Cerebral edema in a newborn baby

Cerebral edema in a newborn is a process caused by excessive accumulation of fluid in the cells and interstitial space of the child's brain. This is a kind of protective reaction in response to damage to brain tissue of any etiology. In small children, the disease has very serious consequences, so it is imperative to diagnose the process at the initial stages.

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Causes cerebral edema in a newborn

The causes of cerebral edema in newborns follow from pathogenesis and can be completely different. Sometimes the process develops so quickly that it is impossible to establish the true cause.

Localized edema occurs in a small area of the brain and may be caused by a tumor of the cerebral hemispheres or meninges. Such a tumor can press on neighboring brain structures and disrupt blood circulation in the vessels, and then the process develops according to the mechanism of increasing pressure and penetration of fluid into the cells. In newborns, tumors can be a consequence of the intrauterine action of environmental factors or can develop and grow after birth.

Traumatic brain injury is one of the most common causes of cerebral edema in newborns. The baby's skull is very flexible at birth due to the fact that the sutures between the bones are not tightly fused and there are fontanelles. On the one hand, this helps the baby to pass through the birth canal better at birth, but on the other hand, it is a very serious risk factor for the development of brain tissue damage. Birth injuries are very common at birth. They can be caused by pathology on the part of the mother, when the birth process is non-physiological with rapid labor. There can also be interventions on the part of doctors, in which birth injuries occur frequently. In any case, birth injury can cause hemorrhage or hematoma, and this is compression of brain tissue with the risk of developing local edema.

The cause of the development of generalized edema is most often ischemic damage to brain tissue. If there is a pathology of pregnancy that disrupts blood circulation in the umbilical veins, this leads to prolonged ischemia of all fetal tissues, including the brain. Premature aging of the placenta can lead to insufficient oxygen supply to brain cells, which in turn affects blood pressure. All of these are additional risk factors for the development of edema.

Another reason for the development of generalized cerebral edema is the toxic effect of drugs and toxic substances on cells. In utero, the child may be affected by excess alcohol, which inhibits brain development. If the mother is intoxicated just before giving birth, the child is born with alcohol syndrome. This concept is that the child's brain is very sensitive to the toxic effects of alcohol. Therefore, the systematic influence of large amounts of alcohol disrupts the glucose ratio in brain cells and can cause edema. After the birth of the child, the toxic effect on brain tissue can be due to an overdose of drugs, more often due to excessive infusion therapy. Fluid overload in newborns develops very quickly, given their body weight. Therefore, it is necessary to be very careful about infusion therapy in these children. An overdose of some drugs: sedatives, antiepileptics can also cause edema.

Inflammatory processes of the brain, such as encephalitis or meningitis, have a direct role in the development of edema. This is explained by the fact that any inflammation is accompanied by tissue edema, and inflammation of brain tissue is accompanied by an increase in volume, i.e. edema.

Arteriovenous malformations are a form of congenital pathology of the structure of blood vessels, in which the vessels disrupt their normal blood flow. This leads to the formation of aneurysms and the accumulation of blood in them. If such a malformation is located near the brainstem, then with significant sizes it can cause edema.

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Risk factors

Considering the many reasons for the development of cerebral edema in newborns, it is advisable to identify risk factors:

1. birth injuries are one of the most common and direct risk factors;
2. tumors of the brain and meninges;
3. abuse of alcohol or medications by a pregnant woman throughout pregnancy or immediately before childbirth;
4. disruption of uteroplacental circulation with the development of chronic or acute fetal hypoxia;
5. infectious pathologies – brain abscess, encephalitis, meningitis;
6. congenital pathologies of the cerebral vessels, which are accompanied by volumetric processes with impaired fluid outflow and the risk of developing hyperhydration of the space between cells.

The many reasons for the development of cerebral edema in newborns indicate that it is important to diagnose the edema itself in time in order to begin treatment, and the cause can be discovered in parallel with treatment measures.

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Pathogenesis

Before talking about the causes of edema, we need to understand the pathogenesis of this process. If fluid accumulates inside the cell, then we are talking about edema, but if fluid accumulates in the interstitial fluid, then it is more correct to say about swelling of the brain. There are no special differences in pathogenesis between these two conditions, but for treatment tactics this is very important.

Under normal conditions, the blood vessels of the brain pass between the cells and supply them with oxygen. This occurs against the background of stable pressure in the arteries, due to which oxygen penetrates into the interstitial space and cells. But in certain cases, the pressure in the arteries of the brain can increase, which leads to an increase in pressure in the interstitium. According to the laws of physics, all elements move towards greater pressure, so proteins from the blood plasma and fluid from the vessels penetrate through its wall into the interstitium. Thus, a greater number of proteins appears in the space between the cells, which increases the oncotic pressure. This leads to the movement of fluid towards increased oncotic pressure and hyperhydration of the brain cells occurs. The ratio of sodium and potassium ions in the cell wall is disrupted so that there is more sodium in the cell. This leads to even greater changes and to the accumulation of water in the cells. This process occurs very quickly and new cells are involved in pathological changes very quickly. This closes the circle and increases the pressure even more and, accordingly, increases the edema.

There are different types of edema depending on the clinical presentation and course. If the process is limited to a small area of the brain, then we are talking about localized edema. Generalized edema is more dangerous and is characterized by diffuse accumulation of fluid involving both hemispheres. The main principle for distinguishing between these two concepts is time, because a localized process can very quickly become generalized.

Symptoms cerebral edema in a newborn

Statistics show that cerebral edema in newborns occurs in no more than 4% of children. Among the causal factors, birth trauma is in first place, as one of the most common causes of edema. The fatal outcome in children with cerebral edema occurs in 67%, which indicates the seriousness of the problem.

Considering that all the symptoms of a newborn baby have their own characteristics, it is a little difficult to immediately suspect the presence of cerebral edema. But if there were complicated births or pregnancy, or there are other risk factors in the form of birth trauma in the child, then he is under the close supervision of doctors. After all, the first signs of cerebral edema can begin three days after the injury, while healthy children are already discharged home. Therefore, not only the doctor should monitor the child, but the mother should also pay attention to all the symptoms.

With edema, each cell increases in volume very quickly, so there is an increase in intracranial pressure, even despite the fact that the skull of a newborn has fontanelles. All symptoms of edema are associated with increased pressure. There may be systemic manifestations and local signs. Systemic symptoms include nausea, vomiting, headache. But these symptoms in a newborn have their own characteristics. So nausea in a small child immediately causes vomiting, and this vomiting is food that was eaten several hours ago. It is very difficult to stop such vomiting and it is difficult to correct, since it occurs due to the fact that the membranes of the brain are irritated by high pressure. Headache in a newborn can manifest itself as the so-called "brain cry", in which the baby cries very loudly and has a characteristic pose with his head thrown back. If cerebral edema develops against the background of an infectious process in the form of encephalitis or meningitis, then systemic manifestations also include an increase in body temperature, as a reaction to the infectious process. But a feature of newborn babies is also that the temperature may not rise, but this does not exclude an infectious process.

Edema of the parenchyma of the brain in newborns is also accompanied by local symptoms. These symptoms appear when certain areas of the cerebral cortex are compressed. Most often, this is manifested by paresis or paralysis of a certain area of the body, or in newborns, convulsions often occur. Convulsions can begin with a simple tremor of the chin and in a few seconds can spread to the entire body. Often, small-amplitude tremor, short-term breath holding, and visual impairment with horizontal nystagmus are detected. Focal and generalized convulsions also occur. One of the specific symptoms in newborns that indicate the onset of the process of damage to the cortex is eye rolling.

Also characteristic of edema, which increases gradually, is the appearance of a group of symptoms, such as increased excitability. The syndrome of increased neuroreflex excitability is manifested by increased spontaneous motor activity, restless superficial sleep, frequent unmotivated crying, increased unconditioned and tendon reflexes, muscle dystonia, tremor of the limbs and chin, emotional lability.

Vegetative dysfunction syndrome also occurs with edema. It manifests itself as mottled skin, transient cyanosis, respiratory and cardiac rhythm disturbances, thermoregulation disorders and gastrointestinal dysfunction with pylorospasm, constant regurgitation, increased peristalsis, constipation, vomiting, persistent hypotrophy. These symptoms can be isolated and can be the first to appear, then it is difficult to think about edema.

Edema of the brain in a newborn during childbirth often occurs with concomitant birth injuries. Then the first signs may begin after birth, when the child cannot breathe or begins to have convulsions. This is a direct indication for resuscitation.

Speaking about the spread of edema, it is necessary to note several types of this pathology, which differ clinically.

Moderate cerebral edema in newborns is when the process does not spread so quickly and is easily corrected. Morphological changes in the brain at this stage do not lead to a pronounced organic neurological deficit in the future.

In this case, transient disturbances of hemoliquorodynamics with mild hypertensive syndrome, diapedetic subarachnoid hemorrhages, local zones of cerebral edema are observed. Clinical manifestations may also be minimal.

Periventricular cerebral edema in newborns is edema in the area around the ventricles. More often, such edema is observed in ischemic brain damage due to acute or chronic hypoxia of the child in utero or already during labor. This type of edema, if diagnosed in time, does not spread quickly with the risk of brain wedging. But there may be other complications.

Edema of the cerebral ventricles in newborns often occurs as a consequence of intragastric hemorrhage. This leads to an increase in their volume, which presses on the parenchyma around the ventricles and causes edema. Then the clinical picture of such edema develops against the background of symptoms of impaired consciousness of the child.

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Complications and consequences

The consequences and complications of cerebral edema in a newborn can be very serious, and there can be immediate and delayed consequences. Lethal outcome is the most terrible consequence of cerebral edema. If treatment tactics are untimely or in the presence of other pathologies, cerebral edema leads to dislocation of the midbrain structures and the brainstem. This is characterized by the fact that the medulla oblongata, which contains the respiratory and cardiovascular system centers, is wedged into the large occipital foramen of the skull. Therefore, death in this case can be instantaneous.

Complications of edema may be remote and they may manifest themselves in lifelong disorders of motor activity, phenomena of cerebral palsy, convulsions. In the presence of periventricular edema, cysts may form in these places, which in the future may lead to persistent disorders of motor activity in the child. If there was edema with the involvement of the ventricular system of the brain, then there may be hydrocephalus. This is a violation of the outflow of cerebral fluid, which leads to an increase in the size of the head.

Thus, the consequences of the pathology are very serious and they prove the need for careful diagnosis and timely treatment.

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Diagnostics cerebral edema in a newborn

In the diagnosis of such pathology, the anamnesis plays a major role first of all. After all, if the child has a birth injury or symptoms of meningitis, then the appearance of any symptoms from the central nervous system should be assessed as edema and immediate action should be taken. Confirmation of the diagnosis can be carried out in parallel with treatment measures.

Symptoms that should suggest a CNS lesion are a loud cry from the child, uncontrollable vomiting, convulsions, agitation or depression of the child, pathological reflexes. During the examination, it is necessary to pay attention to the position of the child, muscle tone, nystagmus, pathological reflexes. The position of the child with the head thrown back is a symptom of possible meningitis, including edema. In newborns, one of the mandatory symptoms of brain damage is a positive Lesage sign. For this, the child must be lifted by the armpits and he will pull his legs to the body, then the symptom is positive. If any of these symptoms appear, it is necessary to immediately begin additional diagnostics.

The tests that need to be done on a child with cerebral edema should be minimally invasive, but informative. Therefore, a general blood test is considered mandatory, which will allow identifying infectious changes or hemorrhagic processes.

When cerebral symptoms appear, a lumbar puncture is considered mandatory. This allows differentiating meningitis, hemorrhage and reduces hydrocephalic syndrome. If there is blood in the cerebrospinal fluid, we can talk about intragastric hemorrhage, and further examination can establish the presence of an inflammatory process and confirm or exclude meningitis. But it should be noted that at the slightest suspicion of edema, puncture is contraindicated. Therefore, priority is given to non-invasive diagnostic methods.

Instrumental diagnostics of edema involves the use of ultrasound diagnostics. Ultrasonography of the brain through the fontanelle is used, which allows for the establishment of changes in the parenchyma and ventricular system.

Another method of instrumental diagnostics is used - Doppler encephalography. This is one of the most modern methods that allows studying the blood flow in the arteries of the brain. In the presence of local edema, there may be changes in the form of a decrease in the perfusion of blood of a certain artery.

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Differential diagnosis

Differential diagnostics should be carried out with hypoxic-ischemic damage to the central nervous system, congenital malformations of the brain, primary hydrocephalus, intrauterine infections with damage to the nervous system. The difficulty of differentiation is that these pathologies can be accompanied by symptoms of local edema or edema of the brain parenchyma already during decompensation. Therefore, careful differential diagnostics are carried out after the acute condition has been relieved.

Treatment cerebral edema in a newborn

Cerebral edema in the neonatal period is a very serious diagnosis that may have complications in the future. Therefore, treatment can be divided into two conditional stages - emergency care and rehabilitation treatment.

The main element in the treatment of edema is active dehydration therapy. This allows to reduce the concentration of fluid in the brain cells and reduce edema. The drugs that are used for rehydration in case of edema are osmotic diuretics. These include mannitol, as well as the saluretic lasix.

1. Mannitol is an osmotic diuretic that acts by increasing the outflow of fluid from tissues, enhancing filtration in the glomeruli, and at the same time, the fluid is not reabsorbed in the tubules. Thus, the drug increases the osmotic pressure in the vessels of the brain and causes the movement of fluid from the cells of the brain into the vessels. Due to this action, the rheological properties of the blood improve and oxygen passes better into the cells of the cortex. This effect of the drug lasts for four to six hours, while its concentration is higher in the vascular bed than in the tissues. Therefore, repeated administration of the drug should be carried out after such a time. The dosage of the drug is 0.5 grams per kilogram of the child's body weight of a 20% solution. Side effects - headache, nausea, vomiting, with prolonged use - dehydration and hypernatremia. Precautions - use with great caution in case of congenital heart defects.
2. Furosemide is a loop diuretic that acts in the proximal tubules and has a rapid diuretic effect. It reduces sodium absorption in the kidneys, but also has a direct effect on cerebral edema by reducing the synthesis of cerebrospinal fluid. And the effect of reducing intracranial pressure is equal to the rate of fluid excretion from the body, which makes it possible to quickly reduce the risk of complications with edema. The method of administration of the drug can be intravenous and intramuscular. Dose - 0.5 - 1 milligram per kilogram of body weight of the child. Side effects - hypovolemia, hypokalemia, metabolic alkalosis, impaired glucose tolerance, arterial hypertension, cardiac arrhythmia, acute tubulointerstitial nephritis, vomiting, diarrhea, aplastic anemia.
3. Glucocorticoids play a significant role in the treatment of cerebral edema due to their wide range of properties. They reduce the permeability of the brain neuron wall for sodium and water and reduce the synthesis of cerebrospinal fluid. If the edema is of infectious origin or there is a suspicion of meningitis or encephalitis, they reduce the inflammation focus and normalize the function of the brain vessels. Any drug can be used, calculated based on dexamethasone: the dosage can be 0.3-0.6-0.9 milligrams per kilogram single dose. The dose should be repeated every four to six hours. Precautions - to avoid drug withdrawal, it is necessary to maintain an interval of at least 15 minutes between hormones and diuretics. Side effects - adrenal hypofunction, septic complications, thromboembolic complications, osteoporosis, muscle atrophy, hypokalemia, sodium retention, leukocytosis, thrombocytosis, intercurrent diseases. To prevent the occurrence of side effects of GCS, they should be prescribed in accordance with the circadian rhythm after the first day of administration, gradually reducing the dose by the 4th-6th day of treatment (to prevent withdrawal syndrome and adrenal atrophy), with the simultaneous administration of potassium, calcium, and vitamin D preparations.
4. A child with cerebral edema is treated only in the intensive care unit, so he is immediately transferred to artificial ventilation of the lungs. Artificial ventilation has a therapeutic effect due to the reduction of CO2 pressure in the vessels. This in turn causes a spasm of the vessels that are not damaged and are normally regulated and causes an additional influx of blood to the damaged areas. The use of artificial ventilation in the hyperventilation mode in short courses allows to reduce intracranial pressure in just 2 hours.
5. In addition to the main drugs, infusion of isotonic solutions in the zero water balance mode is also used. The acid-base balance of the blood is maintained by monitoring and infusing bicarbonate. It is also necessary to monitor the rheological properties of the blood, since hypercoagulation can easily occur.

Treatment of cerebral edema is a very complex task that requires a lot of knowledge and practical skills. Positive dynamics are observed after the first day and in two or three weeks the child can already be discharged. But the consequences can be serious and already at home at the stages of recovery physiotherapy and folk remedies are used.

Physiotherapeutic treatment of children with motor disorders after cerebral edema is one of the main methods in rehabilitation. For this purpose, various methods can be used - massage, exercise therapy, physiotherapy, reflexology. The main type of massage depends on many factors: the presence of hypertonicity or hypotonicity of muscles in the child, impaired motor activity, the state of cognitive functions. Classical massage includes stroking, shaking, rolling, kneading, rubbing, tapping, shading. Along with this, segmental, circular, point massage is used (combines inhibition and stimulating effect). Also, with increased muscle tone, special exercises are recommended for all muscle groups with alternate involvement of the upper and lower extremities.

Vitamins can be used for the syndrome of child oppression. Encephabol is recommended for this. It is a derivative of the pyridoxine molecule (vitamin B6) and has a complex trophic effect at the level of neurons and glial elements. The drug activates glucose metabolism in brain tissue, easily passes through the blood-brain barrier, has antioxidant properties and stabilizes the processes of interneuronal transmission. Encephabol has a positive effect on the microcirculation of the brain, improves the plasticity of red blood cells and increases the level of ATP in them. The drug is available in two forms: 100 mg dragee No. 50 and suspension in 200 ml bottles (100 mg in 5 ml). The scheme of administration to children of the first months of life is 1 ml of suspension (20 mg) daily in the morning for a month, for children under one year, the daily dose is gradually increased to 5 ml (100 mg).

Actovegin is a vitamin preparation containing amino acids, oligopeptides, nucleosides, trace elements, electrolytes, intermediate products of lipid metabolism. The drug is completely free of proteins, antibodies and pyrogens. Due to its low molecular weight, it easily passes through the blood-brain barrier. Actovegin increases the efficiency of energy processes at the cellular level by increasing the accumulation of glucose and oxygen. Increased transport of glucose and oxygen and increased intracellular utilization accelerate ATP metabolism, which in turn increases the energy resources of the cell. The use of fatty acids and amino acids stimulates intracellular protein synthesis and nucleic acid metabolism. Along with this, there is activation of cholinergic processes and accelerated elimination of toxic metabolic products. Therefore, the use of this drug in the recovery period accelerates recovery and restoration after cerebral edema. The drug is used in the early recovery period parenterally (intravenously and intramuscularly), no more than 20 mg / day. for 15-20 days, then orally at a dose of 50 mg 2-3 times a day for 1.5-2 months.

Traditional treatment of cerebral edema

Traditional methods of treating cerebral edema in newborns are used closer to the first year of life, when certain changes that require correction can be seen.

1. Clay is known for its healing properties for children with muscle spasticity or hyperkinetic disorders. For treatment, you can take clay infusion internally. Blue clay is best suited for this. Mix a glass of boiled water with a teaspoon of clay and take a tablespoon of this solution three times a day. Massages with blue clay are very useful. To do this, spread the clay on the limbs or spasmodic muscles and massage with light movements.
2. Baths with medicinal herbs are a very good method for treating the nervous system and restoring excitation or inhibition functions. If a child has increased excitability and muscle hypertonicity after suffering edema, then it is necessary to take an oat bath 1-2 times a week. To do this, dry oat grass should be infused in a liter of water and added to a warm bath. If, on the contrary, the child has hypotonia and reduced motor activity prevails, then in this case, baths should be taken with pine needles.
3. Special gymnastics at home with rubbing the muscles with balls. This treatment should be used daily. It is best for the mother to learn this from a massage therapist and be able to do it herself, taking into account the characteristics of the child's disorders.
4. The wormwood herb should be poured with one hundred grams of olive oil and left for three days in a dark place. After that, the muscles should be rubbed with the oil solution and lightly massaged.

Herbal treatment has many positive results, since herbs can affect muscles, nerve endings and thus stimulate the work of the autonomic nervous system. If a child has a convulsive syndrome after cerebral edema, then in addition to medications, it is very important to correct the work of the nervous system with herbs.

1. A tincture of rue and eryngium has a very good effect in the treatment of edema and its consequences. To do this, take 30 grams of rue and the same amount of eryngium seeds, pour boiled water over them and let it brew. Give the child two drops three times a day. If the mother is breastfeeding, then the mother can take this tincture.
2. If the baby still has movement coordination problems after the edema, then periwinkle flowers are a great help. To prepare the tincture, take 50 grams of dry leaves per glass of hot water. After infusion, dilute this glass of water in half and give the child a teaspoon to drink at night.
3. Oregano herb can be used for convulsive syndrome. To do this, you need to prepare an aqueous solution of 20 grams of herb and 300 grams of water. Give three drops three times a day.

Homeopathy in the treatment of cerebral edema can also be used for a long time during the recovery period.

1. Cannabis indica is a homeopathic remedy used to improve nerve conduction in cases of increased spastic muscle activity. It is available as a single-drug granule. The dosage of the drug for a child at the beginning of therapy is two granules three times, and in more severe cases the dose is doubled. There may be side effects in the form of pale skin and mucous membranes of the child, as well as involuntary muscle twitching, which quickly passes.
2. Tarrantula hispanica 30 is a remedy that improves muscle trophism and the condition of brain neurons, improving the baby's cognitive abilities. It is produced in granules and in such a dilution you need to take one granule three times a day. Side effects can be in the form of abdominal cramps. Precautions - do not use if you are allergic to honey.
3. Secale cornutum - is used to correct hyperexcitability syndrome with pronounced vegetative disorders. The drug is used in granules - two granules four times a day. Side effects may be drowsiness or loss of appetite, then the dose should be reduced.
4. Nervohel is a combination drug that can be used for convulsive syndrome. It contains potassium bromide, ignatia, valerian, zinc. These drugs reduce increased excitability and convulsive readiness. For use by children from 1 year old, you can use half a tablet three times a day, after three years you can use a whole tablet. The course of treatment is from two weeks to a month. Side effects can be in the form of allergic reactions.

Traditional methods of treatment can be used only on the recommendation of a doctor and should not exclude the main drug therapy.

Surgical treatment of edema can be performed when medications are ineffective and under certain conditions. If the edema is caused by a tumor, then during neurosurgical treatment of this tumor, local edema is corrected. Sometimes there is a need to reduce intracranial pressure, then the meninges can be dissected through the fontanelles and decompression can be performed.

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Prevention

Prevention of cerebral edema is non-specific and consists of strictly following all recommendations for a healthy pregnancy and childbirth. It is very important to exclude factors that can lead to injury to the child or an infectious disease after childbirth. Proper care and injury prevention play a key role.

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Forecast

The prognosis for recovery from cerebral edema in newborns is not very favorable, since the process progresses quickly. Often it is not possible to stop the edema and the prognosis is fatal. But local edemas have a milder course. If a child has suffered from cerebral edema, then further disturbances of motor activity, cognitive functions and other disorders are possible.

Cerebral edema in a newborn is a rare pathology, but given the high mortality rate and complications, it is important to know as much about it as possible. The cause may be trauma or an infectious agent, which affects the clinical picture. Any disorders on the part of the child associated with the central nervous system should be assessed as possible edema and immediate action should be taken.

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