Prematüre Bebeklerde İntrakranial Kanamanın Etiyolojisi ve Prognozu

Abstract

Despite advances in obstetric care, the prematurity rate is increasing all over the world with the use of assisted reproductive techniques. Survival rates of these premature infants have also increased because of advances in neonatal and perinatal care. This increase in survival rates has caused short and long-term morbidity due to prematurity. The specific problems and complications seen in early prematurity, determine the long-term neurodevelopmental outcome. One of the most important determinants of neurodevelopmental outcome is intraventricular hemorrhage (IVH). IVH is the form of intracranial hemorrhage specific to prematurity. The incidence is inversely related to gestational age and birth weight and the etiology is multifactorial. In this study, risk factors that could cause IVH and severe IVH were investigated in premature infants. This study was carried out retrospectively between 2003 and 2012 in Neonatal Intensive Care Unit (NICU) of Hacettepe University, Ihsan Doğramacı Children's Hospital. The study group consisted of 40 patients whose gestational ages below 37 weeks and were diagnosed as IVH. The control group were chosen from patients without IVH who hospitalized in same dates, and similar to study group according to birth weight and gestational age. Long-term mechanic ventilation, hypoxemia, hypercapnia, repeated hypercapnia attacks, hypotension, recurrent surfactant requirement, red blood cell transfusion, bicarbonate treatment, use of volume expanders and born following assisted reproductive technology treatment were identified as risk factors for IVH. Mortality rates in IVH group and severe IVH group (grade III-IV hemorrhage) were significantly higher than the control group. Periventricular leukomalacia had developed in 4 patients and hydrocephalus had developed in 10 patients in IVH group. IVH is a complication of prematurity that increases long-term morbidity and mortality. Use of blood transfusions, volume expanders and bicarbonate therapy which are identified as risk factors in this study should be minimized in neonatal intensive care. Since most important risk factor is prematurity, prevention of preterm birth should be main objective of medical care.