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Ioana Codreanu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

HEMORAGIA PERI-INTRAVENTRICULARA LA PREMATURI: IMPORTANTA SCREENINGULUI PRIN ECOGRAFIE TRANSFONTANELARA

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HEMORAGIA PERI-INTRAVENTRICULARA LA PREMATURI: IMPORTANTA SCREENINGULUI PRIN ECOGRAFIE TRANSFONTANELARA

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ABSTRACT

Obiective. Hemoragiile peri-intraventriculare (HPIV) pot determina la sugarii născuţi prematur diferite grade de re tard neuropsihomotor. Un studiu prospectiv efectuat în IOMC pe o perioadă de 4 ani (2009-2012), pe un lot de 160 prematuri, a urmărit prevalenţa gradelor de HPIV diagnosticate prin ecografie transfontanelară (ETF), identificarea factorilor de risc asociaţi şi a severităţii afectării neurologice la aceşti pacienţi prin urmărirea lor pe o perioadă de 12 luni.

Material şi metodă. Pe perioada studiului, prematurii internaţi în IOMC au fost examinaţi sistematic prin ETF, printr-un protocol standardizat; aprecierea gradelor HPIV s-a efectuat conform clasificării Papile. Evaluarea neurologică a fost efectuată sistematic până la vârsta de 1 an.

Rezultate. Cel mai frecvent înregistrate au fost HPIV I şi II – 45%, respectiv 37,5% din numărul total de pacienţi. HPIV gradul IV au reprezentat 4,4%. În HPIV grad I şi II afectarea neurologică a fost uşoară, această corelaţie având semnificaţie statistică (p < 0,01) pentru ambele forme. Hemoragiile gradul III şi IV au fost asociate cu o evoluţie neurologică nefavorabilă, corelaţia între HPIV grad IV şi sechelele neurologice majore având semnificaţie statistică (p < 0,01).

Concluzii. ETF efectuată de rutină tuturor prematurilor permite diagnosticul precoce şi stadializarea HPIV, aprecierea evoluţiei neurologice cu instituirea precoce a tratamentului şi asigurarea consilierii adecvate.

Cuvinte cheie: prematur, ecografie transfontanelară, hemoragie peri-intraventriculară, prognostic neurologic

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PERI-INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS: THE IMPORTANCE OF SCREENING BY TRANSFONTANELLAR ULTRASOUND

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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PERI-INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS: THE IMPORTANCE OF SCREENING BY TRANSFONTANELLAR ULTRASOUND

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ABSTRACT

Objectives. In preterm babies, peri-intraventricular hemorrahges (PIVH) might cause various degrees of neuropsycho-motor impairment. A 4-year prospective study (2009-2012) performed in the IOMC, was aimed to determine the prevalence of different degrees of PIVH diagnosed by head ultrasound (HUS) among 160 admitted preterm babies, the associated risk factors, along with the neuro-developmental effects on a 12-month follow-up period.

Material and methods. In the above-mentioned period all admitted preterms were examined by transfontanelar ultrasound according to a standardized protocol based on Papile’s PIVH classification. For those preterms included in the study a 12-month systematic neurologic follow-up was performed. Results. PIVH grade I (45%) and II (37,5%) were the most prevalent types. Grade IV PIVH represented 4,4% from all PIVH cases. The good neurological outcome of grade I and II PIVH, was found to be statistically significant (p < 0.01) for both types. Severe neurological sequelae were associated with grade III and IV and a statistically significant correlation (p<0.01) was found only for grade IV hemorrhages.

Conclusion. Systematic HUS screenings for all preterm babies is useful for early diagnosis and PIVH staging, for neurologic outcome prediction, providing the appropriate management strategy and a well-suited parental counseling.

Key words: preterm, transfontanelar ultrasound, peri-intraventricular hemorrhage, neurological outcome

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MALFORMATIE CEREBRALA EXTREMA – CONSIDERATII CLINICE SI ETICE PE MARGINEA UNUI CAZ

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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MALFORMATIE CEREBRALA EXTREMA – CONSIDERATII CLINICE SI ETICE PE MARGINEA UNUI CAZ

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REZUMAT

Hidranencefalia reprezintă una dintre malformaţiile cerebrale extrem de rară şi cu prognostic nefavorabil, cu impact psihoafectiv negativ asupra familiei şi societăţii. În mod obişnuit, cei afectaţi rămân într-o stare vegetativă permanentă şi necesită îngrijiri pe termen nelimitat. Deşi majoritatea celor afectaţi decedează în primele zile-luni de viaţă, o parte dintre ei supravieţuiesc până în decada a 2-a a 3-a de viaţă. Din punct de vedere al tratamentului, îngrijirile acordate sunt pur paliative şi sunt îndreptate spre menţinerea funcţiilor vitale.

Concluzii. Hidranencefalia reprezintă o malformaţie cerebrală rară, cu prognostic rezervat şi speranţă de viaţă şi calitate a vieţii scăzute. Diagnosticul impune o serie de probleme etice. Importanţa diagnosticului prenatal se impune prin faptul că hidranencefaliare prezintă indicaţie de avort terapeutic. O altă problemă etică o ridică îngrijirile medicale acordate, ce sunt pur paliative, pacienţii fiind în stare vegetativă permanentă. Atât instituirea tratamentului chirurgical pentru drenajul cantităţii excesive al LCR, cât şi metodele noi terapeutice descrise în literatură, de tipul coagulării endoscopice a plexurilor choroide, nu influenţează statusul neurologic şi dezvoltarea neuropsihomotorie a pacienţilor. Toate aceste date trebuie explicate clar aparţinătorilor, pentru a nu-şi ridica speranţe false în ceea ce priveşte evoluţia acestor bolnavi.

Cuvinte cheie: hidranencefalie, ecografie transfontanelară, hemoragie periintraventriculară, prematuritate

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EXTREME CEREBRAL MALFORMATION – CLINICAL AND ETHICAL ISSUES BASED ON A CASE

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DOI - Crossref
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ICMJE- Recommendations

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Promoting Global Health

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EXTREME CEREBRAL MALFORMATION – CLINICAL AND ETHICAL ISSUES BASED ON A CASE

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ABSTRACT

Hydranencephaly represents one of the most rare cerebral malformations, with poor prognosis and negative impact on both family and society. Usually the patients remain in a permanent vegetative state and require unlimited medical care. Although the majority of affected babies die in utero or in the fi rst days-months of life there have been cases in literature with prolonged survival, for 20 (1), 22 (2) and 32 (3) years. Therapeutically, the medical care provided are purely palliative and oriented to supporting vital function.

Conclusions. Hydranencephaly is a rare brain malformation with poor prognosis, life expectancy and quality of life. Diagnosis imposes a number of ethical issues. The importance resides in the fact that prenatal detection represents an indication for therapeutic abortion. Another ethical issue raised is represented by medical care provided, which is exclusively palliative. Both surgical and novel therapeutic methods described by the literature, like endoscopic coagulation of choroid plexes, do not infl uence the neurological status and the neuropsychomotordevelopment (4). All this data should be clearly explained to parents and legal tutors for not raising any false hopes regarding the evolution.

Keywords: hydranencephaly, transfontanellar ultrasound, peri/intraventricular hemorrhage, prematurity

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