Problemi hirurškog lečenja hidrocefalusa kod prevremeno rođene dece

Abstract

Uvod. Cilj ovog istraživanja je da se identifikuje najsvrsishodniji način hirurškog lečenja hidrocefalusa kod prevremeno rođene dece koji je uzrokovan spontanom intraventrikularnom hemoragijom i identifikuju prediktorni faktori lošeg perioperativnog ishoda. Metodologija. Prikazujemo seriju od 60 pacijenata sa spontanom intraventrikularnom hemoragijom (IVH) i hidrocefalusom, kojima je plasiran ventrikuloperitonealni (VP) šant ili subkutani (Omaya) rezervoar, u Univerzitetskoj Dečijoj klinici u Beogradu u periodu od marta 2006 godine do marta 2011 godine . Rezultati. Prediktori lošeg ishoda lečenja pri plasiranju VP šanta su : gestacijska starost (t=2,323; p=0,024), obim glave na rođenju(t=2,072; p=0,043), porođajna telesna masa (t=2,832; p=0,006), APGAR skor na rođenju(t=5,026; p<0,01), broj dana na asistiranoj ventilaciji (Z=6,203; p<0,001), peripartalna asfiksija (χ2=17,376; p<0,01), respiratorni distres (χ2 =9,176; p=0,002). Prediktori lošeg ishoda lečenja pri plasiranju Omaya rezervoara su: niska porođajna telesna masa (t=2,560; p=0,016), nizak apgar skor (t=3,059; p =0,005), produžen broj dana na asistiranoj ventilaciji (Z=4,404; p<0,001), prisustvo peripartalne asfiksije (χ2=9,977; p=0,002) i kardio-respiratorni arest (χ2=12,804; p<0,001). Zaključak. Ishod lečenja hidrocefalusa uzrokovanog spontanom intraventrikularnom hemoragijom kod prevremeno rođene dece je najlošiji u perinatologiji. Nema konsenzusa u dijagnostici i lečenju postehmoragičkog hidrocefalusa, naši rezultati ukazuju da je glavni prediktorni faktor preoperativno stanje deteta i da su VP šant i Omaya razervoar komplementarne metode hirurškog lečenja.

Object. The aim of this study was to identify the most appropriate method of surgical treatment of hydrocephalus in preterm infants that is caused by spontaneous intraventricular hemorrhage, and to identify predictive factors of poor perioperative outcomes. Methods. We present a series of 60 patients with spontaneous intraventricular hemorrhage (IVH) and hydrocephalus, to whom a VP shunt was placed, or subcutaneous (Omaya) reservoir, at the University Children's Hospital in Belgrade during the period from March 2006 to March 2011. Results. Predictors of poor outcome with VP shunt placement were: gestational age (t=2.323, p=0.024), head circumference at birth (t=2.072, p=0.043), birth weight (t=2.832, p=0.006), APGAR score at birth (t=5.026, p<0.01), number of days on assisted ventilation (Z=6.203, p <0.001), peripartal asphyxia (χ2 =17.376, p<0.01), respiratory distress (χ2=9.176 p=0.002). Predictors of poor outcome in getting Omaya reservoir are: low birth weight (t=2.560, p=0.016), low Apgar scores (t=3.059, p=0.005), an extended number of days on assisted ventilation (Z=4.404, p<0.001), presence of peripartal asphyxia (χ2=9.977, p=0.002) and cardio-respiratory arrest (χ2=12.804, p<0.001). Conclusions. The outcome of treatment of hydrocephalus caused by spontaneous intraventricular hemorrhage in premature born children is the worst in perinatology. There is no consensus in the diagnosis and treatment of posthemorrhagic hydrocephalus, our results suggest that the main predictive factor is preoperative condition of the child and that the VP shunt and Omaya reservoir are complementary methods of surgical treatment.