What is asphyxia of newborns: pulmonary and extrapulmonary causes of development, medical tactics. Grades and consequences of neonatal asphyxia Mild birth asphyxia consequences

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 parameters:

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.

Neonatal asphyxia is suffocation, manifested by a violation of breathing, or the absence of spontaneous breathing in the presence of a heartbeat and other signs of life. In other words, the baby is not capable, cannot breathe on his own immediately after birth, or he breathes, but his breathing is inefficient.

40% of premature and 10% of full-term babies need medical attention due to impaired spontaneous breathing. Neonatal asphyxia is more common in preterm infants. Among all newborns, children born in asphyxia account for 1-1.5% of the total.

A child born in asphyxia is a serious problem for doctors providing care in the delivery room. Around the world, about a million children die every year from asphyxia, and about the same number of children have serious complications later.

Asphyxia of the fetus and newborn proceeds with hypoxia (decrease in oxygen concentration in tissues and blood) and hypercapnia (increase in carbon dioxide in the body), which is manifested by severe respiratory and circulatory disorders and impaired functioning of the child's nervous system.

Causes of asphyxia in newborns

Factors contributing to the development of asphyxia

There are antenatal and intranatal factors.

Antenatal affect the developing fetus in utero and are a consequence of the lifestyle of a pregnant woman. Antenatal factors include:

maternal diseases (diabetes mellitus, hypertension, diseases and malformations of the heart and blood vessels, kidneys, lungs, anemia);
problems of previous pregnancies (miscarriages, stillbirths);
complications during this pregnancy (threat of miscarriage and bleeding, polyhydramnios, oligohydramnios, prematurity or overmaturity, multiple pregnancy);
taking certain medications by the mother;
social factors (drug use, lack of medical supervision during pregnancy, pregnant women under the age of 16 and over 35).

Intranatal factors affect the child during childbirth.

Intranatal factors include various complications that occur immediately at the time of birth (rapid or prolonged labor, placenta previa or premature abruption, anomalies of labor activity).

All of them lead to fetal hypoxia - a decrease in oxygen supply to tissues and oxygen starvation, which significantly increases the risk of having a child with asphyxia.

Causes of asphyxia

Among the many causes, there are five main mechanisms that lead to asphyxia.

Insufficient detoxification of the maternal part of the placenta as a result of low or high maternal pressure, overactive contractions, or other causes.
Decrease in the concentration of oxygen in the blood and organs of the mother, which can be caused by severe anemia, insufficiency of the respiratory or cardiovascular system.
Various pathologies from the placenta, as a result of which gas exchange through it is disturbed. Among them are calcifications, placenta previa or premature detachment, inflammation of the placenta and hemorrhages in it.
Interruption or disruption of blood flow to the fetus through the umbilical cord. This occurs when the umbilical cord tightly wraps around the baby's neck, when the umbilical cord is compressed during the passage of the child through the birth canal, when the umbilical cord falls out.
Insufficient respiratory efforts of the newborn with a depressing effect of drugs on the nervous system (a consequence of the mother's treatment with various drugs), as a result of severe malformations, with prematurity, due to the immaturity of the respiratory organs, due to a violation of the flow of air into the respiratory tract (blockage or compression from the outside), as a result of birth trauma and severe intrauterine infections.

A special risk group for the development of asphyxia is made up of premature babies, whose birth weight is extremely low, post-term and children who have intrauterine growth retardation. These children are at the highest risk of developing asphyxia.

The majority of children who are born with asphyxia have a combined effect of ante- and intranatal factors.

Today, among the causes of chronic intrauterine hypoxia, not the last place is occupied by drug addiction, substance abuse and alcoholism of the mother. The number of smoking pregnant women is progressively increasing.

Smoking during pregnancy causes:

narrowing of the uterine vessels, which continues for another half an hour after a cigarette is smoked;
suppression of the respiratory activity of the fetus;
an increase in the fetal blood concentration of carbon dioxide and the appearance of toxins, which increases the risk of prematurity and premature birth;
hyperexcitability syndrome after birth;
lung damage and delayed physical and mental development of the fetus.

With short-term and moderate hypoxia (decrease in the level of oxygen in the blood), the fetal body tries to compensate for the lack of oxygen. This is manifested by an increase in blood volume, an increase in heart rate, increased respiration, and an increase in fetal motor activity. Such adaptive reactions compensate for the lack of oxygen.

With prolonged and severe hypoxia, the fetal body cannot compensate for the lack of oxygen, tissues and organs suffer from oxygen starvation, because oxygen is delivered primarily to the brain and heart. The motor activity of the fetus decreases, the heartbeat slows down, breathing becomes less frequent, and its depth increases.

The result of severe hypoxia is an insufficient supply of oxygen to the brain and a violation of its development, which can aggravate respiratory failure at birth.

The lungs of a full-term fetus secrete fluid before birth, which enters the amniotic fluid. Fetal breathing is shallow and the glottis is closed, so during normal development, amniotic fluid cannot enter the lungs.

However, severe and prolonged hypoxia of the fetus can cause irritation of the respiratory center, as a result of which the depth of breathing increases, the glottis opens and amniotic fluid enters the lungs. This is how aspiration occurs. Substances present in the amniotic fluid cause inflammation of the lung tissue, make it difficult for the lungs to expand at the first breath, which leads to respiratory failure. Thus, the result of aspiration of amniotic fluid is asphyxia.

Respiratory disorders in newborns can be caused not only by impaired gas exchange in the lungs, but also as a result of damage to the nervous system and other organs.

Non-lung causes of respiratory problems include the following:

Nervous system disorders: abnormalities in the development of the brain and spinal cord, the effects of drugs and drugs, infection.
Violation of the cardiovascular system. These include malformations of the heart and blood vessels, dropsy of the fetus.
Malformations of the gastrointestinal tract: esophageal atresia (blindly ending esophagus), fistulas between the trachea and esophagus.
Metabolic disorders.
Adrenal and thyroid dysfunction.
Blood disorders such as anemia.
Improper development of the airways.
Congenital malformations of the skeletal system: malformations of the sternum and ribs, as well as injuries of the ribs.

Types of asphyxia in newborns

Acute asphyxia caused by exposure to only intranatal factors, that is, that occurred during childbirth.
Asphyxia, which developed against the background of prolonged intrauterine hypoxia. The child developed in conditions of lack of oxygen for a month or more.

According to the severity are distinguished:

mild asphyxia;
moderate asphyxia;
severe asphyxia.

Neonatologists assess the condition of the newborn using the Apgar scale, which includes an assessment of breathing, heart rate, muscle tone, skin color and reflexes of the newborn. Assessment of the condition of the newborn is carried out at the first and fifth minutes of life. Healthy children gain 7-10 points on the Apgar scale.

A low score indicates that the child has problems with either breathing or heartbeat and requires immediate medical attention.

Light asphyxia

Manifested by cardiorespiratory depression. This is the depression of breathing or heartbeat as a result of the stress that the child feels during the transition from intrauterine life to the outside world.

Childbirth is a huge stress for a child, especially if there are any complications. At the same time, in the first minute of life, the baby receives an Apgar score of 4-6 points. As a rule, for such children, it is enough to create optimal conditions for the surrounding world, warmth and temporary support for breathing, and after five minutes the child recovers, he is given 7 points and higher.

Asphyxia of moderate severity

The condition of the baby at birth is assessed as moderate. The baby is lethargic, reacts poorly to examination and stimuli, but spontaneous movements of the arms and legs are observed. The child screams weakly, unemotionally and quickly falls silent. The child's skin is bluish, but quickly turns pink after inhaling oxygen through the mask. Palpitation is rapid, reflexes are reduced.

Breathing after its restoration is rhythmic, but weakened, intercostal spaces may sink. After medical care in the delivery room, children still need oxygen therapy for some time. With timely and adequate medical care, the condition of children improves quite quickly and they recover on 4-5 days of life.

The condition of the baby at birth is severe or extremely severe.

In severe asphyxia, the child reacts poorly to examination or does not react at all, while the muscle tone and movements of the child are weak or absent at all. The skin color is bluish-pale or just pale. It turns pink after breathing oxygen slowly, the skin restores its color for a long time. The heartbeat is muffled. Breathing irregular, irregular.

In very severe asphyxia, the skin is pale or sallow. The pressure is low. The child does not breathe, does not respond to examination, eyes are closed, no movements, no reflexes.

How asphyxia of any severity will proceed depends directly on the knowledge and skills of medical personnel and good nursing, as well as on how the child developed in utero and on existing concomitant diseases.

Asphyxia and hypoxia. Differences in manifestations in newborns

The picture of acute asphyxia and asphyxia in children who have undergone hypoxia in utero has some differences.

Features of children born in asphyxia who suffered prolonged hypoxia in utero are presented below.

Significantly pronounced and long-lasting metabolic and hemodynamic disorders (blood movement in the vessels of the body).
Often there are various bleeding as a result of inhibition of hematopoiesis and a decrease in the content of microelements in the blood, which are responsible for stopping bleeding.
More often, severe lung damage develops as a result of aspiration, surfactant deficiency (this substance prevents the lungs from collapsing), and inflammation of the lung tissue.
Often there are metabolic disorders, which is manifested by a decrease in blood sugar and important trace elements (calcium, magnesium).
Neurological disorders resulting from hypoxia and due to cerebral edema, hydrocephalus (dropsy), and hemorrhages are characteristic.
Often combined with intrauterine infections, often associated with bacterial complications.
After asphyxia, long-term consequences remain.

Among the complications, early ones are distinguished, the development of which occurs in the first hours and days of the baby's life, and late ones, which occur after the first week of life.

Early complications include the following conditions:

Damage to the brain, which is manifested by edema, intracranial hemorrhage, death of parts of the brain due to lack of oxygen.
Violation of blood flow through the vessels of the body, which is manifested by shock, pulmonary and heart failure.
Kidney damage, manifested by renal failure.
Pulmonary involvement, manifested by pulmonary edema, pulmonary hemorrhage, aspiration, and pneumonia.
Damage to the digestive organs. The intestine suffers the most, its motility is disturbed, as a result of insufficient blood supply, some parts of the intestine die off, inflammation develops.
The defeat of the blood system, which is manifested by anemia, a decrease in the number of platelets and bleeding from various organs.

Late complications include the following conditions:

Attachment of infections, meningitis (inflammation of the brain), pneumonia (inflammation of the lungs), enterocolitis (inflammation of the intestines) develops.
Neurological disorders (hydrocephalus, encephalopathy). The most serious neurological complication is leukomalacia - damage (melting) and death of parts of the brain.
Consequences of excessive oxygen therapy: bronchopulmonary dysplasia, damage to the vessels of the retina.

Resuscitation of newborns with asphyxia

The condition of children born in asphyxia requires resuscitation. Resuscitation is a complex of medical measures aimed at reviving, resuming breathing and heart contractions.

Resuscitation is carried out according to the ABC system, developed back in 1980:

"A" means establishing and maintaining a patent airway;
"B" means breath. It is necessary to restore breathing with the help of artificial or assisted ventilation of the lungs;
"C" means to restore and maintain heart contractions and blood flow through the vessels.

Resuscitation measures for newborns have their own characteristics, their success largely depends on the readiness of medical personnel and the correct assessment of the child's condition.

The readiness of medical personnel. Ideally, care should be provided by two people who have the appropriate skills and know how the pregnancy and childbirth proceeded. Before the birth begins, the medical staff should check that the equipment and medicines are ready to assist.
The readiness of the place where the child will be assisted. It should be specially equipped and located directly in the delivery room or in close proximity to it.
Providing resuscitation in the first minute of life.
Staged resuscitation according to the "ABC" system with an assessment of the effectiveness of each stage.
Caution in carrying out infusion therapy.
Observation after relief of asphyxia.

Restoration of breathing begins as soon as the head appears from the birth canal, with the suction of mucus from the nose and mouth. Once the baby is fully born, it needs to be warmed up. To do this, it is wiped, wrapped in heated diapers and placed under radiant heat. In the delivery room should not be drafty, the air temperature should not fall below 25 ºС.

Both hypothermia and overheating depress breathing, so they should not be allowed.

If the child screamed, they lay him out on his mother's stomach. If the baby is not breathing, breathing is stimulated by rubbing the back and patting the baby's soles. With moderate and severe asphyxia, respiratory stimulation is ineffective, so the child is quickly transferred under radiant heat and artificial lung ventilation (ALV) is started. After 20 - 25 seconds, they look to see if breathing has appeared. If the child's breathing is restored and the heart rate is above 100 per minute, resuscitation is stopped and the child's condition is monitored, trying to feed the child with mother's milk as soon as possible.

If there is no effect from mechanical ventilation, the contents of the oral cavity are sucked off again and mechanical ventilation is resumed. In the absence of breathing on the background of mechanical ventilation for two minutes, tracheal intubation is performed. A hollow tube is inserted into the trachea, which ensures the flow of air to the lungs, the child is connected to an artificial respiration apparatus.

In the absence of a heartbeat or a decrease in the frequency of contractions less than 60 per minute, an indirect heart massage is started, continuing mechanical ventilation. Massage is stopped if the heart begins to beat on its own. In the absence of a heartbeat lasting more than 30 seconds, the heart is stimulated with drugs.

Prevention of asphyxia in newborns

All measures for the prevention of asphyxia are reduced to the timely identification and elimination of causes in a pregnant woman that cause fetal hypoxia.

Every pregnant woman should be observed by a gynecologist throughout her pregnancy. It is necessary to register on time, take tests, consult doctors and receive treatment, which is prescribed if necessary.

The lifestyle of the mother has a significant impact on the development of the fetus.

Conclusion

The treatment of children who have suffered asphyxia, until full recovery, is quite a long one.

After the activities carried out in the delivery room, the children are transferred to the pediatric intensive care unit or to the neonatal pathology department. In the future, if required, rehabilitation therapy is prescribed in specialized departments.

The prognosis largely depends on the severity of brain damage caused by hypoxia. The more the brain suffers, the greater the likelihood of death, the risk of complications and the longer the period of full recovery. Premature babies have a worse prognosis than babies born at term.

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 condition 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:

Asphyxia is a dangerous pathological condition that develops in newborns in the first minutes of life (primary) or within the first few days (secondary) after birth. Pathology is characterized by impaired breathing and the development of respiratory failure. In medical practice, it is customary to divide asphyxia into moderate and severe.

Causes of asphyxia in newborns during childbirth

The reasons for the development of a pathological condition are directly dependent on the type of asphyxia in a child. So, the primary develops during childbirth. This condition is usually caused by an acute or chronic fetus. In addition, the causes of asphyxia in newborns can be:

intracranial trauma in a child, which he received during childbirth;
malformations that have a depressing effect on the respiratory system and make breathing difficult;
immunological incompatibility of mother and child by group or Rh factor of blood;
blockage of the baby's airways with mucus or amniotic fluid;
the presence of a woman with diseases of the heart and blood vessels, diabetes, iron deficiency anemia;
preeclampsia (late toxicosis) in the mother, which is accompanied by high blood pressure and severe swelling of the extremities;
pathological structure of the umbilical cord or placenta, its detachment, incorrect position of the fetal head, early discharge of amniotic fluid.

Secondary occurs within a few hours or even days after birth. The causes of asphyxia in a newborn in this case may be:

circulatory disorders in the structures of the brain;
child;
heart defects of varying severity;
pneumopathy: hemorrhages in the lungs, blockage of the respiratory tract with mucus, dysfunction of metabolic processes.

All these conditions can begin to develop even in the prenatal period.

The occurrence of a pathological condition

With various degrees of asphyxia in newborns, a pathological change in metabolic processes in the body begins. Manifestations, severity and duration of such disorders depend on the severity of asphyxia. If the condition develops during childbirth, then there is also a decrease in blood volume, its thickening and viscosity. Edema is possible in the brain, kidneys and liver, heart, hemorrhages are not uncommon, which appear due to insufficient oxygen. Pathology also leads to a decrease in blood pressure in a newborn, a decrease in heart contractions, and impaired urinary function.

Mild degree of asphyxia: condition of the newborn

Primary asphyxia of newborns occurs in the first minutes of life. The condition of the child is assessed on the Apgar scale. With a mild form, the baby's condition is estimated at 6-7 points. At the same time, in the first minutes of life, the newborn independently takes the first breath, but then his breathing becomes intermittent, weak. Muscle tone is usually reduced, and the nasolabial triangle becomes bluish.

Signs of moderate asphyxia in newborns

Symptoms of pathology (in a moderate manifestation, that is, a moderate form of severity) are lethargy, an unemotional short cry, frequent regurgitation, spontaneous movements, a weak reaction to irritating factors and examination, bluish coloration of the skin, a weak manifestation of physiological reflexes.

The condition of the newborn is generally assessed as moderate, the Apgar score is 4-5. At the same time, the heart rate per minute is less than 100 (in healthy children - 100 or more), there is some flexion of the limbs (in children with a score of 2, active movements are noted), intermittent breathing, a grimace on the face (healthy children scream, cough, sneeze) , pink coloring of the body and cyanotic - limbs.

Symptoms of severe asphyxia in children

Severe asphyxia of a newborn is manifested by such signs:

severe or very severe condition at birth;
almost complete absence of physiological reflexes;
muffled heart sounds when listening, systolic murmur;
hemorrhagic shock is possible, in which the child's eyes are closed, there is no spontaneous breathing and there is no reaction to pain.

In the worst case, there may be disturbances in the normal functioning of many organs and systems, lack of pupillary response to light. A neonatologist with such symptoms will rate 1-3 points on the Apgar scale. In this case, there may be no heart contractions, limbs hang down, breathing and reflexes are absent, the skin color is pale, there may be cyanosis.

Clinical death: 0 on the Apgar scale

The most severe form of asphyxia is characterized by clinical death of the newborn. To save the life of the child in this case, doctors immediately begin to carry out resuscitation.

The main signs of secondary asphyxia

Secondary asphyxia of newborns develops a few hours after birth or during the first few days. The condition is marked by the same symptoms. The child becomes lethargic, breathing weakens or disappears, muscle tone decreases, and may not respond to external stimuli. The skin at the same time acquires a bluish tint in the region of the nasolabial triangle.

Early and late complications of asphyxia

Early complications of respiratory failure (that is, those that occur in the first day of life) include:

pulmonary hypertension;
necrosis of brain tissue;
swelling of the brain;
intracranial hemorrhages;
acute renal necrosis;
thrombosis of the vessels of the kidneys;
convulsive syndrome;
pathology of hematopoietic cells of the bone marrow.

Complications that may occur over the next few days in the absence of adequate and comprehensive treatment of newborn asphyxia are:

meningitis - inflammation of the lining of the brain;
sepsis - a general infection with pathogenic bacteria that have entered the bloodstream;
pneumonia - inflammation of the lungs;
hydrocephalic syndrome - excessive synthesis of cerebrospinal fluid.

Therapy of acute asphyxia in a child

The stages of resuscitation in case of asphyxia of the newborn were systematized into a single algorithm of actions in the United States. The system is called ABC-steps. Firstly, neonatologists must ensure the patency of the respiratory tract of the newborn, secondly, the process of natural respiration should be stimulated, and thirdly, it is necessary to support the circulatory system.

When a child with symptoms of asphyxia is born, doctors insert a special probe into the nasal and oral cavity. Often this action is performed even when the head of the child appears from the birth canal of a woman. With the help of a probe, residual mucus and amniotic fluid, which can interfere with normal breathing, are removed from the baby's respiratory tract.

After extraction from the birth canal, doctors cut the newborn's umbilical cord. After that, he will be placed on the resuscitation table, where they will re-clean the contents of the nasopharynx. This time, the stomach will also be cleansed. In this case, you can not touch the back wall of the pharynx, so as not to provoke excitation of the nervous system and bradycardia.

Under an infrared heater, his skin is blotted with a clean diaper. To ensure maximum airway patency, doctors lay out the newborn as follows: on the back, a roller under the shoulders, the head is moderately extended. If there is no breathing at all, then stimulation is carried out: they lightly slap the baby on the heel, sole, rub the skin along the spine.

During asphyxia, it is impossible to give a stream of oxygen to the child's face, pour or sprinkle water on him, compress his chest or clap on the buttocks.

The activities described above should be carried out very quickly, literally within twenty seconds. After resuscitation of a newborn with asphyxia, his condition is again assessed, paying attention to heart rate, breathing and skin tone.

If breathing is absent or insufficient, then the child is artificially ventilated. Help with asphyxia of newborns involves the introduction of medications. Among medicinal resuscitation agents, an adrenaline solution is effective, which is rapidly administered intravenously. A solution of sodium chloride is also administered in the form of a dropper for 5-10 minutes. If necessary, at the 40-50th minute of a child's life, planned infusion therapy is started.

Newborn care after asphyxia

After such a serious condition as asphyxia, special care is needed for the child. He should be given complete rest. The head should be in an elevated position. Often, doctors - neonatologists and pediatricians - prescribe oxygen therapy to such small patients. The duration of such treatment varies in each individual case and depends on the condition of the child. After asphyxia, the newborn is placed in a ward with a high oxygen content.

It is imperative to monitor a child who has suffered respiratory failure during childbirth. It is necessary to systematically measure body temperature, control diuresis and bowel function. Often, the baby needs repeated cleaning of the respiratory tract from foreign contents.

The first feeding of a child with mild or moderate respiratory failure occurs sixteen hours after birth. If the baby's condition was severe, then the first feeding is carried out only after a day and with the help of a special probe. The start time of natural breastfeeding is determined for each case separately.

After discharge from the maternity hospital, the baby should be under the supervision of a pediatrician and a neurologist. The main goal of all therapeutic measures is to avoid (or minimize, if it is not possible to completely eliminate) complications from the nervous system.

Doctors' prognosis and the consequences of asphyxia

The prognosis and consequences of asphyxia in newborns depend on the severity of the pathology, the adequacy of the actions of doctors and the timeliness of the start of therapy. The prognosis directly depends on the second assessment of his health on the Apgar scale. The second assessment is made by a neonatologist five minutes after the baby is born. If the second estimate is higher than the first, then the prognosis is most likely favorable.

Any consequences of asphyxia of newborns at an older age are rarely manifested if the prognosis of doctors was favorable. As a rule, if a child experienced respiratory failure during childbirth, but the doctors managed to stabilize his condition and avoid complications, then at an older age there will be no other consequences of a dangerous condition.

Basic preventive measures

The consequences of asphyxia in newborns are quite serious, but they can be avoided. There are preventive measures, which, of course, not with all 100% probability will avoid respiratory failure in the fetus, but give a result in about 40% of cases. One of the causes of asphyxia, for example, may be intrauterine fetal hypoxia. To avoid this, a pregnant woman needs to visit a doctor regularly.

Also, risk factors that can subsequently provoke respiratory failure in the fetus are:

mother's age over 35;
the presence of bad habits in a pregnant woman;
severe stress during pregnancy;
disruption of the endocrine system of the mother;
changes in the hormonal background of a woman;
infectious and other diseases that have a negative impact on the fetus.

One of the causes of asphyxia is also placental abruption or pathology of its development. In eliminating this factor, regular monitoring by a specialist is important. The doctor will be able to identify dangerous conditions and start therapy on time so that nothing threatens the life and health of the little man.

Walk more outdoors. The woman's body is saturated with the necessary amount of oxygen, which is then transferred to the fetus, which needs this element.
Take vitamins prescribed by a gynecologist. Both the pregnant woman and the baby, who is still developing in close connection with the mother's body, need vitamins and nutrients.
Follow the daily routine. At night, the expectant mother should sleep for at least nine hours, during the day it is also recommended to allocate a couple of hours for sleep or afternoon rest (not at the computer screen).
Maintain peace of mind and a positive attitude. Pregnancy is an unforgettable period in the life of every woman, but it is also associated with stress and feelings. For the health of the child and the woman herself, it is necessary to worry less, learn how to calmly cope with life's conflicts, and devote more time to communicating with positive people.

It is worth saying that respiratory failure, that is, asphyxia, is a serious pathology. But thanks to modern drugs and the professional actions of medical personnel, the lives of most newborns are saved and the possible consequences of the pathology are eliminated.

All future parents are looking forward to the birth of their baby, worried about him. And, alas, sometimes these excuses are justified. One of the most common pathologies is neonatal asphyxia. Hearing this diagnosis, almost all parents are frightened and panicked. Of course, asphyxia is a cause for concern, but often the anxiety of parents is often unnecessarily strong. And most often this happens due to a lack of understanding of what happens to a child during asphyxia.

Asphyxia of newborns is a condition of newborns, in which, due to a violation of the breathing process, oxygen deficiency develops. There are two types of asphyxia: primary, which occurs at the time of birth, and secondary, which develops on the first day after birth.

Causes of asphyxia in newborns

Of course, without any significant reasons, asphyxia in a newborn child will not occur. As a rule, the causes of asphyxia are either acute or chronic intrauterine hypoxia. In addition, the reason for the occurrence of asphyxia can be:

Birth intracranial trauma of the newborn.
Immunological incompatibility between mother and fetus.
Blockage of the airways of a newborn baby - complete or partial, either by amniotic fluid or mucus.
Malformations of the fetus, causing difficulty in the process of breathing.

In addition to the health problems of a newborn child, asphyxia can also be caused by such problems as the presence of extragenital diseases of pregnant women. For example, such as:

Diseases of the cardiovascular system, especially those in the acute stage.
Pronounced iron deficiency anemia, especially in the last trimester of pregnancy.
Diabetes mellitus, especially insulin-dependent form.
Late toxicosis - gestosis, accompanied by swelling of the legs and high blood pressure.

Very often, the pathological course of pregnancy also leads to neonatal asphyxia. Pathology of the structure of the umbilical cord, placenta and membranes, premature detachment of the placenta, premature rupture of amniotic fluid and a long anhydrous period are all risk factors.

Also, very often, asphyxia of newborns occurs if there are any anomalies in labor, improper insertion of the fetal head, a pathologically narrow pelvis of the woman in labor, and so on.

The causes of secondary asphyxia can be such health problems in a child as congenital pneumonia, cerebrovascular accidents, ingress of vomit into the respiratory tract, some types of disruption of the central system of a newborn child.

What happens at the time of asphyxia?

What happens in the body of a newborn baby at the time of asphyxia? Regardless of what exactly caused asphyxia, the child begins an immediate change in metabolic processes, blood microcirculation, hemodynamics. How strongly these changes will be expressed depends on the duration of asphyxia and the degree of its intensity.

During acute hypoxia in a child, the total blood volume increases significantly. This happens due to the fact that the volume of red blood cells circulating in the blood increases. In the event that acute asphyxia develops against the background of chronic fetal hypoxia preceding it, hypovolemia develops. Hypovolemia is a change in the consistency of blood: it thickens, its viscosity increases, and erythrocytes and platelets acquire an increased aggregation ability.

In the internal vital organs of a newborn child - in the liver, in the kidneys and adrenal glands, in the heart and brain - edema and hemorrhage can be detected that occur as a result of tissue hypoxia. Due to the decrease in peripheral and central hemodynamics, the number of heart contractions decreases, and blood pressure falls. Due to a violation of the normal course of the metabolic process, a violation of the urinary function of the kidneys occurs.

Signs of asphyxia in newborns

The most important sign of the presence of asphyxia in a newborn child is a violation of the respiratory process, which leads to a change in the rhythm of cardiac activity, as well as a pathological change in the functioning of the nervous system: impaired neuromuscular conduction and extinction of reflexes. In the very first seconds after birth, neonatologists carefully examine the child and assess his condition. The condition of the child is assessed on a special Apgar scale:

Mild form of asphyxia

In the event that asphyxia is not pronounced, and the child's body has not suffered much, the assessment of the child's condition on the Apgar scale will be 6-7 points. A child born with a mild form of asphyxia takes his first breath within the first minute after birth. However, despite this, the baby's breathing is weakened, there is a decrease in muscle tone and cyanosis (blue) of the nasolabial triangle.

The average severity of asphyxia

In the same case, if the baby is diagnosed with an average severity of hypoxia, the score will be 4-5 points. In the event that a child was born with moderate asphyxia, he will also take his first breath within a minute after birth, but breathing is greatly weakened, it may be irregular, the baby's cry is very weakened.

Also, the baby may experience tachycardia, bradycardia, decreased muscle tone and all reflexes. The skin in the area of the hands and feet, as well as the face, have a pronounced cyanotic tint. The umbilical cord of such a crumb is characterized by intense pulsation.

Severe form of hypoxia

With a pronounced form of asphyxia, doctors assess the child's condition at 1 - 3 points.

In severe asphyxia, breathing is irregular (separate breaths) or absent, the child does not scream, sometimes groans, the heartbeat is slow, in some cases it is replaced by single irregular heartbeats, muscle hypotension or atony is observed, reflexes are absent, the skin is pale as a result of peripheral vascular spasm, the umbilical cord is not pulsating; adrenal insufficiency often develops.

clinical death

In the event that the overall Apgar score is 0, the child is in a state of clinical death. In this case, in order to save the life of the child, resuscitators immediately begin to carry out a set of resuscitation measures.

Treatment of acute asphyxia of newborns

Strictly speaking, all children, without exception, born in a state of asphyxia, need immediate intensive care. How effective all medical manipulations will be depends on how quickly after birth they began. All intensive care activities begin immediately after the birth of the child, right in the delivery room.

During resuscitation, the state of the child is continuously monitored all the main parameters of the vital activity of his body:

Heart rate.
Hematocrit.
The frequency of respiratory movements and their depth.

Based on these indications, doctors have the opportunity to monitor the effectiveness of their actions and, if necessary, correct them.

Immediately after the fetal head is born, the doctor inserts a soft probe into the mouth and nose of the newborn and, using electric suction, removes all the contents of the upper respiratory tract: amniotic fluid residues, mucus. After that, the child's umbilical cord is cut, and the baby is placed on a special resuscitation table, under the rays of a special lamp. After that, the contents of the nasopharynx, as well as the contents of the stomach, are re-aspirated.

After the child's cardiac and respiratory activity is restored, and his condition is stabilized, the baby will be transferred to the intensive care unit. All further medical measures will be aimed at preventing or eliminating the existing cerebral edema, normalizing metabolic processes, restoring kidney function and hemodynamics.

Rules for caring for a child with asphyxia

In order for the child to recover from the consequences of asphyxia as quickly as possible, it is very important to provide him with proper medical care. The child should be completely at rest, and his head should be in an elevated position. Intensive oxygen therapy is very important for all, without exception, babies who have undergone asphyxia.

Children born with mild asphyxia are placed in a special oxygen tent. This tent is a kind of dome, inside of which there is a high content of oxygen. The child spends there from several hours to several days, depending on his state of health.

In the same case, if the child has suffered moderate or severe asphyxia, he must be placed in an incubator. Oxygen is supplied to the flask, its concentration inside should be approximately 40%. In the same case, if for some reason there is no necessary equipment in the maternity hospital, oxygen can be supplied through a special nasal cannula or through a breathing mask.

Very often, a newborn child needs to re-aspirate the contents, usually mucus, from the baby's upper respiratory tract. It also requires careful monitoring of indicators such as bowel function, diuresis, body temperature.

The first feeding of a child who has undergone mild and moderate asphyxia is performed approximately 16 hours after birth. The same children who were born in a state of severe asphyxia are fed for the first time after 24 hours, using a special probe. And here's a question about that. When the baby can begin to be applied to the breast, it is decided individually in each case, depending on the condition of the child.

After discharge from maternity hospital

After the baby is discharged home, he should be under the supervision of specialists such as a pediatrician and a neuropathologist. This is necessary in order to prevent a possible complication from the work of the central nervous system.

The subsequent prognosis depends on several factors, in particular on the severity of asphyxia, the timeliness of the start of therapeutic measures and their adequacy. In the event that the child was born with primary asphyxia, the prognosis depends on the secondary assessment of the state on the Apgar scale (performed 5 minutes after birth). In the event that the second estimate is higher than the first, then the forecasts for the child's life are quite favorable.

In the event that a child was born in a state of asphyxia, such complications may occur during the first years of life. Asphyxia of newborns, consequences:

Hyper and hypoexcitability.
hydrocephalus syndrome.
Convulsive syndrome.
diencephalic disorders.

Especially often they occur if there have been severe asphyxia of newborns. It is precisely in order to reduce the risk of developing such complications and start treatment in a timely manner that dispensary observation by specialists of the relevant profiles is necessary.

Prevention of asphyxia in newborns

In order to avoid all the problems that newborn asphyxia entails, it is necessary to take the necessary preventive measures. Of course, unfortunately, not always preventive measures can prevent asphyxia, but they should not be neglected. In about 40% of cases, preventive measures give a positive result. So:

Prevention of intrauterine hypoxia

In order to avoid the development of intrauterine fetal hypoxia, constant monitoring of the course of pregnancy is necessary. During pregnancy, all risk factors should be identified in a timely manner, such as:

Somatic and infectious diseases, such as colds, flu, acute respiratory infections.
Disorders of the endocrine system and hormonal background of a pregnant woman.
The presence of strong stressful situations in the life of a pregnant woman.
The age of the pregnant woman - the older she is, the higher the risk.
The presence of bad habits such as smoking and drinking alcohol-containing drinks.

In addition, it is very important to conduct intrauterine monitoring of the condition of the fetus and placenta. So, for example, the state of the placenta may clearly indicate a possible oxygen starvation of the fetus, and the presence of meconium in the amniotic fluid is a danger signal. As soon as the first alarm signals are noticed, the necessary therapy should be started immediately.

All of the above once again confirms the need for constant medical supervision of the expectant mother. In no case is it unacceptable to ignore visits to a gynecologist during pregnancy - because by doing so you endanger the health of your baby, and possibly even his life.

In addition, the correct lifestyle of a pregnant woman plays an important role in the prevention of hypoxia. To do this, the expectant mother must follow a few simple rules:

Walks. For the normal course of pregnancy, the expectant mother should spend a sufficient amount of time outdoors. The woman's blood is saturated with oxygen, which enters the baby. Oxygen is necessary for the proper development of internal organs and growth. Many women believe that walks are only useful if they take place outside the city. However, the ordinary square closest to the house is also ideal for a walk.
Daily regime. For a pregnant woman, it is very important to observe the daily routine. Night gatherings at the computer, early awakening in the morning, the crazy rhythm of the day - all this should be left by the expectant mother in her past, "pre-pregnant" life. A woman should sleep at least 9 hours at night, and at least a couple of hours during the day. Make sure you take time to relax.
Reception of vitamin and mineral complexes. No matter how varied the nutrition of a pregnant woman is, the quality features of modern products are such that it is simply impossible to get all the vitamins, trace elements and minerals necessary for the development of a child. That is why any pregnant woman should take a vitamin and mineral complex that will satisfy all the needs of both mother and child. However, you should not choose this or that drug on your own - this should be done by your gynecologist, who knows all the features of your body and the course of pregnancy.

And be sure to stay calm and positive. After all, it is not in vain that they say that faith in success is about half the success!

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