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    Can urinary biomarkers predict acute kidney injury in newborns with critical congenital heart disease?
    (2021) Sözmen, Eser Yıldırım; Yalaz, Mehmet; Uygur, Özgün; Köroğlu, Özge Altun; Kültürsay, Nilgün; Atay, Yüksel; Akisu, Mete
    Background/aim: Congenital heart disease (CHD) is the most common congenital malformation group and is the leading cause of newborn mortality in developed countries. Most of the infants with CHD develop preoperative or postoperative acute kidney injury (AKI). Acute kidney injury may develop before the serum creatinine rise and oliguria. Urinary biomarkers such as kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, and cystatin C may predict AKI in patients with critical CHD (CCHD) before the serum creatinine rise. In this study, we aimed to determine the AKI incidence among newborn patients with CCHD and investigate the predictivity of urinary biomarkers for AKI. Materials and methods: Newborns with a gestational age >34 weeks and birth weight >1500 g with a diagnosis of CCHD were enrolled in the study. Blood and urine samples were collected at birth, during the first 24–48 h, and in the preoperative and postoperative periods. Results: A total of 53 CCHD patients requiring surgery during the neonatal period were enrolled in the study. The 24–48 h KIM-1 levels of the cases with exitus were higher (P = 0.007). The 24–48 h cystatin C and preoperative NGAL levels were higher in patients with postoperative AKI (P = 0.02). Conclusion: In newborns with CCHD, high KIM-1 levels may predict mortality, whereas high cystatin C and preoperative NGAL levels may be indicative of AKI. These biomarkers deserve further investigation in larger study populations. Key words: Acute kidney injury, cardiovascular surgery, critical congenital heart disease, newborn, urinary biomarker
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    Kritik Hasta Yenidoğanların Annelerinde Ardışık ve Eş Zamanlı Süt Sağmanın Etkinlik ve Konforu
    (2017) Köroğlu, Özge Altun; Can, Nazmiye; Atıkan, Başak Yıldız; Tanrıverdi, Sema; Yalaz, Mehmet; Akısü, Mete; Kültürsay, Nilgün
    Amaç: Yenidoğan yoğun bakım ünitesinde (YYBÜ) yatan bebeklerde direkt emzirme mümkün olmasa da sağılmış anne sütü çok faydalıdır. Bu kritik dönemde laktasyonun başlatılması ve sürdürülmesi için elle ya da elektrikli süt pompaları kullanılarak süt sağılması önerilir. Bu çalışmada bebekleri YYBÜ'ye yatırılan yeni doğum yapmış annelerde ardışık ve eş zamanlı süt sağmanın etkinlik ve konforunu karşılaştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya alınan 35 anne, elektrikli pompa kullanarak her iki memeden ardışık (n=21) ya da eş zamanlı (n=14) süt sağdıkları 10 gün içerisinde prospektif olarak izlendi. Süt sağma süresine ek olarak sağılan süt miktarı günlük ve her sağma için ayrı ayrı kaydedildi. Bu uygulamaların kolaylığı ve konforu konusunda annelerin görüşleri ve tatminkarlıkları çalışmanın sonunda bir anket ile değerlendirildi. Bulgular: Günlük ve her sağma girişiminde elde edilen süt miktarları gruplar arasında benzer bulundu. Her iki memeden eş zamanlı süt sağan annelerin süt sağma süreleri anlamlı olarak daha kısa bulundu. Eş zamanlı olarak her iki memeden süt sağan anneler diğerleri ile karşılaştırıldıklarında; kullanım kolaylığı yönünden daha yüksek skorlar verdiler (4,36±0,50'ye karşı 4,00±0,44, p=0,046). Anketin diğer alanlarında her iki süt sağma tekniği de benzer bulundu. Sonuç: Süt sağmak için her iki memenin eş zamanlı sağılması zaman kazandırıcı bir yöntemdir. Bununla beraber hem eş zamanlı hem de ardışık süt sağma yöntemleri; bebekleri YYBÜ'de yatan annelerde laktasyonun sağlanmasında etkin ve iyi tolere edilen yöntemlerdir.
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    Necessity of Electroencephalography in High-risk Brief Resolved Unexplained Event
    (2019) Serin, Hepsen Mine; Şimşek, Erdem; Köroğlu, Özge Altun; Kanmaz, Seda; Çetin, İpek Dökürel; Terek, Demet; Aktan, Gül
    Aim: A brief resolved unexplained event (BRUE) is characterized by sudden alterations in an infant’s breathing, color, tone, or responsiveness. the aim of this study was to evaluate the necessity of electroencephalography (EEG) in high-risk BRUE cases. Materials and Methods: Fifty-one patients’ cases were analyzed retrospectively. All of these patients were younger than 1 month so considered to be a high-risk group. the gestational week, the age of the patient, the duration of the event, the conditions related to the event, whether or not any intervention was needed, the type of intervention if done, if the event recurred, the number of recurrences, the state of consciousness during the event, respiratory pattern, muscle tone, sleeping position, suspicion of trauma, use of medication by mother and/ or baby and smoking exposure were evaluated in detail. Results: the mean age of the patients was 15.74±14.96 days, 31 (60.78%) were male and 20 (39.21%) were female. the mean gestational age was 37.64±2.35 weeks. the neurological examinations of the patients were evaluated as normal. EEG was performed in 36 (70.58%) of the 51 patients and only one patient had sharp waves in the left hemisphere central region. in 11 patients hospitalized with a preliminary diagnosis of BRUE, final diagnoses were found as congenital pyloric stenosis, dehydration, fetal myocarditis, patent ductus arteriosus, lower respiratory tract infection and gastroesophageal reflux. Conclusion: It would be more appropriate to plan the tests to be carried out in the high-risk BRUE group by evaluating many factors such as recurrence of the event, family history, and neurological examination findings. As a result, even in the high-risk BRUE group, it would be cost effective to perform an EEG if only the clinical cues are strongly suggestive for the diagnosis of epilepsy.
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    Reference values of anthropometric measurements in healthy late preterm and term infants
    (2018) Bilgin, Betül Siyah; Uygur, Özgün; Terek, Demet; Köroğlu, Özge Altun; Yalaz, Mehmet; Akısü, Mete; Kültürsay, Nilgün
    Background/aim: Geographical distribution, ethnicity, and other socioeconomic factors may affect anthropometric measurements, and for that reason each society should determine their own measurements accounting for those factors. In this study, we aimed to determine the anthropometric measurements of healthy late preterm and term infants to compare the results with other national and international studies. Materials and methods: This sectional study was carried out among 1197 infants born with a gestational age of ?35 weeks. Chest circumference, ear length, foot length, palmar length, middle finger length, philtrum distance, inner and outer canthal distances, and palpebral fissure length were measured in the first 24 h of life. Results: All measurements of late preterm infants were smaller than those of term infants (P ? 0.05). Compared with male infants, the chest circumference, ear length, foot length, palmar length, philtrum distance, and inner canthal distances of the female infants were lower (P ? 0.05). No significant differences were found between male and female infants’ middle finger length, outer canthal distance, and palpebral fissure length measurements. Percentile values for all measurements of 35–42-week male and female infants were described. Conclusion: These measurements of male and female infants born between 35 and 42 weeks may be useful for early detection of syndromes by detecting anatomical abnormalities in our population.
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    Single Versus Multiple Doses of Surfactant Treatment in Preterm Infants
    (2020) Bilgin, Betül Siyah; Köroğlu, Özge Altun; Terek, Demet; Yalaz, Mehmet; Akisu, Mete; Kültürsay, Nilgün
    Aim: Exogenous surfactant may be needed not only for Respiratory Distress syndrome (RDS) treatment; but also, in the management of other pulmonary diseases of infants. in this study, we aimed to investigate the impact of single versus multiple doses of surfactant therapy in pulmonary problems of preterm infants. Materials and Methods: in this study, preterm infants who needed surfactant treatment were retrospectively evaluated. Surfactant therapy for RDS were given as 200 mg/kg poractant or 100 mg/kg beractant and repeated with 100 mg/kg doses when needed later. Poractant or beractant (100 mg/kg) were given in the treatment of other pulmonary diseases. Results: Totally 64 preterm patients were recruited into this study. Patients in group 1 (43.8%) received a single dose of surfactant; whereas group 2 patients (56.2%) had more than one dose. Mean gestational age and birth weight of infants in group 2 were significantly lower than group 1 (p<0.05). Intrauterine growth restriction (IUGR) was more common in group 2 (p=0.041). Multiple doses of surfactant were needed for severe RDS, atelectasis, pulmonary hemorrhage and pneumonia. Duration of mechanical ventilation and hospitalization were longer in group 2 (p<0.05). Mortality rates were higher in group 2 (p=0.011). Conclusion: Preterm infants with earlier gestational age and lower birth weight; particularly with IUGR may need multiple doses of surfactant due to more severe respiratory problems regardless of antenatal steroid or maternal chorioamnionitis status. Duration of mechanical ventilation, hospitalization and also neonatal mortality remained higher due to disease severity in preterms who needed multiple doses of surfactant.
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    Single Versus Multiple Doses of Surfactant Treatment in Preterm Infants
    (2020) Bilgin, Betül Siyah; Köroğlu, Özge Altun; Terek, Demet; Yalaz, Mehmet; Akisu, Mete; Kültürsay, Nilgün
    Aim: Exogenous surfactant may be needed not only for Respiratory Distress syndrome (RDS) treatment; but also, in the management of other pulmonary diseases of infants. In this study, we aimed to investigate the impact of single versus multiple doses of surfactant therapy in pulmonary problems of preterm infants. Materials and Methods: In this study, preterm infants who needed surfactant treatment were retrospectively evaluated. Surfactant therapy for RDS were given as 200 mg/kg poractant or 100 mg/kg beractant and repeated with 100 mg/kg doses when needed later. Poractant or beractant (100 mg/kg) were given in the treatment of other pulmonary diseases. Results: Totally 64 preterm patients were recruited into this study. Patients in group 1 (43.8%) received a single dose of surfactant; whereas group 2 patients (56.2%) had more than one dose. Mean gestational age and birth weight of infants in group 2 were significantly lower than group 1 (p<0.05). Intrauterine growth restriction (IUGR) was more common in group 2 (p=0.041). Multiple doses of surfactant were needed for severe RDS, atelectasis, pulmonary hemorrhage and pneumonia. Duration of mechanical ventilation and hospitalization were longer in group 2 (p<0.05). Mortality rates were higher in group 2 (p=0.011). Conclusion: Preterm infants with earlier gestational age and lower birth weight; particularly with IUGR may need multiple doses of surfactant due to more severe respiratory problems regardless of antenatal steroid or maternal chorioamnionitis status. Duration of mechanical ventilation, hospitalization and also neonatal mortality remained higher due to disease severity in preterms who needed multiple doses of surfactant.
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    Yenidoğan Yoğun Bakım Ünitesinde Nekrotizan Enterokolit Sıklığı ve Özelliklerinin Değerlendirilmesi
    (2016) Bilgin, Betül Siyah; Terek, Demet; Köroğlu, Özge Altun; Yalaz, Mehmet; Akısü, Mete; Çelik, Ahmet; Kültürsay, Nilgün
    Amaç: Bu çalışma nekrotizan enterokolit (NEK) tanısı ile izlenen olgularda hastalığın risk faktörleri, karakteristik özellikleri, klinik, laboratuvar bulguları ve mortalite oranının değerlendirilmesi amacıyla yapılmıştır.Gereç ve Yöntemler: Çalışmaya 2010-2011 yıllarında kliniğimizde izlenen 488 hasta yenidoğan içinde NEK tanısı alan 37 bebek dahil edilmiştir.Bulgular: NEK sıklığı tüm yatan hasta popülasyonunda %7,5 olarak bulundu. NEK olgularında ortalama gebelik yaşı, 27,5±2,5 hafta, ortalama doğum ağırlığı, 1044±485 gram idi ve NEK'li olguların %90'ı <1500 gr ve 30 hafta altında doğmuştu. Yirmi dört olgu evre 1, 13 olgu evre 2-3 olarak sınıflandırıldı. Çok düşük doğum ağırlıklı bebeklerde evre 2-3 NEK %9,8 sıklıkla görüldü. Bebeklerin ortalama gebelik haftası, doğum ağırlığı, cinsiyet, doğum şekli, Apgar skorları, patent duktus arteriozus varlığı ve tedavisi, intrauterin büyüme kısıtlılığı, prematüre retinopatisi, Respiratuvar distres sendromu, intrakraniyal kanama varlığı ile NEK evreleri arasında fark bulunmadı. Evre 2-3 olgularının altısında gastrointestinal perforasyon gelişti. Evre 2-3 NEK olguları evre 1 NEK olguları ile karşılaştırıldığında; trombosit ve hematokrit değerlerinin anlamlı olarak daha düşük (p<0,01 ve p=0,02), mortalitenin daha yüksek olduğu görüldü (p=0,02).Sonuç: NEK gelişen olgularda çok düşük doğum ağırlığı ve gebelik haftası olduğu ve anemi, lökopeni, lökositoz, trombositopeni ve C-reaktif protein yüksekliği gibi laboratuvar bulgularının hastalığın ciddiyeti ile ilişkili olduğu gözlendi. İleri evre, cerrahi gerektiren olgularda ve özellikle de küçük bebeklerde mortalite riski yüksektir.