Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia; Línea de Investigación en Discapacidad, Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
Biomedica. 2021 Mar 19;41(1):8-16. doi: 10.7705/biomedica.5436.
Hypoxic-ischemic encephalopathy is a frequent and important cause of neurological problems in term and preterm newborns. A sentinel event of this entity is the vasa previa, specifically when there is an abnormality of the placenta such as a velamentous cord insertion. Some reports have shown the association between these two entities, but those regarding the recovery process and the neurological prognosis of children with both conditions are scarce. We present the case of a patient with a history of velamentous cord insertion and hypoxicischemic encephalopathy who received therapeutic hypothermia (cool cap). We describe his neurological rehabilitation process and we calculated the percentage of probability of presenting this condition compared to the population without these factors. The patient was a five-year-old boy with an Apgar index at birth equal to zero at one minute and equal to two at fifteen minutes who developed severe hypoxic-ischemic encephalopathy secondary to a velamentous cord insertion without prenatal diagnosis and a marked initial neurological and multisystemic compromise. The recovery process included early multidisciplinary management in the neonatal intensive care unit and a focus on early neurological habilitation. The patient is currently in school and he undergoes comprehensive therapies; on physical examination, he presents no motor or sensory deficiencies. His neuropsychological test suggests the risk of attention deficit hyperactivity disorder. Children with severe hypoxicischemic encephalopathy usually have disabilities due to motor, cognitive, and/or behavioral deficiencies.
缺氧缺血性脑病是足月和早产儿神经系统问题的常见且重要病因。该病症的一个重要事件是前置血管，特别是当胎盘存在异常如帆状脐带插入时。一些报告显示了这两种情况之间的关联，但关于同时存在这两种情况的儿童的恢复过程和神经预后的报告却很少。我们介绍了一位有帆状脐带插入和缺氧缺血性脑病病史并接受了治疗性低温（冷却帽）的患者。我们描述了他的神经康复过程，并计算了与没有这些因素的人群相比，他出现这种情况的概率百分比。该患者是一名五岁男孩，出生时的 Apgar 评分为一分钟时为零，十五分钟时为二，因帆状脐带插入且无产前诊断以及明显的初始神经和多系统受损而发生严重缺氧缺血性脑病。恢复过程包括在新生儿重症监护病房进行早期多学科管理和早期神经康复。目前该患者正在上学，他接受了全面的治疗；体格检查未发现运动或感觉缺陷。他的神经心理学测试提示注意缺陷多动障碍的风险。患有严重缺氧缺血性脑病的儿童通常因运动、认知和/或行为缺陷而存在残疾。
