Preterm Bebeklerde Nekrotizan Enterokolit için Risk Faktörlerinin Değerlendirilmesi

Yıl 2011, Cilt: 9 Sayı: 2, 7 - 13, 01.09.2011

Cüneyt Tayman , Alparslan Tonbul Nurdan Uras Hasan Kahveci Burhan Köseoğlu M. Mansur Tatlı

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

Öz

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

Anahtar Kelimeler

Necrotizing enterocolitis, prematurity, risk factor, newborn

Kaynakça

• Jobe AH, Bancaları E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9.
• Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pe- diatr 1978;92:529-34.
• Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986;33:179-201.
• Rowe MI, Albanese CT. Necrotizing enterokolitis. In: O’Neill JA. Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG. Pediatric Sur- gery Year Book Medical Publisher, St, Louis, Mosby, 1998.p.1297-320.
• Bülbül A, Okan F, Şahin S, Nuhoğlu A. Düşük doğum ağırlıklı erken doğmuş bebeklerde erken dönem hastalık ve ölüm oranı sonuçları. Türk Ped Arş 2008;43:94-8.
• Catov JM, Nohr EA, Olsen J, Ness RB. Chronic hypertension related to risk for preterm and term small for gestational age births. Obstet Gynecol 2008;112:290-6.
• Hartung J, Kalache KD, Heyna C, Heling KS, Kuhlig M, Wau- rer R, et al. Outcome of 60 neonates who had ARED flow pre- natally compared with a matched control group of approp- riate for gestational age preterm neonates. Ultrasound Obs- tet Gynecol 2005;25:566-72.
• Henry MC, Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004;28:221-33.
• Ray JG, Burrows RF, Burrows EA, Vermeulen MJ. MOS HIP: McMaster outcome study of hypertension in pregnancy. Early Hum Dev 2001;64:129-43.
• Roberts CL, Algert CS, Morris JM, Ford JB, Henderson- Smart DJ. Hypertensive disorders in pregnancy: a population-based study. Med J Aust 2005;182:332-5.
• Faye-Petersen OM. The placenta in preterm birth. J Clin Pat- hol 2008;61:1261-75.
• Goldenberg RL, Hauth JC. Intrauterine infection and preterm delivery. N Engl J Med 2000;342:1500-7.
• Plaisier M, Rodrigues S, Willems F, Koolwijk P, van Hins- bergh VWM, Helmerhorst FM. Different degrees of vascularization and their relationship to the expression of vascular endothelial growth factor, placental growth factor, angiopoietins and their receptors in first-trimester decidual tissues. Fertil Steril 2007;88:176-87.
• Rustveld LO, Kelsey SF, Sharma R. Association between ma- ternal infections and preeclampsia: A systematic review of epidemiologic studies. Matern Child Health J 2008;12:223-42.
• Patole S. Prevention and treatment of of necrotizing enterocolitis in preterm neonates. Early Hum Dev 2007;83:635-42.
• Lin PW, Nasr TR, Stoll BJ. Necrotizing enterocolitis: recent scientific advances in pathophysiology and prevention. Se- min Perinatol 2008;32:70-82.
• Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol 2003;8:449-59.
• Shankaran S, Johnson Y, Langer JC, Vohr BR, Fanaroff AA, Wright LL et al. Outcome of extremely low birthweight in- fants at highest risk: gestational age < or =24 weeks, birthweight < 750g and 1-minute Apgar < or =3. Am J Obstet Gynecol 2004;19:1084-91.
• Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Eh- renkranz RA et al. Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91.
• Kenner C, Lott JW. Comprehensive neonatal nursing: A physiologic perspective. (3rd ed.). St. Louis, MO: Saunders. 2003.p.604.
• Agwu JC, Narchi H. In a preterm infant, does blood transfusion increase the risk of necrotizing enterocolitis? Arch Dis Child 2005;90:102-3.
• Ng S. Necrotizing enterocolitis in the full-term neonate. J Pa- ediatr Child Health 2001;37:1-4.
• Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med 2007;161:583-90.
• Carter BM.Treatment outcomes of necrotizing enterocolitis for preterm infants. J Obstet Gynecol Neonatal Nurs 2007;36:377-84.