About the disease
The name of this disease combines several nosologies. Encephalopathy is a collective concept indicating brain damage, impaired function. And the designated term "perinatal" speaks of the period of the baby's life when these changes occurred. It turns out that the unfavorable factor affected the child's body in the interval, starting from the 22nd week of the baby's intrauterine life or during labor, in the first week of the baby's life.
It is this period that is distinguished by the multifactorial effect on the condition of the baby. There is a combination of the characteristics of the course of pregnancy, disorders of the mother's health, problems in childbirth, which affects the health of the baby. Statistics indicate a high incidence of the disease in newborns. About 5% of children are diagnosed with AED and receive appropriate treatment.
AED is the cause of 60% of pathologies of the total number of neurological diseases of childhood. The danger of the disease lies in the progression of the disease into various neurological disorders, ranging from minimal disorders of brain functions, ending with infantile cerebral palsy, epilepsy, hydrocephalus.
About the reasons
The child's body has its own characteristics, and adverse factors affecting the developing body can cause significant damage to the health of the baby.
The predominance of the main influencing factor formed the basis for the systematization of the disease.
PEP classification
Posthypoxic encephalopathy
This type of AED is associated with insufficient oxygen supply during gestation or the development of acute oxygen starvation - asphyxia. Intrauterine hypoxia leads to a slowdown in the growth of brain capillaries, an increase in their permeability and vulnerability. As a result of significant oxygen starvation, metabolic disorders occur - acidosis, cerebral edema and death of nerve cells.
The most common cause of encephalopathy in a newborn is insufficient oxygen supply to the baby's body, and brain damage is also called hypoxic-ischemic encephalopathy (HIE).
Post-traumatic
This type of illness is caused by trauma during childbirth. Wrong position of the fetus and insertion of the head, prolonged or rapid labor, provoke the development of injuries, hemorrhages in the brain and its membranes.
Infectious
In the event of an infectious disease in a woman or an exacerbation of a chronic process, pathogens can penetrate the placenta and affect the fetus. Many infections are characterized by the formation of latent, latent infection, when the disease can be "disguised" as a hypoxic or traumatic encephalopathy.
Although the hematoplacental barrier "protects" the baby's body from the penetration of many infectious agents, the pathology of the placenta increases its permeability to harmful substances. It turns out that an unhealthy placenta cannot fulfill its protective function. Viruses cross the placenta most easily, which is explained by their small size.
Toxic metabolic encephalopathy
This type of pathology is associated with exposure of the fetus or newborn to harmful substances: nicotine, alcohol, drugs, toxins of viruses and bacteria, drugs. With metabolic disorders, bilirubin, diabetic encephalopathy and others may occur.
The term "perinatal encephalopathy" combines pathological changes in the brain without specifying their cause. Therefore, AED cannot be considered a definitive diagnosis; the disease requires a more thorough analysis of the origin of the disease. If the cause that led to the development of the disease could not be found, the diagnosis of "encephalopathy, unspecified" in infants is made.
Risk factors
After analyzing the course of pregnancy and childbirth in a woman, you can predict possible health problems in the unborn child, select children at risk for this disease.
- diseases of the expectant mother.
Diseases that appear during the carrying of a baby or exacerbation of chronic ailments (arterial hypertension, heart and kidney diseases, bronchial asthma) without proper treatment can lead to pathologies in the child. Particular attention should be paid to the treatment of diabetes mellitus while carrying a baby, an increased sugar level negatively affects the development of the fetus.
Babies born to mothers with diabetes mellitus are heavier, which often leads to difficulties during birth. In addition, these babies are more likely to develop malformations, lingering jaundice, respiratory distress, and low glucose levels after birth. All this can be the reason for the occurrence of perinatal encephalopathy in a newborn;
- pathology of pregnancy.
Gestosis, threats of termination of pregnancy or premature birth, pathology of the placenta, negatively affect the development of the fetus. Hemolytic disease and infections that develop in utero can also lead to perinatal encephalopathy.
The age of the woman in labor is of great importance. It has been proven that pregnant women under 20 and over 35 have an increased risk of developing pathologies during pregnancy and childbirth;
- problems encountered during childbirth.
The birth process is an important factor affecting the health of the baby in the future. Too long or, on the contrary, rapid childbirth increases the chance of trauma to the child and hypoxic complications. The baby may experience a sharp oxygen starvation, in cases where there was a pathology of the umbilical cord (knots and tight entanglement, insufficient length of the umbilical cord), the placenta exfoliated prematurely.
Experts say that a post-term pregnancy is in most cases more dangerous than a premature one. With delayed childbirth, the risk of fetal hypoxia, the appearance of meconium impurities in the amniotic fluid, and inhalation of dirty waters increases. All this can lead to asphyxia, the appearance of respiratory disorders in a newborn, infectious complications;
- toxic effects on the fetus.
Much has been said about the dangers of alcohol, nicotine and drug addiction on the fetus, but even now there are frequent cases of the toxic effects of these substances on the developing organism. Also, professional hazards, the ecological environment in which the expectant mother is located are unfavorable for the health of the crumbs.
Independent, without medical advice, taking medication by a pregnant woman negatively affects the health of the baby. Some of the drugs affect the growth and development of the fetus, and can cause malformations.
Particularly dangerous is the effect of harmful substances in the first trimester of pregnancy, when the vital organs of the child are formed.
How does PEP manifest?
The neonatologist discovers the first signs of the development of the disease even in the delivery room. Unlike healthy babies, these babies are born with complications, start screaming late, and require assistance. The doctor assesses the baby on the Apgar scale, in the future, the data obtained are taken into account when making the diagnosis of PEP. The disease lasts for a long time, manifestations can develop gradually, therefore, experts divide the course of the disease into periods.
PEP periods
- acute, lasting up to 1 month;
- restorative, which lasts up to 12 months of a full-term baby, in premature babies this interval is extended to 24 months;
- Exodus.
The severity of AED and symptoms of the disease in the acute period
- lightweight.
If the action of the damaging factor was moderate, and the child's condition was not significantly impaired (the Apgar score is usually 6-7 points), the syndrome of increased neuro-reflex excitability comes to the fore. Children with this form of the disease are characterized by pronounced anxiety, their sleep is superficial, intermittent, and the periods of wakefulness are lengthened. The baby cries for a long time for no reason, the mother cannot calm the baby by taking it in her arms.
When examining the crumbs, the doctor pays attention to increased motor activity, revitalization of congenital reflexes, and a violation of muscle tone. Often, these babies have tremors, jerking of the chin and limbs while crying.
The syndrome of increased neuro-reflex excitability in premature infants is dangerous by the appearance of seizures;
- moderate form of the disease.
In the case when the baby's condition was regarded as moderate (Apgar score 4 - 6 points), the baby has a syndrome of depression of the nervous system, which is accompanied by an increase in intracranial pressure. Children with this form of the disease differ from their peers by lethargy, muscle weakness.
In connection with the weakening of the reflexes of the newborn, violations occur during the acts of sucking and swallowing - the baby refuses to breast. Hypertensive-hydrocephalic syndrome is manifested by a bulging fontanelle, an increase in the growth rate of the head, pathological reflexes;
- severe course of the disease.
With a significant deterioration in the condition of the crumbs (Apgar score 1 - 4 points), signs of severe damage to the nervous system appear - a coma. The muscle tone of the baby is sharply reduced, the baby does not respond to stimuli, innate reflexes are practically not detected. Breathing may be irregular and interruptions may occur. Blood pressure tends to decrease, and the activity of the heart becomes arrhythmic.
The baby has pathological eye symptoms, convulsions may appear, which, due to the decreased tone, sometimes masked as spontaneous movements of the child.
Manifestations of the disease during the recovery period
After a month of the baby's life, the clinical manifestations of the disease also change, but in most cases there is a combination of syndromes:
- Increased neuro-reflex excitability.
Manifestations of anxiety, with proper treatment and a benign course of the disease, become less pronounced over time, up to disappearance. In some cases, especially in premature babies, the clinic of increased excitability turns into epileptic manifestations.
Hypertensive-hydrocephalic syndrome
The dynamics of this disorder in children may differ. In a benign course, the manifestations of increased intracranial pressure disappear first, and the rate of growth of the head circumference is normalized by the age of 6 months to a year. If the therapeutic measures during this period proved to be ineffective, the baby develops hydrocephalus.
Vegeto-visceral dysfunction
Against the background of the manifestation of other syndromes, the child often has symptoms from the autonomic nervous system. Mothers of these babies come to the doctor with complaints of frequent regurgitation, poor weight gain, and disruption of the digestive system. When examining a child, the doctor may notice thermoregulation disorders, discoloration of the skin: cyanosis of the hands and feet, the nasolabial triangle.
Movement disorder syndrome
The manifestations of this syndrome are associated with an increase or decrease in tone in the muscles of the baby and can manifest itself both in isolation and accompany other pathological manifestations of AED. The crumbs often have a lag in physical development, and later mastery of motor skills.
In severe cases, paresis and paralysis occur, and the increase in hypertonicity can turn into cerebral palsy.
Delayed psychomotor development
Children who have undergone hypoxia often lag behind in psychomotor development. They are characterized by long-term preservation of innate reflexes and a slowdown in the rate of mastering new skills. Babies with developmental delay later begin to fix their gaze, respond to the voice of their mother, and become interested in toys.
With proper treatment and a favorable course of the disease, many children at the age of 4 - 5 months experience a "leap" in development. Kids begin to take an interest in others, "catch up" in the development of their peers. Moreover, mental development outstrips motor development, motor activity is restored only by 1 - 1.5 years. Prolonged mental retardation indicates the possibility of adverse consequences in the child.
Epileptic syndrome
It is characterized by the appearance of seizures associated with increased bioelectrical activity in the brain, and can occur at any age. Premature babies are more at risk of developing epileptic syndrome due to immaturity of the brain structures.
Diagnosis of PEP
Taking anamnesis and examining the baby
When making a diagnosis, the doctor takes into account the peculiarities of the course of pregnancy and childbirth, the influence of adverse factors on the fetus. The well-being of the baby after birth and in the first days of life is also important, assessed on the Apgar scale. Examination of the crumbs reveals syndromes characteristic of AED, changes in the nervous system.
Specialist consultations
Children with suspected AED need to consult an ophthalmologist to examine the condition of the fundus. A neuropathologist will help assess the severity of pathological changes in the brain, prescribe the necessary examination and treatment.
Laboratory diagnostics
Biochemical analyzes will help establish the hypoxic nature of the disease, determine the acid-base and gas composition of the blood. Often, babies are tested for glucose and electrolyte levels. If an infectious cause of brain pathology or traumatic hemorrhage under its membranes is suspected, a spinal tap and analysis of the resulting cerebrospinal fluid are possible.
Instrumental research methods:
- neurosonography.
To clarify the diagnosis, the doctor may recommend an ultrasound examination of the brain structures through the baby's fontanelle. This method is absolutely painless and safe and helps to detect signs of hypoxia, edema, hemorrhage, expansion of the ventricles of the brain and other changes;
- electroencephalography.
Thanks to this method, it is possible to determine the areas of epileptic activity, to identify children prone to the development of convulsive syndrome;
- CT scan.
With this method, structural pathologies, changes in brain tissue are detected. CT is used to clarify the diagnosis when other studies are ineffective.
Treatment of perinatal encephalopathy in children
Therapy for children with AED differs depending on the period of the disease. First of all, treatment is aimed at maintaining vital organs, fighting respiratory disorders. Oxygen therapy is often given to such babies, and tube feeding is prescribed.
Infusion therapy is carried out taking into account the needs, body weight of the child, glucose-electrolyte solutions are injected intravenously.Drugs are used that reduce vascular permeability (kanavit, etamsylate), anticonvulsants (phenobarbital, diazepam), hormonal agents (prednisalone, dexamethasone), drugs that improve blood circulation in the brain (piracetam, cortexin, vinpocetine).
The choice of drugs for the treatment of the disease is carried out taking into account the prevailing symptoms, the severity of the clinical manifestations of the disease.
After stopping acute manifestations of the disease, the doctor's task is to restore brain function. Babies with AED are registered with a neurologist who prescribes courses of drug and physiotherapy treatment. Of the medicines, the specialist most often recommends the use of drugs that improve metabolic processes in the brain - nootropics, with increased excitability, sedatives are prescribed, and if the convulsive syndrome persists, anticonvulsants.
Treatment of AED should be carried out by a neurologist, taking into account the clinical manifestations of the disease and the characteristics of the child. Improper therapy can worsen the condition of the baby, slow down the rate of recovery from illness.
Good results in the treatment of children with AED are provided by massage, physiotherapy (electrophoresis, amplipulse therapy), swimming, physiotherapy exercises. With developmental delays and speech disorders, classes with a speech therapist and psychologist are recommended.
The nervous system of children is distinguished by its plasticity and the ability to restore its functions. Therefore, treatment started on time, in the first months of life, increases the chances of normal development of the child in the future. According to statistics, complete recovery occurs in 20 - 30% of children, in other cases it is possible to preserve the main syndromes with the transition of the disease to minimal cerebral dysfunction, hydrocephalic syndrome. In severe cases, the development of epilepsy, cerebral palsy is possible.
Prevention of the disease
To reduce the risk of trouble for a child, parents-to-be should take a responsible approach to planning pregnancy. You need to pay enough attention to maintaining a healthy lifestyle, proper nutrition, regular walks in the air. An expectant mother should treat chronic diseases even before conceiving a baby, and during pregnancy, avoid contact with infectious patients.
Do not forget about the importance of the examination during pregnancy. Regular examination in the antenatal clinic will help identify pathological conditions that can affect the development of the child and take action in time. Of great importance is the correct management of childbirth, the timely determination of possible complications of labor, the choice of the method of delivery. After the baby is born, an examination by a pediatrician and an assessment of the child's well-being is required.
Conclusions
AED is a fairly common pathology. It arises as a complication of the pathological course of pregnancy and childbirth. The manifestations of the disease are characterized by a variety of symptoms and require immediate, rational therapy. Adequate treatment started on time will help to minimize the risk of dangerous consequences for the health and development of the child.
Parents need to know what causes can lead to the development of the disease in a child and try to prevent them. If the diagnosis of AED is exposed to a newborn baby, moms and dads should take this disease seriously and follow all the doctor's prescriptions, regularly undergo treatment prescribed by a neurologist. After all, the correct treatment started on time significantly reduces the risk of unpleasant consequences for the health of the baby.
