Ultrasound examination of the brain of newborns (normal anatomy). Method for the treatment of perinatal brain damage of hypoxic-ischemic genesis in children of the first year of life Diastasis brain bone normal in newborns

27.04.2014, 19:21

Good evening, dear doctors. I am very worried about the situation that has developed at the moment based on the results of the NSG and examination by a neurologist. I read frequently asked questions, similar questions too, but it’s difficult for me, not being a doctor, to figure it out. I beg you, do not leave without attention. The baby was born at the 40th week, 3680 kg, 53 cm. head: 36 cm. The first NSG per month. MD=49mm MS=49mm VLD=12.8mm VLS=13.5mm V3=3.5mm. There is no offset. Bone-marrow diastasis = normal. M / P gap is not expanded. No pathologies were found. Despite this, I had complaints about the child's poor sleep (practically did not sleep until three and a half months, only in the fresh air), the effect of the "setting sun", shuddering, regurgitation. Head circumference per month 37 cm. Massage is prescribed. At three months, on examination by a neurologist okr. head: 43 cm. Hypotonia of the shoulder girdle. I have the same complaints. Appointed lingonberry decoction before vaccination, electrophoresis, glycine. Vaccination was not carried out due to obstructive bronchitis. Then he was examined by a neurologist at the age of 4 months in the hospital: neuro-reflex excitability syndrome. Recommended massage, nervoheel, turnout in two months.
NSG at 7 months: MD=57 mm MS=56 mm VLD=18.3 mm VLS=10.6 mm (18.6?, written very illegibly, the neurologist did not understand later), V3=3.5 mm. Bone-Marrow Diastasis =4. There is no offset. M / P gap: 22x6. Violation of liquorodynamics by the type of hyposorption. I am attaching the result of the examination by a neurologist. Appointed triampur, pantocalcin. Appearance in 1.5 months. Vaccination medicine. The child received only BCG in the maternity hospital. From 30.03 - 7.04 he had chicken pox, earlier obstructive bronchitis, stenosis of the larynx of the 2nd degree. At the moment, from complaints - shuddering, restless sleep, can wake up four times, sometimes crying in a dream with eyes closed, breastfeeding does not always help. Periodically there are red whites of the eyes. A week ago, he began to frequently "shake" his head from side to side, as if saying "no", involuntarily. Maybe even while feeding. Sometimes vomits. But earlier doctors told me that it was because of overfeeding or because of mobility immediately after eating. Of the "skills" - he rolls over, tries to sit down and crawl, but until he sits himself and crawls only in a plastunsky way, pronounces separate syllables. Active. Smiling, recognizes his. Breastfeeding + complementary foods (vegetables, fruits, cereals). Can you tell me if I should take the prescribed treatment? (For three days we have been drinking Triapur and Pantocalcin). When to repeat NSG? And is it dangerous? And if so, what? Thank you very much![Only registered and activated users can see links] ([Only registered and activated users can see links])

27.04.2014, 19:35

I would also like to add that the weight at the moment is 10 kg, 400 g, height is 69 cm, blood and urine tests are normal. In addition, rickets of the 2nd degree was made from the diagnoses, Vigantol was taken 4 drops for a month, now they switched to two. And the neurologist at the hospital at the age of four months already suspected violations of the cerebrospinal fluid exchange, asked me to do stroking movements every day in the direction from the head to the feet, but in the conclusion he did not write anything, because. NSG was not done at that time.

28.04.2014, 12:16

Dear specialists, pediatric neurologists! I re-read the article about ICP and so on. on the forum. It is written that taking diuretic drugs is contraindicated, but what then to do? I didn’t understand, is an increase in the volume of cerebrospinal fluid this is hydrocephalus? How to treat it, if not promptly, as described in the article? Can it go away on its own? I understand that deviations from the norms in one direction or another are allowed, but as far as I can assess myself, our values differ greatly from the norm. The child does not sleep for a week at night practically + everything that I described above. Although I do not rule out that this may be due to other factors. The norms of the growth of the volume of the head are not opened by the link. The phrase about the hydrocephalic shape of the skull is confusing. Help me, I can't find a place for myself anymore. I think, should I go to another specialist or continue treatment? The doctor who deciphered the NSG said "everything is bad with you." The neurologist just wrote a treatment plan. I would like to know if we are on the right track or do we need to do something fundamentally different or do nothing at all? Thank you very much in advance!

28.04.2014, 12:25

Write down the increase in head circumference by months (preferably with other parameters (body weight, chest circumference).
I would also like to see NSG scans (ultrasound of the head).

28.04.2014, 13:59

Stanislav Ilnurovich, thank you for responding! From the data I found on the map.
At birth: weight - 3680, height - 53, OG - 36, approx. gr. class - 35.
1 month: weight - 4554, height - 56, OG - 37, approx. gr. class - 36., native. 2.5x2.5
2 months 11 days: weight - 6140, height 60.
3 months: weight - 7100, height - 62, OG - 43, native. 3x3.
4 months 7 days: weight 8300, height - 63, OD - 44.5, approx. gr. class - 50.5.
7.5 months: weight 10400, height 69, OD 45, approx. gr. class 47, native 2x2.
Not everywhere there are parameters for the circumference of the head and chest, because. not every month they were measured in the clinic, but I did not assume that this was important. From 4 to 7 months, a break in measurements, because during this period, bronchitis, chickenpox just fell, they did not go to the clinic, weight gain was already less than kg / month.
Neurosonography at 7.5 months
Neurosonography at 1 month:
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28.04.2014, 15:13

It makes sense to look for a 2nd opinion.
According to the data presented, I consider the prescribed treatment inappropriate.
We observe in dynamics, we discuss.

brain encephalopathy
Due to some circumstances and difficult childbirth, from the moment the baby was born, I worry about not overlooking some deviations in him. I know that, for example, brain encephalopathy is very difficult to diagnose in babies. Mine is almost 5 months now. Sometimes I notice that the child does not fall asleep well and is naughty for a long time before going to bed. and sometimes for a long time he cannot focus on any subject. What examination would you recommend to undergo to rule out encephalopathy, thank you!
hyperactive child
What to do with a hyperactive child? Doctor, please advise what to do, I no longer have the strength to deal with a third child. The birth was difficult, almost immediately after the second pregnancy. The third child was born prematurely, but now he has more or less gained weight. And now he is almost a year old, not a minute of literally rest. He crawls, howls, if I don’t look at him or don’t work out with him, he starts screaming, crying, banging his head on the floor ((They did soothing baths, massage, everything helps for a while. Such hyperactivity - is there a reason to prescribe special treatment? And you can can home methods do? thank you very much

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel is closed by ultrasound.

Neurosonography, or ultrasound of the child's brain, can be prescribed by the pediatrician of the maternity hospital, the neurologist of the children's clinic in the 1st month of life as part of the screening. In the future, according to indications, it is carried out on the 3rd month, on the 6th month and until the fontanel closes.

As a procedure, neurosonography (ultrasound) is one of the safest research methods, but it should be carried out strictly according to the doctor's prescription, because. ultrasonic waves can have a thermal effect on body tissues.

At the moment, no negative consequences in children from the neurosonography procedure have been identified. The examination itself does not take much time and lasts up to 10 minutes, while it is completely painless. Timely neurosonography can save the health, and sometimes the very life of the child.

Indications for neurosonography

The reasons for requiring an ultrasound scan in the maternity hospital are varied. The main ones are:

fetal hypoxia;
asphyxia of newborns;
difficult childbirth (accelerated / prolonged, with the use of obstetric aids);
intrauterine infection of the fetus;
birth trauma of newborns;
infectious diseases of the mother during the gestation period;
Rhesus conflict;
C-section;
examination of premature newborns;
ultrasound detection of fetal pathology during pregnancy;
less than 7 points on the Apgar scale in the delivery room;
retraction / protrusion of the fontanel in newborns;
suspected chromosomal pathology (according to a screening study during pregnancy).

The birth of a child by caesarean section, despite its prevalence, is quite traumatic for the baby. Therefore, babies with such a history are required to undergo NSG for early diagnosis of possible pathology.

Indications for ultrasound examination within a month:

suspected ICP;
congenital Apert syndrome;
with epileptiform activity (NSG is an additional method for diagnosing the head);
signs of strabismus and the diagnosis of cerebral palsy;
the girth of the head does not correspond to the norm (symptoms of hydrocephalus / dropsy of the brain);
hyperactivity syndrome;
injuries in the head of the child;
lag in the development of the infant's psychomotor;
sepsis;
cerebral ischemia;
infectious diseases (meningitis, encephalitis, etc.);
rickety shape of the body and head;
CNS disorders due to a viral infection;
suspicion of neoplasms (cyst, tumor);
genetic anomalies of development;
monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when the child has a fever for more than a month and has no obvious causes.

Preparation and method of conducting the study

Neurosonography does not require any preliminary preparation. The baby should not be hungry, thirsty. If the baby fell asleep, it is not necessary to wake him up, this is even welcome: it is easier to ensure the immobility of the head. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take milk for the baby, a diaper with you to put the newborn baby on the couch. Before the NSG procedure, it is not necessary to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin, and also negatively affects the visualization of the organ under study.

The procedure is no different from any ultrasound. The newborn or infant is placed on the couch, the place of skin contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorography.

Access to the structures of the brain during ultrasound is possible through the large fontanelle, the thin bone of the temple, the anterior and posterolateral fontanelles, as well as the large occipital foramen. In a child born at term, small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. The interpretation of neurosonography data is carried out by a qualified doctor.

Normal NSG results and interpretation

Deciphering the diagnostic results consists in describing certain structures, their symmetry and tissue echogenicity. Normally, in a child of any age, the structures of the brain should be symmetrical, homogeneous, corresponding to echogenicity. In deciphering neurosonography, the doctor describes:

symmetry of brain structures - symmetrical / asymmetric;
visualization of furrows and convolutions (should be clearly visualized);
condition, shape and location of the cerebellar structures (natata);
state of the cerebral crescent (thin hyperechoic strip);
the presence / absence of fluid in the interhemispheric fissure (there should be no fluid);
homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
the state of the cerebellar plaque (tent);
absence / presence of formations (cyst, tumor, developmental anomaly, change in the structure of the medulla, hematoma, fluid, etc.);
the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Options	Norms for newborns	Norms at 3 months
Lateral ventricles of the brain	Anterior horns - 2-4 mm. Occipital horns - 10-15 mm. Body - up to 4 mm.	Anterior horns - up to 4 mm. Occipital horns - up to 15 mm. Body - 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric fissure	3-4 mm.	3-4 mm.
big cistern	Up to 10 mm.	Up to 6 mm.
subarachnoid space	Up to 3 mm.	Up to 3 mm.

Structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The decoding also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to the description of those indicators that should normally change.

Pathologies detected by neurosonography

According to the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

Choroid plexus cyst (do not require intervention, asymptomatic), usually there are several. These are small bubble formations in which there is a liquid - cerebrospinal fluid. Self-absorbing.
Subependymal cysts. Formations containing liquid. Occur due to hemorrhage, can be pre- and postpartum. Such cysts require observation and possibly treatment, as they may increase in size (due to the failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, they can grow, they are cavities containing liquid. Self-absorption does not occur.
Hydrocephalus / dropsy of the brain - a lesion, as a result of which there is an expansion of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, control of NSG over the course of the disease.
Ischemic lesions also require mandatory therapy and control studies in dynamics with the help of NSG.
Hematomas of brain tissue, hemorrhages in the space of the ventricles. Diagnosed in premature babies. In full-term - this is an alarming symptom, require mandatory treatment, control and observation.
Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and in term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (liquor) in the space of the brain.

If any pathology is detected during ultrasound, it is worth contacting special centers. This will help to get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for the child.