Preparation for stool testing for occult blood. How to properly prepare and test feces for occult blood

Introduction: birth trauma (BI) in the structure of morbidity in newborns is 26.3–1.9%, and in deceased full-term newborns – 37.9%. Perinatal lesions of the nervous system lead to disability in 35–40% of cases due to both mechanical damage and various disorders of cerebral hemodynamics. Treatment of RT in newborns is carried out differentially, taking into account the type and severity of damage.
Target: to determine the structure of RT in our clinic and identify the main risk factors influencing its formation.
Material and methods:
results: 132 children were born with RT, which accounted for 10.1% of the total incidence. When analyzing the structure of PT, it was revealed that the most common PT of the skull were cephalohematomas (65 newborns (49.3%)), in 2nd place - fractures of the clavicle (31 children (23.5%)), in 3rd place - injuries central and peripheral nervous system: 4 (3%) newborns had Erb's paresis, 17 (12.8%) had lesions of the cervical vertebrae, 15 (11.4%) children had combined RT. Four newborns were born by caesarean section (10.5%), the remaining 118 were born via vaginal birth. Of the total number of newborns, 128 (97.4%) were full-term, 4 (2.6%) were premature. When analyzing the birth histories of postpartum women whose births ended with the formation of the newborn's PT, the following most common complications of pregnancy were identified: preeclampsia - in 34 (26%) postpartum women, narrow pelvis - in 7 (5.3%), fetal weight exceeded the average in 59 (44.7%) cases.
conclusions: the main risk factors influencing the formation of PT in newborns are pregnancy complications such as large fetal weight and preeclampsia, as well as some complications of labor: premature rupture of amniotic fluid, labor anomalies, disruption of the biomechanism of labor.

Keywords: birth trauma, cephalohematoma, cerebral palsy, clavicle fracture, preeclampsia.

For citation: Maiseenko D.A., Polonskaya O.V. Birth trauma of a newborn: the problem of obstetrics and neonatology // RMZh. 2016. No. 15. pp. 998–1000.

For citation: Maiseenko D.A., Polonskaya O.V. Birth trauma of a newborn: the problem of obstetrics and neonatology // RMZh. Mother and child. 2016. No. 15. pp. 998-1000

Neonatal birth injuries, the problem of obstetrics and neonatology
Maiseenko D.A. 1, Polonskaya O.V. 2

1 Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky
2 Maternity hospital, City Clinical Hospital No. 20 named after I.S. Berzon, Krasnoyarsk

Background. Birth injury takes 26.3 -41.9% in the structure of neonatal morbidity and 37.9% - of dead full-term newborns. Perinatal nervous system lesions lead to disability in 35 - 40% of cases due to mechanical damages and cerebral hemodynamics disorders. Birth injuries are treated differently according to the type and severity of damage.
Objective: to determine birth injury structure in our clinic and to identify main risk factors of its formation.
material and methods. Retrospective analysis of 132 clinical records of newborns with birth injury, who were born in 2013in maternity hospital of City Clinical Hospital No. 20 named after I.S. Berzon was conducted.
Results. 132 children were born with birth injury, (10.1%). Most frequent birth injuries are birth skull defects - cephalohematoma in 65 (49.3%) infants, fractured clavicle - 31 (23.5%), injury of central and peripheral nervous system (Erb's palsy in 4 (3%) and damage of cervical vertebrae in 17 (12.8%); combined birth injury in 15 (11.4%). Four infants (10.5%) were born by cesarean section and 118 infants were born vaginally. The total number of full-term births was 128 (97.4%), premature births - 4 (2.6%). The analysis of clinical records of women who gave birth to infants with birth injury, revealed the most common pregnancy complications: preeclampsia - in 34 (26%), narrow pelvis - in 7 (5.3%), high birth weight - in 59 (44.7%).
Conclusions. Main risk factors influencing the formation of birth injury, are such pregnancy complications as high birth weight, preeclampsia as well as some complications during delivery (premature rupture of membranes, labor anomaly, birth biomechanism disorder.

Key words: birth injury, cephalohematoma, cerebral palsy, fractured clavicle, preeclampsia.

For citation: Maiseenko D.A., Polonskaya O.V. Neonatal birth injuries, the problem of obstetrics and neonatology // RMJ. 2016. No. 15. P. 998–1000.

The article highlights the problem of birth trauma of a newborn

Relevance: RT in the structure of morbidity in newborns is 26.3–41.9%, and in deceased full-term newborns – 37.9%. According to E.P. Sushko et al., the incidence of RT is 3–8% among all born children. Perinatal lesions of the nervous system lead to disability in 35–40% of cases. Among all the perinatal factors contributing to the development of cerebral palsy and other lesions of the nervous system in children, the most important is the birth traumatic factor, which causes both mechanical damage and various disorders of cerebral hemodynamics.
PT of newborns - various damage to the fetus that occurs during the birth process. Among newborn PTs, there are injuries to soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous systems. PT of newborns is diagnosed taking into account the mother’s obstetric and gynecological history, characteristics of the course of labor, examination data of the newborn and additional studies (EEG, ultrasound, radiography, ophthalmoscopy, etc.). Treatment of RT in newborns is carried out differentially, taking into account the type and severity of damage.
RTs are diagnosed in 8–11% of newborns and are often combined with maternal birth injuries (ruptures of the vulva, vagina, perineum, uterus, genitourinary and vagina-rectal fistulas, etc.).
The causes of birth trauma during pregnancy can be: the presence of extragenital pathology, pregnancy complications, especially chronic uteroplacental insufficiency, leading to chronic fetal hypoxia and malnutrition, low social status and bad habits of the pregnant woman, such as smoking, alcohol abuse, drug addiction . Poor nutrition of the pregnant woman and occupational hazards also play a role.
During labor, the formation of PT in newborns is influenced by: excessive force of muscle contractions of the uterus in a situation predisposing to injury, anomalies in the location of the fetus, its large mass, reduction in size and rigidity of the birth canal, prolonged, rapid and rapid labor.
Predisposing conditions (prolonged hypoxia, malnutrition and fetal growth, intrauterine infections, prematurity) during pregnancy and childbirth increase the likelihood of birth trauma even during normal labor.
An important role in the occurrence of RT is played by a violation of the biomechanism of labor during labor, especially with breech presentation of the fetus and extensor insertions, and errors in the provision of obstetric care in the second stage of labor.
PT in newborns can have a serious impact on the subsequent physical health and intellectual development of the child. All this makes birth trauma one of the most pressing problems in obstetrics and gynecology, neonatology and pediatrics, child neurology and traumatology.

Clinical forms of birth trauma in newborns
Depending on the location of the damage and the predominant dysfunction, the following types of RT in newborns are distinguished:
– soft tissues (skin, subcutaneous tissue, muscles, birth tumor);
– osteoarticular system (cracks and fractures of the clavicle, humerus and femur; traumatic epiphysiolysis of the humerus, subluxation of the CI-CII joints, damage to the skull bones, cephalohematoma, etc.);
– internal organs (hemorrhages in internal organs: liver, spleen, adrenal glands);
– central and peripheral nervous system:
a) intracranial (epidural, subdural, subarachnoid, intraventricular hemorrhages);
b) spinal cord (hemorrhages in the spinal cord and its membranes);
c) peripheral nervous system (damage to the brachial plexus - Duchenne-Erb paresis/palsy or Dejerine-Klumpke palsy, total paralysis, diaphragm paresis, damage to the facial nerve, etc.).
Target: determine the structure of RT in our clinic and identify the main risk factors influencing its formation.
Material and methods: A retrospective analysis of 132 histories of newborns with RT who were born in the maternity hospital of the KMKB No. 20 named after. I.S. Berzon" in 2013
Results and its discussion: in the maternity hospital in 2013, 2820 children were born alive, of which 1306 were born with various diseases. 132 children were born with RT, which accounted for 10.1% of the total incidence. Birth trauma ranks 6th in the structure of overall morbidity. Compared to 2012, in 2013 the percentage of injuries was slightly lower (in 2012, 2993 children were born, of which 158 were born with injuries, which accounted for 11% of the total incidence) (Fig. 1).

Probably, the reasons for the decrease in birth injuries are an increase in the level of qualifications of personnel, changes in approaches to the management of childbirth, taking into account the developed clinical protocols of the Ministry of Health of the Russian Federation.
Among the 132 children born with injuries, there were 59 (44.8%) boys and 73 (55.2%) girls. 74 newborns with concomitant diseases and associated injuries were transferred to the hospital. The remaining 58 children were discharged home under the supervision of a local pediatrician.
In the maternity hospital structure in the Republic of Tatarstan in 2013, the leading place is occupied by cephalohematomas (49.3%) and clavicle fractures (23.5%) (Fig. 2).

Four newborns (10.5%) were born by cesarean section, the remaining 118 were delivered vaginally. Of the total number of newborns, 128 (97.4%) were full-term, 4 (2.6%) were premature.
When analyzing the structure of the PT, the most common PTs of the skull are: cephalohematomas in 65 (49.3%) newborns, in 2nd place - fractures of the clavicle (31 (23.5%) children), in 3rd place - injuries of the central and peripheral nervous system: 4 (3%) had Erb's paresis, 17 (12.8%) had lesions of the cervical vertebrae, 15 (11.4%) had combined RT.
From the above it follows that most often in children with RT complications of the early neonatal period such as asphyxia (15.9%) and neonatal jaundice (23.5%) were recorded (Table 1). This is probably due to the fact that a predisposing factor in the development of these complications is intrauterine hypoxia.

When analyzing birth histories that resulted in the formation of the newborn's PT, the following most common complications of pregnancy were identified: preeclampsia - in 34 (26%) postpartum women, narrow pelvis - in 7 (5.3%), fetal weight exceeded the average in 59 (44 .7%) cases (Fig. 3).

Among the complications of childbirth, violations of the biomechanism of labor were identified in 21 (15.8%) cases, primary weakness of labor - in 10 (7.9%). A characteristic feature was the presence of premature rupture of amniotic fluid (both prenatal and early) in many of the examined postpartum women (45 (34.2%)). In 3 cases, labor was rapid (Fig. 3).
Thus, the main risk factors influencing the formation of PT in newborns are pregnancy complications, especially large fetal weight, preeclampsia, accompanied by uteroplacental insufficiency, and among the complications of labor, premature rupture of amniotic fluid, labor abnormalities, and disruption of the biomechanism of labor are noted. Therefore, in a modern maternity hospital, in order to reduce birth injuries, it is necessary:
– carry out early diagnosis of fetal hypoxia;
– carry out rational management of childbirth with a large fetal mass with a timely solution to the issue of changing labor tactics;
– constantly improve the professional skills of doctors and midwives in providing obstetric care;
– introduce modern perinatal technologies and achievements of clinical neonatology into practice.

Literature

1. Kravchenko E.N. Birth trauma: obstetric and perinatal aspects. M.: GEOTAR-Media, 2009. 240 p. .
2. Zedgenizova E.V., Ivanov D.O., Priyma N.F., Petrenko Yu.V. Features of cerebral blood flow and central hemodynamics in children born with intrauterine growth retardation (IUGR) // Bulletin of the Federal Center for Heart, Blood and Endocrinology named after. V.A. Almazova. 2012. No. 3. P. 76–82.
3. Ivanov D.O. Neurological disorders in premature infants who suffered an infectious-septic process in the neonatal period // Bulletin of the Federal Center for Heart, Blood and Endocrinology named after. V.A. Almazova. 2012. No. 1. pp. 69–73.
4. Kurzina E.A., Zhidkova O.B., Ivanov D.O. and others. Prediction of health status in follow-up in children who have suffered severe perinatal pathology // Children's Medicine of the North-West. 2010. No. 1. P. 22–27.
5. Surkov D.N., Kapustina O.G., Duka I.G. and others. Post-mortem diagnosis of birth injury: tear of the tentorium in a full-term newborn with severe bronchopulmonary dysplasia // Translational Medicine. 2012. No. 4 (15). C. 42–46.

– various damage to the fetus that occurs during labor. Among birth injuries of newborns, there are injuries to soft tissues (skin, subcutaneous tissue, muscles), skeletal system, internal organs, central and peripheral nervous systems. Birth trauma in newborns is diagnosed taking into account the mother's obstetric and gynecological history, characteristics of the course of labor, examination data of the newborn and additional studies (EEG, ultrasound, radiography, ophthalmoscopy, etc.). Treatment of birth injuries in newborns is carried out differentially, taking into account the type and severity of the injury.

Classification of birth trauma in newborns

Depending on the location of the damage and the predominant dysfunction, the following types of birth trauma in newborns are distinguished:

1. Birth injuries of soft tissues(skin, subcutaneous tissue, muscles, birth tumor, cephalohematoma).

2. Birth injuries of the osteoarticular system(cracks and fractures of the clavicle, humerus and femur; traumatic epiphysiolysis of the humerus, subluxation of the C1 and C2 joints, damage to the skull bones, etc.)

3. Birth injuries of internal organs(hemorrhages in internal organs: liver, spleen, adrenal glands).

4. Birth injuries of the central and peripheral nervous system in newborns:

• intracranial birth injury (epidural, subdural, subarachnoid, intraventricular hemorrhages)
• birth injury of the spinal cord (hemorrhages in the spinal cord and its membranes)
• birth injury of the peripheral nervous system (brachial plexus damage - Duchenne-Erb paresis/palsy or Dejerine-Klumpke palsy, total paralysis, diaphragm paresis, facial nerve damage, etc.).

Causes of birth trauma in newborns

Analysis of the causes of birth trauma in newborns allows us to identify three groups of factors that increase the likelihood of its occurrence: those related to the mother, to the fetus, as well as to the course and management of labor.

Predisposing “maternal” factors may include early or late reproductive age, preeclampsia, narrow pelvis, hypoplasia or hyperanteflexia of the uterus, diseases of the pregnant woman (cardiovascular, endocrine, gynecological, etc.), post-term pregnancy, occupational hazards, etc.

The most extensive group of causes leading to birth trauma in newborns are circumstances related to the fetus. Birth trauma can be provoked by breech presentation of the fetus, oligohydramnios, incorrect (asynclitic or extensor insertion of the head), prematurity, large fetal size, fetal development abnormalities, intrauterine hypoxia and asphyxia, etc.

Birth trauma in a newborn can be caused by labor anomalies: prolonged or rapid labor, labor stimulation during weak labor, discoordinated or excessively strong labor. A serious group of causes of birth injuries in newborns is the incorrect or unreasonable use of obstetric aids (rotation of the fetus, application of obstetric forceps, use of a vacuum extractor, cesarean section, etc.).

As a rule, when birth injuries occur in newborns, there is a combination of a number of unfavorable factors that disrupt the normal biomechanics of childbirth.

Birth injuries of newborns: symptoms, diagnosis, treatment

Birth injuries of soft tissues

The most common manifestations of birth trauma in newborns are damage to the skin and subcutaneous tissue. These include scratches, abrasions, petechiae, and ecchymoses on various parts of the body. Such damage is detected during a visual examination of the newborn by a neonatologist; usually they are not dangerous and require only local antiseptic treatment and the application of an aseptic dressing. Minor birth injuries to soft tissues disappear by the end of the first week of the newborn’s life.

A type of birth injury in newborns is a birth tumor, which is characterized by local swelling of the soft tissues of the head. The birth tumor has a soft elastic consistency, bluish color with multiple petechiae and ecchymoses. Its occurrence is usually associated with prolonged labor in the cephalic presentation or the application of obstetric forceps. The birth tumor does not require treatment and disappears on its own after 1-3 days.

A more severe type of birth injury in newborns is damage (hemorrhage, rupture) to the sternocleidomastoid muscle, usually its lower third. In this case, a small tumor of moderately dense or doughy consistency is determined at the site of damage. Damage to the sternocleidomastoid muscle may not be detected immediately, but after about a week, when the child develops torticollis. In the treatment of birth injury of the sternocleidomastoid muscle in newborns, corrective position of the head with the help of rollers, dry heat, electrophoresis of potassium iodide, massage are used; if ineffective - surgical correction.

Cephalohematoma, as a type of birth injury in newborns, is characterized by hemorrhage under the periosteum of the parietal or occipital bones of the skull. Typical signs of cephalohematoma are elastic consistency, lack of pulsation, painlessness, fluctuation, and the presence of a ridge along the periphery. In the future, newborns with cephalohematoma may experience jaundice caused by increased extravascular production of bilirubin. The cephalohematoma decreases in size by 2-3 weeks of life, and completely resolves by the end of 6-8 weeks. Complications of subperiosteal birth trauma in newborns include anemia, calcification and suppuration of cephalohematoma. Children with large (more than 6 cm in diameter) cephalohematomas require radiography of the skull to exclude bone cracks. Since cephalohematomas in premature infants are often associated with intrauterine mycoplasmosis, PCR or ELISA diagnostics are required.

In most cases, birth injuries to soft tissues in newborns pass without consequences.

Birth injuries of the skeletal system

Among birth injuries of the musculoskeletal system in newborns, injuries to the collarbone and limb bones are more common. They always refer to purely obstetric types of injuries. Subperiosteal fractures of the clavicle without displacement are usually detected 3-4 days after birth by the presence of a fusiform dense swelling - a forming callus. A displaced fracture of the clavicle is accompanied by the inability to perform active movements, pain, crying with passive movement of the arm, swelling and crepitus over the fracture site.

A type of birth injury to the skeletal system of newborns is traumatic epiphysiolysis of the humerus. Its manifestations include pain, swelling and crepitus in the area of ​​the shoulder or elbow joints, and limited range of motion in the affected arm. The outcome of such an injury can be paresis of the radial nerve and the formation of flexion contracture in the joints. Treatment consists of immobilization of the limb, physiotherapeutic procedures, and massage.

Birth injuries of internal organs

Damage to internal organs occurs due to mechanical effects on the fetus during abnormal labor. The most common hemorrhages are in the liver, spleen and adrenal glands. Clinical manifestations of birth trauma of internal organs in newborns develop on days 3-5 due to internal bleeding. When the hematoma ruptures, bloating occurs, intestinal paresis, muscle hypotonia (or atony), suppression of physiological reflexes, arterial hypotension, persistent regurgitation and vomiting develop.

If a birth injury to the internal organs is suspected, the newborn undergoes a survey radiography of the abdominal cavity, ultrasound of the abdominal organs and ultrasound of the adrenal glands. Treatment consists of hemostatic and symptomatic therapy; if necessary, laparoscopy or laparotomy with revision of internal organs.

If there is hemorrhage in the adrenal glands, the child may develop acute or chronic adrenal insufficiency. The prognosis for birth trauma of internal organs in newborns is determined by the volume and severity of the lesion, and the timeliness of detection of the damage.

Birth injuries of the central and peripheral nervous system

Damage to the nervous system in newborns constitutes the most extensive group of birth injuries. In this review, we will focus on birth injury of the spinal cord and peripheral nervous system; A detailed description of intracranial birth injuries in newborns will be given in the corresponding article.

Birth injuries to the spinal cord in newborns can include hemorrhage, stretching, compression, or rupture of the spinal cord at various levels, with or without a vertebral fracture. Severe injuries are characterized by the clinical picture of spinal shock: lethargy, muscle hypotonia, areflexia, weak cry, diaphragmatic breathing. The death of children can occur from respiratory failure. In more favorable cases, there is a gradual regression of the phenomena of spinal shock; hypotension is replaced by spasticity; Autonomic disorders develop (vasomotor reactions, sweating), trophic changes in muscle and bone tissue. Mild birth injuries in newborns are accompanied by transient neurological symptoms: changes in muscle tone, reflex and motor reactions.

The diagnosis is facilitated by examination of the child by a pediatric neurologist, X-ray or MRI of the spine, electromyography, lumbar puncture and examination of cerebrospinal fluid. Treatment of birth injury to the spinal cord in newborns includes immobilization of the area of ​​injury, dehydration and antihemorrhagic therapy, restorative measures (orthopedic massage, exercise therapy, electrical stimulation, physiotherapy).

Birth injuries of the peripheral nervous system in newborns include damage to the roots, plexuses, peripheral and cranial nerves.

Taking into account the localization, brachial plexus paresis (obstetric paresis) can be upper (proximal), lower (distal) or total. Superior Duchenne-Erb paresis is associated with damage to the plexuses and roots originating in the C5-C6 segments, which is accompanied by dysfunction of the proximal upper limb. In this case, the child takes a characteristic position with the arm adducted to the body, extended at the elbow joint, rotated inward at the shoulder and pronated at the forearm; with the hand bent in the palm and the head tilted towards the sore shoulder.

With lower obstetric Dejerine-Klumpke paresis, the plexuses or roots originating from C7-T1 are affected, resulting in dysfunction of the distal arm. Manifestations include muscle hypotonia, hypoesthesia, limitation of movements in the wrist and elbow joints, fingers, and the “clawed paw” symptom. With the total type of obstetric paresis, the arm is completely inactive, muscle hypotonia is pronounced, and muscle atrophy develops early.

The diagnosis and localization of damage is clarified using electromyography. Treatment of birth injury of the brachial plexus in newborns consists of immobilization of the arm using a splint, massage, exercise therapy, physiotherapy (applications of ozokerite, paraffin, electrical stimulation, electrophoresis), and drug therapy.

With paresis of the diaphragm, the newborn develops shortness of breath, paradoxical breathing, cyanosis, and bulging of the chest on the affected side. The detection of paresis is facilitated by fluoroscopy and chest radiography, which determines the high standing and inactivity of the dome of the diaphragm. Against this background, children may develop congestive pneumonia. Treatment of birth injury involves transcutaneous stimulation of the phrenic nerve; if necessary, mechanical ventilation until adequate spontaneous breathing is restored

Facial nerve paresis is associated with damage to the trunk or branches of the facial nerve. In this case, the child has facial asymmetry, lagophthalmos, upward displacement of the eyeball when crying, mouth asymmetry, and difficulty sucking. Birth trauma in newborns is diagnosed based on clinical signs, electroneurography, and recording of evoked potentials. Often, paresis of the facial nerve goes away without special treatment; in other cases, heat therapy and drug therapy are performed.

More rare types of birth injuries in newborns include injuries to the pharyngeal, median, radial, sciatic, peroneal nerves, and lumbosacral plexus.

Prevention of birth trauma in newborns

Prevention of birth injuries in newborns involves assessing the degree of risk of their occurrence even at the stage of pregnancy, the most careful attitude towards the child during childbirth, and refusal of the unreasonable use of aids for fetal extraction and operative delivery.

BIRTH INJURY (trauma obstetricum; Greek trauma wound, mutilation) - damage to the tissues and organs of the fetus during childbirth, caused by pathology of the prenatal or intranatal period.

The frequency of R. t., according to I. S. Der-gachev (1964), ranges from 2.1 to 7.6% of the number of children born alive, and 40.5% of the number of stillborn and deceased newborns. According to I. II. Elizarova (1977), birth trauma is the direct cause of death in 0.2% of full-term children and 1.4% of premature children born alive. Among the causes of perinatal mortality (see), birth trauma, according to E.I. Andreeva (1973), is approx. eleven%.

Factors predisposing to the occurrence of R. t. are various patol. condition of the fetus, a special place among which is occupied by hypoxia (see), which contributes to increased vascular permeability (see Asphyxia of the fetus and newborn). Unfavorable course of pregnancy, inf. diseases, cardiovascular and endocrine diseases of the mother, toxicosis of pregnant women, Rh incompatibility, prematurity and post-term pregnancy cause the condition of the chronic. hypoxia and decreased adaptive abilities of the fetus. In such cases, even normal labor can have a damaging effect on the fetus. In the pathogenesis of R. t., the leading role belongs to two factors: mechanical influences that occur during the passage of the fetus through the birth canal and during obstetric interventions, and circulatory disorders of a general and local nature caused by intrauterine hypoxia. Mechanical impacts on the fetus that exceed its stability occur when there is a significant discrepancy between the sizes of the fetus and the mother’s pelvis (clinically or anatomically narrow pelvis, etc.), anomalies and presentation (extensor presentation: anteroparietal, frontal, facial), during prolonged and rapid labor, and also violations of the technique of obstetric delivery operations and aids (application of obstetric forceps, vacuum extractor, turning the fetus onto its leg, providing aids for breech presentation).

There are R. t. of the nervous system (craniocerebral birth injury, birth injury of the spine and spinal cord, birth injury of the peripheral nervous system), soft tissues, bones, internal organs, etc.

Traumatic brain birth injury

Traumatic birth injury is damage to the newborn’s brain during childbirth, often due to intrauterine fetal hypoxia. Due to damage to the vessels of the brain and its membranes, subdural, primary subarachnoid, intracerebral (intra-, periventricular and intracerebellar) hemorrhages occur.

Subdural hemorrhage occurs when there are ruptures of the tentorium of the cerebellum, the direct, transverse, occipital and inferior sagittal sinuses, the great cerebral vein (vein of Galen), and the superficial cerebral veins. Blood flowing under the dura mater leads to compression and displacement of the brain. Subdural hematomas (see Intrathecal hemorrhages) can be unilateral or bilateral, combined with parenchymal hemorrhages resulting from hypoxia.

With the rapid growth of hematoma, the condition of newborns is extremely serious, symptoms of compression of the brain stem, pallor of the skin, coldness of the extremities, tachypnea (see), bradycardia (see), arrhythmia (see Cardiac Arrhythmias), weak filling of the pulse appear. There is muscle hypotonia, inhibition of unconditioned reflexes, periodic vomiting, sometimes opisthotonus (see), convulsions (see). Characterized by deviation of the eyeballs, which does not disappear when moving the head, anisocoria (see), sluggish reaction of the pupils to light (see Pupillary reflexes). Within minutes or hours, as the hematoma increases, coma develops (see). Pupil dilation is observed, symptoms of damage to the lower parts of the brain stem appear: arrhythmic breathing, pendulum-like eye movements. Death can occur on the first day due to compression of the vital centers of the brain stem. With a gradual increase in the hematoma, neurol. violations may appear by the end of the first day or even after a few days. Excitement, regurgitation, vomiting, arrhythmic breathing, bulging of the large (anterior) fontanel, Graefe's symptom, sometimes focal convulsive attacks, hyperthermia are observed.

When the superficial cerebral veins rupture wedge, the manifestations depend on the size of the hematoma. A small hematoma causes mild agitation, sleep disturbance, and regurgitation. In more severe cases, focal symptoms appear on the 2-3rd day - convulsions, hemiparesis (see Hemiplegia), deviation of the eyeballs in the direction opposite to hemiparesis. Sometimes there is damage to the third pair of cranial (cranial, T.) nerves, manifested by mydriasis (see). Symptoms of damage to the brain stem often indicate an infratentorial hematoma resulting from a rupture of the tentorium of the cerebellum. Symptoms characteristic of damage to the cerebral hemispheres indicate a convexital subdural hematoma. Wedge, the diagnosis is confirmed by puncture of the subdural space, craniography (see), echoencephalography (see), computed tomography of the brain (see Computer tomography).

Differential diagnosis of subdural hematoma is carried out with intrauterine brain damage, abscess, brain tumor (see Brain), meningitis (see).

At ruptures tentorium cerebellum, dural sinuses, falx cerebri, causing severe damage to the brain stem, the prognosis for life is usually unfavorable. However, early removal of the hematoma can save the newborn. With superficial subdural hemorrhage, the prognosis is favorable if a subdural puncture is performed in a timely manner, the hematoma is removed and intracranial pressure is reduced (see). If subdural puncture is ineffective, neurosurgical intervention is necessary (see Craniotomy). In the future, subdural hemorrhage can cause hydrocephalus (see), focal neurol. symptoms, delayed psychomotor development.

Primary subarachnoid hemorrhage in contrast to secondary, associated with intra- and periventricular hemorrhages, rupture of an aneurysm, it occurs as a result of damage to large and small vessels of the soft meninges (see). It occurs more often in premature babies. Hypoxia of brain tissue is of great importance in the development of primary subarachnoid hemorrhage. The hemorrhage is located between protruding areas of the brain, most often in the temporal lobes and in the posterior cranial fossa. The brain tissue is swollen, the vessels are overflowing with blood. Severe primary subarachnoid hemorrhage is sometimes accompanied by coagulopathy, aggravating the severity of the child’s condition.

Neurol. disorders vary depending on the size of the hemorrhage and the presence of other hemorrhages. A small subarachnoid hemorrhage is characterized by minimal neurol. symptoms: regurgitation, slight tremor when changing body position, increased tendon reflexes. Sometimes neurol. Symptoms appear on the 2-3rd day after the baby is put to the breast. More massive hemorrhage is often combined with asphyxia (see Asphyxia of the fetus and newborn) or is its cause, accompanied by agitation, regurgitation, vomiting, tremor, sleep disturbance, and convulsions. Seizures are more common in full-term infants, usually on the 2nd day of life. Increased muscle tone, hyperesthesia, stiff neck, spontaneous Moro and Babinski reflexes are noted. Pathology of the cranial nerves is manifested by strabismus (see), nystagmus (see), Graefe's symptom. On the 3-4th day after birth, Harlequin syndrome may be observed - a transient (from 30 seconds to 20 minutes) periodically repeating change in the color of the skin of half the newborn’s body from pink to cyanotic, most pronounced when the child is positioned on his side. When the skin color changes, the child’s well-being is not affected.

The diagnosis is established on the basis of the wedge, manifestations, the presence of blood and increased protein content, and then cytosis in the cerebrospinal fluid (see), the results of computed tomography of the brain, ultrasound examination.

Treatment in the acute period is aimed at correcting cardiovascular, respiratory, metabolic disorders and stopping bleeding. A spinal puncture is indicated to reduce intracranial pressure and remove blood. If inflammatory changes are detected, antibacterial therapy is carried out. If conservative therapy is ineffective and hydrocephalus progresses, surgical intervention is indicated (see Hydrocephalus).

The prognosis depends on the severity of hypoxia and brain damage. With subarachnoid hemorrhage, accompanied by mild hypoxia, the prognosis is favorable. With prolonged brain hypoxia, newborns often die. Surviving children have hydrocephalus, convulsions, and motor disorders.

Intracerebral hemorrhage. Intraventricular and periventricular hemorrhages occur more often in premature infants. Their development is facilitated by the immaturity of the choroid plexuses of the ventricles of the brain. Violation of self-regulation of cerebral blood flow (see Cerebral circulation), most pronounced under conditions of hypoxia, easily leads to increased blood pressure and vascular rupture. In premature infants, hemorrhages most often occur in the area of ​​the caudate nucleus, in full-term infants, in the area of ​​the choroid plexus of the lateral ventricle. With periventricular hemorrhage, in 75% of cases, penetration of the spilled blood into the ventricles of the brain is noted. Blood passing through the foramina of Magendie (median aperture of the fourth ventricle) and Luschka (lateral aperture of the fourth ventricle) accumulates in the posterior cranial fossa. As a result of this, after a few weeks, obliterating fibrous arachnoiditis develops (see), which subsequently causes a disturbance in the outflow of cerebrospinal fluid.

Neurol. symptoms depend on the extent of the hemorrhage and the speed of its spread through the ventricles of the brain. With a fulminant course, the symptoms develop within a few minutes or hours. The newborn is in a comatose state, arrhythmic breathing, bradycardia, decreased blood pressure, gaze paresis, sluggish reaction of the pupils to light, tension in the large fontanel, muscle hypotonia, tonic convulsions, sharp inhibition of unconditioned reflexes (children do not suck or swallow), metabolic acidosis ( see), disturbance of water-electrolyte balance (see Water-salt metabolism), hypo- or hyperglycemia (see Hypoglycemia, Hyperglycemia). There may be cases with a slower development of the wedge, pictures. With intraventricular hemorrhage, 50% of newborns have almost no symptoms. To clarify the diagnosis, a spinal puncture is performed (the cerebrospinal fluid is bloody in the first days, then xanthochromic, with an increased protein content and a decreased glucose content), ultrasound examination and computed tomography of the brain.

Intraventricular hemorrhages arise and develop in the first two days of a newborn’s life, so it is advisable to carry out preventive measures (maintaining metabolic homeostasis, normalizing blood pressure, ensuring constant ventilation, limiting unnecessary manipulations with the child).

Emergency measures in the acute period are aimed at preventing hypovolemia (intravenous administration of fluids), reducing intracranial pressure (using glycerol, magnesium, mannitol) and correcting metabolic disorders with the help of oxygen therapy (see), administration of sodium bicarbonate, glucose, and electrolytes. These activities should be carried out with great caution due to the possibility of a paradoxical reaction. Subsequently, repeated spinal punctures are performed to remove blood elements, reduce intracranial pressure and control the composition of the cerebrospinal fluid, and also administer drugs that prevent the development of hydrocephalus (diacarb, lasix, glycerol). If the expansion of the ventricles of the brain stops, treatment is continued for 3-4 months. and more. When prescribing dehydrating agents, it is necessary to monitor the osmolarity of the blood, the content of sodium, glucose, nitrogen, and urea in it. If conservative therapy is ineffective and hydrocephalus develops, neurosurgical intervention is resorted to.

The prognosis depends on the severity and extent of the hemorrhage.

With massive hemorrhage, newborns often die. In other cases, the prognosis is more favorable, but hydrocephalus and delayed psychomotor development are possible in the future. Damage to the periventricular white matter leads to spastic paralysis (see Paralysis, paresis).

Intracerebellar hemorrhage more common in premature babies. Its occurrence is predisposed by the softness of the skull bones, abundant vascularization of the cerebellum and disruption of vascular auto-regulation, as well as hypoxia, which contributes to cardiovascular disorders and increased pressure in the blood vessels of the brain. A pathological examination reveals a rupture of the cerebellar vessels, great cerebral vein or occipital sinus.

In the wedge, the picture is dominated by symptoms of damage to the brain stem: pendulum-like eye movements, abduction of the abdomen to one side, damage to the caudal group of cranial nerves (IX - XII pairs). Apnea and bradycardia arise as a result of involvement in patol. process of the medulla oblongata.

The diagnosis is made on the basis of a wedge, pictures, detection of blood in the cerebrospinal fluid and computed tomography confirming the presence of blood in the posterior cranial fossa. In case of a hematoma in the cerebellar region (see), lumbar puncture should be performed with caution, since this may result in herniation of the cerebellar tonsils into the foramen magnum (see Brain dislocation).

Treatment consists of evacuating the hematoma from the posterior cranial fossa. The effectiveness of treatment depends on the severity of neurol. disorders and the degree of dysfunction of other organs and systems.

The prognosis is unfavorable, mortality in the acute period is high. Those who have suffered intracerebellar hemorrhage subsequently develop disorders caused by destruction of the cerebellum.

Birth injury of the spine and spinal cord

Birth trauma to the spine and spinal cord most often occurs in breech presentation of the fetus in cases where the angle of extension of the head exceeds 90°, which may be due to a congenital anomaly of the cervical spine, severe muscle hypotonia. With cephalic presentation, R. t. of the spinal cord occurs when abdominal obstetric forceps are applied. Damage to the spinal cord during childbirth occurs as a result of intense longitudinal traction (with breech presentation) or torsion (with cephalic presentation).

In the acute period, swelling of the meninges and substance of the spinal cord, epidural and intramedullary hemorrhages are observed, which can be combined with stretching and rupture of the spinal cord, separation of the anterior and posterior roots of the spinal nerves. Spinal injuries are found much less frequently. Later, fibrous cords form between the dura mater of the spinal cord and the spinal cord, foci of necrosis in the tissue of the spinal cord, followed by the formation of cystic cavities. With breech presentation, the lower cervical and upper thoracic segments of the spinal cord are more often damaged, with cephalic presentation - the upper cervical segments; changes can also be observed throughout the spinal cord. By determining the level of puncture sensitivity, the upper limit of spinal cord injury can be established. Trauma in the upper cervical segments can be combined with intracranial injuries (rupture of the tentorium, damage to the cerebellum).

Nevrol. Symptoms depend on the location and severity of the injury. In severe cases, symptoms of spinal shock are observed (see Diaschisis): severe lethargy, adynamia, weak cry, depression of the chest, paradoxical breathing, retraction of the intercostal spaces, bloating. There is severe muscle hypotonia, absence of tendon and unconditioned reflexes. Spontaneous movements are weak or absent, but the withdrawal reflex in response to a prick may be enhanced. There is a dysfunction of the upper extremities: in some cases - asymmetry of muscle tone, spontaneous movements, in others - preservation of the function of the biceps brachii muscles with triceps paralysis, which is manifested by characteristic flexion of the arms against the background of muscle hypotonia. Sometimes paresis of the hands is detected (the “pistol” pose) with relatively intact movements in the proximal parts of the arms. In the first days of life, bladder dysfunction is noted. With simultaneous injury to the spinal cord and brachial plexus, Duchenne-Erb palsy (see Duchenne-Erb palsy), Dejerine-Klumpke palsy (see Dejerine-Klumpke palsy), diaphragm paresis, Bernard-Horner syndrome (see Bernard-Horner syndrome) are observed. When an injury to the upper cervical segments of the spinal cord is combined with damage to the brain stem, there is no spontaneous breathing, so artificial ventilation is used (see Artificial respiration).

For mild spinal cord injuries, neurol. symptoms are not pronounced. There is transient muscle hypotonia, weakened screaming, and mild breathing problems. Subsequently, in some children, muscle hypotonia and areflexia (see) persist for a long time, in others - after a few months, muscle tone increases in the affected limbs (see), tendon reflexes increase (see), clonus appear (see) and patol. reflexes (see Pathological reflexes).

The diagnosis is established on the basis of a characteristic wedge, picture and myelography data (see), with the help of a cut in the first days of life it is possible to identify a block of the subarachnoid space resulting from hemorrhage, and later - local atrophy of the spinal cord. At rentgenol. A study in a lateral projection sometimes determines the displacement of one of the vertebrae from the midline.

Differential diagnosis should be carried out with Werdnig-Hoffmann disease (see Amyotrophy), congenital myopathies (see) and anomalies of the spinal cord (see).

Treatment consists of immobilization of the spine (see) with complete restriction of the mobility of its cervical spine, and the administration of hemostatic agents. With the development of persistent focal neurol. violations require long-term rehabilitation measures. The prognosis depends on the severity of the spinal cord injury.

Birth trauma of the peripheral nervous system

Birth trauma of the peripheral nervous system includes obstetric paresis of the arms, paresis of the diaphragm, and facial muscles.

Obstetric paresis of the hands- dysfunction of the muscles of the upper limbs due to damage during childbirth to the peripheral motor neuron of the anterior horn of the spinal cord. Their frequency is 2-3 per 1000 newborns. Depending on the location, there are the upper Duchenne-Erb type (see Infantile paralysis, Duchenne-Erb palsy), the lower Dejerine-Klumpke type (see Infantile paralysis, Dejerine-Klumpke paralysis) and the total type of obstetric paresis. The latter develops as a result of injury to the upper and lower trunks of the brachial plexus or the roots of the Cv-Thi spinal nerves and is the most severe. With this type of obstetric paresis, damage occurs to all the muscles of the arm and there is a complete absence of active movements in the acute period, muscle atrophy develops early, especially in the distal parts of the limb, pain and temperature sensitivity in the lower part of the shoulder, forearm and hand is reduced, tendon reflexes are not evoked .

Treatment should begin as early as possible, it should be comprehensive and continuous. Orthopedic styling, exercise therapy, massage, and drug therapy are used.

The prognosis in mild cases is favorable, restoration of function begins in the first days of life and after 3-5 months. the range of active movements becomes complete (sometimes muscle weakness persists for a long time). In severe cases, recovery is usually incomplete due to degeneration of nerve fibers, muscle atrophy and developed contractures.

Diaphragm paresis(Cofferat syndrome) - limitation of diaphragm function as a result of damage to the phrenic nerve (usually the left) or the roots of the C3-C4 spinal nerves. It manifests itself as repeated attacks of cyanosis, rapid, irregular breathing, bulging of the chest and neck on the affected side, paradoxical breathing. During auscultation on the side of the paresis, weakened breathing is heard, sometimes isolated wheezing in the upper parts of the lungs. Paresis of the diaphragm is often detected only with rentgenol. examination of the chest by the high standing of the diaphragm, its paradoxical movement (raising the paralyzed half of the diaphragm during inhalation and lowering during exhalation) and atelectasis at the base of the lung on the affected side. Paresis of the diaphragm is often combined with obstetric paresis of the upper arm (see Duchenne-Erb palsy).

Treatment is the same as for other types of peripheral paralysis (see Infantile paralysis).

Paresis of facial muscles as a result of damage to the facial nerve, it occurs due to prolonged standing of the head in the birth canal, pressing it against the bones of the mother’s pelvis, compression with obstetric forceps, hemorrhage into the nerve trunk or into the medulla oblongata, as well as a fracture of the temporal bone in the mastoid area.

Peripheral paresis of a traumatic nature tend to recover quickly, sometimes without specific treatment. For pronounced changes, physiotherapy and medications are used (see Infantile paralysis).

Children who have undergone R. t. of the nervous system require treatment in neurol conditions. hospital for newborns and infants and in subsequent dispensary observation by a neurologist.

Neurological disorders and mental disorders in the late period of birth trauma of the nervous system

The following nevrol belong to them. disorders: hydrocephalus (see), convulsions (see), infantile paralysis (see), delayed age-related psychomotor development, isolated lesions of the cranial nerves, small cerebral and cerebellar disorders (see Cerebellum).

Delayed psychomotor development at an early age is manifested by a delay in the development of motor and mental functions. It can be total, when the development of these and other functions is delayed relatively evenly, or partial, when motor development lags behind mental development, or vice versa. One can also observe a disproportion of development within one functional system. For example, within the motor function, the formation of static functions is delayed, but voluntary movements develop in a timely manner. Lesions of the cranial nerves are manifested by divergent strabismus (see), ptosis (see) with damage to the oculomotor nerve (see), convergent strabismus with damage to the abducens nerve (see), central and peripheral damage to the facial nerve (see), bulbar palsy with damage to the glossopharyngeal nerve (see), vagus nerve (see), hypoglossal nerve (see). Often lesions of the cranial nerves are combined with motor and mental disorders, but they can also be isolated.

Minor brain disorders are manifested by asymmetry of muscle tone, skin and tendon reflexes, voluntary movements, motor clumsiness of the hands, and gait disturbance. These changes can be combined with a deficiency of higher cortical functions (speech, attention, memory, etc.).

Mental disorders in traumatic brain injury

Mental disorders in cases of traumatic brain injury are expressed in various manifestations of psychoorganic syndrome (see). In childhood, they correspond to syndromes of early cerebral insufficiency or organic defect. The severity of the psychoorganic syndrome is the same as neurol. symptoms, with R. t. depend on the severity and localization of brain damage (chief example of hemorrhages). There is no reliable data on the frequency of mental disorders caused by craniocerebral R. t.

Mental disorders in the long-term period of cranial R. t. are manifested by conditions characterized by intellectual disability (mental retardation, secondary mental retardation, etc.), conditions with a predominance of behavioral disorders (psychopathic syndromes), conditions accompanied by convulsive manifestations (epileptiform syndromes, symptomatic epilepsy), as well as asthenic conditions and psychotic disorders.

Oligophrenia associated with R. t. is relatively rare. Its distinctive feature is the combination of mental underdevelopment with signs of psychoorganic syndrome (asthenic, psychopathic, epileptiform disorders) and residual organic neurol. symptoms. The structure of dementia appears to be more complex than in simple (uncomplicated) mental retardation (see). In severe cases, the wedge, the picture largely corresponds to organic dementia (see Dementia).

Secondary delays in mental development, arising on residual organic grounds, are distinguished by milder intellectual disability and the reversible nature of the disorders compared to oligophrenia. Clinically, they are expressed in delays in the rate of mental development, in particular in the form of organic mental (or psychophysical) infantilism (see).

Psychopathic-like syndromes in the long-term period of R. t. are characterized by a predominance of emotional-volitional disorders and special psychomotor agitation. Most often, increased excitability, motor disinhibition, instability, increased gross instincts are observed, combined with variously expressed asthenic disorders, and sometimes a decrease in intelligence. Aggression and brutality are also characteristic. In conditions of neglect and an unfavorable microsocial environment, various pathols easily arise on this basis. reactions and pathological development of personality (see).

Epileptiform manifestations in the long-term period of R. t. are varied and expressed to varying degrees depending on the location and severity of brain damage. The accompanying mental disorders are also heterogeneous: along with an organic decrease in the level of personality (see Psychoorganic syndrome), epileptic changes in personality are possible, especially in cases of malignant symptomatic epilepsy (see).

Asthenic conditions are observed in almost all forms of long-term consequences of cranial R. t. They usually manifest themselves in the form of a prolonged asthenic syndrome (see). A significant place in the clinical picture belongs to other neurosis-like disorders, the distinctive feature of which is their lability and reversibility. However, under the influence of unfavorable external and internal factors (infections, injuries, psychogenic disorders, age-related crises, etc.), decompensation of the condition can easily occur.

Psychotic disorders in the long-term period of R. t. are observed rarely and have a complex pathogenesis. Apparently, hereditary predisposition also plays a certain role. Wedge, the picture largely corresponds to organic psychoses (see), in particular periodic and episodic psychoses on organically defective soil. Protracted forms often occur with various schizophrenia-like pictures.

Treatment of mental disorders is usually symptomatic. Dehydration, restorative and stimulating therapy are of great importance. If necessary, anticonvulsant and psychotropic drugs are used, including nootropic drugs. For social readaptation, therapeutic and pedagogical measures and special teaching methods are of great importance.

The prognosis of mental disorders caused by R. t. depends on the severity of the initial brain damage and the characteristics of the wedge, the picture. In mild cases it is relatively favorable.

Prevention of neurol. and mental disorders comes down to the prevention of R. t.

Birth trauma of soft tissues

A birth tumor refers to damage to the soft tissue of the presenting part of the fetus and is characterized by swelling and often hematoma. A hematoma formed under the periosteum of one of the skull bones on its surface is called a cephalhematoma (see). The birth tumor (see Caput succedaneum) is most often located on the fetal head in the parietal and occipital regions. Unlike cephalhematoma, swelling in a birth tumor can spread beyond one cranial bone. When other parts of the fetus are present, a birth tumor occurs respectively on the face, buttocks, perineum, and lower leg. Wedge, manifestations depend on its size and location, as well as on combination with other types of R. t.

With breech presentation, a birth tumor occurs in the genital area (labia majora and minora in girls, scrotum and testicles in boys). Hemorrhage into the scrotum and testicles may be accompanied by painful shock.

With facial presentation, the birth tumor is located in the forehead, eye sockets, zygomatic arches, mouth, sometimes accompanied by significant swelling of the conjunctiva and mucous membrane of the lips, petechial and larger hemorrhages, and is often combined with traumatic brain injury. Swelling of the mucous membrane of the lips makes sucking difficult; the child is fed through a tube. When treating a birth tumor, cold is used locally and hemostatic agents (calcium chloride, rutin, Vicasol) are used internally.

Usually the birth tumor resolves on the 2-3rd day of the child’s life.

Often during childbirth, hemorrhages in the sclera are observed, which occur in large newborns with difficulty passing the shoulder girdle through the mother's birth canal, as well as during rapid labor and tight entanglement of the umbilical cord around the neck. Hemorrhages in the sclera of one or both eyes have a crescent shape. For such disorders, oxygen therapy (see), hemostatic agents, and rinsing of the conjunctiva with 2% boric solution are used. Hemorrhages resolve within 12-14 days.

Hemorrhages in the retina of the eyes are combined with cranial R. t. When examining the fundus (see), in this case, intracranial hypertension can be established by swelling of the optic disc, dilation of the veins and the presence of foci of hemorrhage. Newborns with retinal hemorrhage require dehydration therapy.

Damage to the skin and subcutaneous tissue occurs as a result of compression and is localized in places where tissue is pressed against the promontory of the sacrum of the mother’s bony pelvis, as well as in the area of ​​application of monitor electrodes, obstetric and cephalic forceps, and the cup of a vacuum extractor, which is especially unfavorable. Areas of damaged skin are treated with 0.5% alcohol solution of iodine and a dry aseptic bandage is applied. When blisters with hemorrhagic contents form, ointment dressings with 1% synthomycin emulsion and antibacterial therapy are indicated.

Aseptic necrosis of the subcutaneous tissue in the form of merging nodular compactions and bright hyperemia of the skin above them is noted in the subscapular region and the shoulder girdle area. Its cause is compression of the child’s tissues, which results in the accumulation of acidic metabolic products and the loss of fatty acids (stearic and palmitic) with the formation of oleogranulomas. More often observed in large fetuses, as well as in fetuses who have suffered diabetic fetopathy (see). The prognosis is favorable. Infection, as a rule, does not occur. Complete resorption of compacted areas is possible in 2-3 weeks. or partial impregnation with calcium salts. Ointment dressings and warm baths promote the resorption of seals. If infection is suspected, antibacterial therapy is administered.

Damage to the fetal muscles can occur due to rough obstetric care. Damage to the sternocleidomastoid muscle occurs during extraction of the fetus by the pelvic end, application of obstetric forceps and difficulty in removing the head during breech presentation. A hematoma accompanying a rupture of the fibers of the sternocleidomastoid muscle is detected by a plum-like thickening of this muscle in its middle or lower third. In this case, the newborn tilts his head to the affected side, torticollis is noted due to shortening and thickening of the affected muscle, which disappears after the use of UHF, special head positioning and massage of the muscles of the cervical-brachial region. Torticollis, untreated in infancy, requires further orthopedic and surgical treatment (see Torticollis). R. t. of the facial muscles can occur as a result of compression by the spoons of obstetric forceps; it is characterized by the formation of a hematoma and swelling in the area of ​​the child’s cheek, sometimes making sucking difficult.

Birth trauma to bones

A clavicle fracture is one of the most common birth injuries (1-2%), the cut is caused by a wedge, a discrepancy between the size of the mother’s pelvis and the shoulder girdle of a large fetus. A fracture of the clavicle is observed during rapid childbirth, when the shoulder girdle does not have time to rotate in a straight line and is born through a narrower size of the outlet from the pelvis. Often the cause of a clavicle fracture is improper provision of manual assistance during childbirth, with premature removal of the fetal posterior shoulder and excessively strong pressing of the fetal anterior shoulder to the mother's pubic symphysis. A fracture of the right clavicle is more common, since birth usually occurs in the first fetal position. A clavicle fracture is detected immediately after birth by crepitus and limitation of active movements of the arm. A subperiosteal fracture of the clavicle and a fracture without displacement can be detected only on the 5-7th day of the child’s life, after the formation of a cartilaginous callus. If the clavicle is fractured, a fixing bandage is applied to the child’s shoulder girdle and arm, a cushion is placed under the shoulder and the arm is taken away from the chest, and the forearm is bent at the elbow joint and brought to the body. The clavicle fracture heals on the 7-8th day, active movements in the arm are restored. When displaced fragments put pressure on the brachial plexus area or the formation of a hematoma, traumatic plexitis may occur (see).

A fracture of the humerus occurs in one case per 2 thousand births. Occurs when it is difficult to remove the fetal arm during the provision of obstetric care for breech presentation. More often it occurs in the middle third of the shoulder, accompanied by slight displacement of fragments. It is recognized by crepitation of fragments and the formation of a tumor at the site of the hematoma. Treatment consists of fixing the arm along the body or applying a plaster splint to the back of the shoulder. Fusion occurs within 2-3 weeks. A fracture is also possible in the area of ​​the epiphysis of the shoulder, which may be accompanied by its separation from the diaphysis of the bone, rupture of ligaments and the formation of an intra-articular hematoma. The arm on the side of the injury hangs, adducted to the body, rotated inward. In this case, a splint is applied to the injured limb and the arm is placed in a position of abduction and outward rotation. Cure occurs within 3 weeks.

Fractures of the bones of the forearm and ribs are very rare and are caused not by R. t., but by resuscitation measures.

Fractures of the femur and tibia in newborns are observed in one case per 4 thousand births and are possible during fetal extraction by the leg during childbirth or extraction of the fetus by the legs during cesarean section. A fracture of the femur is observed more often in the middle third, determined by the shortening of the femur associated with strong muscle retraction and the formation of swelling, as well as by the painful reaction of the child. The diagnosis is confirmed by x-ray. research. Treatment is carried out with skeletal traction. Cure occurs in the 4th week of life. A fracture of the lower leg bones is determined by crepitation of fragments, swelling of the limb, and a painful reaction of the child. Confirmed by x-ray. Immobilization of the limb with a splint is necessary. Callus forms in the 3rd week of a child’s life.

In case of prolonged labor during breech presentation and as a result of mechanical compression of the pelvic end of the fetus, injury to the pubic symphysis is possible. During treatment, painkillers (droperidol) and hemostatic agents, local cold, applications with 0.25% novocaine solution or lead lotions are used. The child is placed in protective mode and placed on his back with his hips apart. The prognosis is favorable in most cases.

Birth trauma of internal organs

Birth trauma of internal organs accounts for approximately 30% of the total number of R. t., which were the cause of death of newborns. The liver, adrenal glands and kidneys are most often damaged. Trauma to the abdominal organs and retroperitoneal space received during childbirth can cause the death of a child in the first hours or days of life. Occurs more often in large and premature fetuses, during rapid or protracted labor accompanied by hypoxia. Liver injury is facilitated by its enlargement (with hemolytic disease, vascular tumors) and improper location. Even with a minor injury to the liver, a gradually increasing hematoma leads to extensive detachment of the capsule, and then its rupture, followed by bleeding into the abdominal cavity. The severity of the picture depends on the degree of damage and the size of the hematoma. There is pallor of the skin, lethargy, bloating, asymmetry, tension and pain in the abdomen, vomiting of bile, sometimes visible hematoma through the anterior abdominal wall, and a decrease in hemoglobin content in the blood. To confirm the diagnosis, a puncture of the abdominal cavity is performed (see Laparocentesis). Treatment consists of emergency laparotomy (see), hemihepatectomy (see), blood transfusion.

If the kidney is damaged, the general condition of the child soon after birth progressively worsens, blood appears in the urine, regurgitation, vomiting, and swelling in the lumbar region. The diagnosis is confirmed by urological examination. Hemostatic and antibacterial therapy is indicated.

Hemorrhages into the adrenal glands are characterized by pronounced general weakness, the development of collapse (see) and anemia (see). Treatment is carried out with hydrocortisone and hemostatic agents.

The prognosis for R. of internal organs is serious, mortality is high.

Bibliography: Badalyan L. O., Zhurba L. T. and Vsevolozhskaya N. M. Guide to neurology of early childhood, Kyiv, 1980; Barash-n e in Yu. I. Diseases of the nervous system of newborn children, M., 1971, bibliogr.; Dergachev I. S. Pathological anatomy and pathogenesis of diseases of newborns, infants and young children, M., 1964, bibliogr.; Elizarova I. P. Cerebral disorders in newborns who have suffered birth trauma and asphyxia, JI., 1977, bibliogr.; Kovalev VV Psychiatry of children's age, p. 280, M., 1979; Lebedev B.V., Barashnev Yu.I. and Yakunin Yu.A. Neuropathology of early childhood, M., 1981; Pathological anatomy of diseases of the fetus and child, ed. T. E. Ivanovskaya and B. S. Gusman, vol. 1, p. 57, M., 1981; Blind A. S. Birth traumatism of mother and fetus, L., 1978; Sukhareva G. E. Clinical lectures on childhood psychiatry, vol. 1, p. 275, 428, M., 1955; aka, Lectures on childhood psychiatry, p. 99, 121, M., 1974; Tour A. F. Physiology and pathology of newborn children, L., 1967; Fan-koni G. and Valgren A. Guide to childhood diseases, trans. from German, M., 1960; Shukhova E. V. Rehabilitation of children with diseases of the nervous system, M., 1979, bibliogr.; I k u n i n Yu. A. et al. Diseases of the nervous system in newborns and young children, M., 1979, bibliogr.; Clinical management of mother and newborn, ed. by G. F. Max, B., 1979; Fenichel G. M. Neonatal neurology, N. Y.-L., 1980; Harbauer H. u. a. Lehrbuch der speziellen Kinder-und Jugendpsychiatrie, S. 352, B. u. a., 1980; K 1 o s K. u. Vogel M. Pathologie der Perinatalperiode, S. 232, Stuttgart, 1974; Neonatal medicine, ed. by F. Cockburn a. S. M. Drillien, L., 1974; Das Neugeborene, ed. by H. Haupt, Stuttgart, 1971; Perinatal medicine, ed. by E. Kerpel-Fronius a. o., Budapest, 1978; Potter E. a. Craig J. M. Pathology of the fetus and the infant, p. 103, L., 1976; Schaffer A. J. a. Avery M. E. Disease of the newborn, Philadelphia a. o., 1977; Volpe J. J. Neurology of the newborn, Philadelphia a. o., 1981.

I. P. Elizarova; L. O. Badalyan, L. T. Zhurba (neur.), M. Sh. Vrono (psychiat.).

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Few people, having emptied their intestines, think that the characteristics of this biomaterial can be used to judge the presence of such serious pathologies as stomach ulcers, Crohn's disease, polyps and malignant neoplasms of the intestine.

To identify them, you will need to take fecal occult blood tests. Diagnosis does not take much time, is painless and allows you to suspect the development of ailments even at an early stage.

Fecal occult blood test - what is it?

In some pathologies of the rectum, for example, internal hemorrhoids or anal fissure, inclusions of scarlet blood are visible to the naked eye in the stool.

However, when bleeding occurs in the small intestine, a different picture is observed. Blood components are digested by enzymes, mixed with feces and excreted. In this case, the blood loses its scarlet color. If the bleeding in the small intestine is severe enough, the stool may turn black - this is an alarming sign. However, such a clinical picture does not always develop.

More often, the components of digested blood are mixed with feces and become indistinguishable to the naked eye. You can't even look at them with a microscope. This is what is called hidden blood.

It can be detected in feces in the following ways:

• guaiac or benzidine test;
• immunological method;
• fluorescence analysis.

Chemical tests

Historically, reactions with guaiac and benzidine were the first to appear in the arsenal of diagnostic methods. The principle of their action is based on the fact that blood hemoglobin is a strong oxidizing agent. By reacting with substances such as benzidine and guaiac, it changes their color. The more hidden blood in the stool, the more intense and faster the color of the reagents changes.

The disadvantage of the method is the relatively low sensitivity of these samples. The reaction with benzidine allows one to detect a daily blood loss of at least 15 ml. Normally, a person can lose up to 1 ml of blood during bowel movements in 24 hours.

Slight increases in this indicator can warn of the first stages of various gastrointestinal pathologies, but a benzidine test cannot detect them.

The reaction with guaiac is more accurate, but it can also warn about incipient colon cancer in only 50% of patients. In the case of colorectal oncopathology, the sensitivity of the method does not exceed 30%.

Both tests can give false positive results. Most often this is due to improper preparation for the analysis.

Immunochromatography method

Immunochemical analysis of stool is more advanced. It is convenient, standardized and simple. Immunochromatographic determination of occult blood is similar to the procedure for performing a pregnancy test.

Monoclonal antibodies are used to perform this stool analysis. The prepared biomaterial sample is applied to the test strip.

Monoclonal particles bind to human hemoglobin, forming a colored complex compound. Further, it is captured by other antibodies localized in the control area, and two marks appear on the test strip if the concentration of occult blood is higher than normal. Otherwise, one stripe is visualized.

The immunochemical method is highly sensitive and does not require special preparation. It can detect mild bleeding in the early stages of colon cancer in 97% of cases. However, the analysis is not suitable for diagnosing diseases developing in the small intestine.

Fluorescence analysis

The breakdown products of hemoglobin in feces can also be detected using fluorescence. In this case, the biomaterial is processed in a special way, and its glow is recorded. It is known that porphyrin pigments, which are part of hemoglobin molecules, can be detected by fluorescence when the latter is destroyed.

This method is quite accurate, but if a person eats meat the day before, animal hemoglobin will appear in his stool - this will cause a false result.

Recently, another approach to diagnosis has been developed. Human DNA is extracted from the stool sampled for analysis and examined for changes characteristic of the tumor process.

When should you take a stool occult blood test?

Obviously, the study is indicated when there are signs of disorders of the digestive system. The following symptoms should be the reason for the analysis:

• heartburn;
• stomach ache;
• change in the nature of the chair;
• nausea or vomiting, disturbing for a long time;
• mucus impurities in stool;
• foamy inclusions.

In addition, everyone over the age of 40 should undergo an occult blood test annually. This is the best measure for the timely detection of inflammatory and especially oncological pathologies. The following clinical picture can warn about the development of a malignant process in the gastrointestinal tract:

• regular increase in body temperature for no apparent reason;
• decreased appetite;
• aversion to meat food;
• sudden loss of body weight;
• constipation;
• pain during defecation.

In addition, if bloody discharge visible to the naked eye appears from time to time in the stool, or the stool turns black, you should not hesitate to get tested. These signs warn of bleeding caused by polyps, tumors, erosions or ulcers.

How to prepare for the analysis?

Taking a stool occult blood test requires special preparation. Depending on which research method or methods will be used, the patient will have to adhere to a certain regimen.

Diet

Chemical samples and fluorescent analysis are non-selective. They identify the components of not only human, but also animal hemoglobin obtained from food. For this reason, before such a stool test for occult blood, a diet is indicated that implies a complete abstinence from meat, fish, and poultry. Any by-products are also prohibited.

In addition, when preparing for a stool occult blood test, you should not eat foods rich in iron:

• beans;
• pomegranate;
• bell pepper;
• tomatoes;
• spinach, parsley;
• apples;
• Brussels sprouts, broccoli;
• carrot.

If the study is carried out using immunochromatography, the need for a special diet disappears. Monoclonal antibodies bind exclusively to human hemoglobin and do not react to compounds of other origin.

Medicines and medical procedures

Diets must be followed for at least 3 days before analysis. At this time, it is also important to completely stop taking iron supplements, ascorbic acid and all non-steroidal anti-inflammatory drugs (Aspirin, Ibuprofen, etc.).

During this period, you should refrain from any procedures that could theoretically disrupt the integrity of the intestinal and gastric mucosa. You cannot give enemas, undergo fibrogastroscopic examination, undergo irrigoscopy, sigmoidoscopy, or colonoscopy. Even laxatives are banned. You need to stop taking them at least a week before the analysis.

At least 3 days must pass from the moment of the last x-ray examination to the moment when stool is collected for analysis.

Other Features

Some diagnostic methods are highly sensitive and can detect even minimal amounts of blood in the biomaterial. For this reason, in order to avoid false results, on the eve of the test you should refrain from brushing your teeth, because bleeding from the gums is not uncommon.

Women should not take feces for analysis during menstruation. Even nosebleeds that occurred the day before can distort the results. In addition, when taking the material, it is important to ensure that urine does not get into it.

Features of the collection of biomaterial

Feces for analysis are taken into a sterile special container. You can buy it at the pharmacy.

• It is necessary to collect biomaterial from different parts of the feces: 2-3 fragments.

After this, it is important to place the container in the refrigerator and deliver it to the laboratory within 3 hours.

The less time passes from the moment of collection, the better.

Interpretation of stool occult blood test

Immunochemical analysis and tests with benzidine and guaiac are semi-quantitative methods for determining occult blood. The first diagnosticum answers the question: does the hemoglobin concentration in a stool sample exceed the normal value?

• If a laboratory technician or patient at home sees 2 marks on the test strip, the answer is yes. One control is negative.

When testing with guaiac and benzidine, the intensity and speed of coloring of the reagents is assessed. The reaction can be of 5 types:

• negative (no color change);
• weakly positive (+);
• positive (++);
• positive (+++);
• sharply positive (++++).

Fluorescent analysis is a quantitative method. It is not sensitive at porphyrin concentrations up to 2 mg/g of biomaterial. But when their content in 1 g of feces is equal to or exceeds 4 mg, pathology is diagnosed. The test is also able to detect borderline values: from 2 to 4 mg.

The test is positive, what does this mean?

If you receive a conclusion that occult blood has been detected in a stool sample, do not panic. In addition to pathological conditions, the result may be positive in the following cases:

• non-compliance with the rules of preparation for analysis;
• nose bleed;
• menstruation;
• stomatitis;
• periodontal disease.

If occult blood is detected, the doctor will refer the patient for additional examination. Colonoscopy will allow you to assess the condition of the mucous membrane of the large intestine and identify foci of altered cells (polyps and tumors).

If necessary, a biopsy of pathological material is performed. In addition to colonoscopy, computed tomography and magnetic resonance imaging (CT and MRI) are used.

A positive stool test for occult blood occurs in cases of helminthiasis, ulcers of the stomach and small intestine, Crohn's disease, colitis, intestinal tuberculosis, hemorrhoids, anal fissures, as well as polyps and tumors.

The latter may not cause constant bleeding and can only be detected through systematic diagnosis. It is advisable to conduct at least 3 studies in succession.

A stool occult blood test detects even a small amount of blood, makes it possible to detect diseases in the primary stages, and this increases the likelihood of a favorable outcome. In the initial stages, the pathology is asymptomatic, and it is impossible to independently detect internal bleeding. Biological fluid in feces can indicate a dangerous disease - from hemorrhoids to malignant neoplasm.

• colorectal cancer;
• abnormal growth of tissue over the mucous membrane of the large intestine;
• ulcers, stomach erosions;
• diverticular disease of the colon;
• granulomatous enteritis;
• inflammatory processes that damage the inner lining of the intestine;
• haemorrhoids;
• nonspecific ulcerative colitis.

In young children, this may be due to individual sensitivity to cow's milk. If the baby is breastfeeding, then the mother's consumption of dairy products is to blame for the bleeding.

Indications for prescribing analysis

The study is a typical method for detecting a malignant tumor of the colon and rectum in the initial stages of development.

A positive test result may indicate the development of colorectal cancer

The doctor prescribes the donation of biomaterial if certain symptoms are present. which the patient addresses:

• abdominal pain, acid reflux, nausea, vomiting (follow this link to find out);
• systematically repeated false urge to defecate;
• regular constipation or diarrhea, fever, chills, lack of appetite, rapid weight loss;
• after detection of tumors in the gastrointestinal tract, diagnosis is necessary to exclude internal bleeding;
• helminths - a study is carried out to determine the degree of damage to the inner lining of the gastrointestinal tract (from this publication you will learn);
• previously discovered ulcers, Crohn's disease, infectious diseases caused by Mycobacterium tuberculosis.

Testing every 2 years is prescribed during preventive examinations after 50 years for timely diagnosis of colorectal cancer. Indications for the test pose a health risk. If your doctor recommends a stool test, you should not take it lightly. The process of taking a stool occult blood test is absolutely safe and painless. The diagnostic price varies from 300 to 750 rubles.

Watch in the next video what the indications may be for prescribing a stool test for occult blood.

Types of occult blood tests

Laboratory testing allows you to find biological fluid in the intestines. The research is carried out in two ways:
1

Benzidine test (Gregersen method)

The method detects the presence of hemoglobin even in a small volume, which is both an advantage and a disadvantage of this type of study. Used to register colorectal bleeding.
2

Immunochemical method

The fecal occult blood immunochemical test targets only human hemoglobin, so there is no need to follow a diet that excludes the use of foods rich in iron-containing protein before the test.

The method is not able to detect colorectal bleeding in the stomach, esophagus and duodenum.

The immunochemical type is more reliable, it will detect 0.05 mg of iron-containing protein per 1 g of the sample (with 0.2 biomaterial, the test is positive). The choice of type of testing is made by the doctor and depends on the reason for issuing the referral for testing.

Preparing for analysis

To take the benzidine test, you should stop taking certain medications, in particular aspirin, for 3 days

The test result will be accurate if you follow the rules for preparing for the test. They are different for each method (in this publication you will read how to prepare for the test).

Preparation for stool occult blood test using the Gregersen reaction:

• Within 3 days before submitting the biomaterial, stop eating meat, liver and other foods that contain iron (chickpeas, lentils, cashews, apples, dark chocolate, etc.).
• For 3 days, do not take medications that contain iron, ascorbic acid, aspirin and non-hormonal drugs that have an anti-inflammatory effect. Discontinuation of medications should be discussed with your doctor.
• Women are prohibited from donating feces for diagnostics during menstruation, 3 days before and after.

How to take a stool occult blood test, which is performed using an immunochemical method:

• There is no need to adhere to a special diet before testing stool for occult blood..
• If you regularly take medications that increase the risk of bleeding, it is important to consult your doctor about the procedure for conducting the test.
• The test is prohibited from being taken within 14 days after undergoing instrumental methods for diagnosing the digestive tract, which can lead to a violation of the anatomical integrity of the mucous membrane (these include colonoscopy, sigmoidoscopy and others).

Compliance with the rules is the key to obtaining a reliable result of the study of biomaterial.

How to properly collect feces

The material is collected from the vessel into a universal container using a special spatula attached to the lid of the container.

The sampling is carried out after spontaneous defecation (it is not allowed to take the biomaterial after using an enema or laxatives!).

The material is collected in a universal transport container. You can buy a container at pharmacies and laboratories.

The required sample volume is tsp. from 3 servings. It is forbidden to take areas contaminated with urine and discharge from the genitals. Material containing blood is not examined.

You can't take material out of the toilet. To do this, use a duck or a special vessel. In newborn babies, feces are collected from a cotton diaper immediately after defecation.

How to get tested

Having received a referral for a test, the patient independently decides where to go for the test: to a public medical institution or to a private laboratory.

Rules for storing and transporting feces: up to 12 hours at a temperature of 4-8 °C. The biomaterial must be delivered to the laboratory on the day of collection.

How much stool occult blood testing is done depends on the method chosen. The study using the immunochemical method takes about 14 days, and the Gregersen reaction - 4 days.

There is a test for rapid research using the immunochromatographic method. To implement this, a tablet has been developed that reacts to human hemoglobin cells in feces.

How to conduct express research yourself:

• buy a rapid diagnostic test at a pharmacy;
• open the package;
• collect feces with an applicator into a container with a reagent;
• Add 2 drops of liquid to the tablet with an indicator;
• wait for the results to appear.

The appearance of two stripes means that the diagnosis of the biomaterial for colorectal bleeding is positive; you should consult a doctor for further clarification of the circumstances. Correct use of the rapid test allows you to obtain a result with a reliability level of 99.9%.

Read in this article how to decipher a urine test for protein levels.

How to determine the presence of blood in stool

There are two types of stool occult blood tests: the immunochemical method and the benzidine test.

The Gregersen reaction is carried out as follows: 0.025 g of basic benzidine and 0.1 g of barium compound with oxygen are mixed, and 5 ml of 50% ethanoic acid is added before the test. The reagent is shaken until a homogeneous solution is obtained.

A thin layer of biomaterial is applied to the cover glass with a smear, then a few drops of the prepared reagent are added on top.

The color of the biomaterial in blue or green indicates the presence of biological fluid. This is due to the fact that when interacting with benzidine, the hemoglobin molecule is oxidized by hydrogen peroxide and changes color.

Analysis of feces for occult blood by the immunochemical method is based on the antigen-antibody adhesion reaction between the human iron-containing protein and anti-HbF antibodies present in the sample on latex microspheres. The adhesion and precipitation from a homogeneous suspension of antigen-bearing cells under the influence of specific substances is measured as an increase in absorbance of 570 nm, the size of which is directly dependent on the level of hemoglobin in the sample.

Decoding the results

Normally, the human body excretes blood with feces in the amount of 2 mg or less of iron-containing protein per 1 g of material. A positive result indicates the presence of internal blood in the biomaterial. The intensity of the reaction is marked with a "+" sign: weakly positive ("+"), positive ("++" or "+++") and sharply positive ("++++").

In a healthy person, the result of the benzidine test should be negative.

In a healthy person, the result of a benzidine test test is negative. A negative indicator is not significant for establishing a diagnosis.

Positive means that the stool contains more body fluid than normal.

This is a sign of the presence of diseases such as: stomach ulcer, inflammation of the duodenum, ulcerative colitis, malignant tumor of the stomach, thrombophlebitis, esophageal varicose veins, stomatitis, periodontal disease, periodontitis, bleeding from the gums or nasopharynx.

If the result is positive, it is necessary to re-test, since there is a possibility of an incorrect result associated with a deviation from the instructions for obtaining the biomaterial.

The norm of the result is the analysis of feces for occult blood by the immunochemical method: 0-50 ng / ml.

A positive fecal occult blood test indicates bleeding in the digestive tract. According to the test results, it is impossible to judge in which part of the digestive tract it occurs and what is the reason for this. To obtain additional data, endoscopic types of diagnostics (sigmoidoscopy, colonoscopy) are required.

When receiving a negative indicator, the presence of colorectal cancer cannot be completely excluded. Only a specialist should interpret the stool occult blood test.

Causes of false positive and false negative results

In some cases, the result of a stool occult blood test is false positive. The reason for this may be poor preparation for collecting material. A false positive test may be due to bleeding from the gums and nose, causing the person to swallow a small amount of blood.

A false positive result may be the result of menstrual fluid in the stool, as well as adherence to a meat and fish diet.

False-negative indicators can occur if there is no free hemoglobin in the feces, but only undestroyed fresh red blood cells as a result of external bleeding (for example, from an anal fissure).

Taking stool samples 2-3 times is more informative. This will eliminate false positive and false negative indicators. If the repeated test shows the original result, then it is reliable.

conclusions

A diagnosis cannot be made based on what a stool occult blood test shows. A positive result means that the disease is progressing and, in combination with the signs and symptoms exhibited, allows a preliminary diagnosis to be made.