What homeopathic remedy can treat perinatal encephalopathy. Perinatal encephalopathy in children: symptoms, treatment, consequences in adulthood

This is not an inflammatory disease of the brain, it is associated with a violation of the blood supply, a decrease and destruction of brain cells. It can be an acquired disease, as a result of birth trauma, hypoxia, which leads to serious brain disorders, but most often congenital pathology. Such a disease is diagnosed in approximately 50% of infants. More severe forms of PCOS are found in only 10% of newborns. More vulnerable Congenital is encephalopathy in the baby, complicated during childbirth (birth trauma, placental abruption, incorrect fetal position, large head in a child, narrow pelvis in a woman). She can be suspected in the first immediately after the birth of the baby. At birth, the internal organs, including the central nervous system, are not quite developed, a time period is needed for the development of all systems. There are several forms of encephalopathy.

Perinatal encephalopathy in newborns.

It is considered from 28 weeks of pregnancy to 8 days of a child's life. It can occur if (causes of encephalopathy):

• The mother of the child is too young or age
• Abortion
• Miscarriage
• Infertility treatment
• Mom's diabetes
• Mom's heart defects
• Mum flu
• Smoking, alcohol
• Risk of miscarriage
• Work in hazardous work
• Medication
• Fast (less than 6 hours, slow more than a day) childbirth
• Cesarean section
• Premature placental abruption
• Umbilical cord entanglement, umbilical cord prolapse
• Multiple birth

Periods of perinatal encephalopathy in newborns.

• An acute period of 7-10 days to a month.
• Early recovery period up to 4 - 6 months.
• Late recovery period up to 1 - 2 years.

In the acute period  observed: lethargy, muscle hypotension, decreased reflexes (sluggishly sucking), or vice versa, hyper excitability of the nervous system (superficial sleep, trembling of the chin and limbs), throws back his head.

The early period of perinatal encephalopathy in newborns,when cerebral symptoms decrease, and focal lesions of the brain appear. Muscle hypotension or hypertonicity is manifested. Paresis and paralysis, hyperkinesis are possible (enlargement of the head, expansion of the venous network on the forehead, temples, enlargement and swelling of the fontanel. Marble and pale skin, cold hands and feet, changes in the gastrointestinal tract (constipation, increased gas formation), heart rhythm disturbance and breathing.

Late period of perinatal encephalopathy in newborns,muscle tone and other functions are gradually normalized. There is a dynamic development in the central nervous system and the psyche of the child. There is a formation of pre-speech and speech development. At this age, you can already notice the lag of the child, those reflexes and skills that should be, or they are not there, or they are very weak, is sharply delayed,. There may be persistent spastic syndrome or vice versa muscle hypotension.

Hypoxic - ischemic damage to the nervous system.

One form of encephalopathy caused by fetal hypoxia (oxygen starvation of brain cells). In chronic intrauterine hypoxia, they suffer, the capillaries of the brain, they grow slowly and become more penetrating. In childbirth, this leads to asphyxia (severe respiratory and circulatory disorders). Therefore, asphyxia of a newborn at birth is a consequence of fetal hypoxia. Several degrees of hypoxic - ischemic form can be distinguished encephalopathy:

1. Depression and agitation of the central nervous system, which lasts up to 7 days after birth.
2. After 7 days, convulsions, increased intracranial pressure, a violation of the rhythm of the heart and breathing are added.
3. Severe convulsive state, high intracranial pressure.

Mixed lesion disease.

To hypoxic - ischemic damage to the central nervous system, intracranial hemorrhage (not traumatic) is added, the severity depends on where the hemorrhage occurred.

Traumatic damage to the central nervous system.

Damage to the spinal cord during childbirth, this can happen if the large fetus is or is improperly located. While facilitating the removal of the head and shoulders, with a hard turn of the head during its removal, pulling it over the head, the obstetrician makes these manipulations to reduce child hypoxia. It all depends on the experience of the physician. Damage can also occur during cesarean section with a “cosmetic incision” insufficient to remove the child’s head. Artificial ventilation of the lungs in the first 2 days can lead to damage, especially in children and with low weight.

Metabolic disorders.

Alcohol syndrome, nicotine, narcotic, violations occur as a result of the cessation of the intake of alcohol, nicotine, drugs.

Intrauterine infection.

Depends on the type and severity of the disease. Such children are often born in a state of asphyxia, with low weight, with an enlarged liver, malformations, there may be a convulsive syndrome.

In the maternity hospital, neonatologists examine the newborns and identify the perinatal lesion of the central nervous system and prescribe treatment. But this treatment should be continued at home. What should alert the mother: frequent anxiety of the child, regurgitation, trembling of the chin, arms and legs, fading of the child in one position, unusual eye movement, rapid head growth of more than 1 cm per week, an increase in the edges of the fontanel, its bulging.

If your baby has something, you need to consult a neurologist, the sooner the better, and start treatment to completely restore your baby’s health.

Treatment of encephalopathy in infants.

The treatment is usually complex, it begins after a full examination of the baby, for this you need to pass tests:

Take the exam:

• NSG (neurosonography)
• EEG (encephaloelectrography)
• MRI (magnetic resonance imaging)
• Cerebrospinal fluid
• Neurologist
• Oculist

With proper treatment and on time diagnosis encephalopathy of infants well treated, treatment is carried out both at home and in the hospital, it all depends on the severity of the disease, but the treatment is carried out for a long time and courses. Drugs are prescribed to restore the brain structure, improve blood supply to the brain, B vitamins (Magne B6, Magnelis), sedatives, drugs treating symptoms: cramps, anticonvulsants (Konvuleks, Finlepsin, Depakin), drugs that relieve muscle hypertonicity, and drugs that treat motor disorders. More drugs can be prescribed both intramuscularly and intravenously. Electrophoresis is well used for the treatment of encephalopathy (if there was no history of seizures), neurologists like to prescribe physiotherapy exercises, massage, herbal medicine. One of the important principles of treatment is this.

The birth of a baby is a significant and touching event in the life of every family. But not always the birth of a child goes smoothly, and the pathology of pregnancy and childbirth can not be called a rare situation. The diagnosis of perinatal encephalopathy (PEP) made in a maternity hospital raises many questions in mothers and fathers.

Parents who are faced with this situation need to understand what this medical term says and what consequences it carries for the life and development of the baby. Future mothers and fathers should know how to prevent the disease and reduce the risk of unpleasant complications for the baby.

Pediatrician, neonatologist

The name of this disease combines several nosologies. Encephalopathy is a collective concept indicating brain damage, impaired function. And the designated term “perinatal” speaks of the period of the baby’s life when these changes occurred. It turns out that an unfavorable factor affected the child’s body in the period starting from the 22nd week of the fetal life of the baby or during labor, in the first week of the baby’s life.

It is this period that has a multifactorial effect on the condition of the baby. There is a combination of the features of the course of pregnancy, maternal health disorders, birth problems, which affects the health of the crumbs. Statistics indicate a high incidence of the disease in newborns. About 5% of children are diagnosed with PEP and receive appropriate treatment.

PEP is the cause of 60% of pathologies of the total number of neurological diseases of childhood. The danger of the disease lies in the progression of the disease into various neurological disorders, ranging from minimal impairment of brain functions to cerebral palsy, epilepsy, and hydrocephalus.

About the reasons

The child’s body has its own characteristics, and adverse factors affecting the developing organism can significantly damage the baby’s health.

The prevalence of the main influencing factor formed the basis for the systematization of the disease.

PEP classification

Posthypoxic encephalopathy

This type of PEP is associated with insufficient oxygen supply during gestation or the development of acute oxygen starvation - asphyxiation. Hypoxia that occurred in utero leads to a slowdown in the growth of brain capillaries, an increase in their permeability and vulnerability. Due to significant oxygen starvation, metabolic disorders occur - acidosis, cerebral edema and death of nerve cells.

The most common cause of encephalopathy in a newborn is the lack of oxygen in the baby's body, and brain damage is also called hypoxic-ischemic encephalopathy (HIE).

Post-traumatic

This type of disease is due to the trauma received during childbirth. Incorrect position of the fetus and insertion of the head, prolonged or rapid delivery, provoke the development of injuries, hemorrhages in the brain and its membranes.

Infectious

In the case of an infectious disease in a woman or an exacerbation of the chronic process, pathogens can penetrate the placenta and affect the fetus. Many infections are characterized by the formation of latent, latent infection, when the disease can be “masked” by hypoxic or traumatic encephalopathy.

Although the hematoplacental barrier “protects” the baby’s body from the penetration of many infectious agents, the pathology of the placenta increases its permeability to harmful substances. It turns out that an unhealthy placenta cannot fulfill its protective function. Viruses most easily penetrate the placenta, due to their small size.

Toxic metabolic encephalopathy

This type of pathology is associated with exposure to the body of the fetus or newborn harmful substances: nicotine, alcohol, drugs, toxins of viruses and bacteria, drugs. With a metabolic disorder, bilirubin, diabetic encephalopathy and others can occur.

The term "perinatal encephalopathy" combines pathological changes in the brain, without indicating their causes. Therefore, PEP can not be considered the final diagnosis, the disease requires a more thorough analysis of the origin of the disease. If the cause leading to the development of the disease was not found, a diagnosis of “unspecified encephalopathy” in the infant is made.

After analyzing the course of pregnancy and childbirth in a woman, you can predict possible health problems in the unborn child, select children at risk for the occurrence of this disease.

• illness of the expectant mother.

Diseases that appear during the bearing of a baby or exacerbation of chronic ailments (arterial hypertension, heart and kidney diseases, bronchial asthma) without proper treatment can lead to the appearance of pathologies in the child. Particular attention should be paid to the treatment of diabetes mellitus during the gestation of the baby, elevated sugar levels negatively affect the development of the fetus.

Children born to mothers with diabetes have a greater body weight, which often leads to difficulties during birth. In addition, these babies are more likely to have malformations, protracted jaundice, respiratory distress, and low glucose after birth. All this can cause the occurrence of perinatal encephalopathy in the newborn;

• pathology of pregnancy.

Gestosis, the threat of termination of pregnancy or premature birth, placental pathology, adversely affect the development of the fetus. Hemolytic disease and infections that developed in utero can also lead to perinatal encephalopathy.

Of great importance is the age of the woman in childbirth. It is proved that pregnant women under the age of 20 and over 35 have an increased risk of developing pathologies during pregnancy and childbirth;

• problems encountered during childbirth.

The process of being born is an important factor affecting the health of crumbs in the future. Too long or, conversely, rapid childbirth increases the chance of trauma to the child and hypoxic complications. The baby may experience a sharp oxygen starvation, in cases where there was a pathology of the umbilical cord (nodes and tight entanglement, insufficient length of the umbilical cord), the placenta exfoliated prematurely.

Experts say that a postponed pregnancy is in most cases more dangerous than a premature one. With delayed births, the risk of fetal hypoxia, the appearance in the amniotic fluid of an impurity of meconium, inhalation of dirty water increases. All this can lead to asphyxia, the appearance of respiratory disorders in the newborn, infectious complications;

• toxic effects on the fetus.

Much has been said about the dangers of alcohol, nicotine and drug dependence on the fetus, but there are also frequent cases of toxic effects of these substances on the developing organism. Occupational hazards, the ecological environment in which the expectant mother is also unfavorable for the health of the crumbs.

Independent, without medical advice, the intake of medicines by a pregnant woman negatively affects the health of the baby. Some of the drugs affect the growth and development of the fetus, can cause malformations.

Especially dangerous is the effect of harmful substances in the first trimester of pregnancy, when the formation of the vital organs of the child occurs.

The neonatologist finds the first signs of the development of the disease in the delivery room. Unlike healthy babies, these babies are born with complications, start screaming late, and require help. The doctor evaluates the baby on the Apgar scale, in the future, the obtained data are taken into account when diagnosing PEP. The disease proceeds for a long time, manifestations can develop gradually, so experts divide the course of the disease into periods.

PEP periods

• acute, lasting up to 1 month;
• recovery, which lasts up to 12 months of a full-term baby, in premature babies this period is extended to 24 months;
• exodus.

Severity of PEP and acute illness symptoms

• easy.

If the effect of the damaging factor was moderate, and the condition of the child was not significantly disturbed (the Apgar score is usually 6 to 7 points), the syndrome of increased neuro-reflex excitability comes to the fore. Children with this form of the disease are characterized by severe anxiety, their sleep is superficial, intermittent, and wakeful periods are elongated. The baby cries for a long time without reason, the mother cannot calm the baby by taking it in her arms.

When examining the crumbs, the doctor draws attention to increased motor activity, revitalization of congenital reflexes, impaired muscle tone. Often, such babies experience tremors, trembling of the chin and limbs during crying.

Syndrome of increased neuro-reflex excitability in premature infants is dangerous by the appearance of seizures;

• moderate form of the disease.

In the case when the condition of the crumbs was regarded as moderate (Apgar score 4 - 6 points), the baby has a syndrome of depression of the nervous system, which is accompanied by an increase in intracranial pressure. Children with this form of the disease differ from their peers in lethargy, muscle weakness.

In connection with the weakening of the reflexes of the newborn, violations occur with acts of sucking and swallowing - the baby refuses to breast. Hypertension-hydrocephalic syndrome is manifested by bulging of a large fontanel, an increase in head growth, pathological reflexes;

• severe course of the disease.

With a significant deterioration in the condition of the crumbs (Apgar score of 1 to 4 points), signs of severe damage to the nervous system — a coma — appear. The baby’s muscle tone is sharply reduced, the baby does not respond to stimuli, and innate reflexes are practically not detected. Breathing can be arrhythmic, stopping may occur. Blood pressure tends to decrease, and the activity of the heart becomes arrhythmic.

The baby has pathological eye symptoms, convulsions may appear, which, due to reduced tone, are sometimes masked by the spontaneous movements of the child.

After a month of the baby’s life, the clinical manifestations of the disease also change, but in most cases a combination of syndromes takes place:

1. Increased neuro-reflex excitability.

Manifestations of anxiety, with proper treatment and a benign course of the disease, become less pronounced over time, until extinction. In some cases, especially in premature babies, the clinic of increased excitability becomes epileptic.

Hypertensive hydrocephalic syndrome

The dynamics of this disorder in children may vary. In a benign course, the first manifestations of increased intracranial pressure disappear, and the growth rate of the head circumference normalizes by age from 6 months to a year. If therapeutic measures during this period were ineffective, the baby develops hydrocephalus.

Vegeto-visceral dysfunction

Against the background of the manifestation of other syndromes, the child often has symptoms from the autonomic nervous system. Moms of such babies come to the doctor with complaints of frequent spitting up, poor weight gain, and digestive disorders. When examining a child, the doctor may notice thermoregulatory disorders, discoloration of the skin: cyanosis of the hands and feet, nasolabial triangle.

Movement Disorder Syndrome

The manifestations of this syndrome are associated with an increase or decrease in tone in the muscles of the baby and can occur both in isolation and accompany other pathological manifestations of PEP. The crumbs often have a lag in physical development, later mastering motor skills.

In severe cases, paresis and paralysis occur, and an increase in hypertonicity can go into cerebral palsy.

Delay in psychomotor development

Children who have undergone hypoxia often lag behind in psychomotor development. They are characterized by a long-term preservation of congenital reflexes and a slowdown in the acquisition of new skills. Kids with developmental delays later begin to fix their gaze, respond to their mother’s voice, become interested in toys.

With proper treatment and a favorable course of the disease, many children aged 4 to 5 months experience a “jump” in development. Kids begin to be interested in others, “catch up” in the development of their peers. Moreover, mental development is ahead of motor development, motor activity is restored only to 1 - 1.5 years. A long delay in mental development indicates the possibility of adverse effects in the child.

Epileptic syndrome

It is characterized by the appearance of seizures associated with increased bioelectric activity in the brain, and can occur at any age. Premature babies are more at risk of developing epileptic syndrome due to the immaturity of brain structures.

Medical history and examination of the baby

When making a diagnosis, the doctor takes into account the features of the course of pregnancy and childbirth, the influence of adverse factors on the fetus. It is important that the baby feels after birth and in the first days of life, an Apgar score. When examining the crumbs, syndromes characteristic of PEP are found, changes from the nervous system.

Specialist consultations

Children with suspected PEDs need an optometrist consultation to examine the condition of the fundus. A neuropathologist will help assess the severity of pathological changes in the brain, prescribe the necessary examination and treatment.

Laboratory diagnostics

Biochemical analyzes will help establish the hypoxic nature of the disease, determine the acid-base and gas composition of the blood. Often, children are examined the level of glucose, electrolytes. If you suspect an infectious cause of a brain pathology or traumatic hemorrhage under its shell, a spinal puncture and analysis of the resulting cerebrospinal fluid are possible.

Instrumental research methods:

• neurosonography.

To clarify the diagnosis, the doctor may recommend an ultrasound examination of the brain structures through the fontanel of the baby. This method is absolutely painless and safe and helps to detect signs of hypoxia, edema, hemorrhage, expansion of the ventricles of the brain and other changes;

• electroencephalography.

Thanks to this method, it is possible to determine areas of epileptic activity, to identify children prone to the development of convulsive syndrome;

• cT scan.

Using this method, structural pathologies and changes in brain tissue are detected. CT is used to clarify the diagnosis with the ineffectiveness of other studies.

Treatment of perinatal encephalopathy in children

Therapy for children with PEP differs depending on the period of the disease. First of all, treatment is aimed at maintaining vital organs, fighting respiratory disorders. Such babies are often given oxygen therapy, probe nutrition is prescribed.

Infusion therapy is carried out taking into account the needs, body weight of the child, glucose-electrolyte solutions are administered intravenously. Vascular permeability reducing agents (canavit, etamsylate), anticonvulsants (phenobarbital, diazepam), hormones (prednisone, dexamethasone), and drugs that improve blood circulation in the brain (piracetam, cortexin, vinpocetine) are used.

The choice of drugs for the treatment of the disease is carried out taking into account the prevailing symptoms, the severity of the clinical manifestations of the disease.

After stopping the acute manifestations of the disease, the doctor’s task is to restore brain function. Kids with PEP are registered with a neurologist who prescribes courses of drug and physiotherapy treatment. Of medications, the specialist most often recommends using drugs that improve metabolic processes in the brain - nootropics, sedatives are prescribed for increased irritability, and anticonvulsants are prescribed if the convulsive syndrome persists.

PEP treatment should be carried out by a neurologist taking into account the clinical manifestations of the disease and the characteristics of the child. Improper therapy can worsen the condition of the crumbs, slow down the pace of recovery from the disease.

Good results in the treatment of children with PEP are provided by massage, physiotherapy (electrophoresis, amplipulse therapy), swimming, physiotherapy exercises. If there is a lag in development and speech disorders, classes with a speech therapist, psychologist are recommended.

The nervous system of children is characterized by plasticity and the ability to restore their functions. Therefore, the treatment started on time, in the first months of life, increases the chances of a normal development of the child in the future. According to statistics, a full recovery occurs in 20-30% of children, in other cases, it is possible to maintain the main syndromes with the transition of the disease into minimal cerebral dysfunction, hydrocephalic syndrome. In severe cases, the development of epilepsy, cerebral palsy is possible.

To reduce the risk of troubles in the child, future parents should be responsive to the issue of pregnancy planning. It is necessary to pay enough attention to maintaining a healthy lifestyle, proper nutrition, regular walks in the air. The future mother should treat chronic diseases before the conception of the baby, and during pregnancy avoid contact with infectious patients.

Do not forget about the importance of examination during pregnancy. A regular examination in a antenatal clinic will help to identify pathological conditions that can affect the development of the child and take measures in time. Of great importance is the correct management of childbirth, the timely determination of possible complications of labor, the choice of method of delivery. After the appearance of the crumbs in the world, an examination by a children's doctor and an assessment of the well-being of the child are mandatory.

conclusions

PEP is a fairly common pathology. It occurs as a complication of the pathological course of pregnancy and childbirth. Manifestations of the disease are characterized by a variety of symptoms and require immediate, rational therapy. Adequate treatment started on time will help minimize the risk of dangerous consequences for the health and development of the child.

Perinatal encephalopathy  - This is a collective term that includes various non-inflammatory lesions of the tissue structures of the brain, with the development of a dysfunctional state, which is caused by various etiopathogenetic factors: hypoxia, traumatic effects, infectious agents, toxic-metabolic changes that acted in utero or during the birth. The perinatal period covers the period from 28 weeks of prenatal stay to 8 weeks of prenatal life. It is during this period that the causal factors listed above can act.

The diagnosis of perinatal encephalopathy does not imply a specific pathology, that is, it can not even be allocated to a separate nosological unit. This is rather the first bell that the child has syndromic manifestations in the brain and the baby needs to be examined by narrow specialists to exclude the development of pathological changes in the future. The diagnosis is insidious in that its manifestations are very diverse, which complicates early diagnostic measures and differentiation from other organ diseases.

Encephalopathy of perinatal origin belongs to the group of hypoxic vascular lesions, so the term “perinatal hypoxic encephalopathy” can often be found.

In the structure of the general lesion of the nervous system, perinatal encephalopathy is more than 62%, and according to statistics 3-5% of newborns are born with signs of minimal brain damage.

Perinatal encephalopathy is very common, but it is not a sentence at all, because at the present stage of development of medical technology, it lends itself well to treatment. But it is certainly worth noting that early timely intervention is important, the course of therapy itself is very long and requires vigilant attention and control by the parents.

What is perinatal encephalopathy?

The diagnosis of perinatal encephalopathy implies the presence of diffuse small focal lesions of the brain, in the context of the studies performed, the disease can be considered as a result of oxygen starvation of brain tissue or arterial obstructive mechanisms of the arteries with their narrowing, which complicates normal blood flow and oxygen molecule delivery. Also, often a lesion occurs after a toxic effect, that is, with various diseases with a drug effect. In any of these cases, the cortex and subcortical white matter is affected, which, if untimely corrected, entails serious consequences, up to tetraplegia and intellectual deficiency.

The perinatal hypoxic encephalopathy in the overwhelming majority manifests itself syndromically: with depression or vice versa, an increase in the processes of central nervous system excitability, motor disorders, hydrocephalic complications, convulsive status, and motor and speech development retardation.

Perinatal encephalopathy is divided into the following types:

Hypoxic - formed with a lack of oxygen supply to the peripheral bloodstream or asphyxiation in childbirth. Its subspecies is hypoxic-ischemic, when serious destructive processes occurring in the foci of tissues join. Etiologically provoked by smoking, stress and alcohol abuse.

The post-traumatic, or residual form - occurs when receiving birth injuries: presentation by buttocks or laterally, provokes her obstetric error, unfavorable birth conditions, anomalies of labor. It can form both immediately and after months and years. Manifested by migraines, mental problems, intellectual deficiency, learning difficulties.

Toxic - develops under the influence of toxic substances in infections, alcohol, drugs, poisoning with chemicals (lead, carbon monoxide).

Toxic-metabolic - with organ malformations of the fetus, inflammatory processes of the mother during gestation. With internal metabolic intoxication and the inability of the body to self-extract poisons (for example, bilirubin encephalopathy with hemolytic disease).

Diabetic perinatal encephalopathy - brain damage, in the presence of diabetes mellitus with metabolic disorders.

Radiation - when irradiated with ionizing waves.

Dyscirculatory, or vascular perinatal encephalopathy - is inherent in senile age. The cause of this form is vascular damage, with existing diseases such as dystonia, increased intracranial pressure. This form is inherent in the elderly.

Infectious - under the influence of infections persistent in the body.

Transient perinatal encephalopathy - transient disorders, manifested in a short loss of consciousness, alternating visual impairment.

There is a classification of periodicals of the disease perinatal encephalopathy:

The acute period lasts up to 1 month of life.

Recovery - early to six months and late for a maximum of 2 years.

The initial or period of residual manifestations.

The diagnosis of perinatal encephalopathy is based on a history of life, an extensive symptom complex and the results of the following instrumental studies of the brain:

Ultrasound (neurosonography) is a safe method for examining tissues, cerebrospinal fluid spaces, anatomical structures through an overgrown large fontanel. It is possible to determine intracranial lesions and their nature.

Electroencephalography - allows you to determine the leading syndromes, 100% informative for predicting the consequences (deafness, loss of vision,).

Dopplerography is applicable to assess the pathology of blood flow in the vessels of the brain.

CT scan and MRI are difficult for children, since children need to be anesthetized.

A trip to the optometrist is mandatory, because changes in the fundus verify the level.

Examination by a neurologist, with an advisory opinion and recommendations for further action.

Causes of Perinatal Encephalopathy

Perinatal encephalopathy disease risk factors include:

- Infectious acute diseases that occur when a pregnant woman carries a child are especially dangerous, in terms of death, and the development of pneumonia.

- Chronic diseases (heart defects, anemic manifestations, diabetes, impaired renal system, surgical interventions), hereditary and genetic metabolic abnormalities, endocrine system pathology, hormonal fluctuations.

- Tobacco, alcoholism, drug addiction.

- The young age of the woman in labor is up to 17 or older than 31 years.

- Adverse environmental effects (ionizing radiation, toxic damage to drugs, heavy metal salts, gas pollution from cars).

- Poor conditions of rest and work associated with the interaction with chemicals, under the influence of radiation, vibration, physically difficult with weight lifting.

- Eating disorders, which entails the development of the phenomenon of gestosis - internal edema is dangerous to the life of children.

- In the history of repeated medical abortions, true repeated miscarriages and prolonged.

- Pathology of the very period of pregnancy:, the threat of interruption and the presence of placental chronic insufficiency.

- Anomaly of the birth process: rapid or prolonged, early discharge of water and, as a result, the anhydrous period is delayed, cord entanglement, premature placental detachment, cesarean section, incommensurability of the fetal head with a pathologically narrow pelvis, presentation of the buttocks or multiple infertility, helping a woman in labor.

- After birth, the incompatibility of the mother and the baby by blood, their Rh conflict, is much less likely due to group incompatibility.

Symptoms of perinatal encephalopathy

The clinical picture of the disease, perinatal encephalopathy is very diverse and many-sided, mainly depends on the site of the lesion and the depth of the damaging power in the brain, the age of the child, the causative factor and the duration of its impact. For differentiation, a syndromic system was created. All syndromes simultaneously cannot be present, more often it is a combination of several, with one prevailing.

There are a number of signs inherent in perinatal encephalopathy that help to suspect something is wrong in time:

- weak late cry;

- problems with the heart at birth;

- weakness or increased muscle tone;

- Inadequate reactions to external stimuli;

- spontaneous startle;

- the absence of physiologically induced reflexes - sucking, swallowing, search;

- excessive nervous excitement;

- damage to the oculomotor nerve;

- tilting the head;

- Frequent regurgitation, vomiting, gastrointestinal tract disorders, which may be unrelated to food intake;

- dissomnia.

At an older age it is important to notice the following symptoms: disturbances in the sphere of mental processes (memory, attention, perception of information); passivity to everything that happens, impaired speech, apathy; depressed state, lack of initiative, unwillingness to participate in the game, not contact, narrowed circle of interests, distraction, irritability, poor sleep, dizziness, migraine pains.

The following signs of perinatal encephalopathy are noted on a syndrome:

- An increase in neuro-reflex excitability. It manifests itself in tremors of the chin, arms and legs, anxiety with poor surface sleep and trembling, there is excessive lethargy, stiffness, increased reactions to sound and light, uncontrolled loud crying, failure of thermoregulation. Premature - cramps.

- General oppression of the central nervous system. All indicators are reduced: muscle tone, reflexes, consciousness is depressed, the cry is quiet and weak, babies quickly get tired during feeding or their sucking reflex, different muscles of the body and facial features, anisocoria, ptosis, disappear completely.

- Coma syndrome. Inherent deep lesions that depress vital functions, with a transition to a coma, convulsive seizures. More often this condition is observed with massive hemorrhages and cerebral edema, characteristic of birth trauma and asphyxiation. They are treated only under conditions of constant monitoring in the intensive care unit on the ventilator.

- Motor disorders are the most common. Manifested in a violation of the normal formation of muscle tone, with muscle hypo-, hypertonicity or dystonia, hyperkinesis (unfocused, chaotic movements), impaired coordination, paresis and paralysis, there is a psychomotor and speech developmental delay.

- Hypertension-hydrocephalus is one of the most serious and common, because it can go into requiring surgical intervention. Anatomically observed excessive production of intracranial fluid with an increase in intracranial pressure. It appears with tension and bulging of a large fontanel, the seams of the skull diverge, the head circumference increases by 1-2 cm, sleep disturbance, there are piercing cries against the background of monotonous crying, head tilting. Among the local symptoms, it is important to note: strabismus and nystagmus, asymmetry with mandibular sagging, uneven facial muscles. A characteristic "Gref symptom" - when you turn your eyes down and up, a white strip of the cornea appears.

- Convulsive syndrome, or epileptic. We are distinguished by short duration, a sharp sudden onset, a chaotic principle of repetition and is independent of sleep or feeding. Cramps themselves are observed in the form of small-amplitude trembling, automatic chewing movements, short-term, trembling feet, hiccups, regurgitation, excessive salivation. These cramps are similar to normal movements, which makes diagnosis difficult.

- Cerebrosthenic syndrome. Movement disorders are noted as a startle, with the absolutely normal mental and physical development of the baby.

- Vegeto-visceral. Microcirculatory disorders: marbling of the skin, cold hands and feet; dyspeptic symptoms with intestinal colic; lability of the cardiovascular system (tachy and arrhythmias). Often enteritis and enterocolitis (inflammation of the intestine with diarrhea and impaired weight gain), of various degrees of severity.

- Hyperactivity. It is expressed in the inability to concentrate and concentrate attention.

The problem of perinatal encephalopathy is that the disease is similar to other diseases of the central nervous system too much. Therefore, the first signs may be misinterpreted, which entails the transition to more difficult stages, which are difficult to correct and treat. Parents should be alarmed by constant causeless anxiety, poor sleep, lethargy, twitching, lethargic sucking, regurgitation.

Treatment of perinatal encephalopathy

Children, starting from the moderate stages and beyond, need inpatient treatment. In mild forms, you can limit yourself to outpatient monitoring by specialists, with the selection of adequate treatment regimens.

The treatment of perinatal encephalopathy takes a long period of time. Usually, 2-3 courses of therapy per year are needed.

Among the treatment methods, the following are distinguished:

- Injection blockades;

- Metabolite and antioxidant therapy, vascular and reflexology;

- Physiotherapeutic methods: SMT, UHF;

- Osteopathic treatment or orthopedic correction. After a traumatic effect during childbirth, it is recommended to reduce the effects of labor stress and correct the tension of the skull bones, restore their proper location and fusion in the future.

- Massotherapy. For the correction of muscle tone, the development of motor functions. Applicable techniques: articular, radicular, muscle;

- Gymnastics, or exercise therapy, and swimming. For the development of muscles and mobility, stress relief in the baby’s body.

- Herbal medicine. It is very often applicable for perinatal encephalopathy, because the use of herbs minimizes the consequences. These are herbal teas from dandelion, plantain, peppermint, knotweed, sweet clover, lingonberry, St. John's wort, lemon balm, calamus, oregano. But strictly after consultation with your doctor;

- Aromatherapy. Essential oils of chamomile, ginger, lavender, rosemary improve the general condition;

- Rational feeding. Breastfeeding is vital for the baby, because despite the variety of the pharmaceutical line of milk mixtures, even the highest quality, expensive and adapted mixtures are a metabolic load on the baby's body. It is proved that cure occurs faster on natural feeding, such children have higher rates of emotional and physical development;

- Baths. Their action is similar to the use of sedatives.

Drug-induced syndrome of perinatal encephalopathy:

- In case of muscle pathology and paresis, drugs that improve neuromuscular transmission are administered - Dibazol, Galantamine. With hypertension - Midokalm, Baclofen. The introduction of these drugs is applicable orally or by electrophoresis.

- In case of hypertension-hydrocephalus: an arrangement in bed with a raised head end up to 30 °. Among herbal remedies, preference is given to field horsetail, bearberry leaf. In more severe cases - Diacarb (reduces cerebrospinal fluid production and facilitates outflow). In critical situations, an operation of a neurosurgical profile is indicated. In addition, hemodialysis, mechanical ventilation, parenteral nutrition are applicable.

- In case of epileptic syndrome - administration of anticonvulsant anticonvulsants, under the control of laboratory tests and EEG.

- In case of psychomotor retardation of development, drugs are used that activate mental activity, normalize cerebral blood flow, and have the ability to form new intercellular connections - Nootropil, Pantogam, Actovegin, Cortexin.

- Be sure to prescribe groups of vitamin complexes, especially group B.

The consequences of perinatal encephalopathy

The consequences of perinatal encephalopathy are usually leveled by the first year of life, but other mechanisms of the course of the disease are also likely. Signs disappear or slightly manifest with adequate timely treatment and then the disease perinatal encephalopathy does not significantly affect the future development of the central nervous system of the child.

But there are often cases of development that aggravate the life of the baby, they include:

- cerebral dysfunction (moderate manifestations of hydrocephalus, asthenia, nervous conditions, behavioral deviations and difficulties in the learning process);

- the most difficult is cerebral palsy of children and;

- epileptic disorders;

- osteochondrosis of childhood;

- severe migraine pain;

- hypertension;

- scoliosis;

- visual impairment,

- underdevelopment of motility;

- pace delay in the development of the physical, mental, motor and speech apparatus.

The diagnosis of perinatal encephalopathy or abbr. PEP has recently been placed on almost every second baby.

Such incomprehensible medical terms lead parents into anxiety and fear for their child.

However, one should not panic. Firstly, in many cases, the baby’s parents do not have real reasons for disappointment, because very often doctors diagnose a child’s problem absolutely unreasonably. And secondly, perinatal encephalopathy, even when it is indeed symptomatically confirmed, is not a hopeless situation, doomed in its resolution to the most adverse consequences.

The child’s body has outstanding healing and recovery capabilities. The main thing is to create the most comfortable living conditions for the baby, taking into account the peculiarities of his diagnosis and ensure the proper treatment.

What is perinatal encephalopathy?

The phrase “perinatal encephalopathy” originally appeared among medical terms in 1976. Abbreviated, this diagnosis looks like an abbreviation - PEP.

PEP develops in the perinatal period - that is, from the beginning of the 28th week of pregnancy to the 7th day from the moment of birth (inclusive).

The diagnosis of perinatal encephalopathy indicates a malfunction of the central nervous system and is a kind of collective unit, combining a whole mass of a wide variety of conditions, syndromes, symptoms and diseases of the fetus or newborn.

Photo

Below in the photo are children with PEP

Causes of PEP

The condition of PEP develops as a result of exposure to an unborn or newborn child of any adverse factors during the bearing of the child, during delivery or in the first days after birth. A.

Often such factors cannot be specified and identified with sufficient certainty. But most often, such a factor is an insufficient supply of oxygen to cells, tissues, organs of the developing fetus in the womb, the child during childbirth, or the newborn. In a word, hypoxia.

Assume the presence of PEP, hypoxia allows assessment of a newly born child on the Apgar scale.

For scoring on this scale, doctors evaluate: breathing, physical activity, reflex processes, baby's cry, skin color, etc.

A low score indicates the possibility of neurological lesions.

Although even high scores are often not reliable evidence of the absence of problems from the field of neurology: PEP, hypoxia. It happens that symptoms are detected only during the infant's infancy.

Factors that increase the risk of developing the disease

The circumstances that increase the likelihood of having a baby with a disease are as follows:

• giving birth to a woman with a number of hereditary and chronic diseases;
• diseases of an infectious nature in the mother during pregnancy (so-called ACH infections are especially dangerous);
• improper malnutrition of the expectant mother during pregnancy;
• the presence of bad habits of the mother during pregnancy (smoking, alcohol, drugs);
• alcoholism, drug addiction of the father of the child;
• giving birth to a woman whose pregnancy was early;
• the frequent presence of a woman bearing a child in a state of stress;
• heavy loads of the expectant mother;
• pregnancy pathology (toxicosis, threat of miscarriage, etc.);
• pathology of labor (rapid labor, weak labor);
• delivery through surgery (cesarean section);
• malposition;
• anatomical features of the structure of the pregnant pelvis;
• entwining the fetus with an umbilical cord;
• the birth of a child sooner or later;
• fetal hypoxia;
• the impact on a pregnant woman of negative environmental factors (inhalation of gases, toxic substances, harmfulness of work, overdose of drugs, etc.).

It should be noted that this list is only an approximation, since it is often impossible to establish the factor provoking PEP.

It happens that in apparently healthy parents a child is born with significant dysfunctions of the central nervous system, although pregnancy proceeded safely.

Symptoms of perinatal encephalopathy by the age of the baby

For the purpose of timely diagnosis, parents of a newborn child should be extremely attentive to such manifestations of the child as:

• violation of the functions of breast sucking;
• weak scream;
• throwing the head back;
• abundant, frequent spitting up, especially in the form of a fountain;
• inactivity, lethargy, lack of reaction to loud unexpected sounds;
• bulging eyes while lowering simultaneously, a strip of white is visible above the iris - Grefe syndrome or rising sun syndrome;
• unexpected attacks of a crying baby while sucking a bottle or breast;
• fontanel swelling;
• restless sleep, difficulty falling asleep.

When the baby is 3 months old, the presence of the following manifestations will become alarming:

• stiffness of movements, difficulty in flexion and extension of the limbs;
• constant compression of the handles into cams, unclenching requires effort;
• difficulties in holding the head while on the stomach;
• tremor of chin, pens; trembling, cramps, twitching;
• the gaze is not focused;
• a monthly increase in head circumference of more than three centimeters.

Alarming symptoms of 6 months of life:

• lack of interest in the world (for toys, people, decor);
• emotionlessness, unsmiling;
• uniformity of movements.

Alarming symptoms of eight to nine (8-9) months of life:

• emotionlessness full or partial;
• lack of interest in playing with adults;
• lack of self-sitting skills;
• activity of only one hand when grabbing.

Alarming symptoms at the end of the twelfth (12) month of life:

• standing on tiptoe;
• pronunciation of mooing sounds;
• monotonous emotionless crying;
• the main way of the game is to destroy, scatter
• lack of understanding of simple requests and phrases.

Alarming symptoms by 3 years of life:

• gait disturbance;
• lack of proper coordination of movements;
• lack of social skills (dressing, fastening, tying, walking on a pot, using a mug, spoon, etc.).

PEP development periods

There are three periods of the development of the disease:

• acute (during the first 30 days of life);
• recovery period (from the second month of life to one year - for children born on time and from the second month of life to two years - for children born earlier);
• the period when judging the results, here are a few options for the outcome:
  • recovery;
  • developmental delay;
  • vegetative-visceral disorders (impaired functioning of any internal organs);
  • cerebral dysfunction (as a result - excessive activity, problems with concentration and perseverance);
  • epilepsy;
  • neurotic reactions;
  • Cerebral palsy (cerebral palsy).

Diagnostic Methods

• Neurosonography  It provides an opportunity to study the internal structure of the brain, the state of tissues, identify various neoplasms or excess cerebrospinal fluid.
• .   Allows you to obtain data on the functional activity of the brain, the presence of pathological formations or dysfunctions.
• Electroneuromyography.  Allows you to check for the presence of neuromuscular diseases.
• Dopplerography.  Allows you to evaluate the characteristics of blood flow in the vessels of the brain.

Infrequently in pediatric neurology, examination methods such as computed tomography, magnetic resonance imaging. Indirectly, the presence of the disease will help to judge the examination of an ophthalmologist.

Late effects of the disease

The consequences of PEP can occur much later than in infancy. So, preschoolers who were previously not correctly diagnosed with PEP or were untreated:

• suffer from speech delay, stuttering;
• hyperactivity ();
• retardation;
• increased excitability;
• irritability;
• insomnia;
• bouts of rage, aggression and hysteria.

In school years, such children may appear:

• headaches;
• violation of writing, reading, concentration;
• fast fatiguability;
• restlessness;
• low level of development of thinking, memory, and, as a result, poor performance.

Treatment

During the acute course of the disease, newborns with pathologies of high or moderate severity are shown inpatient treatment, newborns with a mild course of the disease are shown treatment at home.

The psychological attitude of adults surrounding the baby is of great importance in the treatment of PEP.

An exceptionally friendly atmosphere full of love and care for the baby should triumph in the house. This is extremely important for a baby with PEP symptoms. Often used as treatment methods:

• physiotherapeutic procedures;
• massages;
• baths with sea salt or with medicinal infusions and decoctions (needles, oregano, string, chamomile, oats).

Doctors recommend taking herbs and medicine ( Novo-Passit, Elkar, Glycine) with sedative effect, vitamin, strengthening syrups. Also, drugs that activate cerebral circulation are popular among doctors:

• "Hopantenic acid"
• Piracetam
• "Vinpocetine"
• Actovegin
• "Pyritinol".

A great effect is characterized by homeopathic, osteopathic treatment.

In case of high intracranial pressure syndrome, diuretic agents are used ( "Acetazolamide"Together with" Asparkam "), it is recommended to slightly raise the baby’s head when he is lying (put a special orthopedic pillow, put something under the mattress).

For symptoms of epilepsy, anticonvulsants are used. Severe forms of the disease require surgical intervention.

Prognosis for recovery

Thus, making the diagnosis in question is not a sentence; with early diagnosis and treatment, the prognosis is quite favorable.

In many cases, it is possible to achieve a full recovery. However, it should be remembered that, even after the disappearance of the symptoms of the disease, you should remain vigilant by regularly visiting a neurologist.

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According to statistics, 30% - 70% of newborns are diagnosed with PEP (perinatal encephalopathy). In the article, we have collected material that will help parents understand the causes of this disease, recognize its manifestations in babies by their symptoms, and also learn about methods of treating perinatal encephalopathy.

What can a diagnosis of PEP mean?

Perinatal encephalopathy is a collective term that summarizes brain pathologies that occurred during the perinatal period, that is, from the 28th week of pregnancy until the newborn reaches 7 days of age.

This term was introduced in 76 of the 20th century and is used only in the CIS countries (perinatal encephalopathy is not diagnosed abroad). The reason for making this diagnosis is the presence of symptoms of brain damage.

Perinatal encephalopathy: causes

The etiology of the occurrence of PEP can be:

• Chronic diseases of the mother.
• Viral diseases transferred during pregnancy or exacerbation of chronic diseases.
• Improper or malnutrition.
• Pregnancy at a very young age.
• Heredity.
• The presence of pregnancy pathologies (toxicosis, threatened abortion, etc.).
• Pathology of the birth process (rapid or prolonged delivery resulting from assisting with childbirth, etc.).
• Bad environmental and environmental conditions.
• Preterm birth, the birth of a premature fetus.
• Intrauterine hypoxia.
• Asphyxia of the fetus at birth.

How can a PEP manifest in a child?

Allocate three periods of PEP :

1. Acute (from birth to the end of 1 month of life).
2. Subacute or early recovery (from 1 to 4 months of life).
3. Late recovery  (from 4 months to 1-2 years).

In order to avoid adverse effects, timely treatment of PEP is necessary. However, for this you need to diagnose the pathology in time for the corresponding symptoms.

Symptoms of perinatal encephalopathy in a newborn in the acute period of the disease (from birth to the end of the first month of life):

1. Inhibition of the central nervous system due to trauma or hypoxia.
2. PEP can be manifested by lethargy, weak reaction to others, problems with reflexes of swallowing, regurgitation, and even sucking.
3. Lack of response to irritants (coma).
4. Increased excitability of the nervous system (increased reaction to sound, trembling, anxiety, sleep disturbance, headaches).
5. Seizures from subtle to epileptic seizures.
6. Combined hydrocephalus with hypertension (increased intracranial pressure against the background of accumulation of excessive amounts of fluid in the head).

Against the background of these symptoms in the future, such diagnoses as:

• epilepsy;
•   impaired motor activity;
•   vegeto-visceral dysfunction with somatic abnormalities;
• hydrocephalus;
• developmental delay (speech, mental, motor);
• neurosis;
• Cerebral palsy, etc.

Symptoms characteristic of the early and late recovery period of PEP:

• increased neuro-reflex excitability;
• epileptic symptom;
• hydrocephalus syndrome and hypertension;
• vegetative – visceral syndrome;
• motor impairment;
• symptoms of delayed psychomotor development.

The manifestation of clinical periods can be different in strength, so experts distinguish between mild, moderate and severe forms of PEP.
  In the first case, treatment can be carried out on an outpatient basis. In the case of moderate and severe brain damage, inpatient treatment is mandatory.

How to identify PEP: examinations, diagnostics

Making any diagnosis, including PEP, requires an integrated approach. For this, the specialist needs to know how the pregnancy progressed, the features of the course of the birth period, and also what symptoms appeared in the neonatal period. To clarify the diagnosis, additional examinations are carried out:

Methods of treating perinatal encephalopathy

• Moderate and severe manifestations of perinatal encephalopathy   acute period are treated in a hospital. In other cases, it is possible to select an individual regimen, massage, exercise therapy and physiotherapeutic methods for the treatment of PEP. As a medical treatment, phytotherapeutic agents and homeopathy are most often used.
• When hypertensive hydrocephalic syndrome it is recommended to raise the head end of the crib by 30 degrees. Medicines are prescribed by the attending physician taking into account the clinical manifestations and neurosonography data. With a mild defeat, a decoction of horsetail, bearberry leaf, etc. is prescribed. In more severe cases, Diacarb may be prescribed. It allows you to reduce the amount of liquor production with an increase in its outflow. In severe cases, resort to neurosurgical intervention.
• When pronounced motor abnormalities resort to massage, physiotherapy and physiotherapy.
• In the case of prescribed Midokalm or Baclofen, contributing to its reduction. If muscle hypotension syndrome predominates, drugs are prescribed to improve neuromuscular transmission. It can be Galantomin or Dibazole.
• With epileptic syndrome the child is prescribed anticonvulsants (anticonvulsants). The dosage and time of taking the medicine is determined by a specialist. Massage and physiotherapy are contraindicated in this case.
    The lack of timely treatment contributes to the violation of mental development.
• If observed psychomotor retardation   recommend social and pedagogical correction in conjunction with medications that activate brain activity and improve cerebral blood flow. The range of such drugs is wide: Nootropil, Actovigil, Pantogam, etc.
    The treatment regimen in each case is selected individually.
• The general treatment for all syndromes of this disease is the intake of B vitamins.

With timely treatment, the signs of perinatal encephalopathy completely disappear by the age of one year, or minor symptoms remain that have almost no negative effect on the development of the child. An adverse outcome in severe cases of PEP may be cerebral palsy or epilepsy.