Risk factors and onset time of periventricular hemorrhagic infarction in preterm born children and periventricular venous infarction in term born children
Date
2024-01-24
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Abstract
Insult võib esineda kogu elu jooksul, sealhulgas ka vastsündinutel ja looteeas. Vastsündinueas esineb insulti ligikaudu ühel lapsel tuhande elussünni kohta. Insult loote- ja vastsündinuperioodil toob kaasa elukestva motoorse kahjustuse, kognitiivsed- ja käitumishäired, epilepsia ning sotsiaalsed probleemid, mis on sageli kombineeritud. Insult mõjutab nii lapsi kui ka nende lähedasi terve elu ja rehabilitatsiooniks kulub tohutu ühiskonna ressurss. Seetõttu on oluline insuldi ennetamine ja varajane avastamine.
Looteeas kujuneva insuldi tekkepõhjused pole selged, kuna insult on harvaesinev ja suhteliselt vähe uuritud. Lisaks on looteeas tekkinud insuldi korral lapsed sünnijärgselt tihti ilma sümptomiteta ja neuroloogilised sümptomid ilmnevad alles imikueas. Püsiva neuroloogilise häire leevendamiseks on aga oluline alustada varakult rehabilitatsiooniga.
Uurimistöö eesmärk oli uurida emade rasedus- ja sünnitusaegseid riskitegureid ning geneetilisi riske enneaegsetel lastel, kellel insult on välja kujunenud sünnimomendiks, ja ajalistel lastel, kellel looteea insuldi sümptomid avalduvad imikueas.
Uuringu tulemused näitavad, et rasedusaegne infektsioon on oluline riskitegur ajukahjustuse tekkimisel nii enneaegselt kui ajaliselt sündinud lastel. Neeruvaagnapõletik emal tõstab 43-kordselt insuldi tekkimise riski lootel. Tähtis on vältida ja kiirelt ravida rasedusaegseid kuse-suguteede põletikke, aga ka teisi ema bakteriaalseid infektsioone. Ema infektsiooni järgselt on soovitav last jälgida ja vajadusel teha ultraheliuuring peast, et võimalikult varakult avastada insult ja alustada rehabilitatsiooniga. Leidsime, et kuna insuldiga lastel on geneetilised muutused sagedased, siis kõiki insuldiga vastsündinuid peaks geneetiliselt uurima, et leida perekondlikud juhud. Uuringus saadud teadmised on olulised kõigile arstidele, kes puutuvad kokku rasedate raviga. Kuna ema rasedusaegne infektsioon võib kahjustada loote aju, siis seda infektsiooni tuleb kiiresti ravida.
Stroke can occur during the entire lifetime, including the fetal and neonatal periods. The incidence of stroke in the neonatal period is 1:1000 live births. Stroke occurring in the fetal or neonatal period leads to lifelong combined motor, cognitive and language impairment, epilepsy, and behavioral and social problems. Stroke impacts children and their families during the entire life, while substantial societal resources are allocated for rehabilitation. Therefore, prevention and early recognition of stroke are of great importance. The etiology of fetal stroke is not fully understood, because this stroke is relatively rare and poorly researched. Additionally, fetal stroke does not often present with symptoms after birth and symptoms will develop later in infancy. In the case of stroke, it is crucial to initiate early rehabilitation. The aim of the research was to study pregnancy and delivery associated risk factors and genetic risks in preterm children with fetal development of stroke and in term born children with stroke, in whom the symptoms of fetal stroke develop during infancy. According to the results of this research, infection during pregnancy is an important risk factor for brain damage in preterm and term born children. Pyelonephritis in pregnant women can increase the risk for fetal stroke 43 times. Prevention and prompt treatment of maternal genitourinary infections and other bacterial infections is essential. In neonates born to mothers with severe bacterial infection during pregnancy, neurological monitoring and cerebral ultrasonography are indicated for early detection of stroke and for early rehabilitation. Children with stroke show high prevalence of pathogenic variants in collagen genes, and should be tested for familial cases. The results of the research are useful for all physicians who treat pregnant women. Maternal bacterial infection during pregnancy can damage the fetal brain and should be treated promptly.
Stroke can occur during the entire lifetime, including the fetal and neonatal periods. The incidence of stroke in the neonatal period is 1:1000 live births. Stroke occurring in the fetal or neonatal period leads to lifelong combined motor, cognitive and language impairment, epilepsy, and behavioral and social problems. Stroke impacts children and their families during the entire life, while substantial societal resources are allocated for rehabilitation. Therefore, prevention and early recognition of stroke are of great importance. The etiology of fetal stroke is not fully understood, because this stroke is relatively rare and poorly researched. Additionally, fetal stroke does not often present with symptoms after birth and symptoms will develop later in infancy. In the case of stroke, it is crucial to initiate early rehabilitation. The aim of the research was to study pregnancy and delivery associated risk factors and genetic risks in preterm children with fetal development of stroke and in term born children with stroke, in whom the symptoms of fetal stroke develop during infancy. According to the results of this research, infection during pregnancy is an important risk factor for brain damage in preterm and term born children. Pyelonephritis in pregnant women can increase the risk for fetal stroke 43 times. Prevention and prompt treatment of maternal genitourinary infections and other bacterial infections is essential. In neonates born to mothers with severe bacterial infection during pregnancy, neurological monitoring and cerebral ultrasonography are indicated for early detection of stroke and for early rehabilitation. Children with stroke show high prevalence of pathogenic variants in collagen genes, and should be tested for familial cases. The results of the research are useful for all physicians who treat pregnant women. Maternal bacterial infection during pregnancy can damage the fetal brain and should be treated promptly.
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Keywords
enneaegsed lapsed, vastsündinud, insult, riskitegurid, premature infants, stroke, risk factors, newborns