Diagnosis:“ perinatal encephalopathy“
Perinatal encephalopathy (PEP) (a feather - + lat. natus - “birth“ + Greek encephalon - “brain“ + Greek patia - “violation“) - the term uniting big group various for the reason and the damages of a brain which are not specified by origin arising during pregnancy and childbirth. PEP can be shown differently, for example by a hyper excitability syndrome when irritability of the child is increased, appetite is reduced, the kid often belches during feeding and refuses a breast, sleeps less, falls asleep etc. more difficultly. More rare, but also heavier display of perinatal encephalopathy is the syndrome of oppression of the central nervous system. At such children physical activity is considerably reduced. The kid looks sluggish, shout silent and weak. He quickly is tired during feeding, in the most hard cases the sosatelny reflex is absent. Often displays of perinatal encephalopathy are expressed slightly, but the kids which transferred this state nevertheless require to themselves special attention, and sometimes - and special treatment.
of the Cause of illness
treat risk factors of developing of perinatal pathology of a brain:
- Various chronic diseases of mother.
- Acute infectious diseases or aggravations of the chronic centers of an infection in mother`s organism during pregnancy.
- of Violation of food.
- Too young age of the pregnant woman.
- Hereditary diseases and metabolic disorders.
- Pathological course of pregnancy (early and late toxicoses, pregnancy interruption threat and so forth).
- Pathological course of childbirth (prompt childbirth, weakness of patrimonial activity and so forth) and injuries at assistance at the time of delivery.
- Harmful effects of environment, an adverse ecological situation (ionizing radiation, toxic influences, including at use of various medicinal substances, environmental pollution by salts of heavy metals and industrial wastes and so forth) .
- Prematurity and immaturity of a fruit with various violations of its activity in the first days of life.
that most often meet hypoxemic - ischemic (their reason - the insufficiency of oxygen arising during pre-natal life of the kid) and the mixed defeats of the central nervous system that is explained by the fact that practically any trouble during pregnancy and childbirth leads to violation of supply with oxygen of fabrics of a fruit and first of all a brain. In many cases of the reason of emergence of PEP it is not possible to establish.
helps to Make objective idea of a condition of the child at the time of the birth 10 - a mark scale Apgar. At the same time activity of the child, color of integuments, expressiveness of physiological reflexes of the newborn, a condition of respiratory is considered and it is warm - vascular systems. Each of indicators is estimated from 0 to 2 points. The scale Apgar allows to estimate already in the rodzal adaptation of the child to extra uterine living conditions within the first minutes after the birth. The score from 1 to 3 indicates a serious condition, from 4 to 6 - a condition of average weight, from 7 to 10 - on satisfactory. Low points carry to risk factors for life of the child and development of neurologic violations and dictate need of application of the emergency intensive therapy.
Unfortunately, high points on a scale Apgar completely do not exclude risk of emergence of neurologic violations, a number of symptoms arises after 7 - go day of life, and it is very important to reveal possible manifestations of PEP as soon as possible. Plasticity of a brain of the child is extraordinary big, in due time held medical events help to avoid in most cases development of neurologic deficiency, to prevent violations in emotionally - the strong-willed sphere and cognitive activity.the Current PEP and possible forecasts allocate to
During PEP three periods: sharp (1 - y month of life), recovery (from 1 month to 1 year at full-term, till 2 years - at premature) and a disease outcome. In every period of PEP allocate various syndromes. The combination of several syndromes is more often observed. Such classification is expedient as it allows to allocate syndromes depending on age of the child. The corresponding tactics of treatment is developed for each syndrome. Expressiveness of each syndrome and their combination allow to define weight of a state, it is correct to appoint therapy, to build forecasts. There is a wish to note that even the minimum displays of perinatal encephalopathy demand the corresponding treatment for prevention of failures.
It is enumerable the main syndromes of PEP.
Sharp period :
- Syndrome of oppression of TsNS.
- Coma syndrome.
- the Syndrome raised nervously - reflex excitability.
- Convulsive syndrome. Gipertenzionno`s
- - a gidrotsefalny syndrome.
Recovery period :
- the Syndrome raised nervously - reflex excitability.
- Epileptic syndrome. Gipertenzionno`s
- - a gidrotsefalny syndrome.
- the Syndrome vegeto - visceral dysfunctions.
- Syndrome of motive violations.
- Syndrome of a delay of psychomotor development.
- Absolute recovery.
- Delay of mental, motor or speech development.
- a hyperactivity Syndrome with deficiency of attention (the minimum brain dysfunction).
- Neurotic reactions. Vegetativno`s
- - visceral dysfunctions.
- Children`s cerebral palsy.
All patients with crushing and medium-weight damages of a brain need hospitalization. Children with easy violations are discharged from maternity hospital under out-patient supervision of the neurologist.
we Will stop in more detail on clinical manifestations of separate syndromes of PEP which most often meet in out-patient conditions.
the Syndrome raised nervously - reflex excitability is shown by strengthening of spontaneous physical activity, an uneasy superficial dream, lengthening of the period of active wakefulness, difficulty of falling asleep, frequent unmotivated crying, revival of unconditioned congenital reflexes, a variable muscular tone, a tremor (twitching) of extremities, a chin. At premature this syndrome in most cases reflects reduction of the threshold of convulsive readiness, that is says that at the kid spasms easily can develop, for example, at temperature increase or action of other irritants. At a favorable current expressiveness of symptoms gradually decreases and disappears in terms from 4 - 6 months till 1 year. At the adverse course of a disease and lack of timely therapy the epileptic syndrome can develop.the Convulsive (epileptic) syndrome can be shown by
at any age. In infancy it is characterized by variety of forms. Imitation of unconditioned motive reflexes in the form of pristupoobrazno the arising bendings and a ducking with tension of hands and legs, turn of the head aside and extension of the same name hands and legs is often observed; episodes of starts, pristupoobrazny twitchings of extremities, imitations of sosatelny movements and so forth. Sometimes even to the expert it is difficult without additional methods of researches to define the nature of the arising convulsive states.
of Gipertenzionno - the gidrotsefalny syndrome is characterized by excess amount of liquid in the spaces of a brain containing a likvor (cerebrospinal fluid) that leads to increase of intra cranial pressure. Doctors often call this violation to parents quite so - say that the kid has an increased intra cranial pressure. The mechanism of emergence of this syndrome can be various: excessive development of a likvor, violation of absorption of surpluses of a likvor to the blood course, or their combination. The main symptoms at gipertenzionno - a gidrotsefalny syndrome by which doctors are guided and which can control and parents, are rates of a gain of a circle of the head of the child and the sizes and a condition of a big fontanel. At most of the full-term newborns normal the head circle at the birth makes 34 - 35 cm. In the first half of the year the monthly gain of a circle of the head averages 1,5 cm (in the first month - to 2,5 cm), reaching about 44 cm by 6 months. In the second half of the year rates of a gain decrease; by a year a head circle - 47 - 48 cm. An uneasy dream, frequent plentiful vomiting, monotonous crying in combination with a vybukhaniye, the strengthened pulsation of a big fontanel and a zaprokidyvaniye of the head behind - the most typical manifestations of this syndrome.
However the big sizes of the head often happen also at absolutely healthy kids and are defined by constitutional and family features. The big size of a fontanel and “delay“ of its closing are often observed at rickets. The small size of a fontanel at the birth increases risk of developing of intra cranial hypertensia at various adverse situations (overheating, temperature increase of a body, etc.) . Carrying out neyrosonografichesky research of a brain allows to make correctly the diagnosis to such patients and to decide on therapy tactics. In most cases by the end of the first half of the year of life of the child normalization of growth of a circle of the head is noted. At part of sick children by 8 - 12 months the gidrotsefalny syndrome without signs of increase of intra cranial pressure remains. In hard cases development of hydrocephaly is noted.
the Coma syndrome is manifestation of a serious condition of the newborn which is estimated by 1 - 4 points on a scale Apgar. At sick children the expressed slackness, decrease in physical activity up to its total absence are shown, all vital functions are oppressed: breath, warm activity. Attacks of spasms can be noted. The serious condition remains 10 - 15 days, at the same time there are no reflexes of sucking and swallowing.the Syndrome vegeto - visceral dysfunctions is, as a rule, shown by
after the first month of life against the increased nervous excitability and gipertenzionno - a gidrotsefalny syndrome. Frequent vomiting, a delay of an increase of body weight, violation of a warm and respiratory rhythm, thermal control, change of coloring and temperature of integuments, skin “mramornost“, violation of functions zheludochno - an intestinal path are noted. Often this syndrome can be combined with enterita, enterokolita (the inflammation of a small, large intestine which is shown the frustration of a chair, violation of an increase of body weight) caused by pathogenic microorganisms with rickets, making heavier their current.
the Syndrome of motive violations comes to light from first weeks of life. Since the birth violation of a muscular tone can be observed as towards its decrease, and increase, its asymmetry can come to light, decrease or excessive strengthening of spontaneous physical activity is noted. Often the syndrome of motive violations is combined with a delay of psychomotor and speech development since violations of a muscular tone and existence of pathological physical activity (giperkineza) interfere with carrying out purposeful movements, formation of normal motive functions, mastering the speech.
At a delay of psychomotor development the child begins to hold later the head, to sit, creep, go. Primary violation of mental development can be suspected at weak monotonous shout, violation of an articulation, poverty of a mimicry, late emergence of a smile, a delay visually - acoustical reactions.
the Children`s Cerebral Palsy (CCP) - the neurologic disease arising owing to early defeat of the central nervous system. At cerebral spastic infantile paralysis violations of development carry, as a rule, difficult structure, violations motive, violations of the speech, a delay of mental development are combined. Motive violations at cerebral spastic infantile paralysis are expressed in damage of the top and lower extremities; small motility, muscles of the articulation device, a muscle - glazodvigatel suffers. Violations of the speech come to light at most of patients: from the easy (erased) forms before absolutely illegible speech. 20 - 25% of children have characteristic violations of sight: the meeting and dispersing squint, nistagm, restriction of fields of vision. At most of children the delay of mental development is noted. At part of children violations of intelligence (intellectual backwardness) take place.
a hyperactivity Syndrome with deficiency of attention - the violation of behavior connected with the fact that the child badly holds the attention. It is difficult for such children to concentrate on any business, especially if it is not really interesting: they spin and cannot sit quietly still, constantly distract even on trifles. Their activity often too rough and chaotic.