Perinatal encephalopathy

Description:

Perinatal encephalopathy (PEP) (peri-+ lat. natus — "birth" + Greek encephalon — "brain" + Greek patia — "disturbance") — the term combining big group various for the reason and the damages of a brain which are not specified by origin arising during pregnancy and childbirth. PEP can be shown differently, for example by a hyper excitability syndrome when irritability of the child is increased, appetite is reduced, the kid often belches during feeding and refuses a breast, sleeps less, falls asleep, etc. more difficultly. More rare, but also heavier display of perinatal encephalopathy is the syndrome of oppression of the central nervous system. At such children a physical activity is considerably reduced. The kid looks sluggish, shout silent and weak. He quickly is tired during feeding, in the most hard cases the sucking reflex is absent. Often displays of perinatal encephalopathy are expressed slightly, but the kids which transferred this state nevertheless require to themselves special attention, and sometimes — and special treatment.

Symptoms of Perinatal encephalopathy:

During PEP allocate three periods: acute (the 1st month of life), recovery (from 1 month to 1 year at full-term, up to 2 years — at premature) and a disease outcome. In every period of PEP allocate various syndromes. The combination of several syndromes is more often observed. Such classification is reasonable as it allows to allocate syndromes depending on age of the child. The corresponding tactics of treatment is developed for each syndrome. Expressiveness of each syndrome and their combination allow to define weight of a state, it is correct to appoint therapy, to build forecasts. There is a wish to note that even the minimum displays of perinatal encephalopathy demand the corresponding treatment for prevention of failures.

Let's list the main syndromes of PEP.

Acute period:

    * Syndrome of oppression of TsNS.
    * Coma syndrome.
    * A syndrome of the increased neuroreflex irritability.
    * Convulsive syndrome.
    * Gipertenzionno-gidrotsefalny syndrome.

Recovery period:

    * A syndrome of the increased neuroreflex irritability.
    * Epileptic syndrome.
    * Gipertenzionno-gidrotsefalny syndrome.
    * Syndrome of vegeto-visceral dysfunctions.
    * Syndrome of motive disturbances.
    * Syndrome of a delay of psychomotor development.

Outcomes:

    * Absolute recovery.
    * Delay of mental, motor or speech development.
    * A hyperactivity syndrome with deficit of attention (the minimum brain dysfunction).
    * Neurotic reactions.
    * Vegetative and visceral dysfunctions.
    * Epilepsy.
    * Hydrocephaly.
    * Cerebral palsy.

All patients with crushing and medium-weight damages of a brain need hospitalization. Children with easy disturbances are discharged from maternity hospital under outpatient observation of the neurologist.

Let's stop in more detail on clinical manifestations of separate syndromes of PEP most of which often meet in out-patient conditions.

The syndrome of the increased neuroreflex irritability is shown by strengthening of a spontaneous physical activity, an uneasy superficial dream, lengthening of the period of active wakefulness, difficulty of backfilling, frequent unmotivated crying, revival of instinctive congenital reflexes, a variable muscle tone, a tremor (twitching) of extremities, a chin. At premature this syndrome in most cases reflects reduction of the threshold of convulsive readiness, that is says that at the kid spasms easily can develop, for example, at temperature increase or action of other irritants. At a favorable current expressiveness of symptoms gradually decreases and disappears in terms from 4-6 months till 1 year. At the adverse course of a disease and lack of timely therapy the epileptic syndrome can develop.

The convulsive (epileptic) syndrome can be shown at any age. In infancy it is characterized by variety of forms. Imitation of instinctive motive reflexes in the form of pristupoobrazno the arising bendings and a ducking with tension of hands and legs, turn of the head aside and extension of the same name hands and legs is often observed; episodes of starts, pristupoobrazny twitchings of extremities, imitations of sucking movements and so forth. Sometimes even to the specialist it is difficult without additional methods of researches to define the nature of the arising convulsive states.

The Gipertenzionno-gidrotsefalny syndrome is characterized by excess amount of liquid in the spaces of a brain containing liquor (cerebrospinal fluid) that leads to increase in intracranial pressure. Doctors often call this disturbance to parents quite so — say that the kid has an increased intracranial pressure. The origins of this syndrome can be various: excessive production of liquor, disturbance of absorption of excess of liquor in a circulatory bed, or their combination. The main symptoms at a gipertenzionno-gidrotsefalny syndrome by which doctors are guided and which can control and parents, are rates of a gain of a circle of the head of the child and the sizes and a condition of a big fontanel. At most of the full-term newborns normal the head circle at the birth makes 34 — 35 cm. In the first half of the year the monthly gain of a circle of the head averages 1,5 cm (in the first month — to 2,5 cm), reaching about 44 cm by 6 months. In the second half of the year rates of a gain decrease; by a year a head circle — 47-48 cm. An uneasy dream, frequent plentiful vomiting, monotonous crying in combination with protrusion, the strengthened pulsation of a big fontanel and a zaprokidyvaniye of the head behind — the most typical manifestations of this syndrome.

However the big sizes of the head often happen also at absolutely healthy kids and are defined by constitutional and family features. The big size of a fontanel and "delay" of its closing are often observed at rickets. The small size of a fontanel at the birth increases risk of developing of intracranial hypertensia at various adverse situations (overheating, fervescence, etc.). Carrying out a neyrosonografichesky research of a brain allows to make correctly the diagnosis to such patients and to decide on therapy tactics. In most cases by the end of the first half of the year of life of the child normalization of growth of a circle of the head is noted. At a part of sick children by 8-12 months the gidrotsefalny syndrome without signs of increase in intracranial pressure remains. In hard cases development of hydrocephaly is noted.

The coma syndrome is manifestation of serious condition of the newborn which is estimated by 1-4 points on a scale Apgar. At sick children the expressed slackness, decrease in a physical activity up to its total absence are shown, all vital functions are oppressed: breath, cordial activity. Attacks of spasms can be noted. Serious condition remains 10-15 days, at the same time there are no reflexes of suction and swallowing.

The syndrome of vegeto-visceral dysfunctions is, as a rule, shown after the first month of life against the background of the increased nervous irritability and a gipertenzionno-gidrotsefalny syndrome. Frequent vomiting, a delay of an increase of body weight, disturbance of a cordial and respiratory rhythm, thermal control, change of coloring and temperature of integuments, skin "mramornost", disturbance of functions of digestive tract are noted. Often this syndrome can be combined with enterita, coloenterites (the inflammation of a small, large intestine which is shown the frustration of a chair, disturbance of an increase of body weight) caused by pathogenic microorganisms with rickets, making heavier their current.

The syndrome of motive disturbances comes to light from first weeks of life. Since the birth disturbance of a muscle tone can be observed as towards its decrease, and increase, its asymmetry can come to light, decrease or excessive strengthening of a spontaneous physical activity is noted. Often the syndrome of motive disturbances is combined with a delay of psychomotor and speech development since disturbances of a muscle tone and existence of a pathological physical activity (hyperkinesias) interfere with carrying out purposive movements, formation of normal motive functions, mastering the speech.

At a delay of psychomotor development the child begins to hold later the head, to sit, creep, go. Preferential disturbance of mental development can be suspected at weak monotonous shout, disturbance of an articulation, poverty of a mimicry, late emergence of a smile, a delay of visual and acoustical reactions.

The Cerebral Palsy (CP) — the neurologic disease arising owing to early damage of the central nervous system. At a cerebral palsy disturbances of development carry, as a rule, complex structure, disturbances motive, disturbances of the speech, a delay of mental development are combined. Motive disturbances at a cerebral palsy are expressed in damage of upper and lower extremities; small motility, muscles of the articulation device, a muscle-glazodvigateli suffers. Disturbances of the speech come to light at most of patients: from the easy (erased) forms before absolutely illegible speech. 20 — 25% of children have characteristic vision disorders: the meeting and dispersing squint, a nystagmus, restriction of fields of vision. At most of children the delay of mental development is noted. At a part of children disturbances of intelligence take place (mental retardation).

Hyperactivity syndrome with deficit of attention — the behavior disorder connected with the fact that the child badly holds the attention. It is difficult for such children to concentrate on any business, especially if it is not really interesting: they spin and cannot sit quietly still, constantly distract even on trifles. Their activity often too rough and chaotic.

Reasons of Perinatal encephalopathy:

Treat risk factors of developing of perinatal pathology of a brain:

    * Various chronic diseases of mother.
    * Acute infectious diseases or aggravations of the chronic centers of an infection in mother's organism during pregnancy.
    * Disturbances of food.
    * Too young age of the pregnant woman.
    * Hereditary diseases and disbolism.
    * Pathological course of pregnancy (early and late toxicoses, threat of abortion and so forth).
    * The pathological course of childbirth (rapid childbirth, weakness of patrimonial activity and so forth) and injuries at assistance at the time of delivery.
    * Harmful effects of the environment, an adverse ecological situation (ionizing radiation, toxic influences, including at use of various medicinal substances, environmental pollution by salts of heavy metals and industrial wastes and so forth).
    * Prematurity and immaturity of a fruit with various disturbances of its life activity in the first days of life.

It should be noted that most often meet hypoxemic - ischemic (their reason — the insufficiency of oxygen arising during an antenatal life of the kid) and the mixed damages of the central nervous system that is explained by the fact that practically any trouble during pregnancy and childbirth leads to disturbance of supply with oxygen of fabrics of a fruit and first of all a brain. In many cases of an origin of PEP it is not possible to establish.

The 10-mark scale Apgar helps to make objective idea of a condition of the child at the time of the birth. At the same time activity of the child, color of integuments, expressiveness of physiological reflexes of the newborn, a condition of respiratory and cardiovascular systems is considered. Each of indicators is estimated from 0 to 2 points. The scale Apgar allows to estimate already in the rodzal adaptation of the child to extra uterine living conditions within the first minutes after the birth. Score from 1 to 3 indicates serious condition, from 4 to 6 — a moderately severe state, from 7 to 10 — on satisfactory. Low points carry to risk factors for life of the child and development of neurologic disturbances and dictate need of use of the emergency intensive care.

Unfortunately, high points on a scale Apgar completely do not exclude risk of emergence of neurologic disturbances, a number of symptoms arises after the 7th day of life, and it is very important to reveal possible manifestations of PEP as soon as possible. Plasticity of a brain of the child is extraordinary big, timely held medical events help to avoid in most cases development of neurologic deficit, to prevent disturbances in the emotional and strong-willed sphere and cognitive activity.

Treatment of Perinatal encephalopathy:

  

    * Publications
    * Conferences
    * Reference books

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Perinatal encephalopathy (PEP) (peri-+ lat. natus — "birth" + Greek encephalon — "brain" + Greek patia — "disturbance") — the term combining big group various for the reason and the damages of a brain which are not specified by origin arising during pregnancy and childbirth. PEP can be shown differently, for example by a hyper excitability syndrome when irritability of the child is increased, appetite is reduced, the kid often belches during feeding and refuses a breast, sleeps less, falls asleep, etc. more difficultly. More rare, but also heavier display of perinatal encephalopathy is the syndrome of oppression of the central nervous system. At such children a physical activity is considerably reduced. The kid looks sluggish, shout silent and weak. He quickly is tired during feeding, in the most hard cases the sucking reflex is absent. Often displays of perinatal encephalopathy are expressed slightly, but the kids which transferred this state nevertheless require to themselves special attention, and sometimes — and special treatment.
Causes of illness

Treat risk factors of developing of perinatal pathology of a brain:

    * Various chronic diseases of mother.
    * Acute infectious diseases or aggravations of the chronic centers of an infection in mother's organism during pregnancy.
    * Disturbances of food.
    * Too young age of the pregnant woman.
    * Hereditary diseases and disbolism.
    * Pathological course of pregnancy (early and late toxicoses, threat of abortion and so forth).
    * The pathological course of childbirth (rapid childbirth, weakness of patrimonial activity and so forth) and injuries at assistance at the time of delivery.
    * Harmful effects of the environment, an adverse ecological situation (ionizing radiation, toxic influences, including at use of various medicinal substances, environmental pollution by salts of heavy metals and industrial wastes and so forth).
    * Prematurity and immaturity of a fruit with various disturbances of its life activity in the first days of life.

It should be noted that most often meet hypoxemic - ischemic (their reason — the insufficiency of oxygen arising during an antenatal life of the kid) and the mixed damages of the central nervous system that is explained by the fact that practically any trouble during pregnancy and childbirth leads to disturbance of supply with oxygen of fabrics of a fruit and first of all a brain. In many cases of an origin of PEP it is not possible to establish.

The 10-mark scale Apgar helps to make objective idea of a condition of the child at the time of the birth. At the same time activity of the child, color of integuments, expressiveness of physiological reflexes of the newborn, a condition of respiratory and cardiovascular systems is considered. Each of indicators is estimated from 0 to 2 points. The scale Apgar allows to estimate already in the rodzal adaptation of the child to extra uterine living conditions within the first minutes after the birth. Score from 1 to 3 indicates serious condition, from 4 to 6 — a moderately severe state, from 7 to 10 — on satisfactory. Low points carry to risk factors for life of the child and development of neurologic disturbances and dictate need of use of the emergency intensive care.

Unfortunately, high points on a scale Apgar completely do not exclude risk of emergence of neurologic disturbances, a number of symptoms arises after the 7th day of life, and it is very important to reveal possible manifestations of PEP as soon as possible. Plasticity of a brain of the child is extraordinary big, timely held medical events help to avoid in most cases development of neurologic deficit, to prevent disturbances in the emotional and strong-willed sphere and cognitive activity.
Current PEP and possible forecasts

During PEP allocate three periods: acute (the 1st month of life), recovery (from 1 month to 1 year at full-term, up to 2 years — at premature) and a disease outcome. In every period of PEP allocate various syndromes. The combination of several syndromes is more often observed. Such classification is reasonable as it allows to allocate syndromes depending on age of the child. The corresponding tactics of treatment is developed for each syndrome. Expressiveness of each syndrome and their combination allow to define weight of a state, it is correct to appoint therapy, to build forecasts. There is a wish to note that even the minimum displays of perinatal encephalopathy demand the corresponding treatment for prevention of failures.

Let's list the main syndromes of PEP.

Acute period:

    * Syndrome of oppression of TsNS.
    * Coma syndrome.
    * A syndrome of the increased neuroreflex irritability.
    * Convulsive syndrome.
    * Gipertenzionno-gidrotsefalny syndrome.

Recovery period:

    * A syndrome of the increased neuroreflex irritability.
    * Epileptic syndrome.
    * Gipertenzionno-gidrotsefalny syndrome.
    * Syndrome of vegeto-visceral dysfunctions.
    * Syndrome of motive disturbances.
    * Syndrome of a delay of psychomotor development.

Outcomes:

    * Absolute recovery.
    * Delay of mental, motor or speech development.
    * A hyperactivity syndrome with deficit of attention (the minimum brain dysfunction).
    * Neurotic reactions.
    * Vegetative and visceral dysfunctions.
    * Epilepsy.
    * Hydrocephaly.
    * Cerebral palsy.

All patients with crushing and medium-weight damages of a brain need hospitalization. Children with easy disturbances are discharged from maternity hospital under outpatient observation of the neurologist.

Let's stop in more detail on clinical manifestations of separate syndromes of PEP most of which often meet in out-patient conditions.

The syndrome of the increased neuroreflex irritability is shown by strengthening of a spontaneous physical activity, an uneasy superficial dream, lengthening of the period of active wakefulness, difficulty of backfilling, frequent unmotivated crying, revival of instinctive congenital reflexes, a variable muscle tone, a tremor (twitching) of extremities, a chin. At premature this syndrome in most cases reflects reduction of the threshold of convulsive readiness, that is says that at the kid spasms easily can develop, for example, at temperature increase or action of other irritants. At a favorable current expressiveness of symptoms gradually decreases and disappears in terms from 4-6 months till 1 year. At the adverse course of a disease and lack of timely therapy the epileptic syndrome can develop.

The convulsive (epileptic) syndrome can be shown at any age. In infancy it is characterized by variety of forms. Imitation of instinctive motive reflexes in the form of pristupoobrazno the arising bendings and a ducking with tension of hands and legs, turn of the head aside and extension of the same name hands and legs is often observed; episodes of starts, pristupoobrazny twitchings of extremities, imitations of sucking movements and so forth. Sometimes even to the specialist it is difficult without additional methods of researches to define the nature of the arising convulsive states.

The Gipertenzionno-gidrotsefalny syndrome is characterized by excess amount of liquid in the spaces of a brain containing liquor (cerebrospinal fluid) that leads to increase in intracranial pressure. Doctors often call this disturbance to parents quite so — say that the kid has an increased intracranial pressure. The origins of this syndrome can be various: excessive production of liquor, disturbance of absorption of excess of liquor in a circulatory bed, or their combination. The main symptoms at a gipertenzionno-gidrotsefalny syndrome by which doctors are guided and which can control and parents, are rates of a gain of a circle of the head of the child and the sizes and a condition of a big fontanel. At most of the full-term newborns normal the head circle at the birth makes 34 — 35 cm. In the first half of the year the monthly gain of a circle of the head averages 1,5 cm (in the first month — to 2,5 cm), reaching about 44 cm by 6 months. In the second half of the year rates of a gain decrease; by a year a head circle — 47-48 cm. An uneasy dream, frequent plentiful vomiting, monotonous crying in combination with protrusion, the strengthened pulsation of a big fontanel and a zaprokidyvaniye of the head behind — the most typical manifestations of this syndrome.

However the big sizes of the head often happen also at absolutely healthy kids and are defined by constitutional and family features. The big size of a fontanel and "delay" of its closing are often observed at rickets. The small size of a fontanel at the birth increases risk of developing of intracranial hypertensia at various adverse situations (overheating, fervescence, etc.). Carrying out a neyrosonografichesky research of a brain allows to make correctly the diagnosis to such patients and to decide on therapy tactics. In most cases by the end of the first half of the year of life of the child normalization of growth of a circle of the head is noted. At a part of sick children by 8-12 months the gidrotsefalny syndrome without signs of increase in intracranial pressure remains. In hard cases development of hydrocephaly is noted.

The coma syndrome is manifestation of serious condition of the newborn which is estimated by 1-4 points on a scale Apgar. At sick children the expressed slackness, decrease in a physical activity up to its total absence are shown, all vital functions are oppressed: breath, cordial activity. Attacks of spasms can be noted. Serious condition remains 10-15 days, at the same time there are no reflexes of suction and swallowing.

The syndrome of vegeto-visceral dysfunctions is, as a rule, shown after the first month of life against the background of the increased nervous irritability and a gipertenzionno-gidrotsefalny syndrome. Frequent vomiting, a delay of an increase of body weight, disturbance of a cordial and respiratory rhythm, thermal control, change of coloring and temperature of integuments, skin "mramornost", disturbance of functions of digestive tract are noted. Often this syndrome can be combined with enterita, coloenterites (the inflammation of a small, large intestine which is shown the frustration of a chair, disturbance of an increase of body weight) caused by pathogenic microorganisms with rickets, making heavier their current.

The syndrome of motive disturbances comes to light from first weeks of life. Since the birth disturbance of a muscle tone can be observed as towards its decrease, and increase, its asymmetry can come to light, decrease or excessive strengthening of a spontaneous physical activity is noted. Often the syndrome of motive disturbances is combined with a delay of psychomotor and speech development since disturbances of a muscle tone and existence of a pathological physical activity (hyperkinesias) interfere with carrying out purposive movements, formation of normal motive functions, mastering the speech.

At a delay of psychomotor development the child begins to hold later the head, to sit, creep, go. Preferential disturbance of mental development can be suspected at weak monotonous shout, disturbance of an articulation, poverty of a mimicry, late emergence of a smile, a delay of visual and acoustical reactions.

The Cerebral Palsy (CP) — the neurologic disease arising owing to early damage of the central nervous system. At a cerebral palsy disturbances of development carry, as a rule, complex structure, disturbances motive, disturbances of the speech, a delay of mental development are combined. Motive disturbances at a cerebral palsy are expressed in damage of upper and lower extremities; small motility, muscles of the articulation device, a muscle-glazodvigateli suffers. Disturbances of the speech come to light at most of patients: from the easy (erased) forms before absolutely illegible speech. 20 — 25% of children have characteristic vision disorders: the meeting and dispersing squint, a nystagmus, restriction of fields of vision. At most of children the delay of mental development is noted. At a part of children disturbances of intelligence take place (mental retardation).

Hyperactivity syndrome with deficit of attention — the behavior disorder connected with the fact that the child badly holds the attention. It is difficult for such children to concentrate on any business, especially if it is not really interesting: they spin and cannot sit quietly still, constantly distract even on trifles. Their activity often too rough and chaotic.
Diagnosis

The diagnosis of perinatal damage of a brain can be made on the basis of clinical data and knowledge of features of a course of pregnancy and childbirth.

Data of additional methods of researches have auxiliary character and help to specify character and extent of damage of a brain, serve for observation of the course of a disease, assessment of efficiency of the carried-out therapy.

Neyrosonografiya (NSG) — the safe method of survey of a brain allowing to estimate a condition of tissue of brain, likvorny spaces. It reveals intracranial defeats, the nature of damages of a brain.

Doppler sonography allows to estimate blood-groove size in brain vessels.

The electroencephalogram (EEG) — the method of a research of functional activity of a brain based on registration of electric potentials of a brain. According to EEG it is possible to judge degree of a delay of age development of a brain, existence of mezhpolusharny asymmetries, existence of epileptic activity, its centers in various departments of a brain.

Video monitoring — the way allowing to estimate spontaneous physical activity at the child by means of videos. The combination video and EEG-monitorings allows to reveal precisely character of attacks (paroxysms) at children of early age.

Elektroneyromiografiya (ENMG) — an irreplaceable method in diagnosis of the inborn and acquired neuromuscular diseases.

The Computer Tomography (CT) and the magnetic and resonant tomography (MRT) — the modern methods allowing to estimate in details structural changes of a brain. Wide use of these methods at early children's age is complicated because of need of use of an anesthesia.

The Positron Emission Tomography (PET) allows to define metabolic rate in fabrics and intensity of a brain blood-groove at various levels and in various structures of the central nervous system.

Most widely at PEP the neyrosonografiya and an electroencephalography are used.

At pathology of TsNS survey of the oculist is obligatory. The changes revealed on an eyeground help to diagnose genetic diseases, to estimate degree of manifestation of intracranial hypertensia, a condition of optic nerves.
Treatment

As it was already told above, children with crushing and medium-weight damages of the central nervous system during the acute period of a disease need hospitalization. At most of children with easy manifestations of syndromes of the increased neuroreflex irritability and motive disturbances it is possible to be limited to selection of the individual mode, pedagogical correction, massage, physiotherapy exercises, use of physiotherapeutic methods. From medicamentous methods for such patients use phytotherapy (infusions and broths of sedative and diuretic herbs) and homeopathic medicines more often.

At a gipertenzionno-gidrotsefalny syndrome degree of manifestation of hypertensia and expressiveness of a gidrotsefalny syndrome is considered. With the increased intracranial pressure it is recommended to raise the head end of a bed on 20-30 °. For this purpose it is possible to enclose something under legs of a bed or under a mattress. Medicamentous therapy is appointed only by the doctor, efficiency is estimated on clinical manifestations and data of NSG. In mild cases are limited to phytodrugs (broths of a horsetail field, a leaf of a bearberry, etc.). At more hard cases use the Diacarbum reducing production of liquor and increasing it outflow. At inefficiency of drug treatment in especially hard cases it is necessary to resort to neurosurgical methods of therapy.

At the expressed motive disturbances the main accent is given to methods of massage, physiotherapy exercises, physical therapy. Medicamentous therapy depends on the leading syndrome: at a hypomyotonia, peripheral paresis appoint the drugs improving neuromuscular transmission (Dibazolum, sometimes Galantaminum) at the raised tone apply the means promoting its decrease — Mydocalmum or Baclofenum. Various options of administration of drugs in and by means of an electrophoresis are used.

Selection of drugs to children with an epileptic syndrome depends on a disease form. Reception of anticonvulsant drugs (antikonvulsant), doses, time of reception are defined by the doctor. Change of drugs is carried out gradually under control of EEG. Sharp spontaneous cancellation of drugs can provoke increase of attacks. Now use a wide arsenal of anticonvulsants. Reception of antikonvulsant is not indifferent for an organism and is appointed only at the established diagnosis of epilepsy or an epileptic syndrome under control of laboratory indicators. However lack of timely treatment of epileptic paroxysms leads to disturbance of mental development. Massage and physiotherapeutic treatment are contraindicated to children with an epileptic syndrome.

At a syndrome of a delay of psychomotor development along with non-drug methods of treatment and social and pedagogical correction the drugs activating brain activity, improving a brain blood stream, promoting formation of new bonds between nervous cells are used. Choice of drugs big (nootropil, to lutseta, Pantogamum, Vinpocetine, Actovegin, кортексин and so forth). In each case the scheme of drug treatment is selected individually depending on expressiveness of symptomatology and individual portability.

Practically at all syndromes of PEP sick appoint drugs of vitamins of group "B" which can be applied inside, intramusculary and in an electrophoresis.

To one-year-old age at most of mature children of the phenomenon of PEP the insignificant displays of perinatal encephalopathy which are not making essential impact on further development of the child disappear or come to light. Frequent effects of the postponed encephalopathy are the minimum brain dysfunction (easy behavior disorders and training), a gidrotsefalny syndrome. The heaviest outcomes are cerebral palsy and epilepsy.