Nekrotizan enterokolit olgularının geriye dönük olarak değerlendirilmesi ve risk faktörlerinin araştırılması
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Dosyalar
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Nekrotizan enterokolit özellikle ileri derecede prematür yenidoğanlarda önemli bir ölüm ve morbidite nedenidir. İnsidansı ve risk faktörleri üniteler arasında değişkenlik gösterir. Hastalığın patogenez ve etyolojisinin net aydınlatılamaması nedeniyle hastalığın risk faktörlerinin belirlenmesi önemlidir. Amacımız neonatal yoğun bakım ünitemizde takip ettiğimiz yenidoğanlar arasında nekrotizan enterokolit risk faktörlerini belirlemektir. Ocak 2008 - Aralık 2012 tarihleri arasında takip edilen ve nekrotizan enterokolit saptanan 198 yenidoğan Grup 1 olarak belirlendi. Bunlardan 66 yenidoğan şüpheli nekrotizan enterokolit (Grup 1a) ve 132 yenidoğan kesin nekrotizan enterokolit (Grup 1b) olarak ikiye ayrıldı. Nekrotizan enterokolit gelişmeyen 99 olgu kontrol grubu (Grup 2) olarak tanımlandı. Nekrotizan enterokolit insidansı %9,7 olarak saptandı. Nekrotizan enterokolit mortalitesi %6,8 tespit edildi. Çalışmamız sonucunda yapılan istatistiksel analizde Grup 1 ve Grup 2 olgular incelendiğinde nekrotizan enterokolit için bağımsız risk faktörleri sırasıyla preeklampsi gelişimi, Doppler kan akım bozukluğu, hipotermi atağı geçirme, hipomagnezemi gelişimi ve anemi varlığı olarak belirlendi. Grup 1b ve Grup 2 olgular incelendiğinde kesin nekrotizan enterokolit için bağımsız risk faktörleri düşük doğum tartısı, Doppler kan akım bozukluğu, mekanik ventilasyonda kalma, hipotermi atağı geçirme, hipomagnezemi gelişimi ve anemi varlığı olarak saptandı. Grup 1a ile Grup 1b olgular incelendiğinde kesin nekrotizan enterokolit için bağımsız risk faktörleri sırasıyla nekrotizan enterokolit gelişiminden 48 saat önce kan transfüzyonu almış olma, anemi varlığı ve O2 tedavisi almış olma olarak tespit edildi.Sonuç olarak çalışmamızda bulunan risk faktörleri NEK ile ilgili yapılan diğer çalışmalarda bulunan risk faktörleri ile uyumludur. Çalışmada bulunan bu risk faktörlerine yönelik olarak anemi, hipotermi ve hipomagnezemi gelişimini önlemek, O2 ve mekanik ventilatör tedavilerini mümkün olan en kısa sürede sonlandırmak, gereksiz kan transfüzyonlarından kaçınmak, Doppler kan akımı bozuk ve preeklamptik anne bebeklerinde daha dikkatli besleme yapmak NEK gelişimini önlemede faydalı olacaktır.
Abstract
Necrotizing enterocolitis is an important reason of mortality and morbidity especially for extremely low birth weight neonates. The incidence and risk factors vary between units. Determining the risk factors is important because pathogenesis and etiology of disease is not well explained. Our aim is to reveal the risk factors of necrotizing enterocolitis among the neonates followed up in our neonatal intensive care unit.One hundred and ninety-eight neonates with necrotizing enterocolitis, followed between January 2008 and December 2012, were defined as Group 1. Group 1 was divided into 2 subgroups; 66 infants with suspected necrotising enterocolitis infants (Group 1a) and 132 definite necrotizing enterocolitis infants (Group 1b). Ninety-nine infants without necrotizing enterocolitis was defined as control group (Group 2). The incidence and mortality of necrotizing enterocolitis was found as 9.7% and 6.8%, respectively. Multivariate analysis revealed that when infants with necrotizing enterocolitis and those without were compared, the independent risk factors for the development of necrotizing enterocolitis were found to be preeclampsia, abnormal Doppler blood flow, episodes of hypothermia, development of hypomagnesemia and anemia. When Group 1b and 2 examined, the independent risk factors for definite necrotizing enterocolitis was found as low birth weight, abnormal Doppler blood flow, having mechanical ventilation, episodes of hypothermia, development of hypomagnesemia and anemia. When Group 1a and 1b examined, the independent risk factors for definite necrotizing enterocolitis was found as having blood transfusion which was given 48 hours before the development of necrotizing enterocolitis, presence of anemia and having received O2 theraphy.In conclusion, risk factors found in our study are compatible with the risk factors associated with NEC in other studies. Preventing development of anemia, hypothermia and hypomagnesemia, ending O2 and mechanical ventilation therapy as soon as possible, avoiding unnecessary blood transfusions and feeding the babies of mothers with abnormal Doppler blood flow and preeclampsia more carefully would be benefical in preventing the development of NEC.
Abstract
Necrotizing enterocolitis is an important reason of mortality and morbidity especially for extremely low birth weight neonates. The incidence and risk factors vary between units. Determining the risk factors is important because pathogenesis and etiology of disease is not well explained. Our aim is to reveal the risk factors of necrotizing enterocolitis among the neonates followed up in our neonatal intensive care unit.One hundred and ninety-eight neonates with necrotizing enterocolitis, followed between January 2008 and December 2012, were defined as Group 1. Group 1 was divided into 2 subgroups; 66 infants with suspected necrotising enterocolitis infants (Group 1a) and 132 definite necrotizing enterocolitis infants (Group 1b). Ninety-nine infants without necrotizing enterocolitis was defined as control group (Group 2). The incidence and mortality of necrotizing enterocolitis was found as 9.7% and 6.8%, respectively. Multivariate analysis revealed that when infants with necrotizing enterocolitis and those without were compared, the independent risk factors for the development of necrotizing enterocolitis were found to be preeclampsia, abnormal Doppler blood flow, episodes of hypothermia, development of hypomagnesemia and anemia. When Group 1b and 2 examined, the independent risk factors for definite necrotizing enterocolitis was found as low birth weight, abnormal Doppler blood flow, having mechanical ventilation, episodes of hypothermia, development of hypomagnesemia and anemia. When Group 1a and 1b examined, the independent risk factors for definite necrotizing enterocolitis was found as having blood transfusion which was given 48 hours before the development of necrotizing enterocolitis, presence of anemia and having received O2 theraphy.In conclusion, risk factors found in our study are compatible with the risk factors associated with NEC in other studies. Preventing development of anemia, hypothermia and hypomagnesemia, ending O2 and mechanical ventilation therapy as soon as possible, avoiding unnecessary blood transfusions and feeding the babies of mothers with abnormal Doppler blood flow and preeclampsia more carefully would be benefical in preventing the development of NEC.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Nekrozitan Enterokolit, Prematüre Yenidoğan, Risk Faktörleri, Necrotizing Enterocolitis, Premature Neonates, Risk Factors
