What's behind the diagnosis?
The wording conflates very different conditions, which is why it often scares parents more than it should. It may be behind either severe hypoxic-ischemic damage with impaired consciousness and convulsions in the first day of life, or mild transient changes in muscle tone that disappear by several months. In modern practice, they try to indicate a specific condition: hypoxic-ischemic encephalopathy of a certain degree, intraventricular hemorrhage, bilirubin encephalopathy. A general formulation without specification says little about the forecast.
- Hypoxic-ischemic encephalopathy
- Intraventricular hemorrhages in premature infants
- Damage due to severe jaundice
- Infectious brain lesion
- Birth trauma
- Metabolic and hereditary disorders
Causes and risk factors
The newborn's brain is especially sensitive to lack of oxygen and changes in blood flow. The risk is increased by complications of pregnancy and childbirth, premature birth, infections of the mother and child, severe anemia, placental abruption, entanglement of the umbilical cord with impaired blood flow, and a long anhydrous period. In premature babies, the blood vessels of the brain are especially fragile, so they are more likely to experience hemorrhages. Many factors can be controlled with regular monitoring during pregnancy.
- Acute and chronic fetal hypoxia
- Prematurity and low birth weight
- Complications of childbirth, prolonged anhydrous period
- Infections during pregnancy
- Placental abruption, umbilical cord pathology
- Severe jaundice of the newborn
- Multiple pregnancy
What signs are really important?
In the first days of life, doctors evaluate the level of wakefulness, muscle tone, reflexes, cry patterns, ability to suck, and the presence of seizures. Excessive lethargy or, conversely, persistent agitation, pronounced asymmetry of movements, and convulsive episodes are alarming. At the same time, many things that worry parents are a variant of the norm: shuddering in sleep, trembling of the chin when crying, regurgitation, “marbling” of the skin. The key guideline after discharge is the pace of development: whether the child holds his head, follows the object, rolls over, or walks at the appropriate age.
- Persistent increase or decrease in muscle tone
- Marked asymmetry of movements and posture
- Convulsions and stereotypical freezing
- Difficulty sucking and swallowing
- Lack of visual and auditory concentration
- Delayed emergence of age-related skills
- Loss of already mastered skills
Survey
The main screening method for infants is neurosonography: ultrasound examination of the brain through the large fontanel. It is safe, accessible and allows you to see hemorrhages, dilatation of the ventricles and changes in brain tissue. For convulsions and suspected epileptic seizures, electroencephalography is performed. MRI is prescribed for severe lesions and to clarify the prognosis; in young children it requires special conditions. Hearing and vision must be checked, since their impairment greatly affects development. Equally important is regular assessment of the child’s skills using development scales.
- Neurosonography, if necessary with Dopplerography
- Electroencephalography for seizures
- MRI of the brain according to indications
- Assessment of development using age scales
- Hearing and vision testing
- Blood tests, bilirubin, glucose, electrolytes
- Testing for infections if suspected
Help and rehabilitation
In the acute period, treatment is carried out in a hospital: breathing, blood circulation, glucose levels are supported, and anticonvulsants are prescribed for seizures. After discharge, the main thing is early intervention - regular classes aimed at developing movements, communication and everyday skills, teaching parents correct positioning and games. Physical therapy, massage as prescribed, classes with a speech therapist and speech pathologist are selected individually. Drugs “to improve brain function” in children without proven indications are not recommended, and the decision on any treatment is made by the doctor.
- Observation by a pediatric neurologist and pediatrician according to schedule
- Early help and development classes
- Physical therapy and correct positioning
- Massage as prescribed by a doctor
- Anticonvulsant therapy for epileptic seizures
- Vision and hearing correction
- Breastfeeding support and weight gain control
- Classes with a speech therapist and speech pathologist for speech delays