Öz
Amaç: Bu çalışmada, yenidoğan yoğun bakım ünitesinde farklı tanılarla izlenen bebeklerin kan basınçlarının sağlıklı bebeklerle karşılaştırılması, doğum şekli, gebelik yaşı, kilo, cinsiyet ve postnatal yaşa göre değerlendirilmesi ve hipertansiyon sıklığının belirlenmesi amaçlanmıştır.
Gereçler ve Yöntem: Bu prospektif, gözlemsel, kohort bir çalışmada, Ankara Dışkapı Çocuk Hastanesi Yenidoğan Servisinde 1 yıl süreyle izlenen 465 bebeğin kan basıncı değerleri değerlendirildi. Kan basıncı değerlerinin cinsiyet, postnatal yaş, doğum şekli, doğum ağırlığı, annedeki hipertansiyon ve diyabet öyküsü gibi parametreler ile ilişkisi değerlendirildi. Değişik tanı gruplarındaki (respiratuar distres sendromu (RDS), neonatal pnömoni, sepsis, indirek hiperbilirubinemili (İHB)) hasta bebekler, gestasyonel yaşları dikkate alınarak kontrol grubuyla sistolik, diastolik, nabız ve ortalama arteriyel kan basınçları (OAKB) açısından karşılaştırıldı.
Bulgular: Çalışmamıza 465 yenidoğan bebek dahil edildi. Bunlardan 217’si kız idi (%46,7). Doğum ağırlığı ve gebelik yaşı arttıkça kan basıncının da paralel olarak arttığı görüldü (p<0,05). Term ve preterm sepsis, RDS, neonatal pnömoni tanısı olan bebeklerin kontrol grubuna göre sistolik kan basınçları düşük (p<0,05), diastolik kan basınçları ise yüksek bulundu (p<0,05). Altı bebekte hipertansiyon saptandı (%1,3). Bu bebeklerin tanıları bilateral renal displazi (n=1), akut böbrek yetmezliği (dehidratasyona bağlı) (n=1), hipoksik iskemik ensefolopatiye bağlı böbrek yetmezliği (n=1), aort koarktasyonu (n=1), konjenital adrenal hiperplazi (tuz kaybettiren form) (n=1) ve pnömotoraks (n=1) idi.
Sonuç: Yenidoğan yoğun bakım ünitesinde yatan hastaların takip ve tedavisinde tansiyon ölçümü son derece önemlidir. Kan basıncı ölçümü tanı koydurucudur. Bu yüzden ölçüm dikkatli yapılmalıdır. Direkt ölçüm standart olsa da noninvaziv metotlar klinik olarak daha kullanışlıdır.
Anahtar Kelimeler
Yenidoğan Kan basıncı Yenidoğan yoğun bakım Hipertansiyon. Yenidoğan, Kan basıncı, Yenidoğan yoğun bakım, Hipertansiyon.
Destekleyen Kurum
yok
Proje Numarası
-
Teşekkür
-
Kaynakça
- 1. Abman SH, Worady BA, Lum GM. Systemic hypertension in infants with bronkopulmoner dysplasia. J Pediatr 1984;104-928.
- 2. Starr MC, Flynn JT. Neonatal hypertension: cases, causes, and clinical approach. Pediatr Nephrol 2019 May;34(5):787-799.
- 3. Sharma D, Farahbakhsh N, Shastri S, Sharma P. Neonatal hypertension. J Matern Fetal Neonatal Med 2017 Mar;30(5):540-550.
- 4. Giri P, Roth P. Neonatal Hypertension. Pediatr Rev 2020 Jun;41(6):307-311.
- 5. Batisky DL. Neonatal hypertension. Clin Perinatol 2014 Sep;41(3):529-42.
- 6. Arar MY, Hogg RJ, Arant BS. Etiology of sustained hypertension in children in the southhwestern United States. Pediatr Nephrol 1994; 8:186-189.
- 7. Dionne JM, Flynn JT. Management of severe hypertension in the newborn. Arch Dis Child 2017 Dec;102(12):1176-1179.
- 8. Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL. Neonatal Kidney Collaborative (NKC), Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]. Pediatr Res 2018 Aug;84(2):279-289.
- 9. Adelman RD. The hipertensive neonate. Clin Perinatal 1988;15:567.
- 10. Flynn JT. The hypertensive neonate. Semin Fetal Neonatal Med 2020 Oct;25(5):101138.
- 11. Frisen RH, Lichtor JL. İndirect measurement of blood presure in neonates and infants utilazing an outomatic noinvaziv ossilometric monitor. Anest Anolog 1981;60(10):742-745.
- 12. Fanaroff AA, Wright E. Profiles of mean arterial blood pressure for infants weighing 501-1500 grams. Pediatr. Research 1990; 27:205.
- 13. Swiet M, Fayers P, Shinebourne EA. Systolic blood pressure in a population of infants in the first year of life Brompton study. Pediatrics 1980; 65:1028-1035.
- 14. Park MK, Lee DH. Ossilometric blood pressure in the arm, thigt and calf. Pediatric 1993; 91:761-765.
- 15. Zubrow AB, Hulmon S, Kushner H. Determinants of blood pressure in infants admitted to neonatal intensive care units;a prospective multicenter study. J Perinatol 1995; 15:470-479.
- 16. Faxelius G, Logerciantz H, Yao A. Sympathoadrenal activity and peripheral blood flow after birth, comparison in infants delivered vaginally and by cesarean section. J. Pediatr 1984; 105:144-148.
- 17. Gimenez BV, Rosadaj P. Arterial blood pressure in the term neonate in the first month of life. An Esp Pediatr 1986; 25(6):407-410.
- 18. Montoring JV, Ostrea EM. Effect of perinatal factors on blood pressure in neonates. Pediatr Research 1996; 39:228.
- 19. Rennie JM. Cerebral blood flow velocity variability after cardiovasculer support in premature babies. Arch Dis Child 1989; 64:897-901.
- 20. Cabal LA, Larrazabal C, Siassi B. Hemodynamic variables in infants weighing less than 1000grams. Clin Perinatol 1986; 13:327-338.
- 21. Meadow W, Rudinsky B, Bell A. Effects of inhibition of endothellium-derived relaxion factor on hemodynamics and oxygen utilization during group B streptococal sepsis in piglets. Crit Care Med 1995; 23(4):705-714.
- 22. Polat A, Öktem F, Koç H. Yenidoğan hiperbilirübinemili 963v hastanın değerlendirilmesi. TÇ Klinik Dergisi 1993; 2:26-30.
- 23. Wu JM, Yelh TF, Wang JN. The role of pulmonary inflamation in the development of pulmonary hypertension in newborn with meconium aspiration syndrome(MAS). Pediatr Pulmonol Suppl 1999; 18:205-208.
Öz
Objective: In this study, we aimed to compare the blood pressures of babies followed up with different diagnoses in the neonatal intensive care unit with healthy babies, to evaluate them according to delivery type, gestational age, weight, gender and postnatal age, and to determine the frequency of hypertension.
Method: A prospective, observational and cohort study was conducted on blood pressures of 465 infants for a year in Ankara Pediatrics Training Hospital Neonatal Service. The relationship between blood pressure values and parameters such as gender, postnatal age, type of delivery, birth weight, maternal hypertension and diabetes history were evaluated. Ill babies in different diagnosis groups (respiratory distress syndrome(RDS), neonatal pneumonia, sepsis, indirect hyperbilirubinemia (İHB)) were compared with the control group in terms of systolic, diastolic, arterial pulse and mean blood pressures, taking into account their gestational age.
Results: A total of 465 newborns, of whom 217 (46.7%) were female, were included in our study. It was observed that blood pressure increased in parallel with increasing birth weight and gestational age (p <0.05). Compared to the control group, infants diagnosed with early and late neonatal sepsis, RDS and neonatal pneumonia had lower systolic blood pressures (p<0.05) and higher diastolic blood pressures (p<0.05). Hypertension was found in six infants (1.3%). The diagnoses of these babies were as follows; Bilateral Renal Dysplasia (n=1), Acute Prerenal Kidney Failure (Due to Dehydration) (n=1), Hypoxic Ischemic Encephalopathy and Intrinsic Renal Kidney Failure (n=1), Aortic Coarctation (n=1), Congenital Adrenal Hyperplasia (salt-losing form) (n=1) and Pneumothorax (n=1).
Conclusion: Blood pressure measurement is extremely important in the follow-up and treatment of patients hospitalized in the neonatal intensive care unit. Blood pressure measurement is diagnostic. Although direct measurement is standard, noninvasive methods are more clinically useful.
Anahtar Kelimeler
Neonatal Blood pressure Neonatal intensive care Hypertension. Neonatal, Blood pressure, Neonatal intensive care, Hypertension.
Proje Numarası
-
Kaynakça
- 1. Abman SH, Worady BA, Lum GM. Systemic hypertension in infants with bronkopulmoner dysplasia. J Pediatr 1984;104-928.
- 2. Starr MC, Flynn JT. Neonatal hypertension: cases, causes, and clinical approach. Pediatr Nephrol 2019 May;34(5):787-799.
- 3. Sharma D, Farahbakhsh N, Shastri S, Sharma P. Neonatal hypertension. J Matern Fetal Neonatal Med 2017 Mar;30(5):540-550.
- 4. Giri P, Roth P. Neonatal Hypertension. Pediatr Rev 2020 Jun;41(6):307-311.
- 5. Batisky DL. Neonatal hypertension. Clin Perinatol 2014 Sep;41(3):529-42.
- 6. Arar MY, Hogg RJ, Arant BS. Etiology of sustained hypertension in children in the southhwestern United States. Pediatr Nephrol 1994; 8:186-189.
- 7. Dionne JM, Flynn JT. Management of severe hypertension in the newborn. Arch Dis Child 2017 Dec;102(12):1176-1179.
- 8. Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL. Neonatal Kidney Collaborative (NKC), Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]. Pediatr Res 2018 Aug;84(2):279-289.
- 9. Adelman RD. The hipertensive neonate. Clin Perinatal 1988;15:567.
- 10. Flynn JT. The hypertensive neonate. Semin Fetal Neonatal Med 2020 Oct;25(5):101138.
- 11. Frisen RH, Lichtor JL. İndirect measurement of blood presure in neonates and infants utilazing an outomatic noinvaziv ossilometric monitor. Anest Anolog 1981;60(10):742-745.
- 12. Fanaroff AA, Wright E. Profiles of mean arterial blood pressure for infants weighing 501-1500 grams. Pediatr. Research 1990; 27:205.
- 13. Swiet M, Fayers P, Shinebourne EA. Systolic blood pressure in a population of infants in the first year of life Brompton study. Pediatrics 1980; 65:1028-1035.
- 14. Park MK, Lee DH. Ossilometric blood pressure in the arm, thigt and calf. Pediatric 1993; 91:761-765.
- 15. Zubrow AB, Hulmon S, Kushner H. Determinants of blood pressure in infants admitted to neonatal intensive care units;a prospective multicenter study. J Perinatol 1995; 15:470-479.
- 16. Faxelius G, Logerciantz H, Yao A. Sympathoadrenal activity and peripheral blood flow after birth, comparison in infants delivered vaginally and by cesarean section. J. Pediatr 1984; 105:144-148.
- 17. Gimenez BV, Rosadaj P. Arterial blood pressure in the term neonate in the first month of life. An Esp Pediatr 1986; 25(6):407-410.
- 18. Montoring JV, Ostrea EM. Effect of perinatal factors on blood pressure in neonates. Pediatr Research 1996; 39:228.
- 19. Rennie JM. Cerebral blood flow velocity variability after cardiovasculer support in premature babies. Arch Dis Child 1989; 64:897-901.
- 20. Cabal LA, Larrazabal C, Siassi B. Hemodynamic variables in infants weighing less than 1000grams. Clin Perinatol 1986; 13:327-338.
- 21. Meadow W, Rudinsky B, Bell A. Effects of inhibition of endothellium-derived relaxion factor on hemodynamics and oxygen utilization during group B streptococal sepsis in piglets. Crit Care Med 1995; 23(4):705-714.
- 22. Polat A, Öktem F, Koç H. Yenidoğan hiperbilirübinemili 963v hastanın değerlendirilmesi. TÇ Klinik Dergisi 1993; 2:26-30.
- 23. Wu JM, Yelh TF, Wang JN. The role of pulmonary inflamation in the development of pulmonary hypertension in newborn with meconium aspiration syndrome(MAS). Pediatr Pulmonol Suppl 1999; 18:205-208.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | - |
| Erken Görünüm Tarihi | 30 Ağustos 2023 |
| Yayımlanma Tarihi | 1 Eylül 2023 |
| Gönderilme Tarihi | 7 Aralık 2021 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 9 Sayı: 3 |
