Yenidoğan Döneminde Sık Görülen Solunum Problemleri ve Mekanik Ventilatör Stratejileri
Özet
Yenidoğan döneminde solunum sıkıntısı, yenidoğan yoğun bakım ünitelerine yatışın en sık nedenlerinden biridir ve etiyolojisi gestasyonel yaş, doğum özellikleri ve altta yatan pulmoner veya kardiyak hastalıklara göre değişir. Prematüre bebeklerde en önemli neden respiratuvar distres sendromu (RDS) olup temel patogenez surfaktan eksikliğine bağlı alveoler kollaps ve akciğer kompliyansında azalmadır. Güncel RDS yönetimi antenatal kortikosteroid uygulaması, doğum salonunda erken CPAP, uygun zamanlı sürfaktan tedavisi ve akciğer koruyucu ventilasyon stratejilerini içermektedir. Term ve geç preterm bebeklerde sık görülen yenidoğanın geçici takipnesi (TTN), fetal akciğer sıvısının gecikmiş rezorpsiyonu sonucu gelişir ve genellikle destekleyici tedavi ile kendini sınırlayan bir seyir gösterir. Noninvaziv solunum desteği, oksijen tedavisi ve uygun sıvı yönetimi tedavinin temelini oluşturur. Persistan pulmoner hipertansiyon (PPHN) ise doğum sonrası pulmoner vasküler direncin düşmemesi sonucu sağdan sola şant ve ciddi hipoksemi ile karakterizedir. Tedavide yeterli oksijenasyon ve ventilasyonun sağlanması, hemodinamik stabilizasyon ve gerektiğinde inhale nitrik oksit gibi selektif pulmoner vazodilatörlerin kullanımı esastır. Güncel yaklaşımlar, yaşam sağkalımını artırırken uzun dönem solunumsal ve nörogelişimsel morbiditeleri azaltmayı hedeflemektedir.
Respiratory distress is one of the most common causes of admission to neonatal intensive care units, and its etiology varies according to gestational age, delivery characteristics, and underlying pulmonary or cardiac conditions. In preterm infants, the leading cause is respiratory distress syndrome (RDS), primarily resulting from surfactant deficiency, which leads to alveolar collapse and reduced lung compliance. Contemporary management of RDS includes antenatal corticosteroid administration, early continuous positive airway pressure (CPAP) in the delivery room, timely surfactant therapy, and lung-protective ventilation strategies. Transient tachypnea of the newborn (TTN), frequently observed in term and late preterm infants, develops due to delayed resorption of fetal lung fluid and typically follows a self-limited course with supportive care. Noninvasive respiratory support, oxygen therapy, and appropriate fluid management constitute the main components of treatment. Persistent pulmonary hypertension of the newborn (PPHN) is characterized by failure of the normal postnatal decline in pulmonary vascular resistance, resulting in right-to-left shunting and severe hypoxemia. Management focuses on optimizing oxygenation and ventilation, ensuring hemodynamic stability, and, when necessary, administering selective pulmonary vasodilators such as inhaled nitric oxide. Current therapeutic approaches aim not only to improve survival but also to reduce long-term respiratory and neurodevelopmental morbidity.
Referanslar
Martin RJ, Garcia-Prats JA. Overview of neonatal respiratory distress and disorders of transition. UpToDate. 2024. Erişim tarihi: 08 Şubat 2026.
Martin RJ, Fanaroff AA, Walsh MC, editors. Avery’s Diseases of the Newborn. 10th ed. Philadelphia: Elsevier; 2018. p. 653.
Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-456. doi:10.1542/peds.2009-2959.
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120:3-23. doi:10.1159/000528914.
Jobe AH. Lung development and maturation. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Neonatal-Perinatal Medicine. 9th ed. St Louis: Elsevier Mosby; 2010. p. 1075.
Türk Neonatoloji Derneği. Respiratuvar Distres Sendromu ve Surfaktan Tedavi Rehberi. Ankara: Türk Neonatoloji Derneği; 2018.
Guo BB, Pang L, Yang B, et al. Lung ultrasound for the diagnosis and management of neonatal respiratory distress syndrome: a minireview. Front Pediatr. 2022;10:864911. doi:10.3389/fped.2022.864911.
Martin RJ, Ryan RM. Respiratory distress syndrome (RDS) in preterm neonates: clinical features and diagnosis. UpToDate. 2025. Erişim tarihi: 08 Şubat 2026.
SUPPORT Study Group. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362:1970-1979. doi:10.1056/NEJMoa0911783.
Dunn MS, Kaempf J, de Klerk A, et al. Randomized trial comparing three approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128(5):e1069-e1076. doi:10.1542/peds.2010-3848.
Verlato G, Cogo PE, Balzani M, et al. Surfactant status in preterm neonates recovering from respiratory distress syndrome. Pediatrics. 2008;122(1):102-108. doi:10.1542/peds.2007-1905.
Göpel W, Kribs A, Ziegler A, et al. Less invasive surfactant administration in extremely preterm infants: a meta-analysis. Pediatrics. 2015;136(4):730-739. doi:10.1542/peds.2015-0948.
Tarawneh A, Kaczmarek J, Bottino MN, Sant’anna GM. Severe airway obstruction during surfactant administration: a prospective observational study. J Perinatol. 2012;32(4):270-275. doi:10.1038/jp.2011.99.
Polin RA, Carlo WA. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156-163. doi:10.1542/peds.2013-3443.
Van Kaam AH, Rimensberger PC. Lung-protective ventilation strategies in neonatology. Pediatr Pulmonol. 2007;42(11):1027-1036. doi:10.1002/ppul.20698.
Meyers JM. High-frequency ventilation in the neonate. UpToDate. 2025. Erişim tarihi: 08 Şubat 2026.
Johnson KE, Garcia-Prats JA. Transient tachypnea of the newborn. UpToDate. 2025. Erişim tarihi: 08 Şubat 2026.
Bruschettini M, Hassan KO, Romantsik O, et al. Interventions for management of transient tachypnea of the newborn. Cochrane Database Syst Rev. 2022;2:CD013563. doi:10.1002/14651858.CD013563.pub2.
Türk Neonatoloji Derneği. Term Yenidoğanda Solunum Sıkıntısı Tanı, Tedavi ve Koruma Rehberi. Ankara: Türk Neonatoloji Derneği; 2021.
Betran AP, Ye J, Moller AB, et al. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6:e005671. doi:10.1136/bmjgh-2021-005671.
Avery ME, Gatewood OB, Brumley G. Transient tachypnea of newborn: possible delayed resorption of fluid at birth. Am J Dis Child. 1966;111:380-385. doi:10.1001/archpedi.1966.02090010382011.
O’Brodovich HM. Immature epithelial Na+ channel expression and neonatal respiratory disorders. Proc Assoc Am Physicians. 1996;108:345-355. doi:10.1111/j.1525-1381.1996.tb00069.x.
Daley SF, Nassar GN, Makker K. Transient tachypnea of the newborn. StatPearls [Internet]. 2025. Erişim tarihi: 08 Şubat 2026.
Keszler M, Carbone MT, Cox C, et al. Severe respiratory failure after elective repeat cesarean delivery: a potentially preventable condition leading to ECMO. Pediatrics. 1992;89:670-673. doi:10.1542/peds.89.4.670.
Ma HR, Liu J, Yan WK. Accuracy and reliability of lung ultrasound to diagnose transient tachypnea of the newborn. Am J Perinatol. 2022;39(9):973-979. doi:10.1055/s-0041-1733801.
Hermansen CL, Mahajan A. Newborn respiratory distress. Am Fam Physician. 2015;92(11):994-1002.
McGillick EV, Te Pas AB, van den Akker T, et al. Evaluating respiratory support in term infants with TTN. Front Pediatr. 2022;10:878536. doi:10.3389/fped.2022.878536.
Moresco L, Romantsik O, Calevo MG, Bruschettini M. Non-invasive respiratory support for the management of transient tachypnea of the newborn. Cochrane Database Syst Rev. 2020;4:CD013231. doi:10.1002/14651858.CD013231.pub2.
Steinhorn RH. Diagnosis and treatment of pulmonary hypertension in infancy. Early Hum Dev. 2013;89(11):865-874. doi:10.1016/j.earlhumdev.2013.09.019.
Stark AR, Eichenwald EC. Persistent pulmonary hypertension of the newborn: clinical features and diagnosis. UpToDate. 2025. Erişim tarihi: 08 Şubat 2026.
Nandula PS, Shah SD. Persistent pulmonary hypertension of the newborn. StatPearls [Internet]. 2025. Erişim tarihi: 08 Şubat 2026.
Lakshminrusimha S, Steinhorn RH. Pulmonary vascular biology during neonatal transition. Clin Perinatol. 1999;26(3):601-619.
Chojnacka K, Singh Y, Gahlaut S, et al. Persistent pulmonary hypertension of the newborn: a pragmatic review of pathophysiology, diagnosis, and advances in management. Biomedicines. 2025;13(10):2332. doi:10.3390/biomedicines13102332.
Vargas-Origel A, Gómez-Rodríguez G, et al. The use of sildenafil in persistent pulmonary hypertension of the newborn. Am J Perinatol. 2010;27:225-230. doi:10.1055/s-0029-1243315.
Singh Y, Lakshminrusimha S. Pathophysiology and management of persistent pulmonary hypertension of the newborn. Clin Perinatol. 2021;48(3):595-618. doi:10.1016/j.clp.2021.05.006.
Kaltsogianni R, Bhat R, Greenough A, Dassios T. Tachycardia and persistent pulmonary hypertension of the newborn. Front Pediatr. 2025;13:1607907. doi:10.3389/fped.2025.1607907.
Cookson MW, Kinsella JP. Inhaled nitric oxide in neonatal pulmonary hypertension. Clin Perinatol. 2024;51:95-109. doi:10.1016/j.clp.2023.10.005.
Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term infants with hypoxic respiratory failure. N Engl J Med. 1997;336:597-604. doi:10.1056/NEJM199702273360901.
González A, Bancalari A, Osorio W, et al. Early use of combined surfactant and iNO reduces treatment failure in PPHN. J Perinatol. 2021;41:32-39. doi:10.1038/s41372-020-00853-y.
