Browsing by Author "Tarcan, Aylin"

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Acupressure at BL60 and K3 Points Before Heel Lancing in Preterm Infants
(2015) Abbasoglu, Aslihan; Cabioglu, Mehmet Tugrul; Tugcu, Ali Ulas; Ince, Deniz Anuk; Tekindal, Mustafa Agah; Ecevit, Ayse; Tarcan, Aylin; 0000-0002-2232-8117; 0000-0002-4060-7048; 0000-0002-4369-2110; 26242287; ABI-2113-2020; AAJ-4616-2021; U-9270-2018; I-6746-2016
Context: Acupressure is an ancient Chinese healing art. In this pain-relieving method, the fingers are used to press key acupuncture points on the skin surface that stimulates the body's regulatory processes. Objective: The aim of this study was to investigate the effect of acupressure at Kun Lun (UB60) and Taixi (K3) points for pain management in preterrn infants prior to heel lancing for blood collection. Design: This was a prospective, randomized controlled study. Setting: The study setting was the neonatal intensive care unit at Baskent University Hospital in Turkey. Patients: A total of 32 preterm infants between 28 and 36 weeks' gestational age were randomly assigned to one of two groups: an acupressure group (n = 16) or a control group (n = 16). Intervention: In the acupressure group, immediately before the heel prick, acupressure was applied for three minutes at UB60 and K3 points. Main Outcome Measures: A behavioral pain score was determined using the Premature Infant Pain Profile (PIPP) scale. Results: There were no significant differences between the groups with respect to gestational age, birth weight, sex, mode of delivery, age at time of procedure, weight at time of procedure, or PIPP score. Mean duration of procedure and mean duration of crying were both shorter in the acupressure group (both P = .001). Conclusions: Applying acupressure at the BL60 and K3 points before heel lancing was associated with shorter procedural time and shorter duration of crying in preterm infants.
Association of Respiratory Distress Syndrome and Perinatal Hypoxia with Histologic Chorioamnionitis in Preterm Infants
(2014) Ecevit, Ayse; Anuk-Ince, Deniz; Yapakci, Ece; Kupana-Ayva, Sebnem; Kurt, Abdullah; Yanik, Filiz F.; Tarcan, Aylin; 0000-0002-4369-2110; 0000-0002-4430-444X; 0000-0002-2232-8117; 24827948; I-6746-2016; HIU-0129-2022; AAJ-4616-2021; AIC-4823-2022
The aim of this study was to evaluate the relationship between neonatal mortality-morbidity and pregnancies with preterm premature rupture of membranes (PPROM), particularly those complicated by histologic chorioamnionitis (HCA), in preterm infants. A retrospective study was conducted on 58 preterm neonates born to 46 pregnant women with PPROM. Maternal characteristics, placental examination, and neonatal morbidity and mortality were analyzed. Of 1,392 deliveries, 46 (3.3%) pregnancies and 58 newborn infants were complicated with PPROM. HCA was present in 21 (1.5%) cases, and 15 of them were <28 weeks of gestational age. In the HCA (+) group, 8/21(38%) neonates had 5-minute Apgar scores of <5, 12/21 (57.1%) infants had patent ductus arteriosus (PDA), and 16/21 (76.1%) infants had respiratory distress syndrome (RDS). The latency period was significantly longer and the rate of chorioamnionitis and percentage of major neonatal morbidity and mortality were significantly higher in preterm infants with gestational age <28 weeks. Respiratory distress syndrome, perinatal hypoxia and PDA were significantly associated with HCA in preterm infants.
Congenital Hyperinsulinism in A Newborn with A Novel Homozygous Mutation (P.Q392H) in The ABCC8 Gene
(2014) Ince, Deniz Anuk; Sahin, Nursel Muratoglu; Ecevit, Ayse; Kurt, Abdullah; Kinik, Sibel Tulgar; Flanagan, Sarah E.; Hussain, Khalid; Tarcan, Aylin; https://orcid.org/0000-0002-4369-2110; https://orcid.org/0000-0002-8215-0146; https://orcid.org/0000-0002-2232-8117; https://orcid.org/0000-0002-4430-444X; https://orcid.org/0000-0002-8670-6340; 24945427; I-6746-2016; AAA-1266-2019; AAJ-4616-2021; HIU-0129-2022; AFK-0591-2022
Congenital hyperinsulinism is the most frequent cause of persistent hypoglycemia in infancy. We present the case of a preterm, large-for-gestation-age infant with congenital hyperinsulinism who was found to have a novel p.Q392H homozygous mutation in the ABCC8 gene. The patient had severe brain damage, despite early diagnosis and appropriate management. The new mutations may provide an understanding of the prognosis and treatment of the disease. In addition, the data will help the family make informed decisions about future pregnancies.
Determination of tissue hypoxia by physicochemical approach in premature anemia
(2017) Torer, Birgin; Ozdemir, Zeliha; Hanta, Deniz; Cetinkaya, Min; Gulcan, Hande; Tarcan, Aylin; 28395879
Background: Anemia is a common problem in premature infants and its most rapid and effective therapy is erythrocyte transfusion. However, owing to inherent risks of transfusion in this population, transfusions should be administered only when adequate oxygen delivery to tissues is impaired. The aim of this study was to determine tissue acid levels using Stewart method in an attempt to evaluate the tissue oxygenation level and thereby the accuracy of transfusion timing. Methods: This study included 47 infants delivered at gestational age below 34 weeks who required erythrocyte transfusion for premature anemia. Strong ion gap (SIG), unmeasurable anions (UMA), tissue acid levels (TA), and Cl/Na ratios were calculated before and after transfusion. Results: The mean birth weight and gestational age of the study population were 121 +/- 365 g and 29.2 +/- 2.7 weeks, respectively. Tissue acid levels were increased (TA > 4) and tissue hypoxia developed in 10 (16.6%) of 60 erythrocyte transfusions administered according to the restrictive transfusion approach. The patients were divided into two. groups according to tissue acid levels as low (<4) and high (>4) tissue acid groups. The group with tissue hypoxia (TA > 4) had significantly higher UMA levels but a significantly lower Cl/Na ratio; and UMA levels decreased and Cl/ Na ratio increased after transfusion in this group. Tissue hypoxia secondary to anemia was shown to be improved by erythrocyte transfusion. Conclusion: The results of the present study suggest that the determination of the level of tissue hypoxia by the Stewart approach may be an alternative to restrictive transfusion guidelines for timing of transfusion in premature anemia. It also showed that a low Cl/Na ratio can be used as a simple marker of tissue hypoxia. Copyright (C) 2017, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license
Effect of Maternal and Neonatal Interleukin-6-174 G/C Polymorphism on Preterm Birth and Neonatal Morbidity
(2018) Karakas, N. Mutlu; Ecevit, Ayse N.; Yalcin, Yaprak; Ozdemir, Beril; Verdi, Hasibe; Tekindal, M. Agah; Ozbek, Namik Y.; Tarcan, Aylin; Atac, Fatma B.; Haberal, Ali; 0000-0002-9337-9106; 0000-0003-4286-7086; 0000-0001-6857-0681; 0000-0002-4060-7048; 0000-0002-2232-8117; 0000-0003-0591-009X; 0000-0002-1486-7209; 0000-0001-6868-2165; 28279124; ABB-4078-2020; AAX-3831-2020; HPC-6496-2023; U-9270-2018; AAJ-4616-2021; ABG-9940-2020; AAI-9331-2021; ABG-9966-2020
Objective: The aim of this study was to analyze maternal and neonatal interleukin 6 (IL-6) (-174 G/C) polymorphism and to determine effect on preterm birth and neonatal morbidity. Study Design: One hundred and sixty-four mothers (100 term births, 64 preterm births) and 183 newborn infants who were 100 healthy term and 83 preterm babies followed in newborn intensive care units were evaluated. PCR-RFLP was performed for IL-6 (-174 G/C) genotyping. Results: The rate of GG genotype in mothers of term and preterm infants were 54% (n = 54/100), 75% (n = 48/64), respectively (p>.05) and the rate of GC+CC genotype was 46% (n = 46/100) and 25% (n = 16/64) in mothers giving term and preterm birth (PTB), respectively (p<.05). Additionally, the rate of GG genotype was 65% (n = 65/100) and 81.9% (n = 68/83) in term infants and preterm infants, respectively. GC+CC genotype was 35% (n = 35/100) in term infants and 18.1% (n = 15/83) in preterm infants (p<.05). The effect of IL-6 (-174) GC+CC genotype on PTB was statistically significant. Conclusion: The IL-6 174 G/C gene polymorphism was significantly different between mothers who were giving to term and preterm birth. The presence of polymorphism is protective against preterm birth and was not associated with neonatal outcome.
Evaluation of Moro reflex with an objective method in late preterm and term infants
(2019) Ince, Deniz Anuk; Ecevit, Ayse; Yildiz, Metin; Tugcu, Ali Ulas; Ceran, Burak; Tekindal, Mustafa Agah; Turan, Ozden; Tarcan, Aylin; 0000-0002-4369-2110; 0000-0002-2554-6953; 30660088; I-6746-2016
Evaluation of peripheral perfusion in term newborns before and after Yintang (EX-HN 3) massage
(2015) Tugcu, Ali Ulas; Cabioglu, Tugrul; Abbasoglu, Aslihan; Ecevit, Ayse; Ince, Deniz Anuk; Tarcan, Aylin; 26742308
OBJECTIVE: To identify how acupressure on the acupoint Yintang (EX-HN 3) impacts oxygen saturation, pulse rate, and peripheral perfusion in term-born infants without underlying disease. METHODS: Infants born between weeks 37 and 42 of gestation were included in this study. The polyclinic's neonatology room was noise-controlled and made half-dark to prevent the perfusion index from being confounded. A pulse oximeter was linked to the baby's left lower extremity. Acupressure was applied on Yintang (EX-HN 3) for 30 s clockwise, held for 30 s, and then acupressure was applied for another 30 s counterclockwise. The baby's SaO(2), pulse rate, and perfusion index were recorded for each minute before and after acupressure. RESULTS: When pre- and post-acupressure pulse rate values were compared, a significant decrease in pulse rate values after acupressure application was observed. When pre- and post-acupressure oxygen saturation values were compared, a significant increase in post-acupressure oxygen saturation was observed. In addition, peripheral perfusion increased significantly after acupressure. CONCLUSION: Acupressure application has been used in traditional medicine for many years. However, it is not yet widely used in modern medicine. This study shows the impact of acupressure on neonatal skin perfusion, oxygen saturation, and pulse rate. (C) 2015 JTCM. All rights reserved.
Experience with Continuous Venovenous Hemodiafiltration in Four Newborns: A Case Series and Review of the Literature
(2015) Tugcu, Ali Ulas; Kantar, Asli; Abbasoglu, Aslihan; Ecevit, Ayse; Tarcan, Aylin; Baskin, Esra; 0000-0002-2232-8117; 0000-0003-4361-8508; 25330394; ABI-2113-2020; AAJ-4616-2021; B-5785-2018
When conventional methods for treating complicated problems such as acute and chronic renal failure or metabolic diseases fail, the therapy of choice is peritoneal dialysis (PD) in neonatal period. However, in cases that involve technical difficulties, such as bulky lesions in the abdomen or complications from previous abdominal surgeries, it is not always possible to place a peritoneal catheter. In such situations, continuous venovenous hemodiafiltration (CVVHDF) can be effective. This case series presents our experience in 2013 with the administration of CVVHDF to four patients in our neonatal intensive care unit who could not undergo PD for various reasons.
Goniometer Measurements of Oral Labial Angle and Evaluation of Oral Motor Reflexes in Preterm Infants: Comparison to Findings in Term Infants
(2015) Ince, Deniz Anuk; Tugcu, Ali Ulas; Ecevit, Ayse; Ciyiltepe, Muzeyyen; Kurt, Abdullah; Abbasoglu, Aslihan; Tekindal, Mustafa Agah; Tarcan, Aylin; 0000-0002-4430-444X; 0000-0002-2232-8117; 0000-0002-4369-2110; 0000-0003-4161-8117; 0000-0002-4060-7048; 25792430; HIU-0129-2022; AAJ-4616-2021; I-6746-2016; Q-1547-2019; U-9270-2018; ABI-2113-2020
To date, no study has evaluated changes in oral labial angle as preterm infants mature. The main purpose of this study was to document goniometer measurements of the labial angle of the mouth in preterm infants, to assess changes with development, to compare to findings in healthy term infants, and also evaluate oral motor reflexes in these groups. Seventy-eight preterm infants and 45 healthy term infants were recruited for the prospective study. Labial angle was assessed via goniometer, and oral motor reflexes and the volume of milk ingested were evaluated. There was significant difference between term and preterm infants' labial angles (P < .01). The distribution of preterm infants' angles were similar to term infants' by 36 to 40 weeks' postmenstrual age. Goniometer measurements of the oral labial angle may reveal oral motor performance in preterm infants and may be relevant for feeding skills assessment in this group of infants.
Inferior Vena Cava Oxygen Saturation during the First Three Postnatal Days in Preterm Newborns with and without Patent Ductus Arteriosus
(2014) Yapakci, Ece; Ecevit, Ayse; Ince, Deniz Anuk; Gokdemir, Mahmut; Tekindal, M. Agah; Gulcan, Hande; Tarcan, Aylin; 25337418
Background: Inferior vena cava (IVC) oxygen saturation as an indicator of mixed venous oxygenation may be valuable for understanding postnatal adaptations in newborn infants. It is unknown how this parameter progresses in critically ill premature infants. Aims: To investigate IVC oxygen saturation during the first three days of life in preterm infants with and without patent ductus arteriosus (PDA). Study Design: Case-control study. Methods: Twenty-seven preterm infants were admitted to the Neonatal Intensive Care. Preterm infants with umbilical venous catheterization were included in the study. Six umbilical venous blood gas values were obtained from each infant during the first 72 hours of life. Preterm infants in the study were divided into two groups. Haemodynamically significant PDA was diagnosed by echocardiography in 11 (41%) infants before the 72nd hour of life in the study group and ibuprofen treatment was started, whereas 16 (59%) infants who didn't have haemodynamically significant PDA were included in the control group. Results: In the entire group, the highest value of mean IVC oxygen saturation was 79.9% at the first measurement and the lowest was 64.8% at the 72nd hour. Inferior vena cava oxygen saturations were significantly different between the study and control groups. Posthoc analysis revealed that the first and 36th hour measurements made the difference (p=0.01). Conclusion: Inferior vena cava oxygen saturation was found to be significantly different between preterm infants with and without PDA. Further studies are needed to understand the effect of foetal shunts on venous oxygenation during postnatal adaptation in newborn infants.
The Influence of Igm-Enriched Immunoglobulin Therapy on Neonatal Mortality and Hematological Variables in Newborn Infants with Blood Culture-Proven Sepsis
(2014) Abbasoglu, Aslihan; Ecevit, Ayse; Tugcu, Ali Ulas; Yapakci, Ece; Tekindal, Mustafa Agah; Tarcan, Aylin; Ecevit, Zafer; https://orcid.org/0000-0002-4060-7048; 25341598; ABI-2113-2020; U-9270-2018
The aim of this study was to determine the effects of adjuvant immunoglobulin M (IgM)-enriched intravenous immunoglobulin (IVIG) therapy on mortality rate, hematological variables and length of hospital stay in newborn infants with blood culture-proven sepsis. Demographic and clinical features and outcome measures of 63 newborn infants with blood culture-proven sepsis were documented retrospectively from the medical records. The patients were divided into two groups according to their treatment history. The patients in Group 1 received antibiotic therapy only and the patients in Group 2 received both antibiotic and adjuvant IgM-enriched IVIG. The study revealed that mortality rates were 28.1% and 12.9% in Group 1 and Group 2, respectively. The mortality rate was lower in Group 2, but the difference between the two groups was not statistically significant (p=0.21). Coagulase-negative Staphylococcus was the most common type of bacteria isolated from the blood culture in both groups. When changing laboratory results were compared between the two groups, hemoglobin, leukocyte count and C-reactive protein levels were different during the first three days of antibiotic treatment. Our study revealed that if diagnosed at an early stage and treated aggressively with appropriate and effective antibiotics, adjuvant IgM-enriched IVIG treatment has no additional benefits in neonatal sepsis.
Is it Accurate to Separate Glucose-6-Phosphate Dehydrogenase Activity in Neonatal Hyperbilirubinemia as Deficient and Normal?
(2014) Kilicdag, Hasan; Gokmen, Zeynel; Ozkiraz, Servet; Gulcan, Hande; Tarcan, Aylin
Background: The aim of this study was to investigate glucose 6-phosphate dehydrogenase (G6PD) activity in term and late preterm babies with severe neonatal hyperbilirubinemia and its relationship to the severity and treatment of this disorder, regardless of level of G6PD activity (deficient/normal). Methods: A total of 529 term and late preterm (>= 35 weeks) infants (228 female, 301 male) who were diagnosed with severe hyperbilirubinemia were included in this study. In each case, serum was collected to evaluate blood group, direct Coombs' test, complete blood cell count, total and direct bilirubin, thyroid-stimulating hormone, and G6PD activity. A partial correlation analysis was carried out to assess the relationship between G6PD activity and total bilirubin levels. Results: A significant correlation was found between the severity of hyperbilirubinemia and G6PD activity in both males and females. Male neonates who had G6PD levels <12 U/g Hb required more phototherapy time than neonates who had G6PD levels >12 U/g Hb; and female neonates who had G6PD levels <16 U/g Hb required more phototherapy time than neonates who had G6PD levels >= 16 U/g Hb (p < 0.0001). When we analyzed only breastfed infants, a significant difference also emerged in both sexes. Decreased G6PD activity was associated with increased phototherapy time and the need for exchange transfusion. Conclusion: Routine checks of G6PD level in hyperbilirubinemic neonates are very important in providing proper medical management to prevent bilirubin-induced neurological dysfunction.
Laser Acupuncture Before Heel Lancing for Pain Management in Healthy Term Newborns: A Randomised Controlled Trial
(2015) Abbasoglu, Aslihan; Cabioglu, Mehmet Tugrul; Tugcu, Ali Ulas; Yapakci, Ece; Tekindal, Mustafa Agah; Tarcan, Aylin; 0000-0002-4060-7048; 26438556; AIC-4823-2022; ABI-2113-2020; U-9270-2018
Background Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Non-pharmacological strategies have currently become more important than pharmacological analgesic agents in neonatal pain management. Acupuncture is a new non-pharmacological method for preventing pain in newborns. Objective We aimed to investigate the effect of laser acupuncture (LA) at the Yintang point before heel lancing as a non-pharmacological intervention for procedural pain management in infants. MethodsForty-two term newborns, who were undergoing heel lancing between postnatal days 3 to 8 as part of routine neonatal screening, were randomly assigned to the LA group or the oral sucrose group. In the LA group, 2 min before the heel lancing, 0.3 J of energy was applied to the Yintang point using a Laser PREMIO-30 unit for 30 s. In the sucrose group, each infant received 0.5 mL of 24% sucrose orally via syringe 2 min before the heel lancing. Each baby's behaviour was scored using the Neonatal Infant Pain Scale (NIPS), assessed blinded to group. Results There were no significant differences between the LA and oral sucrose groups with respect to means for gestational week of age at birth, birth weight, actual weight, or Apgar score. Mean procedure time was significantly shorter in the LA group; however, mean crying time was longer and NIPS score was lower compared to the oral sucrose group. Conclusions Our results indicate that 0.3 J of LA at the Yintang point before heel lancing is less effective than oral sucrose for reducing the discomfort of this procedure.
Neonatal Thyrotoxicosis with Severe Supraventricular Tachycardia: Case Report and Review of the Literature
(2015) Abbasoglu, Aslihan; Ecevit, Ayse; Tugcu, Ali Ulas; Erdogan, Ilkay; Kinik, Sibel Tulgar; Tarcan, Aylin; 0000-0002-2232-8117; 0000-0001-6887-3033; 25153577; AAJ-2305-2021; AAJ-4616-2021; ABB-2220-2021; ABI-2113-2020
Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves' disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves' disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves' disease associated pregnancies and management of newborns after birth.
Noninvasive Evaluation of Swallowing Sound is an Effective Way of Diagnosing Feeding Maturation in Newborn Infants
(2014) Ince, Deniz Anuk; Ecevit, Ayse; Acar, Banu Oskay; Saracoglu, Ahmet; Kurt, Abdullah; Tekindal, Mustafa Agah; Tarcan, Aylin; https://orcid.org/0000-0002-4369-2110; https://orcid.org/0000-0002-2232-8117; https://orcid.org/0000-0002-4430-444X; https://orcid.org/0000-0002-4060-7048; 24814215; I-6746-2016; AAJ-4616-2021; HIU-0129-2022; U-9270-2018
Aim: Despite extensive research, there is still controversy regarding the time at which sucking and swallowing functions mature in preterm infants. This study aimed to evaluate maturation using the noninvasive method of swallowing sound. Methods: We compared 52 preterm infants of between 27 and 36 weeks' gestational age with a control group of 42 healthy full-term infants. Feeding performance was based on swallowing data collected during two-minute audio recordings. The following variables were generated for each evaluation: total number of swallows, total number of rhythmic swallows, total number of resting intervals, average time between resting intervals, average time between swallows, average time between rhythmic swallows, maximum number of rhythmic swallows and volume of milk ingested. The dependency of the variables on postmenstrual age was also investigated. Results: The volume of milk ingested by the preterm infants and the maximum number of rhythmic swallows were positively correlated with postmenstrual age (PMA). The preterm infants reached the 10th percentile of the control infants at 34-35 weeks' PMA and were not significantly different from the control infants at 38-40 weeks' PMA. Conclusion: Swallowing sound can be used to assess feeding maturation in preterm infants during neonatal intensive care unit follow-up.
Prematüre bebeklerde umbilikal kord klepleme zamanının periferik kan değerleri ve periferik kan hematopoetik kök hücre düzeylerine etkisi
(Başkent Üniversitesi Tıp Fakültesi, 2010) Gökmen, Zeynel; Tarcan, Aylin
Doğumda göbek bağının bağlanması ve kesilmesi yenidoğan bebeklerdeki en eski ve en yaygın kullanılan tibbi müdahaledir. Buna rağmen, göbek bağının en uygun bağlanma zamanı uzun yıllardan beri tartısmalıdır ve bu konuda tam bir fikir birliği yoktur. Erken bağlandığında bebeğe hemen resusitasyon yapılması mümkün olurken geç bağlama durumunda plasentadan bebeğe daha fazla kan transfüzyonu söz konusu olmaktadır. Yenidoğan yoğun bakım ünitelerinde enfeksiyonlar morbidite ve mortalite nedenleri arasında önemli bir yer tutarlar. Enfeksiyonlar hem iyatrojenik sebepler hem de yenidoğanın hematopoetik hücre havuzunun eksikliğinden ve immün sisteminin yeterince olgunlasmamasından kaynaklanabilir. Hematopoetik kök hücreler gebeliğin 2. trimesterinde karaciğerden kemik iliğine dolasım vasıtasıyla tasındığı için 32. gebelik haftasından önce göbek kordonunda yüksek miktarda hematopoetik kök hücre bulunur. Prematüre doğan bebeklerde kord bağlanmasının biraz geciktirilerek plasental transfüzyona izin verilmesi, kemik iliği kök hücre havuzunun gelismesini sağlayarak neonatal immünitenin ilerlemesine katkıda bulunabilir. Bu çalısmada 32 gebelik haftasından erken doğan bebeklerde kord klempleme zamanının neonatal periferik kandaki hematopoetik kök hücrelerine düzeyine etkisi arastırıldı. Çalısma grubu 24 ile 32 gebelik haftaları arasında doğan toplam 42 prematüre bebekten (25 kız, 17 erkek) olustu. Çalısmamızda, göbek bağı doğumdan sonra ilk 10 saniyede klemplenenler erken kord klempleme (EKK) grubunu, 30-45 saniye geciktirildikten sonra klemplenenler ise geç kord klempleme (GKK) grubunu olusturdu. Doğumdan sonra ilk 30 dakika içerisinde rutin kanları alınırken ek olarak EDTA içeren tüplere 2ml kan alındı ve kan örneklerinden akım sitometri cihazında özgün antikorlar kullanılarak kök hücre sayımı yapıldı. Çalısmaya alınan hastaların maternal ve neonatal demografik özellikleri birbirine benzerdi. Çalısma grubumuzda neonatal periferik kandaki tüm kök hücre sayıları beklentimizin dısında EKK grubunda daha yüksekti. Common myeloid progenitor (CMP) değerleri EKK grubunda 93,8 ± 144,6/ml iken, GKK grubunda ise 14,9 ± 31,1/ml idi ve aradaki fark istatistiksel olarak anlamlı idi ( p = 0.00 ). Granülosit-makrofaj progenitor (GMP) değerleri EKK grubunda 1778,6 ± 2532,6/ml iken, GKK grubunda ise 1047,7 ± 811,3/ml idi ve aradaki fark yine istatistiksel olarak anlamlı idi ( p = 0.05 ). Megakaryosit-eritroid progenitor (MEP) değerleri de EKK grubunda daha yüksek olmakla birlikte sonuçlar istatistiksel olarak anlamlı değildi. Sonuç olarak çalısmamızda her iki grubun gestasyonel özellikleri, doğum ağırlıkları ve kan alınma zamanları benzer olması nedeniyle, GKK grubunda hematopoetik hücre sayısını yüksek beklerken düsük bulmamızın plasental faktörlerin (stromal cell derived faktör-1 = SDF-1 ve stem cell faktör = SCF gibi) hematopoetik kök hücrelerin kinetik özelliklerini değistirmesinden kaynaklandığı düsündük. Clamping and cutting of the umbilical cord at birth is the most prevalent and oldest intervention in humans. In spite of that, the optimal timing of cord clamping is controversial in both preterm and term neonates. Immediate cord clamping provides rapid resussitation, but delayed cord clamping provides more blood tranfusion from placenta to baby. Infections are the most important reasons of neonatal morbidity and mortality in NICU. Poor hematopoietic cell pool and immaturity of immune system of neonates may be the reasons of neonatal infections. Transport of hematopoietic stem cells at 2nd trimester of pregnancy from liver to bone marrow is ensured by circulation, therefore umbilical cord involves too much hematopoietic cells before the gestation weeks 32. Delayed cord clamping in preterm neonates may support the neonatal immunity by improving the bone marrow stem cell pool due to the more placentofetal transfusion. We investigated the effects of delayed umbilical cord clamping on peripheral hematological parameters and peripheral blood hematopoietic stem cells in premature neonates. The study comprised of 42 preterm infants (male:17, female:25) was born between 24 and 32 weeks of gestation. Patients were divided into two groups as immediately cord clamping (ICC) and delayed cord clamping (DCC) groups. For the ICC group, the obstetrician clamped the umbilical cord immediately (<10 seconds) after birth. For the DCC group, the obstetrician clamped the cord at 30 to 45 seconds after birth. After management of the newborn in NICU, 2 ml blood sample was taken with an ethylene diamine tetra acetic acid (EDTA) containing tube while taking routine blood samples 30 minutes of life. Hematopoietic progenitor cells measured by three-colour flow cytometry using monoclonal antibodies. There were no any significant differences in either maternal and neonatal demographics between the ICC and DCC groups. In opposition to our expectance all haematopoietic stem cell counts were higher in ICC group. Common-myeloid progenitor cell (CMP) counts were 93,8 ± 144,6/ml in ICC, and 14,9 ± 31,1/ml in DCC group (p=0.00). Granulocyte-macrophage progenitor cell (GMP) counts were 1778,6 ± 2532,6/ml in ICC, and 1047,7 ± 811,3/ml in DCC group (p=0.05). Megakaryocyte-erytroid progenitor cell (MEP) counts were higher in ICC group without any significant difference. In conclusion, in opposition to our expectance, all hematopoetic stem cell counts were lower in DCC group. We suggested that some placental factors such as stromal cell derived factor- 1 and stem cell factor may change the hematopoietic stem cell kinetics.
Prematüre yenidoğanlarda yaşamın ilk üç gününde inferior vena kava oksijen satürasyonunun patent duktus arteriozusun tanısında kullanımının araştırılması
(Başkent Üniversitesi Tıp Fakültesi, 2010) Yapakçı, Ece; Tarcan, Aylin
Bu çalısmada, prematüre yenidoğanlarda yasamın ilk üç gününde inferior vena kava oksijen satürasyonu ve bununla iliskili parametreler, arteriyel oksijen satürasyonu ile inferior vena kava oksijen satürasyonu arasındaki fark (DSO2), bölgesel oksijen tutulumu (FOE) ve sant indeksi (SI)’nin, patent duktus arteriozusun tanısında kullanımı arastırılmıstır. Bu amaçla, Baskent Üniversitesi Yenidoğan Yoğun Bakım Ünitesinde izlenen ve tıbbi nedenlerle umbilikal arter ve ven kateterizasyonu uygulanan toplam 27 bebek çalısmaya alınmıstır. Doğum sonrası ilk 72 saatlik sürede her bebekten toplam altı kez es zamanlı arteriyel ve umbilikal venöz kan gazı ölçümleri yapılarak, her ölçüm için DSO2, alt vücut FOE ve SI hesaplanmıstır. Yetmis iki saatten önce klinik olarak patent duktus arteriozus (PDA) süphesi olan hastalarda, 72 saatten önce ekokardiyografi ile duktus varlığı gösterildiyse tedavi baslanmıs, klinik olarak PDA süphesi olmayanlara 72. saatten sonra ekokardiyografik inceleme yapılmıstır. Ekokardiyografide hemodinamik olarak anlamlı duktusu saptanan 11 (%41) hastaya ilk 72 saatte ibuprofen tedavisi baslanmıs, 16 (%59) bebek ibuprofen tedavisi almamıstır. Tüm hasta grubunda inferior vena kava oksijen satürasyonu ortalaması en yüksek olarak ilk ölçümde %79,9, en düsük ise 72. saatte %64,8 olarak saptanmıstır. PDA nedeniyle tedavi alan ve almayan gruplarda inferior vena kava oksijen satürasyonu ortalamaları farklı bulunmamıstır (sırasıyla %83,7±10,7; %77,1±14,9; p>0,05). Tedavi gerektiren PDA’u olan grupta tedavi almayan gruba göre yasamın ilk saatlerinde ölçülen DSO2 (sırasıyla 1,9±13,4; 12,6±9,3; P=0,034) ve alt vücut FOE (sırasıyla 0,01±0,16; 0,14±0,10; P=0,030) düsük, SI (sırasıyla %126,84±94,95; %39,51±32,83; P=0,006) yüksektir. Bu çalısma ile prematüre bebeklerde ilk saatlerde hesaplanan SI’nin hemodinamik anlamlı PDA’u öngörmede kullanılabilecek bir parametre olduğu gösterilmistir. In this study, inferior vena cava oxygen saturation and associated parameters, difference between arterial and inferior vena cava oxygen saturation (DSO2), fractional oxygen extraction (FOE) and shunt index (SI), were investigated in the diagnosis of patent ductus arteriosus (PDA) in premature newborns during the postnatal three days. For this purpose, 27 infants who were admitted to the Baskent University Hospital Neonatal Intensive Care Unit and required umbilical venous and arterial catheters for clinical reasons were included in the study. Totally six synchronous umbilical arterial and venous blood gas measurements were performed from each infant during their first 72 hours period after birth and DSO2, lower body FOE and SI were calculated for each measurement. If PDA was confirmed by echocardiography before the 72nd hour for the patients who were clinically suspicious of PDA before the postnatal 72nd hour, medical treatment was started, whereas echocardiography was performed after the 72nd hour for infants who were not clinically suspicious of PDA. While ibuprofen was started at the first 72 hours on 11 (41%) patients who were determined as hemodynamically significant for PDA, ibuprofen was not given to 16 (59%) infants who didn’t have PDA. In whole patient group, the highest value of the mean of inferior vena cava oxygen saturation was found as 79.9% at the first measurement and the lowest value of it was detected as 64.8% at the measurement done at 72nd hour. The groups that were treated and nontreated for PDA were not significantly differentiated from each other in terms of their mean inferior vena cava oxygen saturation values, having the values 83.7±10.7% and 77.1±14.9%, respectively at P>0.05. DSO2 and lower body FOE were significantly lower and SI was significantly higher in treated PDA group than in non-treated group (DSO2: 1.9±13.4; 12.6±9.3; P=0.034; lower body FOE: 0.01±0.16; 0.14±0.10; P=0.030; SI: 126.84±94.95%; 39.51±32.83%; P=0.006; respectively). In this study, it was shown that SI calculated at the first hours of premature newborns could be used as a parameter for the prediction of hemodynamically significant PDA.
Prenatal Evaluation and Postnatal Early Outcomes of Fetal Ventriculomegaly
(2014) Tugcu, Ali Ulas; Gulumser, Cagri; Ecevit, Ayse; Abbasoglu, Aslihan; Uysal, Nihal Sahin; Kupana, Ebru Sebnem; Yanik, Fatma Filiz; Tarcan, Aylin; https://orcid.org/0000-0002-2232-8117; https://orcid.org/0000-0001-5385-5502; 25135472; AAJ-4616-2021; AAA-9475-2020
Objective: This study aims to determine the incidence, etiology, diagnostic criteria and early outcomes of prenatally diagnosed fetal ventriculomegaly (VM). Methods: Diagnostic criteria for the fetal VM was atrial diameter of lateral ventricle measuring >= 10 mm, independent from gestational age. Results of our patients from ultrasonography (USG), karyotyping, congenital infections, and associated abnormalities were noted. Progress during pregnancy, postnatal USG results and neurobehavioral outcomes were recorded. Results: In our study, 40 subjects of fetal VM were recorded. 16 and 24 of those were bilateral (40%) and unilateral (60%) respectively. Female to male fetus ratio was 19/21 (0.9). Median gestational age at the diagnosis was 22 weeks (ranging between 16 and 34 weeks). While 21 VM subjects were isolated (52.5%) only 19 of the total were shown associated structural abnormalities in (47.5%) in addition to VM. Toxoplasmosis were diagnosed only in One subject (2.5%). Nineteen subjects had amniocentesis (47.5%) and 2 of them were showed abnormalities (10.5%) as follows; "inversion and duplication 8 (p11.2p23)" and "deletion 3". VM got back in to normal size during pregnancy in 24 subjects (24/40, 60%). Eight pregnancies were terminated (8/40) (20%). Five babies passed away during neonatal and postneonatal period. Some other structural abnormalities were diagnosed after the birth at six babies who classified as mild "isolated" VM. Conclusions: Our study revealed that amongst mild VM subjects, incidence of associated abnormalities and termination rate were higher. Although most of mild VM subjects are thought to be benign, associated abnormalities should be carefully evaluated and determined pre- and postnatally. (C) 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Preterm bebeklerde ilk hafta mikroalbuminürinin erken neonatal sepsis ve respiratuar distres sendromu ile ilişkisi
(Başkent Üniversitesi Tıp Fakültesi, 2012) Özdemir, Beril; Tarcan, Aylin
Erken neonatal sepsis ve respiratuvar distres sendrom, preterm bebeklerde erken dönemde görülen ve mortalite oranı yüksek hastalıklardır. Ciddi hastalık durumlarında serum albumin düzeylerinin düstügü ve hipoalbumineminin hastalık ciddiyeti ve kötü prognoz ile iliskili oldugu birçok çalısmada gösterilmistir. Bu konuda çocuklarda daha sınırlı sayıda çalısma olmasına ragmen özellikle yogun bakım hastalarında hipoalbumineminin morbidite ve mortaliteyi artırdıgı bildirilmistir. Yenidoganlarda serum albumin düzeyi ile mikroalbuminüri arasındaki iliskiyi ise gösteren çalısma yoktur. Preterm bebeklerde mikroalbuminürinin hastalık durumlarında degisimi ve mortaliteye etkisi ise bilinmemektedir. Preterm bebeklerde mortalitenin önemli nedenlerinden olan erken neonatal sepsis ve respiratuvar distres sendromunun erken dönemde tanınması ve tedavisi önem tasımaktadır. Bu çalısmada yenidogan yogun bakım ünitesinde yatırılarak izlenen, gebelik haftası 34 hafta ve altında olan preterm bebeklerde serum albumin, kreatinin ve C-reaktif degerleri ile, spot idrar mikroalbumin kreatinin oranının, protein ve kreatinin düzeylerinin 1. 3. ve 7. günlerdeki degisimi, bu parametrelerin her birinin erken neonatal sepsis ve respiratuvar distres sendromuna etkisi arastırıldı. Çalısmaya toplam 126 preterm bebek alındı. Serum kreatinin, albumin, CRP degerlerinin ve idrar mikroalbumin kreatinin oranının, protein, kreatinin düzeylerinin ortalama degerleri olusturuldu. lk haftada bakılan serum albumin düzeyi ile spot idrar mikroalbumin kreatinin oranı arasında anlamlı iliski gösterilemedi. drar mikroalbuminüri ile gebelik haftası ve dogum agırlıgı arasında korelasyon ve respiratuvar distres sendrom ile mikroalbuminüri arasında etkilesim gösterilemedi. drar mikroalbumin kreatinin oranının ve serum C-reaktif düzeyinin 1., 3. ve 7. günlerdeki degisimi ile erken neonatal sepsis arasında ise anlamlı etkilesim bulundu.
Preterm bebeklerde postnatal 1. günde el ve el başparmak postür analizi
(Başkent Üniversitesi Tıp Fakültesi, 2014) Ben, Esra; Tarcan, Aylin
Büyümenin hızlı olduğu geç intrauterin ve erken postnatal periyod, preterm bebeklerde nörogelişim açısından önemlidir. Bebeklerde postür özellikleri, kas iskelet sistemi ve nörolojik sistemin gelişimi ve koordinasyonu ile ilişkilidir; bu nedenle nörogelişimi gösteren bulgulardan biridir. Preterm bebeklerde el ve el başparmak postürü, normal dağılımı, gelişimi ve değişimi ile ilgili yeterli çalışma bulunmamaktadır. Bu çalışmada preterm bebeklerde postnatal 1. günde el duruşlarının değerlendirilmesi, gebelik haftalarına göre el ve başparmak duruş özelliklerinin tanımlanması amaçlanmıştır. Çalışmamızda, 37 hafta altında doğan 190 preterm bebeğin postnatal ilk 24 saat içinde anne sütü veya formula ile herhangi bir beslenmeden 30-60 dakika sonra uykuda ve moro refleksi ile uyarıldıktan sonra uyanık halde el ve başparmak fotoğrafları çekildi. Fotoğraflar birbirinden bağımsız iki kişi tarafından değerlendirildi. El ve başparmak duruşları sınıflandırıldı. Her iki elde de açık el pozisyonu olan bebeklerin gebelik haftası daha küçük, kısmi ve tam yumruklama duruşu olan bebeklerin gebelik haftaları daha büyük bulundu. Başparmak el parmakları yanında duruşu olan bebeklerde, gebelik haftası küçük olup bu fark sağda anlamlı bulundu. Gebelik haftalarına göre gruplandırdığımızda gebelik haftası 29 hafta altında olan bebeklerde her iki eldeki simetrik duruşun daha fazla olduğu görüldü. Bu sonuçlar bize değişik gestasyonel haftalarda doğan bebeklerin farklı nörogelişim evrelerine göre farklı el postür özelliklerine sahip olduğunu gösterdi. El ve başparmak duruşunun gözlemlenmesi ve fizik incelemenin önemli bir bulgusu olarak kaydedilmesinin gerekli olduğunu düşünmekteyiz.