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Öğe A 10-year-old boy with limping complaint(Galenos Yayincilik, 2015) Ciftdemir, Mert; Ciftdemir, Nukhet Aladag; Aydin, Deniz; Ozbek, Ulfet Vatansever; Saridogan, Kenan[Abstract Not Available]Öğe Assessment of Healthcare-Associated Infections in Pediatric Intensive Care Unit(Aves Yayincilik, Ibrahim Kara, 2021) Cataltas, Elif Damla Oz; Ciftdemir, Nukhet Aladag; Duran, RidvanObjective: In this study, it was aimed to determine the incidence and rate of healthcare-associated infections, and to determine the susceptible microorganisms and antibiotic susceptibilities by examining the patients hospitalized in our Pediatric Intensive Care Unit retrospectively. Material and Methods: Patients who were hospitalized for more than 48 hours between January 2014 and June 2019 at Trakya University Hospital Pediatric Intensive Care Unit were examined retrospectively and criteria and formulas for Centers for Disease Control and Prevention were used in calculations. Results: A total of 49 healthcare-associated infections were detected in 6825 patient days in a total of 725 patients. Healthcare-associated infection rate was found to be 6.76%. 29 invasive device related infections were detected. Ventilator usage rate was 38%, ventilator associated pneumonia rate was found to be 11.19 per 1000 interventional device days, central venous catheter usage rate was 40%, central venous catheter related hospital infection rate was found to be 0.73 per 1000 interventional device days and urinary catheter usage rate was 26%, catheter related urinary tract infection rate was found to be 0.56 per 1000 interventional device days. The most common agents were Acinetobacter baumannii (37%), Pseudomonas aeruginosa (16.6%), Klebsiella pneumoniae (16.6%), Escherichia coli (9.2%), respectively. Conclusion: The healthcare-associated infection rates of our Pediatric Intensive Care Unit were found at the level of developed countries when compared to other countries. However, our rate of ventilator-associated pneumonia was high. The common problem of pediatric intensive care units is multi-antibiotic resistant microorganisms.Öğe Comparison of sleep problems between term and preterm born preschool children(Elsevier, 2020) Durankus, Ferit; Ciftdemir, Nukhet Aladag; Ozbek, Ulfet Vatansever; Duran, Ridvan; Acunas, BetulObjectives: Sleep disorders are common problems among all age groups. If sleep problems detected in childhood are not resolved successfully, they become sleep disorders and a chronic state. In this study, we aimed to compare sleep problems between preterm-born and term-born preschool-age children. Methods: In the cross-sectional study, children were grouped according to whether they were born preterm or at term. The preterm group included 137 children aged four to six years. The control group comprised 145 age-matched term-born preschool children. The prenatal, natal, demographical, and clinical characteristics of preterm- and term-born preschool-age children were compared. The Children's Sleep Habits Questionnaire (CSHQ) was used to identify sleep problems. The total score and subscores of the CSHQ were compared between the groups. Results: The percentage of gastroesophageal reflux (GER) symptoms and obstructive sleep apnea (OSA) symptoms were significantly higher in the preterm group. According to the cutoff point of the CSHQ, 97 children in the preterm group (70.8%) and 88 children in the control group (60.7%) had a sleep disorder. The total score of the CSHQ was significantly higher in the preterm group compared with the control group; however, the scores of the subscales were similar between the groups. In the regression analysis, a significant association was found between being born preterm and having sleep disorder (beta = 0.308, OR = 1.36, p = 0.04). Conclusions: Our study reported a high percentage of sleep problems in preterm-born preschool children. We suggest that prematurity is associated with sleep problems even if the etiology of sleep problems is heterogeneous. Symptoms regarding GER and OAS should be investigated, and precautions, such as prohibiting maternal cigarette smoking, should be taken in preterm infants. (C) 2020 Elsevier B.V. All rights reserved.Öğe Congenital and Perinatal Cytomegalovirus Infections in the Neonatal Period: Case Series(Aves Yayincilik, Ibrahim Kara, 2020) Ciftdemir, Nukhet Aladag; Acunas, BetulObjective: Cytomegalovirus infection when diagnosed in the first three weeks of life is generally accepted to be indicative of a congenital or vertical infection, whereas when cytomegalovirus infection is diagnosed after the first three weeks of life, it is generally considered as perinatal or horizontal infection. Since diagnosis of either a congenital or perinatal cytomegalovirus infection is challenging, as well as their treatment, this study aimed to address the issues about the diagnosis and treatment of congenital/perinatal cytomegalovirus infection by presenting a series of infants followed-up in our neonatal intensive care unit. Material and Methods: Medical records of newborn infants with congenital/perinatal cytomegalovirus infection who were admitted to our level ill neonatal intensive care unit between August 2015 and May 2018 were evaluated retrospectively. Only infants who received cytomegalovirus-specific therapy were included. Results: Out of 1039 infants admitted to the neonatal intensive care unit during the study period, 8 (0.8%) were diagnosed and treated for congenital/perinatal cytomegalovirus infections. All of them were preterm infants. Four infants found to be CMV positive during the first 21 days of life were diagnosed as congenital cytomegalovirus infection, while a perinatal and congenital infection differentiation could not be made in the rest of the patients. Anemia (75%), thrombocytopenia (62.5%) and hearing loss (62.5%) were the most common findings in patients with congenital/perinatal infection. None of the infants had chorioretinitis. Two infants (25%) with microcephaly had intracranial calcifications. Sepsis-like findings were present in three very preterm infants (37.5%). Cytomegalovirus-IgM was positive in all 8 infants with infection; however, serum CMV-DNA was positive in seven of them. All infants with moderate to severe symptoms were treated with ganciclovir and/or valganciclovir. Viral load decreased dramatically at the end of the treatment period. Conclusion: Cytomegalovirus infection, either congenital or perinatal, is a greater risk especially for preterm infants who may warrant and benefit from newborn cytomegalovirus screening, early detection, and effective antiviral treatment.Öğe Eating Behaviors of Late and Moderately Preterm Infants at Two Years of Age and Their Associations With Mothers' Mental Health(Lippincott Williams & Wilkins, 2021) Duran, Sedef; Duran, Ridvan; Acunas, Betul; Cesur, Gulay; Ciftdemir, Nukhet AladagObjectives: Preterm infants are at high risk for nutritional difficulties during the neonatal period and early childhood. Long-term nutritional difficulties contribute to unbalanced food intake and growth disorders and are the source of major emotional stress for the family. The aim of this study is to investigate the eating problems of late and moderately preterm (LMPT) infants at the age of 2 years, and to examine the association of these problems with the mental status of their mothers. Methods: In this cross-sectional study, group 1 included LMPT infants born between 32 and 36 + 6 weeks of gestation and Group 2 included term infants born between 37 and 41 + 6 weeks of gestation. Children's Nutrition Difficulties Questionnaire and 21-item Depression Anxiety and Stress Scales (DASS 21) were used for the detection of nutritional difficulties of infants and mothers' mental health status. Results: Groups 1 and 2 were consisted of 79 LMPT and 38 term infants, respectively. Late and moderately preterm infants were found to have a lower drive-to-eat and food repertoire scores as well as lower appetite and food enjoyment than term infants. Pickiness and food neophobia were found to be higher in LMPT infants than term infants. The DASS-21 scores of the mothers of the LMPT infants were higher than those of the term ones. Conclusions: These findings suggest that LMPT infants have more nutritional difficulties at the age of 2 years than term infants and their mothers exhibit more emotional distress than term infant's mothers.Öğe Effect of neonatal resuscitation courses on long-term neurodevelopmental outcomes of newborn infants with perinatal asphyxia(Wiley-Blackwell, 2012) Duran, Ridvan; Gorker, Isik; Kucukugurluoglu, Yasemin; Ciftdemir, Nukhet Aladag; Ozbek, Ulfet Vatansever; Acunas, BetulBackground: In previous studies, it has been demonstrated that Neonatal Resuscitation Program (NRP) courses improve the early outcomes of infants with perinatal asphyxia, but there has been no evidence to demonstrate the effect of NRP on long-term outcomes of perinatal asphyxia. The goal of the present study was to determine the effect of NRP courses on the long-term neurodevelopmental outcome of perinatal asphyxia. Methods: This prospective study included infants referred to the Neonatal Unit during the years 2003-2005. Those patients who were referred before NRP courses (pretraining period) were designated as group 1, those who were referred after the first NRP course (transition period) as group 2, and those who were referred after the second NRP course (post-training period) as group 3. Neurodevelopmental outcomes were assessed and compared at 4-6 years of age. Results: The study involved 40 patients: 23 in group 1, nine in group 2 and eight in group 3. The number of patients who had been diagnosed with cerebral palsy was 13 in group 1, two in group 2, and one in group 3, which was a significant decrease. The number of patients with seizures and electroencephalography abnormality was 12 and 14 in group 1, three and two in group 2, and one and one in group 3, respectively, which was also a significant decrease. Conclusions: NRP courses have positive effects on short-term as well as long-term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required to determine the effects of NRP courses on minor deficits, such as cognitive and behavioral disturbances.Öğe The effect of prenatal breast-feeding and breast-milk training given to expectant mothers on the behaviour of breast-feeding(Turkish Pediatrics Assoc, 2011) Onbasi, Senay; Duran, Ridvan; Ciftdemir, Nukhet Aladag; Vatansever, Ulfet; Acunas, Betul; Sut, NecdetAim: At present, training given during pregnancy has been shown to affect the beginning, percentage and duration of breast-feeding. The present study aims to inform expectant mothers about breast-milk and breast-feeding via a prenatal training and to emphasize the advantages of the training. Material and Method: Trainings on and breast-milk were held for the pregnant womens on two days in a week. Each expectant mother was given prenatal training once. Data were collected via a questionnaire composed of 42 questions about breast-milk and breastfeeding. Statistical 7.0 package was used for statistical analysis. All numeric values were expressed as mean +/- SD and n (%). A p value of < 0.05 was considered statistically significant. This study was approved by the Trakya University Local Ethics Committee. Results: A total of 190 mothers, 90 in training group and 100 in control group were included in the study. A significant difference in the breast-feeding percentage was found in the first six months. The bottle feeding was found to be the case of breast-feeding for less than six months. Conclusions: It is concluded in the present study that the percentage and duration of feeding only with breast-milk could be increased if pregnant women are given training about breast-milk. (Turk Arch Ped 2011; 46: 75-80)Öğe The effects of noise reduction by earmuffs on the physiologic and behavioral responses in very low birth weight preterm infants(Elsevier Ireland Ltd, 2012) Duran, Ridvan; Ciftdemir, Nukhet Aladag; Ozbek, Ulfet Vatansever; Berberoglu, Ufuk; Durankus, Ferit; Sut, Necdet; Acunas, BetulObjective: Preterm infants are exposed to loud noises during their stay in the neonatal intensive care unit which can lead to physiologic and behavioral alterations and even hearing loss. The use of earmuffs can reduce sound level and these changes. The objective of the present study is to evaluate the effectiveness of the earmuffs in preterm infants solely cared for in closed incubators. Methods: A comparative prospective study comprising 20 clinically stable preterm infants weighing less than 1500 g cared in closed incubator was conducted. Preterm infants acted as their own controls whereby they were observed without earmuffs (Group 1) for 2 days and with earmuffs (Group 2) on consecutive 2 days. The preterm infants' physiologic responses and Anderson Behavioral State Scoring System (ABSS) scores were assessed over 30 s every 2 h for 8 h during daytime for 4 days. Results: Out of 20 preterm infants, 6 were male and 14 female with a mean birth weight of 1220 +/- 209 g, gestational age of 29.9 +/- 2.1 weeks. The total number of measurements was 320. The mean ABSS scores of Group 1 and 2 were 3.07 +/- 1.1 and 1.34 +/- 0.3, respectively. Statistically significant difference was noted between the means of ABSS scores (p < 0.001). Preterm infants with earmuffs (87.5%) were more frequently observed in a quiet sleep state of ABSS compared with those without earmuffs (29.4%). Conclusions: Noise level reduction was associated with significant improvement in behavioral states of ABSS. We suggest that noise reduction in preterm infants with earmuffs is helpful by improving sleep efficiency and increasing time of quiet sleep. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Öğe Evaluation of Infant Mortality in Edirne Between Years 2012-2013(Galenos Yayincilik, 2015) Ciftdemir, Nukhet Aladag; Ozden, Deniz; Sayin, Muge; Oksay, Altan; Tarim, Celalettin; Ozbek, Ulfet Vatansever; Ceylan, GulsahAim: Infant mortality rate is one of the most important medical indicators of the quality of health services provided in a country or region. The goal of the study is to detect causes of the infant mortality in Edirne province in 2012 and 2013 and to investigate the factors that affect this rate. Materials and Methods: This descriptive study was carried out retrospectively and the authors examined Infant Mortality Provincial Preliminary Examination reports for babies. Causes of mortality and preventability were examined, analyzed on SPSS 20.0 program, percentage and Chi-square test were used in statistical analysis and p<0.05 level was accepted as significant. Results: Infant mortality rate was found to be 8.3 per thousand in 2012 and 7.5 per thousand in 2013. The first three causes of mortality and their percentages were prematurity-immaturity 39.4% (n=26), congenital anomalies-syndromes 13.6% (n=9) and congenital heart diseases 12.1% (n=8). 86.4% of child deaths (n=57) occurred due to unpreventable causes and 9.1% (n=6) occurred due to preventable causes while no decision could be made in 2 cases and no data were reported in 1 stillbirth case. 59.6% (n=34) of the babies whose mortality causes were unpreventable died at early neonatal period while 100% (n=6) of the babies whose mortality causes were preventable died at post-neonatal period and no significant difference was detected (p<0.05). The rate of unpreventable causes increased as gestational age and birth weight decreased while the rate of preventable causes increased as gestational age and birth weight increased and a significant difference was detected (p<0.05). Conclusion: Neonatal deaths comprise a vast majority of infant mortality cases in our country and worldwide. Decreasing prematurity, improving perinatal care, developing staff and technical requirements of newborn intensive care units, increasing the number of centers to give medical and surgical care for congenital heart diseases, terminating congenital anomalies during pregnancy will help dropping infant mortality rate.Öğe Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society(Aves, 2021) Okulu, Emel; Erdeve, Omer; Tuncer, Oguz; Ertugrul, Sabahattin; Ozdemir, Hulya; Ciftdemir, Nukhet Aladag; Zenciroglu, AysegulObjective: The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods: We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born >= 35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results: One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9 +/- 9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion: Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breast-feeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.Öğe Fungal septic arthritis in newborn(Galenos Yayincilik, 2011) Ciftdemir, Nukhet Aladag[Abstract Not Available]Öğe Identification of Substance Abuse Among Children in a Pediatric Emergency Department(Galenos Yayincilik, 2020) Ciftdemir, Nukhet Aladag; Eren, Tuba; Karal, YaseminAim: Illicit substance use is a worldwide important public health problem with increasing substance abuse rates and decreasing starting age. In this study, our aim was to determine the complaints of the patients in pediatric emergency department (PED) admission in order to increase awareness about substance abuse. Materials and Methods: The data of this cross-sectional study was gathered from those patients admitted to a PED with complaints of substance abuse and patients without a history of substance abuse, but with a positive urine drug test. A screening urine test was used for the qualitative determination of drug substances. If positive, a quantitative liquid chromatography integrated mass/mass spectrometry test was ordered for confirmation. Results: A total of 17 patients presented to the emergency department. The most frequent symptoms were unstable cognitive conditions and tachycardia. Laboratory analyses showed high creatine kinase-MB. Synthetic cannabinoids were the most frequently detected substance in urine screening and confirmation tests. Twenty-nine percent of patients were hospitalized and no mortality was observed. Conclusion: The use of illegal substances has increased in teenagers. Emergency department doctors must be informed and trained regarding substance abuse since patients frequently presented to the emergency department with cognitive malfunctions. Also, it should be remembered that patients may present with symptoms concerning various organ systems.Öğe The Journey to the Pediatric Intensive Care Unit Following Vaccine Refusal(Springer, 2019) Ciftdemir, Nukhet Aladag; Duran, Ridvan; Eren, Tuba; Aslan, Mustafa Torehan[Abstract Not Available]Öğe Papular-Purpuric Gloves and Socks Syndrome(Aves Yayincilik, Ibrahim Kara, 2016) Ciftdemir, Nukhet Aladag; Eren, Tuba; Duran, Ridvan; Acunas, BetulPapular-purpuric gloves and socks syndrome is characterized by focal acral purpuric petechial eruptions. There are various causative agents related to this condition. In most cases, parvovirus B19 has been implicated as the etiological factor. In this report, we present the case of an 11-year-old female patient with papular-purpuric gloves and socks syndrome having petechial and erythematous lesions only on her feet and legs. Acute parvovirus B19 infection was confirmed by serological tests. The purpose of this report is to emphasize the presence of atypical presentation of this syndrome in children.Öğe A Rare Cause of Torticollis: Grisel Syndrome(Oxford Univ Press, 2018) Ciftdemir, Nukhet Aladag; Eren, Tuba; Ciftdemir, MertPainful torticollis in children requires specific attention. Grisel syndrome is diagnosed on suspicion in patients with recent or history of ongoing upper respiratory tract infections and in patients with restriction of movement or deformity following oto-rhino-laryngologic surgery. Pediatricians should be aware of this condition because early diagnosis and intervention are critical for prognosis in Grisel syndrome.Öğe The Relation Between Serum Levels of Insulin-like Growth Factor-1 and Bronchopulmonary Dysplasia(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2019) Ciftdemir, Nukhet Aladag; Acunas, Betul; Ozbek, Ulfet Vatansever; Duran, RidvanObjective: The etiology of bronchopulmonary dysplasia (BPD) which is the most important unwanted consequence of premature delivery at long term has not been determined clearly yet.. Insulin-like growth factor-1 (IGF-1) is involved in both prenatal and postnatal lung growth. Our aim is to characterize postnatal changes in serum IGF-1 in relation to development of BPD in preterms. Method: Sixty-seven preterm newborns were evaluated prospectively in order to investigate independent risk factors associated with BPD and to determine the relation between serum IGF-1 levels and BPD. Infants included in the study were divided into two groups as those that developed (Group 1; n=12) and did not develop BPD (Group 2; n=55). Serum IGF-1 levels were measured from venous blood samples of each infant on days 1, 7, 14 and 28 after birth. Results: When the variables showing significant differences in the comparisons between the two groups were evaluated in different logistic regression models, according to the most significant model; presence of chorioamnionitis did not contribute significantly to the development of BPD. It was found that 1 week increase in gestational week reduced the risk of BPD formation by half, while the presence of RDS or sepsis increased the risk of development of BPD by 14.4, and 9.6 times, respectively. ROC analysis with serial measurements of IGF-1 showed that IGF-1 was not a determinant of BPD development. Conclusion: We could not find any relation between development of BPD and serum IGF-1 levels in our study and concluded that the smaller number of newborn who developed BPD could have limited the evaluation of this association.Öğe The relationship between leukemoid reaction and perinatal morbidity, mortality, and chorioamnionitis in low birth weight infants(Elsevier Sci Ltd, 2010) Duran, Ridvan; Ozbek, Ulfet Vatansever; Ciftdemir, Nukhet Aladag; Acunas, Betul; Sut, NecdetObjectives: Neonatal leukemoid reaction (NLR) is relatively rare and considered as a white blood cell (WBC) count >= 50 x 10(9)/l. The aim of this study was to investigate the association of NLR with neonatal morbidity and mortality and maternal chorioamnionitis in low birth weight infants. Methods: In this case-controlled retrospective study, the medical records of 1200 newborn infants with a birth weight <2500 g admitted to the neonatal unit over a period of 5 years were reviewed. The infants who developed features of NLR (n = 17, 1.4%) formed the study group, while the remainder without NLR, matched for gestational age and birth weight (n = 123), formed the control group. A chart review was performed and salient demographic, clinical, and laboratory data abstracted. A statistical analysis was subsequently performed on this data. Results: The mean WBC and absolute neutrophil counts of infants with NLR were significantly higher than those in the control group. The peak time of NLR was at 7.9 +/- 3.6 (interquartile range (IQR) 1-30) days and on average it improved within 4.1 +/- 1.95 (IQR 2-9) days. It was noted that those infants with NLR were mostly born by vaginal delivery and their mothers had a higher rate of early rupture of the membranes and chorioamnionitis. NLR was associated with a 4-fold increase in sepsis, 20-fold increase in intraventricular hemorrhage, 54-fold increase in bronchopulmonary dysplasia, and 6-fold increase in mortality. In the study group, those infants whose mothers had chorioamnionitis had a higher rate of early rupture of the membranes and they developed sepsis and intraventricular hemorrhage more often than those whose mothers did not have clinical chorioamnionitis. Conclusions: In low birth weight newborn infants, NLR is significantly associated with sepsis, intraventricular hemorrhage, bronchopulmonary dysplasia, and a high mortality rate. Also, those infants with NLR are more likely to be born to mothers with chorioamnionitis and they face sepsis and intraventricular hemorrhage more often. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.