General Description of the Work

Investigation of neonatal neurological status requires a thorough knowledge of the anatomical and physiological characteristics of the nervous system in this age primarily in the brain. Many of nervous system departments at time of birth are in state of development which accounts as period of evolve for the originally existing reflexes to various external stimuli. During the first months of life the highest level of integration is Thalamo-Pallidum System (Corpus Striatum-Globus Pallidus). Now it is wellknown that most neonatal reflexes are represented in spinal cord, brain stem and in the subcortex. Later and during the processes of myelination and differentiation of the previously not well-evolved system, there will be phylogenic inhibition of the aforementioned nerve systems which consequently modify the neonatal reflexes. Abnormal reflexes or persistence of such

reflexes may indicate lesion of one part or another in the brain. In order to obtain a reliable and objective findings, neonatal examination is best done after birth stress and the state of hibernation. So, neonatal examination should always be performed in the same suitable conditions. The most optimal time of neonatal neuro-examination is one hour before the next feeding, when the baby is awake and showing some activities. Examination of the child while he sleep, immediately after feeding or during anxiety may give a distortion of responses of the baby. During inspection, the child should be totally stripped, and subjected to an ideal surrounding condition of room temperature between 24 to 26C (32 to 35C for premature baby), subdued lighting and disposable semi-rigid examination table. A low ambient temperature can lead to increase in muscle tone and tremors, while

in high surrounding temperature muscular hypotonia may occur. For most of the neonatologists they must meet certain criteria such as he should be unhurried, balanced and worm handed. The reflexes that cannot be precisely defined by the examiner cannot be regarded as pathological or missing, so the newborn should be examined repeatedly with further questioning of the parents. The result of a comprehensive neurological examination should be a functional assessment of a newborn central nervous system with the detection of the leading neurological syndromes which will correctly identify the meaning of certain neurological symptoms.

Aims and Objectives of the study

The study newborn reflexes is one of the main methods for assessing the state of the nervous system and recognition of a defect. The clinical diagnosis of reflexes can be

divided into physiological and pathological. For infants and children and during the first months of their lives, its quite reasonable to differentiate the pathological and physiological reflexes on the basis of the severity and the duration of such reflex. In studying reflexes, it is necessary to consider not only their presence but also the duration of the latent period, severity of response, time of emergence, and time of reduction. According to our observations in healthy stereotyped neonatal reflexes, they have a very short latency period. Reflexes usually fade after repeating the reflex for 710 times and regain after 1-2 minutes rest.

Material
Quantities of this study includes babies from first month to one year.
The Dynamics of the Segmental Motor Automatisms The Name of the Reflex Protective Reflex Support Automatic Gait Time of Time of Appearance Reduction Spinal Automatism From birth 1.5 months From birth Becomes standing alone From birth 3-4 months

Infants Upper Grasping Lower Grasping Bauer Moro Gallant Perez Babinski Hand to Mouth Suckling Rooting or Search Bucco-rotating Naso-labial

From birth From birth From birth From birth From birth From birth From birth Oral Automatisms From birth From birth From birth From birth From birth

6-12 months 12 months 4-5 months 5-6 months 3 months 3 months 12 months 3-4 months 12 months 1-1.5 months 2-3 months 2-3 months

From that study I deduced that 44.4% of neurologically healthy children revealed transient physiological changes in neurological status such as squint or occasionally nystagmus, hypo-activity, non-persistent tremors, slight changes in the amplitude of periosteal reflexes, mild increase or decrease of muscle tone and reduced Moro, Galant, Stepper, and Support reflexes. State of Adaptation: reflecting a process of neonatal adaptation to the new

postpartum environment. These adaptation processes took place early during labor or just after delivery which then disappear within seven days of babys life.

Neonatal Adaptation Syndrome (NAS)

It is a behavioral disorder in which neonate is either irritable or hypoactive with loss of attention and slight changes in reflexes such as muscle dystonia, changes in amplitude of deep tendon reflex, absent or decrease primitive reflex, transient squint, nystagmus or non-persistent tremors.

State of Adaptation: In the first 3-5 seconds of a babys live, the fetus is said to be in ultra-deep slumber or anesthesia state Professor P. Babkin described it as Intrapartum Fetal Hibernation. This state is characterized by immobility, lake of response to external stimuli, areflexia, severe muscular hypotonia or atony, abd bradycardia. Hibernation state decreases the susceptibility to oxygen deficiency and provide protection from hypoxia, CNS insult and make the child less prone to pain shock. Hibernation state slows down centers in the brain stem including respiratory center which protect the fetus from amniotic fluid aspiration. This phenomena has been described as physiological in nature. It provides the fetus during delivery to adapt conditions that are supposed to be incompatible with life.

3-5 seconds later after birth, comes the dehibernation or awakening state. Her the child acquires the typical features of newborns: awake, spontaneous motor activity, reflexes, increase flexors muscle tone. After birth of a child, there is a great variety in living conditions than those where intrauterine in each of temperature, gravity, visual, tactile, auditory, vestibular and other stimuli that require a different type of feeding and breathing. These changes are accompanied by reorganization of functional systems. Identification the differences between symptoms caused by prenatal or generic hypoxic brain damage and adaptation in the infants is difficult. Pay attention to diversity and dynamics of the symptoms.

Conclusions

1. CNS pathology of newborn is relevant with the course of pregnancy, delivery and early neonatal period.
2. Collection of detailed information about the course of pregnancy, delivery and exposure time to pathological factors contribute to the prcised neurological evaluation of the baby. 3. The highest level of integration is ThalamoPallidum System.
4.

Athetoid movements in older children indicates damage to Corpus Striatum-

Globus Pallidus system. 5. Hypoxia is the leading factor for brain damage.
6.

Abnormal postures and absence of reflexes in infants would almost always refer to a neurologic organic lesion. In preterm baby it is important to pay attention to the degree of prematurity. The risk and severity of neurological abnormalities in infant with very low birth weight is three times the frequency and

7.

severity of neurological disorders in term. Thus, preterm babies are often develop hypoxic brain injury, peri-ventricular hemorrhage and peri-ventricualr leukomalecia (i.e. necrosis and/or gliosis of white brain matter). The later is thr most frequent cause of cerebral palsy in surviving preterm infants. 8. State of Adaptation: reflecting a process of neonatal adaptation to the new postpartum environment. 9. Long term persistent muscular hypotonia in combination with exaggerated deep tendon reflexes in newborns may be an early sign of cerebral quadriplegia.
10.

Neonatal primitive reflexes represent the evolutionary and the functional maturity of the child.