The concept of "perinatal encephalopathy" is familiar to many parents, since today it is found in various versions in almost half of children's medical records with neurological diagnoses. This pathology is understood as a set of disorders of the nervous tissue under the influence of hypoxia, injuries, infections that affect the fetal brain during pregnancy or at the time of childbirth. The consequences of such an influence range from minimal brain dysfunctions to severe manifestations in the form of cerebral palsy, hydrocephalus and epileptic syndrome.
Scientific research data
Many do not know how to respond to the diagnosis of perinatal encephalopathy syndrome, especially when the child looks he althy and develops according to his age. Not surprising, because this pathology is not in international classifications.
According to many scientific researchers, real casesencephalopathy of hypoxic and ischemic genesis occurs only in 4% of infants, however, in polyclinics, at least half of the babies are diagnosed with such a diagnosis.
The nervous system in the first year of a person's life is extremely fickle. It is rapidly improving and maturing, as a result of which both the reactions to the outside world and the behavior of the child change, so it is very difficult to systematize the changes that are taking place into any norms, however, experts have tried to do this.
There are a lot of factors that influence development. Therefore, it often happens that in quite he althy children one of the parameters goes beyond the normal range. From this comes information about the frequency of diagnoses of perinatal disorders. Even in cases where a child cries for a long time or his chin suddenly trembles, or he burps several times, parents rush to a specialist, and he does not hesitate to determine brain dysfunction and diagnose “perinatal encephalopathy.”
Therapy given at an early age is often not only inappropriate, but also harmful to the child in cases where the diagnosis is not confirmed by the bulk of diagnostic measures, which often happens in modern clinics.
Naturally, it is wrong to completely deny the presence of perinatal brain damage, but such a diagnosis should be treated very carefully in order to avoid unreasonable treatment.
Main causes of ischemic brain injury
Perinatal encephalopathy of hypoxic or ischemic origin can be caused by certain negativefactors that affect the fetus during pregnancy, as well as some circumstances of complicated childbirth and the early period after them. These preconditions typically include:
- Chronic diseases of a pregnant woman that can affect blood circulation and exchange in the placenta, such as heart failure with heart defects, anemia, lung pathology, hypothyroidism, etc.
- Acute infectious pathologies or exacerbation of chronic inflammatory processes during gestation.
- Eating errors, alcohol abuse and smoking.
- Too young or mature age of a pregnant woman.
- Hereditary pathologies and metabolic disorders.
- Preeclampsia, the threat of miscarriage, as well as chronic fetoplacental disorders.
- Pathologies of labor such as weakness in labor, use of forceps, rush labor, or vacuum extraction of the fetus.
- Intoxication, radiation exposure, the effects of certain drugs during pregnancy.
- Preterm infant condition.
Thus, any undesirable effect on the body of a pregnant woman, including frequent stress, can disrupt the maturation of the fetal brain, cause fetoplacental insufficiency and perinatal encephalopathy. The ICD-10 code encrypts this disease as G 93.4 (unspecified encephalopathy). Often, doctors fail to see a clear link between a disease and a particular adverse factor.
Apgar score
Assess the depth of brain damagehelps, as a rule, the Apgar scale, which takes into account the activity, reflexes of babies, the color of their skin and the activity of organs such as the heart, lungs, etc. Based on such data, we can conclude that the severity of symptoms of hypoxia, and the higher the indicator on this scale, the he althier the child is, and a value of 3 points or less indicates an extremely high risk of perinatal lesions of the nervous tissue, which are the result of deep hypoxia. In such cases, the child needs emergency help.
Hypoxia
The main cause of perinatal encephalopathy is intrauterine hypoxia. At the same time, high scores on the aforementioned scale do not guarantee absolute he alth, since the symptoms of the disease may appear after some time. Timely help from doctors and the high ability of the child's brain to adapt have a positive outcome of such disorders and the absence of all kinds of neurological disorders in children.
Symptomatics
Perinatal hypoxic-ischemic encephalopathy can usually occur in several stages, which differ in the originality of clinical symptoms, the severity of their course and different outcomes:
- Acute - in the first month of life.
- Recovery stage up to a year in a full-term baby and up to two years in a premature baby.
- Residual changes.
Most often there are combinations of several syndromes of impaired brain activity, which can be expressed to varying degrees, and for each of them a special treatment regimen has been establishedand prognosis for recovery.
In the acute period of perinatal encephalopathy of ischemic-hypoxic genesis, brain depression syndromes can be observed, in which coma, increased reflex and nervous excitability, convulsions, symptoms of intracranial hypertension due to severe hydrocephalus are possible.
At the recovery stage of the disease, these syndromes persist, although their severity decreases under the influence of therapy. Various visceral and vegetative disorders, lag in psychomotor development, etc. appear.
During the period of residual changes, there is a delay in speech development, hyperactivity, neurasthenia, vegetative dysfunctions, and in severe cases there is a convulsive syndrome, hydrocephalus itself is not resolved. A very dangerous manifestation during this period is persistent cerebral palsy.
Clinical picture
The clinical picture of perinatal encephalopathy (ICD-10: G93.4) and neuroreflex excitability syndrome is expressed by the following features:
- Activation of spontaneous movements, as well as innate reflexes.
- Anxiety, crying, shallow and short sleep.
- Prolonged wakefulness and trouble falling asleep.
- Fluctuations in muscle tone, trembling of the chin, legs or arms of the child.
Premature babies with this syndrome are most likely to experience seizures that occur when exposed to certain irritating factors, such as increasedtemperature. With a complicated course of the disease, over time, the child may develop epilepsy.
Convulsions
Seizures are another specific sign of encephalopathy. They can occur regardless of age and be quite diverse - from attacks of head tilt with increased tone of the limbs and shudders to generalized phenomena with loss of consciousness.
Hypertension-hydrocephalic syndromes occur due to too much cerebrospinal fluid, which leads to an increase in intracranial pressure. This phenomenon can be manifested by swelling and pulsation of the fontanel, the growth of the baby's head, which sometimes does not correspond to the age norm. Children with hydrocephalus are very calm, sleep poorly and spit up frequently.
However, it is necessary to know that a large head may be the constitution of a particular child, and regurgitation and restlessness are often observed in intestinal colic. The fontanel does not overgrow for a long time with rickets, so you should not make diagnoses yourself.
Coma
Coma is a very severe symptom of brain pathology, which characterizes deep hypoxic lesions of neurons. In children in this condition, lethargy of movements or their absence, inhibition of the respiratory reflex, bradycardia, decreased sucking and swallowing reflexes, and convulsive seizures appear. This condition requires emergency treatment, as well as parenteral nutrition and careful monitoring. The coma sometimes lasts up to two weeks.
Autonomic dysfunction and disorder of visceral innervation in hypertensive-hydrocephalic syndrome and similar disorders begin at about two months. They are characterized by such symptoms as regurgitation, insufficient weight gain, pathologies of the heart rhythm and breathing, impaired thermoregulation and digestion. With this syndrome, enteritis and colitis often occur with stool disorders.
Motor disorders
Motor disorders in this pathology are noticeable already in the first weeks after birth. Muscle tone can be high or, conversely, reduced, and movements slow down or intensify. This syndrome may be accompanied by a lag in psychomotor development, speech delays, and a decrease in intelligence. Also characteristic are weak facial expressions, slow reactions to auditory and visual stimuli, belated mastery of the acts of sitting, walking and crawling.
One of the most severe manifestations of the pathology of motor disorders is cerebral palsy, when the motor sphere, speech is disturbed, there are mental retardation and strabismus.
How is perinatal posthypoxic encephalopathy diagnosed?
Diagnosis of pathology
Diagnosis of perinatal disorders of the brain is made on the basis of symptoms, anamnesis data on the course of pregnancy and childbirth, when gestosis, various infections, birth injuries, etc. were possible. This information is contained in the card and extract from the maternity hospital.
Additional examination greatly facilitatesdiagnostic searches and helps to clarify the degree of damage to the nervous system, as well as to track the dynamics of the disease and the effect of the treatment.
Instrumental methods for diagnosing perinatal encephalopathy in newborns in this case include:
- Neurosonography, which is very safe and allows you to evaluate the morphological and functional features of the brain, as well as the CSF system. Using this method, you can identify the presence of damage and their degree.
- Dopplerography, which evaluates blood circulation in the vessels of the brain.
- Electroencephalography is a method for studying the electrical activity of neurons by registering cellular potentials. The study shows the maturity of the nervous system, possible developmental delays, asymmetry of the cerebral hemispheres, convulsive readiness.
- Video monitoring, with the help of it it is possible to analyze the spontaneous movements of the child in order to assess the assessment of epileptic activity
- Electroneuromyography allows you to diagnose neuromuscular pathologies, congenital or acquired.
- CT and MRI are studies that clarify the features of the anatomical structure of the brain, but have a significant drawback, since they are performed under anesthesia.
- Positron emission tomography, which shows a picture of metabolic processes, as well as the speed of blood flow in certain areas of the brain.
The most common methods for diagnosing hypoxic perinatal encephalopathy are neurosonography and EEG, which are easilyare reproducible, safe and can provide a very large amount of information.
In case of hypoxic lesions of the brain, consultation with an ophthalmologist is mandatory. The study of the fundus helps to diagnose genetic pathologies, analyze the levels of intracranial pressure and the condition of the optic nerves.
Treatment of pathology
Treatment of perinatal encephalopathy (ICD code - G93.4) in the moderate and severe course of the acute phase is carried out in a hospital setting. In mild forms of the disease, in most cases, specialists are limited to the following activities:
- Correction of the regimen, set individually and depending on the nature of motor disorders and the degree of nervous and reflex excitability of the child.
- Pedagogical assistance.
- Massage and therapeutic exercises.
- Physiotherapy methods.
As a drug therapy for perinatal encephalopathy (ICD-10: G93.4), various sedatives with herbal ingredients and diuretics are prescribed.
Hypertensive-hydrocephalic disorders require conservative treatment:
- The head section of the crib is raised 30 degrees.
- Phytotherapeutic treatments for mild disease - bearberry, horsetail and other plants.
- In the absence of the effect of herbs in severe and moderate course, medicines are used - "Diakarb", which reduces the production of cerebrospinal fluid and increases its outflow from the skull, as well as"Mannitol".
- Surgical correction (bypass surgery) may be required if medical therapy fails.
Motor disorders in perinatal hypoxic encephalopathy are usually treated conservatively:
- exercise.
- Massage.
- Physiotherapy - electrophoresis, amplipulse.
Medication support
Depending on the prevailing clinical manifestations, medication support is prescribed:
- "Dibazol", "Galantamine" - drugs to enhance neuromuscular impulses with hypotension and paresis.
- "Mydocalm", "Baclofen" - in cases of hypertonicity, as well as spasms.
These drugs are taken orally, injected or by electrophoresis. Attention and caution requires anticonvulsant treatment of children with epilepsy. The doses and type of anticonvulsant, as well as the regimen, are determined by the severity and course of the pathology, as well as the age of the child. In this case, "Depakin", "Phenobarbital", "Diazepam" and others are used.
Change of drugs is possible under the supervision of a neurologist, taking into account the encephalogram.
The intake of anticonvulsants in hypoxic or ischemic genesis of perinatal encephalopathy is sometimes accompanied by side effects and affects the development of the child. Their use should be monitored by blood tests and liver function indicators.
Another important fact is that massage and physiotherapycontraindicated in children with epileptic syndrome. Swimming, overheating, overwork can also provoke an epileptic seizure, so they must be excluded.
With developmental delay, which almost accompanies brain damage, drugs are used to improve brain activity and blood circulation in it, which increase metabolic processes and contribute to the formation of connections between neurons.
Consequences of perinatal encephalopathy
- Full recovery. If the disease is detected in a timely manner and complex treatment is carried out, then this option is possible.
- Delay in psychomotor development. Varies in severity. The child will not be severely limited in opportunities.
- Hyperactivity and Attention Deficit.
- Hydrocephalus.
- Manifestations of neurotic reactions. It is considered a more severe complication requiring constant follow-up of the child.
- Epilepsy.
- Vegetative-visceral dysfunction.
- Infantile cerebral palsy.
