Publication: Yenidoğan yoğun bakım ünitelerinde sağlık hizmeti ilişkili nekrotizan enterokolit prevalansı: İlk nokta prevalans çalışmasının sonuçları
Abstract
Amaç: Nekrotizan enterokolit (NEK) yenidoğan infantların en acil gastrointestinal acillerinden biridir. NEK bin canlı doğumda 1-3, tüm yenidoğan yoğum bakım ünitesi (YYBÜ) yatışlarının %1-7.7sinde görülmektedir. Artan gestasyonel yaş ve artan doğum ağırlığı ile sıklığı azalır ve çok düşük doğum ağırlıklı (doğum ağırlığı 1500 g altı olanlar) infantlarda %6-7 sıklığında ortaya çıkar. Biz çok merkezli bu çalışmada yenidoğan yoğun bakım ünitelerinde NEK prevalansını ve risk faktörlerini değerlendirdik. Yöntem: Otuz sekiz YYBÜde NEKli hastalar üzerinde nokta prevalans anket çalışması yaptık. Çalışmaya anket tarihinde mevcut olan hastalar dâhil edildi. Tüm yoğun bakım hastalarının demografik verileri, altta yatan hastalıkları, tıbbi müdahaleler/tedaviler, infeksiyonlar ve hastaların klinik gidişleri kaydedildi. Bulgular: Çalışmaya 38 merkezden 933 hasta dâhil edildi, bunların 39u NEK ve NEK prevalansı %4,2 idi. On dört hastada (%35.8) Evre 1, 16 hastada (%41) Evre 2 ve dokuz hastada (%23) Evre 3 NEK tespit edildi. Yedi hastada (%17,9) etken patojenler tespit edildi. Üç hastada Klebsiella pneumoniae (%12,9, iki tekrarlayan enfeksiyon), iki hastada koagülaz negatif stafilokok (%5,1, iki tekrarlayan enfeksiyon) iki hastada kandida türleri (%5.1, iki tekrarlayan enfeksiyon) tespit edildi. İnfeksiyon gelişimi için total parenteral nutrisyon, gestasyon yaşının 32 haftadan küçük olması ve cerrahi uygulamalar risk faktörü olarak tespit edildi. NEK neonatal mortalite için bir risk faktörü olarak tespit edildi (p=0,017). Sonuç: Çok merkezli bu çalışma göstermiştir ki YYBÜ kaynaklı infeksiyonların prevalansı yüksektir. Bu infeksiyonların önlenmesi ulusal öncelik olmalıdır.
Objective: Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn. NEC occurs in 1 to 3 per 1000 live births and in 1 to 7.7 percent of admissions to neonatal intensive care units (NICUs) The incidence decreases with increasing gestational age and birth weight, and it is about 6 to 7 percent in very low birth weight infants (birth weight less than 1500 g). We conducted a national multicenter assessment of NEC in NICUs to evaluate the prevalence of infections, and associated risk factors. Methods: We conducted a point prevalence survey of NEC in 38 NICUs. Patients available at the onset of survey were included in the study. Data on demographics, underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes were recorded for all NICU patients. Results: A total of 933 patients in 38 NICUs participated in the study, 39 of whom had NEC, corresponding to a prevalence of 4.2%. The stage of NEC patients were reported as stages 1 (n=14: 35.8%), 2 (n=16: 41%), and 3 (n=9: 23%) 3. Causative microorganisms were isolated in seven (17.9%) patients with NEC. This pathogens were Klebsiella pneumoniae (3 infections, 12.9%) coagulase negative Staphylococcus (2 recurrent infections, 5.1%), and Candida spp. (2 recurrent infections, 5.1%). The risk factors for NEC were total parenteral nutrition (TPN), gestation age <32 weeks and previous surgical operation. NEC was found to be a risk factor for neonatal mortality (p=0,017). Conclusion: This national multicenter study documented the high prevalence of NICU-acquired infections. Preventing these infections should be a national priority.
Objective: Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn. NEC occurs in 1 to 3 per 1000 live births and in 1 to 7.7 percent of admissions to neonatal intensive care units (NICUs) The incidence decreases with increasing gestational age and birth weight, and it is about 6 to 7 percent in very low birth weight infants (birth weight less than 1500 g). We conducted a national multicenter assessment of NEC in NICUs to evaluate the prevalence of infections, and associated risk factors. Methods: We conducted a point prevalence survey of NEC in 38 NICUs. Patients available at the onset of survey were included in the study. Data on demographics, underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes were recorded for all NICU patients. Results: A total of 933 patients in 38 NICUs participated in the study, 39 of whom had NEC, corresponding to a prevalence of 4.2%. The stage of NEC patients were reported as stages 1 (n=14: 35.8%), 2 (n=16: 41%), and 3 (n=9: 23%) 3. Causative microorganisms were isolated in seven (17.9%) patients with NEC. This pathogens were Klebsiella pneumoniae (3 infections, 12.9%) coagulase negative Staphylococcus (2 recurrent infections, 5.1%), and Candida spp. (2 recurrent infections, 5.1%). The risk factors for NEC were total parenteral nutrition (TPN), gestation age <32 weeks and previous surgical operation. NEC was found to be a risk factor for neonatal mortality (p=0,017). Conclusion: This national multicenter study documented the high prevalence of NICU-acquired infections. Preventing these infections should be a national priority.