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  • Küçük Resim
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    Early neonatal outcomes of very-low-birthweight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society
    (Public Library of Science, 2019) Koç, Esin; Demirel, Nihal; Baş, Ahmet Yağmur; Işık, Dilek Ulubaş; Hirfanoǧlu, İbrahim Murat; Tunç, Turan; Sari, Fatma Nur; Karatekin, Güner; Özdemir, Ramazan; Altunhan, Hüseyin; Çetinkaya, Merih; Özcan, Beyza; Özkiraz, Servet; Çalkavur, Şebnem; Tekgündüz, Kadir Şerafettin; Taştekin, Ayhan; Özlü, Ferda; Özyurt, Banu Mutlu; Özdemir, Ahmet; Çetinkaya, Bilin; Demirelli, Yaşar; Köklü, Esad; Çelik, Ülker; Tarakçı, Nuriye; Armangil, Didem; Okulu, Emel; Narter, Fatma Kaya; Mutlu, Birgül; Mert, Mustafa Kurthan; Bülbül, Ali; Asker, Hüseyin Selim; Uygur, Özgün; Uslu, İlker Sait; Ertuǧrul, Sabahattin; Aydemir, Cumhur; Çelik, Hasan Tolga; Küçüktaşçı, Kazım; Arslan, Selda; Ergin, Hacer; Zenciroğlu, Ayşegül; Yurttutan, Sadık; Orman, Ayşen; Tuncer, Oǧuz; Yaşa, Beril; Acunaş, Betül Ayşe; Takçı, Şahin; Gökmen, Zeynel; Özkan, Hilal; Cömert, Serdar; Üstün, Nuran Uzunalic; Mutlu, Mehmet; Bayraktar, Bilge Tanyeri; Bilgin, Leyla Karadeniz; Tüzün, Funda; Aydemir, Özge; Gürsoy, Tuǧba; Akdaǧ, Arzu; Memişoǧlu, Aslı Çınar; Can, Emrah; Terek, Demet Tümay; Turan, Özden; Güzoǧlu, Nilüfer; Örs, Rahmi; Kale, Yusuf; Hekimoğlu, Berna; Aylanç, Hakan; Eroglu, Funda; Şahin, Suzan; Konak, Murat; Sarıcı, Dilek; Kılıç, İlknur; Hakan, Nilay
    Objective To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. Material and methods A prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived. Results Data from 69 NICUs were obtained. The mean birth weight and gestational age were 1137 ±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: Bronchopulmonarydysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. Conclusion The present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.
  • [ X ]
    Öğe
    Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units
    (Bmj Publishing Group, 2018) Bas, Ahmet Yagmur; Demirel, Nihal; Koc, Esin; Isik, Dilek Ulubas; Hirfanoglu, Ibrahim Murat; Tunc, Turan; Sari, Fatma Nur
    Background To evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition. Methods A prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)=1500 g or gestational age (GA)<= 32 weeks and those with a BW> 1500 g or GA> 32 weeks with an unstable clinical course were included in the study. Predictors for the development of ROP were determined by logistic regression analyses. Results The TR-ROP study included 6115 infants: 4964 (81%) with a GA <= 32 weeks and 1151 (19%) with a GA>32 weeks. Overall, 27% had any stage of ROP and 6.7% had severe ROP. A lower BW, smaller GA, total days on oxygen, late-onset sepsis, frequency of red blood cell transfusions and relative weight gain were identified as independent risk factors for severe ROP in infants with a BW=1500 g. Of all infants, 414 needed treatment and 395 (95.4%) of the treated infants had a BW <= 1500 g. Sixty-six (16%) of the treated infants did not fulfil the Early Treatment for Retinopathy of Prematurity requirements for treatment. Conclusions Screening of infants with a GA <= 34 weeks or a BW<1700 g appears to be appropriate in Turkey. Monitoring standards of neonatal care and conducting quality improvement projects across the country are recommended to improve neonatal outcomes in Turkish NICUs.
  • Küçük Resim
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    An Observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for patent ductus arteriosus
    (Frontiers Media SA, 2020) Okulu, Emel; Erdeve, Ömer; Arslan, Zehra; Demirel, Nihal; Kaya, Hüseyin; Gökçe, İsmail Kürşad; Ertuğrul, Sabahattin; Çetinkaya, Merih; Büyükkale, Gökhan; Özlü, Ferda; Şimşek, Hüseyin; Çelik, Yalçın; Özkan, Hilal; Köksal, Nilgün; Akcan, Barış; Türkmen, Münevver; Çelik, Kıymet; Armangil, Didem; Bülbül, Ali; Tekgündüz, Kadir Şerafettin; Öncel, Mehmet Yekta; Tüzün, Funda; Ergenekon, Ebru; Ergin, Hacer; Arsan, Saadet
    No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7)and 28(6/7)weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 +/- 1.4 weeks and 926 +/- 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (>= Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p> 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80,p= 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92,p= 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p= 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.