Consequences of perinatal encephalopathy in children. If they wrote "PEP" on the medical record

Perinatal encephalopathy in newborns has recently been quite common, and this is associated with an increasing number of risk factors. Most often, the diagnosis of "PEP for newborns" is made to children born to mothers older than 30 years, and women who have had several abortions or have had several miscarriages. Also, this disease is common among those babies whose mothers suffered prolonged infertility.

What it is  - Perinatal encephalopathy in children, and how is this disease manifested in newborns?

Chronic oxygen deficiency of the fetus, acute oxygen starvation that occurred during childbirth, and birth trauma lead to gross disorders in the central nervous system. These disorders are manifested by perinatal encephalopathy (PEP), which is quite common at the present time.

Being in the womb, the fetus may experience oxygen starvation if the pregnancy proceeds with complications (toxicosis, infections, intoxication, premature detachment of the placenta, a long anhydrous period, etc.). A difficult birth, a narrow pelvis, entwining of the umbilical cord around the neck, obstetric manipulations can lead to asphyxiation of the newborn, as a result of which the flow of oxygen to organs and tissues is disrupted.

The most sensitive to oxygen deficiency are brain cells, which are damaged in the first place. The degree of damage depends on the severity and duration of oxygen starvation. Mild CNS disorders can go unnoticed in the hospital, and the child is discharged home. An attentive mother who watches the baby around the clock, faster than any doctor, will notice symptoms that signal a violation of the central nervous system, an increase in neuro-reflex irritability, and will seek the advice of a neurologist complaining of anxiety, shallow sleep, trembling, trembling of the chin and hands aggravated by screaming.

A medical examination will confirm the observations of the mother and note a violation of muscle tone, which, with a diagnosis of PEP in newborns, can be increased (muscle hypertension), decreased (hypotension) and uneven (dystonia), when hypertonicity of individual muscle groups occurs due to muscle hypotension associated with anxiety of the child , a change in the position of his body.

In the mother’s womb, the fetus is in an embryonic position, which allows it to occupy as little space as possible: the limbs are bent and, together with the chin, are firmly pressed to the body.

In infants, the tone of the flexor muscles of the upper and lower extremities remains elevated for another six months, and this is considered normal, as well as the boxer's pose typical of newborns. A gradual decrease in muscle tone and an increase in the motor activity of the baby enable the pediatrician and neuropathologist to control his physical development. Violation of muscle tone entails a delay in physical and mental development.

Symptoms and consequences of perinatal encephalopathy (PEP) in newborns

And again, an important role in the diagnosis of this pathology belongs to mom. Most often it is she who can notice the symptoms of perinatal encephalopathy in a newborn, observing the development of motor activity, the movements of the child from the first days of his life.

So the child woke up and stretched sweetly, bending his whole body, stretching out his arms, and mom notices that one handle rises behind his head, and the second is pressed to the chest. Or when crying, the baby leads the legs to the stomach, but one leg lags behind the other. But it’s worth swaddling him, as he always “falls” on one side. And about this symptom of PEP in a newborn must certainly tell a neurologist.

Movement in the infant is the main type of its activity. Often, the consequence of PEP in children can be a lag in mental development, since this disease limits the child's ability to cognize the outside world and makes it difficult to actively manipulate toys and other objects. With deep disorders of muscle tone and motor functions, the consequence of perinatal encephalopathy in children can be the formation of a severe pathology - cerebral palsy (cerebral palsy).

The inability to sit, get up, crawl forces the baby to look at the same objects of the situation, while the transition to a vertical position significantly expands the overview and opportunities for exploring the world.

If the child is lethargic, adynamic, lethargic, does not react to the mother’s gentle treatment, and any irritant causes him negative emotions, screaming, anxiety, you should think about the lag in psychomotor development.

The symptoms of PEP in a newborn, detected by an alert mother, the slightest deviations in the child’s behavior will help early diagnosis of a pathological condition. In order to avoid the negative consequences of encephalopathy in children, it is necessary to begin timely treatment with specialists.

Treatment of perinatal encephalopathy (PEP) in newborns

A therapy for a child with motor impairment should be long, comprehensive and continuous. And the effectiveness of the treatment of perinatal encephalopathy in children will primarily depend on the mother, her perseverance, perseverance, discipline and desire to defeat the disease.

Without underestimating the importance of drug therapy, the leading role of physical rehabilitation methods should be recognized: gymnastics, exercises in water and physiotherapeutic procedures.

If the pathology is detected in the maternity hospital, then immediately begin treatment with the "position". The baby is given a physiological position with the help of rollers, styling, spacers for the affected limbs. If neurological disorders persist, the child is transferred to a specialized department, where treatment is continued. At home, the child should be on an even, dense mattress, without a pillow. It is necessary to change the position of the child in the crib so that the light source and bright toys are from him to the left or to the right.

When treating PEP in newborns, provide the baby with a protective regimen. The family should have a favorable psycho-emotional climate conducive to the development of the child’s nervous system. More often take the baby in your arms, talk with him quietly and gently, he should feel your love and care, which needs more than his healthy peer. Reduces the tone of spasmodic muscles with the symptoms of encephalopathy in newborns, the child swaying in his arms, in the cradle, a special rocking chair for babies. The beneficial effect in the treatment of PEP in children is exerted by melodic classical music, which causes a soothing and stimulating effect on the child’s brain.

Massage and physiotherapy for perinatal encephalopathy in children (with video)

To relax spastically contracted muscles, special massage techniques are used for perinatal encephalopathy: stroking, vibration, shaking, felting, skating, which you must master yourself, or invite a professional massage therapist. Massage improves blood circulation, stimulates lymph flow, improves metabolism in organs and tissues. It is very important that the massage evokes positive emotions in the child. If the child is hungry or wants to sleep, resists massage and gymnastics, you should not continue to forcefully manipulate, so you will achieve the opposite effect - increased muscle tone. Massage for encephalopathy in children and physiotherapy exercises should give the child pleasure, pass with a smile, in the form of a game, to pleasant music - only then they will be effective.

The muscles have a relaxing effect on exercises on a large inflatable ball, which are accepted by the baby for an exciting game and are performed with pleasure. And spasmodic calf muscles will respond to hot leg wraps that are easily performed at home, and are not inferior to physiotherapeutic procedures in effectiveness.

Watch the video “Massage for Encephalopathy in Children” to better understand how this procedure is performed:

An exercise therapy doctor should become your friend and ally in the fight against the disease. Under his leadership, you will learn various complexes of physiotherapy exercises to daily stubbornly and persistently overcome the consequences of encephalopathy.

In the treatment of encephalopathy in newborns, gymnastic exercises develop the musculoskeletal system, develop motor skills, stimulate physical and mental development. During classes, the child receives air baths, and, therefore, is tempered.

Regular physical therapy exercises for months and years make it possible to compensate for the lag in the development of the psyche and motor skills and enable the child to catch up with his peers. Now he will not shun collective children's games, embarrassed by his awkwardness and awkwardness, but will become an equal participant in moving fun and entertainment.

If the children's clinic has a pool - your place is there. Exercise in water helps to reduce increased tone, facilitate movement in the limbs with muscle hypotension, improve coordination, give a powerful positive charge to the baby, increase appetite and help normalize sleep. After completing a course with an experienced instructor, you can continue to study at home in the bath.

Undoubtedly, the baby will benefit from modern physiotherapeutic procedures. Physiotherapy for encephalopathy in children will help to cope with a violation of muscle tone, with increased nervous excitability and a lag in physical development.

Perhaps later classes with a speech therapist, orthopedic treatment will be required, but the main role in early diagnosis and successful treatment belongs to the mother, since the outcome of the disease depends on her observation, perseverance and patience.

Perinatal Encephalopathy (PEP)

E.S. Bondarenko, V.P. Zykov

Perinatal hypoxic encephalopathy is a frequent complication of the pathology of pregnancy and childbirth and is diagnosed in newborns in up to 5% of cases. Perinatal brain injuries account for more than 60% of the entire pathology of the childhood nervous system, are directly involved in the development of diseases such as cerebral palsy, epilepsy, and minimal cerebral dysfunction.

Risk factors

To recognize the clinical signs of perinatal hypoxia, risk factors predisposing to its development must be taken into account:

Maternal age limit (under 20 and over 35)
  Premature placental abruption
  Placenta previa
  Preeclampsia
  Premature or late birth
  Amniotic fluid staining with meconium
  Bradycardia, fetal tachycardia, muffling of fetal heart sounds
  Multiple pregnancy
  Long dry span
  Mother's diabetes
  Any maternal illness during pregnancy
  Mother taking potentially harmful drugs to the fetus

Among the causes of lung ventilation and blood oxygenation disorders, peripheral and central hypoxia are distinguished. In peripheral hypoxia, pathology of the respiratory tract or alveolar blood flow takes part, in central hypoxia, the basis is a violation of the function of the respiratory center.

Etiology of hypoxia

Peripheral

1. Respiratory distress syndrome
  2. Aspiration of amniotic fluid
  3. Pneumothorax (with birth injury)
  4. Bronchopulmonary dysplasia
  5. Congenital malformations (Pierre-Robin syndrome)

Central

1. Reduced maternal pressure
  2. Maternal Anemia
  3. Arterial hypertension
  4. Placental insufficiency
  5. Brain malformations

Hypoxia leads to a violation of oxidative processes, the development of acidosis, a decrease in the energy balance of the cell, an excess of neurotransmitters, and a violation of the metabolism of glia and neurons. Acidosis increases the permeability of the vascular wall with the development of intercellular edema and impaired cerebral hemodynamics. Under conditions of hypoxia, lipid peroxidation is disrupted with the accumulation of aggressive free radicals, hydroperoxides, which have a destructive effect on the membranes of neurons. Violations of cerebral hemodynamics of an ischemic-hemorrhagic nature are the result of severe brain hypoxia.
  In the antenatal period, the main etiological factor of hypoxia is placental insufficiency. Trophic insufficiency occurs with malabsorption and assimilation of nutrients through the placenta, deficiency of oxygen and carbon dioxide transport, which is manifested by fetal development retardation syndrome, intrauterine malnutrition, immaturity of the lungs and surfactant. It was found that a decrease in uteroplacental blood flow serves as an objective indicator of hypoxic brain damage. Surfactant deficiency and respiratory anoxia are the main pathogenetic factors of cerebral hypoxia in premature and newborns from diabetic mothers. In the pathogenesis of neonatal surfactant deficiency, secondary hyperinsulinism of the fetus lies, which develops in response to maternal glycemia. Insulin inhibits the synthesis of lecithin - the main element of surfactant, the lack of which prevents the alveoli from breaking out, which leads to impaired lung ventilation.
  Thus, compensation for pregnant diabetes is the prevention of respiratory distress syndrome in newborns and hypoxic encephalopathy. In the neonatal period, the cause of cerebral hypoxia and ischemia can be a pronounced intrapulmonary shunt. In the pathogenesis of brain hypoxia, a significant role is played by hypoxic cardiopathy of the newborn and adrenal insufficiency. Hypoglycemia and a deficiency of glycogen supply are considered as factors causing increased vulnerability of the brain tissue to hypoxia in newborns, especially premature low birth weight.

Morphology of hypoxic encephalopathy

The brain normally absorbs a fifth of the oxygen entering the body. In young children, the proportion of the brain in the use of oxygen is almost half, which ensures a high level of metabolism of oxidative processes. Depending on the duration of hypoxia in the brain, changes develop from local edema to necrosis with hemorrhagic impregnation. A number of studies have shown that there is a different sensitivity of brain structures to hypoxia, which depends on the characteristics of metabolism and blood supply. The most sensitive to hypoxia are the Sommer zone of the Ammon horn and the periventricular region of adjacent blood supply between the anterior, middle and posterior cerebral arteries. With a combination of hypoxia and ischemia, foci of necrosis occur in the cortex, optic tubercle, striatum, cerebellum. The following stages of morphological hypoxic changes in the brain are distinguished: stage I - edematous hemorrhagic, stage II - encephal gliosis, stage III - leukomalacia (necrosis), stage IV - leukomalacia with hemorrhage. The first two stages of acute hypoxia are curable, it is possible to restore the metabolism of neurons and glia, stages III and IV lead to irreversible death of neurons. With antenatal hypoxia, neuronal dystrophy, glia proliferation, sclerosis phenomena, cystic cavities at the sites of small foci of necrosis are observed.

Clinic of hypoxic encephalopathy

Three periods are distinguished in the clinical picture of hypoxic encephalopathy - acute (1st month of a child’s life), recovery (from 1st month to 1 year old, and in premature immature infants up to 2 years old) and outcome.

In the acute period, according to the severity, a mild form of damage to the nervous system is distinguished, reflecting transient hemoliquorodynamics; moderate form with edematous hemorrhagic changes, gliosis, single leukomalacia; severe form, characteristic of generalized cerebral edema, multiple leukomalacia and hemorrhages. To determine the severity and severity of cerebrovascular accidents, the Apgar scale is used.
In the acute period, 5 clinical syndromes are distinguished: an increase in neuro-reflex excitability, convulsive, hypertensive, hydrocephalic, inhibition syndrome, and coma. Usually a combination of several syndromes is observed. A feature of the acute period is the dominance of cerebral disorders without pronounced local symptoms. With a mild form of brain damage (score on the Apgar scale of 6 - 7 points), a syndrome of increased neuro-reflex excitability is characteristic. The main manifestations of the syndrome are increased spontaneous motor activity, restless superficial sleep, lengthening the period of active wakefulness, difficulty falling asleep, frequent unmotivated crying, revitalization of unconditional congenital reflexes, muscular dystonia, increased knee reflexes, tremor of the limbs and chin. In preterm infants, neuro-reflex excitability syndrome in 94% of cases is a clinical sign of lowering the threshold of convulsive readiness, which is confirmed by the data of electroencephalography (EEG). Patients who, according to the EEG, have a decrease in the threshold of convulsive readiness, should be considered at risk for convulsive syndrome.

The moderate form of hypoxic encephalopathy (evaluated on an Apgar scale of 4 to 6 points) is manifested by hypertensive hydrocephalic syndrome and depression syndrome.

An increase in the size of the head by 1–2 cm compared to the norm (or chest circumference), the opening of the sagittal suture of more than 0.5 cm, and an increase and swelling of the large fontanel are characteristic of hypertension-hydrocephalic syndrome. Typical is the brachiocephalic shape of the head with enlarged frontal tubercles or dolichocephalic - with an overhanging back of the head. Gref's symptom, the symptom of the "setting sun", inconsistent horizontal nystagmus, descending strabismus are noted. Muscular dystonia is detected, more in the distal extremities in the form of a symptom of “seal legs” and “calcaneal piles”. In most children, especially in the early days of life, these phenomena are combined with paroxysms of flinching, spontaneous Moro reflex, sleep disturbance, Harlequin symptom, general and local cyanosis. The development of hypertension-hydrocephalic syndrome on the 3-5th day of life can be a sign of periventricular hemorrhage. Hypertension-hydrocephalic syndrome can be isolated, but more often combined with oppression syndrome or coma. Oppression syndrome is manifested by lethargy, physical inactivity, decreased spontaneous activity, general muscle hypotension, hyporeflexia, inhibition of newborn reflexes, and decreased sucking and swallowing reflexes. Local symptoms are observed in the form of divergent and convergent strabismus, nystagmus, asymmetry and sagging of the lower jaw, asymmetry of facial muscles, bulbar and pseudobulbar symptoms. The syndrome characterizes the course of the acute period of hypoxic encephalopathy and usually disappears at the end of the first month of life. In the acute period, inhibition syndrome can be a harbinger of cerebral edema and the development of coma.

Comatose syndrome is a manifestation of a serious condition of the newborn, according to the Apgar scale, 1 to 4 points are estimated. In the clinical picture, severe lethargy, adynamia, muscle hypotension to atony are detected, congenital reflexes are not detected, the pupils are narrowed, the reaction to light is slight or absent. There is no reaction to pain stimuli, “floating” movements of the eyeballs, horizontal and vertical nystagmus, tendon reflexes are inhibited. Arrhythmic breathing, with frequent apnea, bradycardia, deaf heart sounds, arrhythmic pulse, low blood pressure. Attacks of seizures with a predominance of the tonic component may be noted. A serious condition lasts 10-15 days, there are no reflexes of sucking and swallowing. The appearance in the acute period of hydrocephalus with bulging and tension of the large fontanel, divergence of cranial sutures, protrusion of the eyeballs, rapid growth of the head indicates intracranial hemorrhage.

Convulsive syndrome in the acute period, as a rule, is combined with oppression syndrome or coma. It occurs as a result of hypoxic cerebral edema, hypoglycemia, hypomagnesemia or intracranial hemorrhage. It appears in the first days of life with tonic-clonic or tonic convulsions. Along with this, local clonic convulsions or hemiconvulsions are observed. Convulsive seizures in newborns are characterized by short duration, sudden onset, lack of regularity of repetition and dependence on the state of sleep or wakefulness, feeding regimen and other factors. Convulsions are observed in the form of small-amplitude tremor, short-term respiratory arrest, tonic spasm of the eyeballs, such as paresis of the gaze up, imitation of the setting sun symptom, nystagmus, automatic chewing movements, clonus of the feet, vasomotor reactions. These convulsions by their nature sometimes resemble spontaneous movements of a child, which makes diagnosis difficult.

The recovery period of hypoxic encephalorrhea includes the following syndromes: increased neuro-reflex excitability, hypertensive hydrocephalic, vegetovisceral dysfunctions, motor disorders, delayed psychomotor development, epileptic.

The syndrome of increased neuro-reflex excitability in the recovery period has two variants of the course. With a favorable version of the course, the disappearance or decrease in the severity of symptoms of increased neuro-reflex excitability is noted in the period from 4 to 6 months to 1 year. In an unfavorable option, especially in premature infants, epileptic syndrome may develop.

Hypertension-hydrocephalic syndrome has two variants of the course:

1. hypertension-hydrocephalic syndrome with a favorable course, in which there is the disappearance of hypertensive symptoms with a delay in hydrocephalic;
  2. An unfavorable variant of hypertension-hydrocephalic syndrome, which is part of the symptom complex of organic cerebral syndrome.

Outcomes of hypertension-hydrocephalic syndrome:

1.Normalization of head circumference growth by 6 months.
  2. Compensated hydrocephalic syndrome in 8 to 12 months.
  3. The development of hydrocephalus.

Vegeto-Visceral Dysfunction Syndrome  it begins to appear after 1 - 1.5 months of life amid increased neuro-reflex excitability and hypertension-hydrocephalic syndrome. In the clinical picture, persistent regurgitation, persistent hypotrophy, respiratory rhythm disturbance and apnea, discoloration of the skin, acrocyanosis, paroxysms of tachy and bradypia, thermoregulation disorders, gastrointestinal dysfunction, temporal alopecia are noted in the clinical picture.

Epileptic syndrome  can occur at any age (as a continuation of seizures after birth or against a somatic infection). In newborns and infants, he has a so-called age face, that is, convulsive paroxysms mimic the motor capabilities that the child has at the time of their appearance.
  In newborns and infants (especially in premature infants), convulsive syndrome is characterized by a variety of clinical forms of seizures. There are generalized convulsive seizures (tonic-clonic, clonic, tonic), abortive, focal, hemiconvulsive, polymorphic seizures, simple and complex absences. The frequency is dominated by polymorphic seizures. In premature infants with perinatal encephalopathy, propulsive and impulsive paroxysms in an isolated form do not occur, but are observed only in polymorphic seizures. The greatest difficulties in diagnosis are abortive and non-convulsive forms of paroxysms.
There is an imitation of unconditioned motor reflexes in the form of paroxysmally arising manifestations of a neck-tonic symmetric reflex with a tilt of the head and tonic tension of the arms and legs; cervical-tonic asymmetric reflex with turning the head to the side and extension of the same arm and leg; the first phase of the Moro reflex with the opening of the handles. There are paroxysms in the form of eye spasm and nystagmus, an imitation of the "setting sun symptom." Often there are bouts of redness and blanching of the skin with increased sweating, sometimes regurgitation. After 3 to 4 months of life, as the ability to hold the head appears, “nods”, “nods” appear, and from 6 to 7 months, “nods” (bending the body back and forth).
  Such features of the convulsive syndrome in premature infants, such as the instability of clinical manifestations with a predominance of polymorphic seizures, the presence of abortive forms of seizures, and complex absences with imitation of unconditioned reflexes of newborns (the first phase of the Moro reflex, asymmetric cervical-tonic reflex) are probably the result of immaturity of structures brain. However, an increase in the frequency of seizures, an increase in the polymorphism of their manifestations, and resistance to anticonvulsant therapy should be alarming regarding the formation of gross organic forms of brain damage.
  Polymorphism of seizures, their resistance to therapy is a prognostically unfavorable sign.

Movement Disorder Syndrome  detected from the first weeks of life, can occur with muscle hypotension or hypertension. When the syndrome of motor disorders with muscle hypotension occurs, a decrease in spontaneous motor activity, inhibition of tendon reflexes and congenital unconditioned reflexes of newborns is noted. The syndrome of motor disorders with muscle hypotension occurs in isolation, as well as in combination with hypertension-hydrocephalic syndrome, a syndrome of increased neuro-reflex excitability with a decrease in the threshold of convulsive readiness. Adverse combination of motor impairment syndrome and convulsive syndrome.
  The buildup of muscle hypertension in full-term children, the appearance of the sideness of focal symptoms should be alarming in terms of the development of cerebral palsy.

Psychomotor retardation syndromebegins to appear from 1 to 2 months. In the structure of the syndrome, a violation of the reduction of unconditional congenital reflexes is noted. The cervical-tonic symmetric and asymmetric reflexes, the delay in the formation of rectifying labyrinth chain tonic reflexes, acquire a large diagnostic role. If there is a delay in mental development in children in their structure by the age of one month, insufficiently stable gaze fixation, short-term follow-up with rapid exhaustion are observed. There is no reaction to the mother’s voice, auditory concentration. By 2 - 3 months of age, there is insufficient animation when communicating, the cry is not very pronounced, there is no humming, children look for a sound source with their eyes without turning their heads, a rare, hard-to-smile smile appears. By six months, they are not actively enough interested in toys and surrounding objects, they are not sufficiently responsive to the presence of their mother, their walks are inactive and short, manipulations with objects are delayed, and there is no active attention. If the developmental delay is "pace", it begins to disappear with proper nursing. This group of children in 4 - 5 months, as it were, "jump" becomes more active, and mental development is ahead of motor. There is an emotional reaction to others, an interest in toys.
  Age-related motor functions begin to be actively compensated after 6 - 7 months and, as a rule, are restored by 1 - 1.5 years. Prognostically unfavorable prolonged mental retardation.

Diagnostics

Examination of the fundus in the acute period of mild hypoxic encephalopathy does not reveal abnormalities, less commonly observed moderate plethora of veins. With moderate severity, dilatation of the veins, edema, and separate hemorrhages are noted. With a severe degree of damage, against the background of pronounced edema of vasodilation, blurring of the borders of the optic disc, hemorrhage is noted. In the future, such children may show atrophy of the nipples of the optic nerves.
  In the cerebrospinal fluid, changes are detected in the presence of intracranial hemorrhage. In these cases, the cerebrospinal fluid has fresh and alkaline red blood cells. After the 7-10th day of life, confirmation of the hemorrhage suffered is the presence of macrophages in the cerebrospinal fluid.

Neurosonography- two-dimensional ultrasound examination of the anatomical structures of the brain through the large fontanel - allows you to establish periventricular hemorrhage, foci of leukomalacia, expansion of the ventricular system - ventriculomegaly. Neurosonography allows for differential diagnosis with brain defects. Signs of brain hypoplasia: an increase in subarachnoid spaces, an expansion of the interhemispheric gap, ventriculomegaly, increased density in the area of \u200b\u200bthe brain parenchyma without clear differentiation of convolutions, porencephaly. Haloproencephaly - an increase in one ventricle, shadow, an increase in echo density from the brain stem structures, a decrease in density from the brain parenchyma. Clinical and neurosonographic comparisons reveal a correlation between the number of leukomalacia and neurological outcomes. Multiple leukomalacia in both hemispheres, found in patients according to neurosonography in the acute period of the disease, are combined with the syndrome of motor disorders and a severe delay in psychomotor development in the recovery period. Computed tomography of the brain helps to objectify the hypoxic changes in brain tissue in the structures of the cerebellum and brain stem, which are not clearly identified in neurosonography.

Electroencephalographic (EEG)  the study reveals foci of slow-wave activity, foci of reduction of cortical rhythm, foci of epileptic activity. An EEG study is of great importance for identifying a risk group for convulsive syndrome and for diagnosing clinically “silent” attacks. An indirect confirmation of the convulsive syndrome, as well as a sign of lowering the threshold of convulsive readiness in patients, is the presence of paroxysmal changes in the EEG. Repeated seizures can lead to increased severity of paroxysmal activity on the EEG.
  From biochemical studies in the acute period, an indicator of the depth of hypoxic disorders is the assessment of acidosis from mixed to pronounced decompensated metabolic. In severe hypoxia, the osmotic pressure of blood plasma increases, the level of lactate dehydrogenase increases. Lactate dehydrogenase and other glycolysis enzymes correlate with the severity of the condition of children and reflect the severity of hypoxia in the acute period of perinatal encephalopathy.
  Radiography of the lungs is used to diagnose congenital atelectasis, pneumopathy, and inflammatory changes in the lungs.

Acute treatment

In the acute period, timely correction of respiratory respiratory distress syndrome and adequate ventilation of the lungs are necessary. In premature infants, endotracheal administration of colfosceryl palmitate 5 ml / kg is carried out. The use of surfactant analogues leads to a significant regression of the neurological syndromes of hypoxic encephalopathy.

Correction of homeostasis and hypovolemia: freshly frozen plasma 5 - 10 ml / kg, 10% albumin 5 - 10 ml / kg, reopoliglyukin 7 - 10 ml / kg, hemodesis 10 ml / kg.
  Decreased vascular permeability: 12.5% \u200b\u200bethamylate solution intramuscularly or intravenously, 1% vicasol 0.1 ml / kg.
   Metabolic and antioxidant therapy: piracetam 50 mg / kg, 10% glucose 10 ml / kg, Actovegin intravenously, 5% vitamin E 0.1 ml per day. As an antioxidant, soybean oil 2 - 3 ml is used for 4-6 days on the skin of the abdomen.
  Vascular therapy: vinpocetine 1 mg / kg intravenously.
  Dehydration therapy: hydrocortisone 3 - 10 mg / kg, prednisone 1 - 2 mg / kg, 25% magnesium sulfate 0.2 ml / kg.
  Improvement of tissue metabolism of the heart muscle: cocarboxylase 8 mg / kg, ATP 10 mg / kg.
  Anticonvulsant therapy: diazepam 1 mg / kg intramuscularly or intravenously, GHB 50 mg / kg, barbiturates when benzodiazepines are not effective, 5 mg / kg.
  Recovery treatment
  Treatment of the recovery period is carried out according to the syndromological principle.

With a syndrome of increased neuro-reflex excitability with manifestations of vegetovisceral dysfunctions, sedatives are indicated: diazepam 0.001 g 2 times a day, tazepam 0.001 g 2 times a day, medicine with citral - citral 2.0 solution, magnesium sulfate 3.0, 10% solution glucose 200.0 - a teaspoon 3 times a day; from 2 months of age, a soothing cocktail of herbs (valerian root, motherwort, sage) is prescribed 1 teaspoon 3 times a day.
  With pronounced manifestations of hypertension-hydrocephalic syndrome, acetazolamide is used at 0.02 g / kg per day once according to the scheme: 3 days - intake, 1 day break, course from 3 weeks to 1 - 1.5 months with panangin.
  In case of motor impairment syndrome: vitamin B6 5 mg, vitamin B1 2 mg, ATP 0.5 ml 10-12 injections, pyritinol 10-20 drops per 1 kg of body weight 2 times a day in the morning for 1-3 months. Massage. Therapeutic gymnastics, the mother is trained in rehabilitation skills.
With a syndrome of delayed psychomotor development: piracetam 30 - 50 mg / kg in 3 divided doses, pyritinol. From 6 months, cerebrolysin 0.5 ml No. 20 (contraindicated in convulsive syndrome), vitamins B6, B1. Gamma-aminobutyric acid 0.06 g 2 to 3 times a day.
  In convulsive syndrome: sodium valproate 20 - 50 mg / kg, clonazepam up to 1 - 2 mg per day, phenobarbital 1 - 2 mg / kg. With resistant convulsions, lamotrigine 1 - 2 mg / kg.
  Surgical treatment is used for combined periventricular hemorrhages and the development of posthemorrhagic hydrocephalus, ventricular bypass surgery is performed.
  Therapeutic measures are further individualized depending on the outcome of the process. By the age of one year, the majority of mature children with the appearance of verticalization and speech functions can identify the outcomes of perinatal hypoxic encephalopathy. Recovery occurs in 15 - 20% of children. Common consequences of encephalopathy are minimal cerebral dysfunction, hydrocephalic syndrome. The most severe outcomes are cerebral palsy and epilepsy.

Of course, the success of perinatal medicine, adequate management of labor and the acute period of hypoxic encephalopathy will reduce the neuropsychiatric outcomes of the disease.

Literature:

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  Kulakov V.I. Prenatal medicine and woman reproductive health. Akush. and gin. 1997; 5: 19-22.
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Encephalopathy is a non-inflammatory disease of the brain in which its tissue changes, as a result of which its basic functions are disturbed. Pathology can be congenital and acquired.

Congenital perinatal encephalopathy in children suggests the presence of various pathologies of the nervous system that arose during their intrauterine development, during childbirth or immediately after birth. The diagnosis is very serious, requiring medical intervention, a sufficiently long course of treatment and vigilant attention from the parents.

Since the child acquires perinatal encephalopathy at the very beginning of his life's journey, careful parents from the first days of his life may notice some deviations. Over time, they will intensify, grow and will distinguish a sick baby from the rest, healthy babies. The disease covers a fairly wide range of manifestations of nervous disorders and pathologies. Doctors distinguish from them a number of the most typical, basic symptoms of perinatal encephalopathy in children.

In infancy:

• weak or very late cry at the birth of the baby;
• heartbeat problems;
• lack of sucking reflexes;
• anxiety;
• frequent, angry crying;
• excessive lethargy or increased muscle tone;
• inadequate reactions to sound and light;
• reflexive jerking;
• bulging eyes, squint;
• head tilting;
• frequent spitting up during meals and after eating (read more about why);
• sleep disturbances.

At an older age, you can note:

• disorders of memory and consciousness;
• inactivity, lack of initiative, apathy to everything;
• permanent
• depression
• fatigue, distraction, irritability, tearfulness, general weakness, poor sleep, lack of appetite;
• dizziness
• vagueness of thought;
• narrowed circle of interests;
• verbosity;

The problem of perinatal encephalopathy in children is that the disease borders too close to many other similar diseases of the central nervous system. Parents may miss the first signs due to their ignorance. Even if the child often lags behind their peers in mental and mental development, parents hope that over time they will catch up with them. But with severe forms of congenital encephalopathy, this is almost impossible. With timely access to a doctor and the correct diagnosis, therapy is prescribed depending on the form and severity of the disease.

Types of disease

The child can be diagnosed with various forms of the disease, which are quite a lot. Classification is based on the genesis (origin) of brain disorders. The most common types of encephalopathy are:

• posthypoxic perinatal  - due to a lack of oxygen, even during fetal development or during childbirth;
• hypoxic-ischemic  - brain damage due to not only oxygen deficiency, but also a serious violation of cerebral circulation;
• transient  - transient disorders in the blood circulation of the brain, which can manifest in short-term loss of consciousness, temporary visual impairment, speech impairment, weakness in different parts of the body, numbness, and tingling of muscles.

Each of these species is not only distinguished by special symptoms, but also requires some treatment.

Treatment methods

Treatment of perinatal encephalopathy in children is long-term. The doctor tries to take into account the severity and length of the disease, the age of the child, and concomitant diseases. Therapy is carried out on an outpatient basis or in a hospital, as decided by the doctor. Usually, two or three courses of therapy are required during the year - it all depends on the severity of encephalopathy. The main methods of treatment are:

• drug therapy (analgesics, NSAIDs, hormones);
• blockade (injection);
• metabolic, antioxidant, vascular therapy;
• manual therapy (articular, muscle, radicular technique);
• physiotherapy (SMT, UHF);
• osteopathy;
• medical gymnastics (well-known exercise therapy);
• surgical treatment;
• acupuncture (reflexology);
• herbal medicine: herbal treatment minimizes the negative effects of encephalopathy in children - herbal teas are prescribed from knotweed, dandelion, plantain, clover, mountaineer, mint, clover, lingonberry, hypericum, lemon balm, calamus root, thyme, oregano - they contribute to a noticeable improvement even severe or late consequences of encephalopathy (including oligophrenia);
• aromatherapy in such cases also comes to the rescue: ginger, chamomile, geranium, lavender, rosemary essential oils improve the condition of sick children;
• stem cell treatment.

The indicated therapeutic actions and methods are used depending on the causes, symptoms and severity of the manifestations of the disease in the child. Constant monitoring by a doctor helps to minimize the dangerous effects on children's health, which can overtake in adulthood.

Consequences of perinatal encephalopathy in adulthood

Many adult neurological ailments come from childhood. Doctors say their cause is untreated congenital encephalopathy. The consequences can be very diverse:

• early osteochondrosis;
• severe migraines;
• cardiopsychoneurosis;
• impotence;
• hypertension;
• scoliosis;
• attention deficit disorder;
• hyperactivity
• vision problems;
• fine motor impairment.

The disease itself and its grave consequences are a real tragedy for parents. However, such dysfunctions of the brain and central nervous system are not a sentence, many manifestations are treatable. Moreover, the modern development of medical technology is rapidly progressing. Medicines and treatments are becoming more advanced. Perhaps in the very near future a cure for encephalopathy will be found.

Many couples prefer to plan a pregnancy in advance, and often in the process of preparing for the conception of a child, they encounter such a concept as perinatal encephalopathy. This is a fairly serious disease, but at present it can be treated.

Thanks to adequate and timely therapy, it is possible to achieve good results and stabilize the development of the baby. And ongoing research allows us to increase the effectiveness of the treatment of the disease every year.

Causes

Perinatal encephalopathy is the appearance of various brain disorders in a child that occur before childbirth or directly in their process.

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The main cause of this disease in newborns is considered to be the impact of negative factors on the mother's body during pregnancy.

These include the following:

• acute infectious diseases of the expectant mother during the bearing of the child or the presence of chronic pathologies in the mother, which worsen during pregnancy;
• improper diet of a woman during pregnancy and lactation;
• problems in the process of labor - for example, weakness or rapid delivery;
• traumatic injuries of the baby during childbirth - for example, fractures or atypical position of the fetus;
• toxicosis - early and late;
• very young age of the expectant mother;
• hereditary diseases, congenital abnormalities of metabolism;
• the influence of negative factors - toxic substances, radiation, exhaust gases, etc .;
• premature birth;
• threatened abortion;
• congenital malformations;
• bad habits of future parents - alcoholism, drug addiction, smoking, excessive consumption of coffee.

Since the development of perinatal encephalopathy can occur under the influence of various factors, parents must prepare in advance for the birth of the baby, and for this they need to first take care of their own health.

Symptoms

Since perinatal encephalopathy develops at a very young age, parents can literally from the first days of life see abnormalities in the development of the baby.

As the disease progresses, the symptoms will increase, which will lead to the appearance of differences between a sick baby and healthy children.

Pathology is accompanied by a large number of symptoms of nervous disorders.

The most common signs of this type of encephalopathy in infants include the following:

• weak or too late cry during childbirth;
• lack of sucking reflexes;
• palpitations;
• reflexive jerking;
• frequent crying;
• increased anxiety;
• abnormal reactions to light and sound;
• high muscle tone;
• lethargy;
• head tilting;
• bulging eyes or squint;
• constant regurgitation during or immediately after a meal;
• trouble sleeping.

In older children, the following symptoms appear:

• memory problems
• impaired consciousness;
• frequent depression;
• apathy, lack of initiative;
• fatigue;
• lack of appetite;
• distraction;
• speech impairment;
• bad sleep;
• irritability;
• verbosity;

The difficulty in diagnosing perinatal encephalopathy is that the pathology has many common symptoms with other disorders in the central nervous system.

Many parents ignorantly ignore the symptoms of this dangerous disease, hoping that the child will eventually catch up with their peers in development.

It is worth considering that with complex forms of encephalopathy this can not be achieved. Therefore, it is so important to start treatment in a timely manner - it is precisely on this that its effectiveness ultimately depends.

Classification

Depending on the causes and characteristics of the course of the disease, quite a few types of perinatal encephalopathy are distinguished.

Kinds

	Such a diagnosis is made if the child, after receiving injuries during childbirth, suffers inflammatory or infectious diseases. Insufficient blood supply to the brain also plays an important role in the development of pathology. Such children often experience headaches, mental disorders, and intellectual disabilities.
	In this case, brain tissue suffers from insufficient blood supply. The cause of this ailment can be dystonia, osteochondrosis, high intracranial pressure or hypertension.
Ischemic	It is a consequence of insufficient blood supply to the brain and destructive processes in certain foci. Diseases of ischemic genesis are often the result of drinking alcohol, smoking, stressful situations.
	It is the result of poisoning the brain with toxic substances. This problem occurs with infectious pathologies, exposure to chemicals or alcohol. Significant poisoning of brain tissue can trigger the development of epilepsy.
Beam	It develops due to the effect of ionizing radiation on the human brain.
	It is the result of oxygen deficiency in peripheral blood. Perinatal encephalopathy of hypoxic origin can also be a consequence of asphyxiation at the time of birth.
	It is accompanied by a large number of symptoms and complaints of the patient, therefore only a qualified doctor can make a reliable diagnosis.

Severity

The course of the disease can have several periods. So, the acute period begins immediately after birth and continues throughout the first month of life. From a year to two, a recovery period takes place. After this, the outcome of the disease is observed.

Each of the periods is characterized by a special course and development of certain syndromes. Sometimes different manifestations of the disease can be combined. In any case, each period requires the appointment of special drugs.

Even with mild symptoms of the disease, the patient should be examined in detail. If treatment is not started on time, developmental delays and adverse outcomes may occur.

If a child has a severe or moderate form of the disease, he needs qualified help in a hospital. Mild abnormalities are usually treated on an outpatient basis under the close supervision of a neurologist.

Syndromes

There are a number of syndromes that accompany perinatal encephalopathy:

Hypertensive hydrocephalic syndrome	In this case, the child accumulates an increased amount of fluid in the brain, which provokes a change in intracranial pressure. To make an accurate diagnosis, the doctor must monitor the size of the head and large fontanel. Hypertension syndrome is accompanied by sleep disorders, increased pulsation of the fontanel, constant crying.
Hyperactivity Syndrome	In this case, there is an increase in motor activity, sleep disturbance, constant crying. In a child, the threshold of convulsive readiness decreases and the tone of muscle tissue rises.
Convulsive syndrome	This condition is known as, and quite a lot of forms are characteristic of it. These include tremors, body movements that occur in the form of seizures, cramps and all kinds of twitching of limbs.
Coma syndrome	It manifests itself in the form of severe lethargy and a decrease in motor activity. The child has inhibition of important functions, there are no reflexes of swallowing and sucking.
Vegeto-visceral dysfunction syndrome	This condition is characterized by high nervous excitability, constant regurgitation, enteritis, and stool disorders. The digestive system is often disturbed and an abnormal condition of the skin is observed.
Movement Disorder Syndrome	In this condition, the baby's muscle tone may decrease or increase. Often this symptom is accompanied by impaired development, the child has difficulty with mastering the speech.
Cerebral palsy	This disease has a complex structure, which includes damage to the limbs, speech impairment, problems with fine motor skills, and visual impairment. Also, the child has a lag in mental development and decreases the ability to learn, as well as adaptation in society.
Hyperactivity syndrome	This violation manifests itself in the form of a decrease in the child’s ability to concentrate and focus.

Diagnostics

Usually this disease is detected by pediatricians who accidentally detect a manifestation of encephalopathy during a routine examination of the baby. You can also diagnose pathology based on the stories of parents.

To assess the condition of the child, the doctor prescribes such studies:

Analysis of the medical history of the mother, baby and medical history	Negative factors are present that are present before and during pregnancy, as well as deviations in the process of labor.
Clinical examination	Analysis of the signs and syndromes that are inherent in this group of disorders: motor disorders; depression of the nervous system; high neuro-reflex excitability;
Prenatal diagnosis	With the help of ultrasound, it is possible to detect the entanglement of the umbilical cord or the wrong position of the fetus, and Dopplerography makes it possible to detect abnormalities in the heart and blood vessels of the child.
Neurosonography	With the help of an ultrasound of the brain, the presence of foci of hemorrhages is diagnosed.
Electroencephalography	Detects the presence of pathological waves or impaired brain activity.

Treatment of perinatal encephalopathy

If the signs of pathology are weak or moderate, the child is at home treatment, and doctors give parents advice on maintaining his condition.

Sometimes they use herbal medicine and homeopathy.

Medicines

The treatment of the disease depends on the severity of the diagnosis. To improve blood supply to the brain, newborns can be prescribed drugs such as Actovegin, Piracetam, Vinpocentin. In case of serious motor impairment, agents such as dibazole and galantamine can be used. If there is an increased tone, use midocal and baclofen. To introduce drugs, use different options, and includes an electrophoresis method. Physiotherapeutic procedures, massage, medical exercises are very useful. If the child has epileptic syndrome, the doctor prescribes anticonvulsants in the right dosage. With severe epilepsy, the use of anticonvulsants is indicated. Physiotherapeutic methods are contraindicated in this case. If there are disorders of psychomotor development, medications are indicated that are aimed at stimulating the brain and normalizing blood flow. They include actovegin, pantogam, nootropil. Cortexin or vinpocetine may also be used. If hypertension-hydrocephalic syndrome is available, therapy depends on the intensity of its manifestations. In mild cases, herbal remedies are indicated - in particular, decoctions of horsetail or bearberry. In severe situations, it is necessary to use diacarb, which helps to increase the outflow of cerebrospinal fluid. In difficult cases, the doctor may prescribe methods of neurosurgical treatment. There may also be a need for hemodialysis, ventilation, reflexology. Parenteral nutrition is sometimes required. Children who have perinatal encephalopathy syndromes are often prescribed B vitamins.

At home

Babies with such a diagnosis, literally from the first days of life, need special attention. Parents should temper the child, regularly massage him, provide swimming lessons and take air baths. Therapeutic massage and special gymnastics help improve body tone, normalize motor functions of the hands, strengthen the general condition of the child. If the baby has an asymmetry of muscle tone, therapeutic massage is very important for him. It should be borne in mind that during high loads, the syndromes may worsen. This usually happens when the child goes to kindergarten or school. Weather changes or changes in climatic conditions can also aggravate. This often happens during active growth. Infectious diseases often influence the appearance of signs of perinatal encephalopathy. To minimize the likelihood of relapse, you need to take vitamins, regularly walk in the fresh air, do special exercises. Equally important is proper nutrition and a relaxed atmosphere in the house. The child should not be exposed to stressful situations or a sharp change in the usual regimen. Adequate treatment and proper care of a child with perinatal encephalopathy significantly minimize the likelihood of developing severe brain damage.

Effects

Perinatal encephalopathy can provoke very unpleasant consequences in adulthood:

• early onset of osteochondrosis;
• hypertonic disease;
• impotence;
• severe migraines;
• scoliosis;
• hyperactivity
• cardiopsychoneurosis;
• visual impairment;
• problems with fine motor skills;
• attention deficit disorder.

What should mom do?

• First of all, in no case should one panic, because perinatal encephalopathy can be very successfully corrected, and in most cases this ailment is completely cured.
• To begin with, you should contact a qualified neurologist and undergo a comprehensive examination. Thanks to this, it will be possible to detect the mechanism and causes of the development of perinatal encephalopathy in a child. It is strongly not recommended to reject the fact of the presence of the disease.
• After that, you can independently familiarize yourself with the features of the pathology in order to understand what procedures the child needs for successful treatment. It is important to follow the sleep, nutrition and treatment regimen established by your doctor.
• You can meet the parents of children who have the same problems. This will help you share your experience and get support. Clear observance of all medical recommendations is of no small importance. To improve the condition of the child, he needs to be supported and demonstrate his love by all available means.
• Of course, follow-up examinations should be systematically followed. In this situation, it is worth keeping a diary of the baby’s health, in which every day it is necessary to note the emerging symptoms, the treatment and the child’s reaction to it. Thanks to this, parents will be able to organize proper care, and the doctor will be able to control the dynamics of the disease.
• To conduct psychocorrectional work, you should visit a medical psychologist or psychotherapist. It is not recommended to limit the social contacts of the baby - on the contrary, it is worth promoting his communication with other children.

Perinatal encephalopathy is a rather complex disease that can be accompanied by a number of serious syndromes. However, timely prescribed therapy and constant classes with the child will help to completely get rid of this diagnosis.

  Therefore, it is so important for any violations in the behavior of the baby immediately consult a doctor. If this is not done on time, he may face disability in adulthood.

The term "encephalopathy" means a combination of symptoms and syndromes of varying severity, indicating impaired brain activity. Such disorders, for the most part, occur in the perinatal or neonatal period of the baby's life. Therefore, encephalopathy in newborns is also called perinatal.

Necessarily an adjective is added to the term, which gives an idea of \u200b\u200bthe cause of brain damage and some of the symptoms that accompany it.

Kinds

Depending on the nature and causes of encephalopathy, the following forms are distinguished:

• Hypoxic - is formed in case of a lack of oxygen supply to the brain. Hypoxic type encephalopathies include perinatal, asphyxial, postresuscitative.
• Toxic - the culprits of its development are poisons in the form of alcohol, drugs or poisoning with various chemicals (lead, carbon monoxide).
• Toxic and metabolic. Poisoning also occurs due to toxic substances, but they only form inside the human body due to metabolic disorders and the inability to completely remove poisons from the body. The most striking example is bilirubin encephalopathy, which develops with.
• Diabetic - damage to the brain structures against the background of diabetes mellitus and metabolic disorders associated with the disease.
• Post-traumatic. It is formed after head injuries in the near future or after months, or even years.
• Radiation - is formed under the influence of ionizing radiation.
• Discirculatory (another name for vascular) - develops due to impaired blood supply to the brain, the cause of which lies in vascular damage. This is mainly a disease of the elderly, so we will not consider it in detail.

Perinatal hyposcopic encephalopathy

The correct, dynamic development of the nervous system and psyche is especially important at the beginning of the infant's life path. Therefore, parents should be wary if the child has the following clinical symptoms:

• the baby cries for no reason for a long time (especially on the first day after birth);
• he is too sluggish, there is muscle hypotension;
• restless behavior, muscle hypertonicity;
• inadequately reacts to light or sound;
• throws back his head;
• often shivers spontaneously;
• strongly and often spits up;
• bulging eyes, a symptom of Gref.

Curving the back and tilting the head are warning signs. They can not be ignored

Even when the child is in the delivery room, neurological disorders and brain damage can be suspected by low ratings on the Apgar scale, cyanosis of the skin, weak motor activity, impaired heartbeat, and a weak sucking reflex. Such children are often poorly gain weight. In order not to miss the development of pathology, the child needs additional attention and consultation of a neurologist.

Causes of occurrence

Perinatal encephalopathy occurs for various reasons, but in the vast majority of cases it is associated with hypoxia at different stages of development of the baby. So, brain hypoxia in the prenatal period provokes:

• threatened abortion;
• diseases of the expectant mother: chronic (heart defects, diabetes, pyelonephritis) and acquired (rubella, SARS);
• early and late toxicosis;
• chronic placental insufficiency;
• bad habits of the mother.

During childbirth, situations are dangerous when:

• the child swallowed amniotic fluid;
• there was asphyxiation;
• premature detachment of the placenta occurred;
• the waters have departed, and the labor is prolonged;
• rapid delivery.

Encephalopathy is also differentiated depending on its severity:

1. Mild. The behavior of the crumbs is restless, accompanied by prolonged crying and frequent spitting up. The child does not sleep well, sleep is divided into short intervals. Strabismus develops.
2. Moderate severity. One or more syndromes indicating neurological dysfunction are present. These include hypertension, hydrocephalic syndromes, motor disorders. The reflexes of sucking and swallowing are broken, the scream is piercing, the baby cries out even in a sleepy state.
3. Severe degree. Comatose syndrome, clouding of consciousness is expressed, brain functions are completely depressed.

Encephalopathy Syndromes

Hypertension hydrocephalus

First of all, the syndrome is recognizable by the rapid growth of the head circumference. Cranial sutures are more open, and fontanelles swell. Nystagmus, suppression of reflexes and motor activity, strabismus, asymmetry of facial muscles are observed. With this disease, severe symptoms indicate a developing brain edema.

Movement Disorder Syndrome

It is expressed in the disorganization of muscle tone both in the direction of its weakening and increase. Together with hyper- or hypotension, a delay in psychomotor development is observed, since motor functions are not formed in a timely manner. Therefore, you need to pay attention to the late appearance of the first smile, the inhibited perception of an auditory or light stimulus, meager facial expressions.

Irritability syndrome

The child is overly active, wakeful periods are increased, and sleep intervals are reduced. There are extremities, febrile seizures are possible with an increase in body temperature.

  Muscle hypotone and hypertonicity must be adjusted using massage techniques and physiotherapy

Convulsive

It manifests itself in the form of episodic tremors, twitching of limbs. Attacks can be expressed in bending the head with tilts, the arms and legs are tense, and sucking movements are imitated.

Comatose

The baby's condition is extremely difficult, on the Apgar scale, a maximum of 4 points is estimated. Hypotension is pronounced, oppressed or completely disappear, there is no reaction to light, the pupils are narrowed. The breathing rhythm and pulse are irregular, the pressure is low, the heart sounds are deaf, they are barely audible, and convulsive seizures are possible.

Diagnostics

The diagnosis is made on the basis of the collected medical history, the current clinical picture and the results of a brain ultrasound study. The maternity card is carefully studied: how the pregnancy went, whether fetal pathologies were detected in the prenatal period, and whether the mother was treated for infection. The estimates of the newborn on the Apgar scale are taken into account, how the delivery took place, whether there were complications.

Necessarily repeated examination of the child by a neurologist. It is revealed whether there is a suspicion of encephalopathy, an additional consultation with an ophthalmologist is prescribed, where the fundus is examined for the baby.

In the diagnosis of pathology, neurosonography helps - an ultrasound scan conducted through an overgrown large fontanel. It makes it possible to assess the structure of the brain, the state of the ventricles and gyrus. With electroencephalography (abbreviated EEG), the activity of the cerebral cortex is studied for the presence of convulsive signs. If such an examination does not give an objective picture and it is difficult to make a diagnosis, computed tomography of the brain is performed.

  Neurosonography is essential for determining brain dysfunctions.

Treatment

Mild forms of encephalopathy are treated using homeopathic remedies and herbal remedies, as well as using physiotherapeutic techniques, physiotherapy exercises, and massage.

Treatment of perinatal encephalopathy of moderate severity largely depends on the severity of certain syndromes. For example, diacarb is often prescribed - a tool that contributes to the normal discharge of cerebrospinal fluid. With muscle hypertension, muscle relaxants are prescribed - drugs that relax muscles (midocal). Dibazole is used for muscle spasms. And to improve cerebral circulation and the formation of new connections between nerve cells, pantogam, lucetam, vinpocetine, nootropil are prescribed. Almost always, treatment is accompanied by the intake of B vitamins, which positively affect the development of the nervous system.

If convulsive syndrome is expressed, the doctor selects anticonvulsants, taking into account the age, body weight and degree of illness of the baby. Antiepileptic drugs are necessarily taken under the supervision of doctors, they can not be independently canceled, otherwise the seizures may become more frequent. Children with epileptic syndrome are contraindicated in massage and physiotherapy.

Attention!  All the drug names listed in the article are serious drugs, only a doctor can prescribe them. Almost all of them, according to the instructions, are not designed for infancy, so the doctor makes the choice of dosages and the drug itself, based on his experience and clinical cases on their use and treatment of newborns. The names of the drugs are given in the article for informational purposes only. Self-medication in such situations is prohibited.

Toxic encephalopathy

It manifests itself when brain cells are poisoned by poisons and pesticides received from the outside or formed inside the body. Most often occurs against the background of:

• hemolytic disease;
• taking during pregnancy by the mother of narcotic substances, antipsychotics, antidepressants or anticonvulsants;
• mother's intake of alcohol in large quantities;
• household poisoning with vapors of mercury, gasoline or other substances.

A typical example of toxic encephalopathy is bilirubin. Yellowness of the skin, which appears against the background of an increased level of bilirubin, is often found in infants of the first month of life. However, in only 4-5% of all cases, the bilirubin content is so high that it is able to penetrate the blood-brain barrier and have a toxic effect on the brain. Such a state is characterized by drowsiness, oppression of reflexes, spasm of the occipital muscles, falling into a coma.

  With hyperbilirubinemia, phototherapy is used.

Intoxication of the body and, in particular, the brain, can take place in different ways. The disease proceeds in acute form, when the poisoning effect is single, but in large doses. The symptomatology of inhibition of all organs and systems in such situations is pronounced.

In chronic intoxication with small doses of poisons, the clinical picture may be somewhat blurred, can be expressed mainly by weakness, nausea, weakening of sensitivity in the upper and lower extremities. In addition to general diagnostics, blood and urine are examined for the presence of a suspected toxic substance.

Treatment

A feature of the treatment of bilirubin encephalopathy is phototherapy. The child is placed under blue light bulbs, while constant monitoring of body temperature (to avoid overheating) and the weight of the newborn (as the baby loses fluid) is carried out. Up to three times a day, blood sampling is done to study the level of bilirubin.

Detoxification therapy is mandatory, Ringer's solutions, glucose, nootropic and antioxidant drugs, vitamins are administered intravenously. In especially severe cases, a replacement transfusion of blood or its plasma is proposed.

Post-traumatic encephalopathy

This pathology does not always make itself felt immediately. It may take months, or even years, before its symptoms appear:

• dizziness with reeling in different directions;
• delayed psychomotor development;
• convulsive seizures;
• fainting conditions.

Such symptoms develop as a result of a serious injury (a concussion in a mild form does not lead to serious consequences), for example, due to fractures of the cranial bones from beating, falls from a height, complications after an accident.

Treatment

The treatment will largely depend on the injury itself. In severe cases, neurosurgeons perform surgery. The lighter are treated with medication with nootropics and antioxidants.

Possible consequences

The outcome of brain pathologies may result in complete recovery, however, in severe cases, vegetative-visceral disorders, delayed speech and mental development, and hyperactivity are observed.

  Cerebral palsy is one of the most serious consequences of brain disorders

The most serious consequences are those that provoke the development of diseases that affect the social adaptation of the child: cerebral palsy, epilepsy, hydrocephalus.

Prevention

Prevention of brain pathologies includes a responsible approach to pregnancy and childbirth on the part of the mother: her good rest, lack of bad habits, timely visits to the doctor along with the necessary tests and the proposed examinations. Competent birth management and due attention to the baby in the first weeks of his life are no less significant.

Today, a diagnosis of perinatal encephalopathy (PEP) is often abused. According to statistics, only 4% of children have serious abnormalities affecting the nervous system and brain activity. But the reality is that any neurological disorder, such as, for example, chin trembling, which in the first months can be considered the norm, is attributed to brain pathologies.

So, true encephalopathy in infants is not common and is accompanied by serious syndromes that cannot be ignored. After a certain time, this term is replaced by a specific diagnosis, which requires vigilant observation and treatment. Patience to you, dear parents.