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    Developing necrotizing enterocolitis: retrospective analysis of 1428 preterm infants at a level-III neonatal intensive care unit over a four years period
    (Sociedad Argentina de Pediatria, 2020) Ongun, Hakan; Demirezen, Selim; Demir, Meltem
    Aim. To investigate NEC frequency in premature infants and assess risk factors associated with disease-onset and progression to intestinal perforation. Methods. Retrospective cohort in preterm neonates hospitalized between 2015 and 2018. Perinatal characteristics, clinical features, nutritional data and laboratory outcome were analyzed using SPSS-23 statistical package. Logistic regression was performed to analyze associated risk factors. Results. In 1428 neonates, the rate of developing NEC was 18.28 %. Conception with assisted reproductive technology, cesearean section and postnatal-steroids were associated with NEC (OR: 4.056, 95 % CI: 2.810-5.854, OR: 1.961, 95 % CI: 1.321-2.910, OR: 6.422; 95 % CI: 4.327-9.530). Timing of first enteral feeding was associated to developing NEC, but not to intestinal perforation (p < 0.001, p = 0.604). Forty-seven of 261 NEC patients (18 %) have developed intestinal perforation. Antenatal steroids showed to reduce severe consequences (p = 0.001). Timing of first enteral feeding and hemodynamically significant PDA were predisposing factors for NEC and low 5-minutes Apgar score for intestinal perforation. (OR: 6.515; 95 % CI: 5.011-8.470; OR: 4.715; 95 % CI: 2.717-8.183; OR: 2.748; 95 % CI: 1.100-6.866). Mortality was 9 %. Developing NEC increased risk of mortality by 2.192 times (95 % CI: 1.469- 3.271); in intestinal perforation, mortality risk increased to 11.527 (95 % CI: 6.293-21.115). Conclusion. NEC frequency was 18.28 %. Intestinal perforation occurred in 18 % of NEC patients. PDA and delay in first enteral nutrition were predisposing factors for acquiring NEC and low 5-minutes Apgar scores for intestinal perforation.
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    Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021) Ongun, Hakan; Demir, Meltem
    Background: There is great variability in breastfeeding implications upon neonatal intensive care unit discharge for preterm infants. Aims and Objectives: To examine the breastfeeding rates and the impact of lactation-counseling on the nutrition following hospital discharge in preterm infants. Materials and Methods: A three-page survey was applied to the families of infants of gestational age <= 34 weeks who were hospitalized between 2016-2(118. Exclusion criteria were family reluctance to consent, foster-care placement, acquiring enteral feeding by orogastric tube/gastrostomy. The group categorization was based on lactation-counselling that involved both parents and elderly relatives who would assist the mother at neonatal care. Statistics were performed using SPSS-22 for covariates of neonatal intensive care interventions and post-discharge nutrition. Results: Exclusive breastfeeding was 49.2% at hospital-discharge and declined to 31.3% at six months. Early introduction of complementary foods was 51.1%. Total duration of breastfeeding was 7.38 +/- 3.98 months. Lactation-counseling prolonged breastfeeding duration to 8.47 +/- 3.87 months. The program presented the highest odds of extending breastfeeding interventions beyond six months (OR: 2.183, 95% CI: 1.354-3.520). It favored the outcomes by reducing the introduction of formulas and complementary foods before six months (P = 0.044, P = 0.018). The physical contribution of the father towards nutrition was the most significant benefit claimed by the participants. (71.6 versus 51.8%). Conclusion: Family-centered peer lactation-counseling by the medical staff and increasing awareness for infant nutrition are promising local strategies in reaching the goals of national nutrition policies guided by the international recommendations in preterm infants.
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    Mortality caused by late-onset sepsis in very low birth weight infants: risk analysis and the performance of diagnostic tools
    (Coll Physicians & Surgeons Pakistan, 2020) Ongun, Hakan; Demir, Meltem
    Objective: To assess the risk on late-onset sepsis attributed mortality in very low birth weight (VLBW) infants. Study Design: Observational study. Place and Duration of Study: Level-III Neonatal Intensive Care Unit, Istinye University, Antalya Medical Park Hospital, Turkey, between January 2014 and December 2018. Methodology: Perinatal characteristics and clinical features of 198 septic preterm neonates were evaluated to predict sepsis-attributed mortality. ROC analysis was employed to drive optimal-cutoffs for laboratory parameters and logistic regression to calculate mortality risk factors using SPSS version-22 and MedCalc software. Results: Mean gestational age was 28.91 +/- 2.67 weeks. Umbilical catheterisation was the principal risk factor for culture-positive sepsis (OR 2.860, 95%CI: 1.232-6.639). Outborn infants were more likely to deliver surfactant and longer intubation (p=0.013, and p=0.005, respectively), manifested frequent BPD (p=0.014), and at greater risk of proven sepsis and mortality (OR: 1.796, 95%CI: 1.011-3.191; OR: 1.950, 95%CI: 1.002-3.794). Low Apgar scores necrotising enterocolitis (NEC) and prolonged intubation were independent risk factors for mortality (OR: 13.840, 95%CI: 6.384-30.005; OR: 5.410, 95%CI: 2.113-13.849; OR: 10.037, 95%CI: 4.700-21.434). An increase in high-sensitivity C-reactive protein (hsCRP)-ratio >6.08-fold afforded good sensitivity and specificity (AUC: 0.914; sensitivity: 89.36%, specificity: 86.09%). Logistic regression of various combinations has shown a >6.08-fold change in hsCRP-ratio over 24-hours and platelet counts <88x10(9)/L optimally predicted mortality (OR: 27.983, 95%CI: 9.704-80.697). Conclusion: Low Apgar scores, NEC and prolonged intubation are independent risk factors for mortality of VLBW infants. Birth in level III-IV NICUs featuring special neonatal care, avoidance of prolonged intubation, and timely prediction of fatal sepsis using hsCRP ratio and platelets could prevent sepsis-related mortality.
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    Predictors of intraventicular hemorhage in the neonatal intensive care unit
    (TURKISH SOC MEDICAL & SURGICAL INTENSIVE CARE MEDICINE, 2021) Ongun, Hakan; Özyazıcı Özkan, Sarıye Elif
    Aim: To analyze intraventricular hemorrhage (IVH) incidence, clinical features and risk factors in extremely low birth weight infants. Materials and Method(s): It is a single-center, retrospective cohort in infants delivering neonatal intensive care between 2010 and 2019. Infants of birth weight <1000 grams who had transfontanel-ultrasounds in the first week of life were included. Postnatal transfers, central nervous system anomalies, antenatal-diagnosed hemorrhage, death before obtaining transfontanel-ultrasound and incomplete dataset were excluded from the study. Infants were categorized as mild IVHs (grades 1-2), severe IVHs (grade-3, periventricular-hemorrhagic infarct) and control group. Ante-perinatal characteristics, clinical and laboratory features were recorded. SPSS23 program utilized analysis for three groups. Results: Overall IVH incidence was 22.9% in 455 neonates (52.9%, 49%, 31.5%, 13.4%, 6.7% at =25, 26, 27, 28 and 29 gestational weeks. Seizure was the first sign in 32.7% of the infants. Neonatal resuscitation, umbilical-cord blood pH, chorioamnionitis, patent ductus arteriosus were associated with developing mild IVH, but did not influence the progression to severe hemorrhage (p=0.782, p=0.109, p=0.566, p=0.111). Gestational age, invasive mechanical ventilation, inotrope-required hypotension was related to high-grade IVHs (p<0.001, p=0.025, p=0.013). The predictive strength of platelets to define IVH was poor at intensive care admission (sensitivity: 74%, specificity: 68.3%). Inotrope-required hypotension and low-umbilical-cord blood pH were determined as independent risk factors of high-grade IVHs (OR: 6.678, 95% CI: 2.557-17.443 and OR: 3.554, 95%CI: 1.089-11.602). Four infants necessitated ventriculo-peritoneal shunting. Mortality was 23.1% in infants developing IVH. Conclusion: Inotrope-required hypotension is the strongest predisposing factor for high-grade ventricular hemorrhage in extremely low birth weight infants.
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    Retinopathy in the preterm infant born over 1500 grams
    (DergiPark, 2021) Ongun, Hakan; Özdemir Şahin, Seçil; Sam, Mehmet Tahir; Gözkaya, Onursal; Özyazıcı Özkan, Sariye Elif
    Objective: To investigate the incidence of retinopathy of prematurity (ROP) and assess risk analysis in infants of birth weight (BW) ?1500 grams. Material and Methods: Retrospective, single-center, cohort included preterm intensive-care admissions who were screened for ROP between 2010-2019. Exclusion criteria were BW <1500 grams, congenital anomalies, death or postnatal transfers before ROP-screening. Data were extracted for maternal/neonatal characteristics, clinical features, retinopathy’s grade–zone, plus-disease and treatment. Multivariate regression analysis determined risk factors for developing retinopathy. Results: ROP incidence was 7.6% in 1431 infants with the largest-one born 2450 grams at 36th gestational weeks (BW between 1500–1599 gr: 17.1%, 1600–1699 gr: 13.8%, 1700–1799 gr: 8.8%, 1800–1899 gr: 8.2%, 1900–1999gr: 2.9%, ?2000 gr: 1.3%). Small for gestational age (SGA; OR:2.52, 95% CI:1.48-4.30), neonatal resuscitation (OR:3.23, 95% CI:1.87-5.57), low Apgar score (OR:2.08, 95% CI:1.03-4.20), congenital heart disease (OR:2.25, 95% CI:1.38- 3.69), hemodynamic instability (OR:3.67, 95% CI:1.92-7.02), intraventricular hemorrhage (OR:2.86, 95% CI:1.40-5.86) were associated with ROP. In the multivariate logistic regression, prolonged mechanical ventilation (duration >2 days) and oxygen supplement (duration >9 days) were identified as independent risk factors that presented highest odds for retinopathy (OR:8.79, 95% CI: 5.53-13.99 and OR:4.67, 95% CI: 2.26-9.66). Therapy was warranted in 22 (1.5%) neonates (Type-1 ROP in eighteen, aggressive-ROP in four patients). Four infants with BW ?1800 grams delivered ROP-treatment. Conclusion: ROP incidence is 7.6% and treatment-warranted retinopathy is 1.5% in neonates born ?1500 grams. Preterm-infants with SGA, neonatal resuscitation, congenital heart disease and hemodynamic instability requiring inotropes, intraventricular hemorrhage and the ones necessitating prolonged mechanical ventilation and oxygen supplement are more likely to develop ROP.