Preeklamptik Anne Bebeklerinin 36. Aydaki Nörogelişimlerinin Değerlendirilmesi

Yıl 2018, Cilt: 10 Sayı: 4, 0 - 0, 25.07.2018

Fahri Ovalı

Öz

ÖzPreeklampsi değişik klinik tablolarla seyredebilen, preterm doğum, maternal vefetal/neonatal morbidite ile mortalitenin başlıca nedenlerinden biridir ve nörogelişim problemlerine neden olabilmektedir. Çalışmamızda 32 hafta ve altında doğan preeklamptikanne bebeklerinin 36.aydaki nörogelişiminin değerlendirmesi ile majör sekel oranını, bilişsel, dil, ince ve kaba motor alanlarında gelişimsel gecikmenin varlığını ve oranını saptamayı amaçladık. 32 hafta ve altında doğan preeklamptik anne bebekleri ve başka nedenlerden dolayı erken doğum yapmış normotansif annelerin prematüre bebekleri; ebeveyn eğitim durumu, doğum öncesi ve doğum öyküsü, morbidite, fiziki gelişim, laboratuar sonuçları, nörolojik muayene ve Bayley nörogelişim testi ile değerlendirildi. 36preeklamptik anne bebeği ve 28 kontrol grubu olmak üzere toplam 64 preterm olgu dâhil edildi. Preeklamptik anne bebekleri ile kontrol grubu arasında erken dönem morbidite ve 36. ay nörogelişim açısından fark saptanmadı. Ancak kontrol grubuna göre beyaz küre ve mutlak nötrofil sayısı, taburculuk kilosu persantili istatistiksel olarak anlamlı derecede daha düşük saptandı.  Kız bebeklerin Bayley dil gelişim skorlarının erkeklere göre daha yüksek olduğu ve 5.dk APGAR skoru ile Bayley indeks skoru arasındapozitif yönde istatistiksel olarak anlamlı korelasyon saptandı. Nörolojik muayenesinde majör nörolojik defisit olan bebeklerin Bayley dil gelişim ve motor skorlarının da anormal olduğu görüldü. Sonuç olarak  preeklampsinin erken doğan bebeklerde prematüreliğin yanında artı bir risk oluşturmadığı görüldü.

Anahtar Kelimeler

preeklampsi, nörogelişim, prematürite

Neurodevelopmental Evaluation of Infants of Preeclamptic Mothers at 36 Months Of Age

Öz

Abstract

Preeclampsia is a disorder of pregnancy leading to preterm birth, maternal and neonatal mortality and morbidity and may cause neurodevelopmental problems. We aimedto evaluate the neurodevelopment of infants of preeclamptic mothers at 36 months ofage, namely majör neurological sequeale, cognitive, language, fine and gross motor abnormalities and their prevalances. Infants of  preeclamptic mothers delivering before 32 weeks of gestation were included into the study. Mothers who delivered before 32 weeks of gestation for another reason constituted the controlgroup. Parental educational status, prenatal and natal history, morbidities, physical development, laboratory results, neurological examinations and Bayley neurodevelopmental scores were compared. There were 36 infants in thestudy group and 28 infants in the control group. There wereno statistically significant differences between both groupregarding early morbidities and 36th month neurodevelopment. In the study group, leukocyte and absolute neutrophil counts and weight at discharge were significantly lower.Bayley developmental scores were higher in the girls andthere was a positive correlation between the 5th minute Apgar scores and Bayley scores. Bayley scores were also lower in infants whose neurological exams were abnormal. Weconcluded that preeclampsia does not pose an additional riskto preterm infants, apart from their own risks.

Anahtar Kelimeler

preeclampsia, neurodevelopment, prematurity

Kaynakça

• Kaynaklar 1. McCowan LME, Buist RG, North RA, Gamble G. Perinatal morbidityin chronic hypertension. Br J Obstet Gynaecol 1996; 103: 123-9. 2. Brown MA, Buddle ML. Hypertension in pregnancy: maternal andfetal outcome according to laboratory and clinical features. Med JAust 1996; 165: 360-5 3. Jonas O, Stern LM, Macharper T. A South Australian study of preg-nancy and birth risk factors associated with cerebral palsy. Int J Re-habil Res 1989;12.159-66. 4. Van Zeban der Aa DM, Verwey RA, Verloove-Vanhorick SP, Brand R,Ruys JH. Maternal hypertension and very preterm infants’ mortalityand handicaps. Eur J Obstet Gynecol Reprod Biol 1986;23.137-44 5. Sagial S, Rosenbaum P, Stoskopf B, Hoult L, Furlong W, Feeny D,Burrows E, Torrance G. Compherensive assesment of the health sta-tus of extremely low birth weight children at eight years of age: Com-parison with a reference group. J. Pediatr. 1994;125:411- 417 6. Paz I, Gale B, Labor A Ve ark. The cognitive outcome of full-termsmall for gestational age infants at late adolescence. Obstet. Gyne-col.1995;65.452. 7. Ovalı F. Intrauterine growth curves for Turkish babies born betwe-en 25 to 42 weeks gestation. J Trop Pediatr 2003; 49: 381-383 8. Amiel TC, Steward A. Follow up studies during the first five yearsof life. A pervasive assesment of neurologic function. Arc Dis Child1989; 64: 496-8. 9. Bayley N. Bayley Scales of Infant Development. 2nd ed. San Anto-nio, TX: Psychological Corp; 1993 10. Eide GE, Irgens LM and Markestad T, Farstad T, Skranes J, StoenR, Elgen IE, Rettedal S, Leversen KT, Sommerfelt K,Ronnestad A,Kaaresen Pİ. Norwegian Children Born Extremely Preterm Predic-tion of Neurodevelopmental and Sensory Outcome at 5 Years in Nor-wegian Children Born Extremely Preterm. Pediatrics 2011;127;e630 11. Spinillo A, Iasci A, Capuzzo, E, Egbe TO, Colona L, Fazzi E. Two-year neurodevelopmental outcome after expectant management andindicated preterm delivery in hypertensive pregnancies. Acta Obs-tet Gynecol Scand 1994; 73: 625-9. 12, Sütçüoğlu S, Dikerler A, Halıcıoğlu O, İnal Akkaya M, Öztürk C, AşıkAkman S, Özer E. Çok düşük doğum ağırlıklı prematüre bebeklerdenörogelişimsel izlem sonuçları ve etkileyen faktörler. İzmir Dr. Beh-çet Uz Çocuk Hast Dergisi. 2012; 2(2):94-101 13. Szymonowıcz W and Yu VYH. Severe pre-eclampsia and infants of verylow birth weight, Arch Dis Child 1987; 62: 712-716 14. Baud O, Zupan V, Lacaze-Masmonteil T, Audibert F, Shojaei T, The-baud B, et al. The relationships between antenatal management, thecause of delivery and neonatal outcome in a large cohort of very pre-term singleton infants. BJOG. 2000; 107(7):877 – 84. 15. Catanzarite V, Quirk JG, Aisenbrey G. How do perinatologists ma-nage preeclampsia? Am J Perinatol 1991; 8: 7-10. 16. Banias BB, Devoe LD, Nolan TE. Severe preeclampsia in pretermpregnancy between 26 and 32 weeks’ gestation. Am J Perinatol 1992;9: 357-60. 17. Cheng SW, Chou HC, Tsou KI, Fang LJ, Tsao PN. Delivery befo-re 32 weeks of gestation for maternal pre-eclampsia: neonatal out-come and 2-year developmental outcome, Early Human Development2004; 76 : 39–46 18. Paul DA, Kepler J, Leef KH, Siscione A, Palmer C, Stefano JL. Ef-fect of preeclampsia on mortality, intraventricular hemorrhae, andneed for mechanical ventilations in very low-birth-weight infants. AmJ Perinatol 1998;15(6):381 – 6. 19. . Hansen AR, Barn´es CM, Folkman J, McElrath TF. Maternal pre-eclampsia predicts the development of bronchopulmonary dyspla-sia. Journal of Pediatrics. 2010; 156(4):532–6. 20. Koenig JM, Christensen RD. The mechanism responsible for dimi-nished neutrophil production in neonates delivered of women withpregnancy-induced hypertension. Am J Obst Gynecol, 1991; 165,(2):467–73, 21. Kuban KC, Leviton A, Pagano M, Fenton T, Strassfeld R, Wolff M.Maternal toxemia is associated with reduced incidence of germinalmatrix hemorrhage in premature babies. J Child Neurol1992;7(1):70–6. 22, Paul DA, Leef KH, Sciscione A, Tuttle DJ, Stefano JL. Preeclamp-sia does not increased the risk for culture proven sepsis in very lowbirth weight infants. Am J Perinatol 1999;16(7):365 – 72. 23. Koenig JM, Christensen RD. The mechanism responsible for dimi-nished neutrophil production in neonates delivered of women withpregnancy-induced hypertension. American Journal of Obstetrics andGynecology, 1991; 165, 467–73 24. Odegard RA, Vatten LJ, Nilsen ST, Salvesen KA, Austgulen R. Pre-eclampsia and fetal growth. Obstetrics and Gynecology, 2000; 96,950–5 25. Gray PH, O’Callaghan MJ, Mohay HA, Burns YR, King JF. Mater-nal hypertension and neurodevelopmental outcome in very preterminfants. Arch Dis Child 1998;79:F88– 93 26. Murphy DJ, Sellers S, MacKenzie IZ, Yudkin PL, Johnson AM. Case-control study of antenatal and intrapartum risk factors for cerebralpalsy in very preterm singleton babies. Lancet 1995;346:1449-54. 27. Spinillo A, Iasci A, Capuzzo, E, Egbe TO, Colona L, Fazzi E. Two-year neurodevelopmental outcome after expectant management andindicated preterm delivery in hypertensive pregnancies. Acta Obs-tet Gynecol Scand 1994; 73: 625-9. 28. Ounsted MK, Moar VA, Good FJ, Redman CWG. Hypertension du-ring prcgnancy with and without specific treatment; thedevelopmentof the children at the age of four years. Br J Obstet Gynaecol 1980;87: 19-24 29. Taylor DJ, Davidson J, Howie PW, Davidson D. Do pregnancy com-plications contribute to neurodevelopmental disability? Lancet 1985;8431:713–716. 30. . Many A, Fattal A, Leitner Y, Kupferminc MJ, Harel S, Jaffa A. Neu-rodevelopmental and cognitive assessment of children born growthrestricted to mothers with and without preeclampsia. Hypertens Preg-nancy. 2003;22(1):25-9 31. Spinillo A, Stronati M, Ometto A, Fazzi E, Lanzi E, Guaschino S. In-fant neurodevelopmental outcome in pregnancies complicated by ge-stational hypertension and intra uterine growth retardation. J Pe-rinat Med 1993; 21: 195–203. 32. Schlapbach LJ, Ersch J, Adams M, Bernet V, Bucher HU, Latal B.Im-pact of chorioamnionitis and preeclampsia on neurodevelopmentaloutcome in preterm infants below 32 weeks gestational age. Acta Pae-diatr. 2010 Oct;99(10):1504-9. 33. Silveira RC, Procianoy RS, Koch MS, Benjamin ACW and Schlind-wein CF. “Growth and neurodevelopment outcome of very low birthweight infants delivered by preeclamptic mothers,” Acta Paediatr,2007; 96, 1738–42, 34. Seidman DS, Laor A, Gale R, Stevenson DK, Mashiach S and Da-non YL, “Pre-eclampsia and offspring’s blood pressure, cognitiveability and physical development at 17-years-of-age,” British Jour-nal of Obstetrics and Gynaecology, 1991; 98, 1009–1014.