İleri derece preterm yenidoğanların doğum zamanına göre erken dönem sonuçları
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Tarih
2022
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızın amacı, hastanemizde doğumu gerçekleşmiş olan ve yenidoğan yoğun bakım ünitesine gece, hafta sonu ve tatil günlerinde başvuran ileri derece preterm yenidoğanların morbidite ve mortalitesini hafta içi kabul edilen bebeklerinki ile karşılaştırmaktı. Bununla birlikte bakım olanakları, deneyimli insan gücü ve alt yapıya bağlı çeşitli risk faktörlerinin morbidite ve mortalite ile ilişkisini belirlemekti. Çalışmamıza 2014-2021 yılları arasındaki sekiz yıllık süreçte, yenidoğan yoğun bakım ünitesine kabul edilen ileri derece preterm yenidoğanlar (23+0 ile 31+6 hafta) dahil edildi. Hafta içi mesai saatlerinde doğan yenidoğanlar Grup 1 olarak ve hafta içi mesai dışı, haftasonu ve tatil günleri doğan yenidoğanlar da Grup 2 olarak kabul edildi. Major konjenital anomalisi bulunanlar, kromozomal kusuru saptananlar ve hasta takip dosyalarında eksik bilgisi olan bebekler çalışmadan dışlandı. Çalışmaya dahil edilen her yenidoğanın demografik verileri, perinatal özellikleri, morbiditeler, mortalite ve hastanede kalma süreleri kaydedildi. Veriler 326 bebek için analiz edildi. Grup 1 ve Grup 2 arasında demografik faktörler arasında anlamlı fark bulunmadı. Grup 1 ve Grup 2’de gestasyonel hipertansiyon, plasental yetmezlik, sezaryen oranı arasında anlamlı fark gözlendi. Çalışmamızda 28. gebelik haftasının altında doğan yenidoğanları kapsayan daha küçük bir grubu incelediğimizde; prenatal ve natal faktörler içerisinde farklar saptanırken; postnatal faktörler için anlamlı istatistiksel fark saptanmadı. Yapılan çok değişkenli regresyon analizinde, gebelik yaşı 28 hafta ve altında olan pretermlerin mesai içi veya mesai sonrası saatlerde doğmalarının morbidite ve mortaliteye bir katkısının olmadığı saptandı. Sonuç olarak; çalışmamızda ileri derece preterm yenidoğanların mesai içi veya mesai dışı saatlerde doğum zamanlarına göre mortalite oranları ve morbiditeler açısından anlamlı bir fark saptanmadı. Ünitemizde mesai içi ve dışı saatlerde bakım veren hemşire sayısında değişkenlik olmaması bunun nedeni olabilir. Çalışan hekim sayısında hafta sonu azalma olmaktadır; ancak bu durumun mortalite ve morbiditeler üzerine etkisi görülmemiştir. Bu konuda daha kapsamlı prospektif çalışmalara ihtiyaç vardır.
The aim of our study was to compare the morbidity and mortality of very preterm infants who were delivered in our hospital and admitted to the neonatal intensive care unit at night, on weekends and on holidays, with those babies admitted on weekdays. In addition, we aim to determine the relationship of various risk factors related to care facilities, experienced manpower and infrastructure with morbidity and mortality. Very preterm infants (23+0 to 31+6 weeks) admitted to the neonatal intensive care unit during the eight-year period between 2014 and 2021 were included in our study. Infants born during working hours on weekdays were accepted as Group 1, and infants born on weekdays out of working hours, on weekends and holidays were considered as Group 2. Babies with major congenital anomalies, chromosomal defects, and babies with missing information in their follow-up files were excluded from the study. Demographic data, perinatal characteristics, morbidities, mortality and survival times of each infants included in the study were recorded. Data were analyzed for 326 infants. There was no significant difference in demographic factors between Group 1 and Group 2. A significant difference was observed between the rates of gestational hypertension, placental insufficiency and cesarean section in Group 1 and Group 2. When we examined a smaller group including newborns born below the 28th gestational week in our study; While there are differences in prenatal and natal factors; No statistically significant difference was found for postnatal factors. In the multivariate regression analysis, it was determined that the birth of preterms with a gestational age of 28 weeks and below during or after working hours did not contribute to morbidity and mortality. As a result; in our study, no significant difference was found in terms of mortality rates and morbidities of very preterm infant according to delivery times during working hours or out of working hours. This may be due to the lack of variability in the number of nurses providing care during and out of working hours in our unit. There is a decrease in the number of working physicians on weekends; however, this did not have an effect on mortality and morbidity. More comprehensive prospective studies are needed in this regard.
The aim of our study was to compare the morbidity and mortality of very preterm infants who were delivered in our hospital and admitted to the neonatal intensive care unit at night, on weekends and on holidays, with those babies admitted on weekdays. In addition, we aim to determine the relationship of various risk factors related to care facilities, experienced manpower and infrastructure with morbidity and mortality. Very preterm infants (23+0 to 31+6 weeks) admitted to the neonatal intensive care unit during the eight-year period between 2014 and 2021 were included in our study. Infants born during working hours on weekdays were accepted as Group 1, and infants born on weekdays out of working hours, on weekends and holidays were considered as Group 2. Babies with major congenital anomalies, chromosomal defects, and babies with missing information in their follow-up files were excluded from the study. Demographic data, perinatal characteristics, morbidities, mortality and survival times of each infants included in the study were recorded. Data were analyzed for 326 infants. There was no significant difference in demographic factors between Group 1 and Group 2. A significant difference was observed between the rates of gestational hypertension, placental insufficiency and cesarean section in Group 1 and Group 2. When we examined a smaller group including newborns born below the 28th gestational week in our study; While there are differences in prenatal and natal factors; No statistically significant difference was found for postnatal factors. In the multivariate regression analysis, it was determined that the birth of preterms with a gestational age of 28 weeks and below during or after working hours did not contribute to morbidity and mortality. As a result; in our study, no significant difference was found in terms of mortality rates and morbidities of very preterm infant according to delivery times during working hours or out of working hours. This may be due to the lack of variability in the number of nurses providing care during and out of working hours in our unit. There is a decrease in the number of working physicians on weekends; however, this did not have an effect on mortality and morbidity. More comprehensive prospective studies are needed in this regard.
Açıklama
Anahtar Kelimeler
Doğum zamanı, İleri derecede preterm, Morbidite, Mortalite, Yenidoğan, Morbidity, Mortality, Newborn, Timing of birth, Very preterm infant
