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inönü Üniversitesi Yenidoğan Yoğun Bakım Ünitesinde izlenen Çok Düşük Doğum Ağırlıklı Preterm Olgularımızın Değerlendirilmesi

Outcome of Very Low Birth Weight Infants in Neonatal Intensive Care Unit of İnönü University Faculty of Medicine

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2004

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: Preterm infants, especially with very low birth weight (VLBW) have high mortality rate because of the various severe postnatal problems. We aimed to present neonatal outcomes, including morbidity, mortality, and care practices for preterm infants admitted to our tertiary neonatal intensive care unit in our region. Materials and Methods: Perinatal data were collected prospectively from January 2002 through August 2003. The rate and the causes of mortality, and the properties of morbidity of VLBW infants were evaluated. Results: In total, 95 VLBW infants were admitted to this study. Thirty nine percent (37) of the infants were female and 61% (58) were male. The mean birth weight was 1222+240 g (458-1500 g) and mean gestational age was 30+3 weeks (25-36). The mortality rate was 33.7% for all infants and it was greater for the male than that of the female infants (25.2%, 8%). Antenatal steroids were administered to only 19°/o of mothers. The most important maternal risk factors were preeclampsia/eclampsia (26.3%) and premature rupture of membranes (>24 h, 23.2%). Respiratory distress syndrome was diagnosed in 39%, surfactant was administered to 91.8% of these infants. The rate and mean duration of ventilator support were 53.7% and 5+7.67 days. The most important morbidities were severe intracranial hemorrhage (20%) and periventricular leukomalacia (10.5%). Chronic lung disease and retinopathy of prematurity (stage >II) were diagnosed in 4.2%. Necrotizing enterocolitis was developed only in three infants. The major causes of death were early-onset sepsis and/or pneumonia (44.4%), intracranial hemorrhage (22.2%) and extreme prematurity (18.5%). The rate of survival without major morbidity was 81%. Conclusion: In our study, early neonatal sepsis or pneumonia and intracranial hemorrhage were detected as the most important causes of death for VLBW infants. We conclude that, the major cause of high mortality rate depends on low-sociocultural conditions associated with insufficient prenatal care and inaccurate neonatal transport in our region.
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Abstract (Original Language): 
Amaç: Çok düşük doğum ağırlıklı (VLBW; <1500 g) prematüreler, daha farklı ve ağır seyreden postnatal sorunları nedeniyle morbidite ve mortalitesi yüksek bir grubu oluşturmaktadır. Biz bu çalışmamızda yenidoğan yoğun bakım ünitemizde izlenen VLBW infantlann sorunlarını, mortalite ve morbidite ile ilgili özelliklerini sunmayı amaçladık . Materyal ve Metod : Ocak 2002 — Ağustos 2003 tarihleri arasında yenidoğan yoğun bakım ünitesinde izlenen 1500 g ve altındaki tüm prematüreler çalışmaya alındı. Olgularımızda mortalite oranı, nedenleri, gestasyonel yaş ve doğum ağırlığına göre mortalite oranları ile morbidite özellikleri değerlendirildi. Bulgular : Çalışma süresi boyunca ünitemizde izlenen 95 olgunun %39'u kız (37) , %61'i erkek (58) idi. Ortalama doğum ağırlığı 1222+240 g (458-1500 g), ortalama gestasyon yaşı 30±3 hafta (25-36 hafta) olarak tespit edildi. Tüm olgularımız için mortalite oranı %33.7 olup, erkeklerdeki mortalite oranı kızlardan daha yüksek idi (%25.2-%8). Antenatal steroid annelerin sadece %19'una uygulanmıştı. En sık saptanan anneye ait risk faktörleri preeklampsi/eklampsi (%26.3) ile 24 saatten uzun süren erken membran rüptürü (%23.2) idi. Tüm pretermlerin %39'una respiratuvar distres sendromu tanısı kondu ve bunların %91.8'ine sürfaktan tedavisi uygulandı. Mekanik ventilatör desteğine gereksinim oranı %53.7, ventilatörde kalış süresi ortalama 5+7.7 gün olarak tespit edildi . Ağır intrakraniyal kanama (evre III-IV; %20) ile periventriküler lökomalazi (%10.5) en sık karşılaşılan morbidite nedenleri idi. Bronkopulmoner displazi ile prematüre retinopatisi %4.2 oranlarında tespit edildi. Üç olgumuzda nekrotizan enterokolit gelişti. En önemli ölüm nedenleri sırasıyla, erken neonatal sepsis ve/veya pnömoni (%44.4), intraventriküler kanama (%22.2) ile aşırı prematüritelik (%18.5) olarak bulundu. Majör morbidite olmaksızın sağkalım oranımız %81 olarak tespit edildi. Sonuç: Çok düşük doğum ağırlıklı pretermler için erken neonatal sepsis/pnömoni ile intrakraniyal kanama en önemli ölüm nedenlerini oluşturmaktadır. Ünitemizde %33.7 olarak belirlediğimiz mortalite oranının en önemli nedeninin bölgemizdeki düşük sosyokültürel düzeyle ilişkili olarak karşılaştığımız takipsiz gebeliklere, perinatal bakımdaki yetersizliğe ve uygunsuz transport koşullarına bağlı olduğunu düşünmekteyiz.
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  • 1
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  • Turkish

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