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DIAGNOSTIC FEATURES OF NEUROSONOGRAPHY IN
INTRAUTERINE INFECTION IN NEWBORNS
Usmanova Munira Fayzullayevna
Аssistant of the Department of №1 Pediatrics and neonatology
Samarkand State Medical University
Tolibjonova Nozanin Xusenovna
Student of the 622
th
group of the Faculty of Pediatric
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.
Intrauterine infections (IUIs) are characterized by
polyetiology, the absence of specific signs and a wide variety of clinical
manifestations, which complicates their antenatal diagnosis and, as a consequence,
preventive measures and treatment of a realized infection [8,9,12].
Neurosonography (NSG) is currently the primary screening method of research,
due to its ease of implementation and relative availability. Neurosonography is a
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method of two-dimensional ultrasound examination of the anatomical structures of
the brain, which uses the property of sound to be reflected from the boundaries of
tissue structures [3,4,14]. Acoustic windows: large and small fontanelles, defects
in the bones of the skull, enlarged sutures, foramen magnum in newborns. The
method is non-invasive, does not require preliminary preparation and allows you
to trace the dynamics of the pathological process in real time. The image is
presented on the monitor screen in the form of signals of hyper- and hypoechoic
density [10,15].
The method is used for prenatal and postnatal diagnostics of cerebral
malformations; hypoxic-ischemic, hemorrhagic, traumatic and inflammatory brain
injuries and their consequences; tumors, ventriculomegaly. A sign of cerebral
ischemia is the presence of diffuse hyperechoic foci, more often in the
periventricular region, expansion of the interhemispheric groove, subarachnoid
spaces, symmetrical expansion of the ventricular system [1,2,7,10]. Intraventricular
hemorrhages (IVH) and parenchymal-hyperechoic formations with clear contours,
located intraventricularly, subcortically or cortically. Has great diagnostic value in
assessing the severity of GIE in newborns [5,6,11,13].
Objective
: Determination of the nature of neurosographic data in hypoxic-
ischemic encephalopathy in newborns with intrauterine infection.
Materials and methods
: A study was conducted in 24 full-term newborns
who had intrauterine infection and with signs of DIE according to anamnestic,
clinical and paraclinical data. All children underwent neurosonographic studies on
the 3rd, 5-7, 14-16 days of life.
Research results
: The overall frequency of neurosonographic changes in
newborns with HIE was 55.6%. The predominant symptom in the early neonatal
period was a local increase in echogenicity, the frequency of which significantly
decreased by the end of the first week of life. The neurosonographic picture had a
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certain staging in the dynamics of the neonatal period, which made it possible to
identify 2 NSH variants of its course in newborns with moderate HIE.
The first option: a local increase in echogenicity - expansion of the
interhemispheric groove. The latter could indicate the presence of atrophic changes
in the brain tissue. The presence of this variant could be determined in 24 newborns
who had changes in the NSH picture.
The second option: a local increase in echogenicity - an increase in the
echogenicity of the choroidal plexuses - a moderate increase in the lateral
ventricles, subarachnoid space. This variant was more common in 24 children with
neurosonographic changes (Fig1.).
Figure 1. Ultrasound of the brain.
The advantages of ultrasound methods in examining the brain in children of
the first year of life are obvious. Non-invasiveness, absence of radiation exposure,
and the possibility of dynamic research make echography one of the main
diagnostic methods in perinatal neurology. No special training or anesthesia is
required. Modern ultrasound methods make it possible to assess not only the
structure of the brain, but also the state of cerebral blood flow. The severity of the
underlying disease is not a contraindication for neurosonography (Table 1).
Table 1.
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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%)
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 newborns,
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)
There were no children with signs of periventricular leukomalacia among the
studied groups at the age of 5 - 7 days. In premature infants of groups 1 and 2,
hemorrhagic changes were more often recorded on NSH (IVH of I and II degrees)
compared with full-term infants.
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
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periventricular edema over time, but it still persisted in 40% of children in group 1
of 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. Subependymal cysts, according to the ultrasound
examination of the brain, in most cases as a consequence of the transferred
intraventricular hemorrhage, were recorded only in premature infants 5% and 10%,
respectively, in groups 1 and 2.
Dilation of the lateral ventricles in newborns at 1 month was noted less
frequently in all observation groups than in the early neonatal period (15%, 10%,
and 5%, respectively, in groups 1, 2 and 3). It was also noted that the number of
premature newborns in the neonatal period who did not have pathological changes
on neurosonography was significantly (p <0.05) less than in the comparison group,
where normal neurosonograms were detected in almost half of the examined
newborns, 10% and 15% in groups of premature babies, versus 40% in the group
of full-term newborns. Hypoxic-hemorrhagic lesions of the central nervous system
(IVH grade I) at the end of the neonatal period were diagnosed in children in 15%
and 10% of groups 1 and 2, respectively. 1 full-term newborn from the comparison
group also had grade I IVH.
The results obtained indicate that in premature infants with DIE, gross
structural changes in the brain according to ultrasound (PVO, IVH) persist longer.
At the age of 3 months, during neurosonography, it was noted that in the
group of full-term newborns, most children did not have pathological changes
(65%), while in the groups of premature babies, their number was much less than
25% and 35%, respectively (P <0.05). the incidence of lateral ventricular
dilatations also decreased compared to 1 month of age, but had no confidence
limits. Subependymal cysts persisted in 5% of group 1 premature infants and 10%
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of group 2 premature infants.
Conclusions:
Thus, deviations from the norm in the neurosonographic
picture are observed in 55% of newborns with moderate hypoxic-ischemic
encephalopathy. The main variants of neurosonographic changes were: a local
increase in echogenicity - expansion of the interhemispheric sulcus and a local
increase in echogenicity - an increase in echogenicity of the choroidal plexus - a
moderate increase in the lateral ventricles, subarachnoid space.
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