HİPOKSİK İSKEMİK ENSEFALOPATİDE UMBLİKAL KORD PH VE İZLEMDE ALINAN KARDİYAK BELİRTEÇLERİN YENİDOĞAN VE BEBEKLİK DÖNEMİ NÖROGELİŞİMSEL SONUÇLARA ETKİSİ
Öz
AMAÇ: Hipoksik iskemik ensefalopati (HİE); anormal bilinç durumu, nöbetler, çoklu organ yetmezliği ile seyredebilen klinik bir durumdur. Bu retrospektif çalışma ile terapötik hipotermi (TH) uygulanan HİE tanılı yenidoğanların kord kan gazı pH değeri ve kardiyak belirteçleri ile difüzyon Manyetik rezonans görüntüleme (MRG), nörolojik muayeneleri ve gelişimsel sonuçlarının değerlendirilmesi amaçlanmıştır.
GEREÇ- YÖNTEM: Ocak 2015- Ocak 2021 tarihleri arasında Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi Yenidoğan Yoğun Bakım Ünitesi'ne yatırılarak HİE evre 2-3 tanısı ile TH tedavisi almış ve poliklinik izlemine gelen hastalar çalışmaya dahil edildi. Umblikal kord kan gazı pH, Troponin-I, CK-MB değerleri, diffüzyon MRG bulguları ile Bayley Bebekler ve Küçük Çocuklar için Gelişimi Değerlendirme Ölçeği-III (BSID-III) sonuçları karşılaştırıldı.
BULGULAR: Çalışmaya alınan 17 hastanın ortalama gebelik haftası 39 hafta (37-41), doğum ağırlıkları ortalama 3360 ± 325 g, 13’ü (%59) erkekti. Hastaların aEEG/EEG izleminde 10 (%59)’unda nöbet tespit edilmedi. Kordon kan gazı pH değeri ortancası ile anormal difüzyon MRG sonuçları arasında istatistiksel olarak fark saptanmadı. BSID-III skorları ile kord kan gazı pH değerinin ortancası arasında; kalp belirteçleri ile difüzyon MRG ve BSID-III sonuçları arasında istatistiksel fark saptanmadı.
SONUÇ: Hipoksik iskemik ensefalopati olan bebeklerde TH endikasyonu için kullanılan kord kan gazı değerleri uzun dönem nörolojik-gelişimsel prognozun öngörülmesinde yeterli değildir. Hasta sayısı arttırıldığı takdirde bu hastalarda kalp kasının hipoksiden etkilendiğini gösteren kardiyak enzimleri uzun dönem izlemde bebeğin karşılaşabileceği nörolojik-gelişimsel sorunları öngörmede yararlı olabileceğini söyleyebiliriz.
Anahtar Kelimeler
Hipoksik iskemik ensefalopati terapötik hipotermi kardiyak belirteçler nörogelişimsel izlem
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
yok
Kaynakça
- 1) Bonifacio SL, Hutson S. The Term Newborn: Evaluation for Hypoxic-Ischemic Encephalopathy. Clin Perinatol. 2021; 48:681-95.
- 2) Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86:329-38.
- 3) Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma Grubu. Türkiye’de yenidoğan yoğun bakım ünitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51:123-129.
- 4) Lawn JE, Osrin D, Adler A, Cousens S. Four million neonatal deaths: counting and attribution of cause of death. Paediatr Perinat Epidemiol. 2008 Sep;22(5):410-6. doi: 10.1111/j.1365-3016.2008.00960.x.
- 5) AKISÜ, Mete, Abdullah KUMRAL, and F. Emre CANPOLAT. "NEONATAL ENSEFALOPATİ TANI VE TEDAVİ REHBERİ."
- 6) Sweetman DU, Kelly L, Hurley T, Onwuneme C, Watson RWG, Murphy JFA, et al. Troponin T correlates with MRI results in neonatal encephalopathy. Acta Paediatr. 2020;109:2266-2270. doi: 10.1111/apa.15255.
- 7) Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling: a randomized clinical trial. JAMA. 2014; 24-31;312:2629-39.
- 8) Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976; 33:696-705. doi: 10.1001/archneur.1976.00500100030012. 9) Thompson CM, Puterman AS, Linley LL, Hann FM, van der Elst CW, Molteno CD, et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997 Jul;86(7):757-61. doi: 10.1111/j.1651-2227.1997.tb08581.x.
- 10) Y.Hollingshead AB, Redlich FC. Social class and mental illness: Community study. 1958.
- 11) Bayley N. Techical manual of the bayley scales of infant and toddler development. 3rd edt. San Antonio, TX: HarcourtAssessmentInc; 2006.)
- 12) Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long-term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
- 13) ACOG Task Force on Neonatal Encephalopathy. Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Obstet Gynecol. 2014; 123:896–901.
- 14) Armstrong, L; Stenson, B J (2007). Use of umbilical cord blood gas analysis in the assessment of the newborn. Archives of Disease in Childhood - Fetal and Neonatal Edition, 92, F430–F434.doi:10.1136/adc.2006.099846
- 15) Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD003311. doi: 10.1002/14651858.CD003311.pub3.
- 16) Al Amrani F, Kwan S, Gilbert G, Saint-Martin C, Shevell M, Wintermark P. Early Imaging and Adverse Neurodevelopmental Outcome in Asphyxiated Newborns Treated with Hypothermia. Pediatr Neurol. 2017; 73:20-27. doi: 10.1016/j.pediatrneurol.2017.04.025.
- 17) Hunt RW, Neil JJ, Coleman LT, Kean MJ, Inder TE: Apparent diffusion coeffi cient in the posterior limb of the internal capsule predicts outcome after perinatal asphyxia. Pediatrics 2004; 114: 999–1003.
- 18) L’Abee C, de Vries L, S, van der Grond J, Groenendaal F: Early Diffusion-Weighted MRI and H-Magnetic Resonance Spectroscopy in Asphyxiated Full-Term Neonates. Biol Neonate 2005; 88:306-312. doi: 10.1159/000087628
- 19) V. Charon, M. Proisy, G. Bretaudeau, B. Bruneau, P. Pladys, A. Beuch e, et al. Early MRI neonatal hypoxic-ischaemic encephalophathy treated with hypothermia: prognostic role at 2-year follow-up, Eur. J. Radio. 85 (2016) 1366–1374.
- 20) Montaldo P, Rosso R, Chello G, Giliberti P. Cardiac troponin I concentrations as a marker of neurodevelopmental outcome at 18 months in newborns with perinatal asphyxia. J Perinatol. 2014 Apr;34(4):292-5. doi: 10.1038/jp.2014.1.
EFFECT OF UMBLICAL CORD PH AND FOLLOW-UP CARDIAC MARKERS ON NEURODEVELOPMENTAL RESULTS IN HYPOXIC ISCHEMIC ENCEPHALOPATHY
Öz
AİM: Hypoxic ischemic encephalopathy (HIE); It is a clinical condition that can progress with abnormal consciousness, seizures, and multi-organ failure. In this retrospective study, it was aimed to evaluate the cord blood gas pH value and cardiac markers, as well as diffusion magnetic resonance imaging (MRI), neurological examinations and developmental results of newborns diagnosed with HIE who underwent therapeutic hypothermia (TH).
MATERIALS-METHODS: Patients who were hospitalized in the Neonatal Intensive Care Unit of Hacettepe University İhsan Doğramacı Children's Hospital between January 2015 and January 2021 and received TH treatment with the diagnosis of HIE stage 2-3 and were followed up in the outpatient clinic were included in the study. Umbilical cord blood gas pH, Troponin-I, CK-MB values, diffusion MRI findings and Bayley Developmental Assessment Scale for Infants and Young Children-III (BSID-III) results were compared.
RESULTS: Mean gestational week of 17 patients included in the study was 39 weeks (37-41), mean birth weight was 3360 ± 325 g, 13 (59%) were male. Seizures were not detected in 10 (59%) of the patients in aEEG/EEG follow-up. There was no statistical difference between the median cord blood gas pH value and abnormal diffusion MRI results. Between the BSID-III scores and the median of the cord blood gas pH; There was no statistical difference between heart markers and diffusion MRI and BSID-III results.
CONCLUSION: Cord blood gas values used for TH indication in infants with hypoxic ischemic encephalopathy are not sufficient to predict long-term neurodevelopmental prognosis. If the number of patients is increased, we can say that cardiac enzymes, which show that the heart muscle is affected by hypoxia in these patients, may be useful in predicting the neurological-developmental problems that the baby may presence in long-term follow-up.
Anahtar Kelimeler
Hypoxic ischemic encephalopathy therapeutic hypothermia cardiac markers neurodevelopmental follow-up
Proje Numarası
yok
Kaynakça
- 1) Bonifacio SL, Hutson S. The Term Newborn: Evaluation for Hypoxic-Ischemic Encephalopathy. Clin Perinatol. 2021; 48:681-95.
- 2) Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86:329-38.
- 3) Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma Grubu. Türkiye’de yenidoğan yoğun bakım ünitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51:123-129.
- 4) Lawn JE, Osrin D, Adler A, Cousens S. Four million neonatal deaths: counting and attribution of cause of death. Paediatr Perinat Epidemiol. 2008 Sep;22(5):410-6. doi: 10.1111/j.1365-3016.2008.00960.x.
- 5) AKISÜ, Mete, Abdullah KUMRAL, and F. Emre CANPOLAT. "NEONATAL ENSEFALOPATİ TANI VE TEDAVİ REHBERİ."
- 6) Sweetman DU, Kelly L, Hurley T, Onwuneme C, Watson RWG, Murphy JFA, et al. Troponin T correlates with MRI results in neonatal encephalopathy. Acta Paediatr. 2020;109:2266-2270. doi: 10.1111/apa.15255.
- 7) Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling: a randomized clinical trial. JAMA. 2014; 24-31;312:2629-39.
- 8) Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976; 33:696-705. doi: 10.1001/archneur.1976.00500100030012. 9) Thompson CM, Puterman AS, Linley LL, Hann FM, van der Elst CW, Molteno CD, et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997 Jul;86(7):757-61. doi: 10.1111/j.1651-2227.1997.tb08581.x.
- 10) Y.Hollingshead AB, Redlich FC. Social class and mental illness: Community study. 1958.
- 11) Bayley N. Techical manual of the bayley scales of infant and toddler development. 3rd edt. San Antonio, TX: HarcourtAssessmentInc; 2006.)
- 12) Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long-term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
- 13) ACOG Task Force on Neonatal Encephalopathy. Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Obstet Gynecol. 2014; 123:896–901.
- 14) Armstrong, L; Stenson, B J (2007). Use of umbilical cord blood gas analysis in the assessment of the newborn. Archives of Disease in Childhood - Fetal and Neonatal Edition, 92, F430–F434.doi:10.1136/adc.2006.099846
- 15) Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD003311. doi: 10.1002/14651858.CD003311.pub3.
- 16) Al Amrani F, Kwan S, Gilbert G, Saint-Martin C, Shevell M, Wintermark P. Early Imaging and Adverse Neurodevelopmental Outcome in Asphyxiated Newborns Treated with Hypothermia. Pediatr Neurol. 2017; 73:20-27. doi: 10.1016/j.pediatrneurol.2017.04.025.
- 17) Hunt RW, Neil JJ, Coleman LT, Kean MJ, Inder TE: Apparent diffusion coeffi cient in the posterior limb of the internal capsule predicts outcome after perinatal asphyxia. Pediatrics 2004; 114: 999–1003.
- 18) L’Abee C, de Vries L, S, van der Grond J, Groenendaal F: Early Diffusion-Weighted MRI and H-Magnetic Resonance Spectroscopy in Asphyxiated Full-Term Neonates. Biol Neonate 2005; 88:306-312. doi: 10.1159/000087628
- 19) V. Charon, M. Proisy, G. Bretaudeau, B. Bruneau, P. Pladys, A. Beuch e, et al. Early MRI neonatal hypoxic-ischaemic encephalophathy treated with hypothermia: prognostic role at 2-year follow-up, Eur. J. Radio. 85 (2016) 1366–1374.
- 20) Montaldo P, Rosso R, Chello G, Giliberti P. Cardiac troponin I concentrations as a marker of neurodevelopmental outcome at 18 months in newborns with perinatal asphyxia. J Perinatol. 2014 Apr;34(4):292-5. doi: 10.1038/jp.2014.1.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 3 Temmuz 2023 |
| Gönderilme Tarihi | 14 Ekim 2022 |
| Kabul Tarihi | 12 Ocak 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 20 Sayı: 2 |
