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Öğe 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, NilayObjective 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.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 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 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.
