Taburculuk sırasında ekstrauterin büyüme geriliği saptanan prematüre bebeklerde risk faktörlerinin retrospektif olarak değerlendirilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş -Amaç: Tüm dünyada üzerine odaklanılan sorunlardan biri prematüre bebeklerde ekstrauterin büyüme geriliği (EUBG) dir. EUBG, taburculuk sırasındaki vücut ağırlığının, büyüme eğrilerine göre 10 persantilin altında veya z skorunda 2 SD ‘den daha fazla düşme olarak tanımlanmaktadır. EUBG gelişiminde rol oynayan risk faktörlerinin belirlenmesi ve erken tanınması sayesinde alınabilecek yeterli önlemler, prematüre bebeğin sağlıklı büyüme ve gelişiminin sağlanmasına katkı sağlayacaktır. Bu bağlamda çalışmadaki primer amacımız prematüre bebeklerin ünitemiz protokollerince optimal beslenme desteği altında EUBG oranını saptamak, risk faktörlerini belirlemek ve izlemde EUBG gelişebilecek riskli grubun saptanması için ek belirteçlerin bulunmasını sağlamaktır.
Gereç ve Yöntem: Çalışmamız Ege Üniversitesi Çocuk Hastanesi Yenidoğan Yoğun Bakım Ünitesi’nde Ocak 2020-Aralık 2020 tarihleri arasında 12 aylık süreçte yatarak izlenen < 34 hafta ve/veya vücut ağırlığı <2000 gr olan, ilk 24 saati içinde Yenidoğan Yoğun Bakım Ünitesi’ne yatırılan, en az 14 gün yoğun bakımda yatış öyküsü olan, konjenital anomali, genetik anomali ve metabolik hastalığı olmayan, taburculuk sırasında ekstrauterin büyüme geriliği saptanan prematüre bebeklerde risk faktörlerinin belirlenmesi amacıyla, retrospektif tek merkezli kohort çalışması olarak planlandı. Bulgular: Araştırmaya 59 preterm olgu dahil edilmiştir. Bu hastaların 36’sı (%61) kız, 23’ü(%39) erkektir. Hastaların 44’ü 1500-2500 gr arası (DDA), 11’i 1000-1500 gr arası (ÇDDA) ve 4’ü 1000 gramın altında (ADDA) oldukları belirlenmiştir. Olguların, %5’i ileri, %20,5’i erken, %45,7’si orta ve %20,3’ü geç preterm olarak saptanmıştır. Beslenmeye başlamada anne sütü %89,8 oran ile ön plandadır. Beslenme intoleransı gelişim oranı ise %27,1 oranındadır. Taburculukta EUBG’si olanlar 14. gün NTÖ’de orta ve ağır anlamlı yüksek seyretmiştir. Eşlik eden IUGR, EUBG olma riskini 31,1 kat arttırmaktadır Sepsis bulgusu olanların taburculukta EUBG olması istatistiksel olarak anlamlı yüksek ve taburculukta EUBG olma riskini 3,17 kat arttırmaktadır. 36. hafta Fenton ve İntergrowth 21 ölçüm değerlendirme sistemleri arasında kilo, boy ve baş çevresi antropometrik ölçümlerin %10 cut-off percentil ve z skorları (-1SD ve -2SD) değerlendirmelerinde mükemmel uyum sağlanmıştır. Sonuç: Çalışmamızda; preterm bebeklerin büyüme – gelişme izlemlerinde SGA, IUGR, sepsis, literatürde bahsedilen NTÖ ile bebeklerin yakın takibi bize taburculukta EUBG gelişebilecek olguların çok daha erken dönemde saptanması amacıyla kullanılabileceğini ve fosfor (P) başta olmak üzere anlamlı laboratuar parametreleri ile uyumlu olduğunu göstermektedir. Bizim çalışmamızda büyüme izleminde kullanılan önemli parametrelerden biri olan büyüme eğrilerinin karşılaştırmasında mükemmel uyum değeri yakalanmakla birlikte yüzdesel olarak özellikle boy parametresinde Intergrowth-21’in daha duyarlı olduğu görülmüştür.
Introduction-Aim: Extrauterine growth retardation (EUGR) in premature babies is one of the important problems that focused on neonatalogy. EUGR is defined as decreased in body weight at discharge below the 10th percentile on growth curves or more than 2 SD in z-score. It is clear that early recognition and prevent to develop of risk factors absolutely would contribute to healthy growth of premature babies. We aimed to not only determine EUGR ratio and risk factors in preterm babies that has been hospitalized in our neonatalogy unite under optimal nutrition protocols, but also to describe new parameters that can point out to risky group in terms of EUGR development. Materials and Methods: Between January 2020- December 2020 for <34 weeks and/or those with a body weight <2000gr, who were admitted to the Neonatal Intensive Care Unit within the first 24 hours of their lifes the babies were included in study. This study was planned as a retrospective single-center cohort study to determine the risk factors in premature infants who had diagnoses EUGR at discharge, had a history of hospitalization in the intensive care unit for at least 14 days, otherhand the patients who had any of these congenital anomalies, genetic anomalies and metabolic diseases has been excluded from study. Results: A total of 59 preterm cases were included in the study. Of these patients, 36 (61%) were female and 23 (39%) were male. It was determined that 44 of the patients were between 1500-2500 g (LBW), 11 of them were between 1000-1500 g (VLBW), and four of them were under 1000 g (WLBW). Advanced prematurity was determined as 5%, early prematurity was 20.5%, moderate prematurity was 45.7% and late prematurity was 20.3%. It was determined that 89,8% of cases has started to enteral nutrition with breast milk. Feeding intolerans ratio was noted as 27,1%. Nutritionel Screening Scale (NSS) in 14th day in prematures who had diagnosed with EUGR at discharge has been determined moderate and high severity. Presence of IUGR have been determined with increased EUGR risk with 31,1 times. Presence of sepsis was noted statistically significantly higher in EUGR group associated with 3,17 times increased risk in terms of EUGR diagnosed at discharge. In our study showed that the evaluation of 36th week weight, height and head circumference measurements based on Fenton and Intergrowth 21 growth standarts have been resulted in perfectly compatible in terms of cut-off levels of z-scores and percentiles. Conclusion: In our study comorbidities as like SGA, IUGR and sepsis have effect on growth and development of premature babies, other hand it has showned that to follow-up via NST could detect earlier the cases who can be diagnosed with EUGR at discharge and this scale has showned that it is correlated with as a primarly phospor, a number of laboratuary parameters. Other hand our study has pointed that Intergrowth-21 is more sensitive to detect EUGR based on especially height measurement although antropometric measurements based on Fenton and Intergrowth 21 growth standarts have been resulted in perfectly compatible in terms of cut-off levels of z-scores and percentiles.
Introduction-Aim: Extrauterine growth retardation (EUGR) in premature babies is one of the important problems that focused on neonatalogy. EUGR is defined as decreased in body weight at discharge below the 10th percentile on growth curves or more than 2 SD in z-score. It is clear that early recognition and prevent to develop of risk factors absolutely would contribute to healthy growth of premature babies. We aimed to not only determine EUGR ratio and risk factors in preterm babies that has been hospitalized in our neonatalogy unite under optimal nutrition protocols, but also to describe new parameters that can point out to risky group in terms of EUGR development. Materials and Methods: Between January 2020- December 2020 for <34 weeks and/or those with a body weight <2000gr, who were admitted to the Neonatal Intensive Care Unit within the first 24 hours of their lifes the babies were included in study. This study was planned as a retrospective single-center cohort study to determine the risk factors in premature infants who had diagnoses EUGR at discharge, had a history of hospitalization in the intensive care unit for at least 14 days, otherhand the patients who had any of these congenital anomalies, genetic anomalies and metabolic diseases has been excluded from study. Results: A total of 59 preterm cases were included in the study. Of these patients, 36 (61%) were female and 23 (39%) were male. It was determined that 44 of the patients were between 1500-2500 g (LBW), 11 of them were between 1000-1500 g (VLBW), and four of them were under 1000 g (WLBW). Advanced prematurity was determined as 5%, early prematurity was 20.5%, moderate prematurity was 45.7% and late prematurity was 20.3%. It was determined that 89,8% of cases has started to enteral nutrition with breast milk. Feeding intolerans ratio was noted as 27,1%. Nutritionel Screening Scale (NSS) in 14th day in prematures who had diagnosed with EUGR at discharge has been determined moderate and high severity. Presence of IUGR have been determined with increased EUGR risk with 31,1 times. Presence of sepsis was noted statistically significantly higher in EUGR group associated with 3,17 times increased risk in terms of EUGR diagnosed at discharge. In our study showed that the evaluation of 36th week weight, height and head circumference measurements based on Fenton and Intergrowth 21 growth standarts have been resulted in perfectly compatible in terms of cut-off levels of z-scores and percentiles. Conclusion: In our study comorbidities as like SGA, IUGR and sepsis have effect on growth and development of premature babies, other hand it has showned that to follow-up via NST could detect earlier the cases who can be diagnosed with EUGR at discharge and this scale has showned that it is correlated with as a primarly phospor, a number of laboratuary parameters. Other hand our study has pointed that Intergrowth-21 is more sensitive to detect EUGR based on especially height measurement although antropometric measurements based on Fenton and Intergrowth 21 growth standarts have been resulted in perfectly compatible in terms of cut-off levels of z-scores and percentiles.
Açıklama
Anahtar Kelimeler
Ekstrauterin Büyüme Geriliği, Beslenme, Prematürite, Extrauterine Growth Retardation, Nutrition, Prematurity
