| Abstract | Cilj istraživanja: Cilj je bio ispitati učestalost intrakranijalnog krvarenja te ishod u novorođenčadi liječene u jedinici intenzivnog liječenja. Ispitali smo i utjecaj spola, gestacijske dobi, porodne mase i duljine, poroda po redu, načina poroda, prednjačeće česti, perinatalne anamneze, Apgar zbroja u 1. i 5. minuti, načina transporta, reanimacije, strojne ventilacije, primjene iNO, surfaktanta i nalaza rentgenograma pluća na težinu intrakranijalnog krvarenja te na ishod liječenja novorođenčadi.
Ispitanici i postupci: Istraživanje je provedeno na 133 novorođenčadi s intrakranijalnim krvarenjem koja su liječena u Zavodu za intenzivnu pedijatriju, Klinike za dječje bolesti, KBC-a Split u razdoblju od 1. siječnja 2008. do 31. prosinca 2017. godine. Da bi se dobili opći podatci o svakom ispitaniku, koristila se bolnička medicinska dokumentacija. Prikupljeni podatci su uneseni u elektroničke tablice podataka i analizirani pomoću računalnih programa Microsoft Office Excel i MedCalc Statistical Software version 17.6. Obrađeni su deskriptivnim (standardnim) statističkim metodama i prikazani su tablično i grafički. Za računanje statistički značajnog utjecaja varijabli korištena je funkcija logističke regresije u računalnom programu MedCalc Statistical Software version 17.6. Razina statističke značajnosti zaključivanja postavljena je na P<0,05.
Rezultati: Od ukupno 405 primljene novorođenčadi u jedinicu intenzivnog liječenja (JILD), njih 133 (32,8%) je imalo intrakranijalno krvarenje. Najučestaliji zabilježeni stupanj krvarenja po Papile-u je bio 2. stupanj (64,4%), zatim slijedi 3. stupanj (12,3%), 4. stupanj (11,6%), a najrjeđe zabilježeni stupanj krvarenja je bio 1. stupanj (6,8%). Od ukupno 133 ispitanika, 105 (78,9%) je preživjelo, a 28 (21,1%) je umrlo. Bilo je 85 (63,9%) ispitanika muškog spola, a 48 (36,1%) ženskog spola. Medijan gestacijske dobi je bio 34 tjedna (raspon od 22,5 - 42). Nedonoščadi je bilo 93 (71,5%), a donošene novorođenčadi 37 (28,5%). Medijan porodne mase bio je 2100 g (raspon od 530 – 4195). Medijan porodne duljine bio je 45 cm (raspon od 28 – 55). Medijan za Apgar zbroj u 1. i 5. minuti iznosio je 8 (raspon od 0 – 10). Prirodnim putem (vaginalno) je rođeno 65 (49,2%) ispitanika, carskim rezom 66 (50%) novorođenčadi, a vakuumom je dovršen 1 porod (0,7%). Prednjačeća čest je u 124 (93,9%) ispitanika bila glava, zadak u 6 (4,5%) ispitanika, a 2 (1,5%) ispitanika je bilo u poprečnom položaju intrauterino. Najučestalija perinatalna anamneza su: prijeteći prijevremeni porod u 30 (22,6%) ispitanika, mekonijska plodova voda u 11 (8,3%) ispitanika, patološki CTG u 8 (6%) ispitanika, prijevremeno prsnuće vodenjaka u 6 (4,5%) ispitanika, placenta previa i krvarenje majke u po 5 (3,8%) ispitanika, a negativna anamneza je bila u 10 (7,5%) ispitanika. Većina ispitanika je bila transportirana iz drugih gradova (82,4%). Nalazi rentgenograma pluća bili su: uredan nalaz u 51 (43,4%) ispitanika, respiratorni distres sindrom u 36 (30,1%) ispitanika, pneumotoraks u 6 (5,1%) ispitanika, aspiracija mekonija u 8 (6,8%) ispitanika, atelektaza u 5 (4,3%) ispitanika, pneumonija u 8 (6,8%) ispitanika te u po 1 (0,9%) ispitanika aspiracija plodove vode, pleuralni izljev i dijafragmalna hernija. Rentgen pluća nije urađen u 16 (12%) ispitanika. U terapiji su korišteni: CMV, HFOV, iNO i reanimacija. Najučestalije pridružene dijagnoze su: respiratorni distres sindrom kojeg je imalo 67 (50,4%) ispitanika, hiperbilirubinemija koju je imalo 45 (33,4%) ispitanika, sepsa koju je imalo 43 (32,3%) ispitanika i otvoreni foramen ovale što je imao 41 (30,1%) ispitanik.
Zaključci: Gestacijska dob, porodna masa, porodna duljina, Apgar zbroj u 1. minuti, reanimacija i liječenja egzogenim surfaktantom imali su statistički značajan utjecaj na nastanak lakšeg i težeg tipa krvarenja. Gestacijska dob, porodna masa, porodna duljina, način poroda, Apgar zbroj u 1. i u 5. minuti, liječenje strojnom ventilacijom, visokofrekventnom oscilacijskom ventilacijom i nalaz rentgenograma pluća imali su statistički značajan utjecaj na konačan ishod. |
| Abstract (english) | Objectives: The aim was to examine the incidence of intracranial hemorrhage and the outcome of treatment in newborns treated in the pediatric intensive care unit. We also examined the effects of sex, gestation age, birth weight and length, parity, way of delivery, fetal presentation, perinatal anamnesis, Apgar score in the 1st and 5th minute, mode of transport, reanimation, mechanical ventilation, iNO, surfactant and findings of chest roentgenogram on the severity of intracranial hemorrhage and the outcome.
Patients and Methods: The study was conducted on 133 newborns with intracranial hemorrhage treated at the Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Split in the period from 1 January 2008 to 31 December 2017. In order to obtain general information on each subject, medical documentation was used. Collected data was entered into electronic data tables and analyzed using Microsoft Office Excel and MedCalc Statistical Software version 17.6.
Results: Out of a total of 405 newborns received in the Intensive Care Unit, 133 (32.8%) had intracranial hemorrhage. The most commonly reported grade of hemorrhage on Papile was 2nd grade (64.4%), followed by 3rd grade (12.3%), 4th grade (11.6%), and the rarest reported grade of hemorrhage was 1st (6.8%). Of the 133 newborn, 105 (78.9%) survived and 28 (21.1%) died. There were 85 (63.9%) male and 48 (36.1%) female newborns. Median for gestational age was 34 weeks (range 22.5 - 42). There were 93 (71.5%) preterm newborn, and 37 (28.5%) term newborn. Median for birth weight was 2100 g (range 530-4195). The median birth length was 45 cm (range 28-55). Median for Apgar score in 1st minute was 8 (range 0-10), while the median for Apgar score in 5th minute was also 8 (range 0-10). 65 (49.2%) of the newborn were born naturally (vaginal), 66 (50%) were born via C-section, and 1 (0.7%) was delivered with vacuum extractor. Most common fetal presentation was cephalic presentation in 124 (93.9%) of the subjects, breech presentation in 6 (4.5%) subjects, and 2 (1.5%) subjects were in transverse lie. The most common perinatal anamnesis was: premature birth in 30 (22.6%) subjects, negative anamnesis in 10 (7.5%) subjects, meconium water in 11 (8.3%), abnormal CTG in 8 (6% ) of the examinees, premature rupture of membranes in 6 (4.5%) subjects, placenta previa and bleeding of a mother in 5 (3.8%) subjects. Most of the respondents were transported from other cities (82.4%). The findings of chest roentgenogram were: a normal finding in 51 (43.4%) subjects, respiratory distress syndrome in 36 (30.1%) subjects, pneumothorax in 6 (5.1%) subjects, meconium aspiration in 8 (6.8 %) of subjects, atelectasis in 5 (4.3%), pneumonia in 8 (6.8%) subjects and in 1 (0.9%) subjects aspiration of water, pleural effusion and diaphragmatic hernia. The chest roentgen was not performed in 16 (12%) respondents. The therapy was used: CMV, HFOV, iNO and reanimation. The most commonly associated diagnoses were: respiratory distress syndrome with 67 (50.4%) subjects, hyperbilirubinemia with 45 (33.4%) subjects, sepsis with 43 (32.3%) subjects and open foramen ovale had 41 (30.1%) respondents.
Conclusions: Gestational age, birth weight, birth length, Apgar score in 1st minute, reanimation and treatment with exogenous surfactant had a statistically significant effect on the formation of mild and more severe type of hemorrhage. Gestational age, birth weight, birth length, way of delivery, Apgar score in 1st and 5th minute, treatment with mechanical ventilation, high frequency oscillatory ventilation and chest roentgenogram findings had a statistically significant effect on the ultimate outcome. |
