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FEATURES OF THE CLINICAL COURSE OF HYPOXIC-ISCHEMIC
ENCEPHALOPATHY IN NEWBORNS
Sirojiddinova Khiromon Nuriddinovna
Docent Candidate of Medical Sciences (PhD) of the
Department of Pediatrics №1 and neonatology
Samarkand State Medical University
Sodikova Ozoda Shavkatovna
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. The children
were divided into 3 groups: 1 group of 20 newborns with GIE with gestation period
28-31 weeks, 2 groups of 20 newborns with GIE with gestation period of 32-37
weeks and 3 group of 20 newborns with GIE period and 38-4 gestation
period.Teaching,that the degree of gestational maturity of the fruit determines the
morphological features of cerebral damage, as well as the spectrum of somatic
pathology of the neonatal period, in the analysis and presentation of the results
obtained by the group as the main results.
Key words: hypoxia, central nervous system, neonatal period, gestation
period.
Introduction.
Intrauterine fetal hypoxia occupies one of the first places in
the structure of the causes of perinatal diseases and mortality. This pathology, as a
rule, is a consequence of placental insufficiency, which accompanies almost all
complications of pregnancy - miscarriage, gestosis, developmental delay or fetal
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death, premature birth, acute or chronic infection [2,3,10]. Recent epidemiological
studies indicate the leading role of brain lesions that occurred during the perinatal
period in the further dysadaptation, and in some cases, disability in children. Thus,
in the structure of children's disability, lesions of the nervous system account for
about 50% [1,5,11]. Thus, 35-40% of disabled children are disabled due to perinatal
lesions of the nervous system [4,6]. Therefore, the issues of hypoxic-ischemic
encephalopathy remain relevant.
In the scientific community, the study of the diagnosis and clinical
consequences of perinatal lesions of the central nervous system (CNS) is actively
continuing, and significant progress has been made in studying the mechanisms of
development of certain forms of hypoxic - ischemic lesions of the central nervous
system in newborns. Previous studies revealed that the central links in the
pathogenesis of hypoxic lesions of the central nervous system are both
cerebrovascular disorders and metabolic disorders [7,13].
Revealing the dynamics of metabolic disorders in CNS lesions in newborns
with CHD remains an urgent task and opens up fundamentally new opportunities
both for understanding the pathogenesis and for early diagnosis and correction of
identified disorders [8,14,15]. 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 [9,12].
Purpose of the study
: to establish anamnestic and clinical features of
hypoxic lesions of the central nervous system in newborns with different periods
of gestation.
Material and research methods.
We observed 60 newborns with a
gestational age of 28 to 41 weeks with hypoxic-ischemic lesions of the central
nervous system (HIE). The children were divided into 3 groups: group 1 of 20
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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.
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 on the Angar scale,
the presence of resuscitation measures, and the type of feeding were analyzed. In
dynamics, the neuropsychic status of the examined children was assessed. To
determine the degree of damage to the central nervous system, a neurosonographic
study (NSG) was carried out.
Results and their discussion.
According to the results of clinical and
instrumental examination, hypoxic lesions of the central nervous system of varying
severity were diagnosed: in 14 newborns (in 23,3% of cases) there was a mild
central nervous system lesion, in 26 (44,3%) - moderate, and in 20 (33, 3%) severe
(Fig1).
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;
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Figure 1. Distribution of newborns with hypoxic-ischemic encephalopathy
according to the severity of CNS damage.
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.The
clinical severity of perinatal CNS pathology was analyzed both as an independent
23%
43,40%
33,30%
0,333
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factor and in combination with gestational age.
There were no significant intergroup differences in gender composition,
although in comparison group I there was a slight predominance of girls. 11 (55%)
newborns in group I, 2 (10%) children in group II and 1 child (5%) with
intrauterine growth retardation (IUGR) II-III degree in group III had very low
birth weight (Fig 2).
Figure 2. Frequency of observation of cases of very low div weight in
the compared groups.
It should be noted that children with extremely low div weight were not
observed. In general, the general characteristics of the comparison groups
corresponded to the literature data on gender composition, div weight and
condition at birth, as well as the frequency of occurrence of lesions of varying
severity in children born at different stages of gestation.
The period of early postnatal adaptation was complicated in all children. The
condition at birth was assessed as severe in 20 (100%) children of group I, 18 (90%)
children of group II, in 12 (60%) patients of group III, respectively (Fig 3).
0%
10%
20%
30%
40%
50%
60%
0
0,5
1
1,5
2
2,5
3
3,5
Ряд1
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Figure 3. Distribution of newborns in the compared groups according to the
severity of the general condition.
The main scale used to determine the assessment of the condition of the
newborn and the degree of asphyxia in the child is the Apgar scale. In this regard,
during the study, it was found that low scores on the Apgar scale at 1 minute of life
were detected in newborns with HIE of all compared groups, but with a greater
frequency in newborns of groups 1 and 2 and significantly in relation to both
healthy newborns (p <0.001 ), and to the group of children with HIE but born with
a normal gestational age. Neonatal vital activity indices at the 5th minute of life in
the 1st group of the study remained at 1-3 points in 50% of newborns, in group 2
this indicator was only 20%, while all children with normal gestational terms with
an assessment of 1-3 points showed improvement states.
Apgar score at 1 min. had a significant positive relationship with the
gestational age of the child and the severity of subsequently diagnosed perinatal
CNS pathology, however, significant differences between the assessments of
children with perinatal CNS pathology of varying severity occurred only in group
90%
10%
0%
70%
25%
5%
40%
20%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ТЯЖЕЛОЕ СОСТОЯНИЕ
СРЕДНЕЙ ТЯЖЕСТИ
ЛЕГКОЙ СТЕПЕНИ
1 группа
2 группа
3 группа
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III. So in children of this group with normal weight and gestational age, severe
damage to the central nervous system was observed.
Thus, it can be concluded that premature infants with severe HIE have the
greatest severe metabolic disorders, which tend to normalize over time, but still
significantly differ from the norm. Also, premature infants have more severe shifts
in blood gas composition compared to full-term infants with DIE.
CONCLUSIONS
The hypoxic-ischemic nature of the lesion of the central nervous system in
newborns depends on the gestational age, the Apgar score and is manifested by
oppression syndromes in premature infants, agitation syndromes and hypertensive-
hydrocephalic phenomena in full-term infants.
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