Perinatal encephalopathy. Perinatal encephalopathy in children under one year of age and its consequences

What is perinatal encephalopathy: a lifelong sentence or a common treatable disease?

Encephalopathy is an organic lesion or damage to human brain tissue by various factors.

The perinatal period is the period from the 28th week of pregnancy to the seventh day after birth. The perinatal period consists of three parts: antenatal (from the 28th week of pregnancy to childbirth), intranatal period (the period of childbirth itself) and postnatal (from childbirth to the seventh day of life).

Perinatal encephalopathy in children - severe and very dangerous disease with a huge number of consequences, received by a child during the perinatal period and representing a lesion of the most important organ that forms a person’s personality - the brain.

The degree of danger of perinatal encephalopathy in newborns depends on the degree and severity of damage to brain tissue, as well as on the specific type of affected area. First of all, a serious lesion can disrupt the physical-motor and rational functions of the body. Consequences of perinatal encephalopathy: impaired vision, hearing, speech (if the speech center is affected), convulsive activity, memory and consciousness disorders, paralysis - complete or partial, general weakness, frequent dizziness and loss of consciousness, delayed psychomotor development, and much more, since the concept of encephalopathy is a very general term for a huge number of disorders, some of which may not even appear.

Many modern mothers, having heard such a diagnosis, unfortunately, try to terminate a long-awaited pregnancy or abandon their children in the maternity hospital, fearing that they will end up with a severely disabled or mentally handicapped child. But with such a diagnosis often made, most children are able to lead an active, full-fledged lifestyle, if the diagnosis is made on time and treatment is started.

You shouldn’t write your baby off and take the diagnosis as a death sentence. All human organs have increased regeneration at an early age, which is especially pronounced in infants, and the consequences of perinatal encephalopathy in adult life may not even appear, it is only necessary special treatment, care and proper lifestyle.

Consequences in adulthood

In adult life, the disease suffered at an early age can have residual severe consequences:

Epilepsy.
Mental retardation.
Violation of any body functions.
psychoneurological diseases.
Autonomic-visceral dysfunctions are disruptions in the functioning of any internal organs due to incorrect signals sent by the brain.
Disorders of memory and consciousness.

But with proper care you can minimize possible risks:

Hyperactivity syndrome and attention disorders.
Headaches and tinnitus, dizziness.
Physical weakness, fatigue and increased morbidity.
Lack of activity and lack of initiative.
Narrowed circle of interests.
Absent-mindedness.
Tendency to depression.

With minimal lesions or lesions of not too vital parts of the brain and a timely diagnosis, complete recovery from perinatal encephalopathy in newborns is also possible. Almost all sick children in adulthood are fully functional citizens who can take care of themselves.

Probable causes

Encephalopathy in newborns can be caused by a huge number of factors, which explains its wide prevalence. Intrauterine development the child and his nervous system is such a fragile process that it is extremely easy to be knocked down by any negative influence. The placental barrier, of course, is a great protective force of nature, but, unfortunately, it cannot protect from everything, and especially from the stupidity of the mother herself. Here is an incomplete list of causes of perinatal encephalopathy in children:

The most common reason for diagnosis is pregnancy pathologies, all kinds of birth injuries received during labor disruption or medical error, shock to the abdominal area, thermal overload during pregnancy, etc.
In second place is toxic encephalopathy in newborns, caused by the penetration of harmful toxins, most often of alcoholic, narcotic, nicotine or medicinal origin, through the placental barrier.
In third place is encephalopathy in infants, caused by fetal hypoxia for various reasons.
An autoimmune conflict caused by a difference in the Rh factors of the blood of the mother and child carries the risk of this disease.
Unsuccessful independent attempts to abort unwanted pregnancy cause not only perinatal encephalopathy in newborns, but also many other serious abnormalities.
Chronic diseases and infectious diseases suffered by the mother during pregnancy can be transmitted to the child and destroy the fragile process of fetal formation. Thus, infection with rubella during pregnancy is a factor in its mandatory medical termination at any stage.
The borderline age of a woman or a man may be the cause of the production of defective germ cells, which as a consequence leads to developmental disorders, including prenatal encephalopathy.
Early age of parents when reproductive system parents are underformed.
Stress during pregnancy does not seem to be a problem for new mothers. a serious factor risk, however, excess hormones easily penetrate the placental barrier and are transmitted to the child’s nervous system. Excessive levels of adrenaline and cortisol burn neurons in adults, and an undeveloped child’s brain can be seriously damaged, because during the period of intensive development, every cell from which this or that organ or part of the brain ultimately becomes is counted.

Prematurity of the fetus causes in newborns, expressed in the underdevelopment of its parts. This syndrome may easily go away during age-related development, or it may, on the contrary, remain if the development of the brain has been stopped or disrupted by some factors.
Malnutrition of the mother is another cause of various developmental abnormalities, which is rarely taken seriously. The fact is that all the organs and cells of the child are formed from substances received by the mother’s body. If the mother is sharply lacking some substance, vitamin or mineral, then the body’s self-defense mechanism turns on, which does not allow the baby to take the last remnants. Lack of necessary building material– this is a disruption of the entire process of constructing a new organism, resulting in deviations physical development, low quality of immunity and muscular system, weakness and underdevelopment of internal organs, as well as deviations in the development of the nervous system, including encephalopathy of the newborn. Periodic desires expectant mother ice cream at three in the morning or jam from potatoes is not a whim caused by hormonal mood swings, but a child’s real need for building materials.
A disturbed ecological situation around a pregnant mother can be affected by a whole range of reasons that cause disturbances in its natural course. There is stress, toxin poisoning, hypoxia due to carbon dioxide, and many other factors.

A huge number of traumatic factors surrounding a pregnant mother in modern world, led to the spread of the diagnosis of perinatal encephalopathy in the newborn. In most cases, these are minor disorders that go away by adulthood or do not cause significant symptoms. Many newborns, without undergoing a special examination, suffered this syndrome unnoticed by their parents and doctors. But there are also the opposite cases, when a small deviation does not return to normal over time, but, on the contrary, grows and worsens with development, causing irreparable harm to the child. For timely detection, it is necessary to have an idea of the symptoms of encephalopathy in newborns and promptly consult a doctor at their first manifestations.

Symptoms of perinatal encephalopathy

Identify the symptoms of encephalopathy in infants early stages development is very difficult. The fact is that small deviations in the erratic movements and incoherent cooing of a newborn are invisible to an untrained eye and become noticeable only by the age of six months, and mental disorders even later - already in the conscious period.

Perinatal encephalopathy, symptoms in newborns:

Absence or weakness of the sucking and or swallowing reflex.
Deviations in the muscle tone of the newborn.
Too violent a reaction or lack thereof to various stimuli.
Sleep disorders. Restless sleep. Sleepless nights with constant crying.
Sharp, rapid raising of arms and legs.
Frequent regurgitation.
Convulsions and epileptic seizures.
High or low blood pressure.

Perinatal encephalopathy in older children can manifest itself as:

Syndrome of increased excitability.
Convulsive syndrome.
Lethargy, inactivity, apathy, absence of any reflexes, depression of vital functions. Collectively, these symptoms are called “comatose syndrome.”
Increased intracranial pressure caused by a consequence of perinatal encephalopathy - excess fluid in the brain (Hypertension-hydrocephalus).
Hyperactivity.
Violation motor functions, increased awkwardness and carelessness.
Vegetovascular dysfunction, causing both constant belching, indigestion and stool disorders, as well as various skin symptoms.
Retardation in physical and or mental development.
Depression.
Sleep disorders.
Speech disorders.
Lack of clarity in expressing your thoughts.
Migraines and acute headaches.

Varieties

Perinatal encephalopathy is primarily divided into simply encephalopathy with established cause occurrence and perinatal encephalopathy unspecified.

Perinatal encephalopathy unspecified - perinatal encephalopathy in newborns caused by unspecified factors (the cause of its occurrence is not clear).

Encephalopathy unspecified is a more difficult type of encephalopathy to treat, since treatment is based only on minimizing the consequences without eliminating the causes of its occurrence, which can result in residual encephalopathy at an older age.

Residual encephalopathy is the residual manifestations of the disease or its consequences some time after the disease or brain injury.

Unspecified encephalopathy in children is dangerous due to lack of follow-up treatment and confusion of symptoms with other disorders of the child’s nervous system.

Unconfirmed encephalopathy in newborns is a type of disease in which symptoms of encephalopathy appear that are not caused by brain damage.

There are also subtypes of perinatal encephalopathy:

Posthypoxic perinatal encephalopathy caused by lack of oxygen.

Transient or dyscirculatory - caused by impaired blood circulation in the brain.
Hypoxic-ischemic – arising against the background of hypoxia, complicated by circulatory disorders.
- caused by the action of toxins.
Radiation encephalopathy – developed under the influence of radiation.
Ischemic encephalopathy - caused by destructive processes (destruction processes) in certain areas of brain tissue.
Encephalopathy of mixed origin, most often related to unconfirmed encephalopathy in newborns.

This is not the entire list of encephalopathic subspecies, subdivided according to the causes of occurrence and area of localization of the disease.

Diagnosis of encephalopathy

The presence of symptoms characteristic of the disease is not yet a basis for making a final diagnosis. If encephalopathy is suspected, which is quite easily confused with other diseases of the nervous system, thorough examination:

General tests that reveal inflammatory processes, including in the brain, and disruption of the body systems.
Magnetic resonance imaging.
Electroneuromyography – modern method, testing the sensitivity of peripheral nerve fibers.
An electroencephalogram, which detects epileptic signs by recording the electrical potentials of the brain.
Neurosonography is an ultrasound scan of a child’s brain, which is performed on almost all children as a preventive measure.

Prognosis for children who have had the disease

In most cases, even in the absence of obvious symptoms of encephalopathy, automatic preventive examination is carried out for all risk categories, which now include the majority of the world's population.

At early diagnosis and not too advanced brain lesions, the child most often recovers and has no deviations in the future. Such cases are the most common, since the plasticity of the growing child's body very high. Even children who have developmental disabilities can become independent, practically healthy people.

Epilepsy.
Decreased activity.
, small psychical deviations etc., which do not overly poison the patient’s life and do not interfere with the people around him.

Severe cases consequently entail more dire consequences:

Paralysis.
Mental disability.
Disability.
Early mortality.
Life restrictions (ban on certain products, mandatory procedures, etc.)

Severe consequences occur quite rarely and mainly in the absence of proper treatment and care, which is most often the fault of parents leading an immoral lifestyle (alcoholics, drug addicts) or in low-income or large families where there is not enough money or time for proper care for the baby, or a cruel decision was made to direct them to normal children, and not to bother with a defective child. With the right efforts, severe injuries can have very moderate consequences.

Treatment of a child

Self-medication of perinatal encephalopathy in children is out of the question.

Treatment takes a lot of effort and is carried out exclusively with medication and physiotherapeutic methods. It is very long-term with constant monitoring by the attending physician.

With mild and moderate symptoms, sick children remain on home treatment, which consists of taking medications, physiotherapeutic procedures and periodic observation.

Severe disorders are treated exclusively in a hospital and may even require surgical intervention, for example, in case of hydroencephalic syndrome or damage caused by various tumors, hematomas or death of too large areas.

Treatment is prescribed in a variety of ways, depending on the type and causes of damage, and consists of several interconnected blocks:

Eliminating the cause of the disease.
Treatment of damaged tissue.
Normalization of the nervous system and stabilization of its signals.
Restoring body functions.
General rehabilitation therapy.
Prevention of resistance.

As a restorative therapy and additional assistance in treatment, they often resort to procedures from traditional medicine, which can only be prescribed by a doctor. By independently interfering with the course of treatment, parents can cause irreparable harm to their child.

Prevention of disease in newborns

The diagnosis of perinatal encephalopathy, of course, in most cases is not a death sentence, however, it is much easier to prevent its development in a baby than to deal with the consequences all his life.

There are cases when the mother is powerless to do anything: an accidental blow or disrupted labor, but often the cause of the disease is simply an incorrect lifestyle or genetic predisposition.

Modern medicine has already discovered many ways to deceive nature at the genetic level and give birth absolutely healthy baby at almost any age and with any genetic pathologies. It is enough to plan your pregnancy correctly and conduct a thorough examination, based on which you can choose the right method of action.

It is also easy to insure against accidents by preparing for pregnancy in advance and preparing for childbirth for all 9 months. In order to avoid all kinds of birth injuries, you do not need to refuse a cesarean section, which has become a very common and fairly easy procedure, if there is even the slightest indication for it, and also choose in advance good hospital where the birth will take place.

Pregnancy lasts only 9 months and many women experience it only once or twice in their lives. This is not such a long period of time in which you can be patient and take care of your child, while at the same time saving yourself from big troubles in the future.

One of the most terrible diseases is encephalopathy in children, which can have either a congenital form (perinatal) or acquired during life. The disease itself is a diffuse brain disorder, which in children manifests itself in an accelerated form of development.

Consequences of encephalopathy in children

As it became known only recently, the perinatal form of the disease in newborns can be inherited. However, this information is unspecified. Symptoms in the youngest children are not as pronounced as in adults, and therefore it is rarely possible to diagnose the disease in time and take measures to eliminate it. The most a terrible consequence encephalopathy in newborns is a lack of supply to the brain nutrients(for example, when the bilirubin form of encephalopathy occurs). As a result, nerve cells acquire signs of dystrophy and die, due to which important departments and functions of the body stop developing.

Treatment should also be aimed at eliminating swelling of the brain. It is the increase in brain size that leads to enlargement of the head in children whose skull has not yet formed to the proper extent. Consequences - hydrocephalus, Down syndrome, cerebral palsy and this is not the entire list; an unspecified cause of the anomaly may occur.

Types of encephalopathy

The childhood form of the disease is no different from the adult form according to the classification - encephalopathy can be congenital hereditary or developed in the womb, so to speak, perinatal and acquired due to the influence of harmful factors on the brain area. The symptoms of both forms of encephalopathy in newborns or adult children are similar.

The disease can be caused not only by non-compliance with the diet during pregnancy, but also by birth trauma - such cases of residual encephalopathy account for about 8-10% of all registered cases.

The children's nervous system is very unstable and delicate, especially when receiving traumatic brain injuries, there is a risk of developing consequences even some time after treatment has been provided. Compare: if a child can get a concussion only from jumping from a great height or sudden braking while running, what could cause a rupture of the vessel?

Discirculatory or toxic

This form of brain disease differs from residual disease in that it can cause organic changes in neurons due to the effects of vascular diseases or the entry of toxins into the blood. This may be due to an unspecified reason, or due to the following factors:

Vascular insufficiency.
Arterial or venous aneurysm.
Blood diseases - toxicoplasmosis, leukemia, bilirubin deficiency or elevated level, etc.
Viruses and infectious diseases - from jaundice (Botkin's disease) to hepatitis, influenza with complications, pneumonia.
Diseases of other organs, etc.

Signs of encephalopathy begin to appear in children with sleep disorders: the child has trouble falling asleep and is capricious. His perception deteriorates, his psyche suffers. All these are symptoms of the so-called pseudoneurasthenic syndrome. It includes dizziness and unsteadiness when walking, problems with blood pressure, and failure of the brain to perform the work of the organs of hearing or vision. Since the children's nervous system is quite fragile, sudden mood swings may occur - tearfulness, increased activity or consequences of epileptic encephalopathy in children.

If treatment is not prescribed on time, perinatal or other encephalopathy that is not specified during the diagnostic process will lead to more harmful abnormalities in the functioning of the brain. Stagnation of consciousness will become permanent; for children it is like being in prostration. Frequent fainting, asymmetry of tendon reflexes, and increased muscle tone in newborns and older children are possible. Finally, symptoms will often manifest as vegetative-vascular dystonia and lability. As for the emotional state, it is accompanied by deterioration of attention and memory in children.

Perinatal

Another form of brain disease is encephalopathy, which appears either in the last 12 weeks of pregnancy or during childbirth. The cause may be unspecified - stress, trauma, poor nutrition, so specific disease suffered by the expectant mother. For example, anemia or pneumonia.

To prevent encephalopathy in newborns, it is recommended to monitor your diet, walk in the fresh air and completely relieve yourself of stress. You should also be careful with drinking coffee, chocolate, especially alcohol and cigarettes - even passive smoking provokes a disease such as perinatal or a form of residual encephalopathy of the brain in newborns. By the way, even if the disease could not be avoided (birth trauma), treatment in the first weeks of life is quite easy, and the chances of completely getting rid of the consequences by 12 months of life are 90-95%.

Bilirubin

This form of cerebral encephalopathy occurs due to a hemolytic disease, which is caused by incompatibility of blood groups between mothers and children. If bilirubin, which has not been processed by the liver, is elevated in the blood - above 0.1-0.2 grams per 1 liter, then it leads to toxic poisoning, that is, to the entry of dangerous substances into the brain area.

Bilirubin disease encephalopathy can be caused by causes of jaundice:

Sepsis.
Birth injuries or injuries received during the life of children.
Toxoplasmosis.
Propensity for maternal diabetes mellitus.
Heredity in children.
Unfinished treatment of intrauterine jaundice.

Symptoms or what happens as a result of damage to the brain, its subcortical nuclei, and cerebellum: tissue metabolism is disrupted, which leads to an inevitable decline in immunity and failure of body functions, as with later residual encephalopathy in children.

The clinical picture divides symptoms into three phases:

Signs appear food poisoning, such as weakness, nausea, decreased skeletal muscle tone. However, conventional treatment for poisoning does not help: babies continue to regurgitate frequently and may refuse to eat.
Symptoms present in kernicterus appear - bent joints, clenched hands. The neck bends painfully, bilirubin encephalopathy can lead to an increase in body temperature and even respiratory failure.
A false effect occurs, which actually indicates that the treatment does not produce results. Usually, a short-term improvement is replaced by a return of symptoms in an intensified form - to cerebral palsy, a mask-like face, overstrain of the back muscles, and rolling of the iris behind the eyelid.

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Treatment of the disease

Each doctor will advise starting a set of preventive and therapeutic measures as soon as the primary symptoms of encephalopathy appear. So, in addition to medications, it is prescribed special diet, in which you need to eliminate as much as possible the consumption of table salt, polyunsaturated fats, cholesterol, and chocolate. Instead, consume more iodine-containing foods, vitamins and ascorbic acid.

Neurologist, website editor

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

What does a PEP diagnosis mean?

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

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

Perinatal encephalopathy: causes

The etiology of PEP may be:

Chronic diseases of the mother.
Transferred during pregnancy viral diseases or exacerbation of chronic diseases.
Incorrect or inadequate nutrition.
Pregnancy at a very young age.
Heredity.
Presence of pregnancy pathologies (toxicosis, threat of miscarriage, etc.).
Pathologies of the birth process (rapid or protracted delivery resulting from assistance during childbirth, etc.).
Unfavorable environment and ecological situation.
Premature birth, birth of a premature fetus.
Intrauterine hypoxia.
Fetal asphyxia during birth.

How can a child exhibit PEP?

There are three periods of PEP :

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

To avoid adverse consequences, it is necessary to carry out timely treatment with AEDs. However, for this it is necessary to diagnose the pathology in time based on the corresponding symptoms.

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

Depression of the central nervous system due to injury or hypoxia.
PEP can manifest itself as lethargy, poor reaction to others, problems with swallowing reflexes, regurgitation and even sucking.
Lack of response to stimuli (coma).
Increased excitability of the nervous system (increased reaction to sound, trembling, anxiety, sleep disturbance, headaches).
Convulsions range from barely noticeable to epileptic seizures.
Combined hydrocephalus with hypertension (increased intracranial pressure due to the accumulation of excess fluid in the head).

Against the background of these symptoms, the following diagnoses may be established in the future:

epilepsy;
motor activity disorders;
vegetative-visceral dysfunction with somatic abnormalities;
hydrocephalus;
developmental delay (speech, mental, motor);
neuroses;
Cerebral palsy, etc.

Symptoms characteristic of early and late recovery period PEP:

increased neuro-reflex excitability;
epileptic symptom;
syndrome of hydrocephalus and hypertension;
vegetative-visceral syndrome;
movement disorders;
symptoms of delayed psychomotor development.

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

How to identify PEP: examinations, diagnostics

Making any diagnosis, including PEP, requires an integrated approach. To do this, the specialist needs to know how the pregnancy proceeded, the peculiarities of the course of the labor period, as well as what symptoms appeared in the neonatal period. To clarify the diagnosis, additional examinations are carried out:

Treatment methods for perinatal encephalopathy

Moderate and severe manifestations of perinatal encephalopathy acute period are treated in hospital. In other cases, it is possible to select an individual regimen, massage, exercise therapy and physiotherapeutic methods for the treatment of PEP. As drug treatment Herbal remedies and homeopathy are most often used.
When hypertensive-hydrocephalic syndrome It is recommended to raise the head end of the crib by 30 degrees. Medications prescribed by the attending physician, taking into account clinical manifestations and neurosonography data. At mild damage a decoction of horsetail, bearberry leaf, etc. is prescribed. In more severe cases The drug Diacarb may be prescribed. It allows you to reduce the amount of cerebrospinal fluid production while increasing its outflow. In especially severe cases, neurosurgical intervention is used.
When pronounced motor abnormalities resort to massage, physiotherapy and physical therapy.
In this case, Mydocalm or Baclofen is prescribed to help reduce it. If muscle hypotension syndrome predominates, drugs are prescribed to improve neuromuscular transmission. This could be Galantomin or Dibazol.
For epileptic syndrome the child is prescribed anticonvulsants(anticonvulsants). The dosage and time of taking medications is determined by a specialist. Massage and physiotherapy in in this case contraindicated.
Lack of timely treatment contributes to mental development disorders.
If observed psychomotor development delay They recommend socio-pedagogical correction together with medications that activate brain activity and improve cerebral blood flow. The range of such drugs is wide: Nootropil, Actovigil, Pantogam, etc.
The treatment regimen is selected individually in each case.
General treatment for all syndromes of this disease is taking B vitamins.

With timely treatment, the signs of perinatal encephalopathy completely disappear by the age of one, or minor symptoms remain that have virtually no negative impact on the development of the child. An unfavorable outcome in severe cases of PEP may be childhood cerebral paralysis or epilepsy.

Diagnosis of “perinatal encephalopathy” or abbr. PEP in Lately is diagnosed in almost every second baby.

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

However, there is no need to panic. Firstly, in many cases, the baby’s parents have no real reasons for grief, because often doctors diagnose a child with a similar problem absolutely without reason. And secondly, perinatal encephalopathy, even when it is indeed confirmed symptomatically, is not one of the hopeless situations doomed to the most unfavorable consequences in its resolution.

The child's body has outstanding healing and restoration abilities. The main thing is to create the most comfortable living conditions for the baby, taking into account the characteristics of his diagnosis and ensure the implementation of proper treatment.

What is perinatal encephalopathy?

Initially, the phrase “perinatal encephalopathy” arose among medical terms in 1976. Abbreviated this diagnosis looks like an abbreviation - PEP.

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

The diagnosis of perinatal encephalopathy indicates disturbances in the functioning of the central nervous system and is a kind of collective unit that combines a wide variety of conditions, syndromes, symptoms and diseases of the fetus or newborn.

Photos

The photos below show children with PEP

Causes of PEP

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

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

The presence of PEP and hypoxia can be assumed by assessing the newly born child on the Apgar scale.

To assign points on this scale, doctors evaluate: breathing, physical activity, reflex processes, baby’s cry, skin color, etc.

A low score indicates the possibility of neurological involvement.

Although even high scores are often not reliable evidence of the absence of problems in the field of neurology: PEDs, hypoxia. It happens that symptoms are detected only during the child’s infancy.

Factors that increase the risk of developing the disease

Circumstances that increase the likelihood of having a child with the disease are as follows:

the birth of a child by a woman with a number of hereditary and chronic diseases;
diseases of an infectious nature in the mother during pregnancy (so-called spot infections are especially dangerous);
improper malnutrition of the expectant mother during pregnancy;
Availability bad habits mothers during pregnancy (smoking, alcohol, drugs);
alcoholism, drug addiction of the child's father;
the birth of a child by a woman whose pregnancy was early;
Frequently a woman carrying a child is in a state of stress;
heavy loads of the expectant mother;
pathologies of pregnancy (toxicosis, threat of miscarriage, etc.);
pathologies of labor (rapid labor, weak labor);
delivery through surgery ( C-section);
malposition;
anatomical features of the structure of the pregnant pelvis;
entanglement of the fetus with the umbilical cord;
birth of a child earlier or later;
fetal hypoxia;
impact on a pregnant woman negative factors environment (inhalation of gases, toxic substances, hazardous work, drug overdose, etc.).

It should be noted that this list is only approximate, since often the factor that provokes PEP cannot be established.

It happens that seemingly healthy parents give birth to a child with significant impairments in the functioning of the central nervous system, although the pregnancy proceeded well.

Symptoms of perinatal encephalopathy by baby's age

In order to make a timely diagnosis, parents of a newborn child should be extremely attentive to such manifestations of the child as:

dysfunction of breast sucking;
faint cry;
throwing the head back;
copious, frequent regurgitation, especially in the form of a fountain;
inactivity, lethargy, lack of reaction to loud unexpected sounds;
bulging of the eyes while they simultaneously drop down, a stripe is noticeable above the iris white– Graefe syndrome or rising sun syndrome;
unexpected bouts of baby crying while sucking on a bottle or breast;
swelling of the fontanel;
restless sleep, difficulty falling asleep.

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

stiffness of movements, difficulties in flexion and extension of limbs;
constant clenching of the handles into fists, unclenching requires effort;
difficulty holding the head while lying on the stomach;
tremor of the chin, hands; shudders, convulsions, twitching;
the gaze is not focused;
monthly increase in head circumference by more than three centimeters.

Alarming symptoms 6 months of life:

lack of interest in the world (toys, people, surroundings);
lack of emotion, unsmiling;
monotony of movements.

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

lack of emotion, complete or partial;
lack of interest in playing with adults;
lack of independent sitting skills;
activity of only one hand when grasping.

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

standing or walking on tiptoes;
pronunciation of mooing sounds;
monotonous, emotionless crying;
The main way to play is to destroy, throw
misunderstanding of simple requests and phrases.

Alarming symptoms by 3 years of life:

gait disturbance;
lack of proper coordination of movements;
lack of social and everyday skills (dressing, buttoning, tying, going to the potty, using a mug, spoon, etc.).

Periods of development of PEP

There are three periods of development of the disease:

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

Diagnostic methods

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

Infrequently in pediatric neurology such examination methods as computed tomography, magnetic resonance imaging. An examination by an ophthalmologist will help determine the presence of the disease indirectly.

Late consequences of the disease

The consequences of AEDs may appear much later than in infancy. Thus, preschoolers who were not previously correctly diagnosed with PEP or were undertreated:

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

During school years, such children may develop:

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

Treatment

During acute course diseases in newborns with pathologies of high or moderate severity Inpatient treatment is indicated for newborns with light current The disease is indicated for treatment at home.

The psychological attitude of adults surrounding the baby becomes important in the treatment of PEP.

An exceptionally friendly environment, full of love and care for the baby, should prevail in the house. This is extremely important for an infant with PEP symptoms. Often used as treatment methods:

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

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

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

Homeopathic and osteopathic treatment has a great effect.

For the syndrome of increased intracranial pressure, drugs with a diuretic effect are used ( "Acetazolamide» together with Asparkam), it is recommended to slightly raise the baby’s head when he is lying down (place a special orthopedic pillow, place something under the mattress).

For symptoms of epilepsy, anticonvulsants are used. Severe forms The course of the disease requires surgical intervention.

Prognosis for recovery

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

In many cases, complete recovery is achieved. However, it should be remembered that, even after the symptoms of the disease disappear, you should remain vigilant by regularly visiting a neurologist.

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

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

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

In structure general defeat nervous system, encephalopathy of perinatal origin accounts for more than 62%, and according to statistics, 3-5% of newborns are born with signs of minimal brain disorders.

Perinatal encephalopathy occurs very often, but is not at all a death sentence, because at the current stage of development of medical technologies, it responds well to treatment. But it is definitely worth noting that early, timely intervention is important; the course of therapy itself is very long and requires constant attention and control from parents.

What is perinatal encephalopathy?

The diagnosis of perinatal encephalopathy implies the presence of diffuse small-focal brain damage; in the context of the studies conducted, the disease can be considered as a consequence oxygen starvation brain tissue or the resulting obstructive mechanisms of the arteries with their narrowing, which impedes normal blood flow and the delivery of oxygen molecules. Also, damage often occurs after toxic exposure, that is, when various diseases under drug influence. In any of these cases, the cortex and subcortical white matter are affected, which, if not corrected in a timely manner, leads to severe consequences, up to tetraplegia and intellectual disability.

Perinatal hypoxic encephalopathy in the overwhelming majority manifests itself syndromically: with inhibition or, conversely, increased excitability of the central nervous system, movement disorders, hydrocephalic complications, convulsive status, delayed motor and speech development.

Perinatal encephalopathy is divided into the following types:

Hypoxic - formed when there is a lack of oxygen supply in the peripheral bloodstream or asphyxia during childbirth. Its subtype is hypoxic-ischemic, when serious destructive processes occur in tissue foci. Etiologically provoked by smoking, stress and alcohol abuse.

Post-traumatic, or residual form - occurs when receiving birth injuries: presentation of the buttocks or transversely, it is provoked by an obstetric error, unfavorable conditions of childbirth, anomalies of labor. It can form either immediately or after months and years. Manifested by migraines, mental problems, intellectual disability, learning difficulties.

Toxic - develops under the influence of toxic substances during infections, consumption of alcohol, drugs, chemical poisoning (lead, carbon monoxide).

Toxic-metabolic – for organ malformations of the fetus, inflammatory processes mother during pregnancy. With intraorganismal metabolic intoxication and the body’s inability to eliminate poisons on its own (for example, bilirubin encephalopathy in hemolytic disease).

Diabetic perinatal encephalopathy is brain damage caused by diabetes mellitus with metabolic disorders.

Radiation - when irradiated with ionizing waves.

Dyscirculatory or vascular perinatal encephalopathy is inherent old age. The reason for this form is vascular damage, with existing diseases such as dystonia, increased intracranial pressure. This form is typical for old people.

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

Transient perinatal encephalopathy is a transient disorder manifested in a short loss of consciousness and alternating deterioration of vision.

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

The acute period lasts up to 1 month of life.

Restorative – early up to six months and late lasting up to a maximum of 2 years.

Initial or period of residual manifestations.

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

Ultrasound (neurosonography) is a safe method for examining tissues, cerebrospinal fluid spaces, and anatomical structures through a non-overgrown large fontanel. Intracranial lesions and their nature can be determined.

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

Doppler sonography is applicable to assess the pathology of blood flow in cerebral vessels.

Carrying out CT and MRI scans is difficult at an older age, since children need to be put under anesthesia.

A trip to the ophthalmologist is required, because changes in the fundus of the eye verify the level.

Examination by a neurologist, with an advisory report and recommendations on further actions.

Causes of perinatal encephalopathy

Risk factors for the occurrence of perinatal encephalopathy include:

— Infectious acute diseases, which occur when a pregnant woman is carrying a child, are especially dangerous, in terms of death, and pneumonia that develops.

— Chronic diseases (heart defects, anemic manifestations, diabetes, disorders in renal system, surgical interventions), hereditary and genetic metabolic disorders, pathology endocrine system, hormonal fluctuations.

— Tobacco smoking, alcoholism, drug addiction.

- The young age of the woman giving birth is up to 17 or over 31 years.

— Adverse environmental influences (ionizing radiation, toxic damage from medicinal substances, salts of heavy metals, air pollution from cars).

— Poor rest and working conditions associated with interaction with chemicals, under the influence of radiation, vibration, physically difficult with heavy lifting.

— Eating disorders, which leads to the development of such a phenomenon as gestosis - internal edema that is life-threatening for children.

— History of repeated medical abortions, true repeated miscarriages and long-term pregnancy.

— Pathology of the pregnancy period itself: threats of miscarriage and the presence of placental chronic insufficiency.

— Anomaly of the birth process: rapid or prolonged, early release of water and, as a result, the anhydrous period is prolonged, entanglement of the umbilical cord, premature placental abruption, cesarean section, incommensurability of the fetal head with pathological narrow pelvis, breech or multiple births, obstetric injuries when assisting a woman in labor.

- After birth, the incompatibility of mother and baby by blood, their Rh conflict, has a great negative impact, much less often due to group incompatibility.

Symptoms of perinatal encephalopathy

The clinical picture of the disease, perinatal encephalopathy, is very diverse and multifaceted, depending mainly on the site of the lesion and the depth of the damaging force in the brain, the age of the child, causative factor and the duration of its impact. For differentiation, a syndromic system was created. All syndromes cannot be present at the same time; more often it is a combination of several, with one prevailing.

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

- weak late cry;

- heart problems at birth;

- weakness or increased muscle tone;

- inadequate reactions to external stimuli;

- spontaneous shudders;

- absence of physiologically evoked reflexes - sucking, swallowing, searching;

- excessive nervous excitement;

- damage oculomotor nerve;

- throwing back the head;

- frequent regurgitation, vomiting, gastrointestinal disorders, which may not be related to food intake;

- dissomnia.

At an older age, it is important to notice the following symptoms: disturbances in the sphere of mental processes (memory, attention, perception of information); passivity to everything that happens, speech impairment, apathy; depressed state, lack of initiative, reluctance to participate in the game, lack of contact, narrowed range of interests, absent-mindedness, irritability, poor sleep, dizziness, migraine pain, .

The following signs of perinatal encephalopathy are syndromic:

— Increased neuro-reflex excitability. It manifests itself in tremors of the chin, arms and legs, restlessness with poor superficial sleep and shudders, there is excessive lethargy, stiffness, increased reactions to sound and light, uncontrollable loud crying, and failure of thermoregulation. Premature babies have seizures.

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

- Comatose syndrome. There are deep lesions that depress vital functions, leading to coma, seizures. More often, this condition is observed with massive hemorrhages and cerebral edema, characteristic of birth trauma and asphyxia. They are treated only under conditions of constant observation in intensive care on a ventilator.

— Movement disorders the most common. Manifested in a violation of the normal formation of muscle tone, with muscle hypo-, hypertonicity or dystonia, hyperkinesis (undirected, chaotic movements), impaired coordination, paresis and paralysis, psychomotor and speech delay development.

— Hypertension-hydrocephalic is one of the most serious and common, since it can develop into, requiring surgical intervention. Anatomically, there is excess production of intracranial fluid with increased intracranial pressure. Appears as tension and bulging of the large fontanelle, diverging sutures of the skull, an increase in head circumference by 1-2 cm, sleep disturbance, there are high-pitched screams against the background of monotonous crying, throwing back the head. Among the local symptoms it is important to note: strabismus and nystagmus, asymmetry with mandibular sagging, unevenness of facial muscles. A characteristic “Graefe symptom” is when the eyes turn down and up, a white stripe of the cornea appears.

— Convulsive syndrome, or epileptic. It is distinguished by its short duration, sharp sudden onset, chaotic repetition principle and is independent of sleep or feeding patterns. The convulsions themselves are observed in the form of small-amplitude trembling, automatic chewing movements, short-term trembling of the feet, hiccups, regurgitation, and excessive salivation. These spasms are similar to normal movements, making diagnosis difficult.

- Cerebrasthenic syndrome. Celebrate movement disorders like shudders, with absolutely normal mental and physical development of the baby.

- Vegetative-visceral. Microcirculation disorders: marbling of the skin, cold hands and feet; dyspepsia with intestinal colic; lability of the cardiovascular system (tachycardia, arrhythmias). Enteritis and enterocolitis (inflammation of the intestines with diarrhea and impaired weight gain) of varying degrees of severity are often associated.

- Hyperactivity. Expressed in the inability to concentrate and concentrate.

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

Treatment of perinatal encephalopathy

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

Treatment of perinatal encephalopathy takes a long period of time. Usually 2-3 courses of therapy per year are necessary.

Treatment methods include the following:

— Injection blockades;

- Metabolite and antioxidant therapy, vascular and reflexology;

— Physiotherapeutic methods: SMT, UHF;

— Osteopathic treatment or orthopedic correction. After a traumatic impact during childbirth, it is recommended to reduce the effects of birth stress and correct tension in the bones of the skull, restoring their correct location and fusion in the future.

- Massotherapy. To correct muscle tone, development motor functions. Applicable techniques: articular, radicular, muscular;

— Gymnastics, or exercise therapy, and swimming. For the development of muscles and mobility, relieving tension in the baby’s body.

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

— Aromatherapy. Improve general state essential oils of chamomile, ginger, lavender, rosemary;

— Rational feeding. Breastfeeding is vital for a baby, because despite the diversity of the pharmaceutical line of infant formulas, even the highest quality, expensive and adapted formulas place a metabolic load on the baby’s body. It has been proven that breastfeeding results in faster healing; such children have higher rates of emotional and physical development;

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

Drug syndromic therapy of perinatal encephalopathy:

- For muscle pathology and paresis, drugs that improve neuromuscular transmission are administered - Dibazol, Galantamine. For hypertension - Mydocalm, Baclofen. Administration of these drugs can be done orally or by electrophoresis.

— For hypertensive-hydrocephalic: position in bed with the head end elevated to 30°. Among herbal remedies, preference is given to horsetail and bearberry leaf. In more severe cases - Diacarb (reduces the production of cerebrospinal fluid and facilitates outflow). In critical situations, neurosurgical surgery is indicated. In addition, hemodialysis, mechanical ventilation, and parenteral nutrition are applicable.

- For epileptic syndrome - taking anticonvulsants, under supervision laboratory tests and EEG.

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

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

Consequences of perinatal encephalopathy

The consequences of perinatal encephalopathy are usually leveled out by the first year of life, but other mechanisms of the disease are also likely. The signs disappear or appear slightly with adequate, timely treatment, and then the disease, perinatal encephalopathy, does not have a significant impact on the future development of the child’s central nervous system.

But there are often cases of development that burden the baby’s life, these include:

- brain dysfunction (moderate manifestations of hydrocephalus, asthenia, nervous conditions, behavioral deviations and difficulties educational process);

- the hardest thing is cerebral palsy in children and;

- epileptic disorders;

— childhood osteochondrosis;

- severe migraine pain;

- hypertension;

- scoliosis;

- blurred vision,

- underdevelopment of motor skills;

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