NEURORAZVOJNI ISHOD PRETERMINSKE NOVOROĐENČADI
Sažetak
Oko 15 miliona dece se rodi pre vremena svake godine. Prevremeni porođaj je glavni uzrok smrti dece mlađe od pet godina širom sveta. Novorođenčad rođena sa veoma malom telesnom masom (< 1500 g) i rođena veoma pre vremena (< 32 nedelje gestacije) su u visokom riziku za neurorazvojna kašnjenja. Tri uobičajena i česta oblika oštećenja mozga prematurusa su intraventrikularno krvarenje, oštećenje bele i sive moždane mase. Zastoj u motornom razvoju se identifikuje rano kod preterminske novorođenčadi, posebno tokom prve tri godine života. Najveći motorni deficit je cerebralna paraliza, ali se u školskom uzrastu dijagnostikuje manja motorna disfunkcija, označena kao poremećaj razvojne koordinacije. Drugi domen u kome se identifukuje razvojno kašnjenje je kognitivni razvoj. Prevremeno rođena deca imaju niži koeficijent inteligencije i visok rizik od kašnjenja u razvoju govora i jezika. Niska gestacijska starost i niska telesna masa na rođenju su faktori rizika za emocionalne poremećaje, poremećaj pažnje i hiperaktivnost i poremećaje iz autističnog spektra. Inicidencija oštećenja vida i gubitka sluha opada sa porastom gestacijske starosti na rođenju. Intrakranijalna hemoragija i neonatalne konvulzije su identifikovani kao istaknuti faktori rizika za kasniju pojavu epilepsije. Ključna strategija za smanjenje neurorazvojnog kašnjenja je prevencija prevremenog porođaja. Transport žena sa rizikom od prevremenog porođaja i porođaj u tercijarnom centru, prenatalna primena glukokortikoida i magnezijum sulfata smanjuje rizik od oštećenja mozga kod prematurusa i poboljšava neurorazvojni ishod. Takođe, program „Neonatalna individualizovana razvojna nega i program procene” i metoda „kontakt koža-na-kožu” (eng. Kangaroo Mother Care) imaju povoljan efekat na neurorazvojni ishod preterminske novorođenčadi. Buduća istraživanja trebalo bi da donesu nove preporuke za neuroprotekciju preterminske novorođenčadi.
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