Yaşamın üçüncü gününde preterm bebeklerde hemodinamik olarak anlamlı patent duktus arteriozusun tanısında klinik bulguların önemi

Year 2020, Volume: 17 Issue: 2, 342 - 344, 25.06.2020

Ozkan İlhan , Senem Alkan Özdemir , Sinem Akbay , Ali Bakiler , Berat Kanar , Şeyma Memur , Meltem Bor , Esra Özer

https://doi.org/10.38136/jgon.673678

Abstract

Amaç: Bu çalışmanın amacı preterm bebeklerde yaşamın üçüncü gününde hemodinamik olarak anlamlı patent duktus arteriozusun (PDA) tanısında ekokardiyografik bulgularla klinik bulguları karşılaştırmaktır.
Gereç ve Yöntemler: Bu retrospektif çalışmaya 31. gestasyonel hafta ve 1250 gramın altında doğan, yaşamın üçüncü gününde ekokardiyografi yapılan 47 preterm bebek alındı. Klinik bulguların hemodinamik olarak anlamlı PDA’yı öngörüp öngörememesi primer sonuç olarak belirlendi.
Bulgular: Çalışmaya alınan 47 preterm bebeğin ekokardiyografik olarak 29’unda hemodinamik olarak anlamlı PDA (hemodinamik olarak anlamlı PDA grubu) tespit edilirken, 18’inde PDA tespit edilmedi (kontrol grubu). Takipne ve artmış oksijen ihtiyacı oranı hemodinamik olarak anlamlı PDA grubunda kontrol grubuna göre anlamlı olarak daha yüksekti (sırasıyla, p = 0.01 ve p = 0.004). Taşikardi, hipotansiyon ve metabolik asidoz oranı hemodinamik olarak anlamlı PDA grubunda anlamlı olarak daha yüksekti (sırasıyla, p = 0.03, p = 0.004 ve p = 0.005). Üfürüm, hiperdinamik prekordiyum ve genişlemiş nabız basıncı açısından gruplar arasında anlamlı fark saptanmadı. Takipne, artmış oksijen ihtiyacı, taşikardi ve hipotansiyon oranı hemodinamik olarak anlamlı PDA grubunda anlamlı olarak daha yüksek olsa da, lojistik regresyon analizinde sadece metabolik asidozun hemodinamik olarak anlamlı PDA’yı öngörebileceği gösterildi [OR:7.10 (p = 0.02, 95% CI: 1.34-37.53)].
Sonuç: Metabolik asidoz, preterm bebeklerde yaşamın üçüncü gününde hemodinamik olarak anlamlı PDA’yı öngörmede en güvenilir klinik bulgudur.

Keywords

Klinik bulgular, ekokardiyografi, yenidoğan, patent duktus arteriozus, preterm

Diagnostic value of clinical criteria in the diagnosis of hemodynamically significant patent ductus arteriosus in the preterm infants on their third day of life

Abstract

Aim: The purpose of this study is to compare the clinical criteria of preterm infants on their third day of life with their echocardiographic findings for the correct diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA).
Material And Methods:The infants with a gestational age of <31 weeks and with a birth weight of <1250 g who underwent echocardiography on their third day of life were included in this retrospective study. The primary motive of this study is to identify whether clinical findings are feasible in the prediction of hsPDA.
Results: Of the 47 preterm infants, 29 had hsPDA (the hsPDA group) and 18 did not had patent ductus arteriosus (the control group). This observation was made by an echocardiographic examination. The rate of tachypnea and increased oxygen requirement were statistically significantly higher in the hsPDA group than in the control group (p = 0.01 and p = 0.004, respectively). The incidence of tachycardia and hypotension was statistically significantly higher in the hsPDA group than in the control group (p = 0.03 and p = 0.004, respectively). The rate of metabolic acidosis was significantly higher in the hsPDA group than in the control group (p = 0.005). There were no significant differences in murmur, hyperdynamic precordium, and widened pulse pressure between the groups. The incidence rates of tachycardia, hypotension, and metabolic acidosis were statistically significantly higher in the hsPDA group even when the rates of tachypnea increased the oxygen requirement. Thelogistic regression demonstrated that the metabolic acidosis was the only significant predictor of hsPDA [OR: 7.10 (p = 0.02, 95% CI: 1.34–37.53)].
Conclusion: Metabolic acidosis is the most reliable clinical finding for the prediction of hsPDA in the preterm infants on the third day of life.

Keywords

Clinical criteria, echocardiography, newborn, patent ductus arteriosus, preterm

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