Perinatal encephalopathy: causes, symptoms and consequences

The concept of “perinatal encephalopathy” is familiar to many parents, because today in various versions it is found in almost half of children's medical records with neurological diagnoses. This pathology refers to a set of disorders of the nervous tissue under the influence of hypoxia, injuries, infections that affect the fetal brain during pregnancy or at the time of delivery. The consequences of this effect are from minimal cerebral dysfunctions to severe manifestations in the form of cerebral palsy, hydrocephalus, and epileptic syndrome.

Research data

Many do not know how to react to the diagnosis of perinatal encephalopathy syndrome, especially when the child looks healthy and develops in accordance with his age. Not surprising, because this pathology is not in international classifications.

According to many scientific researchers, real cases of encephalopathy of hypoxic and ischemic genesis are found in only 4% of infants, however, at least half of the babies make a similar diagnosis.

The nervous system in the first year of a person’s life is extremely unstable. It quickly improves and matures, as a result of which both the reactions to the outside world and the behavior of the child change, therefore, it is very difficult to systematize the changes in any norms, however, the specialists tried to do this.

There are a lot of factors that influence development. Therefore, it often happens that in completely healthy children one of the parameters goes beyond the normal range. From this comes the information on the frequency of diagnoses of perinatal disorders. Even in cases when the child cries for a long time or his chin suddenly trembles, or he jumped several times, his parents rush to a specialist, who does not hesitate to determine brain dysfunction and diagnose “perinatal encephalopathy”.

The therapy prescribed at an early age is often not only impractical, but also harmful to the child in those cases when the diagnosis is not confirmed by the bulk of diagnostic measures, which often happens in modern clinics.

Naturally, it is wrong to completely deny the presence of perinatal brain injuries, however, such a diagnosis should be treated very carefully in order to avoid unreasonable treatment.

The main causes of ischemic brain damage

Perinatal encephalopathy of hypoxic or ischemic genesis can be caused by certain negative factors that affect the fetus during pregnancy, as well as some circumstances of complicated birth and the early period after them. Such prerequisites, as a rule, include:

1. Chronic diseases of a pregnant woman that can affect blood circulation and metabolism in the placenta, for example, heart failure with heart defects, anemia, lung pathology, hypothyroidism, etc.
2. Acute infectious pathologies or exacerbation of chronic inflammatory processes during gestation.
3. Errors in nutrition, alcohol abuse and smoking.
4. Too young or mature age of a pregnant woman.
5. Hereditary pathologies and metabolic disorders.
6. Gestosis, the threat of miscarriage, as well as chronic fetoplacental disorders.
7. Pathology of childbirth, for example, birth weakness, the use of forceps, rapid delivery or vacuum extraction of the fetus.
8. Intoxication, radiation, the effect of certain drugs during pregnancy.
9. The state of prematurity of the baby.

Thus, any undesirable effect on the pregnant woman’s body, including frequent stresses, can disrupt the maturation of the fetal brain, cause fetoplacental insufficiency and perinatal encephalopathy. The ICD-10 code encrypts this disease as G 93.4 (unspecified encephalopathy). Often, doctors fail to see a clear link between the disease and a specific adverse factor.

Apgar Scale

The Apgar scale, which takes into account the activity, reflexes of infants, the color of their skin and the activity of organs such as the heart, lungs, etc., helps to assess the depth of brain damage. an indicator on this scale, the healthier the child, and a value of 3 points or less indicates an extremely high risk of perinatal lesions of the nervous tissue, which are the result of deep hypoxia. In such cases, the child needs emergency assistance.

Hypoxia

The main cause of perinatal encephalopathy is intrauterine hypoxia. At the same time, high rates on the aforementioned scale do not guarantee absolute health, since the symptoms of the disease may appear after some time. Timely help from doctors and the child’s high ability to adapt to the brain have a positive outcome for such disorders and the absence of all kinds of neurological disorders in children.

Symptomatology

Perinatal hypoxic-ischemic encephalopathy can occur, as a rule, in several stages, which are distinguished by the peculiarity of clinical symptoms, the severity of its course and various outcomes:

1. Acute - in the first month of life.
2. The recovery phase is up to a year in a full-term and before reaching two years in a premature baby.
3. Residual changes.

Most often, there are combinations of several syndromes of brain impairment, which can be expressed to different degrees, and for each of them a special treatment regimen and prognosis for recovery are established.

In the acute period of perinatal encephalopathy of ischemic-hypoxic genesis, brain oppression syndromes may occur, in which coma, increased reflex and nervous irritability, convulsions, symptoms of intracranial hypertension due to severe hydrocephalus are possible.

At the recovery stage of the disease, these syndromes persist, although their severity under the influence of therapy decreases. A variety of visceral and autonomic disorders, lag in psychomotor development, etc. are manifested.

During the period of residual changes, there is a delay in speech development, hyperactivity, neurasthenia, autonomic dysfunctions, and in severe cases, convulsive syndrome occurs, hydrocephalus per se is not resolved. A very dangerous manifestation in this period is persistent cerebral palsy.

Clinical picture

The clinical picture of perinatal encephalopathy (ICD-10: G93.4) ​​and the syndrome of neuro-reflex excitability is expressed by the following symptoms:

1. Activation of spontaneous movements, as well as innate reflexes.
2. Anxiety, crying, shallow and short sleep.
3. Prolonged wakefulness and trouble falling asleep.
4. Fluctuations in muscle tone, trembling of the chin, legs or arms of the child.

Premature infants with a similar syndrome are most likely to experience seizures that occur when certain irritating factors act, for example, when the temperature rises. With a complicated course of the disease, a child may develop epilepsy over time.

Cramps

Seizures are another specific symptom of encephalopathy. They can occur regardless of age and be quite diverse - from attacks of head tilts with an increased tone of limbs and trembling to generalized phenomena with loss of consciousness.

Hypertension-hydrocephalic syndromes occur due to too much cerebrospinal fluid, which entails an increase in intracranial pressure. This phenomenon can be manifested by swelling and pulsation of the fontanel, the growth of the baby’s head, which sometimes does not correspond to the age norm. Children with hydrocephalus are very calm, they sleep poorly and often spit up.

However, you need to know that a large head can be the constitution of a particular child, and regurgitation and anxiety are often observed with intestinal colic. The fontanel does not overgrow for a long time with rickets, so you should not diagnose yourself.

Coma

Coma is a very severe symptom of a brain pathology that characterizes deep hypoxic lesions of neurons. Children in a similar condition appear to be lethargic or lack of movement, inhibition of the respiratory reflex, bradycardia, decreased sucking and swallowing reflexes, and convulsive seizures. This condition requires emergency therapy, as well as parenteral nutrition and careful monitoring. Coma sometimes lasts up to two weeks.

Vegetative dysfunctions and a disorder of visceral innervation in hypertensive hydrocephalic syndrome and similar disorders begin from about two months. They are characterized by symptoms such as regurgitation, insufficient weight gain, pathology of the heart rhythm and breathing, impaired thermoregulation and digestion. With this syndrome, enteritis and colitis with stool disorders often occur.

Motor impairment

Motor disorders with this pathology are noticeable in the first weeks after birth. Muscle tone can be high or, conversely, reduced, and movements slow down or increase. This syndrome may be accompanied by a lag in psychomotor development, speech delays, and a decrease in intelligence. Mild facial expressions, delayed reactions to auditory and visual stimuli, delayed mastery of the acts of sitting, walking and crawling are also characteristic.

One of the most severe manifestations of the pathology of motor disorders is cerebral palsy, when the motor sphere, speech are disturbed, there is mental retardation and squint.

How is perinatal posthypoxic encephalopathy detected?

Pathology diagnostics

The diagnosis of perinatal disturbance in brain activity is made on the basis of symptoms, anamnesis of pregnancy and childbirth, when gestosis, various infections, birth injuries, etc. were possible. This information is contained in the card and the extract from the hospital.

An additional examination greatly facilitates diagnostic searches and helps to clarify the degree of damage to the nervous system, as well as to trace the dynamics of the disease and the effect of the treatment.

Instrumental methods for diagnosing perinatal encephalopathy in newborns in this case include:

1. Neurosonography, which is very safe and allows you to evaluate the morphological and functional characteristics of the brain, as well as the cerebrospinal fluid system. Using this method, you can detect the presence of damage and their degree.
2. Dopplerography, which is used to evaluate blood circulation in the vessels of the brain.
3. Electroencephalography is a method for studying the electrical activity of neurons by registering cell potentials. The study shows the maturity of the nervous system, possible developmental delays, asymmetry of the cerebral hemispheres, and convulsive readiness.
4. Video monitoring, with the help of it it is possible to analyze the spontaneous movements of the child in order to assess the assessment of epileptic activity
5. Electroneuromyography allows you to diagnose neuromuscular pathologies, congenital or acquired.
6. CT and MRI are studies that clarify the features of the anatomical structure of the brain, but have a significant drawback, since they are performed under anesthesia.
7. Positron emission tomography, which shows a picture of metabolic processes, as well as the speed of blood flow in certain areas of the brain.

The most common methods for diagnosing perinatal encephalopathy of hypoxic origin are neurosonography and EEG, which are easily reproducible, safe and can provide a very large amount of information.

With hypoxic brain damage, an consultation with an ophthalmologist is mandatory. Studying the fundus helps to diagnose genetic pathologies, analyze the levels of intracranial pressure and the condition of the optic nerves.

Pathology treatment

Treatment of perinatal encephalopathy (ICD code - G93.4) ​​in moderate to severe acute phase is carried out in a hospital setting. In mild forms of the disease in most cases, specialists are limited to the following measures:

1. Correction of a regimen established individually and depending on the nature of motor disorders in the degree of nervous and reflex excitability of the child.
2. The pedagogical help.
3. Massage and healing exercises.
4. Physiotherapeutic methods.

As medication for perinatal encephalopathy (ICD-10: G93.4), various sedatives with herbal components and diuretics are prescribed.

Hypertension-hydrocephalic disorders require conservative treatment:

1. The head section of the crib is raised 30 degrees.
2. Phytotherapeutic methods of treatment for a mild disease - bearberry, horsetail, and other plants.
3. In the absence of the effect of herbs in severe and moderate course, medicines are used - “Diacarb”, which reduces the production of cerebrospinal fluid and enhances its outflow from the skull, as well as “Mannitol”.
4. In the absence of the effect of drug therapy, surgical correction may be required (bypass surgery).

Movement disorders in perinatal hypoxic encephalopathy are treated, as a rule, conservatively:

1. Exercise therapy.
2. Massage.
3. Physiotherapy - electrophoresis, amplipulse.

Drug support

Depending on the prevailing clinical manifestations, drug support is prescribed:

1. "Dibazol", "Galantamine" - drugs to enhance neuromuscular impulses with hypotension and paresis.
2. "Midokalm", "Baclofen" - in cases of hypertonicity, as well as with spasms.

These drugs are taken orally, injected or by electrophoresis. Attention and caution requires anticonvulsant treatment for children with epilepsy. Doses and type of anticonvulsant, as well as the mode of administration are determined by the severity and course of the pathology, as well as the age of the child. In this case, Depakin, Phenobarbital, Diazepam, etc. are used.

Change of drugs is possible under the supervision of a neurologist taking into account the encephalogram.

Taking anticonvulsants with the hypoxic or ischemic genesis of perinatal encephalopathy is sometimes accompanied by side effects and affects the development of the child. Their use should be controlled by blood tests and liver function indicators.

Another important circumstance is that massage and physiotherapy are contraindicated in children with epileptic syndrome. Swimming, overheating, overwork also can provoke an epileptic seizure, so they must be excluded.

With a developmental delay that almost accompanies brain damage, agents are used to improve brain activity and blood circulation in it, which increase metabolic processes and promote the formation of connections between neurons.

The consequences of perinatal encephalopathy

• Full recovery. If the disease is timely detected and complex treatment is carried out, then this option is possible.
• Delay in psychomotor development. Varies by severity. At the same time, the child will not be very limited in possibilities.
• Hyperactivity and attention deficit disorder.
• Hydrocephalus.
• Manifestations of neurotic reactions. It is considered a more serious complication requiring constant follow-up of a child.
• Epilepsy.
• Vegetative-visceral dysfunction.
• Cerebral palsy.