Gestasyon haftası <30 hafta olan prematüre bebeklerde doğum şekli neonatal sonuçları etkiler mi?

Year 2022, Volume: 19 Issue: 2, 1272 - 1276, 01.07.2022

Mustafa Şenol Akın , Fatma Nur Sarı , Mehmet Büyüktiryaki , Ömer Ertekin , Evrim Alyamac Dizdar , Şerife Oğuz

https://doi.org/10.38136/jgon.904134

Abstract

Giriş: Son yıllarda dünyada ve ülkemizde sezaryen ile doğum oranları giderek artmaktadır. Bu durum, yenidoğan ve sonraki çocukluk döneminde olumsuz bazı etkilere sebep olmaktadır. Bu çalışmada, doğum şeklinin, çok küçük prematüre bebeklerde neonatal sonuçlar üzerine olan etkisinin incelenmesi amaçlanmıştır.
Metot: 2015-2019 yılları arasında III. düzey yenidoğan yoğun bakım ünitesinde izlenen, gebelik haftası <30 hafta ve doğum ağırlığı 1000-1500 g olan prematüre bebekler retrospektif olarak değerlendirildi. Doğum şeklinin neonatal sonuçlar üzerine olan etkilerini değerlendirmek için çalışma populasyonu normal vajinal yol (NVY) ve sezaryen (C/S) ile doğanlar olmak üzere 2 gruba ayrıldı. Prematüre bebeklerin neonatal sonuçları doğum şekline göre karşılaştırıldı.
Bulgular: Çalışmamızda 404 bebeğin verileri analiz edildi. Çalışma grubunun ortanca (minimum-maksimum) gebelik haftası ve doğum ağırlığı sırasıyla 28 (25-29) hafta, 1200 (1000-1500) g idi. Bebeklerin 70’i (%17,3) NVY ile doğmuştu. Her iki grubun demografik özellikleri incelendiğinde ortanca gebelik haftalarının (28 vs 29) ve doğum ağırlıklarının (1200 vs 1195) benzer olduğu görüldü. Ancak preeklampsi ve çoğul gebelik sezaryen ile doğanlarda daha fazlaydı (p=<0,001; p=<0,001).
Sezaryen ile doğan bebeklerde surfaktan kullanımı anlamlı oranda yüksekti. (% 55 vs % 28,6; p=<0,001). Ayrıca sezaryen ile doğan bebeklerde ilk haftada inotrop kullanımının daha sık olduğu görüldü (p=0,001). Doğum salonunda canlandırma ihtiyacı sezaryen ile doğan bebeklerde daha fazla idi (p=0,021). Non invaziv ventilasyon ve mekanik ventilasyon süresi sezeryan ile doğan bebeklerde daha yüksek saptandı (sırasıyla ; p=0,002, p=0,001).
Sonuç: Sezaryan ile doğum, çok küçük prematüre bebeklerde neonatal morbidite ve mortalite riskini artırmaktadır.

Keywords

prematürite, vajinal doğum, doğum şekli

Supporting Institution

Yok

Does delivery mode effect neonatal outcomes in premature infants <30 weeks gestational age?

Abstract

Introduction: In recent years, cesarean delivery rates have been increasing in the world and in our country. This situation causes some negative effects on infant and child health in the early neonatal period and later childhood. In this study, we aimed to examine the effect of delivery method on neonatal outcomes in very premature infants.
Methods: Premature infants with a gestational age of <30 weeks and a birth weight of 1000-1500 g who were followed at a tertiary neonatal intensive care unit between 2015-2019 were evaluated retrospectively. In order to assess the effects of delivery mode on neonatal outcomes, the study population was divided into 2 groups as those born by vaginal route or cesarean section. Neonatal outcomes of infants were compared according to delivery type.
Results: Data of 404 infants were analyzed. The median (min-max) gestational age and birth weight of the study group were 28 (25-29) weeks and 1200 (1000-1500) g, respectively. Seventy (17.3%) infants were born with vaginal route. Demographic characteristics of both groups including median gestational age (28 vs 29 weeks) and birth weight (1200 vs 1195 g) were similar. However, preeclampsia and multiple pregnancy were higher in infants born by cesarean section. (p = <0.001, p = <0.001)
Surfactant use was significantly higher in infants born by cesarean section. (55% vs 28.6%; p = <0.001). In addition, it was observed that the use of inotropes in the first week of life was more frequent in infants born by cesarean section. (p=0.001). The need for resuscitation in the delivery room was higher in infants born by cesarean (p=0,021). Also, duration of non-invasive or mechanical ventilation were higher in infants born by cesarean section (p = 0.002, p = 0.001, respectively).
Conclusion: Caesarean delivery increases the risk of neonatal morbidity and mortality in very premature infants

Keywords

prematurity, vaginal delivery, mode of delivery

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