Asphyxia in newborns. What is newborn asphyxia: pulmonary and extrapulmonary causes of development, medical tactics Mild asphyxia at birth

A pathological condition of a newborn caused by respiratory failure and resulting oxygen deficiency.

There are primary (at birth) and secondary (in the first hours and days of life) asphyxia of the newborn.

Etiology.

The causes of primary A. n. are acute and chronic intrauterine oxygen deficiency - fetal hypoxia, intracranial injury, immunological incompatibility of the blood of mother and fetus, intrauterine infection, complete or partial blockage of the respiratory tract of the fetus or newborn with mucus, amniotic fluid (aspiration asphyxia), defects fetal development.

The occurrence is facilitated by extragenital diseases of the pregnant woman (cardiovascular, especially in the stage of decompensation, severe lung diseases, severe anemia, diabetes mellitus, thyrotoxicosis, infectious diseases, etc.), late toxicosis of pregnant women, post-term pregnancy, premature placental abruption, pathology of the umbilical cord, fetal membranes and placenta, complications during childbirth (untimely rupture of amniotic fluid, labor anomalies, discrepancy between the sizes of the mother’s pelvis and the fetal head, incorrect insertion of the fetal head, etc.).

Secondary may be associated with impaired cerebral circulation in a newborn, pneumopathy, etc.

Pathogenesis.

Regardless of the causes of oxygen deficiency, a restructuring of metabolic processes, hemodynamics and microcirculation occurs in the newborn’s body. Their severity depends on the intensity and duration of hypoxia.

Metabolic or respiratory-metabolic acidosis develops, accompanied by hypoglycemia, azotemia and hyperkalemia, followed by potassium deficiency. Electrolyte imbalance and metabolic acidosis lead to cellular hyperhydration.

In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating red blood cells. A. n., which developed against the background of chronic fetal hypoxia, is accompanied by hypovolemia. Blood thickens, its viscosity increases, and the aggregation ability of red blood cells and platelets increases. In the brain, heart, kidneys, adrenal glands and liver of newborns, as a result of microcirculatory disorders, edema, hemorrhages and areas of ischemia occur, and tissue hypoxia develops. Central and peripheral hemodynamics are disrupted, which is manifested by a decrease in stroke and cardiac output and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation disrupt the urinary function of the kidneys.

Clinical picture.

The leading symptom of A. n. is a breathing disorder, leading to changes in cardiac activity and hemodynamics, disruption of neuromuscular conduction and reflexes. Severity of A. n. determined by the Apgar scale (see Apgar method). There are A. n. moderate and severe (Apgar score in the first minute after birth, 7-4 and 3-0 points, respectively). In clinical practice, it is customary to distinguish three degrees of severity of asphyxia:

mild (Apgar score in the first minute after birth 7-6 points),
moderate severity (5-4 points)
severe (3-1 points).

A total score of 0 points indicates clinical death. With mild asphyxia, the newborn takes his first breath within the first minute after birth, but his breathing is weakened, acrocyanosis and cyanosis of the nasolabial triangle, and a slight decrease in muscle tone are noted. With moderate asphyxia, the child takes his first breath within the first minute after birth, breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted, but there may also be tachycardia, muscle tone and reflexes are reduced, the skin is bluish, sometimes mainly in areas of the face, hands and feet, the umbilical cord is pulsating. In severe asphyxia, breathing is irregular (individual breaths) or absent, the child does not scream, sometimes groans, the heartbeat is slow, in some cases replaced by single irregular heart contractions, muscle hypotonia or atony is observed, there are no reflexes, the skin is pale as a result of spasm of peripheral vessels, the umbilical cord is not pulsates; Adrenal insufficiency often develops.

In the first hours and days of life, newborns who have suffered asphyxia develop posthypoxic syndrome, the main manifestation of which is damage to the central nervous system. At the same time, every third child born in a state of moderate asphyxia has a cerebral circulation disorder of the 1st-2nd degree, and all children who have suffered severe asphyxia develop the phenomena of impaired cerebrospinal fluid dynamics and cerebral circulation of the 2nd-3rd degree. Oxygen deficiency and disorders of the external respiration function disrupt the formation of hemodynamics and microcirculation, and therefore fetal communications are preserved: the arterial (botal) duct remains open; as a result of spasm of the pulmonary capillaries, leading to increased pressure in the pulmonary circulation and overload of the right half of the heart, the foramen ovale does not close. Atelectasis and often hyaline membranes are found in the lungs. Cardiac disturbances are noted: dullness of tones, extrasystole, arterial hypotension. Against the background of hypoxia and reduced immune defense, microbial colonization of the intestine is often disrupted, which leads to the development of dysbiosis. During the first 5-7 days of life, metabolic disorders persist, manifested by the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance and true potassium deficiency in the child’s body. Due to impaired renal function and a sharp decrease in diuresis after the 2-3rd day of life, newborns develop edema syndrome.

The diagnosis of asphyxia and its severity is established on the basis of determining in the first minute after birth the degree of respiratory impairment, changes in heart rate, muscle tone, reflexes, and skin color. The severity of asphyxia is also indicated by indicators of the acid-base state (see Acid-base balance). So, if in healthy newborns the pH of blood taken from the umbilical cord vein is 7.22-7.36, BE (base deficiency) is from - 9 to - 12 mmol/l, then with mild asphyxia and moderate asphyxia these indicators are respectively equal 7.19-7.11 and from - 13 to - 18 mmol/l, with severe asphyxia pH less than 7.1 BE from - 19 mmol/l or more. A thorough neurological examination of the newborn and ultrasound examination of the brain make it possible to differentiate hypoxic and traumatic damage to the central nervous system. In the case of predominantly hypoxic damage to the central nervous system. focal neurological symptoms are not detected in most children; a syndrome of increased neuro-reflex excitability develops, and in more severe cases - a syndrome of central nervous system depression. In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.) at birth, hypoxemic vascular shock is detected with spasm of peripheral vessels and severe pallor of the skin, hyperexcitability, focal neurological symptoms and convulsive syndrome that occurs several hours after birth are often observed. .

Treatment.

Children born with asphyxia require resuscitation care. Its effectiveness largely depends on how early treatment is started. Resuscitation measures are carried out in the delivery room under the control of the basic parameters of the body’s vital activity: respiratory rate and its conductivity to the lower parts of the lungs, heart rate, blood pressure, hematocrit and acid-base status.

At the moment of birth of the fetal head and immediately after the birth of the child, the contents of the upper respiratory tract are carefully removed using a soft catheter using an electric suction (while using tees to create intermittent rarefaction of air); The umbilical cord is immediately cut and the baby is placed on a resuscitation table under a radiant heat source. Here, the contents of the nasal passages, oropharynx, and stomach contents are re-aspirated. In case of mild asphyxia, the child is placed in a drainage (knee-elbow) position, inhalation of a 60% oxygen-air mixture is prescribed, and cocarboxylase (8 mg/kg) in 10-15 ml of a 10% glucose solution is injected into the umbilical cord vein. In case of moderate asphyxia, to normalize breathing, artificial pulmonary ventilation (ALV) is indicated using a mask until regular breathing is restored and the skin appears pink (usually within 2-3 minutes), then oxygen therapy is continued by inhalation. Oxygen must be supplied humidified and warmed with any method of oxygen therapy. Cocarboxylase is injected into the umbilical cord vein in the same dose as for mild asphyxia. In case of severe asphyxia, immediately after crossing the umbilical cord and suctioning the contents of the upper respiratory tract and stomach, tracheal intubation is carried out under the control of direct laryngoscopy and mechanical ventilation until regular breathing is restored (if within 15-20 minutes the child has not taken a single independent breath, resuscitation measures are stopped even if heartbeat). Simultaneously with mechanical ventilation, cocarboxylase (8-10 mg/kg in 10-15 ml of 10% glucose solution), 5% sodium bicarbonate solution (only after creating adequate ventilation of the lungs, on average 5 ml/kg), 10% solution is injected into the umbilical cord vein calcium gluconate (0.5-1 ml/kg), prednisolongemisuccinate (1 mg/kg) or hydrocortisone (5 mg/kg) to restore vascular tone. If bradycardia occurs, 0.1 ml of a 0.1% atropine sulfate solution is injected into the umbilical cord vein. If the heart rate is less than 50 beats per minute or in case of cardiac arrest, an indirect cardiac massage is performed, 0.5-1 ml of a 0.01% (1: 10000) solution of adrenaline hydrochloride is injected into the umbilical cord vein or intracardially.

After the restoration of breathing and cardiac activity and stabilization of the child’s condition, he is transferred to the intensive care unit of the neonatal department, where measures are taken aimed at preventing and eliminating cerebral edema, restoring hemodynamic and microcirculatory disorders, normalizing metabolism and kidney function. Craniocerebral hypothermia is carried out - local cooling of the newborn's head (see Artificial hypothermia) and infusion-dehydration therapy. Before craniocerebral hapotothermia, premedication is required (infusion of a 20% solution of sodium hydroxybutyrate at 100 mg/kg and a 0.25% solution of droperidol at 0.5 mg/kg). The scope of treatment measures is determined by the child’s condition; they are carried out under the control of hemodynamics, blood coagulation, acid-base status, protein, glucose, potassium, sodium, calcium, chloride, magnesium levels in the blood serum. To eliminate metabolic disorders, restore hemodynamics and renal function, a 10% glucose solution, rheopolyglucin is injected intravenously, and hemodez is administered from the second to third day. The total volume of administered fluid (including feeding) on the first and second days should be 40-60 ml/kg, on the third day - 60-70 ml/kg, on the fourth - 70-80 ml/kg, on the fifth - 80-90 ml/kg, on sixths and sevenths - 100 ml/kg. From the second or third day, a 7.5% solution of potassium chloride (1 ml/kg per day) is added to the dropper. Cocarboxylase (8-10 mg/kg per day), 5% ascorbic acid solution (1-2 ml per day), 20% calcium pantothenate solution (1-2 mg/kg per day), 1% riboflavin solution are injected intravenously. mononucleotide (0.2-0.4 ml/kg per day), pyridoxal phosphate (0.5-1 mg per day), cytochrome C (1-2 ml of 0.25% solution per day for severe asphyxia), 0 is administered intramuscularly .5% solution of lipoic acid (0.2-0.4 ml/kg per day). Tocopherol acetate 5-10 mg/kg per day intramuscularly or 3-5 drops of a 5-10% solution per 1 kg of body weight orally, glutamic acid 0.1 g 3 times a day orally are also used. In order to prevent hemorrhagic syndrome in the first hours of life, a 1% solution of Vikasol (0.1 ml/kg) is administered intramuscularly once, and rutin is prescribed orally (0.005 g 2 times a day). For severe asphyxia, a 12.5% solution of etamsylate (dicinone) 0.5 ml/kg intravenously or intramuscularly is indicated. For the syndrome of increased neuro-reflex excitability, sedative and dehydration therapy is prescribed: 25% magnesium sulfate solution 0.2-0.4 ml/kg per day intramuscularly, Seduxen (Relanium) 0.2-0.5 mg/kg per day intramuscularly or intravenously, sodium hydroxybutyrate 150-200 mg/kg per day intravenously, Lasix 2-4 mg/kg per day intramuscularly or intravenously, mannitol 0.5-1 g of dry matter per 1 kg of weight intravenously drip by 10% glucose solution, phenobarbital 5-10 mg/kg per day orally. In case of development of cardiovascular failure accompanied by tachycardia, 0.1 ml of 0.06% solution of corglycone, digoxin is administered intravenously (the saturation dose on the first day is 0.05-0.07 mg/kg, on the next day 1/5 is administered part of this dose), 2.4% aminophylline solution (0.1-0.2 ml/kg per day). To prevent dysbacteriosis, bifidumbacterin is included in the therapy complex, 2 doses 2 times a day.

Care is important. The child should be ensured rest, the head should be placed in an elevated position. Children who have suffered mild asphyxia are placed in an oxygen tent; children who have suffered moderate to severe asphyxia are placed in an incubator. Oxygen is supplied at a rate of 4-5 l/min, which creates a concentration of 30-40%. If the necessary equipment is not available, oxygen can be supplied through a mask or nasal cannula. Repeated suction of mucus from the upper respiratory tract and stomach is often indicated. It is necessary to monitor body temperature, diuresis, and bowel function. The first feeding for mild and moderate asphyxia is prescribed 12-18 hours after birth (expressed breast milk). Those born with severe asphyxia begin to be fed through a tube 24 hours after birth. The timing of breastfeeding is determined by the condition of the child. Due to the possibility of complications from the central nervous system. After discharge from the maternity hospital, children born with asphyxia are monitored by a pediatrician and a neurologist.

The prognosis depends on the severity of asphyxia, the completeness and timeliness of treatment measures. In case of primary asphyxia, to determine the prognosis, the condition of the newborn is re-evaluated using the Apgar scale 5 minutes after birth. If the score increases, the prognosis for life is favorable. During the first year of life, children who have suffered asphyxia may experience hypo- and hyperexcitability syndromes, hypertensive-hydrocephalic, convulsive, diencephalic disorders, etc.

Prevention includes timely detection and treatment of extragenital diseases in pregnant women, pathologies of pregnancy and childbirth, prevention of intrauterine fetal hypoxia, especially at the end of the second stage of labor, suction of mucus from the upper respiratory tract immediately after the birth of the child.

Newborn asphyxia is a condition of a child at birth, which is characterized by impaired breathing and cardiac activity.

These disorders can be mild, passing on their own or with minimal medical assistance, or severe with full resuscitation measures.

Children born in a state of asphyxia do not cry or scream, they have no independent movements or they are minimal, the skin is cyanotic (with a bluish tint).

Asphyxia of newborns can be intrauterine; it develops due to chronic or acute intrauterine hypoxia of the fetus (oxygen starvation).

The reasons for the development of this type of newborn asphyxia are intrauterine infections, developmental defects, various toxic substances, including medications, alcohol, and nicotine.

In general, almost all negative effects on a pregnant woman can lead to the development of hypoxia in the fetus, and as a consequence, the development of asphyxia.

The development of asphyxia in the newborn is possible due to a disruption in the supply of oxygen to the baby during childbirth. This is due to a change or cessation of blood flow in the vessels of the umbilical cord: entanglement of the umbilical cord around the fetal neck, loss of umbilical cord loops, thrombosis of the umbilical vein, premature placental abruption.

Violation of oxygen supply leads to the development of hypoxia in the baby.

Asphyxia can also develop in a newborn child who has developed normally.

The reasons for the development of such postpartum asphyxia are, as a rule, cerebrovascular accident or pneumopathy (perinatal non-infectious lung diseases that are associated with incomplete expansion of the lung tissue).

All organs of the fetus suffer from a lack of oxygen, but primarily the heart and brain. Depending on the degree of oxygen starvation, asphyxia can be moderate, moderate or severe.

Moderate asphyxia

Moderate asphyxia at birth is characterized by the absence of a cry, but the child responds to touch, breathing is independent but irregular (slow), arms and legs have a bluish tint, and cardiac activity is not affected.

The doctor uses a special probe to remove mucus from the baby’s mouth and nasal passages (this is where any assistance to a newborn in the delivery room begins), then pats the baby’s heels, runs his fingers along the back along the spine (this is called tactile stimulation) and gives oxygen through a mask. Usually this is enough.

A child born in a state of moderate asphyxia does not have any problems in the future. Only minor neurological changes are possible: tremor of the arms, legs, lower jaw, increased muscle tone. But these changes do not require treatment and go away on their own.

Moderate asphyxia

Asphyxia of moderate severity is also characterized by the absence of a cry, but the child does not respond to touch, the skin has a bluish tint, breathing movements are sporadic, but cardiac activity is also not yet affected.

In addition to the listed measures, such a baby requires artificial ventilation of the lungs, usually manually using a special bag and mask, and in some cases, short-term breathing with a device through an endotracheal tube, which is inserted into the child’s trachea.

Asphyxia of moderate severity always leaves neurological changes in the form of increased excitability of the child (unreasonable screaming, prolonged tremor of the arms, legs, lower jaw) or depression (few movements, sluggish sucking).

Such children require further treatment in the neonatal pathology department, but the prognosis for their further development is usually favorable, although the development of neurological disorders and mild delays in neuropsychic development are possible.

Severe asphyxia

Severe asphyxia is characterized by the absence of breathing at birth, the baby is cyanotic or pale, does not respond to touch, the number of heartbeats is slow (bradycardia), in the most severe cases, heart sounds may be completely absent. Such children require full resuscitation measures.

The child undergoes tracheal intubation, a machine breathes for the baby through the endotracheal tube, and medications are injected into the umbilical cord vein to stimulate cardiac activity. Such children are on mechanical breathing for a long time, they develop severe neurological disorders, including seizures.

Babies require long-term intensive treatment in the neonatal intensive care unit, and then in the neonatal pathology department. The prognosis for such children is serious. In most cases, persistent neurological disorders remain, and there is a delay in neuropsychic development.

Obstetricians are involved in the prevention of newborn asphyxia. During pregnancy, heart sounds are recorded and an ultrasound of the fetus is performed in order to detect abnormalities in time.

During childbirth, fetal heart sounds are also recorded, and the doctor listens to them with the ear. If a change in heart sounds occurs, the doctor decides to complete the birth as quickly as possible, either by cesarean section, or, if this is not possible, by applying a vacuum extractor.

All this is done to ensure that the baby suffers as little as possible from lack of oxygen.

And of course, the mother herself should not forget that pregnancy is a very important time. And the baby’s health directly depends on her lifestyle, nutrition and health!

Mild severity of asphyxia:

The baby takes his first breath in the first minute;
Apgar score of the newborn is 6 – 7 points;
weakened breathing;
decreased muscle tone;
cyanosis (blueness) of the nasolabial triangle.

Average severity of asphyxia:

According to Apgar, the child’s condition is assessed at 4 – 5 points;
breathing is very weakened, possibly irregular;
the child's cry is greatly weakened;
decrease in all reflexes;
cyanosis (blueness) of the skin not only of the face, but also of the hands and feet;
bradycardia (decreased heart rate) 90–160 beats/min.

Severe form of asphyxia (so-called “pale” asphyxia):

the child’s Apgar condition is 1 – 3 points for more than five minutes;
breathing is spontaneous (individual breaths) or absent altogether;
a newborn does not cry. Pulse less than one hundred beats per minute. Arrhythmia. Deafness of heart sounds;
muscle tone is sharply reduced, up to atony (lack of muscle tone);
no reflexes;
pale skin;
lack of pulsation of the umbilical cord;
possible:
- complications from the central nervous system - ischemic encephalopathy, convulsions, cerebral edema;
- homeostasis disorders - decompensated acidosis and hypoglycemia, disseminated intravascular coagulation syndrome. Immunodeficiency occurs.

Forms

Depending on when asphyxia occurs, there are two types:

primary (occurs at the birth of a child);
secondary (develops within 24 hours after birth).

Depending on the severity there are:

mild asphyxia;
moderate asphyxia;
severe asphyxia.

Treatment of newborn asphyxia

The doctor determines the need for resuscitation measures - the child’s condition is assessed immediately after birth.
Ensure free passage of the respiratory tract (mucus and amniotic fluid, or meconium, are suctioned from the child’s mouth and nose) and adequate breathing.
Adequate cardiac activity is restored. If necessary, medications are administered (they are used in the absence of cardiac activity or bradycardia below 80 beats per minute, if chest compressions and artificial ventilation with 100% oxygen for 30 seconds have no effect).

Complications and consequences

The brain reacts most acutely to a lack of oxygen.

Even with short-term hypoxia, changes in the central nervous system are reversible. They appear:

circulatory disorders (dilation of blood vessels and their overflow with blood, increased permeability of the vascular wall) and hemorrhages;
subsequently – necrosis of parts of the brain.

For mild to moderate asphyxia, the prognosis is favorable.

In severe asphyxia, 60% of full-term infants and 50–100% of very low birth weight newborns die during childbirth or the first week of life.
Survivors often experience mental and physical developmental disorders, as well as chronic pneumonia.

Prevention of newborn asphyxia

Regular visits (once a month in the 1st trimester, once every 2-3 weeks in the 2nd trimester and once every 7-10 days in the 3rd trimester).
Timely registration of a pregnant woman at the antenatal clinic (up to 12 weeks of pregnancy).
Pregnancy planning and timely preparation for it (detection and treatment of chronic and gynecological diseases before pregnancy).
Timely detection and treatment of complications during pregnancy (, etc.).
The correct lifestyle of a pregnant woman: daily routine, walks, taking vitamin and mineral complexes, maintaining inner peace, regular exercises for pregnant women.

Additionally

The Apgar score is a way to assess the health of a newborn. At the first and then the fifth minutes of life, and in case of problems also at the 10th, the child is examined by a neonatologist.

5 criteria:

color of the skin;
heartbeat;
reflex excitability;
muscle tone;
breath.

The maximum is two points, that is, the score on this scale cannot be higher than 10.

For 9 months, parents eagerly await the birth of a little miracle. During this time, expectant mother and father experience diverse feelings: joy and anxiety, happiness and fear. The birth of a baby is the happiest moment in their life, which is often overshadowed by the news that the newborn has some health problems. For example, the child may experience asphyxia. Many mothers and fathers begin to get very nervous about this.

In most cases, the experiences turn out to be too strong, because parents do not know what is happening to their child at this time and how modern medicine copes with such situations.

Asphyxia of newborns is understood as a pathological condition of newborn children, in which breathing is impaired and oxygen deficiency develops. This dangerous and serious condition can occur both during childbirth and after it in the first days of the baby’s life.

Asphyxia cannot occur in a baby without a specific reason, but before talking about them, it is worth paying attention to the types of this pathological condition of the child. Asphyxia is classified into primary and secondary. First view occurs in the fetus during childbirth. Chronic or acute intrauterine hypoxia causes this pathological condition. Asphyxia can also occur due to:

intracranial injury to the baby received during childbirth;
fetal malformations that affect breathing and cause difficulty;
immunological incompatibility of the child and mother;
blockage of the baby's respiratory tract with mucus or amniotic fluid.

The causes of primary asphyxia in a child may be the presence of extragenital diseases in the mother. For example, the fetus may suffer due to the fact that a pregnant woman has diseases of the cardiovascular system, diabetes, or iron deficiency anemia. The child may also experience asphyxia if the expectant mother suffers from (late toxicosis), which is accompanied by high blood pressure and swelling of the extremities.

Quite often, the causes of asphyxia in newborns lie in the pathological structure of the placenta, umbilical cord, and fetal membranes. Risk factors include premature rupture of amniotic fluid, premature birth, and improper insertion of the fetal head during labor.

Secondary asphyxia occurs in a child several hours or days after birth. Its reasons may be:

heart defects;
cerebrovascular accident in a child;
damage to the central nervous system.

The most common cause of secondary asphyxia is pneumopathy (disseminated and polysegmental atelectasis, hemorrhages in the lungs, edematous-hemorrhagic syndrome, hyaline membranes). They occur in the prenatal period or during childbirth and are accompanied by the development of respiratory distress syndrome.

What happens in the body of newborns during asphyxia?

With this pathological condition, the newborn begins to change metabolic processes in the body, the severity of which depends on the degree of intensity of asphyxia and its duration.

At acute asphyxia , developing against the background of chronic, hypovolemia is observed. This term refers to a decrease in circulating blood volume. It becomes thicker and more viscous.

In the brain, heart, liver, kidneys, there may be hemorrhages and swelling that occur due to lack of oxygen. Hypoxia of the fetus and asphyxia of the newborn leads to a decrease in blood pressure. The number of heart contractions decreases significantly. The urinary function of the kidneys is impaired.

Signs of asphyxia in newborns

Doctors detect this pathological condition in children in the first seconds of life. The frequency and adequacy of breathing, skin color, indicators of muscle tone, heartbeat, and reflex excitability are assessed.

The main sign of asphyxia in a child is breathing disorder, leading to serious changes in the body. Immediately after the baby is born, doctors conduct a thorough examination. His condition is assessed using the Apgar score.

The following forms of asphyxia are distinguished:

light;
average;
heavy;
clinical death.

At mild form Asphyxia, the baby’s condition on the Apgar scale is estimated at 6–7 points. The baby takes its first breath within the first minute after birth. However, his breathing is weakened, muscle tone is reduced, and the nasolabial triangle has a bluish tint.

At average shape asphyxia, the assessment of the baby’s condition is 4–5 points. The child, as with mild asphyxia, will inhale within the first 60 seconds. His breathing will be weakened (irregular or regular). The baby may experience tachycardia, extinction of reflexes, decreased muscle tone, and bradycardia. The skin of the face, hands and feet will have a bright bluish tint.

The child's condition severe form asphyxia is estimated at 1–3 points. Breathing is characterized by an irregular nature. It may be absent altogether. The baby does not scream, but only moans sometimes. The heart rate is slow and reflexes are absent. Muscle atony or hypotension is also observed. The skin is characterized by a pale tint. The umbilical cord does not pulsate. Quite often, with such a severity of asphyxia, a newborn develops adrenal insufficiency.

At clinical death Doctors give the child's condition a zero rating on the Apgar scale. To save the baby’s life, specialists immediately begin to carry out a set of resuscitation measures.

It is worth noting that asphyxia is detected not only by external examination and assessment of the baby’s condition on the Apgar scale. A study of the acid-base state of the blood confirms the diagnosis. Using ultrasound of the brain and neurological research methods, it is possible to determine damage to the central nervous system (extensive subdural, subarchanoid, intraventricular hemorrhages, etc.).

Treatment of acute asphyxia

All babies born with this pathological condition require intensive care. Doctors carry out certain activities in the delivery room in the first minutes of the baby’s life, carefully monitoring the main vital parameters:

heart rate;
frequency and depth of inhalations and exhalations;
hematocrit.

Based on these indications, medical professionals evaluate the effectiveness of the measures taken and adjust them if necessary.

What actions do doctors perform at the birth of a child? First of all, when the head is born, the doctor will examine the nasal and oral cavity inserts a special probe . With its help, residual mucus and amniotic fluid are removed from the upper respiratory tract.

Once the baby is completely removed from the birth canal, doctors will cut the umbilical cord. The baby will be placed on the resuscitation table and the contents of the nasopharynx and stomach will be aspirated again.

After the child’s cardiac and respiratory activity has been restored will be transferred to the intensive care unit . The doctors' actions will not end there. Further measures by medical workers will be aimed at eliminating the consequences of newborn asphyxia: restoring metabolic processes, eliminating cerebral edema, and normalizing kidney function.

Caring for a child after asphyxia

After suffering from asphyxia, a baby requires special medical care. The child needs to be provided with complete rest. Its head should be in an elevated position. Oxygen therapy plays an important role.

Babies after a mild form of asphyxia should be in a special tent with a high oxygen content inside it. There is no specific period of stay in it. One child needs to stay in a tent for several hours, while another needs to stay in a tent for several days. The length of stay in the oxygen tent is determined by the doctor after assessing the child’s condition.

A newborn who has suffered severe or moderate asphyxia is placed in an incubator. Oxygen is supplied there. Inside the incubator, the concentration of this chemical element should be about 40%. Some maternity hospitals may not have the necessary equipment. In this case, special nasal cannulas or breathing masks are used. Oxygen is supplied through them.

A newborn child after asphyxia must be monitored. It is necessary to monitor body temperature, bowel function, and diuresis. Quite often, repeated cleaning of the respiratory tract from mucus and other contents is required.

The first feeding of a baby who has suffered a mild or moderate form of asphyxia is performed 16 hours after birth. Children experiencing severe asphyxia are fed one day after birth using a special tube. The question of when to put a baby to the breast after asphyxia interests many mothers. There is no specific answer to this. The time to start breastfeeding is determined individually depending on the condition of the baby.

What to do after discharge from the maternity hospital?

After discharge from the maternity hospital, the baby should remain under the dispensary supervision of a neurologist and pediatrician. The purpose of medical supervision is to prevent the occurrence of complications from the central nervous system.

Doctors' prognosis depends on the following factors:

severity of the pathological condition;
timely start of treatment;
adequacy of medical measures.

If the baby was born with asphyxia, then the prognosis is directly dependent on the secondary assessment of his condition, which is performed on the Apgar scale 5 minutes after birth. The forecast will be favorable if the second estimate is higher than the first.

During the first years of life, the following consequences of asphyxia in newborns may be observed:

hydrocephalic syndrome;
diencephalic disorders;
convulsive syndrome;
hypo- and hyperexcitability.

The above complications most often occur after severe asphyxia. To prevent their occurrence, medical supervision by doctors is necessary.

Measures to prevent asphyxia in newborns

Asphyxia can cause quite serious health problems. You may not encounter this pathological condition at all if you perform certain actions aimed at preventing asphyxia. They don't always help, but despite this you shouldn't give them up. In 40% of cases they give a positive result.

It was already mentioned above that the cause of asphyxia can be intrauterine hypoxia. It can be avoided by visiting your doctor regularly.

During an “interesting situation” you need to identify all the risk factors:

infectious and somatic diseases (acute respiratory diseases, flu, colds);
age of the fair sex;
disruption of the endocrine system;
changes in a woman’s hormonal levels;
the presence of situations in life that cause stress;
bad habits (alcohol, smoking).

We should not forget about intrauterine monitoring of the condition of the placenta and fetus. It is very important, since thanks to it it is possible to identify various violations in a timely manner. Based on the condition of the placenta, you can determine whether the fetus is oxygen starved or not. A danger signal is the presence of meconium in the amniotic fluid. At the first suspicion of hypoxia, it is necessary to begin appropriate therapy as quickly as possible.

All of the above is confirmation that it is necessary to regularly visit a gynecologist. This should never be neglected, because the baby’s health and life are at risk.

A woman’s correct lifestyle plays an important role in the prevention of hypoxia and asphyxia of the fetus and newborn. The expectant mother should follow a few simple rules:

Walk more. A pregnant woman should spend more free time outdoors. Her blood is saturated with oxygen, which is then transported to the fetus. The child needs this element. It needs oxygen for proper development and growth.

Some women believe that walks are only useful if they take place not in the city, but outside it. This point of view is incorrect. You can take a walk in the city at any time of the year in the nearest park or square.

Maintain a daily routine. A pregnant woman should forget about the previous “crazy rhythm of life” when she sat at the computer at night, went to bed late, woke up early in the morning and went to work. Now you need to sleep at least 9 hours at night and it is recommended to find a couple of hours to sleep during the day.

Take vitamin and mineral complexes. A pregnant woman and her baby, who is still in her tummy, need vitamins and nutrients. Unfortunately, the quality of modern products does not allow us to obtain all the necessary minerals and trace elements. Special preparations – vitamin-mineral complexes – serve as a “lifesaver”.

With their help, you can meet the needs of mother and child. However, the drug must be prescribed by a gynecologist. You should not make decisions on your own, because some people do not need vitamins and minerals, and their excess can harm both mother and child.

Maintaining peace of mind and positive mood. Pregnancy is an unforgettable period in a woman’s life. It is associated not only with joyful moments, but also with experiences and stress. The expectant mother needs to worry less. All worries and worries can be easily dealt with. You just need to learn how to do it.

Pregnant women are advised to eliminate negative emotions from their lives. Dreaming about the future will help maintain a positive attitude and peace of mind. You can bring bright colors into your life by watching good comedies, reading funny books, and communicating with positive people.

In conclusion, it is worth noting that asphyxia is a serious pathological condition, but there is no need to worry if it affects your children. Thanks to modern devices, doctors will quickly notice that something is wrong and take the necessary measures that will protect newborns from the consequences of asphyxia and save their lives.

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A diagnosis such as asphyxia occurs with alarming frequency. Children are born with signs of hypoxia, do not breathe on their own, or their breathing is weakened. At this moment, determination and professionalism are required from doctors, and faith in the best from mothers. What is happening at these moments? How to care for your baby in the future? How to avoid complications?

Asphyxia is a pathological condition of a newborn that requires immediate medical intervention.

What is newborn asphyxia?

Asphyxia of newborns is a pathology in which gas exchange in the child’s body is disrupted. This condition is accompanied by an acute deficiency of oxygen and an excess of carbon dioxide. When there is a lack of air, the child is able to make only infrequent and weak attempts to breathe or does not breathe at all. In this condition, the child is immediately subjected to resuscitation.

According to the severity, asphyxia is divided into mild, moderate and severe, and clinical death is distinguished separately. Let's look at what symptoms they are characterized by.

Severity of asphyxia	Apgar scores	Breathing Features	Skin color	Heart rate	Muscle tone	Manifestation of reflexes	Additional symptoms
Lightweight	6 - 7	Weakened, but the baby can breathe on his own	Blueness of lips and nose	Normally – over 100	Demoted	No deviations	After 5 minutes the child’s condition improves independently
Moderate (average)	4 - 5	Weak with impairments	Blue	Below 100	Dystonia with hypertonicity	Reduced or increased	Tremors of the arms, legs and chin
Heavy	1 - 3	Rare breaths or no breaths at all	Pale	Below 100, in most cases below 80	Much reduced	Not observed	The child does not cry, there is no pulsation in the umbilical cord. Possible cerebral edema.
Clinical death	0	There's no breathing	Pale	None	Absent	Not visible	None

Intrauterine and postpartum asphyxia and its causes

Like any disease, newborn asphyxia has causes. Why does a lack of oxygen occur? First, let's look at the types of this condition. Asphyxia can be primary or secondary.

Primary (intrauterine) is a pathological condition that is diagnosed at the time of birth. It is caused by acute or chronic intrauterine lack of oxygen (hypoxia). Causes of intrauterine asphyxia also include:

trauma to the newborn's skull;
developmental pathologies during gestation;
Rhesus conflict;
blockage of the airways with mucus or amniotic fluid.

Another reason for the occurrence of intrauterine pathologies is the presence of serious diseases in the expectant mother. The condition of the newborn may be affected by the pregnant woman's history of heart problems, kidney problems, diabetes mellitus or iron deficiency. The occurrence of oxygen deficiency is possible against the background of late toxicosis, in which a woman’s legs swell and her blood pressure rises.

Often, asphyxia during childbirth occurs due to the abnormal structure of the placenta and amniotic membranes. Particular attention should be paid if the pregnant woman's history indicates early placental abruption and premature rupture of water.

Secondary asphyxia occurs some time after birth due to:

heart problems in a child;
CNS disorders;
improper cerebral circulation in a newborn;
pathologies in intrauterine development and during labor that affect the respiratory system.

Consequences of asphyxia of the fetus and newborn

Consequences of newborn asphyxia almost always occur. The lack of oxygen in the baby during or after childbirth in one way or another affects the child’s organs and systems. The greatest trace is left by severe asphyxia, which is associated with multiple organ failure.

How much asphyxia will affect the child’s future life depends on the Apgar score. If at 5 minutes of life the general condition of the newborn has improved, then the chances of a successful outcome increase.

The severity of the consequences and prognosis depend on how well and timely medical care was provided by doctors during a period of serious illness. The faster treatment was prescribed and the better resuscitation measures were carried out, the less serious complications should be expected. Particular attention should be paid to newborns with severe asphyxia or those who have experienced clinical death.

The consequences of asphyxia can be very severe, so doctors carry out emergency resuscitation measures

with hypoxia or asphyxia, which is assigned degree 1, the child’s condition is absolutely no different from a healthy baby, increased drowsiness is possible;
in the second degree, a third of children are diagnosed with neurological disorders;
in the third degree, half of the newborns do not survive to 7 days, and the remaining half have a high probability of severe neurological diseases (mental development disorders, seizures, etc.).

Do not despair when making a diagnosis such as asphyxia. It's been happening quite often lately. The main property of a child’s body is that it can repair itself. Do not neglect the advice of doctors and maintain a positive attitude.

How is asphyxia diagnosed?

Primary asphyxia is detected by visual examination of doctors present at birth. In addition to the Apgar assessment, laboratory blood tests are prescribed. The pathological condition is confirmed by test results.

Carrying out an ultrasound examination of the brain

The newborn should be sent for examination by a neurologist and have an ultrasound scan of the brain - this will help determine whether the baby has damage to the nervous system (more details in the article:). Using such methods, the nature of asphyxia is determined, which is divided into hypoxic and traumatic. If the lesion is associated with a lack of oxygen in the womb, then the newborn experiences neuro-reflex excitability.

If asphyxia occurs due to injury, then vascular shock and vasospasm are detected. The diagnosis depends on the presence of seizures, skin color, excitability and other factors.

First aid and treatment features

Regardless of what causes asphyxia in a child, treatment is carried out on absolutely all children from the moment of birth. If signs of a lack of oxygen are observed during contractions or pushing, then emergency delivery by cesarean section is performed immediately. Further resuscitation actions include:

cleansing the respiratory tract of blood, mucus, water and other components that impede the flow of oxygen;
restoring normal breathing by administering medications;
maintaining the normal functioning of the circulatory system;
warming a newborn;
control of intracranial pressure.

During resuscitation measures, constant monitoring is carried out over the heart rate, respiratory rate and other vital signs of the newborn.

If the heart beats less than 80 times per minute, and independent breathing does not improve, then the baby is immediately given medication. The increase in vital signs occurs gradually. Adrenaline is used first. If there is heavy blood loss, a sodium solution is needed. If after this breathing does not return to normal, then a second injection of adrenaline is given.

Rehabilitation and child care

After the acute condition is relieved, control over the newborn's breathing should not be weakened. Further care and treatment of newborn asphyxia takes place under the constant supervision of doctors. The baby needs absolute peace. The head should always be raised.

Oxygen therapy is of no small importance. After mild asphyxia, it is important to prevent the child from being deprived of oxygen again. The baby needs increased amounts of oxygen. For this purpose, some maternity hospitals are equipped with special boxes, inside of which an increased concentration of oxygen is maintained. As prescribed by a neonatologist and neurologist, the baby should spend from several hours to several days in it.

If the child has suffered asphyxia in more severe forms, then after resuscitation measures he is placed in special incubators. This equipment is capable of providing oxygen in the required concentration. The concentration is prescribed by doctors (usually at least 40%). If such a device is not available in the maternity hospital, then oxygen masks or special inserts for the nose are used.

After asphyxia, the child must be registered with a pediatrician and neurologist

When caring for a baby after asphyxia, regular monitoring of his condition is necessary. It is important to monitor body temperature, the functioning of the intestines and the genitourinary system. In some cases, it is necessary to clear the airways again.

If the newborn has suffered a lack of oxygen, then he is fed for the first time no earlier than 15-17 hours after birth. Children with severe asphyxia are fed through a feeding tube. The time when you can start breastfeeding is determined by the doctor, since the condition of each child is individual, and the time to start breastfeeding directly depends on the general condition of the baby.

After rehabilitation and discharge home, the newborn must be registered with a pediatrician and neurologist. Timely diagnosis will help prevent negative consequences and complications.

The baby is prescribed gymnastics, massage and medications that improve blood circulation and reduce intracranial pressure.

During the first 5 years of life, the child may experience seizures and hyperexcitability (see also:). You should not neglect medical recommendations and ignore health-improving activities. General restorative massage and other procedures should be carried out only by a specialist. In the future, parents can master the basic techniques on their own. The lack of general strengthening measures can affect the mental development and behavior of the child.

Children who have suffered asphyxia should not introduce complementary foods too early. Until the age of 8-10 months, the child should be fed with adapted infant formula or breast milk. Parents should closely monitor their child and strengthen him. You should discuss with your pediatrician the need for vitamin therapy.

It is very important to continue breastfeeding for as long as possible

Prevention of asphyxia

It is easier to prevent any disease than to treat it and fear complications. Measures to prevent asphyxia are very simple. Of course, prevention does not provide an absolute guarantee of the absence of breathing problems in the future, but in approximately 40% of cases a positive effect is observed.

The most important thing is medical supervision of pregnancy. A woman must register and undergo timely examinations. All risk factors must be identified and eliminated. These include:

infection during pregnancy;
malfunction of the thyroid gland;
hormonal imbalance;
severe stress;
age over 35 years;
bad habits (drug addiction, smoking, alcoholism).

The timing of fetal screening tests cannot be ignored. Ultrasound readings may indicate problems. Based on the condition of the placenta and amniotic fluid, the doctor can determine the development of hypoxia and prevent it in a timely manner. When the first signals of danger appear, urgent measures must be taken and the necessary therapy carried out.

You should not skip scheduled visits to the gynecologist and ignore medical recommendations. With her neglect, the expectant mother endangers not only her health, but also the condition of the fetus and its life.

When preventing oxygen starvation, the lifestyle of the expectant mother has a significant influence. Doctors recommend following these rules:

Walks. For normal oxygen supply to the fetus, a pregnant woman must spend a sufficiently long time outdoors. Ideally, walks are held in a park or public garden. Within a few hours outside, the mother’s body is saturated with oxygen, which is supplied to the fetus. Oxygen has a positive effect on the proper formation of the organs of the future person.
Schedule. For a woman carrying a child, the correct daily routine should become law. Getting up early, watching movies at night and the frantic rhythm of the day are not for her. You need to leave all the turmoil in the past and try to rest more. Night sleep should be at least 8-9 hours, and at least 1-2 hours should be devoted to it during the day.
Taking vitamins and minerals. Even if a woman’s diet consists of the highest quality and healthiest foods, taking vitamins is still necessary. Unfortunately, modern products do not contain the amount of useful substances that are necessary for women and children. That is why every pregnant woman should take vitamin complexes that can meet her needs and the needs of the child. The choice of vitamin and mineral complex is carried out independently or together with a gynecologist. The most popular are Femibion and Elevit Pronatal (we recommend reading:).
You can't lift weights.
It is important to maintain inner peace and a positive attitude.