Yildiz Atalay

Gazi University, Engüri, Ankara, Turkey

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Publications (94)167.42 Total impact

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    ABSTRACT: Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation.
    No preview · Article · Dec 2015 · Journal of Tropical Pediatrics

  • No preview · Conference Paper · Feb 2015
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    ABSTRACT: Introduction Volume guarantee (VG) ventilation is frequently used for newborns, mostly combined with SIMV or A/C modes. Aim of this study was to compare effect of SIMV+VG or PSV+VG ventilation on ventilatory and laboratory parameters and clinical findings. Patients and methods Preterms with RDS < 34thgestational age (GA)requiring mechanical ventilation in the first 12 h were randomised to either SIMV+VG or PSV+VG after surfactant treatment. Patients were ventilated with Draeger Babylog 8000+. Set and measured ventilatory parameters were downloaded by Babyview® software for 72 h unless extubation or need for HFO ventilation occurred. Actual peak inspiratory pressure (PIP), set and measured tidal volume (TV), mean airway pressure (MAP) and FiO2 were analysed. If measured TV percentage was between 80–120% of set TV, it was considered appropriate. Results 42 patients (21 PSV+VG, 21 SIMV+VG) were enrolled. Median GA were 29 weeks and BW were 980,0 and 870,0 gr in each group. Demographic characteristics were similar. ‘Appropriate TV’ was higher in PSV+VG group. PIP, MAP and FiO2 were similar in two groups. Hypocarbia, hypercarbia, hyperoxemia and hypoxemia incidences were not different. PSV+VG group were less tachycardic than SIMV+VG group. Acute and chronic prematurity problems including chronic lung disease (CLD) defined as oxygen requirement at 36th GA were not different. Conclusion PSV+VG was associated with higher ‘appropriate TV’ without any adverse effects and similar CLD occurence. These findings can support the beneficial use of PSV+VG which is more physiologic due to better inspiratory – expiratory synchrony.
    Preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Introduction Noninvasive ventilation with nasal CPAP (n-CPAP), or nasalintermittant positive pressure ventilation (n-IPPV) is becoming standard ofcare in preterm. Limited experience has been reported withnasal high frequency oscillatory ventilation (n-HFOV). We present 2 newbornstreated by n-HFOV applied with binasal prongs (Ram cannula Neotech) and DraegerBabylog 8000+ ventilator. Cases 1. A 900 gr. 28 weeks gestation infant was intubated, given surfactant and ventilated by volume guarantee pressure-support ventilation for RDS. On 2nd day HFOV was started due to worsening respiratory status. On 11th day patient was extubated to n-HFOV and continued for 4 days followed by n-IPPV/n-CPAP. 2. A 830 gr. 28 weeks gestation infant was resuscitated in the delivery room. RDS and pulmonary interstitial emphysema was detected on radiography and surfactant was given. At 12 h pneumothorax occurred necessitating thoracal tube insertion and HFOV. Conventional ventilation was tried several times without success. HFOV continued for 46 days then baby was extubated to n-HFOV. Patient required reintubation after 4 days due to sepsis. Conclusion n-HFOV with binasal prongs could be an alternative for preterms after prolonged HFOV.
    Preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Background and aims Microcirculation is important to ensure adequate tissue oxygenation and nutrient delivery. Clinical findings, perfusion index (PI) measurements are used to assess microcirculation. Side stream dark field (SDF) imaging is a noninvasive method of assessing microcirculation by means of a videomicroscope. This study aimed to assess microcirculation in healthy term newborns born either by spontaneous vaginal delivery (SVD) or caesarean section (C/S). Methods The assessments were done within the first 30 min of life (T0) and repeated at the 24th hour of life (T1). Microcirculation was assessed from axillary skin by using SDF technique with Microscan device where total and perfused vessel density (TVD, PVD) and microvascular flow index (MFI) were calculated, as well as by using microcirculation score (MS) based on capillary refill time, skin colour and warmth and PI measured by Masimo Radical7 pulse oxymeter. Vital signs were also recorded. Nonparametric tests were used for statistical analysis. Results Twelve newborns born by SVD and 25 newborns born C/S were included. The mean, SD, median values for temperature, TVD, PVD, MFI, MS, and PI at T0 and T1 are as follows; T0: Temp:36 ± 0,44(36,1), TVD: 18,79 ± 1,49(18,81), PVD: 18,73 ± 1,5(18,81), MFI: 3,07 ± 0,25(3), MS: 2,14 ± 1,36(2), PI: 1,84 ± 0,97(1,75). T1: Temp:37,1 ± 0,26(37,1), TVD: 18,93 ± 2,1(18,73), PVD: 18,9 ± 2,13(18,73), MFI: 3,17 ± 0,32(3,1), MS:1,65 ± 0,48(2), PI: 1,9 ± 0,8(2). Temperature was significantly and MFI was slightly higher at T1 compared to T0 (p = 0,001 and p = 0, 04). No difference was observed between SVD or C/S groups or at different times within the same group. Conclusions Peripheral microcirculation in general is not affected by mode of delivery in term healthy newborns and doesn’t seem to change significantly within the first 24 h of life.
    Preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Background Near infrared spectroscopy (NIRS) is evolving into a clinical monitorization method providing information regarding not only cerebral but abdominal or renal tissue oxygenation (rSO2) as well. Fractional tissue oxygen extraction (FTOE) is calculated from NIRS measurements and arterial haemoglobin oxygen saturation (SpO2) measured by pulse oxymeter. Multichannel NIRS devices maybe very helpful in newborns with multisystem problems enabling realtime simultaneous measurements of rSO2 from different parts of the body. Pulse oxymeter integrated into a multichannel NIRS device provides simultaneous SpO2 monitoring making FTOE calculations more accurate and easier. Methods Three term newborns; 2 undergoing therapeutic hypothermia for hypoxic ischaemic encephalopathy grade II, 1 with critical pulmonary stenosis before and after cardiac surgery were monitored by multichannel NIRS (Sensmart X-100, NONIN, USA) device including cerebral, abdominal, renal rSO2 and SpO2 probes. FTOE was calculated using the equation; (SpO2-rSO2)/SpO2. Results Duration of monitorization and rSO2 and FTOE values of different body sites are presented in table with mean±SD. Discussion Longterm simultaneous monitoring of tissue oxygenation in brain, abdomen and kidneys is useful while following newborns with multisystem problems requiring hypothermia or circulatory medications to titrate the treatment accordingly. NIRS device with integrated pulse oxymeter maybe helpful for realtime calculation of FTOE to assess hemodynamics.
    No preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Background and aims We aimed to identify the neurodevelopmental and behaviour outcome of preterms (GA <30 wks) at 8 years by age appropriate psychometric evaluations to see whether tests used at younger ages could predict worst outcomes at older ages in relation to some neonatal factors. Method Along with neurologic examinations, 33 infants were prospectively evaluated at 3, 6, 12,18, 24 months of corrected age with Bayley Scales of Infant Development – II (BSID-II), at 3, 5 years with Stanford-Binet, at 8 years with WISC-R. Results 72% of children had no (IQ >85), 24.3% had mild (IQ 74–84), 3% had major (IQ <70, blindness) impairments. 24.2% had special education, 15.2% ADHD, 6.1% autism, 9.1% learning/language, 6.1% anxiety disorders. The probability of neurodevelopmental test and IQ scores of VLBW infants <1000 gr being lower than healthy children at same age was 10.5 times higher (OR 4.7, 95%, CI 0.92–24.5) at 8 years of age. Oxygen treatment >30 days adversely affected the scores up to 18th month (OR 2.1,%95, CI 0.44–9.8). Babies having low scores of the18th month-cognitive and motor sub-test of BSID-II had 16 times higher probability of having low WISC-R total IQ scores at 8 years. (p < 0.05). 19 children with sepsis at 8 years had lower performance and total IQ scores (p < 0.05). Conclusion Prolonged oxygen therapy and having and sepsis are significant factors affecting later IQ of VLBW infants. Lower BSID-II scores at 18th month may predict future lower total IQ scores. Longitudional follow up and early intervention is of paramount importance.
    Preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 ± 1.3 days in Group I and 2.27 ± 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 ± 2.2 days in Group I and 3.53 ± 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 ± 1.5 days and 2.73 ± 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn’t decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.
    No preview · Article · Mar 2014 · Indian Journal of Hematology and Blood Transfusion

  • No preview · Article · Jan 2014
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    ABSTRACT: Newborns are exposed to a considerable number of painful stimuli. This study is aimed to investigate the effects of 30% glucose solution and nonnutritive sucking on pain perception during venipuncture. Twenty-five term infants were randomized as receiving 30% dextrose (group 1) or sterile water (group 2). Neonatal Infant Pain Scale scores, skin conductance algesimeter recordings, and near-infrared spectroscopy measurements were recorded during the procedure. Neonatal Infant Pain Scale and skin conductance algesimeter results were decreased in both groups from that during venipuncture to after the procedure. Group 1 had lower Neonatal Infant Pain Scale scores compared with group 2 after venipuncture, different from the skin conductance algesimeter, where no difference was observed between groups. In group 1, cerebral blood volume increased after venipuncture. Glucose does not attenuate the Neonatal Infant Pain Scale score and skin conductance algesimeter index during venipuncture, but it leads to a lower Neonatal Infant Pain Scale score after venipuncture unlike the skin conductance algesimeter index, which was not lowered.
    No preview · Article · Dec 2013 · Journal of child neurology
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    ABSTRACT: Gamma-glutamyltransferase (GGT) is commonly measured in newborn infants as a sensitive liver function test, however reference ranges mostly based on early studies including relatively small number of patients. The aim of this study was to emphasise recently changed GGT values due to changed newborns profile admitted to neonatal intensive care units (NICU) and establish new cross-sectional reference ranges for the serum GGT levels in a cohort of neonates between 26 and 42 weeks gestational age in one center. From January 1, 2010 to December 31, 2012 liver function tests including serum GGT measurement were performed in 705 newborns who were admitted to NICU due to different etiologies at Gazi University School of Medicine Hospital, Ankara, Turkey. Infants with Apgar score <8 on 5th minutes, any metabolic or liver disease, cholestasis, congenital infection, culture proven sepsis, elevated serum aminotransferases, who treated with phenobarbital were excluded. Clinical and laboratory data of 583 neonates was analysed retrospectively. GGT was measured by enzymatic method by Abbott Architect C16000 autoanalyser. Mean, 2.5th and 97.5th percentiles were used to express the reference range data. Four hundred sixty one GGT values of 200 preterm infants and 501 GGT values of 383 term infants during the first 28 days after birth were analysed. Serum GGT levels of preterm infants in the first 7 days and between 8-28 days after delivery were (mean ± SD; 141.81 ± 88.56 U/L and 131.17 ± 85.53 U/L) similar with term infants (139.90 ± 86.46 U/L and 144.56 ± 86.51 U/L) respectively (p = 0.649 and p = 0.087). Serum GGT levels were found to be significantly higher in male infants (145.98 ± 93.68 U/L) than females (132.18 ± 78.97 U/L) (p = 0.035) and infants born vaginally (152.24 ± 90.71 U/L) had also higher serum GGT activity than those born by cesarean section (135.38 ± 85.37 U/L) (p = 0.005). A new reference range for serum GGT levels which higher than previous reference values can identify neonates with actually abnormal results and prevent unnecessary interventions.
    Full-text · Article · Aug 2013 · Journal of pediatric gastroenterology and nutrition
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    ABSTRACT: We report a case of a newborn with severe respiratory distress since birth with two giant intrathoracic and separate eneteric duplication cysts in right hemithorax. On day 19, the intrathoracic cysts were removed, and the baby was discharged on his 22nd day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This report is the first case of two isolated, separated and giant right intrathoracic gastric duplication cysts in literature. The diagnostic values of radiological evaluation and surgical and pathological management for precise diagnosis are discussed.
    No preview · Article · Aug 2013 · Scottish medical journal
  • N. Altuntas · C. Turkyilmaz · K. Sonmez · Y. Atalay

    No preview · Article · Apr 2013 · Hong Kong Journal of Paediatrics
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    ABSTRACT: Perinatal asphyxia is an important cause of neonatal morbidity and mortality. Hypothermia is an effective treatment of neonatal hypoxic-ischemic encephalopathy in infants. Cold agglutination is a primary or acquired autoimmune disease that involves autoantibodies that lead to hemagglutination at low temperatures lower than that of the body. In this case the importance of cold agglutinins during therapeutic hypothermia is presented.
    No preview · Article · Dec 2012 · The Indian Journal of Pediatrics

  • No preview · Article · Oct 2012 · Archives of Disease in Childhood

  • No preview · Article · Oct 2012 · Archives of Disease in Childhood
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    ABSTRACT: Background and Aim Sweet tasting solutions and non-nutritive sucking are strong pain reducers for newborns. This study aimed to investigate effects of 30% glucose solution and non-nutritive sucking on amplitude of pain perception with pain scale, stress detector and near infrared spectroscopy (NIRS) during and after venipuncture. Method Term newborns were randomised into two groups before venipuncture for bilirubin measurement. Recordings of skin conductance algesimeter (SCA, Med-Storm Innovation, Norway) from foot and NIRS (NIRO 200 Hamamatsu, Japan) from head were obtained starting 7 minutes before venipuncture until 7 minutes after. PAIN scores were obtained during and 7 minutes after procedure. Non-nutritive sucking was provided throughout the study. Results 25 patients were included. Median PAIN scores were similar in both groups during venipuncture 5 (1–8) in Group 1, and 6 (1–10) in Group 2. Scores were decreased significantly seven minutes after procedure in both groups; as 1 (0–1) and 3 (1–3) in Group 1 and 2 respectively. In Group 1, cerebral blood volume (CBV) was increased from baseline after the procedure (p=0.008) however in Group 2 there was a decrease in CBV from baseline without statistical significance. Cerebral blood flow (CBF) was increased from baseline in both groups without statistical significance. SCA values were slightly increased from 0.23 to 0.29 in Group 1 and from 0.23 to 0.59 in Group 2. Conclusion Nonnutritive sucking and 30% glucose attenuate pain and stress responses during venipuncture however cerebral effects are open to investigation.
    Preview · Article · Oct 2012 · Archives of Disease in Childhood
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    ABSTRACT: Background and aim Post-hemorrhagic hydrocephalus (PHH) is one of the most serious complications of intraventricular hemorrhage (IVH) in a newborn. Causes are multifactorial including genetical, pre and postnatal complications. Conditions assosciated with hydrocephalus following IVH were investigated. Methods Charts of patients admitted to the neonatal intensive care unit (NICU) over last 5 years were investigated retrospectively, newborns with grade 3–4 IVH were analyzed for risk factors in the perinatal and neonatal period. Ones with and without hydrocephalus were compared. Results are expressed as median and range and percentage where required. Results 24 newborns were diagnosed with IVH, 9 of whom developed hydrocephalus. Most significant risk factors are shown in table 1. Hypotension, asidosis, were more frequent in the PHH group. GA, BW, Apgar scores, lowest-highest CO2, Crib score are shown in table 2. Highest CO2 in the first 10 days of life was significantly higher in the PHH group (p=0.044). Conclusion PHH remains to be one of the most severe complications of IVH. In this small group of patients, high CO2 levels, hypotension seem to be important risk factors.
    Preview · Article · Oct 2012 · Archives of Disease in Childhood
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    ABSTRACT: Background and Aim Neonatal Intensive Care Unit (NICU) is a noisy environment in which infants can be exposed to high noise levels. The aim of the study is to evaluate the adverse effects of noise on hearing and, neurological outcomes of NICU graduates at six months of age. Methods Thirty two infants that had been admitted to Gazi University Hospital NICU and 25 healthy controls, were included in the study. Noise levels were recorded continously during hospitalization period. TEOAE, DPOAE and ABR tests were used to assess hearing. Neurological outcome was assessed with Bayley II Infant Development Scale. Results The median period of noise exposure above 45 dB, was 50.1% of the entire hospitalization period. Levels exceeding 45 dB were mostly below 124 Hz. Major source of noise was traced back to the incubators. All patients passed the hearing screening tests before discharge. On the sixth month follow up; hospitalized infants had lower DPOAE SNR amplitudes (dB) at five frequencies including 1001, 1501, 3003, 4004, 6006 Hz in both ears. DPOAE fail rates at 1001 Hz and 1501 Hz were higher in hospitalized infants (p=0.001). Positive correlation between noise exposure and duration of hospitalization was determined. Infants who failed at 1001 and 1501 Hz had similar Bayley II Infant Development Scale scores and there were no difference between groups. Conclusion Major noise source in NICU was found to be the incubators. Although hearing loss was not detected in any infants, hearing tests at sixth months of life were adversely affected.
    Preview · Article · Oct 2012 · Archives of Disease in Childhood
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    ABSTRACT: Background and Aim Patent ductus arteriosus (PDA) is a frequent problem in preterms known to have significant effects on organ perfusion. The aim of this study was to investigate the difference between cerebral and abdominal tissue oxygenation index (TOI) measured by near infrared spectroscopy (NIRS) before and after treatment of hemodynamically significant PDA in preterm newborns. Methods Cerebral and abdominal TOI were recorded by NIRS (NIRO 200 Hamamatsu, Japan) in preterm newborns with hemodynamically significant PDA requiring ibuprofen treatment. Newborns with congenital anomalies were excluded. 20 minute recordings were obtained before treatment and after documented ductal closure by echocardiography as well as real time oxygen saturation (SaO2) monitoring by pulse oxymetry. Fractional tissue oxygen extraction (FTOE) was calculated using TOI and SaO2. Results Fourteen newborns were included, abdominal recordings were available in 13. Mean BW and GA were 1089 g and 29 weeks respectively. No change was observed in cerebral or abdominal tissue oxygenation and oxygen extraction before and after medical closure of PDA. Pre and posttreatment cerebral TOI values (median and range) were 67.17 (50.9–89.1) and 64.35 (54.9–87.4) P=0.3, and pre and posttreatment cerebral FTOE values were 0.3 (0.03–0.45) and 0.29 (0.05–0.42)p=0.09 respectively. Pre and postreatment abdominal TOI values were (median and range) 53.9 (40.1–62.9) and 50.29 (39.2–78.5) P=0.7, pre and posttreatment abdominal FTOE values were 0.44 (0.32–0.59) and 0.46 (0.2–0.6) p=0.8 respectively. Conclusion Results of this small group may suggest that cerebral and abdominal tissue oxygenation is preserved during hemodynamically significant PDA, however more detailed studies are warranted.
    Preview · Article · Oct 2012 · Archives of Disease in Childhood