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MODERN APPROACHES TO PATOGENESIS AND PROGNOSIS OF CNS HYPOXIC-ISCHEMIC LESION OUTCOMES IN PERINATAL PERIOD

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Abstract

CNS hypoxic-ischemic lesion is one of the causes of newborns invalidism in perinatal period. Under the «perinatal hypoxia» the complex of symptoms caused by oxygen insufficiency of fetus and newborn is considered. Combined prenatal and early neonatal impact of hypoxia is considered as a perinatal hypoxic-ischemic lesion. Regeneration phases that have place after perinatal ischemia are reperfusion phase (±0-4 h), latent phase (0-8 h), phase of secondary energy disorder (8-72 h) and late phase (>72 h), when brain electric activity decreases and seizures take place. The first phase in further development of pathologic process is an acute period of 1 month, associated with CNS hypoxic-ischemic lesion. The second phase (2nd-3 rd months) are characterized with decrease in neuronal loss, reduction of neurologic disorders. The third phase (3-6th months) is characterized with spastic events. In some of the children the progress of the second phase is fixing in the same time, it is shown by decrease in neurologic disorders. The final forth phase has no timing limits and is characterized with children’s cerebral paralysis as an outcome, syndrome of minimal brain dysfunctions, astenoneurotic syndrome, hydrocephalic syndrome, syndrome of motion disorders, epileptic disorders, psychomotor and prespeech development delay or, in case of good outcomes of pathologic process, regeneration of functions may occur. Accurate evaluation of degree of CNS perinatal hypoxic-ischemic disorders with routine methods of clinical, instrumental and laboratory investigations is not always possible. Perinatal hypoxic-ischemic CNS disorders are always associated with hematoencephalic barrier transparency disorders and with release of neurospecific proteins in blood flow. Therefore dynamic evaluation of neurospecific proteins in blood serum may be reasonable for evaluation of CNS lesion degree and disease prognosis.

About the Author

D. V. Blinov
GBOU VPO RSMU named after N.I. Pirogov, Ministry of Health and Social Development of Russian Federation, Moscow
Russian Federation


References

1. Антонова О.М. Нейроспецифическая енолаза и ее роль в механизмах антительной агрессии в мозг. Дисс. канд. мед. наук. 1997; 121 с.

2. Блинов Д.В. Общность ряда нейробиологических процессов при расстройствах деятельности ЦНС. Эпилепсия и пароксизмальные состояния. 2011; 2:28-33.

3. Блинов Д.В. Иммуноферментный анализ нейроспецифических антигенов в оценке проницаемости гематоэнцефалического барьера при перинатальном гипоксически-ишемическом поражении ЦНС (клинико-экспериментальное исследование). Дисс. канд. мед. наук. М. 2004; 153 с.

4. Блинов Д.В., Сандуковская С.И. Статистикоэпидемиологическое исследование заболеваемости неврологического профиля на примере детского стационара. Эпилепсия и пароксизмальные состояния. 2010; 2 (4): 12-22.

5. Бредбери М. Концепция гематоэнцефалического барьера. М. 1983; 480 с.

6. Ганнушкина И.В. Патофизиология нарушений мозгового кровообращения. Кн. Мозг: теоретические и клинические аспекты (под ред. Покровского В.И.). Медицина. 2003; 463-489.

7. Дегтярева М.Г. Динамический контроль функционального состояния ЦНС у детей с перинатальными постгипоксическими поражениями головного мозга на первом году жизни. Дисс. канд. мед. наук. 2002; 254 с.

8. Журба Л.Т., Мастюкова Е.М. Нарушение психомоторного развития детей первого года жизни. Медицина. 1981; 272 с.

9. Казьмин А.М., Дайхина Л.В., Озерова О.Е. Состояние нервной системы в первые 12-16 месяцев у детей, перенесших перивентрикулярную лейкомаляцию в периоде новорожденности. Материнство и детство. 1992; 37 (4-5): 8-13.

10. Классификация последствий перинатальных поражений нервной системы у новорожденных. Методические рекомендации. РАСПМ. 2005; 40 с.

11. Мухтарова С.Н. Значение определения нейроспецифической енолазы в оценке тяжести гипоксически-ишемических поражений мозга у новорожденных. Медицинские Новости Грузии. 2010; 4 (181): 49-54.

12. Приказ Минздравсоцразвития России № 1687н от 27 декабря 2011 г.

13. Чехонин В.П., Дмитриева Т.Б., Жирков Ю.А. Иммунохимический анализ нейроспецифических антигенов. М. 2000; 416 с.

14. Якунин Ю.А., Перминов В.С. Прогностические критерии гипоксических поражений ЦНС у детей. Рос. Вест. перинат. и пед. 1993; 38 (2): 20-24.

15. Berger R., Garnier Y. Pathophysiology of perinatal brain damage. Brain. Res. Rew. 1999; 30: 107-134.

16. Brown J.K., Minns R.A. Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects. Dev. Med. Child. Neurol. 1993; 35 (10): 849-69.

17. Chopp M., Li Y. Apoptosis in focal cerebral ischemia. Acta Neurochir. 1996; 66: 21-26.

18. Chopp M., Chan P.H., Hsu C.Y., Cheung M.E., Jacobs T.P. DNA damage and repair in central nervous system injury: National Institute of Neurological Disorders and Stroke Workshop Summary. Stroke. 1996; 27 (3): 363-369.

19. Clark R.K., Lee E.V., Fish C.J., White R.F., Price W.J, Jonak Z.L., Feuerstein G.Z., Barone F.C. Development of tissue damage, inflammation and resolution following stroke: an immunohistochemical and quantitative planimetric study. Brain Research Bull. 1993; 31: 565-572.

20. Dennery P.A. Predicting neonatal brain injury: are we there yet? Arch. Pediatr. Adolesc. Med. 2003; 157 (12): 1151-1152.

21. Du Plessis A.J., Volpe J.J. Perinatal brain injury in the preterm and term newborn. Curr. Opin. Neurol. 2002; 15 (2): 151-157.

22. Eng L.F., Ghirnikar R.S., Lee Y.L. Glial fibrillary acidic protein: GFAP-thirty-one years (1969-2000). Neurochem. Res. 2000; 9-10: 1439-1451.

23. Ennen C.S., Huisman T.A., Savage W.J., Northington F.J., Jennings J.M., Everett A.D., Graham E.M. Glial fibrillary acidic protein as a biomarker for neonatal hypoxic-ischemic encephalopathy treated with whole-body cooling. Am J. Obstet. Gynecol. 2011; 205 (3): 251-257.

24. Fazzi E., Lanners J., Danova S., Ferrarri-Ginevra O., Gheza C., Luparia A., Balottin U., Lanzi G. Stereotyped behaviours in blind children. Brain Dev. 1999; 21 (8): 522-528.

25. Greishen G. Ischaemia of the preterm brain. Biol. Neonate. 1992; 62: 243-247.

26. Grogaard B., Schurer L., Gerdin B., Arfors K.-E. The role of polymorphonuclear leukocytes in postischemic delayed hypoperfusion. In Oxygen Free Radicals in Shock, ed. U. Novelli, Karger, Basel, Florence. 1985; 74-78.

27. Giulian D., Reactive microglia and ischemic injury. In: Primer on cerebrovascular diseases (M. Welsh, L. Caplan, B. Siesjo, B. Weir, D. Reis, eds.). San Diego, CA, Academic. 1997; 117-124.

28. Haataja L., Mercuri E., Regev R., Cowan F., Rutherford M., Dubowitz V., Dubowitz L. Optimality score for the neurologic examination of the infant at 12 and 18 months of age. J. Pediatr. 1999; 135 (2 Pt 1): 153-161.

29. Hunt R.W., Loughnan P., Fink A.M., Volpe J.J., Inder T.E. Magnetic resonance demonstration in the newborn of generalized cerebral venous dilation with spontaneous resolution. Eur. J. Paediatr. Neurol. 2002; 6 (5): 289-92.

30. Huppi P.S., Warfield S., Kikinis R., Barnes P.D., Zientara G.P., Jolesz F.A., Tsuji M.K., Volpe J.J. Quantitative magnetic resonance imaging of brain development in premature and mature newborns. Ann. Neurol. 1998; 43 (2): 224-35.

31. Iadecola C. Mechanisms of cerebral ischemic damage. In: Cerebral ischemia (W. Watz ed.). New Jersey, Totowa, Humana Press. 1999; 3-33.

32. Inder T.E., Volpe J.J. Mechanisms of perinatal brain injury. Semin. Neonatol. 2000; 5 (1): 3-16.

33. Kermer P., Klocker N., Bahr M. Neuronal death after brain injury (models, mechanisms, and therapeutic strategies in vivo). Cell Tissue Res. 1999; 298: 383-395.

34. Levene M. Role of excitatory amino acid antagonists in the management of birth asphyxia. Biol Neonate. 1992; 62: 248-251.

35. McGeer P.L., Kawamata T., Walker D.G., Akiyama H., Tooyama I., McGeer E.G. Microglia in degenerative neurological disease. Glia. 1993; 7: 84-92.

36. Middeldorp J., Hol E.M. GFAP in health and disease. Prog Neurobiol. 2011; 93 (3): 421-443.

37. Palmer C. Neurobiology of perinatal asphyxia. Penn. State Coll. Med. 2001; 1: 1-18.

38. Petty M., Wettstein J. Elements of cerebral microvascular ischaemia. Brain Res. Reviews. 2001; 36:23-34.

39. Roth S.C., Edwards A.D., Cady E.B., Delpy D.T., Wyatt J.S., Azzopardi D. Relation between cerebral oxidative metabolism following birth asphyxia and neurodevelopmental outcome and brain growth at one year. Dev. Med. Child. Neurol. 1992; 34: 285-95.

40. Ruppel R., Kochalek P., Adelson P. Excitotoxicy after severe traumatic brain injury in infants and children: the role of chield abuse. J. Pediatr. 2001; 138: 18-25. Sehba F.A., Hou J., Pluta R.M., Zhang J.H. The importance of early brain injury after subarachnoid hemorrhage. Prog Neurobiol. 2012; 97 (1): 14-37. Sehba F.A., Pluta R.M., Zhang J.H. Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury. Mol Neurobiol. 2011; 43 (1): 27-40.

41. Tan S., Parks D.A. Preserving brain function during neonatal asphyxia. Clinics in Perinatology. 1999; 26 (3): 733-735.

42. Thompson C.M., Puterman A.S., Linley L.L., Hann F.M., Vanderelst C.W., Molteno C.D. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997; 86 (7): 757-761.

43. Volpe J.J. Neurology of the Newborn. Saunders Elsevier. 2008; 1120 p.

44. Volpe J.J. Overview: normal and abnormal human brain development. Ment. Retard. Dev. Disabil. Res. Rev. 2000; 6 (1): 1-5.

45. Volpe J.J. Perinatal brain injury: from pathogenesis to neuroprotection. Ment. Retard. Dev. Disabil. Res. Rev. 2001; 7 (1): 56-64.

46. Zhang F., White J., Iadecola C. Nitric oxide donors increase blood flow and reduce brain damage in focal ischemia: evidence that nitric oxide is beneficial in the early stages of cerebral ischemia. J. Cereb. Blood Flow. Metab. 1994; 14: 217-226.


For citation:


Blinov D.V. MODERN APPROACHES TO PATOGENESIS AND PROGNOSIS OF CNS HYPOXIC-ISCHEMIC LESION OUTCOMES IN PERINATAL PERIOD. Obstetrics, Gynecology and Reproduction. 2012;6(3):34-38. (In Russ.)

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