MERVAN BEKDAŞ, Sevil GÖKSÜGÜR BİLİR, Beyhan KÜÇÜKBAYRAK, Ayhan EKİCİ

Düşük doğum ağırlıklı bebeklerde morbidite ve mortaliteyi etkileyen faktörler

Amaç: Hastanemizde doğan düşük doğum ağırlıklı bebeklerdeki kısa dönem morbidite ve mortalite sıklığını ve bunları etkileyen faktörleri incelemek. Yöntemler: 18 aylık dönem içinde hastanemizde doğan düşük doğum ağırlıklı 195 bebek ve aynı dönem içinde normal doğum ağırlıklı doğan 150 bebek kontrol grubu olarak seçildi. Bulgular: Söz konusu süre içinde hastanemizde doğan bebeklerin %4,4ü (n=168) düşük doğum ağırlıklı, %0,7si (n=27) çok düşük doğum ağırlıklı idi. Bu bebeklerde kontrol grubuna kıyasla çoğul gebelik ve asfiktik doğum anlamlı oranda yüksekti (sırasıyla p=0,029, p=0,011). Çok düşük doğum ağırlıklı bebeklerde asfiktik doğum (OR=14,2, 95% CI (6,6-30,7, p

The factors affecting morbidity and mortality in low birth-weight infants

Objective: To investigate the frequency of short term morbidity and mortality and the factors affecting them for the infants born with low birth-weight at our hospital Methods: At our hospital, 195 infants born with low birthweight within a period of 18 months were identified and 150 infants born with normal birth-weights were selected as the control group. Results: Within the mentioned period of time, 4.4% (n=168) of the infants born in our hospital had low birthweight, 0.7% (n=27) had very low birth-weight (VLBW). Multiple pregnancies and asphyxiating birth rates were significantly high in these infants as compared to the control group. (p=0.029, p=0.011, respectively). For VLBW infants, the rates of asphyxiating birth (OR=14.2, 95% CI (6.6-30.7, p<0.001), hospitalization at the neonatal intensive care unit (OR=34.8, 95% CI (4.7-256.3, p<0,001) and diagnosis of respiratory distress syndrome (OR=11.5, 95% CI (4-33.5, p<0.001) were significantly high. In all infants, the transient metabolic disorders were identified at a significantly high rate (p=0.045). The birth-weight and gestational age of infants were inversely correlated with their fetal and neonatal mortalities (for all p<0.001). Conclusion: This study demonstrated that the most important factor affecting infants was multiple pregnancies. The birth-weight and gestational age of infants were inversely correlated with their morbidity and mortality rates.

PDF

___

1. Manning FA, Hohler C. Intrauterine growth retardation: diagnosis, prognostication, and management based on ultrasound methods, in Fleisher AÇ, Romero R, Manning FA, et al (eds): The principles and practices and ultrasonography, 4th. Ed. Norwalk, CT Appleton and Lange. 1991:331.
2. Joseph KS. Theory in obstetrics: an epidemiologic framework for justifying indicated early delivery. BMC Pregnancy Childbirth 2007;7:1-15.
3. Eichenwald EC. Care of the extremely low-birth-weight ınfant. In: Taeusch HW, Ballard RA, Gleason CA (eds). Averys Diseases of the Newborn. 8th ed. Philadelphia: Saunders, 2005:410-426.
4. Creasy RK, Iams JD. Preterm labor and delivery. In: Creasy RK, Resnik R (eds). Maternal-Fetal Medicine. 4th ed. Philedelphia: Saunders, 1999:498-531
5. Horbar J, Badger G, Carpanter J. Trends in mortality and morbidity for very low birth weight infants 1991-1999. Pediatrics 2002;110:143-151.
6. Gülcan H, Üzüm İ, Aslan S, et al. Outcome of very low birth weight infants in neonatal intensive care unit of İnönü University Faculty of Medicine. J Inonu Fac Med 2004;11:19- 23.
7. Armangil D, Yiğit Ş, Tekinalp G, et al. The effect of antenatal corticosteroids on neonatal mortality and morbidity. Çocuk Sağlığı ve Hastalıkları Derg 2007;50:79-90.
8. Thornberg E, Thiringer K, Odeback A, et al. Birth asphyxia: Incidence, clinical course and outcome in a Swedish population. Acta Paediatr 1995;84:927932.
9. Nobile CG, Raffaele G, Altomare C, et al. Influence of maternal and social factors as predictors of low birth weight in Italy. BMC Public Health 2007;7:192-195.
10. Verrier M, Spears W, Ying J, et al. Patterns of birth weight in relation to gestational age, maternal age, parity, and prenatal care in Texas triethnic population, 1984 through 1986. Tex Med 1993;89:51-56.
11. Kuo CP, Lee SH, Wu WY. Birth outcomes and risk factors in adolescent pregnancies: Results of a Taiwanese national survey. Pediatrics Intern 2010;52:447-452.
12. Gonik B. Creasy RK. Preterm labor: Its diagnosis and management. Am J Obstet Gynaecol 1986;154:3-9.
13. Yogev Y, Melamed N, Tenenbaum-Gavish K, et al. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010;203;1-7.
14. Turhan AH, Atıcı A, Özkan BA, et al. Outcomes of very low birth weight infants treated in neonatal intensive care unit of Mersin University. J Ist Faculty Med 2006;69:105-109.
15. Güvenal T, Çetin M, Mamik BA, et al. Evaluation of Perinatal Outcome of Small for Gestational Age Babies. CÜ Tıp Fakültesi Dergisi 2001;23:189-193.
16. Onyiriuka AN. Trends in incidence of delivery of low birth weight infants in Benin City, Southern Nigeria. Nig Postgrad Med J 2006;13:189-194.
17. Kul M, Saldır M, Gülgün M. Retrospective evaluation of low birth weight newborns followed up with the diagnosis of respiratory distress syndrome in the newborn intensive care unit. Gulhane Med J 2005;47:290-293.
18. Onyiriuka AN. Incidence of delivery of low birth weight infants in twin gestations. Nig J Clin Pract 2010;13:365-370.
19. Coutinho PR, Cecatti JG, Fernanda GS, et al. Perinatal outcomes associated with low birth weight in a historical cohort. Reproductive Health 2011;8:18-23.
20. Volpe JJ. Neurology of Newborn. 3th ed. WB Saunders Company, 1995;211-360.
21. Catlin EA, Carpenter MW, Brann BS, et al. The Apgar score revisited: influence of gestational age. J Pediatr 1986;109:865-868.
22. Wu YW, Backstrand KH, Zhao S, et al. Declining diagnosis of birth asphyxia in California: 19912000. Pediatrics 2004:114:1584-1590.
23. Katar S, Devecioğlu C. Outcome of very low birth weight infants in neonatal care unit of Dicle University Faculty of Medicine. Dicle Med J 2006;33:248-251.
24. Bellad MB, Srividhya K, Ranjit K, et al. Factors associated with perinatal mortality: a descriptive observational study. JSAFOG 2010;2:49-51.
25. www.neonatology.org.tr/images/NeonBulten17.pdf
26. Doyle LW, Bowman E. Davis P, et al. Preterm infants 30-36 weeks gestation in Victoria, where should they be delivered. Aust NZJ Obstet Gynecol 1998;38:298-300.
27. Siza JE. Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in northern Tanzania. Tanzania J Health Res 2008;10:1-8.
28. Whitsett JA, Pryhuber GS, Rice WR. Acute respiratory disorders. In: Avery GB, MacDonald MG (eds). Neonatology: Pathophysiology and Management of the Newborn, 5th ed. Philadelphia: Lippincott Williams&Wilkins, 1999:505- 515.
29. Bülbül A, Okan F, Şahin S. Mortality and morbidity of very low birth weight preterm infants: short-term outcomes. Turk Arch Ped 2008;43:94-98.
30. Stark AR, Franta ID. Respiratory distress syndrome. Pediatr Clin North Am 1986;33:533-543. 31. Avery GB, Fletcher M, MacDonald M. Neonatology. 4 th
edition. 1994 JB Lippincott Comp. Philadelphia. 1000- 1028.
32. Eicher DJ, Annibale DJ. Neonatal sepsis: evaluation and management. J S C Med Assoc 2002;98:106-112.
33. Erdem G, Erdoğan-Bakar E, Yiğit Ş, et al. Neurodevelopmental outcome of premature babies treated in Hacettepe University Hospital Neonatal Intensive Care Unit. Çocuk Sağlığı ve Hastalıkları Dergisi 2006;49:185-192.
34. Çiçek N, Vitrinel A, Cömert S, et al. Follow up results of premature infants. Turk Arch Ped 2005;40:33-38.
35. Atasay B, Günlemez A, Ünal S, et al. Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000.Turk J Pediatr 2003;45:283-289.