Yenidoðan yoðun bakým ünitesindeki cerrahi olgularýn deðerlendirilmesi

Amaç: Yenidoðan döneminde cerrahi giriþim uygulanan hastalarýn demografik özellikleri, tanýlarý, operasyon zamanlarý ve erken dönem komplikasyonlarýný deðerlendirmek.
Gereç ve Yöntem: Ocak 2007 ile Ocak 2011 tarihleri arasýnda cerrahi giriþim uygulanan ve yenidoðan yoðun bakým ünitesinde takip edilen hastalarýn dosyalarý retrospektif olarak incelendi. Olgular cerrahi yapýlan sisteme göre üç gruba ayrýldý; merkezi sinir sistemi, solunum sistemi ve gastrointestinal sistem.
Bulgular: YYBÜ’de Ocak 2007 ile Ocak 2011 tarihleri arasýnda 3246 hasta takip edildi. Cerrahi giriþim uygulanan 94 (%2.8) hastanýn 51’i erkek (%54.2) ve 80’ni (%85) zamanýnda doðan bebekler olup ortalama doðum aðýrlýklarý 3053±614 g idi. Olgularýn taný daðýlýmlarý; merkezi sinir sistemi, solunum sistemi toplam ve gastrointestinal sistem sýrasý ile 65, 14 ve 15 olgu idi. Ortalama cerrahi giriþim uygulanma zamaný 8.4±17.1 gün iken ortalama hastanede kalýþ süresi ise 21.7±26.7 gün idi. Olgularýn 36’sýnda (%38.2) cerrahi uygulama sonrasý 43 komplikasyon (17’si sepsis, 14’ü klinik sepsis, 6’sý menenjit, 2’si pnömotoraks, 2’si pnömoni, 2’si restenoz) geliþmiþti. 12 olgu (%12.7) kaybedildi. Kaybedilen olgularýn 6’sý diafragma hernisi nedeni ile cerrahi giriþim uygulanan olgulardý. Merkezi sinir sistemi olgularýnda
yaþamýnýn ilk 3 günü düzeltme operasyonu uygulanlarda ile ilk 3. günden sonra uygulananlara göre erken dönem komplikasyonlarý (sepsis, menenjit) anlamlý düzeyde düþüktü (p<0.001).
Sonuçlar: Yenidoðan döneminde cerrahi giriþimin en sýk nedeni merkezi sinir sistemi anomalileridir. Nöral tüp defektinde cerrahi giriþiminin ilk 3 günde yapýlmasýnýn erken dönem komplikasyonlarý anlamlý derecede azaltmaktadýr. En yüksek ölüm oraný konjenital diafragma hernisi idi.

The evaluation of the surgical cases in neonatal intensive care unit

Objective: To evaluate the demographic features, diagnosis, timing of the surgery and early complication in patients undergoing surgery in the neonatal period.
Material and Method: The files of the patients who were undergone surgery and followed up in neonatal intensive care unit between the January 2007 and January 2011 were investigated retrospectively. The cases were divided in three groups according to surgical performed system; central nervous systems, respiratory systems and gastrointestinal system.
Results: 3246 patients were followed up between the January 2007 and January 2011 in neonatal intensive care unit. 94 (2.8%) of these patients 51 male (54.2) and 80 of these were full-term (85%) were undergone surgery and their mean birth weight was 3053±614 g. The diagnosis of patients were central nervous system, respiration system, and gastrointestinal system in 65 patients, 14 patients, and 15 patients, respectively. The mean time of surgery was 8.4±17.1 days, and the mean length of hospital stay was 21.7±26.7 days. 43 complication (17 sepsis, 14 clinic sepsis, 6 meningitis, 2 pneumothorax, 2 pneumonitis, 2 restenosis) were occurred in the 36 of the all patients after the surgery. 12 (12.7%) patients were death in follow up. In six of the patients who died had undergone surgery due to diaphragmatic hernia. In central nervous system group, the early complication (e.g. sepsis, meningitis) were significantly lower in first three days compared with the patients who had corrective surgery after three days (p<0.001).
Conclusions: The most reason of surgery was central nervous system anomaly in neonatal period. The early complications (e.g. sepsis, meningitis) were significantly lower in patients who had corrective surgery in central nervous system group in first three days. The highest mortality rate was found in congenital diaphragmatic hernias.