PNEUMOTHORAX IN NEWBORN AND COMPARISON OF DEMOGRAPHIC AND CLINICAL FEATURES ACCORDING TO DRAINAGE TREATMENT REQUIREMENT WITH CHEST TUBE

Yıl 2019, Cilt: 13 Sayı: 2, 50 - 56, 26.03.2019

Mehmet Büyüktiryaki Evrim Alyamaç Dizdar Nilüfer Okur Buse Özer Bekmez Cüneyt Tayman

https://doi.org/10.12956/tchd.510587

Cited By: 1

Öz

Objective: Pneumothorax,
which is an important cause of morbidity and mortality especially in premature
infants, is the most common neonatal period in childhood. Our aim is to
evaluate newborns diagnosed as pneumothorax in our unit.

Material and Methods: The
records of newborn babies who were diagnosed as pneumothorax in the Neonatal
Intensive Care Unit of Zekai Tahir Burak Women's Health Education and Research
Hospital between January 1, 2015 and December 31, 2015 were analyzed
retrospectively. Newborn infants who were diagnosed radiologically as
pneumothorax were included in the study. Major congenital anomalies were
excluded from the study.

Results: The incidence of
pneumothorax was 0.37% in all live births and 2.6% in the neonatal intensive
care unit. The mean gestation age of the babies was 34.2 ± 3.6 weeks and birth
weight was 2322 ± 841 gr. Of the 67 newborns with pneumothorax, 49 were male
(73.1%), and 59 (88.1%) were born by cesarean section. TTN (38.8%) and RDS
(31.3%) were the most common underlying pulmonary diseases in infants who
developed pneumothorax. For the treatment of pneumothorax, 50 (74.7%) babies
were treated with chest tube and 17 (25.3%) had no chest tube. Gestational age
and birth weight were significantly lower in the drainage group (p <0.05).
The duration of MV and NDA was significantly longer in the drainage group, but
the free oxygen requirement was longer, but there was no significant
difference. There was no difference between the two groups in terms of preterm
morbidity and mortality.

Conclusion: In
neonatal period, pneumothorax is frequently encountered and usually within the
first two days. The most common underlying lung disease in premature infants is
RDS, while term infants is TTN. About ¾ of newborns developing pneumothorax
should be treated by inserting a chest tube. In case of pneumothorax development
in infants with gestational age <32 weeks, a chest tube should be inserted
in almost all of them. In infants who need drainage, the duration of invasive
and noninvasive respiratory support and the time of hospitalization are
significantly longer.

Anahtar Kelimeler

Pneumothorax, incidence, drainage

YENİDOĞANDA PNÖMOTORAKS VE GÖĞÜS TÜPÜ İLE DRENAJ TEDAVİSİ GEREKSİNİMİNE GÖRE DEMOGRAFİK VE KLİNİK ÖZELLİKLERİN KARŞILAŞTIRILMASI

Öz

Amaç: Özellikle prematüre
bebeklerde önemli bir morbidite ve mortalite nedeni olan pnömotoraks, çocukluk
çağında en sık yenidoğan döneminde görülür. Amacımız, ünitemizde pnömotoraks tanısı
konulan yenidoğanların değerlendirilmesidir.

Gereç ve Yöntemler: Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma
Hastanesi Yenidoğan Yoğun Bakım ünitesinde 1 Ocak 2015 ile 31 Aralık 2015
tarihleri arasında pnömotoraks tanısı alarak izlenen yenidoğan bebeklerin
kayıtları geriye dönük olarak incelenmiştir. Radyolojik olarak pnömotoraks
tanısı doğrulanan yenidoğan bebekler çalışmaya dahil edildi. Majör konjenital
anomalisi olanlar ise çalışma dışı bırakıldı.

Bulgular: Pnömotoraks insidansı,
tüm canlı doğumlar içerisinde %0.37, yenidoğan yoğun
ba­kım ünitesinde takibi yapılanlar arasında ise %2.6 olarak saptandı. Bebeklerin
ortalama gestasyon yaşı 34.2±3.6 hafta ve doğum
ağırlığı 2322±841 gr idi. Pnömotoraks saptanan 67
yenidoğanın 49’u erkek (%73.1) idi ve 59’unun (%88.1)
sezaryen ile doğduğu saptandı. Pnömotoraks
gelişen bebeklerde alttan yatan en sık primer akciğer hastalıklarının TTN
(%38.8) ve RDS (%31.3) olduğu belirlendi. Pnömotoraks tedavisi için göğüs tüpü
ile 50 (%74.7) bebeğe drenaj tedavisi uygulanırken, 17 (%25.3) bebeğin göğüs
tüpü gereksinimi olmadı. Drenaj gereken grupta gestasyon yaşı ve doğum ağırlığı
anlamlı olarak düşük bulundu (p<0.05). Drenaj gereken grupta MV ve NİV
süreleri anlamlı olarak uzun iken, serbest oksijen gereksinimi de daha uzun
olmakla birlikte anlamlı fark saptanmadı. Preterm morbiditeleri ve mortalite
açısından iki grup arasında fark saptanmadı.

Sonuç: Yenidoğan döneminde pnömotoraks ile sık olarak ve genellikle
ilk iki gün içerisinde karşılaşılır. Prematüre bebeklerde en sık altta yatan
akciğer hastalığı RDS iken, term bebeklerde TTN’ dir. Pömotoraks gelişen
yenidoğanların yaklaşık ¾’üne göğüs tüpü takılarak drenaj tedavisi gerekir.
Gestasyon yaşı <32 hafta olan bebeklerde pnömotoraks gelişmesi durumunda
neredeyse tamamına göğüs tüpü takılması gerekmektedir. Drenaj gereken bebeklerde
invaziv ve noninvaziv solunum destek süreleri ile hastanede kalış zamanı
belirgin olarak uzamaktadır.

Anahtar Kelimeler

Pnömotoraks, insidans, drenaj

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