Prematüre bebeklerde intrakranial kanama: etiyoloji ve mortalitenin araştırılması

Abstract

Amaç: Yenidoğan bakımındaki ilerlemeler prematüre bebeklerin hayatta kalma oranlarını artırmış olsa da yenidoğan yoğun bakım ünitelerinde (YYBÜ) görülen intrakraniyal kanama (iKK) önemli bir sorun olmaya devam etmektedir. Bu çalışmada, 29. gebelik haftasından önce doğan prematüre bebeklerde İKK risk faktörlerini değerlendirmeyi, önleyici stratejileri öne çıkarmayı amaçladık. Gereç ve yöntem: Bu retrospektif kohort çalışması, perinatoloji merkezinde bulunan 61 yatak kapasiteli, 4.seviye YYBÜ'de yürütülmüştür. Dijital hastane kayıtları, ≤290/7 gebelik haftasında doğan ve 2021-2023 yılları arasında hastaneye yatırılan bebekler için tarandı. Çalışma popülasyonu, ilk hafta yapılan transfontanel ultrasonografi bulgularına göre İKK'nın giderek artan şiddetine dayanarak üç gruba ayrıldı. Demografik ve perinatal özellikler ile birlikte, kordon kan gaz değerleri, platelet sayısı, platelet kütlesi laboratuvar parametreleri kapsamında kaydedildi. Klinik müdahaleler, takip verileri, kan ürünü transfüzyonu, mekanik ventilasyon gereklilikleri, ilk 72 saat içinde inotrop kullanımı, hastanede kalış süresi ve ölüm oranı gibi bilgiler analiz edildi. Bulgular: Çalışmaya 96 hasta (kadın/erkek: 39/57) dahil edildi. Gebelik haftası ortalamaları açısından Grup 1 (İKK olmayan, n=50), Grup 2 (hafif İKK, n=25) ve Grup 3 (şiddetli İKK, n=21) arasında istatistiksel olarak anlamlı bir fark bulundu (p<0.001). Ayrıca, Grup 2 ve Grup 3’te antenatal kortikosteroid tedavisinin uygulanma oranı anlamlı derecede daha düşüktü (p=0.044). Kordon laktatı ve metabolik asidoz oranı Grup 3'te anlamlı derecede yüksekti (p=0.026, <0.001). Trombosit sayısı ve trombosit kütlesi değerleri Grup 3'te diğer iki gruba kıyasla belirgin şekilde daha düşük çıktı (p=0.014, p=0.023). Tartışma: Bulgularımız, azalmış antenatal kortikosteroid kullanımı, yüksek metabolik asidoz oranları, artan transfüzyon ihtiyaçları, düşük trombosit kütlesi gibi önemli risk faktörlerini vurgulamakta, İKK'nın çok faktörlü yapısını yeniden doğrulamaktadır. Bu bulguların "İKK önleme paketi" çerçevesinde klinik protokollere entegre edilebileceğini düşünüyoruz.

Keywords

• Yenidoğan
• intrakraniyal kanama
• prematürite
• trombosit kütlesi

Intracranial hemorrhage in premature infants: investigation of etiology and mortality

Abstract

Purpose: Advancements in neonatal care have increased the survival rates of premature infants, but intracranial hemorrhage (ICH) continues to be a concerning issue in neonatal intensive care units (NICU). This study sought to evaluate the risk factors associated with ICH in preterm infants born before 29 weeks of gestation, with a particular focus on the preventive measures. Materials and methods: In a perinatology center with a 61-bed level-4 unit, this retrospective cohort study was conducted in the neonatal intensive care unit. Digital hospital records were scanned for infants born ≤290/7 weeks and hospitalized between 2021-2023. We categorized the study population into three groups based on the increasing severity of ICH according to the first week transfontanelle ultrasonography findings. Demographic, perinatal characteristics, cord blood gas values, platelet count, platelet mass were recorded as laboratory parameters. Clinical interventions, follow-up data and transfusion of blood products, mechanical ventilation requirements, inotrope use within the first 72 hours, length of hospital stay, mortality data were recorded. Results: A total of 96 patients (female/male: 39/57) were enrolled in the study. A significant difference in mean gestational age was observed among patients in Group 1 (no-ICH, n=50), Group 2 (mild, n=25), and Group 3 (severe, n=21) (p<0.001). Additionally, antenatal corticosteroid therapy was notably less frequent in Groups 2 and 3 (p=0.044). Cord lactate and the rate of metabolic acidosis were significantly higher in Group 3 (p=0.026, <0.001). The platelet count and platelet mass were significantly lower in Group 3 compared to the other two groups (p=0.014, p=0.023). Conclusion: Our findings emphasize reduced antenatal corticosteroid use, higher metabolic acidosis rates, increased transfusion needs, and lower platelet mass as prominent risk factors, reaffirming the multifactorial nature of ICH. We believe these measures can be integrated into clinical protocols within the framework of an ''ICH prevention bundle''.

Keywords

• Newborn
• intracranical hemorrhage
• prematurity
• platelet mass

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