Pages 9-14

Yıl 2013, Cilt: 15 Sayı: 3 - 2013; 15(3), 9 - 14, 01.09.2013

Osman Köse Savaş Özdemir

Öz

The aim of this study was to investigate the diagnostic value of umbilical artery blood gases and APGAR scores in defining neonatal morbidity in patients with fetal distress. 151 patients diagnosed with fetal distress were enrolled in the study. All neonates were evaluated by APGAR scoring system. The umbilical cords of all patients were clamped by two Kocher clamps at least 10 cm apart from each other before breathing and blood gas values were assessed in the specimen collected from umbilical artery. The results were evaluated by SPSS 18 program and regression analysis was performed. There were 17 (11.2%) newborns with 1st minute APGAR score <7. The rate of newborns with normal umbilical artery pH was 70.5% among patients with low 1st minute APGAR score (12/17). Only 4.6% of all cases had acidotic umbilical artery pH values. The sensitivity and specificity of 1st minute APGAR score <7 for neonatal intensive care unit (NICU) admittance were 83.3% and 83.3%, respectively. The positive predictive value of umbilical artery pH was markedly higher than 1st minute APGAR score to determine NICU admittance (85.7% vs. 29.5%, respectively). There were no early neonatal mortalities. Grade 1 hypoxic ischemic encephalopathy was determined in 2 babies and both were regressed spontaneously. The umbilical artery pH measurement is more valuable than APGAR scoring in defining neonatal morbidity.

Anahtar Kelimeler

Fetal distress , APGAR score , umbilical cord pH

Fetal Morbiditeyi Öngörmede Umblikal Arter Kan pH’i ve Birinci Dakika APGAR Skorunun Değerleri

Öz

Fetal distress olgularında umbilikal arter kan gazı değerleri ve APGAR skorunun yenidoğan morbiditesinin belirlenmesindeki tanısal değerini araştırmak. Fetal distress tanısı alan 151 olgu çalışmaya dâhil edildi. Bütün yenidoğanlar APGAR skorlama sistemi ile değerlendirildi. Tüm yenidoğanların umbilikal kordları nefes almadan önce, arada en az 10cm mesafe bırakacak şekilde, 2 adet Kocher pensi ile klampe edildi ve alınan umbilikal arter kan örneğinde kan gazı değerlerine bakıldı. Sonuçlar SPSS 18 programı ile değerlendirildi ve regresyon analizi uygulandı. Birinci dakika APGAR skorları 7'nin altında olan yenidoğan sayısı 17 (%11,2) idi. Birinci dakika APGAR skorları düşük olan yenidoğanlar içinde normal umblikal arter pH değeri saptananların oranı %70,5 (12/17) olarak bulundu. Tüm olguların sadece %4,6’sında (n=7) umbilikal arter pH'ı asidotikti. Birinci dakika APGAR skorunun < 7 olmasının yenidoğan yoğun bakım ünitesi (YYBÜ) gereksinimi için duyarlılığı %93,3 ve özgüllüğü %83,3 olarak tespit edildi. YYBÜ gereksinimini belirlemede umbilikal arter pH’ının pozitif prediktif değerinin birinci dakika APGAR skorundan belirgin olarak daha yüksek olduğu tespit edildi (sırasıyla %85,7 ve %29,5). Hiçbir yenidoğanda erken neonatal ölüm gerçekleşmedi. İki bebekte evre 1 hipoksik iskemik ensefolopati gelişti ve her ikisi de kendiliğinden geriledi. Yenidoğan morbiditesinin belirlenmesinde umbilikal arter pH ölçümü APGAR skorlamasından daha değerlidir.

Anahtar Kelimeler

Fetal distress , APGAR skoru , umblikal kord pH

Kaynakça

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