Suzan GÜNDÜZ, AYŞEGÜL ZENCİROĞLU, Nurullah OKUMUŞ

Ateşli term yenidoğanlarda ciddi bakteriyel enfeksiyon birlikteliği

Giriş ve Amaç: Bu çalışma; hastanemiz acil servisine ateş yakınması ile başvurup yenidoğan servisine yatırılan bebeklerde ateş nedenlerinin, ciddi bakteriyel enfeksiyon (CBE) ve dehidratasyon ateşi sıklığının belirlenmesi amacıyla yapıldı. Materyal ve Metot: Çalışmaya acil serviste rektal ateşi en az 38 oC ölçülüp ateş etiyolojisi araştırılmak ve tedavi edilmek üzere Yenidoğan Yoğun Bakım Ünitesi’ne yatırı-lan yenidoğan bebekler alındı. CBE tanısını başlangıçta öngörmeye yardımcı olabilecek parametreler ve “dehid-ratasyon ateşi” tanısı alan hastalar değerlendirildi. Bulgular: Hastanede ilk ölçülen rektal vücut sıcaklığı hastaların %68'inin 38-38,9 °C arasında, %32'sinin 38.9°C ve üzerinde idi. Her iki grupta rektal ateş ara-sında fark saptanmadı. Hastaların 15’inde (%21,1) CBE belirlendi. Kan kültüründe 4 (%5,6), idrar kültüründe (biri ürosepsis, biri pnömoniyle birlikte) 12 (%16,9) hastada üreme belirlendi. Hastaneye başvuru yaşı CBE grubunda diğer gruba göre anlamlı yüksekti. C-reaktif protein (CRP) değeri CBE grubunda (37,9 mg/dl), olmayan gruba göre (17,3 mg/dl) anlamlı yüksekti. Her iki grup arasında beyaz küre ve mutlak nötröfil sayıları açısından anlamlı fark yoktu. Hastaların ateş yanında % 71,9’unda ek yakınmalar vardı. Çalışma grubunda dehidratasyon ateşi olan 21 (%29,6), olmayan 50 (%70,4) hasta belir-lendi. Dehidratasyon ateşi olan bebeklerin hastanede ölçülen rektal ateş derecesi, beyaz küre sayısı, absüle nötrofil sayısı, sodyum, kreatinin, kan üre nitrojeni (BUN), bilirubin değerleri, dehidratasyon ateşi olmayan gruptan anlamlı yüksek, hastaneye başvuru günü, CRP ve glukoz değerleri anlamlı düşük bulundu. Tartışma: Hasta populasyonumuzda vücut sıcaklığı 38 oC’yi geçen her yenidoğanın ciddi bakteriyel enfeksiyon riski açısından dikkatle değerlendirilmesi, kültürlerinin alınarak ampirik antibiyotik tedavisi başlanmasının güve-nilir bir yaklaşım olmakla birlikte, kültür sonuçlarının yakından izlenerek kültür sonuçlarına ve hastanın klini-ğine göre antibiyotik tedavisinin gereksiz uzatılmaması gerekir. Özellikle yaz aylarında, hayatın ilk haftası içe-risinde ateşle başvuran bebeklerde dehidratasyon ateşi tanısı da akılda tutulmalıdır.

Anahtar Kelimeler:

Su kaybı, Süt çocuğu, yenidoğan, Bakteriyel enfeksiyonlar, Ateş

Serious bacterial infections in term newborns with fever

Objective: The purpose of our study is to determine the cause of fever in neonates who has been admitted to emergency department because of fever and then hospitalized in our neonatal intensive care unit, the incidence of serious bacterial infections (SBI) and the incidence of dehydration fever were investigated. Materials and Methods: In our study, neonates admitted to emergency unit with a rectal fever of at least 38 oC were included. The neonates hospitalized in the Neonatal Intensive Care Unit for investigation of infection source and treatment. The initial history, physical examination and laboratory parameters for predicting serious bacterial infections, and “dehydration fever groups” were evaluated. Results: First measured rectal temperature in hospital was between 38-38.9 °C in 68% of patients, while 32% had a fever more than 38.9°C.There was no statistical difference in rectal fever between two groups. Fifteen (21%) of 71 patients were SBI. Blood culture was positive in 4 (5.6%) and urine culture was positive (including one case with urosepsis and one case with pneumonia) in 12 (16.9%) patients. The day of admission to the hospital in SBI group was significantly higher as compared to the non-SBI group. C-reactive protein (CRP) values in SBI and non-SBI group were 37.9 mg/dl and 17.3 mg/l dl, respectively, with a statistical difference. There was no significant difference between both groups in terms of white blood cell and absolute neutrophile count. Percen-tage 71.9 patients had additional complaints. Twenty one (29.6%) patients were determined as dehydration fever and 50 (70.4%) were in “non-dehydrateted fever group”. While the rectal fever measured in hospital, white blood count, absolute neutrophile count, sodium, creatinine, BUN, bilirubin values were significantly higher in dehydration group, the admission day to the hospital, CRP and glucose values were significantly lower in dehydration group. Conclusion: In our patients, each neonate with a body temperature more than 38 oC’ should be evaluated with caution in terms of risk of SBI; and cultures should be obtained, than empirical antibiotic treatment should be performed. Although this is a reliable approach, culture results should be closely monitored. According to the culture results of patient’s clinical condition, antibiotic treatment should not be extended unnecessarily. However, especially in summer, within the first week of life, in infants who has been admitted due to fever, the diagnosis of dehydration fever should be kept in mind.

Keywords:

Dehydration, Infant, Newborn, Bacterial Infections, Fever,

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