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

Currently, asphyxia of a newborn is understood as a condition when, in the presence of a heartbeat, there is no breathing or there are individual convulsive, irregular, shallow breaths.

Asphyxia is divided into:

1) fetal asphyxia , which is divided into antenatal and intranatal;

2) asphyxia of a newborn .

At the core intrauterine asphyxia is a circulatory disorder, and the basis asphyxia of a newborn– breathing disorders, which are often a consequence of intrauterine circulatory disorders.

Newborn asphyxia is also divided into on primary when the newborn baby does not breathe independently after ligation of the umbilical cord, and secondary– occurring in the subsequent hours and days of the newborn’s life.

There are 5 leading mechanisms leading to acute asphyxia of newborns:

1) interruption of blood flow through the umbilical cord ( true umbilical cord knots, its depression, tight entanglement of the umbilical cord around the neck or other parts of the child’s body);

2) disturbance of gas exchange through the placenta ( premature complete or incomplete placental abruption, placenta previa, etc.);

3) circulatory disorders in the maternal part of the placenta ( excessively active contractions, arterial hypotension or hypertension of any etiology in the mother);

4) deterioration in oxygen saturation of the mother’s blood ( anemia, cardiovascular diseases, respiratory failure);

5) insufficiency of extrauterine respiratory movements of the newborn ( the influence of drug therapy on the mother, antenatal brain damage to the fetus, congenital malformations of the lungs, etc.).

Secondary hypoxia can develop as a result of aspiration, pneumopathy, birth injury of the brain and spinal cord, congenital defects of the heart, lungs, and brain.

Therefore, asphyxia- this is suffocation, an acute pathological process caused by various reasons, which are based on a lack of oxygen in the blood (hypoxemia) and tissues (hypoxia) and the accumulation of carbon dioxide (hypercapnia) and other acidic metabolic products in the body, which leads to the development of metabolic acidosis . Under-oxidized metabolic products circulating in the blood inhibit biochemical processes in cells and cause tissue hypoxia; body cells lose their ability to absorb oxygen. Pathological acidosis increases the permeability of the vascular wall and cell membranes, which entails circulatory disorders, impaired blood clotting processes, and hemorrhages in various organs.

The vessels lose their tone and become overfilled with blood, the liquid part of the blood leaks into the surrounding tissues, edema and dystrophic changes develop in the cells of all organs and systems.

Asphyxia of newborns - Clinic.

The main clinical sign of asphyxia– disturbance or lack of breathing. The degree of asphyxia is determined using the Apgar scale. According to the International Classification of Diseases, IX revision (Geneva 1980) distinguish asphyxia: moderate (moderate) and severe.

In case of moderate severity of asphyxia the total Apgar score at 1 minute is 4-6 points, but by the 5th minute it usually reaches values ​​typical for healthy children (8-10 points).

severe asphyxia diagnosed in a child who has an Apgar score of 0-3 points 1 minute after birth and less than 7 points after 5 minutes.

The Apgar score is assessed at the end of the 1st and 5th minute after birth. If after 5 minutes the total score has not reached 7 points, it must be performed further every 5 minutes until normalization or for 20 minutes.

Apgar score

Asphyxia of newborns - Treatment.

Asphyxia is a critical condition that requires emergency resuscitation measures. The need for these measures is judged by the presence of signs of a live birth in the child:

1. Independent breathing.
2. Heartbeat.
3. Pulsation of the umbilical cord.
4. active movements.

If all 4 signs of a live birth are absent, the child is considered stillborn and cannot be resuscitated. If there is at least 1 sign, resuscitation assistance must be provided.

Removal from asphyxia requires the use of generally accepted resuscitation principles, formulated by P. Safar (1980) as ABS resuscitation, where: A – airway – release, maintaining free patency of the airways; B - breath - breathing, providing ventilation - artificial (IVL) or auxiliary (AVL); C - cordial circulation restoration or maintenance of cardiac activity and hemodynamics.

In or near the delivery room, a “resuscitation island”, which consists of several blocks, must be ready to assist a newborn around the clock:

1) environmental optimization and temperature protection unit - heated table, radiant heat source, sterile warm diapers;

2) block for restoring airway patency - electric suction, rubber bulbs, oral air ducts, endotracheal tubes, children's laryngoscope;

3) oxygen therapy unit - a source of compressed air, a unit for humidifying and heating the air-oxygen mixture, a set of connecting tubes and devices for introducing oxygen;

4) artificial lung ventilation unit (Ambu-type breathing bag, devices for automatic ventilation of the lungs);

5) drug therapy unit - disposable syringes, gloves, sets of medications, sets of catheters for the umbilical vein;

6) vital activity control unit - cardiac monitor, blood pressure measuring device, stopwatch, phonendoscope.

The algorithm for primary care for a newborn born with asphyxia includes several stages.

I stage of resuscitation begins with suction of the contents of the oral cavity with a catheter at the time of birth of the head or immediately after the birth of the child. If, after suctioning from the oropharynx, the child is not breathing, gentle but active tactile stimulation should be performed - click the child on the sole or vigorously wipe his back. The child is received in sterile heated diapers and quickly transferred to a resuscitation table under a radiant heat source. When laying down, the baby's head should be slightly lowered (about 15°).

Amniotic fluid, mucus, and sometimes maternal blood from the baby’s skin are wiped with a warm diaper. In case of severe asphyxia and the presence of meconium in the amniotic fluid or oropharynx, immediate intubation is performed, followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby is separated after 1 minute. At the end of the first stage of resuscitation, the duration of which should not exceed 20-2 5 seconds, the child’s breathing is assessed. With adequate breathing, heart rate above 100 per minute and slight acrocyanosis of the skin, resuscitation measures are stopped, and the child is monitored. If possible, we should strive to start feeding the baby with mother's milk as early as possible.

If the heart rate is less than 100 per minute, then go to Stage II of resuscitation whose task is to restore external respiration. Activities begin with ventilation of the lungs using a mask and breathing bag. The respiratory rate is 30-50 per minute. More often, a 60% oxygen-air mixture is used (40% for premature babies). Good chest excursions indicate sufficient ventilation of the alveoli, as well as the absence of serious airway obstructions. Ineffectiveness of bag and mask ventilation, suspicion of meconium aspiration, count less than 80 and the need for external cardiac massage and long-term respiratory support are indications for endotracheal intubation.

Simultaneously with mechanical ventilation, breathing is stimulated by intravenous administration of nalorphine or etimizol. 20-30 seconds after the start of mechanical ventilation, it is necessary to calculate the frequency of cardiac contractions; if it is in the range of 80-100 per minute, mechanical ventilation is continued until the frequency increases to 100 per minute.

If the heart rate is less than 80 per minute, then switch to III stage of resuscitation. It is urgent to begin external cardiac massage against the background of mechanical ventilation with a mask with 100% oxygen concentration. If there is no effect within 20-30 seconds of massage, intubate and start mechanical ventilation in combination with massage. Press on the lower third of the sternum (but not on the xiphoid process due to the risk of liver rupture) strictly downward by 1.5-2.0 cm with a frequency of 100-140 times per minute.

The effectiveness of chest compressions should be assessed by the color of the skin and the pulse in the femoral artery.

If there is no effect within 60 seconds of cardiac massage, then cardiac activity should be stimulated with adrenaline, which is administered at a dose of 0.1 ml/kg body weight of a 0.01% solution either endotracheally or into the umbilical cord vein. Administration can be repeated after 5 minutes (up to 3 times). At the same time, mechanical ventilation and indirect cardiac massage are continued. Then the color of the skin and the state of microcirculation are assessed. According to indications, infusion therapy is carried out (albumin, native plasma, isotonic sodium chloride solution). If planned infusion therapy is necessary, it begins 40-50 minutes after birth. It is very important to remember that the pace of infusion therapy is much more important than the volume. All children born with asphyxia in the delivery room are given vitamin K. In the case of a very serious condition, after initial resuscitation and slow recovery of vital functions, transfer to the neonatal intensive care unit of a children's hospital is advisable.

If within 15-20 minutes the child does not begin to breathe independently and has persistent bradycardia, then there is a high probability of severe brain damage, and it is necessary to decide on stopping resuscitation measures.

Asphyxia of newborns - Complications.

There are two groups of complications– early, developing in the first hours and days of life, late – from the end of the first week of life and later.

Among the early complications, in addition to brain damage (edema, intracranial hemorrhage, necrosis, etc.), hemodynamic (pulmonary hypertension, heart failure), renal, pulmonary, gastrointestinal, hemorrhagic (anemia, thrombocytopenia, disseminated intravascular coagulation syndrome) are especially common. Late complications are dominated by infectious (pneumonia, meningitis, sepsis) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy).

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 pulsates. 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. In the lungs, atelectasis and often hyaline membranes are found. 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.

is a pathology of the early neonatal period, caused by respiratory failure and the development of hypoxia in the newborn child. Asphyxia of a newborn is clinically manifested by the absence of spontaneous breathing of the child in the first minute after birth or the presence of isolated, superficial or convulsive irregular respiratory movements with intact cardiac activity. Newborns with asphyxia require resuscitation measures. The prognosis for asphyxia of a newborn depends on the severity of the pathology, the timeliness and completeness of the provision of therapeutic measures.

The woman herself should engage in prevention by giving up bad habits, following a rational regimen, and following the instructions of the obstetrician-gynecologist. Prevention of asphyxia of a newborn during childbirth requires the provision of competent obstetric care, prevention of fetal hypoxia during childbirth, and release of the child’s upper respiratory tract immediately after birth.

Asphyxia of newborns is a special type of pathology during childbirth, in which the access of oxygen through the umbilical cord is completely blocked while the baby passes through the birth canal. In this case, the child can be born in serious condition or die during childbirth in just a few minutes. This is caused by sudden disturbances in metabolic processes and acute hypoxia of vital organs - the heart and brain.

Up to 5% of children can be born in a state of asphyxia; the degree of its severity depends on the duration of the period of suffocation, changes in gas exchange, and how much carbon dioxide has accumulated in the tissues. Asphyxia can be in utero, during childbirth, and after birth, on the first day, secondary. It is one of the main causes of death of children in childbirth.

Asphyxia will be the result of an unfavorable course of pregnancy and childbirth, pathologies of both the mother and the fetus. A baby may be born in asphyxia due to acute or chronic fetal hypoxia as a result of congenital infections (syphilis, rubella, herpes, chlamydial and other infections), in the presence of intracranial injuries, developmental defects, in the presence of Rh-conflict or blood group, if amniotic fluid into the respiratory tract, if the baby takes the first breath before birth, when the umbilical cord is clamped during childbirth (loops fell out, breech presentation). Asphyxia threatens the fetus during placental abruption during childbirth, during postterm pregnancy, or late gestosis.

A secondary process occurs when the lungs are damaged (failure to expand, pulmonary edema) after childbirth or disruption of brain function (hemorrhage, damage).

The stronger and longer the hypoxia was, the more severe the asphyxia will be; internal organs, the brain, and blood circulation will suffer. Severe hypoxia leads to decreased blood pressure and death.

Symptoms

First of all, asphyxia is manifested by the absence of breathing at birth, which leads to impaired circulation, decreased muscle tone and the disappearance of reflexes. Asphyxia is recorded on the Apgar scale immediately after birth, while the presence of scores from 5 to 7 indicates a slight degree of fetal hypoxia, with 4-5 points of severe hypoxia, and with a decrease in scores to 3-1, birth is indicated by asphyxia (suffocation). If there is a score of 0, clinical death is indicated and resuscitation measures are carried out.

At birth in asphyxia, children are cyanotic throughout the body or pale, there is no heartbeat, no first breath and no cry, no independent movements, reflexes and muscle tone. Children do not react to stimuli; there is no pulsation of the umbilical cord. This condition requires immediate measures to restore breathing.

Weaker degrees - hypoxia of newborns at birth results in the presence of heartbeat, partial cyanosis, isolated movements of the limbs, screaming after first aid and skin irritation, clearing the respiratory tract of mucus. Usually, children can be brought out of a state of asphyxia if it lasted no more than 5 minutes.

Diagnosis of asphyxia in a newborn

The basis for diagnosing asphyxia during the newborn period is an Apgar assessment immediately after birth, or registration of asphyxia in utero according to CTG data with immediate assistance. In addition to the external examination, the blood gas composition is immediately determined using a cutaneous pulse oximeter; all assessments are carried out during resuscitation. The doctor immediately listens to heart sounds and breathing with a stethoscope, immediately checks reflexes and visually the color of the skin, their reaction to resuscitation.

Immediately after removing the child from asphyxia, an additional full examination is necessary to determine the consequences. These include an examination by a neurologist and an urgent ultrasound of the head through the fontanel, determination of reflexes, and the condition of internal organs. A chest x-ray may also be indicated to evaluate the condition of the lungs.

Complications

The main complication of asphyxia is the death of the fetus during childbirth or severe damage to the brain, heart or internal organs, which can remain for life. Often such children suffer from neurological disorders, have cysts or hemorrhages in the brain, decreased tone, motor dysfunction, and developmental delays - physical or mental.

Treatment

What can you do

Asphyxia is a life-threatening condition; only a doctor can provide all measures to a newborn. If there is a threat of asphyxia during childbirth, it is important to listen carefully to the doctor and strictly follow all his instructions when to push and when to breathe.

What does a doctor do

At birth in asphyxia, immediate cutting of the umbilical cord and initiation of resuscitation measures are required. This is carried out by a neonatologist immediately in the delivery room. This includes suctioning out all the mucus from the nose and throat, respiratory tract, performing pulmonary and cardiac resuscitation if it is necessary to intubate the baby and immediately connect to a ventilator, administering the necessary medications, correcting circulatory and breathing disorders as soon as the baby begins to breathe.

After suffering from asphyxia during childbirth, the baby is immediately taken to the neonatal department, to the intensive care unit, and is given full treatment with the restoration of all organ functions. It is indicated to be on mechanical ventilation or transfer to mask breathing with oxygen, to be in an incubator with heating and oxygen supply, gastric lavage, and the introduction of special solutions into a vein in order to eliminate excess acid (CO2) and normalize the amount of oxygen. Such children remain under the control of doctors for a long time until their condition does not cause concern, they breathe normally on their own and their condition is stable.

Prevention

Childbirth is carried out under the control of CTG to detect the slightest deviations in the condition of the fetus. If there are signs of hypoxia, a cesarean section may be indicated. It is important to listen to all the doctor’s instructions during childbirth, and at the slightest doubt, agree to an emergency completion of labor through surgery. During pregnancy, constant medical supervision and monitoring of the condition of the fetus is necessary.

According to statistics, asphyxia of varying severity is diagnosed approximately in 4-6% of the total number of newborns children.

The severity of the disease depends on the extent to which the baby’s gas exchange process was disrupted during the prenatal period, that is, on the ratio of the amount of oxygen and carbon dioxide in the child’s tissues and blood cells. ABOUT consequences of asphyxia We'll talk about newborns in the article.

stages

What is asphyxia in a newborn baby? Asphyxia may be primary when the gas exchange process is disrupted in the prenatal period. This condition occurs against the background of oligohydramnios and pathological conditions during pregnancy.

Secondary asphyxia develops in the first days of a child’s life. Occurs with various types of dysfunction of the respiratory system.

This condition is considered very dangerous, as it is considered a common cause of stillbirth and mortality in children in the first days of life.

Forecast depends on the severity of the violation, but in any case, the newborn requires urgent assistance from specialists in intensive care conditions.

What happens during asphyxia?

Regardless of the reasons that led to the development of asphyxia, this condition negatively affects metabolic processes occurring in the body of a newborn. The processes of blood circulation and blood microcirculation are disrupted.

This leads to a deterioration in the nutrition of all organs and systems of the baby. It is known that for normal functioning, each organ requires nutrients and oxygen. With their deficiency, the normal development of organs and body systems is impossible.

Asphyxia can have varying degrees of severity. It depends on the duration and intensity of oxygen starvation. In the child’s body, important processes that regulate nutrition at the cellular level are disrupted, and pathologies such as acidosis, accompanied by a lack of glucose, may appear.

At the initial stage, the volume of blood in the child’s body increases; over time, when the disease becomes chronic, this volume decreases significantly. This leads to a change in the composition of the blood (an increase in the number of red blood cells, platelets), and its greater viscosity.

This condition is dangerous for the body due to the possibility of blood clots and obstruction of blood vessels.

As a result of these pathological processes, it is observed disturbance of blood microcirculation in internal organs (brain, heart, etc.). Such disorders cause swelling, minor hemorrhages, and the development of diseases and other systems.

In order to assess the general condition of the child, the severity of birth asphyxia, and the impact that this pathology has on the body, doctors conduct a special examination of the newborn (at 1 and 5 minutes of life). The results are assessed using a special table:

A healthy child without signs of asphyxia is gaining more than 8 points on the Apgar scale, if these indicators are reduced, pathology of varying severity occurs.

How to treat asthenic syndrome in children and adolescents? Find out about this from ours.

Reasons for the development of pathology

There are several groups of negative factors that can lead to the development of asphyxia.

This pathology is not considered independent, but is only a consequence of these reasons.

Fetal factors:

1. Traumatic brain injury of a newborn received during childbirth.
2. Rhesus is a conflict with the mother’s body. This phenomenon is possible if the Rhesus status of the pregnant woman is negative, and that of the child is positive. In this case, the white blood cells of the expectant mother perceive the embryo as a foreign body and try to destroy it. This leads to various kinds of pathologies.
3. Respiratory system dysfunctions.
4. Intrauterine infections.
5. premature birth.
6. Anomalies of growth and development of a child in the prenatal period.
7. Entry into the respiratory organs of amniotic fluid, mucus, feces secreted by the fetus into the amniotic fluid.
8. Developmental disorders of the heart and brain.

Mother factors:

Factors that disrupt blood circulation in the placenta:

1. Post-term pregnancy.
2. Pathology of the placenta (premature aging, abruption, presentation).
3. Entanglement of the fetus by the umbilical cord.
4. Multiple pregnancy.
5. Polyhydramnios or oligohydramnios.
6. Disturbances of the natural birth process (weakness of contractions, use of medications, cesarean section, use of general anesthesia).

To the development of secondary asphyxia The following negative factors may result:

1. Birth injuries to the fetus, leading to impaired blood circulation in the brain.
2. Cardiac pathologies.
3. Improper feeding, when mother's milk enters the newborn's nose, complicating the normal breathing process.
4. Features and pathological deviations of the structure of the lungs.

Clinical manifestations

Pathology manifests itself in different ways, depending on its severity.

Mild degree characterized by:

• slight delay in the moment of the first inhalation (inhalation occurs in the first minute of life);
• the baby's cry is slightly muffled;
• breathing is regular but weakened;
• the color of the skin in the area of ​​the nasolabial triangle is pale or bluish;
• Apgar score 6-7.

Asphyxia moderate severity manifested by such symptoms as:

• irregular, severely weakened breathing;
• the child almost does not cry;
• reduced reflexes and heart rate;
• the skin has a bluish color in the area of ​​the face, hands, and feet;
• Apgar score 4-5.

heavy asphyxia manifests itself as:

• lack of breathing (single breaths are possible at large intervals);
• lack of cry;
• a significant decrease in muscle tone, or their complete absence;
• Heart rate less than 100 beats per minute;
• there is no pulsation in the umbilical cord area;
• bluish skin color;
• Apgar score 1-3.

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Treatment

Regardless of the severity of the pathology, the child requires urgent resuscitation, aimed at restoring the functionality of organs and systems affected by oxygen deficiency.

Asphyxia mild to moderate severity eliminated in several stages:

1. It is necessary to thoroughly clean the child’s nasal passages, oral cavity, and stomach.
2. If necessary, artificial ventilation of the lungs is carried out using a special mask.
3. A 20% glucose solution is injected into the umbilical cord vein. The amount of the drug depends on the weight of the newborn.
4. If these measures were not enough, the child will need mechanical ventilation.

Treatment of severe asphyxia requires more radical measures, such as:

• mechanical ventilation;
• external cardiac massage;
• intravenous administration of glucose, prednisolone, adrenaline, calcium gluconate.

Newborn care

A newborn who has suffered asphyxia requires more careful monitoring and care. In particular, the baby needs constant oxygen support.

To do this, it is placed in special incubator or oxygen tent(with mild pathology). The newborn will also need symptomatic treatment aimed at eliminating pathologies caused by prolonged lack of oxygen.

It is necessary to resolve the issue of feeding the baby. Of course, if possible, it is best improve breastfeeding process.

However, it all depends on the condition of the newborn.

In the future, the child will need the supervision of specialists, such as pediatrician, neurologist.

Consequences and complications

Lack of oxygen, even for a short period of time, has a negative impact on state of the brain and central nervous system. This manifests itself in the form of a violation of circulatory processes, when the vessel increases in size as a result of its overfilling with blood.

This leads to the formation of blood clots and hemorrhages. If this phenomenon is observed in the brain area, necrosis (death of certain areas of the cerebral cortex) may develop.

For severe asphyxia high risk of fetal death in utero or in the first days of a child's life. Children who have suffered severe asphyxia develop mental and physical disorders.

Prevention

Think about preventive measures to reduce the risk of asphyxia, woman should be before the conception of the child. In particular, it is necessary to monitor your health, the state of your immunity, and prevent the development of chronic diseases.

During pregnancy necessary:

1. Regularly visit a gynecologist who will monitor the pregnancy and strictly follow all his instructions.
2. To refuse from bad habits.
3. Normalize your daily routine, get more rest.
4. Eat properly.
5. Be in the fresh air.
6. Provide moderate physical activity (unless contraindicated).
7. Protect yourself from infectious diseases.
8. Take medications prescribed by your doctor.
9. Provide yourself with peace of mind and positive emotions.

Asphyxia – a dangerous phenomenon that threatens the health and life of a newborn. As a result of a lack of oxygen, all organs and systems of his body suffer, because in this case, nutrition at the cellular level is disrupted.

The nervous, respiratory and cardiovascular systems are especially susceptible to negative changes. The consequences of asphyxia can be very negative, including significant retardation in mental and physical development.

ABOUT causes of asphyxia newborns in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!