Perinatal encephalopathy causes. Perinatal encephalopathy, recovery period syndromes

Date: 19.04.2019

Often, after the first examination of a neuropathologist in a clinic or in a maternity hospital, the baby is diagnosed with perinatal encephalopathy. According to various sources, it has from 30 to 70% of newborns. What complaints do moms make the doctor make such a diagnosis? Long crying and generally tearfulness, frequent sucking, regurgitation, flinching or throwing up arms and legs, poor nighttime (frequent waking up, restless superficial sleep) and naps (sleeping a little during the day), difficulty falling asleep (long motion sickness). When examining a child, the doctor may notice a violation of muscle tone - hypertonus or hypotonia, dystonia. In neurosonographic studies, dark or modified areas of the brain are sometimes visible, sometimes not. The doctor prescribes a means of improving cerebral circulation (piracetam, nootropil, cavinton) and sedatives (glycine, mixture with citral, valerian, sometimes luminal or phenobarbital), and also recommends a course of massage, swimming in soothing herbal tea. That you probably know everything.

And now it’s worth talking about a different approach to the problem.

Perinatal encephalopathy is a complication of the pathology of pregnancy and childbirth and is diagnosed in newborns up to 5% of cases (or 1.5-3.6%) !!! Where does this discrepancy come from? In the book A.A. Palchik and Shabalova N.P. “Hypoxic-ischemic encephalopathy of the newborn: a guide for doctors”. (St. Petersburg: Peter, 2000) The reasons for the overall incidence of encephalopathy in newborns are explained very well. The reason, in general, is one, and it is called overdiagnosis.

What is the cause of overdiagnosis? What makes doctors put this diagnosis “for everyone”? In the framework of the research work carried out by St. Petersburg scientists, the following causes of "overdiagnosis" of perinatal encephalopathy were identified:

Firstx, this is a violation of the principles of neurological examination:

a) violations of the standardization of inspection (the most frequent of them are: diagnostics of increased excitability in a shivering and fettered child in a cold room, as well as in the excited state or excessive manipulation of the researcher; diagnosis of central nervous system depression in a sluggish child during overheating or drowsiness).

For example, in the maternity hospital, the pediatrician put the probe, as the child often cried loudly, but when the neurologist came to examine the child, the baby was fast asleep, and the doctor said that the tone was normal and he did not see any pathologies. A month later, in the clinic, the examination was performed when the child was asleep, woke up and was afraid that his foreign aunt was tugging at his hands and feet. Naturally, he wept and tensed. AED confirmed.

So, one child can be diagnosed with hyper or hypotonia.

b) incorrect assessment of a number of evolutionary phenomena (that is, pathology is considered to be the norm for this age, especially for 1 month baby). This is a diagnosis of intracranial hypertension based on a positive symptom of Grefe, Grefe's symptom can be detected in full-term babies in the first months of life, in premature babies, with intrauterine growth retardation, constitutional features); diagnostics of spasticity on the basis of crossing the legs at the level of the lower third of the lower legs of the newborn when checking the support reaction or step reflex (may be physiological due to the physiological hyper tone of some muscles of the thighs, but pathological in children older than 3 months); diagnosis of segmental disorders in the detection of "heel foot" (dorsal flexion of the foot - 120 ° is the norm); hyperkinesis in a child of 3-4 months with anxiety of the tongue (is the physiological stage of maturation of the child's motility).

This may include regurgitation as a result of the immaturity of the nervous system and the weakness of the sphincter - the muscle valve located in the upper part of the stomach, which does not hold its contents too well. Regurgitating after each feeding in the amount of 1-2 tables of spoons and vomiting “fountain” more than 3 spoons once a day is considered normal, if the baby often pees, feels good and gains weight normally. Diagnosis of the symptom of marbling of the skin - due to the immaturity of the vegetative-vascular system.

But up to 3 years is absolutely normal, because it is only being formed!

Bad night's sleep - when the child often wakes up. But for an infant it is mainly characterized by superficial, shallow sleep and sucking during such sleep. Since 3-4 months in children, night sucking can become more active, because in the daytime, they begin to be easily distracted from the breast and suck relatively long. Due to the active night sucking, they get the required amount of milk.

American sleep researcher James McKenna, in his work Breastfeeding & Bedsharing Still Useful (and Important) after All These Years, writes that in the study of sleep in infants, it was found that the average interval between night breastfeeding was about one and a half hours - the approximate length of an adult sleep cycle. Minimize the time of my mother's "lack of sleep" by using rational organization of joint sleep and night feedings. Very often, children sleep better next to their mothers. Motion sickness can also be replaced by attachment to the chest before bedtime (but not everyone succeeds). When I learned that it was “possible” to do this, the time of motion sickness was significantly reduced. Often children wake up after sleeping in a bad mood, you can also offer breasts, and the world will once again delight the baby!

Secondx, this assignment to the pathological series of adaptive, passing phenomena from the nervous system of the newborn (for example, startle or throwing up arms and legs, trembling of the chin with strong crying or fright, postnatal depression, physiological muscle hypertension, etc.).

Thirdly, poor awareness in the classification of Hypoxic Ischemic Encephalopathy (mainly due to foreign origin of studies on this topic) and insufficient qualifications of the doctor.

For example, a month-old child was diagnosed with Minimal Brain Dysfunction, which should be put after 2 or even 5 years, according to different sources. Another child was prescribed to drink ginseng tincture, which is unacceptable at his age. Often, drug treatments lead to a further deterioration in the behavior of children. Doctors know about the dangers of various medications for children, but either simply do not inform parents, or consciously or unconsciously do not pay their attention to side effects.

FourthThese are psychological reasons. They consist in the fact that due to the current situation in the domestic healthcare system, “overdiagnosis” has no administrative, legal, ethical consequences for the doctor. The diagnosis leads to the prescription of treatment, and in the case of the correctness or incorrectness of the diagnosis, the outcome (more often, recovery or minimal disorders) is favorable. Thus, it can be argued that a favorable outcome is a consequence of the "correct" diagnosis and the "correct" treatment.

Overdiagnosis of the disease is no better than underdiagnosis. With insufficient diagnostics, the negative consequences are clear - due to the lack of timely assistance, the development of a disabling disease is possible. And overdiagnosis? According to Petersburg researchers, with whom it is difficult to disagree, “overdiagnosis” is not a harmless phenomenon, as some doctors sometimes believe. The negative consequences of “overdiagnosis” consist, first of all, in the fact that long-term work within the framework of the “overdiagnosis” doctrine leads to a “blurring” of boundaries in the perceptions of doctors between normal and pathological conditions. Diagnose "disease" is a "win-win" option. Diagnosing "PEP" turned into an unaccountable ritual of a children's neurologist, which naturally leads to the unexplained statistics of diseases "PEP".

The study of St. Petersburg scientists described in detail the most common errors during echoencephalography, neurosonography, Doppler, axial computed and magnetic resonance imaging.

The causes of errors are different and are related to the fact that when interpreting the data obtained, parameters and norms developed for older children and adults are used, inadequate assessment of the data obtained and their absolutization are used, methods that are insufficiently informative in diagnosing this disease are used, having inappropriate specifications.

FifthThis is a misunderstanding by doctors and parents of the natural needs of the newborn child. Most often, the child signals an error in the care of his crying. The child needs contact with the mother constantly immediately after birth.

It is well known that sucking has a kind of sedative effect on the child, which is incomparable in its usefulness to any medication. The amino acid content of taurine in human milk, in contrast to cow's milk, is very high. Taurine is necessary for the absorption of fat, and also serves as a neurotransmitter and neuromodulator in the development of the central nervous system. Since children, unlike adults, are not able to synthesize taurine, it is believed that it should be considered as an amino acid necessary for a small child. Among the polyunsaturated fatty acids, arachidonic and linolenic acids are particularly important, which are essential components for the formation of a child’s brain and retina. Their content in human milk is almost four times higher than in cow's milk (0.4 g and 0.1 g / 100 ml, respectively). In human milk nucleotides and numerous growth factors are represented. The latter include, in particular, nerve growth factor (NGF). That is why it is very important for the baby to be breastfed if you had problems during childbirth or during pregnancy, which could lead to fetal hypoxia and injury to his nervous system.

There is no clear standard tactic for the management of children with the syndrome of increased neuro-reflex excitability, many experts treat this state as a borderline, and it is advised only to watch such children refraining from treatment. In domestic practice, some doctors continue to use quite serious drugs (phenobarbital, diazepam, sonapax, etc.) in children with the syndrome of increased neuro-reflex excitability, the purpose of which in most cases is little justified ...

If you are still worried about the condition of your child, you should go or invite several specialists to the house (at least two, preferably on the recommendation (there are doctors who sincerely care for the health of children and who are not trying to make money on children's problems)) indeed, sometimes problems are very serious, such as cerebral palsy and hydrocephalus.About my girlfriend's child, for example, with the same symptoms as my son, the district neuropathologist said that you can complain about every child, and did not make any diagnosis .

Homeopaths have a good experience in treating neurological disorders, and official medicine confirms this. But the high plasticity of the child’s brain, its ability to compensate for structural defects, is well known. So you can never find out whether the therapy helped the child or he himself managed the problems. Massage helps very well, and my mother and professional (but only if the child responds well to it, does not cry, is not overworked, does not lose weight and does not stop gaining) Vitamin therapy is indicated, and, given the good digestibility of vitamins from mother’s milk, pay attention to this is attention.

There is more to say about vaccinations for restless children. In a Moscow clinic where babies with severe hypoxic disorders are nursed, treatment focuses on non-drug methods and maximum avoidance of injections (administration of drugs using electrophoresis, physiotherapy, etc.). My son after vaccinations (injections) increased the tone of the extremities, general anxiety, however, no one didn’t remove us, because in general perinatal encephalopathy is considered a false contraindication to vaccination, allegedly doctors and patients protect children from vaccinations on the basis of "universal" and "General scientific" considerations not confirmed by official medicine.

Also I will say that in the side effects of vaccines you can find the word "encephalopathy", that is, vaccination can cause this condition! The child was born healthy, we gave him several vaccinations in the first days, isolated from her mother, told her to feed by the hour, to give the child some medications that schizophrenics use, and we are happy to state that half of the children suffer from perinatal encephalopathy! What else to add?

The diagnosis of hyperactivity syndrome is very popular in America and is increasingly coming to us. On the other hand, in America and Germany they do not know what perinatal encephalopathy is. There is another view on the problem - that the whole thing is not in neurological pathology and not in the disease, but simply in a special type of people, the individual structure of their nervous system. Lee Carroll’s Indigo Children’s book is proof of this.

To change the psychoemotional constitution (personality type), you understand, not a single drug can. Of great importance is the psychological attitude in the family (understanding the needs of a small child, caring according to the Serzov approach method) and proper child care (breastfeeding, carrying on hands (the sling helps a lot), sharing sleep, respecting the child’s personality).

In our clinic there is a poster about the benefits of breastfeeding with the words of the ancient Greek philosopher: "Together with the mother's milk, the soul enters the child." Mother's milk is not just food, it is both a medicine, and a connection with the world, and the transfer of mother's knowledge about life to a child.

What makes you send a child to a neurologist? First, information about how the pregnancy and childbirth. Make you alert:

strong manifestations of toxicosis (especially late);

suspicion of intrauterine infection;

maternal anemia (hemoglobin below 100 units);

weakness of labor, prolonged dry period, use in labor of drug stimulation or obstetric forceps;

cord entanglement; too much weight of the child or, on the contrary, signs of immaturity and prematurity;

childbirth in breech presentation, etc.

In short, everything that can lead to fetal hypoxia during childbirth, that is, to a lack of oxygen, almost inevitably leading to a temporary disruption of the central nervous system (CNS). Viral infections of a woman during the period when the fetal nervous system is laid out, or the ecology of a home or place of work, can also damage her work.

There is no direct relationship between the level and duration of oxygen starvation: sometimes the child’s brain suffers a serious oxygen deficiency without causing much harm to itself, but it happens that a small deficiency does a rather tangible damage.

In addition to clarifying the circumstances of pregnancy and childbirth, there are certain clinical signs that alert the pediatrician. The child is too lethargic or, more often, excited, screaming a lot, when screaming his chin trembles, he often spits up, reacts to the deterioration of the weather. Or to all of this, his tummy is swollen, the chair cannot be adjusted at all - it is with green, it is frequent or, on the contrary, it has a tendency to constipation.

Comparing all these data, making sure that the baby is properly fed, the pediatrician directs such a child to a neurologist - a specialist aimed at examining the state of the central and peripheral nervous system. The task is to find out to what extent the hypoxia present in the birth has left its unpleasant mark.

Just do not panic!

Here it often begins for the sake of what, in fact, this article was started - the fear covers the parents. How, our child is not all right with his head? This fear goes back to our common mentality, which says that it is a shame to have deviations in the sphere of the nervous system.

Convince, say that these deviations are most likely temporary, that the sooner we help the child, the faster he will cope with them ... Most parents, heeding the assurances of the pediatrician, go to the neurologist and return with a record that reads usually the following:

PEP (perinatal encephalopathy), recovery period, SPNRV (syndrome of increased neuro-reflex excitability).

What is written in parentheses, deciphered by the author of the article - unfortunately, neurologists do not often condescend to clarify incomprehensible abbreviations. They write for themselves and for the pediatrician, and both sides are well aware of each other. But not the parents.

How scary is it? Most often with this question they run to the pediatrician, who at that moment is a translator from an incomprehensible medical language into everyday language.

And all would be nothing if it were not for one regrettable fact: some parents do nothing at all. The compassionate others contribute to this, reassuring them with something like the following words: “Yes, doctors write to every other person. They wrote to us, but we did nothing and we grow! ”

And it really grows and grows. But parents do not try to associate their inaction with severe manifestations of exudative diathesis in a child, symptoms of dyskinesia of the gastrointestinal tract, with a tendency to constipation, and even with such obvious things as lagging speech development, disinhibition, disobedience.

But many of these troubles could have been avoided, take your parents to the problem as it deserves it - seriously enough, but without excessive drama. These diagnoses in the child’s card are not a signal of panic, but a signal to action! There are doubts in the recommendations of the district child neurologist? Consult a child with another specialist.

What lies behind obscure words?

So, AED stands for perinatal encephalopathy. That is, the child in childbirth had factors that could damage the brain. Something has happened, and we need to figure out what damage this organism has caused in the body.

The words “recovery period” quite rightly indicate that the nervous system itself is restored without outside intervention — the only thing is the pace and quality of this recovery. And they are not always satisfactory.

As for the hard-to-pronounce abbreviation SPNRV (syndrome of increased neuro-reflex excitability), it just means the sad fact that the child is tearful, spit up a lot, is easily excited, and is difficult to calm down. And he needs to help get rid of it.

“Will not it go by itself?” You ask. Will pass. In part of the children. And the rest will have to carry this burden in life. They will be disinhibited, restless, will not be able to communicate normally with their peers.

Through the eyes of a specialist

What do neurologists pay attention to during their examination? First, on reflexes and muscle tone. Are reflexes uniform on the right and left? Are there any muscle spasms? And vice versa - are they reducing too little?

Then check whether the child has signs of increased intracranial pressure. To do this, an ultrasound scan (neurosonogram) is done through an open fontanelle — they look to see if the ventricles of the brain are enlarged. And in conclusion, examine the child's behavior, the relevance of his so-called psychomotor and physical development to age.

If the case is limited to a violation of muscle tone and excitation of the nervous system, the neurologist usually prescribes a massage, light sedatives and medications that improve the cerebral circulation.

If a neurologist has discovered in a child the phenomena of increasing intracranial pressure, which usually depends on the excessive production of cerebrospinal fluid, he prescribes a course of so-called dehydration therapy (dehydration - dehydration). For this purpose, various diuretics are given. To compensate for the loss of potassium with increased urination, drugs containing potassium are prescribed.

No need to hope that with the growth of the skull, these phenomena will pass by themselves - this may not happen. By the way, monitoring of indicators of intracranial pressure should be carried out later, for several years, which will relieve your child from headaches and bouts of so-called vegetative-vascular dystonia in preschool and school age.

Motion therapy

But the most important with the forms of AED of any complexity are sparing and drug-free methods of rehabilitation treatment: reflex massage, special methods of therapeutic massage, elements of therapeutic gymnastics, hydrotherapy with massage and therapeutic gymnastics in water of different temperatures and composition, etc.

They require perseverance and a lot of effort from the parents of the child — giving the medicine, perhaps, is easier than doing the exercises every day — but very effective. This results from the fact that the injured brain, receiving correct "information" at massage, swimming and gymnastics, is restored more likely.

Reflex massage (impact on active points) is initially done by the hands of an experienced masseuse, who then passes the baton to the parents in their competent handling of the baby. Do not forget: babies get tired quickly, all procedures should be carried out briefly, but often, at the height of positive emotions.

Early child swimming with obligatory diving is also of great help in solving the neurological problems of the infant. What is painful and unpleasant to do on land, "with a bang" takes place in the water. During diving into the water column, the body experiences a baroeffect - gentle, soft and, most importantly, uniform pressure on all organs and tissues. Hands clenched into fists, cramped muscles and ligaments of the body are straightened. The water column restores intracranial pressure in all directions, carries out baromasazazh chest, leveling intrathoracic pressure.

After diving, the child receives a full, competent breath, which is especially important for babies born by caesarean section, who had hypoxia, etc. Water helps and with problems with intestinal colic - improves stool, spastic painful phenomena go away.

And what about the stomach?

Often, children with perinatal encephalopathy have serious disorders of the gastrointestinal tract: constipation and diarrhea, abdominal distention, intestinal colic. Usually it all starts with dysbiosis and, unfortunately, often ends with various skin manifestations - exudative diathesis or even eczema.

What is the connection here? The simplest. During hypoxia of the brain during labor, the center of maturation of immunity, located in the medulla oblongata, almost always suffers. As a result, the intestine is colonized by the flora that lives in maternity hospitals, especially when it is late attached to the breast and the early transition to artificial feeding. As a result, the baby has dysbacteriosis very early: after all, instead of the necessary bifidobacteria, its intestines are filled with staphylococcus, E. coli, etc.

All this is aggravated by the fact that the intestine of the infant, due to the “breakdown” of the nervous system, functions poorly, is not correctly reduced, and the combination of intestinal dyskinesia with “bad” microbial flora leads to a violation of food digestion. Poorly digested food causes upset stools, anxiety of the child and ultimately allergic skin.

It happens and vice versa: the prolonged action of a damaging factor not related to the central nervous system can cause secondary encephalopathy. For example, if you do not pay attention to the flora of the gastrointestinal tract, especially the presence in the intestine of such "saboteurs" as staphylococcus, there may appear clear signs of CNS damage - delayed psychomotor development of the child, weakness of sphincters, symptoms of increased neuro-reflex excitability and etc.

How to be? To achieve the best effect, treat not only the intestines, but also the nervous system. Only joint efforts of a pediatrician and a neurologist with the most active help from parents can give the desired effect.

And finally, I want to remind you that a baby with an unstable nervous system is warmly motherly, tender touches, affectionate conversation, peace in the house - in short, everything that makes him feel protected is needed even more than a healthy child.

First results

How does the treatment of encephalopathy understand that the efforts of doctors and parents have been crowned with success? The child has become calmer, has ceased to cry for a long time, his sleep has improved. He began to hold the head in time, sat down, then stood up, took the first step. His digestion has improved, he is gaining weight well, he has healthy skin. This is visible not only to doctors, but also to you. So you helped your baby to overcome damage to the nervous system.

And finally, one example of what motherly love can do.

In the mid-60s, a young midwife had a daughter in one of the maternity hospitals on far Sakhalin. As it is, unfortunately, it often happens in the medical profession, the birth was extremely difficult, the child was born in deep asphyxiation, he did not breathe for a long time, then he was practically in paralysis for several weeks.

The girl was fed from a pipette, nursed as they could. To be honest, the doctors thought that this child was not a tenant. And only mother thought otherwise. She didn’t move away from the baby, perfectly mastered the massage and stubbornly massaged with difficulty the reviving body.

After 18 years, the author of this article met his daughter and mother in Leningrad. They came to enter the Leningrad University. It turned out that the girl with a gold medal graduated from school on Sakhalin. It was difficult to take her eyes off her - she was so slim and beautiful. Then she graduated from the university, defended her PhD thesis in biology, became a scientist, got married, gave birth to two beautiful children. None of this could be, be the love of the mother less selfless and reasonable.

Rules for all

Examine and show an experienced pediatrician discharge from the hospital. If it has low Apgar scores (6 and below), other marks (for example, did not scream after birth immediately, there was a cephalohematoma, hypoxia, asphyxia, convulsive syndrome, etc.), do not delay consultation with a children's neurologist.

If there is no objective evidence to consult a neurologist, but it seems to you that the baby is too excited, whiny, capricious above all reasonable limits - trust your parental intuition and show the child to the doctor. A baby is hardly healthy if it is pathologically passive in the first weeks of life, lies like a cloth, or vice versa, cries 24 hours a day if it is indifferent to food or has vomiting “fountain” after each feeding.

Breastfeeding is necessary for your baby! Even the most high-quality and expensive adapted milk formulas are an additional metabolic stress for the infant's body. It has been scientifically proven that children who are naturally breastfed “quickly overcome” infant problems (neurological, intestinal, etc.) have a higher rate of emotional and physical development.

If you are planning the next child, find out all the causes of perinatal encephalopathy in the first child. And if possible, try to correct the situation if it is associated with an inattentive attitude toward your health during pregnancy and childbirth. Attend courses on preparing couples for childbirth. Carefully consider the choice of doctors and medical institutions where you plan to give birth to a baby.

In medicine, encephalopathy is understood as various types of non-inflammatory processes that directly affect or destroy the brain itself. In this article we will talk about how encephalopathy develops in a newborn and what its primary symptoms are.

general information

Experts conditionally distinguish two types of this disease: congenital and acquired. It is believed to be primarily innate. This means that the disease begins its development even during the period of the formation of the fetus inside the womb (approximately from week 28). This kind of pathology is most often caused and called "hypoxic-ischemic encephalopathy". The newborn specialists identify a number of additional factors leading to the development of such an unpleasant problem, namely:

preterm delivery;
maternal diseases during gestation;
complications;
difficulty in opening the birth canal;
excessive fetal weight;
neuroinfection.

Main symptoms

In a newborn, encephalopathy is usually diagnosed in the maternity hospital. The reason for the additional examination often becomes a faint or somewhat late cry of the infant after birth. In addition, the following factors may also be cause for concern: cyanosis of the skin, disturbance of certain innate reflexes, relatively frequent regurgitation, convulsions, lethargy, etc. In some cases, these symptoms go away on their own. In other situations, not to do without the help of qualified professionals.

Diagnostics

According to experienced doctors, in a newborn, encephalopathy is very difficult to diagnose due to physiological tone. On the other hand, specialized computer research is easier to do through an open spring. This type of diagnosis is prescribed to all children up to a month for prophylactic purposes in order to start treatment earlier if necessary.

Treatment

In newborns it is very difficult to treat. This is a very long process, which, in turn, consists of several courses. Methods of treatment are selected exclusively by a qualified specialist, based on the root cause that caused the disease. As a rule, treatment involves taking certain medications, physiotherapy, and massage.

Possible complications

Unfortunately, it also happens that after this disease, young patients have very serious complications in the form of the development of hydrocephalus or convulsive epilepsy. In some cases, even a surgery may be required to correct these problems. In order to avoid the development of complications of any degree, doctors strongly advise to fully, and most importantly, promptly pass the recommended competent therapeutic course.

Encephalopathy is a pathology of the brain caused by the death of nerve cells. In the presence of encephalopathy in children and adults, there is a violation of the blood supply, and oxygen deficiency of the brain is also manifested. Encephalopathy is not a single disease. By this concept it is customary to mean common pathological states and diseases of the brain. Encephalopathy can be congenital or acquired. Congenital abnormality occurs when receiving traumatic brain injury during childbirth, due to deviations in the development of the brain and in metabolic disorders in the embryonic period. Acquired encephalopathy occurs for various reasons:

Due to exposure to toxic agents;
When receiving a head injury;
Due to metabolic disorders in the body;
Due to exposure to ionizing radiation;
When violations of the blood supply to the brain.

The reasons

Pathology of the brain occurs in infants infrequently. The reasons why encephalopathy may be the following:

Deviations and pathological processes during pregnancy;
Complicated childbirth or a traumatic brain injury during this process;
Metabolic disorders in the body of the baby;
Infection with infectious diseases of the future mother during gestation;
Hypoxia of the fetus can cause encephalopathy in the newborn. There is insufficient blood supply to the baby’s brain; ·
Congenital diseases of the child.

Symptoms

When a pathological brain disorder occurs in an infant, certain signs may appear.

Disorders of the motor activity of the newborn: hypertonus and hypotonia of muscle tissue. It is necessary to distinguish physical tone from encephalopathy syndrome. In hypertonus and hypotoneus, asymmetrical lines of the face and a disproportionate body are observed.
Increased excitability of the infant: sleep quality, sleep time, possible trembling of the limbs and chin.
Increased lethargy and lethargy of the newborn.
Sluggish sucking and disturbance during swallowing.
The manifestation of intracranial hypertension. Possible complication of the brain in the form of dropsy. For this reason, surgery is necessary. Hypertension can be determined by swelling and increased fontanel, as well as by large head sizes.
The onset of seizures, frequent regurgitation, increased salivation.

Diagnosis of encephalopathy in the newborn

A neurologist will be able to diagnose a pathological brain disorder by visual inspection and after obtaining the results of laboratory and instrumental examinations.

The child is sent for delivery of the general analysis of blood and urine;
A biochemical blood test is required;
Blood test for the presence of toxins in the children's body;
Oximetry is prescribed: the level of oxygen in the blood is studied;
Requires analysis of cerebrospinal fluid;
Computed or magnetic resonance imaging of the brain, ultrasound and other instrumental methods may be prescribed. In some cases, to determine the diagnosis requires consultation of an ophthalmologist, speech therapist and psychologist.

Complications

What is dangerous encephalopathy for the newborn? Depending on the severity of the pathology, the consequences and complications may be different. In mild encephalopathy, if diagnostics and treatment is carried out in a timely manner, many diseases of the central nervous system are treatable. According to statistics, 1/3 of the children who were diagnosed with this disease were completely cured of their pathology. If the treatment was not prescribed in time or if the damage to the nerve cells was significant, dangerous consequences may occur.

Child developmental delays are the most common consequence of a congenital malady. In the future, the child does not remember well, can not concentrate attention and is not capable of learning.
Violation of the functions of internal organs and systems.
The occurrence of severe and dangerous diseases.

Treatment

What can you do

Encephalopathy cannot be treated on its own. Consultation with a physician and compliance with all treatment recommendations is necessary. Parents should give the baby prescribed drugs in dosage in accordance with the instructions. When manifestations of complications, you must report this to your doctor. Also, moms and dads should provide the child with good nutrition. If necessary, vitamin complexes can be given to increase the effectiveness of the immune system. But taking vitamins and other nutritional supplements should occur after consulting a doctor.

What the doctor does

With mild signs of pathology, the newborn is treated at home.
If serious disturbances of the central nervous system are observed, the infant should be in the hospital.
Treatment of the newborn will take into account the severity of encephalopathy and the individual characteristics of its korganism.
If the lungs are underdeveloped, artificial ventilation is prescribed.
Power can be supplied through a probe.
Oxygen therapy and hemodialysis can be given to the infant.
When residual encephalopathy requires long-term treatment with the use of many drugs, depending on the manifestation and signs of the disease. Nootropic drugs, medications for hypertonia, disorders of motor activity, convulsive syndrome are prescribed.
Drugs can be administered intramuscularly, intravenously or by electrophoresis.
Surgical intervention may be performed to improve blood circulation in the brain. Often an operation is performed without compromising the integrity of the brain tissue.
As additional methods of treatment, massage, physiotherapy procedures and physical therapy classes are prescribed.

Prevention

Prevent congenital pathology can be in the embryonic period. During pregnancy, the expectant mother should:

monitor your health
avoid stressful situations
do not take drugs without a doctor's prescription.
not be exposed to toxic substances
eat well
time to eliminate infectious diseases,
comply with measures to improve the effectiveness of immunity,
undergo regular examinations and examinations in the antenatal clinic.

During childbirth, physicians should be extremely careful to prevent brain damage and other complications.

The diagnosis seems alarming and frightening, but MirSovetov immediately wants to point out that often the diagnosis is made without obvious grounds, and then it is removed. Secondly, it should not be considered a sentence and discouraged, because the children's body is endowed with amazing abilities and abilities that allow you to fully heal. The main thing is if the baby still has perinatal encephalopathy confirmed during examinations, then try to provide him with good care and timely adequate and effective treatment.

Some adult neurological ailments, such as severe, early, neurocirculatory dystonia, can be caused by perinatal encephalopathy, found in infancy, but not properly corrected. Perinatal damage at school age can provoke hyperactivity, development of attention deficit disorder, problems with motility and organs of sight. Let's talk about the causes of this pathology, the signs pointing to it, methods of diagnosis and correction.

General information about perinatal encephalopathy

For the first time this concept was proposed to be introduced into the lexicon of medical workers in 1976, at the same time, for convenience, the abbreviation was established - AED. The word "encephalopathy" is made up of two Greek words meaning "brain" and "violation". And the perinatal period is considered the interval from the 28th week of pregnancy, when intrauterine development occurs, until the 7th day after the birth of the baby. This term unites a rather extensive group of syndromes, conditions and diseases of the fetal (or newborn) nervous system, which develop due to the action of damaging factors, sometimes even unexplained causes, which played a negative role during a woman’s gestation, during the first days life of a newborn. Such disadvantage is most often caused by factors accompanied by the intake of insufficient amount of oxygen into the blood of the developing and developing fetus. Doctors call such oxygen starvation hypoxia. In recent years, neonatologists and pediatricians use other terms and names for neurological pathologies in children, but the collective name “perinatal encephalopathy” also remains to be heard.

The Apgar Apbar scale helps doctors understand and objectively assess the condition of the newborn. The color of the skin, the state of the cardiovascular, respiratory systems, the activity of the born, the severity of physiological reflexes are taken into account. If the total scores are low, then there is a risk to the life of the baby or the development of neurological disorders. Sometimes it is necessary to urgently apply intensive care. But even if the newborn has high scores, a number of symptoms of neurological disorders can appear even after the seventh day from the moment of birth. It is important to be attentive to the condition of the baby, in order to notice negative changes in behavior, similar to manifestations of AED. The baby's brain is very plastic, so if you take timely medical and corrective measures, you will be able to avoid and prevent violations in the formation of emotions, behavioral reactions, cognitive activity.

During perinatal encephalopathy, there are 3 periods:

Acute (this is the first month of a baby’s life).
Recovery (for full-term children, it is calculated from the beginning of the second month to the 12th month of life, and for premature babies, the time is extended to 24 months).
Exodus:

full recovery;
delayed motor, speech or mental development;
MMD - this is how the minimal brain dysfunction is defined, at which hyperactivity syndrome can develop with a deficit (lack of) attention;
autonomic-visceral dysfunctions (disorders of some internal organs);
neurotic reactions;
(the so-called dropsy of the brain);
epilepsy (convulsions);
Cerebral palsy (stands for cerebral palsy).

Why does the probe appear?

First, MirSovetov will list the risk factors that can lead to AEDs:

some hereditary and chronic diseases in the future mother;
infections during pregnancy, for example, cytomegaly;
nutritional disorders during pregnancy;
taking alcohol, drugs and smoking in the months of gestation;
alcoholism and drug addiction at the father of the child;
constant stress or heavy physical work during pregnancy;
pathology of pregnancy (the threat of miscarriage, toxicosis in early or late periods, and the like);
pathology during childbirth (weakness of labor or, on the contrary, rapidly proceeding childbirth, injuries in the provision of assistance;
incorrect position of the fetus, cesarean section, features of the anatomy of the structure of the pelvis of the woman, cord entanglement);
postmaturity or prematurity of the fetus, which caused disturbances in the activity of the organism;
lack of oxygen during fetal development;
adverse effects of the environment during gestation, for example, work in hazardous production, inhalation of toxic fumes or overdose of drugs for the purpose of poisoning, ionizing radiation, pollution of the nature with production waste, air pollution.

There are cases when it is not possible to establish the cause of perinatal encephalopathy, when an outwardly healthy parents have a baby with brain pathologies.

When do I need to sound the alarm?

In the first days of the appearance to the outside world of a small tiny creature, especially sensitively observe its condition. Be sure to inform the nurse or pediatrician who comes to visit if:

the baby sucks the breast badly, often chokes, cries weakly;
throws his head back, spits almost after every feeding, and the spray often flies like a fountain;
moves a little, sluggish, does not respond to loud noises;
eyes are bulging, but as if dropped down, and a white strip is visible above the iris - doctors call this phenomenon “Gref syndrome” or “rising sun syndrome”;
the newborn suddenly starts crying when sucking from a bottle or breast — this can be a sign of increased intracranial pressure;
eduction of the fontanel is observed;
it is very difficult for baby to rock, he falls asleep badly, constantly wakes up.

At three months of age, such manifestations of trouble should be alerted:

motor stiffness, the baby flexes the arms and legs better, but it is difficult for him to unbend them;
the knobs are constantly compressed into cams, it takes effort to bend them - this is a signal of hyper tone;
it is difficult for the baby to hold the head when it is lying on the tummy;
the eyeballs wander, the gaze does not focus on a beautiful and attractive toy;
sometimes there is noticeable trembling of the chin or of the handles, twitching, flinching, convulsions;
the head increases in its size by more than three centimeters per month - here you can suspect brain edema (hydrocephalus).

And what should alarm parents in six months?

The kid is not interested in toys, the setting.
Does not show joyful emotions, does not smile.
The child has few movements, sometimes they can be one-sided.

At eight or nine months, suspicions are caused by:

paucity of emotions;
no interest when parents offer to play;
the baby cannot sit by itself;
items takes only one hand, the second as if idle.

You need to worry if by the year:

the baby does not understand simple and elementary requests and phrases, all games are reduced only to destruction;
makes a lowing sound, its crying monotonous;
when you put him on two legs, he tries to walk on his toes, does not step on the whole foot.

If by three years the child’s gait is disturbed, the movements are not coordinated, he is untidy, he cannot maintain himself (tie shoelaces, fasten buttons), does not ask for a pot, go to the toilet, cannot properly use a spoon or mug, then this is alarming “bells” ".

Diagnostics

Perinatal lesions are noted on the basis of data on the course of pregnancy and childbirth, as well as additional examinations conducted to clarify the location, characteristics and extent of brain tissue damage. Further, such examinations allow one to judge whether the treatment tactics are effective.

Neurosonography (abbreviated NSG) allows you to assess the state of the brain, its tissues, gives an idea of the nature of brain damage.
Electroencephalogram in abbreviated form (EEG) - helps to understand how the brain functions, whether there are developmental abnormalities, whether there are foci of epileptic activity.
Electroneuromyography (abbreviated ENMG) - the method allows to determine whether the child has neuromuscular diseases.
Doppler - shows the amount of blood flow in the vessels of the brain.

There are other modern diagnostic assistants, for example, CT, MRI.

In addition, the child will be examined by an ophthalmologist, an otolaryngologist, and, if necessary, by other children's specialists.

Consequences of perinatal encephalopathy in the preschool and school years

In preschool children one of the late effects of AED may be speech delay. There certainly need to turn to a neurologist, speech therapist, a psychologist to help the child. Anyway, any developmental delays cannot be left unattended, so be sure to visit the district pediatrician on time, give him your doubts, worries. Do not expect that everything will pass "by itself". At preschool age, the following AEP effects are also stated:

stuttering, speech problems;
hyperactivity or, on the contrary, inhibition;
irritability, irritability, sleep disturbances;
bouts of anger, rage, aggression towards others, hysteria, other neurological and mental manifestations.

Non-treated perinatal encephalopathy during school years can give such trouble:

violation of the letter (disgrafiya);
reading problems (this is dyslexia);
difficulty concentrating, fatigue from mental activity, restlessness;
decreased thinking, memory, performance;
conflicts with parents, teachers, especially in adolescence.

In the acute period of perinatal encephalopathy, newborns with severe and moderate pathologies of the brain and nervous system need to be treated in a hospital. If the syndromes appear in a mild form, then home treatment is possible. Try to create a friendly and calm atmosphere around your baby. Do not be discouraged, panic or depression, if the diagnosis is made at an early age, then much can be corrected. The parents' task: to surround the baby with love, to follow the recommendations of the doctors, to be patient. Often, the doctor prescribes physical therapy, physical therapy, baths with medicinal infusions and decoctions (pine needles, oats, chamomile, oregano, train) or with the addition of sea salt. Herbs can be administered with a calming, relaxing effect, the drug, Glycine, Novo-Passit, vitamin and firming syrups. Good results are obtained by treatment with a homeopath, an osteopath.

If a child has an increased intracranial pressure, it is recommended to put something under the mattress so that the head is higher, herbs with diuretic action or Diacarb are prescribed. In severe cases, hydrocephalus has to resort to the help of neurosurgeons.

When the doctor selects anticonvulsants. If required, drugs are prescribed that activate the brain, improve its blood supply, for example, Nootropil, Pantogam, Vinpocetine, Actovegin, Encephabol. The selection of drugs is carried out by the doctor individually for each small patient.

Even if the child’s state of health stabilizes in the future, manifestations of AED will disappear, periodically visit a neurologist for prevention. Sometimes you take massage courses, if there are no contraindications, strengthen the child, increase immunity, develop, coordination of movements, mental activity, but do not allow at the same time overexcitement, overwork.

This is not an inflammatory disease of the brain, it is associated with impaired blood supply, reduction 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. This disease is diagnosed in about 50% of infants. Heavier forms of PCNS occur only in 10% of newborns. More vulnerable Congenital is encephalopathy in infants, complicated during childbirth (birth trauma, placental abruption, incorrect position of the fetus, large head in a child, narrow pelvis in a woman). She can be suspected in the first immediately after birth. At birth, internal organs, including the central nervous system, are not fully 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 the 28th week of pregnancy to the 8th day of the child's life It may occur if (causes of encephalopathy):

The mom of the child is too young or age
Abortions
Miscarriage
Infertility Treatment
Diabetes mom
Mother's heart defects
Mom's flu
Smoking, alcohol
Risk of miscarriage
Work in hazardous production
Medication
Fast (less than 6 hours, slow more than a day) delivery
Cesarean section
Premature placental abruption
Umbilical cord entanglement
Multiple birth

Periods of perinatal encephalopathy in newborns.

The acute period is 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 there is: lethargy, muscular hypotonia, lowered reflexes (sluggishly sucks) or, on the contrary, hyper-excitability of the nervous system (shallow sleep, trembling of the chin and limbs), throws the head back.

The early period of perinatal encephalopathy in newborns,when cerebral symptoms decrease, and focal brain lesions appear. Manifested muscle hypotonia or hypertonia. Possible paresis and paralysis, hyperkinesis (Enlarged head, enlarged venous network on the forehead, temples, enlarged and bulged springwood. Marbling and pallor of the skin, cold hands and feet, changes in the gastrointestinal tract (constipation, increased gas generation), heart rhythm disturbance and breathing.

Late period of perinatal encephalopathy in newborns,gradually normalized muscle tone and other functions. 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, one can already notice the child’s lag, those reflexes and skills that should be, or they are not, or they are very weak, are sharply delayed,. There may be persistent spastic syndrome or, on the contrary, muscular hypotension.

Hypoxic - ischemic damage to the nervous system.

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

Depression and arousal of the central nervous system, which lasts up to 7 days after birth.
After 7 days, seizures, increased intracranial pressure, heart rhythm and respiration rhythm are added.
Severe convulsive state, high intracranial pressure.

Disease mixed lesions.

To hypoxic - ischemic damage of the central nervous system, intracranial hemorrhage (non-traumatic) is added, the degree of severity depends on where the hemorrhage occurred.

Traumatic lesion of the central nervous system.

Damage to the spinal cord during childbirth, this can happen if a large fetus or is incorrectly located. In facilitating the removal of the head and shoulders, with a diligent rotation of the head during its removal, pulling over the head, the obstetrician makes these manipulations to reduce hypoxia of the child. It all depends on the experience of the medic. Damage may also occur during a cesarean section with a “cosmetic incision” that is not sufficient to remove the baby’s head. Artificial ventilation of the lungs in the first 2 days, especially in children and with a small weight, can lead to injury.

Metabolic disorders.

Alcohol syndrome, nicotine, narcotic, violations occur as a result of stopping the flow of alcohol, nicotine, drugs.

Intrauterine infection.

It depends on the type and severity of the disease. Such children are often born in a state of asphyxia, with a small weight, with an enlarged liver, developmental defects, and a convulsive syndrome.

In the maternity hospital, neonatologists examine newborns and detect perinatal damage to 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 growth of the head more than 1 cm per week, an increase in the edges of the fontanel of his bulging.

If your baby has something, a neurologist must be consulted; the sooner the better, and start treatment to fully restore your baby’s health.

Treatment of encephalopathy in infants.

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

Complete the survey:

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

With the right treatment and timely diagnosis encephalopathy of infants It is well treated, the 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. Prescribed drugs to restore the structure of the brain, improve blood supply to the brain, vitamins of group B (Magne B6, Magnelis), sedatives, drugs that treat symptoms: seizures, anticonvulsants (Konvuleks, Finlepsin, Depakine), medicines that relieve hypertonic muscle, and drugs that treat movement disorders. More drugs can be prescribed both intramuscularly and intravenously. Well used for the treatment of encephalopathy electrophoresis (if there were no convulsions in history), neurologists like to prescribe physical therapy, massage, phytotherapy. One of the important principles of treatment is.