Yenidoğan Yoğun Bakımda İzlenen Pnömotorakslı Olguların Değerlendirilmesi

Abstract

Amaç: Pnömotoraks, en sık görülen pulmoner hava kaçağı sendromlarından biridir ve yenidoğan döneminde yaşamın diğer dönemlerinden daha sık ortaya çıkar. Primer ve sekonder pnömotoraksın karşılaştırmalı klinik seyri hakkında sınırlı veri olduğundan, bu çalışmada primer ve sekonder pnömotorakslı yenidoğanların demografik özelliklerini, klinik seyirlerini ve sonuçlarını belirlemeyi ve karşılaştırmayı amaçladık. Materyal-metot: Tek merkezli ve retrospektif tasarlanan çalışmaya, Malatya Turgut Özal Üniversitesi Tıp Fakültesi Hastanesi'nde Ocak 2020-Temmuz 2021 tarihleri arasında izlenen pnömotoraks tanılı yenidoğanlar alındı. Bulgular: Çalışma boyunca yenidoğan yoğun bakım ünitesine yatan 1491 yenidoğanın 29’una pnömotoraks tanısı kondu ve bunların 16'sı (%55.2) erkek, 19'u (%65.5) sezaryen ile doğum ve 6'sı (%20.7) prematüre idi. Ortalama gebelik yaşı 37.5±2.6 hafta ve doğum ağırlığı 3063.4±53 gram idi. Pnömotoraks tanı anındaki medyan yaş 5 saat (1-96) ve ortalama hastanede kalış süresi 9,55±4,38 gündü. 13 (%44.8) yenidoğan primer pnömotoraks olarak gruplandırılırken, 16 hastada (%55.2) altta yatan bir akciğer hastalığı veya predispozan faktör vardı. Toraks tüpü takılan hastalarda ortalama drenaj süresi 4.1±2.13 gündü. 5.dk Apgar skoru ve SNAP-II skorları açısından gruplar arasında istatistiksel olarak anlamlı bir fark olduğunu gösterdi (p < 0.05). Ayrıca pnömotoraks tanı zamanı primer pnömotoraks grubunda anlamlı olarak daha erkendi (p < 0.05). Çalışmamız sekonder pnömotoraks grubunda anlamlı olarak daha uzun total oksijen gereksinimi, CPAP ve mekanik ventilasyon süreleri ortaya koydu (p < 0.05). Toplamda üç yenidoğan kaybedildi ve hepsi sekonder pnömotoraks grubundaydı. Sonuç: Pnömotoraks yenidoğanlar için hala önemli bir morbidite ve mortalite nedenidir ve primer pnömotoraks olan olgular sekonder olanlara göre daha ılımlı klinik seyire sahiptir. Anahtar kelimeler: yenidoğan, pnömotoraks, solunum sıkıntısı

Keywords

• yenidoğan
• pnömotoraks
• solunum sıkıntısı

Evaluation of pneumothorax in the neonatal intensive care unit

Abstract

Objective: Pneumothorax is one of the most common pulmonary air leak syndromes and appears more often in the newborn period than at any other time of life. In this study, we aimed to determine and compare the demographic characteristics, clinical courses and outcomes of newborns with primary and secondary pneumothorax. Methods: In this single-centre retrospective study, maternal and neonatal data were collected from medical records at Turgut Ozal University Hospital between January 2020 to July 2021. Results: Twenty-nine newborns diagnosed with pneumothorax, and of these, 16 were male (55.2%), 19 (65.5%) were born by cesarean section, and six (20.7%) were premature. The mean gestational age was 37.5±2.6 weeks, and birth weight was 3063.4±53 grams. The median age at diagnosis was 5 h (1-96), and the mean hospital stay was 9.55±4.38 days. The mean drainage time was 4.1±2.13 days. 13 (44.8%) neonates were classified as primary, while 16 patients (55.2%) had an underlying pulmonary disease or predisposing factor. Our study showed a statistically significant difference between groups regarding Apgar score 5th min and SNAP-II scores (p < 0.05). The occurence of pneumothorax was significantly earlier in the primary group (p < 0.05). Our study revealed significantly longer total oxygen, continuous positive airway pressure and mechanical ventilation durations in the secondary pneumothorax group (p<0.05). Conclusion: Neonatal pneumothorax is still associated with significant morbidity and mortality, and primary pneumothorax had more favorable outcomes than secondary pneumothorax.

Keywords

• newborn
• pneumothorax
• respiratory distress

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