Prematüre sepsisinde intravenöz immünglobulin kullanımı

Sema ÖZSOY, Tülin GÖKMEN, Ayşe SERDAROĞLU, Arzu KAÇAN, Gülten TANYER, Yıldız DALLAR

Özet

Yenidoganda sepsis insidansi prenatal bakima, dogum §artlanna, prematurelik oranina ve cocuk kliniklerindeki cevresel ozelliklere bagh olarak degipnektedir. Gelismi§ ulkelerde yenido-gan enfeksiyon insidansi %0.2-14 arasmdadir. Gelismekte olan ulkelerde ise bu oran %14-25 gi-bi daha yiiksek olup %45'e varan mortalite bildirilmektedir. Bu cahsmada intravenoz immunglobulin (lVIG) tedavisi prospektif ve rastgele segilmis. pre¬mature sepsisli vakalarda arastirtldi. Gestasyonel yas, cinsiyet, postnatal ya§, agtrhk ve diger de-gi§kenler yonunden farklan olmayan sepsis §iipheli veya sepsisli prematureler iki gruba aynldi, Elli vakalik birinci gruba (tedavi grubu) antibiyotige ek olarak 6 gun boyunca her gun dort sa-atlik su'rede 400 mg/kg IVlG verilirken, 50 vakalik ikinci gruba (kontrol grubu) antibiyotikle be-raber 5 ml/kg %10'luk dekstroz verildi. Vakalann tiimunde toplam kulturde ureme orani %21 olup tedavi grubunda en sik. iireyen mikroorganizma Salmonella subgrup I (%27.27); kontrol grubunda ise Klebsiella pneumoniae (%40) idi. Tedavi gi~ubunda %18 olan eksitus orani kont¬rol grubunda %44 bulundu. Iki grup arasmdaki fark istatistiksel olarak anlamhydi (p

Abstract

Incidence of sepsis is higher in neonatal period due to environmental factors ofpediatric cli¬nics, rate of prematurity, birth conditions, and prenatal care. Incidence of neonatal infections in developed countries is 0,2% to 14%. This rate is as high as 14% to 25% in developing countries ■ with up to 45% reported mortality... In this randomized study, intravenous immunoglobulin (IVIG) treatment was evaluatedpros-pectively in the patients with prematurity sepsis. Premature infants with suspected or diagnosed sepsis: were divided into two groups matched to gestational age, sex, postnatal age, weight and ot¬her parameters: First group consisting of 50patients (treatment group) was given 400 mg/kg IVIG,in four hours daily for 6 days in addition to antibiotics. In second group with 50 patients (cont¬rol group), 5 ml/kg 10% dextrose in water was given in addition to antibiotics. Rate of bacterial growth in cultures of both groups was 21%. The most common identified microorganism was Sal¬monella subgroup I (27.27%). in treatment group and Klebsiella pneumoniae (40%) in control group. Mortality was 18% in treatment group and 44% in control group. Difference between two groups was statistically significant (p