Antenatal steroid yapılan ve yapılmayan hastaların solunum morbiditeleri ve tansiyon değerleri
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Tarih
2020
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Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Preterm doğum, özellikle 32 haftalık gebelikten önce daha yüksek mortalite, solunum sıkıntısı sendromu (RDS) ve diğer morbiditelerin riskini taşır. 35 yıldan uzun bir süredir antenatal steroid (ANS) kullanımının prematüre bebeklerde yenidoğan solunum sıkıntısı sendromu ve diğer morbidite insidansını azalttığı bilinmektedir. Biz çalışmamızda yenidoğan yoğun bakım ünitesinde yatarak tedavi edilen doğum haftası ≤ 32 hafta olan antenatal steroid yapılan ve yapılmayan prematüre bebeklerin solunum morbiditelerini ve kan basıncı değerlerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma Ocak 2012-Aralık 2018 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Yenidoğan Yoğun Bakım Ünitesi'nde takip ve tedavi edilen ≤ 32 haftalık 116 prematüre bebek antenatal steroid uygulanmayan, tek doz steroid uygulanan ve iki doz steroid uygulanan olmak üzere üç gruba ayrıldı; solunum morbiditeleri ve kan basıncı değerlerinin incelendi. Hastane dosyaları geriye dönük incelenerek çalışma yürütüldü. Çalışmaya alınan bebeklerin doğumlarının Selçuk Üniversitesi Tıp Fakültesi Kadın Doğum Servisinde olmasına özen gösterildi. Bebeğin cinsiyeti, doğum kilosu, doğum şekli, annenin yaşı, gestasyonel yaşı, 1. ve 5.dk apgar değeri, hastanın hastanede yatış süresi, solunum problemleri (respiratuar distres sendromu, yenidoğan geçici takipnesi) ve kan basıncı ile ilgili özellikleri, İKK, sürfaktan kullanımı gibi özelliklerle ilgili bilgiler neonatal ve maternal dosyalardan elde edildi. Hastaların postnatal ilk 72 saatte 2 saatlik aralıklarla osilometrik yöntemle ölçülmüş sistolik, diyastolik kan basınçları ve sayılan kalp tepe atımları dosyalardan elde edildi. Ortalama Kan Basıncı: Sistolik x 1/3+Diastolik x 2/3 olarak hesaplandı. İstatistiksel testlerde 0.05'in altındaki p değerleri istatiksel olarak anlamlı kabul edildi. Bulgular: Olgular antenatal steroid uygulanmayan (Grup-I) 22 bebek, tek doz steroid uygulanan (Grup-II) 20 bebek ve iki doz steroid uygulanan (Grup-III) 74 bebek olmak üzere üç gruba ayrıldı. Her üç grup, cinsiyet, anne yaşı, hastanede yatış süreleri, gestasyonel yaş, 1. ve 5. dk Apgar skorları, ortalama entübasyon süresi, CPAP/NIPPV desteği oranı, ortalama CPAP/NIPPV süresi, sürfaktan kullanımı, inotrop kullanımı, İKK varlığı ve sağ kalım açısından değerlendirildiğinde anlamlı fark olmadığı görülmüştür (p>0.05). Her üç grup RDS, TTN, BPD varlığı açısından kıyaslandığında gruplar arasında istatistiksel olarak anlamlı fark olmadığı görülmüştür (p>0.05). Her üç grubun ortalama kan basıncı değerleri karşılaştırıldığında, gruplar arasında istatistiksel olarak anlamlı fark görülmemiştir (p>0.05). Gruplar doğum ağırlığı bakımından karşılaştırıldığında, istatistiksel olarak anlamlı fark olduğu görüldü (p:0,043). Doğum şekli açısından gruplar karşılaştırıldığında, Grup-III'de anlamlı olarak sezaryen oranının daha yüksek olduğu görüldü (p:0,002). Grupların entübasyon oranı karşılaştırıldığında, Grup-III'de anlamlı olarak entübasyon oranının daha yüksek olduğu görüldü (p:0,048). Hastaların geriye dönük incelemesinde gestasyonel haftaları ile sağ kalım açısından istatistiksel olarak anlamlı fark olduğu görüldü (p:0,001). Sonuç: Antenatal steroidler preterm infantları solunum yolu sorunlarından korumak için yaklaşık 30 yıldır bilinmekte ve kullanılmaktadır. Yayınlanmış çok sayıda randomize kontrollü çalışmada antenatal steroidlerin solunum, sinir sistemi ve gastrointestinal sistem üzerine faydalı etkileri gösterilmiştir. Antenatal steroidlerin özellikle aşırı düşük doğum ağırlığı olan prematürelerde KB desteği gereksinimini azalttığı bildirilmektedir. Her yıl antenatal steroidden faydalanmayan, her yıl 1 milyondan fazla preterm ölüm olduğu göz önüne alındığında, bu müdahalenin her yıl 500.000 yenidoğan ölümünü önleme potansiyeli vardır.
Patients with and without Antenatal Steroids Comparison of Respiratory Morbidity and Blood Pressure Values Objective: Preterm birth carries a higher risk of mortality, respiratory distress syndrome (RDS), and other morbidities, particularly prior to 32 weeks' gestation. It has been known for more than 35 years that exposure to antenatal steroids (ANS) decreases the incidence of neonatal respiratory distress syndrome and other morbidities in premature infants. In our study; we aimed to compare the respiratory morbidity and blood pressure values of prematüre babies with and without antenatal steroids with an inpatient week of birth ≤ 32 weeks in the neonatal intensive care unit. Material and methods: This study was conducted between January 2012 and December 2018 at Selcuk University Faculty of Medicine, Department of Pediatrics, Department of Neonatal Intensive Care Unit, 116 primary babies of ≤ 32 weeks of age, without antenatal steroid application, single dose steroid application and two dose steroid application, divided into three groups; respiratory morbidity and blood pressure values were examined. Hospital files were examined retrospectively and the study was carried out. Care was taken to ensure that the births of the babies included in the study were in Selcuk University Medical Faculty Maternity Service. Sex of the baby, birth weight, birth type, mother's age, gestational age, 1. and 5. minutes Apgar value, length of hospital stay, respiratory problems (respiratory distress syndrome, transient tachypnea of the newborn) and blood pressure related features, intracranial hemorrhage, use of surfactant Information about features such as was obtained from neonatal and maternal files. Systolic, diastolic blood pressures and counted heart peaks measured by oscillometric method at 2-hour intervals in the first 72 hours of the patients were obtained from the files. Mean Blood Pressure: Calculated as systolic x 1/3 + Diastolic x 2/3. In statistical tests, p values below 0.05 were considered statistically significant. Results: The cases were divided into three groups: 22 babies who did not receive antenatal steroids (Group-I), 20 babies who received a single dose steroid (Group-II) and 74 babies who received two doses of steroid (Group-III). All three groups, gender, maternal age, hospitalization times, gestational age, 1. and 5. minutes Apgar scores, mean intubation time, CPAP / NIPPV support rate, average CPAP / NIPPV duration, surfactant use, inotrop use, intracranial hemorrhage and when evaluated in terms of survival, there was no significant difference (p>0,05). When all three groups were compared in terms of RDS, TTN and BPD, it was seen that there was no statistically significant difference between the groups (p>0,05). When the mean blood pressure values of all three groups were compared, there was no statistically significant difference between the groups (p>0,05). When the groups were compared in terms of birth weight, there was a statistically significant difference (p:0,043). When the groups were compared in terms of delivery type, the cesarean rate was significantly higher in Group-III (p:0,002). When the intubation rate of the groups was compared, it was observed that the intubation rate was significantly higher in Group-III (p:0,048). In the retrospective examination, there was a statistically significant difference in terms of survival with gestational weeks (p:0,001). Conclusion: Antenatal steroids have been known and used for about 30 years to protect preterm infants from respiratory problems. Many published randomized controlled trials have shown beneficial effects of antenatal steroids on respiratory, nervous system and gastrointestinal tract. Antenatal steroids have been reported to reduce the need for BP support, especially in premature babies with extremely low birth weight. Given that there are more than 1 million preterm deaths every year that do not benefit from antenatal steroids every year, this intervention has the potential to prevent 500,000 neonatal deaths each year.
Patients with and without Antenatal Steroids Comparison of Respiratory Morbidity and Blood Pressure Values Objective: Preterm birth carries a higher risk of mortality, respiratory distress syndrome (RDS), and other morbidities, particularly prior to 32 weeks' gestation. It has been known for more than 35 years that exposure to antenatal steroids (ANS) decreases the incidence of neonatal respiratory distress syndrome and other morbidities in premature infants. In our study; we aimed to compare the respiratory morbidity and blood pressure values of prematüre babies with and without antenatal steroids with an inpatient week of birth ≤ 32 weeks in the neonatal intensive care unit. Material and methods: This study was conducted between January 2012 and December 2018 at Selcuk University Faculty of Medicine, Department of Pediatrics, Department of Neonatal Intensive Care Unit, 116 primary babies of ≤ 32 weeks of age, without antenatal steroid application, single dose steroid application and two dose steroid application, divided into three groups; respiratory morbidity and blood pressure values were examined. Hospital files were examined retrospectively and the study was carried out. Care was taken to ensure that the births of the babies included in the study were in Selcuk University Medical Faculty Maternity Service. Sex of the baby, birth weight, birth type, mother's age, gestational age, 1. and 5. minutes Apgar value, length of hospital stay, respiratory problems (respiratory distress syndrome, transient tachypnea of the newborn) and blood pressure related features, intracranial hemorrhage, use of surfactant Information about features such as was obtained from neonatal and maternal files. Systolic, diastolic blood pressures and counted heart peaks measured by oscillometric method at 2-hour intervals in the first 72 hours of the patients were obtained from the files. Mean Blood Pressure: Calculated as systolic x 1/3 + Diastolic x 2/3. In statistical tests, p values below 0.05 were considered statistically significant. Results: The cases were divided into three groups: 22 babies who did not receive antenatal steroids (Group-I), 20 babies who received a single dose steroid (Group-II) and 74 babies who received two doses of steroid (Group-III). All three groups, gender, maternal age, hospitalization times, gestational age, 1. and 5. minutes Apgar scores, mean intubation time, CPAP / NIPPV support rate, average CPAP / NIPPV duration, surfactant use, inotrop use, intracranial hemorrhage and when evaluated in terms of survival, there was no significant difference (p>0,05). When all three groups were compared in terms of RDS, TTN and BPD, it was seen that there was no statistically significant difference between the groups (p>0,05). When the mean blood pressure values of all three groups were compared, there was no statistically significant difference between the groups (p>0,05). When the groups were compared in terms of birth weight, there was a statistically significant difference (p:0,043). When the groups were compared in terms of delivery type, the cesarean rate was significantly higher in Group-III (p:0,002). When the intubation rate of the groups was compared, it was observed that the intubation rate was significantly higher in Group-III (p:0,048). In the retrospective examination, there was a statistically significant difference in terms of survival with gestational weeks (p:0,001). Conclusion: Antenatal steroids have been known and used for about 30 years to protect preterm infants from respiratory problems. Many published randomized controlled trials have shown beneficial effects of antenatal steroids on respiratory, nervous system and gastrointestinal tract. Antenatal steroids have been reported to reduce the need for BP support, especially in premature babies with extremely low birth weight. Given that there are more than 1 million preterm deaths every year that do not benefit from antenatal steroids every year, this intervention has the potential to prevent 500,000 neonatal deaths each year.
Açıklama
Anahtar Kelimeler
Antenatal Steroid, Yenidoğan Solunum Problemleri, Kan Basıncı Değerleri, Newborn Breathing Problems, Blood Pressure Value
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Esatoğlu, Ç. (2020). Antenatal steroid yapılan ve yapılmayan hastaların solunum morbiditeleri ve tansiyon değerleri. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
