Preterm bebeklerde sepsis tanısı ve prognoz tahmininde nsofa, SNAP-II, SNAPPE II ve laktat kriterlerinin karşılaştırılması
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Tarih
2022
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Neonatoloji bilimindeki gelişmelere rağmen prematüre yenidoğanlar mortalite ve morbidite açısından yüksek risk oluşturmaktadır. Neonatal sepsis önemli bir morbidite ve mortalite nedenidir. Yenidoğan yoğun bakım ünitelerinde mortalite riskinin önceden belirlenmesi hem ailenin bilgilendirilmesi hem de izlemde erken mortalite gibi karşılaşılabilecek ağır durumlara hazırlık açısından çok önemlidir. Bu çalışmada prematüre yenidoğanlarda mortalite riskini ve buna sebep olacak hastalıkların şiddetini belirlemede SNAP-PE, SNAPPE-II, nSOFA ve laktat değerlerini karşılaştırmayı amaçladık. Yöntem: Çalışmamızda Ekim 2017 - Haziran 2021 tarihleri arasında Hatay Mustafa Kemal Üniversitesi Eğitim ve Arastırma Hastanesi Yenidoğan Yoğun bakım ünitesinde gestasyonel yaşı 34 hafta ve altındaki, sepsis tespit edilen 112 prematüre yenidoğanın dosyaları retrospektif olarak değerlendirildi. Bulgular: Çalışma grubundaki olguların 57'si kız (% 50,9), 55'i erkek (%49,1) toplam 112 olgunun ortalama gebelik yaşı 28.16±2.95 hafta, doğum ağırlığı 1109.91±371.15 gr olarak hesaplandı. Çalışmaya alınan bebeklerin APGAR, SNAP- II, SNAP-PE-II, nSOFA skorları ve laktat değerleri hesaplanarak olgular mortalite açısından değerlendirildi. Çalışmamızda yapılan ROC analizleri sonucunda mortalite ile ilişkisi en yüksek olan skorlamalar, SNAPPE-II (AUC 0,802;%95 CI 0,632-0,972) ve sepsis tanısından 24 saat sonraki nSOFA (AUC 0,865;%95 CI 0,767-0,962) için elde edilmiştir. Sonuç: Çalışmamızda mortaliteyi ön görmede 5. Dakika Apgar skoru, SNAP-PE-II, sepsisten 24 saat sonraki nSOFA skorlarının belirleyici olduğu saptanmıştır. Mortalite ile ilişkisi en yüksek olan skorlamalar, SNAPPE-II ve sepsis tanısından 24 saat sonra hesaplanan nSOFA için elde edilmiştir.
Aim: Despite advances in neonatology, premature newborns pose a high risk of mortality and morbidity. Neonatal sepsis is an important cause of morbidity and mortality. Predetermining the risk of mortality in neonatal intensive care units is very important both in terms of informing the family and in preparation for serious situations that may be encountered such as early mortality in the follow-up. In this study, we aimed to compare the SNAP-PE, SNAPPE-II, nSOFA and lactate values in determining the risk of mortality in premature newborns and the severity of the diseases that will cause it. Methods: In our study, the files of 112 premature newborns with a gestational age of 34 weeks and younger who were diagnosed with sepsis in the Neonatal Intensive Care Unit of Hatay Mustafa Kemal University Training and Research Hospital between October 2017 and June 2021 were evaluated retrospectively. Results: Mean gestational age was calculated as 28.16±2.95 weeks and birth weight was 1109.91±371.15 g in a total of 112 cases, 57 of which were female (50.9%) and 55 (49.1%) of the cases in the study group. The APGAR, SNAP-II, SNAP-PE-II, nSOFA scores and lactate values of the babies included in the study were calculated and the cases were evaluated in terms of mortality. As a result of the ROC analyzes performed in our study, the scores with the highest correlation with mortality were obtained for SNAPPE-II (AUC 0.802; 95% CI 0.632-0.972) and nSOFA (AUC 0.865; 95% CI 0.767-0.962) 24 hours after the diagnosis of sepsis. Conclusion: In our study, Apgar score at 5th minute, SNAP-PE-II, and nSOFA scores 24 hours after sepsis were found to be determinative in predicting mortality. Scores with the highest association with mortality were obtained for SNAPPE-II and nSOFA calculated 24 hours after sepsis diagnosis.
Aim: Despite advances in neonatology, premature newborns pose a high risk of mortality and morbidity. Neonatal sepsis is an important cause of morbidity and mortality. Predetermining the risk of mortality in neonatal intensive care units is very important both in terms of informing the family and in preparation for serious situations that may be encountered such as early mortality in the follow-up. In this study, we aimed to compare the SNAP-PE, SNAPPE-II, nSOFA and lactate values in determining the risk of mortality in premature newborns and the severity of the diseases that will cause it. Methods: In our study, the files of 112 premature newborns with a gestational age of 34 weeks and younger who were diagnosed with sepsis in the Neonatal Intensive Care Unit of Hatay Mustafa Kemal University Training and Research Hospital between October 2017 and June 2021 were evaluated retrospectively. Results: Mean gestational age was calculated as 28.16±2.95 weeks and birth weight was 1109.91±371.15 g in a total of 112 cases, 57 of which were female (50.9%) and 55 (49.1%) of the cases in the study group. The APGAR, SNAP-II, SNAP-PE-II, nSOFA scores and lactate values of the babies included in the study were calculated and the cases were evaluated in terms of mortality. As a result of the ROC analyzes performed in our study, the scores with the highest correlation with mortality were obtained for SNAPPE-II (AUC 0.802; 95% CI 0.632-0.972) and nSOFA (AUC 0.865; 95% CI 0.767-0.962) 24 hours after the diagnosis of sepsis. Conclusion: In our study, Apgar score at 5th minute, SNAP-PE-II, and nSOFA scores 24 hours after sepsis were found to be determinative in predicting mortality. Scores with the highest association with mortality were obtained for SNAPPE-II and nSOFA calculated 24 hours after sepsis diagnosis.
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, prematürite, neonatal sepsis, SNAPPE-II, nSOFA, prematurity, neonatal sepsis, SNAPPE-II, nSOFA
