Person: ÇAKIR, SALİH ÇAĞRI
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ÇAKIR
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SALİH ÇAĞRI
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Publication The diagnostic value of serum amyloid a in early-onset neonatal sepsis in premature infants(Medcom, 2021-01-01) Dorum, Bayram Ali; Özkan, Hilal; Çakır, Salih Çağrı; Köksal, Nilgün; Gözal, Zeynep; Çelebi, Solmaz; Hacımustafoğlu, Mustafa; Dorum, Bayram Ali; ÖZKAN, HİLAL; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Gözal, Zeynep; ÇELEBİ, SOLMAZ; Hacımustafoğlu, Mustafa; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hastalıkları Anailim Dalı/Neonatoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Enfeksiyon Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hastalıkları Anabilim Dalı.; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8451-2021; HJZ-4508-2023; A-5375-2017; AEZ-2469-2022; JLX-9286-2023; FFA-6764-2022; CRX-2793-2022; CSN-9445-2022Purpose: In this study, the aim was to determine the distinct effectiveness of serum amyloid A in the early stage of early-onset neonatal sepsis in premature infants. Methods: Preterm newborns hospitalised between 2014 and 2017 for suspected early-onset neonatal sepsis were included in this prospective study. Patients were evaluated according to clinical and laboratory findings at admission and at the 24th and 48th hours after admission. The serum amyloid A values of the patients with sepsis and a control group were compared, and the blood cultures were evaluated. Results: A total of 319 premature newborns were included in the study: 150 in the sepsis group and 169 in the control group. Their birth weight ranged between 590 g and 3000g and the gestational age was 24-36 weeks. The serum amyloid A values at admission were significantly higher in the cases diagnosed with sepsis compared to the control group. Conclusion: Serum amyloid A is a reliable diagnostic marker for the early onset of neonatal sepsis, and it has a higher sensitivity at symptom onset or in the first hours after birth in premature infants.Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Onkoloji Anabilim Dalı.; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication What should be the protein target for adjustable human milk fortification in premature infants?(Professional Medical Publications, 2019-01-01) Dorum, Bayram Ali; Özkan, Hilal; ÖZKAN, HİLAL; Çakir, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Şen, Gizem Ezgi; ŞEN, GİZEM EZGİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8393-2021; HJZ-4508-2023; AEZ-2469-2022; A-5375-2017Objective: To assess the short- and long-term effects of the adjustable fortification (ADJ) regimen on growth parameters in premature infants and to evaluate the amount of protein supplements given to reach the targeted blood urea nitrogen (BUN) levels.Methods: In this retrospective study, preterm babies who were born at <= 32 weeks gestational age and fed with human milk, were evaluated in two groups. Infants in Group-I were fed only standard fortification (STD). Infants in Group-II were fed the ADJ regimen. The study was conducted between 2011 and 2016.Results: There were 123 infants in the STD group and 119 in the ADJ group. The mean gestational age of the patients in Group-I was 29.7 +/- 1.8 weeks, and mean birth weight was 1266.1 +/- 347.1 g. The mean gestational age of the patients in Group-II was 29.5 +/- 1.9 weeks, and the mean birth weight was 1217.5 +/- 345.5 g. The daily increase in weight and weekly increase in HC were significantly higher in the ADJ group infants. Weight and HC of infants in the ADJ group were significantly higher at 40 weeks. At one year corrected age, weight, length, and HC measurements of both groups were similar. In Group-II, 63% of patients required additional protein supplementation up to 1.6 g/day to achieve the target BUN levels.Conclusion: A higher protein intake through the ADJ regimen improves the physical growth rate of premature infants in the NICU and after discharge. However, sometimes, the targeted growth and BUN values cannot be achieved despite the administration of protein at the recommended increased doses. Increasing protein supplementation up to 1.6 g/day is safe, feasible, and beneficial for these infants.Publication Radiation exposure in the neonatal intensive care unit in newborns and staff(Thieme Medical Publ Inc, 2021-07-28) Çakır, Salih Çağrı; Dorum, Bayram Ali; Köksal, Nilgün; Özkan, Hilal; Yazıcı, Zeynep; Parlak, Müfit; Gülleroğlu, Nadide Başak; ÇAKIR, SALİH ÇAĞRI; Dorum, Bayram Ali; Köksal, Nilgün; ÖZKAN, HİLAL; YAZICI, ZEYNEP; PARLAK, MÜFİT; Gülleroğlu, Nadide Başak; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediat Bölümü; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Bölümü; 0000-0001-5761-4757; 0000-0002-2823-8454; HJZ-4508-2023; AEZ-2469-2022; A-5375-2017; A-5375-2017; CZV-1969-2022; IGT-7005-2023; AAI-2303-2021; AAG-8521-2021; EZQ-1350-2022Objective Portable X-rays remain one of the most frequently used diagnostic procedures in neonatal intensive care units (NICU). Premature infants are more sensitive to radiation-induced harmful effects. Dangers from diagnostic radiation can occur with stochastic effects. We aimed to determine the radiation exposure in premature infants and staff and determine the scattering during X-ray examinations in the NICU. Study Design In this prospective study, dosimeters were placed on premature infants who were <= 1,250 g at birth and <= 30 weeks of gestational age who stayed in the NICU for at least 4 weeks. The doses were measured at each X-ray examination during their stay. The measurements of the nurses and the doctors in the NICU were also performed with dosimeters over the 1-month period. Other dosimeters were placed in certain areas outside the incubator and the results were obtained after 1 month. Results The mean radiation exposure of the 10 premature infants, monitored with dosimeters, was 3.65 +/- 2.44 mGy. The mean skin dose of the six staff was 0.087 +/- 0.0998 mSV. The mean scattered dose was 67.9 +/- 26.5 mu Gy. Conclusion Relatively high exposures were observed in 90% of the patients and two staff. The radiation exposure levels of premature infants and staff may need to be monitored continuously.Publication The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study(Elsevier Taiwan, 2021-03-03) Demirdağ, Tuğba Bedir; Koç, Esin; Tezer, Hasan; Oğuz, Suna; Satar, Mehmet; Sağlam, Özge; Uygun, Saime Sunduz; Önal, Esra; Hirfanoğlu, İbrahim Murat; Tekgündüz, Kadir; Oygur, Nihal; Bülbül, Ali; Zubarioğlu, Adil Umut; Ustun, Nuran; Ünal, Sezin; Aygun, Canan; Karagöl, Belma Saygılı; Zenciroğlu, Ayşegül; Öncel, M. Yekta; Sağlık, Adviye Çakıl; Okulu, Emel; Terek, Demet; Narlı, Nejat; Aliefendioğlu, Didem; Gürsoy, Tuğba; Ünal, Sevim; Türkmen, Münevver Kaynak; Narter, Fatma Kaya; Çiftdemir, Nükhet Aladağ; Beken, Serdar; Çakır, Salih Çağrı; Yiğit, Şule; Çoban, Asuman; Ecevit, Ayşe; Çelik, Yalçın; Kulalı, Ferit; ÇAKIR, SALİH ÇAĞRI; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; 0000-0001-5761-4757 ; HJZ-4508-2023Background: Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis.Methods: A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (& thorn;). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005).Conclusions: Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.Publication Etiology, clinic and prognosis of seizures in preterm and term neonates: A retrospective study(Bursa Uludag Üniversitesi, 2021-08-01) Cakir, Salih Cagri; ÇAKIR, SALİH ÇAĞRI; Toker, Rabia Tutuncu; TÜTÜNCÜ TOKER, RABİA; Koksal, Nilgun; Ozkan, Hilal; ÖZKAN, HİLAL; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Kocael, Fatma; KOCAEL, FATMA; Yoruk, Gulce; YÖRÜK, GÜLCE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dali; 0000-0001-5761-4757; 0000-0002-3129-334X; 0000-0002-9303-5768; 0000-0002-1787-6872; IZP-6290-2023; HJZ-4508-2023Introduction: The seizure is one of the most common neurological problems in neonatal intensive care units (NICU). Its frequency and etiology differ between preteen and term babies. This study aimed to investigate the properties, causes, response to treatment, and prognostic factors of neonatal seizures in term and preterm babies.Materials and Methods: The files of patients with a diagnosis of neonatal seizure in the NICU between 01/01/2014 and 01/09/2019 were analyzed retrospectively. Gross motor function classification, hearing test results and epilepsy rates were examined for neurological outcomes.Results: A total of 86 patients (43 preterm and 43 term infants) were included in this study. The most common etiological factors were hypoxic-ischemic encephalopathy (HIE) (35%) in term infants and intraventricular hemorrhage (IVH) in preterm infants (54%). The most common seizure type was subtle seizures in preterm babies and clonic seizures in term babies. The first seizure day was more on the first day and between the 4-7 days in term babies and after seventh days in preterm babies (p <0.05). The onset time of seizures in preterm babies was more after seven days at IVH, and on the first day at HIE (p<0.05). Status epilepticus frequency is higher in preterm (30%) than term (9.3%) (p = 0.015). The response rate to phenobarbital treatment was 71% in term infants and 50% in preterm infants (p = 0.06). According to the criteria (death, epilepsy, hearing loss, autism and gross motor function scale> 2) in our study, the poor prognosis rates were (52%) in term infants and (75%) in preterm infants (p = 0.051).Conclusion: In the etiology of neonatal seizures, IVH in preterm infants and HIE in term infants were the first. The neurological outcomes of patients who had convulsions in the neonatal period should be followed closely.Publication 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-5805-2022Background: 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.Publication Results of the use of micafungin in newborns(Ankara Microbiology Soc, 2019-01-01) Çakır, Salih Çağrı; ÇAKIR, SALİH ÇAĞRI; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgün; Dorum, Bayram Ali; Yeşil, Edanur; YEŞİL, EDANUR; Hacımustafaoğlu, Mustafa; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Anabilim Dalı.; 0000-0001-5761-4757; 0000-0002-2823-8454; 0000-0002-8926-9959; 0000-0003-4646-660X; AAG-8393-2021; AEZ-2469-2022; GSO-3630-2022; HJZ-4508-2023; A-5375-2017; JCD-9679-2023Invasive candidiasis is a common and serious infection in premature newborns. Preventing and treating fungal infections is very important to improve the prognosis of premature infants. Fluconazole and amphotericin B are used as the first choice in the treatment of invasive fungal infections of the newborns. In some cases, fluconazole and amphotericin B cannot be used due to nephrotoxicity, hepatotoxicity or resistant strains. Micafungin, which is among recently developed echinocandins, is the drug of choice in these cases. The use of micafungin in newborns is new and there is a limited experience about the effect of high dose usage in the central nervous system. The aim of this study was to evaluate the electronic files of patients who used micafungin for the treatment of culture-proven or possible invasive fungal infection during their hospital stay in the neonatal intensive care unit during a 24-month period (2016-2017) in the third-level intensive care unit. A total of 15 patients (10 premature and 5 term babies) were included in the study. The mean birth weight of the patients was 1732 +/- 999 g and the mean gestational age was 32.2 +/- 5.8 weeks. All patients had long-term intensive care and increased risk of invasive candidiasis infection. Central venous catheterization and multiple antibiotics usage were the most common risk factors in these patients. The other risk factors included intubation, total parenteral nutritional use and surgical procedure application. Candida species were isolated from the cultures of four patients. Candida species isolated from patients were Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis. The mean time for onset of micafungin was 29.9 +/- 16.6 days. Mean duration of micafungin therapy was 22.4 +/- 11.2 days. Eight patients received amphotericin B, three patients received fluconazole therapy and four patients did not receive any antifungal therapy before the onset of micafungin. None of these patients had an abnormal kidney or liver function tests due to micafungin use. As a conclusion, high dose (10 mg/kg/day) micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections that were caused by refractory Candida strains, and in the case of nephrotoxicity and hepatotoxicity.