Emel ALTUNCU, Esin Yıldız ALDEMİR, Sibel ÖZBEK, Sultan KAVUNCUOĞLU, Mehmet Nevzat ÇİZMECİ

Bronkopulmoner displazi gelişen çok düşük doğum ağırlıklı erken doğmuş bebeklerin değerlendirilmesi

Amaç: Bu çalışma Yenidoğan Yoğun Bakım Birimi’mizde (YYBB) izlenen 32. gebelik haftasından erken doğan çok düşük doğum ağırlıklı (ÇDDA) bebeklerde bronkopulmoner displazi (BPD) sıklığını ve etiolojik risk etmenlerini, klinik özelliklerini, erken hastalık ve ölüm oranını irdelemek için yapıldı. Gereç ve Yöntem: Ocak 2003-Aralık 2004 tarihleri arasında YYBB’de izlenen ÇDDA erken doğmuş bebeklerde BPD tanısı alanların; doğum şekli, cinsiyeti, doğum ağırlığı, gestasyon haftası ve etiolojik risk etmenleri araştırıldı. Steroid tedavi gerekçesi, süresi ve erken komplikasyonları kaydedildi. Olguların diğer hastalık oranları irdelendi. Ölüm oranı ve nedenleri sorgulandı. Bulgular: Yoğun bakım birimimizde bu dönemde 2226 erken doğmuş bebek izlendi. Bunların 825’i (%37) ÇDDA olup yaşayan 663 olgudan 42’sine (%6,3) BPD tanısı konuldu. Etiolojik risk etmenlerinden erken membran rüptürü %24, geç sepsis %66 (kültür (+) %20, klinik sepsis %46), respiratuar distres sendromu %60, pnömoni %52, menenjit %14, patent duktus arteriyozus %25 olguda tanımlandı. Kırkbir olgu ventilatör desteği aldı, 22 olguya sürfaktan verildi. Ortalama ventilatöre giriş süresi 5,3±6,6 gün, ortalama ventilatörde kalış süresi 12,3±11,0 gün idi. Steroide klinik yanıt %80 olup, tedavi sonrası oksijenden ayrılma zamanı ortalama 8,50±5,49 gün olarak bulundu. Steroid komplikasyonlarından hiperglisemi %38, hipertansiyon %21, enfeksiyon %9 sıklığında olup, hepsi geçici yan etkilerdi. Bronkopulmoner displazi’li yedi olgu (%16) kaybedildi. Ölüm nedenleri sepsis, pnömoni ve nekrotizan enterokolit idi. Çıkarımlar: Bronkopulmoner displazi çok etmenli olarak gelişmektedir. Ancak en önemli risk etmenleri erken doğum, ÇDDA, mekanik ventilasyon, doğum öncesi ve sonrası enfeksiyonlardır.

Evaluation of very-low-birth-weight preterm infants with bronchopulmonary dysplasia

Aim: The study has been done to assess the frequency, etiological risk factors, clinical characteristics, mortality and morbidity rates of bronchopulmonary displasia (BPD) in very-low-birth-weight (VLBW) preterm infants under 32nd gestational weeks, in the neonatal intensive care unit (NICU).Material and Method: Preterm infants with VLBW characteristics who were diagnosed with BPD between January 2003 and December 2004 have been evaluated for the way of delivery, gender, birth weight, gestational age and etiological risk factors. Duration of the steroid therapy and its early complications have been recorded. Other causes of morbidity and mortality have been assessed. Results: 2226 preterm infants have been admitted to the NICU between January 2003 and December 2004. 825 (37%) of these infants were VLBW and 162 died. Forty-two (6.3%) of these cases were diagnosed with BPD. Of the etiological factors premature rupture of membranes represented 24%, respiratory distress syndrome 60%, sepsis %66, pneumonia 52%, meningitis 14% and patent ductus arteriosus 25% among the cases. Ventilatory support was needed for 41 infants and 22 of the cases were administered surfactant therapy. Mean initial time for ventilatory support was 5.3±6.6 days wheras mean duration of the ventilatory support was 12.3±11.0 days. Clinical response to steroid therapy was found to be 80% whereas weaning from oxygen took 8.50±5.49 days. Of the steroid complications hyperglycemia represented 38%, hypertension 21% and infection 9% of the cases and none of these adverse effectes were permanent. Seven infants (16%) with BPD died and sepsis, pneumonia and necrotizing enterocolitis were found to be responsible. Conclusions: BPD arises multifactorially. Preterm labor, VLBW, mechanical ventilation, prenatal and postnatal infections should be mentioned among the most important risk factors.

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