BibTex RIS Kaynak Göster

Analysis Of Hypoxic-Ischemic Encephalopathy Cases At a Tertiary Care Hospital And Correlation Between Cesarean and Hypoxic-Ischemic Encephalopathy Rates

Yıl 2019, Cilt: 16 Sayı: 3, 135 - 139, 01.07.2019

Öz

Objective: Hypoxic-ischemic encephalopathy HIE is the most important cause of neonatal encephalopathy. Worldwide, İncidence of HİE is approximately ‰ 2-9 of live births. Aur aim is to analyse the neonatal encephalopathy cases treated with hypothermia and to evaluate the correlation between cesarean and Hypoxic-ischemic encephalopathy rates.Methods: This cross sectional descriptive retrospective study was performed on HIE cases treated with hypothermia in the neonatal intensive care unit. We compared the caesarean section and HIE rates between May 2015-December 2016 and January 2017-August 2018 during which effective methods for decreasing caesarean section rates used. We also analysed the maternal and neonatal characteristics, delivery methods, caesarean indications of neonates treated with hypothermia because of HIE between January 2017-August 2018.Results: Despite 4,4 % decrease in primary caesarean section rates between May 2015-December 2016 and January 2017-August 2018 23,6% versus 19,2% , HIE 3.01‰ versus 3,26‰ didn’t change significantly p> 0,05 . The number of HIE cases treated with hypothermia between January 2017-August 2018 were 102. Delivery methods of 52,9 % were vaginal birth and 47,1 % primary caesarean section birth. All caesarean section births were emergency caesarean and indications of all were fetal distress. 14,8 % of vaginal births were operative vaginal birth. Convulsion was seen in % 45,1 of cases and %17,6 of cases died before discharged. There were‘nt sitatistically significant differance between blood parameters of died and survived HIE cases p>0.05 .Conclution: HIE is complex, multifactorial and unexplained chain of events. We think that heading to emergency caesarean birth because of decreasing neonatal morbidity don’t have positive effect on neonatal morbidity and also lead to increase in the number of caesarean births.

Kaynakça

  • Ekwochi U, Asinobi NI, Osuorah CD, Ndu IK, Ifediora C, Amadi OF et al. Incidence and Predictors of Mortality Among Newborns with Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria. Clin Med Insights Pediatr. 2017;11:1-10.
  • Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res. 2013;74:50-72.
  • Volpe JJ. Neonatal encephalopathy: an inadequate term for hypoxic-isc- hemic encephalopathy. Ann Neurol. 2012;72:156-66.
  • Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gy- necologists’ Task Force on Neonatal Encephalopathy. Obstet Gynaecol. 2014;123:896–901.
  • Martinello K, Hart AR, Yap S, Mitra S, Robertson NJ. Management and investigation of neonatal encephalopathy: Arch Dis Child Fetal Neonatal Ed. 2017;102:346-58.
  • Committee on Fetus and Newborn, Papile LA, Baley JE, Benitz W, Cum- mings J, Carlo WA, Eichenwald E et al. Hypothermia and neonatal en- cephalopathy. Pediatrics. 2014;133:1146-50.
  • Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392:1341-8.
  • Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361:1349–58.
  • Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizu- res. Semin Fetal Neonatal Med. 2013;18:185-91.
  • World Health Organization, WHO Statement on Caeserean Rates 2015. http://www.who.int/reproductivehealth/publications/maternal_perina- tal_health/cs-statement/.
  • Türkiye Halk sağlığı kurumu Sağlık istatistikleri yıllığı 2017 Haber bülteni. https://dosyamerkez.saglik.gov.tr/Eklenti/27344,saglik-istatistikleri-yilli- gi-2017-haber-bultenipdf.pdf
  • Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. J Nepal Health Res Counc. 2017;15:178-81.
  • Gurung P, Malla S, Lama S, Malla A, Singh A. Caesarean Section During Second Stage of Labor in a Tertiary Centre. Obstet gynecol. 2013;121:122-8.
  • Ayres-De-Campos D, Arulkumaran S. FIGO consensus guidelines on intrapartum fetal monitoring: Physiology of fetal oxygenation and the main goals of intrapartum fetal monitoring. Int J Gynecol Obstet. 2015;131:5–8.
  • Walsh CA, Robson M, McAuliffe FM. Mode of delivery at term and ad- verse neonatal outcomes. Obstet Gynecol. 8-121:122;2013.
  • Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M, Domingues RMSM, Dias MAB, Moreira ME et al. Burden of early-term birth on adverse in- fant outcomes: a population-based cohort study in Brazil. BMJ Open. 2017;7:1-11.
  • Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal en- cephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86:329-38.
  • Prior T, Kumar S. Mode of delivery has an independent impact on neona- tal condition at birth. Eur J Obstet Gynecol Reprod Biol. 2014;181:135-9.
  • Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR et al. Antepartum risk factors for newborn encephalopathy: the Wes- tern Australian case-control study. BMJ. 1998;317:1554-8.
  • Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-is- chemic encephalopathy. Pediatrics. 2013;132:952-9.
  • Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999;341:1709-14.
  • Aslam S, Molloy EJ. Biomarkers of multiorgan injury in neonatal encep- halopathy. Biomark Med. 2015;9:267-75.
  • Beken S, Aydın B, Dilli D, Erol S, Zenciroğlu A, Okumuş N. Can biochemi- cal markers predict the severity of hypoxic-ischemic encephalopathy? Turk J Pediatr. 2014;56:62-8
  • Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in in- fants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004;89:152-5.

Hipoksik İskemik Ensefalopati Vakalarının Analizi, Sezaryen Doğum ve Hipoksik İskemik Ensefalopati Oranları Arasındaki İlişki

Yıl 2019, Cilt: 16 Sayı: 3, 135 - 139, 01.07.2019

Öz

Amaç: Hipoksik iskemik ensefalopati HİE , neonatal ensefalopatinin NE , en önemli etkenlerindendir. Dünya genelinde canlı doğumların ‰ 2-9’unda izlenir. Bu çalışmanın amacı HİE tanısı ile hipotermi tedavisi uygulanan hastaları tanımlamak ve sezaryen oranları ile hipoksik iskemik ensefalopati oranlarının arasındaki ilişkiyi analiz etmekti.Gereç ve Yöntemler: Bu kesitsel retrospektif tanımlayıcı çalışma yenidoğan yoğun bakım ünitesinde HİE tanısıyla hipotermi tedavisi alan yenidoğanlar üzerinde yapıldı. Mayıs 2015-Aralık 2016 ve hastanemizde sezaryen oranlarını azaltmak için etkili yöntemler uyguladığımız Ocak 2017-Ağustos 2018 dönemleri arasındaki sezaryen oranları ve HİE tanısı ile hipotermi alan yenidoğanların oranları karşılaştırıldı. Ayrıca Ocak 2017-Ağustos 2018 döneminde hipotermi tedavisi uygulanan yenidoğanların ve annelerinin özellikleri, doğum yöntemleri ve sezaryen endikasyonları tanımlandı.Bulgular: Mayıs 2015-Aralık 2016 ve Ocak 2017-Ağustos 2018 dönemleri arasındaki primer sezaryen oranlarındaki % 23,6 ve % 19,2 % 4,4’lük azalmaya rağmen, HİE oranlarında ‰ 3,01 ve ‰ 3,26 istatistiksel olarak anlamlı fark tespit edilmedi p>0.05 . Ocak 2017-Ağustos 2018 aralığında HİE nedeni ile hipotermi uygulanan 102 hastanın % 52,9’unun vajinal yol, % 47,1’inin primer sezaryen ile doğduğu saptandı. Sezaryen ile doğum gerçekleşenlerin tümü ‘acil sezaryen’ ve endikasyonları ‘fetal distres’ idi. Vajinal doğumlarda operatif doğum oranı % 14,8 idi. Hipotermi tedavisi alan yenidoğanların % 45,1’inde konvulsiyon izlendi ve %17,6’sı öldü. Ölen ve canlı olarak taburcu edilen yenidoğanların karaciğer ve böbrek fonksiyonları, LDH, CK-MB, troponin ve kan gazı değerleri arasında anlamlı fark saptanmadı p>0.05 .Sonuç: HİE karmaşık, çok faktörlü ve tamamen açıklanamamış bir olaylar zinciridir. Doğum eylemindeki gebede yenidoğan morbiditesini azaltmak amacı ile acil sezaryen doğuma yönelmenin sezaryen doğumların sayısının artmasına yol açarken, yenidoğan morbiditesini azaltmadığı kanaatindeyiz.

Kaynakça

  • Ekwochi U, Asinobi NI, Osuorah CD, Ndu IK, Ifediora C, Amadi OF et al. Incidence and Predictors of Mortality Among Newborns with Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria. Clin Med Insights Pediatr. 2017;11:1-10.
  • Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res. 2013;74:50-72.
  • Volpe JJ. Neonatal encephalopathy: an inadequate term for hypoxic-isc- hemic encephalopathy. Ann Neurol. 2012;72:156-66.
  • Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gy- necologists’ Task Force on Neonatal Encephalopathy. Obstet Gynaecol. 2014;123:896–901.
  • Martinello K, Hart AR, Yap S, Mitra S, Robertson NJ. Management and investigation of neonatal encephalopathy: Arch Dis Child Fetal Neonatal Ed. 2017;102:346-58.
  • Committee on Fetus and Newborn, Papile LA, Baley JE, Benitz W, Cum- mings J, Carlo WA, Eichenwald E et al. Hypothermia and neonatal en- cephalopathy. Pediatrics. 2014;133:1146-50.
  • Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392:1341-8.
  • Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361:1349–58.
  • Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizu- res. Semin Fetal Neonatal Med. 2013;18:185-91.
  • World Health Organization, WHO Statement on Caeserean Rates 2015. http://www.who.int/reproductivehealth/publications/maternal_perina- tal_health/cs-statement/.
  • Türkiye Halk sağlığı kurumu Sağlık istatistikleri yıllığı 2017 Haber bülteni. https://dosyamerkez.saglik.gov.tr/Eklenti/27344,saglik-istatistikleri-yilli- gi-2017-haber-bultenipdf.pdf
  • Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. J Nepal Health Res Counc. 2017;15:178-81.
  • Gurung P, Malla S, Lama S, Malla A, Singh A. Caesarean Section During Second Stage of Labor in a Tertiary Centre. Obstet gynecol. 2013;121:122-8.
  • Ayres-De-Campos D, Arulkumaran S. FIGO consensus guidelines on intrapartum fetal monitoring: Physiology of fetal oxygenation and the main goals of intrapartum fetal monitoring. Int J Gynecol Obstet. 2015;131:5–8.
  • Walsh CA, Robson M, McAuliffe FM. Mode of delivery at term and ad- verse neonatal outcomes. Obstet Gynecol. 8-121:122;2013.
  • Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M, Domingues RMSM, Dias MAB, Moreira ME et al. Burden of early-term birth on adverse in- fant outcomes: a population-based cohort study in Brazil. BMJ Open. 2017;7:1-11.
  • Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal en- cephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86:329-38.
  • Prior T, Kumar S. Mode of delivery has an independent impact on neona- tal condition at birth. Eur J Obstet Gynecol Reprod Biol. 2014;181:135-9.
  • Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR et al. Antepartum risk factors for newborn encephalopathy: the Wes- tern Australian case-control study. BMJ. 1998;317:1554-8.
  • Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-is- chemic encephalopathy. Pediatrics. 2013;132:952-9.
  • Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999;341:1709-14.
  • Aslam S, Molloy EJ. Biomarkers of multiorgan injury in neonatal encep- halopathy. Biomark Med. 2015;9:267-75.
  • Beken S, Aydın B, Dilli D, Erol S, Zenciroğlu A, Okumuş N. Can biochemi- cal markers predict the severity of hypoxic-ischemic encephalopathy? Turk J Pediatr. 2014;56:62-8
  • Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in in- fants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004;89:152-5.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Şule Özel Bu kişi benim

Cüneyt Tayman Bu kişi benim

Sabriye Korkut Bu kişi benim

Umutcan Kayıkçı Bu kişi benim

Yaprak Engin Üstün Bu kişi benim

Yayımlanma Tarihi 1 Temmuz 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 16 Sayı: 3

Kaynak Göster

Vancouver Özel Ş, Tayman C, Korkut S, Kayıkçı U, Üstün YE. Hipoksik İskemik Ensefalopati Vakalarının Analizi, Sezaryen Doğum ve Hipoksik İskemik Ensefalopati Oranları Arasındaki İlişki. JGON. 2019;16(3):135-9.