Üçüncü Düzey Bir Ünitede Germinal Matriks-İntraventriküler Kanama Tanısı Alan Pretermlerin İncelenmesi: 4 Yıllık Deneyim

Öz

Germinal matrix kanaması-intraventriküler kanama, özellikle erken doğumların önemli bir komplikasyonu olup pretermlerde görülen beyin hasarının en sık nedenidir. Etiyolojisi karmaşık ve multifaktöriyel olup yenidoğanlarda sık görülen morbidite ve mortalite nedenlerindendir. Hastanemiz Yenidoğan Yoğun Bakım Ünitesinde doğum ağırlığı 1500 gramın ve gestasyon yaşı 32 haftanın altında doğan toplam 391 yenidoğan (n=119 prematüre germinal matrix kanaması-intraventriküler kanama, n=27 prematüre ileri evre kanama tanılı) çalışmaya dahil edilmiştir. Çalışmaya dahil edilen pretermlerin %30,4’ü germinal matrix kanaması-intraventriküler kanama, bu bebeklerin %6,9’u ileri evre kanama tanısı almıştır. Hastaların doğum ağırlığı ve gestasyon haftası azaldıkça germinal matrix kanaması-intraventriküler kanama ve ileri evre kanama riskinin anlamlı düzeyde arttığı ve mortalite üzerine olumsuz etkisi gösterilmiştir. Yenidoğan Yoğun Bakım Ünitesinde yatış süresi boyunca kanama riski olan bebekler ve eşlik eden morbideteler değerlendirilmiştir. Biz bu çalışmada ileri derece preterm bebeklerin hayatta kalma şansı arttıkça, güncel bir problem olan germinal matrix kanaması-intraventriküler kanamanın önlenmesi için riskli grupları gösterdik.

Anahtar Kelimeler

• germinal matriks kanaması-intraventriküler kanama
• prematürite
• risk faktörleri.

Investigation of Preterms Diagnosed with Germinal Matrix Hemorrhage-Intraventricular Haemorrhage in the Third Level Intensive Care Unit: 4-Years Experience

Öz

Germinal matriks hemorrahage-intraventricular hemorrhage is an serious complication of premature births and is the most common cause of brain damage in preterm babies. The etiology of germinal matrix hemorrhage and intraventricular hemorrhage is complex and multifactorial. Germinal matriks hemorrahage-intraventricular hemorrhage are common causes of morbidity and mortality in neonates. A total of 391 neonates (n=119 preterms with germinal matrix hemorrhage and intraventricular hemorrhage, n=27 preterms with high grade hemorrhage with born in the our Neonatal Intensive Care Unit, birth weight <1500 grams and <32 weeks of gestation were included in the study. Of the included infants, 30.4% had germinal matrix hemorrhage and intraventricular hemorrhage, and 6.9% of germinal matriks hemorrahage-intraventricular hemorrhage diagnosed infants had high grade hemorrhage. Germinal matriks hemorrahage-intraventricular hemorrhage were found to be higher in premature babies with gestational week and birth weight decreased. At risk of germinal matriks hemorrahage-intraventricular hemorrhage and the clinical morbidities they experienced were evaluated during their stay in the Neonatal Intensive Care Unit. In this study, we demonstrated the risk groups for the prevention of germinal matriks hemorrahage-intraventricular hemorrhage, which is a current problem as the chance of survival of severe preterm infants increases.

Anahtar Kelimeler

• germinal matrix hemorrhage-intraventricular hemorrhage
• prematurity
• risk factors.

Kaynakça

1. 1. Christian EA, Jin DL, Attenello F, Wen T, Cen S, Mack WJ, et al. Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010. J Neurosurg Pediatr. 2016;17(3):260-9.
2. 2. Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. Handb Clin Neurol. 2019;162:173-99.
3. 3. Hou D, Shetty U, Phillips M, Gray PH. Cerebellar haemorrhage in the extremely preterm infant. J Paediatr Child Health. 2012;48(4):350-5.
4. 4. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand. 1977;56(3):247-53.
5. 5. Huang J, Meng J, Choonara I, Xiong T, Wang Y, Wang H, et al. Antenatal infection and intraventricular hemorrhage in preterm infants: A meta-analysis. Medicine (Baltimore). 2019;98(31):e16665.
6. 6. Humberg A, Hartel C, Paul P, Hanke K, Bossung V, Hartz A, et al. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network. Eur J Obstet Gynecol Reprod Biol. 2017;212:144-9.
7. 7. Zhao Y, Zhang W, Tian X. Analysis of risk factors of early intraventricular hemorrhage in very-low-birth-weight premature. infants: a single center retrospective study. BMC Pregnancy Childbirth. 2022;22(1):890.
8. 8. Özdemir ÖMA, Gürses M, Küçüktaşçı K, Koçyiğit A, Ergin H.Risk factors of newborns with periventricular/intraventricular hemorrhage. J Dr Behcet Uz Child Hosp. 2015;5(3):161-6.

9. 9. Jang HG, Choi S, Noh OK, Hwang JH, Lee JH, KoreanNeonatal N. Comparison of neonatal outcomes betweenmultiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study. J Matern Fetal Neonatal Med. 2023;36(2):2245530.
10. 10. Kim HR, Lee BK. Outcomes of singleton preterm very lowbirth weight infants born to mothers with pregnancy-induced hypertension. Sci Rep. 2023;13(1):6100.
11. 11. Spiegler J, Stichtenoth G, Weichert J, Konig IR, Schlaud M, A VDW, et al. Pregnancy risk factors for very premature delivery:what role do hypertension, obesity and diabetes play? ArchGynecol Obstet. 2013;288(1):57-64.
12. 12. Wei W, Sun Z, He S, Zhang W, Chen S, Cao YN, et al.Mechanical ventilation induces lung and brain injury throughATP production, P2Y1 receptor activation and dopamine release. Bioengineered. 2022;13(2):2346-59.
13. 13. Helwich E, Rutkowska M, Bokiniec R, Gulczynska E, Hozejowski R. Intraventricular hemorrhage in premature infants with Respiratory Distress Syndrome treated with surfactant: incidence and risk factors in the prospective cohort study. Dev Period Med. 2017;21(4):328-35.
14. 14. Poryo M, Boeckh JC, Gortner L, Zemlin M, Duppre P,Ebrahimi-Fakhari D, et al. Ante-, peri- and postnatal factorsassociated with intraventricular hemorrhage in very premature infants. Early Hum Dev. 2018;116:1-8.
15. 15. Fuloria M, Aschner JL. Persistent pulmonary hypertension ofthe newborn. Semin Fetal Neonatal Med. 2017;22(4):220-6.
16. 16. Kim KR, Jung SW, Kim DW. Risk factors associated with germinal matrix-intraventricular hemorrhage in preterm neonates. J Korean Neurosurg Soc. 2014;56(4):334-7.
17. 17. Cizmeci MN, Akin MA, Ozek E. Turkish Neonatal Society Guideline on the Diagnosis and Management of Germinal Matrix Hemorrhage-Intraventricular Hemorrhage and Related Complications. Turk Arch Pediatr. 2021;56(5):499-512.
18. 18. Al-Mouqdad MM, Huseynova R, Khalil TM, Asfour YS,Asfour SS. Relationship between intraventricular hemorrhage and acute kidney injury in premature infants and its effect onneonatal mortality. Sci Rep. 2021;11(1):13262.
19. 19. Hatzidaki E, Giahnakis E, Maraka S, Korakaki E, Manoura A, Saitakis E, et al. Risk factors for periventricular leukomalacia. Acta Obstet Gynecol Scand. 2009;88(1):110-5.
20. 20. Ohlin A, Bjorkman L, Serenius F, Schollin J, Kallen K. Sepsis as a risk factor for neonatal morbidity in extremely preterminfants. Acta Paediatr. 2015;104(11):1070-6.
21. 21. Kazan S, Gura A, Ucar T, Korkmaz E, Ongun H, Akyuz M.Hydrocephalus after intraventricular hemorrhage in preterm and low-birth weight infants: analysis of associated risk factors forventriculoperitoneal shunting. Surg Neurol. 2005;64 Suppl 2:S77-81; discussion S.