PCNA in a newborn may result from the presence of the following components:
- birth injuries
- infectious diseases of the mother during pregnancy,
- decrease in the level of hemoglobin in the mother’s blood in the process of carrying a child,
- pathology of the placenta.
The risk of PCNS is higher if there are predisposing factors:
- pelvic presentation of the fetus,
- premature or delayed
- large fruit (more than four kilograms).
PCV in newborns: symptoms
In the case of making a diagnosis of a newborn baby, he has the following signs of a newborn child:
- change in muscle tone (hyper- or hypotonia),
- motive concern
- tremor chin and limbs,
- sensitivity impairment
- gastrointestinal dyskinesia (unstable stool, flatulence, regurgitation),
- change in heart rate,
- the muffled sound of heart tones,
- change in breathing rhythm
- an increase in the head of a child more than one centimeter per week,
- uneven coloring of the skin of the child.
As a rule, by the year of the child, the manifestations diminish or disappear completely. However, perinatal lesions may have long-term effects:
- delayed mental, speech or motor development,
- cerebroasthenic syndrome (mood swings, motor restlessness, meteo-dependence, restless sleep),
- attention deficit hyperactivity disorder.
PCV in newborns: treatment
In the acute period, the newborn baby enters the intensive care unit for complex treatment:
- hemostasis: dicinone, rutin and calcium preparations are injected intravenously,
- dehydration therapy: the use of diuretics,
- detoxification therapy: correction of metabolic processes by entering 10% glucose solution, ascorbic acid,
- symptomatic therapy, which includes the elimination of seizures, pathologies of the respiratory and cardiovascular systems.
Breastfeeding is carried out by means of a probe or breast, depending on the severity of the course of the disease.
In the recovery period, the main task is to reduce the manifestations of a neurological symptom. Against convulsions, the doctor may prescribe phenobarbital, radodorm, finlepsin, with frequent regurgitation, motilium or cyrucal, in case of motor impairment, alizin, galantamine, dibazol, prozerin.
In order to reduce hemorrhage prescribe drug lidazu. To restore the trophic processes of the brain use nootropic drugs: piracetam, glutamic acid, cerebrolysin.
To stimulate general reactivity, a newborn baby is given a course of therapeutic massage and special gymnastics.
At the slightest suspicion of parents that a child has a perinatal lesion of the central nervous system, one should immediately seek the advice of a neuropathologist for the selection of a comprehensive treatment. The earlier the treatment is started, the higher the probability of the child’s complete recovery.
It should be remembered that the development of the child occurs individually, including the organization of brain activity. Such individual characteristics of the newborn child in each case play an important role in the process of restoring the functions of higher nervous activity.
Perinatal nervous system damage in the newborn (PCNS)
Perinatal CNS damage is a pathology that includes a group of various conditions that, under the influence of negative factors, adversely affect the spinal cord or brain of a newborn.
To date, there is no clear terminology describing PCV in newborns. Up to the 1990s, the classification proposed by Yu. Ya. Yakunin was used, where terms were used that were not quite relevant from the point of view of modern medicine.
Thus, the term "perinatal encephalopathy" (literally means "brain weakness") indicated persistent, almost irreversible changes in the nervous system. But many perinatal disorders are reversible. In the initial period of life, the brain has enormous compensatory capabilities and is able to fully recover, even with moderate pathology.
And the term “cerebrovascular accident” was associated by neurologists with strokes and had no clear signs. Over time, it became known as "cerebral ischemia." Separate conversation about hypertensive-hydrocephalic syndrome. Intracranial hypertension is often diagnosed, while measuring CSF pressure is rather difficult, and the diagnosis is often made on the basis of symptoms that are quite common for infants during the first weeks of life: chin tremor, irritability, shivering, superficial sleep, anxiety and cry. As a result, children unreasonably take serious drugs from an early age.
However, perinatal lesions exist and cannot be ignored. Pathology in severe form is really dangerous for the life of the baby. According to some estimates, the diagnosis of PCV is given from 5 to 55% to newborns. This difference is due to the inclusion here and mild forms of violations in this period. This is mainly a problem of premature babies, since birth weight directly affects the formation and functioning of the nervous system.
The diagnosis is relevant only for babies of the first year of life (this is why it is called “perinatal”, the word indicates time close to birth). When a baby reaches 12 months, another diagnosis is made, based on the combination of the existing symptoms.
How does the disease develop
- acute - from birth or even from the prenatal period to the 1st month of life,
- restorative, it is divided into early (2-3rd month) and late (4-12 months, in premature up to 24 months),
- the outcome of the disease.
Each gap has its own clinical picture and manifests itself in the form of certain syndromes. The extent to which they are expressed, judge the severity of the disease. Consider their features.
- Hypertension-hydrocephalic syndrome. Cerebrospinal fluid accumulates in the ventricles of the brain due to the violation of its outflow - thus increasing intracranial pressure. Parents or doctors may notice a rapid increase in head circumference, as well as protrusion of a spring. Indirectly, regurgitation similar to vomiting, eye nystagmus, and poor superficial sleep indicate indirect development of hydrocephalus.
- Convulsive syndrome. Rarely occurs in the form of twitching arms, legs and head, episodic flinching.
- Vegetative-visceral syndrome. It is manifested by a marble tinge of skin (since the tone of the peripheral vessels is disturbed), problems by the gastrointestinal tract and the cardiovascular system.
- Apathy syndrome. Vital reflexes of sucking and swallowing are weakened, and motor activity is reduced, along with reduced muscle tone.
- Increased neuro-reflex excitability. It is characterized by muscular dystonia: the tone can be either increased or decreased, reflexes die out longer than usual, the chin trembles in children, especially when crying, which continually occurs for no apparent reason. The baby sleeps superficially. The syndrome accompanies mild illness.
- Comatose syndrome. It arises as a result of strong oppression of the central nervous system and indicates the dire state of the newborn. A young child who has fallen into a coma is placed in intensive care in an unconscious state, since there are no signs of coordinating brain activity.
The early recovery period is deceptive, because it seems that neurological disorders are not so pronounced, muscle tone returns to normal, reflexes are restored. But after a while, the clinical picture again becomes aggravated. It should be noted that a similar situation occurs only when the CNS lesion was diagnosed in moderate to severe newborns.
It is logical that a child who has suffered this pathology will develop late. He later his peers will hold his head, sit and walk. Later, the first smile will appear, interest in the world around. All delays in motor and mental development should encourage parents to once again show the baby to a neurologist, although with such a diagnosis, children are so registered with him.
Also, if intensive drug therapy is used during the acute period, then during the recovery phase, emphasis is placed on physiotherapy, massage courses, and psychocorrection.
Outcome of the disease
The results of the therapy are brought closer to one year old. With a favorable prognosis, the following consequences may be preserved:
- delayed development of speech skills, motor and mental state,
- hyperactivity and attention deficit - the child cannot concentrate on the subject under study for a long time, he hardly remembers the new, is inclined to show aggression and impulsivity,
- cerebroasthenic syndrome (expressed in anxiety, shallow sleep, manifestation of hysteria, meteorological dependence).
Severe course of the disease leads to the development of:
- cerebral palsy,
In numbers, the variants of development of the outcome of the disease can be expressed as follows: 30% - complete recovery, 40% - functional impairment, about 30% are organic disorders, in rare cases death occurs.
Speaking about the causes of depression of the nervous system, there are 4 main factors contributing to the development of the disease:
Our habits influence the future of our children.
- Acute hypoxia. Oxygen starvation can begin even during fetal development due to chronic maternal diseases (diabetes, nephropathy), placental insufficiency or infection. The development of hypoxia is quite possible during childbirth, if they are swift or protracted, the position of the fetus is not the main one, placental abruption has occurred, etc.
- Trauma. Occurs during delivery due to unprofessional actions of personnel or due to other circumstances (narrow pelvis, large head size, entanglement with umbilical cord, pelvic presentation).
- Toxic metabolic damage. It develops if the metabolism is disturbed in the infant’s body or the mother has taken toxic products (drugs, nicotine, certain medications, alcohol) while carrying the fetus.
- Viral or bacterial infection.
Degrees of severity
- Easy Muscle tone is moderately increased or decreased. Strabismus, a symptom of Gref, slight reflex excitability. Chin trembles. Signs of oppression can alternate with excitement.
- Average. Inhibition of reflexes, rare seizures, restless behavior, disorders of the heart system, gastrointestinal tract and kidney function. Symptoms of oppression prevail over symptoms of arousal.
- Heavy Respiratory and cardiac disorders, low Apgar score, condition requires resuscitation.
An affordable, safe and widely practiced method for studying the structures of the cranial box using ultrasound. The procedure is performed by a special device through an open spring. It is possible to make a study for very premature babies who are in the intensive care unit, even if they are connected to mechanical ventilation.
Neurosonography allows you to see the degree of filling of the ventricles of the brain and suggest the reasons why brain activity suffers. Less research - any zone with altered echogenicity can be mistaken for pathology. Also, the accuracy of the study is affected by the state of the baby (he is calm or crying) and even the way the sensors are attached.
Computed tomography and MRI
It so happens that neurosonography has not revealed severe pathologies, and the symptoms of CNS depression are evident. Then appointed to conduct research using magnetic resonance or computed tomography. This method is more informative, it allows you to "look" into the most remote corners of the brain, to evaluate its smallest structures.
MRI - a modern diagnostic method
An important rule: during the study, the child should not move. Therefore, before the procedure, he can enter special medications.
EEG and Doppler
Electroencephalography helps to see the bioelectric brain activity, to evaluate the pulsation of blood vessels. Here only the brain in the perinatal period is immature, and the study should be carried out more than once, comparing performance. Using dopplerography, blood flow in the vessels is evaluated.
The task of the medical staff is to establish as soon as possible the fact of disturbances in the activity of the central nervous system and begin treatment in the hospital. Recall that the first month of life is the most decisive when maturation of nerve cells is possible and full replacement of those who died after oxygen starvation.
PCNS in the acute period is treated in the intensive care unit. The baby is placed in a special hood and directs all efforts to maintain the heart, kidneys and lungs, eliminate cramps, brain edema. During this period, treatment with medications that improve cerebral circulation, normalizing the outflow of cerebrospinal fluid, is indicated. At the same time, doctors are responsible for choosing the dosage of drugs, especially when it comes to premature babies with a small mass. Conducted round the clock surveillance by neonatologists. A neurologist can be invited to the consultation directly to the intensive care unit.
When the condition returns to normal, the infant is transferred to the neonatal pathology department or to the neurological department for further treatment. Reflexes gradually return to normal, the work of the heart muscle, the organs of the gastrointestinal tract is stabilized, and the ventilation of the lungs is improved. The choice of therapeutic drugs is aimed at eliminating the existing syndromes.
What should mom know about perinatal CNS damage in a child
Pathological changes in the brain of a child that formed during fetal development or during passage through the birth canal are called perinatal CNS damage. There are many causes of perinatal CNS damage in newborns, a variety of clinical manifestations and consequences are observed.
Modern medicine has great potential for the diagnosis and treatment of such conditions. CNS lesion in newborns and consequences - are there any reasons for mothers to be afraid of this pathology?
Varieties of pathology
There are many types of morphological damage to the substance of the brain in the period of fetal development and childbirth. They differ in the mechanism of occurrence, in the clinical course, in possible consequences. Perinatal lesions of the central nervous system, resulting from the oxygen starvation of brain cells:
- cerebral ischemia of three degrees of severity
- cerebral hemorrhage,
- traumatic and non-traumatic injuries of the brain.
Lesions resulting from metabolic disorders:
- bilirubin encephalopathy,
- hypoglycemic damage,
- damage due to imbalance of minerals,
- toxic lesions of medicinal and infectious nature.
Sometimes a perinatal CNS lesion of mixed origin can occur - with a combination of several factors at the same time.
Symptoms of CNS damage in newborns depend on the mechanism of their occurrence. With oxygen starvation, there are three degrees of pathology.
The first degree is characterized by:
- excessive excitability of the child,
- increase in motor activity,
- restless sleep
- constant regurgitation when feeding.
This condition is completely reversible, all signs disappear in two weeks. When the second degree of severity:
- respiratory disorders in the form of frequent superficial movements of the chest,
- skin cyanosis, palpitations,
- reduced strength of physiological reflexes,
- muscle hypotension and decreased motor activity.
These signs also regress completely, but after a longer time - within two months.
With the third degree of severity, the child’s condition is critical:
- disturbed breathing and heartbeat,
- skin is pale with a gray tint,
- muscle atony of limbs
- lack of physiological reflexes,
- focal symptoms begin in the form of eye nystagmus,
- possible development of coma.
Hemorrhages in the brain substance are manifested by focal lesions, corresponding to the localization of hemorrhage. Often, coma develops. Metabolic disorders lead to almost the same symptoms as hypoxic conditions.
Important! The severity of symptoms will depend on the level of metabolic disorders - the amount of free bilirubin, the sugar content in the blood, the concentration of minerals.
The first changes in the child’s condition are usually noticed by a neonatologist. He examines immediately after birth and assesses the degree of hypoxia. Metabolic disorders are diagnosed later, after laboratory testing.Hemorrhages in the brain can be suspected by the presence of focal symptoms, and the diagnosis is confirmed using imaging techniques - this is usually computed tomography.
The consequences of perinatal CNS damage primarily depend on the severity of the condition.
- A mild subject to the full treatment does not leave behind any consequences.
- The second degree of severity - symptomatology can completely regress, but later upon adherence of certain somatic diseases, neurological manifestations are possible, which are a consequence of the pathology suffered in the neonatal period. The most frequent manifestation is asthenoneurotic syndrome — disorders of the nervous system that exhibit behavioral changes. The child becomes too naughty, increases motor activity, disrupts sleep, there is excessive irritability.
- Severe lesions - with third-degree hypoxia, hemorrhage, severe bilirubin encephalopathy - subsequently manifest serious defects in development. Among them are:
- late physical development of the child,
- motor impairment,
- mental retardation
- speech disorders
- decrease in learnability to skills.
Principles of treatment
Treatment of perinatal CNS damage - the basic principle is to start it immediately, immediately after the diagnosis has been clarified. Immediately after birth, correction of the impaired vital functions of the body — respiration and cardiac activity — should be carried out.
At the same time, detoxification therapy is carried out to restore the activity of nerve cells. After elimination of the main symptoms, rehabilitation treatment should be carried out. Antiedematous, infusion therapy, sedatives, anticonvulsants and nootropic drugs are used.
Pathology of the nervous system in the neonatal period - the state is not always prosperous. Some mothers should prepare to raise a child with developmental disabilities of varying degrees of severity. However, proper upbringing and treatment will make it possible to correct these deviations as much as possible and to achieve good learning of the child.
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Perinatal damage to the central nervous system: symptoms and treatment of PCNS
The very phrase “perinatal period” means that the perinatal CNS lesion develops in an unborn child, that is, a fetus.
Perinatal damage to the central nervous system (PCNS) is a diagnosis that implies a dysfunction of work in the fetal brain.
The entire period of the perinatal period is divided into three stages:
- from the 28th week until the moment of delivery the antenna period lasts,
- the birth process itself is called the intrapartum period,
- The neonatal period is the period from the moment of birth and the first week of life.
In modern medicine, there is no exact name of the disease with the defeat of the central nervous system of the fetus, there is only a national one, it is called PCNS or perinatal encephalopathy.
Perinatal CNS damage in newborns, manifested by abnormalities in the functioning of the musculoskeletal system, speech and mental disorders.
With the development of medicine, they stopped using this diagnosis for children older than one month. After a month, the doctor must make an accurate diagnosis of the child. It is during this period that the neurologist determines with accuracy how badly the nervous system is damaged. Prescribes treatment and ensures that it is selected correctly.
The reasons why perinatal damage to the central nervous system can develop are quite diverse, among the most popular:
- somatic disease of the mother, which is accompanied by chronic intoxication,
- the presence of acute infectious diseases or chronic foci of infection, while the expectant mother was carrying a child,
- if the woman has a disturbed nutritional process, or is not ripe for pregnancy and childbirth,
- changes in metabolism or the presence of a hereditary factor also entails a nervous system disorder in the unborn child,
- in case of severe toxemia, both at an early stage and at a late stage, or the appearance of other problems with carrying a child,
- the environment is an important factor in the development of the disease,
- the appearance of pathology during childbirth, it can be a weak labor activity, accelerated labor,
- if a child is born prematurely, then his body is not fully developed, so a disturbance in the work of the central nervous system may appear against this background,
- children with a hereditary factor are most at risk of developing CNS lesions.
All other causes of PCNS situational and to a greater extent, to predict their appearance is simply impossible.
Classification and varieties of syndromes
PCNS is conditionally divided into several periods, depending on what stage the violation was detected and how it manifested itself.
The acute period lasts from 7 to 10 days, it is extremely rare, but it can last for up to a month. The period in which recovery takes place can last up to half a year. If the child's body recovers slowly, then this period can take up to 2 years.
Pediatric neurologists distinguish the following types of perinatal CNS lesions, depending on the associated symptoms and syndrome:
- Disturbance of muscle tone, which is accompanied by a complex of disorders associated with breathing. This syndrome is diagnosed according to abnormalities, depending on the age of the newborn. In the initial period of the child's lifetime, it is quite difficult to diagnose this syndrome, since in addition to this there is a physiological hypertonus.
- Syndrome associated with sleep disturbance, chin twitching. This syndrome can be diagnosed only in the case when meteorism is excluded.
- Depression of the nervous system. This syndrome is diagnosed in children who are not active in the first months of their life, they sleep a lot, their tone is lowered.
- An unfavorable prognosis for a child if intracranial hypertension syndrome has developed. Its main signs are irritability and nervousness, while the spring begins to swell.
- One of the most dangerous and severe syndromes in PCPSN is convulsive, it is one of the most serious manifestations in perinatal CNS damage. In addition, any attentive mother can notice deviations in the health of her child much faster than a neuropathologist, if only because she is watching him around the clock and not one day.
In any case, the child, living the first year with any (even minimal, but not passing) deviations in the state of health, requires repeated consultations from specialists (if necessary, additional examination), careful observation and medical measures if necessary.
Symptoms and diagnostic criteria
Not every mother who does not have a medical education can, at first glance, distinguish and determine that her child has a perinatal CNS lesion.
But, neuropathologists accurately determine the disease by the appearance of symptoms that are not characteristic of other disorders that are characteristic of the smallest patients.
- When examining a baby, hypertonus or hypotonia of muscles can be detected,
- the child is extremely restless, anxious and agitated,
- the occurrence of shaking in the chin and limbs (tremor),
- the appearance of convulsions
- when viewed with a hammer there is a noticeable loss of sensitivity,
- the appearance of an unstable chair,
- heart rate changes
- the appearance of bumps on the skin of a child.
As a rule, after a year, these symptoms disappear, but then appear with a new force, so it is simply impossible to start this situation.
One of the most dangerous manifestations and consequences of PCND in the absence of response to symptoms is the suspension of the development of the child’s psyche. Speech apparatus does not develop, there is a delay in the development of motility. Also one of the manifestations of the disease may be cerebrosthenic syndrome.
There are several ways to develop perinatal CNS damage in newborns, depending on the cause and subsequent symptoms, the analysis of which allows the initial diagnosis to be made:
- If the lack of oxygen is clearly recorded, while the baby is inside the mother's body (hypoxia), then they will diagnose hypoxic ischemic damage to the central nervous system.
- During childbirth, the baby’s tissue structure can be damaged (this can be either the brain or the spinal cord). In this case, we are already talking about a traumatic damage to the central nervous system, resulting in changes in the brain.
- In the case of metabolic disorders, metabolic and toxic-metabolic lesions may appear. This may be due to the use of alcohol, drugs, narcotic drugs, nicotine during pregnancy.
- Changes in the central nervous system in the presence of infectious diseases of the perinatal period.
The complex of therapeutic activities
In the case when the child develops an acute period of the disease, his first thing is sent to the intensive care unit. Diuretics are used in cases of suspected brain edema - dehydration therapy can be performed.
Depending on what symptoms the baby has, with proper treatment you can get rid of cramps, respiratory and cardiovascular disorders, and muscular disorders.
If the disease is difficult, then the baby is fed through a tube. To restore the main functions of the central nervous system, as well as to reduce the manifestation of neurological symptoms, the baby is given a whole range of drugs:
- a course of taking Radodorm, Finlepsin, Phenobarbital,
- if a child periodically regurgitates - designate Motilium or Zeercal,
- if there are violations of the musculoskeletal system, appointed - Galantamine, Dibazol, Alizin, Prozerin,
- in order to reduce the possible hemorrhages recommend the use of the drug Lidaza.
Also in the treatment can be used and nootropic drugs that can restore trophic processes in the brain - Piracetam, Cerebrolysin, glutamic acid.
In order to stimulate the overall reactivity of a newborn baby, a course of therapeutic massage and special gymnastics is conducted.
In the event that parents find at least one of the signs of CNS lesions, an urgent need to consult a doctor. Do not forget that the development of each child is an individual process.
Such individual characteristics of each newborn child in each case play an important role in the process of restoring the functions of higher nervous activity.
Perinatal lesions of the central nervous system:
Danger and consequences
Among experts there is a perception that if the central nervous system of the fetus was affected, it cannot be fully restored. But neuroscientists claim the opposite. They say that if the disease is properly treated, then it is possible to achieve a partial or complete restoration of the functions of the nervous system.
But even despite such an optimistic prognosis, if you look at all diseases associated with the nervous system, 50% of their total number leads to disability, while about 80% of it is devoted to perinatal damage of the central nervous system.
The concept of PCNS
Perinatal damage to the central nervous system (or hypoxic due to encephalopathy) is a combination of various changes and disturbances in the functioning of the nervous system caused by many factors. The term “perinatal” means the period from the 28th week of gestation to a few weeks after delivery - changes in the nervous system develop over a period of time.
Classification of pathology
At the heart of perinatal CNS damage are pathological factors that occur immediately before birth, during or immediately after them. Factors of development of PCNS can be divided into 3 groups:
- hypoxic (lack of oxygen) damage to the fetal brain in the antenatal period (intrauterine hypoxia), during childbirth (acute birth hypoxia) and immediately after birth leads to ischemic genesis of the disease,
- traumatic lesions of the fetal head in the generic period,
- mixed (hypoxic-traumatic) factors.
Each group includes many causes of changes in the nervous system. The etiology of the disease creates difficulties in its diagnosis and treatment.
The most common factors in the development of CNS pathology are hypoxic-ischemic, causing bright clinical manifestations. There are several degrees of such lesions:
- I degree - stable condition of the newborn, score 6-7 on the Apgar scale, slight cyanosis, reduced muscle tone and reflexes, sleep disturbance, increased excitability, frequent regurgitation.
- Grade II - pronounced ischemic damage, depression of reflexes, including sucking, hyper tone, vegetative disorders (change in heart rhythm, impaired respiratory movements), intracranial hypertension syndrome.
- Grade III - deep hypoxic damage, impaired cardiac activity, lack of respiration, after birth, cardiopulmonary resuscitation, severe suppression of brain function, atony, areflexia are performed. The prognosis is unfavorable.
There are several periods of the disease:
- acute - from 7 days to 1 month - severe symptoms, inpatient treatment is necessary,
- recovery - up to 6-24 months - improving the general condition, the focus is on restorative procedures (massage, exercise therapy, physiotherapy).
Symptoms of pathology
The clinical picture of perinatal lesions may be different. A neurologist diagnoses the perinatal lesion of the nervous system, taking into account the present symptoms, only after a complete examination of the patient.
- muscle tone disorder - hypotonia (meaning muscle slackness in a newborn) or hypertonicity (bent arms and legs), respiratory disorders, at an early age - increased physiological tone, which is difficult to distinguish from the manifestations of the disease,
- chin twitch and sleep disorders,
- signs of depression of the nervous system - the child is sluggish, sleeps a lot, is inactive,
- Hypertensive syndrome (increased intracranial pressure) - headaches, anxiety, mild excitability, bulging of fontanel,
- convulsive syndrome - convulsions of different localization and severity,
- change in heart rhythm,
- dyspeptic symptoms in the form of unstable stool.
Causes PCVSN and risk group
The causes of perinatal lesions depend both on the pathologies and lifestyle of the mother, and on the effects of toxic factors during pregnancy and childbirth:
- infectious diseases of the mother during childbirth,
- chronic illness of a pregnant woman, accompanied by intoxication,
- metabolic disorders and maternal hereditary diseases,
- early pregnancy, lack of vitamins and other substances,
- severe pregnancy (early and late toxicosis, threatened miscarriage),
- prematurity of the fetus at birth,
- complications of the generic period (rapid delivery, a long anhydrous period, entanglement by the umbilical cord),
- harmful effects of external factors (ecology, toxic emissions).
The perinatal period is a concept that unites several time intervals in the development of a child. In each of these intervals, certain factors have the greatest influence:
- Antenatal (from 28 weeks before delivery) fetus is influenced by intrauterine infections - IUI (toxoplasmosis, cytomegalovirus infection, hepatitis, etc.), exacerbation of chronic diseases of the mother, toxic factors (alcohol, smoking, drugs), the effects of various types of radiation. In this period, intense maturation of the nervous system occurs, and adverse factors can lead to the birth of a premature baby.
- Intranatal period (childbirth) - prolonged anhydrous interval, weak labor, rapid delivery, manual obstetric aid, cesarean section, fetal umbilical cord fetus (hypoxia).
- Postnatal period (immediately after birth) - trauma and neuroinfection.
Damage to the central nervous system can be caused not only by one cause, but also by a combination of factors. The more factors involved in the development of the disease, the harder it proceeds.
Periods of the disease
Depending on the duration of the pathological process, the symptoms of the disease vary. Each period has its own manifestations:
- acute - weakness, lethargy, hypodynamia, muscle hypotonia, hyper excitability, hyper tone, sleep disorders, limbs of the baby are bent and do not straighten themselves, the chin is shaking,
- в ранний период восстановления симптоматика сглаживается, но могут возникнуть очаговые неврологические проявления (парезы, параличи), развивается гидроцефальный синдром (выбухает родничок, расширена подкожная венозная сеть на голове), наблюдаются изменение терморегуляции, выраженные нарушения функций органов пищеварения, синдром двигательных нарушений,
- late recovery - restoration of muscle tone (complete normalization of tone depends on the depth of the nervous system),
- residual manifestations - mental and neurological disorders.
Diagnosis of PCNS should be timely. The pediatrician makes a preliminary diagnosis and prescribes a consultation with a specialist. The pediatric neuropathologist, based on the symptoms and history data, concludes and prescribes the necessary research methods:
- Neurosonography (ultrasound examination of the brain) can only be carried out in children of the first year of life (until the spring is closed); this is the simplest and safest diagnostic method.
- MRI (magnetic resonance imaging) allows you to assess the state of the substance of the brain, to establish the presence of developmental anomalies, inflammatory and neoplastic processes. The disadvantage is the length of the procedure - during the scan, the child must be introduced into artificial sleep (any movement can lead to dynamic blurring and the inability to perform the study qualitatively), advantage is the lack of ionizing radiation, this method is considered the “gold standard” for diagnosing diseases of the brain substance (ischemic injury) . Conducting research is possible in the prenatal period.
- CT scan (computed tomography) - indications and limitations are the same as for MRI. The advantage is the speed of research, the disadvantage is the presence of ionizing radiation.
- EEG (electroencephalography) allows to assess the tone of the vascular structures of the brain, the study should be conducted in dynamics.
- Doppler sonography - helps to assess the speed of blood flow in the vessels of the brain and the presence of their constrictions.
The sooner a diagnosis is made and treatment is started, the greater the chances for a full recovery of the child. The general course of therapy includes: drug therapy, physiotherapy, massage, physical therapy. In each period of the disease, an individual scheme of rehabilitation is assigned, which depends on the patient's age, the severity of the lesion and the duration of the disease.
Increased intracranial pressure
Therapy is aimed at normalizing the production and outflow of cerebrospinal fluid in the brain. Apply Diacarb, which improves the outflow of liquor and reduces its production. In severe cases, when conservative therapy is powerless, hydrocephalus (expansion of the ventricles of the brain and cerebrospinal spaces) is increasing, methods of surgical correction (ventriculoperitoneal shunting, etc.) are used.
The scheme of therapy is built according to their severity. When muscle hypotonia treatment is aimed at increasing muscle tone, use Dibazol or Galantamine (affect the central nervous system). Use these drugs with caution - so as not to cause a spastic reaction.
With hypertonus it is necessary to relax the spasmodic muscles, for which use Mydocalm or Baclofen. In addition to drug therapy, physiotherapy methods, massage and exercise therapy are used.
Syndrome of increased nervous excitability
Currently, there is no clearly defined tactic for treating such children. Some neurologists prefer to prescribe such heavy drugs as Phenobarbital, Sonapaks, Diazepam. Herbal medicine is widely used (herbal teas, decoctions). When mental retardation is used, nootropics are used to improve cerebral circulation. Developmental classes are conducted with a speech therapist, a psychologist in special groups.
Therapy in the recovery period and rehabilitation
In the recovery period, special attention is paid to the physical and mental development of the child. Regular courses of therapeutic and tonic massage, physical therapy complexes, aimed at the overall development and the most problematic areas of damage. It is necessary to develop fine motor skills and mental activity. Classes with a psychologist and a speech therapist will help the child to adapt to the social environment. If necessary, the attending physician prescribes supportive medical therapy.
Possible effects of perinatal CNS damage
Consequences of damage to the nervous system - delayed motor, mental and speech development (we recommend to read: delayed speech development in children under 2 years of age: causes and treatment). In case of late diagnosis or poor-quality treatment, children may later fall behind in psychomotor and verbal development. The child does not find a common language with peers, begins to speak late. It is recommended to start the correction in 2-4 years - later the problem is aggravated, and the difference in development becomes more noticeable.
Attention Deficit Disorder and Motor Disorder Syndrome (VDS) are the most common complications. The second pathology manifests itself at the age of 3-4 years and requires immediate treatment. It is characterized by increased activity, the inability to hold attention for a long time, a decrease in memory and the quality of assimilation of a new material. In case of late treatment, the brightest manifestations occur at school age, when the child does not keep up with the school program, does not study well, and there are behavioral problems.
One of the most serious consequences is convulsive syndrome, which is manifested by epilepsy. The presence of such a lesion of the central nervous system significantly reduces the quality of life of the child and parents. Therapy should be systematic and, as a rule, continue throughout the patient's life.
Is there a prevention?
Perinatal damage to the central nervous system is a polyetiological disease, and there are no general recommendations for prevention. Preventive measures should be directed at eliminating each cause separately.
Particular attention should be paid to the health of the future mother. Women should get registered for pregnancy in the antenatal clinic in time and undergo all necessary examinations. Only a complete picture of the future mother's state of health will enable the gynecologist to plan the pregnancy correctly. If necessary, you should undergo additional research and treatment. During pregnancy, the expectant mother should avoid contact with potential carriers of infections, stop drinking, smoking and drugs.
In emergency situations in the hospital, mother and newborn are provided with qualified medical assistance. A neonatologist assesses the condition of the baby and, if necessary, prescribes therapy.
In the postnatal period, it is necessary to carefully monitor the condition of the baby, regularly visit the pediatrician, to perform all necessary appointments. It is obligatory to consult narrow specialists to identify early signs of pathology. Even in healthy children, preventive courses of massage, exercise therapy and physiotherapeutic procedures are carried out.
Perinatal damage to the central nervous system is not a sentence. With timely accurate diagnosis and effective treatment, care and monitoring by the parents, it is possible to fully restore the functions of the nervous system. With severe perinatal damage, you can achieve a good result and minimize the consequences. If this pathology is ignored, the risks of severe irreversible consequences are high.
In order for the baby to be healthy, it is necessary:
- completely give up alcohol, drugs, smoking,
- avoid infectious diseases during pregnancy,
- in case of indications, to carry out heat treatment, due to which the blood flow improves, and the tissues are warmed,
- as soon as the baby is born, you can visit the underwater shower-massage course, which is held in warm water and has a beneficial effect on the development of the baby’s muscle tone, but if there is no such possibility, you can do a manual massage under water.
CNS pathology in newborns | OkayDok| OkayDok
Pathologies of the central nervous system (CNS) in newborns are a large group of spinal / brain lesions. Such lesions may occur during fetal development, during childbirth and in the first days of life.
Table of contents: Causes of development of CNS pathologies in newborns Classification of CNS pathologies in newborns - Hypoxic lesions - Traumatic lesions - Dysmetabolic disorders - CNS lesions in infectious diseases 3. Periods of CNS pathologies in newborns - Acute period - Recovery period - Outcome of the disease 4. Diagnostic measures 5 Treatment and rehabilitation methods - Rehabilitation period 6. Prevention of CNS pathologies in newborns
Causes of the development of CNS pathologies in newborns
According to statistics, up to 50% of newborns receive a diagnosis of perinatal CNS pathologies, because doctors often include transient disorders in the functioning of the central nervous system in this concept. If we look at the statistics in more detail, it will be clarified:
- 60-70% of cases of diagnosing pathologies of the central nervous system in newborns occur at the birth of a premature baby,
- 1.5 - 10% of cases - for full-term babies born in a timely and natural way.
A factor that provokes the appearance of pathological changes in the work of the central nervous system in newborns may be absolutely any negative impact on the fetus during its intrauterine development. In general, doctors distinguish several main causes of the condition in question:
- Hypoxia of the fetus. We are talking about oxygen starvation, when an insufficient amount of oxygen from the mother’s body enters the child’s blood. Hypoxia can also be provoked by harmful production (it’s not for nothing that pregnant women are immediately transferred to easier work), and infectious diseases that were carried over before pregnancy, and the harmful habits of a woman (especially smoking). A very strong influence on the oxygen supply to the fetus and the number of abortions performed earlier - artificial interruption of pregnancy provokes in the future a disturbance in the blood flow between the mother and the fetus.
- Injuries to the newborn. We are talking about injury during childbirth (for example, when applying forceps for medical reasons) in the first hours / days of a newborn's life. It is physical injury that is considered the least likely cause of the development of central nervous system pathologies in newborns.
- Dysmetabolic processes in the newborn. Disturbances in the metabolic processes of the body of the fetus may occur due to smoking of the mother, taking drugs, drinking alcoholic beverages, or being forced to take strong medicines.
- Infectious diseases of the mother in the period of childbearing. Pathological damage to the central nervous system occurs with the direct impact on the body of the fetus viral agents, pathogenic microorganisms.
Note: regardless of whether the above factors were present, more often CNS pathologies in newborns are diagnosed in the case of premature birth, in premature babies.
Oxygen starvation of the fetus can lead to the following lesions of the central nervous system in newborns:
- Cerebral ischemia. The nosological form of this pathology is manifested in various degrees of severity of the course - cerebral ischemia 1, 2 and 3 degrees of severity. Clinical symptoms:
- cerebral ischemia 1 degree - depression or excitation of the central nervous system is observed, lasting no more than 7 days after birth,
- cerebral ischemia 2 degrees - depression and excitation of the nervous system lasts for more than 7 days, short-term convulsions can occur, increased intracranial pressure and disturbances of the vegetative-visceral type can be observed,
- cerebral ischemia 3 degrees - powerful convulsions, up to epileptic seizures, dysfunction of the brain stem, constantly increased intracranial pressure.
Please note: for grade 3 severity of the pathological state in question, progressive central nervous system depression is characteristic - in some cases, the newborn enters a comatose state.
- Intracranial hemorrhage hypoxic genesis. Nosological forms are diverse:
- hemorrhage of intraventricular type 1 degree - specific neurological symptoms, as a rule, are completely absent,
- Grade 2 intraventricular hemorrhage - seizures may develop, often the newborn falls into a coma, progressive intracranial hypertension, shock, apnea,
- Grade 3 intraventricular hemorrhage - deep depression of the central nervous system (coma), shock and apnea, long spasms, high intracranial pressure,
- primary type of subarachnoid hemorrhage - doctors diagnose central nervous system hyper-excitability, focal clonic convulsions, acute hydrocephalus,
- hemorrhage in the substance of the brain - the appearance of specific symptoms depends only on the localization of hemorrhage. There are possible: intracranial hypertension / focal convulsions / convulsions / coma, but in some cases even such a serious disruption of the central nervous system is asymptomatic.
- The combination of ischemic and hemorrhagic lesions of the central nervous system. The clinical picture and nosological forms of this condition will depend only on the localization of hemorrhage, the severity of the pathology.
We are talking about birth injuries, which caused the development of pathological disorders in the central nervous system. They are divided according to the following principle:
- Intracranial birth injury. May manifest in several nosological forms:
- epidural hemorrhage - a condition characterized by high intracranial pressure (the very first sign), convulsive syndrome, in rare cases, doctors fix the dilation of the pupil on the side of the hemorrhage,
- subdural hemorrhage - subdivided into supratentorial (asymptomatic, but partial seizures may occur, pupil dilation from hemorrhage, progressive intracranial hypertension) and subtentorial (acute increase in intracranial pressure, cardiac / respiratory activity, progressive action, inhibition of the central nervous system with transient movement, transient intracranial pressure, impaired cardiac / respiratory activity of a progressive action, inhibition of the central nervous system with a transition in humans).
- intraventricular type hemorrhage - characterized by convulsions (multifocal), cardiac / respiratory failure, CNS depression, hydrocephalus,
- hemorrhagic infarction - the course may be asymptomatic, but it may manifest convulsions, depression of the central nervous system with a transition to a coma, high intracranial pressure,
- subarachnoid hemorrhage - doctors diagnose acute external hydrocephalus, hyperexcitability and convulsions.
- Spinal cord injury during childbirth. Hemorrhage occurs in the spinal cord - strain, sprain. It can be accompanied by a spinal cord injury or it can proceed without this moment. The clinical picture is characterized by impaired functioning of the respiratory system, dysfunctional sphincters, motor impairment and spinal shock.
- Peripheral nervous system trauma during childbirth. Nosological forms and symptoms:
- damage to the brachial plexus — paresis of the flaccid nature of the proximal part of one or both hands in the case of the proximal type, flaccid paresis of the distal upper limbs, and Claude Bernard-Horner syndrome in the distal type of damage. Total paralysis may develop - there is a paresis of the total part of the arm or both hands at once, possibly a violation of the respiratory system,
- damage to the phrenic nerve - often proceeds without any pronounced symptoms, but respiratory disorders may occur,
- traumatic lesion of the facial nerve - in a child, while screaming, the mouth is twisted to a healthy side, the nasolabial folds are smoothed out.
First of all, doctors consider transient metabolic disorders:
- nuclear jaundice - characterized by a symptom of the "setting sun", convulsions, opisthotonus and apnea,
- hypomagnesaemia - convulsions and hyperexcitability are noted,
- hypernatremia - high blood pressure, rapid breathing and heartbeat,
- hyperglycemia - depressed consciousness, convulsions, but often such a violation is asymptomatic and is detected only after laboratory tests of blood and urine tests of the newborn,
- hypercalcemia - convulsions, tachycardia, high blood pressure, muscle spasms of tetanic nature,
- hyponatremia - lowering blood pressure, depression of the central nervous system.
Newborns may have dysmetabolic disorders of the central nervous system and against the background of toxic effects on the fetus - for example, if the mother is forced to take potent drugs, did not rule out alcohol, drugs and tobacco. In this case, the clinical picture will be as follows:
- судороги – редко, но этот синдром может присутствовать,
- угнетение ЦНС, переходящее в кому.
Поражения ЦНС при инфекционных заболеваниях
If during pregnancy a woman has been diagnosed with cytomegalovirus infection, toxoplasmosis, rubella, herpes infection or syphilis, then the probability of having a child with pathologies of the central nervous system increases significantly. There are some infectious diseases that can contribute to the development of problems in the work of the central nervous system after the birth of a child - sepsis, sinus infection, streptococcal and staphylococcal infections, candidiasis and others.
With lesions of the CNS infectious etiology, the following symptoms will be identified:
- intracranial hypertension,
- focal disorders,
- meningeal syndrome.
Periods of the pathology of the CNS in newborns
Regardless of what causes the development of CNS lesions in newborns, experts identify three periods of the disease:
- acute - in the first month of a child’s life,
- restorative - can run from 2 to 3 months of a baby’s life (early) and from 4 months to 1 year (late),
- the outcome of the disease.
For each of the listed periods, characteristic features are inherent, which may be present separately, but more often manifest themselves in original combinations individually for each child.
Outcome of the disease
By the 12 months of a child’s life, the symptoms of CNS abnormalities in newborns almost always disappear, but this does not mean that the above-described lesions have disappeared without any consequence. The most frequent effects of damage to the central nervous system in newborns include:
- hyperactivity syndrome accompanied by lack of attention - memory impairment, learning difficulties, aggressiveness and attacks of hysteria,
- delay of speech, psychomotor and physical development,
- cerebroasthenic syndrome - characterized by meteo-dependence, anxious sleep, sudden mood swings.
But the most severe, complex consequences of CNS pathologies in newborns are epilepsy, cerebral palsy and hydrocephalus.
It is very important for the correct diagnosis to conduct a proper examination of the newborn and monitor its behavior / condition in the first hours of the infant's life. If you suspect pathological lesions of the central nervous system, it is advisable to appoint a comprehensive examination:
- ultrasound - study the state of the cerebral vessels, “working” by the sensor through a spring,
- computed tomography - the study allows not only to confirm the alleged diagnosis, but also to assess the degree of damage to the central nervous system of the newborn,
- x-ray of the brain and / or spinal cord - is used only when absolutely necessary.
The first stage of assistance
It consists in restoring the health of vital organs and systems - we recall that in almost all types / forms of pathologies of the central nervous system of newborns cardiac / respiratory failure and problems in the kidneys work. Doctors with the help of drugs normalize metabolic processes, relieve the newborn from convulsive syndrome, relieve swelling of the brain and lungs, normalize indicators of intracranial pressure.
Second stage of help
Very often, after providing emergency measures to help a newborn with pathologies of the central nervous system even in the maternity hospital, visible signs disappear, often the condition of the child is normalized. But if this did not happen, then the patient is transferred to the neonatal pathology department and continue treatment / rehabilitation.
The second stage of assistance involves the appointment of drugs that act to eliminate the causes of the pathologies in question - for example, antiviral, antibacterial agents. At the same time, therapy is prescribed to restore brain activity, stimulate the maturation of brain cells, and improve cerebral circulation.
The third stage of assistance
If a newborn has significant improvements, then it is advisable to switch to non-drug treatment. These are massages and physiotherapeutic procedures, the most effective of which are:
- therapy "position" - the installation of tutors, "collars", styling,
- a specially designed exercise cycle in water
- imitation of weightlessness
- Vojt therapy,
- paraffin therapy
- alternating magnetic field
- color therapy and light therapy,
Please note: the third stage of care with the safe passage of the first two full-term babies is assigned at 3 weeks of age, and prematurely a little later.
Doctors prescribe a child with diagnosed pathologies of the central nervous system for outpatient treatment only in the case of positive dynamics. Many experts believe that it is the rehabilitation period outside the hospital that plays a big role in the further development of the child. Much can be done with medicines, but only permanent care can ensure the mental, physical and psychomotor development of the baby within the normal range. Be sure to:
- protect your baby from harsh sounds and bright light,
- create an optimal climate for the child - there should not be sudden changes in air temperature, high humidity or dry air,
- If possible, protect the baby from infection.
Please note: for mild and moderate lesions of the central nervous system in newborns, doctors do not prescribe medication at the second stage — usually providing urgent medical care and restoring normal functioning of vital organs and systems. In the case of the diagnosis of severe CNS lesions in newborns, some medications are prescribed in courses and at an older age, during outpatient treatment.
Prevention of CNS pathologies in newborns
Most often, the pathologies considered are easy to predict, so doctors strongly recommend that preventive measures be taken at the planning stage of pregnancy:
- cure all previously diagnosed infectious diseases,
- medical vaccination,
- give up bad habits - stop smoking, stop drinking alcohol and drugs,
- undergo a full examination by narrow specialists,
- normalize hormones.
Secondary prevention is considered to be rendering full-fledged assistance in identifying pathologies of the central nervous system in newborns, preventing the development of serious consequences.
At the birth of a child with pathologies of the central nervous system, you should not panic and immediately record a newborn with disabilities. Doctors are well aware that in a timely manner the medical care provided in most cases gives positive results - the child is fully restored and in the future is no different from his peers. Parents will just need a lot of time and patience.
Yana Alexandrovna Tsygankova, medical reviewer, general practitioner of the highest qualification category.
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