3 research outputs found
EXTREME CEREBRAL MALFORMATION – CLINICAL AND ETHICAL ISSUES BASED ON A CASE
Hydranencephaly represents one of the most rare cerebral malformations, with poor prognosis and negative
impact on both family and society. Usually the patients remain in a permanent vegetative state and require
unlimited medical care. Although the majority of affected babies die in utero or in the fi rst days-months of life
there have been cases in literature with prolonged survival, for 20 (1), 22 (2) and 32 (3) years. Therapeutically, the medical care provided are purely palliative and oriented to supporting vital function.
Conclusions. Hydranencephaly is a rare brain malformation with poor prognosis, life expectancy and quality of life. Diagnosis imposes a number of ethical issues. The importance resides in the fact that prenatal detection represents an indication for therapeutic abortion. Another ethical issue raised is represented by medical care provided, which is exclusively palliative. Both surgical and novel therapeutic methods described by the literature, like endoscopic coagulation of choroid plexes, do not infl uence the neurological status and the neuropsychomotordevelopment (4). All this data should be clearly explained to parents and legal tutors for not raising any false hopes regarding the evolution
HEMORAGIA PERI-INTRAVENTRICULARĂ LA PREMATURI: IMPORTANŢA SCREENINGULUI PRIN ECOGRAFIE TRANSFONTANELARĂ
Obiective. Hemoragiile peri-intraventriculare (HPIV) pot determina la sugarii născuţi prematur diferite grade de
re tard neuropsihomotor. Un studiu prospectiv efectuat în IOMC pe o perioadă de 4 ani (2009-2012), pe un lot
de 160 prematuri, a urmărit prevalenţa gradelor de HPIV diagnosticate prin ecografi e transfontanelară (ETF),
identifi carea factorilor de risc asociaţi şi a severităţii afectării neurologice la aceşti pacienţi prin urmărirea lor pe o perioadă de 12 luni.
Material şi metodă. Pe perioada studiului, prematurii internaţi în IOMC au fost examinaţi sistematic prin ETF,
printr-un protocol standardizat; aprecierea gradelor HPIV s-a efectuat conform clasifi cării Papile. Evaluarea
neurologică a fost efectuată sistematic până la vârsta de 1 an.
Rezultate. Cel mai frecvent înregistrate au fost HPIV I şi II – 45%, respectiv 37,5% din numărul total de pacienţi.
HPIV gradul IV au reprezentat 4,4%. În HPIV grad I şi II afectarea neurologică a fost uşoară, această corelaţie
având semnifi caţie statistică (p < 0,01) pentru ambele forme. Hemoragiile gradul III şi IV au fost asociate cu o
evoluţie neurologică nefavorabilă, corelaţia între HPIV grad IV şi sechelele neurologice majore având
semnifi caţie statistică (p < 0,01).
Concluzii. ETF efectuată de rutină tuturor prematurilor permite diagnosticul precoce şi stadializarea HPIV,
aprecierea evoluţiei neurologice cu instituirea precoce a tratamentului şi asigurarea consilierii adecvate
PERI-INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS: THE IMPORTANCE OF SCREENING BY TRANSFONTANELLAR ULTRASOUND
Objectives. In preterm babies, peri-intraventricular hemorrahges (PIVH) might cause various degrees of neuropsycho-motor impairment. A 4-year prospective study (2009-2012) performed in the IOMC, was aimed to
determine the prevalence of different degrees of PIVH diagnosed by head ultrasound (HUS) among 160 admitted preterm babies, the associated risk factors, along with the neuro-developmental effects on a 12-month follow-up period.
Material and methods. In the above-mentioned period all admitted preterms were examined by transfontanelar ultrasound according to a standardized protocol based on Papile’s PIVH classifi cation. For those preterms
included in the study a 12-month systematic neurologic follow-up was performed.
Results. PIVH grade I (45%) and II (37,5%) were the most prevalent types. Grade IV PIVH represented 4,4%
from all PIVH cases. The good neurological outcome of grade I and II PIVH, was found to be statistically signifi cant (p < 0.01) for both types. Severe neurological sequelae were associated with grade III and IV and a
statistically signifi cant correlation (p<0.01) was found only for grade IV hemorrhages.
Conclusion. Systematic HUS screenings for all preterm babies is useful for early diagnosis and PIVH staging,
for neurologic outcome prediction, providing the appropriate management strategy and a well-suited parental counseling