Each expectant mother is afraid of pathologies of pregnancy and childbirth and wants to prevent them.

One of these pathologies is fetal hypoxia and hypoxia during childbirth, which can lead to disruptions in the functioning of many organs and tissues, including the brain.

The consequences of such damage can affect long time, sometimes all my life.

Causes of hypoxic damage to the central nervous system in a newborn

The central nervous system is the first to suffer from a lack of oxygen, which can lead to various factors during pregnancy and childbirth. These could be:

During pregnancy:

Preeclampsia on later;

Premature placental abruption, threat of miscarriage;

Heart defects in mother and fetus;

Anemia in mother;

Lack or excess of amniotic fluid;

Maternal intoxication (drug, occupational, smoking);

Rhesus conflict between mother and fetus;

Infectious diseases of the mother;

During childbirth:

Entanglement of the umbilical cord around the fetal neck;

Weakness of labor;

Prolonged labor;

Maternal bleeding;

Birth injuries to the neck.

As you can see, the majority hazardous factors affect the health of the baby even before birth, and only some - during childbirth.

Pregnancy pathologies leading to hypoxic damage to the central nervous system in a newborn can aggravate overweight, chronic illnesses of the mother or her too young or too mature age (under 18 or over 35). And with any type of hypoxia, the brain is affected first.

Symptoms of Brain Damage

In the first hours and days after birth signs of violations on the part of cardiovascular system, and symptoms of hypoxic damage to the central nervous system begin to manifest themselves later.

If brain damage is caused by pregnancy pathology, the baby may be lethargic and have weakened or completely absent reflexes that a healthy newborn should have. If there is a pathology that occurs during childbirth, the baby does not immediately begin to breathe after birth, the skin has a bluish tint, and the respiratory rate is lower than normal. And in the same way, physiological reflexes will be reduced - based on these signs one can suspect oxygen starvation.

At an older age brain hypoxia, if it was not cured on time, manifests itself as a slowdown psycho-emotional development up to severe forms dementia, motor disorders. In this case, the presence of organic pathology is possible - brain cysts, hydrocephalus (especially often occurs with intrauterine infections). Severe brain hypoxia can be fatal.

Diagnosis of hypoxic damage to the central nervous system in a newborn

First diagnostic procedure, which is carried out for all newborns immediately after birth, is an assessment of his condition on the Apgar scale, which takes into account such vital indicators as breathing, heartbeat, skin condition, muscle tone and reflexes. A healthy child scores 9-10 points on the Apgar scale; signs of hypoxic damage to the central nervous system can significantly reduce this indicator, which should be the reason for more accurate examinations.

Ultrasound Dopplerography allows you to assess the condition blood vessels brain and identify their congenital anomalies, which can become one of the causes of hypoxia in the fetus and newborn.

Ultrasound, CT and MRI of the brain can identify various organic pathologies nervous system– cysts, hydrocephalus, areas of ischemia, underdevelopment of certain sections, tumors. The difference in the operating principles of these methods allows us to see the most complete picture of brain damage.

To assess damage to the functions of the nervous system, neurography and myography are used - these are methods based on the effect on muscle and nervous tissue electric shock, and allowing you to track how they react to it different areas nerves and muscles. In the case of congenital hypoxic damage to the central nervous system in a newborn, this method allows us to understand how damaged the peripheral nervous system is, and how great are the child’s chances for a full-fledged life in this case? physical development.

Additionally appointed biochemical analysis blood, urine tests to identify biochemical disorders associated with brain hypoxia.

Treatment of hypoxia in newborns

Treatment for hypoxic brain injury depends on its cause and severity. If hypoxia occurs during childbirth and is not accompanied by organic pathology of the brain, blood vessels, heart, lungs or spine, then, depending on the degree, it can either go away on its own within a few hours ( light form, 7-8 Apgar), or require treatment in an oxygen chamber with normal or high blood pressure (hyperbaric oxygen therapy).

Organic pathology that causes constant brain hypoxia (heart defects, respiratory system, neck injuries) is usually treated surgically. The question of the possibility of surgery and its timing depends on the condition of the child. The same applies to organic pathology of the brain (cysts, hydrocephalus), which occurs as a consequence of intrauterine fetal hypoxia. In most cases, the earlier the operation is performed, the greater the child’s chances for full development.

Prevention of hypoxic brain damage

Since the consequences of intrauterine fetal hypoxia are extremely destructive for the child’s brain in the future, a pregnant woman needs to be very careful about her health. It is necessary to minimize the impact of factors that can disrupt the normal course of pregnancy - avoid stress, eat well, exercise in moderation, give up alcohol and smoking, visit on time antenatal clinic.

In case of severe gestosis, as well as when signs of premature placental abruption and threat of miscarriage appear - abdominal pain, spotting from the genital tract, sharp decline blood pressure, sudden nausea and vomiting for no reason - you should immediately consult a doctor. It may be recommended to go into conservation - this recommendation should not be neglected. Complex therapeutic measures carried out in the hospital will avoid severe fetal hypoxia and its consequences in the form congenital pathologies brain.

Ultrasound, which is done on last weeks pregnancy, allows us to identify such potentially dangerous conditions such as entanglement with the umbilical cord, which during childbirth can prevent the baby from taking his first breath, pelvic or lateral presentation, which is also dangerous because hypoxia of the newborn will develop during childbirth. To correct dangerous presentation, there are sets of exercises, and if they are ineffective, it is recommended C-section. It is also recommended for entwined umbilical cords.

Measuring the size of a woman's fetus and pelvis allows us to determine anatomically and clinically narrow pelvis– discrepancy between the size of the pelvis and the size of the child’s head. In this case, giving birth naturally will be very traumatic for both mother and child, or may be completely impossible. The most safe method Delivery in this case is a cesarean section.

During childbirth, it is imperative to monitor the intensity of contractions - if it becomes insufficient for rapid delivery, labor is induced. Prolonged stay of the fetus in birth canal can lead to the development of brain hypoxia, since the placenta no longer supplies the body with oxygen, and the first breath is possible only after birth. This condition can be avoided physical exercise to prepare for childbirth.

An expectant mother is always very worried about the health of her baby. On forums on the Internet, a topic related to disorders of intrauterine (perinatal) development is often discussed. For the most part, they are afraid of pathologies of the central nervous system. And this is not at all in vain, since lesions of the newborn’s central nervous system can lead to serious and severe complications, even to disability.

The body of a baby is very different from that of an adult. The process of brain formation is not complete, it is still very vulnerable, differentiation of the hemispheres continues.

At risk:

• premature or, on the contrary, born later than expected;
• infants with extremely low weight (less than 2800 g);
• with pathology of body structure;
• when there is a Rh conflict with mom.

Damage to the central nervous system in newborns: main factors:

• hypoxia or oxygen starvation of the brain. It is not always a consequence of unsuccessful childbirth; sometimes the pathology develops even during the period of gestation. For example, infectious diseases that the mother suffered during pregnancy, smoking, working in hazardous work, nervous stress, previous abortions. The consequence of this is a violation of the woman’s blood circulation, which means that the child is experiencing a deficiency nutrients, including oxygen. Hypoxia develops, from which the fetal central nervous system suffers;
• birth injuries. Coming into the world is a difficult process and it does not always go smoothly. Sometimes doctors need to intervene seriously to allow new life to emerge. Prolonged intrauterine hypoxia, severe asphyxia, obstetric manipulations, and operations in approximately 10% of cases lead to damage to the baby’s tissues and organs during childbirth. The photo clearly shows how, in especially severe cases, obstetricians literally pull out the child;
• dysmetabolic disorders ( wrong exchange substances). The reasons here are the same as for hypoxia: smoking, drinking alcohol, drugs, illness of the expectant mother, her taking potent medications;
• Infectious diseases suffered by a pregnant woman have an extremely serious impact on the health of the newborn. First of all, herpes and rubella. Viral agents and microorganisms also negatively affect intrauterine development;

Periods of the course of central nervous system pathologies in newborns

Acute period

Immediately after the baby is born, doctors begin to take the necessary measures:

• the baby is placed in rehabilitation, where the child lies in an incubator. Doctors fully restore the functions of the heart, kidneys and lungs, normalize blood pressure;
• remove convulsive conditions;
• relieve cerebral edema.

The first thirty days of life are decisive, when dead cells can be replaced by new, healthy ones. Most often, the symptoms stop after the manipulations, and the baby is transferred from intensive care. Next, drug antiviral and anti-inflammatory therapy is carried out to eliminate the causes of the lesion.

Recovery period

Paradoxically, this time is sometimes more difficult for parents than the acute phase due to the fact that at the first stage it was not bright severe symptoms. The period lasts from the second month of life and ends when the baby turns six months old. At this time, the following behavioral characteristics are noted:

• the child does not show emotion, there are no smiles, the usual “humming” or baby talk;
• lack of interest in the surrounding world;
• does not respond to toys;
• quiet cry.

Notice similar manifestations Only his parents can guide a child's behavior. They must show the child to a pediatrician for diagnosis and treatment. The late recovery period, which lasts until the age of one, also deserves close attention parents.

In cases where the acute phase passed with severe symptoms, manifestations of disturbances in the functioning of the central nervous system may disappear by the second month. This is not a sign of final recovery, but shows that the measures taken have produced results and the baby’s body is beginning to recover, so it is important not to stop the therapy that has been started.

Parents of sick children should:

• monitor the temperature in the baby’s room to avoid hypothermia or overheating;
• avoid loud noises, including from TV or radio;
• keep visits from friends and relatives to a minimum so as not to infect the baby with any infection;
• If possible, do not neglect breastfeeding;
• talk to the baby, play. Use massage mats, books, developmental complexes. But everything must be done in moderation so as not to overload the baby’s weakened nervous system.

Outcome of the disease

If a child was born in a modern clinic or maternity hospital, then in case of pathologies, doctors immediately begin his treatment and rehabilitation. When measures are taken in a timely manner, the chances of a favorable outcome increase.

By the end of the first twelve months of life, it becomes clear exactly how the disease affected the child’s health. It is important to understand that there will still be some developmental delays: the baby will begin to sit, walk and talk later than his peers. If you try not to start the disease, then when mild degree lesions can almost always avoid serious complications.

Only those processes that have entered an advanced stage become irreversible. Modern medicines ways to fully or partially restore the functioning of the central nervous system in case of severe damage. With the help of drugs, the nutrition of nerve cells is improved, blood circulation is normalized, muscle tone decreases or increases.

Rehabilitation period

Here drug therapy fades into the background. Recovery methods used:

• massage;
• special gymnastics;
• physiotherapy: electropheresis, acupuncture, use of a magnetic field;
• heat therapy;
• music therapy;
• swimming, water exercises;
• Educational psychologists work with the baby.

Classification of CNS pathologies in newborns

Hypoxic lesions

It is believed that 10% of infants suffer from some degree of oxygen deprivation. Modern medicine unable to influence the formation of hypoxia and structural damage to the brain, because to bring the dead back to life nerve cells no drugs can do it. Treatment today is focused on the consequences.

Hypoxia can begin in utero due to disturbances in blood flow in the placenta and uterus, thrombosis, pathologies of child development, bad habits, which the mother could not refuse. During childbirth, a lack of oxygen leads to heavy bleeding, entanglement of the baby's neck with the umbilical cord, bradycardia and hypotension, trauma (in particular the use of forceps).

After birth, oxygen starvation is provoked by improper functioning of the lungs, respiratory arrest, heart defects, hypotension, and blood clotting disorders.

Hypoxic injuries are:

• mild degree. Experts call it hypoxic-ischemic injury. Doesn't last long. As a rule, it does not affect later life, since the brain recovers on its own;
• expressed. In this case, asphyxia may begin, when oxygen stops flowing, organic damage to the central nervous system occurs in children, which leaves a mark forever, including disability.

Traumatic lesions

After the release of amniotic fluid, the child experiences uneven pressure, as a result of which blood circulation is disrupted and the brain is injured. Factors contributing to this:

• large baby size (macrosomia);
• breech presentation;
• postmaturity or prematurity;
• oligohydramnios;
• developmental abnormalities;
• turning on the leg, obstetric forceps and other techniques that doctors use for successful delivery.

They lead to intracranial injury, when hemorrhage occurs, convulsions begin, and breathing becomes difficult. There are known cases of hemorrhagic infarction and coma. If the spinal cord is affected, motor function suffers.

Dysmetabolic disorders

Metabolism changes due to:

• intoxication (mother took drugs, strong drugs, smoked, drank alcohol);
• kernicterus;
• an excess of certain substances in the blood: calcium, potassium, magnesium or sodium.

Depending on the cause of dysmetabolic changes, they manifest themselves as: convulsions, hypertension, tachycardia, hypotension, depression, rapid breathing, muscle spasms, intracranial hypertension, apnea.

CNS lesions in infectious diseases

The list of ailments that cause complications in the unborn child includes: rubella, syphilis, herpes, cytomegalovirus, toxoplasmosis. After birth, the baby himself can become infected with candidiasis, pseudomonas infection, staphylococcus, sepsis, streptococcus. The diseases cause hydrocephalus, increased intracranial pressure, and meningeal syndrome.

Diagnostic measures

Damage to the central nervous system of a child occurs in 50% of cases, and most of it occurs during premature birth.

Signs (vary depending on the degree of damage):

• excessive anxiety, nervous excitability;
• trembling in the limbs and chin;
• regurgitation is likely;
• reflexes are reduced or, on the contrary, strengthened. For example, a child does not breastfeed well;
• muscle tone is increased or decreased, there is no motor activity;
• the skin has a blue tint;
• high intracranial pressure;
• the baby is slowly gaining weight;
• rapid pulse;
• bradycardia;
• thermoregulation disorders;
• respiratory arrest;
• diarrhea or vice versa constipation;
• cyanosis.

At organic lesions The central nervous system requires immediate cardiopulmonary resuscitation to save the newborn. Doctors determine PPCNS in the first minutes after birth, and when symptoms appear, neonatologists prescribe examinations.

1. Ultrasound of the brain through an open fontanel. The procedure is simple in nature and can be carried out even if the baby is in intensive care and connected to life support devices. Flaw this method The fact is that the results are greatly influenced by the child’s condition: whether he is sleeping or awake, crying or not. It is also easy to mistake a place with a different echogenicity for the onset of pathology.
2. EEG – electroencephalography. The activity and degree of activity of the brain is determined through electrical potentials. Most often, it is carried out while the child is sleeping; in this state, the method is most informative, since there is no muscle tension.
3. ENMG – electroneuromoiography. With the help of the procedure, it is possible to see violations actually before the birth of the child, when he is still in the womb. The degree of motor activity is assessed, since healthy children and children with developmental disorders, muscles work differently.
4. Video monitoring – allows you to dynamically monitor motor activity.
5. Positron emission tomography determines how metabolism occurs in the brain and shows blood flow.
6. MRI - displays any disturbances in the functioning of the central organ of the nervous system, allows you to determine the location of swelling and its signs. The procedure is considered one of the most informative.
7. Dopplerography – displays blood circulation in the vessels of the head.
8. Laboratory tests: urine and blood tests. Some CNS lesions, such as hyperklemia, do not produce pronounced symptoms.

The well-known CT scan for newborns is rarely used. At the moment x-ray examination the baby must be motionless, he has to be given anesthesia. That's why similar method applied after several years. On the monitor, the specialist sees the patient’s brain, any disorders and neoplasms.

Consequences of central nervous system damage

The main question that torments parents after diagnosis of damage to the central nervous system in newborns is the consequences. Here the doctors' reviews agree: it all depends on the degree of deviation. After all, a child’s body can recover and adapt so quickly that after a year, with a mild degree of damage from the disease, only memories remain.

The neurologist makes a prognosis after the first month of life. It could be:

• complete recovery without complications;
• minor violation brain function: hyperactivity (attacks of aggression, difficulty concentrating), attention disorder, school maladjustment, developmental delay, asthenia;
• neuropathic reactions;
• the child is weather dependent, sleeps poorly, his mood often changes (manifestations of cerebrasthenic syndrome);
• autonomic-visceral dysfunction syndrome;
• most dire consequences- epilepsy, cerebral palsy and hydrocephalus.

Parents of the baby must strictly adhere to all the instructions of the neurologist, regularly carry out the required examinations, and not neglect any medicines and methods to help your baby recover.

Damage to the central nervous system in newborns is the result of pathology of intrauterine development or a number of other reasons that lead to serious complications in the functioning of the body. Such lesions are diagnosed in almost 50% of infants. More than half, even almost two-thirds, of these cases occur in premature babies. But, unfortunately, pathologies also occur in full-term babies.

Most often, doctors call the main cause of damage to the central nervous system difficulty in pregnancy, the influence negative factors for the fruit. Among the sources of the problem:

• Lack of oxygen, or hypoxia. This condition occurs when a pregnant woman works in hazardous work, smokes, has infectious diseases that could have occurred immediately before conception, or had previous abortions. All this disrupts blood flow and oxygen saturation in general, and the fetus receives it from the mother’s blood.
• Birth injuries. They are considered unlikely causes of damage to the central nervous system, but it is assumed that injury can lead to disturbances in the maturation and further development of the central nervous system.
• Metabolic disorder. This occurs for the same reasons as hypoxia. Both drug addiction and alcoholism lead to dysmetabolic pathologies. Reception also affects medical supplies strong action.
• Infections suffered by the mother during pregnancy. Viruses themselves can negatively affect fetal development. But there are a number of diseases that are considered critical for the life of the fetus. Among these are rubella and herpes. However, any pathogenic bacteria and microbes are also capable of causing irreversible negative processes in the child’s body while still in the womb.

Types of CNS lesions

Each of the reasons leads to the development of a certain pathology, the severity of which affects the possibility of recovery and complete rehabilitation of the newborn.

1. Lack of oxygen

Fetal hypoxia in the womb can cause the following pathologies:

• Cerebral ischemia. At grade 1, depression or, conversely, stimulation of the central nervous system in the infant can be noted. The condition usually goes away within a week. Grade 2 severity can be recognized by short-term convulsions, increased intracranial pressure, and more prolonged disruption of the functioning of the nervous system. In the most difficult situation complications lead to epileptic seizures, serious pathologies of the brain stem, as well as increased intracranial pressure. The result is often coma and progressive central nervous system depression.
• Hemorrhage. This phenomenon can affect the ventricles and brain matter, or subarachnoid hemorrhage occurs. Manifestations of such consequences include convulsions, invariably increased intracranial pressure, hydrocephalus, shock and apnea, coma. In mild cases there are often no symptoms. Sometimes the only sign of a problem is hyperexcitability or, conversely, depression of the central nervous system.

1. Birth injuries

The consequences vary depending on the type of injury that occurred during childbirth:

• Intracranial trauma can lead to hemorrhage with seizures and increased intracranial pressure. Other consequences include impaired cardiac and respiratory activity, hydrocephalus, coma, and hemorrhagic infarction.
• Damage spinal cord leads to hemorrhage in this organ with stretching or tearing. The result may be impaired respiratory function, motor activity and spinal shock.
• Damage to the peripheral nervous system. These are complications such as damage to the brachial plexus, which can lead to total paralysis and impaired respiratory function. Pathologies of the phrenic nerve can lead to complications in the functioning of the respiratory system, although most often it occurs without obvious signs. Damage to the facial nerve becomes obvious if there is a twisting of the mouth while the baby is crying.

1. Metabolic disorder

Among the consequences of dysmetabolic lesions:

• Kernicterus, which is accompanied by convulsions, apnea, etc.
• Decreased magnesium levels, which leads to hyperexcitability and seizures.
• Excess sodium levels cause high blood pressure, as well as increased heart rate and breathing.
• An increased concentration of glucose in the blood, which causes depression of the central nervous system and convulsions, although it can often occur without any symptoms.
• Low sodium levels cause low blood pressure and central nervous system depression.
• An increased concentration of calcium causes tachycardia, convulsions, and muscle spasms.

1. Infectious diseases

TO infectious diseases that can cause damage to the central nervous system of the fetus include rubella, syphilis, herpes, cytomegalovirus and toxoplasmosis. Certainly, past illnesses will not necessarily lead to pathologies in the development of the baby, but significantly increase their risk. Doctors also note a number of diseases that cause problems even after the baby is born. Among these are candidiasis, pseudomonas infection, staphylococci, sepsis and streptococci. Such phenomena can cause hydrocephalus, increased intracranial pressure, meningeal syndrome and focal disorders.

Development of CNS lesions

In the process of development of lesions of the central nervous system, doctors distinguish three main stages:

1. spicy;
2. restorative;
3. Exodus.

Acute period

This period lasts about a month. Its course depends on the severity of the damage. Defeats most light form- these are shudders, trembling of the chin, increased excitability, sudden movements of the limbs, abnormal states of muscle tone, sleep disturbances.

The baby may cry often and for no reason.

Grade 2 severity is manifested at this time by a decrease in motor activity and muscle tone, reflexes will be weakened, especially sucking, which an attentive mother will definitely notice. In this case, by the end of the first month of life, such symptoms may be replaced by hyperexcitability, marbled skin color, flatulence and frequent regurgitation.

Often at this time, children are diagnosed with hydrocephalic syndrome. Its the most obvious symptoms can be called a rapid increase in head circumference, an increase in intracranial pressure, which is manifested by the bulging of the fontanel, unusual eye movements.

When the severity is greatest, coma usually occurs. Such complications leave the child in the hospital under the supervision of doctors.

Rehabilitation period

Interestingly, it is the recovery period that can be more difficult than the acute one, if there were no symptoms as such in the first months. The second period lasts approximately from 2 to 6 months. Expressed similar phenomenon something like this:

• the baby hardly smiles, does not show emotions;
• the baby is not interested in rattles;
• the baby's cry is rather weak;
• The child practically does not roar.

If in the first period the symptoms were quite pronounced, then from the second month of life they may, on the contrary, decrease and disappear, but this does not mean that it is necessary to completely stop treatment. This only gives reason to understand that the child is really recovering.

Result of CNS damage

By about a year of a baby’s life, the consequences of damage to the central nervous system become obvious, although the main symptoms go away. The result is:

1. developmental delay - psychomotor, physical or speech;
2. hyperactivity, which affects the ability to concentrate, learn, and remember something in the future, is also expressed in increased aggressiveness and hysteria;
3. cerebroasthenic syndrome – poor sleep, mood swings, weather dependence;
4. epilepsy, cerebral palsy, hydrocephalus are pathologies that develop with particularly severe lesions of the central nervous system.

Diagnostics

Obviously, the consequences of damage to the central nervous system can be quite serious, so it is important to diagnose them in a timely manner. A newborn examination alone is usually not enough. At the slightest suspicion of pathology, doctors prescribe computed tomography, Ultrasound of the brain, X-ray of the brain or spinal cord - depending on assumptions about the location of hemorrhages or other complications.

Treatment

The development of consequences and complications of central nervous system lesions depends on the timeliness of diagnosis and taking measures. Therefore, first aid to such babies must be provided in the first hours of life.

First of all, doctors strive to restore the activity of the lungs, heart, kidneys, normalize metabolism, eliminate seizures, and strive to relieve edema that forms in the lungs and brain. It is important at this moment to normalize intracranial pressure.

A child with central nervous system damage needs preventive massage

If the measures provided do not lead to complete normalization of the baby’s condition, he is left in the neonatal pathology department to continue rehabilitation. At this stage of treatment, antibacterial or antiviral therapy is possible, drug treatment to restore brain activity. To do this, the baby receives medications to improve blood circulation and maturation of brain cells.

An important stage in any rehabilitation is non-drug methods. These include gymnastics, massage, physiotherapy, paraffin therapy, etc.

If the dynamics are positive and the symptoms of central nervous system lesions are eliminated, the baby and mother are discharged with the following recommendations:

• regular examination by a neurologist;
• application non-drug methods recovery;
• maximum protection of the baby from infection;
• establishing a comfortable and permanent temperature regime and the level of humidity at home;
• careful handling - no harsh sounds or excessively bright light.

With constant monitoring large number children is completely restored and is eventually removed from the neurologist’s register. Level 3 severity of lesions forces you to regularly take courses of medications that normalize many life processes and help the baby recover more effectively.

The best solution is always to prevent damage to the newborn's central nervous system. To do this, doctors recommend planning your pregnancy in advance, getting examined and giving up bad habits. If necessary, you should undergo antiviral therapy, get vaccinated, and normalize your hormonal levels.

If a defeat does occur, do not despair: doctors, as a rule, immediately take first aid measures. Parents need to be patient and not give up - even the most difficult conditions can be changed in a positive direction.