CNS pathology in newborns
Central nervous system pathology( CNS) in newborns is a large group of spinal / brain lesions.Similar lesions can occur during intrauterine development, during childbirth and in the first days of life.Table of contents: Causes of CNS pathology development in newborns Classification of CNS pathologies in newborns
Causes of CNS pathology development in newborns
According to statistics, up to 50% of newborn children are diagnosed with perinatal pathology of the central nervous system because in this concept doctors often include transientDisorders in the functioning of the central nervous system .If we consider the statistics in more detail, it will be clarified:
- 60-70% of diagnoses of central nervous system pathologies in newborns occur in the birth of a premature baby;
- 1,5 - 10% of cases - on fully full-term children born in a timely and natural way.
The factor provoking the appearance of pathological changes in the functioning of the central nervous system in newborns can be absolutely any negative impact on the fetus during its intrauterine development.
- Fetal hypoxia.It's about oxygen starvation, when an insufficient amount of oxygen enters the child's blood from the mother's body.Hypoxia can provoke and harmful production( not without reason pregnant women are immediately transferred to a lighter work), and transferred to pregnancy infectious diseases, and harmful habits of women( especially - smoking).Very much affects the supply of oxygen to the fetus and the number of previously performed abortions - the artificial termination of pregnancy provokes in the future a violation of blood flow between the mother and the fetus.
- Injuries to the newborn.It is about injuring during childbirth( for example, when applying forceps on medical indicators), in the first hours / days of a newborn's life.It is physical trauma that is considered the least likely cause of the development of central nervous system pathologies in newborns.Dysmetabolic processes in a newborn.There may be abnormalities in the metabolic processes of the fetus due to the mother's smoking, taking drugs, drinking alcohol or taking strong drugs.
- Infectious diseases of the mother during the period of bearing of the child.Pathological lesion of the central nervous system occurs when the fetus is directly affected by viral agents, pathogenic microorganisms.
Note: , regardless of whether the above factors were present, more often the pathology of the CNS in newborns is diagnosed in the case of premature birth, in premature infants.
Classification of CNS pathologies in newborns
Depending on the causes of the development of disturbances in the functioning of the central nervous system of a newborn, doctors also classify them.For each species specific symptoms and nosological forms are characteristic.
Oxygen fasting of the fetus can lead to the following lesions of the central nervous system in newborns:
- Cerebral ischemia.The nosological form of this pathology is manifested in different degrees of severity of the course - cerebral ischemia 1, 2 and 3 degrees of severity of the course.Clinical symptoms:
- cerebral ischaemia of 1 degree - oppression or excitation of the central nervous system lasting no more than 7 days after birth;
- cerebral ischaemia of 2 degrees - oppression / excitation of the nervous system lasts more than 7 days, there may be short-term convulsions, increased intracranial pressure and violations of the vegetative-visceral type;
- cerebral ischaemia of 3 degrees - powerful seizures, up to epileptic seizures, impaired functions of the brain stem cells, constantly increased intracranial pressure.
Note: for 3 degrees of severity of the current pathological condition is characterized by a progressive depression of the central nervous system - in some cases, the newborn enters a coma.
- Intracranial hemorrhages of hypoxic origin.Nosological forms are diverse:
- intraventricular hemorrhage type 1 degree - specific neurological symptoms are usually completely absent;
- intraventricular hemorrhage 2 degrees - convulsions may develop, often a newborn falls into a coma, progressive hypertension is noted intracranial, shock, apnea;
- intraventricular hemorrhage of the third degree - deep central nervous system( coma) depression, shock and apnea, long convulsions, high intracranial pressure;
- subarachnoid haemorrhage of the primary type - doctors diagnose hyperexcitability of the central nervous system, focal clonic seizures, acute hydrocephalus;
- hemorrhage into the brain substance - the appearance of specific symptoms depends only on the localization of hemorrhage.Possible: intracranial hypertension / focal seizures / convulsions / coma, but in some cases even such a serious disruption of the central nervous system is asymptomatic.
- A combination of ischemic and hemorrhagic lesions of the central nervous system.The clinical picture and nosological forms of this condition will depend only on the localization of hemorrhage, the severity of the pathology.
This is a birth injury that caused the development of pathological disorders in the central nervous system. They are subdivided according to the following principle:
- Intracranial birth injury.It can be manifested in several nosological forms:
- epidural hemorrhage - the condition is characterized by high intracranial pressure( the very first sign), convulsive syndrome, in rare cases, doctors fix the dilated pupil on the side of the hemorrhage;
- subdural hemorrhage - subdivided into supratentorial( the course is asymptomatic, but partial seizures, enlargement of the pupil on the side of hemorrhage, progressive intracranial hypertension) and subtentorial( acute increase in intracranial pressure, cardiac / respiratory activity of progressive action, oppression of the central nervous system with transition to coma);
- intraventricular hemorrhage - characterized by convulsions( multifocal), cardiac / respiratory insufficiency, CNS depression, hydrocephalus;
- hemorrhagic infarct - the course may be asymptomatic, but may manifest as seizures, central nervous system depression with the transition to coma, high intracranial pressure;
- subarachnoid hemorrhage - doctors diagnose acute external hydrocephalus, hyperexcitability and convulsions.Trauma of the spinal cord during childbirth.
- .There is a hemorrhage in the spinal cord - tearing, stretching.Can both be accompanied by a trauma of the spine, and proceed without this moment.The clinical picture is characterized by abnormalities in the functioning of the respiratory system, dysfunctional sphincters, motor impairment and spinal shock.Trauma of the peripheral nervous system during childbirth.
- .Nosological forms and symptoms:
- Brachial plexus injury - a paresis of the flaccid character of the proximal part of one or both of the proximal arms is noted, the flaccid paresis of the distal upper limbs and the Claude Bernard-Horner syndrome in the distal type of injury.Paralysis can develop - there is a paresis of the total part of the hand or both arms at the same time, possibly disrupting the work of the respiratory system;
- Damage to the diaphragmatic nerve - often occurs without any severe symptoms, but there may be a respiratory disorder;
- traumatic lesion of the facial nerve - the child during the screaming of the mouth turns into a healthy side, nasolabial folds are smoothed.
First of all, doctors consider transient metabolic disorders:
- nuclear jaundice - characterized by a symptom of the "setting sun", seizures, opisthotonus and apnea;
- hypomagnesemia - convulsions and hyperexcitability are noted;
- Hypernatremia - high blood pressure, rapid breathing and palpitations;
- hyperglycemia is an oppressed consciousness, convulsions, but often this disorder is asymptomatic and is only detected after laboratory tests of blood and urine tests of the newborn;
- hypercalcemia - convulsions, tachycardia, increased blood pressure, muscle spasms of a tetanic nature;
- hyponatremia - lowering of arterial pressure, depression of the central nervous system.
Newborns may develop dismetabolic disorders of the central nervous system and against the background of toxic effects on the fetus - for example, if the mother was forced to take strong drugs, did not exclude alcohol, drugs and tobacco. In this case, the clinical picture will be as follows:
- convulsions - rarely, but this syndrome may be present;
- oppression of the central nervous system, passing into coma.
CNS lesions in infectious diseases
If during pregnancy a woman has been diagnosed with a cytomegalovirus infection, toxoplasmosis, rubella, herpetic infection or syphilis, the probability of a child with central nervous system pathologies rises many times.There are some infectious diseases that can contribute to the development of problems in the work of the central nervous system after the birth of the child - sepsis, Pseudomonas aeruginosa, streptococcal and staphylococcal infections, candidiasis and others.
For lesions of the CNS of infectious etiology, the following symptoms will be revealed:
- intracranial hypertension;
- focal disturbances;
- meningeal syndrome.
Periods of CNS pathology in newborns
Regardless of the reasons for the development of CNS lesions in newborns, specialists distinguish three periods of the disease:
- acute - falls on the first month of the child's life;
- restorative - can occur from 2 to 3 months of life of the baby( early) and from 4 months to 1 year( late);
- outcome of the disease.
For each of the periods listed, there are inherent characteristics that may be present separately, but more often appear in the original combinations individually for each child.
If a neonate has a mild injury to the central nervous system, then a syndrome of increased excitability is most often diagnosed.It manifests itself by a sharp flinch, irregularities in the muscle tone( it can be raised or lowered), trembling of the chin and upper / lower extremities, unmotivated crying and shallow sleep with frequent waking.
For violations of the central nervous system, there will be a decrease in muscle tone and motor activity, weakening of swallowing and sucking reflexes.
Note: by the end of the first month of life, hypotension and lethargy are replaced by increased excitability, there is uneven skin coloration( marbling of the skin), there are abnormalities in the digestive system( constant regurgitation, flatulence, vomiting
Very often acute period of the diseaseAccompanied by the development of hydrocephalic syndrome - parents can note the rapid growth of the head circumference, protrusion of the fontanel, the divergence of the cranial sutures, the anxiety of the newborn and are unusualEye movements
A coma can occur only if the neonatal CNS is severely affected - this condition requires immediate medical attention, all medical procedures are performed in the intensive care unit of the medical institution
If up to 2 monthsThe child looked absolutely healthy, the parents did not notice any strange / unusual syndromes, then the recovery period can proceed with pronounced symptoms:
- mimicry is very poor - the kid seldom smiles, does not frown, does not show any emotion;
- there is no interest in toys and any other subjects;
- cry is always weak and monotonous;
- children's babbling and "walking" either appear with a delay, or completely absent.
Note: is the parents who must pay attention to the above symptoms and report them to the pediatrician.The specialist will appoint a full-fledged examination of the child, send a small patient for an examination to the neurologist.
Outcome of the disease
By the 12 months of the child's life, almost always the symptoms of CNS pathologies in newborns disappear, but this does not mean that the above lesions disappeared without any consequences. The most common consequences of central nervous system damage in newborns are:
- hyperactivity syndrome, accompanied by a lack of attention - memory impairment, learning difficulties, aggressiveness and bouts of hysterics;
- delayed speech, psychomotor and physical development;
- Cerebroasthenic syndrome - characterized by meteorological dependence, anxious sleep, sudden mood swings.
But the most severe, complex consequences of CNS pathologies in newborns are epilepsy, cerebral palsy and hydrocephalus.
It is very important for correct diagnosis to conduct a proper examination of the newborn and to monitor his behavior / condition in the first hours of life of the baby. When suspected of pathological lesions of the central nervous system, it is advisable to design a comprehensive examination:
- ultrasound - study the state of the brain vessels by "working" the sensor through the fontanelle;
- computed tomography - the study allows not only to confirm the expected diagnosis, but also to assess the degree of damage to the central nervous system of the newborn;
- X-ray of the head and / or spinal cord - only used when absolutely necessary.
Methods of treatment and rehabilitation
Newborns with CNS pathologies are needed in the first hours of life - many disorders are completely reversible, there is a immediate start to rehabilitation / treatment.
The first stage of assistance
It consists in restoring the working capacity of vital organs and systems - we recall that practically with all types / forms of pathologies of the central nervous system of newborns, cardiac / respiratory failure and kidney problems are manifested.Doctors with the help of medications normalize metabolic processes, relieve the newborn from convulsive syndrome, stop the swelling of the brain and lungs, normalize the indicators of intracranial pressure.
The second stage of assistance
Very often, after providing emergency measures to a newborn with CNS pathologies, the visible signs disappear in the maternity hospital, often the child's condition is normalized.But if this does not happen, the patient is transferred to the department of pathologies of newborns and continues treatment / rehabilitation.
The second stage of care involves the appointment of medications that act to eliminate the cause of the pathologies under consideration - for example, antiviral, antibacterial agents.Simultaneously, a therapy is prescribed to restore brain activity, stimulate maturation of brain cells, improve cerebral circulation.
Third stage of assistance to
If a newborn has significant improvement, then it is advisable to switch to non-drug treatment. We are talking about massages and physiotherapy procedures, the most effective of which are:
- medical gymnastics;
- therapy "position" - installation of tutors, "collars", laying;
- specially designed cycle of exercises in the water;
- simulation of weightlessness;
- therapy for Vojtu;
- vibrating massage;
- paraffin therapy;
- alternating magnetic field;
- color therapy and light therapy;
Note: the third stage of assistance for the safe passage of the first two full-term children is appointed at 3 weeks of life, and prematurely a little later.
Doctors prescribe a child with diagnosed pathologies of the central nervous system for outpatient treatment only in case of positive dynamics.Many experts believe that it is the rehabilitation period outside the medical institution that plays a big role in the further development of the child.Drugs can be done a lot, but to ensure the mental, physical and psychomotor development of the baby within the norm will only be permanent care. It is necessary to:
- to protect the child from sharp sounds and bright light;
- to create the optimal climatic regime for the child - there should be no sharp changes in air temperature, high humidity or dry air;
- if possible, protect the baby from infection.
Note: for mild to moderate central nervous system damage in newborns, doctors do not prescribe drug therapy in the second stage - it is usually enough to provide emergency medical care and restore the normal functioning of vital organs and systems.In the case of diagnosing severe CNS lesions in newborns, some medications are prescribed by courses and at an older age, during outpatient treatment.
Prevention of CNS pathology in newborns
The most common pathology is easy to predict, therefore doctors strongly recommend that preventive measures be taken during the pregnancy planning stage. :
- cure all previously diagnosed infectious diseases;
- to carry out vaccination on medical parameters;
- abandon bad habits - quit smoking, stop drinking alcohol and drugs;
- to undergo a complete examination with narrow specialists;
- normalize the hormonal background.
Secondary prevention is the provision of full-fledged assistance in the detection of central nervous system pathologies in newborns, prevention of the development of severe consequences.
At the birth of a child with CNS pathology, it is not necessary to panic and immediately write a newborn to an invalid.Doctors perfectly understand that timely medical assistance in most cases gives positive results - the child is fully recovered and in the future is no different from his peers.Parents just need a lot of time and patience.
Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category.