Method of antenatal prediction of consequences of perinatal lesions of nervous system in children

FIELD: medicine.

SUBSTANCE: clinical examination of pregnant woman is carried out, additionally performed are Stange's and Hench's functional respiratory tests in early period at terms of 11-19, 21-29, 31-39 weeks of gestation period, also in dynamics in I and III trimesters determined are indices of blood hormonal spectrum: T4, TSH, T3, cortisole, vitamin E, insulin, indices of lipid peroxidation and antioxidative blood activity, blood indices - hemoglobin, platelets, total protein, fibrinogen. Analysis of risk factors is carried out, their gradations and numerical values are determined and prognostic coefficients S₁ and S₂ are calculated by formulas. If S₁>S₂, presence of moderate or severe CNS lesion in children at the age of 4 is predicted. If S₁<S₂, presence of light degree of severity, or absence of consequences of CNS lesion in children at the age of 4 is predicted.

EFFECT: application of claimed method makes it possible to increase accuracy of prediction of consequences of CNS lesion and administer early complex of measures in due time and prevent formation of pathology in children from the risk group of neurological disability development.

2 ex, 6 tbl

The invention relates to medicine, specifically to Perinatology, neonatology, neurology, and can be used for antenatal prediction of the consequences of perinatal lesions of the Central nervous system (CNS) in children.

Perinatal lesions of the Central nervous system are one of the leading causes of morbidity in children neonatal period and have not only medical but also social value. This pathology affects a child's life, his intellectual, physical development and the ensuing diseases. In the structure of early childhood disability perinatal lesions of the nervous system make up 60-70% [1].

Clinical consequences of perinatal CNS lesions are the subject of heated discussions pediatricians, neonatologists and neurologists for many decades. It is widely believed that the Central nervous system in children after damage are not able to regenerate. However, these modern literature and practical experience suggest that after cerebral damage is partial or complete recovery of neurological function. This is because in the nervous system in response to exposure to traumatic agent activates compensatory-adaptive mechanisms that provide the appropriate recovery of lost nerve connections and preservation of a functional unit of the nervous system [2]. According to recent research perinatal CNS damage in 86% of cases leads to impaired development of psychological functions in children [3]. In addition, it contributes to the maintenance of painful conditions throughout infancy (hyperactivity, seizures, hypertensive syndrome) and the emergence of affective disorders and further maladjustment, and in some cases disability children [4, 5]. Due to the imperfection of timely forecasting and rehabilitation approaches most children can be expressed consequences of perinatal CNS pathology in the form of a speech delay, impaired memory, attention, perception, mental retardation, which leads to poor learning, violations of the emotional-volitional sphere, social disadaptation, General underdevelopment of speech, somatic pathology, scoliosis, neurological pathology. About 15% of children with neurological pathology at an early age become disabled due to the development of cerebral palsy. This pathology can not only correct, but also, like any other, it is easier to prevent that will promptly appoint an early set of rehabilitation measures and to significantly reduce the number of children with disabilities, to restore health and to prevent the formation of the tion pathology in children from the risk group for the development of neurological disability.

There is a method of forecasting the development of the consequences of cerebral ischemia in children in the first year of life [6]. To predict the development of the consequences of cerebral ischemia in the first year of life in children undergoing chronic intrauterine hypoxia, determine the level of endothelin-1 in umbilical cord blood. If the amount of endothelin-1 is equal to or greater than the value of 1.3 fmol/ml, predict the development consequences of perinatal lesions of the Central nervous system in the first year of life.

The disadvantages of this method are that it is not possible to determine the antenatal development of the consequences of cerebral ischemia in children. Insufficiently informative due to the fact that the results are based only on the determination of the concentration of endothelin-1 and neurosonography, and in addition, there is an age limit prediction in children up to 1 year.

Also known is a method for predicting cerebral disorders in newborns from mothers of high-risk groups [7]. The essence of the method lies in the fact that pregnant women risk group with verified urogenital infection and/or placental insufficiency taking amniotic fluid at birth and determine TNF - and neopterin. When the value of TNF - above is 88.1±7,9 PG/ml and neopterin concentrations above the 17.3±1.6 ng/ml predict hypoxic-isemi the definition CNS newborn. This method has the following disadvantages: prediction of lesions of the Central nervous system in children from mothers only high-risk groups, there are no additional methods of monitoring and evaluation for pregnancy at an earlier time; conduct research amniotic fluid is very time consuming and technically difficult.

Closest to the present invention is a method for predicting the development of hypoxic-ischemic encephalopathy in full-term newborns [8]. The invention consists in the fact that conduct clinical examination of pregnant ultrasound examination of the uterine artery, umbilical artery and middle cerebral artery of the fetus, identify risk factors, conduct analysis, and analysis of indicators ultrasound determine their grades and numeric values and calculate the prognostic factors F₁and F₂according to the proposed formula. When the value of prognostic factors F₁≥F₂predict the development of hypoxic-ischemic encephalopathy in full-term newborn is born to the woman examined. The method is as follows: the woman in the third trimester of pregnancy have a clinical examination, ultrasound examination of blood flow in the umbilical artery, uterine artery is, middle cerebral artery of the fetus, identify risk factors and provide an analysis of the recent, and analysis of indicators of ultrasound and determine their grades and numeric values.

1. Age: in years.

2. Chronic psycho-emotional stress: 0 - no; 1 - Yes.

3. Hypertension or vegetative-vascular dystonia: 0 - no; 1 - Yes.

4. Menstrual function: 0 - no; 1 - Yes.

5. Smoking during pregnancy: 0 - no; 1 - Yes.

6. The number of abortions more than 3: 0 - no; 1 - Yes.

7. The threat of termination during the second half of pregnancy: 0 - no; 1 - Yes.

8. Chronic fetoplacental insufficiency: 0 - no; 1 - Yes.

9. Chronic intrauterine hypoxia: 0 - no; 1 - Yes.

10. The syndrome of intrauterine development of the fetus: 0 - no; 1 - Yes.

11. WHOLESALE-eclampsia lasting 4 weeks or more: 0 - no; 1 - Yes.

12. Systole-diastolic ratio of umbilical artery: 0 - 2.7 and less; 1 - more than 2.7.

13. Systole-diastolic ratio of the uterine arteries: 0 to 2.5 or less; 1 - more than 2.5.

14. Systole-diastolic ratio of the middle cerebral artery of the fetus: 0 - 4.0 and above; 1 - less than 4.0.

Then calculate the prognostic factors for formulas F₁=-33,42+2,12 and₁+2,19 and₂+7,17 and₃+to 7.61 and₄+8,72 and₅-3,85 and₆+1,79 and₇-6,92 and₈+10,04 and_{9 -0,06 and10+0,49 and11+3,74 and12+3,56 and13-11,8 and14; F2=-24,48+1,95 a1+0,62 a2+5,09 and3+6,01 a4+7,46 a5-3,99 and6-0,23 a7-7,48 a8+6,7 a9+0,71 and10+0,13 and11+4,25 a12+1,81 a13-11,16 a14where a1,2...14- grades and numerical values of risk factors, indicators ultrasound (a1- age and2- chronic psycho-emotional stress, and3-hypertension or vegetative-vascular dystonia, and4- menstrual dysfunction, and5- Smoking during pregnancy, and6- the number of abortions more than 3, and7the threat of termination during the second half of pregnancy, a8- chronic fetoplacental insufficiency, and9chronic intrauterine hypoxia and10syndrome of intrauterine development of the fetus, and11- OPT-eclampsia lasting 4 weeks or more, a12- systole-diastolic ratio of the umbilical artery, a13- systole-diastolic ratio of the uterine arteries, and14- systole-diastolic ratio of the middle cerebral artery of the fetus).}

When the value of prognostic factors F₁≥F₂predict the development of hypoxic-ischemic encephalopathy in full-term newborn born to the survey is Noi women.

This method has several disadvantages, is not sufficiently accurate and informative, because:

- limited range of the listed risk factors for the evaluation of prognostic factors;

- assessment according to the study only in the third trimester, without taking into account these indicators in early pregnancy, which is of great prognostic value for the development of the child in the future;

the lack of laboratory studies, which are more informative than instrumental methods.

A new technical challenge - improving the accuracy and informative way.

To solve the problem in the way the antenatal prediction of the effects of Central nervous system in children, including clinical survey, conducted additionally functional respiratory sample Rod and Genc in the initial period on the terms 11-19, 21-29, 31-39 weeks of gestational period, and also carry out the determination of the dynamics in I and III trimester of indicators of hormonal spectrum of blood: T4, TSH, T3, cortisol, vitamin E, insulin, indicators of lipid peroxidation and antioxidant activity of the blood, the blood - hemoglobin, platelet count, total protein, fibrinogen, analyze risk factors, determine their grades and numerical values and calculate the prog is oticheskie coefficients S ₁and S₂by the formulas:

S₁=e1*9,02+EE*0,30+E3*3,13+E4*5,41+E5*0,59+E6*0,01+E7*11,63+E8*7,42+e*(-5)+E10*8,35-91.

S₂=e1*4,90+E2*1,21+E3*2,14+E4*9,42+E5*0,70+E6*0,02+E7*14,49+E8*4,60+e*(-0.03)+E10*7,81-143,92,

where

e1 - severity of risk factors in the perinatal period in the third trimester,

E2 - Vit. E, mmol/ml in the third trimester,

E3 - insulin, mked/ml in the third trimester,

E4 - assessment sample Rod 3P (31-39 weeks)

E5 - T4, nmol/l in the third trimester,

E6 - cortisol, nmol/l in the third trimester,

E7 - TSH, mIU/l in the third trimester,

E8 - T3, nmol/l in the third trimester,

e - visit to the set of recreational activities (not visited -0),

E10 - assessment samples Genc 2P (21-29 weeks)

and when S₁>S₂predict the presence of moderate or severe severity of the consequences of the Central nervous system in children aged 4 years,

and when S₁<S₂predict the presence of mild severity or absence of effects of the Central nervous system in children aged 4 years.

For antenatal prediction of the effects of lesions of the Central nervous system in children at an older age is crucial to the study of hormone status of pregnant women, characterized by a high content of cortisol and insulin, as well as the determination of lipid peroxidation and antioxidant activity of the blood. Lipid peroxidation was estimated by the content of the malondialdehyde (MDA) in the serum, antioxidant activity in the blood was estimated by the content in the serum of vitamin E.

To identify adaptation strategies in pregnant women and their children used the method proposed Navoceano and Gvitamashia considering information measures the Kullback as measures of preference behavior of the bio-object.

Research a number of authors [9, 10] showed the feasibility of using the samples from breath to breath (sample Post) and with the breath on the exhale (sample Genc) to assess the functionality of pregnant women, where the norm duration of breath samples for pregnant women are set as follows:

sample Post:

- less than 20 sec - poor,

- 20-40 s - satisfactory,

more than 40 seconds - well,

sample Genc:

- less than 15 seconds - poor,

- 15-25 s - satisfactory,

more than 25 seconds - well.

Based on the adaptation strategies, using integral criteria, we developed an algorithm to determine the level of functioning of the body systems of pregnant women, the functional reserve and the degree of tension of the bio-object.

The proposed criteria were based on the analysis of the results of the study. Were surveyed 163 pregnant women with somatic pathology, children to the who at the age of 4 years showed the effects of lesions of the nervous system. All pregnant conducted clinical examination, history taking, assessment of the hormonal spectrum of blood tests (TSH, T3, T4, cortisol, insulin) by ELISA; blood counts (hemoglobin, platelet count, total protein, total fibrinogen); lipid peroxidation and antioxidant activity of the blood (MDA, vitamin E) in the dynamics of pregnancy I and III trimester. Additionally conducted functional respiratory samples from pregnant women (sample Rod and Genc) in the initial period (11-19), 21-29, 31-39 weeks of gestational period.

Building a model of antenatal prediction of the consequences of perinatal lesions of the Central nervous system in infants of women with somatic pathology was conducted in several stages.

At the first stage a group of pregnant women with somatic pathology (n=163) was divided into 2 groups depending on the severity of the consequences of CNS involvement in their children at age 4 years.

The first group consisted of pregnant women whose children aged 4 years had average or severe severity of the consequences of the defeat of the Central nervous system, n₁=44 (27,0%).

The second group consisted of pregnant women whose children aged 4 years had a mild degree of severity of the consequences of CNS lesions or was not registered to any of the clinical forms of the consequences of Central nervous system lesions, n₂=119 (73,0%).

Next, the first (n_{1 =44) and second (n2=119) group by random sampling were divided into 2 subgroups: (n11=24 and n12=20) and (n21=60 and n22=59), respectively. Physical exercises, breathing exercises, Aqua gym and music relaxation was carried out to pregnant women in the second group, whose children are aged 4 years had a mild degree of severity of the consequences of CNS lesions or was not registered to any of the clinical forms of the consequences of Central nervous system lesions (n2=119).}

To build a predictive model of perinatal pathology was used subgroup n₁₁=24 and n₂₁=60 is the training sample. And to assess the effectiveness of the classification after the discriminant analysis was used subgroup n₁₂=20 and n₂₂=59 is the experimental group.

At the second stage in the training group compared to the subgroups was assessed distribution of pregnant women (see tables 2, 3, 4) according to the following criteria:

- the severity of somatic diseases,

- risk factors in the first and third trimesters,

perinatal risk factors in the first and third trimesters,

- intrapartum risk factors

- visit to the set of recreational activities (from the first trimester or second trimester),

- to assess the duration of the breath sample Rod and Genc in the initial period (11-19), 21-29, 31-39 the components of pregnancy.

As can be seen from tables 3, 4 (see Appendix), we detected no statistically significant differences among the indicators of gestational period pregnant women with somatic pathology of the first trimester in comparison subgroups. While the indicators of the third trimester had statistically significant differences.

Thus, it was confirmed that statistically significant to predict in pregnant women, the presence of perinatal pathology of them children under the age of 4 years is possible only in terms of the third trimester.

In the third stage to build the model of antenatal prediction of the consequences of perinatal lesions of the nervous system in children of women with somatic pathology was used classification method stepwise discriminant analysis, which allows to retrieve one or more functions of several variables simultaneously, providing the possibility of assigning this object to one of the groups. These functions are called classifying and depend on the values of variables so that you could assign each object to one of the groups. In our case it will be two classification functions:

the first function is to predict in pregnant women, the presence of moderate or severe severity of the consequences of the Central nervous system in children aged 4 years - S₁;

- the second function is to predict in pregnant women, the presence of mild severity or absence of effects of the Central nervous system in children aged 4 years S₂.

Each function allows us to each sample and for each set to calculate the weight classification according to the formula:

S_i=c_i+w_i1*x₁+w_i2*x₂+...+w_im*x_m

In this formula the index i denotes the corresponding set, and the indices 1, 2, ..., m denote the m variables; c_iare constants for the i-th aggregate, w_ij- the weight for the j-th variable in the calculation of the quantities for the i-th aggregate; x_j- observed value for the respective sample of the j-th variable. The value of S_iis the result of the quantities.

Once calculated the indicators classification for observation, it is easy to decide how to perform classification of the observations. In General, the observation is considered to belong to that subset for which obtained the highest classification.

To build these classification functions were used the following parameters.

1. The severity of risk factors in the third trimester.

2. The severity of risk factors in the perinatal period in the third trimester.

3. The severity of risk factors for intrapartum period in the third trimester.

4. Visiting the set of recreational activities.

5. TSH, mIU/l in the third trimester.

6. T3, nmol/l in the third trimester.

7. T4, nmol/l in the third trimester is.

8. Cortisol, nmol/l in the third trimester.

9. Insulin, mked/ml in the third trimester.

10. MDA, nmol/l in the third trimester.

11. Vit. E, mmol/ml in the third trimester.

12. Evaluation of the sample Rod 2S (21-29 weeks).

13. Evaluation of the sample Rod 3P (31-39 weeks).

14. Evaluation samples Genc 2P (21-29 weeks).

15. Evaluation samples Genc 3P (31-39 weeks).

Alarm for categorical indicators was as follows.

0 - absence of risk factors.

1 - light the severity /good assessment sample/ Wellness events of the first trimester.

2 - medium severity /satisfactory samples/ Wellness activities in the third trimester.

3 - severe severity /unsatisfactory samples/ absence of recreational activities.

In the data processing method of discriminant analysis of 15 indicators was highlighted 10, which simultaneously statistically distinguish between the compared subgroups. In table 5 in descending order of informativeness presents the indicators that make the maximum contribution to defined (discriminant) functions and their weights in the two subgroups.

Thus, the model of antenatal prediction of the consequences of perinatal pathology in pregnant women with somatic pathology presents two classification functions S ₁and S₂with 10 variables with the corresponding weights and constant.

If the function S₁>S₂it is possible to predict in pregnant women, the presence of moderate or severe severity of the consequences of the Central nervous system in children aged 4 years.

If the function S₁<S₂it is possible to predict in pregnant women, the presence of mild severity or absence of effects of the Central nervous system in children aged 4 years.

At the tetrad stage was assessed the effectiveness of the constructed model according to the experimental sample: n₁₂=20 and n₂₂=59.

The efficiency of the classification are presented in table 6.

Thus, the sensitivity classification (Se) is the frequency of availability of perinatal morbidity in children was 95,0%; specificity (Sp) is the frequency of the absence of perinatal morbidity in children - 96,6%; prognostically positive result in classification (PP) - the frequency of its coincidence with the presence of perinatal pathology - 90,5%; prognostically negative result of classification (PN) is the frequency it is consistent with the absence of perinatal pathology - 98,3%.

Thus, the presence or absence of the effects of Central nervous system in children aged 4 years directly depends on early (first trimester) for pregnant women with somatic Zab what diseases are easy to use Wellness activities (exercise, respiratory gymnastics, Aqua gym and relaxation music)aimed at increasing the reserve capacity of the body that contributes to a significant reduction in the severity of perinatal CNS lesions in children and risk factors to the third trimester of pregnancy.

Example 1.

Anan V.M., 23 years appealed to the antenatal clinic on pregnancy 7-8 weeks. The first pregnancy was a threat of premature miscarriage 9 weeks. and 12-13 weeks. ber-Ty, OCR a period of 16 weeks. with the rise of temperature of 38.7°, was hospitalized. The second half of pregnancy: anaemia Art. II (HB 94 g/l), the threat of termination of pregnancy in the period 24-26 weeks, was hospitalized. The survey: history taking, clinical examination, laboratory methods of research: assessment of the hormonal spectrum of blood, lipid peroxidation and antioxidant activity of the blood, the blood counts (hemoglobin, platelet count, total protein, fibrinogen) in I and III trimester of pregnancy.

2)blood:

Additional research methods (breathing tests) in the first and third trimester of pregnancy:

sample Post on the breath -

NP, up to 11 weeks - 7

P, 11-19 weeks - 9

2S, 21-29 weeks - 13

3P, 31-39 weeks - 11

sample Genc on the exhale -

NP, up to 11 weeks and 5

2S, 21-29 weeks - 10

3P, 31-39 weeks - 9

Visiting the set of recreational activities: not visited.

Surveillance in antenatal clinics in the usual way.

According to the proposed method of antenatal prediction of the consequences of perinatal lesions of the nervous system in this clinical case, the newborn threaten the development of perinatal lesions of the nervous system moderate or severe severity, since S₁>S₂.

S₁=2*9,02+12*0,30+22,34*3,13+11*5,41+101,16*0,59+389,14*0,01+2,13*11,63+2,15*7,42+0+10*8,35-91=247,84

S₂=2*4,09+12*1,21+22,34*2,14+11*9,42+101,16*0,70+389,14*0,02+2,13*14,49+2,15*4,60+0+10*7,81-143,92=227,41

where

e1 - severity of risk factors in the perinatal period in the third trimester, average = 2,

E2 - Vite, mmol/ml in the third trimester = 12 mmol/ml,

E3 - insulin, mked/ml in the third trimester = 22,34 mked/ml,

E4 - assessment sample Rod 3P (31-39 weeks)=11,

E5 - T4, nmol/l in the third trimester = 101,16 nmol/l,

E6 - cortisol, nmol/l in the third trimester = 389,14 nmol/l,

E7 - TSH, mIU/l in the third trimester = 2,13 mIU/l,

E8 - T3, nmol/l in the third trimester = 2,15 nmol/l,

e - visit to the set of recreational activities - not visited = 0,

E10 - assessment samples Genc 2P (21-29 weeks)=10.

Obtained: S₁>S₂.

Forecast: perinatal CNS damage.

Births occurred in the period 37-38 weeks, prenatal rupture of amniotic fluid, weakness R is a yearly activity. Redistillate. Duration 2 year of birth - 2 hours 45 minutes

The true knot of the umbilical cord.

A girl was born weighing 2.940, height 50 cm, with a score on the Apgar 6/7 points.

Cried after rehabilitation of the upper respiratory tract. The cry of the weak force is short. The General condition of the child during his stay in the nursing home to heavy due to neurological symptoms. The cry of the weak. The skin is pale pink, acrocyanosis of the hands and feet. Reflexes are reduced. Eye symptoms. On the 7th day of life for further examination and treatment of the child was transferred to the neonatal care unit of children's hospital. The state remained heavy. On the background of the treatment condition improved. At the age of 29 days, the child was discharged under the supervision of a primary care physician and a neurologist diagnosed with perinatal CNS damage, hypoxic-traumatic Genesis syndrome neuro-reflex excitability, the compression ratio of C2-C3.

In the first year of life: the child's condition is satisfactory, cooing in 3-4 months., gets started in 8-9 months. - unstable, could not stand, not crawling, bearing support. 1 year diagnosed with perinatal CNS damage. Threatened by infantile cerebral paralysis (ICP).

At the age of 3.5 years old child diagnosed with organic residual CNS syndrome motor-digitalsignature, Cerebral palsy, spastic lower prepares. Group health III.

Example 2.

Valieva N.P., 28 years has been registered in female consultations in 9-10 weeks of pregnancy. From the anamnesis: suffering from atopic dermatitis; with 20 years bronchial asthma, lung during the last exacerbation 3 years ago. In the period of 10-12 weeks, the risk of premature miscarriage, anemia Art. I, was treated in hospital. The survey: history taking, clinical examination, laboratory methods of research: assessment of the hormonal spectrum of blood, lipid peroxidation and antioxidant activity of the blood, the blood counts (hemoglobin, platelet count, total protein, fibrinogen) in I and III trimester of pregnancy.

Additional research methods (breathing tests) in the first and third trimester of pregnancy:

sample Post on the breath -

NP, up to 11 weeks - 11

P, 11-19 weeks - 23

2S, 21-29 weeks - 36

3P, 31-39 weeks - 54

sample Genc on the exhale -

NP, up to 11 weeks - 8

1H, 11-19 weeks - 17

2S, 21-29 weeks - 34

3P, 31-39 weeks - 29.

Conducted a range of recreational activities: gymnastics in the dynamic mode, respiratory gymnastics, Aqua gym, music therapy, psychological support pregnancy.

Visit the recreational complex is s activities: visited regularly throughout pregnancy.

According to the proposed method of antenatal prediction of the consequences of perinatal lesions of the nervous system in this clinical case, the newborn threaten the development of perinatal lesions of the nervous system mild severity or you can predict the absence of effects of lesions of the nervous system to the child, as S₁<S₂.

S₁=1*9,02+15,26*0,30+21,64*3,13+54*5,41+134,20*0,59+665,93*0,01+2,81*11,63+2,61*7,42-5+34*8,35-91=690,93

S₂=1*4,09+15,26*1,21+21,64*2,14+54*9,42+134,20*0,70+665,93*0,02+2,81*14,49+2,61*4,60-0,03+34*7,81-143,92=859,26

where

e1 - severity of risk factors in the perinatal period in the third trimester, average = 1,

E2 - Vit. E, mmol/ml in the third trimester = 15,26 mmol/ml,

E3 - insulin, mked/ml in the third trimester = 21,64 mked/ml,

E4 - assessment sample Rod 3P (31-39 weeks)=54,

E5 - T4, nmol/l in the third trimester = 134,20 nmol/l,

E6 - cortisol, nmol/l in the third trimester = 665,93 nmol/l,

E7 - TSH, mIU/l in the third trimester = 2,81 mIU/l,

E8 - T3, nmol/l in the third trimester = 2,61 nmol/l,

e - visit to the Wellness complex events=-5,

E10 - assessment samples Genc 2P (21-29 weeks)=34.

Obtained:S₁<S₂.

Forecast: absence of effect of lesions of the nervous system to the child.

Delivery on time 38-39 weeks. Urgent delivery in the head previa. Weakness potuznogo period. A girl was born weighing 3540, a growth of 53 cm, score Apgar 8/9 b is low, cried at once, cry loud.

Status in the nursing home satisfactory vaccinated. On day 4 was discharged from the hospital in satisfactory condition. In the first year of life physical development, mental development corresponds to the age. Group health II A.

Conclusion: in this case the baby is healthy. Group health II a.

Thus, the proposed method antenatal prediction of the consequences of CNS lesions will promptly appoint an early set of rehabilitation measures and to significantly reduce the number of children with disabilities, to restore health and to prevent the formation of pathology in children from the risk group for the development of neurological disability.

Application.

Table 1. "Comparative characteristics of the study groups".

Table No. 2. "The distribution of pregnant women according to the compared subgroups in the training set on the main clinico-anamnestic parameters".

Table No. 3. "The distribution of pregnant women in the training set for estimating the duration of a breath sample Rod and Genc".

Table No. 4. "The distribution of pregnant women in the training set for the main laboratory values in the compared subgroups".

Table No. 5. "Function classification model predicting the effects of perinatal poraj the deposits of the nervous system of children from mothers with somatic pathology.

Table No. 6. "The main operational characteristics of the classification of objects. Note: Se is sensitivity; Sp - specificity, PP - predictive value of a positive result, PN - prognostically negative result of classification.

Sources of information taken into account when drafting

1. "Neonatology" national leadership. CH. editor, academician of the Russian Academy of medical Sciences NAT, Moscow, "GEOTAR-Media", 2007, 355 S.

2. Beresnev I Perinatal neurology. - Moscow: Triada-X, 2001. - 640 S.

3. Bulakova S.A., Belikova A.I Treatment of perinatal lesions of the nervous system in children of early age: pharmacotherapeutic effect gopantenovoy acid // Pediatrics. - 2007. No. 1. - C.11-13.

4. Kachurin D.R., Saulembekov LO, Almagambetova A.N. Features of emotional development and psychosomatic dysfunctions in children with perinatal Central nervous system //Russian journal of Perinatology and Pediatrics. - 2006. - Vol. 51. No. 2. - P.41-43.

5. Snetkova E.V., Burtseva E.M., Novikov A. et al. Neuro-mental health children who had perinatal nervous system // Journal of neurology and psychiatry. - 2000. No. 3.- P.57-59.

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7. (19) RU (11) 2290644 (13) C1, (46) published 27.12.2006. Authors: Levkovich Marina A.; Orlov, Vladimir Ivanovich, Plahuta Tatyana Grigoryevna, Afonin, Alexander Alexeevich, Sozaeva Diana Ismailova, FGU "Rostov scientific research Institute of obstetrics and Pediatrics, Ministry of (and found the source Tipsy).

8. (19) RU (11) 2167608 (13) C1, (46) published 27.05.2001. Authors: Sautin D.B, Sprach CENTURIES, Protopopov, NV, Maksimova OG, Rozhkova POSTGRADUATE Irkutsk state Institute of advanced medical health Ministry (found from a source Tipsy).

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The way antenatal prediction of the effects of Central nervous system in children, including clinical examination of pregnant, characterized in that it further conduct functional respiratory sample Rod and Genc in the initial period on the terms 11-19, 21-29, 31-39 weeks of gestational period, and also carry out the determination of the dynamics in I and III trimester of indicators of hormonal spectrum of blood: T4, TSH, T3, cortisol, vitamin E, insulin, indicators of lipid peroxidation and antioxidant activity of the blood, the blood - hemoglobin, platelet count, total protein, fibrinogen, analyze risk factors, determine their grades and numeric values and calculate the predictive coefficients S₁and S₂formula:
S1=e1·9,02+e2E·0,30+e3·3,13+e4·5,41+e5·0,59+e6·0,01+e7·11,63+e8·7,42+e9·(-5)+E10·8,35-91,
S2=e1·4,90+e2·1,21+e3·2,14+e4·9,42+e5·0,70+e6·0,02+e7·14,49+e8·4,60+e9·(-0.03)+E10·7,81-143,92,
where e1 is the severity of risk factors in the perinatal period in the third trimester;

E3 - insulin, mked/ml in the third trimester;
E4 - assessment sample Rod 3P (31-39 weeks);
E5 - T4, nmol/l in the third trimester;
E6 - cortisol, nmol/l in the third trimester;
E7 - TSH, mIU/l in the third trimester;
E8 - T3, nmol/l in the third trimester;
e - visit to the set of recreational activities (did not attend - 0);
e10 - assessment samples Genc 2P (21-29 weeks);
and when S₁>S₂predict the presence of moderate or severe severity of the consequences of the Central nervous system in children aged 4 years and when S₁<S₂predict the presence of mild severity or absence of effects of the Central nervous system in children aged 4 years.