Yenidoğan yoğun bakım ünitesinden solunum destek cihazları ile taburcu edilen hastaların değerlendirilmesi
Yükleniyor...
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yenidoğan dönemi doğumu izleyen 4 haftalık süreyi içerir. Yenidoğan bebeklerde
ortaya çıkan en yaygın sorunlardan biri solunum sıkıntısıdır.Solunum sıkıntısı, bir bebeğin
yenidoğan yoğun bakım ünitesine kabulünün en yaygın nedenlerinden biridir.
Çalışmamızın amacı farklı etyolojik nedenlerle yenidoğan yoğun bakım ünitesine kabul
edilen ancak solunum sıkıntısının geçmemesi sebebiyle solunum destek cihazları ile
taburcu edilen hastaların yenidoğan dönemi özelliklerini, yatış ve taburculuk tanılarını,
hastanede yatış sürelerini, taburculukta verilen solunum destek cihazı tiplerini, mortalite
oranını ve taburculuk sonrası seyrini belirlemekti. Çalışmamızda yenidoğan yoğun bakım
ünitemizden 2011–2021 yılları arasında solunum destek cihazları ile taburcu edilen
hastalar geriye dönük incelendi. Yenidoğanların cinsiyeti, doğum haftası, doğum
ağırlıkları, doğum haftasına göre ağırlıkları, apgar puanları, yoğun bakıma yatış tanıları,
yoğun bakımda kaldıkları süre, yoğun bakım yatışı sırasında verilen solunum desteği ve
süresi, taburculuk tanıları, taburcu edilirken verilen solunum destek cihazı tipleri, sağkalım
durumu ve ortalama yaşam süresi değerlendirildi. İstatistiksel analizler için SPSS 22.0
programı kullanıldı. p <0,05 olması anlamlı kabul edildi.Çalışmaya, yenidoğan yoğun
bakım ünitemizden 2011–2021 yılları arasında solunum destek cihazları ile taburcu edilmiş
89 hasta dahil edildi. Cinsiyet dağılımları incelendiğinde %55,1’i (n=49) erkek, %44,9’u
(n=40) kız cinsiyetteydi.Yoğun bakıma yatış nedeniolarak en yüksek oran %61,8(n=55) ile
prematüriteydi. Prematüriteden sonra en sık yoğun bakım yatışı gerektiren sorun solunum
sıkıntısıydı. Solunum sıkıntısı alt tanı gruplarına ayrılarak incelendiğinde yenidoğanların
yatış anında %42,7’sinde (n=38) respiratuar distres sendromu,%6,7’sinde (n=6)
pnömotoraks,%2,2’sinde (n=2) yenidoğanın geçici takipnesi, %2,2’sinde (n=2) pnömoni,
%3,4’ünde (n=3) mekonyum aspirasyon sendromutanısı bulunmaktaydı. Diğer önemli
yatış sebepleri arasında % 29,2 (n=26) ileSSS hastalığı, %22,5 (n=20) ile konjenital kalp
hastalığı bulunuyordu.
Yoğun bakım yatış günü ortalaması 98,3±63,9 gün olarak saptandı. Yenidoğan
yoğun bakım yatış süresi ile doğum ağırlığı arasında anlamlı ilişki vardı (p<0,001). Doğum
v
ağırlığı azaldıkça yoğun bakımda yatış süresi uzamakta idi. Yenidoğanların %14,6’sı
(n=13) geç preterm, %11,2’si (n=10) orta derecede preterm, %13,5’i (n=12) ileri derecede
preterm, %22,5’i (n=20) aşırı derecede preterm, %31,5’i (n=28) erken term, %5,6’sı (n=5)
term ve %1,1’i (n=1)geç termdi. Doğum haftası ile yoğun bakım yatış günü arasında
anlamlı negatif yönlü orta düzey bir ilişki vardı(p<0,001, r=-0,537). Doğum haftası
azaldıkça yoğun bakım yatış günü artmakta idi.
Yoğun bakım yatışı boyunca yenidoğanların %69,7’si (n=62) non-invaziv mekanik
ventilatör, %85,4’ü (n=76) invaziv mekanik ventilatör desteği almıştır. Yenidoğanların %
64’ü (n=57) hem non-invaziv mekanik ventilatör hem invaziv mekanik ventilatör desteğini
birlikte almıştır. Yalnız non-invaziv mekanik ventilatör desteği alan hastalar %5,6 (n=5),
yalnız invaziv mekanik ventilatör desteği alan hastalar %21,3 (n=19) olarak saptandı. Noninvaziv
mekanik ventilatör ve/veya invaziv mekanik ventilatör desteğine ihtiyaç
duymayan, yalnızca oksijen desteği alan hastalar %9 (n=8)’du. Taburculukta en sık tanılar
%53,9 (n=48) ilebronkopulmoner displazive %38,2 (n=34) ile kronik akciğer hastalığı
olarak saptandı. Taburculukta yenidoğanların %74,2’si (n=66) yalnız oksijen
konsantratörü, %23,6’sı (n=21) trakeostomi ve ev tipi invaziv mekanik ventilatör , %2,2’si
(n=2) ev tipi non-invaziv mekanik ventilatör ile taburcu edildi. Taburculuk sonrası
hastaların %30,3’ü (n=27) vefat etmişti.Vefat eden hastaların ortalama yaşam süresi
16,1±18,5 aydı. Non-invaziv mekanik ventilatör ile taburcu edilenlerin %50’si (n=1),
trakeostomi/ev tipi invaziv mekanik ventilatör ile taburcu edilenlerin %42,9’u (n=9) vefat
etmişti.Non-invaziv mekanik ventilatör ve trakeostomi/ev tipi invaziv mekanik ventilatör
ile taburcu edilme ve ölüm arasında anlamlı ilişki saptanmadı.
Sonuç olarak solunum sıkıntısı yenidoğan döneminde önemli bir sağlık sorunudur.
Farklı etyolojik tanılarla yoğun bakıma kabul edilen hastaların bir kısmında yatış nedenleri
tedavi edilse ve çözüme kavuşsa dahi, oksijen ve basınç desteği gereksinimi devam
etmekte ve hastaların bazıları solunum destek cihazları ile taburcu edilmektedir. Son
yıllarda tıbbi teknoloji ve neonatoloji alanındaki gelişmeler sayesinde çok düşük gebelik
haftasına ve çok düşük doğum ağırlığına sahip yenidoğanların sağ kalım oranı giderek
artmaktadır. Bu durum evde solunum destek cihazları ile takip edilen hasta sayısını
katlayarak artırmaktadır ve bir başka sağlık sorununu doğurmaktadır. Bu artan ihtiyacın
karşılanması içinmaddi kaynakların ekonomik kullanımına, gelecek planlamasına ve bu
sorunun azaltılması için ileri araştırmalara gerek duyulmaktadır.
The neonatal period includes the period of 4 weeks following birth. One of the most common problems that occur in newborn babies is respiratory distress. Respiratory distress is one of the most common reasons for an infant's admission to the neonatal intensive care unit. The aim of our study was to determine the neonatal period characteristics, hospitalization and discharge diagnoses, duration of hospitalization, types of respiratory support devices given at discharge, mortality rate and post-discharge course of patients who were admitted to the neonatal intensive care unit for different etiological reasons but were discharged with respiratory support devices due to respiratory distress.In our study, patients who were discharged from our neonatal intensive care unit with respiratory support devices between 2011 and 2021 were retrospectively analyzed. Gender of newborns, week of birth, birth weight, weight by week of birth, apgar scores, diagnosis of intensive care unit admission, duration of stay in intensive care unit, respiratory support and duration given during intensive care hospitalization, discharge diagnoses, types of respiratory support devices given at discharge, survival status and average life expectancy were evaluated. SPSS 22.0 program was used for statistical analysis. A p <0.05 was considered significant. 89 patients who were discharged from our neonatal intensive care unit with respiratory support devices between 2011 and 2021 were included in the study. When the gender distributions were examined, 55.1% (n=49) were male and 44.9% (n=40) were female. The highest rate of admission to the intensive care unit was prematurity with 61.8% (n=55). After prematurity, the most common problem requiring intensive care admission was respiratory distress. When respiratory distress was analyzed by dividing into sub-diagnostic groups, 42.7% (n=38) of the newborns were hospitalized with respiratory distress syndrome, 6.7% (n=6) had pneumothorax, 2.2% (n=2) Transient tachypnea of newborn, 2.2% (n=2) had pneumonia and 3.4% (n=3) had meconium aspiration syndrome. Other important reasons for hospitalization included central nervous system disease with 29.2% (n=26) and congenital heart disease with 22.5% vii (n=20).The mean day of hospitalization in the intensive care unit was 98.3±63.9 days. There was a significant relationship between neonatal intensive care hospital stay and birth weight (p<0.001). As the birth weight decreases, the length of stay in the intensive care unit increases. 14.6% (n=13) of newborns were late preterm, 11.2% (n=10) moderately preterm, 13.5% (n=12) severely preterm, 22.5%' i (n=20) extremely preterm, 31.5% (n=28) early term, 5.6% (n=5) term and 1.1% (n=1) late term. There was a significant negative moderate correlation between the week of birth and the day of hospitalization in the intensive care unit (p<0.001, r=-0.537). As the week of birth increases, the days of intensive care stay decrease. During the intensive care stay, 69.7% (n=62) of the newborns received noninvasive mechanical ventilator support and 85.4% (n=76) invasive mechanical ventilator support. 64% (n=57) of newborns received both non-invasive mechanical ventilator and invasive mechanical ventilator support. Patients who received non-invasive mechanical ventilator support alone were 5.6% (n=5), and patients who received only invasive mechanical ventilator support were 21.3% (n=19). 9% (n=8) of the patients who did not need non-invasive mechanical ventilator and/or invasive mechanical ventilator support and only received oxygen support. The most common diagnoses at discharge were bronchopulmonary dysplasia with 53.9% (n=48) and chronic lung disease with 38.2% (n=34). At discharge, 74.2% (n=66) of the newborns received oxygen concentrator only, 23.6% (n=21) had tracheostomy and home-type invasive mechanical ventilator, 2.2% (n=2) home-type non He was discharged with an invasive mechanical ventilator. 30.3% of the patients (n=27) died. The mean life expectancy of deceased patients was 16.1±18.5 months. 50% (n=1) of those discharged with non-invasive mechanical ventilator and 42.9% (n=9) of those discharged with tracheostomy/home type invasive mechanical ventilator died. No significant correlation was found between discharge and death with non-invasive mechanical ventilator and tracheostomy/home type invasive mechanical ventilator.As a result, respiratory distress is an important health problem in the neonatal period. Even if some of the patients admitted to the intensive care unit with different etiological diagnoses are treated and resolved, the need for oxygen and pressure support continues and some of the patients are discharged with respiratory support devices. Thanks to the developments in medical technology and neonatology in recent years, the survival rate of newborns with very low gestational week and very low birth weight has been increasing. This situation exponentially increases the number of patients followed up with viii respiratory support devices at home and causes another health problem. In order to meet this increasing need, economic use of financial resources and future planning are needed. Further research is needed to reduce this problem.
The neonatal period includes the period of 4 weeks following birth. One of the most common problems that occur in newborn babies is respiratory distress. Respiratory distress is one of the most common reasons for an infant's admission to the neonatal intensive care unit. The aim of our study was to determine the neonatal period characteristics, hospitalization and discharge diagnoses, duration of hospitalization, types of respiratory support devices given at discharge, mortality rate and post-discharge course of patients who were admitted to the neonatal intensive care unit for different etiological reasons but were discharged with respiratory support devices due to respiratory distress.In our study, patients who were discharged from our neonatal intensive care unit with respiratory support devices between 2011 and 2021 were retrospectively analyzed. Gender of newborns, week of birth, birth weight, weight by week of birth, apgar scores, diagnosis of intensive care unit admission, duration of stay in intensive care unit, respiratory support and duration given during intensive care hospitalization, discharge diagnoses, types of respiratory support devices given at discharge, survival status and average life expectancy were evaluated. SPSS 22.0 program was used for statistical analysis. A p <0.05 was considered significant. 89 patients who were discharged from our neonatal intensive care unit with respiratory support devices between 2011 and 2021 were included in the study. When the gender distributions were examined, 55.1% (n=49) were male and 44.9% (n=40) were female. The highest rate of admission to the intensive care unit was prematurity with 61.8% (n=55). After prematurity, the most common problem requiring intensive care admission was respiratory distress. When respiratory distress was analyzed by dividing into sub-diagnostic groups, 42.7% (n=38) of the newborns were hospitalized with respiratory distress syndrome, 6.7% (n=6) had pneumothorax, 2.2% (n=2) Transient tachypnea of newborn, 2.2% (n=2) had pneumonia and 3.4% (n=3) had meconium aspiration syndrome. Other important reasons for hospitalization included central nervous system disease with 29.2% (n=26) and congenital heart disease with 22.5% vii (n=20).The mean day of hospitalization in the intensive care unit was 98.3±63.9 days. There was a significant relationship between neonatal intensive care hospital stay and birth weight (p<0.001). As the birth weight decreases, the length of stay in the intensive care unit increases. 14.6% (n=13) of newborns were late preterm, 11.2% (n=10) moderately preterm, 13.5% (n=12) severely preterm, 22.5%' i (n=20) extremely preterm, 31.5% (n=28) early term, 5.6% (n=5) term and 1.1% (n=1) late term. There was a significant negative moderate correlation between the week of birth and the day of hospitalization in the intensive care unit (p<0.001, r=-0.537). As the week of birth increases, the days of intensive care stay decrease. During the intensive care stay, 69.7% (n=62) of the newborns received noninvasive mechanical ventilator support and 85.4% (n=76) invasive mechanical ventilator support. 64% (n=57) of newborns received both non-invasive mechanical ventilator and invasive mechanical ventilator support. Patients who received non-invasive mechanical ventilator support alone were 5.6% (n=5), and patients who received only invasive mechanical ventilator support were 21.3% (n=19). 9% (n=8) of the patients who did not need non-invasive mechanical ventilator and/or invasive mechanical ventilator support and only received oxygen support. The most common diagnoses at discharge were bronchopulmonary dysplasia with 53.9% (n=48) and chronic lung disease with 38.2% (n=34). At discharge, 74.2% (n=66) of the newborns received oxygen concentrator only, 23.6% (n=21) had tracheostomy and home-type invasive mechanical ventilator, 2.2% (n=2) home-type non He was discharged with an invasive mechanical ventilator. 30.3% of the patients (n=27) died. The mean life expectancy of deceased patients was 16.1±18.5 months. 50% (n=1) of those discharged with non-invasive mechanical ventilator and 42.9% (n=9) of those discharged with tracheostomy/home type invasive mechanical ventilator died. No significant correlation was found between discharge and death with non-invasive mechanical ventilator and tracheostomy/home type invasive mechanical ventilator.As a result, respiratory distress is an important health problem in the neonatal period. Even if some of the patients admitted to the intensive care unit with different etiological diagnoses are treated and resolved, the need for oxygen and pressure support continues and some of the patients are discharged with respiratory support devices. Thanks to the developments in medical technology and neonatology in recent years, the survival rate of newborns with very low gestational week and very low birth weight has been increasing. This situation exponentially increases the number of patients followed up with viii respiratory support devices at home and causes another health problem. In order to meet this increasing need, economic use of financial resources and future planning are needed. Further research is needed to reduce this problem.
Açıklama
Anahtar Kelimeler
Solunum destek cihazları, Trakeostomi, Ventilasyon, Yenidoğan, Respiratory support devices, Tracheostomy, Ventilation, Newborn
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çopur, A. (2022). Yenidoğan yoğun bakım ünitesinden solunum destek cihazları ile taburcu edilen hastaların değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
