Yenidoğanda Ateş ve HipotermiyeYaklaşım
ÖzYenidoğanda rektal olarak ölçülen vücut sıcaklığının 38ºC ve üzerinde olması ateş olarak tanımlanır. Mekanizması tam belli olmamakla beraber, ateşin, ısı üretimi ve tüketimi arasındaki kompleks ilişkilerdeki bozukluktan kaynaklandığı düşünülmektedir.Yenidoğanda enfeksiyonlar veya enfeksiyon dışı birçok neden ateşe neden olabilir. Bu yaş grubunda ateşin en sık nedeni, viral enfeksiyonlardır. Bakteriyel patojenlerden ise,başta Escherichia coli olmak üzere diğer gram negatif patojenler en sık etkenlerdir. Ateşi olan tüm yenidoğanlar, genel durumları iyi olsa bile, hastaneye yatırılmalı ve enfeksiyon açısından değerlendirilmelidir. Ciddi bakteriyel enfeksiyon tanısını koymada (ilk 72 saatten sonra) CRP ve prokalsitoninin birlikte gönderilmesi daha değerlidir. Lökosit sayısının tek başına enfeksiyonu belirlemedeki duyarlılığı düşüktür. Yenidoğan bebeklerde, vücut sıcaklığının 36,0-36,4ºC arasında olması hafif hipotermi (soğuk stresi) ,32,0-35,9ºC arasında olması orta derecede hipotermi ve 32ºC altında olması ise ciddi hipotermi olarak tanımlanır. Preterm yenidoğanlarda hipotermi riski term yenidoğanlara göre daha da fazladır. Hipotermiye müdahale edilmezse tüm vücutta soğukluk, emmede/aktivitede azalma ve zayıf ağlama ortaya çıkar. Hipoglisemi, hipotalamik/otonomik santral patolojiler, enfeksiyonlar, endokrin/metabolik hastalıklar, santral sinir sisteminde depresyon ve kalori alımında azalma hipotermi ayırıcı tanısında düşünülmelidir. Hipotermisi olan yenidoğan bebek, mümkün olan en kısa sürede ancak çok hızlı olmadan ısıtılmalıdır.
Anahtar Kelimeler:
Ateş, hipotermi, enfeksiyon
Fever and Hypothermia in Newborns
Abstract Fever in the neonatal period is defined as a body temperature above 38 C. Although the exact mechanisms are unknown, fever results from a dispruption of complex relations between heat production and heat loss. Many infectious or non-infectious causes may leadto fever. Most common infectious agents are viruses. Bacterial agents include E coli and other gram negative pathogens. All newborns who have fever should be admitted to the hospital and evaluated for infections even if they look well. Evaluation of procalcitonin and CRP is better in diagnosing serious bacterial infections in the first 36-72 hours of life. Leukocyte count is insufficient to diagnose an infection. In newborn infants, a body tem-perature of 36.,0 – 36,4 is known as mild hypothermia (cold stress), 32,0 – 35,9 C is known as moderate hypothermia and below 32 C is diagnosed as severe hypothermia. Risk of hypothermia is larger in preterminfants. If not treated, hypothermia may result in whole body coldness, loss of activity and suck, and weak cry. Differential diagnoses include hypoglycemia, hypothalamic and autonomic dysfunction, infections, endocrine and metabolic diseases, central nervous system depression and decreased caloric intake. A hypothermic infant should be warmed as soonas possible, but not too quickly.
Keywords:
Fever, hypothermia,
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- ISSN: 1309-0453
- Başlangıç: 2009
- Yayıncı: Selen Medya Yayıncılık Tanıtım ve Organizasyon Hizmetleri