Dear Parents.
Congratulations on having a lovely baby.
However, because your baby was born with certain high-risk factors (such as asphyxia, prematurity, low birth weight, hyperbilirubinemia, etc.), we need to take more care of your baby’s growth and follow up regularly to detect problems in time. Through the efforts of both parents and doctors to intervene early in the child’s health after years of efforts by child health care doctors.
Many babies with developmental delays or cerebral palsy are not noticed by parents to have any obvious abnormal conditions after they croak, especially those children with mild cerebral palsy are more likely to be neglected. Even if some of them can draw the attention of parents and clinicians, there is no clear diagnosis, and they may even mistake them for other diseases such as rickets, zinc deficiency, malnutrition, chondromalacia, etc. This makes the infant miss the early diagnosis and the opportunity of early treatment.
In fact, the abnormal movements, abnormal posture and abnormal feeding of children with cerebral palsy in the early stage are not difficult to be detected with careful observation. The following aspects are generally observed to identify them.
Early symptoms.
Too rowdy: easily irritated, continuous crying, sleep disturbance, etc. Too quiet: ignoring the outside world and being excessively quiet.
Too difficult to feed: difficulty in sucking, frequent vomiting.
Too difficult to carry: difficult to care for, stiff limbs, tossing and turning like a rolling log.
Too difficult to see: clenched fists, “airplane hands”, “ballet feet”, etc.
Clinical manifestations.
Infants with cerebral palsy have poorer development in all aspects than normal children of the same age. For example, “the whole body is soft, weak or the limbs are tight; easy to be frightened, horns are turned back, little or too much movement; weak sucking, difficult swallowing or frequent choking, choking and vomiting when feeding; the baby’s mouth cannot close well, and the cry is weak or screaming; at 2-3 months, the baby cannot laugh, lift the head, and cry continuously, and the fingers are clenched and will not open; at 4-5 months, the baby cannot roll over; at 8 months, the baby cannot sit or even sit. At 8 months, they can’t sit, or even grasp or hold, or put their hands to their mouths. In addition, their intellectual development lags behind that of normal children of the same age.
Abnormal movements or postures include drooling and trembling; when learning to stand, legs together, feet always landing on the toes, some even appear crossed and scissor-shaped; uncoordinated and asymmetrical limb movements, and head not being able to maintain a central position.
In conclusion, based on the various different postures of children with cerebral palsy and normal children, combined with the high-risk factors of the mother during pregnancy and delivery, early detection can be made, and the child should go to the neurology department of the hospital as early as possible for a clear diagnosis and early treatment.
The main 52 neuromotor examination abnormalities in children with brain injury
1. Abnormal head circumference and chimney gate.
2.Overexcitation, irritability, drowsiness, little natural activity, abnormal activities appear.
3.Feeding difficulties.
4. Significant strabismus, persistent nystagmus, and high tone of the levator muscle.
5.Abnormal posture appears, such as rigid posterior extension of both upper limbs, coracoacromial dystonia, pointed feet, crossed and inward lower limbs, etc.
6.Poor visual tracking and poor hearing orientation.
7.Weak or absent primitive reflexes, or hyperactive or delayed disappearance.
8.Inability to raise the head in prone position after 3 months, head low and hip high position or tilted to one side.
9. The head cannot be erected, and the head is unstable in upright or sitting position, swaying back and forth.
10.After 3 months, the thumbs are still inward and the hands clench fists.
11.Abnormal limb movements, continuous tremor, paroxysmal clonic movements, etc.
12.Abnormal passive muscle tone. Heel sign angle, adductor angle, N fossa angle foot dorsiflexion angle is too large and too small, scarf sign abnormal, etc.
13.Delayed appearance of protective reflex or none.
14.Inability to actively grasp objects at 6 months, unable to sit at 8 months, unable to crawl at 10 months.
High-risk infants include: (Be sure to follow up regularly!)
(1) Preterm birth, gestational age <37 weeks.
(2) Low birth weight, birth weight <2500g.
(3) perinatal asphyxia, including intrauterine distress and postnatal apgar score of ≤3min or ≤6min.
(4) Hyperbilirubinemia with total serum bilirubin ≥ 342 μmol/l.
(5) Neonatal ischemic-hypoxic encephalopathy; (6) Neonatal intracranial hemorrhage (grade III-IV).
(7) Smaller than gestational age infants with birth weight less than 2 standard deviations from the mean weight for the same age group.
(8) Persistent hypoglycemia with blood glucose <1.11 mmol/L.
(9) Neonatal convulsions, with more than 3 convulsions before admission.
(10) Persistent hypoxemia with alveolar partial pressure of oxygen PaO2 <5 33kPa (40mmHg).
(11) Erythrocytosis: venous erythrocyte pressure product > 0.65 or hemoglobin > 220 g/L.
(12) Imaging showing brain abnormalities.
(13) Difficult labor for various reasons during delivery (including forceps, fetal head extraction, amniotic fluid and fetal fecal contamination above II°), etc.
Post-discharge management of pediatric high-risk infants.
1. NBNA testing for high-risk infants on days 3-5 of corrected age 40 weeks, with repeat testing on days 10-12 if abnormal.
2. infant massage exercises given after stabilization.
3.Infant neurological examination at 0-1 years of age.
4.Infant intelligence test at 1 year old.
Procedures of the intervention clinic for high-risk infants.
1.Purchase early education CDs and books before discharge – health education for parents.
2.Come back to the hospital on 42 days to establish a follow-up file for high-risk children, and then return once a month or as prescribed by the doctor.
3.At least one parent meeting every 2-3 months to explain the importance of early movement promotion, intelligence development and whole body massage, infant intellectual development rules, feeding care and prevention of common diseases.
4.Feed preterm infants breast milk or/and preterm infant formula at least until weight 2000g, change to 1/2 preterm infant formula + 1/2 full term infant formula for 1 month. Start iron supplementation from 2 weeks to 1 month after birth depending on anemia and continue until 4-6 months of corrected age. All high-risk infants were given supplemental feeding instructions to prevent iron deficiency anemia. To prevent rickets start vitD from 2 weeks with 400u daily supplementation along with appropriate calcium supplementation.
5. If motor backwardness, muscle tone and postural abnormalities are found go to the rehabilitation room of the child health center as soon as possible to start formal rehabilitation training.
The timing of early intervention treatment early intervention is an important issue, the structure and function of the brain compensate within 2 years after birth.
The earlier the treatment, the more effective it is.
Starting interventions in the neonatal period is a new trend in technologically developed countries.
Some even advocate that early intervention for at-risk children should begin immediately at birth and continue through preschool.
In fact, the clinical management of high-risk infants in the NICU is itself an integral part of early intervention.
In general, early intervention can be started once the neonate is clinically stable and continues until 3 years of age, or beyond if available. The earlier the start of early intervention, the longer it lasts and the more comprehensive the brain recovery and compensation.
Early intervention therapy is implemented in four major areas of training according to the different areas of intellectual development.
1, gross motor training: vertical head, head lift, chest lift, arm support, pull sitting, lean sitting, sitting alone, turning over, crawling, walking and other items.
2, cognitive ability training, including hand fine motor and cognitive ability; active hand grasp, hand-eye-brain coordination, finger dexterity, accuracy training, visual, auditory, tactile perceptual ability, understanding, observation, memory, thinking and other ability training.
3.Language skills training: imitation of pronunciation, understanding language, expression of language, etc.
4, personal and social interaction skills training: child and child, child and adult, child and environment adaptation, character, ideological character, self-care ability, etc.
Parents must remember: regular follow-up visits; early detection and early intervention for a good prognosis.