Yenidoğan Sepsisi
Özet
Yenidoğan sepsisi, yaşamın ilk ayında ortaya çıkan ve sistemik enfeksiyon bulguları ile seyreden önemli bir klinik tablodur. Tanı ve tedavideki gelişmelere rağmen özellikle prematüre ve düşük doğum ağırlıklı bebeklerde önemli bir morbidite ve mortalite nedeni olmaya devam etmektedir. Klinik bulguların özgül olmaması ve birçok enfeksiyon dışı durumla benzerlik göstermesi nedeniyle tanı koymak güçtür ve bu nedenle erken tanı ile hızlı tedavi büyük önem taşımaktadır. Yenidoğan sepsisi klinik olarak kanıtlanmış, klinik ve şüpheli sepsis olarak sınıflandırılmakta; başlangıç zamanına göre ise erken başlangıçlı, geç başlangıçlı ve çok geç başlangıçlı sepsis olarak üç gruba ayrılmaktadır. Tanıda kan kültürü altın standart yöntem olmakla birlikte, duyarlılığının sınırlı olması nedeniyle hematolojik parametreler ve C-reaktif protein, prokalsitonin gibi inflamatuvar biyobelirteçler destekleyici olarak kullanılmaktadır. Son yıllarda presepsin, fibrinojen/albümin oranı ve metabolomik analizler gibi yeni tanısal yaklaşımlar da araştırılmaktadır. Tedavide kültür örnekleri alındıktan sonra ampirik antibiyotik başlanmalı ve tedavi süresi klinik ve laboratuvar bulgularına göre düzenlenmelidir. Yenidoğan yoğun bakım ünitelerinde enfeksiyon kontrol önlemleri, akılcı antibiyotik kullanımı ve riskli bebeklerde uygun profilaksi uygulamaları sepsise bağlı morbidite ve mortalitenin azaltılmasında önemli rol oynamaktadır.
Neonatal sepsis is a serious clinical condition occurring within the first month of life and characterized by signs of systemic infection. Despite advances in diagnosis and treatment, it remains an important cause of morbidity and mortality, particularly among premature and low birth weight infants. Diagnosis is challenging because clinical manifestations are often nonspecific and may resemble many non-infectious conditions; therefore, early recognition and prompt treatment are crucial. Neonatal sepsis is classified as proven, clinical, or suspected sepsis, and according to the time of onset it is divided into early-onset, late-onset, and very late-onset sepsis. Blood culture remains the gold standard for diagnosis; however, due to its limited sensitivity, hematological indices and inflammatory biomarkers such as C-reactive protein and procalcitonin are widely used as supportive diagnostic tools. In recent years, novel biomarkers including presepsin, fibrinogen-to-albumin ratio, and metabolomic approaches have been investigated for early diagnosis. Empirical antibiotic therapy should be initiated after obtaining appropriate culture samples, and the duration of treatment should be determined according to clinical and laboratory findings. Infection control strategies in neonatal intensive care units, rational antibiotic use, and prophylactic measures in high-risk infants play a key role in reducing sepsis-related morbidity and mortality.
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