The neurological outcome of hypoxic ischemic encephalopathy

Yıl 2004, Cilt: 35 Sayı: 1, 33 - 39, 01.02.2004

Turgut Ağzıkuru Ayça Vitrinel Serdar Cömert Gülay Çiler Erdağ Feza Aksoy Yasemin Akın

Öz

Objective: The purpose of this study was to determine the morbidity and mortality rates of HIE patients in our neonatal unit and to evaluate the prognostic values of Apgar scores, convulsions and Sarnat Sarnat staging. Mateikd and Methods: Of the 679 neonates followed in our unit between )anuary 2000 and June 2001, 51 (7.51 %) fuUterm infants with HIE were included in our study. Results: AU of them were classifed according to Samat Samat staging system as mHd (stage I, 8 cases 15.68%), moderate (stage II, 28 cases 54.90%) and severe (stage III, 15 cases 29.42 %) 10 of the patients (19.60%) died in the neonatal period. 24 patients {47.06 %lwere foHowed up for a year at 3™, 6™ , 9™" and 12th months withphysical and neurological examinations. The morbidity rates for 3 stages were 0%, 3.57% and 60% respectively. There was a significant relation between the neurological findings and higher Sarnat Sarnat HIE grades (p 0.01). Conclusion: In our patients we found significant relation between the increased SarnatEfSarnat HIE grade and mortality and morbidity; but no signicat relation between the Apgar score and norologic outcome and mortality.

Anahtar Kelimeler

Hypoxia-Ischemia, Brain, Infant, Newborn, Apgar Score, Mortality, Morbidity

Hipoksik iskemik ensefalopatide izlem

Öz

Amaç: HIE nedeniyle yenidoğan ünitesinde yatan hastalarımızın morbidite, mortalite oranlarını belirlemek, Apgar skorunun, konvülziyonıın ve Sarnat&Sarnat HIE evrelemesinin nörolojik defisitin erken tahmini açısından uygunluğunu de ğ e de n dirm e yi am a ç la dik. Materyal ve Metod : Ocak 2000 ile Haziran 2001 tarihleri arasında 18 ay süre içerisinde yenidoğan ünitesinde yatan 679 hastadan asfiksisonrası HIE tanısı konulan 51 term yenidoğan bebek alınmıştır. Bulgular: Tüm hastalar SarnatfrSamat HIE evrelemeşine göre evrelendirildi. 8 (%15.68) olgu Evre I, 28 (%54.90) olgu Evre live 15 (%29.42) olgu Evre III olarak değerlendirildi. HIE olguların 10'u (%19.60) yenidoğan döneminde eksitus oldu. 17 (%33.34) olgu kontrole gelmezken 24 (%47.06) olgu kontrole geldi. Kontrole gelen hastalar 3,6,9 ve 12. aylarda fizik ve nörolojik muayeneleri yapıldı. Evre I, II, ve IIIiçin morbidite oranlan sırasıyla %0, %14.28, ve %6.66 ve mortalite oranları ise yine sırasıyla %0, %3.57, ve %60 olarak tespit edildi. Evrelerin artması ile nörolojik def is it ve mortalite arasında ileri derecede ilişki saptandı (p

Anahtar Kelimeler

Hipoksi-iskemi, beyin, Süt çocuğu, yenidoğan, Apgar skoru, Ölüm oranı, Hastalık oranı

Kaynakça

• 1. Can G. Neonatal asfiksi Pediatri I. Neyzi O, ErtuğrulT. 2. baskı. Nobel tıp Kitapevi, İstanbul 1993; 235-241
• 2. John Hç Menkes and Harvey B. Sarnat. Perinatal Asphyxia and Trauma. Child Neurology 2000: 401- 455
• 3. Nelson BK, Levintan A. How much of neonatal encephalopatyis due to birth asphixia? AJDC 1991; 145:1325-31
• 4. ClothertyJP, SynderEY Perinatal Asphyxia. In Manual of Neonatal Care. Eds: Clotherty JP and Stark AR, 3rd ed. A Little Brown, 1993; 383-411
• 5. Fanaroj.AA, Martin RJ. Neonatal-Perinatal Medicine. 5 ed. Mosby Year Book, St. Louis 1992; 702-723
• 6. Yang LL. Perinatal Asphyxia. In Neonatology: Management, Procedures, On-Call Problems, Diseases and Drugs. Eds: Gomella TL, Cunningham MD, EyalFG. 3rd ed. Prentice-Hall International, 1994; 399-408
• 7. Bollard RA. Resusitation in the delivery room
• In S chaffer and Avery's Diseases of the Newborn
• Eds: Taeusch HW, Ballard RA, Avery MD. 7th ed
• WB Saunders Co, Philadelphia 1998; 319-333
• 8. Küçükhödük Ş. Yenidoğan ve Hastalıkları. Ankara 1994;28-32 9. Eken P, Toet MC, Groenen DF, De Urics LS: predictive value of early neuroimagining, pulsed doppler and neurophysiology in full term infants with hypoxic-ischemic encephalopathy Arch. Dis. Child. 1995; 73: F75-80
• 10. Volpe JJ. Neurology of Newborn. 3 Saunders Company, 1995; 211-360
• 11. Mimouni F, Muodovnik M, Sıddıgı TA, et al
• Perinatal asphyxia in infants of insulin dependent diabetic mothers. J. Pediat. 1988; 113: 345-353
• 12. Berg TA. Indices of fetal growth-retardation, perinatal hypoxia-related factors and childhood neurological morbidity. Early Human Dev. 1988; 19:271-283
• 13. Uvenbrant P, Hogberg G. Intrauterine growth in children with cerebral palsy. Ada Paediatr. Scand
• 1992; 81: 407-412
• 14. Sexon WR, Sexon SB, RawsonJE, BrannAW
• The multisystem involvement of asphyxiated newborn. Pediatrres. 1976; 10: 432
• 15. Mas ter D, Lie RT, Irgens LM, e t al. The association of Apgar score with subsequent death and'cerebral palsy. A population-based study in term infants. J Pediatr, 2001; 138 (6): 798-803
• 16. Casey BM, Mclntire DD, Levena KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Eng J Med, 2001;344 (7): 467-71
• 17. Paul E, Max P, Maja S. Predicting the outcome of post as phyxial hypoxic-ischemic encefalopathy within 4 hours of birth. J Pediatr, 1997;131(4):613- 17
• 18. Robertson CMT, FirmerNN. Long-term foUow- up of term neonates with perinatal asphyxia. Clin Perinatal 1993; 20:483-500
• 19. O. Halhoglu. Yenidoğan hipksik iskemik ensefalopatisinde iki yıllık izle m ve prognoz. Tez çalışması. Dr. Sami Ulus Çocuk Hastanesi, Yenidoğan Servisi 1997
• 20. S. Güllü. Hipoksik iskemik ensefalopatili olgularımızın retrospektif değerlendirilmesi. Dr
• Behçet Uz Çocuk Hastanesi, Yenidoğan Servisi
• Uneko'98 IX. Ulusal Neonatoloji Kongresi Özet Kitabı 1998: 61
• 21. Futagi Y, Suzuki Y, Toribe Y, Kato T. Neurologic outcomes of infants with tremor within the first year of life. Pediatr Neurol 1999 Aug: 21 (2): 557-61
• 22. Bohr L, Greisen G. Prognosis after perinatal asphyxia inful-term infants. Ugeskr Laeger 1998 May 4; 160(19): 2845-50: