Prognostic Factors And Accompanying Anomalies In Neonates With Meningomyelocele: Experience Of 40 Patients

Öz

Aim: The aim of this study was to determine clinical features and short-term prognosis of hospitalized neonates with meningomyelocele, and to asses the association between the serum levels of vitamin D and meningomyelocele.Material and Methods: In this single center retrospective study, all infants with meningomyelocele were considered eligible. This study was conducted in Tepecik Training and Research Hospital between January 2014 and December 2015. Data of the patients were noted from the medical records.Results: A total of 40 infants with meningomyelocele were eligible for the study. The mean gestational age of infants was 38.6 ± 2.2 weeks and mean birth weight was 3099 ± 553 g. None of the mothers had taken folic acid support preconceptionally. The meningomyelocele was localized in lumbar 80% , thoracolumbar 12.5% and cervical 7.5% areas. The average time of surgical operation for meningomyelocele was 5.1 ± 4.65 days and the rate of operation in the first 72 hours of life for meningomyelocele was 50%. The mean length of stay in hospital was 27.3 ± 13.8 days, although the length of stay is shorter in the early surgery group first 72 hours than late surgery group after 72 hours there were no statistically significant difference between the groups p=0.25 . The incidence of sepsis in the study group was 45% and length of stay was statistically longer in the infants with sepsis p=0.006 . Additional accompanying anomalies were hydrocephaly 77.5% , hydronephrosis 10% , congenital heart disease 7.5% and congenital hypothyroidism 7.5% . The mortality rate of babies during the hospitalization was 0%. Of all patients, 70% of the infants had vitamin D deficiency, 20% of the infants had vitamin D insufficiency and only 10% of the infants had normal serum vitamin D levels, but vitamin D levels were statistically similar between sepsis and non-sepsis group.Conclusion: Surgical operation of meningomyelocele within 72 hours of life and to prevent sepsis development after operation reduces duration of hospitalizaton. This study also shows an association between a decreased vitamin D level and meningomyelocele.

Anahtar Kelimeler

• Newborn,meningomyelocele,operation time,sepsis,vitamin D

Meningomyelosel Olgularında Prognozu Etkileyen Faktörler ve Eşlik Eden Anomaliler: 40 Olguluk Deneyim

Öz

Amaç: Bu çalışmada kliniğimizde yenidoğan döneminde izlenen ve opere edilen meningomyelosel tanılı olguların klinik özellikleri, kısa dönem prognozları ve D vitamin ile meningomyelosel arasındaki ilişkinin değerlendirilmesi amaçlandı.Gereç ve Yöntemler: İzmir Tepecik Eğitim ve Araştırma Hastanesi’ne Ocak 2014 ile Aralık 2015 tarihleri arasında meningomyelosel tanısıyla yenidoğan kliniğine yatırılan tüm bebekler bu tek merkezli retrospektif çalışmaya alındı. Hastalara ait verilere tıbbi kayıtlardan ulaşıldı.Bulgular: Çalışmaya toplam 40 bebek dahil edildi. Hastaların ortalama doğum ağırlığı 3099 ± 553 g ve ortalama gebelik yaşı 38.6 ± 2.2 haftaydı. Antenatal dönemde folik asit kullanan anne yoktu. Meningomiyelosel %80 lomber, %12.5 torakolomber ve %7.5 servikal bölgedeydi. Ortalama operasyon zamanı 5.1 ± 4.65 gündü ve hastaların %50’si ilk 72 saatte operasyon geçirmişti. Ortalama yatış süresi 27.3 ± 13.8 gündü, ilk 72 saatte opere edilen grupta yaşamın 72. saatinden sonra opere edilen gruba göre hastanede yatış süresi daha kısa olsa da gruplar arasında istatistiksel açıdan anlamlı bir fark yoktu. Çalışmada operasyon sonrası sepsis oranı %45 olarak saptandı ve yatış süresi sepsis grubunda istatiksel olarak daha uzun bulundu p=0.006 . Hidrosefali %77.5 , hidronefroz %10 , konjenital kalp hastalığı %7.5 ve konjenital hipotiroidizm %7.5 eşlik eden ek anomalilerdi. Serum D vitamini düzeyi tüm hastaların %70’inde eksik, %20’sinde yetersiz ve %10’unda normal olarak saptandı, ancak serum D vitamini düzeylerinde sepsis saptanan grupla saptanmayan grup arasında istatiksel olarak fark yoktu.Sonuç: Yenidoğan döneminde meningomyelosel tanısı alan bebeklerin yaşamın ilk 3 günü içerisinde opere edilmesi ve operasyon sonrası sepsis gelişiminin önlenmesi hastanede yatış süresini kısaltır. Bu çalışmada aynı zamanda azalmış serum D vitamini düzeyleri ile meningomyelosel arasında bir ilişki olduğu gösterildi.

Anahtar Kelimeler

• Yenidoğan,meningomyelosel,operasyon zamanı,sepsis,D vitamini

Kaynakça

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