apresentação do powerpoint•hipóxia-isquemia •hemorragia (parenquimatosa, intraventricular)...
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NEUROPROTECÇÃO
Serviço de Neonatologia
Centro Materno Pediátrico
Centro Hospitalar Universitário São João
Faculdade de Medicina da Universidade do Porto
Lisboa
4 de Dezembro
2019
48º Congresso Português de Neonatologia
Ana Vilan
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• Hipóxia-isquemia• Hemorragia (parenquimatosa,
intraventricular)• Infecção• AVC• Hiperbilirrubinemia• Trauma
• 1-3/1000 EHI• 12% partos prematurosLundgren et al, 2018WHO Fact sheet, 2012
Abordar as várias intervenções pré clínicas e clínicas na lesão cerebral no recém nascido termo e pré termo
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Quanto mais cedo melhor….
Gunn A et al. Early Hum Dev 1998
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48h,72h,120h…32°C vs 33.5°C
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Encefalopatia leve
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Mas….
• Apesar do tratamento com hipotermia induzida, cerca de 40-50% morrem ou ficam com sequelas neurológicas
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• Ion-channels• Phenobarbital
• Ketamin
• Amiloride
• Xenon-inhalation
• Topiramate
• Levetiracetam
• Anti-oxidants• Erythropoietin
• Allopurinol
• Selective NOS-inhibitors
• Anti-inflamation• Erythropoietin
• Melatonin
• IL-10
• Trophic factors• Erythropoitin
• Growth factors
• Others• Bumetamide
• Stem cell therapyJohsnton MV. Lancet Neurol 2011;10:372-82
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Pediatr Neurol. 2014 Oct; 51(4): 481–488.
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Volpe J. Volpe´s Neurology of Newborn. 6th edition
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HSJ : 1 Dez 2001 - 31 Nov 2012 (10 years)
• Subjects
• Diagnostic coding of hydrocephaly after IVH
• Exclusion: > 37 weeks GA, brain malformations
• Results
• 27 infants
• Inborn – 12 (44%)
• Outborn – 15 (55.6%)
• Male -13 (48.1%)
• Female – 14 (51.9%)
GA(weeks) n (%)
24-26 5 (18.5%)
27-28 13 (48.1%)
29-30 3 (11.1%)
31-32 2 (7.4%)
33-34 2 (7.4%)
35-36 2 (7.4%)
• Results
• Diagnostic approach
• CT - 13 (48.1%)
• cUS - 8 (29.6%)
• MR - 6 (22.2%)
• Treatment modalities
• VPS – 12 (66.7%)
• External drain – 5 (27.85)
• Reservoir (Omaya) – 1 (5.5%)
• Infection
• 4 (22.2%)
Birth weigt (g) N (%)
< 1000 11 (40.7%)
1000-1499 12 (44.4%)
1500-1999 2 (7.4%)
2000-2499 1 (3.7%)
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• Results
• More than 1 intervention
• N=10 (1 with 17 and another one with 19 during the first 2 twoyears of life)
• Outcome
• Death – 6 (22%)
• Severe disability – 11 (40.7%)
• Mild disability – 1 (3.7%)
• Normal – 4 (14.8%)
• ? – 5 (18.5%)
HSJ : 1 Dez 2001 - 31 Nov 2012 (10 years)
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Resumo
• Diversos “caminhos” para atingir a neuroprotecção
• A hipotermia induzida é o standard of care para a EHI moderada a grave nos RN termo. No entanto, o protocolo actual é parcialmente eficaz
• ….as 1as 72h de vida…janela de oportunidades
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