Patent Duktus Arteriozusun Risk Faktörlerinin ve Klinik Sonuçlarının Değerlendirilmesi

Abstract

AMAÇ: Patent duktus arteriyozus (PDA) özellikle prematüre bebeklerde önemli morbiditeler ve mortaliteye neden olabilen sık görülen kardiyolojik bir hastalıktır. Çalışmamız prematüre bebeklerde PDA ile ilişkili risk faktörlerini belirleyip ileride bu risk faktörlerini azaltmayı amaçlamıştır. GEREÇ VE YÖNTEM: Çalışmamız tek merkezden gebelik haftası ≤ 32 hafta veya doğum ağırlığı ≤ 1500 gram olan prematüre bebeklerde 1 Eylül 2019 ile 31 Aralık 2020 tarihleri arasında retropektif olarak gerçekleştirildi. Hemodinamik olarak anlamlı PDA (haPDA) olan hastalarda risk faktörlerini ve klinik sonuçlarını değerlendirmek için haPDA olan ve haPDA olmayan gruplar karşılaştırıldı. BULGULAR: Çalışmamızda 182 (%27,6) haPDA ve 478 (%72,4) haPDA olmayan toplam 660 prematüre bebek değerlendirildi. haPDA olan ve haPDA olmayan gruplar arasında maternal özellikler, cinsiyet, sezaryen doğum, gebelik yaşına göre küçük bebek (SGA), fototerapi ve intraventriküler kanama (İVK) açısından sonuçlar benzerdi (p>0,05). haPDA grubunda gebelik haftası, doğum ağırlığı, doğumda hemoglobulin ve hematokrit düzeyi, kırmızı küre dağılım genişliği (RDW), trombosit sayısı ve kalsiyum düzeyi haPDA olmayan gruptan anlamlı düşüktü (p<0.05). Ortalama kırmızı küre hacmi (MCV), eritrosit ve taze donmuş plazma transfüzyonu, neonatal sepsis, pulmoner kanama, bronkopulmoner dizplazi (BPD), respiratuvar distres sendromu (RDS), nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), tam enteral beslenmeye geçiş zamanı, mekanik ve invaziv olmayan ventilasyon ile oksijen destek süresi, hastane yatış süresi ve mortalite haPDA grubunda anlamlı yüksekti (p<0,05). Çok değişkenli lojistik regresyon analizi sonrasında haPDA ile eritrosit transfüzyonu (OR 3.651, 95%CI 2.068–6.445, p<0.001), taze donmuş plazma transfüzyonu (OR 1.999, 95%CI 1.084–3.688, p=0.027), mekanik ventilasyon süresi (OR 1.030, 95%CI 1.017–1.042, p<0.001), oksijen destek süresi (OR 1.029, 95%CI 1.012-1.046, p<0.001) ve RDS (OR 3.344, 95%CI 1.440–7.763, p<0.001) bağımsız ilişkili faktörlerdi. SONUÇ: Çalışmamızda eritrosit ve plazma transfüzyonu, daha uzun solunum desteği ve RDS varlığı haPDA için bağımsız ilişkili faktörlerdi. Ünitemizde belirlenen haPDA ilişkili faktörleri azaltmaya yönelik alınacak önlemler haPDA sıklığını ve haPDA ilişkili olumsuz klinik sonuçları azaltabilir.

Keywords

• patent duktus arteriozus
• respiratuvar distres sendromu
• prematürite
• morbidite

Supporting Institution

yok

Project Number

yok

Ethical Statement

Çalışmamızın tasarımı belirlendikten sonra Sağlık Bilimleri Üniversitesi Ankara Bilkent Şehir Hastanesi Sağlık Uygulama ve Araştırma Klinik Araştırmalar Etik Kurulu’na başvuruldu. Çalışmamıza ait 06.07.2022 tarih ve E2-22-2049 sayılı ile etik onam alındı.

Thanks

yok

Investigation of Risk Factors and Clinical Outcomes of Patent Ductus Arteriosus

Abstract

AIM: Patent ductus arteriosus (PDA) is a common cardiological condition, particularly in premature infants, that can lead to significant morbidity and mortality. Our study aimed to identify risk factors associated with PDA in premature infants and to reduce these risk factors in the future. MATERIAL AND METHOD: Our study was conducted retrospectively in premature infants with a gestational age ≤ 32 weeks or birth weight ≤ 1500 grams from a single center between September 1, 2019, and December 31, 2020. To evaluate risk factors and clinical outcomes in patients with hemodynamically significant PDA (hsPDA), groups with and without hsPDA were compared. RESULTS: In our study, a total of 660 premature infants were evaluated, 182 (27.6%) with hsPDA and 478 (72.4%) without hsPDA. The results were similar between the hsPDA and non-hsPDA groups in terms of maternal characteristics, gender, cesarean delivery, small for gestational age (SGA), phototherapy, and intraventricular hemorrhage (IVH) (p>0.05). In the hsPDA group, gestational age, birth weight, hemoglobin and hematocrit levels, red blood cell distribution width (RDW), platelet count, and calcium level at birth were significantly lower than in the non-hsPDA group (p<0.05). Mean red blood cell volume (MCV), erythrocyte and fresh frozen plasma transfusion, neonatal sepsis, pulmonary hemorrhage, bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), time to full enteral feeding, duration of mechanical and non-invasive ventilation and oxygen support, length of hospital stay, and mortality were significantly higher in the hsPDA group (p<0.05). After multivariate logistic regression analysis, hsPDA and erythrocyte transfusion (OR 3.651, 95%CI 2.068–6.445, p<0.001), fresh frozen plasma transfusion (OR 1.999, 95%CI 1.084–3.688, p=0.027), duration of mechanical ventilation (OR 1.030, 95%CI 1.017–1.042, p<0.001), duration of oxygen support (OR 1.029, 95%CI 1.012–1.046, p<0.001), and RDS (OR 3.344, 95%CI 1.440–7.763, p<0.001) were independent associated factors. CONCLUSION: In our study, erythrocyte and plasma transfusion, prolonged respiratory support, and RDS were independent associated factors for hsPDA. Measures taken to reduce the hsPDA associated factors identified in our unit may reduce the incidence of hsPDA and hsPDA-related adverse clinical outcomes.

Keywords

• patent ductus arteriosus
• respiratory distress syndrome
• prematurity
• morbidity

Supporting Institution

none

Project Number

yok

Ethical Statement

After determining the design of our study, an application was submitted to the Health Sciences University Ankara Bilkent City Hospital Clinical Research Ethics Committee. Ethical approval for our study was obtained on July 6, 2022, with approval number E2-22-2049.

Thanks

none

References

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