COMPREHENSIVE NEUROMONITORING OF THE NEWBORN WITH MANIFESTATIONS OF SEVERE ASPHYXIA AND THERAPEUTIC HY

Abstract

Birth asphyxia is a separate nosological form characterized by clinical symptoms ofcardiorespiratory and neurological depression of a newbornwith possible subsequent development of encephalopathyand multiorgan dysfunction, as well as laboratory signsof side effects of fetal hypoxia before or during childbirth(significant metabolic or mixed acidosis in umbilical cordblood gases). The current method of treatment of childrenwith manifestations of asphyxia is therapeutic hypothermia,that should be accompanied by continuous monitoring ofthe patient's cerebral functions.The article presents a clinical case of severe asphyxiain the full-term boy born by cesarean section due to fetaldistress and effusion of meconium amniotic fluid. The scoreon the Apgar scale was 1 point at the end of the first minuteof life, and 3 points five minutes after birth. Therapeutichypothermia by passive cooling was started at the maternityhospital and continued in the intensive care unit of NationalChildren’s Specialized Hospital “OKHMATDYT” of theMinistry of Health of Ukraine (Kyiv, Ukraine).The child was getting dynamic complex neuromonitoringthat included clinical assessment of neurologicalstatus, cerebral oximetry by near-infrared spectroscopy,neurosonography, magnetic resonance imaging, videoelectroencephalographic monitoring and polysomnography.The results of a comprehensive examination of the childmade it possible to identify functional markers of cerebraldisorders: cortical rhythm depression, electro-clinicalseizures, changes in oxygenation of brain tissues, signs ofleukomalacia and ischemic damage, etc. Polysomnographicsigns of sleep-related breathing disorders were found outwith the development of mild apnea-hypopnea syndrome,sinus bradycardia, delayed maturation of physiologicalsleep precursors. Delayed motor development withoutstructural epilepsy were noted at follow-up at the age of2 months.