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Yıl 2014, Cilt: 45 Sayı: 1, 30 - 37, 01.03.2014

Özge Serçe Derya Benzer Tuğba Gürsoy Fahri Ovalı , Güner Karatekin

Öz

Background: TThe outcome of preterm neonates’ varies in different hospitals in developing countries. Due to monitoring the effectiveness of current practice, every hospital should evaluate their own surveillance of up-todate outcome of the infants. The aim of this study is to establish the morbidity and mortality of very low birth weight (VLBW) infants admitted to a referral hospital in Istanbul, Turkey and to analyze risk factors associated with poor outcome.Method: PThe files of the neonates (≤ 32 gestational weeks, ≤ 1500 g birth weight) who were born and hospitalized in Neonatology unit between January 1, 20102011 at Zeynep Kamil Maternity and Childrens’ Training and Research Hospital were investigated retrospectively. Risk factors were analyzed using logistic regression models. Results: Of all, 154/370 (41.6%) infants died. The main reasons of mortality were respiratory distress syndrome (RDS) (39.2%), congenital anomalies (14.4%), pulmonary hemorrhage (13.7%), and sepsis (12.4%). In the infants who survived the incidence of retinopathy of prematurity was 49.6%; of RDS, 44.7%; of bronchopulmonary dysplasia, 29.7%; of patent ductus arteriosus, 21.8%; of intraventricular hemorrhage, 18.6%; of necrotizing enterocolitis, 13%. Lower birth weight, resuscitaCİLT: 45 YIL: 2014 SAYI: 1ZEYNEP KAMİL TIP BÜLTENİKLİNİK ARAŞTIRMAİstanbul’da Bir Referans Hastanesinin Üçüncü Basamak Yoğun Bakım Ünitesinde İzlenen Çok Düşük Doğum Ağırlıklı Yenidoğanların Klinik SeyriÖzge Serçe*, Derya Benzer*, Tuğba Gürsoy*,Fahri Ovalı*, Güner Karatekin*(*) Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim Araştırma Hastanesi, Yenidoğan Kliniğiİletişim BilgileriSorumlu Yazar: Özge SERÇEYazışma Adresi: İzmit Kadın Doğum ve Çoc. Hastalıkları Hast. Neonatoloji Ünt. Karadenizliler Mah. Elmatepe Cad. No:57 İzmit / KOCAELİEmail: ozge_serce@hotmail.com Tel: +90 262 319 50 80-2120 Tel: +90 532 327 03 75 Makalenin Geliş Tarihi: 17.05.2013Makalenin Kabul Tarihi: 01.12.2013tion at delivery room, RDS, acute renal failure, and umbilical venous catheterization were negatively; cesarean delivery and physiological weight loss were positively correlated with mortality.Conclusions: Even with modern perinatal care, deaths of VLBW infants are still common in our hospital in which high risk pregnancies or without follow up pregnancies admitted. Lower birth weight was the significant risk factor for death and short-term disability.

Anahtar Kelimeler

Low birth weight; morbidity; mortality risk factor.

Kaynakça

  • McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985; 312: 82-90.
  • Heron M. Deaths: leading causes for 2006. Natl Vital Stat Rep 2010; 58: 1-100.
  • Bodeau- Livinec F, Malow N, Ancel PY, Kurinczuk JJ, Costelae K, Kaminski M. Pediatrics 2008; 122: e 1014-1021.
  • Muglia LJ, Karlz M. The enigma of spontaneous preterm birth. N Engl J Med 2010; 362: 529-535.
  • Iams JD, Romano RL, Culhane JF, Goldenberg RL. Preterm birth; primary, secondary, and tertiary intervantions to reduce the morbidity and mortality of preterm birh. Lancet 2008; 371: 164-175.
  • Jones HP, Karuri S, Cronin CM, Ohlsson A, Peliowski A, Synnes A et al. Actuarial survival of a large Canadian cohort of preterm infants. BMC Pediatr 2005; 5: 40.
  • Ovalı F. Intrauterine growth curves for Turkish infants born between 25 and 42 weeks of gestation. J Trop Pediatr 2002; 49: 381-383.
  • Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723-9.
  • Kramer MS, Demissie K, Yang H, Platt RW, Sauve´ R, Liston R. The Contribution of Mild and Moderate Preterm Birth to Infant Mortality. JAMA 2000; 284: 843-9.
  • Tommiska V, Heinonen K, Ikonen S, Kero P, Pokela ML, Renlund M, et al. A national short-term follow-Up study of extremely low birth weight infants born in Finland in 1996-1997. Pediatrics 2001; 107: E2.
  • Brito AS, Matsuo T, Gonzalez MR, de Carvalho AB, Ferrari LS. CRIB score, birth weight and gestational age in neonatal mortality risk evaluation. Rev Saude Publica 2003; 37: 597-602.
  • Callaghan WM, Mac Dorman MF, Rasmussen SA, Quin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006. 118; 1566-1573.
  • Zardo MS, Procianoy RS. Comparison between different mortality risk scores in a neonatal intensive care unit. Rev Saude Publica 2003; 37:591-596.
  • Atasay B, Günlemez A, Unal S, Arsan S. Outcomes of very low birth weight infants in a newborn tertiary center in Turkey 1997-2000. Turk J Pediatr 2003; 45:283-289.
  • Dorman M, Monan F. Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: An overview. Semin in Perin 2011: 35; 200-208.
  • Yasmin S, Osrin D, Paul E, Costello A. Neonatal mortality of low-birth-weight infants in Bangladesh. Bull World Health Organ 2001; 79: 608-614.
  • Navaei F, Aliabady B, Moghtaderi J, Moghtaderi M, Kelishadi R. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran. World J Pediatr 2010; 6:228-32.
  • Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 2000; 5: 89–106.
  • Hack M, Friedman H, Fanaroff AA. Outcomes of Extremely Low Birth Weight Infants. Pediatrics 1996; 98:931–937.
  • Tin W, Wariyar U, Hey E. Changing prognosis for babies of less than 28 weeks’ gestation in the north of England between 1983 and 1994. Br Med J 1997; 314: 107–111.
  • Bartels DB, Wypij D, Wenzlaff P, Dammann O, Poets CF. Hospital volume and neonatal mortality among very low birth weight infants. Pediatrics 2006; 117:2206-2214.
  • Ghi T, Maroni E, Arcangeli T, Alessandroni R, Stella M, Youssef A, et al. Mode of delivery in the preterm gestation and maternal and neonatal outcome. J Matern Fetal Neonatal Med 2010; 2223: 1424-8.
  • Ahmeti F, Azizi I, Hoxha S, Kulik- Rechberger B, Rechberger T. Mode of delivery and mortality among preterm newborns. Ginekol Pol 2010; 81: 203-7.
  • Sankusane S, Rai L, Naik P. Preterm birth; mode of delivery and neonatal outcome. Med J Malaysia 2009; 64: 303-6.
  • Cooke RWI. Factors affecting survival and development in extremely tiny babies. Sem Neonatol 1996; 1: 267–276.
  • Gascon C, Skoll A, Lefevbre F, Glorieux G. The influence of maternal factors on the outcome at 18 months of babies born at 23 to 28 weeks gestation. Am J Obstet Gynecol 1995; 172: 418.
  • Ferrara TB, Hoekstra RE, Couser RJ, Gaziano EP, Calvin SE, Payne N, et al. Survival and follow-up of infants born at 23 to 26 weeks of gestational age: effects of surfactant therapy. J Pediatr 1994; 124: 119–124.
  • Msall ME, Buck GM, Rogers BT, Merke DP, Wan CC, Catanzaro NL, et al. Multivariate risks among extremely premature infants. J Perinatol 1994; 14:41–47

İSTANBUL'DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ

Yıl 2014, Cilt: 45 Sayı: 1, 30 - 37, 01.03.2014

Özge Serçe Derya Benzer Tuğba Gürsoy Fahri Ovalı , Güner Karatekin

Öz

Giriş: Gelişmekte olan ülkelerde bulunan değişik hastanelerin preterm yenidoğanlarla ilgili klinik sonuçları farklılık göstermektedir. Pratik hayatta yapılan uygulamaların etkinliğini monitorize etmek için her bir hastanenin kendisine ait güncel sürveyans çalışmalarını yapması gerekmektedir. Bu çalışmanın amacı İstanbul’da bulunan ana merkezlerden biri olan hastanemize yatırılmış çok düşük doğum ağırlıklı (ÇDDA) bebeklerin morbidite ve ölüm sonuçlarını değerlendirmek ve kötü seyirle ilişkili risk faktörlerini belirlemektir.

Materyal-Metod: Ocak 1, 2010-2011 tarihleri arasında Zeynep Kamil Kadın Doğum ve Çocuk Hastanesinde doğarak yenidoğan ünitesine yatırılan yenidoğanların (≤1500 gram, doğum ağırlığı ≤32 gebelik haftası) dosyaları geriye dönük tarandı. Risk faktörleri lojistik regresyon modelleri ile araştırıldı. 

Sonuçlar: Tüm vakalar içinde 154/370 (%41.6) yenidoğan ölmüştü. Ölümün ana nedenleri respiratuar distress sendromu (RDS) (%39.2), konjenital anomali (%14.4), pulmoner kanama (%13.7) ve sepsisti (%12.4). Yaşayan yenidoğanlarda prematüre retinopatisi %49.6; RDS %44.7; bronkopulmoner displazi %29.7; patent duktus arteriyozus %21.8; ventrikül içi kanama %18.6; nekrotizan enterokolit %13 sıklıkta görülmekteydi. Düşük doğum ağırlığı, doğum odasında canlandırma uygulanması, RDS, akut böbrek yetmezliği, göbek ven kateteri takılması arttırıcı; sezeryan ile doğum ve fizyolojik tartı kaybının olması azaltıcı yönde ölüm ile ilişkiliydi.  

Tartışma: Takipsiz veya yüksek riskli gebeliklerin kabul edildiği hastanemizde uygulanan modern perinatal bakıma rağmen, ÇDDA’lı bebeklerin ölüm oranları halen sıktı. Ölüm ve kısa dönem morbiditeler açısından düşük doğum ağırlığına sahip olmanın en önemli risk faktörü olduğu görülmekteydi.

Anahtar Kelimeler:  Düşük doğum ağırlığı, morbidite, ölüm, risk faktörü

 

 

[Outcomes of very low birth weight infants in a reference hospital with a tertiary neonatal intensive care unit in Istanbul]

Abstract

Background: The outcome of preterm neonates’ varies in different hospitals in developing countries. Due to monitoring the effectiveness of current practice, every hospital should evaluate their own surveillance of up-to-date outcome of the infants. The aim of this study is to establish the morbidity and mortality of very low birth weight (VLBW) infants admitted to a referral hospital in Istanbul, Turkey and to analyze risk factors associated with poor outcome.

Methods: The files of the neonates (≤ 32 gestational weeks, ≤ 1500 g birth weight) who were born and hospitalized in Neonatology unit between January 1, 2010-2011 at Zeynep Kamil Maternity and Childrens’ Training and Research Hospital were investigated retrospectively. Risk factors were analyzed using logistic regression models.

Results: Of all, 154/370 (41.6%) infants died. The main reasons of mortality were respiratory distress syndrome (RDS) (39.2%), congenital anomalies (14.4%), pulmonary hemorrhage (13.7%), and sepsis (12.4%). In the infants who survived the incidence of retinopathy of prematurity was 49.6%; of RDS, 44.7%; of bronchopulmonary dysplasia, 29.7%; of patent ductus arteriosus, 21.8%; of intraventricular hemorrhage, 18.6%; of necrotizing enterocolitis, 13%. Lower birth weight, resuscitation at delivery room, RDS, acute renal failure, and umbilical venous catheterization were negatively; cesarean delivery and physiological weight loss were positively correlated with mortality.

Conclusions: Even with modern perinatal care, deaths of VLBW infants are still common in our hospital in which high risk pregnancies or without follow up pregnancies admitted. Lower birth weight was the significant risk factor for death and short-term disability.

Key words:  Low birth weight; morbidity; mortality, risk factor

Anahtar Kelimeler

Düşük doğum ağırlığı morbidite ölüm risk faktörü.

Kaynakça

  • McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985; 312: 82-90.
  • Heron M. Deaths: leading causes for 2006. Natl Vital Stat Rep 2010; 58: 1-100.
  • Bodeau- Livinec F, Malow N, Ancel PY, Kurinczuk JJ, Costelae K, Kaminski M. Pediatrics 2008; 122: e 1014-1021.
  • Muglia LJ, Karlz M. The enigma of spontaneous preterm birth. N Engl J Med 2010; 362: 529-535.
  • Iams JD, Romano RL, Culhane JF, Goldenberg RL. Preterm birth; primary, secondary, and tertiary intervantions to reduce the morbidity and mortality of preterm birh. Lancet 2008; 371: 164-175.
  • Jones HP, Karuri S, Cronin CM, Ohlsson A, Peliowski A, Synnes A et al. Actuarial survival of a large Canadian cohort of preterm infants. BMC Pediatr 2005; 5: 40.
  • Ovalı F. Intrauterine growth curves for Turkish infants born between 25 and 42 weeks of gestation. J Trop Pediatr 2002; 49: 381-383.
  • Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723-9.
  • Kramer MS, Demissie K, Yang H, Platt RW, Sauve´ R, Liston R. The Contribution of Mild and Moderate Preterm Birth to Infant Mortality. JAMA 2000; 284: 843-9.
  • Tommiska V, Heinonen K, Ikonen S, Kero P, Pokela ML, Renlund M, et al. A national short-term follow-Up study of extremely low birth weight infants born in Finland in 1996-1997. Pediatrics 2001; 107: E2.
  • Brito AS, Matsuo T, Gonzalez MR, de Carvalho AB, Ferrari LS. CRIB score, birth weight and gestational age in neonatal mortality risk evaluation. Rev Saude Publica 2003; 37: 597-602.
  • Callaghan WM, Mac Dorman MF, Rasmussen SA, Quin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006. 118; 1566-1573.
  • Zardo MS, Procianoy RS. Comparison between different mortality risk scores in a neonatal intensive care unit. Rev Saude Publica 2003; 37:591-596.
  • Atasay B, Günlemez A, Unal S, Arsan S. Outcomes of very low birth weight infants in a newborn tertiary center in Turkey 1997-2000. Turk J Pediatr 2003; 45:283-289.
  • Dorman M, Monan F. Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: An overview. Semin in Perin 2011: 35; 200-208.
  • Yasmin S, Osrin D, Paul E, Costello A. Neonatal mortality of low-birth-weight infants in Bangladesh. Bull World Health Organ 2001; 79: 608-614.
  • Navaei F, Aliabady B, Moghtaderi J, Moghtaderi M, Kelishadi R. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran. World J Pediatr 2010; 6:228-32.
  • Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 2000; 5: 89–106.
  • Hack M, Friedman H, Fanaroff AA. Outcomes of Extremely Low Birth Weight Infants. Pediatrics 1996; 98:931–937.
  • Tin W, Wariyar U, Hey E. Changing prognosis for babies of less than 28 weeks’ gestation in the north of England between 1983 and 1994. Br Med J 1997; 314: 107–111.
  • Bartels DB, Wypij D, Wenzlaff P, Dammann O, Poets CF. Hospital volume and neonatal mortality among very low birth weight infants. Pediatrics 2006; 117:2206-2214.
  • Ghi T, Maroni E, Arcangeli T, Alessandroni R, Stella M, Youssef A, et al. Mode of delivery in the preterm gestation and maternal and neonatal outcome. J Matern Fetal Neonatal Med 2010; 2223: 1424-8.
  • Ahmeti F, Azizi I, Hoxha S, Kulik- Rechberger B, Rechberger T. Mode of delivery and mortality among preterm newborns. Ginekol Pol 2010; 81: 203-7.
  • Sankusane S, Rai L, Naik P. Preterm birth; mode of delivery and neonatal outcome. Med J Malaysia 2009; 64: 303-6.
  • Cooke RWI. Factors affecting survival and development in extremely tiny babies. Sem Neonatol 1996; 1: 267–276.
  • Gascon C, Skoll A, Lefevbre F, Glorieux G. The influence of maternal factors on the outcome at 18 months of babies born at 23 to 28 weeks gestation. Am J Obstet Gynecol 1995; 172: 418.
  • Ferrara TB, Hoekstra RE, Couser RJ, Gaziano EP, Calvin SE, Payne N, et al. Survival and follow-up of infants born at 23 to 26 weeks of gestational age: effects of surfactant therapy. J Pediatr 1994; 124: 119–124.
  • Msall ME, Buck GM, Rogers BT, Merke DP, Wan CC, Catanzaro NL, et al. Multivariate risks among extremely premature infants. J Perinatol 1994; 14:41–47
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Cover Pages
Yazarlar

Özge Serçe Bu kişi benim

Derya Benzer Bu kişi benim

Tuğba Gürsoy Bu kişi benim

Fahri Ovalı

Güner Karatekin

Yayımlanma Tarihi 1 Mart 2014
Yayımlandığı Sayı Yıl 2014 Cilt: 45 Sayı: 1

Kaynak Göster

APA Serçe, Ö., Benzer, D., Gürsoy, T., Ovalı, F., vd. (2014). İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ. Zeynep Kamil Tıp Bülteni, 45(1), 30-37. https://doi.org/10.16948/zktb.84910
AMA Serçe Ö, Benzer D, Gürsoy T, Ovalı F, Karatekin G. İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ. Zeynep Kamil Tıp Bülteni. Mart 2014;45(1):30-37. doi:10.16948/zktb.84910
Chicago Serçe, Özge, Derya Benzer, Tuğba Gürsoy, Fahri Ovalı, ve Güner Karatekin. “İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ”. Zeynep Kamil Tıp Bülteni 45, sy. 1 (Mart 2014): 30-37. https://doi.org/10.16948/zktb.84910.
EndNote Serçe Ö, Benzer D, Gürsoy T, Ovalı F, Karatekin G (01 Mart 2014) İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ. Zeynep Kamil Tıp Bülteni 45 1 30–37.
IEEE Ö. Serçe, D. Benzer, T. Gürsoy, F. Ovalı, ve G. Karatekin, “İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ”, Zeynep Kamil Tıp Bülteni, c. 45, sy. 1, ss. 30–37, 2014, doi: 10.16948/zktb.84910.
ISNAD Serçe, Özge vd. “İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ”. Zeynep Kamil Tıp Bülteni 45/1 (Mart 2014), 30-37. https://doi.org/10.16948/zktb.84910.
JAMA Serçe Ö, Benzer D, Gürsoy T, Ovalı F, Karatekin G. İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ. Zeynep Kamil Tıp Bülteni. 2014;45:30–37.
MLA Serçe, Özge vd. “İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ”. Zeynep Kamil Tıp Bülteni, c. 45, sy. 1, 2014, ss. 30-37, doi:10.16948/zktb.84910.
Vancouver Serçe Ö, Benzer D, Gürsoy T, Ovalı F, Karatekin G. İSTANBUL’DA BİR REFERANS HASTANESİNİN ÜÇÜNCÜ BASAMAK YOĞUN BAKIM ÜNİTESİNDE İZLENEN ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARIN KLİNİK SEYRİ. Zeynep Kamil Tıp Bülteni. 2014;45(1):30-7.
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