Kordon klempleme zamanının term ve preterm yenidoğanlarda oksidan-antioksidan medyatörler üzerine etkisi
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Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kordon klempleme, günümüzde her doğumda uygulanmasına rağmen süresi ve tekniği ile ilgili ortak bir yöntem belirlenememiştir. Geçmiş yıllarda uygulanan geç kordon klemplenmesi (30-60 sn) yapılan doğum sayısının artmasıyla yerini erken kordon klemplenmesine (0-29 sn) bırakmıştır. Klempleme zamanındaki değişim bağlamında, net ve ortak bir tekniğin olmaması bu konuya ilginin artmasına neden olmuştur. Doğumda düşük oksijenli intrauterin ortamdan yüksek oksijenli ekstrauterin ortama geçen yenidoğan bebeklerde serbest oksijen radikalleri üretiminde artış olmaktadır. Neonatal tıp alanındaki gelişmeler sayesinde çok düşük ağırlıklı ve immatür bebeklerin yaşatılması mümkün hale gelmiştir. Bu bebeklerde mekanik ventilasyon, resusitasyon gibi işlemler serbest oksijen radikali üretimini artırmaktadır. Ancak yenidoğan bebeklerde ve özellikle prematüre bebeklerde antioksidan savunma sistemi yeteri kadar gelişmemiştir. Tüm bunların sonucunda bu bebekler oksidan strese karşı büyük risk altındadır. Oluşan oksidatif stres diabetes mellitus, nekrotizan enterokolit (NEK), patent duktus arteriosus (PDA), hipoksik iskemik ensefalopati (HİE), prematüre retinopatisi (ROP), bronkopulmoner displazi (BPD), periventrikuler lökomalazi (PVL), intraventriküler hemoraji (İVH) gibi patolojiler başta olmak üzere çok fazla hastalığın gelişmesinden sorumlu tutulmaktadır. Bu hastalıkların önlenmesi için önerilen çözümlerden biri, antioksidan takviyesi ile serbest oksijen radikallerinin oluşumunun engellenmesidir. Kordon klemplenme zamanı, kan akımı sürdüğü zaman boyunca geçişi devam eden medyatörler nedeni ile bebeklerdeki oksidan-antioksidan denge üzerine etkili olabilir. AMAÇ: Bu çalışmada; term ve preterm yenidoğanlarda kordon klemplenme zamanının, bebeklerdeki oksidan ve antioksidan medyatörler üzerine etkilerinin aydınlatılması amaçlanmıştır. MATERYAL VE METOD: Çalışmamıza Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğine Nisan 2018- Haziran 2018 tarihleri arasında sezaryen endikasyonu olup doğum yapan 80 gebe dahil edildi. Gebeler gestasyonel haftalarına göre preterm ve term (<37, ≥37) olmak üzere her biri 40'ar kişilik iki gruba ayrıldı. Bu gruplar daha sonra kendi içerisinde hemen klempleme yapılanlar ve en az 30 sn beklendikten sonra klempleme yapılanlar olmak üzere iki alt gruba ayrıldı. Sezaryen sırasında alınan umblikal kan örneklerinde katalaz, MDA, MPO, HIF1α ve PGF2 α gibi oksidan-antioksidan medyatör düzeyleri ölçülerek kordon klemplenme zamanının bu medyatör düzeylerine etkisinin incelenmesi hedeflendi. Hastalardan 2 tanesinin kan örneklerinin hemolizli olması nedeniyle bu hastalar çalışmadan çıkarıldı ve kalan 78 hasta ile çalışma tamamlandı. SONUÇLAR: Sonuçlar değerlendirildiğinde; gruplar arasında maternal yaş, gravida, parite ve abortus sayısı yönünden istatiksel olarak anlamlı bir fark saptanmadı. PGF2α, HIF1α ve MDA açısından istatistiksel olarak anlamlı sonuçlar elde edildi ancak katalaz ve MPO düzeyleri için sonuçlar istatistiksel olarak anlamlı değildi. TARTIŞMA: Çalışmamızın sonucunda; umblikal kordun geç klemplenmesinin özellikle preterm yenidoğanlarda oksidatif stresle başa çıkmayı da iyileştirdiği ve böylece bebeği oksidan strese daha dayanıklı hale getirdiğini de göstermiş olmaktayız. Ayrıca günümüzde artan sezaryen doğumlar için geç kordon klemplenmesinin yararları konusunda yeterli çalışma bulunmamaktadır. Bizim çalışmamıza ise sadece sezaryen ile doğum yapan gebe hastalar dahil edilmiştir. Bu da, günümüzde artan sezaryen oranları ve bu konuda yapılmış çalışmaların azlığı nedeniyle ayrı bir önem taşımaktadır. Çalışmamızın bu yönde yapılacak diğer çalışmalara ışık tutacağını düşünmekteyiz.
INTRODUCTION: Although the cord clamping is applied in every birth, a common method has not been determined regarding its duration and technique. Late cord clamping (30-60 sec) applied in previous years has been replaced by early cord clamping (0-29 sec) with increasing number of deliveries. In the context of the change in clamping time, the lack of a clear and common technique has increased the interest in this issue. There is an increase in the production of free oxygen radicals in newborn infants who have undergone a low oxygenation intrauterine environment and a high oxygenated extrauterine environment at birth. Thanks to advances in neonatal medicine, very low weight and immature babies have become possible. In these infants, mechanical ventilation and resuscitation increases the production of free oxygen radicals. However, antioxidant defense system has not been developed enough in newborn infants and especially premature infants. As a result, these infants are at great risk for oxidant stress. The resulting oxidative stress is responsible for the development of many diseases, such as diabetes mellitus, necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), hypoxic ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH). One of the proposed solutions for the prevention of these diseases is the inhibition of the formation of free oxygen radicals by antioxidant supplementation. The cord clamping time may be effective on the oxidant-antioxidant balance in babies due to mediators that continue to pass through when blood flow continues. OBJECTIVE: In our study we aimed to clarify the effects of cord clamping time on oxidant and antioxidant mediators in term and preterm newborns. MATERIAL AND METHOD: In our study, we included 80 pregnant women who were admitted to the Department of Obstetrics and Gynecology, Ege University Hospital between April 2018 and June 2018 and required cesarean section. Pregnants were divided into two groups, each of which consisted of preterm and term (<37, ≥37) according to their gestational weeks. These groups were then divided into two subgroups, including those that were immediately clamped in their own, and after waiting for at least 30 sec. In the cord blood samples taken during cesarean section, oxidant-antioxidant mediator levels such as catalase, MDA, MPO, HIF1α and PGF2α were measured and the effect of cord clamping time on these mediator levels was aimed. Because of the hemolysis of the blood samples of 2 patients, these patients were excluded from the study and the study was completed with the remaining 78 patients. RESULTS: When the results are evaluated; there was no statistically significant difference between the groups in terms of maternal age, gravida, parity and number of abortion. There were statistically significant results for PGF2α, HIF1α and MDA but no significant results were obtained for catalase and MPO levels. CONCLUSION: Our study showed that late clamping of the umblical cord improves the coping with oxidative stress, especially in preterm newborn babies, thus making the baby more resistant to oxidative stress. Furthermore, there is not enough study on the benefits of late cord clamping for increased cesarean delivery. In our study, only pregnant women who had delivered by cesarean section were included. This is of particular importance due to increasing cesarean rates and the lack of studies in this area. Our aim is to be a leading study for the future studies.
INTRODUCTION: Although the cord clamping is applied in every birth, a common method has not been determined regarding its duration and technique. Late cord clamping (30-60 sec) applied in previous years has been replaced by early cord clamping (0-29 sec) with increasing number of deliveries. In the context of the change in clamping time, the lack of a clear and common technique has increased the interest in this issue. There is an increase in the production of free oxygen radicals in newborn infants who have undergone a low oxygenation intrauterine environment and a high oxygenated extrauterine environment at birth. Thanks to advances in neonatal medicine, very low weight and immature babies have become possible. In these infants, mechanical ventilation and resuscitation increases the production of free oxygen radicals. However, antioxidant defense system has not been developed enough in newborn infants and especially premature infants. As a result, these infants are at great risk for oxidant stress. The resulting oxidative stress is responsible for the development of many diseases, such as diabetes mellitus, necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), hypoxic ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH). One of the proposed solutions for the prevention of these diseases is the inhibition of the formation of free oxygen radicals by antioxidant supplementation. The cord clamping time may be effective on the oxidant-antioxidant balance in babies due to mediators that continue to pass through when blood flow continues. OBJECTIVE: In our study we aimed to clarify the effects of cord clamping time on oxidant and antioxidant mediators in term and preterm newborns. MATERIAL AND METHOD: In our study, we included 80 pregnant women who were admitted to the Department of Obstetrics and Gynecology, Ege University Hospital between April 2018 and June 2018 and required cesarean section. Pregnants were divided into two groups, each of which consisted of preterm and term (<37, ≥37) according to their gestational weeks. These groups were then divided into two subgroups, including those that were immediately clamped in their own, and after waiting for at least 30 sec. In the cord blood samples taken during cesarean section, oxidant-antioxidant mediator levels such as catalase, MDA, MPO, HIF1α and PGF2α were measured and the effect of cord clamping time on these mediator levels was aimed. Because of the hemolysis of the blood samples of 2 patients, these patients were excluded from the study and the study was completed with the remaining 78 patients. RESULTS: When the results are evaluated; there was no statistically significant difference between the groups in terms of maternal age, gravida, parity and number of abortion. There were statistically significant results for PGF2α, HIF1α and MDA but no significant results were obtained for catalase and MPO levels. CONCLUSION: Our study showed that late clamping of the umblical cord improves the coping with oxidative stress, especially in preterm newborn babies, thus making the baby more resistant to oxidative stress. Furthermore, there is not enough study on the benefits of late cord clamping for increased cesarean delivery. In our study, only pregnant women who had delivered by cesarean section were included. This is of particular importance due to increasing cesarean rates and the lack of studies in this area. Our aim is to be a leading study for the future studies.
Açıklama
Anahtar Kelimeler
Kordon Klempleme, Yenidoğan, Oksidan, Antioksidan, Sezaryen, Cord Clamping, Newborn, Oxidant, Antioxidant, Cesarean
