Slight asphyxia of the newborn. Measures for the prevention of asphyxia in newborns. Asphyxia is divided into

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 species asphyxia may occur various reasons. The first is chronic or acute condition, which appears due to 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;
• overlap respiratory tract 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 cardio-vascular system, diabetes, anemia, increased blood pressure, limb edema.

The list continues with shock during childbirth, smoking and alcoholism, lack of nutrients, taking medications. 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 may arise from the following reasons: heart disease, trauma at birth, disruption of the central nervous system, poor blood supply brain cells, hemorrhage in the lungs, atelectasis in the lungs, aspiration of milk after feeding.

This pathology is not 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 individual symptoms manifestations.

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, there is a violation metabolic processes, which are more pronounced in severe 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 suffering from pathological mild condition 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, it is required urgent care and resuscitation.

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 carry out indirect massage hearts.

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%.

At the birth of a child in a state 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 ward intensive care. 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. You can feed a baby with a mild degree of asphyxia after 16 hours, with severe course pathology, feeding begins a day later with the help of a probe.

Start breastfeeding considered individually, depending on the state. 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 undergone asphyxia depend on the severity and how correctly and in a timely manner primary care. 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 more high 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 high level 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 of a gynecologist, laboratory research, KTG;
• walk on fresh air, away from cars;
• stop using alcoholic beverages 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, passing complete examination. This is especially important for women with disabilities. endocrine system, 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. These activities provide right conditions stay of the child, 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 suitable conditions in the intensive care unit where the patient is staying.
• 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.
• Explaining to parents the importance of 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. When conducting a survey that showed clear improvements and the absence of violations in development and condition, little patient removed from the dispensary.

Asphyxia of the newborn is a condition of the pathology of the newborn, which is caused by violations of the respiratory apparatus with the resulting lack of oxygen.

Primary asphyxia that occurred at the birth of a child and secondary, occurring during the first hours and days of life of newborns, is revealed.

Causes of asphyxia

The causes of primary asphyxia of the newborn are acute and chronic oxygen deficiency in the womb. It includes:

• intracranial injury;
• immunological incompatibility of the blood of the fetus and mother;
• various intrauterine infections;
• the presence of complete or partial impossibility of the functioning of the respiratory tract of the fetus or newborn due to overflow with amniotic fluid (aspiration asphyxia), as well as mucus;
• the presence of fetal malformations.

Asphyxia of newborns occurs due to extragenital diseases of the pregnant woman:

1. cardiovascular pathologies in the stage of decompensation;
2. diseases of the respiratory apparatus and lungs in severe forms;
3. anemia;
4. diabetes mellitus of various types;
5. thyrotoxicosis;
6. all kinds of infectious diseases.

The causes of asphyxia in newborns are also often called late toxicosis of a pregnant woman, pregnancy in the stage of postmaturity, premature detachment of the placenta, pathology of the placenta, membranes and umbilical cord. In the presence of complications in childbirth, such as early rupture of amniotic fluid, anomalies in labor activity of a pregnant woman, wrong positions fetal head, discrepancies in the size of the pelvic section of the woman in labor and the fetal head, the possibility of neonatal asphyxia is not excluded. In case of violation cerebral circulation in a newborn, pneumopathy and other diseases, secondary asphyxia occurs.

The body of a newborn, despite the cause of asphyxia, will undergo a restructuring of all metabolic processes from oxygen deficiency. Hemodynamics and microcirculation are part of the restructuring in the body of the fetus. The longer and more intense the hypoxia, the more pronounced and brighter the picture of changes. There is a development of metabolic and respiratory-metabolic acidosis, which is accompanied by manifestations of hypoglycemia, azotemia and hyperkalemia, then this process is replaced by potassium deficiency. Cellular overhydration begins as a result of electrolyte imbalance and metabolic acidosis. The volume of circulating erythrocytes in the event of acute hypoxia provokes an increase in the volume of circulating blood.

Hypovolemia accompanies asphyxia of the newborn, which develops when chronic course fetal hypoxia. The ability of erythrocytes and platelets to aggregate increases, the blood gradually thickens, its viscosity increases. The brain, heart, kidneys, adrenal glands and liver of a newborn after a microcirculatory disorder suffer edema, hemorrhage and ischemia, tissue hypoxia of the newborn develops. Central and peripheral hemodynamics are accompanied by a decrease in shock and minute volumes hearts, sharp drop blood pressure. The urinary function of the kidneys is impaired due to disorders of metabolism, hemodynamics and microcirculation.

Symptoms of asphyxia

The main symptom of asphyxia of the newborn is a violation respiratory function, which leads to changes in cardiac activity, disorders of neuromuscular conduction and reflex activity of organs. The Apgar score is an indicator of the severity of neonatal asphyxia. International classification diseases of the 9th revision provides for 2 stages of asphyxia of the newborn - the stage of asphyxia moderate and severe (the first minute after birth reveals 7-4 and 3-0 points on the Apgar scale). Clinical practice distinguishes three degrees of severity of asphyxia of the newborn:

• mild (7-6 points on the Apgar scale);
• asphyxia of moderate severity (5-4 points, respectively);
• severe (Apgar scale has 3-1 points);

Clinical death is diagnosed with general assessment at 0 points. Mild severity manifests itself in the first breath in the first minute of life: weakened breathing, acrocyanosis and cyanosis of the nasolabial triangle, a slight decrease in muscle tone. The average severity shows the presence of the first breath in the first minute after birth: weakened breathing (both regular and irregular), the presence of a weak cry of the newborn, bradycardia, tachycardia are noted, muscle tone and reflexes are reduced, the skin of the newborn is cyanotic (mainly the face area , hands and feet), pulsating umbilical cord. A severe degree of asphyxia of the newborn is manifested in irregular separate breaths, or in their absence, the silence of the child (groans are possible), slow heartbeat, which may be accompanied by a single irregular contraction of the heart, muscle hypotension and atony. In this case, reflections are not observed, that is, they are absent. Spasm peripheral vessels causes pallor of the skin, there is no pulse in the umbilical cord, the development of adrenal insufficiency occurs in most cases.

In newborns who suffered asphyxia in the first hours and days of life, the development of posthypoxic syndrome is noted, its main lesion is the central nervous system. 1-2 degree cerebrovascular accidents are detected in 1 out of 3 children who suffered asphyxia at the time of birth. Severe asphyxia suffered by children, as a rule, gives rise to the development of disorders of liquorodynamics and cerebral circulation of 2-3 degrees. The formation of hemodynamics and microcirculation is disturbed due to oxygen deficiency and in disorders of the functions of the external respiratory apparatus. As a result, fetal communications are preserved - the arterial (botallian) duct is open, spasm of the pulmonary capillaries leads to an increase in pressure in the area of ​​the pulmonary circulation, the right area of ​​the heart is overloaded, oval hole remains open. In the lungs, atelectases and hyaline membranes are detected.

Cardiac activity also notes the following disorders: muffled tones, extrasystolic picture, detection of arterial hypotension. Hypoxia and reduced immune defense cause microbial colonization of the intestine, that is, the occurrence and development of dysbacteriosis.

The first 5-7 days of a child's life show the persistence of metabolic disorders, which manifest themselves in the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance, potassium deficiency in children's body. 2-3 days of life baby is coming the development of edematous syndrome due to impaired renal function and with a sharp decrease in diuresis.

In the first minutes of a newborn's life, when determining the degree of respiratory dysfunction, as well as changes in heart rate, muscle tone, reflex function, skin color, the diagnosis of asphyxia and its severity are determined. Acid-base condition shows severity transferred by a child asphyxia.

A healthy newborn has:

• pH-blood, which is taken from the umbilical cord - 7.22-7, 36;
• BE - (base deficiency) - 9-12 mmol / l;

Light asphyxia and its indicators:

• pH-blood - 7.19-7.11;
• BE - 13-18 mmol/l;

Severe asphyxia and its indicators:

• pH-blood - less than 7.1;
• BE - 19 mmol/l and more;

Hypoxic and traumatic lesions of the central nervous system are detected during a thorough neurological examination and ultrasound examination of the brain. A hypoxic lesion of the central nervous system begins, focal neurological symptoms cannot be detected, a syndrome of increased neuro-reflex excitability develops. In severe cases, a syndrome of depression of the central nervous system is possible. In newborns with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhage, etc.), in the first moments of life, hypoxemic vascular shock occurs, accompanied by spasm of peripheral vessels, the skin is pale, hyperexcitability is also noted, often there are focal neurological disorders and convulsive syndromes that appear in the first moments after birth.

Treatment and care for asphyxia

Newborns in an asphyxial state cannot do without the help of resuscitation. The effectiveness of resuscitation care lies in the timely start of treatment. Resuscitation activities and assistance to newborns with asphyxia are beginning to be carried out in the maternity room. The control of the main parameters of human life must be observed: respiratory capabilities and their frequency, blood pressure indicators, hematocrit and acid-base states.

Immediately after the birth of the child, the doctor, using a soft catheter and an electric suction, carefully removes all excess from the upper respiratory tract (tees are used that create intermittent air rarefaction), the umbilical cord is cut off immediately. The child is placed under heat sources on the resuscitation table. The nasal passages, oropharynx, stomach contents are aspirated again here. In the diagnosis of mild asphyxia, the child is placed in the knee-elbow position, he is prescribed inhalation of a 60% oxygen-air mixture, cocarboxylase (8 mg / kg) and 10-15 ml of 10% glucose solution are injected into the umbilical vein. With asphyxia of moderate severity, the newborn is shown artificial ventilation of the lungs with a mask to normalize respiratory capabilities. As the restored regular breathing and coloration of the skin integuments occur, pink color(duration 2-3 minutes), oxygen therapy is continued by inhalation measures. Any method of oxygen therapy involves humidified and heated oxygen. Cocarboxylase is injected into the umbilical vein at the same dose as prescribed for mild asphyxia.

In severe asphyxia, after the umbilical cord is cut off and the contents of the upper respiratory tract of the newborn are removed, tracheal intubation measures are started with the control of direct laryngoscopy and artificial ventilation of the lungs until regular breathing is fully restored (resuscitation measures stop after 15-20 minutes of the child's life without a single breath and if there is a heartbeat).

After the restoration of breathing, the child is transferred to the ward in the neonatal unit (intensive care).

Caring for such a newborn is special meaning. Peace is provided immediately, the head is placed on a hill. At diagnosis mild asphyxia the child is placed in an oxygen tent. In the incubator there are children diagnosed with moderate and severe asphyxia. Removal of residual mucus from the oropharynx and from the stomach is often carried out. The child's temperature, diuresis, and bowel function are monitored. After 12-18 hours, the child is prescribed the first feeding with expressed breast milk(diagnosis of mild and moderate asphyxia). In severe asphyxia of newborns, feeding occurs every other day using a probe.

Consequences of asphyxia

In the first year of life of a child who has undergone asphyxia of a newborn, the following consequences are observed:

• hypo- and hyperexcitability syndrome;
• hypertensive-hydrocephalic, convulsive, diencephalic disorders.

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 injury, 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), fetal malformations.

The occurrence is facilitated by extragenital diseases of the pregnant woman (cardiovascular, especially in the stage of decompensation, serious illnesses lungs, severe anemia, diabetes mellitus, thyrotoxicosis, infectious diseases etc.), late toxicosis of pregnant women, prolongation of pregnancy, premature detachment placenta, pathology of the umbilical cord, 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). AT 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 moans, the heartbeat is slow, in some cases it is replaced by single irregular heartbeats, there is muscular hypotension or atony, there are no reflexes, the skin is pale as a result of spasm of peripheral vessels, the umbilical cord does not pulsate; 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 I-II degree, in all children who have undergone severe asphyxia, the phenomena of violation of liquorodynamics and cerebral circulation develop II-III degree. Oxygen deficiency and dysfunction external respiration violate the formation of hemodynamics and microcirculation, in connection with which fetal communications are preserved: the arterial (botall) 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 protection often disrupted microbial colonization of the intestine, 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 sharp decline diuresis after the 2nd-3rd day of life in newborns, edematous syndrome develops.

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. About severity transferred asphyxia indicators of the acid-base state also testify (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, an ultrasound examination of the brain make it possible to differentiate hypoxic and traumatic injury senior researcher 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 occurring a few hours after birth.

Treatment.

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

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). Volume medical measures determined by the child's condition, they are carried out under the control of hemodynamic parameters, blood coagulation, acid-base state, protein, glucose, potassium, sodium, calcium, chloride, magnesium in the blood serum. For elimination metabolic disorders, recovery of hemodynamics and kidney function intravenously injected 10% glucose solution, reopoliglyukin, 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 is injected intravenously (8-10 mg / kg per day), 5% solution 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), 0.5% lipoic acid solution is injected intramuscularly (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 case of development 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 of this dose is administered), 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%. With absence necessary equipment oxygen can be delivered 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, dispensary observation pediatrician and neurologist.

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, pathology of pregnancy and childbirth, prevention of intrauterine fetal hypoxia, especially at the end of the second stage of childbirth, suction of mucus from the upper respiratory tract immediately after the birth of a child.

The birth of a child for a mother is definitely a joyful event. However, childbirth does not always go smoothly. to the most frequent postpartum complications the newborn has asphyxia. 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 severe and dangerous state, 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. Hypoxia usually develops at the stage prenatal development infant, sometimes due to 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.

AT severe cases suffocation 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. An infant with a history of this disorder, even mildly, may experience weak immunity, prone to colds , 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;
   • reception medications 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 gestosis, accompanied high blood pressure and severe edema;
   • the presence in a pregnant woman of pathologies of the cardiovascular and respiratory systems.
3. With problems disruptive in the uteroplacental circle:
   • childbirth with caesarean section;
   • general anesthesia;
   • polyhydramnios or oligohydramnios;
   • ruptures, damage to the uterus;
   • abnormal labor: fast, rapid labor, weak generic 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 reasons for the development of secondary asphyxia can be the following pathologies newborn:

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 rapid the right help returns to normal on the 4-6th 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 features that are rated - 0, 1 or 2. 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.
   • Newborn 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 out of breath or rare breaths are noted, heartbeat rare or absent, muscle tone is greatly 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. Important indicator- comparison of Apgar scores made at the first and fifth minute of the birth of the baby. 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, big chance avoid consequences. In children who have had more than severe forms breathing problems, abnormalities in work may develop internal organs. by the most frequent consequences such a state become 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 have been discussed above, and were breathing, 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. Normal indicator acid-base balance 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 lesion of the nervous system of the newborn, neurosonography is indicated - ultrasound procedure brain. ultrasound, along with neurological examination, will help distinguish traumatic disorders in the brain from disorders due to oxygen starvation.

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 average degree 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 the 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 may be favorable if, after mild or moderate asphyxia, proper treatment. 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 exercise, walks in the open air;
   • compliance with medical recommendations.