Akut Alt Solunum Yolu Enfeksiyonu Nedeni ile Yatırılarak İzlenen Yenidoğanların Klinik ve Virolojik Özellikleri

Yıl 2021, Cilt: 3 Sayı: 2, 33 - 38, 25.06.2021

İstemi Han Çelik , Zehra Arslan , Sezin Unal , Leyla Mollamahmutoğlu , Ahmet Yağmur Baş , Nihal Demirel

https://doi.org/10.46969/ezh.946825

Öz

Amaç: Respiratuvar sinsityal virüs, parainfluenza virüs ve rhinovirüs yenidoğan döneminde akut alt solunum yolu
enfeksiyonlarının en sık nedenidirler. Bu çalışmada alt solunum yolu enfeksiyonu mevcut olan yenidoğanların klinik ve
demografik özelliklerini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Yenidoğan yoğunbakım ünitemize Ocak 2013 ve Nisan 2016 tarihleri arasında yatırılan hastaların
medikal kayıtları retrospektif olarak incelendi.
Bulgular: Çalışmaya 19'u kız 24'ü erkek olmak üzere 43 hasta alındı. Ortalama gestasyonel hafta ve doğum ağırlığı 32 ±
4.4 hafta ve 1735 ± 820 gr'dı. Başvuru anında ortalama postnatal gün ve postmenstrüel hafta 61 ± 48 gün ve 41 ± 4.3
haftaydı. Polimeraz zincir reaksiyonu testi sonucunda respiratuvar sinsityal virüs (n:8), rhinovirüs (n:3), parainfluenza-3
virüs (n:3) ve adenovirus (n:3), respiratuvar sinsityal virüs ve parechovirus (n:1), respiratuvar sinsityal virüs ve adenovirüs
(n:1), rhinovirus ve insan bocavirüs (n:1) tespit edildi (toplam 20 hasta). Evde kardeş (n:31), ailede viral enfeksiyon (n:23),
yetersiz anne sütü (n:15), bronkopulmoner displazi (n:13), okula giden kardeş (n:10) ve ikiz veya üçüz olma (n:7) en
sık ana risk faktörleriydi. Ortanca hastanede kalış süresi 9 (1-60) gündü. Prematürite, ral, solunum desteği ihtiyacı ve
beslenme güçlüğü polimeraz zincir reaksiyonu pozitif hastalarda istatistiksel olarak daha sıktı. Respiratuvar sinsityal
virüs pozitif hastalar diğer virüslerin saptandığı gruba göre daha büyük gestasyonel hafta ve doğum ağırlığına sahipken
daha az respiratuvar distres sendromu, surfaktan kullanımı, patent duktus arteriozus öyküsü mevcuttu ve semptomların
başlangıcı ile hastaneye başvuru zamanı arasında geçen süre daha kısaydı.
Sonuç: Respiratuvar sinsityal virüs yenidoğanlarda alt solunum yolu enfeksiyonunun en sık rastlanan etkeni iken koenfeksiyon
ve daha nadir görülen insan bocavirüs ve parechovirus gibi etkenlerin klinik önemi akılda tutulmalıdır. Destek
tedavisi tedavinin en önemli bileşenidir.

Anahtar Kelimeler

yenidoğan dönemi, viral pnömoni, respiratuvar sinsityal virüs, polimeraz zincir reaksiyonu

Clinical and Virological Characteristics of Neonates Admitted with Acute Lower Respiratory Tract Infections

Öz

Aim: Viruses including respiratory syncytial virus, parainfluenza virus, rhinovirus are the primary etiologic agents in acute
lower tract infections in neonates. We aimed to evaluate the clinical and demographic characteristics of newborns with
acute lower tract infections.
Material and Method: Data was recorded from patients' medical records admitted between January 2013 and April 2016.
Results: The study population consisted of 43 neonates (19 girls, 24 boys). Mean gestational age and birthweight were 32 ±
4.4 weeks and 1735 ± 820 g, respectively. On admission, mean postnatal day and postmenstrual ages were 61 ± 48 days and
41 ± 4.3 weeks. Respiratory syncytial virus (n:8), rhinovirus (n:3), parainfluenza-3 virus (n:3) and adenovirus (n:3), respiratory
syncytial virus and parechovirus (n:1), respiratory syncytial virus and adenovirus (n:1), rhinovirus and human bocavirus (n:1)
were detected by polymerase chain reaction 20 patients in total. Siblings in the house (n:31), viral infection in the family
(n:23), insufficient breastfeeding (n:15), bronchopulmonary dysplasia (n:13), siblings attending school (n:10) and being twin
or triplet (n:7) were leading risk factors. Median hospital stay was 9 (1-60) days. Prematurity, fever, rales, respiratory support
and feeding difficulty were statistically more common in polymerase chain reaction positive patients. Patients with the
respiratory syncytial virus had higher gestational age, birth weight, less respiratory distress syndrome, surfactant use and
patent ductus arteriosus, and lower postnatal day on admission than patients with other viruses (p<0.05).
Conclusion: Respiratory syncytial virus is the commonest cause of acute lower tract infections in newborns, but the
clinical importance of co-infection and rare agents such as human bocavirus and parechovirus should be kept in mind.
Supportive management is the mainstay of the therapy.

Anahtar Kelimeler

neonates, viral pneumoniae, respiratory syncytial virus, polymerase chain reaction

Kaynakça

• Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed 2005; 90: F211-9.
• Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed 2005; 90: F211-9.
• Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002; 2:25-32.
• Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002; 2:25-32.
• Regamey N, Kaiser L, Roiha HL, et al. Viral etiology of acute respiratory infections with cough in infancy: a community-based birth cohort study. Pediatr Infect Dis J 2008; 27:100-105.
• Regamey N, Kaiser L, Roiha HL, et al. Viral etiology of acute respiratory infections with cough in infancy: a community-based birth cohort study. Pediatr Infect Dis J 2008; 27:100-105.
• Cho HJ, Shim SY, Son DW, Sun YH, Tchah H, Jeon IS. Respiratory viruses in neonates hospitalized with acute lower respiratory tract infections. Pediatr Int 2013; 55:49-53.
• Cho HJ, Shim SY, Son DW, Sun YH, Tchah H, Jeon IS. Respiratory viruses in neonates hospitalized with acute lower respiratory tract infections. Pediatr Int 2013; 55:49-53.
• Garcia CG, Bhore R, Soriano-Fallas A, et al. Risk factors in children hospitalized with RSV bronchiolitis versus non-RSV bronchiolitis. Pediatrics 2010; 126: e1453-1460.
• Garcia CG, Bhore R, Soriano-Fallas A, et al. Risk factors in children hospitalized with RSV bronchiolitis versus non-RSV bronchiolitis. Pediatrics 2010; 126: e1453-1460.
• Aydin B, Zenciroglu A, Dilli D, et al. Clinical course of community-acquired respiratory syncytial virus pneumonia in newborns hospitalized in neonatal intensive care unit. Tuberk Toraks 2013; 61:235-244.
• Aydin B, Zenciroglu A, Dilli D, et al. Clinical course of community-acquired respiratory syncytial virus pneumonia in newborns hospitalized in neonatal intensive care unit. Tuberk Toraks 2013; 61:235-244.
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163:1723-1729.
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163:1723-1729.
• Garcia-Garcia ML, Gonzalez-Carrasco E, Quevedo S, Munoz C, et al. Clinical and Virological Characteristics of Early and Moderate Preterm Infants Readmitted With Viral Respiratory Infections. Pediatr Infect Dis J 2015; 34:693-699.
• Garcia-Garcia ML, Gonzalez-Carrasco E, Quevedo S, Munoz C, et al. Clinical and Virological Characteristics of Early and Moderate Preterm Infants Readmitted With Viral Respiratory Infections. Pediatr Infect Dis J 2015; 34:693-699.
• Smit PM, Pronk SM, Kaandorp JC, et al. RT-PCR detection of respiratory pathogens in newborn children admitted to a neonatal medium care unit. Pediatr Res 2013; 73:355-361.
• Smit PM, Pronk SM, Kaandorp JC, et al. RT-PCR detection of respiratory pathogens in newborn children admitted to a neonatal medium care unit. Pediatr Res 2013; 73:355-361.
• American Academy of Pediatrics Committee on Infectious D, American Academy of Pediatrics Bronchiolitis Guidelines C. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134: 415-420.
• American Academy of Pediatrics Committee on Infectious D, American Academy of Pediatrics Bronchiolitis Guidelines C. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134: 415-420.
• Alan S, Erdeve O, Cakir U, et al. Outcome of the Respiratory Syncytial Virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study. J Matern Fetal Neonatal Med 2016; 29: 2186-2193.
• Alan S, Erdeve O, Cakir U, et al. Outcome of the Respiratory Syncytial Virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study. J Matern Fetal Neonatal Med 2016; 29: 2186-2193.
• Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatr 2003; 143:S127-132.
• Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatr 2003; 143:S127-132.
• Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev 2014; 35:519-530.
• Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev 2014; 35:519-530.
• Kumar P, Medigeshi GR, Mishra VS, et al. Etiology of Acute Respiratory Infections in Infants: A Prospective Birth Cohort Study. Pediatr Infect Dis J 2017; 36:25-30.
• Kumar P, Medigeshi GR, Mishra VS, et al. Etiology of Acute Respiratory Infections in Infants: A Prospective Birth Cohort Study. Pediatr Infect Dis J 2017; 36:25-30.
• Lim JS, Woo SI, Kwon HI, Baek YH, Choi YK, Hahn YS. Clinical characteristics of acute lower respiratory tract infection due to 13 respiratory viruses detected by multiplex PCR in children. Korean J Pediatr 2010; 53:373-379.
• Lim JS, Woo SI, Kwon HI, Baek YH, Choi YK, Hahn YS. Clinical characteristics of acute lower respiratory tract infection due to 13 respiratory viruses detected by multiplex PCR in children. Korean J Pediatr 2010; 53:373-379.
• Siyah Bilgin B, Yazici A, Ozkaya Parlakay A, Unal S. Acute lower respiratory tract infections caused by PCR proven RSV and non-RSV viruses in the NICU. Turkish J Pediatr Dis 2020; 14:168-175.
• Siyah Bilgin B, Yazici A, Ozkaya Parlakay A, Unal S. Acute lower respiratory tract infections caused by PCR proven RSV and non-RSV viruses in the NICU. Turkish J Pediatr Dis 2020; 14:168-175.
• Okulu E, Akduman H, Tunc G, et al. Viral Alt Solunum Yolu Enfeksiyonu Nedeniyle Yatırılan Yenidoğanların Epidemiyolojik ve Klinik Özellikleri. Turkish J Pediatr Dis 2018; 1:31-35.
• Bonzel L, Tenenbaum T, Schroten H, Schildgen O, Schweitzer-Krantz S, Adams O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediatr Infect Dis J 2008; 27:589-594.
• Bonzel L, Tenenbaum T, Schroten H, Schildgen O, Schweitzer-Krantz S, Adams O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediatr Infect Dis J 2008; 27:589-594.
• Strenger V, Diedrich S, Boettcher S, et al. Nosocomial Outbreak of Parechovirus 3 Infection among Newborns, Austria, 2014. Emerg Infect Dis 2016; 22:1631-1634.
• Strenger V, Diedrich S, Boettcher S, et al. Nosocomial Outbreak of Parechovirus 3 Infection among Newborns, Austria, 2014. Emerg Infect Dis 2016; 22:1631-1634.
• Cabrerizo M, Trallero G, Pena MJ, et al. Comparison of epidemiology and clinical characteristics of infections by human parechovirus vs. those by enterovirus during the first month of life. Eur J Pediatr 2015; 174:1511-1516.
• Cabrerizo M, Trallero G, Pena MJ, et al. Comparison of epidemiology and clinical characteristics of infections by human parechovirus vs. those by enterovirus during the first month of life. Eur J Pediatr 2015; 174:1511-1516.
• Rossi GA, Medici MC, Arcangeletti MC, et al. Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics. Eur J Pediatr 2007; 166:1267-1272.
• Rossi GA, Medici MC, Arcangeletti MC, et al. Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics. Eur J Pediatr 2007; 166:1267-1272.