Çetin OKUYAZ, Yalçın ÇELİK, Aytuğ ATICI, Mehmet Ali SUNGU, Selvi GÜLAŞI, Ali Haydar TURHAN

Hipoksik iskemik ansefalopatili yenidoğan bebeklerde seçici baş soğutma tedavisi ile tüm beden soğutma tedavisinin karşılaştırılması: Kısa dönem sonuçları

ÖzetAmaç: Bu çalışmada orta ya da ağır hipoksik iskemik ansefalopati tanısıalan yenidoğan bebeklere seçici baş soğutma ya da tüm beden soğutmatedavisi uygulayarak hangi yöntemin daha üstün olduğunun araştırıl-ması amaçlandı.Gereç ve Yöntemler: Çalışmaya 35. gebelik haftasından büyük, orta yada ağır hipoksik iskemik ansefalopati tanısı alan yenidoğanlar alındıve rastlantısal olarak seçici baş soğutma ya da tüm beden soğutmatedavisi uygulandı. Her iki yöntemle soğutma tedavisi uygulananyenidoğanlar erken dönemde istenmeyen etkiler ve kısa dönem so-nuçları açısından karşılaştırıldı. Çalışma için etik kurul izni alındı(06.01.2010/35).Bulgular: Hipoksik iskemik ansefalopati tanısı alan 53 bebek incelendive 17 bebeğe seçici baş soğutma, 12 bebeğe tüm beden soğutma uygu-landı. Soğutma tedavisine bağlı olarak gelişebilecek istenmeyen etkileraçısından iki grup arasında fark bulunmadı. Erken dönem sonuçlarıincelendiğinde hastanede yatış süresi seçici baş soğutma grubunda 34(7-65) gün iken, tüm beden soğutma grubunda 18 (7-57) gün idi vearalarında anlamlı fark yoktu (p=0,097). Seçici baş soğutma grubundandört, tüm beden soğutma grubundan iki hasta uzamış mekanik venti-lasyon gereksinimi nedeniyle trakeostomi ile taburcu edildiler ve tra-keostomi ile taburculuk açısından gruplar arasında fark yoktu (p=0,528).Seçici baş soğutma grubundan beş, tüm beden soğutma grubundan üçhasta ağızdan beslenememeleri nedeniyle gastrostomi tüpü ile taburcuedildiler ve gastrostomi tüpü ile taburculuk açısından gruplar arasındafark yoktu (p=0,586). Seçici baş soğutma tedavisi uygulanan bebekler-den biri, tüm beden soğutma uygulanan bebeklerden biri hastanede ya-şamını kaybetti ve ölüm açısından gruplar arasında fark yoktu (p=0,665).Çıkarımlar: Seçici baş soğutma ve tüm beden soğutma yöntemleri ara-sında istenmeyen etkiler ve kısa dönem sonuçları açısından fark yoktur.

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

Aim: In this study, it was aimed to investigate which method was supe-rior by applying selective head cooling or whole body cooling therapyin newborns diagnosed with moderate or severe hypoxic ischemic en-cephalopathy.Material and Methods: Newborns above the 35th gestational age diag-nosed with moderate or severe hypoxic ischemic encephalopathy wereincluded in the study and selective head cooling or whole body coolingtherapy was performed randomly. The newborns who were treated byboth methods were compared in terms of advers effects in the early stageand in terms of short-term results. Ethics committee approval was ob-tained for the study (06.01.2010/35).Results: Fifty three babies diagnosed with hypoxic ischemic encephalop-athy were studied. Selective head cooling was applied to 17 babies andwhole body cooling was applied to 12 babies. There was no signifcantdifference for adverse effects related to cooling therapy between twogroups. When the short-term results were examined, it was found thatthe hospitalization time was 34 (7-65) days in the selective head coolinggroup and 18 (7-57) days in the whole body cooling group and there wasno signifcant difference between the two groups (p=0.097). Four patientsin the selective head cooling group and two patients in the whole bodycooling group were discharged with tracheostomy because of the needfor prolonged mechanical ventilation and there was no difference be-tween the groups in terms of discharge with tracheostomy (p= 0.528).Five patients in the selective head cooling group and three patients inthe whole body cooling group were discharged with a gastrostomy tubebecause they could not be fed orally and there was no difference betweenthe groups in terms of discharge with a gastrostomy tube (p=0.586). Onepatient who was applied selective head cooling and one patient who wasapplied whole body cooling died during hospitalization and there was nodifference between the groups in terms of mortality (p=0.665).Conclusions : There is no difference between the methods of selectivehead cooling and whole body cooling in terms of adverse effects andshort-term results. (Türk Ped Arş 2015; 50: 27-36)

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