Η προγνωστική σημασία μιας νέας κλινικής βαθμολόγησης της εγκεφαλοπάθειας των νεογνών από περιγεννητική ασφυξία, σε συνδυασμό με τα ευρήματα άλλων εργαστηριακών εξετάσεων

The purpose of this study was to determine the prognostic value of the diagnosis of post asphyxial encephalopathy made on the basis of the clinical symptoms, based on a modification of the description of Fenichel, in combination with imaging and other laboratory examinations. We studied 60 full-term neonates with perinatal asphyxia. Immediately after delivery, and for the whole duration of their hospitalization, we clinically evaluated and determined the grade of severity of encephalopathy as mild, moderate (A and B) and severe. The differentiation of the moderate grade of encephalopathy, according to the duration of the symptoms into A and B, was made for the first time with our study. The laboratory evaluation of the neonates included determination of transaminase levels, urea, creatinine, serum CRP, cytological examination of the cerebrospinal fluid and urinalysis within the first 3 days of life. An electroencephalogram (EEG) was performed at the age between 15 days and 2 months, ultrasonogram of the brain was done at the age between 15 and 30 days, axial tomography was performed during the first two weeks of life and an electrocardiogram was done on the first day, first week and first month of life of the infant. A clinical, neurologic and developmental examination of the infant with Griffith's I method was performed on the 3rd, 6th and 18th month of the life of the infant. The clinical and laboratory findings of the first neonatal period were correlated with follow-up findings and it was found that: a) the neonates with mild encephalopathy had a good prognosis, b) those with moderate encephalopathy had a good prognosis if their symptoms lasted up to 3 days (type A). When the abnormal clinical findings persisted for more than 3 days (type B), the prognosis varied from good to poor. The prognosis was also poor when the neonates with type Β moderate encephalopathy had abnormal EEG findings after the first week of life or when computerized axial tomographic studies (CAT) demonstrated extensive hypo or hyperdense areas, c) Most of the neonates with severe encephalopathy died and those who survived presented with serious neurologic defects. The biochemical examinations showed that transaminase and creatinine blood levels increased in parallel with the severity of the clinical manifestations of encephalopathy, whereas there was no such correlation with urea and CRP levels. The findings of the urinary examination were abnormal in the severe form of encephalopathy and occasionally in the moderate type Β encephalopathy. The cerebrospinal fluid was bloody in many cases of moderate (types A and B) and in severe encephalopathy. There was no significant correlation between the ultrasonographic findings and the outcome of the encephalopathy of the neonates. No conclusions could be drawn from the degree of ischemia of the myocardium demonstrated by the electrocardiograms. In conclusion, the clinical evaluation of the neonates during the first days of life has prognostic value for the outcome of neonates with perinatal asphyxia encephalopathy. The imaging techniques are of special value only in type Β moderate grade of encephalopathy in which the prognosis based on clinical evaluation is difficult. The biochemical examinations are simply an adjunct index of the severity of peninatal asphyxia. The differentiation of moderate encephalopathy into types A and Β done for the first time in our study and is a significant improvement in the classification of the grades of hypoxic ischemic encephalopathy.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1991

Authors dc:creator

• Karakoli, Anna
• Καρακόλη, Άννα

• Ιατρική και Επιστήμες Υγείας
• Κλινική Ιατρική
• Medical and Health Sciences
• Clinical Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1681

OAI identifier oai:identifier

oai:10442/1681