home Diseases Perinatal lesions of the central nervous system. Perinatal damage to the nervous system in newborns (PPNS)

Perinatal lesions of the central nervous system. Perinatal damage to the nervous system in newborns (PPNS)

Damage to the nervous system in newborns can occur both in utero (prenatal) and during childbirth (intrapartum). If harmful factors act on a child at the embryonic stage of intrauterine development, severe, often incompatible with life, defects occur. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes manifest themselves as small deviations in the formation of the child - stigmas of disembryogenesis.

If a damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but any disease may occur in a normally formed child. It is very difficult to isolate the impact harmful factor separately in each of these periods. Therefore, they often talk about the impact of a harmful factor in general during the perinatal period. And the pathology of the nervous system of this period is called perinatal damage to the central nervous system.

Various acute or chronic diseases mothers, work in hazardous chemical industries or work associated with various radiations, as well as bad habits of parents - smoking, alcoholism, drug addiction.

A child growing in the womb may be adversely affected by severe toxicosis of pregnancy, pathology of the child's place - the placenta, and the penetration of infection into the uterus.

Childbirth is very important event for a child. The baby faces especially great trials if the birth occurs prematurely (prematurity) or quickly, if labor weakness occurs, the amniotic sac ruptures early and water leaks, when the baby is very large and is helped to be born with special techniques, forceps or a vacuum extractor.

The main causes of damage to the central nervous system (CNS) are most often hypoxia, oxygen starvation of various nature and intracranial birth injury, less often - intrauterine infections, hemolytic disease newborns, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.

Hypoxia ranks first among the causes of damage to the central nervous system; in such cases, doctors talk about hypoxic-ischemic damage to the central nervous system in newborns.

Hypoxia of the fetus and newborn is a complex pathological process, in which the access of oxygen to the child’s body is reduced or completely stopped (asphyxia). Asphyxia can be one-time or repeated, varying in duration, as a result of which carbon dioxide and other under-oxidized metabolic products accumulate in the body, primarily damaging the central nervous system.

With short-term hypoxia in the nervous system of the fetus and newborn, only minor disturbances of cerebral circulation occur with the development of functional, reversible disorders. Prolonged and repeated hypoxic conditions can lead to sudden violations cerebral circulation and even the death of nerve cells.

Such damage to the newborn’s nervous system is confirmed not only clinically, but also using Doppler ultrasound examination of cerebral blood flow (USDG), ultrasound examination brain - neurosonography (NSG), computed tomography and nuclear magnetic resonance (NMR).

In second place among the causes of damage to the central nervous system in the fetus and newborn is birth trauma. The true meaning, the meaning of birth trauma is damage to a newborn child caused by mechanical impact directly on the fetus during childbirth.

Among the diversity birth injuries During the birth of a baby, the child’s neck experiences the greatest load, resulting in various injuries cervical region spine, especially intervertebral joints and the junction of the first cervical vertebra And occipital bone(atlanto-occipital joint).

There may be shifts (dislocations), subluxations and dislocations in the joints. This disrupts blood flow in important arteries that supply blood to the spinal cord and brain.

The functioning of the brain largely depends on the state of the cerebral blood supply.

Weakness is often the root cause of such injuries. labor activity in a woman. In such cases, forced labor stimulation changes the mechanism of fetal passage through the birth canal. With such stimulated childbirth, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, spraining and tearing of ligaments, dislocations, and cerebral blood flow is disrupted.

Traumatic injuries CNS during childbirth most often occurs when the size of the child does not correspond to the size of the mother’s pelvis, when incorrect position fetus, during breech birth, when premature, low birth weight babies are born and, conversely, children with large mass bodies, large sizes, since in these cases various manual obstetric techniques are used.

When discussing the causes of traumatic lesions of the central nervous system, we should specifically focus on childbirth using obstetric forceps. The fact is that even if the forceps are applied to the head flawlessly, intense traction on the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is pulled is transmitted to the body through the neck. For the neck, such a huge load is unusually large, which is why when removing a baby using forceps, along with brain pathology, damage to the cervical portion of the spinal cord occurs.

The issue of injuries to the child arising during surgery deserves special attention. caesarean section. Why is this happening? Indeed, it is not difficult to understand the trauma of a child as a result of passing through the birth canal. Why does a cesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during a caesarean section? The fact is that the transverse incision during a caesarean section in the lower segment of the uterus should theoretically correspond to the largest diameter of the head and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the head of an average child is 34-35 cm. Therefore, removing the head and especially the shoulders of the child by pulling the head with an insufficient incision of the uterus inevitably leads to injury to the cervical spine. That is why the most common cause of birth injuries is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.

In such cases, they speak of hypoxic-traumatic damage to the central nervous system in newborns.

With birth trauma, cerebral circulation disorders often occur, including hemorrhages. More often these are small intracerebral hemorrhages in the cavity of the ventricles of the brain or intracranial hemorrhages between meninges(epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic damage to the central nervous system in newborns.

When a baby is born with central nervous system damage, the condition can be severe. This is an acute period of illness (up to 1 month), followed by an early recovery period (up to 4 months) and then a late recovery period.

Important to prescribe the most effective treatment for CNS pathology in newborns, it has a definition of the leading set of signs of the disease - neurological syndrome. Let's consider the main syndromes of CNS pathology.

Main syndromes of central nervous system pathology

Hypertensive-hydrocephalic syndrome

When examining a sick infant, the expansion of the ventricular system of the brain is determined, detected using ultrasound of the brain, and an increase in intracranial pressure is recorded (as shown by echo-encephalography). Externally, in severe cases of this syndrome, there is a disproportionate increase in the size of the brain part of the skull, sometimes asymmetry of the head in the case of a unilateral pathological process, divergence of cranial sutures (more than 5 mm), expansion and intensification of the venous pattern on the scalp, thinning of the skin on the temples.

In hypertensive-hydrocephalic syndrome, either hydrocephalus, manifested by expansion of the ventricular system of the brain, or hypertension syndrome with increased intracranial pressure may predominate. When increased intracranial pressure predominates, the child is restless, easily excitable, irritable, often screams loudly, sleeps lightly, and the child often wakes up. When hydrocephalic syndrome predominates, children are inactive, lethargy and drowsiness, and sometimes developmental delays are noted.

Often, when intracranial pressure increases, children goggle their eyes, Graefe’s symptom periodically appears (a white stripe between the pupil and upper eyelid), and in severe cases there may be a “setting sun” symptom, when the iris of the eye, like the setting sun, is half immersed under the lower eyelid; sometimes convergent strabismus appears, the baby often throws his head back. Muscle tone can be either decreased or increased, especially in the leg muscles, which is manifested by the fact that when supporting oneself, one stands on tiptoes, and when trying to walk, one crosses the legs.

The progression of hydrocephalic syndrome is manifested by increased muscle tone, especially in the legs, while support reflexes, automatic walking and crawling are reduced.

In cases of severe, progressive hydrocephalus, seizures may occur.

Movement disorder syndrome

Movement disorder syndrome is diagnosed in most children with perinatal pathology CNS. Movement disorders are associated with a violation of the nervous regulation of muscles in combination with an increase or decrease in muscle tone. It all depends on the degree (severity) and level of damage to the nervous system.

When making a diagnosis, the doctor must resolve several very important questions, the main one of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is fundamentally important because the approach to treating these conditions is different.

Secondly, assessing muscle tone in various muscle groups is very important. The doctor uses special techniques to identify a decrease or increase in muscle tone in order to choose the right treatment.

Violations increased tone in different groups leads to a delay in the development of new motor skills in the child.

With an increase in muscle tone in the hands, the development of grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grasps it with his entire hand; fine movements with the fingers are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later stands on his legs, while relying mainly on the forefoot, as if “standing on tiptoes”; in severe cases, the lower extremities cross at the level of the shins, which prevents the formation of walking. In most children, over time and thanks to treatment, it is possible to reduce muscle tone in the legs, and the child begins to walk well. As a memory of increased muscle tone, a high arch of the foot may remain, which makes choosing shoes difficult.

Autonomic-visceral dysfunction syndrome

This syndrome manifests itself as follows: marbling of the skin caused by blood vessels, impaired thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders - regurgitation, less often vomiting, a tendency to constipation or unstable stool, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply posterior sections brain, in which all the main centers of the autonomic nervous system are located, providing guidance to the most important life-support systems - cardiovascular, digestive, thermoregulatory, etc.

Convulsive syndrome

The tendency to convulsive reactions during the neonatal period and in the first months of a child’s life is due to the immaturity of the brain. Seizures occur only in cases of spread or development of a disease process in the cerebral cortex and have many different causes that a doctor must identify. This often requires instrumental research brain function (EEG), its blood circulation (Dopplerography) and anatomical structures (ultrasound of the brain, computed tomography, NMR, NSG), biochemical studies.

Convulsions in a child can manifest themselves in different ways: they can be generalized, involving the entire body, or localized - only in a specific muscle group.

Convulsions are also different in nature: they can be tonic, when the child seems to stretch out and freeze on a short time in a certain position, as well as clonic, in which twitching of the limbs and sometimes the entire body occurs, so that the child may be injured during convulsions.

There are many variants of manifestations of seizures, which are identified by a neuropathologist based on the story and description of the child’s behavior by attentive parents.

lyami. Correct diagnosis, that is, determining the cause of a child’s seizure, is extremely important, since the timely prescription of effective treatment depends on it.

It is necessary to know and understand that convulsions in a child during the neonatal period, if serious attention is not paid to them in time, can become the onset of epilepsy in the future.

Symptoms to contact pediatric neurologist

To summarize all that has been said, let us briefly list the main deviations in the health status of children, for which it is necessary to contact a pediatric neurologist:

If the baby sucks sluggishly, takes breaks, and gets tired. There is choking and leakage of milk through the nose;

If the newborn burps frequently and does not gain enough weight;

If the child is inactive, lethargic or, on the contrary, too restless and this restlessness intensifies even with minor changes in the environment;

If the child has trembling of the chin, as well as the upper or lower extremities, especially when crying;

If the child often shudders for no reason, has difficulty falling asleep, and the sleep is superficial and short in duration;

If the child constantly throws his head back while lying on his side;

If there is too rapid or, conversely, slow growth in head circumference;

If the child’s motor activity is reduced, if he is very lethargic and his muscles are flabby (low muscle tone), or, conversely, the child seems constrained in his movements (high muscle tone), so that even swaddling is difficult;

If one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);

If a child squints or goggles, a white stripe of sclera is periodically visible;

If the baby constantly tries to turn his head in only one direction (torticollis);

If the hip extension is limited, or, conversely, the child lies in a frog position with the hips separated by 180 degrees;

If the child was born by caesarean section or in a breech presentation, if birth control was used obstetric forceps, if the baby was born premature or with a large weight, if the umbilical cord was entangled, if the child had convulsions in the parental home.

Accurate diagnosis and timely and correctly prescribed treatment of nervous system pathology are extremely important. Lesions of the nervous system can be expressed in varying degrees: in some children they are very pronounced from birth, in others even severe disturbances gradually decrease, but do not disappear completely, and mild manifestations remain for many years - these are the so-called residual phenomena.

Late manifestations of birth trauma

There are also cases when at birth the child had minimal impairments, or no one noticed them at all, but after a while, sometimes years, under the influence of certain stresses: physical, mental, emotional - these neurological impairments manifest themselves with varying degrees of severity. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists most often deal with such patients in daily practice.

What are the signs of these consequences?

Most children with late manifestations show a marked decrease in muscle tone. Such children are credited with “innate flexibility,” which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the “frog” pose and do the splits without difficulty. Often such children are gladly accepted into rhythmic or artistic gymnastics sections and choreographic clubs. But most of them can't stand it heavy loads and are eventually expelled. However, these activities are enough to develop a spinal pathology - scoliosis. It is not difficult to recognize such children: they often clearly exhibit protective tension in the cervical-occipital muscles, they often have mild torticollis, their shoulder blades stick out like wings, the so-called “pterygoid shoulder blades,” they can stand on different levels, like the shoulders. In profile, it is clear that the child has a sluggish posture and a stooped back.

By the age of 10-15 years, some children with signs of cervical spine injury in the neonatal period develop typical signs early cervical osteochondrosis, the most characteristic symptom of which in children is headaches. The peculiarity of headaches with cervical osteochondrosis in children is that, despite their different intensity, the pain is localized in the cervical-occipital region. As you grow older, the pain often becomes more pronounced on one side and, starting in the occipital region, spreads to the forehead and temples, sometimes radiating to the eye or ear, intensifying when turning the head, so that a short-term loss of consciousness may even occur.

A child’s headaches are sometimes so intense that they can deprive him of the ability to study, do anything around the house, and force him to go to bed and take analgesics. At the same time, some children with headaches exhibit a decrease in visual acuity - myopia.

Treatment for headaches, aimed at improving blood supply and nutrition to the brain, not only relieves headaches, but also improves vision.

The consequences of pathology of the nervous system in the newborn period can be torticollis, certain forms of scoliotic deformities, neurogenic clubfoot, and flat feet.

In some children, enuresis - urinary incontinence - can also be a consequence of birth trauma - just like epilepsy and others convulsive states in children.

As a result of hypoxic injury to the fetus in the perinatal period, the brain is primarily affected, and the normal course of maturation is disrupted functional systems brain, which ensure the formation of such complex processes and functions of the nervous system as stereotypes of complex movements, behavior, speech, attention, memory, perception. Many of these children show signs of immaturity or disorders of certain higher mental functions. The most common manifestation is the so-called active attention deficit hyperactivity disorder and hyperactive behavior syndrome. Such children are extremely active, disinhibited, uncontrollable, they lack attention, they cannot concentrate on anything, they are constantly distracted, and cannot sit still for several minutes.

ABOUT hyperactive child They say: this is a child “without brakes.” In the first year of life, they give the impression of very developed children, as they are ahead of their peers in development - they begin to sit, crawl, and walk earlier. It is impossible to hold a child; he certainly wants to see and touch everything. Increased physical activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to their inability to concentrate, organize, and impulsive behavior. Due to low performance, the child does his homework until the evening, goes to bed late and, as a result, does not get enough sleep. The movements of such children are awkward, clumsy, and poor handwriting is often noted. They are characterized by disorders of auditory-verbal memory; children poorly learn material from hearing, while visual memory disorders are less common. They often have a bad mood, thoughtfulness, and lethargy. It is difficult to involve them in the pedagogical process. The consequence of all this is negative attitude to study and even refusal to attend school.

Such a child is difficult for both parents and teachers. Behavioral and school problems grow like a snowball. During adolescence, these children have a significantly increased risk of developing persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.

Functional disorders cerebral blood flow especially make themselves felt during periods of accelerated growth - in the first year, at 3-4 years, 7-10 years, 12-14 years.

It is very important to notice the first signs as early as possible, take action and carry out treatment at an early stage. childhood, when the development processes have not yet been completed, while the plasticity and reserve capabilities of the central nervous system are great.

Back in 1945, the domestic obstetrician Professor M.D. Gütner rightly called birth injuries to the central nervous system “the most common folk disease.”

In recent years, it has become clear that many diseases of older children and even adults have their origins in childhood and are often a late retribution for unrecognized and untreated pathology of the newborn period.

One conclusion must be drawn - be attentive to the health of the baby from the moment of conception, and, if possible, eliminate all problems in a timely manner. harmful influences on his health, and even better - to prevent them altogether. If such a misfortune occurs and a pathology of the nervous system is detected in the child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible to ensure that the baby makes a full recovery.

Organic damage to the central nervous system is a pathology that consists of the death of neurons in the brain or spinal cord, necrosis of the tissues of the central nervous system or their progressive degradation, due to which it becomes inferior and cannot adequately perform its functions in ensuring the functioning of the body and motor activity of the body. , as well as mental activity.

Organic damage to the central nervous system has another name - encephalopathy. This may be a congenital or acquired disease due to a negative effect on the nervous system.

Acquired can develop in people of any age due to various injuries, poisoning, alcohol or drug addiction, previous infectious diseases, radiation and similar factors.

Congenital or residual - inherited due to genetic malfunctions, fetal development disorders during the perinatal period (the period of time between the one hundred and fifty-fourth day of pregnancy and the seventh day of extrauterine existence), as well as due to birth injuries.

The classification of lesions depends on the cause of the development of the pathology:

Discirculatory – caused by a violation of the blood supply.
Ischemic – discirculatory organic lesion, supplemented by destructive processes in specific foci.
Toxic – cell death due to toxins (poisons).
Radiation – radiation damage.
Perinatal-hypoxic – due to fetal hypoxia.
Mixed type.
Residual – resulting from a violation of intrauterine development or birth injuries.

Causes of acquired organic brain damage

It is not at all difficult to acquire damage to cells of the spinal cord or brain, since they are very sensitive to any negative impact, but most often it develops for the following reasons:

Spinal injuries or traumatic brain injuries.
Toxic damage, including alcohol, medications, drugs and psychotropic drugs.
Vascular diseases that cause circulatory disorders, and with it hypoxia or lack of nutrients or tissue injury, such as a stroke.
Infectious diseases.

You can understand the reason for the development of one or another type of organic lesion based on the name of its variety; as mentioned above, the classification of this disease is based on the reasons.

How and why residual damage to the central nervous system occurs in children

Residual organic damage to the central nervous system in a child occurs due to a negative impact on the development of his nervous system, or due to hereditary genetic abnormalities or birth injuries.

The mechanisms of development of hereditary residual organic lesions are exactly the same as in any hereditary diseases when distortion of hereditary information due to DNA damage leads to improper development of the child’s nervous system or the structures that ensure its vital functions.

An intermediate process to a non-hereditary pathology looks like a failure in the formation of cells or even entire organs of the spinal cord and brain due to negative environmental influences:

Serious illnesses suffered by the mother during pregnancy, as well as viral infections. Even the flu or a simple cold can provoke the development of residual organic damage to the fetal central nervous system.
Lack of nutrients, minerals and vitamins.
Toxic effects, including medicinal ones.
Bad habits of the mother, especially smoking, alcoholism and drugs.
Bad ecology.
Irradiation.
Fetal hypoxia.
Physical immaturity of the mother, or, conversely, the advanced age of the parents.
Use of special sports nutrition or some dietary supplements.
Severe stress.

The mechanism of the influence of stress on premature birth or a miscarriage due to convulsive contraction of its walls is understandable, not many understand how the mother’s stress leads to the death of the fetus or disruption of its development.

With severe or systematic stress, the mother’s nervous system suffers, which is responsible for all processes in her body, including the life support of the fetus. With the disruption of its activity, a variety of malfunctions and the development of vegetative syndromes can occur - dysfunctions of internal organs, which destroys the balance in the body that ensures the development and survival of the fetus.

Traumatic injuries of various types during childbirth, which can cause organic damage to the child’s central nervous system, are also very different:

Asphyxia.
Injury to the spine or base of the skull due to improper removal and twisting of the child from the uterus.
Child falling.
Premature birth.
Uterine atony (the uterus is unable to contract normally and push out the baby).
Compression of the head.
Hit amniotic fluid into the respiratory tract.

Even during the perinatal period, a child can become infected with various infections, both from the mother during childbirth and from hospital strains.

Symptoms

Any damage to the central nervous system has symptoms in the form of disturbances in mental activity, reflexes, motor activity and disruption of the functioning of internal organs and sensory organs.

It is quite difficult even for a professional to immediately see the symptoms of residual organic damage to the central nervous system in an infant, since the movements of infants are specific, mental activity is not immediately determined, and disturbances in the functioning of internal organs with the naked eye can only be noticed with severe pathologies. But sometimes clinical manifestations can be noticed from the first days of life:

Violation of muscle tone.
and head (most often benign, but can also be a symptom of neurological diseases).
Paralysis.
Impaired reflexes.
Chaotic rapid eye movements back and forth or frozen gaze.
Impaired functions of the sense organs.
Epileptic seizures.

At an older age, from about three months, you can notice the following symptoms:

Impaired mental activity: the child does not follow the toys, shows hyperactivity or, on the contrary, apathy, suffers from attention deficit, does not recognize acquaintances, etc.
Delayed physical development, both direct growth and acquisition of skills: does not hold his head up, does not crawl, does not coordinate movements, does not try to stand up.
Rapid physical and mental fatigue.
Emotional instability, moodiness.
Psychopathy (tendency to affect, aggression, disinhibition, inappropriate reactions).
Organic-psychic infantilism, expressed in the suppression of personality, the formation of dependencies and increased reporting.
Loss of coordination.
Memory impairment.

If a child is suspected of having a central nervous system lesion

If any symptoms of central nervous system dysfunction appear in a child, you must immediately contact a neurologist and undergo comprehensive examination, which may include the following procedures:

General tests, various types of tomography (each type of tomography examines from its own side and therefore gives different results).
Ultrasound of the fontanel.
EEG is an electroencephalogram that allows you to identify foci of pathological brain activity.
X-ray.
CSF analysis.
Neurosonography is an analysis of neuron conductivity that helps identify minor hemorrhages or disturbances in the functioning of peripheral nerves.

If you suspect any abnormalities in your child’s health, you should consult a doctor as early as possible, since timely treatment will help avoid a huge number of problems, and will also significantly shorten the recovery time. You should not be afraid of false suspicions and unnecessary examinations, since they, unlike probable pathologies, will not harm the baby.

Sometimes this pathology is diagnosed during fetal development during a routine ultrasound examination.

Methods of treatment and rehabilitation

Treatment of the disease is quite labor-intensive and lengthy, however, with minor injuries and proper therapy, congenital residual organic damage to the central nervous system in newborns can be completely eliminated, since nerve cells babies are able to divide for some time, and the entire nervous system of young children is very flexible.

First of all, this pathology requires constant monitoring by a neurologist and the attentive attitude of the parents themselves.
If necessary, drug therapy is carried out both to eliminate the root cause of the disease, and in the form symptomatic treatment: withdrawal convulsive symptom, nervous excitability, etc.
At the same time, as a method of treatment or recovery, physiotherapeutic treatment is carried out, which includes massage, acupuncture, zootherapy, swimming, gymnastics, reflexology or other methods designed to stimulate the nervous system, encourage it to begin recovery by forming new neural connections and teach the child himself to use his body in case of impaired motor activity in order to minimize its inability to live independently.
At a later age, psychotherapeutic influences are used both on the child himself and on his immediate environment in order to improve the moral environment around the child and prevent development mental disorders him.
Speech correction.
Specialized training tailored to individual characteristics child.

Conservative treatment is carried out in a hospital and consists of taking medications in the form of injections. These medications reduce brain swelling, reduce seizure activity, and improve blood circulation. Almost everyone is prescribed piracetam or drugs with a similar effect: pantogam, caviton or phenotropil.

In addition to the main drugs, symptomatic relief of the condition is carried out with the help of sedatives, painkillers, improve digestion, stabilize heart function and reduce any other negative manifestations diseases.

After eliminating the cause of the disease, therapy for its consequences is carried out, designed to restore brain function, and with them the work of internal organs and motor activity. If it is impossible to completely eliminate residual manifestations, the goal of restorative therapy is to teach the patient to live with his body, use his limbs and self-care as independently as possible.

Many parents underestimate the benefits of physiotherapeutic methods in the treatment of neurological ailments, but they are the fundamental methods for restoring lost or impaired functions.

The recovery period is extremely long, and ideally lasts a lifetime, since when the nervous system is damaged, the patient has to overcome himself every day. With due diligence and patience, by a certain age a child with encephalopathy can become completely independent and even lead an active lifestyle, the maximum possible at the level of his damage.

It is impossible to cure the pathology on your own, and if mistakes are made due to a lack of medical education, you can not only aggravate the situation many times over, but even get death. Collaboration with a neurologist for people with encephalopathy becomes lifelong, but the use traditional methods Nobody forbids therapy.

Traditional methods of treating organic damage to the central nervous system are the most effective methods of recovery, which do not replace conservative treatment with physiotherapy, but complement it very well. Only when choosing one method or another is it necessary to consult a doctor again, so as to distinguish between useful and effective methods from useless and harmful it is extremely difficult without deep specialized medical knowledge, as well as minimal chemical literacy.

If it is impossible to visit specialized institutions to take a course of exercise therapy, massage and aquatherapy, they can be easily carried out at home, having mastered simple techniques with the help of a neurologist consultation.

No less important aspect treatment is social rehabilitation with the psychological adaptation of the patient. You should not overprotect a sick child, helping him in everything, because otherwise he will not be able to fully develop, and as a result, he will not be able to fight pathology. Help is needed only for vital things or special cases. In everyday life self-execution everyday duties will work as additional physiotherapy or exercise therapy, and will also teach the child to overcome difficulties and that patience and perseverance always lead to excellent results.

Consequences

Organic damage to parts of the central nervous system in the perinatal period or at an older age leads to the development of a large number of various neurological syndromes:

Hypertension-hydrocephalic – hydrocephalus, accompanied by increased intracranial pressure. It is determined in infants by the enlargement of the fontanel, its swelling or pulsation.
Hyperexcitability syndrome - increased muscle tone, sleep disturbance, increased activity, frequent crying, high convulsive readiness or epilepsy.
Epilepsy is a convulsive syndrome.
Comatose syndrome with opposite symptoms of hyperexcitability, when the child is lethargic, apathetic, moves little, lacks sucking, swallowing or other reflexes.
Autonomic-visceral dysfunction of internal organs, which can be expressed as frequent regurgitation, digestive disorders, skin manifestations and many other deviations.
Motor disorders.
Cerebral palsy is a movement disorder complicated by other defects, including mental retardation and weakness of the senses.
Hyperactivity is an inability to concentrate and lack of attention.
Mental retardation or physical development, or complex.
Mental illness due to brain disorders.
Psychological illnesses due to the patient’s discomfort among society or physical disability.

Endocrine disorders, and as a result, decreased immunity.

Forecast

The prognosis of acquired organic damage to the central nervous system is rather unclear, since everything depends on the level of damage. In the case of a congenital type of disease, in some cases the prognosis is more favorable, since the child’s nervous system recovers many times faster, and his body adapts to it.

After proper treatment and rehabilitation, the function of the central nervous system can be either completely restored or have some residual syndrome.

The consequences of early organic damage to the central nervous system often lead to mental and physical retardation in development, and also lead to disability.

One of the positive aspects is that many parents whose children have received this terrible diagnosis, with the help of intensive rehabilitation therapy, achieve magical results, refuting the most pessimistic predictions of doctors, providing their child with a normal future.

Cardiologist

Higher education:

Cardiologist

Saratov State Medical University named after. IN AND. Razumovsky (SSMU, media)

Level of education - Specialist

Additional education:

"Emergency Cardiology"

1990 - Ryazan medical school named after academician I.P. Pavlova

Today, 10% of newborn babies are diagnosed with encephalopathy of varying severity. This pathology occupies a leading place in modern neonatology and represents a significant problem. Medicine is not able to completely cure its consequences, since structural damage to the brain can cause irreversible nature. What is neonatal hypoxic-ischemic encephalopathy (HIE)?

Origin of HIE

While in the womb, the fetus “feeds” on what it receives from the mother’s blood. One of the main components of nutrition is oxygen. Its deficiency negatively affects the development of the central nervous system of the unborn child. And the oxygen needs of his developing brain are even higher than those of an adult. If a woman experiences harmful influences during pregnancy, eats poorly, gets sick or leads an unhealthy lifestyle, this will inevitably affect the child. He receives less oxygen.

Arterial blood with low oxygen content causes metabolic disorders in brain cells and the death of some or entire groups of neurons. The brain has increased sensitivity to fluctuations in blood pressure, especially to its decrease. Metabolic disorders cause the formation of lactic acid and acidosis. Further, the process increases - cerebral edema forms with increased intracranial pressure and necrosis of neurons.

Perinatal lesion The central nervous system can develop in utero, during childbirth and the first days after birth. Doctors consider the time range from a full 22 weeks of pregnancy to 7 days after birth. Intrauterine risks:

disorders of uterine and placental circulation, umbilical cord abnormalities;
toxic effects from smoking and taking certain medications;
hazardous production where a pregnant woman works;
gestosis.

During childbirth, risk factors are:

weak labor activity;
long or rapid labor;
prolonged lack of water;
birth injury;
bradycardia and decreased blood pressure The child has;
placental abruption, umbilical cord entanglement.

Immediately after birth, the development of hypoxic- ischemic lesion CNS in newborns is possible due to low blood pressure, the presence DIC syndrome(pathology of hemostasis, accompanied by increased thrombus formation in microcirculatory vessels). In addition, HIE can be provoked by heart defects and breathing problems in the newborn.

Clinical periods and degrees of brain damage

The clinical course of hypoxic-ischemic damage to the central nervous system is divided into periods:

acute occurs in the first 30 days after birth;
recovery lasts up to a year;
After a year, long-term consequences are possible.

CNS lesions due to hypoxia in newborns in the acute period are divided into three degrees depending on the presence and combination of syndromes:

Syndrome	Signs
Increased neuro-reflex excitability (cerebrasthenic syndrome)	poor sleep and decreased sucking reflex;
	flinching from touch;
	frequent screaming for no apparent reason;
	trembling of the chin, arms and legs;
	throwing the head back;
	motor restlessness;
	sweeping movements of arms and legs
Convulsive syndrome	Paroxysmal seizures
Hypertensive-hydrocephalic	excitability;
	superficial sleep;
	restlessness and irritability;
	hypo- or hypertonicity of the leg muscles (lack of automatic walking, standing on tiptoes);
	lethargy and low activity with hydrocephalic syndrome;
	increase in head size
Oppression syndrome	lethargy;
	low activity;
	decreased muscle tone;
	poor reflex reaction
Comatose syndrome	lack of response to touch and pain;
	“floating” eyeballs;
	breathing disorders;
	lack of sucking reflex and swallowing;
	convulsions are possible

First degree

Neurologically, it manifests itself as a syndrome of increased neuro-reflex excitability. As a rule, by the end of the first week of life, the symptoms smooth out, the baby becomes calmer, his sleep normalizes, and no further development of neurological pathology is observed.

An examination by a neurologist after the first month is not mandatory. But if a child continues to have even the slightest symptoms associated with oxygen deprivation, it is necessary to undergo a thorough examination. The doctor may prescribe medications or physical therapy. By the time the child is one year old, functions are fully restored.

Second degree

Deeper brain hypoxia causes moderate ischemic damage. Neurological symptoms are determined by a gradual increase in intracranial pressure. These babies have impaired reflexes and involuntary motor activity - at the very beginning they may not show it at all. Their skin bluish color, muscle tone is reduced or increased. The autonomic nervous system is unbalanced, which is expressed in an acceleration or slowdown of the heartbeat, respiratory arrest, intestinal dysfunction, and weight loss due to constant regurgitation.

The main syndromes characteristic of the second degree of the disease are hypertensive-hydrocephalic, depression syndrome. The newborn's condition becomes more stable by the end of the first week of life. Further during the recovery period neurological manifestations can soften with intensive treatment decrease. An unfavorable course involves their worsening, even to the point of coma.

Third degree

This form of ischemia is most often caused by severe maternal gestosis, which occurs with all the unfavorable pathological manifestations - high blood pressure, edema and protein excretion by the kidneys. Newborns with third-degree hypoxic-ischemic injury usually do not survive without resuscitation immediately after birth. One of the development options is comatose syndrome.

Another severe manifestation of severe hypoxia may be post-asphyxia syndrome. It is characterized by suppressed reflexes, low mobility, lack of response to touch, decreased temperature and bluish skin. Severe cerebral ischemia makes it impossible to feed the child naturally; life is maintained with the help of intensive care. By the 10th day of life, the condition may stabilize, but more often the prognosis remains unfavorable.

In general, an acute pathological process can occur with varying intensity:

symptoms of HIE disappear quickly;
gradual regression of neurological symptoms by the time of leaving the hospital;
severe course with persistence and further development of neurological deficit with subsequent disability;
hidden current manifesting nervous disorders(slow development and decreased cognitive function) after 6 months.

Recovery period

During the recovery period, ischemia manifests itself mainly as a syndrome of increased neuro-reflex excitability. Manifestations of convulsive and hydrocephalic syndrome are possible. Symptoms of neurological deficiency include developmental delay, speech impairment and other disorders. Another syndrome characteristic specifically for the recovery period is vegetative-visceral. Its signs:

violation of thermoregulation;
the appearance of vascular spots;
indigestion - vomiting, regurgitation, stool disorder, bloating;
low weight gain;
heart rhythm disturbances;
rapid shallow breathing.

If a child begins to hold his head up later, smile, sit up, crawl and walk, then he has delayed psychomotor development syndrome.

Treatment

Treatment is aimed at restoring body functions, since it is impossible to treat the brain in isolation. Therapy involves the use of medications depending on the most severe syndrome.

Treatment in the acute period consists of the use of drugs that relieve seizures, restore breathing, and diuretics for hydrocephalus. To reduce hyperactivity, sedatives are used, including herbal ones (valerian, mint, lemon balm). To increase blood volume - plasma and albumin. For improvement metabolic processes Piracetam and glucose solution are used in nerve tissues.

During the recovery period, drug treatment is combined with hydrotherapy and massage, which gives good results. Cerbrasthenic syndrome is corrected using sedatives, soothing herbs and medications that improve cerebral circulation (Cinarizine, Cavinton).

Persisting hydrocephalus continues to be treated with diuretics and absorbable drugs (Cerebrolysin, Lidaza, aloe). Impaired motor activity is restored with B vitamins, ATP, and Proserin. For delayed psychomotor development, B vitamins and nootropics are also used.

A child diagnosed with hypoxic-ischemic damage to the central nervous system in best case scenario needs constant monitoring. If you strictly follow the doctor’s prescriptions, then over time many syndromes will go away, and the baby will be no different from his peers. The main thing is not to waste time.

Unfortunately, central nervous system disorders in newborns are not uncommon. Up to 50% of all children are exposed to this disorder to one degree or another.

Today we will talk about perinatal damage to the central nervous system (CNS) in newborns, we will tell you what symptoms this disease is characterized by, what methods of diagnosing and treating damage to the central nervous system exist, and we will also understand what the consequences may be of this disease.

The essence of the disease

Damage to the central nervous system is diagnosed quite often, and Among premature babies, this diagnosis occurs many times more often. This disease includes a number of different diagnoses characterized by damage to the brain and/or spinal cord.

In most cases, damage to the central nervous system has a favorable outcome. Now let's take a closer look at the causes of this disease.

Causes of central nervous system damage in children

The causes of this disease during pregnancy may be:

somatic diseases in the mother;
metabolic disorder;
poor nutrition;
unfavorable environmental conditions;
mother's age is over 35 or less than 18 years;
spicy infectious diseases;
pathological course of pregnancy;
the influence of toxins on the body of the expectant mother (smoking, drinking alcohol and drugs).

In some cases, the causes of damage to the central nervous system are injuries and fetal hypoxia during the birth process.
Any lesions of the central nervous system can be divided into two types.

Organic damage to the central nervous system

This diagnosis occurs among people of different ages. Organic damage to the central nervous system in both children and adults is characterized by pathological changes in the brain.

Perinatal CNS damage

Diagnosed in newborns. Depending on the period in which this lesion occurred, the following types are divided:

antenatal (the period of intrauterine development from 28 weeks until birth);
intrapartum (damage occurs directly during childbirth);
neonatal (the lesion is diagnosed in the first week of life).

Depending on the causes, this disease is divided into several types.

Hypoxic damage to the central nervous system

Hypoxic, or hypoxic-ischemic, damage to the central nervous system in newborns is characterized by oxygen starvation for one reason or another. It appears in the womb or due to asphyxia during childbirth.

Traumatic

Traumatic, or residual, damage to the central nervous system in children is a residual phenomenon after injury and structural changes brain

It is very important to diagnose this pathology as early as possible, since brain cells in infants have the ability to regenerate. Accordingly, terrible consequences can be avoided.

Diagnosis of central nervous system lesions in children

An experienced doctor can diagnose central nervous system damage with one look at the child. But to make a final diagnosis, the following research methods are used:

various types of tomography;
electroencephalogram;

Ultrasound of the brain with Dopplerography of blood vessels;
X-ray of the skull and spine.

These studies are easy to perform even in the youngest patients. Moreover, an open large fontanel in newborns allows one to perform ultrasound of the brain repeatedly and monitor its condition over time.

Also, one of the diagnostic methods is collecting anamnesis and monitoring the symptoms of the disease.

Symptoms of the disease

According to its course, perinatal damage to the central nervous system can be divided into three stages, each of which is characterized by its own symptoms.

Acute period

This period lasts up to one month and is characterized by the following symptoms:

CNS depression syndrome (hypodynamia, lethargy, decreased reflexes, muscle hypotension);
CNS hyperexcitability syndrome (restless and often superficial sleep, trembling chin, muscle hypertonicity, etc.) is less common.

Early recovery period

This period lasts for the 2nd and 3rd months and is characterized by a decrease in the symptoms of the acute period. At the same time, the location of the lesion becomes obvious. This phenomenon characterized by the following symptoms:

divergence of the sutures of the skull, increase in head circumference;
impairment of motor activity;
thermoregulation disorder, marbled skin color, disruption of the gastrointestinal tract.

Late recovery period

The period lasts up to 1 year in children born at term, and up to 2 years in premature children. IN this period static functions and muscle tone are restored. The recovery process depends on the degree of damage during the perinatal period.

Period of residual effects

In most cases, during this period there is complete restoration of all neurological functions. At the same time, every fifth child has serious consequences disorders of neurological functions during this period.

Treatment of the disease

Important! Only a doctor can conduct the necessary examination and prescribe the correct treatment.

Treatment of moderate to severe central nervous system damage is often carried out in an intensive care setting, often using special equipment to support the functioning of vital organs.

In the acute period The following treatment methods are used for the disease:

reducing cerebral edema and maintaining the functioning of internal organs;
reduction in the frequency of seizures;
restoration of metabolism nerve tissue;
restoration of oxygen metabolism in cells.

During the recovery period In addition to the above methods, the following therapy is used:

stimulant drugs;
sedative therapy for increased excitability;
drugs to improve cerebral circulation;
massage;
physiotherapy;

IN further treatment carried out up to three times a year under the supervision of a neurologist for several years.

Prevention of central nervous system damage

The most important thing is to eliminate all possible factors that provoke oxygen starvation of the fetus during pregnancy. Treat infectious diseases in a timely manner, provide favorable conditions for the pregnant woman, and also prevent the possibility of birth injuries.
For you to receive complete information We suggest watching the following video about perinatal damage to the central nervous system.

Damage to the central nervous system in newborns - video

From this video you will learn about the nuances of central nervous system damage and methods of treating this disease.

To summarize, I would like to note that changes due to this pathology are completely reversible if treatment is started on time, namely in the first weeks of the baby’s life. Don't ignore the first symptoms. If any suspicious signs If you have this disease, immediately contact a neurologist for consultation.

Have you encountered CNS damage in your children? What treatments were you prescribed? What was the result? Tell us about your experience in the comments.