Senem ALKAN ÖZDEMİR, Nail ÖZDEMİR, Esra Arun ÖZER

Meningomyeloselli 50 yenidoğanın prospektif-gözlemsel değerlendirilmesi

Amaç: Yenidoğan yoğun bakım ünitesine meningomyelosel tanısıyla yatırılan hastaların klinik sonuçları ile annenin sosyodemografik özelliklerini araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2012 - Aralık 2014 tarihleri arasında meningomyelosel nedeni ile yatan tüm yenidoğanların perinatal bilgileri, annenin sosyodemografik özellikleri, prenatal tanısı, kesenin özellikleri, operasyon zamanı, hastanede yatış süresi, eşlik eden ek anomalileri, ventriküloperitoneal şant gerekliliği, şant enfeksiyonu, taburculuk sonrası poliklinik kontrolleri ile hastaneye yatış sıklığı ve yatış nedenleri prospektif-gözlemsel olarak kaydedildi. Denver Gelişimsel Tarama Testi-II ile postnatal 18. ayda psikomotor değerlendirme yapıldı ve çocuklar normal, sınırda gerilik ve ciddi gerilik şeklinde sınıflandı. Bulgular: İki yılda yatırılan 50 hastanın ortalama doğum ağırlığı 3012±485 g, gestasyon haftası 37.9±1.4 hafta idi. Hiçbir anne prekonsepsiyonel dönemde folik asid kullanmamıştı. Gebelikte %90'ında kullanım yoktu. Keselerin 25'i torakolomber, 24'ü lumbosakral ve 1'i servikotorasik yerleşimliydi. Alt ekstremite muayenesinde 27 yenidoğan paraplejik, 11'i minimal ve 12'si ise tam hareketliydi. Ortalama operasyon günü 4.9±3 gündü. Hidrosefali 35, hidronefroz 33, Chiari tip 2 malformasyonu 24, pes ekinovarus 22, kifoz 16 yenidoğanda mevcuttu. Denver Gelişimsel Tarama Testi-II ile 14 bebekte normal, 31 bebekte sınırda ve 5 bebekte ise ciddi gerilik saptandı. Sonuç: Gebelikte folik asid alınması, tüketilen gıdalardaki folik asid miktarının arttırılması ve kadınların eğitimi meningomyeloselin insidansının azaltılmasında önemlidir.

Prospective-observational evaluation of the 50 meningomyelocele neonates

Aim: We aimed to analyze the clinical outcomes and maternal sociodemographic features of the patients followed in the neonatal intensive care unit with meningomyelocele diagnosis. Materials and Methods: Babies with meningomyelocele followed in the unit between January 2012 and December 2014 were analyzed prospectively and observationally. Perinatal data, maternal sociodemographic features, prenatal diagnosis, features of the sac, operation time, hospitalization duration, associated abnormalities, need of ventriculoperitoneal shunt, shunt infection, controls of policlinic, rehospitalization frequency and causes for each baby were recorded. Eighteen months after birth, children were assessed by the Denver Development Screening Test-II for psychomotor delay and the children were classified as normal, borderline delay and significant delay. Results: Fifty neonates admitted to the unit were diagnosed as meningomyelocele during the study period. Mean birth weight and gestational age were 3012±485 g and 37.9±1.4 weeks, respectively. 90% of the mothers had never used folic acid during pregnancy. Twenty-five of sacs were located in the lumbosacral, 24 in the thoracolumbar, and 1 in the cervicothoracic regions. Paraplegia was determined in 27 neonates. Mean operation time was within 4.9 ± 3 days. Among all neonates, 35 were diagnosed as hydrocephaly, 33 as hydronephrosis, 24 as Chiari type 2 malformation, 22 as pes equinovarus, and 16 as kyphosis. Denver Development Screening Test-II were normal in 14 babies whereas borderline delay in 31 and significant delay in 5. Conclusion: Educating women, folic acid use during pregnancy and fortification of food seem to be the important for reducing incidence of meningomyelocele.

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