Evolução neurologica de recem-nascidos com asfixia neonatal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

The aim of this study was to evaluate the neurological examination and neurodevelopment by Denver Development Screening Test (DDST) evolution, at one year and its association with clinical variables, in 81 term neonates with birth asphyxia, born in the Maternity Unit of the Center for Integral Assistance to Women?s Health at the State University of Campinas, from january 1991 to january 1999. The study had a observational rectrospective cohort design, of the folow-up of these neonates at three, six months and one year. Neonatal asphyxia was diagnosed by the presence of at least three of the folowing criteria: an Apgar score of less than six at five minutes, a need for positive pressure ventilation via an endotracheal tube for more than one minute after delivery, hipoxic-ischemic encephalopathy, and sistemic abnormalities during neonatal period. The statistical analysis employed, was innitially descriptive of different consultations, then, comparative, with McNemar test for matched samples and then, bivariate and multiple, to evaluate the relationship between independent variables or interactions of variables and abnormal neurological examination and delayed DDST. At year, 54 (66,6 %) infants were normal, 34 of wich, had transient abnormalities, at least in one of consultations and 27 (33,3%) had normal neurological examination. The DDST showed to be normal in 66 (81,5) and delayed in 15 (18,5%). In bivariate analysis, maternal chronic hipertension, ultrassonografy with brain edema, neurological examination at seven days and discharge, a lenght of hospital stay more than 12 days, were factors associated with abnormal neurologic outcome and hipoxic-ischemic encephalopathy, seizures, more than three sistemic abnormalities, renal failure, neonatal ventilation, starting oral feeding more than four days, neurological examination at seven days and discharge, and a lenght of hospital stay, more than 12 days, were factors associated with delayed DDST. After multiple analysis, chronic maternal hipertension and neurological examination at seven days, were significantly associated variables. Concerning DDST at year, bivariate analysis, showed more than three sistemic abnormalities, hipoxic-ischemic encephalopathy 2 or 3, seizures at 24 hours, neonatal ventilation, starting oral feeding >4 days, and lenght of hospital stay more than 12 days, associated with delay. In the logístic regression, only neurological examination reamained as independent variable, associated with delay. Bivariate analysis of interactions, showed that neurological examination with neonatal ventilation and interaction neurological examination with brain edema, in ultrassonografy, were associated with abnormal neurological outcome. In multiple analysis, only the first interaction remained as independent variable associated with abnormal neurological outcome. When neurological examination at first consultation was studied as independent factor, it showed independent association with abnormal neurological outcome and DDST delay. We conclude that, neonatal asphyxia still contributes to a great number of neurological abnormalities, wich are associated with clinical events, wich, isolated or in interactions, can predict desfavorable evolution, and it is important to analyse the diagnosis, to permit early treatment, and prognosis, to permit counselling parents and referral to early intervention programs. There are, however, a distinct group of infants, with transient abnormalities, wich knowledge is important to avoid pessimism in this counselling

ASSUNTO(S)

prognostico asfixia neonatal recem-nascidos exame neurologico hipoxia-isquemia encefalica

ACESSO AO ARTIGO

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