АКТУАЛЬНЫЕ МЕТОДЫ ДИАГНОСТИКИ И ПРОГНОЗИРОВАНИЯ ГИПОКСИЧЕСКИ-ИШЕМИЧЕСКИХ ЦЕРЕБРАЛЬНЫХ НАРУШЕНИЙ В ДЕТСКОМ ВОЗРАСТЕ: КЛИНИКО-НЕЙРОФИЗИОЛОГИЧЕСКИЕ, НЕЙРОВИЗУАЛИЗАЦИОННЫЕ И БИОМАРКЕРНЫЕ ПОДХОДЫ

Abstract

Background. Hypoxic-ischemic cerebral injury remains an important cause of neurological morbidity, long-term disability, and adverse neurodevelopmental outcomes in childhood. Neonatal hypoxic-ischemic encephalopathy is characterized by complex interactions between energy failure, excitotoxicity, mitochondrial dysfunction, oxidative stress, and neuroinflammation. Despite advances in neuroprotective treatment, early diagnosis and reliable prediction of motor, cognitive, and behavioral impairments remain challenging.

Materials and Methods. A narrative analytical review of clinical studies, systematic reviews, meta-analyses, and international recommendations was conducted. The analysis focused on neurological assessment, conventional and amplitude-integrated electroencephalography, magnetic resonance imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopy, cerebral near-infrared spectroscopy, and circulating biomarkers of brain injury.

Results. A multimodal and time-dependent diagnostic approach was identified as an important strategy for improving the characterization of cerebral injury and estimation of later neurodevelopmental outcomes. An original conceptual framework, PED-HI-PROGNOSIS, was developed to integrate neurological status, EEG background activity, structural brain injury, metabolic abnormalities, and longitudinal developmental assessment.

Conclusion. Reliable neuroprognostication following pediatric hypoxic-ischemic cerebral injury requires integration of clinical, neurophysiological, and neuroimaging findings rather than reliance on isolated markers. Individualized assessment may facilitate early identification of children at increased risk of neurological impairment and support long-term developmental surveillance and rehabilitation.