Pelin ÇELİK

Hipoksik İskemik Ensefalopati Nedeniyle Terapötik Hipotermi Uygulanan Bebeklerin Nörogelişimsel Sonuçları

Amaç: Hipoksik iskemik ensefalopati (HİE) dünyada olduğu gibi ülkemizde de gelişimsel sorunların önemli nedenlerinden biridir. Çalışmamızda terapötik hipotermi uygulanan bebeklerin nörogelişimsel sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Ocak 2017-Ağustos 2019 tarihleri arasında Gelişimsel Pediatri Polikliniği’nde HİE nedeniyle izlenen ve yenidoğan döneminde terapötik hipotermi uygulanan 47 hastanın tıbbi kayıtları retrospektif olarak incelendi. Gelişimsel değerlendirmede Bayley Bebek ve Çocuklar için Gelişimsel Değerlendirme Ölçeği II (Bayley-II) kullanıldı. Bulgular: Otuz dokuz (%83) hastada orta HİE; 8 (%17) hastada ağır HİE saptandı. Orta HİE’li hastaların, Bilişsel Gelişim İndeksi (MDI) ve Psikomotor Gelişim İndeksi (PDI) skorları ağır HİE’li hastalardan daha yüksekti (ortanca MDI sırasıyla 95 ve 49, p=0.007; PDI sırasıyla 89 ve 49, p=0.013). Bilişsel gelişimde gecikme, hareket gelişiminde gecikme, serebral palsi ve ciddi nörogelişimsel sorun sırasıyla hastaların %42.6, %42.5, %19.1 ve %17’sinde saptandı. Bayley-II skorları hastaların sadece %44.6’sında normaldi. Ağır HİE’li hastalarda bilişsel gelişimde belirgin gecikme (MDI≤69), hareket gelişiminde belirgin gecikme (PDI≤69), serebral palsi ve ciddi nörogelişimsel sorun daha sıktı (sırasıyla p=0.001, p=0.020, p=0.004 ve p=0.002). Epilepsi, mikrosefali, işitme kaybı, görme kaybı ve yutma sorunu ağır HİE’li hastalarda daha sık görülmesine rağmen istatistiksel anlamlı fark saptanmadı (p>0.05). Özel eğitim, fizyoterapi ve dil terapisi gereksinimi ağır HİE’li hastalarda daha sıktı (sırasıyla p=0.001, p=0.028 ve p=0.033). Yenidoğan döneminde nöbet geçiren hastaların ortanca MDI skorları, geçirmeyenlerden düşüktü (sırasıyla 79.6 ve 93.8, p=0.020). Sonuç: Terapötik hipotermi, HİE’li bebeklerde ölüm ya da ağır engel gelişme riskini azaltsa da hayatta kalanların yaklaşık yarısında nörogelişimsel sorunlar görülmektedir. Bu bebeklerde gelişimin izlenmesi, desteklenmesi, zamanında ve uygun sağaltımı uzun vadeli sonuçların iyileştirilmesi bakımından önemlidir.

Anahtar Kelimeler:

hipoksik iskemik ensefalopati, gelişimsel sonuçlar, terapötik hipotermi

Neurodevelopmental outcomes of infants who underwent therapeutic hypothermia due to hypoxic ischemic encephalopathy

Objective: Hypoxic ischemic encephalopathy (HIE), is one of the most important causes of neurodevelopmental problems in our country as well as in the world. We aimed to evaluate the neurodevelopmental outcomes of children who underwent therapeutic hypothermia. Material and Methods: Medical records of 47 children who were followed up in the Developmental Pediatrics Outpatient Clinic for HIE between January 2017-August 2019 and underwent therapeutic hypothermia were retrospectively reviewed. Neurodevelopmental assessment was performed with the Bayley Scales of Infant and Toddler Development 2nd Edition (BSID-II). Results: Moderate and severe HIE were in 39 (83%) and 8 (17%) patients. Patients with moderate HIE had higher median mental developmental index (MDI) and psychomotor developmental index (PDI) scores than patients with severe HIE (median MDI 95 vs 49, p=0.007; PDI 89 vs 49, p=0.013, respectively). Cognitive delay, motor delay, cerebral palsy and severe neurodevelopmental disability were found in 42.6%, 42.5%, 19.1% and 17% of patients, respectively. Bayley-II scores were normal in only 44.6% of patients. Severe cognitive delay (MDI≤69), severe motor delay (PDI≤69), cerebral palsy and severe neurodevelopmental disability were more common in patients with severe HIE (p=0.001, p=0.020, p=0.004 and p=0.002, respectively). Epilepsy, microcephaly, hearing impairment, blindness and swallowing problems were more frequent in patients with severe HIE but not statistically significant (p>0.05). Special education, physiotherapy and language therapy were found statistically higher in patients with severe HIE (p=0.001, p=0.028 and p=0.033, respectively). Patients with seizures in the neonatal period had lower median MDI scores than patients without seizures (79.6 vs 93.8, p=0.020). Conclusion: Although therapeutic hypothermia reduces the mortality or major disability in children with HIE, about half of the survivors have neurodevelopmental problems. Neurodevelopmental monitoring, support, timely and appropriate intervention are important to improve long-term outcomes of these patients.

Keywords:

hypoxic ischemic encephalopathy, therapeutic hypothermia, neurodevelopmental outcomes,

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