Terapötik hipotermi uygulanan hipoksik iskemik ensefalopatili hastalarda mortalite

Year 2025, Volume: 50 Issue: 1, 47 - 55, 31.03.2025

Gaffari Tunç , Elif Ünver Korğalı , Gülşah Ünsal , Muhammet Ali Mutlu , Esra Akaydın Gültürk

https://doi.org/10.17826/cumj.1569520

Abstract

Amaç: Hipoksik-iskemik ensefalopati perinatal dönemde ortaya çıkan ve bilinç bozukluğu veya nöbetler, solunum depresyonu ve hipotoni ile karakterize heterojen bir klinik sendromdur. Bu çalışmanın amacı terapötik hipotermi uygulanan hipoksik-iskemik ensefalopati hastalarında mortalite oranlarını değerlendirmektir.
Gereç ve Yöntem: Çalışmaya Yenidoğan Yoğun Bakım Ünitesinde terapötik hipotermi uygulanan 97 hipoksik-iskemik ensefalopati vakası dahil edildi. Olgular mortalite açısından değerlendirilmiş ve Grup 1 (n:9, hayatta kalmayanlar) ve Grup 2 (n: 88, hayatta kalanlar) olmak üzere iki grup oluşturulmuştur. Demografik veriler, tanılar, hipoksik-iskemik ensefalopati komplikasyonları, APGAR skorları, kan ürünü desteği ve laboratuvar parametreleri mortalite açısından değerlendirildi.
Bulgular: Bu çalışmaya 97 hipoksik-iskemik ensefalopati vakanın 40’ı kadın ve 57’si erkek cinsiyet idi. Grup 1 (hayatta kalmayanlar) 9 (%9,3) ve Grup 2 (hayatta kalanlar) 88 olgu içermekteydi. Etyolojide en sık neden kordon prolapsusu (n=40) olup, mekonyum aspirasyon sendromu nedeniyle hipoksik-iskemik ensefalopati gelişen bebeklerde mortalite oranı anlamlı derecede yüksek (%29,40) olarak belirlendi. Mortalite riskinin bebekte kanama varlığı ile 4,6 kat, akut böbrek hasarı ile 7,3 kat, trombositopeni ile 15,5 kat, taze donmuş plazma alma durumu ile 4,6 kat ve pulmoner hemoraji ile 12,3 kat arttığı belirlenmiştir. Entübe gün sayısındaki 1 birimlik artışın mortalite riskini 1,2 kat artırdığı belirlenmiştir.
Sonuç: Mekonyum aspirasyonuna bağlı hipoksik-iskemik ensefalopati gelişen vakaların ölüm oranları, mekonyum aspirasyon sendromu olmayan hipoksik-iskemik ensefalopati vakalarınkinden önemli ölçüde daha yüksekti. Düşük APGAR skoru, artmış entübasyon günü sayısı, akut böbrek hasarı, trombositopeni ve taze donmuş plazma ihtiyacı, hipoksik-iskemik ensefalopati için terapötik hipotermi alan bebeklerde yüksek mortalite riski ile ilişkilendirilmiştir ve mekonyum aspirasyon sendromu varlığı bu riski önemli ölçüde artırmıştır.

Keywords

Hipoksik iskemik ensefalopati, mekonyum aspirasyon sendromu, yenidoğan, mortalite, terapötik hipotermi

Ethical Statement

The study protocol was approved by the Ethics Committee of Sivas Cumhuriyet University Medical Faculty (Decision no:2019-05/03, dated:22.05.2019).

Supporting Institution

No

Project Number

No

Mortality in patients with hypoxic ischemic encephalopathy treated with therapeutic hypothermia

Abstract

Purpose: Hypoxic-ischemic encephalopathy is a heterogeneous clinical syndrome that occurs in the perinatal period and is characterized by altered consciousness or seizures, respiratory depression, and hypotension. The aim of this study was to evaluate mortality in hypoxic-ischemic encephalopathy patients receiving therapeutic hypothermia.
Materials and Methods: The study included 97 hypoxic-ischemic encephalopathy cases who underwent therapeutic hypothermia in the Neonatal Intensive Care Unit. The cases were evaluated for mortality and were divided into two groups: group 1 (n: 9, non-survivors) and group 2 (n: 88, survivors). Demographics, diagnoses, hypoxic-ischemic encephalopathy complications, APGAR scores, blood support, and laboratory parameters were evaluated for mortality.
Results: The 97 hypoxic-ischemic encephalopathy cases in this study included 40 females and 57 males. There were 9 (9.3%) cases in group 1 (non-survivors) and 88 (90.7%) cases in group 2 (survivors). The most common etiology was umbilical cord prolapse 40 (41.2%), and the mortality rate in infants who developed hypoxic-ischemic encephalopathy due to meconium aspiration syndrome was found to be significantly high (29.4%). The risk of death was found to be increased 4.6-fold by the presence of hemorrhage in the infant, 7.3-fold by acute kidney injury, 15.5-fold by thrombocytopenia, 4.6-fold by administration of fresh frozen plasma, and 12.3-fold by pulmonary hemorrhage. A 1-unit increase in the number of intubated days was associated with a 1.2-fold increase in the risk of death.
Conclusion: Mortality rates were significantly higher in cases that developed Meconium aspiration syndrome associated hypoxic-ischemic encephalopathy than in hypoxic-ischemic encephalopathy cases without meconium aspiration syndrome. A low APGAR score, increased number of intubation days, acute kidney injury, thrombocytopenia, and need for fresh frozen plasma were associated with a high risk of mortality in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy, and the presence of meconium aspiration syndrome significantly increased this risk.

Keywords

Hypoxic ischemic encephalopathy, meconium aspiration syndrome, newborn, mortality, therapeutic hypothermia

Project Number

No

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