Structural changes in the brain during hypoxic-ischemic damage to the central nervous system in newborns of different gestational ages. Comparison of echographic picture with data

Hypoxia in newborns and older children

Hypoxia (or oxygen starvation) is a fairly common pathology that occurs in children of all ages and especially in newborns.

In newborns, hypoxia is often provoked by diseases of the mother, which affect the intrauterine development of the child and complicate the birth process. These include problems with the circulatory system, heart failure, unhealthy lifestyle - smoking, alcohol, taking drugs prohibited during pregnancy - and much more. If a pathological birth is added to the child’s hypoxia, which arises from the mother’s illnesses, then the degree of hypoxia can increase many times.

In this article we will consider the initial manifestations of insufficient blood supply to the brain.

Damage to the cervical spine, perinatal encephalopathy, asphyxia and other diagnoses can be given to the child immediately after birth, which will be common causes of the development of cerebral hypoxia. Parents most often come to a pediatric neurologist or other specialized specialist when the child’s nervous system receives increased stress - the diagnosis is made immediately before school or in first grade. Moreover, according to experts, the number of such children today is 70-80%. The most common complaints from parents are:

• emotional lability of your child and weather dependence;
• high nervous excitability;
• speech dysfunction of varying degrees;
• difficulties with learning and concentrating;
• bad behavior;
• headaches and dizziness;
• visual impairment, etc.

Despite the fact that cerebral hypoxia as a result of vascular disorders is very often diagnosed in schoolchildren, its first symptoms can be noticed in the first year of a child’s life. Such children, literally from the first days, are characterized by increased excitability, they have sleep and appetite disturbances, increased muscle tone, and suppression of unconditioned reflexes.

The main and most common cause of hypoxia in children is birth trauma. Rapid labor, stimulation of labor, and cesarean section are a trigger for weakening one or another function of the child’s body, resulting in symptoms characteristic of vascular disorders. While moving through the birth canal, the baby's cervical region experiences enormous stress, which can cause displacement of the cervical vertebrae and lead to disruption of the blood supply to the brain.

No less common and dangerous is compression, deformation and damage to the bones of the skull. All this directly affects the membranes of the brain and the blood circulation and oxygen supply.

The nervous system, together with the muscular, skeletal, circulatory and other systems, is part of a single whole organism, and disruptions or changes in function and structure in one of them always cause failure in the others. Therefore, vascular disorders of the brain are always a complex of disorders and symptoms, characterized by individuality for each child. And if your child has some of these manifestations, it is advisable not to delay a visit to specialists.

Treatment of a child with hypoxia should always be comprehensive: the main thing in the process of treating vascular disorders is a favorable atmosphere in the family, a regime and corrective measures that contribute to the child’s recovery, observation by a neurologist, speech therapist, orthopedist and other specialists. Osteopathy has proven itself well in the treatment of hypoxia, since the osteopath, during correction, considers the child’s body as an integral system.

It is a mistake to believe that an osteopath will cure all diseases and forever relieve your child of all adaptive symptoms of vascular disorders of the brain, make him a good student and a successful person in life. Osteopathy only makes some changes, affecting the vascular and nervous systems, the child’s circulatory system and other systems. Since the most common cause of hypoxia is a traumatic injury that provokes impaired blood circulation in the brain, an osteopath must find the main source of the problem and restore these processes using gentle techniques. Osteopathic correction is especially effective in cases where the cause of the disorder lies in the displacement of the vertebrae, block of the sutures of the vault and base of the skull, or injuries of the cervical spinal column. After all, the blood supply to the brain depends on the correct location of the meninges, skull bones and vertebrae and the possibility of free micromovements. During treatment, positive dynamics are not immediately observed. An osteopath can work with both large organs, bones and muscles, and very subtle matters and not only heals them, but directs the child’s body to independent adaptation and correction of congenital and acquired disorders.

It is desirable that osteopathic treatment be combined with a complex of other therapeutic and preventive measures, including physical therapy, constant classes and exercises with the child, work on his upbringing, etc. For example, if the blood circulation in the speech areas of the brain is impaired, the child may pronounce words or letters incorrectly. With osteopathic treatment, restoration of blood supply to these areas will improve the condition of damaged neural connections, and the child’s speech apparatus will have more opportunities to adapt to the new conditions of the body. This moment will be the most fruitful if you work with the child, instilling in him the correct pronunciation. As a result of regular classes, he will learn to speak and think correctly without outside help. We can observe the same processes with disorders in physical development, psychological state, etc.

It is obvious that the mechanical consequences of injury cannot be eliminated with any medications. An osteopath has a large variety of soft manual techniques in his arsenal, which can be used to eliminate the root cause and thereby remove obstacles to good blood circulation and cerebrospinal fluid flow. And the body will then begin to work on its own, because... The self-healing process will begin.

Osteopathic sessions for children with vascular disorders of the brain are usually prescribed once a week and last no more than 30-60 minutes. The duration of the therapeutic course is selected individually in each case. As a rule, after four to five sessions it is possible to normalize the patient’s condition and create the conditions necessary for the proper development of his body. Therefore, if it is important for parents not to let mild hypoxia of their child’s brain turn into more severe forms, it is advisable to see a specialist if there are any abnormalities.

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Causes

In newborns, the pathology in question can be provoked by the following factors:

• During contractions and pushing, the umbilical cord is pinched, which affects the blood supply to the brain and other organs
• long labor
• placental abruption
• acute placental insufficiency
• asphyxia (suffocation) during childbirth
• intrauterine hypoxia
• prematurity, which causes respiratory failure in the baby
• patent ductus arteriosus
• disruption of blood flow to the heart
• congenital heart defects
• sepsis, which causes the child’s blood pressure to decrease
• heavy bleeding caused by various reasons

Risk factors for pathology

On the mother's side, factors may be:

• epilepsy in a pregnant woman
• neurological pathologies in the family, in close relatives
• endocrine disorders, including thyroid dysfunction
• infertility therapy
• pathology of the placenta
• preeclampsia and eclampsia
• emergency caesarean section
• fever at the time of birth (body temperature more than 38˚ C)
• labor lasting up to 2 hours (called rapid labor in medicine)
• lack of professional medical assistance
• low birth weight
• gestation period up to 37 weeks
• The pregnancy period is more than 42 weeks.
• heavy bleeding during pregnancy and at the time of birth

But the presence of any of these reasons does not mean that the child will have hypoxia at the time of birth or after birth. They only affect how healthy the baby will be and how safe the birth will be. Many factors-causes are connected. For example, bleeding, abnormal placental function and condition, and low infant weight are associated. When they are combined, an emergency cesarean section is often prescribed or premature birth occurs. And in some cases, cerebral ischemia occurs in the newborn.

About 70 out of 100 babies with encephalopathy had developmental disorders and risk factors already when they arrived in the expectant mother’s belly. A quarter of the children also had less than healthy births. And only a small percentage of babies developed ischemia after they were born.

Degrees

• light

With mild ischemia, muscle tone increases, but not too much. Deep tendon reflexes in such children are enhanced. They suckle poorly, cry constantly, or, conversely, sleep constantly. During the first 3 days of life, manifestations of pathology are eliminated. Children who have not spent 9 months in their mother’s belly may have decreased rather than increased reflexes and muscle tone.

• average

- frequent apneas

- decreased grasping and sucking reflex

- sluggish Moro reflex

- decreased tendon reflexes

- weak muscle tone

Symptoms of moderate ischemia in newborns appear in the first 24 hours after birth. Doctors talk about a favorable prognosis if the symptoms of ischemia disappear within 14 days.

• heavy

- uncoordinated eye movements

- strabismus, nystagmus

- lack of reflexes that a newborn should normally have

- irregular breathing, such children have to be connected to a ventilator

- stupor or coma

- convulsions

- surges in blood pressure (BP)

- heart rhythm disturbances

Prognosis and consequences of cerebral ischemia

It is much more effective to eliminate ischemia itself after the birth of a baby than to treat its complications. Among the consequences of cerebral ischemia of the 2nd degree:

• sleep disorders;
• headache;
• irritability;
• isolation;
• physical inactivity.
• Stage 3 disease has severe consequences:
• cerebral palsy;
• attention deficit disorder;
• mental retardation;
• Graefe's symptom, etc.

If all actions to eliminate ischemia were carried out by doctors in a timely manner, then the symptoms disappear during the rehabilitation period, which usually lasts 6-12 months.

Diagnostics

Doctors usually find ischemia in a baby in the first few days after birth. If the degree of oxygen starvation is severe, then the child may be in a normal state for 3-4 hours or even several days, and then suddenly a very bad state occurs. Therefore, it is important to thoroughly examine the baby.

Examination of the baby . Doctors assess the patient's situation using the Apgar scale, which was discussed above. To do this, reflexes are checked, body weight and height are measured.

Analyzes:

• general blood analysis
• electrolytes
• coagulability
• gases

Magnetic resonance imaging is performed if cerebral ischemia is severe or moderate. MRI is almost never used for mild cerebral ischemia in a newborn. Using ultrasound, it is impossible to accurately determine encephalopathic processes, and it is worth considering that the result may be false positive. Ultrasound can be used to make a primary diagnosis, but other studies are required.

The current method is electroencephalography, abbreviated as EEG. Mandatory for children with severe degrees of the pathology in question. EEG makes it possible to detect hidden seizures. The method also shows how damaged the brain is and how active it can be. An EEG is also done to choose adequate treatment.

Signs and symptoms of cerebral ischemia in newborns

The disease manifests itself with obvious symptoms that attract attention.

• The child is easily excitable, cries for no reason, sleeps poorly, shudders, and has tremors.
• Muscle tone is reduced, the baby moves little, has difficulty sucking and swallowing.
• The fontanel is enlarged, intracranial pressure is increased due to the fact that fluid accumulates in the brain.
• Convulsions, twitching of the limbs and head, as well as comatose states with loss of coordination of movements and consciousness occur.
• The newborn's skin takes on a marbled hue.
• The functioning of the gastrointestinal tract is disrupted - bloating, constipation, and diarrhea are observed.