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Yenidoğan Yoğun Bakım Ünitesindeki 119 Bebeğin Klinik ve Ekokardiyografik Değerlendirilmesi

Year 2010, Volume: 4 Issue: 1, 22 - 29, 01.12.2010

Abstract

Giriş-Amaç: Çalışmamızda Yenidoğan yoğun bakım ünitesin (YYBÜ)’deki bebeklerde kardiyoloji konsültasyonu istenme nedenleri ve kardiyovasküler sistem (KVS) hastalıklarının sıklığı araştırılmıştır. Ayrıca doğumsal kalp hastalıkları (DKH) için risk faktörleri ve mortalite oranları belirlenmeye çalışılmıştır. Gereç ve Yöntem: Mart 2005 ile Mart 2006 tarihleri arasında YYBÜ’de yatırılarak izlenen 1146 bebekten kalp hastalığı şüphesi ile ekokardiyografik inceleme yapılan 119 bebeğin (çalışma grubu) KVS bulguları geriye dönük olarak değerlendirilmiştir. Bulgular: Yenidoğan yoğun bakım ünitesinde en sık kardiyoloji konsültasyonu istenme nedeni üfürüm (%52.9) idi. Tüm bebeklerde ve çalışma grubunda DKH sıklığı sırasıyla %3.49 ve %33.6 olarak belirlendi. En sık karşılaşılan asiyanotik DKH %27.5 oranıyla izole PDA idi. Siyanotik DKH olarak en sık görülen defekt %12.5 oranıyla büyük arter transpozisyonu oldu. Çalışma grubunda bulunan 39 preterm bebeğin %17.9’unda semptomatik PDA belirlendi. Yenidoğanlarda aritmi insidansı %1.6 olarak bulundu. Atrioventriküler (AV) tam blok ve SVT birer olguda saptandı. Annede diyabet öyküsü 15 olguda ve genetik sendromlar (Down sendromu, Turner sendromu, Di George sendromu ve konjenital rubella sendromu) 11 olguda belirlendi. Eşlik eden genetik sendromlar ve ekstrakardiyak anomaliler DKH için en sık rastlanılan risk faktörleri idi (%90.9 ve %62.5). Yenidoğan yoğun bakım ünitesinde bir yıl içinde 57 yenidoğan bebek (%4.9) kaybedilmiştir veölümlerin %21’inde eşlik eden DKH saptanmıştır. Sonuçlar: Yenidoğan bebeklerde duyulan patolojik üfürümler en önemli DKH bulgusudur. Prematüre bebekler, kromozomal veya ekstrakardiyak anomalileri saptanan olgular ve diyabetik anne bebeklerinde sıklıkla eşlik eden KVS hastalıklarıyla karşılaşılmaktadır. Yenidoğan yoğun bakım ünitesinde izlediğimiz bebeklerde ölümlerin en önemli nedenleri arasında DKH önemini korumaktadır.

References

  • 1. Ainsworth S, Wylie JP, Wren C.Prevelance and clinical signifance of cardiac murmurs in neonates. Arch Dis Child Fetal and Neonatal Ed. 1999; 80: 43-45.
  • 2. Meberg A, Lindberg H, Thaulow E.Congenital heart defects:the patients who die. Acta Pediatr. 2005;94:1060-1065.
  • 3. Richmond S, Wren C. Early diagnosis of congenital heart disease. Semin Neonatal. 2001;6:27-35.
  • 4. Rosati E, Chitano G, Dipaola L, De Felice C, Latini G. Indications and limitations for a neonatal pulse oximetry screening of critical congenitalheart disease. J Perinat Med. 2005; 33: 455-457.
  • 5. Park MK, Troxler RG. Manifestation of cardiac disease problems in newborns. In: Park MK, Troxler RG (eds). Pediatric Cardiology.for practitioners. 4th ed. USA: Mosby Inc., 2002; 372-396.
  • 6. Moss S, Kitchiner DJ, Yoxall CW, Subhedar NV. Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal and Neonatal Ed. 2003;88: 287.
  • 7. Azhar AS, Habib HS. Accuracy of initial evaluation of heart murmurs in neonates: Do we need an echocardiogram ?. Pediatr Cardiol. 2006;27:234- 237.
  • 8. Du ZD, Roguin N, Barak M. Clinical and echocardiyografik evaluation of neonates with heart murrnurs. Acta Pediatr 1997;86:752-737.
  • 9. Güven H, Bakiler AR, Kozan M, Aydınoglu H, Helvacı M, Dorak C. Echocardiographic screening in newborn infants. Çocuk Sağlığı ve Hastalıkları Dergisi 2006;49:8-11.
  • 10. Aydoğdu SA, , Münevver Türkmen M, Özkan P. Adnan Menderes Ünıversitesi Yenidoğan yoğun bakım ünıtesinde izlenen bebeklerde doğumsal kalp hastalığı sıklığı ADÜ Tıp Fakültesi Dergisi 2008; 9:5-8.
  • 11. Azaria JJT Rein, Samuel I Omokhodion, Amiram Nir. Signafance of a cardiac murmur as the sole clinical sign in the newborn. Clinical Pediatrics; 2000:511-520
  • 12. Bernstein D. Epidemiology and genetic basis of congenital heart disease. In: Behrman RE, Kliegman RM, Jenson HB, (eds). Nelson Textbook of Pediatrics, 17th ed. Philadelphia : Saunders, 2004:1499-1502.
  • 13. Samanek M. Congenital heart disease among 815.569 children born between 1980-1990 and their 15 year survival: Aprospective bohemia survival study. Pediatr Cardiol.1999;20:411-415.
  • 14. Figueroa RJ, Magana PM, Hach P. Heart malformation in children with Down syndrome. Rev Esp Cardiol. 2003;56: 894-899
  • 15. Atalay S, Balcı S, Özkutlu S, Erdal MD, Özme Ş. Yüz Down sendromlu vakada kongenital kalp hastalıklarının sıklığı ve ekokardiyografik değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi.1991;34:33-39.
  • 16. Atalay S, Kürkçü F, Altuğ N, Dilek N, İmamoğlu A. Kromozom aberasyonları ile birlikte görülen konjenital kalp hastalıkları. MN Klinik Bilimler. 1996;11:186-190.
  • 17. Kava MP, Tulu MS, Muranjan MN, Girisha KM. Down syndrome: clinical profile from India. Arch Med Res.2004;35:31-35.
  • 18. Simsic JM, Coleman K, Maher KO, Cuadrado A, Kirshbom PM Do neonates with genetic abnormalities have an increased morbidity and mortality following cardiac surgery? Congenit Heart Dis. 2009;4:160-165.
  • 19. Artman M, Mahony L, Teitel DF. Counseling families based on etiology and epidemiology. In Artman M. Mahony L, Teitel DF (eds). Neonatal Cardiology. 1th ed. USA: Mc Graw-Hill., 2002: 253-262.
  • 20. Güçer Ş, İnceT, Kale G, Akçören Z, Özkutlu S. Noncardiac malformations in congenital heart disease; A retrospective analysis of 305 pediatric autopsies. The Turk J Pediatr. 2005; 47:159-166 . 21. Abu-sulaiman RM, Subaih B. Congenital heart disease in infants of diabetic mothers: Echocardiographic study. Pediatr Cardiol 2004; 25: 137-140.
  • 22. Ekici F, Atasay B, Günlemez A, Naçar N, Tutar E, Atalay S, Eyileten Z, Uysalel A, Arsan S. Management of patent ductus arteriosus in preterm infants. Anadolu Kardiyol Derg. 2006; 6: 28-33.
  • 23. Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr. 1983;102: 895-906.
  • 24. Artman M, Mahony L, Teitel DF. Common Arrhythmias. In Artman M. Mahony L, Teitel DF (eds). Neonatal Cardiology. 1th ed. USA: Mc GrawHill., 2002: 161-189.
  • 25. Canpolat E, Korkmaz A, Yurdakök M, Çeliker A, Önderoğlu L, Özer S, Özkutlu S, Erdem G, Tekinalp G, Yiğit Ş. Neonatal aritmiler: yenidoğan yoğun bakım ünitesinde on yıllık deneyim. Çocuk Sağlığı ve Hastalıkları Dergisi.2003;46:187-194.

CLINICAL AND ECHOCARDIOGRAPHIC EVALUATION OF 119 NEONATES IN NEONATAL INTENSIVE CARE UNIT

Year 2010, Volume: 4 Issue: 1, 22 - 29, 01.12.2010

Abstract

Aims: We evaluated the reasons of cardiac consultation and the rate of cardiovascular system (CVS) disease in neonates we followed at our NICU. Risk factors for congenital heart disease (CHD) and mortality rates were also investigated.Material- Methods: During March 2005 – 2006 period, among 1146 neonates hospitalized at our NICU, we evaluated retrospectively the CVS findings of 119 neonates (Study group) examined by echocardiography.Results: The most frequent (52.9%) reason for cardiology consultation was cardiac murmur. The incidences of CHD in all neonates and the study group were found as 3.49% and 33.6%, respectively. The most frequent acyanotic CHD and cyanotic CHD were patent ductus arteriosus and transposition of great arteries with a prevalence of 27.5% and 12.5%, respectively. Among 39 preterm newborns included in our study group, the incidence of symptomatic PDA was determined as 17.9%. The incidence of neonatal arrhythmia was found to be 1.6%. Supraventricular tachycardia and complet atrioventricular block were seen in 2 infants.Maternal diabetes mellitus and genetic syndromes (Down syndrome, Turner syndrome, Di-George syndrome, congenital rubella syndrome) were determined in 15 and 11 cases, respectively. Genetic syndromes and extracardiac abnormalities were the most common risk factors for CHD with ratios of 90.9% and 62.5%, respectively. Mortality rate of all neonates was 4.9% (57 cases) and 21% of them had CHD.Conclusion: Patological heart murmur is the most important clinical findings for CHD in neonates. In this study, CVS disease were the most frequently observed in neonates associated with premature, genetic syndrome or extracardiac abnormalities and maternal diabetes mellitus. Among the mortality reasons of neonates, CHD still maintains its importance at our intensive care unit

References

  • 1. Ainsworth S, Wylie JP, Wren C.Prevelance and clinical signifance of cardiac murmurs in neonates. Arch Dis Child Fetal and Neonatal Ed. 1999; 80: 43-45.
  • 2. Meberg A, Lindberg H, Thaulow E.Congenital heart defects:the patients who die. Acta Pediatr. 2005;94:1060-1065.
  • 3. Richmond S, Wren C. Early diagnosis of congenital heart disease. Semin Neonatal. 2001;6:27-35.
  • 4. Rosati E, Chitano G, Dipaola L, De Felice C, Latini G. Indications and limitations for a neonatal pulse oximetry screening of critical congenitalheart disease. J Perinat Med. 2005; 33: 455-457.
  • 5. Park MK, Troxler RG. Manifestation of cardiac disease problems in newborns. In: Park MK, Troxler RG (eds). Pediatric Cardiology.for practitioners. 4th ed. USA: Mosby Inc., 2002; 372-396.
  • 6. Moss S, Kitchiner DJ, Yoxall CW, Subhedar NV. Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal and Neonatal Ed. 2003;88: 287.
  • 7. Azhar AS, Habib HS. Accuracy of initial evaluation of heart murmurs in neonates: Do we need an echocardiogram ?. Pediatr Cardiol. 2006;27:234- 237.
  • 8. Du ZD, Roguin N, Barak M. Clinical and echocardiyografik evaluation of neonates with heart murrnurs. Acta Pediatr 1997;86:752-737.
  • 9. Güven H, Bakiler AR, Kozan M, Aydınoglu H, Helvacı M, Dorak C. Echocardiographic screening in newborn infants. Çocuk Sağlığı ve Hastalıkları Dergisi 2006;49:8-11.
  • 10. Aydoğdu SA, , Münevver Türkmen M, Özkan P. Adnan Menderes Ünıversitesi Yenidoğan yoğun bakım ünıtesinde izlenen bebeklerde doğumsal kalp hastalığı sıklığı ADÜ Tıp Fakültesi Dergisi 2008; 9:5-8.
  • 11. Azaria JJT Rein, Samuel I Omokhodion, Amiram Nir. Signafance of a cardiac murmur as the sole clinical sign in the newborn. Clinical Pediatrics; 2000:511-520
  • 12. Bernstein D. Epidemiology and genetic basis of congenital heart disease. In: Behrman RE, Kliegman RM, Jenson HB, (eds). Nelson Textbook of Pediatrics, 17th ed. Philadelphia : Saunders, 2004:1499-1502.
  • 13. Samanek M. Congenital heart disease among 815.569 children born between 1980-1990 and their 15 year survival: Aprospective bohemia survival study. Pediatr Cardiol.1999;20:411-415.
  • 14. Figueroa RJ, Magana PM, Hach P. Heart malformation in children with Down syndrome. Rev Esp Cardiol. 2003;56: 894-899
  • 15. Atalay S, Balcı S, Özkutlu S, Erdal MD, Özme Ş. Yüz Down sendromlu vakada kongenital kalp hastalıklarının sıklığı ve ekokardiyografik değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi.1991;34:33-39.
  • 16. Atalay S, Kürkçü F, Altuğ N, Dilek N, İmamoğlu A. Kromozom aberasyonları ile birlikte görülen konjenital kalp hastalıkları. MN Klinik Bilimler. 1996;11:186-190.
  • 17. Kava MP, Tulu MS, Muranjan MN, Girisha KM. Down syndrome: clinical profile from India. Arch Med Res.2004;35:31-35.
  • 18. Simsic JM, Coleman K, Maher KO, Cuadrado A, Kirshbom PM Do neonates with genetic abnormalities have an increased morbidity and mortality following cardiac surgery? Congenit Heart Dis. 2009;4:160-165.
  • 19. Artman M, Mahony L, Teitel DF. Counseling families based on etiology and epidemiology. In Artman M. Mahony L, Teitel DF (eds). Neonatal Cardiology. 1th ed. USA: Mc Graw-Hill., 2002: 253-262.
  • 20. Güçer Ş, İnceT, Kale G, Akçören Z, Özkutlu S. Noncardiac malformations in congenital heart disease; A retrospective analysis of 305 pediatric autopsies. The Turk J Pediatr. 2005; 47:159-166 . 21. Abu-sulaiman RM, Subaih B. Congenital heart disease in infants of diabetic mothers: Echocardiographic study. Pediatr Cardiol 2004; 25: 137-140.
  • 22. Ekici F, Atasay B, Günlemez A, Naçar N, Tutar E, Atalay S, Eyileten Z, Uysalel A, Arsan S. Management of patent ductus arteriosus in preterm infants. Anadolu Kardiyol Derg. 2006; 6: 28-33.
  • 23. Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr. 1983;102: 895-906.
  • 24. Artman M, Mahony L, Teitel DF. Common Arrhythmias. In Artman M. Mahony L, Teitel DF (eds). Neonatal Cardiology. 1th ed. USA: Mc GrawHill., 2002: 161-189.
  • 25. Canpolat E, Korkmaz A, Yurdakök M, Çeliker A, Önderoğlu L, Özer S, Özkutlu S, Erdem G, Tekinalp G, Yiğit Ş. Neonatal aritmiler: yenidoğan yoğun bakım ünitesinde on yıllık deneyim. Çocuk Sağlığı ve Hastalıkları Dergisi.2003;46:187-194.
There are 24 citations in total.

Details

Other ID JA42PY23DS
Journal Section Research Article
Authors

Filiz Ekici This is me

Sevim Ünal This is me

Sevcan Dablan This is me

Nursel Alpan This is me

Berna Şaylan Çevik This is me

Sadi Vidinlisan This is me

Publication Date December 1, 2010
Submission Date December 1, 2010
Published in Issue Year 2010 Volume: 4 Issue: 1

Cite

Vancouver Ekici F, Ünal S, Dablan S, Alpan N, Çevik BŞ, Vidinlisan S. CLINICAL AND ECHOCARDIOGRAPHIC EVALUATION OF 119 NEONATES IN NEONATAL INTENSIVE CARE UNIT. Türkiye Çocuk Hast Derg. 2010;4(1):22-9.


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