10. Diseases of central nervous system in neonatal age.
Covers brain injury in newborns, starting with how term and preterm babies are hurt differently. It goes through hypoxic-ischaemic encephalopathy with the Sarnat staging table and cooling criteria, then intraventricular haemorrhage with the Papile grading table, periventricular leukomalacia, and neonatal seizures with a table of causes. It ends with neonatal meningitis, birth injuries to the head and nerves in a comparison table, and other conditions.
Topic 10 of 30 in the MU Sofia syllabus for Pediatrics (Medicine, Year 5). The free AceMed note covers it in 8 sections, about 517 words (5 min of reading), with 16 flashcards.
In this note
Introduction
Hypoxic-ischaemic encephalopathy (HIE)
Intraventricular haemorrhage (IVH)
Periventricular leukomalacia (PVL)
Neonatal seizures
Neonatal meningitis
Birth injuries to the head and nerves
Other conditions
Introduction
The newborn brain is easily injured by lack of oxygen and blood flow, bleeding, infection and metabolic upset. Preterm and term babies are hurt in different ways: the term brain mainly by hypoxia-ischaemia and stroke, the preterm brain by bleeding into the ventricles and white-matter injury.
Hypoxic-ischaemic encephalopathy (HIE)
Brain injury from a lack of oxygen and blood around birth (cord prolapse, placental abruption, uterine rupture, shoulder dystocia). Evidence of an insult: cord or early blood pH ≤ 7.0 or base deficit ≥ 16, Apgar ≤ 5 at 10 minutes or ongoing resuscitation, then signs of encephalopathy.
Therapeutic hypothermia: cooling to 33.5 °C for 72 hours, started within 6 hours of birth, for babies ≥ 36 weeks with moderate or severe HIE, lowers death and disability. Also: ventilation, careful fluids, treat seizures (amplitude-integrated EEG), check glucose, calcium, liver, kidneys and clotting; MRI at days 4–14 shows the pattern of injury. Later problems: cerebral palsy (often dyskinetic or quadriplegic), epilepsy, learning difficulties.
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