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3.4. Features of psychomotor and speech development of children with SD. Neurologic aspects

The delay of psychomotor and speech development in different degree is characteristic for all children with SD. For an estimation of rates of psychomotor development, and also terms of formation of motor skills at children with a trisomy of 21st chromosome, being on education in a family research of dynamics of psychomotor development in investigated children during the periods of infancy and the early childhood has been carried out.

The factors influencing rates of development, including possible perinatalnoe lesion TSNS have been analysed. The condition after a birth of the majority of children with SD was satisfactory. The value median on scale APGAR on 1 minute has made 7 points and on the fifth - 8 points. An asphyxia in moderate severity level sorts have transferred 115 (22,37 %) children. A serious asphyxia - 4 (0,78 %). Signs perinatalnogo lesions of the central nervous system became perceptible at 200 (38,91 %) children and basically in the form of a syndrome of oppression TSNS (at 99,1 % from among amazed). The convulsive syndrome in the first days of a life became perceptible at 7 (1,36 %) newborns.

In the neonatal period nejrosononografija it has been spent to 275 newborns with SD. Changes have been taped at 86 (31,27 %). Basically it is signs of an ischemic lesion of a brain in the form of rising ehogennosti periventrikuljarnyh zones, ustanovsennye at 72 (83,72 %) newborns, a hemorrhage - at 48 (55,81 %), ventrikulomegalija at 59 (68,2 %) (a Fig. 25). The external hydrocephaly is taped at 5 (5,81 %), periventrikuljarnaja lejomaljatsija at 1 (1,01 %) the newborn with a trisomy

To 222 babies with SD was more senior 1 month it is spent nejrosonografija. Changes have been found out at 180 (81,08 %) children. At 52 (28,89 %) children are long remained rising ehogennosti periventrikuljarnyh zones. The cortex atrophy is taped at 3 (1,67 %), at the same number are taped kaltsinaty a brain. At one child - a cerebellum hypoplasia (0,56 %).

Drawing 25. Structure nejrosonograficheskih changes at children with SD

In the neonatal period.

Echoencephalography is spent to 24 children with SD by which results, at 8 children the intracranial hypertensia is taped, at 17 - a hydrocephaly.

Quantity of children, convulsive syndrome at which it became perceptible at least unitary, including fibrilnye cramps, has made 25 (4,86 %).

The symptomatic epilepsy, syndrome Vesta and other conditions which have demanded appointment antikonvulsantov have been taped at 11 (2,14 %) children with SD.

Stereotypies became perceptible at 5 (0,97 %) children.

The electroencephalography was spent under indications and has been executed to 61 child (11,87 %). Changes have been established at 44 children (72,13 % from
Numbers surveyed). Convulsive patterns became perceptible at 17 children, diffusive changes of is residual-organic character at 11, a delay of formation of cortical rhythmics at 13, depression of a threshold of convulsive activity at 3 children (a Fig. 26).

Drawing 26. Results EEG of research at children with SD.

For the purpose of revealing of the factors influencing development of a convulsive syndrome at children with SD the group of children is analysed, the convulsive syndrome at which became perceptible at least unitary.

In total 25детей (4,86 % from the general number).

Distribution on a floor: approximately fifty-fifty (girls - 13, boys - 12). In the given group almost all children had a regular trisomy of 21st chromosome (24), one child with translokatsinnoj the form; with the mosaic form there was no child. Full-term 91,67 % of children were born. 8,33 % of children - not full-term on term 34 ±1,2 weeks.

Morofofunktsionalnaja immaturity became perceptible at 0,04 % of children, as much with a delay of pre-natal development. The median on scale APGAR on 1 minute has made 7 points, on 5-5 - 8 points. Among children with SD and an epilepsy there were no what have transferred a serious asphyxia in sorts. The intensive care right after births in the form of giving of additional oxygen through a mask was required 3 (12 %) to children. In the neurologic status after
Births of change in a kind of a syndrome of oppression TSNS it became perceptible at 7 (28 %) children. At one child the condition has worsened on 20 minute of a life in the form of occurrence apnoe. Neonatal cramps became perceptible at 2 (8 %) children. At one child the manifestation of a convulsive syndrome has fallen to 9 days of a life. At one child the epilepsy has arisen after a serious lesion of a brain owing to the transferred clinical mors and development detserebratsionnogo a syndrome during surgical correction of a congenital heart disease.

The analysis of the received results shows, that the asphyxia in sorts was not the basic etiological factor of occurrence of an epilepsy at children with SD. Possibly, it is bound to the is functional-anatomic features caused by presence of three spears of 21st chromosome.

Research of dynamics of psychomotor and speech development in children with SD during the periods of infancy and the early childhood is carried out. retrospektivno terms of occurrence of skills at children with SD have been estimated. Medians, and also the earliest and latest terms of occurrence of skills have been calculated. The received results are presented in tables (tab. 9,10).

The wide range between the minimum and maximum terms of acquisition of skills becomes perceptible. For example, children with SD start to go at the age from 12 till 30 months, and to sit - during the period from 6 до16 months. It speaks about high heterogeneity of population of children with a trisomy of 21st chromosome, including for the account soputsvujushchej to a somatic pathology.

Special interest in these tables represents area of extreme maximum value as children having indicators of development, close to those, require special attention from the pediatrist. In such cases it is necessary to be assured, that the child has no the diseases interfering its development, such as relative deafness or a hypothyrosis.

The hypomyotonia, influences both motor development and on speech development. The newborn with SD has a number of facial signs, such as narrow nasal courses, big and gipotonichnyj tongue, and also a low tonus mimic musculations.

Table 9. Rates of motor development and acquisition of skills of children with SD.

Skills Міп

(Months)

Me (months) Move

(Months)

Holds a head 1 3 5
Turns over from a back on a stomach 2 6 12
Turns over from a stomach on a back 2 6,5 14
Creeps on a stomach 4 10 15
Grabbles 8 14 18
Sits 6 9 16
Costs 10 12 18
Goes 12 18 30
Eats with arms 6,5 10 16
Eats with a spoon 12 18 18
Drinks from a cup 8 18 18
Uses a pot 11 18 36

Table 10. Rates of speech development of children with SD.

Skills Міп (Months) Me (months) Move

(Months)

Smiles 1 3 5
Laughs 4 7 12
Babbles 1 3 6
Murmurs 4 6,5 13
Gestures 8 12 18
zvukopodrazhanie 10 15 19
The first words 6 10 16
Phrase speech 12 19 36

The teething is characteristic later. On the average, a teeth is cut through at children with SD в10±3 months. The child late enough start to accustom to chewing and swallowing of firm nutrition. Thus, long use of invalid's cups and small horns detains development of a mimic musculation and occurrence in children of expressional speech.

At comparison of rates of motor and speech development of children with SD nahodjashchihs on thoracal feeding more than 6 months and children who were on artificial feeding are taped authentic difference (r

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Scientific source Semenova Natalia Aleksandrovna. STATE OF HEALTH of CHILDREN With the SYNDROME of Down. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2013. 2013

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