Neurodevelopmental outcomes in preterm infants

Yıl 2024, Cilt: 5 Sayı: 2, 66 - 72, 29.07.2024

Arzu Ekici , Emine Gülben Yurdagül , Günel Aghazada , Taha Metin , Sevgi Yimenicioğlu

Öz

Objective: The increasing technological equipment of neonatal intensive care units (NICU), the experienced intensive care team, and the use of supportive treatments (antenatal corticosteroid, surfactant) increased the survival rates of premature babies and therefore the morbidity rates. It was aimed at evaluating the frequency of cerebral palsy (CP) and epilepsy, which are the most common neurological problems at premature infants (≤ 34 weeks of age).
Method: Two hundred fifty-three premature infants who were born ≤ 34 weeks of age and followed between 2016 and 2020 were included in this study. Patients’ gestational age, birth weight, mechanical ventilation, seizure status, internalization duration in the NICU, neurologic examinations, and DDST-II of the patients were reviewed.
Result: The mean gestational age was 29.44 (24–34) weeks and the birth weight was 1225 (990–1607) grams. During the NICU stay, 26 patients (10.3%) had seizures. Seizures were the most common in 28–31-week preterms (57.7%; p=0.02). Fifty-five (21.7%) patients had abnormal DDST-II. There was a significant difference between seizures in the neonatal period and internalization duration and abnormal DDST-II (respectively p <0.001, p<0,05). Forty-six patients (15.8%) had neurodevelopmental delay, and nine (3.6%) had CP (five had hemiparetic CP, two had spastic paraplegia, and two had spastic tetraparesis). Sixteen (6.3%) patients had epilepsy; 9 (3.6%) had speech disturbance; 3 (1.2%) had hydrocephaly; 1 (0.4%) had microcephaly; and 1 (0.4%) had macrocephaly. Epilepsy was more common in patients with neonatal seizures (p<0.001).
Coclusion: Continuous developmental monitoring and evaluation allows for the early detection of developmental delays in preterm infants. Early recognition and referral to rehabilitation programs can reduce the level of sequel. We mostly encountered neurodevelopmental delay, CP, epilepsy, and speech disturbance

Anahtar Kelimeler

cerebral palsy, DDST-II, epilepsy, preterm infants

Erken doğmuş bebeklerde nörogelişimsel sonuçlar

Öz

Giriş: Yenidoğan yoğun bakım ünitelerinin (YYBÜ) artan teknolojik donanımı, deneyimli yoğun bakım ekibi ve destekleyici tedavilerin (antenatal kortikosteroid, sürfaktan) kullanılması, prematüre bebeklerin hayatta kalma oranlarını ve dolayısıyla morbidite oranlarını artırdı. Prematüre bebeklerde (≤ 34 hafta) en sık görülen nörolojik problem olan serebral palsi (SP) ve epilepsi sıklığının değerlendirilmesi amaçlandı.
Yöntem: Bu çalışmaya 2016-2020 yılları arasında 34 hafta ve altı doğan ve takip edilen 253 prematüre bebek dahil edildi. Hastaların gebelik yaşı, doğum kilosu, mekanik ventilasyonu, nöbet durumu, YYBÜ'de kalış süresi, nörolojik muayeneleri ve DDST-II'si incelendi.
Bulgular: Ortalama gebelik yaşı 29,44 (24-34) hafta, doğum ağırlığı ise 1225 (990-1607) gramdı. YYBÜ'de kaldığı süre boyunca 26 hastada (%10,3) nöbet görüldü. Nöbetler en sık 28-31 haftalık prematürelerde görüldü (%57,7; p=0,02). Elli beş (%21,7) hastada anormal DDST-II vardı. Yenidoğan dönemindeki nöbetler ve içselleştirme süresi ile anormal DDST-II arasında anlamlı fark vardı (sırasıyla p<0,001, p<0,05). Hastaların 46'sında (%15,8) nörogelişimsel gecikme, dokuzunda (%3,6) SP vardı (beşinde hemiparetik SP, ikisinde spastik parapleji ve ikisinde spastik tetraparezi vardı). On altı (%6,3) hastada epilepsi vardı; 9'unda (%3,6) konuşma bozukluğu vardı; 3'ünde (%1,2) hidrosefali vardı; 1'inde (%0,4) mikrosefali vardı; ve 1'inde (%0,4) makrosefali vardı. Yenidoğan nöbeti geçiren hastalarda epilepsi daha sık görüldü (p<0,001).
Sonuç: Sürekli gelişimsel izleme ve değerlendirme, erken doğmuş bebeklerde gelişimsel gecikmelerin erken tespitine olanak sağlar. Erken tanı ve rehabilitasyon programlarına yönlendirme sekel düzeyini azaltabilir (19). En sık nörogelişimsel gecikme, SP, epilepsi ve konuşma bozukluğuyla karşılaştık.

Anahtar Kelimeler

serebral palsi, DDST-II, epilepsi, erken doğmuş bebekler

Kaynakça

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