Çocukluk Çağında Pnömotoraks
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Aka, M. Pneumothorax in childhood. Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara 2023. Pneumothorax is the presence of air in the pleural space due to alveolar damage. Although pneumothorax in childhood is rare, it is an important cause of morbidity and mortality in this term as well as in adults, as patients usually have an underlying disease. In this study, the records of patients followed up and treated for pneumothorax between January 1, 2010, and February 9, 2021, at Hacettepe University İhsan Doğramacı Children's Hospital were retrospectively reviewed. A total of 117 patients were included in the study. The median age of the patients was 5.33 years (0.04-16). Age distribution was 0-28 days for 27.4% of the patients, 28 days-10 years for 26.5%, and 10-18 years for 46.2%. 74.4% of the patients were observed to be male, and 25.6% were female. Considering the etiological distribution, of 117 patients in our case series, 28.2% were found to have an iatrogenic pneumothorax (IP), 25.6% were secondary spontaneous pneumothorax (SSP), 19.7% were primary spontaneous pneumothorax (PSP), 13.7% were traumatic pneumothorax (TP), 12.8% were neonatal pneumothorax (NP). Of the patients in the current study, 50.4% were diagnosed with outpatient admission, and 49.6% were diagnosed while they were in inpatient treatment for a reason other than a pneumothorax. All PSPs and the majority of SSPs (76.7%) were observed to be diagnosed on an outpatient basis, and all of the NPs and almost all of the IPs (97%) had pneumothorax during hospital follow-up. Of the cases, 35.9% had a large pneumothorax. Besides, 25.6% of the patients had recurrent pneumothorax, 43.3% of recurrent pneumothoraxes were SSP, 30% were PSP, 23.3% were IP, and 3.3% were NP. Since the incidence of SSP and PSP was found to be significantly higher in recurring than in non-recurring cases, there was detected to be a significant relationship between etiology and recurrence (p=0.001). The median age of those who recurred was 14.85 years (9.16-16.58), while the median age of those who non-recurred was 2.04 years (0.03-15), and the median of those who recurred was found to be significantly higher (p=0.017). Furthermore, 40% of recurrent pneumothoraxes were determined as asthenic in nature, and there was observed to be a correlation between asthenic structure and recurrence (p=0.038). When the family histories of recurrent pneumothoraxes were questioned, 10% of them were also learned to have pneumothorax in their families, and a significant correlation was found between family history and recurrence (p=0.017). Bulla, bleb, or air cysts were detected in 28% of the cases with recurrent, and a significant correlation was found between them and the recurrent rates (p=0.012). Although male gender, low body mass index (BMI) and smoking were shown as risk factors for pneumothorax, no effect on recurrence was detected in our study. The size of the pneumothorax and the location of the pneumothorax had no effect on recurrence. In our study, 31.6% of the patients died. Underlying diseases in 56.8% of the patients who died from premature complications in 37.8%, and falling from a height in 5.4% were shown as the cause. It was observed that 51.4% of the patients who died had IP, 24.3% had SSP, 18.9% had NP, and 5.4% had TP. The incidence of IP was found to be significantly higher among those with mortality (p<0.001). No patient died with PSPs. Age was determined to be a factor with a significant effect on mortality and a decrease in age increased the risk of mortality 1.16 times (p<0.001).