Nöral tüp defektli bebeklerin kısa ve uzun dönem izlemi
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yenidoğan yoğun bakım ünitemizde 1 Ocak 2010 – 30 Haziran 2022 tarihleri arasında
takip edilmiş olan nöral tüp defekti (NTD) olan olgular (meningosel, meningomiyelosel,
anensefali, ensefalosel, spina bifida okkulta) retrospektif olarak incelendi. Olguların
yenidoğan yoğun bakım ünitesinde yatışı boyunca klinik takibini, NTD etiyolojisindeki
muhtemel faktörleri, demografik özelliklerini ve taburculuk sonrası yapılan klinik takiplerini
inceledik. İstatistiksel analizler için SPSS 22.0 programı kullanıldı ve p<0,05 olması anlamlı
kabul edildi.
Çalışmamızda incelemiş olduğumuz 121 hastanın %46,3’ü erkek (n = 56) ve %53,7’si
kız (n = 65) idi. Hastaların ortalama doğum ağırlığı 2843,1±522,5 gr idi. Ortalama gebelik
haftası 36,9±1,8 hafta olarak saptandı ve 11 (%9,1) hasta normal spontal vajinal yol ile, 110
(%90,9) hasta ise sezaryenle doğmuştu. Bu vakaların 68’inde (%56,2) prematür doğum,
53’ünde (%43,8) miad doğum öyküsü vardı. Annelerdeki folik asit kullanımı sorgulandığında
48’i (%39,66) folik asit desteği almıştı. Çalışmamızda üç (%2,47) annenin antiepileptik ilaç
kullanım öyküsü mevcuttu. Hastalarımızda meningomiyelosel %69,4 (n=84) en sık görülen
NTD tipi idi. Lezyonun anatomik yerleşimine göre en sık %24,8 (n=30) lumbosakral bölge
olduğu görüldü. NTD’li hastaların nörolojik anomalileri incelendiğinde; en sık bulgu olan
hidrosefali %64,4 (n=78) hastada saptandı. Hastalarda nörolojik komplikasyonların
meningosel ve meningomiyelosel ile doğan hastalarda daha sık olduğu görüldü. Ortopedik
anomaliler hastaların %61,2’sinde (n=74) saptandı ve en sık skolyoz %47,1 (n=57) saptandı.
Üriner sistem anomalileri incelendiğinde %57 (n=69) anomali saptanmış olup en sık nörojenik
mesane %38 (n=46) tespit edildi. Spina bifida aperta ile doğan hastalarda da üriner sistem
komplikasyonları daha fazla görüldü. NTD olan olgulardan %83,5’i (n=101) ameliyat edildi.
Hastaların opere edilme zamanı 2,77±4,52 gün olarak belirlendi. İlk 72 saat içinde hastaların
%65,2’sine (n=79) cerrahi onarım yapıldı. Hidrosefalisi olan hastaların %44,6’sı (n=54) aynı
v
seans veya farklı seansta ventrikülo-peritoneal şant (VPŞ) için opere edildi. VPŞ takılmış
olan 20 (%37) olguda şant revizyonları yapıldı. VPŞ operasyonundan sonra 15 (%27,7)
hastada şant menenjiti gelişti. İzlemimizde kalan hastaların en sık üriner sistem enfeksiyonları
nedeniyle hastane yatışları oldu. Takip edilen hastalarımızın mortalite oranı %23 olarak
saptandı.
Bu çalışmada bulunduğumuz bölgede hastaların demografik özelliklerini, mortalitesi
ve morbiditesini değerlendirdik. NTD tüm konjenital anomaliler içinde ikinci sıklıkta
görülmekte olup, folik asit desteği ile azaltılabildiği için önemli bir yere sahiptir.
Çalışmamızda nörolojik ve ürolojik komplikasyonların spina bifida aperta tanılı
hastalarımızda daha sık görüldüğünü saptadık. Prenatal tanı ile NTD olduğu saptanan
bebeklerin, üçüncü basamak merkezlerde dünyaya gelmesi ve defektlerin erken onarımının
sağlanmasıyla komplikasyonların azalabileceğini düşünüyoruz. Bununla birlikte postnatal
dönemde bakım olanakları iyi olan yenidoğan ünitesinde takip edilmesi ve çocukluk
döneminde multidisipliner bir yönetim benimsenmesi ile nörolojik, ürolojik ve ortopedik
komplikasyonların etkisi azaltılabilir.
In this study, we included patients who were hospitalized in the neonatal intensive care unit due to neural tube defects (NTD) (meningocele, myelomeningocele, anencephaly, encephalocele, spina bifida occulta), between January 2010 to June 2022, at Necmettin Erbakan University Meram Medical Faculty, were analyzed retrospectively. Clinical followup, etiology of NTD, demographic characteristics, follow-up after discharge were retrospectively scanned. SPSS 22.0 program was used for statistical analysis. A p<0.05 was considered significant. This research study examined 121 patients; 46.3% male (n = 56) and 53.7% female (n = 65). The mean birth weight of the patients was 2843.14±522.59 grams. The mean gestational week was 36.91±1.8. The patients who had normal spontaneous vaginal delivery 11 (9.1%), and 110 (90.9%) patients had a cesarean delivery. Premature birth occurred in 68 (56.2%) along with term delivery birth was 53 (43.8%) of the cases. The number of mothers who received folic acid supplementation is 48 (39.66%). A total of three mothers (2.47%) were taking antiepileptic drugs. Myelomeningocele was the major type of NTD in 69.4% (n=84) of the patients. The most common anatomical location of the lesion, 24.8% (n=30) was the lumbosacral region. When the neurological anomalies of the patients with NTD were examined, the most commonly detected finding was hydrocephalus in a total of 64.4% (n=78) patients. Neurological complications of the patients were frequent in patients born with meningocele and meningomyelocele. Orthopedic anomalies were detected in 61.2% (n=74) of the patients, and scoliosis was the most common type in a total of 47.1% (n=57). As part of urinary system anomalies, 57% (n=69) of patients had anomalies, and frequently neurogenic bladder was found in 38% (n=46). Urinary system complications were also vii prevalent in patients born with spina bifida aperta. Patients who had NTD cases, 83.5% (n=101) were operated on. The range of the operation time of the patients was determined as 2.77±4.52 days. Surgical repair was performed in 65.2% (n=79) of the patients within the first 72 hours. The patients with hydrocephalus 44.6% (n=54) were operated on for ventriculoperitoneal (VP) shunt in the same or different sessions. Shunt revisions were performed in 20 (37%) cases with a VP shunt. Shunt meningitis developed in 15 (27.7%) patients after the VP shunt operation. In the follow-up of the patients, the most frequent hospitalizations were due to urinary system infections. The mortality rate of the patients who were followed up during the was 23%. This study evaluated the demographic characteristics, mortality, and morbidity of the patients in the Konya region of Turkey. NTD is the second most common among all congenital anomalies which has an important position since it can be reduced with folic acid supplementation. In this research, neurological and urological complications were more common in the patients with spina bifida aperta has been found. The result of this study shows that the complications can be reduced by the delivery of babies who have NTD with prenatal diagnosis in tertiary care centers and early treatments of defects. The effects of complications can be reduced by observing the babies in the neonatal unit with good care facilities in the postnatal period along with adopting multidisciplinary management of neurological, urological, and orthopedic during childhood.
In this study, we included patients who were hospitalized in the neonatal intensive care unit due to neural tube defects (NTD) (meningocele, myelomeningocele, anencephaly, encephalocele, spina bifida occulta), between January 2010 to June 2022, at Necmettin Erbakan University Meram Medical Faculty, were analyzed retrospectively. Clinical followup, etiology of NTD, demographic characteristics, follow-up after discharge were retrospectively scanned. SPSS 22.0 program was used for statistical analysis. A p<0.05 was considered significant. This research study examined 121 patients; 46.3% male (n = 56) and 53.7% female (n = 65). The mean birth weight of the patients was 2843.14±522.59 grams. The mean gestational week was 36.91±1.8. The patients who had normal spontaneous vaginal delivery 11 (9.1%), and 110 (90.9%) patients had a cesarean delivery. Premature birth occurred in 68 (56.2%) along with term delivery birth was 53 (43.8%) of the cases. The number of mothers who received folic acid supplementation is 48 (39.66%). A total of three mothers (2.47%) were taking antiepileptic drugs. Myelomeningocele was the major type of NTD in 69.4% (n=84) of the patients. The most common anatomical location of the lesion, 24.8% (n=30) was the lumbosacral region. When the neurological anomalies of the patients with NTD were examined, the most commonly detected finding was hydrocephalus in a total of 64.4% (n=78) patients. Neurological complications of the patients were frequent in patients born with meningocele and meningomyelocele. Orthopedic anomalies were detected in 61.2% (n=74) of the patients, and scoliosis was the most common type in a total of 47.1% (n=57). As part of urinary system anomalies, 57% (n=69) of patients had anomalies, and frequently neurogenic bladder was found in 38% (n=46). Urinary system complications were also vii prevalent in patients born with spina bifida aperta. Patients who had NTD cases, 83.5% (n=101) were operated on. The range of the operation time of the patients was determined as 2.77±4.52 days. Surgical repair was performed in 65.2% (n=79) of the patients within the first 72 hours. The patients with hydrocephalus 44.6% (n=54) were operated on for ventriculoperitoneal (VP) shunt in the same or different sessions. Shunt revisions were performed in 20 (37%) cases with a VP shunt. Shunt meningitis developed in 15 (27.7%) patients after the VP shunt operation. In the follow-up of the patients, the most frequent hospitalizations were due to urinary system infections. The mortality rate of the patients who were followed up during the was 23%. This study evaluated the demographic characteristics, mortality, and morbidity of the patients in the Konya region of Turkey. NTD is the second most common among all congenital anomalies which has an important position since it can be reduced with folic acid supplementation. In this research, neurological and urological complications were more common in the patients with spina bifida aperta has been found. The result of this study shows that the complications can be reduced by the delivery of babies who have NTD with prenatal diagnosis in tertiary care centers and early treatments of defects. The effects of complications can be reduced by observing the babies in the neonatal unit with good care facilities in the postnatal period along with adopting multidisciplinary management of neurological, urological, and orthopedic during childhood.
Açıklama
Anahtar Kelimeler
Nöral tüp defekti, Meningomiyelosel, Hidrosefali, Folik asit, Neural tube defect, Meningomyelocele, Hydrocephalus, Folic acid
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Taşar, K. (2022). Nöral tüp defektli bebeklerin kısa ve uzun dönem izlemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
