Hipoksik iskemik ensefalopatili infantlarda tam kan sayımı parametreleri ve ekokardiyografi bulgularının prognostik değeri
Abstract
Amaç: Bu çalışmanın amacı hipoksik iskemik ensefalopati(HİE) tanılı yenidoğanlarda tam kan sayımı parametrelerinin, pulmoner hipertansiyon (PH) ve kapak yetmezliği varlığının prognostik değerini incelemektir.
Gereç ve Yöntem: Sarnat ölçeğine göre evre 2 ve 3 HİE olan 115 term yenidoğan ile 90 sağlıklı yenidoğan hastanın verileri retrospektif olarak değerlendirilmiştir. İlk 6 saatteki ve hipotermi tedavisi sonrası 72.saatteki ekokardiyografik inceleme, kırmızı kan hücresi dağılım genişliği (RDW), trombosit dağılımı genişliği (PDW) ve CRP değerleri, kontrol grubu ile karşılaştırılmıştır.
Bulgular: Mitral yetmezlik, aortik yetmezlik ile persistan PH ve ölüm arasında anlamlı bir ilişki bulunmuştur. İlk 6 saat ve 72. saatteki ortalama RDW, PDW ve CRP değerleri kontrol sağlıklı gruba göre hastalarda daha yüksek çıkmıştır. Özellikle evre 3 HİE hastalarında daha belirgin olmak üzere, bu parametrelerin 72.saatte ilk 6 saate göre önemli oranda arttığı görülmüştür. RDW, CRP değerlerinde artış ile MY, AY olması ve mortalite arasında anlamlı bir ilişki bulunmuştur.
Sonuç: Çalışmamız PH derecesi ve kapak yetmezliği varlığının, HİE’de prognozu belirlemede önemli parametreler olduğunu göstermektedir. RDW ve CRP gibi basit kan testleri ile ekokardiyografik değerlendirme yapılması yatış zamanı ve mortalite ile ilişkili olup prognozu belirlemede rehber olabilir.
Keywords
Echocardiography Hypoxic-ischemic encephalopathy Pulmonary hypertension Red blood cell distribution width
References
- Referans1. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst. Rev. 2013; (1): CD003311.
- Referans2. Takenouchi T, Iwata O, Nabetani M, Tamura M. Therapeutic hypothermia for neonatal encephalopathy. Brain Dev 2012; 34:165-70.
- Referans3. Shah P, Riphagen S, Beyene J, Perlman M: Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004; 89:152-55.
- Referans4. Nestaas E, Skranes JH, Støylen A, Brunvand L, Fugelseth D. The myocardial function during and after whole-body therapeutic hypothermia for hypoxic–ischemic encephalopathy, a cohort study. Early Human Development 2014; 90:247-52.
- Referans5. Adcock LM, Papile LA: Perinatal asphyxia. In Manual of neonatal care. 6th edition. Edited by Cloherty JP, Eichenwald EC, Stark AR. New Delhi: Wolters Kluwer; 2008:518-23.
- Referans6. Liu F, McCullough LD: Inflammatory responses in hypoxic ischemic encephalopathy. Acta Pharmacol Sin 2013; 34:1121 30.
- Referans7. Bonestroo HJ, Nijboer CH, van Velthoven CT, Kavelaars A, Hack CE, van Bel F, Heijnen CJ. Cerebral and hepatic inflammatory response after neonatal hypoxia ischemia in newborn rats. Dev Neurosci 2013; 35: 197 211.
- Referans8. Zalawadiya S.K, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell distribution width and risk of coronary heart disease events, Am. J. Cardiol 2010; 106:988-93.
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- Referans14. American College of Obstetricians and Gynecologists (ACOG). Neonatal encephalopathy and cerebral palsy: Executive summary. Obstet Gynecol 2004; 103:780-81.
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- Referans18. Aggarwal S, Natarajan G. Biventricular function on early echocardiograms in neonatal hypoxic–ischaemic encephalopathy. Acta Paediatr 2017; 106(7):1085-90.
- Referans19. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr 2011; 158:19-24.
- Referans20. Liu J, Feng ZC. Changes in pulmonary arterial pressure in term-infants with hypoxic–ischemic encephalopathy. Pediatr Int 2009; 51:786-89.
- Referans21. Kanik E, Ozer EA, Bakiler AR, et al. Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: Is it a significant predictor of mortality? J Matern Fetal Neonatal Med 2009; 22: 239-42.
- Referans22. Zhao M, Zhu P, Fujino M, et al. Oxidative Stress in Hypoxic-Ischemic Encephalopathy: Molecular Mechanisms and Therapeutic Strategies Int J Mol Sci 2016; 10:17-29.
- Referans23. Emans M.E, Gaillard CA, Pfister R, et al.Red cell distribution width is associatedwith physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study, Int. J. Cardiol 2013; 168:3550-55.
- Referans24. Isik T, Uyarel H, Tanboga IH, et al. Relation of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23:51-6.
- Referans25. Hofer N, Zacharias E, Muller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012; 102:25-36.
- Referans26. Chakkarapani E, Davis J, Thoresen M. Therapeutic hypothermia delays the C-reactive protein response and suppresses white blood cell and platelet count in infants with neonatal encephalopathy 2014; 99(6):458-63.
- Referans27. Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009; 104:868-72.
- Referans28. Wang W, Liu J, Yang Y, Zhai Z, Wang C, Wang J. Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension. Clin Respir J 2016; 10:54-60.
Prognostic value of whole blood count parameters and echocardiographic findings in infants with hypoxic ischemic encephalopathy
Abstract
Purpose: The aim of this study was to investigate the prognostic value of complete blood count parameters, presence of pulmonary hypertension (PH) and valve failure in newborns with hypoxic ischemic encephalopathy (HIE).
Materials and Methods: 115 term newborns with Sarnat Stage 2 and 3 with HIE and 90 healthy newborns were included in this retrospective study. Echocardiographic examination, red blood cell distribution width (RDW), platelet distribution width (PDW), and C-reactive protein (CRP) values at the first six hours and at 72 hours after the cooling treatment were compared with controls.
Results: There was a relationship between presence of mitral regurgitation (MR), aortic regurgitation (AR), and persistent PH and death. The mean RDW, PDW and CRP levels at the first six and after 72 hours were significantly higher in infants with HIE when compared with the control group, and these parameters were significantly increased in the stage 3 group. A significant relationship was found between the increase in RDW and CRP values and the presence of MR, AR and mortality.
Conclusion: The degree of PH and presence of valvular insufficiency are important parameters in determining prognosis in HIE. Also, simple blood tests such as RDW and CRP and the echocardiographic evaluation are found to be correlated with hospitalization period and mortality and may be a guide in prognosis.
References
- Referans1. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst. Rev. 2013; (1): CD003311.
- Referans2. Takenouchi T, Iwata O, Nabetani M, Tamura M. Therapeutic hypothermia for neonatal encephalopathy. Brain Dev 2012; 34:165-70.
- Referans3. Shah P, Riphagen S, Beyene J, Perlman M: Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004; 89:152-55.
- Referans4. Nestaas E, Skranes JH, Støylen A, Brunvand L, Fugelseth D. The myocardial function during and after whole-body therapeutic hypothermia for hypoxic–ischemic encephalopathy, a cohort study. Early Human Development 2014; 90:247-52.
- Referans5. Adcock LM, Papile LA: Perinatal asphyxia. In Manual of neonatal care. 6th edition. Edited by Cloherty JP, Eichenwald EC, Stark AR. New Delhi: Wolters Kluwer; 2008:518-23.
- Referans6. Liu F, McCullough LD: Inflammatory responses in hypoxic ischemic encephalopathy. Acta Pharmacol Sin 2013; 34:1121 30.
- Referans7. Bonestroo HJ, Nijboer CH, van Velthoven CT, Kavelaars A, Hack CE, van Bel F, Heijnen CJ. Cerebral and hepatic inflammatory response after neonatal hypoxia ischemia in newborn rats. Dev Neurosci 2013; 35: 197 211.
- Referans8. Zalawadiya S.K, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell distribution width and risk of coronary heart disease events, Am. J. Cardiol 2010; 106:988-93.
- Referans9. Endler G, Klimesch A, Sunder-Plassmann H, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol 2002; 117(2):399-404.
- Referans10. Yousuf O, Mohanty BD, Martin SS, et al. High sensitivity C reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol 2013; 62: 397 408.
- Referans11. Shang Y, Mu L, Guo X, et al. Clinical significance of interleukin-6, tumor necrosis factor-αand high-sensitivity C-reactiveprotein in neonates with hypoxic ischemic encephalopathy. Exp Ther Med 2014; 8(4):1259-62.
- Referans12. Aly H, Khashaba MT, El Ayouty M, El Sayed O and Hasanein BM: IL 1beta, IL 6 and TNF alpha and outcomes of neonatal hypoxic ischemic encephalopathy. Brain Dev 2006; 28:178 82.
- Referans13. Windgassen EB, Funtowicz L, Lunsford TN, Harris LA and Mulvagh SL: C reactive protein and high sensitivity C reactive protein: an update for clinicians. Postgrad Med 2011; 123:114 19.
- Referans14. American College of Obstetricians and Gynecologists (ACOG). Neonatal encephalopathy and cerebral palsy: Executive summary. Obstet Gynecol 2004; 103:780-81.
- Referans15. Levene MI, de Vries L. Hypoxic-ischemic encephalopathy. In: Martin RJ, Fanaroff AA, Walsh MC (eds). Neonatal-Perinatal Medicine, 8th edn. Elsevier, Philadelphia 2006; 938-56.
- Referans16. Matter M, Abdel-Hady H, Attia G, Hafez M, Seliem W, AlArman M. Myocardial performance in asphyxiated full-term infants assessed by Doppler tissue imaging. Pediatr Cardiol 2010; 31:634-42.
- Referans17. Van Bel F, Walther FJ. Myocardial dysfunction and cerebral blood flow velocity following birth asphyxia. Acta Pediatr Scand 1990; 79:756-62.
- Referans18. Aggarwal S, Natarajan G. Biventricular function on early echocardiograms in neonatal hypoxic–ischaemic encephalopathy. Acta Paediatr 2017; 106(7):1085-90.
- Referans19. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr 2011; 158:19-24.
- Referans20. Liu J, Feng ZC. Changes in pulmonary arterial pressure in term-infants with hypoxic–ischemic encephalopathy. Pediatr Int 2009; 51:786-89.
- Referans21. Kanik E, Ozer EA, Bakiler AR, et al. Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: Is it a significant predictor of mortality? J Matern Fetal Neonatal Med 2009; 22: 239-42.
- Referans22. Zhao M, Zhu P, Fujino M, et al. Oxidative Stress in Hypoxic-Ischemic Encephalopathy: Molecular Mechanisms and Therapeutic Strategies Int J Mol Sci 2016; 10:17-29.
- Referans23. Emans M.E, Gaillard CA, Pfister R, et al.Red cell distribution width is associatedwith physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study, Int. J. Cardiol 2013; 168:3550-55.
- Referans24. Isik T, Uyarel H, Tanboga IH, et al. Relation of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23:51-6.
- Referans25. Hofer N, Zacharias E, Muller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012; 102:25-36.
- Referans26. Chakkarapani E, Davis J, Thoresen M. Therapeutic hypothermia delays the C-reactive protein response and suppresses white blood cell and platelet count in infants with neonatal encephalopathy 2014; 99(6):458-63.
- Referans27. Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009; 104:868-72.
- Referans28. Wang W, Liu J, Yang Y, Zhai Z, Wang C, Wang J. Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension. Clin Respir J 2016; 10:54-60.
Details
| Primary Language | English |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research |
| Authors | |
| Publication Date | March 31, 2020 |
| Acceptance Date | December 5, 2019 |
| Published in Issue | Year 2020 Volume: 45 Issue: 1 |
