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FEATURES OF THE STUDY OF PERINATAL LESIONS OF THE
CENTRAL NERVOUS SYSTEM IN NEWBORNS
Sirojiddinova Khiromon Nuriddinovna
Docent Candidate of Medical Sciences (PhD) of the
Department of Pediatrics №1 and neonatology
Samarkand State Medical University
Ismatova Iroda Farhodovna
Student of the 636
th
group of the Faculty of Medicine
Samarkand State Medical University
Annotation. In the article are given date 60 newborns with gestation period
from 28 to 41 weeks with hypoxic lesion of the CNS of the early period. At all stages
of the study and observation of newborns conducted a collection of gynecological,
obstetric anamnesis, studied the specifics of the course of pregnancy and
childbirth. The early neonatal period was assessed by taking into account the data
of gestational age, mass and length of the div at birth, the circumference of the
head and stem cells, physiological destruction of the mass of the div, analyzed
the state of recurrence of childbirth. The dynamics of the neuropsychological status
of the examined children was assessed.
Keywords: hypoxia, central nervous system, neonatal period, gestation
period.
Introduction.
The neonatal period and the first year of a child's life are
characterized by the most active period of brain maturation, and the action of such
an aggressive factor as hypoxia on the developing brain of a child dictates the need
for further study of this pathology [1,3,9]. Achievements of fundamental sciences
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- pathomorphology, pathophysiology, biochemistry, methods of instrumental
diagnostics and technologies for assisting newborn children have formed the basis
for a serious change in the understanding of the pathogenetic mechanisms of
perinatal pathology, algorithms for diagnostic search, therapy tactics and follow-
up of newborns and young children [5,6,13,14].
The most significant changes in the statistical indicators of mortality and
morbidity were noted among premature babies. The high frequency of severe
concomitant perinatal pathology in this category of children led to an increase in
childhood disability, in the structure of which the leading positions (21,2%) belong
to the pathology of the nervous system and sensory organs Among the etiological
factors that are most significant in the pathogenesis of perinatal cerebral injuries,
the leading role belongs to hypoxia [2,4,8,10].
The issues of the features of the clinical, instrumental and laboratory course
of hypoxic lesions of the central nervous system in newborns, depending on the
gestational age, both in the acute period and in dynamics, as well as the further
neuropsychic development of children, remain poorly studied and require
additional scientific substantiation [7,11,12,15].
Purpose of the study
: to establish the nature of clinical, instrumental and
psychomotor changes in hypoxic lesions of the central nervous system in newborns
with different gestational periods in the acute period and in dynamics.
Materials and methods:
under our supervision there were 60 newborns with
a gestational age of 28 to 41 weeks with hypoxic damage to the central nervous
system of the early period. The children were divided into 3 groups: group 1 of 20
newborns with HIE with gestational age 28-31 weeks, group 2 of 20 newborns with
HIE with gestational age 32-37 weeks, and group 3 of 20 newborns with HIE and
gestational age 38-41 weeks. The control group consisted of 20 healthy full-term
newborns.
The examination of children was carried out on the basis of the department
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of pathology of newborns of the regional children's multidisciplinary medical
center from 2020 to 2021. At all stages of the study and observation of newborns,
a gynecological and obstetric anamnesis was collected, the features of the course
of pregnancy and childbirth were studied. The early neonatal period was assessed
taking into account data on gestational age, birth weight and length, head and chest
circumference, physiological loss of div weight, the state of the child at birth
according to the Apgar scale, the presence of resuscitation measures, and the type
of feeding were analyzed. In dynamics, the neuropsychic status of the examined
children was assessed. The study of the neuropsychic status was carried out by the
method of quantitative assessment of motor, speech and mental functions according
to L.T. Zhurba.
The criteria for including children in the control group were:
1.
The gestation period of newborns is 38 - 40 weeks, with an Apgar
score of 8-10 points, the conformity of the physical development of the newborn
to the gestational age;
2.
Physiological course of pregnancy in the mother without exacerbation
of chronic foci of infection, clinical and laboratory signs of the course of the
infectious process (syphilis, toxoplasmosis, CMVI, herpes, chlamydia, etc.);
3.
Absence of genetic pathology in a child (Down syndrome, Pattau,
etc.);
4.
Absence of congenital malformations of the central nervous system
(microcephaly, congenital hydrocephalus, etc.) in the newborn according to the
data of clinical examination and instrumental methods of research;
5.
Absence of clinical and laboratory signs of TORCH syndrome in
newborns and children of the first half of life;
The examination of children was carried out on the basis of the department
of pathology of newborns of the regional children's multidisciplinary medical
center from 2020 to 2021.
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Research results and their discussion.
According to the results of clinical and instrumental examination, all
children were diagnosed with hypoxic damage to the central nervous system of
varying severity: 14 newborns (in 23.3% of cases) had mild central nervous system
damage, in 26 (43,3%) - moderate, and in 20 ( 33,3%) severe.
The severity of hypoxic encephalopathy was established on the basis of
clinical syndromes and examination results according to the following criteria: -
for mild degree, cerebral ischemia of the 1st degree (mild), intrapartum hypoxia,
mild asphyxia at birth; excitation of the central nervous system is more common in
full-term, depression - in premature, lasting no more than 5-7 days; moderate
hypoxemia, acidosis; NSG - no pathological abnormalities;
for moderate severity: cerebral ischemia of the II stage, the syndrome of
suppression of excitation, hypertensive-hydrocephalic syndrome, moderate
periventricular edema or IVH of the I stage. on NSG;
- for severe degree: cerebral ischemia grade III, severe depression /
excitement syndrome, convulsive syndrome, dense periventricular edema or IVH
grade II. on the NSG.
Taking into account that the degree of gestational maturity of the fetus
determines both the morphological features of cerebral injury and the spectrum of
somatic pathology of the neonatal period, gestational age was used as the main
grouping feature in the analysis and presentation of the results obtained. In
accordance with the tasks set, the observed newborns were divided into the
following groups: group 1 - 20 newborns with HIE with gestational age 28-31
weeks, group 2 - 20 newborns with HIE with gestational age 32-37 weeks and
group 3 - 20 newborns with HIE and with a gestation period of 38-41 weeks.
Vital activity indicators of newborns at 5 minutes of life in 1
In 20% of children in group 3 and 1 child (5%) in group 2, clinical signs of
CNS damage were not observed, all children had a mild degree of HIE (Table 1).
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Table 1.
Dynamics of neurological syndromes in children of the compared groups
during follow-up at 3 months of age.
Indicators
1st group
2nd group
Group 3
Intracranial hypertension syndrome
3 (15%)
3 (15%)
3 (15%)
Movement disorder syndrome
5 (25%)
4 (20%)
2 (10%)
Hyperexcitability syndrome
2 (10%)
3 (15%)
2 (10%)
Delayed motor development
10 (50%)
7 (35%)
3 (15%)
Convulsive syndrome
15%)
2 (10%)
No symptoms of CNS damage
-
15%)
4 (20%)
Thus, the recovery period after undergoing perinatal hypoxia for newborns
of the observed groups in the neonatal period was characterized by the presence of
intracranial hypertension and movement disorders, which were mostly observed in
the groups of premature newborns.
To carry out differential diagnosis and clarify the severity of CNS lesions, a
complex of laboratory and instrumental research methods was carried out. All
newborns at the age of 5-7 days and 1, 3 months of life underwent ultrasound
examination of the brain. The research results are presented in table 2.
Table 2.
Characteristics of neurosonography data in newborns on the 5-7th day of
life
Indicators
1st group
2nd group
Group 3
Periventricular edema
18 (90%)
16 (80%)
13 (65%)
IVH of 1 degree
5 (25%)
3 (15%)
2 (10%)
IVH of the 2nd degree
3 (15%)
2 (10%)
15%)
Dilation of the lateral ventricles
5 (25%)
4 (20%)
3 (15%)
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Periventricular cerebral edema, which occurs as a result of intrauterine or
intrapartum hypoxia, was found much more often among others in all examined
children. In all comparison groups, both full-term and premature infants,
periventricular edema was observed with approximately the same frequency. There
was no significant difference between the groups.
Dilation of the lateral ventricles, as a manifestation of hypertensive
syndrome, was detected both in full-term newborns - 15%, and in premature
newborns of groups 1 and 2 (25% and 20%, respectively). Thus, in the early
neonatal period in newborns with DIE, according to the data of ultrasound
examination of the brain, dilatation of the lateral ventricles and the phenomenon of
periventricular cerebral edema are quite often revealed, which indicates a deep
degree of CNS damage in newborns of this group. Hypoxic-hemorrhagic lesions of
the central nervous system were significantly more frequent in premature infants.
At the age of one month in newborns with HIE, various changes in the
structure of the brain persisted. According to the NSG, there was a significant
decrease in the incidence of periventricular edema in dynamics, but it still persisted
in 40% of children of group 1, full-term infants, in 30% of children born with a
gestational age of 32-37 weeks, and in 20% of full-term infants. This indicator of
hypoxic-ischemic damage to the central nervous system decreased by almost 2-3
times (p <0.01) compared with the early neonatal period in all observation groups.
At the same time, the lowest values of psychomotor functions were observed
in newborns of group 1 with gestational periods of 28-31 weeks (13.8 ± 0.9 points).
So in the children of this group, the cry was absent, or was aphonic, it was difficult
to wake them up, not all unconditioned reflexes were evoked and were quickly
exhausted. Muscle hypotonia was observed, and in some children the posture of an
embryo or a frog was observed. Sensory responses were reduced. Some children
had a constant Graefe symptom, persistent squint, bulbar or pseudobulbar
syndrome.
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Conclusions.
In this way
in premature infants with a severe degree of
HIE, psychomotor changes are observed, which in dynamics tend to
normalize, but still significantly differ from the norm. These facts may
contribute to the worsening of neurological symptoms in HIE in the acute
period, as well as in the later period of the development of hypoxic - ischemic
encephalopathy.
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