Derya KARPUZ, Yalçın ÇELİK, Gülçin BOZLU, Baki KARA, Dilek GİRAY, Olgu HALLIOĞLU

Patent duktus arteriozuslu bebeklerde konservatif tedavinin sonuçları

Amaç: Bu çalışmada hastanemizde izlenen prematürelerde gebelik haftasına göre patent duktus arteriosus (PDA) sıklığının, kendiliğinden kapanma oranlarının ve kapanmayanlarda oral tedavi etkinliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Yenidoğan yoğun bakım ünitemizde 2013-2016 yılları arasında PDA tanısıyla izlenen hastalar retrospektif olarak tarandı. Kardiyak incelemede yalnızca PDA tanısı konulan 231 hasta, gebelik haftasına göre gruplara ayrılarak ekokardiyografik ölçümleri karşılaştırıldı. Ekokardiyografik değerlendirme doğumdan sonra ortalama 4.6±15 günlük iken uygulandı. Hastaların demografik verilerin yanı sıra PDA boyutu, sol atrium/aorta oranı, PDA gradienti, sol ventrikül fonksiyonları değerlendirildi. Bulgular: Yenidoğan yoğun bakım ünitemize izlenen hastalar arasında PDA sıklığı %10,8 (231/2127 hasta) idi. Hastaların 41’inde (%17.7) anlamlı PDA vardı, bu hastalarda duktus çapı ortalamaları 2.5±0.5 ve sol atrium/aorta oranı 1.37±0.15 bulundu. Kapanma olmayan ve hemodinamik olarak anlamlı PDA’sı olan 8 (%19.5) hastaya oral ibuprofen verildi. Kapatma verilen hastaların tümünün gestasyonel yaşı <32 hafta ve <1500gr idi. Yalnızca bir hastada cerrahi kapatma gerekti. Sonuç: Günümüzde preterm bebeklerde hangi bebeğe ve ne zaman PDA kapatma tedavisi verilmesi gerektiği önemli bir tartışma konusudur. Yenidoğan yoğun bakım ünitesinde PDA’sı olan prematüre bebeklere konservatif yaklaşım uygulanmaktadır ve sonuçlarımıza bakıldığında konservatif yaklaşımla sadece bir hastada cerrahi gereksinim olmuştur. Buna göre PDA’sı olan prematüre bebeklerde tedavi kararı verirken acele edilmemesi ve yakın izlemin yapılmasını önerebiliriz.

Anahtar Kelimeler:

Ekokardiyografi, Patent Duktus Arteriozus

Outcomes of conservative treatment in infants with patent ductus arteriosus

Purpose: The aim of this study is to investigate frequency of patent ductus arteriosus (PDA) according to gestational week, spontaneous closure rate and effectiveness of oral treatment in closure in premature infants.Materials and Methods: Patients who had only PDA in neonatal intensive care unit in 2013-2016 were retrospectively screened and 231 patients included in the study. The demographic data of the patients were recorded and they were divided into groups according to gestational week; size and gradient of PDA. Left atrium/aorta ratio and left ventricular functions were evaluated echocardiographically in 4.6±1.5th day of birth.Results: The frequency of PDA in our neonatal intensive care unit was 10.8% (231/2127 patients). Significant PDA was present in 41(17.7%) of patients, mean diameter of ductus was 2.5±0.5 and the left atrium/aorta ratio was 1.37±0.15 in these patients. Ibuprofen (po) was given to 8(19.5%) of the patients having hemodynamically significant PDA. All of the patients given medical closure treatment were <32 weeks of gestation and <1500g. Surgical closure was required in only one patient. Conclusion: It is still controversial that PDA closure treatment should be given when and to which preterm infants. As only one of the patients needed surgery with the conservative approach, we suggest that treatment decision should not be given early in premature infants with PDA and they should be closely monitored.

Keywords:

Echocardiography Patent Ductus Arteriozus, Prematurity,

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