Asphyxia of the newborn - complete information. Asphyxia of newborns

Asphyxia of the newborn(asphyxia neonatorum) is a pathological condition of the 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.

The reasons:

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

The occurrence of asphyxia of the newborn 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 detachment of the placenta, pathology of the umbilical cord, fetal membranes and placenta, complications in childbirth (untimely discharge of amniotic fluid, anomalies in labor, discrepancy between the size of the pelvis of the woman in labor and the fetal head, incorrect insertion of the fetal head, etc.).
Secondary asphyxia of the newborn may be associated with impaired cerebral circulation in the newborn, pneumopathy, etc.

What happens with asphyxia?

Regardless of the causes of oxygen deficiency in the body of a newborn, there is a restructuring of metabolic processes, hemodynamics and microcirculation. 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 overhydration. In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating erythrocytes.

Asphyxia of the newborn, which developed against the background of chronic fetal hypoxia, is accompanied by hypovolemia.
There is a thickening of the blood, its viscosity increases, the aggregation ability of erythrocytes 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 disturbed, which is manifested by a decrease in stroke and minute volume of the heart and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation disrupt the urinary function of the kidneys.

Symptoms:

The leading symptom of newborn asphyxia is respiratory failure, leading to changes in cardiac activity and hemodynamics, impaired neuromuscular conduction and reflexes. The severity of asphyxia of the newborn is determined by the Apgar scale.
In accordance with the International Classification of Diseases of the IX revision, moderate and severe asphyxia of the newborn is distinguished (Apgar score in the first minute after birth, respectively, 7-4 and 3-0 points). In clinical practice, it is customary to distinguish three degrees of severity of asphyxia: mild (score on a scale

Apgar in the first minute after birth - 7-6 points), moderate (5-4 points) and severe (3-1 points). A total score of 0 points indicates clinical death. With mild asphyxia, the newborn takes the first breath within the first minute after birth, but his breathing is weakened, acrocyanosis and cyanosis of the nasolabial triangle are noted, and some decrease in muscle tone. With asphyxia of moderate severity, the child takes the 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 cyanotic, sometimes mainly in areas of the face, hands and feet, the umbilical cord pulsates.

In severe asphyxia, breathing is irregular (separate breaths) or absent, the child does not scream, sometimes groans, the heartbeat is slow, in some cases it is replaced by single irregular heartbeats, muscle hypotension or atony is observed, reflexes are absent, the skin is pale as a result of peripheral vascular spasm, the umbilical cord is not pulsating; adrenal insufficiency often develops.

In the first hours and days of life, newborns who have undergone asphyxia develop a posthypoxic syndrome, the main manifestation of which is the defeat of the central nervous system. At the same time, every third child born in a state of moderate asphyxia has a violation of cerebral circulation of the I-II degree, in all children who have undergone severe asphyxia, the phenomena of impaired liquorodynamics and cerebral circulation of the II-III degree develop.

Oxygen deficiency and disorders of the function of external respiration disrupt the formation of hemodynamics and microcirculation, in connection with which fetal communications are preserved: the arterial (botallian) duct remains open; as a result of a spasm of the pulmonary capillaries, leading to an increase in pressure in the pulmonary circulation and an overload of the right half of the heart, the foramen ovale does not close. In the lungs, atelectasis and often hyaline membranes are found. There are violations of cardiac activity: deafness 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 dysbacteriosis. 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, edematous syndrome develops in newborns after the 2-3rd day of life.

The diagnosis of asphyxia and its severity is established on the basis of determining the degree of respiratory failure, changes in heart rate, muscle tone, reflexes, and skin color in the first minute after birth. The degree of severity of the transferred asphyxia is also evidenced by indicators of the acid-base state. So, if in healthy newborns the pH of the blood taken from the vein of the umbilical cord 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 and more.

A thorough neurological examination of the newborn, ultrasound examination of the brain allow us to differentiate between hypoxic and traumatic lesions of the central nervous system. In the case of a predominantly hypoxic lesion of the c.n.s. focal neurological symptoms are not detected in most children, a syndrome of increased neuro-reflex excitability develops, in more severe cases - a syndrome of depression of the central nervous system. In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.), hypoxemic vascular shock with spasm of peripheral vessels and severe pallor of the skin, hyperexcitability are often observed at birth, focal neurological symptoms and convulsive syndrome that occurs a few hours after birth .

Treatment of asphyxia in a newborn:

Children born in asphyxia need resuscitation assistance. Its effectiveness largely depends on how early treatment is started. Resuscitation measures are carried out in the delivery room under the control of the main parameters of the body's vital activity: respiratory rate and its conduction to the lower parts of the lungs, heart rate, blood pressure, hematocrit and acid-base state.

At the time of the birth of the fetal head and immediately after the birth of the child, the contents of the upper respiratory tract are carefully removed with a soft catheter using an electric suction (in this case, tees are used to create intermittent air rarefaction); immediately cut the umbilical cord and place the child on the resuscitation table under a source of radiant heat. Here, the contents of the nasal passages, oropharynx, and also the contents of the stomach are re-aspirated.

With mild asphyxia, the child is given a drainage (knee-elbow) position, inhalation of a 60% oxygen-air mixture is prescribed, cocarboxylase (8 mg / kg) is injected into the vein of the umbilical cord in 10-15 ml of 10% glucose solution. In the case of moderate asphyxia, to normalize breathing, artificial lung ventilation (ALV) is indicated with a mask until regular breathing is restored and a pink color of the skin appears (usually within 2-3 minutes), then oxygen therapy is continued by inhalation. Oxygen must be supplied humidified and heated in any type of oxygen therapy.

Cocarboxylase is injected into the vein of the umbilical cord in the same dose as in 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 performed under the control of direct laryngoscopy and mechanical ventilation until regular breathing is restored (if the child has not taken a single breath within 15-20 minutes, resuscitation is stopped even if heartbeat).

Simultaneously with mechanical ventilation, cocarboxylase is injected into the vein of the umbilical cord (8-10 mg / kg in 10-15 ml of 10% glucose solution), 5% sodium bicarbonate solution (only after creating adequate ventilation of the lungs, an average of 5 ml / kg), 10% solution calcium gluconate (0.5-1 ml/kg), prednisolonehemisuccinate (1 mg/kg) or hydrocortisone (5 mg/kg) to restore vascular tone. In the event of bradycardia, 0.1 ml of a 0.1% solution of atropine sulfate is injected into the vein of the umbilical cord. At a heart rate of less than 50 beats per 1 min or during cardiac arrest, an indirect heart massage is performed, 0.5-1 ml of a 0.01% (1: 10,000) solution of adrenaline hydrochloride is injected into the umbilical cord vein or intracardiac.

After restoring breathing and cardiac activity and stabilizing the child’s condition, he is transferred to the intensive care unit of the neonatal unit, where measures are taken to prevent and eliminate cerebral edema, restore hemodynamic and microcirculation disorders, normalize metabolism and kidney function. Spend craniocerebral hypothermia - local cooling of the head of the newborn and infusion-dehydration therapy.

Premedication is required before craniocerebral hypothermia (infusion of 20% sodium hydroxybutyrate solution 100 mg/kg and 0.25% droperidol solution 0.5 mg/kg). The volume of therapeutic measures is determined by the state of the child, they are carried out under the control of hemodynamic parameters, blood coagulation, acid-base status, protein, glucose, potassium, sodium, calcium, chloride, magnesium in the blood serum. To eliminate metabolic disorders, restore hemodynamics and kidney function, 10% glucose solution, rheopolyglucin is injected intravenously, from the second or third day - hemodez.

The total volume of fluid administered (including feeding) on ​​the first or second day 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, for the sixth-seventh - 100 ml / kg. From the second or third day, a 7.5% potassium chloride solution (1 ml / kg per day) is added to the dropper. Cocarboxylase (8-10 mg / kg per day), 5% solution of ascorbic acid (1-2 ml per day), 20% solution of calcium pantothenate (1-2 mg / kg per day), 1% solution of riboflavin- mononucleotide (0.2-0.4 ml / kg per day), pyridoxal phosphate (0.5-1 mg per day), cytochrome C (1-2 ml of a 0.25% solution per day for severe asphyxia), intramuscularly administered 0 5% solution of lipoic acid (0.2-0.4 ml / kg per day). Tocopherol acetate is also used 5-10 mg / kg per day intramuscularly or 3-5 drops of a 5-10% solution per 1 kg of body weight inside, glutamic acid 0.1 g 3 times a day inside.

In order to prevent hemorrhagic syndrome in the first hours of life, a 1% solution of vikasol (0.1 ml / kg) is injected intramuscularly once, rutin is prescribed orally (0.005 g 2 times a day). In severe asphyxia, a 12.5% ​​solution of etamsylate (dicynone) is indicated at 0.5 ml / kg intravenously or intramuscularly. In 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 body weight intraveinally 10% glucose solution, phenobarbital 5-10 mg / kg per day orally. In the case of the development of cardiovascular insufficiency, accompanied by tachycardia, 0.1 ml of a 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 part of this dose), 2.4% solution of aminophylline (0.1-0.2 ml / kg per day). For the prevention of dysbacteriosis, bifidumbacterin is included in the complex of therapy, 2 doses 2 times a day.

Care is essential. The child should be provided with peace, the head is given an elevated position. Children who have suffered mild asphyxia are placed in an oxygen tent; children who have undergone moderate and severe asphyxia - in an incubator. Oxygen is supplied at a rate of 4-5 l / min, which creates a concentration of 30-40%. In the absence of the necessary equipment, oxygen can be supplied through a mask or nasal cannula. Often shown repeated suction of mucus from the upper respiratory tract and stomach.

It is necessary to monitor body temperature, diuresis, bowel function. The first feeding with mild asphyxia and moderate asphyxia is prescribed 12-18 hours after birth (expressed breast milk). Those born in 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 c.n.s. for children born in asphyxia, after discharge from the maternity hospital, a dispensary observation of a pediatrician and a neuropathologist is established.

Forecast and prevention:

The prognosis depends on the severity of asphyxia, the completeness and timeliness of therapeutic measures. In case of primary asphyxia, to determine the prognosis, the condition of the newborn is reassessed on 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 had 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 a child.

In the womb, the baby cannot breathe with lungs, their role is played by the placenta. Until the very moment of birth, the child depends on how well the blood is saturated with oxygen in the placenta and flows to his brain. Any obstruction in this area can cause fetal asphyxia:

  • The entanglement of the umbilical cord - the vessels inside the umbilical cord are clamped, the blood does not flow well from the placenta to the fetus.
  • Premature placental abruption - oxygen does not flow from the mother to the placenta, the child does not receive it for a long time, because the blood circulation in the placenta is impaired.
  • Very long childbirth, weakness of labor activity also reduce the flow of oxygen to the brain of the child, as a result of which asphyxia may develop.

Already after birth, the cause of asphyxia can be a blockage of the child's airways with mucus, meconium, amniotic fluid.

The risk of asphyxia increases if the expectant mother has heart disease, anemia, diabetes, suffered an infectious disease on the eve of childbirth. Contributes to the development of asphyxia and a clinically narrow pelvis, a long anhydrous period in childbirth, oligohydramnios and other problems of pregnancy.

Consequences of asphyxia of newborns

Short-term asphyxia does not cause permanent damage to the child's brain, since his body is adapted for this. However, prolonged oxygen starvation can cause the death of cortical neurons, which will definitely make itself felt in the future.

The consequences of severe asphyxia are disorders of the mental and motor development of the child, late onset of walking and speech, developmental delay, cortical visual and hearing impairments - a whole range of serious diseases that can be prevented by simple prevention.

Treatment and prevention of asphyxia in newborns

Treatment of severe asphyxia should begin immediately after birth. To do this, the child is sucked mucus from the respiratory tract, stimulate breathing with special techniques, and give oxygen. In the most severe cases, resuscitation incubators for newborns are used.

Our doctors have extensive experience working with expectant mothers, constantly improve their skills at advanced training courses, attend scientific symposiums on osteopathic care for pregnant women and infants. From experience, we can say for sure that careful preparation for childbirth, including osteopathy, significantly reduces the risk of complications and asphyxia during childbirth, guarantees the safe birth of your baby and good development in the future.

At present, asphyxia of a newborn is understood as his condition when, in the presence of a heartbeat, there is no breathing or there are separate convulsive, irregular, superficial breaths.

Asphyxia is divided into:

1) fetal asphyxia , which is subdivided 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- respiratory disorders, which are often the result of intrauterine circulation disorders.

Asphyxia of the newborn, in addition, is divided on the primary when the born baby does not breathe on its own after ligation of the umbilical cord, and secondary- arising in the following hours and days of a newborn's life.

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

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

2) violation 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 disease, respiratory failure);

5) insufficiency of extrauterine respiratory movements of the newborn ( the impact of maternal drug therapy, antenatal lesions of the fetal brain, congenital malformations of the lungs, etc.).

Secondary hypoxia can develop as a result of aspiration, pneumopathy, birth trauma of the brain and spinal cord, congenital malformations 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 . Underoxidized 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 leads to circulatory disorders, impaired blood coagulation processes, and hemorrhages in various organs.

The vessels lose their tone and overflow with blood, the liquid part of the blood goes into the surrounding tissues, edema and degenerative changes develop in the cells of all organs and systems.

Asphyxia of newborns - Clinic.

The main clinical sign of asphyxia- Impaired or absent breathing. The degree of asphyxia is determined by the Apgar scale. According to the International Classification of Diseases IX Revision (Geneva 1980) distinguish asphyxia: moderate (moderate) and severe.

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

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

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

Apgar score


Asphyxia of newborns - Treatment.

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

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

In the absence of all 4 signs of a live birth, the child is considered stillborn and is not subject to resuscitation. If there is at least 1 sign, it is necessary to provide resuscitation assistance.

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 airway patency; B - breath - breathing, providing ventilation - artificial (IVL) or auxiliary (IVL); C- cordial circulation restoration or maintenance of cardiac activity and hemodynamics.

In the delivery room or near it, the resuscitation island, which consists of several blocks, should be ready to assist the newborn around the clock:

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

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

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

4) block of artificial lung ventilation (breathing bag type Ambu, devices for automatic lung ventilation);

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

6) vital activity control unit - a heart monitor, an apparatus for measuring blood pressure, a stopwatch, a phonendoscope.

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

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

Amniotic fluid, mucus, sometimes maternal blood is wiped from the baby's skin with a warm diaper. In severe asphyxia and the presence of meconium in the amniotic fluid or oropharynx, immediate intubation is carried out, followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby after 1 minute. At the end of stage I of resuscitation, the duration of which should not exceed 20-25 seconds, the child's breathing is assessed. With adequate breathing, a heart rate above 100 per minute and a slight acrocyanosis of the skin, resuscitation is 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 II stage of resuscitation whose task is to restore external respiration. Activities begin with ventilation with a mask and breathing bag. The respiratory rate is 30-50 per minute. More often, a 60% oxygen-air mixture is used (in premature babies, 40%). Good chest excursions indicate sufficient ventilation of the alveoli, as well as the absence of serious airway obstruction. Failure of bag and mask ventilation, suspected meconium aspiration, less than 80 h, and the need for external cardiac massage and prolonged respiratory support are indications for endotracheal intubation.

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

If the heart rate is less than 80 per minute, then go to III stage of resuscitation. It is urgent to start an external heart 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 down 1.5-2.0 cm with a frequency of 100-140 times per minute.

Evaluate the effectiveness of indirect heart massage by skin color and pulse on 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 of body weight of a 0.01% solution either endotracheally or into the umbilical cord vein. The introduction can be repeated after 5 minutes (up to 3 times). At the same time continue IVL and indirect heart massage. Then assess the color of the skin and the state of microcirculation. According to indications, infusion therapy is carried out (albumin, native plasma, isotonic sodium chloride solution). If necessary, planned infusion therapy is started 40-50 minutes after birth. It is very important to remember that the rate of infusion therapy is much more important than the volume. Vitamin K is administered to all children born with asphyxia in the delivery room. In case of a very serious condition, after primary resuscitation and slow recovery of vital functions, it is desirable to transfer to the neonatal intensive care unit of a children's hospital.

If within 15-20 minutes the child does not have spontaneous breathing and persistent bradycardia persists, then there is a high probability of severe brain damage, and it is necessary to decide on the termination of resuscitation.

Neonatal asphyxia - 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 hemorrhages, necrosis, etc.), hemodynamic (pulmonary hypertension, heart failure), renal, pulmonary, gastrointestinal, hemorrhagic (anemia, thrombocytopenia, DIC syndrome) are especially frequent. Late complications are dominated by infectious (pneumonia, meningitis, sepsis) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy).

is a pathology of the early neonatal period, caused by respiratory failure and the development of hypoxia in a born child. Asphyxia of the newborn is clinically manifested by the absence of independent breathing of the child in the first minute after birth or the presence of separate, superficial or convulsive irregular respiratory movements with intact cardiac activity. Newborns with asphyxia need resuscitation. 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 also be engaged in prevention, giving up bad habits, observing a rational regimen, following the instructions of an obstetrician-gynecologist. Prevention of asphyxia of a newborn during childbirth requires the provision of competent obstetric assistance, the prevention of fetal hypoxia during childbirth, and the release of the upper respiratory tract of the child immediately after birth.

Asphyxia of newborns- a complication that develops in the early postpartum period. This pathology is accompanied by a violation of the breathing process and the work of the cardiovascular system in an infant. Let us consider this condition in more detail, determine its causes, types, find out: what is the difference between fetal hypoxia and asphyxia of the newborn.

What is "asphyxia" in a newborn baby?

Asphyxia of newborns is a condition of a small organism, in which there is a violation of breathing. However, there is a difference between this pathology and the definition of "hypoxia of the newborn". Oxygen starvation (), develops during pregnancy or childbirth (placental abruption, umbilical cord compression), and is accompanied by insufficient oxygen supply. In this case, the breathing process is not disturbed. Asphyxia (suffocation) is characterized by a temporary cessation of breathing and requires resuscitation.

Causes of asphyxia in newborns

Asphyxia in a child during childbirth can be triggered by numerous factors. At the same time, the causes of pathology can be directly related to the process of delivery and to the peculiarities of intrauterine development of the fetus. Among the main pathological factors that cause asphyxia, doctors distinguish:

  1. Sharp, sudden failures in the blood flow and in the umbilical cord -, the formation of a knot on the umbilical cord, constriction.
  2. Violation of the gas exchange process in the uteroplacental system - incorrect presentation of the child's place, premature and partial.
  3. Failure in the process of blood circulation in the placenta caused by the mother.
  4. Decrease in the level of oxygen in the blood of a woman in labor -, cardiovascular diseases, diseases of the respiratory system.
  5. Difficulty in the process of breathing in the fetus - anomalies in the development of the lungs, chronic infectious processes, a consequence of the medications taken.

These causes provoke primary asphyxia of newborns, which develops in the process of delivery. However, asphyxia can also be secondary, when a violation occurs immediately after the baby is born. Among the causes of secondary asphyxia, it is necessary to name:

  • airway aspiration - fluid entering the lungs;
  • violation of the process of blood circulation of the brain;
  • immaturity of the lungs - the body is not able to make respiratory movements;
  • congenital malformations of the brain, heart, lungs.

Degrees of asphyxia of newborns

Depending on the clinical picture and the severity of the disorder, doctors distinguish several degrees of pathology. The assessment is carried out immediately after the birth of the baby in the first minute. Classification of asphyxia of newborns looks like this:

  • mild degree;
  • average;
  • heavy;
  • clinical death.

Mild neonatal asphyxia

Mild asphyxia is characterized by the absence of a cry, but the infant's reaction to touch is present. The breathing of a newborn is independent, but slow and irregular. The legs and arms have a bluish tint, cardiac activity is not disturbed. After cleaning the upper respiratory tract from mucus and fluid, performing tactile stimulation (stroking the back, patting on the heels) and oxygen therapy through a mask, the newborn's condition returns to normal.

A child born in a state of moderate asphyxia has no further problems with breathing. In this case, minor neurological disorders are possible, in the form of:

  • increased muscle tone;
  • arms, legs, mandible.

Asphyxia of moderate severity in a newborn

This degree of impairment is also characterized by the absence of a cry at the time of birth. In this case, the reaction to tactile stimuli of touch is not observed. A characteristic feature of this form is a change in the color of the skin, so it is often referred to as blue asphyxia of newborns. Respiratory movements are single, but cardiac activity is not disturbed.

Medium neonatal asphyxia requires ventilation. To do this, they often use a special bag, occasionally an oxygen mask. The transferred form of pathology always leaves an imprint on the health of the baby, provoking neurological changes:

  • increased excitability - causeless screams, prolonged tremor of the arms and legs;
  • depression - sluggish breast sucking, low physical activity (movements of the arms and legs are practically not carried out).

Severe asphyxia in newborns

A severe degree of pathology is accompanied by a complete absence of breathing at the time of birth. The skin due to insufficient blood circulation becomes pale. Because of this, this form of pathology is referred to as white asphyxia of the newborn. When conducting a tactile test, the baby does not react to touch in any way. There is a violation of the cardiovascular system - when listening to the heart sounds are very muffled or completely absent. Severe bradycardia develops.


This neonatal asphyxia requires urgent resuscitation. The actions of doctors in this case are aimed at restoring the respiratory and cardiac activity of the newborn. The child is connected to the artificial respiration apparatus. At the same time, drugs are injected into the umbilical cord that stimulate cardiac activity. Such babies are on apparatus breathing for a long time, and later severe neurological disorders develop, and a delay in neuropsychic development is possible.

Clinical death of a newborn

The clinical death of an infant occurs when doctors record the complete absence of signs of life. In this case, after birth, the baby does not take a single breath on his own, there is no cardiac activity, and there is no reaction to stimuli either. The correct and timely start of resuscitation measures gives hope for a favorable outcome. At the same time, the severity of the neurological consequences for the health of the baby depends on how long the absence of breathing was. In such situations, the brain is severely damaged.

Asphyxia of the newborn - symptoms

In order to assess the severity of this pathology, doctors use the Apgar scale. The method is based on the assessment in points of several indicators at once:

  • reflex excitability;
  • breath;
  • cardiac activity;
  • muscle tone;
  • skin color.

For each parameter, points are awarded, which are summed up and a total score is displayed. The results look like this:

  • mild degree - 6-7 points;
  • medium - 4-5;
  • severe - the baby is gaining 1-3 points;
  • clinical death - 0 points.

When setting the degree of asphyxia, obstetricians evaluate the present symptoms of the disorder. The pulse during asphyxia in newborns decreases and is less than 100 beats per minute. For a mild degree of asphyxia are characteristic:

  • the first breath occurs at 1 minute;
  • muscle tone is slightly reduced;
  • nasolabial triangle blue;
  • breathing is weakened.

With moderate severity of asphyxia, doctors fix:

  • weakened breathing
  • legs and arms turn blue;
  • the number of heartbeats decreases;
  • muscle tone is reduced;
  • there is a pulsation of the vessels of the umbilical cord.

A severe degree of this pathology is manifested by the following symptoms:

  • breathing is absent;
  • severe bradycardia;
  • muscle atony;
  • pallor of the skin;
  • development of adrenal insufficiency;
  • strong pulsation of the veins of the umbilical cord.

Asphyxia of newborns - consequences

Talking about the danger of asphyxia in newborns, doctors note that with a severe degree of violation, the death of the baby is possible. This happens in the first hours of life. With an average and mild degree, the prognosis is favorable. The outcome depends on the time of the start of resuscitation, the presence of concomitant disorders. The consequences of the pathology that developed during the neonatal period can occur both in the first hours of life and at an older age.

Asphyxia in a newborn after childbirth - consequences

Severe asphyxia of newborns, the consequences of which depend on the correctness and timeliness of the therapy started, does not go unnoticed for the body. Complications can occur both in the early stages of perinatal development and at an older age. Complete atrophy of the brain after asphyxia in newborns is rare. Among the frequent complications of the early recovery period:

  • convulsive encephalopathy;
  • hydrocephalus;
  • hypertensive syndrome;
  • hypo- or hyperexcitability.

Asphyxia of newborns - consequences at an older age

Asphyxia and hypoxia of newborns are among those complications of pregnancy that affect the health of the baby after birth. Problems can appear in a few months, and sometimes even years. Late complications include:

  • meningitis;
  • pneumonia;
  • sepsis.

Treatment of asphyxia in newborns

Apgar scores of 4 or less in the first minute require resuscitation. Resuscitation of a newborn with asphyxia is carried out in 4 stages:

  1. The release of the respiratory tract, ensuring their patency. It is carried out using a catheter and an electric pump. If asphyxia occurs in utero, the cleaning manipulation is carried out immediately after the appearance of the head.
  2. Maintaining the breathing process. Assisted ventilation is carried out using a breathing bag, and if ineffective, intubation is carried out and a ventilator is connected.
  3. Restoration of the circulatory process. For this purpose, a closed body massage is performed, even in the presence of contractions (with bradycardia 60-70 beats per minute). It is carried out by pressing on the sternum with two thumbs, with a frequency of 100-120 times per minute. When cardiac activity is not restored within a minute, proceed to the next stage.
  4. The introduction of drugs. At this stage of therapy, doctors use the following drugs to treat newborn asphyxia:
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