Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

Abstract

RESUMO -Objetivo: Avaliar a relação do índice de resistência (IR) obtido pela ultra-sonografia Doppler transfontanela com o neurodesenvolvimento até um ano de idade, em recém-nascidos (RN) a termo com encefalopatia hipóxica-isquêmica (EHI) leve a moderada, secundária à asfixia intra-parto. Método: Estudo prospectivo em 20 RN com EHI leve a moderada, IR elevado no primeiro exame de Doppler, e sem doenças associadas ou anormalidades morfológicas cerebrais. Foram realizados exames seriados bimensais de Doppler transfontanela a partir do sétimo dia de vida, e avaliações clínicas mensais do neurodesenvolvimento no primeiro ano de vida. Resultados: Houve normalização progressiva dos valores de IR até o último exame realizado. Cinco pacientes apresentaram normalização clínico-neurológica no período neonatal, após o primeiro exame de Doppler. Quinze lactentes apresentaram alterações neurológicas com resolução a partir do segundo trimestre de vida. Conclusão: Houve relação entre os períodos em que ocorreu a normalização dos valores de IR e a melhora clínica-neurológica. PALAVRAS-CHAVE: encefalopatia hipóxica-isquêmica, ultra-sonografia Doppler, recém-nascido, neurodesenvolvimento.Relation between the resistance index obtained by the transfontanellar Doppler ultrasonography and the neurological development until the first year of life in term infants with mild or moderate hypoxic-ischaemic encephalopathy ABSTRACT -Objective: To evaluate the relation between the resistance index (RI) obtained by transfontanellar Doppler ultrasonography, and the neurodevelopment until one year of life, at term newborns with mild or moderate hypoxic-ischaemic encephalopathy due to intrapartum asphyxia. Method: 20 term newborns, with mild or moderate hypoxic-ischemic encephalopathy, high values of resistance index in the first exam, and without cerebral morfologic abnormalities or other diseases. They were submitted to serial bimonthly transfontanellar Doppler ultrasonography, from the seventh day of life on, and monthly clinical neurodevelopment assessment until one year of life. Results: There was a progressive normalization of RI values until the last examination. In five cases there were clinical neurologic normalization in the neonatal period after the first Doppler exam. Fifteen infants presented neurologic abnormalities, with normalization after the second trimester of life. Conclusion: There was a relation between the normal RI values with the normalization of the clinical assessment.

Perinatal Asphyxia: Factors Associated with Noncompliance in the specialized Outpatient Treatment

“…Regarding the reasons for the abandonment of the medical follow-up in the follow-up service, predominated the reasons related to the absence of symptoms (13) and the distance from home (9), despite having been made the request for free transportation to the Department of Health of the municipality of residence of the child through the social service.…”

“…Ratifying the literature, perinatal asphyxia was directly related to gestational age [12][13][14] but had no relation with birth weight 16 . The mortality rate of the sample, as well as the percentage of children presenting neurological sequelae was lower than that reported by other studies.…”

“…Among those who survive, approximately 25% evolve with permanent neurological sequelae, with or without mental retardation, learning disorders, visual or motor dysfunction, hyperactivity, epilepsy and cerebral palsy 11 . HIE is the main cause of brain damage and neurological sequelae in NBs born between 37 and 42 weeks; it is the main responsible for the development of motor, sensory and cognitive dysfunctions, generating high individual, family and social cost [12][13][14] . The severity of the lesion in the brainstem is strongly associated with death during or after the neonatal period, lesions in the basal ganglia and thalamus are correlated with the inability to wander without aid, at two years of age 15 .…”

Diagnóstico por imagem e aspectos clínicos da trombose venosa cerebral em recém-natos a termo sem dano cerebral: revisão em 10 anos

“…TFUS with Doppler fluxometry presents great advantages, principally the noninvasiveness to measure blood flow velocity in intracranial vessels and to evaluate physiopathological changes in the cerebral hemodynamics, besides the bed-side capability, low cost and non-necessity of sedation and of ionizing radiation exposure (24)(25)(26)(27) . Several studies on TFUS Doppler fluxometry have demonstrated changes of RI in pathological conditions as, for example, hypoxia with presence of reversed diastolic flow, inclusive, reflecting the increased vascular resistance as a result from edema (17,24) .…”

“…Several studies on TFUS Doppler fluxometry have demonstrated changes of RI in pathological conditions as, for example, hypoxia with presence of reversed diastolic flow, inclusive, reflecting the increased vascular resistance as a result from edema (17,24) . The results of the present study are in agreement with the literature, considering that the increased RI values were observed in all the studied vessels.…”