Hypoxic-ischemic encephalopathy

Violations of the brain caused by prolonged shortage of oxygen included in a syndrome called hypoxic-ischemic encephalopathy (HIE). Brain abnormalities may be the result of coma, stroke, prolonged mechanical ventilation. Mostly, these factors relate to adult patients, but most STI are observed in newborns.

General concepts

Encephalopathy is called organic (irreversible) brain damage caused by degenerative changes in brain tissue. There are disorders of brain functions – from the relatively mild to rough. In clinical practice there are several forms of encephalopathy depending on the reasons caused them.

Post hypoxic encephalopathy (PE) develops on the background of long-term hypoxia – insufficient oxygen delivery to the neurons of the brain due to impaired blood supply. Perinatal PE – cerebral function in the newborn due to hypoxia during the mother’s pregnancy and the birth process. Reasons for PPE may also be:

  • the entanglement neck of the newborn by the umbilical cord;
  • prematurity of the child;
  • high body weight of the child at birth.

Perinatal hypoxic-ischemic encephalopathy

Perinatal HIE is a complication of pathology of pregnancy and childbirth. Pathology can contribute:

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  • severe complications of pregnancy – preeclampsia and eclampsia;
  • problems with the placenta: previa or premature detachment;
  • the Farrow;
  • maternal age over 35 years (especially at first birth);
  • chronic intoxication pregnancy (inhalation of toxic substances under adverse conditions, Smoking);
  • the mother of the disease viral or bacterial etiology during pregnancy and chronic infection and diseases of the internal organs;
  • violations of functioning of cardiovascular system of the fetus;
  • infection of amniotic fluid.
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The most common causes PGIA are birth injuries and improper conduct caesarean section. They damage the blood vessels of the brain of the newborn.
Symptoms and syndromes of encephalopathy of hypoxic Genesis in newborns:

Гипоксически-ишемическая энцефалопатия

  • Weak reaction to light, sound, tactile stimulation.
  • Wince, jerking limbs.
  • Restlessness, frequent unexplained crying.
  • Superficial and restless sleep with frequent awakenings.
  • Unnaturally frequent vomiting.
  • Seizures.
  • Increased head size in General, and the large Fontanelle, in particular (hydrocephalus).
  • The decrease up to the complete oppression of the basic reflexes of sucking and swallowing.
  • The weakening of muscle tone – may cause facial asymmetry, strabismus.
  • Reduction or total absence of activity.
  • Coma with complete absence of the basic reflexes and response to painful stimuli. This serious condition is accompanied by a decrease in blood pressure, impaired cardiac and respiratory activity.

Depending on the severity of the disease hypoxic encephalopathy is divided into 3 degrees or stages:

  • Mild or compensatory stage. Manifested by increased excitability, but sometimes – benign oppression of the nervous system. Treatment begin to carry out in a nursing home. After discharge the child by a neurologist of the children’s clinic.
  • Moderate degree, or subcompensation stage. The characteristic depression of the Central nervous system, convulsions, hydrocephalus and intracranial hypertension. The treatment begins in the maternity ward, then the child transferred to hospital to stabilize the condition.
  • Severe degree or end-stage. Stop the oxygen supply to the brain is to prekomatosnoe CNS depression or coma. The treatment is carried out only in conditions of intensive care.
  • Treatment

    In the acute period of the disease the child receives treatment in the Department of pathology with specially created conditions. Is oxygen therapy, if needed – powered via the probe. Monitoriaus all vital signs. If necessary, a lumbar puncture. Medicines are prescribed depending on symptoms the predominant symptoms. To improve metabolism in the neurons of the brain and spinal cord, conduct infusion therapy – the introduction of a physiological solution of sodium chloride, dextrose with added minerals and vitamins (potassium, magnesium, calcium, ascorbic acid).

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    To reduce hypertensive syndrome dehydration is used with the drug Mannitol. For the relief and prevention of seizures applied potent anticonvulsants (Phenobarbital, Diazepam). To improve blood circulation in the brain is assigned nootropics (Cortexin, Nootropil, Actovegin, Cavinton).

    The recovery period

    While improving the well-being of the child is transferred to a day hospital or outpatient treatment. Drug treatment combined with physiotherapy, massage, physical therapy, swimming in the pool. If in the future the child have abnormal functions of speech, are speech therapy lessons with a specialist.

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    The consequences

    The most fearsome complications are PGIA the development of epilepsy, hydrocephalus and cerebral palsy. Therefore it is necessary to direct all forces on strict adherence to doctor’s recommendations.