Prognostic significance of electroencephalographic findings in children diagnosed with periventricular/intraventricular hemorrhage

[M. D. Radovanović]

86 listova

Uvod: Periventrikularna/intraventrikularna hemoragija (PVH/IVH) ima značajan uticaj na neurološki razvoj dece zbog brojnih komplikacija i sekvela. Cilj rada: Ispitivanje uticaja periventrikularne/intraventrikularne hemoragije različitog stepena na dugoročne neurorazvojne ishode i utvrđivanje prognostičkog značaja neurosonografskih i elektroencefalografskih nalaza. Materijali i metode: Klinička opservaciona analitička, retrospektivna kohortna studija kojom je obuhvaćeno 102-je dece rođene pre termina i u terminu kod koje je neurosonografski dijagnostikovana (PVH/IVH) tokom neonatalnog perioda. Kontrolnu grupu čini 102-je dece koja su imala normalan neurosonografski nalaz. Period praćenja je bio sedam godina. Praćeni su neurosonografski i elektroencefalografski nalazi, kao i neurološki razvoj dece. Rezultati: U prvoj godini života, hipertonus, oštećenje vida, sluha i epilepsija a nakon sedam godina praćenja, psihomotorna retardacija, cerebralna paraliza, kognitivni poremećaji i epilepsija bili su najčešći neurorazvojni ishodi u obe posmatrane grupe ispitanika sa hemoragijom III i IV gradusa. U grupi sa I i II gradusom hemoragije neurorazvojni ishodi su bili značajno ređi. Neurosonografski nalazi su stacionarni nakon 3. meseca od rođenja. Patološka EEG aktivnost ima lošiji prognostički značaj. Zaključak: PVH/IVH gradus III i IV udružena sa periventrikularnom leukomalacijom kod preterminske novorođenčadi ima značajan uticaj na neurorazvojne ishode. Neurosonografski i elektroencefalografski pregledi su značajni za dijagnostiku i praćenje evolucije hemoragije, kao i razvoja komplikacija i sekvela koje bi se sprečile ili bar ublažile pravovremenom ranom primenom mera prevencije i terapije.

Introduction: Periventricular/intraventricular hemorrhage (PVH/IVH) has a significant impact on the neurodevelopment of children due to numerous complications and sequelae. Objectives: Examination of the impact of periventricular/intraventricular hemorrhage of varying degrees on long-term neurodevelopmental outcomes and determination of the prognostic significance of neurosonographic and electroencephalographic findings. Methods: The clinical, observational, retrospective cohort study included 102 preterm and interm neonates diagnosed with PVH/IVH by transfontanellar neurosonography. The control group consisted of 102 neonates, with a regular neurosonographic finding. The follow-up period was seven years. Neurosonographic and electroencephalographic findings, as well as the children's neurological development, were monitored. Results: In the first year of life, hypertonus, impaired vision, hearing and epilepsy, and after seven years of follow-up, psychomotor retardation, cerebral palsy, cognitive disorders and epilepsy were the most common neurodevelopmental outcomes in both observed groups of subjects with grade III and IV hemorrhage. Neurodevelopmental outcomes were significantly less common in the group with grade I and II hemorrhage. Neurosonographic findings are stationary after the 3rd month after birth. Pathological EEG activity has a worse prognostic significance. Conclusion: PVH/IVH grade III and IV associated with periventricular leukomalacia in preterm infants has a significant impact on neurodevelopmental outcomes. Neurosonographic and electroencephalographic examinations are important for the diagnosis and monitoring of the evolution of hemorrhage, as well as the development of complications and sequelae that could be prevented or at least mitigated by timely and early use of preventive measures and therapy.

cerebralna intraventrikularna hemoragija, periventrikularna leukomalacija, neurosonografija, elektroencefalografija, novorođenče, neurološki razvoj

cerebral intraventricular hemorrhage, periventricular leucomalacia, neurosonography, electroencephalography, neonate, neurodevelopment

616.8-005.1-053.31(043.3)

Tekst