Prematürede intraventriküler kanama

Germinal matriks-intraventriküler kanama, prematüreliğin majör bir komplikasyonu olup gestasyonel yaş ve doğum ağırlığıyla ters orantılıdır. İntraventiküler kanama, nöroglial öncül hücrelerin damarlanmasının yoğun olduğu ve aktif hücre proliferasyonunun fazla olduğu germinal matrikste gerçekleşmektedir. Çok düşük doğum ağırlıklı bebeklerde yaklaşık %20 sıklıkla görülmektedir. Germinal matriks-intraventriküler kanama, kız cinsiyette, siyah ırkta ve antenatal steroid kullanımında daha az; mekanik ventilasyon, respiratuar distres, pulmoner kanama, pnömotoraks, koryoamniyonit, asfiksi, sepsis varlığında daha sık görülmektedir. Ultrasonografi, tanıda ilk seçilecek yöntemdir. Germinal matriks-intraventiküler kanamaların yaklaşık %25–50’si asemptomatiktir. Rutin taramalar sırasında tanı alan bu olgularda, genellikle düşük evre kanamalar saptanmaktadır. Ağır kanamalarda nörolojik semptomlar ön plandadır. Pretermde intraventriküler hemoraji, periventriküler hemorajik infarkt, posthemorajik ventriküler dilatasyon, periventriküler lökomalazi, serebellar hemoraji gibi komplikasyonlarla birlikte olabilmektedir. Önemli bir hastalık ve ölüm nedenidir. Doğru hemodinami ve ventilasyon yönetimi, uygun izlem, erken tanı ve zamanında müdahale ile hastalıklar en aza indirilebilir. İntraventriküler kanamada seyir, kanamanın ciddiyeti, parankim hasarı, nöbet ve şant varlığı ile ilişkilidir. Seyirin ana belirleyicisi de periventriküler hemorajik infarkt ve bu infarktın ciddiyetidir. Orta-ağır şiddetteki intraventriküler kanama posthemorajik hidrosefali, serebral palsi, zeka geriliğine neden olabilmektedir. Hafif intraventriküler kanama dahi, gelişimsel bozukluklarla sonuçlanabilmektedir. Kısa dönemde karşılaşılan sorunlar kadar uzun dönemde nörogelişimsel bozukluk, serebral palsi gibi sorunların takibinin yapılması; gerekli tedavi ve özel eğitim ile bu bebeklerin yaşam kalitesinin artırılması amaçlanmalıdır. Bu derlemede germinal matriks-intraventriküler kanama ve komplikasyonları tartışılmaktadır.

Intraventricular hemorrhage in preterm babies

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity and inversely associated with gestational age and birth weight. The hemorrhage originates from the germinal matrix with an immature capillary bed where vascularization is intense and active cell proliferation is high. It occurs in around 20% of very low-birth-weight preterm neonates. Germinal matrix-intraventricular hemorrhage is less common in females, the black race, and with antenatal steroid use, but is more common in the presence of mechanical ventilation, respiratory distress, pulmonary bleeding, pneumothorax, chorioamnionitis, asphyxia, and sepsis. Ultrasonography is the diagnostic tool of choice for intraventricular hemorrhage and its complications. Approximately 25–50% of the germinal matrix-intraventricular hemorrhage cases are asymptomatic and diagnosedduring routine screening. These cases are usually patients with lowgrade hemorrhage. Neurologic findings are prominent in severe intraventricular hemorrhage cases. The major complications of the germinal matrix-intraventricular hemorrhage in preterm babies are periventricular hemorrhagic infarction, posthemorrhagic ventricular dilatation, periventricular leukomalacia, and cerebellar hemorrhage. It is an important cause of mortality and morbidity. The management of hemodynamics and ventilation of patients, appropriate follow-up, and early diagnosis and treatment can minimize morbidity. Prognosis in intraventricular hemorrhage is related to the severity of bleeding, parenchymal damage, and the presence of seizures and shunt surgery. The main determinant of prognosis is periventricular hemorrhagic infarction and its severity. Moderate-severe intraventricular hemorrhagecan cause posthemorrhagic hydrocephalus, cerebral palsy, and mentalretardation. Even mild germinal matrix-intraventricular hemorrhage can result in developmental disorders. Long-term problems such as neurodevelopmental disorders and cerebral palsy are as important as short-term problems. Improving the quality of life of these babies should be aimed through appropriate treatment and follow-up. In this review, intraventricular hemorrhage and complications are discussed.

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