Birth asphyxia causes consequences in the future. Asphyxia: types, symptoms, treatment and consequences

According to statistics, asphyxia of varying severity is diagnosed approximately in 4-6% of the total number of newborns children.

The severity of the disease depends on the extent to which the baby's gas exchange process was disturbed in the prenatal period, that is, on the ratio of the amount of oxygen and carbon dioxide in the tissues and blood cells of the child. O consequences of asphyxia newborns will talk in the article.

stages

What is asphyxia in a newborn baby? Asphyxia may be primary when the process of gas exchange is disturbed even in the prenatal period. This condition occurs against the background of oligohydramnios, pathological conditions during pregnancy.

Secondary asphyxia develops in the first days of a child's life. Occurs with various kinds of disorders of the respiratory system.

This condition is considered very dangerous, as it is considered a common cause of stillbirth and death in children in the first days of life.

Forecast depends on the severity of the violation, but, in any case, the newborn needs urgent help from specialists in intensive care.

What happens with asphyxia?

Regardless of the reasons that led to the development of asphyxia, this condition negatively affects metabolic processes occurring in the body of the newborn. The processes of blood circulation, blood microcirculation are disturbed.

This leads to a deterioration in the nutrition of all organs and systems of the baby. It is known that for the normal functioning of each organ requires nutrients and oxygen. With their lack, the normal development of organs and body systems is impossible.

Asphyxia can have varying degrees of severity. It depends on the duration and intensity of oxygen starvation. In the body of a child, important processes that regulate nutrition at the cellular level are disrupted; pathologies such as acidosis, accompanied by a lack of glucose, may appear.

At the initial stage, the volume of blood in the child's body increases, over time, when the disease becomes chronic, this volume decreases significantly. This leads to a change in the composition of the blood (an increase in the number of erythrocytes, platelets), its greater viscosity.

This condition is dangerous for the body by the possibility of the formation of blood clots, obstruction of blood vessels.

As a result of these pathological processes, there is violation of blood microcirculation in internal organs (brain, heart, etc.). Such disorders cause edema, small hemorrhages, the development of diseases and other systems.

In order to assess the general condition of the child, the severity of asphyxia during childbirth, and the impact that this pathology had on the body, doctors conduct a special examination of the newborn (at 1 and 5 minutes of life). The results are evaluated according to a special table:

A healthy child without signs of asphyxia is gaining more than 8 points on the Apgar scale, if these indicators are reduced, there is a pathology of varying severity.

How to treat asthenic syndrome in children and adolescents? Learn about it from ours.

Reasons for the development of pathology

There are several groups of negative factors that can lead to the development of asphyxia.

This pathology is not considered independent, but is only a consequence of these causes.

Fetal factors:

Traumatic brain injury of a newborn, received by him in the process of childbirth.
Rhesus - a conflict with the mother's body. This phenomenon is possible if the Rh status of the pregnant woman is negative, and the child is positive. In this case, the leukocytes of the expectant mother perceive the embryo as a foreign body and try to destroy it. This leads to various kinds of pathologies.
Violations of the functions of the respiratory system.
intrauterine infections.
premature birth.
Anomalies of growth and development of the child in the prenatal period.
Entry into the respiratory organs of amniotic fluid, mucus, feces secreted by the fetus into the amniotic fluid.
Violations of the development of the heart, brain.

Mother factors:

Factors that disrupt blood circulation in the placenta:

Postponed pregnancy.
Pathology of the placenta (its premature aging, detachment, presentation).
Entanglement of the fetus by the umbilical cord.
Multiple pregnancy.
Polyhydramnios or oligohydramnios.
Violations of the natural birth process (weakness of contractions, the use of drugs, caesarean section, the use of general anesthesia).

To the development of secondary asphyxia may result in the following negative factors:

Birth trauma to the fetus, leading to circulatory disorders in the brain.
Cardiac pathologies.
Improper feeding when mother's milk enters the nose of the newborn, making it difficult for the normal breathing process.
Features and pathological deviations of the structure of the lungs.

Clinical manifestations

Pathology manifests itself in different ways, depending on the degree of its severity.

Light degree characterized by:

a slight delay in the moment of the first breath (inhalation occurs in the first minute of life);
the cry of the child is slightly muffled;
breathing is regular, but weakened;
skin color in the region of the nasolabial triangle is pale or cyanotic;
Apgar score 6-7.

Asphyxia moderate manifested by symptoms such as:

irregular, severely weakened breathing;
the child almost does not cry;
reduced reflexes and heart rate;
the skin has a bluish color in the face, hands, feet;
Apgar score 4-5.

heavy asphyxia manifests itself in the form:

lack of breathing (single breaths are possible with a large interval);
lack of cry;
a significant decrease in muscle tone, or their complete absence;
Heart rate less than 100 beats per minute;
there is no pulsation in the umbilical cord;
cyanotic color of the skin;
Apgar score 1-3.

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Treatment

Regardless of the severity of the pathology, the child needs urgent resuscitation aimed at restoring the functionality of organs and systems affected by oxygen deficiency.

Asphyxia mild and moderate severity removed in several steps:

It is necessary to thoroughly clean the child's nasal passages, oral cavity, stomach.
If necessary, artificial ventilation of the lungs is carried out using a special mask.
A 20% glucose solution is injected into the vein of the umbilical cord. The amount of the drug depends on the weight of the newborn.
If these measures were not enough, the child will need hardware ventilation.

Treatment of severe asphyxia requires more drastic measures such as:

hardware ventilation of the lungs;
external heart massage;
intravenous administration of glucose preparations, prednisolone, adrenaline, calcium gluconate.

Newborn care

A newborn who has undergone asphyxia requires more careful monitoring and care. In particular, the baby needs constant oxygen support.

For this, it is placed in special incubator or oxygen tent(with a mild degree of pathology). The newborn will also need symptomatic treatment aimed at eliminating pathologies caused by a prolonged lack of oxygen.

It is necessary to solve the problem of feeding the baby. Of course, if there is such an opportunity, it is best improve the process of breastfeeding.

However, it all depends on the condition of the newborn.

In the future, the child will need the supervision of specialists, such as pediatrician, neurologist.

Consequences and complications

The lack of oxygen, even for a short time, negatively affects state of the brain and central nervous system. This manifests itself in the form of a violation of the processes of blood circulation, when the vessel increases in size as a result of its overfilling with blood.

This leads to the formation of blood clots, hemorrhages. If this phenomenon is observed in the area of the brain, the development of necrosis (death of certain parts of the cerebral cortex) is possible.

With severe asphyxia high risk of fetal death in utero or in the first days of a child's life. Children who have had a severe degree of asphyxia develop mental and physical disorders.

Prevention

Think about preventive measures to reduce the risk of asphyxia, woman should be before the conception of the child. In particular, it is necessary to monitor your health, the state of immunity, and prevent the development of chronic diseases.

During pregnancy necessary:

Regularly visit a gynecologist who will observe the pregnancy, strictly follow all his instructions.
To refuse from bad habits.
Normalize the daily routine, relax more.
Eat properly.
Be outdoors.
Provide moderate physical activity (if not contraindicated).
Protect yourself from infectious diseases.
Take medications prescribed by your doctor.
Provide yourself with peace and positive emotions.

Asphyxia - a dangerous phenomenon that threatens the health and life of a newborn. As a result of a lack of oxygen, all organs and systems of his body suffer, because in this case nutrition is disrupted at the cellular level.

The nervous, respiratory and cardiovascular systems are especially susceptible to negative changes. The consequences of asphyxia can be very negative, up to a significant lag in mental and physical development.

O causes of asphyxia newborns in this video:

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Asphyxia during childbirth is very dangerous and unpleasant, however, unfortunately, it is not uncommon in newborns. Hearing such a diagnosis, many parents at first panic, which is categorically not recommended. It is better to study the problem first, so that in which case you know how to react, and what exactly is the threat of asphyxia.

What is it

The terrible word "asphyxia" in fact means a violation of the respiratory functions in newborns during childbirth. As a rule, the danger manifests itself in the first seconds of the baby's exit. Breathing may be absent altogether, or be intermittent, rare. Roughly speaking, this is the usual suffocation.

Also, the term "asphyxia" means a whole range of changes and disorders in the body of a newborn child, which occur due to a lack of oxygen. The most common occurrence in the fetus is acidosis, which means that the acid-base balance is tilted to one side. At the same time, the heartbeat also slows down, and there is a violation of the metabolic processes of the body. Adaptation of a child with asphyxia, as a rule, turns out to be very difficult, and takes more time than for other children.

Asphyxia can develop in different forms, different conditions, as well as at different stages of pregnancy and the birth of a baby.

In order to understand what measures to take, and whether it is worth fearing the consequences, you need to study all the possible causes of asphyxia - this will help the expectant mother to be more careful.

The reasons

There are many reasons why asphyxia can occur, and they all fall into different groups.

insufficient amount of oxygen or an excess of carbon dioxide, or simply a lack of oxygen in the body of a young mother. This occurs as a result of acute blood loss, shock, diseases of the cardiovascular system, or intoxication;
it is through the umbilical cord that the necessary oxygen and nutrients are transferred to the fetus. With impaired circulation of the blood vessels of the umbilical cord or with pathologies of the placenta, a violation of respiratory functions may also occur. This list includes any other problems during pregnancy: severe toxicosis, prolonged gestation, violation of labor, and so on;
however, the presence or absence of asphyxia is provoked not only by factors dependent on the mother. Sometimes a lack of oxygen occurs due to dysfunction of the central nervous system of the child, malformations, as well as birth injuries and congenital heart defects;
sometimes the cause is absolute or intermediate obstruction of the fetal airways. If during pregnancy the mother had a cyst removed, or she was ill with infectious diseases, the child may be born with congenital pneumonia;
sometimes the lungs of a premature fetus cannot expand, because their body is simply not yet able to produce a substance such as a surfactant. It is this that contributes to the fact that the lungs healthy person constantly spread out.

As you can see, the sources are very diverse, and they all lead to different side effects.

Video "How to reduce the risk of asphyxia of the baby?"

Effects

The diagnosis of "asphyxia" can be made only in the first 24 hours after the birth of a child, and parents should not forget about it. If oxygen deficiency was recorded later, then the disease will be called differently. Various complications can appear as consequences, which are divided into two groups: early (in the first 24 hours) and late (starting from the first week of life).

The result of a lack of oxygen in the first day can be cerebral edema, hemorrhages inside the cranium, and death of the brain substance. Changes in the cardiovascular system, heart failure and impaired renal function are also possible. In some cases, pulmonary edema and pulmonary hemorrhage are obtained, as well as, as already mentioned, a lack of a substance that helps to restore the lungs. Certain consequences also apply gastrointestinal tract: intestinal obstruction, damage to the mucous membrane of the stomach and intestines.

There is also a group of late complications, including general brain damage, circulatory disorders, convulsive syndrome, and colds.

Signs and forms

As already mentioned, the first and most obvious consequence of asphyxia is impaired breathing. Further, the symptoms vary depending on the form of the disease.

with a mild form, the child inhales for the first time within 60 seconds after birth, however, there is a weakened intensity of breathing, reduced muscle tone, and in the region of the nose and lips, the skin has a bluish tint;
a severe form is also characterized by the first breath within a minute after birth, however, breaths are accompanied by tachycardia, extinction of reflexes, decreased muscle tone, and a bluish tint to the hands, feet and face skin;
in severe form, breathing is very irregular, or may be absent altogether. The child does not cry, only makes weak moans, the heartbeat slows down very much, primary reflexes do not appear. The skin takes on a pale bluish tint, the umbilical cord does not pulsate. Also, a severe form causes adrenal insufficiency;
the most dangerous form is called clinical death. Here it is necessary to immediately carry out a complex of resuscitation measures, otherwise the consequences may be irreparable.

Any experienced form of asphyxia requires some care and treatment later, even if the child's condition has returned to normal.

Treatment and care after

The first condition for therapy after complications of respiratory functions is a state of complete rest for the child. The child is placed in a chamber with a high oxygen content for some time, but only a doctor can predict how long this treatment will last.

All vital signs of the child are carefully observed and controlled, sometimes the body needs one or more cleanings of the respiratory tract from accumulated mucus. With a mild form of asphyxia, after 16 hours the child will be given to the mother, if the form is acute, feeding is carried out through a special probe.

After discharge, the baby must be registered at the dispensary, as well as under the supervision of a whole group of doctors. Depending on the severity of the condition, the speed of the measures taken, as well as the presence of complications, appropriate treatment may be necessary, which depends on the affected areas of the body.

It can be summarized that in order to prevent asphyxia in a child, it is necessary, first of all, if possible, to prevent various kinds of infections and stress during pregnancy, and otherwise everything will depend on the competence of doctors.

Video "Asphyxia - what is it?"

What is this danger that lies in wait for the baby when it is born? How to protect the child from the dangers of childbirth? You will learn all this from the video.

Asphyxia of newborns is a special type of pathology in childbirth, in which there is a complete blockage of oxygen access through the umbilical cord during the passage of the baby through the birth canal. In this case, a child can be born in a serious condition or die during childbirth in just a few minutes. This is caused by sharp disturbances in metabolic processes and acute hypoxia of vital organs - this is the heart and brain.

In a state of asphyxia, up to 5% of children can be born, the degree of its severity depends on the duration of the period of suffocation, changes in gas exchange, how much carbon dioxide the tissues have accumulated. Asphyxia can be in utero, during childbirth, and after birth, on the first day, secondary. It is one of the main causes of death of children in childbirth.

Asphyxia will be the result of an unfavorable course of pregnancy and childbirth, pathologies of both the mother's body and the fetus. A baby can be born in asphyxia during acute or chronic fetal hypoxia as a result of congenital infections (affection with syphilis, rubella, herpes, chlamydial and other infections), in the presence of intracranial injuries, malformations, in the presence of an Rhesus conflict or in the blood group, if amniotic fluid into the respiratory tract, if the baby takes the first breath before birth, when the umbilical cord is clamped during childbirth (loops fell out, breech presentation). Asphyxia threatens the fetus with placental abruption during childbirth, with prolonged pregnancy, late gestosis.

The secondary process occurs when the lungs are damaged (did not straighten out, pulmonary edema) after childbirth or disruption of the brain (hemorrhage, damage).

The stronger and longer the hypoxia was, the more severe the course of asphyxia will be, the internal organs, brain, and blood circulation suffer. Severe hypoxia leads to a decrease in pressure and death.

Symptoms

First of all, asphyxia is manifested by the absence of breathing at birth, which leads to impaired blood circulation, decreased muscle tone and the disappearance of reflexes. Asphyxia is recorded on the Apgar scale immediately after birth, while the presence of points from 5 to 7 indicates fetal hypoxia of a small degree, with 4-5 points of severe hypoxia, with a decrease in points to 3-1, birth in asphyxia (suffocation) is put. If there is a score of 0, they talk about clinical death and carry out resuscitation.

At birth in asphyxia, children are bluish all over the body or pale, there is no heartbeat, the first breath and cry, there are no independent movements, reflexes and muscle tone. Children do not react to irritants, there is no pulsation of the umbilical cord. This condition requires immediate measures to restore breathing.

Weaker degrees - hypoxia of newborns at birth give the presence of palpitations, partial cyanosis, single movements of the limbs, a cry after first aid and skin irritation, clearing the respiratory tract from mucus. Usually, children can be removed from the state of asphyxia if it lasted no more than 5 minutes.

Diagnosis of asphyxia in a newborn

The basis for diagnosing asphyxia in the neonatal period is an Apgar assessment immediately after birth, or registration of asphyxia intrauterine according to CTG data with immediate assistance. In addition to an external examination, the gas composition of the blood is immediately determined using a skin pulse oximeter, all assessments are carried out already against the background of resuscitation. The doctor immediately listens to heart sounds and breathing with a stethoscope, immediately checks reflexes and visually skin color, their reaction to resuscitation.

Immediately after the removal of the child from asphyxia, an additional complete examination is necessary to determine the consequences. These include an examination by a neurologist and an urgent ultrasound of the head through the fontanel, determination of reflexes, the state of internal organs. A chest x-ray may also be shown to evaluate the condition of the lungs.

Complications

The main complication of asphyxia is the death of the fetus during childbirth or severe disorders of the brain, heart or internal organs, which can remain for life. Often such children suffer from neurological disorders, have cysts or hemorrhages in the brain, decreased tone, disorders of motor functions, developmental delays - physical or mental.

Treatment

What can you do

Asphyxia is a life-threatening condition, only a doctor provides all measures to a newborn. It is important, if there is a threat of asphyxia in childbirth, to listen carefully to the doctor and strictly follow all his instructions when to push and when to breathe.

What does a doctor do

At birth in asphyxia, immediate cutting of the umbilical cord and the beginning of resuscitation are required. This is carried out by a neonatologist immediately in the delivery room. This is the suction of all the mucus of the nose and throat, the respiratory tract, conducting pulmonary and cardiac resuscitation, if it is necessary to intubate the baby and connect it immediately to the ventilator, administer the necessary drugs, correct circulatory and respiratory disorders as soon as the baby breathes.

After suffering asphyxia in childbirth, the baby is immediately taken to the neonatal unit, to the intensive care unit and a full-fledged treatment is carried out with the restoration of all organ functions. It is shown to be on a ventilator or transfer to mask breathing with oxygen, being in an incubator with heating and oxygen supply, gastric lavage, the introduction of special solutions into a vein in order to eliminate excess acid (CO2) and normalize the amount of oxygen. Such children remain under the supervision of doctors for a long time until their condition causes concern, they will breathe normally on their own and their condition will be stable.

Prevention

Childbirth is carried out under the control of CTG to detect the slightest deviations in the condition of the fetus. With signs of hypoxia, a caesarean section may be indicated. It is important to listen to all the instructions of the doctor during childbirth, with the slightest doubt, to agree to an emergency completion of childbirth through surgery. During pregnancy, you need constant medical supervision and monitoring of the condition of the fetus.

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

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

Asphyxia in a newborn child (fetus)

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

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

Classification of asphyxia of newborns

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

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

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

Asphyxia against the background of chronic antenatal fetal hypoxia

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

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

Acute asphyxia on the background of intranatal hypoxia

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

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

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

Degrees of asphyxia in newborns

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

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

moderate;
heavy.

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

Causes of asphyxia in newborns

There are two groups of reasons:

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

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

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

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

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

Treatment of asphyxia in newborns

newborns

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

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

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

Resuscitation of newborns with asphyxia

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

Adrenalin

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

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

infusion therapy.

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

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

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

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

Prevention of asphyxia in newborns

Prevention includes:

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

Effective measures should include:

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

Caring for a child after suffering asphyxia

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

The consequences of asphyxia in a newborn during childbirth

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

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

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

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

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

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

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

Conclusion

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

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

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

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

Asphyxia classification

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

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

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

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

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

Causes of asphyxia in newborns

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

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

Secondary asphyxia of newborns develops due to the following factors:

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

Clinical manifestations of asphyxia

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

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

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

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

In a later period, the child may develop meningitis, sepsis, hydrocephalus, pneumonia.

Diagnosis of asphyxia in newborns

It is not difficult to diagnose asphyxia, but it is very important to correctly assess the degree of lesions in a newborn. To do this, the child undergoes a series of diagnostic measures. AT without fail a blood test is performed from the umbilical vein - a blood pH of 9-12 mmol / l is an indicator of mild asphyxia, and an indicator of 7.1 BE -19 mmol / g or more corresponds to a severe degree.

A newborn is necessarily shown neurosonography, due to which it is determined what caused the brain damage - trauma or hypoxia. Thanks to neurosonography, it is possible to determine damage to different parts of the brain - intraventricular, subdural hemorrhages, and others.

Treatment of asphyxia of newborns

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

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

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

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

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

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

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

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

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

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

a clinical blood test, the level of hematocrit and platelets is necessarily determined;
blood chemistry,
blood sugar test,
acid-base state and electrolytes,
blood clotting,
bacterial culture from the nasopharynx and rectum.
mandatory examination of the abdominal cavity organs is carried out for the newborn,
with asphyxia of moderate and severe severity, an x-ray of the chest and abdomen is performed.

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

Proper care of a newborn in a hospital

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

In intensive care units, babies receive appropriate medical treatment. In newborns after asphyxia, constant monitoring of body temperature, bowel functions, and the volume of urine excreted is carried out. Feeding of newborns with a mild degree of asphyxia begins sixteen hours after birth, with a severe degree 22-26 hours after birth using a probe. The decision to start breastfeeding is made by the doctor in each case individually.

Consequences of asphyxia of newborns and further prognosis

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

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

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

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

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

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

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

If the heart and blood vessels are affected, then the baby may experience a decrease in myocardial contractility, necrosis of the papillary muscles of the heart, myocardial ischemia, and a decrease in blood pressure.

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

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

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

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

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

Prevention of asphyxia in newborns

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

Risk factors during pregnancy include:

Infectious diseases,
Mother's age over 35 years
Hormonal disorders,
Endocrine disorders in pregnant women
stressful situations,
Alcohol, smoking, drugs,
Intrauterine fetal hypoxia.

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

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

The expectant mother should monitor her lifestyle - relax more, take walks, as they saturate the blood with oxygen. A pregnant woman should have enough time for sleep, at least nine hours, it is very good if she also has daytime sleep. The diet of the expectant mother should consist of healthy foods, but it is better to exclude harmful foods altogether, just as prescribed by the doctor, a woman should take a mineral-vitamin complex.

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

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