Određivanje prediktora lošeg ishoda i terapijskih postupaka kod preterminske novorođenčadi sa intraventrikularnom hemoragijom
Determination of poor outcome and therapeutic procedures in preterm newborns with intraventricular hemorrhage
Author
Stević, Marija M.Mentor
Tasić, GoranCommittee members
Simić, Dušica
Milaković, Branko
Pavlović, Dragan M.
Budić, Ivana
Metadata
Show full item recordAbstract
Kod preterminske novorođenčadi, mnogi faktori povećavaju rizik od slabog
neuronskog razvoja, intaraventrikularnih krvarenja, infekcije i dovode do veće stope
mortaliteta. Primarni cilj ovog istraživanja, bila je evaluacija faktora rizika koji su
povezani sa lošim ishodom kod preterminske novorođenčadi koji su imali
posthemoragični hidrocefalus (PHH) i koji su bili podvrgnuti neurohirurškoj intervenciji.
Sekundarni cilj je bio da se identifikuju prediktori za nastanak kasne neonatalne sepse.
Metodologija. Retrospektivno su analizirana preterminska novorođenčad koji su
podvrgnuti inserciji VP šanta ili Ommaya rezervoara, tokom desetogodišnjeg perioda u
Univerzitetskoj dečjoj klinici. Prema prisustvu ili odsustvu kasne neonatalne sepse,
pacijenti su podeljeni na grupu sa kasnom neonatalnom sepsom (KNS) i u grupu bez
sepse ne-KNS.
Rezultati. U studiju je uključeno ukupno 74 pacijenta, u KNS grupi (35 slučajeva, 47.3%)
i ne-KNS grupi (39 slučajeva, 52.7%). Koristeći multivarijantnu logistič...ku regresiju,
identifikovali smo da je ductus atreriosus persistens (OR 1.12, 95% CI 1.13-1.42, p <
0.000), bronhopulmonalna displazija (OR 1.29, 95% CI 1.10-1.53, p = 0.003), i
pneumotoraks (OR 1.37, 95% CI 1.17-1.61, p < 0.001) nezavisni faktori rizika za letalan
ishod, a da su srednja vrednost laktata>2 (OR 1.12, 95% CI 1.04-1.21, p=0.002),
reanimacija posle rođenja (OR 1.62, 95% CI 1.36-1.92, p=0.000) i pol (OR 1.24, 95% Cl
1.04-1.47, p=0.015) nezavisni faktori rizika za razvoj KNS-a.
Zaključak. Neurohirurški zahvati su relativno bezbedni kod novorođenčadi sa PHH bez
KNS-a nakon rođenja. Međutim, ako je prisutna KNS, duktus arteriosus persistens,
bronhoplumonalna displazija i pneumotoraks značajno povećavaju rizik za letalni ishod
posle operacije. Srednja vrednost laktata>2, reanimacija posle rođenja i pol su nezavisni
faktori rizika za razvoj KNS-a kod preterminske novorođenčadi.
Preterm newborns, due to many factors are at increased risk for poor neural
development, intraventricular hemorrhages, infections and higher rate of mortality. The
primary outcome of this study was to evaluate the risk factors associated with poor
outcome in preterm neonates with late onset neonatal sepsis (LONS) who had
posthemorrhagic hydrocephalus (PHH) and underwent neurosurgical procedures.
Secondary outcome was to identify predictors for LONS.
Methods. Preterm neonates who had undergone insertion of ventriculoperitoneal (VP)
shunt or Ommaya reservoir, during the 10-year period at University Children’s Hospital,
were retrospectively analyzed. According to the presence or absence of late-onset
neonatal sepsis (LONS), patients were divided into LONS group and non-LONS group.
Results. A total of 74 patients, were included in the study, in LONS group (35 cases,
47.3%) and non-LOS group (39 cases, 52.7%). Using multivariable logistic regression
analysis we identified that the ductus ar...teriosus persistent (OR 1.12, 95% CI 1.13-1.42, p
< 0.000), bronchopulmonary dysplasia (OR 1.29, 95% CI 1.10-1.53, p = 0.003), and
pneumothorax (OR 1.37, 95% CI 1.17-1.61, p < 0.001) were independent preoperative
risk factors for lethal outcome, and the mean value of lactate >2 (OR 1.12, 95% CI 1.04-
1.21, p=0.002), resuscitation after birth (OR 1.62, 95% CI 1.36-1.92, p=0.000) and gender
(OR 1.24, 95% Cl 1.04-1.47, p=0.015) are the independent risk factors for the
development of LONS.
Conclusion. Neurosurgical procedures are relatively safe in neonates with PHH without
LONS after birth. However, if LONS is present, ductus arteriosus persistent,
bronchopulmonary dysplasia, and pneumothorax markedly increase the risk for a lethal
outcome after the operation. The mean value of lactate>2, resuscitation after birth and
gender are independent risk factors for the development of LONS in preterm infants.