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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:

Should note

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

with

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.

Outcomes :

  • 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.
  • Epilepsy.
  • Hydrocephaly.
  • 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.

Diagnostics of perinatal damage of a brain

the Diagnosis of perinatal damage of a brain can be made to

by

on the basis of clinical data and knowledge of features of a course of pregnancy and childbirth.

Data of additional methods of researches have auxiliary character and help to specify character and extent of damage of a brain, serve for supervision over the course of a disease, an assessment of efficiency of the carried-out therapy.

of Neyrosonografiya (NSG) - the safe method of survey of a brain allowing to estimate a condition of tissue of brain, likvorny spaces. It reveals intra cranial defeats, nature of damages of a brain.

Doppler sonography allows to estimate blood-groove size in brain vessels.

the Electroencephalogram (EEG) - the method of research of functional activity of a brain based on registration of electric potentials of a brain. According to EEG it is possible to judge degree of a delay of age development of a brain, existence of mezhpolusharny asymmetries, existence of epileptic activity, its centers in various departments of a brain.

Videomonitoring - the way allowing to estimate spontaneous physical activity at the child by means of videos. Video combination - and EEG - monitorings allows to reveal precisely character of attacks (paroxysms) at children of early age.

of Elektroneyromiografiya (ENMG) - an irreplaceable method in diagnostics congenital and acquired nervously - muscular diseases.

the Computer Tomography (CT) and magnitno - a resonant tomography (MRT) - the modern methods allowing to estimate in details structural changes of a brain. Wide use of these methods at early children`s age is complicated from - for need of application of an anesthesia.

It is positron - the issue tomography (PET) allows to define intensity of a metabolism in fabrics and intensity of a brain blood-groove at various levels and in various structures of the central nervous system.

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Most widely at PEP use a neyrosonografiya and an electroencephalography.

survey of the oculist is obligatory for

At pathology of TsNS. The changes revealed at an eye bottom help to diagnose genetic diseases, to estimate degree of expressiveness of intra cranial hypertensia, a condition of optic nerves.

Treatment of PEP

As was already told to

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above, children with crushing and medium-weight defeats of the central nervous system during the sharp period of a disease need hospitalization. At most of children with easy manifestations of syndromes raised nervously - reflex excitability and motive violations it is possible to be limited to selection of the individual mode, pedagogical correction, massage, physiotherapy exercises, application of physiotherapeutic methods. From medicamentous methods for such patients use phytotherapy (infusions and broths of sedative and diuretic herbs) and homeopathic medicines more often.

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At gipertenzionno - a gidrotsefalny syndrome considers degree of expressiveness of hypertensia and expressiveness of a gidrotsefalny syndrome. With the increased intra cranial pressure it is recommended to raise the head end of a bed on 20 - 30 °. For this purpose it is possible to enclose something under legs of a bed or under a mattress. Medicamentous therapy is appointed only by the doctor, efficiency is estimated on clinical manifestations and data of NSG. In mild cases are limited to phytopreparations (broths of a horsetail field, a leaf of a bearberry, etc.) . At more hard cases use diakarb , the outflow reducing development of a likvor and increasing it. At inefficiency of drug treatment in especially hard cases it is necessary to resort to neurosurgical methods of therapy.

the main accent is given by

At the expressed motive violations to methods of massage, physiotherapy exercises, physical therapy. Medicamentous therapy depends on the leading syndrome: at muscular hypotonia, peripheral paresis appoint the preparations improving nervously - muscular transfer ( dibazol , sometimes galantamin ), at the raised tone apply the means promoting its decrease - midokalm or baklofen . Various options of introduction of preparations in and by means of an electrophoresis are used.

Selection of preparations to children with an epileptic syndrome depends on a disease form. Reception of anticonvulsive preparations (antikonvulsant), doses, time of reception are defined by the doctor. Change of preparations is carried out gradually under control of EEG. Sharp spontaneous cancellation of preparations can provoke increase of attacks. Now use a wide arsenal of anticonvulsive means. Reception of antikonvulsant is not indifferent for an organism and is appointed only at the established diagnosis of epilepsy or an epileptic syndrome under control of laboratory indicators. However lack of timely treatment of epileptic paroxysms leads to violation of mental development. Massage and physiotherapeutic treatment are contraindicated to children with an epileptic syndrome.

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At a syndrome of a delay of psychomotor development along with non-drug methods of treatment and socially - pedagogical correction apply the preparations activating brain activity, improving a brain blood-groove, promoting formation of new communications between nervous cages. The choice of preparations big ( nootropit, to lutseta, pan-togas, vinpotsetin, aktovegin, korteksin and so forth) . In each case the scheme of drug treatment is selected individually depending on expressiveness of symptomatology and individual shipping.

Practically at all syndromes of PEP sick are appointed by preparations of vitamins of group “B“ which can be applied inside, intramuscularly and in an electrophoresis.

To one-year-old age at most of mature children of the phenomenon of PEP disappear or the insignificant displays of perinatal encephalopathy which are not making essential impact on further development of the child come to light. Frequent consequences of the postponed encephalopathy are the minimum brain dysfunction (easy violations of behavior and training), a gidrotsefalny syndrome. The heaviest outcomes are the children`s cerebral palsy and epilepsy.

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