Hypertension of leg and arm muscles in an infant: causes, when passes, how to determine, what to do?

Hypertonicity in newborns is an important indicator not only of the child's adaptation to environmental conditions, but can also signal serious disorders of the central nervous system. It is very important to evaluate the muscle tone of a newborn in combination with other symptoms in order to more accurately speak about the presence of a particular problem.

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Epidemiology

Statistics on the prevalence of hypertonia indicate that this is the most common symptom of damage to the central nervous system of various etiologies. The degree of trauma during childbirth is from 3 to 6 per 1000 newborn babies, and in terms of prevalence among normal births this number reaches 7%. According to research, birth trauma of the cervical spine accounts for 85.5% of all birth injuries. Such trauma to the cervical spine can also occur during absolutely physiological births, which, according to data, is more than 80% (especially in primiparous women). All these injuries in more than 96% of cases are accompanied by muscle tone disorders, and more than 65% are pronounced hypertonia.

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Causes hypertonicity in newborns

Muscle tone in a child is one of the indicators of the state of the nervous system. Despite its low information content at first glance, this indicator can really say a lot about the nervous regulation of the baby. This is due to some features of the structure of the nervous system in newborns.

A newborn baby, and especially a premature baby, is a unique object of research, which has its own specifics, determined by a certain stage of development of the nervous system. First of all, this concerns the periods of development of the brain, which ensures the uniqueness of responses to the action of various external and internal factors. Difficulties in analyzing the neurological status are created by the corresponding features of the anatomy and physiology of the nervous system of newborns:

1. The highest level of integration is the thalamopallidal system;
2. Most of the response reactions are closed at the level of the brain stem and subcortex;
3. Predominance of inhibition processes over excitation;
4. The dominance of general cerebral symptoms over focal symptoms, regardless of the nature of the active pathogenic factor;
5. The presence of symptoms in the neurological status that, unlike in adults and older children, are of a physiological nature;
6. Lack of speech and inability to talk about one’s feelings;
7. The presence of peculiar behavioral reactions;
8. High neuroplasticity of the central nervous system and the associated increased ability to repair nervous tissue.

Further, during differentiation of the nerve cells of the brain and myelination of the conductive pathways, the activity of ancient structures is inhibited and the nature of the body's response to stimuli changes. In this case, damage to various structures of the brain leads to disruption of its work as a whole, and the sick child develops general symptoms as a reaction to local damage. Therefore, a violation of tone can be considered one of such general reactions, signaling certain problems.

A healthy newborn baby has physiological hypertonicity of all muscles up to one month. If this condition is expressed longer or is not the same on both sides, then we are talking about pathological hypertonicity, the cause of which must be identified.

Therefore, damage to the central nervous system of a newborn of any nature can cause a general reaction, in this case hypertonia. But there are a number of reasons that most often lead to hypertonia. One of such etiological factors is hypoxic or ischemic brain damage. The most sensitive to the effects of hypoxia is the central nervous system, where protective mechanisms are weakly expressed. Nerve cells are the first to suffer under conditions of oxygen starvation. The pathogenesis of hypertonia development in this case lies in the disruption of oxygen delivery directly to the brain cells. But the brain, as a central organ, receives more energy and oxygen, as a priority organ. After all, at the moment of oxygen deficiency, the cardiovascular system reacts by redistributing blood with preferential blood supply to vital organs - the so-called "centralization of blood circulation" (brain, heart). This slows down the capillary blood flow of the parenchymatous organs. Hypoxia of muscles and internal organs leads to the accumulation of lactate and the occurrence of metabolic acidosis. Metabolic acidosis leads to increased permeability of the vascular wall, which together with slowing blood flow and increasing concentration leads to a sludge effect and microthrombosis. Diapedetic hemorrhages (pinpoint and large in size), cerebral edema, hypovolemia, dysfunction of all organs and systems, including muscles, occur secondary. Central inhibition of muscle tone regulation under the influence of oxygen deficiency of the brain on the one hand, and accumulation of lactate in the muscles on the other hand - all this underlies the development of hypertonicity as a reaction to brain damage.

Among other causes of hypertonia, there is often trauma during childbirth, as a direct factor in the disruption of muscle innervation. Such trauma is often observed under the influence of mechanical external factors, as well as with excessive non-physiological movements due to active labor. In addition, such damage can be caused by obstetric interventions, in which it is possible to extract the child by the head with fixed shoulders, and by the shoulders with a fixed head in breech presentation, as well as excessive rotation in face presentation. Rough extraction of the fetus and abnormal turns lead to disruption of the vascular structure, compression of the Adamkiewicz artery, which supplies blood to the spinal cord and above the lumbar thickening. In case of minor stress, damage can sometimes be accompanied by simple cerebral edema or hematoma. Severe forms of trauma are based on hemorrhages. Spinal cord injuries can be accompanied by subluxation, vertebrae and disruption of the framework of the entire spinal column. As a result of spinal trauma, ischemia of the spinal cord substance develops with predominant damage to the nuclei of motor motor neurons and peripheral motor nerve spinal fibers of the brain. It happens that the pyramidal tract, located in the lateral parts of the brain, is also damaged. With edema, transient changes in muscle tone, involuntary contraction of individual muscles, pathological reflexes or asymmetry of physiological reflexes, disturbances of movements along the periphery of the type at the level of damage, and of the central type in the sections located below are clinically manifested. All these types of birth trauma will be accompanied by hypertonus, expressed to varying degrees.

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Risk factors

Considering that the causes of hypertonia are various injuries to the brain of a newborn, it is necessary to identify risk factors under which such injuries can develop. The risk factors may be the following:

1. blood loss during childbirth, which causes a lack of oxygen due to a deficiency of hemoglobin in the mother's blood;
2. cardiovascular pathologies in the decompensation stage in pregnant women lead to prolonged cerebral ischemia in the child;
3. taking medications or narcotics that inhibit the delivery and normal consumption of oxygen by the child;
4. violation of intrauterine gas exchange due to premature aging of the placenta or placenta previa;
5. pathologies during childbirth that lead to prolonged standing of the fetus in the birth canal and birth injuries.

All these factors, one way or another, lead to a decrease in oxygen delivery to neurons or injuries to nerve pathways, and this is accompanied by damage to the regulatory system and can manifest itself as hypertonicity, as one of the symptoms of such damage.

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Symptoms hypertonicity in newborns

Physiological hypertonicity in newborns is caused by the position in which the baby is located throughout the entire period of intrauterine life. Therefore, healthy full-term babies are born with physiological hypertonicity, which persists for the first month of life and then fades away. But there are cases when the tone is expressed unequally on both sides or persists longer than the stipulated period, then we are talking about a pathological condition.

Symptoms of hypertonia in newborns may appear immediately after birth, even before any other signs appear. They increase as ischemia or hypoxia of the brain increases. But there are also other manifestations that may indicate a pathology of the central nervous system. The first signs of hypertonia of the central nervous system may be breathing problems immediately after birth. If the damage is moderate, symptoms of shrill and frequent crying, impaired motor activity and tone may appear. The appearance of seizures and heart rhythm disturbances are characteristic of more severe damage. Convulsive syndrome can also be observed in the form of both widespread tonic-clonic seizures and local contractions of muscle groups. In this case, in newborns, the equivalent of seizures is often a spasm of the facial muscles with various facial expressions in the form of movement of the facial muscles. These symptoms, together with hypertonia, may indicate hyperexcitability syndrome.

Spinal cord injury due to birth trauma in the acute period is accompanied by lethargy, mild muscle hypotonia, which can change to hypertonia. Later, respiratory disorders, spastic tetraparesis or tetraplegia below the level of the lesion, and central urination disorders may appear. A common manifestation of such injuries may be the symptom of a short neck with a large number of transverse folds of the "accordion" type and subsequent tension of the occipital group of neck muscles in the postnatal period. Hypertonia of the neck in newborns is combined with the symptom of a doll's head, which is manifested by a deep transverse fold at the back on the border of the shoulder girdle with the head.

Hypertonicity of the limbs in newborns often persists during the first six months of life after CNS damage. This can be considered a normal recovery period, when the tone on one side may predominate or the hypertonicity of the upper limbs may be more pronounced.

Hypertonicity of muscles in newborns can appear for the first time already at the stage of the child’s recovery, which indicates the need for complex treatment.

When does hypertonia in newborns go away? If we are talking about physiological hypertonia, then by the end of the neonatal period it should go away. If the child has suffered hypoxic or ischemic damage to the central nervous system, then hypertonia may persist until the end of the first year of life. Later, consequences in the form of motor disorders may develop. Complications of hypertonia are not common, and they are not persistent, therefore, the earlier treatment is started, the faster all manifestations and complications will go away. Such children may have delayed physical growth indicators, as well as psychomotor ones, which can be corrected by various treatment methods.

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Diagnostics hypertonicity in newborns

Hypertonia in newborns is diagnosed based on anamnesis, examination, motor function testing, sensory analyzer function testing, autonomic nervous system testing, and speech testing. Newborns are characterized by uncoordinated athetosis-like limb movements, muscle rigidity, physiological hypertonia of flexor muscles, and loud crying. Their hearing is reduced and the sensation of pain is weakened. In addition, the neuropsychic development of the child in the neonatal period is characterized by the presence of a number of unconditioned reflexes of the newborn. During the examination, the following is necessarily assessed:

1. The child's position in bed;
2. Coordination of movements;
3. Head examination:
   • its position in relation to the body
   • skull shape
   • presence of asymmetry, deformations
4. Child's face:
   • condition of the eye slits
   • condition of the eyeball
   • pupil condition
   • eye movements
   • position and movements of the upper eyelids
   • symmetry of the nasolabial fold.
5. Torso, upper and lower limbs:
   • presence of paralysis, paresis, convulsions, tremors, athetosis
   • forced positions of the limbs and torso.

The general appearance and behavior of the newborn have important diagnostic data. For correct and objective data, it is necessary to take into account the gestational age and maturity of the child. Stigmas of dystembryogenesis are normally absent or their number is minimal. The presence of more than 6 stigmas of dystembryogenesis is the basis for the syndromological diagnosis of "Dysplastic status". Active movements of the newborn depend on the behavioral state and the presence or absence of damage to the nervous system. For example, behavioral disorders of the child in the form of long-term or constant crying, or general depression. Excitement, constant, piercing cry often indicate cerebral pathology (birth injury, asphyxia). General depression, comatose state are often a sign of severe cerebral disorders (massive intracranial hemorrhages, congenital malformations).

Clinical description of the seizure character (minor or minimal, latent, tonic, clonic, myoclonic), onset, duration and end of the attack, as well as the child's condition in the interictal period are important in determining the syndromological diagnosis. Therefore, it is important to monitor the child's condition and observe him/her all the time for a more accurate diagnosis. EEG monitoring, neurosonography and MRI of the brain, biochemical and clinical blood tests, genetic testing allow for a differential diagnosis of hypertonia in a newborn with pathologies that can cause it. Neurosonograms can identify symptoms that are characteristic of a particular pathology. For example, hyperechogenicity of the periventricular zones in the area of the anterior and posterior horns of the lateral ventricles allows one to suspect periventricular leukomalacia, which can occur with ischemia. Hyperechogenicity in the subependymal areas and intraventricularly allows one to assume the presence of hemorrhage. The presence of cysts indicates a past or persistent infection.

The tests that are necessary for diagnosing hypertonia are not limited to general indicators. If, along with muscle hypertonia, there are other symptoms characteristic of intrauterine infections, then the child and mother are necessarily tested for the presence of such infections. After all, confirmation of the etiology of the process is very important for further treatment.

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Differential diagnosis

In case of any CNS lesions, an ophthalmologist consultation is considered mandatory. The fundus can be examined from the first days of life: children with intracranial hemorrhages may have small or more massive hemorrhages, and in certain forms of microelement metabolism disorders - pigment inclusions. This allows not only diagnostics, but also differential diagnostics.

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Treatment hypertonicity in newborns

Today, there is no clear idea of the advisability of prescribing a particular drug for hypertonus for restorative treatment. It is necessary to take into account the period of ontogenetic development, lack of differentiation and high individual sensitivity in newborns. For example, the widespread use of vasoactive agents, intensive methods of resuscitation of the newborn, is used today in the acute period of brain damage, which can lead to secondary cerebrovascular accidents. Recently, the main principle of therapy for CNS disorders in newborns is to support their own adaptive mechanisms instead of prescribing multiple drugs. From the first minutes of life of a newborn, the entire spectrum of therapeutic effects should be aimed at correcting those organs and systems (heart, lungs, kidneys, etc.) that ensure the viability and normal functioning of the central nervous system. The rest of the treatment is carried out according to the syndromological principle. At the same time, only three clinical syndromes (convulsive, hypertensive-hydrocephalic, muscular hypertonus) are certainly subject to the appointment of drugs.

In recent years, methods for treating convulsive syndrome in a child with hypoxic damage to the central nervous system have included the use of barbiturates, hydantoin, and benzodiazepines. In infants, carbamazepine can be added to anticonvulsant drugs after the first month after preliminary testing of individual sensitivity. Cerebrocurin, Ceroxon, and Somazina are also used in treatment. Today, metabotropic therapy in the form of Actovegin, Instenon, B vitamins, ATP, as well as the multiprobiotic "Simbiter" and others is widely used in practical medicine. The above list of medications refers to basic therapy. Drugs with a predominantly vasoactive effect - cavinton, cinnarizine, and others - are prescribed in the presence of changes in cerebral hemodynamics, which are diagnosed using neurophysiological methods. Considering that during the first year of life two processes occur in parallel in the nervous system - restoration and degeneration of hypoxically altered neurons, the action of Actovegin is aimed at activating neuroplasticity processes.

1. Elkar is a drug from the group of metabolic agents, which is used in the complex therapy of muscle tone disorders and nervous system lesions. The active substance of the drug is levocarnitine. This is a natural compound that, when entering the cell, transfers the necessary metabolites to the mitochondria, which increases the amount of synthesized energy. In neurons, this helps to quickly restore connections and accelerates the myelination of fibers. Elkar is used in the form of drops for hypertonicity in newborns. Dosage - 2 drops three times a day, for the full effect, the drug must be used for at least a month. Side effects can be weakness, dyspepsia, which requires a reduction in dosage.
2. Glycine is a drug whose active ingredient is the eponymous essential amino acid glycine. The drug works by activating GABA receptors and blocking alpha receptors. This reduces the stimulating effect in the brain and reduces muscle hypertonicity and other symptoms of hyperexcitability. The drug also has a protective effect on nerve cells and fibers. The method of administration of the drug is in the form of a tablet that needs to be crushed and dissolved in milk. The dose is one third of a tablet three times a day. Side effects may be in the form of minor depression, which may be accompanied by drowsiness and lethargy. Glycine for newborns with hypertonicity is also used to reduce the toxicity of other active drugs.
3. Tolperil is a drug used to correct increased muscle tone. It reduces the amount of active acetylcholine, which increases muscle contraction. Due to this action, hypertonicity decreases and the work of all organs and systems improves. The dosage of the drug is 0.0125-0.025 g / day. The method of application can be intramuscular, dividing the drug into two or three doses. Side effects can be in the form of twitching of individual muscle groups, severe hypotension, lethargy.
4. Somazina is a nootropic drug, the active substance of which is citicoline. This substance enters the brain and improves the conductivity of ions through the neuron wall, normalizes nerve conductivity. Such effects against the background of hypoxic damage to neurons are very important for a faster recovery of the child. The drug is administered intravenously by drip. The dosage for children is 100 milligrams per day, which is one fifth of an ampoule. Side effects can be in the form of increased pressure, tachycardia.

Vitamins and physiotherapy are used very widely, because it is important to stimulate muscles by using physiotherapy in addition to central regulation with medications. Massage and gymnastics for newborns with hypertonicity must be performed during the recovery period, first by a specialist, and then the mother herself can do it for the child every day. Therapeutic gymnastics and massage begin to be performed from the 2nd-3rd week of life.

1. For better tone reduction, the mother can lay the baby on her stomach in the "embryo" pose. To relax the muscles, you can also lay the baby on a large ball with the following rocking. After this, you need to massage the muscles of the limbs in combination with the withdrawal of the arms, and pressing on the chest.
2. Normalization of tone is also facilitated by acupressure massage with light finger pressure on the affected muscles.
3. Next, they massage the plantar surface of the feet, then grab them, and bend and straighten the legs at the joints.
4. The support reaction is stimulated in a standing position with the child supported under the armpits.
5. Exercises for developing articulation and tongue massage can be done while talking to the child so that he repeats the sounds.
6. Mandatory orthopedic regimen for creating a special position of the head, arms, legs.

Physical therapy sessions should be individual, at least twice a day, lasting 20-30 minutes.

Folk remedies

1. Baths with calming herbs are very useful for reducing muscle tone. To do this, you need to steam 50 grams of mint, string, oak bark and 100 grams of sage in a separate container. This solution should be poured with a liter of water and infused for a day. Then, when bathing a child, you need to add half a liter to the bath, and leave the rest for another time. After such a relaxing bath, you should also do a point massage of the limbs.
2. Use a prepared ointment made from bay leaf, honey and olive oil. To do this, take three large bay leaves and grind them into powder. Add a tablespoon of honey and ten drops of olive oil to the leaf. Mix the ointment into a uniform consistency in a water bath, then cool. Apply one drop of the ointment to the arms and legs and rub. Before the procedure, make sure that the baby is not allergic. To do this, apply a small drop to the forearm and watch the skin reaction for half an hour.
3. Cucumber flowers should be mixed with chamomile flowers and olive oil should be added until the consistency of ointment is obtained. Apply a small drop and rub thoroughly.
4. When bathing, adding aromatic oils is good for relaxing muscles. For this, you can use one drop of cinnamon oil and two drops of lavender oil, adding them to the water before each bath.

Herbal treatment can be used already during the recovery period.

1. Oregano herb combined with flax seeds activates the reparative powers of neurons and has a relaxing effect on muscles. To prepare the infusion, take 10 grams of the herb and 20 grams of flax seeds, pour boiled hot water over them. Give the child five grams every other day for a month.
2. Barberry infusion is widely used to relax muscles as an ointment, as well as an infusion. To prepare the medicine, take thirty grams of herbs and pour boiling water in a volume of 300 milliliters. After settling in three hours, you can begin to give the infusion to the child two drops twice a day.
3. Marshmallow herb also has a calming effect. To prepare an infusion, take 50 grams of the herb and pour hot water over it. After infusion, add a drop of olive oil and give the child one drop of this infusion once a day.

Homeopathy is also used in the treatment of hypertension.

1. Acidum nitricum is an inorganic homeopathic remedy that is a derivative of nitrate acid. This drug is used to treat muscle hypertonicity, which is accompanied by pronounced changes in the upper limbs and neck. The dosage of the drug for newborns is two granules three times a day. Side effects may include lethargy, decreased reflexes, and urinary disorders.
2. Arnica is a herbal homeopathic preparation that is widely used in pediatric practice. It is effective in the treatment of hypertonicity in newborns, which is caused by traumatic factors or birth trauma. The drug is used in granules and the dosage is four granules once a week, then two granules a day for three more months. Side effects can only occur if the dose is exceeded, then twitching of the child's facial muscles may occur.
3. Berberis is a single-component organic drug used to treat hypertonia accompanied by motor impairments of the lower extremities. The drug is often used to treat severe forms of cerebral palsy. The dosage of the drug depends on the degree of impairment and, with minimal impairments, it is one granule per day. Side effects may include allergic reactions and severe itching.
4. Lycopodium is a homeopathic medicine used to treat tone disorders in children with low birth weight, anemia and developmental disorders. The medicine not only affects tone, but also improves peripheral conductivity of nerve fibers. The medicine is used in granules, two granules five times a day for five days, and then three granules twice a week. The course of treatment is 40 days. Side effects are very rare, may cause facial flushing.

Folk and homeopathic remedies can only be used on the advice of a doctor.

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Prevention

Untreated children develop headaches of unclear etiology, increased fatigue, scoliosis, vegetative-vascular dystonia (including instability of blood pressure, palpitations, weather dependence, dizziness, increased sweating). Such children often have poor memory, decreased visual acuity, impaired general and fine motor skills, possible attention deficit syndrome, difficulty concentrating, problems with learning and social adaptation in a children's group. Impaired growth and development of the musculoskeletal system occurs due to a failure of regulation and disruption of the formation of physiological curves of the spine with prolonged hypertonicity.

Therefore, preventive measures should come first, and they should exclude harmful factors during pregnancy and normal labor of the mother, avoiding birth injuries.

Hypertonicity in newborns can be physiological up to one month, but if it lasts longer or is expressed asymmetrically, then it requires diagnostics. Such a symptom, as a rule, is not isolated, and it indicates damage to the nervous system. To avoid complications in the future, it is best to use complex treatment using both medications and physiotherapeutic methods.

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Forecast

The prognosis for life and normal restoration of muscle function depends on the structural damage to the newborn's brain, which determines the child's further development. The most common consequences of hypoxic damage to the central nervous system include seizures, spastic paresis, ataxia, and hyperkinesis. Sometimes they are combined with subcortical blindness and cognitive disorders. Young children (under 3 years old) often upset their parents with poor sleep, frequent regurgitation, constant anxiety and crying, weak sucking at the breast, and delayed psychomotor development. Hydrocephalus may develop. If the diagnosis was not made in the delivery room or in the first month of the child's life, neurological symptoms will begin to appear before 3 months. Bronchial asthma, eczema, food allergies, neurodermatitis, spinal column deformities, epilepsy, and anemia may develop.

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