BibTex RIS Kaynak Göster

Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: Current Experience of a Turkish Tertiary Center

Yıl 2014, Cilt: 11 Sayı: 2, 50 - 54, 01.04.2014

Öz

Objective: We conducted a study to demonstrate the effect of early initiation of cooling in newborns with Hypoxic-ischemic encephalopathy HIE , before and during their transport to a cooling center.Study Design: A total of 32 outpatient neonates were enrolled in the study. Because of the implementation of a new local guideline concerning the preparation and transport of neonates who are therapeutic hypothermia TH candidates, the data gathered belonged to two distinct patient groups; Group I before guideline, n=18 and Group II after guideline , n=14 .Results: With respect to clinical characteristics, application of TH and conservative therapies both groups were similar. The frequency of observed clinical seizures, the occurence of an abnormal aEEG and the mean body temperature of the outborn infants at their admission were all lower in Group II. With respect to mortality, the mortalities of Group I and Group II were 44.4% and 21.4% respectively and except hypotension, all complications were less frequent in Group II. An organized team approach with early cooling is important for the success of TH.Conclusion: We found that with education, our referring and transport physicians can initiate and maintain TH for neonates before and during their transport.

Kaynakça

  • 1. World Health Organization: World Health Statistics, 2011. France; 2011.
  • 2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365: 891–900.
  • 3. Pierrat V, Haouari N, Liska A, et al.; Grouped’ Etudes en Epidémiologie Périnatale. Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study. Arch Dis Child Fetal Neonatal Ed 2005; 90:F257-61.
  • 4. Marlow N, Rose AS, Rands CE, et al. Neuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2005; 90:F380- 7.
  • 5. Gül NA, Comert S, Ağzıkuru T, Vitrinel A, Akın Y, Telatar B, et al. An evaluation of cases wıth perinatal asphyxia Over a 7-year period. J Kartal TR 2010; XXI:77-83.
  • 6. Turkish Neonatal Society Hypoxic Ischemic Encephalopathy Study Group, Turkey.Hypoxic ischemic encephalopathy in neonatal intensive care units of Turkey: risk factors, incidence and short-term prognosis. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 123-129.
  • 7. Satar M, Narlı N, Kırımi E, Atıcı A. Hipoksik iskemik ensefalopatili 205 olgunun değerlendirilmesi. Turkiye Klinikleri J Pediatr 2001; 10: 36-41.
  • 8. Demirel G, Tezel B, Ozbas S, Oguz SS, Erdeve O, Uras N, et al. Rapid Decrease of Neonatal Mortality in Turkey. 2011
  • 9. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomized trial. Lancet 2005; 365:663–670.
  • 10. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic ischemic encephalopathy. N Engl J Med 2005; 353:1574– 1584.
  • 11. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32:11– 17.
  • 12. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361:1349–1358.
  • 13. Simbruner G, Mittal RA, Rohlmann F, Muche R and neo.nEURO. network Trial Participants. Systemic Hypothermia after neonatal Encephalopath: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126:e771-778.
  • 14. Kendall GS, Kapetanakis A, Ratnavel N, Azzopardi D, Robertson NJ. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010; 95:F408-F412.
  • 15. Sarnat HB O, Sarnat M S. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study Arch Neurol 1976; 33: 696-705.
  • 16. Al Naqueeb N, Edwards A D, Cowan F et al. Assessment of neonatal encephalopathy by amplitude integrated electroencephalography. Pediatrics 1999; 103: 1263-1271.
  • 17. Blackmon LR, Stark AR; American Academy of Pediatrics Committee on the Fetus and Newborn. Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy. Pediatrics 2006; 117: 942-948.
  • 18. Wilkinson DJ, Casalaz D, Watkins A, Andersen CC, Duke T. Hypothermia: a neuroprotective therapy for neonatal hypoxicischemic encephalopathy. Pediatrics 2007; 119: 422-3.
  • 19. Wu L, Yi B, Hu Y, Ji C, Zhang T, Wang Y. The efficacy of hypothermia in hypoxic-ischemic encephalopathy at 18 mo or more Indian J Pediatr 2012;79:1342-6.
  • 20. Gunn AJ, Gunn TR, Gunning MI, Williams CE, Gluckman PD. Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatrics 1998; 102:1098- 106.

Yenidoğanda Hipoksik İskemik Ensefalopati Tedavisinde Hipotermi Uygulaması: Tek Merkez Deneyimi

Yıl 2014, Cilt: 11 Sayı: 2, 50 - 54, 01.04.2014

Öz

Amaç: Çalışmanın amacı hipotermi uygulama merkezine transport edilmeden önce ve transport sırasında erken soğutma başlamasının etkilerini araştırmaktır.Metod: Değerlendirmeye 32 yenidoğan bebek alındı. Tedavi amaçlı hipotermi uygulamasına aday yenidoğan bebeklerin transportu ve kazırlanmasında yeni bölgesel rehberin etkilerini araştırmak için bu rehberin kullanılmasından önce n=18 ve sonra n=14 kabul edilen yenidoğan bebekler çalışmaya dahil edildi.Sonuçlar: Her iki grupta da sırasıyla klinik özellikler hipotermi uygulaması ve diğer tedaviler benzerdi. Lokal rehberin kullanıma girmesinden sonra hastanemize dış merkezlerden kabul edilen bebeklerde grup II klinik nöbet, anormal aEEG bulgusu ve geliş ortalam vücut sıcaklığında artış saptandı. Mortalite oranları Grup I’de %44.4 ve Grup II’de %21.4 olarak hesaplandı. Hipotansiyon dışında tüm komplikasyonların sıklığı Grup II’de daha az bulunndu. Başarılı tedavi amaçlı hipotermi için organize ekip yaklaşımı önemlidir.Tartışma: Sevk eden ve transfer eden ekiplerin eğitimi ile yenidoğanların transport öncesi ve sırasında hipotermi başlanabilir ve sürdürülebilir.

Kaynakça

  • 1. World Health Organization: World Health Statistics, 2011. France; 2011.
  • 2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365: 891–900.
  • 3. Pierrat V, Haouari N, Liska A, et al.; Grouped’ Etudes en Epidémiologie Périnatale. Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study. Arch Dis Child Fetal Neonatal Ed 2005; 90:F257-61.
  • 4. Marlow N, Rose AS, Rands CE, et al. Neuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2005; 90:F380- 7.
  • 5. Gül NA, Comert S, Ağzıkuru T, Vitrinel A, Akın Y, Telatar B, et al. An evaluation of cases wıth perinatal asphyxia Over a 7-year period. J Kartal TR 2010; XXI:77-83.
  • 6. Turkish Neonatal Society Hypoxic Ischemic Encephalopathy Study Group, Turkey.Hypoxic ischemic encephalopathy in neonatal intensive care units of Turkey: risk factors, incidence and short-term prognosis. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 123-129.
  • 7. Satar M, Narlı N, Kırımi E, Atıcı A. Hipoksik iskemik ensefalopatili 205 olgunun değerlendirilmesi. Turkiye Klinikleri J Pediatr 2001; 10: 36-41.
  • 8. Demirel G, Tezel B, Ozbas S, Oguz SS, Erdeve O, Uras N, et al. Rapid Decrease of Neonatal Mortality in Turkey. 2011
  • 9. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomized trial. Lancet 2005; 365:663–670.
  • 10. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic ischemic encephalopathy. N Engl J Med 2005; 353:1574– 1584.
  • 11. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32:11– 17.
  • 12. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361:1349–1358.
  • 13. Simbruner G, Mittal RA, Rohlmann F, Muche R and neo.nEURO. network Trial Participants. Systemic Hypothermia after neonatal Encephalopath: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126:e771-778.
  • 14. Kendall GS, Kapetanakis A, Ratnavel N, Azzopardi D, Robertson NJ. Passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010; 95:F408-F412.
  • 15. Sarnat HB O, Sarnat M S. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study Arch Neurol 1976; 33: 696-705.
  • 16. Al Naqueeb N, Edwards A D, Cowan F et al. Assessment of neonatal encephalopathy by amplitude integrated electroencephalography. Pediatrics 1999; 103: 1263-1271.
  • 17. Blackmon LR, Stark AR; American Academy of Pediatrics Committee on the Fetus and Newborn. Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy. Pediatrics 2006; 117: 942-948.
  • 18. Wilkinson DJ, Casalaz D, Watkins A, Andersen CC, Duke T. Hypothermia: a neuroprotective therapy for neonatal hypoxicischemic encephalopathy. Pediatrics 2007; 119: 422-3.
  • 19. Wu L, Yi B, Hu Y, Ji C, Zhang T, Wang Y. The efficacy of hypothermia in hypoxic-ischemic encephalopathy at 18 mo or more Indian J Pediatr 2012;79:1342-6.
  • 20. Gunn AJ, Gunn TR, Gunning MI, Williams CE, Gluckman PD. Neuroprotection with prolonged head cooling started before postischemic seizures in fetal sheep. Pediatrics 1998; 102:1098- 106.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Şerife Suna Oğuz Bu kişi benim

Mehmet Yekta Öncel Bu kişi benim

Melek Akar Bu kişi benim

Nurdan Uras Bu kişi benim

Fuat Emre Canpolat Bu kişi benim

Uğur Dilmen Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2014
Yayımlandığı Sayı Yıl 2014 Cilt: 11 Sayı: 2

Kaynak Göster

Vancouver Oğuz ŞS, Öncel MY, Akar M, Uras N, Canpolat FE, Dilmen U. Yenidoğanda Hipoksik İskemik Ensefalopati Tedavisinde Hipotermi Uygulaması: Tek Merkez Deneyimi. JGON. 2014;11(2):50-4.