Perinatal encephalopathy in children (PEP). What is perinatal encephalopathy in children? Perinatal encephalopathy pep

(PEP) (peri- + lat. natus - “birth” + Greek. encephalon - “brain” + Greek patia - “impairment”) - a term that unites a large group of brain lesions that are different in cause and not specified in origin, occurring during pregnancy and childbirth. PEP can manifest itself in different ways, for example, hyperexcitability syndrome, when the child’s irritability is increased, appetite is decreased, the baby often spits up during feeding and refuses to breastfeed, sleeps less, has difficulty falling asleep, etc. A rarer, but also more severe manifestation of perinatal encephalopathy is central nervous system depression syndrome. In such children, motor activity is significantly reduced. The baby looks lethargic, the cry is quiet and weak. He gets tired quickly during feeding, and in the most severe cases the sucking reflex is absent. Often the manifestations of perinatal encephalopathy are mild, but children who have suffered this condition still require increased attention and sometimes special treatment.

Causes of perinatal pathology

Risk factors for perinatal brain pathology include:

• Various chronic diseases of the mother.
• Acute infectious diseases or exacerbations of chronic foci of infection in the mother’s body during pregnancy.
• Eating disorders.
• The pregnant woman is too young.
• Hereditary diseases and metabolic disorders.
• Pathological course of pregnancy (early and late toxicosis, threat of miscarriage, etc.).
• Pathological course of labor (rapid labor, weakness of labor, etc.) and injuries when providing assistance during childbirth.
• Harmful environmental influences, unfavorable environmental conditions (ionizing radiation, toxic effects, including the use of various medicinal substances, environmental pollution with salts of heavy metals and industrial waste, etc.).
• Prematurity and immaturity of the fetus with various disorders of its vital functions in the first days of life.

It should be noted that the most common are hypoxic-ischemic (their cause is oxygen deficiency that occurs during the baby’s intrauterine life) and mixed lesions of the central nervous system, which is explained by the fact that almost any problem during pregnancy and childbirth leads to disruption of the oxygen supply to tissues the fetus and primarily the brain. In many cases, the causes of PEP cannot be determined.

The 10-point Apgar scale helps to form an objective picture of the child’s condition at the time of birth. This takes into account the child’s activity, skin color, the severity of the newborn’s physiological reflexes, and the state of the respiratory and cardiovascular systems. Each indicator is scored from 0 to 2 points. The Apgar scale allows already in the delivery room to assess the child’s adaptation to extrauterine conditions of existence within the first minutes after birth. A score of 1 to 3 indicates a severe condition, 4 to 6 indicates a moderate condition, and 7 to 10 indicates a satisfactory condition. Low scores are considered risk factors for the child’s life and the development of neurological disorders and dictate the need for emergency intensive care.

Unfortunately, high Apgar scores do not completely exclude the risk of neurological disorders; a number of symptoms appear after the 7th day of life, and it is very important to identify possible manifestations of PEP as early as possible. The plasticity of a child’s brain is unusually high; timely treatment measures help in most cases to avoid the development of neurological deficits and prevent disorders in the emotional-volitional sphere and cognitive activity.

Course of PEP and possible prognosis

During PEP, three periods are distinguished: acute (1st month of life), recovery (from 1 month to 1 year in full-term infants, up to 2 years in premature infants) and outcome of the disease. In each period of PEP, various syndromes are distinguished. More often there is a combination of several syndromes. This classification is appropriate, since it allows us to distinguish syndromes depending on the age of the child. For each syndrome, appropriate treatment tactics have been developed. The severity of each syndrome and their combination make it possible to determine the severity of the condition, correctly prescribe therapy, and make prognoses. I would like to note that even minimal manifestations of perinatal encephalopathy require appropriate treatment to prevent adverse outcomes.

Let us list the main syndromes of PEP.

Acute period:

• CNS depression syndrome.
• Comatose syndrome.
• Convulsive syndrome.

Recovery period:

• Syndrome of increased neuro-reflex excitability.
• Epileptic syndrome.
• Hypertensive-hydrocephalic syndrome.
• Syndrome of vegetative-visceral dysfunctions.
• Movement impairment syndrome.
• Psychomotor development delay syndrome.

Outcomes:

• Full recovery.
• Delayed mental, motor or speech development.
• Attention deficit hyperactivity disorder (minimal brain dysfunction).
• Neurotic reactions.
• Autonomic-visceral dysfunctions.
• Epilepsy.
• Hydrocephalus.
• Cerebral palsy.

All patients with severe and moderate brain damage require hospital treatment. Children with mild impairments are discharged from the maternity hospital under outpatient supervision by a neurologist.

Let us dwell in more detail on the clinical manifestations of individual PEP syndromes, which are most often encountered in outpatient settings.

Syndrome of increased neuro-reflex excitability manifested by increased spontaneous motor activity, restless shallow sleep, prolongation of the period of active wakefulness, difficulty falling asleep, frequent unmotivated crying, revitalization of unconditioned innate reflexes, variable muscle tone, tremor (twitching) of the limbs and chin. In premature infants, this syndrome in most cases reflects a lowering of the threshold for convulsive readiness, that is, it indicates that the baby can easily develop convulsions, for example, when the temperature rises or when exposed to other irritants. With a favorable course, the severity of symptoms gradually decreases and disappears within a period of 4-6 months to 1 year. If the course of the disease is unfavorable and there is no timely treatment, epileptic syndrome may develop.

Convulsive (epileptic) syndrome can appear at any age. In infancy it is characterized by a variety of forms. An imitation of unconditioned motor reflexes is often observed in the form of paroxysmal bending and tilting of the head with tension in the arms and legs, turning the head to the side and straightening the arms and legs of the same name; episodes of shuddering, paroxysmal twitching of the limbs, imitations of sucking movements, etc. Sometimes it is difficult even for a specialist to determine the nature of the convulsive conditions that arise without additional research methods.

Hypertensive-hydrocephalic syndrome characterized by excess fluid in the spaces of the brain containing cerebrospinal fluid (CSF), which leads to increased intracranial pressure. Doctors often call this disorder to parents exactly this way - they say that the baby has increased intracranial pressure. The mechanism of occurrence of this syndrome can be different: excessive production of cerebrospinal fluid, impaired absorption of excess cerebrospinal fluid into the bloodstream, or a combination of both. The main symptoms of hypertensive-hydrocephalic syndrome, which doctors focus on and which parents can control, are the rate of increase in the child’s head circumference and the size and condition of the child’s head. For most full-term newborns, the normal head circumference at birth is 34 - 35 cm. On average, in the first half of the year, the monthly increase in head circumference is 1.5 cm (in the first month - up to 2.5 cm), reaching about 44 cm by 6 months. In the second half of the year, the growth rate decreases; by one year, head circumference is 47-48 cm. Restless sleep, frequent profuse regurgitation, monotonous crying combined with bulging, increased pulsation of the large fontanel and throwing the head back are the most typical manifestations of this syndrome.

However, large head sizes often occur in absolutely healthy babies and are determined by constitutional and family characteristics. The large size of the fontanel and the “delay” in its closure are often observed with rickets. The small size of the fontanel at birth increases the risk of intracranial hypertension in various unfavorable situations (overheating, increased body temperature, etc.). Carrying out a neurosonographic examination of the brain makes it possible to correctly diagnose such patients and determine treatment tactics. In the vast majority of cases, by the end of the first six months of a child’s life, normal growth of head circumference is noted. In some sick children, hydrocephalic syndrome persists by 8-12 months without signs of increased intracranial pressure. In severe cases, development is noted.

Comatose syndrome is a manifestation of the serious condition of the newborn, which is assessed by 1-4 points on the Apgar scale. Sick children exhibit severe lethargy, decreased motor activity up to its complete absence, and all vital functions are depressed: breathing, cardiac activity. Seizures may occur. The severe condition persists for 10-15 days, with no sucking or swallowing reflexes.

Syndrome of vegetative-visceral dysfunctions, as a rule, manifests itself after the first month of life against the background of increased nervous excitability and hypertensive-hydrocephalic syndrome. Frequent regurgitation, delayed weight gain, disturbances in cardiac and respiratory rhythm, thermoregulation, changes in the color and temperature of the skin, marbling of the skin, and dysfunction of the gastrointestinal tract are noted. Often this syndrome can be combined with enteritis, enterocolitis (inflammation of the small and large intestines, manifested by stool upset, impaired weight gain), caused by pathogenic microorganisms, with rickets, aggravating their course.

Movement disorder syndrome is detected from the first weeks of life. From birth, a violation of muscle tone can be observed, both in the direction of its decrease and increase, its asymmetry can be detected, and there is a decrease or excessive increase in spontaneous motor activity. Often the syndrome of motor disorders is combined with a delay in psychomotor and speech development, because disturbances in muscle tone and the presence of pathological motor activity (hyperkinesis) interfere with purposeful movements, the formation of normal motor functions, and mastery of speech.

With delayed psychomotor development, the child later begins to hold his head up, sit, crawl, and walk. A predominant disorder of mental development can be suspected in the presence of a weak monotonous cry, impaired articulation, poor facial expressions, late appearance of a smile, and delayed visual-auditory reactions.

Cerebral palsy (CP)- a neurological disease that occurs as a result of early damage to the central nervous system. In cerebral palsy, developmental disorders usually have a complex structure, combining motor disorders, speech disorders, and mental retardation. Motor disorders in cerebral palsy are expressed in damage to the upper and lower extremities; fine motor skills, articulatory muscles, and oculomotor muscles suffer. Speech disorders are detected in most patients: from mild (erased) forms to completely unintelligible speech. 20 - 25% of children have characteristic visual impairments: convergent and divergent, nystagmus, limitation of visual fields. Most children have mental retardation. Some children have intellectual impairments (mental retardation).

Attention deficit hyperactivity disorder- behavior disorder associated with the fact that the child has poor control of his attention. It is difficult for such children to concentrate on any task, especially if it is not very interesting: they fidget and cannot sit still calmly, and are constantly distracted even by trifles. Their activity is often too violent and chaotic.

Diagnosis of perinatal brain damage

Treatment with AEDs

As mentioned above, children with severe and moderate damage to the central nervous system during the acute period of the disease require hospital treatment. In the majority of children with mild manifestations of syndromes of increased neuro-reflex excitability and motor disorders, it is possible to limit oneself to the selection of an individual regimen, pedagogical correction, massage, physical therapy, and the use of physiotherapeutic methods. Of the medicinal methods for such patients, herbal medicine (infusions and decoctions of sedative and diuretic herbs) and homeopathic drugs are most often used.

In case of hypertensive-hydrocephalic syndrome, the severity of hypertension and the severity of hydrocephalic syndrome are taken into account. If intracranial pressure is increased, it is recommended to raise the head end of the crib by 20-30°. To do this, you can place something under the legs of the crib or under the mattress. Drug therapy is prescribed only by a doctor, the effectiveness is assessed by clinical manifestations and NSG data. In mild cases, they are limited to herbal remedies (decoctions of horsetail, bearberry leaf, etc.). For more severe cases use diacarb, reducing the production of cerebrospinal fluid and increasing its outflow. If drug treatment is ineffective in especially severe cases, it is necessary to resort to neurosurgical methods of therapy.

In cases of severe movement disorders, the main emphasis is placed on the methods of massage, physical therapy, and physiotherapy. Drug therapy depends on the leading syndrome: for muscle hypotonia and peripheral paresis, drugs that improve neuromuscular transmission are prescribed ( dibazole, Sometimes galantamine), with increased tone, means are used to help reduce it - mydocalm or baclofen. Various options for administering drugs orally and using electrophoresis are used.

The selection of drugs for children with epileptic syndrome depends on the form of the disease. Taking anticonvulsants (anticonvulsants), doses, and time of administration are determined by the doctor. The change of drugs is carried out gradually under EEG control. Abrupt spontaneous withdrawal of drugs can provoke an increase in attacks. Currently, a wide range of anticonvulsants are used. Taking anticonvulsants is not indifferent to the body and is prescribed only if a diagnosis of epilepsy or epileptic syndrome is established under the control of laboratory parameters. However, the lack of timely treatment of epileptic paroxysms leads to impaired mental development. Massage and physiotherapeutic treatment for children with epileptic syndrome are contraindicated.

For psychomotor development delay syndrome, along with non-drug treatment methods and socio-pedagogical correction, drugs are used that activate brain activity, improve cerebral blood flow, and promote the formation of new connections between nerve cells. The choice of drugs is large ( nootropil, lucetam, pantogam, vinpocetine, actovegin, cortexin etc.). In each case, the drug treatment regimen is selected individually depending on the severity of symptoms and individual tolerance.

For almost all PEP syndromes, patients are prescribed preparations of B vitamins, which can be used orally, intramuscularly and in electrophoresis.

By the age of one year, in most mature children, PEP phenomena disappear or minor manifestations of perinatal encephalopathy are detected, which do not have a significant impact on the further development of the child. Frequent consequences of encephalopathy are minimal brain dysfunction (mild behavioral and learning disorders), hydrocephalic syndrome. The most severe outcomes are cerebral palsy and epilepsy.

Often, after the first examination by a neurologist in a clinic or maternity hospital, the baby is diagnosed with perinatal encephalopathy. According to various sources, from 30 to 70% of newborns have it. What complaints do mothers have that force the doctor to make such a diagnosis? Prolonged crying and generally tearfulness, frequent sucking, regurgitation, flinching or throwing up of arms and legs, poor nighttime (frequent waking up, restless shallow sleep) and daytime sleep (sleeps little during the day), difficulty falling asleep (long rocking in arms). When examining a child, the doctor may notice disturbances in muscle tone - hypertonicity or hypotonicity, dystonia. Neurosonographic studies sometimes show darkened or altered areas of the brain, sometimes not. The doctor prescribes drugs that improve cerebral circulation (piracetam, nootropil, Cavinton) and sedatives (glycine, citral mixture, valerian, sometimes luminal or phenobarbital), and also recommends massage courses, bathing in soothing herbal mixtures. You probably all know this.

And now it’s worth talking about a different approach to the problem.

Perinatal encephalopathy is a complication of the pathology of pregnancy and childbirth and is diagnosed in newborns in up to 5% of cases (or 1.5-3.6%)! Where does this discrepancy come from? In the book Palchik A.B. and Shabalova N.P. “Hypoxic-ischemic encephalopathy of newborns: a guide for doctors.” (St. Petersburg: "Piter", 2000) the reasons for the widespread incidence of encephalopathy in newborns are explained very well. There is, in general, one reason, and it is called overdiagnosis.

What is the reason for overdiagnosis? What makes doctors give this diagnosis to “everyone”? As part of the research work carried out by St. Petersburg scientists, the following reasons for the “overdiagnosis” of perinatal encephalopathy were identified:

First of all x, this is a violation of the principles of neurological examination:

a) violations of standardization of examination (the most common of them: diagnosis of increased excitability in a trembling and stiff child in a cold room, as well as in an excited state or excessive manipulation by the researcher; diagnosis of depression of the central nervous system in a lethargic child when overheated or in a drowsy state).

For example, in the maternity hospital, the pediatrician prescribed a PEP because the child often cried loudly, but when the neurologist came to examine the child, the baby was fast asleep, and the doctor said that the tone was normal and he did not see any pathologies. A month later, an examination was carried out at the clinic when the child was sleeping, woke up and was afraid that his strange aunt was pulling his arms and legs. Naturally, he cried and became tense. PEP confirmed.

So, one child may be diagnosed with either hyper or hypotonicity.

b) incorrect assessment of a number of evolutionary phenomena (that is, something that is normal for that age, especially for a 1 month old child, is considered pathological). This is a diagnosis of intracranial hypertension based on a positive Graefe symptom; Graefe’s symptom can be detected in full-term children in the first months of life, in premature children, with intrauterine growth retardation, constitutional features); diagnosis of spasticity based on crossing the legs at the level of the lower third of the legs in newborns when checking the support reaction or step reflex (may be physiological due to the physiological hypertonicity of some muscles of the thighs, but pathological in children older than 3 months); diagnosis of segmental disorders when identifying a “calcaneal foot” (dorsal flexion of the foot - 120° is the norm); hyperkinesis in a 3-4 month old child with restlessness of the tongue (this is a physiological stage of maturation of the child’s motor skills).

This may include regurgitation, as a result of the immaturity of the nervous system and the weakness of the sphincter - a muscular valve located in the upper part of the stomach, which does not hold its contents very well. The norm is considered to be regurgitation after each feeding in a volume of 1-2 tablespoons and once a day vomiting in a “fountain” of more than 3 spoons, if at the same time the baby pees often, feels well and gains weight normally. Diagnosis of the symptom of marbling of the skin - due to the immaturity of the vegetative-vascular system.

But up to 3 years is an absolutely normal phenomenon, because it is just being formed!

Poor night sleep – when the child wakes up frequently. But an infant is characterized by predominantly superficial, shallow sleep and sucking during such sleep. From 3-4 months in children, night sucking may become more active, because During the day, they begin to be easily distracted from the breast and suckle for a relatively short time. Due to active night sucking, they obtain the required amount of milk.

American sleep researcher James McKenna, in his work Breastfeeding & Bedsharing Still Useful (and Important) after All These Years, writes that a study of infant sleep found that the average interval between nightly breastfeedings was about an hour and a half - the approximate length of an adult sleep cycle. You can minimize your mother’s time of “lack of sleep” with the help of rational organization of joint sleep and night feedings. Very often, children sleep better next to their mothers. Rocking motion can also be replaced by breastfeeding before bed (but not everyone succeeds). When I found out that it was “possible” to do this, the time of motion sickness decreased significantly. Often children wake up after sleep in a bad mood, you can also offer the breast, and the world will make the baby happy again!

Secondly x, this is the classification as pathological of a number of adaptive, passing phenomena on the part of the nervous system of the newborn (for example, shuddering or throwing up of arms and legs, trembling of the chin during severe crying or fear, postnatal depression, physiological muscle hypertension, etc.).

Third, poor awareness of the classification of Hypoxic Ischemic Encephalopathy (mainly due to the foreign origin of research on this topic) and insufficient qualifications of the doctor.

For example, a one-month-old child was diagnosed with Minimal Brain Dysfunction, which should be diagnosed after 2 or even 5 years, according to various sources. Another child was prescribed to drink ginseng tincture, which is unacceptable at his age. Often, drug treatments lead to even greater deterioration in children's behavior. Doctors know about the dangers of various medications for children, but either simply do not inform parents, or consciously or unconsciously do not draw their attention to the side effects.

Fourth, these are psychological reasons. They lie in the fact that due to the current situation in domestic healthcare, “overdiagnosis” does not have any administrative, legal, or ethical consequences for the doctor. Making a diagnosis leads to the prescription of treatment, and if the diagnosis is correct or incorrect, the outcome (usually recovery or minimal disorders) is favorable. Thus, it can be argued that a favorable outcome is a consequence of the “correct” diagnosis and the “correct” treatment.

Overdiagnosis of a disease is no better than underdiagnosis. With insufficient diagnosis, the negative consequences are clear - due to the lack of timely assistance, the development of a disabling disease is possible. What about overdiagnosis? According to St. Petersburg researchers, with whom it is difficult to disagree, “overdiagnosis” is not a harmless phenomenon, as some doctors sometimes believe. The negative consequences of “overdiagnosis” lie, first of all, in the fact that long-term work within the framework of the doctrine of “overdiagnosis” leads to a “blurring” of the boundaries in doctors’ perceptions between normal and pathological conditions. Diagnosing the “disease” turns out to be a “win-win” option. Diagnosing PEP has become an unaccountable ritual of the pediatric neurologist, which naturally leads to inexplicable statistics on PEP diseases.

The study by St. Petersburg scientists describes in detail the most common errors when performing echoencephalography, neurosonography, Dopplerography, axial computed tomography and magnetic resonance imaging.

The reasons for the errors are different and are associated with the fact that when interpreting the data obtained, parameters and norms developed for older children and adults are used, inadequate assessment of the data obtained and their absoluteization are used, methods are used that have insufficient information content when diagnosing this disease, devices are also used having unsuitable technical characteristics.

Fifthly, this is a lack of understanding by doctors and parents of the natural needs of a newborn child. Most often, a child signals errors in care by crying. The child needs constant contact with his mother immediately after birth.

It is well known that sucking has a kind of sedative effect on the child, which is not comparable in its usefulness to any medicine. The content of the amino acid taurine in human milk, unlike cow's milk, is very high. Taurine is necessary for the absorption of fats, and also serves as a neurotransmitter and neuromodulator during the development of the central nervous system. Since children, unlike adults, are not able to synthesize taurine, it is believed that it should be considered as an amino acid essential for a small child. Among polyunsaturated fatty acids, arachidonic and linolenic acids are especially important, which are necessary components for the formation of the child’s brain and retina. Their content in human milk is almost four times higher than in cow's milk (0.4 g and 0.1 g/100 ml, respectively). Human milk contains nucleotides and numerous growth factors. The latter includes, in particular, nerve growth factor (NGF). That is why it is very important for the child to be breastfed if you had problems during childbirth or during pregnancy, which could lead to fetal hypoxia and injury to its nervous system.

There is still no clear generally accepted tactic for managing children with increased neuro-reflex excitability syndrome; many experts treat this condition as borderline and advise only monitoring such children and refraining from treatment. In domestic practice, some doctors continue to use quite serious drugs (phenobarbital, diazepam, Sonapax, etc.) for children with the syndrome of increased neuro-reflex excitability, the prescription of which in most cases is poorly justified...

If you are still concerned about your child’s condition, it is worth going to or inviting several specialists to your home (at least two, preferably on recommendation (there are doctors who sincerely care about the health of children and are not trying to make money from children’s “problems”), Indeed, sometimes the problems are very serious, such as cerebral palsy and hydrocephalus. About my friend’s child, for example, with the same symptoms as my son, the district neurologist said that you can find fault with every child, and did not make any diagnosis. .

Homeopaths have good experience in treating neurological disorders, and official medicine confirms this. But the high plasticity of the child’s brain, its ability to compensate for structural defects, is well known. So you may never know whether the child was helped by therapy or whether he coped with the problems on his own. Massage, both mother's and professional, helps very well (but only if the child responds well to it, does not cry, does not become overexcited, does not lose weight and does not stop gaining weight) Vitamin therapy is indicated, and, given the good absorption of vitamins from mother's milk, pay attention to this is attention.

It is also worth saying about vaccinations for restless children. In one of the Moscow clinics, where babies with severe hypoxic disorders are cared for, the emphasis in treatment is on non-drug methods and maximum avoidance of injections (administration of drugs using electrophoresis, physiotherapy, etc.). My son, after vaccinations (injections), had increased tone in his limbs, general anxiety, however, no one gave us an excuse, since in general perinatal encephalopathy is considered a false contraindication to vaccination, supposedly doctors and patients protect children from vaccinations on the basis of “universal human” and “general scientific” considerations not confirmed by official medicine.

I will also say that in the side effects of vaccines you can find the word “encephalopathy”, that is, the vaccine can cause this condition! The child was born healthy, we gave him several vaccinations in the first days, isolated him from his mother, told her to feed him by the hour, give the child medicines that schizophrenics use, and in a month we are pleased to note that half of the children suffer from perinatal encephalopathy! What else to add?!

The diagnosis of hyperactivity syndrome is very popular in America and is increasingly penetrating to us. On the other hand, in America and Germany they do not know what perinatal encephalopathy is. There is another way to look at the problem - that the whole point is not a neurological pathology or a disease, but simply a special type of people, the individual structure of their nervous system. The book “Indigo Children” by Lee Carroll is proof of this.

You understand, no drug can change the psycho-emotional constitution (personality type). Of great importance is the psychological attitude in the family (understanding the needs of a small child, caring using the Serzov method of “bringing together”) and proper care of the child (breastfeeding, carrying in arms (a sling helps a lot), sleeping together, respecting the child’s personality).

In clinics there is a poster about the benefits of breastfeeding with the words of the ancient Greek philosopher: “Together with the mother’s milk, the soul enters the child.” Mother’s milk is not just food, it is also medicine, a connection with the world, and the transfer of mother’s knowledge about life to the child.

What makes you refer a child to a neurologist? Firstly, information about how the pregnancy and childbirth went. Makes you wary:

• severe manifestations of toxicosis (especially late);
• suspicion of intrauterine infection;
• maternal anemia (hemoglobin below 100 units);
• weakness of labor, long anhydrous period, use of drug stimulation or obstetric forceps during labor;
• umbilical cord entanglement; the child’s weight is too high or, conversely, signs of immaturity and prematurity;
• breech birth, etc.

In a word, everything that can lead to fetal hypoxia during childbirth, that is, to a lack of oxygen, almost inevitably leading to a temporary disruption of the central nervous system (CNS). Viral infections in a woman during the formation of the fetal nervous system, or disturbed ecology of her home or place of work can also damage her work.

There is no direct relationship between the level and duration of oxygen starvation: sometimes a child’s brain tolerates a serious oxygen deficiency without much harm to itself, but it happens that a small deficiency causes quite significant harm.

In addition to clarifying the circumstances of pregnancy and childbirth, there are certain clinical signs that alert the pediatrician. The child is too lethargic or, more often, excited, screams a lot, his chin trembles when screaming, he often spits up, and reacts to worsening weather. Or, in addition to all this, his tummy is swollen, his stool does not improve in any way - it is green, frequent, or, on the contrary, he has a tendency to constipation.

Having compared all this data, making sure that the baby is fed correctly, the pediatrician refers such a child to a neurologist - a specialist aimed at studying the condition of the central and peripheral nervous system. The task is to find out to what extent the hypoxia present during childbirth left its unpleasant mark.

Just don't panic!

This is where the reason why this article was actually started often begins - parents are gripped by fear. How is it that our child is not right in the head?! This fear goes back to our general mentality, which says that having deviations in the nervous system is, first of all, shameful.

You convince, you say that these deviations are most likely temporary, that the sooner we help the child, the faster he will cope with them... Most parents, heeding the pediatrician’s assurances, go to a neurologist and return with a note that usually reads as follows:

PEP (perinatal encephalopathy), recovery period, SPNRV (syndrome of increased neuro-reflex excitability).

And, unfortunately, neurologists do not often deign to explain incomprehensible abbreviations. They write for themselves and for the pediatrician, and both parties understand each other perfectly. But not the parents.

What are the dangers of PEP and SPNRV?

How scary is this? Most often, with this question, they run to the pediatrician, who at this moment serves as a translator from an incomprehensible medical language into everyday language.

And everything would be fine if not for one sad fact: some parents do nothing at all. This is facilitated by compassionate people around them, reassuring them with approximately the following words: “Yes, doctors write this to every second person. They wrote to us, but we did nothing and are growing!”

And they really do grow and grow. But parents do not try to connect their inaction with pronounced manifestations of exudative diathesis in the child, symptoms of gastrointestinal dyskinesia, a tendency to constipation, and even with such obvious things as a lag in speech development, disinhibition, and disobedience.

But many of these troubles could have been avoided if parents had treated the problem as it deserved - quite seriously, but without excessive drama. The named diagnoses in the child’s chart are not a signal of panic, but a signal to action! Do you have any doubts about the recommendations of your local pediatric neurologist? Consult your child with another specialist.

What is hidden behind the incomprehensible words?

So, PEP stands for perinatal encephalopathy. That is, the child during childbirth had factors that could damage the brain. Something happened, and we need to figure out what damage this accident caused in the body.

The words recovery period quite rightly indicate that the nervous system itself, without outside interference, is restored - it’s only a matter of the pace and quality of this recovery. And they are not always satisfactory.

As for the difficult-to-pronounce abbreviation SPNRV (syndrome of increased neuro-reflex excitability), it precisely means the sad fact that the child is whiny, spits up a lot, is easily excited, and difficult to calm down. And he needs help to get rid of it.

“Won’t it go away on its own?” - you ask. It will pass. Some children. And the rest will have to carry this burden throughout life. They will be disinhibited, restless, and will not be able to communicate normally with their peers.

What do neurologists pay attention to during examination? Firstly, on reflexes and muscle tone. Are the reflexes equal on the right and left? Are there any muscle spasms? And vice versa - aren't they contracting too weakly?

Then they check whether the child has signs of increased intracranial pressure. To do this, an ultrasound (neurosonogram) is done through an open fontanel - they look to see if the ventricles of the brain are dilated. And in conclusion, the child’s behavior is examined, the correspondence of his so-called psychomotor and physical development to his age.

The diagnosis has been made. What's next?

If the matter is limited to a violation of muscle tone and excitement of the nervous system, the neurologist usually prescribes massage, mild sedatives and drugs that improve cerebral circulation.

If a neurologist discovers that a child has increased intracranial pressure, which usually depends on excess production of cerebrospinal fluid, he prescribes a course of so-called dehydration therapy (dehydration - dehydration). For this purpose, various diuretics are given. To compensate for the loss of potassium due to increased urination, drugs containing potassium are prescribed.

One should not hope that these phenomena will go away on their own as the skull grows - this may not happen. By the way, monitoring of intracranial pressure indicators should be carried out later, for several years, which will relieve your child of headaches and attacks of the so-called vegetative-vascular dystonia in preschool and school age.

Treatment

But the most important thing for forms of PEP of any complexity are gentle and drug-free methods of restorative treatment: reflexology, special therapeutic massage techniques, elements of therapeutic exercises, hydrotherapy with massage and therapeutic exercises in water of various temperatures and compositions, etc.

They require persistence and great effort from the child’s parents - giving medicine is probably easier than doing a set of exercises every day - but they are very effective. This is explained by the fact that the injured brain, receiving the correct “information” through massage, swimming and gymnastics, recovers more quickly.

Reflexomassage (impact on active points) is first done by the hands of an experienced massage therapist, who then passes the baton of competent handling of the baby to the parents. Don’t forget: babies get tired quickly, all procedures should be carried out briefly, but often, at the height of positive emotions.

Early swimming of a child with mandatory diving is also a huge help in solving the neurological problems of the baby. What is painful and unpleasant to do on land can be done with a bang in water. When diving into the water column, the body experiences a baroeffect - gentle, soft and, most importantly, uniform pressure on all organs and tissues. Hands clenched into fists, spasmed muscles and ligaments of the body straighten. The thickness of the water restores intracranial pressure in all directions, provides baromassage to the chest, equalizing intrathoracic pressure.

After emerging, the child receives a full, competent breath, which is especially important for babies born by cesarean section, who had hypoxia, etc. Water also helps with problems with intestinal colic - stool improves, spastic painful phenomena go away.

Tummy and PEP

Often children with perinatal encephalopathy have serious disorders of the gastrointestinal tract: constipation and diarrhea, bloating, intestinal colic. Usually all this begins with dysbiosis and, unfortunately, often ends with various skin manifestations - exudative diathesis or even eczema.

What's the connection here? The simplest one. When brain hypoxia occurs during childbirth, the center for maturation of immunity, located in the medulla oblongata, almost always suffers. As a result, the intestines are populated by the flora that lives in maternity hospitals, especially with late breastfeeding and early transition to artificial feeding. As a result, the baby develops dysbiosis very early: after all, instead of the necessary bifidobacteria, his intestines are filled with staphylococci, E. coli, etc.

All this is aggravated by the fact that the baby’s intestines, due to a “breakdown” of the nervous system, function poorly, contract incorrectly, and the combination of intestinal dyskinesia with “bad” microbial flora leads to impaired digestion of food. Poorly digested food causes stool disorders, anxiety in the child and, ultimately, skin allergization.

It also happens the other way around: long-term exposure to a damaging factor not related to the central nervous system can cause secondary encephalopathy. For example, if you do not pay attention to the state of the flora of the gastrointestinal tract, especially the presence in the intestines of such “saboteurs” as staphylococci, clear signs of damage to the central nervous system may appear - delayed psychomotor development of the child, weakness of the sphincters, symptoms of increased neuro-reflex excitability and etc.

What should I do? To achieve the best effect, treat not only the intestines, but also the nervous system. Only the joint efforts of a pediatrician and a neurologist with the most active assistance of parents can give the desired effect.

And finally, I would like to remind you that a baby with an unstable nervous system needs maternal warmth, gentle touches, affectionate conversation, peace in the house - in a word, everything that makes him feel protected - needs it even more than a healthy child.

Results and forecast

When treating encephalopathy, how can you understand that the efforts of doctors and parents have been successful? The child became calmer, stopped crying for a long time, and his sleep improved. He began to hold his head in time, sat down, then stood up and took the first step. His digestion has improved, he is gaining weight well, and his skin is healthy. This is visible not only to doctors, but also to yourself. This means you have helped your baby overcome damage to the nervous system.

And finally, one example of what a mother's love can do.

In the mid-60s, in one of the maternity hospitals on distant Sakhalin, a daughter was born to a young midwife. As, unfortunately, often happens with doctors, the birth was extremely difficult, the child was born in deep asphyxia, did not breathe for a long time, and then was practically paralyzed for several weeks.

The girl was fed from a pipette and nursed as best she could. To be honest, the doctors thought that this child was dead. And only the mother thought differently. She did not leave the baby, mastered massage perfectly and persistently massaged the barely reviving body.

Eighteen years later, the author of this article met his daughter and mother in Leningrad. They came to enter Leningrad University. It turned out that the girl graduated from school on Sakhalin with a gold medal. It was difficult to take your eyes off her - she was so slender and beautiful. Then she graduated from university, defended her PhD thesis in biology, became a scientist, got married, and gave birth to two beautiful children. None of this might have happened if the mother’s love had been less selfless and reasonable.

Rules for everyone

Study and show an experienced pediatrician the extract from the maternity hospital. If it contains low scores on the Apgar scale (6 and below), or other marks (for example, he did not cry immediately after birth, there was cephalohematoma, hypoxia, asphyxia, convulsive syndrome, etc.), do not delay a consultation with a pediatric neurologist.

If there are no objective indications for consulting a neurologist, but it seems to you that the baby is overly excited, whiny, and capricious beyond all reasonable limits, trust your parental intuition and show the child to the doctor. The baby is unlikely to be healthy if in the first weeks of life he is pathologically passive, lies like a rag, or vice versa, cries 24 hours a day, if he is indifferent to food or vomits like a fountain after each feeding.

Breastfeeding is necessary for your baby! Even the highest quality and most expensive adapted milk formulas place additional metabolic stress on the baby’s body. It has been scientifically proven that breastfed children “overcome” infantile problems (neurological, intestinal, etc.) faster and have a higher rate of emotional and physical development.

If you are planning your next child, find out all the causes of perinatal encephalopathy in your firstborn. And if possible, try to correct the situation if it is associated with inattention to your health during pregnancy and childbirth. Attend courses to prepare couples for childbirth. Carefully choose doctors and medical institutions where you plan to give birth to your baby.

Often in the medical records of newborn children you can see the abbreviation PEP, which frightens young mothers. The term “perinatal encephalopathy” itself was proposed in 1976 and comes from four Greek words: the prefix “peri” - located near, at something, “natus” - birth, “pathos” - disease and “enkefalos” - brain.

The perinatal period is the time from the 28th week of pregnancy to the seventh day after birth (up to the 28th day in premature babies), and encephalopathy is a term that refers to various brain pathologies.

Thus, PEP is a kind of collective diagnosis to designate neurological disorders in newborns, and the specific symptoms, causes and severity of this condition may vary.

In the international classification, there are various types of encephalopathy, their names indicate the cause of the disease (for example, hypoxic or diabetic encephalopathy), but there is no perinatal form, since this term only indicates the time interval for the appearance of disorders.

In recent years, domestic pediatric neurologists are also increasingly using other diagnoses, for example, perinatal asphyxia and hypoxic-ischemic encephalopathy.

The intrauterine development of the brain and nervous system as a whole is influenced by various unfavorable factors, in particular the health of the mother and the state of the environment.

Complications can also occur during childbirth.

1. Hypoxia. When a child in the womb or during childbirth lacks oxygen, all body systems suffer, but primarily the brain. The cause of hypoxia can be chronic diseases of the mother, infections, incompatibility by blood group or Rh factor, age, bad habits, polyhydramnios, malformations, unsuccessful pregnancy, unsuccessful childbirth and many others.
2. Birth injury, causing hypoxic or mechanical injuries (fractures, deformations, hemorrhages). Injury can be caused by: weak labor, rapid labor, poor fetal position, or obstetrician error.
3. Toxic lesions. This group of reasons is associated with bad habits and the intake of toxic substances during pregnancy (alcohol, drugs, some medications), as well as with environmental influences (radiation, industrial waste in air and water, heavy metal salts).
4. Maternal infections– acute and chronic. The greatest danger is posed by infection of a woman while carrying a child, since in this case the risk of infection of the fetus is very high. For example, toxoplasmosis, herpes, rubella, and syphilis rarely cause symptoms of an infectious disease in the fetus, but cause serious disturbances in the development of the brain and other organs.
5. Developmental and metabolic disorders. These can be congenital diseases of both mother and child, prematurity of the fetus, and developmental defects. Often the cause of PEP is severe in the first months of pregnancy or gestosis in the last.

The above factors can cause various types of disease. The most common are the following:

• hemorrhagic form, caused by bleeding in the brain;
• ischemic, caused by problems with blood supply and oxygen supply to brain tissue;
• dysmetabolic is a pathology of metabolism in tissues.

Symptoms and prognosis

Immediately after birth, the child’s well-being is assessed using a ten-point Apgar scale, which takes into account heartbeat, breathing parameters, muscle tone, skin color, and reflexes. Scores of 8/9 and 7/8 are given to healthy newborns without signs of perinatal encephalopathy.

According to research, the severity and prognosis of the disease can be correlated with the scores obtained:

• 6–7 points – mild degree of impairment, in 96–100% of cases recovery without the need for drug treatment and without further consequences;
• 4–5 points – average degree, in 20–30% of cases leads to pathologies of the nervous system;
• 0–3 points – severe, most often leading to serious impairment of brain function.

Doctors distinguish three stages of encephalopathy - acute (during the first month of life), recovery (up to six months), late recovery (up to 2 years) and the period of residual effects.

Neonatologists and obstetricians speak of encephalopathy if a child under the age of one month has the following syndromes:

1. Nervous system depression syndrome. Characterized by lethargy, decreased muscle tone, reflexes, and consciousness. Occurs in children with moderate severity of the disease.
2. Comatose syndrome. The child is lethargic, sometimes to such an extent that there is no physical activity. Cardiac activity and breathing are inhibited. Basic reflexes (searching, sucking, swallowing) are absent. This syndrome occurs as a result of hemorrhage, birth asphyxia, or cerebral edema and leads to the need to place the child in intensive care with the connection of an artificial respiration apparatus.
3. Increased neuro-reflex excitability. Anxiety, shuddering, causeless frequent crying, similar to hysterical, poor sleep, arms and legs. Premature babies are more likely to have seizures, for example at high temperatures, until they develop. This syndrome is observed in mild forms of PEP.
4. Convulsive syndrome. Unmotivated paroxysmal movements of the head and limbs, tension in the arms and legs, shuddering, twitching.
5. Hypertensive-hydrocephalic syndrome. Characterized by an increase in the amount of cerebrospinal fluid and an increase in intracranial pressure. At the same time, the head circumference grows faster than normal (more than 1 cm weekly), and the size of the large fontanel also does not correspond to age. The child's sleep becomes restless, there is monotonous prolonged crying, regurgitation, throwing back of the head and bulging of the fontanelle, as well as characteristic trembling of the eyeballs.

During the recovery period, perinatal encephalopathy is accompanied by symptoms:

1. Convulsive syndrome.
2. Syndrome of increased neuro-reflex excitability.
3. Syndrome of vegetative-visceral changes. Due to the pathological functioning of the autonomic nervous system, the child experiences delayed weight gain, regurgitation, disturbances in breathing rhythm and thermoregulation, changes in the functioning of the stomach and intestines, and “marbling” of the skin.
4. Hypertensive-hydrocephalic syndrome.
5. Movement impairment syndrome. Normally, up to a month old, a child’s limbs are semi-bent, but easily unbend, and then immediately return to their original position. If the muscles are flaccid or so tense that it is impossible to straighten the legs and arms, then the cause is decreased or increased tone. In addition, limb movements must be symmetrical. All this interferes with normal motor activity and purposeful movements.
6. Psychomotor development delay syndrome. The child begins to raise his head, roll over, sit, walk, smile, and so on later than normal.

About 20–30% of children diagnosed with PEP recover completely; in other cases, complications develop, depending on the severity of the disease, completeness and timeliness of treatment.

Perinatal encephalopathy can lead to the following consequences:

• attention deficit disorder;
• delayed speech and mental development, brain dysfunction;
• epilepsy;
• Cerebral palsy (cerebral palsy);
• oligophrenia;
• progressive hydrocephalus;
• vegetative-vascular dystonia.

Diagnostics

Perinatal encephalopathy is diagnosed by a pediatrician and pediatric neurologist based on examination data, tests and examinations of the child, as well as information about pregnancy, childbirth and the health of the mother.

The most effective and modern diagnostic methods are the following:

1. Neurosonography (NSG) is an ultrasound examination of the brain through the fontanel to identify intracranial damage and the condition of brain tissue.
2. Electroencephalogram (EEG) – records electrical potentials of the brain and is of particular value in diagnosing PEP with convulsive syndrome. Also, using this method, it is possible to establish the asymmetry of the brain hemispheres and the degree of delay in their development.
3. Doppler ultrasound to evaluate blood flow in the tissues of the brain and neck, narrowing or blockage of blood vessels.
4. Video monitoring. Video recording is used to establish spontaneous movements.
5. Electroneuromyography (ENMG) is electrical stimulation of a nerve to determine if there is a violation of the interaction between nerves and muscles.
6. Positron emission tomography (PET), based on the introduction into the body of a radioactive tracer, which accumulates in tissues with the most intense metabolism. It is used to assess metabolism and blood flow in various parts and tissues of the brain.
7. Magnetic resonance imaging (MRI) is the study of internal organs using magnetic fields.
8. Computed tomography (CT) is a series of x-rays used to create a complete picture of all brain tissue. This study makes it possible to clarify hypoxic disorders that are not clearly identified in NSH.

For diagnosis, NSG and EEG are the most informative and most often used. Without fail, the child must be sent to an ophthalmologist to examine the fundus, the condition of the optic nerves, and to determine congenital disorders.

It is worth noting that, according to various sources, in Russia perinatal encephalopathy is diagnosed in 30–70% of newborns, while according to foreign studies, only about 5% of children actually suffer from this disease. There is overdiagnosis.

The reasons for this may be failure to comply with examination standards (for example, diagnosing increased excitability in a child examined in a cold room by strangers), attributing transient phenomena (for example, throwing up limbs) or ordinary signals of needs (crying) to pathology.

Treatment

The central nervous system of newborns is plastic, capable of development and recovery, so treatment of encephalopathy must begin as early as possible. It depends on the severity of the disease and specific symptoms.

If brain dysfunction is mild or moderate, the child remains on home treatment. In this case, use:

• individual regime, calm atmosphere at home, balanced nutrition, lack of stress;
• assistance from correctional teachers, psychologists, speech therapists for alalia and dysarthria
• massage and physical therapy to normalize tone, develop motor functions and coordination of movements
• physiotherapy;
• herbal medicine (various sedatives and herbs to normalize water-salt metabolism).

For severe motor and nervous disorders, delayed development of the child and other PEP syndromes, medications are used. The doctor prescribes medications, as well as other treatment methods, based on the manifestations of the disease:

1. For movement disorders, dibazole and galantamine are most often prescribed. With increased muscle tone - Baclofen and Mydocalm to reduce it. These drugs are introduced into the body, including through electrophoresis. Massage, special exercises, and physiotherapy are also used.
2. If PEP is accompanied by convulsive syndrome, the doctor prescribes anticonvulsant drugs. For seizures, physiotherapy and massage are contraindicated.
3. Delayed psychomotor development is a reason for prescribing drugs to stimulate brain activity and increase blood circulation in it. These are Actovegin, Pantogam, Nootropil and others.
4. For hypertensive-hydrocephalic syndrome, herbal medicine is used, and in severe cases, Diacarb is used to accelerate the outflow of cerebrospinal fluid. Sometimes part of the cerebrospinal fluid is removed through a puncture of the fontanel.

For the treatment of PEP of any severity, B vitamins are prescribed, as they are necessary for the normal development and functioning of the nervous system. In many cases, swimming, baths with salt or herbal remedies, and osteopathy may be recommended.

Perinatal encephalopathy is one of the most common diagnoses among pediatric neurologists. This is due to the fact that PEP is a collective term denoting disorders of the child’s brain in the perinatal period, which have various causes, including the health of the mother, the course of pregnancy, the absence of congenital diseases, complications during childbirth, ecology and other circumstances.

Symptoms can be different, relating to disorders of the nerves, muscles, internal organs, metabolism, therefore, for an accurate diagnosis, the doctor must not only examine the child, but also collect the entire history regarding the health of the mother and father, complications during pregnancy, labor, and also order additional examinations.

An untimely or incorrectly treated disease can lead to complications including cerebral palsy and epilepsy.

Useful video about perinatal encephalopathy

Perinatal encephalopathy is a brain lesion that has various causes and manifestations. This is a huge variety of symptoms and syndromes, manifestations and features: children with severe perinatal encephalopathy require special attention and mandatory medical supervision. Perinatal injuries of this nature account for about half of the pathologies of the nervous system in children and often become the causes of epilepsy, cerebral palsy, and brain dysfunction.

Perinatal posthypoxic encephalopathy

PPE (transient encephalopathy of newborns) implies the appearance of disorders of the child’s brain that arose before or during childbirth. The most important factors contributing to the occurrence of PPE are birth injuries, neuroinfections, fetal intoxication and oxygen deprivation.

Symptoms also occur in large newborns, premature babies, and if the child was born entwined with the umbilical cord. The diagnosis is indicated by high fetal weakness on the Apgar scale, the absence of a sucking reflex in children, heart rhythm disturbances and constant nervous agitation.

About the diagnosis "hypoxic-ischemic perinatal encephalopathy" we are talking about when multiple disorders are noticed in the prenatal period. This leads to a pathology in the supply of oxygen to the fetal tissues, but the brain is primarily affected.

Perinatal encephalopathy in newborns

Immediately after birth, a child with brain damage attracts attention with restless behavior, frequent spontaneous flinching and regurgitation, excessive lethargy and stiffness, and increased reactions to sound and light.

Throwing back the head with uncontrollable crying, poor thermoregulation, and disturbed sleep often resolve within the first week of life. CNS depression syndrome in newborns manifests itself in the form of lethargy, lethargy, and often different muscle tone, leading to asymmetry of the body and facial features.

If the symptoms do not disappear during the first month of life, but acquire a new color and strength, doctors diagnose perinatal encephalopathy.

Types of encephalopathy in children

• Residual form Brain damage is diagnosed if, in the presence of previous birth injuries, the child suffers infections, inflammation, and also with poor blood supply to the brain. Such children suffer, often with mental problems, decreased intelligence, and learning difficulties.
• Encephalopathy– damage to brain tissue caused by impaired blood supply. The causes are osteochondrosis, hypertension, increased blood pressure, and dystonia.
• Ischemic encephalopathy is expressed in poor blood supply to the brain and destructive processes occurring in certain tissue areas. Excessive smoking, stress and alcohol abuse lead to this diagnosis.
• Toxic encephalopathy becomes a consequence of brain poisoning by toxic substances during infections, poisoning with chemicals and alcohol. Severe poisoning of brain tissue leads to epileptic seizures.
• Radiation encephalopathy appears as a result of exposure to ionizing radiation on the brain of patients.
• Encephalopathy of mixed origin characterized by the presence of extensive complaints and symptoms; only a doctor can make a correct diagnosis based on tests and brain studies.

Severity

During PE it is customary to distinguish several periods.

The period after birth and up to the 1st month of life is considered acute. The recovery period lasts up to a year or two. What follows is the outcome of the disease.
Each period is characterized by a special course and the presence of various syndromes; sometimes combinations of manifestations are noted.

Each syndrome requires appropriate treatment and correctly prescribed medications.

Even mild manifestations of brain disorders should be carefully examined - untreated disorders are fraught with developmental delays and adverse outcomes. When the severity of brain damage is severe or moderate, qualified inpatient treatment is necessary.

Mild disorders can be treated on an outpatient basis under the supervision of a neurologist.

Video of Dr. Komarovsky talking about the difference between perinatal encephalopathy and normal physiological reflexes of newborns:

Causes of perinatal encephalopathy

Risk factors, contributing to the appearance of this group of brain lesions:

• The presence of chronic diseases of the mother;
• Eating disorders;
• Maternal alcohol intake and smoking;
• Autoimmune conflict;
• Previous infectious diseases during pregnancy;
• Borderline age of the woman in labor;
• Stress;
• Pathology during pregnancy and childbirth (toxicosis, rapid labor, trauma during childbirth);
• Prematurity of the fetus;
• Unfavorable environmental conditions.

Symptoms of the disease

• Prolonged crying;
• Frequent regurgitation;
• Throwing of limbs;
• Restless shallow sleep at night and short sleep during the day;
• Lethargy or hyperactivity;
• Inadequate reaction to light and sound stimuli;
• Lack of sucking reflexes;
• Muscle tone disorders.

These and many other symptoms need to be carefully studied by your doctor.

At a later age, the child experiences frequent bad mood, absent-mindedness, sensitivity to weather changes, and difficulty getting used to child care facilities.

Main syndromes of perinatal encephalopathy

• Hypertensive-hydrocephalic syndrome manifested by the presence of excess fluid inside the brain, this leads to changes in intracranial pressure. The diagnosis is made based on observation of the size of the head and the condition of the large fontanel. Also manifestations of the syndrome are restless sleep, monotonous crying, increased pulsation of the fontanel.
• Hyperexcitability syndrome more often makes itself felt by increased motor activity, problems with falling asleep and staying asleep, frequent crying, a decrease in the threshold of convulsive readiness, and increased muscle tone.
• Convulsive syndrome known as epileptic and has a variety of forms. These are paroxysmal movements of the body, shudders, twitching and spasms of the limbs.
• Comatose syndrome manifests itself as severe lethargy, decreased motor activity, depression of vital functions, and absence of sucking and swallowing reflexes.
• Vegetative-visceral dysfunction syndrome expressed by increased nervous excitability, frequent regurgitation, disorders of the digestive system, enteritis, stool disorder, and abnormal skin condition.
• Movement disorder syndrome manifests itself in the direction of a decrease or increase in muscle tone, which is often combined with developmental disorders, making it difficult to master speech.
• Cerebral palsy has a complex structure: these are disorders of fine motor skills, lesions of the limbs, speech dysfunction, visual impairment, mental retardation and reduced ability to learn and social adaptation.
• Hyperactivity syndrome is expressed in children’s reduced ability to concentrate and attention disorders.

Diagnostics

The diagnosis is made based on clinical data and information about the course of pregnancy and childbirth. The following modern and effective methods are used for diagnosis.

• Neurosonography reveals intracranial brain damage.
• Doppler sonography studies the amount of blood flow in brain tissue.
• An electroencephalogram, by recording the electrical potentials of the brain, makes it possible to determine the presence of epilepsy and delayed age-related development at various stages.
• Video monitoring helps to evaluate the characteristics of children’s motor activity based on video recordings.
• Electroneuromyography allows you to study the sensitivity of peripheral nerve fibers.
• Available types of tomography are used to assess structural changes in the brain.

Most often, objective information about the disease is obtained using neurosonography and electroencephalography. Sometimes an examination by an ophthalmologist is prescribed, who examines the fundus and the condition of the optic nerves, and identifies genetic diseases.

Treatment of encephalopathy in children

If the symptoms are moderate and mild, doctors leave the child for home treatment and give recommendations to parents on how to maintain the condition.

But severe damage to the nervous system and an acute period require hospital treatment. In any case, it is necessary to choose an individual regimen, massage, physical therapy, herbal medicine methods and homeopathic remedies.

Drug treatment

When prescribing treatment, the severity of the diagnosis is taken into account. To improve blood supply to the brain, a newborn is prescribed piracetam, actovegin, and vinpocentine.

Drug therapy is prescribed by a doctor.

• For severe motor dysfunctions, the emphasis is placed on the drugs dibazole and galantamine; for increased tone, baclofen or mydocalm are prescribed. To administer drugs, various options for oral administration and the electrophoresis method are used. Massages, physiotherapy, and daily special exercises with the child are also indicated.
• For epileptic syndrome, taking anticonvulsants in doses recommended by a doctor is indicated. Anticonvulsants are prescribed for serious indications and severe epilepsy. Physiotherapy methods are contraindicated for children with this syndrome.
• For disorders of psychomotor development, medications are prescribed that are aimed at stimulating brain activity and improving cerebral blood flow - these are nootropil, actovegin, cortexin, pantogam, vinpocetine and others.
• For hypertensive-hydrocephalic syndromes, appropriate drug therapy is prescribed based on the severity of symptoms. In mild cases, the use of herbal remedies (decoctions of bearberry and horsetail) is indicated; in more complex cases, diacarb is used, which increases the outflow of liquor.

  For particularly severe patients, it is rational to prescribe methods of neurosurgical therapy. Hemodialysis, reflexology, ventilation, and parenteral nutrition are also used. Children with PEP syndromes are often prescribed B vitamins.

Treatment at home

It is important to pay special attention to children with perinatal encephalopathy from the first days of life. Parents should tune in to the need to introduce hardening, massage, swimming, and air baths.

Therapeutic massage and special gymnastics complexes help improve body tone, develop motor functions of the hands, train and strengthen the baby’s health. If a child has been diagnosed with asymmetry of muscle tone, therapeutic massage is indispensable.

Parents should be prepared for the fact that at times of increased stress, all syndromes may worsen. This happens when children go to kindergarten or school, when the weather and climate change, during a period of intensive growth of the child. Childhood infections may also influence symptoms.

It is mandatory to take vitamin complexes, you should allocate enough time for walks in the fresh air, activities and exercises. You also need a balanced diet and a calm, balanced environment in the house, the absence of stress and sudden changes in daily routine.

The better the quality of treatment a child receives, the more attention is paid to such children from birth and in the first years of life, the lower the risk of severe consequences of brain damage.

Consequences and possible prognosis of the disease

The most common consequences of perinatal encephalopathy can be: delayed development of the child, brain dysfunction (expressed in lack of attention, poor learning ability), various dysfunctions of internal organs, epilepsy and hydrocephalus. Vegetative-vascular dystonia may occur.

About a third of children recover completely.

A woman's adherence to a daily routine, rules of conduct during pregnancy and personal hygiene, and abstinence from smoking and alcohol can reduce the risk of brain damage in newborns.

Adequately conducted childbirth, qualified medical care and observation by a neurologist, timely diagnosis and treatment reduce the risk of the consequences of perinatal encephalopathy.

Perinatal encephalopathy and can it be cured:

Many responsible couples, preparing to become parents, come across the term “perinatal encephalopathy”, or PEP, in the literature. Specialized medical literature gives definitions that are difficult for ordinary people to understand, operates with terms and concepts, explanations for which will have to be sought additionally. As a result of such a responsible attitude towards the birth of a child, future parents receive fear, anxiety - anything, but not an understanding of the problem.

PEP is a serious disease, but nowadays it is treatable. Timely therapy with AEDs allows you to achieve good results and stabilize the child’s mental development. In addition, every year the results of research in the field of AED treatment prove that the effectiveness of treatment is increasing.

What is perinatal encephalopathy?

Medical literature gives the following definition:

Perinatal encephalopathy, or PEP, is a group of brain lesions of various etiologies and development mechanisms that occur during the perinatal period.

In more understandable terms, perinatal encephalopathy is a group of brain diseases caused by various causes. PEP occurs during the perinatal period, that is, from the 28th week of pregnancy to the 7th day of life in full-term babies, and up to 28 days in premature babies. Depending on the mechanism of occurrence, specific types of AEDs are distinguished - hypoxic, traumatic, toxic-metabolic or infectious.

According to statistics, from 3 to 5% of newborns are born with signs of perinatal encephalopathy. Perinatal encephalopathy is a common pathology. It is not a sentence at all; you can and should work with it.

Why does the disease develop?

The main and most common cause of perinatal encephalopathy in newborns is the negative impact of various harmful factors on the mother’s body during pregnancy. These factors include the following:

• acute infectious diseases of the mother during pregnancy, as well as chronic diseases of the mother with exacerbation during pregnancy;
• violation of the mother's diet during pregnancy and breastfeeding;
• pathology of labor (weakness, rapid labor) or trauma during childbirth (fractures, atypical position of the fetus);
• toxicosis (both early and late);
• insufficient maturity of the mother’s body, too young age;
• threat of miscarriage;
• various hereditary genetic diseases, as well as congenital metabolic disorders;
• adverse effects of harmful environmental factors - toxic substances, radiation, harmful substances in food, heavy metal salts, exhaust gases, harmful factors at work, industrial waste in water and air;
• prematurity and immaturity of the fetus, congenital malformations;
• bad habits of mother and father: smoking, drinking alcohol, drug addiction, coffee abuse.

As you can see, the reasons can be any adverse effects, so future parents need to prepare in advance for the conception and birth of a child - take care of their own health first.

Types of perinatal encephalopathies

Perinatal encephalopathies are classified according to the causes that cause them. Accordingly, the following groups of PEP can be distinguished:

Hypoxic . Occurs as a result of lack of oxygen in the peripheral blood or asphyxia at birth.

Traumatic . Develops as a consequence of fetal injuries during childbirth: incorrect position, obstetric error, incorrect conditions during childbirth, pathology of labor.

Toxic-metabolic – occurs due to malformations of fetal organs, inflammatory processes in the mother during pregnancy.

Infectious , of course, implies the presence of infection.

Depending on the severity, PEP is classified into mild, moderate and severe perinatal ecephalopathy.

Depending on the mechanism of development, perinatal encephalopathies can also be hemorrhagic, ischemic and dysmetabolic. Simply put, brain damage caused by hemorrhages (hemorrhagic), lack of blood supply and oxygen (ischemic) and disturbances in metabolic processes in tissues and cells (dysmetabolic).

How to recognize perinatal encephalopathy?

Usually, obstetricians and pediatricians almost accurately recognize the symptoms of perinatal encephalopathy. But even in the absence of a qualified specialist, one can suspect PEP in a child already in the first hours after birth.

What you should pay attention to in the behavior of a newborn:

• weak or late cry;
• problems with the state of the cardiovascular system at birth - arrhythmia, absence of heartbeat, tachycardia, bradycardia;
• excessive weakness or increased muscle tone;
• inadequate reactions to stimuli (light, sound);
• reflex voluntary shudders;
• lack of newborn reflexes (sucking, swallowing, searching, etc.);
• causeless anxiety, nervous behavior;
• frequent, hysterical, hysterical-like, with frequent voice breakdowns, difficult to stop crying;
• lesions of the oculomotor nerve (strabismus, exophthalmos);
• throwing back the head when lying on the back;
• frequent regurgitation, vomiting, digestive disorders related and not related to food intake;
• sleep disorders (difficulty falling asleep, frequent awakenings).

Unfortunately, symptoms of perinatal encephalopathy often appear at a later age. This greatly facilitates diagnosis, but complicates the treatment of AEDs.

At older ages, you may notice the following symptoms:

• disorders of mental processes (memory, attention, sensation, perception, etc.);
• passivity, lack of interest in everything that is happening, apathy, lack of initiative;
• constant signs of depression - lack of appetite, depressed state, reluctance to participate in the game, make contact, fatigue, confusion, absent-mindedness, irritability, tearfulness, weakness, poor sleep, depression;
• signs of VSD – dizziness, headaches, low blood pressure;
• inability to express one's thoughts;
• lack of interest in cognitive activity (narrowing the range of interests);
• speech disorder.

As you can see, all these disorders can be combined into two groups - deterioration in general well-being and delayed mental development.

Diagnostics

Often, the diagnosis of perinatal encephalopathy is made by pediatricians who accidentally discovered symptoms during a routine examination of the child, or based on the stories of parents.

In general, a doctor will make a diagnosis of PEP based on the following indicators and studies.

1. Anamnesis of the life of the mother, child and anamnesis of the disease - the presence of unfavorable factors before and during pregnancy, pathological labor.
2. Clinical picture - symptoms and syndromes characteristic of this group of diseases:
3. Syndrome of movement disorders - muscle hypotonia or hypertension.
4. Syndrome of increased neuro-reflex excitability.
5. Central nervous system depression syndrome
6. Intracranial hypertension syndrome - the large fontanel is enlarged and bulging, the head circumference is increased, the cranial sutures diverge.
7. Convulsive syndrome.
8. Prenatal diagnosis - ultrasound (umbilical cord entanglement, abnormal fetal position), Dopplerography (pathologies of the development of the heart and vascular bed in the fetus).
9. Neurosonography - ultrasound of the brain - reveals areas of hemorrhage.
10. Electroencephalography – pathological waves or disturbances in brain activity.

How is perinatal encephalopathy treated?

As mentioned earlier, today perinatal encephalopathy is highly treatable with timely diagnosis and an integrated approach.

Here are the main components of AED treatment. Constant medical supervision. Regular monitoring by a good pediatrician, pediatric neurologist, cardiologist and orthopedist is needed. These four doctors are the “backbone” of medical supervision.

Correct mode. This is a gentle regime, taking into account the child’s personal biorhythms and his needs for activity and rest. Psychocorrectional and pedagogical correctional work with a child. It is better to do this yourself, following the recommendations of specialists. Massage. This will help improve muscle tone and overcome neuropsychic disorders. Physiotherapy – inhalations, electrical stimulation.

Drug treatment, which depends on the predominant disorder: If there are signs of cerebral edema, hydrocephalus, increased intracranial pressure, diuretics and decongestants (Lasix, Mannitol) are prescribed. Convulsive syndrome is treated with anticonvulsants (Difenin). In this case, physiotherapeutic procedures and massage are contraindicated. For dystonic disorders, Dibazol or another conduction-improving drug is indicated. Drugs that improve blood supply to the nervous system and brain, in particular Piracetam and its analogues.

In complex cases, neurosurgical intervention demonstrates very high effectiveness. Treatment with herbs, wraps and sanatorium-resort treatment is also used.

The total duration of treatment for perinatal encephalopathy ranges from one to several years. The effectiveness of treatment is quite high, and with an integrated approach, the first results will be obvious already in the first months of therapy.

Consequences of the disease

Perinatal encephaloppotia has a number of possible outcomes of the disease:

1. Full recovery. In case of timely detection and an integrated approach to treatment, this option is quite possible.
2. Delayed psychomotor development. It can vary in severity. Even if a child remains with a slight mental retardation (mental development delay), this does not mean that he will be severely limited in his capabilities. With mental retardation, a child can live a full life.
3. Attention deficit hyperactivity disorder (minimal brain dysfunction). Similar to the previous option.
4. Neurotic reactions. This is a more severe complication that requires constant follow-up of the child.
5. Autonomic-visceral dysfunctions. Violation in this area can lead to disruptions in the functioning of organs.
6. Epilepsy.
7. Hydrocephalus.

A diagnosis of PEP was made. What to do?

First of all, stop panicking and re-read the article carefully. The main idea is that perinatal encephalopathy can be successfully corrected. In many cases it is cured.

The first thing you need to do is contact a good neurologist and undergo a full examination, which will reveal the mechanism and cause of the occurrence of PEP in the child. The fact of the disease should not be denied.

Next, you should independently study the features of this pathology in order to navigate all the procedures that await the child during the treatment process. Adhere to the diet, sleep, and treatment regimen prescribed by your doctor.

It is worth making acquaintances with parents of children with the same problems, sharing experiences and providing (as well as receiving) support.

Follow all the doctors’ recommendations, knock on all doors one by one and try all common sense ways to help the child. Go through this period with your baby, support him and show him in every possible way that he is loved and needed.

Regularly undergo follow-up examinations. Keep a diary of your child’s health, in which you note daily the symptoms that arise, the therapy performed, and the response to treatment. This will help parents properly organize care, and the doctor will help monitor the dynamics of the child’s health.

Visit a psychotherapist and/or medical psychologist for psychocorrectional work. Do not limit the child’s social contacts, but promote their emergence.

The main thing is to remember that the PEP is not a sentence.

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