Ferda ÖZLÜ, Hacer YAPİCİOGLU, Kenan OZCAN, Nejat NARLI, Mehmet SATAR

Ventrikülit Tanısı Alan Yenidoğan Bebeklerin Değerlendirilmesi

Giriş: Neonatal menenjit ve ventrikülit, sistemik ve intraventriküler antibiotik tedavilerine rağmen hala yüksek mortalite oranlarına sahip problemlerdir. Preterm infantlarda posthemorajik hidrosefali ciddi bir problem olmakla beraber tekaralanan ventriküler girişimlerde ventrikülit oluşumuna neden olmaktadır. Materyal ve Metod: Çalışmamızda Çukurova Üniversitesi Tıp Fakültesi yeni doğan yoğun bakım ünitesinde Ocak 1999-Aralık 2004 tarihleri arasında takip edilen ve ventrikülit tanısı konulmuş 16 yenidoğan değerlendirilmiştir. Bulgular:Ortalama gebelik haftası 33±5 (25-40) hafta ve ortalama doğum ağırlığı ise 2090±912 (980-3500) gramdı. Ventrikülit tanısı yaklaşık 38±22. günlerde konuldu. 11 infantta intraventriküler hemoraj ve 15 infantta hidrosefali vardı ki bunların 5 tanesi konjenital hidrosefalidir. 13 infantta serebrospinal sıvı (BOS) taps ile drene edildi. Kültürü yapılan sıvıda GR(-) bakteriler (klebsiella pnömoni, Pseudomonas auroginasa) baskın olarak bulundu. BOS kültür sonuçlarına göre intraventriküler ve intravenöz tedavi yöntemi uygulandı. 28±17 gün intraventriküler olarak vankomisin ve amikasin tedavisi uygulandı. İntraventriküler tedavi sırasında 8 infanta ait BOS proteinleri seviyelerinde artışlar görülmüştür. İntraventriküler tedaviye başlarken BOS protein miktarı ortalama 624,1±429,1 (109-1330) mg/dl iken tedavinin 14. günü bu oran 993,7±582,2 (89-1750) mg/dl olmuştur. Ventriküloperitoneal şantı olan 7 infanttan 6 sında enfeksiyon tekrarı gözlenmiştir. İnfantların 7 si tedavi sırasında yaşamını yitirmiştir, ventriküloperitoneal şantı olan 1 infant tedavi edilirken, ailesi tedaviyi reddeden 8 infant taburcu edilmiştir. Sonuç: Yeni tedavi metodlarının geliştirilmesine rağmen, ventrikülit neonatal bakımda belirli bir standardizasyon olmamasında ötürü halen önemli bir problemdir.

Anahtar Kelimeler:

Ventrikülit, neonatal

Evaluation of Neonates with Ventriculitis

Backgroud: Neonatal meningitis and ventriculitis still remain a problem with high mortality in spite of systemic and intraventricular antibiotics. Ventriculitis due to repeated taps is a serious problem of posthemorragic hydrocephalus in preterm infants. Methods: In this study, we evaluated 16 infants with ventriculitis followed at Cukurova University Faculty of Medicine Neonatal Intensive Care Unit between January 1999-December 2004. Results: Mean gestational week was 33± 5 (25-40) weeks and mean birth weight was 2096 ± 912 (980-3500) grams. Venticulitis was diagnosed at 38 ± 22 days. Eleven of the infants had intraventricular hemorrhage and 15 had hydrocephalus, 5 of whom had congenital hydrocephalus. Drainage of CSF was performed by taps in 13 infants. Gram negative microorganisms (Klebsiella pneumonia, Pseudomonas aeruginosa) were predominating in cultures. Both intravenous and intraventricular antibiotic treatment was performed according to the cerebrospinal fluid cultures. Vancomycine and amicasine as intraventricular therapy were performed for 28 ±17 days. Cerebrospinal fluid protein levels increased significantly at 8 infant during intraventricular therapy. Mean cerebrospinal fluid protein at the begining of intraventricular treatment was 624.1± 429.1 (109-1330) mg/dl while on 14th day of treatment it was 993.7± 582.2 (89-1750) mg/dl. Seven of the infants were ventriculoperitoneal shunted 6 of them were reinfected. Seven of the infants were died during treatment, 1 infant with ventriculoperitoneal shunt was treated and 8 infants were discharged during treatment because of parents" refusal of therapy. Conclusion: Despite the new treatment regimens, the ventriculitis still remains a problem because of nonstandardized practice in neonatal care.

Keywords:

ventricülitis, neonate,

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Yazışma Adresi / Address for Correspondence: Dr. Dr Ferda Ozlu Cukurova University Faculty of Medicine, Neonatology Department, 01330 Balcalı-ADANA e-mail: fozlu@cu.edu.tr geliş tarihi/received :07.03.2013 kabul tarihi/accepted:15.04.2013