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Bozda S.,Umraniye Research and Training Hospital | Dilli D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Gokmen T.,Bacilar Research and Training Hospital | Dilmen U.,Zekai Tahir Burak Maternity Teaching Hospital | Dilmen U.,Yildirim Beyazit University
American Journal of Perinatology | Year: 2015

Objective To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low-birth-weight (VLBW) infants. Study Design A prospective randomized controlled trial was conducted on 42 infants who were divided into two groups, poractant alfa (n = 21) and beractant (n = 21). Results In both the groups, the mean standard deviation (SD) birth-weight and gestational age were similar (p = 0.33 and 0.89, respectively). Although, the mean oxygenation index (OI) increased after pulmonary hemorrhage compared with baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group (before hemorrhage: 11.9, after hemorrhage: 22.7, 1 hour of surfactant: 14.6, 8th hour of surfactant: 7.8, 24th hour of surfactant: 8.5, p = 0.007 vs. before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, 1 hour of surfactant: 12.8, 8th hour of surfactant: 12.8, 24th hour of surfactant: 9.7, p = 0.02). There was no significant difference between the groups for OI values at all time points (p > 0.05). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in both the groups. Conclusion Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients. © Georg Thieme Verlag KG Stuttgart New York.


PubMed | Dr Sami Ulus Maternity and Children Research and Training Hospital, Zekai Tahir Burak Maternity Teaching Hospital, Bagclar Research and Training Hospital and Umraniye Research and Training Hospital
Type: Comparative Study | Journal: American journal of perinatology | Year: 2015

To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low-birth-weight (VLBW) infants.A prospective randomized controlled trial was conducted on 42 infants who were divided into two groups, poractant alfa (n=21) and beractant (n=21).In both the groups, the mean standard deviation (SD) birth-weight and gestational age were similar (p=0.33 and 0.89, respectively). Although, the mean oxygenation index (OI) increased after pulmonary hemorrhage compared with baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group (before hemorrhage: 11.9, after hemorrhage: 22.7, 1 hour of surfactant: 14.6, 8th hour of surfactant: 7.8, 24th hour of surfactant: 8.5, p=0.007 vs. before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, 1 hour of surfactant: 12.8, 8th hour of surfactant: 12.8, 24th hour of surfactant: 9.7, p=0.02). There was no significant difference between the groups for OI values at all time points (p>0.05). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in both the groups.Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.


Dilli D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Aydin B.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Fettah N.D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Ozyazici E.,Dr Sami Ulus Maternity and Children Research and Training Hospital | And 8 more authors.
Journal of Pediatrics | Year: 2015

Objective To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Study design A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage 2). Results The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P <.001). The times to reach full enteral feeding were faster (P <.001), the rates of clinical nosocomial sepsis were lower (P =.004), stays in the neonatal intensive care unit were shorter, (P =.002), and mortality rates were lower (P =.003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6). Conclusions In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC. © 2015 Elsevier Inc.


Dilli D.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Aydin B.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Zenciroglu A.,Dr Sami Ulus Maternity and Children Research and Training Hospital | Ozyazici E.,Dr Sami Ulus Maternity and Children Research and Training Hospital | And 2 more authors.
Pediatrics | Year: 2013

Objectives: The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). Methods: A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage ≥2), length of NICU stay, and death. Results: A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture-proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14-36] vs 32 days [20-44], P = .07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). Conclusions: Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death. © 2013 by the American Academy of Pediatrics.


Dilli D.,Dr Sami Ulus Maternity And Children Research And Training Hospital | Ozbas S.,Turkish Directorate of Public Health | Acican D.,Turkish Directorate of Public Health | Yamak N.,Turkish Directorate of Public Health | And 2 more authors.
JCRPE Journal of Clinical Research in Pediatric Endocrinology | Year: 2013

Objective: To assess the Turkish National Newborn Screening Programme (NNSP) for congenital hypothyroidism (CH). Retrospective study based on the data from NNSP. Methods: Since December 2006, a nationwide screening programme for CH has been conducted in Turkey by the Turkish Directorate of Public Health (TDPH) in cooperation with several institutions. We evaluated the database between January 2008 and July 2010 of this programme. According to the methodology of the NNSP, between three and five days of age (or at discharge from the hospital, if this occurs earlier) blood specimens were routinely collected from neonates on filter paper, by puncturing the heel. The accepted thyroid-stimulating hormone cut-off level for recall was 20 mU/L initially and 15 mU/L subsequently. The incidence of possible CH by years was reported. Results: During the evaluation period, 3223765 newborns were tested. The mean annual incidence of possible CH showed a gradual increase over the years (1:888 in 2008, 1:592 in 2009, and 1:469 in 2010). Regional differences were noted. Although the mean age of blood sampling did not change by years, the mean age at notification for suspected CH decreased from 19.2 to 15.7 days from 2008 to 2010. Conclusions: We reported the first assessment of NNSP in Turkey. An improvement in performance measures for the CH screening programme has been noted. Knowledge on incidence of confirmed CH is not yet available in the database. © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.


Beken S.,Dr Sami Ulus Maternity And Children Research And Training Hospital | Dilli D.,Dr Sami Ulus Maternity And Children Research And Training Hospital | Fettah N.D.,Dr Sami Ulus Maternity And Children Research And Training Hospital | Kabatas E.U.,Dr Sami Ulus Maternity And Children Research And Training Hospital | And 2 more authors.
Early Human Development | Year: 2014

Objective: To compare the effect of two lipid emulsions on the development of retinopathy of prematurity in very low birth weight infants. Design: Randomized controlled study. Patients and methods: Eighty very low birth weight infants receiving parenteral nutrition from the first day of life were evaluated. One of the two lipid emulsions were used in the study infants: Group 1 (n = 40) received fish-oil based lipid emulsion (SmofLipid®) and Group 2 (n = 40) soybean oil based lipid emulsion (Intralipid®). Main outcome measures: The development of retinopathy of prematurity and the need for laser photocoagulation were assessed. Results: The maternal and perinatal characteristics were similar in both groups. The median (range) duration of parenteral nutrition [14. days (10-28) vs 14 (10-21)] and hospitalization [34. days (20-64) vs 34 (21-53)] did not differ between the groups. Laboratory data including complete blood count, triglyceride level, liver and kidney function tests recorded before and after parenteral nutrition also did not differ between the two groups. In Group 1, two patients (5.0%) and in Group 2, 13 patients (32.5%) were diagnosed with retinopathy of prematurity (OR: 9.1, 95% CI 1.9-43.8, p = 0.004). One patient in each group needed laser photocoagulation, without significant difference. Multivariate analysis showed that only receiving fish-oil emulsion in parenteral nutrition decreased the risk of development of retinopathy of prematurity [OR: 0.76, 95% CI (0.06-0.911), p = 0.04]. Conclusions: Premature infants with very low birth weight receiving an intravenous fat emulsion containing fish oil developed less retinopathy of prematurity. © 2013 Elsevier Ltd.


PubMed | Dr Sami Ulus Maternity and Children Research and Training Hospital
Type: Journal Article | Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians | Year: 2016

To examine asymmetric dimethylarginine (ADMA) level as an endothelial function parameter in addition to ultrasonographic evaluation of carotid arteries in babies born small for gestational age (SGA).Twenty-six neonates born SGA and 34 appropriate for gestational age (AGA) controls were included in the study. The serum levels of ADMA were measured. Intima-media thickness (cIMT) and resistive index (cRI) of the both carotid arteries were determined by ultrasonography.The mean ADMA level was higher in SGA neonates compared to AGAs (16 267.76050 versus 12 810.23302ng/L; p=0.01). The mean cIMT (0.340.02 versus 0.310.03mm; p=0.001) and cRI (0.660.07 versus 0.610.04, p=0.003) were also higher in SGAs. Serum ADMA levels were positively correlated to the mean cIMT (r=0.41, p=0.001). Although there was a weak correlation between cIMT and mean cRI (r=0.26, p=0.04), no correlation was found between ADMA and mean cRI (r=0.17, p=0.18).Neonates born SGA have elevated cord blood ADMA level in addition to thicker IMT and higher RI of carotid arteries at birth. ADMA was correlated to cIMT, suggesting that higher ADMA levels might influence vascular health in later life in these neonates.


PubMed | Dr Sami Ulus Maternity and Children Research and Training Hospital
Type: Case Reports | Journal: The Annals of otology, rhinology, and laryngology | Year: 2015

To evaluate the effectiveness and safety of sirolimus therapy in a child with macroglossia due to lymphatic malformation.Sirolimus treatment was applied to the patient with an initial dosing of 0.8 mg/m2 per dose, administered orally, twice daily at approximately 12-hour intervals.After 9 months of sirolimus therapy, there was a nearly complete resolution of lymphatic malformation. The last evaluation was performed 6 months after withdrawal of treatment, and the lesion had almost completely resolved.This article presents a novel approach to the treatment of lymphatic malformation of the tongue using sirolimus, which appears to be safe and effective for the management of complex cases.


PubMed | Dr Sami Ulus Maternity And Children Research And Training Hospital
Type: Journal Article | Journal: American journal of perinatology | Year: 2015

To determine the changes in serum C-reactive protein (CRP) levels during therapeutic hypothermia.Between January 2011 and June 2013, 133 hypoxic-ischemic encephalopathy patients being followed up in the neonatal intensive care unit of Dr. Sami Ulus Maternity and Childrens Hospital are prospectively evaluated. Group 1; patients that received therapeutic hypothermia (n=74) and group 2; patients that did not required therapeutic hypothermia (n=59). All the patients underwent serial complete blood cell count and CRP assessments; blood cultures were obtained from all the cases at the time of admission and when CRP levels were elevated.Positive blood cultures were encountered in five cases (6.7%) in group 1 while no blood culture-proven septicemia was encountered in group 2. The CRP levels elevated gradually reaching a peak level on the 4th day and then decreased during the therapeutic hypothermia in patients with no blood culture-proven septicemia in group 1. The CRP levels showed statistically significant changes reaching a peak level on the 7th day in patients with blood culture-proven septicemia in group 2. Also, the CRP levels showed no alteration with time in group 2.Therapeutic hypothermia itself might be associated with CRP elevation rather than an actual infection.


PubMed | Dr Sami Ulus Maternity And Children Research And Training Hospital, Ankara Childrens Hematology Oncology Training and Research Hospital, Public Health Agency and Board of Health Policies
Type: Journal Article | Journal: Central European journal of public health | Year: 2016

Infant mortality rate (IMR) and neonatal mortality rate (NMR) are accepted as good indicators to measure the health status of a nation. This report describes recent declines in IMR and NMR in Turkey.Data on infants who died before 12 months of life were obtained from the Infant Mortality Monitoring System of Ministry of Health of Turkey between 2007 and 2012. A total of 94,038 infant deaths were evaluated.Turkey IMR and NMR exhibited a marked decline from 2007 (16.4 and 12.2) to 2010 (10.1 and 6.6) and then plateaued in 2012 (9.7 and 6.3), despite regional differences. Prematurity, congenital anomalies and congenital heart diseases (CHD) were the three most common causes of infant deaths between 2007 and 2012. While the rates of respiratory distress syndrome (RDS), sudden infant death syndrome (SIDS), and metabolic diseases increased, the rates of congenital anomalies and birth injuries decreased. IMR and NMR significantly increased with the number of infants per paediatrician, per doctor, and per midwife, while was decreasing with the increased rate of hospital birth, caesarean delivery, antenatal care, infant follow-up, and staff trained within the Neonatal Resuscitation Programme (NRP).From 2007-2012, Turkey showed remarkable encouraging advances in reducing IMR and NMR. Any interventions aimed at further reductions in IMR and NMR should target the common causes of death and defined risk factors especially in socioeconomically disadvantaged regions.

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