Residual ischemic phenomena in the VBB of an infant. Cerebral ischemia symptoms and treatment in a child

The brain is main body in organism. The functioning of all organ systems, general condition and quality of life depend on its functioning. With the development of certain pathologies, the brain begins to suffer due to lack of oxygen, and this can lead to serious consequences. One of these diseases is grade 2 cerebral ischemia in newborns; the consequences can be disastrous if urgent measures are not taken and therapy is not started. Let's look at what it is this pathology and is it possible to get rid of it?

Concept of cerebral ischemia

Not everyone understands the name of the disease as stage 2 in newborns." What a doctor can explain and choose treatment tactics. This pathology is a condition in which the blood supply to the brain is disrupted. In newly born infants, this pathology is an independent disease , is not often diagnosed.

Most often, newborns are diagnosed with ischemic encephalopathy, in which brain cells are damaged due to poor blood supply, that is, lack of oxygen.

If a diagnosis of grade 2 cerebral ischemia in newborns is made, how to treat this pathology is determined by the attending physician, depending on the condition of the body and concomitant diseases.

Reasons for the development of ischemia

This pathology in newborns can develop for several reasons:

1. If during gestation the placental blood flow was disrupted.
2. After birth, respiratory distress was observed.
3. Respiratory distress syndrome.
4. Congenital pneumonia.
5. Frequent episodes of respiratory arrest.
6. Aspiration.
7. Congenital malformations.

Whatever the degree of ischemia in a newborn, the consequences can be serious if therapy is not started in a timely manner.

Development of pathology in a child

Oxygen is carried throughout the body along with blood. It is vital for the normal functioning of all organs. If there is a deficiency, a redistribution of blood flow occurs and the heart and brain receive oxygen-rich blood first. It turns out that other organ systems begin to suffer from its deficiency.

If the pathology is not identified in a timely manner and the causes that provoked it are not eliminated, then the lack of oxygen will gradually begin to negatively affect the condition of the nerve cells - they begin to die. This is how grade 2 cerebral ischemia develops in newborns, the consequences depend on the severity of the condition and the quick response of doctors. The prognosis for the baby will also depend on the number of dead cells. If this happens, the chances of recovery and survival are significantly reduced.

Provoking factors

Concomitant factors that can lead to the development of ischemia can be grouped into three groups:

1. Leakage labor activity. The risk of pathology increases if:

• bleeding occurred during pregnancy or during labor;
• emergency C-section;
• high temperature in a woman in labor;
• premature birth;
• low baby weight;
• turbidity of amniotic fluid;
• premature placental abruption;
• rapid labor activity.

2. The mother's condition can cause the development of ischemia in the child, especially when:

3. The course of pregnancy is also very important: if preeclampsia or eclampsia was observed, then there is every chance of developing a pathology such as grade 2 cerebral ischemia in the newborn. The consequences may vary.

These factors are not a 100% guarantee of the development of pathology. Even intrauterine disorders do not always end with cerebral ischemia developing after birth; the consequences can be eliminated if the pathology is detected in time and all measures are taken.

How does the disease manifest itself?

This pathology has varying degrees of manifestation. Stage 2 cerebral ischemia in newborns has serious symptoms, and immediate treatment is required. Here's what should alert doctors and mommy:

• Decreased muscle tone.
• Large pauses in breathing.
• Tendon reflexes are poor.
• Sluggish Moro reflexes.

The following syndromes are also noted:

When lack of oxygen threatens the baby's life

If this pathology has grade 1, then it is considered a mild lesion, and doctors assess the condition of the newborn at 6-7 points. This degree of excitement is manifested nervous system, if the child was born on time, and oppression in premature infants. This condition can be observed for 5-7 days.

Cerebral ischemia of the 2nd degree in newborns has more serious consequences; clinical convulsions, respiratory arrest, and floating movements of the arms may appear. If you carry out laboratory research, then lesions of the brain parenchyma and impaired blood flow speed are detected.

If there are long periods of impaired motor activity, poor appetite, violation of the swallowing process, then an urgent consultation with a neurologist is necessary.

A severe degree can result in coma, which is life-threatening for the baby. Increasing symptoms increase the risk of developing hydrocephalus.

How is the disease diagnosed?

Almost always, the manifestation of cerebral ischemia begins immediately after childbirth. If the disease has mild degree, then the symptoms may go away on their own, but a severe form may slightly weaken its symptoms, but only for a while, and then flare up again with renewed vigor. Therefore, if ischemia is suspected, various diagnostic procedures, these include:

If a diagnosis of grade 2 cerebral ischemia in newborns is suspected, treatment will be prescribed after all studies.

Main goals of ischemia therapy

If the diagnosis is confirmed after all studies, then measures begin to maintain normal temperature, humidity, protection from external irritants.

Therapy in newborns should be as less aggressive as possible. It pursues the following goals:

Where is cerebral ischemia treated?

We have already found out that this disease has several degrees, which differ in severity. Therapy will depend entirely on the symptoms.

Treatment methods for ischemia

This pathology is characterized by the fact that there is no conservative treatment, since dead brain cells cannot be replaced with viable ones. But timely prescribed maintenance therapy allows you to stop the progression of the disease and makes it possible to rehabilitate.

If the pathology is severe, it is visible immediately after birth. In such cases, do the following:

1. Artificial ventilation is performed to help restore spontaneous breathing. After this, the baby’s condition is constantly monitored.
2. Cardiac supportive care is needed to prevent damage heart rate Dopamine and Dobutamine are prescribed.
3. Phenobarbital and Phenytoin will help prevent seizures.
4. One of the new methods is hypothermia. It is believed to reduce the rate of brain cell death. But it must be carried out only under the supervision of a doctor. If the temperature is lowered by several degrees, the child is gradually warmed up.

If the disease is mild, then it is enough to take medications that will improve blood circulation in the brain and prevent further damage to neurons.

If there is a threat of developing hydrocephalus, Furosemide and Manitol are prescribed.

Stages 2 and 3 of the disease threaten more serious consequences, so it is important to take all measures and prescribe therapy that will prevent the development of complications of ischemia. They can appear as in mild degree, for example, attention deficit, and more serious ones, including dementia and disability.

Komarovsky's opinion on the disease

If there is grade 2 cerebral ischemia in newborns, Komarovsky believes that drug therapy gives a result, but not what everyone expects. She is very important in acute period when the impact of the damaging factor on the brain is observed, but, as a rule, the pathology is detected much later, when the so-called recovery period. At this time, massage and physiotherapeutic procedures will be more effective, which will help the brain recovery process. Dr. Komarovsky believes that all neurological manifestations in newborns are associated with brain immaturity, which will gradually disappear if there are no serious chronic pathologies.

Consequences of cerebral ischemia

Currently, medicine is at a level of development that makes it possible to avoid the serious consequences of cerebral ischemia, but provided that the diagnosis was identified in a timely manner. Many children who have suffered from this disease experience rapid fatigue, hyperactivity, and problems with remembering, which can affect their performance at school. Even when there are consequences (if a diagnosis of grade 2 cerebral ischemia in newborns is made), reviews from mothers confirm that they can be dealt with if you consult a doctor and take the necessary medications.

With their help, you can significantly influence the child’s excessive activity, improve his memory and attention, and accordingly, his performance at school will also improve. It is very important to find a competent specialist who will help cope with the accompanying symptoms.

The most severe consequences of cerebral ischemia are cerebral palsy and epilepsy. But this most often happens in the most severe cases and when the diagnosis is not made in a timely manner.

What parents can do for their child

Even the 2nd degree of pathology is not a death sentence. After completing the course drug therapy the recovery period begins. At this time, parents play a big role; it often depends on them how severe the consequences of the pathology will be. In order for the baby’s development to return to normal, parents must:

Any neurological problems can be solved, because the child’s nervous system is not yet fully formed, it is quite flexible and capable of recovery, so one should not give up. Even with a diagnosis of grade 2 cerebral ischemia in newborns, the consequences may not be so dire. The care and love of parents, and, of course, the help of doctors, will certainly work a miracle, and the child will not lag behind his peers.

Diseases of the nervous system in children in half of the cases cause disability and, as a consequence, disruption of normal interaction with others. About 70% of cases of pathology are associated with ischemic brain damage received during the perinatal period. They are caused by oxygen starvation and impaired metabolic processes. Treatment of this disease is carried out with medication and physiotherapeutic methods.

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Description of the disease

Cerebral ischemia in newborns is neurological disease, associated with impaired blood circulation in the brain tissues and their insufficient oxygen supply (hypoxia). Typically, in the fetus, the ischemic process rarely occurs in isolation; a complex syndrome of hypoxic-ischemic encephalopathy (HIE) often develops.

The prevalence of this disease in Russia among full-term newborns ranges from 8 to 38 cases per 1000 children. Among premature babies, this figure is higher - up to 88 patients per 1000 newborns. The share of HIE with damage to the central nervous system during the perinatal period (from the 22nd week of pregnancy to the 7th day after birth) is half of the total number of central nervous system pathologies in children during this period of life. However, as noted by the famous popularizer of pediatrics Komarovsky, the diagnosis of perinatal hypoxic-ischemic encephalopathy in many medical institutions In Russia it is diagnosed unreasonably often - up to 70% of newborns. Thus, in the USA this figure does not exceed 3%.

Insufficient oxygen supply to the brain leads to a slowdown in the growth of small blood vessels of this organ and increases the permeability of their walls. As a result, the acid-base state of the blood is disrupted, amino acids accumulate, and tissue ischemia develops with disruption of intracellular metabolic processes.

The deterioration of blood microcirculation in the brain and metabolism is caused by 2 main complications: ischemic tissue necrosis and damage to the white matter of the brain, which in severe cases can lead to cerebral palsy. These processes are enhanced by some medical manipulations, which are forced to be carried out for premature newborns in the first hours of their life.

In the development of HIE, the causes and consequences often change places - disruption of macro- and microcirculation of blood in the brain leads to various disorders metabolic processes, which, in turn, aggravate the deterioration of blood circulation and nutrition of nerve cells, can cause cerebral edema. The death of nerve cells can occur either in the rapid form of neuronal necrosis or in a delayed manner, making it possible to stop this mechanism with the help of therapeutic agents.

There are several degrees of severity of HIE: mild, moderate and severe, each of which is characterized by its own symptom complex.

In recent years, the role of various factors in the development of cerebral ischemia has been identified in perinatal neurology:

• free radicals and oxidative damage to brain cell membranes;
• increased concentration of calcium ions, increasing the need of tissues for oxygen;
• energy “hunger” of intracellular elements observed during cerebral ischemia.

Based on these studies, appropriate therapeutic drugs– antioxidant and neuroprotective agents, peptide and nootropic drugs, drugs to eliminate energy deficiency in brain cells.

Causes

The main reasons for the development of cerebral ischemia are:

• asphyxia at birth (oxygen starvation of the brain when the upper respiratory tract is blocked) - up to 95% of cases;
• congenital heart diseases;
• open ductus arteriosus in premature babies;
• trauma to the cervical or thoracic spine of a child during childbirth;
• placental insufficiency;
• neonatal sepsis;
• hereditary predisposition to central nervous system diseases.

Asphyxia may be caused by meconium entering the Airways or respiratory failure fetus as a result of prematurity, umbilical cord entanglement, prolonged difficult labor.

There are the following risk factors for the occurrence of this pathology associated with the condition of the mother and child:

• deviations in normal development placenta;
• diseases thyroid gland at the mother's;
• toxicosis in late pregnancy;
• viral diseases in the mother;
• moderate to severe bleeding during pregnancy;
• rapid labor;
• breech presentation of the fetus;
• use of obstetric forceps during childbirth;
• emergency caesarean section, application general anesthesia for mother;
• prematurity (birth date before the 37th week) or post-term pregnancy beyond 42 weeks;
• low birth weight of the baby;
• late health care newborn.



Symptoms

With cerebral ischemia in infants, the following neurological syndromes and changes are detected:

• violation muscle tone;
• autonomic dysfunction syndrome;
• neuro-reflex excitability;
• torticollis associated with unilateral muscle tension;
• hyperexcitability syndrome;
• facial paralysis;
• vertebrobasilar insufficiency syndrome;
• cerebral edema;
• convulsive syndrome;
• left-sided Duchenne-Herbe paresis (weakening of the brachial plexus muscles).

Depending on the severity of HIE, sick babies most often exhibit the following symptoms:

• 1st degree. Increased nervous excitability, child's anxiety, sensitivity to external stimuli, trembling of hands, legs, chin, tachycardia, dilated pupils. In premature babies, depression of the central nervous system is observed, which lasts 5-7 days. Further psychophysical development of the child in the next 3 years can proceed without deviations from the norm.
• 2nd degree. Drowsiness, decreased tone in the limbs, the child is in the fetal position, suppressed reflexes, slow heart rate, constriction of the pupils, excessive salivation, short-term convulsions, hypertension (bulging, pulsating fontanelle on the child’s head). Electroencephalography reveals seizure activity. Changes in brain tissue are reversible, but their duration can reach 3 weeks. In children under 3 years of age, minimal disturbances manifest themselves in hyperactivity, increased tearfulness, sleep disorders. The appearance of seizures predicts a poor prognosis in the development of the disease.
• 3rd degree (severe). Complete immobility, very weak reaction to external stimuli, including painful ones, coma with a short onset of wakefulness, lack of reflexes, repeated convulsions, muscle resistance when trying to make a passive movement. Two postures are also characteristic: arms bent and pressed to the chest, or straightened limbs and the head thrown back with clenched jaws. Loss of activity occurs more than 10 days after birth. Progressive intracranial hypertension. Children in the first 3 years of development experience developmental delays, in some cases cerebral palsy. Severe condition during the perinatal period and damage to vital organs can lead to death.



Diagnostics

The diagnosis of cerebral ischemia in newborns is established based on the following studies:

• General blood test (anaemia, changes in the leukocyte formula are detected).
• General urine analysis (protein, leukocytes, bacteria).
• Neurosonography (ultrasound of the head through open fontanelles), which reveals asymmetry of brain structures, enlarged cerebrospinal fluid spaces, formations that are lighter than the surrounding tissues. This method is the “gold standard” for diagnosis of this disease in newborns.
• Ultrasound of the blood vessels of the brain using Doppler. This may reveal a change in the speed of blood flow through the anterior cerebral artery.
• Electroencephalography (paroxysmal changes are determined bioelectrical activity, disorganization of cortical rhythms).
• MRI of the brain. It is carried out in exceptional cases, since young children require general anesthesia. This method is used when severe brain malformations are suspected.
• Computed tomography of the brain, if hemorrhage is suspected or if there is a skull injury.
• Fundus examination, which helps identify intracranial hypertension.
• Genetic research.

Treatment

In the acute period after birth with ischemic brain damage, treatment of children is aimed at maintaining vital body functions:

• artificial ventilation lungs;
• administration of glucose-electrolyte solutions to maintain water-salt balance and replenish energy in tissues;
• anticonvulsants (Phenobarbital, Difenin, Midazolam and others).

Subsequently, the following groups of drugs are used:

• Medicines for improvement vascular circulation and metabolism in cells (Vinpocetine, Nicergoline, Cinnarizine), the duration of treatment is 1 month.
• Diuretics to reduce intracranial and intraocular pressure(Acetazolamide, Glycerol, Diacarb).
• Metabolic therapy, restoration of electrolyte balance with potassium and magnesium aspartate preparations (Asparkam, Panangin).
• Nootropic agents for improving higher brain functions and increasing resilience when exposed to stress factors:
  • Polypeptides of the cerebral cortex of cattle (Cortexin, Cerebrolysin).
  • Choline acel phosphate (Gliatilin, Noocholin).
  • Hopanthenic acid (Pantogam, Pantocalcin).
  • Nootropic drug Semax, which has a complex effect on the brain - psychostimulating, neuroprotective, antioxidant and antihypoxic.
  • A synthetic analogue of aspartic acid is acetylaminosuccinic acid.
  • Magne B6 in syrup.



Rehabilitation non-drug therapy consists of the following procedures:

• relaxing and tonic massage (the number of courses depends on the degree of damage to the central nervous system);
• therapeutic exercises (for infants - in combination with massage);
• kinesitherapy;
• hydrotherapy;
• electrophoresis, paraffin therapy, magnetic therapy and other physical procedures as indicated.

The duration of rehabilitation depends on the severity of brain damage and lasts on average up to 2, 3 and 18 years, respectively, according to the degrees of HIE.

According to pediatrician Komarovsky, after the child’s brain is exposed to a damaging factor, which results in the development of cerebral ischemia, the acute phase of encephalopathy begins. Its duration is 3-4 weeks. It is at this point that therapy with medicines is the most effective. In more late period Only physiotherapy and massage should be used to treat a child.

Consequences

Possible consequences of cerebral ischemia depend on several factors:

• The degree of damage to brain structures. Ischemia of 1st and 2nd degrees is easily corrected in the initial stages of a child’s life.
• Start date for rehabilitation. The earlier treatment was started, the less pronounced the central nervous system disorders will be. Phenomena such as hyperactivity, attention deficit disorder, and developmental delay can be noticed in a child more late age– from 3 years and older. The most effective period for treating encephalopathy caused by ischemic disorders in the brain is when the child is under 1 year of age. Therefore, it is important to identify the disease in time and adhere to the doctor’s recommendations.
• Systematic rehabilitation procedures, conducting the necessary repeated courses.

The consequences of grade 1-2 ischemic brain damage in newborns include the following pathologies:

• benign hypertension syndrome (increased intracranial pressure);
• disorders of the autonomic nervous system (impaired functioning of the heart and other organs, changes in blood pressure);
• hyperexcitability, hyperactive behavior and attention deficit disorder;
• motor development disorders;
• convulsions, loss of consciousness for a short time;
• a combination of several of the above phenomena.

At an older age, the consequences of ischemic brain damage manifest themselves in psychoneurological disorders, mental retardation and physical development child, deterioration of motor functions, behavioral disorders. Schoolchildren have problems with learning and relationships with peers (10-25% of children who have suffered from this disease).

The worst prognosis is for grade 3 ischemia, which leads to severe disability, cerebral palsy, organic brain damage, hydrocephalus, epilepsy and death of the child.

) a newborn child should be observed by a neurologist. The consequences of cerebral ischemia can be very different - from minimal developmental deviations to quite severe.

The prognosis largely depends on the severity of hypoxia suffered and the severity of encephalopathy.

So, at I degree hypoxic-ischemic encephalopathy, the prognosis is favorable; at II degree- doubtful (i.e. much depends on the presence or absence concomitant pathology and on the characteristics of the child’s body); at III degree - forecast for full recovery, as a rule, unfavorable.

The Russian Association of Perinatal Medicine Specialists has developed a classification of the consequences of perinatal lesions of the nervous system in children in the first year of life.

According to this classification, the following types of consequences of cerebral ischemia are distinguished:

• Consequences of cerebral ischemia-hypoxia degrees I-II (perinatal transient hypoxic-ischemic encephalopathy).

Basic clinical forms consequences of cerebral ischemia degrees I-II:

1. Benign intracranial hypertension;
2. Disorder of the autonomic nervous system;
3. Hyperactive behavior, hyperexcitability;
4. Impaired/delayed motor development;
5. Combined forms of delay, mental retardation not specified;
6. Symptomatic convulsions and situationally caused paroxysmal disorders.
7. It should be noted that with perinatal transitronic hypoxic-ischemic encephalopathy, complete compensation of neurological abnormalities occurs in the first year of life. In some cases, non-severe functional impairments may persist.

• Consequences of cerebral ischemia-hypoxia of II-III degree (perinatal persistent (organic) post-hypoxic damage to the central nervous system).

The main clinical forms of the consequences of cerebral ischemia of II-III degree:

1. Various forms of hydrocephalus;
2. Organic forms of mental development disorders;
3. Cerebral palsy (CP);
4. Symptomatic epilepsy and epileptic syndromes of early childhood.
5. Perinatal persistent posthypoxic damage to the central nervous system is characterized by the fact that neurological abnormalities are not compensated by 1 year. In this case, total or partial neurological deficit remains. This is the main difference between transient (passing) damage to the central nervous system and persistent (organic) damage.

Consequences of cerebral ischemia-hypoxia grade 1-2

Benign intracranial hypertension

Clinical manifestations: the course of this symptom complex is subacute (symptoms increase gradually). There is an increase in the child's head circumference in the first half of the year, which is somewhat different from the norm. In full-term infants, the increase is noted to be more than 1 cm (but not more than 3 cm), in premature infants it is more than 2 cm (but not more than 4 cm). There is also a divergence of cranial sutures, tension and bulging of the large fontanelle, regurgitation not associated with food intake, increased excitability and irritability in the child, difficulty falling asleep, shallow sleep, revitalization of tendon reflexes.

Survey for benign intracranial hypertension

Against the background of the treatment, for this pathology, compensation neurological disorders occurs at 3-6 months of age.

Autonomic nervous system disorder

Clinical manifestations

Instability (lability) of heart rate and blood pressure (without connection with physical activity). There is also a change in the color of the skin - “marbling”, the “Harlequin” symptom (one half of the body is red, the other white), pronounced red and white dermographism, cyanosis of the nasolabial triangle, “blue” around the eyes. There may be gastrointestinal dyskinesia - regurgitation, vomiting, unstable stool (either diarrhea or constipation), flatulence. Many experience postnatal malnutrition.

At the same time, it should be noted that this symptom complex has diagnostic value only if somatic diseases are excluded in the child.

Survey

• With this form, monitoring of ECG, blood pressure, and body temperature is mandatory. Cardiointervalography and remote thermography are performed.
• On the EEG, changes are nonspecific; regulatory disturbances in the sleep-wake cycle may be noted. varying degrees expressiveness.
• On the NSG, structural changes are not detected.
• Examination methods such as MRI and CT scan of the brain are carried out only when indicated.

Compensation of neurological disorders, as a rule, occurs by 3-6 months of life, against the background of ongoing therapy.

Hyperactive behavior, hyperexcitability

Clinical manifestations

This pathology is characterized by: excessive motor activity, muscle dystonia, emotional lability. Children have an unstable concentration of attention and concentration, and their rapid exhaustion. Children have difficulty falling asleep, their sleep is superficial, and they wake up frequently. Tremors and increased reflexes are often observed.

This diagnosis is made only if other causes of the child’s anxiety are excluded (diathesis, colic, rickets, metabolic disorders, etc.).

Examination for hyperexcitability and hyperactivity syndrome

On the EEG there may be no deviations from the age norm. In a state of quiet wakefulness, there may be a slowdown and disorganization of the basic cortical rhythm, signs of delayed maturation of the BEA, as well as regulatory disturbances on the part of subcortical systems of varying degrees of severity.

On NSG, structural changes, as a rule, are not detected.

Compensation of neurological disorders is also observed at the age of 3-6 months (against the background of conservative therapy).

Motor development disorder

Clinical manifestations

A slight delay in the reduction (extinction) of unconditioned motor automatisms. Slightly delayed formation of age-related physiological motor reactions in a child - attitudinal reactions, visual-motor interaction, manual activity (working with hands), straightening reactions (preparation for standing, walking), balance functions, walking. As a result, children begin to hold their heads up, sit, crawl, stand, and walk later. Muscle tone disturbances such as hypotonia, hypertonicity, or dystonia may occur. These violations are transitory in nature and, against the background of corrective measures, are compensated by 1-1.5 years.

Additional examination methods

According to indications (to exclude structural damage to the brain), NSG, CT, and MRI are performed.

ENMG - to assess the state of neuromuscular conduction.

Combined forms of developmental delay

Symptoms- signs of decreased emotional reactions, weak expression does not react emotionally to the mother or other loved ones), low cognitive activity in the baby. There is a delay in the rate of formation of communicative reactions, speech skills, and voluntary motor acts. At the same time, muscle tone disorders are rare.

This symptom complex has diagnostic value in cases where other causes are excluded (rickets, metabolic disorders and etc.)

Symptomatic convulsions and situationally caused paroxysmal disorders

Clinical signs: convulsions, paroxysmal disorders that first appeared after the neonatal period. The cause of the attack may be: increased body temperature, excessive excitement, pain, toxicosis, exicosis, infectious process and others. Seizures can manifest themselves in the form of various convulsions (clonic, tonic, tonic-clonic), as well as in the form of atonic paroxysms.

Symptomatic seizures are characterized by: are transient in nature, quickly stop on their own or when prescribed symptomatic treatment, there is no stereotypical occurrence and progression of seizures (this is typical for epilepsy).

Survey

• EEG - to assess the state of bioelectrical activity of the brain.
• NSG - as a rule, structural changes the brain is not detected.
• MRI and CT are performed according to indications.

It is characteristic of transient hypoxic-ischemic encephalopathy that convulsive attacks (during monotherapy with minimal doses of anticonvulsants) are absent for three months or more and do not recur during the first year of the child’s life.

The prognosis for HIE is significantly influenced by the course of the neonatal period (newborn period), the presence of concomitant pathology and timely treatment.

Also, we should not forget that the brain of young children has enormous plastic and reparative (restorative) capabilities and when carrying out all methods rehabilitation treatment you can achieve very good results.

Unfortunately, the diagnosis of “cerebral ischemia in newborns” is often made today. This disease is a condition in which brain cells do not receive the required amount of oxygen. As a rule, such a diagnosis is first made to children in the maternity hospital after a special test has been carried out. It implies a score general condition child's Apgar score. This examination is performed on a newborn immediately after birth. However, the final diagnosis with determination of the degree of ischemia can only be established after a series of instrumental studies.

This disease has several other names: perinatal hypoxic-ischemic brain damage and hypoxic-ischemic encephalopathy (HIE).

There are 3 degrees of cerebral ischemia. Each of these degrees has its own characteristics clinical manifestations. In the first degree they manifest themselves weakly, in the second and third they have a pronounced character. Cerebral ischemia of the 1st degree in a newborn occurs in mild form and does not require hospitalization. With the second and third HIE, the baby requires hospital treatment. And the sooner it begins, the fewer health complications the child will experience in the future.

Reasons for the development of HIE

Ischemia in a newborn is not an independent disease, but a consequence oxygen starvation brain (hypoxia). During its development, metabolic processes in brain cells are disrupted, and the brain is subject to various disorders. Such disorders cause the death of neurons, the development of necrosis and other conditions that negatively affect the functionality of the brain. And the higher the degree of oxygen deficiency, the more severe the child’s condition.

A The reasons for the development of hypoxia may be various factors . The most important and frequently encountered of them are:

1. Intrauterine fetal hypoxia. One of the most common reasons. It occurs against the background of a disturbance in the flow of blood from the mother to the placenta, or vice versa.
2. Asphyxia of a child. There are intranatal and postnatal. In the first case, asphyxia occurs during the period when the child passes through birth canal, in the second - in the first minutes after birth.
3. Respiratory distress syndrome. A serious condition in which non-cardiogenic (not related to the functionality of the heart) pulmonary edema and disruption of external respiration occurs.
4. Apnea attacks. The peak occurs during sleep and is accompanied by cessation of breathing.
5. Congenital heart defect. If it is present, the blood flow to the brain is disrupted, which provokes the appearance of hypoxia. The most common occurrence in young children is PDA (patent ductus arteriosus).
6. Disturbance of the hemodynamic system. In newborns this state causes a sharp drop in blood pressure, resulting in a decrease in the speed of cerebral blood flow.

It should also be noted that the development of hypoxia in a child can also occur for other reasons related to the condition of the mother during pregnancy. For example:

• respiratory viral diseases;
• decreased level of hemoglobin in the blood (iron deficiency anemia);
• elevated blood glucose levels (diabetes mellitus);
• malnutrition (lack of the required amount of micro- and macroelements in the diet);
• bad habits (smoking, alcohol abuse, drug use, etc.);
• age (after 35 years, women are more likely to give birth to children with HIE, and than older age, the higher the risk of developing this disease).

There is also so-called periventricular ischemia in newborns. What it is? This condition is also characterized by oxygen starvation of the brain, but the reason for this is most often premature birth. The peculiarities of this lesion are that it involves areas of the brain located around its ventricles.

How does it manifest?

Clinical manifestations of central ischemia can be noticed already from the first days of a child’s life. The degree of their severity depends on the stage of the disease. Most often, children with this diagnosis experience the following changes in their condition:

1. decreased muscle tone;
2. excitability of the nervous system, which manifests itself as shudders during sleep, trembling of the jaw and limbs;
3. weakening of sucking reflexes;
4. lethargy, decreased activity;
5. lethargy of the child;
6. asymmetry of facial muscle movements;
7. convulsions;
8. increase in head volume.

1st degree

Cerebral ischemia in a newborn of the first degree manifests itself with mild symptoms. At this stage of development of the disease, the child may experience headaches and a feeling of heaviness in the head. At the same time, the baby becomes lethargic, eats and sleeps poorly.

During sleep, you may notice frequent shuddering, and after strong crying, trembling lower jaw and limbs that do not disappear long after the baby has calmed down. The last sign is very important, because When crying and normally, many children's chin may tremble.

Cerebral ischemia in a child of the first degree is relatively easy to treat. As a rule, therapy is carried out on an outpatient basis.

2nd degree

Cerebral ischemia of the 2nd degree in newborns is characterized by local lesions in children's brain and requires hospitalization of the child. Symptoms at this stage of the disease become more pronounced.

The child experiences frequent dizziness, instability and spontaneity of movements. There is a decrease in motor activity, involuntary muscle contractions and cramps. Tremors during sleep become more frequent, and the duration of trembling of the jaw and limbs increases.

In addition, the baby exhibits symptoms of intracranial hypertension and autonomic-visceral disorders. That is, the skin becomes pale and becomes “marbled.” At the same time, the functioning of organs is disrupted gastrointestinal tract– violation of defecation, flatulence, etc.

3rd degree

Cerebral ischemia of the 3rd degree in children develops against the background of perinatal asphyxia or prolonged intrauterine oxygen starvation. As it develops, the newborn experiences a rapid decrease in cerebral activity. There are cases when babies even fall into a coma. Next, there is a short-term increase in activity, then again its sharp inhibition.

With grade 3 cerebral ischemia, newborns experience repeated seizures. Brain stem cells almost completely stop functioning, which leads to disruption of the breathing process and oculomotor disorders.

Symptoms of autonomic-visceral disorders and increased intracranial pressure also occur. In cases where extensive brain damage occurs, the child changes in appearance. His body lengthens due to the maximally reduced muscle tone, internal rotation syndrome is observed on the limbs, and frequent rolling of the eyes and dilation of the pupils occur.

In severe forms of cerebral ischemia, comatose syndrome may occur. It is characterized by symptoms such as infrequent blinking, “floating” eyeballs", muscle atony and disorders of the urinary system.

Possible consequences

The consequences of cerebral ischemia can be very different. And most often they are severe. It is for this reason that treatment should begin immediately after the diagnosis is made.

The most common consequences of cerebral ischemia are the following states:

• frequent headaches;
• sleep disturbance;
• increased irritability;
• mental retardation;
• epilepsy.

Childhood ischemia of the first degree is easily treated and almost never leaves any consequences.

However, parents should understand that the longer they delay treatment, the more difficult it will be, and the risk of health complications increases.

Diagnostics

Used to make a diagnosis following methods diagnostics:

• OAM ( general analysis urine);
• CBC (general stool analysis);
• blood chemistry;
• MRI (magnetic resonance imaging);
• CT (computed tomography);
• NSG (neurosonography);
• DEG (Doppler encephalogram).

Based on the data obtained and an external examination of the child, the doctor can detect not only the presence of cerebral ischemia, but also determine the degree of brain damage. Thanks to this, he can decide further tactics treatment that will quickly put the child on his feet.

Medical therapy

primary goal therapeutic therapy for cerebral ischemia – normalization cerebral circulation and eliminating the consequences that have arisen due to oxygen starvation of the brain. Ischemia in children is treated individually. In this case, the gestational age, the degree of damage to the child’s brain, the presence of other health problems in the baby, etc. are taken into account.

Treatment of the first stage of cerebral ischemia does not require the use of any medications. At this stage, only therapeutic massage. During its implementation, muscle tone increases and blood circulation throughout the body improves, which has a beneficial effect on the overall well-being of the newborn. After the massage, the child’s sleep normalizes and his motor activity increases.

It is not recommended to massage yourself. In this case, you need to contact a specialist who knows all the intricacies. Massage should be carried out in courses. Their duration is selected individually, but most often it does not exceed 10 sessions. In total, you should undergo 3-4 massage courses per year. The interval between them should not exceed 3 months.

Even if first-degree cerebral ischemia in a child has been cured, the baby still needs constant monitoring by doctors.

Unfortunately, the formation and development are not always internal organs and the child’s systems are proceeding normally. Despite the fact that medicine does not stand still and today there are modern and improved methods of supporting children with various disabilities, the mortality and disability rate of children remains quite high. A fairly common problem is cerebral ischemia and asphyxia.

What is cerebral ischemia?

Cerebral ischemia (hypoxic-ischemic encephalopathy) is a brain pathology that occurs due to oxygen starvation (more details in the article:). There is a blockage or reduction in the lumen of one or more blood vessels, so that not enough oxygen enters the brain tissue through the bloodstream. This, in turn, leads to problems in the formation of the brain itself and the central nervous system.

Such a deviation from the norm is one of the most dangerous diseases in newborns. Without proper oxygen supply, cells cannot regenerate and tissues die. Without proper treatment, this is fraught with serious consequences leading to disability and even the death of the child.

What are the causes of illness in a newborn?

Cerebral ischemia in a newborn can be provoked during pregnancy or childbirth.

The most likely factors leading to ischemic changes brain and central nervous system include:

• placental abruption or impaired blood flow in it;
• entanglement with the umbilical cord, which may result in suffocation of the fetus;
• difficult labor that took too long or was performed by caesarean section;
• birth injuries;
• Congenital heart defect;
• patent ductus arteriosus;
• pathologies with blood circulation, including thrombosis and problematic blood clotting;
• intrauterine hypoxia;
• an infection that entered the newborn's body during childbirth;
• infectious diseases suffered by the pregnant woman;
• pathologies of respiratory, cardiovascular, genitourinary systems V chronic form in a pregnant woman;
• bad habits expectant mother;
• acute placental insufficiency.

There are many reasons for the development of cerebral ischemia - it is not possible to predict its development, but it can be diagnosed and treated in time!

Symptoms and degrees of the disease

In medicine, there are three degrees of severity of hypoxia in anoxic brain damage. Each has its own characteristics. The more severe the disease, the more severe the symptoms and the sooner they appear after childbirth. The table below shows the symptoms and features of all three degrees of ischemia:

Degree of ischemia	Characteristic symptoms	Features of the course of the disease
1	overexcitation or depression; little muscle tone; strengthening tendon reflexes.	the signs are poorly expressed and become noticeable in the first 3-5 days after the birth of the child; symptoms disappear on their own without consequences; The baby needs constant supervision from specialists.
2	breathing stops in sleep; grasping and sucking reflexes are weakly expressed; weak muscle tone; enlarged head shape due to fluid accumulation; impaired coordination of movements; the child loses consciousness; changed skin color.	symptoms appear on the first day of the baby’s life and last from 2 to 4 weeks; the baby needs medical supervision and a special therapeutic course; if necessary, the clot is removed surgically.
3	complete absence of reflexes; coma; heart rhythm disturbance; a sharp increase in blood pressure; independent breathing becomes problematic; strabismus.	experienced specialists diagnose hypertension as early as 5 minutes of a child’s life; the baby requires intensive care and possibly artificial ventilation.

How is pathology diagnosed?

The first signs of cerebral hypoxia appear immediately after the birth of the child. However, they can pass quickly enough, and the newborn will experience false improvement.

to install accurate diagnosis cerebral ischemia, a number of examinations should be carried out:

1. Examination of a newborn (we recommend reading:). The baby is weighed and his height is measured, assessed on the Apgar scale, checking all the necessary reflexes - sucking, grasping, swallowing (we recommend reading:).
2. Taking tests. These include: a general clinical blood test, the level of electrolytes in it, the degree of coagulation and quantitative indicators of oxygen and carbon dioxide in the circulatory system.
3. MRI. It is carried out for the second and third degrees of severity of the disease. In mild forms, symptoms usually go away within a day and there is no need for an MRI.
4. Ultrasound. An ultrasound examination shows swelling of the brain and hemorrhages. However, ultrasound often gives a false positive diagnosis and is therefore not suitable for making an accurate diagnosis.
5. Electroencephalography. EEG helps to identify hidden seizures, assess the safety and activity of the brain, as well as its damage (we recommend reading:). Prescribed if a severe form of the pathology is suspected, in order to correctly choose treatment that eliminates seizures.

Ultrasonography baby's brain

Treatment of ischemia in children

The correct selection of a treatment regimen for hypoxic-ischemic brain damage in children plays a very important role. If in a timely manner early stage take all the required measures, then the disease goes away without a trace. Delayed intervention may result in the death of the newborn.

The primary goal of therapy is to restore normal blood circulation in the brain tissues in order to avoid pathological changes. Further treatment is aimed at eliminating the effects of oxygen starvation and preserving intact areas of the brain.

The therapeutic course is prescribed individually. The doctor takes into account:

• manifestations of the disease;
• the degree of their expression;
• body weight at birth, which plays a significant role for a premature baby;
• intrauterine pathologies;
• features of the perinatal period;
• method of childbirth - natural or caesarean section.

The doctor prescribes treatment based on the severity of the disease

1st degree

For stage 1 disease, the mildest, special drug treatment not required. Improved blood circulation is achieved by massage. Important nuance– creating comfortable conditions for the baby’s life, which include:

• prevention of seizures;
• natural ventilation of the lungs by providing the required amount of oxygen in the room where the child lives.

2 degrees

Degree 2 or moderate severity of the pathology is dangerous due to complications and requires specific therapeutic measures. In addition to a relaxing massage, the patient is prescribed a course of electrophoresis. Also, if necessary, a blood clot is removed to restore blood circulation.

At this stage, it is no longer possible to do without taking medications. These include:

1. Medicine for seizures. Removes and prevents their appearance.
2. Diuretics. Applicable for hydrocephalus or minor cerebral edema (we recommend reading:). Remove excess fluid from the body. Sometimes bypass surgery is required.
3. Anticoagulants. Thin the blood.
4. Vasodilator medications. Prescribed for increased intracranial pressure.

3 degrees

The third is the heaviest and dangerous stage. It requires a quick response and competent treatment, which includes:

• artificial ventilation in case of respiratory failure;
• surgery to remove blood clots;
• combating the symptoms of hydrocephalus through diuretics and shunt placement;
• taking anticoagulants and vasodilators;
• massage and electrophoresis during the rehabilitation period.

What are the consequences for the child and is it possible to prevent the disease?

Cerebral ischemia can cause various complications and negative consequences, the manifestation of which depends on:

• severity of the pathology;
• concomitant diseases;
• literacy and timeliness of the therapeutic course;
• rehabilitation period.

If cerebral ischemia is not treated in time, it is fraught with serious complications.

The most common possible consequences after ischemia are:

• disturbed sleep;
• headache;
• increased irritability;
• isolation;
• physical inactivity;
• mental development disorder;
• high blood pressure;
• autism;
• cerebral palsy;
• attention deficit disorder;
• mental disability;
• Graefe's symptom;
• death.

Despite such extensive list complications after hypoxic-ischemic or anoxic damage to the brain or central nervous system, with correctly prescribed and timely treatment, the prognosis is quite favorable. Symptoms disappear during the rehabilitation period, which takes from 6 to 12 months.

A healthy lifestyle for the expectant mother is an opportunity to prevent the development of fetal pathology

For health small child Parents are responsible. It is in their power to prevent the appearance of such a pathology in the baby. To do this, you must follow the rules healthy image life:

• regular exercise;
• constant walks in the fresh air;
• good nutrition;
• adherence to meal schedules;
• refusal bad habits including smoking and alcohol;
• avoidance of stressful situations;
• positive attitude.