Rizični čimbenici i prevencija respiratornog distres sindroma u novorođenčadi

master's thesis

• Title (english): Risk factors and prevention of neonatal respiratory distress syndrome
• Author: Mirela Sunara
• Mentor: Boris Filipović-Grčić (mentor)
• Committee member: Ruža Grizelj (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Boris Filipović-Grčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Respiratorni distres sindrom (RDS) predstavlja klinički entitet koji je posljedica manjka plućnog surfaktanta u novorođenčeta. „Hijalinomembranska plućna bolest“ je stari naziv koji se bazira na patoanatomskom aspektu bolesti. No danas se smatra da je pogodniji naziv „novorođenačka plućna hiposurfaktoza“ jer sadrži u sebi etiologiju i patogenezu bolesti. RDS je jedan od glavnih uzroka novorođenačkog morbiditeta i mortaliteta usprkos dobro istraženim mogućnostima prevencije i liječenja. U Hrvatskoj i drugim razvijenim zemljama se uočava smanjenje dojenačke smrtnosti uzrokovane RDS-om (u 2004. 15%, u 2014. 7.5%), no i dalje ima prostora za dodatno smanjenje. Njegova incidencija opada s porastom gestacijske dobi fetusa pa tako prijevremeni porod predstavlja najvažniji rizični čimbenik za razvoj RDS-a. Uz skraćenu dob trudnoće, glavni rizični čimbenici su dijabetes melitus, muški spol, carski rez prije početka poroda, blizanačka trudnoća te genetska predispozicija. Smanjenjem stope prijevremenih poroda te izbjegavanjem drugih čimbenika rizika uvelike možemo umanjiti učestalost RDS-a. U slučajevima neizbježnih prijevremenih poroda, europske i američke smjernice preporučuju antenatalnu primjenu kortikosteroida trudnicama od 24. tjedna trudnoće do punog 34. tjedna trudnoće, a i nakon tog razdoblja. Slična je i preporuka Hrvatskog društva za perinatalnu medicinu Hrvatskog liječničkog zbora kod prijetećeg prijevremenog poroda. Istraživanja pokazuju da se antenatalnom primjenom kortikosteroida trudnicama za 34% smanji rizik razvoja RDS-a u novorođenčadi. Primjenjuju se 2 doze po 12 mg betametazona u razmaku od 24 sata intramuskularno ili 4 doze po 6 mg deksametazona u razmacima od 12 sati intramuskularno, a profilaksa je učinkovita u razdoblju između 24 sata nakon prve doze i 7 dana. Zbog smanjenja učestalosti RDS-a primjenom kortikosteroidne profilakse diljem svijeta, preporučam Hrvatskom društvu za perinatalnu medicinu da bi bilo korisno da prate usklađenost u provođenju ove preventivne mjere.

Abstract (english)

Respiratory distress syndrome (RDS) is a common pulmonary disorder in premature infants due to immature lungs and pulmonary surfactant deficiency. Hyaline membrane disease is the old term and it is based on the pathoanatomic aspect of the disease. Today is considered that term „newborn pulmonary hyposufactosis“ is more suitable, because it contains an etiology and pathogenesis of the disease. It is one of the main causes of neonatal morbidity and mortality, beside well-researched prevention and treatment possibilites. In Croatia and other developed countries is noticed a reduction of infant mortality caused by RDS (in 2004, 15%, in 2014, 7.5%), but there is still space for further reduction. The incidence of RDS declines with increasing gestational age. Preterm birth is the most frequent risk factor for RDS, but diabetes mellitus (DM), male sex, twin or multiple pregnancy, caesarean delivery before term of birth, and genetic predisposition are also significant risk factors. Reducing the rate of premature birth and avoiding other risk factors can greatly reduce the incidence of RDS. In cases of unavoidable premature births, European and American guidelines recommend administration of antenatal corticosteroids to pregnant women from the 24 weeks' gestation age (GA) to full 34 weeks' GA, and to all women for whom an elective caesarean section is planned prior to 386/7 weeks' GA. Croatian Society for Perinatal Medicine of the Croatian Medical Association has a similar recommendation in cases of treathening preterm delivery. Studies show that administration od ACS to pregnant women reduces risk of developing RDS in newborn for 34%. 2 doses of 12 mg betamethasone should be administered at a 24-hour interval intramuscularly or 4 doses of 6 mg dexamethasone at intervals of 12 hours intramuscularly, and the prophylaxis is effective for 24 hours after the first dose and 7 days. Due to the reduction of RDS frequency by using corticosteroid prophylaxis worldwide, I recommend to the Croatian Society for Perinatal Medicine to follow the compliance in the guiding of this preventive measure.

• Keywords: respiratorni distres sindrom; novorođenče; rizični čimbenici; prevencija; kortikosteroidi
• Keywords (english): respiratory distress syndrome; newborn; risk factors; prevention; corticosteroids
• Language: croatian
• URN:NBN: urn:nbn:hr:105:739486
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-28 11:41:08