Parents of a newborn most often learn about cerebral ischemia in the hospital. If this is not reported there, then later a neurologist and pediatrician may mention ischemia, trying to explain what is happening to their child, why he spits up, slowly gains weight or sleeps poorly. In this article, we will talk about why ischemia develops, how it can be treated and what consequences it can have.
What it is?
Under this concept in official medicine describes the state of oxygen starvation of the brain. In a newborn baby, cerebral ischemic disease is essentially a response to a state of hypoxia.
With a lack of oxygen, neurons begin to change and die, which causes hypoxic-ischemic changes in the cerebral cortex. The longer the fasting was, the wider the affected area, and hence the more severe the consequences.
The most common ischemia is found in premature babies. It can also be in a baby who experienced a lack of oxygen so important to him during pregnancy or experienced acute hypoxia during childbirth.
It should be noted that this diagnosis has recently become very widespread. And not because children are born worse or more often suffocate in the womb. Some experts, including Dr. Komarovsky, believe that neurologists quite often give babies such a diagnosis, since mild ischemia is very easy to explain to parents the most complex processes and features of the development of a newborn. Another reason is the doctor's own lack of understanding of what is happening. If it is not clear what is wrong with the child, the easiest way is to say that "he has it because of ischemic metamorphoses in the brain."
Mild degrees indicate that the violations did not cause irreversible consequences. These include 1 and 2 degrees of cerebral ischemia. The third degree is much more difficult. Until now, medicine does not know for certain how to treat it, and therefore the prognosis is considered unfavorable.
Causes
Ischemic brain damage is always closely associated with only one root cause - a lack of oxygen to nourish the cells of the organ. There are many reasons that lead to a lack of oxygen, and they are divided into perinatal and postnatal.
If chronic hypoxia was observed during pregnancy, then brain lesions are somewhat compensated. With acute hypoxia, which the baby could experience at the time of childbirth, ischemia develops more severe.
Common causes of intrauterine hypoxia:
- chronic diseases of a pregnant woman, especially if there are ailments of the lungs, kidneys, liver, heart and blood vessels;
- acute infectious diseases in the first trimester (flu, chickenpox, rubella, ARVI, herpes infections);
- improper lifestyle of the expectant mother: smoking while carrying a baby, taking drugs and alcoholic beverages, medicines for which the doctor did not give permission;
- the age of the expectant mother at the time of pregnancy: the risk of developing fetal hypoxia is higher in very young pregnant women who have not yet turned 19 years old, as well as in aged expectant mothers over 36 years old;
- problems that arose directly during pregnancy: violations of the placenta and uteroplacental blood flow, the threat of miscarriage, which persisted for a long time, oligohydramnios and polyhydramnios, as well as cord entanglement or nodes on the umbilical cord, Rh-conflict);
- insufficient nutrition of the mother during pregnancy, her violation of the doctor's recommendations.
Acute oxygen deficiency can also occur during childbirth. The risk group includes premature birth and late birth (after 42 weeks of pregnancy). Rapid labor is dangerous, as well as protracted, long labor with weak labor.
A large fetus, multiple pregnancies, entanglement with the umbilical cord, early discharge of water or premature placental abruption often lead to the development of acute hypoxia, followed by cerebral ischemia of the newborn baby to one degree or another.
Symptoms and Signs
Symptoms depend on how large-scale the damage to the central neurons of the baby's brain has become. The stronger the oxygen starvation was, the longer it lasted, the more nerve cells die. The earliest symptoms are observed immediately after birth: the child does not cry in the time allotted for this in obstetrics, or his cry is too weak. Children with ischemia most often have an Apgar score below 7/7.
On the first day, doctors may suspect cerebral ischemia due to increased hypertonicity of large muscle groups of the baby, convulsions, tremors, long drawn-out crying of the newborn, even if there are no objective reasons for crying. Too sluggish apathetic newborns who do not suck well, sleep a lot will also raise reasonable suspicions.
The symptoms of ischemia depend on the degree. Grade 1 is characterized by minor deviations in the behavior of the child and his condition. In the first days of life, it manifests itself either by excessive suppression of the nervous system, or by its increased arousal. Usually, this mild ischemia resolves within a week.
If pathological abnormalities are noticeable even after the first seven days of a baby's life, they speak of grade 2 ischemia. With her, convulsions, strabismus are added to minor neurological manifestations (crying, sleep disturbances, profuse regurgitation). With timely medical assistance, it is possible to cope with it.
The third degree of ischemia is usually manifested by coma. The baby is unconscious, he has no swallowing and sucking reflexes, muscle tone. Many children cannot breathe on their own - without the use of a ventilator. If a baby can be saved in resuscitation, then brain lesions are most often large-scale and can manifest themselves both in disorders of certain functions (hearing or vision) and systemic lesions - paralysis, paresis, cerebral palsy, dementia.
Infant stroke - a cerebral hemorrhage in acute cerebral ischemia - mainly develops in premature babies. In babies who appeared on time, the probability of such a complication is only 10%, while in children weighing less than 2 kilograms, a stroke or microstroke (transient ischemic attack) develops in 35% of cases, and in deep premature babies weighing less than a kilogram, a stroke occurs in 95% cases.
The symptoms of ischemic stroke are also based on neurological manifestations and are similar in many ways to the symptoms described above.
Treatment
Unfortunately, medicine cannot give an accurate and definite answer to the question of how to treat cerebral ischemia in newborns. Pharmacology has not created medicines for oxygen starvation, and there are no effective methods for restoring dead central neurons.
With mild and moderate ischemia, all hope is for the compensatory capabilities of the child's body. In the third degree, by the way, too. Healthy neurons can take on the duties of dead “comrades”. With minor ischemic brain damage, this works great. The more severe the damage, the more difficult it is to compensate.
This does not mean that the child is not receiving treatment. The task of doctors after the detection of ischemia in a newborn is to quickly establish the extent of the lesion and begin in every possible way to promote natural compensatory mechanisms. For this, symptomatic treatment is prescribed. If the baby is agitated, he is given sedatives, if he has convulsions - anticonvulsants.
Common treatment regimens include drugs to improve blood flow to the brain. For this, vascular and nootropic drugs are recommended. The effectiveness of these groups of funds is currently in question, but they are approved by the Ministry of Health.
With the third degree of ischemia, the child is provided with a full range of resuscitation measures. This is artificial ventilation of the lungs, and tube feeding, and heating of the incubator. Medications are basically the same. The task at the stage of resuscitation is to stop the death of neurons, to prevent the death of adjacent areas of the cerebral cortex. After the child is transferred to the general department, he is shown a long course of treatment and rehabilitation, depending on the severity of the consequences of ischemia.
After being discharged home, a child with a history of ischemia is prescribed a massage. Outdoor walks, adherence to the daily routine, water procedures, swimming in the bathroom with a cervical orthopedic circle (from 1 month) are recommended.
If, on examination at 1 month during the passage of neurosonography, brain pathologies are detected, a new course of drug treatment is prescribed.
Forecasts
Possible negative consequences of severe ischemia include epilepsy, mental retardation, paralysis, and a decrease in the child's adaptive abilities and learning abilities. Mild forms of cerebral ischemia usually do not have serious long-term consequences.
Doctors generally do not like to predict anything when it comes to brain damage, since the consequences are actually unpredictable and can manifest themselves in five, ten, or twenty years.
After severe ischemia and a long stay of the child in intensive care, the consequences are inevitable. Quite often, they lead to disability.
Reviews
According to parents, in the case of severe third-degree ischemia, newborn girls usually show more "fighting qualities" than newborn boys, so they survive more often and the impact on their health is often not so significant.
Whatever the degree and cause of cerebral brain damage, mothers emphasize that much depends on whether parents can find a good neurologist who will plan treatment. According to reviews, in the case of mild ischemia and with timely treatment started, neurological symptoms disappear by six months. Some mothers claim that in a year the child after the 2nd degree of ischemia was already completely healthy.
The treatment is long. The first six months are usually the most difficult, and experienced mothers who have gone through this test warn that you need to be patient. A young mother will have to master both nursing and massage, and learn to understand medicines, and become a rehabilitation therapist for her baby. It will take strength. But the main thing is to love your baby and support him. Newborn babies feel great maternal support, even if they are in intensive care. You can't live without it.
For signs of a violation of the nervous system in a child, see the next video.
