Damage to the central nervous system in newborns. Residual organic damage to the central nervous system: causes, symptoms, treatment and prognosis

The central nervous system (CNS) is the main part of the human nervous system, which consists of a collection of nerve cells. In humans, it is represented by the spinal cord and brain. The departments of the central nervous system regulate the activities of individual organs and systems of the body, and generally ensure the unity of its activities. With lesions of the central nervous system, this function is disrupted.

Damage to the central nervous system can occur in a child both during fetal development (perinatal) and during childbirth (intrapartum). If harmful factors affected the child at the embryonic stage of intrauterine development, then severe defects incompatible with life may occur. After eight weeks of pregnancy, damaging influences will no longer cause gross disturbances, but sometimes slight deviations appear in the formation of the child. After 28 weeks of intrauterine development of a child, damaging influences will not lead to developmental defects, but a normally formed child may develop some kind of disease.

Perinatal damage to the central nervous system (PP CNS)

This pathology is most often registered in children of the first year of life. This diagnosis implies a dysfunction or structure of the brain of various origins. CNS PP occurs during the perinatal period. This includes antenatal (from the 28th week of intrauterine development until the onset of labor), intranatal (the act of childbirth itself) and early neonatal (the first week of the child’s life) periods.

Symptoms of CNS PP include increased neuro-reflex excitability; decreased muscle tone and reflexes, short-term cramps and anxiety; muscle hypotonia, hyporeflexia; respiratory, cardiac, renal disorders; paresis and paralysis, etc.

The occurrence of perinatal damage to the central nervous system is influenced by the following reasons: somatic diseases of the mother, malnutrition and immaturity of the pregnant woman, acute infectious diseases during pregnancy, hereditary diseases, metabolic disorders, pathological course of pregnancy, as well as unfavorable environmental conditions.

According to their origin, all perinatal lesions of the central nervous system can be divided into:

1. Hypoxic-ischemic damage to the central nervous system. Hypoxic-ischemic damage to the central nervous system occurs due to a lack of oxygen supply to the fetus or its utilization during pregnancy or childbirth;
2. Traumatic damage to the central nervous system. Traumatic damage to the central nervous system is caused by traumatic damage to the fetal head at the time of birth;
3. Hypoxic-traumatic damage to the central nervous system. Hypoxic-traumatic damage to the central nervous system is characterized by a combination of hypoxia and damage to the cervical spine and the spinal cord located in it;
4. Hypoxic-hemorrhagic damage to the central nervous system. Hypoxic-hemorrhagic damage to the central nervous system occurs during birth trauma and is accompanied by cerebral circulation disorders, including hemorrhages.

In recent years, the diagnostic capabilities of children's medical institutions have improved significantly. After one month of the child’s life, a neurologist can determine the exact nature and extent of damage to the central nervous system, as well as predict the further course of the disease, or completely remove suspicion of brain disease. The diagnosis can be characterized either by complete recovery or the development of minimal disorders of the central nervous system, or by severe diseases that require mandatory treatment and regular monitoring by a neurologist.

Treatment of the acute period of perinatal CNS lesions is carried out in a hospital. Drug therapy, massage, physical therapy and physiotherapeutic procedures, acupuncture, as well as elements of pedagogical correction are used as the main treatment of the disease.

Organic damage to the central nervous system

This diagnosis means that a person's brain is defective to a certain extent. Pathomorphological changes occur in the brain substance. A mild degree of organic damage to the central nervous system is characteristic of almost all people and does not require medical intervention. But the moderate and severe degree of this disease is already a disruption of the nervous system. Symptoms include freezing spells, sleep disturbances, increased excitability, easy distractibility, repetition of phrases, and daytime enuresis. Vision and hearing may deteriorate, and coordination of movements may be impaired. Human immunity decreases, and various colds occur.

The causes of organic damage to the central nervous system are divided into congenital and acquired. The first include cases when during pregnancy the mother of the child suffered an infection (acute respiratory infection, flu, sore throat), took certain medications, smoked and drank alcohol. During periods of psychological stress in the mother, the unified blood supply system can transfer stress hormones to the fetus’s body. The impact is caused by sudden changes in temperature and pressure, exposure to radioactive and toxic substances contained in the air, dissolved in water, food, etc.

Diagnosing organic damage to the central nervous system is quite simple. An experienced psychiatrist can determine the presence or absence of organic matter by looking at a child’s face. However, the types of disorders in the functioning of the brain are determined by laboratory diagnostics, which are based on a series of procedures that are harmless to the body and informative for the doctor: ultrasound diagnostics of the brain, electroencephalogram, rheoencephalogram.

Treatment of organic matter is a very long process. It is mainly medicinal. To treat organic damage to the central nervous system, medications are used. For example, nootropic drugs can improve brain activity. Vascular drugs are used.

Children are often diagnosed with “residual damage to the LES.” Residual organic damage to the central nervous system occurs in children mainly as residual effects of birth injuries and brain disorders. It manifests itself as a disorder of associative thinking, and in more severe cases, neurological disorders. Treatment is prescribed by a doctor. Various elements of pedagogical correction and concentration exercises are used, and sessions with a psychologist and speech therapist are useful.

The consequences of damage to the central nervous system depend primarily on the degree of the disease. It is possible that a complete recovery may occur, as well as a delay in the child’s mental, motor or speech development, various neurological reactions, etc. It is important that during the first year of life the child receives full rehabilitation.

Help children with diseases affecting the central nervous system

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Traumatic lesions of the nervous system occur in children of all ages. They are fraught with great danger, because the consequences of injuries can affect the entire future life of the child. Their range is so wide that it equally covers both periodic headaches and delayed physical development and mental disorders.

As doctors note, traumatic damage to the central nervous system is one of the least common causes of diseases of the central nervous system. Along with infectious and hypoxic-ischemic lesions, it is less common. But the physical impact is difficult to predict. Injuries are spontaneous and unexpected. They require urgent and immediate medical attention.

Nervous system injuries in children

• Intrauterine – physical impact on the fetus during a fall, catastrophe, accident, when compression or impact occurs in the mother’s abdomen and lower back. Injuries that do not result in termination of pregnancy and are compatible with the further development of the fetus may affect its health after birth. Consequences include disturbances in psychomotor development, motor activity, and speech function.
• Labor – weak labor, premature birth, complications and the use of forceps can lead to physical damage to the fetus. Traumatic lesions of the fetal central nervous system also occur during cesarean section.
• Postnatal – skull injuries that occur after the birth of a child. This could be a bruise, concussion or crushing. A closed craniocerebral injury is accompanied by a concussion. A bruise is a local injury to the brain. Crushing or compression is accompanied by cerebral edema, intracranial hemorrhage, and bone fracture. This is a serious injury with unpredictable consequences.

Traumatic lesions of the central nervous system in newborns

Birth trauma ranks second among the causes of damage to the central nervous system of a newborn. This is a rough mechanical impact on the baby during his birth. Most often, the intervertebral joints of the cervical spine are damaged. They bear the greatest burden during childbirth. Traumatic brain injuries, joint dislocations, and joint dislocations also occur. Any injury disrupts blood flow in important arteries that supply blood to the brain and spinal cord.

Among the causes of birth injuries, the most common are:

• Discrepancy between the size of the child and the size of the mother's pelvis, premature babies, children with low weight or, conversely, very large children, rapid labor, breech presentation. In these cases, delivery aids are often used, which lead to injury to the newborn.
• Weak labor – medication and physiotherapeutic stimulation of labor are used. The mechanism of passage of the fetus through the birth canal changes. Sprains, misalignment of vertebrae, and dislocations often occur. Cerebral blood flow deteriorates.
• The use of forceps is an extremely undesirable and dangerous auxiliary method, which entails traumatic brain injuries and injuries to the cervical spinal cord.
• Caesarean section - as a rule, the incision of the uterus is 25-26 cm. The baby's head circumference is on average 35 cm. For the baby to be born, it must be pulled out by the head and shoulders. In this case, injuries to the cervical spine often occur in combination with fetal hypoxia.

Post-traumatic syndromes of central nervous system lesions

Traumatic lesions of the central nervous system in children are manifested by one of the following syndromes or a combination of them:

Cerebroasthenia or encephalasthenia

After a minor skull injury. The child experiences frequent headaches, becomes inactive, gets tired quickly and cannot concentrate, attention is unstable, and memory deteriorates. Such consequences are functional in nature and amenable to therapeutic correction.

Cerebropathy or encephalopathy

After a brain injury. The syndrome manifests itself in vestibular, motor, speech and sensory disorders. There may be severe dizziness, coordination disorders, stuttering, dysarthria, and paralysis. The child requires systematic medication and physiotherapeutic therapy.

Hypo- or hyperdynamic syndrome

Some children are inactive, lethargic and slow. Others are too energetic, affective, noisy and easily excitable. Intellectual activity is reduced, attention is unstable.

Convulsive syndrome

This syndrome occurs immediately after a serious injury, which is accompanied by contusion and cerebral hemorrhage. But periodic seizures can appear some time after the injury and appropriate treatment. They are often accompanied by memory impairment, apathy and indifference in the child.

Delayed intellectual development

Most often occurs after trauma in the perinatal period. Birth trauma in combination with fetal hypoxia can lead to irreversible structural changes in the brain. As a result, the child lags behind in his physical, psycho-emotional and mental development.

Diagnosis and treatment of nervous system injuries in children

To diagnose traumatic lesions of the central nervous system and their consequences, a clinical examination, analysis of the child’s reflexes and behavior, his psycho-emotional state, and the functioning of all vital organs are performed. To assess the structure of the brain and spinal cord, its blood flow, neurosonography, Dopplerography, CT and MRI are performed.

In the acute period of traumatic damage to the central nervous system, immediately after injury, therapy is aimed at restoring blood flow and the functioning of all vital organs. It is necessary to reduce cerebral edema, normalize intracranial pressure, and level out convulsive syndrome. In the future, the child requires effective restorative treatment to improve the activity of cerebral cortex cells and correct physical and mental development.

Every expectant mother is afraid of the pathologies of pregnancy and childbirth and wants to prevent them.

One of these pathologies is fetal hypoxia and hypoxia during childbirth, which can lead to disruptions in the functioning of many organs and tissues, including the brain.

The consequences of such damage can last a long time, sometimes throughout life.

Causes of hypoxic damage to the central nervous system in a newborn

The central nervous system is the first to suffer from a lack of oxygen, which can be caused by various factors during pregnancy and childbirth. It can be:

During pregnancy:

Preeclampsia in late stages;

Premature placental abruption, threat of miscarriage;

Heart defects in mother and fetus;

Anemia in mother;

Lack or excess of amniotic fluid;

Maternal intoxication (drug, occupational, smoking);

Rhesus conflict between mother and fetus;

Infectious diseases of the mother;

During childbirth:

Entanglement of the umbilical cord around the fetal neck;

Weakness of labor;

Prolonged labor;

Maternal bleeding;

Birth injuries to the neck.

As you can see, most of the dangerous factors affect the health of the baby even before birth, and only a few - during childbirth.

Excess weight, chronic diseases of the mother, or her too young or too mature age (under 18 or over 35) can aggravate the course of pregnancy pathologies leading to hypoxic damage to the central nervous system in the newborn. And with any type of hypoxia, the brain is affected first.

Symptoms of Brain Damage

In the first hours and days after birth signs of disorders of the cardiovascular system come to the fore, and symptoms of hypoxic damage to the central nervous system begin to manifest themselves later.

If brain damage is caused by pregnancy pathology, the baby may be lethargic and have weakened or completely absent reflexes that a healthy newborn should have. If there is a pathology that occurs during childbirth, the baby does not immediately begin to breathe after birth, the skin has a bluish tint, and the respiratory rate is lower than normal. And in the same way, physiological reflexes will be reduced - based on these signs, oxygen starvation can be suspected.

At an older age brain hypoxia, if it was not cured on time, manifests itself as a slowdown in psycho-emotional development up to severe forms of dementia, and motor disorders. In this case, the presence of organic pathology is possible - brain cysts, hydrocephalus (especially often occurs with intrauterine infections). Severe brain hypoxia can be fatal.

Diagnosis of hypoxic damage to the central nervous system in a newborn

The first diagnostic procedure, which is carried out for all newborns immediately after birth, is to assess their condition using the Apgar scale, which takes into account vital signs such as breathing, heartbeat, skin condition, muscle tone and reflexes. A healthy child scores 9-10 points on the Apgar scale; signs of hypoxic damage to the central nervous system can significantly reduce this indicator, which should be the reason for more accurate examinations.

Doppler ultrasound allows you to assess the condition of the blood vessels of the brain and identify their congenital anomalies, which can become one of the causes of hypoxia in the fetus and newborn.

Ultrasound, CT and MRI of the brain can identify various organic pathologies of the nervous system - cysts, hydrocephalus, areas of ischemia, underdevelopment of certain parts, tumors. The difference in the operating principles of these methods allows us to see the most complete picture of brain damage.

To assess damage to the functions of the nervous system, neurography and myography are used - these are methods based on the effect of electric current on muscle and nervous tissue, and allow us to monitor how different parts of the nerves and muscles react to it. In the case of congenital hypoxic damage to the central nervous system in a newborn, this method allows us to understand how damaged the peripheral nervous system is, and how great are the child’s chances for full physical development in this case.

Additionally, a biochemical blood test and urine test are prescribed to identify biochemical disorders associated with brain hypoxia.

Treatment of hypoxia in newborns

Treatment for hypoxic brain injury depends on its cause and severity. If hypoxia occurs during childbirth and is not accompanied by organic pathology of the brain, blood vessels, heart, lungs or spine, then, depending on the degree, it can either go away on its own within a few hours (mild form, 7-8 Apgar), or require treatment in an oxygen chamber with normal or increased pressure (hyperbaric oxygenation).

Organic pathology that causes constant brain hypoxia (heart defects, respiratory system, neck injuries) is usually treated surgically. The question of the possibility of surgery and its timing depends on the condition of the child. The same applies to organic pathology of the brain (cysts, hydrocephalus), which occurs as a consequence of intrauterine fetal hypoxia. In most cases, the earlier the operation is performed, the greater the child’s chances for full development.

Prevention of hypoxic brain damage

Since the consequences of intrauterine fetal hypoxia are extremely destructive for the child’s brain in the future, a pregnant woman needs to be very careful about her health. It is necessary to minimize the impact of factors that can disrupt the normal course of pregnancy - avoid stress, eat well, exercise in moderation, give up alcohol and smoking, and attend antenatal clinics on time.

In case of severe gestosis, as well as when signs of premature placental abruption and the threat of miscarriage appear - abdominal pain, bleeding from the genital tract, a sharp decrease in blood pressure, sudden nausea and vomiting for no reason - you should immediately consult a doctor. It may be recommended to go into conservation - this recommendation should not be neglected. A set of therapeutic measures carried out in the hospital will help avoid severe fetal hypoxia and its consequences in the form of congenital brain pathologies.

Ultrasound, which is done in the last weeks of pregnancy, allows us to identify such potentially dangerous conditions as entanglement in the umbilical cord, which during childbirth can prevent the baby from taking its first breath, pelvic or lateral presentation, which is also dangerous because hypoxia of the newborn will develop during childbirth. To correct dangerous presentation, there are sets of exercises, and if they are ineffective, a caesarean section is recommended. It is also recommended for entwined umbilical cords.

Measuring the size of the fetus and the woman's pelvis allows us to determine an anatomically and clinically narrow pelvis - a discrepancy between the size of the pelvis and the size of the child's head. In this case, giving birth naturally will be very traumatic for both mother and child, or may be completely impossible. The safest method of delivery in this case is cesarean section.

During childbirth, it is imperative to monitor the intensity of contractions - if it becomes insufficient for rapid delivery, labor is induced. Prolonged stay of the fetus in the birth canal can lead to the development of cerebral hypoxia, since the placenta no longer supplies its body with oxygen, and the first breath is possible only after birth. Physical exercises to prepare for childbirth can help you avoid this condition.

Etiology. The most common causes of damage are oxygen deficiency (hypoxia, asphyxia), various infections and intoxications. Less commonly, the direct cause may be mechanical damage to the brain in the intrapartum period.

Early diagnosis of the nature of cerebral damage in a newborn is very difficult. The variety and similarity of clinical manifestations of dysfunction of the central nervous system, the tendency of the brain to generalized reactions, the dynamism of the process, changing symptoms over several hours, layers of birth stress complicate the diagnostic capabilities of the doctor. In the acute period of the disease, it is often difficult to differentiate the infectious-inflammatory process, the consequences of mechanical intracranial trauma and asphyxia; it is difficult to establish whether certain symptoms are the result of a major hemorrhage or are caused by impaired cerebral hemodynamics, cerebral edema.

In clarifying the cause of dysfunction of the central nervous system and in making a leading diagnosis in the first days of a child’s life, anamnesis data are important. A detailed analysis of the mother’s health status, the characteristics of the course of pregnancy and childbirth makes it possible to clarify the nature of the damaging factor and determine the degree of risk of damage to the fetus.

Damage to the nervous system in newborns is characterized by a wide range of clinical and morphological changes - from mild functional disorders in hemolytic circulation disorders to severe symptoms of brain damage and vital functions in diffuse edema and intracranial hemorrhage.

Terminology. There is no generally accepted classification of CNS lesions in newborns yet. In recent years, the term “perinatal encephalopathy in newborns with central nervous system lesions” has become widespread in medical practice.

The most famous is the clinical classification of lesions of the nervous system in newborns and young children, developed by Yu. A. Yakunin et al.

According to the International Classification of Diseases, adopted by the 21st World Health Assembly for the Ninth Revision, in the perinatal period, the causes of damage to the central nervous system in children can be “asphyxia” (hypoxia) and “birth trauma”. To ensure possible earlier prediction and determination of pathogenetic therapy in the perinatal period, it is important to clarify the leading syndrome of the acute period, identifying the so-called “syndromic diagnosis”. In this regard, when making a diagnosis, the above classification can be used with the following changes: in the early neonatal period, the leading cause of damage to the central nervous system is indicated - “asphyxia” or “birth injury”, then the form of the disease is noted according to severity and the leading clinical syndrome; for example, with a predominantly hypoxic genesis of CNS damage, the diagnosis may be as follows:

1. Asphyxia. Mild form of central nervous system damage. Acute period. Violation of hemocerebrospinal fluid dynamics. Syndrome of increased neuro-reflex excitability.
2. Chronic intrauterine hypoxia, asphyxia during childbirth. Severe form of central nervous system damage. Brain swelling. Convulsive syndrome.
3. Chronic intrauterine hypoxia. Moderate form of central nervous system damage. Violation of hemocerebrospinal fluid dynamics. Hypertensive-hydrocephalic syndrome.

For mechanical birth trauma:

1. Birth trauma of the central nervous system. Moderate form. Violation of hemocerebrospinal fluid dynamics. Hypertension syndrome. Convulsive syndrome.
2. Birth trauma of the central nervous system against the background of chronic intrauterine hypoxia. Severe form. Intracranial hemorrhage. Coma.

Clinic. Currently, depending on the severity of the damage, there are 3 clinical forms of central nervous system damage in newborns: mild, moderate and severe. The acute period of the disease lasts 7-10 days.

In mild forms of the lesion, clinical manifestations are based on transient disturbances of hemolytic circulation, which are associated with short-term hypoxic effects and the influence of birth stress. Cerebral disorders in most cases are caused by mild complications during labor, surgical interventions, and short-term acute fetal hypoxia. The duration and depth of damage to the fetus can be approximately determined by changes in the fetal cardiac activity during labor, the presence of meconium in the amniotic fluid, and a decrease in the pH value of the fetal blood.

The condition of such children at birth is usually not severe. The Apgar score is 6-7 points, due to impaired development of external respiration, cyanosis of the skin, and decreased muscle tone. Primary resuscitation measures, as a rule, turn out to be highly effective and permanently restore vital functions. Symptoms of cerebral disorders appear and may increase during the first 24-48 hours of postnatal life. Usually these are mild, unstable neurological symptoms in the form of general cerebral functional disorders, manifested by a syndrome of increased neuro-reflex excitability. The general condition of such children in the first days is moderate. Sleep disturbances, emotional motor restlessness, small-amplitude tremor of the upper and lower extremities, chin, spontaneous Moro reflex, and episodic horizontal nystagmus are noted. Children may experience regurgitation in the first hours after birth. Congenital unconditioned reflexes are revived with rapid depletion, some reflexes are depressed. Muscle tone is little changed and can be characterized by intermittent muscle dystonia. The functions of thermoregulation, sucking, and swallowing are preserved.

The mild form of the lesion is characterized by the rapid disappearance of clinical pathological symptoms. In most cases, persistent improvement in the condition of children is observed by the 4-5th day of life.

Moderate damage to the central nervous system is usually observed in children with a combination of unfavorable course of the ante- and intranatal periods of development. The history reveals a variety of damaging factors during pregnancy associated with maternal diseases, occupational hazards, malnutrition of the pregnant woman, negative emotional reactions, various somatic and acute infectious diseases. During the period of childbirth; Women in labor develop weakness of labor forces, incoordination of labor, untimely rupture of amniotic fluid. Some children are born with the help of special obstetric techniques and surgical interventions (extraction by the pelvic end, obstetric forceps, vacuum extraction of the fetus, etc.). These complications contribute to longer-term fetal oxygen deficiency, metabolic disorders, and mechanical damage to the fetal brain. During childbirth, deafness of the fetal heart sounds, prolonged constant tachycardia or arrhythmias of cardiac activity are noted, which indicates the depletion of its compensatory adaptation mechanisms.

At birth, children in this group have Apgar scores ranging from 4 to 5 points. Suppression of reflex irritability, decreased muscle tone, and widespread cyanosis of the skin are noted. Children need respiratory resuscitation and correction of homeostasis. In the early post-resuscitation period of life, they require special therapeutic measures to normalize vital functions.

A dysfunction of the central nervous system is detected immediately after initial resuscitation or a short “light interval”. In most cases, the condition of children is severe, with a predominance in the first hours and days of life of general depression or the development of intracranial hypertension syndrome. With general depression, muscle tone is reduced or increased, and its asymmetry in the upper and lower extremities is possible. In the dynamics of the disease, muscle hypotension can often be replaced by dys- or hypertension. The child sometimes has no spontaneous movements for several days. There is inhibition of many innate unconditioned reflexes. Along with this, vegetative-visceral disorders are also observed in the form of periodic respiratory arrests, tachy- or bradycardia, gastrointestinal dyskinesias, and disturbances in thermoregulation (hypothermia in the first days of life) are often noted. Children suck sluggishly, often regurgitate, especially in the first hours after birth. They often have a reduced reaction to painful stimuli. Local neurological symptoms in most cases are absent or may be unstable in the form of differences in palpebral fissures, spontaneous large-scale horizontal nystagmus, and strabismus.

The clinical picture of hypertension syndrome is dominated by symptoms of increasing motor restlessness, hyperesthesia of the skin, and intermittent sleep of the child. Small-amplitude tremor of the chin and limbs is observed, sharply increasing with irritation. Symptoms of intracranial hypertension are bulging fontanelles, Graefe's and "setting sun" signs, and horizontal nystagmus. In children, short-term clonic convulsive twitching of the facial muscles or atypical convulsions in the form of automatic chewing movements, “pedaling” of the feet, and vasomotor disturbances are possible. These convulsive attacks are short-term, inconsistent, but they are characterized by their uniformity and recurrence in the same child. Convulsive seizures are more often detected during examination of the child, his swaddling and external irritations

The basis of the clinical symptoms in children with moderate damage to the central nervous system, according to most researchers, are edematous-hemorrhagic changes in the membranes and substance of the brain with dyscirculatory vascular paralysis and pinpoint diapedetic hemorrhages. In this case, the disease often occurs with liquor hypo- or normotension.

In the dynamics of the disease against the background of treatment, stabilization of the child’s vital functions occurs quite quickly, usually no later than the 6-7th day of life.

Most children with a moderate form of central nervous system damage are discharged home on the 10-12th day of life as their condition normalizes. This group of children should be under clinical supervision of a local pediatrician and neurologist. In cases where symptoms of intracranial hypertension persist during treatment, the child should be transferred to a specialized neurological department on the 7-10th day of life.

A severe form of central nervous system damage is the result of a combination of damaging factors during pregnancy and childbirth. Long-term chronic oxygen deficiency can be caused by severe forms of toxicosis (nephropathy, eclampsia), arterial hypertension in a pregnant woman, widespread edema, and significant proteinuria. As a result of this pathology, severe disturbances occur in the uteroplacental circulation and gas exchange between the mother and the fetus, which leads to a general delay in fetal development and intrauterine malnutrition. Along with chronic disorders, a severe form of central nervous system damage can be caused by acute pathology during childbirth (premature placental abruption, rupture of umbilical cord vessels, prolapse of the umbilical cord loop, uterine rupture during childbirth, massive blood loss during placenta previa, ii incorrect insertion of the presenting part of the fetus during childbirth, difficulties in removing the head and shoulder girdle of the fetus, etc.).

Children are born in a state of hypoxemic shock with severe! hemodynamic disorders. The Apgar score at birth does not exceed 3 points. Lack of breathing, impaired cardiac activity, atony and suppression of reflexes are noted. Newborns need respiratory and cardiac resuscitation, restoration of hemodynamics and metabolism. Newborns who have suffered severe intrauterine hypoxia develop post-asphyxia syndrome, the main manifestations of which are pulmonary, cardiovascular and cerebral disorders. After primary resuscitation and restoration of cardiac activity and external respiratory function, the child continues to have vascular insufficiency, respiratory disorders and insufficiency of adrenal cortex function against the background of severe depression of the central nervous system. The children are in a comatose state. They are inactive, moan weakly, there is no cry or it is weak, monotonous, sometimes aphonic. The child does not respond to painful and tactile stimuli. The skin is gray-cyanotic, cold to the touch, and general hypothermia is noted. Pronounced cyanosis around the eyes, mouth, cyanosis of the hands and feet. Breathing is uneven, shallow, with long pauses. Heart sounds are muffled, bradycardia is often observed, and a systolic murmur is heard over the heart area.

Symptoms of bulbar and pseudobulbar disorders with impaired sucking and swallowing may be observed. Lesions of individual cranial nerves are manifested by facial asymmetry, sagging of the lower jaw, ptosis, strabismus, etc. This condition is characteristic of diffuse cerebral edema or intracranial hemorrhage under the tentorium cerebelli. With hemorrhages over the tentorium cerebelli, the child’s severe anxiety, persistent yawning, forced positioning, and general stiffness due to increased muscle tone in various muscle groups predominate. Character! a sharp short or low-pitched cry. The palpebral fissures are wide open, the gaze is fixed, the pupils are wide or narrowed, motionless, exophthalmos and rotatory nystagmus are noted. Children lie with their heads thrown back due to a paradoxical redistribution of muscle tone. Sometimes heads; can be turned to one side. In this group of newborns, frequent repeated convulsive seizures are noted with a predominance of the tonic component with the shutdown of the respiratory muscles and attacks of secondary asphyxia. Unilateral seizures may also be observed, indicating subdural hemorrhages, which occur predominantly in full-term newborns. Convulsive syndrome is not always detected in the early stages of the disease and can appear only with the development of hydrocephalus.

The severity of clinical symptoms is due to generalized cerebral edema and intracranial hemorrhages. With asphyxia, subarachnoid hemorrhages are most often observed, clinically causing acute meningeal-hypertensive syndrome. Hemorrhages are often found in the substances of the brain, perivascularly in the cerebral cortex and in the medulla oblongata. With massive intracranial hemorrhages, especially with subtentorial localization, diffuse cerebral edema, compression of subcortical-stem formations occurs with a sharp disruption of vital functions and the development of cerebral coma.

Intensive therapy is indicated for children with severe central nervous system damage after initial resuscitation. Their prognosis is often unfavorable. In surviving newborns, the unstable condition persists until the 8-10th day of life; loss of sucking function and impaired swallowing are noted. These newborns require long-term therapy in a specialized neurological department and must be transferred at 7-10 days of age from the maternity hospital to the hospital.

The central nervous system is part of the human nervous system, consisting of a collection of nerve cells. In humans, it is represented by the brain and spinal cord. Divisions of the central nervous system regulate the activity of individual systems and organs. This function is impaired when the central nervous system is damaged. in children it can occur during the perinatal period and during childbirth. If harmful factors acted on the child at the embryonic stage, then defects that are incompatible with life may occur. After the eighth week of pregnancy, damaging effects will no longer lead to the development of gross disorders, but small deviations may sometimes occur in the formation of the child. After the twenty-eighth week of the child's development, the damaging effect does not cause any malformations, but if the child is formed normally, then he may develop some kind of disease.

Perinatal damage to the central nervous system is registered in children in the first year of their life. This diagnosis implies a violation of the structure or function of the brain of various origins. It occurs in the perinatal period. This includes antenatal (twenty-eighth week of intrauterine development), intrapartum and neonatal.

Symptoms include decreased reflexes and muscle tone, increased reflex excitability, anxiety and short-term convulsions, renal, cardiac and respiratory disorders, paralysis and paresis.

The appearance of perinatal damage to the central nervous system is influenced by the following reasons: immaturity of the pregnant woman, malnutrition, somatic diseases of the mother, pathological course of pregnancy itself, metabolic disorders and unfavorable environmental conditions. All perinatal lesions of the central nervous system according to their origin are divided into:

Hypoxic-ischemic damage to the central nervous system. Such damage occurs when there is a lack of oxygen in the fetal body or during its disposal during childbirth or pregnancy.

Traumatic lesions of the central nervous system are caused by injuries to the child during childbirth.

Hypoxic-traumatic damage to the central nervous system is characterized by a combination of damage to the cervical spine and hypoxia.

Hemorrhagic-hypoxic lesion occurs due to birth injuries and is accompanied by impaired blood circulation in the brain.

Organic lesions of the central nervous system. This diagnosis indicates that the brain is defective. Pathomorphological changes begin to occur in the substance of the human brain. Severe and moderate degrees of this disease are a disorder of the nervous system. Symptoms include sleep disturbances, freezing spells, rapid distractibility, increased excitability, daytime enuresis and repetition of phrases. Hearing and vision may deteriorate, and movement coordination may also be impaired. Human immunity decreases, as a result of which he begins to suffer from colds. The causes of organic damage to the central nervous system can be acquired and congenital factors. Congenital cases include those cases when during pregnancy the mother suffered an infection (sore throat, flu, acute respiratory infections), drank alcohol, smoked or took some medications. During a woman’s psychological stress, the blood supply system can transfer stress hormones to the fetus. Sudden changes in pressure and temperature, as well as the effect of toxic and radioactive substances contained in food, water and air, also affect. Diagnosing such a lesion is simple. An experienced psychiatrist will determine the absence or presence of organic matter from a child’s face. Treatment takes quite a long time and is medicated. In the treatment of organic lesions of the central nervous system, drugs are used. For example, nootropic drugs improve brain activity, and vascular drugs are also used.

Children are often diagnosed with abdominal lesions of the central nervous system. This is a combination of brain disorders and birth injuries. This disease is manifested by disorders of associative thinking, and in severe cases, neurological disorders. During treatment, various exercises are used to concentrate attention, pedagogical correction, and it is also necessary to work with a speech therapist and psychologist. The consequences will depend on the degree of the disease. The child may recover completely, or he may experience delayed speech, motor and mental development.