PREGLED NEUROPROTEKTIVNIH STRATEGIJA KOD PRETERMINSKE NOVOROĐENČADI
DOI:
https://doi.org/10.46793/PP241127001PKljučne reči:
prematuritet, preterminsko novorođenče, neurorazvojna oštećenja, neuroprotekcija, oštećenje mozgaApstrakt
Sa napretkom antenatalne i neonatalne terapije i nege, preživljavanje preterminske novorođenčadi, posebno ekstremno nezrele je poraslo. Oštećenje mozga javlja se znatno češće kod preterminske u odnosu na terminsku novorođenčad, što je povezano i sa većim rizikom od neurorazvojnih poremećaja. Tri uobičajena i česta oblika oštećenja mozga preterminske novorođenčadi su intraventrikularno krvarenje, oštećenje bele i sive moždane mase. Postoje brojne antenatalne, intrapartalne i postnatalne strategije u cilju smanjenja rizika od oštećenja mozga preterminske novorođenčadi i lošeg neurorazvojnog ishoda. Pre svega, studije su pokazale da antenatalna primena kortikosteroida i magnezijum-sulfata u slučaju pretećeg prevremenog porođaja ima važnu ulogu u smanjenju rizika od oštećenja mozga i neurorazvojnih poremećaja. Takođe, odloženo klemovanje pupčane vrpce i mnoge intervencije u ranom neonatalnom periodu, kao što su održavanje optimalne ventilacije i hemodinamske stabilnosti, praćenje koncentracije glukoze u krvi, prepoznavanje neonatalnih napada i primena lekova protiv napada, upotreba kofeina i optimalna ishrana utiču na poboljšanje neurološkog razvoja preterminske novorođenčadi. Krajem 20. veka razvijen je poseban program za negu i procenu ponašanja novorođenčadi. Neonatalna individualizovana razvojna nega i program procene, koji se danas koristi u mnogim jedinicama neonatalne intenzivne nege u cilju minimiziranja razvojnih poremećaja preterminske novorođenčadi. Brojni lekovi i intervencije čiji se mogući neuroprotektivni efekti istražuju uključuju blagu hipotermiju, eritropoetin, melatonin, alopurinol, terapiju matičnim ćelijama, suplementaciju vitaminom D kod majke tokom trudnoće, terapiju zasnovanu na egzozomima i dr.
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