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Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi

Yıl 2010, Cilt: 8 Sayı: 3, 56 - 62, 01.12.2010

Öz

Giriş: Bu çalışmanın amacı yenidoğan yoğun bakım ünitesinde nekrotizan enterokolit NEK ile izlenmiş olan prematüre bebeklerin karakteristik özellikleriyle kısa ve uzundönem sonuçlarının değerlendirilmesidir.Gereç ve Yöntem: Çalışmaya Ocak 2005 ile Aralık 2009 yılları arasında yenidoğan yoğunbakım ünitemizde yatarak takip edilen gestasyon yaşı ≤34 hafta olan ve NEK tanısı alan50 prematüre bebek alındı ve bu bebeklerin karakteristik özellikleri, klinik ve laboratuvarbulguları ve prognozları değerlendirildi.Bulgular: Çalışmaya alınan prematüre bebeklerin 15’inde %30 evre 1, 21 %42 tanesinde evre 2 ve 14 %28 tanesinde evre 3 NEK mevcuttu. NEK insidansı %7,5 50/658 idi. NEK gelişen bebeklerin ortalama gestasyon yaşlarının ve doğum ağırlıklarının,sırasıyla 29±2,2 hafta ve 1142±300 gram olduğu görüldü. Ortalama NEK başlangıç zamanı18,5±8,1 gün idi. Olguların %64’ünde hipoksik doğum öyküsünün olduğu saptandı ve annesütü ile beslenme oranı %54 olarak bulundu. NEK’li olguların %36’sında kan kültüründeüreme tespit edildi. Evre 3 NEK olan 8 olguda cerrahi tedavi uygulanırken diğer olgularmedikal tedaviye cevap verdi. Mortalite oranı %12 olarak bulundu ve yaşayan bebeklerdekısa ve uzun dönem en sık sorunların sırası ile beslenme problemleri ve malabsorbsiyonolduğu görüldü.Sonuç: NEK prematüre bebeklerde görülen en ciddi sorunlardan biridir. Yenidoğanyoğun bakımındaki gelişmelerle mortalitesi ve sıklığı azaltılabilmiştir. Etyolojide yer alanen önemli faktörler prematürite, hipoksi ve enteral beslenmedir

Kaynakça

  • 1. Oygür N. Nekrotizan Enterokolit. Yurdakök M, Erdem G (eds). Neonatoloji. 2.Bask›. Alp Ofset I. 2004. p.552-6.
  • 2. Çetinkaya M, Köksal N. Nekrotizan Enterokolit. Güncel Pediatri 2004;2:146-51.
  • 3. Fell JM. Neonatal inflammatory intestinal diseases: necrotizing enterocolitis and allergic colitis. Early Hum Dev 2005;81:117-22.
  • 4. Coombs RC. The prevention and management of necrotizing enterocolitis. Current Paediatrics 2003;13:184-9.
  • 5. The Canadian Neonatal Network. Variations in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units. Journal of Pediatric Gastroenterology & Nutrition 2004;39:366-72.
  • 6. Henry MC, Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004;28:221-33.
  • 7. Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003;6:6-23.
  • 8. Ragazzi S, Pierro A, Peters M, Fasoli L, Eaton S. Early full blood count and severity of disease in neonates with necrotizing enterocolitis. Pediatr Surg Int 2003;19:376-9.
  • 9. Jane S Lee, Richard A Polin. Treatment and prevention of necrotizing enteocolitis. Seminars in Neonatology 2003;8:449-59.
  • 10. Dimmit RA, Lawrance R. Clinical management of necrotizing enterocolitis. American Academy of Pediatrics 2001;2:110-7. 11. Lin PW, Stoll BJ. Necrotising enterocolitis. Lancet 2006;368:1271-83.
  • 12. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Ped Clin North Am 1986;33:179-201.
  • 13. Arnold M, Moore SW, Sidler D, Kirsten GF. Long-term outcome of surgically managed necrotizing enterocolitis in a developing country. Pediatric Surgery 2010;26:355-60.
  • 14. Kaul A, Balisteri WF. Necrotizing enterocolitis. In: Fanaroff AA, Martin RJ (eds). Neonatal Perinatal Medicine: Diseases of the fetus and infant. 7nd edition. St. Lois: Mosby; 2002. p.1299-1307.
  • 15. Wilson R, Kanto WP Jr, McCarthy BJ, Burton T, Lewin P, Terry J et al. Epidemiologic characteristics of necrotizing enterocolitis: apopulation-based study. Am J Epidemiol 1981;114:880-7.
  • 16. Abdullah F, Zhang Y, Camp M, Mukherjee D, Gabre-Kidan A, Colombani PM et al. Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical Treatments. Clin Pediatr 2010;49:166.
  • 17. Claud EC, Walker WA. Hypotehesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis. Faseb J 2001;15:1398-403.
  • 18. Ng PC, Li K, Wong RP, Chui K, Wong E, Li G et al. Proinflammatory cytokine responses in preterm infants with systemic infections. Arch Dis Child Fetal Neonatal Ed 2003;88:209-13.
  • 19. Stoll BJ, Kanto WP Jr, Glass RI, Nahmias AJ, Brann AW Jr. Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr 1980;96:447-51.
  • 20. Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994;21:205-18.
  • 21. Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2007;4:1858-91.
  • 22. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. Journal of Perinatology 2009;29:57-62.
  • 23. Henderson G, Craig S, Brocklehurst P, McGuire W. Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case-control study. Arch Dis Child Fetal Neonatal Ed 2009;94:120-3.
  • 24. Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Archives of Disease in Childhood Fetal & Neonatal Edition 2005;90:147-51.
  • 25. Flidel-Rimon O, Friedman S, Lev E, Juster-Reicher A, Amitay M, Shinwell ES. Early enteral feeding and nosocomial sepsis in very low birthweight infants. Archives of Disease in Childhood Fetal&Neonatal Edition 2004;89:289-92.
  • 26. Flidel-Rimon O, Branski D, Shinwell ES. The fear of necrotizing enterocolitis versus achieving optimal growth in preterm infants an opinion. Acta Paediatrica 2006;95:1341-4.
  • 27. McClure RJ. Trophic feeding of the preterm infant. Acta Paediatrica (supplement) 2001;436:19-21.
  • 28. Bombell S, McGuire W. Early trophic feeding for very low birth weight infants. Cochrane Database of Systematic Reviews 2009;3:1-22.
  • 29. Hällström M, Koivisto AM, Janas M, Tammela O. Laboratory parameters predictive of developing necrotizing enterocolitis in infants born before 33 weeks of gestation. J Pediatr Surg 2006;41:792-8.
  • 30. Pourcyrous M, Korones SB, Yang W, Boulden TF, Bada SH. C-reactive protein in the diagnosis, management and prognosis of neonatal necrotizing enterocolitis. Pediatrics 2005; 116:1064-9.
  • 31. Philip AGS, Sann L, Bienvenu F. Acute phase proteins in necrotizing enterocolitis. Acta Paediatr Scand 1986;75:1032-3.
  • 32. Isaacs D, North J, Lindsell D, Wilkinson AR. Serum acute phase reactants in necrotizing enterocolitis. Acta Paediatr Scand 1987;76:923-7.
  • 33. Turner D, Hammerman C, Rudensky B, Schlesinger Y, Wine E, Muise A et al. Low levels of procalcitonin during episodes of necrotizing enterocolitis. Dig Dis Sci 2007;52:2972-6.
  • 34. Acunafl B, Vatansever Ü, Duran R, Alada¤ N. Çok Düflük Do¤um Tart›l› Yenido¤anlarda Nekrotizan Enterokolit fiiddetini Öngörecek Etmenlerin ‹ncelenmesi. Türk Pediatri Arflivi 2006;41:15-21.

Evaluation of Premature Newborns with Necrotizing Enterocolitis

Yıl 2010, Cilt: 8 Sayı: 3, 56 - 62, 01.12.2010

Öz

Introduction: The aim of this study was to evaluate the characteristic features and bothearly and late term prognosis of premature infants who were followed-up with NEC inthe neonatal intensive care unit. Materials and Method: A total of 50 premature infants less than 34 gestational weekswith NEC between January 2005 and December 2009 were included to this study and thecharacteristic features, clinical and laboratory findings, and prognosis of these infantswere evaluated.Results: In this study, 15 infants 30% had stage 1, 21 infants 42% had stage 2 and 14infants 28% had stage 3 NEC. The incidence of NEC was 7.5% 20/568 . The mean gestational age and birth weight of infants who developed NEC were 29±2.2 weeks and1142±300 grams, respectively. The mean onset of NEC was 18.5±8.1 days. There washypoxic birth history in 64% of infants and the ratio of breastfed infants was 54%. Therewas a positive blood culture in 36% of infants with NEC. Surgery was performed in 8infants with stage 3 NEC, whereas the other infants responded well to medical treatment. The mortality rate was 12% and feeding problems and malabsorption werefound to be the most common early and late term problems in infants who survived. Conclusions: NEC is one of the serious problems in premature infants. The mortality andfrequency of NEC was decreased with the improvements in the Neonatal Intensive Care.The most important etiological factors were prematurity, hypoxia and enteral feeding

Kaynakça

  • 1. Oygür N. Nekrotizan Enterokolit. Yurdakök M, Erdem G (eds). Neonatoloji. 2.Bask›. Alp Ofset I. 2004. p.552-6.
  • 2. Çetinkaya M, Köksal N. Nekrotizan Enterokolit. Güncel Pediatri 2004;2:146-51.
  • 3. Fell JM. Neonatal inflammatory intestinal diseases: necrotizing enterocolitis and allergic colitis. Early Hum Dev 2005;81:117-22.
  • 4. Coombs RC. The prevention and management of necrotizing enterocolitis. Current Paediatrics 2003;13:184-9.
  • 5. The Canadian Neonatal Network. Variations in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units. Journal of Pediatric Gastroenterology & Nutrition 2004;39:366-72.
  • 6. Henry MC, Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004;28:221-33.
  • 7. Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003;6:6-23.
  • 8. Ragazzi S, Pierro A, Peters M, Fasoli L, Eaton S. Early full blood count and severity of disease in neonates with necrotizing enterocolitis. Pediatr Surg Int 2003;19:376-9.
  • 9. Jane S Lee, Richard A Polin. Treatment and prevention of necrotizing enteocolitis. Seminars in Neonatology 2003;8:449-59.
  • 10. Dimmit RA, Lawrance R. Clinical management of necrotizing enterocolitis. American Academy of Pediatrics 2001;2:110-7. 11. Lin PW, Stoll BJ. Necrotising enterocolitis. Lancet 2006;368:1271-83.
  • 12. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Ped Clin North Am 1986;33:179-201.
  • 13. Arnold M, Moore SW, Sidler D, Kirsten GF. Long-term outcome of surgically managed necrotizing enterocolitis in a developing country. Pediatric Surgery 2010;26:355-60.
  • 14. Kaul A, Balisteri WF. Necrotizing enterocolitis. In: Fanaroff AA, Martin RJ (eds). Neonatal Perinatal Medicine: Diseases of the fetus and infant. 7nd edition. St. Lois: Mosby; 2002. p.1299-1307.
  • 15. Wilson R, Kanto WP Jr, McCarthy BJ, Burton T, Lewin P, Terry J et al. Epidemiologic characteristics of necrotizing enterocolitis: apopulation-based study. Am J Epidemiol 1981;114:880-7.
  • 16. Abdullah F, Zhang Y, Camp M, Mukherjee D, Gabre-Kidan A, Colombani PM et al. Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical Treatments. Clin Pediatr 2010;49:166.
  • 17. Claud EC, Walker WA. Hypotehesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis. Faseb J 2001;15:1398-403.
  • 18. Ng PC, Li K, Wong RP, Chui K, Wong E, Li G et al. Proinflammatory cytokine responses in preterm infants with systemic infections. Arch Dis Child Fetal Neonatal Ed 2003;88:209-13.
  • 19. Stoll BJ, Kanto WP Jr, Glass RI, Nahmias AJ, Brann AW Jr. Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr 1980;96:447-51.
  • 20. Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994;21:205-18.
  • 21. Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2007;4:1858-91.
  • 22. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. Journal of Perinatology 2009;29:57-62.
  • 23. Henderson G, Craig S, Brocklehurst P, McGuire W. Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case-control study. Arch Dis Child Fetal Neonatal Ed 2009;94:120-3.
  • 24. Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Archives of Disease in Childhood Fetal & Neonatal Edition 2005;90:147-51.
  • 25. Flidel-Rimon O, Friedman S, Lev E, Juster-Reicher A, Amitay M, Shinwell ES. Early enteral feeding and nosocomial sepsis in very low birthweight infants. Archives of Disease in Childhood Fetal&Neonatal Edition 2004;89:289-92.
  • 26. Flidel-Rimon O, Branski D, Shinwell ES. The fear of necrotizing enterocolitis versus achieving optimal growth in preterm infants an opinion. Acta Paediatrica 2006;95:1341-4.
  • 27. McClure RJ. Trophic feeding of the preterm infant. Acta Paediatrica (supplement) 2001;436:19-21.
  • 28. Bombell S, McGuire W. Early trophic feeding for very low birth weight infants. Cochrane Database of Systematic Reviews 2009;3:1-22.
  • 29. Hällström M, Koivisto AM, Janas M, Tammela O. Laboratory parameters predictive of developing necrotizing enterocolitis in infants born before 33 weeks of gestation. J Pediatr Surg 2006;41:792-8.
  • 30. Pourcyrous M, Korones SB, Yang W, Boulden TF, Bada SH. C-reactive protein in the diagnosis, management and prognosis of neonatal necrotizing enterocolitis. Pediatrics 2005; 116:1064-9.
  • 31. Philip AGS, Sann L, Bienvenu F. Acute phase proteins in necrotizing enterocolitis. Acta Paediatr Scand 1986;75:1032-3.
  • 32. Isaacs D, North J, Lindsell D, Wilkinson AR. Serum acute phase reactants in necrotizing enterocolitis. Acta Paediatr Scand 1987;76:923-7.
  • 33. Turner D, Hammerman C, Rudensky B, Schlesinger Y, Wine E, Muise A et al. Low levels of procalcitonin during episodes of necrotizing enterocolitis. Dig Dis Sci 2007;52:2972-6.
  • 34. Acunafl B, Vatansever Ü, Duran R, Alada¤ N. Çok Düflük Do¤um Tart›l› Yenido¤anlarda Nekrotizan Enterokolit fiiddetini Öngörecek Etmenlerin ‹ncelenmesi. Türk Pediatri Arflivi 2006;41:15-21.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Hilal Özkan Bu kişi benim

Merih Çetinkaya

Nilgün Köksal Bu kişi benim

Evren Özboyacı Bu kişi benim

Ali Özboyacı Bu kişi benim

Şenay Yapıcı Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2010
Yayımlandığı Sayı Yıl 2010 Cilt: 8 Sayı: 3

Kaynak Göster

APA Özkan, H., Çetinkaya, M., Köksal, N., Özboyacı, E., vd. (2010). Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi. Güncel Pediatri, 8(3), 56-62.
AMA Özkan H, Çetinkaya M, Köksal N, Özboyacı E, Özboyacı A, Yapıcı Ş. Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi. Güncel Pediatri. Aralık 2010;8(3):56-62.
Chicago Özkan, Hilal, Merih Çetinkaya, Nilgün Köksal, Evren Özboyacı, Ali Özboyacı, ve Şenay Yapıcı. “Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi”. Güncel Pediatri 8, sy. 3 (Aralık 2010): 56-62.
EndNote Özkan H, Çetinkaya M, Köksal N, Özboyacı E, Özboyacı A, Yapıcı Ş (01 Aralık 2010) Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi. Güncel Pediatri 8 3 56–62.
IEEE H. Özkan, M. Çetinkaya, N. Köksal, E. Özboyacı, A. Özboyacı, ve Ş. Yapıcı, “Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi”, Güncel Pediatri, c. 8, sy. 3, ss. 56–62, 2010.
ISNAD Özkan, Hilal vd. “Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi”. Güncel Pediatri 8/3 (Aralık 2010), 56-62.
JAMA Özkan H, Çetinkaya M, Köksal N, Özboyacı E, Özboyacı A, Yapıcı Ş. Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi. Güncel Pediatri. 2010;8:56–62.
MLA Özkan, Hilal vd. “Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi”. Güncel Pediatri, c. 8, sy. 3, 2010, ss. 56-62.
Vancouver Özkan H, Çetinkaya M, Köksal N, Özboyacı E, Özboyacı A, Yapıcı Ş. Nekrotizan Enterokolitli Prematüre Bebeklerin Değerlendirilmesi. Güncel Pediatri. 2010;8(3):56-62.