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Fayzullayeva Kh.B., Samarkand State Medical Institute, Uzbekistan, Samarkand Corresponding author Nazarova G.SH. Samarkand State Medical Institute, Uzbekistan, Samarkand Corresponding author DOI: 10.24411/2520-6990-2020-12041 THE SPECIFICS OF NEUROSANOGRAPHIC CHANGES IN THE DIAGNOSIS OF POSTHYPOXIC COMPLICATIONS IN CHILDREN BORN IN ASPHYXIA
Abstract.
Establishing the cause of acute perinatal hypoxia in children causes great difficulties [2], due to which, in childhood, in 20-30% of cases pass under other erroneous diagnoses [1,3,]. Perinatal hypoxia, damaging the cyto-chemo-angio-architectonics of the nervous system, leads to multiple organ disorders affecting the adaptation of the body, severity and prognosis of the course of the disease [3, 4]. Clinical methods used in the treatment of posthypoxic changes in the brain in newborns, without taking into account the anatomical and physiological, age-related characteristics of the child's body.
Keywords: posthypoxic encephalopathy, newborns, neurosonography, ultrasound diagnostics
Purpose of the study- study of the clinical features of post-hypoxic changes in the brain in newborns.
Materials and research methods.The neurosonography signs of perinatal posthypoxic encephalopathy (PES) were studied using ultrasound diagnostics, and clinical features of posthypoxic brain damage in newborns were revealed.
The clinical features and results of a brain examination in 54 newborns with posthypoxic brain damage were studied.
This pathology requires in addition to clinical and neurological examination, echoencephalography, neu-rosonography, comprehensive research methods: computed tomography, magnetic resonance imaging, elec-troencephalography, rheoencephalography, Doppler ultrasonography, cerebral angiography.
All children underwent a differentiated complex of conservative-rehabilitation therapy, adapted to the peculiarities of the child's age and the nuances of the morphological substrate in the acute and rehabilitation periods.
Research results and discussion. Among 54 newborns, gestational age was dominated by 30 full-term babies (55%), premature babies were 24 (45%). A study of the course of pregnancy revealed in 100% of cases the presence of a pathological factor - in 15% of cases fetal pathology was established: chronic placental insufficiency, low water, in 85% of the mother's pathology: anemia, acute viral diseases, hypertension, chronic diseases. Chronic fetal hypoxia, detected in 40% of pregnant women. Among newborns: 65% of children (6-8 points on the Apgar scale) are in a state of mild severity of asphyxia, children of moderate severity and severe were respectively 35%. Up to 60% of patients came from non-core clinics - ordinary infectious diseases hospitals, after consultation with neuropathologists. The reason for the late diagnosis is the lack of awareness of medical personnel about posthypoxic changes in the brain in newborns, the complexity of diagnosis and the need to differentiate with a whole group of different conditions.
In most children in the family circle, relatives suffered from a variety of cerebrovascular diseases and suffered cerebral strokes. In older children, background diseases of a neurological nature with elements of meteorological dependence, occurring with an extensive group of subjective complaints, episodes of transient disturbances of cerebral circulation in the pre-stroke period were noted.
When neurosonography studies revealed:
- periventricular hemorrhages (PVH) - 96 (40%), with dilatation of the ventricular system (hydrocephalus) - 48 (20%), with ischemia of the subcortical nuclei - 24 (10%);
- combined forms distinguished: with PVH and ischemia of subcortical nuclei - 38 (15.8%), with hydrocephalus and ischemia of subcortical nuclei - 34 (14.2%) children;
- diffuse changes in brain tissue: cerebral parenchyma edema (36) and periventricular (subcortical) cerebral ischemia (70).
A feature of brain ultrasound of the acute period of PPE in 54 newborns was the predominance of periventricular ischemia of the brain tissue (mainly in preterm infants), with intraventricular hemorrhage (mainly in full-term newborns) and with cerebral edema (mainly in full-term babies). Periventricular ischemia of the brain tissue - a sign of functional immaturity of the brain [3,4] was detected in premature infants and in full-term babies (15%), which is a manifestation of cerebrovascular accident. Puffiness and ischemia of brain tissue in children with previous cerebral hypoxia first appeared within a few days of life.
The etiological factors of perinatal lesions of the nervous system in newborns were: asphyxia in 75% of children, in 10% - infections, 8% - endocrine effects and 7% - trauma.
In the acute period of perinatal lesions of the nervous system in newborns, the following clinical syndromes most often occurred:
- with increased neuroreflex excitability - 15 of 46 children (34%),
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- 2 times less common were children with general oppression syndrome - 17.5%,
- 7 times less likely - convulsive syndrome (4.8%).
In children with cerebral ischemia, the clinic was
dominated by central nervous system syndromes, signs of intracranial hypertension and central nervous system depression.
Among newborns with intracranial hemorrhages in the acute period of PPE, children with grade 2 highgrade IVH (introventricular hemorrhages of degree 2) prevailed in the clinic with signs of intracranial hypertension dominating in the clinic, including 30% of patients with the development of hydrocephalic syndrome (in premature infants), and 25% of children with symptoms of central nervous system depression (in full-term newborns).
In 25% of children with grade 2 IVH, convulsive syndrome was detected (only in full-term newborns).
The fact of revealing clinical syndromes in some children with no ultrasonic brain pathology in all periods of perinatal posthypoxic encephalopathy (mainly at the age of 1-3 months of life) indicates the presence of cerebral hemodynamics in both newborns who underwent hypoxia and at a later age.
With a ratio of children with PVH of varying severity, mild forms of pathology were encountered -55% of children with PVH of 1-2 degrees. A study of the timing of the appearance of other neurosonography signs of PES revealed that dilatation of the ventricular system of the brain and ischemia of the subcortical nuclei were first observed in patients mainly at the age of 1-3 months (48-20%), 2-4 times less often - for the first day of life, even less often (24-10%) - at the age of 4-9 months of life.
Combined forms of pathology (PVH and subcortical ischemia, hydrocephalus and subcortical ischemia) were first detected in children 1-3 months of life (55%), in 90 (37.5%) children - this pathology appeared at the age of 4 to 9 months , less often 18 (7.5%) - at the age of 6-30 days.
A study of the reverse development of neurosonographic signs of PPE made it possible to establish that compensation of pathology during its formation in the acute period of PPE (1 month of life) is only 35%, in the early recovery period (1-3 months of life) it almost doubles - 75% , and in the late recovery period (4 months-3 years of life) is reduced to 31.4%.
Of the 54 newborns with various injuries of the nervous system, 15 (27.5%) did not subsequently compensate for the pathology.
Conclusion.
Neurosonography is a valuable method for diagnosing posthypoxic pathology of the brain in newborns, which, due to non-invasiveness, lack of radiation exposure, the possibility of multiple studies (monitoring), does not require special preparation of patients, to identify the timing of the appearance of neurosonography
signs of PPE: PVH, hydrocephalus, ischemic changes in brain tissue and subcortical nuclei, swelling of the cerebral parenchyma and their combination.
Prevention of perinatal encephalopathy is the possible minimization of risk factors during pregnancy, primarily in the refusal of the mother to use substances that are potentially dangerous for the child.
Under these conditions, it is completely impossible to exclude perinatal encephalopathy. Timely treatment guarantees the full recovery of 20-30% of children.
The rest may have minor cerebral dysfunction, vegetative-vascular dystonia, temporary generalization of hydrocephalic syndrome. In case of delayed diagnosis and treatment procedures, severe outcomes (cerebral palsy, epilepsy, persistent damage to the central nervous system and other brain diseases) that require a very serious long and expensive treatment are not excluded [5].
These data allow neonatologists, neuropathologists and pediatricians to more accurately assess the dynamics of posthypoxic changes in the brain in newborns and children of the first three years of life, the compensatory capabilities and adaptive reserves of the child's body.
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