PER( perinatal encephalopathy) in a newborn and infants - Causes, symptoms and treatment. MF.
Often after the first examination of a neuropathologist in a polyclinic or in a hospital, the baby is diagnosed with perinatal encephalopathy. According to various sources, it has from 30 to 70% of newborns. What complaints do mom make a doctor make such a diagnosis? Long-term crying and generally tearful, frequent sucking, regurgitation, flinching or throwing up of hands and feet, poor night( frequent waking, restless sleep) and daytime sleep( little sleep during the day), difficulty falling asleep( long motion sickness).When the child is examined, the doctor may notice a violation of the muscle tone - hypertonus or hypotension, dystonia. With neurosonography, sometimes darkened or altered parts of the brain are sometimes visible, sometimes not. The doctor prescribes funds that improve the cerebral circulation( piracetam, nootropil, cavinton) and soothing( glycine, citral, valerian, sometimes luminol or phenobarbital), and also recommends a massage course, bathing in gatherings of soothing herbs. You probably all know this.
And now it's worth mentioning another approach to the problem.
Perinatal encephalopathy is a complication of pregnancy and childbirth pathology and is diagnosed in newborns up to 5% of cases( or 1.5-3.6%)!Where does this discrepancy come from? In the book Palchik A.B.and Shabalova NP"Hypoxic-ischemic encephalopathy of newborns: a guide for physicians".(St. Petersburg: "Peter", 2000) the reasons for the total incidence of neonatal encephalopathy are explained very well. The reason, in general, is one, and it is called overdiagnosis.
What is the cause of overdiagnosis? What makes doctors put "all in a row" this diagnosis? The following reasons for the "overdiagnosis" of perinatal encephalopathy were revealed in the framework of the research carried out by St. Petersburg scientists:
Firstly x, this is a violation of the principles of neurological examination:
a) violations of the standardization of the examination( the most frequent of them are the diagnosis of increased excitability in a shivering and chained childin a cold room, as well as with an excited state or excessive manipulation of the researcher, diagnostics of the central nervous system depression in a limp child at a peregrineor in a drowsy state).
For example, the pediatrician delivered a PEP in the maternity home, as the child often cried aloud, but when the neurologist came to inspect the baby, the baby slept soundly and the doctor said that the tone was normal and he did not see any pathologies. A month later, the clinic was examined when the child was sleeping, woke up and was afraid that his aunt's other hand was pulling his legs. Naturally, he cried and tensed. PEP confirmed.
So, one child can diagnose something hyper, then a hypotonic.
b) incorrect evaluation of a number of evolutionary phenomena( that is, the pathology is considered what is the norm for this age, especially for 1 month of the child).This diagnosis of intracranial hypertension on the basis of a positive symptom Gref, a Gref symptom can be detected in term infants of the first months of life, in premature infants, with a delay in intrauterine development, constitutional features);diagnostics of spasticity based on crossing the legs at the level of the lower third of the shins to newborns when testing the reaction of the support or step reflex( it may be physiological due to the physiological hypertension of some hip muscles, but pathological in children older than 3 months);Diagnosis of segmental disorders in detecting "heel foot"( the rear flexion of the foot - 120 ° is the norm);Hyperkinesis in a child 3-4 months with language anxiety( is the physiological stage of maturation of the child's motor skills).
This can be attributed and regurgitation, as a result of immaturity of the nervous system and the weakness of the sphincter - the muscular valve located in the upper part of the stomach, which does not hold its contents too well. The norm is considered regurgitation after each feeding in a volume of 1-2 table spoons and once a day vomiting "fountain" more than 3 spoons, if the baby often pisses, feels well and normally adds weight. 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 only being formed!
A bad night's sleep - when a child wakes up often. But for a baby, a superficial superficial dream and sucking during such a dream are characteristic. From 3-4 months in children, night sucking can become more active, becausein the afternoon they begin to easily distract from the breast and suck relatively not for long. Due to active night sucking, they get the necessary amount of milk.
American dream researcher James McKenna in his work Breastfeeding &Bedsharing Still Useful( and Important) after All These Years writes that when examining sleep of infants it was revealed that the average interval between nighttime breastfeeding was about one and a half hours - the approximate length of the adult sleep cycle. Minimize the time of my mother's "lack of sleep" can be through the rational organization of joint sleep and night feeding. Very often, children sleep better next to their mothers. Swaying can also be replaced by applying to the chest before going to bed( but not all are obtained).When I found out that it was "possible" to do so, the time for motion sickness decreased significantly. Often children wake up after sleep in a bad mood, you can also offer breasts, and the world will rejoice the baby again!
Secondly, the x is a reference to the pathological series of adaptive, passing phenomena from the nervous system of the newborn( for example, flinching or throwing up of hands and feet, tremor of the chin with strong crying or fright, postnatal depression, physiological muscle hypertension, etc.)).
Thirdly, , poor knowledge of the classification of hypoxic ischemic encephalopathy( mainly due to the foreign origin of research on this topic) and insufficient qualification of the physician.
For example, a month-old baby was diagnosed with a Minimal Brain Dysfunction, which should be placed after 2 or even 5 years, according to different sources. Another child was prescribed to drink tincture of ginseng, which is unacceptable at his age. Often, medical methods of treatment lead to an even greater deterioration in the behavior of children. Doctors are aware of the dangers of various medicines for children, but either they simply do not inform their parents, or consciously or unconsciously do not pay their attention to side effects.
Fourthly, , these are psychological reasons. They are that, due to the situation in the domestic healthcare system, "overdiagnosis" does not have any administrative, legal, ethical consequences for the doctor. The diagnosis leads to the appointment of treatment, and in the case of the correctness or incorrectness of the diagnosis, the outcome( often a recovery or minimal disorders) is favorable. Thus, it can be argued that a favorable outcome is a consequence of a "correct" diagnosis and "proper" treatment.
Hyperdiagnosis of the disease is no better than hypodiagnosis. With insufficient diagnosis, negative consequences are clear - due to the lack of timely assistance, development of a disabling disease is possible. A hyperdiagnosis? According to St. Petersburg researchers, which is difficult to disagree with, "overdiagnosis" is not a harmless phenomenon, as some doctors sometimes think. The negative consequences of "overdiagnosis" are, first of all, that the long work within the framework of the doctrine of "overdiagnosis" leads to a "blurring" of boundaries in the representations of doctors between normal and pathological conditions. Diagnose "disease" is a "win-win" option. Diagnosis of "PEP" has turned into an unconscious ritual of a child neurologist, which naturally leads to poorly explained statistics of diseases "PEP".
The study of St. Petersburg scientists details the most common errors in the conduct of echoencephalography, neurosonography, dopplerography, axial computer and magnetic resonance imaging.
Causes of errors are different and are related to the fact that the interpretation of the data obtained uses parameters and norms developed for older children and adults, an inadequate evaluation of the data obtained and their absolutization is used, methods are used that have insufficient information in diagnosing this disease,having inappropriate technical characteristics.
Fifth, , this is a misunderstanding by doctors and parents of the natural needs of a newborn baby. Most often the child signals about the mistakes in the care of his crying. The child needs contact with the mother constantly after birth.
It is generally known that sucking has a kind of sedative effect on the child that is not comparable in its usefulness with any medications. The content of the amino acid taurine in human milk, in contrast to the cow, is very high. Taurine is necessary for the assimilation of fats, and also serves as a neurotransmitter and neuromodulator in 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 necessary for a young child. Among polyunsaturated fatty acids, arachidonic and linolenic acids are especially important, which are essential components for the formation of the brain and retina of the child's eyes. 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).In human milk, nucleotides and numerous growth factors are presented. The latter include, in particular, the growth factor of the neural tissue( NGF).That is why it is very important for a child to be breastfeeding if you have had problems during childbirth or during pregnancy, which could lead to fetal hypoxia and trauma to his nervous system.
There is no clear-cut, generally accepted tactic for managing children with advanced neuro-reflex irritability syndrome, many experts refer to this condition as borderline, and it is advised only to observe such children, refraining from treatment. In the domestic practice, some doctors continue to use serious drugs( phenobarbital, diazepam, sonapaks, etc.), which are usually not well-used in children with a syndrome of increased nervous reflex irritability. ..
If you are still concerned about your child's condition, it is worthwhilego or invite to the house several specialists( at least two, preferably on the recommendation( there are doctors who sincerely care for the health of children, and do not seek to make money on children's "problems"), because the actionsIn other words, sometimes the problems are very serious, such as cerebral palsy and hydrocephalus. . About the child of my friend, for example, with the same symptomatology as my son's, the regional neurologist stated that every child can be disgusted and did not make any diagnosis.
Homeopaths have a good experience in treating neurological disorders, and official medicine confirms this, but the plasticity of the child's brain, its ability to compensate for structural defects is generally known. So you can never know if the therapy helped the child or he coped with the problems himself. Very well helps massage, and mother, and professional( but only if the child responds well to it, does not cry, does not overexcite, does not lose weight and does not stop the increase). Vitaminotherapy is indicated, and, given the good assimilation of vitamins from mother's milk,this is attention.
It is worth mentioning about vaccinations for restless children. In one of the Moscow clinics where babies with severe hypoxic disorders are nursed, treatment is focused on non-drug methods and maximum avoidance of injections( introduction of drugs with the help of electrophoresis, physiotherapy, etc.).My son after the vaccinations( injections) increased tone of the extremities, general anxiety, however, no one gave us a challenge, 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" and"General scientific" considerations, not confirmed by official medicine.
Also I will say that in the side effects of vaccines you can find the word "encephalopathy", that is, the vaccine can cause this condition! The child was born healthy, we made several vaccinations in the first days, we isolated him from my mother, told her to feed by the hour, give the child the medicines that schizophrenics use, and a month with pleasure we ascertain 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 getting to us. On the other hand, in America and Germany they do not know what perinatal encephalopathy is. There is one more view of the problem - that it's not a matter of neurological pathology or illness, but simply of a special type of people, an individual arrangement of their nervous system. The book "Indigo Children" by Lee Carroll is proof of this.
To change the psychoemotional constitution( type of personality), you know, not a single drug can. Of great importance is the psychological attitude in the family( understanding the needs of a small child, caring for the Serzov approach) and the proper care of the child( breastfeeding, wearing on hands( the sling helps a lot), sleeping together, respect for the child's personality).
In the clinics hangs a poster about the benefits of breastfeeding with the words of the ancient Greek philosopher: "Together with the mother's milk, the child enters the soul."Mom's milk is not just food, it's a medicine, and a connection to the world, and the transfer of Mama's knowledge of life to the child.
What causes the child to go to a neurologist? First, information about how the pregnancy and childbirth took place. Watch out:
- strong manifestations of toxicosis( especially late);
- suspicion of intrauterine infection;
- maternal anemia( hemoglobin below 100 units);
- weakness of labor, a long anhydrous period, the use in the birth of drug stimulation or obstetric forceps;
- umbilical cord entanglement;too much weight of the child or, conversely, signs of immaturity and prematurity;
- birth in the breech presentation, etc.
In a word, everything that can lead to fetal hypoxia in childbirth, that is, to a lack of oxygen, almost inevitably leading to a temporary disruption of the central nervous system( CNS).Damage to her work can also be caused by viral infections in the woman during the period of the fetal nervous system, the disturbed ecology of the home or place of work.
There is no direct relationship between the level and duration of the oxygen starvation that has occurred: sometimes the child's brain suffers a serious oxygen deficiency without much harm for himself, but it happens that a small deficit brings quite tangible harm.
In addition to clarifying the circumstances of pregnancy and childbirth, there are certain clinical signs that alert the pediatrician. The child is too lazy or, more often, excited, screams a lot, crying, his chin trembles, he often regurgitates, reacts to weather worsening. Or to all this, his tummy swells, there is no getting a chair - he is with greens, frequent or, on the contrary, there is a tendency to constipation.
Comparing all these data, making sure that the baby is properly fed, the pediatrician directs such a child to a neurologist - a specialist, aimed at examining the state of the central and peripheral nervous system. The task is to find out to what extent the hypoxia present in the births left its unpleasant trail.
Only without panic!
Here often begins for what, for what, actually, and this article was conceived - the parents embrace fear. How, our child is not all right with his head? !This fear goes back to our general mentality, saying that having deviations in the nervous system is first and foremost a shame.
Convincing, you are saying that these deviations are likely to be temporary, that the sooner we help the child, the faster he will cope with them. .. Most parents, having heeded the pediatrician's assurances, go to the neurologist and come back with a record that usually says:
PEP( perinatal encephalopathy), recovery period, SPNRV( syndrome of increased nervous reflex excitability).
And, unfortunately, neurologists do not often condescend to explain incomprehensible abbreviations. They write for themselves and for the pediatrician, and both sides understand each other perfectly. But not parents.
Than PEP and SPNRV are dangerous
How much is it terrible? Most often with this question they run to the pediatrician, who at this moment is an interpreter from an incomprehensible medical to a domestic language.
And all would be nothing, if not one unfortunate fact: some parents do nothing at all. This is promoted by the compassionate surrounding, calming down with approximately the following words: "Yes, doctors write to every second one." They wrote us out, but we did nothing and grew! "
And they really grow and grow. But parents do not try to connect their inaction with expressed manifestations of exudative diathesis in a child, dyskinesia of the gastrointestinal tract, with a tendency to constipation and even with such obvious things as a lag in the development of speech, disinhibition, disobedience.
But many of these troubles could be avoided, refer parents to the problem the way it deserves - quite seriously, but without excessive drama. The named diagnoses in the child's map are not a signal of panic, but a signal to action! Are there any doubts in the recommendations of the district child neurologist? Consult a child with another specialist.
What is hidden behind incomprehensible words?
So, PEP stands for perinatal encephalopathy. That is, the child in childbirth had factors that could damage the brain. Something happened, and it is necessary to understand what kind of breakdown in the body this accident produced.
The words of the recovery period quite rightly indicate that the nervous system itself, without outside interference, is being restored - it is only a matter of the pace and quality of this recovery. And they are not always satisfactory.
As for the hard-to-pronounce abbreviation SPNRV( syndrome of increased neural reflex excitability), it just indicates the sad fact that the child is crying, spewing, easily excited, difficult to calm down. And he needs help to get rid of it.
"But it will not work?"- you ask. Will pass. At a part of children. And the rest will have to carry this load through life. They will be disinhibited, restless, they will not be able to communicate normally with their peers.
What do neurologists pay attention to when they are examined? First, the reflexes and muscle tone. Are the reflexes right and left uniform? Are there muscle spasms? And vice versa - are they not too weak?
Then, check if the child has signs of increased intracranial pressure. To do this, through an open fontanel make ultrasound( neurosonogram) - see if the ventricles of the brain are dilated. Finally, the child's behavior is examined, the correspondence of his so-called psychomotor and physical development to age.
The diagnosis is made. What's next?
If the case is limited to a violation of muscle tone and excitation of the nervous system, usually a neurologist appoints a massage, mild sedatives and drugs that improve cerebral circulation.
If a neurologist has detected a phenomenon of increased intracranial pressure in a baby, which usually depends on excessive production of cerebrospinal fluid, he prescribes to him a course of so-called dehydration therapy( dehydration - dehydration).To this end, various diuretics are given. To compensate for potassium loss with increased urination, drugs containing potassium are prescribed.
It is not necessary to hope that with the growth of the skull these phenomena will pass by themselves - this may not happen. By the way, control over the indicators of intracranial pressure should be carried out later, for several years, which will save your child from headaches and attacks of so-called vegetative-vascular dystonia at preschool and school age.
Treatment of
But the most important for the forms of PEP of any complexity are sparing and drug-free methods of restorative treatment: reflex massage, special methods of therapeutic massage, elements of therapeutic gymnastics, hydrotherapy with massage and therapeutic gymnastics in water of various temperatures and composition, etc.
They requireperseverance and great efforts from the child's parents - it is perhaps easier to give medicine than to do exercises every day - but very effective. This is because the injured brain, getting the right "information" for massage, swimming and gymnastics, is restored sooner.
Reflexomassage ( impact on active points) is first done by the hands of an experienced masseur, who then passes on the parents to the torch of competent treatment of the baby. Do not forget: babies quickly get tired, all procedures need to be done briefly, but often, at the height of positive emotions.
Early swimming of a child with mandatory diving is also a huge help in solving neurological problems of the baby. What is painful and unpleasant to do on land, "with hurray" passes in the water. During diving into the body of water, the body experiences a baroeffect - gentle, soft and, most importantly, uniform pressure on all organs and tissues. Straightened clenched hands, spasmed muscles and ligaments of the body. The water column restores intracranial pressure in all directions, carries out the chest baromassage, leveling the intrathoracic pressure.
After emergence, the child receives a full, competent breath, which is especially important for babies born with caesarean section, who had hypoxia, etc. Water helps and with problems with intestinal colic - improves the stool, spastic painful phenomena leave.
Tummy and PEP
Often in children with perinatal encephalopathy there are serious disorders from the gastrointestinal tract: constipation and diarrhea, bloating, intestinal colic. Usually it all starts with dysbiosis and, unfortunately, often ends with various cutaneous manifestations - exudative diathesis or even eczema.
What is the connection here? The most simple. With hypoxia of the brain in labor, the center of maturation of immunity almost always suffers, located in the medulla oblongata. Because of this, the intestine is populated with the flora that lives in the maternity hospitals, especially with late application to the breast and an early transition to artificial feeding. As a result, the baby very early develops dysbiosis: in fact, instead of the necessary bifidobacteria, the intestine is filled with staphylococcus, E. coli, etc.
All this is aggravated by the fact that the intestines of the baby due to the "breakdown" of the nervous system function poorly, improperly contracting, and the combination of dyskinesia of the intestine with a "bad" microbial flora leads to a disruption in the digestion of food. Poorly digested food causes stool disorders, a child's anxiety and eventually skin allergization.
It happens, and vice versa: a prolonged action of a damaging factor not associated with 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 the presence of such "saboteurs" as staphylococci in the intestine, clear signs of central nervous system lesions may appear-a delay in the child's psychomotor development, weakness of sphincters, symptoms of increased nervous reflex excitability andetc.
How to be? To achieve a better effect, treat not only the intestines, but also the nervous system. Only joint efforts of the pediatrician and neurologist with the most active help of parents can give the desired effect.
And finally I want to remind you that a baby with an unstable nervous system maternal warmth, tender touches, affectionate conversation, peace in the house - in short, everything that makes him feel secure - is needed even more than a healthy child.
Results and Forecast
How does the treatment of encephalopathy understand that the efforts of doctors and parents have been successful? The child became calmer, ceased to cry for a long time, he had a good sleep. He began to hold his head in time, sat down, then stood up, took the first step. He developed digestion, he adds weight, he has healthy skin. This is evident not only to doctors, but also to you. So, you helped your child overcome the damage to the nervous system.
And in conclusion one example of what maternal love can do.
In the mid-1960s, a young midwife had a daughter in a maternity hospital in remote Sakhalin. Unfortunately, this is often the case with doctors, the birth was extremely difficult, the child was born in deep asphyxia, did not breathe for a long time, then for several weeks was practically paralyzed.
The girl was fed from a pipette, nursed as best she could. Honestly, the doctors thought that this child is not a tenant. And only my mother thought otherwise. She did not leave the baby, perfectly mastered the massage and stubbornly massaged the life-giving body with difficulty.
After 18 years, the author of this article met his daughter and mother in Leningrad. They came to enter Leningrad University. It turned out that the girl with the gold medal graduated from school on Sakhalin. It was difficult to take her eyes off her-she was so slender and beautiful. Then she graduated from the university, defended her Ph. D. in biology, became a scientist, married, gave birth to two beautiful children. There could be no such thing, be the mother's love less self-sacrificing and reasonable.
Rules for all
Study and show an experienced pediatrician an extract from the hospital. If it shows low scores on the Apgar scale( 6 and below), other notes( for example, screamed after birth not immediately, there was a cephalomatome, hypoxia, asphyxia, convulsive syndrome, etc.), do not postpone consultation with a pediatric neurologist.
If there are no objective indications to a neurologist's consultation, but it seems to you that the kid is overly excited, crying, capricious above all reasonable limits - trust your parental intuition and show the child to the doctor. The kid is unlikely to be healthy if in the first weeks of life he is pathologically passive, lies like a rag or, on the contrary, cries 24 hours a day if he is indifferent to food or has a vomiting "fountain" after each feeding.
Breastfeeding is necessary for your baby! Even the most high-quality and expensive adapted milk formulas are an additional metabolic stress for the baby's body. It has been scientifically proven that children who are naturally breastfed, "outlive" infant problems faster( neurological, intestinal, etc.), have a higher rate of emotional and physical development.
If you are planning the next child, find out all the reasons for perinatal encephalopathy in the 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. Carefully refer to the choice of doctors and a medical institution where you plan to give birth to a baby.