Treatment of birth trauma. Children who have suffered a birth injury to the bones, as a rule, fully recover. Symptoms of Birth Head Injury

The birth process does not always proceed favorably for both the woman in labor and the child. Birth trauma in newborns occurs due to various reasons. Timely and adequate diagnosis and then treatment of this pathology is extremely important. Otherwise, the consequences can become unpredictable: from intellectual problems to disability or even death of the fetus.

What is a birth trauma of a child, we will consider in more detail below. In obstetric practice, this concept means such a condition of the child, which is characterized by damage to the integrity of tissues, organs or the skeleton and causes a violation of their functions.

All damage to the fetus in the birth process is conditionally divided into:

• mechanical, that is, created by some external stimulation;
• hypoxic, that is, occurring as a result of asphyxia or fetal hypoxia.

Functional disorders can be observed in various areas of the body and, depending on the location, are classified as follows:

• injuries of bones, joints (cracks or fractures of the shoulder, clavicle, femur and skull);
• damage to soft tissues (skin or muscles, cephalohematoma, birth tumor);
• injuries of internal organs (hemorrhages in the abdominal organs);
• disorders of the nervous system (damage to the nerve trunk in the brain or spinal cord).

The last type of trauma in newborns is divided into the following types:

• defects of the peripheral nervous system;
• injury in the spinal cord.

There is also a classification of birth injuries based on the actions of the obstetric team:

1. Spontaneous. It is formed in the process of standard or difficult childbirth for reasons beyond the control of medical personnel.
2. Obstetric. Occurs as a result of certain methods of the midwife (both correct and incorrect).

Cervical injury

The human cervical region is characterized by mobility, fragility and extreme sensitivity to all sorts of influences. In this regard, the cause of injury may be too rough bending, careless stretching or violent rotation.

In the birth process, various types of disorders in the neck can occur:

1. Distraction.
2. Rotational.
3. Compression-flexion.

A rotational violation of the neck occurs as a result of the actions of the obstetrician aimed at helping the child to move through the birth canal. In the process of manipulations performed by hands or obstetric forceps, rotational movements of the head are carried out, which in some cases lead to subluxation of the first cervical vertebra (atlas) or to a defect in the articulation of the first and second vertebrae.

Occasionally, the atlas shifts and the spinal canal narrows, which is accompanied by pressure on the spinal cord.

In some situations, at the time of natural childbirth and in the presence of a large fetus, obstetricians are required to make additional efforts that can cause separation of the vertebral bodies from the discs, rupture of ligaments in the neck, or dysfunction of the spinal cord.

Compression-flexion injuries are most common in rapid labor, especially when the fetus is large enough. When the child moves through the birth canal, his head experiences resistance, which is why compression fractures of the vertebrae are not excluded.

Consequences of natal injuries of the cervical spine

Birth trauma to the neck causes:

1. Osteochondrosis and scoliosis.
2. Decreased muscle tone with overall increased flexibility.
3. Weakness in the muscles of the shoulder girdle.
4. Clubfoot.
5. Headache.
6. Violations in fine motor skills.
7. Vegetovascular dystonia.
8. Increased blood pressure.

Note! Three times more often birth injuries are recorded during the procedure of caesarean section than during the most natural childbirth. This is due to the so-called can effect.

When the child is pulled out artificially from the uterus, negative pressure is formed in it. The resulting vacuum prevents the free exit of the newborn.

It takes a lot of effort to get it out. Such manipulations can cause damage to the spine.

Intracranial injuries

Intracranial birth trauma of newborns is cerebral disturbances in brain activity of different location and degree of manifestation, which are formed during childbirth as a result of mechanical damage to the skull. Factors that can provoke injuries of this nature are conventionally divided into 2 groups:

1. Associated with the intrauterine state of the child.
2. Depending on the characteristics of the birth canal in the mother.

Factors associated with the prenatal state of the child:

• embryofetopathy: developmental defects with hemorrhagic syndrome, venous congestion in tissues;
• hypoxic state of the fetus due to placental insufficiency;
• prematurity: tissue weakness, a small number of elastic fibers, excessive vascular permeability, liver immaturity, insufficient prothrombin, soft cranial bones;
• post-term pregnancy: hypoxia that occurred against the background of involution of the placenta.

Factors that depend on the characteristics of the birth canal of the mother:

• rigidity of tissues in the birth canal;
• irregular shape of the pelvis;
• insufficient volume of amniotic fluid;
• premature discharge of amniotic fluid.

In violation of the blood circulation of the brain, an important role is played by the difference between the pressure of the atmosphere, which affects the presenting part of the head, and the intrauterine pressure, which increases with uterine contraction. In addition, in the pathogenesis of cerebral abnormalities, dislocation syndrome is of particular importance.

The fundamental factor of genesis is mechanical damage to the contents of the skull. Even with naturally proceeding childbirth, there is some difficulty in blood circulation. And in case of pathological delivery, unfavorable factors are summed up and even a slight mechanical stimulation of the head can provoke intracranial hemorrhage in premature babies as a result of damage to blood vessels or duplications of the brain membrane.

Depending on the location of the hemorrhage are divided into:

• epidural (between the membranes of the brain and the bones of the skull);
• subdural (between the meninges and the substance of the brain);
• intraventricular (blood in the ventricles of the brain).

The consequences of birth trauma are characterized by a number of features: from small deviations in development to serious pathologies. Often, due to hemorrhage in the internal organs, anemia develops. As a result of increased heat transfer and reduced heat production, the thermoregulation system is disrupted, and newborns suffer from rapid hypothermia.

Often, natal trauma causes hypoglycemia. Physiological weight loss is compensated more slowly, signs of jaundice persist for a long time. In connection with a decrease in specific and nonspecific immunity in newborns with intracranial injuries, infectious diseases (in particular pneumonia) are common.

Recovery of a child depends on the form and degree of brain damage and on the rationality and intensity of therapy in both acute and recovery periods.

Fatal cases occur in 3-10%, while cranial trauma accounts for 97% of all cases of birth trauma with a fatal outcome.

An absolute recovery is possible. But as a rule, 20-40% of children with hypoxic CNS lesions are diagnosed with residual signs:

• delay in physical, psycho-emotional and speech development;
• cerebrasthenic syndrome with neurosis-like symptoms;
• scattered microsymptoms in the foci;
• moderate hypertension (intracranial);
• hydrocephalus (compensated or progressive);
• epilepsy.

In 7% of children with posthypoxic encephalopathy, a severe organic lesion of the central nervous system is manifested with pronounced motor disorders (cerebral palsy) and mental disorders up to oligophrenia.

Birth trauma in newborns is a common occurrence, and it is impossible to completely protect yourself from traumatism in childbirth. But you can minimize the risks as much as possible. It is necessary for obstetricians to timely identify pregnant women at risk for perinatal pathology, as well as professional and competent use of various manipulations in childbirth. It is advisable for future mothers to plan conception after the treatment of chronic diseases and to register for pregnancy in a timely manner.

Birth trauma to the head of newborns is a direct threat to the life of the child, in which drug therapy is carried out from the first minutes. The head of a child passing through the birth canal is subjected to a certain pressure. In the pathological course of childbirth, damage occurs that affects the health of the newborn.

A diagnostic examination is carried out to determine the degree of brain damage or to confirm the absence of internal injuries to the head. External injuries in the form of hematomas, abrasions, skin tears are easier to tolerate and do not imply serious consequences. An exception is subcutaneous hemorrhage with penetration under the membranes of the brain.

Causes of traumatic brain injury in newborns

A head injury in a child, the symptoms of which do not always appear from the first days of a child's life. Causes of head injuries in newborns include:

• the process of childbirth (rapid childbirth, too long a process of moving the fetus through the birth canal, pathological childbirth, trauma to pregnant women);
• specificity of the birth canal (pelvic deformities, narrow pelvis, strain of the birth canal);
• the fetus and its condition (large size of the fetus (head), pregnancy longer than expected, prematurity, intrauterine injuries complicated by compression in the birth canal).

Birth traumatic brain injury occurs as a result of compression of the bones of the skull of a newborn and their displacement. There is a pathological flow of cerebrospinal fluid from the ventricles of the brain into the cerebrospinal fluid spaces of the back, which causes pressure on the spinal cord and displacement of the brain itself. The child may develop

Symptoms of brain injury in children

Received during childbirth, traumatic brain injury in children and the symptoms that confirm this, appear immediately or along with the growing up of the child. There is no specific classification, and the condition is assessed according to the following criteria:

• the severity of the injury;
• the area of ​​the lesion;
• the origin of mechanical injury (compression when overcoming the birth canal or obstetric injury).

Head injuries during childbirth and brain damage are divided into the following gradation:

• damage to the brain tissue (in the brain or hematoma that has impregnated the medulla);
• hemorrhages or hematomas penetrating under the meninges (subdural, subarachnoid, epidural);
• traumatic brain damage;
• hemorrhage in the cerebral ventricles.

Traumatic brain injury in infants causes lethargic sleep, interrupted only by strong, specially created pain sensations. Stunning and stupor is manifested by a slight reaction to various external stimuli. In an extremely severe state - coma. The state of the cerebral fontanel and the ability to suck and swallow the newborn are also assessed.

Consequences of birth traumatic brain injury

Birth injuries of the brain in the absence of proper assistance or in complicated conditions cause pathological consequences up to the most terrible (fatal outcome). Hemorrhages under the meninges or in the tissue of the medulla can cause convulsions, disruption of the normal functioning of brain functions, mental retardation, and various types of paralysis.

The child has frequent tearfulness, a constant desire to sleep, fatigue, lethargy. At an older age, there is a decrease in memory, difficulty in learning, a violation of behavior in society.

Medical tactics

Treatment procedures for brain injury in children begin with a diagnostic examination. Treatment is carried out therapeutically, and if necessary, surgically, depending on the condition of the child and the degree of damage.

First of all, urgent symptomatic treatment is carried out. In the presence of a hematoma or liquid blood fraction, they are surgically removed under local anesthesia. Displacement of the skull bones (dents or bulges with displacement) of the newborn is also reconstructed by surgery.

Simultaneously with such procedures, drugs are prescribed that improve the condition of the brain tissue and blood vessels, as well as painkillers according to the weight of the child.

Important! Newborns in this condition are under the supervision of specialists around the clock in the intensive care unit until the condition stabilizes. The prognosis of further recovery is not stable, depending on the severity of the birth injury and the quality of the treatment.

The prognosis for birth head injuries is always serious due to high mortality and disability of the child. In order to prevent pathology, the mother needs to adhere to the correct lifestyle during gestation, eliminate bad habits that lead to underdevelopment of the skull bones. Doctors and obstetricians during childbirth should prevent asphyxia and adequately treat toxicosis of pregnant women.

The content of the article:

Birth trauma is a fairly typical phenomenon in obstetrics, which is gradually being eradicated with the development of medicine. But still, no one excludes medical errors, the characteristics of the female body and the complex course of pregnancy, which together or individually play a key role in the process of the birth of a child.

Description and types of birth injuries in children

Birth trauma is damage to the tissues and organs of the child when leaving the vagina, leading to a violation of compensatory-adaptive mechanisms or the development of a number of diseases (cerebral palsy, epilepsy). The risk group includes babies born prematurely, with low or large body weight, with fast contractions or with the use of forceps. According to statistics, this problem is detected in about 10% of all births.

There are two types of birth injuries - mechanical and hypoxic. The first are the result of exceeding the gestational age, improper position of the fetus in the uterus, too much weight of the child and anomalies in the structure of the mother's pelvis.

Hypoxic deviations are observed during oxygen starvation of the baby, which occurs due to pinching of the umbilical cord of the respiratory tract, accumulation of mucus in the mouth, or retraction of the tongue.

In medical practice, the division of all birth injuries into spontaneous ones, which occur during normal childbirth, and neonatal ones, due to pre-identified anomalies in the development of the fetus, is widespread. An unexpected problem suggests the guilt of the obstetrician, since in most cases it makes itself felt during unprofessional manipulations of the doctor (too much pressure on the fundus of the uterus, inaccurate use of forceps, etc.).

Most often injured:

• Skeleton bones. During childbirth, the hip, collarbone, and brachial plexus can be damaged, which manifests itself in their dislocation, fracture, or cracks.
• soft tissues. Bruises, hematomas, bruises, subcutaneous hemorrhages - all this accompanies this type of injury. It is not as dangerous as, for example, damage to the central nervous system, because the violation of the integrity of the dermis is quite easily eliminated and allows you to quickly establish a normal lifestyle for the child. It is somewhat more difficult when ligaments are torn and muscles are stretched.
• Nervous system. It is considered the most severe of all injuries and the most life-threatening. A serious threat comes from intracranial hemorrhages, hypoxia and apnea.
• Internal organs. The adrenal glands, spleen, liver are mainly affected, in rare cases, pathologies of the heart, kidneys, spleen, pancreas develop, which can be compressed and even torn as a result of mechanical influences.
• cervical. Such a problem in terms of frequency of distribution is in second place after damage to the central nervous system. This is due to the vulnerability of this part of the spine, which is sensitive even in adults, and even more so in children. Difficulties are also created by the fact that most often the baby is removed precisely by the neck.
• Scull. The injury may be due to an abnormal condition of the woman's birth canal, her narrow pelvis, or premature rupture of the water bladder. As a result, the integrity of the vessels of the head is violated and cerebral circulation worsens. Often after childbirth, a tumor or cephalohematoma is fixed, although the latter tends to resolve.
• Spine and spinal cord. The most dangerous, but at the same time rare, is a fracture of the spine. This can manifest itself in paralysis of the limbs and asymmetry of the shoulder girdle. Such a birth injury of the spine leads to complete or partial disability of the child.

Note! The risk of a baby being harmed is much lower with a caesarean section than with a natural birth.

Causes of birth trauma in children

They are caused by the mistake of the doctor, the course of pregnancy and the characteristics of the body of the woman in labor. The so-called maternal factors include too early (up to 20 years) or too late age (from 40 years) of a woman. Hypoplasia of the uterus is not excluded, which in this case is called a child because of its small size. Various endocrine and cardiovascular diseases also do not contribute to normal childbirth. The situation is aggravated by a narrow pelvis and an inflection of the uterus (hyperanteflexia). The work of the expectant mother in the hazardous industries of the chemical or oil industry will not be in hand either.

The following fetal pathologies can also exacerbate the situation:

1. breech presentation. We are talking about the position of the fetus with the genitals to the pelvis of the woman in labor. It is finally possible to confirm this only at the 32nd week of gestation, since before that the baby can change position.
2. oligohydramnios. It occurs in about 4% of all pregnant women and is easily detected on a planned ultrasound. Symptoms of this condition are pain in the abdomen at the beginning of the second trimester.
3. Big weight. Normal body weight is from 2.6 to 4 kg. With its increase, childbirth is delayed, which may lead to the need to use forceps, and this is one of the factors of injury.
4. prematurity. You can talk about it if the baby was born before the 37th week of pregnancy. In this case, the 1st degree is placed, with delivery before the start of the 27th week, the 4th degree is determined. The most critical body weight in this case is 1000 g.
5. hypoxia. This is a lack of oxygen, which, if not reacted in time, can lead to immersion of the baby in a coma and damage to the nervous system. All this can be provoked by compression of blood vessels, through which blood is simply not able to flow to organs and tissues in the normal mode.
6. Asphyxia. This refers to the usual suffocation as a result of a violation of the respiratory function. Most often, it is caused by anomalies in the development of the fetus, intrauterine infections in the form of syphilis, rubella, herpes, and maternal nicotine addiction.

Anomalies of labor activity are of great importance, one of the manifestations of which is a prolonged pregnancy.

Childbirth occurring at 35-40 weeks is a variant of the norm and does not cause anxiety among obstetricians. But after this period, symptoms of a late birth of a baby may occur: dense bones of the child's skull and the so-called intestinal discharge, an immature cervix in the mother. Labor that is too fast (30-60 minutes) or too long (more than 5 hours) also increases the chance of injury.

Far from last are obstetrician errors, among which the most common damage to the head or neck with forceps, too small an incision during cesarean section, turning the fetus on a leg, which is necessary to change the incorrect position of the baby in the womb. The condition of the child is also threatened by the use of a vacuum extractor, which creates pressure between the inner surface of its calyx and the head of the fetus. This is encountered when the moment of caesarean section has already been missed, but the use of forceps is still premature.

Note! In most cases, several unfavorable factors are combined at once, which have not been identified and, if possible, eliminated even before the onset of childbirth.

Symptoms of birth trauma in newborns

Damage to the skull may indicate a violation of the central nervous system, and the spine - paralysis of the legs.

The affected soft tissues have only external defects in the form of hematomas and swelling and do not cause serious damage to health. The pain syndrome is almost always present, so the child becomes restless and cries a lot.

The main clinical manifestations of various injuries are listed below:

• CNS damage. It is closely associated with intracranial birth injuries, when cerebral edema, internal hemorrhages, and hypoxia are recorded. In severe forms, paralysis, mental retardation and slow physical development of the baby are observed. In the first moments after birth, the problem is indicated by the anxiety and cry of the child, tremor of the arms and legs, depressed reflexes of swallowing and sucking, low muscle activity, pallor of the skin and drowsiness. Often there are frequent bouts of apnea. With hypoxia lasting more than 7-10 minutes, brain cells gradually die off, which leads to death.
• Skin problems. Hemorrhage in tissues, hematomas, abrasions, swelling on the body and local edema, especially on the baby's head, impaired integrity of the dermis, scratches - all this is included in the clinical picture with birth injuries of soft tissues.
• bone fractures. They can be caused by strong pressure on the fetus, a narrow pelvis in a woman in labor, weak labor activity, and late turning on the leg. In this case, there is a significant limitation in the activity of the baby's movements, severe crying and paralysis of the limbs. On palpation, swelling is felt in the area of ​​​​the problem area. All this creates the basis for diagnosing a birth injury of the cervical or lumbar.
• cephalohematoma. This is a postpartum hematoma that occurs when a hemorrhage occurs in the layer between the flat bones of the skull and the connective tissue. As a result, swelling on the head is noticeable, which in about half of all cases resolves on its own in the first 2-3 days. Otherwise, a sharp increase in the tumor is possible, requiring puncture and drainage.
• Violation of the internal organs. The insufficiency of the functions of the intestines, liver, heart, spleen and stomach provokes vomiting and nausea, arterial hypotension, bloating, muscle atony.

In the first hours after birth, a birth injury is diagnosed only with literal signs in the form of, for example, fractures, hematomas, and hemorrhages. All other symptoms appear after a few days or even years. Children who have experienced unsuccessful childbirth are often worried about severe migraines, dizziness, insomnia, gallbladder bending, and scoliosis.

Features of the treatment of a child with birth trauma

To diagnose the disease, ultrasonography and radiography are used, which are especially informative in case of damage to the skull. First of all, you need to consult a pediatrician and a surgeon. Treatment begins with proper care: in the first days, the baby is weaned from breast milk, fed with a spoon or pipette to save energy. The volume of the resulting liquid is reduced to 100-150 ml. Therapy includes medication and physiotherapy, in the most extreme cases surgery is required.

The use of medications for birth injuries

With petechiae and ecchymosis on the head, the child is not given a breast for three days and is placed in a hospital. As a rule, during this time they resolve themselves, and control is needed in order to avoid hemorrhage in the meninges.

For bruises and abrasions, treatment of problem areas with antiseptic and decongestant solutions is indicated, which helps to relieve inflammation and sanitize wounds, for example, Miramistin. The course is selected by the doctor, but on average its duration is a week.

To prevent complications, calcium, aminocaproic acid, ascorutin and vikasol are prescribed. In the case of large cephalohematomas, all fluid is first sucked out of them, and then antibiotics are administered by puncture. After that, a sterile dressing is applied. The procedure is performed on the 8-12th day of the baby's life.

For deep lesions, injections of B vitamins are given. If adiponecosis is diagnosed, alpha-tocopherol helps.

Acute spinal cord injuries require intravenous administration of hemostatic drugs, with manifestations of enuresis, it is necessary to add diuretics to the regimen. The condition, accompanied by large blood loss, needs to replenish iron deficiency and drugs that lower the level of bilirubin.

The pain syndrome is relieved by promedol, analgin, fentanyl, relanium or seduxen, administered intramuscularly 2-3 times a day. To accelerate tissue regeneration, paraffin and ozocerite are used in the form of applications.

Physiotherapy for birth injuries

Especially useful are water and thermal procedures, electric shock, immobilization, taking baths with herbs, applying antiseptic dressings. In addition, it is recommended to do a massage and contact an osteopath for acupuncture. Also very effective is therapeutic massage and exercise therapy.

Let's take a closer look at each procedure:

1. Sollux. It is indicated for focal necrosis of the subcutaneous fat and involves local irradiation of the affected areas of the body, as well as deep thermal effects on the tissues. Severe pathologies are treated with a large Sollux, and mild ones with a small one, in which the burner power does not exceed 300 watts. The course consists of 20 sessions, which are held in 1-2 days.
2. microwave radiation. It is often included in the treatment regimen for birth trauma of the brain, which occurs with severe hypoxia and circulatory disorders. This method is based on exposing the patient to electromagnetic waves with a length of 1 mm to 1 m. Its task is to improve the blood supply to the organ, reduce spasm of smooth muscles, relieve CNS excitation and speed up the passage of nerve impulses. The course of treatment includes 10 procedures lasting 15 minutes.
3. Dry aseptic dressings. They are relevant for damage to soft tissues, thanks to them the risk of infection is eliminated and the drying of the wound is accelerated. They are made in 2-3 layers of sterile hygroscopic gauze, the bandage is changed every day or after it gets wet until the symptoms are eliminated.
4. Immobilization. With spinal injuries, the main event is the application of a bandage with a cotton-gauze collar using the donut method. They keep it for 10-14 days, until the cartilage grows together.
5. electrophoresis. It is relevant if the cervical spine is affected. In this case, the Ratner method is used, which involves soaking the pad with a solution of 0.5-1% aminophylline and applying it to the diseased area. Another dressing is soaked in nicotinic acid and applied to the ribs near the chest. After that, the skin is exposed to a current of 3-5 mA for 5-6 minutes. The optimal duration of treatment is 10 days with a break of 2 days at the weekend.
6. Acupuncture. It can be carried out on the 8th day of life, osteopathic doctors do this. This technique allows you to stimulate cell regeneration, cartilage nutrition and oxygen penetration into tissues. This method is especially useful for spinal cord injuries.
7. Massage. To improve the effect, warm fir or olive oils are used. Vibration, kneading, stroking, rubbing are selected from the movements; in no case should you compress the skin. During the procedure, the arms, legs, abdomen, collar zone, back are worked out. It lasts about 15 minutes, only 35 sessions per year are needed. Thus, it is possible to improve the permeability of blood through the vessels, normalize the nutrition of cartilage and tissues, and enhance skin regeneration.

Medicinal baths with pine needles or sea salt are quite effective, which are recommended to be taken for 10 minutes every day until recovery. In modern medical practice, attention is paid to dolphin therapy, hippotherapy, and therapeutic exercises in the pool (hydrocolonotherapy). Spinal injuries are also treated with exercise therapy.

Surgical intervention for birth injuries

By this is meant craniotomy, which is necessary as a result of his internal injuries and injuries, for example, with a hematoma. In this case, it is gradually removed by puncture and drainage, pumping out 30-40 ml of blood at a time. The remains of the cyst are removed after the stabilization of the baby's condition. To do this, make small incisions and, controlling the progress with a microscope, organize the drainage of the liquid. The operation is performed under local or general anesthesia.

If the baby has numerous fractures, it may be necessary to restore the shape of the skull with an elevator that is inserted inside. This technique is called cranioplasty which is performed under general anesthesia. The operation lasts about an hour, during which a titanium plate is implanted, which is responsible for the shape of the skull.

Consequences of birth trauma

The most frequent and dangerous complication is damage to the central nervous system of a child, which in most cases leads to the development of cerebral palsy, epilepsy and other serious diseases. As a result, everything often ends with the disability of the baby. Retardation in physical and mental development is also quite common - underweight, asymmetric body proportions and short stature, inappropriate for age.

Among the complications, the following should be noted:

• Problems with the cardiovascular system. The thinness and ease of damage to the capillaries increase the risk of violation of their integrity and hemorrhage in the tissue. Sharp jumps in blood pressure and tachycardia are also possible.
• Skin diseases. Such children are often worried about eczema, increased dryness of the skin, atopic dermatitis, which manifests itself only over the years.
• Slow development. We are talking about both the mind and the body - slow growth and weight gain, intellectual failure, speech impairment, which may be the result of damage to the central nervous system or the pressure of a birth tumor that did not resolve in time. Often, a complete or partial absence of various reflexes is diagnosed - swallowing, chewing, etc.
• Enuresis. Urinary incontinence can disturb both day and night, while the diagnosis is difficult, the causes of the disease cannot be established.
• Unstable psycho-emotional state. In this case, the child has increased nervousness, rapid excitability, hyperactivity, sometimes replaced by apathy.

Rare complications include spasms of the extremities, dropsy of the brain, muscle atrophy, food allergies, scoliosis, and bronchial asthma.

What is birth trauma - look at the video:

Any damage to the bones, central nervous system, or birth trauma to the brain requires urgent medical attention, which reduces the risk of possible complications. At the same time, it must be borne in mind that this can manifest itself absolutely at any time, even after ten years of the absence of any symptoms. Serious violations are detected immediately and must be eliminated immediately.

Birth traumatic brain injury is the most common and severe brain injury in childbirth, accompanied by compression, crushing, rupture and, as a rule, hemorrhage and swelling of the brain.

The occurrence of birth traumatic brain injury is due to a combination of a number of adverse factors, such as perinatal hypoxia, perinatal features of hemostasis, gestational age, and the presence of intrauterine viral infections. However, it should be noted that most often it is hypoxia that is pathogenetically associated with mechanical damage to the brain. These factors are usually combined, and in some cases, damage to brain tissue is the cause of hypoxia, in others - its consequence.

The ratio of traumatic and non-traumatic hemorrhages in the brain and its soft membranes is 1:10.

Birth traumatic brain injury is classified according to:hemorrhage level

epidural (traumatic origin)

subdural (traumatic origin)

intracerebral - extensive (in the hemispheres, visual tubercles, cerebellum) and small-pointed (traumatic, hypoxic genesis, due to changes in the hemostasis system)

subarachnoid (traumatic or hypoxic origin)

intraventricular (hypoxic origin)

periventricular (hypoxic genesis)

period

acute (7-10 days to 1-1.5 months)

subacute (early recovery period 3-4 months and late 1-2 years)

outcome (recovery or organic brain damage)

severity

• medium heavy

leading syndromes depending on the period

spicy(neuroreflex excitability, excitation, depression, hypertensive, hypertensive-hydrocephalic, convulsive, cerebral coma);

subacute(asthenoneurotic, vegetative-visceral disorders, motor disorders, hydrocephalic, convulsive, delayed psychomotor or pre-speech development)

Exodus(recovery, disorders of psychomotor, neuropsychic or speech development, organic lesions - cerebral palsy, mental retardation, epilepsy, deafness, blindness, etc.).

The overall incidence of intracranial hemorrhage in term newborns is 2-4%.

In preterm infants, there are mainly periventricular (PVC), intraventricular (IVH) and intracerebral hemorrhages, the frequency of which ranges from 25-40%. In very premature newborns ( 1500 g), the frequency of PVK and IVH increases from 56 to 75%.

Clinical manifestations of intracranial hemorrhage depend on the location and size of the hematoma.

For the acute period of severe birth traumatic brain injury in full-term newborns, 4 phases are characteristic. Typical for the 1st phase: excitation of the central nervous system against the background of tolerance to sedative therapy, centralization of blood circulation, hyperventilation syndrome (tachypnea), oliguria, hypoxemia, acidosis. With the transition to the 2nd phase, CNS depression, acute heart failure with functioning fetal blood flow and edematous-hemorrhagic syndrome dominate, peripheral edema and scleroma appear. In the 3rd phase, the respiratory syndrome with persistent heart failure and the development of cerebral coma comes to the fore. In the 4th (recovery) phase, muscle tone normalizes, physiological reflexes and an emotional reaction to irritation appear. Pulmonary, cardiovascular insufficiency is eliminated, metabolic processes and electrolyte balance are restored.

In premature newborns, intracranial birth hemorrhages in the acute period proceed according to the following options: 1) asymptomatically or with a poor atypical clinical picture; 2) with a predominance of signs of respiratory disorders, apnea attacks; 3) the prevalence of the syndrome of general oppression; 4) the prevalence of hyperexcitability syndrome with focal symptoms, hypertensive-hydrocephalic syndrome

epidural hemorrhages- mostly found in term infants. They arise as a result of a fracture or cracks in the temporal bones of the skull with a rupture of the middle meningeal artery when applying obstetric forceps, mismatch of the birth canal with the size of the fetal head, anomalies of presentation.

With this hemorrhage, a light interval of up to 2-3 hours is characteristic, with a further increase in excitation syndromes, hypertensive-hydrocephalic (stiff neck muscles, tilting of the head, tension and bulging of the fontanel, divergence of cranial sutures), convulsive syndrome, focal symptoms (horizontal nystagmus, s- m "setting sun", anisocoria on the side of the hemorrhage). These syndromes are followed by growing signs of stem cerebral insufficiency (depression, coma).

FROM ubdural hemorrhages. The true prevalence is not known. It is rare, more often in overweight and overweight newborns. The causes of hemorrhage are the inconsistency of the birth canal with the size of the fetal head, rigidity of the birth canal, pathological presentation of the fetus, the imposition of obstetric forceps. Subdural hemorrhages are divided into:

1) Supratentorial - when the skull (parietal bones) is compressed or deformed, the veins that flow into the superior sagittal and transverse sinuses, as well as the vessels of the cerebellar tenon, break.

In the clinic, a light interval is possible (up to several days), then excitation syndromes, hypertensive-hydrocephalic, convulsive syndrome, hemiparesis on the opposite side of the hematoma, focal (horizontal nystagmus, "setting sun" syndrome, anisocoria on the side of hemorrhage, come to the fore, s-m Graefe, deviation of the eyes in the opposite direction of hemiparesis) symptoms with the development of stupor or coma. As the hematoma grows, attacks of secondary asphyxia, bradycardia, and violation of thermoregulation progress. Metabolic disorders in isolated subdural hematoma are not typical.

With early removal of the hematoma, the prognosis for 50-80% of children is favorable.

2) Subtentorial - rupture of the tentorium of the cerebellum and hemorrhage in the posterior cranial fossa.

The condition of the child from the moment of birth is extremely severe (catastrophic), due to the development of compression of the brain stem from the first minutes and hours of life. In the clinic, the loss of cerebral activity progresses with the development of depression syndromes (coma), hypertensive, convulsive. There are focal symptoms, rough vertical or rotatory nystagmus, fixed gaze, pupillary reaction disorders, sucking, swallowing disorders, progression of respiratory and cardiovascular disorders. Difficult-to-correct metabolic disorders.

In dynamics, the syndrome of depression is replaced by a syndrome of excitation, signs of intracranial hypertension and compression of the brain stem increase.

With a rupture of the cerebellar tentorium, a fatal outcome is usually observed, without damage to the cerebellar tentorium, a favorable outcome is possible, but with the further development of hydrocephalus due to obstruction of the CSF pathways.

Subarachnoid hemorrhages- occur when the integrity of the meningeal vessels is violated, without borders. With this type of hemorrhage, the blood settles on the membranes of the brain, causing their aseptic inflammation, which subsequently leads to a violation of liquorodynamics due to cicatricial-atrophic changes. Predisposing factors in the development of this type of hemorrhage are hypoxia, coagulopathy, vascular malformations, tumors. In 25% of cases, they are combined with linear and depressed skull fractures.

The clinical picture of this hemorrhage consists of syndromes of inhibition of cerebral activity, or hyperexcitability, hypertensive-hydrocephalic, convulsive and focal symptoms, hyperesthesia. The clinical picture develops immediately after birth. Metabolic disorders are not specific.

The prognosis for isolated hemorrhages is favorable.

Intraventricular and periventricular hemorrhages- in full-term newborns, they occur when the vessels of the plexus chorioideus rupture, due to compression and deformation of the skull in combination with hypoxia. In premature newborns, a high percentage of this type of hemorrhage is due to the fact that the lateral ventricles are lined with germinal tissue (germinal matrix). The vessels of the matrix tissue consist of only one layer of the epithelium, do not have a framework of elastic and collagen fibers, and therefore are often damaged when arterial and venous pressure increases against the background of changes in the hemostasis system. Matrix tissue is reduced by the 30th week of gestation, its islets remain until 36-39 weeks (in the region of the visual tubercles and between the caudate nuclei), and only by the year it finally disappears.

IVH and PVH occur in the first 3 days (60-75%), less often on the 2nd-4th week of life (10%). During mechanical ventilation, this type of hemorrhage can occur during the entire period of ventilation.

IVH and PVK are classified into IV degree:

subepindymal (due to ante- and intranatal hypoxia, repeated attacks of apnea, jet administration of hypertonic solutions),

intraventricular hemorrhages without their expansion (35-65%),

intraventricular hemorrhages with ventricular dilatation (12-17%),

distribution of intraventricular hemorrhages to the brain parenchyma (12-17%).

Depending on the severity of IVH, PVK, the clinical picture may be different. In 60-70% of cases, this type of hemorrhage in IVH, IVH of the 1st degree can be "clinically silent" with transient metabolic disorders and can only be detected using additional research methods. At the same time, the terms of transformation of a subependymal hematoma into a cyst are 10-14 days or more.

For a typical clinical picture of IVH, PVC II, III IV degree, depression syndromes, hypertensive-hydrocephalic, convulsive, focal symptoms (fixed gaze, horizontal or vertical, rotatory nystagmus, lack of pupillary response to light) are characteristic, followed by an increase in the excitation syndrome, as well as the development CNS depression.

The prognosis for IVH and PVK I degree is favorable. IVH and PVH of III-IV degree have a much worse prognosis - the survival rate of children is 50-70% and 20-40%, respectively.

intracerebral hemorrhage arise due to damage to the terminal branches of the anterior and posterior cerebral vessels, hypoxia, and disturbances in the hemostatic system.

Clinical manifestations depend on their size and localization. With punctate hemorrhages in the hemispheres, the clinic may be asymptomatic or mild: there is lethargy, regurgitation, impaired muscle tone, decreased reflexes, unstable focal symptoms (nystagmus, anisocoria, Grefe's s.), focal convulsions. Extensive intracerebral hematomas are accompanied by pronounced focal symptoms (anisocoria, strabismus, horizontal or vertical, rotatory nystagmus) and cerebral (hypotension, adynamia, hypo- or areflexia, unilateral convulsions in the face, limbs, more often upper ones) up to the development of coma.

In the case of intracerebellar hemorrhages, the course is asymptomatic, in the case of hemorrhages in the marginal parts of the cerebellar hemisphere - with increasing intracranial hypertension. With massive hemorrhages in the cerebellar hemispheres, compression of the brain stem with respiratory and cardiovascular disorders, bulbar and oculomotor disorders is noted.

Metabolic disorders are not specific.

BIRTH INJURY (trauma obstetricum; Greek trauma wound, mutilation) - damage to tissues and organs of the fetus during childbirth, due to pathology of the intrauterine or intranatal period.

The frequency of R. t., according to I. S. Der-gachev (1964), ranges from 2.1 to 7.6% of the number of children born alive, and 40.5% of the number of stillborn and dead newborns. According to I. II. Elizarova (1977), birth trauma is the direct cause of death for 0.2% of term infants and 1.4% of premature infants born alive. Among the causes of perinatal mortality (see) birth trauma, according to E. I. Andreeva (1973), is approx. eleven%.

The factors predisposing to R.'s emergence of t. are various patol. conditions of a fruit, the special place among to-rykh is occupied with a hypoxia (see), promoting increase in permeability of vessels (see. Asphyxia of a fruit and the newborn). Unfavorable course of pregnancy, inf. illnesses, cardiovascular and endocrine diseases of mother, toxicoses of pregnant women, Rhesus incompatibility, prematurity and prolongation of pregnancy cause a state hron. hypoxia and a decrease in the adaptive abilities of the fetus. In such cases, even normally proceeding childbirth can have a damaging effect on the fetus. In the pathogenesis of R. t., the leading role belongs to two factors: mechanical influences that occur during the passage of the fetus through the birth canal and during obstetric interventions, and circulatory disorders of a general and local nature caused by intrauterine hypoxia. Mechanical effects on the fetus, exceeding its stability, occur with a significant discrepancy between the size of the fetus and the mother's pelvis (clinically or anatomically narrow pelvis, etc.), anomalies of preposition (extensor presentation: anterior parietal, frontal, facial), with prolonged and rapid labor, and as well as violations of the technique of obstetric delivery operations and benefits (imposing obstetric forceps, a vacuum extractor, turning the fetus on a leg, providing assistance with breech presentation).

Distinguish R. t. of the nervous system (craniocerebral birth injury, birth injury of the spine and spinal cord, birth injury of the peripheral nervous system), soft tissues, bones, internal organs, etc.

Traumatic brain injury

Traumatic brain injury - damage to the brain of a newborn during childbirth, often against the background of intrauterine fetal hypoxia. Due to damage to the vessels of the brain and its membranes, subdural, primary subarachnoid, intracerebral (intra-, periventricular and intracerebellar) hemorrhages occur.

subdural hemorrhage occurs with ruptures of the cerebellum, direct, transverse, occipital and lower sagittal sinuses, great cerebral vein (Galen's vein), superficial cerebral veins. Blood pouring out under the dura mater leads to compression and displacement of the brain. Subdural hematomas (see. Intrathecal hemorrhages) can be unilateral or bilateral, combined with parenchymal hemorrhages resulting from hypoxia.

With a rapid increase in hematoma, the condition of the newborn is extremely severe, symptoms of compression of the brain stem, pallor of the skin, cold extremities, tachypnea (see), bradycardia (see), arrhythmia (see. Arrhythmias of the heart), weak filling of the pulse. There is muscle hypotension, inhibition of unconditioned reflexes, periodic vomiting, sometimes opisthotonus (see), convulsions (see). The deviation of the eyeballs, which does not disappear when the head is moved, anisocoria (see), sluggish reaction of the pupils to light (see Pupillary reflexes) are characteristic. Within minutes or hours as the hematoma increases, a coma develops (see). Pupil dilation is observed, symptoms of damage to the lower sections of the brain stem appear: arrhythmic breathing, pendulum eye movements. A lethal outcome can occur on the first day due to compression of the vital centers of the brain stem. With a gradual increase in hematoma nevrol. violations may appear by the end of the first day or even after a few days. Excitation, regurgitation, vomiting, arrhythmic breathing, bulging of a large (anterior) fontanel, Graefe's symptom, sometimes focal convulsive seizures, hyperthermia are observed.

At a rupture of superficial cerebral veins a wedge, manifestations depend on the size of a hematoma. A small hematoma causes mild agitation, sleep disturbance, regurgitation. In more severe cases, focal symptoms appear on the 2-3rd day - convulsions, hemiparesis (see Hemiplegia), deviation of the eyeballs in the direction opposite to hemiparesis. Sometimes note the defeat of the III pair of cranial (cranial, T.) nerves, manifested by mydriasis (see). Symptoms of damage to the brain stem often indicate an infratentorial hematoma resulting from a rupture of the cerebellar tentorium. Symptoms characteristic of damage to the cerebral hemispheres indicate a convexital subdural hematoma. Wedge, the diagnosis is confirmed by a puncture of subdural space, craniography (see), echoencephalography (see), computed tomography of the brain (see Computer tomography).

Differential diagnosis of subdural hematoma is carried out with intrauterine brain damage, abscess, brain tumor (see Brain), meningitis (see).

At breaks cerebellum, sinuses of the dura mater, falx of the brain, causing severe damage to the brain stem, the prognosis for life is usually unfavorable. However, early removal of the hematoma can save the newborn. With a superficial subdural hemorrhage, the prognosis is favorable if a subdural puncture is performed in a timely manner, a hematoma is removed and intracranial pressure is reduced (see). If subdural puncture fails, neurosurgical intervention is necessary (see Craniotomy). In the future, subdural hemorrhage can cause hydrocephalus (see), focal nevrol. symptoms, delayed psychomotor development.

Primary subarachnoid hemorrhage in contrast to the secondary, associated with intra- and periventricular hemorrhages, aneurysm rupture, occurs as a result of damage to large and small vessels of the soft meninges (see). More common in premature babies. In the development of primary subarachnoid hemorrhage, brain tissue hypoxia is of great importance. The hemorrhage is located between the protruding areas of the brain, more often in the region of the temporal lobes and in the posterior cranial fossa. The brain tissue is edematous, the vessels are overflowing with blood. Severe primary subarachnoid hemorrhage is sometimes accompanied by co-agulopathy, exacerbating the severity of the child's condition.

Nevrol. disorders vary depending on the size of the hemorrhage and the presence of other hemorrhages. The small subarachnoid hemorrhage is characterized by minimum nevrol. symptoms: regurgitation, slight tremor when changing body position, increased tendon reflexes. Sometimes nevrol. symptoms appear on the 2-3rd day after the baby is put to the breast. A more massive hemorrhage is often combined with asphyxia (see Asphyxia of the fetus and newborn) or is its cause, accompanied by agitation, regurgitation, vomiting, tremor, sleep disturbance, convulsions. Seizures are more common in term infants, usually on the 2nd day of life. There is an increase in muscle tone, hyperesthesia, stiff neck, spontaneous Moro and Babinski reflexes. The pathology of the cranial nerves is manifested by strabismus (see), nystagmus (see), Graefe's symptom. On the 3rd-4th day after birth, Harlequin syndrome can be observed - a transient (from 30 seconds to 20 minutes) periodically recurring discoloration of the skin of half of the body of the newborn from pink to cyanotic, most pronounced when the child is positioned on its side. When the color of the skin changes, the child's well-being is not disturbed.

The diagnosis is established on the basis of a wedge, manifestations, the presence of blood and increased protein content, and then cytosis in the cerebrospinal fluid (see), the results of computed tomography of the brain ultrasound.

Treatment in the acute period is aimed at correcting cardiovascular, respiratory, metabolic disorders and stopping bleeding. A lumbar puncture is indicated to reduce intracranial pressure and remove blood. If inflammatory changes are detected, antibiotic therapy is carried out. With the ineffectiveness of conservative therapy and the progression of hydrocephalus, surgery is indicated (see Hydrocephalus).

The prognosis depends on the severity of hypoxia and brain damage. With subarachnoid hemorrhage, accompanied by mild hypoxia, the prognosis is favorable. With prolonged hypoxia of the brain, newborns often die. Surviving children have hydrocephalus, convulsions, and movement disorders.

intracerebral hemorrhage. Intraventricular and periventricular hemorrhages are more common in preterm infants. Their development is facilitated by the immaturity of the choroid plexuses of the ventricles of the brain. Violation of self-regulation of cerebral blood flow (see. Cerebral circulation), most pronounced in conditions of hypoxia, easily leads to an increase in blood pressure and rupture of blood vessels. In premature infants, hemorrhages often occur in the region of the caudate nucleus, in full-term infants, in the region of the choroid plexus of the lateral ventricle. With periventricular hemorrhage, in 75% of cases, the penetration of the outflowing blood into the ventricles of the brain is noted. Blood, passing through the holes of Magendie (median aperture of the fourth ventricle) and Luschka (lateral aperture of the fourth ventricle), accumulates in the posterior cranial fossa. As a result of it in some weeks the obliterating fibrous arachnoiditis develops (see), to-ry further causes disturbance of outflow of cerebrospinal liquid.

Nevrol. symptoms depend on the extent of the hemorrhage and the speed of its spread through the ventricles of the brain. At the lightning current a wedge, symptoms develop within several minutes or hours. The newborn is in a coma, there are arrhythmic breathing, bradycardia, decreased blood pressure, gaze paresis, sluggish pupillary reaction to light, tension of the large fontanel, muscle hypotension, tonic convulsions, a sharp inhibition of unconditioned reflexes (children do not suck and do not swallow), metabolic acidosis ( see), violation of water and electrolyte balance (see Water-salt metabolism), hypo- or hyperglycemia (see Hypoglycemia, Hyperglycemia). Cases with slower development a wedge, pictures can be observed. With intraventricular hemorrhage, 50% of newborns have almost no symptoms. To clarify the diagnosis, a spinal puncture is performed (cerebrospinal fluid is bloody in the first days, then xanthochromic, with a high protein content and a low glucose content), ultrasound and computed tomography of the brain.

Intraventricular hemorrhages arise and develop in the first two days of a newborn's life, therefore, it is advisable to carry out preventive measures (maintaining metabolic homeostasis, normalizing blood pressure, ensuring constant ventilation, limiting unnecessary manipulations with the child).

Urgent measures in the acute period are aimed at preventing gpovolemia (intravenous fluids), lowering intracranial pressure (using glycerol, magnesia, mannitol) and correcting metabolic disorders with oxygen therapy (see), the introduction of sodium bicarbonate, glucose, electrolytes. These activities should be carried out with great caution because of the possible paradoxical reaction. Subsequently, repeated spinal punctures are performed to remove blood elements, reduce intracranial pressure and control the composition of cerebrospinal fluid, and also administer drugs that prevent the development of hydrocephalus (diacarb, lasix, glycerol). If the expansion of the ventricles of the brain stops, treatment is continued for 3-4 months. and more. When prescribing dehydrating agents, it is necessary to monitor the osmolarity of the blood, the content of sodium, glucose, nitrogen, and urea in it. With the ineffectiveness of conservative therapy and the development of hydrocephalus, neurosurgical intervention is resorted to.

The prognosis depends on the severity and extent of the hemorrhage.

With massive hemorrhage, newborns often die. In other cases, the prognosis is more favorable, but in the future, hydrocephalus and delayed psychomotor development are possible. The defeat of the periventricular white matter leads to spastic paralysis (see Paralysis, paresis).

intracerebellar hemorrhage more common in premature babies. Softness of the bones of the skull, abundant vascularization of the cerebellum and impaired vascular auto-regulation, as well as hypoxia, which contributes to cardiovascular disorders, increase pressure in the vessels of the brain, predispose to its occurrence. Pathological anatomical examination reveals rupture of the vessels of the cerebellum, the great vein of the brain or the occipital sinus.

In a wedge, the picture is dominated by symptoms of damage to the brain stem: pendulum-like eye movements, abduction of px to one side, damage to the caudal group of cranial nerves (IX-XII pairs). Apnea and bradycardia result from involvement in patol. medulla oblongata process.

The diagnosis is established on the basis of a wedge, pictures, detection of blood in cerebrospinal fluid and computed tomography, confirming the presence of blood in the posterior cranial fossa. At a hematoma in the field of a cerebellum (see) the lumbar puncture should be made with care since at the same time wedging of tonsils of a cerebellum in a big occipital opening (see. Dislocation of a brain ) is possible.

Treatment consists in evacuating the hematoma from the posterior cranial fossa. Efficiency of treatment depends on weight nevrol. disorders and the degree of dysfunction of other organs and systems.

The prognosis is unfavorable, mortality in the acute period is high. In those who have undergone intracerebellar hemorrhage, disorders caused by destruction of the cerebellum are further detected.

Birth trauma of the spine and spinal cord

Birth injury of the spine and spinal cord often occurs with breech presentation of the fetus in cases where the extension angle of the head exceeds 90°, which may be due to a congenital anomaly of the cervical spine, severe muscular hypotension. With head presentation R. t. of the spinal cord occurs when abdominal obstetric forceps are applied. Spinal cord injury during childbirth occurs as a result of intense longitudinal traction (with breech presentation) or torsion (with head presentation).

In the acute period, there is swelling of the meninges and the substance of the spinal cord, epidural and intramedullary hemorrhages, which can be combined with stretching and rupture of the spinal cord, separation of the anterior and posterior roots of the spinal nerves. Spinal injuries are much less common. Later, fibrous strands form between the dura mater of the spinal cord and the spinal cord, foci of necrosis in the tissue of the spinal cord, followed by the formation of cystic cavities. With breech presentation, the lower cervical and upper thoracic segments of the spinal cord are more often damaged, with the head presentation - the upper cervical segments; changes can also be observed throughout the spinal cord. By determining the level of sensitivity to a prick, you can set the upper limit of damage to the spinal cord. Trauma in the region of the upper cervical segments can be combined with intracranial injuries (rupture of the cerebellar tenon, damage to the cerebellum).

Nevrol. symptoms depend on the location and severity of the injury. In severe cases, symptoms of spinal shock are observed (see Diaschiz): severe lethargy, weakness, weak cry, depression of the chest, paradoxical breathing, retraction of the intercostal spaces, bloating. There is a sharp muscular hypotension, the absence of tendon and unconditioned reflexes. Spontaneous movements are weak or absent, but the withdrawal reflex in response to a prick may be enhanced. There is a violation of the function of the upper limbs: in some cases - asymmetry of muscle tone, spontaneous movements, in others - the preservation of the function of the biceps of the shoulder with paralysis of the triceps, which is manifested by a characteristic flexion of the arms against the background of muscle hypotension. Sometimes paresis of the hands (“pistol” posture) is detected with relatively intact movements in the proximal parts of the arms. In the first days of life, bladder dysfunction is noted. With simultaneous injury of the spinal cord and brachial plexus, Duchenne-Erb paralysis (see Duchenne-Erba paralysis), Dejerin-Klumpke (see Dejerin-Klumpke paralysis), paresis of the diaphragm, Bernard-Horner syndrome (see Bernard-Horner syndrome) are observed. With a combination of trauma to the upper cervical segments of the spinal cord with damage to the brain stem, there is no spontaneous respiration, therefore, artificial ventilation of the lungs is used (see Artificial respiration).

At easy injuries of a spinal cord nevrol. symptoms are mild. There is a transient muscular hypotension, a weakened cry, slight respiratory disturbances. In the future, in some children, muscle hypotonia and areflexia (see) persist for a long time, in others, after a few months, muscle tone increases in the affected limbs (see), tendon reflexes increase (see), clonuses appear (see) and patol. reflexes (see Pathological reflexes).

The diagnosis is established on the basis of a characteristic wedge, a picture and data of a myelography (see), by means of a cut in the first days of life it is possible to reveal the block of subarachnoid space which arose as a result of hemorrhage, and further - a local atrophy of a spinal cord. At rentgenol. a study in the lateral projection sometimes determines the displacement of one of the vertebrae from the midline.

Differential diagnosis should be carried out with Werdnig-Hoffmann's disease (see Amyotrophy), congenital myopathies (see) and anomalies in the development of the spinal cord (see).

Treatment consists in immobilization of the spine (see) with a complete restriction of the mobility of its cervical region, the appointment of hemostatic agents. With the development of persistent focal neurol. violations require long-term rehabilitation measures. The prognosis depends on the severity of the spinal cord injury.

Birth trauma of the peripheral nervous system

Birth trauma of the peripheral nervous system includes obstetric paresis of the hands, paresis of the diaphragm, and mimic muscles.

Obstetric paresis of the hands- dysfunction of the muscles of the upper limbs due to damage in childbirth of the peripheral motor neuron of the anterior horn of the spinal cord. Their frequency is 2-3 per 1000 newborns. Depending on the localization, the upper type of Duchenne-Erb is distinguished (see Infantile paralysis, Duchenne-Erba paralysis), the lower type of Dejerine-Klumpke (see Infantile paralysis, Dejerine-Klumpke paralysis) and the total type of obstetric paresis. The latter develops as a result of injury to the superior and inferior trunks of the brachial plexus or Cv-Thi spinal nerve roots and is the most severe. With this type of obstetric paresis, all the muscles of the arm are damaged and there is a complete absence of active movements in the acute period, muscle atrophy develops early, especially in the distal limbs, pain and temperature sensitivity in the lower part of the shoulder, forearm and hand is reduced, tendon reflexes are not caused .

Treatment should begin as early as possible, it should be comprehensive and continuous. Apply orthopedic styling, exercise therapy, massage, drug therapy.

The prognosis in mild cases is favorable, the restoration of function begins from the first days of life and after 3-5 months. the range of active movements becomes complete (sometimes muscle weakness persists for a long time). In severe cases, recovery is usually incomplete due to degeneration of nerve fibers, muscle atrophy, and developed contractures.

Diaphragm paresis(Cofferat's syndrome) - restriction of the function of the diaphragm as a result of damage to the phrenic nerve (usually the left) or the roots of the spinal nerves C3-C4. Manifested by repeated bouts of cyanosis, rapid, irregular breathing, bulging of the chest and neck on the side of the lesion, paradoxical breathing. During auscultation on the side of the paresis, weakened breathing is heard, sometimes single wheezing in the upper sections of the lungs. Paresis of a diaphragm is often found only at rentgenol. examination of the chest by the high standing of the diaphragm, its paradoxical movement (raising the paralyzed half of the diaphragm during inhalation and lowering during exhalation) and atelectasis at the base of the lung on the side of the lesion. Paresis of the diaphragm is often combined with obstetric paresis of the upper hand type (see Duchenne-Erba paralysis).

Treatment is the same as for other types of peripheral paralysis (see Infantile paralysis).

Paresis of mimic muscles as a result of damage to the facial nerve, it occurs due to prolonged standing of the head in the birth canal, pressing it against the bones of the mother's pelvis, compression with obstetric forceps, hemorrhage in the nerve trunk or in the medulla oblongata, as well as a fracture of the temporal bone in the mastoid process.

Peripheral paresis of a traumatic nature tend to recover quickly, sometimes without specific treatment. With pronounced changes, physiotherapy and drugs are used (see Infantile paralysis).

The children who transferred R. of t. of a nervous system need treatment in the conditions nevrol. hospital for newborns and infants and in the subsequent dispensary observation of a neuropathologist.

Neurological disorders and mental disorders in the late period of birth trauma of the nervous system

The following nevrol belong to them. disorders: hydrocephalus (see), convulsions (see), childhood paralysis (see), delayed age-related psychomotor development, isolated lesions of the cranial nerves, small brain and cerebellar disorders (see Cerebellum).

The delay in psychomotor development at an early age is manifested by a delay in the formation of motor and mental functions. It can be total, when the delay in the development of those and other functions occurs relatively evenly, or partial, in which the motor development lags behind the mental one, or vice versa. One can also observe the disproportion of development within one functional system. For example, within the limits of a motor function, the formation of static functions is delayed, and voluntary movements develop in a timely manner. Damage to the cranial nerves is manifested by divergent strabismus (see), ptosis (see) with damage to the oculomotor nerve (see), convergent strabismus with damage to the abducens nerve (see), central and peripheral lesions of the facial nerve (see), bulbar paralysis with damage to the glossopharyngeal nerve (see), vagus nerve (see), hypoglossal nerve (see). Often, lesions of the cranial nerves are combined with motor and mental disorders, but they can also be isolated.

Minor brain disorders are manifested by asymmetry of muscle tone, skin and tendon reflexes, voluntary movements, motor clumsiness of the hands, and gait disturbance. These changes can be combined with insufficiency of higher cortical functions (speech, attention, memory, etc.).

Mental disorders in traumatic brain birth trauma

Mental disorders in traumatic brain birth trauma are expressed in various manifestations of the psychoorganic syndrome (see). In childhood, they correspond to syndromes of early cerebral insufficiency or an organic defect. Expressiveness of a psychoorganic syndrome as well as nevrol. symptoms, with R. t. depends on the severity and location of brain damage (ch. arr. hemorrhages). There are no reliable data on the frequency of mental disorders caused by craniocerebral R. t.

Mental disorders in the late period of craniocerebral R. t. are manifested by conditions characterized by intellectual insufficiency (oligophrenia, secondary mental retardation, etc.), conditions with a predominance of behavioral disorders (psychopathic syndromes), conditions accompanied by convulsive manifestations (epileptiform syndromes, symptomatic epilepsy), as well as asthenic conditions and psychotic disorders.

The oligophrenia connected with R. t. meets rather seldom. Its distinctive feature is the combination of mental underdevelopment with signs of a psychoorganic syndrome (asthenic, psychopathic, epileptiform disorders) and residualorganic neurol. symptoms. The structure of dementia seems to be more complex than in simple (uncomplicated) oligophrenia (see). In hard cases a wedge, a picture in many respects corresponds to organic dementia (see. Dementia ).

Secondary mental retardation that occurs on residual organic grounds is characterized by milder intellectual insufficiency and the reversible nature of disorders compared to oligophrenia. Clinically they are expressed in delays in the rate of mental development, in particular in the form of organic mental (or psychophysical) infantilism (see).

Psychopathic-like syndromes in the late period of R. t. are characterized by a predominance of emotional-volitional disorders and special psychomotor agitation. Most often, increased excitability, motor disinhibition, instability, increased gross drives are observed, combined with variously pronounced asthenic disorders, and sometimes with a decrease in intelligence. Aggressiveness and brutality are also characteristic. In the conditions of neglect and an unfavorable microsocial environment, various patol easily arise on this basis. reactions and pathological development of personality (see).

Epileptiform manifestations in the late period of R. t. are varied and expressed to varying degrees, depending on the location and severity of brain damage. The mental disorders accompanying them are also heterogeneous: along with an organic decrease in the level of personality (see Psychoorganic syndrome), epileptic personality changes are possible, especially in cases of malignant symptomatic epilepsy (see).

Asthenic conditions are observed in almost all forms of long-term effects of craniocerebral R. t. Usually they manifest themselves in the form of a protracted asthenic syndrome (see). A significant place in the clinical picture belongs to other neurosis-like disorders, a distinctive feature of which is their lability and reversibility. However, under the influence of unfavorable external and internal factors (infections, traumas, psychogenies, age-related crises, etc.), decompensation of the state can easily occur.

Psychotic disorders in the remote period of R. t. are rare and have a complex pathogenesis. Certain value has, apparently, and hereditary predisposition. Wedge, the picture in many respects corresponds to organic psychoses (see), in particular to periodic and episodic psychoses on organically defective soil. Prolonged forms often occur with various schizophrenia-like patterns.

Treatment of mental disorders is usually symptomatic. Of great importance are dehydration, restorative and stimulating therapy. If necessary, anticonvulsants and psychotropic drugs are used, including nootropics. For social readaptation, therapeutic and pedagogical measures and special teaching methods are of great importance.

The forecast of the mental disorders caused by R. t., depends on weight of initial damage of a brain and features a wedge, pictures. In mild cases, it is relatively favorable.

Prevention nevrol. and mental disorders comes down to R.'s prevention of t.

Birth injury of soft tissues

A birth tumor refers to damage to the soft tissues of the presenting part of the fetus and is characterized by edema and often hematoma. A hematoma formed under the periosteum of one of the bones of the skull on its surface is called cephalhematoma (see). A birth tumor (see Caput succedaneum) is more often located on the head of the fetus in the parietal and occipital regions. Unlike cephalhematoma, edema in a birth tumor can spread beyond one cranial bone. When other parts of the fetus are presented, the birth tumor occurs, respectively, on the face, buttocks, perineum, and lower leg. Wedge, manifestations depend on its sizes and localization, and also from a combination with other types of R. of t.

With breech presentation, a birth tumor occurs in the genital area (large and small labia - in girls, scrotum and testicles - in boys). Hemorrhage in the scrotum and testicles may be accompanied by pain shock.

With facial presentation, the birth tumor is located in the forehead, eye sockets, zygomatic arches, mouth, sometimes accompanied by significant swelling of the conjunctiva and mucous membrane of the lips, petechial and larger hemorrhages, often combined with a traumatic brain birth injury. Swelling of the mucous membrane of the lips makes sucking difficult, the child is fed through a tube. In the treatment of a birth tumor, local cold is used, inside hemostatic agents (calcium chloride, rutin, vikasol).

Usually, the birth tumor resolves on the 2-3rd day of the child's life.

Often during childbirth, hemorrhages in the sclera are observed, to-rye occur in large newborns with difficult passage of the shoulder girdle through the birth canal of the mother, as well as with rapid childbirth and tight entanglement of the umbilical cord around the neck. Hemorrhages in the sclera of one or both eyes are crescent-shaped. At such disturbances apply oxygen therapy (see), hemostatic means, washing of a conjunctiva with 2% solution of boric to - you. Hemorrhages resolve within 12-14 days.

Hemorrhages in the retina are combined with craniocerebral R. t. In the study of the fundus (see) in this case, edema of the optic disc, vein dilation and the presence of foci of hemorrhages can establish intracranial hypertension. Newborns with retinal hemorrhage require dehydration therapy.

Injuries to the skin and subcutaneous tissue occur as a result of compression and are localized in places where tissues are pressed against the cape of the sacrum of the mother's bone pelvis, as well as in the area where monitor electrodes, obstetric and skin-head forceps, and a vacuum extractor cup are applied, which is especially unfavorable. Areas of damaged skin are treated with 0.5% alcohol solution of iodine and a dry aseptic bandage is applied. With the formation of blisters with hemorrhagic contents, ointment dressings with 1% synthomycin emulsion, antibiotic therapy are indicated.

Aseptic necrosis of the subcutaneous tissue in the form of confluent nodular seals and bright hyperemia of the skin over them is noted in the subscapular region and the region of the shoulder girdle. Its reason is the prelum of fabrics of the child, as a result to-rogo there is an accumulation of sour products of an exchange and loss fatty to - t (stearic and palmitic) with formation of oleogranulomas. It is more often observed in large fetuses, as well as in fetuses that have undergone diabetic fetopathy (see). The prognosis is favorable. Infection usually does not occur. Perhaps complete resorption of areas of compaction after 2-3 weeks. or partial impregnation with calcium salts. Ointment dressings and warm baths contribute to the resorption of seals. If infection is suspected, antibiotic therapy is carried out.

Fetal muscle injury can occur with gross obstetric care. Damage to the sternocleidomastoid muscle occurs when the fetus is extracted by the pelvic end, the application of obstetric forceps and difficulty in removing the head during breech presentation. A hematoma accompanying a rupture of the fibers of the sternocleidomastoid muscle is detected by a plum-like thickening of this muscle in its middle or lower third. At the same time, the newborn tilts his head to the affected side, torticollis is noted due to the shortening and thickening of the affected muscle, which disappear after the use of UHF, special head positioning and massage of the muscles of the cervico-shoulder region. Torticollis, untreated in infancy, requires further orthopedic and surgical treatment (see Torticollis). R. t. facial muscles can occur as a result of compression of obstetric forceps with spoons, is characterized by the formation of a hematoma and swelling in the child's cheek area, sometimes making sucking difficult.

Birth injury to bones

A clavicle fracture is one of the most common birth injuries (1-2%), the cause of which is a wedge, a discrepancy between the size of the mother's pelvis and the shoulder girdle of a large fetus. A clavicle fracture is observed during rapid delivery, when the shoulder girdle does not have time to turn in a direct size and is born through a narrower size of the exit from the pelvis. Often, the cause of a clavicle fracture is the incorrect provision of manual assistance during childbirth, with premature removal of the posterior shoulder of the fetus and excessively strong pressing of the anterior shoulder of the fetus to the mother's pubic symphysis. A fracture of the right clavicle is more common, as childbirth usually occurs in the first position of the fetus. A clavicle fracture is detected immediately after birth by crepitus and limitation of active hand movements. A subperiosteal fracture of the clavicle and a fracture without displacement can be detected only on the 5-7th day of a child's life, after the formation of a cartilaginous callus. In case of a fracture of the clavicle, a fixing bandage is applied to the shoulder girdle and arm of the child, a roller is placed under the shoulder and the arm is taken away from the chest, and the forearm is bent at the elbow joint and brought to the body. The fracture of the clavicle grows together on the 7-8th day, active movements in the hand are restored. With the pressure of displaced fragments on the area of ​​the brachial plexus or the formation of a hematoma, traumatic plexitis may occur (see).

A fracture of the humerus occurs in one case in 2 thousand births. Occurs when it is difficult to remove the handle of the fetus during the provision of obstetric assistance in breech presentation. More often occurs in the middle third of the shoulder, accompanied by a slight displacement of fragments. It is recognized by crepitation of fragments and the formation of a tumor at the site of a hematoma. Treatment consists in fixing the arm along the body or applying a plaster splint from the back of the shoulder. Fusion occurs after 2-3 weeks. A fracture is also possible in the area of ​​the epiphysis of the shoulder, which may be accompanied by its separation from the diaphysis of the bone, rupture of the ligaments and the formation of an intraarticular hematoma. The hand hangs on the side of the injury, brought to the body, rotated inward. In this case, a splint is applied to the injured limb and the arm is placed in a position of abduction and rotation outward. Healing occurs after 3 weeks.

Fractures of the bones of the forearm and ribs are very rare and are not caused by R. t., but by resuscitation.

Fractures of the femur and lower leg bones in newborns are observed in one case per 4 thousand births and are possible when the fetus is extracted by the leg during childbirth or the fetus is extracted by the legs during caesarean section. Fracture of the femur occurs more often in the middle third, is determined by the shortening of the thigh associated with strong muscle retraction, and the formation of swelling, as well as by the painful reaction of the child. The diagnosis is confirmed at rentgenol. research. Treatment is carried out by skeletal traction. Healing occurs at the 4th week of life. A fracture of the bones of the lower leg is determined by crepitation of fragments, swelling of the limb, and a painful reaction of the child. Confirmed radiographically. Immobilization of the limb with a splint is required. The callus is formed on the 3rd week of a child's life.

In the case of prolonged labor with breech presentation and as a result of mechanical compression of the pelvic end of the fetus, trauma to the pubic symphysis is possible. In the treatment, painkillers (droperidol) and hemostatic agents, local cold, applications with 0.25% solution of novocaine or lead lotions are used. The child is placed in a protective mode and laid on his back with his hips apart. The prognosis is favorable in most cases.

Birth trauma of internal organs

Birth trauma of the internal organs is approximately 30% of the total number of R. t., which caused the death of newborns. The liver, adrenal glands and kidneys are most often damaged. Injury to the abdominal cavity and retroperitoneal space, received during childbirth, can be the cause of the death of a child in the first hours or days of life. Occurs more often in large and premature fetuses, with rapid or prolonged labor, accompanied by hypoxia. Liver injury is promoted by its increase (with hemolytic disease, vascular tumors) and improper location. Even with a slight injury to the liver, a gradually increasing hematoma leads to extensive detachment of the capsule, and then its rupture, followed by bleeding into the abdominal cavity. The severity of the picture depends on the degree of damage and the size of the hematoma. Pallor of the skin, lethargy, bloating, asymmetry, tension and soreness of the abdomen, vomiting of bile, sometimes translucence of a hematoma through the anterior abdominal wall, and a decrease in hemoglobin in the blood are noted. To confirm the diagnosis, a puncture of the abdominal cavity is performed (see Laparocentesis). Treatment consists in emergency laparotomy (see), hemihepatectomy (see), blood transfusion.

If the kidney is damaged, the general condition of the child progressively worsens soon after birth, blood appears in the urine, regurgitation, vomiting, swelling in the lumbar region. The diagnosis is confirmed by urological examination. Shown hemostatic and antibacterial therapy.

Hemorrhages in the adrenal glands are characterized by a pronounced general weakness, the development of collapse (see) and anemia (see). Treatment is carried out with hydrocortisone and hemostatic agents.

The prognosis for R. t. of internal organs is serious, the mortality rate is high.

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I. P. Elizarova; L. O. Badalyan, L. T. Zhurba (neur.), M. Sh. Vrono (psychiat.).