Features of arterial, pulmonary and intracranial hypertension in infants

Increased intracranial pressure in a child (arterial hypertension, intracranial hypertension) is a common disorder that can be a sign of various diseases. Intracranial pressure increases with brain tumors, hydrocephalus, neuroinfections (meningitis, encephalitis), intracerebral effusions, traumatic brain injuries, some hereditary pathologies and other diseases.

The development of arterial hypertension in a child is especially dangerous. Unstable pressure readings can cause serious abnormalities in brain development: mental retardation, blindness, paralysis and other pathological conditions.

Increased intracranial pressure is not always a sign of disorders. It can increase with everyday activities: defecation, coughing, stressful situations, suckling at the mother's breast, lifting heavy objects. It is not dangerous for the child. If intracranial pressure increases regularly and is permanent, parents and their child should seek medical help.

Clinical picture (symptoms)

With arterial hypertension, the manifestations are different and depend on the severity. With moderate high blood pressure, there may be no symptoms, but rarely the child experiences headaches, fatigue, and excessive irritability. A significant increase in blood pressure is accompanied by:

• anxiety;
• unmotivated crying;
• apnea attacks;
• shortness of breath.

Pulmonary hypertension manifests itself:

• heavy breathing of the child;
• retracting the pliable parts of the chest while inhaling;
• reduced saturation (saturation of hemoglobin with oxygen);
• cyanosis of the skin and mucous membranes.

With increased pressure in the pulmonary arteries, the child’s response to oxygen therapy is practically absent, which is why the procedure is ineffective.

Among the clinical manifestations of intracranial high pressure :

• decreased sucking activity;
• tense, swollen fontanelles that lack pulsation;
• dilated superficial veins of the head area;
• unmotivated crying, screaming;
• convulsions;
• divergent cranial sutures;
• damage to the cranial nerves, which is accompanied by impaired motor functions of the eyeball, sense of smell, work of the cervical, facial and trapezius muscles, heart, gastrointestinal tract and many other systems.

Also, the newborn develops Graefe syndrome, in which part of the sclera can be seen at the top of the eyeball. The phenomenon is observed only when the child’s eyes are downcast.

Memo to parents

Head and chest circumference standards

Reasons for the development of the pathological condition

Among the main reasons for the development of the pathological process, doctors name:

1. Heredity.
2. Somatic pathologies.
3. Exchange disorders.

Manifestation of headache

Factors for the development of ICH

The main provocateur of intracranial pathology is the improper movement of fluid that is produced by the ventricles of the brain.

An episodic jump in ICP can also occur in a completely healthy baby for physiological reasons, for example, during the period of crying or breastfeeding, which is explained by physical and mental stress at this moment.

If it is impossible to determine the provoking factor of the painful condition, doctors diagnose the baby with a congenital pathology - intracranial hypertension of the idiopathic type.

Causes of pulmonary hypertension

Pulmonary hypertension in infants of the persistent type is diagnosed in babies born on time or post-term.

• Indirect signs of intracranial hypertension

Main reasons for development:

• Hypoxia or suffocation during the perinatal period of the fetus.
• Meconium staining of amniotic fluid.
• Penetration of original feces into the trachea.
• Respiratory distress syndrome.
• Closure of the foramen rotundum or arterial canal.
• Underdevelopment of the entire lung structure.
• Diaphragmatic hernia of intrauterine nature.
• Pneumonia of newborns (neonatal sepsis).

Signs of intracranial pressure in a child

In children, the following signs of persistent increased intracranial pressure are identified:

• headache;
• nausea;
• pain in the chest cavity;
• irritability;
• vomit;
• loss of appetite;
• moderate weight loss;
• fatigue.

Intracranial hypertension in infants

With the development of benign hypertension, the occurrence of dangerous complications, such as hydrocephalus or deformation of the bones or sutures of the skull, is not observed. Severe ICH is usually a consequence of neurological pathologies, brain tumors or injuries, which are accompanied by hemorrhage. The main symptoms of ICP in one-year-old children:

• long healing of fontanelles;
• restless sleep;
• increase in head size;
• delayed neuropsychic and physical development.

Diagnostics

It is extremely difficult to suspect an increase in ICP based on external signs.
The doctor must know all the complaints and those facts from life that preceded the symptoms. This could be a hypertensive crisis, head injury, severe infection, kidney or liver problems. In order to confirm the diagnosis, the doctor will prescribe a number of studies to the patient: CT or MRI of the brain to evaluate the structure of all tissues of the skull, note the condition of the ventricles of the brain where cerebrospinal fluid accumulates;

• echoencephaloscopy to determine brain function;
• Ultrasound of the brain (mainly in children through the fontanelle);
• examination of the condition of the fundus by an ophthalmologist;
• spinal cord puncture with measurement of the pressure of the escaping cerebrospinal fluid (the cerebrospinal fluid itself is taken for analysis).

ICH treatment tactics

When ICH syndrome is detected, therapy is carried out under medical supervision. The need for inpatient treatment is due to the fact that intracranial hypertension is not an autonomous disease, but acts as a sign of another pathological process (hydrocephalus or encephalopathy). Therefore, doctors need to find the root cause of this abnormality.

Therapy of intracranial hypertension in one-year-old children is carried out using several methods, based on the severity of the pathology.

For mild to moderate severity of the disease, non-drug and drug therapy is practiced:

• With a non-drug approach, it is recommended: diet, massage, physiotherapy, therapeutic exercises.
• With regular surges in intracranial pressure, medications are prescribed whose action is aimed at stopping the etiological factor. Additionally, one or more types of diuretics are prescribed.

At the same time, a number of therapeutic measures are carried out to significantly improve the baby’s well-being and prevent the development of complications.

Drastic treatment methods are also practiced in advanced stages of intracranial hypotension or the presence of a malignant focus, when the use of conservative measures is no longer advisable.

Modern methods of treatment

In some cases, the patient does not require treatment; he is observed and treated for the underlying disease, which caused the increase in ICP.
If it is necessary to treat pathology, two approaches are used - conservative and surgical.

Conservative interventions are carried out for those patients whose ICP elevation is chronic and there is no significant deterioration of the condition over time. The basis of treatment is drugs that have a diuretic effect, which reduce the volume of fluid in the head. The specific medicine is determined by the level of pressure and the situation. In severe and acute processes, osmotic diuretics (mannitol) are used, in chronic cases - furosemide, hydrochlorothiazide, spironalactone. While taking them, you need to drink a potassium preparation - Asparkam, Potassium orotate, Panangin.

Surgical methods for treating increased ICP depend on the stage and severity of the disease. In acute situations, craniotomy is performed to reduce fluid pressure on the brain and drain excess fluid. Special shunts (tubes) are installed as planned, which drain fluid from the brain into the abdominal cavity.

Types of neonatal hypertension and causes of their occurrence

In pediatrics, there are 3 types of hypertension:

• Arterial.
• Pulmonary.
• Intracranial.

Depending on the type of pathological phenomenon, the clinical picture, complications, treatment methods and causes will vary.

• All about intracranial hypertension: causes, symptoms, diagnosis and treatment

Arterial hypertension

This is a secondary disease, which most often manifests itself against the background of other pathologies of the child. For a baby born at 38-42 weeks of gestation (full-term baby), the diagnosis of arterial hypertension is made when the systolic pressure level is more than 90 mmHg. Art., diastolic - more than 60. For premature babies, the level of indicators for diagnosis is reduced to 80 and 50 mm Hg. Art. respectively.

Possible causes of arterial hypertension in newborns:

• coarctation of the aorta;
• blockage or blood clots in the renal arteries;
• pyelonephritis;
• renal failure;
• kidney tumor or hyperplasia of renal tissue.

Kidney pathologies occupy a significant place in the development of hypertension and account for about 70% of all cases of the disease in children. Also, the pathological condition in question may occur against the background of an unsuccessful blood transfusion to the baby.

You can learn from this video what a disease such as arterial hypertension is, how it is characterized and why it can occur in children.

Pulmonary hypertension

This is a syndrome in which an infant experiences increased pressure in the pulmonary arteries. The syndrome manifests itself in 2 forms: primary and secondary.

Primary hypertension occurs in 0.3% of cases in both full-term and post-term infants. Causes of primary hypertension:

• pathologies that lead to hypoxia and asphyxia;
• diaphragmatic hernia;
• neonatal sepsis.

Secondary syndrome is the result of congenital diseases affecting the lung parenchyma. Possible causes of the disease:

• meconium aspiration syndrome;
• distress syndrome;
• pneumonia in a newborn.

Premature babies are less susceptible to this disease, which is due to the anatomical features of the development of smooth muscle tissue that surrounds the arterioles and appears by the 30th week of the gestational period.

• Intracranial pressure in infants: symptoms, dangers, how to treat

This video talks about the features of pulmonary hypertension in children: forms, symptoms, diagnosis, and other nuances.

Intracranial hypertension

Hypertension is characterized by increased intracranial pressure. This condition is a manifestation of another pathology that cannot occur independently.

Diseases that can cause the development of hypertension:

• intrauterine hypoxia;
• birth of a child at 22-30 weeks of pregnancy;
• tumor, the presence of other foreign tissues compressing the tissue of the cerebral hemispheres;
• injuries to the head and neck vessels that occurred during passage through the birth canal.

An increase in intracranial pressure occurs due to an increase in fluids, such as tissue, cerebrospinal fluid, and blood, which compress the brain tissue.

What can cause brain pathologies?

The main cause of ICP in infants is hydrocephalus, which occurs due to increased production of cerebrospinal fluid.
As a result, excess fluid accumulates in various parts of the brain, disrupting the normal patency and absorption of cerebrospinal fluid. Typically, hydrocephalus in the fetus begins to develop in the last months of a woman’s pregnancy. Symptoms of this congenital disease can be detected immediately after birth. If treatment is started in a timely manner, there is every chance that the child’s cranial pressure will soon return to normal.

There are cases when cranial pressure in an infant increases gradually, the reason for this may be:

• a genetic or chromosomal disorder that causes congenital neurological defects;
• very early birth, when the child’s cerebral cortex has not yet fully formed;
• difficult pregnancy with pathologies;
• intrauterine infectious disease transmitted to the child from the mother;
• birth injuries to the head or concussion.

Among the diseases accompanied by the development of ICP, the most common are:

• encephalopathy and hydrocephalus;
• neuroinfectious diseases (meningitis, encephalitis, etc.);
• severe disturbance of metabolic processes in the body, leading to diabetes mellitus and hypothyroidism;
• brain tumor.