Yenidoğan yoğunbakım ünitesinde izlenen prematüre bebeklerde sepsis gelişimi ile beyaz küre ve trombosit sayılarının ilişkisi.
The relation between platelet and leucocyte counts and sepsis in neonatal intensive care unit in premature patients.
Yazar: ŞULE TOPRAK
Danışman: DOÇ. DR. DİDEM ALİEFENDİOĞLU
Kırıkkale Üniversitesi / Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2007
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases

Özet:
In this study, it is aimed to investigate the identification of extended spectrum
p-Iactamases (GSBL) of 960 Eseheriehia eoli ve 300 Klebsiella spp which
were isolated from wound and urine Ispecimens of hospitalized patients and
outpatients, and their resistance to same anti-biotics, by double disc sinergy
test and phenotipical confirmatory test. The bacteria were isolated by
standart methods. Antibiotic resistance was tested by disc diffusion method,
while, double disc sinergy test and phenotipical confirmatory tests were used
to find the existence of GS BL. All the tests were done according to criteria of
the National Commit!ee for Clinical Laboratory Standarts(NCCLS). The
Fisher's ki-square test was used to show the antibiotic resistance. 162 of 960
E. eoli strains (%16,8) and 66 of 300 Klebsiella spp strains (%22) (54 of
which K. pneumoniae (%18) and 12 of which was K. oxytoea (%8) were
found to be positive. The resistance of amicasin of the GS BL positive strains
has been found %5,9 in the urine material, while it was %14,5 in the wound
material and it was statistically significant (p <0,031 ). Consequently, the disc
diffusion test, double disc sinergy test and the phenotipical contirmative tests
were found to be compatible and it is determined that there is a necessity to
be careful for the amicasin resistance in the strains isolated from the GSBL
posilive wound samples.
Keywords: Exlended-speclrum p-Iaclamases, Resistance of antibiolics,
Klebsiella spp., E. eoli.değişiklikler değerlendirilmış ve sepsis gelişen ve gelişmeyen bebeklerden
elde edilen ölçümlerin (1., 3., 5., 7. günlerdeki) karşılaştırılması yapılmıştır.
Araştırma sonucunda elde edilen veriler SPSS programında analiz edilerek
p< 0.05 anlamlılık sınırı olarak kabul edilmiştir. Çalışmaya alınan tüm
olguların % 14'ünde ilk hafta içinde sepsis gelişmiştir. Sepsis grubu ve
kontrol grubu arasında gebelik haftası ve doğum ağırlığı açısından farklar
anlamlı bulunmuştur. Gruplar arasında cinsiyet dağılımı , doğum şekli ,
annelerin yaş ortalaması , gebelik sayısı , hipertansiyon, diyabet, erken
membran rüptürü ve preeklampsi oranları açısından fark bulunmamıştır. Hem
1. ve 5. dakika Apgar skorları hem de resüsitasyon uygulanma oranları
anlamlı farklılık göstermiştir. Sepsis ve sepsis olmayan gruplar arasında
lökosit sayıları açısından fark bulunamazken sepsis ve kontrol grubu
arasında 1, 3, 5. ve 7. günlerde bakılan hem trombosit sayıları hem de
trombositopeni oranları açısından arasındaki farklar oldukça anlamlı
bulunmuştur . Bu çalışma sonucunda, ilk hafta içerisinde alınan ardışık kan
örneklerinde sepsis geliştiren bebeklerde yaşamın ilk gününden başlayarak
hem ortalama trombosit sayısının daha düşük hem de trombositopeni
oranlarının anlamlı şekilde yüksek olduğu görülmüştür.
Anahtar kelimeler: Trombosit sayısı , lökosit sayısı , sepsis, yenidoğan

Abstract:
The rate of mortality is deereated signifieanııy in prematurity and its
coneomitant problems depending on the improvement in neonatal intensive
care. On the other hand mortalities and morbidities due to sepsis are stili
high. Humoral and eellular defans meehanisms are poorly developed in
neonatal period. It explains high rate of morbidities in premature neonates.
While weeks of pregnancies deerease, the rate of infeetions increases.
Sepsis whieh represents sings and symptoms within first week usually
progresses rapidly and effeets multiple organs. Most of the affeeted neonates
are premature and have low birth weighl. Mieroorganisms eausing infeetions
have maternal origin. And mortality rates are higher than Iate sepsis. Early
diagnosis and proper management are very important to reduee mortalities
and for good prognosis. The diagnosis usually depends on clinie of neonates.
Howewer sing of sepsis may not be present at the beginning or or other
pathological conditions that mimic sepsis during this period make diagnosis
difficull. A number of screaning tests are available for early diagnosis.
Howewer test of choice must be sensitive, can be done easily and should
give fast results. By this study we aimed to eveluate the relations between
hematological parameters that that includes leucocyte count and changes in
platelet numbers and sepsis in premature neonates in neonatal interısive
care units. AIso we aimed to eveluate how those parameters may prediet
sepsis or help to diagnose sepsis and is there any relation between the
duration and the range of changes in parameters and clinical course,
prognosis of disease and responsible microorganisms. We included 207
premature neonate who are under 37 weeks of gestational age and in
neonatal intensive care units into study. Hematological parameters weremeasured eonseeutively at 1, 3, 5. and 7. days. The changes in the
parameters within the first week were evaluated. Results of sepsis developed
group and control groups were compared.for statistical analysis we used
SPSS programs. P values < 0.05 were accepted as a border for statistical
signifance. The rate of sepsis was 14 % within first week. Gestational age
and birth weight differences were statistically significant in sepsis group and
control groups. There were no differences between the groups according to
sexes, types of delivery, maternal age, number of pregnancies, history of
hypertantion, diabetes, premature rupture of membrane and preeclamycia.
APGAR scores at 1 and 5 minutes and resusoutation rates were significantly
different. Leucocyte counts were similar howewer platelet numbers at 1, 3, 5.
and 7. days and rate of thrombocytopenia were significanııy different in septic
groups and control groups. As a conclusion, analysis of consecutive
hematological parameters showed that the mean platelet numbers is lower
and the rate of thrombocy,t openia is higher in sepsis developed group in
comparison with control group.
Key words: Platelet count, leucoeytes count, sepsis, newbom