Açık Spinal Disrafizm Nedeniyle Opere Olan Yenidoğanlarda Komorbid Durumlar ve Bunların Gebelikte Folik Asit Kullanımıyla İlişkisinin Retrospektif İncelenmesi

Yıl 2018, Cilt: 8 Sayı: 3, 194 - 202, 01.12.2018

Abdurrahman Çetin Abdulkadir Yektaş

Öz

Amaç: Biz bu çalışmada, opere edilen meningosel ve miyelomeningosel olgularına eşlik eden komorbid durumları ve bunların gebelikte kullanılan folik asitle ilişkisini incelemeyi amaçladık.
Materyal ve Metot: Meningosel ve myelomeningosel tanısıyla opere edilen 81 yenidoğan bu çalışmaya dahil edildi. Hasta dosyaları
retrospektif olarak taranarak olguların veriler kaydedildi. Olgular, gebelik döneminde folik asit kullanan ve kullanmayan grup olarak ikiye
ayrıldı. İki grup arasında yenidoğanların ağırlık, boy, hemogram, biyokimya, tanı zamanı, doğum şekli, maturite, lokalizasyon, tip, nörolojik
defisit, skolyoz, hidrosefali, cerrahi zamanı, ventrikülomegali, tedavi
şekli, ek patoloji, tetheredcord sendromu, dermal sinüs traktı, maternal hastalık birlikteliği ve BOS fistülü gibi malformasyonların sayısı,
karşılaştırıldı.
Bulgular: Antenatal dönemde folik asit kullanımı %44,4 olarak
saptandı. Meningomiyelosel %40,7 lomber, ve %46,9 sakral bölgedeydi. Erken tanılı yenidoğanlarda ( <1 hafta) operasyon oranı
daha (%60,5) yüksekti. Cerrahi zamanlama ile komplikasyonlar arasında anlamlı bir ilişki yoktu. Hidrosefali (%55,0), ventrikülomegali
(%61,7), skolyoz (%34,6), BOS fistülü (%4,9) ve dermal sinüs traktı
(%46,9) eşlik eden ek anomalilerdi. Folik asit kullanılan ve kullanılmayan gruplar karşılaştırıldığında, folik asit kullanılmayan grupta
sezaryenle doğum oranı (%75) (p=0,017), myelomeningosel oranı (%80) (p<0,01), paraparezi %39,5 ve parapleji %16 (p=0,006)
anlamlı derecede yüksek, dermal sinüs traktı (%35,6) (p=0,022)
ve ortalama doğum ağırlığı ise anlamlı derecede düşük (p=0,04)
saptandı.
Sonuç: Bizim yaptığımız bu retrospektif çalışmada, meningosel
ve miyelomeningosel tanısıyla opere olan yenidoğanlarda gebelik
döneminde folik asit kullanımı daha yüksek doğum ağırlığı ve daha
yüksek oranda normal doğumla birliktelik göstermekte, daha az
oranda miyelomeningosel, parapleji ve parapareziye neden olmakta ancak folik asit kullanımı daha yüksek oranda dermal sinüs traktına neden olmaktadır, bu bilgiler doğrultusunda gebelik döneminde
folik asit kullanımını önermekteyiz.

Anahtar Kelimeler

açık spinal disrafizm; miyelomeningosel; meningosel; folik asit; gebelik

Comorbid Conditions in Newborn Operated Due to Open Spinal Dysraphism and Retrospective Evaluation of Relation Between These Situations with Folic Acid Usage During the Pregnancy

Öz

Aim: In the present study, we aimed to analyze comorbid
conditions associated with operated myelomeningocele and their relationship
with folic acid usage during pregnancy.

Material
and Method: Eighty-one
newborns who were operated on due to myelomeningocele were included in this
study. The patient’s files were retrospectively reviewed, and the data of the
patients were recorded. The patients were divided into two groups: folic acid
users and non-folic acid users during pregnancy. The two groups were compared
in terms of weight, height, hemogram, biochemistry, time of diagnosis, delivery
method, maturity, localization, type (meningocel or myelomeningocel), neurological
deficit, scoliosis, hydrocephalus, timing of surgery, ventriculomegaly, treatment
method, additional pathology, tethered cord syndrome, dermal sinus, maternal
disease, and number of malformations such as cerebrospinal fluid fistula.

Results: The rate of folic acid usage during the antenatal
period was 44.4%. Myelomeningocele was located in lumbar (40.7%) and sacral
(46.9%) regions. The rate of operation with early diagnosis newborn (1<week)
was high (60.5%). There was no significant relationship between the timing of
surgery and complications. Hydrocephalus (55.0%), ventriculomegaly (61.7%),
scoliosis (34.6%), cerebrospinal fluid fistula (4.9%), and dermal sinus (46.9%)
accompanied anomalies. Comparing the folic acid group with the non-folic acid
group, it was revealed that the rates of cesarean delivery (75%; p = 0.017),
meningomyelocele (80%; p < 0.01), paraparesis (39.5%;p=0.006), paraplegia
(16%; p = 0.006), and dermal sinus (53.1%; p = 0.022) were significantly higher
in the non-folic acid group, whereas the mean birth weight was significantly
lower (p = 0.04) in the non-folic acid group.

Conclusion: In our study, folic acid usage during pregnancy
results in higher birth weight, higher number of normal births, and lower rates
of myelomeningocele, paraplegia, and paraparesis but a higher rate of dermal
sinus in newborn who have been operated for meningocele or myelomeningocele. Therefore,
we recommend folic acid usage during pregnancy. 

Anahtar Kelimeler

open spinal disraphism; myelomeningocele; meningocele; folic acid; pregnancy

Kaynakça

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