Yenidoğan yoğun bakım ünitesinde izlenen hastalarda hiponatremi
Hyponatremia in neonatal intensive care unit
- Tez No: 522855
- Danışmanlar: PROF. DR. HASİBE CANAN AYGÜN
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2018
- Dil: Türkçe
- Üniversite: Ondokuz Mayıs Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Neonatoloji Bilim Dalı
- Sayfa Sayısı: 78
Özet
Amaç: Hiponatremi, yenidoğan yoğun bakım ünitesinde (YYBÜ) özellikle çok düşük doğum ağırlıklı (ÇDDA) bebeklerde izlenen bir sorun olup önemli bir mortalite ve morbidite nedenidir. Yenidoğanlarda hiponatremiyle ilgili çalışmalar hem az sayıdadır hem de modern yoğun bakım uygulamalarından farklı uygulamaların yapıldığı eski yıllarda yapılmışlardır. Bu çalışmanın amacı, YYBÜ'de takip edilen hastalarda hiponatremi insidansını, risk faktörlerini, eşlik eden durumları ortaya koymak ve hiponaterminin mortaliteye etkisini belirlemektir. Gereç ve Yöntem: 1 Ocak 2016-31 Temmuz 2016 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi YYBÜ'de yatarak izlenen 527 bebeğin verileri retrospektif olarak incelendi. Hiponatremi sınırı, serum Na+ değerinin135 mEq/L'nin altında olması olarak belirlendi. Na+
Özet (Çeviri)
Aim: Hyponatremia is a problem in neonatal intensive care units (NICU) especially in very low birth weight (VLBW) infants and is a major cause of mortality and morbidity. However, studies on hyponatremia in neonates are few in number and they were performed long ago when the practice of care was different from that of today. The aim of this study was to determine the incidence and risk factors of hyponatremia along with the accompanying clinical conditions and to describe the effect of hyponatremia on mortality in patients in the NICU. Material and Method: 527 patients were retrospectively analyzed to the NICU of Ondokuz Mayıs University Faculty of Medicine Hospital between 1 January 2016 and 31 July 2016. Hyponatremia was defined as a serum Na+ level below 135 mEq/L. Pseudohyponatremia and laboratory errors excluded from study. A total of 112 patients included in the study were diagnosed with hyponatremia. Based on sodium levels, hyponatremia was categorised as mild if the levels were between 130-134,99 mEq/L, moderate if levels were between 120-129.99 mEq/L, and severe if the sodium levels were lower than 120 mEq/L. Hyponatremia, lasting longer than 48 hours, was defined as chronic hyponatremia. The normalisation of the sodium levels sooner than 48 hours was defined as an acute hyponatremia. The patients with hyponatremia were evaluated in regards to age, gender, gestational week, gestational week, birth weight, and concomitant pre- and postnatal problems. The incidence and duration of hyponatremia, as well as its risk factors and prognosis, were investigated in the patients admitted in the newborn intensive care unit. Results: During the study period, a total of 527 infants were admitted to NICU. Of them, 131 patients had serum Na+ levels lower than 135 mEq/L. Pseudohyponatremia and laboratory errors were found in 17 (3,2%) and 2 (0,3%) patients respectively and these patients were excluded from the study. A total of 112 (21,2%) patients included in the study were diagnosed with hyponatremia. Of the patients with hyponatremia, 64 (57,1%) were males and 48 (42,9%) were females. The mean gestational age was 35,1 ± 4,3 (23-41) weeks and the mean birth weight was 2419,7 ± 956,4 (480-4300) gr. of the hyponatremia patients, 52,3% were premature. The median hyponatremia duration was 1 (1-13). The degree was severe in eight (4,5%) hyponatremia periods, moderate in 28 (15,6%), and mild in 143 (79,9%). The most common cause of admission to NICU was the presence of pulmonary problems (24,7%) in the patients with hyponatremia. The most common accompanying problem in the prenatal period was maternal disorders (30,5%). Diuretic use due to a variety of indications was present before hyponatremia in 67 (31,8%) patients. Of the 112 patients, only 9 (8,1%) had pathological findings in the kidneys as diagnosed in the renal ultrasound. The duration was longer than 48 hours (chronic hyponatremia) in 50 (28%) hyponatremia periods. Hyponatremia recovered in a median of 2 (1-15) days. The comparison of patients with and without hyponatremia by their gestational week and birth weight revealed that patients with hyponatremia were born at earlier gestational weeks and had lower birth weights compared to the patients without hyponatremia. The difference between these two groups of patients was statistically significant (p=0,038 and p=0,011 respectively). The logistic regression analysis (LRA), evaluating the gestational age, birth weight, and gender, demonstrated that early gestational age was an independent risk factor (p=0,031) and associated with a higher risk for developing hyponatremia. It was demonstrated that the birth weight and gender were not the independent risk factors for hyponatremia (p=0,711 and p=0,844, respectively) Of the patients with hyponatremia, 9,8% died. The most common cause of death was sepsis (33,3%). The mortality rate was 2,2% in the patients without hyponatremia. The comparison of the patients with and without hyponatremia demonstrated statistically significantly higher rates of mortality in the patients with hyponatremia (p=0,001). Of the patients who died during the study period, there were no statistically significant differences in terms of birth week and birth weight between the groups of patients with and without hyponatremia (p=0,486 and p=0,564 respectively). Because of the number of patients who died in the study period was low, an LRA could not be performed. Conclusion: The incidence of hyponatremia in the NICU was 21,2%, indicating that this problem occurred in one in five inpatients. Being born at an early gestational age is the most critical risk factor for developing hyponatremia. The mortality rate wassignificantly higher in patients with hyponatremia compared to those patients with normal serum sodium levels. The diuretic use in one-third of the patients suggests that this group of medications may be overused. The recognition of hyponatremia by the clinicians and its management based on the etiopathogenesis and the individual clinical characteristics of patients are of critical importance in the care of infants admitted in NICU.
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