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Baldan E, Varal IG, Dogan P, Cizmeci MN. The effect of non-invasive high-frequency oscillatory ventilation on the duration of non-invasive respiratory support in late preterm and term infants with transient tachypnea of the newborn: a randomized controlled trial. Eur J Pediatr 2023; 182:4499-4507. [PMID: 37491619 DOI: 10.1007/s00431-023-05128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34 weeks' gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21 h [IQR: 16-68] for nHFOV vs 15 h [IQR: 11-33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3 h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications. Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN. Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016. What is Known: • nHFOV is a ventilation model that has been increasingly used for the management of RDS. • TTN is one of the most common causes of neonatal respiratory distress. What is New: • nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support. • nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN.
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Affiliation(s)
- Emre Baldan
- Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey.
| | - Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Mehmet N Cizmeci
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
- Department of Pediatrics, Division of Neonatology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
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Guney Varal I, Dogan P, Acar Celik E, Güler Kazancı E. Mean Platelet Volume and Mean Platelet Volume/Platelet Count Ratio Are Predictors of Late-Onset Sepsis in Preterm Infants: A Case-Control Study. Fetal Pediatr Pathol 2023; 42:44-54. [PMID: 35438038 DOI: 10.1080/15513815.2022.2064574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Our aim was to assess mean platelet volume (MPV) and mean platelet volume to platelet count ratio (MPR) in the setting of late-onset sepsis (LOS) and their association with the type of bacteria causing LOS. Study design: The MPV and MPR levels were obtained at the onset of LOS and then assessed in intra/inter group analyses in preterm infants. Results: Overall, 136 preterm infants were enrolled. The MPV and MPR levels were higher during a LOS event (P < 0.001). A MPV cutoff of >9.2 was related with a sensitivity of 63% and a specificity of 73% for predicting LOS (P < 0.001). A MPR cutoff of >0.15 was related with a sensitivity of 88% and a specificity of 63% for predicting gram negative LOS (P < 0.001). Conclusion: Elevated MPV values and MPR ratios may be helpful in assessing LOS.
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Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Ezgi Acar Celik
- Department of Pediatrics, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Elif Güler Kazancı
- Department of Pediatrics, Division of Pediatric Hematology, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
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Dogan P, Ozkan H, Koksal N, Celebi S, Bagci O, Topcu M, Guney Varal I. The Role of Low 25-Hydroxyvitamin D Levels in Preterm Infants with Late-Onset Sepsis. Fetal Pediatr Pathol 2021; 40:571-580. [PMID: 32065014 DOI: 10.1080/15513815.2020.1725941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IntroductionWe investigated the association between low 25-hydroxyvitamin D (25-OHD) levels and late-onset sepsis (LOS) in preterm infants (<37 weeks). Methods: Infants with culture-proven LOS were the study group, infants without LOS were the controls. 25-OHD levels were compared between these groups. Low vitamin D was defined as 25-OHD ≤15 ng/ml. Maternal 25-OHD levels were compared to their infant's level. Results: 108 infants were included. The study group was significantly younger (p = 0.02) with significantly lower 25-OHD levels (p < 0.001). Multivariable logistic regression analyses revealed that infants with low 25-OHD levels were 7.159 (95%CI: 1.402-36.553, p = 0.018) times more likely to develop LOS. A positive correlation was detected between maternal and neonatal 25-OHD levels for both study and control groups (r = 0.425, p = 0.009; r = 0.739, p < 0.001, respectively). Conclusions: Low 25-OHD levels are associated with an increased risk of developing LOS development in preterm infants.
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Affiliation(s)
- Pelin Dogan
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Hilal Ozkan
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Nilgun Koksal
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Solmaz Celebi
- Faculty of Medicine, Department of Pediatrics, Division of Infectious Diseases, Uludag University, Bursa, Turkey
| | - Onur Bagci
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
| | - Merve Topcu
- Faculty of Medicine, Department of Pediatrics, Uludag University, Bursa, Turkey
| | - Ipek Guney Varal
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Uludag University, Bursa, Turkey
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Dogan P, Ozkan H, Koksal N, Oral HB, Celebi S, Bagci O, Guney Varal I. Mannose-Binding Lectin Levels in Late-Onset Sepsis in Preterm Infants: Results from a Prospective Study in a Tertiary Care Center. Fetal Pediatr Pathol 2020; 39:363-372. [PMID: 31411530 DOI: 10.1080/15513815.2019.1652374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: This study aimed to determine the association between serum mannose-binding lectin (MBL) levels, gene polymorphisms and late-onset sepsis (LOS) in preterm infants. Methods: Infants with <37 gestational weeks were categorized into two groups according to the presence of LOS during their hospitalization. An MBL level <700 ng/ml was defined as deficiency, <400 ng/ml as severe deficiency. Codon 54 and 57 polymorphisms of MBL2 gene were analyzed. Results: Overall, 153 preterm infants were included. MBL deficiency was found to be more common in the LOS group (p = 0.02). The rate of Gram-negative sepsis was higher in MBL2 variant-type (p = 0.01). In the logistic regression analysis, MBL levels <700 ng/ml were found to have a significant effect on LOS development (odds ratio: 2.692, 95% confidence interval 1.196-5.8, p = 0.02). Conclusions: MBL deficiency is an important risk factor for the development of LOS. Furthermore, there is an association between MBL2 gene polymorphism and Gram-negative sepsis.
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Affiliation(s)
- Pelin Dogan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Hilal Ozkan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Nilgun Koksal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Haluk Barbaros Oral
- Uludag University, Faculty of Medicine, Department of Immunology, Bursa, Turkey
| | - Solmaz Celebi
- Uludag University, Faculty of Medicine, Department of Pediatrics, Division of Infectious Diseases, Bursa, Turkey
| | - Onur Bagci
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Ipek Guney Varal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
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Dogan P, Ozkan H, Koksal N, Oral HB, Bagci O, Guney Varal I. Mannose-binding lectin gene polymorphism and its effect on short term outcomes in preterm infants. J Pediatr (Rio J) 2020; 96:520-526. [PMID: 31029683 PMCID: PMC9432184 DOI: 10.1016/j.jped.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Mannose-binding lectin, which belongs to the collectin family, is an acute-phase reactant that activates the complement system. This study aimed to investigate the effect of MBL2 gene polymorphism on short-term outcomes in preterm infants. METHOD Infants of <37 gestational weeks who were admitted to the neonatal intensive care unit during a two-year period were enrolled in this prospective study. The neonates were categorized into two groups according to their MBL2 genotypes. Normal MBL2 genotype was defined as MBL2 wild-type (AA genotype), whereas mutant MBL2 genotype was defined as MBL2 variant-type (AO/OO genotype). The relationship between MBL2 genotype and short-term morbidity and mortality was evaluated. RESULTS During the two-year study period, 116 preterm infants were enrolled in this study. In MBL2 variant-type, mannose-binding lectin levels were significantly lower and incidences of mannose-binding lectin deficiency (MBL level<700ng/mL) were higher (p<0.001). In this group, the prevalence of respiratory distress syndrome and mortality was significantly higher (p<0.001, p=0.03 respectively). In the MBL2 wild-type group, the prevalence of necrotizing enterocolitis (NEC) was higher (p=0.01). Logistic regression analyses revealed that MBL2 variant-type had a significant effect on respiratory distress syndrome development (odds ratio, 5.1; 95% confidence interval, 2.2-11.9; p<0.001). CONCLUSIONS MBL2 variant-type and mannose-binding lectin deficiency are important risk factors for respiratory distress syndrome development in preterm infants. Additionally, there is an association between MBL2 wild-type and NEC. Further studies on this subject are needed.
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Affiliation(s)
- Pelin Dogan
- Uludag University, Faculty of Medicine, Department of Pediatrics, Bursa, Turkey.
| | - Hilal Ozkan
- Uludag University, Faculty of Medicine, Department of Pediatrics, Bursa, Turkey
| | - Nilgun Koksal
- Uludag University, Faculty of Medicine, Department of Pediatrics, Bursa, Turkey
| | - Haluk Barbaros Oral
- Uludag University, Faculty of Medicine, Department of Immunology, Bursa, Turkey
| | - Onur Bagci
- Uludag University, Faculty of Medicine, Department of Pediatrics, Bursa, Turkey
| | - Ipek Guney Varal
- Uludag University, Faculty of Medicine, Department of Pediatrics, Bursa, Turkey
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Dogan P, Ozkan H, Koksal N, Oral HB, Bagci O, Varal IG. Mannose‐binding lectin gene polymorphism and its effect on short term outcomes in preterm infants. Jornal de Pediatria (Versão em Português) 2020. [DOI: 10.1016/j.jpedp.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
Objective: This study aimed at assessing the serial carboxyhemoglobin (COHb) levels in preterm infants during the first week of life and their variation with late-onset sepsis (LOS). Study Design: Infants with <37 gestational weeks were categorized into two groups according to the presence of culture proven LOS. Serial COHb levels were obtained during the first week of life, at the onset of the LOS episode, and upon blood culture negativity with response to antibiotics. Result: Overall 207 infants were enrolled. A LOS episode resulted in a significant increase in COHb levels (p < 0.001), which decreased to normal levels when the blood cultures were sterile (p < 0.001). At a cut of level of 1.35% COHb had a sensitivity of 56% and a specificity of 90% to confirm LOS (p < 0.001). Conclusion: In this study, we demonstrated an increase in COHb levels at the onset of LOS and a decrease with response to antibiotherapy.
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Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
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Dogan P, Guney Varal I. Red cell distribution width as a predictor of late-onset Gram-negative sepsis. Pediatr Int 2020; 62:341-346. [PMID: 31880020 DOI: 10.1111/ped.14123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/15/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Late-onset sepsis (LOS) remains an important cause of morbidity and mortality in preterm infants. In this study, our aim was to investigate the red-cell distribution width (RDW) levels during a LOS episode, and its association with the type of growing microorganism and mortality. METHODS Preterm infants with culture-proven sepsis during their neonatal intensive care unit stay were enrolled. Red-cell distribution width levels were obtained in the first 4 h of postnatal life and at the onset of the LOS episode, and compared for these time frames. The study cohort was divided into two groups according to the type of the growing microorganism. The RDW levels were then assessed in intra- and inter-group analyses. RESULTS Eighty-six infants were included in the final analysis. RDW levels were increased in the study cohort after a LOS attack (P < 0.001). Infants with Gram-negative sepsis showed a significant increase in their RDW levels, but they remained unchanged in infants with Gram-positive sepsis (P < 0.001 and P = 0.4, respectively). An RDW cut-off of >19.50% was related with a sensitivity of 87% and a specificity of 81% for predicting late-onset Gram-negative sepsis (P < 0.001). Logistic regression analysis showed a positive association of RDW with mortality when adjusted for covariants (adjusted odds ratio: 1.40; 95% confidence interval: 1.02-1.80; P = 0.03). CONCLUSIONS Our findings show that RDW levels increased during a LOS episode in preterm infants, which was especially evident in Gram-negative infections. We believe that these findings may be of importance in the early diagnosis and prognosis of LOS in preterm infants.
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Affiliation(s)
- Pelin Dogan
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
| | - Ipek Guney Varal
- Division of Neonatology, Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, University of Health Sciences, Bursa, Turkey
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Ozcakir E, Okay ST, Guney Varal I, Kaya M. Cloacal dysgenesis sequence with bilateral renal agenesis, bladder agenesis, pulmonary hypoplasia and left choanal atresia: A case report. j-pucr 2020. [DOI: 10.14534/j-pucr.2020258451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Dogan P, Ozkan H, Koksal N, Bagci O, Varal IG. Vitamin D deficiency and its effect on respiratory distress syndrome in premature infants: results from a prospective study in a tertiary care centre. Afr Health Sci 2020; 20:437-443. [PMID: 33402932 PMCID: PMC7750057 DOI: 10.4314/ahs.v20i1.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The positive effects of steroids on lung development are well known, and 1,25-dihydroxy vitamin D3 has been shown to exert positive effects on fetal lung development. OBJECTIVE We aimed to investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and respiratory distress syndrome (RDS) in premature infants. METHODS Infants aged ≤32 gestational weeks who were admitted to the neonatal intensive care unit (NICU) during 1 year were enrolled in this prospective study. 25(OH)D levels were obtained at the time of admission to NICU. Patients were divided into three groups according to their 25(OH)D levels: severe (group 1), moderate (group 2), and mild (group 3) 25(OH)D deficiencies. RESULTS The study comprised 72 patients; of them, RDS was observed in 49 and not observed in 23 patients. The mean 25(OH)D levels were significantly lower in RDS patients (p=0.04). Multivariate analysis showed that patients with higher 25(OH)D levels can be preventive for the development of RDS (odds ratio 0.89; 95% confidence interval 0.8-0.99; p=0.04). CONCLUSION Our study revealed that 25(OH)D deficiency is an independent risk factor for RDS in premature infants. However, further studies are necessary to explore the association between 25(OH)D deficiency and RDS.
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Affiliation(s)
- Pelin Dogan
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology
| | - Hilal Ozkan
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology
| | - Nilgun Koksal
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology
| | - Onur Bagci
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology
| | - Ipek Guney Varal
- Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology
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Abstract
Introduction: Glutathione synthetase (GSS) deficiency is an autosomal recessive disorder (frequency < 1/1,000,000) with different varyingly severe clinical manifestations that include metabolic acidosis, hemolytic anemia, hyperbilirubinemia, neurological disorders and sepsis. Case report: This infant was small for gestational age, had hemolytic anemia, metabolic acidosis, bilateral subependymal pseudocysts and increased echogenicity of the basal ganglia. GSS deficiency was confirmed by genetic analysis. The patient also had unilateral right femur agenesis. Conclusion: By using next generation sequencing analysis, we identified a novel homozygous variant c.800G > A, p.Arg267Gln in the GSS gene of this patient. Femur agenesis had not previously been associated with GSS.
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Affiliation(s)
- Ipek Guney Varal
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Orhan Gorukmez
- Department of Genetics, University of Health Sciences Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Sevil Dorum
- Division of Metabolism, Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Arzu Akdag
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey
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Varal IG, Dogan P. Egg on a string sign. Pan Afr Med J 2019; 31:79. [PMID: 31007826 PMCID: PMC6457718 DOI: 10.11604/pamj.2018.31.79.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/24/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
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Ozkan H, Koksal N, Dorum BA, Kocael F, Ozarda Y, Bozyigit C, Dogan P, Guney Varal I, Bagci O. New-generation fish oil and olive oil lipid for prevention of oxidative damage in preterm infants: Single center clinical trial at university hospital in Turkey. Pediatr Int 2019; 61:388-392. [PMID: 30739376 DOI: 10.1111/ped.13798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/10/2018] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) has been widely used in preterm infants. The lipid solutions used for PN, however, are associated with oxidative stress and morbidity. The aim of this study was to compare the effectiveness of a new-generation lipid emulsion (SMOFLipid) and olive-oil based lipid emulsion for prevention of PN-associated oxidative damage. METHODS Preterm infants < 32 weeks of gestational age were included in this prospective randomized study. All infants were randomized to SMOFlipid or olive-oil based lipid emulsion (ClinOleic). Lipid peroxidation products were evaluated in all infants. In addition, total antioxidant capacity (TAC), and both pro- and anti-inflammatory cytokines were studied at days 0, 7 and 14. RESULTS A total of 89 infants (SMOFlipid, n = 42; ClinOleic, n = 47) were enrolled. TAC was higher in the SMOFlipid group compared with the ClinOleic group at all time points, and the difference on day 7 was statistically significant. Although the anti-inflammatory cytokine interleukin-10 was higher in the SMOFlipid group, this difference was not significant. Bronchopulmonary dysplasia (BPD) was lower in the SMOFlipid group (14.1%) than in the ClinOleic group (31.2%), but this finding was non-significant p > 0.05. The rate of severe BPD was significantly lower in the SMOFlipid group. CONCLUSION To our best of knowledge, this is the first study to suggest that SMOFlipid might decrease oxidative damage and oxidative-stress-associated morbidity compared with olive oil-based emulsion in preterm infants.
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Affiliation(s)
- Hilal Ozkan
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Nilgun Koksal
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Bayram Ali Dorum
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Fatma Kocael
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Yesim Ozarda
- Department of Medical Biochemistry, Uludag University Medical Faculty, Bursa, Turkey
| | - Cengiz Bozyigit
- Department of Medical Biochemistry, Uludag University Medical Faculty, Bursa, Turkey
| | - Pelin Dogan
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Ipek Guney Varal
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Onur Bagci
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
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Guney Varal I, Mengi S, Dogan P, Tutanc M, Bostanci M, Cizmeci MN. Elevated blood carboxyhemoglobin levels as an early predictor of phototherapy requirement in moderate and late preterm infants. J Matern Fetal Neonatal Med 2019; 33:1441-1446. [PMID: 30373420 DOI: 10.1080/14767058.2018.1542675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Preterm infants are prone to increased bilirubin burden and display adverse outcomes if left unmonitored; therefore, predicting an increased bilirubin production is of paramount importance.Methods: We aimed to evaluate carboxyhemoglobin (COHb) levels in moderate (GA: 320/7-336/7) and late preterm (GA: 340/7-366/7) infants to assess whether this molecule could be used as an early predictor of phototherapy requirement.Results: A total of 221 infants were enrolled in the study. On admission, carboxyhemoglobin levels of infants who received phototherapy were significantly higher than that of infants who did not require this treatment, and this difference persisted in the consecutive hours (median (min-max): 1.2% (0.3-1.7) versus 0.8% (0.4-1.1); p < .001). The initial and consecutive COHb levels showed positive correlation (r = 0.77, p < .001). In the post-hoc analysis, direct antiglobulin test positivity significantly affected phototherapy requirement (p < .001). Receiver operating characteristics analysis showed that a COHb level of ≥0.95% was found to have a sensitivity of 90% and a specificity of 88%. Multinomial logistic regression analysis demonstrated that high COHb levels on admission significantly increased the likelihood of phototherapy requirement when adjusted for covariants (adjusted odds ratio: 2.2; 95% confidence interval: 1.4-3.5; p < .001).Conclusion: Carboxyhemoglobin measurement can be simply used to predict preterm infants who will require phototherapy.
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Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Senay Mengi
- Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Murat Tutanc
- Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Muharrem Bostanci
- Department of Pediatrics, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Mehmet N Cizmeci
- Department of Pediatrics, Division of Neonatology, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
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Varal IG, Dogan P. Hanhart syndrome: hypoglossia-hypodactylia syndrome. Pan Afr Med J 2019; 32:213. [PMID: 31312325 PMCID: PMC6620079 DOI: 10.11604/pamj.2019.32.213.17493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/29/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
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Abstract
Background & Objective Preterm infants need nutritional and medical requirements in accordance with the physiologic maturity at birth and maintaining optimal postnatal corporal and cerebral growth is one of the main targets of medical caregivers. However, only a few strategies exist to improve the outcomes of infants in a pathogen-rich and nutrient-poor neonatal intensive care unit environment. In this pilot study, we hypothesize that synbiotics may enhance brain growth, which is reflected indirectly by an increase in head circumference through several signalling molecules. Methods A pilot study was conducted in preterm infants with a gestational age of ≤32 weeks and a birth weight of ≤1500 grams at neonatal intensive care unit of Uludag Univeristy Medical Faculty (NICU) for one-year period. Following the randomization of the infants, a prepared commercial synbiotic solution containing multi-combined probiotics and prebiotics was administered enterally to the study group. Results The odds of a patient having a lower body weight and head circumference below the 10th percentile were significantly lower in the probiotic group (p=0.001, p=0.03, respectively). Moreover, the infants in the synbiotics group had a more optimal head circumference (between the 50th and 90th percentiles, p=0.001). Conclusions Our results show that if we can maintain optimal gut microbiota, we might achieve better neuro-development via the beneficial effects of synbiotics on cytokines, neurotransmitters, and the cellular immunity of the nervous system. Further investigational models are needed to demonstrate the beneficial effects of synbiotics on the central nervous system.
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Affiliation(s)
- Ipek Guney Varal
- Ipek Guney-Varal, M.D. Department of Pediatrics, Division of Neonatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nilgun Koksal
- Nilgun Koksal, M.D, Professor of Pediatrics, Department of Pediatrics, Division of Neonatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Hilal Ozkan
- Hilal Ozkan, M.D, Associate Professor of Neonatology, Department of Pediatrics, Division of Neonatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Onur Bagci
- Onur Bagci, M.D. Department of Pediatrics, Division of Neonatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Pelin Dogan
- Pelin Dogan, M.D. Department of Pediatrics, Division of Neonatology, Uludag University Faculty of Medicine, Bursa, Turkey
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Varal IG, Dogan P. Abdominal eggshell calcifications in the newborn: meconium peritonitis. Pan Afr Med J 2018; 31:84. [PMID: 31011385 PMCID: PMC6462155 DOI: 10.11604/pamj.2018.31.84.16592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ipek Guney Varal
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
| | - Pelin Dogan
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yüksek Ihtisas Teaching Hospital, Bursa, Turkey
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18
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Akdogan M, Demirag DA, Varal IG, Cevik SG, Ustundag Y. Haemogram Parameters in the Development of Retinopathy of Prematurity. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojoph.2018.82011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ataoglu E, Civilibal M, Ozkul AA, Varal IG, Oktay ER, Murat E. Indomethacin-induced colon perforation in Bartter's syndrome. Indian J Pediatr 2009; 76:322-3. [PMID: 19347676 DOI: 10.1007/s12098-009-0062-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 02/08/2008] [Indexed: 10/20/2022]
Abstract
Bartter's syndrome (BS) is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperaldosteronism with normal blood pressure. A 22-year-old woman was referred at 23 week of gestation. Polyhydramnios was detected and the chloride level of the amniotic fluid was high. The mother was treated with indomethacin from 26 to 31 week of gestation. The newborn was delivered at 34 week of gestation. At 8th day of life, indomethacin was also started for the baby. After three days, a colonic perforation developed. Indomethacin-induced colon perforation is uncommon in antenatal Bartter's syndrome. This patient indicates that administration of indomethacin in both antenatal and/or early postnatal period may be associated with colonic perforation.
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Affiliation(s)
- Emel Ataoglu
- Department of Neonatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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