Consequences of asphyxia in newborns. What is asphyxia of newborns: pulmonary and extrapulmonary causes of development, medical tactics

Asphyxia of a newborn(asphyxia neonatorum) is a pathological condition of the newborn, caused by respiratory failure and resulting oxygen deficiency. There are primary (at birth) and secondary (in the first hours and days of life) asphyxia of the newborn.

The reasons:

The causes of primary asphyxia of a newborn are acute and chronic intrauterine oxygen deficiency - fetal hypoxia, intracranial trauma, immunological incompatibility of the blood of the mother and fetus, intrauterine infection, complete or partial blockage of the respiratory tract of the fetus or newborn with mucus, amniotic fluid (aspiration asphyxia), malformations of the fetus.

The occurrence of asphyxia of the newborn is facilitated by extragenital diseases of the pregnant woman (cardiovascular, especially in the stage of decompensation, severe lung diseases, severe anemia, diabetes mellitus, thyrotoxicosis, infectious diseases, etc.), late toxicosis of pregnant women, post-term pregnancy, premature detachment of the placenta, pathology of the umbilical cord, fetal membranes and placenta, complications in childbirth (untimely discharge of amniotic fluid, anomalies in labor, discrepancy between the size of the pelvis of the woman in labor and the fetal head, incorrect insertion of the fetal head, etc.).
Secondary asphyxia of a newborn may be associated with impaired cerebral circulation in a newborn, pneumopathy, etc.

What happens with asphyxia?

Regardless of the causes of oxygen deficiency in the body of a newborn, there is a restructuring of metabolic processes, hemodynamics and microcirculation. Their severity depends on the intensity and duration of hypoxia. Metabolic or respiratory-metabolic acidosis develops, accompanied by hypoglycemia, azotemia and hyperkalemia, followed by potassium deficiency. Electrolyte imbalance and metabolic acidosis lead to cellular overhydration. In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating erythrocytes.

Asphyxia of the newborn, which developed against the background of chronic fetal hypoxia, is accompanied by hypovolemia.
There is a thickening of the blood, its viscosity increases, the aggregation ability of erythrocytes and platelets increases. In the brain, heart, kidneys, adrenal glands and liver of newborns, as a result of microcirculatory disorders, edema, hemorrhages and areas of ischemia occur, and tissue hypoxia develops. Central and peripheral hemodynamics are disturbed, which is manifested by a decrease in stroke and minute volume of the heart and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation disrupt the urinary function of the kidneys.

Symptoms:

The leading symptom of newborn asphyxia is respiratory failure, leading to changes in cardiac activity and hemodynamics, impaired neuromuscular conduction and reflexes. The severity of asphyxia of the newborn is determined by the Apgar scale.
In accordance with the International Classification of Diseases of the IX revision, moderate and severe asphyxia of the newborn is distinguished (Apgar score in the first minute after birth, respectively, 7-4 and 3-0 points). In clinical practice, it is customary to distinguish three degrees of severity of asphyxia: mild (score on a scale

Apgar in the first minute after birth - 7-6 points), moderate (5-4 points) and severe (3-1 points). A total score of 0 points indicates clinical death. With mild asphyxia, the newborn takes the first breath within the first minute after birth, but his breathing is weakened, acrocyanosis and cyanosis of the nasolabial triangle are noted, and some decrease in muscle tone. With asphyxia of moderate severity, the child takes the first breath within the first minute after birth, breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted, but there may also be tachycardia, muscle tone and reflexes are reduced, the skin is cyanotic, sometimes mainly in areas of the face, hands and feet, the umbilical cord pulsates.

In severe asphyxia, breathing is irregular (separate breaths) or absent, the child does not scream, sometimes 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.

In the first hours and days of life, newborns who have undergone asphyxia develop a posthypoxic syndrome, the main manifestation of which is the defeat of the central nervous system. At the same time, every third child born in a state of moderate asphyxia has a violation of cerebral circulation of the I-II degree, in all children who have undergone severe asphyxia, the phenomena of impaired liquorodynamics and cerebral circulation of the II-III degree develop.

Oxygen deficiency and disorders of the function of external respiration disrupt the formation of hemodynamics and microcirculation, in connection with which fetal communications are preserved: the arterial (botallian) duct remains open; as a result of a spasm of the pulmonary capillaries, leading to an increase in pressure in the pulmonary circulation and an overload of the right half of the heart, the foramen ovale does not close. In the lungs, atelectasis and often hyaline membranes are found. There are violations of cardiac activity: deafness of tones, extrasystole, arterial hypotension.

Against the background of hypoxia and reduced immune defense, microbial colonization of the intestine is often disrupted, which leads to the development of dysbacteriosis. During the first 5-7 days of life, metabolic disorders persist, manifested by the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance and true potassium deficiency in the child's body. Due to impaired renal function and a sharp decrease in diuresis, edematous syndrome develops in newborns after the 2-3rd day of life.

The diagnosis of asphyxia and its severity is established on the basis of determining the degree of respiratory failure, changes in heart rate, muscle tone, reflexes, and skin color in the first minute after birth. The degree of severity of the transferred asphyxia is also evidenced by indicators of the acid-base state. So, if in healthy newborns the pH of blood taken from the vein of the umbilical cord is 7.22-7.36, BE (base deficiency) is from - 9 to - 12 mmol / l, then with mild asphyxia and moderate asphyxia, these indicators are respectively equal 7.19-7.11 and from - 13 to - 18 mmol / l, with severe asphyxia pH less than 7.1 BE from - 19 mmol / l and more.

A thorough neurological examination of the newborn, ultrasound examination of the brain allow us to differentiate between hypoxic and traumatic lesions of the central nervous system. In the case of a predominantly hypoxic lesion of the c.n.s. focal neurological symptoms are not detected in most children, a syndrome of increased neuro-reflex excitability develops, in more severe cases - a syndrome of depression of the central nervous system. In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.), hypoxemic vascular shock with spasm of peripheral vessels and severe pallor of the skin, hyperexcitability are often observed at birth, focal neurological symptoms and convulsive syndrome that occurs a few hours after birth .

Treatment of asphyxia in a newborn:

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

At the time of the birth of the fetal head and immediately after the birth of the child, the contents of the upper respiratory tract are carefully removed with a soft catheter using an electric suction (in this case, tees are used to create intermittent air rarefaction); immediately cut the umbilical cord and place the child on the resuscitation table under a source of radiant heat. Here, the contents of the nasal passages, oropharynx, and also the contents of the stomach are re-aspirated.

With mild asphyxia, the child is given a drainage (knee-elbow) position, inhalation of a 60% oxygen-air mixture is prescribed, cocarboxylase (8 mg / kg) is injected into the vein of the umbilical cord in 10-15 ml of 10% glucose solution. In the case of moderate asphyxia, to normalize breathing, artificial lung ventilation (ALV) is indicated using a mask until regular breathing is restored and a pink color of the skin appears (usually within 2-3 minutes), then oxygen therapy is continued by inhalation. Oxygen must be supplied humidified and heated in any type of oxygen therapy.

Cocarboxylase is injected into the vein of the umbilical cord in the same dose as in mild asphyxia. In case of severe asphyxia, immediately after crossing the umbilical cord and suctioning the contents of the upper respiratory tract and stomach, tracheal intubation is performed under the control of direct laryngoscopy and mechanical ventilation until regular breathing is restored (if the child has not taken a single spontaneous breath within 15-20 minutes, resuscitation is stopped even if there is heartbeat).

Simultaneously with mechanical ventilation, cocarboxylase is injected into the vein of the umbilical cord (8-10 mg / kg in 10-15 ml of 10% glucose solution), 5% sodium bicarbonate solution (only after creating adequate ventilation of the lungs, an average of 5 ml / kg), 10% solution calcium gluconate (0.5-1 ml/kg), prednisolonehemisuccinate (1 mg/kg) or hydrocortisone (5 mg/kg) to restore vascular tone. In the event of bradycardia, 0.1 ml of a 0.1% solution of atropine sulfate is injected into the vein of the umbilical cord. With a heart rate of less than 50 beats per 1 min or with cardiac arrest, an indirect heart massage is performed, 0.5-1 ml of a 0.01% (1: 10,000) solution of adrenaline hydrochloride is injected into the umbilical cord vein or intracardiac.

After restoring breathing and cardiac activity and stabilizing the child’s condition, he is transferred to the intensive care unit of the neonatal department, where measures are taken to prevent and eliminate cerebral edema, restore hemodynamic and microcirculation disorders, normalize metabolism and kidney function. Spend craniocerebral hypothermia - local cooling of the head of the newborn and infusion-dehydration therapy.

Premedication is required before craniocerebral hypothermia (infusion of 20% sodium hydroxybutyrate solution 100 mg/kg and 0.25% droperidol solution 0.5 mg/kg). The volume of therapeutic measures is determined by the child's condition, they are carried out under the control of hemodynamic parameters, blood coagulation, acid-base status, protein, glucose, potassium, sodium, calcium, chloride, magnesium in the blood serum. To eliminate metabolic disorders, restore hemodynamics and kidney function, 10% glucose solution, rheopolyglucin is injected intravenously, from the second or third day - hemodez.

The total volume of fluid administered (including feeding) on the first or second day should be 40-60 ml / kg, on the third day - 60-70 ml / kg, on the fourth - 70-80 ml / kg, on the fifth - 80-90 ml / kg, for the sixth-seventh - 100 ml / kg. From the second or third day, a 7.5% potassium chloride solution (1 ml / kg per day) is added to the dropper. Cocarboxylase (8-10 mg / kg per day), 5% solution of ascorbic acid (1-2 ml per day), 20% solution of calcium pantothenate (1-2 mg / kg per day), 1% solution of riboflavin- mononucleotide (0.2-0.4 ml / kg per day), pyridoxal phosphate (0.5-1 mg per day), cytochrome C (1-2 ml of a 0.25% solution per day for severe asphyxia), intramuscularly administered 0 5% solution of lipoic acid (0.2-0.4 ml / kg per day). Tocopherol acetate is also used 5-10 mg/kg per day intramuscularly or 3-5 drops of a 5-10% solution per 1 kg of body weight inside, glutamic acid 0.1 g 3 times a day inside.

In order to prevent hemorrhagic syndrome in the first hours of life, a 1% solution of vikasol (0.1 ml / kg) is injected intramuscularly once, rutin is prescribed orally (0.005 g 2 times a day). In severe asphyxia, a 12.5% solution of etamsylate (dicynone) is indicated at 0.5 ml / kg intravenously or intramuscularly. With the syndrome of increased neuro-reflex excitability, sedative and dehydration therapy is prescribed: 25% magnesium sulfate solution 0.2-0.4 ml / kg per day intramuscularly, seduxen (Relanium) 0.2-0.5 mg / kg per day intramuscularly or intravenously, sodium hydroxybutyrate 150-200 mg / kg per day intravenously, lasix 2-4 mg / kg per day intramuscularly or intravenously, mannitol 0.5-1 g of dry matter per 1 kg of body weight intraveinally 10% glucose solution, phenobarbital 5-10 mg / kg per day orally. In the case of the development of cardiovascular insufficiency, accompanied by tachycardia, 0.1 ml of a 0.06% solution of corglycone, digoxin is administered intravenously (the saturation dose on the first day is 0.05-0.07 mg / kg, on the next day 1/5 part of this dose), 2.4% solution of aminophylline (0.1-0.2 ml / kg per day). For the prevention of dysbacteriosis, bifidumbacterin is included in the complex of therapy, 2 doses 2 times a day.

Care is essential. The child should be provided with peace, the head is given an elevated position. Children who have suffered mild asphyxia are placed in an oxygen tent; children who have undergone moderate and severe asphyxia - in an incubator. Oxygen is supplied at a rate of 4-5 l / min, which creates a concentration of 30-40%. In the absence of the necessary equipment, oxygen can be supplied through a mask or nasal cannula. Often shown repeated suction of mucus from the upper respiratory tract and stomach.

It is necessary to monitor body temperature, diuresis, bowel function. The first feeding with mild asphyxia and moderate asphyxia is prescribed 12-18 hours after birth (with expressed breast milk). Those born in severe asphyxia begin to be fed through a tube 24 hours after birth. The timing of breastfeeding is determined by the condition of the child. Due to the possibility of complications from the c.n.s. for children born in asphyxia, after discharge from the maternity hospital, a dispensary observation of a pediatrician and a neuropathologist is established.

Forecast and prevention:

The prognosis depends on the severity of asphyxia, the completeness and timeliness of therapeutic measures. In case of primary asphyxia, to determine the prognosis, the condition of the newborn is reassessed on the Apgar scale 5 minutes after birth. If the score increases, the prognosis for life is favorable. During the first year of life, children who have had asphyxia may experience hypo- and hyperexcitability syndromes, hypertensive-hydrocephalic, convulsive, diencephalic disorders, etc.

Prevention includes timely detection and treatment of extragenital diseases in pregnant women, pathologies of pregnancy and childbirth, prevention of intrauterine fetal hypoxia, especially at the end of the second stage of labor, suction of mucus from the upper respiratory tract immediately after the birth of a child.

Asphyxia of newborns is a critical condition characterized by a violation of gas exchange: an insufficient amount of oxygen enters the child, and an excess of carbon dioxide accumulates in his body. Asphyxia is manifested by the absence or weakening of breathing with the preserved work of the heart. Approximately 4-6% of births are diagnosed with neonatal asphyxia.

The reasons

Doctors distinguish 2 types of asphyxia:

primary, appears at the time of the birth of a child;
secondary, the newborn suffocates or stops breathing a few hours or days after birth.

Primary asphyxia

Appears due to chronic or acute intrauterine oxygen deficiency. We list the reasons for the development of this state:

failure of the child's respiratory movements (intrauterine brain damage by infection, abnormal development of the lungs, a consequence of drug treatment of a woman);
insufficient supply of oxygen to the blood of a pregnant woman (thyroid disease, diabetes mellitus, respiratory system disease, cardiovascular pathology, anemia);
circulatory disorder in the placenta (dysfunction of labor, increased blood pressure in a pregnant woman);
disorder of gas exchange in the placenta (previa or premature detachment of the placenta);
sudden cessation of blood flow in the umbilical cord (multiple entanglement of the umbilical cord around the child's neck, constriction of the umbilical cord).

Also, the cause of asphyxia of the newborn can be:

complete or partial blockage of the respiratory tract with amniotic fluid, meconium, mucus;
Rh-conflict of mother and child;
intracranial trauma of the newborn.

Secondary asphyxia

It can happen for the following reasons:

lung immaturity in premature babies;
pneumopathy;
congenital malformation of the brain, heart, lungs;
aspiration of the respiratory tract with vomit;
circulatory disorder in the brain.

Signs and degrees of asphyxia

The main sign of asphyxia in a newborn is respiratory distress, which leads to impaired blood circulation and heart rhythm, which weakens reflexes and worsens neuromuscular conduction.

To assess the severity of asphyxia, the Apgar scale is used, taking into account the following criteria: reflex excitability, muscle tone, skin color, respiratory movements, and heart rate. Depending on how many points the newborn scored on the Apgar scale, doctors distinguish 4 degrees of asphyxia.

Light degree. According to Apgar, the child's condition is estimated at 6-7 points. The newborn takes the first spontaneous breath within the first minute after birth. But the child's breathing is weak, the cyanosis of the nasolabial triangle is visible, the muscle tone is reduced. There is a reflex excitability: the baby coughs or sneezes.
Average degree. Apgar score 4-5 points. The newborn takes the first breath in the first minute, but the breathing is irregular, very weakened, the cry is weak, the heartbeat is slow. There is also a cyanosis of the face, hands, feet of the child, a grimace on his face, muscle tone is weak, the umbilical cord pulsates.
Severe degree. Apgar status is estimated at 1-3 points. Breathing is irregular and rare or non-existent. The newborn does not scream, there are no reflexes, heartbeats are rare, muscle tone is weak or absent, the skin is pale, the umbilical cord does not pulsate.
clinical death. The Apgar score is 0 points. The child has no signs of life. He needs immediate resuscitation.

Treatment

Treatment of a newborn with asphyxia begins immediately after his birth. Resuscitation and further treatment is carried out by a resuscitator and a neonatologist.

In the delivery room

The child is placed on a changing table, wiped dry with a diaper, and mucus is sucked out of the mouth and upper respiratory tract with the help of an aspirator. If the baby's breathing is irregular or absent, an oxygen mask is put on his face for artificial lung ventilation (ALV). After 2 minutes, cardiac activity is assessed, if the heart rate (HR) per minute is 80 or less, they begin to give the child an indirect heart massage. After 30 seconds, the condition of the newborn is again assessed, if there is no improvement, then drugs are injected into the umbilical vein of the baby. At the end of resuscitation, the child is transferred to the intensive care unit.

In the intensive care unit

Newborns with mild asphyxia are in the oxygen ward, and babies with moderate and severe asphyxia are in incubators. The child is provided with warmth and rest. The newborn is given an intravenous infusion of the following drugs: vitamins, antibacterial agents, Calcium Gluconate (to prevent cerebral hemorrhage), Vikasol, Dicinon, ATP, Cocarboxylase. A child with mild asphyxia is allowed to feed 16 hours after birth. A newborn with a severe form is fed through a tube after 24 hours. The duration of the baby's stay in the intensive care unit depends on his condition, in most cases it is from 10 to 15 days.

Effects

The consequences of asphyxia in newborns are no less dangerous than the condition itself, as they lead to the development of complications.

Early complications:

brain necrosis;
hemorrhage in the brain;
cerebral edema.

late complications.

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 happens. 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 minute 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.

Asphyxia of newborns- a complication that develops in the early postpartum period. This pathology is accompanied by a violation of the breathing process and the work of the cardiovascular system in an infant. Let us consider this condition in more detail, determine its causes, types, find out: what is the difference between fetal hypoxia and asphyxia of the newborn.

What is "asphyxia" in a newborn baby?

Asphyxia of newborns is a condition of a small organism, in which there is a violation of breathing. However, there is a difference between this pathology and the definition of "hypoxia of the newborn". Oxygen starvation (), develops during pregnancy or childbirth (placental abruption, umbilical cord compression), and is accompanied by insufficient oxygen supply. In this case, the breathing process is not disturbed. Asphyxia (suffocation) is characterized by a temporary cessation of breathing and requires resuscitation.

Causes of asphyxia in newborns

Asphyxia in a child during childbirth can be triggered by numerous factors. At the same time, the causes of pathology can be directly related to the process of delivery and to the peculiarities of intrauterine development of the fetus. Among the main pathological factors that cause asphyxia, doctors distinguish:

Sharp, sudden failures in the blood flow and in the umbilical cord -, the formation of a knot on the umbilical cord, constriction.
Violation of the gas exchange process in the uteroplacental system - incorrect presentation of the child's place, premature and partial.
Failure in the process of blood circulation in the placenta caused by the mother.
Decrease in the level of oxygen in the blood of a woman in labor -, cardiovascular diseases, diseases of the respiratory system.
Difficulty in the process of breathing in the fetus - anomalies in the development of the lungs, chronic infectious processes, a consequence of the medications taken.

These causes provoke primary asphyxia of newborns, which develops in the process of delivery. However, asphyxia can also be secondary, when a violation occurs immediately after the baby is born. Among the causes of secondary asphyxia, it is necessary to name:

airway aspiration - fluid entering the lungs;
violation of the process of blood circulation of the brain;
immaturity of the lungs - the body is not able to make respiratory movements;
congenital malformations of the brain, heart, lungs.

Degrees of asphyxia of newborns

Depending on the clinical picture and the severity of the disorder, doctors distinguish several degrees of pathology. The assessment is carried out immediately after the birth of the baby in the first minute. Classification of asphyxia of newborns looks like this:

mild degree;
average;
heavy;
clinical death.

Mild neonatal asphyxia

Mild asphyxia is characterized by the absence of a cry, but the infant's reaction to touch is present. The breathing of a newborn is independent, but slow and irregular. The legs and arms have a bluish tint, cardiac activity is not disturbed. After cleaning the upper respiratory tract from mucus and fluid, tactile stimulation (stroking the back, patting on the heels) and oxygen therapy through a mask, the newborn's condition returns to normal.

A child born in a state of moderate asphyxia has no further problems with breathing. In this case, minor neurological disorders are possible, in the form of:

increased muscle tone;
arms, legs, lower jaw.

Asphyxia of moderate severity in a newborn

This degree of impairment is also characterized by the absence of a cry at the time of birth. In this case, the reaction to tactile stimuli of touch is not observed. A characteristic feature of this form is a change in the color of the skin, so it is often referred to as blue asphyxia of newborns. Respiratory movements are single, but cardiac activity is not disturbed.

Medium neonatal asphyxia requires ventilation. To do this, they often use a special bag, occasionally an oxygen mask. The transferred form of pathology always leaves an imprint on the health of the baby, provoking neurological changes:

increased excitability - causeless screams, prolonged tremor of the arms and legs;
depression - sluggish breast sucking, low physical activity (movements of the arms and legs are practically not carried out).

Severe asphyxia in newborns

A severe degree of pathology is accompanied by a complete absence of breathing at the time of birth. The skin due to insufficient blood circulation becomes pale. Because of this, this form of pathology is referred to as white asphyxia of the newborn. When conducting a tactile test, the baby does not react to touch in any way. There is a violation of the cardiovascular system - when listening to the heart sounds are very muffled or completely absent. Severe bradycardia develops.

This neonatal asphyxia requires urgent resuscitation. The actions of doctors in this case are aimed at restoring the respiratory and cardiac activity of the newborn. The child is connected to the artificial respiration apparatus. At the same time, drugs are injected into the umbilical cord that stimulate cardiac activity. Such babies are on machine breathing for a long time, and later severe neurological disorders develop, and a delay in neuropsychic development is possible.

Clinical death of a newborn

The clinical death of an infant occurs when doctors record the complete absence of signs of life. In this case, after birth, the baby does not take a single breath on his own, there is no cardiac activity, and there is no reaction to stimuli either. The correct and timely start of resuscitation measures gives hope for a favorable outcome. At the same time, the severity of the neurological consequences for the health of the baby depends on how long the absence of breathing was. In such situations, the brain is severely damaged.

Asphyxia of the newborn - symptoms

In order to assess the severity of this pathology, doctors use the Apgar scale. The method is based on the assessment in points of several indicators at once:

reflex excitability;
breath;
cardiac activity;
muscle tone;
skin color.

For each parameter, points are awarded, which are summed up and a total score is displayed. The results look like this:

mild degree - 6-7 points;
medium - 4-5;
severe - the baby is gaining 1-3 points;
clinical death - 0 points.

When setting the degree of asphyxia, obstetricians evaluate the present symptoms of the disorder. The pulse during asphyxia in newborns decreases and is less than 100 beats per minute. For a mild degree of asphyxia are characteristic:

the first breath occurs at 1 minute;
muscle tone is slightly reduced;
nasolabial triangle blue;
breathing is weakened.

With moderate severity of asphyxia, doctors record:

weakened breathing
legs and arms turn blue;
the number of heartbeats decreases;
muscle tone is reduced;
there is a pulsation of the vessels of the umbilical cord.

A severe degree of this pathology is manifested by the following symptoms:

breathing is absent;
severe bradycardia;
muscle atony;
pallor of the skin;
development of adrenal insufficiency;
strong pulsation of the veins of the umbilical cord.

Asphyxia of newborns - consequences

Talking about the danger of asphyxia in newborns, doctors note that with a severe degree of violation, the death of the baby is possible. This happens in the first hours of life. With an average and mild degree, the prognosis is favorable. The outcome depends on the time of the start of resuscitation, the presence of concomitant disorders. The consequences of the pathology that developed during the neonatal period can occur both in the first hours of life and at an older age.

Asphyxia in a newborn after childbirth - consequences

Severe asphyxia of newborns, the consequences of which depend on the correctness and timeliness of the therapy started, does not go unnoticed for the body. Complications can occur both in the early stages of perinatal development and at an older age. Complete atrophy of the brain after asphyxia in newborns is rare. Among the frequent complications of the early recovery period:

convulsive encephalopathy;
hydrocephalus;
hypertensive syndrome;
hypo- or hyperexcitability.

Asphyxia of newborns - consequences at an older age

Asphyxia and hypoxia of newborns are among those complications of pregnancy that affect the health of the baby after birth. Problems can appear in a few months, and sometimes even years. Late complications include:

meningitis;
pneumonia;
sepsis.

Treatment of asphyxia in newborns

Apgar scores of 4 or less in the first minute require resuscitation. Resuscitation of a newborn with asphyxia is carried out in 4 stages:

The release of the respiratory tract, ensuring their patency. It is carried out using a catheter and an electric pump. If asphyxia occurs in utero, the cleaning manipulation is carried out immediately after the appearance of the head.
Maintaining the breathing process. Assisted ventilation is carried out with the help of a breathing bag, and if ineffective, intubation is carried out and a ventilator is connected.
Restoration of the circulatory process. For this purpose, a closed body massage is performed, even in the presence of contractions (with bradycardia 60-70 beats per minute). It is carried out by pressing on the sternum with two thumbs, with a frequency of 100-120 times per minute. When cardiac activity is not restored within a minute, proceed to the next stage.
The introduction of drugs. At this stage of therapy, doctors use the following drugs to treat newborn asphyxia:

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

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

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

The degree of asphyxia of newborns according to the APGAR scale

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

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

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

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

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

What threatens asphyxia during childbirth, what are its consequences

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

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

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

Resuscitation of newborns with asphyxia

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

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

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

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

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

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