Severe asphyxia. Diagnosis of asphyxia in a newborn. Reasons for the development of pathology

Among the many factors that damage the brain of newborns, hypoxia should be highlighted, which can be classified as a universal damaging agent. Asphyxia recorded in newborns is very often only a continuation of hypoxia, which began in utero. Intrauterine hypoxia and hypoxia in childbirth in 20-50% of cases is the cause of perinatal mortality, in 59% of cases it is the cause of stillbirth, and in 72.4% hypoxia and asphyxia become one of the main causes of fetal death in childbirth or early neonatal period.

The term "asphyxia" is a conditional concept and is one of the most inaccurate in neonatology. Translated from Greek, the term "asphyxia" means "impulselessness", and such children are usually stillborn.

A number of other authors consider the term neonatal asphyxia as the absence of gas exchange in the lungs after the birth of a child (suffocation) in the presence of other signs of live birth (heartbeat, umbilical cord pulsation, voluntary muscle movements, regardless of whether the umbilical cord has been cut and whether the placenta has separated).

In general clinical practice, obstetrician-gynecologists and neonatologists understand the terms "fetal hypoxia" and "newborn asphyxia" a pathological condition accompanied by a complex of biochemical, hemodynamic and clinical changes that have developed in the body under the influence of acute or chronic oxygen deficiency with the subsequent development of metabolic acidosis.

In the International Classification of Diseases and Causes of Death X (1995), intrauterine hypoxia (fetal hypoxia) and asphyxia of the newborn are singled out as independent nosological forms of diseases of the perinatal period.

The birth rate of children in asphyxia is 1-1.5% (with fluctuations from 9% in children with a gestational age at birth of less than 36 weeks and up to 0.5% in children with a gestational age of more than 37 weeks).

Distinguish primary(congenital) and secondary(postnatal - occurs in the first hours of life) asphyxia of newborns.

By time of occurrence primary asphyxia is divided into antenatal or intranatal.

Depending on the duration primary asphyxia may be acute (intranatal) or chronic (antenatal).

Depending on the gravity clinical manifestations, asphyxia is divided into moderate (moderate) and severe.

Assessment of the severity of primary asphyxia is carried out using the Apgar scale.

APGAR SCALE

Registration of the state of the newborn according to the Apgar scale is carried out at the 1st and 5th minutes after birth. With scores of 7 and below at the 5th minute, the assessment is also carried out at the 10th, 15th, 20th minutes. The Apgar score at the 5th minute has a greater prognostic value in terms of predicting the further neuropsychic development of the child than the sum of the scores at the 1st minute.

It should be noted that the sensitivity of assessing the state of the newborn according to the Apgar scale is about 50%, therefore, in the presence of asphyxia, additional laboratory studies are required.

In the case of moderate asphyxia, the Apgar score at the 1st minute is 4-7 points, 0-3 points indicates severe asphyxia.

High risk factors for development chronic fetal hypoxia ( antenatal) are divided into three large groups leading to development of hypoxia and hypoxemia of pregnancy, conditioning fetal and maternal circulatory disorders and diseases of the fetus.

The first one includes:

anemia in pregnancy

severe somatic pathology in a pregnant woman (cardiovascular, pulmonary),

malnutrition, smoking, drug and alcohol use, unfavorable environmental conditions,

endocrine diseases (diabetes mellitus, hypothyroidism, ovarian dysfunction).

To the second:

delayed pregnancy,

prolonged gestosis of pregnant women,

anomalies in the development and attachment of the placenta,

multiple pregnancy,

umbilical cord anomalies,

threatened miscarriage,

bleeding,

infectious diseases in the second and third trimester of pregnancy.

By the third:

fetal diseases (intrauterine infections, malformations, fetal growth retardation, fetal hemolytic disease).

High risk factors acute hypoxia ( intranatal) of the fetus are:

C-section,

pelvic, gluteal or other abnormal presentation of the fetus,

premature or delayed birth,

anhydrous interval of more than 12 hours,

rapid and rapid childbirth,

placenta previa or premature detachment of the placenta,

discoordination of labor activity,

uterine rupture,

operative delivery.

acute hypoxia in childbirth in the mother (shock, decompensation of a somatic disease, etc.),

cessation or slowing of blood flow in the umbilical cord (entanglement, true knots, short or long umbilical cord, prolapse, infringement of umbilical cord loops),

malformations of the fetus (brain, heart, lungs)

narcotic and other analgesics administered to the mother 4 hours or less before the birth of the child, general anesthesia in the mother.

The highest risk of birth in asphyxia is among premature, post-term and children with intrauterine growth retardation. Many newborns have a combination of risk factors for both antenatal and intranatal hypoxia, although antenatal hypoxia does not necessarily lead to the birth of a child in asphyxia.

Factors in development secondary asphyxia newborn are:

residual effects of fetal asphyxia and birth injuries of the brain, lungs

symptomatic asphyxia in various pathological processes (malformations, pneumonia, infections)

respiratory distress syndrome

aspiration of breast milk or formula after feeding, or poor-quality sanitation of the stomach at birth.

Pathogenesis. Short-term or moderate hypoxia and hypoxemia cause the inclusion of compensatory adaptive mechanisms of the fetus with activation of the sympathetic-adrenal system by hormones of the adrenal cortex and cytokines. At the same time, the number of circulating erythrocytes increases, the heart rate becomes more frequent, perhaps a slight increase in systolic pressure without an increase in cardiac output.

Continuing hypoxia, hypoxemia, is accompanied by a decrease in pO2 below 40 mm Hg. contributes to the inclusion of an energetically unfavorable way of carbohydrate metabolism - anaerobic glycolysis. The cardiovascular system responds by redistributing circulating blood with the primary blood supply to vital organs (brain, heart, adrenal glands, diaphragm), which in turn leads to oxygen starvation of the skin, lungs, intestines, muscle tissue, kidneys and other organs. Preservation of the fetal state of the lungs is the cause of blood shunting from right to left, which leads to an overload of the right heart by pressure, and the left by volume, which contributes to the development of heart failure, increased respiratory and circulatory hypoxia.

Changes in systemic hemodynamics, centralization of blood circulation, activation of anaerobic glycolysis with the accumulation of lactate contribute to the development of metabolic acidosis.

In the case of severe and (or) ongoing hypoxia, a breakdown of compensation mechanisms occurs: hemodynamics, adrenal cortex function, which, along with bradycardia and a decrease in minute circulation, leads to arterial hypotension up to shock.

The increase in metabolic acidosis contributes to the activation of plasma proteases, pro-inflammatory factors, which leads to damage to cell membranes, the development of dyselectrolytemia.

An increase in the permeability of the vascular wall leads to slugging (gluing) of erythrocytes, the formation of intravascular thrombi and hemorrhages. The release of the liquid part of the blood from the vascular bed contributes to the development of cerebral edema and hypovolemia. Damage to cell membranes aggravates damage to the central nervous system, cardiovascular system, kidneys, adrenal glands with the development of multiple organ failure. These factors lead to a change in the coagulation and platelet hemostasis and can provoke DIC.

Despite the fact that asphyxia and its effect on the brain are constantly in the focus of attention of researchers, nevertheless, there are still many "blank spots" in the study of the leading links of pathogenesis. However, it seems possible to single out two main hypotheses:

in the basis of hypoxic-ischemic brain damage are metabolic disorders , triggered by oxygen deficiency , and directly damaging the brain factors - perverted metabolic products (acidosis, increased lactate level, accumulation of fatty acids - arachidonic acid, amino acids (glutamate), oxygen radicals, prostaglandins, leukotrienes, cytokines - interleukins, etc.), which leads to hemodynamic disorders.

Hypoxic-ischemic brain injury is based on cerebro-vascular disorders and violations of the mechanism of autoregulation cerebral circulation, advancing with oxygen deficiency.

The main pathogenetic mechanisms of the formation of clinical manifestations of hypoxia in newborns born in asphyxia can be combined into a complex of the following interrelated syndromes:

from the side of the central nervous system - a violation of the autoregulation of cerebral circulation, the development of cerebral edema and excessive release of glutamate from neurons, which leads to their ischemic damage, is possible;

from the side of the heart - ischemic cardiopathy with a possible fall in cardiac output,

on the part of the lungs - activation of surfactant synthesis inhibitors with the development of RDS, an increase in pulmonary vascular resistance, which leads to impaired ventilation-perfusion function of the lungs, persistent fetal circulation syndrome (PFC), impaired reabsorption of intrapulmonary fluid,

on the part of the kidneys - a violation of renal perfusion with the development of acute tubular necrosis and inadequate excretion of antidiuretic hormone,

from the gastrointestinal tract - intestinal ischemia with the possible development of ulcerative necrotic enterocolitis,

from the system of hemostasis and erythropoiesis - thrombocytopenia, vitamin K deficiency, DIC,

on the part of metabolism - hyperglycemia at the time of birth and hypoglycemia in the subsequent hours of life, extra- and intracellular acidosis, hyponatremia, hypomagnesemia, hyperkalemia, increased calcium levels in the cell, increased lipid peroxidation processes,

from the endocrine system - adrenal insufficiency, hyper- or hypoinsulinemia, transient hypothyroidism.

The pathogenesis of asphyxia, which arose in a child with chronic antenatal hypoxia, differs significantly from that in acute asphyxia, as it develops against the background of antenatal pathology: pneumopathy, encephalopathy, immaturity of the liver enzymatic systems, low reserves of the adrenal glands and thyroid gland, as well as pathological acidosis and secondary immunodeficiency. The main metabolic component of such hypoxia is the combination hypoxemia, hypercapnia and metabolic acidosis withmoment of birth. At the same time, it must be remembered that perinatal hypoxia and birth stress in this situation occur in conditions of reduced or even exhausted adaptation reserves. Acidosis early causes damage to cell membranes with the development of hemodynamic, hemostatic disorders and transcapillary metabolism, which determines the mechanisms for the development of DN, right ventricular heart failure, collapse with a drop in blood pressure, hypovolemia against the background of insufficiency of the sympathetic-adrenal system, myocardial ischemia and phase disorders of hemostasis, which is even more impairs microcirculation.

The clinical picture of asphyxia depends on its severity. With moderate hypoxia, the condition of the child after birth is usually regarded as moderately severe. In the first minutes of life, the child is lethargic, motor activity and reaction to examination are reduced. The cry is unemotional. Reflexes of the period of newborns are reduced or depressed. Auscultation of the heart - tachycardia, tones are amplified or muffled. It is possible to expand the boundaries of relative cardiac dullness. Breathing is arrhythmic, with the participation of auxiliary muscles, wired wheezing of various sizes is possible. The skin is often cyanotic, but quickly turns pink against the background of oxygenation. In this case, acrocyanosis often persists. During the first two or three days of life, these newborns are characterized by a change in the syndrome of depression to a syndrome of hyperexcitability, manifested by a small-scale tremor of the limbs, hyperesthesia, regurgitation, sleep disturbance, spontaneous Moro reflex (phase I), a decrease or inhibition of support reflexes, step, crawling, muscle hypotension, adynamia. However, changes in the physiological reflexes of newborns and muscle tone are individual.

With adequate therapy, the condition of children with acute moderate asphyxia improves rapidly and becomes satisfactory by the end of the early neonatal period.

In severe hypoxia, the child's condition at birth is severe or very severe, up to clinical death. There may be no reaction to the examination. Reflexes of newborns are oppressed or sharply reduced, adynamia. The skin is cyanotic, pale with a "marble pattern" (impaired microcirculation). Spontaneous breathing is arrhythmic, superficial; auxiliary muscles are involved in the act of breathing, its periodic absence is possible (primary, secondary apnea). Auscultatory breathing is weakened. With aspiration syndrome in the lungs, various rales are heard. Heart sounds are deaf, bradycardia, systolic hemodynamic murmur is often auscultated. On palpation of the abdomen, there is a moderate enlargement of the liver. Meconium often passes during childbirth. When prolonged acute asphyxia the clinic is close to shock. There are pronounced signs of violation of the peripheral (the symptom of the "white spot" for more than 3 s) and central hemodynamics (arterial hypotension, decreased CVP). In the neurological status, there are signs of coma or supor (lack of response to examination and pain stimuli, adynamia, areflexia, atony, pupil reaction to light is sluggish or absent, local eye symptoms are possible). There may be no spontaneous breathing. The heart sounds are muffled, a rough systolic murmur is heard, which is well conducted on the vessels and extracardiac. With symptoms of heart failure - expansion of the boundaries of relative cardiac dullness. In the lungs, moist rales of various sizes (a consequence of aspiration) may be heard against the background of weakened breathing (atelectasis). On the part of the gastrointestinal tract, hepatomegaly is noted, there may be signs of dynamic intestinal obstruction, as a result of ischemic and metabolic disorders.

Against the background of stabilization of the condition, signs of hypertensive syndrome appear, convulsions are often noted against the background of persistent muscle hypotension, and the absence of sucking and swallowing reflexes. From 2-3 days, with a favorable course, normalization of hemodynamics, respiration, neurological status (physiological reflexes, swallowing, and then sucking reflexes) is noted.

The diagnosis of asphyxia is made on the basis of an obstetric history, the course of labor, Apgar scores, and clinical and laboratory data.

Antenatal diagnosis.

Fetal heart rate monitoring (cardiotocography - CTG) - bradycardia and deceleration of the fetal heart rate indicate hypoxia and impaired myocardial function.

Ultrasound examination shows a decrease in motor activity, respiratory movements and muscle tone of the fetus (biophysical profile).

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

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

stages

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

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

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

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

What happens with asphyxia?

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

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

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

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

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

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

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

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

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Reasons for the development of pathology

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

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

Fetal factors:

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

Mother factors:

Factors that disrupt blood circulation in the placenta:

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

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

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

Clinical manifestations

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

Light degree characterized by:

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

Asphyxia moderate manifested by symptoms such as:

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

heavy asphyxia manifests itself in the form:

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

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Treatment

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

Asphyxia mild and moderate severity removed in several steps:

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

Treatment of severe asphyxia requires more drastic measures such as:

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

Newborn care

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

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

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

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

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

Consequences and complications

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

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

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

Prevention

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

During pregnancy necessary:

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

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

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

O causes of asphyxia newborns in this video:

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For 9 months, parents are looking forward to the birth of a small miracle. During this time, future mom and dad experience versatile feelings: joy and feelings, happiness and fear. The birth of a baby is the happiest moment in their life, which is often overshadowed by the news of the discovery of any health problems in the newborn. For example, a child may experience asphyxia. Many mothers and fathers become very nervous about this.

In most cases, the experiences turn out to be too strong, because the parents do not know what is happening at this time with their child and how modern medicine copes with such situations.

Asphyxia of newborns is understood as a pathological condition of newborn children, in which breathing is disturbed and oxygen deficiency develops. This dangerous and serious condition can occur both during childbirth and after them in the first days of the baby's life.

In a baby, asphyxia cannot occur without a specific reason, but before talking about them, it is worth paying attention to the types of this pathological condition of the child. Asphyxia is classified into primary and secondary. First view occurs in the fetus during childbirth. Chronic or acute intrauterine hypoxia causes this pathological condition. Also, asphyxia can occur due to:

• intracranial injury in a baby received by him during childbirth;
• fetal malformations that affect breathing and cause difficulty;
• immunological incompatibility of the child and mother;
• blockage of the respiratory tract crumbs with mucus or amniotic fluid.

The causes of primary asphyxia in a child may be the presence of extragenital diseases in the mother. For example, the fetus may suffer due to the fact that a pregnant woman has diseases of the cardiovascular system, diabetes, iron deficiency anemia. The child may also experience asphyxia if the expectant mother suffers from (late toxicosis), which is accompanied by increased pressure and swelling of the limbs.

Quite often, the causes of asphyxia in newborns lie in the pathological structure of the placenta, umbilical cord, and fetal membranes. Risk factors include premature discharge of amniotic fluid, premature, improper insertion of the fetal head during labor.

Secondary asphyxia occurs in a child a few hours or days after birth. Its reasons may be:

• heart defects;
• violation of cerebral circulation in a baby;
• CNS damage.

The most common cause of secondary asphyxia is pneumopathy (diffuse and polysegmental atelectasis, hemorrhages in the lungs, edematous hemorrhagic syndrome, hyaline membranes). They occur in the prenatal period or during childbirth and are accompanied by the development of a syndrome of respiratory disorders.

What happens in the body of newborns with asphyxia?

With this pathological condition, the newborn begins to change metabolic processes in the body, the severity of which depends on the degree of intensity of asphyxia and its duration.

At acute asphyxia , developing against a chronic background, hypovolemia is observed. This term refers to a decrease in the volume of circulating blood. It becomes thicker and more viscous.

In the brain, heart, liver, kidneys, there may be hemorrhages and edema that occur due to a lack of oxygen. Hypoxia of the fetus and asphyxia of the newborn leads to a decrease in blood pressure. The number of contractions of the heart is significantly reduced. The urinary function of the kidneys is impaired.

Signs of asphyxia in newborns

Doctors detect this pathological condition in children in the first seconds of life. The frequency and adequacy of breathing, skin color, indicators of muscle tone, heartbeat, reflex excitability are assessed.

The main sign of the presence of asphyxia in a child is violation of the breathing process leading to serious changes in the body. Immediately after the birth of the baby, doctors conduct a thorough examination. His condition is assessed on the Apgar scale.

There are the following forms of asphyxia:

• light;
• average;
• heavy;
• clinical death.

At mild form asphyxia, the condition of the crumbs on the Apgar scale is estimated at 6-7 points. The baby takes its first breath within the first minute after birth. However, his breathing is weakened, muscle tone is reduced, and a bluish tint is inherent in the nasolabial triangle.

At average form asphyxia, the assessment of the baby's condition is 4-5 points. The child, as well as with mild asphyxia, will take a breath during the first 60 seconds. His breathing will be weakened (irregular or regular). The baby may experience tachycardia, extinction of reflexes, decreased muscle tone, and bradycardia. The skin of the face, hands and feet will have a bright bluish tint.

The child's condition severe form asphyxia is estimated at 1-3 points. Breathing is irregular. It may or may not be present at all. The baby does not scream, but only sometimes moans. The heartbeat is slow and there are no reflexes. There is also muscle atony or hypotension. The skin is characterized by a pale shade. The umbilical cord does not pulsate. Quite often, with this severity of asphyxia, a newborn develops adrenal insufficiency.

At clinical death doctors give the child's condition a zero Apgar score. Specialists to save the life of the baby begin to immediately carry out a set of resuscitation measures.

It is worth noting that asphyxia is detected not only by external examination and assessment of the condition of the crumbs on the Apgar scale. The study of the acid-base state of the blood serves to confirm the diagnosis. With the help of ultrasound of the brain and methods of neurological examination, it is possible to determine damage to the central nervous system (extensive subdural, subarchanoid, intraventricular hemorrhages, etc.).

Treatment of acute asphyxia

All babies born in this pathological condition need intensive care. Doctors carry out certain activities in the delivery room in the first minutes of the baby's life, carefully monitoring the main parameters of life:

• heart rate;
• frequency and depth of inhalations and exhalations;
• hematocrit.

According to these indications, medical workers evaluate the effectiveness of the measures taken and adjust them, if necessary.

What actions do doctors perform when a child is born? First of all, when the head is born, the doctor in the nasal cavity and mouth introduces a special probe . With its help, the remnants of mucus and amniotic fluid are removed from the upper respiratory tract.

After the baby is completely removed from the birth canal, doctors will cut the umbilical cord. The baby will be placed on the resuscitation table and the contents of the nasopharynx and stomach will be re-aspirated.

After the restoration of the child's cardiac and respiratory activity transferred to the intensive care unit . The actions of doctors will not end there. Further measures of medical workers will be aimed at eliminating the consequences of newborn asphyxia: restoring metabolic processes, eliminating cerebral edema, and normalizing kidney function.

Caring for a child after suffering asphyxia

A baby after asphyxia needs special medical care. The child must be given complete rest. His head should be in an elevated position. Oxygen therapy plays an important role.

Babies after a mild form of asphyxia should be in a special tent with a high oxygen content inside it. There is no specific period of stay in it. One child needs to be in the tent for several hours, and the other for several days. The time spent in the oxygen tent is determined by the doctor after assessing the child's condition.

A newborn who has had asphyxia in severe or moderate form is placed in an incubator. Oxygen is supplied there. Inside the couveuse, the concentration of this chemical element should be about 40%. Some maternity hospitals may not have the necessary equipment. In this case, special nasal cannulas or breathing masks are used. Through them, oxygen is supplied.

A newborn child after asphyxia must be observed. It is necessary to control body temperature, bowel function, diuresis. Quite often, repeated cleaning of the respiratory tract from mucus and other contents is required.

The first feeding of a baby who has had a mild or moderate form of asphyxia is made 16 hours after birth. Children who are faced with a severe form of asphyxia are fed a day after birth using a special probe. The question of when to apply a baby to the breast after asphyxia is of interest to many mothers. There is no specific answer to it. The start time of breastfeeding is determined individually, depending on the condition of the baby.

What to do after discharge from the maternity hospital?

The baby after discharge from the hospital should be under the supervision of a neurologist and pediatrician. The purpose of medical supervision is to prevent the occurrence of complications from the central nervous system.

The prognosis of doctors depends on the following factors:

• the severity of the pathological condition;
• timely initiation of treatment;
• adequacy of medical measures.

If the baby was born with asphyxia, then the prognosis is directly dependent on the secondary assessment of his condition, which is made on the Apgar scale 5 minutes after birth. The forecast will be favorable if the second estimate is higher than the first.

During the first years of life, the following consequences of asphyxia in newborns can be observed:

• hydrocephalic syndrome;
• diencephalic disorders;
• convulsive syndrome;
• hypo- and hyperexcitability.

The above complications most often occur after a severe form of asphyxia. To prevent their occurrence, follow-up care by doctors is necessary.

Measures for the prevention of asphyxia in newborns

Asphyxia can cause quite serious health problems. You may not encounter this pathological condition at all if you perform certain actions aimed at preventing asphyxia. They do not always help, but despite this, you should not refuse them. In 40% of cases they give a positive result.

It has already been mentioned above that intrauterine hypoxia can be the cause of asphyxia. It can be avoided by visiting the doctor regularly.

During the "interesting situation" you need to identify all the risk factors:

• infectious and somatic diseases (acute respiratory diseases, influenza, colds);
• age of the fair sex;
• disruption of the endocrine system;
• change in the hormonal background of a woman;
• the presence of situations in life that cause stress;
• bad habits (alcohol, smoking).

We should not forget about intrauterine monitoring of the state of the placenta and fetus. It is very important, because thanks to it, various violations can be detected in time. By the state of the placenta, you can determine if the fetus is oxygen starvation or not. The danger signal is the presence of meconium in the amniotic fluid. At the first suspicion of hypoxia, it is necessary to start appropriate therapy as soon as possible.

All of the above is a confirmation that it is necessary to regularly visit a gynecologist. In no case should this be neglected, because the health of the baby and his life are at risk.

An important role in the prevention of hypoxia and asphyxia of the fetus and newborn is played by the correct lifestyle of a woman. The expectant mother should follow a few simple rules:

Walk more. A pregnant woman should spend more free time outdoors. Her blood is saturated with oxygen, which is then transported to the fetus. The child needs this element. It needs oxygen for proper development and growth.

Some women believe that walks are useful only if they are not in the city, but outside it. Such a view is incorrect. You can walk in the city at any time of the year in the nearest park or square.

Follow the daily routine. A pregnant woman should forget about the former “crazy rhythm of life”, when she sat at the computer at night, went to bed late, woke up early in the morning and went to work. Now you need to sleep at least 9 hours at night and during the day it is recommended to find a couple of hours for sleep.

Take vitamin and mineral complexes. A pregnant woman and her baby, who is still in the tummy, need vitamins and nutrients. Unfortunately, the quality of modern products does not allow obtaining all the necessary minerals and trace elements. "Magic wand" are special preparations - vitamin-mineral complexes.

They help meet the needs of mother and child. However, the drug must be prescribed by a gynecologist. You should not make decisions on your own, because some people do not need vitamins and minerals, and their excess can harm both mother and child.

Maintaining peace of mind and positive mood. Pregnancy is an unforgettable period in a woman's life. It is associated not only with joyful moments, but also with experiences, stresses. The expectant mother needs to worry less. All worries and worries can be easily dealt with. You just need to learn how to do it.

Pregnant women are encouraged to delete negative emotions from their lives. Dreaming about the future will help you maintain a positive attitude and peace of mind. You can bring bright colors into your life by watching good comedies, reading funny books, communicating with positive people.

In conclusion, it is worth noting that asphyxia is a serious pathological condition, but do not worry if this has affected your children. Thanks to modern devices, doctors will quickly notice something is wrong and take the necessary measures that will protect newborns from the consequences of asphyxia and save their lives.

Answers

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:

1. Sharp, sudden failures in the blood flow and in the umbilical cord -, the formation of a knot on the umbilical cord, constriction.
2. Violation of the gas exchange process in the uteroplacental system - incorrect presentation of the child's place, premature and partial.
3. Failure in the process of blood circulation in the placenta caused by the mother.
4. Decrease in the level of oxygen in the blood of a woman in labor -, cardiovascular diseases, diseases of the respiratory system.
5. 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 fix:

• 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:

1. 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.
2. 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.
3. 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.
4. The introduction of drugs. At this stage of therapy, doctors use the following drugs to treat newborn asphyxia: