Update: October 2018
Achievements of medicine, improved methods of observation
babies and a high level of care gives hope for life and
health many sick kids. But despite this cerebral
ischemia and asphyxia is one of the main causes of death and
disability of children of the younger age group.
What is cerebral ischemia?
Cerebral ischemia literally means insufficient
кровоснабжение the brain. In newborns is rare
only the ischemic process: it happens with heart defects,
eg. 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
ATнутриутробная гипоксия или асфиксия в родах (полная остановка
- acute placental insufficiency (see fetal hypoxia),
- prolonged labor
- clamping of the umbilical cord during contractions and attempts
Respiratory failure after birth
- congenital heart defects
- impaired blood supply to the heart
- open arterial duct
- respiratory failure in premature babies
Lower blood pressure after birth
- heavy bleeding (bleeding disorders, injuries
liver and other reasons)
How does brain ischemia develop in newborns?
Blood-borne oxygen in every cell of the body is
vital factor. With низком его содержании начинается
redistribution of blood in the organs. The brain and heart begin
get the maximum amount of oxygen and nutrients
substances, while other tissues and organs are deficient.
If the asphyxiation continues, then these compensatory abilities
not enough for the life of nerve cells. They begin to die one after another.
other. ATозникает гипоксически-ишемическая энцефалопатия
newborns. The more brain tissue suffered, the worse it will be
прогноз для baby AT ряде случаев из-за гипоксии могут возникать
brain hemorrhage, which increases the risk of adverse
Факторы риска гипоксичеко-ишемической encephalopathy
- Neurological diseases in the family and maternal epilepsy
- Infertility Treatment
- Endocrine diseases (for example, thyroid pathology
Features of pregnancy
- Preeclampsia and eclampsia
- Pathology of the placenta
Features of childbirth
- Heavy bleeding during pregnancy and at the time of
- Срок беременности на момент childbirth менее 37 или более 42
- Low birth weight
- The absence of квалифицированной медицинской помощи
- Prompt delivery (less than 2 hours)
- Лихорадка в момент childbirth (более 38 градусов)
- Emergency C-section
ATсе вышеуказанные факторы не являются гарантами возникновения
hypoxia of the newborn. They only reflect the degree of health of the fetus and
опасности в момент childbirth. For example, bleeding, pathology
placenta and baby weight loss are interrelated factors. They
often lead to premature labor and emergency cesarean section
(testimony). The combination of these moments increases the risk
brain damage in a baby, but only in a small percentage
- Withмерно 70% детей с энцефалопатией имели нарушения в развитии
and risk factors already during pregnancy.
- 25% of babies also had problems in childbirth.
- And only a small number of children with cerebral ischemia.
пострадали уже после of birth.
Degrees of cerebral ischemia
In premature babies, mild ischemia may not manifest.
ATосстановление в течение первых двух weeks говорит о
Withзнаки длительной асфиксии и тяжелой ишемии
- Low scores (0-3) on the Apgar scale after the first 5 minutes
- Coma, lack of tendon reflexes and muscle tone
- Onрушения работы внутренних органов (почки, легкие, печень,
The degree of cerebral ischemia is determined by the doctor after the examination.
child, this number should sound in the discharge diagnosis. Onчальные
data on the state of the baby is obtained immediately after birth, using
|Frequency heartbeats||Missing||Slow (less than 100 beats per minute)||Over 100 beats per minute|
|Breathing attempts||The absence of||Weak squeak, insufficient ventilation||Strong cry|
|Muscle tone||Muscles are relaxed||Limbs slightly bent||Limbs are well bent, movements are active|
|Vivacity of the reflexes (irritation of the foot)||Absent||Grimaces on face||Scream|
|Color of the skin||Bluish, pale||Pink body, bluish limbs||All baby is pink|
The baby’s condition is fixed after 1 and 5 minutes after
of birth. After 1 minute, the number of points is determined
the need for resuscitation. Points for 5 minutes to some extent
reflect hypoxic brain damage (if any).
Ischemia of the brain in full-term and premature babies
The nature of brain damage during asphyxia varies in children
born in time and in premature babies. The earlier the child
was born, the greater the risk of periventricular
leucomalacia (PVL). This term means white matter necrosis.
brain located near the special cavities (ventricles). On
cysts form in place of dead cells. It is PVL that is responsible for
most cases of cerebral palsy and dementia in children born before 31
weeks of pregnancy.
In full-term babies, the cerebral cortex is more often damaged.
Gray matter. Health effects will depend on the amount and
location of damaged neurons. If asphyxia was severe and
acute, the brain stem that is responsible for
breathing and heartbeat. It is a direct threat to life.
Consequences of oxygen starvation of the brain
- Severe cerebral ischemia ends in 25-50% of cases.
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 distant
consequences (dementia, cerebral palsy, autism), 10% suffer from mild
complications and 10% have no pronounced effects of asphyxia.
- Cerebral ischemia 2 severity (moderate) in 30-50% of survivors
children causes severe long-term effects, and in 10-20% –
moderate complications (see increased intracranial pressure,
frequent regurgitation of the newborn).
- Mild cerebral ischemia in newborns is almost always
ends safely, without significant consequences for the child
(see hyperactivity in a child, hypotrophy in a child).
Usually cerebral ischemia manifests itself in the first day after
of birth. Mild encephalopathy passes rather quickly, and with
severe may be a false “light gap”, a few
hours or days of improvement followed by a sharp deterioration.
Therefore, to make a diagnosis, you need to complete
The inspection includes an Apgar score, a check of all important
reflexes (sucking, swallowing, prehensile), measurement
body mass and height.
- general blood analysis
- blood electrolyte level
- blood coagulation assessment
- amount of blood gases (oxygen, carbon dioxide)
MRI of the brain
In moderate to severe cerebral ischemia, they are often used.
magnetic resonance study of its structures. With mild ischemia,
during the day, rarely need
Despite popular belief, ultrasound is not accurate
method for the determination of hypoxic encephalopathy. With his help
sometimes there are signs of brain swelling and hemorrhage. But more often
This research method gives a false positive result. therefore
ultrasound is used for the initial diagnosis, with the need to
This study is indispensable in children with severe ischemia.
the brain. With his help можно выявить скрытые судороги, оценить
the degree of damage to the brain and the safety of its activity, pick up
correct anticonvulsant therapy.
Treatment of cerebral ischemia
Specific treatment capable of repairing damaged
brain cell ischemia does not exist. There are no pills or droppers,
no physiotherapy that can replace dead skin on
viable. But there are methods to prevent
further hypoxia and help the child rehabilitate.
Methods in the acute period of ischemia
Since moderate and severe ischemia usually manifests
immediately and brightly, then on Apgar scale, you can give a preliminary assessment
states. If during the first two minutes of life the baby did not start
breathe on your own or using an oxygen mask, then begin
- Intubation and mechanical ventilation
With minor injuries, most children can
transfer to spontaneous breathing in 2-3 minutes after
intubation. Such babies are passed on to the mother and are under
close medical supervision. If longer
resuscitation, the child is transferred to the department
intensive care, where they actively monitor respiratory rates,
blood circulation, blood gas levels, hemoglobin and glucose.
- Treatment of seizures
Anticonvulsants (phenobarbital, phenytoin, and others) in
the correct dosage suppress convulsions and relieve
baby from дополнительного повреждения the brain.
- Maintaining heart activity
Since the heart suffers along with the brain during hypoxia, sometimes
need to support his work. Drugs like dopamine and
dobutamine, maintain adequate heartbeat.
In recent years, research has been carried out to reduce
temperature 3-4 degrees below normal. There is evidence that such
hypothermia is able to save brain cells by inhibiting
the spread of necrosis. In the standard of encephalopathy treatment, she
introduced from 2010 The main rule of hypothermia: control specialists
and gradual warming.
Thus, while there are no drugs that can cure
гипоксические повреждения the brain. You can only pause them and
provide the child with the support of all important functions up to
Treatment of the effects of cerebral ischemia in newborns
Medium and severe encephalopathy often ends
стойкими изменениями the brain. They may appear slightly
(attention deficit disorder, for example) or lead to disability
(Cerebral palsy, mental retardation).
With any outcome of encephalopathy, a set of medicines to treat
- With persistent convulsions, an anticonvulsant is performed.
- In severe cerebral palsy with spasticity of the arms or legs apply
On этом перечень таблеток оканчивается. The only way
affect the development of a child with the consequences of severe ischemia –
- When cerebral palsy requires a special massage, which is better to trust
to specialists. At least in the early stages.
- For older kids need physical therapy
- Special tools for the correction of incorrect postures. With
spasticity limbs baby often take an inadequate position,
which worsens the forecast in the future. Longets, rollers, strollers,
special chairs provide physiological body position in
- Speech therapy classes and homework for speech development,
- Communication with children, adults and the surrounding wildlife –
важный этап реабилитации детей после ишемии the brain.
Гипердиагностика и неэффективная therapy ишемической
Pediatric neurology is one of the few areas of the domestic
medicine, in which most doctors do not follow the latest
recommendations for the diagnosis and treatment of AED. And if newborns
babies with brain damage in our country are nursed very well,
then the “effects of AED” are treated incorrectly and unreasonably.
- Newborn babies and children in the first 3-6 months of life have
features that are mistaken for encephalopathy. Onпример,
startle, increased muscle tone, a symptom of Gref – all this
norm for kids up to six months. Most pediatricians and neurologists,
Unfortunately, they do not know about it.
- Inspection of a scared or sleepy baby is another reason.
overdiagnosis of cerebral ischemia. In such cases, it may be
excessively excited or lethargic.
- The consequence of overdose is usually appointment
unnecessary medication. Such drugs do not help children with
real effects of hypoxia, and for healthy babies they
not needed at all.
Краткий перечень ненужных медикаментов:
- Vascular preparations (cavinton, cinnarizine, etc.) see preparations
to improve cerebral circulation
- Actovegin, Cerebrolysin, Cortexin
- Nootropics: Phenibut, Piracetam, Pantogam, Picamilon
- All homeopathic medicines (see placebo effect)
- Herbal remedies (motherwort, valerian), see
sedatives for children.
All of the above remedies do not have proven effectiveness and
security. At best, they will not help, at worst – they will cause
various side effects.
Prevention of cerebral ischemia in newborns
- Careful pregnancy planning
- Passing all the necessary studies (ultrasound, blood tests
and urine) during pregnancy
- With необходимости – прием препаратов железа
- Screening for infections before and during pregnancy
- Rejection of bad habits
- With осложненной беременности – своевременная
Сыну в возрасте 1 месяц было проведено плановое Brain ultrasound. AT
заключении было написано: «Последствия перинатальной encephalopathy,
recovery period. Withзнаки повышения внутричерепного
pressure. ” The neurologist diagnosed the threat of cerebral palsy (as there is
small chin tremor), appointed Pantogam. Onсколько серьезен
Given the only complaint of chin tremor, the development
your son most likely does not cause concern. Heavy
encephalopathy is usually visible already in the hospital. Brain ultrasound без
symptomatic reinforcement cannot be a basis for diagnosis.
Pantogam – an ineffective and unsafe drug. Mother’s massage
hands and encouragement of any motor activity is all that
required by a healthy baby.
Is the diagnosis Residual Perinatal
encephalopathy» поводом для отказа от прививок?
Such a diagnosis is incorrect because it does not reflect the state
baby But even if it was actually observed after birth
cerebral ischemia, it is not a contraindication to vaccinations.
Moreover, children with such heavy consequence of ischemia, like cerebral palsy,
must be vaccinated.
Onсколько страшны последствия церебральной ишемии 1 степени,
whose symptoms disappeared after three days from birth?
Children with the first (mild) degree of cerebral ischemia usually
quickly restored, no different from their peers.
With средней и тяжелой степени прогнозы могут быть различны.