Yenidoğan yoğun bakım ünitesinde izlenen geç preterm bebeklerin maternal risk faktörlerine bağlı morbiditelerinin değerlendirilmesi

Amaç: Bu çalışmada, geç preterm bebeklerde maternal risk faktörleri ve bu faktörlerin morbidite ve mortaliteye etkisinin belirlenmesi amaçlandı. Gereç ve Yöntemler: Bu çalışmaya, retrospektif olarak, 1 Ocak 2012 ile 30 Haziran 2015 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi Hastanesi’nde doğan ve Yenidoğan Yoğun Bakım Ünitesi’ne yatırılan gebelik haftası 340/7-366/7 olan 242 geç preterm bebek alındı. Çoklu konjenital anomalisi, kromozom anomalisi olan ve dış merkezde doğup hastanemize yatırılan bebekler çalışma dışı bırakıldı. Her bebeğin doğum bilgileri ve maternal risk faktörleri hastanemiz veri tabanı kullanılarak neonatal veri toplama formlarına kaydedildi. Bulgular ve Sonuç: Tüm gebelik haftalarında en sık görülen morbiditeler; beslenme intoleransı (% 70.2), hiperbilirübinemi (% 43.0), yenidoğanın geçici takipnesi (% 40.0), hipoglisemi (% 16.9), respiratuvar distres sendromu (% 15.7) ve geç neonatal sepsis (% 13.7) olarak saptandı. Ablasyo plasentalı annelerin bebeklerinde respiratuvar distres sendromu (p=0.045), oligohidramniyozlu annelerin bebeklerinde yenidoğanın geçici takipnesi (p=0.04), gestasyonel diyabetes mellitusu olan annelerin bebeklerinde polisitemi (p=0.01) ve plasenta previası olan annelerin bebeklerinde hipoglisemi (p=0.04) anlamlı olarak fazla saptandı. Çalışmamızda 34.gestasyon haftasında doğan bebeklerde, geç preterm grubunun diğer gebelik haftalarına göre daha çok morbidite saptandı (p=0.01). Özellikle respiratuvar distres sendromu ve beslenme intoleransı 34.gestasyon haftasında doğan bebeklerde diğer gebelik haftasında doğan bebeklere göre istatistiksel olarak anlamlı şekilde daha fazla görüldü (p=0.002). Annede preeklampsi, plasenta previa, ablasyo plasenta, oligohidramniyoz ve gestasyonel diyabetes mellitus olmasının morbiditeyi artırdığı belirlendi. Geç preterm bebeklerde mortalite ve morbiditeyi etkileyen maternal risk faktörlerinin bilinmesi ortaya çıkabilecek problemlerin erken belirlenmesi ve önlenmesini sağlayacaktır.

Anahtar Kelimeler:

geç preterm, morbidite, maternal hastalıklar

Evaluation of the morbidity of late preterm infants followed in the neonatal intensive care unit due to maternal risk factor

Objective:.The aim of this study was to determine maternal risk factors and the effect of these factors on morbidity and mortalityin late preterm infants. Materials and method: In this retrospective study, the 242 late preterm babies who were born between 34 0/7 - 36 6/7weeks of gestation, between January 1, 2012 and June 30, 2015 at Başkent University Faculty of Medicine Hospital and hospitalized in the neonatal intensive care unit were included. Babies born at the outside center and hospitalized to our hospital with multiple congenital anomalies, chromosomal abnormalities were excluded from the study. Birth data and maternal risk factors for each neonate were recorded in neonatal data collection forms using the database of our hospital. Results and conclusion: The most common morbidity were identified as feding intolerance (70.2 %), hyperbilirubinemia (43.0 %), transient tachypnea of the newborn (40.0 %), hypoglycemia (16.9 %), respiratory distress syndrome (15.7 %) and late neonatal sepsis (13.7 %). Respiratory distress syndrome in infants of mothers with ablation placenta (p=0.045), transient tachypnea of the newborn in infants of mothers with oligohydramniosis (p=0.04), hypoglycemia in infants of mothers with gestational diabetes mellitus (p=0.01) and hypoglycemia in mothers with placenta previa (p=0.04) were seen significantly higher. In our study, morbidity was found in infants born at 34 weeks of gestation compared to other gestational weeks of late preterm group (p=0.01). Especially respiratory distress syndrome and feeding intolerance were statistically significantly higher in babies born at the 34 gestational week compared to babies born at the other week of gestation (p=0.002). It was determined that preeclampsia, placenta previa, ablation placenta, oligohydramniosis and gestational diabetes mellitus in mother increased to morbidity. Knowing the maternal risk factors affecting mortality and morbidity in late preterm infants will enable early detection and prevention of possible problems

Keywords:

late preterm, morbidity, maternal diseases,

PDF

___

Referans1 Raju TNK, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome forl ate-preterm (near-term) infants: a summary of the workshop sponsored by the NICHD. Pediatrics 2006;118:1207-14
Referans2 Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors fo rneonatal morbidity and mortality among ‘healthy’ late preterm newborns. Semin Perinatol 2006; 30: 54-60
Referans3 Atasay B, Okulu E, Akın Mungan İ, Çandır O, Arsan S, Türmen T. The Early Clinical Outcomes of Late Preterm Newborns 2010; 4(1): 30-35
Referans4 Jenkins AW. Near-term but still a preemie. AWHONN Lifelines 2005; 9(4): 295-7
Referans5 Wang ML, Dorer DJ, Fleming MP et al. Clinical outcomes of near-term infants. Pediatrics 2004; 114: 372-6
Referans6 Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol 2005;25(4):251-7
Referans7 Escobar GJ, Greene JD, Hulac P, Kincannon E, Bischoff K, Gardner MN et al. Rehospitalisation after birth hospitalization: pattern samong infants of all gestations. Arch Dis Child 2005; 90: 125-31
Referans8 Lubow JM, How HY, Habli M, Maxwell R, Sibai BM. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol 2009; 200: e30-3
Referans9 Sohl B, Moore TR. Abnormalities of fetal growth. In: Avery’s Diseases of the Newborn, Seventh Edition, Eds. Taeusch HW, Ballard RA, WB Saunders Company, Philedelphia, 1998, USA, s. 90-101
Referans10 Lewis DF, Futayyeh S, Towers CV, Asrat T, Edwards MS, Brooks GC. Preterm delivery from 34 to 37 weeks of gestation: Is respiratory distress syndrome a problem? Am J Obstet Gynecol. 1996;174: 525-528
Referans11 Vignoles P, Gire C, Mancini J, Bretelle F, Boubli L, Janky E, Carcopino X. Gestational diabetes: a strong in dependent risk factor for severe neonata lrespiratory failure after 34 weeks. Arch Gynecol Obstet 2011;284: 1099-1104
Referans12 Chadakarn P, Sumonmal M, Payon B. Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission. J of Obstetand Gynaecol Res2015;41:680-688
Referans13 Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3’-untranslated region of th eprothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 1996; 88:3698-3703.
Referans14 Zöller B, Svensson P, He X et al. Identification of the same factor V gene mutation in 47 out of 50 thrombosis-prone families within herited resistance to activated protein. Can J ClinInvest 1994;94:2521-2524
Referans15 Crowle MA. Neonatal respiratory disorders. In: Martin RJ, Fanaroff AA, Walsh MC (eds). Fanaroff and Martin’sNeonatal-Perinatal Medicine (10th ed) Volume 2. Philadelphia: Elsevier Saunders, 2015: 1113-1136.
Referans16 Whitsett JA, Rice WR, Warner BB, Wert SE, Pryhuber GS. Acute Respiratory Disorders. In: Avery‟sNeonatology, 6 th Edition, Eds. MacDonald MG, Mullet MD, Seshia MMK, Lipincott Williams andWilkins, Philadelphia, 2005, USA s. 569-576
Referans 17 Adamkin DH. Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127: 575-579
Referans18 American Academy of Pediatrics, Clinical Practice Guideline, Subcommittee on Hyperbilirubinemia. Management of thenewborn 35 ormoreweeks of gestation. Pediatrics 2004; 114: 297-316.
Referans19 Türk Neonatoloji Derneği Tanı ve Tedavi Protokolleri No. 1. Türk Neonatoloji Derneği Bülteni. Sayı: 6 – Güz 2002.
Referans20 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on stagingcriteria. Pediatr Clin North Am 1986; 33: 179-201.15
Referans21 Akisu M, Kumral A, Canpolat FE. Turkish Neonatal Society Guideline on neonatal encephalopathy. Turk Pediatri Ars 2018; 53(Suppl 1): S32-S44
Referans22 Binarbaşı P, Akın Y, Narter F, Telatar B, Polatoğlu E, Ağzıkuru T. Geç preterm yenidoğanlarda hastalık ve ölüm oranları. Türk Ped Arş 2013; 48: 17-22
Referans23 Karataş A, Albayrak M, Keskin F, Bıyık İ, Okur M, Güneş C ve ark. Geç preterm doğum olgularında erken neonatal sonuçlar. Türk Jinekoloji ve Obstretrik Derneği Dergisi 2013;10:165-72
Referans24 Chadakarn P, Sumonmal M, Payon B. Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission. J of Obstet and Gynaecol Res 2015;41:680-688
Referans25 Margaret C, Elly X, Alan H, Donald D. Neonatal intensive care unit admissions and the irassociations with late preterm birth and maternal risk factors in a population based study. J Matern Fetal and Neonatal Med 2012;25(4): 343-345
Referans26 Mateus J, Fox K, Jain S, Latta R, Cohen J. Preterm premature rupture of membranes: Clinical outcomes of late preterm infants. Clin Pediatr 2010;49(1): 60-65
Referans27 Van der Ham DP, Van der Heyden JL, Opmeer BC. Management of late preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet and Gynecol 2012; 207: 1-10
Referans28 Lewis DF, Futayyeh S, Towers CV, Asrat T, Edwards MS, Brooks GC. Preterm delivery from 34 to 37 weeks of gestation: Is respiratory distress syndrome a problem? Am J Obstet Gynecol 1996;174:525-528
Referans29 Arnon S, Dolfin T, Litmanovitz I, Regev R, Bauer S, Fejgin M. Pretermlabour at 34-36 weeks of gestation: should it be arrested? Paediatr Perinat Epidemiol. 2001;15: 252-256
Referans30 Langenveld J, Anita C, Ravelli J et al. Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 36 weeks of gestation: a 7 year retrospective analysis of national registry. Am J ObstetGynecol 2011;205:1-7
Referans31 Habli M, Levine RJ, Qian C et al. Neonatal outcome in pregnancies with preeclampsia or gestational hypertension and in normotensive pregnancies that delivered at 35, 36 or 37 weeks of gestation. Am J Obstet Gynecol 2007; 406:1-7
Referans32 Marwah GS, O’Brien J, Gewolb JH. Effect of acute glucose depletion following glucose excess on surfactant phospholipid synthesis in developing fetal lung 1999; 25: 291-302
Referans33 Chitayat L, Jovanovic L, Hod M. New modalities in the treatment of pregnancies complicated by diabetes: drugs and devices. Sem Fetal Neonat Med 2009;1472-76
Referans34 Hawkins JS, Casey BM, Lo JY, Moss K, McIntire DD, Leveno KJ. Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Obstet Gyn 2009; 113: 1307-1312
Referans35 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet andGynecol 2008;111:35-41
Referans36 Young PC, Glasgow TS, Li X, Guest-Warnick G, Stoddard G. Mortality of late preterm (near-term) newborns in Utah. Pediatrics 2007;119:659-665