Hypertonus of the muscles of the legs and hands of the baby: the reasons when it passes, how to determine what to do?

Hypertension in newborns is an important indicator not only of adapting a child to environmental conditions, but also can signal serious violations from the central nervous system. It is very important to evaluate the tone of the muscles of the newborn in conjunction with other symptoms in order to more accurately talk about the presence of a particular problem.

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology

Statistics of the distribution of hypertension indicate that this is the most frequent symptom of damage to the CNS of different etiologies. The rate of trauma in childbirth ranges from 3 to 6 per 1,000 newborn babies, and by the degree of spread among normal births this number reaches 7%. According to the studies, the birth injury of the cervical spine is 85.5% of all birth injuries. Such a traumatization of the cervical spine can be with absolutely physiological births, which according to the data is more than 80% (especially in primiparas). All these injuries in more than 96% of cases are accompanied by violations of muscle tone, and more than 65% is a pronounced hypertonia.

[9], [10], [11], [12], [13], [14], [15], [16]

Causes of the hypertension in newborns

Muscle tone in a child is one of the indicators of the state of the nervous system. Despite its low informativeness at first glance, this indicator can really say a lot about the nervous regulation in the baby. This is due to certain features of the structure of the nervous system in newborns.

A newborn child, and especially a premature baby, is a kind of research object that has its own specificity, conditioned by a certain stage in the development of the nervous system. First of all, it concerns the development of the brain, which ensures a unique response to the action of various external and internal factors. Difficulties in analyzing the neurological status are created by appropriate features of the anatomy and physiology of the neonatal nervous system:

1. The highest level of integration is the talamopaladar system;
2. Most of the responses are closed at the level of the brainstem and subcortical;
3. The predominance of inhibition over excitation;
4. The dominance of cerebral symptoms over focal symptoms, regardless of the nature of the active pathogenic factor;
5. The presence in the neurological status of symptoms, which, unlike adults and older children, have a physiological character;
6. Lack of speech and inability to tell about your feelings;
7. Presence of peculiar behavioral reactions;
8. High neuroplasticity of the CNS and associated increased ability to repair the nervous tissue.

Further, when differentiating the nerve cells of the brain and myelinating the conducting pathways, inhibition of the activity of ancient structures occurs and a change in the nature of the response of the organism to stimuli. In this case, damage to various structures of the brain leads to a disruption of his work as a whole, and the sick kid develops general symptoms, as a reaction to local injuries. Therefore, the violation of the tone can be considered one of such common reactions, signaling those or other problems.

A healthy newborn child has a physiological hypertension of all muscles for up to one month. If this condition is expressed longer or differently from both sides, then it is already a pathological hypertonia, the cause of which must be identified.

Therefore, damage to the central nervous system of a newborn of any nature can cause a general reaction, in this case, hypertonicity. But there are a number of reasons that most often lead to hypertonia. One of these etiological factors is hypoxic or ischemic brain damage. The most sensitive to the effects of hypoxia is the central nervous system, where defense mechanisms are weakly expressed. Nerve cells are the first to suffer in conditions of oxygen starvation. The pathogenesis of hypertension development in this case is the violation of the delivery of oxygen directly to the cells of the brain. But the brain, as the central organ, receives more energy and oxygen, as a priority organ. After all, at the time of onset of oxygen deficiency, the cardiovascular system reacts with the redistribution of blood with the predominant blood supply of vital organs - the so-called "centralization of blood circulation" (brain, heart). This slows the capillary blood flow of the parenchymal organs. Hypoxia of muscles and internal organs leads to the accumulation of lactate and the emergence of metabolic acidosis. Metabolic acidosis leads to an increase in the permeability of the vascular wall, which together with a slowing of blood flow and an increase in concentration leads to a sludge effect and microthrombosis. Diapedemic hemorrhages (point and large in size), cerebral edema, hypovolemia, violations of the function of all organs and systems, including muscles, are secondary. The central inhibition of the regulation of muscle tone under the influence of oxygen deficiency of the brain on the one hand, and the accumulation of lactate in the muscles on the other hand - this all underlies the development of hypertonia, as a reaction to brain damage.

Among other causes of hypertension is often a trauma in the process of childbirth, as an immediate factor in the violation of innervation of muscles. Such traumatization is often observed under the influence of mechanical external factors, as well as with excessive nonphysiological movements due to active labor. In addition, similar injuries can be caused by obstetric interventions, in which the child can be removed from the head with fixed shoulders, and shoulders with a fixed head in the breech presentation, as well as excessive rotation with facial presentation. Rough extraction of the fetus and abnormal turns lead to a violation of the structure of blood vessels, compression of the Adamkiewicz artery, which delivers blood to the spinal cord and above the lumbar thickening. In the case of a minor load, damage can sometimes be accompanied by simple brain swelling or bruising. At the heart of severe forms of trauma are hemorrhages. Trauma of the spinal cord can be accompanied by subluxation, vertebrae and a violation of the carcass of the whole spinal column. As a result of spinal trauma, ischemia of the spinal cord substance develops with the predominant lesion of motor motoneurons and peripheral motor nerve spinal cord fibers of the brain. Sometimes it also damages the pyramidal path located in the lateral parts of the brain. With edemas, transient changes in muscle tone, involuntary contraction of individual muscles, pathological reflexes or asymmetry of physiological reflexes, impaired movement along the periphery of the type at the lesion level, and the central type in the departments located below are clinically manifested. All these types of birth trauma will be accompanied by hypertension, expressed in varying degrees. 

[17], [18], [19], [20], [21]

Risk factors

Given that the causes of hypertension are various brain damage to the newborn, it is necessary to identify the risk factors in which such damage can develop. Risk factors can be the following:

1. blood loss in childbirth, which causes a lack of oxygen due to a deficiency of hemoglobin in the mother's blood;
2. cardiovascular pathologies in the stage of decompensation in pregnant women lead to prolonged ischemia of the child's brain;
3. drug or narcotic drugs that depress delivery and normal consumption of oxygen by the baby;
4. violation of intrauterine gas exchange with premature aging of the placenta or placenta previa;
5. pathologies in childbirth, which lead to a prolonged fetal position in the birth canal and birth damage.

All these factors, one way or another, lead to a decrease in the delivery of oxygen to neurons or traumas of the neural pathways, and this is accompanied by damage to the regulatory system and may manifest hypertension as one of the symptoms of such damage.

[22], [23], [24], [25]

Symptoms of the hypertension in newborns

Physiological hypertonicity in newborns is due to the posture in which the baby is the entire period of intrauterine life. Therefore, healthy full-term babies are born with a physiological hypertonia, which persists the first month of life and then fades. But there are cases when the tone is expressed unequally from both sides or remains longer than the stipulated time, then it is already a question of a pathological condition.

Symptoms of hypertension in newborns can appear immediately after birth, even before the appearance of any other symptoms. They increase in proportion to the intensification of ischemia or hypoxia of the brain. But there are other manifestations that may indicate the pathology of the central nervous system. The first signs of the GIP of the CNS can be in the form of respiratory disturbances immediately after birth. If the lesions are moderately severe, then symptoms of piercing and frequent screaming, impaired motor activity and tone may appear. The appearance of convulsions and heart rhythm disturbances are typical for more severe injuries. The convulsive syndrome can also be observed in the form of common tonic-clonic seizures, and in the form of local contractions of muscle groups. Moreover, often in newborns, the equivalent of convulsions is spasm of the muscular musculature of the face with various facial expressions in the form of movement of facial muscles. These symptoms together with hypertension may indicate a hyperexcitability syndrome.

Damage to the spinal cord during birth injuries in the acute period is accompanied by lethargy, mild muscle hypotension, which can change to hypertonicity. Later, respiratory distress, spastic tetraparesis, or tetraplegia below the level of lesion may occur, a violation of urination according to the central type. A frequent manifestation of such injuries may be a short neck symptom with a large number of transverse folds like "accordion" and subsequent tension of the occipital neck muscle group in the postnatal period. Hypertension of the neck in newborns is combined with the symptom of the puppet head, which is manifested by a deep transverse fold in the back to the verge of the shoulder girdle with the head.

Hypertension of the extremities in newborns is often retained during the first half of life after the transferred CNS damage. This can be considered a normal recovery period, when the tone on one side may predominate or the hypertonicity of the upper extremities may be more pronounced.

Hypertension of muscles in newborns can appear for the first time already at the stage of child's recovery, which indicates the need for comprehensive treatment.

When does hypertension occur in newborns? If it is a physiological hypertonia, then by the end of the neonatal period, it must pass. If a child underwent hypoxic or ischemic injury to the central nervous system, hypertonicity may persist until the end of the first year of life. In the future, the consequences in the form of violations of the motor sphere can develop. Complications of hypertension are not often, and they are not persistent, therefore, the earlier treatment is initiated, the faster all manifestations and complications will disappear. These children may be delayed physical growth, as well as psychomotor, that can be categorized by different methods of treatment.

[26], [27], [28], [29]

Diagnostics of the hypertension in newborns

Diagnosis of hypertension in newborns is based on the collection of anamnesis, examination, research of motor functions, the study of the functions of sensitive analyzers, the study of the autonomic nervous system, speech research. Newborns are characterized by uncoordinated athetosis-like limb movements, muscle stiffness, physiological hypertension of flexor muscles, loud screaming. Their hearing is reduced, the sensation of pain is weakened. In addition, the neuropsychological development of the child in the period of newborn infancy is characterized by the presence of a number of unconditioned reflexes of the newborn. On examination, it is necessary to evaluate:

1. The position of the child in bed;
2. Coordination of movements;
3. Head examination:
   • her position in relation to the trunk
   • skull shape
   • the presence of asymmetry, deformation
4. The face of the child:
   • condition of the eye slits
   • condition of the eyeball
   • pupilty
   • eye movement
   • position and movements of the upper eyelids
   • symmetrical nasolabial folds.
5. Torso, upper and lower limbs:
   • presence of paralysis, paresis, trial, tremor, athetosis
   • forced positions of limbs and trunk.

The general appearance and behavior of the newborn have important diagnostic data. For correct and objective data, it is necessary to take into account the gestational age and degree of maturity of the child. Stigmas of disembryogenesis are normally absent or their number is minimal. The presence of more than 6 stigmas of disembryogenesis is the basis for the syndromological diagnosis of "dysplastic status." Active movements of the newborn depend on the behavioral state and the presence or absence of damage to the nervous system. For example, violations of the child's behavior in the form of long-term or constant screaming, or general oppression. Excitation, a constant, piercing scream often indicates a cerebral pathology (birth trauma, asphyxia). General oppression, coma is often a sign of severe cerebral disorders (massive intracranial hemorrhage, congenital malformations).

The clinical description of the nature of seizures (small or minimal, hidden, tonic, clonic, myoclonic), debut, duration and end of an attack, as well as the condition of the child during the interictal period are important in determining the syndromic diagnosis. Therefore, it is important to monitor the child's condition and monitor it all the time for more accurate diagnosis. EEG monitoring, neurosonography and MRI of the brain, biochemical and clinical blood tests, genetic examination allow a differential diagnosis of hypertension in a newborn with pathologies that can cause it. On neurosonograms, you can identify the symptoms that are characteristic of a particular pathology. For example, the hypereogeneity of the periventricular zones in the anterior and posterior horns of the lateral ventricles allows one to suspect periventricular leukomalacia, which can occur with ischemia. Hyperogeneity in the subendymal areas and intraventricularly suggests the presence of hemorrhage. The presence of cysts indicates a migraine or persistent infection.

Analyzes that are necessary for the diagnosis of hypertension are not limited to general indicators. If, along with muscle hypertension, there are other symptoms that are characteristic of intrauterine infections, then necessarily carry out tests of the child and mother for the presence of such infections. After all, confirmation of the etiology of the process is very important for further treatment.

[30], [31], [32], [33], [34], [35], [36], [37]

Differential diagnosis

For any lesions of the central nervous system, consultation of an ophthalmologist is mandatory. The ocular fundus can be examined from the first days of life: children with intracranial hemorrhages may have small or more massive bleedings, and in certain forms of metabolic disorders of microelements - pigment inclusions. This allows to carry out not only diagnostics, but also differential diagnostics.

[38], [39], [40], [41], [42], [43], [44], [45]

Treatment of the hypertension in newborns

Today, there is no clear idea of the expediency of prescribing a drug for hypertension for restorative treatment. It is necessary to take into account the period of ontogenetic development, undifferentiation and high individual sensitivity in newborns. For example, widespread use of vasoactive drugs, intensive methods of resuscitation of a newborn, is used today in an acute period of brain damage, which can lead to secondary disorders of cerebral circulation. Recently, the main principle of treatment of CNS disorders in newborns is the support of their own adaptation mechanisms instead of prescribing multiple drugs. From the first minutes of a newborn's life, the entire range of therapeutic effects should be aimed at correcting those organs and systems (heart, lungs, kidneys, etc.) that ensure the viability and normal functioning of the central nervous system. The rest of the treatment is carried out according to the syndromological principle. However, only three clinical syndromes (convulsive, hypertensive-hydrocephalic, muscular hypertonia) are undoubtedly subject to the prescription of medications.

Methods of treatment of convulsive syndrome in a child with hypoxic damage to the central nervous system in recent years include the use of barbiturates, hydantoin, benzodiazepines. In infants, anticonvulsant drugs can be added after the first month of carbamazepine with a preliminary check of individual sensitivity. Also in the treatment use Cerebrokurin, Tserokson, Somazina. To date, in practical medicine is widely used metabotropic therapy in the form of Actovegin, Instenona, vitamins B, ATP, as well as multiprobiotic "Symbier" and others. The described list of medications refers to basic therapy. Preparations with predominantly vasoactive action - cavinton, cinnarizine and others - are prescribed in the presence of changes in cerebral hemodynamics, which are diagnosed with the help of neurophysiological techniques. Taking into account the fact that during the first year of life in the nervous system there are two parallel processes - restoration and degeneration of hypoxically altered neurons, the action of Actovegin is aimed at activating the processes of neuroplasticity.

1. Elkar is a drug from the group of metabolic means, which is used in complex therapy of muscle tone disorders and nervous system lesions. The active substance of the drug is levocarnitine. This is a natural compound, which, entering the cell, carries the necessary metabolites into the mitochondria, which increases the amount of synthesized energy. In neurons, it helps to quickly restore connections and speeds up the myelination of the fibers. Elkar with hypertension of the newborn is applied in the form of drops. Dosage - 2 drops three times a day, for the full effect is required to apply the drug for at least a month. Side effects can be in the form of weakness, dyspepsia, which requires a dose reduction.
2. Glycine is a drug whose active ingredient is glycine, an amino acid that is irreplaceable for the body. The drug acts by activating the GABA receptors and blocking the alpha receptors. This allows to reduce the stimulating effect in the brain and reduces hypertonic muscle and other symptoms of hyperexcitability. Also, the drug has a protective effect on nerve cells and fibers. The way of using the drug is in the form of a tablet, which must be crushed and dissolved in milk. The dose is one third of the tablet three times a day. Side effects can be in the form of slight oppression, which can be accompanied by drowsiness and lethargy. Glycine for newborns with hypertension is also used to reduce the toxicity of other active drugs.
3. Tolperyl is a drug that is used to correct increased muscle tone. It reduces the amount of active acetylcholine, which increases muscle contraction. Due to this action, the hypertonus decreases and the work of all organs and systems improves. The dosage of the drug is 0.0125-0.025 g / day. The method of application can be intramuscular, dividing the drug into two or three doses. Side effects can be in the form of twitching of certain muscle groups, pronounced hypotension, lethargy.
4. Somazine is a nootropic drug, the active ingredient of which is citicoline. This substance, which enters the brain and improves the conductivity of ions through the wall of the neuron, normalizes the nerve conduction. Such effects against the background of hypoxic damage to neurons are very important for a faster recovery of the child. The drug is administered intravenously drip. Dosage for children is 100 milligrams per day, which is one-fifth of the ampoule. Side effects can be in the form of increased pressure, tachycardia.

Vitamins and physiotherapy are used very widely, because it is important to stimulate the muscles by using physiotherapy besides medication. Massage and gymnastics for newborns with hypertension must necessarily be carried out in the recovery period first by a specialist, and then the mother herself can do this to the child on a daily basis. Therapeutic gymnastics and massage begin to be carried out with 2-3 weeks of life.

1. To better reduce the tone, the mother can put the baby on her stomach in the "embryo" position. To relax the muscles, you can also put the baby on the big ball with the next rocking it. After this, you need to massage the muscles of the limbs in conjunction with the removal of hands, and pressing on the chest.
2. Normalization of tone is also facilitated by acupressure by lightly pressing the fingers on the affected muscles.
3. Next, massage the plantar surface of the feet, then they are grasped, bending and extension of the legs in the joints.
4. The reaction of the support is stimulated in a standing position with the support of the child under the armpits.
5. Exercises for the development of articulation, language massage can be done by talking with the child so that he repeats the sounds.
6. Obligatory orthopedic regime for the creation of a special laying of the head, arms, legs.

Classes of curative physical education should be individual, at least 2 times a day, lasting 20-30 minutes.

Alternative treatment

1. Very useful for reducing the muscle tone of the bath with soothing herbs. To do this, you need to fry in a separate container of 50 grams of mint, turn, oak bark and 100 grams of sage. This solution must be poured with a liter of water and insist for 24 hours. Further, when bathing a child, you need to add half a liter to the bath, and leave the rest for another time. After such a relaxing bath you still need to make a point massage of the extremities.
2. Use the prepared ointment from laurel leaf, honey and olive oil. To do this, take three large laurel leaves and grind them into powder. To the leaf you need to add a tablespoon of honey and ten drops of olive oil. It is necessary to combine the ointment in a homogeneous consistency in a water bath, then cool it. Apply ointment should be in the form of a drop on the handles and legs and rub. Before the procedure, you need to make sure that the baby is not allergic. To do this, a small drop should be applied to the forearm and observe half an hour for the reaction of the skin.
3. Cucumber flowers should be mixed with chamomile flowers and add olive oil until a consistency of the ointment is obtained. Apply using a small drop and rub it carefully.
4. During bathing, the muscle relaxes with the addition of fragrant oils. To do this, you can use one drop of cinnamon oil and two drops of lavender oil, adding them to the water before each bathing baby.

Herbal treatment can be used already in the recovery period.

1. The herb of oregano in combination with flax seeds activates the reparative powers of neurons and has a relaxing effect on muscles. To prepare the infusion, you need to take 10 grams of grass and 20 grams of flax seeds, pour them with boiled hot water. Give the child need five grams every other day for a month.
2. Barberry infusion is widely used to relax the muscles as an ointment, and also as a present. To prepare the medicine, you need to take thirty grams of herbs and pour boiling water in a volume of 300 milliliters. After settling in three hours, you can begin to give the infusion of the child two drops twice a day.
3. The altei herb also has a calming effect. To prepare the infusion, you need to take 50 grams of grass and pour hot water. After insisting, you need to add a drop of olive oil and give your child one drop of this infusion once a day.

Homeopathy in the treatment of hypertension is also used.

1. Acidum nitrikum is an inorganic homeopathic remedy, which is a derivative of nitric acid. This drug is used to treat hypertension of the muscles, which is accompanied by pronounced changes in the upper limbs and neck. Dosage of the drug for newborns - two pellets three times a day. Side effects can be in the form of lethargy, lowered reflexes, impaired urination.
2. Arnica is a herbal homeopathic remedy, which is widely used in children's practice. It is effective in treating hypertension in newborns, which is caused by traumatic factors or birth trauma. The preparation is used in granules and the dosage is four granules once a week, then two granules per day for three more months. Side effects can be only when the dose is exceeded, then the twitching of the muscles of the child's face may appear.
3. Berberis is a monocomponent organic drug that is used in the treatment of hypertension, accompanied by impaired motor activity of the lower limbs. Often used in the treatment of severe forms of cerebral palsy. The dosage of the drug depends on the degree of disturbances and, with minimal disturbances, it is one granule per day. Side effects can be in the form of allergic manifestations and pronounced itching.
4. Likopodium - homeopathic preparation, which is used to treat disorders of tonus in children with low birth weight, anemia and developmental disorders. The drug not only affects the tone, but also improves the peripheral conductivity of nerve fibers. The agent is applied in granules two granules five times a day for five days, and then three granules twice a week. The course of treatment is 40 days. Side effects are very rare, can cause reddening of the face.

Alternative and homeopathic remedies can only be used according to the doctor's recommendations.

[46], [47], [48], [49], [50], [51]

Prevention

Untreated children have headaches of unclear etiology, increased fatigue, scoliosis, vegetative-vascular dystonia (including instability of blood pressure, palpitations, meteorological dependence, dizziness, excessive sweating). Such children often have poor memory, reduced visual acuity, impaired general and fine motor skills, attention deficit disorder, severity with concentration of attention, problems with learning and social adaptation in children's team. Disturbance of growth and development of the musculoskeletal system arises from the failure of regulation and disruption in the formation of physiological curves of the spine with prolonged hypertonia.

Therefore, preventive measures should come to the fore, and they should exclude harmful factors during pregnancy and normal maternal labor with the avoidance of birth trauma.

Hypertension in newborns can be physiological up to one month, but if it lasts longer or is asymmetric, then it requires diagnosis. Such a symptom, as a rule, does not happen to be isolated, and it indicates the defeat of the nervous system. To avoid complications in the future, it is best to use complex treatment with the use of both medications and physiotherapy methods.

[52], [53], [54], [55]

Forecast

The prognosis for life and normal recovery of muscle function depends on the structural damage to the brain of the newborn, which determines the further development of the child. The most frequent consequences of hypoxic damage to the central nervous system include seizures, spastic paresis, ataxia, hyperkinesia. Sometimes they are combined with subcortical blindness, cognitive disorders. Young children (up to 3 years old) often upset their parents with bad sleep, frequent regurgitation, constant anxiety and screaming, sluggish breast sucking, delayed psychomotor development. Possible development of hydrocephalus. If the diagnosis was not made in the delivery room or in the first month of the child's life, neurologic symptoms will begin to manifest up to 3 months. It can develop bronchial asthma, eczema, food allergy, neurodermatitis, spine deformities, epilepsy, anemia.

[56], [57], [58], [59], [60], [61], [62]