Pathogenetically Grounded Approach to the Treatment of Children who Underwent Perinatal CNS Lesions

ORIGINAL ARTICLE
Olga N. Krasnorutskaya, Vera S. Ledneva, Galina Golosnaya

 
International Journal of Biomedicine. 2018;8(3):192-196.   
DOI: 10.21103/Article8(3)_OA4
Originally published September 15, 2018  

Abstract: 

The aim of this study was to evaluate, based on the analysis of neurobiochemical markers, the effectiveness of pathogenetically substantiated therapy for disorders of the psychomotor and physical development of children in the first year of life who underwent perinatal hypoxia.
Materials and Methods: The study included 419 patients (52% boys and 48% girls) aged from 1 to 6 months. The main group included 336 patients in the first year of life who received inpatient treatment for perinatal CNS damage of different degrees of severity. The main group was divided into two subgroups according to age: Group 1 (n=163) between the ages of 1 and 3 months and Group 2 (n=173) between the ages of 4 and 6 months.  In accordance with the severity of the CNS lesion, the main group was also divided into 3 subgroups: mild degree (n=122), moderate degree (n=118), and severe degree (n=96). The control group included 83 apparently healthy children (n=43 between the ages of 1 to 3 months and n=40 between the ages of 4 to 6 months). The analysis of individual physical development of the children was carried out using Z scores (weight, age, head circumference) and centiles (7 intervals ("corridors")) according to the WHO standard program WHO AnthroPlus, The concentrations of biochemical markers (L- Homocysteine, beta-NGF, S100 protein, angiotensin II) in the blood were evaluated in all children at admission, as a routine entry investigation. In accordance with a treatment regimen, the main group was also divided into 2 subgroups: subgroup A (n=170), patients who received therapy depending on a general clinical manifestation; and subgroup B (n=166), patients who received therapy depending on a dominant syndrome and variability of neurobiochemical markers.
Results:  We found that Scheme B showed advantages for all studied neurobiochemical markers, with statistical significance for L-Hcy regardless of the age group. The positive dynamics were found in the neurological deficit severity against the background of Scheme B regardless of the age group and the degree of severity of the CNS lesion. Thus, the pronounced positive dynamics in the levels of neurotrophic and neurovascular markers of the CNS lesion in all age groups reflects the advantage of pathogenetic therapy.

Keywords: 
neurological deficit • nervous system • nerve growth factor • homocysteine
References: 
  1. Balakireva EA, Krasnorutskaya ON, Kalmykova GV. [Unresolved issues of pediatric neurology]. Scientific bulletins of Belgorod State University. Series: Medicine. Pharmacia. 2014; 28.(24-1):5-7. [Article in Russian].
  2. Barashnev YuI. [Hypoxic encephalopathy: hypotheses of the pathogenesis of cerebral disorders and the search for methods of drug therapy]. Rossiyskiy Vestnik Perinatologii Pediatrii. 2002; 1:6-13. [Article in Russian].
  3. Krasnorutskaya ON, Ledneva VS. [Clinical and biochemical indices in the diagnosis of developmental disorders of children with consequences of perinatal nervous system damage]. Pediatriia. 2018;97(3):175-9. [Article in Russian].
  4. Afanasyeva NV, Strizhakov AV. [Outcomes of pregnancy and childbirth with fetoplacental insufficiency of various severity]. Problems of Gynecology, Obstetrics and Perinatology. 2004; 3(2):7-13. [Article in Russian].
  5. Golosnaia GS. [The role of inhibitors of apoptosis in the diagnosis and prediction of outcomes of perinatal hypoxic brain lesions in newborns]. Pediatria. 2005; 84(3):30-35. [Article in Russian].
  6. Krasnorutckaya ON, Balakireva EA, Zu’kova AA, Dobrynina IS. [Assessment of Biochemical Markers of Perinatal Injuries of Central Nervous System in the Children]. Journal  of  New  Medical  Technologies. 2014; 21(2):26-29. [Article in Russian].
  7. Lobanova LV. Hypoxic lesions of the brain in term infants - causes, pathogenesis, clinical and ultrasound diagnostics, prognosis and tactics of conducting children at an early age. Abstract of ScD Thesis. Ivanovo; 2000. [In Russian].
  8. Martinchik AN, Baturin AK, Keshabyats EE, Peskova EV. [Retrospective estimation of anthropometric indicators in Russian children in 1994-2012 according to the new WHO standards]. Journal «Pediatria» named after G.N. Speransky. 2015;1:156-60. [Article in Russian].
  9. Petrukhin AS. Neurology of childhood.  M., 2004. [In Russian].
  10. Esser S, Lampugnani MG, Corada M, Dejana E, Risau W. Vascular endothelial growth factor induces VE-cadherin tyrosine phophorylation in endothelial cells. J Cell Sci. 1998;111(Pt 13):1853-65. PubMed
  11. Palchik AB, Shabalov NP. Hypoxic-ischemic encephalopathy of newborns. 2nd ed. M: Medpressinform; 2009. [In Russian].
  12. Baturin AK, Keshabyants EE, Martinchik AN, Peskova EV. [Retrospective assessment of anthropometric measurements of children in Russia 1994–2012 according to the new WHO standards]. Pediatriia. 2015; 94(1):156-160. [Article in Russian].
  13. WHO growth reference. WHO AnthroPlus software [Electroniс resourse]. Available at: http://www.who.int/growthref/tools/en/.
  14. de Onis M, Garza C, Onyango AW, Rolland-Cachera MF; le Comité de nutrition de la Société française de pédiatrie. [WHO growth standards for infants and young children]. Arch Pediatr. 2009;16(1):47-53. doi: 10.1016/j.arcped.2008.10.010. [Article in French]. PubMed
  15. van Beynum 1M, Smeitink JA, den Heijer M, te Poele Pothoff MT, Blom HJ. Hyperhomocysteinemia: a risk factor for ischemic stroke in children. Circulation. 1999;99(16):2070-2. PubMed
  16. Nelson R. Neonatal and childhood stroke remain underdiagnosed. Lancet. 2002;360:1306.
  17. Cardo E, Vilaseca MA, Campistol J, Artuch R, Colome C, Pineda M. Evaluation of hyperhomocysteinaemia in children with stroke. Eur J Paediatr Neurol 1999;3(3):113-7. PubMed
  18.  Hogeveen M, Blom HJ, Van Amerongen M, Boogmans B, Van Beynum IM, Van De Bor M. Hyperhomocysteinemia as risk factor for ischemic and hemorrhagic stroke in newborn infants. J Pediatr. 2002;141(3):429-31. PubMed
  19. Joachim E, Goldenberg NA, Bernard TJ, Armstrong-Wells J, Stabler S, Manco-Johnson MJ. The methylenetetrahydrofolate reductase polymorphism (MTHFR c.677C>T) and elevated plasma homocysteine levels in a U.S. pediatric population with incident thromboembolism.Thromb Res. 2013;132(2):170-4. doi: 10.1016/j.thromres.2013.06.005. PubMed

Download Article
Received July 4, 2018.
Accepted July 29, 2018.
©2018 International Medical Research and Development Corporation.