Oğuz TUNCER, Abdullah CEYLAN, Ercan KIRIMİ, Nihat DEMİR, Erdal PEKER, Suat GEZER

Sıkıntılı solunum sendromlu yenidoğanlarda erken sürfaktan ve nazal devamlı pozitif hava yolu basıncı uygulamasının önemi

Amaç: Mekanik ventilasyon girişimsel bir uygulama olup solunum yollarında ve akciğer parankiminde önemli sorunlara sebep olur. Ça- lışmamızın amacı; erken sürfaktan ve nazal devamlı pozitif hava yolu basıncı (nCPAP) uygulamasının daha geç sürfaktan ve mekanik ven- tilasyon uygulamasına üstünlüğünün olup olmadığını araştırmaktır. Gereç ve Yöntemler: Çalışma Van Yüzüncü Yıl Üniversitesi Tıp Fakül- tesi Hastanesi Yenidoğan Yoğun Bakım Biriminde yapıldı. Araştırma- ya gebelik yaşı 32 hafta ve/veya daha küçük olan 109 sıkıntılı solunum sendromlu (SSS) bebek alındı. Çalışma grubundaki 61 bebeğe doğum odasında veya yenidoğan yoğun bakım biriminde sürfaktan verildi ve ardından nCPAP uygulandı. Kontrol grubundaki 48 bebeğe ise sür- faktan verilmiş ve ardından mekanik ventilasyona bağlanmıştı. Tüm hasta yakınlarından bilgilendirilmiş onam formu ve etik kurul onayı alındı (Onay No:03.02.2011/15). Bulgular: Her iki gruptaki hastalar arasında gebelik yaşları, doğum ağır- lıkları, cinsiyet, boy ve baş çevresi ölçümleri açısından istatistiksel olarak anlamlı farklılık yoktu (p>0,05). Çalışma grubundaki hastaların hastane- deki ortalama yatış süreleri 24,4±17,8 gün iken, nCPAPta kalma süreleri 28,4 (4-120) saatti. Çalışma grubundaki olguların %27,85inde kafa içi kanama, %4,91inde bronkopulmoner displazi, %3,27sinde pnömoto- raks, %3,27sinde nekrotizan enterokolit, %16,39unda patent duktus arteriyozus, %22,95inde sepsis ve %1,63ünde prematüre retinopatisi saptandı. Çalışma ve kontrol grupları arasında sorun görülme oranları bakımından istatistiksel olarak anlamlı farklılık gözlenmedi. İzlem sıra- sında 17 (%27,86) hasta kaybedildi. Çalışma grubu olgularının mekanik ventilatörde kalış süreleri kontrol grubu olgularının kalış süresine göre istatistiksel olarak anlamlı derecede daha kısa bulundu (p

The importance of administration of early surfactant and nasal continuous positive airway pressure in newborns with respiratory distress syndrome

Aim: Mechanical ventilation is an invasive method and causes to impor- tant problems in the respiratory tract and lung parenchyma. The objec- tive of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. Material and Methods: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was admin- istered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). Results: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p>0.05). The mean hospitalization time in the patients in the study group was 24.4±17.8 days, whereas the mean time of nCPAP was 28.4 (4-120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dyspla- sia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was found to be statistically significantly shorter compared to the control group (p

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