Consequences of perinatal damage. Perinatal damage to the central nervous system

Even people who have nothing to do with medicine often hear the term “perinatal central nervous system damage.” This diagnosis seems scary, but not everything is so simple.

The perinatal period begins from the 22nd week of pregnancy and lasts until the 7th day of the baby’s life, including the birth process itself.

Perinatal damage to the central nervous system in newborns is one of the most common diagnoses. And parents often panic. But in many cases, such a diagnosis is routine, that is, a neurologist can make it even if only one reflex is impaired. The birth process is very traumatic for the baby, since it is almost impossible to avoid injury when passing through the birth canal. Therefore, in our time, more than 90% of children make such an entry on their cards.

Causes and features of diagnosis

Doctors identify 4 types of reasons:

hypoxia in newborns (lack of oxygen);
various injuries during birth and in the very first minutes of a child’s life;
toxic-metabolic damage (as a result of the unreasonable use of various toxins by the expectant mother during pregnancy in the form of alcohol, drugs, nicotine, and some medications);
infections.

Hypoxic-ischemic damage takes first place (up to 47% of all cases).

Classification and types of syndromes

There are three main periods during PPCNS:

Acute (first 4 weeks of life).
Recovery: early (8-15 weeks); late (from 16 weeks to 12 months in children born at term, up to 24 in premature infants).
Outcome: complete disappearance of all disorders; persistence of some manifestations: developmental delay, hyperactivity syndrome; severe consequences: epilepsy, cerebral palsy, hydrocephalus.

Each period has its own manifestations and symptoms, which doctors, for convenience, identify in the form of so-called syndromes. In approximately half of the cases, one small patient may experience several syndromes at once.

At the first stage, the following signs are most often identified:

increased nervous excitability (increased or decreased tone, shuddering, tremors, anxious sleep, frequent crying);
vegetative-visceral (cardiovascular rhythm disturbance, unstable stool, marbling of the skin, strong gases, regurgitation);
convulsive (periodic twitching of the arms, legs, head in the form of attacks, frequent shudders);
hypertensive-hydrocephalic (increased intracranial pressure, swelling of the fontanelle, anxiety, accelerated head growth).

The recovery period has similar syndromes, plus the following points are added to them:

delayed PMR;
motor disorders.

If a child does not smile, does not babble, or does not show any interest in toys or the outside world, you need to sound the alarm before it is too late.

Diagnosis of the disease

An experienced neurologist can make a diagnosis during examination. However, to confirm it, more fundamental studies of the central nervous system are often necessary: CT, MRI, Dopplerography, neurosonography.

The last method is used most often. Neurosonography is an ultrasound of the brain, which is done before the opening of the large fontanelle has yet closed. This harmless method allows you to monitor the state of the brain, identify disorders in a modern way, and also suggest possible causes of this condition.

Treatment methods and rehabilitation measures

A mild degree of pathology, as a rule, is treated with conventional massages and physiotherapy. In many cases, the child independently compensates for the detected violations, but each child requires a certain time for this - some a month, some two, some six months.

However, this does not mean that you need to let the situation take its course. If a child with mild impairments is discharged from the maternity hospital home, parents should make every effort to mitigate or completely eliminate stressful situations during the acute period of the illness. This means that it is necessary to limit contact with strangers in order to prevent the baby from becoming infected, and also to protect the child from loud and sharp sounds, hypothermia, and overheating. Nutrition is of great importance: breastfeeding can activate the restoration of the central nervous system and reduce the baby’s stress state.

Rehabilitation must begin as early as possible, since most disorders are reversible in the first months after birth. Brain cells that die due to hypoxia can still be replaced by new ones.

Help for children with severe injuries is carried out in several stages:

Assistance in the maternity hospital: restoration of the full functioning of the main organs, treatment of identified syndromes.
Treatment in the neurological department: drug therapy, therapeutic massage courses, gymnastic exercises, electrophoresis.
Monitoring the child’s development in the 1st year of life: timely visits to specialists, compliance with their recommendations, therapeutic exercises, massage, therapeutic baths, swimming.

During the recovery period, it is very important to work with the baby, developing his hearing, vision, and stimulating emotions. These are a wide variety of toys, educational mats, books, bright pictures, pleasant music. However, you should not get too carried away with various early development methods, as this can be dangerous for the baby’s fragile nervous system. Everything should be done in moderation.

The duration of rehabilitation depends on the severity of the pathology:

in mild cases this period takes a maximum of 24 months;
in cases of moderate severity – approximately 3 years;
severe degree - until adulthood. In rare cases, young people with serious consequences are not able to care for themselves and therefore require lifelong assistance from family and friends.

With adequate and timely rehabilitation, the prognosis for life and health is favorable in most cases.

Danger and consequences of PCNSL in newborns

The consequences of perinatal CNS damage can be very serious. The most formidable diagnoses are the well-known cerebral palsy of varying severity, hydrocephalus, epilepsy and other convulsive conditions.

In milder cases, such children are diagnosed with mental, speech or motor development delays. At school age, children with central nervous system lesions often suffer from attention deficit disorder and hyperactivity: it is very difficult for them to concentrate on one thing, they are constantly distracted, and cannot finish what they start. In many cases, residual changes in the brain (residual effects after a lesion) appear again and again.

Preventive measures

A pregnant woman needs to be very careful about her well-being and health. In many cases, this helps prevent possible problems. The expectant mother needs to give up bad habits, undergo all examinations in a timely manner, treat identified infections, not overload herself with physical work, spend more time in the fresh air, eat right, and establish a sleep and rest routine.

Unfortunately, no one is immune from problems during childbirth, so if such a diagnosis is made, a newborn should not despair. Timely treatment is designed to prevent the development of severe consequences. Preventive measures to prevent consequences should begin from birth, while the plasticity and receptivity of the brain is still very high.

The most common diagnosis that a neurologist makes for a child in the first year of life is perinatal damage to the central nervous system (PP CNS). Previously, another term was used: perinatal encephalopathy (PEP). Synonyms (for the reason that caused the disease): hypoxic-ischemic encephalopathy (HIE), hypoxic-toxic encephalopathy. This diagnosis raises a lot of questions among parents. Is this disease serious? The reasons for it? Is it possible to do without drug treatment? What are the consequences of PEP?

The development of the nervous system begins and proceeds very intensively during the prenatal period. For its full growth and formation, a sufficient amount of oxygen is necessary. The most common cause of brain damage is hypoxic-ischemic encephalopathy. This is damage to the nervous system caused by hypoxia (lack of oxygen supplied to tissues) and ischemia (impaired blood supply to tissues, leading in turn to oxygen starvation). Ischemia causes the death of nerve cells.

In addition, various toxic and infectious factors can also damage the developing nervous system.

The main factors leading to oxygen starvation of the fetus:

Gestosis of pregnancy (increased blood pressure, weight gain of more than 12 kg, edema, polyhydramnios, preeclampsia, eclampsia, etc.)
Anemia (iron deficiency)
Post-term pregnancy
Premature birth, premature baby
Multiple pregnancy
Threat of miscarriage
VSD, low blood pressure, heart defects in a pregnant woman
Intrauterine growth retardation (according to ultrasound)
C-section
Birth in a breech position (there is also a high risk of spinal cord damage at the cervical level)
Long labor
Rapid (up to 2 hours) and rapid (up to 4 hours) labor
Use of obstetric forceps, vacuum extractor or obstetric aids during childbirth
Tight umbilical cord around the neck

Toxic factors (nicotine, alcohol, drugs, many medications, various chemicals, etc.) can cause malformations of the nervous system.

During intrauterine infection of the fetus, the nervous system can also be affected. A child in utero can suffer meningoencephalitis and be born with the consequences of this (brain cysts, disturbances in cerebrospinal fluid dynamics, increased intracranial pressure).

Thus, many reasons can lead to damage to the nervous system during pregnancy and childbirth. Depending on which part of the brain is most affected, perinatal encephalopathy can manifest itself in the form of various syndromes.

Most often diagnosed movement disorder syndrome(or muscular dystonia). The syndrome of movement disorders can be with a predominance of increased muscle tone (hypertonicity) or with a predominance of decreased muscle tone (hypotonicity). Muscle hypertonicity is observed both in the arms (handles in fists, resting on fists, pathological positioning of the hands) and in the legs (resting on tiptoes, bending fingers). Hypertonicity in the arms impairs the development of grasping ability; with an increase in muscle tone in the legs, the development of the support reaction of the legs is delayed, and subsequently the ability to walk. With hypertonicity of the neck extensor muscles, the child throws his head back and holds it in this position for a long time.

Muscle hypotension syndrome is clinically manifested by a local or diffuse (general) decrease in muscle tone. When examining such a child, a characteristic “frog” pose and decreased motor activity may be noted. When a child is pulled up by the arms, his head hangs back; when he is taken under the armpit, he sags in his arms. Another type of movement disorder syndrome is asymmetry of muscle tone. Muscle tone on one side of the body may be higher than on the other.

In the future, children with movement disorder syndrome may experience a delay in motor development: children turn from back to stomach late, sit up late, and start walking late.

Hypertension syndrome(increased intracranial pressure) is manifested by the child’s anxiety, unmotivated crying, frequent regurgitation, vomiting “fountain”, tension of the large fontanel, excessive growth of head circumference. Confirmed by ultrasound examination (neurosonography) of the brain.

Hyperexcitability syndrome– increased excitability of the child, difficulty falling asleep, short periods of sleep, frequent awakenings at night, trembling of the chin and hands, increased reflexes.

Vegetative-visceral syndrome– increased sweating, “marbled” skin pattern, weather dependence, frequent regurgitation.

Speech delay syndrome– diagnosed closer to a year. By the age of one year, a child should speak 10-12 simple words. Delayed speech development can be caused not only by perinatal encephalopathy (if the speech center of the brain is damaged), but also by the parents’ lack of skills to stimulate speech development in the child. A consultation with a neurologist will help find out the cause of delayed speech development in each specific case. Early diagnosis and treatment of speech delay caused by AEDs prevents the formation dysarthria and other speech disorders.

Treatment perinatal encephalopathy is prescribed depending on the diagnosed syndrome and the severity of the course. In some cases, it is enough to prescribe non-drug treatment methods (massage, exercise therapy, physical therapy), in other cases it is impossible to do without prescribing medications.

Unfortunately, nowadays parents in some cases refuse drug treatment. What consequences could this have?

The diagnosis of perinatal encephalopathy is valid only in the first year of a child’s life. At this age, the child’s body has enormous recovery resources, and with proper treatment, in most cases, recovery from PED occurs by one year. However, if treatment is insufficient at the age of 1 year, recovery may not occur, and then a neurological diagnosis is made, with which the child will be monitored throughout life. Mild forms of encephalopathies with insufficient treatment can be clinically compensated by one year. However, under certain conditions, decompensation may occur and neurological symptoms may reappear. Most often this happens at the age of 7-8 years, the child begins to study at school, workloads and responsibilities increase, and the regime changes. The second age period of risk is the period of puberty, puberty.

How Exodus Poorly treated encephalopathy in the first year may cause:

decreased visual acuity,
asthenic syndrome, fatigue,
difficulty in mastering educational material,
tension headaches,
attention deficit hyperactivity disorder (ADHD),
vegetative-vascular dystonia,
cerebral angiodystonia and other diseases.

Perinatal pathology of the NS is a general definition of functional or structural disorders of the cerebral hemispheres, the source of which was various phenomena during prenatal development. Actually, it includes antenatal, intranatal and early neonatal development, which begins at 28 weeks.

In order to protect your child as much as possible from pathologies, it is important to answer the question “What is PCPNS?” It is the answers to these questions that will allow us to understand how to prevent an undesirable future for a child.

In modern medical practice, the disease of perinatal encephalopathies does not exist, however, due to the complexity of diagnostic and therapeutic measures, domestic specialists continue to use this term to define the disease.

Hypoxic ischemic damage to the central nervous system is a common source of various neurological abnormalities in children. Suspicious symptoms appear from the first days of life, but by the end of the 12th month they become more pronounced.

After this period, the neurologist is obliged to identify damage to the central nervous system, as well as develop a treatment strategy for the child. The brain of a small patient is extremely plastic, which allows for highly effective treatment.

Remember that the consequences of perinatal damage to the central nervous system will manifest themselves at all periods of life, so it is important to carry out therapy to improve future functioning.

Classification of PPCNS today

The medical literature describes two ways of causing damage to the central nervous system:

Hypoxic ischemic damage to the central nervous system during pregnancy – intrauterine;
Acute fetal hypoxic syndrome that occurs during pregnancy;

If the first class of pathologies arises due to the anatomical and morological characteristics of a woman during pregnancy, then acute labor hypoxia is most often of traumatic origin.

Perinatal damage to the nervous system is caused by multiple sources, which significantly affect the health of the baby. Sometimes such disorders do not in any way manifest themselves in the baby’s functionality, but develop in the future into serious diseases of a different origin.

The combination of two factors can sometimes lead to catastrophic consequences. This condition is called perinatal damage to the central nervous system of mixed origin. Perhaps, in some cases, a single manifestation of each cause would not lead to the development of pathology, but their simultaneous appearance leads to significant complications.

Intrauterine disorders of the central nervous system largely depend on the mother, her health and lifestyle, and responsibility for postnatal disorders lies on the shoulders of doctors delivering babies.

Common causes of pathologies

As with any other pathology, it is important to understand the causes of the disease so that effective treatments can be developed. Perinatal pathology of the nervous system can be caused by the following reasons:

Somatic disorders in the maternal body, which are accompanied by chronic intoxication;
The presence of an acute infectious disease or exacerbated chronic processes during pregnancy;
Poor nutrition or physiological immaturity of the maternal body;
Tendency to hereditary pregnancy disorders;
Unfavorable environment;
Pathological situations during delivery;

As you can see, there are many different reasons that could potentially ruin the health of your unborn child. Hypoxic ischemic damage to the central nervous system is an extremely difficult prognostic pathology, the development of which is almost impossible to predict or prevent.

Early delivery can also lead to adverse consequences. The metabolic processes of immature babies are not adapted to the independent functioning of the body, which is difficult when they are artificially “gestated.” That is why hypoxic ischemic damage to the central nervous system can appear after childbirth.

Prognostic course of the disease

Ischemic damage to the central nervous system in newborns can be accurately diagnosed after the first months of their life. An experienced doctor is able to assess not only the extent of brain damage, but also make a relatively accurate prognosis of its condition.

The outcome of PPCNSL can be of two types: complete recovery with minimal impairment of the central nervous system or severe manifestations that will require long-term or lifelong treatment by appropriate medical specialists. Each clinical case requires an individual approach in order for the effectiveness of treatment to be maximum.

In general, manifestations of cerebral ischemia in newborns have various consequences, characterized by:

Full restoration of health;
Inhibition of mental, motor or speech activity;
Neurotic deviations;
Post-traumatic abnormalities;
Autonomic-visceral dysfunctions;
Hydrocephalic syndrome;

Some deviations can ruin a patient’s future for the rest of his life, but some (for example, movement disorder syndrome) can only slightly limit the level and quality of a child’s life activity with proper treatment.

Remember that often in late childhood and adolescence, perinatal hypoxic damage to the brain can be complicated by neurotic syndromes and an inability to adapt to the surrounding society. Children will have a negative attitude towards peers with central nervous system disorders of hypoxic origin. Such actions will negatively affect the internal state of the latter.

Diagnostic measures

To make a diagnosis of perinatal CNS lesions, irrefutable data from a clinical examination are required, and all other examinations are only auxiliary and do not play a major role.

In addition, additional methodology in the study of the central nervous system has only clarifying properties to determine a more accurate source of pathology of ischemic origin, as this will allow the selection or development of organ and regionally specific therapy.

The following methodology is used as diagnostic measures to determine the origin of the source of the problem:

Neurophysiological procedures;
X-ray diagnostic procedures;

Unfortunately, today there is no single unified method that will accurately determine the source of the problem. Each method is important and unique in its own way. It is based on certain ones, which allows a comprehensive study of the pathological processes in it.

It is unacceptable to independently prescribe and carry out any diagnostic measures on your own. Although many methods are relatively safe for your baby, they can make him feel uncomfortable or anxious, which can adversely affect his mental health.

Diagnostic methods are aimed at identifying excitation in various parts and assessing it. It is important to identify the pathological origin of nerve impulses so that treatment is as accurate and effective as possible.

Therapeutic measures

Brain damage most often leads to disability of a small patient, which makes him unfit for life in modern society. Fortunately, there are modern therapeutic measures that can compensate for the baby’s pathological condition.

The general complex of treatment procedures consists of several stages:

Drug therapy;
Massage treatments;
Physical therapy exercises;
Physiotherapy;

Relatively non-standard methods of assistance are often used in the form of acupuncture and intensive pedagogical work. Extremely high demands are placed on treatment, since doctors often do not have enough time for treatment, so it is unacceptable to waste it in vain.

The greatest effectiveness is shown by physical therapy, massages and other methods of physical influence. Pharmacological therapy is used for the symptomatic treatment of seizures, hydrocephalus, etc.

There are a huge number of treatment tactics, and only an experienced pediatric neurologist can choose the best one. Often, the doctor may change the treatment plan in order to identify only the most effective techniques, which will be actively included in further therapy.

Common syndromes

CNS disorders can be general in nature, but they often manifest themselves in the form of a set of symptoms (syndrome complexes):

Increased ICP;
Disorders of nerve-reflex conductivity;
Epileptic seizures;
Minimizing brain activity;

Despite the fact that these syndromes have quite unpleasant manifestations, modern medicine is able to effectively hide them and subject them to at least minimal treatment. Pharmacological drugs can stabilize the patient's condition, allowing him to lead a relatively normal life.

So, despite the fact that pregnancy and childbirth are physiological processes, there are a number of different complications that can ruin the life of your heir.

Perinatal pathologies of the nervous system are rare, but it is impossible to calculate and predict their occurrence. Even if you are faced with a similar pathology, do not despair!

A competent medical specialist, using all the achievements of modern medicine, is able to stabilize the baby’s condition so that he can lead a normal life. Remember that only together with your child will you be able to overcome all the difficulties encountered on your common path in life.

Despite the variety of causes leading to perinatal damage to the nervous system during the course of the disease, three periods are distinguished:

acute - 1st month of life);
restorative, which is divided into early (from the 2nd to the 3rd month of life) and late (from 4 months to 1 year in full-term infants, up to 2 years in premature infants);
outcome of the disease.

In each period, perinatal injuries have different clinical manifestations, which doctors are accustomed to distinguishing in the form of various syndromes (a set of clinical manifestations of the disease, united by a common characteristic). In addition, one child often has a combination of several syndromes. The severity of each syndrome and their combination make it possible to determine the severity of damage to the nervous system, correctly prescribe treatment and make predictions for the future.

Acute syndromes

Acute period syndromes include: central nervous system depression syndrome, comatose syndrome, syndrome of increased neuro-reflex excitability, convulsive syndrome, hypertensive-hydrocephalic syndrome.

With mild injuries to the central nervous system in newborns, the most common syndrome of increased neuro-reflex excitability which is manifested by shuddering, increased (hypertonicity) or decreased (hypotonic) muscle tone, increased reflexes, tremor (shaking) of the chin and limbs, restless shallow sleep, frequent “causeless” crying.

With moderate damage to the central nervous system in the first days of life, children more often have CNS depression in the form of decreased motor activity and decreased muscle tone, weakened reflexes of newborns, including sucking and swallowing reflexes. By the end of the 1st month of life, depression of the central nervous system gradually disappears, and in some children it is replaced by increased excitement. With an average degree of damage to the central nervous system, disturbances in the functioning of internal organs and systems are observed ( vegetative-visceral syndrome) in the form of uneven coloring of the skin (marbling of the skin) due to imperfect regulation of vascular tone, disturbances in the rhythm of breathing and heart contractions, dysfunction of the gastrointestinal tract in the form of unstable stools, constipation, frequent regurgitation, flatulence. May occur less frequently convulsive syndrome, in which paroxysmal twitching of the limbs and head, episodes of shuddering and other manifestations of seizures are observed.

Often, children in the acute period of the disease develop signs hypertensive-hydrocephalic syndrome, which is characterized by excess fluid accumulation in the spaces of the brain containing cerebrospinal fluid, which leads to increased intracranial pressure. The main symptoms that the doctor notes and that parents may suspect are the rapid rate of increase in the child’s head circumference (more than 1 cm per week), large size and bulging of the large fontanelle, divergence of cranial sutures, restlessness, frequent regurgitation, unusual eye movements (a kind of trembling of the eye apples when looking away to the side, up, down - this is called nystagmus), etc.

Sharp depression of the activity of the central nervous system and other organs and systems is inherent in the extremely serious condition of a newborn with development comatose syndrome(lack of consciousness and coordinating function of the brain). This condition requires emergency care in intensive care.

Recovery period syndromes

In the recovery period of perinatal lesions of the central nervous system, the following syndromes are distinguished: syndrome of increased neuro-reflex excitability, epileptic syndrome, hypertensive-hydrocephalic syndrome, syndrome of vegetative-visceral dysfunctions, syndrome of motor disorders, syndrome of delayed psychomotor development. Long-term disorders of muscle tone often lead to delayed psychomotor development in children, because disturbances in muscle tone and the presence of pathological motor activity - hyperkinesis (involuntary movements caused by contraction of the muscles of the face, trunk, limbs, less often the larynx, soft palate, tongue, external muscles of the eyes) prevent the performance of purposeful movements and the formation of normal motor functions in the baby. When motor development is delayed, the child later begins to hold his head up, sit, crawl, and walk. Poor facial expressions, late appearance of a smile, decreased interest in toys and environmental objects, as well as a weak monotonous cry, delayed appearance of humming and babbling should alert parents to the delay in mental development of the baby.

Outcomes of the disease

By the age of one year, in most children, manifestations of perinatal lesions of the central nervous system gradually disappear or their minor manifestations persist. Common consequences of perinatal lesions include:

delayed mental, motor or speech development;
cerebroasthenic syndrome (it is manifested by mood swings, motor restlessness, anxious restless sleep, weather dependence);
Attention deficit hyperactivity disorder is a disorder of the central nervous system, manifested by aggressiveness, impulsivity, difficulty concentrating and maintaining attention, learning and memory disorders.

The most unfavorable outcomes are epilepsy, hydrocephalus, and cerebral palsy, indicating severe perinatal damage to the central nervous system.

In the diagnosis, the doctor must necessarily reflect the suspected causes of damage to the central nervous system, the severity, syndromes and period of the disease.

In order to diagnose and confirm perinatal damage to the central nervous system in children, in addition to a clinical examination, additional instrumental studies of the nervous system are performed, such as neurosonography, Dopplerography, computed tomography and magnetic resonance imaging, electroencephalography, etc.

Recently, the most accessible and widely used method of examining children in the first year of life is neurosonography (ultrasound examination of the brain), which is carried out through the large fontanel. This study is harmless and can be repeated in both full-term and premature babies, allowing one to observe the processes occurring in the brain over time. In addition, the study can be carried out on newborns in serious condition who are forced to stay in the intensive care unit in incubators (special beds with transparent walls that allow for a certain temperature regime and control the condition of the newborn) and on mechanical ventilation (artificial respiration through a machine). Neurosonography allows you to assess the state of the brain substance and cerebrospinal fluid tracts (brain structures filled with fluid - cerebrospinal fluid), identify developmental defects, and also suggest possible causes of damage to the nervous system (hypoxia, hemorrhage, infections).

If a child has severe neurological disorders in the absence of signs of brain damage on neurosonography, such children are prescribed more accurate methods of studying the central nervous system - computed tomography (CT) or magnetic resonance imaging (MRI). Unlike neurosonography, these methods allow you to evaluate the smallest structural changes in the brain and spinal cord. However, they can only be carried out in a hospital, since during the study the baby should not make active movements, which is achieved by administering special medications to the child.

In addition to studying the structures of the brain, recently it has become possible to assess blood flow in the cerebral vessels using Doppler sonography. However, the data obtained during its implementation can only be taken into account in conjunction with the results of other research methods.

Electroencephalography (EEG) is a method for studying the bioelectrical activity of the brain. It allows you to assess the degree of brain maturity and suggest the presence of a convulsive syndrome in the baby. Due to the immaturity of the brain in children in the first year of life, a final assessment of EEG indicators is possible only if this study is repeatedly carried out over time.

Thus, the diagnosis of perinatal lesions of the central nervous system in a baby is established by the doctor after a thorough analysis of data on the course of pregnancy and childbirth, the condition of the newborn at birth, the presence of disease syndromes identified in him, as well as data from additional research methods. In the diagnosis, the doctor will necessarily reflect the suspected causes of damage to the central nervous system, the severity, syndromes and period of the disease.

Why do disturbances in the functioning of the central nervous system occur?

Analyzing the causes leading to disturbances in the functioning of the central nervous system of a newborn, doctors distinguish four groups of perinatal lesions of the central nervous system:

hypoxic lesions of the central nervous system, in which the main damaging factor is hypoxia (lack of oxygen);
traumatic lesions resulting from mechanical damage to the tissues of the brain and spinal cord during childbirth, in the first minutes and hours of a child’s life;
dysmetabolic and toxic-metabolic lesions, the main damaging factor of which is metabolic disorders in the child’s body, as well as damage resulting from the use of toxic substances by the pregnant woman (medicines, alcohol, drugs, smoking);
lesions of the central nervous system in infectious diseases of the perinatal period” when the main damaging effect is exerted by an infectious agent (viruses, bacteria and other microorganisms).

Help for children with central nervous system injuries

In connection with the possibilities of early diagnosis of perinatal lesions of the central nervous system, treatment and rehabilitation of these conditions should be carried out as early as possible, so that the therapeutic effects occur in the first months of the baby’s life, when the disorders are still reversible. It should be said that the ability of the child’s brain to restore impaired functions, as well as the capabilities of the entire organism as a whole, is very great during this period of life. It is in the first months of life that it is still possible for the ripening of nerve cells in the brain to replace those lost after hypoxia, the formation of new connections between them, due to which in the future the normal development of the body as a whole will be determined. I would like to note that even minimal manifestations of perinatal lesions of the central nervous system require appropriate treatment for preventing adverse outcomes of the disease.

Providing assistance to children with central nervous system injuries is carried out in three stages.

First stage involves assistance provided in a maternity hospital (maternity ward, intensive care unit, neonatal intensive care unit) and includes restoration and maintenance of vital organs (heart, lungs, kidneys), normalization of metabolic processes, treatment of central nervous system damage syndromes (depression or excitation , seizures, cerebral edema, increased intracranial pressure, etc.). It is at the first stage of care that the main treatments for children with severe central nervous system injuries are medications and intensive (for example, artificial ventilation) therapy.

During treatment, the children's condition gradually improves, however, many symptoms of central nervous system damage (impaired muscle tone, reflexes, fatigue, anxiety, dysfunction in the lungs, heart, gastrointestinal tract) may persist, which requires transfer of children to second stage of treatment and rehabilitation, namely, to the department of pathology of newborns and premature infants or to the neurological department of a children's hospital.

At this stage, drugs are prescribed that are aimed at eliminating the cause of the disease (infections, toxic substances) and affecting the mechanism of development of the disease, as well as drugs used to treat certain syndromes of central nervous system damage. These are drugs that improve the nutrition of nerve cells, stimulate the maturation of brain tissue, improve microcirculation 2 and cerebral circulation, reduce muscle tone, etc. In addition to drug therapy, in full-term children, while their condition improves from the end of the 3rd week of life (in premature children - several later) a course of massage with the gradual addition of therapeutic exercises, electrophoresis sessions and other rehabilitation methods may be prescribed.

After completing the course of treatment, most children are discharged home with recommendations for further observation in a children's clinic ( third stage of rehabilitation). The pediatrician, together with a neurologist, and, if necessary, with other specialized specialists (ophthalmologist, otolaryngologist, orthopedist, psychologist, physiotherapist, etc.), draws up an individual plan for monitoring the child in the first year of life. During this period, non-drug rehabilitation methods begin to acquire increasing importance, such as massage, therapeutic exercises, electrophoresis, pulsed currents, acupuncture, thermal procedures, balneotherapy (therapeutic baths), swimming, as well as psychological and pedagogical correction methods aimed at developing motor skills. , speech and psyche of the child.

If the damage to the central nervous system is not severe and the baby is discharged from the maternity ward home, it is important to create a therapeutic and protective regime during the acute period of the disease. This means protecting the child from unnecessary irritants (loud sound of the radio, TV, loud conversations), creating conditions for thermal comfort (avoiding both overheating and hypothermia), not forgetting to regularly ventilate the room in which the baby is located. In addition, the child should be protected as much as possible from the possibility of any infection by limiting visits to the newborn by friends and relatives.

Particular attention should be paid to proper nutrition, as it is a powerful healing factor. Breast milk contains all the necessary nutrients for the full development of the baby. Early transfer to artificial feeding leads to the early onset and more frequent development of infectious diseases. Meanwhile, the protective factors of mother's milk are able to partially compensate for the lack of their own immune factors during this period of development, allowing the baby to direct all its compensatory capabilities to restore impaired functions after suffering hypoxia. And the biologically active substances, hormones, and growth factors contained in breast milk can activate the recovery processes and maturation of the central nervous system. In addition, maternal touch during breastfeeding is an important emotional stimulant that helps reduce stress, and therefore a more complete perception of the world around the child.

Premature babies and children born with severe damage to the central nervous system are often forced to be fed through a tube or bottle in the first days of life. Don't despair, but try to preserve breast milk by regularly expressing it and giving it to your baby. As soon as your baby's condition improves, he will definitely be attached to his mother's breast.

An important place in the recovery period is occupied by therapeutic massage and gymnastics, which normalize muscle tone, improve metabolic processes, blood circulation, thereby increasing the overall reactivity of the body, and promote the psychomotor development of the child. A massage course includes from 10 to 20 sessions. Depending on the severity of the central nervous system lesion, at least 3-4 courses of massage are carried out in the first year of life with an interval of 1-1.5 months. At the same time, parents continue to practice therapeutic gymnastics with their child between courses at home, having previously learned during the classes.

Methods of massage and therapeutic exercises depend, first of all, on the nature of motor disorders, the characteristics of changes in muscle tone, as well as the predominance of certain syndromes of central nervous system damage.

Thus, for hyperexcitability syndrome, techniques are used aimed at reducing general excitability (rocking in the fetal position or on a ball) and muscle tone (relaxing massage with elements of acupressure). At the same time, in children with signs of depression of the nervous system, a strengthening massage of the muscles of the back, abdomen, gluteal muscles, as well as relaxed arms and legs is used.

Massage and therapeutic exercises create favorable conditions for the overall development of the child and accelerate the development of motor functions (mastering skills such as raising and holding the head, turning on the side, stomach, back, sitting, crawling, walking independently). Particular importance is given to training on inflatable objects - balls, rollers (rollers). They are used to develop vestibular functions, help relax tense muscles and strengthen relaxed muscles, and water. In this case, the exercises are carried out in ordinary baths, their duration initially is 5-7 minutes and gradually increases to 15 minutes. At the beginning of the course, it is advisable to undergo training with a medical instructor, and then it is possible to conduct classes in a home bath. Water not only tones weak muscles and relaxes tense ones, stimulates metabolism and blood circulation, has a hardening effect, but also has a calming effect on the baby’s nervous system. It should be noted that increased intracranial pressure in children is not a contraindication to swimming - in this case, diving should only be excluded.

It is also possible to carry out a stimulating underwater shower-massage in a warm bath. In this case, water entering through a wide tip under low pressure (0.5 atmospheres) has a massaging effect on the muscles. To do this, a stream of water is slowly moved from the periphery to the center at a distance of 10-20 cm from the surface of the body. This massage is performed in a hospital or clinic setting.

Among water procedures that have therapeutic effects, balneotherapy is used for children with perinatal lesions of the central nervous system - taking medicinal baths. Due to the characteristics of children's skin (high permeability, rich vascular network, abundance of nerve endings - receptors), medicinal baths are especially effective. Under the influence of salts dissolved in water, blood circulation and metabolism in the skin, muscles and the entire body increase. Parents can carry out these procedures independently at home, having received doctor’s recommendations. Salt baths are prepared at the rate of 2 tablespoons of sea or table salt per 10 liters of water, water temperature 36°C. Procedures are taken from 3-5 to 10-15 minutes every other day, the course of treatment is 10-15 baths. In excitable children, it is often recommended to add conifers to salt baths, as well as baths with decoctions of valerian and motherwort, which have a calming effect on the central nervous system.

Among the methods of physiotherapy, the most commonly used are medicinal electrophoresis, pulsed currents, inductothermy, ultrasound, etc. The introduction of medicinal substances into the body using direct current (electrophoresis) improves blood circulation in tissues and muscle tone, promotes the resorption of foci of inflammation, and when applied to the collar area improves cerebral circulation and brain activity. The impact of pulsed currents of various characteristics can have both an exciting and an inhibitory effect on muscles, which is often used in the treatment of paresis and paralysis.

In the treatment of perinatal lesions of the central nervous system in children, local thermal procedures (heat therapy) are also used by applying ozokerite (mountain wax), paraffin or sand bags to the affected areas. Thermal effects cause tissue warming, vasodilation, increasing blood circulation and metabolism; in addition, restoration processes are activated and muscle tone decreases. To do this, ozokerite preheated to 39-42°C is applied to the site of exposure, covered with a blanket and left to act for 15-30 minutes, depending on age. Procedures are carried out every other day in the amount of 15-20 per course of treatment.

Impact on particularly sensitive points in order to stimulate reflexes is carried out using the method of acupuncture. In this case, the effects can be carried out with an acupuncture (used in acupuncture) needle, pulsed electric current, laser radiation or a magnetic field.

With the beginning of the recovery period of the disease, it is necessary to gradually expand auditory, visual, and emotional contacts with the baby, since they are a kind of non-drug “nootrophs” - stimulants for the developing brain. These are toys, educational mats and complexes, books and pictures, individually selected music programs recorded on a tape recorder, and of course mother’s songs.

However, it should be remembered that excessive enthusiasm for early development programs can lead to fatigue and breakdown of the baby’s not yet fully strengthened nervous system. Therefore, show moderation and patience in everything, and even better, do not forget to discuss all undertakings with your doctor. Remember - your child's health is in your hands. So do not spare time and effort to restore the injured baby.

New medicine for baby rehabilitation

New methods of rehabilitation of children with central nervous system lesions include the technique of soft vibration massage in zero gravity conditions (Saturn rehabilitation crib). To do this, the child is placed on an individual diaper in a “pseudo-fluid” made of glass microbeads heated to the required temperature, moving in the bed under the influence of the air flow. A buoyancy effect is created (close to intrauterine), in which up to 65% of the child’s body surface is immersed in “pseudo-fluid”. In this case, the gentle massage effect of microballs on the skin leads to irritation of peripheral nerve endings and transmission of impulses to the central nervous system, which provides treatment for paralysis.

Another new method of rehabilitation is the “dry immersion” method, which also creates the effect of partially simulating the intrauterine state of a child. In this case, the babies are placed on a plastic film, freely lying on the swaying surface of water with a temperature of 35 ~ 37 ° C. During the session, excited children calm down and often fall asleep, which contributes to a decrease in muscle tone,” while children with central nervous system depression become somewhat more active.

1 Perinatal - Referring to the period beginning a few weeks before the birth of the child, including the moment of his birth and ending a few days after the birth of the child. This period lasts from the 28th week of pregnancy to the 7th day after the birth of the child.

2 The movement of blood through the smallest vessels of the body for the purpose of better delivery of oxygen and nutrients to the cells, as well as the removal of cell metabolic products

Perinatal damage to the nervous system is precisely this diagnosis that is increasingly being made to newborn babies. Behind these words lies a fairly large group of various lesions of the brain and spinal cord that occur during pregnancy and birth of a baby, as well as in the first days of his life.

Periods of the disease
During this disease, despite the variety of causes that cause it, it is customary to distinguish three periods: acute (1st month of life), recovery, which is divided into early (from 2nd to 3rd months of life) and late (from 4 months up to 1 year in full-term infants, up to 2 years in premature infants), and the outcome of the disease. In each of these periods, perinatal injuries have different clinical manifestations - syndromes, and several of them may be present simultaneously in one child. The severity of each syndrome and their combination make it possible to determine the severity of damage to the nervous system, prescribe the correct treatment and predict the further development of the disease.

Acute syndromes
Acute period syndromes include comatose, convulsive, hypertensive-hydrocephalic syndromes, as well as central nervous system depression and increased neuro-reflex excitability.
With mild damage to the central nervous system in newborns, a syndrome of increased neuro-reflex excitability is most often observed, which is manifested by shuddering, increased (hypertonicity) or decreased (hypotonic) muscle tone, increased reflexes, tremor (trembling) of the chin and limbs, restless shallow sleep, frequent causeless crying .
With moderate damage to the central nervous system in the first days of life, depression of the central nervous system occurs in the form of decreased motor activity and muscle tone, weakened reflexes of newborns, including sucking and swallowing. By the end of the 1st month of life, depression of the central nervous system gradually disappears, and in some children it is replaced by increased arousal. With an average degree of damage to the central nervous system, disturbances in the functioning of internal organs and systems are observed (vegetative-visceral syndrome). Due to imperfect regulation of vascular tone, uneven coloring (marbling) of the skin appears. In addition, there are disturbances in the rhythm of breathing and heart contractions and dysfunction of the gastrointestinal tract in the form of unstable stools, constipation, frequent regurgitation, and flatulence.
Often, children in the acute period of the disease show signs of hypertensive-hydrocephalic syndrome, which is characterized by excessive accumulation of fluid in the spaces of the brain containing cerebrospinal fluid, which leads to increased intracranial pressure. The main symptoms that can be noticed not only by doctors, but also by parents are the rapid growth rate of the child’s head circumference (more than 1 cm per week), significant size and bulging of the large fontanelle, divergence of cranial sutures, restlessness, frequent regurgitation, unusual eye movements (nystagmus). ).
A sharp depression of the activity of the central nervous system and other organs and systems is inherent in the extremely serious condition of a newborn with the development of coma syndrome (lack of consciousness and coordinating function of the brain). This condition requires emergency care in intensive care.

Recovery period syndromes
During the recovery period, parents should be alert to poor facial expressions, late appearance of a smile, decreased interest in toys and environmental objects, as well as a weak monotonous cry, delayed appearance of humming and babbling. Perhaps all this is a consequence of lesions of the central nervous system, in which, among others, syndromes of motor disorders and delayed psychomotor development occur.

Outcomes of the disease
By the age of one year, in most children, manifestations of perinatal CNS lesions gradually disappear. Common consequences of perinatal lesions include:
. delayed mental, motor or speech development;
. cerebroasthenic syndrome (mood swings, motor restlessness, anxious sleep, weather dependence);
. attention deficit hyperactivity disorder: aggressiveness, impulsivity, difficulty concentrating and maintaining attention, learning and memory disorders.
The most unfavorable outcomes are epilepsy, hydrocephalus, and cerebral palsy, indicating severe perinatal damage to the central nervous system.

Causes of disturbances in the functioning of the central nervous system
Experts distinguish four groups of perinatal lesions of the central nervous system:
1) hypoxic, in which the main damaging factor is hypoxia (lack of oxygen);
2) traumatic, resulting from mechanical damage to the tissues of the brain and spinal cord during childbirth in the first minutes and hours of the child’s life;
3) dismetabolic and toxic-metabolic, the main damaging factor of which is metabolic disorders in the child’s body, as well as damage resulting from the use of toxic substances by a pregnant woman (medicines, alcohol, drugs, smoking);
4) damage to the central nervous system during infectious diseases of the perinatal period, when the main damaging effect is exerted by an infectious agent (viruses, bacteria and other microorganisms).

Help for children with central nervous system lesions
Infants with damage to the central nervous system need treatment and rehabilitation as early as possible, since in the first months of a child’s life many of the disorders are reversible without serious consequences. It is during this period that the regenerative abilities of the child’s body are especially great: it is still possible for the nerve cells of the brain to mature to replace those lost after hypoxia, and for the formation of new connections between them, which will be responsible for the normal development of the baby.
First aid is provided to babies in the maternity hospital. This stage includes restoration and maintenance of vital organs (heart, lungs, kidneys), normalization of metabolic processes, treatment of central nervous system damage syndromes (depression or excitation, seizures, cerebral edema, increased intracranial pressure). The basis of treatment is medication and intensive therapy.
During treatment, the child's condition gradually improves, however, many symptoms of central nervous system damage may persist, which requires transfer to the pathology department of newborns and premature infants or to the neurological department of a children's hospital. At the second stage of treatment, drugs are prescribed aimed at eliminating the cause of the disease (infections, toxic substances) and affecting the mechanism of development of the disease, as well as drugs that stimulate the maturation of brain tissue, reduce muscle tone, improve the nutrition of nerve cells, cerebral circulation and microcirculation.
In addition to drug therapy, when the condition improves, a course of massage with the gradual addition of therapeutic exercises, electrophoresis sessions and other rehabilitation methods are prescribed (for full-term infants - from the end of the 3rd week of life, for premature infants - a little later).
After completing the course of treatment, most children are discharged home with recommendations for further observation in a children's clinic (third stage of rehabilitation). The pediatrician, together with a neurologist, and, if necessary, with other specialized specialists (ophthalmologist, otolaryngologist, orthopedist, psychologist, physiotherapist), draws up an individual plan for managing the child in the first year of life. During this period, non-drug rehabilitation methods are most often used: massage, therapeutic exercises, electrophoresis, pulsed currents, acupuncture, thermal procedures, balneotherapy (therapeutic baths), swimming, as well as psychological and pedagogical correction aimed at developing the baby’s motor skills, speech and psyche.

Parents whose baby was born with signs of a central nervous system disorder should not despair. Yes, you will have to put in much more effort than other moms and dads, but in the end they will pay off, and the reward for this work will be the happy smile of the little man.