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2CHARACTERISTICS OF STRUCTURAL CHANGES DEPENDING ON THE SEVERITY OF CNS DAMAGE IN PREMATURE NEWBORNS
Tursunbaeva F.F.
Tashkent Pediatric Medical Institute https://doi. org/10.5281/zenodo. 12731010
Abstract. This article is devoted to studying structural changes depending on the severity of damage to the central nervous system in premature newborns. The author examined 121 premature infants with PCNS. All premature newborns underwent neurosonography (NSG). The pathology of the nervous system was assessed using the Thompson scale.
Keywords: premature newborns; neurosonography; nervous system; Thompson scale; Apgar scale; brain damage; neurological indications.
Relevance. In recent years, there has been an increase in the birth rate of premature babies, amounting to 11.1-20.0% among all live births [1,3,6,7]. The high birth rate of premature babies and a decrease in their mortality in the neonatal period lead to an increase in morbidity and disability in the postnatal period. Brain damage in premature infants is one of the main causes of postnatal morbidity [8,9,10,11,16,17]. The likelihood of developing neurological complications, the nature of brain damage depends on the gestational age of the newborn child, the degree of maturity of cerebral structures. The developing brain of a newborn is extremely sensitive to the effects of hypoxia, which not only causes focal damage to brain tissue, but also delays the development of the vascular system, disrupting cell differentiation. According to foreign authors, the frequency of hypoxic lesions in full-term newborns is no more than 0.6%, while in premature infants it ranges widely to 30% [12,13,14,15].
The use of neuroimaging methods in the neonatal period expands our understanding of the neurobiological development of a premature baby, contributes to the timely detection of cerebral maturation disorders, periods of increased sensitivity of the immature brain to the damaging effect of external factors associated with prematurity.
Objective: To study structural changes depending on the severity of CNS damage in premature newborns.
Materials and methods. A total of 121 premature infants with PCNS were examined. All children were divided into 2 groups: the 1st (main) group consisted of 61 premature newborns with a gestational age of 32-33 + 6 weeks (32.2±0.11), the 2nd group (comparisons) included 60 premature newborns - 34-36 + 6 weeks (35.0±0.11). The control group consisted of 50 full-term newborns. All premature newborns underwent neurosonography (NSG). Assessment of the pathology of the nervous system was carried out according to the Thompson scale. Statistical processing of the results was carried out with the calculation of the Student's criterion (t) and the probability of error (P).
Results and discussions. The state of health of the mother immediately before and during pregnancy plays a great role in the occurrence of pathology of the neonatal period. We have studied the features of the obstetric, gynecological and somatic status of mothers of the examined groups of newborns.
The results of our studies showed (Table 1) that the course of the antenatal period in premature infants in 90.1% (groups 1 and 2) is burdened, while among full-term infants (group 3) the burden was registered 3.2 times less often (28%; P<0.01).
Table 1.
Comparative characteristics of the course of the antenatal period of mothers who gave birth to
premature newborns with PCNS
Provoking risk factors Group 1 (n=61) Group 2 (n=60) Group 3 (n=50)
Abs. % Abs. % Abs. %
Abortions and miscarriages 19 31.1 22 36.7* 8 16
Uterus scar 1 1,6* 7* 11 7*** 2 4
HFPN: 56 91.8* 53 88.3* 14 28
- compensated 9 14.7* 11 18.3 14 28
-c/compensated 20 32.8 21 35 0 0
-Asthma 27 44.3 21 35 0 0
Threat of abortion 55 90.2* 53 76.7* 7 14
Preeclampsia 33 54.1 24 40
- moderate st. 9 14.8 6 16 0 0
-tension bar. Art. 24 39.3 18 30 0 0
Note: * - reliability of di Terences in data for group 3 - P<0.05; ** - reliabi ity of dat
differences between groups 1 and 2 - P<0.05
A thorough analysis of the course of the intrapartum period (Table 2) was aggravated in 91.8% of mothers of group 1, in 91.7% of mothers of group 2 and in 38% of mothers of group 3. The reliability of the data of high rates of burden of the intrapartum period in groups 1 and 2 in relation to group 3 (P<0.05, respectively) was established.
Table 2.
Comparative characteristics of the course of the intrapartum period of mothers who gave birth
to premature newborns with PCNS
Group 1 Group 2 Group 3
Provoking risk factors (n=61) (n=60) (n=50)
Abs. % Abs. % Abs. %
Caesarean section 43 70,5* 46 76,7* 8 16
Placental abruption 28 45.9 23 38.3 0 0
Oligohydramnios 16 26.2* 10 16.7* 3 6
Polyhydramnios 5 8.2 7 117** 6 12
Dirty water 7 11.5* 5 8.3 3 6
Pathological childbirth: 20 32.8 15 25 0 0
- prenatal haemorrhage
-rupture 3 4.9 1 1 7** 0 0
- protracted labor 7 11.5 6 10 4 8
- Rapid labor 2 3.8* 3 5* 1 2
Note: * - reliability of data differences for group 3 - P<0.05; ** - reliability of data differences between groups 1 and 2 - P<0.05
The examined children after birth were evaluated according to the Apgar scale at the 1st and 5th minute of life. The results of our studies showed that among premature babies of both groups, the Apgar score at the 1st minute was significantly lower than at the 5th. Thus, in the 1st group, the average Apgar score at the 1st minute of life was 5.0±0.17 points, at the 5th minute of life 6.3±0.14 points, and in the 2nd group at the 1st minute of life it was 6.2±0.12 points at the 5th minute of life, 7.3±0.10 points. Babies who scored below 7 on the Apgar scale at the 5th minute and had other signs of asphyxia in childbirth were examined according to the Thompson scale to assess the severity of acute cerebral insufficiency.
The Thompson scale is designed to assess the severity of CNS damage and consists of 9 clinical criteria. Each of the clinical criteria is scored points from 0 to 3, and the cumulative scores ranged from 0 to 22. According to the Thompson CNS Severity Rating Scale, 0 points is considered normal for a somatically healthy newborn, and a maximum value of 22 points indicates an unfavorable outcome at an older age. Depending on the sum of points scored, newborns with scores from 1 to 10 have a mild degree, from 11 to 14 have a moderate degree, and children with a total of 15 to 22 points have a severe degree of perinatal damage to the central nervous system.
It was found that premature babies in group 1 scored an average of 10.6±0.4 points, in group 2 - 8.83±0.4 points (P<0.001). Depending on the revealed clinical signs, three groups were identified according to the severity of CNS damage. Mild CNS damage was observed more often in newborns of group 2 (72.5%). Moderate severity was significantly more common (P<0.05) in group 1. Severe degree was observed in 4.8% of premature infants of group 1, in group 2 severe CNS damage was not recorded. In the children of the 1st group, the average score on the Thompson scale for the assessment of muscle tone was 1.97±0.02 points, which is significantly higher than in the 2nd group - 1.87±0.06 (P<0.05) points. In premature babies of both groups, hypotonia was observed in most cases, which was found in 95.1% of cases in group 1, and in 87.5% in group 2. The level of consciousness in children of group 1 was 1.4±0.1, and in group 2 - 1.0±0.1 (P<0.05). Convulsions in Group 1 were 0.13±0.05 and in Group 2 - 0.10±0.04 points (P<0.05). The lowest average scores of physiological reflexes were observed in premature infants of Group 2, compared to Group 1. According to the criteria for assessing breathing, the average score in Group 1 was 2.11±0.13 points versus 1.28±0.2 points in Group 2 (P<0.05). The average scores for the state of the fontanelle in the 1st and 2nd groups were 0.95±0.05 and 0.92±±0.04 points.
Analysis of neurosonography (NSG) revealed increased echogenicity, localized mainly in the frontal and occipital regions, and a slight increase in the ventricular index with the phenomenon of mild and moderately pronounced intracranial hypertension, amounting to 57.4±5.4% (35 out of 61 children) in group 1, against 51.7% in group 2 (31 children out of 60 examined).
Signs of immaturity and delayed brain development (the presence of a Werge cavity) were recorded in 3 cases: in 2 cases in children of group 1 (3.3±2.3%), and in 1 case in group 2 (1.7±1.6%).
Signs of perinatal hypoxic-ischemic brain lesions of the 2nd degree were recorded in groups 1 and 2 with 59% (36/61) and 31.7% of children (19/60), respectively, but stage 3 - 2.2 times more. IVH of 3d stage was diagnosed 1.5 times more often in premature infants of group 1 than in group 2 (4.9% (3/61) and 3.3% (2/60), respectively; P<0.05). Periventricular leukomalacia (PVL) was significantly more common in premature infants of group 1 than in children of group 2 (P<0.05). The data obtained are presented in Table 3.
Cerebral ischemia (CI) of 1st stage was significantly more common in Group 2 than in Group 1 of preterm infants (36.7% vs. 6.6%, respectively). CI of 2nd stage was almost identical in both groups, with a slight predominance in Group 1 (59.0±6.3% vs. 43.3±6.4%, respectively. CI of 3d stage was recorded 2.9 times more often in Group 1 of premature infants compared to Group 2 (P<0.01).
Table 3.
Characteristics of neurosonography data in premature newborns
Group I (n=61) Group II (n=60)
Abs. % Abs. %
CI, Stage I 4 6.6±3.2 22 36.7±6.2*
CI, Stage II 36 59.0±6.3 26 43.3±6.4
CI, Stage III 9 14.7±4.5 3 5.0±2.8*
IVH, Stage I 9 14.7±4.5 7 11.7±4.1
IVH, Stage II 7 11.5±4.1 1 1.7±1.7*
IVH, Stage III 3 4.9±2.8 2 3.3±2.3*
SEH, Stage I 6 9.8±3.8 4 6.7±3.2
SEH, Stage II 4 6.6±3.2 3 5±2.8
SEH, Stage III - - - -
PVL 4 6.6±3.2 2 3.3±2.3*
Note: * - reliability o ? data between groups (P<0.05)
Subependymal hemorrhage (SEH) was more often recorded in premature infants of the 1st group than in the 2nd group with a tendency to percentage predominance. I would especially like to highlight that most often in children of the 1st and 2nd groups there are I degrees and II degrees. The data obtained are presented in (picture 1). As can be seen from the presented data, among children with a mild degree of damage to the central nervous system, hemorrhagic disorders in the brain are less common than ischemic ones, and their degree is less pronounced.
Picture 1
Frequency of occurrence of structural disorders depending on the severity of CNS damage
according to the Thompson scale
With a moderate-severe degree of damage to the central nervous system among premature infants, a more pronounced degree of CI, IVH and SEK is noted. Thus, the 3rd stage of CI is recorded almost 3 times more often compared to children with a mild degree of damage to the central nervous system. Hemorrhagic manifestations of brain lesions of the II and III stages were significantly more often recorded in children with moderate-severe CNS damage according to Thompson scale. The most severe brain injuries according to NSH were registered in children with severe damage to the central nervous system, in the form of the presence of stage 3 of IVH (66.7%) and PVL (33.3%).
Thus, a direct relationship was established between the severity of CNS damage, determined by Thompson scale, and the data of neuroimaging of brain structures. Higher scores on Thompson scale were determined by the presence of organic brain lesions, while low values were accompanied by transient changes during neurosonography. In this regard, it is necessary to
carry out preventive measures in premature newborns, which, in turn, will help reduce disability
and improve the quality of life of children of this contingent.
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