Yenidoğan Yoğun Bakım Ünitesinde Respiratuvar Distres Sendromu Tanısıyla Takip Edilen Prematüre Yenidoğanların Surfaktan Cevabının Retrospektif Değerlendirilmesi
Abstract
Amaç: Preterm doğum yenidoğan ölümlerinin önde gelen nedenidir. Bu ölümlerin arasında en yüksek oran solunum sıkıntısı sendromu’ na (RDS) aittir. Bu çalışmanın amacı, yenidoğanlarda RDS yönetiminin en uygun ve etkin hale getirilmesine yardımcı olmak için; RDS’nin risk faktörlerini, klinik özelliklerini ve komplikasyonlarını belirlemektir.
Gereç ve Yöntemler: Çalışmaya ikinci düzey yenidoğan yoğun bakım servisimizdeki Ocak 2016 ile Haziran 2021 tarihleri arasında düşük doğum ağırlıklı bebekler alındı. Olgular geriye dönük incelenerek, demografik özellikleri, verilmiş olan tedaviler (mekanik ventilasyon, surfaktan), ve erken ve geç komplikasyonları; ölüm oranları ve sebepleri belirlendi.
Bulgular: Toplam 130 olgu çalışmaya alındı. Yüzde altmış ikisi erkek, %38’i kızdı.Yüzde 85’i sezaryen doğum, % 15’inde normal vajinal yoldu. Ortalama doğum ağırlığı 2043±372 gr, ortalama gebelik haftası 32±5 hafta bulundu. Antenatal steroid (ACS), %67,6' sında uygulanmıştı.Yüzde otuzüçünde erken membran rüptürü (EMR) saptandı. Erken ve geç komplikasyonlar; %3,8’inde ventilatöre bağlı pnömoni ve %3’ünde pnömotoraks idi.Yüzde 4,6’ında ise sepsis saptandı. Bronkopulmoner displazi (BPD) %2,3, Prematür Retinopatisi (ROP) %1,5, periventriküler lökomalazi %1,7 ile intrakraniyal kanama (IKK evre III-IV) %2 olarak görüldü. Ölüm oranı %10’du.
Sonuç: Ölüm oranlarımız; ülkemizden yayınlanan verilerle benzer olarak bulundu. Doğum öncesi izlemin iyileştirilmesi, gebe takiplerinin düzenli yapılması, sık görülen ölüm nedenleri için risklerin tespit edilip bunlara karşı yeterli ve etkin önlemlerin alınması durumunda ölüm oranlarımızın azalacağını düşünmekteyiz.
References
- Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019; 115(4): 432-50.
- Gomella T L. Neonatology. 5th Ed., USA : Appleton & Lange, 2004; 524-53 .
- Fanaroff AA, Martin RJ. The Respiratory Distress Syndrome and its Manegement in NeonatalPerinatal Medicine Disease of The Fetus and Infant . 6th Ed, New York: Mosby, 1998
- Yurdakök M. Respiratuvar distres sendromu ve ventilatör tedavisinin ilkeleri. Tunçbilek E, Kınık E, Çevik N (Editör), Katkı Pediatri Dergisi Neonatal Respiratuvar Distres Özel Sayısı, 1991; 299-370.
- Sun H, Zhou Y, Xiong H, Kang W, Xu B, Liu D, et al. Prognosis of very preterm infants with severe respiratory distress syndrome receiving mechanical ventilation. Lung. 2015; 193(2):249-54.
- Yadav S, Lee B, Kamity R. Neonatal Respiratory Distress Syndrome. 2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Donn SM, Sinha SK. Newer techniques of mechanical ventilation: an overview. Semin Neonatol. 2002; 7: 401-7.
- Rodriguez RJ. Management of respiratory distress syndrome: an update. Respir Care. 2003; 48: 279-86.
- Ambalavanan N, Carlo WA. Bronchopulmonary dysplasia: new insights. Clin Perinatol. 2004; 31: 613-28.
- Krauss AN. New methods advance treatment for respiratory distress syndrome. Pediatr Ann. 2003; 32: 585-91.
- rrill JD, Ballard RA. Pulmonary surfactant for neonatal respiratory disorders. Curr Opin Pediatr. 2003; 15: 149-54.
- Smrcek JM , Schwartau N, Kohl M, Berg C, Geipel A, Krapp M, et al. Antenatal corticosteroid therapy in premature infants. Arch Gynecol Obstet. 2005; 271: 26-32.
- Alyamac Dizdar E, Sarı FN, Aydemir C, Oğuz ŞS, Erdeve Ö, et al. A randomized, controlled trial of poractant alfa versus beractant in the treatment of preterm infants with respiratory distress syndrome. Am J Perinatol. 2012; 29(2): 95- 100.
- Whitsett JA., Pryhuber GS, Rice WR. Acute respiratory disorders. In: Avery GB, MacDonald MG (eds). Neonatology: Pathophysiology and Management of the Newborn, 5th ed. Philadelphia: Lippincott Williams&Wilkins, 1999: 505-15.
- McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020; 12:CD004454.
- Jovandaric MZ, Milenkovic SJ, Dotlic J, Babovic IR, Jestrovic Z, Milosevic B, at al. Neonatal pneumothorax outcome in preterm and term newborns. Medicina (Kaunas). 2022; 58(7): 965.
- Malek A,Afzali N, Meshkat M, Yazdi NH. Pneumothorax after mechanical ventilation in newborns. Iran J Pediatr. 2011; 21: 45-50.
- Yalaz M, Arslanoglu S, Akisu M, Atik T, Ergun O, Kultursay N. A comparison of efficacy between two natural exogenous surfactant preparations in premature infants with respiratory distress syndrome. Klin Padiatr. 2004; 216(4): 230-5.
- Dani C, Mosca F, Vento G, Tagliabue P, Picone S, Lista G at al. Effects of surfactant treatment in late preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2018; 31(10): 1259-66.
- Costa S, Zecca E, De Luca D, De Carolis MP, Romagnoli C. Efficacy of a single dose of antenatal corticosteroids on morbidity and mortality of preterm infants. Eur J Obstet Gynecol Reprod Biol. 2007; 131(2): 154-7.
- Salvo V, Zimmermann LJ, Gavilanes AW, Barberi I, Ricotti A, Abella R at al. First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis. Pediatr Crit Care Med. 2012; 13(1): 72-9.
- neonatology.org [Internet]. Ankara: Türk Neonatoloji Derneği Rehberleri; 2018 [Updated: 2020 Apr 16;Cited:2023 Apr 20 ]. Available from: http://www.neonatology.org.tr/.
Retrospective Evaluation of Surfactant Response in Premature Newborns Followed Up with the Diagnosis of Respiratory Distress Syndrome in the Neonatal Intensive Care Unit
Abstract
Aim: Preterm birth is the leading cause of neonatal death. The highest rate among these deaths belongs to respiratory distress syndrome (RDS). The aim of this study is to help the most appropriate and effective management of RDS in newborns; To determine the risk factors, clinical features and complications of RDS.
Material and Methods: Low birth weight infants in our second level neonatal intensive care unit between January 2016 and June 2021 were included in the study. The cases were examined retrospectively, demographic characteristics, treatments given (mechanical ventilation, surfactant), and early and late complications; death rates and causes were determined.
Results: 130 cases were included in the study. Sixty-two percent were boys and 38% were girls. 85% had cesarean section and 15% had normal vaginal delivery. Mean birth weight was 2043±372 g, mean gestational week was 32±5 weeks. Antenatal steroid (ACS) was administered in 67.6% of them. Premature rupture of membranes (PROM) was detected in 33% of them. Early and late complications; Ventilator-associated pneumonia in 3.8% and pneumothorax in 3%. Sepsis was detected in 4.6%. Bronchopulmonary dysplasia (BPD) 2.3%, Retinopathy of Prematurity (ROP) 1.5%, periventricular leukomalacia 1%, 7 with intracranial hemorrhage (IGC stage III-IV) 2%. The death rate was 10%.
Conclusion: Our death rates; was found to be similar to the data published in our country. We think that our mortality rates will decrease if prenatal follow-up is improved, pregnant follow-ups are carried out regularly, risks for common causes of death are determined and adequate and effective measures are taken against them.
References
- Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019; 115(4): 432-50.
- Gomella T L. Neonatology. 5th Ed., USA : Appleton & Lange, 2004; 524-53 .
- Fanaroff AA, Martin RJ. The Respiratory Distress Syndrome and its Manegement in NeonatalPerinatal Medicine Disease of The Fetus and Infant . 6th Ed, New York: Mosby, 1998
- Yurdakök M. Respiratuvar distres sendromu ve ventilatör tedavisinin ilkeleri. Tunçbilek E, Kınık E, Çevik N (Editör), Katkı Pediatri Dergisi Neonatal Respiratuvar Distres Özel Sayısı, 1991; 299-370.
- Sun H, Zhou Y, Xiong H, Kang W, Xu B, Liu D, et al. Prognosis of very preterm infants with severe respiratory distress syndrome receiving mechanical ventilation. Lung. 2015; 193(2):249-54.
- Yadav S, Lee B, Kamity R. Neonatal Respiratory Distress Syndrome. 2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Donn SM, Sinha SK. Newer techniques of mechanical ventilation: an overview. Semin Neonatol. 2002; 7: 401-7.
- Rodriguez RJ. Management of respiratory distress syndrome: an update. Respir Care. 2003; 48: 279-86.
- Ambalavanan N, Carlo WA. Bronchopulmonary dysplasia: new insights. Clin Perinatol. 2004; 31: 613-28.
- Krauss AN. New methods advance treatment for respiratory distress syndrome. Pediatr Ann. 2003; 32: 585-91.
- rrill JD, Ballard RA. Pulmonary surfactant for neonatal respiratory disorders. Curr Opin Pediatr. 2003; 15: 149-54.
- Smrcek JM , Schwartau N, Kohl M, Berg C, Geipel A, Krapp M, et al. Antenatal corticosteroid therapy in premature infants. Arch Gynecol Obstet. 2005; 271: 26-32.
- Alyamac Dizdar E, Sarı FN, Aydemir C, Oğuz ŞS, Erdeve Ö, et al. A randomized, controlled trial of poractant alfa versus beractant in the treatment of preterm infants with respiratory distress syndrome. Am J Perinatol. 2012; 29(2): 95- 100.
- Whitsett JA., Pryhuber GS, Rice WR. Acute respiratory disorders. In: Avery GB, MacDonald MG (eds). Neonatology: Pathophysiology and Management of the Newborn, 5th ed. Philadelphia: Lippincott Williams&Wilkins, 1999: 505-15.
- McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020; 12:CD004454.
- Jovandaric MZ, Milenkovic SJ, Dotlic J, Babovic IR, Jestrovic Z, Milosevic B, at al. Neonatal pneumothorax outcome in preterm and term newborns. Medicina (Kaunas). 2022; 58(7): 965.
- Malek A,Afzali N, Meshkat M, Yazdi NH. Pneumothorax after mechanical ventilation in newborns. Iran J Pediatr. 2011; 21: 45-50.
- Yalaz M, Arslanoglu S, Akisu M, Atik T, Ergun O, Kultursay N. A comparison of efficacy between two natural exogenous surfactant preparations in premature infants with respiratory distress syndrome. Klin Padiatr. 2004; 216(4): 230-5.
- Dani C, Mosca F, Vento G, Tagliabue P, Picone S, Lista G at al. Effects of surfactant treatment in late preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2018; 31(10): 1259-66.
- Costa S, Zecca E, De Luca D, De Carolis MP, Romagnoli C. Efficacy of a single dose of antenatal corticosteroids on morbidity and mortality of preterm infants. Eur J Obstet Gynecol Reprod Biol. 2007; 131(2): 154-7.
- Salvo V, Zimmermann LJ, Gavilanes AW, Barberi I, Ricotti A, Abella R at al. First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis. Pediatr Crit Care Med. 2012; 13(1): 72-9.
- neonatology.org [Internet]. Ankara: Türk Neonatoloji Derneği Rehberleri; 2018 [Updated: 2020 Apr 16;Cited:2023 Apr 20 ]. Available from: http://www.neonatology.org.tr/.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | May 10, 2023 |
| Submission Date | November 18, 2022 |
| Published in Issue | Year 2023 Volume: 13 Issue: 2 |
