Starting the story about the diagnosis of perinatal encephalopathy, which is so popular today, it is necessary to note the following fact. In the international classification of diseases of the 10th revision, that is, the last one, such a diagnosis does not exist.. District neuropathologists continue to expose him to three out of four children. Why is this happening and is it legal Let's think together.

The translation of the term PEP is literal - a pathology of the brain that arose in the perinatal period. In fact, it combines all the brain dysfunction that cannot be more specifically defined..

Some experts believe that such a diagnosis is valid within 1 month of a child's life, others argue that during the first year. Before the baby reaches this age (1 month), it is extremely difficult to determine what kind of brain pathology is present.. And therefore, all cases of violation of the structure or functioning of the brain tissue were called perinatal encephalopathy. The whole insidiousness of the diagnosis lies in the fact that its manifestations are too many-sided.. Competent neurologists diagnose as follows: " If you can, ask your doctor for exactly this wording.. For what? Then, that you yourself will understand much more, both in relation to the manifestations of the disease, and in relation to the prognosis. So, what are the main syndromes that PEP can manifest

Syndrome of movement disorders - muscle hypotension or hypertension. Difficulties in diagnosing these conditions are associated with physiological hypertonicity, the degree of which is not easy to assess.. I know many adult neurologists who are hesitant to look at children for this very reason.. Determining the age norm of tone is one of the most necessary skills for a pediatric neurologist..

Syndrome of increased neuro-reflex excitability speaks for itself. Watch your baby. Does he sleep enough, does he fall asleep easily? How he behaves in the waking state: is he too active? Does his chin and limbs tremble If anything on this list is bothering you, tell your doctor..

CNS depression syndrome is also hard to miss. The child is inactive, sluggish, inhibited. Hypotonic, there may be asymmetry of the face and trunk due to different muscle tone, strabismus for the same reason. Poor sucking, choking when swallowing.

The syndrome of intracranial hypertension is one of the most serious. After all, it is he who can then go into hydrocephalus, requiring surgical treatment.. Pay attention to the skull crumbs. If the large fontanel is enlarged compared to the age norm and bulges, the head circumference is slightly increased, the seams diverge - start sounding the alarm.

convulsive syndrome. In children of the first year of life, it is not so easy to recognize it, because it can manifest itself not only with convulsions, but also with their equivalents.. These include hiccups, regurgitation, increased salivation, automatic chewing movements, small-amplitude trembling. Since all children spit up and hiccup, more research is needed to clarify the diagnosis..

I will express a purely personal opinion (not confirmed by science), if I note that any attentive mother is able to notice deviations in her child much faster than a neuropathologist. Even in a newborn, without even knowing what a healthy child he is. At the level of intuition, this happens, or something. And if it seems to you that the baby is healthy, and the doctor says otherwise, ask him to explain what the problem is. Maybe you really did not notice something important? Or maybe your doctor is overprotective.?

Of course, today there is an overdiagnosis of PEP. What does it have to do with?

The answer is simple - with the reasons for this condition. All damage to the nervous system of newborns is conditionally divided into hypoxic, traumatic, and combined.. Chronic fetal hypoxia can form in the prenatal period, with various pathologies of the mother. For example, with acute infections, chronic intoxications, preeclampsia, threats of interruption, malnutrition, the general influence of exogenous factors (radiation, medication), etc.. Acute fetal hypoxia can be the result of any pathology during childbirth, and the same pathology contributes to traumatic damage to the nervous system (rapid or prolonged labor, prolonged anhydrous period, drug stimulation, caesarean section, cord entanglement). In the period after birth, neuroinfections and injuries of the brain and spinal cord are of the greatest importance..

today it is quite difficult to find a woman who would never get sick during pregnancy, and then give birth perfectly.. You are asked the question “How was the birth? And you answer: “Normal, only there was an entanglement”. And then you get a diagnosis: PEP. Because your doctor thinks that if there was an entanglement, then there was hypoxia.. Since there was hypoxia, it means that there was damage to the nervous system. Most often he is right, but... Children's cells are much less sensitive to a lack of oxygen than adults. And if a 30-year-old man who has not received oxygen for 5 minutes has serious changes in the brain, then children may not have them.. So do not despair those who are not doing well with the course of pregnancy or childbirth. If there is an opportunity to change the situation, influence the course of events - this must be done.. If not, hope for the best. Calmly perceive the phrases: “Your child has an entanglement of the umbilical cord on ultrasound, and therefore chronic hypoxia with the possibility of acute hypoxia in childbirth”. Everything can be quite well, do not let yourself be intimidated! This is not a sentence yet, do not worry ahead of time. I am not asking you to be careless.! Just watch, watch and once again watch yourself and your baby, living inside you or already born. Be her mother, and the first doctor, and psychologist.

But still, suspicions crept in, there is a preliminary diagnosis. It needs to be confirmed. The most common methods for diagnosing perinatal injuries of the nervous system include the following: echoencephalography, dopplerography, neurosonography, electroencephalography with evoked potentials. Using these methods, you can determine the structure and density of the substance of the brain, the size and shape of the CSF spaces, assess the blood supply to the brain and see areas of narrowing or blockage of blood vessels, identify the presence of convulsive readiness. The same studies will help shed light on the nature of damage to the brain tissue, and, accordingly, will help in the treatment.

What is the danger of PEP? The fact that it is not always possible to initially determine the development of the disease. And this is either recovery, or the formation of serious diseases (epilepsy, hydrocephalus, mental or motor retardation, cerebral palsy, neuroses), or the presence of minimal brain dysfunction. The prognosis by the end of the first month of life is already looming, and the term PEP is being replaced by a new one, corresponding to the condition of the child..

Since the difference between the outcomes in recovery and cerebral palsy is obvious, it is also clear that treatment should be started as early as possible.. I will make a reservation right away that the prognosis of the disease is not only the result of the treatment, unfortunately. It is mainly due to the degree of suffering of the nervous system and the depth of structural changes.. No matter how cruel it may sound, but if the cells of the cerebral cortex died due to severe birth trauma, then they died.

So, if you have AED, you need to fight. The main place in the treatment of this condition belongs to physical methods of influence: massage, exercise therapy, physiotherapy procedures.. What is the principle of their action? This can be shown very simply with the following example.. The child has hypertension due to acute fetal hypoxia during childbirth. The mechanisms of regulation are disturbed and tuned precisely to this hypertonicity, t. the body considers it to be the norm, it does not know the state of " If, with the help of massage, the muscles are relaxed, they will give a signal to the brain about their condition as the most physiologically comfortable, setting it up in a new way, which you need to strive for.. In addition, the muscle can contract with the greatest efficiency from a state of complete relaxation, which, again, is achieved by massage.. Plus, massage is certain training, the benefits of which are obvious. In this regard, remember the following. You can carry out light massage and gymnastics at home at a time convenient for you on your own.. Therapeutic massage should only be entrusted to a specialist.! Don't Experiment!

Therapeutic gymnastics and swimming are extremely useful for children with PEP (excluding severe acute conditions). The principle of action is the same as massage. Consult a doctor and instructor about the best time for classes, the optimal load for your child and have fun together.

Don't Forget the Baths. They act like sedatives. With various pathologies of the nervous system, certain herbal preparations can be added to them.. Salt bath recommended. And, of course, everything is “under the sauce of love”. After all, the baby should know that parents defend his health.!

Now a few words about the use of medicines. With the syndrome of intracranial hypertension, episindrome, this is not discussed: the drugs are clearly indicated. With controversial issues, where the doctor says: “You can take it”, it’s up to you. If the baby, for example, has restless sleep and no more symptoms, try to do without drugs, actively exercise. methods. Look at the result in a month, discuss it together with a neurologist. Then make a decision. If in doubt about the need to prescribe medications, ask the doctor why he prescribes them.? If the answer seems unintelligible to you, look for another doctor.. We have several schools of pediatric neurology in Kyiv with opposing views on the same problem. Points of view are reasoned and have successful practical application. So the final choice is yours..

And finally, it is impossible not to say about surgical methods of treatment.. First of all, they relate to hydrocephalus, in which a bypass is created for the outflow of cerebrospinal fluid, and cerebral palsy, in which embryonic stem cells are transplanted directly into the brain..

be healthy! Take care of yourself and your children!

Konotopskaya Tatiana,.

neuropathologist roditeli. ua.