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Publication Open Access Management of hypoglycemia in newborn: Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report(Turkish Pediatric Association, 2019) Aliefendioğlu, Didem; Çoban, Asuman; Hatipoğlu, Nihal; Ecevit, Ayşe; Arısoy, Ayşe Engin; Baş, Firdevs; Bideci, Aysun; Özek, Eren; N/A; Yeşiltepe Mutlu, Rahime Gül; Faculty Member; School of Medicine; 153511Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute alter feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL alter 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is <50 mg/dL in babies receiving parenteral infusion. The hypoglycemic babies in the risk group whose infusions have been terminated can be discharged, if the plasma glucose level is found to be at the target level for two times before feeding and babies with permanent, severe or resistant hypoglycemia can be discharged, if the plasma glucose level is >60 mg/dL following a 6-hour fast. / Hipoglisemi, uzun sürmesi ve tekrarlaması durumunda nörolojik zedelenme riski nedeniyle, yenidoğanın en önemli ve en sık metabolik sorunlarından birisidir. Bu nedenle, hipoglisemi riski taşıyan yenidoğanlar, doğum sonrası hemen beslenmeli ve beslenme sonrası 30. dakikadan itibaren 2-3 saat aralıklarla kan glukozuna bakılmalıdır. Hipoglisemi eşik değerleri, ilk 24 saat için belirtisi olanlarda 40 mg/dL, belirtisiz olanlarda 0 - 4 saatte 25 mg/dL, 4-24 saat aralığında 35 mg/dL, 24 saatten sonra 50 mg/ dL, 48 saatten sonra ise 60 mg/dL olarak kabul edilebilir. Tarama hastabaşı test çubukları ile yapılmalı, sınıra yakın değerlerde, laboratuvar yöntemi ile doğrulama yapılırken, gerekliyse tedavi başlanmalıdır. Tedavi ile ulaşılması hedeflenen düzeyler, beslenme öncesi postnatal ilk 48 saatte 50 mg/dL, 48 saatten sonra riskli olanlarda 60 mg/dL, kalıcı hipoglisemili olgularda ise 70 mg/dL’nin üstü olarak kabul edilebilir. Kan glukozu eşik değerin altında olan ve beslenme ile yükseltilemeyen durumlarda, 6-8 mg/kg/dk glukoz infüzyonu başlanmalı, belirti eşlik etmesi durumunda ise 2 ml/kg %10 dekstroz minibolus eşlik etmelidir. Hedef düzeye ulaşılamaması durumunda artışlar ve beslenme ile stabilizasyonun sağlanması durumunda azaltmalar 2 mg/kg/dk olarak yapılmalı, infüzyon hızının 3-5 mg/kg/dk’ye inmesi durumunda ise infüzyon sonlandırılmalıdır. Gerekliyse ayırıcı tanı açısından kan örnekleri hipoglisemi sırasında alınmalı ve araştırma, enteral beslenen bebeklerde 6 saatlik beslenmeme periyodu sonrasında, parenteral infüzyon alanlarda ise plazma glukozunun 60 mg/dL olması durumunda taburcu edilebilirler.Publication Open Access Being a pediatrician and living in the world of children(Aves, 2022) Hatun, Şükrü; Faculty Member; School of Medicine; 153504Publication Open Access Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice(Turkish Pediatric Association, 2018) Çoban, Asuman; Türkmen, Münevver Kaynak; N/A; Gürsoy, Tuğba; Faculty Member; School of Medicine; 214691Jaundice is one of the most common problems in the newborn. It is generally accepted as a physiologic condition; most cases are benign and transient. However, in a small portion of jaundiced newborn infants, serum bilirubin concentrations increase to a level at which irreversible brain damage can occur. The timely diagnosis and management of severe hyperbilirubinemia is essential to prevent acute bilirubin encephalopathy and kernicterus. Kernicterus still occurs although it is almost always preventable. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy. Therefore, a system-based approach using the recommendations of this guideline should be implemented in all birthing facilities and continued in ambulatory care of the newborn infants. / Sarılık yenidoğan bebeklerde sık görüllen bulgulardan biridir. Normal fizyolojik bir durum olarak kabul edilir; genellikle selim, geçici bir durumdur. Ancak yenidoğanların küçük bir bölümünde geri dönüşümsüz ciddi beyin hasarı için tehdit oluşturabilen düzeylere erişebilir. Zamanında tanı konup tedavi edildiğinde akut bilirubin ensefalopatisi ve kernikterus önlenebilir. Kernikterus her zaman önlenebilir bir durum olmasına rağmen halen görülmektedir. Bu kılavuzun amacı ciddi hiperbilirubinemi sıklığını ve bilirubin ensefalopatisini azaltmaktır. Bundan dolayı bu kılavuzun önerilerinin tüm doğum yapılan kurumlarda ve taburcu etme sonrası izlemde kullanılmasını sağlamak önemlidir.Publication Open Access Infrared temassız alın termometresi: çocukların ateş ölçümünde güvenilir bir yöntem mi? sistematik derleme(Hemşirelikte Araştırma Geliştirme Derneği, 2014) Ekim, Ayfer; Ocakçı, Ayşe Ferda; Faculty Member; School of Nursing; 1729Amaç: Bu sistematik derlemede, son yıllarda çocuklarda yaygın olarak kullanılmaya başlanan infrared temassız alın termometresi ölçümlerinin, diğer ölçüm yöntemleri ile karşılaştırıldığı araştırmaların gözden geçirilmesi amaçlanmıştır. Yöntem: Konu ile ilgili araştırmalara ulaşmak için PubMed, Ulakbim, Türk Medline, Ulusal Tez Tarama veri tabanı ve ülkemizde düzenli olarak yayınlanan, editörlü ve çevrimiçi olarak ulaşılabilen 13 hemşirelik dergisinin arşivleri kullanılmıştır. Bulgular: Araştırmalar, infrared temassız alın termometresinin duyarlılığının “yüksek”, özgüllüğünün “düşük” olduğunu göstermektedir. İncelenen araştırmaların %37,5’i çocukların ateş ölçümlerinde en güvenilir yöntemin rektal ölçümler olduğu, infrared temassız alın termometresinin, rektal ölçüm yapılamadığı durumlarda ancak alternatif olarak kullanılabileceği, %12,5’i ise bu yöntemin kullanılmaması gerektiğini ortaya koymaktadır. Araştırmaların %31,2’sinde rektal termometre ve infrared temassız alın termometre ölçüm sonuçları arasında korelasyon düzeyinin yüksek olduğu (0,74-0,91) saptanmış olup, infrared temassız alın termometresinin çocuklarda güvenle kullanılabileceği gösterilmektedir. Sonuç: Çocuklarda, infrared temassız alın termometresi ölçümlerinin etkililiğini ortaya koyma konusunda verilerin oldukça sınırlı olmasına rağmen, araştırma sonuçları, 0-3 ay arası çocuklarda ve yoğun bakım kliniklerinde infrared temassız alın termometresinin kullanılmasının uygun olmadığını göstermektedir. Bunun yanında, ev ortamında çocuğun ateşinin değerlendirilmesi ve hızlı kullanımından dolayı da taramalarda kullanılabileceği belirtilmektedir. / Objective: In this systematic review, it was aimed to take a glance at the studies in which non-contact infrared forehead thermometer measurements were compared to other measurement techniques. Method: In order to access the studies on the issue, Pubmed, Ulakbim, Turkish Medline, National Thesis Scanning Database and the archives of 13 Nursing journals published either written or online were used. Results: The studies showed that the sensitivity of infrared non-contact forehead thermometer was “high” and its specificity was “low”. In 37.5% of the studies, it was revealed that the most reliable method of measuring fever was rectal measurement, and infrared non-contact forehead thermometer measurement could only be used as an alternative way when rectal measurement could not be performed. In addition; according to 12.5% of studies, infrared non-contact thermometer measurement technique should never be used. In 31.2% of the studies, it was shown that a high correlation (0.74 - 0.91) was determined between the rectal thermometer results and the results of infrared non-contact forehead thermometer, and infrared non-contact thermometer could safely be used in children. Conclusion: Even though the data on efficiency of infrared non-contact forehead thermometer measurements in children are rather limited, the study results set forth that it is not appropriate to use that technique in children between 0-3 months and in intensive care units. However, it is stated that infrared non-contact forehead thermometer is an easy to use technique at home owing to its easy evaluation and practicality.Publication Open Access Neonatal Hyperglycemia, which threshold value, diagnostic approach and treatment?:Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report(Turkish Pediatric Association, 2018) Şimşek, Damla Gökşen; Ecevit, Ayşe; Hatipoğlu, Nihal; Çoban, Asuman; Arısoy, Ayşe Engin; Baş, Firdevs; Bideci, Aysun; Özek, Eren; N/A; Yeşiltepe Mutlu, Rahime Gül; Faculty Member; School of Medicine; 153511Hyperglycemia has become an important risk factor for mortality and morbidity in the neonatal period, especially with increased survival rates of very low birth weight neonates. Hyperglycemia in the neonatal period develops as a result of various mechanisms including iatrogenic causes, inability to supress hepatic glucose production, insulin resistance or glucose intolerance, specifically in preterm neonates. Initiation of parenteral or enteral feeding in the early period in preterm babies increases insulin production and sensitivity. The plasma glucose is targeted to be kept between 70 and 150 mg/dL in the newborn baby. While a blood glucose value above 150 mg/dL is defined as hyperglycemia, blood glucose values measured with an interval of 4 hours of >180-200 mg/dL and +2 glucosuria require treatment. Although glucose infusion rate is reduced in treatment, use of insulin is recommended, if two blood glucose values measured with an interval of 4 hours are >250 mg/dL and glucosuria is present in two separate urine samples. / Yenidoğan döneminde özellikle çok düşük doğum ağırlıklı bebeklerin yaşamda kalmaya başlamaları ile birlikte, hiperglisemi morbidite ve mortalite için önemli bir risk etmeni olmuştur. Yenidoğan döneminde özellikle preterm bebeklerde hiperglisemi, iyatrojenik nedenler, karaciğerde glukoz üretiminin baskılanamaması, insülin direnci ya da glukoz intoleransı gibi mekanizmalar sonucu gelişmektedir. Preterm bebeklerin erken dönemde parenteral ya da enteral beslenmeye başlanması; insülin yapımını ve duyarlılığını arttırır. Yenidoğan bebekte kan şekerinin 70-150 mg/dL arasında olması hedeflenmektedir. Kan şeker düzeyi >150 mg/dL olması hiperglisemi olarak tanımlanırken; 4 saat ara ile bakılan kan şekerinin >180-200 mg/dL olması ve +2 glukozüri olması tedaviyi gerektirmektedir. Tedavide glukoz infüzyon hızı azaltılmasına rağmen; 4 saat ara ile bakılan 2 kan şekeri değeri >250 mg/dL ve alınan iki ayrı idrar örneğinde glukozüri varsa insülin kullanılması önerilmektedir.Publication Open Access The effect of chewing gum on oral mucositis in children receiving chemotherapy(Insight Medical Publishing, 2014) Ayverdi, Didem; Ekim, Ayfer; Ocakçı, Ayşe Ferda; Faculty Member; School of Nursing; 1729Background: Oral mucositis is an important clinical problem, resulting in significant patient morbidity, a change in health-related quality of life, and supportive care. The purpose of this study was to assess the efficiency of chewing gum on children, who are receiving chemotherapy regimens, for prevention and treatment of oral mucositis. Method and Material: The study sample consisted of 60 children (30 study group-30 control group) between the ages 6-18 years. All the children have received chemotherapy at least once. Study group children chewed non-sugar gums three times a day at least 20 minutes during 10 days. In oral assessment, WHO Oral Mucositis Assessment Scale and Eilers’ Oral assessment Guide was used and also salivary pH measurement was done. Results: The rate of children who was assessed as Grade 1 and Grade 2, decreased 46.1% in study group and this rate decreased to 20.8% in the control group. At the beginning of the study, 13.3% of the study group children were assessed as Grade 3 but at the end of the study none of the children were observed at Grade 3. Also, statistically significant difference was found between study and control groups’ pH values. Conclusion: The results of that study show new evidence about preventing and decreasing severity of oral mucositis for the children, receiving chemotherapy.Publication Open Access Does being born small-for-gestational-age affect cerebellar size in neonates?(Taylor _ Francis, 2016) Imamoglu, Ebru Yalin; Sancak, Selim; Ovali, Fahri; Gürsoy, Tuğba; Faculty Member; School of Medicine; Koç University Hospital; 214691Objective: To investigate how cerebellar vermis height (CVH) and transverse cerebellar diameter (TCD) measurements are affected in SGA neonates.Methods: A total of 176 [88 SGA and 88 appropriate for gestational age (AGA)] neonates between 26 and 42 weeks of gestation were included. Midsagittal plane through the anterior fontanel and coronal plane through the left mastoid fontanel were used to measure CVH and TCD, respectively. CVH and TCD values were considered normal when they were 10th percentile, according to nomograms of AGA neonates.Results: Thirty-six asymmetric SGA neonates, 52 symmetric SGA neonates and their 88 gestational age-matched AGA controls were studied. The percentages of neonates with normal CVH and TCD in the symmetric SGA sub-group were significantly lower than those in the AGA and asymmetric SGA sub-groups. The percentages with normal CVH and TCD in the asymmetric SGA sub-group were also found to be low when compared with the AGA sub-group.Conclusion: Growth and development of cerebellum may be less spared in SGA neonates. Further studies with larger series are needed in order to evaluate how being born SGA (symmetric and asymmetric) affects cerebellar size and also to see how these findings influence the neurocognitive outcomes of these infants at long-term follow-up.Publication Open Access Differential lung ventilation via tracheostomy using two endotracheal tubes in an infant: a case report(BioMed Central, 2017) Ataman, Yasemin; N/A; Demirkol, Demet; Gündoğdu, Gökhan; Faculty Member; School of MedicineBackground: This case report presents differential lung ventilation in an infant. The aim is to define an alternative technique for performing differential lung ventilation in children. To the best of our knowledge, this is the first report of this kind. Case presentation: A 4.2-kg, 2.5-month-old Asian boy was referred to our facility with refractory hypoxemia and hypercarbia due to asymmetric lung disease with atelectasis of the left lung and hyperinflation of the right lung. He was unresponsive to conventional ventilator strategies; different ventilator settings were required. To perform differential lung ventilation, two separate single-lumen endotracheal tubes were inserted into the main bronchus of each lung by tracheotomy; the tracheal tubes were attached to discrete ventilators. The left lung was ventilated with a lung salvage strategy using high-frequency oscillatory ventilation, and the right lung was ventilated with a lung-protective strategy using pressure-regulated volume control mode. Differential lung ventilation was performed successfully with this technique without complications. Conclusions: Differential lung ventilation may be a lifesaving procedure in select patients who have asymmetric lung disease. Inserting two single-lumen endotracheal tubes via tracheotomy for differential lung ventilation can be an effective and safe alternative method.Publication Open Access Birth weight reference percentiles by gestational age for Turkish twin neonates(Aves, 2021) İmamoğlu, Ebru Yalın; Hayran, Mutlu; Kayıran, Sinan Mahir; Zeybek, Gözde; Özumut, Sibel Sevuk; Karatekin, GÜner; Ovalı, Fahri; Gürsoy, Tuğba; Faculty Member; School of Medicine; 214691Aims: in clinical practice, birth weight reference percentiles for singletons are used to evaluate twin births. The utilization of singleton reference percentiles for twins is not appropriate as they experience different growth trajectories. However, Turkey still lacks such references. Our aim was to create gestational age-specific birth weight references for female and male Turkish twins. Materials and methods: this is a hospital-based, multi-centered, retrospective study. In total, 2544 live-born twins between 2010 and 2019 were included in the study. Gestational age, birth weight, mode of delivery, gender, birth order, chorionicity, maternal age, pregnancy resulting from assisted reproduction techniques, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score at 5 minutes, admission to the neonatal intensive care unit (NICU), length of stay in NICU, and death during the NICU stay were recorded. Results: smoothed reference curves for birth weight by gestational age and separate tables for female and male twin neonates for the 3rd, 10th, 50th, 90th, and 97th percentiles from 26 to 39 weeks of gestational age were constructed. Overall neonatal and infant mortality rates during NICU stay in our twin cohort were 12/1000 and 16/1000, respectively. Conclusion: twin-specific birth weight nomograms could be helpful as a reference for clinicians to identify high-risk neonates and fetuses who need specialized care. However, further studies with larger series are urgently needed for validation and use of these nomograms in clinical practice.Publication Open Access Evaluation of arterial functions and carotid intima media thickness in children during mid-term follow-up after Kawasaki disease(Aves, 2021) Akalın, Figen; Erolu, Elif; Bayram, Tevfik; Haklar, Goncagül; Çetiner, Nilüfer; Faculty Member; School of MedicineObjective: Kawasaki disease (KD) is a multisystemic vasculitis of medium-and small-sized arteries. The involvement of the coronary arteries may lead to long-term cardiovascular sequelae. We studied the elasticity of the aorta and the common carotid artery (CCA), flow-mediated dilatation of the brachial artery, and carotid intima media thickness, as well bio-markers such as high-sensitivity C-reactive protein (hs-CRP) and elastin, as useful indicators of cardiovascular risk in patients, following KD. Methods: the study group consisted of 26 patients with a history of KD, and 26 healthy children. Echocardiography, and carotid and brachial ultrasound studies were performed. Plasma hs-CRP and elastin levels were studied in both groups. Results: the stiffness indices (SI) obtained from the aortic arch, abdominal aorta, and the CCA were increased in the patients, compared to the controls. Distensibility was decreased at the sinus of Valsalva, the sinotubular junction, the aortic arch, and the ascending aorta, compared to the control group. Flow-mediated dilatation (FMD) was lower in the patients than in the con-trols. The age of the patients had a negative correlation to distensibility of the aortic arch and abdominal aorta, and a positive correlation to the stiffness of the aortic arch. Follow-up dura-tion correlated positively to stiffness of the aortic arch. Carotid intima-media thickness (CIMT), serum hs-CRP, and elastin levels did not differ between the groups. Conclusion: increased aortic and carotid stiffness and decreased aortic distensibility suggest impaired arterial functions following KD. Long-term follow-up and monitorization early in cardiovascular disease is needed.