Physician: Perinatal Lesion of Central Nervous System

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Perinatal (prenatal) encephalopathy

We were just referred a 7 month old boy that was born at 35-36 weeks. The medical report we received says that the neurologist diagnosed him as having "perinatal lesion of central nervous system." In June and August, the notation "early recovery period" was on the report. In October, the notation was "late recovery period."

Is "perinatal lesion of CNS" something that you frequently see? How concerned should we be?

This is an excellent question because it is found all too commonly on many of the medical reports. I have also personally found that many adoptive parents access the internet for most of their adoptive information. It is well know that this is a common diagnosis and that most of the children do very well and do not have a neurological problem. It is because of this internet buzz that many parents and agencies just dismiss this diagnosis without a medical evaluation. Obviously, if a child has this diagnosis and is walking, running and normal developmental milestones on the video, chances are really good that this child will have a good neurological outcome.

While at first glance one would worry about this diagnosis because it sounds as if the child may have suffered insult to the brain. Most intelligent people obviously are concerned about future neurological damage. According to Russian medical teaching, this diagnosis is given to an infant who had anything out of the ordinary that may have a future impact on the infant’s brain development. It does not necessarily mean that the infant has brain damage. The diagnosis can be made on the behalf of the mother with something as common as no prenatal care, or on behalf of the infants status such as prematurity, abnormal laboratory testing or jaundice.

All that it really means is that this infant is a high risk infant and it needs to be closely observed for problems during the first year of life. It does not necessarily mean that every infant will have a poor neurological outcome. This is obvious since most of the children that have this diagnosis are actually very normal.

Below I am attaching a accurate translation of this diagnosis in a Russian text book. As you will see, that many of the things listed especially on the behalf of the mother will trigger this diagnosis, especially if the child is left in an orphanage. Such common issues are
  • no prenatal care,
  • lack of medical history,
  • chronic health conditions of the mother.
Most children who are abandoned in an orphanage, there is a lack of medical information on the mother, hence making this a higher risk infant. I think that this is why this diagnosis is so very common.

Perinatal (prenatal) encephalopathy: (Variably translated "perinatal lesion or affectation of the central nervous system," "encephalopathia," and many others.)

One or more risk factors present in me history of the mother or the baby which may allow for a poor neurological outcome. (see the table that follows.) There may be mild neurological impairment in the infant.

Perintal (prenatal) encephalopathy:
Maternal factors :
  • Lack of known medical history, alcohol or cigarette use, No prenatal care, Anemia Past miscarriages, abortions or premature delivery, Young or old maternal age, High number pregnancy, Chronic health problems, Infections, Poor social situation, Difficult or complicated delivery, Abnormal placenta
Infant factors:
  • Low Apgar scores, Abnormal muscle tone or reflexes, Jaundice, Seizures, Irritability or depression, Tremor, Poor suck, feeding problems, Abnormal head circumference, Congenital abnormalities Genetic conditions, Abnormal ultrasound of brain or other parts of body, Intrauterine or perinatal infections, Prematurity, Abnormal prenatal growth, Abnormal laboratory tests,
Perinatal trauma (affectation) of the central nervous system: Synonym for perinatal encephalopathy. Also called perinatal lesion, cranio-cerebal trauma of the newborn and other variations

Stage of condition: The progression of a disease
  1. Recuperation or rehabilitation: Improving but still requiring treatment.
  2. Residual: Almost recovered but signs or symptoms not completely resolved, expected to be healthy. Also used for late or permanent results such as scar or stroke.
  3. Recovery period: Condition or illness completely resolved.
  4. Compensated: Abnormal but stable.
  5. Subcompensated: Abnormal, clinically unstable, may deteriorate.
Logistically interpreting the limited information given about this child, the diagnosis was given because of the slight prematurity. A couple of months later, he was categorized as being in the Early Recovery period, they thought that the child was doing good and then in the late recovery period: Condition or illness completely resolved.

I am really fortunate to see many children who have this diagnosis listed on their medical, yet after I see them in the U.S.A, most of these children do very very well.

by Nicholas Rogu, M.D.

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