İstemi Han ÇELİK, Zehra ARSLAN, Sezin UNAL, Leyla MOLLAMAHMUTOĞLU, Ahmet Yağmur BAŞ, Nihal DEMİREL

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Akut Alt Solunum Yolu Enfeksiyonu Nedeni ile Yatırılarak İzlenen Yenidoğanların Klinik ve Virolojik Özellikleri

Amaç: Respiratuvar sinsityal virüs, parainfluenza virüs ve rhinovirüs yenidoğan döneminde akut alt solunum yolu enfeksiyonlarının en sık nedenidirler. Bu çalışmada alt solunum yolu enfeksiyonu mevcut olan yenidoğanların klinik ve demografik özelliklerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Yenidoğan yoğunbakım ünitemize Ocak 2013 ve Nisan 2016 tarihleri arasında yatırılan hastaların medikal kayıtları retrospektif olarak incelendi. Bulgular: Çalışmaya 19'u kız 24'ü erkek olmak üzere 43 hasta alındı. Ortalama gestasyonel hafta ve doğum ağırlığı 32 ± 4.4 hafta ve 1735 ± 820 gr'dı. Başvuru anında ortalama postnatal gün ve postmenstrüel hafta 61 ± 48 gün ve 41 ± 4.3 haftaydı. Polimeraz zincir reaksiyonu testi sonucunda respiratuvar sinsityal virüs (n:8), rhinovirüs (n:3), parainfluenza-3 virüs (n:3) ve adenovirus (n:3), respiratuvar sinsityal virüs ve parechovirus (n:1), respiratuvar sinsityal virüs ve adenovirüs (n:1), rhinovirus ve insan bocavirüs (n:1) tespit edildi (toplam 20 hasta). Evde kardeş (n:31), ailede viral enfeksiyon (n:23), yetersiz anne sütü (n:15), bronkopulmoner displazi (n:13), okula giden kardeş (n:10) ve ikiz veya üçüz olma (n:7) en sık ana risk faktörleriydi. Ortanca hastanede kalış süresi 9 (1-60) gündü. Prematürite, ral, solunum desteği ihtiyacı ve beslenme güçlüğü polimeraz zincir reaksiyonu pozitif hastalarda istatistiksel olarak daha sıktı. Respiratuvar sinsityal virüs pozitif hastalar diğer virüslerin saptandığı gruba göre daha büyük gestasyonel hafta ve doğum ağırlığına sahipken daha az respiratuvar distres sendromu, surfaktan kullanımı, patent duktus arteriozus öyküsü mevcuttu ve semptomların başlangıcı ile hastaneye başvuru zamanı arasında geçen süre daha kısaydı. Sonuç: Respiratuvar sinsityal virüs yenidoğanlarda alt solunum yolu enfeksiyonunun en sık rastlanan etkeni iken koenfeksiyon ve daha nadir görülen insan bocavirüs ve parechovirus gibi etkenlerin klinik önemi akılda tutulmalıdır. Destek tedavisi tedavinin en önemli bileşenidir.
Anahtar Kelimeler:

yenidoğan dönemi, viral pnömoni, respiratuvar sinsityal virüs, polimeraz zincir reaksiyonu

Clinical and Virological Characteristics of Neonates Admitted with Acute Lower Respiratory Tract Infections

Aim: Viruses including respiratory syncytial virus, parainfluenza virus, rhinovirus are the primary etiologic agents in acute lower tract infections in neonates. We aimed to evaluate the clinical and demographic characteristics of newborns with acute lower tract infections. Material and Method: Data was recorded from patients' medical records admitted between January 2013 and April 2016. Results: The study population consisted of 43 neonates (19 girls, 24 boys). Mean gestational age and birthweight were 32 ± 4.4 weeks and 1735 ± 820 g, respectively. On admission, mean postnatal day and postmenstrual ages were 61 ± 48 days and 41 ± 4.3 weeks. Respiratory syncytial virus (n:8), rhinovirus (n:3), parainfluenza-3 virus (n:3) and adenovirus (n:3), respiratory syncytial virus and parechovirus (n:1), respiratory syncytial virus and adenovirus (n:1), rhinovirus and human bocavirus (n:1) were detected by polymerase chain reaction 20 patients in total. Siblings in the house (n:31), viral infection in the family (n:23), insufficient breastfeeding (n:15), bronchopulmonary dysplasia (n:13), siblings attending school (n:10) and being twin or triplet (n:7) were leading risk factors. Median hospital stay was 9 (1-60) days. Prematurity, fever, rales, respiratory support and feeding difficulty were statistically more common in polymerase chain reaction positive patients. Patients with the respiratory syncytial virus had higher gestational age, birth weight, less respiratory distress syndrome, surfactant use and patent ductus arteriosus, and lower postnatal day on admission than patients with other viruses (p<0.05). Conclusion: Respiratory syncytial virus is the commonest cause of acute lower tract infections in newborns, but the clinical importance of co-infection and rare agents such as human bocavirus and parechovirus should be kept in mind. Supportive management is the mainstay of the therapy.
Keywords:

neonates, viral pneumoniae, respiratory syncytial virus, polymerase chain reaction,

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Türk Kadın Sağlığı ve Neonatoloji Dergisi-Cover
  • Başlangıç: 2019
  • Yayıncı: Sağlık Bilimleri Üniversitesi Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi
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