Asphyxia of newborn consequences. What to do after discharge from the maternity hospital? Measures for the prevention of asphyxia in newborns

Asphyxia in a newborn is a pathology of the infant's respiratory function, with the concomitant development of oxygen deficiency. Such a problem can occur both during the birth process and during the first days after the baby is born. Asphyxia is enough dangerous state requiring the provision of competent and, importantly, timely professional assistance.

Varieties and degrees of asphyxia in newborns

Asphyxia in newborn babies is a fairly common problem. Depending on the causes of its occurrence, doctors distinguish 2 types of asphyxia:

1. Intrauterine- develops against the background of a long stay of the baby in the mother's womb.
2. Postpartum- is a complication of the birth process.

note: according to statistics, manifestations of asphyxia are diagnosed in 4% of newborn babies!

Depending on the severity of manifestations, asphyxia is divided into 3 degrees: mild, moderate, severe. The pathological process is accompanied by a disorder of the respiratory function and disturbances in the activity of the cardiovascular system. The reasons that can provoke the development of asphyxia in a newborn are numerous and varied. In many ways, provoking factors depend on the type of pathology and the time of its manifestation (primary or secondary).

What causes intrauterine asphyxia?

Primary intrauterine asphyxia, in most cases, develops against the background of a long, located in the womb . provoke this pathology According to doctors, the following factors can:

Important! The presence in the expectant mother of diseases of an infectious, cardiovascular and endocrine nature, occurring in chronic form, increase the risk of asphyxia in the baby. Therefore, a pregnant woman with such health problems should be under the constant supervision of the attending physician!

Causes of postpartum asphyxia

Primary postpartum asphyxia occurs mainly against the background of violations of the birth process and congenital diseases the baby himself .

The causes of this pathology in a newborn may be the following factors:

Important! Most often, postpartum asphyxia is diagnosed in. Also, defects can lead to this problem. internal organs fetus, so during pregnancy it is important to do control, so that doctors are as ready as possible to provide first aid to the baby.

What complications during childbirth can lead to asphyxia?

Quite often, asphyxia in an infant is recorded in the case of difficult childbirth. According to obstetrician-gynecologists, the following complications of the birth process lead to the development of pathology:

What causes secondary asphyxia?

Problems with the respiratory system can occur in a baby a few days after he is born.

This type of pathology is called secondary asphyxia.

To possible reasons Doctors attribute the following factors:

• constriction respiratory tract(stenosis);
• hemorrhages in the lungs;
• not detected immediately after birth;
• violations of circulatory processes in the brain area;
• pneumopathy;
• manifestations of respiratory distress syndrome;
• hyaline membranes;
• the presence of atelectasis, localized in the lungs;
• insufficient sanitation gastric cavity after the birth of the baby;
• disorders in the activity of the central nervous system.

Important! The ingress of breast milk or mixture during feeding into the respiratory tract of the baby can also lead to the development of secondary asphyxia!

How does pathology manifest itself?

Clinical manifestations of asphyxia in newborn babies depend on the severity pathological process. In the case of mild asphyxia, the child may show signs such as weakened respiratory function, blue color of the skin in the area of ​​the lips and nose, reduced muscle tone.

For a moderate degree of asphyxia, the following signs are characteristic:

With a severe degree of asphyxia, the baby's breathing is either completely absent, or manifested by rare, superficial breaths.

In addition, the child has the following alarming symptoms:

• severe bradycardia;
• violations heart rate ();
• decline muscle tone;
• pallor of the skin and mucous membranes;
• numerous hemorrhages in the area of ​​the skin.

Important! In the absence of any signs of life, the newborn is recorded clinical death. In this case, the child needs urgent help from resuscitators!

Consequences of asphyxia of newborns

Asphyxia is an extremely serious and dangerous condition, which is fraught with numerous complications.

Among early complications of this pathology, physicians distinguish the following:

• necrotic processes;
• swelling and hemorrhage in the brain area;

Important! In the absence of timely medical care, asphyxia can lead to blockage of the respiratory function and death of the baby!

However, even if the efforts of doctors were crowned with success, and respiratory function the infant was restored within a few months, the following complications are highly likely to occur, which are classified as late:

• blood poisoning;
• hydrocephalus;
• encephalopathy;
• increased excitability of the nervous system;
• slow reactions;
• convulsive syndrome;
• disturbances in the functioning of the gastrointestinal tract.

Note: a baby who has undergone asphyxia should be under the supervision of a qualified specialist during the first year of life!

First aid measures for asphyxia of the newborn

If signs characteristic of asphyxia appear, the infant needs urgent health care ! Therapeutic measures begin with draining skin baby and place him under a heat source.

The newborn is placed on its back, slightly tilting its head back, after which the area of ​​​​the nasopharynx is thoroughly cleaned and oral cavity, as well as the respiratory tract from the remnants of amniotic fluid.

In case of weakening or complete absence of respiratory function, doctors resort to hardware ventilation of the lungs and purification of the gastric cavity from accumulated gases, using a special probe for this purpose.

note: if the measures listed above do not bring proper results within 3 minutes, the doctors inject Adrenaline to the child, do indirect stimulation of the heart area (massage), and perform infusion therapy!

Therapy after asphyxia

Therapy of young patients after asphyxia should be aimed at preventing the development possible complications, especially hemorrhages in the brain area. In most cases, babies are recommended such medications, as glutamine and a nicotinic acid, Vikasol, Dicinon, etc. In without fail a course of oxygen therapy.

Further treatment depends on general condition the child, presenting symptoms and general clinical picture, and therefore is selected by a specialist pediatrician on an individual basis. Average duration The therapeutic course is about 2 weeks.

note: You can feed a child after suffering asphyxia no earlier than after 15-16 hours. Infants with severe asphyxia are usually fed by tube after 24 hours.

For the rehabilitation of a child after asphyxia for 3 years, physiotherapeutic procedures such as massage and therapeutic exercises are recommended.

Further care

After discharge from the maternity hospital, it is important to strictly follow all the recommendations issued by the specialist regarding further treatment and care of the baby! Pediatricians do not recommend starting complementary foods for children who have had asphyxia earlier one year old. If there is such an opportunity, it is desirable that the baby eat mother's milk until one and a half years old.

Since babies with asphyxia are especially susceptible to viral and infectious nature, in preventive purposes pediatricians recommend them a course of vitamin therapy.

About prevention

Prevent the development of asphyxia in a baby future mom can if it does following recommendations specialists:

1. . Even before conception, undergo a comprehensive medical examination and treat all identified pathologies.
2. Eat healthy and nutritious meals while you're expecting a baby.
3. Take special vitamin and mineral complexes for expectant mothers.
4. Do gymnastics for pregnant women, regularly take walks on fresh air and avoid psycho-emotional shocks.

Of great importance in the prevention of asphyxia in newborns is the regular visit by the expectant mother to a gynecologist, scheduled ultrasound and delivery laboratory tests . Timely diagnosis will allow to identify and treat possible complications during pregnancy, fraught with subsequent asphyxia (such as preeclampsia, hypoxia, placental insufficiency, etc.).

note: according to statistics, measures to prevent asphyxia in newborns give positive results in 40% of cases!

Asphyxia in newborns is a dangerous condition, fraught with complete inhibition of respiratory function and the development of severe complications. At the first signs characteristic of this pathology, the baby needs urgent help doctors - resuscitators! Subsequent treatment is aimed at preventing possible complications and is established on an individual basis. The causes of asphyxia are very diverse, however, pregnancy planning and strict observance the future mother of the recommendations of a specialist will allow to reduce possible risks to the minimum!

Betsik Julia, obstetrician-gynecologist

The pathological condition of the newborn, due to respiratory failure and resulting oxygen deficiency.

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

Etiology.

The causes of primary A. N. are acute and chronic intrauterine oxygen deficiency - fetal hypoxia, intracranial 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), defects fetal development.

The occurrence is facilitated by extragenital diseases of a 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-pregnancy, premature detachment of the placenta, pathology of the umbilical cord, fetal membranes and placenta, complications in childbirth (untimely rupture 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 may be associated with impaired cerebral circulation in a newborn, pneumopathy, etc.

Pathogenesis.

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. A. n., 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.

clinical picture.

The leading symptom of A. n. is a violation of breathing, leading to a change in cardiac activity and hemodynamics, a violation of neuromuscular conduction and reflexes. Severity A. n. determined by the Apgar scale (see Apgar method). Allocate A. n. moderate and severe (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 (Apgar score in the first minute after birth 7-6 points),
• moderate (5-4 points)
• 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 severity of asphyxia is also indicated by indicators of the acid-base state (see. Acid-base balance). So, if in healthy newborns the pH of blood taken from the 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.

Children born in asphyxia need resuscitation assistance. Its effectiveness largely depends on how early treatment is started. Resuscitation is 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 using 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 spontaneous breath within 15-20 minutes, resuscitation is stopped even if there is 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. With a heart rate of less than 50 beats per 1 min or with 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 department, where measures are taken to prevent and eliminate cerebral edema, restore hemodynamic and microcirculation disorders, normalize metabolism and kidney function. Craniocerebral hypothermia is carried out - local cooling of the head of the newborn (see Artificial hypothermia) 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 child's condition, 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. With 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 (with 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.

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.

Asphyxia is one of the most common pathologies in newborns. Asphyxia of newborns in medicine means a pathological condition that occurs in the early neonatal period, due to impaired respiratory function, the occurrence of hypoxia and, as a result, oxygen starvation in an infant.

This condition can occur both during childbirth and over the next two to three days. Neonatal asphyxia occurs in approximately five births out of a hundred, such newborns need to be resuscitation. Depending on the lack of oxygen and the accumulation of carbon dioxide in the tissues and blood of the child, the severity of the condition is diagnosed.

Asphyxia classification

Depending on the time interval for the manifestation of signs of asphyxia, it is divided into:

• Primary, developing during birth,
• Secondary, the manifestations of which are diagnosed more than an hour after birth.

Primary asphyxia can develop even before the child is taken out, this is due to a lack of oxygen and an increase in carbon dioxide in a pregnant woman, which occurs due to various diseases: heart defects, pneumonia, tuberculosis and emphysema.

Asphyxia of newborns is divided into degrees, each of which is characterized by the severity of the condition. There are four degrees of asphyxia in newborns:

1. Mild asphyxia of newborns: the baby takes a breath on his own, however, breathing is weak, sharp, muscle tone is reduced, the nasolabial triangle is cyanotic, the child has sneezing or coughing. Asphyxia of newborns on the Apgar scale for a child is six to seven points.
2. Medium or moderate neonatal asphyxia: the condition is estimated at four to five points. The newborn begins to breathe on his own, breathing is assessed as weak and irregular, the cry of the child is more like a squeak, stable bradycardia is observed. The muscle tone is reduced, the cyanosis of the bones, feet and face is pronounced, there is a pulsation on the umbilical cord.
3. Severe neonatal asphyxia: the child's condition is estimated at one to three points, respiratory function is completely absent or breathing is rare and irregular. The baby does not make any sounds, heartbeats are extremely rare, muscle tone may be completely absent, the skin is pale, there is no pulsation of the umbilical cord.
4. Clinical death - complete absence all signs of life, urgent resuscitation is required.

Causes of asphyxia in newborns

Asphyxia of newborns, although it occurs spontaneously, it is always due to a number of reasons. The main reasons that lead to the occurrence of asphyxia during birth are:

• Violation or complete cessation blood circulation in the umbilical cord,
• Violation of placental gas exchange, for example, due to pathologies of the placenta or high blood pressure in a pregnant woman, or due to irregular or stopped contractions.
• Lack of oxygen in the mother's blood, which occurs, for example, due to anemia, cardiovascular pathologies, diabetes, diseases respiratory system.
• Poor quality respiratory movements newborn, usually occur due to drug treatment of the mother during pregnancy, the pathology of lung development in the fetus.
• Brain injury received during childbirth.
• Rhesus conflict during pregnancy.
• Intrauterine infections: rubella, venereal diseases, and others.
• Entry into the nasal cavity, pharynx, larynx or trachea of ​​amniotic fluid, mucus or meconium, which causes their blockage.

Secondary asphyxia of newborns develops due to the following factors:

1. insufficient blood supply to the brain
2. airway aspiration,
3. Congenital malformations of the lungs, heart, brain,
4. Pneumopathy in premature babies occurs due to the immaturity of the lungs.

Clinical manifestations of asphyxia

Primary asphyxia of newborns is diagnosed in the first seconds of life. To do this, an objective assessment of the frequency and adequacy of breathing, skin color, muscle tone, heart rate, reflex excitability is carried out. The main sign of asphyxia is a violation of breathing, which results in a violation of the heart rhythm and blood circulation, which in turn entails conduction disturbances in the nerves, muscles and impaired reflexes. Depending on the severity of the symptoms, the condition of the newborn and the degree of asphyxia are assessed according to the Apgar scale, and the severity of asphyxia is revealed.

The severity of asphyxia causes a restructuring of the metabolism in the child's body, which leads to cellular overhydration. In the blood of a newborn, the volume of circulating erythrocytes increases, which leads to an increase in blood viscosity and an increase in the aggregation ability of platelets. This leads to disturbances in blood dynamics and, as a result, to a decrease in heart rate, arterial pressure decreases, the work of the kidneys is disturbed.

Unfortunately, the more severe asphyxia of newborns, the more complications are provoked, which are observed in the first twenty-four hours of life:

• brain hemorrhage,
• swelling of the brain,
• brain necrosis,
• myocardial ischemia,
• Thrombosis of the renal vessels.

In more late period the child may develop meningitis, sepsis, hydrocephalus, pneumonia.

Diagnosis of asphyxia in newborns

It is not difficult to diagnose asphyxia, but it is very important to correctly assess the degree of lesions in a newborn. To do this, the child undergoes a series of diagnostic measures. It is mandatory to conduct a blood test from the umbilical vein - blood pH 9-12 mmol / l are mild asphyxia, and an indicator of 7.1 BE -19 mmol / g or more correspond to a severe degree.

A newborn is necessarily shown neurosonography, due to which it is determined what caused the brain damage - trauma or hypoxia. Neurosonography can detect damage different departments brain - intraventricular, subdural hemorrhages and others.

Treatment of asphyxia of newborns

Assistance with asphyxia of newborns is provided in the delivery room, and the pediatric resuscitator and neonatologist are responsible for resuscitation and further procedures.

Resuscitation of a newborn with asphyxia includes the removal of mucus from the respiratory tract and mouth of the child, if after these activities the child does not begin to breathe, then the baby is lightly slapped on the heels. If the child’s breathing is absent or it remains irregular, then the neonatologist connects the newborn to the apparatus artificial ventilation lungs, an oxygen mask is put on his face, through which oxygen is supplied.

It is strictly forbidden for a stream of oxygen to be directed directly into the face of a newborn, it is also impossible to water the baby with cold or hot water, spank on the buttocks and press on the heart area. In the event that the child is on the device artificial respiration is more than two minutes, a probe is inserted into the stomach to remove gastric contents.

When the heart rate drops critically, that is, it is eighty beats per minute or less, an indirect heart massage is shown to the child. To support the life of the child, the necessary drugs are injected into the umbilical vein.

In the event that a child has been diagnosed with clinical death, intubation is immediately performed and drug therapy, resuscitation is terminated in the event that twenty-minute resuscitation measures have not restored cardiac activity.

If a resuscitation were successful, the newborn is transferred to the intensive care unit. Further treatment depends on the state of the child's body and the identified lesions of systems and organs.

To prevent cerebral edema, the baby is injected with plasma and cryoplasma, mannitol through the umbilical catheter, and special drugs are prescribed to restore the blood supply to the brain, such as cavinton, vinpocetine, and antihopoxants are also mandatory for the child.

AT complex therapy the child is prescribed diuretic and hemostatic drugs. In the intensive care unit, the child undergoes symptomatic treatment, therapy is carried out to prevent seizures and hydrocephalic syndrome, for this, anticonvulsant drugs are administered to the newborn.

If necessary, the baby is corrected for metabolic disorders, intravenous infusions are carried out saline solutions and glucose solution.

To monitor the child's condition, he is weighed twice a day, his somatic and neurological status is assessed. The baby is constantly undergoing laboratory and clinical studies:

1. a clinical blood test, the level of hematocrit and platelets is necessarily determined;
2. blood chemistry,
3. blood sugar test,
4. acid-base state and electrolytes,
5. blood clotting,
6. bacterial culture from the nasopharynx and rectum.
7. mandatory examination of the abdominal cavity organs is carried out for the newborn,
8. with asphyxia of moderate and severe severity, radiography is performed chest and belly.

Usually treatment lasts about two weeks, but can last more than 21-30 days, and in severe cases even longer.

Proper care of a newborn in a hospital

Newborns who have suffered asphyxia need special care. Measures for asphyxia of a newborn are carried out strictly according to medical protocols. The child should be at constant rest, the baby's head should be in a slightly elevated state. The child is provided with oxygen therapy. If the baby was diagnosed with mild asphyxia, then he should be in the oxygen chamber, the length of stay in it for each little patient individual. If the degree of asphyxia is moderate or severe, then the child is placed in a special incubator, where oxygen is constantly supplied, the concentration of which is about 40%, if there is no incubator in the hospital, the child is put on special oxygen masks.

In intensive care units, babies receive appropriate drug treatment. In newborns after asphyxia, constant control body temperature, bowel function, urine output. Feeding of newborns with a mild degree of asphyxia begins sixteen hours after birth, with a severe degree 22-26 hours after birth using a tube. The decision to start breastfeeding is made by the doctor in each case individually.

Consequences of asphyxia of newborns and further prognosis

Asphyxia of newborns does not pass without a trace, it leaves its mark on further development and child health. This is explained by the fact that all human systems and organs need oxygen, and even its short-term lack causes damage to them.

The degree of damage to organs depends on time oxygen starvation and the sensitivity of a particular organ to a lack of oxygen. So at low degree of asphyxia, 97% of children continue to develop without deviations, with an average degree, this figure decreases to 20%, and with a severe degree, about 50% die in the first week of life, and of the survivors, 80% of children remain disabled for life. In especially severe cases, the consequences are irreversible.

The lack of oxygen as a result of asphyxia causes damage to the following systems:

• Brain,
• Respiratory system,
• Heart and vascular system,
• digestive organs,
• Urinary system,
• Endocrine system.

The severity of disorders in the work of the brain directly depends on the severity of diagnosed asphyxia. There are three degrees of HIE (hypoxic-ischemic encephalopathy) arising from asphyxia of the newborn:

1. Mild: muscle hypertonicity occurs, the child cries at the slightest touch;
2. Average: decrease in muscle tone, the child is lethargic, inhibited, does not respond to manipulations carried out with him. The baby has convulsions, breathing can become spontaneous, the heart rate decreases.
3. Severe: the child is apathetic to any manipulations, there are no reflexes, apnea, bradycardia are observed. Such disorders are manifested in cerebral edema, cerebral hemorrhages and necrosis of the medulla.

Violations of the respiratory system are expressed in the form of hyperventilation of the lungs, that is, frequent intermittent breathing with difficulty inhaling. Children may also develop pulmonary hypertension.

If the heart and blood vessels are affected, then the baby may experience a decrease contractile abilities myocardium, necrosis of the papillary muscles of the heart, myocardial ischemia, lowering blood pressure.

Quite often, after asphyxia, newborns develop pathologies of the digestive and excretory systems organism. Sometimes when breastfeeding, these children experience aspiration of food, in which case breast-feeding stop. Also, the child may have violations of the act of sucking and there may be problems with intestinal motility. After a severe degree of asphyxia, children may develop necrotizing enterocolitis, necrosis of part of the intestine, which can even lead to the death of a newborn.

Kidney damage is usually expressed in reduced filtering function and the appearance of blood in the urine. Endocrine disorders expressed in the appearance of hemorrhage in the adrenal glands, this condition almost always ends in death.

After suffering asphyxia, malfunctions in the child's body may occur over the next eighteen months of the baby's life. So in such children, pathologies such as:

• hyperexcitability syndrome,
• hypoexcitability syndrome,
• hypertensive hydrocephalic encephalopathy,
• Convulsive perinatal encephalopathy,
• hypothalamic disorder,
• convulsive syndrome,
• Syndrome sudden death newborn.

Growing up, the child retains the consequences of oxygen starvation, for example, lags in the development of speech, inappropriate actions, reduced school performance, reduced immunity, which leads to frequent illnesses, approximately 25% of children remain behind in physical and mental health.

Prevention of asphyxia in newborns

The gynecological service is interested in preventing the development of pathologies in newborns, including asphyxia. However, the prevention of asphyxia should be carried out not only by obstetricians and gynecologists, but also by the future mommy in close association with physicians.

Risk factors during pregnancy include:

1. Infectious diseases,
2. Mother's age over 35 years
3. Hormonal disorders,
4. Endocrine disorders in pregnant women
5. stressful situations,
6. Alcohol, smoking, drugs,
7. Intrauterine fetal hypoxia.

During pregnancy, it is very important to timely and regularly visit a gynecologist and pass a medical commission of medical specialists before the thirtieth week of pregnancy.

The woman must have three ultrasound examinations and screenings at 11-13, 18-21 and 30-32 weeks. These studies help to find out the condition of the fetus, placenta, exclude the absence of oxygen starvation, if there is a suspicion of fetal hypoxia, the woman will be prescribed appropriate drug therapy.

The expectant mother should follow her lifestyle - relax more, make hiking because they oxygenate the blood. A pregnant woman should have enough time for sleep, at least nine hours, it is very good if she has and daytime sleep. The diet of the expectant mother should consist of useful products, but harmful products it is better to exclude it altogether, just as prescribed by a doctor, a woman should take a mineral-vitamin complex.

Unfortunately, to give a 100% guarantee that will be born healthy child, more than one doctor will not give, however, the expectant mother must do everything in her power to ensure that the child is born healthy.

In order to minimize the consequences of asphyxia in a newborn, after arriving home from medical institution the baby should be taken to the dispensary by a neurologist and a pediatrician, this is necessary for correct assessment growth and development of the child and to prevent the development of disorders in the activity of the central nervous system further.

Insufficient supply of oxygen to the body is very dangerous for normal activities all organs, tissues and cells human body. And than longer man experiencing a lack of oxygen, the more pronounced Negative consequences may come. This condition is considered especially dangerous if we are talking about more developing organism- fetus or newborn baby. With an acute lack of oxygen, children can face directly at the time of birth. Let's talk about what neonatal asphyxia is, consider the consequences of such a violation and the degree of asphyxia on the Apgar scale, and also figure out how a newborn is resuscitated during asphyxia.

The term neonatal asphyxia refers to critical situation, which develops due to impaired gas exchange: due to oxygen deficiency and carbon dioxide accumulation. Such a pathological condition makes itself felt by the absence of breathing or its weakness against the background of the intact work of the heart.

Neonatal asphyxia during childbirth may be due to intracranial injury newborn, received during the passage through birth canal. It can also be provoked by cord entanglement, oligohydramnios, blockage of the respiratory tract with mucus, malformations, etc.

The degree of asphyxia of newborns according to the APGAR scale

When a baby is born, doctors evaluate his condition, focusing on the criteria of the Apgar scale.

So if the baby is completely healthy, they talk about eight to ten points on the Apgar scale. At mild degree asphyxia, we are talking about six to seven points, and with an average - about four to five points. If severe asphyxia has occurred, the baby needs resuscitation, and his condition is estimated at zero to three points on the Apgar scale.

Children after asphyxia in a mild degree have a decrease in muscle tone, as well as respiratory activity. The lack of oxygen causes a decrease in physiological reflexes. Breathing in such children is superficial, diffuse cyanosis is recorded. However, the child's condition stabilizes rather quickly, after two or three days the baby feels good.

If a child is born with medium degree asphyxia, he does not have physiological reflexes, a noticeable decrease in tone is recorded, motor activity and pain sensitivity. There is marked cyanosis.

Severe asphyxia is often incompatible with life, in this case the child does not breathe on his own, he does not have physiological reflexes, the pulse is thready, and the heartbeat is weak.

What threatens asphyxia during childbirth, what are its consequences

Birth asphyxia of the brain in newborns, which we continue to talk about on this page www .. They can be early or late. The first include swelling of the brain, hemorrhages in the brain and its necrosis. BUT late complications can be infectious ( , ) or neurological ( or ).

The consequences of asphyxia during childbirth are usually diagnosed in the first year of a baby's life. They can be represented by hyperexcitability, delayed reactions, convulsive syndrome, encephalopathy and even the death of the baby.

Many children who have suffered asphyxia during childbirth have a lag in the formation of speech, they may behave inappropriately and have reduced academic performance. Also, these children have significantly reduced immunity. In a third of babies with a similar history, there is a lag in mental and / or physical development.

Resuscitation of newborns with asphyxia

If asphyxia is suspected in a newborn child, doctors immediately predict the need for resuscitation and take measures to prepare them. Immediately after delivery, the condition of the newborn is assessed. Further, specialists restore free patency of the paths, try to achieve adequate breathing and normal cardiac activity. Enter as needed medicines.

Medicines for primary resuscitation are used only if, even with artificial ventilation of the lungs with one hundred percent oxygen and with indirect massage heart for thirty seconds, the crumbs have a bradycardia of less than eighty beats per minute.

Of the medicines, the most commonly used solution is adrenaline hydrochloride, which can increase the frequency and strength of heart contractions. In addition, such a tool effectively increases coronary blood flow and improves blood supply to the heart muscle.

In addition, during resuscitation, doctors can use agents that replenish the volume of circulating fluid. They can be represented by a 5% albumin solution or isotonic saline sodium chloride or Ringer's solution. Such compounds are injected directly into the umbilical cord vein, for every kilogram of body weight, the crumbs use ten milliliters of the solution in five to ten minutes. Such funds effectively reduce pallor, increase pulse and heart rate, increase blood pressure and reduce acidosis (due to improved microcirculation in tissues).

In some cases, a 4% solution of sodium bicarbonate can also be used. It allows you to increase the heart rate to 100 or more beats per minute and significantly reduce acidosis. This is the treatment of asphyxia of newborns.

Neonatal asphyxia is quite serious violation requiring immediate correction and further monitoring.