GEÇ PRETERM (≥34 GH) VE TERM BEBEKLERDESÜRFAKTAN TEDAVİSİ UYGULANAN OLGULARIN KLİNİK,DEMOGRAFİK VE LABORATUVAR ÖZELLİKLERİ İLEMORBİDİTE VE MORTALİTE SONUÇLARININKARŞILAŞTIRILMASI
“Comparison of the Clinical, Demographic, and Laboratory Characteristics, as well as Morbidity and Mortality Outcomes, of Late Preterm (≥34 Gestational Weeks) and Term Infants Treated with Surfactant Therapy”
- Tez No: 1011076
- Danışmanlar: PROF. DR. SERDAR CÖMERT
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2026
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Hamidiye Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Eğitimi Ana Bilim Dalı
- Bilim Dalı: Çocuk Neonatoloji Bilim Dalı
- Sayfa Sayısı: Belirtilmemiş.
Özet
Sürfaktan, Geç preterm, Term yenidoğan, Solunum yetmezliği, Sekonder sürfaktan disfonksiyonu, Sürfaktan Replasman Tedavisi
Özet (Çeviri)
ABSTRACT Objective: Respiratory distress is one of the most common reasons for admission to neonatal intensive care units among late preterm (≥34 weeks of gestation) and term neonates. In these infants, particularly in those requiring invasive mechanical ventilation, surfactant dysfunction may develop due to various mechanisms and may aggravate the clinical course. This study aimed to compare the clinical, demographic, and laboratory characteristics, as well as morbidity and mortality outcomes, of neonates born at ≥34 weeks of gestation who were followed in the neonatal intensive care unit and required invasive mechanical ventilation, according to whether they received surfactant therapy or not. The study also aimed to evaluate the response to surfactant therapy. Materials-Methods: This retrospective, descriptive, and observational study included a total of 154 neonates born at ≥34 weeks of gestation who were followed in the Neonatal Intensive Care Unit of the University of Health Sciences İstanbul Training and Research Hospital between 01.01.2020 and 31.12.2025 and required invasive mechanical ventilation. The cases were divided into two groups as those who received surfactant therapy (n=99) and those who did not (n=55), and the groups were compared. Demographic data, clinical characteristics, laboratory parameters, and morbidity and mortality outcomes were recorded. In cases who received surfactant replacement therapy, treatment response was evaluated using the SpO₂/FiO₂ (S/F) ratio before surfactant administration and at 1–4 hours and 8–12 hours after treatment. An increase of ≥50% in the S/F ratio compared with baseline and/or reaching an S/F ratio of ≥428 was accepted as a treatment response. Cases were classified into three groups according to the timing and pattern of response: sustained, transient, and late responders. Sustained and late responders were classified as responsive, whereas the remaining cases were classified as non-responsive and compared accordingly. Results: Among the 154 cases included in the study, 64.3% (n=99) received surfactant therapy. No significant difference was found between the surfactant-treated and non-treated groups in terms of demographic and prenatal characteristics (p>0.05). The mean gestational age was 37.30±2.04 weeks and 37.11±1.99 weeks, respectively; mean birth weight was 2889.64±575.54 g and 2936.96±570.62 g, with no significant difference between the groups (p>0.05).When evaluated in terms of underlying etiologies of respiratory distress, respiratory distress syndrome (RDS) and persistent pulmonary hypertension (PPHN) were significantly more common in the surfactant-treated group (9% vs 32.3%, p=0.027 and p<0.001, respectively), whereas transient tachypnea of the newborn (TTN) was significantly more frequent in the non-treated group (76.3% vs 18%; p<0.001). Idiopathic respiratory distress and pneumonia were more commonly observed in the surfactant-treated group (38.3% vs 21.8%; p<0.001). Among patients receiving surfactant therapy, the mean duration of invasive mechanical ventilation was significantly shorter in responders (4 [2–7] days) compared to non-responders (10.5 [2.5–25] days) (p<0.001). Persistent pulmonary hypertension (PPHN) and pneumothorax were significantly more frequent in non-responders (9.1%; p=0.027). Length of neonatal intensive care unit stay was also significantly shorter in the surfactant-treated group (13 [9–19] vs 9 [6–12] days; p<0.001). Response rate to treatment was 56.4% within the first 1–4 hours, decreasing to 46.5% at 8–12 hours. Overall evaluation showed that 46.5% of the cases were classified as responders. Sustained response was observed in 28.3% of cases, late response in 17.2%, and transient response in 5.1%. Conclusion: In late preterm and term neonates, cases who received SRT were found to have a more severe clinical condition and required longer mechanical ventilation, greater oxygen support, and longer hospitalization. A significant early response to surfactant therapy was observed, and an adequate response was achieved in approximately half of the cases. The findings suggest that the effect of surfactant replacement therapy on the clinical course may vary according to patient characteristics and the underlying etiology. Determine which subgroups derive the greatest benefit from surfactant therapy.
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