Özgül BULUT, Kaan KAHRAMAN, Çağla UÇAR, Fahri OVALI

ALT SOLUNUM YOLU ENFEKSİYONU TANISI İLE YENİDOĞAN YOĞUN BAKIM ÜNİTESİNE YATIRILAN OLGULARIN DEĞERLENDİRİLMESİ

AMAÇ: Bu çalışmanın amacı, alt solunum yolu enfeksiyonu (ASYE) tanısıyla yenidoğan yoğun bakım ünitesine yatırılan bebeklerin klinik özelliklerinin ve laboratuvar bulgularının, tanı ve tedavilerinin değerlendirilmesidir.GEREÇ VE YÖNTEM: Hastanemizde 2017 - 2019 tarihleri arasında yenidoğan yoğun bakım ünitesine ASYE tanısı konularak yatırılan bebeklerin verileri retrospektif olarak dosya kayıtlarından elde edildi. Demografik özellikleri, tanı ve tedavileri analiz edildi.BULGULAR: Çalışmaya ASYE tanısı alan toplam 57 hasta dahil edildi. Hastaların ortalama gestasyon yaşı 36.8±3 hafta, ortalama doğum ağırlığı 2864±787 g idi. % 67 (n=38)’si term, % 33 (n=19)’ü preterm bebekti. Olguların başvuru anındaki semptom, muayene bulguları ve akciğer grafileri incelendiğinde; %67 (n=38)’inde takipne, ekspiryumda uzama ve beslenme güçlüğü, %26 (n=15)’sında öksürük, %20 (n=12)’sinde ateş, %12 (n=7)’sinde kusma, %7 (n=4)’sinde apne, %21 (n=12)’inde akciğer grafisinde havalanma artışı saptandı. Hastaların %61 (n=35)’inde nazofarengeal sürüntü örneklerinde PCR yöntemi ile solunum paneli bakıldı, bunlarında %57 (n=20)’sinde Respiratuvar sinsityal virüs (RSV) enfeksiyonu, %14 (n=5)’ünde Rhinovirüs, %3 (1)’ünde Metapnömovirüs pozitif saptandı. Hastaların %47 (n=27)’si yüksek akımlı oksijen, %26 (n= 15)’sı nazal CPAP, %58 (n=33)’i antibiyotik, % 63 (n= 36)’ü inhaler bronkodilatör ve hipertonik salin tedavisi aldı.SONUÇ: Hastanemizde ASYE tanısı ile yatırılan olgularda literatürle uyumlu olarak yüksek oranda RSV enfeksiyonu saptandı. Tanının erken konulması, gereksiz antibiyotik kullanımı ve nozokomiyal enfeksiyonları önlemek açısından önem taşımaktadır.

Anahtar Kelimeler:

Yenidoğan, Polimeraz zincir reaksiyonu, Respiratuvar sinsityal virüs, Solunum yolu enfeksiyonları

ASSESSMENT OF CASES ADMITTED TO THE NEONATAL INTENSIVE CARE UNIT WITH LOWER RESPIRATORY TRACT INFECTION

OBJECTIVE: The purpose of this study is to assess the clinical features, laboratory findings, diagnosis and treatments of neonates in the neonatal intensive care unit with a diagnosis of lower respiratory tract infection (LRTI).MATERIAL AND METHODS: The data of neonates hospitalized in the neonatal intensive care unit of our hospital between 2017 and 2019 with a diagnosis of LRTI was retrospectively obtained from the file records. Demographical features, diagnosis and treatments were analyzed.RESULTS: A total of 57 patients diagnosed with LRTI were included in the study. The mean gestational age of the patients was 36.8 ± 3 weeks and their mean birth weight was 2864 ± 787 g. The 67% (n = 38) of them were term infants and the 33% (n = 19) of them were preterm infants. When the symptoms, examination findings and chest radiographs of the cases were examined at the time of admission, tachypnea, prolonged expiration, and nutritional difficulty in 67% of cases (n = 38), cough in 26% (n = 15) of the cases, fever in 20% (n = 12) of the cases, vomiting in 12% (n = 7) of the cases, apnea in 7% (n = 4)of the cases, and increased aeration in lung imaging in 21% (n = 12) of the cases were detected. Respiratory panel using Polymenase Chain Reaction (PCR) method was investigated in nasopharyngeal swab samples of 61% (n = 35) of the patients, respiratory syncytial virus (RSV) in 57% (n = 20), rhinovirus in 14% (n = 5), and metapneumovirus in 3% (n = 1) of the cases were observed. The 47% of the patients (n = 27) received high-flow oxygen, 26% (n= 15) nasal CPAP, 58% (n=33) antibiotics, 63% (n= 36) inhaler bronchodilator and hypertonic saline treatment.CONCLUSIONS: In accordance with the literature, a high rate of RSV infection was detected in neonates with LRTI in the neonatal intensive care unit of our hospital. Early diagnosis is important to prevent unnecessary use of antibiotics and to prevent nosocomial infections.

Keywords:

Newborn, Polymerase chain reaction, Respiratory syncytial virus, Respiratory tract infections,

PDF

___

1. World Health Statistics 2015. World Health Organization. Available at: https://www.who.int/docs/default-source/gho-documents/world-health-statistic-reports/world- health-statistics-2015.pdf
2. Hatipoğlu S, Arıca S, Çelik Y, ve ark. Alt solunum yolu enfeksiyonu tanısıyla hastanemize yatırılan olgularda RSV enfeksiyonu sıklığı ve klinik özellikleri. Düzce Tıp Fakültesi Dergisi. 2009;11:38-44.
3. Hsegawa K, Tsugawa Y, Brown DF, Mansbach JM, Camargo CA Jr. Trends in bronchiolitis hospitalizations in the United States, 2000-2009. Pediatrics. 2013;132(1):28-36.
4. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128.
5. Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132(2):341-48.
6. Hacımustafaoğlu M, Celebi S, Bozdemir SE, et al. RSV frequency in children below 2 years hospitalized for lower respiratory tract infections. Turk J Pediatr. 2013;55(2):130-39.
7. Turkish Neonatal Society. The seasonal variations of respiratory syncytial virus infections in Turkey: a 2-year epidemiological study. Turk J Pediatr. 2012;54(3):216-22.
8. Shi T, McAllister DA, O’Brien KL, et al. RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946-58.
9. Scheltema NM, Gentile A, Lucion F, et al. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. Lancet Glob Health. 2017;5(10):984-91.
10. Alan S, Erdeve O, Cakir U, et al. TurkNICU-RSV Trial Group. Outcome of the Respiratory Syncytial Virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study. J Matern Fetal Neonatal Med. 2016;29(13):2186-93.
11. Borchers AT, Chang C, Gershwin ME, Gershwin LJ. Respiratory syncytial virus--a comprehensive review. Clin Rev Allergy Immunol. 2013;45(3):331-79.
12. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta- analysis. Lancet. 2010;375:1545-55.
13. Walsh EE, McConnochie KM, Long CE, Hall CB. Severity of respiratory syncytial virus infection is related to virus strain. J Infect Dis. 1997;175(4):814-20.
14. Belderbos ME, Houben ML, Wilbrink B, et al. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics. 2011;127(6):1513-20.
15. Dixon DL. The role of human milk immunomodulators in protecting against viral bronchiolitis and development of chronic wheezing illness. Children (Basel). 2015;2(3):289- 304.
16. Weissenbacher M, Carballal G, Avila M, et al. Etiologic and clinical evaluation of acute lower respiratory tract infections in young Argentinian children: an overview. Rev Infect Dis. 1990;12(8):889-98.
17. Okulu E, Akduman H, Tunç G, ve ark. Viral Alt Solunum Yolu Enfeksiyonu Nedeniyle Yatırılan Yenidoğanların Epidemiyolojik ve Klinik Özellikleri. Türkiye Çocuk Hastalıkları Dergisi. 2018;12(1):31-5.
18. Rawlinson WD, Waliuzzaman Z, Carter IW, Belessis YC, Gilbert KM, Morton JR. Asthma exacerbations in children associated with rhinovirus but not human metapneumovirus infection. J Infect Dis. 2003;187(8):1314-18.
19. Sancaklı Ö, Yenigün A, Kırdar S. Alt Solunum Yolu Enfeksiyonunda Nazofaringeal Örneklerde Polimeraz Zincir Reaksiyonu Sonuçları. Çocuk Enfeksiyon Dergisi. 2012;6(3): 84- 9.
20. Tregoning JS, Schwarze J. Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev. 2010;23(1):74-98.
21. Vandini S, Biagi C, Lanari M. Respiratory Syncytial Virus: The Influence of Serotype and Genotype Variability on Clinical Course of Infection. Int J Mol Sci. 2017;18(8):1717.
22. National Collaborating Centre for Women's and Children's Health (UK). Bronchiolitis: Diagnosis and Management of Bronchiolitis in Children. London: National Institute for Health and Care Excellence (NICE), 2015.
23. Kayıran MS, Palaoğlu E, Gürakan B. Bronşiyolit tanısıyla izlenen küçük çocuklarda RSV sıklığı, klinik ve laboratuvar özellikleri. Türk Pediatri Arşivi. 2010;45(3):252-56.
24. Drysdale SB, Green CA, Sande CJ. Best practice in the prevention and management of paediatric respiratory syncytial virus infection. Ther Adv Infect Dis. 2016;3(2):63-71.
25. Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. J Clin Microbiol. 2015;53(12):3738-49.
26. Somerville LK, Ratnamohan VM, Dwyer DE, Kok J. Molecular diagnosis of respiratory viruses. Pathology. 2015;47(3):243-49.
27. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):1474-502.
28. Bisgaard H, Flores-Nunez A, Goh A, et al. Study of montelukast for the treatment of respiratory symptoms of post-respiratory syncytial virus bronchiolitis in children. Am J Respir Crit Care Med. 2008;178(8):854-60.
29. Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review. Pediatrics. 2015;136(4):687-701.
30. Türk Neonatoloji Derneği Palivizumab ile RSV Proflaksisi Çalışma Grubu. Türk Neonatoloji Derneği Palivizumab Proflaksisi Önerileri, 2014.
31. Buraphacheep W, Britt WJ, Sullender WM. Detection of antibodies to respiratory syncytial virus attachment and nucleocapsid proteins with recombinant baculovirus- expressed antigens. J Clin Microbiol. 1997;35(2):354-57.
32. Ginocchio CC, McAdam AJ. Current Best Practices for Respiratory Virus Testing. J Clin Microbiol. 2011; 49(9):44-8.