Öz
Giriş
Son dönemde, yenidoğan yoğun bakım ünitelerinde çok düşük doğum ağırlıklı
prematüre bebeklerin sağ kalımındaki artışa bağlı, intraventriküler kanama
(IVK) ve post-hemorajik hidrosefali (PHH) ciddi bir sorun olarak karşımıza
çıkmaktadır. PHH tedavisinde kabul edilmiş yöntem olan ventrikülo-peritoneal
şant, ventrikül içi rezervuar ve ekstra-ventriküler drenaj (EVD) girişimleri
prematüre bebeklere erken dönemde düşük doğum tartısı nedeniyle bazı durumlarda
ise merkezin deneyim yetersizliğine bağlı uygulanamamaktadır.
Olgu
27 gestasyon haftasında 860 gr olarak doğan ve takibinde intraventriküler
kanama sonucunda post-hemorajik hidrosefali gelişen olgumuzu, düşük tartısı
nedeniyle cerrahi girişim yapılamaması nedeniyle –son çare olarak- yapılan seri
lomber ponksiyonlar (SLP) sonrası hidrosefalisi gerilemesi ve ek cerrahi
girişim gereksinimi olmaması üzerine sunmayı amaçladık.
Sonuç
Ventrikülo-peritoneal şant ve ventrikül içi rezervuar uygulamalarının
yapılamadığı durumlarda “seri lomber ponksiyon girişiminin -son tercih olarak
denenebilecek- alternatif bir tedavi olabileceğini vurgulamak amacıyla sunduk.
Anahtar Kelimeler
prematürite hidrosefali intraventriküler kanama seri lomber ponksiyon
Kaynakça
- Kaynaklar 1. JJ Volpe. Intracranial Hemorrhage: Germinal Matrix-Intraventricular Hemorrhage of the Premature Infant. In: JJ Volpe. Neurology of the Newborn. 5th ed. Philedelphia: Elsevier; 2008; P. 517-588 2. Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatrics 2012;9:242–258, 3. Anwar M, Kadam S, Hiatt IM, Hegyi T. Serial lumbar punctures in prevention of post-hemorrhagic hydrocephalus in preterm infants. J Pediatr. 1985;107(3):446-50. 4. Whitelaw A. Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage. Cochrane Database SystRev. 2001;(1):CD000216. 5. Strahle J, Garton HJ, Maher CO, Muraszko KM, Keep RF, Xi G. Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage. Transl Stroke Res. 2012;3(Suppl 1):25-38. 6. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA. Improved survival rates with increased neurodevelopmental disability for extremelylow birth weight infants in the 1990s, Pediatrics 2005;115:997-1003. 7. Mancini MC, Barbosa NE, Banwart D, Silveira S, Guerpelli JL, Leone CR. Intraventricular hemorrhage in very lowbirth weight infants: associated risk factors and outcome inthe neonatal period. Rev Hosp Clin Fac Med Sao Paulo 1999;54(5):151-4. 8. N Sajjadian, Fakhrai H, Jahadi R. Incidence of Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus in Preterm Infants. Acta Med Iran. 2010;48(4):260-2 9. Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD Jr, Rogido M, Mitchell L, Flannery AM. Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr. 2014;14 Suppl 1:8-23.
Öz
Introduction
Intra-ventricular
hemorrhage and post-hemorrhagic hydrocephalus come across as a serious problem
as survival rates of very low birth weight preterm babies increase in neonatal
intensive care units. Although ventriculo-peritoneal shunting is the accepted
treatment for post-hemorrhagic hydrocephalus, it cannot be performed in early
stages of premature babies because of low birth weight.
Case
In this case report we
present a case, in which attempting surgical treatment is not possible because
of low birth weight and performing serial lumbar puncture has regressed
hydrocephalus and has resorbed intracranial hematoma.
Conclusion
In this case report, it
is aimed to emphasize that serial lumbar puncture may be an alternative “last
resort” treatment in cases which reservoir and shunt cannot be performed.
Anahtar Kelimeler
prematurity intraventricular hemorrhage posthemorrhagic hydrocephalus serial lombar puncture
Kaynakça
- Kaynaklar 1. JJ Volpe. Intracranial Hemorrhage: Germinal Matrix-Intraventricular Hemorrhage of the Premature Infant. In: JJ Volpe. Neurology of the Newborn. 5th ed. Philedelphia: Elsevier; 2008; P. 517-588 2. Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatrics 2012;9:242–258, 3. Anwar M, Kadam S, Hiatt IM, Hegyi T. Serial lumbar punctures in prevention of post-hemorrhagic hydrocephalus in preterm infants. J Pediatr. 1985;107(3):446-50. 4. Whitelaw A. Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage. Cochrane Database SystRev. 2001;(1):CD000216. 5. Strahle J, Garton HJ, Maher CO, Muraszko KM, Keep RF, Xi G. Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage. Transl Stroke Res. 2012;3(Suppl 1):25-38. 6. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA. Improved survival rates with increased neurodevelopmental disability for extremelylow birth weight infants in the 1990s, Pediatrics 2005;115:997-1003. 7. Mancini MC, Barbosa NE, Banwart D, Silveira S, Guerpelli JL, Leone CR. Intraventricular hemorrhage in very lowbirth weight infants: associated risk factors and outcome inthe neonatal period. Rev Hosp Clin Fac Med Sao Paulo 1999;54(5):151-4. 8. N Sajjadian, Fakhrai H, Jahadi R. Incidence of Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus in Preterm Infants. Acta Med Iran. 2010;48(4):260-2 9. Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD Jr, Rogido M, Mitchell L, Flannery AM. Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr. 2014;14 Suppl 1:8-23.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Eylül 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 48 Sayı: 3 |
