Emine AZAK, Burak CERAN, Denizhan BAĞRUL, Betül SİYAH, Hayriye Gözde KANMAZ, Fuat Emre CANPOLAT, İbrahim İlker ÇETİN

Terapötik Hipotermi Uygulanan Hipoksik İskemik Ensefalopatili Yenidoğanların Kardiyak Bulgularının Değerlendirilmesi

Amaç: Terapötik hipotermi tedavisi alan hipoksik iskemik ensefalopatili (HİE) yenidoğanların kardiyak bulgularının; biyobelirteçler, EKG ve ekokardiyografi ile değerlendirilmesi ve bu belirteçlerin hipoksik myokard hasarı şiddetinin belirlenmesindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Evre II ve III HİE tanısı alan ve terapötik hipotermi uygulanmış 50 yenidoğan bebeğin verileri retrospektif olarak incelendi. Demografik özellikler, sistemik ve kardiyak muayene bulguları, serum CK-MB, troponin-I, EKG ve ekokardiyografi raporları kaydedildi. Evre II ve Evre III HİE’li hastaların bulguları karşılaştırıldı. Bulgular: Elli olgunun 11’inde (%22) miyokardiyal disfonksiyon saptandı. EKG kayıtlarında tüm olgular normal sinüs ritmine sahipti. EKG’de patolojik bulgu evre II’de 2 (%8.3) olguda, evre III’de ise 5 (%19.8) olguda mevcuttu. Serum CK-MB ve troponin-I olguların 30’unda (%60) yüksek izlendi. Tüm olguların 5’inde (%10) orta derecede triküspit yetersizliği, 1’inde (%2) şiddetli triküspit yetersizliği, 4’ünde (%8) sağ ventrikül hipokinezisi, 6’sında (%12) sol ventrikül hipokinezi ve 1’inde (%2) biventriküler hipokinezi mevcuttu. Evre III HİE’li olgularda enzim düzeylerinin daha yüksek, EKG ve EKO anormalliklerinin daha yaygın olduğu görüldü (p<0.05). Sonuç: Hipoksik iskemik ensefalopatili yenidoğanlarda kardiyak etkilenme prognoz açısından son derece önemlidir. Olgularda tedavinin daha iyi yönetilmesi için kardiyak değerlendirme ve yakın takip çok önemlidir. Kardiyak biyobelirteçler, EKG ve EKO perinatal asfikside miyokardiyal hasarın ciddiyetinin erken tanı ve değerlendirilmesinde faydalıdır.

Anahtar Kelimeler:

Perinatal asfiksi, Miyokardiyal hasar, Kardiyovasküler insitabilite

Evaluation of Cardiac Manifestations in Neonates With Hypoxic İschemic Encephalopathy Received Therapeutic Hypothermia

Objective: The aim of this study is to evaluate the severity of cardiac complications of hypoxic ischemic encephalopathy (HIE) according to the degree of hypoxia and to evaluate the efficacy of cardiac biomarkers, electrocardiography (ECG) and echocardiography (ECHO) for myocardial injury.Material and Methods: Fifty term babies with HIE without any additional disease were selected. Myocardial dysfunction was evaluated using clinical examination, serum CK-MB, troponin-I and ECG and ECHO. Results: According to Sarnat and Sarnat classificiation, 24 neonates were diagnosed stage II and 26 neonates were diagnosed stage III HIE. Among these 50 cases, 11 (22%) had evidence of myocardiac dysfunction. All the cases had normal sinus rhythm. ECG changes (ST depression, T wave inversion, pathological Q wave as signs of ischemia) were present in 2 (8.3%) cases in the stage II, and 5 (19.8%) cases in the stage HIE group. ECG showed. Serum levels of troponin-I and CK-MB were increased in 30 (60%) patients. Moderate tricuspid regurgitation was present in 5 (10%), severe tricuspid regurgitation in 1 (2%), right ventricular hypokinesia in 4 (8%), left ventricular hypokinesia in 6 (12%) and biventricular hypokinesia in 1 (2%) neonate among all the cases. Enzyme levels were higher, ECG and ECHO abnormalities were more common in the neonates with stage III HIE (p<0.05). Conclusion: Cardiac involvement is extremely important in terms ofprognosis in the neonates with HIE. Cardiac evaluation and close followup should be performed for the better management of HIE. Cardiac biomarkers, ECG and ECHO are useful in the early recognition and evaluating the severity of myocardial damage in perinatal asphyxia.

Keywords:

Cardiovascular instability, Myocardial damage, Perinatal asphyxia,

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