Menenjit tanısı alan yenidoğan olguların laboratuvar ve görüntüleme bulgularının değerlendirilmesi ve ilk 12 ay izlem sonuçları
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Date
2019
Authors
Parlakay, Gülşah
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Neonatal menenjit, yenidoğanlarda mortalite ve morbiditenin önemli sebeplerinden biridir. Mortalite ve uzun dönem komplikasyon oranı tanı zamanı, sebep olan etken ve tedavi başlangıç zamanına göre değişmektedir. Uzun dönemde nörolojik sekeller, görsel ve işitsel kayıp, kognitif ve davranışsal bozukluklar görülebilmektedir. Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi Yenidoğan Yoğunbakım Kliniği'nde tedavi gören ve menenjit tanısı almış olan hastaların epidemiyolojik karakteristiklerinin, klinik özelliklerinin ve ilk bir yıldaki izlem sonuçlarının ortaya konması amaçlanmıştır. Çalışmaya Ocak 2010 ile Aralık 2015 tarihleri arasında kliniğimizde yatarak tedavi gören ve menenjit tanısı almış olan hastalar dahil edildi. Hastaların dosyaları geriye dönük olarak incelendi. Hastaların epidemiyolojik özellikleri ve ilk bir yaşları içerisindeki izlem verileri değerlendirildi. Altı yıllık süre içerisinde neonatal sepsis tanısıyla 1360 hasta yatırılarak izlenmişti. Toplam 118 hasta menenjit tanısı almıştı. Hastaların ortalama gestasyonel yaşları 32.7 hafta (24-40 hafta), ortalama doğum ağırlıkları 1987 gram (690-5020 gram) idi. Hastaların %25'i term, %75'i preterm bebeklerdi. Ortalama menenjit tanı zamanları 11 gün (2-40gün), ortalama yatış süreleri 45 gün (13-154 gün) idi. Menenjit tanısı alan 12 (%10) olgunun tanısı erken sepsis ile, 106 (%90) olgunun tanısı geç sepsis ile birlikteydi. Hastaların %17.7'sinde kan kültürlerinde, %17.7'sinde BOS (beyin omurilik sıvısı) kültürlerinde etken izole edildi. Her iki kültürde de en sık üreyen etken Staphylococcus Epidermidis'di. Hastaların mortalite oranı %15.2 olarak saptanırken, taburcu olan hastaların %30'unun kraniyal MR'da (manyetik rezonans görüntüleme) patoloji saptandı. İlk bir yıllık izlemlerini tamamlamış olan hastalarda ABR (BERA, beyinsapı işitsel davranımı) testlerinde işitme problemi çıkan hasta oranı %25 iken, hastaların %23'ünde birinci yaşlarında nöromotor gerilik mevcuttu. Çalışmamızda menenjit tanısında risk faktörleri literatür ile uyumlu olarak erkek cinsiyet, prematürite, C/S (sezaryen) ile doğum, düşük doğum ağırlığı (<2500 gram) ve annede EMR (erken membran rüptürü) öyküsü olarak belirlenmiştir. Kültürde izole edilen mikroorganizmaların yüksek oranda gram pozitif etkenler olması gelişmekte olan ülkelerdeki çalışmalar ile benzer bulunmuştur. Kültürde etken izole edilemeyen olgularda BOS bulgularının kullanılabilirliğini destekleyen bulgular elde edilmiştir. Menenjit tanısı alan olgularda kötü prognoz göstergeleri yüksek BOS proteini ve BOS lökosit sayısı, düşük BOS glukozu, düşük 5.dk APGAR skoru, nöbet öyküsü ve işitme kaybı olarak belirlenmiştir. BOS bulgularının mortalite ve morbidite üzerine etkisini gösteren veriler bizim çalışmamızda da güncel çalışmalarla benzer bulunmuştur. Kötü prognoza sahip olduğu belirlenen olgularda diğer çalışmalardan farklı olarak geç sepsise eşlik eden menenjit tanısı alan olgu oranı daha yüksek bulunmuştur.
Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. Mortality and long-term complication rates vary according to the time of diagnosis, the causative agent and the time of onset of treatment. Long term neurological sequelae, visual and auditory loss, cognitive and behavioral disorders can be seen. In this study, it was aimed to reveal the epidemiological and clinical characteristics and the results of the first year follow-up of the patients who were treated from diagnosis of meningitis in Neonatal İntensive Care Unit of Uludag University. Our study included patients who were diagnosed meningitis and hospitalized between January 2010 and December 2015 in Neonatal İntensive Care Unit of Uludag University. Patients' files were reviewed retrospectively. The epidemiological characteristics of the patients and follow-up data in the first year of life were evaluated. In the six-year period, 1360 patients were hospitalized with the diagnosis of neonatal sepsis. A total of 118 patients were diagnosed meningitis. Mean gestational ages of the patients were 32.7 weeks (24-40 weeks) and mean birth weight were 1987 gram (690-5020 gram). The rate of term patients was 25% and the rate of preterm patients was 75%. Mean diagnosis time was 11th day (2-40 day), mean hospital stay was 45 days (13-154 days). Patients who were diagnosed meningitis within early sepsis had a ratio of 10 (n:12) and within late sepsis had a ratio of 90 (n:106). In 17.7% of patients blood cultures and in 17.7% CSF (cerebrospinal fluid) cultures were positive. Staphylococcus Epidermidis was the most commonly produced microorganism in both cultures. Mortality rate was determined as 15.2% and pathology was found in cranial MR (magnetic resonance imaging) of 30% of discharged patients. The rate of patients with hearing problems in ABR (Auditory Brainstem Response) tests was 25% and 23% of patients had neuromotor retardation in their first year. In our study, risk factors in the diagnosis of meningitis were determined as male gender, prematurity, C/S (cesarean) birth, low birth weight (<2500 gram) and maternal PMR (premature membrane rupture) history. Microorganisms isolated in culture were found to be highly gram positive and similar to studies in developing countries. Findings supporting the availability of CSF findings were obtained in patients within non-isolated active culture was obtained. Poor prognosis in patients with meningitis was determined related with high CSF protein and CSF leukocyte count, low CSF glucose, low 5th minute APGAR score, seizure history and hearing loss. Data showing the effect of CSF findings on mortality and morbidity were similar in our study to the current studies. The rate of cases with meningitis accompanying late sepsis was found to be higher in patients with poor prognosis.
Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. Mortality and long-term complication rates vary according to the time of diagnosis, the causative agent and the time of onset of treatment. Long term neurological sequelae, visual and auditory loss, cognitive and behavioral disorders can be seen. In this study, it was aimed to reveal the epidemiological and clinical characteristics and the results of the first year follow-up of the patients who were treated from diagnosis of meningitis in Neonatal İntensive Care Unit of Uludag University. Our study included patients who were diagnosed meningitis and hospitalized between January 2010 and December 2015 in Neonatal İntensive Care Unit of Uludag University. Patients' files were reviewed retrospectively. The epidemiological characteristics of the patients and follow-up data in the first year of life were evaluated. In the six-year period, 1360 patients were hospitalized with the diagnosis of neonatal sepsis. A total of 118 patients were diagnosed meningitis. Mean gestational ages of the patients were 32.7 weeks (24-40 weeks) and mean birth weight were 1987 gram (690-5020 gram). The rate of term patients was 25% and the rate of preterm patients was 75%. Mean diagnosis time was 11th day (2-40 day), mean hospital stay was 45 days (13-154 days). Patients who were diagnosed meningitis within early sepsis had a ratio of 10 (n:12) and within late sepsis had a ratio of 90 (n:106). In 17.7% of patients blood cultures and in 17.7% CSF (cerebrospinal fluid) cultures were positive. Staphylococcus Epidermidis was the most commonly produced microorganism in both cultures. Mortality rate was determined as 15.2% and pathology was found in cranial MR (magnetic resonance imaging) of 30% of discharged patients. The rate of patients with hearing problems in ABR (Auditory Brainstem Response) tests was 25% and 23% of patients had neuromotor retardation in their first year. In our study, risk factors in the diagnosis of meningitis were determined as male gender, prematurity, C/S (cesarean) birth, low birth weight (<2500 gram) and maternal PMR (premature membrane rupture) history. Microorganisms isolated in culture were found to be highly gram positive and similar to studies in developing countries. Findings supporting the availability of CSF findings were obtained in patients within non-isolated active culture was obtained. Poor prognosis in patients with meningitis was determined related with high CSF protein and CSF leukocyte count, low CSF glucose, low 5th minute APGAR score, seizure history and hearing loss. Data showing the effect of CSF findings on mortality and morbidity were similar in our study to the current studies. The rate of cases with meningitis accompanying late sepsis was found to be higher in patients with poor prognosis.
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Keywords
Neonatal menenjit, Morbidite, İzlem, Risk faktörleri, Neonatal meningitis, Morbidity, Follow-up, Risk factor
Citation
Parlakay, G. (2019). Menenjit tanısı alan yenidoğan olguların laboratuvar ve görüntüleme bulgularının değerlendirilmesi ve ilk 12 ay izlem sonuçları. Yayınlanmamış uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.