The perinatal period is the period of a child's life from the 28th week of pregnancy to the 7th day after birth. It is during this period that the child’s nervous system intensively develops and most often it is at this time that the child may develop central nervous system diseases if he is so inclined.
Of course, if doctors find a similar disease, then parents begin to become interested in what methods are available for the rehabilitation of perinatal CNS damage and in general information about this problem. The causes of lesions of this type occupy a very important place.
Signs of perinatal central nervous system damage
The manifestation of perinatal CNS damage will depend entirely on the severity of the disease that caused this pathology. If a child has a mild form of damage, then we can talk about a decrease in muscle tone and innate reflexes, the appearance of tremors (the chin and, in some cases, limbs shake) and motor restlessness. Typically, symptoms appear gradually over 5-7 days after the birth of the baby.If a moderate form of severity of central nervous system damage is observed, then depression occurs for more than 7 days in the form of muscle hypotonia and a strong decrease in innate reflexes. In some cases, you may notice the appearance of seizures and loss of sensitivity. IN Lately more and more cases can be found medium shape defeats nervous system which are accompanied by vegetative-visceral disorders, dyskinesias gastrointestinal tract and unstable stools, regurgitation, flatulence and disturbances in the full functioning of the respiratory and of cardio-vascular system.
If a newborn child has a severe form of perinatal damage to the central nervous system, then one can note long-term and very clearly expressed depression of the nervous system, convulsions, strong problems, which regularly occur with the respiratory, cardiovascular and digestive systems.
It is worth noting that any damage to the nervous system of a newborn child should be identified by a neonatologist during the baby’s stay with his mother in the maternity hospital. He must also prescribe the necessary and appropriate treatment in a particular case. Clinical manifestations pathologies may manifest themselves for some time after discharge from the hospital, and in some cases even intensify. If this happens, then any deviations from the norm and problems with the child’s nervous system should and may well be noticed even by the mother, being outside the walls of the maternity hospital. If a child has similar problems, he may have following signs:
- anxiety or constant lethargy and drowsiness that cannot be explained by anything;
- regular regurgitation that occurs both after feeding and in the intervals between it;
- unusual eye movement of the child;
- trembling of the chin or limbs, convulsions.
Today, doctors distinguish four groups of perinatal lesions of the central nervous system in a newborn child, namely:
- hypoxic lesions due to lack of oxygen;
- traumatic lesions due to damage to tissues of the nervous system and brain during childbirth or during the first minutes of a child’s life;
- dysmetabolic due to metabolic disorders in the child’s body that occur during pregnancy;
- infectious that occurs during illness infectious diseases throughout the perinatal period.
Group 1 of perinatal CNS lesions
This type of lesion can be found most often. The causes of hypoxia in a child are: illnesses of the mother during pregnancy, polyhydramnios, oligohydramnios, multiple pregnancies, and so on. The acute form of hypoxia can be caused by severe bleeding, poor blood flow to the baby’s brain during childbirth, disturbances in the uteroplacental circulation, and premature placental abruption.The duration and severity of hypoxia affect the degree of damage to the central nervous system, because it is especially sensitive to the lack of oxygen in the body. If throughout intrauterine development the child constantly needs oxygen, this causes a number of different pathological changes in the body.
Group 2 perinatal lesions of the central nervous system
The traumatic factor plays a very important role in injuries. spinal cord. Quite often, the reason for this may be the unprofessionalism of obstetricians or the special instruments that they may use during childbirth. Also, the causes of damage can be the large weight of the child, the woman’s narrow hips, the breech presentation of the child, the child’s pulling on the head, incorrect insertion of the head, and so on. Sometimes spinal cord damage can occur even during a caesarean section, when a “cosmetic” incision is made along the pubic hairline and, accordingly, in the lower segment of the uterus.Group 3 perinatal lesions of the central nervous system
This group includes metabolic disorders: alcohol syndrome fruit, nicotine, narcotic withdrawal syndrome, the presence of viral or bacterial toxins that are introduced into the child’s body, medications.Group 4 perinatal lesions of the central nervous system
In the last few years, it has been noted that the number of cases of a child becoming infected during pregnancy has increased significantly. Of course, equipment has been invented that makes it possible to determine the presence of infection in a child’s body at an early stage. Of course, this does not eliminate all the risks of damage to the baby’s nervous system. It is also worth noting that the mechanism of damage to the central nervous system will completely depend on the type of pathogen and the severity of the disease.When perinatal damage to the central nervous system is detected, treatment must be started immediately, because the consequences can be even more severe.
Perinatal damage to the central nervous system in newborns: consequences
If you have any suspicions that there is something wrong with your child, you should immediately consult a doctor. IN in this case Every minute will be important, because the sooner treatment is started, the faster you can restore all body functions. If you start treatment too late, then there is a high risk of not restoring functions and then the child will have serious health problems.Once again, I would like to remind you that a child’s diagnosis should only be made by a doctor. This diagnosis will reflect the form of perinatal damage to the central nervous system, the factors that caused it, the causes and syndromes to which the pathology will relate. When making a diagnosis, you need to be as careful as possible, because further treatment will depend on this. If the doctor makes the diagnosis incorrectly, then the treatment will be inappropriate and will not solve the problem that has arisen in your newborn child. Let us remind you that treatment should not only be correct, but also as early as possible so that the disease does not have time to progress.
Unfortunately, central nervous system disorders in newborns are not uncommon. Up to 50% of all children are exposed to this disorder to one degree or another.
Today we will talk about perinatal damage to the central nervous system (CNS) in newborns, we will tell you what symptoms this disease is characterized by, what methods exist for diagnosing and treating damage to the central nervous system, and we will also understand what the consequences of this disease may be.
The essence of the disease
Damage to the central nervous system is diagnosed quite often, and Among premature babies, this diagnosis occurs many times more often. This disease includes a number of different diagnoses characterized by damage to the brain and/or spinal cord.
In most cases, damage to the central nervous system has a favorable outcome. Now let's take a closer look at the causes of this disease.
Causes of central nervous system damage in children
The causes of this disease during pregnancy may be:
- somatic diseases in the mother;
- metabolic disorder;
- poor nutrition;
- unfavorable environmental conditions;
- mother's age is over 35 or less than 18 years;
- acute infectious diseases;
- pathological course of pregnancy;
- the influence of toxins on the body of the expectant mother (smoking, drinking alcohol and drugs).
In some cases, the causes of damage to the central nervous system are injuries and fetal hypoxia during the birth process.
Any lesions of the central nervous system can be divided into two types.
Organic damage to the central nervous system
This diagnosis occurs among people of different ages. Organic damage to the central nervous system in both children and adults is characterized by pathological changes in the brain.
Perinatal CNS damage
Diagnosed in newborns. Depending on the period in which this lesion occurred, the following types are divided:
- antenatal (the period of intrauterine development from 28 weeks until birth);
- intrapartum (damage occurs directly during childbirth);
- neonatal (the lesion is diagnosed in the first week of life).
Depending on the causes, this disease is divided into several types.
Hypoxic damage to the central nervous system
Hypoxic, or hypoxic-ischemic, damage to the central nervous system in newborns is characterized by oxygen starvation for one reason or another. It appears in the womb or due to asphyxia during childbirth.
Traumatic
Traumatic, or residual, damage to the central nervous system in children is a residual phenomenon after injury and structural changes brain
It is very important to diagnose this pathology as early as possible, since brain cells in infants have the ability to recover. Respectively, dire consequences can be avoided.
Diagnosis of central nervous system lesions in children
An experienced doctor can diagnose central nervous system damage with one look at the child. But to make a final diagnosis, the following research methods are used:
- various types of tomography;
- electroencephalogram;
- Ultrasound of the brain with Dopplerography of blood vessels;
- X-ray of the skull and spine.
These studies are easy to perform even in the youngest patients. Moreover, an open large fontanel in newborns allows one to perform ultrasound of the brain repeatedly and monitor its condition over time.
Also, one of the diagnostic methods is collecting anamnesis and monitoring the symptoms of the disease.
Symptoms of the disease
According to its course, perinatal damage to the central nervous system can be divided into three stages, each of which is characterized by its own symptoms.
Acute period
This period lasts up to one month and is characterized by the following symptoms:
- CNS depression syndrome (hypodynamia, lethargy, decreased reflexes, muscle hypotension);
- CNS hyperexcitability syndrome (restless and often superficial sleep, trembling chin, muscle hypertonicity, etc.) is less common.
Early recovery period
This period lasts for the 2nd and 3rd months and is characterized by a decrease in the symptoms of the acute period. At the same time, the location of the lesion becomes obvious. This phenomenon characterized by the following symptoms:
- divergence of the sutures of the skull, increase in head circumference;
- impairment of motor activity;
- thermoregulation disorder, marbled skin color, disruption of the gastrointestinal tract.
Late recovery period
The period lasts up to 1 year in children born at term, and up to 2 years in premature children. During this period, static functions and muscle tone are restored. The recovery process depends on the degree of damage during the perinatal period.
Period of residual effects
In most cases, during this period there is complete restoration of all neurological functions. At the same time, every fifth child has serious consequences disorders of neurological functions during this period.
Treatment of the disease
Important! Conduct necessary examination and appoint correct treatment Only a doctor can.
Treatment of moderate to severe central nervous system damage is often carried out in an intensive care setting, often using special equipment to support the functioning of vital organs.
In the acute period The following treatment methods are used for the disease:
- reducing cerebral edema and maintaining the functioning of internal organs;
- reduction in the frequency of seizures;
- restoration of nervous tissue metabolism;
- restoration of oxygen metabolism in cells.
During the recovery period In addition to the above methods, the following therapy is used:
- stimulant drugs;
- sedative therapy for increased excitability;
- enhancement drugs cerebral circulation;
- massage;
- physiotherapy;
Subsequently, treatment is carried out up to three times a year under the supervision of a neurologist for several years.
Prevention of central nervous system damage
The most important thing is to eliminate everything possible factors, provoking oxygen starvation fetus during pregnancy. Treat infectious diseases in a timely manner, provide favorable conditions for the pregnant woman, and also prevent the possibility of birth injuries.
For you to receive complete information We suggest watching the following video about perinatal damage to the central nervous system.
Damage to the central nervous system in newborns - video
From this video you will learn about the nuances of central nervous system damage and methods of treating this disease.
To summarize, I would like to note that changes due to this pathology are completely reversible if treatment is started on time, namely in the first weeks of the baby’s life. Don't ignore the first symptoms. If any suspicious signs of this disease appear, immediately contact a neurologist for consultation.
Have you encountered CNS damage in your children? What treatments were you prescribed? What was the result? Tell us about your experience in the comments.
Each expectant mother is afraid of pathologies of pregnancy and childbirth and wants to prevent them.
One of these pathologies is fetal hypoxia and hypoxia during childbirth, which can lead to disruptions in the functioning of many organs and tissues, including the brain.
The consequences of such damage can affect long time, sometimes all my life.
Causes of hypoxic damage to the central nervous system in a newborn
The central nervous system is the first to suffer from a lack of oxygen, which can lead to various factors during pregnancy and childbirth. It can be:
During pregnancy:
Preeclampsia on later;
Premature placental abruption, threat of miscarriage;
Heart defects in mother and fetus;
Anemia in mother;
Lack or excess of amniotic fluid;
Maternal intoxication (drug, occupational, smoking);
Rhesus conflict between mother and fetus;
Infectious diseases of the mother;
During childbirth:
Entanglement of the umbilical cord around the fetal neck;
Weakness labor activity;
Prolonged labor;
Maternal bleeding;
Birth injuries to the neck.
As you can see, the majority hazardous factors affect the health of the baby even before birth, and only some - during childbirth.
Excess weight, chronic diseases of the mother, or her too young or too mature age (under 18 or over 35) can aggravate the course of pregnancy pathologies leading to hypoxic damage to the central nervous system in the newborn. And with any type of hypoxia, the brain is affected first.
Symptoms of Brain Damage
In the first hours and days after birth signs of disorders of the cardiovascular system come to the fore, and symptoms of hypoxic damage to the central nervous system begin to manifest themselves later.
If brain damage is caused by pregnancy pathology, then the child may be lethargic, have weakened or completely absent reflexes that should be present. healthy newborn. If there is a pathology that occurs during childbirth, the child does not immediately begin to breathe after birth, the skin has a bluish tint, frequency breathing movements lower than normal. And in the same way, physiological reflexes will be reduced - based on these signs, oxygen starvation can be suspected.
At an older age brain hypoxia, if it was not cured on time, manifests itself as a slowdown in psycho-emotional development up to severe forms of dementia, and motor disorders. In this case, the presence of organic pathology is possible - brain cysts, hydrocephalus (especially often occurs with intrauterine infections). Severe brain hypoxia can be fatal.
Diagnosis of hypoxic damage to the central nervous system in a newborn
First diagnostic procedure, which is carried out for all newborns immediately after birth - this is an assessment of his condition on the Apgar scale, which takes into account such vital important indicators like breathing, heartbeat, condition skin, muscle tone and reflexes. A healthy child scores 9-10 points on the Apgar scale; signs of hypoxic damage to the central nervous system can significantly reduce this indicator, which should be the reason for more accurate examinations.
Doppler ultrasound allows you to assess the condition of the blood vessels of the brain and identify their congenital anomalies, which can become one of the causes of hypoxia in the fetus and newborn.
Ultrasound, CT and MRI of the brain can identify various organic pathologies of the nervous system - cysts, hydrocephalus, areas of ischemia, underdevelopment of certain parts, tumors. The difference in the operating principles of these methods allows us to see the most complete picture of brain damage.
To assess damage to the functions of the nervous system, neurography and myography are used - these are methods based on the effect on muscle and nervous tissue electric shock, and allowing you to track how they react to it different areas nerves and muscles. In the case of congenital hypoxic damage to the central nervous system in a newborn, this method allows us to understand how damaged the peripheral nervous system is, and how great are the child’s chances for full physical development in this case.
Additionally appointed biochemical analysis blood, urine analysis, allowing to identify biochemical disorders associated with brain hypoxia.
Treatment of hypoxia in newborns
Treatment for hypoxic brain injury depends on its cause and severity. If hypoxia occurs during childbirth and is not accompanied by organic pathology of the brain, blood vessels, heart, lungs or spine, then, depending on the degree, it can either go away on its own within a few hours ( light form, 7-8 Apgar), or require treatment in an oxygen chamber with normal or high blood pressure(hyperbaric oxygenation).
Organic pathology that causes constant brain hypoxia (heart defects, respiratory system, neck injuries) are usually treated surgically. The question of the possibility of surgery and its timing depends on the condition of the child. The same applies to organic pathology of the brain (cysts, hydrocephalus), which occurs as a consequence of intrauterine fetal hypoxia. In most cases, the earlier the operation is performed, the greater the child’s chances for full development.
Prevention of hypoxic brain damage
Since the consequences of intrauterine fetal hypoxia are extremely destructive for the child’s brain in the future, a pregnant woman needs to be very careful about her health. It is necessary to minimize the impact of factors that can disrupt the normal course of pregnancy - avoid stress, eat well, exercise in moderation, give up alcohol and smoking, visit on time antenatal clinic.
In case of severe gestosis, as well as when signs of premature placental abruption and threat of miscarriage appear - abdominal pain, bloody issues from the genital tract, a sharp decline blood pressure, sudden nausea and vomiting for no reason - you should immediately consult a doctor. It may be recommended to go into conservation - this recommendation should not be neglected. Complex therapeutic measures carried out in a hospital will avoid severe fetal hypoxia and its consequences in the form of congenital brain pathologies.
Ultrasound, which is done on last weeks pregnancy, makes it possible to identify such potentially dangerous conditions as entanglement with the umbilical cord, which during childbirth can prevent the baby from taking the first breath, pelvic or lateral presentation, which is also dangerous because hypoxia of the newborn will develop during childbirth. To correct dangerous presentation, there are sets of exercises, and if they are ineffective, a caesarean section is recommended. It is also recommended for entwined umbilical cords.
Measuring the size of a woman's fetus and pelvis allows us to determine anatomically and clinically narrow pelvis– discrepancy between the size of the pelvis and the size of the child’s head. In this case, giving birth naturally will be very traumatic for both mother and child, or may be completely impossible. The most safe method Delivery in this case is a cesarean section.
During childbirth, it is imperative to monitor the intensity of contractions - if it becomes insufficient for rapid delivery, labor is induced. Prolonged stay of the fetus in the birth canal can lead to the development of cerebral hypoxia, since the placenta no longer supplies its body with oxygen, and the first breath is possible only after birth. Physical exercises to prepare for childbirth can help you avoid this condition.
Damage to the central nervous system in newborns is the result of pathology of intrauterine development or a number of other reasons that lead to serious complications in the functioning of the body. Such lesions are diagnosed in almost 50% of infants. More than half, even almost two-thirds, of these cases occur in premature babies. But, unfortunately, pathologies also occur in full-term babies.
Most often, doctors call the main cause of damage to the central nervous system difficulty in pregnancy, the influence negative factors for the fruit. Among the sources of the problem:
- Lack of oxygen, or hypoxia. This condition occurs when a pregnant woman works in hazardous work, smokes, has infectious diseases that could have occurred immediately before conception, or had previous abortions. All this disrupts blood flow and oxygen saturation in general, and the fetus receives it from the mother’s blood.
- Birth injuries. They are considered unlikely causes of damage to the central nervous system, but it is assumed that injury can lead to disturbances in maturation and further development central nervous system.
- Metabolic disease. This occurs for the same reasons as hypoxia. Both drug addiction and alcoholism lead to dysmetabolic pathologies. Taking strong medications also has an effect.
- Infections suffered by the mother during pregnancy. Viruses themselves can negatively affect fetal development. But there are a number of diseases that are considered critical for the life of the fetus. Among these are rubella and herpes. However, any pathogenic bacteria and microbes are also capable of causing irreversible negative processes in the child’s body while still in the womb.
Types of CNS lesions
Each of the reasons leads to the development of a certain pathology, the severity of which affects the possibility of recovery and complete rehabilitation of the newborn.
- Lack of oxygen
Fetal hypoxia in the womb can cause the following pathologies:
- Cerebral ischemia. At grade 1, depression or, conversely, stimulation of the central nervous system in the infant can be noted. The condition usually goes away within a week. Grade 2 severity can be recognized by short-term convulsions, increased intracranial pressure, and more prolonged disruption of the functioning of the nervous system. In the most difficult situation complications lead to epileptic seizures, serious pathologies stem sections of the brain, as well as increased intracranial pressure. The result is often coma and progressive central nervous system depression.
- Hemorrhage. This phenomenon can affect the ventricles and brain matter, or subarachnoid hemorrhage occurs. Manifestations of such consequences include convulsions, invariably increased intracranial pressure, hydrocephalus, shock and apnea, coma. In mild cases there are often no symptoms. Sometimes the only sign of a problem is hyperexcitability or, conversely, depression of the central nervous system.
- Birth injuries
The consequences vary depending on the type of injury that occurred during childbirth:
- Intracranial trauma can lead to hemorrhage with seizures and increased intracranial pressure. Other consequences include impaired cardiac and respiratory activity, hydrocephalus, coma, and hemorrhagic infarction.
- Damage to the spinal cord leads to hemorrhage in this organ with stretching or tearing. The result may be a violation respiratory function, motor activity and spinal shock.
- Damage to the peripheral nervous system. These are complications such as damage brachial plexus, which can lead to total paralysis and impaired respiratory function. Pathologies of the phrenic nerve can lead to complications in the functioning of the respiratory system, although most often it occurs without obvious signs. Defeat facial nerve It becomes obvious if there is a twisting of the mouth while the baby is crying.
- Metabolic disorder
Among the consequences of dysmetabolic lesions:
- Kernicterus, which is accompanied by convulsions, apnea, etc.
- Decreased magnesium levels, which leads to hyperexcitability and seizures.
- Excess sodium levels cause high blood pressure, as well as increased heart rate and breathing.
- An increased concentration of glucose in the blood, which causes depression of the central nervous system and convulsions, although it can often occur without any symptoms.
- Low sodium levels cause low blood pressure and central nervous system depression.
- An increased concentration of calcium causes tachycardia, convulsions, and muscle spasms.
- Infectious diseases
TO infectious diseases that can cause damage to the central nervous system of the fetus include rubella, syphilis, herpes, cytomegalovirus and toxoplasmosis. Of course, past illnesses will not necessarily lead to pathologies in the development of the baby, but they significantly increase their risk. Doctors also note a number of diseases that cause problems even after the baby is born. Among these are candidiasis, pseudomonas infection, staphylococci, sepsis and streptococci. Such phenomena can cause hydrocephalus, increased intracranial pressure, meningeal syndrome and focal disorders.
Development of CNS lesions
In the process of development of lesions of the central nervous system, doctors distinguish three main stages:
- spicy;
- restorative;
- Exodus.
Acute period
This period lasts about a month. Its course depends on the severity of the damage. Defeats most light form- these are shudders, trembling of the chin, increased excitability, sudden movements of the limbs, abnormal states of muscle tone, sleep disturbances.
The baby may cry often and for no reason.
Grade 2 severity is manifested at this time by a decrease in motor activity and muscle tone, reflexes will be weakened, especially sucking, which an attentive mother will definitely notice. In this case, by the end of the first month of life, such symptoms may be replaced by hyperexcitability, marbled skin color, flatulence and frequent regurgitation.
Often at this time, children are diagnosed with hydrocephalic syndrome. Its most obvious symptoms include a rapid increase in head circumference, increased intracranial pressure, which is manifested by a bulging fontanel and unusual eye movements.
When the severity is greatest, coma usually occurs. Such complications leave the child in the hospital under the supervision of doctors.
Rehabilitation period
Interestingly, it is the recovery period that can be more difficult than the acute one, if there were no symptoms as such in the first months. The second period lasts approximately from 2 to 6 months. This phenomenon is expressed approximately as follows:
- the baby hardly smiles, does not show emotions;
- the baby is not interested in rattles;
- the baby's cry is rather weak;
- The child practically does not roar.
If in the first period the symptoms were present quite clearly, then from the second month of life they may, on the contrary, decrease and disappear, but this does not mean that treatment should be stopped completely. This only gives reason to understand that the child is really recovering.
Result of CNS damage
By about a year of a baby’s life, the consequences of damage to the central nervous system become obvious, although the main symptoms go away. The result is:
- developmental delay - psychomotor, physical or speech;
- hyperactivity, which affects the ability to concentrate, learn, and remember something in the future, is also expressed in increased aggressiveness and hysteria;
- cerebroasthenic syndrome – poor sleep, mood swings, weather dependence;
- epilepsy, cerebral palsy, hydrocephalus are pathologies that develop with particularly severe lesions of the central nervous system.
Diagnostics
Obviously, the consequences of damage to the central nervous system can be quite serious, so it is important to diagnose them in a timely manner. A newborn examination alone is usually not enough. At the slightest suspicion of pathology, doctors prescribe a computed tomography, ultrasound of the brain, x-ray of the brain or spinal cord - depending on assumptions about the location of hemorrhages or other complications.
Treatment
The development of consequences and complications of central nervous system lesions depends on the timeliness of diagnosis and taking measures. Therefore, first aid to such babies must be provided in the first hours of life.
First of all, doctors strive to restore the activity of the lungs, heart, kidneys, normalize metabolism, eliminate seizures, and strive to relieve edema that forms in the lungs and brain. It is important at this moment to normalize intracranial pressure.
A child with central nervous system damage needs preventive massage
If the measures provided do not lead to complete normalization of the baby’s condition, he is left in the neonatal pathology department to continue rehabilitation. At this stage of treatment, antibacterial or antiviral therapy is possible, drug treatment recovery brain activity. To do this, the baby receives medications to improve blood circulation and maturation of brain cells.
An important stage in any rehabilitation is non-drug methods. These include gymnastics, massage, physiotherapy, paraffin therapy, etc.
If the dynamics are positive and the symptoms of central nervous system lesions are eliminated, the baby and mother are discharged with the following recommendations:
- regular examination by a neurologist;
- the use of non-drug methods of recovery;
- maximum protection of the baby from infection;
- establishing a comfortable and permanent temperature regime and the level of humidity at home;
- careful handling - no harsh sounds or excessively bright light.
With constant monitoring a large number of children is completely restored and is eventually removed from the neurologist’s register. Level 3 severity of lesions forces you to take courses regularly medicines, which normalize many life processes and help the baby recover more effectively.
The best solution is always to prevent damage to the newborn's central nervous system. To do this, doctors recommend planning your pregnancy in advance, getting examined and giving up bad habits. If necessary, you should go antiviral therapy, get vaccinated, normalize hormonal levels.
If a defeat does occur, do not despair: doctors, as a rule, immediately take first aid measures. Parents need to be patient and not give up - even the most difficult conditions can be changed in a positive direction.
Damage to the nervous system in newborns can occur both in utero (prenatal) and during childbirth (intrapartum). If harmful factors act on a child at the embryonic stage of intrauterine development, severe, often incompatible with life, defects occur. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes manifest themselves as small deviations in the formation of the child - stigmas of disembryogenesis.
If a damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but any disease may occur in a normally formed child. It is very difficult to isolate the impact harmful factor separately in each of these periods. Therefore, they often talk about the impact of a harmful factor in general during the perinatal period. And the pathology of the nervous system of this period is called perinatal damage to the central nervous system.
The child may be adversely affected by various acute or chronic diseases of the mother, work in hazardous chemical industries or work associated with various radiations, as well as bad habits parents - smoking, alcoholism, drug addiction.
A child growing in the womb may be adversely affected by severe toxicosis of pregnancy, pathology of the child's place - the placenta, and the penetration of infection into the uterus.
Childbirth is very important event for a child. Particularly great trials come to the baby if the birth occurs prematurely (prematurity) or rapidly, if there is birth weakness, breaks early amniotic sac and the water leaks when the baby is very large and is helped to be born with special techniques, forceps or a vacuum extractor.
The main causes of damage to the central nervous system (CNS) are most often hypoxia, oxygen starvation of various natures and intracranial birth trauma, less commonly - intrauterine infections, hemolytic disease of newborns, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.
Hypoxia ranks first among the causes of damage to the central nervous system; in such cases, doctors talk about hypoxic-ischemic damage to the central nervous system in newborns.
Hypoxia of the fetus and newborn is a complex pathological process in which the access of oxygen to the child’s body is reduced or completely stopped (asphyxia). Asphyxia can be one-time or repeated, varying in duration, as a result of which carbon dioxide and other under-oxidized metabolic products accumulate in the body, primarily damaging the central nervous system.
With short-term hypoxia in the nervous system of the fetus and newborn, only minor disturbances of cerebral circulation occur with the development of functional, reversible disorders. Prolonged and repeated hypoxic conditions can lead to severe disturbances in cerebral circulation and even to the death of nerve cells.
Such damage to the newborn’s nervous system is confirmed not only clinically, but also using Doppler ultrasound examination of cerebral blood flow (USDG), ultrasound examination brain - neurosonography (NSG), computed tomography and nuclear magnetic resonance (NMR).
In second place among the causes of damage to the central nervous system in the fetus and newborn is birth trauma. The true meaning, the meaning of birth trauma is damage to a newborn child caused by mechanical impact directly on the fetus during childbirth.
Among the variety of birth injuries during the birth of a baby, the child’s neck experiences the greatest load, resulting in various damages cervical spine, especially the intervertebral joints and the junction of the first cervical vertebra And occipital bone(atlanto-occipital joint).
There may be shifts (dislocations), subluxations and dislocations in the joints. This disrupts blood flow in important arteries that supply blood to the spinal cord and brain.
Brain functioning is highly dependent on the condition cerebral blood supply.
Often the root cause of such injuries is the weakness of labor in a woman. In such cases, forced labor stimulation changes the mechanism of fetal passage through birth canal. With such stimulated childbirth, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, spraining and tearing of ligaments, dislocations, and cerebral blood flow is disrupted.
Traumatic injuries CNS during childbirth most often occurs when the size of the child does not correspond to the size of the mother’s pelvis, when the fetus is in an incorrect position, during birth in the breech presentation, when premature, low-weight children are born and, conversely, children with large mass bodies, large sizes, since in these cases various manual obstetric techniques are used.
When discussing the causes of traumatic lesions of the central nervous system, we should specifically focus on childbirth using obstetric forceps. The fact is that even if the forceps are applied to the head flawlessly, intense traction on the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is pulled is transmitted to the body through the neck. For the neck, such a huge load is unusually large, which is why when removing a baby using forceps, along with brain pathology, damage to the cervical portion of the spinal cord occurs.
Special attention deserves a question about the damage to the child that occurs during surgery caesarean section. Why is this happening? Indeed, it is not difficult to understand the trauma of a child as a result of passing through the birth canal. Why does a cesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during a caesarean section? The fact is that the transverse incision during a caesarean section in the lower segment of the uterus should theoretically correspond to largest diameter heads and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the head of an average child is 34-35 cm. Therefore, removing the head and especially the shoulders of the child by pulling the head with an insufficient incision of the uterus inevitably leads to injury to the cervical spine. That is why the most common cause of birth injuries is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.
In such cases, they speak of hypoxic-traumatic damage to the central nervous system in newborns.
With birth trauma, cerebral circulation disorders often occur, including hemorrhages. More often these are small intracerebral hemorrhages in the cavity of the ventricles of the brain or intracranial hemorrhages between meninges(epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic damage to the central nervous system in newborns.
When a baby is born with central nervous system damage, the condition can be severe. This acute period illness (up to 1 month), followed by early recovery (up to 4 months) and then late recovery.
Important for prescribing the most effective treatment Pathology of the central nervous system in newborns has a definition of the leading complex of signs of the disease - neurological syndrome. Let's consider the main syndromes of CNS pathology.
Main syndromes of central nervous system pathology
Hypertensive-hydrocephalic syndrome
When examining a sick infant, the expansion of the ventricular system of the brain is determined, detected using ultrasound of the brain, and an increase in intracranial pressure is recorded (as shown by echo-encephalography). Externally, in severe cases of this syndrome, there is a disproportionate increase in the size of the brain part of the skull, sometimes asymmetry of the head in the case of unilateral pathological process, divergence of cranial sutures (more than 5 mm), expansion and strengthening of the venous pattern on the scalp, thinning of the skin on the temples.
In hypertensive-hydrocephalic syndrome, either hydrocephalus, manifested by expansion of the ventricular system of the brain, or hypertension syndrome with increased intracranial pressure. When increased intracranial pressure predominates, the child is restless, easily excitable, irritable, often screams loudly, sleeps lightly, and the child often wakes up. When hydrocephalic syndrome predominates, children are inactive, lethargy and drowsiness, and sometimes developmental delays are noted.
Often, when intracranial pressure increases, children goggle their eyes, Graefe’s symptom periodically appears (a white stripe between the pupil and upper eyelid), and in severe cases there may be a “setting sun” symptom, when the iris of the eye, like the setting sun, is half immersed under the lower eyelid; sometimes convergent strabismus appears, the baby often throws his head back. Muscle tone can be either decreased or increased, especially in the leg muscles, which is manifested by the fact that when supporting oneself, one stands on tiptoes, and when trying to walk, one crosses the legs.
The progression of hydrocephalic syndrome is manifested by increased muscle tone, especially in the legs, while support reflexes, automatic walking and crawling are reduced.
In cases of severe, progressive hydrocephalus, seizures may occur.
Syndrome motor disorders
Movement disorders syndrome is diagnosed in most children with perinatal pathology of the central nervous system. Movement disorders associated with a violation nervous regulation muscles in combination with an increase or decrease in muscle tone. It all depends on the degree (severity) and level of damage to the nervous system.
When making a diagnosis, the doctor must decide several very important issues, the main one of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is fundamentally important because the approach to treating these conditions is different.
Secondly, assessing muscle tone in various groups muscles. The doctor uses special techniques to identify a decrease or increase in muscle tone in order to choose the right treatment.
Violations of increased tone in various groups lead to a delay in the emergence of new motor skills in the child.
With increased muscle tone in the hands, the development of grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grasps it with his entire hand; fine movements with the fingers are formed slowly and require additional training sessions with the child.
With an increase in muscle tone in the lower extremities, the child later stands on his legs, while relying mainly on the forefoot, as if “standing on tiptoes”; in severe cases, decussation occurs lower limbs at the level of the shins, which prevents the formation of walking. In most children, over time and thanks to treatment, it is possible to reduce muscle tone in the legs, and the child begins to walk well. Like a memory of increased tone muscles may leave a high arch of the foot, which makes choosing shoes difficult.
Autonomic-visceral dysfunction syndrome
This syndrome manifests itself as follows: marbling of the skin caused by blood vessels, impaired thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders- regurgitation, less often vomiting, tendency to constipation or unstable stool, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply to the posterior parts of the brain, in which all the main centers of the autonomic nervous system are located, providing guidance to the most important life-support systems - cardiovascular, digestive, thermoregulatory, etc.
The tendency to convulsive reactions during the neonatal period and in the first months of a child’s life is due to the immaturity of the brain. Convulsions occur only in cases of spread or development disease process in the cerebral cortex and have many of the most various reasons which the doctor must identify. This often requires instrumental studies of the brain (EEG), its blood circulation (Dopplerography) and anatomical structures (ultrasound of the brain, computed tomography, NMR, NSG), and biochemical studies.
Convulsions in a child can manifest themselves in different ways: they can be generalized, involving the whole body, and localized - only in a specific muscle group.
Convulsions are also different in nature: they can be tonic, when the child seems to stretch out and freeze a short time in a certain position, as well as clonic, in which twitching of the limbs and sometimes the entire body occurs, so that the child may be injured during convulsions.
There are many variants of manifestations of seizures, which are identified by a neuropathologist based on the story and description of the child’s behavior by attentive parents.
lyami. Correct diagnosis, that is, determining the cause of a child’s seizure, is extremely important, since the timely prescription of effective treatment depends on it.
It is necessary to know and understand that convulsions in a child during the neonatal period, if serious attention is not paid to them in time, can become the onset of epilepsy in the future.
Symptoms that should be addressed to a pediatric neurologist
To summarize all that has been said, let us briefly list the main deviations in the health status of children, for which it is necessary to contact a pediatric neurologist:
If the baby sucks sluggishly, takes breaks, and gets tired. There is choking and leakage of milk through the nose;
If the newborn burps frequently and does not gain enough weight;
If the child is inactive, lethargic or, on the contrary, too restless and this restlessness intensifies even with minor changes in the environment;
If the child has trembling of the chin, as well as the upper or lower extremities, especially when crying;
If the child often shudders for no reason, has difficulty falling asleep, and the sleep is superficial and short in duration;
If the child constantly throws his head back while lying on his side;
If there is too rapid or, conversely, slow growth in head circumference;
If reduced physical activity a child if he is very lethargic and the muscles are flabby (low muscle tone), or, conversely, the child seems to be constrained in his movements (high muscle tone), so even swaddling is difficult;
If one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);
If a child squints or goggles, a white stripe of sclera is periodically visible;
If the baby constantly tries to turn his head in only one direction (torticollis);
If the hip extension is limited, or, conversely, the child lies in a frog position with the hips separated by 180 degrees;
If the child was born by caesarean section or in a breech presentation, if obstetric forceps were used during childbirth, if the baby was born prematurely or with a large weight, if the umbilical cord was entangled, if the child had convulsions in the parental home.
Accurate diagnosis and timely and correctly prescribed treatment of nervous system pathology is extremely important. Damages to the nervous system can be expressed to varying degrees: in some children they are very pronounced from birth, in others even severe disturbances gradually decrease, but do not disappear completely, and mild manifestations remain for many years - these are the so-called residual phenomena.
Late manifestations of birth trauma
There are also cases when at birth the child had minimal impairments, or no one noticed them at all, but after a while, sometimes years, under the influence of certain stresses: physical, mental, emotional - these neurological impairments manifest themselves with to varying degrees expressiveness. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists in everyday practice deal most often with such patients.
What are the signs of these consequences?
Most children with late manifestations show a marked decrease in muscle tone. Such children are credited with “innate flexibility,” which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the “frog” pose and do the splits without difficulty. Often such children are gladly accepted into rhythmic or artistic gymnastics sections and choreographic clubs. But most of them can't stand it heavy loads and are eventually expelled. However, these activities are enough to develop a spinal pathology - scoliosis. It is not difficult to recognize such children: they often clearly exhibit protective tension in the cervical-occipital muscles, they often have mild torticollis, their shoulder blades stick out like wings, the so-called “pterygoid shoulder blades,” they can stand on different levels, like the shoulders. In profile, it is clear that the child has a sluggish posture and a stooped back.
By the age of 10-15 years, some children with signs of cervical spine injury in the neonatal period develop typical signs of early childhood development. cervical osteochondrosis, the most characteristic symptom of which in children is headaches. The peculiarity of headaches with osteochondrosis in children is that despite their different intensity pain is localized in the cervical-occipital region. As you grow older, the pain often becomes more pronounced on one side and, starting in the occipital region, spreads to the forehead and temples, sometimes radiating to the eye or ear, intensifying when turning the head, so that a short-term loss of consciousness may even occur.
A child’s headaches are sometimes so intense that they can deprive him of the ability to study, do anything around the house, and force him to go to bed and take analgesics. At the same time, some children with headaches exhibit a decrease in visual acuity - myopia.
Treatment for headaches, aimed at improving blood supply and nutrition to the brain, not only relieves headaches, but also improves vision.
The consequences of pathology of the nervous system in the newborn period can be torticollis, certain forms of scoliotic deformities, neurogenic clubfoot, and flat feet.
In some children, enuresis - urinary incontinence - can also be a consequence of birth trauma - just like epilepsy and other convulsive conditions in children.
As a result of hypoxic injury to the fetus in the perinatal period, the brain is primarily affected; the normal course of maturation of the functional systems of the brain that ensure the formation of such complex processes and functions of the nervous system, such as stereotypes of complex movements, behavior, speech, attention, memory, perception. Many of these children show signs of immaturity or disorders of certain higher mental functions. The most common manifestation is the so-called active attention deficit hyperactivity disorder and hyperactive behavior syndrome. Such children are extremely active, disinhibited, uncontrollable, they lack attention, they cannot concentrate on anything, they are constantly distracted, and cannot sit still for several minutes.
They say about a hyperactive child: this is a child “without brakes.” In the first year of life, they give the impression of very developed children, as they are ahead of their peers in development - they begin to sit, crawl, and walk earlier. It is impossible to restrain a child; he certainly wants to see and touch everything. Increased physical activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low performance, the child does his homework until the evening, goes to bed late and, as a result, does not get enough sleep. The movements of such children are awkward, clumsy, and poor handwriting is often noted. They are characterized by disorders of auditory-verbal memory; children poorly learn material from hearing, while visual memory disorders are less common. They often meet Bad mood, thoughtfulness, lethargy. It is difficult to involve them in the pedagogical process. The consequence of all this is negative attitude to study and even refusal to attend school.
Such a child is difficult for both parents and teachers. Behavioral and school problems grow like a snowball. During adolescence, these children have a significantly increased risk of developing persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.
Functional disorders cerebral blood flow especially make themselves felt during periods accelerated growth- in the first year, at 3-4 years, 7-10 years, 12-14 years.
It is very important to notice the first signs as early as possible, take action and carry out treatment at an early stage. childhood, when the development processes have not yet been completed, while the plasticity and reserve capabilities of the central nervous system are great.
Back in 1945, the domestic obstetrician Professor M.D. Gütner rightly called birth injuries to the central nervous system “the most common folk disease».
IN last years It became clear that many diseases of older children and even adults have their origins in childhood and are often a late retribution for unrecognized and untreated pathology of the newborn period.
One conclusion must be drawn - to be attentive to the health of the baby from the moment of conception, to eliminate, if possible, all harmful effects on his health in a timely manner, and even better, to prevent them altogether. If such a misfortune occurs and a pathology of the nervous system is detected in the child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible to ensure that the baby makes a full recovery.
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