What causes asphyxia in a newborn. What is asphyxia of a newborn: consequences for the child, treatment and prevention. Factors contributing to the development of disorders in the uteroplacental circle

The birth of a child for a mother is definitely a joyful event. However, childbirth does not always go smoothly. Asphyxia is one of the most common postpartum complications in the newborn. Such a diagnosis is made in 4-6% of all babies born. According to other sources, choking to one degree or another occurs in approximately one in ten newborns. The severity of this deviation depends on the degree of lack of oxygen and the accumulation of carbon dioxide in the blood and tissues of the infant. Pathology can develop inside the womb (primary) or outside it (secondary). The latter manifests itself during the first days of a baby's life. Asphyxia is a serious and dangerous condition, sometimes leading to the death of the fetus or newborn baby.

Frequently Asked Questions from Parents

What is asphyxia?

Asphyxia is a condition of impaired breathing of a child or fetus, its oxygen starvation against the background of an excess of carbon dioxide in the blood. More common during childbirth. Sometimes reaching the development of hypoxia of the newborn. Clinically, asphyxia is manifested by the lack of breathing of a newborn baby. It may not be complete, or the infant may have convulsive, shallow, irregular breathing movements. Pathology requires urgent resuscitation procedures, on the correctness of which the further prognosis depends.

What is the difference between hypoxia and asphyxia?

Hypoxia - oxygen starvation of the tissues and organs of the baby, which develops with a lack of oxygen. Asphyxia is a violation of the independent breathing of a newborn child that arose after his birth. Usually, hypoxia develops even at the stage of intrauterine development of an infant, sometimes it becomes a consequence of suffocation.

All human tissues and organs need a constant supply of oxygen. With its shortage, violations occur, the severity and consequences of which depend on the degree of pathology, the timeliness and correctness of first aid. In newborns, tissue damage quickly becomes irreversible. The most sensitive to oxygen deficiency are the brain, liver, kidneys, heart and adrenal glands of the baby.

Why is asphyxia dangerous?

Insufficient oxygen supply, even limited in time, adversely affects the state and vital activity of the body. The brain and nervous system are especially affected. There may be disturbances in the processes of blood supply, manifested in an increase in blood vessels in size from overflowing with blood. Hemorrhages, blood clots are formed, which leads to damage to certain areas of the brain. It is also possible to develop areas of necrosis - dead brain cells.

In severe cases, choking leads to the death of the fetus during childbirth or in the first few days of the baby's life. Children who have been diagnosed with severe respiratory failure have physical and mental abnormalities.

The consequences of asphyxia can be far-reaching. A baby with a history of this disorder, even mildly, may have weak immunity, a tendency to catch a cold, and developmental delays. Schoolchildren have a decrease in attention, problems with remembering material, low academic performance. In severe forms of suffocation, epilepsy, mental retardation, paresis, cerebral palsy, convulsive syndrome, and other serious pathologies can develop.

Why pathology occurs in newborns

According to the time of occurrence of asphyxia, there are:

1. Primary (intrauterine), developing immediately after the birth of the child.
2. Secondary (extrauterine), which can manifest itself during the first day of a baby's life.

Depending on the severity of the injury

• heavy;
• average;
• light.

Causes of primary asphyxia

All reasons fit into three groups:

1. Fetal related:
   • intrauterine developmental delay;
   • prematurity;
   • pathology of growth or development of the heart (brain) of the fetus;
   • airway aspiration with mucus, meconium, or amniotic fluid;
   • Rhesus conflict;
   • birth traumatic brain injury;
   • pathology of the development of the respiratory system;
   • intrauterine infection.
2. With maternal factors:
   • infectious diseases transferred during pregnancy;
   • malnutrition;
   • taking medications that are contraindicated for pregnant women;
   • pathologies of the endocrine system: diseases of the thyroid gland or ovaries, diabetes mellitus;
   • anemia in a pregnant woman;
   • bad habits: alcohol, smoking, drug addiction;
   • shock during childbirth;
   • severe preeclampsia, accompanied by high blood pressure and severe edema;
   • the presence in a pregnant woman of pathologies of the cardiovascular and respiratory systems.
3. With problems causing disturbances in the uteroplacental circle:
   • childbirth with caesarean section;
   • general anesthesia;
   • polyhydramnios or oligohydramnios;
   • ruptures, damage to the uterus;
   • abnormal childbirth: fast, rapid labor, weak labor activity, discoordination;
   • placenta previa;
   • multiple pregnancy;
   • placental abruption or its premature aging;
   • delayed pregnancy;
   • severe pregnancy, accompanied by a constant threat of miscarriage.

Prerequisites for secondary

The following pathologies of the newborn can become the reasons for the development of secondary asphyxia:

1. Undiagnosed heart defects.
2. Aspiration of milk or formula while feeding.
3. Incorrect sanitation of the baby's stomach after childbirth.
4. Damage to the tissues of the brain or heart, accompanied by a violation of the blood circulation of the brain.
5. Respiratory syndrome, which can develop with edematous-hemorrhagic syndrome, lung atelectasis, the appearance of hyaline membranes.

Symptoms

Primary asphyxia is detected immediately after the birth of a child based on an objective assessment of its indicators:

• skin color;
• heart rate;
• breathing frequency.

The main sign of suffocation is a violation of breathing, which leads to disruption of the heart and blood circulation. The severity of the condition of the newborn is due to changes in metabolism. In a child with impaired breathing, the concentration of erythrocytes, blood viscosity increases, and platelet aggregation increases. The result of this is improper blood circulation, leading to a decrease, a decrease in heart rate, disruption of organs and systems.

With moderate severity, the child:

• lethargic;
• he has reduced reactions;
• spontaneous movements may be observed;
• reflexes are weakly expressed;
• the skin has a cyanotic color, which quickly changes to pink during resuscitation.

During the examination, doctors reveal:

• tachycardia;
• muffled heart sounds;
• weakened breathing;
• moist rales are possible.

The condition of the newborn with quick proper help returns to normal on the 4th-6th day of life.

Severe manifests itself:

• lack of physiological reflexes;
• deafness of heart sounds;
• the appearance of systolic murmur;
• possible development of hypoxic shock.

Symptoms include:

• lack of response to pain and external stimuli;
• lack of breathing.

Apgar grades of asphyxia

The severity of suffocation is determined by the Apgar scale. It includes five signs for which marks are given - 0, 1 or 2. A healthy baby must score at least 8 points. Such an assessment is carried out twice in the first minute of a child's life and in the fifth.

Criteria

Apgar score criteria and scores:

1. Color of the skin:
   • 0 - cyanotic, 1 - pale pink, 2 - pink.
2. Reflexes:
   • 0 - no, 1 - weak, 2 - normal.
3. Muscle tone:
   • 0 - absent, 1 - weak, 2 - good.
4. Heartbeat:
   • 0 - no, 1 - less than 100 beats per minute, 2 - more than 100 beats per minute.
5. Breath:
   • 0 - no, 1 - superficial, intermittent, irregular, 2 - normal spontaneous breathing, loud crying of the child.

Degrees

Based on the results of the examination of the child and the assessment on the Apgar scale, the presence of asphyxia and its degree (in points) are determined:

1. 8-10 is the norm.
   • The baby is healthy, there are no problems with breathing.
2. 6-7 - mild degree.
   • The child is noted: weak, sharp breathing, decreased muscle tone, cyanosis of the nasolabial triangle.
3. 4-5 - moderate.
   • The newborn has the following symptoms: irregular, intermittent breathing, bradycardia, weak first cry. Cyanosis of the skin of the face, feet, hands.
4. 1-3 - heavy.
   • The child is completely absent from breathing or rare breaths are noted, the heart rate is rare or absent, muscle tone is severely reduced, the skin is pale or sallow.
5. 0 - clinical death.
   • A condition in which a newborn does not show signs of life. Requires immediate resuscitation.

Likely consequences

Asphyxia rarely leaves no consequences. Violation of gas exchange and lack of oxygen affects the work of all organs and systems of the child. An important indicator is the comparison of Apgar scores made at the first and fifth minutes of the baby's birth. With an increase in points, you can count on a favorable outcome. If the assessment does not change or even worsens, an unfavorable development of events is possible. The severity of the development of the consequences of suffocation also depends on the correctness of the provision of resuscitation measures.

With a mild degree of asphyxia, especially with timely assistance, there is a great chance to avoid consequences. Children who have had more severe forms of respiratory failure may develop abnormalities in the functioning of internal organs. The most common consequences of this condition are neurological disorders, developmental delays, increased muscle tone, convulsions, and other pathologies. Cases of severe suffocation often end in death. According to statistics, about half of these children die.

Diagnostic procedures

Asphyxia is easy to diagnose. Her main symptoms were discussed above, and were respiration, heart rate, muscle reflexes, and skin tone. Here we consider more specific approaches.

Diagnosis can take place on the pH of the blood, which is taken from the umbilical cord.

1. Normally, the indicator of acid-base balance is shifted towards alkali, the newborn has a little more: 7.22–7.36 BE, lack of 9–12 mmol / l.
2. With a lack of air of mild / moderate severity, pH values: 7.19–7.11 BE, deficiency 13–18 mmol / l.
3. Severe choking: less than 7.1 BE or more than 19 mmol / l.

To determine the hypoxic damage to the nervous system of a newborn, neurosonography is indicated - an ultrasound examination of the brain. Ultrasound, together with a neurological examination, will help distinguish traumatic disorders in the brain from disorders due to anoxia.

First aid and resuscitation

Supervises the first aid to a choking baby neonatologist.

After a successful birth, suction of mucus from the lungs and nasopharynx, assess the condition of the newborn. The first is the presence of breath.

If it is not there, they try to use reflexes by slapping the baby on the heels. The breath that appeared after the procedure indicates a mild degree of suffocation, which is noted in the baby's card. This ends the treatment.

If the actions taken did not help, breathing did not recover or fails, then they put on an oxygen mask. The appearance of stable breathing for a minute indicates that the newborn had an average degree of asphyxia.

In the absence of breathing for a longer period, they begin resuscitation, which is carried out by a resuscitator.

Ventilation of the lungs continues for two minutes, if the patient is at least breathing weakly, a probe is inserted into him, removing the contents of the stomach. The number of heartbeats is measured. If the pulse is less than 80, chest compressions are started.

Lack of improvement leads to the next stage - drug therapy. Solutions of indicated drugs are injected into the umbilical vein of the newborn, continuing massage and artificial ventilation. After 15-20 minutes, in the absence of improvement in the condition, resuscitation is stopped.

Prohibited actions

With asphyxia, you can not:

• slap on the back or buttocks;
• blow oxygen over the baby's face;
• press on the chest;
• splash with cold water.

Treatment

If first aid or resuscitation procedures are successful, then the baby falls under special supervision. With him, a course of events and medical procedures is carried out.

1. Special care.
2. Shown feeding.
3. Oxygen therapy.
4. Prevention of cerebral edema.
5. Metabolism correction.
6. Seizure prevention.
7. Prevention of hydrocephalic syndrome.
8. Other types of symptomatic treatment.
9. Twice a day, general monitoring of the condition is carried out.

Possible Complications

The lack of oxygen affects the brain the most. Changes increase in three stages, even with short-term hypoxia:

1. Blood vessels expand and fill with blood.
2. Blood clots form, the walls of blood vessels become thinner, hemorrhages occur.
3. Areas of the brain with microstrokes die off - tissue necrosis.

The prognosis can be favorable if the correct treatment has been carried out after mild or moderate asphyxia. With a severe form it is more difficult. Normal, full-term babies survive in 10-20% of cases, 60% have severe consequences - physical or mental disorders, pneumonia. The mortality rate for premature or low birth weight babies approaches 100%.

Prevention

The prevention of breathing problems in a newborn consists in the measures taken:

1. Doctors:
   • observation and management of a woman throughout the entire period of pregnancy;
   • prevention of vaginal infections;
   • timely therapy of extragenital diseases;
   • monitoring the condition of the fetus and placenta.
2. Pregnant:
   • rejection of bad habits;
   • adherence to dietary guidelines;
   • feasible physical activity, walks in the fresh air;
   • compliance with medical recommendations.

Pathological respiratory failure resulting from oxygen deficiency is fraught with consequences of varying severity and requires urgent resuscitation. In newborns, asphyxia can occur during childbirth or in the first few days after birth.

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Causes and risk factors

Asphyxiation is characteristic of intrauterine development and can develop due to:

• violations of the course of pregnancy;
• pathologies of the pregnant woman or fetus;
• lack of access to oxygen at the time of the first breath of the newborn (diagnosed as asphyxia of the lungs);
• deviations in the body of the infant.

There are a number of risk factors leading to asphyxia.

Placental factors

Associated with the state of the placenta:

• delayed or multiple pregnancy (oxygen deficiency is created to nourish the fetus);
• premature aging, placenta previa, or bleeding;
• placental abruption;
• pathological features of the development of the umbilical cord (formation of nodes);
• chronic threat of premature birth;
• placenta previa, bleeding;
• excess or shortage of water;
• weak or rapid labor activity;
• C-section;
• the use of general anesthesia;
• the use of pregnant drugs less than 4 hours before delivery;
• uterine rupture.

fruit factors

Situations related to the growth and condition of the embryo:

• head injury;
• Rhesus conflict;
• pathology of the development of the respiratory system of the embryo;
• infections during pregnancy (rubella, measles, chickenpox and others);
• premature birth;
• growth retardation;
• malformations of the heart or brain development;
• blockage of the respiratory organs with mucus, meconium, amniotic fluid.

maternal factors

Pathologies associated with childbirth:

• severe gestosis as a result of severe swelling and high blood pressure;
• iron deficiency (anemic disorders);
• diseases of the lungs, endocrine system (thyroid gland, diabetes, ovarian dysfunction), cardiovascular system;
• severe stress of the expectant mother;
• environmental factors;
• bad habits;
• poor nutrition;
• infections;
• taking medications with contraindications for pregnant women.

Causes of secondary asphyxia

It is the result of factors such as:

• trauma to the brain and lungs during labor;
• heart disease that was not diagnosed or did not manifest itself in the first hours of life;
• obstruction of the respiratory tract with milk or inadequate sanitation of the stomach;
• effects of respiratory distress;
• hyaline membranes;
• atelectasis;
• hemorrhage in the lungs;
• edematous-hemorrhagic syndrome.

Development mechanism

Asphyxiation leads to a restructuring of metabolic processes and microcirculation. The classification of asphyxia depends on the duration and intensity of oxygen starvation. As a result, acidosis, glucose deficiency, azotemia and hyperkalemia appear in the baby's body. In the acute degree of asphyxia, the blood volume increases, in the chronic stage, the blood becomes thick, and its circulation decreases, which can lead to the formation of blood clots.

These processes in the body lead to the pathology of microcirculation of blood with oxygen in the vital organs of the baby (heart, kidneys, brain, liver, adrenal glands). As a result of hypoxia, a violation of the normal development of the baby's systems occurs.

Clinical picture

The degree of damage is characterized in the clinic by a doctor immediately after delivery using an Apgar score. Fixing the state of the newborn is carried out at the 1st and 5th minute of life. Each symptom is scored from 0 to 2 points. A healthy baby gains from 8 to 10 points at the first examination.

Mild neonatal asphyxia

The Apgar score is 6-7 points. The baby takes his first breath on his own in the first minute, but breathing is weakened, there is cyanosis in the nose and lips.

Asphyxia of moderate severity

4-5 points on Apgar. Breathing is weakly expressed, irregular, the rhythm is disturbed. There is cyanosis of the face, feet and hands, the heart rate is up to 100 beats per minute. Cramps in the limbs and chin may be present. Reflexes are either weakened or excessively strengthened. There is hypertonicity in the muscles.

Severe asphyxia

Acute state of suffocation, Apgar 1 to 3 on first examination. The baby is not breathing, or takes single breaths. The heart rate is less than 100 per minute, bradycardia is recorded, and the heart sounds are muffled. The newborn does not scream, greatly reduced muscle tone. The skin is cyanotic, pulsation in the umbilical cord and reflexes are absent. The eyeballs float, a spasm and swelling of the brain develops. Multiple hemorrhages on the skin, changes in blood viscosity.

With an Apgar score of 0, clinical death of the infant is observed, in rare cases, resuscitation can lead to the appearance of breathing and heart rhythms in the newborn.

Diagnostics

Apgar scores:

• the presence and frequency of breathing;
• heartbeat;
• muscle tone;
• reflexes;
• skin tone.

Apgar scores

In addition to external indicators, a blood test is carried out for the acid-base state. After the initial diagnosis is made, an ultrasound (ultrasound examination) of the brain is done. It can be used to determine the degree and type of damage to the central nervous system, that is, traumatic or hypoxic pathogenesis.

Treatment Methods

The main method of assistance for asphyxia is resuscitation carried out by doctors in the maternity hospital. Efficiency depends on the timeliness of the measures taken.

Resuscitation is carried out by monitoring the main parameters of vital activity:

• respiratory rate;
• conduction of oxygen to the lower zones of the lungs;
• heart rate;
• indicators of blood pressure, hematocrit and acid-base parameters.

The sequence of resuscitation

First aid in the form of emergency resuscitation of the baby is represented by the following scheme of actions:

1. Clear the baby's nose and mouth of meconium, mucus and amniotic fluid.
2. Restore respiratory function.
3. Support the circulatory system.

Scheme of actions in the absence of meconium in the water around the fetus:

1. The baby is transferred under the lamp to the changing table.
2. Water and mucus are sucked out of the respiratory tract, without contact with the posterior pharyngeal wall. The skin is wiped dry.
3. The newborn is laid on his back. For better airway patency, a special roller is placed under the shoulders.
4. To stimulate the baby's breathing, they clap on the heels, massage the back along the spine with the palm of your hand.
5. If the breath does not appear, and the heart rate drops to 80 beats per minute, the lungs are ventilated using a mask in combination with a heart massage.
6. If the measures above do not help, medications are used (0.01% adrenaline solution).

If the infant was diagnosed with clinical death, then resuscitation is carried out for no more than 20 minutes.

On the video you will see resuscitation actions. Photographed in GBUZ JSC "Arkhangelsk maternity hospital named after K. N. Samoilova", 2013

Further treatment and observation

After resuscitation and restoration of breathing, the baby is transferred to a special room (couveuse), equipped with a heating and oxygen supply function.

Further treatment includes:

• infusion therapy (helps restore metabolism, kidney function);
• dehydration measures (aimed at removing and preventing cerebral edema);
• the appointment of calcium gluconate to prevent cerebral hemorrhage;
• the use of sedatives with increased nervous excitability;
• feeding (begin after 16 hours, with more severe degrees of suffocation, the first day the nutrients are supplied to the baby through the probe).

On average, the duration of treatment is from 10 to 15 days. A more accurate period is determined by the neonatologist depending on the condition of the baby.

Caring for a child after suffering asphyxia

After an asthma attack and rehabilitation therapy, the baby needs special care.

Health workers and parents should ensure:

• complete rest for the newborn and mother;
• the correct position of the child in the incubator (with a raised head);
• clearing the airways of mucus;
• dynamic control of body temperature, defecation, urination, regurgitation after feeding;
• constant monitoring of the frequency and presence of breathing during sleep.

Prognosis and consequences of the disease

Any prognosis for an infant depends on the severity of suffocation, the timeliness and effectiveness of resuscitation.

All the consequences of asphyxia are related to the functioning of the nervous system. Up to a year, a child may be overly excitable. Convulsions and hypothalamic problems are not excluded.

Consequences of asphyxia of newborns at an older age:

• hyperactivity;
• inattention;
• phlegmatism;
• poor learning.

The worst consequence of asphyxia is death. In the absence of positive dynamics in the 20th minute of the measures taken, a lethal outcome is diagnosed in up to 60% with timely delivery and up to 100% with premature birth.

In severe asphyxia, cerebral palsy is the most serious complication. The disease develops when the newborn does not respond to resuscitation within 15 minutes - in 10% of cases, within 20 minutes - in 60%.

Prevention

On the part of doctors, preventive measures are:

• timely treatment of diseases in a woman in labor;
• Ultrasound diagnosis of the intrauterine state of the fetus and placenta;
• monitoring of pregnancy with the identification of possible risk factors.

Preventive measures to prevent asphyxia of the newborn should be observed by the mother in the prenatal period:

• healthy lifestyle;
• check adherence to the regime of the day;
• walks in the open air;
• proper and nutritious nutrition;
• taking vitamins;
• calmness, lack of stressful situations, positive emotions;
• timely diagnosis and treatment of infections both before and during pregnancy;
• preparation for conception in the form of control of chronic, especially endocrine diseases;
• constant monitoring by a gynecologist, the implementation of all the recommendations of the doctor.

Video "Causes of asphyxia in a newborn"

In the video, you will learn how to properly push during childbirth, as well as what can lead to suffocation of the baby. Author Marina Aist.

Such a diagnosis as asphyxia occurs with frightening frequency. Children are born with signs of hypoxia, do not breathe on their own, or their breathing is weakened. From doctors at this moment, determination and professionalism are required, and from the mother - faith in the best. What is happening in these minutes? How to take care of the baby in the future? How to avoid complications?

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

What is neonatal asphyxia?

Asphyxia of newborns is a pathology in which gas exchange in the body of a child is disturbed. This condition is accompanied by an acute oxygen deficiency and an excess of carbon dioxide. With 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 state, the child immediately undergoes resuscitation.

By severity, asphyxia is divided into mild, moderate and severe, clinical death is separately distinguished. Consider what symptoms they are characterized by.

Intrauterine and postpartum asphyxia and its causes

Like any disease, asphyxia of a newborn has causes. Why is there a lack of oxygen? First, let's look at the types of this state. Asphyxia is primary and secondary.

Primary (intrauterine) is a pathological condition that is diagnosed at the time of childbirth. It is caused by acute or chronic intrauterine lack of oxygen (hypoxia). Also, the causes of intrauterine asphyxia include:

• trauma to the skull of a newborn;
• pathologies in development during the gestation period;
• 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 presence in the anamnesis of the pregnant woman of problems with the heart, kidneys, 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 pressure rises.

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

Secondary asphyxia occurs some time after childbirth due to:

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

Consequences of asphyxia of the fetus and newborn

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

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

The severity of the consequences and the prognosis depend on how well and on time the doctors provided medical care during a serious condition. The sooner the treatment was prescribed and the better the resuscitation measures were carried out, the less serious complications should be expected. Particular attention should be paid to newborns with severe asphyxia or clinical death.

• with hypoxia or asphyxia, which is assigned 1 degree, 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 live up to 7 days, and the remaining half have a high probability of severe neurological diseases (mental disorders, seizures, etc.).

Do not despair when making such a diagnosis as asphyxia. It has been seen quite frequently lately. The main property of the child's body is that he knows how to recover on his own. Do not neglect the advice of doctors and keep a positive attitude.

How is asphyxia diagnosed?

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

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

If asphyxia arose due to trauma, 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 caused asphyxia in a child, treatment is carried out for absolutely all children from the moment of birth. If signs of lack of oxygen are noted during contractions or attempts, then an emergency delivery by caesarean section is immediately performed. Further resuscitation actions include:

• purification of the respiratory tract from blood, mucus, water and other components that impede the supply of oxygen;
• restoration of normal breathing by administering medications;
• maintaining the normal functioning of the circulatory system;
• heating the newborn;
• control of intracranial pressure.

During the implementation of resuscitation, the heart rate, respiratory rate and other vital signs of the newborn are constantly monitored.

If the heart contracts less than 80 times per minute, and spontaneous breathing does not improve, then the baby is immediately administered medication. The increase in vital signs occurs gradually. First, adrenaline is used. With profuse blood loss, a sodium solution is needed. If after this breathing has not returned to normal, then a second injection of adrenaline is given.

Rehabilitation and child care

After the acute condition is removed, control over the breathing of the newborn should not be weakened. Further care and treatment of asphyxia of the newborn takes place under the constant supervision of doctors. The baby needs absolute rest. The head must always be in a raised position.

Oxygen therapy is of no small importance. After mild asphyxia, it is important to prevent repeated oxygen starvation of the child. The baby needs more oxygen. To do this, some maternity hospitals are equipped with special boxes, inside which an increased concentration of oxygen is maintained. According to the appointment of a neonatologist and a neurologist, the baby must spend from several hours to several days in it.

If the child has suffered asphyxia in more severe forms, then after resuscitation, he is placed in special incubators. This equipment is able to provide oxygen in the required concentration. The concentration is prescribed by doctors (usually not less than 40%). If there is no such device in the maternity hospital, then oxygen masks or special liners for the spout are used.

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 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 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 should be registered with a pediatrician and a neurologist. Timely diagnosis will help prevent negative consequences and complications.

The baby is prescribed gymnastics, massage and drugs 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 the implementation of recreational activities. General strengthening 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 activities can affect the mental development and behavior of the child.

Children who have had asphyxia should not introduce complementary foods too early. Until the age of 8-10 months, the child should eat adapted infant formula or breast milk. Parents should carefully monitor the child and temper it. The need for vitamin therapy should be discussed with the pediatrician.

It is very important to keep breastfeeding as long as possible.

Asphyxia prevention

Any disease is easier to prevent than to treat and be afraid of complications. Asphyxia prevention measures are very simple. Of course, prevention does not give a 100% guarantee that there will be no breathing problems in the future, but in about 40% of cases a positive effect is observed.

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

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

You can not ignore the timing of the passage of fetal screening studies. Ultrasound readings may indicate a problem. According to the condition of the placenta and amniotic fetus, the doctor can determine the development of hypoxia and prevent it in a timely manner. When the first danger signals appear, urgent measures must be taken and the necessary therapy should be carried out.

You can 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.

In the prevention of oxygen starvation, the lifestyle of the expectant mother has a significant impact. Doctors recommend following the rules:

• Walks. For a normal supply of oxygen to the fetus, a pregnant woman must spend a sufficiently long time outdoors. Ideally, if walks are held in the park or in the square. In a few hours on the street, the mother's body is saturated with oxygen, which enters 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 the law. Getting up early, watching movies at night and the “frantic” rhythm of the day is not for her. All the turmoil must be left in the past and try to relax 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 healthy products, then taking vitamins is still necessary. Unfortunately, in modern products there are not so many useful substances that are necessary for a woman and a child. That is why every pregnant woman should take vitamin complexes that can meet her needs and the needs of the child. The choice of a vitamin-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.

Asphyxia of newborns - what is it? First of all, it should be said that this concept is not clearly defined. In the most general sense, they denote one or another degree of respiratory depression while maintaining other signs of life (heartbeat, movement of arms and legs, contraction of other muscles, etc.).

In most cases, neonatal asphyxia is a consequence of oxygen starvation during fetal development. Therefore, in relation to newborns, the terms and hypoxia are used interchangeably.

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Asphyxia in a newborn child (fetus)

According to world statistics, about 20% of those born with asphyxia die after childbirth. Another 20% subsequently suffer from certain functional disorders associated with the functioning of the nervous system.

Complete absence of breathing in newly born children is diagnosed in 1% of children. Breathing with insufficiently effective gas exchange is observed in 15% of newborns. Thus, about 16% of children are born with varying degrees of hypoxia. More often premature babies are born with respiratory failure.

Classification of asphyxia of newborns

The state of suffocation in newborns is classified according to the time of occurrence and duration of oxygen deficiency. According to this principle, 2 types of asphyxia are distinguished:

• Arising from prolonged hypoxia in the womb;
• resulting from the course of childbirth.

This division is important in understanding what asphyxia is in newborns.

Asphyxia against the background of chronic antenatal fetal hypoxia

Insufficient supply of oxygen to the fetus leads to stable hypoxia and increases the likelihood of a child being born with asphyxia.
Causes of antenatal fetal asphyxia:

• The presence of chronic, infectious, endocrine diseases in a woman;
• low hemoglobin;
• unbalanced diet during pregnancy;
• lack of vitamins and minerals (in particular, iron);
• exposure to toxins during pregnancy;
• anomalies in the development of the placenta or umbilical cord.

Acute asphyxia on the background of intranatal hypoxia

The birth process is a great stress for both the woman and the child. At this stage, risk factors include:

• Abnormal position of the fetus;
• deviations during pregnancy and childbirth - premature, rapid, belated;
• maternal hypoxia during childbirth;
• fetal aspiration of amniotic fluid;
• trauma to the brain or spinal cord;
• the use of painkillers during childbirth;
• C-section.

It would be wrong to assume that any hypoxia will inevitably lead to postnatal asphyxia. For example, caesarean section is being used more and more frequently. In most cases, healthy children are born.

Degrees of asphyxia in newborns

For a more detailed understanding of what asphyxia is in a child, a special scale developed by Virginia Apgar, an anesthesiologist from the USA, is used.

In accordance with the ICD, two forms of suffocation are distinguished:

• moderate;
• heavy.

Table. Characteristics of mild (moderate) and severe asphyxia in newborns.

Causes of asphyxia in newborns

There are two groups of reasons:

• intrauterine hypoxia;
• inability of the newborn to adapt to postnatal circulation and respiration.

Intrauterine hypoxia can occur for numerous reasons, among which the main ones include:

• Violation of the blood supply to the fetus through the umbilical cord (presence of nodes, mechanical compression);
• placental disorders (insufficient gas exchange, low or high blood pressure, edema, heart attacks, inflammation, premature detachment);
• pathologies in a pregnant woman (cardiac, hematopoietic, pulmonary, endocrine diseases);
• smoking, alcohol abuse or systemic exposure to other toxic substances during pregnancy.

The inability of the child to go to postnatal breathing is based on the following reasons:

• Systemic developmental disorders, including as a result of intrauterine hypoxia;
• congenital stenosis (narrowing) of the airways;
• birth trauma of the brain;
• disorders of the thyroid gland;
• prematurity.

Treatment of asphyxia in newborns

newborns

First aid for asphyxia in a newborn involves the following steps:

• The child is placed under a heat source;
• dry the skin;
• conduct tactile stimulation on the back, sole of the foot;
• put the child on his back, throw his head back a little;
• clean the mouth and nasopharynx from the contents;
• amniotic fluid is sucked out of the respiratory tract using an endotracheal tube;
• in case of insufficient breathing or its complete absence, hardware ventilation of the lungs is started;
• with prolonged ventilation of the lungs, a probe is inserted into the stomach, through which the gas accumulating in it is sucked off.

All the above steps are carried out quickly for 2-3 minutes, periodically fixing vital signs. If, after the manipulations, the heart rate reached 100 bpm, spontaneous breathing appeared, and the skin became pinkish, artificial ventilation was stopped. If the child's condition has not improved, continue further resuscitation.

Resuscitation of newborns with asphyxia

Resuscitation is continued with an indirect heart massage, which is carried out for 30 s. If heart contractions remain at the level of 60-80 beats / min. or absent altogether resort to medication.

1. Adrenalin

A solution of adrenaline is administered intravenously at a dosage of up to 0.3 ml / kg. It enhances heart contractions, increases its blood supply, increases blood pressure, and has a bronchodilatory effect.

If, within 30 seconds after the administration of adrenaline, the heartbeat does not accelerate above 80 beats / min, repeat again.

1. infusion therapy.

In cases where there is no effect from the measures taken, blood volume replenishers are used - solutions of albumin, sodium chloride - at the rate of 10 ml / kg intravenously for 5 minutes.

In conjunction with other resuscitation measures, the introduction of blood replenishing drugs improves blood circulation, increases blood pressure and heart rate.

If the measures taken are ineffective, intravenous administration of a 4% solution of sodium bicarbonate at a dosage of 4 ml / kg is indicated.

If necessary, pulmonary ventilation and fluid therapy continue as part of post-resuscitation intensive care.

Prevention of asphyxia in newborns

Prevention includes:

• Right way of life;
• timely preparation for pregnancy, including treatment of chronic somatic and endocrine diseases;
• intensive and effective treatment of infectious diseases during pregnancy;
• observation by a gynecologist during pregnancy.

Effective measures should include:

• Quit smoking and alcohol;
• compliance with the daily routine;
• daily walks several times a day;
• a balanced diet rich in vegetables, proteins, amino acids, vitamins and trace elements;
• additional vitamin support;
• positive emotions and a calm balanced state.

Caring for a child after suffering asphyxia

A child who has undergone asphyxia has a high probability of developing disorders of the nervous system. After discharge from the hospital, such a child should be under the supervision of a neurologist. No special home care is required.

The consequences of asphyxia in a newborn during childbirth

The most vulnerable in oxygen deficiency is the nervous tissue. Long periods of hypoxia during the formation of the fetal nervous system, as well as as a result of an acute lack of oxygen during childbirth, significantly increase the likelihood of developing certain disorders.

The consequences of severe neonatal asphyxia are manifested primarily in a poor response to resuscitation. In the absence of positive dynamics in the state of the newborn at the 20th minute after birth, the probability of death increases and amounts to:

• up to 60% - in those born in a normal period;
• up to 100% - in prematurely born.

The consequences of severe birth trauma asphyxia are reflected in the brain. For example, a child's poor response to resuscitation within 15 minutes after birth results in the development of cerebral palsy in 10% of cases, and within 20 minutes - in 60%. But these are very difficult cases.

More common are cases of moderate suffocation during childbirth. The consequences of asphyxia of newborns at an older age manifest themselves in different ways, but all of them will be associated with the functioning of the nervous system.

Such children, for example, are too active or, conversely, too phlegmatic. Sometimes they may not do well at school, but, on the contrary, they show themselves well in creative activities, circles. A possible later appearance of speech was noted.

Similar variations in the development of the child can also occur for other reasons unrelated to birth asphyxia. All this is usually called in one word - individuality, and should not cause concern to parents.

Conclusion

Despite the fact that the complete absence of breathing at birth occurs only in 6% of cases of all hypoxic conditions, to one degree or another, birth asphyxia is a phenomenon that occurs much more often than many people think. The consequences of asphyxia in a newborn may be delayed in the later life of the child. Any expectant mother should be attentive to her health, keep a calm and positive mood during pregnancy.

In the video, the doctor gives advice on behavior during childbirth, which will reduce the risk of developing newborn asphyxia

Asphyxia of newborns is a pathology manifested by the child's inability to breathe independently, as a result of which hypoxia develops, while the heart functions normally.

Lack of oxygen in this case can lead to the most serious consequences, up to the death of the baby. To eliminate the consequences, the born child needs urgent resuscitation. The consequences of asphyxia depend on the severity and timely provision of qualified medical care.

Asphyxia of newborns is classified according to the time of development:

• primary - appears in utero;
• secondary - characterized by the appearance in the first day of the baby's life.

Also in terms of severity:

• light;
• moderate;
• heavy;
• clinical death.

According to statistics, approximately 4-6% of all children born suffer from this pathology. The consequences of neonatal asphyxia are very severe, it is one of the frequent causes of death or stillbirth.

The reasons

Primary and secondary types of asphyxia can occur for various reasons. The first is a chronic or acute condition that appears as a result of such provoking factors:

• trauma received by a child in the womb or during childbirth;
• malformations associated with the respiratory system;
• immunological incompatibility;
• Rhesus conflict;
• intrauterine infection;
• postmaturity;
• premature aging of the placenta or its detachment;
• multiple pregnancy;
• little or polyhydramnios;
• rapid childbirth;
• uterine rupture;
• obstruction of the airways with amniotic fluid, meconium, or mucus.

Various pathologies during pregnancy can cause the development of asphyxia in a newborn

In addition, extragenital diseases of the mother can also cause suffocation. For example, it can be diseases of the cardiovascular system, diabetes mellitus, anemia, high blood pressure, swelling of the extremities.

The list continues with shock during childbirth, smoking and alcoholism, nutritional deficiencies, and medication. Other causes of fetal asphyxia are impaired functioning of the placenta, umbilical cord, premature discharge of amniotic fluid.

Secondary asphyxia is a pathology that occurs on the first day after birth. It can occur for the following reasons: heart disease, trauma at birth, disruption of the central nervous system, poor blood supply to brain cells, hemorrhage in the lungs, atelectasis in the lungs, aspiration of milk after feeding.

This pathology is not an independent disease, but is a consequence of complications during the period of gestation, diseases of the mother and fetus.

Symptoms

As already mentioned, there are 4 degrees of development of asphyxia. Each is characterized by individual symptoms of manifestation.

The condition of the child is assessed on the Apgar scale in the first minute of life

The main symptom of newborn asphyxia is hypoxia, which results in a decrease in heart rate, the development of CNS pathology, a decrease in reflexes and muscle tone.

Effects

Immediately after the birth of the child, it is assessed on the Apgar scale - from 0 to 10 points. Repeat this procedure after 5 minutes. If improvements are detected, the prognosis of the condition of the newborn is positive. If breathing does not improve, then this can lead to the following consequences.

With asphyxia in a newborn, metabolic processes are disturbed, which are more pronounced with a severe degree of pathology.

In case of asphyxia, it is important to carry out timely medical intervention

Acute asphyxia caused by a chronic lack of oxygen in a child is characterized by complications such as a decrease in blood volume, it becomes thick and viscous. Hypoxia entails hemorrhages in the brain, kidneys, liver, as well as a decrease in pressure and a decrease in heart rate.

After asphyxia, infants must be constantly monitored by a pediatrician - this will reduce the risks for damage to health. When transferring a pathological condition of a mild degree, the consequences can be avoided.

Diagnostics

Diagnosis - asphyxia of the newborn is made in the first minute after birth. Diagnostics includes tracking such basic functions:

• breathing rate;
• heartbeat;
• muscle tone;
• reflex activity;
• coloration of the skin.

In addition to the examination and assessment of the child's condition on the Apgar scale, a study of the acid-base state of the blood is carried out. To identify destructive processes in the brain, ultrasound and a neurological examination are performed. In case of respiratory failure and hypoxia in a child, emergency care and resuscitation are required.

Resuscitation and treatment

The sooner the treatment of a newborn with asphyxia is started, the fewer risks and consequences for the child in the future. For this reason, first aid to the baby is provided in the delivery room.

It follows in this order:

• Clear the airways of mucus, amniotic fluid, meconium.
• Restore breathing activity.
• Provide support for blood circulation.

In the process of resuscitation, it is necessary to monitor changes in heart rate and breathing, changes in skin color. In the absence of meconium in the amniotic fluid, the sequence of actions is as follows:

• The child is placed under infrared radiation.
• They suck out all the excess from the respiratory tract and dry the baby's skin with a diaper.
• Lay the newborn on his back, placing a roller under his shoulders.
• Stimulate breathing by massaging the back along the line of the spine and slapping the heels.

Assistance to the baby should occur in an urgent manner

If meconium is present in the amniotic fluid, then it is necessary to additionally clean the trachea, then once again carry out the procedure in the respiratory tract. If the heart rate is less than 80 beats per minute, it is necessary to connect a ventilator and conduct an indirect heart massage.

If there is no improvement within 30 seconds, then a solution of adrenaline is injected through the umbilical vein at a concentration of 0.01%.

When a child is born in a state of clinical death, resuscitation lasts 20 minutes, if there are no signs of life, then doctors stop resuscitation. After resuscitation, the child is placed in the intensive care unit. Vitamins, Vikasol, Cocarboxylase, ATP, calcium gluconate, infusion therapy are prescribed.

With a mild degree of pathology, the newborn is placed in an oxygen chamber, with a severe one - in an incubator, providing peace, warmth and antibiotic therapy. It is possible to feed a baby with a mild degree of asphyxia after 16 hours; in case of severe pathology, feeding begins a day later with the help of a probe.

The start of breastfeeding is considered individually, depending on the condition. Treatment can last from 10 to 15 days, depending on the condition of the child.

Forecast

The prognosis and consequences for a child who has had asphyxia depend on the severity and how correctly and timely primary care is provided. With an increase in the Apgar score after 5 minutes of life, a favorable prognosis is made. The first year of life, such a child may be hyper- or hypoactive. He can be tormented by convulsions and hypertensive-hydrocephalic encephalopathy. Some children die after this pathology.

Caring for a child after asphyxia

After the transfer of the pathology, the baby must be provided with complete rest. It must be placed in such a position that the head is raised. It is necessary to carry out oxygen therapy by placing the child in a special tent where oxygen is at a higher concentration. The time spent in it is individual, determined by the doctor and depends on the condition of the newborn.

It is very important for an infant with asphyxia to provide a high level of oxygen.

After severe asphyxia, the child is placed in an incubator where the percentage of oxygen in the air is 40%. If this equipment is not available in the maternity hospital, a breathing mask or nasal prongs are used to provide oxygen.

A child after a pathology needs constant monitoring. It is necessary to monitor the temperature, the work of the digestive tract and kidneys. In most cases, the airway is re-cleared.
After discharge, the newborn should be observed at the place of residence by a pediatrician and a neurologist in order to exclude CNS complications.

Prevention

• timely conduct an examination of the development of the embryo - ultrasound, observation by a gynecologist, laboratory tests, CTG;
• walk in the fresh air, away from cars;
• stop drinking alcohol and smoking;
• take vitamin complexes;
• monitor sleep and rest;
• eat properly.

Prevention at the stage of pregnancy planning consists in observing a gynecologist, following his recommendations, and undergoing a full examination. This is especially important for women suffering from endocrine disorders, infections and chronic diseases.

nursing

An infant after asphyxia requires special conditions. To do this, parents need to know the nursing process - a science-based technology for caring for a baby. Thanks to these activities, the correct conditions for the child's stay are provided, contributing to the improvement of his condition.

In the intensive care unit, child care is provided using nursing technology

In addition, nursing intervention provides support for mom and dad of the newborn. This process includes:

• Informing parents about the factors contributing to the development of suffocation, the course of pathology and prognosis.
• Creation of suitable conditions in the intensive care unit where the patient stays.
• Carrying out careful care of the child, carrying out the procedure without disturbing him and without transferring him from the crib.
• Tracking the condition of the baby and writing records of breathing, heartbeat, pressure, skin color, tone and reflexes, convulsions, regurgitation, reflexes.
• Monitor diuresis, temperature, weight and document changes. Making a change in the position of the baby, holding a toilet and hygiene, providing oxygen saturation.
• The work of sanitation of the trachea and cleansing of the respiratory tract.
• Assessing the result of treatment, making adjustments to treatment, consulting with a doctor, fulfilling his appointment.
• Collection of analyzes for laboratory research.
• Making sure food is provided in the right way.
• Interaction with parents, explanation of the course of therapy, notification of manipulations, further observation by a pediatrician and other specialists.
• Explanation to parents of the importance of conducting rehabilitation therapy, monitoring the development and abilities of the child. Conducting classes with him, aimed at stimulating mental and physical activity.

After asphyxia, the child is observed by a neurologist for two years. There are also courses of treatment in sanatoriums and resorts. During the examination, which showed clear improvements and the absence of disturbances in development and condition, a small patient is removed from the dispensary.