RETROSPECTIVE EVALUATION OF THE PATIENTS FOLLOWED IN THE NEONATAL INTENSIVE CARE UNIT

Öz

OBJECTIVE: Preterm birth is the leading cause of neonatal mortality and a substantial portion of neonatal morbidities. The perinatal mortality and morbidity statistics in developing countries are inadequate. The aim of this study was to evaluate the prematurity problems retrospectively that are the significant causes of morbidity and mortality in tertiary care university hospitals.

MATERIAL AND METHODS: The premature infants hospitalized in the tertiary neonatal intensive care unit between January 2015 and December 2017 were included in this study. Maternal and neonatal demographic characteristics and mortality and morbidity were recorded. Respiratory disstres syndrome (RDS), intracranial hemorrhage (İCH), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), prematurity retinopathy (ROP) and bronchopulmonary dysplasia (BPD) were accepted as morbidity.

RESULTS: The morbidity rates of the premeture infants were as follows; RDS 156 (43.9%), ICH 42 (11.8%), PDA 74 (21%), NEC 20 (5.6%), ROP 89 (25%), BPD 74 (20.7%).

CONCLUSIONS: Although mortality and morbidity rates were similar to the other data published from our country, this rates were higher than those of developed countries. We believe that our morbidity and mortality rates can reach levels comparable to ratio of developed countries with improved antenatal care, regular follow-up of pregnancy, determine the risks for common causes of mortality such as sepsis and respiratory distress.

Anahtar Kelimeler

• Premature,morbidity,mortality

YENİDOĞAN YOĞUN BAKIM ÜNİTESİNDE TAKİP EDİLEN HASTALARIN RETROSPEKTİF DEĞERLENDİRİLMESİ

Öz

Amaç: Preterm doğum yenidoğan ölümlerinin önde gelen nedeni ve yenidoğan morbiditelerinin önemli bir kısmını oluşturur. Gelişmekte olan ülkelerde preterm bebeklerin perinatal mortalite ve morbidite istatistikleri yetersizdir. Bu çalışmada üçüncü düzey yoğun bakım ünitesinde prematüreliğe bağlı morbidite ve mortalite nedenlerini değerlendirmek amaçlandı.

Gereç ve Yöntem: Bu çalışmaya 3.düzey bir yenidoğan yoğun bakım servisi’ne Ocak 2015 ile Aralık 2017 arasında yatan prematüre bebekler dahil edildi.

Bulgular: Bebeklerin 156’sında (%43.9) respiratuar distres sendromu (RDS), 42’sinde (%11.89) intrakranial kanama (İKK), 78’inde (%21.9) patent duktus arteriosus (PDA), 20’sinde (%5,6) nekrotizan enterokolit (NEK), 89’ında (%25) prematüre retinopatisi (PR),  74’ünde (%21) bronkopulmoner displazi (BPD), tespit edildi.

Sonuç: Mortalite ve morbidite oranlarımızın ülkemizden yayınlanan verilerle benzerlik göstermesine karşın, gelişmiş ülkelerin oranlarının üzerinde olduğu görüldü. Antenatal bakımın iyileştirilmesi, gebelik takiplerinin düzenli yapılması, sepsis ve respiratuvar distres gibi sık görülen mortalite nedenleri için risklerin belirlenmesi ve bunlara karşı önlem alınması durumunda morbidite ve mortalite oranlarımızın azalacağını düşünmekteyiz.

Anahtar Kelimeler

• Prematüre,morbidite,mortalite

Kaynakça

1. KAYNAKLAR: 1. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012 Jun 9;379(9832):2162-72. 2. Luke B, Brown MB, Wantman E, Seifer DB, Sparks AT, Lin PC et al. Risk of prematurity and infant morbidity and mortality by maternal fertility status and plurality. J Assist Reprod Genet. 2018 (17): 1-18.3. WHO [World Health Organization]. 2018. Preterm birth. Cited 2018 Feb 19. Available from: https://www.who.int › News › Fact sheets.4. Zegers-Hochschild F, Schwarze JE, Crosby JA, Musri C, Urbina MT. Assisted reproductive techniques in Latin America: The Latin American Registry, 2014. JBRA Assisted Reproduction 2017; 21(3): 164-175. 5. Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstetrics & Gynecology 1989;73:576–582.6. Klein L, Gibbs R. Infection and preterm birth. Obstetrics and Gynecology Clinics of North America 2005; 32:397–410.7. Chan BC, Lao TT. Maternal height and length of gestation: does this impact on preterm labour in Asian women? Australian and New Zealand Journal of Obstetrics and Gynaecology 2009; 49:388–392.8. Bayat MM, Tabrizian F, Dolatabady E, Khalesian B. Analysis of some maternal risk factors in preterm delivery. Journal of Medicali Science of Islamic Azad University of Mashhad, Iran 2009; 5:141–146.9. Ahern J, Pickett KE, Selvin S, Abrams B. Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking. Journal of Epidemiology and Community Health 2003; 57:606–611.10. Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S. Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology 1996; 7:339–345.11. Ahern J, Pickett KE, Selvin S, Abrams B. Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking. Journal of Epidemiology and Community Health 2003; 57:606–611.
2. 12. Bayingana C, Muvunyi CM, Africa CWJ. 2010. Risk factors of preterm delivery of low birth weight (plbw) in an African population. Journal of Clinical Medicine and Research 2010; 2:114–118. 13. Abaraya M, Seid SS, Ibro SA. Determinants of preterm birth at Jimma University Medical Center, southwest Ethiopia. Pediatric Health Med Ther. 2018 Sep 18;9:101-107.14. BA Ülkümen, HG Pala, F Aktenk, Baytur YB. Preeklampsi ve HELLP olgularında feto-maternal sonuçlarınn değerlendirilmesi. Perinatoloji Dergisi, 2014: 22(2) 65-68.15. Aktar F, Yolbaş İ, Tan İ, Ertuğrul S, İpek MŞ, Yılmaz K et al. Retrospective evaluation of low birth weight infants that monitored in neonatal intensive care unit of an university Journal of Clinical and Experimental Investigations 2015; 6 (3): 291-295.16. Aldous MB, Edmonson MB. Maternal age at first child¬birth and risk of low birth weight and preterm delivery in Washington State. JAMA 1993;270:2574-2577.17. Harlow BL, Frigoletto FD, Cramer DW et al. Determi¬nants of preterm delivery in low-risk pregnancies. The RADIUS Study Group. J Clin Epidemiol 1996;49:441- 448.18. Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. New England Journal of Medicine 2008; 358:1700–1701.19. Roberts D, Brown J, Medley N et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454. 20. Sackey AH, Tagoe LG. Audit of antenatal steroid use in mothers of preterms admitted to a neonatal intensive care unit in Ghana. Ghana Med J. 2018 Mar; 52(1): 3-7.21. Razaz N, Skoll A, Fahey J, Allen VM, Joseph KS. Trends in optimal, suboptimal, and questionably appropriate receipt of antenatal corticosteroid prophylaxis. Obstet Gynecol 2015; 125: 288-296.22. Vogel JP, Souza JP, Gülmezoglu AM, Mori R, Lumbiganon P, Qureshi Z et al. Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health. The Lancet. 2014; 384(9957): 1869–187723. Armangil D, Yiğit Ş, Tekinalp G, Durukan T, Yurdakök M, Korkmaz A. Antenatal kortikosteroidlerin neonatal mortalite ve morbidite üzerine etkileri. Çocuk Sağlığı ve Hastalıkları Dergisi 2007; 50: 79-90.24. Jaberi E, Roksana M. A study on preterm births during 2013-2015, Shiraz, Iran. J Obstet Gynaecol. 2018; 38(1):22-26.25. Horbar JD, Soll RF, Edwards WH. 2010. The Vermont Oxford network: a community of practice. Clinics in Perinatology, 2010; 37 (1): 29–47.26. Caner I, Tekgunduz KS, Temuroglu A, Demirelli Y, Kara M. Evaluation of Premature Infants Hospitalized in Neonatal Intensive Care Unit between 2010-2012. Eurasian J Med. 2015; 47(1):13-20.27. Heljić S, Maksić H, Kalkan I, Krdalić B. The effects of antenatal corticosteroids and surfactant replacement on neonatal respiratory distress syndrome. Bosn J Basic Med Sci. 2009; 9(3):225-8.28. Dani C, Mosca F, Vento G, Tagliabue P, Picone S, Lista G et al. Effects of surfactant treatment in late preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2018; 31(10): 1259-1266.29. Çetin H, Eren E, Olgar Ş, Öktem F, Ayata A. SDÜ Neonatoloji Bilim Dalında İzlenen Çok Düşük Doğum Ağırlıklı Preterm Bebeklerde Mortalite ve Morbidite. Ege Pediatri Bülteni 2005; 12 (2): 83-88.30. Handley SC, Passarella M, Lee HC, Lorch SA. Incidence Trends and Risk Factor Variation in Severe Intraventricular Hemorrhage across a Population Based Cohort. J Pediatr. 2018; 200: 24-29.31. BJ. Stoll, NI. Hansen, EF. Bell, MC. Walsh, WA. Carlo, S. Shankaran, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA, 2015; 314 (10): 1039-1051.32. Horbar JD, Edwards EM, Greenberg LT, Morrow KA, Soll RF, Buus-Frank ME, et al. Variation in performance of neonatal intensive care units in the United States. JAMA Pediatr, 2017; 171 (3): e16439633. Özdemir ÖMA, Kökten YN, Alkılıç L, Yener ÖŞ, Adalı F. Postnatal erken dönemde kraniyal ultrasonografi incelemesi yapılan yenidoğanlarda periventriküler/intraventriküler kanama sıklığı ve risk faktörleri. Ege Tıp Dergisi 2011; 50: 247-25234. Kervancıoğlu S, Sivaslı E, Kervancıoğlu R, Andiç Ç, Özkur A. Yenidoğan yoğun bakım ünitesinde serebral ultrasonografi incelemesi yapılan yenidoğanlarda germinal matriks/intraventriküler hemoraji sıklığı ve predispozan faktörleri. Gaziantep Tıp Dergisi, 2008; 14: 6-9.35. Bixler GM, Powers GC, Clark RH, Walker MW, Tolia VN. Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units. J Pediatr. 2017; 189: 105-112.36. Tayman C, Tonbul A, Uras N, Kahveci H, Köseoğlu B. Preterm bebeklerde nekrotizan enterokolit için risk faktörlerinin değerlendirilmesi. Güncel Ped. Der 2011; 9: 7-13.37. Kavuncuoğlu S, Aldemir EY, Çelik N, Çetindağ F, Sander S, Payaslı M et al. Prematüre Bebeklerde Önemli Bir Morbidite Nedeni; Nekrotizan Enterokolit: Dokuz Yıllık Çalışmanın Sonuçları . JOPP Derg 5(1): 13-20, 2013.38. Choi CW, Kim B, Kim Ee-K, Song ES, Lee J. Incidence of bron¬chopulmonary dysplasia in Korea. J Korean Med Sci 2012; 27: 914-21.39. Yurttutan S, Korkmaz A, Yiğit Ş, Yurdakök M, Tekinalp G. Bronkopulmoner displazili bebeklerin kısa ve uzun süreli izlemi: on yıllık deneyim. Çocuk Sağ. ve Hast. Dergisi 2011; 54: 1-15.40. Türkmen M, Altıncık A, Acar Ç, Tosun A, Aydoğdu A. Adnan Menderes Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesi’nde izlenen çok düşük doğum ağırlıklı bebeklerin değerlendirilmesi. ADÜ Tıp Fakültesi Dergisi 2006; 7: 3-6.41. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB et al. The Cryotherapy for Prematurity Cooperative Group. Incidence and early course of retinopathy of prematurity. Ophthalmology 1991; 98: 1628-40.42. Bas AY, Demirel N, Koc E, Ulubas Isik D, Hirfanoglu İM, Tunc T; TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol. 2018; 102(12): 1711-1716.43. Özbek E, Genel F, Atlıhan F, Güngör İ, Malatyalı R, Menteş J et al . Yenidoğan Yoğun Bakım Ünitemizde Prematüre Retinopatisi İnsidansı, Risk Faktörleri Ve İzlem Sonuçları. Behcet Uz Cocuk Hast Derg. 2011; 1(1): 7-12.
3. 44. Müstakim H, Şatırav G, Oltulu R, Kerimoğlu H, Özkağnıcı A, Altunhan H. Prematüre Retinopatisinde Tarama ve Tedavi Sonuçlarımız. Selcuk Med J 2017; 33(2): 26-28.