Preterm Bebeklerde Nekrotizan Enterokolit için Risk Faktörlerinin Değerlendirilmesi

Öz

Giriş: Bu çalışmada nekrotizan enterokolit NEK gelişiminde anne, bebek ve bebekbakımı ile ilişkili faktörlerin etkilerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Doğum haftası ≤32 ve doğum ağırlığı ≤1500 gram olan hastalar çalışmaya dâhil edildi. Maternal demografik özellikler ve gebelik öyküsü, antenatal venatal takipteki problemler, antenatal steroid tedavisi, doğum şekli NVY, C/S , ve bebeğin doğum öyküsü kayıt edildi. NEK tanısından önce prematüre bebeğe uygulananventilasyon tedavisinin süresi ve transfüzyon sayıları kayıt edildi. Çalışmaya evre 2 veevre 3 NEK olguları alındı.Bulgular: Beş yüz otuz iki hastadan 61’ine %11,4 NEK tanısı konuldu ve çalışma grubu olarak belirlendi. 60 hasta kontrol grubu olarak seçildi. Çalışma ve kontrol grubuarasında demografik özellikler, APGAR skoru, resüsitasyon gereksinimi ve antenatalsteroid kullanımı açısından farklılık bulunmadı. NEK’li hastalarda ventilatörde kalımsüresinin p=0,037 ve eritrosit süspansiyonu transfüzyon sıklığının daha fazla olduğugörüldü p=0,032 . Antenatal steroid kullanımının evre 2 NEK’li hastalarda daha fazlaolduğu p=0,011 , evre 3 olanlarda ventilatörde kalım süresinin daha fazla olduğu bulundu p=0,020 . NEK’li hastalarda mortalite oranı %31,1 olarak saptandı. Ölen hastaların %84’ünde evre 3 NEK olduğu, doğum ağırlığı ve haftalarının daha düşük olduğugörüldü. NEK grubunda respiratuvar distress sendromu RDS p=0,02 ; RDS ve patent duktus arteriosus PDA birlikteliği daha fazla olduğu p=0,03 , intrakranial kanamanın İKK evre 3 NEK’te fazla olduğu p=0,034 saptandı. Evre 3 NEK’li olgulardaRDS, PDA ve İKK birlikteliği daha fazla bulundu p=0,006 . Evre 3 NEK’li hastaların annelerinde kronik hipertansiyon p=0,003 , eklampsi p=0,034 ve infeksiyon p=0,011 sıklığının fazla olduğu görüldü.Sonuç: Bu çalışmada antenatal, natal ve postnatal faktörlerin NEK gelişiminde önemli rol oynadığı gösterilmiş olup, bu faktörlere yönelik alınacak önlemlerle hastalığınsıklığının azaltılabileceği önerilmiştir

Anahtar Kelimeler

• Nekrotizan enterokolit,prematüre,risk faktör,yenidoğan

Evaluation of Risk Factors for Necrotizing Enterocolitis in Preterm Infants

Abstract

Introduction: In the present study, it was aimed to evaluate the effects of the maternaland infantile factors and factors associated with the care of the infants in the development of necrotizing enterocolitis NEC . Materials and Method: Infants with ≤32 weeks of gestational age and ≤1500 gramsof birth weight were included in the study. Maternal demographic characteristicsand pregnancy history, antenatal and postnatal follow-up problems, antenatalsteroid treatment, modes of delivery NVY, C/S , and the babies’ birth history wererecorded. The duration of ventilation treatment and the number of transfusionsapplied before the diagnosis of NEC in premature infants were recorded. Patientswith stage II and stage III NEC were included in the study.Results: Sixty one of 532 patients 11,4% were diagnosed as NEC and allocated in thestudy group. Sixty patients were enrolled as the control group. There were no differencesbetween both groups with respect to demographic characteristics, APGAR score, need for resuscitation and antenatalsteroid treatment. The duration of ventilation treatment p=0.037 and the frequency of red blood cell transfusion p=0.032 were considered to be higher in the NEC group. Antenatal steroid administration was higher in patients with stage 2 NEC p=0.011 , but the duration of ventilation treatment was higher in those with stage 3 p=0.020 . The mortality rate was 31.1%in the patients with NEC. It was observed that 83% of patients who died had stage 3 NEC and a lower birth weight and gestational age. Respiratory distress syndrome RDS p=0.02 , togetherness of RDS and patent ductus arteriosus PDA werehigher in the NEC group p=0.03 , and more intracranial hemorrhage ICH was detected at stage 3 NEC p=0.034 . RDS, PDAand İCH were frequently determined together in patients with stage 3 NEC p=0.006 . Chronic hypertension p=0.003 ,eclampsia p=0.034 , and infection p=0.011 were found to be more frequent in the mother of the patients with stage 3 NEC. Conclusion: In the present study, antenatal, natal and postnatal factors were shown to play an important role in the development of NEC, and if proposed measures to be taken, these factors may reduce the incidence of the disease. Journal

Keywords

• Necrotizing enterocolitis,prematurity,risk factor,newborn

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