Term ve Preterm Yenidoğanlarda Doğum Odası Bakımında Yenilikler

Yıl 2017, Cilt: 17 Sayı: 4, 151 - 157, 01.10.2017

Beril Yaşa Asuman Çoban Elmas Zeynep İnce

https://doi.org/10.5222/j.child.2017.151

Öz

Yenidoğan bebeklerin sağkalımlarının iyileştirilmesi için annelerine iyi bir antenatal bakım verilirken bebeğe de doğru postnatal yaklaşımda bulunulmalıdır. Doğum odası yönetiminde en önemli zaman “ilk altın dakika” olarak adlandırılan, doğum sonrası ilk bir dakikalık süredir. Bu süre içerisinde bebeğin ısı kontrolü sağlanmalı, hava yolu açıklığı, solunumu ve kalp atım hızı değerlendirilmeli, gereksinim varlığında ilk solunumu başlatılmış olmalı ve satürasyon değerleri nabız oksimetre ile objektif olarak takip edilmelidir. Doğum sonrası zamana göre belirlenen hedef satürasyon değerleri göz önünde bulundurularak fazla ve gereksiz oksijen tedavisinden kaçınılmalıdır. Yapılan son çalışmalar kordon klemplenmesinin en az 30-60 sn geciktirilmesinin bebeklerin daha yüksek hemog- lobin değerleri ve demir deposu ile doğduklarını göster- mekte, bebeklerin transfüzyon gereksinimlerinin azaldığını bildirmektedir. Solunum desteği gereksinimi olabilecek preterm bebeklerde daha ilk nefesten itibaren sürekli pozitif havayolu basıncı CPAP uygulanması bebeklerin entübas- yon gereksiniminı ve surfaktan uygulamalarını azaltmakta- dır. Preterm bebeklerde profilaktik surfaktan uygulanması günümüzde terk edilmeye başlanmış bir uygulama olup, yalnızca gereksinimi olan preterm bebeklere surfaktan verilmelidir. Günümüzde daha az invazif yöntemlerle sur- faktan uygulanması denenmektedir. Canlandırma gereksi- nimi varlığında gestasyon yaşı 35 hafta ve üzerinde olan bebeklere %21 oksijen ile, gestasyon yaşı 35 hafta altında olan bebeklere ise %21-30 oksijen ile destek başlanmalı, hedef satürasyon değerlerine ulaşana kadar oksijen desteği kontrollü olarak arttırılmalıdır

Anahtar Kelimeler

Term, preterm, yenidoğan, doğum odası bakımı

Novel Approaches in the Delivery Room Care of Term and Preterm Newborns

Öz

While optimal antenatal care is provided for the mother to improve survival of newborn babies, appropriate should be given to the babies. The most important time period in delivery room management is the first minute which is named as “first golden minute”. Within this period, body temperature of the baby should be checked , patency of its airway, its respiratory and heart rate should be assesed, first breath should be initiated in case of need, and saturation must be measured objecti- vely using a pulse oximeter. Excessive and unnecessary use of oxygen should be prevented by considering targe- ted saturation values which are determined according to the time passed after birth. Recent studies showed that 30-60 seconds delay in umbilical cord clamping time will lead to higher hemoglobin concentrations and iron stores in newborns. Preterm babies who may need ventilatory support should be put on continuous positive airway pressure CPAP even from the first breath which will decrease the need for intubation and surfactant administration. Prophylactic administration of surfac- tant in preterm newborns is being abandoned today, surfactant should only be given to preterm newborns in need. Nowadays, less invasive administration of surfac- tant LISA is being tested. If resuscitation is needed oxygen support should be started with 21% saturated oxygen in newborns at or above 35th gestational age. If the gestational age is less than 35th weeks, 21-30% saturated oxygen should be given at the beginning then, oxygen support should be increased up to targeted satu- ration levels in a controlled manner

Anahtar Kelimeler

Term, preterm, newborn, delivery room care

Kaynakça

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