Davut BOZKAYA, Atakan ATALAY, Sabriye KORKUT, Cüneyt TAYMAN, İrfan TAŞOĞLU

Medikal Tedaviye Yanıtsız Duktus Arteriosuslu Preterm İnfantların Tedavisinde Güvenli Bir Yöntem: Yatakbaşı Cerrahi ligasyon

Giriş:Pretrematüre bebeklerde, özellikle çok düşük doğum ağırlıklı (ÇDDA) olanlarda bakım kalitesinin iyileşmesi sonucu sağ kalım oranlarının artması, prematürite ilişkili morbiditelerde de artışa neden olmuştur. Bu morbiditelerden biri olan patent duktus arteriozus (PDA) ve ilişkili komplikasyonların (konjestif kalp yetmezliği, bronkopulmoner displazi, nekrotizan enterokolit, intrakranial kanama ve ölüm gibi) uygun yönetimi, kısa ve uzun dönem sonuçların iyileştirilmesi için çok önemlidir. Bu nedenle hemodinamik anlamlı PDA’nın (HAPDA) zamanında ve etkin bir şekilde tedavi edilmesi önem kazanmaktadır. Amaç: Bu çalışmada, HAPDA tanısıyla uygulanan medikal kapatma tedavisine cevapsızlık sonrası yatakbaşı cerrahi PDA ligasyon yapılan prematüre bebeklerin sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır.Metaryal ve MetodBu retrospektif çalışmada, yenidoğan yoğun bakım ünitesinde (YYBÜ) HAPDA tanısıyla yatakbaşı cerrahi PDA ligasyonu uygulanan bebeklerin sonuçları retrospektif olarak değerlendirildi. Çalışmaya 84 prematüre bebek dahil edildi. Demografik özellikler, ameliyat öncesi ve sonrası solunum desteğinin tipi ve süresi, intraventriküler kanama ve bronkopulmoner displazi oranları, hastanede kalış süresi ve mortalite verileri analiz edildi. BulgularÇalışmaya 84 premature infant dahil edildi. HAPDA tanısıyla 61 (% 72.6) infantta medikal tedaviyle kapatma, 23 (%27,4) infantta ise cerrahi ligasyon uygulandı. Ameliyat edilme yaşı ortanca 35 (25-46) gün, ameliyat gününde ortanca vücut ağırlığı 1150 gr (870-1100 gr) idi. Cerrahi ligasyon uygulanan grupta, uygulamadan yaklaşık 60 gün sonra bir bebek (% 4,3) kaybedilirken (sendromik infant), 22 bebek taburcu edilebildi. Ligasyon ihtiyacı olan bebeklerin solunum destek, oksijen kesilme ve taburculuk süreleri medikal tedaviye yanıt veren bebeklere göre istatiksel olarak anlamlı uzun olduğu görüldü (p<0.001). Yatakbaşı cerrahi ligasyonu yapılan bebeklerde izlemde cerrahiye bağlı komplikasyon izlenmedi. Sonuç:

Anahtar Kelimeler:

premature, PDA, yatakbaşı cerrahi ligasyon

Medikal Tedaviye Yanıtsız Duktus Arteriosuslu Preterm İnfantların Tedavisinde Güvenli Bir Yöntem: Yatakbaşı Cerrahi ligasyon

The appropriate management of patent ductus arteriosus (PDA) and associated complications (such as congestive heart failure, bronchopulmonary dysplasia, necrotizing enterocolitis, intracranial hemorrhage and death), which is one of these morbidities, is very important for the improvement of short and long-term results.AimThe aim of this study was to retrospectively evaluate the results of premature infants who underwent bedside surgery PDA ligation after a non-responding medical closure therapy.MethodsIn this retrospective study, the results of babies who underwent bedside surgical PDA ligation with the diagnosis of HAPDA in the neonatal intensive care unit (NICU) were evaluated retrospectively. 84 premature babies were included in the study. Demographic characteristics, type and duration of pre- and postoperative respiratory support, intraventricular hemorrhage and bronchopulmonary dysplasia rates, hospital stay duration and mortality data were analyzed.Results 84 premature infants were included in the study. In 61 infants (72.6%) closure with medical treatment and surgical ligation in 23 infants (27.4%) were performed with the diagnosis of HAPDA. The median operating age was 35 (25-46) days and the median body weight on the day of surgery was 1150 g (870-1100 g). In the group undergoing surgical ligation, a baby (4.3%) was lost about 60 days after the administration, while 22 infants could be discharged. Respiratory support, oxygen withdrawal and discharge time of the babies who needed ligation were statistically significantly longer than those responding to medical treatment (p <0.001). No complication related to surgery was observed in infants who underwent bed ligand surgery.ConclusionsThe prolonged patency of the ductus arteriosus in preterm infants is related to an increased morbidity. Bedside PDA ligation in NICUs where there is no pediatric cardiovascular surgery team should be kept in mind as an alternative safe method to reduce PDA-related morbidity and mortality by preventing delay in treatment in patients who do not respond to medical treatment.

Keywords:

premature, PDA,

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