Special interest last decade in modern pediatrics is represented by the pathological conditions of newborns arising in perinatalnom the period. It is caused by absence of uniform approaches to diagnostics, observation and treatment of these diseases.

Perinatalnaja an encephalopathy - the most frequent reason of the neurologic diseases shown in the neonatal period also involves high level of an invalidism, including a cerebral paralysis, a mental retardation and epipristupy. Occurrence of a serious cerebral ischemia (perinatalnoj encephalopathies of 2-3 degrees) makes about 1,0-1,5 % among newborns and usually corresponds with small gestatsionnym age and in low weight of the child at a birth. Serious form PEP meets in 9,0 % of cases of a birth of children term gestatsii less than 36 weeks and at 0,5 % of newborns more, than 36 weeks gestatsionnogo age. Aetiology PEP includes the factors breaking a cerebral blood flow and oxygenation of a brain. They can influence in antenatalnom the period (20 %), intranatal (30 %), antenatalnom and intranatal (35 %), or in postnatalnom the period (10 %) [211, 212, 222]. According to the literature perinatalnye encephalopathies, as a rule, carry behind themselves those or other disturbances of development in the future (the minimum cerebral dysfunctions - 38 %, refractory epilepsies - 23 %, intelligence disturbance - 3,3 %, disturbances of impellent development - 18 %; clinically not shown - 17,7 %) [118].

For the purpose of prevention of development of consequences perinatalnoj encephalopathies at children with neurologic disturbances it is justified early (in the acute period) the beginning of active regenerative therapy that allows to achieve more favorable outcome, in comparison with the late beginning of correction. At use in regenerative correction of principles of continuity, integrated approach, etapnosti,
There is a possibility to improve the quality of a life bound to health at the individual and to warn development in it of physical inability [155].

All above-stated and.posluzhilo the basis to carrying out of the present work.

Results are presented to dissertations anamnestic, katamnesticheskogo, clinico-tool, nejrofiziologicheskogo inspections, 86 children, at the age from two about twelve months living in Krasnoyarsk.

II group of research was made by 35 children in which anamnesis in a maternity home the diagnosis perinatalnoj gipoksicheski - an ischemic encephalopathy (a cerebral ischemia of 2-3 degrees) has been exposed. Children have been referred for realisation of rehabilitational actions to unit of regenerative treatment of a psychoneurological profile of MUSES GDB №1. At survey at these children the neurologic semiology became perceptible, various variants of syndromes GIE (gipertenzionnyj, gidrotsefalnyj, the impellent disturbances, raised nervnoreflektornoj excitabilities, delays of motor, mental and psychomotor development) are diagnosed. In this group to children the complex is spent; stage-by-stage, multidisciplinary regenerative therapy with use abilitatsionnoj techniques under the program of an early intervention.

I group included 51 children of similar age and a parity to the sexual sign, having the verified diagnosis перинатальной* the encephalopathies, receiving "traditional" medical aftertreatment.

Modern methods of the research were applied, allowing to state a complex estimation of a condition of somatic and nervous system at children of the surveyed groups before treatment, after the spent therapy and in
katamnesticheskom observation. It has allowed to tap at them functional disturbances from the above-stated systems.

The inspection program included genealogical, nejrofiziologichesky (the ECHO-ENTSEFALOGRAFIJA, nejrosonografija, spondilo - and a craniography), clinico-anamnestichesky methods, anthropometry, an estimation on scales of development KID-R and R-CDI.

Clinical survey with research of the neurologic status was spent, the special attention was given to presence of focal microsemiology, signs of suffering of a motor analyzer with an obligatory estimation of degree spastichnosti on scale Ashworth, hyperexcitability, disturbances of rates of formation of motor and mental development, dream disturbances. Typical

nejrosonograficheskimi signs at children with perinatalnoj an encephalopathy were: periventrikuljarnaja lejkomaljatsija (a necrosis of the white substance visualised as white maculae, interfacing to external angles of lateral ventricles), peri - and intraventricular hemorrhages (a hemorrhage in a germinal matrix), parasagittalnyj a cerebral necrosis (bilateral symmetric damage of a cerebral cortex and subcortical white substance in parietooktsipitalnoj areas), status marmoratus (gipoksicheski - ischemic damage of subcortical ganglions leading to a mottled drawing of these areas), focal and multfokalnyj ischemic nejronalnyj the necrosis shown in remote terms by augmentation of an index of Evans and expansion likvoroprovodjashchih of spaces. Criteria of an estimation corresponded to literature data [151, 209, 246, 247].

Survey of the ophthalmologist included eyeground survey. Signs of an intracranial hypertensia included congestive changes in a kind of a tortuosity and a plethora of veins, stushevannosti borders of disks
Optic nerve, angiopatii retinas on hypertensive type, however, at comparison of results of survey of the ophthalmologist with data of clinical survey, the diagnosis of an intracranial hypertensia has not proved to be true.

Mathematical processing of the received data was carried out by means of a package of applied programs Statisticks and Biostat on personal computer Pentium-4.

As a result of the spent inspection it is taped, that mothers of children who have transferred a cerebral ischemia, had in the anamnesis following contributing factors to disease development: the spontaneous abortions, stood pregnancy, antenatalnuju destruction of a foetus. The obtained data were comparable in both groups. The greatest percentage parity among risk factors was occupied with medical abortions. Frequency of medical abortions in group I has appeared a little above, than in group II (39,2 % in group I and 42,9 % in group II). At the collecting of the anamnesis of the present pregnancy it has been established, that those or other menacing factors and their combination have been found out in all mothers of observable groups (more than two). The greatest quantity of mothers were during pregnancy on conservation in connection with abortion threat. Data were comparable in both groups, however number of mothers with discontinuing threat in group I was slightly above (84,3 % in group I and 77,1 % in group II). perinatalnoj encephalopathies concern one of the most menacing factors of development in the child of an anaemia pregnant 1-Й half of pregnancy, gestozy I and II half of pregnancy, anomaly of patrimonial activity, untimely izlitie amniotic waters. The given pathological changes were available in group I and in group II.

To all surveyed children in the first days of a life the diagnosis of a cerebral ischemia has been exposed. A cerebral ischemia easy (І-H) degrees
It has been diagnosed for 70,6 % among children in I group and at 74,3 % in group II. The number of children (P-SH) in group I and group II also was comparable to a cerebral ischemia of average and serious degree (29,4 % in group I and 25,7 % in group II). Criteria of statement of the diagnosis were it is abnormal a low estimation on scale Apgar on 1st and 5th minute after a birth; neurologic disturbances in the form of changes of movements, epipristupov, comas, hyperexcitabilities; data about the chronic pre-natal hypoxia, specific nejrosonograficheskie brain changes [118, 151, 212, 213, 244].

Syndrome of impellent disturbances as implication of a cerebral ischemia in the first days of a life after a birth has been diagnosed for all children who are under observation. The greatest quantity of children with disturbances of movements, was made by children with muscle tone rising; a little larger quantity of children with the raised tonus in muscles was observed in group II (group I - 68,6 %, group II - 80,0 %). Children with the lowered or azygomorphous tonus in muscles have made 31,4 % in group I and 20,0 % in group II. Our data differed from the spent researches described earlier by other authors a little. On various data of the literature, the syndrome of impellent disturbances approximately in 80 % of cases of the acute period of disease associates with depression of a motor performance and a hypomyotonia, about 20 % of cases of change of a motor performance — with tonus rising in muscles [10, 18, 25, 68, 118, 212, 244]. Those or other basic nejrosonograficheskie markers of a cerebral ischemia, namely, a dilatation of horns of lateral ventricles, an ischemia of basal ganglions, periventrikuljarnyj an edema, hemorrhages in substance and brain ventricles have been registered at 90,2 % of newborn children of group I and at 94,3 % in group And. In 9,8 % of children in I group and in 5,7 % in II group of significant changes from brain structures on

To data nejrosonografii it has not been fixed. This fact speaks that researches at them have been spent for the first days after a birth when characteristic signs of an ischemia were not generated yet.

At an adverse current of the neonatal period and at presence srednetjazheloj and serious forms of a cerebral ischemia, restoration of functioning of nervous system to the extremity of an acute phase of illness does not come. Disease flows during the regenerative period. In this period posindromnaja diagnostics is partially based on the complaints shown by parents. At entering in unit of regenerative treatment the basic complaints which were shown by parents of children who have entered into research, were complaints to disturbance of processes of a backfilling and a dream; the superfluous excitability accompanied by a tremor of a chin and extremities; muscle tone and motor performance change. Diagnosis verification was spent to conformity with demands and according to X International classification of illnesses [71].

On various data of the literature in the period of restoration GIE about 80 % of cases of a syndrome of impellent disturbances associates with tonus rising in muscles and the phenomena spastichnnosti, approximately in 20 % of cases of change of a motor performance — with depression of a motor performance and a hypomyotonia [9, 118, 244]. In the work, analyzing anamnestic data of children who have transferred a cerebral ischemia, and the past further rehabilitational actions in unit of regenerative treatment, we have received similar results. So, muscle tone rising in the acute period disease was leading implication of a syndrome of impellent disturbances, and a percentage parity of such children above in group II (68,6 % in group I and 80,0 % in group II). To an exact estimation of degree spastichnosti and muscle tone risings it is applied
Uniform scale spastichnosti Ashworth [44]. At an estimation spastichnosti on this scale we have obtained data, that children in the investigated groups had approximately in peer percentage parities easy and average degree spastichnosti (21,6 % and 29,4 % in group I; 25,7 % and 31,4 % in group II). Other children had the expressed and serious degree spastichnosti. Motor performance depression, assotsiirovannoe with the lowered tonus, on our observation was in 21,6 % of cases in group I and in 20,0 % of cases in group II. The delay of rates of formation of psychospeech and motor development was considerably above in group II and has made 22,9 % (in group of 1-11,8 %).

Results of the spent questioning on scales of development KID-R have shown, that the arrest of development was above in group II (27,5 % in group I and 51,4 % in group II). The greatest quantity of children was made by children with an arrest of development bound to disturbance of socialisation and self-service. The quantity of children with an arrest of development of movements was authentically above in group II (29,4 % in group I and 57,1 % in group II; р1-П

<< | >>
Scientific source BARHATOV Michael Valerevich. USE of the PROGRAM of the EARLY INTERVENTION In MEDICAL AFTERTREATMENT of CHILDREN With PERINATALNOJ the ENCEPHALOPATHY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Krasnoyarsk -. 2007

Other medical related information the CONCLUSION:

  2. Conclusions
  5. Chapter 8. The CONCLUSION
  12. the CONCLUSION