Yenidoğanın geçici takipnesi ve konjenital pnömoni ayırıcı tanısında n-terminal pro-beyin natriüretik peptitin yeri ve önemi
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Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Bu çalışmanın amacı, solunum sıkıntısı ile doğan bebeklerde erken dönemde serum N-terminal pro-beyin natriüretik peptitin (NT-proBNP) neonatal pnömoni (NP) ve yenidoğanın geçici takipnesini (YGT) ayırmadaki tanısal gücünü değerlendirmektir. MATERYAL-METOD: Çalışmamız prospektif, gözlemsel olarak Temmuz 2020 ve Temmuz 2021 tarihleri arasında düzenlendi. Gestasyonel yaşı 340/7 ve 410/7 haftalar arasında olan solunum sıkıntısı nedeniyle yenidoğan yoğun bakım ünitesine (YYBÜ) yatırılan bebekler çalışmaya dahil edildi. Hastaların yatışından sonra ilk 6 saat içinde ve postnatal 24-48. saatleri arasında çekilen akciğer ultrason değerleri kaydedilerek akciğer ultrason skoru (AUS) hesaplandı. Kan gazı değerleri, beyaz küre sayısı, trombosit sayısı ve serum NT-proBNP düzeyleri yatışın 1. saati ve postnatal 24. saatlerde; C-reaktif protein ve prokalsitonin düzeyleri postnatal 24. saatinde kaydedildi. BULGULAR: Çalışmaya 42 YGT (%72) ve 16 NP (%28) olmak üzere 58 bebek dahil edildi. Hastaların ortalama gestasyon yaşı 35,0 (34,0-41,0) hafta ve ortalama doğum ağırlığı 2589,7±495,7 gr idi. Yatışın 1. saatinde alınan NT-proBNP serum düzeyi YGT grubu için 1779.5 (359-11639) pg/mL ve NP grubu için 2200 (632-26594) pg/mL idi (p=0.230). İkinci NT-proBNP ise postnatal 24. saatte alındı, ortanca değer YGT grubu için 3308.0 (69-19746) pg/mL ve NP grubu için 7263.5 (1643-35000) pg/mL idi (p=0.004). ROC (Receiver operator characteristics curve) analizi ile NP tanısını öngörmede kullanılabilecek NT-proBNP eşik değeri 5515.5 pg/mL %75 duyarlılık ve %73.8 özgüllük ile anlamlı bulundu. Akciğer ultrason skorlarına göre 7 ve üzeri yüksek skorlu; 6 ve altı düşük skorlu grup olmak üzere karşılaştırdık. Yatışın 1. saatinde bakılan NT-proBNP değeri yüksek skorlu grup için 1870 (547-26594) pg/mL ve düşük skorlu grup için 1219 (359-21300) pg/mL idi (p=0.298). Postnatal 24. saatte bakılan NT-proBNP değerleri ise düşük skorlu grup için 3500 (570-15948) pg/mL ve yüksek skorlu grup için 6320 (69-35000) pg/mL olarak görüldü (p=0.044). SONUÇ: Postnatal 24. saatte bakılan NT-proBNP değeri NP grubunda, YGT grubuna göre daha yüksek görüldü. Ayrıca, tanıdan bağımsız olarak AUS'nın, NT-proBNP değerleri ile korele olduğu saptandı.
OBJECTİVE: We hypothesized that N-terminal probrain natriuretic peptide (NT-proBNP) might be reliable to differenciate transient tachypnea of newborn (TTN) and neonatal pneumonia (NP) in the early onset of the respiratory distress. METHODS: A prospective and observational study between July 2020 and July 2021 in a tertiary-care academic center. Inborn neonates at 340/7 and 41 weeks' gestation presented with signs of respiratory distress immediately after birth were included. We calculated the Lung Ultrasound Scores (LUS) in the first 6 hours after admission and in between the postnatal 24-48 hours. Blood gase analysis from umblical kord, total white blood cell count, hemoglobin and total platelet count, serum NT-proBNP levels in the first hour of admission and 24. hour postnatally, C-reactive protein and procalsitonin levels in the 24 hour postnatally were recorded. RESULTS: We included 42 patients with TTN and 16 with NP. Median gestational age was 35,0(34,0-41,0) weeks and mean birth weight was 2589,7±495,7 gr. The first NT-proBNP value were taken in the first hour after admission was 1779.5(359-11639) pg/mL for TTN group and 2200(632-26594) pg/mL for NP group. (p=0.230) The second NT-proBNP value was taken at 24. hour postnatally; was 3308(69-19746) pg/mL for TTN group and 7263.5(1643-35000) pg/mL for NP group. (p=0.004*) A 24. hour NT-proBNP value higher then 5515.5 pg/mL, can be used to accurately predict the diagnosis of NP (area under the curve = 0.74; 95% confidence interval: 0.60-0.89; p =.0004) with %75 sensitivity and %73.8 spesifity. LUS in the first 6 hours after admission wass used to split cases in to two groups; high score group was points of 7 and more, low score group was 6 points and lower. NT-proBNP levels in the first hour after admission to the NICU were ; for high scored group 1870.0(547-26594) pg/mL and for low scored group 1219.0(359-21300) pg/mL. (p=0.298) And these values were 3500.0(570-15948) pg/mL for the low score group and 6320.0(69-35000) pg/mL for the high score group with a p value 0.044 for the 24. hour postnatally NT-proBNP. RESULTS: Our results confirmed that, NT-proBNP values were higher at 24 hour postnatally in patient with NP then the TTN. Furthermore, LUS were correlated with NT- proBNP levels. NT-proBNP values may be used to predict the diagnosis of NP in the first day of life.
OBJECTİVE: We hypothesized that N-terminal probrain natriuretic peptide (NT-proBNP) might be reliable to differenciate transient tachypnea of newborn (TTN) and neonatal pneumonia (NP) in the early onset of the respiratory distress. METHODS: A prospective and observational study between July 2020 and July 2021 in a tertiary-care academic center. Inborn neonates at 340/7 and 41 weeks' gestation presented with signs of respiratory distress immediately after birth were included. We calculated the Lung Ultrasound Scores (LUS) in the first 6 hours after admission and in between the postnatal 24-48 hours. Blood gase analysis from umblical kord, total white blood cell count, hemoglobin and total platelet count, serum NT-proBNP levels in the first hour of admission and 24. hour postnatally, C-reactive protein and procalsitonin levels in the 24 hour postnatally were recorded. RESULTS: We included 42 patients with TTN and 16 with NP. Median gestational age was 35,0(34,0-41,0) weeks and mean birth weight was 2589,7±495,7 gr. The first NT-proBNP value were taken in the first hour after admission was 1779.5(359-11639) pg/mL for TTN group and 2200(632-26594) pg/mL for NP group. (p=0.230) The second NT-proBNP value was taken at 24. hour postnatally; was 3308(69-19746) pg/mL for TTN group and 7263.5(1643-35000) pg/mL for NP group. (p=0.004*) A 24. hour NT-proBNP value higher then 5515.5 pg/mL, can be used to accurately predict the diagnosis of NP (area under the curve = 0.74; 95% confidence interval: 0.60-0.89; p =.0004) with %75 sensitivity and %73.8 spesifity. LUS in the first 6 hours after admission wass used to split cases in to two groups; high score group was points of 7 and more, low score group was 6 points and lower. NT-proBNP levels in the first hour after admission to the NICU were ; for high scored group 1870.0(547-26594) pg/mL and for low scored group 1219.0(359-21300) pg/mL. (p=0.298) And these values were 3500.0(570-15948) pg/mL for the low score group and 6320.0(69-35000) pg/mL for the high score group with a p value 0.044 for the 24. hour postnatally NT-proBNP. RESULTS: Our results confirmed that, NT-proBNP values were higher at 24 hour postnatally in patient with NP then the TTN. Furthermore, LUS were correlated with NT- proBNP levels. NT-proBNP values may be used to predict the diagnosis of NP in the first day of life.
Açıklama
Tıp Fakültesi, Çocuk Sağlığı ve Eğitimi Ana Bilim Dalı
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
