Prematüre bebeklerde çoklu organ disfonksiyon sendromunun modifiye neomod skorlama sistemine göre değerlendirilmesi
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Date
2010
Authors
Çetinkaya, Merih
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çoklu organ disfonksiyon sendromu (ÇODS), iki veya daha fazla organ sisteminde disfonksiyon ile karakterizedir. Bu çalışmanın amacı geliştirilen modifiye NEOMOD skorlama sisteminin kullanması ile prematüre bebeklerdeki ÇODS gelişim sıklığı, ÇODS'a bağlı mortalite oranı ve mortaliteden sorumlu organ sistemleri, tutulum sırası ve sıklığının değerlendirilmesi idi.Ocak 2007-Temmuz 2009 tarihleri arasında yatırılan prematüre bebekler yattıkları günden taburcu olana veya kaybedilene kadar günlük olarak modifiye NEOMOD skorlama sistemine göre değerlendirildi. En az iki organ sistem tutulumu ve her sisteme ait en az bir bulgusu olan hastalar ÇODS olarak kabul edildi. Bu skorlama sisteminde santral sinir sistemi, hematolojik sistem, gastrointestinal sistem (GİS), kardiyovasküler sistem, solunum sistemi ve renal fonksiyonlarla birlikte asit-baz metabolizması ve mikrovasküler tutulum değerlendirildi.Çalışmaya toplam 198 prematüre bebek alındı. Toplam 160 bebekte (%80.8) ÇODS gelişti. ÇODS gelişen 160 hastanı tümünde GİS, 141 tanesinde solunum sistemi ve 94 tanesinde hematolojik sistem tutulmuştu. Ortalama ÇODS gelişme zamanı 1.4±1.8 gün olup, %99.4'ünde GİS, %86.3'ünde solunum sistemi ve %26.3'ünde asit-baz dengesi ilk olarak tutulmuştu. ÇODS başlangıcında en sık GİS+solunum sistemi birlikte tutulmuştu. İlk 28 günde kaybedilen olguların ortalama modifiye NEOMOD skorunun sağ kalan olgulara göre anlamlı şekilde daha yüksek olup, daha fazla sayıda sistem tutulumları mevcuttu. Ölümden önceki son 24 saatte olguların %39'unda 5 sistemde ciddi disfonksiyon saptandı.Sonuç olarak, ÇODS gelişecek prematüre bebekleri önceden belirleyebilmek için oluşturulan modifiye NEOMOD skorlama sistemi ile bu bebeklerdeki mortalitenin anlamlı ve güvenilir bir şekilde tahmin edilebileceği ve mortaliteye etkisi olan çeşitli organ sistemlerinin disfonksiyonu hakkında günlük bilgi elde edilebileceği gösterilmiştir.
Multiple organ dysfunction syndrome (MODS) is characterized by dysfunction in two or more organ systems. The aim of this study was to evaluate the frequency of MODS, mortality rates due to MODS, the organ systems involved in MODS, their frequency and involvement sequence in preterm infants by using modified NEOMOD scoring system.The preterm infats that were hospitalized between January 2007 and July 2009 were evaluated with modified NEOMOD scoring systems until discharge or death. İnfants who had at least two or more organ system involvement and one finding for each system were diagnosed as MODS. In this scoring system,central nervous system, hematological system, gastrointestinal system (GIS), cardiovascular system, respiratory system, renal system, acid-base metabolism and microvascular system were evaluated.A total of 198 premature infants were included to this study. MODS developed in 160 infants (80.8%). In infants with MODS, gastrointestinal system involvement, respiratory system involvement and hematologic system involvement were determined in 160, 141 and 94 infants, respectively. The mean MODS development time was 1.4±1.8 days and gastrointestinal system, respiratory system and acid-base metabolism were involved initially in 99.4%, 86.3% and 26.3% of infants, respectively. At the initial development of MODS, the most combined common involved systems were GIS+respiratory system. The mean modified NEOMOD score of the infants died in the first 28 days of life were significantly higher compared to those who survived and they also had more number of system involvement. In the last 24 hours of life before death, severe dysfunction in 5 organ systems was determined in 39% of infants.In conclusion, it was shown that mortality could be safely and accurately determined and data about the dysfunction of different organ systems which had an effect on mortality could be obtained with the modified NEOMOD scoring system developed for predicting MODS in preterm infants
Multiple organ dysfunction syndrome (MODS) is characterized by dysfunction in two or more organ systems. The aim of this study was to evaluate the frequency of MODS, mortality rates due to MODS, the organ systems involved in MODS, their frequency and involvement sequence in preterm infants by using modified NEOMOD scoring system.The preterm infats that were hospitalized between January 2007 and July 2009 were evaluated with modified NEOMOD scoring systems until discharge or death. İnfants who had at least two or more organ system involvement and one finding for each system were diagnosed as MODS. In this scoring system,central nervous system, hematological system, gastrointestinal system (GIS), cardiovascular system, respiratory system, renal system, acid-base metabolism and microvascular system were evaluated.A total of 198 premature infants were included to this study. MODS developed in 160 infants (80.8%). In infants with MODS, gastrointestinal system involvement, respiratory system involvement and hematologic system involvement were determined in 160, 141 and 94 infants, respectively. The mean MODS development time was 1.4±1.8 days and gastrointestinal system, respiratory system and acid-base metabolism were involved initially in 99.4%, 86.3% and 26.3% of infants, respectively. At the initial development of MODS, the most combined common involved systems were GIS+respiratory system. The mean modified NEOMOD score of the infants died in the first 28 days of life were significantly higher compared to those who survived and they also had more number of system involvement. In the last 24 hours of life before death, severe dysfunction in 5 organ systems was determined in 39% of infants.In conclusion, it was shown that mortality could be safely and accurately determined and data about the dysfunction of different organ systems which had an effect on mortality could be obtained with the modified NEOMOD scoring system developed for predicting MODS in preterm infants
Description
Keywords
ÇODS, Modifiye NEOMOD skoru, Mortalite, Organ disfonksiyonu, MODS, Modified NEOMOD score, Mortality, Organ dysfunction
Citation
Çetinkaya, M. (2010). Prematüre bebeklerde çoklu organ disfonksiyon sendromunun modifiye neomod skorlama sistemine göre değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.