The birth of a baby is a significant and touching event in the life of every family. But the birth of a child does not always go smoothly, and the pathology of pregnancy and childbirth cannot be called a rare situation. When a baby is diagnosed with perinatal encephalopathy (PEP) in the maternity hospital, it raises many questions for moms and dads.

Parents faced with this situation need to understand what this is saying. medical term and what consequences does it have for the life and development of the baby. Future mothers and fathers should know how to prevent the disease and reduce the risk of unpleasant complications for the baby.

Pediatrician, neonatologist

The name of this disease combines several nosologies. Encephalopathy is a collective concept indicating brain damage and disruption of its function. And the designated term “perinatal” speaks of the period of the baby’s life when these changes occurred. It turns out that the unfavorable factor affected the child’s body in the period starting from the 22nd week of the baby’s intrauterine life or during labor activity, in the first week of the baby’s life.

It is this period that is distinguished by its multifactorial influence on the baby’s condition. There is a combination of features of the course of pregnancy, maternal health problems, and problems during childbirth, which affects the health of the baby. Statistics indicate a high incidence of the disease in newborns. About 5% of children are diagnosed with PEP and receive appropriate treatment.

PEP is the cause of 60% of pathologies of the total number neurological diseases childhood. The danger of the disease lies in the progression of the disease into various neurological disorders, ranging from minimal impairment of brain function to hydrocephalus.

About the reasons

The child’s body has its own characteristics, and unfavorable factors influencing developing organism, can cause significant damage to the baby’s health.

The predominance of the main influencing factor formed the basis for the systematization of the disease.

Classification of PEP

Posthypoxic encephalopathy

This type of AED is associated with insufficient oxygen supply during pregnancy or the development of acute oxygen starvation -. Hypoxia that occurs in utero leads to a slowdown in the growth of brain capillaries, increasing their permeability and vulnerability. Due to significant oxygen starvation, metabolic disorders occur - acidosis, cerebral edema and death of nerve cells.

Most common cause Encephalopathy in a newborn is caused by insufficient oxygen supply to the baby’s body, and brain damage is also called hypoxic-ischemic encephalopathy (HIE).

Post-traumatic

This type of disease is caused by trauma received during childbirth. Incorrect position fetus and insertion of the head, prolonged or rapid labor, provoke the development of injuries, hemorrhages in the brain and its membranes.

Infectious

If infectious disease in a woman or an exacerbation of a chronic process, pathogens can penetrate the placenta and infect the fetus. Many infections are characterized by the formation of latent, hidden infection, when the disease can “masquerade” as hypoxic or traumatic encephalopathy.

Although the hematoplacental barrier “protects” the baby’s body from the penetration of many infectious agents, the pathology of the placenta increases its permeability to harmful substances. It turns out that an unhealthy placenta cannot fulfill its protective function. Viruses penetrate the placenta most easily, which is explained by their small size.

Toxic-metabolic encephalopathy

This type of pathology is associated with exposure of the fetus or newborn to harmful substances: nicotine, alcohol, narcotic drugs, toxins of viruses and bacteria, medications. Metabolic disorders may cause bilirubin encephalopathy, diabetic encephalopathy, and others.

The term “perinatal encephalopathy” combines pathological changes in the brain without indicating their cause. Therefore, PEP cannot be considered a definitive diagnosis; the disease requires a more thorough analysis of the origin of the disease. If the cause that led to the development of the disease could not be found, a diagnosis of “unspecified encephalopathy” is made in the infant.

By analyzing the course of pregnancy and childbirth in a woman, we can predict possible problems with the health of the unborn child, select children at risk for developing of this disease.

• illness of the expectant mother.

Diseases that appeared during pregnancy or exacerbation chronic illnesses (arterial hypertension, heart and kidney diseases, bronchial asthma) without proper treatment can lead to pathologies in the child. Particular attention should be paid to therapy during pregnancy, increased level sugar negatively affects fetal development.

Children born from mothers with diabetes mellitus, are distinguished by greater body weight, which often leads to difficulties during birth. In addition, these babies are more likely to experience developmental defects, prolonged jaundice, respiratory disorders, low level glucose after birth. All this can cause perinatal encephalopathy in a newborn;

• pregnancy pathologies.

Preeclampsia, threats of miscarriage or premature birth, pathology of the placenta, negatively affect the development of the fetus. It can also lead to perinatal encephalopathy hemolytic disease and infections that developed in utero.

The age of the woman giving birth plays a big role. It has been proven that pregnant women under 20 years of age and over 35 have an increased risk of developing pathologies during pregnancy and childbirth;

• problems that arose during childbirth.

The process of birth important factor, affecting the health of the baby in the future. Too long or, conversely, rapid labor increases the chance of trauma to the child and hypoxic complications. The baby may experience severe oxygen starvation, in cases where there was pathology of the umbilical cord (knots and tight entanglement, insufficient length of the umbilical cord), the placenta was detached prematurely.

Experts say that a post-term pregnancy is in most cases more dangerous than a premature one. With delayed birth, the risk of fetal hypoxia, the appearance of meconium in the amniotic fluid, and inhalation increases dirty waters. All this can lead to asphyxia, breathing problems in the newborn, and infectious complications;

• toxic effect on the fetus.

Much has been said about the harm of alcohol, nicotine and drug addiction on the fetus, but nowadays there are frequent cases of the toxic effects of these substances on the developing organism. Occupational hazards are also unfavorable for the baby’s health, ecological environment, in which the expectant mother is located.

Independent, without medical consultation, taking medications by a pregnant woman negatively affects the health of the baby. Some of medicines affect the growth and development of the fetus and can cause malformations.

Exposure to harmful substances is especially dangerous in the first trimester of pregnancy, when the formation of the child’s vital organs occurs.

The neonatologist discovers the first signs of the development of the disease in the delivery room. Unlike healthy babies These children are born with complications, start crying late, and require assistance. The doctor evaluates the baby using the Apgar scale, and the data obtained is subsequently taken into account when diagnosing PEP. The disease takes a long time, manifestations can develop gradually, so experts divide the course of the disease into periods.

PEP periods

• acute, lasting up to 1 month;
• restorative, which lasts up to 12 months for a full-term baby; in premature babies, this period is extended to 24 months;
• Exodus.

Severity of PEP and symptoms of the disease in the acute period

• light.

If the effect of the damaging factor was moderate, and the child’s condition was not significantly impaired (the Apgar score is usually 6–7 points), the syndrome of increased neuro-reflex excitability comes to the fore. Children with this form of the disease are characterized by severe anxiety, their sleep is superficial, intermittent, and periods of wakefulness are extended. The baby cries for a long time for no reason, the mother cannot pick it up.

When examining the baby, the doctor pays attention to increased motor activity, revitalization of innate reflexes, and impaired muscle tone. Often such babies experience tremors, trembling of the chin and limbs while crying.

The syndrome of increased neuro-reflex excitability in premature newborns is dangerous due to the appearance of;

• moderate form of the disease.

In cases where the baby’s condition was assessed as moderate (Apgar score 4–6 points), the baby experienced depression syndrome nervous system, which is accompanied by an increase. Children with this form of the disease differ from their peers in lethargy and muscle weakness.

Due to the weakening of the newborn's reflexes, disturbances occur during the acts of sucking and swallowing - the baby refuses the breast. Hypertensive-hydrocephalic syndrome is manifested by bulging of the large fontanel, an increase in the growth rate of the head, and pathological reflexes;

• severe course of the disease.

With a significant deterioration in the baby’s condition (Apgar score 1 – 4 points), signs of severe damage to the nervous system appear - coma. The baby's muscle tone is sharply reduced, the baby does not respond to stimuli, and innate reflexes are practically undetectable. Breathing may be arrhythmic, and stoppages may occur. Blood pressure tends to decrease, and heart activity becomes arrhythmic.

The baby has pathological eye symptoms, convulsions may appear, which, due to decreased tone, are sometimes disguised as spontaneous movements of the child.

After a month of the baby’s life, the clinical manifestations of the disease also change, but in most cases there is a combination of syndromes:

1. Increased neuro-reflex excitability.

Manifestations of anxiety, with proper treatment and a benign course of the disease, become less pronounced over time, even disappearing. In some cases, especially in premature babies, the clinic of increased excitability turns into epileptic manifestations.

Hypertensive-hydrocephalic syndrome

The dynamics of this disorder in children may differ. In a benign course, the manifestations of increased intracranial pressure, and the rate of growth of head circumference is normalized by the age of 6 months to a year. If therapeutic measures during this period are ineffective, the baby develops hydrocephalus.

Vegetative-visceral dysfunctions

Against the background of other syndromes, the child often develops symptoms from the autonomic nervous system. Mothers of such babies come to the doctor with complaints of frequent regurgitation, poor weight gain, and disruption of the digestive system. When examining a child, the doctor may notice thermoregulation disorders, discoloration skin: cyanosis of hands and feet, nasolabial triangle.

Movement disorder syndrome

The manifestations of this syndrome are associated with an increase or decrease in tone in the baby’s muscles and can occur either in isolation or accompany other pathological manifestations of PED. The baby often has a delay in physical development and delayed mastery of motor skills.

In severe cases, paresis and paralysis occur, and the increase in hypertension can develop into cerebral palsy.

Psychomotor development delay

Children who have suffered hypoxia often lag behind in psychomotor development. They are characterized by long-term preservation of innate reflexes and a slowdown in the pace of mastering new skills. Babies with developmental delays later begin to fixate their eyes, respond to their mother’s voice, and become interested in toys.

With proper treatment and a favorable course of the disease, many children at the age of 4–5 months experience a “leap” in development. Children begin to take an interest in those around them and “catch up” with the development of their peers. Moreover, mental development is ahead of motor development, motor activity is restored only by 1 – 1.5 years. Long-term mental retardation indicates the possibility adverse consequences at the child.

Epileptic syndrome

It is characterized by the appearance of seizures associated with increased bioelectrical activity in the brain and can occur at any age. Premature babies are at greater risk of developing epileptic syndrome due to immaturity of brain structures.

Taking anamnesis and examining the baby

When making a diagnosis, the doctor takes into account the characteristics of the course of pregnancy and childbirth, the influence unfavorable factors for the fruit. The baby’s well-being after birth and in the first days of life, the Apgar score, is also important. When examining the baby, syndromes characteristic of PEP and changes in the nervous system are revealed.

Specialist consultations

Children with suspected PEP need to consult an ophthalmologist to examine the condition of the fundus. A neurologist will help assess the severity pathological changes brain, prescribe the necessary examination and treatment.

Laboratory diagnostics

Biochemical tests will help establish the hypoxic nature of the disease, determine acid-base and gas composition blood. Children often have their glucose and electrolyte levels examined. If infectious causes of brain pathology or traumatic hemorrhage under its membranes are suspected, a spinal puncture and analysis of the resulting cerebrospinal fluid may be performed.

Instrumental research methods:

• neurosonography.

To clarify the diagnosis, the doctor may recommend ultrasound examination brain structures through the baby's fontanel. This method is absolutely painless and safe and helps to detect signs of hypoxia, edema, hemorrhage, dilation of the ventricles of the brain and other changes;

• electroencephalography.

Thanks to this method, it is possible to identify areas of epileptic activity and identify children prone to developing convulsive syndrome;

• computed tomography.

By using this method structural pathologies and changes in brain tissue are detected. CT is used to clarify the diagnosis when other studies are ineffective.

Treatment of perinatal encephalopathy in children

Therapy for children with PEP differs depending on the period of the disease. First of all, treatment is aimed at maintaining vital organs, combating respiratory disorders. Such babies are often given oxygen therapy and tube feeding is prescribed.

Conducted infusion therapy Taking into account the needs and body weight of the child, glucose-electrolyte solutions are administered intravenously. Drugs that reduce vascular permeability (kanavit, etamzilate) are used. anticonvulsants(phenobarbital, diazepam), hormonal agents(prednisone, dexamethasone), medications that improve blood circulation in the brain (piracetam, cortexin, vinpocetine).

The choice of medications for the treatment of the disease is carried out taking into account the prevailing symptoms and the severity of the clinical manifestations of the disease.

After cupping acute manifestations disease, the doctor’s task is to restore brain function. Children with PEP are registered with a neurologist, who prescribes courses of medicinal and physiotherapeutic treatment. Of the medications, the specialist most often recommends the use of drugs that improve metabolic processes in the brain - nootropics, with increased excitability, sedatives are prescribed, and if the convulsive syndrome persists, anticonvulsants are prescribed.

Treatment with AEDs should be carried out by a neurologist, taking into account the clinical manifestations of the disease and the characteristics of the child. Incorrect therapy can worsen the baby’s condition and slow down the rate of recovery from illness.

Good results in the treatment of children with PEP are provided by massage, physiotherapy (electrophoresis, amplipulse therapy), swimming, physical therapy. In case of developmental delays and speech disorders, classes with a speech therapist or psychologist are recommended.

The nervous system of children is characterized by plasticity and the ability to restore its functions. Therefore, treatment started on time, in the first months of life, increases the chances normal development child in the future. According to statistics, complete recovery occurs in 20–30% of children; in other cases, the main syndromes may persist with the disease transitioning to minimal cerebral dysfunction, hydrocephalic syndrome. In severe cases, epilepsy and cerebral palsy may develop.

To reduce the risk of troubles for the child, future parents should take a responsible approach to pregnancy planning. You need to pay enough attention to maintaining healthy image life, proper nutrition, regular walks in the air. The expectant mother must treat chronic diseases even before conceiving the baby, and during pregnancy, avoid contact with infectious patients.

Do not forget about the importance of examination during pregnancy. Regular inspection in antenatal clinic will help identify pathological conditions that can affect the development of the child and take timely measures. Proper management of labor and timely determination are of great importance. possible complications labor activity, choice of method of delivery. After the baby is born, it is mandatory to be examined by a pediatrician and assess the child’s well-being.

Conclusions

PEP is a fairly common pathology. It occurs as a complication of the pathological course of pregnancy and childbirth. Manifestations of the disease are characterized by a variety of symptoms and require immediate, rational therapy. Timely, adequate treatment will help minimize the risk dangerous consequences for the health and development of the child.

Parents need to know what reasons can lead to the development of the disease in a child and try to prevent them. If a newborn baby is diagnosed with PEP, mothers and fathers must take this disease seriously and follow all doctor’s instructions and regularly undergo treatment prescribed by a neurologist. After all, started on time, correct treatment significantly reduces the risk unpleasant consequences for the health of the baby.

(2 ratings, average: 5,00 out of 5)

Graduated from Lugansk State medical university in the specialty “Pediatrics” in 2010, completed an internship in the specialty “Neonatology” in 2017, in 2017 she was awarded category 2 in the specialty “Neonatology”. I work in Lugansk Republican perinatal center, formerly - the Rovenkovsky neonatal department maternity hospital. I specialize in nursing premature babies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Just don't panic!

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

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

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

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

What are the dangers of PEP and SPNRV?

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

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

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

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

What is hidden behind the incomprehensible words?

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

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

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

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

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

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

The diagnosis has been made. What's next?

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

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

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

Treatment

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

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

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

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

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

Tummy and PEP

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

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

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

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

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

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

Results and forecast

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

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

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

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

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

Rules for everyone

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

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

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

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

Often the complicated course of pregnancy and childbirth leads to very undesirable consequences for newborn child. Some of these consequences, such as perinatal encephalopathy, are quite dangerous conditions for the life and health of the baby.

However, a timely diagnosis and timely therapy can reduce the risk of adverse complications that can lead to this disease and eliminate its symptoms and manifestations.

Therefore, it is important to understand What is perinatal encephalopathy? in children, why it occurs and how it manifests itself.

Concept

Perinatal encephalopathy (PEP) is a disease brain-affecting.

Various reasons lead to the development of the disease, depending on which the manifestations of the disease vary. The disease develops in children during the perinatal period of their development.

This period starts at 28 weeks of pregnancy and ends on the 7th day after birth in full-term infants and on the 28th day in premature infants. Pathology has a different development mechanism, according to which certain varieties and forms of the disease are distinguished.

PEP is considered a fairly common disease, occurring in approximately 3-5% of newborns. The risk of developing the disease increases if the child is born before the due date.

Radial encephalopathy occurs with prolonged radiation exposure to a child in the prenatal period, or in the first days after his birth.

Mixed the form occurs due to a combination of unfavorable factors and is characterized by numerous signs and deviations.

Symptoms and signs

PEP is characterized by a wide variety of signs and manifestations.

General symptoms illnesses are considered:

• strong and prolonged crying;
• excessive regurgitation;
• trembling of the limbs and their involuntary movements;
• sleep disturbances (the child often wakes up at night, sleeps little during the day);
• behavioral disorder (the child is lethargic, or, on the contrary, too active);
• the baby does not respond to light and sounds;
• the child's sucking reflex is impaired;
• there is a decrease in muscle tone.

Besides, various shapes Over time, illnesses can manifest themselves in the form of certain syndromes, such as:

Complications and consequences

AEDs may lead to the development most unfavorable for child consequences, such as:

1. Serious delays in mental and physical development.
2. Attention deficit, which leads to difficulties in learning and decreased academic performance.
3. Development of neurotic reactions.
4. The occurrence of VSD, which often leads to disruption of the functionality of other internal organs and systems.
5. Development of epileptic seizures.

Diagnostics

To make a diagnosis, the doctor must provide data on the course of pregnancy and childbirth, illnesses suffered expectant mother during the period of bearing a child, the condition of the baby in the first days of his life.

In addition, the following instrumental diagnostic methods are used:

• neurosonography to detect brain damage;
• Dopplerography to determine blood flow in organ tissues;
• electroencephalogram to determine the electrical activity of the brain;
• video monitoring for monitoring motor activity newborn;
• CT to detect structural lesions of organ tissue.

Treatment methods

The choice of one or another method of therapy is made by the doctor after diagnosis. It is necessary to take into account not only the form and clinical manifestations of PEP in a child, but also individual characteristics development child's body.

Depending on the existing complaints, the child is prescribed the following groups of drugs:

Predictions and outcome

Prognosis for successful healing depends on the severity of the disease and its symptoms, as well as on how timely and correct the prescribed treatment was.

Prevention

To reduce the risk of developing PEP in a newborn, it is necessary to take care of prevention still at the stage of pregnancy planning.

So, a few weeks before conception, a woman should undergo full examination, and if any deviations have been identified, you must first eliminate them, and then start conceiving.

During pregnancy the expectant mother should give up bad habits, eat right, protect herself from infections, and visit the gynecologist monitoring the pregnancy on time.

PEP - dangerous disease , which develops even in the prenatal period of a child’s life, or in the first days after his birth.

Pathology occurs as a result of numerous causes and has various characteristic manifestations.

Depending on this, the doctor prescribes appropriate treatment, the forecast of which depends on its timeliness.

Perinatal encephalopathy in children under one year of age—a diagnosis or a “transitional” condition? Find out about it in the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Today it is a fairly common problem. That is why many parents are interested in questions about why PEP occurs, what kind of disease it is and is it treatable? Indeed, in such a situation, it is extremely important to timely and correctly assess the child’s condition.

PEP - what is it?

As you know, PEP, or perinatal encephalopathy, is a term that combines a group of abnormalities. Such a diagnosis means that a newborn baby has been found to have structural or functional abnormalities

It is immediately worth noting that such pathologies usually develop either at the end of pregnancy (after 28 weeks) or directly during childbirth. This group usually includes early pathologies formed in the first week of a newborn’s life.

Of course, disruption of the nervous system is extremely dangerous. But, on the other hand, the baby’s body’s ability to adapt is simply enormous. This is why it is so important to start treatment on time.

PEP: what is it and why does it occur?

In fact, the causes of encephalopathy can be very different, and doctors are not always able to establish why a particular disorder occurred. However, there are some risk groups.

First of all, hypoxia (oxygen starvation) leads to disruption of the normal development of the nervous system. In turn, such a disorder can occur due to an unfavorable course of the disease, difficult, protracted labor, entanglement of the baby’s neck with the umbilical cord, etc.

In addition, encephalopathy is often a consequence of constant stress during pregnancy, the use of dangerous medications, alcohol abuse, addiction to drugs, etc.

PEP in a child: symptoms

The manifestations of perinatal encephalopathy are as varied as the causes of its occurrence - it all depends on the degree. In some cases, disorders are detected already in the first days of life - these are cyanosis, problems with thermoregulation and heart function, lack of a sucking reflex, poor sleep.

Later, other symptoms appear. In some children, you may notice a decrease or, conversely, an increase in muscle tone, while other children suffer from convulsive symptom. Manifestations of PEP include increased nervous excitability (children constantly cry and sleep poorly), as well as nervous activity, which is accompanied by lethargy, lethargy and apathy of the child.

In the absence of treatment, they are expressed by a lag in mental, physical or intellectual development.

PEP in a child: treatment

Of course, before making such a diagnosis, it is necessary to carry out thorough examination baby's body. Remember that only an experienced doctor knows why PEP appears, what it is and what symptoms it is accompanied by. As for treatment, again, therapy depends on the degree of damage to the nervous system and the developmental and behavioral disorders present. In some cases, soft sedatives, medications that stimulate blood circulation and trophism of nerve tissue. Also needed permanent classes with the baby, which will help him develop communication abilities and will contribute intellectual development. Some experts also recommend regular therapeutic exercises, massages, swimming lessons, etc. The treatment regimen is drawn up individually for each child.

The diagnosis of perinatal encephalopathy is made to newborns quite often. Sometimes this is done after the first medical examination in the children's clinic, and sometimes even before discharge from the maternity hospital. This medical term is translated into Russian as brain disease in newborns. The abbreviated name PEP is often used to refer to this disease. What are its features? This will be discussed in the article..

What is perinatal encephalopathy

To be precise, brain disease cannot be considered as a specific disease. Rather, encephalopathy is a generalized name for several ailments. Therefore, it is not easy to treat AEDs, but rather encephalopathy, indicating the factor that is its cause.

Here specific examples , showing that encephalopathy occurs:

• Bilirubin– with brain damage associated with high levels of bilirubin. This is one of the main components of bile, formed during the breakdown of protein;
• Hypoxic– associated with a lack of oxygen;
• Ischemic – accompanying the violation cerebral circulation;
• Traumatic.

Typically, symptoms that may indicate signs of perinatal encephalopathy are:

Medical prescriptions during examination

At the appointment, the doctor, examining the child, notices an increase or decrease in muscle tone, and jumps in blood pressure. And also during ultrasound The images sometimes reveal areas of the brain that have darkening or changes.

This is followed by appointments such as:

Drugs that restore normal cerebral circulation:

• Cavinton;
• nootropil;
• piracetam.

Calming medications:

• valerian;
• glycine;
• luminal;
• potion with citral;
• phenobarbital.

But are such indications always and prescription indicates PEP disease? The fact is that the opinions of doctors differ here.

Difficulties in diagnosis

On the one hand, there is evidence that childhood encephalopathy is present in 30–70% of newborns. On the other hand, it is said that PEP is a consequence pathological pregnancy and childbirth and is diagnosed in no more than 5%.

Medical research suggests that AEDs are often overdiagnosed or underdiagnosed. That is, some doctors “hurry” to make this diagnosis without thoroughly understanding the examination data . And some doctors, on the contrary, miss “ alarm bells» and does not notice that the child has perinatal encephalopathy.

One of the most common reasons for overdiagnosis is a violation of the principles of neurological examination, in particular:

• His standards. For example, increased excitability is diagnosed when a child is examined in a cold office and he is trembling. Or, conversely, the room is hot, the child is lethargic, his reactions are inhibited, and he is immediately diagnosed with depression of the central nervous system (CNS).
• Incorrect assessment of symptoms. Regurgitation and restless night sleep are regarded as a pathology, while for one month of age this is the norm.

Other reasons for overdiagnosis

There are a number of other reasons that lead to the fact that the diagnosis of PEP is made to “everyone”.

Among them are:

Underdiagnosis is also an alarming factor in medical statistics. This happens when the doctor is not careful enough treats the symptoms, believing that the child will “outgrow” and everything will work out on its own.

When to consult a neurologist

If the above symptoms and ultrasound results are present, you should contact a neurologist if the following were observed during pregnancy and childbirth:

Thus, you should be wary when there are factors that can lead to fetal hypoxia during childbirth - that is, oxygen deficiency as the cause disturbances in the activity of the central nervous system. Infection is also a risk factor viral infection a pregnant woman during the period of the beginning of the formation of the nervous organization of the fetus.

Pay attention! There is no direct relationship between the duration of oxygen starvation in the fetus and PEP disease. There are situations when hypoxia lasts for a short period of time, but the brain suffers quite seriously, and vice versa.

If the diagnosis is confirmed

What should parents do if they are diagnosed with NEP?

Start of treatment

When a neurologist notices only a violation of the tone of the muscular system in one direction or another and excitement of the nervous system, he prescribes:

• therapeutic massage;
• sedatives of moderate effect;
• medications that improve cerebral circulation.

If a child experiences increased intracranial pressure, he is prescribed a course of dehydration therapy. This prescription is associated with increased pressure in the cranium, often indicating that in spinal cord excess fluid is produced. Diuretics are needed to remove excess. To compensate for the loss of potassium due to increased excretion of fluid in the urine, potassium-containing drugs are taken.

Pay attention! You should not hope that with age the pressure inside the baby’s skull will decrease on its own, without the use of medications. It needs to be monitored over the next few years. This will save the child from headaches and pressure surges in preschool and school years.

Gentle methods

Gentle methods that do not have a medicinal component play a major role in the treatment of any form of AEDs.

These include, in particular:

• reflex massage;
• therapeutic massage, including a number of special techniques;
• elements of therapeutic exercises;
• hydrotherapy including massage and gymnastic exercises in water with different temperatures and composition.

It should be noted that the use of these methods requires patience and perseverance from parents. But their effectiveness is recognized by all doctors. It is explained by the fact that the brain that has been damaged during swimming, massage and gymnastics receives the right impulses that help it recover more quickly.

Pay attention! Physiotherapeutic methods should not be neglected in the treatment of perinatal encephalopathy. They are no less effective than medications, but are safer as they have no side effects.

Massage and swimming

Reflex massage is called the impact on certain active points. At the first stage, it is performed by a massage therapist who has experience in treating a small child. Then he teaches the parents necessary techniques in order to carry out massage procedures on their own at home. At the same time, mothers and fathers need to take into account that babies are susceptible to fatigue, therefore, sessions should be short-term and bring pleasure to the child.

Swimming

Swimming is beneficial for the following:

How does the tummy suffer with PEP?

• Disorders of the gastrointestinal tract are often accompanying encephalopathy in newborns. This is constipation and loose stool, bloating and colic. As a rule, it all starts with banal dysbiosis and often ends with diathesis or eczema. The question arises: what is the connection here?
• The connection is quite simple and is as follows. When the brain structures are deprived of oxygen during childbirth, the center for the formation of the immune system suffers in most cases. It is located in medulla oblongata. Due to hypoxia, microflora characteristic of maternity hospitals settles in the baby’s intestines, including harmful ones: E. coli, staphylococcus. It displaces beneficial bifidobacteria, resulting in bacteriosis.
• Defects in the development of the nervous system aggravate the picture, since, when subjected to spasms, the intestines contract incorrectly, food is poorly digested, and stools are upset. When harmful microflora is added to this, the result is child anxiety and skin allergies.

How to break the vicious circle

Pay attention! When a baby has unstable indicators of the development of the nervous system, he needs increased attention, more tenderness, affection and maternal warmth than healthy children.

What might be the results?

How can parents conclude that treatment has been successful? – This can be judged by such signs as:

1. The child began to behave much calmer.
2. He doesn't cry for a long time.
3. His sleep returned to normal.
4. The baby began to hold his head up in due time.
5. I was able to sit up in time, stood up, and took my first steps.
6. Digestion has improved.
7. Weight gain is good.
8. The skin became healthy.

Pay attention! If these signs were noticed not only by doctors, but also by the baby’s relatives, it means that damage to the nervous system has been overcome.

Below is one of the examples given in the medical literature, which testifies to the dedication of maternal love.

The power of a mother's love

Stick to the rules