home Folk remedies Hypoxic damage to the central nervous system in newborns treatment. Residual period. Degrees of cerebral ischemia

Hypoxic damage to the central nervous system in newborns treatment. Residual period. Degrees of cerebral ischemia

Compared to other biological species, man is born the most helpless, and this is largely determined by large mass brain - from birth we are not able to somehow protect ourselves from the external environment, but in return we get a powerful instrument of higher nervous activity. It is the central nervous system of the newborn that is one of the most important systems organism, since the development, vital activity and viability of the child, as well as his chances to feel himself a full and harmonious part of this still new world for him, depend on it. However, despite the achievements modern medicine many children are born with various forms damage to the central nervous system.

CNS in newborns

By the end of fetal development, the child's CNS is considered to be structurally formed, and the fetus demonstrates amazing functional readiness, which is clearly visible with the help of ultrasound. He smiles, swallows, blinks, hiccups, moves his arms and legs, although he does not yet have any higher mental functions.

After childbirth, the child's body experiences severe stress associated with changes in the environment with new conditions for him:

the effect of gravity;
sensory stimuli (light, sound, smells, tastes, tactile sensations);
change in the type of breathing;
changing the type of food.

Nature has endowed us with unconditioned reflexes that help to adapt to life in a new environment, and for which the central nervous system is responsible. If they are not stimulated, they fade away. Congenital reflexes include sucking, swallowing, grasping, blinking, protective, support reflex, crawling, stepping reflex and others.

The central nervous system of a newborn is designed in such a way that the basic skills develop under the influence of stimuli. Light stimulates visual activity, the sucking reflex turns into eating behavior. If some functions remain unclaimed, then proper development also does not occur.

Features of the CNS in newborns are characterized by the fact that development occurs not due to an increase in the number of nerve cells (this process stops by the time of birth), but due to the establishment of additional synoptic connections between nerve cells. And the more of them, the more actively the departments of the central nervous system are involved. This explains the incredible plasticity of the central nervous system, and its ability to restore and compensate for damage.

Causes of CNS lesions

CNS damage can occur for a variety of reasons. Neonatologists divide them into four groups:

In the development of CNS lesions in newborns, three periods are distinguished:

acute (first month of life);
early recovery (2-3 months) and late recovery (4-12 months in full-term, 4-24 months in premature babies);
outcome of the disease.

For an acute period common symptoms are:

Syndrome of depression of the central nervous system is expressed in a decrease in motor activity and muscle tone, as well as the weakening of congenital reflexes.
The syndrome of increased neuro-reflex excitability, on the contrary, is characterized by an increase in spontaneous muscle activity. At the same time, the baby shudders, he has muscle hypertonicity, trembling of the chin and limbs, causeless crying and superficial sleep.

During early recovery period cerebral symptoms are reduced, and become pronounced signs focal lesions of the CNS. At this stage, one of the following symptom complexes may be observed:

The syndrome of movement disorders is expressed in excessive or weak muscle tone, paresis and paralysis, spasms, pathological spontaneous motor activity (hyperkinesis).
Hypertensive-hydrocephalic syndrome is caused by excessive accumulation of fluid in the spaces of the brain and, as a result, an increase intracranial pressure. Outwardly, this is expressed in the bulging of the fontanel and an increase in the circumference of the head. The syndrome is also indicated by the baby's anxiety, trembling eyeballs, frequent regurgitation.
The vegetative-visceral syndrome is expressed in the marble color of the skin, violation of the heart and respiratory rhythms, as well as functional disorders of the gastrointestinal tract.

late recovery period characterized by gradual fading of symptoms. Static functions and muscle tone gradually begin to return to normal. The degree of recovery of functions will depend on how severe the CNS damage was in the perinatal period.

Period of outcome or residual effects may proceed differently. In 20% of children there are obvious psychoneurological disorders, in 80% the neurological picture returns to normal, but this does not mean a complete recovery and requires increased attention from both parents and pediatricians.

Diagnostics

The presence of certain lesions of the central nervous system can be judged by the course of pregnancy and childbirth. But in addition to collecting anamnesis, various instrumental studies are also used, for example, neurosornography, X-ray examination of the skull and spine, CT, MRI.

When making a diagnosis, it is important to distinguish CNS lesions from malformations, metabolic disorders due to genetic causes, and rickets, since treatment approaches are fundamentally different.

Treatment

Treatment options for CNS lesions will depend on the stage of the disease. In the acute period, as a rule, resuscitation measures are carried out:

elimination of cerebral edema (dehydration therapy);
elimination and prevention of seizures;
restoration of myocardial contractility;
normalization of the metabolism of nervous tissue.

IN recovery period treatment is aimed at improving the trophism of the damaged nervous tissue and stimulating the growth of brain capillaries.

Parents can make a significant contribution to the care of a child with CNS disease. After all, they should create favorable conditions for general development with massage and therapeutic gymnastics, water procedures and physiotherapy procedures. And as non-drug agents in the recovery period, sensory stimulation of brain development has a beneficial effect.

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DEFINITION

Perinatal encephalopathy (PEP) is a collective diagnosis that implies a violation of the function or structure of the brain of various origins that occurs during the perinatal period.

The perinatal period includes the antenatal, intranatal and early neonatal periods.

The antenatal period begins at 28 weeks of fetal development and ends with the onset of labor.

The intranatal period includes the act of childbirth itself from the onset of labor to the birth of a child.

The early neonatal period corresponds to the first week of a child's life and is characterized by the processes of adaptation of the newborn to environmental conditions.

MODERN VIEWS

In the modern international classification of diseases (ICD-10), the diagnosis " perinatal encephalopathy» does not apply. But given the tradition established in our country, as well as the existing difficulties in early and accurate diagnosis of the nature of perinatal brain lesions, this “diagnosis” still continues to be used in children under the age of 1 year of age with various disorders of motor, speech and mental functions.

IN last years there has been a significant improvement in the diagnostic capabilities of children's medical institutions. With this in mind, the diagnosis of perinatal brain damage can only be made until the end of the neonatal period, after 1 month of the child's life, the neurologist must determine the exact nature and degree of damage to the central nervous system, predict the further course of the disease found in the child and determine the tactics of treatment, or remove the suspicion of brain disease.

CLASSIFICATION

According to their origin and course, all lesions of the brain of the perinatal period can be conditionally divided into hypoxic-ischemic, arising from a lack of oxygen in the fetal body or its utilization during pregnancy (chronic intrauterine fetal hypoxia) or childbirth (acute fetal hypoxia, asphyxia), traumatic , most often caused by traumatic damage to the fetal head at the time of delivery and mixed, hypoxic-traumatic lesions of the central nervous system.

The development of perinatal lesions of the central nervous system is based on numerous factors that affect the condition of the fetus during pregnancy and childbirth and the newborn in the first days of his life, causing the possibility of developing various diseases both at the 1st year of the child's life and at an older age.

REASONS FOR DEVELOPMENT

Causes affecting the occurrence of perinatal lesions of the central nervous system.

Somatic diseases of the mother with symptoms of chronic intoxication.
Acute infectious diseases or exacerbation of chronic foci of infection in the mother's body during pregnancy.
Malnutrition and general immaturity of the pregnant woman.
Hereditary diseases and metabolic disorders.
Pathological course of pregnancy (early and late toxicosis, the threat of abortion, etc.).
Harmful effects environment, unfavorable environmental conditions (ionizing radiation, toxic effects, including the use of various medicinal substances, environmental pollution with salts heavy metals and industrial waste, etc.).
Pathological course of childbirth (rapid childbirth, weakness of labor activity, etc.) and injuries during the use of labor benefits.
Prematurity and immaturity of the fetus with various disorders of its vital activity in the first days of life.

Antenatal period

The damaging factors of the antenatal period include:

intrauterine infections
exacerbation of chronic diseases of the expectant mother with adverse changes in metabolism
intoxication
action various kinds radiation
genetic conditioning

Of great importance is miscarriage, when a child is born prematurely or biologically immature due to a violation of intrauterine development. An immature child, in most cases, is not yet ready for the process of childbirth and receives significant damage during labor.

It is necessary to pay attention to the fact that in the first trimester of intrauterine life, all the main elements of the nervous system of the unborn child are laid, and the formation of the placental barrier begins only from the third month of pregnancy. The causative agents of such infectious diseases as toxoplasmosis. chlamydia, listerellosis, syphilis, serum hepatitis, cytomegaly, etc., having penetrated the immature placenta from the mother's body, deeply damage the internal organs of the fetus, including the developing nervous system of the child. These damages to the fetus at this stage of its development are generalized, but the central nervous system suffers first of all. Subsequently, when the placenta has already formed and the placental barrier is sufficiently effective, the effects of adverse factors no longer lead to the formation of fetal malformations, but can cause premature birth, functional immaturity of the child and intrauterine malnutrition.

At the same time, there are factors that can adversely affect the development of the fetal nervous system in any period of pregnancy and even before it, affecting reproductive organs and tissues of parents (penetrating radiation, alcohol consumption, severe acute intoxications).

Intranatal period

Intranatal damaging factors include all adverse factors of the birth process that inevitably affect the child:

long dry period
the absence or weak severity of contractions and the inevitable stimulation in these cases
labor activity
insufficient opening of the birth canal
rapid delivery
use of manual obstetrics
C-section
entanglement of the fetus with the umbilical cord
large body weight and size of the fetus

The risk group for intranatal injuries are premature babies and children with low or too large body weight.

It should be noted that intranatal damage to the nervous system in most cases does not directly affect the structures of the brain, but their consequences in the future constantly affect the activity and biological maturation of the developing brain.

postnatal period

Considering the postnatal period, it can be noted that here in the genesis of damage to the central nervous system, the greatest role is played by

neuroinfections
injury

FORECAST AND OUTCOMES

In a child with a diagnosis of perinatal brain damage after 1 month of life, the doctor is able to determine the prognosis for the further development of the child, which can be characterized by either a complete recovery or the development of minimal disorders of the central nervous system, or serious diseases that require mandatory treatment and observation by a neurologist.

The main options for the consequences of perinatal lesions of the central nervous system and children early age:

Full recovery
mental, motor or speech development child
(minimal brain dysfunction)
Neurotic reactions
Cerebrasthenic (post-traumatic) syndrome
Syndrome of vegetative-visceral dysfunction
Hydrocephalus
Cerebral palsy

Children with the consequences of perinatal brain damage at an older age often have impaired adaptation to environmental conditions, manifested by various behavioral disorders, neurotic manifestations, hyperactivity syndrome, asthenic syndrome, school maladjustment, impaired autonomic-visceral functions, etc.

Given the insufficiently high medical literacy of the population and the shortage of pediatric neurologists, during the first year of life, especially, such children do not receive full-fledged rehabilitation.

The practice of work of educators and teachers preschool institutions And primary school schools shows that in recent years there has been a sharp increase in the number of children with speech defects, lack of attention, memory, increased distractibility and mental fatigue. Many of these children have social adaptation disorders, posture defects, allergic dermatoses, various dysfunctions of the gastrointestinal tract and dysgraphia. The range of these disorders is quite wide, varied, and the "set" of defects in each individual child is individual.

It should be immediately noted that with timely diagnosis in the early childhood existing disorders, primarily of the nervous system, in the overwhelming majority of cases can be almost completely eliminated by corrective measures, and children can continue to live a full life.

With the beginning of classes at school, the process of maladaptation with manifestations of violations of higher functions of the brain, somatic and autonomic symptoms accompanying minimal brain dysfunction, grows like an avalanche.

Diagnosis of perinatal lesions of the central nervous system

The diagnosis of perinatal brain damage can only be made on the basis of clinical data, data various methods studies are only auxiliary in nature and are necessary not for making the diagnosis itself, but for clarifying the nature and localization of the lesion, assessing the dynamics of the disease and the effectiveness of treatment.

Additional research methods in the diagnosis of perinatal lesions of the central nervous system

Ultrasound diagnostics (ECHO-EG, NSG, dopplerography)

Echoencephalography-ECHO-EG

Method ultrasound diagnostics, based on the property of ultrasound to deviate at the interface between media with different densities. The method allows to estimate the size of the third ventricle of the brain, the ventricular index and the amplitude of pulsations.

One-dimensional echoencephalography is widely used in various medical institutions, including children, to determine the displacement of the median structures of the brain, with suspicion of intracranial hemorrhage and expansion of the corresponding sections of the CSF pathways of the brain.

Modern, safe method brain imaging, which allows assessing the state of the brain tissue, formations of the anterior, middle, posterior cranial fossae and cerebrospinal fluid spaces through an open large fontanel, sutures, external auditory canal or orbit, can be used as a screening method for suspected intracranial (intracranial) damage to the brain brain.

With the help of neurosonography, the structure and echogenicity (echo density) of the medulla, the size and shape of the cerebrospinal fluid spaces of the brain are described, and their changes are evaluated.

The most important feature of the method is its ability

identify the presence of birth and early postpartum brain damage (cerebral hemorrhage and cerebral infarction) and assess the nature of the consequences of such damage, identify atrophic changes in the brain and changes in brain tissue and cerebrospinal fluid pathways in hydrocephalus.

The method allows you to determine the presence of edema of the brain tissue, compression and dislocation of brain structures, malformations and tumors of the central nervous system, brain damage in traumatic brain injuries.

With a repeated (dynamic) neurosonographic study, it is possible to assess the dynamics of previously identified structural changes brain tissue and cerebrospinal fluid.

The method is based on the ability of an ultrasonic signal to change its frequency when passing through a moving medium and be reflected from this medium and allows you to estimate the amount of blood flow in intracerebral vessels (cerebral vessels) and extracerebral vessels and is highly accurate in occlusive processes.

Neurophysiological diagnostics (EEG, ENMG, evoked potentials)

Electroencephalography is a method for studying the functional activity of the brain, based on the registration of electrical potentials of the brain. The technique allows to correctly assess the state of the functional activity of the brain, the stages of maturation of the bioelectrical activity of the brain in children of the first years of life and provides information on the presence pathological changes bioelectric activity at various diseases central nervous system.

An electroencephalographic study during sleep is the most adequate method for assessing the functional state of the brain of children in infancy, since infants and young children spend most of their time in sleep, and, moreover, when recording EEG during sleep, artifacts of muscle tension (electrical muscle activity) are excluded, which, in the state of wakefulness, are superimposed on the bioelectrical activity of the brain, distorting the latter.

It should be added that the EEG of wakefulness in newborns and young children is not sufficiently informative, since they have not formed the main cortical rhythm.

However, on the EEG of sleep, already in the first months of a child's life, all the main rhythms of bioelectric activity inherent in the EEG of sleep in an adult are observed. Neurophysiological study of sleep using EEG and a complex of various physiological indicators allows you to differentiate the phases and stages of sleep and test functional states brain.

Evoked potentials - EP

The evoked potentials of the brain are the electrical activity of brain neurons that occurs in response to stimulation of the corresponding analyzer. According to the method of obtaining evoked potentials are divided into auditory, visual and somato-sensory.

Evoked potentials are isolated from the background spontaneous bioelectrical activity of the brain (EEG) and are often used to determine the presence of changes in the conduction pathways of the central nervous system and their dynamics in perinatal CNS damage.

Visual evoked potentials show the path of a nerve impulse from optic nerve to the visual zones of the occipital areas of the cerebral cortex and are used more often in premature infants to determine the condition of the conduction pathways in the region of the posterior horns of the lateral ventricles, most often suffering from periventricular leukomalacia.

Auditory evoked potentials reflect the passage of a nerve impulse from the auditory nerve to the projection zones of the cerebral cortex and are used more often in full-term children.

Somatosensory evoked potentials reflect the path traversed by an electrical signal upon stimulation of peripheral nerves to the corresponding projection zone of the cerebral cortex and are used in both full-term and premature babies.

Video monitoring

It is a simple and relatively inexpensive diagnostic method that allows you to evaluate the stages of the formation of a child's spontaneous motor activity from the moment of birth using the analysis of video recordings. The spontaneous motor activity of the child, the timeliness and nature of the change in types of motor activity are assessed.

The combination of EEG monitoring in the state of wakefulness and natural sleep with the recording of other physiological indicators of the child's vital activity (ENMG, EOG, etc.) and video monitoring allows you to more accurately differentiate the nature of paroxysmal conditions of various origins in young children.

Electroneuromyography - ENMG

EMG (electromyography) and ENMG (electroneuromyography) are often used in the diagnosis of perinatal lesions of the nervous system, including those of a hypoxic nature (in healthy newborns and children born in hypoxia, various electrical muscle activity is detected, which differs in amplitude and frequency of clonic contractions of muscle fibers during various options manifestations of perinatal lesions of the central nervous system).

X-ray methods of research (CT, MRI, PET)

Computed tomography - CT

Computed tomography is a research method based on sequential scanning of organs and parts of the human body with an x-ray and subsequent restoration of the image of the resulting sections.

Widely used in older children and in adult practice, the method of visualization of macrostructural changes in the central nervous system (hemorrhages, cysts, tumors, etc.) is quite problematic to use in young children due to the need for anesthesia (to achieve child immobility).

Magnetic resonance imaging - MRI

Magnetic resonance imaging is a research method that allows you to assess not only the violation of the macrostructure of the organ under study, but also the state and differentiation of brain tissue, identify foci of increased and decreased density and signs of cerebral edema.

Positron emission tomography - PET

Positron emission tomography - allows you to determine the intensity of metabolism in tissues and the intensity of cerebral blood flow on various levels and in various structures of the central nervous system.

TREATMENT OF CONSEQUENCES OF PERINATAL DAMAGE OF THE CENTRAL NERVOUS SYSTEM

Brain lesions in the perinatal period are the main cause of disability and maladaptation in children.

Treatment of the acute period of perinatal lesions of the central nervous system is carried out in a hospital, under the constant supervision of a doctor.

Treatment of the consequences of lesions of the central nervous system of the perinatal period, which pediatricians and neurologists often encounter, includes drug therapy, massage, physiotherapy exercises and physiotherapy procedures, acupuncture and elements of pedagogical correction are often used.

The requirements for treatment should be quite high and, it should be added that the main emphasis in the treatment of the consequences of CNS damage in the perinatal period is placed precisely on physical methods of influence (exercise therapy, massage, FTL, etc.), while drug treatment it is used only in a number of cases (convulsions, hydrocephalus, etc.).

Tactics of treatment of the main syndromes occurring in newborns, infants and young children with brain lesions of various origins

Syndrome of intracranial hypertension

Significant value in treatment, it has control of the volume of fluid in the cerebrospinal fluid. The drug of choice in this case is diacarb (carbonic anhydrase inhibitor), which reduces the production of cerebrospinal fluid and increases its outflow. With the ineffectiveness of the treatment of increased intracranial pressure with diacarb, progressive enlargement of the ventricles according to neuroimaging methods and an increase in atrophy of the medulla, it is advisable to use neurosurgical methods of treatment (ventriculo-peritoneal or ventriculo-pericardial shunting).

movement disorder syndrome

Treatment of movement disorders is carried out in accordance with the nature of movement disorders.

With the syndrome of muscular hypotension (decrease in muscle tone), dibazol or, sometimes, galantamine is used. The advantage of these drugs lies in their direct action on the central nervous system, while other drugs act on the peripheral nervous system. However, the appointment of these drugs should be very careful to avoid changing muscle hypotonia spastic conditions.

With the syndrome of muscular hypertension (increased muscle tone), midocalm or baclofen is used.

However, the leading role in the treatment of movement disorder syndrome in children with the consequences of perinatal CNS damage is played by the physical methods of exposure listed above.

Syndrome of increased neuro-reflex excitability

There is still no clear generally accepted tactics for managing children with increased neuro-reflex excitability syndrome, many experts refer to given state how to border state and advise only to observe such children, refraining from treatment.

In domestic practice, some doctors continue to use quite serious drugs (phenobarbital, diazepam, sonapax, etc.) for children with increased neuro-reflex excitability syndrome, the appointment of which in most cases is hardly justified. Prescription of nootropic drugs with inhibitory action, such as patnogam, phenibut, is widespread. Phytotherapy is used quite effectively (sedative teas, fees and decoctions).

In the presence of a delay in speech, mental or motor development, the basic drugs of domestic medicine in the treatment of these conditions are nootropic drugs (nootropil, aminalon, encephabol). Along with nootropics, all kinds of classes are used to develop the impaired function (classes with a speech therapist, psychologist, etc.).

Epilepsy

Or, as this disease is often called in Russia, epileptic syndrome is often one of the consequences of perinatal brain damage. Treatment this disease should be performed by a neurologist with sufficient qualifications in this field or by an epileptologist, which is preferable.

For the treatment of epilepsy, anticonvulsants (anticonvulsants) are used, the appointment and control of which is carried out directly by the attending physician. Abrupt withdrawal of drugs, substitution of one drug for another, or any unauthorized change in regimen anticonvulsants often provoke the development of epileptic seizures. Since anticonvulsants are not harmless drugs, they should be taken strictly according to indications (exactly established diagnosis epilepsy, epileptic syndrome).

Minimal brain dysfunction (MMD, hyperactivity syndrome, hypermotor child)

The development of this syndrome is associated with immaturity and a decrease in the activity of the inhibitory mechanisms of the brain. Therefore, in some foreign countries, amphetamines are used to treat this syndrome, which are prohibited for use in Russia (drugs fall into the category of narcotic substances that cause rapid addiction).

Various elements of pedagogical correction are also used, classes with a psychologist and a speech therapist, exercises for concentration of attention.

Damage to the nervous system in newborns can occur both in utero (prenatally) and during childbirth (intranatally). If harmful factors acted 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 they manifest themselves as small deviations in the formation of the child - the stigmas of disembryogenesis.

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

Various acute or chronic diseases of the mother, work in hazardous chemical industries or work associated with various radiations can have an adverse effect on the child, as well as bad habits parents - smoking, alcoholism, drug addiction.

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

Childbirth is very important event for a child. Particularly great tests fall on the lot of the baby if the birth occurs prematurely (prematurity) or rapidly, if there is generic weakness, breaks early amniotic sac and the waters flow out when the baby is very large and he 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 different nature and intracranial birth trauma, less often intrauterine infections, hemolytic disease of the newborn, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.

Hypoxia ranks first among the causes of CNS damage, in such cases, doctors talk about hypoxic-ischemic CNS damage in newborns.

Hypoxia of the fetus and newborn is a complex pathological process in which the access of oxygen to the child's body decreases or completely stops (asphyxia). Asphyxia can be single or repeated, of varying duration, as a result of which carbon dioxide and other incompletely 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 small disturbances of cerebral circulation occur with the development of functional, reversible disorders. Prolonged and repeated hypoxic conditions can lead to severe disorders of cerebral circulation and even to the death of nerve cells.

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

In second place among the causes of CNS damage in the fetus and newborn is birth trauma. true value, the meaning of birth trauma is damage to a newborn child caused by mechanical action directly on the fetus during childbirth.

Among the variety of birth injuries during the birth of a baby, the neck of the child experiences the greatest load, resulting in various injuries. cervical spine, especially intervertebral joints and the junction of the first cervical vertebra and the occipital bone (atlanto-occipital articulation).

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

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

Often the root cause of such injuries is the weakness of labor in a woman. In such cases, forcedly applied rhodostimulation changes the mechanism of passage of the fetus 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, sprains and ruptures of ligaments, dislocations, and cerebral blood flow is disturbed.

Traumatic injuries CNS during childbirth most often occurs when the size of the child does not match the size of the mother's pelvis, with wrong position fetus, during childbirth in the breech presentation, when premature, underweight children are born and, conversely, children with a large body weight, large sizes, since in these cases various manual obstetrical techniques are used.

Discussing the causes of traumatic lesions of the central nervous system, one should separately dwell on childbirth using the imposition obstetric forceps. The fact is that even with the immaculate application of the forceps head, intense traction behind 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 the baby with forceps, along with the pathology of the brain, damage to the cervical region of the spinal cord occurs.

Particular attention should be paid to the issue of injuries to the child that occurs during caesarean section. Why is this happening? Indeed, it is not difficult to understand the traumatization of a child as a result of its passage through the birth canal. Why does a caesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during caesarean section? The fact is that the transverse incision during 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 on the head with an insufficient incision of the uterus inevitably leads to injury of 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 a birth injury, cerebrovascular accidents often occur, up to 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 lesions of the central nervous system in newborns.

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

Importance to prescribe the most effective treatment for CNS pathology in newborns, it has the definition of the leading set of signs of the disease - neurological syndrome. Consider the main syndromes of CNS pathology.

The main syndromes of CNS pathology

Hypertension-hydrocephalic syndrome

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

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

Often, with an increase in intracranial pressure, children goggle their eyes, Graefe's symptom periodically appears (a white strip between the pupil and upper eyelid), and in severe cases, there may be a symptom of the "setting sun", 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 low or high, especially in the muscles of the legs, which is manifested by the fact that when supported, he stands on tiptoe, and when he tries to walk, he crosses his legs.

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

In cases of severe progressive hydrocephalus, seizures may occur.

Movement Disorder Syndrome

The syndrome of movement disorders is diagnosed in most children with perinatal pathology of the central nervous system. 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 solve several very important questions, the main of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is of fundamental importance, since the approach to the treatment of these conditions is different.

Secondly, the assessment of muscle tone in various groups muscles. The doctor uses special techniques to detect a decrease or increase in muscle tone in order to choose the right treatment.

Violations of increased tone in different groups lead to a delay in the emergence of new motor skills in a 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 grabs it with the whole hand, fine finger movements are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later gets up on his legs, while leaning mainly on the front sections of the feet, as if "standing on tiptoe", in severe cases, a cross occurs. lower extremities at the level of the shins, which prevents the formation of walking. In most children, with time and treatment, it is possible to achieve a decrease in muscle tone in the legs, and the child begins to walk well. Like a memory of increased tone muscles, a high arch of the foot may remain, which makes it difficult to choose shoes.

Syndrome of vegetative-visceral dysfunctions

This syndrome manifests itself as follows: marbling of the skin due to blood vessels, violation of thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders- regurgitation, rarely vomiting, tendency to constipation or unstable stools, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply. posterior divisions the brain, in which all the main centers of the autonomic nervous system are located, which provide guidance for the most important life-supporting 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 the doctor must identify. This often requires instrumental research brain function (EEG), its blood circulation (Dopplerography) and anatomical structures(ultrasound of the brain, CT scan, NMR, NSG), biochemical research.

Convulsions in a child can manifest themselves in different ways: they can be generalized, capturing the whole body, and localized - only in a certain muscle group.

Seizures are also different in nature: they can be tonic, when the child stretches out and freezes for a short time in a certain position, as well as clonic, in which the limbs twitch, and sometimes the entire body, so that the child may be injured during convulsions. .

There are many options for the manifestations of seizures, which are revealed by a neuropathologist according to the story and description of the child's behavior by attentive parents.

lyami. Correct staging diagnosis, that is, determining the cause of the child's seizures, is extremely important, since the timely appointment of effective treatment depends on this.

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 beginning of epilepsy in the future.

Symptoms to look out for pediatric neurologist

Summing up all that has been said, we briefly list the main deviations in the state of health of children with which it is necessary to contact a pediatric neurologist:

If the child sluggishly sucks the breast, takes breaks, gets tired at the same time. There is choking, leakage of milk through the nose;

If the newborn often spits up, does not gain enough weight;

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

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

If the child often shudders for no reason, falls asleep with difficulty, while sleep is superficial, short in time;

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

If there is too fast or, conversely, a slow increase in head circumference;

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

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

If the 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 spread of the hips is limited, or, conversely, the child lies in the frog position with the hips separated by 180 degrees;

If the child was born by caesarean section or in breech presentation, if obstetrical forceps were used during childbirth, if the infant was born prematurely or with a large weight, if umbilical cord entanglement was noted, if the child had convulsions in the maternity home.

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

Late manifestations of birth trauma

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

What are the signs of these consequences?

Most children with late manifestations show a pronounced 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” position, easily do the splits. Often such children are gladly accepted into the rhythmic or artistic gymnastics section, into choreographic circles. But most of them can't stand heavy loads and eventually withdraw. However, these activities are enough to form the pathology of the spine - scoliosis. It is not difficult to recognize such children: they often clearly show a protective tension of the cervico-occipital muscles, often there is a slight torticollis, the shoulder blades stick out like wings, the so-called "pterygoid shoulder blades", they can stand on different levels like the shoulders. In profile, it can be seen that the child has a sluggish posture, a stooped back.

By the age of 10-15, some children with signs of trauma to the cervical spine in the neonatal period develop typical signs early cervical osteochondrosis, most hallmark which in children are headaches. The peculiarity of headaches in cervical osteochondrosis in children is that, despite their different intensity, the pains are localized in the cervical-occipital region. As they grow older, the pains often become more pronounced on one side and, starting in the occipital region, spread to the forehead and temples, sometimes they radiate to the eye or ear, intensify when turning the head, so that a short-term loss of consciousness may even occur.

Headaches in a child are sometimes so intense that they can deprive him of the opportunity to study, do something around the house, force him to go to bed and take analgesics. At the same time, some children with headaches have a decrease in visual acuity - myopia.

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

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

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

As a result of hypoxic trauma of the fetus in the perinatal period, the brain primarily suffers, the normal course of maturation is disrupted. functional systems brain, which provide 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 violations 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, they 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 the development - they begin to sit, crawl, and walk earlier. It is impossible to keep a child, he certainly wants to see and touch everything. Increased motor activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low efficiency, the child does 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 auditory-speech memory disorders, children do not learn material from hearing well, while visual memory impairment is less common. They often have a bad mood, thoughtfulness, lethargy. It is difficult to involve them in the pedagogical process. The consequence of all this is negative attitude learning and even refusing to attend school.

Such a child is difficult for both parents and teachers. Behavioral and school problems are snowballing. In 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 measures and carry out treatment already in early childhood, when the development processes are not yet completed, while the plasticity and reserve capabilities of the central nervous system are great.

Domestic obstetrician Professor M. D. Gyutner in 1945 rightly called birth injuries of 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 an unrecognized and untreated pathology of the neonatal period.

One conclusion should be made - to be attentive to the health of the baby from the moment of his conception, to eliminate all harmful effects on his health as soon as possible, and even better - not to allow them at all. If such a misfortune happened and a pathology of the nervous system was detected in a child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible so that the baby fully recovers.

Anomalies of the central nervous system are formed during the perinatal period, which lasts from the 28th week of pregnancy to the 7th day of life. Violations appear in the womb, during childbirth or immediately after birth. Neonatal depression syndrome and hyperexcitability are the main manifestations of perinatal encephalopathy. CNS disorders are characterized by movement disorders, hydrocephalus, seizures, developmental delay.

Causes

Failures, which are the consequences of brain dysfunction, are included in the understanding of the collective term perinatal transient encephalopathy. Structural pathologies of the main organ of the central nervous system at birth lead to hydrocephalus, epilepsy, cerebral palsy.

The syndrome of oppression is a consequence of damage to brain cells of a non-inflammatory nature. The causes of the pathology are the abnormal course of pregnancy and childbirth:

Somatically burdened history of gestation: heart disease, diabetes, pyelonephritis, hypertension and bronchial asthma in a future mother.
Unfavorable gestation with risks of miscarriage, intrauterine infection, preeclampsia and fetoplacental insufficiency.
Rapid or prolonged labor, narrow pelvis in the mother, premature birth or weakness of labor activity.
Bad habits that could not be eliminated during the bearing of a child: drinking alcohol, smoking, taking antibiotics and other drugs prohibited for pregnant women.
The impact of production and environmental factors, food toxins.
The actions of obstetricians that caused intracranial birth trauma during breech presentation, incorrect entry of the head into the small pelvis, the use of forceps and vacuum.
A mild form of disorders develops with stress, excessive anxiety and irritability of the expectant mother under the influence of the hormone cortisol.

The brain is damaged by respiratory failure, congenital heart defects, blood poisoning. The syndrome of oppression is provoked by the introduction of magnesium sulfate to the woman in labor.

Main symptoms

The syndrome of oppression manifests itself immediately after birth, if the cause was hypoxia during pregnancy or childbirth, or intrauterine infection. Signs that occur several hours after birth indicate infection during delivery or intraventricular hemorrhage. The development of the syndrome of oppression on the 3-5th day from birth is due to infectious toxicosis.

The Apgar score serves as a guideline for assessing the function of the nervous system in preterm infants:

6–7 - excessive neuro-reflex excitability, convulsions;
4–6 - CNS depression and hypertensive-hydrocephalic syndrome;
1–4 points is a pre-coma or coma.

A neonatologist examines a newborn for CNS damage:

weak or delayed cry;
prolonged cyanosis;
depressed sucking reflex;
movement pathology.

CNS depression syndrome manifests itself in a pronounced form:

lethargy;
suppression of reflexes;
muscle hypotension.

With a mild form, the baby often throws up its legs and arms, cries, falls asleep heavily and does not sleep well. Neurologists diagnose muscular dystonia, chin tremor. Changes usually pass during the first month without consequences.

At a moderate degree, focal neurological lesions are detected: anisocoria (difference in the diameter of the pupils), omission of the eyelid, converging strabismus, tremor of the pupil, impaired sucking and swallowing, asymmetry of the nasolabial folds and the difference in tendon reflexes.

With a severe degree of depression, adynamia, atony are observed, there are no reflexes and reactions to pain (prick with a blunt needle), pulse and breathing slow down. The condition can persist for up to two months, ending with the development of neurological disorders.

Neurologists distinguish four degrees of depression of the central nervous system:

Lethargy is a state of constant sleep. An awakened baby shows a small number of unconditioned reflexes. Their disappearance depends on the severity of the lethargy.
Stupefaction is expressed in the fact that, in response to touch, the child grimace, weakly move his limbs, close his eyes. Babinski's reflex is present, upper grasping, but the baby does not suckle the breast.
Stupor is a stage in which the reaction occurs only to pain. Characterized by tonic flexion of the arms and legs in response to stimuli.
Coma can be of different degrees, which depends on the inhibition of the tendon, grasping and Babinsky reflex.

There are several syndromes in the development of encephalopathy:

Violation of the motor function is formed according to the hypo- or hypertonic type, manifested by hyperkinesis, paresis and paralysis. The syndrome of movement disorders is characterized by a lack of facial expressions: children begin to smile only at three months, there is no reaction to sounds and relatives, the child screams without changing tones. The syndrome of muscular dystonia in newborns is common (generalized) - flexion of the sole or arching of the whole body, as well as focal - the muscles of one part of the body contract.
Astheno-neurotic syndrome consists of chronic sleep disorders, emotional lability and anxiety.
Spastic or convulsive syndrome It is expressed by convulsions, small-amplitude trembling, automatisms in chewing, short-term respiratory arrests.
The syndrome of vegetative-visceral pathologies is manifested by pallor of the skin, frequent regurgitation, colic, disorders heart rate. It develops against the background of intracranial hypertension and hyperexcitability syndrome. The child has cold hands and feet, poor weight gain. Intestinal colic develop in 15% of children under three months of age and have almost become the norm.
Hyperexcitability syndrome manifests itself in 10% of babies in the neonatal period and outgrows in the absence of concentration in kindergarten. The child looks squeezed, clenching his fists, a grimace of pain remains on his face. Frequent crying and skin of a marble shade are characteristic.
Syndrome of increased neuro-reflex excitability usually precedes or alternates with CNS depression. The child reacts sharply to sounds and touches by waving his hands and crying, throwing his head back.
Hydrocephalic syndrome: a child with internal hydrocephalus lethargic and sleepy. His fontanel bulges, the circumference of his head increases, and his sleep is disturbed. Neurological disorders partially regress.

The outcome of the depression syndrome is varied. Possible full recovery CNS functions, minimal dysfunctions, attention deficit hyperactivity disorder. With a moderate degree of damage, a mental retardation, logopedic problems. With gross organic changes - cerebral palsy, epilepsy, delay intellectual development progressive hydrocephalus.

The consequences can affect different areas of the brain:

Hypothalamic syndrome is diagnosed as a constitutional insufficiency of the hypothalamus. Causes may include perinatal encephalopathy, difficult labor, hormonal drugs, neuroinfections. It is manifested by early puberty in girls, polycystosis, in boys - gynecomastia.
Delayed psychomotor development refers to a violation in the development of natural movements, such as running, walking, speech. Affects the ability to read and write.
Attention Deficit Hyperactivity Disorder is a new diagnosis, which is established by the inability to concentrate and learn. Manifested by the inability to listen to what he is told, to calm down, agitation, aggression and excessive laziness. Dr. Komarovsky speaks of hyperactivity if such behavior interferes with the socialization and development of the child.

Methods of detection and treatment

To diagnose encephalopathy of the newborn, a number of studies are carried out:

blood test for glucose, electrolytes;
examination of the cerebrospinal fluid for infection;
neurosonography through the large fontanel.

A comprehensive examination includes MRI or CT to clarify ischemia and hypoxia, encephalography for convulsions, Dopplerography to study the state of blood vessels. The child needs an examination by an ophthalmologist, and with age, consultations with a psychologist and a speech therapist.

Drug treatment depends on the syndromes that develop in a child:

To eliminate motor disorders, Dibazol and Galantamine are prescribed. To reduce muscle tone - Baclofen and Mydocalm. Treatment is supplemented with electrophoresis, paraffin therapy, massages and gymnastics.
At seizures anticonvulsants are prescribed - "Diazepam" and "Phenobarbital". Children with epilepsy are prohibited from swimming, gymnastics and massages.
With increased intracranial pressure, "Diakarb" is prescribed - a decongestant with diuretic functions. Most children are prescribed phytotherapy. Dehydration treatment includes "Mannitol", sometimes requires a lumbar puncture, the use of corticosteroids.
For correction restless sleep, spontaneous movements, emotional lability apply "Actovegin", "Partogram" - means aimed at increasing blood flow to the brain and improving the nerve conduction of cells.

Complex therapy is aimed at restoring and maintaining the growth of neurons. Solutions of glucose, electrolytes, magnesium, a complex of B and C vitamins are administered intravenously.

Means are used to increase the metabolism of brain tissue - "Vinpocetine" and "Cortexin". In severe cases, surgery is performed. Children with an impaired sucking reflex require parenteral nutrition.

To relieve the autonomic symptoms of colic and regurgitation, more frequent feeding, reduced portions, and verticalization of the child after eating are recommended.

In case of hyperexcitability, the neurologist prescribes psychostimulant drugs, directs him to sessions of behavioral therapy. A visit to an osteopath can solve a child's problems with sleep, fatigue, headaches, as the specialist normalizes the blood supply to the brain with manual techniques.

If the damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but some disease may occur in a normally formed child. It is very difficult to isolate the impact of a harmful factor separately in each of these periods. Therefore, more often they talk about the impact of a harmful factor in general in 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 of the mother, work in hazardous chemical industries or work associated with various radiation, as well as bad habits of parents - smoking, alcoholism, drug addiction - can have an adverse effect on the child.

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

Childbirth is a very important event for a child. Particularly great tests fall on the baby if the birth occurs prematurely (prematurity) or rapidly, if birth weakness occurs, the fetal bladder bursts early and water flows out when the baby is very large and he 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 trauma, less often intrauterine infections, hemolytic disease of the newborn, 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.

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

In second place among the causes of CNS damage 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 action directly on the fetus during childbirth.

Among the variety of birth injuries during the birth of a baby, the child's neck experiences the greatest load, resulting in various injuries of the cervical spine, especially the intervertebral joints and the junction of the first cervical vertebra and the occipital bone (atlanto-occipital articulation).

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

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

Traumatic injuries of the central nervous system during childbirth most often occur when the size of the child does not correspond to the size of the mother's pelvis, with an incorrect position of the fetus, during childbirth in breech presentation, when premature, underweight babies are born and, conversely, children with large body weight, large sizes, as in In these cases, various manual obstetrical techniques are used.

Discussing the causes of traumatic lesions of the central nervous system, it is necessary to dwell separately on childbirth using obstetric forceps. The fact is that even with the immaculate application of the forceps head, intense traction behind 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 the baby with forceps, along with the pathology of the brain, damage to the cervical region of the spinal cord occurs.

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

With a birth injury, cerebrovascular accidents often occur, up to hemorrhages. More often these are small intracerebral hemorrhages in the cavity of the ventricles of the brain or intracranial hemorrhages between the meninges (epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic lesions of the central nervous system in newborns.

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

Important for the appointment of the most effective treatment of CNS pathology in newborns is the definition of the leading complex of signs of the disease - the neurological syndrome. Consider the main syndromes of CNS pathology.

The main syndromes of CNS pathology

Hypertension-hydrocephalic syndrome

When examining a sick baby, an expansion of the ventricular system of the brain is determined, detected by ultrasound of the brain, and an increase in intracranial pressure is recorded (given by echo-encephalography). Outwardly, in severe cases with this syndrome, there is a disproportionate increase in the size of the cerebral 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 strengthening of the venous pattern on the scalp, thinning of the skin at the temples.

Often, with an increase in intracranial pressure, children goggle, Gref's symptom periodically appears (a white strip between the pupil and the upper eyelid), and in severe cases, the “setting sun” symptom may be noted, 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 low or high, especially in the muscles of the legs, which is manifested by the fact that when supported, he stands on tiptoe, and when he tries to walk, he crosses his legs.

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

In cases of severe progressive hydrocephalus, seizures may occur.

Movement Disorder Syndrome

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

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

With an increase in muscle tone in the lower extremities, the child later gets up on his legs, while leaning mainly on the forefoot, as if “standing on tiptoe”, in severe cases, the lower extremities cross at the level of the shins, which prevents the formation of walking. In most children, with time and treatment, it is possible to achieve a decrease in 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 can remain, which makes it difficult to choose shoes.

Syndrome of vegetative-visceral dysfunctions

This syndrome manifests itself as follows: marbling of the skin due to blood vessels, violation of 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 stools, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply to the posterior parts of the brain, in which all the main centers of the autonomic nervous system are located, which provide guidance for the most important life-supporting 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 the doctor must identify. This often requires an instrumental study of the brain (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, capturing the whole body, and localized - only in a certain muscle group.

There are many options for the manifestations of seizures, which are revealed by a neuropathologist according to the story and description of the child's behavior by attentive parents.

lyami. The correct diagnosis, that is, determining the cause of the child's seizures, is extremely important, since the timely appointment of effective treatment depends on this.

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 beginning of epilepsy in the future.

Symptoms to Seek to a Pediatric Neurologist

Summing up all that has been said, we briefly list the main deviations in the state of health of children with which it is necessary to contact a pediatric neurologist:

if the child sucks sluggishly at the breast, takes breaks, gets tired at the same time. There is choking, leakage of milk through the nose;
if the child has a weak cry, and the voice has a nasal tone;
if the newborn often spits up, does not gain enough weight;
if the child is inactive, lethargic or, on the contrary, too restless and this anxiety increases even with minor changes in the environment;
if the child has a trembling of the chin, as well as the upper or lower extremities, especially when crying;
if the child often shudders for no reason, falls asleep with difficulty, while sleep is superficial, short in time;
if the child constantly throws back his head, lying on his side;
if too fast or, conversely, slow growth of head circumference is noted;
if the child's motor activity is reduced, if he is very lethargic, and the muscles are flabby (low muscle tone), or, conversely, the child is as if constrained in 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 the 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 spread of the hips is limited, or, conversely, the child lies in the frog position with the hips separated by 180 degrees;
if the child was born by caesarean section or in breech presentation, if obstetrical forceps were used during childbirth, if the infant was born prematurely or with a large weight, if umbilical cord entanglement was noted, if the child had convulsions in the maternity home. Accurate diagnosis and timely and correctly prescribed treatment of the pathology of the nervous system are extremely important. Damage to the nervous system can be expressed to varying degrees: in some children from birth they are very pronounced, in others even severe disorders gradually decrease, but they do not completely disappear, and mild manifestations remain for many years - these are the so-called residual effects.

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 loads: physical, mental, emotional - these neurological disorders manifest themselves with varying degrees of severity. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists often deal with such patients in their daily practice.

What are the signs of these consequences?

Most children with late manifestations show a pronounced 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” position, easily do the splits. Often such children are gladly accepted into the rhythmic or artistic gymnastics section, into choreographic circles. But most of them do not endure heavy loads and are eventually expelled. However, these activities are enough to form the pathology of the spine - scoliosis. It is not difficult to recognize such children: they often clearly show a protective tension of the cervico-occipital muscles, often there is a slight torticollis, the shoulder blades stick out like wings, the so-called “pterygoid shoulder blades”, they can stand at different levels, like the shoulders. In profile, it can be seen that the child has a sluggish posture, a stooped back.

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

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

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

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

As a result of fetal hypoxic trauma in the perinatal period, the brain primarily suffers, the normal course of maturation of the functional systems of the brain, which provide the formation of such complex processes and functions of the nervous system as stereotypes of complex movements, behavior, speech, attention, memory, and perception, is disrupted. Many of these children show signs of immaturity or violations 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, they cannot sit still for several minutes.

They say about a hyperactive child: this is a child "without brakes." In the first year of life, they give the impression of very developed children, as they are ahead of their peers in the development - they begin to sit, crawl, and walk earlier. It is impossible to keep a child, he certainly wants to see and touch everything. Increased motor activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low efficiency, the child does 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 auditory-speech memory disorders, children do not learn material from hearing well, while visual memory impairment is less common. They often have a bad mood, thoughtfulness, lethargy. It is difficult to involve them in the pedagogical process. The result of all this is a negative attitude towards learning and even a refusal to attend school.

Functional disorders of 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.

Domestic obstetrician Professor M. D. Gyutner back in 1945 rightly called birth injuries of the central nervous system "the most common folk disease."