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Ozdemir R.,Neonatal Intensive Care Unit | Erdeve O.,Neonatal Intensive Care Unit | Dizdar E.A.,Neonatal Intensive Care Unit | Oguz S.S.,Neonatal Intensive Care Unit | And 4 more authors.
Pediatrics | Year: 2011

OBJECTIVE: To evaluate the efficacy and safety of clarithromycin treatment in preventing bronchopulmonary dysplasia (BPD) in Ureaplasma urealyticum-positive preterm infants. PATIENTS AND METHODS: Nasopharyngeal swabs for U urealyticum culture were taken from infants with a birth weight between 750 and 1250 g in the first 3 postnatal days. Infants with a positive culture for U urealyticum were randomly assigned to 1 of 2 groups to receive either intravenous clarithromycin or placebo. All the patients were followed at least up to the 36th postmenstrual week. RESULTS: A total of 224 infants met the eligibility criteria of the study. Seventy-four (33%) infants had a positive culture for U urealyticum in the first 3 day cultures. The rate of BPD development was significantly higher in patients with U urealyticum positivity (15.9% vs 36.4%; P<.01). However, multivariate logistic regression analysis failed to reveal a significant association between the presence of U urealyticum and BPD development (odds ratio: 2.4 [95% confidence interval: 0.9-6.3]; P<.06). Clarithromycin treatment resulted in eradication of U urealyticum in 68.5% of the patients. The incidence of BPD was significantly lower in the clarithromycin group than in the placebo group (2.9% vs 36.4%; P<.001). Multivariate logistic regression analysis confirmed the independent preventive effect of clarithromycin for the development of BPD (odds ratio: 27.2 [95% confidence interval: 2.5-296.1]; P=.007). CONCLUSIONS: Clarithromycin treatment prevents development of BPD in preterm infants who are born at 750 to 1250 g and colonized with U urealyticum. Copyright © 2011 by the American Academy of Pediatrics. Source

Oncel M.Y.,Zekai Tahir Burak Maternity Teaching Hospital | Erdeve O.,Ankara University
Current Drug Safety | Year: 2015

Patent ductus arteriosus (PDA) is the most common cardiac condition in preterm infants. The most commonly used drugs for this purpose are cyclooxygenase inhibitors, mainly indomethacin and ibuprofen, which block the conversion of arachidonic acid to prostaglandins. On the other hand, several adverse effects have been reported with such medications, including peripheral vasoconstriction, gastrointestinal bleeding and perforation, weakened platelet aggregation, hyperbilirubinemia and renal failure. The role of oral paracetamol as an alternative treatment for the closure of PDA has gained importance in recent years. In this review, we aimed to determine safety of therapeutic drugs used in management of PDA in preterm infants rather than their efficacy in ductal closure. Two worldwide commonly used therapeutics (indomethacin and ibuprofen) and a new alternative medication as paracetamol are discussed. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects than indomethacin. Recent studies suggest that paracetamol may be a medical alternative in the management of PDA with low adverse events and side effects. © 2015 Bentham Science Publishers. Source

Nosocomial sepsis agents with multidrug resistance have led to higher morbidity and mortality in premature infants in the recent years. Acinetobacter baumannii has become a leading cause of nosocomial sepsis in several neonatal intensive care units. In this study, the demographic, clinic, microbiologic characteristics and risk factors of 21 premature infants hospitalized in newborn intensive care unit between January 2010-February 2011 and developed A.baumannii infection, have been evaluated retrospectively. The isolates were identified by conventional methods and antibiotic susceptibility tests were performed by Vitek 2 GN and AST-N090 using Vitek 2 Compact system (BioMerieux, France). A.baumannii was isolated from the blood samples of 10 patients, central venous catheter samples of three patients, CSF samples of two, tracheal aspirate of two and urine sample of one patient. In two patients both blood and central venous catheter samples and in one patient both blood and CSF samples revealed A.baumannii. Gestational age was between 22-30 weeks and birth weight was between 500-1320 grams (17 were < 1000 g) in 19 patients. A.baumannii caused early onset (≤ 3 days) sepsis in four, and late onset (≥ 4 days) sepsis in 17 patients. The main risk factors were detected as mechanical ventilation (n= 20, 95%), prematurity (n= 19, 91%), total parenteral nutrition (n= 17, 81%) and central catheter use (n= 14, 67%). Antibiotics with highest rates of susceptibility were gentamicin (18/21), amikacin (14/21), and colistin (10/21). Twenty (95%) isolates had multiple drug resistance. Amikacin, gentamicin, colistin and imipenem were used for treatment, however 12 infants, 8 of which due to sepsis, died. In conclusion, A.baumannii which is an important nosocomial sepsis agent with multidrug resistance, is increasing in incidence. To control Acinetobacter infections especially in low-birth weight infants, the use of invasive procedures, total parenteral nutrition and broad spectrum antibiotics should be limited and infected patients should be isolated besides establishment of other appropriate infection control measures. Source

Kanmaz H.G.,Zekai Tahir Burak Maternity Teaching Hospital | Erdeve O.,Ankara University | Canpolat F.E.,Zekai Tahir Burak Maternity Teaching Hospital | Mutlu B.,Zekai Tahir Burak Maternity Teaching Hospital | And 2 more authors.
Pediatrics | Year: 2013

BACKGROUND: The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) requirement with the InSurE (Intubate, Surfactant, Extubate) procedure. METHODS: Preterm infants, who were ,32 weeks and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room, were randomized to receive early surfactant treatment either by the Take Care or InSurE technique. Tracheal instillation of 100 mg/kg poractant a via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group. In the InSurE procedure, infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately. RESULTS: One hundred infants in each group were analyzed. The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group (30% vs 45%, P = .02, odds ratio -0.52, 95% confidence interval -0.94 to -0.29). Mean duration of both nCPAP and MV were significantly shorter in the Take Care group (P values .006 and .002, respectively). Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique (relative risk -0.27, 95% confidence interval -0.1 to -0.72) CONCLUSIONS: The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight. It significantly reduces both the need and duration of MV, and thus the bronchopulmonary dysplasia rate in preterm infants. Copyright © 2013 by the American Academy of Pediatrics. Source

Oncel M.Y.,Zekai Tahir Burak Maternity Teaching Hospital | Sari F.N.,Zekai Tahir Burak Maternity Teaching Hospital | Arayici S.,Zekai Tahir Burak Maternity Teaching Hospital | Guzoglu N.,Zekai Tahir Burak Maternity Teaching Hospital | And 5 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2014

Objective To evaluate the effect of oral Lactobacillus reuteri (L reuteri) first on the incidence and severity of Necrotising enterocolitis (NEC) and second on sepsis. Design Prospective randomised controlled study. Setting Tertiary neonatal intensive care unit. Patients and interventions Preterm infants with a gestational age of ≤32 weeks and a birth weight of ≤1500 g were included (n=400). Infants in the first group were given 100 million CFU/day (5 drops) of lyophilised L reuteri (DSM 17938) mixed in breast milk or formula, starting from first feeding until discharge. Participants in the control group were given a placebo. Main outcome measures To determine and compare the frequency of NEC and/or death after 7 days, frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay. Results There was no statistically significant difference between groups in terms of frequency of NEC stage ≥2 (4% vs 5%; p=0.63) or overall NEC or mortality rates (10% vs 13.5%; p=0.27). Frequency of proven sepsis was significantly lower in the probiotic group compared to the control group (6.5% vs 12.5%; p=0.041). A significant difference was also observed with regard to rates of feeding intolerance (28% vs 39.5%; p=0.015) and duration of hospital stay (38 (10-131) vs 46 (10-180) days; p=0.022). Conclusions Our results show that oral L reuteri does not seem to affect the overall rates of NEC and/or death in preterm infants followed up in the neonatal intensive care unit, and significant reductions were observed in the frequency of proven sepsis, rates of feeding intolerance and duration of hospital stay. Source

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