Halil İbrahim YAKUT, Nilüfer GÜZOĞLU, Nurdan URAŞ, Zeynep ERAS, Suna OĞUZ, Emre CANPOLAT, H GÖZDE KANMAZ

Bütüncül İzlem Modelinin Preterm Bebeklerin Nörolojik Ve Gelişimsel Sonuçları Üzerine Etkisi

Giriş: Çalışmanın amacı Türkiye’de büyük bir doğum hastanesinde taburculuk sonrası yapılan bütüncül izlem modeli ile izlenen preterm bebekler ile birinci basamakta sağlık hizmeti alan preterm bebeklerin 2 yaştaki nörolojik ve gelişimsel sonuçlarını karşılaştırmaktı.Gereç ve Yöntemler: Çalışmaya 32 gestasyon haftası ve altında doğan, Ekim 2007 ile Aralık 2011 arasında taburcu olan bebekler alındı. Girişim grubu bütüncül izlem modeli kapsamında prospektif olarak izlendi Ekim 2009-Aralık 2011 ve kontrol grubu birinci basamakta standart sağlık hizmeti aldı Ekim 2007-Aralık 2009 . Diizeltilmis 18-24 aylarmda bebeklerin nörolojik muayeneleri ve “Bayley Bebekler için Gelişimi Değerlendirme Ölceği II” ile gelişimsel değerlendirmeleri yapıldı.Bulgular: Girişim grubunun %10.6 n=17 ve kontrol grubunun %17.4 n=27 ’ünde serebral palsi saptandı ve gruplar arasındaki fark anlamlı değildi p=0.107 . Ancak gelişimsel sorun oranının girişim grubunda kontrol grubuna göre anlamlı düzeyde düşük olduğu saptandı %25 ve %38.7; p=0.011 .Sonuç: Bulgularımız, bütüncül izlem modeli kapsamında yapılan iyi bir izlem, yeterli gelişimsel destek ve sorunların erken farkedilip yönlendirme yapılmasının 2 yaştaki nörolojik ve gelişimsel sorunların görülme oranında azalma sağlayabileceğini göstermiştir.

Anahtar Kelimeler:

Prematürite, nörolojik ve gelişimsel sonuç, bütüncül izlem modeli, birinci basamak sağlık izlemi

The Impact Of Medical Home Model On Neurological And Developmental Outcomes Of Preterm Infant

Aim: The medical home also known as the patient-centered medical care, is a team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The aim of the study is to compare the 2-year neurodevelopmental outcomes of very preterm infants who received health care in a medical home at a big maternity hospital in Turkey with the historical controls who delivered standard care.Material and Methods: Inborn infants who were ≤32 week’s gestation and discharged between September 2007 and December 2011 were enrolled to the study. Intervention group were prospectively followed within the concept of medical home between September 2009 and December 2011 and the control group were followed with standard health care between September 2007 and September 2009 . At 18-24 months’ of corrected age, the neurological examinations and the developmental assessments using the Bayley Scales of Infant Development-II were performed.Results: The cerebral palsy rates in the intervention and control group were 10.6% n=17 and 17.4% n=27 respectively and the difference was not statistically significant p=0.107 . Whereas the rate of neurodevelopmental impairment in the intervention group was significantly lower than the control group 25% and 38.7%; p=0.011 .Conclusion: Our data suggest that beginning a good follow-up process within the context of medical home, with efficient developmental support and guidance provided a reduction on neurodevelopmental impairment rate at 2 years of age.

Keywords:

Prematurity, neurodevelopment, medical home, primary health care,

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