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CNAA / Theses / 2009 / June /

The incidence of neurological outcomes in preterm newborns with extreme and very low birth weight with intrauterine infection


Author: Miron Anna
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2009
Scientific adviser: Ion Iliciuc
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Petru Stratulat
doctor habilitat, professor, Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Institution:
Scientific council:

Status

The thesis was presented on the 17 June, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document0.41 Mb / in romanian

Keywords

preterm, extremely and very low birth weight, intrauterine infection, inflammation, neurodevelopment, proiflamatory cytokines, neurological sequelaes, cerebral palsy, neurodevelopment evaluation tests

Summary

In this scientific research we suggest that neurological disabilities frequently diagnosticated in preterm children can be associated with intrauterine infection exposure that frequently is a major cause of prematurity. For the first time was designed a complex study about the neurodevelopmental peculiarities of preterm newborns with extreme and very low birth weight, that alow to establish the incidence of neurological outcomes. It was elaborated the algorithm of normal neurodevelopment of preterm newborns with extreme and very low birth weight from 28 gestational weeks to 40 gestational weeks. It was established neurological signs of alertness from neonatal period associated with development of neurological disabilities to 24 months corrected age.

It was determinate the role of proinflammatory cytokines (IL-1α, IL-1β, IL-6, TNF-α) in early neonatal period and development of neurological disabilities in dynamic. It was established that high concentration of IL-1α and IL-6 in blood serum are markers in prognostic of severe intraventricular hemorrhage and subsequent development of neurological disabilities. The high serum concentration of IL-6 is a marker in diagnostic of inflammatory process and intrauterine infection with early prognosis of the risk of infection realization and neurological disabilities. It was established that association of high concentration of proinflammatory cytokines in blood serum and the histological corioamnionitis are a major factor of risk for development of neurological disabilities.

It was demonstrated the importance of evaluation of neurodevelopment with neurocomportamental tests at 3, 6, 9, 12, 18 and 24 months corrected age: BINS (Bayley Infant Neurodevelopment Screener) and BSID-III (Bayley Scale of Infant and Toddler Development III edition). For the first time it was obtained an objective early diagnosis of major and minor disabilities of neurodevelopmental domains: Cognitive, Receptive Language, Expressive Language, Fine Motor and Gross Motor. It was established the importance of diagnosis and early rehabilitation for prevention and amelioration of the neurological handicap. It was demonstrated the practical utility of the use of Developmental Coefficient from Gissel.

It was established the criterias that defined the optimality of cerebral function in neurodevelopment to 24 months corrected age for preterm newborns with extreme and very low birth weight. It was determinate the hierarchy of neurological signs of alertness in development of neurological disabilities. It was established the connection between the extreme prematurity with extreme and very low birth weight and the determinant role of proinflammatory cascade in frame of intrauterine infection for development of neurological disabilities in dynamic. It was elaborated the algorithm of diagnosis and prophylaxis of neurological disabilities at preterm children with extreme and very low birth weight.

Implementation of the algorithm of diagnosis and prophylaxis of neurological disabilities at preterm children with extreme and very low birth weight and of follow-up protocol will be an action etalon in neuropediatric practice.