Evaluation of whole body hypothermia on term neonates with hypoxic ischemic encepholopathy/tum vucut sogutma yontemi ile hipotermi uygulanan hipoksik iskemik ansefalopatili yenidoganlarin degerlendirilmesi

• Published in: Turk Pediatri Arsivi p. 286
• Main Authors: Akar, Melek, Aydemir, Ozge, Oguz, Serife Suna, Erdeve, Omer, Aydemir, Cumhur, Gokmen, Tulin, Eras, Zeynep, Uras, Nurdan, Dilmen, Ugur
• Format: Journal Article
• Language: Turkish
• Published: AVES 01.12.2011
• Subjects: Asphyxia neonatorum; Demographic aspects; Development; Encephalopathy; Hypothermia; Infants; Patient outcomes; Prognosis
• ISSN: 1306-0015
• DOI: 10.4274/tpa.552

Aim: To investigate the effect of whole body hypothermia on short term neonatal morbidities and long term neurodevelopmental outcome in term neonates with hypoxic ischemic encephalopathy Material and Method: Neonates with perinatal asphyxia and hypoxic ischemic encepholopathy (stage 2 and 3) were enrolled. Patients were divided into 2 groups according to findings observed on amplitude-integrated electroencephalography (aEEG). Patients with abnormal aEEG pattern in the first six hours after birth were defined as group 1 and others as group 2. Patients in group 1 were treated with whole body hypothermia. Neurodevelopmental outcome was evaluated at 18 months of age in survivors using Bayley Scales of Infant Development II. Mental developmental index and psychomotor development index scores were calculated. Results: Thirty five patients were enrolled (M/F=17/18), 18 (51%) of whom were treated with hypothermia. Bradycardia was observed in 44.4% of patients in group 1 and 5.9% of patients in group 2 (p=0.04). Incidence of other possible adverse events related to hypothermia were similar between the two groups. Mortality was higher in group 1 (p=0.03). In group 1, 70% of the patients and in group 2, 86% of the patients were evaluated using Bayley Scales of Infant Development II. Although patients treated with hypothermia had a higher mental developmental index and psychomotor development index scores, the difference was not statistically significant. Conclusions: Whole body hypothermia can be safely applied in term neonates with HIE. Hypothermia may improve neurodevelopmental outcome. Key words: Hypothermia, hypoxic ischemic encephalopathy, newborn, perinatal asphyxia Amac: Bu calismada hipoksik iskemik ansefalopatili zamaninda dogmus yenidoganlara tum vucut sogutma yontemi ile uygulanan hipotermi tedavisinin hem dogum sonrasi erken sorunlara hem de uzun donem norogelisimsel sonuclara olan etkisinin degerlendirilmesi amaclandi. Gerec ve Yontem: Calismaya perinatal asfiksi ve hipoksik iskemik ansefalopati evre 2-3 tanili yenidogan bebekler alindi. Olgular ilk alti saatteki amplitut entegre elektroansefalogram (aEEG) bulgularina gore iki gruba ayrildi; Grup 1: aEEG bulgulari anormal olan veya klinik nobet gozlenen ve hipotermi tedavisi uygulananlar, Grup 2: aEEG bulgulari normal olan ve hipotermi tedavisi uygulanmayanlar. Yasayan olgularin 18. ayda Bayley Gelisim Olcegi-2 kullanilarak mental gelisim indeksi ve psikomotor gelisim indeksi puanlari hesaplandi. Calisma icin yerel etik kuruldan onay alindi (Onay no:8). Bulgular: Toplam 35 hasta (Kiz=18, Erkek=17) calismaya alindi. On sekiz olguya (%51) hipotermi tedavisi uygulandi. Grup 1'deki olgularin %44,4'unde, grup 2'deki olgularin ise %5,9'unda bradikardi saptandi (p=0,04). Diger klinik bozukluklarin gorulme sikligi bakimindan gruplar arasinda onemli bir fark yoktu. Grup 1'deki olgularin olum orani grup 2'den yuksekti (p=0,03). Grup 1'deki olgularin %70'i; grup 2'deki olgularin ise %86'si norogelisimsel acidan degerlendirilebildi. Hipotermi uygulanan olgularin norogelisimsel degerlendirme sonuclari diger gruba gore daha iyi olmakla birlikte aradaki fark istatistiksel olarak anlamli degildi. Cikarimlar: Hipotermi tedavisi hipoksik iskemik ansefalopatili olgularda uygulanabilir. Hipotermi, uzun donemde norogelisimsel sonuclarin daha iyi olmasina katki saglayabilir. Anahtar sozcukler: Hipoksik iskemik ansefalopati, hipotermi, perinatal asfiksi, yenidogan