULGULAR: Çalışmaya toplam 93 bebek alındı. Bebeklerin ortalama doğum ağırlığı 1236,11±354,06 gr, ortalama doğum yaşları 29,43±2,10 hafta idi. BPD ve PR gelişen bebeklerin serum IGF-1 değerleri, gelişmeyenlere göre anlamlı olarak düşük saptandı. İVK ve NEK gelişen hastalarda ise IGF-1 düzeyleri açısından gelişmeyenlere göre anlamlı fark saptanmadı. TARTIŞMA ve SONUÇ: Prematüre bebeklerde BPD ve PR gelişimi ile ilk 4 haftadaki düşük IGF-1 düzeyleri arasında belirgin ilişki mevcuttur.
Insulin-like growth factor-1 and morbidities of prematurity: Bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and necrotizing enterocolitis
(Galenos Yayincilik, 2019-08-01) ÖZKAN, HİLAL; Dorum, Bayram Ali; Köksal, Nilgün; ÇAKIR, SALİH ÇAĞRI; Çakır, Salih Çagri; Özgür, Taner; Budak, Ferah; Yılmaz, Cansu; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmunoloji Anabilim Dalı.; 0000-0002-2823-8454; 0000-0001-5761-4757; 0000-0001-7625-9148; AAG-8393-2021; IZP-9398-2023; AEZ-2469-2022; HJZ-4508-2023; AAG-8381-2021; F-4657-2014; A-5375-2017
INTRODUCTION: Insulin-like growth factor-1 (IGF-1) is important for fetal and postnatal development. After premature births, serum IGF-1 concentrations rapidly decrease and can stay at much lower levels than during the intrauterine period. In this study, we aimed to ascertain whether IGF-1 is associated with morbidities of prematurity such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), and is a useful predictor of these diseases.METHODS: We enrolled newborn infants born at a postmenstrual age of <= 32 weeks in this prospective observational cohort study. Serum IGF-1 levels were measured serially in blood samples on the 1st, 3rd, 7th, 21st, and 28th day.RESULTS: A total of 93 infants were enrolled in the study. All these infants had the following characteristics at birth: weight 1236.11 +/- 354.06 g, and gestational age 29.43 +/- 2.10 weeks. All of the IGF-1 levels were significantly lower in the group which developed BPD or ROP (p<0.001). The patients who developed IVH and NEC also had lower IGF-1 levels.DISCUSSION and CONCLUSION: Strong correlations have been found between low serum IGF-1 levels during the first four weeks and development of BPD and ROP.
Konjenital diyafragma hernisi: On yıllık tek merkez sonuçları
(Uludağ Üniversitesi, 2017) Dorum, Bayram Ali; Çakır, Salih Çağrı; Yakut, Uğur; Özkan, Hilal; Gürpınar, Arif Nuri; Köksal, Nilgün; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Çocuk Cerrahisi Anabilim Dalı.
Giriş ve Amaç: Konjenital diyafragma hernisi (KDH) yüksek mortalite ve uzun dönem morbiditeler ile ilişkili nadir bir anomalidir. Bu çalışmanın amacı ünitemizde KDH tanısı ile takip edilen hastaların demografik, klinik özelliklerini, uygulanan tedavi ve sonuçlarını tanımlamaktır. Yöntem ve Gereçler: Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi yenidoğan yoğun bakım ünitesinde KDH tanısı ile tedavi gören hastalar retrospektif olarak taranmıştır. Ocak 2007 ile Aralık 2016 arasında ünitemizde tedavi gören hastaların medikal kayıtları incelenmiştir. Hastaların demografik ve doğum özellikleri, pulmoner hipertansiyon durumları, karaciğer ve mide herniasyonları, ek konjenital anomalileri, mekanik ventilasyon şekilleri değerlendirilmiştir. Bulgular: Çalışma periyodu boyunca KDH nedeniyle tedavi gören 40 hasta çalışmaya alınmıştır. Tüm hastalar içinde ölüm oranı %67.5 (27/40) olarak gerçekleşmiştir. Düşük doğum ağırlığı, düşük gestasyonel hafta, düşük APGAR skorları ve başlangıçta yüksek oksijen ihtiyacı mortalite ile ilişkili bulunmuştur. Opere edilen hastalar içinde yaşama oranı %61 (13/21) idi. Yaşayan hastaların ortalama hastanede kalış süreleri 23 (14–35) idi. Taburculuk sonrası komorbid durumlar kronik gastrointestinal, pulmoner sorunlar ve büyüme geriliği olarak saptandı. Tartışma ve Sonuç: KDH halen yüksek mortalite ve morbiditeye sahiptir. Prenatal tanı alan hastaların uygun merkezlerde doğması başarılı müdahale şanslarını artıracaktır.
Low serum IGF-1 and increased cytokine levels in tracheal aspirate samples are associated with bronchopulmonary dysplasia
(Türk Pediatri Dergisi, 2017-02-20) Yılmaz, Cansu; Köksal, Nilgün; Özkan, Hilal; Dorum, Bayram Ali; Bağcı, Onur; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; 0000-0002-2823-8454; A-5375-2017; AAG-8393-2021; 57209112906; 7003323615; 16679325400; 37661266800; 20733563300
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.
Mesenteric tissue oxygenation status on the development of necrotizing enterocolitis
(Türk Pediatri Dergisi, 2021-09-01) Özkan, Hilal; Çetinkaya, Merih; Dorum, Bayram Ali; Köksal, Nilgün; ÖZKAN, HİLAL; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı; 0000-0001-5454-5119; 0000-0002-6067-3886; JLK-4920-2023; JGS-7600-2023
Background. Necrotizing enterocolitis (NEC) is an important cause of morbidity and mortality in preterm infants. There is limited data about the role of mesenteric oxygenation status during the first enteral feeding. Therefore, the aim of this study was to determine the mesenteric tissue oxygen saturation values before, during and after the first enteral feeding and to evaluate the effect of these values on the development of NEC in preterm infants. Methods. A total of 105 preterm babies with <= 32 gestational weeks were included in this prospective study. The continuous monitoring of the mesenteric tissue oxygenation status was performed before, during and 3 hours after the first feeding by near-infrared spectroscopy (NIRS). Results. The mean gestational week and birth weight of the study group were 28.8 +/- 2.1 weeks, and 1215 +/- 387 g, respectively. The first enteral feeding was started at 2.4 +/- 1.4 days with breast milk in 85% of infants. A total of 12 infants (11.4%) developed NEC (66% stage II, 34% stage III). The mean mesenteric tissue oxygen saturation levels of the infants that developed NEC were significantly lower both before and one hour after feeding (56.1 +/- 3.4 vs. 34 +/- 8.8, and 47.4 +/- 3.3 vs 37.8 +/- 10.9, respectively) compared with infants that did not develop NEC. Conclusions. Lower mesenteric tissue oxygenation values measured before, and one hour after enteral feeding was associated with NEC development. We suggest that lower mesenteric tissue oxygenation during continuous monitoring of first enteral feeding may be used to predict NEC development during follow-up.
Mesenteric tissue oxygenation status on the development of necrotizing enterocolitis
(Turkish J Pediatrics, 2021-09-01) Çetinkaya, Merih; Dorum, Bayram Ali; Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neontoloji Anabilim Dalı.; 0000-0002-2823-8454; A-5375-2017; AFP-9671-2022
Background. Necrotizing enterocolitis (NEC) is an important cause of morbidity and mortality in preterm infants. There is limited data about the role of mesenteric oxygenation status during the first enteral feeding. Therefore, the aim of this study was to determine the mesenteric tissue oxygen saturation values before, during and after the first enteral feeding and to evaluate the effect of these values on the development of NEC in preterm infants. Methods. A total of 105 preterm babies with <= 32 gestational weeks were included in this prospective study. The continuous monitoring of the mesenteric tissue oxygenation status was performed before, during and 3 hours after the first feeding by near-infrared spectroscopy (NIRS). Results. The mean gestational week and birth weight of the study group were 28.8 +/- 2.1 weeks, and 1215 +/- 387 g, respectively. The first enteral feeding was started at 2.4 +/- 1.4 days with breast milk in 85% of infants. A total of 12 infants (11.4%) developed NEC (66% stage II, 34% stage III). The mean mesenteric tissue oxygen saturation levels of the infants that developed NEC were significantly lower both before and one hour after feeding (56.1 +/- 3.4 vs. 34 +/- 8.8, and 47.4 +/- 3.3 vs 37.8 +/- 10.9, respectively) compared with infants that did not develop NEC. Conclusions. Lower mesenteric tissue oxygenation values measured before, and one hour after enteral feeding was associated with NEC development. We suggest that lower mesenteric tissue oxygenation during continuous monitoring of first enteral feeding may be used to predict NEC development during follow-up.
New-generation fish oil and olive oil lipid for prevention of oxidative damage in preterm infants: Single center clinical trial at university hospital in Turkey
(Wiley, 2019-04) Ozkan, Hilal; Köksal, Nilgün; Dorum, Bayram Ali; Kocael, Fatma; Ozarda, Yeşim; Bozyigit, Cengiz; Doğan, Pelin; Varal, Ipek Güney; Bağci, Onur; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri/Çocuk Sağlığı ve Hastalıkları Bölümü.; 0000-0002-2823-8454; 0000-0001-9308-9806; 0000-0003-2215-6973; 0000-0002-1787-6872; 0000-0002-3298-066X; AAI-5981-2020; A-5375-2017; AAL-8873-2021; AAG-8393-2021; 16679325400; 7003323615; 37661266800; 57208440144; 35741320500; 57207927074; 55316686500; 57197818259; 20733563300
BackgroundParenteral nutrition (PN) has been widely used in preterm infants. The lipid solutions used for PN, however, are associated with oxidative stress and morbidity. The aim of this study was to compare the effectiveness of a new-generation lipid emulsion (SMOFLipid) and olive-oil based lipid emulsion for prevention of PN-associated oxidative damage. MethodsPreterm infants<32weeks of gestational age were included in this prospective randomized study. All infants were randomized to SMOFlipid or olive-oil based lipid emulsion (ClinOleic). Lipid peroxidation products were evaluated in all infants. In addition, total antioxidant capacity (TAC), and both pro- and anti-inflammatory cytokines were studied at days 0, 7 and 14. ResultsA total of 89 infants (SMOFlipid, n=42; ClinOleic, n=47) were enrolled. TAC was higher in the SMOFlipid group compared with the ClinOleic group at all time points, and the difference on day 7 was statistically significant. Although the anti-inflammatory cytokine interleukin-10 was higher in the SMOFlipid group, this difference was not significant. Bronchopulmonary dysplasia (BPD) was lower in the SMOFlipid group (14.1%) than in the ClinOleic group (31.2%), but this finding was non-significant p>0.05. The rate of severe BPD was significantly lower in the SMOFlipid group. ConclusionTo our best of knowledge, this is the first study to suggest that SMOFlipid might decrease oxidative damage and oxidative-stress-associated morbidity compared with olive oil-based emulsion in preterm infants.
Nöral tüp defektli yenidoğanların kısa dönem sonuçları
(Uludağ Üniversitesi, 2018) Çakır, Salih Çağrı; Dorum, Bayram Ali; Özkan, Hilal; Taşakapılıoğlu, Özgür; Köksal, Nilgün; Toker, Rabia Tütüncü; Okan, Mehmet Sait; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Nörolojisi Bilim Dalı.
GİRİŞ ve AMAÇ: Nöral tüp defektleri (NTD) yenidoğanlarda en sık saptanan konjenital anomalilerden biridir. Türkiyedeki görülme sıklığı 3/1000’dir. NTD’lerin etiyolojisi multifaktöriyel olup önemli bir kısmının folik asit desteği ile önlenebilmesi mümkündür. NTD olan hastaların uzun dönem medikal, cerrahi ve bakım desteği ihtiyacı vardır. YÖNTEM ve GEREÇLER: Bu çalışmada retrospektif olarak 2013-2017 yılları arasında Yenidoğan Yoğun Bakım Ünitesinde yatan NTD’li hastaların özellikleri incelenmiştir. BULGULAR: Toplam 29 NTD’li hasta incelendi. Hastaların 16’sı (%55) erkek, 13’ü (%45) kız idi. Ortalama gestasyon yaşı 37,5±1,97 hafta, ortalama doğum ağırlığı 3050±703,29 gramdı. NTD gelişimi için altı hastada maternal risk faktörü saptandı. . Hastaların hiçbirinde prekonsepsiyonel folik asit kullanımı yoktu. Hastaların tümü antenatal dönemde ultrason ile tanınmış olup 16 hasta 22 gestasyonel haftadan önce tanınıp terminasyon önerilmiştir. NTD’lerin 23’ü meningomyelosel (%79), 1’i meningosel, 3’ü ensefalomyelosel, 1’i ensefalosel, ve 1’i akrani şeklindeydi. Hastaların on birinde bacak hareketlerinde tam kayıp, dokuzunda kısmi kayıp mevcuttu. Tam motor defisiti olanların hepsinde, kısmi motor defisiti olanların ise 4’ünde (%44) lezyon seviyesi L4’den üst seviyelerdeydi. Yedi hastanın meningomyelosel kesesi yırtıktı. Hidrosefalisi olan 19 hastanın 17’sine ventrikülo peritoneal şant, birine lumboperitoneal şant takılması gerekti. Şant takılması 11 hastada meningomyelosel operasyonu ile aynı zamanda yapıldı. TARTIŞMA ve SONUÇ: NTD’lerin önlenebilir etiyolojik risk faktörlerinin bilinmesi ve çocuk sahibi olmayı düşünen ailelerin bu konuda daha çok bilinçlendirilmesi gerekmektedir.
Prematüre retinopatisi ve intravitreal bevacizumab Tedavisi: Tek merkez deneyimi
(Bursa Uludağ Üniversitesi, 2023-01-18) Dorum, Bayram Ali; Şenocak, Zeynep; Yaşar, Mustafa; Demirağ, Didem
Bu çalışmanın amacı üçüncü basamak bir devlet hastanesinde doğan prematüre bebeklerdeki prematüre retinopatisi (ROP) sıklığı, ROP saptanan ve tedavi gereken bebeklerin özellikleri, uygulanan tedavi ve takip süreçleri ile ilgili deneyimlerin paylaşılmasıdır. Çalışmada 35 haftadan erken doğan prematüre bebeklerin verileri retrospektif olarak incelendi. ROP gelişen bebekler içinde tedavi endikasyonu konan ve konmayan bebeklerin verileri karşılaştırıldı. Çalışmada iki yıllık süre içerisinde ünitemizde tedavi görmüş ve ROP açısından takipleri tamamlanmış olan, 112 bebeğin verileri değerlendirildi. Bebeklerin ortalama gestasyonel yaşı 28,37±2,55 hafta, ortalama doğum ağırlığı 1171,66±405,17 gram idi. Bebeklerin 44 tanesinde (%39,2) ROP saptandı. ROP gelişen bebekler arasında tedavi endikasyonu alanlar (n: 10) daha düşük doğum ağırlığı ve daha yüksek oranda inotrop gereksinimi olan bebeklerdi (p<0.05). Otuz hafta ve üzerinde doğan prematüre bebeklerde ROP saptanmadı. Ciddi ROP gelişen bebeklerin en yüksek doğum haftası 27 idi. Tedavi olarak intravitreal bevacizumab enjeksiyonu başarılı ile uygulandı. Sonuç olarak ROP saptanma yaşı ülkemizde daha düşük haftalara doğru gerilemektedir. İntravitreal bevacizumab hasta başında uygulanabilen etkin ve kısa dönemde güvenilir bir tedavi yöntemidir.