Premature bebeklerde probiyotik desteğinin beslenme intoleransı ve mortalite üzerine etkisi
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Date
2014
Authors
Varal, İpek Güney
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Yenidoğan yoğun bakım ünitesinde yatan bebeğin mikroflorası sağlıklı bir yenidoğan bebeğin mikroflorasından belirgin olarak farklılık göstermektedir. Probiyotikler uygun miktarda alındıklarında konağın sağlığı üzerinde olumlu etkiler sağlayan (hastalığı önleyen veya hastalığı düzelten) patolojik olmayan canlı mikroorganizmalardır. Bu çalışmada amaç, preterm bebeklerde probiyotik vererek beslenme intoleransı, nekrotizan enterokolit (NEK) ve diğer morbiditeler üzerine etkisini göstermektir. Çalışma Uludağ Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesinde izlenen 32 hafta ve altında veya 1500 gram ve altında doğan preterm bebeklerde prospektif randomize kontrollü olarak düzenlendi. Çalışmaya toplam 110 prematüre bebek alındı. Probiyotik verilen birinci grupta 70 bebek, kontrol grubunda 40 bebek vardı. Tüm bebeklerin %3.6'sında (n=4) olmak üzere 2 bebekte (%1,8) evre 2, 2 bebekte de (%1,8) evre 3 NEK görüldü. Probiyotik grubunda NEK görülme oranı, kontrol grubuna göre istatistiksel olarak anlamlı düzeyde düşük bulundu (p=0.016; p<0.05). Nozokomiyal sepsis oranı tüm bebeklerin %23.6'sında (n=26) görüldü. Gruplara göre nozokomiyal sepsis görülme oranı istatistiksel olarak anlamlı olmasa da, probiyotik grubunun kontrol grubuna göre düşük olması dikkat çekici idi (p=0.059, p>0.05). Ölüm, NEK ve sepsis nedenli ölüm oranlarının probiyotik grubunda anlamlı derecede düşük olduğu saptandı (p< 0.05). Probiyotik verilen hastalarda beslenme intoleransı daha az görülerek, hızlı beslenmeye başlandı ve total parenteral nutrisyon süresi daha kısa bulundu (p=0.05). Çalışmada yine ikincil kazanç olarak probiyotik verilen hastaların taburculuk kilo ve baş çevresi persentillerinin 10 persentilin altında olma oranlarının kontrol grubuna göre anlamlı derecede düşüktür (%32.9-%67.5) (%27.1-%50). Sonuç olarak özellikle çoklu probiyotik desteği NEK ve mortalite üzerine etkilidir. Aynı zamanda beslenme intoleransını azaltması, kilo alımını ve taburculuk persentillerini iyileştirmesi hastaların uzun vadeli nörogelişimleri açısından umut vaadedicidir. Hastaların uzun dönem takibini yapan yeni çalışmalara ihtiyaç vardır.
Microflora of an inpatient newborn at the neonatal intensive care unit is significantly different than a healthy newborn. Probiotics are nonpathogenic alive microorganisms which effect the health of host positively (prevent or cure the illness) when taken as proper amount. This study aims to indicate the effects of probiotics given to the preterm infants, on the NEC (necrotizing enterocolitis) feeding intolerance and other morbidities. Study was designed as prospective randomized controlled at pretherm infants who were borned ≤32 week or ≤1500 gr weight and hospitalized at Uludag University Faculty of Medicine Neonatal Intensive Care Unit. Total number of babies assesed in this study was 110 as the 70 of them were in the probiotic given group and 40 of them were in the control group. NEC was determined for the all babies with the percentage of 3.6% (n=4) as 2 (1.8%) of them was grade2 and 2 (1.8%) of them was grade3. Incidence rate of NEC was significantly low at the group of probiatic group in comparison to control group (p=0.016; p<0.05). Nosocomial sepsis was seen at the 23.6% (n=26) of the babies and its incidance rate was remarkably low at the probiotic group (p=0.059, p>0.05). Mortality, NEK and mortality due to sepsis were signicantly low at the probiotic group (p< 0.05). Early nutrition was started due to low frequency of the feeding intolerance at the probiatic given patients and TPN period was found shorter (p=0.05). In the study, as a secondary benefit, rate of percentile being lower than 10 for the discharge, weight and head circumference was significantly low (%32.9-%67.5) (%27.1-%50). In conclusion, multiple probiotic support is effective on the NEC and mortality. Reducing the difficulties of the nutrition is also promising for the long term neurodevelopment of the patients as it improves the weight gain and discharge percentiles. New studies which will conduct the long term follow ups of the patients are needed.
Microflora of an inpatient newborn at the neonatal intensive care unit is significantly different than a healthy newborn. Probiotics are nonpathogenic alive microorganisms which effect the health of host positively (prevent or cure the illness) when taken as proper amount. This study aims to indicate the effects of probiotics given to the preterm infants, on the NEC (necrotizing enterocolitis) feeding intolerance and other morbidities. Study was designed as prospective randomized controlled at pretherm infants who were borned ≤32 week or ≤1500 gr weight and hospitalized at Uludag University Faculty of Medicine Neonatal Intensive Care Unit. Total number of babies assesed in this study was 110 as the 70 of them were in the probiotic given group and 40 of them were in the control group. NEC was determined for the all babies with the percentage of 3.6% (n=4) as 2 (1.8%) of them was grade2 and 2 (1.8%) of them was grade3. Incidence rate of NEC was significantly low at the group of probiatic group in comparison to control group (p=0.016; p<0.05). Nosocomial sepsis was seen at the 23.6% (n=26) of the babies and its incidance rate was remarkably low at the probiotic group (p=0.059, p>0.05). Mortality, NEK and mortality due to sepsis were signicantly low at the probiotic group (p< 0.05). Early nutrition was started due to low frequency of the feeding intolerance at the probiatic given patients and TPN period was found shorter (p=0.05). In the study, as a secondary benefit, rate of percentile being lower than 10 for the discharge, weight and head circumference was significantly low (%32.9-%67.5) (%27.1-%50). In conclusion, multiple probiotic support is effective on the NEC and mortality. Reducing the difficulties of the nutrition is also promising for the long term neurodevelopment of the patients as it improves the weight gain and discharge percentiles. New studies which will conduct the long term follow ups of the patients are needed.
Description
Keywords
Preterm, Probiyotik desteği, Nekrotizan enterokolit, Ölüm, Beslenme intoleransı, Probiotic support, Necrotising enterocolitis, Mortality, Feeding intolerance
Citation
Varal, İ. G. (2014). Premature bebeklerde probiyotik desteğinin beslenme intoleransı ve mortalite üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.