A newborn child has not yet fully formed organs and systems, and it takes some time to complete the formation. It is in the process of growth that the baby also forms and matures its central nervous system. The nervous system of the baby helps to regulate its normal existence in the world.
In some cases, a CNS lesion of the newborn can be diagnosed, which occurs quite often lately. The depression of the nervous system can provoke serious consequences and leave the child disabled.
Feature of the nervous system of the newborn
An infant differs from an adult not only in external differences, but also in the structure of its organism, since all systems and organs are not fully formed. During the formation of the brain in a child, unconditioned reflexes are pronounced. Immediately after birth, the level of hormone regulating substances responsible for the functioning of the digestive system rises. At the same time, all receptors are already well developed.
The causes of the pathology of the central nervous system
The causes and consequences of CNS damage in newborns can be very different. The main factors provoking the disruption of the functioning of the nervous system are:
- lack of oxygen, or hypoxia,
- birth injuries
- disruption of normal metabolism,
- infectious diseases that the expectant mother suffered during pregnancy.
Birth injuries are considered one of the factors leading to damage to the nervous system, since any injury can provoke a violation of the maturation and subsequent development of the central nervous system.
Disruption of normal metabolism occurs for the same reasons as the lack of air. Drug-addiction and alcoholism of the future mother also lead to dismetabolic disorders. In addition, potent drugs can affect the nervous system.
Critical for the fetus can be infectious diseases, transferred by the expectant mother when carrying a child. Herpes and rubella should be distinguished among such infections. In addition, absolutely any pathogenic microbes and bacteria can provoke irreversible negative processes in the child’s body. Most problems with the nervous system occur in premature babies.
Periods of CNS pathologies
Syndrome of lesion and depression of the nervous system combines several pathological conditions that arise during the period of intrauterine development, during labor, and also in the first hours of infancy. Despite the presence of many predisposing factors, during the course of the disease there are only 3 periods, namely:
In each period, CNS damage in newborns has different clinical manifestations. In addition, children may experience a combination of several different syndromes. The severity of each flowing syndrome allows you to determine the severity of damage to the nervous system.
The acute period lasts for a month. Its course depends on the degree of damage. In the mild form of the lesion, there is a start, an excitability of nerve reflexes, chin tremor, sharp uncontrolled movements of the limbs, sleep disturbances. A child may very often cry for no apparent reason.
With the most severe degree usually comes coma.Such a complication requires the stay of the child in the hospital under the supervision of a doctor.
CNS lesion in newborns during the recovery period has the following syndromes:
- increased excitability
- motor disorders
- delays in the development of the psyche.
With prolonged violation of the muscle tone often there are delays in the development of the psyche and the presence of disorders of motor functions, which are characterized by involuntary movements, provoked by contraction of the muscles of the body, face, limbs, eyes. This prevents the child from making normal, purposeful movements.
The result of the disease
Around the year, CNS damage in newborns becomes apparent, although the main symptoms of the disease gradually disappear. The result of the pathology becomes:
- developmental delay
- cerebroasthenic syndrome,
This may result in cerebral palsy and a child’s disability.
Perinatal CNS damage
Perinatal CNS damage in newborns is a collective concept, implying a violation of the functioning of the brain. Similar disorders are observed in the antenatal, intranatal and neonatal period.
Antenatal starts from the 28th week of intrauterine development and ends after birth. Intranatal includes the period of childbirth, from the beginning of the course of labor to the moment of birth of the child. The neonatal period begins after birth and is characterized by the adaptation of the infant to environmental conditions.
The main reason for the occurrence of perinatal CNS damage in newborns is hypoxia, which develops during unfavorable pregnancy, birth injuries, asphyxia, and infectious diseases of the fetus.
Cause of brain damage are considered intrauterine infections, as well as birth injuries. In addition, there may be spinal cord injury resulting from injuries during childbirth.
Symptoms largely depend on the period of the disease and the severity of the lesion. In the first month after the birth of the child, an acute period of the course of the disease is observed, characterized by depression of the nervous system, as well as hyper-irritability. Gradually normal muscle tone. The degree of recovery depends largely on the degree of damage.
The disease is diagnosed in the maternity hospital by a neonatologist doctor. The specialist conducts a comprehensive examination of the baby and, based on the available signs, makes a diagnosis. After discharge from the hospital, the child is under the supervision of a neurologist. For statement of more exact diagnosis hardware inspection is carried out.
The recovery period is carried out in a comprehensive manner, and at the same time, physiotherapeutic methods, such as physical therapy, swimming, manual therapy, massages, and speech therapy classes, are used together with medical preparations. The main purpose of such methods is the correction of mental and physical development in accordance with age-related changes.
Hypoxic-ischemic damage to the central nervous system
Since hypoxia often provokes damage to the nervous system, every expectant mother should know what causes hypoxia and how to avoid it. Many parents are interested in what this is hypoxic-ischemic CNS damage in newborns. The severity of the main symptoms of the disease depends largely on the duration of hypoxia of the child in the prenatal period.
If the hypoxia is short-term, then the disturbances are not so serious, the oxygen starvation, which lasts for a long time, is more dangerous. In this case, functional disorders of the brain or even death of nerve cells can occur.In order to prevent a disorder of the nervous system in a baby, a woman should be very attentive to her state of health when carrying a child. If you suspect the presence of diseases that trigger fetal hypoxia, you should immediately consult a doctor for treatment. Knowing what it is - hypoxic-ischemic CNS damage in newborns, and what are the signs of the disease, it is possible to prevent the occurrence of pathology during the timely treatment.
Forms and symptoms of the disease
CNS damage in newborns can occur in several different forms, namely:
The mild form is characterized by the fact that in the first days of a child’s life an excessive excitability of nerve reflexes and a weak muscle tone can be observed. Slithering squint or irregular, wandering movement of the eyeballs may appear. After a while, a chin and limb tremor may be observed, as well as restless movements.
The average form has symptoms such as lack of emotion in a child, poor muscle tone, paralysis. There may be convulsions, excessive sensitivity, involuntary eye movement.
The severe form is characterized by serious disorders of the nervous system with its gradual oppression. It appears in the form of convulsions, kidney failure, disorders of the bowels, cardiovascular system, respiratory system.
Since the consequences of damage to the central nervous system can be quite dangerous, it is therefore important to timely diagnose disorders. Sick children generally behave uncharacteristically for newborns, which is why when the first symptoms of the disease appear, it is necessary to consult a doctor for examination and subsequent treatment.
Treatment of CNS damage
Some pathological processes occurring in the body of the infant may be irreversible at an advanced stage, therefore they require urgent measures and timely therapy. Treatment of newborns should be carried out in the first months of their lives, since during this period the baby’s body is able to fully restore impaired brain functions.
Deviations in the work of the central nervous system are corrected with the help of drug therapy. Its structure includes drugs that help improve the power of nerve cells. In the course of therapy, drugs that stimulate blood circulation are used. With the help of drugs, you can reduce or increase muscle tone.
After the child’s condition has stabilized, an individualized program of supporting complex therapy is developed and regular monitoring of the baby’s condition is carried out. Throughout the year, the dynamics of the child’s condition are analyzed, and other methods of therapy are selected that contribute to the speedy recovery and development of the required skills and reflexes.
Prevention of CNS damage
In order to prevent the occurrence of a serious and dangerous disease, it is necessary to carry out prevention of damage to the CNS of the infant. For this, doctors recommend planning a pregnancy in advance, taking the required examinations in a timely manner and discarding bad habits. If necessary, antiviral therapy is carried out, all necessary vaccinations are given, and hormonal background is normalized.
If the central nervous system of the infant still occurs, it is important to help the newborn from the first hours of his life and to monitor the condition of the baby.
Consequences of the central nervous system
The consequences and complications of CNS damage in a newborn baby can be very serious, dangerous to health and life, and they are expressed in the form of:
- severe forms of mental development
- severe forms of motor development, cerebral palsy,
- neurological deficit.
Why there are lesions of the central nervous system, the stage of their development
People talk about perinatal CNS damage in the case when the baby was exposed to negative factors during the neonatal period, during birth or while in the womb.
Causes that can cause disturbances in the functioning of the child’s nervous system:
Impaired blood flow in the uterus and placenta. Placental thrombosis, delayed fetal development, bleeding in a pregnant woman.
Acceptance of alcohol during pregnancy, smoking and the passage of therapy with certain drugs.
Severe blood loss during labor, entanglement of the umbilical cord around the baby’s neck. Hypotension or bradycardia in a child, birth trauma.
Heart defects, DIC, pathology of the respiratory system organs, respiratory arrest episodes in an infant that was born.
The lack of oxygen in arterial blood is a factor that triggers metabolic disturbances in the nervous tissue. At the same time, individual neurons, or their entire groups, begin to die. In such conditions, brain tissue becomes as susceptible as possible to any fluctuations in blood pressure. If at this time the child develops hypotension, then the pathological process is further aggravated.
Violations of metabolic processes in the brain provoke acidosis of its tissues, which entails brain edema with increased intracranial pressure. This causes massive brain cell death.
Deep asphyxia affects the functioning of all organs of the child. The kidneys, intestines, and liver suffer. Hypoxia causes the death of the tissues of these organs.
There are differences in the course of complications caused by oxygen starvation in full-term infants and in preterm infants. So, if a child who was born on time was hypoxia, then the cerebral cortex, its subcortical structures and the brainstem will be affected to a greater extent. If the child is premature, then he is likely to develop periventricular leukomalacia, that is, areas of necrosis will be concentrated in the region of the lateral ventricles of the brain.
The severity of hypoxic encephalopathy has a direct relationship with the depth of ischemic brain damage.
In this regard, distinguish:
Easy or 1 degree of severity. Neurological disorders are transient, after 7 days they will be completely stopped.
Medium or 2 severity. Hypoxic-ischemic disorders persist for more than one week. In this case, the child’s nervous system is either depressed or hyper-excitable, convulsions are observed, intracranial pressure is elevated, but the increase is not stable. Disorders of the autonomic nervous system also appear.
Severe form of violation or 3 degree of severity. In this case, the child will be either in a coma or in a support. He has convulsions, there is swelling of the brain, the work of the internal organs is impaired.
Symptoms of hypoxic-ischemic damage to the central nervous system
If the child has a central nervous system, the doctors will establish this fact from the first minutes of his life. Symptoms directly depend on the severity of the infant’s condition.
If hypoxic-ischemic encephalopathy has a mild course, then the child’s condition will be stable. On the Apgar scale, the baby gets 6-7 points. He will experience cyanotic staining of the skin, his muscle tone is somewhat reduced.
From the nervous system, the following symptoms are observed:
Neuro-reflex excitability increased.
Sleep is disturbed, the child is anxious.
Chin and limbs tremble slightly.
The child often spits up.
Perhaps the gain, or, conversely, a decrease in reflexes.
As a rule, over the next 7 days after the baby is born, all these pathological symptoms will be stopped. The kid becomes calmer, begins to gain weight. Severe disorders of the nervous system are absent.
In the second degree of hypoxic brain damage, the symptoms will be more intense. Most often, infants with moderately severe hypoxic-ischemic encephalopathy suffered from oxygen starvation while still in the womb, and were adversely affected during labor. On the Apgar scale, such a child is given a mark of 5 points, he can be followed by arrhythmias, and deaf heart sounds are heard.
The nervous system disorders are as follows:
Reflexes are depressed, this is true, including with respect to the sucking reflex.
Muscle tone is reduced, voluntary movements are minimal or absent altogether.
Intracranial pressure rises.
The skin has a bluish color.
Vegetative disturbances are observed: periodic stops of breathing occur, the pulse can be accelerated, bradycardia is often diagnosed. The intestine is weakly reduced, thermoregulation is impaired.
The child often spits up, may suffer from constipation or diarrhea, gaining weight slowly.
The higher the child's intracranial pressure, the more anxiety he will manifest. The skin is sensitive, sleep is restless. The chin and hands of the child tremble, springs emanate. The baby has oculomotor disorders, nystagmus. Seizures may also indicate increased intracranial pressure.
By the 7th day from the moment the child is born, his condition is stabilized. However, he should receive intensive therapy. Fully by this time, neurological symptoms do not pass. If the pathology progresses, then the depression of brain activity increases, a drop in muscle tone occurs. A child may fall into a coma.
If a child is diagnosed with grade 3 hypoxic-ischemic lesions, then the woman always has severe preeclampsia in the second half of pregnancy. She suffers from high blood pressure, she has a violation of the kidneys, pronounced swelling.
The baby is born with the symptoms of oxygen starvation, the developmental delay is clearly visible. If the birth proceeded with complications, then the existing violations will only be exacerbated.
The child suffers from severe circulatory disorders, may not breathe, muscle tone and reflex activity are often absent. If resuscitation is not carried out on an emergency basis, the child will die.
In the first hours after his birth, depression of the brain is observed, coma develops. Reflexes and motor activity in the infant are absent, pupils are dilated, the reaction to light is zero.
Cerebral edema is manifested by convulsions, it is possible to stop breathing and cardiac activity. The pressure in the pulmonary artery rises, urine filtration worsens, blood pressure drops, intestinal tissues begin to die, the liver stops functioning, and DIC develops.
Post-fix syndrome is a consequence of severe hypoxia of the newborn. The child is practically immobilized, does not cry, does not respond to pain stimuli, to touch, the skin is pale, the body temperature is lowered. The baby hardly swallows and sucks, therefore the woman cannot feed him independently. Without intensive care, the child will die. The prognosis is unfavorable, the stability of the state cannot be concluded before 10 days from the moment of its birth.
The subsequent increase in neurological deficit characterizes all forms of hypoxic-ischemic disorders.The fact is that neurons that were damaged as a result of hypoxia continue to die.
Possible options for the pathology:
The condition of the child is improving rapidly. The prognosis is favorable.
Neurological disorders pass by the time the baby is discharged from the maternity hospital. The prognosis is favorable.
Neurological disorders continue to progress. The prognosis is unfavorable.
During the first month of life, the child becomes disabled.
An unfavorable course with a latent increase in neurological disorders that develop during the first six months of a child’s life.
Encephalopathy of the newborn is divided into 3 periods:
An acute period that lasts for the first month. At this time, there are maximum disorders of the nervous activity. They can be mild, or reach coma.
The recovery period, which may continue throughout the year. At this time, the child may experience convulsive syndrome, hydrocephalus, increases neuro-reflex excitability, and there is a lag in physical and mental development.
The long-term period, when the consequences of the transferred hypoxia manifest themselves. Some symptoms may disappear, while others appear, for example, a child may experience a delay in speech development.
To diagnose hypoxic-ischemic encephalopathy, it is required to identify the characteristic symptoms in an infant, to study the history of the management of a pregnant woman. Also in the diagnosis of the pathological condition assist instrumental methods of examination, including:
Computed tomography and magnetic resonance imaging of the brain.
Doppler study of cerebral vessels.
The difficulty in treating hypoxic-ischemic complications lies in the fact that not a single drug can achieve recovery of once damaged nerve tissue. However, it is still possible to normalize the work of the brain to one degree or another.
Depending on the prevalence of specific symptoms and the severity of hypoxia, the therapeutic scheme will vary.
If hypoxia has a moderate or mild severity, then the child is taken diuretics, nootropic drugs, medicines to eliminate seizures. Provided that hypoxia has a severe course, the patient is urgently given intensive therapy.
When a child has symptoms of mild hypoxic-ischemic encephalopathy, but there are no convulsions, the doctor can only restrict observation of the patient. Sometimes with such a clinical picture, Diazepam can be indicated, but for a short time. This drug can inhibit the development of the child, so it is prescribed only according to strict indications.
Pantogam and Phenibut have a complex nootropic and inhibitory effect on the nervous system of a child. Nitrazepam is prescribed to normalize the sleep of the child. Also, valerian extract, lemon balm, motherwort, peppermint can be used for this purpose. Sedative effect has a massage and hydrotherapy.
If hypoxia has a severe course, then the child is prescribed anticonvulsant drugs, diuretics (Furosemide, Mannitol, Diacarb) and Magnesium sulfate.
The child is urgently reanimated if he has a breath hold or cardiac arrest. It is shown that the patient is connected to the ventilator, the introduction of cardiotonic drugs, conducting infusion therapy.
Diuretics are prescribed as the main drug for hypertensive-hydrocephalic syndrome. Preference is given to a drug called Diacarb. It can be used to treat children of any age. Operative intervention is resorted to in the case when conservative therapy does not bring the desired effect.For this purpose, shunting operations are carried out with a conclusion of the CSF in the peritoneal cavity or in the pericardial cavity.
To relieve seizures and reduce the excitability of the nervous system, prescribe such drugs as: Diazepam, Phenobarbital, Clonazepam, Phenytoin. If the child is newborn, then preference should be given to barbiturates, namely Phenobarbital. If the baby is nursing, then carbamazepine is prescribed.
For removal of the increased tone from muscles, use Baclofen or Mydocalm. If, on the contrary, muscle tone is reduced, then Dibazol and Galantamine are prescribed to the child. Physical therapy helps in the treatment of hypoxia complications. For this, the child is sent for a course massage, with him doing therapeutic exercises. Reflexology and water treatments have a good effect.
If a child has difficulty in speech development, which becomes obvious by the end of the first year of life, then he is shown the reception of Nootropil and Encephabol, vitamins of group B. The baby must necessarily interact closely with the speech therapist and the pathologist.
The appointment of a large number of drugs is not always the right tactic for treating children who have had hypoxia with subsequent encephalopathy. Diakarb, nootropic drugs, vitamins, Actovegin is often prescribed without need to the child. However, if encephalopathy has a mild course, these drugs will not be beneficial, since the body can recover on its own. Moreover, they have age contraindications, therefore their unreasonable use can even be harmful.
Restoration of the child is possible, with this comes a full recovery. However, it cannot be excluded that the baby will remain disabled if the hypoxia was severe. It is also possible the development of minor brain dysfunction with oligosymptomatic course of pathology.
The consequences of hypoxic-ischemic encephalopathy are epilepsy, cerebral palsy, hydrocephalus, oligophrenia. The last violation is persistent in time, it is impossible to cure oligophrenia.
If a child lags slightly behind in development during the first year of life, but at the same time receives adequate treatment, he will most likely catch up with his peers in the near future and will not differ in any way from healthy children.
About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical and sanitary unit No. 21, the city of Elektrostal. Since 2016 he has been working in the diagnostic center №3.
Schemes of taking medicinal herbs for any female diseases (bases of herbal medicine)
Causes and stages of hypoxic-ischemic lesion
Perinatal CNS damage in newborns is formed by the action of adverse factors in utero, during childbirth or during the newborn. The reasons for these changes can be:
- Blood flow disorders in the uterus and placenta, bleeding in pregnant women, pathology of the placenta (thrombosis), lagging development of the fetus,
- Smoking, drinking alcohol, taking certain medications during pregnancy,
- Massive bleeding during childbirth, entanglement of the umbilical cord around the fetal neck, severe bradycardia and hypotension in the infant, birth injuries,
- After childbirth - hypotension in the newborn, congenital heart defects, DIC, episodes of respiratory failure, dysfunction of the lungs.
example of hypoxic ischemic brain damage
The initial moment of the development of HIE is the lack of oxygen in arterial blood, which provokes the pathology of metabolism in the nervous tissue, the death of individual neurons or their whole groups. The brain becomes extremely sensitive to fluctuations in blood pressure, and hypotension only aggravates the existing lesions.
Against the background of metabolic disorders, “acidification” of the tissue (acidosis) occurs, swelling and swelling of the brain increase, and intracranial pressure increases. These processes provoke a common necrosis of neurons.
Severe asphyxiation affects the work of other internal organs. Thus, systemic hypoxia causes acute renal failure due to necrosis of the tubule epithelium, necrotic changes in the intestinal mucosa, and liver damage.
In full-term infants, post-hypoxic damage is noted predominantly in the area of the cortex, subcortical structures, brain stem, in prematurity, due to the peculiarities of the maturation of the nervous tissue and the vascular component, periventricular leucomalation is diagnosed when necroses are concentrated mainly around the lateral ventricles of the brain.
Depending on the depth of cerebral ischemia, several degrees of hypoxic encephalopathy are distinguished:
- The first degree - mild - transient violations of neurological status, lasting no more than a week.
- Second-order HIE - lasts longer than 7 days and is manifested by depression or excitation of the central nervous system, convulsive syndrome, temporary increase in intracranial pressure, autonomic dysfunction.
- Severe hypoxic-ischemic lesion - a disorder of consciousness (stupor, coma), convulsions, manifestations of brain edema with stem symptoms and impaired activity of vital organs.
Origin of GIE
Being in the womb, the fetus "feeds" on the fact that it comes with maternal blood. One of the main components of nutrition is oxygen. His lack of a negative impact on the development of the central nervous system of the unborn child. And the oxygen demand of his emerging brain is even higher than that of an adult. If a woman during pregnancy experiences harmful influences, is poorly nourished, ill or leads an unhealthy lifestyle, this will inevitably affect the child. He gets less oxygen.
Arterial blood with low oxygen content causes metabolic disturbances in brain cells and the death of some or whole groups of neurons. The brain has an increased sensitivity to fluctuations in blood pressure, especially to its decrease. Exchange disorders cause the formation of lactic acid and acidosis. Then the process grows - brain edema is formed with increased intracranial pressure and necrosis of neurons.
Perinatal damage to the central nervous system can develop in utero, during childbirth and the first days after birth. Doctors consider the time range from the full 22 weeks of pregnancy to 7 days from birth. Fetal risks:
- disorders of the uterine and placental circulation, umbilical anomalies,
- toxic effects from smoking and taking certain drugs,
- harmful production, where a pregnant woman works,
At birth, risk factors are:
- weak labor activity
- prolonged or rapid delivery,
- prolonged lack of water
- birth injury,
- bradycardia and low blood pressure in a child
- placental abruption, umbilical cord entanglement.
Immediately after birth, the development of hypoxic-ischemic CNS damage in newborns is possible due to low blood pressure, the presence of DIC syndrome (hemostasis pathology, accompanied by increased thrombosis in microcirculatory vessels). In addition, HIE can be provoked by heart defects, breathing problems in a newborn.
Clinical periods and degrees of brain damage
The clinical course of hypoxic-ischemic damage to the central nervous system is divided into periods:
- acute occurs in the first 30 days after birth,
- recovery continues up to a year
- after a year there may be long-term consequences.
CNS lesions during hypoxia in newborns in the acute period are divided into three degrees depending on the presence and combination of syndromes:
|Increased neuro-reflex excitability (cerebrastenic syndrome)||poor sleep and reduced sucking reflex,|
|startling from touch|
|a cry for no apparent reason|
|trembling of the chin, arms and legs,|
|dropping your head back|
|sweeping arm and leg movements|
|Convulsive syndrome||Paroxysmal convulsions|
|restlessness and irritability|
|hypo or hypertonus of the leg muscles (lack of automatic walking, getting up on tiptoe),|
|lethargy and low activity in hydrocephalic syndrome,|
|head size increase|
|reduced muscle tone|
|poor reflex reaction|
|Comatose syndrome||lack of reaction to touch and pain,|
|lack of sucking reflex and swallowing,|
|convulsions are possible|
Neurologically, it manifests itself as a syndrome of increased neuro-reflex excitability. As a rule, by the end of the first week of life, the symptoms smooth out, the baby becomes calmer, his sleep normalizes, and there is no further development of neurological pathology.
Examination by a neurologist after the first month is optional. But if the child still has even the most minor symptoms associated with oxygen starvation, it is necessary to undergo a thorough examination. Perhaps the doctor will prescribe medication or physiotherapy. By the time the child turns a year, the functions are fully restored.
Deeper brain hypoxia causes moderate ischemic damage. Neurological symptoms are determined by a gradual increase in intracranial pressure. These kids have impaired reflexes and involuntary physical activity - at the very beginning they may not show it at all. Their skin is bluish in color, muscle tone is reduced or increased. The autonomic nervous system is unbalanced, which results in an acceleration or slowing of the heartbeat, breathing stops, bowel problems, and a lack of weight due to constant regurgitation.
The main syndromes characteristic of the second degree of the disease are hypertensive-hydrocephalic, depression syndrome. The condition of the newborn becomes more stable by the end of the first week of life. Further, during the recovery period, neurological manifestations may soften and decrease with intensive treatment. Unfavorable course implies their aggravation up to coma.
This form of ischemia is most often caused by severe gestosis of the mother, which proceeded with all unfavorable pathological manifestations - increased pressure, edema and kidney excretion of protein. Newborns with a hypoxic — ischemic lesion of the third degree without resuscitation immediately after birth usually do not survive. One of the development options is comatose syndrome.
Another severe manifestation of severe hypoxia can be post-asphyxian syndrome. It is characterized by the depression of reflexes, low mobility, lack of response to touch, a decrease in temperature and blueness of the skin. Severe cerebral ischemia leads to the impossibility of feeding the child naturally, life is maintained through the use of intensive therapy. By the 10th day of life, the condition may stabilize, but more often the prognosis remains unfavorable.
In general, an acute pathological process can occur with different intensity:
- GIE symptoms pass quickly
- gradual regression of neurological symptoms by the time of exit from the hospital,
- severe course with the preservation and further development of neurological deficit, followed by disability,
- latent course, showing nervous disorders (delayed development and decrease in cognitive functions) after 6 months.
During the recovery period, ischemia is manifested mainly in the syndrome of increased neuro-reflex excitability. Manifestations of convulsive and hydrocephalic syndrome are possible. Symptoms of neurological failure - developmental delay, speech disorders and other disorders. Another syndrome characteristic of the recovery period is vegeto-visceral. His signs are:
- violation of thermoregulation,
- the appearance of vascular spots
- indigestion - vomiting, regurgitation, breaking stools, bloating,
- low weight gain
- heart rhythm disorders
- rapid shallow breathing.
If the child begins to hold his head later, smile, sits down, crawl and walk, it means that he has late psychomotor development syndrome.
The treatment is aimed at restoring the functions of the body, since it is impossible to treat the brain in isolation. Therapy involves the use of drugs depending on the most pronounced syndrome.
Treatment in the acute period consists in the use of drugs that relieve convulsions, restore breathing, diuretic for hydrocephalus. To reduce hyperactivity apply sedatives, including herbal remedies (valerian, mint, lemon balm). To increase blood volume - plasma and albumin. To improve the metabolic processes in the nerve tissues using Piracetam and glucose solution.
During the recovery period, medical treatment is combined with hydrotherapy and massage, which gives good results. Cerebrastenic syndrome is corrected with the help of sedatives, soothing herbs and drugs that improve cerebral circulation (Tsinarizin, Cavinton).
Persisting hydrocephalus continues to be treated with diuretics and absorbable drugs (Cerebrolysin, Lidaza, aloe). Disturbed motor activity is restored with vitamins of group B, ATP, Prozerin. When psychomotor development is delayed, B vitamins and nootropics are also used.
A child diagnosed with hypoxic-ischemic damage to the central nervous system needs constant monitoring at best. If you strictly follow the prescription of a doctor, then over time, many syndromes will go away, and the baby will be no different from their peers. The main thing - do not miss the time.
Symptoms of hypoxic-ischemic damage to the central nervous system
CNS lesion in newborns is diagnosed in the first minutes of the infant’s life, and the symptoms depend on the severity and depth of the pathology.
In case of mild HIE, the condition remains stable; on the Apgar scale, the child is rated at least 6-7 points, noticeable cyanosis, reduced muscle tone. Neurological manifestations of the first degree of the central nervous system hypoxic damage:
- High neuro-reflex excitability,
- Sleep disorders, anxiety,
- Trembling limbs, chin,
- Regurgitation possible
- Reflexes can be both enhanced and reduced.
The described symptoms usually disappear during the first week of life, the child becomes calmer, begins to gain weight, and gross neurological disorders do not develop.
With moderate brain hypoxia, signs of brain depression are more obvious, which is expressed in deeper disorders of the brain. Usually, the second degree of HIE accompanies the combined forms of hypoxia, which is diagnosed both during the intrauterine growth stage and at the time of birth. At the same time, deaf heart sounds of the fetus, an increase in rhythm or arrhythmia are recorded, on the Apgar scale the newborn gains no more than 5 points. Neurological symptoms include:
- Inhibition of reflex activity, including sucking,
- A decrease or increase in muscle tone, spontaneous physical activity may not manifest itself in the first days of life,
- Pronounced cyanosis of the skin,
- Increase intracranial pressure
- Vegetative dysfunction - respiratory arrest, acceleration of the pulse or bradycardia, disturbances of intestinal peristalsis and thermoregulation, a tendency to constipation or diarrhea, regurgitation, slow weight gain.
intracranial hypertension accompanying the expressed forms of HIE
As the intracranial pressure increases, anxiety of the baby increases, excessive skin sensitivity appears, sleep is disturbed, the chin, handles and legs tremor increases, the bulging of the fontanelles becomes noticeable, horizontal nystagmus and oculomotor disorders are characteristic. Symptoms of intracranial hypertension can be seizures.
By the end of the first week of life, the condition of a newborn with a second degree of HIE gradually stabilizes on the background of intensive treatment, but neurological changes do not disappear completely. Under unfavorable circumstances, deterioration of the state is possible with depression of the brain, decreased muscle tone and motor activity, exhaustion of reflexes, and coma.
Treatment and prognosis for HIE
Diagnosis of HIE is established on the basis of symptoms, data on the course of pregnancy and childbirth, as well as special research methods, among which neurosonography, echocardiography, CT, brain MRI, coagulogram, ultrasound with Doppler brain blood flow are most often used.
Treatment of ischemic CNS lesions in newborns is a big problem for neonatologists, since no single drug allows for the regression of irreversible changes in the nervous tissue. Nevertheless, it is still possible, at least partially, to restore brain activity in marked forms of pathology.
Drug treatment of HIE is carried out depending on the severity of a particular syndrome or symptom.
When mild and moderate disease is prescribed anticonvulsant therapy, diuretics, nootropics, a severe form of perinatal encephalopathy requires immediate resuscitation and intensive therapy.
With increased excitability of the nervous system without convulsive syndrome, neonatologists and pediatricians are usually limited to monitoring the child, without resorting to specific therapy. In rare cases, diazepam may be used, but not for a long time, since the use of such drugs in pediatrics is fraught with a delay in further development.
Perhaps the appointment of pharmacological agents that have a combined nootropic and inhibitory effect on the central nervous system (pantogam, phenibut). In case of sleep disorders, the use of nitrazepam and herbal sedatives is allowed - valerian extract, mint, lemon balm, motherwort. A good soothing effect have a massage, hydrotherapy.
For severe hypoxic lesions in addition to anticonvulsants, measures are necessary to eliminate swelling of the brain:
Respiratory and palpitations require immediate resuscitation, the establishment of artificial ventilation of the lungs, the introduction of cardiotonics and infusion therapy.
In hypertensive-hydrocephalic syndrome, diuretics occupy the main place in the treatment, and diakarb is considered the drug of choice for children of all ages. If drug therapy does not lead to the desired result, then surgical treatment of hydrocephalus is indicated - shunting operations aimed at discharge of the CSF into the abdominal or pericardial cavity.
In convulsive syndrome and increased excitability of the central nervous system, anticonvulsants can be prescribed - phenobarbital, diazepam, clonazepam, phenytoin. Newborn babies are usually given barbiturates (phenobarbital), babies are given carbamazepine.
Syndrome of motor disorders is treated with drugs that reduce hypertonia (mydocalm, baclofen), with hypotoneus shows dibazol, galantamine in low doses. To improve the patient's motor activity, massage, therapeutic exercises, physiotherapeutic procedures, water therapy and reflex therapy are used.
The delay of mental development and the formation of speech, according to the child's age, becomes noticeable by the end of the first year of life. In such cases, the use of nootropic drugs (nootropil, encephabol), vitamins of group B. A very important role is played by special classes with teachers and defectologists who specialize in working with children lagging behind in development.
Very often, parents of children who have undergone perinatal encephalopathy, are faced with the appointment of a large number of different drugs, which is not always justified. Hyperdiagnosis, “reinsurance” of pediatricians and neurologists leads to a wide use of diacarb, nootropics, vitamins, actovegin and other means that are not only not effective for mild HIE, but are often contraindicated in age.
The prognosis for hypoxic-ischemic lesions of the CNS is variable: there may be regression of cerebral disorders with recovery, and progression with disability, and oligosymptomatic form of neurological disorders - minimal brain dysfunction.
The long-term effects of HIE are epilepsy, cerebral palsy, hydrocephalus, mental retardation (oligophrenia). Oligophrenia always has a persistent character, does not regress, and the somewhat late development of the psychomotor sphere during the first year of life may pass with time, and the child will not be any different from most of his peers.
Pb # 8: What is and how we were afraid of hypoxic ischemic lesion of the central nervous system
Eighth week of life. New achievements of my petty in physical development and games, very pleased dad and mom. True, it was also necessary to enjoy it ... On examination by a neuropathologist We were diagnosed with hypoxic-ischemic damage to the central nervous system (CNS).
Hypoxic and ischemic lesions of the central nervous system of newborns - causes, symptoms, diagnosis, treatment, consequences
Hypoxic and ischemic lesions of the central nervous system occupy a leading place among neurological diseases of the newborn.
This is caused by intrauterine pathologies, which are accompanied by acute hypoxia, severe or premature birth.
The consequences of CNS lesions can be very diverse - from minor muscle hypotension to serious structural changes in the brain.
Meanwhile, hypoxic and ischemic lesions of the central nervous system can be provided. During pregnancy should be the prevention of chronic hypoxia. Also, doctors note that in premature babies, 2/3 of the causes of cerebral circulation disorders occur after birth. They can be predicted, which allows you to prevent serious damage to the brain.
Causes of hypoxic and ischemic lesions of the CNS
Hypoxic and ischemic lesions of the CNS are brain lesions resulting from chronic or acute hypoxia of the fetus, which are combined with secondary ischemia. They can occur both during pregnancy and during childbirth, in the postperinatal period.
Among the main causes of hypoxic and ischemic lesions of the central nervous system of newborns are present:
- Delay in fetal development,
- Thromboembolism, impaired uterine and placental blood flow,
- The threat of interruption, uterine bleeding,
- Bradycardia in the fetus,
- Asphyxia and acute hypoxia,
- Severe bleeding during childbirth, placental abruption,
- Umbilical cord pathologies,
- Reducing blood pressure in the newborn - below 30 mm Hg. st,
- Thromboembolic complications after childbirth - sepsis, DIC, polycythemia,
- Congenital heart disease in a baby with persistent hypoxemia,
- Increased intracranial pressure.
The symptomatology of lesions in the central nervous system of a newborn depends on the severity of cerebral ischemia.
A mild form of hypoxic and ischemic CNS lesions in full-term babies. At birth, the child’s assessment is 4-7 points on the Apgar scale.
Morphological changes in the brain, as a rule, do not lead to obvious neurological disorders.
In infants, there is a decrease in the muscle tone of the legs along with general excitability, lip tremor, slight drooping of the head, weak sucking activity, restless sleep.
One of the syndromes is clearly manifested: arousal or, on the contrary, depression, hypertensive syndrome. 24 hours after birth, the child’s condition worsens. Hypotension of the legs, increased reflexion, excitability, anxiety, bradycardia, rolling of the eyes, seizures are possible.
The difficult condition of the child, which is caused by premature or difficult childbirth. Assessment of the condition of the newborn - 0-3 points on the Apgar scale at 10 minutes of life. The condition of the baby is deteriorating. Brain activity decreases, cerebral edema, convulsions are noted. Possible violation of the function of the brain stem, develops stupor or coma.
Perinatal CNS pathology in newborns
The following variants of the Cheka are distinguished: epidural, subdural, subarachnoid, intraventricular, parenchymal and cerebellar, hemorrhagic brain infarction (hemorrhage at the site of softening of the brain after ischemia due to thrombosis or embolism). Supratentorial and subtentorial hemorrhages are also distinguished.
Indirect signs of trauma to the brain of a newborn are a large generic tumor, cephalhematoma, and skull deformity.
In supratentorial hemorrhage, there may be a light period from several hours to several days, since the hemorrhages are located relatively far from the medulla oblongata, where life-support centers are located - respiratory and vasomotor.
Very often, with the first attachment to the breast, the condition worsens dramatically, there is a pronounced syndrome of CNS arousal: piercing cry, moan, symptoms of hypertensive syndrome - tension of a large spring, stiff neck, ocular symptoms appear: "floating movements of the eyeballs", staring look, turning eyes apples in one direction (hematomas), nystagmus, squint, pupil dilation on the affected side. Convulsive syndrome, seizures of tonic or tonic-clonic seizures (monotone contractions of a certain muscle group or extremities) may occur; there may be equivalents of seizures: large-scale tremor, symptoms of oral automatism (constant sucking movements or persistent protrusion of the tongue). and is replaced by a period of CNS depression: there is no reaction to the inspection or a very weak reaction, silent or silent crying, eyes wide open, glance without ACTH, muscular hypotonia, physiological reflexes or very reduced or absent (including sucking, swallowing). Attacks of apnea, SDR, tachycardia or bradycardia are possible.
Depending on the localization of the Cheka and the period of the disease, there is a significant fluctuation in the general condition of the excitation syndrome, which turns into a depression syndrome, up to a coma with a periodic change of these conditions.
Additional research methods used in the diagnosis of the Cheka:
- Spinal puncture. In subarachnoid and intraventricular hemorrhage, a large number of red blood cells are found in the cerebrospinal fluid.
- Echo-encephaloscopy - ultrasound examination of the brain.
- Neurosonography is a two-dimensional ultrasound examination of the brain through a large spring.
- Computed tomography gives the greatest amount of information about the nature and location of pathological changes in the brain.
Treatment. In epidural and subdural hemorrhages, surgical treatment is the most effective - removal of hematoma.
Protective mode: reduce the intensity of sounds and visual irritations, gentle examinations, all manipulations are carried out on site (washing, processing, injections), prescribing minimally traumatic procedures, preventing cooling and overheating, participation of the mother in the care of the child.
Fed depending on the state: parenterally, through a probe or from a bottle. It is necessary to establish monitoring of the basic parameters of vital activity: blood pressure, Ps, BH, temperature, diuresis, body weight, amount of injected fluid, assessment of 02 and C02 in the blood. Craniocerebral hypothermia is performed - cold to the head.
Hemostatic preparations are introduced: vikasol, preparations strengthening the vascular wall - ascorbic acid, rutin, calcium chloride. Dehydration therapy - magnesia sulfate, lasix, plasma. Anticonvulsants - phenobarbital, GHB, seduxen, drugs that improve cerebral circulation - Cavinton, and trophism of brain tissue - Piracetam.
Hypoxic-ischemic encephalopathy (HIE) - brain damage caused by perinatal hypoxia, leading to motor impairment, convulsions, mental development disorders and other signs of cerebral insufficiency.
Any trouble during pregnancy results in hypoxia for the fetus, asphyxiation during childbirth leads to a decrease in cerebral blood flow in certain areas of the brain, resulting in ischemia of this area, leading to changes in cell metabolism and their death. The lesion may spread beyond ischemia, and the condition worsens.
The acute period is 1 month, the recovery period is up to 1 year and the outcome. In the acute period, mild, moderate and severe forms of HIE and 5 clinical syndromes are distinguished: increased neuro-reflex excitability, convulsive, hypertensive-hydroceleral, depression syndrome, comatose .
Mild brain damage (OSHA 6-7 b) is characterized by increased neuro-reflex excitability: increased spontaneous motor activity, restless sleep, difficult falling asleep, unmotivated crying, tremor of limbs and chin. Medium-severe form (OSH 4-6 b) manifested hypertensive-hydrocephalic syndrome and depression syndrome.
An increase in the size of the head by 1-2 cm, opening of the sagittal suture, an increase and bulging of a large fontanelle, a symptom of Grefe, “the setting sun”, intermittent nystagmus, convergent squint are characteristic. Depression syndrome: lethargy, decreased motor activity, muscular hypotonia, hyporeflexia. In severe form of HIE, comatose syndrome is typical (OSA 1-4 b).
There is no reaction to the inspection, there is no reaction to painful irritations, “floating eyeballs”, reflexes are depressed, respiratory disorders, seizures, convulsions, no sucking and swallowing. It can be combined with convulsive syndrome. The recovery period begins after the end of the acute process of the most diverse etiology, the beginning of it is conditionally attributed to the middle of the 2nd week of life.
Syndromes of the early recovery period are designated by the term “encephalopathy”, under which brain diseases characterized by dystrophic changes are combined.
The recovery period of HIE includes the following syndromes: increased neuro-reflex excitability, or cerebrastenic, hypertensive-hydrocephalic, vegeto-visceral disorders, motor disorders, psychomotor retardation, epileptic syndrome. The cerebrosthenic syndrome manifests itself against the background of normal psychomotor development of children.
Emotional lability, excitability, motor restlessness are noted, congenital reflexes, spontaneous Moro reflex, wince, tremor of chin and extremities, superficial sleep, difficulty falling asleep, poor appetite, poor weight gain are enhanced. Syndrome of vegeto-visceral disorders.
There are vascular spots, impaired thermoregulation (hypo-and hyperthermia), gastrointestinal dyskinesias (regurgitation, vomiting, unstable stool or constipation, flatulence) with symptoms of pylorospasm, insufficient body mass, tachycardia or bradycardia, tendency to lower blood pressure, tachypnea, discomfort respiration at the slightest excitement.
Syndrome of vegeto-visceral disorders is almost always combined with other syndromes of the recovery period, more often with hypertensive and hydrocephalic. Syndrome of motor disorders occurs in 2/3 of children with encephalopathy, manifested by a decrease or increase in muscle tone, paresis or paralysis of the limbs.
At the same time, the limbs are in an unbent or excessively bent state, hanging down, there is no physiological reflex of the support, or the child stands on tiptoe. Muscular hypotonia syndrome: the limbs are unbent, the “frog posture” with the lower limbs turned out is reduced, and the child’s motor activity is reduced.
When the child is placed on the palm face down, the limbs, and often the head, hang down, there is no support on the legs. Muscle hypertension syndrome: the child's physical activity is reduced due to the hypertonicity of the extremities, therefore stiffness is noted.
Possible appearance of pathological postures - “Boxer posture”, when there is an increase in the tone of the flexors of the arms while the arms are bent, the cams are tightly compressed, and in the lower extremities the extensor tone is increased, because of which the legs are bent and difficult to bend, or bend at all is impossible.
In severe cases, the tone of all the extensor groups — the neck, back, and extremities — is increased, which leads to opisthotonus. In this case, the child is bent in the form of a "bridge", can rest on the back of the head and heels.
With a high tonus of the adductors of the thighs and flexors, an “embryo” posture appears - the head is thrown back, the upper limbs are bent and pressed to the body, cross legs are noted. Children with increased muscle tone during the examination of the physiological reflexes of the support and automatic walking stand on “chicks”, and automatic walking does not appear. Hydrocephalic syndrome.
In newborns, there is a disproportionate increase in the head circumference (head circumference exceeds the chest circumference by more than 3 cm).
In the first 3 months of life, the head circumference increases by more than 2 cm monthly, there is a discrepancy of cranial sutures more than 5 mm, a large spring increases and erupts, small and lateral fontanelles open, the brain skull prevails over the front part, the overhanging forehead, the subcutaneous venous network on the hairy part is expanded heads, on the forehead, temples, the bones of the cranial vault become thinner and softer. Clinical manifestations depend on the severity of the hypertensive syndrome: children are easily excitable, irritable, cry loud, shrill, sleep by erhnostny, children do not go to sleep. With the prevalence of hydrocephalic syndrome, lethargy, drowsiness, and syndrome of vegeto-visceral disorders are noted. There is a symptom of "the setting sun", convergent squint, horizontal nystagmus. Muscle tone is reduced, sucking reflex is expressed, symptoms of oral automatism may appear - protruding and chewing the tongue. Reflex support missing. With the progression of hydrocephalus muscle tone increases, there is a drooping of the head, large-scale tremor of the limbs and chin, the appearance of convulsions is possible. Psychomotor development delay syndrome.The child later begins to hold his head, sit, crawl, walk, a smile later appears, there is a delay in visual and auditory reactions, later he begins to recognize the mother, to speak, he is less oriented in the environment.
Treatment of HIE in the acute period. It is impossible to treat the brain in isolation.
- Restoration of normal airway and adequate ventilation of the lungs.
- Correction of hypovolemia: plasma, albumin 5-10 ml / kg, reopolyglucin 10 ml / kg.
- Dehydration: magnesium sulfate 0.2 ml / kg, lasix, plasma.
- Improving the metabolism of nervous tissue: piracetam 50 mg / kg, 10% glucose solution.
- Anticonvulsants: phenobarbital 5 mg / kg, GHB 50 mg / kg, diazepam 1 mg / kg.
Treatment of HIE in the subacute period.
- Cerebrastenic syndrome: a mixture with citral, diazepam, tazepam, valerian root, motherwort, nootropil, drugs that improve cerebral circulation (cynarisin, cavinton).
- Hypertension-hydrocephalic syndrome: dehydration 'therapy (furosemide, glycerol, diacarb), resolving therapy (lidaza, aloe, cerebrolysin).
- Motor disorders: vitamins Wb, B1, ATP, prozerin, galantamine.
- Convulsive syndrome: phenobarbital, ben-zone. Mandatory nootropic and absorbable drugs.
Convulsive syndrome in newborns
Seizures - sudden involuntary violent movements.
Causes of cramps in newborns:
- The most common cause (65-70%) is perinatal hypoxia and the development of hypoxic-ischemic encephalopathy.
- The second causal factor in frequency is intracranial hemorrhage.
- Metabolic disorders: hypoglycemia, hypocalcemia, hypomagnesemia, hypo-and hypernatremia, hyperbilirubinemia.
- Infections: meningitis, encephalitis, sepsis.
- Genetic and congenital defects of brain development: familial epilepsy, malformations of the brain, chromosomal diseases.
- Withdrawal syndrome (cancellation) in children whose mothers had a drug or drug addiction during pregnancy (opium-containing substances, barbiturates, etc.).
- Congenital metabolic abnormalities: phenylketonuria, "maple syrup disease", etc.
Convulsive syndrome manifests itself with various paroxysmal phenomena. Clonic convulsions are repetitive rhythmic contractions of the muscles of the face and extremities. May be limited in one face face, one or two limbs, and may extend to all limbs, muscles of the face, and body. Tonic spasms are a relatively long contraction of all the muscles of the limbs and body.
At the same time, the limbs are extended, the cams are tightly compressed, the head is thrown back, the gaze is fixed at one point, accompanied by bouts of apnea. Myoclonic convulsions are sudden, irregular shudders of various groups of limb muscles.
Minimal convulsions or equivalents of convulsions - manifest as unexpected cries, paroxysmal ocular symptoms (nystagmus, open, unblinking eyes with a fixed look, twitching of the eyelids), symptoms of oral automatism - sucking, chewing, protrusion, trembling of the tongue, general freezing, paroxysmal movements in the upper limbs (“swimmer movements”) or in the lower extremities (“cycling movements”), apnea attacks (in the absence of bradycardia). Newborns also develop symptoms of increased neuro-reflex oh excitability: tremor of the extremities, spontaneous Moro reflex (covering hand movements), clonus of the feet, flinching at sharp sounds. Unlike true seizures, external stimuli are necessary for the onset of symptoms of increased neuro-reflex excitability (for example, examination of a child). - level of glucose, calcium, sodium, magnesium, bilirubin, urea, etc. It is necessary to carry out echoencephaloscopy, echo-encephalography, lumbar puncture, radiography of the skull, computed tomography, screen ing urine and serum for defects in the metabolism of amino acids, examination for the presence of intrauterine infections. Treatment. The main task is to stop seizures, since during a convulsive seizure the oxygen consumption of the brain increases, and neurons inevitably die.To eliminate a convulsive attack, apply: sibazon (seduxen, Relanium) 0.5% solution of 0.04 ml / kg, the dose can be increased by 2 times. Re-enter this drug can be 30 minutes in the absence of effect. Side effects - respiratory depression, drowsiness, suppression of the sucking reflex, hypotonia, decrease in blood pressure. Phenobarbital - in case of convulsions administered intravenously at a dose of 20 mg / kg (administered very slowly within 15 minutes), if there is no effect, phenobarbital can be re-administered 2 times with interval of 30-60 minutes. In the absence of seizures in the future, phenobarbital is administered inside.
Sodium hydroxybutyrate (GHB) is administered intravenously in a 20% solution very slowly due to possible respiratory failure. The anticonvulsant effect develops in 10-15 minutes and lasts 2-3 hours and longer.
With non-stopping convulsions, vitamin B6 is injected. Magnesium sulfate is administered with hypomagnesemia and swelling of the brain. Intramuscularly injected 25% solution at a dose of 0.4 ml / kg body weight.
In poorly relieved convulsions, finlepsin, Radeorm, Benzonal, Diacarb are prescribed along with phenobarbital.
CNS lesion in newborns - causes, symptoms, treatment
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Unfortunately, a disorder of the central nervous system in newborns is not uncommon. Up to 50% of all babies are exposed to this disorder to one degree or another.
Today we will talk about perinatal lesions of the central nervous system (CNS) in newborns, tell you what symptoms the disease is characterized by, what methods of diagnosis and treatment of CNS damage exist, and also examine what the consequences of this disease can be.
The essence of the disease
CNS is often diagnosed, and among premature babies this diagnosis occurs many times more often.. This disease includes a number of different diagnoses, characterized by lesions of the brain and / or spinal cord.
The defeat of the central nervous system in most cases has a favorable outcome. Now let's take a closer look at the causes of this disease.
Causes of CNS damage in children
The causes of this disease during pregnancy can be:
- hypoxia in the fetus,
- somatic diseases of the mother
- metabolic disorder,
- poor nutrition,
- unfavorable ecological situation
- maternal age over 35 or less than 18 years old
- acute infectious diseases
- pathological course of pregnancy
- the effect of toxins on the future mother's body (smoking, alcohol and drug use).
In some cases, injuries and hypoxia of the fetus during the labor process are causes of CNS damage.
Any damage to the central nervous system can be divided into two types.
Hypoxic CNS damage
Hypoxic, or hypoxic-ischemic, CNS damage in newborns is characterized by oxygen starvation for one reason or another. It appears even in the womb or because of asphyxiation in the process of delivery.
Traumatic, or residual, damage to the central nervous system in children is residual effects after injuries and structural changes in the brain.
It is very important to diagnose this pathology as early as possible, since brain cells in infants have the ability to recover. Accordingly, terrible consequences can be avoided.
This period lasts up to one month and is characterized by the following symptoms:
- CNS depression syndrome (hypodynamia, lethargy, decreased reflexes, muscular hypotonia),
- less common syndrome of hyperexcitability of the central nervous system (restless and often superficial sleep, chin tremor, hypertonicity of muscles, convulsions).
Early recovery period
This period lasts for the 2nd and 3rd months and is characterized by a decrease in the manifestation of symptoms of the acute period. At the same time, the place of localization of the lesion becomes apparent.This phenomenon is characterized by the following symptoms:
- discrepancy of the sutures of the skull, increase in head circumference, swelling of the fontanel,
- disruption of motor activity,
- thermoregulation disorder, marble skin color, gastrointestinal dysfunction.
Period of residual effects
In most cases, this period is full restoration of all neurological functions. At the same time, every fifth child has serious consequences of impaired neurological functions in this period.
Important! Only a doctor can carry out the necessary examination and prescribe the correct treatment.
Treatment of lesions of the central nervous system with moderate and severe is often carried out in intensive care settings, often with the use of special equipment to maintain the functioning of vital organs.
In the acute period Diseases use the following treatments:
- reduction of cerebral edema and maintenance of the internal organs,
- decrease in the frequency of seizures,
- recovery of nervous tissue metabolism
- restoration of oxygen metabolism in cells.
In the recovery period in addition to the above methods, use the following therapy:
- stimulating drugs
- sedation with increased excitability,
- drugs to improve cerebral circulation,
- Exercise therapy.
Further treatment is carried out up to three times a year under the supervision of a neurologist for several years.
CNS lesion in newborns - video
From this video you will learn about the nuances of CNS damage and methods of treatment of this disease.
Summing up, I would like to note that the changes due to this pathology are completely reversible if the treatment is started on time, namely, in the first weeks of the baby’s life. Do not ignore the first symptoms.
If any suspicious signs of this disease appear, immediately contact a neurologist for consultation.
Have you encountered CNS damage in your children? What treatments were prescribed to you? What was the result? Tell us about your experiences in the comments.
Table of contents:
The term hypoxic-ischemic damage to the central nervous system is more traumatic for parents, and it is more expedient to use it in case of gross lesions of the central nervous system, while the term “encephalopathy” is more appropriate for milder manifestations of the disease. For the designation of both terms the abbreviation “GIE” is used. The diagnosis of HIE is complemented by appropriate neurological syndromes in the presence of a characteristic clinical picture.
In terms of the frequency of hypoxic-ischemic lesion of the central nervous system takes the first place not only among brain lesions, but among all pathological conditions of newborns, especially premature babies.
It is based primarily on antenatal damage to the fetus - chronic placental insufficiency, then hypoxia associated with the nature of the birth (late birth, weakness of the labor) and acute development of hypoxia as a result of placental abruption.
In addition, hypoxic brain damage can occur in the postnatal period due to inadequate respiration, a drop in blood pressure and other causes.
The pathogenesis of hypoxic-ischemic damage to the central nervous system can be summarized as follows.
Perinatal hypoxia (asphyxia) of the fetus (child) leads to hypoxemia and an increase in carbon dioxide (hypercapnia) content with subsequent development of metabolic acidosis due to lactate accumulation, then intracellular edema occurs — tissue swelling — decrease in cerebral blood flow — generalized edema — increase in intracranial pressure - a common and significant reduction in cerebral circulation - and necrosis of the brain substance.
This scheme reflects severe damage to the central nervous system, which can be one of the manifestations of the general systemic reaction of the body to severe asphyxia and can be combined with acute tubular necrosis of the kidneys, primary pulmonary hypertension and the result of preservation of the fetal circulation, reduced secretion of antidiuretic hormone, necrotic bowel damage, aspiration of meconium, adrenal insufficiency and cardiomyopathy.
At the same time, the pathological process can stop at any stage and in some children restrict itself to mild cerebral circulation disorders with local foci of ischemia, leading to functional changes in the brain. On the one hand, it manifests itself in a diverse clinical picture, and on the other hand, it affects the incidence of hypoxic-ischemic CNS lesions in newborns, which is given by different authors.
Localization of hypoxic-ischemic lesions of the central nervous system has its own characteristics.
For premature babies, the periventricular zones in the area of the embryonic matrix are primarily characterized by severe hypoxia and ischemia, leading to necrosis of the white matter.
In full-term infants with severe hypoxia, parasagittal parts of the cortex lying on the border of the basins of the cerebral arteries are affected. In addition, areas of the basal ganglia, thalamus and brainstem, including the reticular formation, may be affected.
The clinical picture of hypoxic-ischemic lesion of the central nervous system is characterized by a great variety from erased, poorly symptomatic forms to “juicy”, immediately apparent manifestations that fit into certain syndromes.
There are 3 degrees of the acute period: mild, moderate and severe.
A mild degree is usually characterized by hyporeflexia, moderate hypotension of the upper limbs, tremor, periodic anxiety or moderate lethargy, slight drooping of the head, decreased sucking activity in mature children and signs of immaturity that go beyond their gestation.
Symptoms of moderate form usually fit one of the syndromes characteristic of this pathological condition:
- hypertensive syndrome,
- excitement syndrome
- depression syndrome.
Along with hyporeflexia, hypotension of the muscles of the upper extremities 2 degrees, isolated or in combination with hypotonia of the legs, moderate physical inactivity, short-term bouts of apnea, single cramps, severe eye symptoms and bradycardia can be observed.
Severe form is characterized by a pronounced syndrome of depression, up to the development of coma, repeated convulsions, the presence of stem signs in the form of bulbar and pseudobulbar symptoms, slowed movement of the eyeballs, the need for mechanical ventilation, early mental retardation, and manifestations of multiorgan failure.
A characteristic feature of the hypoxic-ischemic lesion of the central nervous system is the increase in dynamics, after a short or longer period of time, of individual neurological symptoms, which largely determine the further development of the child.
From patients with hypoxic-ischemic lesion of the central nervous system, children born in severe asphyxia should be distinguished, requiring long-term mechanical ventilation from the first minutes of life. This contingent of children stands alone, since the ventilator itself, and often the accompanying sedative therapy, makes its own adjustments and modifies the clinical picture.
In addition, in rare cases, mainly in full-term, from the first days of life there may be marked spasticity of the limbs, mainly the lower ones, which persists for a long time.
The course of hypoxic-ischemic damage to the central nervous system has several options:
- favorable current with fast positive dynamics
- neurological symptoms, reflecting severe brain damage in the acute period of the disease, by the time of discharge from the department completely disappears or remains in the form of moderate or more pronounced residual effects,
- neurological symptoms after an acute period of illness have a tendency to progression,
- severe brain damage with an outcome in disability is detected in the first month,
- latent, after a long period of imaginary well-being at the age of 4-6 months, signs of movement disorders begin to appear.
Ischemic CNS damage in newborns - Treatment of hypertension
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Hypoxic-ischemic damage to the central nervous system in newborns is a significant problem of modern neonatology, because according to statistics, almost every tenth newborn baby has certain signs of impaired brain activity due to hypoxia. Among all the pathological conditions of the neonatal period, hypoxic brain damage ranks first. Especially often the disease is diagnosed in premature babies.
Despite the rather high frequency of pathology, effective measures to combat it have not yet been developed, and modern medicine is powerless against irreversible structural brain damage. None of the known drugs can restore the dead nerve cells of the brain, but research in this area continues, and the preparations of the latest generations are in clinical trials.
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The central nervous system (central nervous system) is very sensitive to the lack of oxygen in the blood.
In a growing fetus and a newborn baby, the immature brain structures need nutrition even more than in an adult; therefore, any adverse effects on the future mother or the fetus itself during pregnancy and childbirth can be detrimental to the nervous tissue, which later manifests neurological disorders.
Hypoxia can be severe or mild, it lasts a long time or a few minutes during childbirth, but always provokes disorders of brain function.
In the case of lung damage, the process is completely reversible, and some time after birth, the brain will resume its work.
With deep hypoxia and asphyxia (complete cessation of oxygen supply to the brain) organic damage develops, often serving as a cause of disability of young patients.
Most often, brain hypoxia occurs in the prenatal period or in the process of childbirth in their pathological course. However, after birth, hypoxic-ischemic changes can occur in the case of a violation of the respiratory function of the baby, a drop in blood pressure, blood clotting disorders, etc.
In the literature, you can find two names of the described pathology - hypoxic-ischemic damage of the central nervous system and hypoxic-ischemic encephalopathy (HIE). The first option is more often used in the diagnosis of severe disorders, the second - in milder forms of brain damage.
Discussions regarding predictions for hypoxic brain damage do not subside, but the accumulated experience of neonatology specialists shows that the child’s nervous system has several mechanisms of self-defense and is even capable of regeneration. This is evidenced by the fact that not all children who have suffered severe hypoxia have gross neurological abnormalities.
In severe hypoxia, the immature structures of the stem and subcortical nodes primarily suffer, and during prolonged, but not intense hypoxia, diffuse lesions of the cerebral cortex develop.One of the factors of brain protection in a fetus or newborn is redistribution of blood flow in favor of stem structures, therefore, with prolonged hypoxia, the gray matter of the brain suffers to a large extent.
The task of neurologists in examining newborns who have undergone hypoxia of varying severity is to objectively assess the neurological status, exclude adaptive manifestations (tremor, for example) that may be physiological, and identify truly pathological changes in brain activity. In the diagnosis of hypoxic damage of the central nervous system, foreign specialists are based on the staging of pathology, Russian doctors use the syndromic approach, pointing to specific syndromes on the part of a particular part of the brain.