Cerebral ischemia in newborns - description, degrees, consequences. Treatment of cerebral ischemia in newborns and adults

Cerebral ischemia in a newborn is one of the most serious problems of pediatric neurology, which has not yet been developed effective methods pathology therapy. The prognosis of the course of the disease directly depends on the severity and timeliness of the treatment started.

The only reason for the development cerebral ischemia is a violation of the blood supply to the child’s brain during pregnancy and childbirth. There are two forms of the disease: partial (hypoxia) and complete (anoxia). Designate this problem in a newborn, the term is usually “hypoxic-ischemic encephalopathy”, which means damage to brain tissue due to insufficient oxygen supply. Among the most common and dangerous species Encephalopathy includes periventricular ischemia, affecting the vessels of the brain and having serious consequences for the child, up to development of cerebral palsy and epilepsy.

The mechanism of development of cerebral ischemia in newborns is as follows. With sufficient blood supply to the body, oxygen is distributed evenly between all organs and tissues. In the event of a short-term disruption of blood flow, oxygen flows primarily to vital organs - the heart and brain, and other body systems experience its deficiency. If it continues, the blood supplies oxygen primarily to the heart, and the brain tissue gradually begins to die. The longer the state of oxygen starvation of the brain continues, the more severe the consequences for the child.

Circulatory deficiency in a newborn baby occurs in the following situations:

Unfavorable pregnancy
– any sharp and chronic diseases mothers, including hormonal disorders;
– preeclampsia, eclampsia and gestosis;
– detachment and damage to the placenta, pathology of the umbilical cord;
– lack of water;
– bad habits;
– use of prohibited medicines;
– age less than 18 and over 35 years.
Complications during childbirth
– childbirth before 37 or after 42 weeks;
– prolonged/rapid labor;
– long waterless period;
– large blood loss;
– umbilical cord entanglement;
– artificial stimulation of labor.
Other factors
– hereditary predisposition to neurological disorders;
– some pathologies of cardio-vascular system in the fetus.

The risk of cerebral ischemia increases in the case of long-term drug treatment for infertility. According to statistics, in almost two thirds of infants the first signs of brain pathology are noted even during the period intrauterine development, and a small proportion of cases develop after childbirth.

Types of pathology

Cerebral ischemia in newborns is different to varying degrees severity:

The first (mild) degree is characterized slight increase muscle tone and increased tendon reflexes. During the first 3–7 days after birth, the child experiences increased drowsiness, lethargy or excessive excitement. In some cases, there is slight tremor of the chin and limbs, disturbances in the gastrointestinal tract, and excessive regurgitation. Usually the symptoms go away on their own and do not pose a threat to the health and development of the child.
The second (medium) degree is accompanied by decreased muscle tone and the extinction of some innate reflexes. Convulsions and sudden short-term holds of breath occur. If therapy is started in a timely manner, the prognosis is generally favorable, up to complete cure.
The third (severe) degree is expressed in the absence of the required reflexes, decreased tone, severe convulsions of the body and limbs, hydrocephalus of the brain, organs of hearing and vision. In most cases, the child cannot breathe on his own and does not respond to external stimuli.

Diagnosis of ischemia

Typically, cerebral ischemia in a newborn is diagnosed in the first hours after birth. The disease is confirmed by testing innate reflexes, and its severe course is usually determined by the naked eye. ABOUT serious violations and severe are indicated by low Apgar scores within 5 minutes after birth (from 0 to 3) and visible symptoms disturbances in the functioning of the brain and other internal organs.

In addition to external examination, in order to confirm the disease and determine the severity, the following research methods are used:

general blood test with assessment of coagulation and quantification electrolytes and dissolved gases (with hypoxia, high content carbon dioxide in the child's body);
magnetic resonance imaging, which allows you to assess the degree of damage to brain and central nervous tissue;
Ultrasound of the head, which helps to exclude the presence of edema and vascular damage;
electroencephalography – reveals hidden convulsions.

Consequences

When talking about the prognosis of the disease, one should take into account its severity, timeliness and success of prescribed therapy. Cerebral ischemia of the 1st degree in a newborn, as a rule, ends safely. Long-term consequences include the following:

hyperactivity;
increased excitability;
irritability, tearfulness;
difficulty falling asleep.

Cerebral ischemia grade 2 is characterized by more severe complications: headaches, sleep disturbances, nervous disorders. Such children are much more difficult to adapt to their environment, develop more slowly than their peers and experience learning difficulties.

Severe cerebral ischemia is fatal in almost half of the cases. Complications are common among surviving children: cerebral palsy, epilepsy, autism, mental retardation. Only 10% of children with a complicated form of the disease, even with timely medical care, do not have significant complications.

Experts note that if within one month the child’s symptoms do not subside or increase, brain activity is not restored and the disease has an unfavorable prognosis.

Treatment

The primary goal of therapy is to restore normal cerebral circulation and preventing the development of irreversible complications. Specific treatment does not exist, in each case an individual approach is applied depending on the characteristics of the pathology and the presence of concomitant diseases.

At mild degree dysfunction, standard treatment is to prescribe general massage stimulating normal blood flow. Therapy for grade 2 ischemia in newborns, in addition to massage, usually requires the use of drug therapy, restoring the normal functioning of vital organs. Treatment for severe disease includes the following:

prescribing medications to prevent the development of seizures and medications to support the child’s heart function;
artificial ventilation;
hypothermia to preserve brain tissue;
special massage and exercises for cerebral palsy.

Rehabilitation takes from 2–3 months to several years. Children who have suffered from moderate to severe illness are registered with a neurologist. They are shown physiotherapy, physiotherapy, swimming in the pool. If necessary, children are prescribed additional course therapy with nootropics, vascular drugs, herbs, homeopathic remedies. and disorders of the musculoskeletal system, wearing special restraint devices is prescribed: corsets, splints, orthopedic shoes. In some situations, it is necessary to conduct classes with speech therapists and defectologists.

Cerebral ischemia in newborns is preventable. In order to minimize the risk of serious pathology in the child, a pregnant woman should follow the following recommendations:

comply with the instructions of the supervising doctor;
prevent exacerbation of chronic diseases;
take tests and undergo research on time;
do not neglect physical exercise, walk more;
eat well and get enough sleep;
lead healthy image life.

If it was not possible to avoid the problem, it is important to take measures to eliminate it as soon as possible. It is much more effective to eliminate the disease itself at an early stage than to treat its consequences.

Cerebral ischemia is a disorder of the brain that develops as a result of prolonged lack of oxygen. After oxygen starvation, the blood vessels of the brain narrow or become completely clogged with blood clots.

In modern neurology of children it is recognized as one of the most acute problems. This is caused primarily by the fact that the ways effective treatment illness is not enough yet.

General information

Hypoxia, or lack of oxygen, during pregnancy or the birth process can lead to negative effects on the baby's brain.
is also extremely dangerous. This especially applies to cases of untimely diagnosis and delayed or incorrect treatment.

Classification by severity

Cerebral ischemia in medicine is divided into degrees depending on the level of brain damage:

Cerebral ischemia grade 1. Neurological disorders are not clearly expressed, the following symptoms may be observed:

headaches, feeling of constant heaviness in the head;
general weakness, feeling of persistent fatigue;
decreased concentration, memory failures;
insomnia;
emotional instability;
in newborn children - unusual excitement or depression in the first week after birth.

Symptoms at this stage are not clearly specific; it is not always possible to recognize grade 1 ischemia in a patient with similar complaints.

Patients themselves rarely seek medical care, explaining the state of health by overwork.

Meanwhile, it is at this stage that cerebral ischemia is relatively easy to treat. It is possible not only to relieve current symptoms, but also to prevent the situation from getting worse.

Cerebral ischemia grade 2. The next stage of the disease has more severe symptoms. They also mean deeper neurological disorders. Among them:

dizziness;
profound memory impairment;
instability when moving;
disturbances in habitual movements;
Newborn babies may have seizures.

At the 2nd stage of cerebral ischemia, the ability to work may be completely lost. This is caused by the appearance of focal lesions in the brain tissue. Abilities physical work lost due to lack of coordination. Mental work also ceases to be possible due to brain damage and the occurrence of pathological reflexes.

Cerebral ischemia grade 3. At this stage of the disease, brain dysfunction is extremely pronounced. Symptoms include:

complete loss of ability to work;
inability to self-service;
frequent fainting;
in newborns - hearing and vision impairment, seizures.

The 3rd degree of cerebral ischemia can be characterized by the absence of formulated complaints from the patient. For neurologists, making a diagnosis at this stage does not cause difficulties.

Cerebral ischemia in premature infants

The mechanism of development of the disease in premature infants differs from children who were born full term. This is due to the fact that in the first case the brain is not yet formed and is not resistant to damage.

In addition, the birth of a premature baby is often accompanied by other neurological problems. This both makes diagnosis difficult and can complicate treatment.

Symptoms in newborns

Among the signs of ischemia in newborns are the following:

increased excitability, increased muscle reflexes, tremor;
CNS depression syndrome. Decreased muscle tone, weakened reflexes.
hydrocephalus syndrome;
convulsions of varying severity.

The diagnosis of cerebral ischemia is always based on the results of an ultrasound examination and a medical examination, including a study of reflexes.

The chronic stage is more common in older people. It is caused by irreversible changes in brain tissue. The main factors in the transition of cerebral ischemia to chronic stage doctors believe:

atherosclerosis;
arterial hypertension.

The blood vessels of the brain are narrowed due to a blood clot or sclerotic plaque, which causes a lack of oxygen and then ischemia. Clinical manifestations The diseases are quite diverse, which complicates timely diagnosis.

Causes

Among the causes of cerebral ischemia in newborns, the most important is the lack of oxygen either during pregnancy or during childbirth.

For adults, the causes of the disease are much greater:

cerebral atherosclerosis;
heart failure;
increased blood viscosity;
cardiac arrhythmias.

All these diseases contribute to the deterioration of blood flow in the vessels supplying the brain. This almost inevitably causes ischemia.

Signs in children under one year of age

In most cases, newborns are diagnosed with the first stage of cerebral ischemia. It goes away within a few days after birth. Signs of cerebral ischemia in children may be as follows:

at mild stage increased depression or excitation of the central nervous system.
At the moderate stage, convulsions may occur.
Severe degrees can cause visual and hearing impairment, coma.

Treatment and rehabilitation of children

In the treatment of cerebral ischemia in newborns, the main task is to restore impaired blood circulation in the brain. All intact areas of blood vessels are stimulated for maximum efficiency.

The 1st degree of the disease is corrected with the help of a special massage. The doctor may not even consider it necessary to prescribe medications.

All subsequent stages of ischemia are treated exclusively under medical supervision and depending on the symptoms. You cannot delay treatment - this will help avoid huge problems in the future.

Cerebral ischemia is treated with the following drugs:

vasodilators, which improve cerebral blood supply;
nootropic, promoting brain activity;
vitamins;
diuretics.

If the case is particularly complex, the child is hospitalized and prescribed anticonvulsant treatment, IVs and intramuscular injections.

Parents must strictly comply with all appointments. A child with ischemia is advised to have a relaxing massage, baths with soothing mixtures and a ban on visiting crowded places. In some cases, electrophoresis with papaverine is prescribed.

The role of massage in treatment

At the first stage of cerebral ischemia, massage is the main method of treatment. In addition to its main purpose, therapeutic massage has a beneficial effect on the child’s muscle tone and well-being.

You cannot perform therapeutic massage on your own; it must be done by a specialist.. It is most effective to massage 4 times in the first year of life. The interval between courses should be 3 months. Massotherapy promotes

relaxation of the nervous system;
improvement of muscle tone;
improving the general condition of the child.

Consequences

Among the possible mild consequences and moderate cerebral ischemia in newborns:

sleep disorders;
headache;
feeling tired and irritable;
Difficulty studying, lack of concentration.

Severe degree causes in the future

mental disability;
inability to walk;
epilepsy.

It is necessary to carefully study the behavior of a newborn child to promptly identify symptoms of cerebral ischemia.

The disease of the 1st degree responds well to treatment and leaves no consequences. The more time passes from the onset of the first symptoms, the more difficult the treatment will be..

Adults should protect themselves from risk factors as much as possible. These are obesity, alcohol abuse, smoking and stress.

Scientific medical knowledge on chronic cerebral ischemia is demonstrated in this video:

Cerebral ischemia is a condition in which the organ suffers from oxygen deficiency. Cerebral ischemia in newborns is serious problem perinatal neurology, because in modern medicine No effective ways treatment of this disease. The brain is the most sensitive organ to oxygen deficiency. If it is left without adequate supply for some time, some neurons die. But in young children, unlike adults, nerve cells are numerous and capable of restoring their functions, which reduces the likelihood negative consequences ischemia. Effective and timely treatment can help restore brain tissue.

Degrees and reasons

There are 2 degrees of this pathology:

Cerebral ischemia grade 1: the infant experiences periods of excessive lethargy or, conversely, activity. This condition lasts up to 7 days. With mild cerebral hypoxia, a child rarely develops significant neurological disorders.
Cerebral ischemia of the 2nd degree is characterized by a longer period of behavioral disturbances, the appearance of seizures, twitching of the limbs, and frequent and profuse regurgitation. The child has an increased risk of developing neurological disorders in the future (mental and speech development, visual and hearing impairments, etc.).

Mild cerebral ischemia in newborns develops if:

a woman while carrying a child led an unhealthy lifestyle (smoked, drank alcoholic drinks, did not follow a daily routine, moved little, was in a state of severe stress);
The expectant mother's chronic diseases worsened during pregnancy.

These negative factors contribute to the development of feto-placental insufficiency, which negatively affects the oxygen supply to the fetus, as well as the development of the unborn child.

The risk of such an anomaly in a baby increases if it was given birth to by a woman under 17 years of age. There is also an increased likelihood of developing an adverse condition in an infant born as a result of late pregnancy(after 40 years).

Grade 2 cerebral ischemia develops for the following reasons:

late gestosis;
oligohydramnios;
abnormal structure of the placenta and (or) umbilical cord;
premature birth or, conversely, post-term pregnancy;
high blood pressure in a pregnant woman;
birth injuries;
intrauterine infections.

Symptoms

With mild cerebral ischemia in a newborn, the following signs are observed:

poor sleep, crying even while staying in comfortable conditions;
weakening of the sucking (swallowing) reflex;
facial asymmetry, strabismus (less commonly).

Stage 2 of this pathology has the following symptoms:

increase in head size;
increased nervous excitability ( disturbing dream, tremor of the chin and lips, involuntary shudders, monotonous crying for no reason);
“marbled” skin (spotted red or bluish stains on the child’s skin);
gastrointestinal disorders (bloating, diarrhea, frequent and profuse regurgitation);
increased muscle tone;
convulsions;
cessation of breathing;
frequent episodes of loss of consciousness.

Diagnostics

If the parents of a newborn notice some of the listed symptoms in their child, they should immediately contact a pediatric neurologist. The sooner treatment is started, the faster baby will recover. The following studies are indicated for infants suspected of having this pathology:

pulse oximetry (determination of oxygen saturation in the blood);
magnetic resonance imaging (MRI) of the brain;
Doppler examination of cerebral vessels;
ultrasound examination (ultrasound) of the brain;
echoencephalography.

Treatment

Therapy is aimed at restoring impaired blood circulation in the brain and eliminating the effects of hypoxia. The child’s body weight, type of delivery, and the presence of other pathologies are taken into account. First of all, a child with cerebral ischemia is provided with comfortable living conditions:

maintain a daily routine;
often go for walks fresh air(the baby is dressed according to the weather);
do not overfeed;
in the house where the baby lives, they take care of a calm environment.

Young patients with mild cerebral ischemia do not need drug therapy; treatment is limited to massage and recreational exercises. In the first years of life, it is important to observe a protective regime, which consists in eliminating factors that negatively affect the child’s psyche (aggression, noise, overabundance of impressions).

Grade 2 cerebral ischemia in newborns requires intensive treatment. The baby is prescribed:

anticonvulsants (Phenytonin, Phenobarbital);
drugs that support normal heart function (Dopamine, Dobutamine);
diuretics (Furosemide, Lasix);
nootropics (Actovegin, Phenibut, Glycine, Encephabol, Pantogam).

The drugs are given to the child in strict accordance with the regimen prescribed by the doctor. If taking medications caused adverse reactions, you should immediately consult a doctor.

For cerebral ischemia of the 2nd degree, a relaxing massage and therapeutic exercises. However, with convulsions physical methods do not apply. It is prohibited to treat pathology using traditional methods, because the fragile body of a newborn does not tolerate such experiments.

Parents of a child diagnosed with cerebral ischemia should carefully monitor the characteristics of his physical and mental development and report them to your doctor. Often children with a similar diagnosis begin to hold their heads up, roll over, sit up, walk, and talk later than their peers. But adequate therapy helps normalize the development of the child.

Consequences

The risk of negative consequences depends on the severity of the disease, the effectiveness and timeliness of treatment, as well as the presence of other pathologies in the patient. Consequences of the disease:

weather dependence;
headache;
insomnia at night or drowsiness during the day;
retardation in speech and mental development;
epilepsy;
difficulties with communication;
impaired concentration;
excessive nervous excitability or aggression;
psychical deviations;
learning disabilities.

In the most severe cases, the baby develops infantile cerebral paralysis(cerebral palsy).

A child who has the negative consequences of cerebral hypoxia should grow up under the supervision of a child psychologist, speech therapist and psychiatrist.

Cerebral ischemia is a disease in which a lack of oxygen leads to damage to parts of the brain. Grade 1 severity of the disease has become common, and is increasingly observed in newborns. The above diagnosis may be one of the most serious problems in normal development child. According to ICD 10, the disease is coded P 91.0 – P 91.9.

Let us consider in more detail the degrees of cerebral ischemia:

1st degree

Talking about mild form disease and most often manifests itself in newborns in stages of nervous depression or, conversely, excitement. With timely response from perinatologists, the disease passes quickly and without consequences.

Causes

Perinatologists identify factors leading to the occurrence of the 1st degree of the disease. Let's list them:

the presence of diseases in a fertile woman. It is worth observing the manifestations with special care chronic pathologies;
The age of the expectant mother plays a major role in the occurrence of this disease. Lack of oxygen in the fetus (hypoxia) can occur in a woman giving birth who is too young or in a woman who becomes pregnant after 35 years;
The lifestyle of the expectant mother plays a direct role in the development of cerebral ischemia. Drinking alcohol, smoking, drug addiction, non-compliance with the daily routine - these are just a few of the harmful factors;

Symptoms

With this degree of disease, the symptoms in a newborn baby are minor:

the child shudders. Trembling can be observed throughout the baby’s entire body, or separately from the head or upper and lower limbs;
such a child’s sleep is disturbed, crying is observed, for no apparent reason;
when the central nervous system is depressed, lethargy may, on the contrary, be observed, partial absence motor activity, impaired or weakened sucking or swallowing of food;
Facial asymmetry may be visually noticeable, and sometimes squint appears.

Consequences

Considering the mildness of the disease and the timeliness of the prescribed treatment, it is possible to completely eliminate the occurrence of complications. You just have to follow what is done in the hospital. It is worth violating the treatment plan and taking appointments strictly according to the prescribed schedule.

Treatment

The main direction in the treatment of grade 1 cerebral ischemia is to restore impaired blood circulation to the baby’s brain as quickly as possible. Remove the effects of oxygen starvation and preserve intact areas of the brain.

Appropriate treatment is selected for each small patient individually, depending on the signs of the disease, his weight at birth, the birth plan (natural birth or C-section), the presence of intrauterine pathology.

Grade 1 (mild), most often does not require special drug treatment, the main thing is to create the most comfortable conditions for the baby. Ventilation and prevention of seizures are the main criteria for treatment of this degree.

2nd degree

A moderately severe condition of a child, in which convulsions, shudders and twitching of arms and legs are added to the depression or excitation of the central nervous system.

At proper care and treatment of the newborn, timely assistance, grade 2 cerebral ischemia is completely curable and leaves no consequences in the future.

Causes

This degree of the disease has more expressed reasons manifestations of the disease, mainly associated with serious pathology in a pregnant woman.

the presence of toxicosis, especially late;
oligohydramnios;
problems with the umbilical cord, placenta;
premature birth, as well as childbirth at a late age;
Grade 2 severity can also occur during childbirth;
systematic increase in blood pressure in the expectant mother, in particular taking antihypertensive drugs during gestation;
damage at the time of delivery;
infection of the fetus.

It has been noted that children born to women under 17 years of age and over 40 years of age have brain pathology in 85% of cases.

Symptoms

Stage 2 of the disease is more severe than the first and is manifested by significant impairments:

CSF fluid collects in parts of the brain, so-called hydrocephalus. Intracranial pressure is higher than normal; The head takes on an irregular shape, becomes like a pear fruit, and greatly increases in size;
in more severe cases, the baby may become unconscious, and coordination of movements is severely impaired or completely absent. Convulsions are present, they may be complicated by respiratory arrest;
The color of the baby’s skin changes, it becomes “marbled”. There are also visible changes in the organs of the gastrointestinal tract, which manifest themselves in the form of bloating, flatulence, diarrhea or constipation;

Consequences

With the 2nd degree of cerebral ischemia, even with the most correct and timely treatment, the child may begin the following complications:

mental retardation of the child in development;
changes in sleep patterns, which will manifest itself as insomnia at night, and drowsiness during the day;
frequent irritability and fatigue;
causeless headaches;
isolation, reluctance to take part in group games, ignoring communication with peers;
difficulties in educational process;
physical inactivity. Such children may remain in one place or in a certain position for more than five minutes.

In some cases, complications of stage 2 disease can lead to disability.

Treatment

The second degree occurs more aggressively in a newly born child.

Medication

Drug treatment consists of a mandatory appointment anticonvulsants. They are prescribed based on the weight and age of the baby.

To level out the manifestations of edema, a “diuretic” is indicated, most often it is Lasix or furosemide. Good effect They will give you drugs designed to stimulate metabolism in cells.

Auxiliary

Sometimes pediatricians prescribe massage (relaxing). It will significantly improve blood flow to the organ suffering from the disease and increase metabolic processes. Since children with this pathology often lag behind in physical education. development, they are shown classes with an instructor in therapeutic exercises. After simple training, parents will be able to continue studying at home.

Working with a psychologist, speech therapist, and increased attention to the development of the child are far from unnecessary methods of treating pathology and preventing its complications.

ethnoscience

Traditional medicine must be approached with great caution, because infants are capable of giving an inadequate reaction to the usual compositions of medicines. Yes, and with the selection of dosages, annoying mistakes can occur, with far-reaching unpleasant consequences.

Diagnostics

TO diagnostic procedures include:

blood analysis. It will indicate the level of decrease in oxygen in the blood, and carbon dioxide, on the contrary, can increase in the blood to its maximum level. The blood pH shifts to the acidic side.
examination methods using computed tomography, magnetic resonance imaging, as a rule, does not reveal any deviations.

In babies, the same indicators of decreased oxygen and increased carbon dioxide are present in the blood as in the first degree.

An MRI of the brain shows small lesions, a type of cyst, in the brain tissue.

When diagnosed using CT, it is possible to detect a reduced density of the meninges(fabrics).

Doppler encephalogram shows a decrease in the level of blood flow in the bloodstream cerebral artery. In full-term babies, blood flow is reduced in the middle part of the artery, and in premature babies - in the anterior part of the artery.

It would be useful to go through the full laboratory test, which will help diagnose concomitant pathologies on early stages.

Preventive measures

After discharge from the maternity or somatic department, children suffering from cerebral ischemia of 1st and 2nd degrees are registered at the clinic at the place of residence.

Every month until a year of life, and if after past illness If complications arise, then until the age of three, the baby should be shown to a neurologist monthly.

Once every six months, if necessary more often, an examination using CT or MRI should be performed.

Every six months, children with the second severity of the disease should be prescribed a course of nootropic and diuretic drugs.

Parents should learn to constantly monitor their child, observe his behavior, manner of communication, monitor sleep and waking hours. Special attention it is necessary to devote attention to understanding the world around us. All these observations, which are worth remembering or writing down, must be told during an examination by a neurologist in order not to miss any abnormalities in the nervous system.

If small child There is increased irritability or aggressiveness; you should not provoke it. The same applies to external stimuli: loud television, noisy companies, entertainment venues. Under no circumstances should the child be allowed to become irritated, lose his temper, or become overexcited.

It is best to arrange frequent walks in the fresh air, away from the noise of passing cars, this way his nervous system will recover faster.

In most cases, newborns with grades 1 and 2 cerebral ischemia may be slightly delayed in physical development. They begin to hold and raise their head and shoulder girdle later, and also later master the skills of sitting and standing up. Therefore, it is recommended to do a relaxing massage and special therapeutic exercises to strengthen muscles every day.

Reasons for development

Ischemia in newborns occurs as a result of hypoxia, which can occur during different stages fetal and infant development:

Intrauterine hypoxia, or asphyxia (suffocation), develops as a result of:
- disorders of placental circulation;
- too fast or prolonged labor;
- umbilical cord damage during childbirth.
Postpartum hypoxia develops as a result of:
- infection of the newborn;
- prematurity of the child;
- heart defect in a newborn.
Hypoxia due to low blood pressure in an infant can be caused by:
- bacterial infection;
- bleeding associated with liver injuries, bleeding disorders, etc.

Development ischemic encephalopathy in newborns is often associated with factors depending on the mother: her age, lifestyle during pregnancy, the nature of gestation, etc.

The risk of developing encephalopathy in a newborn increases if:

woman refers to age category before 18 or after 35 years;
during pregnancy the woman suffered acute diseases or had chronic disorders, such as pathologies of the heart and blood vessels, anemia, hypertension;
the woman suffers from pathologies associated with poor blood clotting or thrombosis;
a woman suffers from alcohol or nicotine addiction;
the pregnant woman experienced bleeding at any stage;
the pregnant woman was in a state of preeclampsia, characterized by swelling, high level blood pressure and the presence of protein in the urine;
turbidity of the amniotic fluid has occurred;
polyhydramnios was diagnosed during pregnancy;
there was a malnutrition of the placenta or it detached too early;
blood circulation between the uterus and placenta is disrupted;
multiple pregnancy;
at the time of birth, the woman in labor had a temperature above 38°C;
birth occurred at less than 37 or more than 42 weeks of pregnancy;
an emergency caesarean section was performed;
complications arose during childbirth that required the use of drug stimulation;
the fetus became entangled with the umbilical cord during intrauterine development or during childbirth.

Symptoms and signs

Symptoms ischemic lesion brain in a newborn appear immediately after birth or within a few days after it. Depending on the severity of functional damage to brain cells, 3 stages of the disease are distinguished, each of which has characteristic signs.

1st degree

This degree of the disease is the mildest. Its signs appear at 1 week of a baby’s life and may go away without medical intervention. However, if grade 1 cerebral ischemia is diagnosed, the child should remain under the supervision of a specialist even after discharge from hospital. maternity ward.

Manifestations of first degree encephalopathy include:

severe headaches, as a result of which the child worries, cries, or sleeps poorly;
oppressed general state a newborn, which is determined visually by a pediatrician;
hypertonicity of muscle tissue: they are very tense, resulting in a dense feel;
increased response of elbow and knee tendon reflexes, which are tested by easy tapping your fingers on the elbows and knees.

It is extremely difficult to recognize grade 1 cerebral ischemia in newborns and infants in the early stages, and the later therapy begins, the lower the chances of full recovery.

2nd degree

Cerebral ischemia of the 2nd degree in newborns manifests itself already on the 1st day of the child’s life, and with timely and correct therapy, many of the signs disappear after 2-4 weeks. However, this stage of the disease is dangerous because in the future it can lead to the development of central nervous system pathologies of varying severity.

Pathology of the 2nd degree in a newborn manifests itself as:

periodic cessation of breathing during sleep;
holding your breath;
slowing heart rate;
blue lips;
weakening of muscle tissue tone;
weakening of innate reflexes: grasping and sucking;
impaired coordination of movements;
paleness or blueness skin;
fainting resulting from arterial hypertension and disruption of neural connections.

At this stage, the development of hydrocephalic syndrome is possible, in which due to the accumulation of fluid in the peri-cerebral space, an increase in the size of the head occurs. The child develops intracranial and arterial hypertension accompanied by severe headaches.

At this stage coronary disease brain tissue is formed with disturbances, as a result of which the most important reflexes do not develop correctly.

3rd degree

This degree of cerebral ischemia in newborns is the most severe. Against the backdrop of changes taking place in the central nervous system, the risk of developing irreversible consequences increases. Due to insufficiency of cerebral circulation, part of the brain tissue dies and the majority is vitally important functions becomes impossible. Stage 3 ischemia in a newborn can be detected already in the first hours of life. It appears as:

complete absence of innate reflexes;
damage to areas of the brain responsible for spontaneous breathing and food intake;
violations heart rate and light perception;
difficulty supplying blood to the brain, resulting in increased intracranial pressure;
loss of consciousness;
periodic immersion in a coma;
seizures;
strabismus.

Stage 3 cerebral ischemia in a newborn is difficult to treat. Immediately after birth, infants with this diagnosis are placed in intensive care. In most cases, they require artificial ventilation. There is a high probability of death, and if treatment is successful, the child will subsequently be severely retarded in physical and mental development.

How is it diagnosed?

To establish accurate diagnosis cerebral ischemia in a newborn, visual observation is not enough; it is necessary to carry out a series of laboratory and functional studies.

General examination of the patient includes:

determination of weight, height and assessment of indicators on the Apgar scale;
determination of presence and strength unconditioned reflexes: grasping, sucking, swallowing;
assessment of respiratory and cardiac functions;
determination of the child’s nervous status.

To avoid overdiagnosis, it is important to conduct a general examination of the child while he is awake and calm.

Laboratory tests include a general blood test, as well as specific blood tests showing:

clotting;
electrolyte levels;
amount of oxygen and carbon dioxide.

From methods functional diagnostics cerebral ischemia in children is used:

Ultrasound. This diagnostic method shows the presence of hemorrhages in the brain and its swelling.
Duplex ultrasound examination of arteries to analyze blood circulation in vessels.
Angiography to detect disorders in the functioning of the brain: aneurysms, narrowing of arteries, thrombosis.
MRI. Used for stages 2 and 3 of the disease.
EEG (electroncephalography) - prescribed for the most severe degree of cerebral ischemia in a newborn. This method research allows:
- assess the integrity of the brain and its activity;
- establish the degree of tissue damage;
- identify hidden convulsive readiness.
Additionally, an ECG, ECHO-CG, and X-ray may be prescribed.

Treatment

the main objective treatment of cerebral ischemia in newborns - restoration of vascular circulation and provision of normal operation damaged areas of the brain. Despite the great achievements of medicine in the treatment of ischemic encephalopathy, effective means There is no cure for the pathology yet.

Stage 1 of the disease is easiest to treat. There is no need to use medications - a massage is enough. Regular massage courses conducted by a specialist help relax muscles, restore blood circulation and improve the supply of the required amount of oxygen to the brain. Massage therapy effectively resists the progression of ischemia and eliminates the possibility of developing negative consequences. In addition to massage, the room where the child is located should be regularly ventilated.

Despite the favorable prognosis, children with grade 1 ischemic encephalopathy should be registered with a neurologist for at least 3 years.

Moderate and severe forms of the pathology are often complicated by cerebral palsy and require hospitalization. The treatment regimen is selected individually, but it always includes the following drugs:

stimulating blood circulation;
restoring brain functions;
anticonvulsants;
anticoagulants for blood thinning;
vasodilators (in case of intracranial pressure);
diuretics (in case of slight cerebral edema or hydrocephalus);
strengthening the child’s body’s defenses.

In rare cases, it may be necessary to remove a blood clot. It's done operationally.

To relax muscles, massage and electrophoresis are prescribed.

Stage 3 is the most severe and requires complex and immediate therapy. Most often, a child with this diagnosis requires resuscitation care, because he cannot breathe on his own and is often unconscious. Once a blood clot is detected, it should be removed as quickly as possible. This is done using a surgical method or a more gentle method, in which a tube is inserted into the area where the blood clot is formed, and through it, a blood thinning medication is inserted. To avoid the formation of blood clots in the future, the patient is prescribed anticoagulants.

Hydrocephalus at this stage is extremely dangerous, because it compresses the brain tissue, preventing it from functioning normally. To alleviate the patient's condition, he is prescribed diuretics. In the most severe cases, they resort to installing a shunt, with the help of which water from the peri-cerebral space moves into abdominal cavity and from there it is deduced naturally. The tube must be constantly monitored and replaced with a more suitable size as the child grows.

Since 2010 for treatment severe cases ischemic encephalopathy, they began to use the method of hypothermia, which consists in reducing the patient’s body temperature by 3-4°C, which prevents the progression of brain tissue necrosis.

Drug and physiotherapeutic treatment for severe stages prescribed individually.

Consequences

The consequences of cerebral ischemia in a newborn depend on the severity of the disease, concomitant pathologies, timely therapy and well-planned rehabilitation.

The first degree in most cases passes without a trace. Sometimes the consequences manifest themselves in the form of hyperactivity.

With pathology of 2nd degree of severity, death is already possible. In 10-20% of survivors, disorders manifest themselves in the form of frequent regurgitation and increased intracranial pressure. Such violations are considered moderate. However, more than 50% of children with stage 2 disease are at risk of developing severe consequences in the distant future, such as:

isolation;
autism;
physical inactivity;
attention deficit disorder;
mental development disorder;
increased irritability;
headache;
sleep problems;
high blood pressure;
difficulties in communication and learning;
epilepsy (in the most severe cases).

With stage 3 pathology, 50% of newborns die in the first days or after some time as a result of the development of severe infectious diseases. 80% of survivors experience irreversible changes in the functioning of the brain, resulting in the development of dementia, cerebral palsy, severe autism, 10% have moderate developmental disabilities, and only 10% of newborns can avoid the consequences.

How to prevent illness from occurring

To prevent the development of cerebral ischemia in a child, it is necessary to minimize risk factors. When planning a pregnancy, you should:

give up alcohol and smoking in advance;
Go to balanced diet and begin to observe a work and rest schedule;
take daily walks in the fresh air;
play sports, observing moderate loads;
normalize body weight and maintain it;
protect yourself from infectious diseases;
monitor hemoglobin levels and blood pressure;
avoid stressful situations;
be regularly examined by a doctor and follow all instructions;
If you experience the slightest ailment, you should immediately go to the hospital.

By following these simple rules, you can give birth healthy child. If the disease does appear, then it is necessary to as soon as possible contact a specialist and start treatment. In this case, the chances of a full recovery increase.

Types of pathology

Diagnosis of ischemia

Consequences

Treatment

General information

Classification by severity

Cerebral ischemia in premature infants

Symptoms in newborns

Causes

Signs in children under one year of age

Treatment and rehabilitation of children

The role of massage in treatment

Consequences

Degrees and reasons

Symptoms

Diagnostics

Treatment

Consequences

1st degree

Causes

Symptoms

Consequences

Treatment

2nd degree

Causes

Symptoms

Consequences

Treatment

Medication

Auxiliary

ethnoscience

Diagnostics

Preventive measures

Related video 🎞

Reasons for development

Symptoms and signs

1st degree

2nd degree

3rd degree

How is it diagnosed?

Treatment

Consequences

How to prevent illness from occurring