Yenidoğan sepsis tanısında EMA, Töllner ve Rodwell skorlarının değerlendirilmesi

Yıl 2024, Cilt: 17 Sayı: 4, 746 - 754, 09.10.2024

Özmert M.a. Özdemir , Büşra Erdal , Musa Turgut

https://doi.org/10.31362/patd.1457265

Öz

Amaç: Yenidoğan döneminde sepsis tanısını kesin olarak saptayacak özgün belirti, bulgu ve hızlı laboratuvar testleri bulunmamaktadır. Bu nedenle bu çalışmada yenidoğan sepsisinin erken tanısında EMA (European Medicines Agency), Töllner ve Rodwell hematolojik skorlamalarının klinik yeterlilik ve güvenirliğini araştırmayı planladık.
Yöntem: Her hastaya EMA, Töllner ve Rodwell hematolojik skorlaması yapıldı. Sepsis düşünülen yenidoğan bebeklerin tam kan sayımı, periferik yayma, C-reaktif protein, prokalsitonin, kan gazı ve kan şekeri değerleri kaydedildi, bebeklerden alınan kan kültürü, idrar kültürü ve gerekli hallerde alınmış beyin omurilik sıvı incelemesi ve kültürleri değerlendirildi. İstatistiksel analizler kullanılarak skorlamaların ‘Pozitif Beklenen Değer ve Negatif Beklenen Değerler’ oranları elde edildi, performans sonuçları incelendi.
Bulgular: Klinik sepsis ön tanısı alan 95 yenidoğan çalışmaya alındı. Bu bebekler kan kültürü sonuçlarına göre klinik (n:71) ve kanıtlanmış sepsis (n:24) olmak üzere iki gruba ayrıldı. Kesin sepsis tanısında skorlama sistemlerinin pozitif ve negatif prediktif değerleri; sırasıyla EMA için; %21,5, %56,3, Töllner için; %31,3, %77,8, Rodwell için ise %100, %77,8 saptandı.
Sonuç: Çalışmamız, yenidoğan sepsis tanısında klinisyen görüşünün ve standart laboratuvar testlerin sınırlı olduğunu, Rodwell hematolojik skorlamasının diğer iki skorlamaya göre kanıtlanmış sepsisi tanımada daha ön planda olduğunu göstermiştir

Anahtar Kelimeler

Sepsis, yenidoğan, EMA, Töllner, Rodwell

Evaluation of EMA, Töllner and Rodwell scores in the diagnosis of neonatal sepsis

Öz

Purpose: There are no specific signs, symptoms and rapid laboratory tests to definitively diagnose sepsis in the neonatal period. Therefore, in this study, we planned to investigate the clinical adequacy and reliability of EMA (European Medicines Agency), Töllner and Rodwell hematological scoring in the early diagnosis of neonatal sepsis.
Materials and methods: EMA, Töllner and Rodwell hematological scoring was performed on each patient. Complete blood count, peripheral smear, C-reactive protein, procalcitonin, blood gas and blood sugar values of newborn babies with suspected sepsis were recorded, blood culture, urine culture and cerebrospinal fluid examination and cultures taken when necessary were evaluated. Using statistical analysis, the 'Positive Expected Value and Negative Expected Values' ratios of the scores were obtained, and the performance results were examined.
Results: 95 newborns with a preliminary clinical diagnosis of sepsis were included in the study. These babies were divided into two groups: clinical (n:71) and proven sepsis (n:24) according to blood culture results. Positive and negative predictive values of scoring systems in definitive sepsis diagnosis; for EMA respectively; 21.5%, 56.3% for Töllner; It was determined as 31.3%, 77.8%, and 100%, 77.8% for Rodwell.
Conclusion: Our study showed that clinician opinion and standard laboratory tests are limited in the diagnosis of neonatal sepsis, and Rodwell hematological scoring is more prominent in recognizing proven sepsis compared to the other two scores.

Anahtar Kelimeler

Sepsis, newborn, EMA, Töllner, Rodwell

Kaynakça

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