Person: ÇAKIR, SALİH ÇAĞRI
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ÇAKIR
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SALİH ÇAĞRI
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Publication What should be the protein target for adjustable human milk fortification in premature infants?(Professional Medical Publications, 2019-01-01) Dorum, Bayram Ali; Özkan, Hilal; ÖZKAN, HİLAL; Çakir, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Şen, Gizem Ezgi; ŞEN, GİZEM EZGİ; Tıp Fakültesi; Pediatri Ana Bilim Dalı; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8393-2021; HJZ-4508-2023; AEZ-2469-2022; A-5375-2017Objective: To assess the short- and long-term effects of the adjustable fortification (ADJ) regimen on growth parameters in premature infants and to evaluate the amount of protein supplements given to reach the targeted blood urea nitrogen (BUN) levels.Methods: In this retrospective study, preterm babies who were born at <= 32 weeks gestational age and fed with human milk, were evaluated in two groups. Infants in Group-I were fed only standard fortification (STD). Infants in Group-II were fed the ADJ regimen. The study was conducted between 2011 and 2016.Results: There were 123 infants in the STD group and 119 in the ADJ group. The mean gestational age of the patients in Group-I was 29.7 +/- 1.8 weeks, and mean birth weight was 1266.1 +/- 347.1 g. The mean gestational age of the patients in Group-II was 29.5 +/- 1.9 weeks, and the mean birth weight was 1217.5 +/- 345.5 g. The daily increase in weight and weekly increase in HC were significantly higher in the ADJ group infants. Weight and HC of infants in the ADJ group were significantly higher at 40 weeks. At one year corrected age, weight, length, and HC measurements of both groups were similar. In Group-II, 63% of patients required additional protein supplementation up to 1.6 g/day to achieve the target BUN levels.Conclusion: A higher protein intake through the ADJ regimen improves the physical growth rate of premature infants in the NICU and after discharge. However, sometimes, the targeted growth and BUN values cannot be achieved despite the administration of protein at the recommended increased doses. Increasing protein supplementation up to 1.6 g/day is safe, feasible, and beneficial for these infants.Publication Insulin-like growth factor-1 and morbidities of prematurity: Bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and necrotizing enterocolitis(Galenos Yayincilik, 2019-08-01) ÖZKAN, HİLAL; Dorum, Bayram Ali; Köksal, Nilgün; ÇAKIR, SALİH ÇAĞRI; Çakır, Salih Çagri; Özgür, Taner; Budak, Ferah; Yılmaz, Cansu; Tıp Fakültesi; İmmunoloji Ana Bilim Dalı; 0000-0002-2823-8454; 0000-0001-5761-4757; 0000-0001-7625-9148; AAG-8393-2021; IZP-9398-2023; AEZ-2469-2022; HJZ-4508-2023; AAG-8381-2021; F-4657-2014; A-5375-2017INTRODUCTION: Insulin-like growth factor-1 (IGF-1) is important for fetal and postnatal development. After premature births, serum IGF-1 concentrations rapidly decrease and can stay at much lower levels than during the intrauterine period. In this study, we aimed to ascertain whether IGF-1 is associated with morbidities of prematurity such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), and is a useful predictor of these diseases.METHODS: We enrolled newborn infants born at a postmenstrual age of <= 32 weeks in this prospective observational cohort study. Serum IGF-1 levels were measured serially in blood samples on the 1st, 3rd, 7th, 21st, and 28th day.RESULTS: A total of 93 infants were enrolled in the study. All these infants had the following characteristics at birth: weight 1236.11 +/- 354.06 g, and gestational age 29.43 +/- 2.10 weeks. All of the IGF-1 levels were significantly lower in the group which developed BPD or ROP (p<0.001). The patients who developed IVH and NEC also had lower IGF-1 levels.DISCUSSION and CONCLUSION: Strong correlations have been found between low serum IGF-1 levels during the first four weeks and development of BPD and ROP.Publication Radiation exposure in the neonatal intensive care unit in newborns and staff(Thieme Medical Publ Inc, 2021-07-28) Çakır, Salih Çağrı; Dorum, Bayram Ali; Köksal, Nilgün; Özkan, Hilal; Yazıcı, Zeynep; Parlak, Müfit; Gülleroğlu, Nadide Başak; ÇAKIR, SALİH ÇAĞRI; Dorum, Bayram Ali; Köksal, Nilgün; ÖZKAN, HİLAL; YAZICI, ZEYNEP; PARLAK, MÜFİT; Gülleroğlu, Nadide Başak; Tıp Fakültesi; Pediat Bölümü; 0000-0001-5761-4757; 0000-0002-2823-8454; HJZ-4508-2023; AEZ-2469-2022; A-5375-2017; A-5375-2017; CZV-1969-2022; IGT-7005-2023; AAI-2303-2021; AAG-8521-2021; EZQ-1350-2022Objective Portable X-rays remain one of the most frequently used diagnostic procedures in neonatal intensive care units (NICU). Premature infants are more sensitive to radiation-induced harmful effects. Dangers from diagnostic radiation can occur with stochastic effects. We aimed to determine the radiation exposure in premature infants and staff and determine the scattering during X-ray examinations in the NICU. Study Design In this prospective study, dosimeters were placed on premature infants who were <= 1,250 g at birth and <= 30 weeks of gestational age who stayed in the NICU for at least 4 weeks. The doses were measured at each X-ray examination during their stay. The measurements of the nurses and the doctors in the NICU were also performed with dosimeters over the 1-month period. Other dosimeters were placed in certain areas outside the incubator and the results were obtained after 1 month. Results The mean radiation exposure of the 10 premature infants, monitored with dosimeters, was 3.65 +/- 2.44 mGy. The mean skin dose of the six staff was 0.087 +/- 0.0998 mSV. The mean scattered dose was 67.9 +/- 26.5 mu Gy. Conclusion Relatively high exposures were observed in 90% of the patients and two staff. The radiation exposure levels of premature infants and staff may need to be monitored continuously.Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Tıp Fakültesi; Pediatri Onkoloji Ana Bilim Dalı; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication The diagnostic value of serum amyloid a in early-onset neonatal sepsis in premature infants(Medcom, 2021-01-01) Dorum, Bayram Ali; Özkan, Hilal; Çakır, Salih Çağrı; Köksal, Nilgün; Gözal, Zeynep; Çelebi, Solmaz; Hacımustafoğlu, Mustafa; Dorum, Bayram Ali; ÖZKAN, HİLAL; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Gözal, Zeynep; ÇELEBİ, SOLMAZ; Hacımustafoğlu, Mustafa; Tıp Fakültesi; Çocuk Hastalıkları Ana Bilim Dalı; Neonatoloji Bilim Dalı; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8451-2021; HJZ-4508-2023; A-5375-2017; AEZ-2469-2022; JLX-9286-2023; FFA-6764-2022; CRX-2793-2022; CSN-9445-2022Purpose: In this study, the aim was to determine the distinct effectiveness of serum amyloid A in the early stage of early-onset neonatal sepsis in premature infants. Methods: Preterm newborns hospitalised between 2014 and 2017 for suspected early-onset neonatal sepsis were included in this prospective study. Patients were evaluated according to clinical and laboratory findings at admission and at the 24th and 48th hours after admission. The serum amyloid A values of the patients with sepsis and a control group were compared, and the blood cultures were evaluated. Results: A total of 319 premature newborns were included in the study: 150 in the sepsis group and 169 in the control group. Their birth weight ranged between 590 g and 3000g and the gestational age was 24-36 weeks. The serum amyloid A values at admission were significantly higher in the cases diagnosed with sepsis compared to the control group. Conclusion: Serum amyloid A is a reliable diagnostic marker for the early onset of neonatal sepsis, and it has a higher sensitivity at symptom onset or in the first hours after birth in premature infants.Publication Evaluation of risk and prognostic factors in neonatal meningitis(Galenos Yayınevi, 2023-04-01) Parlakay, Gülşah; Çakır, Salih Çağrı; Dorum, Bayram Ali; Özkan, Hilal; Çelebi, Solmaz; Hacımustafaoğlu, Mustafa; Köksal, Nilgün; Parlakay, Gülşah; ÇAKIR, SALİH ÇAĞRI; Dorum, Bayram Ali; ÖZKAN, HİLAL; ÇELEBİ, SOLMAZ; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Köksal, Nilgün; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; Çocuk Enfeksiyon Hastalıkları Bilim Dalı; 0000-0001-5761-4757; 0000-0002-2823-8454; 0000-0003-4646-660X; HJZ-4508-2023; A-5375-2017; JJW-4932-2023; JJY-3921-2023; JHN-1091-2023; CTG-5805-2022; JGS-7600-2023Introduction: Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. In this study, it was aimed to examine the microbiological factors, biochemical and clinical characteristics of neonatal meningitis cases, to reveal the risk factors, and to investigate the effect on the morbidities associated with meningitis in the first year of life.Materials and Methods: The files of patients diagnosed with meningitis in the level 3 Neonatal Intensive Care Unit between January 2010 and December 2015 were retrospectively analyzed.Results: There were 118 patients diagnosed with meningitis. The median gestational age of the patients was 32 weeks (24-40 weeks), and the median birth weight was 1987 grams (690-5020 grams). Most of the meningitis patients (n=106, 90%) were with late sepsis. The diagnosis day of those with poor prognosis was found to be greater [9.7 (2-28) days to 15.5 (3-138) days, p=0.03]. Cerebrospinal fluid (CSF) leukocytes were significantly higher in term babies with abnormal cranial magnetic resonance imaging (MRI) findings (p=0.037) and loss in hearing tests (p=0.045). CSF sugar levels were significantly lower in preterm babies with neuromotor retardation (p=0.001), history of seizures (p=0.003), abnormal cranial MRI findings (p=0.008) and hearing loss (p=0.005).Conclusion: In the long term, a significant number of cases with neonatal meningitis have neuromotor retarda-tion and hearing problems. Factors that can be used as predictors for poor neurological development; late-onset day, increased CSF leukocyte in all babies, and decreased CSF sugar in preterm babies.Publication Effects of early aggressive total parenteral nutrition on biochemical parameters outcome in preterm infants(Galenos Yayincilik, 2019-12-01) Özkan, Hilal; ÖZKAN, HİLAL; Başak, Mehmet Fatih; Köksal, Nilgün; Dorum, Bayram; Çakır, Salih Cağri; ÇAKIR, SALİH ÇAĞRI; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; 0000-0002-2823-8454; 0000-0001-5761-4757; AAG-8393-2021; HJZ-4508-2023; A-5375-2017; AEZ-2469-2022INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants.METHODS: Premature infants born <= 34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth.RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital dischargeDISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.Publication The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study(Elsevier Taiwan, 2021-03-03) Demirdağ, Tuğba Bedir; Koç, Esin; Tezer, Hasan; Oğuz, Suna; Satar, Mehmet; Sağlam, Özge; Uygun, Saime Sunduz; Önal, Esra; Hirfanoğlu, İbrahim Murat; Tekgündüz, Kadir; Oygur, Nihal; Bülbül, Ali; Zubarioğlu, Adil Umut; Ustun, Nuran; Ünal, Sezin; Aygun, Canan; Karagöl, Belma Saygılı; Zenciroğlu, Ayşegül; Öncel, M. Yekta; Sağlık, Adviye Çakıl; Okulu, Emel; Terek, Demet; Narlı, Nejat; Aliefendioğlu, Didem; Gürsoy, Tuğba; Ünal, Sevim; Türkmen, Münevver Kaynak; Narter, Fatma Kaya; Çiftdemir, Nükhet Aladağ; Beken, Serdar; Çakır, Salih Çağrı; Yiğit, Şule; Çoban, Asuman; Ecevit, Ayşe; Çelik, Yalçın; Kulalı, Ferit; ÇAKIR, SALİH ÇAĞRI; Tıp Fakültesi; Neonatoloji Ana Bilim Dalı; 0000-0001-5761-4757 ; HJZ-4508-2023Background: Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis.Methods: A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (& thorn;). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005).Conclusions: Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.Publication Can tissue oxygen saturation levels in the first 24 hours predict the development of patent ductus arteriosus in premature babies with respiratory distress syndrome?(Galenos Yayınevi, 2023-12-01) Dorum, Bayram Ali; Özkan, Hilal; Çetinkaya, Merih; Çakır, Salih Çağrı; Köksal, Nilgün; ÖZKAN, HİLAL; ÇAKIR, SALİH ÇAĞRI; Köksal, Nilgün; Tıp Fakültesi; Neonatoloji Ana Bilim Dalı; 0000-0001-5761-4757; JJY-3921-2023; HJZ-4508-2023; JGS-7600-2023Introduction: Patent ductus arteriosus (PDA) causes a substantial increase in morbidities in premature babies by causing changes in organ perfusion. Various echocardiographic parameters are used to diagnose PDA and determine whether it is hemodynamically significant (HsPDA). This study aimed to investigate the role of tissue oxygen saturation in the first 24 hours in predicting HsPDA in high-risk premature babies who received respiratory support because of respiratory distress syndrome. Materials and Methods: In this prospective, observational study, cerebral, renal, and mesenteric regional tissue oxygen saturation levels were monitored by near infrared spectroscopy (NIRS) for the first 24 hours of the lives of preterm babies at <= 28 weeks of gestation. The NIRS data of babies with and without HsPDA as diagnosed by echocardiographic examination were compared. Results: Eighty-one premature babies who had HsPDA were included in the study. In the control group 51 premature babies who had not HsPDA were evaluated. The median standard deviation (SD) gestational age of the babies included in the study was 26.9 +/- 1 weeks, and the mean +/- SD birth weight was 880 +/- 218 g. Renal and mesenteric NIRS measurements during follow-up were lower in babies with versus without HsPDA, but the difference was not statistically significant. Conclusion: Low renal and mesenteric stO2 values detected on the first day of life in high-risk infants may be associated with HsPDA. More studies are needed to reveal the effects of HsDPA on organs in these vulnerable babies with NIRS monitoring.Publication Etiology, clinic and prognosis of seizures in preterm and term neonates: A retrospective study(Bursa Uludag Üniversitesi, 2021-08-01) Cakir, Salih Cagri; ÇAKIR, SALİH ÇAĞRI; Toker, Rabia Tutuncu; TÜTÜNCÜ TOKER, RABİA; Koksal, Nilgun; Ozkan, Hilal; ÖZKAN, HİLAL; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Kocael, Fatma; KOCAEL, FATMA; Yoruk, Gulce; YÖRÜK, GÜLCE; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dali; 0000-0001-5761-4757; 0000-0002-3129-334X; 0000-0002-9303-5768; 0000-0002-1787-6872; IZP-6290-2023; HJZ-4508-2023Introduction: The seizure is one of the most common neurological problems in neonatal intensive care units (NICU). Its frequency and etiology differ between preteen and term babies. This study aimed to investigate the properties, causes, response to treatment, and prognostic factors of neonatal seizures in term and preterm babies.Materials and Methods: The files of patients with a diagnosis of neonatal seizure in the NICU between 01/01/2014 and 01/09/2019 were analyzed retrospectively. Gross motor function classification, hearing test results and epilepsy rates were examined for neurological outcomes.Results: A total of 86 patients (43 preterm and 43 term infants) were included in this study. The most common etiological factors were hypoxic-ischemic encephalopathy (HIE) (35%) in term infants and intraventricular hemorrhage (IVH) in preterm infants (54%). The most common seizure type was subtle seizures in preterm babies and clonic seizures in term babies. The first seizure day was more on the first day and between the 4-7 days in term babies and after seventh days in preterm babies (p <0.05). The onset time of seizures in preterm babies was more after seven days at IVH, and on the first day at HIE (p<0.05). Status epilepticus frequency is higher in preterm (30%) than term (9.3%) (p = 0.015). The response rate to phenobarbital treatment was 71% in term infants and 50% in preterm infants (p = 0.06). According to the criteria (death, epilepsy, hearing loss, autism and gross motor function scale> 2) in our study, the poor prognosis rates were (52%) in term infants and (75%) in preterm infants (p = 0.051).Conclusion: In the etiology of neonatal seizures, IVH in preterm infants and HIE in term infants were the first. The neurological outcomes of patients who had convulsions in the neonatal period should be followed closely.