DOĞUMDA POZİTİF BASINÇLI VENTİLASYON UYGULANAN BEBEKLERİN ERKEN NÖROGELİŞİMSEL SONUÇLARININ SAĞLIKLI KONTROLLERLE KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışmada, doğumda yalnızca pozitif basınçlı ventilasyon desteği alan, ileri resüsitasyon gereksinimi veya klinik ensefalopati bulgusu olmayan term bebeklerin erken dönem nörogelişimsel sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif, tek merkezli, vakakontrol çalışmasına gestasyon haftası ≥37 hafta olan 34 bebek ve benzer gestasyon haftasında doğmuş 35 sağlıklı kontrol dâhil edildi. Çalışma grubuna doğumda pozitif basınçlı ventilasyon uygulanan ve sonrasında entübasyon, göğüs kompresyonu veya adrenalin gereksinimi olmayan bebekler alındı. Asfiksi, klinik ensefalopati, terapötik hipotermi gereksinimi, majör konjenital anomali, kromozomal, genetik veya metabolik hastalığı olan olgular dışlandı. Tüm bebekler Bayley bebekler ve küçük çocuklar için gelişim ölçeği-III ile bilişsel, dil ve motor gelişim alanları açısından değerlendirildi. Bulgular: Çalışmaya toplam 69 bebek dâhil edildi. Pozitif basınçlı ventilasyon uygulanan bebeklerde bilişsel toplam ham skor, bilişsel ölçek skoru ve bilişsel kompozit skor kontrol grubuna göre anlamlı olarak daha düşüktü. Motor gelişim alanında ince motor ve kaba motor toplam ham skorları çalışma grubunda anlamlı olarak daha düşük bulundu. Dil gelişimiyle ilişkili parametreler açısından gruplar arasında anlamlı fark saptanmadı. Bilişsel gelişim geriliği çalışma grubunda 7 bebekte (%20,6) saptanırken kontrol grubunda izlenmedi. Motor gelişim geriliği çalışma grubunda 9 bebekte (%26,5), kontrol grubunda ise 1 bebekte (%2,9) saptandı. Ağır gelişimsel gerilik, görme veya işitme kaybı hiçbir olguda saptanmadı. Sonuç: Doğumda yalnızca pozitif basınçlı ventilasyon desteği alan ve klinik ensefalopati bulgusu olmayan term bebeklerde erken dönemde özellikle bilişsel ve motor gelişim alanlarında etkilenme görülebilir. Bu bebeklerin taburculuk sonrası yapılandırılmış nörogelişimsel izlem programlarıyla takip edilmesi önemlidir.

Anahtar Kelimeler

• Pozitif basınçlı ventilasyon
• yenidoğan resüsitasyonu
• Bayley-III
• nörogelişimsel sonuçlar

Destekleyen Kurum

Çalışmada hiçbir kurum ya da kişiden finansal destek alınmamıştır.

Etik Beyan

Yazarlar arasında herhangi bir çıkar çatışması bulunmamaktadır.

Early Neurodevelopmental Outcomes of Infants Receiving Positive Pressure Ventilation at Birth: A Comparison with Healthy Controls

Öz

Objective: This study aimed to evaluate early neurodevelopmental outcomes in term infants who required only positive pressure ventilation at birth and had no need for advanced resuscitation or clinical signs of encephalopathy. Material and Methods: This retrospective, single-center, casecontrol study included 34 infants born at ≥37 weeks of gestation who received only positive pressure ventilation at birth and 35 healthy controls of similar gestational age. Infants requiring intubation, chest compressions, or epinephrine were excluded. Infants with asphyxia, clinical encephalopathy, therapeutic hypothermia, major congenital anomalies, chromosomal, genetic, or metabolic disorders were also excluded. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, including cognitive, language, and motor domains. Results: A total of 69 infants were included. Infants who received positive pressure ventilation had significantly lower total raw scores, scaled scores, and composite scores in cognitive domains compared with controls. In the motor domain, fine motor and gross motor total raw scores were also significantly lower in the study group. No significant differences were found between the groups in language-related parameters. Cognitive developmental delay was detected in 7 infants (20.6%) in the study group, whereas none of the controls had cognitive delay. Motor developmental delay was observed in 9 infants (26.5%) in the study group and in 1 infant (2.9%) in the control group. Severe developmental delay, visual impairment, or hearing loss was not detected in any infant. Conclusion: Term infants who require only positive pressure ventilation at birth and do not show clinical signs of encephalopathy may still demonstrate early neurodevelopmental vulnerability, particularly in cognitive and motor domains. Structured neurodevelopmental follow-up after discharge may be important for this group.

Anahtar Kelimeler

• Positive pressure ventilation
• neonatal resuscitation
• Bayley-III
• neurodevelopmental outcomes

Destekleyen Kurum

There was no financial support from any institution or individual for this study.

Etik Beyan

There is no conflict of interest between the authors.

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