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Follow-Up Of Hıgh-Risk Infants

Yıl 2019, Cilt: 11 Sayı: 4, 177 - 182, 03.07.2019

Öz

bstract

The follow-up of high risk infants discharged from the Neonatal intensive care units is a highly important health issue in order to early recognition and treatment of 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 infants with a high-calorie, low protein formula may result in adequate weight gain but calculation 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 should be started after 1 month at a dose of 2-3 mg/kg per day until 12 months. ESPHGAN does not recommend to start on solid foods before a chronological age of 17 weeks (4 months). 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. Infants with bronchopulmonary dysplasia should be prevented from environmental irritants and contagious diseases as much as possible and intermittant illnesses should be treated immediately. These infants should be left to sleep on their 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 examinations should be repeated at 6 months, 2-3 years and preschool age for amblyopia and refraction errors. All infants < 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 they may need special education. Attention deficit hyperactivity disorder and autism specturm disorders are also common in these infants.

Kaynakça

  • Kaynaklar 1.Wilson-Costello DE, Hack M. Follow up for high risk neonates. Mar-tin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin’s Neonatal-Pe-rinatal Medicine Diseases of the Fetus and Infant. 8th ed. Mosby-Els-evier, Philadelphia, 2006 pp: 1035-1043 2.Lucas A. Long term programming effects of early nutrition-impili-cations for the preterm infant. J Perinatol 2005; 25 Suppl 2: S2-6 3.Lemons JA. Bauer CR, Oh W et al. Very low birth weight outcomesof the National Institute of Child health and human development neo-natal research network. Januray 1995 through December 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. Sem Neonatol 2000; 5: 89 5.Ramel SE, Zhang L, Misra S et al. Do anthropometric measures ac-curetly reflect body composition in preterm infants? Pediatr Obes 2016Sept; doi: 10.1111/ijpo.12181 6.Vohr BR, Poindeşter BB; Dusick AM et al. Persistent beneficial ef-fects of breast milk ingested in the neonatal intensive care unit onoutcomes of extremely lo birth weight infants at 30 months of age.Pediatrics 2007; 120: e953-9 7.Palmer DJ, Makrides M. Introducing solid foods to Preterm infantsin developed countries. Ann Nutr Metab 2012; 60 (supp 2): 31-38 8.Palmer DJ, Makrides M. Introducing solid foods to preterm infantsin developed countries. Ann Nutr Metab 2012; 60 (supp 2): 31-38 9.Rigo J, Pieltain C, Salle B, Senterre J Enteral calcium, phosphateand Vitamin D requirements and bone mineralization in preterm in-fants. Acta Paediatr 2007; 96B 969-874 10.Hall RD; Wheeler RE, Rippetoe LE. Calcium and phosphorus supp-lementation after initial hospital discharge in breast fed infants ofless than 1800 grams birthweight. J Perinatol 13: 272, 1993 11.Sancak S, Arman D; Gürsoy T, Topçuoğlu S; Karatekin G, Ovalı F. In-testinal blood flow by doppler ultrasound: The impact of clarithromy-cin treatment for feeding intolerance in preterm neonates. J Matern Fe-tal Neonatal Med 2016; 29(11): 1853-6 12.Vanderhoof JA, ,Moran JR Harris CL et al. .Efficacy of a pre thic-kened infant formula: a multicenter, double blind, randomized, pla-cebo controlled parallel group trial in 104 infants with symptoma-tic gastoresophageal reflux. Clin Pediatr (Phila) 2003 42: 483-95 13.Biniwaale MA, Ehrenkranz RA. The role of nutrition in the preven-tion and management of bronchopulmonary dysplasia. Semin Peri-natol 2006; 30: 200-8 14.http://www.neonatology.org.tr/images/stories/files/ palivizumab.pdf 15.Doyle LW, Chavasse R, Ford GW et al. Changes in lung function bet-ween age 8 and 14 years in children with birth weight less than 1501grams. Pediatr Pulmonol 1999; 7: 185-90 16.Santuz P, Baraldi E, Zaramella P et al. Factors limiting exercise per-formance in long term survivors of bronchopulmonary dysplasia. AmJ Respir Crit Care Med 1995; 152: 1284-89 17.Hoffman HJ, Hillman LS: Epidemiology of the sudden infant deathsyndrome: Maternal, neonatal, and postneonatal risk factors, apneaand 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 of hea-ring impairment in infants and children. NIH Consensus Statement.1993; 11: 1-24 20.Kültürsay N, Bilgen H, Türkyılmaz C. Prematüre ve hasta term be-beğin beslenmesi rehberi. Türk Neonatoloji Derneği; Ankara, 2015 21.Widness JA. Pathophysiology, diagnosis and prevention of neona-tal anemia. NeoReviews 2000; 1: e61-8 22.Vollmen B; Roth S; Riley K et al. neurodevelopmental outcome of pre-term infants with ventricular dilatation with and without associatedhaemorrhage. Dev Med Child neurol 2006; 23.Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury ofprematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93: F153-61 24.Anderson NG, Laurent I, Qoodward LJ, Inder T. Detection of impai-red growth of the corpus callosum in premature infants. Pediatrics2006; 118: 951-60 25.Rennie JM, Boylan GB. Neonatal seizures and their treatment. CurrOpin Neurol 2003; 16: 177-81 26.Tin W, Wariyor C, Hey E. Changing prognosis for babies of less than28 weeks’ gestation in the North of England between 1983 and 1994.Br Med J 1997; 314: 107-111 27.Wallace IF, Rose SA, McCarton CM et al. Relations between infantneobehavioral performance and cognitive outcome in very low birthweight preterm infant. Dev Behav Pediatr 1995; 16: 309-17 28.Saigal S; Szatmeri P, Rosenbaum P et al. Cognitive abilities and scho-ol performance of extremely low birth weight children and matchedterm controls children at 8 years. A regional 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 prema-turely. J Dev Behav Pediatr 2005; 26: 427-40 31.Staebler DL. Letter: Binocularly induced motion of flicker patterns.J Opt Soc Am 1976; 66: 156-7 32.Bhutta AT; Cleves MA, Casey PH et al. Cognitive and behavioral out-comes of school aged children who were born Preterm: a meta-analy-sis. JAMA 2002; 288: 728-37 33.Breslau N. Psychiatric sequelae of low birthweight. Epidemiol Rev1995; 17: 96-106 34.Johnso, Marlow N. Preterm birth and childhood psychiatric disor-ders. Pediatr Res 2011; 69(5 Pt 2) 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

Yüksek Riskli Bebeklerin Takibi

Yıl 2019, Cilt: 11 Sayı: 4, 177 - 182, 03.07.2019

Öz

Öz

Yenidoğan yoğun bakım ünitelerinden taburcu edilen bebeklerin uzun süreli takiplerinin yapılması, gelişebilecek morbiditelerin erken ve zamanında tanınması ve tedavisi açısından büyük önem taşımaktadır. Ailelere bebeğin tıbbi sorunları ve muhtemel komplikasyonlar ve sonuçlar hakkında uygun bir dille bilgi verilmeli ve bir check-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 bir yaklaşımdır. Anne sütü  büyümeyi yakalama için gerekli kaloriyi sağlayamaz ve bu nedenle anne sütünün güçlendirilmesi gerekir. 1. aydansonra 2-3 mg/kg/gün demir takviyesi 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 bebeklerde beslenme sorunları daha sıktır. Prematüre bebeklere uygun kronolojik yaşlarda tam doz 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 bozuklukları sıktır ve genellikle eğitim yardımı veya özel eğitim gerekir. Dikkat eksikliği hiperaktivite bozukluğu ile otizm spektrum bozukluğu da bu bebeklerde sıktır.

Kaynakça

  • Kaynaklar 1.Wilson-Costello DE, Hack M. Follow up for high risk neonates. Mar-tin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin’s Neonatal-Pe-rinatal Medicine Diseases of the Fetus and Infant. 8th ed. Mosby-Els-evier, Philadelphia, 2006 pp: 1035-1043 2.Lucas A. Long term programming effects of early nutrition-impili-cations for the preterm infant. J Perinatol 2005; 25 Suppl 2: S2-6 3.Lemons JA. Bauer CR, Oh W et al. Very low birth weight outcomesof the National Institute of Child health and human development neo-natal research network. Januray 1995 through December 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. Sem Neonatol 2000; 5: 89 5.Ramel SE, Zhang L, Misra S et al. Do anthropometric measures ac-curetly reflect body composition in preterm infants? Pediatr Obes 2016Sept; doi: 10.1111/ijpo.12181 6.Vohr BR, Poindeşter BB; Dusick AM et al. Persistent beneficial ef-fects of breast milk ingested in the neonatal intensive care unit onoutcomes of extremely lo birth weight infants at 30 months of age.Pediatrics 2007; 120: e953-9 7.Palmer DJ, Makrides M. Introducing solid foods to Preterm infantsin developed countries. Ann Nutr Metab 2012; 60 (supp 2): 31-38 8.Palmer DJ, Makrides M. Introducing solid foods to preterm infantsin developed countries. Ann Nutr Metab 2012; 60 (supp 2): 31-38 9.Rigo J, Pieltain C, Salle B, Senterre J Enteral calcium, phosphateand Vitamin D requirements and bone mineralization in preterm in-fants. Acta Paediatr 2007; 96B 969-874 10.Hall RD; Wheeler RE, Rippetoe LE. Calcium and phosphorus supp-lementation after initial hospital discharge in breast fed infants ofless than 1800 grams birthweight. J Perinatol 13: 272, 1993 11.Sancak S, Arman D; Gürsoy T, Topçuoğlu S; Karatekin G, Ovalı F. In-testinal blood flow by doppler ultrasound: The impact of clarithromy-cin treatment for feeding intolerance in preterm neonates. J Matern Fe-tal Neonatal Med 2016; 29(11): 1853-6 12.Vanderhoof JA, ,Moran JR Harris CL et al. .Efficacy of a pre thic-kened infant formula: a multicenter, double blind, randomized, pla-cebo controlled parallel group trial in 104 infants with symptoma-tic gastoresophageal reflux. Clin Pediatr (Phila) 2003 42: 483-95 13.Biniwaale MA, Ehrenkranz RA. The role of nutrition in the preven-tion and management of bronchopulmonary dysplasia. Semin Peri-natol 2006; 30: 200-8 14.http://www.neonatology.org.tr/images/stories/files/ palivizumab.pdf 15.Doyle LW, Chavasse R, Ford GW et al. Changes in lung function bet-ween age 8 and 14 years in children with birth weight less than 1501grams. Pediatr Pulmonol 1999; 7: 185-90 16.Santuz P, Baraldi E, Zaramella P et al. Factors limiting exercise per-formance in long term survivors of bronchopulmonary dysplasia. AmJ Respir Crit Care Med 1995; 152: 1284-89 17.Hoffman HJ, Hillman LS: Epidemiology of the sudden infant deathsyndrome: Maternal, neonatal, and postneonatal risk factors, apneaand 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 of hea-ring impairment in infants and children. NIH Consensus Statement.1993; 11: 1-24 20.Kültürsay N, Bilgen H, Türkyılmaz C. Prematüre ve hasta term be-beğin beslenmesi rehberi. Türk Neonatoloji Derneği; Ankara, 2015 21.Widness JA. Pathophysiology, diagnosis and prevention of neona-tal anemia. NeoReviews 2000; 1: e61-8 22.Vollmen B; Roth S; Riley K et al. neurodevelopmental outcome of pre-term infants with ventricular dilatation with and without associatedhaemorrhage. Dev Med Child neurol 2006; 23.Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury ofprematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93: F153-61 24.Anderson NG, Laurent I, Qoodward LJ, Inder T. Detection of impai-red growth of the corpus callosum in premature infants. Pediatrics2006; 118: 951-60 25.Rennie JM, Boylan GB. Neonatal seizures and their treatment. CurrOpin Neurol 2003; 16: 177-81 26.Tin W, Wariyor C, Hey E. Changing prognosis for babies of less than28 weeks’ gestation in the North of England between 1983 and 1994.Br Med J 1997; 314: 107-111 27.Wallace IF, Rose SA, McCarton CM et al. Relations between infantneobehavioral performance and cognitive outcome in very low birthweight preterm infant. Dev Behav Pediatr 1995; 16: 309-17 28.Saigal S; Szatmeri P, Rosenbaum P et al. Cognitive abilities and scho-ol performance of extremely low birth weight children and matchedterm controls children at 8 years. A regional 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 prema-turely. J Dev Behav Pediatr 2005; 26: 427-40 31.Staebler DL. Letter: Binocularly induced motion of flicker patterns.J Opt Soc Am 1976; 66: 156-7 32.Bhutta AT; Cleves MA, Casey PH et al. Cognitive and behavioral out-comes of school aged children who were born Preterm: a meta-analy-sis. JAMA 2002; 288: 728-37 33.Breslau N. Psychiatric sequelae of low birthweight. Epidemiol Rev1995; 17: 96-106 34.Johnso, Marlow N. Preterm birth and childhood psychiatric disor-ders. Pediatr Res 2011; 69(5 Pt 2) 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
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm makale
Yazarlar

Prof. Dr. Fahri Ovalı

Yayımlanma Tarihi 3 Temmuz 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 11 Sayı: 4

Kaynak Göster

APA Ovalı, P. D. F. (2019). Yüksek Riskli Bebeklerin Takibi. Klinik Tıp Pediatri Dergisi, 11(4), 177-182.
AMA Ovalı PDF. Yüksek Riskli Bebeklerin Takibi. Pediatri. Temmuz 2019;11(4):177-182.
Chicago Ovalı, Prof. Dr. Fahri. “Yüksek Riskli Bebeklerin Takibi”. Klinik Tıp Pediatri Dergisi 11, sy. 4 (Temmuz 2019): 177-82.
EndNote Ovalı PDF (01 Temmuz 2019) Yüksek Riskli Bebeklerin Takibi. Klinik Tıp Pediatri Dergisi 11 4 177–182.
IEEE P. D. F. Ovalı, “Yüksek Riskli Bebeklerin Takibi”, Pediatri, c. 11, sy. 4, ss. 177–182, 2019.
ISNAD Ovalı, Prof. Dr. Fahri. “Yüksek Riskli Bebeklerin Takibi”. Klinik Tıp Pediatri Dergisi 11/4 (Temmuz 2019), 177-182.
JAMA Ovalı PDF. Yüksek Riskli Bebeklerin Takibi. Pediatri. 2019;11:177–182.
MLA Ovalı, Prof. Dr. Fahri. “Yüksek Riskli Bebeklerin Takibi”. Klinik Tıp Pediatri Dergisi, c. 11, sy. 4, 2019, ss. 177-82.
Vancouver Ovalı PDF. Yüksek Riskli Bebeklerin Takibi. Pediatri. 2019;11(4):177-82.