ANTİBİYOTİK TEDAVİSİ ALAN YENİDOĞANLARDA PROBİYOTİK DESTEĞİNİN İDRAR D-LAKTİK ASİT DÜZEYİ ÜZERİNE ETKİSİNİN İNCELEMESİ
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Tabur Y. Investigation of the effect of probiotic supplementation on urinary D-lactic acid level in newborns receiving antibiotic treatment. Hacettepe University Faculty of Medicine, Department of Child Health and Diseases, Neonatology Department. Thesis. Ankara 2020. D-Lactic acid is a lactate isomer that normally does not have a major role in humans. The most important source of D-lactic acid in humans is microbial production in the gut. While it has no clinical significance in healthy individuals under normal conditions, it can be detected in blood, urine and feces as a result of increased gastrointestinal microbial production for various reasons. Neonatal intestinal flora is highly sensitive and extremely sensitive to external influences that can significantly affect the short or long term health of the host. Detection of dysbiosis and correction of dysbiosis with probiotic supplementation is a promising area of research in neonatology, as early intestinal dysbiosis is associated with the risk of developing various chronic diseases. The aim of the study is to determine normal D-lactate levels in urine in healthy babies born in late preterm and term, to show the negative effect of antibiotic treatment on the intestinal flora indirectly by measuring D-lactate in the urine, and to investigate the corrective effect of probiotic supplementation on flora by comparing urine D-lactate levels. Forty healthy late premature and term babies in the control group and 39 babies who were given antibiotic treatment during the newborn period were included in the study. Urine samples were taken from the babies in the study group before the antibiotic treatment was started, at the end of the treatment and 4 weeks after the end of the treatment. In the study group, babies who took probiotics and those who did not were examined as a subgroup. D-lactic acid level determination in urine samples was performed following the instructions of the Human D-lactic acid Elisa kit (BT Lab). In our study, the mean urinary D-lactate levels in the first 48-72 hours of life in healthy babies born late premature and term were 20.57 ± 3.67 µmol / L and the median urinary D-lactate excretion levels were 3.15 mmol / mol creatinine (minimum and maximum values were measured as 1.23-14.11 mmol / mol creatinine, respectively). Post-treatment urinary D-lactate excretion levels (median: 20.27 mmol / mol creatinine) were significantly higher in babies who received antibiotic treatment compared to pre-treatment (median: 13.12 mmol / mol creatinine) (p = 0.047). There was no statistically significant difference in the 4th week urinary D-lactate excretion levels (median: 27.2 mmol / mol creatinine) of babies who received probiotic support after antibiotic treatment compared to babies who did not receive probiotics (median: 27.01 mmol / mol creatinine) (p > 0.05). Our study shows that urinary D-lactate excretion levels can be used as an indirect indicator of intestinal dysbiosis due to antibiotic treatment. As far as we know, this study is the first study evaluating antibiotic-associated dysbiosis and the corrective effect of probiotic supplementation on flora with urine D-lactate excretion levels, which is the product of intestinal flora, and investigating normal reference values in healthy late preterm-term babies. Our study will guide other studies on this subject.