Çok düşük doğum ağırlıklı prematüre yenidoğanlarda pulmoner kanama sıklığı ve risk faktörleri

Yıl 2020, Cilt: 17 Sayı: 4, 515 - 518, 31.12.2020

Özlem Bozkurt , Ebru Yücesoy Ayşe Zöhre Deniz Akça

https://doi.org/10.38136/jgon.778713

Öz

Amaç: Pulmoner kanama prematüre bebeklerde önemli bir mortalite nedenidir. Bu çalışmada çok düşük doğum ağırlıklı prematüre bebeklerde pulmoner kanama sıklığı ve pulmoner kanama ilişkili risk faktörlerinin belirlenmesi amaçlanmıştır.
Gereçler ve Yöntem: Şanlıurfa Eğitim Araştırma Hastanesi Yenidoğan Yoğun Bakım Ünitesi’ne Eylül 2017 ve Şubat 2019 tarihleri arasında yatırılan doğum ağırlığı ≤1500 gram, gestasyon haftası ≤32 hafta olan prematüre bebekler retrospektif olarak çalışmaya alındı. Pulmoner kanama gelişen bebeklerin özellikleri ve risk faktörleri kontrol grubuyla karşılaştırıldı.
Bulgular: İki yüz doksan sekiz çok düşük doğum ağırlıklı prematüre bebek çalışmaya dahil edildi. Hastaların %20,8’inde pulmoner kanama gelişti. Pulmoner kanama gelişen grupta ortalama gestasyon haftası (26,5 ± 1,9) ve doğum ağırlığı (892 ± 269) anlamlı olarak düşüktü (p<0,001). Doğum ağırlığı (OR = 0,99 [%95 CI = 0,99-0,99]; p = 0,037), antenatal steroid uygulanmamış olması (OR = 3,26 [%95CI = 1,246-8,54]; p = 0,016) ve doğum salonunda entübasyon varlığı (OR = 5,32 [%95CI = 1,694-16,72]; p = 0,004) pulmoner kanama açısından anlamlı risk faktörleri olarak saptandı.
Sonuç: Doğum ağırlığının düşüklüğü, antenatal steroid uygulanmaması ve doğum salonunda entübasyon gereksinimi pulmoner kanama riskini artırmaktadır. Antenatal bakımı iyileştirmek pulmoner kanama sıklığını azaltabilir.

Anahtar Kelimeler

prematürite, yenidoğan, pulmoner kanama

The frequency of pulmonary hemorrhage and associated risk factors in very low birth weight premature newborns

Öz

Aim: Pulmonary hemorrhage is an important reason for mortality in premature infants. In this study we aimed to evaluate the frequency of pulmonary hemorrhage and associated risk factors in very low birth weight premature infants.
Materials and Method: Premature infants with birth weight ≤1500 g and gestational age ≤32 weeks admitted to Sanliurfa Training and Research Hospital Neonatal Intensive Care Unit between September 2017 and February 2019 were included retrospectively in the study. The characteristics and risk factors of infants with pulmonary hemorrhage were compared with the control group.
Results: Two hundred and ninety eight infants were included in the study. Pulmonary hemorrhage developed in 20.8% of patients. Mean gestational age (26.5 ± 1.9) and birth weight (892 ± 269) were significantly lower in pulmonary hemorrhage group (p<0.001). Birth weight (OR = 0.99 [%95 CI = 0.99-0.99]; p = 0.037), lack of antenatal steroid therapy (OR = 3.26 [%95CI = 1.246-8.54]; p = 0.016) and intubation in delivery room (OR = 5.32 [%95CI = 1.694-16.72]; p = 0.004) were significant risk factors for development of pulmonary hemorrhage.
Conclusion: Lower birth weight, lack of antenatal steroid therapy and intubation in delivery room increase the risk of pulmonary hemorrhage. Improving antenatal care may reduce pulmonary hemorrhage.

Anahtar Kelimeler

prematurity, newborn, pulmonary hemorrhage

Kaynakça

• 1. Riad Abou Zahr AA. Mary Marron-Corwin Neonatal pulmonary hemorrhage NeoReviews 2012;13:e302-6.
• 2. Berger TM, Allred EN, Van Marter LJ. Antecedents of clinically significant pulmonary hemorrhage among newborn infants. J Perinatol 2000;2:295-300.
• 3. Yen TA, Wang CC, Hsieh WS, Chou HC, Chen CY, Tsao PN. Short-term Outcome of Pulmonary Hemorrhage in Very-Low-Birth-Weight Preterm Infants. Pediatr Neonatol. 2013;54(5):330-4.
• 4. Ferreira CH , Carmona F, Martinez FE. Prevalence, Risk Factors and Outcomes Associated with Pulmonary Hemorrhage in Newborns. J Pediatr (Rio J) 2014;90(3):316-22.
• 5. Pandit PB, O’Brien K, Asztalos E, Colucci E, Dunn MS. Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant. Arch Dis Child Fetal Neonatal Ed 1999;81:F40-4.
• 6. Tomaszewska M , Stork E, Minich NM, Friedman H, Berlin S, Hack M. Pulmonary Hemorrhage: Clinical Course and Outcomes Among Very Low-Birth-Weight Infants. Arch Pediatr Adolesc Med 1999;153(7):715-21.
• 7. Garland J, Buck R, Weinberg M. Pulmonary Hemorrhage Risk in Infants With a Clinically Diagnosed Patent Ductus Arteriosus: A Retrospective Cohort Study. Pediatrics 1994;94(5):719-23.
• 8. Bozkurt O. Causes of death in a neonatal intensive care unit in Southeast region of Turkey. Annals of Medical Research. 2019;26(5):879-83.
• 9. Parry G, Tucker J, Tarnow-Mordi W, UK Neonatal Staffing Study Collaborative Group. CRIB II: an update of the clinical risk index for babies score. Lancet 2003;361(9371):1789-91.
• 10. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92(4):529-34.
• 11. Özalkaya E, Karatepe HÖ, Topçuoğlu S, Dinçer E, Karatekin G, Ovalı F. Premature yenidoğanlarda pulmoner kanama risk faktörleri. Zeynep Kamil Tıp Bülteni 2015;46(3):116-119.
• 12. Cole VA, Normand IC, Reynolds EO, Rivers RP. Pathogenesis of hemorrhagic pulmonary edema and massive pulmonary hemorrhage in the newborn. Pediatrics 1973;51(2):175-187.
• 13. Ren XL , Fu W, Liu J, Liu Y, Xia RM. Lung ultrasonography to diagnose pulmonary hemorrhage of the newborn. J Matern Fetal Neonatal Med 2017;30(21):2601-2606.
• 14. Chen YY, Wang HP, Lin SM, Chang JT, Hsieh KS, Huang FK, et al; Taiwan Premature Infant Development Collaborative Study Group. Pulmonary Hemorrhage in Very Low-Birthweight Infants: Risk Factors and Management. Pediatr Int 2012;54(6):743-7.
• 15. Sarno L, Corte LD , Saccone G, Sirico A, Raimondi F, Zullo F, et al. Histological chorioamnionitis and risk of pulmonary complications in preterm births: a systematic review and Meta-analysis. J Matern Fetal Neonatal Med 2019;13:1-10.
• 16. Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage. J Pediatr 2000;137(1):68-72.
• 17. Scholl JE, Yanowitz TD. Pulmonary hemorrhage in very low birth weight infants: a case-control analysis. J Pediatr 2015;166(4):1083-4.
• 18. Alfaleh K, Smyth JA, Roberts RS, Solimano A, Asztalos EV, Schmidt B, Trial of Indomethacin Prophylaxis in Preterms Investigators. Prevention and 18-month outcomes of serious pulmonary hemorrhage in extremely low birth weight infants: results from the trial of indomethacin prophylaxis in preterms. Pediatrics 2008;121(2):e233-8.
• 19. Thakur N , Saili A, Kumar A, Kumar V. Predictors of mortality of extremely low birthweight babies in a tertiary care centre of a developing country. Postgrad Med J 2013;89(1058):679-84.
• 20. Dufourq N, Thomson M, Adhikari M, Moodley J. Massive pulmonary haemorrhage as a cause of death in the neonate--a retrospective review. S Afr Med J 2004;94(4):299-302.