The diagnosis of PEP is perinatal encephalopathy. Perinatal encephalopathy in newborns: how to recognize and what to do? Mild perinatal encephalopathy of hypoxic genesis

Perinatal encephalopathy in newborns has recently been encountered quite often, and this is due to an increasing number of risk factors. Most often, the diagnosis of PEP of the newborn is made to children born to mothers over 30 years old, and women who have had several abortions or had several miscarriages. Also, this disease is common among those babies whose mothers suffered from long-term infertility.

What it is- perinatal encephalopathy in children, and how does this disease manifest itself in newborns?

Chronic fetal oxygen deficiency, acute oxygen starvation that occurred during childbirth, and birth trauma lead to severe disorders in the central nervous system. These disorders are manifested by perinatal encephalopathy (PEP), which is quite common today.

While in the womb, the fetus may experience oxygen starvation if the pregnancy proceeds with complications (toxicosis, infections, intoxication, premature placental abruption, a long anhydrous period, etc.). Difficult childbirth, a narrow pelvis, entanglement of the umbilical cord around the neck, obstetric manipulations can lead to asphyxia of the newborn, as a result of which the supply of oxygen to organs and tissues is disrupted.

The most sensitive to lack of oxygen are the cells of the brain, which are damaged in the first place. The degree of their damage depends on the severity and duration of oxygen starvation. Mild CNS disorders may go unnoticed in the hospital, and the child is discharged home. An attentive mother, who watches the baby around the clock, will notice symptoms faster than any doctor that signal a violation of the central nervous system, an increase in neuro-reflex excitability, and will seek advice from a neurologist with complaints of anxiety, superficial sleep, tremors, trembling of the chin and hands , aggravated by screaming.

A medical examination will confirm the mother’s observations and note a violation of muscle tone, which, when diagnosed with PEP in newborns, can be increased (muscle hypertension), decreased (hypotension) and uneven (dystonia), when, against the background of muscle hypotension, hypertonicity of individual muscle groups occurs, associated with the child’s anxiety by changing the position of his body.

In the mother's womb, the fetus is in an embryonic position, which allows it to take up as little space as possible: the limbs are bent and, together with the chin, are tightly pressed to the body.

In infants, the tone of the flexor muscles of the upper and lower extremities remains elevated for another six months, and this is considered normal, as well as the typical boxer position for newborns. A gradual decrease in muscle tone and an increase in the baby's motor activity enable the pediatrician and neurologist to control his physical development. Violation of muscle tone entails a delay in physical and mental development.

Symptoms and consequences of perinatal encephalopathy (PEP) in newborns

And again, an important role in the diagnosis of this pathology belongs to the mother. Most often, it is she who can notice the symptoms of perinatal encephalopathy in a newborn, observing the development of motor activity, the movements of the child from the first days of his life.

Here the child woke up and stretches sweetly, arching his whole body, stretches out his arms, and his mother notices that one arm rises behind his head, and the second is pressed to his chest. Or when crying, the baby brings the legs to the stomach, but one leg lags behind the other. And as soon as he is swaddled, he always “falls over” on one side. And about this sign of PEP in a newborn, you must certainly tell a neurologist.

Movement in an infant is the main type of its activity. Quite often, a consequence of PEP in children can be a mental retardation, since this disease limits the child's ability to cognize the outside world and makes it difficult to actively manipulate toys and other objects. With deep disorders of muscle tone and motor functions, the consequence of perinatal encephalopathy in children may be the formation of a severe pathology - cerebral palsy (ICP).

The inability to sit, get up, crawl forces the baby to look at the same objects of the situation, while the transition to a vertical position significantly expands the view and opportunities for exploring the outside world.

If the child is lethargic, adynamic, inhibited, does not react with animation to the affectionate treatment of the mother, and any irritant causes him negative emotions, screaming, anxiety, you should think about the lag in psychomotor development.

The symptoms of PEP detected by a vigilant mother in a newborn, the slightest deviations in the behavior of the child will help early diagnosis of the pathological condition. To avoid the negative consequences of encephalopathy in children, you need to start timely treatment from specialists.

Treatment of perinatal encephalopathy (PEP) in newborns

And the therapy of a child with movement disorders should be long-term, complex and continuous. And the effectiveness of the treatment of perinatal encephalopathy in children will primarily depend on the mother, her perseverance, perseverance, discipline and desire to defeat the disease.

Without downplaying the importance of drug therapy, the leading role of physical rehabilitation methods should be recognized: gymnastics, exercises in water and physiotherapy procedures.

If the pathology is detected in the maternity hospital, then treatment with the “position” is immediately started. The baby is given a physiological position with the help of rollers, laying, splint for the affected limbs. If neurological disorders persist, the child is transferred to a specialized department, where treatment is continued. At home, the child should be on a flat, dense mattress, without a pillow. It is necessary to change the position of the child in the crib so that the light source and bright toys are from him either to the left or to the right.

When treating PEP in newborns, provide the baby with a protective regimen. The family should have a favorable psycho-emotional climate that contributes to the development of the child's nervous system. Take the baby in your arms more often, talk to him quietly and kindly, he should feel your love and care, which he needs more than his healthy peer. Reduces the tone of spasmodic muscles with symptoms of encephalopathy in newborns rocking the baby in his arms, in the cradle, a special rocking chair for babies. Melodious classical music has a beneficial effect in the treatment of AEDs in children, which has both a calming and stimulating effect on the child's brain.

Massage and physiotherapy for perinatal encephalopathy in children (with video)

To relax spastic contracted muscles, special massage techniques are used for perinatal encephalopathy: stroking, vibration, shaking, wallowing, rolling, which you must master yourself, or invite a professional massage therapist. Massage improves blood circulation, stimulates lymph flow, improves metabolism in organs and tissues. It is very important that the massage evokes positive emotions in the child. If the child is hungry or wants to sleep, resists massage and gymnastics, you should not forcefully continue manipulations, so you will achieve the opposite effect - increased muscle tone. Massage for encephalopathy in children and physiotherapy sessions should give the child pleasure, take place with a smile, in the form of a game, to pleasant music - only then will they be effective.

Exercises on a large inflatable ball have a relaxing effect on the muscles, which are taken by the baby for an exciting game and are performed by him with pleasure. And spasmodic calf muscles will respond to hot foot wraps, which are easily performed at home, and are not inferior in effectiveness to physiotherapy procedures.

Watch the video "Massage for encephalopathy in children" to better understand how this procedure is performed:

The exercise therapy doctor should become your friend and colleague in the fight against the disease. Under his guidance, you will master various complexes of physiotherapy exercises in order to persistently and persistently overcome the consequences of encephalopathy every day.

In the treatment of encephalopathy in newborns, gymnastic exercises develop the musculoskeletal system, develop motor skills, and stimulate physical and mental development. During classes, the child receives air baths, and, therefore, hardens.

Regular physiotherapy exercises for months and years make it possible to compensate for the lag in the development of the psyche and motor skills and enable the child to catch up with their peers. Now he will not shy away from collective children's games, embarrassed by his awkwardness and clumsiness, but will become an equal participant in outdoor fun and entertainment.

If the children's clinic has a swimming pool - your place is there. Exercises in water help to reduce increased tone, facilitate movements in the limbs with muscle hypotension, improve coordination of movements, give a powerful positive charge to the baby, increase appetite and help normalize sleep. After completing a course with an experienced instructor, you will be able to continue exercising at home in the bath.

Modern physiotherapy procedures will bring undoubted benefits to the baby. Physiotherapy for encephalopathy in children will help to cope with a violation of muscle tone, with increased nervous excitability and a lag in physical development.

Perhaps later, classes with a speech therapist, orthopedic treatment will be required, but the main role in early diagnosis and successful treatment belongs to the mother, since the outcome of the disease depends on her observation, perseverance and patience.

The diagnosis of encephalopathy in children began to be made more and more often, which is very scary for thousands of parents. This disease is indeed very serious and requires an urgent start of complex treatment in order to avoid various complications. Timely initiation of adequate therapy can lead to a complete recovery of the child, but if this cannot be achieved, under the supervision of doctors, the condition can be stabilized, and the likelihood of serious consequences for the baby can be reduced.

A doctor's diagnosis of encephalopathy can be confusing for parents who don't know what it is. This term implies a whole group of diseases of the child's brain that are not associated with inflammatory processes. This diffuse disorder develops under the influence of various causes and consists in damage to brain cells.

Encephalopathy in children can develop both in utero and during life. Depending on this, congenital (perinatal) or acquired forms of the disease are distinguished.

Perinatal encephalopathy can develop from 28 weeks of pregnancy to 7 days after the birth of a child (and in premature babies up to 28 days). If, upon detection of the first signs of the disease, competent complex treatment is started, in 90% of cases it is possible to stop absolutely all the symptoms and avoid the consequences that manifest themselves in adulthood.

Regardless of the form of the disease and the time when it manifested itself, childhood encephalopathy is treated under the supervision of a neurologist.

Reasons for the development of the disease

Encephalopathy in newborns often occurs during fetal development or at the time of birth. However, in older children, the disease can develop under the influence of a variety of reasons. The most common causes of the onset of the disease in newborns are:

Early pregnancy.
hereditary diseases.
Infections during pregnancy.
Pathologies of pregnancy, including toxicosis, threats of premature birth or miscarriage.
Taking certain medications.
Prematurity.
Pathology of the birth process and trauma during childbirth.

Often it is not possible to reliably determine the cause of the development of perinatal encephalopathy.

Often this disease can have several causes of development at once. The treatment of encephalopathy depends on what influenced its occurrence, so doctors first of all try to determine as accurately as possible what caused the development of the disease.

Symptoms of encephalopathy

The variety of symptoms of the disease is due to a wide range of possible pathologies of the nervous system. The most specific signs of encephalopathy in infants are:

Late or too weak first cry in childbirth.
Absent sucking reflex.
Poor sleep (excessive sleepiness or, conversely, insomnia at night), frequent anxiety and continuous crying.
Heartbeat disorders.
Hypo- or hypertonicity of the muscles.
Head tilting.
Intracranial pressure.
Strabismus.
Vomiting during or immediately after eating.
Decreased memory and cognitive function.
Hyperactivity and uncontrollability or the opposite state - lethargy.

Signs of encephalopathy can be both pronounced and barely noticeable, so it is extremely important to observe the child with a neurologist. The severity of symptoms directly depends on the location of organic brain damage in children, as well as on its volume, as well as on other diseases that the child has, his age and degree of maturity of the nervous system.

With the aggravation of encephalopathy, the signs of the disease become more serious - the child may begin fainting, dizziness, impaired intelligence, thinking and memory, as well as general developmental delay.

Possible complications of the disease

Thanks to the possibilities of modern medicine, most cases of childhood encephalopathy can be treated with subsequent full recovery. But if there are too many affected brain cells, there is no therapy, or it is impossible to eliminate the factor that negatively affects the brain, there is a high probability of developing various consequences. The most common complications are:

migraine;
asthenic syndrome;
neuroses;
hydrocephalus;
epilepsy;
eye pathology;
difficulties of social adaptation;
depression and other pathologies of the emotional sphere;
development of schizophrenia in adulthood;
dementia.

The consequences can be both minor and very serious, which will entail considerable problems in adulthood. Therefore, it is extremely important to monitor the child's condition and, at the slightest suspicion of encephalopathy, undergo a full examination and, upon confirmation of the diagnosis, begin treatment.

Diagnostics

Depending on the severity of the disease, the treatment of encephalopathy in children can take place both on an outpatient basis and in a hospital setting. In case of serious damage to the brain structures, therapy is necessarily carried out under the constant supervision of doctors - hospitalization is required. Treatment can be very long.

Methods of treatment are selected based on the severity of the disease and the complex of symptoms in the child. In addition to the main course of treatment, the child may need mechanical ventilation, tube feeding, and hemodialysis.

Medical therapy may include:

neuroprotectors (nootropics, as well as amino acids), which are designed to restore the structure of the brain and prevent negative effects on neurons;
drugs to improve the blood supply to the brain;
B vitamins, which help improve metabolic processes in brain cells;
tranquilizers and sedative drugs;
medications that eliminate symptoms (relieving muscle hypertonicity, convulsions, correcting motor dysfunctions).

Depending on the prescribed drugs and the age of the child, various methods of administering drugs can be used - intramuscularly and intravenously, enterally, as well as using electrophoresis.

In addition to drug treatment, the use of physiotherapeutic procedures can be indicated, and physiotherapy exercises, massage, and herbal medicine are often prescribed for encephalopathy. At the end of the treatment, the child is shown swimming lessons with an experienced instructor.

In especially severe cases, surgery can also be used, which consists in performing an operation in order to improve blood circulation in the brain.

In parallel with any prescribed treatment, it is important to organize a proper and balanced diet for the child, regular walks in the fresh air. It is also important to normalize the daily routine with the regulation of sleep and wakefulness.

It is very useful for children with encephalopathy to periodically take vitamin complexes, especially preparations of B vitamins. It is better to entrust the choice of drugs to the attending physician.

The effectiveness of the treatment of brain damage in a newborn depends on the timely diagnosis, the appointment of a full and comprehensive treatment in accordance with the existing problems, as well as the strict implementation of all recommendations of specialists. In this case, most children have a favorable prognosis for recovery without the development of consequences in adulthood.

Prevention of encephalopathy

There are a number of preventive measures that are aimed at preventing the development of encephalopathy and the child. These include:

Timely and adequate treatment of any infectious diseases during pregnancy and in a newborn child.
Prevention of fetal hypoxia.
Actions to protect the newborn from toxic substances.

Such measures can significantly reduce the likelihood of developing a disease in a newborn.

Diagnosing encephalopathy in a newborn can be a real tragedy for parents. But damage to the nervous system with such a disease often does not become a sentence for the child, since the vast majority of manifestations of the disease can be cured by strictly following the instructions of doctors. And with early detection of such problems in a newborn, there are high chances for a full recovery.

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According to statistics, perinatal encephalopathy (PEP) is diagnosed in 4-5% of newborns every year. This is a serious disease, but thanks to the development of medicine, it is now treatable. Depending on the type of provoking factor, experts distinguish several types of the disease. Each of them can and should be fought. The sooner the problem is identified, the higher the patient's chances of recovery or a high quality of life. The best prevention of pathology is the planning of pregnancy, its proper management, and the exclusion of the influence of negative external stimuli on the fetus.

Perinatal encephalopathy in children - what is it

A complex name means a whole group of pathological conditions that arise during the period of intrauterine development of a child or the first days of his life.

The diagnosis of perinatal encephalopathy is made with brain damage in full-term babies in the period from 28 weeks of pregnancy to 7 days after birth, in premature babies - up to 28 days after birth.

Diseases have different mechanisms of development, causes, consequences. They can manifest themselves in different ways, but often have common features. An experienced specialist may suspect that a baby has problems immediately after it is born.

Probable causes

The influence of negative external factors on the body of a pregnant woman affects the nervous system of the child. In some cases, this even becomes an indication for termination of pregnancy due to too high a risk to the fetus.

Moments contributing to the development of PEP:

exacerbation of chronic diseases in a pregnant woman;
acute infectious pathologies in the expectant mother;
the woman's age is under 18 or over 35;
non-compliance with a pregnant or lactating diet, a violation of the diet;
early and late toxicosis;
the threat of miscarriage, interrupted or frozen pregnancy in history;
prematurity of the baby, the presence of congenital developmental anomalies;
bad habits in parents, especially in women (smoking, drinking coffee, alcohol, drugs);
taking potentially dangerous drugs during gestation, during lactation;
injuries or complications during childbirth, weak labor activity, rapid labor;
the presence in the anamnesis of the mother of genetic pathologies, metabolic disorders;
adverse environmental conditions - the impact on the body of toxins, radiation, industrial chemicals, gases, salts of heavy metals.

The more of these factors that affect a woman's body, the higher the risk of developing perinatal encephalopathy in an infant. After their impact, it is impossible to reduce the damage done. Only pregnancy planning and comprehensive prevention of complications will protect against the development of problems.

Symptoms of perinatal encephalopathy

In most cases, the signs of PEP make themselves felt immediately after the birth of the baby. Comparing them with the patient's history, the doctor immediately makes a preliminary diagnosis, prescribes a profile diagnosis.

Early signs of perinatal encephalopathy are:

lethargy of the infant, delay in his cry, or obvious weakness of the lungs;
lack of heartbeat, arrhythmia, increased or slowed heart rate;
hypertonicity or pathological muscle weakness;
too violent reaction to sounds, light or lack of response to external stimuli;
involuntary reflex shudders, muscle twitches;
lack of reflexes, which should be present in every newborn;
nervous behavior of the baby, unreasonable anxiety;
constant crying of a hysterical type, the inability to calm the child;
problems with the functionality of the oculomotor nerve, leading to bulging eyes or strabismus;
when laying out on the back, tilting the head back;
dyspeptic disorders not related to digestion - vomiting, frequent or profuse regurgitation;
superficial sleep, leading to frequent awakenings, difficulty falling asleep.

Sometimes the symptoms of encephalopathy do not appear in infancy, but much later. This can be expressed in the form of depression, VVD, speech disorders. Some children have problems expressing their thoughts, do not show interest in what surrounds them. At a more adult age, disorders of such mental processes as attention, perception, and memory clearly appear. The clinical picture, manifested at an older age, allows you to quickly suspect the diagnosis, but the chances of recovery are lower than when you start working with a newborn.

Varieties

Experts divide the pathology into several groups according to the type of provoking factor. Knowing the cause of the disease, it is easier to choose a treatment, methods of rehabilitation therapy.

Perinatal encephalopathy can be:

hypoxic - a consequence of asphyxia of newborns or oxygen deficiency in the blood during the period of bearing a baby;
traumatic - the result of injuries that a baby can receive during childbirth. Such a danger occurs when the fetus is in the wrong position, inappropriate environmental conditions, problems with labor, medical error;
toxic-metabolic - disorders provoke inflammatory or systemic diseases suffered by a woman during pregnancy, congenital malformations. The risk group also includes expectant mothers who take potentially dangerous drugs during gestation;
infectious - the result of an infectious process in the body of the mother that affected the fetus.

This is the basic classification of perinatal encephalopathy. The disease is also divided into three degrees of severity, which help to make a prognosis. According to the mechanism of development of PEP, there are also several types. The hemorrhagic form occurs as a result of hemorrhage, the ischemic form becomes a consequence of impaired blood supply, the dysmetabolic form is associated with metabolic failures.

What is dangerous perinatal encephalopathy

The risks associated with PEP, the consequences of the disease directly depend on the degree of brain damage. The indicator is also influenced by the location of the source of the problem, the mechanism of the development of the disease.

In severe cases, pathology threatens with disability against the background of a failure of physiological processes. Intrauterine brain damage can adversely affect the quality of speech, memory, intelligence, and perception. Problems associated with a delay in psycho-emotional development, a decrease in the functionality of muscle tissue are not ruled out.

The following consequences are also not excluded:

attention deficit, hyperactivity;
interruptions in the work of internal organs;
hydrocephalus, cerebral ischemia;
epileptic seizures;
reactions of a neurotic type that affect the quality of sleep and the behavior of the patient - often such children require regular monitoring in order to assess the dynamics of the condition;

Fortunately, today the disease in most cases can be cured or at least can be corrected. The main thing to remember is that such a diagnosis persists for life. The danger of perinatal encephalopathy also lies in the fact that its consequences can manifest themselves many years after the end of therapy, if professional help is abandoned.

Consequences in adulthood

If the disease is detected in time, the necessary therapy is carried out, and the doctor's recommendations are followed, then the probability of completely getting rid of the problem is high. Therapy in this case requires a complex and often long-term. It is selected individually, taking into account the specifics of the situation.

The list of possible negative consequences of perinatal encephalopathy in adult life:

hypertension;
migraine;
osteochondrosis already at a young age;
decreased libido, impotence;
scoliosis;
decreased quality of vision;
fine motor problems.

Much depends on the severity of the disease, the quality of medical care provided to the child. Some parents are unwilling to admit that something is wrong with their baby, which can be a waste of precious time.

Diagnosis of encephalopathy

In the process of making a diagnosis, anamnesis and the history of the course of pregnancy play an important role. At certain times, a woman undergoes an ultrasound scan, which allows to exclude anomalies in the development of the child, entanglement with the umbilical cord, and other alarming signals. If a problem is suspected in a newborn, such research methods as MRI, EEG, neurosonography, and other hardware approaches are additionally prescribed. Be sure to check the child with a pediatrician and a neurologist. Specialists check the reflexes of the newborn, exclude the presence of syndromes characteristic of the pathology. In addition, an examination of the fundus is carried out by an ophthalmologist.

Predictions for children who have had the disease

Today, PEP is not a sentence. Previously, women with a high risk of developing the disease in a child were recommended by doctors to terminate the pregnancy. Parents refused such children, pediatricians did not know how to deal with their treatment. Now the situation has changed radically. The statistics of a complete cure after the detection of a mild form of perinatal encephalopathy is rapidly improving. Even with moderate and severe degrees of pathology, the chances of success are high. Such children at least can count on a full life without restrictions.

Child treatment

The fight against the diagnosis of perinatal encephalopathy requires an integrated approach. The list of measures is selected in accordance with the symptoms, test results, goals, and the degree of brain damage. Treatment is aimed at alleviating the condition of the child, preventing complications, restoring the efficiency of the affected organ.

The basic scheme of therapy for PEP:

the use of medicines - these can be drugs to improve microcirculation, muscle relaxants, anticonvulsants, nootropics, diuretics, vitamins;
herbal medicine - most often, herbal remedies are used for hydrocephalus;
physiotherapy - electrophoresis facilitates and simplifies the process of administering drugs. Massage for encephalopathy in children allows you to cope with impaired muscle tone. Exercise therapy contributes to the normal development of the child;
radical measures - rarely, but it happens that the patient needs a neurosurgical operation, hemodialysis, ventilation of the lungs to maintain vital signs at the desired level.

An important point is to provide the baby with suitable conditions. Such children should be protected from stress, excessive physical and mental stress. From an early age, children are shown water procedures, hardening, air baths, massage, gymnastics. It is necessary to monitor the diet of the child, starting from infancy.

Prevention of disease in newborns

Pregnancy planning, medical examination before conception, timely implementation of the gynecologist's recommendations, a woman's attentive attitude to her health are moments that reduce the risks of developing PEP to a minimum. Every expectant mother is advised to treat her chronic diseases in advance, eliminate potential sources of infection, and strengthen immunity with vitamins.

It is not worth risking the baby's life by considering non-traditional delivery options. New-fangled methods of childbirth in unsanitary conditions, unnatural positions, without the control of professionals threaten with serious complications. It is better to find an experienced doctor in advance who will know about all the nuances of pregnancy and help prepare for it.

The development of perinatal encephalopathy in children can complicate the life of both the child and his parents. It is much wiser to take care of the prevention of pathology in advance, to minimize all risks. Even if such a diagnosis is made, the chances of a positive outcome are high. It is only necessary to turn to specialists in a timely manner, strictly follow their recommendations.

Often in the medical records of newborns 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, with something, "natus" - birth, "pathos" - disease and "enkefalos" - brain.

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

Thus, PEP is a collective diagnosis for neurological disorders in newborns, and the specific symptoms, causes, and severity of this condition may be different.

In the international classification, there are various types of encephalopathy, their names indicate the cause of the onset 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 onset of disorders.

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

The prenatal development of the brain and the nervous system as a whole is affected by various adverse factors, in particular the health of the mother and the state of the environment.

Complications can also occur during childbirth.

Hypoxia. When a child in the womb or during childbirth lacks oxygen, all body systems suffer, but above all the brain. The cause of hypoxia can be chronic diseases of the mother, infections, incompatibility by blood type or Rh factor, age, bad habits, polyhydramnios, malformations, unfavorable pregnancy, unsuccessful birth, and many others.
Birth injury, causing hypoxic or mechanical injuries (fractures, deformities, hemorrhages). Injury can be caused by: weak labor activity, rapid labor, poor fetal position, or obstetrician error.
Toxic lesions. This group of causes is associated with bad habits and the intake of toxic substances during pregnancy (alcohol, drugs, certain drugs), as well as environmental influences (radiation, industrial waste in the air and water, salts of heavy metals).
Maternal infections- acute and chronic. The greatest danger is the infection of a woman during the bearing of a child, since in this case the risk of infection of the fetus is very high. For example, toxoplasmosis, herpes, rubella, syphilis rarely cause symptoms of an infectious disease in the fetus, but they cause serious disorders in the development of the brain and other organs.
Developmental and metabolic disorders. These can be congenital diseases of both the mother and the child, prematurity of the fetus, malformations. Often the cause of PEP is severe in the first months of pregnancy or preeclampsia in the latter.

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

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

Symptoms and prognosis

Immediately after birth, the child's well-being is assessed on a ten-point Apgar scale, which takes into account the heartbeat, respiratory rates, muscle tone, skin color, and reflexes. Scores 8/9 and 7/8 are obtained by healthy newborns without signs of perinatal encephalopathy.

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

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

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 a period of residual effects.

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

Syndrome of depression of the nervous system. It is characterized by lethargy, decreased muscle tone, reflexes, consciousness. Occurs in children with moderate severity of the disease.
coma syndrome. The child is lethargic, sometimes to such an extent that there is no motor activity. Inhibited cardiac activity, breathing. The main reflexes (search, sucking, swallowing) are absent. This syndrome occurs due to hemorrhage, asphyxia during childbirth or cerebral edema and leads to the need to place the child in intensive care with the connection of an artificial respiration apparatus.
Increased neuro-reflex excitability. Anxiety, trembling, causeless frequent crying, similar to hysterical, poor sleep, hands and feet. Premature babies are more likely to have convulsions, for example, at high temperatures, up to development. This syndrome is observed in mild forms of PEP.
Convulsive syndrome. Unmotivated paroxysmal movements of the head and limbs, tension of the arms and legs, shuddering, twitching.
Hypertension-hydrocephalic syndrome. It is 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 the norm (more than 1 cm weekly), the size of the large fontanel also does not correspond to age. The child's sleep becomes restless, there is a monotonous prolonged crying, regurgitation, tilting of the head and bulging of the fontanel, as well as a characteristic trembling of the eyeballs.

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

Convulsive syndrome.
Syndrome of increased neuro-reflex excitability.
Syndrome of vegetative-visceral changes. In a child, due to the pathological functioning of the autonomic nervous system, there is a delay in weight gain, regurgitation, disturbances in the rhythm of breathing and thermoregulation, changes in the functioning of the stomach and intestines, and “marbling” of the skin.
Hypertension-hydrocephalic syndrome.
Syndrome of movement disorders. Normally, in a child up to a month, the limbs are half-bent, but easily unbent, 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 a decreased or increased tone. In addition, the movements of the limbs must be symmetrical. All this interferes with normal physical activity and purposeful movements.
Syndrome of delayed psychomotor development. A child later than the norm begins to raise his head, roll over, sit, walk, smile, and so on.

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

Perinatal encephalopathy can lead to the following consequences:

syndrome and attention deficit;
delayed speech and mental development, brain dysfunction;
epilepsy;
cerebral palsy (infantile cerebral palsy);
oligophrenia;
progressive hydrocephalus;
vegetative dystonia.

Diagnostics

Perinatal encephalopathy is diagnosed by a pediatrician and a pediatric neurologist based on the data of the examination, 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:

Neurosonography (NSG) is an ultrasound examination of the brain through the fontanelle to detect intracranial damage and the state of brain tissues.
Electroencephalogram (EEG) - registers the electrical potentials of the brain and is of particular value in the diagnosis of PEP with convulsive syndrome. Also, using this method, you can establish the asymmetry of the cerebral hemispheres and the degree of delay in their development.
Dopplerography to assess blood flow in the tissues of the brain and neck, narrowing or blockage of blood vessels.
Video monitoring. Video recording is used to establish spontaneous movements.
Electroneuromyography (ENMG) - electrical stimulation of the nerve to determine the violation of the interaction of nerves and muscles.
Positron emission tomography (PET), based on the introduction into the body of a radioactive tracer, which accumulates in tissues with the most intensive metabolism. It is used to assess metabolism and blood flow in various parts and tissues of the brain.
Magnetic resonance imaging (MRI) - the study of internal organs using magnetic fields.
Computed tomography (CT) is a series of X-ray images to create a complete picture of all brain tissues. This study makes it possible to clarify hypoxic disorders that are not clearly identified in NSH.

NSG and EEG are the most informative and most often used for diagnosis. Without fail, the child must be sent to an ophthalmologist for examination of the fundus, the condition of the optic nerves and the establishment of 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 really suffer from this disease. There is overdiagnosis.

Reasons for this may include non-compliance with examination standards (for example, diagnosing hyperexcitability in a child examined in a cold room by strangers), pathology of transient phenomena (for example, tossing of limbs) or ordinary signals of need (crying).

Treatment

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

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

individual mode, calm atmosphere in the house, balanced nutrition, lack of stress;
assistance of correctional teachers, psychologists, speech therapists with alalia and dysarthria
massage and physiotherapy exercises to normalize tone, develop motor functions and coordinate movements
physiotherapy;
phytotherapy (various sedative preparations and herbs for the normalization of water-salt metabolism).

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

With motor disorders, dibazol and galantamine are most often prescribed. With increased muscle tone - Baclofen and Mydocalm to reduce it. These drugs are introduced into the body, including using electrophoresis. Massage, special exercises, physiotherapy are also used.
If PEP is accompanied by a convulsive syndrome, anticonvulsant drugs are prescribed by the doctor. With convulsions, physiotherapy and massage are contraindicated.
Delayed psychomotor development is a reason for prescribing drugs to stimulate brain activity, increasing blood circulation in it. These are Actovegin, Pantogam, Nootropil and others.
With hypertension-hydrocephalic syndrome, phytotherapy is used, and in severe cases, Diakarb is used to accelerate the outflow of cerebrospinal fluid. Sometimes a 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, since they are necessary for the normal development and functioning of the nervous system. In many cases, swimming, salt or herbal baths, and osteopathy may be recommended.

Perinatal encephalopathy is one of the most common diagnoses of pediatric neurologists. This is due to the fact that PEP is a collective term for disorders of the brain of a child in the perinatal period, which have various causes, including maternal health, 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 anamnesis regarding the health of the mother and father, complications during pregnancy, labor, as well as appoint additional examinations.

An untimely or incorrectly treated disease threatens with complications up to cerebral palsy and epilepsy.

Useful video about perinatal encephalopathy

(PEP) (peri- + Latin natus - "birth" + Greek encephalon - "brain" + Greek patia - "violation") - a term that unites a large group of brain lesions of different causes and not specified by origin, occurring during pregnancy and childbirth. PEP can manifest itself in different ways, for example, a syndrome of hyperexcitability, when the child's irritability is increased, appetite is reduced, the baby often spits up during feeding and refuses to breastfeed, sleeps less, falls asleep more difficult, etc. A rarer, but more severe manifestation of perinatal encephalopathy is the syndrome of depression of the central nervous system. These children have significantly reduced motor activity. The baby looks lethargic, the cry is quiet and weak. He quickly gets tired during feeding, in the most severe cases, the sucking reflex is absent. Often the manifestations of perinatal encephalopathy are slightly expressed, but the children who have undergone 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.
Too young pregnant.
Hereditary diseases and metabolic disorders.
Pathological course of pregnancy (early and late toxicosis, the threat of abortion, etc.).
Pathological course of childbirth (rapid childbirth, weakness of labor, etc.) and injuries in the provision of assistance during childbirth.
Harmful effects of the environment, adverse 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 activity 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 intrauterine life of the baby) and mixed lesions of the central nervous system, which is explained by the fact that almost any trouble during pregnancy and childbirth leads to a disruption in the supply of oxygen to tissues fetus and especially the brain. In many cases, the cause of PEP cannot be established.

A 10-point Apgar scale helps to make an objective idea of the state of the child at the time of birth. This takes into account the activity of the child, the color of the skin, the severity of the physiological reflexes of the newborn, the state of the respiratory and cardiovascular systems. Each of the indicators is estimated from 0 to 2 points. The Apgar scale allows you to assess the child's adaptation to extrauterine conditions of existence already in the delivery room during the first minutes after birth. The sum of points from 1 to 3 indicates a serious condition, from 4 to 6 - a condition of moderate severity, from 7 to 10 - satisfactory. Low scores are attributed to risk factors for the life of the child 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 already after the 7th day of life, and it is very important to identify possible manifestations of PEP as soon as possible. The plasticity of the child's brain is unusually high, timely therapeutic measures help in most cases to avoid the development of a neurological deficit, to prevent disturbances in the emotional-volitional sphere and cognitive activity.

The course of PEP and possible forecasts

During PEP, three periods are distinguished: acute (1st month of life), recovery (from 1 month to 1 year in full-term ones, up to 2 years in premature ones) and the outcome of the disease. In each period of PEP, various syndromes are distinguished. Often there is a combination of several syndromes. This classification is appropriate, as it allows you to identify syndromes depending on the age of the child. For each syndrome, an appropriate treatment strategy has 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 predictions. It should be noted that even minimal manifestations of perinatal encephalopathy require appropriate treatment to prevent adverse outcomes.

We list the main syndromes of PEP.

Acute period:

CNS depression syndrome.
coma syndrome.
Convulsive syndrome.

Recovery period:

Syndrome of increased neuro-reflex excitability.
epileptic syndrome.
Hypertension-hydrocephalic syndrome.
Syndrome of vegetative-visceral dysfunctions.
Syndrome of movement disorders.
Syndrome of delayed psychomotor development.

outcomes:

Full recovery.
Delayed mental, motor or speech development.
Attention deficit hyperactivity disorder (minimum brain dysfunction).
neurotic reactions.
Vegetative-visceral dysfunctions.
Epilepsy.
Hydrocephalus.
Cerebral palsy.

All patients with severe and moderate brain damage require inpatient treatment. Children with mild disorders 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 common in outpatient settings.

Syndrome of increased neuro-reflex excitability manifested by increased spontaneous motor activity, restless superficial sleep, prolongation of the period of active wakefulness, difficulty falling asleep, frequent unmotivated crying, revival of unconditioned congenital reflexes, variable muscle tone, tremor (twitching) of the limbs, chin. In premature babies, 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, with an increase in temperature or the action of other stimuli. With a favorable course, the severity of symptoms gradually decreases and disappears within a period of 4-6 months to 1 year. With an unfavorable course of the disease and the absence of timely therapy, an epileptic syndrome may develop.

Convulsive (epileptic) syndrome can appear at any age. In infancy, it is characterized by a variety of forms. Often there is an imitation of unconditioned motor reflexes in the form of paroxysmal flexions and tilts of the head with tension in the arms and legs, turning the head to the side and extension of 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 resulting convulsive conditions without additional research methods.

Hypertension-hydrocephalic syndrome characterized by an excess amount of fluid in the spaces of the brain containing CSF (cerebrospinal fluid), which leads to an increase in intracranial pressure. Doctors often call this violation to parents that 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 are guided by and which parents can also control, are the growth rate of the child's head circumference and the size and condition of a large one. In 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 the year, the head circumference is 47-48 cm. Restless sleep, frequent profuse regurgitation, monotonous crying in combination with bulging, increased pulsation of the large fontanelle and tilting the head back are the most typical manifestations of this syndrome.

However, large head sizes are often found in absolutely healthy babies and are determined by constitutional and family characteristics. The large size of the fontanel and the "delay" of its closure are often observed in rickets. The small size of the fontanel at birth increases the risk of intracranial hypertension in various adverse situations (overheating, fever, etc.). Conducting a neurosonographic study of the brain allows you to correctly diagnose such patients and determine the tactics of therapy. In the vast majority of cases, by the end of the first six months of a child's life, there is a normalization of the growth of the head circumference. In some sick children, hydrocephalic syndrome persists by 8-12 months without signs of increased intracranial pressure. In severe cases, development is noted.

Coma syndrome is a manifestation of a serious condition of the newborn, which is estimated at 1-4 points on the Apgar scale. In sick children, pronounced lethargy, a decrease in motor activity up to its complete absence, all vital functions are depressed: breathing, cardiac activity. Seizures may occur. The severe condition persists for 10-15 days, while there are no sucking and 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 skin color and temperature, "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, large intestine, manifested by stool disorder, impaired body weight gain), caused by pathogenic microorganisms, with rickets, making their course worse.

Movement Disorder Syndrome 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, a decrease or excessive increase in spontaneous motor activity is noted. Often the syndrome of motor disorders is combined with a delay in psychomotor and speech development, because. violations of muscle tone and the presence of pathological motor activity (hyperkinesis) prevent the implementation of purposeful movements, the formation of normal motor functions, and the acquisition of speech.

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

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

Attention Deficit Hyperactivity Disorder- a violation of behavior associated with the fact that the child has poor control of his attention. It is difficult for such children to concentrate on any business, especially if it is not very interesting: they spin around and cannot sit still, they are constantly distracted even by trifles. Their activity is often too violent and chaotic.

Diagnosis of perinatal brain damage

AED treatment

As mentioned above, children with severe and moderate lesions of the central nervous system during the acute period of the disease need inpatient treatment. In most children with mild manifestations of syndromes of increased neuro-reflex excitability and motor disorders, it is possible to limit themselves to the selection of an individual regimen, pedagogical correction, massage, physiotherapy exercises, and the use of physiotherapeutic methods. Of the medicinal methods for such patients, phytotherapy (infusions and decoctions of sedative and diuretic herbs) and homeopathic preparations are more often used.

With hypertension-hydrocephalic syndrome, the severity of hypertension and the severity of hydrocephalic syndrome are taken into account. With increased intracranial pressure, it is recommended to raise the head end of the crib by 20-30°. To do this, you can put 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 (broths of horsetail, bearberry leaf, etc.). For more severe cases, use diacarb, which reduces the production of cerebrospinal fluid and increases its outflow. With the ineffectiveness of drug treatment in especially severe cases, one has to resort to neurosurgical methods of therapy.

With pronounced motor disorders, the main emphasis is on massage methods, physiotherapy exercises, and physiotherapy. Drug therapy depends on the leading syndrome: with muscle hypotension, peripheral paresis, drugs are prescribed that improve neuromuscular transmission ( dibazole, sometimes galantamine), with increased tone, use means that help reduce it - mydocalm or baclofen. Various options for the introduction of drugs inside and with the help of electrophoresis are used.

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

With psychomotor retardation syndrome, along with non-drug methods of treatment 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. Large selection of drugs 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.

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

By the age of one, in most mature children, the phenomena of PEP 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 past encephalopathy are minimal brain dysfunction (mild behavioral and learning disorders), hydrocephalic syndrome. The most severe outcomes are cerebral palsy and epilepsy.