Fakülteler / Faculties
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Item Antibiotic Use in Pediatric and Neonatal Intensive Care Units; Multicenter Point Prevalence Study(2014) Tolunay, Orkun; Celik, Umit; Yucel, Gulperi; Celik, Tamer; Mert, Mustafa Kurthan; Resitoglu, Salim; Ozdemir, Ulas; Narli, Nejat; Hanta, Deniz; Yapicioglu, Hacer; Gulcan, Hande; Ozcan, Kenan; Yildizdas, Dincer; Tolunay, Ilknur; Gokay, Naime; Kiraz, KemalObjective: Identifying antibiotic use in pediatric and neonatal intensive care units with a point prevalence study in Adana, Turkey's sixth largest city. Material and Methods: In this point prevalence study, demographic information and antibiotic treatment data were taken on the same day from patients in pediatric and neonatal intensive care units of 6 hospitals located in Adana's city center. Results: Four pediatric intensive care units (two university, one research and training hospital, and one public hospital) and six neonatal intensive care units (two university, one research and training hospital, one public hospital, and two private hospital) were included in the study; 220 patients were at the intensive care units at the time of the study-44 (20%) of the patients were in the pediatric intensive care units, and 176 (80%) of them were at the neonatal intensive care units. Also, 146 (66.4%) of the patients were using antibiotics. The frequency of antibiotic use was 72.7% in the pediatric intensive care units and 64.8% in neonatal intensive care units. There was a pediatric infectious disease physician at the university and research and training hospital. Antibiotic usage was lower (p= 0.002) in clinics where pediatric infectious disease physician consultations could be done. Dual antibiotic combination was applied most frequently. Mostly, ampicillin was preferred at neonatal intensive care units. Clarithromycin was used as a second choice because of seasonal lower respiratory tract infections. Vancomycin was the most preferred antibiotic in pediatric intensive care units, and meropenem and linezolid were the second and third choices. At both intensive care units, use of empiric antibiotic treatment was more frequent. Empiric treatment was applied in 22 (68.7%) patients in the pediatric intensive care units and 95 (83.3%) in neonatal intensive care units. Antibiotics were given to 14.3% of the patients in line with the resulting cultures. Conclusion: Intensive care units are services where antibiotics are used most frequently both in Turkey and in the world. In our opinion, protocols need to be established in clinics, national and international guides should be followed; and pediatric infectious disease physician consultations should be increased in order to reduce the frequency of antibiotic use, inappropriate indications, and inappropriate doses.Item "Shunt Index'' Can Be Used to Predict Clinically Significant Patent Ductus Arteriosus in Premature Neonates in Early Post-Natal Life(2014) Yapakci, Ece; Ecevit, Ayse; Torer, Birgin; Ince, Deniz Anuk; Gokdemir, Mahmut; Gulcan, Hande; Tarcan, Aylin; https://orcid.org/0000-0002-2232-8117; https://orcid.org/0000-0002-4369-2110; https://orcid.org/0000-0002-5676-2747; 23816200; AIC-4823-2022; AAJ-4616-2021; I-6746-2016; N-4174-2014Background: This study aimed to examine the differences between arterial and inferior caval vein oxygen saturation, fractional oxygen extraction, and the shunt index, which were calculated in the diagnosis of patent ductus arteriosus. Methods: Twenty-seven preterm infants were included in this study and were divided into two groups according to patent ductus arteriosus. Among them, 11 (41%) infants had haemodynamically significant patent ductus arteriosus and 16 (59%) did not have significant patent ductus arteriosus. Synchronous arterial and venous blood gases were measured during the first post-natal hours after the insertion of umbilical catheters. The differences between arterial and inferior caval vein oxygen saturation, inferior body fractional oxygen extraction, and the shunt index were calculated. Echocardiography was performed before the 72nd hour of life in a selected group of patients who had haemodynamically significant patent ductus arteriosus. Ibuprofen treatment was administered to patients with patent ductus arteriosus. Echocardiography was performed on the 72nd hour of life in preterm infants without any clinical suspicion of patent ductus arteriosus. Results: The early measured differences between arterial and inferior caval vein oxygen saturation and inferior body fractional oxygen extraction were found to be lower and the shunt index was found to be higher in the haemodynamically significant patent ductus arteriosus group than in the group without haemodynamically significant patent ductus arteriosus. Conclusion: We found that the shunt index, calculated in the first hours of life as >= 63%, predicted haemodynamically significant patent ductus arteriosus with a sensitivity of 78% and specificity of 82% in preterm newborns.Item An Aggressive Parenteral Nutrition Protocol Improves Growth in Preterm Infants(2015) Torer, Birgin; Hanta, Deniz; Ozdemir, Zeliha; Cetinkaya, Bilin; Gulcan, Hande; 0000-0003-0055-8277; 0000-0003-0866-7339; 26701941; F-5143-2017; JMQ-5983-2023; AAF-1346-2021Item Is Umbilical Cord Milking Always an Advantage?(2016) Kilicdag, Hasan; Gulcan, Hande; Hanta, Deniz; Torer, Birgin; Gokmen, Zeynel; Ozdemir, Sonay Incesoy; Antmen, Bulent Ali; 25731653Objective: The role of cord milking as an alternative to delayed cord clamping is an area that requires more research. Purpose of this clinical trial was to investigate the impact of umbilical cord milking on the absolute neutrophil counts (ANCs) and the neutropenia frequency of preterm infants.Methods: Fifty-eight pregnant women were randomly assigned to one of the umbilical cord milking and control groups. A total of 54 preterm infants (gestational age 32 weeks) were enrolled into the study. The umbilical cords of 25 infants were clamped immediately after birth, and in 29 infants, umbilical cord milking was performed first.Results: The ANCs were statistically significantly lower in the cord milking group compared with the control group on days 1, 3 and 7. The frequency of neutropenia was higher in the cord milking group compared with the control group.Conclusion: In our study, ANCs were lower in the cord milking group and the frequency of neutropenia was higher. Umbilical cord milking plays a role on the ANCs of preterm infants.Item Impact of Platelet Count in Retinopathy of Prematurity(2020) Keskek, Nedime Sahinoglu; Gulcan, Hande; Yilmaz, Gursel; Akkoyun, Imren; 0000-0001-8544-103X; 33389935; T-4258-2017Objectives: The aim of the study was to investigate the risk factors for retinopathy of prematurity (ROP), including platelet count. Materials and Methods: This retrospective study analyzed 137 infants in 3 subgroups: no ROP; mild RAP, and severe ROP requiring laser treatment (type 1 ROP). A retrospective review of records was performed and statistical analysis of possible risk factors for ROP including platelet count was evaluated by using logistic regression. Results: Birth weight (BW), gestational age (GA), and low platelet count in the first week after birth were significant risk factors for developing ROP (p=0.038, 0.02, and 0.004, respectively). BW, GA, ventilation, and lower platelet count were associated with progression to type 1 ROP (p=0.004; 0.027, and 0.021, respectively). Conclusion: Lower platelet count in the first week after birth is a risk factor for ROP development in addition to the previously established factors of ventilation need, low BW, and low GA.Item Idiopathic congenital unilateral vocal cord paralysis: a rare cause of recurrent pneumonia attacks in a newborn(2019) Gulcan, Hande; Cetinkaya, Bilin; Torer, Birgin; Ozer, FulyaItem 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, AylinBackground: 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.Item 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; 25337418Background: 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.Item Epidermoid Cyst of Orbit in a Newborn(2015) Canan, Handan; Altan-Yaycioglu, Rana; Bal, Nebil; Torer, Birgin; Cetinkaya-Cakmak, Bilin; Gulcan, Hande; 26075126A 3-day-old male newborn presented with a severe proptosis of the left eye leading to exposure keratopathy. He underwent debulking of the cyst and biopsy of the tumour and received the pathological diagnosis of epidermoid cyst of orbit. Clinicopathological features of this rare disease are discussed.Item Cardiac rhabdomyoma associated with tuberosclerosis complex in a newborn(2016) Torer, Birgin; Cetinkaya, Bilin; Arslan, Alevi; Alkan, Ozlem; Erol, Ilknur; Gulcan, Hande; 0000-0002-3530-0463; 0000-0003-0866-7339; 0000-0003-4444-0027; 0000-0001-7526-3460; AAK-4825-2021; AAF-1346-2021; V-1112-2019; AAM-4169-2021Cardiac rhabdomyomas are the most comman cardiac tumors in children. They are hamartomatous benign tumors composed of myocytes. They often presents as multiple lesions involving the ventricular cavities. Rhabdomyomas are usually detected in utero by fetal echocardiography. Although patients with cardiac rhabdomyomas are generally asymptomatic these tumors may cause heart failure, severe arrhyhmias and sudden death. Cardiac rhabdomyomas are often associated with tuberosclerosis and they may be the earliest manifestation of tuberosclerosis. Here, we report a newborn infant with antenatally detected cardiac rhabdomyomas associated with tuberosclerosis and we want to emphasize that other diagnostic features of tuberosclerosis should be evaluated in patients with cardiac rhabdomyomas.