Neurološke komplikacije u djece s perinatalnom hipoksično-ishemijskom encefalopatijom

master's thesis

• Title (english): Neurological complications in children with perinatal hypoxic-ischemic encephalopathy
• Author: Doroteja Meštrić
• Mentor: Nina Barišić (mentor)
• Committee member: Boris Filipović-Grčić (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Nina Barišić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Unatoč napretku opstetričke, prenatalne i neonatalne skrbi, perinatalna asfiksija i danas je jedan od glavnih uzroka novorođenačkog mortaliteta i morbiditeta. Hipoksično–ishemijska encefalopatija posljedica je novorođenačke asfiksije, a može nastati za vrijeme trudnoće, porođaja ili poslije rođenja. Najčešće je korištena klasifikacija HIE prema Sarantu i Sarnatovoj koja ju dijeli na blagi,umjereni i teški oblik. Prognoza HIE ovisi o težini i stupnju moždane ozljede pa tako 10-15% novorođenčadi s umjerenim i teškim oblikom umire unutar prvih mjesec dana života dok 25-50% preživjelih ima teška neurološka oštećenja kao što su cerebralna paraliza, epilepsija, sljepoća i poremećaji sluha. Klinička slika cerebralne paralize ovisi o vremenu, težini i lokalizaciji djelovanja štetnog uzroka, a možemo ju klasificirati u spastični, diskinetički i ataktični oblik. U dijagnostici neuropatoloških oštećenja se najčešće koristi MR jer je znatno osjetljiviji za prognozu razvoja cerebralne paralize u odnosu na ostale slikovne metode. Liječenje cerebralne paralize zahtjeva individualiziran pristup multidisciplinarnog tima baziran na kliničkoj prezentaciji bolesti. Epilepsija je kronična bolest koju obilježava sklonost ponavljanju epileptičkih napadaja. Djeca s perinatalnom hipoksično-ishemijskom encefalopatijom imaju 5 puta veći rizik za njezin razvoj od djece bez ove bolesti. S HIE se povezuju Westov i Lennox-Gastautov sindrom. U većine bolesnika epileptički napadaji se uspijevaju kupirati antiepileptičkim lijekovima dok se kod manjeg broja farmakorezistentnih bolesnika vrši klasično ili minimalno invazivno neurokirurško liječenje. Kortikalno oštećenje vida najčešći je oblik poremećaja vida u djece, a često je uzrokovano hipoksično-ishemičnom ozljedom. Stupanj oštećenja vida ovisi o opsežnosti moždane ozljede te lokalizaciji. U djece s HIE često nastaju i bilateralni senzoneuralni poremećaji sluha. Osim evocirane otoakustične emisije, u neurorizične djece porebno je učiniti i A-ABR u prvih 6 mjeseci života.

Abstract (english)

Despite the progress in obstetric, prenatal and neonatal care, perinatal asphyxia is still one of leading causes of newborn mortality and morbidity. Hypoxic-ischemic encephalopathy is the result of newborn asphyxia which can occur during pregnancy, during birth or after birth. HIE can be classified as mild, moderate or severe according to the Sarant and Sarnat classification. Outcomes of HIE depend on the severity of brain injury. 10-15 % of newborns with moderate and severe HIE die within the first month after birth, while 25-50 % of survivors suffer from severe neurologic deficits such as cerebral palsy, epilepsy, blindness or hearing disorders. Clinical presentation of cerebral palsy varies based on the duration, severity and localization of the effect of the causative agent. It can be classified as spastic, dyskinetic and ataxic cerebral palsy. Magnetic resonance imaging is the diagnostic imaging modality of choice in the workup of cerebral palsy due to it’s higher sensitivity compared to other imaging studies. Treatment of cerebral palsy requires a multidisciplinary team and an individual approach to the patient based on clinical presentation of the disease. Epilepsy is a chronic disease characterized by recurrent epileptic seizures. Children suffering from hypoxic-ischemic encephalopathy are 5 times more likely to develop epilepsy than healthy children. West and Lennox-Gastaut syndromes are associated with HIE. In most patients, seizures can be managed using antiepileptic drugs, while a smaller number of pharmacoresistant cases require conventional or minimally invasive neurosurgical treatment. Cortical visual impairment is the most common type of visual impairment in children and is often caused by a hypoxic-ischemic brain injury. The severity of visual impairment depends on the size and localization of the brain injury. Furthermore, children with HIE often develop bilateral sensorineural hearing loss. Besides evoked otoacoustic emission, in children at high risk of neurologic complications, it is often necessary to perform A-ABR during the first 6 months of life.

• Keywords: hipoksično-ishemijska encefalopatija; neurološke komplikacije; cerebralna paraliza; epilepsija
• Keywords (english): hypoxic-ischemic encephalopathy; neurologic complications; cerebral palsy; epilepsy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:031622
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-16 12:00:23