Muhittin Çelik

Colistin use in critically ill neonates: A case–control study

BACKGROUNDnThe aim of this study was to assess the safety and efficacy of colistin use in critically ill neonates.nnnMETHODSnThis was a case-control study that included newborn infants with proven or suspected nosocomial infections between January 2012 and October 2015, at two centers in Diyarbakir, Turkey. The clinical and laboratory characteristics and outcomes of patients who received colistin therapy were reviewed and compared to patients who were treated with antimicrobial agents other than colistin during the same period.nnnRESULTSnForty-seven cases who received intravenous colistin (colistin group) and 59 control patients (control group) were included. There were no significant differences between the groups regarding outcomes and nephrotoxicity, including acute renal failure. Colistin therapy was associated with significantly reduced serum magnesium (1.38xa0±xa00.39xa0mg/dL vs. 1.96xa0±xa00.39xa0mg/dL, pxa0<xa00.001) and hypokalemia (46.8% vs. 25.4%, pxa0=xa00.026). The patients who received colistin also had longer hospital stays (43 (32-70) days vs. 39 (28-55) days, pxa0=xa00.047), a higher rate of previous carbapenem exposure (40.4% vs. 11.9%, pxa0=xa00.001), and a higher age at the onset of infection (13 (10-21) days vs. 11 (9-15) days, pxa0=xa00.03).nnnCONCLUSIONnThis study showed that colistin was both effective and safe for treating neonatal infections caused by multidrug-resistant gram-negative bacteria. However, intravenous colistin use was significantly associated with hypomagnesemia and hypokalemia.

Problems of the neonates with congenital heart disease requiring early interventions: a regional report.

AIMnIn this study, it was aimed to determine the problems of the neonates who were diagnosed with congenital heart disease requiring early intervention in our hospital.nnnMATERIAL AND METHODSnThe files of the newborn babies with congenital heart disease requiring early intervention who were admitted to the neonatal intensive care unit of our hospital between January 2011 and January 2013 were evaluated retrospectively. In all cases, echocardiography and Score for Neonatal Acute Physiology-II (SNAP-II) scoring were performed within the first day of admission. The data were interpreted using Number Cruncher Statistical System 2007 software. The statistical significance was set at p<0.05.nnnRESULTSnA total of 83 babies were included in the study. Forty six of the patients were male (55%), and 37 (45%) were female. Sixty eight percent of the patients were referred from the neighboring provinces and 32% were transferred from the centers within the city. The age range was between 0 and 28 (5.6±6.4 day) days. The SNAP-II scores upon admission ranged between 0 and 90 (mean: 20±20.3). None of the patients was diagnosed prenatally. The most common diagnoses included transposition of the great arteries (33.7%) and pulmonary atresia (19.3%). Nineteen (22%) patients were lost in the neonatal intensive care unit. There was a significant relationship between the mortality and the SNAP-II scores (p=0.0001) and use of vasopressors (p=0.004). The diagnosis, gender, use of alprostadil and age were not related to mortality. Three patients were discharged following planning of elective surgery and 60 patients were referred to a tertiary center by air ambulance.nnnCONCLUSIONSnThe results of our study indicated that prenatal diagnosis could not be made in neonates with congenital heart disease requiring intervention in our region. The mortality rates of these patients were related to the severity of the clinical status at presentation rather than to the age, gender and type of congenital heart disease. The mortality was much higher in the patients who developed circulatory failure. Most of the patients who survived were sent by air ambulance to the centers where the intervention was to be performed.

Efficacy of Peritoneal Dialysis in Neonates Presenting With Hyperammonaemia Due to Urea Cycle Defects and Organic Acidaemia: Peritoneal Dialysis in Hyperammonaemia

Newborns with inborn errors of metabolism can present with hyperammonaemic coma. In this study, we evaluated the effect of peritoneal dialysis on plasma ammonium levels and on the short‐term outcome in neonatal patients with urea cycle defects and organic acidaemia.

Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

AimsnTo compare the effect of early nasal intermittent positive pressure ventilation (nIPPV) and nasal continuous positive airway pressure (nCPAP) in terms of the need for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants born between 24 and 32 gestational weeks.nnnMethodsnThis is a randomized, controlled, prospective, single-centered study. Forty-two infants were randomized to nIPPV and 42 comparable infants to nCPAP (birth weight 1356u2009±u2009295 and 1359u2009±u2009246xa0g and gestational age 29.2u2009±u20091.7 and 29.4u2009±u20091.5u2009weeks, respectively).nnnResultsnThe need for endotracheal intubation and invasive mechanical ventilation was significantly lower in the nIPPV group than the nCPAP group (11.9% and 40.5%, respectively, pu2009<u20090.05). There were no differences in the duration of total nasal respiratory support, duration of invasive mechanical ventilation, bronchopulmonary dysplasia or other early morbidities.nnnConclusionnnIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

A comparison of the effects of invasive mechanic ventilation/surfactant therapy and non-invasive nasal-continuous positive airway pressure in preterm newborns

Abstract Aims: This study compared the early-term outcomes of mechanical ventilation (MV)/surfactant treatment with nasal-continuous positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS). Materials and methods: Data from newborns born between ≥24 and ≤32 weeks of gestation, hospitalized at our newborn intensive care unit, and diagnosed with RDS between January 2009 and February 2012 were analyzed. Results: Of 193 newborns with RDS who were enrolled in the study, 113 were treated with nCPAP and 80 with MV at a level of 57.5% of nCPAP. Within the study group, 46.3% of the infants were female. The mean gestation of the continuous positive airway pressure (CPAP) group was 29.07u2009±u20091.99 weeks; that of the MV group was 28.61u2009±u20092.01 weeks. The birth weight was 1321.1u2009±u2009325.4u2009g and 1240.3u2009±u2009366.1u2009g; however, the difference between the two groups was not significant. MV was not required in 54.9% of the patients with nCPAP treatment. Bronchopulmonary dysplasia (BPD) developed in 20 (18.7%) patients in the nCPAP group and 18 (24.4%) patients in the MV group; the difference was not significant (pu2009=u2009.351). Between 2009 and 2012, nCPAP was used at a rate of 33.9, 70.8, 68.4, and 69%. The risk factors for developing BPD were low gestation week, duration of intubation, and proven sepsis (pu2009=u2009.0001, pu2009=u2009.004, and pu2009=u2009.011, respectively). Conclusions: Early nCPAP treatment in preterm infants (≤32 weeks of gestation) decreases both the need for MV and the use of surfactant, but without a significant effect on BPD development. (No. 2016/324)

Novel ubiquitin protein ligase E3 component N-Recognin 1 gene mutation in johanson–blizzard syndrome: Development of hypothyroidism during infancy

Johanson–Blizzard syndrome (JBS) is a rare autosomal recessive disorder, characterized by exocrine pancreatic deficiency and a wide range of other abnormalities. Here, we present an infant with failure to thrive, exocrine pancreatic deficiency, developmental delay, cutis aplasia on the scalp, aplasia of alae nasi, hypospadias, and hypothyroidism. Molecular studies revealed a novel homozygous nonsense mutation in exon exon 22 of the ubiquitin protein ligase E3 component N-recognin 1 gene, which confirmed the diagnosis of JBS. In conclusion, it was reported that mutations were mostly family-specific and the same mutation was rarely present in another family. Autosomal recessive diseases are more common in Turkey than in other European countries due to the high frequency of consanguineous marriage. Investigations revealed deafness and congenital hypothyroidism.

Sirolimus-Induced Hepatitis in Two Cases with Hyperinsulinemic Hypoglycemia

Sirolimus has been reported to be effective in the treatment of the diffuse form of congenital hyperinsulinism (CHI), unresponsive to diazoxide and octreotide, without causing severe side effects. Two newborns with CHI due to homozygous ABCC8 gene mutations were started on sirolimus aged 21 and 17 days, due to lack of response to medical treatment. A good response to sirolimus was observed. At follow-up after ten and two months of treatment, liver enzymes were found to be increased [serum sirolimus level 1.4 ng/mL (normal range: 5-15), aspartate aminotransferase (AST): 298U/L, alanine aminotransferase (ALT): 302U/L and serum sirolimus level: 9.9 ng/mL, AST: 261U/L, ALT: 275U/L, respectively]. In Case 1, discontinuation of the drug resulted in normalization of liver enzymes within three days. Two days after normalization, sirolimus was restarted at a lower dose, which resulted in a repeated increase in transferases. In Case 2, a reduction of sirolimus dose caused normalization of liver enzymes within ten days. When the dose was increased, enzymes increased within three days. Sirolimus was discontinued in both cases. The rapid normalization of liver enzyme levels after sirolimus withdrawal or dose reduction; elevation of transaminases after restart or dose increase and rapid normalization after sirolimus withdrawal were findings strongly suggestive of sirolimus-induced hepatitis. To the best of our knowledge, this is the first report of sirolimus-induced hepatitis in CHI. Sirolimus is a promising drug for CHI patients who are unresponsive to medical treatment, but physicians should be vigilant for adverse effects on liver function.

Yenidoğandaki iyatrojenik kalsinozis kutisin topikal steroid ile tedavisi

Kalsinosis kutis ciltte kalsiyum tuzlarinin birikimi olup, distrofik, metastatik, idiyopatik ve iyatrojenik olarak ayrilmaktadir. Kalsinozis kutis cesitli patogenetik mekanizmalar araciligiyla meydana gelir. Bu yazida, intravenoz kalsiyum iceren cozeltinin ekstravazasyonu sonucu gelisen, topikal steroid ile tedavi edilen bir yenidogan olgusu sunulmustur. Şu anda ozgul tedavisi olmayan bu durumun, topikal steroid tedavisi ile klinik ve radyolojik duzelme donemini kisalttigi goruldu.

Türkiye'nin Güneydoğu Anadolu Bölgesi'ndeki Down sendromlu yenidoğanlarda konjenital kalp hastalığı prevalansı ve dağılımı

Amac: Down sendromlu (DS) hastalarda konjenital kalp hastaligi (KKH) sikligi %40-60 arasinda degismektedir. Down sendromlu hastalarda KKH sikligi ve dagilimi toplumlara ve etnik kokene gore farklilik gosterebildiginden bu calismada, Guneydogu Anadolu Bolgesinde DS olan yenidoganlarda KKH sikligini ve dagilimini incelemeyi amacladik. Gerec ve Yontem: Calismaya 2011-2013 yillari arasinda yenidogan yogun bakim unitesine izlenen DS olgular alindi. Deneyimli pediyatrik kardiyolog, tum olgulari GE Vivid 3 cihazi ile transtorasik ekokardiyografi ile incelendi. Tum hastalarin hastane dosyalari degerlendirildi. Bulgular: Calismaya 53u erkek toplam 87 yenidogan alindi. Olgularin yas ortalamasi 8.6±5.2 gun (0-30) idi. Elli yedi olguda (%65.5) KKH saptandi; 37 olguda (%64.9) tek defekt, 16 olguda (%28) iki defekt, 4 olguda (%7) ise uc defekt birlikte bulundu. Defekt sikligi olarak 23 (%29.8) atrioventrikuler septal defekt (AVSD), 22 (%28.5) ventrikuler septal defekt (VSD),18 (%23.3) sekundum atriyal septal defekt, 11 (%14.2) patent duktus arteriosus, 1 Fallot tetralojisi, 1 tek ventrikul ve 1 kesintili aortik ark saptandi. Sonuc: Bilgilerimize gore, yenidogan doneminde DS hastalarda yapilan ilk calismadir. AVSD en sik gorulen defekt olmakla beraber VSD beklenenden daha yuksek bulundu. DS hastalarda KKH taramasinin yenidogan doneminde gerceklestirilmesi daha guvenilirdir, KKH sikligi ve dagiliminin varyasyonu bolgesel ve etnik farkliliklar gostermektedir.