Turkiye Klinikleri Journal of Pediatrics

Neonatoloji Ünitemizde uzamış sarılık tanısı alan yenidoğanların değerlendirilmesi
EVALUATION OF NEONATES DIAGNOSED AS PROLONGED HYPERBILIRUBINEMIA IN THE OUR NEONATOLOGY UNIT
Ayça TÖREL ERGÜR*, Metin MURAT**, Özkan Aydın LEYLEK***, Ömer CEVİT*, Dilara ÎÇAĞASIOĞLU****, Asım GÜLTEKİN*****
*Cumhuriyet Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları AD,
**Arş.Gör.Cuınhuriyet Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları AD,
***Cumhuriyet Üniversitesi Tıp Fakültesi Kadın Doğum ve Hastalıkları AD,
****Doç.Cumhuriyet Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları AD,
*****Cumhunyet Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları AD, SİVAS
Turkiye Klinikleri J Pediatr. 1997;6(4):167-72
Article Language: TR
Full Text
ÖZET
 Bu çalışma, 1993 Ocak - 1997 Ocak tarihleri arasında Neonatoloji Ünitemizde uzamış sarılık nedeniyle yatırılan hastaları kapsamaktadır. Amacımız uzamış sarılığı olan yenidoğanlarda etyolojik faktörleri araştırmak, uygulanan tedavi şekilleri ve sonuçlarını belirlemektir. Dört yıllık izlemimizde doğum ağırlığı ortalaması 2800 ± 506 gr olan 45 olguda uzamış sarılık saptandı. Tüm olguların sarılık başlama zamanı ortalaması 14.2 ± 1.8 gündü. Bu yenidoğanların 13ü (%28.8) preterm, 32si (%71.2) termdi. Tüm hastalara kan grubu değerlendirilmesi, tam kan sayımı, retikülosit, direkt Coombs, total biyokimya, diz, kafa grafileri, TORCHESe ait serolojik tetkikler, idrarda redüktan madde, tiroid fonksiyon testleri ve batın ultrasonografisi yapıldı. Tüm hastaların 13ünde (%28) anne sütü sarılığı, 6sında (%13) ABO uygunsuzluğu, 3ünde (%6) Rh uygunsuzluğu, 2sinde (%4) ABO ve Rh uygunsuzluğu, 5inde (%11) sepsis, 2sinde (%4) koyulaşmış safra sendromu, 4ünde (%8) prematürite, 3ünde (%6) konjenital hipotiroidi, ikisinde (%4) safra yollarına ait patoloji, ikisinde (%4) anneye oksitosin uygulama öyküsü, ikisinde (%4) Down Sendromu ve birinde (%2) sefal hematom saptandı. En yüksek indirekt bilirubin değeri 43.5 mg/dl olup, sepsisli bir olguya, en yüksek direkt bilirubin değeri 4mg/dl olup koyulaşmış safra sendromlu bir yenidoğana aitti. Etyolojiye yönelik olarak bu olgulara fototerapi, kan değişimi, plazma ve immunoglobin infüzyonu, anne sütüne 48 saat ara verme, L-tiroksin ve fenobarbital gibi tedavi yöntemleri uygulandı. Hastaların 34ü (%75) şifa ile taburcu olurken, üç (%6) olgu sepsis, iki (%4) olgu da prematürite nedeniyle eksitus oldu. Dört (%6) olguda kernikterus gelişti.

Anahtar Kelimeler: Yenidoğan, Uzamış sarılık
ABSTRACT
 This study covers patients hospitalized in our Neonatology Unit during January 1993 - January 1997. It has been aimed at investigating the etiological factors in the newborn with prolonged hyperbilirubinemia and define the therapeutic methods and their results. Prolonged hyperbilirubinemia was determined in 45 cases with an average birth weight of 2800 ± 506 gr during the 4-year follow-up. The average initation of hyperbilirubinemia in all the cases was days 14.2 ± 1.8 Of these neonates 13 (28.8%) were preterm and 32 (71.2%) term. All the patients had blood group determination, complete blood count, reticulocyte, direct Coombs, total biochemical analysis, knee and head graphies, TORCHES serological tests, reductant substance in the urine, thyroid function tests and abdominal ultrasonography. Of all the patients, mothers milk jaundice was determined in 13 (28.0%) cases, ABO incompatibility in 6 (13%) cases, Rh incompatibility in 3 (6%) cases, ABO & Rh incompatibility in 2 (4%) cases, sepsis in 5 (11%) cases, concentreated biliary syndrome in 2 (4%) cases, prematurity in 4 (8%) cases and congenital hyperthyroidism in 3 (6%) cases, biliary duct pathology in 2 (4%) cases, history of oxytocin application to the mother in 2 (4%) cases, Down Syndrome in 2 (4%) cases and cephal hematom in 1 (2%) cases. The highest indirect bilirubinemia value of 43.5 mg/dl was noted in a case with sepsis and the highest direct bilirubinemia value of 4 mg/dl in a newborn with concentreated biliary syndrome. Therapeutic methods such as phototherapy, exchange transfusion, plasma and immunoglobuline infusion, not feeding with mothers milk for 48 hours, L-Thyroxin and phenobarbital were applied on these patients in line with etiological factors. While 34 (75%) patients were discharged with full recovery, 3 (6%) patients became exitus due to sepsis and 2 (4%) cases died because of prematurity. Kernicterus developed in 4 (6%) cases.

Keywords: Newborn, Prolonged hyperbilirubinemia

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