| Abstract | Cilj istraživanja: Cilj je bio ispitati ishod liječenja novorođenčadi premještene transportom „k sebi“ u Zavod za intenzivnu pedijatriju s postintenzivnom skrbi, Klinike za dječje bolesti KBC-a Split.
Ispitanici i metode: Istraživanje je provedeno na 98 novorođenčadi premještenih transportom „k sebi“ u Zavod za intenzivnu pedijatriju u razdoblju od 1. siječnja 2003. do 31. prosinca 2018. godine. Prikazali smo spol, gestacijsku dob, porođajnu masu, porod po redu, načine poroda, perinatalnu anamnezu, Apgar zbroj u 1. i 5. minuti, dijagnoze, način ventilacije, korištenje surfaktanta, reanimacije i stupanj intrakranijalnog krvarenja kao i ishod. Novorođenčad je većinom bila iz Dubrovnika, a tek nekolicina iz drugih gradova i mjesta.
Rezultati: Od 98 novorođenčadi primljene u Zavod, 65% je bilo muškog spola. Prvorotkinja je bilo 51,7%, a 60,4% trudnica su rodile prirodnim (vaginalnim) putem. Nedonošene djece je bilo 72% dok je najčešća perinatalna anamneza bio prijeteći prijevremeni porod. Zadovoljavajući Apgar zbroj u 1. minuti imalo je 57,5%, a u 5. minuti 71,4% novorođenčadi. Novorođenčad je u više od 60% slučajeva bila porođajne mase ispod 2500 g. Vodeće dijagnoze ove skupine novorođenčadi bile su perinatalna hipoksija, konatalna infekcija i konvulzije. Novorođenčad je većinom ventilirana samo konvencionalnom strojnom ventilacijom, u 18 slučajeva je korišten HFOV, a u 15 slučajeva nCPAP kao neinvazivna ventilacija. Reanimirano je 25 od ukupno 98 novorođenčadi. Vodeće ultrazvučne dijagnoze bile su HIC st. III, HIC st. II i PVL I. Ukupno preživljenje je bilo 70,4%.
Zaključci: Iako je transport „k sebi“ odličan način zbrinjavanja životno ugrožene novorođenčadi rođene izvan tercijarnog centra, sam transport je i dalje stresan period za ugroženo novorođenče. Transport povećava izglede nastanka i pogoršanja intrakranijalnog krvarenja koje je svojstveno osobito nedonoščadi niske porođajne mase. Najbolje rješenje je da se trudnice premjeste u tercijarne centre transportom „in utero“ kako bi se nedonoščad i novorođenčad iz patoloških trudnoća rodila u centru u kojem će im se odmah pružiti najbolja skrb od strane visoko educiranih neonataloga i dječjih intenzivista. |
| Abstract (english) | Objectives: The aim was to examine the outcome of the treatment of two-way transported newborns to the PICU.
Patients and Methods: The study was conducted on 98 newborns who were two-way transported to the PICU from January 1th 2003 to December 31th 2018. Sex, gestation age, birth weight, parity, way of delivery, perinatal anamnesis, Apgar score in the 1st and 5th minute, diagnosis, type of ventilation, surfactant use, resuscitation and intracranial bleeding rate were studied as well as final outcome. Newborns were mostly transported from Dubrovnik, with only a few of them transported from other cities and towns.
Results: During that period 98 infants were admited to the Pediatric Intensive Care Unit and 65% were male. From total number of mothers 51.7% were first-childbirth and 60.4% gave birth vaginally. 72% of newborns were preterm and the most common perinatal anamnesis was premature birth. 57.5% newborns had normal Apgar score in the 1st minute and 71.4% in the 5th minute. In more than 60% cases newborns had a birth weight below 2500 g. Leading diagnosis of this group of newborns were perinatal hypoxia, conatal infection and seizures. Newborns were mostly ventilated only by conventional mechanical ventilation, while in 18 cases HFOV was used, and in 15 cases nCPAP as non-invasive ventilation. 25 out of 98 newborns were successfully reanimated. Leading ultrasound diagnoses were HIC gr. III, HIC gr. II and PVL I. Total survival rate was 70,4%.
Conclusions: Although two-way transport is an excellent way to take care of life-threatened newborns born outside the tertiary center, transportation itself is still a stressful period for the endangered newborn. Transport increases the chances of developing and worstening intracranial bleeding which is characteristic for this group, especially for those newborns with low birth weight. The best solution would be to transport pregnant women in utero so that the child will be born in a tertiary center where neonatologist and pediatric intensivist can take care of it. |
