International Journal of Medical Sciences And Clinical Research
75
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue01 2025
PAGE NO.
75-78
10.37547/ijmscr/Volume05Issue01-12
The state of neonatal neurosonography in infants with
perinatal nervous system damage
Ziyadullaeva H.
Samarkand State Medical University, Samarkand, Uzbekistan
Turaeva I.
Samarkand State Medical University, Samarkand, Uzbekistan
Nizamova D.
Samarkand State Medical University, Samarkand, Uzbekistan
Ravshanova B.
Samarkand State Medical University, Samarkand, Uzbekistan
Sharipova M.
Samarkand State Medical University, Samarkand, Uzbekistan
Received:
20 October 2024;
Accepted:
29 December 2024;
Published:
30 January 2025
Abstract:
In this study, the authors conducted ultrasound examinations of the central nervous system in newborns
with perinatal nervous system damage. It was observed that infants born to mothers with a complicated obstetric
history and pathological course of delivery constitute a high-risk group for perinatal nervous system damage. To
early detect structural brain changes, neurosonographic examinations of the central nervous system are
recommended for all newborns in the high-risk group.
Keywords:
Hypoxia, asphyxia, depth of the anterior horns of the lateral ventricles, intraventricular hemorrhage,
brain edema.
Introduction:
Perinatal hypoxia occupies a prominent
place among perinatal factors that affect not only the
fetus's condition but also the characteristics of the
neonatal period, ultimately impacting the child's health
and future development [5]. More than half of all cases
of central nervous system (CNS) dysfunction in infants
are attributed not to acute hypoxia during childbirth
but to prolonged, chronic hypoxia in the fetus and
newborn [1,3]. Among perinatal brain injuries,
cerebrovascular pathology takes a leading role. One of
the primary causes of hemorrhagic and ischemic brain
injuries is cerebral hemodynamic disturbances [4].
Hypoxia is recognized as the primary etiological factor
in perinatal nervous system pathology, cerebral
vascular disorders, leading to the development of
hemorrhagic and ischemic CNS injuries in newborns
[2,4].
Objectives
The aim of this study was to investigate the clinical
manifestations and neurosonography features in
newborns with perinatal nervous system injuries.
METHODS
A total of 60 newborns with various gestational ages
and perinatal nervous system injuries were observed in
the Physiological and Neonatal Intensive Care
International Journal of Medical Sciences And Clinical Research
76
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Department of the Samarkand Regional Perinatal
Center.
The criteria for including children in the study groups
were as follows: Group I consisted of 20 healthy
newborns born to healthy mothers aged 21 to 33 years,
with no complicated obstetric history, and a normal
course of pregnancy and delivery. Among them, 12
were full-term infants, and 8 were "conditionally
healthy" preterm infants. The group of "conditionally
healthy" preterm infants included children born with a
gestational age between 35 and 37 weeks and a div
weight ranging from 1500 to 2500 grams.
The second group consisted of 20 children who
experienced acute asphyxia during childbirth but were
born to healthy mothers. The causes of acute hypoxia
were as follows: cesarean section (5); umbilical cord
entanglement around the neck (5); prolonged labor (7);
foot and breech presentation (3). Group II comprised
20 newborns born to healthy mothers who
experienced acute asphyxia during childbirth, with
Apgar scores averaging below 6-7 points. The clinical
picture manifested as a syndrome of increased neuro-
reflex excitability characterized by regurgitation, sleep
disturbances, chin tremors, restlessness, spontaneous
Moro reflex (phase I), and a syndrome of depression
characterized by muscle hypotonia, hypodynamia,
weak
suckling,
horizontal
nystagmus,
and
gastrointestinal dyskinesias.
The third group included 20 newborns who
experienced chronic intrauterine hypoxia. The causes
of chronic intrauterine hypoxia were severe anemia (5);
exacerbation of chronic pyelonephritis with severe
preeclampsia (5); elevated blood pressure and edema
(4); threatened abortion and vomiting in pregnant
women (4); prolonged gestosis (1); complete low fetal
presentation (1). This group exhibited low Apgar scores
of 1-3 points, a complicated obstetric-gynecological
history, and more pronounced signs of immaturity.
When studying neurological symptoms in these
children, there were observations of no reaction to
examination and painful stimuli, adynamia, areflexia,
atony, a sluggish or absent pupillary reaction to light,
sometimes localized ocular symptoms. The skin was
cyanotic, pale with a "marble shade" (indicative of
microcirculation disturbances). Spontaneous breathing
was shallow, with intercostal retraction. Heart sounds
were diminished, and moderate hepatomegaly was
palpable.
The
diagnosis
of
perinatal
encephalopathies,
depending on the nervous system lesions, was
established according to the classification of perinatal
nervous system injuries in newborns by Sarnat and
Sarnat in 1976.
The structural ultrasound examination of the brain
using B-mode (neurosonography) was performed on
the GE Logic F 8 device (USA) with the use of multi-
frequency convex probes of 5.5 MHz.
Statistical data analysis was carried out using
specialized SPSS software (version 29, IDV Co., Armonk,
NY, USA).
RESULTS AND DISCUSSION
During the analysis of neurosonography parameters,
including the depth of the anterior horns (right and left)
and the depth of the lateral ventricles (right and left),
in healthy newborns and those with acute and chronic
hypoxia, significant alterations were identified,
demonstrating statistically significant differences.
Conversely, data for the parameters of the third and
fourth ventricles in healthy infants and those with
acute or chronic hypoxia did not exhibit statistical
variance.
Specifically, the depth of the right anterior horn of the
lateral ventricles in healthy subjects was 0.3 cm, while
in cases of acute asphyxia, it averaged 0.388 ± 0.100
cm, with statistical significance (p ≤ 0.05), and in
instances of chronic hypoxia, it measured 0.418 ± 0.124
cm (p ≤ 0.05). On the left side, the depth of the anterior
horns of the lateral ventricles was 0.3 cm in healthy
subjects, 0.388 ± 0.103 cm in cases of acute asphyxia (p
≤ 0.05), and 0.437 ± 0.133 cm in cases of chronic
hypoxia, all showing statistical differences (p ≤ 0.05).
The depth of the lateral ventricles' bodies on the right
side in healthy newborns was 0.3 cm, whereas in cases
of acute asphyxia, it averaged 0.426 ± 0.134 cm with
statistical significance (p ≤ 0.05), and in instances of
chronic intrauterine hypoxia, it measured 0.448 ± 0.172
cm (p ≤ 0.05). On the left side, the depth of the lateral
ventricles' bodies was 0.3 cm in healthy subjects, 0.417
± 0.147 cm in cases of acute asphyxia (p ≤ 0.05), and
0.425 ± 0.185 cm on average in cases of chronic
intrauterine hypoxia (p ≤ 0.05). Conversely, the
parameters of the third and fourth ventricles in healthy
newborns and in children with acute asphyxia and
chronic hypoxia did not exhibit statistically significant
differences (Table 1)
International Journal of Medical Sciences And Clinical Research
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Comparative characteristics of neurosonography parameters in newborns (M±m).
Table 1.
No
Groups of examined
patients
Variables
Healthy
newborns
n=20
Acute hypoxia
n=20
Chronic hypoxia
n=20
1
The depth of the
anterior horns of
the lateral
ventricles
Right
(0,2-0,3
sm)
0,3±0,000
0,388±0,100
р≤0,05
0,418±0,124
р1≤0,05, р2>0.5
Left
(0,2-0,3
sm)
0,3±0,000
0,388±0,103
р≤0,05.
0,437±0,133 р1≤0,05,
р2>0.5
2
The depths of
lateral ventricles
Right
(0,2-0,3
sm)
0,300±0,000
0,426±0,134
р≤0,05
0,448±0,172 Р1≤0,05,
р2>0.5
Left
(0,2-0,3
sm)
0,300±0,000
0,417±0,147
р≤0,05
0,425±0,185 р1≤0,05,
р2>0.5
3
III ventricle ( 0,3-0,5 см)
0,450±0,000
0,515±0,124 р-
р>0.5
0,492±0,173
р1>0.5;
р2>0.5
4
IV ventricle (0,3-0,5 см)
0,460±0,000
0,461±0,101
р>0.5
0,462±0,111
р1>0.5
р2>0.5;
“
P” stands for the significance of the differences between healthy and acute hypoxia groups.
“P1” stands for the significance of the differences between healthy and chronic hypoxia groups.
“P2” stands for the significance of the differences between the acute and chronic hypoxia groups.
During neurosonography in Group II (Figure 1)
newborns, the following findings were observed: 1st-
degree lateral ventricular dilatation (LVH) in 4
newborns (20%); ventriculomegaly in 6 newborns
(30%); hypoxic changes in the basal ganglia and
periventricular area in 9 newborns (45%), and one
newborn without pathology (5%).
The ultrasonographic picture in Group III was
characterized by immaturity of brain structures in 2
newborns (10%), hypoxic changes in the basal ganglia
and periventricular area in 4 newborns (20%),
ventriculomegaly in 6 newborns (30%), 1st to 2nd-
degree lateral ventricular dilatation (LVH) in 6
newborns (30%), brain edema in one newborn (5%),
and a pseudocyst of the cerebral ventricles in one
newborn (5%).
CONCLUSIONS
Therefore, infants born with chronic intrauterine
hypoxia and acute birth asphyxia are at risk of perinatal
nervous system damage. To facilitate early detection
and timely staged treatment of infants with hypoxic
nervous system damage, it is recommended to perform
neurosonography of the brain structures for all
newborns in the risk group.
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