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Öğe Comparison of Three Different Administration Positions for Intratracheal Beractant in Preterm Newborns with Respiratory Distress Syndrome(Elsevier Taiwan, 2016) Karadag, Ahmet; Ozdemir, Ramazan; Degirmencioglu, Halil; Uras, Nurdan; Dilmen, Ugur; Bilgili, Gokmen; Erdeve, OmerBackground: The aim of this study was to compare the efficacy and adverse effects of various intratracheal beractant administration positions in preterm newborns with respiratory distress syndrome. Methods: This study was performed on preterm newborns with respiratory distress syndrome. The inclusion criteria were being between 26 weeks and 32 weeks of gestational age, having a birth weight between 600 g and 1500 g, having received clinical and radiological confirmation for the diagnosis of respiratory distress syndrome (RDS) within 3 hours of life, having been born in one of the centers where the study was carried out, and having fractions of inspired oxygen (FiO(2)) >= 0.40 to maintain oxygen saturation by pulse oximeter at 88-96%. Beractant was administered in four positions to Group I newborns, in two positions to Group II, and in neutral position to Group III. Results: Groups I and II consisted of 42 preterm infants in each whereas Group III included 41 preterm infants. No significant differences were detected among the groups with regards to maternal and neonatal risk factors. Groups were also similar in terms of the following complications: patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH), chronic lung disease (CLD), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC), death within the first 3 days of life, death within the first 28 days of life, and rehospitalization within 1 month after discharge. Neither any statistically significant differences among the parameters related with surfactant administration, nor any significant statistical differences among the FiO(2) levels and the saturation levels before and after the first surfactant administration among the groups were determined. Conclusion: In terms of efficacy and side effects, no important difference was observed between the recommended four position beractant application, the two position administration, and the neutral position. Copyright (C) 2016, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.Öğe Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study(Taylor & Francis Ltd, 2014) Dilmen, Ugur; Ozdemir, Ramazan; Aksoy, Hatice Tatar; Uras, Nurdan; Demirel, Nihal; Kirimi, Ercan; Erdeve, OmerObjective: Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants. Methods: All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf (R) administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf (R) administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assesment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) >= grade III). Results: Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH >= grade III when compared to the LS treatment group. Conclusions: ES treatment decreases IVH (>= grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.Öğe Mean Platelet Volume in Neonatal Sepsis(Wiley, 2012) Oncel, Mehmet Yekta; Ozdemir, Ramazan; Yurttutan, Sadik; Canpolat, Fuat Emre; Erdeve, Omer; Oguz, Serife Suna; Uras, NurdanBackground The aim of this study was to investigate any changes in mean platelet volume (MPV) in patients with neonatal sepsis (NS). Methods Subjects were stratified into two groups: proven sepsis (Group 1a) and clinical sepsis (Group 1b). The control group (Group 2) consisted of healthy newborns matched for gestational age and birth weight. Results A total of 100 patients with NS (35 with proven sepsis and 65 with clinical sepsis) and 50 healthy controls were enrolled. A comparison of markers of sepsis obtained at baseline revealed white blood cell count (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), and MPV levels to be significantly higher in newborns with sepsis compared to healthy controls (P = 0.01, <0.001, <0.001, and 0.001, respectively). Mean baseline serum levels of CRP and MPV were significantly higher in Group 1a compared to Group 1b (P = 0.003, P = 0.007, respectively), whereas the difference between group with regards to baseline serum levels of IL-6 and platelet count was statistically insignificant (P = 0.14, P = 0.28, respectively). Conclusion This is the first study to demonstrate a statistically significant difference with regard to baseline MPV values between patients with sepsis (proven or clinical) and healthy controls. J. Clin. Lab. Anal. 26:493-496, 2012. (C) 2012 Wiley Periodicals, Inc.Öğe Postnatal hydrocortisone therapy for the treatment of bronchopulmonary dysplasia in very low birth weight infants(2019) Buyuktiryaki, Mehmet; Alyamac Dizdar, Evrim; Okur, Nilufer; Sari, Fatmanur; Bezirganoglu, Handan; Canpolat, Fuat Emre; Uras, Nurdan; Oguz, Serife SunaAim: Corticosteroids are widely used to prevent and treat bronchopulmonary dysplasia (BPD) due to their strong anti-inflammatory effects. We aim to evaluate the outcomes of late onset systemic hydrocortisone (HC) therapy in very low birth weight infants with BPD.Material and Methods: The medical records of 706 preterm infants with gestational age ≤ 30 weeks over a 4-year period were retrospectively reviewed. Infants who required invasive/noninvasive respiratory support or ≥ 30% oxygen due to BPD and were treated with HC after the third postnatal week were included. The infants were divided into 3 groups according to respiratory support at the beginning of the HC treatment: mechanical ventilation (MV), noninvasive ventilation (NIV), and free oxygen.Results: Seventy-six (11.9%) infants in our cohort received HC therapy. In the MV group, 83.3% of the infants were successfully extubated after a median of 4 days (interquartile range [IQR], 2-8 days). In the NIV group, 83.9% of the infants required no longer respiratory support after a median of 6 days (IQR, 3-16 days). In the free oxygen group, none of the infants needed supplemental oxygen after a median of 8 days (IQR, 6-12 days). Conclusion: Late HC therapy facilitates extubating without adverse short-term effects, reduces the need of invasive and noninvasive ventilation, and facilitates discharge without supplemental oxygen.Öğe Prolonged jaundice in newborns is associated with low antioxidant capacity in breast milk(Taylor & Francis Ltd, 2010) Uras, Nurdan; Tonbul, Alpaslan; Karadag, Ahmet; Dogan, Derya G.; Erel, Ozcan; Tatli, Mustafa M.In breastfeeding newborns who are otherwise healthy, the mechanism of prolonged jaundice remains unclear. The aim of this study was to investigate relations between prolonged jaundice and oxidative parameters in breast milk. Full-term, otherwise healthy newborns with jaundice lasting more than 2 weeks were enrolled prospectively in the study. As a control group, newborns in the same age group but without prolonged jaundice were selected. All newborns in the study were exclusively breastfed. In the newborns with prolonged jaundice, investigations of the etiology of the jaundice included complete blood count, peripheral blood smear, blood typing, direct Coombs test, measurement of serum levels of total and direct bilirubin, tests for liver and thyroid function (TSH, free T4, total T4), urine culture and measurement of urine reducing substances, and determination of glucose 6 phosphate dehydrogenase enzyme levels. Breast milk was collected from the mothers of the newborns in both groups. The antioxidant status of the breast milk was assessed via determination of total antioxidant capacity (TAG). Oxidative stress was also assessed in breast milk by measurement of total oxidation status (TOS) and calculation of the oxidative stress index (OSI). The prolonged jaundice group differed significantly from the control group in terms of mean TAG and OSI (p < 0.001), but not in terms of TOS. In conclusion, in the breast milk of mothers of newborns with prolonged jaundice, oxidative stress was found to be increased, and protective antioxidant capacity was found to be decreased.Öğe Renal and mesenteric tissue oxygenation in preterm infants treated with oral ibuprofen(Taylor & Francis Ltd, 2014) Guzoglu, Nilufer; Sari, Fatma Nur; Ozdemir, Ramazan; Oguz, Serife Suna; Uras, Nurdan; Altug, Nahide; Dilmen, UgurBackground: Hemodynamically significant patent ductus arteriosus (PDA) is a common problem in preterm infants which often causes significant morbidities. Although PDA induces alterations in various tissue perfusion, there is scarce information about the effect of oral ibuprofen on hemodynamics of regional tissues. Objective: To investigate, using near-infrared spectroscopy, the effect of oral ibuprofen on renal and mesenteric tissue oxygenation and oxygen extraction in preterm infants with a diagnosis of hemodynamically significant PDA. Patients and methods: Fifteen infants (gestational age <32 weeks) with the diagnosis of hemodynamically significant PDA treated with oral ibuprofen were monitored for near-infrared spectroscopy - determined renal and mesenteric oxygenation. The infants with PDA were matched for gestational age, postnatal age with infants without PDA, who served as control subjects. Results: In infants with PDA, mean arterial blood pressure was significantly lower compared with the control infants [39.3 (range: 36-54) versus 51 (range: 43-66) mmHg, respectively; p < 0.001)]. There were no significant differences in regional oxygen saturation and fractional oxygen extraction of renal and mesenteric tissues in PDA and control infants (p > 0.05). And ibuprofen treatment did not negatively influence renal and mesenteric oxygenation and extraction in infants with PDA (p > 0.05). Conclusion: Renal and mesenteric tissue oxygenation and oxygen extraction were preserved in preterm infants with a diagnosis of hemodynamically significant PDA treated with oral ibuprofen.Öğe Serum Interleukin-6 Levels in the Differential Diagnosis of Sepsis and Transient Tachypnea of Newborn(Aves Yayincilik, Ibrahim Kara, 2010) Uras, Nurdan; Karadag, Ahmet; Tonbul, Alparslan; Mete, Emin; Kara, Semra; Karabel, Musemma; Tatli, Mustafa MansurObjective: The aim of this study was to evaluate the role of serum interleukin-6 (IL-6) levels in the differentiation of neonatal bacterial sepsis and TTN. Material and Methods: The hospital records of 58 newborn infants with respiratory distress who were above 35 weeks of gestational age were investigated. Patients were divided into two groups. The infection group consisted of patients with proven sepsis and clinical sepsis and the other was the UN group. Clinical findings and white blood cell count, serum C-reactive protein (CRP), IL-6 levels and the ratio of immature neutrophils to total neutrophils count (UT) were recorded and compared between the two groups. Results: Serum CRP and IL-6 levels were found higher than the normal limits in both of the groups. However there was no significant difference between them. Duration of respiratory distress was longer and I/T ratio significantly higher in the infection group than the UN group. The combination of IL-6 and I/T ratio yielded a sensitivity of 80%, a specificity of 48%, a positive predictive value of 44.7%, and a negative predictive value of 80% Conclusion: The I/T ratio and IL-6 may contribute to the early diagnosis of sepsis with respiratory symptoms in newborn infants but IL-6 alone cannot distinguish between TIN and sepsis.Öğe Subclinical hypoxia of infants with intrauterine growth retardation determined by increased serum S100B protein levels(Tubitak Scientific & Technological Research Council Turkey, 2011) Kirmemis, Ozlem; Tatli, Mustafa Mansur; Tayman, Cuneyt; Koca, Cemile; Karadag, Ahmet; Uras, Nurdan; Dilmen, UgurAim: To test the hypothesis that serum S100B levels could be useful in detecting neurological damage in infants with intrauterine growth retardation (IUGR). Materials and methods: The study group consisted of infants with IUGR and the control group consisted of age-matched healthy infants. S100B protein levels were measured after birth and compared between groups. Results: For this study, 43 infants with IUGR and 25 infants as a control group were recruited. Gender, gestational age, type of delivery, and maternal age of the groups were statistically insignificant, with the exception of the mean birth weights (2120 +/- 450 g in the IUGR group and 3096 +/- 570 g in the control group (P < 0.001), respectively). S100B protein levels of the IUGR infants (1.13 +/- 0.54) were significantly higher than those of the control group (0.45 +/- 0.13) (P < 0.001). IUGR infants treated with antenatal steroids showed lower S100B levels than IUGR infants that did not receive antenatal steroid treatments (P < 0.05). The study group infants were divided into 2 groups, for growth retardation (GR) that was asymmetric (n = 15) and symmetric (n = 28). The asymmetric and symmetric GR infants' S100B levels were 1.14 +/- 0.47 pg/mL and 1.21 +/- 0.34 pg/mL, respectively, and no significant differences were found between the 2 groups in terms of S100B levels (P = 0.32). Conclusion: The results of this study favor the opinion that there is an existing intrauterine hypoxia causing hypoxic brain tissue damage in IUGR infants, even when followed up with modern obstetrical screening protocols. Measurements of S100B may be useful in the prediction of outcome in these infants.Öğe Successful Implementation of a Bundle Strategy to Prevent Ventilator-Associated Pneumonia in a Neonatal Intensive Care Unit(Oxford Univ Press, 2018) Gokce, Ismail Kursad; Kutman, Hayriye Gozde Kanmaz; Uras, Nurdan; Canpolat, Fuat Emre; Dursun, Yasemin; Oguz, Serife SunaBackground: We aimed to investigate the effectiveness of evidence-based bundle that we developed to reduce ventilator-associated pneumonia (VAP) rates and to assess the degree of compliance rates to this strategy in a tertiary neonatal intensive care unit. Methods: This before-after prospective cohort trial divided into two periods was conducted. All neonates requiring ventilation were enrolled in the study. VAP incidence, compliance rates to bundle components and the contribution of each bundle component to VAP rates were compared between the periods. Results: Throughout the study period, 13 VAP episodes were observed. Full adherence to all six components of the bundle doubled in the active-bundle period (12.8 vs. 24.3%, p<0.01). The mean VAP rate decreased from 7.33/1000 to 2.71/1000 ventilator days following intervention (p = 0.083). Conclusion: This study showed that reliable implementation of a neonate-specific VAP prevention bundle can produce sustained reductions in VAP rates.Öğe Successful ımplementation of a bundle strategy to prevent ventilator-associated pneumonia in aneonatal ıntensive care unit(Oxford unıv press, great clarendon st, oxford ox2 6dp, england, 2018) Gokce, Ismail Kursad; Kutman, Hayriye Gozde Kanmaz; Uras, Nurdan; Canpolat, Fuat Emre; Dursun, Yasemin; Oguz, Serife SunaBackground: We aimed to investigate the effectiveness of evidence-based bundle that we developed to reduce ventilator-associated pneumonia (VAP) rates and to assess the degree of compliance rates to this strategy in a tertiary neonatal intensive care unit. Methods: This before-after prospective cohort trial divided into two periods was conducted. All neonates requiring ventilation were enrolled in the study. VAP incidence, compliance rates to bundle components and the contribution of each bundle component to VAP rates were compared between the periods. Results: Throughout the study period, 13 VAP episodes were observed. Full adherence to all six components of the bundle doubled in the active-bundle period (12.8 vs. 24.3%, p<0.01). The mean VAP rate decreased from 7.33/1000 to 2.71/1000 ventilator days following intervention (p = 0.083).
