Neonatal hiperbilirubineminin prediktörü olarak umblikal kord kanı kırmızı hücre dağılım genişliği

Öz

Amaç: Yenidoğanların doğum sonrası erken taburcu edilmesi, çoğunlukla neonatal hiperbilirubinemi nedeniyle hastaneye yeniden yatış riskine yol açar. Bu nedenle hiperbilirubinemi riski yüksek olan yenidoğanların erken teşhisi önemlidir. Kırmızı hücre dağılım genişliği (RDW), rutin tam kan sayımında bulunan basit bir testtir. Bu çalışmada, hiperbilirubinemi gelişme riski yüksek olan yenidoğanları belirlemek için kord kanı kırmızı hücre dağılım genişliği (RDW) düzeylerinin kullanılıp kullanılamayacağını değerlendirmeyi amaçladık. Gereç ve yöntem: Ocak-Haziran 2017 tarihleri arasında hastanemizde doğan ve kordon kanı örneği alınan tüm term bebeklerin verileri geriye dönük olarak incelendi. Kord kanı RDW, kord kanı bilirubin, yenidoğan/anne kan grupları ve direkt Coombs testi (DCT) sonuçları analiz edildi. Bulgular: Çalışmaya toplam 175 yenidoğan dahil edildi. 58 yenidoğana postnatal ilk 48 saatte fototerapi verildi. Hiperbilirubinemili yenidoğanlarda ortalama kord kanı RDW düzeyleri kontrollere göre anlamlı derecede yüksekti (18±1.6'ya karşı 16.4±1.0, p<0.001). Belirgin hiperbilirubinemi gelişme riskini öngörmek için kord kanı RDW düzeyinin cut off değeri, %70.7 duyarlılık ve %88 özgüllük ile 17.1 idi. DCT pozitif olan infantların hemoglobin değerleri daha düşük ve kord kanı RDW ve bilirubin düzeyleri daha yüksekti (p<0.05). DCT pozitif olan bebeklerde kord kanı RDW ve bilirubin değerleri arasında pozitif güçlü bir korelasyon tespit edildi (p=<0,001, r:0.663). Çoklu regresyon analizinde kord kanı RDW, bilirubin düzeyi ve DCT pozitifliğinin fototerapi gereksinimi için bağımsız birer risk faktörü olduğu bulundu. Sonuç: Kord kanı RDW, belirgin hiperbilirubinemi geliştirme riski taşıyan yenidoğanların belirlenmesinde yararlı bir belirteç olabilir

Anahtar Kelimeler

• RDW
• umblikal kord kanı bilirubin
• yenidoğan
• hiperbilirubinemi
• hemolitik hastalık

Umbilical cord blood red cell distribution width as a predictor of neonatal hyperbilirubinemia

Öz

Aim: Early postnatal discharge of newborns leads to the risk of hospital readmission, mostly due to neonatal hyperbilirubinemia. Therefore, early identification of newborns at high risk of hyperbilirubinemia is important. In this study, we aimed to evaluate whether cord blood red cell distribution width (RDW) levels could be used to identify newborns at high risk of developing hyperbilirubinemia. Material and methods: The data of all term infants who were born in our hospital between January and June 2017 whose cord blood samples were examined were reviewed retrospectively. Cord blood RDW, cord blood bilirubin, newborn/mother’s blood groups and direct Coombs’test (DCT) results were analyzed. Results: A total 175 newborns were included. Phototherapy was required 58 newborns in the first 48 hours postnatally. The mean cord blood RDW levels among newborns with hyperbilirubinemia was significantly higher compared to controls (18±1.6 vs. 16.4±1.0, p<0.001). The cut-off value of cord blood RDW to predict the occurrence of significant hyperbilirubinemia was 17.1 with a sensitivity of 70.7 % and specificity of 88 %. Infants with positive DCT had lower hemoglobin values and higher cord blood RDW and bilirubin levels (p<0.05). There was a strong positive correlation between cord blood RDW and bilirubin values in infants with positive DCT (p=<0.001, r:0.663). Multiple regression analysis showed that cord blood RDW, bilirubin level and DCT positivity were found to be an independent risk factor for phototherapy requirement. Conclusion: Cord blood RDWcan be used as a useful marker to identify the newborns at high risk of developing hyperbilirubinemia.

Anahtar Kelimeler

• RDW
• umbilical cord blood bilirubin
• newborn
• hyperbilirubinemia;
• hemolytic disease

Kaynakça

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