Cerebral ischemia grade 2 in newborns: symptoms and treatment. Cerebral ischemia grade 2 in newborns: consequences

The brain is the main organ in the body. The functioning of all organ systems, general condition and quality of life depend on its functioning. With the development of certain pathologies, the brain begins to suffer due to lack of oxygen, and this can lead to serious consequences. One of these diseases is grade 2 cerebral ischemia in newborns; the consequences can be disastrous if urgent measures are not taken and therapy is not started. Let's look at what this pathology is and whether it is possible to get rid of it.

Concept of cerebral ischemia

Not everyone understands the name of the disease as “cerebral ischemia of the 2nd degree in newborns.” The doctor can explain this and choose treatment tactics. This pathology is a condition in which the blood supply to the brain is disrupted. In newly born infants, this pathology, as an independent disease, is not often diagnosed.

Most often, newborns are diagnosed with “ischemic encephalopathy,” in which brain cells are damaged due to poor blood supply, that is, lack of oxygen.

If a diagnosis of “grade 2 cerebral ischemia in newborns” is made, how to treat this pathology is determined by the attending physician, depending on the condition of the body and concomitant diseases.

Cerebral ischemia in prematurity and in full-term infants

At term and at prematurity, the nature of brain damage is different. If a baby is not carried to term for 9 months, he or she is at risk of periventricular leukomalacia (PVL). This means that the white matter of the brain, located near the ventricles, dies and cysts form there.

PVL causes dementia and cerebral palsy in those born before the 31st week of gestation.

And for those who spent the entire period in the mother’s belly, damage mainly occurs to the cerebral cortex, that is, to the gray matter. The consequences for the child will depend on where the necrotic zone is located and how large it is. In acute and severe asphyxia (suffocation), damage to the brain stem is likely. Therefore, the child will have problems with heartbeat and breathing, which in some cases causes death, that is, death.

Reasons for the development of ischemia

This pathology in newborns can develop for several reasons:

1. If during gestation the placental blood flow was disrupted.
2. After birth, respiratory distress was observed.
3. Respiratory distress syndrome.
4. Congenital pneumonia.
5. Frequent episodes of respiratory arrest.
6. Aspiration.
7. Congenital malformations.

Whatever the reasons, grade 2 cerebral ischemia in a newborn can have serious consequences if therapy is not started in a timely manner.

Causes

In newborns, the pathology in question can be provoked by the following factors:

• During contractions and pushing, the umbilical cord is pinched, which affects the blood supply to the brain and other organs
• long labor
• placental abruption
• acute placental insufficiency
• asphyxia (suffocation) during childbirth
• intrauterine hypoxia
• prematurity, which causes respiratory failure in the baby
• patent ductus arteriosus
• disruption of blood flow to the heart
• congenital heart defects
• sepsis, which causes the child’s blood pressure to decrease
• heavy bleeding caused by various reasons

Development of pathology in a child

Oxygen is carried throughout the body along with blood. It is vital for the normal functioning of all organs. If there is a deficiency, a redistribution of blood flow occurs and the heart and brain receive oxygen-rich blood first. It turns out that other organ systems begin to suffer from its deficiency.

If the pathology is not identified in a timely manner and the causes that provoked it are not eliminated, then the lack of oxygen will gradually begin to negatively affect the condition of the nerve cells - they begin to die. This is how grade 2 cerebral ischemia develops in newborns, the consequences depend on the severity of the condition and the quick response of doctors. The prognosis for the baby will also depend on the number of dead cells. If a cerebral hemorrhage occurs, the chances of recovery and survival are significantly reduced.

Provoking factors

Concomitant factors that can lead to the development of ischemia can be grouped into three groups:

1. The course of labor. The risk of pathology increases if:

• bleeding occurred during pregnancy or during labor;
• emergency caesarean section;
• high temperature in a woman in labor;
• premature birth;
• low baby weight;
• turbidity of amniotic fluid;
• premature placental abruption;
• rapid labor activity.

2. The mother's condition can cause the development of ischemia in the child, especially when:

• the expectant mother suffers from neurological problems;
• there are pathologies in the functioning of the endocrine system;
• pregnancy at a later age;
• the presence of chronic pathologies in the mother.

3. The course of pregnancy is also very important: if preeclampsia or eclampsia was observed, then there is every chance of developing a pathology such as grade 2 cerebral ischemia in the newborn. The consequences may vary.

These factors are not a 100% guarantee of the development of pathology. Even intrauterine disorders do not always end with cerebral ischemia developing after birth; the consequences can be eliminated if the pathology is detected in time and all measures are taken.

Risk factors

Various vascular and neurological pathologies, problems with blood pressure (especially hereditary) in the mother should alert the doctor who is managing the pregnancy. Also, risk factors for cerebral ischemia in a child are:

• mother's age is more than 35 years;
• endocrine diseases;
• premature, prolonged labor;
• multiple pregnancy;
• late toxicosis;
• failure of the mother to follow a healthy lifestyle;
• exacerbation of chronic or acute diseases in the mother during pregnancy.

How does the disease manifest itself?

This pathology has varying degrees of manifestation. Stage 2 cerebral ischemia in newborns has serious symptoms, and immediate treatment is required. Here's what should alert doctors and mommy:

• Decreased muscle tone.
• Large pauses in breathing.
• Tendon reflexes are poor.
• Sluggish Moro reflexes.

The following syndromes are also noted:

1. Syndrome of increased excitability, which manifests itself in crying for no reason, restless and superficial sleep, twitching.

2. Hydrocephalic syndrome can be recognized by an increase in the size of the head and a large fontanel.
3. Convulsive syndrome is present.
4. If there is grade 2 cerebral ischemia in newborns, depression syndrome reduces sucking and swallowing reflexes, muscle tone is weakened, and strabismus may occur.
5. The most serious syndrome is comatose. If it is present, the baby’s condition is serious, there are no reflexes, no reaction to external stimuli, low blood pressure, and breathing problems appear.

When lack of oxygen threatens the baby's life

If this pathology has grade 1, then it is considered a mild lesion, and doctors assess the condition of the newborn on the Apgar scale at 6-7 points. This degree is manifested by stimulation of the nervous system if the child was born at term, and depression in premature infants. This condition can be observed for 5-7 days.

Cerebral ischemia of the 2nd degree in newborns has more serious consequences; clinical convulsions, respiratory arrest, and floating movements of the arms may appear. If laboratory tests are performed, lesions of the brain parenchyma and disturbances in blood flow speed are detected.

If long periods of impaired motor activity, poor appetite, and impaired swallowing are observed, then an urgent consultation with a neurologist is necessary.

A severe degree can result in coma, which is life-threatening for the baby. Increasing symptoms increase the risk of developing hydrocephalus.

How is the disease diagnosed?

Almost always, the manifestation of cerebral ischemia begins immediately after childbirth. If the disease is mild, then the symptoms may go away on their own, but a severe form may slightly weaken its symptoms, but only for a while, and then flare up again with renewed vigor. Therefore, if ischemia is suspected, various diagnostic procedures should be carried out, these include:

1. Examination of the child for the presence of reflexes and assessment of the condition using the Apgar scale.
2. General blood analysis.
3. MRI if moderate or severe is suspected. This study helps to examine the structures of the brain and determine the extent of their damage.
4. Ultrasound - allows you to detect cerebral edema or an area of ​​hemorrhage.
5. An electroencephalogram is mandatory for newborns with severe disease.

If a diagnosis of grade 2 cerebral ischemia in newborns is suspected, treatment will be prescribed after all studies.

Diagnostics

The disease is usually diagnosed within the first few hours.

The presence of pathology is indicated by deviations in checking reflexes and a general blood test . Typically, the analysis shows an increased level of carbon dioxide in the body.

If obvious symptoms of a serious illness are detected magnetic resonance imaging , as well as electroencephalography , which reveals hidden convulsions and other abnormalities in the functioning of the brain.

Main goals of ischemia therapy

If the diagnosis is confirmed after all the studies, then measures begin to maintain normal temperature, humidity, and protection from external irritants.

Therapy in newborns should be as less aggressive as possible. It pursues the following goals:

• Provide adequate ventilation.
• Support hemodynamics.
• Constantly monitor the biochemical parameters of the tests.
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• Prevent seizures.

Where is cerebral ischemia treated?

We have already found out that this disease has several degrees, which differ in severity. Therapy will depend entirely on the symptoms.

1. If a mild degree is observed, then even in the maternity ward, doctors take the necessary measures and discharge the baby. Subsequently, it is recommended to visit a neurologist and get the necessary advice. Most often, massage and adherence to a daily routine are recommended.

2. Cerebral ischemia of the 2nd degree in newborns, what it is has already been found out, requires treatment in the maternity hospital and it continues in the hospital, since the symptoms are more serious.
3. In severe cases, the child is immediately placed in intensive care after birth.

Prevention of ischemia

It is necessary to talk about pregnancy in advance. Preparations begin half a year, or at most 3 months before conception. And not only the expectant mother, but also the father of the child must prepare. During gestation, a woman should undergo all examinations on time, especially in the first trimester. Tests are taken and ultrasound diagnostics are performed.

Before and during pregnancy, a woman is examined for infections. As is known, after conception, latent infections can worsen and manifest themselves. Mom needs to give up smoking, alcohol, drugs and other habits that are harmful to her and the baby. Smoking has a particularly negative effect on the process of oxygen supply to the fetus. If the doctor discovers pregnancy complications, it is important for the woman to go to the hospital on time.

Treatment methods for ischemia

This pathology is characterized by the fact that there is no conservative treatment for it, since dead brain cells cannot be replaced with viable ones. But timely prescribed maintenance therapy allows you to stop the progression of the disease and makes it possible to rehabilitate.

If the pathology is severe, it is visible immediately after birth. In such cases, do the following:

1. Artificial ventilation is performed to help restore spontaneous breathing. After this, the baby’s condition is constantly monitored.
2. Cardiac supportive care is needed to prevent cardiac dysfunction, Dobutamine.
3. Phenobarbital and Phenytoin will help prevent seizures.
4. One of the new methods is hypothermia. It is believed to reduce the rate of brain cell death. But it must be carried out only under the supervision of a doctor. If the temperature is lowered by several degrees, the child is gradually warmed up.

If the disease is mild, then it is enough to take medications that will improve blood circulation in the brain and prevent further damage to neurons.

If there is a threat of developing hydrocephalus, Furosemide and Manitol are prescribed.

Stages 2 and 3 of the disease threaten more serious consequences, so it is important to take all measures and prescribe therapy that will prevent the development of complications of ischemia. They can manifest themselves as mild, for example, attention deficit, or more serious, up to dementia and disability.

Degrees

• light

With mild ischemia, muscle tone increases, but not too much. Deep tendon reflexes in such children are enhanced. They suckle poorly, cry constantly, or, conversely, sleep constantly. During the first 3 days of life, manifestations of pathology are eliminated. Children who have not spent 9 months in their mother’s belly may have decreased rather than increased reflexes and muscle tone.

• average

- frequent apneas

- decreased grasping and sucking reflex

- sluggish Moro reflex

- decreased tendon reflexes

- weak muscle tone

Symptoms of moderate ischemia in newborns appear in the first 24 hours after birth. Doctors talk about a favorable prognosis if the symptoms of ischemia disappear within 14 days.

• heavy

- uncoordinated eye movements

- strabismus, nystagmus

- lack of reflexes that a newborn should normally have

- irregular breathing, such children have to be connected to a ventilator

- stupor or coma

- convulsions

- surges in blood pressure (BP)

- heart rhythm disturbances

Komarovsky's opinion on the disease

If there is grade 2 cerebral ischemia in newborns, Komarovsky believes that drug therapy gives a result, but not what everyone expects. It is very important in the acute period, when the impact of the damaging factor on the brain is observed, but, as a rule, pathology is detected much later, when the so-called recovery period for the brain begins. At this time, massage and physiotherapeutic procedures will be more effective, which will help the brain recovery process. Dr. Komarovsky believes that all neurological manifestations in newborns are associated with brain immaturity, which will gradually disappear if there are no serious chronic pathologies.

Consequences of cerebral ischemia

Currently, medicine is at a level of development that makes it possible to avoid the serious consequences of cerebral ischemia, but provided that the diagnosis was identified in a timely manner. Many children who have suffered from this disease experience rapid fatigue, hyperactivity, and problems with remembering, which can affect their performance at school. Even when there are consequences (if a diagnosis of grade 2 cerebral ischemia in newborns is made), reviews from mothers confirm that they can be dealt with if you consult a doctor and take the necessary medications.

With their help, you can significantly influence the child’s excessive activity, improve his memory and attention, and accordingly, his performance at school will also improve. It is very important to find a competent specialist who will help cope with the accompanying symptoms.

The most severe consequences of cerebral ischemia are cerebral palsy and epilepsy. But this most often happens in the most severe cases and when the diagnosis is not made in a timely manner.

Treatment

To date, specific therapy that “revives” dead brain cells has not been developed. There are medical methods that stop the process of hypoxia and death so that the child does not die.

Treatment of acute ischemic period

As already noted, severe and moderate cerebral ischemia makes itself felt immediately, the symptoms are specific. If there is no spontaneous breathing in the first 2 minutes of life (as well as in the absence of breathing with an oxygen mask), resuscitation must be performed. do intubation and mechanical ventilation. If small areas of the brain are damaged, then 2-3 minutes after the start of resuscitation the baby is already breathing on his own. Then the child is given to the mother. Such a small patient is being observed.

If resuscitation takes longer, the baby is taken to the intensive care unit. There you need to constantly monitor the readings of the body’s condition, including the amount of glucose and hemoglobin in the blood, the level of gases, the processes of blood circulation and the beating of the newborn’s heart. There is special equipment for this.

Anticonvulsant therapy consists of prescribing special drugs, for example, phenytoin. The dose is selected by the doctor individually. This helps stop the seizures and prevents further brain damage. Since ischemia has a negative effect not only on the brain, but also on the heart, special therapy is needed for this organ. To prevent the little patient’s heart from stopping, he is injected with dobutamine and dopamine.

Today, research data is relevant that a temperature that is 3-4 degrees lower than normal can save parts of the brain from dying, which prevents disability and death. This method is called hypothermic therapy. It has been practiced not so long ago, only since 2010. It is necessary that the process be supervised by experienced doctors. The patient is warmed up gradually.

Treatment of consequences

As mentioned above, there are always consequences for a child with severe and even moderate cerebral ischemia. It could just be attention deficit disorder. But in other cases, mental retardation and cerebral palsy are noted. If there are convulsions, special drugs are used to stop them. Prescribed by a doctor in an individual dosage; self-medication is strictly prohibited.

If the baby has severe cerebral palsy with spasticity of the limbs, then muscle relaxants are taken to alleviate the situation. Whatever the consequences, treatment will not be limited to medications. Daily rehabilitation is important. Children with cerebral palsy are given special massage courses. This should be done by a specialist. At home, you can do only part of the exercises that experts will show parents. Older children who are diagnosed with cerebral palsy due to cerebral ischemia need exercise therapy.

Correction of incorrect postures is carried out using special devices: strollers, bolsters, splints, special chairs. If there is spasticity, the arms and legs of a sick baby may become unphysiological. It's better to avoid this.

In our country there are few specialists who can adequately treat the consequences of cerebral ischemia in newborns. There is overdiagnosis. Children under 6 months of age may have Graefe's sign, increased muscle tone and shuddering. And doctors may think that these are manifestations of encephalopathy. Accordingly, they will prescribe treatment that is actually unnecessary.

Newborns should not be examined when they are drowsy or frightened in some way. Then it is also possible to diagnose neurological pathologies that do not exist. Unnecessary medications that may be prescribed in error include:

• vascular
• nootropics
• homeopathy

What parents can do for their child

Even the 2nd degree of pathology is not a death sentence. After completing a course of drug therapy, the recovery period begins. At this time, parents play a big role; it often depends on them how severe the consequences of the pathology will be. In order for the baby’s development to return to normal, parents must:

• Visit a neurologist regularly with your child.
• Give the baby medications prescribed by the doctor.
• Closely monitor psychomotor development in order to promptly notice deviations.
• Strictly follow the recommendations for your daily routine.
• If the child has increased excitability, then provide him with a calm environment and eliminate sources of noise.
• Get outdoors more often.

• Take massage courses.
• Do exercises with your baby; a set of exercises may be recommended by your doctor.

Any neurological problems can be solved, because the child’s nervous system is not yet fully formed, it is quite flexible and capable of recovery, so one should not give up. Even with a diagnosis of grade 2 cerebral ischemia in newborns, the consequences may not be so dire. The care and love of parents, and, of course, the help of doctors, will certainly work a miracle, and the child will not lag behind his peers.