Basic management principles
The success of therapy for perinatal nervous system lesions largely depends on compliance with two main conditions:
- The "therapeutic window" rule. The timing of initiation of therapeutic measures directly determines the prognosis. The earlier adequate therapy is started, the greater the chances of restoring the function of damaged neurons.
- Comprehensiveness. Full-fledged treatment should include two equally important components: drug support and physical rehabilitation methods.
Pharmacotherapy strategy
Pharmacological correction is based on three classical directions:
- Etiotropic therapy. Aimed at eliminating the root cause; for example, antibacterial and antiviral drugs are used for infectious lesions.
- Pathogenetic therapy. Its goal is to interrupt the mechanisms of nerve tissue damage and improve its trophism. It includes the restoration of hemodynamics using vascular agents, neuroprotection (nootropics, amino acids), combating oxidative stress (antioxidants), and cofactor vitamin support. In the late recovery period, nootropics are particularly indicated.
- Symptomatic therapy. Relieves acute conditions: reducing intracranial pressure and eliminating brain edema (dehydration therapy), suppressing epileptiform activity (anticonvulsants), and treating concomitant somatic pathologies.
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Physical rehabilitation (habilitation) methods
Non-drug habilitation is the basis for restoring motor skills and preventing pathological motor stereotypes. The arsenal of methods includes:
- General strengthening and specialized neurological massage.
- Therapeutic physical training (exercise therapy).
- Physiotherapy procedures.
- Vojta therapy (Vojta therapy) is a kinesiotherapy method that stimulates innate motor reflexes to form correct movements (reflex locomotion).
Important clinical aspects
When studying this topic, one should keep in mind some characteristic features of the clinical course and management tactics:
- Recovery period: The most frequent manifestation at this time is liquor-vascular dystension syndrome.
- Cerebral palsy: The severity of infantile cerebral palsy is largely determined by the presence of symptomatic epilepsy in the child.
- Management of cephalhematoma: In most cases (especially with small sizes), a conservative approach is chosen—dynamic observation, as the hematoma resolves spontaneously within the first week. If there is no positive dynamics or the hematoma becomes denser (organizes), surgical intervention—puncture—is indicated.
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What else to study on this topic
- Mechanisms of hypoxic nerve tissue damage
- Differential diagnosis of recovery period syndromes
- Specifics of anticonvulsant use in newborns
- Features of neurosonography (NSG) as a screening method
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Other topics in «Chapter 2. Neonatology»
Neonatal Adaptation and Birth StressTransitory Skin Changes in NewbornsHormonal Crisis of NewbornsTransitory HyperbilirubinemiaTransitory Conditions of NewbornsNeonatal ScreeningNeonatal Screening DisordersNeonatal Audiological ScreeningMorphofunctional Criteria of a Full-Term InfantPremature InfantPathology of Premature InfantsNursing and Care of Premature InfantsPost-Term NewbornIntrauterine Growth RestrictionPerinatal CNS LesionsIntrauterine Infections (IUI)Clinical Presentation of Perinatal CNS LesionsCerebral palsyIntrauterine infectionsDiagnosis of Intrauterine InfectionsDiagnostic Imaging of Perinatal CNS Lesion SequelaeTreatment of Intrauterine InfectionsNeonatal SepsisLocalized Purulent-Inflammatory Diseases of Newborns
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