Neurological follow-up in a lot of newborns with intrauterine growth restriction

Spitalul Clinic de Obstetrică şi Ginecologie „Cuza Vodă”, Iaşi, Divizia de Neonatologie, Departamentul Mama şi Copilul, Universitatea de Medicină şi Farmacie Grigore T.Popa, IaşiIntroducere. Restricţia de creştere intrauterină (IUGR) reprezintă un factor de risc cunoscut pentru morbiditatea perinatală precoce şi tardivă. Scop. Evaluarea patologiei din maternitate şi a riscului de a dezvolta sechele neurologice la un lot de nou-născuţi cu IUGR. Material şi metodă. Studiu prospectiv longitudinal efectuat pe o perioadă de trei ani, asupra unei cohorte de copii IUGR afl aţi în programul de urmărire al nou-născutului cu risc. Parametrii cuantifi caţi: mediul de provenienţă, vârsta de gestaţie (VG), greutatea la naştere (GN), indice ponderal, patologie prezentată în maternitate, rezultatele examenului Amiel-Tison la externarea din maternitate şi riscul fi nal în funcţie de scala BSID II (Bayley Scale of Infant Development). Datele au fost prelucrate SPSS versiunea 20.0. Rezultate. Au întrunit criteriile de includere în studiu 145 nou-născuţi cu VG medie de 35,5 săptămâni (s) cu limite între 28 s şi 42 s, toţi cu GN sub percentila 10. Afecţiuni diagnosticate pe parcursul spitalizării: asfixie perinatală 8,3%, sindrom de detresă respiratorie (SDR) 66,2%, dintre care 17,2% au necesitat ventilaţie mecanică invazivă, apnee 34,5%, hemoragie intraventriculară (IVH) 10,3%, leucomalacie periventriculară (LPV) 2,8%, enterocolită ulcero-necrotică (EUN) 31% (26,7% std I, 73,3% std II), hipoglicemie 27,6%.72,2% dintre nou-născuţii cu hipoglicemie au avut IP < 1,5, (p=0,001), retinopatie de prematuritate (ROP) 4,8%. 11,3% au necesitat peste 60 zile de spitalizare. În lotul studiat nu s-a înregistrat nici un deces pe parcursul spitalizării. La externare, conform evaluării Amiel-Tison, 93% au fost încadraţi în grupul de risc mediu. 49,7% nu au mai venit la control, iar dintre aceştia 60,3% au fost din mediu rural (p=0,037). La finalul evaluărilor, respectiv 2 ani, 69% au fost încadraţi în grupul de risc uşor, 27,6% risc mediu şi 3,4% risc sever. Cel mai ridicat procent (95,9%) au avut la final deficienţe pe sfera motorie, 4,8% pe cea cognitivă şi 4,1% cognitivo-motorie. 10,3% dintre nou-născuţii cu IUGR au fost încadraţi în diferite sindroame genetice asociind risc final sever în procent de 80% (p=0,001). Greutatea sub percentila 10 s-a menţinut la vârsta de un an la 59% dintre copii şi sub 5 la 38% la 2 ani, ambele asociate cu mediul rural de provenienţă (p=0,044) şi cu deficienţe pe sfera motorie (p=0,05). Concluzii. Vârsta de gestaţie mică îşi pune amprenta asupra patologiei şi în cazul nou-născuţilor cu IUGR, respectiv procent mare (66,2%) de copii cu SDR. Subiecţii diagnosticaţi cu IVH, LPV şi ROP au avut VG sub 30 s (p=0,05). EUN a fost diagnosticată la peste 25% (31%) dintre copiii cu IUGR, aspect semnalat şi în literatura de specialitate. Efectuarea evaluărilor regulate asociază risc uşor (69%) indiferent de patologie şi mediul de provenienţă (p=0,894).Greutatea la naştere sub percentila 10, ca factor de risc independent nu afectează gradul de risc neurologic (p=0,001).Introduction. Intrauterine growth restriction (IUGR) is known to be a risk factor for perinatal early and late morbidity. Objective. The aim of this paper was to study the impact of IUGR on clinical evolution and neurological outcome in a lot of selected newborns. Methods. Longitudinal prospective study over a 3 years period of time in a lot of IUGR newborns, included in a follow-up program. We quantify the environment of origin, gestational age (GA), ponderal index, pathology during hospitalization, the result of neurological evaluation according to Amiel-Tison at discharge and at two years of age, according to BSID II (Bayley Scale of Infant Development). The data were analyzed using SPSS Statistics version 20.0. Results. 145 newborns meet the criteria for inclusion in this study, with GA between 28 weeks of gestation (wk)-2,8% and 42 wk-0,7%, all with a birth weight below the 10th percentile for GA. Pathology during hospitalization: respiratory distress syndrome (RDS) -66,2%, 17,2 % among them necessitated invasive ventilation, apnea 34,5%, intraventricular hemorrhage (IVH) 10,3%, periventricular leukomalacia (LPV)- 2,8%, necrotizing enterocolitis (NEC)- 31% (26,7% stage I and 73,3% stage II), hypoglycemia 26,7% (72,2% among them had ponderal index < 1,5- p=0,001), retinopathy of prematurity (ROP)- 4,8%. 11,3 % were admitted over 60 days period of time and no deaths were recorded in the studied lot. At discharge 93% according to Amiel-Tison's evaluation were categorized in the medium-risk group. After discharge, 49,7% didn’t come for evaluation and among them 60,3% were from countryside (p=0,037). At the end of the follow-up program, 2 years of life, 69% were included in the low-risk category, 27,6% medium risk, and 3,4% high risk. Deficiencies in the motor area were recorded in the highest percentage - 95,9%, 4,8% had low scores on the cognitive areas and 4,1% both, cognitive and motor. 10,3% of subjects were diagnosed with genetic syndromes and associated severe risk at final evaluation (p=0,001) Weight under ten percentile were recorded at one year in 59% of patients and under 5 in 38% of patients, both associated with deficiencies in the motor area (p=0,005) and rural provenience (p=0,044). Conclusions. Gestational age remains the main factor that influences pathology also in IUGR newborns - 66.2% presented RDS. We found a correlation between GA under 30 wk and IVH, PVL, and ROP (p=0.005). Similar literature data, NEC were found in more than 25%, respectively in 31% cases. Regular evaluations associate low risk - 69% - no matter of pathology and environment of origin. (p=0.894). Birthweight <10th percentile alone does not appear to be an independent risk factor of neurodevelopmental adverse outcomes

USE OF HIGH SURFACE NANOFIBROUS MATERIALS IN MEDICINE

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