PEP (perinatal encephalopathy) in the newborn and infant - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Perinatal Period

Often after the first survey of the neuropathologist in the clinic or in the hospital baby diagnosed perinatal encephalopathy.According to various sources, it has from 30 to 70% of newborns.What moms complaints forced the doctor to put such a diagnosis?Prolonged crying and crying at all, frequent sucking, vomiting, tremors or vskidyvaniem hands and feet, poor night (frequent waking, restless sleep surface) and a nap (little sleep during the day), difficulty falling asleep (long rocking on hands).On examination, the child's physician may notice a violation of muscle tone - hypertonicity or hypotonia, dystonia.When neurosonographic studies are sometimes visible blackout or modified parts of the brain, sometimes not.The doctor assigns the tools to improve cerebral blood flow (piracetam, nootropics, cavinton) and sedatives (glycine, a mixture of citral, valerian, sometimes luminal or phenobarbital), and also recommends that massage courses, swimming in the collections of soothing herbs.That you probably all


Now, it should be said about another approach to the problem.

Perinatal encephalopathy is a complication of pregnancy and childbirth pathology and diagnosed in infants up to 5% of the cases (or in 1,5-3,6%)!Where does this discrepancy?The book Thumb ABand Shabalova NP"Hypoxic-ischemic encephalopathy newborns: a guide for physicians."(St. Petersburg, "Peter", 2000), the reasons for the incidence of neonatal encephalopathy-embracing explained very well.The reason, in general, is one, and it is called overdiagnosis.

What is the cause of overdiagnosis?What makes the doctors put "all in a row," this diagnosis?Within the framework of the St. Petersburg scientists research the following reasons "overdiagnosis" perinatal encephalopathy were identified:

First x, is a violation of the neurological examination guidelines:

a) violations of inspection standards (the most common of them: diagnosis increased excitability in tremblingand chained the child in a cold room, and in the excited state or excessive manipulation of the researcher; diagnosis depression of the central nervous system in a sluggish child when overheating or dormant).

example, a pediatrician at the hospital put the PEP as a child often cried loudly, but when the neurologist came to inspect the baby, the baby was fast asleep, and the doctor said that the tone is normal and he does not see any abnormalities.After a month in the clinic examination was carried out when the child is asleep, woke up and scared that someone else his aunt's hands and legs twitching.Naturally, he started to cry and stiffened.PEP confirmed.

example, one child can diagnose the hyper, the hypotonia.

b) incorrect assessment of a number of evolutionary phenomena (ie pathology is considered that the rate for this age, especially for a child 1 month).This diagnosis of intracranial hypertension on the basis of the positive symptom Graefe, Graefe symptom may be identified in full-term children during the first months of life, in preterm infants with intrauterine growth retardation, constitutional features);diagnosis of spasticity through the legs crossing at the level of the lower third of shin newborn when checking floor reaction or stepping reflex (may be due to physiological saline hypertonicity some thigh muscles, but abnormal in children older than 3 months);segmental diagnosis in identifying violations, "the heel of the foot" (dorsiflexion of the foot - 120 ° is the norm);hyperkineses a child 3-4 months with anxiety Language (is the physiological stage of the child's motor skills maturation).

These include regurgitation, and, as a result of the immaturity of the nervous system and the weakness of the sphincter - the muscular valve located in the upper part of the stomach, which is not too well keeps its contents.The norm is considered regurgitation after each feeding in the volume of 1-2 table spoons and vomiting once a day "fountain" more than 3 tablespoons, if this kid pees often, feeling well and gaining weight normally.Diagnosis of skin symptom marbling - due to immaturity of the vegetative-vascular system.

But up to 3 years - it is absolutely normal, because it is being formed!

Bad night's sleep - when the child wakes up frequently.But the baby is characterized mainly superficial shallow sleep and sucking during such sleep.With 3-4 months in children at night sucking can become more active becauseday they start easily distracted from the breast and suck relatively long.Through active night suckling they get the required amount of milk.

American sleep researcher James McKenna in his work Breastfeeding & amp;Bedsharing Still Useful (and Important) after All These Years writes that in the study of sleep in infants it was found that the average interval between the night of breastfeeding was about one and a half hours - the approximate length of an adult sleep cycle.Minimize the time of my mother's "lack of sleep", you can use the rational organization of co-sleeping and nighttime feedings.Very often, children are better sleep next to their mothers.Motion sickness can also replace breastfeeding before bedtime (but not all turns out).When I learned that since "can" do, rocking time decreased significantly.Most children wake up after sleeping in a bad mood, you can also offer the breast, and the world will once again delight the kid!

Second x is the assignment of pathological series adaptation, passing phenomena in the nervous systems of the newborn (eg, startle or vskidyvaniem hands and feet, trembling chin with strong crying and fright, postpartum depression, physiological muscle hypertension and so on.d.).

Third , poor awareness of the classification of hypoxic ischemic encephalopathy (mainly due to the foreign origin of the research on this topic), and the lack of qualification of the doctor.

example, the monthly child was diagnosed with minimal brain dysfunction, which should be placed after 2 or even 5 years, according to different sources.Another child was appointed to drink ginseng tincture, which is inadmissible at his age.Most drug treatments lead to a further deterioration in the behavior of children.Doctors are aware of the dangers of various drugs for children, but not, or simply inform parents or consciously or unconsciously do not pay attention to their side effects.

Fourth , this psychological reasons.It lies in the fact that, in view of the current situation in the national health care, "overdiagnosis" has no administrative, legal and ethical implications for the doctor.The diagnosis leads to treatment assignment, and in the case of right or wrong diagnosis outcome (often minimal recovery or disorder) is favorable.Thus, it can be argued that a favorable outcome is a consequence of the "correct" diagnosis and "right" treatment.

Over-diagnosis of the disease is no better than underdiagnosis.With the lack of clear diagnosis of negative consequences - because of lack of timely assistance may develop disabling disease.A overdiagnosis?According to the St. Petersburg researchers, which is difficult not to agree, "overdiagnosis" is not a harmless phenomenon, as some people think some doctors.The negative effects of "overdiagnosis" are, first of all, that the long-term operation under the doctrine of "overdiagnosis" leads to "blurring" the boundaries in the views of doctors between normal and pathological conditions.Diagnose "illness" is "win-win" option.Diagnosing "PEP" turned into irrational ritual child neurologist, which naturally leads to the statistics of diseases maloobyasnimoy "PEP".

In a study of St. Petersburg scientists detail the most common errors during echoencephalography, neurosonography, Doppler ultrasound, computed axial and magnetic resonance imaging.

Causes of errors are different and due to the fact that the interpretation of the data, use the parameters and rules designed for older children and adults, use an inadequate assessment of the data and their absolutization, using techniques that have the diagnosis of this disease are not sufficiently informative, are also usedapparatus having unsuitable specifications.

Fifth , this misunderstanding of doctors and natural parents of a newborn baby needs.Most often, the child indicates an error in the care of their crying.The child needs constant contact with the mother immediately after birth.

well known that the sucking child has on a kind of sedative effect, can not be compared by its usefulness to any medications.Amino acid taurine content in human milk, unlike cows, very high.Taurine is necessary for the absorption of fats, and also serves as a neurotransmitter and neuromodulator in the development of the central nervous system.Since children, unlike adults, are unable to synthesize taurine, it is believed that it should be regarded as an amino acid required for a small child.Among the polyunsaturated fatty acids are particularly important arachidonic and linolenic acids which are components necessary for formation of the brain and retina of the eye of the child.Their content in human milk is almost four times higher than in the cow (0.4 g and 0.1 g / 100 ml, respectively).In human milk, and numerous nucleotides represented growth factors.The latter include, inter alia, nerve growth factor (NGF).That is why it is very important the child is breast-fed, if you have had problems in childbirth or during pregnancy, which may lead to fetal hypoxia and injury to his nervous system.A clear

conventional tactics of children with a syndrome of increased neuro-reflex excitability to date does not exist, many experts refer to this condition as a border, and only advised to observe these children, refraining from treatment.In domestic practice, some physicians continue to apply to children with a syndrome of increased neuro-reflex excitability are serious medications (phenobarbital, diazepam, sonapaks, etc.), the purpose of which, in most cases, little is justified ...

If you are still worried about the condition of your child,should go or invite to the house several experts (in at least two, preferably, on the recommendation (there are doctors, sincerely radeyuschie for children's health, and does not seek to make a baby "problems" money), it really is, sometimes the problems are very serious,such as cerebral palsy and hydrocephalus. About the child of my girlfriend, for example, with the same symptoms as my son, District neurologist said that it is possible to find fault, and no diagnosis is put not become to each child.

homeopathy has a good experience in the treatmentneurological disorders, and official medicine confirms it. But the well-known high plasticity of a child's brain, its ability to compensate for structural defects.So we can never know whether a child therapy helped or he cope with the problem.Very well to massage, and my mother, and professional (but only if the child is good at it reacts, not crying, not overexcited, do not lose weight and does not suspend the increase) is shown vitamin therapy, and considering the good digestibility of vitamins from breast milk, pay atthis attention.

worth more to say about vaccinations for restless children.In a Moscow clinic, where nursed babies with severe hypoxic disorders, in the treatment of stress placed on the non-pharmacological methods to prevent and maximum injection (injection of drugs by electrophoresis, physiotherapy, etc.).My son after vaccination (injection) to strengthen the tone of the limbs, general anxiety, however, no retraction, we did not give as general perinatal encephalopathy is false contraindications to vaccination allegedly doctors and patients protect Child vaccinations on the basis of "universal" and"general scientific" reasons, not confirmed by official medicine.

also say that the side effects of vaccines can find the word "encephalopathy", that is, the vaccine can cause this condition!The child was born healthy, we have done it in the first few days of immunization, they were isolated from the mother, told her to feed on the clock, baby drink medicines that schizophrenics use and monthly pleased to state that half of the children suffer from perinatal encephalopathy!What else to add ?!

diagnosis of hyperactivity is very popular in America and increasingly penetrates us.On the other hand, do not know in America and Germany, what perinatal encephalopathy.There is another approach to the problem - it's all about is not in neurological pathology and not the disease, but simply a special type of people an individual unit of the nervous system.The book "The Indigo Children" Lee Carroll this proof.

Change psycho-emotional constitution (personality type), you know, can not any one drug.Of great importance is the psychological mood of the family (the understanding of a young child needs care on a "rapprochement" Serzov) and proper care of the child (breastfeeding, wearing on the hands (very helpful Sling), co-sleeping, respect for the child's personality).

in clinics hangs a poster about the benefits of breastfeeding with the words of the ancient Greek philosopher: "Together with the mother's milk in the child enters the soul."Mother's milk - not just food, it's a drug, and connection to the world, and my mother's child transmission of knowledge about life.

What makes refer the child to a neurologist?First, information about how the pregnancy and childbirth.Cheerleaders make:

  • severe manifestations of toxicity (especially late);
  • suspected intrauterine infection;
  • mother anemia (hemoglobin less than 100 units);
  • uterine inertia, prolonged rupture of membranes, used in the delivery of drug stimulation or forceps;
  • cord entanglement;too much weight or a child, on the contrary, signs of immaturity and prematurity;
  • birth in breech presentation, etc.

In short, everything that can lead to fetal hypoxia during labor, that is, the lack of oxygen, almost inevitably leads to a temporary disruption of the central nervous system (CNS).Harm her work can also be viral infection in women during Bookmarks nervous system of the fetus, impaired ecology of the home or workplace.

direct relationship between the level and duration of oxygen starvation took place there: sometimes the child's brain suffers a serious shortage of oxygen without much harm to ourselves, but it happens that a small deficit brings a fairly considerable damage.

Besides clarifying the circumstances of pregnancy and childbirth, there are certain clinical signs alarming pediatrician.The child is too sluggish or, more often, excited, a lot of yelling, screaming at his trembling chin, he often vomits, responds to worsening weather.Or all this had blown up belly, never getting better chair - he with greens, parts or, on the contrary, there is a tendency to constipation.

Putting all this data, making sure that the baby is fed properly, pediatrician directs such a child to a neurologist - a specialist, focused on investigating the state of the central and peripheral nervous system.The task - to find out to what extent had intrapartum hypoxia left a nasty mark.

Do not panic!

here often starts the sake of what, in fact, was started this article - parents fear grips.How have our baby is not all right with his head ?!This fear dates back to the general mentality of our telling that to have abnormalities in the nervous system primarily ashamed.

Be sure to mention the fact that these deviations are likely temporary, the sooner we can help the child, the faster it will cope with them ... Most parents, heeding assurances pediatrician, neurologist and go to return to the entry that says usually follows:

PEP (perinatal encephalopathy), the recovery period, SPNRV (increased neuro-reflex excitability syndrome).

And, unfortunately, neurologists do not often condescend to explain the incomprehensible acronyms.They write for themselves and for the pediatrician, and both sides understand each other perfectly.But parents.Pass.What's next?