Aile merkezli yenidoğan yoğun bakım ünitesinde ileri düzey non-invaziv izlem ve takip platformu ile hiperbilirubinemili hastaların yönetimi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ ve AMAÇ: Sarılık, kandaki bilirubin düzeyinin artması sonucu deri, sklera ve mukozaların sarı renk alması durumudur. Yenidoğan döneminde en sık karşılaşılan problemlerden biri olup yaşamın ilk iki haftasında hastaneye yatışın en sık nedenidir. Ciddi hiperbilirubinemi zamanında tanı alırsa ve tedavi edilirse akut bilirubin ensefalopatisi ve kernikterus gibi ciddi nörolojik komplikasyonlar önlenebilir. Son yıllarda invaziv monitörizasyon yöntemleri yerine non-invaziv monitörizasyon yöntemlerine olan yönelim artmaktadır. Non-invaziv yöntem olarak nabız oksimetre kullanımı yaygınlaşmıştır. Bu nabız oksimetre teknolojisi günümüzde daha da geliştirilerek yedi dalga boylu ko-oksimetre yöntemi ortaya çıkmıştır. Nabız ko-oksimetre yöntemiyle hemoglobin (Hb) düzeyinin non-invaziv olarak spektrofotometrik yöntemle ciltten ölçümü (SpHb), pletismografik varyabilite indeksi (PVİ), perfüzyon indeksi (Pİ), oksijen satürasyonu (SpO2), kalp tepe atımı (KTA) parametreleri aynı anda ölçülebilmektedir. Bu çalışmanın amacı da Hb ve bilirubinin non-invaziv ölçümlerinin doğruluğu ve güvenilirliğinin laboratuvar ölçümleriyle karşılaştırılmasıdır. Ayrıca hiperbilirubinemi nedeniyle hastaneye yatırılan olguların yönetiminde non-invaziv yöntemlerin uygulanabilirliğini değerlendirmek amaçlanmıştır.
GEREÇ ve YÖNTEM: Çalışmamız Ege Üniversitesi Tıp Fakültesi Aile Merkezli Yenidoğan Yoğun Bakım Ünitesinde prospektif olarak Mayıs 2021- Ekim 2021 tarihleri arasında yürütüldü.Çalışmamıza GH≥35 hafta olan ve hiperbilirubinemi nedeniyle yatırılan ve fototerapi alan toplam 35 olgu dahil edildi. Olguların demografik, klinik, laboratuvar bulgular ve hiperbilirubinemi risk faktörleri olgu formuna kaydedildi. Transkutan bilirubin olguların yatışında, fototerapi kesildiğinde ve fototerapi kesildikten 6 saat sonra ölçüldü. Ko-oksimetre (Masimo Radical-7) ile SpHb ölçümü olgudan kan alındığında ölçüldü. Veriler Sınıf İçi Korelasyon ve Bland-Altman yöntemi ile analiz edildi. BULGULAR: Çalışmamıza dahil edilen toplam 35 olgunun 20’si (%57,1) kız, 15’i (%42,9) erkekti. Olguların ortalama gestasyonel haftası36,9±1,3 (35-40) hafta saptandı.Tüm olgularımız fototerapiyle tedavi edildi, sadece 1 olgumuz fototerapiye ek olarak İVİG (İntravenöz immünglobulin) tedavisi aldı. Hiçbir olgumuza kan değişimi uygulanmadı. Hiperbilirubinemi risk faktörlerine bakıldığında en sık sebep ABO uygunsuzluğu olarak görüldü (%28,6). Olguların yatışında ko-oksimetre ile ölçülen SpHb (spektrofotometrik hemoglobin) ve alınan venöz kandaki hemoglobin değerleri Sınıf-içi Korelasyon (ICC) ile değerlendirildiğinde istatistik olarak kabul edilebilir düzeyde korele saptandı (r 0,786, p<0,001). Ko-oksimetre ile ölçülen non-invaziv hemoglobin değerleri laboratuvar hemoglobin değerleriyle karşılaştırıldığında daha düşük saptandı (16,9±2,2 SD-16,2±1,6 SD mg/dL). İki yöntemle ölçülen hemoglobin değerleri Bland-Altman yöntemiyle analiz edildiğinde bias 0,7 gr/dl %95 GA -2,6 ile 3,9 mg/dL saptandı. STB ve alından ölçülen trans kutan bilirubin değerleri arasındaki uyuma bakıldığında fototerapi öncesi ve sonrası güçlü bir korelasyon saptandı (r0,938-0,897, p<0,001). SONUÇ: Sonuç olarak çalışmamızda non-invaziv hemoglobin ve bilirubin ölçümlerinin laboratuvar değerleriyle korele olduğunu saptandı. Hiperbilirubinemili olguların tanı ve tedavisininyönetiminon-invaziv yöntemler kullanılarak yapıldığında kan alma gibi ağrılı işlemlerin azalacağı, iyatrojenik anemi ve enfeksiyonların önüne geçilebileceği düşünülmektedir. Tabiki non-invaziv yöntemlerin güvenilirliği vekullanılabilirliği için daha fazla klinikçalışma yapılmalıdır.
INTRODUCTION and AIM: Jaundice is yellowing of the skin, scleras, and mucous membranes as a result of the increase in blood bilirubin level. It’s one of the most common problems of the newborn and the most common cause of hospitalization in the first two weeks of life. The timely diagnosis and management of severe hyperbilirubinemia are essential to prevent acute bilirubin encephalopathy and kernicterus. The trend towards non-invasive monitoring methods instead of invasive monitoring methods has increased recently. The use of pulse oximetry as a noninvasive method has become widespread. This pulse oximetry technology has been further developed today, resulting in the seven-wavelength co-oximetry method. Non-invasive measurement of hemoglobin level by spectrophotometric method (SpHb), plethysmographic variability index (PVI), perfusion index (PI), oxygen saturation (SpO2), peak heart rate (HR) parameters can be measured simultaneously with the pulse co-oximetry method. The purpose of this study was to assess the accuracy and utility of the non-invasive measurement of Hb and bilirubin compared to standard laboratory measurements. This study, it was aimed to evaluate the clinical applicability of noninvasive measurements in neonates who admitted to the hospital due to hyperbilirubinemia. MATERIALS and METHOD: This study between May 2021 and October 2021 was prospectively examined in the Family-Centered Neonatal Intensive Care Unit of Ege University Faculty of Medicine. Thirty-five newborns with gestational age ≥35 weeks who were admitted to the hospital due to hyperbilirubinemia and received phototherapy were included in the study. The case report form included demographic, clinical, laboratory findings, and risk factors of hyperbilirubinemia on the infants. Transcutan bilirubin was measured at admission, discontinuation of phototherapy, and 6 h later. SpHb levels were measured with CO-Oximetry (Masimo Radical-7) at the time of laboratory Hb blood draw. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were performed. RESULTS: Of the 35 newborns included in the study, 20 (%57,1) were female and 15 (%42,9) were male. The mean gestational week was 36,9±1,3 (35-40) weeks. All infants received phototherapy, only 1 infant received intravenous immunoglobulin in addition to phototherapy. Exchange transfusion was not required. ABO blood incompatibility was the most common cause of risk factors of hyperbilirubinemia (%28,6). There was a statistically significant correlation in a positive direction between hemoglobin values obtained with the Masimo (SpHb) and venous hemoglobin levels (r 0,764, p<0,001). Hb values measured with a pulse CO-oximeter were lower than those measured with a laboratory hematology analyzer (16,9±2,2 SD -16,2±1,6 SD mg/dL). The difference between Hb levels by the two methods analyzed using Bland-Altman method, the mean bias between SpHb and Hb-Lab was 0.05 g/dl and the 95% limits of agreement were -2,6 to 3,9 g/dL. There is a statistically significant positive and strong correlation between STB and transcutaneous values before and after phototherapy (r 0,938-0,897, p<0,001). CONCLUSION: In conclusion, we found that non-invasive hemoglobin and bilirubin measurements were correlated with laboratory values in our study. It is thought that when the diagnosis and treatment of hyperbilirubinemia cases are managed using non-invasive methods, painful procedures such as bloodletting will decrease, and iatrogenic anemia and infections can be prevented. Of course, more clinical studies should be done for the reliability and utility of non-invasive methods.
INTRODUCTION and AIM: Jaundice is yellowing of the skin, scleras, and mucous membranes as a result of the increase in blood bilirubin level. It’s one of the most common problems of the newborn and the most common cause of hospitalization in the first two weeks of life. The timely diagnosis and management of severe hyperbilirubinemia are essential to prevent acute bilirubin encephalopathy and kernicterus. The trend towards non-invasive monitoring methods instead of invasive monitoring methods has increased recently. The use of pulse oximetry as a noninvasive method has become widespread. This pulse oximetry technology has been further developed today, resulting in the seven-wavelength co-oximetry method. Non-invasive measurement of hemoglobin level by spectrophotometric method (SpHb), plethysmographic variability index (PVI), perfusion index (PI), oxygen saturation (SpO2), peak heart rate (HR) parameters can be measured simultaneously with the pulse co-oximetry method. The purpose of this study was to assess the accuracy and utility of the non-invasive measurement of Hb and bilirubin compared to standard laboratory measurements. This study, it was aimed to evaluate the clinical applicability of noninvasive measurements in neonates who admitted to the hospital due to hyperbilirubinemia. MATERIALS and METHOD: This study between May 2021 and October 2021 was prospectively examined in the Family-Centered Neonatal Intensive Care Unit of Ege University Faculty of Medicine. Thirty-five newborns with gestational age ≥35 weeks who were admitted to the hospital due to hyperbilirubinemia and received phototherapy were included in the study. The case report form included demographic, clinical, laboratory findings, and risk factors of hyperbilirubinemia on the infants. Transcutan bilirubin was measured at admission, discontinuation of phototherapy, and 6 h later. SpHb levels were measured with CO-Oximetry (Masimo Radical-7) at the time of laboratory Hb blood draw. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were performed. RESULTS: Of the 35 newborns included in the study, 20 (%57,1) were female and 15 (%42,9) were male. The mean gestational week was 36,9±1,3 (35-40) weeks. All infants received phototherapy, only 1 infant received intravenous immunoglobulin in addition to phototherapy. Exchange transfusion was not required. ABO blood incompatibility was the most common cause of risk factors of hyperbilirubinemia (%28,6). There was a statistically significant correlation in a positive direction between hemoglobin values obtained with the Masimo (SpHb) and venous hemoglobin levels (r 0,764, p<0,001). Hb values measured with a pulse CO-oximeter were lower than those measured with a laboratory hematology analyzer (16,9±2,2 SD -16,2±1,6 SD mg/dL). The difference between Hb levels by the two methods analyzed using Bland-Altman method, the mean bias between SpHb and Hb-Lab was 0.05 g/dl and the 95% limits of agreement were -2,6 to 3,9 g/dL. There is a statistically significant positive and strong correlation between STB and transcutaneous values before and after phototherapy (r 0,938-0,897, p<0,001). CONCLUSION: In conclusion, we found that non-invasive hemoglobin and bilirubin measurements were correlated with laboratory values in our study. It is thought that when the diagnosis and treatment of hyperbilirubinemia cases are managed using non-invasive methods, painful procedures such as bloodletting will decrease, and iatrogenic anemia and infections can be prevented. Of course, more clinical studies should be done for the reliability and utility of non-invasive methods.
Açıklama
Anahtar Kelimeler
Anahtar kelime mevcut olmadığı için bu alan boş bırakılmıştır.
