Treatment of brain and behaviour problems in premature babiesTTreatment of brain and behaviour problems in premature babiesTreatment of brain and behaviour problems in premature babiesEnglishNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)BrainNervous systemDrug treatment;Non-drug treatment;ProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZHilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC12.000000000000036.0000000000000227.000000000000Flat ContentHealth A-Z<p>Learn about treatment of brain injuries in premature infants. Treatment really is a process of trying to prevent further damage both short- and long-term.</p><p>Except for a few specific conditions, treatment of brain injuries is really a process of trying to prevent further damage, minimize existing damage, and assess the extent of the damage, both in the short- and long-term.</p><h2>Key points</h2> <ul><li>Treatment for most brain injuries involve prevention of further damage, minimizing existing damage and assessing the short- and long-term damage.</li> <li>Assessment of damage to the brain includes evaluation of the injury to the brain itself and the wider effects on the body and mind.</li> <li>Some conditions, such as hydrocephalus, may require more invasive treatment such as surgery.</li></ul>
Traitement des troubles du cerveau et du comportement chez les bébés prématurésTTraitement des troubles du cerveau et du comportement chez les bébés prématurésTreatment of brain and behaviour problems in premature babiesFrenchNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)BrainNervous systemDrug treatment;Non-drug treatment;ProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZHilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC12.000000000000036.0000000000000227.000000000000Flat ContentHealth A-Z<p>Renseignez-vous au sujet du traitement des lésions cérébrales chez les bébés prématurés. Le traitement est en réalité un processus qui tente de prévenir des lésions éventuelles à court et à long terme.</p><p>Mis à part quelques conditions particulières, le traitement des lésions cérébrales est en réalité un processus qui tente de prévenir des lésions éventuelles, de réduire au minimum les dommages existants et d’évaluer l’étendue des dommages à court et à long terme. </p><h2>À retenir</h2> <ul><li>Le traitement de la plupart des lésions cérébrales est un processus qui tente de prévenir des lésions éventuelles, de réduire au minimum les dommages existants et d’évaluer l’étendue des dommages à court et à long terme.</li> <li>L’évaluation des dommages au cerveau consiste à étudier la lésion cérébrale en soi ainsi que les conséquences étendues sur le corps et la pensée.</li> <li>Certains troubles, dont l’hydrocéphalie, peuvent nécessiter un traitement plus invasif comme l’intervention chirurgicale.</li></ul>

 

 

Treatment of brain and behaviour problems in premature babies1846.00000000000Treatment of brain and behaviour problems in premature babiesTreatment of brain and behaviour problems in premature babiesTEnglishNeonatology;NeurologyPremature;Newborn (0-28 days);Baby (1-12 months)BrainNervous systemDrug treatment;Non-drug treatment;ProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZHilary Whyte, MSc, MB, BCh, BAO, MRCPI, FRCPC12.000000000000036.0000000000000227.000000000000Flat ContentHealth A-Z<p>Learn about treatment of brain injuries in premature infants. Treatment really is a process of trying to prevent further damage both short- and long-term.</p><p>Except for a few specific conditions, treatment of brain injuries is really a process of trying to prevent further damage, minimize existing damage, and assess the extent of the damage, both in the short- and long-term.</p><h2>Key points</h2> <ul><li>Treatment for most brain injuries involve prevention of further damage, minimizing existing damage and assessing the short- and long-term damage.</li> <li>Assessment of damage to the brain includes evaluation of the injury to the brain itself and the wider effects on the body and mind.</li> <li>Some conditions, such as hydrocephalus, may require more invasive treatment such as surgery.</li></ul><p>The optimum care of a baby in the Neonatal Intensive Care Unit (NICU), which includes warmth, nutrition, metabolic stability, proper ventilation, and so on, is aimed at preventing further damage and minimize existing damage. Additional treatments may also be given depending on the injury or condition. </p><p>Assessment of damage to the brain is an evaluation of both the injury to the brain itself and an evaluation of the wider implications on the body and mind since brain injury can affect body movement as well as cognitive function. This total assessment is imprecise and, unless an injury is massive or tiny, the long-term effects can only be estimated. Having said that, doctors and other experts are becoming better at making what turn out to be accurate estimates based on improved diagnostic tools such as magnetic resonance imaging (MRI). </p><p>In addition, brain injuries are usually complex in the sense that they often have more than one cause. For example, a baby who has been deprived of oxygen may also be subject to seizures. Treatment of one condition may have little impact on the other underlying condition. </p><h2>Asphyxia</h2><p>Asphyxia implies an inadequate delivery of oxygen to the brain. This low oxygen level may be detected with blood gas tests on either the baby’s blood or that of the umbilical cord. Also, when the blood has been low in oxygen for some time, it begins to show other abnormal signs. For example, the blood will become acidic, which can also be detected with blood tests. </p><p>The effect of asphyxia generally depends on how long the baby has not had enough oxygen.</p><p>Treatment for asphyxia consists of strategies to improve oxygen delivery within the body. Usually, this means delivering oxygen rather than air to the baby, often with mechanical ventilation. Additionally, blood circulation is monitored and, when necessary, improved by giving extra fluids, blood, or drugs to support heart function and blood pressure. A balance must be maintained; if blood pressure is too high, there is a risk of bleeding in the brain. </p><p>If severe, asphyxia will also affect other parts of the body as well as the brain. For this reason, any baby with asphyxia will be monitored with special attention to the kidneys, liver, and heart. Asphyxia is most commonly seen in the newborn baby immediately following birth and it is generally only severe cases that will cause death or long-term disability. </p><h2>Seizures</h2><p>One of the prime functions of the brain is to receive, interpret, and send information. This information comes to us in the form of sight, sounds, smells, and so on. Within the brain, this information takes the form of electrical signals passed on by specialized cells called neurons. These signals are usually ordered: the body detects something hot, and the brain interprets the signal and sends another signal for the body to pull away. During a seizure, the brain misfires, sending overwhelming amounts of disorganized signals through the brain at the same time. </p><p>Seizures are a symptom of an insult to the brain but they do not tell us about the mechanism; they do not necessarily imply injury or permanent damage. Premature babies with seizures often have had asphyxia. However, they may have had an infection involving the brain; a metabolic or chemical imbalance in the brain; bleeding into the ventricles of the brain, called intraventricular hemorrhage (IVH); or low blood sugar. </p><p>Treatment of seizures depends on their severity or duration and whether they are recurrent. Many babies may have one or two seizures but never have them again. If the problem is ongoing, there are several treatment options that can control the seizures. </p><p>If the baby’s sugar level is low, glucose must be administered. Seizures consume a baby’s energy at a high rate; therefore, a low glucose level may be a cause or an effect of seizures. The glucose level must be carefully monitored and treated. Oxygen may also be given. </p><p>The primary medications given for seizures are a class of drug called anticonvulsants. These include phenobarbital, phenytoin, <a href="/Article?contentid=123&language=English">diazepam</a>, and <a href="/Article?contentid=176&language=English">lorazepam</a>. During anticonvulsant treatment, the baby’s level of consciousness is closely monitored. Generally, phenobarbital is tried first and if the baby does not respond, phenytoin will be tried. Diazepam​ and lorazepam​ are relatively fast-acting agents and are generally administered when seizures are interfering with vital functions of the body and need to be quickly stopped. As a rule, phenobarbital is then given as it has a long duration of action and may only require one dose to have a positive effect. </p><p>Anticonvulsant treatment is usually stopped before a baby is ready to leave the Neonatal Intensive Care Unit (NICU). Occasionally, anticonvulsants are continued for several months after discharge. </p><p>A very small number of these babies will go on to develop epilepsy and require ongoing treatment.</p><h2>Intraventricular hemorrhage (IVH)</h2><p>Intraventricular hemorrhage (IVH) is bleeding into the ventricles of the brain. IVH is generally caused by blood pressure changes that cause the immature blood vessels of the baby’s brain to rupture. It may occur because of direct trauma to the baby’s head, even as a result of normal vaginal delivery if excessive pressure is exerted on the head by the bony pelvis or by forceps or vacuum). In most cases, the IVH does not produce any symptoms or signs since they are usually small bleeds. They are only visible on ultrasound scans of the baby’s head. The bleeding gradually stops and the blood vessels heal themselves. There are no immediate treatments necessary. If damage has occurred to brain tissue, this does not heal and there may be long-term problems with development. </p><p>In more severe cases of IVH, other treatments may be necessary. Blood pressure must be monitored and maintained in the normal range. At times, the bleeding and pressure within the ventricles of the brain can interfere with the flow of cerebrospinal fluid (CSF). Over time, typically a few weeks, it may cause a condition called hydrocephalus, where there is a build-up of CSF in the ventricles of the brain due to blocked flow from blood clots. This causes enlargement of the baby’s head. </p><p>The treatment of hydrocephalus may involve the surgical placement of a shunt, which is a thin tube that drains off the CSF from the brain to another part of the body such as the abdomen. Prior to surgery, CSF may be drained off using a needle to relieve pressure in the ventricles and relieve symptoms of increased pressure on the brain. More detailed information on hydrocephalus can be accessed using the links in the menu box on the left of this page. </p><h2>Periventricular leucomalacia (PVL)</h2><p>Periventricular leucomalacia (PVL) is severe damage in the white matter located around the ventricles of the brain. Decreased blood flow to brain tissues cause them to soften and eventually die, leaving behind cysts filled with fluid. Over time, these cysts may fuse together and collapse or become hard and calcified. The affected brain tissue, and the nerve fibers that run through it, are in a part of the brain responsible for body movement; the loss of these nerves will affect this ability. Generally, babies have no symptoms or signs of this damage until they are older. It can only be recognized on head ultrasound scans (HUS) and later by enlargement of the ventricles without a significant increase in head size. </p><p>Improving blood flow and oxygen delivery within the brain, if possible, may prevent further cysts from developing; however, there is no immediate or effective treatment for PVL. </p><h2>White matter damage (WMD)</h2><p>White matter in the brain is made of axons, which are like wires that carry messages between neurons. The white matter sits underneath the cortex of the brain, which is known as the grey matter. </p><p>Although periventricular leucomalacia (PVL) may cause white matter damage (WMD) adjacent to the ventricles, WMD can occur in other areas of the brain for other reasons. In general, the damage is caused by a lack of oxygen to part of the brain. </p><p>There is a wide range of severity and possible subsequent long-term outcomes from WMD. In many cases, the area of damage may be more important than the extent of damage; the various functions of the brain are often controlled by very specific and small, well defined areas. For this reason, a limited amount of damage in the wrong place can mean lasting and possibly even catastrophic effects. Conversely, some babies can recover from extensive damage provided no vital areas are affected. The brain, especially in babies, has a degree of flexibility in that if a certain neural pathway is damaged, sometimes the brain can find a new route to send information and commands from one part of the brain to another. </p><p>As with PVL, while WMD may appear on a magnetic resonance imaging (MRI) scan, the effects of the damage may not appear for up to a year. The more severe the damage, however, the more likely it is that the effects will show early. </p><p>Improving blood flow and oxygen delivery within the brain may prevent WMD. However, once the injury has occurred, beyond the normal support that all babies receive in the Neonatal Intensive Care Unit (NICU), there is no treatment for WMD. Prevention rather than treatment should always be the goal. For this reason, attention to maintenance of physiological stability and issues impacted by developmental care are of utmost importance.</p><h2>Hydrocephalus</h2><p>Hydrocephalus is a condition in which the cerebrospinal fluid (CSF) within the ventricles of the brain does not drain properly or at all. The condition can lead to a build-up of pressure in the ventricles and the surrounding brain tissue, and an enlargement of the head due to excess CSF. Hydrocephalus can sometimes be a result of a brain tumour or a congenital obstruction to flow of spinal fluid. Frequently, intraventricular hemorrhage, which is bleeding in the ventricles of the brain, is a cause of hydrocephalus. </p><p>A baby’s enlarging head can be the first indication of hydrocephalus. Also, any baby at risk of brain injury will have a head ultrasound or several head ultrasounds, which may also spot hydrocephalus before the head is visibly enlarged. Although CSF can be drained off with a needle to relieve pressure, the long-term solution is the surgical placement of a shunt. </p><h3>Shunts</h3> <span class="asset-image-title">Hydrocephalus</span> <p>A shunt is a soft flexible tube that acts as a drain from the ventricles. It provides another pathway for CSF to be drained away from the brain. One end of the shunt is placed in one ventricle. The shunt is then threaded under the skin, like a tunnel, to another part of the body. Usually it goes to the abdomen, but sometimes it goes to the chest and rarely to the heart. The CSF is drained and reabsorbed into the bloodstream. </p><p>The shunt tube is attached to a valve in some shunts. The valve controls the flow of fluid. You can’t see a shunt because it is under the skin, but you can feel the shunt valve and tubing under the skin with your fingers. In children who are thin, it may be more noticeable under the skin. </p><p>There are many different kinds of shunts. The shunt is inserted during a simple operation which takes about three hours.</p><h3>Shunt complications</h3><p>Occasionally, there can be problems with the shunt. For example, it can be blocked or infected, or the tubing may become too short and disconnected as the child grows. If a shunt is not working well, your baby will need to have an operation to fix the problem. The surgeon will either clear the blockage or replace the shunt. If the shunt is infected, your child will need to have the shunt removed, have an external ventricular drain placed temporarily, and take antibiotics.</p>Treatment of brain and behaviour problems in premature babies

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