Bağ Dokusu Hastalığı Olan Annelerden Doğan Bebeklerin Kardiyolojik Bulguları

Öz

Amaç: Başta sistemik lupus eritematozus (SLE) ve Sjögren sendromlu (SS) olmak üzere annelerinde bağ dokusu hastalığı olan yenidoğanlarda kardiyak iletim sistemi etkilenmekte ve kalp blokları görülebilmektedir. Bu durumdan annenin dolaşımındaki anti-SS-A (Ro), anti- SS-B (La) antikorları sorumludur. Bu çalışmada hastanemizde bağ dokusu hastalığı olan annelerden doğan bebeklerin klinik özellikleri ve uzun dönem takip sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Yenidoğan yoğun bakım ünitesinde Ocak 2001 ile Ocak 2016 arasında annelerinde SLE, SS veya bağ dokusu hastalığı tanısı olması nedeniyle yatırılarak izlenen hastalar geriye dönük olarak tarandı, demografik ve klinik özellikleri ile elektrokardiyografik bulguları kayıt edildi. Bulgular: Çalışmaya toplam 48 anneden 49 bebek alındı. Annelerin doğum sırasında ortalama yaşı 30,8±5,0 yıl (28-41), hastaların ortalama gestasyonel haftası 35,8±2,5 hafta (28-41), ortalama doğum ağırlığı ise 2614±680 gr (730-3810 gr) idi. On yenidoğanda (%20,4) 3. derece atrioventriküler (AV) blok, bir bebekte ise 1. derece AV blok tespit edildi. Beş hastaya yenidoğan döneminde kalıcı kalp pili takıldı, bu hastalardan ikisi yenidoğan döneminde yaşamını yitirdi. AV blok ile takip edilen bir hastaya ise 6. ayında kalp pili takıldı. Kardiyak iletim sorunu olmayan bir bebek ise prematüriteye bağlı nedenler ile yaşamını yitirdi. Yaşayan 46 bebeğin ortalama takip süresi 4,6±3,1 (1,2-10,75) yıl, bunlardan AV tam bloklu olup kalp pili takılmadan izlenen hastaların takip süresi 5,6±2 yıl idi. Sonuç: Yenidoğan döneminde görülen tam AV blok hızlı müdahale edilmesi gereken ciddi bir kardiyak problemdir. Bilinen bağ dokusu hastalığı olan anne adayları üçüncü basamak merkezlerde izlenmeli, fetüs yakın takip edilmelidir. Gereken yenidoğanlara kalp pili takılarak normal yaşamlarına dönmeleri mümkündür.

Anahtar Kelimeler

• sistemik lupus eritamatozus
• Sjögren sendromu
• atrioventriküler blok

Cardiological Findings of Babies Born to Mothers with Connective Tissue Disease

Öz

Objective: Cardiac conduction system is affected and heart blocks can be seen in newborns whose mothers have connective tissue disease, especially with systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS). Anti-SS-A (Ro), anti-SS-B (La) antibodies in the mother's circulation are responsible for this situation. In this study, it was aimed to evaluate the clinical features and long-term follow-up results of babies born to mothers with connective tissue disease in our hospital. Materials and methods: Patients who were hospitalized in the neonatal intensive care unit between January 2001 and January 2016 due to the diagnosis of SLE, SS or connective tissue disease in their mothers were retrospectively screened, and their demographic and clinical characteristics and electrocardiographic findings were recorded. Results: A total of 49 babies from 48 mothers were included in the study. Mean age of mothers at birth was 30.8±5.0 years (28-41), mean gestational week of patients was 35.8±2.5 weeks (28-41), mean birth weight was 2614±680 g (730-3810 g). Ten newborns (20.4%) had 3rd degree atrioventricular (AV) block, and 1 baby had 1st degree AV block. Permanent pacemaker was implanted in five patients in the neonatal period, two of these patients died in the neonatal period. A pacemaker was inserted in a patient who was followed up with AV block in the 6th month. One baby who had no cardiac conduction problem died due to reasons related to prematurity. The mean follow-up period of 46 living babies was 4.6±3.1 (1.2-10.75) years, and the follow-up period of the patients with complete AV block and without a pacemaker was 5.6±2 years. Conclusion: Complete AV block in the neonatal period is a serious cardiac problem that requires rapid intervention. Expectant mothers with known connective tissue disease should be followed in tertiary care centers and the fetus should be followed closely. It is possible for newborns in need to return to their normal lives by inserting pacemakers.

Anahtar Kelimeler

• Atrioventricular (AV) Block
• Sjögren’s Syndrome
• Systemic Lupus Erythematosus

Kaynakça

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