Perinatal defeats of the central nervous system
the Perinatal period (from 28 weeks of pregnancy to 7 days of life of the child) - one of fundamental stages of ontogenesis, that is individual development of an organism which “events“ influence emergence and the course of diseases of nervous system and internals at children. The greatest interest for parents, obviously, is represented by methods of rehabilitation of children with perinatal defeats of the central nervous system (CNS), that is restoration of the broken functions. But at first we consider important to acquaint you with those reasons which can lead to perinatal defeats of TsNS at the child, and also with diagnostic opportunities of modern medicine. It will be a question of rehabilitation in the following issue of the magazine.
Modern classification of perinatal defeats of TsNS is based by
on the reasons and mechanisms leading to violations in work of TsNS at the child. According to this classification, allocate four groups of perinatal defeats of TsNS:
- hypoxemic defeats of TsNS at which the major damaging factor is the lack of oxygen,
- traumatic defeats , in this case the leading damaging factor is mechanical damage of fabrics of the central nervous system (a head and spinal cord) to childbirth and the first minutes and hours of life of the child,
- dismetabolichesky and toksiko - metabolic defeats , at the same time the major damaging factor are metabolic disorders in the child`s organism in the pre-natal period,
- defeat of TsNS at infectious diseases of the perinatal period : the main damaging impact is made by the infectious agent (as a rule, a virus).
needs to be noticed Here that often doctors deal with a combination of several factors therefore this division is to a certain extent conditional.we Will tell
in more detail about each of the above-stated groups.
1 group of perinatal defeats of TsNSto
First of all, it is necessary to tell that hypoxemic defeats of TsNS meet most often. Are the reasons of a chronic pre-natal hypoxia of a fruit:
- of a disease of the pregnant woman (diabetes, infection, anemia, increase of arterial pressure, etc.)
- abundance of water,
- lack of water,
- polycarpous pregnancy, etc.
the Reasons of a sharp hypoxia (i.e. arising at the time of delivery) are:
- of violation matochno - placentary blood circulation at a premature otsloyka of a placenta,
- heavy bleedings,
- delay of a blood-groove at compression of the head of a fruit in labor in a cavity of a small pelvis, etc.
Duration and expressiveness of a hypoxia, and, respectively, extent of defeat of TsNS are defined by toxicosis degree, an aggravation at mother during pregnancy of associated diseases, is especially warm - vascular system. TsNS of a fruit is most sensitive to shortage of oxygen. At a chronic pre-natal hypoxia a number of pathological changes (delay of growth of capillaries of a brain, increase in their permeability) which promote development of heavy disorders of breath and blood circulation in labor is started (this state is called asphyxia). Thus, asphyxia of the newborn at the birth in most cases is a consequence of a hypoxia of a fruit.
the II group of perinatal defeats of TsNS
the Traumatic factor plays the main role in injuries of a spinal cord. As a rule, the obstetric grants injuring a fruit take place here (we will remind that obstetric grants are manual manipulations which carries out the heads delivering the midwife for the purpose of simplification of removal and a coat hanger of a fruit) with a big mass of a fruit, the narrowed basin, the wrong insertion of the head, pelvic prelying, unjustified application of methods of protection of a crotch (methods of protection of a crotch are directed to control of fast advance of the head of a fruit on patrimonial ways; on the one hand, it protects a crotch from excessive stretching, with another - time of stay of a fruit in patrimonial ways that, under the corresponding conditions, aggravates a hypoxia), excessive turns of the head at its removal, draft for the head increases at removal of a humeral belt and so forth. Sometimes such injuries arise even when carrying out Cesarean section with a so-called “cosmetic“ section (a horizontal section on a pubis through growth of hair and the corresponding horizontal section in the lower segment of a uterus), as a rule, insufficient for the sparing removal of the head of the child. Besides, medical manipulations in the first 48 hours (for example, intensive artificial ventilation of lungs), especially with malovesny premature, can also lead to development of perinatal defeats of TsNS.
the III group of perinatal defeats of TsNS
treat group of metabolic disorders such metabolic violations as an alcoholic syndrome of a fruit, a nicotinic syndrome, a narcotic abstinence syndrome (that is the violations developing owing to cancellation of drugs, and also the states caused by action on TsNS of virus and bacterial toxins or entered to a fruit or the child of medicines.
the IV group of perinatal defeats of TsNS
a factor of pre-natal infection gains in recent years the increasing value that is explained by more perfect methods of diagnosis of infections. Finally, the mechanism of damage of TsNS in many respects is defined by a type of the activator and disease severity.by
As show perinatal defeats of TsNS?
of Manifestation of perinatal defeats of TsNS is varied depending on weight of an illness. So, at an easy form moderate increase or decrease in a muscular tone and reflexes is noted in the beginning, symptoms of unsharp oppression usually in 5 - 7 days are replaced by excitement with a tremor (trembling) of hands, a chin, motive concern. At average weight oppression (more than 7 days) in the form of muscular hypotonia, weakening of reflexes is more often noted in the beginning. Spasms, sensitivity violations are sometimes noted. Are often observed vegetativno - the visceral violations which are shown diskineziya zheludochno - an intestinal path in the form of an unstable chair, vomiting, a meteorizm, violation of regulation of activity it is warm - vascular and respiratory systems (the increased or reduced heart rate, a priglushennost of warm tones, violation of a rhythm of breath etc.) . At a severe form the expressed and long oppression of TsNS, spasms, the expressed violations from respiratory prevail, it is warm - vascular and digestive systems.
Of course, in maternity hospital the doctor - neonatolog at survey of the newborn has to reveal perinatal defeats of TsNS and to appoint the corresponding treatment. But clinical manifestations can remain also after an extract from maternity hospital, and sometimes and to amplify. In this situation mother can suspect “malfunctions“ of work of TsNS of the child. What can guard her? We will list several characteristic signs: frequent concern of the child or his inexplicable constant slackness, regular vomiting, trembling of a chin, handles, legs, the unusual movements of eyes, dying down (the child as if “stiffens“ in one pose). Frequent syndrome in case of defeat of TsNS is and gipertenzionno - a gidrotsefalny syndrome - in this case signs of increase of intra cranial pressure, fast increase in a circle of the head have to guard (more than 1 cm in a week), disclosure of cranial seams, increase in the sizes of fontanels, at the same time can be noted and various vegeto - visceral violations.
If at you appeared though the slightest suspicions, by all means consult at the neuropathologist - what began treatment earlier or correction, by that a high probability of a complete recovery of the broken functions is carried out it.Once again we will emphasize
that the diagnosis to your child will be made by the doctor. Existence of perinatal defeat of TsNS, whenever possible - group of the factors which caused its development and names of syndromes to which the clinical manifestations of defeat of TsNS revealed at the child belong will be reflected in the diagnosis. For example:“ Perinatal defeat of TsNS of hypoxemic genesis: a syndrome of muscular dystonia, a syndrome vegeto - visceral violations“. It means that shortage of oxygen was the main reason for the defeat of the central nervous system which developed at the kid (hypoxia) during pregnancy that at survey at the child are revealed an uneven tone of muscles in hands and/or in legs (dystonia), skin of the child has uneven coloring owing to imperfection of regulation of a tone of vessels (vegeto-) and it notes dyskinesia zheludochno - an intestinal path (a chair delay, or, on the contrary, the increased motility of intestines, a meteorizm, persistent vomiting), violation of a rhythm of heart and breath (visceral violations).
of the Phase of development of pathological processto
are Allocated by four phases of development of pathological process at defeats of nervous system at children within the first year of life.by
the First phase - the sharp period of an illness, life lasting up to 1 month which is directly connected with a hypoxia and violation of blood circulation can clinically be shown in the form of a syndrome of oppression or a syndrome of excitement of TsNS.
the Second phase pathological process extends on 2 - 3 - y months of life, there is a reduction of expressiveness of neurologic frustration: the general state improves, physical activity increases, there is a normalization of a muscular tone, reflexes. Elektroentsefalografichesky indicators improve. This results from the fact that the affected brain does not lose ability to restoration, but duration of the second phase is small and soon (to 3 - mu to month of life) there can come increase of the spastic phenomena. The phase of “unjustified hopes for an absolute recovery“ comes to the end (it can be called a phase of false normalization).
the Third phase - the phase of the spastic phenomena (3 - 6 - y months of life) is characterized by prevalence of a muscular hypertension (i.e. increase of a muscular tone). The child throws back the head, bends in elbows of a hand and leads them to a breast, crosses legs and at a support puts on socks, the tremor is expressed, convulsive states, etc. are frequent. Change of clinical displays of an illness can be caused by the fact that in this period there is a process of a degeneration (the number of a distoficheska of the changed neurons increases). At the same time at many children with hypoxemic defeat of nervous system the outlined progress in the second phase of an illness is fixed that is found in the form of decrease in neurologic frustration.
the Fourth phase (7 - 9 months of life) is characterized by division of children with perinatal defeat of nervous system on two groups: children with obvious psychoneurological frustration up to severe forms of a children`s cerebral palsy (20%) and children with normalization of earlier observed changes from nervous system (80%). This phase can be conditionally called a phase of end of an illness.
Methods of laboratory diagnostics of perinatal defeats of nervous system at children
According to pilot studies, the brain of the newborn child in response to damage is capable to form new neurons. Early diagnostics and timely treatment are a guarantee of restoration of functions of the struck bodies and systems as pathological changes at small children give in to the return development, correction better; the anatomist - functional restoration happens more stoutly, than at the started changes to irreversible structural changes.
Restoration of the TsNS functions depends on severity of primary damage. In laboratory of clinical biochemistry of Scientific center of health of children of the Russian Academy of Medical Science researches which showed were conducted: for laboratory diagnostics of severity of perinatal defeats of nervous system at children it is possible to determine in blood serum the content of special substances - “markers of defeat of nervous tissue“ - a neyronspetsifichesky enolaza (NSE) which contains generally in neurons and neuroendocrine cages, and a myelin - the main protein which is a part of the cover surrounding shoots of neurons. Increase in their concentration in blood at newborns at crushing perinatal defeats of nervous system is explained by intake of these substances in blood current as a result of processes of destruction in cells of a brain. Therefore, on the one hand, emergence of NSE in blood allows to confirm the diagnosis of “perinatal defeat of TsNS“, and with another - to establish severity of this defeat: the more concentration of NSE and a myelin - the main protein in blood of the kid, the there is a speech about more severe defeat.
Besides, the brain of each child has, genetically determined (only to it peculiar) structural, functional, metabolic and other features. Thus, the accounting of severity of defeat and specific features of each sick child plays an important role in processes of restoration of TsNS and development of the individual program of rehabilitation.to
As it was already told above, methods of rehabilitation of children with perinatal defeats of TsNS will be lit in the following issue of the magazine.