Nilgün KARADAĞ, Dilek DİLLİ, Belma KARAGÖl, ARZU DURSUN, Afşın KUNDAK, NİLAY HAKAN, Ayşegül ZENCİROĞLU, Nurullah OKUMUŞ

Hidrops fetalis: Üçüncü düzey bir yenidoğan yoğun bakım ünitesinde 6 yıllık deneyim

Amaç: Yenidoğan yoğun bakım ünitesinde hidrops fetalis tanısıyla izlenen hastaların etiyolojilerinin, klinik bulguları- nın, tedavi ve prognozlarının değerlendirmesi amaçlandı. Materyal ve Metot: Ocak 2005-Ocak 2011 tarihleri arasında yenidoğan yoğun bakım ünitesinde yatan ve hidrops fetalis tanısı ile izlenen hastalar çalışmaya alındı. Bulgular: Çalışma döneminde yenidoğan yoğun bakım ünitesine yatan hastalar arasında hidrops fetalis görülme sıklığının %0,02 (25/10.099) olduğu saptandı. Hastaların %40ı (n=10) prenatal tanılıydı. Ortanca doğum ağırlığı 3260g (3100-3635), prematürite oranı %44 (n=11) ve erkek cinsiyet oranı %64 (n=16) idi. Cilt ödemi (n=18, %72), anemi (n=13, %52) ve asit (n=11, %44) en sık saptanan bulgulardı. Nonimmun hidrops fetalis sıklığı %60 (n=15) olup olguların %32sinde (n=8) kardiyovasküler, %12- sinde (n=3) genitoüriner sistem ve %12sinde (n=3) ge- netik nedenler belirlendi. Olguların %40ında immün hid- rops fetalis (n=10) saptandı; %20 Rh (n=5) ve %20 (n=5) subgrup uygunsuzluğu (anti-C, c, anti-E) gözlendi. Başlıca komplikasyonlar solunum sıkıntısı (n=15, %60), böbrek yetmezliği (n=14, %56), kalp yetmezliği (n=12, %48) ve karaciğer fonksiyon bozukluğu (n=8, %32) idi. Kaybedilen olguların tamamı nonimmun hidrops fetalis tanılıydı (n=8, %32). Kalp yetmezliği gelişen (p=0,007) ve mekanik ventilatör gereksinimi (p=0,02) olan hasta- larda mortalite daha yüksekti. Tartışma: Hidrops fetaliste prognoz altta yatan nedene bağlı olarak değişmekle birlikte, mortalite nonimmün hidrops fetaliste daha yüksektir. Sonuçlar: Hidrops fetalis etiyolojisinde nonimmün ne- denler daha çok rol oynamakla birlikte immün nedenler halen önemli bir yere sahiptir. Prenatal dönemde hidrops fetalis tanısı alan olgular üçüncü düzey yenidoğan yoğun bakım merkezlerinde izlenmelidir.

(Hydrops Fetalis: A six years experience in a tertiary neonatal intensive care unit)

Background: It was aimed to evaluate the etiologies, clinical findings, treatment and prognosis of the patients with hydrops fetalis who were followed up in the neonatal intensive care unit. Material and Methods: The patients who were followed up in neonatal intensive care unit with hydrops fetalis between January 2005 and January 2011 were included to the study. Results: The frequency of hydrops fetalis was 0.02% (25/10.099). Forty percent (n=10) of the patients were diagnosed prenatally. Median birth weight was 3260g (3100-3635) with prematurity rate of 44% (n=11), and male rate of 64% (n=16). Skin edema (n=18, 72%), anemia (n=13, 52%) and ascites (n=11, 44%) were among the most common clinical findings. The frequency of nonimmune hydrops fetalis was 60% (n=15); cardiovasculary (32%, n=8), genitourinary system (n=3, 12%), and genetical (n=3, 12%) causes were identified. Immune hydrops fetalis was detected in 40% (n=10) of the patients with the same rates of Rh incompatibility (n=5, 20%) and subgroub incompatibility (n=5, 20%). The main complications were respiratory distress (n=15, 60%), renal failure (n=14, 56%), cardiac failure (n=12, 48%), and liver dysfunction (n=8, 32%). All of the patients who died were with nonimmune hydrops fetalis (n=8, 32%). Mortality rates were higher among patients with cardiac failure (p=0.007) and requiring mechanical ventilatory support (p=0.02). Conclusions: Although nonimmune causes play major role in the etiology of hydrops fetalis immune causes are still important. Prenatally diagnosed patients with hydrops fetalis should be followed up in tertiary neonatal intensive care units.

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