Yenidoğan geçici takipnesinin retrospektif analizi: Sezaryende spinal anestezi ile ilişkili midir?

Yıl 2012, Cilt: 18 Sayı: 2, 77 - 80, 01.03.2012

Berrin Gunaydın Ayca Tas Nur Aksakal Fatma Faydacı İbrahim Murat Hırfanoğlu

Öz

We investigated whether maternal gestation, newborn gender, delivery times and cord blood gas and pH might play a role in the increased risk of transient tachypnea of the newborn (TTN) after cesarean section (C/S). Data from 114 term parturients scheduled for elective C/S under spinal anesthesia were retrospectively analyzed according to having a newborn with TTN or not. Presence of TTN, neonatal Apgar scores, umbilical artery (UA) and umbilical venous (UV) blood gas analysis and pH, total amount of fluid and ephedrine administered, time intervals related to delivery were documented. TTN was observed in 15 out of 114 cases (13.2%). No significant differences were observed in gestation age, Apgar scores, newborn gender, amount of ephedrine and fluid administered between newborns with or without TTN. Mean UA PO2 tensions of TTNs were significantly lower than in newborns without TTN (p=0.043). Time interval from spinal block to skin incision was significantly longer in newborns with TTN than without TTN (p=0.046). In conclusion, TTN might be associated with spinal anesthesia for C/S. Therefore, reducing the time interval from spinal block to onset of surgery might be one of the important factors to decrease the incidence of TTN after elective C/S under spinal anesthesia.

Anahtar Kelimeler

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Retrospective analysis on transient tachypnea of the newborn: İs it associated with spinal anesthesia after cesarean section?

Öz

Sezaryenden sonra görülen yenidoğan geçici takipnesi (YGT) riskindeki artışta gebelik haftası, yenidoğan cinsiyeti, doğum süreleri ve kord kan gazı ve pH’nın rolünü gözden geçirdik. Spinal anestezi altında elektif sezaryen uygulanan 114 term gebe, YGT’li yenidoğanı olanlar ya da olmayanlar olarak retrospektif incelendi. YGT bulunması, neonatal Apgar skorları, umbilikal arter (UA) ve umbilikal ven (UV) kan gazı incelemesi ve pH, uygulanan toplam sıvı ve efedrin miktarları, doğum ile ilişkili süreler incelendi. YGT, 114 olgunun 15’inde tespit edildi (%13,2). Gebelik haftası, Apgar skorları, yenidoğan cinsiyeti, efedrin ve sıvı uygulama miktarları bakımından YGT olan ve olmayan yenidoğanlar arasında anlamlı fark yoktu. YGT bulunanlarda ortalama UA PO2 düzeyleri YGT bulunmayanlardan anlamlı derecede düşüktü (p=0.043). Spinal blok ile cilt insizyonu arasındaki süre, YGT bulunanlarda YGT bulunmayanlara göre daha uzundu (p=0.046). Sonuç olarak, YGT sezaryende uygulanan spinal anestezi ile ilişkili olabilir. Bu nedenle, spinal blok ile cerrahiye başlama arasındaki süreyi azaltmak, spinal anestezi altındaki elektif sezaryenlerden sonra görülen YGT insidansını azaltmadaki önemli faktörlerden biri olabilir.

Anahtar Kelimeler

Sezaryen, spinal anestezi, yenidoğan geçici takipnesi (YGT)

Kaynakça

• 1. Kasap B, Duman N, Özer E, Tatli M, Kumral A, Özkan H
• Transient tachypnea of the newborn: predictive factor for prolonged tachypneas. Ped Int 2008;50(1):81-4
• 2. Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol 2006;30(1):34-43
• 3. Aslan E, Tutdibi E, Martens S, Han Y, Monz D, Gortner L
• Transient tachypnea of the newborn (TTN): a role for polymorphisms in the beta-adrenergic receptor (ADRB) encoding genes? Acta Pediatr 2008;97(10):1346-50
• 4. Gross TL, Sokol RJ, Kwong MS, Wilson M, Kuhnert PM
• Transient tachypnea of the newborn: the relationship to preterm delivery and significant neonatal morbidity. Am J Obstet Gynecol 1983;146(3):236-41
• 5. Jain L. Alveolar fluid clearance in developing lungs and its role in neonatal transition. Clin Perinatol 1999;26(3):585-99
• 6. Perez Molina JJ, Romero DM, Ramirez Valdivia JM, Corona MQ. Transient tachypnea of the newborn, obstetric and neonatal risk factors. Ginecol Obstet Mex 2006;74(2):95-103
• 7. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW
• Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006;18(4):CD002251
• 8. Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using? Curr Opin Anaesthesiol 2006;19(3):238- 43
• 9. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002;94(4):920- 6
• 10. Chen M, McNiff C, Madan J, Goodman E, Davis JM, Dammann O. Maternal obesity and neonatal Apgar scores. J Matern Fetal Neonatal Med 2010;23(1):89-95
• 11. Takaya A, Igarashi M, Nakajima M, Miyake H, Shima Y, Suzuki S. Risk factors for transient tachypnea of the newborn in infants delivered vaginally at 37 weeks or later. J Nippon Med Sch 2008;75(5):269-73
• 12. Su CF, Tsai HJ, Huang CC, Luo KH, Lin LY. Fetal acidosis from obstetric interventions during the first vaginal delivery
• Taiwan J Obstet Gynecol 2008;47(4):397-401
• 13. Ismail S, Huda A. An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth 2009;18(4):352-5
• 14. MacKenzie IZ, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries. BJOG 2002;109(5):498-504
• 15. McCahon RA, Catling S. Time required for surgical readiness in emergency caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth 2003;12(3):178-82
• 16. Reynolds F, Seed PT. Anesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005;60(7):636-53