Yoğun Bakim Üni̇temi̇zde Kan Transfüzyon Sikliği Ve Transfüzyon Eşi̇k Değerleri̇

Abstract

N eonatal convulsions are one of the most common emergency neurological diseases in the neonatal period. Since the potential adverse effects of convulsions on the brain are known, they must be treated urgently. In recent years, many studies have examined the use of anticonvulsant drugs in the newborn period; however, there is currently no standardized treatment protocol for neonatal convulsion management. A convulsion is defined as a transient change in neurological function caused by a sudden, paroxysmal depolarization of a group of neurons. In cases of convulsions seen in the neonatal period, it is important to consider the seriousness of potential underlying diseases, the treatments that might be applied targeted at the etiology, and to remember that repetitive convulsions may have a permanent effect on the brain. [1,2] The frequency of neonatal convulsion has been reported to be 1.5 to 3 in 1000 live births. [3] Pathophysiology Neonates have immature neurons and differences in neurotransmitter levels make them susceptible to seizures. [4] Immature neurons contain a larger number of excitatory N-methyl-D-aspartate and α-amino-3-hydroxy-5-methyl-4isoxazolpropionic acid (AMPA) receptors, and fewer gamma-aminobutyric acid (GABA) receptors, which is one of the reasons for a low convulsion threshold in neonates. In addition, unlike in adults, GABAA receptors in neonates work as excitators through sodium-potassium-chloride cotransporter 1 (NKCC1), which also contributes to a low convulsion threshold. [5] (Fig. 1) In addition, in cases of hypoxia, the NKCC1 channel is upregulated and the convulsion threshold is decreased even more. Neonatal convulsions are one of the most common emergency neurological events in the early period after birth. The frequency has been reported to be 1.5 to 3 in 1000 live births. It has been established that the convulsion threshold is lower in infants due to immature neonatal neurons and differences in neurotransmitters. Hypoxic ischemic encephalopathy is the most common etiology in neonatal convulsions. Other causes vary, and may be related to the level of development of the country. Convulsions are classified into 4 different types according to the clinical findings. The most common is the subtle (undefined) type of seizure; the other types are defined as clonic, tonic, and myoclonic seizures. Non-epileptic paroxysmal movements frequently seen in the neonatal period, should not be confused with seizures. The most common non-epileptic paroxysmal movements are jitteriness, benign neonatal sleep myoclonus, and hyperekplexia. A newborn that experiences convulsions should be hospitalized and monitored with continuous video electroencephalogram, if possible. If an initial rapid evaluation detects an acute metabolic disorder, treatment is provided, and, if warranted, it will be followed by a plan for further treatment with anticonvulsant drugs. Phenobarbital is still currently recommended as first-line therapy, though there are studies of other anticonvulsant drugs. Levetiracetam and phenytoin...