학술논문
The Impact of Treatment Options on Neurodevelopmental Status of Neonates with Jaundice Requiring Exchange Transfusion/Kan Degisimi Gerektiren Yenidogan Sariliginda Risk Faktorleri, Tedavi Seceneklerinin Norogelisimsel Duruma Etkisi
ORIGINAL ARTICLE/OZGUN ARASTIRMA
ORIGINAL ARTICLE/OZGUN ARASTIRMA
Document Type
Report
Author
Source
The Journal of Current Pediatrics. August 2021, Vol. 19 Issue 2, p151, 11 p.
Subject
Language
Turkish
ISSN
1304-9054
Abstract
Giris Indirekt hiperbilirubinemi (IHB), yenidogan doneminde en sik hastane yatis nedenleri arasindadir. Ozellikle gelismekte olan ulkelerde onemli bir halk sagligi sorunu olmaya devam etmektedir (1). IHB saglikli, term bebeklerde %60 [...]
Introduction: Though predicting the emerging hyperbiluribinemia is the rational approach, timely exchange transfusion in significant neonatal hyperbilirubinemia is vital. The aim of this study is to evaluate the socio-demographic and clinical characteristics of newborns with significant hyperbilirubinemia, to evaluate risk factors for exchange transfusion and long-term neurodevelopmental status. Materials and Methods: Newborns who were admitted with bilirubin levels above the excahge transfusion thresholds (American Academy of Pediatrics, guideline 2004) total 104 cases were enrolled to the study. A total of 65 cases at 12- 36 months were evaluated with Guide for Monitoring Child Development. The clinical and demographic characteristics, risk factors, treatment modalities, etiology of the groups and long-term neurodevelopmental status were compared between the groups with and without exchange transfusion, Results: Exchange transfusion was performed in 19 (18.3%) patients. Main factors that increase the risk of exchange transfusion were bilirubin level and bilirubin/albumin ratio. Cut-off bilirubin level and bilirubin/albumin ratio which increase the risk for exchage transfusion were 26.43mg/dl and 7.43mg/g respectively. The underlying etiologies were hemolytic disease (29.8%), dehydration and breast milk jaundice (28.8%), prematurity (26.9%). Late comers (postnatal >96 hours) were more likely to have bilirubin level [greater than or equal to] 25 mg/dl. Development delays were detected in 13.8% of 65 cases. Conclusions: Admission bilirubin level and the ratio of bilirubin to albumin was among the factors that increase the risk of exchange transfusion. Late admission with significant hyperbiluribinemia may be prevented by identification of neonates at risk for developing significant hyperbilirubinemia before discharge or early in follow-up. Keywords Hyperbilirubinemia, exchange transfusion, jaundice, newborn Giris: Yenidogan sariliginda kan degisimi, yasamsal onemde ancak riskleri olan girisimsel bir islemdir. Kan degisimi gerektirecek hiperbilirubinemi gelisiminin onlenmesi oncelikli yaklasimdir. Calismamizda siddetli hiperbilirubinemide, kan degisimi risk faktorleri ve ileri donem norogelisimsel durumun arastirilmasi amaclanmistir. Gerec ve Yontem: Total serum bilirubin degeri Amerikan Pediatri Akademisi rehberine gore kan degisimi sinirinda veya sinirin ustunde, 35 ve ustu gestasyonel hafta dogumlu 104 yenidogan calismaya dahil edildi. Olgularin 12-36 ayindayken ulasilabilen 65'ine Gelisimi Izleme ve Destekleme Rehberi uygulandi. Kan degisimi uygulanan ve uygulanmayanlar sosyodemografik ozellikler, risk faktorleri, etiyoloji, tedavi surecleri ve ileri donem norogelisimsel durum acilarindan karsilastirildi. Bulgular: Kan degisimi olgularin %18,3'unde uygulandi. Basvuru total serum bilirubin ve bilirubin/albumin orani yuksekligi kan degisimi riskini arttiran temel degiskenlerdi. Kan degisimi riskini artiran esik degerler, total serum bilirubinde 26,43 mg/dl ve bilirubin albumin oraninda 7,43 mg/g saptandi. Sarilik etiyolojisinde ilk uc sirada; hemolitik hastalik, dehidratasyon ve erken anne sutu sariligi ile prematurelik saptandi. Etiyolojilerle tedavi sekilleri arasinda anlamli iliski bulunmadi. Postnatal 96 saatten sonra hastaneye basvuranlarin istatistiksel anlamli yusek bilirubinle ([greater than or equal to] 25 mg/dl) yattigi goruldu. On iki-otuz alti ayinda degerlendirilen 65 olgunun %13,8'inde farkli alanlarda gelisimsel gecikme saptandi. Basvuru zamani, tedavi sekilleri, total serum bilirubin ve bilirubin albumin oraniyla norogelisimsel durum arasinda anlamli farklilik saptanmadi. Sonuc: Kan degisimi icin baslica risk faktorleri yuksek total serum bilirubin ve bilirubin albumin orani bulundu. Hastaneye gec basvuranlarin daha siklikla ciddi hiperbilirubinemiyle yatmasi, taburculuk oncesi riskli grubun saptanmasi temel yaklasiminin onemini vurgulamaktadir. Ciddi hiperbilirubinemili olgular gelisimsel gecikmeler icin riskli sayilmali, duzenli izlem ve erken taniyla mudahale firsatlari kacirilmamalidir. Anahtar kelimeler Hiperbilirubinemi, kan degisimi, norogelisim, yenidogan
Introduction: Though predicting the emerging hyperbiluribinemia is the rational approach, timely exchange transfusion in significant neonatal hyperbilirubinemia is vital. The aim of this study is to evaluate the socio-demographic and clinical characteristics of newborns with significant hyperbilirubinemia, to evaluate risk factors for exchange transfusion and long-term neurodevelopmental status. Materials and Methods: Newborns who were admitted with bilirubin levels above the excahge transfusion thresholds (American Academy of Pediatrics, guideline 2004) total 104 cases were enrolled to the study. A total of 65 cases at 12- 36 months were evaluated with Guide for Monitoring Child Development. The clinical and demographic characteristics, risk factors, treatment modalities, etiology of the groups and long-term neurodevelopmental status were compared between the groups with and without exchange transfusion, Results: Exchange transfusion was performed in 19 (18.3%) patients. Main factors that increase the risk of exchange transfusion were bilirubin level and bilirubin/albumin ratio. Cut-off bilirubin level and bilirubin/albumin ratio which increase the risk for exchage transfusion were 26.43mg/dl and 7.43mg/g respectively. The underlying etiologies were hemolytic disease (29.8%), dehydration and breast milk jaundice (28.8%), prematurity (26.9%). Late comers (postnatal >96 hours) were more likely to have bilirubin level [greater than or equal to] 25 mg/dl. Development delays were detected in 13.8% of 65 cases. Conclusions: Admission bilirubin level and the ratio of bilirubin to albumin was among the factors that increase the risk of exchange transfusion. Late admission with significant hyperbiluribinemia may be prevented by identification of neonates at risk for developing significant hyperbilirubinemia before discharge or early in follow-up. Keywords Hyperbilirubinemia, exchange transfusion, jaundice, newborn Giris: Yenidogan sariliginda kan degisimi, yasamsal onemde ancak riskleri olan girisimsel bir islemdir. Kan degisimi gerektirecek hiperbilirubinemi gelisiminin onlenmesi oncelikli yaklasimdir. Calismamizda siddetli hiperbilirubinemide, kan degisimi risk faktorleri ve ileri donem norogelisimsel durumun arastirilmasi amaclanmistir. Gerec ve Yontem: Total serum bilirubin degeri Amerikan Pediatri Akademisi rehberine gore kan degisimi sinirinda veya sinirin ustunde, 35 ve ustu gestasyonel hafta dogumlu 104 yenidogan calismaya dahil edildi. Olgularin 12-36 ayindayken ulasilabilen 65'ine Gelisimi Izleme ve Destekleme Rehberi uygulandi. Kan degisimi uygulanan ve uygulanmayanlar sosyodemografik ozellikler, risk faktorleri, etiyoloji, tedavi surecleri ve ileri donem norogelisimsel durum acilarindan karsilastirildi. Bulgular: Kan degisimi olgularin %18,3'unde uygulandi. Basvuru total serum bilirubin ve bilirubin/albumin orani yuksekligi kan degisimi riskini arttiran temel degiskenlerdi. Kan degisimi riskini artiran esik degerler, total serum bilirubinde 26,43 mg/dl ve bilirubin albumin oraninda 7,43 mg/g saptandi. Sarilik etiyolojisinde ilk uc sirada; hemolitik hastalik, dehidratasyon ve erken anne sutu sariligi ile prematurelik saptandi. Etiyolojilerle tedavi sekilleri arasinda anlamli iliski bulunmadi. Postnatal 96 saatten sonra hastaneye basvuranlarin istatistiksel anlamli yusek bilirubinle ([greater than or equal to] 25 mg/dl) yattigi goruldu. On iki-otuz alti ayinda degerlendirilen 65 olgunun %13,8'inde farkli alanlarda gelisimsel gecikme saptandi. Basvuru zamani, tedavi sekilleri, total serum bilirubin ve bilirubin albumin oraniyla norogelisimsel durum arasinda anlamli farklilik saptanmadi. Sonuc: Kan degisimi icin baslica risk faktorleri yuksek total serum bilirubin ve bilirubin albumin orani bulundu. Hastaneye gec basvuranlarin daha siklikla ciddi hiperbilirubinemiyle yatmasi, taburculuk oncesi riskli grubun saptanmasi temel yaklasiminin onemini vurgulamaktadir. Ciddi hiperbilirubinemili olgular gelisimsel gecikmeler icin riskli sayilmali, duzenli izlem ve erken taniyla mudahale firsatlari kacirilmamalidir. Anahtar kelimeler Hiperbilirubinemi, kan degisimi, norogelisim, yenidogan