Perinatal pathology of the fetus Perinatal pathology of the fetus and newbornand newborn (ПП) (ПП)

Group of diseases that arise in Group of diseases that arise in newborns due to newborns due to trauma, hypoxia, trauma, hypoxia, toxic-metabolic and infectious injury toxic-metabolic and infectious injury of organs and tissuesof organs and tissues, as a result of , as a result of adverse pregnancy or childbirthadverse pregnancy or childbirth

CAUSES OF MECHANICAL DAMAGE (NON-CAUSES OF MECHANICAL DAMAGE (NON-CONFORMITY OF PARTURIENT CONFORMITY OF PARTURIENT

CANAL/GENERATIVE PASSAGE TO FETUS CANAL/GENERATIVE PASSAGE TO FETUS SIZE)SIZE)

MotherMother Age Age Anomalies of the Anomalies of the

pelvis (narrow, pelvis (narrow, flat rachitic)flat rachitic)

Exostosis ,traumExostosis ,trauma fractures a fractures pelvispelvis

FetusFetus Giant fetusGiant fetus Diabetic FetopathyDiabetic Fetopathy Multiple pregnanciesMultiple pregnancies Abnormal location Abnormal location

and presentation and presentation Defects development Defects development

of(hydrocephalus)of(hydrocephalus) Prolonged pregnancyProlonged pregnancy

MECHANICAL DAMAGEMECHANICAL DAMAGE

SOFT TISSUE, MUSCLE, BONE SOFT TISSUE, MUSCLE, BONE Nervous System: Nervous System:

- Peripheral nerves - Peripheral nerves

- Central nervous system (damage to the - Central nervous system (damage to the brain and spinal cord)brain and spinal cord)

Mechanical damage of ( soft Mechanical damage of ( soft tissues, muscles, bones)tissues, muscles, bones)

Labor tumorLabor tumor Cephalohematoma Cephalohematoma Sternocleidomastoid muscle Sternocleidomastoid muscle

hemorrhagehemorrhage Fractures of clavicle, epiphysisFractures of clavicle, epiphysis

Labor TumorLabor Tumor

Swelling of soft tissue where the presenting part Swelling of soft tissue where the presenting part (often the head) due to venous stagnation in (often the head) due to venous stagnation in children as they pass through the mother parturient children as they pass through the mother parturient canal.canal.

Often with punctulated hemorrhages on the skin. Often with punctulated hemorrhages on the skin.

More frequently it is encountered in the children of More frequently it is encountered in the children of the first-born mothers due to prolong disengagement the first-born mothers due to prolong disengagement of fetus head because of the giant size of fetus. of fetus head because of the giant size of fetus.

Swelling disappears within 1-2 days. Treatment is Swelling disappears within 1-2 days. Treatment is not requirednot required

CephalohematomaCephalohematoma Effusion of blood beneath the pericranium(0,3-0,5% of Effusion of blood beneath the pericranium(0,3-0,5% of

newborns) newborns) Increases during the first 2-3 days of life. Increases during the first 2-3 days of life. One or both parietal bones, rarely in the occipital and One or both parietal bones, rarely in the occipital and

frontal, still less on the temporal bones.frontal, still less on the temporal bones. Capacity from Capacity from 5 to 150 ml 5 to 150 ml of blood ( long duration - of blood ( long duration -

liquid) liquid) The boundaries do not extend beyond the bone that The boundaries do not extend beyond the bone that

involved. involved. The surface of the skin over the tumor was not changed. The surface of the skin over the tumor was not changed. Under CT sometimes observed- broken bones, Under CT sometimes observed- broken bones,

Perhaps the message with epidural hematomaPerhaps the message with epidural hematoma

CephalohematomaCephalohematoma

From 7-10 days - reduced in size From 7-10 days - reduced in size Usually disappear in 3-8 weeks. Usually disappear in 3-8 weeks. With significant hemorrhages of compacted With significant hemorrhages of compacted

periosteum, hematoma ossified, which leads periosteum, hematoma ossified, which leads to distortion or asymmetry of the skull.to distortion or asymmetry of the skull.

Diff.diagnoz-labor tumor; hemorrhage Diff.diagnoz-labor tumor; hemorrhage beneath the aponeurosis; cerebral hernia. beneath the aponeurosis; cerebral hernia.

Complications: anemia, due to considerable Complications: anemia, due to considerable blood loss; jaundice , due to progress of blood loss; jaundice , due to progress of hemorrhage resolution, suppuration.hemorrhage resolution, suppuration.

Treatment of Treatment of CephalohematomaCephalohematoma

Feed the child with expressed breast Feed the child with expressed breast milk in the course of 3-4 days.milk in the course of 3-4 days.

After that calcium gluconate and Vit. 3 After that calcium gluconate and Vit. 3 days (0,001 g 3 times ) days (0,001 g 3 times )

Puncture cephalohematoma ,suck out Puncture cephalohematoma ,suck out the blood and apply compressive the blood and apply compressive bandage.bandage.

With infection and suppuration CT-With infection and suppuration CT-surgical treatment, antibiotics.surgical treatment, antibiotics.

Hemorrhage in Hemorrhage in sternocleidomastoid musclesternocleidomastoid muscle

Always arise during breech presentation at birth, or Always arise during breech presentation at birth, or by using forceps or manual extraction of the fetus. by using forceps or manual extraction of the fetus.

Small, moderately dense or rather small Small, moderately dense or rather small consistency of tumor with the size of a walnut and consistency of tumor with the size of a walnut and plum, which often appears only at the end of the plum, which often appears only at the end of the first - the start of the 2nd week of life. first - the start of the 2nd week of life.

Further develops torticollis - head tilted to the Further develops torticollis - head tilted to the patient’s side, and chin in the opposite direction. patient’s side, and chin in the opposite direction.

Diff.diagnoz: congenital torticollis, developed in Diff.diagnoz: congenital torticollis, developed in the uterus as a result of prolonged pressure of the the uterus as a result of prolonged pressure of the mother's pelvic bones on the muscle owing to mother's pelvic bones on the muscle owing to insufficiency of amniotic fluidinsufficiency of amniotic fluid

Hemorrhage in Hemorrhage in sternocleidomastoid musclesternocleidomastoid muscle

TreatmentTreatment: Immediately after birth, : Immediately after birth, hemostasis therapy, turning heads in a proper hemostasis therapy, turning heads in a proper way especially during sleep, after a while way especially during sleep, after a while overlay thermal compress and massage. It is overlay thermal compress and massage. It is recommended to injects prednisolone and recommended to injects prednisolone and hyaluronidase into hematoma. hyaluronidase into hematoma.

PrognosisPrognosis is usually favorable. When is usually favorable. When inefficient conservative treatment, inefficient conservative treatment, between between the ages of 4 and 6 monthsthe ages of 4 and 6 months after birth after birth indicate surgical treatment (tendotomy)indicate surgical treatment (tendotomy)

Fracture of clavicleFracture of clavicle Observed in 0,03-0,1% of newborns Observed in 0,03-0,1% of newborns Possible with spontaneous delivery without aid from Possible with spontaneous delivery without aid from

obstetric . Fracture form in the giant fetus, when pelvic obstetric . Fracture form in the giant fetus, when pelvic present with fall back arm.present with fall back arm.

Violent or weak uterine contraction, delayed exit of fetus Violent or weak uterine contraction, delayed exit of fetus shoulder, narrow pelvis of parturient women promote shoulder, narrow pelvis of parturient women promote fractures. Always lead to right clavicle fracture. fractures. Always lead to right clavicle fracture.

Subperiosteum fracture in the middle third of the Subperiosteum fracture in the middle third of the clavicle without dislocation. clavicle without dislocation.

Diagnosis: movement of the hand on the side of fracture Diagnosis: movement of the hand on the side of fracture is limited, there is a local swelling, the Moro reflex on the is limited, there is a local swelling, the Moro reflex on the side of lesion is absent, crepitation during palpationside of lesion is absent, crepitation during palpation

Fracture of clavicleFracture of clavicle

Favorable Favorable prognosisprognosis, formation of bone , formation of bone marrow advanced rapidly on- 3-4-day, marrow advanced rapidly on- 3-4-day, subsequently the function of limbs are not subsequently the function of limbs are not affected. affected.

Diff.diagnozDiff.diagnoz: avulsion fracture the head of : avulsion fracture the head of shoulder bone , palsy Brachial Plexus and shoulder bone , palsy Brachial Plexus and central paralysis. When suspect fracture central paralysis. When suspect fracture carry out X-ray examination.carry out X-ray examination.

TreatmentTreatment: short-term slightly immobilised : short-term slightly immobilised limb on the side of the clavicle fracture and limb on the side of the clavicle fracture and the child laid on the unaffected side.the child laid on the unaffected side.

MECHANICAL DAMAGE OF MECHANICAL DAMAGE OF NERVOUS SYSTEMNERVOUS SYSTEM

Damage to the Damage to the spinal cordspinal cord (neck (neck region Caesarian region Caesarian section)section)

Damage to Damage to peripheral nerves peripheral nerves (paralysis): (paralysis): facial nerve facial nerve Brachial plexus Brachial plexus

(top, bottom, total)(top, bottom, total)

Intracranial Intracranial birth injury birth injury (bleeding): (bleeding): Epidural Epidural Subdural (supra, Subdural (supra,

subtentorialnoe)subtentorialnoe) Intraventricular Intraventricular ParenchymatousParenchymatous SubarachnoidSubarachnoid

Damage to peripheral Damage to peripheral nervesnerves

Paralysis of the facial nerve Paralysis of the facial nerve            - Assimmetrical face with eye slits gape, hanging-down of            - Assimmetrical face with eye slits gape, hanging-down of

cheeks, displacement of the mouth angle toward the cheeks, displacement of the mouth angle toward the unaffected side . unaffected side .

           - All of these symptoms intensified when the child cry.           - All of these symptoms intensified when the child cry. Upper brachial plexus paralysis Erba - Dyushena Upper brachial plexus paralysis Erba - Dyushena

             -Damage at the level of C5 - C6              -Damage at the level of C5 - C6              -Hand and the fingers moving, sometimes-clicking in the              -Hand and the fingers moving, sometimes-clicking in the shoulder shoulder joint. joint.

Lower brachial plexus paralysis Dezherin - Klyumpke Lower brachial plexus paralysis Dezherin - Klyumpke              - Damage at the level of C7 - Th1              - Damage at the level of C7 - Th1              - Hand passively hanging in the form of seals feet or has the              - Hand passively hanging in the form of seals feet or has the form form of "sharp-clawed paws." of "sharp-clawed paws." Total brachial plexus palsyTotal brachial plexus palsy

Upper brachial plexus Upper brachial plexus paralysis Erba - Dyushenaparalysis Erba - Dyushena

Damage at the level of C5-C6Damage at the level of C5-C6

The damaged extremity hangs along the body, its upper part is The damaged extremity hangs along the body, its upper part is turned inward and is forced against the bodyturned inward and is forced against the body. .

Forearm is slightly [pronirovano] and is bent in the elbow Forearm is slightly [pronirovano] and is bent in the elbow

Palm is turned back and towards the outside. Hand is isolated Palm is turned back and towards the outside. Hand is isolated from the body by the deep and wide slot (symptom of puppet from the body by the deep and wide slot (symptom of puppet hand). hand).

Hand and fingers move, sometimes flick in the humeral jointHand and fingers move, sometimes flick in the humeral joint

Frequently it is combined with paralysis of diaphragms & nerveFrequently it is combined with paralysis of diaphragms & nerve

Lower paralysis Lower paralysis Дежерин - Клюмпке

Damage at the level ofDamage at the level of C7 – Th1 C7 – Th1 Encountered considerably frequent – paralysis of Encountered considerably frequent – paralysis of

muscles of the forearm and hand. muscles of the forearm and hand. Brush passively overhangs in the form “seal paw “or Brush passively overhangs in the form “seal paw “or

takes the form “clawed-shaped paw takes the form “clawed-shaped paw Decreased movements in the humeral and elbow joint.Decreased movements in the humeral and elbow joint. Pallor of the skin (symptom of the ischemic glovePallor of the skin (symptom of the ischemic glove).).

Тотальный парез плечаТотальный парез плеча

Therapeutic measures Therapeutic measures during nerve paralysisduring nerve paralysis

Acute phase: : preparations improving cerebral blood preparations improving cerebral blood circulation, diuretics, the complex of the vitamins of circulation, diuretics, the complex of the vitamins of group [v], papaverine, folic, lipoic acids, nicotinamidegroup [v], papaverine, folic, lipoic acids, nicotinamide

Early regression period and furtherperiod and further: : together with the together with the drug therapy - massage, gymnastics, floating, hydro-drug therapy - massage, gymnastics, floating, hydro-massage with physiotherapy (thermal procedures, massage with physiotherapy (thermal procedures, electrophoresis with the nicotinic acid), acupunctureelectrophoresis with the nicotinic acid), acupuncture

Epidural BleedingEpidural Bleeding Fast-increasing HF hypertension in the first Fast-increasing HF hypertension in the first

hours of life hours of life ВЧ: ВЧ: --hyper-excitabilityhyper-excitability --spasmsspasms --On the side of hematoma frequentlyOn the side of hematoma frequently dilation of the pupildilation of the pupil

-Сочетается с кефалогематомой-Сочетается с кефалогематомой CCТ – Т – band-shaped very dense formation band-shaped very dense formation

between the solid cerebral membrane and by between the solid cerebral membrane and by the bones of the skullthe bones of the skull

НСГ – НСГ – poorly informativepoorly informative

Subdural BleedingSubdural Bleeding

AsymptomaticAsymptomatic

Neurology- disturbance in the first 72 hours of the life: the Neurology- disturbance in the first 72 hours of the life: the asymmetry of muscular tone, spasm in the section the asymmetry of muscular tone, spasm in the section the groups of muscles, the deflection of eyes in side of groups of muscles, the deflection of eyes in side of hematoma, dilation of pupil on the side of hematoma hematoma, dilation of pupil on the side of hematoma

General cerebral symptoms (increase in the intracranial General cerebral symptoms (increase in the intracranial pressure, hyper-excitability) pressure, hyper-excitability)

CCТ- Т- “crescent-shaped” zone of increased density, that is “crescent-shaped” zone of increased density, that is adjacent to the arch of the skulladjacent to the arch of the skull

НСГ- НСГ- poorly informativepoorly informative

Subdural BleedingSubdural Bleeding(субтенториальное)(субтенториальное)

CatastrophicCatastrophic – –from the first minute of life - signs of from the first minute of life - signs of the compression of the brain stem: coma, the compression of the brain stem: coma, opisthotonus, the disturbance of pupil reactions, opisthotonus, the disturbance of pupil reactions, , , фиксир. взор, прогрессир.нарастание серд.-сосуд. и дыхат. фиксир. взор, прогрессир.нарастание серд.-сосуд. и дыхат. наруш.наруш.

DeferredDeferred – после периода относит. благополу-чия (неск. – после периода относит. благополу-чия (неск. часов или дней)- признаки ВЧГ и компрессии ствола мозга. часов или дней)- признаки ВЧГ и компрессии ствола мозга. Наиболее частый исход-летальный.Наиболее частый исход-летальный.

Disturbances of metabolism, decreased BP, Disturbances of metabolism, decreased BP, bradyarrhythmia & anemia bradyarrhythmia & anemia

НСГ- НСГ- deformation of the 4deformation of the 4thth ventricle ventricle., ., thromb in the latge cisternthromb in the latge cistern КТ - КТ - extensive hematomas of the rear fossasextensive hematomas of the rear fossas

Intraventricular BleedingIntraventricular Bleeding((traumatrauma))

Rarely encountered Rarely encountered predominantly reported & predominantly reported & manifested during 1-2 days of life manifested during 1-2 days of life (sometimes on 2-4 weeks(sometimes on 2-4 weeks))

Hyper-excitability, by oppression, focus spasms, Hyper-excitability, by oppression, focus spasms, secondary apneas secondary apneas

ProgressiveProgressive ВЧГ ВЧГ vomitvomit, , unjoined fontanelsunjoined fontanels)) HydrocephalyHydrocephaly НСГ – НСГ – VentriculomegalyVentriculomegaly.. Deformation of outlines and an Deformation of outlines and an

increase in the sizes vessels. Thromb in the openings of increase in the sizes vessels. Thromb in the openings of ventriclesventricles

PARENCHYMATOUS PARENCHYMATOUS HEMORRHAGESHEMORRHAGES

Rarely encounteredRarely encountered, , frequently in newborns frequently in newborns >>40004000

Полушарные крПолушарные кр. –. –asymptomatic flow or asymptomatic flow or the increasing oppression of cerebral the increasing oppression of cerebral activity, by hemisyndrom, activity, by hemisyndrom, очаговые клоничочаговые клонич,, spasm,spasm, ВЧГ ВЧГ (perifocal edema of the brain) (perifocal edema of the brain)

Внутримозжечковые крВнутримозжечковые кр.- .- asymptomaticasymptomatic(кр. в (кр. в краевые отделы полушар. мозжечка) краевые отделы полушар. мозжечка) or or increasingincreasing ВЧГ, ВЧГ, the compression of the the compression of the brain stem with massive bleeding in the brain stem with massive bleeding in the hemispheres of the cerebellumhemispheres of the cerebellum

Subarachnoid BleedingSubarachnoid Bleeding

First 12 hrs of lifeFirst 12 hrs of life- - the oppression of cerebral the oppression of cerebral activity till comaactivity till coma

At timesAt times– – the widely open eyes, “cerebral the widely open eyes, “cerebral cry”, the pose of decortication (inflexion of cry”, the pose of decortication (inflexion of hands, the extension of feet)hands, the extension of feet)

Hyperesthesia Hyperesthesia Hyper-excitability, the generalized spasms Hyper-excitability, the generalized spasms Rapidly increasing external hydrocephalus Rapidly increasing external hydrocephalus НСГ, НСГ, increase in the density and expansion increase in the density and expansion

of the subarachnoid spacesof the subarachnoid spaces

Hypoxic РТ

Asphyxia (suffocation) -Asphyxia (suffocation) -острое прекращение острое прекращение поступления кислорода (5-7% н/р).поступления кислорода (5-7% н/р).

Asphyxia Asphyxia - - fetal (center.) and post-natal fetal (center.) and post-natal (СДР)(СДР)

Hypoxia - - the prolonged repeated the prolonged repeated limitations of constant O2 supplyleads to limitations of constant O2 supplyleads to excess accumulation in the organism of excess accumulation in the organism of CO2 and other incompletely oxidized CO2 and other incompletely oxidized products (80% of all damages to CNSproducts (80% of all damages to CNS).).

Hypoxia -chronic intrauterine Hypoxia -chronic intrauterine

CAUSES FOR HYPOXIC DAMAGESCAUSES FOR HYPOXIC DAMAGES

MaternalState and disease of the State and disease of the mother leads to the mother leads to the depletion of fetal-depletion of fetal-placental-central blood placental-central blood flow (toxicosisflow (toxicosis) )

Excessively rapid or Excessively rapid or protracted laborprotracted labor

Child Delay of the intrauterine Delay of the intrauterine

development of the fetusdevelopment of the fetus Premature birthPremature birth Congenital defectCongenital defect Pathology of the Pathology of the

placenta and the placenta and the umbilical cordumbilical cord

HYPOXIC DEFECTS OF CNS

Cerebral IschemiaCerebral Ischemia (1-3 (1-3 stagestage)) Intracranial the hemorrhage of the Intracranial the hemorrhage of the

hypoxic genesis (they are characteristic hypoxic genesis (they are characteristic for the premature children)for the premature children)

Combination of ischemic and Combination of ischemic and hemorrhagic defeats CNS of the hemorrhagic defeats CNS of the nontraumatic naturenontraumatic nature

Cerebral Ischemia (hypoxic-ischemic encephalopathy)-1

Ceberal Ischemia - 1 (light)

Ceberal Ischemia - 2

(medial severity)

Light asphyxia upon birthLight asphyxia upon birth. . Excitation CNS Excitation CNS in the mature babies, oppression in in the mature babies, oppression in premature babies, the duration not more premature babies, the duration not more than 5-7 daysthan 5-7 days

В/у В/у hypoxiahypoxia,,intranatal asphyxiaintranatal asphyxia Opression of the CNSOpression of the CNS, смена фаз церебр. , смена фаз церебр.

активн. активн. More than 7 daysMore than 7 days, , spasmspasm (тонич. или (тонич. или атипичн.- апноэ, трепет. век у атипичн.- апноэ, трепет. век у недоношнедонош, , клонические у клонические у доношдонош.).)

Транзиторная ВЧГ ( у донош.)Транзиторная ВЧГ ( у донош.) Vegetative-visceral defectVegetative-visceral defect

Ceberal Ischemia (Hypoxic-Ischemic-Encephalopathy)-2

Cerebral Ischemia - 3

(chronic)

В/у В/у fetal hypoxiafetal hypoxia, , chronic perinatal asphyxiachronic perinatal asphyxia,, extracerebral causeextracerebral cause for steadfast hypoxia for steadfast hypoxia of the brainof the brain (ВПС, СДР, (ВПС, СДР, hypovolemic shockhypovolemic shock))

Progressive loss of cerebral activityProgressive loss of cerebral activity more than 10 more than 10 daysdays ( (first 12 hours-comfirst 12 hours-comа, 12-24 а, 12-24 hourshours – – increase increase level of awakenesslevel of awakeness, 24-72 , 24-72 hours -comhours -comа)а)

Repetitive spasmRepetitive spasm, эпистатус, эпистатус Dysfunctional brain stemDysfunctional brain stem ( (respiratory defectrespiratory defect.).) The pose of decortication (decerebration) The pose of decortication (decerebration)

- depends on the volume of the defect.- depends on the volume of the defect. Vegetative-visceral defectVegetative-visceral defect ProggressiveProggressive ВЧГ ВЧГ

Intracranial Hemorrhage of Hypoxic GenesisIntracranial Hemorrhage of Hypoxic Genesis

Intraventricular Intraventricular hemorrhagehemorrhage -1 -1

(субэпинди- (субэпинди-

мальное)мальное)

Predominantly in premature Predominantly in premature and immature newbornsand immature newborns

Ante and intranatal hypoxiaAnte and intranatal hypoxia, , повторн. повторн. Apnea attacks, jet-Apnea attacks, jet-like introduction of like introduction of hyperosmolar solution.hyperosmolar solution.

Asymptomatic courseAsymptomatic course Transitory mechanical Transitory mechanical

disturbances.disturbances.

Intracranial hemorrhage of hypoxic genesisIntracranial hemorrhage of hypoxic genesis (2) (2)

Intraventricular Intraventricular hemorrhagehemorrhage - -

22 (субэпиндим.+(субэпиндим.+ интравентрик.)интравентрик.)

В/у В/у hypoxia,intranatal asphyxiahypoxia,intranatal asphyxia., ., defect upon first defect upon first reanimationreanimation., АГ, СДР. ИВЛ, ., АГ, СДР. ИВЛ, fast introduction of fast introduction of large volumes or hyperosmolar large volumes or hyperosmolar solutionsolution,,coagulopathycoagulopathy

Catastrophic courseCatastrophic course short periodshort period. . Mobile Mobile excitementexcitement. . passes into the coma, deep apnea, passes into the coma, deep apnea, cyanosis and marbling of the skincyanosis and marbling of the skin, тонич. , тонич. spasmspasm, , oculomotor disorders, bradyarrhythmia, the oculomotor disorders, bradyarrhythmia, the disturbance of the thermostatic controldisturbance of the thermostatic control – – intraventricular hypertensionintraventricular hypertension. .

Волнообразн. течение-Волнообразн. течение- смена фаз церебр. смена фаз церебр. активности, приступы апноэ, активности, приступы апноэ, muscular hypotoniamuscular hypotonia, , atypical spasmatypical spasm..

Decrease in arterial pressureDecrease in arterial pressure, , hematocritehematocrite, , HBHB, , hypoxemiahypoxemia, , acidosisacidosis, , fluctuating glycemia.fluctuating glycemia.

Внутричерепные кровоизлияние Внутричерепные кровоизлияние гипоксического генеза (3)гипоксического генеза (3)

Intraventricular Intraventricular

hemorrhagehemorrhage -3 -3 (субэпиндим.(субэпиндим.

++

интравентрик.интравентрик.

+ +

перивентрик.)перивентрик.)

12-17% ВЖК, 12-17% ВЖК, immature withimmature with экстрем. экстрем. Low Low body weightbody weight

Typical catastrophic courseTypical catastrophic course. . Rapid Rapid developmetn of comadevelopmetn of coma, , progressive defect of progressive defect of vital functionsvital functions((bradycardia, arrythmiabradycardia, arrythmia, , apnoe, apnoe, dyspnoedyspnoe))

Tonic spasmsTonic spasms, , oculomotor defectoculomotor defect caused by caused by displacement of the brain stamdisplacement of the brain stam. . High letality High letality on the first day of lifeon the first day of life..

Труднокоррегируемые Труднокоррегируемые hypoxemia, acidosis, hypoxemia, acidosis, electrolyticelectrolytic solutionsolution, ДВС-, ДВС-syndromesyndrome..

Proggressive drop in arterial Proggressive drop in arterial pressurepressure,,arrythmiaarrythmia, , critical drop in critical drop in hematocritehematocrite и НВ. и НВ.

Ultrasonic picture of the brain of newborn with the intra-ventricular hemorrhage: moderated of ventriculomegalia, the unevenness of the outlines of vascular interlacement, dust devil in the occipital horn of the lateral ventricle

ПЕРВИЧНОЕ СУБАРАХНОИДАЛЬНОЕ КРОВОИЗЛИЯНИЕ

frequencyfrequency ~~20%,20%, from thatfrom that 3/43/4- - premature and premature and immature newbornsimmature newborns

Intranatal hypoxia or asphyxiaIntranatal hypoxia or asphyxia, , prematurity, prematurity, immaturity, coagulopathyimmaturity, coagulopathy

CourseCourse: - : - asymptomaticasymptomatic - - the syndrome of excitation with the syndrome of excitation with

hyperesthesiahyperesthesia, , acuteacute ВЧГ ( ВЧГ (stress and the protrusion of large fontanel, the stress and the protrusion of large fontanel, the

divergence of seams, transitorydivergence of seams, transitory Greffe Syndrome) Sudden spasmSudden spasm on the 2-3 days of lifeon the 2-3 days of life (очаговые (очаговые

клонические клонические for mature babiesfor mature babies, , atypical for atypical for premature)premature)

Ultrasonic picture of the brain of child with the plural cysts on the spot of the centers of the hemorrhages.

Combintaion of ischemic and hemorrhagic

defects of the CNS of the nontraumatic nature They are encountered considerably

more frequently than all enumerated isolated forms of damages to CNS, predominantly in premature babies .

В/у гипоксия, asphyxia during labor, for premature with low body weight (1000-1500g), defets of first animation, АГ or fluctuatuion system of arterial pressure, coagulopathy, ДВС-syndrome

These damages are the most chronic. Clinical picture depends on the leading defect types of CNS

(ischemia, hemorrhage), of severity , localization, Regulative defect of metabolism

Prenatal Classification of Brain Pathology

0 – 14 0 – 14 days of lifedays of life::

Asphyxia, hypoxia

Syndrome of the Syndrome of the excitationexcitationSyndrome of the Syndrome of the oppressionoppression

More than 2 weeksMore than 2 weeks::

Peinatal encephalopathyPeriodPeriod: : acuteacute ( (1 month1 month),),stoppingstopping

((earlyearly--tilltill 4-5 4-5 momo, ,

latelate- - up to 1 yrup to 1 yr.), .), residual phenomenaresidual phenomena

Perinatal Hypoxic defect of the brain

Syndrome of the increased Syndrome of the increased nervous reflex excitabilitynervous reflex excitability

Hypertensional-hydrocephalic syndromeHypertensional-hydrocephalic syndrome Vegetative-visceral defect syndromeVegetative-visceral defect syndrome Muscular dystonia syndromeMuscular dystonia syndrome Spasmic syndromeSpasmic syndrome Depression(depressive) syndromeDepression(depressive) syndrome

Syndrome of the increased Syndrome of the increased nervous reflex excitabilitynervous reflex excitability

Increase in spontaneous motor activityIncrease in spontaneous motor activity RestlessnessRestlessness, , unmotivated(of unknown unmotivated(of unknown

cause) weepingcause) weeping Animation of the innate and Animation of the innate and

tendinous reflexestendinous reflexes Frequent tremor of limbs and chinFrequent tremor of limbs and chin Convulsive readinessConvulsive readiness

Hypertensive-hydrocephalic syndrome

Lobular or brachycephalyLobular or brachycephaly Fast increase in head circumferenceFast increase in head circumference ( (more more

than 1cm in a week)than 1cm in a week) Expansion and protusion of the fontanelleExpansion and protusion of the fontanelle Opening of seamsOpening of seams ( (arrow-shapedarrow-shaped >> 0,5 см) 0,5 см) Graefe'sGraefe's symptom symptom, нистагм, косоглазие, нистагм, косоглазие Muscular dystoniaMuscular dystonia, , spontaneous reflex of spontaneous reflex of

MoroMoro, срыгивания, , срыгивания, tachyarrythmiatachyarrythmia, , tachypnoetachypnoe

Vegetative-visceral defect syndrome

Combination with one of the behavioral Combination with one of the behavioral syndromessyndromes

DyskinesiaDyskinesia of the GIT (diarrhoea, of the GIT (diarrhoea, meteorismmeteorism, , gastro-esophageal refluxgastro-esophageal reflux- - упорные срыгивания)упорные срыгивания)

Rare – defects in heart and respiratory Rare – defects in heart and respiratory rhythmsrhythms

RestlessnessRestlessness or weaknessor weakness

Syndrome of the Syndrome of the oppressionoppression

It is characteristic for premature kidsIt is characteristic for premature kids Apathy, hypodynamia, general Apathy, hypodynamia, general

muscular hypotonia muscular hypotonia Hypo-reflectionHypo-reflection ( в т.ч. ( в т.ч. sucking and sucking and

swallowing reflexes) - feeding swallowing reflexes) - feeding through the probe through the probe

There can be bulbar and pseudo-There can be bulbar and pseudo-bulbar disturbances, during bulbar disturbances, during excitationexcitation

Treatment of hypoxic damages to the CNS(1)

Primary resuscitationPrimary resuscitation: the warming of child (radiant heat-, the the warming of child (radiant heat-, the

incubator incubator ), (А) the release of the upper respiratory the release of the upper respiratory

tract + is NOT EARLIER than 5 min. tract + is NOT EARLIER than 5 min. after [birth. Haltage of stomach after [birth. Haltage of stomach contractioncontraction

(В) – O2 therapy ( вплоть до ИВЛ 100% О2 15-30”),

(С) - completion ОЦК (физ.р-р, 5% аalbumin, 4% NaHCO3).

Treatment of hypoxic damages to the CNS(2)

Intensive therapy during the acute stageIntensive therapy during the acute stage::

the optimum regime of the tarrythe optimum regime of the tarry O2 therapyO2 therapy ( ( maskmask, ИВЛ ), , ИВЛ ), completioncompletion ОЦК ( ОЦК (maintenance AD maintenance AD

stabilizationstabilization МЦР ), МЦР ), the correction of disturbancesthe correction of disturbances КОС КОС Hemostatic therapyHemostatic therapy( викасол ), ( викасол ), antioxidantsantioxidants (ГОМК), (ГОМК), edema of the brain (diuretics, edema of the brain (diuretics,

glucocorticoids, Ca 2+ channel glucocorticoids, Ca 2+ channel blockersblockers

Treatment of hypoxic damages to the CNS(3)

Treatment in the early period Treatment in the early period ::

with edema of the brain (under the control of with edema of the brain (under the control of neurosonography neurosonography))Diuretics according to schemeDiuretics according to scheme, , Ca channel blockersCa channel blockersSedative therapySedative therapy( фенобарбитал ), ( фенобарбитал ), the maintenance of the hemodynamics of the the maintenance of the hemodynamics of the brain brain ( ноотропил, ( ноотропил, glycineglycine, энцефабол, , энцефабол, глютаминовая кислота, аминокислот. комплексы ), глютаминовая кислота, аминокислот. комплексы ), maintenance of the hemodynamics of the maintenance of the hemodynamics of the brain brain ( трентал, кавинтон, циннаризин, ( трентал, кавинтон, циннаризин, оксибрал ), оксибрал ), therapeutic exercise, massage therapeutic exercise, massage

Outcomes of hypoxic- Outcomes of hypoxic- traumatic damages of CNStraumatic damages of CNS

4 - 5% - ДЦП, 4 - 5% - ДЦП, oligophreniaoligophrenia 20 - 40% - 20 - 40% - other:other:

Delay in the rates of physical, mental and Delay in the rates of physical, mental and vocal developmentvocal development,,

цереброастенический цереброастенический syndrome with syndrome with neurosis-like stateneurosis-like state,,

scatteredscattered очаговые очаговые microsymptomsmicrosymptoms,, Moderate intracranial hypertensionModerate intracranial hypertension,, Compensated or progressive hydrocephalusCompensated or progressive hydrocephalus,, epilepsyepilepsy

Possible for complete recovery.