Yenidoğan döneminde solunum problemi olan hastalarda 4-9 yaşları arasında kronik akciğer hastalığı, astım ve atopi sıklığı
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Date
2007
Authors
Öcal, Murat
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Astım ve diger allerjik hastalıkların sıklıgı son yıllarda artmaktadır. Yenidogan solunum problemlerinin astım ve diger allerjik hastalıkların gelisiminde rolü oldugu ileri sürülmektedir. Bu çalısmada; yenidoganın geçici takipnesi (YGT) tanılı olgularda 4-9 yasları arasında astım ve diger allerjik hastalık sıklıgını ve etkili risk faktörlerini uluslararası anket ve laboratuvar testleri ile degerlendirmeyi amaçladık. Ocak 1997 ile Aralık 2002 tarihleri arasında Uludag Üniversitesi Tıp Fakültesi Çocuk Saglıgı ve Hastalıkları Anabilim Dalı Yenidogan Yogunbakım Servisi’ne YGT tanısı ile yatırılan olguların kayıtları incelendi ve olgular telefonla arandı. Çalısmaya katılmayı kabul eden toplam 128 olgu Nisan 2006 ile Eylül 2006 tarihleri arasında degerlendirildi. Deri prick testi (DPT), solunum fonksiyon testi (SFT) ve egzersiz provokasyon testi (EPT) sırasıyla 123, 32 ve 26 olguya uygulandı. Olguların dogum bilgileri, klinik özellikleri ile demografik verileri, olgular ve ailelerinin astım ve diger allerjik hastalık öyküleri kaydedildi. Olguların ortalama yası 76 ± 18 aydı ve %60,2’si erkek, %71,1’i sezeryan ile dogurtulmustu. Olguların ortalama gebelik haftası 34,2 ± 3 hafta ve %80,5’i prematür idi. Olguların ortalama dogum agırlıgı 2070 ± 807 gram ve 38’inin dogum agırlıgı 1500 gramın, 94’ünün ise 2500 gramın altındaydı. Olguların %23’üne mekanik ventilasyon tedavisi uygulanmıs ve toplam oksijen alma süresi 7,2 ± 9 gündü. Olguların %10,1’i kronik akciger hastalıgı (KAH) tanısı ile tedavi almıs ve %9,4’ünde kültür pozitifligi vardı. Olgularda kümülatif hısıltı sıklıgı % 28,1 (36 olgu), hısıltılı bebek sıklıgı %10,2 (13 olgu) ve doktor tanılı (DT) astım sıklıgı %8,6 (11 olgu) olarak saptandı. Kümülatif ve DT allerjik rinit (AR) sıklıgı %15,6 (20 olgu) ve %3,9 (5 olgu), kümülatif atopik dermatit (AD) sıklıgı %9,4 (12 olgu) ve DT egzema sıklıgı %1,6 (2 olgu) olarak saptandı. DPT yapılan olguların %9,8’inde test pozitif olarak saptandı (6 olguda ev tozu akarlarına, 6 olguda polenlere karsı). SFT yapılan 32 olguda test normal, EPT yapılan 26 olgunun birinde test pozitif olarak saptandı. Çalısmamızdaki DT astım ve AD sıklıgı bölgemizde yakın zamanda bildirilen çalısmalar ile benzer, fakat AR sıklıgı daha yüksek olarak saptandı. Ailede astım ve atopi öyküsü, sık üst solunum yolu enfeksiyonu (ÜSYE) öyküsü ve evde büyük kardesin olmayısı olgularımızda astım ve allerjik hastalıklar için risk faktörleri olarak saptandı (p<0,05). Dogum agırlıgı, gebelik haftası, sezeryanla dogum, Apgar skorunun 7’nin altında olusu ve yenidogan dönemi klinik özellikleri ile astım ve allerjik hastalıklar arasında anlamlı iliski saptanmadı (p>0,05). Erkek cinsiyet, toplam oksijen alma süresi ve mekanik ventilasyon uygulanması hısıltılı bebek öyküsü ile iliskili bulundu (p<0,05). Anne veya babanın sigara kullanması, anne sütü alımı ve DPT pozitifligi ile astım ve allerjik hastalıklar arasında anlamlı iliski saptanmadı (p>0,05). Sonuç olarak; çalısmamızda YGT tanılı olgularda 4-9 yaslarında astım ve AD riskinde artıs saptanmadı. YGT tanılı olguların özellikle ailede astım ve atopi öyküsü, sık ÜSYE öyküsü varlıgında ve tek çocuk olmaları durumunda sonraki çocukluk yıllarında astım ve diger allerjik hastalık gelisimi açısından izlenmelerini önermekteyiz.
The prevalance of the asthma and other allergic diseases have been increasing in recent years. It has been suggested that neonatal respiratory problems might have a role on the development of asthma and other allergic diseases. In this study; we aimed to evaluate the prevalance of asthma and other allergic diseases and related risk factors according to international questionnaire and laboratory tests in cases who had diagnosis of transient tachypnea of the newborn (TTN). The records of cases who were hospitalized with TTN diagnosis at Uludag University, Faculty of Medicine, Department of Pediatrics, Neonatal Intensive Care Unit between January 1997 - December 2002 were reviewed and they are called by phone. Total 128 cases accepted to join study and they were evaluated between April 2006 – September 2006. Skin prick test (SPT), respiratory function test (RFT) and exercise provocation test (EPT) were applied to 123, 32 and 26 cases, respectively. Birth informations, clinical characteristics, demographic informations, personal and family histories of asthma and other allergic diseases were recorded. The mean age of the cases were 76 ± 18 months and 60,2% of them were male, 71,1% of them were born with caesarean/sectio (C/S). Mean gestational age of the cases were 34,2 ± 3 weeks and 80,5% of them were born premature. Mean birth weight of the cases were 2070 ± 807 grams and 38 of them were below 1500 g and, 94 of them were below 2500 g. Mechanical ventilation therapy was applied to 23% of the cases and mean total oxygen duration were 7,2 ± 9 days. The 10,1% of the cases were treated with the diagnosis of chronic lung disease, and 9,4% had culture positivity. Cumulative wheezing fequency was found as 28,2% (36 case), wheezy infant frequency as 10,2% (13 case), and doctor-diagnosed (DD) asthma frequency as 8,6% (11 case). Cumulative and DD allergic rhinitis (AR) frequency were found to be as 15,6% (20 case) and 3,9% (5 case), respectively. Cumulative atopic dermatitis (AD) and DD eczema frequency were found to be as 9,4% (12 case) and 1,6% (2 case), respectively. In %9,8 of the cases to whom SPT was applied the test was found positive (in 6 cases to house dust mites, in 6 cases to polens). RFT was found normal in 32 cases but in one of the 26 cases to whom EPT was applied the test found positive. In our study DD asthma and AD frequency was similar, but AR frequency was found higher than recent reported studies in our region. Family history of asthma and atopy, frequent upper respiratory tract infection and absence of siblings at home were found risk factors for asthma and allergic diseases in our study (p<0,05). There were not significant relations between birth weight, gestational age, caesarean birth, Apgar score being below 7, and clinical characteristics at newborn period and asthma or other allergic diseases (p>0,05). Male sex, total oxygen duration and mechanical ventilation therapy were related with history of wheezy infant (p<0,05). Maternal or paternal smoking, breastfeeding and SPT positivity were not related with asthma and other allergic diseases (p>0,05). In conclusion; in our study we did not find increased asthma and AD risk at 4-9 years, in cases who had a diagnosis of TTN. We suggest that cases who had a diagnosis of TTN; especially who have family history of asthma and atopy, frequent upper respiratory tract infection, and being single child might fallowed against development of asthma and other allergic diseases in later childhood.
The prevalance of the asthma and other allergic diseases have been increasing in recent years. It has been suggested that neonatal respiratory problems might have a role on the development of asthma and other allergic diseases. In this study; we aimed to evaluate the prevalance of asthma and other allergic diseases and related risk factors according to international questionnaire and laboratory tests in cases who had diagnosis of transient tachypnea of the newborn (TTN). The records of cases who were hospitalized with TTN diagnosis at Uludag University, Faculty of Medicine, Department of Pediatrics, Neonatal Intensive Care Unit between January 1997 - December 2002 were reviewed and they are called by phone. Total 128 cases accepted to join study and they were evaluated between April 2006 – September 2006. Skin prick test (SPT), respiratory function test (RFT) and exercise provocation test (EPT) were applied to 123, 32 and 26 cases, respectively. Birth informations, clinical characteristics, demographic informations, personal and family histories of asthma and other allergic diseases were recorded. The mean age of the cases were 76 ± 18 months and 60,2% of them were male, 71,1% of them were born with caesarean/sectio (C/S). Mean gestational age of the cases were 34,2 ± 3 weeks and 80,5% of them were born premature. Mean birth weight of the cases were 2070 ± 807 grams and 38 of them were below 1500 g and, 94 of them were below 2500 g. Mechanical ventilation therapy was applied to 23% of the cases and mean total oxygen duration were 7,2 ± 9 days. The 10,1% of the cases were treated with the diagnosis of chronic lung disease, and 9,4% had culture positivity. Cumulative wheezing fequency was found as 28,2% (36 case), wheezy infant frequency as 10,2% (13 case), and doctor-diagnosed (DD) asthma frequency as 8,6% (11 case). Cumulative and DD allergic rhinitis (AR) frequency were found to be as 15,6% (20 case) and 3,9% (5 case), respectively. Cumulative atopic dermatitis (AD) and DD eczema frequency were found to be as 9,4% (12 case) and 1,6% (2 case), respectively. In %9,8 of the cases to whom SPT was applied the test was found positive (in 6 cases to house dust mites, in 6 cases to polens). RFT was found normal in 32 cases but in one of the 26 cases to whom EPT was applied the test found positive. In our study DD asthma and AD frequency was similar, but AR frequency was found higher than recent reported studies in our region. Family history of asthma and atopy, frequent upper respiratory tract infection and absence of siblings at home were found risk factors for asthma and allergic diseases in our study (p<0,05). There were not significant relations between birth weight, gestational age, caesarean birth, Apgar score being below 7, and clinical characteristics at newborn period and asthma or other allergic diseases (p>0,05). Male sex, total oxygen duration and mechanical ventilation therapy were related with history of wheezy infant (p<0,05). Maternal or paternal smoking, breastfeeding and SPT positivity were not related with asthma and other allergic diseases (p>0,05). In conclusion; in our study we did not find increased asthma and AD risk at 4-9 years, in cases who had a diagnosis of TTN. We suggest that cases who had a diagnosis of TTN; especially who have family history of asthma and atopy, frequent upper respiratory tract infection, and being single child might fallowed against development of asthma and other allergic diseases in later childhood.
Description
Keywords
Çocukluk çagı astımı, Allerjik hastalıklar, Yenidoganın geçici takipnesi, Deri prick testi, Prematürite, Childhood asthma, Allergic diseases, Transient tachypnea of the newborn, Skin prick test, Prematurity
Citation
Öcal, M. (2007). Yenidoğan döneminde solunum problemi olan hastalarda 4-9 yaşları arasında kronik akciğer hastalığı, astım ve atopi sıklığı. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.