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Yenidoğan Yoğun Bakımda İzlenen Pnömotorakslı Olguların Değerlendirilmesi

Yıl 2022, Cilt: 13 Sayı: 46, 168 - 173, 01.08.2022
https://doi.org/10.17944/mkutfd.991806

Öz

Amaç: Pnömotoraks, en sık görülen pulmoner hava kaçağı sendromlarından biridir ve yenidoğan döneminde yaşamın diğer dönemlerinden daha sık ortaya çıkar. Primer ve sekonder pnömotoraksın karşılaştırmalı klinik seyri hakkında sınırlı veri olduğundan, bu çalışmada primer ve sekonder pnömotorakslı yenidoğanların demografik özelliklerini, klinik seyirlerini ve sonuçlarını belirlemeyi ve karşılaştırmayı amaçladık.

Materyal-metot: Tek merkezli ve retrospektif tasarlanan çalışmaya, Malatya Turgut Özal Üniversitesi Tıp Fakültesi Hastanesi'nde Ocak 2020-Temmuz 2021 tarihleri arasında izlenen pnömotoraks tanılı yenidoğanlar alındı.

Bulgular: Çalışma boyunca yenidoğan yoğun bakım ünitesine yatan 1491 yenidoğanın 29’una pnömotoraks tanısı kondu ve bunların 16'sı (%55.2) erkek, 19'u (%65.5) sezaryen ile doğum ve 6'sı (%20.7) prematüre idi. Ortalama gebelik yaşı 37.5±2.6 hafta ve doğum ağırlığı 3063.4±53 gram idi. Pnömotoraks tanı anındaki medyan yaş 5 saat (1-96) ve ortalama hastanede kalış süresi 9,55±4,38 gündü. 13 (%44.8) yenidoğan primer pnömotoraks olarak gruplandırılırken, 16 hastada (%55.2) altta yatan bir akciğer hastalığı veya predispozan faktör vardı. Toraks tüpü takılan hastalarda ortalama drenaj süresi 4.1±2.13 gündü. 5.dk Apgar skoru ve SNAP-II skorları açısından gruplar arasında istatistiksel olarak anlamlı bir fark olduğunu gösterdi (p < 0.05). Ayrıca pnömotoraks tanı zamanı primer pnömotoraks grubunda anlamlı olarak daha erkendi (p < 0.05). Çalışmamız sekonder pnömotoraks grubunda anlamlı olarak daha uzun total oksijen gereksinimi, CPAP ve mekanik ventilasyon süreleri ortaya koydu (p < 0.05). Toplamda üç yenidoğan kaybedildi ve hepsi sekonder pnömotoraks grubundaydı.

Sonuç: Pnömotoraks yenidoğanlar için hala önemli bir morbidite ve mortalite nedenidir ve primer pnömotoraks olan olgular sekonder olanlara göre daha ılımlı klinik seyire sahiptir.

Anahtar kelimeler: yenidoğan, pnömotoraks, solunum sıkıntısı

Kaynakça

  • Fernandes CJ, Redding G. "Pulmonary air leak in the newborn." U: UpToDate, Post TW ur. UpToDate [Internet]. Waltham, MA: UpToDate (2020).
  • Malek A, Afzali N, Meshkat M, Yazdi NH. Pneumothorax after mechanical ventilation in newborns. Iran J Pediatr. 2011;21(1):45-50.
  • Shaireen H, Rabi Y, Metcalfe A, et al. Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study. BMC Pediatr. 2014;14:208. https://doi.org/10.1186/1471-2431-14-208.
  • Aly H, Massaro A, Acun C, Ozen M. Pneumothorax in the newborn: clinical presentation, risk factors and outcomes.J Matern Fetal Neonatal Med. 2014;27(4):402-6. https://doi.org/10.3109/14767058.2013.818114
  • Finer NN, Carlo WA, Walsh MC, et al. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362:1970–9. https://doi.org/10.1056/NEJMoa0911783
  • Cizmeci MN, Kanburoglu MK, Akelma AZ, Andan H, Akin K, Tatli MM. An abrupt increment in the respiratory rate is a sign of neonatal pneumothorax. J Matern Fetal Neonatal Med. 2015;28(5):583-7. https://doi.org/ 10.3109/14767058.2014.927425
  • Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: Trends, predictors and outcomes. J Neonatal Perinatal Med. 2014;7(1):29-38. https://doi.org/10.3233/NPM-1473813
  • Mannan A, Dey SK, Jahan N, Iqbal S, Karim SMR, Ferdous N. Spectrum of neonatal pneumothorax at a tertiary care hospital of Bangledesh: a retrospective observational study. Bangladesh Crit Care J. 2019;7(1):12-19. https://doi.org/10.3329/bccj.v7i1.40758
  • Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. J Matern Fetal Neonatal Med. 2020;19:1-5. https://doi.org/10.1080.14767058.2020.1727880
  • Shen A, Yang J, Chapman G, Pam S. Can neonatal pneumothorax be successfully managed in regional Australia? Rural Remote Health. 2020;20(3):5615. https://doi.org/10.22605/RRH5615
  • Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015; 132(16 Suppl 1): S204– S241. https://doi.org/10.1161/CIR.0000000000000276
  • Al Matary A, Munshi HH, Abozaid S, Qaraqei M, Wani TA, Abu-Shaheen AK. Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years' Experience. Oman Med J. 2017;32(2):135-139. https://doi.org/10.5001/omj.2017.24
  • Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology. 2017;111:303-308. https://doi.org/10.1159/000453029
  • Okumus M, Zubarioglu AU. Neonatal Pneumothorax-10 years of experience from a single center. J Pediatr Res. 2020;7(2):163-7. https://doi.org/10.4274/jpr.galenos.2019.50133
  • Girard I, Sommer C, Dahan S, Mitanchez D, Morville P. Risk factors for developing pneumothorax in full-term neonates with respiratory distress. Arch Pediatr. 2012;19(4):368-73. https://doi.org/10.1016/j.arcped.2012.01.019
  • Büyüktiryaki M , Alyamaç Dizdar E , Okur N , Özer Bekmez B , Tayman C . Yenidoğanda pnömotoraks ve göğüs tüpü ile drenaj tedavisi gereksinimine göre demografik ve klinik özelliklerin karşılaştırılması. Türkiye Çocuk Hast Derg. 2019; 13(2): 50-56. https://doi.org/10.12956/tchd.510587
  • Kolas T, Saugstad OD, Daltweit AK, Nilsen ST, Qian P. Planned ceserean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006;195:1538-43. https://doi.org/10.1016/j.ajog.2006.05.005
  • Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax. J Int Med Res. 2011;39(6):2436-40. https://doi.org/10.1177/147323001103900645
  • Smith J, Schumacher RE, Donn SM, Sarkar S. Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort. Am J Perinatol. 2011;28(2):163-8. https://doi.org/10.1055/s-0030-1263300
  • Hadzic D, Skokic F, Husaric E, Alihodzic H, Softic D, Kovacevic D. Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton. Mater Sociomed. 2019;31(1):66-70. https://doi.org/10.5455/msm.2019.31.66-70.
  • Karabel M, Karabel D, Okur MH, Tan I, Kelekci S, Sen V, Uluca U. The evaluation of cases with pneumothorax in the neonatal intensive care unit. J Clin Exp Invest. 2013;4(3):289-292. https://doi.org/10.5799/ahinjs.01.2013.03.0286
  • Basheer F, Aatif M, Saeed MHB, Jalil J. Clinical profile and outcome of neonatal pneumothorax in resource-limited neonatal intensive care unit. J Matern Fetal Neonatal Med. 2020;27:1-6. https://doi.org/
  • Silva IS, Flor-de-Lima F, Rocha G, Alves I, Guimaraes H. Pneumothorax in neonates: a level III neonatal intensive care unit experience. J Pediatr Neonat Individual Med. 2016;5(2):e050220 https://doi.org/10.7363/050220

Evaluation of pneumothorax in the neonatal intensive care unit

Yıl 2022, Cilt: 13 Sayı: 46, 168 - 173, 01.08.2022
https://doi.org/10.17944/mkutfd.991806

Öz

Objective: Pneumothorax is one of the most common pulmonary air leak syndromes and appears more often in the newborn period than at any other time of life. In this study, we aimed to determine and compare the demographic characteristics, clinical courses and outcomes of newborns with primary and secondary pneumothorax.
Methods: In this single-centre retrospective study, maternal and neonatal data were collected from medical records at Turgut Ozal University Hospital between January 2020 to July 2021.
Results: Twenty-nine newborns diagnosed with pneumothorax, and of these, 16 were male (55.2%), 19 (65.5%) were born by cesarean section, and six (20.7%) were premature. The mean gestational age was 37.5±2.6 weeks, and birth weight was 3063.4±53 grams. The median age at diagnosis was 5 h (1-96), and the mean hospital stay was 9.55±4.38 days. The mean drainage time was 4.1±2.13 days. 13 (44.8%) neonates were classified as primary, while 16 patients (55.2%) had an underlying pulmonary disease or predisposing factor. Our study showed a statistically significant difference between groups regarding Apgar score 5th min and SNAP-II scores (p < 0.05). The occurence of pneumothorax was significantly earlier in the primary group (p < 0.05). Our study revealed significantly longer total oxygen, continuous positive airway pressure and mechanical ventilation durations in the secondary pneumothorax group (p<0.05).
Conclusion: Neonatal pneumothorax is still associated with significant morbidity and mortality, and primary pneumothorax had more favorable outcomes than secondary pneumothorax.

Kaynakça

  • Fernandes CJ, Redding G. "Pulmonary air leak in the newborn." U: UpToDate, Post TW ur. UpToDate [Internet]. Waltham, MA: UpToDate (2020).
  • Malek A, Afzali N, Meshkat M, Yazdi NH. Pneumothorax after mechanical ventilation in newborns. Iran J Pediatr. 2011;21(1):45-50.
  • Shaireen H, Rabi Y, Metcalfe A, et al. Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study. BMC Pediatr. 2014;14:208. https://doi.org/10.1186/1471-2431-14-208.
  • Aly H, Massaro A, Acun C, Ozen M. Pneumothorax in the newborn: clinical presentation, risk factors and outcomes.J Matern Fetal Neonatal Med. 2014;27(4):402-6. https://doi.org/10.3109/14767058.2013.818114
  • Finer NN, Carlo WA, Walsh MC, et al. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362:1970–9. https://doi.org/10.1056/NEJMoa0911783
  • Cizmeci MN, Kanburoglu MK, Akelma AZ, Andan H, Akin K, Tatli MM. An abrupt increment in the respiratory rate is a sign of neonatal pneumothorax. J Matern Fetal Neonatal Med. 2015;28(5):583-7. https://doi.org/ 10.3109/14767058.2014.927425
  • Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: Trends, predictors and outcomes. J Neonatal Perinatal Med. 2014;7(1):29-38. https://doi.org/10.3233/NPM-1473813
  • Mannan A, Dey SK, Jahan N, Iqbal S, Karim SMR, Ferdous N. Spectrum of neonatal pneumothorax at a tertiary care hospital of Bangledesh: a retrospective observational study. Bangladesh Crit Care J. 2019;7(1):12-19. https://doi.org/10.3329/bccj.v7i1.40758
  • Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. J Matern Fetal Neonatal Med. 2020;19:1-5. https://doi.org/10.1080.14767058.2020.1727880
  • Shen A, Yang J, Chapman G, Pam S. Can neonatal pneumothorax be successfully managed in regional Australia? Rural Remote Health. 2020;20(3):5615. https://doi.org/10.22605/RRH5615
  • Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015; 132(16 Suppl 1): S204– S241. https://doi.org/10.1161/CIR.0000000000000276
  • Al Matary A, Munshi HH, Abozaid S, Qaraqei M, Wani TA, Abu-Shaheen AK. Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years' Experience. Oman Med J. 2017;32(2):135-139. https://doi.org/10.5001/omj.2017.24
  • Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology. 2017;111:303-308. https://doi.org/10.1159/000453029
  • Okumus M, Zubarioglu AU. Neonatal Pneumothorax-10 years of experience from a single center. J Pediatr Res. 2020;7(2):163-7. https://doi.org/10.4274/jpr.galenos.2019.50133
  • Girard I, Sommer C, Dahan S, Mitanchez D, Morville P. Risk factors for developing pneumothorax in full-term neonates with respiratory distress. Arch Pediatr. 2012;19(4):368-73. https://doi.org/10.1016/j.arcped.2012.01.019
  • Büyüktiryaki M , Alyamaç Dizdar E , Okur N , Özer Bekmez B , Tayman C . Yenidoğanda pnömotoraks ve göğüs tüpü ile drenaj tedavisi gereksinimine göre demografik ve klinik özelliklerin karşılaştırılması. Türkiye Çocuk Hast Derg. 2019; 13(2): 50-56. https://doi.org/10.12956/tchd.510587
  • Kolas T, Saugstad OD, Daltweit AK, Nilsen ST, Qian P. Planned ceserean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006;195:1538-43. https://doi.org/10.1016/j.ajog.2006.05.005
  • Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax. J Int Med Res. 2011;39(6):2436-40. https://doi.org/10.1177/147323001103900645
  • Smith J, Schumacher RE, Donn SM, Sarkar S. Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort. Am J Perinatol. 2011;28(2):163-8. https://doi.org/10.1055/s-0030-1263300
  • Hadzic D, Skokic F, Husaric E, Alihodzic H, Softic D, Kovacevic D. Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton. Mater Sociomed. 2019;31(1):66-70. https://doi.org/10.5455/msm.2019.31.66-70.
  • Karabel M, Karabel D, Okur MH, Tan I, Kelekci S, Sen V, Uluca U. The evaluation of cases with pneumothorax in the neonatal intensive care unit. J Clin Exp Invest. 2013;4(3):289-292. https://doi.org/10.5799/ahinjs.01.2013.03.0286
  • Basheer F, Aatif M, Saeed MHB, Jalil J. Clinical profile and outcome of neonatal pneumothorax in resource-limited neonatal intensive care unit. J Matern Fetal Neonatal Med. 2020;27:1-6. https://doi.org/
  • Silva IS, Flor-de-Lima F, Rocha G, Alves I, Guimaraes H. Pneumothorax in neonates: a level III neonatal intensive care unit experience. J Pediatr Neonat Individual Med. 2016;5(2):e050220 https://doi.org/10.7363/050220
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Articles
Yazarlar

Nuriye Melekoğlu 0000-0002-3491-2337

Muhammed Selçuk Sinanoğlu 0000-0003-1596-4323

Erhan Berk 0000-0002-5558-6489

Yayımlanma Tarihi 1 Ağustos 2022
Gönderilme Tarihi 8 Eylül 2021
Kabul Tarihi 28 Ocak 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 13 Sayı: 46

Kaynak Göster

Vancouver Melekoğlu N, Sinanoğlu MS, Berk E. Evaluation of pneumothorax in the neonatal intensive care unit. mkutfd. 2022;13(46):168-73.