Nilay HAKAN, Nurullah OKUMUŞ, Eriş BİLALOĞLU, Ayşgül ZENCİROĞLU, Ramiz Coşkun GÜNDÜZ, Mustafa AYDIN, Zehra AYCAN, Semra ÇETİNKAYA, Mehmet Şah İPEK

Yenidoğanda Hiperglisemi: Hastalarımızın Demografik ve Klinik özelliklerinin Değerlendirilmesi

Amaç: Yenidoğan bebeklerde görülen hipergliseminin sıklığı, altta yatan nedenleri, klinik seyri ve sonuçlarının araştırılması. Olgular ve Yöntem: Kasım 2008-Şubat 2010 tarihleri arasında yenidoğan yoğun bakım ünitemize herhangi bir nedenle yatan hastalar arasında plazma glukozu ≥180 mg/dl bulunan hastaların tümü (112 hasta) çalışmaya alındı. Bulgular: Olguların 52’si (%46.4) preterm, 60’ı term (%53.6) hastalardı. Hiperglisemi prevalansı genel olarak %6.9 bulunurken; bu değer term gruba (%4.95) kıyasla preterm grupta (%12.7) daha yüksek bulundu (p<0.05). Transport sırasında fazla mayi verilmesine bağlı olarak 10 preterm (10/23) ve bir term hastada (1/19) ağırlık artışı saptandı. Preterm grupta hiperglisemiye neden olan durumların başlıca respiratuvar distres sendromu (%44.2), asfiksi-asidoz (%36.5), enfeksiyon (%32.7), total parenteral beslenme (%23.1) veya ilaç tedavisi (%9.6) olduğu belirlendi. Term grupta ise altta yatan nedenlerin asfiksi-asidoz (%58.3), enfeksiyon (%26.7), kan değişimi (%25) ve periton diyalizi (%10) olduğu görüldü. İnsülin tedavisi preterm grupta dokuz (%17.3), term grupta dört hastaya (%6.7) verilmişti. Preterm hastaların 14’ünün (%26.9), term hastaların ise 20’sinin (%33.3) hiperglisemi/altta yatan hastalığa bağlı kaybedildiği görüldü. Sonuçlar: Transport sırasında fazla mayi verilmesi ve ısı düzensizlikleri yanında respiratuvar distres sendromu, asfiksi-asidoz ve enfeksiyon gibi stres durumları yenidoğan hiperglisemisine zemin hazırlayan başlıca nedenlerdir.

Anahtar Kelimeler:

Düşük doğum ağırlığı, hiperglisemi, insülin, yenidoğan, preterm bebek, sonuç

NEONATAL HYPERGLYCEMIA: EVALUATION OF THE DEMOGRAPHYCAL AND CLINICAL CHARACTERISTICS OF OUR PATIENTS

Aim: To evaluate the prevalence, underlying causes, clinical course, and outcomes of the neonatal hyperglycemia. Patient and method: Among the all patients that hospitalized in our neonatal intensive care unit (NICU) for any reason between November 2008 and February 2010, the 112 patients with a plasma glucose level of ≥180 mg/dl were enrolled into the study. Results: Of the 112 hyperglycemic patients, 52 (46.4%) were preterm and 60 (53.6%) were full-term infants. While the rate of hyperglycemia was 6.9% in all of the patients; it was found higher in preterm group (12.7%) than that of full-term group (4.95 %), (p<0.05). Weight gain was noticed in 10 preterm (10/23) and one fullterm infants (1/19) due to excess parenteral fluid administration during transport of neonates. Respiratory distress syndrome (44.2%), asphyxia-acidosis (36.5%), infection (32.7%), and use of total parenteral nutrition (23.1%) or medications (9.6%) were the main underlying causes of the hyperglycemia in preterm group. In full-term group, asphyxia-acidosis (58.3%), infection (26.7%), exchange transfusion (25%), and peritoneal dialysis (10%) were the main causes of hyperglycemia in term group. Insulin treatment was needed in 9 (17.3%) preterm and 4 (6.7%) full-term patients. Of the study patients, 14 (26.9%) preterm and 20 (33.3%) full-term infants died from hyperglycemia/underlying diseases. Conclusions: In addition to excess parenteral fluid administration and hypothermia during the transportation of neonates, stressful conditions like respiratory distress syndrome, asphyxia-acidosis, and infection are main underlying causes for neonatal hyperglycemia

Keywords:

Low birth weight, hyperglycemia, insulin, newborn, preterm infant, outcome,

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