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YENİDOĞAN VE SÜT ÇOCUKLARINDA PERİFERİK İSKEMİ

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Abstract (2. Language): 
Peripheral ischemia in the newborn and infant Because of hypercoagulable blood due to fetal fibrinogen and circulating placental thromboplastins, neonates are more susceptible to thrombosis than adults. In this study, we retrospectively reviev/ed the records of 8 patients with peripheral limb ischemia, treated at Department of Pediatric Surgery, istanbul Medical Faculty between 1983 and 1998. The causes of ischemia included; iatrogenic injury (3 patients, 38 %), possible alterations in blood flow properties (3 patients, 38 %), disorder of the clooling system (1 patient, 12 %), and vvringer injury (1 patient, 12 %). One patient is treated with supportive/conservative therapy. The remaining patients received anticoagulant and/or thrombolytic treatment. Five patients required amputation, one patient had soft tissue loss treated with skin graft. While complete resolution with supportive treatment vvas achieved in 1 patient, another patient is died. AH amputations were performed after clear demarcation of the gangrenous tissue. Peripheral limb ischemia in the newborn and infant is due to incomplete adaption of an unmatured vascular system which has certain hemorrheological properties. Avvareness of this rare problem may render prompt identifıcation and early medical management which may prevent inevitable sequelae of gangrene. Minimal handling of the newborn and infant. with less diagnostic vascular punctures and injections, should also be considered
Abstract (Original Language): 
Yenidoğanda, fetal fibrinojen ve plasenta tromboplastinlerinin varlığı nedeniyle kanın pıhtılaşmaya eğilimi fazla, tromboz riski yüksektir. Bu çalışmada İstanbul Tıp Fakültesi Çocuk Cerrahisi Anabilim Dah'nda, 1983-1998 yılları arasında periferik iskemi nedeni ile takip ve tedavisi yapılan 8 hastanın klinik kayıtları retrospektif olarak incelenmiştir. İskemi nedenleri arasında iatrojenik travma (3 hasta,%38), pıhtılaşma sisteminde defekt (1 hasîa,%12), uzun süreli bası (1 hasta, % 12) tespit edilmiştir. Konservatif olarak izlenen bir hasta dışında tüm hastalara antikoagulan ve/veya trombolitik tedavi uygulanmıştır. Beş hastaya demarkasyon hattının belirmesinden sonra amputasyon yapılmış, bir hastaya geniş doku kaybı nedeniyle cilt grefti uygulanmıştır. Bir hastada konservatif tedavi ile şifa sağlanırken bir hasta kaybedilmiştir. Yenidoğan ve süt çocuklarında görülen periferik iskemi, vasküler sistemin maturasyon ve adaptasyonunu henüz tamamlamamış olmasına ve farklı hemoreolojik özelliklere bağlıdır. Nadir görülen bu tablonun erken tanı ve tedavisi ile gangren ve sekel oluşumu engellenebilir. Yenidoğan ve süt çocuklarında vasküler müdahale ve enjeksiyonların olabildiğince az uygulanması iatrojenik hasar sıklığını azaltacaktır.

REFERENCES

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