Received: 10.05.2021 Revision: 19.05.2021 Accepted: 28.05.2021 Published: 10.06.2021
Tareq Khudhair Jasim Al-Amar1, Osama S. Nadhum2 and Muhammad Abass Muhammad3
1Ministry of Health, Baghdad Al-Rusafa Health Directorate, AL-Shaheed Al-Sadir Hospital, Baghdad, Iraq
2Ministry of Health of Kurdistan-Iraq, Erbil Health Directorate, Rizgary Hospital, Erbil, Iraq
3Ministry of Health, Baghdad Al-Karkh Health Directorate, Central Pediatric Teaching, Hospital, Baghdad, Iraq
Abstract: Description of neurodevelopmental disorders in infants with low-birth-weight Neonatal Intensive Care Unit of the hospital in Baghdad, Iraq. A descriptive study was conducted on a certain 130 children who were distinguished by low weight. Samples were collected in a hospital in Baghdad, Iraq, where these steps were followed by a descriptive procedure for general evaluation of the motor development of children in addition to the hearing problem. The improvement of the methods of care for premature babies over the past ten years has resulted in a significant reduction in the incidence of diseases associated with prematurity - chronic respiratory diseases, severe neurological disorders, and cases of severe retinopathy, as well as to improvements in the physical condition and psychological functioning. A newborn's weight is an important indicator of the health of the mother and the newborn, and a newborn is considered underweight if his weight is less than 2500 grams. Birth weight is also a means of predicting the probability of death or developing several chronic diseases that affect adults. And that the reasons for this include uterine infections, chronic diseases in mothers, old age of the mother, lack of nutrition and obesity, smoking, and environmental factors.
Prematurity should not be confused with immaturity, Immature babies are those who were born on time, but have signs of prematurity (body weight less than 2.5 kg, height less than 45 cm, insufficiently developed subcutaneous fat, wrinkled skin, fluffy fluff on body parts).
The internal organs of premature babies are fully developed, but the respiratory, digestive, cardiovascular, and excretory systems function to the maximum. The vast majority of premature babies suffer from nervous system immaturity, impaired immunity, and unstable thermoregulation. Muscle tension in these babies is reduced, crying is weak (or stridor), and swallowing and absorption reflexes may be weak or absent altogether (depending on the gestational age).
First of all, pediatricians pay attention to the development of a respiratory function. In the lungs of a premature baby, not enough special substance is produced - a surfactant, which helps him to function fully: it prevents the alveoli from collapsing and ensures the normal exchange of gases. A lack of surfactant can lead to various breathing disorders - from mild respiratory distress syndrome to severe disease in which spontaneous respiration is impossible, and artificial ventilation is required.
Another condition that occurs in newborns is physiological jaundice. But in premature babies, jaundice is more pronounced and has a longer duration than in mature infants, which in some cases requires treatment. This is due to the functional properties and immaturity of liver enzymes.
All premature babies are at increased risk of developing various visual impairments, thus visual evaluation and follow-up by an ophthalmologist are essential. Children born weighing 1500 grams or less often develop retinopathy of prematurity, a serious condition that is the most common cause of childhood vision loss. Retinopathy of prematurity is caused by the growth of abnormal blood vessels in the retina. Several factors play a role in the development of this disease.
The eyes of a fetus begin to develop in the 16th week of pregnancy when blood vessels in the retina of the eye begin to form. Blood vessels grow slowly towards the edges of the retina, providing it with oxygen and nourishment. In this regard, the last 12 weeks of pregnancy are especially important for the fetus's eye development. However, if the baby is born prematurely, before the blood vessels reach the edges of the retina, normal blood vessel growth may stop, in which case the periphery of the retina may lack oxygen and nutrients. As a result, a pathological proliferation of blood vessels begins, which, however, does not spread along the retina, but forms a stem. Connective tissue begins to grow inside the vitreous. Stretching of the connective tissue cords that reach the vitreous can cause retinal detachment. In this case, the periphery of the retina may decrease oxygen and nutrients.
The periodic hearing evaluation is a must for premature babies. Modern objective methods of diagnosing auditory function (stimulated short-latency auditory latency recording; recording of different classes of acoustic emission) allow very early detection of hearing loss and, therefore, timely initiation of programs to help children with impaired hearing. The causes of auditory impairment in preterm infants are multifactorial. First of all, it is associated with a child's deep functional immaturity. In addition, immaturity with cerebral lesions of the central nervous system, exposure to sound shocks (in intensive care units, due to device noise is unavoidable), the use of drugs with ototoxic effect, and the hyperbilirubinemia that often occurs in premature babies determines the high probability For sensorineural hearing loss. One of the types of diseases of the auditory system is auditory neuropathy. With this type of hearing damage, the inner ear's receptor cells remain intact, and the conduction of nerve impulses along the auditory nerve is disrupted.
The appearance of premature babies can be significantly different from babies born on time. Their legs appear short compared to the body. The head is disproportionately large (about a third of the length of the body), the seams between the bones of the skull are often open, the fontanels are large. The ears are soft. The subcutaneous fat is poorly expressed, the skin is wrinkled, it can be folded easily, and there is a lot of lubrication on the premature baby's body. There is fluff (fluff) on the back, shoulders, and face. Nails are not fully formed and do not reach the fingertips. A premature baby's navel is too low. Boys often have undescended testicles in the scrotum, and girls have underdeveloped labia and "gaps" in the genital cleft.
In the case of premature labor, the principle of minimizing injuries is observed, so an episiotomy is often performed. These births happen faster than usual. Baby tactics depend on the age and weight of the pregnancy he was born. If the baby was born much earlier and was not able to breathe on his own, then he will be placed in neonatal intensive care, connected to a ventilator. These crumbs are fed through a probe since a sucking reaction in them has not yet developed. Feeding a premature baby can cause some problems because babies born prematurely do not absorb the nutrition well. Newborn feeding begins to decrease, gradually increasing the size.
After a premature baby begins to retain heat better, can breathe on its own, and does not need intensive care, it can be moved from the maternity hospital to the second stage of nursing in a specialized department for premature babies.
If the condition of a premature baby is not so difficult, and he can breathe and suckle on his own, he is placed in a special incubator, where the optimum temperature and humidity are maintained. Premature babies cannot independently regulate their body temperature, so such a special "camera" is necessary for them. To ensure normal breathing, the incubators are supplied with hot oxygen.
The cerebral cortex in a premature baby is immature due to what the child is born weak, muscle tone is reduced, and the child less than 900 grams may be absent (atony) Scream is weak, child lethargic, adynamic. Reflexes are weak or absent (Sucking, swallowing, searching, etc.). Due to the immature head brain thermoregulation is impaired, the child does not maintain normal body temperature, which leads to overheating or hypothermia. Poor thermoregulation is one of the most important risk factors for the development of complications during the adaptation of a premature baby to the environment. The development of the central nervous system affects all systems of the body of a premature baby. Breathing in a premature baby irregular, unstable. There may be rapid breathing (tachypnea) or infrequent breathing (bradypnea), and in severe children, breathing may be absent (apnea). Respiratory rate can be 35 to 80 V 1 minute Breath. In extremely low birth weight children, breathing can be of the "gasping" type, that is, convulsive breathing. Also, have premature babies breathing during sleep can be intermittent and different breathing amplitude (Cheyne-Stock breathing).
A descriptive study was carried out on children to know the cases of neurological development and the stages that it went through, where the crisis and required monitoring of the stages of development was carried out. The condition present about neurological development in addition to that, where the child's age was determined at 40 weeks of the gestational age, where this method is considered the most common and ideal way to do a follow-up on a child Gestational age at birth (in weeks) was recorded, starting from the first day of the mother’s last menstrual cycle.
Figure Image is available at PDF file
Figure 1- The distribution of 130 samples in the discovery of neurodevelopment
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Figure 2. Neurodevelopment in first 2-year-olds and birth weight
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Figure 3-: Neurodevelopment in the first two years with the condition
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Figure 4- result Neurodevelopment in the first two years with Apgar
In this regard, special attention is paid to disorders that occur in the prenatal and peripheral periods of development. It should be noted that the technical capabilities of diagnostic medicine (including DNA - diagnostics), and fetal imaging methods have expanded greatly, and therefore the early diagnosis of diseases and malformations became possible. Early childhood diseases, especially newborns, are an increasingly complex diagnosis. To a large extent, this applies to a neurological examination. At this age, the general symptoms associated with the immaturity of the central nervous system come to the fore. The morphological immaturity of the central nervous system is manifested by the specificity of its action, which is characterized by an undifferentiated response to various stimuli, as 130 samples were collected from the hospital, it was noticed that the weight value was the highest value from 1500-1300, as it was for 55 children, and that is for normal. As for the medium distortions, which were represented by a very small percentage.
The condition of the newborn can change significantly with intrauterine growth retardation. In addition, when examining a child, it is necessary to take into account the condition of the environment: lighting, noise, air temperature in the room, etc. For the final diagnosis, a repeated examination is performed, in which the neurological symptoms of the first time may disappear upon repeated examination, or the symptoms, which are for the first time mild signs of a violation of the central nervous system, may become more significant later. Assessment of the neurological condition of children of the first year of life, including newborns, has several features. Therefore, general reactions are predominant, regardless of the nature of the irritating factors, and some symptoms that in older children and adults are undoubtedly pathological, in newborns and infants it is the norm, which reflects the degree of maturity of some structures of the nervous system and stages of functional morphology. Scanning begins with the child's visual observation. Pay attention to the position of the head, torso, and limbs. The spontaneous movements of the arms and legs are evaluated, the position of the child is determined, and the volume of active and passive movements is analyzed. In the case of newborns, the arms and legs are constantly moving. Automatic movement and crying increase before feeding and decrease after feeding. The newborn sucks and swallows well. Spontaneous movement and crying increase before feeding and decreases after feeding. The newborn sucks and swallows well.
The neurodevelopmental reflex test is used commonly in clinical practice to assess the maturity of the nervous system. Neurodevelopmental reflexes are also referred to as primitive reflexes. They are sensitive and consistent with later results. Abnormal reflexes are described as the absence, persistence, onset, or latency of reactions, which are predictive indicators of children that are susceptible to neurodevelopmental disorders. Animal models of neurodevelopmental disabilities, such as cerebral palsy, often exhibit abnormal developmental reactions, as seen in children where children under 30 weeks of age are more vulnerable than others.
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