Hipoksik iskemik ensefalopati nedeni ile hipotermi tedavisinin, epilepsi ve nöromotor gelişimindeki prediktif rolü
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı, hipoksik iskemik ensefalopati (HİE) tanısı alan yenidoğanlarda uygulanan hipotermi tedavisinin, uzun dönem epileptik nöbet gelişimi ve nöromotor gelişim üzerine olan prediktif etkisini değerlendirmektir. Gereç ve Yöntem: Bu ambidireksiyonel gözlemsel çalışmaya, 2013–2023 yılları arasında İnönü Üniversitesi Turgut Özal Tıp Merkezi Yenidoğan Yoğun Bakım Ünitesi'nde Evre II–III HİE tanısı almış, hipotermi tedavisi uygulanmış veya uygulanmamış 110 hasta dahil edilmiştir. Hastaların yenidoğan dönemine ait klinik, laboratuvar, görüntüleme ve elektroensefalogram (EEG)/amplitüd entegre elektroensefalogram (aEEG) bulguları retrospektif olarak incelenmiş; takiben çocuk nöroloji polikliniğinde güncel nörolojik muayeneleri, epileptik nöbet öyküleri ve gelişim basamakları değerlendirilmiştir. Nörogelişimsel değerlendirme, Denver II Gelişim Tarama Envanteri ile analiz edilmiştir. Bulgular: Çocuk nöroloji polikliniğinde değerlendirilen hastaların yaş ortalaması 79,52 ± 30,28 ay olarak saptandı. Hipotermi tedavisi almayanlarda mikrosefali, Babinski refleksi pozitifliği, hipertoni, hiperaktif DTR, kuadripleji (p<0,001), distoni (p=0,001), klonus refleksi pozitifliği (p=0,003) gibi nörolojik bulgular belirgin yüksekti. Lojistik regresyon analizine göre, yenidoğan döneminde anormal nörolojik muayene bulgusu olan hastalarda, çocuk nöroloji polikliniğinde anormal nörolojik muayene saptanma riski 22,5 kat daha yüksek olarak belirlendi (OR: 22,512; %95 GA: 2,905–174,451; p=0,003). Ayrıca, hipotermi tedavisi almayan olgularda bu risk 9,05 kat artmıştı (OR: 9,052; %95 GA: 3,029–27,048; p<0,001) Hipotermi tedavisi almayan % 65 hastada epileptik nöbet gelişti. Günde birden çok nöbet geçiren hastaların %83,3'ü hipotermi tedavisi almamıştı. Yenidoğan döneminden itibaren epileptik nöbeti devam eden hastaların %57,2'si hipotermi tedavisi almamıştı (p<0,001). Hipotermi tedavisi alan hastalarda epileptik nöbet prevalansı anlamlı derecede düşük saptandı (p<0,001). Günde birden çok epileptik nöbet geçiren hastaların büyük çoğunluğunun hipotermi tedavisi almadığı belirlendi (p<0,001). Yenidoğan döneminde nöbet gözlemlenen ve takip sürecinde nöbeti tekrarlamayan 21 hastanın %95,2'sinin hipotermi tedavisi aldığı saptandı. Lojistik regresyon analizine göre, hipotermi tedavisi almayan olgularda çocuk nöroloji polikliniğinde epileptik nöbet görülme riski 15,61 kat daha yüksekti (OR: 15,619; %95 GA: 4,903–49,759; p<0,001). Yenidoğan döneminde anormal nörolojik muayene bulgusu olan hastalarda ise bu risk 8,88 kat artmıştı (OR: 8,880; %95 GA: 1,952–40,408; p=0,005). Ayrıca hipotermi tedavisi almayan hastalarda baş tutma, desteksiz oturma, yürüme gibi kaba motor gelişiminde (p<0,001), tek kelime söyleme (p<0,001) ve iki kelimeli cümle kurma (p<0,001) gibi erken gelişim basamaklarında anlamlı gecikmeler saptandı. Denver II gelişim testinde hipotermi tedavisi almayanların %63,2'si kişisel-sosyal alanda, %63,2'si kaba motor alanda ileri düzeyde gecikme göstermekteydi (p<0,001). Sonuç: Elde edilen bulgular, HİE tanısı alan hastalarda hipotermi tedavisinin, epileptik nöbet gelişimini azaltmada ve nörogelişimsel sonuçları iyileştirmede anlamlı rol oynadığını göstermektedir. Hipotermi tedavisi almayan hastalarda epilepsi sıklığı daha yüksek, nöromotor gelişim parametrelerinde ise ciddi gecikmeler saptanmıştır. Bu bağlamda, uygun kriterleri karşılayan tüm HİE olgularında erken dönemde hipotermi tedavisinin başlanması nörolojik prognozu anlamlı ölçüde iyileştirebilir ve epilepsi riskini azaltabilir. Anahtar Kelimeler: Hipoksik iskemik ensefalopati, Hipotermi tedavisi, Epilepsi, Nörogelişim, Yenidoğan, Denver II testi.
Objective: The aim of this study was to evaluate the predictive effect of therapeutic hypothermia on long–term epileptic seizure development and neuromotor outcomes in newborns diagnosed with hypoxic–ischemic encephalopathy (HIE). Materials and Methods: This ambidirectional observational study included 110 patients diagnosed with stage II–III HIE, admitted to the Neonatal Intensive Care Unit of Inönü University Turgut Özal Medical Center between 2013 and 2023, who received or not receive therapeutic hypothermia. Clinical, laboratory, imaging, and electroencephalogram (EEG)/amplitude–integrated electroencephalogram (aEEG) findings from the neonatal period were reviewed retrospectively. Subsequently, patients were re–evaluated at the pediatric neurology outpatient clinic, where neurological examinations, seizure history, and developmental milestones were assessed. Neurodevelopmental status was measured using the Denver II Developmental Screening Test. Results: The average age of patients assessed in the pediatric neurology clinic was 79.52 ± 30.28 months. Neurological findings such as microcephaly, positive Babinski sign, hypertonia, hyperactive deep tendon reflexes (DTR), quadriplegia (p<0,001), dystonia (p=0,001), and positive clonus reflex (p=0,003) were significantly more common in patients who did not receive hypothermia treatment. According to the logistic regression analysis, patients with abnormal neurological examination findings during the neonatal period had a 22.5-fold higher risk of having abnormal neurological examination findings in the pediatric neurology outpatient clinic (OR: 22.512; 95% CI: 2.905–174.451; p=0.003). Additionally, this risk increased 9.05-fold in patients who did not receive hypothermia treatment (OR: 9.052; 95% CI: 3.029–27.048; p<0.001). Epileptic seizures developed in 65% of the patients who did not receive hypothermia treatment. 83,3% Of the patients who experienced multiple seizures per day did not receive therapeutic hypothermia. Of the patients whose epileptic seizures persisted since the neonatal period, 57.2% had not received hypothermia treatment (p<0,001). The prevalence of epileptic seizures was found to be significantly lower in patients who received hypothermia treatment (p<0,001). The majority of patients who experienced more than one epileptic seizure per day were found not to have received hypothermia treatment (p<0,001). Among 21 patients who had seizures during the neonatal period but did not experience recurrence during follow–up, 95.2% had received hypothermia treatment. According to the logistic regression analysis, the risk of epileptic seizures observed in the pediatric neurology outpatient clinic was 15.61 times higher in patients who did not receive hypothermia treatment (OR: 15.619; 95% CI: 4.903–49.759; p<0.001). In patients with abnormal neurological examination findings during the neonatal period, this risk increased 8.88 times (OR: 8.880; 95% CI: 1.952–40.408; p=0.005). Furthermore, significant developmental delays were noted in early milestones, including head control (p<0,001), unsupported sitting (p<0,001), ambulation (p<0,001), first words (p<0,001), and two–word sentence formation (p<0,001). According to the Denver II test, 63.2% of patients who did not receive hypothermia therapy exhibited severe developmental delays in both personal-social and gross motor domains (p<0,001). Conclusion: The findings suggest that therapeutic hypothermia affects a significant role in reducing epileptic seizure development and improving long–term neurodevelopmental outcomes in patients with HIE. Those who did not receive hypothermia treatment exhibited a higher incidence of epilepsy and substantial delays in neuromotor development. Thus, initiating hypothermia therapy promptly in eligible HIE cases may substantially improve neurological prognosis and decreasing the risk of epilepsy. Keywords: Hypoxic-ischemic encephalopathy, Therapeutic hypothermia, Epilepsy, Neurodevelopment, Newborn, Denver II test.
Objective: The aim of this study was to evaluate the predictive effect of therapeutic hypothermia on long–term epileptic seizure development and neuromotor outcomes in newborns diagnosed with hypoxic–ischemic encephalopathy (HIE). Materials and Methods: This ambidirectional observational study included 110 patients diagnosed with stage II–III HIE, admitted to the Neonatal Intensive Care Unit of Inönü University Turgut Özal Medical Center between 2013 and 2023, who received or not receive therapeutic hypothermia. Clinical, laboratory, imaging, and electroencephalogram (EEG)/amplitude–integrated electroencephalogram (aEEG) findings from the neonatal period were reviewed retrospectively. Subsequently, patients were re–evaluated at the pediatric neurology outpatient clinic, where neurological examinations, seizure history, and developmental milestones were assessed. Neurodevelopmental status was measured using the Denver II Developmental Screening Test. Results: The average age of patients assessed in the pediatric neurology clinic was 79.52 ± 30.28 months. Neurological findings such as microcephaly, positive Babinski sign, hypertonia, hyperactive deep tendon reflexes (DTR), quadriplegia (p<0,001), dystonia (p=0,001), and positive clonus reflex (p=0,003) were significantly more common in patients who did not receive hypothermia treatment. According to the logistic regression analysis, patients with abnormal neurological examination findings during the neonatal period had a 22.5-fold higher risk of having abnormal neurological examination findings in the pediatric neurology outpatient clinic (OR: 22.512; 95% CI: 2.905–174.451; p=0.003). Additionally, this risk increased 9.05-fold in patients who did not receive hypothermia treatment (OR: 9.052; 95% CI: 3.029–27.048; p<0.001). Epileptic seizures developed in 65% of the patients who did not receive hypothermia treatment. 83,3% Of the patients who experienced multiple seizures per day did not receive therapeutic hypothermia. Of the patients whose epileptic seizures persisted since the neonatal period, 57.2% had not received hypothermia treatment (p<0,001). The prevalence of epileptic seizures was found to be significantly lower in patients who received hypothermia treatment (p<0,001). The majority of patients who experienced more than one epileptic seizure per day were found not to have received hypothermia treatment (p<0,001). Among 21 patients who had seizures during the neonatal period but did not experience recurrence during follow–up, 95.2% had received hypothermia treatment. According to the logistic regression analysis, the risk of epileptic seizures observed in the pediatric neurology outpatient clinic was 15.61 times higher in patients who did not receive hypothermia treatment (OR: 15.619; 95% CI: 4.903–49.759; p<0.001). In patients with abnormal neurological examination findings during the neonatal period, this risk increased 8.88 times (OR: 8.880; 95% CI: 1.952–40.408; p=0.005). Furthermore, significant developmental delays were noted in early milestones, including head control (p<0,001), unsupported sitting (p<0,001), ambulation (p<0,001), first words (p<0,001), and two–word sentence formation (p<0,001). According to the Denver II test, 63.2% of patients who did not receive hypothermia therapy exhibited severe developmental delays in both personal-social and gross motor domains (p<0,001). Conclusion: The findings suggest that therapeutic hypothermia affects a significant role in reducing epileptic seizure development and improving long–term neurodevelopmental outcomes in patients with HIE. Those who did not receive hypothermia treatment exhibited a higher incidence of epilepsy and substantial delays in neuromotor development. Thus, initiating hypothermia therapy promptly in eligible HIE cases may substantially improve neurological prognosis and decreasing the risk of epilepsy. Keywords: Hypoxic-ischemic encephalopathy, Therapeutic hypothermia, Epilepsy, Neurodevelopment, Newborn, Denver II test.
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
