Prematüre yenidoğanlarda serum sodyum-potasyum düzeyleri ve hiperpotasemi ile C-peptid ilişkisi

Abstract

70 ÖZET Günümüzde, ileri derecede düşük doğum ağırlıklı yenidoğanlann yaşama oranlarının artırılması ile beraber bazı sorunlar da ağırlaşarak ön plana çıkmaktadır. ağırlıklı yenidoğanlann özellikle yaşamlarının ilk 48 saati içerisinde, oligüri olmaksızın görülen hiperpotasemi, oldukça sık karşılaşılan ve tedavi edilmediğinde önemli komplikasyonlara yol açabilen bir sorun olarak karşımıza çıkmaktadır. Çalışmamızda, 60 prematüre yenidoğan gebelik haftası ve doğum ağırlığına göre gruplandırıldı. Çalışma grubundaki 60 olgu gebelik haftasına göre iki alt gruba, doğum ağırlığına göre üç alt gruba ayrıldı. Oluşan gruplar; gebelik haftası 32 haftadan küçük olanlar (Grup I) ve gebelik haftası 32 haftadan büyük olanlar (Grup E), doğum ağırlığı lOOOgr altında olanlar (Grup A), doğum ağırlığı 1000-1500gr arasında olanlar (Grup B) ve doğum ağırlığı 1500-2500gr arasında olanlar (Grup C) şeklindeydi. Olguların 5 gün boyunca sodyum ve potasyum değerleri ve ilk 72 saatte ki C-peptid değerleri 24 saatlik aralarla ölçüldü. Ölçülen serum potasyum düzeylerine göre de olgular iki alt grupta incelendi. Serum potasyum değerleri 6.7mEq/L ve üzerinde olanlar (Grup X) hiperpotasemik, 6.7mEq/L altında olanlar (Grup Y) normopotasemik kabul edildi. Yaşamın ilk 48 saati içerisinde ölçülen serum potasyum düzeyleri, gebelik yaşı ile ters orantılı bulundu (p<0.05). Aynı şekilde, yaşamın 48 ve 72. saatlerinde ölçülen C- peptid düzeyleri gebelik yaşı ile (-) korelasyon gösteriyordu (p<0.05). Gebelik haftasına göre oluşturulan iki grup birbiriyle karşılaştırıldığında Grup I'deki olguların ilk 48 saatteki potasyum değerleri ile 48 ve 72. saatlerindeki C-peptid değerleri, Grup İT den anlamlı şekilde yüksekti (p<0.05).

72 SERUM SODIUM - POTASSIUM LEVELS IN PREMATURE NEONATES AND THE RELATION BETWEEN HYPERKALEMIA AND C-PEPTİDE Nowadays, with the improvements achieved in the survival rates of extremely very low birth weight neonates some problems become more _and_more obviously outstanding. One of them is the nonoliguric hyperkalemia of the premature neonates. Hyperkalemia without oliguria which can lead to important complications if not treated is a relatively common condition in low birth weight neonates especially during the first 48 hours of life. In our study, 60 premature infants were grouped according to gestational week and birth weight. These 60 cases were divided into two subgroups in terms of gestational week and three subgroups in terms of birth weight. The groups formed were the ones whose gestational week was less than 32 weeks (Group I), gestational week more than 32 weeks (Group II), the ones whose birth weight was less than lOOOgr (Group A), birth weight between 1000-1500gr (Group B) and birth weight between 1500-2500gr (Group C). Serum sodium and potassium levels were measured for 5 days and serum C-peptide level were obtained with 24 hour intervals in the first 72 hours. According to serum potassium levels the cases were divided into two subgroups. The ones whose serum potassium level was 6.7mEq/L or more were named as (Group X) hyperkalemic and less than 6.7mEq/L are called as (Group Y) normokalemic. The serum potassium levels measured in the first 48 hours of life was found in reverse correlation with gestational age (p<0.05). In the same way, the C-peptide levels measured at 48th and 72nd hours of life was in negative correlation with gestational age (p<0.05). When the two groups were compared to each other in terms of gestational week, the serum potassium levels at the first 48 hours and C-peptide levels at 48th and J2nd hours of life in Group I were significantly higher than those in Group II (p<0.05).73 When the correlation among birth weight and sodium, potassium and C-peptide values was seehed a negative correlation among 24th and 48th hour potassium levels and birth weight was established. When the three groups formed according to birth weight were compared to each other, the 24th and 48th hour potassium levels of Group A were higher than those of the two remaining groups. 72nd hour serum potassium level of Group A was also significantly higher than Group C (p<0.05). When the hyperkalemic and normokalemic groups were compared in terms of C- peptide levels there was no significantly difference between two groups (p<0.05). There was also no remarkable difference among the serum sodium levels of all groups. In conclusion; the serum potassium level reaches its highest level in the first 48 hours of postnatal period than tends to decrease and becomes stable after the 4th day of life. We couldn't demonstrate a direct relationship between the serum potassium and C- peptid consequently insulin levels. The nonoliguric hyperkalemia occuring in the first four days of life in premature and very low birth infants is related to many factors. So we assume that close follow-up of serum potassium levels in these low birth weight neonates will be an accurate action.