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Risk factorsofthe development of perinatal encephalopathy in infants
YutkinaO.S., KarepovaG.V.
Amur State Medical Academy, Blagoveshchensk, Russia Children's City Clinical Hospital, Blagoveshchensk, Russia
Abstracts: According to recent data in the structure of childhood disability diseases of the nervous system is about 50%, 70-80% of cases occur in perinatal lesions. We conducted research to identify highly significant risk factors for the development of pathology in children with perinatal affection of CNS.
That end, we investigated 80 patients with perinatal encephalopathy at the age from 1 to 12 months. Risk factors assessment was carried out by the criteria proposed by Barashnev Y.I. (2001). All the risk factors revealed by terms of effects were divided into 4 groups, and the most important factors operating in each period were identified. Thus, highly significant factors in the development of perinatal cerebral lesions are risk factors, operating antenatal and pre-conceptional periods.
Key words: risk factors, perinatal encephalopathy, hypoxia, antenatal, intrapartum periods.
According to the WHO 10% of children have nervous and mental diseases,70-80% of them are associated with perinatal brain damage. A variety of adverse effects experienced by the fetus, are leading to hemodynamic and metabolic disorders,intrauterine and intrapartumhypoxia.
A complex process of formation of the nervous system of the unborn child takes place during the prenatal period. In this context, women's health protection issues at different stages of gestation, labor, and developing fetuses and infants occupy a leading position in modern health care and research. Identify risk factors for the development of pathology in children with perinatal affection of CNS.
Materials and methods. We investigated 80 patients with perinatal encephalopathy at the age from 1 to 12 months, who were treated at the neurological department of Blagoveshchensk Children's Hospital. Survey among parents, analysis of the case histories, hospital records, copying from the maternity hospital, were conducted.
Results and discussion. Risk factors assessment was carried out by the criteria proposed by Barashnev Y.I. (2001). They are: demographic risk factors, social risk factors, maternal risk factors, the fetus-maternal risk factors, placental risk factors, high perinatal risk factors (parturient), neonatal risk factors.Based on these risk factors a map of the survey of parents and data collection were made.Distribution of children by age and sex. 44 children (55%) were between the ages of 1 to 4 months (early recovery period), 36 children (45%) aged 5 to 12 months (late recovery period). There were 47 (58.7%) and 33 (41.3%) girls.
Hypoxic-ischemic encephalopathy were diagnosed in about 80% of children (64 children), in 16.3% (13 children) - hemorrhagic-hypoxic encephalopathy and in 3.7% (3 children) - a toxic-ischemic encephalopathy. Leading syndrome in 38 children (47.5%) was the syndrome of motor
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disorders,a combination of different syndromes was noted in the remaining 42 children (syndrome of visceral disorders, hydrocephalic-hypertensive syndrome, neuro-reflex excitability, etc.).
I. Demographic risk factors.
Among the demographic risk factors the age of the parents and their height-weight indexes are most significant . Thus, the average age of mothers was 26 years, with a minimum age - 15 years, maximum - 40 years. The average age of the fathers - 29.2 years, with a minimum age - 17 years, maximum - 41 years. The average weight of mothers is 65 kg, fathers' average weight - 82.6 kg. Average height was 164.4 cm mothers, fathers - 175.3 cm
II. Social risk factors.
Of social factors, the family structure, living and material conditions, parental education, adherence to diet, observance of work and leisure of pregnant women were noted.
According to the received information 83.7% of families are full, 16.3% - single parent families. 67.3% of households live in separate apartments, 27.3% of families live with relatives, 5.4% of families - in the hostel.13.5% of the mothers indicated to the good material conditions, the average material conditions - 79.1%, and 7.4% of women considered that their material conditions were below average level. 63.3% of mothers and 49% of fathers have higher education. 36.4% of mothers and 51% of fathers have secondary or vocational education. In the structure of higher education legal and economic profilespredominate.
Professional hazards: work on computers, stresses, dust, household chemicals, etc.
80% of mothers did not comply with the diet, didn't follow the time ofwork and leisure,and did not use fully antenatal leave. 25% of mothers had harmful habits (smoking before and during pregnancy), and 35% of fathers (smoking, alcohol abuse).
III. Maternal risk factors.
In maternal risk factors a hereditary load of physical illness, physical health of mothers and the presence of complicated obstetric history were identified.
45.5% of children have a hereditary load of heart disease (HD, CHD), 43.1% - in diabetes, 27.2% -in myopia, 18.2% - in allergic diseases (asthma, allergic rhinitis).
In the structure of the mothers' somaticstatus diseases of the female reproductive system (erosion, vaginitis, colpites, cycle disorders) were revealed in 30%, of the cardiovascular system (neuro-circulatory dystonia, mitral valve deficiency, varicose veins) -in 27.2%, chronic herpes simplex virus infectionwas revealedin 21.2 %, diseases of upper respiratory tract - in 20%, anemia -in 18.2%, urinary system diseases (chronic pyelonephritis, cystitis, IBC) -in 18.2%, endocrine diseases (diabetes) -in 17.5%, gastrointestinal diseases -in 15.1%.
Complicated obstetrical and gynecological history was noted in 62% of women. Incidence of abortions wasrevealed more often (in 58% of women), then cesarean section (in 14% of women), infertility (in 13% of women), spontaneous abortion in early pregnancy (in 12.5% of women).
IV. Fetal and maternal risk factors.
The threat of interruption of the pregnancy and illness during the pregnancy were noted among fetal and maternal factors.
The threat of interruption of the pregnancy was observed in 77.5% of women, of whom in 28% of women two or more episodes of the threat of termination of pregnancy were marked.
In the structure of diseases of women during the pregnancy: anemia - 40%, ARI - 38%, PIH - 37%, chronic herpes simplex virus infection - 25%, cervical insufficiency - 12% were more common.
V. Placental risk factors.
Chronic feto-placental insufficiency was diagnosed in 18 women (37.5%), placental pathology (low placentation, placenta previa, placental abruption, etc.) was observed in 6 cases (12.5%).
VI. High perinatal risk factors (parturient factors).
Of the parturient risk factors preterm birth, cesarean section, and the use of anesthesia should be noted.
Thus, premature birth were in 22 mothers (46.6%), with anaverage gestational age of 33.6 weeks. The minimum gestational age was 26 weeks.
Delivery by cesarean section was performed in 37 women (46.6%), of whom in 48.5% of cases there was anwas emergency surgery, in the remaining 51.5%the operationwas performed in a planned manner.Vacuum extraction of the fetus was used in 16.4% of cases.
55% of deliveries wereperformed by epidural anesthesia, anesthetization was used in 12.5% of cases.The average Apgar score was 7/8, the most minimal score was 1/3.
VII. Neonatal factors.
The following neonatal factors: body weight and gestational age at birth, the degree of severity of the condition in the first day have been chosen.
Thus, 28 patients (47%) were born less than 37 weeks of gestation, 3 children (5%) were born more than 42 weeks of gestation, and 29 children (48%) were born at term.
16 children were born with birth weight less than 2500 g, which amounted to 20.4%. The minimum weight was 840g. 28 children were born weighing over 3500 g, which made up 35.2%. The maximum weight was 4300 g. The remaining 36 children (44.4%) were born with the normal weight.
The state of 51 children (64%) at the maternity hospital was rated as medium-heavy or mild, and the state of 29 children (36%) was rated as severe.
Conclusions. All the risk factors revealed by terms of effects were divided into 4 groups: Group 1 - harmful factors acting in progeneze, Group 2 - factors working in antenatal (prenatal period), Group 3 - factors operating in the intrapartum period (labor ), Group 4 - factors acting in the early neonatal period (the first 7 days of life).
In progeneze the most important risk factors for perinatal CNS lesions were: high hereditary load of physical illness in children (on the diseases of the cardiovascular system, diabetes mellitus), in women - pathology of the cardiovascular system, complicated obstetric and gynecological history, bad habits of parents.
In the antenatal period - anemia during pregnancy, toxemia, PIH, ARI, the threat of termination of pregnancy, chronic fetoplacental insufficiency, chronic intrauterine hypoxia, inaccuracy in diet, bad conditions of work and leisure, occupational hazard.
In the intrapartum period - premature birth, cesarean section, emergency cesarean section, epidural anesthesia.
In the postnatal period - a serious condition at birth, the birth of children less than 37 weeks of gestation, the birth of babies weighing more than 3500 g.
Highly significant factors in the development of perinatal cerebral lesions are antenatal and pre-conceptional risk factors. Intrapartum and postnatal risk factors are less important.
Antenatal and pre-conceptional risk factors are controllable, intrapartum and postnatal risk factors are partially controlled.
Thus, the work has shown the importance of individual perinatal factors in the formation of cerebral pathology in children and the possibility of their use for prediction and early diagnosis of brain damage in newborns, differentiated approaches in their treatment and rehabilitation, respectively - to reduce the severity of CNS lesions and disability of children.
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3. Barashnev Y.I. Perinatal neurology. - Moscow: Triada-X, 2010. - 640.
4. Volodin N.N., Degtyarev D.N. "Neonatology" textbook for institutions of higher education students, M.: "The Academy", 2005. - 448.
