Celal DEVECİOĞLU, İsmail Hamdi KARA, Osman KARAGÜN, Süber DİKİCİ

Perinatal asfiksili yenidoğanlarda elektroansefalografi bulgularının ve seyirin değerlendirilmesi

Amaç: Hipoksik iskemik ansefalopatili yenidoğanlarda standart elektroansefalogramin (EEG), hastalığın seyrini belirlemedeki değerini ortaya koymak amacıyla gerçekleştirildi. Gereç ve Yöntem: Bu çalışmada, perinatal asfiksi tanısıyla yatırılmış, 31 yenidoğan (37-42 gebelik haftası) çalışma kapsamına alındı. Elektroansefalogram doğumdan sonraki ilk 48 saat içinde mümkün olan en kısa zamanda çekildi. Olgularımızı EEG'ye göre 4 grupta inceledik: 1. normal veya hafif anormal, 2. orta, 3. oldukça anormal, ve 4. aşırı anormal EEG. Ek olarak yenidoğanlar, Sarnat ve Sarnat sınıflamasına göre, Amiel-Tison klinik ölçütleri kullanılarak hafif, orta ve ağır olmak üzere, üç sınıfa ayrıldılar. Bulgular: Çalışmarmzdaki istenmeyen sonuç oranı % 35,5 (n=ll) idi. Grup IV-EEG bulgusu içeren ve klinik olarak Evre III olan üç yenidoğan kaybedildi. Grup III- EEG bulgusu olan 14 yenidoğandan klinik olarak Evre IH'te yer alan dördü öldü. Grup II-EEG'si olan ve klinik olarak Evre II'de yer alan iki yenidoğan ile Grup IH'te yer alan iki yenidoğanda sekel gelişti. Grup I ve Evre I'de yer alan yenidoğanların hiçbirinde sekel ve ölüm görülmedi. Ölüm ve sekel ile EEG bozukluğunun derecesi arasında yüksek düzeyde ilişki vardı (r=0,65; P

Evaluation of prognosis and electroencephalographic findings in fullterm newborns with perinatal asphyxia

Aim: This study was performed to assess the predictive value of standard electroencephalogram (EEG) in full-term infants with hypoxic ischaemic encephalopathy. Material and Method: This prospective study consisted of 31 full-term (37-42 weeks of gestation) newborns with perinatal asphyxia, electroencephogram (EEG) was recorded as soon as possible in the first 48 hours of life. The recordings were divided into four categories: 1. normal or slightly abnormal, 2. intermediate, 3. very abnormal, and 4. extremely abnormal EEGs. In addition, neonates were classified in three grades as having mild, moderate and severe hypoxic ischemic encephalopathy, using Amiel-Tison clinical criteria according to Sarnat and Sarnat classification. Results: In our study, the unfavorable outcome rate was %35.5 (n=ll). Three infants with extremely abnormal EEGs (group IV) and having severe hypoxic ischemic encephalopathy (grade İÜ) died. Among 14 infants with very abnormal EEGs (group III), four died (all of four had clinically severe hypoxic ischemic encephalopathy -grade III), two had sequelae (they had moderate hypoxic ischemic encephalopathy -grade II). Two infants with intermediate activity (group II) and having moderate hypoxic ischemic encephalopathy (grade II) had also squeal. Newborns with normal or slightly abnormal EEGs (group I) and having mild hypoxic ischemic encephalopathy (grade I) had no unfavorable outcome (sequelae or death). There was a highly significant relationship between unfavorable outcome and hypoxic ischaemic encephalopathy grades or EEG findings (r=0,65; P

PDF

___

1. Patel J, Edwards AD. Perinatal asfikside sonuçların tahmini. Pediyatri gündemi 1997; 1: 6-9.
2. Küçüködük Ş: Perinatal Asfiksi. Yenidoğan Hastalıkları. Ankara: Güneş Kitabevi, 1993: 363-5.
3. Menkes JH: Perinatal central nervous system asphyxia and travma. In: Tausch HW, Ballard RA, Avery ME (eds). Schaffer and Avery's diseases of the newborn. 6th ed. Philadelphia: W.B. Saunders Co, 1991: 406-21.
4. Yang LL: Perinatal asphyxia, in: Gomella TL, Cunningham MD, Eyal FG (eds). Neonatology: management, procedures, on call problems, diseases, drugs. 2nd ed. Norwalk: Appleton &Lange, 1992:391-9.
5. Avery GN. Neonatolgy. Philadelphia: JB Lippincott Co. 1987: 22-53.
6. Ellenberg JH, Nelson KB. Cluster of perinatal events identifying newborns at high risk for death or disability. J Pediatrics 1988; 113: 546-52.
7. Tharnberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. ActaPediatr 1995; 84: 927-32.
8. Toet MC, Hellstrom-Westas L, Groenendaal F, Eken P, de Vries LS. Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1999; 81: F19-23.
9. Balcom TA, Redmond BG. Cerebral infarction as miltifocal clonic seizures. J Am Board Fam Pract 1997; 10: 43-9.
10. van Lieshout HB, Jacobs JW, Rotteveel JJ, Geven W, v't Hof M. The prognostic value of the EEG in asphyxiated newborns. Acta Neurol Scand 1995; 91: 203-7.
11. Can G. Perinatal asfiksi. İçinde: Pediatri Neyzi O, Ertuğrul T (yazarlar). 2. Baskı. İstanbul: Nobel Tıp Kitabevleri, 1993: 238-41.
12. Sarnat HB, Sarnat MS. Neonatal encephaopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33: 696-705.
13. Delton D, Andte M. Prognosis of hypoxic-ischaemic encephalopalhy in full-term newborns-value of neonatal electroencephalogrophy. Neuropediatrics 1997; 28: 276-80.
14. Dubowitz D, Werfheim D, Mercuri E, et al. Prognostic value of continuous EEG recording in full term infants with hypoxic ischaemic encephalopathy. Arch Dis Child 1994; 71: 97-102.
15. Martinez BA, Lopez MV, Roche C, Pascual CI. The role of neonatal electroencephalognaphy in the prognosis of the hypoxicishemic syndrome. An Esp Pediatr 1990; 32:7-10
16. Frias PMA, Perez NJL, Ibarra RI, et al. Hypoxicischemic coma in children. Factors related to the prognosis. An Esp Pediatr 1997; 47: 601-5.
17. Dreyfus-Brisac C. Neonatal EEC In: Scarpelli EM, Cosmi EV (eds). Reviews in Perinatal Medicine. New York: Raven Press, 1979; 397-471.
18. Kliegman RM. Fetus ve Yenidoğan Bakımı. İçinde: M. Tuzcu (çeviri ed.). 2. Basım Nelson Essentials of Pediatrics Istanbul: Nobel Tıp Kitabevleri ve Yüce Yayınlan, 1996: 157- 88.
19. Belet NM, Küçüködük Ş. Hipoksik iskemik ansefalopatide tedavi yaklaşımı ve yeni görüşler. OMÜ Tıp Dergisi 1998; 15: 87-94.
20. Guarino Y, Brayshaw C, Edwards AD, Acolet D, Azzopardi D. Prediction of hypoxic-ischaemic encephalopathy by cotinuous EEG in asphyxiated full-term infants (abstract).Pediatr Res. 1996:40:531
21. D'Allest AM, RadvanyiMF, Andre M.etal. Prognostic value of the EEG in perinatal hipoxic ischaemic encephalopathy of the term newborn. First meeting of the European Paediatric Neurology Society, Eilat (Israel). Dev Med Child Neurol Suppl 1995; 72: 27.
22. Eken P, Toet MC, Groenendaal F, de Vries LS. Predictive value of infants early neuroimaging, pulsed doppler and neurophysiology in full term with hypoxic- ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1995; 73: 75-80.
23. Lamblin MD, Andre M, Auzoux M. Indications of electroen cephalogram in the newborn. Arch Pediatr. 2004;ll: 829-33.