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Öğe Bilateral renal agenesis, a severe anomaly in a premature infant with VACTERL association: A case report(2017) Basuguy, Erol; Ertuğrul, Sabahattin; Akdeniz, SevincWe report on a preterm male (birth weight 1,100 g) with bilateral renal agenesis, a lethal malformation. Additionally, the child suffered from an atrial septal defect, ventricular septal defect, right aortic arch anomaly, a high type of anal atresia, vertebral anomalies, limbs defects (VACTERL association). The infant during first day of life was treated with an emergency sigmoid ostomy and peritoneal dialysisbecause of increasing abdominal dilatation and high urea and creatinine levels in blood. Important congenital anomalies associated with VACTERL association and prematurity are very serious causes of mortality in the early periodÖğe Bir üniversite yenidoğan yoğun bakım ünitesinde izlenen düşük doğum ağırlıklı bebeklerin geriye dönük değerlendirilmesi(Modestum Publishing Ltd., 2015) Aktar, Fesih; Yolbaş, İlyas; Tan, İlhan; Ertuğrul, Sabahattin; İpek, Mehmet Şah; Yılmaz, Kamil; Sabaz, Muhammed NurullahAmaç: Gelişmiş ülkelerde düşük doğum ağırlıklı yenidoğanların yaklaşık %70'ini preterm yenidoğanlar oluşturmaktadır. Çalışmamızda 2010-2011 yılları arasında hastanemiz yenidoğan servisinde yatan düşük doğum ağırlıklı bebeklerin geriye dönük olarak değerlendirilmesi amaçlandı. Yöntemler: Bu çalışmaya, 2500 gram altı doğan 626 yenidoğan alındı. Retrospektif olarak, aile öyküsü, natal, prenatal, postnatal, anne ve demografik özellikleri ile risk faktörleri kaydedildi.Bulgular: Çalışmamızda anne yaşı en sık 21-35 yaş arası, gebelik haftası 33 hafta üstü, doğum ağırlığı 20012500 gram arası ve mortalite oranı %29,7 olarak bulundu. Düşük doğum ağırlıklı bebeklerin doğum kilolarına göre karşılaştırmalarında; anne yaşı, çoğul gebelik oranı, doğum yeri, doğum prezentasyonu, yatış süresi, erken doğum nedenleri ve mortalite oranları arasında istatistiksel olarak anlamlı fark bulundu (p<0.05). Tüm bebeklerde en sık erken doğum nedeni eklampsi -preeklampsi iken, <=1000 gram yenidoğanlarda en sık neden oligohidroaminos idi. Solunum distresi ile konvülziyon doğum kilosu 2001-2500 gram olan bebeklerde, hiperbilirubinemi doğum kilosu 1501-2000 gram olan bebeklerde ve mekanik ventilatör ihtiyacı ise <=1000 gram bebeklerde istatistiksel olarak yüksek idi (p<0.05). Sonuç: Prematüre doğumların önlenmesi için toplumun eğitim düzeyinin arttırılması, yeterli düzeyde prenatal takibin sağlanması, uygun ve yeterli miktarda yenidoğan ünitelerinin kurulması, yenidoğan üniteleri olan merkezlerde prematüre doğumlarının gerçekleştirilmesi, prematürelerin uygun koşullarda transportlarının sağlanması, sepsis ve respiratuvar gibi sık görülen mortalite nedenleri için risklerin belirlenmesi ve bunlara karşı önlem alınmasının ciddi önem taşıdığı kanaatindeyiz.Öğe Can platelet count, platelet mass index and mean platelet volume be parameters in retinopathy of prematurity?(Yuzuncu Yil University Faculty of Medicine, 2022) Değer, İbrahim; Ertuğrul, Sabahattin; Kaya, İrfan Kemal; Yılmaz, Sibel Tanrıverdi; Yolbaş, İlyasPlatelet parameters such as platelet count (PLT), mean platelet volume (MPV) and platelet mass index (PMI) are associated with physiological and pathological functions in various inflammatory diseases. The aim of the present study was to investigate whether platelet parameters were related to retinopath y of prematurity (ROP) in premature newborns. We retrospectively evaluated the platelet count, platelet mass index, and MPV parameters measured on the first day and 28th day, which belonged to patients, who were examined for retinopathy of prematurity at n eonatal intensive care unit. Among 343 patients enrolled by the study, 52.8 % (181) were male and 47.2 %(162) were female. The PLT level studied on the first day was 231.6±84(x1000/mm3) in the ROP group and 207.8±81.6(x1000/mm3) in the non ROP group, and t he PLT level studied on the 28th day was 409.9±179.4(x1000/mm3) in the ROP group and 350.7±140.4(x1000/mm3) in the non ROP group. There was a significant difference between the two groups regarding both PLT levels (p=0.007, p=0.006, respectively). The PMI level studied on the first day was 1854.1±774.7 in the ROP group and 1638.2±753.3 in the non ROP group, and the PMI level studied on the 28th day was 3784.5±1797.4 in the ROP group and 3302.8±1452.9 in the non ROP group. This study showed that platelet count and platelet mass index measured on the first and 28th days are important parameters in patients who undergo ROP examination, and these parameters measured prior to examination will guide clinicians in diagnostic process.Öğe The contribution of postnatal steroid administration to early brain damage in preterm babies with bronchopulmonary dysplasia(TÜBİTAK, 2021) Ertuğrul, Sabahattin; Darakci, Savaş Mert; Kaplan, İbrahim; Yolbaş, İlyas; Değer, İbrahim; Yılmaz, Sibel Tanrıverdi; Aktaş, ŞerafettinBackground/aim: Postnatal corticosteroids are commonly used to treat bronchopulmonary dysplasia (BPD). We aimed to show whether S100 calcium-binding B (S100B), neuron-specific enolase (NSE), Tau protein or microtubule-associated protein tau (MAPT), and glial fibrillary acid protein (GFAP) levels would provide any evidence of early neurological damage in premature infants receiving postnatal low dose dexamethasone therapy for BPD treatment. Materials and methods: In this cohort study, 136 preterm infants diagnosed with BPD at ≤32 weeks of gestation formed the study group, and 64 preterm infants formed the control group. NSE, S100B, GFAP, and MAPT levels were first measured before the postnatal corticosteroid treatment in both the patient and the control group on the 28th day and, for a second time, after treatment termination in the patient group. Results: There were significant differences between the measured GFAP, MAPT, and NSE values of the BPD and control groups on the 28th day, whereas there was no significant difference between the measured S100B values of the two groups. There were a statistically significant difference between the NSE values measured on the 28th day and after the treatment within the BPD group, whereas no significant difference existed between the GFAP, MAPT, and S100B values. Conclusion: NSE levels, which indicate brain damage in the early period, increased in preterm babies with BPD who had been administered postnatal dexamethasone.Öğe COVID-19 ve yenidoğan(Dicle Üniversitesi Tıp Fakültesi, 2021) Ertuğrul, Sabahattin; Değer, İbrahim; Yılmaz, Sibel TanrıverdiCOVID-19 pandemisi dünya çapında yayılmaya devam ederken, risk altındaki popülasyonları belirlememiz ve onları korumak için uygun klinik bakım politikaları geliştirmemiz çok önemlidir. Yenidoğan SARS-CoV-2 enfeksiyonunun insidansı ve sonuçlarına ilişkin veriler ortaya çıkmaya devam etse de, öğrenilecek daha çok şey vardır. Şimdiye kadar ki kanıtlar, yenidoğanda dikey bulaşmanın nadir olduğunu ve daha büyük bir oranın doğum sonrası solunum damlacıkları yoluyla veya enfekte anne veya bakıcılarla temas yoluyla enfeksiyon kaptığını göstermektedir. Yenidoğanların çoğunda SARS-CoV-2'ye bağlı semptom gelişmez, ancak prematüreliğe bağlı morbiditeler yoğun bakım ve destek gerektirebilir. Semptomların varlığına bakılmaksızın, COVID-19 enfeksiyonundan şüphelenilen veya teyit edilen annelerden doğan tüm yenidoğanlar test edilmelidir. Yenidoğanda COVID-19 durumu hakkında farkındalık, enfeksiyon önleme ve kontrol önlemleri uygulama yöntemleri teşvik edilmelidir.Öğe Evaluation of factors affecting perinatal mortality in patients with HELLP syndrome(Mebas Medikal Basın Yayın, 2021) Gündüz, Reyhan; Tunç, Senem Yaman; İçen, Mehmet Sait; Gül, Talip; Ertuğrul, SabahattinOBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p<0.05). With respect to methods of delivery, we determined that vaginal delivery was linked to a significantly higher rate of perinatal mortality (p<0.001). Gestational age at delivery, birth weight, 1- and 5-minute APGAR scores were negatively correlated with perinatal mortality. Logistic regression revealed the APGAR score at 5 minutes as the most reliable independent predictive finding for perinatal mortality. CONCLUSION: We think that to decrease perinatal mortality rates, maternal and fetal well-being in patients with HELLP syndrome should be closely monitored and delivery and follow-up should take place at tertiary health institutions after maternal and neonatal intensive care arrangements are made. Particularly, neonates with low 5-minute APGAR scores in the postpartum evaluation of neonatal condition are recommended to be followed-up at the neonatal intensive care unit.Öğe Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society(Aves, 2021) Okulu, Emel; Erdeve, Ömer; Tuncer, Oguz; Ertuğrul, Sabahattin; Özdemir, Hülya; Çiftdemir, Nükhet Aladağ; Zenciroğlu, Ayşegül; Atasay, BegümAbstract Objective: The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods: We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born >= 35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results: One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9 +/- 9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion: Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breast-feeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.Öğe Güneydoğu Anadolu'da bir Eğitim ve Araştırma hastanesine başvuran hastalarda hepatit A seroprevalansı(2015) Onur, Arzu; Toprak, Serdar Ferit; Temiz, Hakan; Ertuğrul, Sabahattin; Özbek, ErdalAmaç: Bu çalışmada; Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesine başvuran hastalarda Hepatit A virüsü seroprevalansı yaş gruplarına göre retrospektif olarak değerlendirilmiştir. Yöntemler: Bu çalışmada, Ocak 2010 ve Aralık 2014 tarihleri arasında hastanemize çeşitli sebeplerle başvuran ve Anti HAV IgG ve Anti HAV IgM testleri çalışılan hastaların sonuçları değerlendirilmiştir. HAV IgG ve HAV IgM antikorları kemilüminesans immün yöntem ile Advia Centaur XP (Siemens, Almanya) cihazında üretici talimatları izlenerek çalışılmıştır. Bulgular: Örneklerin %97,30unda Anti HAV IgG pozitifliği ve %0,87sinde Anti HAV IgM pozitifliği saptanmıştır. Anti HAV IgM pozitifliği 0-10 yaşta %10 ve 11-20 yaş grubunda ise %3,09 oranında tespit edilmiştir. Yaş ilerledikçe hastalığın görülme sıklığının azaldığı ve birçoğunun çocukluk döneminde hastalıkla karşılaşıp bağışıklık kazandığı saptanmıştır. Sonuç: Sonuç olarak, bu çalışma ile ilimizin en büyük hastanesinde HAV seroprevalans verilerini saptadık. Bu bilgiler ışığında; önleyici tedbirler, aşılama programı çalış- maları ve aşı etkinliğinin tespitine katkı sağlayacağımızı düşünüyoruz.Öğe Güneydoğu Anadolu’da bir eğitim ve araştırma hastanesine başvuran hastalarda hepatit A seroprevalansı(Dicle Üniversitesi Tıp Fakültesi, 2015) Temiz, Hakan; Özbek, Erdal; Toprak, Serdar Ferit; Onur, Arzu; Ertuğrul, SabahattinAmaç: Bu çalışmada; Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi’ne başvuran hastalarda Hepatit A virüsü seroprevalansı yaş gruplarına göre retrospektif olarak değerlendirilmiştir. Yöntemler: Bu çalışmada, Ocak 2010 ve Aralık 2014 tarihleri arasında hastanemize çeşitli sebeplerle başvuran ve Anti HAV IgG ve Anti HAV IgM testleri çalışılan hastaların sonuçları değerlendirilmiştir. HAV IgG ve HAV IgM antikorları kemilüminesans immün yöntem ile Advia Centaur XP (Siemens, Almanya) cihazında üretici talimatları izlenerek çalışılmıştır. Bulgular: Örneklerin %97,30’unda Anti HAV IgG pozitifliği ve %0,87’sinde Anti HAV IgM pozitifliği saptanmıştır. Anti HAV IgM pozitifliği 0-10 yaşta %10 ve 11-20 yaş grubunda ise %3,09 oranında tespit edilmiştir. Yaş ilerledikçe hastalığın görülme sıklığının azaldığı ve birçoğunun çocukluk döneminde hastalıkla karşılaşıp bağışıklık kazandığı saptanmıştır. Sonuç: Sonuç olarak, bu çalışma ile ilimizin en büyük hastanesinde HAV seroprevalans verilerini saptadık. Bu bilgiler ışığında; önleyici tedbirler, aşılama programı çalışmaları ve aşı etkinliğinin tespitine katkı sağlayacağımızı düşünüyoruz.Öğe Hipoksik iskemik ensefalopatide N-terminal pro brain natriüretikpeptid ve troponin I düzeylerinin önemi(Dicle Üniversitesi Tıp Fakültesi, 2021) Değer, İbrahim; Ertuğrul, Sabahattin; Yılmaz, Sibel Tanrıverdi; Türe, MehmetAmaç: Hipoksikiskemikensefalopati (HİE), perinatal dönemde hipoksiye bağlı olarak görülen ağır morbidite ve mortalite ile sonuçlanabilen klinik bir durumdur. Bu çalışmanın amacı, hipoksik iskemik ensefalopatide kardiyak biyomarkerlerden N-Terminal pro Brain Natriüretik Peptid (NTproBNP) ve Troponin I’nın rolünü değerlendirmektir. Yöntemler: Bu çalışmada, Ocak 2019 ve Mayıs 2021 tarihleri arasında Yenidoğan Yoğun Bakım Ünitesinde HİE tanısı ile takip ve tedavileri yapılmış olan hastaların Troponin I ve NTproBNP düzeyleri geriye dönük olarak incelendi. Bulgular: Bu çalışma %44,5 (45)’i kız ve %55.5(56)’sı erkek olmak üzere 101 olgudan oluştu. Normal spontan vajinal yol ile doğum oranı %57,8 (63) iken Sezaryenle doğum oranı %42,2 (46) idi. Olgularda HİE evre 1 oranı %31.7 (32), HİE evre2 oranı %31,7 (32) ve HİE evre 3 oranı%36,6 (37) olarak bulundu. Ortalama doğum ağırlığı 3139.95±499.02 g, ortalama gestasyon haftası 38.39±1.69 hafta bulundu. NTproBNP; ortalama 10099.49±12023.03 pg/mL ve Troponin I; 122.575±188.5287 ng/L bulundu. Hipoksik iskemik ensefalopatinin şiddetinin artması ile Troponin I arasında istatistiksel olarak anlamlı bir fark bulunurken, NTproBNP ile HİE’nin şiddeti arasında herhangi bir farklılık bulunmadı. Sonuç: Yenidoğan HİE’li bebeklerde NTproBNP ve Troponin I düzeylerinde artış vardır. Ayrıca, Troponin I düzeyleri ile yenidoğan hipoksik iskemik ensefalopati şiddeti arasında anlamlı ilişki olduğu bulundu.Öğe Infrequent association of two rare diseases: amniotic band syndrome and osteogenesis imperfecta(Walter de Gruyter GMBH, 2021) Darakci, Savaş Mert; Ertuğrul, Sabahattin; Yılmaz, Sibel Tanrıverdi; Ünal, Edip; Yolbaş, İlyas; Değer, İbrahimObjectives: Amniotic band syndrome and osteogenesis imperfecta are two distinct diseases that develop due to structural defects of the collagen protein. In our paper, we report the concurrence of these two diseases rarely seen in the newborn period. Case presentation: A female infant born at 33rd gestational week was found to have constrictive bands in her right lower extremity and flexion contractures in distal joints of lower and upper extremities due to amniotic bands in postnatal physical examination. While being treated for respiratory difficulty, she was diagnosed with osteogenesis imperfecta and treated with bisphosphonates upon being found to suffer bilateral humeral fractures on the sixth day of life. She received respiratory support with mechanical ventilation due to respiratory tract complications related to osteogenesis imperfecta and died on the 384th day of life. Conclusions: One should bear in mind that other collagen tissue diseases may accompany the amniotic band syndrome; this possibility should be definitely pursued if clinical suspicion exists.Öğe Intravenous immunoglobulin use in hemolytic disease due to ABO incompatibility to prevent exchange transfusion(Frontiers Media S.A., 2022) Okulu, Emel; Erdeve, Ömer; Kılıç, İlknur; Olukman, Özgür; Çalkavur, Şebnem; Büyükkale, Gökhan; Ertuğrul, SabahattinIntroduction: Intravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion. Materials and Methods: This study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared. Results: During the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively). Conclusion: In this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.Öğe The measurement of neutrophil gelatinase associated lipocalin in umbilical cord blood and the assessment of its relationship with neonatal results(Dicle Üniversitesi Tıp Fakültesi, 2022) İlter, Seçkin; Ertuğrul, Sabahattin; Değer, İbrahim; Kaplan, İbrahimObjectives: In this study, the relationship of cord blood Neutrophil Gelatinase-Associated Lipocalin (NGAL) with neonatal diseases was investigated. Methods: NGAL levels were measured in the cord blood of 180 babies born between 2015 and 2016. Patients were classified according to maternal diseases, neonatal diseases and demographic characteristics. Obtained data were compared with cord blood NGAL levels. Results: In our study, the mean NGAL levels were 1283.99 ng/mL in boys and 1306.52 ng/mL in girls. Umbilical cord blood NGAL levels of infants diagnosed with intrauterine growth retardation (1913.4±2833.5 ng/mL) and prolonged premature rupture of membranes (2594.2±2037.1 ng/mL) were found to be statistically high (p<0.05). There was no statistically significant difference between NGAL levels in infants of mothers with gestational diabetes mellitus, acyanotic congenital heart diseases, meconium aspiration syndrome, infants of mothers with preeclampsia, Apgar scores and infants of mothers with oligohydramnios (p>0.05). Conclusions: Neutrophil Gelatinase-Associated Lipocalin, may be useful as a diagnostic biomarker in the evaluation of maternal and neonatal diseases. However, studies on larger patient populations are needed.Öğe Neonatal resuscitation practices in Turkey: A survey of the Turkish neonatal society and the union of European neonatal and perinatal societies(Aves Yayıncılık, 2023) Okulu, Emel; Koç, Esin; Erdeve, Ömer; Akdaǧ, Arzu; Aktaş, Selma; Aydemir, Özge; Ertuğrul, SabahattinObjective: Optimal care in the delivery room is important to decrease neonatal morbidity and mortality. We aimed to evaluate neonatal resuscitation practices in Turkish centers. Materials and Methods: A cross-sectional survey consisted of a 91-item questionnaire focused on delivery room practices in neonatal resuscitation and was sent to 50 Turkish centers. Hospitals with <2500 and those with ≥2500 births/year were compared. Results: In 2018, approximately 240 000 births occurred at participating hospitals with a median of 2630 births/year. Participating hospitals were able to provide nasal continuous-positive- airway-pressure/high-flow nasal cannula, mechanical ventilation, high-frequency oscillatory ventilation, inhaled nitric oxide, and therapeutic hypothermia similarly. Antenatal counseling was routinely performed on parents at 56% of all centers. A resuscitation team was present at 72% of deliveries. Umbilical cord management for both term and preterm infants was similar between centers. The rate of delayed cord clamping was approximately 60% in term and late preterm infants. Thermal management for preterm infants (<32 weeks) was similar. Hospitals had appropriate equipment with similar rates of interventions and management, except conti nuous-positive-airway-pressure and positive-end-expiratory-pressure levels (cmH2 O) used in preterm infants (P = .021, and P = .032). Ethical and educational aspects were also similar. Conclusions: This survey provided information on neonatal resuscitation practices in a sam-ple of hospitals from all regions of Turkey and allowed us to see weaknesses in some fields. Although adherence to the guidelines was high among centers, further implementations are required in the areas of antenatal counseling, cord management, and circulation assessment in the delivery room.Öğe 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, SaadetNo 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.Öğe Prematüre bebeklerde nekrotizan enterokolit ve mortalite ilişkisinin değerlendirilmesi(Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2022) Değer, İbrahim; Ertuğrul, Sabahattin; Yolbaş, İlyasGiriş: Nekrotizan enterokolit, yenidoğan yo ğun bak ım ünitelerinde en sık görülen ciddi gastrointestinal problemlerin başında gelmektedir. Bu çalışmada Nekrotizan enterokolit olguları ve mortalite ilişkisi değerlendirildi. Gereç ve Yöntem: Bu çal ışmada Haziran 2019-Haziran 2021 tarihleri aras ında Çocuk Sa ğlığı ve Hastalıkları Anabilim Dalı Yenidoğan Yoğun Bakım Ünitesi’nde evre II ve üstü Nekrotizan enterokolit tanısı ile takip ve tedavisi yapılan 157 olgu çalışmaya alındı. Bulgular: Olguların %51(80)’i kız ve %49(77)’si erkek, doğum ağırlığı 1147±436 g, gebelik haftası 27.9±3.1 hafta, Anne ya şı 29.2±7.4 ve Anne gebelik sayısı 3.59±2.2 bulundu. Doğum ağırlığına göre dağılım, ≤1000 g %41.4 (65), 1001-1500 g %40.8 (64), 1501-2000 g %13.4 (21), 2001-2500 g %3.2 (5) ve 2501 g ve üstü %1.3(2) bulundu. Olguların gebelik haftasına göre dağılımı ≤27 hafta %42.7 (67), 28-32 hafta %49 (77), 33-36 hafta %7.6 (12) ve 37 hafta ve üstü %0.6 (1) bulundu. Cinsiyet ve anne yaşı ile mortalite arasında istatistiksel olarak anlamlı ilişki bulunmadı. Do ğum a ğırlığı ve gestasyon haftası azaldıkça ve anne gebelik say ısı arttıkça mortalite ve nekrotizan enterokolit sıklığının istatistiksel olarak anlamlı şekilde arttığı bulundu (p<0.05). Sonuç: Yenidoğan dönemindeki prematüre bebeklerde, do ğum ağırlığı ve gestasyon haftas ının azalması, hem nekrotizan enterokolit sıklığında hem de nekrotizan enterokolite ba ğlı mortalite oranında ciddi artışa neden olmaktadır.Öğe Prolonged QT dispersion is associated with pediatric syncope(Türkiye Milli Pediatri Derneği, 2019) Bilici, Meki; Dedeoğlu, Zübeyde Fidancı; Demir, Fikri; Akın, Alper; Türe, Mehmet; Balık, Hasan; Tan, İlhan; Ertuğrul, SabahattinAbstract: We aimed to find out whether QT dispersion can be used as a diagnosticmarker in terms of syncope type, and recurrence risk. Fifty-two patients (28male, 53.8%) admitted to the pediatric cardiology clinic with syncope werecompared with 50 healthy controls (28 male, 56%; mean age: 13.8±2.3 years,range: 11-17 years) for QT dispersion (QTd) and other electrocardiographicfindings. Gender, age, echocardiography, blood pressure while standing andsitting, electrolyte levels, liver and kidney function tests, and QTd and QTcd(calculated with corrected QT: QTc) in electrocardiography (ECG) of patientswere all evaluated. Patients’ ages varied between 7-17 years and the meanage at first syncope was 13.9±2.4 years. Mean follow-up duration of thepatients was 10±5 months (range: 5-18 months). Mean number of syncopeattacks was 2.8±2.2. QTd (72±46 ms vs. 34±14 ms) and QTcd (77±45 msvs. 33±14 ms) values of the patients were significantly longer, compared tocontrol group (p<0.001). The age, gender, QTd, and QTcd values did notdiffer between the subtypes of syncope based on pathogenetic mechanism.Additionally, these parameters did not differ in terms of the number ofsyncope recurrence and tilt test. Patients’ complaints reduced after cardiologicevaluation and advice regarding prevention of syncope. We think that infollow-up period, education and preventive precautions that can be takenin the daily life must be emphasized, and drug treatment can be started inunresponsive cases.Öğe Retrospective Evaluation of Term Neonatal Cases with Indirect Hyperbilirubinemia(2022) Ekin, Rezzan Ezgi; Deger, İbrahim; Yolbaş, İlyas; Ertuğrul, SabahattinAlthough jaundice is very common in the neonatal period, it often recovers spontaneously without the ne ed for treatment. In this study, it was aimed to retrospectively evaluate the patients hospitalized with the diagnosis of hyperbilirubinemia an d to determine the risk factors, thus, to early diagnose and guide treatment of severe hyperbilirubinemia.In this study, 250 infants who were followed up and treated for hyperbilirubinemia in Neonatal Intensive Care Unit. When all cases were evaluated etiologically, the highest reason was found to be AB0 incompatibility. In 30% of the cases, the direct Coombs test was positive and the most common reason in the cases with positive direct Coombs test was the association of Rh and subgroup incompatibility with a rate of 29.3%. When the treatments applied to the cases were evaluated, phototherapy was given to all patients. It was found that of the patients, 84% received only phototherapy treatment, 6.4% underwent exchange transfusion with phototherapy, 5.2% received IVIG treatment, 4.4% received exchange transfusion and IVIG treatment. If neonatal hyperbilirubinemia is not diagnosed and treated early, the morbidity and mortality of the brain damage that can occur is high. Today, while AB0 and Rh incompatibilities, which are an important etiologically important problem, are closely monitored, other etiological conditions such as infections, G6PD deficiency, subgroup incompatibility, hypothyroidism should also be kept in mind and early diagnosis and treatment should be performed.Öğe Spinal veya genel anestezi ile yapılan elektif sezeryanlar ve anestezi verilmeyen normal doğumların neonatal sonuçlarının karşılaştırılması(Dicle Üniversitesi Tıp Fakültesi, 2019) Ağaçayak, Elif; Yavuz, Mustafa; Tunç, Senem Yaman; Akın, Gamze; Ertuğrul, Sabahattin; Yıldırım, Zeynep Baysal; Gül, TalipAmaç: Bu çalışmada amacımız normal doğum hastalarını kontrol grubu olarak alarak anestezinin fetüs üzerine kısa dönem etkilerini araştırmak, spinal ve genel anestezinin karşılaştırılmasını yapmaktır. Yöntemler: Bu çalışmaya …… Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğine doğum yapmak için başvurmuş, herhangi bir risk faktörü olmayan 50 normal doğum ve 50 spinal, 50 genel anestezi olmak üzere elektif olarak yapılan sezeryanlar dahil edildi. Hastaların yaşları, gravide, pariteleri, gebelik haftaları, doğum kilosu, 1.dakika ve 5.dakika apgarları kaydedildi. Doğum sonrası balon-valv-maske ihtiyacı olan ve yenidoğanın geçici taşipnesi olan bebekler kaydedildi. Bulgular: Çalışmamızda, her iki anestezi tipi ve normal doğum hastaları karşılaştırıldığında 1. dk apgar skorları arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0.05). 5.dk apgar skorları genel anestezi grubunda spinal anestezi grubuna göre anlamlı olarak daha düşük bulundu (p=0.018). Spinal anestezi grubundaki hastaların 50 (%100)’si, genel anestezi yapılan hastaların 45 (%90)’i, normal doğum yapılan hastaların 48 (%96)’sının 5 dakika apgar skorları>7 üzerinde olup spinal ve genel anestezi grupları arasında anlamlı bir farklılık izlendi (p:0.022). Gruplar arasında balon-valv-maske uygulanması ve yenidoğanın geçici taşipnesi açısından anlamlı bir farklılık izlenmedi (p>0.05). Sonuç: Sonuç olarak spinal anestezi erken dönem neonatal sonuçlar açısından daha iyi olup hangi anestezi yönteminin uygulanacağına her iki yöntemin avantaj ve dezavantajları, hastada mevcut olan patolojiler, operasyonun aciliyeti gibi faktörler, anestezistin deneyimi ve hastanın tercihi göz önünde bulundurularak karar verilmelidir. Genel anestezi yapılma zorunluluğu varsa tercih edilecek ilaçlar açısından fetüse depresan etkisi en az olanlar tercih edilmelidir.Öğe Vitamin D deficiency prevalence in late neonatal hypocalcemia: A multicenter study(Galenos Yayıncılık, 2021) Seymen-Karabulut, Gülcan; Günlemez, Ayla; Gökalp, Ayşe Sevim; Hatun, Şükrü; Narter, Fatma Kaya; Mutlu, Mehmet; Ertuğrul, SabahattinObjective: Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns. Methods: Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels. Results: The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients. Conclusion: Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.
