Excitation of the central nervous system in newborns. Causes of development of depression syndrome in newborns and methods of its treatment. Hypoxic ischemic damage to the central nervous system: features of the disease

Anomalies of the central nervous system are formed during perinatal period, which lasts from the 28th week of pregnancy to the 7th day of life. The disorders appear in the womb, during childbirth, or immediately after birth. Neonatal depression syndrome and hyperexcitability are the main manifestations of perinatal encephalopathy. Central nervous system disorders are characterized by motor disorders, hydrocephalus, seizures, and developmental delays.

Causes

Failures that are consequences of brain dysfunction are included in the understanding of the collective term perinatal transient encephalopathy. Structural pathologies of the main organ of the central nervous system at birth lead to hydrocephalus, epilepsy, and cerebral palsy.

Depression syndrome is a consequence of non-inflammatory damage to brain cells. The causes of the pathology are the abnormal course of pregnancy and childbirth:

1. Somatically aggravated pregnancy history: heart disease, diabetes mellitus, pyelonephritis, hypertension and bronchial asthma in the expectant mother.
2. Unfavorable pregnancy with risks of miscarriage, intrauterine infection, gestosis and fetoplacental insufficiency.
3. Rapid or prolonged labor narrow pelvis in the mother, premature birth or weakness of labor.
4. Bad habits that you could not get rid of while carrying a child: drinking alcohol, smoking, taking antibiotics and other drugs prohibited for pregnant women.
5. The influence of production and environmental factors, food toxins.
6. Actions of obstetricians that caused intracranial birth injury during breech presentation, incorrect entry of the head into the pelvis, use of forceps and vacuum.
7. A mild form of the disorder develops under stress, excessive anxiety and irritability of the expectant mother under the influence of the hormone cortisol.

The brain is damaged by breathing problems, congenital heart defects, and blood poisoning. Depression syndrome is provoked by the administration of magnesium sulfate to a woman in labor.

Main symptoms

Depression syndrome manifests itself immediately after birth if the cause is hypoxia during pregnancy or childbirth or intrauterine infection. Signs that occur several hours after birth indicate infection during delivery or intraventricular hemorrhage. The development of depression syndrome on days 3–5 from birth is caused by infectious toxicosis.

The Apgar score serves as a guideline for assessing the function of the nervous system in premature infants:

• 6–7 - excessive neuro-reflex excitability, convulsions;
• 4–6 - central nervous system depression and hypertensive-hydrocephalic syndrome;
• 1–4 points is a precomatose state or coma.

A neonatologist examines a newborn for damage to the central nervous system:

• weak or delayed cry;
• prolonged cyanosis;
• depressed sucking reflex;
• pathology motor activity.

CNS depression syndrome manifests itself in a pronounced form:

• lethargy;
• suppression of reflexes;
• muscle hypotonia.

In the mild form, the baby often throws up its legs and arms, cries, has difficulty falling asleep and does not sleep well. Neurologists diagnose muscular dystonia and chin tremor. The changes usually go away within the first month without consequences.

With a moderate degree, focal neurological lesions are detected: anisocoria (difference in pupil diameter), drooping eyelid, convergent strabismus, pupil tremors, impaired sucking and swallowing, asymmetry of nasolabial folds and difference tendon reflexes.

With a severe degree of depression, adynamia and atony are observed, there are no reflexes and reactions to pain (prick with a dull needle), the pulse and breathing slow down. The condition can persist for up to two months and ends with the development of neurological disorders.

Neurologists distinguish four degrees of depression of the central nervous system:

1. Lethargy is a state of constant sleep. The awakened infant exhibits little unconditioned reflexes. Their disappearance depends on the severity of lethargy.
2. Stupefaction is expressed in the fact that in response to touch the child grimaces, weakly moves his limbs, and closes his eyes. The Babinski reflex, the upper grasping reflex, is present, but the baby does not suckle.
3. Stupor is a stage in which the reaction occurs only to pain. Characteristic is tonic flexion of the arms and legs in response to stimuli.
4. Coma comes in different degrees, depending on the inhibition of the tendon, grasping and Babinski reflexes.

There are several syndromes in the development of encephalopathy:

1. Impaired motor function is formed by hypo- or hypertensive type, manifested by hyperkinesis, paresis and paralysis. Syndrome motor disorders characterized by the absence of facial expressions: children begin to smile only at three months, there is no reaction to sounds or to relatives, the child screams without changing tones. Syndrome muscular dystonia in newborns it can be general (generalized) - flexion of the sole or arching of the whole body, as well as focal - the muscles of one part of the body contract.
2. Astheno-neurotic syndrome consists of chronic disorders sleep, emotional lability and anxiety.
3. Spastic or convulsive syndrome is expressed by convulsions, small-amplitude tremors, automatisms in chewing, and short-term stops in breathing.
4. The syndrome of vegetative-visceral pathologies is manifested by pale skin, frequent regurgitation, colic, disorders heart rate. Develops against the background of intracranial hypertension and hyperexcitability syndrome. The child has cold hands and feet and poor weight gain. Intestinal colic develop in 15% of children under three months of age and have almost become the norm.
5. Hyperexcitability syndrome manifests itself in 10% of babies during the newborn period and develops into a lack of concentration in kindergarten. The child looks tense, clenches his fists, and a grimace of pain remains on his face. Characteristic frequent crying and marbled leather.
6. The syndrome of increased neuro-reflex excitability usually precedes depression of the central nervous system or alternates with it. The child reacts sharply to sounds and touches by waving his arms and crying, throwing his head back.
7. Hydrocephalic syndrome: child with internal hydrocephalus lethargic and sleepy. His fontanel bulges, his head circumference increases, and sleep is disturbed. Neurological disorders partially regress.

The outcome of oppression syndrome is varied. Full restoration of central nervous system function, minimal dysfunction, and attention deficit hyperactivity disorder are possible. With a moderate degree of damage, mental retardation and speech therapy problems develop. With gross organic changes - cerebral palsy, epilepsy, delay intellectual development, progressive hydrocephalus.

The consequences can affect different areas of the brain:

1. Hypothalamic syndrome is diagnosed as a constitutional deficiency of the hypothalamus. The reasons may be perinatal encephalopathy, difficult childbirth, taking hormonal drugs, neuroinfections. It manifests itself as early puberty in girls, polycystic disease, in boys - gynecomastia.
2. Delayed psychomotor development refers to a disturbance in the development of natural movements, such as running, walking, and speech. Affects the ability to read and write.
3. Attention Deficit Hyperactivity Disorder is a new diagnosis that is determined by the inability to concentrate and learn. It manifests itself as an inability to listen to what is said to him, to calm down, agitation, aggression and excessive laziness. Dr. Komarovsky speaks of hyperactivity if such behavior interferes with the socialization and development of the child.

Methods of detection and treatment

To diagnose neonatal encephalopathy, a number of studies are carried out:

• blood test for glucose and electrolyte levels;
• studying cerebrospinal fluid for infection;
• neurosonography through the large fontanel.

A comprehensive examination includes MRI or CT to clarify ischemia and hypoxia, encephalography for seizures, Doppler ultrasound to study the condition of blood vessels. The child requires an examination by an ophthalmologist, and with age, consultation with a psychologist and speech therapist.

Drug treatment depends on the syndromes that develop in the child:

1. To eliminate movement disorders, Dibazol and Galantamine are prescribed. To reduce muscle tone - Baclofen and Mydocalm. Treatment is supplemented with electrophoresis, paraffin therapy, massages and gymnastics.
2. At seizures Anticonvulsants are prescribed - Diazepam and Phenobarbital. Children with epilepsy are prohibited from swimming, gymnastics and massages.
3. For increased intracranial pressure, Diacarb is prescribed, a decongestant with diuretic functions. More often, children are prescribed herbal medicine. Dehydration treatment includes Mannitol, sometimes a lumbar puncture and the use of corticosteroids are required.
4. To correct restless sleep, spontaneous movements, and emotional lability, Actovegin and Partogram are used - drugs aimed at increasing brain blood flow and improving nerve conduction of cells.

Complex therapy is aimed at restoring and maintaining neuronal growth. Solutions of glucose, electrolytes, magnesium, and a complex of vitamins B and C are administered intravenously.

Agents used to increase the metabolism of brain tissue are Vinpocetine and Cortexin. In severe cases, surgery is performed. Children with impaired sucking reflex require parenteral nutrition.

To relieve the vegetative symptoms of colic and regurgitation, it is recommended to feed more frequently, reduce portions, and position the child in an upright position after meals.

In case of hyperexcitability, the neurologist prescribes psychostimulants and refers them to sessions behavioral therapy. A visit to an osteopath can solve a child’s problems with sleep, fatigue, and headaches, since the specialist normalizes the blood supply to the brain using manual techniques.

It happens that in the maternity hospital or a little later, at an appointment with a pediatrician, a newborn child is given complex diagnoses regarding the state of the central nervous system (CNS). What is hidden behind the words “hypertensive-hydrocephalic syndrome” or “vegetative-visceral dysfunction syndrome” and how can these conditions affect the health and development of a child? Is it possible to treat CNS lesions? Child rehabilitation specialist Natalya Pykhtina, head of the clinic of the same name, tells the story.

The doctor receives the first information about the state of the central nervous system in the first minutes and hours after the baby is born, even in maternity ward. Everyone has heard about the Apgar score, which evaluates a child's vitality based on five main visible signs - heartbeat, skin color, breathing, reflex excitability and muscle tone.

Why is it important to correctly assess a baby’s motor activity? Because it provides information about the state of the spinal cord and brain, their functionality, which helps to recognize in time both minor deviations and serious pathologies.

Thus, the greatest attention is paid to the degree of symmetry of the movements of the limbs: their pace and volume should be the same on both sides, that is, on the left arm and left leg and the right arm and leg, respectively. Also, the doctor conducting the initial examination of the newborn takes into account the clarity and severity of unconditioned reflexes. This is how the pediatrician receives information about the activity of the baby’s central nervous system and finds out whether it is functioning within normal limits.

Damage to the central nervous system in a child occurs in two ways - in utero or during childbirth. If developmental abnormalities occur in the fetus during the embryonic stage intrauterine development, then they often turn into defects that are incompatible with life, or are extremely severe and cannot be treated or corrected.

If there was a damaging effect on the fetus after, this will not affect the child in the form of gross deformity, but it may well cause minor deviations that will have to be treated after birth. Negative effects on the fetus later - after- will not manifest itself in the form of defects at all, but can become a catalyst for the occurrence of diseases in a normally formed child.

It is very difficult to predict which specific negative factor and at what stage of pregnancy will cause irreparable damage to the fetus. Therefore, the expectant mother needs to be extremely careful and monitor her health even before the moment of conception. Preparing for pregnancy is an important stage of family planning, because the child’s health can be affected by both the bad habits of the mother and her chronic diseases, hard work and unhealthy psychological state.

How exactly he is born is also important for the child’s future life. It is at the moment of birth that there is a danger of damage in the second way - intranatally. Any incorrect intervention or, conversely, lack of timely assistance with high probability will have a negative impact on the baby. At risk - premature birth, as well as childbirth at the scheduled time, but rapid or, conversely, protracted.

The main causes of central nervous system damage in newborns are oxygen starvation, which leads to hypoxia, and birth trauma. Less obvious and diagnosable causes are less common: intrauterine infections, hemolytic disease newborns, malformations of the brain and spinal cord, hereditary metabolic disorders or chromosomal pathology.

Doctors identify several syndromes of central nervous system pathology in newborns.

Hypertensive-hydrocephalic syndrome- This is an excessive accumulation of cerebrospinal fluid in the ventricles and under the membranes of the brain. To identify this syndrome in an infant, an ultrasound scan of the brain is performed and data on increased intracranial pressure are recorded (according to echoencephalography - EEG).

In pronounced severe cases of this syndrome, the size of the brain part of the skull increases disproportionately. As is known, children are born with mobile bones of the skull, which fuse during development, therefore, with a unilateral pathological process of this syndrome, divergence of cranial sutures, thinning of the skin in the temporal lobe and increased venous pattern on the scalp will be observed.

If a child has increased intracranial pressure, he will be restless, irritable, easily excitable and whiny. Also, the baby will sleep poorly, roll his eyes and throw his head back. Possible manifestation of Graefe's symptom (white stripe between the pupil and upper eyelid). In more severe cases, there may also be a symptom of the so-called “setting sun”, in which the iris of the eye, like the sun at sunset, is half submerged under the lower eyelid. Also sometimes convergent appears.

With reduced intracranial pressure, on the contrary, the child will be inactive, lethargic and drowsy. Muscle tone in in this case unpredictable - it can be either increased or decreased. The baby may stand on tiptoes when supported, or cross his legs when trying to walk, while the baby’s support, crawling and walking reflexes will be reduced. Seizures can also often occur.

Muscle tone disorders

Movement disorder syndrome- pathology of motor activity - is diagnosed in almost all children with intrauterine abnormalities in the development of the central nervous system. Only the severity and level of damage varies.

When making a diagnosis, the pediatrician must understand what the zone and location of the lesion is, whether there is a problem in the functioning of the brain or spinal cord. This is a fundamentally important question, since treatment methods differ radically depending on the identified pathology. Also of great importance for making a diagnosis is a correct assessment of the tone of various muscle groups.

Impaired tone in various muscle groups leads to a delay in the appearance of motor skills in the baby: for example, the child later begins to grasp objects with the whole hand, finger movements are formed slowly and require additional training, the child gets up on his feet later, and the cross of the lower extremities prevents the formation of correct walking.

Fortunately, this syndrome is treatable - in most children, thanks to proper treatment, there is a decrease in muscle tone in the legs, and the child begins to walk well. Only a high arch of the foot may remain as a memory of the disease. This does not interfere with normal life, and the only difficulty remains choosing comfortable and well-fitting shoes.

Autonomic-visceral dysfunction syndrome characterized by a violation of thermoregulation in a child (body temperature rises or falls without visible reasons), exceptional whiteness of the skin associated with vascular dysfunction, and gastrointestinal disorders (regurgitation, vomiting, tendency to constipation, insufficient weight gain compared to indicators accepted as normal).

All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are directly related to disturbances in the blood supply to the posterior parts of the brain, where all the main centers of the autonomic nervous system are located, which controls the life-supporting systems of the body - digestive, thermoregulatory and cardiovascular.

Convulsive syndrome

The tendency to have seizures in the first months of a child’s life is due to immaturity of the brain. Convulsions occur only in cases where the spread or development of a disease process in the cerebral cortex occurs, and have many of the most various reasons.

In each specific case, the cause convulsive syndrome must be determined by a doctor. For an effective assessment, a number of studies and manipulations are often required: instrumental studies of brain function (EEG), cerebral circulation (Dopplerography) and anatomical structures (brain ultrasound, computed tomography, NMR, NSG), as well as biochemical research blood.

From the point of view of localization, cramps are not the same - they can be generalized, that is, covering the entire body, and localized, which are associated with individual muscle groups.

The convulsions are also different in nature: tonic, when the child seems to stretch out and freeze on a short time in a certain fixed position, and clonic, in which twitching of the limbs and sometimes the entire body occurs.

Parents should carefully monitor their child in the first months of life, because... convulsions in children can be the beginning if you do not immediately contact a specialist and do not carry out proper treatment. Careful observation and a detailed description of emerging seizures on the part of the parents will greatly facilitate the doctor’s diagnosis and speed up the selection of treatment.

Treatment of a child with central nervous system damage

Accurate diagnosis and timely correct treatment of CNS pathology is extremely important. Children's bodies are very susceptible to external influence at the initial stage of development, and timely procedures received can radically change later life child and his parents, allowing the most early stages with relative ease get rid of problems that can become quite significant in later life.

As a rule, children with early age pathologies are prescribed drug therapy in combination with physical rehabilitation. Therapeutic exercise (physical therapy) is one of the most effective non-drug methods rehabilitation of children with central nervous system lesions. A properly selected course of exercise therapy helps restore the child’s motor functions, using the adaptive and compensatory capabilities of the child’s body.

Comment on the article "CNS lesions in children: what are they?"

organic damage to the central nervous system - in all my children. Everyone develops differently. IMHO, taking a child from a child care center means being prepared for behavior problems, poor academic performance, theft, damage and loss of things, hysterics.....I don’t know if you can find someone healthy in the full sense of the word in a child care center...

Discussion

organic damage to the central nervous system in all my children. Everyone develops differently. IMHO, taking a child from a child care center means being prepared for behavior problems, poor academic performance, theft, damage and loss of things, hysterics.....I don’t know if you can find someone healthy in the full sense of the word in a child care center. They get there either because of their health, or because of health (both physical and mental) bio.... Defeat is different from defeat - he walks, sees, hears, understands... this is already not bad. What is amenable to education, will be brought up, what is not amenable to falling in love) how difficult? - exactly as much as you are ready, as far as you can accept (or not accept) it in any way

Discussion of adoption issues, forms of placing children in families, raising adopted children, interaction with guardianship, schooling foster parents. Section: Adoption (diagnosis g96.8 in a child, decoding). Tell me about the diagnoses.

Discussion

G96.8 - may not mean anything at all. If by the age of 4 they still haven’t clarified what was affected there...
In general, just look at the child. Because this diagnosis means “there may be something wrong with the nerves”.....

I took a baby with a diagnosis of “perinatal damage to the central nervous system,” among others, which was expressed in very weak tone muscles, left half the body was generally like a rag, some doctors said that the child would not sit up, then that he would not go... 4 courses of massage, general strengthening measures - he runs around, you’ll catch up with horseradish, he thinks better than me already))) but, I think, we will still have problems with speech therapy.
And a 4-year-old child can already show himself: motor development, speech, and thinking - everything can already be explored. So pay attention to how he moves, how he speaks, talk to the teachers, what they say about mental development girls.

Tell me, if the orphanage is specialized for children with organic damage to the central nervous system and mental disorders, are there only children with serious diagnoses? Conclusion of custody in hand. On Friday, God willing, we will go to such an orphanage (just by acquaintance).

Discussion

We have Sevastyan from such a DR. He is a foundling, apparently someone imagined something in the hospital, where he was immediately sent. Well, or I don't know.
The only diagnosis was speech delay, which was severe.

As far as I know, there are no non-specialized DRs... They are paid a premium for their “specialization”. So read the map. My daughter was in the DR with the same specialization, although her cardiology is semi-fake. It’s just that this is the only DR in that city)))

My child has an organic lesion of the central nervous system. Expressed in mild form of cerebral palsy and some difficulties in learning. But he studies at a regular school and plays sports. And my child was diagnosed with an organic lesion of the central nervous system, paraparesis, and has been disabled since he was one and a half years old.

Discussion

Well, it looks like we're doing an MRI tomorrow. And on Friday - a psychiatrist and neurologist. The DD gave me a lot of blame - why do you need to do this, what kind of checks are these, etc., etc. I'm stupid - on my own. Thank you from the bottom of my heart girls. I myself did not expect such support and was very touched. I will write how and what as soon as something new.

I'm not a doctor. At all. Therefore, my reasoning is completely philistine. So: in my opinion, residual organic damage is a very general diagnosis. Manifestations should depend on the extent and location of the lesion. And they can range from “he doesn’t understand anything, he’s drooling” (sorry for the incorrectness) to “nothing is noticeable at all.” The first option clearly no longer threatens the girl. The child is adequate, obedient, reads poetry, role-playing games plays... So, I think, everything that could have happened has already manifested itself in this “bad student.” Is this critical for you? What if it is difficult to study? What if he doesn't go to university? If in fact as a last resort will he study in correction?
This is, in principle, a real prospect for many adopted children. It’s not a fact; a child taken at a younger age will not get the same problems at school.
In general, since my child is almost like this (he studies with difficulty, he couldn’t do anything after 1st grade), but he is wonderful and beloved, I feel bad for the girl. Somehow in the discussion they almost put an end to it. :(She’s a good girl. Although, of course, it’s up to you to decide.

Inorganic lesions of the central nervous system in young children (from 0 to 2 years) (beginning). Section: Adoption (ROP CNS with hypertension in children, treatment prognosis). So the question is: residual organic damage to the central nervous system - what is it, what are the prognosis and what...

Discussion

depends on the background, and even more on the perspective. any child, whether sick or healthy, in a favorable psycho-social environment has a much greater chance of growing up as a good person than under poor initial conditions. Children with health problems bring no less, and maybe even more, joy than healthy children. unless, of course, you completely dissolve in worries, problems and searches for the best solutions.

Just like on the Internet - from nothing terrible to vagrancy, suicidal tendencies, etc. Look at the children. If anything worries you, contact a specialist. Sorry for the diagnosis on the Internet, but in my opinion, your children look good.

damage to the central nervous system. Medicine/children. Adoption. Discussion of issues of adoption, forms of placement of children in families, education. Please tell me what damage to the central nervous system is without damage to the psyche. I found on the Internet only about perinatal damage to the central nervous system. this is one and...

Discussion

The benefits of swimming are undeniable.

But... if the child is predisposed to allergies, coughs, or there is a hint of asthma, then I would not bother.
Products that are thrown into water for disinfection:
1. They are not beneficial in themselves, they are absorbed through the skin, enter the body through the nose or mouth, etc.
2. Combining with organic matter, they form carcinogens, which also enter the body from water.

Those. look at the child. Water itself and swimming are very useful. Ideal for the sea and for the whole summer.

There are benefits, but the child must have a comfortable temperature. Therefore, if you mean the Lestgaf Institute (I’m not sure if you wrote it correctly), then they wrote that their children are cold. We go to the clinic, where it’s very easy to add hot water. Exercises we are passive, but at one year I think you can still induce reflex swimming movements of the arms and legs, mine in the bathtub only moved on their own after 3 months of daily swimming, then we were 10 months old.

I agree with Ilyusha’s mother. If there is no strong head growth, then it is better to do without diacarb, it greatly disrupts mineral metabolism. In addition, there is a lot of data about an increase in ICP on Cavinton and head growth when taking it (we also had this :-()) So the first scheme is good, I wouldn’t change it. It’s just that Kinder Biovital is a little confusing for such a small child, but if there are no allergic reactions, then give it too.

Organic damage to the central nervous system. Girls, here in the conference there are more children with cerebral palsy, autism and others like them. Is there anyone with organics? (organic brain damage) If there is, please tell us what you did for the child, what changes there were, who could at least somehow really help.

Discussion

There is a brain institute where they teach using the Bronnikov method. I’m not an expert at all, a friend studied there and told me what wonderful results there are. I can ask if it is worth going there if you have problems. Or maybe you already know about them?

Well, we can assume that we also have an organic lesion, after a cerebral hemorrhage and subsequent hydrocephalus, there is hypoplasia of the corpus callosum, a diffuse lesion white matter etc. I don’t know about others, but official medicine could not offer us anything other than standard vascular therapy and light nootropics in the hope that the remnants of the affected areas would “sort out on their own”, redistribute functions, etc. This process was somewhat stimulated by the treatment of the Koreans on the street. ak. Pilyugin, by the way, I saw children with them who also had problems with the cerebellum, there was some progress, but it’s all individual. What city do you live?

damage to the central nervous system. My friend had a premature baby (32nd week) as a result of placental abruption; suffered severe hypoxia, they even say that some lobules in the brain (I don’t understand what they mean) died.

Damage to the nervous system in newborns can occur both in utero (prenatal) and during childbirth (intrapartum). If harmful factors act on a child at the embryonic stage of intrauterine development, severe, often incompatible with life, defects occur. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes manifest themselves as small deviations in the formation of the child - stigmas of disembryogenesis.

If a damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but any disease may occur in a normally formed child. It is very difficult to isolate the impact of a harmful factor separately in each of these periods. Therefore, they often talk about the impact of a harmful factor in general during the perinatal period. And the pathology of the nervous system of this period is called perinatal damage to the central nervous system.

A child can be adversely affected by various acute or chronic diseases of the mother, work in hazardous chemical industries or work associated with various radiations, as well as bad habits of parents - smoking, alcoholism, drug addiction.

A child growing in the womb may be adversely affected by severe toxicosis of pregnancy, pathology of the child's place - the placenta, and the penetration of infection into the uterus.

Childbirth is very important event for a child. Particularly great trials befall the baby if the birth occurs prematurely (prematurity) or rapidly, if labor weakness occurs, the amniotic sac ruptures early and water leaks, when the baby is very large and is being helped to be born special techniques, tongs or vacuum extractor.

The main causes of damage to the central nervous system (CNS) are most often hypoxia, oxygen starvation of different nature and intracranial birth trauma, less often - intrauterine infections, hemolytic disease of the newborn, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.

Hypoxia ranks first among the causes of damage to the central nervous system; in such cases, doctors talk about hypoxic-ischemic damage to the central nervous system in newborns.

Hypoxia of the fetus and newborn is a complex pathological process in which the access of oxygen to the child’s body is reduced or completely stopped (asphyxia). Asphyxia can be one-time or repeated, varying in duration, as a result of which carbon dioxide and other under-oxidized metabolic products accumulate in the body, primarily damaging the central nervous system.

With short-term hypoxia in the nervous system of the fetus and newborn, only minor disturbances of cerebral circulation occur with the development of functional, reversible disorders. Prolonged and repeated hypoxic conditions can lead to severe disturbances in cerebral circulation and even death nerve cells.

Such damage to the nervous system of a newborn is confirmed not only clinically, but also using Doppler ultrasound examination of cerebral blood flow (USDG), ultrasound examination of the brain - neurosonography (NSG), computed tomography and nuclear magnetic resonance (NMR).

In second place among the causes of damage to the central nervous system in the fetus and newborn is birth trauma. The true meaning, the meaning of birth trauma is damage to a newborn child caused by mechanical impact directly on the fetus during childbirth.

Among the variety of birth injuries during the birth of a baby, the child’s neck experiences the greatest load, resulting in various injuries. cervical region spine, especially intervertebral joints and the junction of the first cervical vertebra and the occipital bone (atlanto-occipital joint).

There may be shifts (dislocations), subluxations and dislocations in the joints. This disrupts blood flow in important arteries that supply blood to the spinal cord and brain.

The functioning of the brain largely depends on the state of the cerebral blood supply.

Often the root cause of such injuries is the weakness of labor in a woman. In such cases, forced labor stimulation changes the mechanism of fetal passage through the birth canal. With such stimulated childbirth, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, spraining and tearing of ligaments, dislocations, and cerebral blood flow is disrupted.

Traumatic injuries to the central nervous system during childbirth most often occur when the size of the child does not correspond to the size of the mother’s pelvis, when the fetus is in an incorrect position, during birth in the breech presentation, when premature, low-weight children are born and, conversely, children with a large body weight, large size, since In these cases, various manual obstetric techniques are used.

When discussing the causes of traumatic lesions of the central nervous system, we should separately focus on childbirth using superimposition obstetric forceps. The fact is that even if the forceps are applied to the head flawlessly, intense traction on the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is pulled is transmitted to the body through the neck. For the neck, such a huge load is unusually large, which is why when removing a baby using forceps, along with brain pathology, damage to the cervical portion of the spinal cord occurs.

The issue of injuries to the child that occur during a cesarean section deserves special attention. Why is this happening? Indeed, it is not difficult to understand the trauma of a child as a result of passing through the birth canal. Why does a cesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during a caesarean section? The fact is that the transverse incision during a caesarean section in the lower segment of the uterus should theoretically correspond to the largest diameter of the head and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the head of an average child is 34-35 cm. Therefore, removing the head and especially the shoulders of the child by pulling the head with an insufficient incision of the uterus inevitably leads to injury to the cervical spine. That is why the most common cause of birth injuries is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.

In such cases, they speak of hypoxic-traumatic damage to the central nervous system in newborns.

With birth trauma, cerebral circulation disorders often occur, including hemorrhages. Most often these are small intracerebral hemorrhages in the cavity of the ventricles of the brain or intracranial hemorrhages between meninges(epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic damage to the central nervous system in newborns.

When a baby is born with central nervous system damage, the condition can be severe. This is an acute period of illness (up to 1 month), followed by an early recovery period (up to 4 months) and then a late recovery period.

It is important to determine the leading set of signs of the disease—the neurological syndrome—to prescribe the most effective treatment for CNS pathology in newborns. Let's consider the main syndromes of CNS pathology.

Main syndromes of central nervous system pathology

Hypertensive-hydrocephalic syndrome

When examining a sick infant, the expansion of the ventricular system of the brain is determined, detected using ultrasound of the brain, and an increase in intracranial pressure is recorded (as shown by echo-encephalography). Externally, in severe cases of this syndrome, there is a disproportionate increase in the size of the brain part of the skull, sometimes asymmetry of the head in the case of a unilateral pathological process, divergence of cranial sutures (more than 5 mm), expansion and intensification of the venous pattern on the scalp, thinning of the skin on the temples.

In hypertensive-hydrocephalic syndrome, either hydrocephalus, manifested by expansion of the ventricular system of the brain, or hypertension syndrome with increased intracranial pressure may predominate. When increased intracranial pressure predominates, the child is restless, easily excitable, irritable, often screams loudly, sleeps lightly, and the child often wakes up. When hydrocephalic syndrome predominates, children are inactive, lethargy and drowsiness, and sometimes developmental delays are noted.

Often, when intracranial pressure increases, children goggle, Graefe’s symptom periodically appears (a white stripe between the pupil and the upper eyelid), and in severe cases, the “setting sun” symptom may be observed when the iris of the eye, like the setting sun, is half immersed under the lower eyelid; sometimes convergent strabismus appears, the baby often throws his head back. Muscle tone can be either decreased or increased, especially in the leg muscles, which is manifested by the fact that when supporting oneself, one stands on tiptoes, and when trying to walk, one crosses the legs.

The progression of hydrocephalic syndrome is manifested by increased muscle tone, especially in the legs, while support reflexes, automatic walking and crawling are reduced.

In cases of severe, progressive hydrocephalus, seizures may occur.

Movement disorder syndrome

The syndrome of motor disorders is diagnosed in most children with perinatal pathology of the central nervous system. Movement disorders associated with a violation nervous regulation muscles in combination with an increase or decrease in muscle tone. It all depends on the degree (severity) and level of damage to the nervous system.

When making a diagnosis, the doctor must decide several very important issues, the main one of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is fundamentally important because the approach to treating these conditions is different.

Secondly, assessing muscle tone in various muscle groups is very important. The doctor uses special techniques to identify a decrease or increase in muscle tone in order to choose the right treatment.

Violations of increased tone in various groups lead to a delay in the emergence of new motor skills in the child.

With increased muscle tone in the hands, the development of grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grasps it with his entire hand; fine movements with the fingers are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later stands on his legs, while relying mainly on the forefoot, as if “standing on tiptoes”; in severe cases, a crossing of the lower extremities occurs at the level of the shins, which prevents the formation of walking. In most children, over time and thanks to treatment, it is possible to reduce muscle tone in the legs, and the child begins to walk well. As a memory of increased muscle tone, a high arch of the foot may remain, which makes choosing shoes difficult.

Autonomic-visceral dysfunction syndrome

This syndrome manifests itself as follows: marbling of the skin caused by blood vessels, impaired thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders- regurgitation, less often vomiting, tendency to constipation or unstable stool, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply to the posterior parts of the brain, in which all the main centers of the autonomic nervous system are located, providing guidance to the most important life-support systems - cardiovascular, digestive, thermoregulatory, etc.

Convulsive syndrome

The tendency to convulsive reactions during the neonatal period and in the first months of a child’s life is due to the immaturity of the brain. Seizures occur only in cases of spread or development of a disease process in the cerebral cortex and have many different causes that a doctor must identify. This often requires instrumental studies of the brain (EEG), its blood circulation (Dopplerography) and anatomical structures (ultrasound of the brain, computed tomography, NMR, NSG), and biochemical studies.

Convulsions in a child can manifest themselves in different ways: they can be generalized, involving the whole body, and localized - only in a specific muscle group.

Convulsions are also different in nature: they can be tonic, when the child seems to stretch out and freeze for a short time in a certain position, as well as clonic, in which twitching of the limbs and sometimes the entire body occurs, so that the child can be injured during convulsions .

There are many variants of manifestations of seizures, which are identified by a neuropathologist based on the story and description of the child’s behavior by attentive parents.

lyami. Correct positioning diagnosis, that is, determining the cause of a child’s seizure, is extremely important, since the timely prescription of effective treatment depends on this.

It is necessary to know and understand that convulsions in a child during the neonatal period, if serious attention is not paid to them in time, can become the onset of epilepsy in the future.

Symptoms to contact pediatric neurologist

To summarize all that has been said, let us briefly list the main deviations in the health status of children, for which it is necessary to contact a pediatric neurologist:

if the baby sucks sluggishly, takes breaks, and gets tired. There is choking and leakage of milk through the nose;
if the child has a weak cry and his voice has a nasal tone;
if the newborn burps frequently and does not gain enough weight;
if the child is inactive, lethargic or, on the contrary, too restless and this restlessness intensifies even with minor changes in the environment;
if the child has trembling of the chin, as well as the upper or lower extremities, especially when crying;
if the child often shudders for no reason, has difficulty falling asleep, and the sleep is superficial and short in duration;
if the child constantly throws his head back while lying on his side;
if there is too rapid or, conversely, slow growth in head circumference;
if the child’s motor activity is reduced, if he is very lethargic and his muscles are flabby (low muscle tone), or, conversely, the child seems constrained in his movements (high muscle tone), so even swaddling is difficult;
if one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);
if the child squints or goggles, a white stripe of sclera is periodically visible;
if the baby constantly tries to turn his head in only one direction (torticollis);
if the hip extension is limited, or, conversely, the child lies in a frog position with the hips separated by 180 degrees;
if the child was born by caesarean section or in a breech presentation, if obstetric forceps were used during childbirth, if the baby was born prematurely or with a large weight, if the umbilical cord was entangled, if the child had convulsions in the parental home. Accurate diagnosis and timely and correctly prescribed treatment of nervous system pathology are extremely important. Damages to the nervous system can be expressed to varying degrees: in some children they are very pronounced from birth, in others even severe disturbances gradually decrease, but do not disappear completely, and mild manifestations remain for many years - these are the so-called residual phenomena.

Late manifestations of birth trauma

There are also cases when at birth the child had minimal impairments, or no one noticed them at all, but after a while, sometimes years, under the influence of certain stresses: physical, mental, emotional - these neurological impairments manifest themselves with to varying degrees expressiveness. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists in everyday practice deal most often with such patients.

What are the signs of these consequences?

Most children with late manifestations show a marked decrease in muscle tone. Such children are credited with “innate flexibility,” which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the “frog” pose and do the splits without difficulty. Often such children are gladly accepted into the art or artistic gymnastics, in choreographic circles. But most of them cannot bear the heavy workload and eventually drop out. However, these activities are enough to develop a spinal pathology - scoliosis. It is not difficult to recognize such children: they often clearly exhibit protective tension in the cervical-occipital muscles, they often have mild torticollis, their shoulder blades stick out like wings, the so-called “wing-shaped shoulder blades,” they can stand at different levels, like their shoulders. In profile, it is clear that the child has a sluggish posture and a stooped back.

By the age of 10-15 years, some children with signs of cervical spine injury in the neonatal period develop typical signs early cervical osteochondrosis, most characteristic feature which causes headaches in children. The peculiarity of headaches with cervical osteochondrosis in children is that, despite their different intensity, the pain is localized in the cervical-occipital region. As you grow older, the pain often becomes more pronounced on one side and, starting in the occipital region, spreads to the forehead and temples, sometimes radiating to the eye or ear, intensifying when turning the head, so that a short-term loss of consciousness may even occur.

A child’s headaches are sometimes so intense that they can deprive him of the ability to study, do anything around the house, and force him to go to bed and take analgesics. At the same time, some children with headaches exhibit a decrease in visual acuity - myopia.

Treatment for headaches, aimed at improving blood supply and nutrition to the brain, not only relieves headaches, but also improves vision.

The consequences of pathology of the nervous system in the newborn period can be torticollis, certain forms of scoliotic deformities, neurogenic clubfoot, and flat feet.

In some children, enuresis - urinary incontinence - can also be a consequence of birth trauma - just like epilepsy and other convulsive conditions in children.

As a result of hypoxic injury to the fetus in the perinatal period, the brain is primarily affected, and the normal course of maturation is disrupted functional systems brain, which ensure the formation of such complex processes and functions of the nervous system, such as stereotypes of complex movements, behavior, speech, attention, memory, perception. Many of these children show signs of immaturity or disorders of certain higher mental functions. The most common manifestation is the so-called active attention deficit hyperactivity disorder and hyperactive behavior syndrome. Such children are extremely active, disinhibited, uncontrollable, they lack attention, they cannot concentrate on anything, they are constantly distracted, and cannot sit still for several minutes.

They say about a hyperactive child: this is a child “without brakes.” In the first year of life, they give the impression of very developed children, as they are ahead of their peers in development - they begin to sit, crawl, and walk earlier. It is impossible to restrain a child; he certainly wants to see and touch everything. Increased physical activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low performance, the child does his homework until the evening, goes to bed late and, as a result, does not get enough sleep. The movements of such children are awkward, clumsy, and poor handwriting is often noted. They are characterized by disorders of auditory-verbal memory; children poorly assimilate material from the ear, while a violation visual memory are less common. They often have a bad mood, thoughtfulness, and lethargy. It is difficult to involve them in the pedagogical process. The consequence of all this is a negative attitude towards learning and even a refusal to attend school.

Such a child is difficult for both parents and teachers. Behavioral and school problems grow like a snowball. During adolescence, these children have a significantly increased risk of developing persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.

Functional disorders of cerebral blood flow especially make themselves felt during periods accelerated growth- in the first year, at 3-4 years, 7-10 years, 12-14 years.

It is very important to notice the first signs as early as possible, take action and carry out treatment in early childhood, when the development processes are not yet completed, while the plasticity and reserve capabilities of the central nervous system are great.

Back in 1945, the domestic obstetrician Professor M.D. Gütner rightly called birth injuries to the central nervous system “the most common folk disease.”

In recent years, it has become clear that many diseases of older children and even adults have their origins in childhood and are often a late retribution for unrecognized and untreated pathology of the newborn period.

One conclusion must be drawn - be attentive to the health of the baby from the moment of conception, and, if possible, eliminate all problems in a timely manner. harmful influences on his health, and even better - to prevent them altogether. If such a misfortune occurs and a pathology of the nervous system is detected in the child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible to ensure that the baby makes a full recovery.

The central nervous system is precisely the mechanism that helps a person grow and navigate in this world. But sometimes this mechanism malfunctions and “breaks.” It is especially scary if this happens in the first minutes and days of a child’s independent life or even before he is born. We will talk about why a child’s central nervous system is affected and how to help the baby in this article.

What it is

The central nervous system is a close “ligament” of two 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. The central nervous system, or more precisely, its middle and lower sections, regulate the activities of all organs and systems, ensure communication between them. The highest section is the cerebral cortex. It is responsible for self-awareness and self-awareness, for a person’s connection with the world, with the reality surrounding the child.

Disorders, and consequently, damage to the central nervous system, can begin during the development of the fetus in the mother’s womb, or 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 extent of the consequences.

Causes

In children with central nervous system disorders, about half of all cases occur due to intrauterine lesions; doctors call this perinatal pathologies of the central nervous system. Moreover, more than 70% of them are premature babies, which appeared earlier than the due obstetric period. In this case, the main root cause lies in the immaturity of all organs and systems, including the nervous system; 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. Experts believe that the state of the nervous system in this case is influenced by negative intrauterine factors, such as prolonged hypoxia, which the baby experienced in the mother’s womb during gestation, birth injuries, as well as the state of acute oxygen starvation during a difficult delivery, metabolic disorders of the child that began even before birth, infectious diseases suffered by the expectant mother, complications of pregnancy. All lesions that resulted from 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 this birth is also of great importance, since the changes that occur in the tissues of the uterus after termination of pregnancy contribute to the disruption of uterine blood flow during subsequent pregnancies.

• 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 disruption of the child’s central nervous system after childbirth, in the first hours after birth.
• Fetal metabolic disorders. Such processes usually begin in the first - early second trimester. They are directly related to disruption of the functioning of the organs and systems of the baby’s body under the influence of poisons, toxins, and certain medications.
• Infections in the mother. Particularly dangerous are diseases caused by viruses (measles, rubella, chickenpox, cytomegalovirus infection and a number of other ailments) if the disease occurred in the first trimester of pregnancy.

• Pathologies of pregnancy. The state of the child’s central nervous system is influenced by a variety of features of the gestation period - polyhydramnios and oligohydramnios, pregnancy with twins or triplets, placental abruption and other reasons.
• Severe genetic diseases. Typically, pathologies such as Down and Edwards syndromes, trisomy and a number of others are accompanied by significant organic changes in the central nervous system.

On modern level With the development of medicine, pathologies of the central nervous system become obvious to neonatologists already in the first hours after the birth of the baby. Less often - in the first weeks.

Sometimes, especially with organic lesions of mixed origin, the real reason it is impossible to establish, especially if it is related to the perinatal period.

Classification and symptoms

Scroll possible symptoms depends on the causes, degree and extent of damage to the brain or spinal cord, or combined damage. The outcome is also influenced 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:

• Easy. This degree is manifested slight promotion or a decrease in the baby’s muscle tone, convergent strabismus may occur.

• Average. With such lesions, muscle tone is always reduced, reflexes are completely or partially absent. This condition is replaced by hypertonicity and convulsions. Characteristic oculomotor disturbances appear.
• Heavy. Not only motor function and muscle tone suffer, but also internal organs. If the central nervous system is severely depressed, convulsions may begin different intensity. Problems with cardiac and renal activity can be severe, as can the development of respiratory failure. The intestines may be paralyzed. The adrenal glands do not produce the necessary hormones in the required quantities.

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

• Hypoxic (ischemic, intracranial hemorrhages, combined).
• Traumatic (birth injuries of the skull, birth spinal lesions, birth pathologies of peripheral nerves).
• Dysmetabolic ( kernicterus, excess levels of calcium, magnesium, potassium in the child’s blood and tissues).
• Infectious (consequences of infections suffered by the mother, hydrocephalus, intracranial hypertension).

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

• Ischemic lesions. The most “harmless” disease is cerebral ischemia 1st degree. With it, the child demonstrates central nervous system disorders only in the first 7 days after birth. The reason most often lies in fetal hypoxia. At this time, the baby can observe relatively mild signs stimulation or depression of the central nervous system.
• The second degree of this disease is diagnosed when if disturbances and even seizures last more than a week after birth. We can talk about the third degree if the child has constantly increased intracranial pressure, frequent and severe convulsions are observed, and there are other autonomic disorders.

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

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

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

• Traumatic lesions, birth injuries. If during the birth process doctors had to use forceps on the baby’s head and something went wrong, if acute hypoxia occurred, then most often this is followed by a cerebral hemorrhage. During birth trauma, 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. Main sign traumatic damage to the central nervous system - increased 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 depressed. Not only the brain, but also the spinal cord can be injured. This most often manifests itself as sprains, tears, and hemorrhage. In children, breathing is impaired, hypotension of all muscles, and spinal shock are observed.
• Dysmetabolic lesions. With such pathologies, in the overwhelming majority of cases, the child has increased blood pressure, convulsive attacks are observed, and consciousness is quite clearly depressed. The cause can be determined by blood tests that show either a critical deficiency of calcium, or a lack of sodium, or another imbalance of other substances.

Periods

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

• Spicy. The violations have just begun and have not yet had time to cause serious consequences. This is usually the first month of a child’s independent life, the newborn period. At this time, a baby with lesions of the central nervous system usually sleeps poorly and restlessly, cries often and for no apparent reason, he is excitable, and can flinch without a stimulus even in his sleep. 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, which will be manifested by noticeable head growth and strange eye movements.

• Restorative. It can be early or late. If the baby is aged 2-4 months, then they talk about early recovery, if he is already from 5 to 12 months, then about late recovery. Sometimes parents notice disturbances in the functioning of the central nervous system in their baby for the first time in early period. At 2 months, such toddlers hardly express any emotions and are not interested in bright hanging toys. In the late period, the child noticeably lags behind in his development, does not sit, does not walk, his cry is quiet and usually very monotonous, without emotional coloration.
• Consequences. This period begins after the child turns one year old. At this age, the doctor is able to most accurately assess the consequences of a central nervous system disorder in this particular case. Symptoms may disappear, but the disease does not go away. Most often, doctors make such verdicts per year on such children as hyperactivity syndrome, developmental delay (speech, physical, mental).

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

Treatment

We can talk about treatment when lesions of the central nervous system are diagnosed with maximum accuracy. Unfortunately, in modern medical practice There is a problem overdiagnosis, in other words, every baby whose chin trembles during a monthly examination, who eats poorly and sleeps restlessly, can easily be diagnosed with “cerebral ischemia.” If a neurologist claims that your baby has central nervous system lesions, you should definitely insist on complex diagnostics, which will include an ultrasound of the brain (through the fontanel), computed tomography, and in special cases, an x-ray of the skull or spine.

Each diagnosis that is in some way associated with lesions of the central nervous system must be diagnostically confirmed. If signs of a central nervous system disorder are noticed in the maternity hospital, then timely assistance provided by neonatologists helps to minimize the severity possible consequences. It just sounds scary - damage to the central nervous system. In fact, most of these pathologies are reversible and subject to correction if detected in time.

Treatment usually uses drugs that improve blood flow and blood supply to the brain - large group nootropic drugs, vitamin therapy, anticonvulsants.

Only a doctor can give an exact list of medications, 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 relief of symptoms, the main stage of therapy begins, aimed at recovery. proper operation CNS. This stage usually takes place at home, and parents bear a great deal of responsibility for following numerous medical recommendations.

Children with functional and organic disorders of the central nervous system need:

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

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

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

Consequences and forecasts

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

At 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 type lead to the development of hydrocephalus, cerebral palsy, epileptic seizures. As a rule, some internal organs also suffer; the child simultaneously experiences chronic diseases of the kidneys, respiratory and of cardio-vascular system, marble leather.

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 give up bad habits while carrying a baby - smoking, drinking alcohol or using drugs.

All pregnant women must be registered with an obstetrician-gynecologist in the antenatal clinic. During pregnancy, they will be asked to undergo so-called screening three times, which identifies the risks of having a child with genetic disorders from this particular pregnancy. Many gross pathologies of the fetal central nervous system become noticeable during pregnancy; some problems can be corrected medicines, for example, disturbances of uteroplacental blood flow, fetal hypoxia, 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 careful about various medicines, which have to be taken during the period of bearing a child.

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

After the birth of a healthy baby, it is very important to regularly visit the pediatrician, protect the baby from injuries to the skull and spine, and get 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 signs of a nervous system disorder in a newborn, which you can determine yourself.

Despite the variety of causes leading to perinatal damage to the nervous system during the course of the disease, three periods are distinguished:

• acute - 1st month of life);
• restorative, which is divided into early (from the 2nd to the 3rd month of life) and late (from 4 months to 1 year in full-term infants, up to 2 years in premature infants);
• outcome of the disease.

In each period, perinatal injuries have different clinical manifestations, which doctors are accustomed to distinguishing as various syndromes(collection clinical manifestations diseases grouped by common feature). In addition, one child often has a combination of several syndromes. The severity of each syndrome and their combination make it possible to determine the severity of damage to the nervous system, correctly prescribe treatment and make predictions for the future.

Acute syndromes

Acute period syndromes include: central nervous system depression syndrome, comatose syndrome, syndrome of increased neuro-reflex excitability, convulsive syndrome, hypertensive-hydrocephalic syndrome.

With mild injuries to the central nervous system in newborns, the most common syndrome of increased neuro-reflex excitability which is manifested by shuddering, increased (hypertonicity) or decreased (hypotonic) muscle tone, increased reflexes, tremor (shaking) of the chin and limbs, restless shallow sleep, frequent “causeless” crying.

With moderate damage to the central nervous system in the first days of life, children more often have CNS depression in the form of decreased motor activity and decreased muscle tone, weakened reflexes of newborns, including sucking and swallowing reflexes. By the end of the 1st month of life, depression of the central nervous system gradually disappears, and in some children it changes increased excitement With a moderate degree of damage to the central nervous system, disturbances in functioning are observed internal organs and systems ( vegetative-visceral syndrome) in the form of uneven coloring of the skin (marbling of the skin) due to imperfect regulation of vascular tone, disturbances in the rhythm of breathing and heart contractions, dysfunction of the gastrointestinal tract in the form of unstable stools, constipation, frequent regurgitation, flatulence. May occur less frequently convulsive syndrome, in which paroxysmal twitching of the limbs and head, episodes of shuddering and other manifestations of seizures are observed.

Often, children in the acute period of the disease develop signs hypertensive-hydrocephalic syndrome, which is characterized by excess fluid accumulation in the spaces of the brain containing cerebrospinal fluid, which leads to increased intracranial pressure. The main symptoms that the doctor notes and that parents may suspect are the rapid growth rate of the child’s head circumference (more than 1 cm per week), large size and bulging of the large fontanel, divergence of cranial sutures, restlessness, frequent regurgitation, unusual eye movements (a kind of trembling eyeballs when looking away to the side, up, down - this is called nystagmus), etc.

A sharp depression of the activity of the central nervous system and other organs and systems is inherent in the extremely serious condition of a newborn with the development comatose syndrome(lack of consciousness and coordinating function of the brain). This condition requires emergency care in intensive care conditions.

Recovery period syndromes

In the recovery period of perinatal lesions of the central nervous system, the following syndromes are distinguished: syndrome of increased neuro-reflex excitability, epileptic syndrome, hypertensive-hydrocephalic syndrome, syndrome of vegetative-visceral dysfunctions, syndrome of motor disorders, syndrome of delayed psychomotor development. Long-term disorders of muscle tone often lead to delayed psychomotor development in children, because disturbances in muscle tone and the presence of pathological motor activity - hyperkinesis (involuntary movements caused by contraction of the muscles of the face, trunk, limbs, less often the larynx, soft palate, tongue, external muscles of the eyes) prevent the performance of purposeful movements and the formation of normal motor functions in the baby. When motor development is delayed, the child later begins to hold his head up, sit, crawl, and walk. Poor facial expressions, late appearance of a smile, decreased interest in toys and environmental objects, as well as a weak monotonous cry, delayed appearance of humming and babbling should alert parents to the delay in mental development of the baby.

Outcomes of the disease

By the age of one year, in most children, manifestations of perinatal lesions of the central nervous system gradually disappear or their minor manifestations persist. Common consequences of perinatal lesions include:

• delay in mental, motor or speech development;
• cerebroasthenic syndrome (it is manifested by mood swings, motor restlessness, anxious restless sleep, weather dependence);
• Attention deficit hyperactivity syndrome is a disorder of the central nervous system, manifested by aggressiveness, impulsivity, difficulty concentrating and maintaining attention, learning and memory disorders.

The most unfavorable outcomes are epilepsy, hydrocephalus, childhood cerebral paralysis, indicating severe perinatal damage to the central nervous system.

In the diagnosis, the doctor must necessarily reflect the suspected causes of damage to the central nervous system, the severity, syndromes and period of the disease.

For diagnostic and confirmation purposes perinatal injuries The central nervous system in children, in addition to a clinical examination, conducts additional instrumental studies of the nervous system, such as neurosonography, Dopplerography, computed tomography and magnetic resonance imaging, electroencephalography, etc.

IN Lately The most accessible and widely used method of examining children in the first year of life is neurosonography (ultrasound examination of the brain), which is carried out through the large fontanel. This study is harmless and can be repeated in both full-term and premature babies, allowing one to observe the processes occurring in the brain over time. In addition, the study can be carried out on newborns in serious condition who are forced to stay in the intensive care unit in incubators (special beds with transparent walls that allow for a certain temperature regime, monitor the condition of the newborn) and on mechanical ventilation ( artificial respiration through the device). Neurosonography allows you to assess the state of the brain substance and cerebrospinal fluid tracts (brain structures filled with fluid - cerebrospinal fluid), identify developmental defects, and also suggest possible causes of damage to the nervous system (hypoxia, hemorrhage, infections).

If a child is diagnosed with severe neurological disorders in the absence of signs of brain damage on neurosonography, such children are prescribed more accurate methods of studying the central nervous system - computed tomography (CT) or magnetic resonance imaging (MRI). Unlike neurosonography, these methods allow you to evaluate the smallest structural changes in the brain and spinal cord. However, they can only be carried out in a hospital, since during the study the baby should not make active movements, which is achieved by administering special medications to the child.

In addition to studying brain structures, recently it has become possible to assess blood flow in cerebral vessels using Dopplerography. However, the data obtained during its implementation can only be taken into account in conjunction with the results of other research methods.

Electroencephalography (EEG) is a method for studying the bioelectrical activity of the brain. It allows you to assess the degree of brain maturity and suggest the presence of a convulsive syndrome in the baby. Due to the immaturity of the brain in children in the first year of life, a final assessment of EEG indicators is possible only if this study is repeatedly carried out over time.

Thus, the diagnosis of perinatal lesions of the central nervous system in a baby is established by a doctor after a thorough analysis of data on the course of pregnancy and childbirth, the condition of the newborn at birth, the presence of disease syndromes identified in him, as well as data from additional research methods. In the diagnosis, the doctor will necessarily reflect the suspected causes of damage to the central nervous system, the severity, syndromes and period of the disease.

Why do disturbances in the functioning of the central nervous system occur?

Analyzing the causes leading to disturbances in the functioning of the central nervous system of a newborn, doctors distinguish four groups of perinatal lesions of the central nervous system:

• hypoxic lesions of the central nervous system, in which the main damaging factor is hypoxia (lack of oxygen);
• traumatic lesions arising as a result of mechanical damage to the tissues of the brain and spinal cord during childbirth, in the first minutes and hours of a child’s life;
• dismetabolic and toxic-metabolic lesions, the main damaging factor of which is metabolic disorders in the child’s body, as well as damage resulting from the use of toxic substances by the pregnant woman (medicines, alcohol, drugs, smoking);
• lesions of the central nervous system in infectious diseases of the perinatal period” when the main damaging effect is exerted by an infectious agent (viruses, bacteria and other microorganisms).

Help for children with central nervous system injuries

In connection with the possibilities of early diagnosis of perinatal lesions of the central nervous system, treatment and rehabilitation of these conditions should be carried out as early as possible, so that the therapeutic effects occur in the first months of the baby’s life, when the disorders are still reversible. It should be said that the ability of the child’s brain to restore impaired functions, as well as the capabilities of the entire organism as a whole, is very great during this period of life. It is in the first months of life that it is still possible for the nerve cells of the brain to mature to replace those lost after hypoxia, and for the formation of new connections between them, due to which in the future it will be determined normal development the body as a whole, I would like to note that even minimal manifestations of perinatal lesions of the central nervous system require appropriate treatment to prevent adverse outcomes of the disease.

Providing assistance to children with central nervous system injuries is carried out in three stages.

First stage involves assistance provided in the maternity hospital (delivery room, ward intensive care, neonatal intensive care unit) and includes restoration and maintenance of vital functions important organs(heart, lungs, kidneys), normalization of metabolic processes, treatment of central nervous system damage syndromes (depression or excitation, seizures, cerebral edema, increased intracranial pressure, etc.). It is at the first stage of assistance that the main treatment methods for children with severe central nervous system injuries are medication and intensive therapy (for example, artificial ventilation lungs) therapy.

During treatment, the children's condition gradually improves, however, many symptoms of central nervous system damage (impaired muscle tone, reflexes, fatigue, anxiety, dysfunction in the lungs, heart, gastrointestinal tract) may persist, which requires transfer of children to second stage of treatment and rehabilitation, namely, to the department of pathology of newborns and premature infants or to the neurological department of a children's hospital.

At this stage, drugs are prescribed that are aimed at eliminating the cause of the disease (infections, toxic substances) and affecting the mechanism of development of the disease, as well as drugs used to treat certain syndromes of central nervous system damage. These are drugs that improve the nutrition of nerve cells, stimulate the maturation of brain tissue, improve microcirculation 2 and cerebral circulation, reduce muscle tone, etc. In addition drug therapy, in full-term children, against the background of improvement in condition from the end of the 3rd week of life (in premature children - a little later), a course of massage with the gradual addition of therapeutic exercises, electrophoresis sessions and other rehabilitation methods can be prescribed.

After completing the course of treatment, most children are discharged home with recommendations for further observation in a children's clinic ( third stage of rehabilitation). The pediatrician, together with a neurologist, and, if necessary, with other specialized specialists (ophthalmologist, otolaryngologist, orthopedist, psychologist, physiotherapist, etc.), draws up an individual plan for monitoring the child in the first year of life. During this period, non-drug rehabilitation methods, such as massage, physiotherapy, electrophoresis, pulsed currents, acupuncture, thermal procedures, balneotherapy (therapeutic baths), swimming, as well as psychological and pedagogical correction methods aimed at developing motor skills, speech and the child’s psyche.

If the damage to the central nervous system is not severe and the baby is discharged from maternity ward home, it is important to create a therapeutic and protective regime during the acute period of the disease. And this means protecting the child from unnecessary irritants ( loud noise radio, television, loud conversations), create conditions for thermal comfort (avoid both overheating and hypothermia), remembering to regularly ventilate the room in which the baby is located. In addition, the child should be protected as much as possible from the possibility of any infection by limiting visits to the newborn by friends and relatives.

Particular attention should be paid proper nutrition because it is powerful healing factor. Breast milk contains all the necessary nutrients for the full development of the baby. Early transfer to artificial feeding leads to the early onset and more frequent development of infectious diseases. Meanwhile, the protective factors of mother's milk are able to partially compensate for the lack of their own immune factors during this period of development, allowing the baby to direct all its compensatory capabilities to restore impaired functions after suffering hypoxia. And those contained in breast milk are biologically active substances, hormones, growth factors are able to activate recovery processes and maturation of the central nervous system. In addition, maternal touch during breastfeeding is an important emotional stimulant that helps reduce stress state, which means a more complete perception by children of the world around them.

Premature babies and children born with severe damage to the central nervous system are often forced to be fed through a tube or bottle in the first days of life. Don't despair, but try to save breast milk, regularly expressing it and giving it to the baby. As soon as your baby's condition improves, he will definitely be attached to his mother's breast.

An important place in the recovery period is occupied by therapeutic massage and gymnastics, which normalize muscle tone, improve metabolic processes, blood circulation, thereby increasing the overall reactivity of the body, and promote the psychomotor development of the child. A massage course includes from 10 to 20 sessions. Depending on the severity of the central nervous system lesion, at least 3-4 courses of massage are carried out in the first year of life with an interval of 1-1.5 months. At the same time, parents continue to practice therapeutic gymnastics with their child between courses at home, having previously learned during the classes.

Methods of massage and therapeutic exercises depend, first of all, on the nature of motor disorders, the characteristics of changes in muscle tone, as well as the predominance of certain syndromes of central nervous system damage.

Thus, for hyperexcitability syndrome, techniques are used aimed at reducing general excitability (rocking in the fetal position or on a ball) and muscle tone (relaxing massage with elements of acupressure). At the same time, in children with signs of depression of the nervous system, a strengthening massage of the muscles of the back, abdomen, gluteal muscles, as well as relaxed arms and legs.

Massage and therapeutic exercises create favorable conditions for the overall development of the child and accelerate the development of motor functions (mastering skills such as raising and holding the head, turning on the side, stomach, back, sitting, crawling, walking independently). Special meaning is given to training on inflatable objects - balls, rollers (rollers). They are used to develop vestibular functions, help relax tense muscles and strengthen relaxed muscles, and water. In this case, the exercises are carried out in ordinary baths, their duration is initially 5-7 minutes and gradually increases to 15 minutes. At the beginning of the course, it is advisable to undergo training with a medical instructor, and then it is possible to conduct classes in home bath. Water not only tones weak muscles and relaxes tense ones, stimulates metabolism and blood circulation, has a hardening effect, but also has a calming effect on the baby’s nervous system. It should be noted that increased intracranial pressure in children is not a contraindication to swimming - in this case, diving should only be excluded.

It is also possible to carry out stimulating underwater shower-massage in a warm bath. In this case, water entering through a wide tip under low pressure (0.5 atmospheres) has a massaging effect on the muscles. To do this, a stream of water is slowly moved from the periphery to the center at a distance of 10-20 cm from the surface of the body. This massage is performed in a hospital or clinic setting.

Among water procedures that have therapeutic effects, balneotherapy is used for children with perinatal lesions of the central nervous system - adoption medicinal baths. Due to the characteristics of children's skin (high permeability, rich vascular network, abundance of nerve endings - receptors), medicinal baths are especially effective. Under the influence of salts dissolved in water, blood circulation and metabolism in the skin, muscles and the entire body increase. Parents can carry out these procedures independently at home, having received doctor’s recommendations. Salt baths are prepared at the rate of 2 tablespoons of sea or table salt per 10 liters of water, water temperature 36°C. Procedures are taken from 3-5 to 10-15 minutes every other day, the course of treatment is 10-15 baths. In excitable children, it is often recommended to add conifers to salt baths, as well as baths with decoctions of valerian and motherwort, which have a calming effect on the central nervous system.

Among the methods of physiotherapy, the most commonly used are medicinal electrophoresis, pulsed currents, inductothermy, ultrasound, etc. Introduction to the body medicinal substances with the help of direct current (electrophoresis) improves blood circulation in tissues and muscle tone, promotes the resorption of foci of inflammation, and when exposed to collar area improves cerebral circulation and brain activity. The impact of pulsed currents of various characteristics can have both an exciting and an inhibitory effect on muscles, which is often used in the treatment of paresis and paralysis.

In the treatment of perinatal lesions of the central nervous system in children, local thermal procedures (heat therapy) are also used by applying ozokerite (mountain wax), paraffin or sand bags to the affected areas. Thermal effects cause tissue warming, vasodilation, increasing blood circulation and metabolism, and also activate recovery processes, muscle tone decreases. To do this, ozokerite preheated to 39-42°C is applied to the site of exposure, covered with a blanket and left to act for 15-30 minutes, depending on age. Procedures are carried out every other day in the amount of 15-20 per course of treatment.

Impact on particularly sensitive points in order to stimulate reflexes is carried out using the method of acupuncture. In this case, the effects can be carried out with an acupuncture (used in acupuncture) needle, pulsed electric shock, laser radiation or magnetic field.

With the beginning of the recovery period of the disease, it is necessary to gradually expand auditory, visual, and emotional contacts with the baby, since they are a kind of non-drug “nootrophs” - stimulants for the developing brain. These are toys, educational mats and complexes, books and pictures, individually selected music programs recorded on a tape recorder, and of course mother’s songs.

However, it should be remembered that overindulgence early development programs can lead to fatigue and disruption of the baby’s not yet fully strengthened nervous system. Therefore, show moderation and patience in everything, and even better, do not forget to discuss all undertakings with your doctor. Remember - your child's health is in your hands. So do not spare time and effort to restore the injured baby.

New medicine for baby rehabilitation

New methods of rehabilitation of children with central nervous system lesions include the technique of soft vibration massage in zero gravity conditions (Saturn rehabilitation crib). To do this, the child is placed on an individual diaper in a “pseudo-liquid” made of glass microbeads heated to the required temperature, moving in the bed under the influence of air flow. A buoyancy effect is created (close to intrauterine), in which up to 65% of the child’s body surface is immersed in “pseudo-fluid”. In this case, the gentle massage effect of microballs on the skin leads to irritation of peripheral nerve endings and transmission of impulses to the central nervous system, which provides treatment for paralysis.

Another new method of rehabilitation is the “dry immersion” method, which also creates the effect of partially simulating the intrauterine state of a child. In this case, the babies are placed on a plastic film, freely lying on the swaying surface of water with a temperature of 35 ~ 37 ° C. During the session, excited children calm down and often fall asleep, which contributes to a decrease in muscle tone,” while children with central nervous system depression become somewhat more active.

1 Perinatal - Referring to the period beginning a few weeks before the birth of the child, including the moment of his birth and ending a few days after the birth of the child. This period lasts from the 28th week of pregnancy to the 7th day after the birth of the child.

2 The movement of blood through the smallest vessels of the body for the purpose of better delivery of oxygen and nutrients to the cells, as well as the removal of cell metabolic products