Zeynep Kamil Med J. 2013; 44(4): 233-241

Özofagus Atrezi̇leri̇nde Yoðun Bakým Olanaklarýnýn Sað Kalým Üzeri̇ne Etkisi

Dolunay Alver, Ayþenur Cerrah Celayir, Oktay Bosnalý, Serdar Moralýoðlu
Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, Pediatric Surgery Clinic

INTRODUCTION: In this article, we aimed to investigate the impact of intensive care conditions on survival rates in cases with esophageal atresia.
METHODS: Clinical records of the cases with esophageal atresia, operated between January 2004 and January 2011, were reviewed retrospectively and were divided into two groups according to NICU conditions before and after July 2007 and compared on the basis of gestational week, birth weight, sex, pulmonary status, associated anomalies, operation time, operations, type of atresia, postoperative complications, duration of hospitalization, ventilator dependency, morbidity, mortality rates.
RESULTS: In our series with esophageal atresia totally 92 cases, consisting of two groups: Group 1 with 40 cases of esophagus atresia treated before 2007 compared with Group 2 consisting 52 cases of esophagus atresia treated after 2007 reorganization of our neonatal intensive care unit. The male/female ratio was 1: 1.14 which is compatible with the literature datas. The mean gestational week
in our series was found to be 36 weeks and the average percentage of termed baby was 49%. The mean birth weight was 2495 gr. The mean age at admission of our series was 1.64 days. The types of atresias were as 82.6% EA+distal TEF, 15.4% isolated EA and 2% EA+double fistula. The most common associated anomalies were of the cardiac system. The most common early complication was pneumonia in Group 1 and anastomotic leakage in Group 2. The most common late complication was anastomotic stricture in both groups. Ventilator dependency and duration of hospital stay was found to be longer in Group 2 cases. The principal mortality cause was severe mediastinit, pneumonia and sepsis in Group 1 and multiple congenital anomalies in Group 2.
DISCUSSION AND CONCLUSION: The survival rates showed an increase from 57.5% to 75% after improved NICU. With the increasing numbers of experienced staff and improved conditions in NICU, we determined that survival rates are increasing in esophageal atresia cases with low birth weight and/or severe cardiac anomalies and pneumonia.

Keywords: Esophageal atresia, primary esophageal repairing, esophageal atresia with fistula, esophageal atresia with long gap, neonatal intensive care

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Özofagus Atrezi̇leri̇nde Yoðun Bakým Olanaklarýnýn Sað Kalým Üzeri̇ne Etkisi

Dolunay Alver, Ayþenur Cerrah Celayir, Oktay Bosnalý, Serdar Moralýoðlu
Zeynep Kamil Kadýn ve Çocuk Hastalýklarý Eðitim ve Araþtýrma Hastanesi, Çocuk Cerrahisi Kliniði

GÝRÝÞ ve AMAÇ: Konjnital anomalili bebeklerde yenidoðan yoðun bakýmýndaki geliþmelere paralel olarak yaþam oranlarý giderek artmaktadýr. Bu
çalýþmamýzda,yenidoðan yoðun bakým olanaklarýnýn özofagus atrezili olgularda saðkalým üzerine etkisinin ortaya konulmasý amaçlandý.
YÖNTEM ve GEREÇLER: Ocak 2004-Ocak 2011 tarihleri arasýnda özofagus atrezisi nedeni ile opere edilen 92 yenidoðanýn tüm kayýtlarý, Temmuz 2007 tarihinden önceki ve sonraki yoðun bakým koþullarýmýz dikkate alýnarak geriye dönük olarak incelendi.
BULGULAR: Yedi yýlda toplam 92 özofagus atrezili olgu kliniðimizde interne edilmiþ olup;Grup 1, 2007 Temmuz öncesi yenidoðan yoðun bakýmýmýz
kurulmadan önce tedavi edilen 40 hastayý, Grup 2 ise 2007 Temmuz sonrasý tedavi edilen 52 hastayý içermekteydi. Erkek/kýz oraný 1: 1,14 idi.Ortalama gebelik haftasý 36 hafta ve term bebek oraný %49 olarak saptandý. Ortalama doðum aðýrlýðý 2495 gr. idi.Hastaneye baþvurma ve taný alma yaþý ortalama 1.64 gündü. Distal fistüllü özofagus atrezi oraný %82.6, izole özofagus atrezi oraný %15.4 ve
çift fistüllü özofagus atrezi oraný %2 idi.En sýk karþýlaþýlan ek anomali kardiyak anomalilerdi. En sýk karþýlaþýlan erken dönem komplikasyonu Grup 1’de pnömoni iken Grup 2’de anastomoz kaçaðý idi. En sýk görülen geç dönem komplikasyonu her iki grupta anastomoz striktürü idi. Ventilatorde kalýþ ve hastanede kalýþ süreleri Grup 2 hastalarýnda daha uzun bulundu. Grup 1’de baþlýca mortalite sebepleri aðýr mediastinit, pnömoni ve sepsis iken Grup 2’de multipl konjenital anomaliler olmuþtu.Ýzole özofagus atrezili olgularda mortalite oraný her iki grupta da yüksekti.
TARTIÞMA ve SONUÇ: Yenidoðan cerrahi yoðun bakýmýmýz hizmete girdikten sonra saðkalým oranlarýnda %57.5’ten %75’e artýþ gözlenmiþtir. Özofagus atrezili olgularýn yenidoðan cerrahisi konusunda deneyimli doktor ekibinin takibinde, yenidoðanýn preoperatif ve postoperatif bakýmý hakkýnda bilgilendirilmiþ ve eðitilmiþ hemþirelerin gözleminde olan cerrahi yenidoðan yoðunbakýmlarda izlenmeleri mortalite ve morbiditeyi azaltmaktadýr.

Anahtar Kelimeler: Özofagus atrezisi, primer özofagus onarýmý, fistüllü özofagus atrezisi, Long gap esofagus atrezisi, yenidoðan yoðun bakým

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