Problemi hirurškog lečenja hidrocefalusa kod prevremeno rođene dece
Problems of surgical treatment of hydrocephalus in preterm infants
Author
Mihajlović, Miljan H.Mentor
Nestorović, BranislavCommittee members
Antunović, VasoPavlović, Dragan
Tasić, Goran
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Show full item recordAbstract
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 rezerv...oara 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), l...ow 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.