Cüneyt TAYMAN, Evrim ALYAMAÇ DİZDAR, Nilüfer OKUR, Mehmet BÜYÜKTİRYAK, Buse ÖZER BEKMEZ

YENİDOĞANDA PNÖMOTORAKS VE GÖĞÜS TÜPÜ İLE DRENAJ TEDAVİSİ GEREKSİNİMİNE GÖRE DEMOGRAFİK VE KLİNİK ÖZELLİKLERİN KARŞILAŞTIRILMASI

Amaç: Özellikle prematüre bebeklerde önemli bir morbidite ve mortalite nedeni olan pnömotoraks, çocukluk çağında en sık yenidoğan döneminde görülür. Amacımız, ünitemizde pnömotoraks tanısı konulan yenidoğanların değerlendirilmesidir. Gereç ve Yöntemler: Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Yenidoğan Yoğun Bakım ünitesinde 1 Ocak 2015 ile 31 Aralık 2015 tarihleri arasında pnömotoraks tanısı alarak izlenen yenidoğan bebeklerin kayıtları geriye dönük olarak incelenmiştir. Radyolojik olarak pnömotoraks tanısı doğrulanan yenidoğan bebekler çalışmaya dahil edildi. Majör konjenital anomalisi olanlar ise çalışma dışı bırakıldı. Bulgular: Pnömotoraks insidansı, tüm canlı doğumlar içerisinde %0.37, yenidoğan yoğun bakım ünitesinde takibi yapılanlar arasında ise %2.6 olarak saptandı. Bebeklerin ortalama gestasyon yaşı 34.2±3.6 hafta ve doğum ağırlığı 2322±841 gr idi. Pnömotoraks saptanan 67 yenidoğanın 49’u erkek (%73.1) idi ve 59’unun (%88.1) sezaryen ile doğduğu saptandı. Pnömotoraks gelişen bebeklerde alttan yatan en sık primer akciğer hastalıklarının TTN (%38.8) ve RDS (%31.3) olduğu belirlendi. Pnömotoraks tedavisi için göğüs tüpü ile 50 (%74.7) bebeğe drenaj tedavisi uygulanırken, 17 (%25.3) bebeğin göğüs tüpü gereksinimi olmadı. Drenaj gereken grupta gestasyon yaşı ve doğum ağırlığı anlamlı olarak düşük bulundu (p<0.05). Drenaj gereken grupta MV ve NİV süreleri anlamlı olarak uzun iken, serbest oksijen gereksinimi de daha uzun olmakla birlikte anlamlı fark saptanmadı. Preterm morbiditeleri ve mortalite açısından iki grup arasında fark saptanmadı. Sonuç: Yenidoğan döneminde pnömotoraks ile sık olarak ve genellikle ilk iki gün içerisinde karşılaşılır. Prematüre bebeklerde en sık altta yatan akciğer hastalığı RDS iken, term bebeklerde TTN’ dir. Pömotoraks gelişen yenidoğanların yaklaşık ¾’üne göğüs tüpü takılarak drenaj tedavisi gerekir. Gestasyon yaşı <32 hafta olan bebeklerde pnömotoraks gelişmesi durumunda neredeyse tamamına göğüs tüpü takılması gerekmektedir. Drenaj gereken bebeklerde invaziv ve noninvaziv solunum destek süreleri ile hastanede kalış zamanı belirgin olarak uzamaktadır.

Anahtar Kelimeler:

Pnömotoraks, insidans, drenaj

PNEUMOTHORAX IN NEWBORN AND COMPARISON OF DEMOGRAPHIC AND CLINICAL FEATURES ACCORDING TO DRAINAGE TREATMENT REQUIREMENT WITH CHEST TUBE

Objective: Pneumothorax, which is an important cause of morbidity and mortality especially in premature infants, is the most common neonatal period in childhood. Our aim is to evaluate newborns diagnosed as pneumothorax in our unit.Material and Methods: The records of newborn babies who were diagnosed as pneumothorax in the Neonatal Intensive Care Unit of Zekai Tahir Burak Women's Health Education and Research Hospital between January 1, 2015 and December 31, 2015 were analyzed retrospectively. Newborn infants who were diagnosed radiologically as pneumothorax were included in the study. Major congenital anomalies were excluded from the study.Results: The incidence of pneumothorax was 0.37% in all live births and 2.6% in the neonatal intensive care unit. The mean gestation age of the babies was 34.2 ± 3.6 weeks and birth weight was 2322 ± 841 gr. Of the 67 newborns with pneumothorax, 49 were male (73.1%), and 59 (88.1%) were born by cesarean section. TTN (38.8%) and RDS (31.3%) were the most common underlying pulmonary diseases in infants who developed pneumothorax. For the treatment of pneumothorax, 50 (74.7%) babies were treated with chest tube and 17 (25.3%) had no chest tube. Gestational age and birth weight were significantly lower in the drainage group (p <0.05). The duration of MV and NDA was significantly longer in the drainage group, but the free oxygen requirement was longer, but there was no significant difference. There was no difference between the two groups in terms of preterm morbidity and mortality. Conclusion: In neonatal period, pneumothorax is frequently encountered and usually within the first two days. The most common underlying lung disease in premature infants is RDS, while term infants is TTN. About ¾ of newborns developing pneumothorax should be treated by inserting a chest tube. In case of pneumothorax development in infants with gestational age <32 weeks, a chest tube should be inserted in almost all of them. In infants who need drainage, the duration of invasive and noninvasive respiratory support and the time of hospitalization are significantly longer.

Keywords:

Pneumothorax, incidence, drainage,

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