Ischemic damage to the central nervous system in newborns treatment. Features of the structure of the nervous system of the newborn. Spinal motor automatisms

In modern times, a huge number of children (more than 85%) are born with such an ailment as perinatal encephalopathy, which is a collective concept that combines various syndromes and diseases characterized by brain damage. One of the consequences of damage to the central nervous system during the period of intrauterine development of an infant and the first days of his life, a syndrome of oppression in newborns appears.

The syndrome of oppression in children, which manifests itself in the first days of a baby's life, may arise due to various reasons, the most common of which are:

fetal hypoxia;

birth trauma;

intrauterine infections(herpes, syphilis, cytomegalovirus infection);

asphyxia of the newborn;

the use of alcohol, narcotic drugs and tobacco smoking during pregnancy;

immunological failure in the communication system mother - placenta - fetus.

Children who were born with a diagnosis of "syndrome of oppression" have a weakened muscle tone, in connection with this, their motor activity is significantly reduced. Such babies constantly look tired, weak and absent-minded, their cry or cry is so quiet that it is only heard close up and almost imperceptible from longer distances. In order to eat breast milk a child with a syndrome of oppression has to make great efforts, and in severe cases, the baby does not have a sucking reflex at all, so feeding is carried out through a tube or nipple. CNS depression syndrome is very often the reason for the long stay of a child in need of professional care, in a maternity hospital with his subsequent hospitalization in a specialized medical institution for newborns.

One of the clear signs of this disease is muscular hypotension, indicating the presence of a serious disease in the child, which is important to reliably establish in as soon as possible in order to start treatment in a timely manner.

The subsequent development of the baby very often occurs with a delay: the baby, later than his healthy peers, begins to independently hold his head, roll over, crawl, sit, walk and talk. In some cases, the syndrome of depression has such manifestations as a decrease in the reaction to pain, the development of convulsions, strabismus, a decrease in emotional tone, and in exceptional, advanced cases, the crumbs may fall into a lumpy state.

Only timely and correct treatment, strict adherence to the recommendations of a specialist will help overcome the syndrome of oppression, save the child from all its unpleasant manifestations, achieve a full recovery and give the baby a healthy and fulfilling life.

Parents of children suffering from depression syndrome should first of all seek help from a neurologist and get professional advice from him. The causes that caused the development of this condition are mostly associated with pathologies of intrauterine development, and therefore their elimination during the treatment process is impossible. The main efforts should be directed to the correction of the disease, the main methods of which, along with drug therapy are complex physiotherapy procedures.

Based on the severity of the depression syndrome and the general picture of the disease, the neurologist prescribes the child to take medications, as a rule, these are stimulant drugs. It is worth noting that many medications used to treat this pathology of the central nervous system have no age restrictions and can be used for both adults and children. For this reason, it is forbidden to self-medicate and give the child medicines without appropriate prescriptions, because to achieve positive effect in the absence negative reactions It is possible only by taking the drug in the optimal dosage, which the doctor is able to determine.

Courses of therapeutic massage and special gymnastic exercises will help improve body tone, promote the development of motor skills of the hands, and also strengthen the health of the child as a whole. It is useful during this period of time to harden the body, spend more time outdoors, swim, and then take air baths. It is important that the child receives all the necessary nutrients Therefore, a nursing mother should make adjustments to her diet in order to make it as healthy and balanced as possible. Parents should create a calm, balanced atmosphere in the house, in which there is no place for quarrels, scandals and a showdown in the presence of a small patient, who, as you know, very sensitively takes on the mood of adults.

It has been proven that breast milk helps a child born with central nervous system depression syndrome to overcome this disease, in this regard, caring mothers should try to extend natural feeding for the maximum possible period of time.

CNS depression syndrome in newborns is not a sentence; timely treatment started has every chance of ending in a complete recovery of the child. At the same time, parents should not only follow all the doctor's prescriptions, but also surround the little patient with increased attention, love and care.

The central nervous system is precisely the mechanism that helps a person grow and navigate in this world. But sometimes this mechanism fails, "breaks". It is especially scary if this happens in the first minutes and days of the child's independent life or even before he is born. About why the child is affected by the central nervous system and how to help the baby, we will tell in this article.

What it is

The central nervous system is a close "bundle" of the two most important links - the brain and spinal cord. The main function that nature assigned to the central nervous system is to provide reflexes, both simple (swallowing, sucking, breathing) and complex ones. CNS, or rather, its middle and lower divisions, regulate the activity of all organs and systems, provides communication between them. The highest department is the cerebral cortex. It is responsible for self-awareness and self-awareness, for the connection of a person with the world, with surrounding the child reality.

Violations, and consequently, damage to the central nervous system, can begin even during the development of the fetus in the mother's womb, and can occur under the influence of certain factors immediately or some time after birth.

Which part of the central nervous system is affected will determine which body functions will be impaired, and the degree of damage will determine the degree of consequences.

Causes

In children with CNS disorders, about half of all cases are intrauterine lesions, doctors call it perinatal pathologies CNS. At the same time, more than 70% of them are premature babies, which appeared earlier than the prescribed obstetric period. In this case, the main root cause lies in the immaturity of all organs and systems, including the nervous one, it is not ready for autonomous work.

Approximately 9-10% of toddlers born with lesions of the central nervous system were born on time with normal weight. The state of the nervous system, experts believe, in this case is affected by negative intrauterine factors, such as prolonged hypoxia experienced by the baby in the womb during gestation, birth trauma, as well as the state of acute oxygen starvation during difficult delivery, metabolic disorders of the child, which began even before birth, infectious diseases transferred by the expectant mother, complications of pregnancy. All lesions caused by the above factors during pregnancy or immediately after childbirth are also called residual organic:

Fetal hypoxia. Most often, babies whose mothers abuse alcohol, drugs, smoke or work in hazardous industries suffer from a lack of oxygen in the blood during pregnancy. The number of abortions that preceded these births is also of great importance, since the changes that occur in the tissues of the uterus after an abortion contribute to the disruption of uterine blood flow during a subsequent pregnancy.

traumatic causes. Birth injuries can be associated with both incorrectly chosen delivery tactics and medical errors during the birth process. Injuries also include actions that lead to a violation of the central nervous system of the child after childbirth, in the first hours after birth.
Fetal metabolic disorders. Such processes usually begin in the first - the beginning of the second trimester. They are directly related to the disruption of the functioning of the organs and systems of the baby's body under the influence of poisons, toxins, and some medications.
Maternal infections. Especially dangerous are diseases that are caused by viruses (measles, rubella, chickenpox, cytomegalovirus infection and a number of other ailments) if the disease occurs in the first trimester of pregnancy.

pathology of pregnancy. The state of the central nervous system of the child is affected by a wide variety of features of the gestation period - polyhydramnios and oligohydramnios, pregnancy with twins or triplets, placental abruption and other reasons.
Severe genetic diseases. Usually, pathologies such as Down and Evards syndromes, trisomy, and a number of others are accompanied by significant organic changes in the central nervous system.

At the current level of development of medicine, CNS pathologies become obvious to neonatologists already in the first hours after the birth of a baby. Less often - in the first weeks.

Sometimes, especially with organic lesions of mixed genesis, true reason cannot be established, especially if it is related to the perinatal period.

Classification and symptoms

Scroll possible symptoms depends on the causes, extent and extent of lesions of the brain or spinal cord, or combined lesions. Also, the outcome is affected by the time of negative impact - how long the child was exposed to factors that affected the activity and functionality of the central nervous system. It is important to quickly determine the period of the disease - acute, early recovery, late recovery or the period of residual effects.

All pathologies of the central nervous system have three degrees of severity:

Light. This degree appears a slight increase or a decrease in the tone of the baby's muscles, convergent strabismus may be observed.

Average. With such lesions, muscle tone is always reduced, reflexes are completely or partially absent. This condition is replaced by hypertonicity, convulsions. There are characteristic oculomotor disorders.
Heavy. Not only motor function and muscle tone suffer, but also internal organs. If the central nervous system is severely depressed, convulsions of varying intensity may begin. Problems with cardiac and renal activity can be very pronounced, as well as the development respiratory failure. The intestines may be paralyzed. The adrenal glands do not produce the right hormones in the right amount.

According to the etiology of the cause that caused problems with the activity of the brain or spinal cord, pathologies are divided (however, very conditionally) into:

Hypoxic (ischemic, intracranial hemorrhages, combined).
Traumatic (birth trauma of the skull, birth spinal lesions, birth pathologies of peripheral nerves).
Dysmetabolic ( kernicterus, excess in the blood and tissues of the child of the level of calcium, magnesium, potassium).
Infectious (consequences of maternal infections, hydrocephalus, intracranial hypertension).

Clinical manifestations different types lesions also differ significantly from each other:

ischemic lesions. The most "harmless" disease is cerebral ischemia of the 1st degree. With it, the child demonstrates CNS disorders only in the first 7 days after birth. The reason most often lies in fetal hypoxia. The baby at this time can observe relatively mild signs of arousal or depression of the central nervous system.
The second degree of this disease is put in the event that if violations and even convulsions last more than a week after birth. We can talk about the third degree if the child has a constantly increased intracranial pressure, frequent and severe convulsions, there are other autonomic disorders.

Usually this degree of cerebral ischemia tends to progress, the child's condition worsens, the baby may fall into a coma.

Hypoxic cerebral hemorrhages. If, as a result of oxygen starvation, a child has a hemorrhage into the ventricles of the brain, then at the first degree there may be no symptoms and signs at all. But already the second and third degrees of such a hemorrhage lead to severe brain damage - a convulsive syndrome, the development of shock. The child may go into a coma. If blood enters the subarachnoid cavity, then the child will be diagnosed with overexcitation of the central nervous system. There is a high probability of developing dropsy of the brain in an acute form.

Bleeding into the ground substance of the brain is not always noticeable at all. Much depends on which part of the brain is affected.

Traumatic lesions, birth trauma. If during childbirth, doctors had to use forceps on the baby's head and something went wrong, if there was acute hypoxia, then most often this is followed by a hemorrhage in the brain. With a birth injury, the child experiences convulsions to a more or less pronounced degree, the pupil on one side (the one where the hemorrhage occurred) increases in size. The main sign of traumatic damage to the central nervous system is an increase in pressure inside the child's skull. Acute hydrocephalus may develop. The neurologist testifies that in this case the central nervous system is more often excited than suppressed. Not only the brain, but also the spinal cord can be injured. This is most often manifested by sprains and tears, hemorrhage. In children, breathing is disturbed, hypotension of all muscles, spinal shock is observed.
Dysmetabolic lesions. With such pathologies, in the overwhelming majority of cases, the child has increased blood pressure, convulsive seizures are observed, and consciousness is quite pronouncedly depressed. The cause can be established by blood tests that show either a critical calcium deficiency, or a lack of sodium, or another imbalance of other substances.

Periods

The prognosis and course of the disease depends on the period in which the baby is. There are three main periods of development of pathology:

Spicy. Violations have just begun and have not yet had time to cause serious consequences. This is usually the first month of an independent life of a child, the neonatal period. At this time, a baby with CNS lesions usually sleeps poorly and restlessly, often without visible reasons cries, he is excitable, can shudder without an irritant even in a dream. Muscle tone is increased or decreased. If the degree of damage is higher than the first, then reflexes may weaken, in particular, the baby will begin to suck and swallow worse and weaker. During this period, the baby may begin to develop hydrocephalus, this will be manifested by a noticeable growth of the head and strange eye movements.

Restorative. It may be early or late. If the baby is at the age of 2-4 months, then they talk about early recovery, if he is already from 5 to 12 months, then about late. Sometimes parents notice disturbances in the work of the central nervous system in their crumbs for the first time in the early period. At 2 months, such little ones almost do not express emotions, they are not interested in bright hanging toys. IN late period the child noticeably lags behind in his development, does not sit, does not coo, his cry is quiet and usually very monotonous, emotionally uncolored.
Consequences. This period begins after the child is one year old. At this age, the doctor is able to most accurately assess the consequences of a CNS disorder in this particular case. Symptoms may disappear, however, the disease does not disappear anywhere. Most often, doctors give such children a year such verdicts as hyperactivity syndrome, developmental delay (speech, physical, mental).

The most severe diagnoses that can indicate the consequences of CNS pathologies are hydrocephalus, cerebral palsy, epilepsy.

Treatment

It is possible to talk about treatment when CNS lesions are diagnosed with maximum accuracy. Unfortunately, in modern medical practice there is a problem of overdiagnosis, in other words, every baby whose chin trembled during a month of examination, who does not eat well and sleeps restlessly, can easily be diagnosed with cerebral ischemia. If the neurologist claims that your baby has CNS lesions, you should definitely insist on a comprehensive diagnosis, which will include ultrasound of the brain (through the fontanel), computed tomography, and in special occasions- and X-ray of the skull or spine.

Every diagnosis that is somehow related to CNS lesions must be diagnostically confirmed. If signs of a CNS disorder were noticed in the maternity hospital, then the timely assistance provided by neonatologists helps to minimize the severity of possible consequences. It just sounds scary - CNS damage. In fact, most of these pathologies are reversible and subject to correction if detected in time.

For treatment, drugs are usually used that improve blood flow and blood supply to the brain - a large group nootropic drugs, vitamin therapy, anticonvulsants.

The exact list of drugs can only be called by a doctor, since this list depends on the causes, degree, period and depth of the lesion. Drug treatment for newborns and infants is usually provided in a hospital setting. After the relief of symptoms, the main stage of therapy begins, aimed at restoring the correct functioning of the central nervous system. This stage usually takes place at home, and the parents bear a great responsibility for complying with numerous medical recommendations.

Children with functional and organic disorders the central nervous system needs:

therapeutic massage, including hydromassage (procedures take place in water);
electrophoresis, exposure to magnetic fields;
Vojta therapy (a set of exercises that allow you to destroy reflex incorrect connections and create new ones - correct ones, thereby correcting movement disorders);
Physiotherapy for the development and stimulation of the development of the senses (music therapy, light therapy, color therapy).

Such exposures are allowed for children from 1 month old and should be supervised by specialists.

A little later, parents will be able to master the techniques of therapeutic massage on their own, but it is better to go to a professional for several sessions, although this is quite an expensive pleasure.

Consequences and predictions

Forecasts for the future for a child with lesions of the central nervous system can be quite favorable, provided that he is provided with prompt and timely medical care in the acute or early recovery period. This statement is true only for mild and moderate CNS lesions. In this case, the main prognosis includes a full recovery and restoration of all functions, a slight developmental delay, the subsequent development of hyperactivity or attention deficit disorder.

In severe forms, the forecasts are not so optimistic. The child may remain disabled, and deaths at an early age are not excluded. Most often, lesions of the central nervous system of this kind lead to the development of hydrocephalus, to cerebral palsy, to epileptic seizures. As a rule, some internal organs also suffer, the child has parallel chronic diseases kidney, respiratory and of cardio-vascular system, marble skin.

Prevention

Prevention of pathologies from the central nervous system in a child is the task of the expectant mother. At risk are women who do not leave bad habits while carrying a baby - smoke, drink alcohol or drugs.

All pregnant women must be registered with an obstetrician-gynecologist in a antenatal clinic. During pregnancy, they will be asked to undergo so-called screening three times, which reveals the risks of having a child with genetic disorders from this particular pregnancy. Many gross pathologies of the fetal central nervous system become noticeable even during pregnancy, some problems can be corrected medicines, for example, violations of the uteroplacental blood flow, fetal hypoxia, the threat of miscarriage due to a small detachment.

A pregnant woman needs to monitor her diet, take vitamin complexes for expectant mothers, not self-medicate, and be wary of various medications that have to be taken during the period of bearing a child.

This will avoid metabolic disorders at the baby. You should be especially careful when choosing a maternity home (the birth certificate, which all pregnant women receive, allows you to make any choice). After all, the actions of staff during the birth of a child play an important role in possible risks the appearance of traumatic lesions of the central nervous system in a baby.

After the birth of a healthy baby, it is very important to visit the pediatrician regularly, protect the baby from injuries of the skull and spine, and do age-appropriate vaccinations that will protect the little one from dangerous infectious diseases, which at an early age can also lead to the development of pathologies of the central nervous system.

In the next video, you will learn about the signs of a nervous system disorder in a newborn that you can determine for yourself.

Damage to the central nervous system in newborns is the result of a pathology of intrauterine development or a number of other reasons that lead to serious complications in the functioning of the body. Diagnose such lesions in almost 50% of infants. More than half, even almost two-thirds, of these cases occur in premature babies. But, unfortunately, there are pathologies in full-term children.

Most often, doctors call the main cause of damage to the central nervous system the difficulty in bearing, the influence of negative factors on the fetus. Among the sources of the problem:

Lack of oxygen, or hypoxia. Such a condition arises in the case of a pregnant woman working in hazardous production, smoking, infectious diseases, which could have been immediately before conception, previous abortions. All this disrupts blood flow and oxygen saturation in general, and the fetus receives it from the mother's blood.
Birth trauma. They are considered unlikely causes of CNS damage, but it is assumed that trauma can lead to disturbances in maturation and further development central nervous system.
Metabolic disease. This happens for the same reasons as hypoxia. Both drug addiction and alcoholism lead to dysmetabolic pathologies. Affects and reception medical preparations strong action.
Infections transmitted by the mother during pregnancy. The viruses themselves can adversely affect the development of the fetus. But there are a number of diseases that are considered critical for the life of the fetus. These include rubella and herpes. However, any pathogenic bacteria and microbes can also cause irreversible negative processes in the child's body even in the womb.

Varieties of CNS lesions

Each of the reasons leads to the development of a certain pathology, the severity of which affects the possibility of recovery and complete rehabilitation of the newborn.

lack of oxygen

Hypoxia of the fetus while still in the womb can cause such pathologies:

cerebral ischemia. At 1 degree of severity, depression or, conversely, excitation of the central nervous system in the baby can be noted. The condition usually resolves within a week. Grade 2 severity can be recognized by short-term convulsions, increased intracranial pressure, more prolonged disruption of the functioning of the nervous system. In the most difficult situation, complications lead to epileptic seizures, serious pathologies stem sections of the brain, as well as increased intracranial pressure. Often the result is coma and progressive CNS depression.
Hemorrhage. This phenomenon may affect the ventricles and the substance of the brain, or subarachnoid hemorrhage occurs. Manifestations of such consequences are convulsions, and invariably increased intracranial pressure, and hydrocephalus, shock and apnea, coma. In mild cases, there are often no symptoms. Sometimes the only sign of a problem is hyperexcitability or, conversely, CNS depression.

birth trauma

The consequences differ according to the type of trauma that occurred during childbirth:

Intracranial trauma can lead to hemorrhage with convulsions and increased intracranial pressure. Among other consequences, violation of cardiac and respiratory activity, hydrocephalus, coma, hemorrhagic infarction.
Damage to the spinal cord leads to hemorrhage in this organ with stretching or tearing. The result may be a breach respiratory function, motor activity and spinal shock.
Damage to the peripheral nervous system. These are complications such as damage to the brachial plexus, which can lead to total paralysis, impaired respiratory function. Pathology of the phrenic nerve can lead to complications in the functioning respiratory system, although most often proceeds without obvious signs. Defeat facial nerve it becomes obvious if during the crying of the crumbs the distortion of the mouth is noted.

Metabolic disorder

Among the consequences of dysmetabolic lesions:

Nuclear jaundice, which is accompanied by convulsions, apnea, etc.
Decreased magnesium levels, leading to hyperexcitability and seizures.
Too much sodium is the cause of increased blood pressure and increased heart rate and respiration.
An increased concentration of glucose in the blood, which causes CNS depression, convulsions, although it can often occur without any symptoms.
Reduced sodium content is the cause of lowering blood pressure and depression of the central nervous system.
An increased concentration of calcium causes tachycardia, convulsions, muscle spasms.

Infectious diseases

TO infectious diseases that can cause damage to the fetal central nervous system include rubella, syphilis, herpes, cytomegalovirus, and toxoplasmosis. Certainly, past illnesses do not necessarily lead to pathologies in the development of crumbs, but significantly increase their risk. Doctors also note a number of diseases that cause problems even after the birth of a baby. Among these are candidiasis, Pseudomonas aeruginosa, staphylococci, sepsis and streptococci. Such phenomena can cause hydrocephalus, increased intracranial pressure, meningeal syndrome and focal disorders.

Development of CNS lesions

In the process of development of lesions of the central nervous system, doctors distinguish three main stages:

spicy;
restorative;
Exodus.

Acute period

This period lasts for about a month. Its course depends on the severity of the damage. Lesions of the mildest form are shudders, tremors of the chin, increased excitability, sudden movements of the limbs, abnormal states of muscle tone, and sleep disturbances.

The baby may cry often and for no reason.

2nd degree of severity is manifested at this time by a decrease in motor activity and muscle tone, reflexes will be weakened, especially sucking, which an attentive mother will definitely notice. In this case, by the end of the first month of life, such symptoms may be replaced by hyperexcitability, marble skin color, flatulence and frequent regurgitation.

Often at this time, children are diagnosed with hydrocephalic syndrome. Its most obvious symptoms include a rapid increase in head circumference, an increase in intracranial pressure, which is manifested by a bulge of the fontanel, unusual eye movements.

With the greatest severity, coma usually occurs. Such complications leave the child in the hospital under the supervision of doctors.

rehabilitation period

Interestingly, it is the recovery period that can be more difficult than the acute one, if there were no symptoms as such in the first months. The second period lasts approximately from 2 to 6 months. This phenomenon is expressed as follows:

the baby almost does not smile, does not show emotions;
the baby is not interested in rattles;
the baby's cry is rather weak;
the child practically does not gurgle.

If in the first period the symptoms were present quite clearly, then from the second month of life they may, on the contrary, decrease and disappear, but this does not mean that treatment should be completely stopped. This only gives a reason to understand that the child is really recovering.

Outcome of CNS damage

By about a year old, the consequences of lesions of the central nervous system become apparent, although the main symptoms go away. The result is:

developmental delay - psychomotor, physical or speech;
hyperactivity, which affects in the future the ability to concentrate, learn, remember something, is also expressed in increased aggressiveness and hysteria;
cerebroasthenic syndrome - bad dream, mood swings, weather dependence;
epilepsy, cerebral palsy, hydrocephalus are pathologies that develop with especially severe lesions of the central nervous system.

Diagnostics

Obviously, the consequences of damage to the central nervous system can be quite serious, so it is important to diagnose them in a timely manner. One examination of a newborn is usually not enough. At the slightest suspicion of pathology, doctors prescribe computed tomography, ultrasound of the brain, x-ray of the brain or spinal cord, depending on the assumptions about the localization of hemorrhages or other complications.

Treatment

The development of consequences and complications of CNS lesions depends on the timeliness of diagnosis and taking measures. Therefore, first aid to such crumbs must be provided in the first hours of life.

First of all, doctors seek to restore the activity of the lungs, heart, kidneys, normalize metabolism, eliminate convulsions, and seek to stop edema that forms in the lungs and brain. It is important at this point to normalize and intracranial pressure.

A baby with damage to the central nervous system needs preventive massage

If the measures taken have not led to the complete normalization of the infant's condition, he is left in the neonatal pathology department to continue rehabilitation. On this stage treatment, antibiotic or antiviral therapy is possible, drug treatment to restore brain activity. To do this, the baby receives drugs to improve blood circulation and maturation of brain cells.

An important step in any rehabilitation are non-drug methods. These include gymnastics, massage, physiotherapy, paraffin therapy, etc.

With positive dynamics and elimination of symptoms of CNS lesions, the baby and mother are discharged with the following recommendations:

regular examination by a neurologist;
the use of non-pharmacological methods of recovery;
maximum protection of the baby from infection;
establishing a comfortable and constant temperature and humidity level at home;
careful handling - no harsh sounds and excessively bright light.

With constant monitoring, a large number of children are fully restored and eventually removed from the register of a neurologist. The 3rd degree of severity of lesions makes it necessary to regularly take courses of medications that normalize many life processes and help the baby recover more effectively.

The best solution is always the prevention of lesions of the central nervous system of the newborn. For this, doctors recommend planning a pregnancy in advance, being examined and giving up bad habits. If necessary, go through antiviral therapy, get vaccinated, normalize hormonal levels.

If the defeat nevertheless happened, do not despair: doctors, as a rule, immediately take measures to provide first aid. Parents, on the other hand, need to be patient and not give up - even the most difficult conditions are amenable to changes in a positive direction.

A newborn child is not yet a fully completed creation of nature. Although the baby has arms and legs, and the eyes seem to look at the mother consciously, in fact, in order to complete the maturation of many body systems, it takes time. Digestive system, vision, nervous system continue to develop after the baby is born. The central nervous system of a newborn is one of the most important systems, since it regulates the development of a little man and affects how harmoniously he will feel in a new world for him. Unfortunately, at present, lesions of the central nervous system of newborns are not uncommon. The consequences of damage to the central nervous system of newborns can forever turn a baby into a disabled person.

Features of the central nervous system of a newborn

The CNS of newborns has a number of features. A newborn baby has a fairly large brain mass, it is 10% of body weight. For comparison, in an adult, the brain weighs 2.5% of body weight. At the same time, large convolutions and furrows of the brain have a less pronounced depth than in an adult. At the time of birth, the baby has not yet fully completed the differentiation of the right and left hemispheres, while there are unconditional reflex reactions.

During the first 2-3 days, there is an increase in the level of non-opiate peptides, which are involved in the regulation of certain hormones responsible for the functions of the gastrointestinal tract. There is also an active development of auditory and visual analyzers promoted by close contact with the mother. A newborn child has a very developed gustatory and olfactory analyzer, and the threshold for tasting is much higher than that of an adult.

CNS damage in newborns

CNS lesions in newborns can be mild, moderate, or severe. The Apgar score is used to assess the child's condition. CNS lesions in newborns of mild severity are displayed with scores of 6-7 and can be corrected quite easily with the help of primary resuscitation.

The average degree of damage to the central nervous system of newborns is marked by Apgar scores of 4-5. The child has increased intracranial pressure, a decrease, or vice versa, an increase in muscle tone. For several days, the baby may completely lack spontaneous movements, and there is also an inhibition of the main congenital reflexes. If treatment is started on time, then on the 6-7th day of life, the baby's condition will stabilize.

In the case of severe CNS damage, the newborn is born in a state of hypoxemic shock. There is a lack of breathing, impaired heart rate, muscle atony and inhibition of reflexes. With such a lesion of the central nervous system of a newborn, cardiac and respiratory resuscitation, as well as the restoration of metabolism, will be needed to restore the functioning of important systems. The child has cardiovascular and brain disorders. With severe damage to the central nervous system, the newborn is shown intensive therapy but the prognosis remains poor.

Reasons for the development of perinatal lesions of the central nervous system in newborns

The main cause of the development of perinatal CNS lesions in newborns is oxygen starvation, which the child experiences in the womb or during childbirth. The degree of oxygen starvation suffered by the baby also depends on the duration perinatal lesion CNS in a newborn.

In addition to hypoxia, intrauterine infections, birth trauma, malformations of the spinal cord and brain, as well as hereditary factors, can lead to the development of damage to the central nervous system of a newborn. causing violation metabolism.

Hypoxic - ischemic damage to the central nervous system in newborns

Since hypoxia most often causes damage to the central nervous system of newborns, each future mom should know what causes fetal hypoxia and how to avoid it. The severity of hypoxia - ischemic injury The central nervous system in newborns depends on the duration of hypoxia in a child in utero. If hypoxia is short-term, then the resulting disturbances are not as serious as if the fetus experiences oxygen starvation for a long period, or hypoxia occurs frequently.

In this case, there may be functional disorders brain or even death nerve cells. To prevent hypoxic-ischemic damage to the central nervous system in newborns, a pregnant woman should be attentive to her health. Conditions such as early and late toxicosis, uterine tone, some chronic diseases provoke the occurrence of fetal hypoxia, therefore, at the slightest suspicion, you need to undergo treatment prescribed by a specialist.

Symptoms of ischemic damage to the central nervous system of newborns

Damage to the nervous system can be manifested by several symptoms, one of which is CNS depression in newborns. With depression of the central nervous system in newborns, a decrease in muscle tone and, as a result, motor activity is observed. In addition, with CNS depression in newborns, the child sucks poorly and swallows poorly. Sometimes facial asymmetry and strabismus can be observed.

The syndrome of increased neuro-reflex excitability is also a consequence of damage to the central nervous system of the newborn. The kid constantly shudders, becomes restless, there is a tremor of the chin and limbs.

The hydrocephalic symptom also indicates damage to the central nervous system of the newborn. It manifests itself in the fact that the newborn has a disproportionately enlarged head and fontanelle, which is due to a large accumulation of fluid.

How to treat CNS lesions?

Treatment of CNS lesions in newborns can take long time, but at the same time, if the damage is not too severe, there is a possibility of almost full recovery CNS functions. Important role in the treatment of CNS lesions in newborns proper care for the child. In addition to drugs prescribed by a doctor that improve cerebral circulation, massage and physiotherapy exercises are necessarily included. Treatment of CNS lesions in newborns is carried out in accordance with the symptoms.

The main problem is the fact that the true degree of damage to the central nervous system of a newborn becomes apparent only after 4-6 months. Therefore, it is very important to make every effort to improve the functions of the central nervous system of the newborn, regardless of the severity of hypoxia.

Intracranial birth hemorrhages (ICH).
Hypoxic-ischemic encephalopathy.
Infectious lesions of the brain and its membranes.
Congenital anomalies of brain development.
5 Seizures.

Intracranial birth hemorrhages (ICH). At autopsy, 1/2 - 1/3 of dead newborns are found to have intracranial hemorrhages or damage to the anatomical structures of the brain.
The immediate cause of birth trauma to the brain is a mismatch bone pelvis mother and head of the child, rapid (less than 2 hours) or prolonged (more than 12 hours) labor, forceps, obstetric aids, traction behind the head, surgical interventions, excessive concern for "perineum protection".

The most typical symptoms of any ICH in newborns are:

Sudden worsening of the child's condition with the development of a syndrome of depression with periodically appearing signs of hyperexcitability;
- change in the nature of the cry - the cry becomes monotonous, constant, quiet or loud, irritated, piercing, a groan appears;
- tension and bulging of a large fontanel;
- abnormal movements of the eyeballs - "floating eyeball movements", nystagmus;
- violation of thermoregulation - increase or decrease in temperature;
- vegetative-visceral disorders - regurgitation, pathological weight loss, flatulence, unstable stools, increased respiration, tachycardia;
- motor disorders - decrease or lack of motor activity;
- a change in muscle tone - an increase in the tone of certain muscle groups, for example, extensors or flexors of the limbs, due to which the limbs are in an extended or excessively bent position, with a decrease in muscle tone, the limbs are in an extended position, sag, the child may be in the “frog position” »;
- convulsions can be relied upon. The clinical manifestations of ICH in children depend on
from a combination of these symptoms, depending on the gestational age of the child, the localization and massiveness of ICH, concomitant diseases.

The following variants of ICH are distinguished: epidural, subdural, subarachnoid, intraventricular, parenchymal and cerebellar, hemorrhagic cerebral infarction (hemorrhage at the site of softening of the brain after ischemia due to thrombosis or embolism). Supratentorial and subtentorial hemorrhages are also distinguished.
Indirect signs of brain trauma in a newborn are a large birth tumor, cephalohematoma, and skull deformity.

With supratentorial hemorrhage, there may be a clear interval from several hours to several days, since hemorrhages are located relatively far from medulla oblongata where the life support centers are located - respiratory and vasomotor. Very often, with the first application to the chest, the condition worsens sharply, a pronounced CNS excitation syndrome appears: a piercing cry, groan, symptoms of hypertensive syndrome - tension of the large fontanel, stiff neck, eye symptoms appear: “floating movements of the eyeballs”, a fixed look, turning of the eye apples in one direction (hematomas), nystagmus, strabismus, dilated pupil on the side of the lesion. Can join convulsive syndrome, attacks of tonic or tonic-clonic convulsions (monotonous contractions of a certain group of muscles or limbs), there may be equivalents of convulsions: large-scale tremor, symptoms of oral automatism (constant sucking movements or constant protrusion of the tongue).
With subtentorial hemorrhages, the period of excitation is very short and is replaced by a period of CNS depression: there is no reaction to examination or a very weak reaction, crying is quiet or silent, eyes are wide open, gaze is indifferent, muscle hypotension, physiological reflexes are either very reduced or absent (including sucking, swallowing). Sleep apnea, SDR, tachycardia, or bradycardia may occur.
Depending on the localization of ICH and the period of the disease, there is a significant fluctuation general condition from a syndrome of excitation, turning into a syndrome of oppression up to coma with a periodic change of these states.

Additional research methods used in the diagnosis of ICH:

Spinal puncture. With subarachnoid and intraventricular hemorrhage, a large number of red blood cells are found in the cerebrospinal fluid.
Echo-encephaloscopy - ultrasound examination of the brain.
Neurosonography is a two-dimensional ultrasound examination of the brain through the large fontanel.
Computed tomography provides the greatest amount of information about the nature and location pathological changes in the brain.

Treatment. Most effective for epidural and subdural hemorrhages surgery- removal of a hematoma. Protective mode: reduce the intensity of sounds and visual stimuli, sparing examinations, all manipulations are carried out on the spot (washing, processing, injections), the appointment of minimally traumatic procedures, prevention of cooling and overheating, mother's participation in child care. Feed depending on the condition: parenterally, through a tube or from a bottle. It is necessary to establish monitoring of the main vital parameters: blood pressure, Ps, respiratory rate, temperature, diuresis, body weight, amount of fluid injected, assessment of the content of 02 and CO2 in the blood. Craniocerebral hypothermia is performed - cold to the head. Hemostatic drugs are introduced: vikasol, drugs that strengthen vascular wall- ascorbic acid, rutin, calcium chloride. Dehydration therapy - magnesia sulfate, lasix, plasma. Anticonvulsants - phenobarbital, GHB, seduxen, drugs that improve cerebral circulation - cavinton, and brain tissue trophism - piracetam.

Hypoxic-ischemic encephalopathy (HIE)- brain damage caused by perinatal hypoxia, leading to motor disorders, convulsions, disorders mental development and other signs of cerebral insufficiency.
Any trouble during pregnancy turns into hypoxia for the fetus, asphyxia during childbirth leads to a decrease in cerebral blood flow in certain areas of the brain, resulting in ischemia of this area, leading to a change in cell metabolism, their death. The lesion may spread beyond ischemia, with the condition worsening. Acute period - 1 month, recovery period - up to 1 year and outcome.
In the acute period, there are mild, moderate and severe forms of HIE and 5 clinical syndromes: increased neuroreflex excitability, convulsive, hypertensive-hydrocephalic, depression syndrome, coma.
With a mild form of brain damage (OSHA 6-7 b), a syndrome of increased neuro-reflex excitability is characteristic: increased spontaneous motor activity, restless sleep, difficulty falling asleep, unmotivated crying, tremor of the limbs and chin.
Moderate-severe form (OSHA 4-6 b) is manifested by hypertensive-hydrocephalic syndrome and depression syndrome. Characterized by an increase in head size by 1-2 cm, opening of the sagittal suture, enlargement and bulging of the large fontanel, Graefe's symptom, "setting sun", intermittent nystagmus, convergent strabismus. Syndrome of oppression: lethargy, decreased motor activity, muscle hypotension, hyporeflexia.
In a severe form of HIE, a coma syndrome is characteristic (OSA 1-4 b). No response to examination, no response to painful stimuli, "floating eyeballs”, reflexes are depressed, respiratory disorders, seizures, there is no sucking and swallowing. May be associated with convulsive syndrome.
The recovery period starts after acute process of very different etiology, its onset is conventionally attributed to the middle of the 2nd week of life. Syndromes of the early recovery period are designated by the term "encephalopathy", which combines brain diseases characterized by dystrophic changes.
The recovery period of HIE includes the following syndromes: increased neuro-reflex excitability, or cerebrasthenic, hypertensive-hydrocephalic, vegetative-visceral disorders, movement disorders, delays in psychomotor development, epileptic syndrome.
Cerebrosthenic syndrome manifests itself against the background of normal psychomotor development of children. Emotional lability, irritability, motor restlessness are noted, innate reflexes are enhanced, spontaneous Moro reflex, startle, tremor of the chin and limbs, superficial sleep, difficulty falling asleep, poor appetite, poor weight gain.
Syndrome of vegetative-visceral disorders. There are vascular spots, impaired thermoregulation (hypo- and hyperthermia), gastrointestinal dyskinesias (regurgitation, vomiting, unstable stools or constipation, flatulence) with pylorospasm, underweight, tachycardia or bradycardia, a tendency to lower blood pressure, tachypnea, rhythm disturbance breathing on the slightest stimulation. The syndrome of vegetative-visceral disorders is almost always combined with other syndromes of the recovery period, more often with hypertension and hydrocephalus.
The syndrome of movement disorders occurs in 2/3 of children with encephalopathies, manifested by a decrease or increase in muscle tone, paresis or paralysis of the limbs. In this case, the limbs are in an extended or excessively bent state, hang down, there is no physiological support reflex, or the child stands on tiptoe.
Syndrome of muscular hypotension: the limbs are extended, a “frog posture” is possible with the lower limbs turned outwards, the child’s motor activity is reduced. When the child is placed face down in the palm of his hand, the limbs, and often the head, hang down, there is no support on the legs.
Muscular hypertension syndrome: the child's motor activity is reduced due to hypertonicity of the limbs, therefore, stiffness is noted. Pathological postures may appear - the "boxer's position", when there is an increase in the tone of the flexors of the arms and at the same time the arms are bent, the fists are tightly clenched, and the extensor tone is increased in the lower extremities, due to which the legs are unbent and difficult to bend, or they can be bent at all impossible. In severe cases, the tone of all extensor groups - the neck, back, limbs - is increased, which leads to the appearance of opisthotonus. In this case, the child is curved in the form of a "bridge", can lean on the back of the head and heels. With a high tone of the adductor muscles of the hips and flexors, the “embryo” pose appears - the head is thrown back, the upper limbs are bent and pressed to the body, the legs are crossed.
Children with increased muscle tone, when examining physiological support reflexes and automatic walking, stand on tiptoe, but automatic walking does not appear.
hydrocephalic syndrome. In newborns, there is a disproportionate increase in head circumference (head circumference exceeds chest circumference by more than 3 cm). In the first 3 months of life, the head circumference increases by more than 2 cm monthly, there is a divergence of the cranial sutures by more than 5 mm, the large fontanelle increases and bulges, the small and lateral fontanelles open, cerebral skull dominates the facial part, overhanging forehead, expanded subcutaneous venous network on the scalp, on the forehead, temples, the bones of the cranial vault become thinner and soften.
Clinical manifestations depend on the severity of the hypertension syndrome: children are easily excitable, irritable, the cry is loud, shrill, sleep is superficial, children do not fall asleep well. With the predominance of hydrocephalic syndrome, lethargy, drowsiness, and a syndrome of vegetative-visceral disorders are noted. There is a symptom of the "setting sun", converging strabismus, horizontal nystagmus. Muscle tone is reduced, the sucking reflex is pronounced, symptoms of oral automatism may appear - protrusion and chewing of the tongue. There is no support reflex. With the progression of hydrocephalus, muscle tone increases, head tilting, large-scale tremor of the limbs and chin appear, and seizures may occur.
Syndrome of delayed psychomotor development. The child later begins to hold his head, sit, crawl, walk, a smile appears later, there is a delay in visual and auditory reactions, later he begins to recognize his mother, speak, and is less oriented in the environment.
Treatment of HIE in the acute period. It is impossible to treat the brain in isolation.

Main directions:

Restoration of normal patency respiratory tract and adequate ventilation.
Correction of hypovolemia: plasma, albumin 5-10 ml/kg, reopoliglyukin 10 ml/kg.
Dehydration: magnesium sulfate 0.2 ml/kg, lasix, plasma.
Improvement of nervous tissue metabolism: piracetam 50 mg/kg, 10% glucose solution.
Anticonvulsants: phenobarbital 5 mg/kg, GHB 50 mg/kg, diazepam 1 mg/kg.

Treatment of HIE in the subacute period.

Cerebrasthenic syndrome: mixture with citral, diazepam, tazepam, valerian root, motherwort, nootropil, drugs that improve cerebral circulation (cynarizine, cavinton).
Hypertension-hydrocephalic syndrome: dehydration therapy (furosemide, glycerol, diacarb), absorbable therapy (lidase, aloe, cerebrolysin).
Movement disorders: vitamins Wb, B1; ATP, prozerin, galantamine.
Convulsive syndrome: phenobarbital, benzonal. Nootropic and absorbable drugs are required.

Convulsive syndrome in newborns

Seizures are sudden involuntary violent movements.

Causes of seizures in newborns:

The most common cause (65-70%) is perinatal hypoxia and the development of hypoxic-ischemic encephalopathy.
The second causal factor in terms of frequency is intracranial hemorrhage.
Metabolic disorders: hypoglycemia, hypocalcemia, hypomagnesemia, hypo- and hypernatremia, hyperbilirubinemia.
Infections: meningitis, encephalitis, sepsis.
Genetic and congenital defects in the development of the brain: family epilepsy, malformations of the brain, chromosomal diseases.
Withdrawal syndrome (withdrawal) in children whose mothers had drug or drug addiction during pregnancy (opium-containing substances, barbiturates, etc.).
Congenital metabolic anomalies: phenylketonuria, maple syrup disease, etc.

Convulsive syndrome is manifested by various paroxysmal phenomena.
Clonic convulsions - repetitive rhythmic contractions of the muscles of the face, limbs. They can be limited to one floorboard of the face, one or two limbs, and can spread to all limbs, muscles of the face, torso.
Tonic convulsions are a relatively prolonged contraction of all the muscles of the limbs and torso. At the same time, the limbs are unbent, the fists are tightly compressed, the head is thrown back, the gaze is fixed on one point, accompanied by bouts of apnea.
Myoclonic convulsions are sudden, non-rhythmic jerks of various muscle groups of the limbs.
Minimal convulsions or convulsive equivalents - manifest as sudden screams, ocular paroxysmal symptoms (nystagmus, open, unblinking eyes with a fixed gaze, twitching of the eyelids); symptoms of oral automatism - sucking, chewing, protrusion, trembling of the tongue; general fading, paroxysmal movements in upper limbs(“swimmer movements”) or in the lower extremities (“cyclist movements”); sleep apnea (in the absence of bradycardia).
In newborns, symptoms of increased neuro-reflex excitability are also distinguished: tremor of the limbs, spontaneous Moro reflex (enveloping hand movements), clonus of the feet, startling with sharp sounds. Unlike true convulsions, external stimuli (for example, examining a child) are necessary for the onset of symptoms of increased neuro-reflex excitability.
For proper treatment seizures in children, it is necessary to find out their cause, for which they study the course of pregnancy and childbirth, family history; conduct a biochemical study of blood - the level of glucose, calcium, sodium, magnesium, bilirubin, urea, etc.
It is necessary to carry out echoencephaloscopy, echoencephalography, lumbar puncture, x-ray of the skull, computed tomography, screening of urine and blood serum for defects in amino acid metabolism, examination for intrauterine infections.
Treatment. The main task is to stop seizures, since during a convulsive attack, oxygen consumption by the brain increases, and neurons inevitably die. To eliminate a convulsive attack, apply: sibazon (seduxen, relanium) 0.5% solution of 0.04 ml / kg, the dose can be increased by 2 times. You can re-introduce this drug after 30 minutes if there is no effect. Side effect- respiratory depression, drowsiness, inhibition of the sucking reflex, muscle hypotension, decreased blood pressure.
Phenobarbital - for convulsions, it is administered intravenously at a dose of 20 mg / kg (introduced very slowly over 15 minutes), if there is no effect, phenobarbital can be re-introduced 2 times with an interval of 30-60 minutes. In the absence of convulsions in the future, phenobarbital is administered orally.
Sodium hydroxybutyrate (GHB) is administered intravenously in a 20% solution very slowly due to possible respiratory arrest. The anticonvulsant effect develops after 10-15 minutes and lasts 2-3 hours or longer.

With intractable convulsions, vitamin B6 is administered. Magnesium sulfate is administered for hypomagnesemia and cerebral edema. Enter intramuscularly 25% solution at a dose of 0.4 ml/kg of body weight.
With poorly controlled convulsions, along with phenobarbital, finlepsin, radedorm, benzonal, diacarb are prescribed.