Birth asphyxia. Asphyxia of newborns: diagnosis and causes. From the endocrine system

I didn’t ask her then about such a term that I didn’t understand, it’s embarrassing after all. But such a diagnosis aroused my interest - what you just don’t learn in the hospital and from primiparas. Let's now understand what asphyxia is.

The very diagnosis of asphyxia is a pathology. It is caused by a violation of breathing (that is, a certain oxygen deficiency appears). Usually occurs during childbirth or immediately after the birth of a child (namely: from the first minutes of a newborn's life or in the next couple of days after birth).

Asphyxia is characterized by a change in metabolic processes. These changes manifest themselves in different ways, depending on what degree of asphyxia was detected and how long it lasts.

2. What causes asphyxia

The reasons for the appearance of such a pathology are not so diverse. Let's start with the fact that asphyxia can be primary and secondary.

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2.1. Primary asphyxia

This pathology occurs during the birth of a child. Often it is caused by intrauterine hypoxia (lack of oxygen).

However, there is also other reasons that can cause this disease:

• skull trauma (or intracranial trauma);
• a defect associated with the development of the baby (a defect that has a direct connection with breathing);
• immunological connection "mother-baby" (that is, incompatibility of mother and child for medical reasons, for example, for the Rh factor);
• clogging of the respiratory tract (during childbirth, the child may become clogged with amniotic fluid or mucus of the respiratory tract);

Moreover, this pathology may be due to maternal diseases:

• heart disease;
• the presence of a diagnosis of "diabetes" in the mother;
• violation of the structure of the tissue;
• iron deficiency in the body (here - an insufficient level of hemoglobin);
• toxicosis (meaning exactly the manifestation of this in the last trimeter, here: edema and increased pressure);
• other reasons (placental abruption, earlier discharge of water, incorrect direction of the baby's head at birth, etc.).

2.2. Secondary asphyxia

This pathology occurs immediately after the birth of the baby. Usually in the first few days of a child's life.

The most common causes of secondary asphyxia are considered to be:

• pneumopathy (we are talking about lung diseases that are not associated with infection);
• various heart defects;
• problems with the circulation of the brain;
• damage to the central nervous system;
• other reasons (set by the doctor on an individual basis).

3. What are the signs of asphyxia

The main symptom of this pathology is a violation of the respiratory process. Moreover, it threatens with serious changes in the natural functioning of the body.

Both women who have given birth and those who have not given birth are well aware that immediately after birth, the child is examined by specialists. This is necessary in order to detect possible defects in the child and try to eliminate them (or, conversely, to refute the presence of pathologies in the baby).

The newborn will certainly check:

• breathing (especially if the baby did not cry after birth);
• heartbeat (in beats per minute);
• complexion and body in general;
• muscle tone;
• reflexes.

4. Features of the diagnosis of asphyxia

The condition of the child is usually assessed on a ten-point scale. Young mothers may notice an entry in the baby's card: "Apgar score."

Depending on the form of asphyxia, a certain score is given. In total there are four degrees of this disease:

4.1. Light degree

After birth, the baby should immediately take its first breath. Often, immediately after a sigh, a baby's cry is heard (usually it is at this moment that the mother sighs with relief and begins to cry, not believing her happiness).

With a mild degree of asphyxia, the sigh may be weakened, not inspiring firm confidence. In this case, the health of the newborn put a mark of 6-7 points on the Apgar scale.

4.2. Average degree

When a child takes his first breath, there is a chance that this will not happen instantly, but within one minute.

As with a mild degree, the baby’s weak breathing will be noticed, perhaps the absence of a cry.

The limbs and face of the infant will have a somewhat bluish tint.

Muscle tone in the newborn and symptoms of lung disease may also be seen. Evaluation of this state in points: 4-5.

4.3. Severe degree

After birth, the child does not breathe immediately or may not be present at all. However, the child shows signs of life (not with a cry, but with a weak moaning or lowing).

Also, the newborn has an infrequent heartbeat and no manifestation of unconditioned reflexes.

The body is pale in color. There is no pulsation in the umbilical cord. This condition of the child is estimated at 1-3 points on the Apgar scale.

4.4. critical degree

In this case, the child does not show signs of life at all. They are trying to "awaken" the baby already in intensive care, taking all the necessary actions. Apgar score: 0 points.

However, the initial examination is not enough to make a final diagnosis; in connection with these, other procedures are carried out to detect pathology:

• newborn blood test;
• ultrasound examination of the brain;
• neurological check;
• other (individual appointments for a separate child).

With the help of such diagnostics, it is possible to establish the presence (or absence) of damage to the central nervous system.

In any case, if asphyxia was noticed, the newborn needs urgent help.

5. How to treat asphyxia

I think that any mother understands that asphyxia is not a disease that can be treated without the help of a specialist. The only thing that depends on the parent is "tracking" the child's condition. That is, it will be necessary to pay considerable attention to the child's breathing, his heart rate and hematocrit (do not panic, this is one of the lines in the general blood test).

As for professional help:

1. At the birth of a baby (more precisely, immediately after the appearance of the head), the doctor will insert a probe (in other words, a tube) into the nasal and oral cavity. This is necessary in order to clear the clogged airways from mucus and amniotic fluid.
2. Next, the umbilical cord is tied.
3. After that, the baby is taken to the intensive care unit to repeat the manipulations to cleanse the respiratory tract (including the nasopharynx and stomach).

After the breathing of the newborn is adjusted, the procedures will not end. The baby will have to undergo therapy aimed at eliminating the consequences of asphyxia.

6. Is care required after the procedure

Of course yes! How could it be otherwise? After all measures to eliminate asphyxia have been made, the child needs care. The newborn is transferred to the so-called "oxygen ward" and while the baby is in the hospital, all procedures will be carried out by a doctor. The time spent in such a “room” is unknown and is determined based on the condition of the newborn.

The baby is carefully supervised, because it is important to monitor his body temperature, intestinal condition, and so on. Moreover, it will be possible to feed the baby no earlier than 16 hours after birth.

However, even after discharge from the hospital, in no case should you stop monitoring the health of the child. The newborn should be under careful dispensary supervision.

7. Consequences of asphyxia

Usually the consequences appear only after severe or critical asphyxia and the most common complications are:

• hydrocephalic syndrome (brain damage);
• diencephalic syndrome (complex of different disorders);
• convulsive syndrome;
• motor anxiety (here, sleep disturbance, etc.);
• other complications.

8. Precautions

In order to prevent mothers, it is necessary to monitor their health not only during pregnancy, but also long before conception. It is important to register for pregnancy management at the earliest possible time and is constantly under the supervision of a doctor.

Also, it is very important for a woman to lead a healthy lifestyle, which means that being in a position, a future mother needs:

• spend more time outdoors
• observe the daily routine;
• take vitamins prescribed by a doctor;
• do not be nervous and remain calm in any situation;
• get enough sleep;
• don't overwork.

Well, here we have dealt with such a pathology as asphyxia. But I want to immediately reassure you - do not panic if your newborn has been diagnosed with such a diagnosis. Thanks to modern medicine, the disease is eliminated in the first minutes of your baby's life and most often does not entail any complications.

Watch a video webinar on how to reduce the risk of child asphyxia here:

Asphyxia of the newborn is a clinical syndrome that occurs at birth and in the first days of life, characterized by the absence or failure of spontaneous breathing in the presence of other signs of life.

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

Causes of asphyxia of the newborn

Causes of primary asphyxia newborn are:

• acute and chronic intrauterine oxygen deficiency - fetal hypoxia,
• intracranial trauma,
• immunological incompatibility of maternal and fetal blood,
• 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 of asphyxia of the newborn 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.),
• preeclampsia,
• prolongation of pregnancy,
• premature detachment of the placenta,
• pathology of the umbilical cord, membranes and placenta,
• complications in childbirth (untimely discharge of amniotic fluid, anomalies of labor activity, discrepancy between the size of the pelvis of the woman in labor and the fetal head, incorrect insertion of the fetal head, etc.).

Secondary asphyxia may be associated with impaired cerebral circulation in the newborn, pneumopathies, etc.

Mechanisms of development of asphyxia of the newborn

Regardless of the causes of oxygen deficiency in the body of a newborn, there is a restructuring of metabolic processes, hemodynamics and microcirculation. Their severity depends on the intensity and duration of hypoxia.

Metabolic or respiratory-metabolic acidosis develops, accompanied by hypoglycemia, azotemia and hyperkalemia, followed by potassium deficiency.

Electrolyte imbalance and metabolic acidosis lead to cellular overhydration. In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating erythrocytes.

Asphyxia of the newborn, which developed against the background of chronic fetal hypoxia, is accompanied by hypovolemia. There is a thickening of the blood, its viscosity increases, the aggregation ability of erythrocytes and platelets increases.

In the brain, heart, kidneys, adrenal glands and liver of newborns, as a result of microcirculatory disorders, edema, hemorrhages and areas of ischemia occur, and tissue hypoxia develops.

Central and peripheral hemodynamics are disturbed, which is manifested by a decrease in stroke and minute volumes of the heart and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation cause violations of the urinary function of the kidneys.

Symptoms of asphyxia of the newborn

The leading symptom of asphyxia in a newborn is a violation of breathing, leading to a change in cardiac activity and hemodynamics, a violation of neuromuscular conduction and reflexes.

The severity of asphyxia is determined by the Apgar scale in the first minute after the birth of the child. The Apgar score is based on a three-point system (0; 1; 2) of the five most important signs: heart rate, respiratory activity, muscle tone, reflex excitability and skin color.

In a healthy newborn, the total Apgar score at the 1st minute of life is 8-10. In accordance with the International Statistical Classification of Diseases and Related Health Problems (10th revision, 1995), neonatal asphyxia is classified as medium (blue) and severe (white); Apgar score at the 1st 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 at the 1st minute after birth 7-6 points),
• moderate (5-4 points)
• and severe (3-1 points).

A total score of 0 points indicates clinical death.

With mild asphyxia

With mild asphyxia, the newborn takes the first breath within 1 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

With asphyxia of moderate severity, the child takes the first breath within 1 minute after birth, breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted, but there may also be tachycardia, muscle tone and reflexes are reduced, the skin is bluish, sometimes predominantly in the face, hands and feet, the umbilical cord pulsates.

For severe asphyxia

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.

The first hours and days of life in newborns with asphyxia

In the first hours and days of life, newborns who have undergone asphyxia develop posthypoxic syndrome, the main manifestation of which is CNS damage. 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.

All children who have undergone severe asphyxia develop disorders of liquorodynamics and cerebral circulation of the II-III degree. Oxygen deficiency and disorders of the function of external respiration disrupt the formation of hemodynamics and microcirculation, and therefore fetal communications are preserved:

• the ductus arteriosus 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 oval hole does not close;
• atelectasis and often hyaline membranes are found in the lungs.

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.

Diagnosis of asphyxia and its severity

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 1st minute after birth.

The degree of severity of the transferred asphyxia is also evidenced by indicators of the acid-base state. So, if in healthy newborns the pH of blood taken from the vein of the umbilical cord is 7.22-7.36, BE (base deficiency) ranges from - 9 to - 12 mmol / l, then with mild asphyxia and moderate asphyxia, the pH of the umbilical cord blood decreases to 7.19-7.11, BE increases to - 13 to - 18 mmol/l; with severe asphyxia, pH less than 7.1, BE from - 19 mmol / l and below.

A thorough neurological examination of the newborn, ultrasound of the brain can differentiate between hypoxic and traumatic lesions of the central nervous system.

With a predominantly hypoxic lesion, focal neurological symptoms are not detected in most children, a syndrome of increased neuro-reflex excitability develops, in more severe cases - a syndrome of CNS depression.

In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.), at birth, hypoxemic vascular shock with spasm of peripheral vessels and severe pallor of the skin, hyperexcitability can be observed. Often there are focal neurological symptoms and convulsive syndrome that occurs a few hours after birth.

Treatment of asphyxia of the newborn

Children born in asphyxia need resuscitation assistance. Its effectiveness largely depends on how early treatment is started.

Resuscitation measures are carried out in the delivery room under the control of the main parameters of the body's vital activity:

• respiratory rate and its conduction to the lower parts of the lungs,
• heart rate,
• blood pressure indicators,
• hematocrit and acid-base status.

Newborn resuscitation includes:

• ensuring the patency of the airways,
• active warming of the baby (preferably with a radiant heat source),
• tactile stimulation of breathing.

In the absence or irregular spontaneous breathing 20 s after birth, bradycardia (less than 100 heartbeats per 1 min) begin mask ventilation of the lungs with 90-100% oxygen at a frequency of 40 breaths per 1 min.

In case of aspiration of amniotic fluid that required tracheal sanitation, ineffectiveness of mask ventilation for 1 minute, suspected diaphragmatic hernia, inadequate spontaneous breathing in a child whose gestational age is less than 28 weeks, tracheal intubation and mechanical ventilation through an endotracheal tube are performed.

If the heart rate is less than 80 per 1 min, against the background of mechanical ventilation, a closed heart massage is started, and if it is ineffective, an adrenaline solution (1:10,000) at a dose of 0.1-0.3 is injected into the umbilical cord vein or endotracheally within 30 seconds ml/kg (re-introduction is possible every 5 dynes).

With persistent bradycardia (less than 80 heartbeats per 1 min) and suspected hypovolemic shock and decompensated metabolic acidosis against the background of ongoing mechanical ventilation and closed heart massage, one of the solutions to replenish the volume of circulating blood (for example, 5% albumin solution, isotonic sodium chloride solution at a dose of 10 ml / kg for 5-10 minutes) and 4% sodium bicarbonate solution (4 ml / kg no faster than 2 minutes).

After the restoration of breathing, cardiac activity and stabilization of the child's condition, he is transferred to the intensive care unit of the neonatal department, where measures are taken to prevent and eliminate cerebral edema, restore hemodynamics and microcirculation, normalize gas homeostasis, metabolism and kidney function.

The volume of therapeutic measures and their duration are determined by the condition of the child.

If clinical and laboratory signs of hypoxemia persist, additional oxygen should be provided through an oxygen tent, mask, or nasal catheter.

Effectively, especially with partial atelectasis of the lungs in premature babies, breathing with positive expiratory pressure in the range of 2-6 cm of water. Art. The increase in symptoms of respiratory failure and hypoxemia requires 1 mechanical ventilation.

To correct and prevent systemic and cerebral hemodynamic disorders, metabolic disorders, almost all children born in a state of severe asphyxia need infusion drip therapy. A 10% glucose solution is used as a starter.

In case of microcirculation disorders, drugs are indicated that improve the rheological properties of blood (rheopolyglucin, trental), with arterial hypotension (systolic blood pressure less than 50-55 mm Hg) - dopamine (3-5 mcg / kg / min 1 or more). If necessary, from 2-3 days use solutions of protein preparations (plasma, albumin, amino acids), electrolytes. Hypoglycemia (glucose content less than 2 mmol/l) is corrected with 15-20% glucose solutions. The daily volume of fluid administered, taking into account feeding, should be 30-50 ml / kg on the 1st day of life, 60-70 ml / kg - on the 2nd day, 80-90 ml / kg - on the 3rd day, from 4 -5 days -100-120 ml/kg.

The necessary conditions for the successful nursing of children who have undergone asphyxia are the most gentle care, compliance with the optimal temperature regime, which is most ensured when they are observed and treated in incubators or closed heated beds. Be sure 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 CNS, children born in asphyxia, after discharge from the maternity hospital, are monitored by a pediatrician and a neuropathologist.

Forecast

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 signs of hypo- and hyperexcitability, hypertensive-hydrocephalic, convulsive, diencephalic syndromes, etc.

Prevention

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.

The absence of gas exchange in the lungs, accompanied by hypoxemia, hypercapnia and pathological acidosis in the body of a child after birth is called asphyxia. Of practical importance are the consequences of asphyxia in the form of brain damage. In asphyxia of varying severity, according to some authors, from 6 to 15% of children are born.

Etiology and pathogenesis. Risk factors for antenatal fetal asphyxia are extragenital pathology in the mother (hypertension, diseases of the heart, lungs, kidneys, diabetes mellitus, etc.), multiple pregnancy, infectious diseases during pregnancy, placental pathology, pregnancy complications (primarily gestosis), uterine bleeding , isoimmunization of a pregnant woman, post-term pregnancy. Drug addiction, substance abuse and smoking also lead to fetal hypoxia.

The most important reasons for which intranatal asphyxia of a newborn occurs can be divided into the following groups: disorders of the umbilical circulation (compression, umbilical cord nodes), impaired placental gas exchange (ablation, placenta previa, placental insufficiency); inadequate perfusion of the maternal part of the placenta (hypertension or hypotension in the mother, impaired contractile activity of the uterus), maternal oxygenation disorders (heart disease, lung disease, anemia); the inability of the fetus to make the transition from fetal to postnatal circulation (the effect of drug therapy in the mother, maternal drug addiction, congenital malformations of the lungs, brain, heart in the fetus, etc.).

Short-term moderate fetal hypoxia includes compensatory mechanisms aimed at maintaining adequate oxygenation. The volume of circulating blood increases, the release of glucocorticoids, tachycardia develops. Acidosis increases the affinity of fetal hemoglobin for oxygen. With a longer duration of hypokia, anaerobic glycolysis is activated. A decrease in oxygen leads to a redistribution of circulating blood with a predominant supply of the heart, brain, and adrenal glands. The progression of hypercapnia and hypoxemia stimulates cerebral vasodilation, which first causes an increase in cerebral blood flow followed by a decrease. Over time, cerebral autoregulation of blood flow is lost, a decrease in cardiac output occurs and, as a result, arterial hypotension, which worsens tissue metabolism, and this, in turn, increases lactic acidosis. Reducing the intensity of metabolic processes allows the fetus to endure a long period of asphyxia. Adenosine, gamma-aminobutyric acid, opiates are released to help reduce oxygen consumption.

Prolonged hypoxia leads to inhibition of compensation mechanisms, an increase in the permeability of capillaries and cell membranes, as a result of which hemoconcentration develops, intravascular thrombi form, and hypovolemia occurs. Hemorheological and tissue disorders lead to cardiac hypoperfusion, hypoxic-ischemic encephalopathy, and pulmonary hypertension. Due to energy deficiency and acidosis, the level of free radicals increases, which, in turn, can cause brain hypoperfusion through stimulation of leukotriene production and the formation of leukocyte thrombi, damage to cell membranes and cell disintegration.

A possible consequence of asphyxia is the development of hypoxic-ischemic encephalopathy with partial loss of neurons, secondary deterioration against the background of the court, edema and cerebral infarction, activation of microglia with subsequent production of "excited" glutamate, hydrogen peroxide, glial toxins, which cause brain damage.

Apgar score

Classification. Assessment of the condition of the newborn 1 and 5 minutes after birth is performed according to the V. Apgar scale (1950). The Apgar score of 8, 9, 10 points at the 1st and 5th minutes is normal. A score of 4, 5, 6 points in the first minute of life is a sign of moderate asphyxia, if by the fifth minute it reaches 7-10 points. Severe asphyxia is diagnosed in a child who has an Apgar score of 0-3 points after 1 min or less than 7 points 5 min after birth. Now, according to many researchers, the assessment of the state of the newborn on the Apgar scale is not decisive. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in 1992 proposed the following definition of severe birth asphyxia: profound metabolic or mixed acidosis (pH<7,00) в крови из пуповинной артерии; низкая оценка по Апгар (0-3 балла) после 5 мин реанимации; неврологическая симптоматика сразу после рождения ребенка (судороги, мышечная гипотония, кома) или признаки гипоксически-ишемической энцефалопатии (отсутствие дыхательных движений или их периодический характер; нестабильность температуры тела, отсутствие нейромышечных и нейросенсорных реакций, судороги течение первой суток жизни, развитие моторных нарушений конце первых 7 дн жизни). По нашему мнению, для определения степени тяжести интранатальной асфиксии большое значение имеет реакция новорожденного ребенка на реанимационные мероприятия. Степень тяжести асфиксии целесообразно уточнять после проведения полного объема реанимационной помощи.

Clinic. A child with moderate asphyxia after birth looks like this: there is no normal breathing during the first minute after birth, but the heart rate is 100 or more per minute; muscle tone is insignificant, the reaction to irritation is weak. Apgar score 1 min after birth - 4-6 points. "Blue asphyxia".

The condition of the child after birth is usually moderate. The child is often lethargic, physiological reflexes are suppressed. The cry is short, of little emotion. The skin is cyanotic, but quickly turn pink against the background of additional oxygenation. In the first hours of life, symptoms of hyperexcitability appear: hand tremor, irritated cry, frequent regurgitation, sleep disturbances, hyperesthesia.

Severe primary asphyxia after birth has the following manifestations: pulse less than 100 beats / min, breathing is absent or labored, skin is pale, muscles are atonic. Apgar score - 0-3 points. "White asphyxia".

If muscle tone, spontaneous motor activity, reaction to examination and pain stimulation are reduced or absent, then the child's condition after birth is regarded as severe or very severe. Physiological reflexes of newborns in the first hours of life are not called. The color of the skin is pale or bludocyanotic and is restored to pink with active oxygenation (often mechanical ventilation) slowly. Heart sounds are muffled, systolic murmur may appear. Physical findings over the lungs are variable. Meconium, of course, passes before or during childbirth.

Children born in severe asphyxia constitute a high risk group for the development of hypoxic-ischemic encephalopathy or intracranial hemorrhages of hypoxic genesis - intraductal or subarachnoid.

Diagnostics. The antenatal diagnosis algorithm includes the following activities:

A) monitoring of the fetal heart rate - bradycardia and periodic deceleration of the fetal heart rate indicate hypoxia and impaired myocardial function;
b) ultrasonography - a decrease in motor activity, muscle tone and respiratory movements of the fetus is detected, i.e. the biophysical profile of the fetus changes;
c) biochemical testing - its data indicate antenatal problems.

Intranatal diagnosis algorithm:

Heart rate monitoring;
the presence of meconium in the amniotic fluid;
determination of pH and pO2 in blood taken from the skin of the head of the fetus;
d) determination of pH and pCO2 in arterial and venous blood from umbilical vessels.

Postnatal diagnosis: immediately after the birth of the child, respiratory activity, heart rate, skin color should be immediately assessed. If, after separation from the mother and carrying out the usual measures (drying, placed under radiant heat, drainage position, suction of secretions from the oropharynx), the child remains in a state of apnea, tactile stimulation should be performed. If there is no response, immediately start artificial lung ventilation with 100% oxygen for 15-30 seconds. If, after this, spontaneous breathing is not restored or the heart rate is less than 100 beats / min, it should be considered that the child was born in an asphyxial state.

Treatment. The only method of effective treatment that significantly improves the child's condition and reduces the consequences of hypoxic-ischemic encephalopathy is adequate cardiopulmonary resuscitation.

The following materials are needed:

Sources of radiant heat and oxygen;
suction with manometer;
breathing bag, children's face masks of different sizes;
laryngoscope with blades No. 0, 1; endotracheal tubes No. No. 2.5; 3; 3.5; four;
umbilical catheters No. 8, 10;
medicines: adrenaline hydrochloride, sodium bicarbonate, plasma expansion (5% albumin solution, isotonic sodium chloride solution, Ringeralactate solution), nalorfin.

Technique for primary resuscitation of newborns:

1. After the birth of a child, to prevent hypothermia, it is necessary to place her under a source of radiant heat and dry her skin from amniotic fluid. Remove wet diapers.
2. The child's head should be slightly lowered, the neck slightly extended. The resuscitator is behind the child. Turn the baby's head to the side.
3. To ensure the patency of the respiratory tract, suck out the mucus from the mouth, then from the nose (during the suction of the electric-smoktuvachem, the negative pressure should be no more than 100 mm Hg. St.), Do not allow deep insertion of the catheter. Suction duration - no more than 5-10 s. During the procedure, bring an oxygen source closer to the child's face and monitor the heart rate (HR).
4. In case of severe asphyxia and deep meconium aspiration, suck out the contents of the oropharynx immediately after the birth of the head. After separation of the child from the mother, examine the larynx and trachea using direct laryngoscopy. In the presence of meconium, intubate the trachea with an endotracheal tube, suck out the contents. Start WL.
5. Immediately after the birth of the baby, immediately assess her respiratory activity; Heart rate (calculate for 6 s and multiply by 10); skin coloration.

If the heart rate is less than 60 bpm, there is no breathing, and the skin color is cyanotic, resuscitation should be started immediately. Wipe the newborn, aspirate mucus from the upper respiratory tract and begin mask ventilation of the lungs using a counterlung. If these measures are not effective, repeat suctioning of mucus from the upper respiratory tract and perform endotracheal intubation, followed by chest compressions.

At a heart rate of 60-100 beats / min, if breathing is ineffective, the skin color is cyanotic, you should wipe the newborn, suck out mucus from the upper respiratory tract, at the same time bring an oxygen source closer to the child’s face, if the condition does not improve, start mask ventilation of the lungs using a breathing bag after 1 min or even earlier if bradycardia persists. Start tactile stimulation (applying light blows to the soles and rubbing the back), refraining from more vigorous activities. If heart rate is less than 80 bpm, start chest compressions.

If the heart rate is above 100 beats / min, you need to wipe the child, if there is cyanosis of the skin - bring the oxygen source closer to the face, if there is no effect - conduct tactile stimulation for 2-3 seconds; if the heart rate drops to less than 100 beats / min - mask ventilation using a breathing bag.

When performing mask ventilation, the mask should cover the nose and mouth of the newborn. The initial positive pressure on inspiration is 30-40 cm of water. Art. Pressure control is carried out by a manometer (when a breathing bag with a volume of up to 750 ml is compressed with one hand, the pressure created does not exceed 30 cm of water. Art.). The initial breaths should be long (0.5-1 s), the respiratory rate gradually increases to 40-60 / min.

If, due to adequate ventilation, the child's condition stabilizes and at the same time the heart rate is more than 100 beats / min, artificial ventilation can be stopped, if, despite vigorous efforts, bradycardia persists, orotracheal intubation should be started.

An indirect heart massage is performed with both hands, placing the thumbs on the sternum just below the line connecting the nipples, clasping the chest with the rest of the fingers. When performing an indirect heart massage, avoid compression of the xiphoid process, the sternum should descend to a depth of 1.5-2 cm at a frequency of 90/min. If, despite ventilation of the lungs with 100% oxygen and chest compressions, bradycardia of less than 80 bpm persists, it is necessary to catheterize the umbilical vein and start medical resuscitation in the following sequence:

1) if the condition does not improve - intravenously quickly inject adrenaline hydrochloride 1:10,000 at a dose of 0.1 ml / kg (0.1% solution of the drug is diluted in isotonic sodium chloride solution). An alternative may be the endotracheal administration of epinephrine hydrochloride 1:10,000 at a dose of 0.1-0.3 ml / kg, additionally diluted in a syringe with isotonic sodium chloride solution in a ratio of 1:1;
2) if bradycardia remains less than 80 beats/min, a 5% solution of albumin (plasma, Ringeralactate solution) is used at a dose of up to 10 ml/kg intravenously slowly over 10 minutes;
3) sodium bicarbonate 4.2% solution at a dose of 4 ml / kg intravenously slowly at a rate of 2 ml / (kgmin), against the background of effective ventilation;
4) if the condition does not improve, repeat the administration of epinephrine hydrochloride 1:10,000 at a dose of 0.1-0.2 ml/kg. When conducting medical resuscitation, it is necessary to control the adequacy of heart massage, the position of the endotracheal tube in the trachea, the flow of 100% oxygen into the breathing bag, the reliability of the connection of oxygen hoses, and the adequacy of pressure during ventilation of the lungs.

The newborn may be in a state of narcotic depression, then prolonged ventilation of the lungs is necessary; the introduction of a 0.05% solution of narorphine at a dose of 0.2-0.5 ml intravenously. The drug can be administered repeatedly at two-minute intervals, but the total dose should not exceed 1.6 ml.

If resuscitation does not lead to the appearance of spontaneous sustained breathing within 30 minutes, the prognosis is always poor for severe neurological damage. Therefore, it is justified to stop resuscitation after 30 minutes if there is no spontaneous breathing (provided that the child was given the opportunity to demonstrate it) and bradycardia persists.

Newborns who have undergone asphyxia need supervision and post-resuscitation stabilization in the intensive care unit for at least 24 hours.

The main principles of treatment in the post-resuscitation period are: fluid restriction by 30-40% of the physiological need; maintaining adequate perfusion and blood pressure, treatment with a trial, ensuring adequate oxygenation (against the background of monitoring the level of blood gases and acid-base status); correction of hypoglycemia (monitoring of blood sugar levels); prevention and treatment of hemorrhagic complications.

Possible complications of asphyxia:

1) CNS: hypoxic-ischemic encephalopathy, cerebral edema, neonatal convulsions, intracranial hemorrhage (intraventricular, subarachnoid), which is most typical for premature babies, syndrome of impaired secretion of antidiuretic hormone;
2) respiratory system: pulmonary hypertension, damage to the surfactant system, meconium aspiration, pulmonary hemorrhage;
3) excretory system: proteinuria, hematuria, oliguria, acute renal failure;
4) cardiovascular system: tricuspid valve insufficiency, myocardial necrosis, hypotension, left ventricular dysfunction, sinus bradycardia, rigid heart rate, shock;
5) metabolic disorders: metabolic acidosis, hypoglycemia, hypocalcemia, hyponatremia, hyperkalemia;
6) digestive system: necrotizing enterocolitis, hepatic dysfunction, gastric or intestinal bleeding, reduced tolerance to enteral loading;
7) blood system: thrombocytopenia, DIC, polycythemia.

Prevention. To prevent intranatal asphyxia, you should:

Timely determine the risk factors for the development of asphyxia;
adequately manage high-risk pregnant women;
timely diagnose and treat intrauterine fetal hypoxia;
to monitor the condition of the fetus during childbirth, to carry out adequate management of labor

Forecast. Mortality in severe asphyxia, according to a follow-up study, reaches 10-20%, the frequency of remote neuropsychiatric complications is also high. Therefore, resuscitation measures are stopped after 15-20 minutes in the absence of spontaneous breathing and the presence of persistent bradycardia. The long-term prognosis for acute intranatal asphyxia is better than for neonatal asphyxia that developed against the background of chronic intrauterine hypoxia.

The birth of a long-awaited child is always a joyful event, but childbirth does not always have a positive outcome not only for the woman in labor, but also for the newborn itself. One of the most common complications is fetal asphyxia during childbirth. A similar complication is recorded in 4-6% of barely born babies, and some researchers talk about 6-15% of cases.

Definition of asphyxia at birth

Asphyxia is translated from Latin as "suffocation, or lack of oxygen." Asphyxia of the fetus is usually called a pathological condition in which there is a violation of the process of gas exchange in the body of the baby. This process is accompanied by the accumulation of carbon dioxide and a lack of oxygen in the tissues of the newborn.

In the presence of such a complication, a child born with signs of a live birth makes separate, convulsive, superficial and irregular respiratory movements against the background of the presence of a heartbeat or cannot breathe on its own within the first minute after birth. Such children are subjected to immediate resuscitation, while the prognosis in this case depends on the quality and timeliness of resuscitation and the severity of asphyxia.

Classification of asphyxia in newborns

Depending on the time of occurrence, two forms of asphyxia are distinguished:

immediately after the birth of the baby, primary asphyxia develops;

secondary - diagnosed during the first 24 hours after birth (in other words, the child initially breathed normally, but then asphyxia occurred).

According to the degree of clinical manifestations (severity) there are:

severe asphyxia;

asphyxia of moderate severity;

mild asphyxia.

Factors that provoke the development of asphyxia

This pathological condition is usually referred not to independent diseases, but to complications of the course of pregnancy, diseases of the fetus and woman. Among the causes of asphyxia are:

fruit factors:

malformations of the brain and heart of the fetus;

airway obstruction (meconium, amniotic fluid, mucus) or aspiration asphyxia;

intrauterine growth retardation of the fetus;

prematurity;

intrauterine infections;

anomalies in the development of the organs of the bronchopulmonary system;

Rh-conflict pregnancy;

birth trauma in a child (craniocerebral).

Maternal factors:

infectious diseases;

taking medications that are contraindicated during pregnancy;

malnutrition and malnutrition;

bad habits (drug use, alcohol abuse, smoking);

disturbed ecology;

shock in a woman during childbirth;

endocrine pathologies (ovarian dysfunction, thyroid disease, diabetes mellitus);

anemia of pregnant women;

decompensated extragenital pathology (diseases of the pulmonary system, cardiovascular diseases);

severe gestosis, which occur against the background of severe edema and high blood pressure.

Factors that contribute to the development of disorders in the uteroplacental circle:

uterine rupture;

C-section;

general anesthesia of a woman;

administration of drugs less than 4 hours before the end of labor;

anomalies of tribal forces (rapid and rapid childbirth, discoordination and weakness of labor activity);

lack or excess of amniotic fluid;

multiple pregnancy;

bleeding associated with placenta previa;

permanent threat of interruption;

pathology of the umbilical cord (false and true nodes, cord entanglement);

premature detachment of the placenta;

premature aging of the placenta;

delayed pregnancy.

Secondary asphyxia occurs against the background of the presence of such pathologies in a newborn:

aspiration of the mixture or milk after the feeding procedure, poor-quality sanitation of the stomach after birth;

heart defects that did not appear immediately and were not detected;

violation of cerebral circulation against the background of damage to the lungs and brain during childbirth;

respiratory distress syndrome, which is caused by pneumopathy:

• atelectasis in the lungs;

  pulmonary hemorrhages;

  edematous-hemorrhagic syndrome;

  the presence of hyaline membranes.

The mechanism of development of asphyxia

Regardless of what causes the lack of oxygen in the child's body, there is a restructuring of microcirculation and hemodynamics, as well as metabolic processes in the body.

The severity depends on how intense and prolonged the fetal hypoxia was. Against the background of hemodynamic and metabolic rearrangements, acidosis occurs, accompanied by hyperkalemia (later hypokalemia), azothermia, and a lack of glucose.

In the presence of acute hypoxia, the volume of circulating blood increases, with developed asphyxia and chronic hypoxia, the volume of blood decreases. This leads to thickening of the blood, an increase in the aggregation of red blood cells and platelets, and an increase in blood viscosity.

All processes lead to a disorder of the microcirculation of the most important organs (liver, adrenal glands, kidneys, heart, brain). As a result of impaired microcirculation, ischemia, hemorrhages, and edema develop, which leads to a disruption in the functioning of the cardiovascular system, impaired hemodynamics, and as a result of malfunctions in the work of all other organs and systems of the body.

Clinical picture of pathology

The main sign of the presence of asphyxia in a newborn is a violation of breathing, which leads to a violation of hemodynamics and the work of the cardiovascular system, there is also a violation of neuromuscular conduction, the severity of reflexes.

To assess the severity of pathology, neonatologists use the Apgar scale, which is used in the first and fifth minutes of a baby's life. Each of the signs is estimated at 0, 1 or 2 points. A healthy child in the first minute of life gains 8-10 points.

Degrees of asphyxia of newborns

Light asphyxia

With a mild degree of asphyxia, the number of points on the Apgar scale is 6-7. The newborn takes the first breath within the first minute, but there is a decrease in muscle tone, slight acrocyanosis (cyanosis of the skin in the lips and nose), weakening of breathing.

Moderate asphyxia

The score is 4-5 points. There is a weakened to a large extent breathing, its irregularity, violations are possible. Heart contractions are quite rare, less than 100 beats per minute, there is cyanosis of the feet, hands and face. Motor activity is increased, there is muscular dystonia with predominant hypertonicity. There may be a tremor of the legs, arms, chin. Reflexes are either enhanced or reduced.

Severe asphyxia

The condition of the newborn is very serious, the number of points in the first minute on the Apgar scale is 1-3. Respiratory movements are not performed at all or there are separate breaths. The number of heartbeats is less than 100 per minute, there is a pronounced bradycardia, arrhythmic and muffled heart sounds. There is no cry, muscle atony is observed, muscle tone is significantly reduced. The umbilical cord does not pulsate, the skin is pale, reflexes are not observed. Eye symptoms are present: floating eyeballs and nystagmus, convulsions, cerebral edema, DIC (increased platelet aggregation and impaired blood viscosity) may develop. Hemorrhagic syndrome (multiple hemorrhages on the skin) increases.

clinical death

This diagnosis is relevant, provided that on the Apgar scale all indicators are equal to 0 points. The condition is extremely serious and requires emergency resuscitation.

Diagnostics

To make the final diagnosis of "asphyxia of the newborn", the obstetric history, the course of labor, the assessment of the child's condition on the Apgar scale at the first and fifth minutes, as well as clinical and laboratory studies are taken into account.

Determination of laboratory parameters:

the level of bilirubin, AST, ALT, blood coagulation factors;

glucose, acid-base status, electrolytes;

the level of creatinine and urea, diuresis per day and per minute (work of the urinary system);

determination of base deficiency;

the level of pCO2, pO2, pH (examination of blood taken from the umbilical vein).

Additional methods:

assessment of neurological status and brain (MRI, CT, encephalography, neurosonography);

assessment of the work of the cardiovascular system (chest x-ray, pulse, blood pressure control, ECG).

Treatment

All newborns who were born in a state of asphyxia undergo emergency resuscitation. Further prognosis directly depends on the adequacy and timeliness of assistance. Resuscitation of newborns is carried out according to the ABC system developed in the USA.

Primary care for a child

Principle A

ensure the correct position of the newborn (the head is lowered and slightly thrown back with the help of a roller);

suck amniotic fluid and mucus from the nose and mouth, in some cases from the trachea (if amniotic fluid gets there);

sanitize the lower airways and intubate the trachea.

Principle B

perform tactile stimulation - slap the child on the heels (if there is no cry for 10-15 seconds after birth, the child is transferred to intensive care);

jet supply of oxygen;

implementation of artificial or assisted ventilation of the lungs (endotracheal tube, oxygen mask, Ambu bag).

Principle C

conducting an indirect heart massage;

administration of medications.

The decision to stop resuscitation in the absence of a reaction to these actions (sustained bradycardia, lack of breathing) is made after 15-20 minutes. The termination of resuscitation measures is due to the fact that after this period of time serious brain damage occurs.

Administration of drugs

Against the background of artificial lung ventilation (endotracheal tube, mask), cocarboxylase is injected into the umbilical vein, which is diluted 10 ml in 15% glucose solution. In addition, to correct metabolic acidosis, sodium bicarbonate (5% solution) is administered intravenously, to restore the tone of the walls of blood vessels, "Hydrocortisone" and "10% calcium gluconate" are administered. When bradycardia occurs, a 0.1% solution of atropine sulfate is injected into the umbilical vein.

At a heart rate of less than 80 beats per minute, an indirect heart massage is performed, artificial ventilation of the lungs should continue. Through the endotracheal tube or umbilical vein, 0.01% β-adrenaline is injected. After reaching a heart rate of 80 beats, indirect heart massage is stopped, when spontaneous breathing occurs and the heart rate reaches 100 beats, artificial ventilation is stopped.

Observation and further treatment

After the restoration of respiratory and cardiac activity with the help of resuscitation, the newborn is transferred to the intensive care unit. Here, further treatment of asphyxia of the acute period is carried out:

Feeding and special care

The newborn is placed in a couveuse in which there is a constant heating. At the same time, craniocerebral hypotremia is performed - cooling of the head of the newborn in order to prevent cerebral edema. Feeding of children with moderate and mild asphyxia begins no earlier than after 16 hours, with severe asphyxia, feeding is carried out in a day. Feeding a child is carried out with a bottle or through a tube. Apply to the chest, depending on the condition of the child.

Cerebral edema warning

Through the umbilical catheter, "Mannitol", "Cryoplasm", plasma, "Albumin" are administered intravenously. In addition, drugs are prescribed to stimulate the blood circulation of the brain (Sermion, Vinpocetine, Cinnarizine, Cavinton) and antihypoxants (ascorbic acid, vitamin E, Aevit, Cytochrome C). Assign hemostatic and diuretic drugs ("Vikasol", "Rutin", "Dicinon").

Carrying out oxygen therapy

Continue to supply warmed and humidified oxygen.

Symptomatic treatment

Therapy aimed at preventing hydrocephalic syndrome and seizures. Anticonvulsants are used (Relanium, Phenobarbital, GHB).

Correction of metabolic disorders

Sodium bicarbonate intravenously (continue). Carry out infusion therapy with saline solutions (10% glucose and saline).

Newborn Monitoring

Weighing twice a day, as well as monitoring the excreted and incoming fluid, assessing the somatic and neurological status, and the presence of positive dynamics. With the help of devices, central venous pressure, respiratory rate, blood pressure, and heart rate are monitored. Among the laboratory tests, a complete blood count with platelets and hematocrit, electrolytes and acid-base state, a biochemical blood test (creatinine, urea, ALT, AST, bilirubin, glucose) are performed daily. They also perform an assessment of blood clotting parameters and bacteriological cultures from the rectum and oropharynx. Performing ultrasound of the abdominal organs, ultrasound of the brain, X-ray examination of the abdomen and chest is shown.

Effects

Asphyxia of the newborn very rarely passes without consequences. The lack of oxygen after and during childbirth affects the vital systems and organs of the child. Particularly dangerous is severe asphyxia, occurring with multiple organ failure. In this case, the prognosis for the child's life depends on the sum of the Apgar scores. If at the fifth minute of life the score increases, then the prognosis is favorable. Also, the frequency and severity of the development of consequences largely depends on the timeliness and adequacy of resuscitation and subsequent therapy, as well as on the severity of asphyxia.

The incidence of complications after undergoing hypoxic encephalopathy:

with the first degree of encephalopathy due to asphyxia / hypoxia of the newborn - development is no different from the development of a healthy baby;

with the second degree of hypoxic encephalopathy - further neurological disorders are present in 25-30% of children;

with the third degree of hypoxic encephalopathy, about 50% of children die in the first week of life. The remaining newborns in 75-100% of cases show severe neurological complications with increased muscle tone, seizures (later mental retardation).

After suffering asphyxia during childbirth, the consequences may have a later or early manifestation.

Early Complications

Early complications are those that manifest themselves during the first day of a newborn's life and are a manifestation of difficult childbirth:

gastrointestinal disorders (dysfunction of the digestive tract, intestinal paresis, enterocolitis);

disorders of the urinary system (edema of the interstitium of the kidneys, thrombosis of the renal vessels, oliguria);

development of posthypoxic cardiopathy, heart rhythm disorder;

thrombosis (reduced vascular tone, blood clotting disorders);

hypoglycemia;

against the background of hypovolemic shock and as a result of blood clotting - polycythemic syndrome (increased number of red blood cells);

transient pulmonary hypertension;

apnea (stop breathing);

hand tremor and increased intracranial pressure;

meconium aspiration syndrome, which causes the formation of atelectasis;

convulsions;

hemorrhage in the brain;

cerebral edema.

Late Complications

Late complications include complications that are diagnosed after three days of a newborn's life or later. They can be of neurological and infectious origin. Among the neurological disorders that have arisen against the background of cerebral hypoxia and encephalopathy, there are:

Syndrome of hyperexcitability.

The baby has signs of increased excitability, tachycardia, pupils are dilated, reflexes (hyperreflexia) are pronounced. There are no convulsions.

Syndrome of reduced excitability.

Weak sucking reflex, rare pulse, periodic slowing and cessation of breathing (bradypnea and apnea), a symptom of puppet eyes, a tendency to lethargy, dilated pupils, muscle tone is lowered, the child is adynamic, lethargic, reflexes are poorly expressed.

Convulsive syndrome.

Clonic (rhythmic contractions, twitching of individual muscles of the eyes, face, legs, arms) and tonic (rigidity and tension of the muscles of the limbs and body) convulsions are characteristic. Opcular paroxysms are also present, which manifest as floating eyeballs, protrusion of the tongue and chewing, bouts of unmotivated sucking, spasms of gaze, grimaces. Sudden pallor, increased salivation, slow pulse, bouts of cyanosis and apnea may also be present.

Hypertensive-hydrocephalic syndrome.

Prolapse of the cranial nerves (manifested in the form of smoothing of the nasolabial folds, nystagmus, strabismus), constant convulsive readiness, an increase in the circumference of the head, divergence of the cranial sutures, swelling of the fontanelles, the child begins to throw back his head.

Syndrome of vegetative-visceral disorders.

Constant regurgitation and vomiting, intestinal motility disorders (diarrhea and constipation), rare breathing, bradycardia, marbling of the skin (spasms of blood vessels).

Syndrome of movement disorders.

There are residual neurological disorders (muscle dystonia, paralysis and paresis).

Intraventricular hemorrhages, hemorrhages around the ventricles.

Subarachnoid hemorrhage.

Accession of infectious complications against the background of multiple organ failure and weakened immunity:

necrotizing colitis (infectious bowel disease);

development of sepsis;

meningitis (damage to the hard shell of the brain);

development of pneumonia.

Answers to frequently asked questions

Does a child who has suffered asphyxia during childbirth need special care after discharge from the hospital?

Of course, children with a history of natural asphyxia need especially careful care and observation. In most cases, pediatricians prescribe special massages and exercises that prevent the development of seizures, normalize reflexes and excitability of the baby. Also, the child should receive maximum peace. In terms of feeding, it is advisable to breastfeed.

After what time are newborns discharged from the maternity hospital after asphyxia?

We are not talking about early discharge (usually 2-3 days). The newborn must stay in the maternity ward for at least one week, as an incubator is required. If necessary, the child, together with the mother, is transferred to the children's department, where therapy can last up to a month.

Do newborns who have suffered asphyxia need dispensary observation?

All children who have suffered asphyxia at birth are registered with a neurologist and pediatrician without fail.

What consequences of asphyxia can develop in a child at an older age?

Children with a history of asphyxia during childbirth are more prone to colds, there may be a lag in speech, delays in psychomotor development, the reaction in some situations can be unpredictable, often inadequate, school performance is reduced, immunity is weakened. After suffering severe asphyxia, convulsive syndrome, epilepsy quite often develop, paralysis, paresis, cerebral palsy, mental retardation are also not excluded.

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

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

What is neonatal asphyxia?

Asphyxia of newborns is a pathology in which gas exchange in the body of a child is disturbed. This condition is accompanied by an acute oxygen deficiency and an excess of carbon dioxide. With a lack of air, the child is able to make only infrequent and weak attempts to breathe or does not breathe at all. In this state, the child immediately undergoes resuscitation.

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

Intrauterine and postpartum asphyxia and its causes

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

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

• trauma to the skull of a newborn;
• pathologies in development during the gestation period;
• Rhesus conflict;
• blockage of the airways with mucus or amniotic fluid.

Another reason for the occurrence of intrauterine pathologies is the presence of serious diseases in the expectant mother. The condition of the newborn may be affected by the presence in the anamnesis of the pregnant woman of problems with the heart, kidneys, diabetes mellitus or iron deficiency. The occurrence of oxygen deficiency is possible against the background of late toxicosis, in which a woman's legs swell and pressure rises.

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

Secondary asphyxia occurs some time after childbirth due to:

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

Consequences of asphyxia of the fetus and newborn

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

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

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

• with hypoxia or asphyxia, which is assigned 1 degree, the child's condition is absolutely no different from a healthy baby, increased drowsiness is possible;
• in the second degree - a third of children are diagnosed with neurological disorders;
• in the third degree - half of the newborns do not live up to 7 days, and the remaining half have a high probability of severe neurological diseases (mental disorders, seizures, etc.).

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

How is asphyxia diagnosed?

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

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

If asphyxia arose due to trauma, then vascular shock and vasospasm are detected. The diagnosis depends on the presence of seizures, skin color, excitability, and other factors.

First aid and treatment features

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

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

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

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

Rehabilitation and child care

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

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

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

When caring for a baby after asphyxia, regular monitoring of his condition is necessary. It is important to monitor body temperature, the functioning of the intestines and the genitourinary system. In some cases, it is necessary to clear the airways again.

If the newborn suffered a lack of oxygen, then he is fed for the first time no earlier than 15-17 hours after birth. Children with severe asphyxia are fed through a tube. The time when you can start breastfeeding is determined by the doctor, since the condition of each child is individual, and the time to start breastfeeding directly depends on the general condition of the baby.

After rehabilitation and discharge home, the newborn should be registered with a pediatrician and a neurologist. Timely diagnosis will help prevent negative consequences and complications.

The baby is prescribed gymnastics, massage and drugs that improve blood circulation and reduce intracranial pressure.

During the first 5 years of life, the child may experience seizures and hyperexcitability (see also:). You should not neglect medical recommendations and ignore the implementation of recreational activities. General strengthening massage and other procedures should be carried out only by a specialist. In the future, parents can master the basic techniques on their own. The lack of general strengthening activities can affect the mental development and behavior of the child.

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

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

Asphyxia prevention

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

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

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

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

You can not skip scheduled visits to the gynecologist and ignore medical recommendations. With her neglect, the expectant mother endangers not only her health, but also the condition of the fetus and its life.

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

• Walks. For a normal supply of oxygen to the fetus, a pregnant woman must spend a sufficiently long time outdoors. Ideally, if walks are held in the park or in the square. In a few hours on the street, the mother's body is saturated with oxygen, which enters the fetus. Oxygen has a positive effect on the proper formation of the organs of the future person.
• Schedule. For a woman carrying a child, the correct daily routine should become the law. Getting up early, watching movies at night and the “frantic” rhythm of the day is not for her. All the turmoil must be left in the past and try to relax more. Night sleep should be at least 8-9 hours, and at least 1-2 hours should be devoted to it during the day.
• Taking vitamins and minerals. Even if a woman's diet consists of the highest quality and healthy products, then taking vitamins is still necessary. Unfortunately, in modern products there are not so many useful substances that are necessary for a woman and a child. That is why every pregnant woman should take vitamin complexes that can meet her needs and the needs of the child. The choice of a vitamin-mineral complex is carried out independently or together with a gynecologist. The most popular are Femibion ​​and Elevit Pronatal (we recommend reading:).
• You can't lift weights.
• It is important to maintain inner peace and a positive attitude.