Lung edema occurs with cerebral ischemia
Advances in medicine, improved methodsmonitoring of babies and high level of care gives hope for life and health to many sick babies. But despite this cerebral ischemia and asphyxia is one of the main causes of death and disability of children of younger age group.
What is cerebral ischemia?
Cerebral ischemia means literallyinsufficient blood supply to the brain. In newborn infants, only the ischemic process is rare: this happens with heart defects, for example. Much more often use the term "hypoxic-ischemic encephalopathy". This means damage to brain cells due to low oxygen content and poor blood supply.
The main causes of cerebral ischemia in newborns
Intrauterine hypoxia or asphyxia in labor (complete stop of oxygen intake)
Respiratory failure after birth
- congenital heart disease
- impaired blood flow to the heart
- open arterial duct
- respiratory insufficiency in premature infants
Decrease in blood pressure after birth
- heavy bleeding (bleeding disorders, liver injury and other causes)
How does cerebral ischemia develop in newborns?
Oxygen, carried by blood to every cellbody, is a vital factor. If its content is low, the redistribution of blood begins in the organs. The brain and heart begin to get the maximum possible amount of oxygen and nutrients, while other tissues and organs experience their deficiency.
If the asphyxia continues, then thesecompensatory abilities are not enough for the life of nerve cells. They begin to die one after another. There is a hypoxic-ischemic encephalopathy of newborns. The more brain tissue is affected, the worse will be the prognosis for the baby. In some cases, because of hypoxia, cerebral hemorrhages may occur, which increases the risk of an unfavorable outcome.
Risk factors for hypoxic-ischemic encephalopathy
- Neurological diseases in the family and epilepsy in the mother
- Infertility treatment
- Endocrine diseases (eg, thyroid pathology)
- Preeclampsia and eclampsia
- Pathology of the placenta
- Severe bleeding during pregnancy and at the time of delivery
- The gestational age at the time of delivery is less than 37 or more than 42 weeks
- Low birth weight at birth
- Lack of qualified medical care
- Rapid birth (less than 2 hours)
- Fever at the time of delivery (more than 38 degrees)
- Emergency Cesarean section
All of the above factors are not guarantorsoccurrence of hypoxia of the newborn. They only reflect the degree of fetal health and danger at the time of delivery. For example, bleeding, abnormal placenta and child's lowness are interrelated factors. They often lead to premature birth and emergency cesarean section (indications). The aggregate of such moments slightly increases the risk of brain damage in the baby, but only in a small percentage of cases.
- Approximately 70% of children with encephalopathy had developmental disorders and risk factors already in the mother's pregnancy.
- In 25% of babies there were also problems in childbirth.
- And only a small number of children with cerebral ischemia suffered after birth.
The condition of the baby is fixed after 1 and after 5minutes after birth. After 1 minute by the number of points determine the need for resuscitation. Points at the 5th minute to some extent reflect the hypoxic damage to the brain (if it was).
Ischemia of the brain in term and premature infants
The nature of brain damage in asphyxiadifferent in children born on time, and in premature babies. The earlier the child was born, the greater the risk of periventricular leukomalacia (PVL). This term means necrosis of the white substance of the brain, located near special cavities (ventricles). Cysts are formed on the site of dead cells. It is PVL that is responsible in most cases of cerebral palsy and dementia in children born before the 31st week of pregnancy.
Infant infants often damage the cortexthe brain is a gray matter. The health consequences will depend on the volume and location of the damaged neurons. If asphyxia was severe and acute, the brain stem, responsible for breathing and palpitation, could be damaged. This poses a direct threat to the life of the baby.
Effects of oxygen starvation of the brain
- Severe cerebral ischemia in 25-50% of casesends with the death of the child in the first days of life, or a little later from pneumonia and other infections. Among the surviving children, 80% have severe long-term consequences (dementia, cerebral palsy, autism), 10% suffer from moderate complications and 10% have no pronounced effects of asphyxia.
- Ischemia of the brain 2 degrees of severity (average) in 30-50%surviving children causes severe long-term consequences, and 10-20% have mild complications (see increased intracranial pressure, frequent regurgitation in a newborn).
- Mild cerebral ischemia in newborns almost always ends safely, without significant consequences for the child (see hyperactivity in the child, child's hypotrophy).
Cerebral ischemia usually manifests itself infirst day after birth. Mild encephalopathy passes fairly quickly, and with a severe degree there may be a false "light gap", several hours or days of improvement, followed by a sharp deterioration. Therefore, a full examination is necessary for the diagnosis.
The examination includes an Apgar score, a check of all important reflexes (sucking, swallowing, grasping), measurement of body mass and growth.
- general blood analysis
- blood electrolyte level
- evaluation of blood clotting
- the number of blood gases (oxygen, carbon dioxide)
With moderate and severe brain ischemia, magnetic resonance imaging of its structures is often used. With mild ischemia occurring during the day, there is rarely a need for an MRI.
Despite the widespread opinion, ultrasound is notis an accurate method of determining hypoxic encephalopathy. With it, you can sometimes notice signs of cerebral edema and hemorrhage. But more often this method of research gives a false positive result. Therefore, ultrasound is used for the initial diagnosis, with the need for an additional examination.
This study is indispensable in children withsevere cerebral ischemia. With his help you can identify hidden convulsions, assess the degree of brain damage and the safety of his activity, pick up the correct anticonvulsant therapy.
Specific treatment that can restoredamaged brain cell ischemia, does not exist. There are no tablets, no droppers, no physioprocedures, capable of replacing dead areas with viable ones. But there are methods to prevent further hypoxia and help the child to be rehabilitated.
Methods in the acute period of ischemia
Since ischemia of moderate to severe severitymanifests itself immediately and brightly, then on Apgar scale it is possible to give a preliminary assessment of the state. If during the first two minutes of life the baby does not begin to breathe independently or with the help of an oxygen mask, then resuscitation measures begin:
- Intubation and artificial ventilation
For minor injuries, most childrencan be transferred to self-breathing 2-3 minutes after intubation. These babies are passed on to the mother and are under the close supervision of the doctor. If longer resuscitation is required, the child is transferred to the intensive care unit, where the respiratory, blood circulation, gas levels in the blood, hemoglobin and glucose are actively monitored.
Anticonvulsant drugs (phenobarbital, phenytoin and others) in a properly selected dosage stop cramps and relieve the child of additional brain damage.
- Maintaining Cardiac Activity
Since the heart suffers with hypoxia along with the brain, it is sometimes necessary to support its work. Such drugs as dopamine and dobutamine, retain an adequate palpitation.
In recent years,associated with a decrease in temperature 3-4 degrees below the usual. There is evidence that such hypothermia is capable of retaining brain cells, preventing the spread of necrosis. In the standard of treatment of encephalopathy, it was introduced from 2010. The main rule of hypothermia: control of specialists and gradual warming.
Thus, so far there are no drugs that can cure hypoxic brain damage. You can only suspend them and provide the child with support for all important functions before recovery.
Treatment of cerebral ischemia in neonates
The average and severe degree of encephalopathy is oftenend with persistent changes in the brain. They can manifest themselves negligently (attention deficit disorder, for example) or lead to disability (cerebral palsy, mental retardation).
With any outcome of encephalopathy, the set of medicines for treatment is very limited:
- With persistent convulsions, anticonvulsant therapy is performed
- In severe cerebral palsy with spasticity of the hands or feet, muscle relaxants
On this list of tablets ends. The only way to influence the development of a child with the consequences of severe ischemia is regular sessions.
- Cerebral palsy requires special massage, which is better to entrust to specialists. At least in the early stages.
- For older children, exercise therapy is necessary
- Special tools for correctionincorrect poses. When you rescue a limb, the baby is often mistaken for an inadequate position, which in the future worsens the prognosis. Longets, rollers, strollers, special chairs provide the physiological position of the body in space.
- Lessons with a speech therapist and home exercises for the development of speech, attention, perseverance
- Communication with children, adults and surrounding wildlife is an important stage in the rehabilitation of children after cerebral ischemia.
Hyperdiagnostics and ineffective therapy of ischemic encephalopathy
Pediatric neurology is one of the few areasdomestic medicine, in which the majority of doctors do not follow the latest recommendations on the diagnosis and treatment of PEP. And if newborn babies with brain damage in our country are treated very well, then "consequences of PEP" are treated incorrectly and unreasonably.
- In newborn babies and children of the first 3-6months of life there are features that are mistaken for encephalopathy. For example, trembling, strengthened muscle tone, a Gref symptom - all this is the norm for babies up to six months. Unfortunately, most pediatricians and neurologists do not know about this.
- Survey of a frightened or sleepy baby is another reason for the overdiagnosis of cerebral ischemia. In such cases, he may be unnecessarily agitated or lethargic.
- The consequence of excessive diagnosis is usually the appointment of unnecessary medications. Such drugs do not help children with real consequences of hypoxia, and even for healthy babies they are not needed.
Short list unnecessary medicines:
- Vascular preparations (cavinton, cinnarizine, etc.) see preparations for improvement of cerebral circulation
- Actovegin, cerebrolysin, cortexin
- Nootropics: phenibut, pyracetam, pantogam, picamylon
- All homeopathic remedies (see placebo effect)
- Herbal remedies (motherwort, valerian), see sedatives for children.
All of the above means have no proven effectiveness and safety. At best, they will not help, at worst - will cause a variety of side effects.
Prevention of cerebral ischemia in newborns
- Thorough pregnancy planning
- Passage of all necessary studies (ultrasound, blood and urine tests) in pregnancy
- If necessary - taking iron preparations
- Examination for infection before and during pregnancy
- Rejection of bad habits
- In case of complicated pregnancy - timely hospitalization
A son aged 1 month had a plannedUltrasound of the brain. In conclusion, it was written: "Consequences of perinatal encephalopathy, recovery period. Signs of increased intracranial pressure. " The neurologist diagnosed the threat of cerebral palsy (since there is a small tremor of the chin), appointed Pantogam. How serious is this diagnosis?
Given a single complaint of tremorchin, the development of your son probably does not cause fear. Severe encephalopathy is usually seen already in the hospital. Ultrasound of the brain without reinforcement by symptoms can not be the basis for the diagnosis. Pantogam - an ineffective and unsafe drug. Massage with mother's hands and encouraging any motor activity is all that a healthy child needs.
Is the diagnosis "Residual phenomena of perinatal encephalopathy" an excuse for refusing vaccinations?
Such a diagnosis is incorrect, since it does not reflectstate of the child. But even if in fact after birth cerebral ischemia was observed, this is not a contraindication to vaccination. Moreover, children with such a severe consequence of ischemia, as cerebral palsy, must be vaccinated.
How terrible are the consequences of cerebral ischemia 1 degree, the symptoms of which disappeared after three days from birth?
Children with the first (mild) degree of cerebral ischemia usually recover quickly, not differing from their peers. For moderate to severe, the predictions may be different.