|
"Noviye Issledovaniya. Almanac" (Materials of International Science conference "Physiology of Human Development" November 22-26), 2004, #1-2, p.276-7.
Physical and neurological state of children after the birth trauma.
Nabieva T.N., Ishchenko A.A.
Brain Institute of Russian Academy of Medical Sciences, 105064, per. Obukha 5, Moscow, Russia; I M Sechenov Moscow Medical Academy.
Asphyxia neonatorum is the most widespread birth-trauma. Asphyxia results in a sharp blood-filling and perivascular edema in a newborn's brain. Brain edema can raise the intracranial pressure to such degree that it may considerably increase the pressure in brain vessels. As a result, perfusion pressure is falling and insults begin to develop. Numerous investigators reported about abnormal brain development in 20-90% of children who endured severe asphyxia. Pathomorphological studies showed that hemorrhages provoked by asphyxia was diffuse and evenly distributed not only in different brain regions, but in other organs and tissues as well. Pyramidal cells in the neocortical motor area are most sensitive to asphyxia, which is the reason for motor disturbances. Brain circulation failure includes hemorrhages, ischemic and hemorrhagic infarcts which are localized in brain white matter too. As a result, occurs the disturbance of myelinization of the nervous fibers. In 90% of one-year-old children who endured medium and severe asphyxia, the pathological EEG activity in the form of sharpened waves and spike-wave complexes was recorded (Solovyeva, 1971). In the EEG of such children, Elizarova (1977) observed hypersynchronized slow waves, focal spike-wave complexes, and equivalents of epileptiform seizures. Different intracranial hemorrhages are thought to be one of the reasons of seizures. Convulsive activity in the central nervous system is manifested in tremor, seizures, and tone disorders from the first days of life. Muscle spasticity and hyperkinesis were observed in cases of severe (6-10 minutes) asphyxia (Elizarova, 1977). We examined 20 preschool age children (3-6 years) with birth-trauma (asphyxia neonatorum) in anamnesis. During conversation it was revealed that 15 mothers had pregnancy pathology, labor was induced because of poor labor activity (n=5), ranging from 4 to 38 hours (n=15) with complications (n=12). As a result, 14 of the patients endured asphyxia neonatorum and 3 had fetal hypoxia in anamnesis. Subsequently, children had increased cranial pressure (n=11) and muscle tone disturbances (n=16) during the first year of life. Parents noted anxiety behavior in the first 3 months (n=17); children often cried without apparent reason (n=16), had difficulties in falling asleep (n=17); disturbances in sleep (n=17), appetite and digestion (n=14) were observed. Children demonstrated aggressive reactions (n=6), allergic reactions (n=9) and susceptibility to respiratory illness (n=16). Parents reported about hypersensitization, irritability (n=17) and timidity (n=11) of their children. During the examination, we revealed a physical development delay (n=12), muscle tone disturbances (n=17), speech (n=14) and mental (n=8) development delays, concentration and attention impairment (n=14), undue fatigability (n=9) and restlessness (n=11). So we consider the presence of certain psychoneurologic characteristics in a preschool child (excitability, timidity, rapid fatigability, restlessness, irritability and aggressiveness) as the evidence of endured birth trauma, asphyxia neonatorum.
Key words: birth-trauma, asphyxia neonatorum, EEG, aggressiveness.
|