Browsing by Author "Çetinkaya, Merih"

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Bebek beslenmesinde hurma yaği: Neler biliyoruz?
(Uludağ Üniversitesi, 2018) Gürakan, Berkan; Ertekin, Vildan; Çetinkaya, Merih; Kutluk, Günsel; Mungan, İlke
Beslenmenin ana maddelerinden biri olan yağların temel fonksiyonunun enerji sağlamak olduğu bilinmektedir. Ancak son yıllarda özellikle bebeklik döneminde yağların başka önemli işlevlerinin de olduğu anlaşılmıştır. Önceki araştırmalarda miktar ve enerji/kilo alımı gibi konular üzerinde durulurken yağların içerik ve özelliklerini ele alan güncel çalışmalarda yağ kalitesinin büyüme, gelişme ve uzun süreli sağlık sonuçlarını etkilediği gösterilmiştir. Bebek mamalarında kullanılan hurma yağındaki palmitik asidin yapısal olarak anne sütünden farklı olması nedeniyle bebeklerde sindirim, emilim ile ilgili sorunlar gözlenebilmektedir. Bu sorunlar arasında a) yağ emilimi ve enerji alımının azalması; b) dışkı kıvamı ve sıklığının olumsuz etkilenmesi; c) kolik ve regürjitasyon benzeri sindirim sorunlarının ortaya çıkması ve d) kalsiyum emiliminin azalması ile mineralizasyon ve kemik kütlesi üzerinde olası olumsuz sonuçlar doğurması sayılabilir.
Beneficial effects of nigella sativa oil on intestinal damage in necrotizing enterocolitis
(Taylor & Francis, 2012-10) Tayman, Cüneyt; Çekmez, Ferhat; Canpolat, Fuat Emre; Çetinkaya, Merih; Uysal, Sema; Tunç, Turan; Sarıcı, S. Ümit; Kafa, İlker Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; 0000-0001-8309-0934; AAG-7125-2021; 8450193200
Aim: The aim of this study was to determine the beneficial effects of Nigella sativa oil (NSO) on rats with necrotizing enterocolitis (NEC). Material and Methods: Thirty newborn Sprague-Dawley rats were randomly divided into three groups as NEC, NEC + NSO, and control. NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia and cold stress. Pups in the NEC + NSO group were administered NOS at a dose of 2 ml/kg daily by intraperitoneal route from the first day until the end of the study. Proximal colon and ileum were excised for histopathologic, apoptosis (TUNEL) and biochemical evaluation, including xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malonaldehyde (MDA), and myeloperoxdase (MPO) activities. Results: Pups in the NEC + NOS group had better clinical sickness scores and weight gain compared to the NEC group (p < 0.05). In the macroscopic assessment, histopathologic and apoptosis evaluation (TUNEL), severity of bowel damage was significantly lower in the NEC + NOS group compared to the NEC group (p < 0.05). Tissue GSH-Px and SOD levels were significantly preserved in the NEC + NSO group (p < 0.05), whereas, tissue MDA, MPO levels of the NEC + NSO group were significantly lower than those in the NEC group (p < 0.05). Conclusion: NSO significantly reduced the severity of intestinal damage in NEC.
Bronkopulmoner displazide risk faktörleri
(Uludağ Üniversitesi, 2008) Özkan, Hilal; Köksal, Nilgün; Çetinkaya, Merih; Canıtez, Yakup; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Alerji Bilim Dalı.
Amaç: Bronkopulmoner displazi (BPD) oksijen ve pozitif basınçlı ventilasyon ile tedavi edilen prematüre bebeklerde gelişen kronik bir akciğer hastalığıdır. Yenidoğan bakımındaki tüm gelişmelere rağmen preterm bebeklerde en sık görülen uzun dönem komplikasyonudur. Bu çalışmanın amacı yenidoğan yoğun bakım ünitesinde izlenen ve BPD gelişen olguların değerlendirilmesi, BPD sıklığı- nın belirlenmesi ve BPD ile ilişkili risk faktörlerinin saptanmasıdır. Gereç ve Yöntem: Çalışmaya Ocak 2005 ile Ocak 2006 tarihleri arasında Yenidoğan Yoğun Bakım Ünitesine yatırılarak izlenen 276 prematüre bebek alındı. İzlemlerinde BPD gelişen ve gelişmeyen bebekler karakteristik özellikler ve risk faktörleri açısından karşılaştırıldı. Bulgular: Hastaların gestasyon yaşları ortalama 31±3,1(24-36) hafta, doğum ağırlıkları ortalama 1607±610 (500-4000) gram idi. Çalışmaya alınan hastaların %30’unda (84/276) BPD saptandı. BPD gelişen olguların ortalama gestasyon haftası 30±3 (24-36), doğum ağırlıkları 1171±423 (530-3700) gram bulundu. BPD saptanan bebeklerin %36’sı (31/84) 28 haftadan küçük ve %41,9’unun (26/84) do- ğum ağırlığı 1000 gramın altında idi. BPD gelişimi için en önemli risk faktörlerinin gestasyon haftası ve doğum ağırlığı olduğu, gestasyon haftası ve doğum ağırlığı küçüldükçe BPD riskinin arttığı görüldü. BPD gelişen olgularda mekanik ventiasyon süresi 40±4,3 gün iken, BPD gelişmeyenlerde 17±2 gün olarak bulundu ve farklılık istatistiksel olarak da anlamlı idi (p<0,05). Benzer şekilde oksjen tedavi süresi, BPD’li olgularda, BPD olmayanlara oranla anlamlı yüksekti (p<0,05). Ayrıca respiratuvar distres sendromu, intraventriküler hemoraji, annede koriyoamniyonit varlığı, uzamış total parenteral nütrisyon, sık transfüzyon BPD gelişimi ile anlamlı olarak ilişkili bulundu. Sonuç: BPD multifaktöriyel olarak gelişmektedir. Ancak en önemli risk faktörü prematürite, düşük doğum ağırlığı, mekanik ventilasyon ve uzun süreli oksijen kullanımıdır. En etkin koruma prematüre doğumların önlenmesi, mekanik ventilasyon süresinin azaltılması ve oksijenin gerekli olan en az dozda verilmesi ile mümkün olmaktadır.
Can tissue oxygen saturation levels in the first 24 hours predict the development of patent ductus arteriosus in premature babies with respiratory distress syndrome?
(Galenos Yayınevi, 2023-12-01) Dorum, Bayram Ali; Özkan, Hilal; Çetinkaya, Merih; Çakır, Salih Çağrı; Köksal, Nilgün; ÖZKAN, HİLAL; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; 0000-0001-5761-4757; JJY-3921-2023; HJZ-4508-2023; JGS-7600-2023
Introduction: Patent ductus arteriosus (PDA) causes a substantial increase in morbidities in premature babies by causing changes in organ perfusion. Various echocardiographic parameters are used to diagnose PDA and determine whether it is hemodynamically significant (HsPDA). This study aimed to investigate the role of tissue oxygen saturation in the first 24 hours in predicting HsPDA in high-risk premature babies who received respiratory support because of respiratory distress syndrome. Materials and Methods: In this prospective, observational study, cerebral, renal, and mesenteric regional tissue oxygen saturation levels were monitored by near infrared spectroscopy (NIRS) for the first 24 hours of the lives of preterm babies at <= 28 weeks of gestation. The NIRS data of babies with and without HsPDA as diagnosed by echocardiographic examination were compared. Results: Eighty-one premature babies who had HsPDA were included in the study. In the control group 51 premature babies who had not HsPDA were evaluated. The median standard deviation (SD) gestational age of the babies included in the study was 26.9 +/- 1 weeks, and the mean +/- SD birth weight was 880 +/- 218 g. Renal and mesenteric NIRS measurements during follow-up were lower in babies with versus without HsPDA, but the difference was not statistically significant. Conclusion: Low renal and mesenteric stO2 values detected on the first day of life in high-risk infants may be associated with HsPDA. More studies are needed to reveal the effects of HsDPA on organs in these vulnerable babies with NIRS monitoring.
CDP-choline reduces severity of intestinal injury in a neonatal rat model of necrotizing enterocolitis
(Academic Press Inc Elsevier Science, 2013-07) Çetinkaya, Merih; Çekmez, Ferhat; Canpolat, Fuat Emre; Uysal, Sema; Tunç, Turan; Sarıcı, Serdar Ümit; Cansev, Mehmet; Tayman, Cüneyt; Kafa, İlker Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Farmakoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; M-9071-2019; AAG-7125-2021; 8872816100; 12243787300; 8450193200
Background: Cytidine 5'-diphosphocholine (CDP-choline) is an endogenous intermediate in the biosynthesis of phosphatidylcholine, a contributor to the mucosal defense of the intestine. The aim of this study was to evaluate the possible cytoprotective effect of CDP-choline treatment on intestinal cell damage, membrane phospholipid content, inflammation, and apoptosis in a neonatal rat model of necrotizing enterocolitis (NEC). Methods: We divided a total of 30 newborn pups into three groups: control, NEC, and NEC + CDP-choline. We induced NEC by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. We administered CDP-choline intraperitoneally at 300 mg/kg/d for 3 d starting from the first day of life. We evaluated apoptosis macroscopically and histopathologically in combination with proinflammatory cytokines in the gut samples. Moreover, we determined membrane phospholipid levels as well as activities of xanthine oxidase, superoxide dismutase, glutathione peroxidase, and myeloperoxidase enzymes and the malondialdehyde content of intestinal tissue. Results: Mean clinical sickness score, macroscopic gut assessment score, and intestinal injury score were significantly improved, whereas mean apoptosis score and caspase-3 levels were significantly reduced in pups in the NEC + CDP-choline group compared with the NEC group. Tissue proinflammatory cytokine (interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha) levels as well as tissue malondialdehyde content and myeloperoxidase activities were reduced, whereas glutathione peroxidase and superoxide dismutase activities were preserved in the NEC + CDP-choline group. In addition, NEC damage reduced intestinal tissue membrane phospholipids, whereas CDP-choline significantly enhanced total phospholipid and phosphatidylcholine levels. Long-term follow-up in additional experiments revealed increased body weight, decreased clinical sickness scores, and enhanced survival in CDP-cholineereceiving versus saline-receiving pups with NEC lesions. Conclusions: Our study reports, for the first time, beneficial effects of CDP-choline treatment on intestinal injury in a neonatal rat model of NEC. Our data suggest that CDP-choline may be used as an effective therapeutic agent to prevent NEC.
Colistimethate sodium therapy for multidrug-resistant isolates in pediatric patients
(Wiley, 2010-06) Çelebi, Solmaz; Hacımustafaoğlu, Mustafa Kemal; Köksal, Nilgün; Özkan, Hilal; Çetinkaya, Merih; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; AAG-8393-2021; 7006095295; 6602154166; 7003323615; 16679325400; 23994946300
Aim: The aim of the present study was to assess the efficacy and safety of colistimethate sodium therapy in multidrug-resistant nosocomial infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii in neonates and children. Methods: Pediatric patients hospitalized at the Uludag University Hospital who had nosocomial infections caused by multidrug-resistant P. aeruginosa or A. baumannii, were enrolled in the study. Colistimethate sodium at a dosage of 50-75 x 103 U/kg per day was given i.v. divided into three doses. Results: Fifteen patients received 17 courses of colistimethate sodium for the following infections: ventilator-associated pneumonia (n = 14), catheter-related sepsis (n = 1) and skin and soft-tissue infection (n = 2). The mean age of patients was 53.2 + 74.7 months (range, 8 days-15 years) and 60% were male. Mortality was 26.6%. Conclusion: Colistimethate sodium appears to be safe and effective for the treatment of severe infections caused by multidrug-resistant P. aeruginosa or A. baumannii in pediatric patients.
Comparison of lipid emulsions on antioxidant capacity in preterm infants receiving parenteral nutrition
(Wiley, 2011-08) Köksal, Nilgün; Kavurt, Ahmet Vedat; Çetinkaya, Merih; İlçöl, Yeşim Özarda; Özkan, Hilal; Uludağ Üniversitesi/Tıp Fakültesi/Biyokimya Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Neontoloji Anabilim Dalı.; AAG-8393-2021; AAL-8873-2021; 7003323615; 48361292600; 23994946300; 35741320500; 16679325400
Background: Although a variety of different lipid emulsions with varying fatty acid contents have been developed, there are some concerns about the administration of these lipid emulsions because of potential adverse effects, including oxidative stress-related morbidity. The aim of the present study was to evaluate and compare the effects of the standard soybean oil-based and olive oil-based i.v. lipid emulsions (ILE) on oxidative stress, determined by total antioxidant capacity (TAC), and to investigate the safety of the use of these two emulsions in terms of biochemical indices. Methods: In this prospective study, premature infants were randomly assigned to two groups, each group consisting of 32 patients who received parenteral ILE of either 20% olive oil or 20% soybean oil. They were given ILE for 7 days and then were evaluated with regard to TAC. Results: No statistically significant difference was observed between the groups in terms of routine biochemical parameters. TAC for both groups on day 7 was significantly lower compared with that on day 0. Although the decrease in TAC within 7 days of ILE administration was greater in the soybean group compared with that in the olive oil group, it was not statistically significant. Conclusions: Olive oil-based ILE exhibit similar antioxidant activity and can be used as an alternative to soybean oil-based ILE. TAC significantly decreased in infants following administration of either lipid emulsion, and premature infants tolerated either ILE well, both biochemically and clinically.
Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants
(Springernature, 2009-03) Çetinkaya, Merih; Özkan, Hilal Burcu; Köksal, Nirgül; Çelebi, Solmaz; Hacımustafaoğlu, Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Bölümü/Neonatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Bölümü/Çocuk Enfeksiyon Hastalıkları Anabilim Dalı.; 23994946300; 16679325400; 7003323615; 7006095295; 6602154166
Objective: The purpose of this study was to determine the role of serum amyloid A (SAA) in diagnosis of neonatal sepsis and evaluation of clinical response to antibiotic therapy. We also aimed to compare the efficiency of SAA with that of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosis and follow-up of neonatal sepsis in preterm infants. Study Design: A total of 163 infants were enrolled in this prospective study. The infants were classified into four groups: group 1 (high probable sepsis), group 2 (probable sepsis), group 3 (possible sepsis) and group 4 (no sepsis, control group). Blood samples for whole blood count, CRP, PCT, SAA and culture were obtained before initiating antibiotic treatment. This procedure was repeated three times at 48 h, 7 and 10 days. Result: Initial CRP, PCT and SAA levels were found to be positive in 73.2, 75.6 and 77.2% of all infants, respectively. Sensitivities of CRP, PCT and SAA at 0 h were 72.3, 74.8 and 76.4%, respectively. Although it was not statistically significant, SAA was found to be more sensitive than CRP and PCT in diagnosis of neonatal sepsis. The area under the curve (AUC) for CRP, PCT and SAA at 0 h were 0.870, 0.870 and 0.875, respectively. Although the AUC for SAA at 0 h was higher than PCT and CRP, the difference was not statistically significant. Conclusion: SAA is an accurate and reliable marker for diagnosis and follow-up of neonatal sepsis. It is especially useful at the onset of inflammation for rapid diagnosis of neonatal sepsis and can be safely and accurately used in combination with other sepsis markers such as CRP and PCT in diagnosis and follow-up of neonatal sepsis in preterm infants.
Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants
(W B Saunders Co-Elsevier, 2011-08) Çetinkaya, Merih; Özkan, Hilal; Köksal, Nilgün; Akacı, Okan; Özgür, Taner; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Neonatoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0002-2148-1160; AAG-8381-2021; AAG-8393-2021; 23994946300; 16679325400; 7003323615; 36131105700; 36087775800
Purpose: The aim of this study was to compare the efficacy of serum amyloid A (SAA) with that of Creactive protein (CRP), and procalcitonin (PCT) in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants. Methods: A total of 152 infants were enrolled into this observational study. The infants were classified into 3 groups: group 1 (58 infants with NEC and sepsis), group 2 (54 infants with only sepsis), and group 3 (40 infants with neither sepsis nor NEC, or control group). The data including whole blood count, CRP, PCT, SAA, and cultures that were obtained at diagnosis (0 hour), at 24 and 48 hours, and at 7 and 10 days were evaluated. Results: A total of 58 infants had a diagnosis of NEC. Mean CRP (7.4 +/- 5.2 mg/dL) and SAA (46.2 +/- 41.3 mg/dL) values of infants in group 1 at 0 hour were significantly higher than those in groups 2 and 3. Although the area under the curve of CRP was higher at 0 hour in infants with NEC, there were no significant differences between groups with respect to the areas under the curve of SAA, CRP, and PCT at all measurement times. Levels of SAA decreased earlier than CRP and PCT in the follow-up of NEC (mean SAA levels were 45.8 +/- 45.2, 21.9 +/- 16.6, 10.1 +/- 8.3, and 7.9 +/- 5.1 mg/dL at evaluation times, respectively). Levels of CRP and SAA of infants with NEC stages II and III were significantly higher than those with only sepsis and/or NEC stage I. Conclusions: Serum amyloid A, CRP, and PCT all are accurate and reliable markers in diagnosis of NEC, in addition to clinical and radiographic findings. Higher CRP and SAA levels might indicate advanced stage of NEC. Serial measurements of SAA, CRP, and PCT, either alone or in combination, can be used safely in the diagnosis and follow-up of NEC.
Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7 year period: Coagulase-negative Staphylococcus as the predominant pathogen
(Wiley, 2014-02) Özkan, Hilal; Çetinkaya, Merih; Köksal, Nilgün; Çelebi, Solmaz; Hacımustafaoğlu, Mustafa Kemal; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 16679325400; 23994946300; 7003323615; 7006095295; 6602154166
Background The aim of this study was to determine the causative agents in early, late- and very late-onset sepsis in preterm infants. The demographic features, risk factors, clinical and laboratory findings in sepsis types were also defined. Methods A total of 151 preterm infants with culture-proven neonatal sepsis were enrolled in this prospective study. The infants were classified into three groups with regard to the onset of sepsis: early onset sepsis (EOS), late-onset sepsis (LOS) and very late-onset sepsis (VLOS). A sepsis screen including whole blood count, blood smear, infection markers and cultures was performed before initiating antibiotic therapy. Results EOS, LOS and VLOS groups consisted of 23, 86 and 42 infants, respectively. Coagulase-negative staphylococci (CONS) was the most common organism in all sepsis groups. The main factors associated with EOS included presence of premature rupture of membranes, antibiotic use in pregnancy and choriamnionitis. Previous antibiotic use was the main factor associated with LOS, while low birthweight was the main factor in infants with VLOS. Although mortality rate due to Gram-negative bacteria and fungi was higher, CONS was an important cause of mortality in infants with LOS and VLOS. Conclusions CONS was found to be the most common causative organism in three sepsis types in preterm neonates. Although the mortality rate due to CONS was lower in EOS, it was an important cause of mortality in LOS and VLOS. CONS seems to be the main pathogen in neonatal sepsis in developing countries, as in developed countries.
Cytidine 5 '-diphosphocholine ameliorates hyperoxic lung injury in a neonatal rat model
(Springernature, 2013-07) Çetinkaya, Merih; Tayman, Cüneyt; Çekmez, Ferhat; Canpolat, Fuat Emre; Tunç, Turan; Sarıcı, S. Ümit; Cansev, Mehmet; Kafa, İlker Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Farmakoloji Anabilim Dalı.; M-9071-2019; AAG-7125-2021; 8872816100; 8450193200
BACKGROUND: Bronchopulmonary dysplasia (BPD) is an important cause of morbidity. The aim of this study was to evaluate the preventive effect of cytidine 5'-diphosphocholine (CDP-choline) treatment on hyperoxic lung injury in a neonatal rat model. METHODS: A total of 30 newborn pups were divided into control, hyperoxia, and hyperoxia + CDP-choline groups. After birth, pups in the control group were kept in room air and received saline injections, whereas those in hyperoxia and hyperoxia + CDP-choline groups were exposed to 95% O-2 and received daily injections of saline and CDP-choline throughout postnatal day 10, respectively. Histopathological scoring, radial alveolar count, lamellar body membrane protein expression, fibrosis, proinflammatory cytokine levels, lung tissue and bronchoalveolar lavage (BAL) fluid phospholipid content, and apoptosis were evaluated. RESULTS: Hyperoxia-induced severe lung damage was reduced significantly by CDP-choline treatment. Radial alveolar count and lamellar body membrane protein expression were significantly recovered, and the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling-positive cells, active caspase-3 expression, and tissue proinflammatory cytokine levels were decreased by CDP-choline administration. Lung tissue and BAL phospholipid contents showed significant increases after COP-choline administration. CONCLUSION: These data show that COP-choline ameliorates hyperoxic lung injury in a neonatal rat model. It may therefore be suggested that CDP-choline may be a novel therapeutic option for the prevention of BPD.
Early administration of the second surfactant dose in preterm infants with severe respiratory distress syndrome
(Türk Pediatri Dergisi, 2009) Köksal, Nilgün; Akpınar, Reyhan; Çetinkaya, Merih; Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 7003323615; 35797899400; 23994946300
The aim of this study was to determine whether early administration (2 hours after the first surfactant dose) of the second surfactant dose would be superior to late surfactant treatment (6 hours after the first surfactant dose) in preterm infants with severe respiratory distress syndrome. Between June 2003 and March 2005, 40 newborns born with respiratory distress syndrome in Uludag University Hospital were investigated in this prospective study. The inclusion criteria for the recruitment of the infants were: age <= 2 hours, birth weight between 600-2500 g, gestational age between 24-36 weeks, X-ray consistent with respiratory distress syndrome, and need for mechanical ventilation with inspiratory oxygen fraction >= 0.4 and mean airway pressure >= 7 cm H(2)O to obtain arterial pressure of oxygen between 70-80 mmHg. Infants with lethal congenital anomalies or being treated with high-frequency oscillatory ventilation were excluded from the study. Birth weight, gestational age, gender, and Apgar scores were recorded and complications of the surfactant therapy were examined. Twenty boys and 20 girls were enrolled in the study. The first surfactant dose was administered in the first hour of life in all infants. The second surfactant dose was given 2 hours after the first dose in 20 of them and 6 hours after the first dose in the other 20. Infants in both groups (early versus late) were similar with respect to gestational age, birth weight, gender, and the rate of prenatal corticosteroids. There were also no significant differences between the two groups in terms of the response to surfactant therapy and complications. The results of this study show that administration of the second surfactant dose earlier is as effective as late administration, and it may be suggested that the second surfactant dose can be applied earlier in severe respiratory distress syndrome.
Early left ventricular diastolic dysfunction in premature infants born to preeclamptic mothers
(Walter De Gruyter, 2011-01) Çetinkaya, Merih; Bostan, Özlem Mehtap; Köksal, Nilgün; Semizel, Evren; Özkan, Hilal; Çakır, Seher; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; AAG-8558-2021; AAG-8393-2021; 23994946300; 8676936500; 7003323615; 12646191300; 16679325400; 7005414819
Aim: To evaluate the cardiac function in premature infants born to preeclamptic mothers and its clinical consequences. Methods: This was a prospective observational cohort study performed in a tertiary neonatal intensive care unit. Fifty-three premature infants born to preeclamptic mothers comprising the study group were evaluated and compared with 42 premature infants born to normotensive mothers (control group). Relationship between echocardiographic measures and neonatal morbidity were assessed as the main outcome measures. Results: Left ventricle end-diastolic dimension (LVEDD), peak flow velocities during early diastole (peak E wave), peak flow velocities during atrial contraction (peak A wave), and peak E/A ratio were significantly lower in the study group. Within the study group, these parameters were also significantly lower in infants with respiratory problems. LVEDD was significantly smaller in preeclamptic infants with intrauterine growth retardation (IUGR). Conclusion: Left ventricle diastolic dysfunction (LVDD) was detected in premature infants born to preeclamptic mothers in the first week after delivery. LVDD was associated with higher incidence of respiratory problems, transient tachypnea of the newborn, longer duration of oxygen requirement, and IUGR.
Effect of intrauterine transfusion on neonatal outcomes in rh hemolytic disease
(Galenos Yayincilik, 2010-04-01) Çetinkaya, Merih; Özkan, Hilal; ÖZKAN, HİLAL; Köksal, Nilgün; Kimya, Yalçın; Akkus, Handan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; AFP-9671-2022; AAG-8393-2021
Introduction: The aim of this study was to evaluate the neonates with Rh hemolytic disease according to the severity of hemolytic disease (slight, moderate and severe) and the presence of intrauterine transfusion (IUT) for necessity of postnatal exchange transfusion or phototherapy application and severity of neonatal anemia.Materials and Method: The neonates admitted to Neonatal Intensive Care Unit with Rhesus hemolytic disease between January 2000 and November 2008 were included in this retrospective study. Cord blood hemoglobine and bilirubin levels, reticulocyte count, maximum bilirubin level, number of intrauterine transfusion, duration of phototherapy, requirement of postnatal exchange transfusion or redblood cell transfusions were all recorded.Results: A total of 44 neonates were included in the study. The mean gestational age and birth weight of infants were 37.6 +/- 0.3 week and 3031 +/- 53 g, respectively. Slight, moderate and severe hemolytic disease was determined in 13 (29.5%), 13 (29.5%) and 18 (41%) of infants, respectively. IUT was performed in 12 infants (27%) and 9 of them (75%) had severe hemolytic disease and this ratio was significantly higher compared with the infants without IUT. Similarly, requirement of postnatal exchange transfusion was also higher in infants who had IUT compared with the infants who did not have IUT. No significant difference was determined between infants with and without IUT in terms of duration of phototherapy, maximum bilirubin levels and transfusion requirement.Conclusion: The incidence of severe hemolytic disease and postnatal exchange requirement were significantly higher in infants with IUT compared with the infants without IUT. Therefore, it is concluded that if Rhesus hemolytic disease is severe in utero, it may present as severe hemolytic disease in the postnatal period.
The efficacy of serial serum amyloid A measurements for diagnosis and follow-up of necrotizing enterocolitis in premature infants
(Springer, 2010-08) Çetinkaya, Merih; Özkan, Hilal; Köksal, Nilgün; Akacı, Okan; Özgür, Taner; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0002-2148-1160; AAG-8393-2021; AAG-8381-2021; 23994946300; 16679325400; 7003323615; 36131105700; 36087775800
The purpose of this study was to evaluate the efficacy of serial serum amyloid A (SAA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants. A total of 144 infants were enrolled in this observational study. The infants were classified into three groups: group 1 (infants with NEC and sepsis), group 2 (infants with sepsis), and group 3 (no sepsis and NEC, control group). Data including serial whole blood count (WBC), SAA measurements that were obtained at the initial work-up of NEC and/or sepsis episode (0 day), at 24, 48 h, 7, and 10 day were evaluated. In addition, initial and serial follow-up abdominal radiographies were obtained. A total of 50 infants were diagnosed NEC. Mean SAA values (43.2 +/- A 47.5 mg/dl) of infants in group 1 at 0 h were significantly higher than those in group 2 and group 3. The percentage of infants with abnormal SAA levels was significantly higher in group 1 compared with that in group 2 at 24 h. In addition, the percentage of infants with abnormal SAA levels was slightly but not statistically higher in stage 2 and stage 3 NEC group compared with that stage 1 NEC at 0, 24, 48 h. SAA levels started to decline at 48 h of onset through day 10. The cut-off value for SAA for differentiating NEC from sepsis was 23.2 mg/dl. SAA may be recognized as an accurate laboratory marker in addition to clinical and radiographic findings for NEC diagnosis. It can also be used for determining the severity of NEC and response to therapy in infants with NEC.
Evaluation of melatonin and prostaglandin El combination on necrotizing enterocolitis model in neonatal rats
(Elsevier, 2013-06-10) Çekmez, Ferhat; Çetinkaya, Merih; Tayman, Cüneyt; Canpolat, Fuat Emre; Uysal, Sema; Tunç, Turan; Sarıcı, Serdar Ümit; Kafa, İlker Mustafa; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; AAG-7125-2021; 8450193200
Background: Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in newborn infants but up to now there is no completely effective treatment for it. Objective: In order to show that a combination of melatonin and prostaglandins may be useful to save lives, we use newborn rat as a model of necrotizing enterocolitis to test the hypothesis of using the combination therapy might have more potential effect on mucosal cytoprotection and healing. Patients and methods: A total of 60 newborn pups from 5 time-mated Sprague-Dawley pregnant rats were divided equally into 5 groups as follows: NEC (subjected to NEC), NEC + Melatonin, NEC + Prostaglandin, NEC + Prostaglandin + Melatonin and control. These animals were fed with hyperosmolar formula 3 times daily and subjected to 100% CO2 inhalation for 10 min, +4 degrees C cold exposure for 5 min, and 97% O-2 for 5 min twice daily to induce NEC. This procedure was applied to the pups for 3 days. Results: The macroscopic scoring, intestinal injury scoring and apoptosis index scoring were all found to be significantly lower in NEC + Prostaglandin + Melatonin group compared with NEC group. Anti-oxidant enzyme activities were significantly higher, whereas lipid peroxidation was significantly lower in NEC + Prostaglandin + Melatonin group compared with NEC group. Conclusion: This combination therapy showed cytoprotective and healing effects on mucosa in the intestinal tissue of rat pups in necrotizing enterocolitis model. Therefore, this therapy might also show benefit in preterm infants with NEC. After confirmation of this data by other clinical and experimental studies, it may be a novel therapeutic option for the prevention of NEC in preterm infants.
Evaluation of premature newborns with necrotizing enterocolitis
(Galenos Yayıncılık, 2010-08-01) Özkan, Hilal; Çetinkaya, Merih; Köksal, Nilgün; Özboyacı, Evren; Özboyacı, Ali; Yapıcı, Şenay; ÖZKAN, HİLAL; Çetinkaya, Merih; Köksal, Nilgün; Özboyacı, Evren; Özboyacı, Ali; Yapıcı, Şenay; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı Hastalıkları Anabilim Dalı/Neonatol Bilim Dalı.; AFP-9671-2022; JLK-4920-2023; JKY-6016-2023; JKS-5715-2023; JLB-3549-2023; EHN-3812-2022
Introduction: The aim of this study was to evaluate the characteristic features and both early and late term prognosis of premature infants who were followed-up with NEC in the neonatal intensive care unit.Materials and Method: A total of 50 premature infants less than 34 gestational weeks with NEC between January 2005 and December 2009 were included to this study and the characteristic features, clinical and laboratory findings, and prognosis of these infants were evaluated.Results: In this study, 15 infants (30%) had stage 1, 21 infants (42%) had stage 2 and 14 infants (28%) had stage 3 NEC. The incidence of NEC was 7.5% (20/568). The mean gestational age and birth weight of infants who developed NEC were 29 +/- 2.2 weeks and 1142 +/- 300 grams, respectively. The mean onset of NEC was 18.5 +/- 8.1 days. There was hypoxic birth history in 64% of infants and the ratio of breastfed infants was 54%. There was a positive blood culture in 36% of infants with NEC. Surgery was performed in 8 infants with stage 3 NEC, whereas the other infants responded well to medical treatment. The mortality rate was 12% and feeding problems and malabsorption were found to be the most common early and late term problems in infants who survived.Conclusions: NEC is one of the serious problems in premature infants. The mortality and frequency of NEC was decreased with the improvements in the Neonatal Intensive Care. The most important etiological factors were prematurity, hypoxia and enteral feeding.
Human 2009 influenza a (H1N1) virus infection in a premature infant born to an H1N1-infected mother: Placental transmission?
(Türk Pediatri Dergisi, 2011) Çetinkaya, Merih; Özkan, Hilal; Çelebi, Solmaz; Köksal, Nilgün; Hacımustafaoğlu, Mustafa Kemal; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; AAG-8393-2021; 23994946300; 16679325400; 7006095295; 7003323615; 6602154166
Human infection with H1N1 virus reached pandemic status by the spring of 2009. Consequently, the rates of morbidity and mortality related with H1N1 2009 infections have been reported to be higher in pregnant women. H1N1 viremia is rare in the mother, and the risk for transmission of H1N1 2009 influenza from mother to fetus is unknown. To our knowledge, the literature contains only one previous report of a premature infant with H1N1 2009 infection whose mother also had H1N1 2009 infection. Here, we report an H1N1 pandemic influenza 2009-positive female premature infant born at 32 weeks of gestation whose mother had a confirmed H1N1 2009 infection by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). This case suggests that H1N1 2009 virus might be transmitted across the placenta, and therefore, all infants born to an H1N1 2009-positive mother must be evaluated for possible H1N1 2009 infection.
Hyperprostaglandin E syndrome: Use of indomethacin and steroid, and death due to necrotizing enterocolitis and sepsis
(Türk Pediatri Dergisi, 2008) Çetinkaya, Merih; Köksal, Nilgün; Özkan, Hilal; Dönmez, Osman; Saǧlam, Halil; Kırıştıoğlu, İrfan; Uludağ Üniversitesi/Tıp Fakültesi/Neonatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji ve Romatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; 0000-0003-0710-5422; C-7392-2019; AAA-8778-2021; 23994946300; 7003323615; 16679325400; 19033971800; 35612700100; 21645753900
Hyperprostaglandin E syndrome (HPS) is the antenatal variant of Bartter syndrome and characterized by polyhydramnios and preterm delivery in the antenatal period and salt-wasting, isosthenuric or hyposthenuric polyuria, hypercalciuria and nephrocalcinosis in the postnatal period. We report a one-month-old infant with HPS with a 15-year-old sister with Bartter syndrome. The infant's birth weight was 2750 g and she had severe dehydration on the 2nd day of life. She had hypercalcemia, hyponatremia, hypokalemia, metabolic alkalosis and elevated plasma renin and aldosterone levels. We instituted indomethacin therapy accompanied by steroid therapy for hypercalcermia. However, the patient developed abdominal distention on the 30th day, which was due to diffuse pneumatosis in sigmoid colon revealed by a subsequent surgical intervention. Following surgery, the patient developed fever, electrolyte abnormalities and subsequently sepsis. The patient died due to sepsis 10 days after surgery. We conclude that indomethacin and steroid therapy must be used cautiously in infants with HPS.
Increased incidence of bronchopulmonary dysplasia in preterm infants exposed to preeclampsia
(Taylor & Francis, 2012-12) Özkan, Hilal; Çetinkaya, Merih; Köksal, Nilgün; Uladağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; AAG-8393-2021; 16679325400; 23994946300; 7003323615
Objective: The aims of the study were to determine the effect of preeclampsia on bronchopulmonary dysplasia (BPD) development in preterm infants and to investigate the possible association between BPD severity and preeclampsia. Methods: The study group involved preterm infants (<= 32 gestational week) born to a preeclamptic mother with no co-existing medical condition, whereas the comparison group involved preterm infants born to a normotensive mother. BPD was defined as requirement for supplemental oxygen for the first 28 days of life and classified as mild, moderate and severe. Results: There were a total of 117 and 215 premature infants that were born to a preeclamptic mother and a normotensive mother, respectively. The incidence of BPD in preterm infants born to preeclamptic mothers (38.5%) was significantly higher than those born to normotensive mothers (19.5%). Frequencies of moderate and severe BPD were significantly higher in the infants born to preeclamptic mothers. Moderate and severe BPD was also significantly higher in infants born to a mother with severe preeclampsia compared with a mother with mild preeclampsia. In logistic regression model, preeclampsia was found to be predictive of BPD. Conclusions: Preeclampsia was found to be an important risk factor for BPD development in preterm infants. The incidence of both moderate and severe BPD was significantly higher in infants born to preeclamptic mothers. These findings might be associated with altered angiogenesis in the preeclamptic mother which might be shared by the fetus.