Rani neurološki ishod novorođenčadi s intrauterinim zastojem u rastu

Starčević, Mirta (2012) Rani neurološki ishod novorođenčadi s intrauterinim zastojem u rastu. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objective: intrauterine growth restriction (IUGR) is considered as a risk factor for neurodevelopmental disorders and unfavorable long-term outcome. Aim of the study: to evaluate predictive validity of Doppler arterial indices and umbilical cord acid-base status for early neurological outcome of the newborns with IUGR and to establish reference values of Doppler parameters in the prediction of adverse neurological outcome. Methods: a prospective study included 60 IUGR neonates born between 37th and 40 th week of gestation. Umbilical artery resistance index (URI), middle cerebral artery resistance index (CRI), and cerebro-umbilical (C/U) ratio were followed during the pregnancy. Umbilical cord samples (arterial and venous) were collected at birth for analysis (pH, pO2, pCO2 ). Neurological outcome was evaluated during the first week of life according to brain ultrasound findings and Amiel-Tison neurological assessment at term (ATNAT). Results: brain ultrasound lesions were found in 32 (53,37%) of the newborns, while 42 (70%) had non-optimal neurological status according to ATNAT. Generally, Doppler indices had higher predictive validity for the early neurological outcome than umbilical cord acid-base status. According to P value of the statistical analysis, the differences between the normal and pathological results were more emphasized in ATNAT than brain ultrasound findings. C/U ratio had the highest predictive validity for early neurological disturbances, with the relative risk for adverse neurological outcome at reference validity of 1,13. Conclusions: Doppler indices are highly predictive in the risk assessment for adverse neurological outcome among IUGR infants. C/U ratio was the best predictor of neurological outcome. However, the non-optimal neurological outcome at everage values of C/U ratios more than 1 confirmed that IUGR is connected with the possibility of neurological seqelae even without fetal hemodinamics compromise. Sensitivity and specificity of the ATNAT showed superiority in detecting early neurological disturbances compared to brain ultrasound, so it has to be the basic method for the neurological evaluation of the IUGR newborns, as well as the method of screening those in need for long-term follow up.

Abstract in Croatian

Uvod: intrauterini zastoj u rastu (IUGR) se smatra osobitim čimbenikom rizika za pojavu neurorazvojnih odstupanja i nepovoljan dugoročni neurorazvojni ishod. Ciljevi istraživanja: utvrditi prediktivnu vrijednost doplerskih parametara fetalne cirkulacije, te parametara acido-baznog statusa iz krvi pupkovine za rani neurološki ishod novorođenčadi s IUGR-om. Odrediti optimalne granične vrijednosti praćenih parametara fetalne cirkulacije koji ukazuju na rizik neuroloških posljedica. Ispitanici i postupci: prospektivnim istraživanjem obuhvaćeno je 60 djece sa zastojem u rastu rođenih između navršenih 37 i 40 tjedana trudnoće. Praćeni doplerski parametri su bili: indeks otpora pupčane arterije (URI), indeks otpora srednje moždane arterije (CRI) i cerebo-umbilikalni (C/U) omjer. Na porođaju su uzeti uzorci krvi iz arterije i vene pupkovine, te su određeni pH, pO2 i pCO2. Neurološki ishod je utvrđen tijekom prvog tjedna po rođenju prema nalazu ultrazvuka mozga odnosno kliničkoj neurološkoj procjeni po Amiel-Tison (ATNAT). Rezultati: neurološko oštećenje po ultrazvučnom nalazu nađeno je u 32 djeteta (53,37%), dok su neurološka odstupanja po ATNAT-u imala 42 djeteta (70%). Doplerski indeksi su općenito imali veću prediktivnu vrijednost za rani neurološki ishod od parametara acidobaznog statusa iz pupkovine. Pri tome je razlika između urednih i patoloških nalaza po kriteriju P vrijednosti statističkih testova naglašenija kod ATNAT nalaza u odnosu na ultrazvuk. Najviša prediktivna vrijednost je utvrđena za C/U omjer s relativnim rizikom neurološkog oštećenja već kod vrijednosti od 1,13. Zaključci: potvrđen je prognostički značaj praćenja fetalnih doplerskih parametara u procjeni rizika ranih neuroloških odstupanja kod IUGR-a, pri čemu C/U omjer ima prednost pred pojedinačnim parametrima. Pojava neuroloških odstupanja pri prosječnim vrijednostima C/U omjera >1 potvrđuje da kod IUGR-a postoji rizik ranih neuroloških posljedica i uz održane hemodinamske kompenzacijske mehanizme. Senzitivnost i specifičnost ATNAT-a pokazala se superiornom ultrazvučnom pregledu u otkrivanju neuroloških odstupanja, te zato treba biti osnovna metoda procjene ranog neurološkog ishoda i probira djece s potrebom dugoročnog neurorazvojnog praćenja.

Item Type: Thesis (PhD)
Mentors:
Mentor
Salihagić-Kadić, Aida
Departments: Izvan medicinskog fakulteta
Depositing User: dr.med. Helena Markulin
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 103
Status: Unpublished
Creators:
CreatorsEmail
Starčević, MirtaUNSPECIFIED
Date: 10 October 2012
Date Deposited: 28 May 2014 09:46
Last Modified: 28 May 2014 09:46
Subjects: WQ Obstetrics > WQ 200-212 Pregnancy
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/2122

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