Merih ÇETİNKAYA, Nilgün KÖKSAL, Şenay YAPICI, Ali ÖZBOYACI, Evren ÖZBOYACI, Hilal ÖZKAN

Nekrotizan enterokolitli prematüre bebeklerin değerlendirilmesi

Giriş: Bu çalışmanın amacı yenidoğan yoğun bakım ünitesinde nekrotizan enterokolit (NEK) ile izlenmiş olan prematüre bebeklerin karakteristik özellikleriyle kısa ve uzun dönem sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya Ocak 2005 ile Aralık 2009 yılları arasında yenidoğan yoğun bakım ünitemizde yatarak takip edilen gestasyon yaşı ≤34 hafta olan ve NEK tanısı alan 50 prematüre bebek alındı ve bu bebeklerin karakteristik özellikleri, klinik ve laboratuvar bulguları ve prognozları değerlendirildi. Bulgular: Çalışmaya alınan prematüre bebeklerin 15’inde (%30) evre 1, 21 (%42) tanesinde evre 2 ve 14 (%28) tanesinde evre 3 NEK mevcuttu. NEK insidansı %7,5 (50/658) idi. NEK gelişen bebeklerin ortalama gestasyon yaşlarının ve doğum ağırlıklarının, sırasıyla 29±2,2 hafta ve 1142±300 gram olduğu görüldü. Ortalama NEK başlangıç zamanı 18,5±8,1 gün idi. Olguların %64’ünde hipoksik doğum öyküsünün olduğu saptandı ve anne sütü ile beslenme oranı %54 olarak bulundu. NEK’li olguların %36’sında kan kültüründe üreme tespit edildi. Evre 3 NEK olan 8 olguda cerrahi tedavi uygulanırken diğer olgular medikal tedaviye cevap verdi. Mortalite oranı %12 olarak bulundu ve yaşayan bebeklerde kısa ve uzun dönem en sık sorunların sırası ile beslenme problemleri ve malabsorbsiyon olduğu görüldü. Sonuç: NEK prematüre bebeklerde görülen en ciddi sorunlardan biridir. Yenidoğan yoğun bakımındaki gelişmelerle mortalitesi ve sıklığı azaltılabilmiştir. Etyolojide yer alan en önemli faktörler prematürite, hipoksi ve enteral beslenmedir. (Güncel Pediatri 2010; 8: 56-62)

Evaluation of premature newborns with necrotizing enterocolitis

Introduction: The aim of this study was to evaluate the characteristic features and both early and late term prognosis of premature infants who were followed-up with NEC in the neonatal intensive care unit. Materials and Method: A total of 50 premature infants less than 34 gestational weeks with NEC between January 2005 and December 2009 were included to this study and the characteristic features, clinical and laboratory findings, and prognosis of these infants were evaluated. Results: In this study, 15 infants (30%) had stage 1, 21 infants (42%) had stage 2 and 14 infants (28%) had stage 3 NEC. The incidence of NEC was 7.5% (20/568). The mean gestational age and birth weight of infants who developed NEC were 29±2.2 weeks and 1142±300 grams, respectively. The mean onset of NEC was 18.5±8.1 days. There was hypoxic birth history in 64% of infants and the ratio of breastfed infants was 54%. There was a positive blood culture in 36% of infants with NEC. Surgery was performed in 8 infants with stage 3 NEC, whereas the other infants responded well to medical treatment. The mortality rate was 12% and feeding problems and malabsorption were found to be the most common early and late term problems in infants who survived. Conclusions: NEC is one of the serious problems in premature infants. The mortality and frequency of NEC was decreased with the improvements in the Neonatal Intensive Care. The most important etiological factors were prematurity, hypoxia and enteral feeding. (Journal of Current Pediatrics 2010; 8: 56-62)

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