Papers by Zeynep Alp Ünkar
European Journal of Medical Genetics
Turkish Archives of Pediatrics
Purpose: We aimed to compare the short-term outcomes of infants from our level IIIC neonatal inte... more Purpose: We aimed to compare the short-term outcomes of infants from our level IIIC neonatal intensive care unit (NICU) in two different periods. Method: In this cohort study, data from preterm infants (≤29 weeks and birth weight <1500 g) registered in the Vermont Oxford Network (VON) system were divided into two periods, the first period between January 1, 2005, and December 31, 2009, and the second between January 1, 2010, and December 31,2019.Results: There was no difference in the distribution of preterm infants according to their gestational age subgroups (p=0.169). Although the survival rate increased significantly in the second period (48.1% vs. 64.3%, (p<0.001), there was no difference in terms of survival without morbidity (p=0.480). Conclusion: Analysis of NICU data, through rigorous methods may provide opportunities for the development of quality improvement projects to improve the quality of health care in developing countries.
Bagcilar Medical Bulletin
Iranian Journal of Pediatrics, 2019
Objectives: The aim of this study was to evaluate tubular functions of posterior urethral valve p... more Objectives: The aim of this study was to evaluate tubular functions of posterior urethral valve patients with preserved glomerular functions. Methods: A total of 25 children (ages 1-18) who underwent surgery for PUV and had an estimated glomerular filtration rate ≥ 90 mL/min per 1.73 m 2 on long term follow-up and age-matched 25 healthy controls were enrolled. Blood and urine samples were collected to assess electrolyte reabsorption, proteinuria, enzymuria, urine acidification and concentration. Results: Even though microalbumin/creatinine ratio was higher in the patient group [1.00 (1.98) vs 0.31 (0.34) mg/gr creatinine, P = 0.005] none of the subjects had enzymuria, overt proteinuria or hyperphosphaturia. Serum bicarbonate levels were lower and urinary pH higher in patients than the controls (23.2 ± 2.1 vs. 24.6 ± 1.9 mmol/L, P = 0.028 and 6.24 ± 0.77 vs. 5.60 ± 0.64, P = 0.004); furthermore, patients had lower urinary osmolality and density (525 ± 214 vs. 743 ± 194 mOsm/L, P = 0.001 and 1011 ± 5.0 vs. 1016 ± 6.8, P = 0.005). When patients were compared among themselves according to presence or absence of renal scarring and when patients without renal scars were compared to healthy controls, similar findings persisted. Conclusions: This study showed that during long-term follow-up of posterior urethral valve patients with normal glomerular filtration rates, even though proximal tubular functions do not seem to be impaired, acidification and concentration defects exist indicating distal tubulopathy.
Academic Journal of Pediatrics & Neonatology, 2016
Aim: Preterm infants commonly receive at least one packed red blood cell transfusion during their... more Aim: Preterm infants commonly receive at least one packed red blood cell transfusion during their stay in the neonatal intensive care unit and even though the complications related to prematurity are multifactorial, especially bronchopulmonary dysplasia, necrotizing enterocolitis and intraventricular hemorrhage have been shown to be independently related with red blood cell transfusions. This study aims to determine the extent of lipid peroxidation in preterm babies after multiple transfusions, and to figure out acut-off value of ferritin to start or withhold iron prophylaxis in transfused babies. Methods: Serum malondialdehyde and ferritin levels of 23 preterm babies (born earlier than 35th gestational week) were measured and the relation between total number of red blood cell transfusions, malondialdehyde and ferritin levels were assessed. Results: The relations between the transfusion numbers and ferritin levels; and, ferritin and malondialdehyde levels were statistically significant. Another noteworthy finding was that the increase in serum malondialdehyde levels was significantly higher in infants with serum ferritin levels >450 ng/mL. Conclusion: It is important to monitor serum iron status and lipid peroxidation in preterm babies who were multiply-transfused. Ferritin and malondialdehyde levels can be used for this monitorization.
Türkiye Klinikleri Neonatoloji - Özel Konular, 2021
Journal of pediatric endocrinology & metabolism : JPEM, 2018
In this case report, we present a preterm newborn with persistent lactic acidosis who received to... more In this case report, we present a preterm newborn with persistent lactic acidosis who received total parenteral nutrition (TPN) that lacked thiamine. A 28-week-old, 750 g female infant was born with an Apgar score of 8 at the 5th minute. Umbilical cord blood gas levels, including lactate level, were normal, and she was admitted to our neonatal intensive care unit (NICU). Achieving full enteral feeding was not possible due to gastric residues and abdominal distention, making the patient dependent on TPN during the first 2 weeks of life. An insidious increase in lactic acid levels and uncompensated metabolic acidosis were apparent from the 23rd day of life. Severe metabolic acidosis was persistent despite massive doses of bicarbonate. The acidosis resolved dramatically within 6 h when the patient was administered with thiamine. Although TPN is life saving in the NICU, meticulous attention must be paid to provide all essential macro- and micro-nutrients.
Marmara Medical Journal, 2017
two other grade III patients based on the radiological findings. However, due to the appearance o... more two other grade III patients based on the radiological findings. However, due to the appearance of necrotic bowel segments from the incision site, they underwent bowel resection and ileostomy during a bedside laparotomy. One of these patients improved clinically, but the other patient was lost in the early stages. Due to the deterioration seen in the clinical findings of 5 patients who were radiologically grade II, the decision for laparotomy was made initially. All of these 5 patients were discharged after an uneventful postoperative period. Conclusion: In patients who are grade II radiologically, the decision for surgical intervention in an operating room can be made according to clinical deterioration. In infants who are grade III, and whose clinical condition is poor, bedside surgical intervention in the neonatal intensive care unit is preferable..
The Journal of Maternal-Fetal & Neonatal Medicine, 2015
Indomethacin and ibuprofen are commonly used in the treatment of hemodynamically significant pate... more Indomethacin and ibuprofen are commonly used in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA). These drugs are associated with serious adverse events, including gastrointestinal perforation, renal failure and bleeding. The role of paracetamol has been proposed for the treatment of PDA. We report a series of 11 neonates (birth weight: 415-1580 g; gestational age: 23-30.3 weeks) who were treated with paracetamol for a hsPDA. Neonates with hsPDA were treated with paracetamol in the presence of contraindications to ibuprofen or indomethacin. The condition of significant PDA was defined by the presence of at least one of the following criteria: internal ductal diameter # 1.4 mm/kg body weight, left atrium (LA)-to-aortic (Ao) root ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1.4, unrestrictive pulsatile transductal flow, reverse or absent diastolic flow in the descending aorta along with clinical findings. Intravenous (IV) paracetamol was given at doses 15 mg/kg every 6 h for three days. Successful ductal closure was achieved in 10 out of 11 babies (90.9%). No adverse or side effects were observed during the treatment. On the basis of these results, paracetamol could be considered as a promising and safe therapy for the treatment of PDA in preterm infants.
International Journal of Clinical Pediatrics, 2014
Hypochloremic metabolic alkalosis occurs in pseudo-Bartter's syndrome (PBS) without a primary ren... more Hypochloremic metabolic alkalosis occurs in pseudo-Bartter's syndrome (PBS) without a primary renal tubular defect. Usually seen in cystic fibrosis, this syndrome can also be caused by recurrent vomiting for various reasons. We present a case of multiple gastrointestinal anomalies, each by itself capable of causing the clinical condition, in a 10-day-old infant with PBS.
International Journal of Clinical Pediatrics, 2014
Different modalities of non-invasive ventilation (NIV), one of which is nasal biphasic positive a... more Different modalities of non-invasive ventilation (NIV), one of which is nasal biphasic positive airway pressure (nBiPAP), are used both after extubation and as an alternative to intubation in suitable cases. Just as mechanical ventilation (MV), NIV can be complicated by air leak syndromes. Pneumopericardium (PPC), especially if isolated, is the rarest of these conditions. We present a case of isolated PPC in a preterm newborn as a complication of nBiPAP.
Asia Pacific Journal of Public Health, 2013
The aim of this study was to explore the relationships between involvement in bullying behaviors ... more The aim of this study was to explore the relationships between involvement in bullying behaviors and school, family, and peer factors. Health Behavior in School Age Children survey questionnaire was used. Of the students surveyed, 20% were both bully and victim, 11% were bully, and 21% were victim. Being male, poor parental support, and poor monitoring by the father were found to be risk factors for being both bully and victim. Poor academic achievement, having peers at different ages, poor quality of friendship, poor communication with parents, and not being isolated by peers were found to be risk factors for being bully. Not liking school, feeling pressured by school work, poor quality of friendship, poor monitoring by the father, close bonding with mother, and poor status of the peer group were found to be risk factors for being victim. These findings highlight the importance that bullying intervention programs should include country-specific and culture-specific influences for s...
Molecular Syndromology
Loss of methylation (LoM) of the imprinting control region 1 (ICR1) in the chromosome 11p15.5 dom... more Loss of methylation (LoM) of the imprinting control region 1 (ICR1) in the chromosome 11p15.5 domain is detected in patients with Silver-Russell syndrome (SRS), characterized by asymmetric pre- and postnatal growth restriction, and typical craniofacial features. The patients with intrauterine growth restriction (IUGR) possess a high risk for adult metabolic problems. This study is aimed to investigate the methylation levels of the chromosome 11p15.5 region and metabolic problems in children with syndromic and nonsyndromic IUGR. Methylation analysis was performed for chromosome 11p15.5 in 49 patients (33 with suspected SRS and 16 nonsyndromic IUGR) with Netchine-Harbison clinical scoring (NHCS); uniparental disomy for chromosomes 6, 7, 14, and 20 was evaluated for those who were negative. LoM of ICR1 was detected in 14 of 33 suspected SRS patients with 3 or more criteria of NHCS, 5 had borderline LoM. Maternal uniparental disomy of the chromosomes 7 and 14 was found in 2 patients. Th...
European Journal of Medical Genetics
Background Umbilical artery cord blood gas (UACG) values and Apgar scores (AS) are the two parame... more Background Umbilical artery cord blood gas (UACG) values and Apgar scores (AS) are the two parameters that provide the fastest information about the well-being of a baby after birth. We hypothesized that AS may not be sufficient for a complete and correct evaluation of the newborns and UACG should be used routinely for all births even without any signs of fetal distress. Material-methods In this retrospective study, the data of 1781 babies born between January 2018 and December 2019 at Cerrahpasa Faculty of Medicine were analyzed. Newborn with fetal distress, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at UACG), and pre and postterm newborns are excluded. The UACG and the 1 and 5-minute AS data of 1438 cases were evaluated. Mild acidemia was accepted as a pH between 7.1 and 7.2. Following UACG threshold values were accepted as abnormal pH <7.2, BE
The Journal of Pediatric Research
We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and the... more We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and therefrom, to clarify the clinical importance of routinely checking serum total bilirubin (STB) levels after the cessation of phototherapy and to define an optimal time to check STB levels for the detection of RHB. Materials and Methods: Term and late preterm babies who received phototherapy were included in this study. The demographic and clinical features, time of onset of jaundice, phototherapy time and results to determine the etiology of jaundice were recorded for all babies. Serum "rebound" bilirubin measurements were performed two times at 12 and at 24 hours after the cessation of phototherapy. The re-initiation of phototherapy according to the 12 th and 24 th hour STB levels was accepted as "early rebound" and "late rebound", respectively. IBM SPSS 22 was used for statistical analyses. Results: Data was available for 110 infants. The rebound rate requiring phototherapy was 9.1% (n=10) and all had a risk factor. Most of the babies (9/10) rebounded at the 12 th hour after the termination of phototherapy. Hemolysis and prematurity were found to be statistically significant for RHB (p=0.008; p=0.048). Conclusion: Post-phototherapy bilirubin follow-up may be incorporated using a combined approach of individualization, evaluation of risk factors, and application of common sense before discharge. Our study showed that STB levels could be measured after the cessation of phototherapy, especially in patients with a risk factor, at the 12 th hour before discharge. Randomized controlled studies with larger sample sizes are still needed for definitive recommendations.
Journal of Infection and Public Health, 2017
Raoultella planticola is rarely associated with clinical infection, and a limited number of pedia... more Raoultella planticola is rarely associated with clinical infection, and a limited number of pediatric cases have been reported. Herein we report a case of bacteremia presumptively secondary to bilateral conjunctivitis in an infant caused by R. planticola which was successfully treated with piperacillin-tazobactam. It should be kept in mind that R. planticola can be a pathogen in pediatric age groups.
SpringerPlus, 2016
Background: Chryseobacterium indologenes is an uncommon organism that has been documented to caus... more Background: Chryseobacterium indologenes is an uncommon organism that has been documented to cause a variety of invasive infections mostly in hospitalized patients with severe underlying diseases. Case presentation: A three-month-old female infant born at term by caesarean section with meningomyelocele and congenital diaphragmatic hernia had two surgeries for the repair of meningomyelocele and diaphragmatic hernia on her 3rd and 14th day, respectively. On the 3rd month of her life, she deteriorated clinically with fever, leukocytosis and increase of acute-phase reactants. Gas exchange condition became worse than it was before. Respiratory secretions, oxygen requirements and ventilator demand increased. Chest X-ray showed bilateral pulmonary infiltrates. Bacteriological blood, urine and cerebrospinal fluid culture test results were negative. C. indologenes was isolated from tracheobronchial secretion sample obtained by endotracheal aspiration. Although susceptible to ciprofloxacin (MIC:0.5 gr/L), levofloxacin and piperacillin-tazobactam, the isolate was resistant to meropenem, imipenem and colistin. She was treated with ciprofloxacin successfully. Her fever resolved and gas exchange condition improved after 72 h of the treatment. The antibiotic treatment was given for a course of 14 days. Conclusion: Chryseobacterium indologenes may emerge as a potential pathogen in infants with the factors such as invasive equipment, having underlying diseases and prolonged hospitalization.
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Papers by Zeynep Alp Ünkar