The investigation of the factors which effects prognosis at premature and intraventricular hemorrhage/periventricular leukomalasia babies

ABSTRACTThe Investigation of the Factors Which Effects Prognosis At Premature andIntraventricular Hemorrhage/Periventricular Leukomalasia BabiesThe World Health Organization defines premature birth as the delivery of an infantbetween 20 and 37 weeks gestation. Over past decade, advances in neonatal-perinatalmedicine have resulted in increased survival rates among premature infants. Despitetherapies, however, the rates of birth weight spesific abnormal neurodevelopmentaloutcomes have remained constant. For this reason premature birth is a major public healthconcern. The period between 20 and 32 weeks after conception is one of rapid brain growthand development. Therefore especially brain growth and development are influenced inprematures.The clinical consequences can include serious neuromotor problems(principally intraventricular hemorrhage and periventricular leukomalasia), visual andhearing impairments, learning difficulties, and psychological, behavioural, and socialproblems. In this paper, the factors of possible neuromotor problems at premature andintraventricular hemorrhage babies are searched.Between 2004 July and 2005 February all preterm infants of birth weight 1000-2000 grams and between 28 and 36 gestational weeks, after delivery were admitted to theneonatal intensive care unit of our department. Gestational age was determined by thematernal menstrual history and was confirmed by an ultrasound examination during earlypregnancy and/or by physical examination with the use of the Ballard score. Cranialultrasound was carried out in 48-72 hours of life and whenever problems occur until theywere discharged. Infant intracranial hemorrhage was graded into four categories accordingto Papile et al classification. The patients? prenatal, natal histories and the clinicalobservations while settling down in hospitals are saved. The patients who has been exitusor hidrocephalus/ventricülit are excluded from this search. The patients who are dischargedfrom hospitals are called to control by telephone. Examinations were carried out dischargefrom hospital and at 3, 6, 9, 12 months and after 1-2 years. The Bayley scales of infantdevelopment were used to assess cognitive and motor development (Mental and MotorDevelopmental Index) at 12 to 24 months. Neurologic evaluation of the newbon infantswas based on the methods of Palisano et al. By that way 52 prospective, 9 retrospective andtotally 61 patients are included to this observation.Statical analysis was carried out by using the Mann-Whitney test and Student?s t test tocompare continuous and categorical variables, respectively.. Unconditional logisticregression was used to test for association between variables while adjusting for potentialconfounders and first degree interaction between variables. Differences betweendichotomous risk factor with the X² test. All tests p values <0,05 were consideredstatistically significant.All preterm infants, risk factors delayed motor developmental index at 12-24 months ofage include intraventricular hemorrhage, male gender, low birth weight and low firstminute of delivery APGAR score. However, by logistic regression analysis, onlyintraventricular hemorrhage remained significant risk factors of delayed motordevelopmental index. Only one risk factor delayed mental developmental index at 12-24months of age have determined at all prematüre infants. It is sepsis. The patients withintraventricular hemorrhage taken as a group and searched their risk factors, anymeaningful risk constituted factor is not found while motor and mental measure.Mental and motor developmental index is related meaningful with each other when justcomparing them both. Also while APGAR scores are realized with their numerical values, aweak relation is estimated between 5. minutes APGAR score and motor developmentalindex. According to the evaluation of Palisano and his friends? common motorclassification, there are problems at the babies? intelligence and/or motor developmentalevaluations which have problems.In conclusion, although there are some factors which effects neurodevelopments atbabies; intraventricular hemorrhage, even I. or II. degree, is the most effective factor. Alsoit is meaningful to see that man sex effetcs the motor development. Because of their settlingdown to hospitals and being ex at small ages at followings, intraventricular hemorrhages, inIII. or IV. degree, are with high mortality. For this reason, the observation of the prematurebabies, especially babies with intraventricular hemorrhage are followed theirneurodevelopment carefully.Key Words: Intraventricular hemorrhage, neurodevelopmental prognosis, prematurity