Çok düşük doğum ağırlıklı yenidoğanlarda patent duktus arteriozus sıklığı ve klinik sonuçlara etkisi: üçüncü düzey bir merkezin verileri

Öz

Amaç: Patent duktus arteriozus (PDA) sıklığı, gebelik haftası ve doğum ağırlığıyla ters orantılıdır. Patent duktus arteriozus sıklığı, <1000 gr bebeklerde; %40-55, <1500 gr bebeklerde: %30 olarak belirtilmektedir. Patent duktus arteriozus, bronkopulmoner displazi (BPD), nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), intraventriküler kanama (İVK) ve uzun dönem olumsuz nörogelişimsel sonuçlar ile ilişkili olup, 3 farklı tedavi yaklaşımı (konservatif tedavi, siklooksijenaz (COX) inhibitörleri, cerrahi tedavi) vardır. Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA; <1500g) prematüre bebeklerde hemodinamik anlamlı PDA’nın sıklığının belirlenmesi ve bu bebeklerde demografik ve klinik özelliklerin belirlenmesi amaçlanmıştır.

Materyal ve Metod: Çalışmamızda Ocak 2013 ile Aralık 2016 tarihleri arasında ünitemizde izlenen, gebelik yaşı <30 hafta olan ÇDDA bebeklerin tıbbi kayıtları retrospektif olarak incelendi. Bebeklerin demografik ve klinik özellikleri kayıt edildi. Çalışmaya dahil edilen bebekler patent duktus arteriozusu olan ve olmayanlar olarak iki gruba ayrılarak, demografik ve klinik özellikleri açısından karşılaştırıldı. Major konjenital anomalisi olanlar ve ilk ekokardiyografik değerlendirme öncesi kaybedilen hastalar çalışma dışı bırakıldı.

Bulgular: Toplam 602 ÇDDA bebeğin dahil edildiği çalışmamızda, 257 bebekte (%42,7) hemodinamik anlamlı PDA (haPDA) saptandı ve 11 bebeğe (%1,8) PDA ligasyonu uygulandı. Patent duktus arteriozusu olanlarda gebelik yaşı ve doğum ağırlığı anlamlı olarak düşük; RDS, geç neonatal sepsis, ROP, İVK (evre ≥3), orta-ağır BPD oranları anlamlı olarak yüksek; invaziv ve non-invaziv solunum desteği ile ek oksijen gereksinim süresi, tam enteral beslenmeye geçiş zamanı ve hastanede kalış süresi anlamlı olarak daha uzun olduğu saptandı (p< 0,05).

Sonuç: Çalışmamızda ÇDDA’lı bebeklerde hemodinamik anlamlı PDA oranı %42,7 olarak bulundu. Üniteler arasında farklı klinik yaklaşımlardan dolayı haPDA oranları değişmektedir.

Anahtar Kelimeler

• Morbidite,Hemodinamik,Patent duktus arteriozus,Prematüre,Düşük doğum ağırlığı

The incidence of patent ductus arteriosus (PDA) in very low birth weight infants and its impact on clinical outcomes: data from a third level center

Öz

Background: Bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and long term negative neurodevelopmental outcomes. are associated with PDA. The aim of this study was to determine the frequency of hemodynamically significant (hs) PDA and the demographic and clinical characteristics of very low birth weight (VLBW) premature infants.

Material and Methods: We retrospectively evaluated the medical records of VLBW preterm infants with a gestational age <30 weeks between January 2013 and December 2016. Infants with major congenital anomalies and those who were death before the first echocardiographic evaluation were excluded from the study. Eligible infants were divided into two groups, including group I: with hsPDA and group II: without hsPDA. Demographic and clinical characteristics of infants were recorded and compared between the groups.

Results: A total of 602 VLBW infans were included. 257 (42.7%) infants had hsPDA, and 11 (1.8%) infants with hsPDA had PDA ligation due to being unresponsive to medical treatment. Gestational age and birth weight were significantly lower in infants with hsPDA. RDS, late neonatal sepsis, ROP, IVH (grade ≥3), moderate-severe BPD rates were significantly higher; invasive and non-invasive respiratory support, duration of additional oxygen requirement, time to complete enteral feeding, and duration of hospital stay were significantly longer in infants with hs PDA (p <0.05).

Conclusion: In our study, the rate of hsPDA was found to be 42.7% in VLBW infants. The rates of hsPDA can vary due to different clinical approaches among the units. Although, it is clearly associated with long and short-term morbidities, proper interventions in time should be aimed at minimizing morbidities.

Anahtar Kelimeler

• Hemodynamic,Patent ductus arteriosus,premature,Low birth weight,Morbidity

Kaynakça

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