Ö . M. A ÖZDEMİR, N KÖKTEN YILDIRIM, L ALKILIÇ, Ş YENER ÖZTÜRK, F ADALI

Postnatal erken dönemde kraniyal ultrasonografi incelemesi yapılan yenidoğanlarda periventriküler/intraventriküler kanama sıklığı ve risk faktörleri

Amaç: Yenidoğan yoğun bakım ünitesinde (YYBÜ) takip edilen ve kraniyal ultrasonografi (US) incelemesi yapılan yenidoğanlarda, periventriküler/intraventriküler kanama (PV/İVK) sıklığı ve risk faktörlerinin araştırılması. Gereç ve Yöntem: Hastanemiz YYBÜ’nde prematürite, hipoksik doğum, apne ve solunum sıkıntısı gibi nedenlerle yatan ve kraniyal US incelemesi yapılan 100 yenidoğan çalışmaya alındı. Yenidoğanlar gestasyonel yaşları ve doğum ağırlıklarına göre dört gruba ayrıldı. Risk faktörleri olarak doğum şekli, doğumda neonatal resüsitasyon uygulanması, düşük Apgar skoru, respiratuar distress sendromu (RDS), apne, mekanik ventilasyon, kan ve kan ürünleri transfüzyonu ile total parenteral beslenme gibi değişkenler kaydedildi. Bulgular: Yenidoğanlarda PV/İVK sıklığı % 32 oranında saptanmış olup, gestasyonel yaş ve doğum ağırlığıyla ters orantılı idi. Papile sınıflamasına göre PV/İVK saptanan yenidoğanların çoğunda (% 68.7) kanama derecesi, Grade II ve altında saptandı. Vajinal yolla doğan, prematüre olan ve mekanik ventilatör desteği alan yenidoğanlarda PV/İVK sıklığında anlamlı bir artış bulundu (p

Incidence of periventricular/intraventricular hemorrhage and risk factors in newborns who were examined with cranial ultrasonography during the early postnatal period

Aim: To evaluate the incidence of periventricular/intraventricular hemorrhage (PV/IVH) and risk factors in newborns followed-up in the neonatal intensive care unit (NICU) and examined with cranial ultrasonography (US). Material and Methods: 100 newborns hospitalized in the NICU because of prematurity, hypoxic delivery, apnea and respiratory distress and examined with cranial US were included in the study. The newborns were divided into 4 groups according to their gestational-age and birth-weights. Type of delivery, neonatal resuscitation application in delivery, low Apgar score, respiratory distress syndrome (RDS), apnea, mechanical ventilation, transfusion of blood and blood products and total parenteral nutrition were recorded as risk factors. Results: Incidence of PV/IVH was found to be 32% and inversely proportional with gestational-age and birth-weight. According to Papile Classification, PV/IVH was grade II and below in most (68.7%) of the newborns. A significant increase in PV/IVH incidence was found in newborns delivered vaginally, prematurely and in those received mechanical ventilator support. The mortality rate was 43.7% in newborns with PV/IVH and was significantly higher than those without hemorrhage (P<0.001) Conclusion: Newborns monitored in the NICU and who have the aforementioned risk factors should be evaluated for PV/IVH using cranial US which has no adverse effects and can easily be performed at bed-side and then should be followed-up closely.

PDF

___

1. Dağoğlu T. Prematürite. Dağoğlu T, Ovalı F, eds. Neonatoloji. 2. baskı. İstanbul: Nobel Tıp Kitabevleri, 2007: 221-228.
2. Güleçyüz M, Benian Ö. Prematüre bebeklerde periventriküler/intraventriküler kanamalar. Türkiye Klinikleri J Med Sci 1988; 8(5): 379-383.
3. Apak S. İntrakranial kanamalar. Dağoğlu T, Ovalı F, eds. Neonatoloji. 2. baskı. İstanbul: Nobel Tıp Kitapevleri, 2007: 665-671.
4. Lee JY, Kim HS, Jung E, et al. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci 2010; 25(3): 418-424.
5. Heuchan AM, Evans N, Henderson Smart DJ, Simpson JM. Perinatal risk factors for major intraventricular hemorrhage in the Australian and New Zealand Neonatal Network, 1995-97. Arch Dis Child Fetal Neonatal Ed 2002; 86(2): F86-90.
6. Synnes AR, Chien LY, Peliowski A, et al. Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr 2001; 138(4): 525-531.
7. Khodapanahandeh F, Khosravi N, Larijani T. Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran. Turk J Pediatr 2008; 50(3): 247-252.
8. Badiee Z. Intraventricular hemorrhage in very low birth weight infants. Associated risk factors in Isfahan, Iran. Saudi Med J 2007; 28(9): 1362-1366.
9. Kervancıoğlu S, Sivaslı E, Kervancıoğlu R, ve ark. Yenidoğan yoğun bakım ünitesinde serebral ultrasonografi incelemesi yapılan yenidoğanlarda germinal matriks/intraventriküler hemoraji sıklığı ve predispozan faktörleri. Gaziantep Tıp Dergisi 2008; 14(2): 6-9.
10. Khan IA, Wahab S, Khan RA, et al. Neonatal intracranial ischemia and hemorrhage: role of cranial sonography and CT scanning. J Korean Neurosurg Soc 2010; 47(2): 89-94.
11. Ballard JL, Khoury JC, Wedig K, et al. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119(3): 417-423.
12. Papile LA, Munsick-Bruno G, Schaefer A. Relationship between cerebral intraventricular hemorrhage and early childhood neurologic handicaps. J Pediatr 1983; 103(2): 273-277.
13. Roland EH, Hill A. Germinal matrix-intarventricular hemorrhage in the premature newborn: management and outcome. Neurol Clin 2003; 21(4): 833-851.
14. Gressens P, Hüppi PS. The central nervous system. Martin JR, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s Neonatal- Perinatal Medicine Diseases of the Fetus and Infant. 8th ed. Philadelphia: Mosby Elsevier, 2006: 883-1033.
15. Heljic S. Intraventricular hemorrhage in premature neonates: etiopathogenesis, detection and prevention. Med Arh 2003; 57(3): 179-182.
16. Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child fetal Neonatal Ed 2010; 95(6): F403-407.
17. Dani C, Poggi C, Bertini G, et al. Method of delivery and intraventricular hemorrhage in extremely preterm infants. J Matern Fetal Neonatal Med 2010; 23(12): 1419-1423.
18. Cuestas E, Bas J, Pautasso J. Sex differences in intraventricular hemorrhage rates among very low birth weight newborns. Gend Med 2009; 6(2): 376-382.
19. Futagi Y, Toribe Y, Ogawa K, Suzuki Y. Neurodevelopmental outcome in children with intraventricular hemorrhage. Pediatr Neurol 2006; 34(3): 219-224.
20. Vollmer B, Roth S, Baudin J, et al. Predictors of long-term outcome in very preterm infants: Gestational age versus neonatal cranial ultrasound. Pediatrics 2003; 112(5): 1108-1114.
21. Patra K, Wilson-Costello D, Taylor G, et al. Grade I-II intraventricular hemorrhage in ELBW infants: Effects of neurodevelopment. J Pediatr 2006; 149(2): 169-173.
22. Adams-Chapman I, Stoll BJ. Nervous system disorders. Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders Elsevier, 2007: 713-722.