Person: ÖZKAN, HİLAL
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ÖZKAN
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HİLAL
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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; Tıp Fakültesi; Pediatri Ana Bilim 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 Two cases diagnosed with tuberosclerosis in neonatal period(Galenos Yayıncılık, 2014-12-01) Varal, İpek Güney; Köksal, Nilgün; Özkan, Hilal; Bostan, Özlem; Bağcı, Onur; Uysal, Fahrettin; Yazıcı, Zeynep; Doğan, Pelin; Varal, İpek Güney; Köksal, Nilgün; BOSTAN, ÖZLEM MEHTAP; ÖZKAN, HİLAL; Bağcı, Onur; UYSAL, FAHRETTİN; YAZICI, ZEYNEP; Doğan, Pelin; Tıp Fakültesi; Radyoloji Ana Bilim Dalı; Pediatrik Radyoloji Bilim Dalı; 0000-0001-7707-2174; 0000-0001-9308-9806; CIR-8129-2022; JGS-7600-2023; JJY-3921-2023; AAG-8558-2021; KYP-5736-2024; AAH-4421-2021; AAI-2303-2021; CNZ-3688-2022Congenital heart tumors are very rare and the most common type is the rhabdomyoma. Frequency during autopsy is between 0.027-0.08%. Moreover 51-86% of these tumors are associated with tuberosclerosis. Also hamartomas might accompany, particularly on the central nervous system and skin, kidney, liver, lung and heart. In this paper, two cases diagnosed with tuberculosis who showed rhabdomyomas in fetal echocardiography in the antenatal period and were seen to have tubers in cranial magnetic resonance (MR) postnatally, are presented.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; Tıp Fakültesi; Pediat 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 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; Tıp Fakültesi; Pediatri Onkoloji Ana Bilim 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 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; Tıp Fakültesi; Çocuk Hastalıkları Ana Bilim Dalı; Neonatoloji Bilim 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 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; Tıp Fakültesi; Neontoloji Ana Bilim Dalı; 0000-0002-2823-8454; A-5375-2017; AFP-9671-2022Background. 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.Publication 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; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim 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-7600-2023Introduction: 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.Publication Effects of early aggressive total parenteral nutrition on biochemical parameters outcome in preterm infants(Galenos Yayincilik, 2019-12-01) Özkan, Hilal; ÖZKAN, HİLAL; Başak, Mehmet Fatih; Köksal, Nilgün; Dorum, Bayram; Çakır, Salih Cağri; ÇAKIR, SALİH ÇAĞRI; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8393-2021; HJZ-4508-2023; A-5375-2017; AEZ-2469-2022INTRODUCTION: 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 dischargeDISCUSSION 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.Publication An observational, multicenter, registry-based cohort study of Turkish neonatal society in neonates with hypoxic ischemic encephalopathy(Public Library Science, 2023-12-14) Okulu, Emel; Hirfanoğlu, İbrahim Murat; Satar, Mehmet; Erdeve, Ömer; Koç, Esin; Özlü, Ferda; Gökçe, Mahmut; Armangil, Didem; Tunc, Gaffari; Demirel, Nihal; Ünal, Sezin; Özdemir, Ramazan; Deveci, Mehmet Fatih; Akar, Melek; Demirel, Melike Kefeli; Çetinkaya, Merih; Buker, Halime Sema Can; Karagöl, Belma Saygılı; Yaprak, Deniz; Akcan, Abdullah Barış; Anik, Ayşe; Narter, Fatma; Arayıcı, Sema; Yıldırım, Egemen; Akın, Ilke Mungan; Şahin, Özlem; Özdemir, Özgül Emel Bulut; Ovalı, Fahri; Akın, Mustafa Ali; Çelik, Yalçın; Orman, Ayşen; Uslu, Sinan; Taştekin, Ayhan; Gündüz, Mehmet; Arısoy, Ayşe Engin; Gürpınar, Reşat; Ors, Rahmi; Altunhan, Hüseyin; Keçeci, Ramazan; Yıldızdas, Hacer Yapıcıoğlu; Terek, Demet; Ateş, Mehmet; Kader, Şebnem; Mutlu, Mehmet; Çelik, Kıymet; Yücesoy, Ebru; Mert, Mustafa Kurthan; Gulasi, Selvi; Küçüktasçı, Kazım; Arman, Didem; Hekimoğlu, Berna; Gültekin, Nazlı Dilay; Çelik, Hasan Tolga; Kahvecioğlu, Dilek; Akyıldız, Can; Taşkın, Erdal; Çiftdemir, Nukhet Aladag; Uygun, Saime Sündüs; Kaya, Tuğba Barsan; Akdağ, Arzu; Yılmaz, Aslan; Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgün; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; IGT-7005-2023; CZV-1969-2022Background Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants >= 36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. Methods The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at >= 34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. Results The incidence of HIE among infants born at >= 36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HIE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). Conclusion The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.Publication Effect of intrauterine transfusion on neonatal outcomes in rh hemolytic disease(Galenos Yayincilik, 2010-04-01) Çetinkaya, Merih; Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgün; Kimya, Yalçın; Akkus, Handan; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; AFP-9671-2022; AAG-8393-2021Introduction: The aim of this study was to evaluate the neonates with Rh hemolytic disease according to the severity of hemolytic disease (slight, moderate and severe) and the presence of intrauterine transfusion (IUT) for necessity of postnatal exchange transfusion or phototherapy application and severity of neonatal anemia.Materials and Method: The neonates admitted to Neonatal Intensive Care Unit with Rhesus hemolytic disease between January 2000 and November 2008 were included in this retrospective study. Cord blood hemoglobine and bilirubin levels, reticulocyte count, maximum bilirubin level, number of intrauterine transfusion, duration of phototherapy, requirement of postnatal exchange transfusion or redblood cell transfusions were all recorded.Results: A total of 44 neonates were included in the study. The mean gestational age and birth weight of infants were 37.6 +/- 0.3 week and 3031 +/- 53 g, respectively. Slight, moderate and severe hemolytic disease was determined in 13 (29.5%), 13 (29.5%) and 18 (41%) of infants, respectively. IUT was performed in 12 infants (27%) and 9 of them (75%) had severe hemolytic disease and this ratio was significantly higher compared with the infants without IUT. Similarly, requirement of postnatal exchange transfusion was also higher in infants who had IUT compared with the infants who did not have IUT. No significant difference was determined between infants with and without IUT in terms of duration of phototherapy, maximum bilirubin levels and transfusion requirement.Conclusion: The incidence of severe hemolytic disease and postnatal exchange requirement were significantly higher in infants with IUT compared with the infants without IUT. Therefore, it is concluded that if Rhesus hemolytic disease is severe in utero, it may present as severe hemolytic disease in the postnatal period.