Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
An Overview of Intracranial Hemorrhages in Premature Infants, Risk Factors in Low-Grade Hemorrhages, and an Evaluation of Neurodevelopment with the Bayley III Development Scale: Case-Control Study
Prematürelerde İntrakraniyal Kanamalara Bakış, Düşük Evreli Kanamalarda Etken Risk Faktörleri ve Nörogelişimin Bayley III Gelişim Ölçeği ile Değerlendirilmesi: Olgu-Kontrol Araştırması
Filiz BOLUa, Esin YILDIZ ALDEMİRb, Sultan KAVUNCOĞLUc
aBolu Provincial Health Directorate, Bolu, Türkiye
bClinic of Child Health and Diseases, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
cClinic of Neonatology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Pediatr. 2022;31(3):170-8
doi: 10.5336/pediatr.2022-88999
Article Language: EN
Full Text
ABSTRACT
 Objective: Intracranial hemorrhage is a major morbidity in premature infants. We aimed to evaluate the cases with intracranial hemorrhage and to investigate the neurodevelopmental prognosis of prematures with low grade (Grade I-II) hemorrhage and the risk factors affecting it. Material and Methods: Fiftynine of the 80 cases with intracranial bleeding followed-up in the neonatal intensive care unit were evaluated as Grade I-II and 21 as Grade III-IV-periventricular leukomalacia (PVL). Perinatal neonatal problems were investigated in cases with chronological ages of 24-42 months. The effects of risk factors for both Grade III and Grade III-IV-PVL were examined at logistic regression analysis. Cognition, language, and motor domain characteristics were determined with the Bayley III Scale. The relationship with risk and retardation was also examined. Results: Grade I-II and advanced grade hemorrhage cases were similar in terms of mean gestational week, birth weight or chronological age. Logistic regression analysis showed that the risk of hemorrhage increased with intrauterine growth retardation, sepsis and low Apgar scores. Factors affecting Bayley III scores in cases with Grade I-II were low birth weight and gestational week, intrauterine growth retardation, respiratory distress syndrome, ventilator support requirement, sepsis, seizure, and transport exposure. The motor domain in particular was affected as birth weight and gestational week decreased. Intrauterine growth retardation affected the cognition domain, respiratory problems, seizure, and transport history affected all domains, and sepsis affected the cognition and language domains. The prevalence of cerebral palsy and hydrocephaly was 5%, and that of blindness 1.6%. The advanced grade intracranial hemorrhage group scores were very low in all domains. Cerebral palsy was present at a rate of 33%, hydrocephaly at 23.8%, and blindness at 14.2%. Conclusion: Intracranial hemorrhage is an important morbidity of the immature brain in premature infants. Neurodevelopment is adversely affected in both low and advanced grade hemorrhage.

Keywords: Intracranial hemorrhage; neurodevelopmental prognosis; premature
ÖZET
 Amaç: Preterm bebeklerde intrakraniyal kanama önemli bir sorun olmaya devam etmektedir. Bu çalışmada, intrakraniyal kanama saptanan olguları değerlendirmek ve düşük evre (Evre I-II) kanamalı prematürelerin nörogelişimsel prognozunu ve etkileyen risk faktörlerini araştırmak amaçlandı. Gereç ve Yöntemler: Yenidoğan yoğun bakım ünitesinde izlenirken intrakraniyal kanama tanımlanan 80 olgunun 59'u Grade I-II, 21'i Grade III-IV, PVL olarak değerlendirildi. Kronolojik yaşları 24.-42 ay olan olguların perinatal neonatal dönem sorunları irdelendi. Lojistik regresyon analizinde risk etmenlerinin hem evre I-II, hem de evre III-IV-PVL için etkileri irdelendi. Bayley III ölçeği ile bilişsel, dil, motor alanda özellikleri belirlendi. Risk ve gerilik ilişkisi sorgulandı. Bulgular: 80 intrakraniyal kanamalı olgunun 59'u Grade I-II, 21'i ileri evre kanamalı idi. Evre I-II ve ileri evre olguların gebelik haftası, doğum ağırlığı, kronolojik yaş ortalamaları arasında istatistiksel fark yoktu. Lojistik regresyon analizinde kanama riski intrauterin büyüme geriliğinde, sepsis ve düşük Apgar skoru varlığında artmış bulundu. Evre I-II kanamalı olguların Bayley III puanlarını etkileyen risk faktörleri düşük doğum ağırlığı ve gestasyonel hafta, intrauterin büyüme geriliği, respiratuvar distres sendromu, ventilatör desteği ihtiyacı, sepsis, konvülziyon geçirme ve transport idi. Doğum ağırlığı ve gebelik haftası azaldıkça özellikle motor alan etkileniyordu. İntrauterin büyüme geriliği bilişsel alanı, solunum sorunları, konvülziyon ve transport öyküsü tüm alanları, sepsis bilişsel ve dil alanını etkilemişti. Serebral palsi ve hidrosefali 5%, sağırlık ve körlük 1,6% sıklıkta idi. İleri evre grubunun tüm alanlarda skoru çok düşüktü. Serebral palsi 33%, hidrosefali 23,8%, körlük 14,2% sıklıktaydı. Sonuç: İntrakraniyal kanama prematürelerin immatür beyninin önemli bir morbiditesidir. Hem düşük evre, hem de ileri evre kanamada nörogelişim olumsuz etkilenmektedir.

Anahtar Kelimeler: İntrakraniyal kanama; nörogelişimsel prognoz; prematüre
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