Öz
Abstract
The follow-up of high risk infants discharged from the Neonatal intensive careunits is a highly important health issue in order to early recognition and treatmentof morbidities. The families should be informed about the medical problems and possible complications of the babay and a check-list may be prepared for the families. Corrected age should be used for the early evaluation of Preterm infants. Postnatal growth retardation is common especially in infants < 1500 grams. Feeding the in-fants with a high-calorie, low protein formula may result in adequate weight gain butcalculation of lean body mass is a better measure for the evaluation of these infants. Breast milk is not sufficient frequently to provide the needs of the infants, and it should be fortified. Iron shouldbe started after 1 month at a dose of 2-3 mg/kg per dayuntil 12 months. ESPHGAN does not recommend to starton solid foods before a chronological age of 17 weeks (4months). In infants with chronic or recurrent diseases, vitamins may be used for prolonged periods. Feedings problems are common in infants with permanent neurological deficits or transient neurological immaturity. Infantswith bronchopulmonary dysplasia should be preventedfrom environmental irritants and contagious diseases asmuch as possible and intermittant illnesses should be treated immediately. These infants should be left to sleep ontheir backs, in fear of SIDS. It is the duty of the pediatrician to refer them to the ophthalmologist at the appropriate age for ROP screening. In infants with ROP, eye exa-minations should be repeated at 6 months, 2-3 years andpreschool age for amblyopia and refraction errors. All in-fants < 1500 grams should have a hearing screening before 3 months of age. Infants with intraventricular hemorrhages, hydrocephalus, periventricular leukomalacia and seizures should have close follow-up. Even if they have normal IQs, learning disorders are common at school and theymay need special education. Attention deficit hyperactivitydis order and autism specturm disorders are also commonin these infants.
Anahtar Kelimeler
emature bronchopulmonary dysplasiaa retinopathyof prematurity neurodevelopment
Kaynakça
- Kaynaklar 1)Wilson-Costello DE, Hack M. Follow up for high risk neonates.Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin’s Neo-natal-Perinatal Medicine Diseases of the Fetus and Infant. 8th ed.Mosby-Elsevier, Philadelphia, 2006 pp: 1035-1043. 2)Lucas A. Long term programming effects of early nutrition-im-pilications for the preterm infant. J Perinatol 2005; 25 Suppl2: S2-6. 3)Lemons JA. Bauer CR, Oh W et al. Very low birth weight outco-mes of the National Institute of Child health and human develop-ment neonatal research network. Januray 1995 through Decem-ber 1996. NICHD Neonatal Research Network. Pediatrics,2001; 107: E1 4)Hack M, Fanaroff AA. Outcomes of children of extremely low birth-weight and gestational age in the 1990s. Semin Neonatol 2000;5: 89-106. 5)Ramel SE, Zhang L, Misra S et al. Do anthropometric measuresaccuretly reflect body composition in preterm infants? PediatrObes 2016 Sept; doi: 10.1111/ijpo.12181 6)Vohr BR, Poindeşter BB; Dusick AM et al. Persistent benefici-al effects of breast milk ingested in the neonatal intensive careunit on outcomes of extremely lo birth weight infants at 30 monthsof age. Pediatrics 2007; 120: e953-9. 7)Palmer DJ, Makrides M. Introducing solid foods to Preterm in-fants in developed countries. Ann Nutr Metab 2012; 60 (supp 2):31-38. 8)Palmer DJ, Makrides M. Introducing solid foods to preterm in-fants in developed countries. Ann Nutr Metab 2012; 60 (supp 2):31-38 9)Rigo J, Pieltain C, Salle B, Senterre J. Enteral calcium, phosp-hate and Vitamin D requirements and bone mineralization in pre-term infants. Acta Paediatr 2007; 96: 969-874. 10)Hall RD; Wheeler RE, Rippetoe LE. Calcium and phosphorussupplementation after initial hospital discharge in breast fed in-fants of less than 1800 grams birthweight. J Perinatol 1993;13:272-8., 11)Sancak S, Arman D; Gürsoy T, Topçuoğlu S; Karatekin G, Ovalı F.Intestinal blood flow by doppler ultrasound: The impact of clarith-romycin treatment for feeding intolerance in preterm neonates. J Ma-tern Fetal Neonatal Med 2016; 29(11): 1853-6 12)Vanderhoof JA, ,Moran JR Harris CL, Merkel KL, OrensteinSR.Efficacy of a pre-thickened infant formula: a multicenter, do-uble blind, randomized, placebo controlled parallel group trialin 104 infants with symptomatic gastoresophageal reflux. Clin Pe-diatr (Phila) 2003; 42: 483-95. 13)Biniwaale MA, Ehrenkranz RA. The role of nutrition in the pre-vention and management of bronchopulmonary dysplasia. SeminPerinatol 2006; 30: 200-8. 14)http://www.neonatology.org.tr/images/stories/files/ palivizumab.pdf 15)Doyle LW, Chavasse R, Ford GW, Olinsky A, Davis NM, Calla-nan C. Changes in lung function between age 8 and 14 years inchildren with birth weight less than 1501 grams. Pediatr Pulmo-nol 1999; 7: 185-90. 16)Santuz P, Baraldi E, Zaramella P, Filippone M, Zacchello F. Fac-tors limiting exercise performance in long term survivors of bronc-hopulmonary dysplasia. Am J Respir Crit Care Med 1995; 152:1284-89. 17)Hoffman HJ, Hillman LS. Epidemiology of the sudden infant de-ath syndrome: Maternal, neonatal, and postneonatal risk factors,apnea and SIDS. Clin Perinatol 1992; 19: 717-37. 18)Koç E, Baş AY, Özdek Ş, Ovalı F, Başmak H. Türkiye Prematüre Re-tinopatisi Rehberi. Türk Neonatoloji Derneği, Ankara 2016 19)NIH Consensus Development Conference. Early identification ofhearing impairment in infants and children. NIH Consensus Sta-tement. 1993; 11: 1-24 20)Kültürsay N, Bilgen H, Türkyılmaz C. Prematüre ve hasta termbebeğin beslenmesi rehberi. Türk Neonatoloji Derneği; Ankara,2015 21)Widness JA. Pathophysiology, diagnosis and prevention of neo-natal anemia. NeoReviews 2000; 1: e61-8. 22)Vollmen B; Roth S; Riley K, Sellwood MW, Baudin J, Neville BG,et al. Neurodevelopmental outcome of preterm infants with ven-tricular dilatation with and without associated haemorrhage. DevMed Child Neurol 2006; 23)Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter in-jury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93:F153-61. 24)Anderson NG, Laurent I, Qoodward LJ, Inder T. Detection of im-paired growth of the corpus callosum in premature infants. Pe-diatrics 2006; 118: 951-60. 25)Rennie JM, Boylan GB. Neonatal seizures and their treatment.Curr Opin Neurol 2003; 16: 177-81. 26)Tin W, Wariyar U, Hey E. Changing prognosis for babies of lessthan 28 weeks’ gestation in the North of England between 1983and 1994. BMJ 1997; 314: 107-111. 27)Wallace IF, Rose SA, McCarton CM, Kurtzberg D, Vaughan HG.Relations between infant neobehavioral performance and cog-nitive outcome in very low birth weight preterm infant. J Dev Be-hav Pediatr 1995; 16: 309-17. 28)Saigal S, Szatmeri P, Rosenbaum P, Campbell D, King S. Cog-nitive abilities and school performance of extremely low birth we-ight children and matched term controls children at 8 years. Aregional study. J Pediatr 1991; 118: 751-60. 29)McCormick MC. The outcomes of very low birth weight infants: arewe asking the right questions? Pediatrics 1997; 99: 869-76. 30)Aylward GP. Neurodevelopmental outcomes of infants born pre-maturely. J Dev Behav Pediatr 2005; 26: 427-40. 31)Staebler DL. Letter: Binocularly induced motion of flicker pat-terns. J Opt Soc Am 1976; 66: 156-7. 32)Bhutta AT; Cleves MA, Casey PH, Cradock MM, Anand KJ. Cog-nitive and behavioral outcomes of school aged children who wereborn Preterm: a meta-analysis. JAMA 2002; 288: 728-37. 33)Breslau N. Psychiatric sequelae of low birthweight. EpidemiolRev 1995; 17: 96-106.34)Johnson S, Marlow N. Preterm birth and childhood psychiatricdisorders. Pediatr Res 2011; 69: 1R-8R. 35)Moster D, Lie RT Markestad T. Long term medical and social con-sequences of preterm birth. N Engl J Med 2008; 359: 262-73.
Öz
Öz
Yenidoğan yoğun bakım ünitelerinden taburcu edilen bebeklerin uzun süreli takiplerinin yapılması, gelişebilecek morbiditelerin erken ve zamanında tanınması vetedavisi açısından büyük önem taşımaktadır. Ailelere bebeğin tıbbi sorunları ve muhtemel komplikasyonlar ve sonuçlar hakkında uygun bir dille bilgi verilmeli ve bircheck-list hazırlanmalıdır. Prematüre bebeklerin büyümesini incelerken ‘düzeltilmiş yaş’ kullanılır. Özellikle 1500 gramın altındaki bebeklerde ekstrauterin büyüme geriliği sıktır. Yüksek kalorili ve düşük proteinli beslenen bebeklerde tartı alımı normal gibi gözükse bile yağsız vücut kitlesinin büyümesinin izlenmesi daha doğru biryaklaşımdır. Anne sütü büyümeyi yakalama için gerekli kaloriyi sağlayamaz ve bunedenle anne sütünün güçlendirilmesi gerekir. 1. aydan sonra 2-3 mg/kg/gün demirtakviyesi başlanmalı ve 12 aya kadar devam edilmelidir. ESPGHAN kronolojik yaş 17 haftaya (4 ay) ulaşmadan önce katı gıdalara başlanmasını önermemektedir. Kronik veya rekürran hastalığı olan bebeklerde uzun süreli vitamin kullanılması gerekebilir. Geçici nörolojik immatüritesi veya kalıcı nörolojik defisiti olan bebeklerdebeslenme sorunları daha sıktır. Prematüre bebeklere uygun kronolojik yaşlarda tamdoz aşıları yapılmalıdır. RSV enfeksiyonlarından koruyabilmek için aylık palivizumab kullanılabilir. Bronkopulmoner displazili bebekler çevresel irritanlardan ve bulaşıcı hastalıklardan mümkün olduğu kadar korunmalı ve araya giren hastalıklar hızlı bir şekilde tedavi edilmelidir. Ani bebek ölümü sendromunu önleyebilmek için bebeklerin sırt üstü yatırılması önerilmelidir. Ayaktan takip edilen hastalarda zamanı geldiğinde prematüre retinopatisi açısından göz hekimine muayeneye göndermek çocuk hekiminin görevidir. Retinopati tanısı konan hastaların, 6. ayda, 2-3 yaşta, okula başlarken, ilkokul döneminde ve adolesan döneminde kırma kusurları ve amblyopi açısından tekrar göz muayeneleri yapılmalıdır. 1500 g altında doğan tüm bebeklerin düzeltilmiş yaşları 3 aylık olmadan önce işitme taramasını yapılır. İntraventriküler kanamalar, hidrosefali, periventriküler lökomalazi ve konvülziyonlar, yakın takibi gerektirir. Bu bebeklerin IQ’ları normal olsa da okulda öğrenme bozukluklarısıktır ve genellikle eğitim yardımı veya özel eğitim gerekir. Dikkat eksikliği hiperaktivite bozukluğu ile otizm spektrum bozukluğu da bu bebeklerde sıktır.
Anahtar Kelimeler
prematüre takip bronkopulmoner displazi prematüre retinopatisi nörogelişim
Kaynakça
- Kaynaklar 1)Wilson-Costello DE, Hack M. Follow up for high risk neonates.Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin’s Neo-natal-Perinatal Medicine Diseases of the Fetus and Infant. 8th ed.Mosby-Elsevier, Philadelphia, 2006 pp: 1035-1043. 2)Lucas A. Long term programming effects of early nutrition-im-pilications for the preterm infant. J Perinatol 2005; 25 Suppl2: S2-6. 3)Lemons JA. Bauer CR, Oh W et al. Very low birth weight outco-mes of the National Institute of Child health and human develop-ment neonatal research network. Januray 1995 through Decem-ber 1996. NICHD Neonatal Research Network. Pediatrics,2001; 107: E1 4)Hack M, Fanaroff AA. Outcomes of children of extremely low birth-weight and gestational age in the 1990s. Semin Neonatol 2000;5: 89-106. 5)Ramel SE, Zhang L, Misra S et al. Do anthropometric measuresaccuretly reflect body composition in preterm infants? PediatrObes 2016 Sept; doi: 10.1111/ijpo.12181 6)Vohr BR, Poindeşter BB; Dusick AM et al. Persistent benefici-al effects of breast milk ingested in the neonatal intensive careunit on outcomes of extremely lo birth weight infants at 30 monthsof age. Pediatrics 2007; 120: e953-9. 7)Palmer DJ, Makrides M. Introducing solid foods to Preterm in-fants in developed countries. Ann Nutr Metab 2012; 60 (supp 2):31-38. 8)Palmer DJ, Makrides M. Introducing solid foods to preterm in-fants in developed countries. Ann Nutr Metab 2012; 60 (supp 2):31-38 9)Rigo J, Pieltain C, Salle B, Senterre J. Enteral calcium, phosp-hate and Vitamin D requirements and bone mineralization in pre-term infants. Acta Paediatr 2007; 96: 969-874. 10)Hall RD; Wheeler RE, Rippetoe LE. Calcium and phosphorussupplementation after initial hospital discharge in breast fed in-fants of less than 1800 grams birthweight. J Perinatol 1993;13:272-8., 11)Sancak S, Arman D; Gürsoy T, Topçuoğlu S; Karatekin G, Ovalı F.Intestinal blood flow by doppler ultrasound: The impact of clarith-romycin treatment for feeding intolerance in preterm neonates. J Ma-tern Fetal Neonatal Med 2016; 29(11): 1853-6 12)Vanderhoof JA, ,Moran JR Harris CL, Merkel KL, OrensteinSR.Efficacy of a pre-thickened infant formula: a multicenter, do-uble blind, randomized, placebo controlled parallel group trialin 104 infants with symptomatic gastoresophageal reflux. Clin Pe-diatr (Phila) 2003; 42: 483-95. 13)Biniwaale MA, Ehrenkranz RA. The role of nutrition in the pre-vention and management of bronchopulmonary dysplasia. SeminPerinatol 2006; 30: 200-8. 14)http://www.neonatology.org.tr/images/stories/files/ palivizumab.pdf 15)Doyle LW, Chavasse R, Ford GW, Olinsky A, Davis NM, Calla-nan C. Changes in lung function between age 8 and 14 years inchildren with birth weight less than 1501 grams. Pediatr Pulmo-nol 1999; 7: 185-90. 16)Santuz P, Baraldi E, Zaramella P, Filippone M, Zacchello F. Fac-tors limiting exercise performance in long term survivors of bronc-hopulmonary dysplasia. Am J Respir Crit Care Med 1995; 152:1284-89. 17)Hoffman HJ, Hillman LS. Epidemiology of the sudden infant de-ath syndrome: Maternal, neonatal, and postneonatal risk factors,apnea and SIDS. Clin Perinatol 1992; 19: 717-37. 18)Koç E, Baş AY, Özdek Ş, Ovalı F, Başmak H. Türkiye Prematüre Re-tinopatisi Rehberi. Türk Neonatoloji Derneği, Ankara 2016 19)NIH Consensus Development Conference. Early identification ofhearing impairment in infants and children. NIH Consensus Sta-tement. 1993; 11: 1-24 20)Kültürsay N, Bilgen H, Türkyılmaz C. Prematüre ve hasta termbebeğin beslenmesi rehberi. Türk Neonatoloji Derneği; Ankara,2015 21)Widness JA. Pathophysiology, diagnosis and prevention of neo-natal anemia. NeoReviews 2000; 1: e61-8. 22)Vollmen B; Roth S; Riley K, Sellwood MW, Baudin J, Neville BG,et al. Neurodevelopmental outcome of preterm infants with ven-tricular dilatation with and without associated haemorrhage. DevMed Child Neurol 2006; 23)Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter in-jury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93:F153-61. 24)Anderson NG, Laurent I, Qoodward LJ, Inder T. Detection of im-paired growth of the corpus callosum in premature infants. Pe-diatrics 2006; 118: 951-60. 25)Rennie JM, Boylan GB. Neonatal seizures and their treatment.Curr Opin Neurol 2003; 16: 177-81. 26)Tin W, Wariyar U, Hey E. Changing prognosis for babies of lessthan 28 weeks’ gestation in the North of England between 1983and 1994. BMJ 1997; 314: 107-111. 27)Wallace IF, Rose SA, McCarton CM, Kurtzberg D, Vaughan HG.Relations between infant neobehavioral performance and cog-nitive outcome in very low birth weight preterm infant. J Dev Be-hav Pediatr 1995; 16: 309-17. 28)Saigal S, Szatmeri P, Rosenbaum P, Campbell D, King S. Cog-nitive abilities and school performance of extremely low birth we-ight children and matched term controls children at 8 years. Aregional study. J Pediatr 1991; 118: 751-60. 29)McCormick MC. The outcomes of very low birth weight infants: arewe asking the right questions? Pediatrics 1997; 99: 869-76. 30)Aylward GP. Neurodevelopmental outcomes of infants born pre-maturely. J Dev Behav Pediatr 2005; 26: 427-40. 31)Staebler DL. Letter: Binocularly induced motion of flicker pat-terns. J Opt Soc Am 1976; 66: 156-7. 32)Bhutta AT; Cleves MA, Casey PH, Cradock MM, Anand KJ. Cog-nitive and behavioral outcomes of school aged children who wereborn Preterm: a meta-analysis. JAMA 2002; 288: 728-37. 33)Breslau N. Psychiatric sequelae of low birthweight. EpidemiolRev 1995; 17: 96-106.34)Johnson S, Marlow N. Preterm birth and childhood psychiatricdisorders. Pediatr Res 2011; 69: 1R-8R. 35)Moster D, Lie RT Markestad T. Long term medical and social con-sequences of preterm birth. N Engl J Med 2008; 359: 262-73.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | makale |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Temmuz 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 9 Sayı: 4 |
