With the diagnosis "hydrocephalus", the parents of the baby may face even in the maternity hospital. Often, pathology is also detected later, after discharge. The confusion and fright of the newly-made parents are quite understandable, because the pathology is considered quite serious. But hydroencephalopathy is not a sentence at all, and modern medicine has many ways to help a child. From this material, you will learn how to treat such a diagnosis and how to treat a baby.
About the disease
The child's brain is washed by cerebrospinal fluid, which is called cerebrospinal fluid. This fluid is incredibly important - it cleanses and washes the brain, delivering the white blood cells necessary for protection. The production of cerebrospinal fluid is continuous. In a healthy child, it does not stagnate - washing the brain, the cerebrospinal fluid again enters the spinal canal. If the outflow is disturbed, cerebral fluid begins to accumulate in the ventricles of the brain and under its membranes. This condition is called dropsy, or hydrocephalus of the brain.
An increase in fluid levels leads to an inevitable and obvious increase in pressure within the skull. Under pressure, some structures can partially or completely suffer, "wash out". Severe atrophic hydrocephalus can be quite damaging to the brain.
The sooner this condition is found in a baby, the better. The initial stages of the anomaly are quite easy to eliminate without significant consequences for the health of the baby in the future. Moderate hydrocephalus may well lead to disruption of the functioning of certain parts of the brain, which can manifest itself as impaired speech, psyche, neurological pathologies, problems with hearing and vision, coordination of movements and movements in general. If you do not help a child with dropsy of the brain, he may die.
This condition occurs on average in one newborn in four thousand.
Classification and causes of occurrence
In newborns, there are two types of dropsy - congenital and acquired. Congenital forms develop against the background of damaging factors even during the intrauterine stay of the baby. This may be an infection in the mother, diseases in the first trimester are especially dangerous. Certain malformations of the central nervous system can also cause the accumulation of cerebral fluid in the brain.
Acquired forms of the disease are most often found in premature babies, as well as in children who have received a birth injury. An infection that the baby contracted after birth, as well as the development of a tumor in one or another part of the brain, can cause a violation of the drainage abilities of the cerebrospinal fluid.
The classification of hydrocephalus implies a clear division of the types of ailment according to the place of accumulation of fluid. It can be external, internal or combined. The outer form implies stagnation of fluid in the outer shell, the body of the brain is not affected. Most often, the external form is recorded in children as a consequence of birth trauma.
With the internal form, the cerebrospinal fluid accumulates in the ventricles of the brain, and with the combined, mixed form - both under the membranes and in the body of the brain. This is the most severe form of pathology.
During the examination, they try to immediately identify not only in which area the accumulation of fluid occurs, but also in which place an obstacle to the outflow has arisen. On this basis, hydrocephalus can be open and closed. In the first case, no obstacles to the movement of the cerebrospinal fluid are found, but its amount raises significant questions. In the closed form, the cause of the violation of drainage usually lies in the anomalies in the structure of the ventricles or CSF ducts. The accumulation of cerebral fluid in this case, almost everything affects the internal parts of the brain.
If an anomaly is detected within two days after development, the word "acute" appears in the diagnosis. Subacute dropsy develops over several months, very slowly and almost imperceptibly. Chronic hydrocephalus is present in a child for more than six months and can "hide" for a long time, because the accumulation of cerebrospinal fluid occurs gradually. The closer to the chronic stage, the less favorable the projections for the future will be.
Compensated hydrocephalus is called, the signs of which are not determined externally - the baby looks healthy and behaves normally. With a worsening of the condition and the manifestation of external signs, they speak of a decompensated form of the disease.
Separately, the degree of anomaly is assessed - it can be moderate or severe. According to the rate of development, dropsy is divided into progressive, stable and regressive, in which the symptoms diminish and decline.
Dropsy of the brain in a newborn can develop on the basis of a Rh conflict with the mother, and on the basis of existing genetic diseases, and against the background of rapid childbirth. It often develops after birth due to infection with meningitis.
Symptoms and Signs
The main sign of hydrocephalus in a newborn is an increased head size. If a healthy toddler has a head circumference by 2 centimeters larger than the chest circumference, then by six months the situation changes and the proportions become reversed. In a child with dropsy, the head remains larger than the ribcage.
For hydrocephalus, a rather specific type of skull is characteristic - the frontal lobes protrude, the head looks somewhat unnatural. But in a newborn, such a symptom makes itself felt only with a severe form of an ailment of congenital origin. External changes in the skull with compensated dropsy develop gradually.
The norm for a newborn is a head circumference within 33-35 centimeters. But deviations from the basic dimensions still cannot speak of the presence of dropsy, because a large head can only be an inherited feature of a small person's appearance. The alarming symptom will not be the initial size of the head, but the rate of its growth. If the girth for the first month of life was not 0.5-1 cm, but 4 or more, the doctor may well suspect hydrocephalus in the toddler.
If by the end of the neonatal period the girth of the head grows rapidly, additional signs may appear, for example, blue veins of veins on the forehead and back of the baby's head. By the age of 28, the baby will not even try to hold his head, will not try to follow his mother with his eyes and smile.
The skin over the large "fontanelle" will be convex and pulsating. The baby may show poor appetite, restless sleep, constant crying, and very slow weight gain. By two months, nystagmus of the pupils of the eyes and protrusion of the frontal lobes may appear. By the same age, divergent squint may appear.
Severe dropsy, requiring urgent medical attention, is manifested by vomiting and monotonous crying.
Establishing diagnosis
The main way to check fears in newborns is to conduct neurosonography - an ultrasound of the brain through an unclosed fontanelle. If results are questionable, MRI or CT may be recommended. Neurosonography is now performed by order of the Ministry of Health for all babies at the age of 1 month without exception.
With hydrocephalus as a diagnosis, doctors often reinsure themselves, establishing an excess of fluid according to the results of a study of 30-40% of babies. In this case, the wording may be different, indicating the detection of dilated cerebral ventricles. Parents hear about increased pressure inside the skull from neurologists even more often. At the same time, most moms and dads have absolutely no reason to worry - the amount of cerebrospinal fluid in newborns can be increased for quite normal, physiological reasons. Therefore, it is important to monitor the baby's condition over time.
Neurosonography in itself cannot be a reason for the diagnosis of dropsy of the brain. If there are severe visual abnormalities, a computed tomography or MRI scan will be indicated. For newborns, such diagnostic methods are carried out in a state of deep drug sleep (anesthesia).
If the doctor recommends to undergo echoencephalography or electroencephalography, the baby's mom and dad may well refuse with a clear conscience. These methods are not considered informative in the case of hydrocephalus, but continue to be prescribed by old standards.
Predictions and consequences
If the diagnosis is confirmed, any sane parent has a quite reasonable question about the predictions - what will happen to the baby next? No doctor can give an answer to this question, since predicting hydrocephalus is considered a thankless task.
A mild open dropsy usually has no consequences, however, provided that it is discovered on time and properly treated. With closed dropsy of the occlusive type, the consequences for the health and development of the baby are almost inevitable.
Congenital forms of dropsy are treated faster than acquired ones. Severe deep forms of the disease often lead to debility, mental disorders, and developmental delays. Against the background of severe hydrocephalus, infantile cerebral palsy and epilepsy may develop.
The disease itself is considered curable in medicine. Its consequences may be incurable. If you take care of the child at home and follow the doctor's recommendations, the forecasts are more positive than the forecasts for a similar form and stage, but for a child who was abandoned in a maternity hospital and who ended up in a baby's house.
Treatment
Surgical intervention is considered the main official treatment. But quite often, with non-severe forms of dropsy, doctors prescribe conservative treatment. It is based on diuretics, which help to remove fluid from the body. In addition to medicines, some folk remedies may be recommended, for example, lingonberry leaf.
Most often, the treatment regimens contain such drugs as "Diacarb" and "Asparkam", "Mannitol" and potassium preparations. The kid is recommended gymnastics, massage, sometimes physiotherapy. If no positive changes occur within 3-4 months, a re-examination shows the absence of any significant effect, it is recommended to have an operation.
Bypass surgery is most often performed. As part of the intervention, craniotomy is performed and excess cerebrospinal fluid is removed through a silicone shunt inserted into the cerebral ventricle. The second end is brought out into the abdominal cavity, laying a tube under the baby's skin.
Bypass surgery is quite dangerous, complications occur in 50-60% of cases. The shunt has to be changed, the child has to go through a serious surgical procedure again. Alternative drainage operations do not solve the problem, as fluid can accumulate again and again after a single pumping out.
Endoscopic surgeries are very popular. In modern clinics and medical centers, they try to install a shunt for a baby in this way.
After the operation, the child is registered with a neurologist for life.
The opinion of Dr. Komarovsky
When the diagnosis is proven and justified, it is important for parents to control themselves, says the famous children's doctor Yevgeny Komarovsky. A reasonable and calm attitude towards the prescribed therapy is the key to success. In practice, things may not be at all as we would like. Anxious and desperate parents often start looking for osteopaths who guarantee that they can put the bones of the baby's neck and skull back in place without surgery, so that the outflow of fluid is normalized.
Evgeny Komarovsky emphasizes that appeals to such specialists can end in a rather pitiable manner for the child and his mother and father. There is no official benefit from osteopaths, according to the doctor. And there are no doctors of this specialization. And there are consequences, and they are very sad.
For hydrocephalic syndrome in children under one year old, its signs, diagnosis and prognosis, see the next video.
