Neurodevelopmental Outcomes in Therapeutic Hypothermia: A Single Center Experience

Öz

Objective: Hypoxic-ischemic encephalopathy (HIE) is an acute and progressive encephalopathy resulting from perinatal asphyxia. Approximately 15% infants with neonatal HIE die, whereas 25% exhibit subsequent neurological disabilities. In this study, it was intended to compare effects of total body cooling treatment administered for hypoxic-ischemic encephalopathy on neurological and developmental findings obtained at 18-36 months.

Material and Methods: Patients who have been hospitalized between 2013 and 2014 in Neonatal Intensive Care Unit with a diagnosis of hypoxic-ischemic encephalopathy and treated total body cooling were included. After discharge, neurological examinations of the patients were evaluated by developmental assessments with “Bayley Scales of Infant Development II” at 18-36 months.

Results: Mean MDI score of 17 patients was 90.2±16.3, and mean PDI score was 93.8±17.3. MDI scores were < 70 in 11.8% (n = 2) of all cases, and PDI scores were < 70 in 5.9% (n=1) of all cases. In 5.9% (n=1) of all cases, deafness and cerebral palsy were detected. Developmental disorder were found in 17.6% (n=3) of all cases.

Conclusion: The therapeutic hypothermia in newborns decreased mortality in moderate and severe HIE and improved neurodevelopmental outcomes at 18th month. In our study, early neurological and developmental problem rates after therapeutic hypothermia were found similar with the literature. However, long period follow-up is necessary to determine minor disorders in these patients.

Anahtar Kelimeler

• Hypothermia,
• Hypoxic-Ischemic Encephalopathy,

Terapotik Hipotermide Nörogelişimsel Sonuçlar: Tek merkez deneyimi

Öz

Amaç: Hipoksik iskemik ensefalopati (HİE), perinatal asfiksi sonucunda gelişen akut ve ilerleyici bir ensefalopati tablosudur. Genellikle HİE tanılı hastaların %15’i kaybedilirken, yaklaşık %25’inde nörolojik bozukluk görülmektedir. Bu çalışmada HİE tanılı hastalarda total vücut soğutma tedavisinin 18-36. aylarındaki nörogelişimsel sonuçlar üzerine etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntemler: Çalışmaya 2013-2014 yıllarında, HİE tanısı ile yatırılarak total vücut soğutma uygulanan hastalar dahil edildi. Taburculuk sonrası izlemlerine devam edilen bu hastaların 18-36 ay arasında nörolojik muayeneleri ve “Bayley Bebekler için Gelişimsel Değerlendirme Ölçeği II” ile gelişimsel değerlendirmeleri yapıldı. Bulgular: Çalışmaya alınan 17 hastanın ortalama mental gelişim endeksi (MDI) skoru 90.2±16.3, ortalama psikomotor gelişim endeksi (PDI) skoru 93.8±17.3, MDI skoru %11.8(n:2) olguda <70, PDI skoru %5.9 (n:1) olguda <70, sağırlık ve serebral palsi %5.9 (n:1) olguda saptanmış olup, körlük hiçbir hastada saptanmadı. Toplam nörogelişimsel sorun oranı ise %17.6(n:3) olarak saptandı. Sonuç: HİE’li yenidoğanlarda hipotermi uygulamasıyla beraber orta ve ağır HİE’li olgularda mortalitenin azaldığı ve 18. ayda nörogelişimsel sonuçları olumlu etkilediği gösterilmiştir. Çalışmamızda da terapotik hipotermi sonrası erken dönem nörolojik ve gelişimsel sorun oranları literatür ile benzer bulunmuştur. Ancak bu hastalarda minör bozuklukların saptanması için izlemlerin devamı gerekmektedir.

Anahtar Kelimeler

• HİPOKSİK İSKEMİK ENSEFALOPATİ
• HİPOTERMİ
• YENİDOĞAN

Kaynakça

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