Browsing by Author "Tekin, Mehmet"

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Is Less Invasive Surfactant Administration a Beneficial Method for Late Preterm Infants?
(2021) Tekin, Mehmet; Silahlı, Musa; Gokmen, Zeynel; 0000-0003-0944-7178; 0000-0002-8865-7044; 34816698; AAB-5059-2022
Background: Late preterm infants (LPIs) have increased steadily in all newborns delivery and they are the largest patient group requiring admission to the neonatal intensive care unit. Surfactant treatment is frequently used in LPIs in case of respiratory distress, but the procedure and the timing of surfactant administration are not well-known. Objective: We aimed to evaluate the effect of surfactant administration techniques on pulmonary outcomes in LPIs with respiratory distress. Methods: In this retrospective study, we compared the effects of the less invasive surfactant administration (LISA) technique and conventional treatment on respiratory and other morbidities in LPIs who have respiratory difficulties. We named these two groups as the LISA group and the conventional group (CG). Comparison of the mechanical ventilation (MV) rates between the groups was the primary outcome of our study. Results: There were 25 LPIs in each group. The duration of nasal continuous positive airway pressure (CPAP) and oxygenation were similar in both groups. The rate of MV and the duration of MV (P= 0.004 and P = 0.02) were lower in the LISA group. Also, the need for more than 1 dose of surfactant was higher in the MV requiring group, although it was not statistically significant between the groups (P= 0.21). Conclusion: Using the LISA technique for surfactant instillation reduces any MV requirement. LISA is a very useful and reliable technique in experienced hands in LPIs as in very preterm infants.
Term infantlarda plasental tranfüzyonun hemodinamik etkileri
(Başkent Üniversitesi Tıp Fakültesi, 2017) Tekin, Mehmet; Gökmen, Zeynel
Doğum sonrası göbek bağının bağlanmasında en uygun zamanlama ile ilgili öneriler ilk çağlardan itibaren farklılıklar göstermiştir. Erken kord klempleme (EKK) işlemi modern tıpta doğumun üçüncü evresinin yönetiminde bir rutin haline gelmiştir ancak bu durumun fizyolojik bir temelinin olmadığı düşünülmektedir. EKK hızlı resüsitasyona olanak sağlarken plasental transfüzyon yöntemleri de özellikle prematüre bebeklerde morbidite ve mortaliteyi azaltabilecek olumlu hemodinamik katkılar sağlamaktadır. Yenidoğanlarda kardiyak output ve damar akımlarının değerlendirilmesinde Doppler ultrason güvenilir bir yöntemdir. Ancak özellikle doğum sonrası erken adaptasyon döneminde fetal yolaklar açık olduğundan geleneksel yöntemlerle hemodinamik değerlendirme yapabilmek mümkün gözükmemektedir. Üst gövde venöz sisteminin drenajını (%80’i beyin kaynaklı) sağlayan superior vena cava (SVC) akımının ölçümü serebral perfüzyonun iyi bir göstergesi olarak kabul edilmektedir. Fetal şantlardan etkilenmemesi doğum sonrası erken adaptasyon döneminde kullanımını değerli kılmaktadır. Bu çalışmada plasental transfüzyon yöntemlerinden olan umbilikal kord sıvazlamanın (UKS) term bebeklerin hemodinamisi üzerine olan etkilerini değerlendirdik. Çalışma grubumuz 150 term bebekten (74 erkek, 76 kız) oluştu. UKS işlemi göbek bağı klemplenmeden 20 cm’lik kısmın yaklaşık 10 cm/sn hızla en az 3 kez (3-5 kez) anneden bebeğe doğru sıvazlanması şeklinde uygulanırken, UKS uygulanmayacak grupta (EKK) klempleme işlemi doğumdan sonra ilk 10 saniye içerisinde yapıldı. SVC akımı ölçümleri ile ilgili görüntüler doğum sonrası ilk 6 saat içerisinde randomizasyondan bilgisi olmayan deneyimli bir çocuk kardiyoloğu tarafından kayıt altına alındı ve daha sonra yapılan ölçümler de bu görüntüler üzerinden aynı araştırmacı tarafından yapıldı. Çalışmaya alınan hastaların maternal ve neonatal demografik özellikleri benzerdi. SVC akımı UKS grubunda 132,47±37,04 ml/kg/dk iken, EKK grubunda 126,62±34,35 ml/kg/dk idi. Beklentimiz doğrultusunda çalışma grubunda SVC akımı istatiksel olarak anlamlı düzeyde olmasa da daha yüksek çıktı. Çalışmamıza katılan obstetrisyenlerin UKS konusundaki deneyimlerinin benzer düzeyde olmamasının istatiksel anlamlılık açısından olumsuz etkide bulunmuş olabileceğini düşünüyoruz ve daha geniş populasyonlu çalışmaların istatiksel anlamlılık ortaya koyabileceğini öngörmekteyiz. Bununla birlikteprematüre bebeklerin aksine term bebeklerde plasental transfüzyon ile elde edilen kan hacmi artışı kompanze edilmiş olabilir ve serebral kan akımı otoregülasyonu ile birlikte SVC akımında anlamlı bir artış oluşması engellenmiş olabilir. Sonuç olarak bu çalışmamızla sağlıklı term bebeklerde ilk altı saat içerisindeki SVC akım normatif değerlerini ortaya koymuş ve plasental transfüzyon yöntemlerinin bu bebeklerin SVC akımında anlamlı düzeyde olmasa da yükselme sağladığını göstermiş olduk. Recommendations regarding the optimal timing of postnatal umbilical cord attachment have been different from the earliest ages. Immediately cord clamping (ICC) has become a routine in the management of the third phase of birth at modern medicine, but this is thought to be without a physiological basis. While ICC allows rapid resuscitation, placental transfusion methods provide positive hemodynamic contributions, especially in premature infants, which may reduce morbidity and mortality. Doppler ultrasound is a reliable method for evaluating cardiac output and vascular flow in newborns. However, it is not possible to perform haemodynamic evaluation by conventional methods because of open fetal pathways, especially during the early postnatal adaptation. Measurement of superior vena cava flow, which provides drainage of the upper body venous system (80% from the brain) is considered a good indicator of cerebral perfusion. It is not affected by fetal shunts and this characteristic makes it valuable to use during early postnatal adaptation period. In this study, we evaluated the effects of umbilical cord milking (UCM), which is a placental transfusion method, on hemodynamics of term babies. Our study group consisted of 150 term babies (74 males, 76 females). The UCM procedure was performed by milking from the mother to the baby at least 3 times (3-6 times) at a speed of about 10cm/sec at 20cm without clamping the umbilical cord, whereas the clamping in the non-UCM group (ICC) was performed within the first 10 seconds after birth. Images of SVC flow measurements were recorded by an experienced child cardiologist without randomization within the first 6 hours postpartum and then measurements were made by the same investigator over these images. Maternal and neonatal demographic characteristics of the patients in the study were similar. The SVC flow was 132,47 ± 37,04 ml/kg/min in the UCM group and 126,62 ± 34,35 ml/kg/min in the ICC group. Unsurprisingly SVC flow volume was higher in study group but not statistically significant. The experiences of the participating obstetricians were not at similar level about the UCM and this may have affected adversely about the statistical significance. We anticipate that studies with wider populations may change this situation.With this, contrary to premature infants, blood volume increase which obtained by placental transfusion may be compensated and a significant increase in SVC flow may be prevented together with the cerebral blood flow autoregulation. In conclusion, we have revealed normative values of SVC flow volume in the first six hours in healthy term babies and we have shown that placental transfusion methods increase these infants SVC flow volume, but not to a significant extent.
Vasoactive Inotropic Score for Predicting Pediatric Tracheostomy
(2022) Silahli, Musa; Tekin, Mehmet; Celik, Mehmet
Background: Although tracheostomy is not performed as frequently as in adults, it is also used in children. There is no clear consensus on timing and risk factors, especially in early infancy and in cases who underwent cardiac surgeries. In the early infancy period, pediatric cardiac surgery patients have to receive an inotropic agent after the cardiac surgery due to poor general condition or hemodynamic instability. As a result of prolonged intubation, tracheostomy is required to be performed in some of these patients. Objectives: The present study aimed to investigate the relationship between vasoactive inotropic scores (VIS) and tracheostomy in pediatric cardiac surgery patients. Methods: A total of 47 patients, 21 with tracheostomy and 26 without tracheostomy, who underwent cardiac surgery were included in this retrospective study. The VIS and inotrope score (IS) values were calculated and recorded hourly for 48 h postoperatively. Scores were calculated by multiplying the inotropes infusion rate of the patients with certain coefficients. It was attempted to determine objective formalized models and cut-off values that may benefit the relationship between VIS values and tracheostomy. Results: The median weight was 3,630 g (range, 2,040-13,400), and the median age was 69 days (range, 1-1,081) on the surgery day. The majority (93.6%) of the patients were aged < 1 year. Preoperative C-reactive protein measurements were significantly higher by 50% in patients who underwent tracheostomy (P=0.005). The albumin levels in the tracheostomy group (TG) were low, although not significantly (P=0.057). The VIS values of TG had 50% higher values than the non-tracheostomy group (NTG) (P<0.001). In addition, formula 1 predicted with 57% accuracy that a tracheostomy could be performed (VIS =18.170-0.170* HOUR; P < 0.001), and formula 2 predicted with 72% accuracy that a tracheostomy could not be performed (VIS =17.170-0.170* HOUR; P < 0.001). Hospital stay (P<0.001), mechanical ventilation duration (P<0.001), and the number of ongoing intubation on the 7th day post-surgery were significantly higher in TG. Conclusion: After pediatric cardiac surgery, VIS values can predict tracheostomy status and help intensive care professionals make decisions.