Moderate asphyxia in newborns. Caring for a child after suffering asphyxia. Intrauterine and postpartum asphyxia and its causes

Insufficient supply of oxygen to the body is very dangerous for the normal functioning of all organs, tissues and cells of the human body. And the longer a person experiences a lack of oxygen, the more pronounced negative consequences can occur. This condition is considered especially dangerous when it comes to a still developing organism - a fetus or a newborn child. With an acute lack of oxygen, children can face directly at the time of birth. Let's talk about what neonatal asphyxia is, consider the consequences of such a violation and the degree of asphyxia on the Apgar scale, and also figure out how a newborn is resuscitated during asphyxia.

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

Asphyxia of newborns during childbirth can be explained by intracranial trauma of the newborn received during passage through the birth canal. It can also be provoked by cord entanglement, oligohydramnios, blockage of the respiratory tract with mucus, malformations, etc.

The degree of asphyxia of newborns according to the APGAR scale

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

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

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

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

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

What threatens asphyxia during childbirth, what are its consequences

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

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

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

Resuscitation of newborns with asphyxia

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

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

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

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

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

Neonatal asphyxia is a rather serious disorder that requires immediate correction and further monitoring.

In medicine, neonatal asphyxia is considered a critical pathology: in a child, it occurs due to respiratory failure and the development of hypoxia with a beating heart. This condition is observed in 4-6% of babies. Asphyxia during childbirth develops in children with disorders of the cardiovascular system and the absence of reflex activity. The prognosis for suffocation depends on the timeliness of the therapy and the severity of the condition.

What is neonatal asphyxia

Translated from Latin, asphyxia means suffocation, a significant lack of oxygen. A pathological condition caused by the absence of a respiration reflex leads to a violation of gas exchange. The process is accompanied by a lack of oxygen in the tissues and blood of the child and an increase in the amount of carbon dioxide. This pathology requires immediate resuscitation.

The mechanism of development of asphyxia

A lung disorder develops in children who are born viable, but cannot breathe on their own or breathe spasmodically, superficially against the background of existing heartbeats. The severity of changes occurring in the body due to hypoxia depends on the duration of oxygen starvation. Asphyxia in newborns leads to a restructuring of metabolic processes, blood circulation and hemodynamics.

Complications are manifested by an increase in the volume of circulating blood and hyperhydration of tissues. As a result, the internal organs swell: the heart, liver, brain and others. Areas of ischemia with hemorrhages appear, blood pressure decreases, and the kidneys stop excreting urine. Children who have undergone a long period of oxygen starvation develop serious disorders of the central nervous system.

The reasons

Intranatal asphyxia (occurring at birth) is divided into primary and secondary. The development of primary pathology in the fetus occurs during childbirth due to the following reasons:

acute or chronic intrauterine oxygen starvation;
cranial injury of a child with obstetric care;
malformations;
incompatibility of mother and child by blood type;
blockage by amniotic fluid and mucus of the respiratory tract;
the presence of chronic diseases with exacerbations during pregnancy in the mother;
endocrine disorders;
developmental disorders of the placenta, umbilical cord;
premature discharge of amniotic fluid.

The secondary form develops in the postnatal period, after a few hours or days due to any of the following reasons:

circulatory disorders of the brain in a newborn;
pathologies of the nervous system;
heart disease.

Classification

Asphyxia in children has four degrees of severity, measured on the Apgar scale: mild, moderate, severe and clinical death. The first is given a score of 6-7 points. The child takes a breath after being born. He has a blue face and a moderate decrease in muscle tone. The second degree is rated 4-5 points. The baby's breathing is irregular, the heart rarely beats. There is cyanosis of the skin of the face and extremities. The newborn develops motor activity of the limbs, increased excitability.

The third degree of severity has 1-3 points. It is characterized by lack of breathing, bradycardia, muscle atony. The baby's skin is white, he has convulsions and hemorrhagic syndrome. Clinical death is diagnosed when all indicators are set to 0 points in the absence of signs of life. The child's condition is extremely serious, requiring immediate resuscitation.

Diagnostics

Pathology is diagnosed immediately after the birth of a child, taking into account the characteristics of breathing, heart contractions, muscle tone, skin color and the presence of reflexes. In addition to the examination, the conclusion about the state of health of the baby is confirmed by a blood test. In the case of a diagnosis, a brain examination is performed to determine traumatic and hypoxic lesions.

Treatment

Begin treatment of asphyxia of newborns in the maternity ward. In the process of restoring the vital activity of children, doctors monitor the main vital parameters: heart rate, breathing depth, blood counts and electrolyte levels. Guided by the data obtained, specialists evaluate how effective their actions are, making corrections in case of insufficient blood oxygen saturation.

Resuscitation of a newborn with asphyxia

Regardless of the causes of the pathology, all infants with hypoxia receive the necessary treatment from the first minutes of life. The neonatal resuscitation system provides for a certain sequence of actions. Need:

clear the nasopharynx and breathing passages from amniotic fluid, mucus, meconium;
normalize breathing;
to support the blood circulation system.

Stages of resuscitation

During recovery activities, continuous monitoring of the baby's vital signs is carried out. Resuscitators and neonatologists take the following measures:

The newborn is placed under an infrared lamp on a changing table.
Aspirate fluid from the respiratory tract without touching the posterior pharyngeal wall.
Wipe the skin dry.
The baby is placed on his back, placing a roller under the shoulder girdle to increase the patency of the breathing paths.
Stimulate breaths with stroking movements along the spine along with a pat on the heels.
If breathing is not restored, then carry out artificial ventilation of the lungs with an indirect heart massage.

Administration of drugs

If the heart rate is below 80 beats per minute, and spontaneous breaths are not observed, then the newborn is given drugs. It is necessary to increase the indicators consistently. First, an intravenous solution of adrenaline is administered. With signs of acute blood loss, therapy is carried out to restore its volume with isotonic sodium solution. If breathing is not restored, then repeat the introduction of adrenaline.

Further treatment and observation

After resuscitation, a small patient is transferred to the ward to continue therapy. Babies with a mild degree of pathology are placed in an oxygen room, and with more severe ones, in a special incubator (a device with automated oxygen supply) with heating. These newborns require special attention. They are given dehydration and infusion therapy. The first eliminates swelling of the organs and tissues of the body, and the second normalizes metabolic processes and the functioning of the urinary system.

Calcium gluconate is used to prevent cerebral bleeding. In some cases of asphyxia, symptomatic treatment may be required to prevent the development of hydrocephalic syndrome and limb cramps. Newborns with severe nervous excitability are prescribed sedative drugs. The child is examined twice a day, and regular tests are carried out to assess the functioning of the body.

Special care and feeding

A newborn with mild to moderate severity of asphyxia is fed sixteen hours after birth. Patients with a severe form of food are given a day later through a special probe. When the baby can be breastfed, the supervising doctor determines. It depends on several factors: the severity of the disease, the intensity of the recovery process and the likelihood of complications.

Effects

Asphyxia damages the nervous system and brain of an infant. With a severe degree of the disease, disturbances in the work of the whole organism develop, which can be noticed after weeks or months. Pathologies manifest themselves as:

swelling and hemorrhage in the brain;
necrotic changes in individual sections of brain tissue;
fatal outcome.

Dangerous complications of asphyxia in the work of internal organs include:

brain inflammation;
sepsis;
lung pathology (pneumonia, atelectasis);
hydrocephalus;
encephalopathy.

During the first years of life, newborns who have undergone severe oxygen starvation may show several abnormalities:

unpredictable behavior;
lethargy;
high excitability;
violation of the formation of the immune system;
developmental delay.

Prognosis for asphyxia of the newborn

The prognosis of the health status of a newborn with asphyxia is assessed using the Apgar scale. For the first time, the indicator is determined immediately after the birth of the baby, the second - after five minutes. If there are significant changes in the state in the direction of improvement, then the prognosis is considered favorable. The outcome of the treatment of the disease depends on the timeliness of taking the necessary measures. Even if the newborn has severe asphyxia, but he recovers, then there is a high probability of developing complications.

After discharge, the baby needs proper care. It should be at rest, the head should be placed on a dais. Doctors often prescribe oxygen therapy, for which you can buy breathing masks or nasal prongs at the pharmacy. All newborns who have undergone this situation should be regularly examined by a neurologist and pediatrician in order to identify possible complications and pathologies in time.

Prevention

The risk of developing a situation can be reduced if a number of recommendations are followed. Measures are especially important for pregnant women who are at risk: those with diseases of the internal organs, the endocrine system, and infectious invasions. If, during a periodic examination, a woman has preeclampsia or placental insufficiency, then treatment should be carried out as early as possible.

The following measures will help prevent the development of the disease:

periodic examinations with ultrasound, CT, laboratory tests;
regular visits to the doctor;
walks in the park area;
rejection of bad habits;
taking vitamins;
adherence to the correct diet and daily routine;
treatment of chronic diseases before pregnancy.

Video

The development of oxygen deficiency and shortness of breath - this is asphyxia of newborns. This dangerous disease can occur both at the time of birth and during the first day of a baby's life. When a baby is born, it should immediately learn to breathe on its own. If in the process of adaptation to extrauterine conditions of life a failure occurs, there is a violation of breathing. Topic of the article: asphyxia during childbirth - the consequences of oxygen deficiency.

Asphyxia is congenital when, in the process of formation, the fetus suffers from hypoxia due to malformations, lack of oxygen, and immunological incompatibility (Rhesus factor) with the mother's body. Asphyxia also happens to be acquired (secondary), when during childbirth the baby receives:

intracranial injury;
obstruction of the airways by amniotic fluid.

Intrauterine pathology may appear due to:

chronic diseases of the mother (diabetes, cardiovascular disease, anemia);
late toxicosis of the mother, complicated by edema and high blood pressure;
mother's abuse of alcohol and tobacco;
violations by the mother of the correct daily routine and increased nervous excitability.

Secondary asphyxia may appear due to a violation of the cerebral circulation of the newborn or damage to the central nervous system during birth. Difficulty in breathing the baby can get when the umbilical cord is wrapped around the neck during childbirth or premature detachment of the placenta in the mother (oligohydramnios).

Immediately after the birth of a newborn, obstetricians evaluate his condition on a ten-point Apgar scale. In severe asphyxia (below three points), urgent resuscitation is carried out. From the first minutes of life, experienced specialists can determine the condition of the crumbs by proper breathing, muscle contraction, heartbeats and skin.

Three degrees of disease

The main sign of pathology in a baby is wrong breathing. In the process of intrauterine development and passage through the birth canal, the baby can get asphyxia of varying severity. With mild asphyxia (6-7 points), the newborn has:

slightly reduced muscle tone;
inhibited motor activity;
little pronounced physiological reflexes;
diffuse cyanosis in the nasolabial region;
weak intermittent breathing (shallow).

The baby begins to breathe and scream after birth, however, his breathing is weak, and his movements are devoid of activity.

With pathology of moderate severity (4-5 points) in newborns, the following is observed:

sluggish reaction to irritation during examination;
insensitivity to pain;
partial absence of physiological reflexes;
cyanotic skin tone;
convulsive shallow breathing.

The baby takes a breath, but the breath is devoid of rhythm. This degree of pathology is characterized by the presence of tachycardia in an infant (rapid heartbeat), and the skin on the limbs (feet and palms) and face has a bright bluish tint.

In a severe form of pathology (3-1 points), the following is observed:

lack of spontaneous breathing;
blanching of the skin;
lack of physiological reflexes;
weak pulse and palpitations.

With this degree of pathology, the baby can breathe, but does not scream. The muscular system is characterized by atony / hypotension, there is no pulsation of the umbilical cord. The skin has a pale tint, and congenital reflexes do not appear in any way.

Severe brain damage at birth may result in the absence of an inborn suck/swallow reflex. In an extreme degree (zero Apgar score), fetal asphyxia can result in the death of the newborn.

Important! Fetal asphyxia does not pass without a trace: it has a negative impact on the physiological and mental processes of the child's development.

Effects

This pathology changes the metabolic processes in the baby's body. If asphyxia develops on the basis of intrauterine fetal hypoxia, this leads to thickening of the blood and a decrease in its volume.

Against the background of oxygen deficiency, cerebral edema and micro hemorrhages can form, which destroy the structure of tissues. Hypoxia reduces the pressure in the bloodstream, which affects the work of the heart - the contractions of the heart muscle slow down, their number is reduced.

Pathological processes also capture the area of the urinary system, disrupting its functionality. As the newborn grows older, asphyxia during childbirth leads to:

slow development of speech skills;
inhibition of mental reactions;
inadequate reaction to the situation;
poor assimilation of the school curriculum;
weakening of the immune system.

The child may have unbalanced coordination of movements, increased emotional background, uncoordinated processes of excitation and inhibition.

The most severe form of fetal asphyxia is cerebral palsy (ICP).

Cerebral palsy is not curable, the child constantly needs intensive care and attention. You need to constantly engage with the baby, and when classes are stopped, the symptoms of cerebral palsy worsen.

Baby care

Immediately after identifying signs of pathology with the baby, resuscitation is carried out. Firstly, the oral cavity is freed from the accumulation of mucus and amniotic fluid with a special probe. Secondly, they restore heart rate and respiratory function.

Therapeutic efforts are aimed at eliminating the cause of cerebral edema, restoring metabolic processes and the function of the urinary system.

The consequences of asphyxia are hard to bear by the baby. The newborn needs to be less disturbed, to ensure complete rest. The head should always be raised on a pillow.

After discharge, the newborn is supervised by the local pediatrician and pediatric neuropathologist. Without the necessary therapy, a newborn may develop cerebral palsy. Possible consequences of the transferred asphyxia include:

convulsive and hydrocephalic syndromes;
diencephalic pathology;
hyperexcitability.

At home, the baby needs constant supervision, measuring the body temperature and carefully monitoring the excretory system. A mother must have faith in the complete healing of a newborn baby, make every effort to form a healthy body, and prevent the development of cerebral palsy.

Prevention

To prevent the causes of fetal pathology, care must be taken during pregnancy.

It is necessary to completely change the whole way of life and, above all, give up smoking and alcohol.

The expectant mother should take daily walks, saturating her body with oxygen. Air conditioning and ventilation of the room will not replace walks in the park or square. Oxygen from the mother's blood enters the fetus and prevents the occurrence and development of oxygen starvation.

If it is not possible to travel outside the city limits, you can walk in the nearest park area, where there is a lot of vegetation. Oxygen is vital for the fetus to develop properly.

To prevent the causes of the development of pathology, the expectant mother should:

treat even a minimal runny nose in time;
monitor changes in your hormonal background;
go to bed not at night, but in the evening;
do not sit at a laptop for a long time without a reason;
follow the diet;
do not participate in conflict situations.

The diet involves a large consumption of fruit and vegetable dishes and sufficient consumption of low-fat dairy products. The district gynecologist will tell you in detail about the diet. For the prevention of vitamin deficiency, a special vitamin complex for pregnant women should be used. It also shows the intake of iron and folic acid supplements.

Peace of mind is essential for a successful pregnancy and birth. Calm mothers give birth to babies without deviations in the psyche and health. Of course, subject to all other rules of conduct during pregnancy.

Also, a woman should visit a gynecologist at the stipulated time. Monitoring of the fetus and placenta is important. It is the early detection of fetal oxygen starvation that will help start timely treatment, and fetal asphyxia will not develop.

How to get rid of stretch marks after childbirth?

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.

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:

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.
Next, the umbilical cord is tied.
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:

Update: November 2018

The birth of a long-awaited baby is a joyful event, but not in all cases, childbirth ends successfully, not only for the mother, but also for the child. One of these complications is fetal asphyxia, which occurred during childbirth. This complication is diagnosed in 4-6% of newly born children, and according to some authors, the frequency of asphyxia in newborns is 6-15%.

Definition of neonatal asphyxia

Translated from Latin, asphyxia means suffocation, that is, lack of oxygen. Asphyxia of newborns is a pathological condition in which gas exchange in the body of a newborn is disturbed, which is accompanied by a lack of oxygen in the tissues of the child and his blood and the accumulation of carbon dioxide.

As a result, a newborn who was born with signs of live birth either cannot breathe on his own in the first minute after birth, or he has separate, superficial, convulsive and irregular respiratory movements against the background of an existing heartbeat. Such children immediately undergo resuscitation, and the prognosis (possible consequences) for this pathology depends on the severity of asphyxia, the timeliness and quality of resuscitation.

Classification of asphyxia of newborns

According to the time of occurrence, 2 forms of asphyxia are distinguished:

primary - develops immediately after the birth of the baby;
secondary - diagnosed during the first day after childbirth (that is, at first the child independently and actively breathed, and then suffocation occurred).

According to the severity (clinical manifestations) there are:

mild asphyxia;
moderate asphyxia;
severe asphyxia.

Factors provoking the development of asphyxia

This pathological condition does not belong to independent diseases, but is only a manifestation of complications during pregnancy, diseases of the woman and the fetus. Causes of asphyxia include:

fruit factors

) The child has;
Rh-conflict pregnancy;
anomalies in the development of the organs of the bronchopulmonary system;
intrauterine infections;
prematurity;
intrauterine growth retardation of the fetus;
airway obstruction (mucus, amniotic fluid, meconium) or aspiration asphyxia;
malformations of the heart and brain of the fetus.

maternal factors

severe, occurring against the background of high blood pressure and severe edema;
decompensated extragenital pathology (cardiovascular diseases, diseases of the pulmonary system);
pregnant women;
endocrine pathology (, ovarian dysfunction);
shock of a woman during childbirth;
disturbed ecology;
bad habits (smoking, alcohol abuse, drug use);
inadequate and malnutrition;
taking medications that are contraindicated during gestation;
infectious diseases.

Factors contributing to the development of disorders in the uteroplacental circle:

delayed pregnancy;
premature aging of the placenta;
premature detachment of the placenta;
pathology of the umbilical cord (entanglement of the umbilical cord, true and false nodes);
permanent threat of interruption;
and bleeding associated with it;
multiple pregnancy;
excess or lack of amniotic fluid;
anomalies of tribal forces (and discoordination, fast and rapid childbirth);
administration of drugs less than 4 hours before the completion of labor;
general anesthesia of a woman;
uterine rupture;

Secondary asphyxia is provoked by the following diseases and pathologies in a newborn

impaired cerebral circulation in a child due to residual effects of damage to the brain and lungs during childbirth;
heart defects not detected and not manifested immediately at birth;
aspiration of milk or mixture after the feeding procedure or poor-quality sanitation of the stomach immediately after birth;
respiratory distress syndrome caused by pneumopathy:
- the presence of hyaline membranes;
- edematous-hemorrhagic syndrome;
- pulmonary hemorrhages;
- atelectasis in the lungs.

The mechanism of development of asphyxia

It does not matter what caused the lack of oxygen in the body of a newly born child, in any case, metabolic processes, hemodynamics and microcirculation are rebuilt.

The severity of the pathology depends on how long and intense the hypoxia was. Due to metabolic and hemodynamic changes, acidosis develops, which is accompanied by a lack of glucose, azotemia and hyperkalemia (later hypokalemia).

In acute hypoxia, the volume of circulating blood increases, and in chronic and subsequent asphyxia, the blood volume decreases. As a result, the blood thickens, its viscosity increases, and the aggregation of platelets and red blood cells increases.

All these processes lead to microcirculation disorders in vital organs (brain, heart, kidneys and adrenal glands, liver). Microcirculation disorders cause edema, hemorrhages and ischemia foci, which leads to hemodynamic disturbances, disruption of the functioning of the cardiovascular system, and, as a result, of all other systems and organs.

Clinical picture

The main sign of asphyxia in newborns is a violation of breathing, which entails a malfunction of the cardiovascular system and hemodynamics, and also disrupts neuromuscular conduction and the severity of reflexes.

To assess the severity of the pathology, neonatologists use the Apgar score of the newborn, which is carried out at the first and fifth minute of the child's life. Each sign is estimated at 0 - 1 - 2 points. A healthy newborn in the first minute is gaining 8 - 10 Apgar points.

Degrees of asphyxia of newborns

Light asphyxia

With mild asphyxia, the number of Apgar scores for a newborn is 6-7. The child takes the first breath during the first minute, but there is a decrease in breathing, slight acrocyanosis (cyanosis in the area of the nose and lips) and a decrease in muscle tone.

Moderate asphyxia

The Apgar score is 4-5 points. There is a significant weakening of breathing, its violations and irregularity are possible. Heart contractions are rare, less than 100 per minute, cyanosis of the face, hands and feet is observed. Motor activity increases, muscular dystonia develops with a predominance of hypertonicity. Tremor of the chin, arms and legs is possible. Reflexes can be either reduced or enhanced.

Severe asphyxia

The condition of the newborn is severe, the number of Apgar scores in the first minute does not exceed 1 - 3. The child does not make respiratory movements or takes separate breaths. Heart contractions less than 100 per minute, pronounced, heart sounds are muffled and arrhythmic. There is no cry in the newborn, muscle tone is significantly reduced, or muscle atony is observed. The skin is very pale, the umbilical cord does not pulsate, reflexes are not determined. Eye symptoms appear: nystagmus and floating eyeballs, seizures and cerebral edema, DIC (impaired blood viscosity and increased platelet aggregation) may develop. Hemorrhagic syndrome (numerous hemorrhages on the skin) increases.

clinical death

A similar diagnosis is made when assessing all Apgar scores at zero points. The condition is extremely serious and requires immediate resuscitation.

Diagnostics

When making a diagnosis: "Asphyxia of the newborn" take into account the obstetric anamnesis data, how the birth proceeded, the Apgar score of the child at the first and fifth minutes, and clinical and laboratory studies.

Determination of laboratory indicators:

pH level, pO2, pCO2 (examination of blood obtained from the umbilical vein);
determination of base deficiency;
the level of urea and creatinine, diuresis per minute and per day (work of the urinary system);
the level of electrolytes, acid-base state, blood glucose;
the level of ALT, AST, bilirubin and blood clotting factors (liver function).

Additional methods:

assessment of the work of the cardiovascular system (ECG, blood pressure control, pulse, chest x-ray);
assessment of the neurological status and the brain (neurosonography, encephalography, CT and MRI).

Treatment

All newborns born in a state of asphyxia undergo immediate resuscitation. It is on the timeliness and adequacy of the treatment of asphyxia that the further prognosis depends. Resuscitation of newborns is carried out according to the ABC system (developed in America).

Primary care for the newborn

Principle A

ensure the correct position of the child (lower the head, placing a roller under the shoulder girdle and tilt it back slightly);
suck mucus and amniotic fluid from the mouth and nose, sometimes from the trachea (with aspiration of amniotic fluid);
intubate the trachea and sanitize the lower airways.

Principle B

conduct tactile stimulation - a slap on the heels of the child (if there is no cry for 10 - 15 seconds after birth, the newborn is placed on the resuscitation table);
jet oxygen supply;
implementation of auxiliary or artificial ventilation of the lungs (Ambu bag, oxygen mask or endotracheal tube).

Principle C

conducting an indirect heart massage;
drug administration.

The decision to stop resuscitation is carried out after 15-20 minutes, if the newborn does not respond to resuscitation (no breathing and persistent bradycardia persists). Termination of resuscitation is due to the high probability of brain damage.

Drug Administration

Cocarboxylase, diluted with 10 ml of 15% glucose, is injected into the umbilical vein against the background of artificial lung ventilation (mask or endotracheal tube). Also, 5% sodium bicarbonate is administered intravenously to correct metabolic acidosis, 10% calcium gluconate and hydrocortisone to restore vascular tone. If bradycardia appears, 0.1% - atropine sulfate is injected into the umbilical vein.

If the heart rate is less than 80 per minute, an indirect heart massage is performed with the obligatory continuation of artificial lung ventilation. 0.01% adrenaline is injected through the endotracheal tube (possibly into the umbilical vein). As soon as the heart rate reaches 80 beats, the heart massage stops, ventilation continues until the heart rate reaches 100 beats and spontaneous breathing appears.

Further treatment and observation

After providing primary resuscitation care and restoring cardiac and respiratory activity, the newborn is transferred to the intensive care unit (ICU). In the ICU, further therapy for asphyxia of the acute period is carried out:

Special care and feeding

The child is placed in a couveuse, where constant heating is carried out. At the same time, craniocerebral hypothermia is performed - the head of the newborn is cooled, which prevents. Feeding of children with mild and moderate asphyxia begins no earlier than 16 hours later, and after severe asphyxia, feeding is allowed in a day. Feed the baby through a tube or bottle. Attachment to the breast depends on the condition of the child.

Cerebral edema warning

Intravenously, albumin, plasma and cryoplasma, mannitol are injected through the umbilical catheter. Also, drugs are prescribed to improve the blood supply to the brain (cavinton, cinnarizine, vinpocetine, sermion) and antihypoxants (vitamin E, ascorbic acid, cytochrome C, aevit). Hemostatic drugs (dicinone, rutin, vikasol) are also prescribed.

Carrying out oxygen therapy

The supply of humidified and warmed oxygen continues.

Symptomatic treatment

Therapy aimed at preventing seizures and hydrocephalic syndrome is being carried out. Anticonvulsants are prescribed (GHB, phenobarbital, Relanium).

Correction of metabolic disorders

Continued intravenous administration of sodium bicarbonate. Infusion therapy is carried out with saline solutions (physical solution and 10% glucose).

Newborn Monitoring

Twice a day, the child is weighed, the neurological and somatic status and the presence of positive dynamics are assessed, and the incoming and outgoing fluid (diuresis) is monitored. The devices record heart rate, blood pressure, respiratory rate, central venous pressure. From laboratory tests, a general blood test with and platelets, an acid-base state and electrolytes, blood biochemistry (glucose, bilirubin, AST, ALT, urea and creatinine) are determined daily. The blood coagulation parameters and the tank are also evaluated. cultures from the oropharynx and rectum. X-rays of the chest and abdomen, ultrasound of the brain, ultrasound of the abdominal organs are shown.

Effects

Neonatal asphyxia rarely resolves without sequelae. To some extent, the lack of oxygen in a child during and after childbirth affects all vital organs and systems. Especially dangerous is severe asphyxia, which always occurs with multiple organ failure. The prognosis for a baby's life depends on the Apgar score. In the case of an increase in the score at the fifth minute of life, the prognosis for the child is favorable. In addition, the severity and frequency of development of the consequences depend on the adequacy and timeliness of the provision of resuscitation and further therapy, as well as on the severity of asphyxia.

The frequency of complications after suffering hypoxic:

with I degree of encephalopathy after hypoxia / asphyxia of newborns - the development of the child does not differ from the development of a healthy newborn;
with II degree of hypoxic encephalopathy - 25 - 30% of children later have neurological disorders;
with III degree of hypoxic encephalopathy, half of the children die during the first week of life, and the rest in 75-100% develop severe neurological complications with convulsions and increased muscle tone (later mental retardation).

After suffering asphyxia during childbirth, the consequences can be early and late.

Early Complications

They talk about early complications when they appeared during the first 24 hours of a baby’s life and, in fact, are manifestations of a difficult course of childbirth:

hemorrhage in the brain;
convulsions;
and hand tremor (first small, then large);
apnea (stop breathing);
meconium aspiration syndrome and, as a result, the formation of atelectasis;
transient pulmonary hypertension;
due to the development of hypovolemic shock and blood clotting, the formation of polycythemic syndrome (a large number of red blood cells);
thrombosis (blood clotting disorder, reduced vascular tone);
heart rhythm disorders, development of posthypoxic cardiopathy;
disorders of the urinary system (oliguria, thrombosis of the renal vessels, edema of the interstitium of the kidneys);
gastrointestinal disorders (and intestinal paresis, digestive tract dysfunction).

Late Complications

Late complications are diagnosed after three days of a child's life and later. Late complications can be of infectious and neurological origin. The neurological consequences that appeared as a result of cerebral hypoxia and posthypoxic encephalopathy include:

Syndrome of hyperexcitability

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

Syndrome of reduced excitability

Reflexes are poorly expressed, the child is lethargic and adynamic, muscle tone is reduced, dilated pupils, a tendency to lethargy, there is a symptom of "doll" eyes, breathing periodically slows down and stops (bradypnea, alternating with apnea), a rare pulse, a weak sucking reflex.

convulsive syndrome

Characterized by tonic (tension and rigidity of the muscles of the body and limbs) and clonic (rhythmic contractions in the form of twitching of individual muscles of the arms and legs, face and eyes) convulsions. Opercular paroxysms also appear in the form of grimaces, spasm of gaze, attacks of unmotivated sucking, chewing and tongue protrusion, floating eyeballs. There may be attacks of cyanosis with apnea, a rare pulse, increased salivation and sudden pallor.

Hypertensive-hydrocephalic syndrome

The child throws back his head, the fontanelles bulge, the cranial sutures diverge, the head circumference increases, constant convulsive readiness, loss of cranial nerve functions (strabismus and nystagmus are noted, smoothness of the nasolabial folds, etc.).

Syndrome of vegetative-visceral disorders

Characterized by vomiting and constant regurgitation, disorders of the motor function of the intestine (constipation and diarrhea), marbling of the skin (spasm of blood vessels), bradycardia and rare breathing.

movement disorder syndrome

Characterized by residual neurological disorders (paresis and paralysis, muscle dystonia).

subarachnoid hemorrhage
Intraventricular hemorrhages and hemorrhages around the ventricles.

Possible infectious complications (due to weakened immunity after multiple organ failure):

development ;
damage to the dura mater ();
development of sepsis;
intestinal infection (necrotizing colitis).

Question answer

Question:
Does a child who has suffered birth asphyxia need special care after discharge?

Answer: Oh sure. Such children need especially careful supervision and care. Pediatricians, as a rule, prescribe special gymnastics and massage, which normalize excitability, reflexes in the baby and prevent the development of seizures. The child must be provided with maximum rest, preference should be given to breastfeeding.

Question:
When is a newborn discharged from the hospital after asphyxia?

Answer: It is worth forgetting about early discharge (for 2-3 days). The baby will be in the maternity ward for at least a week (an incubator is required). If necessary, the baby and mother are transferred to the children's department, where treatment can last up to a month.

Question:
Are newborns who have suffered asphyxia subject to dispensary observation?

Answer: Yes, all children who have suffered asphyxia during childbirth are mandatory registered with a pediatrician (neonatologist) and a neurologist.

Question:
What consequences of asphyxia are possible in a child at an older age?

Answer: Such children are prone to colds due to weakened immunity, they have reduced school performance, reactions to some situations are unpredictable and often inadequate, psychomotor development may be delayed, speech lag. After severe asphyxia, epilepsy, convulsive syndrome often develop, oligophrenia, and paresis and paralysis are not excluded.