Aşırı düşük doğum ağırlıklı prematüre bebeklerde erken morbidite ve nörolojik prognoz
Early morbidity and neurological prognosis of extremely low birth weight infants
- Tez No: 281025
- Danışmanlar: PROF. DR. GÜLAY CAN, PROF. DR. ZEYNEP İNCE
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Preterm, ELBW, morbidity, neurodevelopmental impairment
- Yıl: 2010
- Dil: Türkçe
- Üniversite: İstanbul Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Neonatoloji Bilim Dalı
- Sayfa Sayısı: 118
Özet
AMAÇ: Ülkemizde aşırı düşük doğum ağırlıklı (ADDA,
Özet (Çeviri)
OBJECTIVE: Neurodevelopmental outcome of extremely low birth weight (ELBW) infants are not well documented in our country. This study presents data on early morbidity and neurodevelopmental impairment rates from Istanbul Faculty of Medicine Department of Pediatrics Neonatal Intensive Care Unit.METHODS: Perinatal and neonatal data were collected from ELBW infants born in our clinic between 2005 and 2008. They were evaluated for neurodevelopmental morbidities between 12-43 months. Bayley Scales of Infant and Toddler Development-III was used for developmental evaluation. Logistic regression analysis was used to identify risk factors associated with neurodevelopmental impairment.RESULTS: Survival rate of ELBW infants was 65.8%. Of the 123 infants discharged, 81 were evaluated. Mean gestational age was 28.1±2.4 weeks (23.6-34.9), mean birth weight was 803±134g (500-998). Fifty six percent of infants were born small for gestastional age. Male/female ratio was 29/52. Rates of antenatal steroid treatment and cesarean section were 79% and 84% respectively. Overall, 67.9% had respiratory distress syndrome, 27.1% moderate-severe bronchopulmonary dysplasia, 33.3% patent ductus arteriosus, 13.6% severe intraventricular hemorrhage, 13.6% cystic periventricular leukomalacia, 3.7% necrotizing enterocolitis, 40.7% sepsis, 18.5% severe retinopathy of prematurity and 34.6% hypothyroxinemia of prematurity. At the time of evaluation 47% had weight below 10th percentile. The rates of cerebral palsy, blindness, and hearing loss were 14.8%, 1.2%, 2.5% respectively. 8.6% had scores below 70 from cognitive and motor scales, 6.2% from language scales. Neurodevelopmental impairment was detected in 18.5% of infants. 53.1% had mild impairment, 28% was unimpaired. Moderate-severe bronchopulmonary dysplasia, cystic periventricular leukomalacia, maternal infection and growth failure were found to be associated with neurodevelopmental impairment in the logistic regression analysis.CONCLUSION: ELBW infants are at high risk for early morbidities and these morbidities are associated with adverse neurodevelopmental outcome. Compared to results from the developed countries our early morbidity rates were similar. The rate of neurodevelopmental impairment was lower, but the rate of unimpaired infants were similar. To achieve the goal of increasing the number of unimpaired children, long term follow up is essential.
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