perinataluri asfiqsia / hipoqsiur-iSemiuri encefalopaTia

perinataluri asfiqsia / 

hipoqsiur-iSemiuri 

encefalopaTia 

klinikuri praqtikis erovnuli rekomendacia 

(gaidlaini) 

1

klinikuri praqtikis erovnuli rekomendacia (gaidlaini) 

`perinataluri asfiqsia / hipoqsiur-iSemiuri encefalopaTia~ 

miRebulia klinikuri praqtikis erovnuli rekomendaciebis 

(gaidlainebi) da daavadebaTa marTvis saxelmwifo standartebis 

(protokolebi) SemuSavebis, Sefasebis da danergvis erovnuli 

sabWos 2008 wlis 5 noembris #1 sxdomaze da damtkicebulia 

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis 

ministris 2009 wlis 14 aprilis # 142/o brZanebiT. 

2

perinataluri asfiqsia / hipoqsiur-iSemiuri 

encefalopaTia 

1. definicia, sinonimebi, terminologia 1-9 : 

definicia 

perinataluri asfiqsia mdgomareobaa, romelic viTardeba ante, intra an 

postnatalur periodSi Jangbadis miwodebis darRvevis gamo da xasiaTdeba 

bradikardiiT, airTa cvlis darRveviT da organoebis araadekvaturi 

perfuziiT. 

hipoqsiur–iSemiuri encefalopaTia (hie) Jangbadis araadekvaturi miwodebis 

gamo cns (Tavis da zurgis tvini) ujredebis dazianebaa, romelic vlindeba 

sunTqvis problemebiT, tonusisa da refleqsebis daqveiTebiT, cnobierebis 

darRveviT, gulyriT. hie-m SeiZleba gamoiwvios sikvdili neonatalur 

periodSi, mogvianebiT ki – ganviTarebis globaluri Seferxeba, mentaluri 

retardacia, cerebruli dambla 10,11 . hie-s diagnostikisaTvis saWiroa sami 

komponentis arseboba: darRvevebi orsulobis da mSobiarobis periodSi, 

adreul postnatalur periodSi klinikurad gamovlenili nevrologiuri 

darRvevebi da sicocxlis pirvelive dReebSi arsebuli sistemuri 

cvlilebebi. 

neonataluri depresia mdgomareobaa, romelic vlindeba mxolod sicocxlis 

pirveli saaTis ganmavlobaSi axalSobilis daTrgunviT da ar aris 

dakavSirebuli prenatalur paTologiasTan. igi ar moiTxovs laboratoriul 

da instrumentul kvlevebs. 

sinonimebi - perinataluri hipoqsia, iSemia, asfiqsia, axalSobilTa asfiqsia, 

dabadebis asfiqsia. 

gamoyenebuli Semoklebebi 

hie – hipoqsiur iSemiuri encefalopaTia 

gaidlaini gankuTvnilia 

⇒ samedicino personalisaTvis, romelic muSaobs axalSobilTan, rogorc 

samSobiaro saxlSi, ise stacionarSi – neonatologi, mean-ginekologi, 

ojaxis eqimi, pediatri. 

gaidlainis samizne jgufi: 

⇒ axalSobilebi, romlebsac aReniSnebaT perinataluri asfiqsia an misi 

ganviTarebis riski. 

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2. epidemiologia 

perinataluri asfiqsia/hipoqsiur-iSemiuri encefalopaTia (hie) axalSobilTa 

sikvdilobisa da avadobis erT-erT seriozul mizezad rCeba. 

perinataluri asfiqsiis sixSire gestaciis 28 kviraze daaxloebiT 30%, 

droul axalSobilebSi 20% Seadgens 13 . aSS-s janmrTelobis statistikis 

nacionaluri centris monacemebiT axalSobilTa asfiqsiiT gamowveuli 

sikvdiloba 14,4-ia yovel 100 000 cocxladSobilze. janmos monacemebiT 

msoflioSi asfiqsiiT 1 mln bavSvi iRupeba 14 . 

sxvadasxva qveynis monacemebiT mZime hipoqsiur iSemiuri encefalopaTiis 

sixSire Seadgens 2-9 SemTxvevas yovel 1000 cocxladSobilze 15,16 . 

mZime hie-s dros sikvdiloba 50-75%-ia, maT Soris yvelaze maRalia 

neonataluri sikvdiloba, romelic gamowveulia multiorganuli dazianebiT. 

hie-s iwvevs mentaluri retardaciis, epilefsiis, sxvadasxva xarisxis 

cerebruli damblis ganviTarebas. mZime hie-s dros zemoT aRniSnuli 

paTologia gvxvdeba SemTxvevaTa 90-100%, saSualo simZimis hie-s dros ki - 30- 

50% 17 , msubuqi hie-s dros seriozuli nevrologiuri garTulebebi SeiZleba 

ar ganviTardes. im SemTxvevebSic ki Tu ar aRiniSneba Tavis tvinis aSkara 

dazianeba 15-20%-Si SeiZleba aRiniSnos saskolo asakis bavSvebSi swavlis 

siZneleebi. 

3. etiopaTogenezi 1-9,18,19 

asfiqsiis/hie-s risk-faqtorebia: 

antenataluri: 

• saSvilosnosSiga zrdis Seferxeba; 

• mZime preeklamfsia; 

• vadagadacileba; 

• placentis paTologia; 

• dedis virusuli da baqteriuli infeqciebi; 

• sisxldena orsulobisas; 

• dedis farisebri jirkvlis da gul-sisxlZarRvTa paTologia. 

risk-faqtorebs miekuTvneba aseve: socialur_ekonomikuri statusi, gulyris 

an nevrologiuri daavadebis ojaxuri anamnezi, dafexmZimeba uSvilobis gamo 

mkurnalobis Semdeg. 

intranataluri: 

• persistuli oqcipitoposteriuli pozicia; 

• maRali temperatura mSobiarobis dros; 

• saswrafo sakeisro kveTa; 

• placentis gagleja; 

• swrafi vaginaluri mSobiaroba; 

• mwvave intranataluri mdgomareobebi: Wiplaris kompresia, prolapsi 

da a.S. 

4

neonataluri 

• araadekvaturi reanimacia; 

• pirveladi adaptaciis darRveva. 

paTfiziologia: 

hipoqsiur-iSemiuri encefalopaTia ganpirobebulia Tavis tvinis hipoqsiiTa da 

iSemiiT, rasac mosdevs neironebis dazianeba. hipoqsiis/asfiqsiis dasawyisSi 

viTardeba kompensatoruli reaqcia _ adrenalinis hiperproduqcia, sisxlis 

wnevis da cerebruli sisxlis nakadis gazrda (sisxlis mimoqcevis 

centralizacia), rac ganapirobebs Tavis tvinis perfuziis SenarCunebas. 

adreuli kompensaciuri meqanizmebis amowurvis Semdeg, qveiTdeba sisxlis 

wneva, mcirdeba cerebruli sisxlis nakadi, viTardeba hipoqsemia, rac iwvevs 

ujredSiga energetikul ukmarisobas. dazianebis adreul etapze Tavis tvinis 

temperatura qveiTdeba, gamoTavisufldeba neirogadamtani γ-aminoerbos mJava, 

rac amcirebs cerebruli oqsigenaciis moTxovnilebas da Sesabamisad 

tranzitorulad amcirebs asfiqsiis damzianebel efeqts. 

asfiqsiis sawyisi fazis Semdeg cerebruli metabolizmi SeiZleba aRdges, 

Tumca gauareseba viTardeba reperfuziis dros anu meorad fazaSi, romelic 

iwyeba sawyisi dazianebidan 6-24 sT-Si, xasiaTdeba tvinis SeSupebiT da 

apoptoziT (ujredebis programirebuli sikvdili). am fazas ewodeba – 

neironebis dazianebis mogvianebiTi faza. misi xangrZlivoba ar aris zustad 

cnobili, magram miCneulia rom is grZeldeba 24-48 sT, Semdeg ki iwyeba 

aRdgena. 

4. klinikuri simptomatika 1-9,19 : 

amerikis pediatriis akademiis (AAP) da amerikis meanobisa da ginekologiis 

kolejis (ACOG) gaidlainis Tanaxmad perinataluri asfiqsiis ZiriTadi 

kriteriumebia 13 : 

• Rrma metaboluri an Sereuli acidozi, Wiplaris arteriaSi pH < 7,00 

fuZeTaQdeficiti > 12 mmol/l 

• apgaris dabali qulebis (0-3) persistireba 5 wuTze met xans 

• klinikurad nevrologiuri darRvevebi (gulyra, hipotonia, koma) 

• adreul neonatalur periodSi poliorganuli sistemuri disfunqcia 

(Tirkmlis, RviZlis, sasunTqi, gul-sisxlZarRvTa da kuW-nawlvis 

traqtis dazianeba) 

Tu aRniSnuli maxasiaTeblebi ar aris gamoxatuli, SeuZlebelia asfiqsiis 

arsebobaze saubari. maRali apgaris qula > 6 gamoricxavs intranataluri 

asfiqsiis arsebobas 12 . 

asfiqsiis diagnostika mxolod apgaris qulebis mixedviT ar aris 

gamarTlebuli. sicocxlis me-5 wT-ze apgaris qula 3 an naklebi SeiZleba 

5

miuTiTebdes asfiqsiis arsebobaze mxolod sxva diagnostikur 

kriteriumebTan erTad. 

apgaris dabali qulebi hipoqsiis garda SesaZlebelia mTeli rigi 

faqtorebiT iyos ganpirobebuli. mocemuli faqtorebia 13 : 

• dRenakluloba da gestaciur asakTan SedarebiT mcire wona - am 

axalSobilebs axasiaTebT hipotonia, akrocianozi, nevrologiuri 

reaqciisa da refleqsebis daTrgunva. aqedan gamomdinare apgaris 

maqsimaluri qula SeiZleba iyos 6-7. gestaciis 30 kviramde dabadebul 

dRenaklulebSi apgaris qula SeiZleba 2-3 iyos asfiqsiis gareSec; 

• dedasTan gamoyenebuli medikamentebi - dedis anesTeziisa da analgeziis 

gamo ganviTarebuli depresia; 

• infeqcia; 

• nerv-kunTovani darRvevebi; 

• gul-sisxlZarRvTa Tandayolili mankebi. 

Tu apgaris qula 0-3-ia sicocxlis me-15 wuTze bavSvTa cerebruli damblis 

ganviTarebis sixSire 10%-s, xolo Tu me-20 wuTze - 60%_s Seadgens. 

klasifikacia: 

msubuqi Hhie: 

- sicocxlis pirvel dReebSi mcired momatebuli kunTTa tonusi da 

cocxali Rrma myesTa refleqsebi; 

- axalSobili agznebulia, moros da tacebis refleqsi gaZlierebulia. 

cnobierebis daTrgunva iSviaTia, SeiZleba gamovlindes Zilianoba. 

aRiniSneba gardamavali qceviTi anomaliebi, rogoricaa kvebasTan 

dakavSirebuli problemebi; 

- dabadebidan 3-4 dRisaTvis cns-is statusi SeiZleba iyos normaluri. 

sicocxlis pirvel saaTebSi simptomebis ararsebobas an msubuqi hies 

SeiZleba mohyves uecari gauareseba, romelic miuTiTebs Tavis tvinis 

ujredebis mimdinare disfunqciaze, dazianebasa da sikvdilze. 

saSualo simZimis hie: 

mZime hie: 

- vlindeba leTargia, mniSvnelovani hipotonia, daqveiTebuli Rrma 

myesTa refleqsebi; 

- tacebis, moros, wovis refleqsebi daTrgunulia an ar iwveva; 

- sicocxlis pirvel 24 sT-Si SeiZleba gamovlindes gulyra; 

- 1-2 kviraSi SesaZlebelia sruli gamojanmrTeleba, rac 

asocirebulia ukeTes gamosavalTan momavalSi. 

- vlindeba koma an stupori; 

- sunTqva SiZleba iyos araregularuli, axalSobils xSirad 

esaWiroeba damxmare ventilacia; 

6

- damaxasiaTebelia generalizebuli hipotonia da daTrgunuli Rrma 

myesTa refleqsebi; 

- wovis, ylapvis, tacebis, moros refleqsebi ar iwveva; 

- Tavis tvinis nervebis gamokvlevis dros SeiZleba gamovlindes 

Tvalebis asimetriuli deviacia, nistagmi, “Tojinis Tvalebi”; 

- Tvalis gugebi SeiZleba iyos gafarToebuli, Suqze reaqcia 

daqveiTebuli; 

- gulyra vlindeba adreul etapze da dasawyisSi SeiZleba 

rezistentuli iyos tradiciul mkurnalobaze. igi ZiriTadad 

generalizebuli xasiaTisaa. dazianebis progresirebasTan erTad 

gulyra praqtikulad ar vlindeba da eeg xdeba izoeleqtruli an 

gviCvenebs mkveTri supresiis niSnebs. am periodisaTvis progresirebs 

tvinis SeSupeba da gamoixateba yiflibandis daWimva; 

- damaxasiaTebelia araregularuli guliscemis sixSire da arteriuli 

wnevis maCveneblebis cvalebadoba. 

mZime hie-s dros maRalia adreuli neonataluri sikvdilobis maCvenebeli. 

axalSobilebSi, romlebic gadarCebian: 

- cnobierebis done umjobesdeba me-4-5 dRisaTvis; 

- hipotonia da kvebiTi problemebi persistirebs, zondiT kveba SeiZleba 

gaxangrZlivdes ramdenime Tve. 

hies Tan axlavs Semdegi multiorganuli dazianebebi 

⇒ sasunTqi sistema: pulmonuri hipertenzia, surfaqtantis meoradi deficiti, 

mekoniumis aspiracia, filtvidan sisxldena, filtvis SeSupeba. 

⇒ saSarde sistema: mwvave tubuluri da kortikaluri nekrozi, oliguria, 

renuli ukmarisoba. 

⇒ kardiovaskuluri sistema: Ria arteriuli sadinari, miokardiumis 

dazianeba, hipotenzia, Soki, gulis SegubebiTi ukmarisoba, samkariani 

sarqvlis ukmarisoba. 

⇒ metaboluri: acidozi, hipoglikemia, hipokalciemia, hiponatriemia, 

hiperamonemia, hiperkalemia. 

⇒ gastrointestinuri sistema: nekrozuli enterokoliti, stresuli wyluli. 

ZiriTadad damaxasiaTebelia peristaltikis daqveiTeba da kuWis evakuaciis 

Seferxeba. 

⇒ RviZlis disfunqcia: iSemia azianebs RviZlis sinTezur, eqskretorul da 

detoqsikaciur funqciebs. vlindeba transaminazebis donis mateba, sisxlis 

Semadedebeli faqtorebis sinTezis Semcireba, proTrombinis da 

aqtivirebuli parcialuri Tromboplastinis drois gaxangrZliveba, rac 

klinikurad asocirebulia sisxldenebTan. 

⇒ hematologiuri: Trombocitopenia, hemolizi, Zvlis tvinis depresia, 

sisxlZarRvTaSida Sededebis sindromi. 

7

5. daavadebis diagnozi 

hie-s diagozi damyarebulia anamnezze, obieqtur da nevrologiur 

gamokvlevebze. ar arsebobs specifiuri testi romelic yovelTvis 

daadasturebs an uaryofs hie-s. 

perinataluri asfiqsiis damadasturebeli maxasiaTeblebia 9,13 : 

• Rrma metaboluri an Sereuli acidozi; 

• Wiplaris arteriaSi pH < 7,00 fuZeTaQdeficiti > 12 mmol/l; 

• apgaris dabali qulebis (0-3) persistireba 5 wuTze met xans; 

• klinikurad arakeTilsaimedo nevrologiuri darRvevebi, rogoricaa 

gulyra, hipotonia, koma an hie; 

• adreul neonatalur periodSi poliorganuli sistemuri 

disfunqcia. 

Tu aRniSnuli maxasiaTeblebi ar aris gamoxatuli, SeuZlebelia asfiqsiis 

arsebobaze saubari. 

h. sarnatisa da m. sarnatis mier 1976 wels mowodebulia hie-s 

xarisxobrivi klasifikacia. es sqema saukeTesoa hie-is gamosavlis 

I 

prognozirebisaTvis (mtkicebulebis done I) 20 . 

neonataluri hipoqsiur-iSemiuri encefalopaTiis klasifikacia 

niSnebi msubuqi (I x.) saSualo (II x.) mZime (III x.) 

cnobierebis agznebadoba leTargia stupori, koma 

done 

nerv-kunTovani 

kontroli 

• kunTTa norma 

msubuqi 

daqveiTeba 

tonusi 

hipotonia 

• poza norma fleqsia aramyari 

decerebracia 

• Rrma 

gacxovelebuli gacxovelebuli ar iwveva 

refleqsebi 

• miokloniebi aris aris ar aris 

rTuli 

refleqsebi 

• wova susti susti an ar 

aris 

ar aris 

• moro cocxali susti ar aris 

• okulovestibuluri 

• kisris 

tonur 

• autonomiuri 

funqciebi 

norma gacxovelebuli susti an ar aris 

susti cocxali ar aris 

simpatikotonia 

parasimpatikoto 

nia 

orive 

daTrgunulia 

8

• gugebi midriazi miozi araTanabari, 

susti reaqciiT 

sinaTleze 

• guliscema taqikardia bradikardia cvalebadi 

• bronquli mwiri Warbi cvalebadi 

sekreti 

• nawlavTa norma an momatebuli, cvalebadi 

peristaltika daqveiTebuli diarea 

• gulyrebi ar aris xSiria decerebracia 

• eeg normaluri dabali voltaJi, 

romelsac 

erTveba 

iqtaluri 

aqtivoba 

CaqrobaaRmocenebis 

paterni 

izoxazamde 

vardniT 

xangrZlivoba

• metabolizmis Tnadayolili darRvevebi; 

• samSobiaro travmebi; 

• nerv-kunTovani daavadebebi; 

• dedis mier medikamentebis gamoyeneba; 

• neonataluri depresia. 

6. gamokvlevis sqema 5,6,8,9,19 

neirogamosaxviTi kvlevebi 

rutinuli neorogamosaxviTi kvlevebi yovelTvis ar miuTiTebs dazianebaze, 

kvlevis normaluri Sedegi ar gamoricxavs hie-s arsebobas. 

• kraniuli ultrasonografiuli gamokvleva: SeiZleba gamovlindes 

intracerebruli da intraventrikuluri hemoragia. tvinis SeSupebis 

dros aRiniSneba parkuWebis zomis Semcireba. hie-s dros mxolod 

ultrasonografiuli kvleva arainformatiulia. diagnostikurad 

mniSvnelovania dopleruli ultrasonografia, kerZod – arteriebis 

rezistentobis indeqsis gansazRvra. gamosavali arakeTilsaimedoa, Tu 

maCvenebeli < 0,5-0,6_ze. 

gestaciis 30 kviramde dabadebul axalSobilebs yvela SemTxvevaSi 

unda CautardeT ultrasonografiuli kvleva (rekomendacia B) 31 . B 

kvlevis Catarebis saukeTeso periods miekuTvneba sicocxlis me-7- 

14 dRe. 

• kompiuteruli tomografia gansakuTrebiT mniSvnelovania tvinis 

SeSupebis da hemoragiis diagnostirebisaTvis. SeiZleba iyos gverdiTi 

parkuWebis daviwroeba, Rarebis da xveulebis gasadaveba. Semcirebuli 

simkvrivis areebi miuTiTebs infarqtis zonebis arsebobaze. 

intraventrikuluri hemoragia iSviaTia droul axalSobilebSi. 

kompiuteruli tomografiiT SesaZlebelia ukana fosos hemoragiis 

gamovlena, rac ar vlindeba sonografiiT. 

• magnitur rezonansuli gamokvleva - mniSvnelovania saSualo da mZime 

hie-s diagnostikaSi. GgansakuTrebiT mielinizaciis statusis, ruxi- 

TeTri nivTierebis dazianebis xarisxis, Tavis tvinis ganviTarebis 

defeqtebis da Semdgomi nevrologiuri gamosavlis dasadgenad. 

misi Catareba mizanSewonilia sicocxlis me-2-8 dRes droul 

axalSobilebSi (rekomendacia A). kvleva mniSvnelovania 

dinamikaSi monitoringisaTvis. 

sxva testebi: 

• amplitude_integrirebadi eleqtroencefalograma (aEEG) –kvlevebiT 

dadginda, rom dabadebidan ramdenime saaTSi warmoebuli erT arxiani 

aEEG Tavis tvinis dazianebis da hie-s Sefasebis efeqturi saSualebaa. 

normaluri aEEG ar gamoricxavs Tavis tvinis dazianebis arsebobis 

SesaZleblobas, maSin roca aEEG-ze mZime an saSualo dazianebis 

maCvenebeli miuTiTebs Tavis tvinis dazianebasaE da arakeTilsaimedo 

gamosavalze. paTologiad miCneulia amplitudis farTo meryeoba 

A 

10

azisuri voltaJiT nulis axlos da pikuri amplitudiT 5-is qvemoT. 

aEEG -Ti SeiZleba aseveKkrunCxvebis diagnostikac. 

• standartuli eeg: gamoiyeneba rekomendebulia axalSobilis zogadi 

mdgomareobis stabilizaciis Semdeg. mravalarxiani eeg kvleva 

utardeba yvela axlSobils saeWvo krunCxvebiT da hie-iT. is 

mniSvnelovania krunCxvis dros dazianebis lokalizaciisa da 

simZimis Sesafaseblad. ase rom, aSkara klinikuri krunCxvebis ar 

arsebobis drosac ki tradiciuli eeg unda Catardes daavadebis 

adreul stadiaze gansakuTrebiT saSualo da mZime SemTxvevebSi. 

subklinikuri krunCxva, romlebic vlindeba mxolod eeg-ze, iwvevs 

Tavis tvinis dazianebas. axalSobilebSi, romlebic imyofebian 

damxmare ventilaciaze, miorelaqsantebis da sedatiuri saSualebebis 

gamoyenebam SeiZleba SeniRbos adreuli krunCxvebis simptomebi. 

antikonvulsiuri Terapiis didi dozebic cvlis eeg-s monacemebs. 

ganmeorebiTi eeg aucilebelia cvlilebebis dinamikis Sesafaseblad. 

misi Catareba mizanSewonilia gaweris win. pirvel kviraSi klinikur 

mdgomareobasTan erTad eeg-ze gaumjobeseba, dadebiTi prognozuli 

maCvenebelia. 

• specialuri sensoruli gamokvleva: smenis skriningi. 

• retinuli da ofTalmologiuri gamokvleva. 

laboratoriuli gamokvlevebi: 

Tavis tvinis dazianebis simZimis Sesafaseblad da organoTa 

statusis monitorirebisaTvis mravali testia mowodebuli. 

funqciuri 

• mJava tutovani wonasworobis gansazRvra; 

• Sratis eleqtrolitebi: mZime hie-s dros mniSvnelovania Sratis 

eleqtrolitebis yoveldRiuri Sefaseba mdgomareobis gaumjobesebamde. 

mniSvnelovnad daqveiTebulia natriumis, kaliumis, qloridebis done. 

diurezis Semcireba da wonis Warbi namati SeiZleba miuTiTebdes mwvave 

tubulur dazianebasa an antidiurezuli hormonis araadekvatur 

sekreciaze; 

• renuli funqciis Seswavla: Sratis kreatinini, kreatininis klirensi da 

Sardovana; 

• kardiuli da RviZlis enzimebis done Seesabameba hie-s simZimis xarisxs. 

sxva mniSvnelovani gamokvlevebi: 

• sisxlis airebi 

• sisxlis saerTo analizi TrombocitebiT 

• proTrombinis dro, parcialuri Tromboplastinis dro 

• sisxlis bioqimiuri kveleva (glukoza, kalciumi, magniumi, 

osmolaroba) 

• Sardis osmolaroba, saerTo analizi 

• RviZlis funqciebi, pirdapiri da saerTo bilirubini 

• liqvoris gamokvleva 

• ekg, eqokardioskopia 

11

7. mkurnalobis sqema 5,6,8,9,19 

dabadebisTanave aucilebelia adekvaturi reanimaciis Catareba (ix. gaidlaini 

- axalSobilTa reanimacia samSobiaro blokSi). 

krunCxvis SemTxvevaSi SesaZlebelia mniSvnelovnad daziandes organizmis 

sxvadasxva funqcia, ris gamoc xSir SemTxvevaSi axalSobili saWiroebs 

ventilacias, oqsigenacias, sisxlis wnevis stabilizacias. gulyra SeiZleba 

moixsnas fenobarbitaliT an lorazepamiT. mocemuli preparatebi warmodgens 

I rigis antikonvulsantebs. fenitoini gamoiyeneba, Tu aRniSnuli 

medikamentebi uefeqtoa. 

medikamenturi Terapia 

• fenobarbitali 

Cveneba _ klinikuri an subklinikuri gulyra, romelic vlindeba eeg-ze; 

mkurnalobis kursis xangrZlivoba damokidebulia klinikur statusze 

da eeg-s monacemebze,Uumetes SemTxvevaSi SeiZleba Sewydes sicocxlis 

pirvel Tveze. Tu nevrologiuri darRvevebi an eeg-ze cvlilebebi 

persistirebs, mkurnaloba grZeldeba ramdenime Tvidan erT wlamde. eeg 

da klinikuri statusi aris mkurnalobis kursis da xangrZlivobis 

ganmsazRvreli. 

doza _ sawyisi doza 20 mg/kg, preparati SeyavT venaSi 10-15 wT-is 

ganmavlobaSi (infuzomatiT), refraqterul SemTxevebSi SeiZleba 

damatebiTi dozis Seyvana - 5-10 mg/kg-ze. SemanarCunebeli dozaa 3-5 

mg/kg/dReSi, SemanarCunebeli dozis Seyvana xdeba sawyisi dozis 

Seyvanidan 12-24 sT-is Semdeg, dReSi 2-jer 12 saaTis intervaliT, Seyvanis 

gzaa peroraluri, intravenuri, intramuskuluri an reqtaluri. 

sifrTxilis zomebi: 

- saWiroa wnevisa da respiraciis kontroli, SeiZleba ganviTardes 

respiraciuli distresi da saWiro gaxdes damxmare ventilacia. 

- axlSobilSi pirveli 1-2 kviris ganmavlobaSi gaxangrZlivebulia prepartis 

naxevrad daSlis periodi, rasac SeiZleba moyves wamlis akumulacia, 

amitom mizanSewonilia SratSi preparatis koncentraciis (N-15-30 mkg/ml) 

monitoringi da SemanarCunebeli dozis Sesworeba. 

• lorazepami 

Cveneba - gamoiyeneba fenobarbitalze refraqteruli krunCxvis dros. 

doza _ erTjeradi dozaa 0.05-0.1 mg/kg venaSi neli nakadiT, doza meordeba 

klinikuri mdgomareobis mixedviT. 

sifrTxilis zomebi: dRenakl axalSoblebSi, romlebic iReben lorazepams 

sedaciisaTvis, SeiZleba gamoiwvios respiratoruli depresia da 

riTmuli miokloniebi. 

12

• fenitoini 

Cveneba- gamoyeneba fenobarbitalze da lorazepamze refraqteruli krunCxvis 

SemTxevaSi. sococxlis pirveli Tveebis ganmavlobaSi Ppreparatis 

oraluri gamoyenebisas Sewova umniSvneloa. 

doza _ sawyisi doza 15-20 mg/kg. Seyvana xdeba infuzomatiT minimum 30 wT-is 

ganmavlobaSi, SemanarCunebeli dozaa 4-8 mg/kg 24 sT_Si erTxel venaSi 

neli nakadiT, infuzis siCqare ar unda aRematebodes 0.5 mg/kg/wT; 

preparatis ganzaveba xdeba fiziologiur xsnarSi. fenitoinis 

intravenuri Seyvanis win da Semdeg mizanSewonilia kaTeteris Carecxva 

0.9% NaCL-iT. 

sifrTxilis zomebi: sasurvelia SratSi fenitoinis koncentraciis (N- 6-15 

mcg/ml) monitoringi, aucilebelia aseve bradikardiis, ariTmiis da 

hipotenziis monitoringi infuziis ganmavlobaSi; medikamenti aramdgradia 

IV xnarebSi, ar aris mizanSewonili misi Seyvana centraluri venaSi, 

daleqvis riskis gamo. SeuTavsebelia glukozis, deqstrozis da 

aminomJavebis, lipidebis xsnarebTan, bevr antibiotikTan, heparinTan, 

insulinTan. medikamentis sisxlZarRvidan gaJonvam SeiZleba gamoiwvios 

mZime lokaluri nekrozi. 

L 

• diazepami 

Cveneba – gamoiyeneba mxolod im SemTxvevaSi, Tu fenobarbitali da fenitoini 

ar aris xelmisawvdomi. 

doza – erTjeradi dozaa 0,1-0,3 mg/kg venaSi nela, efeqtis ar arsebobisas 

ganmeorebiTi Seyvana xdeba 15-30 wuTSi an iwyeba mudmivi infuzia 0,3 

mg/kg/sT. 

sifrTxilis zomebi: ar aris rekomendebuli diazepamis fenobarbitalTan 

gamoyeneba erTad, radgan maRalia cirkulaciuri kolafsisa da sunTqvis 

gaCerebis ganviTarebis riski. 

damxmare Terapiis sxva aspeqtebi 

saWiroa: 

• adekvaturi ventilaciis, perfuziis da metaboluri statusis 

SenarCuneba; 

• hipoqsiis, hiperkapniis, hipokapniis prevencia; 

• sisxlis gazebis da mJava–tutovani wonasworobis SenarCuneba 

fiziologiur sazRvrebSi; 

• sisxlis wnevis monitoringi da stabilizacia. vazopresorebis da 

inotropuli agentebis, mocirkulire sisxlis moculobis 

Semavseblebis gamoyenebiT; 

• centraluri Ht – 40-45% maCveneblis SenarCuneba; 

• siTxis da glukozis homeostazis SenarCuneba; 

13

• pirveli ori dRis ganmavlobaSi intravenuri siTxis infuziis 

SezRudva gestaciuri asakis mixedviT sadReRamiso siTxis 

moTxovnilebis 2/3-mde; 

• siTxiT da eleqtrolitebiT Terapia individualurad klinikuri 

statusis, wonis cvlilebis, Sardis gamoyofis, Sratis 

eleqtrolitebis da renaluri funqciis gaTvaliswinebiT. 

axalSobilis mdgomareobis gaumjobesebisas (Sardis gamoyofa 

izrdeba) saWiroa siTxis miwodebis koreqcia. 

• hipoTermia mkurnalobis axali meTodia. is gamoiyeneba msubuqi da 

saSualo simZimis hie-s SemTxvevebSi. cxovelis modelze Catarebul 

ramdenime eqspetrimentsa da erTeul limitirebul klinikur cdebSi, 

miRebulia dadebiTi efeqti, magram gamosavali Sefasebulia mxolod 

18-22 Tvis asakamde. sxeulis temperaturis daqveiTeba 2-3 0 C (zomieri 

hipoTermia) tvinis hipoqsia-iSemiis Semdeg amcirebs tvinis dazianebas 

da aumjobesebs gamosavals eqsperimentul kvlevaSi 

(mtkicebulebis done IV) 21-23 . axalSobilebze Catarebuli 

kvlevebi mwiria da urTierTgamomricxavi Sedegebi aqvs 

(mtkicebulebis done II) 24-27 . mZime hipoTermiam SeiZleba 

gamoiwvios ariTmia, sisxldena, Trombozi da sefsisi, Tumca 

es garTulebebi ar gamovlenila zomieri hipoTermiis dros 

(mtkicebulebis done II) 25,26,28 . 

ar arsebobs sakmarisi mtkicebuleba imisTvis, rom rutinulad 

gamoyenebuli iyos sistemuri an cerebruli hipoTermia im 

axalSobilebSi, romlebsac aReniSnebaT asfiqsia da hie. saWiroa 

kvlevebis gagrZeleba am mimarTulebiT. 

cxovelebze Catarebuli kvlevebi gviCvenebs, rom iSemiis 

dros da mis mere ganviTarebuli hiperTermia, iwvevs tvinis 

dazianebas (mtkicebulebis done IV) 29 . 

gamomdinare zemoaRniSnulidan, im axalSobilebs, romlebsac 

CautardaT reanimacia esaWiroebaT temperaturis mkacri 

kontroli, raTa ar ganviTardes iatrogenuli hiperTermia. 

radgan hiperTermiam SeiZleba gamoiwvios tvinis dazianeba 

(rekomendacia B) 14 . 

kveba: 

umetes SemTxvevebSi (saSualo da mZime hie-s dros) pirveli sami dRis 

ganmavlobaSi an sanam cnobierebis done ar gaumjobesdeba mizanSewonilia 

parenteruli kveba. Semdeg iwyeba minimaluri kveba dedis gamowvelili rZiT 

an formuliT daaxloebiT 5 ml yovel 3-4 sT-Si. paralelurad unda 

warmoebdes muclis garSemowerilobis, nawlavTa xmianobis, nawlavTa 

moqmedebis da kuWSi narCeni masebis monitoringi. nebismieri aRniSnul 

simptomTagani SeiZleba miuTiTebdes nekrozul enterokolitis arsebobaze. 

axalSobilebi perinataluri asfiqsiiT miekuTvnebian nekrozuli 

enterokolitis ganviTarebis riskis jgufs. 

IV 

II 

II 

IV 

B 

14

konsultaciebi: 

- krunCxvebis marTvis, eeg-s interpretaciisaTvis aucilebelia bavSvTa 

nevrologis konsultacia. 

referali 9 

hie-s saSualo simZimis da mZime formebis SemTxvevaSi saWiroa axalSobilis 

transportireba maRali donis klinikaSi saTanado nevrologiuri kvlevisa 

da nevrologis konsultaciis Casatareblad. 

8. meTvalyureoba 9 : 

saSualo da mZime xarisxis hies SemTxvevaSi pacients esaWiroeba sxvadasxva 

specialistis meTvalyureoba (pediatri, nevropaTologi, ganviTarebis 

pediatri da sxv.). 

mkurnaloba gaweris Semdeg 

krunCxvis sawinaaRmdego mkurnalobis xangrZlivoba damokidebulia cns-s 

dazianebis xarisxsa da eeg-s monacemebze: 

- axalSobilTa umravlesobasTan, romlebic viTardebian normalurad 

da hospitalidan gaweramde aqvT normaluri eeg, fenobarbitaliT 

mkurnaloba wydeba dabadebidan 3-4 kviris Semdeg. 

- cns-is mniSvnelovani paTologiis mqone CvilebSi fenobarbitalis 

mkurnalobis xangrZlivobis Sesaxeb gadawyvetilebas iRebs nevrologi 

bavSvis mdgomareobis mixedviT. 

prognozi: 

gulyrebi cudi prognozis maCvenebelia: gulyrebis arseboba 2-5-jer zrdis 

nevrologiuri garTulebis risks; antikonvulsantebisadmi rezistentul 

gulyrebs calsaxad axlavs letaloba an myari nevrologiuri darRvevebi; 

arakeTilsaimedo gamosavalis riski miT ufro maRalia, rac ufro adre 

(gansakuTrebiT dabadebidan pirvel 4 saaTSi) iwyeba gulyrebi. 

nevrologiuri statusis darRveva, romelic xangrZlivdeba pirveli 7-10 dRis 

Semdeg, Cveulebriv, cudi prognozis maCvenebelia. M 

persistirebadi kvebiTi problemebi miuTiTebs cns-is mniSvnelovan 

dazianebaze. 

hie-s mqone pacientebSi Tavis garSemowerilobis arasakmarisi zrda 

sicocxlis pirvel wlis ganmavlobaSi momavalSi nevrologiuri problemebis 

ganviTarebis erT-erTi markeria. 

9. gaidlainis gadasinjvisa da ganaxlebis vada – 4 weli 

15

10. gaidlainis miRebis xerxi/wyaro 

gaidlainis SemuSavebis meTodologia 

• axalSobilTa asfiqsiis/hipoqsiur iSemiuri encefalopaTiis 

prevenciis da marTvis principebis Sesaxeb arsebobs samecniero 

mtkicebulebis safuZvelze Seqmnil rekomendaciaTa mcire 

raodenoba. mocemuli gaidlainis Seqmnis procesSi samuSao 

jgufis gadawyvetilebiT moZiebuli da Sefasebuli iqna ukve 

arsebuli praqtikuli rekomendaciebi. moxda arsebuli 

rekomendaciebis adaptirebuli variantis SemuSaveba, romelic 

erTis mxriv pasuxebs saerTaSoriso moTxovnebs, xolo meore 

mxriv iTvaliswineba saqarTvelos samedicino dawesebulebaTa 

rogorc adamianur, ise teqnikur resursebs. 

• rekomendaciaTa moZieba xorcieldeboda eleqtronuli monacemTa 

bazis gamoyenebiT. 

qveyana da resursis 

dasaxeleba 

internet-misamarTi 

aSS 

US National Guideline 

Clearinghouse (NGC) 

Centers for Disease Control and 

Prevention (CDC) 

Agency for Healthcare Research 

and Quality (AHRQ) 

Health Services Technology 

Assessment Text (HSTAT) and 

National Library of Medicine 

(NLM) 

Institute of Clinical Systems 

Improvement (ICSI) 

American Medical Association 

Canadian Medical Association 

(CMA) 

Health Canada – Population and 

Public Health Branch (PPHB) 

didi britaneTi 

National Institute for Clinical 

Excellence (NICE) 

Sheffield Evidence for 

Effectiveness and Knowledge 

http://www.guideline.gov 

http://www.phppo.cdc.gov/CDCRecommends/Adv 

SearchV.asp 

http://www.ahrq.gov/clinic/cpgsix.htm 

http://hstat.nlm.nih.gov 

http://www.icsi.org 

http://www.ama-assn.org 

http://mdm.ca/cpgsnew/cpgs/index.asp 

http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html 

http://www.nice.org.uk 

http://www.shef.ac.uk/seek/guidelines.htm 

16

(SEEK) 

National electronic Library for 

Health (NeLH) 

PRODIGY Clinical Guidance 

Scottish Intercollegiate Guidelines 

Network (SIGN) 

German Guideline Information 

Service (GERGIS) 

avstralia 

Australian National Health and 

Medical Research Council (NHMRC) 

axali zelandia 

New Zealand Guidelines Group 

(NZGG) 

mtkicebiTi 

specialistTa 

regionTaSorisi 

sazogadoeba 

medicinis 

http://www.nelh.nhs.uk/guidelinesfinder 

http://www.prodigy.nhs.uk/ClinicalGuidance 

http://www.sign.ac.uk 

http://www.leitlinien.de/english/english/view; 

http://www.health.gov.au/hfs/nhmrc/publicat/cphome.htm 

http://www.nzgg.org.nz/library.cfm 

http://www.osdm.org 

klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi wyaroebi 

da meTodebi 

• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2; 

• amerikis samedicino biblioTekis mier Seqmnil eleqtronul 

bibliografiul monacemTa baza - medlaini – MEDLINE; 

• jandacvis msoflio organizaciis reproduqciuli janmrTelobis 

biblioTeka. 

publikaciebis CarTvis/gamoricxvis kriteriumebi 

• arCeul iqna kvlevebi Semdegi dizainiT: randomizebuli 

kontrolirebadi kvlevebi, sistemuri mimoxilvebi da meta-analizi, 

erTmomentiani, kohortuli kvlevebi; 

• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12 

wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro adreuli 

publikaciebi, romlebic dResac aqtualuria da safuZvlad udevs 

sxva Tanamedrove mtkicebulebebs; 

• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs 

SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod 

inglisur da rusul enebze. 

17

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi 

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi. 

Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri 

meToduri rekomendacia axalSobilTa asfiqsiis/hie-s marTvis 

sakiTxebze, romlebic Seicavda jgufis miznis Sesaferis saWiro 

informacias. am rekomendaciebis Sefasebisas gamoyenebuli iyo 

rekomendaciaTa atestaciisa da eqspertizis kiTxvari - AGREE (94,96-98). 

samuSao jgufi xelmZRvanelobda saqarTvelos Sromis, janmrTelobisa 

da socialuri dacvis saministros mier SemuSavebuli nacionaluri 

gaidlainebis gzamkvleviT. Sefasebis Sedegad amorCeuli iyo qvemoT 

CamoTvlili organizaciebis gaidlainebi: 

⇒ amerikis pediatriis akademia 

⇒ axalSobilTa movla, manuali – j. kloherti 

⇒ pediatria – nelsoni 

⇒ janmrTelobis msoflio organizacia 

• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas gamoyenebuli 

iyo saqarTvelos Sromis janmrTelobisa da socialuri dacvis 

saministros mier mowodebuli mtkicebulebebis donisa da 

rekomendaciebis xarisxis sqema. 

mtkicebulebaTa doneebisa da rekomendaciebis gradaciebis sqema 

done mtkicebulebis siZlieris 

done (Muir Gray) 

I Zlieri mtkicebuleba, 

eyrdnoba minimum erT 

sistemur mimoxilvas, 

romelic efuZneba swori 

dizainis 

mqone 

randomizebul 

kontrolirebad kvleva 

II Zlieri mtkicebuleba, 

eyrdnoba minimum erTi 

swori dizainis mqone 

randomizebul 

kontrolirebad kvleva 

III klinikuri kvleva 

randomizaciis gareSe, 

kohortuli da SemTxvevakontrolis 

kvlevebi 

IV araeqsperimentuli 

multicentruli kvlevebi 

Va 

avtoritetul 

profesionalTa mosazreba 

xarisxi rekomendaciis xarisxi 

(Cook et al) 

A eyrdnoba I donis 

mtkicebulebas 

da 

Sesabamisad mtkiced 

rekomendebulia 

B eyrdnoba II donis 

mtkicebulebas 

da 

Sesabamisad mtkiced 

rekomendebulia 

C eyrdnoba III donis 

mtkicebulebas SeiZleba 

CaiTvalos Sesabamisad 

D eyrdnoba IV da V donis 

mtkicebulebas saWiroebs 

konsesuss 

18

Vb klinikuri gamocdileba, 

aRwerilobiTi kvlevebi an 

eqspertTa angariSi 

11. alternatiuli gaidlaini ar arsebobs 

12. gamoyenebuli literatura: 

1. Levene, M. Neonatal Neurology. Chp 8, pp 157-200;2000 

2. Volpe, J. Neurology of the Newborn, Chapter 6. Pp. 211-369. W. B. Sauders, 1995 

3. NGC STATUS: The information was veryfied by the guideline developer on April 10. 2003 

4. Shah, P, Riphagen, S, Beyene, J et al. Multiorgan dysfunction in infants with post-asphyxial 

hypoxic-ischemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004; 89:F152. 

5. Manual of Neonatal care; J. Cloherty, E. Eichenwald, A. Strark fifth edition, 2004 

6. Clinical features, diagnosis, and treatment of neonatal encephalopathy; 

Yvonne Wu, MD, MPH UpToDate performs a continuous review of over 350 journals and 

other resources. Updates are added as important new information is published. The literature 

review for version 14.2 is current through April 2006; this topic was last changed on March 31, 

2006. www.uptodate.com 

7. Etiology and pathogenesis of neonatal encephalopathy; Yvonne Wu, MD, MPH; 

www.uptodate.com UpToDate performs a continuous review of over 350 journals and other 

resources. Updates are added as important new information is published. The literature review 

for version 14.2 is current through April 2006; this topic was last changed on April 19, 2005 

8. Systemic effects of perinatal asphyxia; Lisa M Adcock, MD; Ann R Stark, MD UpToDate 

performs a continuous review of over 350 journals and other resources. Updates are added as 

important new information is published. The literature review for version 14.2 is current 

through April 2006; this topic was last changed on April 28, 2006 www.uptodate.com 

9. Hypoxic-Ischemic Encephalopathy; American Academy of Pediatrics, American Association 

for the History of Medicine, American Osler Society, American Pediatric Society, College of 

Physicians of Philadelphia, Society for Pediatric Research; www.emedicine.com; Last 

Updated: June 30, 2006 

10. Hankins G.D.V, - et al - Neonatal Organ System Injury in Acute Birth Asphyxia Sufficient to 

Result in Neonatal Encephalopathy - VOL. 99, NO. 5, PART 1, 2002 The American College of 

Obstetricians and Gynecologists. 

11. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PF, et al. 

Antepartum risk factors for newborn encephalopathy: The Western Australian casecontrol 

study. BMJ 1998;317:1549 –53. 

12. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the 

assessment of newborn infants. N Engl J Med 2001; 344; 467-71 

13. Програма Реанимации новорожденных руководство по подготовке преподователей – 

AIHA - 2000 

14. American Heart Association in collaboration with International Liaison Committee on 

Resuscitation. Guidelines 2005 for Cardiopulmonary Resuscitation and Emergency 

Cardiovascular Care: International Concensus on Science, Part 11, 7: Neonatal Resuscitation. 

Circulation 2005;112:91-9 

15. Futrakul S et al - Risk Factors for Hypoxic-Ischemic Encephalopathy in Asphyxiated Newborn 

Infants J Med Assoc Thai Vol. 89 No. 3 2006 322-328; 

19

16. Badawi N. - Antepartum risk factors for newborn encephalopathy: the Western Australian 

case-control study BMJ 1998;317:1549-1553 

17. Volpe JJ. Hypoxic-ischemic encephalopathy: clinical aspects. In: Volpe JJ, editor. Neurology 

of the newborn. 3rd ed. Philadelphia: WB Saunders; 1995: 314-69. 

18. Badawi N. - Antepartum risk factors for newborn encephalopathy: the Western Australian 

case-control study BMJ 1998;317:1549-1553 

19. Nelson textbook of Pediatricas 2005 

20. Perlman JM, Risser R. Can asphyxiated infants at risk for neonatal seizures be rapidly 

identified by current high-risk markers Pediatrics. 1996 Apr; 97(4): 456-62 

21. Gunn A, Gunn T, de Haan H, Williams C, Gluckman P. Dramatic neuronal rescue with 

prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest 1997;99:248-56. 

22. Laptook A, Corbett R, Sterett R, Burns DK, Tollefsbol G. Modest hypothermia provides partial 

neuroprotection when used for immediate resuscitation after brain ischemia. Pediatr Res 

1997;42:17-23. 

23. Thoresen M, Bagenholm R, Loberg E, Apricena F. Posthypoxic cooling of neonatal rats 

provides protection against brain injury. Arch Dis Child Fetal Neonatal Ed 1996;74:F3-F9. 

24. Bernard S, Gray T, Buist M, Jones B. Treatment of comatose survivors of out-of-hospital 

cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557-63. 

25. Eicher D, Wagner C, Katikaneni L, Hulsey T. Moderate hypothermia in neonatal 

encephalopathy: efficacy outcomes. Pediatr Neurol. 2005;32:11-7. 

26. Gluckman P, Wyatt J, Azzopardi D, Ballard R. Selective head cooling with mild systemic 

hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 

2005;365:663-70. 

27. Thoresen M,.Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and 

rewarming in infants with hypoxic-ischemic encephalopathy. Pediatrics 2000;106:92-9. 

28. Shankaran S, Laptook A, Wright L, Ehrenkranz R. Whole-body hypothermia for neonatal 

encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term 

infants. Pediatrics 2002;110:377-85. 

29. Coimbra C, Boris-Moller F, Drake M, Wieloch T. Diminished neuronal damage in the rat brain 

by late treatment with the antipyretic drug dipyrone or cooling following cerebral ischemia. 

Acta Neuropathol. 1996;92:447-53. 

30. Основы ухода за новорожденнымми и грудное вскармливание - ВОЗб 2002 

31. WHO - Managing Newborn Problems – A Guide for doctors, nurses and midwives – 2003 

20

13. avtorTa jgufi 

pediatrTa da neontologTa kavSiri àlternativa~ 

samuSao jgufi: 

⇒ dimitri abelaSvili - medicinis doqtori; Tbilisis saxelmwifo 

samedicino universitetis diplomis Semdgomi da uwyveti samedicino 

ganaTlebis instituti, m. iaSvilis saxelobis bavSvTa centraluri 

klinikuri saavadmyofos reanimaciisa da gadaudebeli daxmarebis 

samsaxuris ufrosi, axalSobilTa reanimaciis ganyofilebis gamge. 

pediatrTa da neontologTa kavSiri àlternativa~-s wevri; 

⇒ merab maWaraSvili _ neonatologi, m.SaraSiZis samedicino centri 

generaluri direqtoris moadgile neonatologiasa da pediatriaSi. 

pediatrTa da neontologTa kavSiri àlternativa~-s wevri; 

⇒ gela mecxvariSvili - medicinis doqtori, q. Tbilisis ss akademikos 

o. RuduSauris saxelobis erovnuli samedicno centris 

neonatologiis samsaxuris ufrosi; 

⇒ maka mSvildaZe _ neonatologi, CaCavas sax. mean ginekologiisa da 

perinatologiis instituti, saqarTvelos Sromis, janmrTelobisa da 

socialuri dacvis saministros eqsperti. pediatrTa da neontologTa 

kavSiri àlternativa~-s wevri; 

⇒ maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo 

samedicino universitetis pediatriis departamentis asistentprofesori. 

pediatrTa da neontologTa kavSiri àlternativa~-s 

wevri; 

⇒ nani yavlaSvili – medicinis doqtori, Tbilisis saxelmwifo 

samedicino universitetis pediatriis departamentis asistentprofesori. 

pediatrTa da neontologTa kavSiri àlternativa~-s 

wevri. 

eqspertebi: 

⇒ irakli favleniSvili – profesori, Tbilisis saxelmwifo 

samedicino universitetis diplomis Semdgomi da uwyveti samedicino 

ganaTlebis institutis direqtori; 

⇒ nana tatiSvili - medicinis doqtori; m. iaSvilis saxelobis bavSvTa 

centraluri klinikuri saavadmyofos nevrologiuri departamentis 

ufrosi; 

⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da 

socialuri dacvis saministros jandacvis departamenti; 

⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da 

socialuri dacvis saministros jandacvis departamenti. 

21

perinataluri asfiqsia / hipoqsiur-iSemiuri encefalopaTia

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