Overview of neonatal hypoxic-ischemic encephalopathy.
Neonatal hypoxic-ischemic encephalopathy refers to perinatal asphyxia resulting in hypoxic-ischemic damage to the brain, and patients often present with a range of brain dysfunctional manifestations in the first week after birth, especially in the first 3 days. Symptoms such as restlessness or lethargy, vomiting, screaming, and convulsions. In mild cases, the prognosis is good, but in severe cases, the morbidity and mortality rate is high, and survivors may have sequelae such as mental retardation, epilepsy and cerebral palsy. Perinatal hypoxia occurs mainly in utero, with about 80-90% occurring before or during delivery and 10% after delivery. Hypoxic-ischemic encephalopathy is mainly caused by intrauterine hypoxia, abnormal placental function, prolapse of the umbilical cord, compression and neck bypass; abnormal delivery such as emergency delivery, stalled delivery, abnormal fetal position; abnormal fetal development such as premature delivery, overdue delivery and intrauterine growth retardation, and severe pulmonary infection in newborns can also cause this disease. Therefore, prevention of this disease should begin with regular prenatal checkups and delivery in hospital after pregnancy.
Clinical manifestations.
1, disorders of consciousness: manifested as a state of excitation or inhibition of the central nervous system, or both alternately. The former manifests as irritability, irritability, vomiting, screaming; the latter manifests as drowsiness, unresponsiveness, coma.
2, muscle tone changes: increased, decreased or even flaccid, normal muscle tone in mild cases.
3, abnormal primitive reflexes: hug reflex, grip reflex is overactive, weakened or disappeared, sucking reflex is weakened or disappeared.
In severe cases, there may be convulsions. Neonatal convulsions are mostly manifested by irregular and irregular rhythmic twitching of the face and limbs, such as repeated blinking, eye deviation, tremor and gaze; paroxysmal activities such as sucking, chewing and smacking of the mouth and tongue, periodic activities of the upper or lower limbs like rowing or bicycle pedaling, and paroxysmal apnea.
5. In severe cases, central respiratory failure, pupillary changes, interstitial hypertonia and other brain injury manifestations appear.
6.Some patients show fullness and tension of fontanelle.
7.Aspiration pneumonia is the most common of the complications.
Diagnosis based on.
1, there is a clear history of perinatal hypoxia, especially in children with a history of severe perinatal asphyxia.
2. Abnormal neurological symptoms appear in the first week after birth, especially in the first 3 days, with full fontanelle, convulsions and central respiratory failure in more severe cases.
3, often combined with aspiration pneumonia, in severe cases, there may be intracranial hemorrhage at the same time.
4.Cranial CT and cranial ultrasound examination are meaningful for diagnosis, grading, estimation of prognosis and differential diagnosis.
Treatment principles.
1.Strengthen perinatal monitoring, prevent and control asphyxia, and resuscitate in time.
2, eliminate hypoxemia, nasal catheter or hood oxygen administration, nasal CPAP or artificial ventilation.
3.Reduce the multi-organ damage caused by tissue hypoxia-ischemia. Pay special attention to the maintenance of brain, heart, lung and kidney function.
4.Prevent and treat infection.