Encefalopatia hipóxico-isquêmica em recém-nascidos a termo: aspectos da fase aguda e evolução

Funayama, Carolina A. R.; Moura-Ribeiro, Maria Valeriana L. de; Gonçalves, Arthur Lopes

doi:10.1590/S0004-282X1997000500014

Resumos

Noventa e quatro recém-nascidos com encefalopatia hipóxico-isquêmica (EHI), atendidos no Hospital das Clínicas de Ribeirão Preto desde 1982, foram avaliados evolutivamente na fase aguda e por período médio de 47 meses. De 43 casos com EHI 1,40 se recuperaram em 96 horas e 3 faleceram. Dos 40 com EHI II, 37,5% se recuperaram até o sétimo dia e demais permaneceram com alterações. Os 11 casos com grau III faleceram até o segundo mês de vida. As crianças com EHI grau I não apresentaram seqüelas motoras. Do grupo com EHI grau II 34,5% apresentaram paralisia cerebral e 17,7% atraso neuromotor. 80% dos casos com sequela apresentaram exame neurológico anormal além do sétimo dia, na fase aguda da EHI. Epilepsia ocorreu em 17,5% dos casos com EHI grau II e somente no grupo com seqüelas motoras. Teste de QI não evidenciou diferença significativa entre os grupos com grau I, II sem seqüelas motoras e o grupo controle. Com esses dados os autores reafirmaram a importância prognostica da evolução da EHI na fase aguda.

asfixia neonatal; paralisia cerebral; fatores de risco; seguimento

Ninety four neonates with hypoxic ischemic encephalopathy HIE attended at the University of Ribeirão Preto since 1982 were studied in terms of the neurological alterations during the acute phase and outcome over a mean period of 47 months. From 43 newborns with HIE I, 40 recovered within 96 hours and 3 died. Among 40 infants with HIE II, 37.5% recovered within the first week, and the others continued abnormal beyond the 7th day. All 11 infants with HIE III died before the second month of life. The HIE I group had no motor sequelae. Among the HIE II group, 34.5% showed cerebral palsy and 17.7% neuromotor retardation. 80.0% of those with sequelae persisted abnormal beyond 7th day of life, during the acute phase of the HIE. Epilepsy occurred in 17.5% of cases with HIE grade II, only among those with neuromotor sequelae. The 1Q test did not show statistically significant difference between the HIE I, II without motor sequelae and the control groups. The authors reaffirm the value of the findings in the acute phase of HIE on the outcome of these patients.

neonatal asphyxia; cerebral palsy; risk factors; follow-up

Encefalopatia hipóxico-isquêmica em recém-nascidos a termo: aspectos da fase aguda e evolução

Perinatal hypoxic-ischemic encephalopathy: acute period and outcome

Carolina A. R. Funayama^I; Maria Valeriana L. de Moura-Ribeiro^II; Arthur Lopes Gonçalves^III

^IProfessor Doutor do Departamento de Neurologia, Psiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP/USP)

^IIProfessor Associado do Departamento de Neurologia da Faculdade de Medicina da Universidade Estadual de Campinas

^IIIProfessor Titular do Departamento de Puericultura e Pediatria da FMRP/USP

RESUMO

Noventa e quatro recém-nascidos com encefalopatia hipóxico-isquêmica (EHI), atendidos no Hospital das Clínicas de Ribeirão Preto desde 1982, foram avaliados evolutivamente na fase aguda e por período médio de 47 meses. De 43 casos com EHI 1,40 se recuperaram em 96 horas e 3 faleceram. Dos 40 com EHI II, 37,5% se recuperaram até o sétimo dia e demais permaneceram com alterações. Os 11 casos com grau III faleceram até o segundo mês de vida. As crianças com EHI grau I não apresentaram seqüelas motoras. Do grupo com EHI grau II 34,5% apresentaram paralisia cerebral e 17,7% atraso neuromotor. 80% dos casos com sequela apresentaram exame neurológico anormal além do sétimo dia, na fase aguda da EHI. Epilepsia ocorreu em 17,5% dos casos com EHI grau II e somente no grupo com seqüelas motoras. Teste de QI não evidenciou diferença significativa entre os grupos com grau I, II sem seqüelas motoras e o grupo controle. Com esses dados os autores reafirmaram a importância prognostica da evolução da EHI na fase aguda.

Palavras-chave: asfixia neonatal, paralisia cerebral, fatores de risco, seguimento.

ABSTRACT

Ninety four neonates with hypoxic ischemic encephalopathy HIE attended at the University of Ribeirão Preto since 1982 were studied in terms of the neurological alterations during the acute phase and outcome over a mean period of 47 months. From 43 newborns with HIE I, 40 recovered within 96 hours and 3 died. Among 40 infants with HIE II, 37.5% recovered within the first week, and the others continued abnormal beyond the 7^th day. All 11 infants with HIE III died before the second month of life. The HIE I group had no motor sequelae. Among the HIE II group, 34.5% showed cerebral palsy and 17.7% neuromotor retardation. 80.0% of those with sequelae persisted abnormal beyond 7^th day of life, during the acute phase of the HIE. Epilepsy occurred in 17.5% of cases with HIE grade II, only among those with neuromotor sequelae. The 1Q test did not show statistically significant difference between the HIE I, II without motor sequelae and the control groups. The authors reaffirm the value of the findings in the acute phase of HIE on the outcome of these patients.

Key words: neonatal asphyxia, cerebral palsy, risk factors, follow-up.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 11-julho-1997.

Dra Carolina A. R. Funayama - Departamento de Neurologia - HC - Campus -14048-900 Ribeirão Preto - Brasil

1. André M, Vert P, Debruille CH. Diagnostic et evolution de la souffrance cerebrale chez les nouveau-nés ayant presents des signes d'hypoxie foetale: étude prospective. Arch Fr Ped 1978;35:23-36.
2. Apgar V. A proposal for a new method of evaluation of the newborn infant. Anesth Analg 1953;32: 260-267.
3. Bergamasco B, Benna P, Ferrero P, Gavinelli R. Neonatal hypoxia and epileptic risk: a clinical prospective study. Epilepsia 1984;25:131-136.
4. D'Souza SW, Richards B. Neurological sequelae in newborn babies after perinatal asphyxia. Arch Dis Child 1978;53:564-569.
5. Diament AJ. Evolução neurológica do lactente normal. São Paulo: EDART, 1976.
6. Fenichel GM. Hypoxi/Ischemic encephalopathy in the newborn. Arch Neurol 1983;40:261-266.
7. Fenichel GM, Webster DL, Wong WKT. Intracranial hemorrhage in the term newborn. Arch Neurol 1984,41:30-34.
8. Finer N, Robertson CM, Richards RT, Pinnel LE, Peters KL. Hypoxic-ischemic encephalopathy in term neonates: perinatal factors and outcome. J Pediatr 1981;98:112-117.
9. Funayama CAR. Encefalopatia hipóxico-isquêmica perinatal: aspectos epidemiológicos, neurológicos da fase aguda e evolutivos - Tese - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Ribeirão Preto, 1990.
10. Funayama CAR, Moura-Ribeiro MVL, Gonçalves AL. Encefalopatia hipóxico-isquêmica perinatal: aspectos epidemiológicos. Pediatria 1991;67:371-374.
11. Gherpelli JLD, Ferreira H, Costa HPF. Neurological follow-up of small-for- gestational age newborn infants: a study of risk factors related to prognosis at one year of age. Arq Neuropsiquiatr 1993 ;51:50-58.
12. Lefèvre AB. Exame neurológico evolutivo. São Paulo: Sarvier, 1972.
13. Levene MI, Grindulis H, Sands C, Moore JR. Comparation of two methods of predicting outcome in perinatal asphyxia. Lancet, 1986;1:67-68.
14. Lombroso CT. Prognosis in neonatal seizures. Adv Neurol 1983;34:101-113.
15. Michaelis R, Shulte FJ, Noite R. Motor behaviour of small-for-gestational age newborn infants. J Pediatr 1970;76:208-213.
16. Nelson KB, Ellenberg JH. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979;64:225-232.
17. Robertson CM, Finer N. Term infants with hypoxic-ischemic encephalopathy: outcome at 3,5 years. Dev Med Child Neurol 1985;27:437-484.
18. Robertson CM, Finer N, Grace MG. School perfomance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr 1989;114:753-760.
19. Saint-Anne Dargassies S. Desarollo neurológico del recien nacido de termino y prematuro. Buenos Aires: Médica Panamericana 1977.
20. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol 1976;33:696-705.
21. Scher MS, Aso K, Begarly ME, Hamid MY, Steppe DA, Painter MJ. Electrographic seizures in preterm and full-term neonates: clinical correlates associated brain lesions, and risk for neurologic sequelae. Pediatrics 1993;91:128-134.
22. Terman LM, Merrill MA. Stanford-Binet Intelligence Scale (Form L-M). Manual for the 3^rd revision, Norms Edition. Boston: Houghton Mifflin, 1973.
23. Van Kranen-Mastenbroek VHDM, Folmer KB, Kingma H, et al. Postural behavior of term SGA and AGA newborn infants. Dev Med Child Neurol 1993;35:516-524.
24. Volpe JJ. Neurology of the newborn. 3Ş. ed. Philadelphia: Saunders, 1995:314-348.
25. Zdanska-Brincken M, Wolánski N. A graph method for the evaluation of motor development in infants. Dev Med Child Neurol 1969;11:228-241.

Datas de Publicação

Publicação nesta coleção
07 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. André M, Vert P, Debruille CH. Diagnostic et evolution de la souffrance cerebrale chez les nouveau-nés ayant presents des signes d'hypoxie foetale: étude prospective. Arch Fr Ped 1978;35:23-36.

[2] 2. Apgar V. A proposal for a new method of evaluation of the newborn infant. Anesth Analg 1953;32: 260-267.

[3] 3. Bergamasco B, Benna P, Ferrero P, Gavinelli R. Neonatal hypoxia and epileptic risk: a clinical prospective study. Epilepsia 1984;25:131-136.

[4] 4. D'Souza SW, Richards B. Neurological sequelae in newborn babies after perinatal asphyxia. Arch Dis Child 1978;53:564-569.

[5] 5. Diament AJ. Evolução neurológica do lactente normal. São Paulo: EDART, 1976.

[6] 6. Fenichel GM. Hypoxi/Ischemic encephalopathy in the newborn. Arch Neurol 1983;40:261-266.

[7] 7. Fenichel GM, Webster DL, Wong WKT. Intracranial hemorrhage in the term newborn. Arch Neurol 1984,41:30-34.

[8] 8. Finer N, Robertson CM, Richards RT, Pinnel LE, Peters KL. Hypoxic-ischemic encephalopathy in term neonates: perinatal factors and outcome. J Pediatr 1981;98:112-117.

[9] 9. Funayama CAR. Encefalopatia hipóxico-isquêmica perinatal: aspectos epidemiológicos, neurológicos da fase aguda e evolutivos - Tese - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Ribeirão Preto, 1990.

[10] 10. Funayama CAR, Moura-Ribeiro MVL, Gonçalves AL. Encefalopatia hipóxico-isquêmica perinatal: aspectos epidemiológicos. Pediatria 1991;67:371-374.

[11] 11. Gherpelli JLD, Ferreira H, Costa HPF. Neurological follow-up of small-for- gestational age newborn infants: a study of risk factors related to prognosis at one year of age. Arq Neuropsiquiatr 1993 ;51:50-58.

[12] 12. Lefèvre AB. Exame neurológico evolutivo. São Paulo: Sarvier, 1972.

[13] 13. Levene MI, Grindulis H, Sands C, Moore JR. Comparation of two methods of predicting outcome in perinatal asphyxia. Lancet, 1986;1:67-68.

[14] 14. Lombroso CT. Prognosis in neonatal seizures. Adv Neurol 1983;34:101-113.

[15] 15. Michaelis R, Shulte FJ, Noite R. Motor behaviour of small-for-gestational age newborn infants. J Pediatr 1970;76:208-213.

[16] 16. Nelson KB, Ellenberg JH. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979;64:225-232.

[17] 17. Robertson CM, Finer N. Term infants with hypoxic-ischemic encephalopathy: outcome at 3,5 years. Dev Med Child Neurol 1985;27:437-484.

[18] 18. Robertson CM, Finer N, Grace MG. School perfomance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr 1989;114:753-760.

[19] 19. Saint-Anne Dargassies S. Desarollo neurológico del recien nacido de termino y prematuro. Buenos Aires: Médica Panamericana 1977.

[20] 20. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol 1976;33:696-705.

[21] 21. Scher MS, Aso K, Begarly ME, Hamid MY, Steppe DA, Painter MJ. Electrographic seizures in preterm and full-term neonates: clinical correlates associated brain lesions, and risk for neurologic sequelae. Pediatrics 1993;91:128-134.

[22] 22. Terman LM, Merrill MA. Stanford-Binet Intelligence Scale (Form L-M). Manual for the 3^rd revision, Norms Edition. Boston: Houghton Mifflin, 1973.

[23] 23. Van Kranen-Mastenbroek VHDM, Folmer KB, Kingma H, et al. Postural behavior of term SGA and AGA newborn infants. Dev Med Child Neurol 1993;35:516-524.

[24] 24. Volpe JJ. Neurology of the newborn. 3Ş. ed. Philadelphia: Saunders, 1995:314-348.

[25] 25. Zdanska-Brincken M, Wolánski N. A graph method for the evaluation of motor development in infants. Dev Med Child Neurol 1969;11:228-241.