Person: ÖZKAN, HİLAL
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ÖZKAN
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HİLAL
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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 Risk factors for respiratory syncytial virus infections in moderate/late premature infants in Turkey: A prospective multicenter epidemiological study (jul, 10.1055/s-0040-1713928, 2020)(Thieme Medical Publ Inc, 2020-08-13) Hacimustafaoglu, Mustafa; Koç, Esin; Tezer, Hasan; Çetinkaya, Merih; Cebeci, Burcu; Erdeve, Ömer; Özdemir, Halil; Özkan, Hilal; ÖZKAN, HİLAL; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Köksal, Nilgün; Hacımustafaoğlu, Mustafa; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; CTG-5805-2022; CZV-1969-2022; ENK-4130-2022; IGT-7005-2023Publication Extremely preterm infant admissions within the safeboosc-III consortium during the Covid-19 lockdown(Frontiers Media, 2021-06-15) Rasmussen, Marie Isabel; Hansen, Mathias Luehr; Pichler, Gerhard; Dempsey, Eugene; Pellicer, Adelina; El-Khuffash, Afif; Shashidhar, A.; Piris-Borregas, Salvador; Alsina, Miguel; Cetinkaya, Merih; Chalak, Lina; Özkan, Hilal; Baserga, Mariana; Sirc, Jan; Fuchs, Hans; Ergenekon, Ebru; Arruza, Luis; Mathur, Amit; Stocker, Martin; Vaccarello, Olalla Otero; Szczapa, Tomasz; Sarafidis, Kosmas; Krolak-Olejnik, Barbara; Memişoğlu, Aslı; Reigstad, Hallvard; Rafinska-Wazny, Elzbieta; Hatzidaki, Eleftheria; Peng, Zhang; Gkentzi, Despoina; Viellevoye, Renaud; De Buyst, Julie; Mastretta, Emmanuele; Wang, Ping; Hahn, Gitte Holst; Bender, Lars; Cornette, Luc; Tkaczyk, Jakub; del Rio, Ruth; Fumagalli, Monica; Papathoma, Evangelia; Wilinska, Maria; Naulaers, Gunnar; Sadowska-Krawczenko, Iwona; Lecart, Chantal; Couce, Maria Luz; Fredly, Siv; Heuchan, Anne Marie; Karen, Tanja; Greisen, Gorm; ÖZKAN, HİLAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bölümü.; JJY-3921-2023Objective: To evaluate if the number of admitted extremely preterm (EP) infants (born before 28 weeks of gestational age) differed in the neonatal intensive care units (NICUs) of the SafeBoosC-III consortium during the global lockdown when compared to the corresponding time period in 2019.Design: This is a retrospective, observational study. Forty-six out of 79 NICUs (58%) from 17 countries participated. Principal investigators were asked to report the following information: (1) Total number of EP infant admissions to their NICU in the 3 months where the lockdown restrictions were most rigorous during the first phase of the COVID-19 pandemic, (2) Similar EP infant admissions in the corresponding 3 months of 2019, (3) the level of local restrictions during the lockdown period, and (4) the local impact of the COVID-19 lockdown on the everyday life of a pregnant woman.Results: The number of EP infant admissions during the first wave of the COVID-19 pandemic was 428 compared to 457 in the corresponding 3 months in 2019 (-6.6%, 95% CI -18.2 to +7.1%, p = 0.33). There were no statistically significant differences within individual geographic regions and no significant association between the level of lockdown restrictions and difference in the number of EP infant admissions. A post-hoc analysis based on data from the 46 NICUs found a decrease of 10.3%in the total number of NICU admissions (n = 7,499 in 2020 vs. n = 8,362 in 2019).Conclusion: This ad hoc study did not confirm previous reports of a major reduction in the number of extremely pretermbirths during the first phase of the COVID-19 pandemic.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 Regional oxygen saturation and acute kidney injury in premature infants(Wiley, 2021-02-27) Dorum, Bayram Ali; Özkan, Hilal; Çetinkaya, Merih; Köksal, Nilgün; Dorum, Bayram Ali; ÖZKAN, HİLAL; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; 0000-0002-2823-8454; IGT-7005-2023 ; A-5375-2017; CZV-1969-2022Background Decreased renal blood flow plays a vital role in the etiology of acute kidney injury (AKI). In this study, we aim to investigate the role of renal regional oxygen saturation (rSO(2)) reductions in predicting AKI in the first 24 h of life.Methods One hundred premature babies with a gestational age of <= 32 weeks were included. Renal and cerebral rSO(2)s were monitored for 24 h by near-infrared spectroscopy. Infants were followed up for the first 7 days for the diagnosis of AKI.Results Infants' median gestational age was 29 (23-32) weeks, and their birthweight was 1,192 +/- 355 g. It was found that the renal rSO(2) values were lower in the first 24 h of life in patients who developed AKI, and this decrease was statistically significant in the first 6 h of life.Conclusions The low renal rSO(2) values in the early hours of life in premature babies may have a role in predicting AKI.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 The effectiveness of serum amyloid a for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants(Turkish J Pediatrics, 2019-01-01) Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgun; Doğan, Pelin; Güney-Varal, İpek; Bağcı, Onur; Özgür, Taner; ÖZGÜR, TANER; Bursa Uludağ Üniversitesi/Veteriner Fakültesi/Pediatri Anabilim Dalı.; 0000-0002-3298-066X; 0000-0001-9308-9806; AAG-8393-2021; AAI-5981-2020; AAG-8381-2021Parenteral 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.Publication 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-7600-2023Background. 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.