Asphyxia of newborns clinical manifestations. Consequences of newborn asphyxia

Asphyxia of newborns is a critical condition that occurs as a result of gas exchange disorders (lack of oxygen and accumulation of carbon dioxide in the body) and is manifested by the absence of breathing or its weakening while the heart function is preserved.

Neonatal asphyxia is diagnosed in approximately 4-6% of all births.

Kinds

There are two types of newborn asphyxia:

• primary (occurs at the time of birth of the child)
• secondary (the child stops breathing or suffocates a few hours/days after birth).

Causes

Asphyxia of newborns is a consequence of acute or chronic intrauterine oxygen deficiency of the fetus. There are 5 leading moments in the development of asphyxia:

• sudden cessation of blood flow in the umbilical cord (true umbilical cord knot, constriction, tight and, as a rule, repeated entanglement of the umbilical cord around the fetal neck);
• gas exchange disorders in the placenta (premature placental abruption, placenta previa, etc.);
• circulatory disorders in the placenta (increased blood pressure in the mother, dysfunction of labor);
• insufficient oxygen supply to a woman’s blood (anemia, cardiovascular pathology, diseases of the bronchopulmonary system, diabetes mellitus, thyroid disease, etc.);
• failure of the newborn's respiratory movements (the influence of maternal drug treatment, intrauterine brain damage from various infections, lung development abnormalities, etc.).

Also, the cause of asphyxia in a child can be:

• intracranial injury of a newborn,
• Rhesus conflict pregnancy,
• obstruction of the respiratory tract, complete or partial, with mucus, meconium, and amniotic fluid.

Secondary asphyxia of newborns is caused by:

• circulatory disorder in the brain,
• aspiration of the respiratory tract (for example, vomit),
• congenital malformations of the lungs, heart, brain,
• pneumopathy,
• immaturity of the lungs (in premature infants).

Signs of newborn asphyxia

The main symptom of asphyxia in newborns is respiratory distress, which leads to disruption of the heart rhythm, poor circulation in the body, and as a result, neuromuscular conduction and reflexes suffer (they weaken).

The Apgar scale is used to assess the severity of newborn asphyxia. The Apgar score takes into account 5 criteria: heart rate, respiratory movements, skin color, muscle tone and reflex excitability.

The newborn is assessed in the first minute of life and after 5 minutes. Depending on the number of points the child scored, there are 4 degrees of asphyxia. If the Apgar score is more than 7 points, the child’s condition is considered satisfactory.

Degrees of asphyxia

Mild asphyxia

The child's Apgar condition is estimated at 6-7 points.

A newborn who was born with mild asphyxia takes his first independent breath within the first minute. But the child’s breathing is weak, muscle tone is reduced, and the nasolabial triangle appears blue. Reflex excitability persists: the child sneezes or coughs.

Moderate asphyxia (moderate)

The child's Apgar score is within 4-5 points. The newborn, as with mild asphyxia, takes its first breath in the first minute, but the breathing is very weakened, irregular, the cry is weak (the child squeaks or groans), the heartbeat is slow. There is also weak muscle tone, a grimace on the face, cyanosis (cyanosis) of the hands, feet, face, and the umbilical cord is pulsating.

Severe asphyxia

The child's condition on the Apgar scale corresponds to 1-3 points. There is either no breathing at all (apnea), or it is rare and irregular.

The child does not cry, the heartbeat is rare, there are no reflexes, muscle tone is either weak or absent (atony), the skin is pale (a consequence of spasm of the blood vessels), the umbilical cord does not pulsate.

With severe asphyxia, adrenal insufficiency usually develops. This form of asphyxia is called “white” asphyxia.

Clinical death

The newborn's Apgar score is 0. All signs of life are completely absent. In this case, immediate resuscitation is necessary.

Treatment of newborn asphyxia

Treatment of a newborn born in a state of asphyxia begins immediately after birth, that is, in the delivery room. Resuscitation and further therapy are carried out by a neonatologist and resuscitator.

First aid in the delivery room:

Immediately after birth, the newborn is placed on a changing table under a heat source, wiped dry with a diaper, and mucus from the mouth and upper respiratory tract is suctioned.

If after removing the mucus the child does not breathe, then lightly slap him on the heels 1-2 times. In case of absence of breathing or its irregularity, mechanical ventilation is started (artificial ventilation of the lungs (a mask is put on the baby’s face through which oxygen is supplied).

If mechanical ventilation continues for 2 minutes or more, a probe is inserted into the stomach and gastric contents are removed.

Cardiac activity is assessed. If the heart rate (HR) is 80 or less per minute, begin chest compressions.

The administration of drugs begins after 30 seconds at a heart rate of 80 or less against the background of mechanical ventilation, or immediately, in the absence of heart contraction.

Medicines are injected into the umbilical vein (sodium bicarbonate solution, adrenaline solution, albumin with ringer lactate and saline).

If a child is born in a state of clinical death, he is immediately intubated and given the drug therapy indicated above. Resuscitation is stopped if cardiac activity is not restored within 20 minutes after the start of all measures.

After resuscitation is completed, the newborn is transferred to the intensive care unit.

Children with mild asphyxia are placed in an oxygen ward, children with moderate and severe asphyxia are placed in an incubator. The newborn is provided with rest, heating, and antibiotics are prescribed.

Treatment continues in the intensive care ward. Vitamins are indicated (B vitamins, vitamin E, glutamic acid, potassium pantothenate, rutin, nicotinic acid), vikasol, dicinone and calcium gluconate (prevention of cerebral hemorrhages), ATP, cocarboxylase, and infusion therapy is performed.

Feeding a newborn with a mild form of asphyxia begins after 16 hours, children with severe asphyxia after 24 hours through a tube.

The duration of treatment depends on the condition of the newborn and can be 10-15 days or more.

Consequences

Asphyxia of newborns is dangerous due to the development of complications (early and late).

Early complications:

• cerebral edema;
• hemorrhages in the brain;
• brain necrosis, etc.

Late complications:

• infectious complications (pneumonia, meningitis, sepsis);
• neurological complications (hydrocephalus, encephalopathy).

Consequences after asphyxia are diagnosed during the first year of a child’s life:

• hyperexcitability;
• slow reactions;
• convulsive syndrome;
• encephalopathy of the hypertensive-hydrocephalic type;
• death of a child.

Update: November 2018

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

Definition of newborn asphyxia

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

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

Classification of newborn asphyxia

Based on the time of occurrence, there are 2 forms of asphyxia:

• primary – develops immediately after the birth of the baby;
• secondary - diagnosed within the first day after birth (that is, at first the child was breathing independently and actively, and then suffocation occurred).

According to severity (clinical manifestations) there are:

• mild asphyxia;
• moderate asphyxia;
• severe asphyxia.

Factors provoking the development of asphyxia

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

Fruit factors

• ) The child has;
• Rhesus conflict pregnancy;
• anomalies in the development of organs of the bronchopulmonary system;
• intrauterine infections;
• prematurity;
• intrauterine growth restriction;
• obstruction of the respiratory tract (mucus, amniotic fluid, meconium) or aspiration asphyxia;
• malformations of the heart and brain of the fetus.

Maternal factors

• severe, occurring against a background of high blood pressure and severe edema;
• decompensated extragenital pathology (cardiovascular diseases, diseases of the pulmonary system);
• pregnant women;
• endocrine pathology (, ovarian dysfunction);
• woman's shock during childbirth;
• disturbed ecology;
• bad habits (smoking, drinking alcohol, taking drugs);
• insufficient and malnutrition;
• taking medications contraindicated during gestation;
• infectious diseases.

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

• post-term pregnancy;
• premature aging of the placenta;
• premature placental abruption;
• umbilical cord pathology (umbilical cord entanglement, true and false nodes);
• constant threat of interruption;
• and bleeding associated with it;
• multiple pregnancy;
• excess or lack of amniotic fluid;
• anomalies of labor forces (and incoordination, rapid and rapid labor);
• drug administration less than 4 hours before completion of labor;
• general anesthesia for women;
• uterine rupture;

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

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

Mechanism of development of asphyxia

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

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

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

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

Clinical picture

The main sign of asphyxia in newborns is considered to be respiratory failure, which entails a malfunction of the cardiovascular system and hemodynamics, and also impairs neuromuscular conduction and the severity of reflexes.

To assess the severity of the pathology, neonatologists use the Apgar assessment of the newborn, which is carried out in the first and fifth minutes of the child’s life. Each sign is scored 0 – 1 – 2 points. A healthy newborn gains 8–10 Apgar points in the first minute.

Degrees of newborn asphyxia

Mild asphyxia

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

Moderate asphyxia

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

Severe asphyxia

The condition of the newborn is serious, the number of Apgar scores in the first minute does not exceed 1 - 3. The child does not make breathing movements or takes separate breaths. Heart beats are less than 100 per minute, pronounced, heart sounds are dull and arrhythmic. The newborn does not cry, muscle tone is significantly reduced or muscle atony is observed. The skin is very pale, the umbilical cord does not pulsate, reflexes are not detectable. Eye symptoms appear: nystagmus and floating eyeballs, possible development of seizures and cerebral edema, DIC syndrome (impaired blood viscosity and increased platelet aggregation). Hemorrhagic syndrome (numerous hemorrhages on the skin) intensifies.

Clinical death

A similar diagnosis is made when all Apgar indicators are assessed at zero points. The condition is extremely serious and requires immediate resuscitation measures.

Diagnostics

When making a diagnosis: “Asphyxia of a newborn,” data from the obstetric history, how the birth proceeded, the child’s Apgar assessment at the first and fifth minutes, and clinical and laboratory tests are taken into account.

Determination of laboratory parameters:

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

Additional methods:

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

Treatment

All newborns born in a state of asphyxia are given immediate resuscitation measures. The further prognosis depends on the timeliness and adequacy of treatment of asphyxia. Resuscitation of newborns is carried out using the ABC system (developed in America).

Primary care for a newborn

Principle A

• ensure the correct position of the child (lower the head, placing a cushion under the shoulder girdle and tilt it back slightly);
• suck out mucus and amniotic fluid from the mouth and nose, sometimes from the trachea (with aspiration of amniotic fluid);
• intubate the trachea and examine the lower respiratory tract.

Principle B

• carry out tactile stimulation - a slap on the baby’s heels (if there is no cry within 10 - 15 seconds after birth, the newborn is placed on the resuscitation table);
• jet oxygen supply;
• implementation of auxiliary or artificial ventilation (Ambu bag, oxygen mask or endotracheal tube).

Principle C

• performing indirect cardiac massage;
• administration of drugs.

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

Administration of drugs

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

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

Further treatment and observation

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

Special care and feeding

The child is placed in an incubator, where constant heating is provided. At the same time, craniocerebral hypothermia is carried out - the newborn’s head is cooled, which prevents. Feeding of children with mild and moderate asphyxia begins no earlier than 16 hours later, and after severe asphyxia, feeding is allowed after 24 hours. The baby is fed through a tube or bottle. Breastfeeding depends on the baby's condition.

Prevention of cerebral edema

Albumin, plasma and cryoplasma, and mannitol are administered intravenously through the umbilical catheter. Drugs are also prescribed to improve blood supply to the brain (Cavinton, cinnarizine, vinpocetine, sermion) and antihypoxants (vitamin E, ascorbic acid, cytochrome C, aevit). Hemostatic drugs (dicinone, rutin, vikasol) are also prescribed.

Carrying out oxygen therapy

The supply of humidified and warmed oxygen continues.

Symptomatic treatment

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

Correction of metabolic disorders

Intravenous sodium bicarbonate is continued. Infusion therapy with saline solutions (saline and 10% glucose) is carried out.

Newborn monitoring

The child is weighed twice a day, the neurological and somatic status and the presence of positive dynamics are assessed, and the incoming and excreted fluid (diuresis) is monitored. The devices record heart rate, blood pressure, respiratory rate, and central venous pressure. From laboratory tests, a complete blood count with and platelets, acid-base status and electrolytes, blood biochemistry (glucose, bilirubin, AST, ALT, urea and creatinine) are determined daily. Blood clotting indicators and blood vessels are also assessed. cultures from the oropharynx and rectum. X-rays of the chest and abdomen, ultrasound of the brain, and ultrasound of the abdominal organs are indicated.

Consequences

Asphyxia of newborns rarely goes away without consequences. To one degree or another, the lack of oxygen in a child during and after childbirth affects all vital organs and systems. Particularly dangerous is severe asphyxia, which always occurs with multiple organ failure. The baby's life prognosis depends on the Apgar score. If the score increases in the fifth minute of life, the prognosis for the child is favorable. In addition, the severity and frequency of consequences depend on the adequacy and timeliness of resuscitation measures and further therapy, as well as on the severity of asphyxia.

Frequency of complications after suffering from hypoxia:

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

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

Early complications

Early complications are said to occur when they appear during the first 24 hours of the baby’s life and, in fact, are manifestations of a difficult course of labor:

• cerebral hemorrhages;
• convulsions;
• and hand tremors (first small, then large);
• attacks of apnea (stopping breathing);
• meconium aspiration syndrome and, as a result, the formation of atelectasis;
• transient pulmonary hypertension;
• due to the development of hypovolemic shock and blood thickening, the formation of polycythemic syndrome (a large number of red blood cells);
• thrombosis (blood clotting disorder, decreased vascular tone);
• heart rhythm disorders, development of posthypoxic cardiopathy;
• disorders of the urinary system (oliguria, renal vascular thrombosis, swelling of the renal interstitium);
• gastrointestinal disorders (and intestinal paresis, digestive tract dysfunction).

Late complications

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

• Hyperexcitability syndrome

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

• Reduced excitability syndrome

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

• Convulsive syndrome

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

• Hypertensive-hydrocephalic syndrome

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

• Syndrome of vegetative-visceral disorders

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

• Movement disorder syndrome

Residual neurological disorders (paresis and paralysis, muscle dystonia) are characteristic.

• Subarachnoid hemorrhage
• Intraventricular hemorrhages and hemorrhages around the ventricles.

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

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

Question answer

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

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

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

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

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

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

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

Answer: Such children are prone to colds due to weakened immunity, their performance at school is reduced, reactions to some situations are unpredictable and often inadequate, psychomotor development and speech lag are possible. After severe asphyxia, epilepsy, convulsive syndrome often develops, mental retardation is possible, and paresis and paralysis.

The birth of a child is definitely a joyful event for a mother. However, childbirth does not always proceed smoothly. The most common postpartum complication in a newborn is asphyxia. This diagnosis is made in 4-6% of all babies born. According to other data, suffocation occurs to one degree or another in approximately every tenth newborn. The severity of this deviation depends on the degree of lack of oxygen and accumulation of carbon dioxide in the blood and tissues of the baby. The pathology can develop inside the womb (primary) or outside it (secondary). The latter manifests itself during the first days of the baby’s life. Asphyxia is a serious and dangerous condition, sometimes leading to the death of a fetus or newborn baby.

Frequently asked questions from parents

What is asphyxia?

Asphyxia is a condition of impaired breathing of a child or fetus, its oxygen starvation against the background of an excess of carbon dioxide in the blood. Most often occurring during childbirth. Sometimes reaching the development of hypoxia of the newborn. Clinically, asphyxia is manifested by the lack of breathing of a newborn baby. It may be completely absent or the baby may experience convulsive, shallow, irregular breathing movements. Pathology requires urgent resuscitation procedures, the correctness of which determines the further prognosis.

How is hypoxia different from asphyxia?

Hypoxia is oxygen starvation of the baby’s tissues and organs, which develops with a lack of oxygen. Asphyxia is a violation of the spontaneous breathing of a newborn child that occurs after his birth. Typically, hypoxia develops even at the stage of intrauterine development of the baby, sometimes it becomes a consequence of suffocation.

All human tissues and organs require a constant supply of oxygen. With its deficiency, disorders arise, the severity and consequences of which depend on the degree of pathology, timeliness and correctness of first aid. In newborns, tissue damage quickly becomes irreversible. The most sensitive to oxygen deficiency are the baby’s brain, liver, kidneys, heart and adrenal glands.

How dangerous is asphyxia?

Insufficient oxygen supply, even limited in time, negatively affects the condition and functioning of the body. The brain and nervous system are especially affected. There may be disturbances in blood supply processes, manifested by an increase in the size of blood vessels due to blood overflow. Hemorrhages and blood clots form, which leads to damage to certain areas of the brain. It is also possible to develop areas of necrosis - dead brain cells.

In severe cases, suffocation leads to fetal death during childbirth or in the first few days of the baby's life. Children who have been diagnosed with severe breathing disorders have physical and mental abnormalities.

The consequences of asphyxia can be far-reaching. An infant with a history of this disorder, even to a mild degree, may experience weak immunity, a tendency to catch colds, and developmental delays. Schoolchildren have decreased attention, problems with memorizing material, and low academic performance. In severe forms of suffocation, the following may develop: epilepsy, mental retardation, paresis, cerebral palsy, convulsive syndrome, and other serious pathologies.

Why does pathology occur in newborns?

According to the time of occurrence of asphyxia, they are distinguished:

1. Primary (intrauterine), developing immediately after the birth of a child.
2. Secondary (extrauterine), which can manifest itself during the first days of a baby’s life.

Depending on the severity of the lesion

• heavy;
• average;
• light.

Causes of primary asphyxia

All reasons fit into three groups:

1. Related to the fruit:
   • intrauterine developmental delay;
   • prematurity;
   • pathologies of growth or development of the fetal heart (brain);
   • aspiration of the respiratory tract with mucus, meconium, or amniotic fluid;
   • Rhesus conflict;
   • birth traumatic brain injury;
   • pathologies of the development of the respiratory system;
   • intrauterine infection.
2. With maternal factors:
   • infectious diseases suffered during pregnancy;
   • malnutrition;
   • taking medications contraindicated for pregnant women;
   • pathologies of the endocrine system: diseases of the thyroid gland or ovaries, diabetes mellitus;
   • anemia in a pregnant woman;
   • bad habits: alcohol, smoking, drug addiction;
   • shock during childbirth;
   • severe gestosis, accompanied by high blood pressure and severe swelling;
   • the presence of pathologies of the cardiovascular and respiratory systems in a pregnant woman.
3. With problems causing disturbances in the uteroplacental circle:
   • birth by cesarean section;
   • general anesthesia;
   • polyhydramnios or oligohydramnios;
   • ruptures, damage to the uterus;
   • abnormal birth: fast, rapid labor, weak labor, incoordination;
   • placenta previa;
   • multiple pregnancy;
   • placental abruption or premature aging;
   • post-term pregnancy;
   • difficult pregnancy, accompanied by a constant threat of miscarriage.

Prerequisites for secondary

The following pathologies of the newborn can be the causes of the development of secondary asphyxia:

1. Undiagnosed heart defects.
2. Aspiration of milk or formula during feeding.
3. Improper sanitation of the baby's stomach after childbirth.
4. Damage to brain or heart tissue, accompanied by impaired blood circulation in the brain.
5. Respiratory syndrome, which can develop with edematous-hemorrhagic syndrome, pulmonary atelectasis, and the appearance of hyaline membranes.

Symptoms

Primary asphyxia is detected immediately after the birth of a child based on an objective assessment of its indicators:

• skin color;
• heart rate;
• breathing frequency.

The main sign of suffocation is impaired breathing, which leads to disruption of the heart and blood circulation. The severity of the newborn's condition is due to metabolic changes. In a child with impaired breathing, the concentration of red blood cells, blood viscosity increases, and platelet aggregation increases. The result of this is improper blood circulation, leading to a decrease in heart rate, disruption of the functioning of organs and systems.

With moderate severity, the child:

• lethargic;
• his reactions are reduced;
• spontaneous movements may be observed;
• reflexes are weakly expressed;
• the skin has a bluish color, which quickly changes to pink during resuscitation.

During the examination, doctors reveal:

• tachycardia;
• muffled heart sounds;
• weakened breathing;
• possible moist rales.

With prompt, proper care, the condition of a newborn returns to normal on days 4-6 of life.

Severe manifests itself:

• lack of physiological reflexes;
• dullness of heart sounds;
• the appearance of systolic murmur;
• hypoxic shock may develop.

Symptoms include:

• lack of response to pain and external stimuli;
• lack of breathing.

Degrees of asphyxia on the Apgar scale

The severity of suffocation is determined using the Apgar scale. It includes five signs for which scores are given - 0, 1 or 2. A healthy baby must score at least 8 points. This assessment is carried out twice in the first minute of the child’s life and in the fifth.

Criteria

Apgar scale criteria and scores:

1. Color of the skin:
   • 0 – bluish, 1 – pale pink, 2 – pink.
2. Reflexes:
   • 0 – no, 1 – weak, 2 – normal.
3. Muscle tone:
   • 0 – absent, 1 – weak, 2 – good.
4. Heartbeat:
   • 0 – no, 1 – less than 100 beats per minute, 2 – more than 100 beats.
5. Breath:
   • 0 – no, 1 – superficial, intermittent, irregular, 2 – normal spontaneous breathing, loud crying of the child.

Degrees

Based on the results of the examination of the child and the Apgar score, the presence of asphyxia and its degree (in points) are determined:

1. 8-10 is normal.
   • The baby is healthy, there are no breathing problems.
2. 6-7 – mild degree.
   • The child has: weak, sharp breathing, decreased muscle tone, cyanosis of the nasolabial triangle.
3. 4-5 – moderate.
   • The newborn has the following symptoms: irregular, intermittent breathing, bradycardia, weak first cry. Blueness of the skin of the face, feet, hands.
4. 1-3 – heavy.
   • The child has a complete absence of breathing or rare breaths, the heart rate is rare or absent, muscle tone is greatly reduced, the skin is pale or sallow.
5. 0 – clinical death.
   • A condition in which the newborn shows no signs of life. Immediate resuscitation is required.

Likely consequences

Asphyxia rarely leaves any consequences. Impaired gas exchange and lack of oxygen affects the functioning of all organs and systems of the child. An important indicator is a comparison of Apgar scores made in the first and fifth minutes of the baby’s birth. As your scores increase, you can count on a favorable outcome. If the assessment does not change or even worsens, unfavorable developments are possible. The severity of the consequences of suffocation also depends on the correctness of resuscitation measures.

With a mild degree of asphyxia, especially with timely assistance, there is a high chance of avoiding consequences. Children who have suffered more severe forms of breathing problems may develop abnormalities in the functioning of internal organs. The most common consequences of this condition are neurological disorders, developmental delays, increased muscle tone, seizures, and other pathologies. Cases of severe suffocation are often fatal. According to statistics, approximately half of these children die.

Diagnostic procedures

Diagnosing asphyxia is simple. Its main symptoms were discussed above and included breathing, heart rate, muscle reflexes and skin tone. Here we look at more specialized approaches.

Diagnosis can be made by the hydrogen index of blood, which is taken from the umbilical cord.

1. Normally, the acid-base balance is shifted towards alkali, in a newborn it is slightly higher: 7.22–7.36 BE, a deficiency of 9–12 mmol/l.
2. With mild/moderate air deficiency, pH values: 7.19–7.11 BE, deficiency 13–18 mmol/l.
3. Severe choking: less than 7.1 BE or more than 19 mmol/L.

To determine hypoxic damage to the nervous system of a newborn, neurosonography is indicated - ultrasound examination of the brain. Ultrasound, together with a neurological examination, will help distinguish traumatic disorders in the brain from disorders due to oxygen starvation.

First aid and resuscitation measures

A neonatologist administers first aid to a suffocating baby.

After a safe birth, mucus from the lungs and nasopharynx is sucked out, the condition of the newborn is assessed. The first is the presence of breathing.

If it is not there, they try to use the reflexes by slapping the baby on the heels. The breathing that appears after the procedure indicates a mild degree of suffocation, which is noted in the baby’s card. At this point the treatment stops.

If the actions taken do not help, breathing is not restored or fails, then put on an oxygen mask. The appearance of stable breathing within a minute indicates that the newborn had a moderate degree of asphyxia.

If there is no breathing for a longer period, resuscitation begins, which is carried out by a resuscitator.

Ventilation of the lungs lasts two minutes, if the patient is breathing even slightly, a probe is inserted into him, removing the contents of the stomach. The number of heartbeats is measured. If the pulse is less than 80, chest compressions begin.

Lack of improvement leads to the next stage - drug therapy. Solutions of the indicated medications are injected into the newborn's umbilical vein, while massage and artificial ventilation are continued. After 15-20 minutes, if there is no improvement in the condition, resuscitation is stopped.

Prohibited actions

In case of asphyxia you cannot:

• pat on the back or buttocks;
• blow oxygen onto the baby's face;
• press on the chest;
• Sprinkle with cold water.

Treatment

If first aid or resuscitation procedures are successful, the baby comes under special supervision. A course of activities and treatment procedures is carried out with him.

1. Special care.
2. Feeding shown.
3. Oxygen therapy.
4. Preventing cerebral edema.
5. Correction of metabolism.
6. Prevention of seizures.
7. Prevention of hydrocephalic syndrome.
8. Other types of symptomatic treatment.
9. General monitoring of the condition is carried out twice a day.

Possible complications

Lack of oxygen affects the brain the most. Changes increase in three stages, even with short-term hypoxia:

1. The blood vessels dilate and fill with blood.
2. Blood clots form, the walls of blood vessels become thinner, and hemorrhages occur.
3. Areas of the brain with microstrokes die – tissue necrosis.

The prognosis can be favorable if proper treatment is carried out after mild or moderate asphyxia. With a severe form it is more difficult. Normal, full-term children survive in 10-20% of cases, 60% have severe consequences - physical or mental disorders, pneumonia. The mortality rate for premature or low birth weight babies is close to 100%.

Prevention

Prevention of breathing problems in a newborn lies in the measures taken:

1. By doctors:
   • observation and management of the woman throughout the entire pregnancy;
   • prevention of vaginal infections;
   • timely treatment of extragenital diseases;
   • monitoring the condition of the fetus and placenta.
2. Pregnant:
   • rejection of bad habits;
   • compliance with dietary requirements;
   • feasible physical activity, walks in the fresh air;
   • compliance with medical recommendations.

Asphyxia of newborns sounds like a death sentence: terrible, terrifying. You look at a child who has just been born and think how tiny and defenseless this little person is. And you see how this little body is fighting for its life, for the right to exist on this planet.

Yes, asphyxia of newborns often has tragic consequences. However, with proper and prompt medical care, qualified treatment, care for the newborn and close attention to his health in the future, complete restoration of the body is possible.

What is asphyxia and the causes of its occurrence

Asphyxia is a disruption of the respiratory system, as a result of which the child experiences oxygen starvation. This pathology comes in two types: primary, which occurs at birth, and secondary, which manifests itself in the first minutes or hours of a baby’s life.

There are plenty of reasons for the occurrence of pathology. Hypoxia occurs in newborns (this is another name for asphyxia) due to an infection in the mother’s body. Difficulty breathing in a newborn occurs due to blockage of the respiratory tract with mucus and early discharge of amniotic fluid, as a result of which oxygen starvation occurs. Also, asphyxia of the fetus and newborn can be associated with serious illnesses of the mother (diabetes, heart problems, liver problems, respiratory diseases). Among the reasons are also noted maternal late toxicosis (preeclampsia, preeclampsia), difficult and prolonged labor, detachment or disruption of the integrity of the placenta, entanglement of the umbilical cord, post-term pregnancy or, conversely, early rupture of amniotic fluid and premature pregnancy, taking certain medications in large dosages in the last days of pregnancy .

As you can see, there are plenty of reasons. Pathology such as asphyxia of the fetus and newborns (which is especially frightening) is not uncommon today. That is why a woman, while pregnant, should monitor her condition very carefully and, in case of the slightest discomfort, consult a doctor. Self-medication or an illness that occurs without the intervention of a qualified doctor can lead to a serious outcome and not always a pleasant solution to the problem.

If the diagnosis is asphyxia

It doesn’t matter what the cause of asphyxia is, the newborn’s body immediately reacts to this pathology and immediately rebuilds itself. The central nervous system is disrupted, brain function malfunctions, and metabolic processes are suspended. The heart, liver, kidneys and brain suffer. Blood thickening leads to deterioration in the functioning of the heart muscle. Such malfunctions in the functioning of internal organs can lead to swelling and hemorrhages in the tissues.

The degree of asphyxia is assessed using the Apgar score. Depending on how the child’s first breath is taken, what kind of breathing is done in the first minute of life, the color of the skin and what kind of cry he has (weak or loud), doctors assign points. Each point corresponds to a specific assessment of the severity of asphyxia.

The favorable outcome of asphyxia largely depends on how well the treatment and rehabilitation were carried out. The duration of oxygen starvation also affects. Such babies require resuscitation immediately after birth. Resuscitation work begins right in the delivery room. With the help of special suctions, the baby's airways are cleared of mucus, the umbilical cord is cut, and the baby is warmed up. If breathing is not restored, the newborn is connected to an artificial respiration apparatus. Ventilation of the lungs occurs until the skin acquires a natural pink color and breathing becomes even (heart rate of at least 100 per minute). If spontaneous breathing is not restored within 20 minutes, and the baby has not taken a single breath, resuscitation is pointless. In a healthy child, spontaneous breathing begins no later than 1 minute from the time of birth.

Many children who have suffered asphyxia experience convulsive syndrome, increased excitability, motor disturbances, and increased intracranial pressure.

Caring for a child who has suffered asphyxia

Considering the fact that the functioning of the central nervous system is disrupted in a baby with asphyxia, it is necessary to strictly follow all the doctor’s prescriptions. Care is important for a child. Complete peace and close attention. Typically, children with asphyxia are placed in an incubator or tent, which is supplied with oxygen.

After discharge from the hospital, the child should be regularly seen by a neurologist and pediatrician. Further treatment and rehabilitation depend only on the diagnoses (if any) and symptoms. With a mild degree of asphyxia, there may be no disturbances in the child’s body. And in this case, the family just needs to live in peace. Most of these children do not even have contraindications to routine vaccination.

Remember that if asphyxia has had a detrimental effect on the child, this will be visible already in the first days after birth.

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The absence of gas exchange in the lungs, accompanied by hypoxemia, hypercapnia and pathological acidosis in the child’s body after birth, is called asphyxia. The consequences of asphyxia in the form of brain damage are of practical importance. According to some authors, from 6 to 15% of children are born in an asphyxial state of varying severity.

Etiology and pathogenesis. Risk factors for antenatal fetal asphyxia are extragenital pathology in the mother (hypertension, heart disease, lung disease, kidney disease, diabetes mellitus, etc.), multiple pregnancy, infectious diseases during pregnancy, pathology of the placenta, complications of pregnancy (primarily gestosis), uterine bleeding , isoimmunization of a pregnant woman, post-term pregnancy. Drug addiction, substance abuse and smoking also lead to fetal hypoxia.

The most important reasons why intrapartum asphyxia of a newborn occurs can be divided into the following groups: disturbances of the umbilical circulation (compression, umbilical cord nodes), disturbance of placental gas exchange (abruption, placenta previa, placental insufficiency); inadequate perfusion of the maternal part of the placenta (hypertension or hypotension in the mother, impaired contractility of the uterus), disorders of maternal oxygenation (heart disease, lung disease, anemia); inability of the fetus to make the transition from fetal to postnatal blood circulation (the effect of drug therapy in the mother, maternal drug addiction, congenital malformations of the lungs, brain, heart in the fetus, etc.).

Short-term moderate fetal hypoxia includes compensatory mechanisms aimed at maintaining adequate oxygenation. The volume of circulating blood increases, the release of glucocorticoids increases, and tachycardia develops. With acidosis, the affinity of fetal hemoglobin for oxygen increases. With a longer duration of hypokia, anaerobic glycolysis is activated. A decrease in oxygen leads to a redistribution of circulating blood with a predominant supply to the heart, brain, and adrenal glands. Progression of hypercapnia and hypoxemia stimulates cerebral vasodilation, which initially causes an increase in cerebral blood flow followed by a decrease. Over time, cerebral autoregulation of blood flow is lost, a decrease in cardiac output occurs and, as a result, arterial hypotension, which worsens tissue metabolism, and this, in turn, increases lactic acidosis. A decrease in the intensity of metabolic processes allows the fetus to endure a long period of asphyxia. Adenosine, gamma-aminobutyric acid, and opiates are released, which help reduce oxygen consumption.

Prolonged hypoxia leads to inhibition of compensation mechanisms, increased permeability of capillaries and cell membranes, as a result of which hemoconcentration develops, intravascular blood clots form, and hypovolemia occurs. Hemorheological and tissue disorders lead to cardiac hypoperfusion, hypoxic-ischemic encephalopathy, and pulmonary hypertension. Due to energy deficiency and acidosis, the level of free radicals increases, which, in turn, can cause brain hypoperfusion through stimulation of leukotriene production and the formation of leukocyte thrombi, damage to cell membranes and cellular disintegration.

A possible consequence of asphyxia is the development of hypoxic-ischemic encephalopathy with partial loss of neurons, secondary deterioration of the condition against the background of court, edema and cerebral infarction, activation of microglia with subsequent production of “excited” glutamate, hydrogen peroxide, glial toxins that cause brain damage.

Apgar score

Classification. The condition of the newborn is assessed 1 and 5 minutes after birth using the V. Apgar scale (1950). Apgar scores of 8, 9, 10 at 1 and 5 minutes are normal. A score of 4, 5, 6 points in the first minute of life is a sign of moderate asphyxia, if by the fifth minute it reaches 7-10 points. Severe asphyxia is diagnosed in a child with an Apgar score of 0-3 points after 1 minute or less than 7 points after 5 minutes after birth. Now, according to many researchers, assessing the condition of a newborn using the Apgar scale is not decisive. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in 1992 proposed the following definition of severe birth asphyxia: profound metabolic or mixed acidosis (pH<7,00) в крови из пуповинной артерии; низкая оценка по Апгар (0-3 балла) после 5 мин реанимации; неврологическая симптоматика сразу после рождения ребенка (судороги, мышечная гипотония, кома) или признаки гипоксически-ишемической энцефалопатии (отсутствие дыхательных движений или их периодический характер; нестабильность температуры тела, отсутствие нейромышечных и нейросенсорных реакций, судороги течение первой суток жизни, развитие моторных нарушений конце первых 7 дн жизни). По нашему мнению, для определения степени тяжести интранатальной асфиксии большое значение имеет реакция новорожденного ребенка на реанимационные мероприятия. Степень тяжести асфиксии целесообразно уточнять после проведения полного объема реанимационной помощи.

Clinic. A child with moderate asphyxia after birth looks like this: there is no normal breathing during the first minute after birth, but the heart rate is 100 or more per minute; muscle tone is insignificant, the reaction to irritation is weak. The Apgar score 1 minute after birth is 4-6 points. "Blue asphyxia."

The child's condition after birth is usually of moderate severity. The child is often lethargic, physiological reflexes are suppressed. The cry is short and has little emotion. The skin is cyanotic, but with additional oxygenation it quickly turns pink. In the first hours of life, symptoms of hyperexcitability appear: hand tremors, irritated cry, frequent regurgitation, sleep disturbances, hyperesthesia.

Severe primary asphyxia after birth has the following manifestations: pulse less than 100 beats/min, breathing is absent or difficult, pale skin, atonic muscles. The Apgar score is 0-3 points. "White asphyxia."

If muscle tone, spontaneous motor activity, reaction to examination and pain stimulation are reduced or absent, then the child’s condition after birth is regarded as severe or very severe. Physiological reflexes of newborns are not evoked in the first hours of life. The color of the skin is pale or blidocyanotic and is restored to pink with active oxygenation (usually mechanical ventilation) slowly. Heart sounds are muffled, systolic murmur may appear. Physical findings over the lungs are variable. Meconium, of course, passes before or during labor.

Children born with severe asphyxia constitute a high-risk group for the development of hypoxic-ischemic encephalopathy or intracranial hemorrhages of hypoxic origin - intracranial or subarachnoid.

Diagnostics. The antenatal diagnosis algorithm includes the following activities:

A) monitoring the fetal heart rate - bradycardia and periodic decelerations of the fetal heart rate indicate hypoxia and impaired myocardial function;
b) ultrasonography - a decrease in motor activity, muscle tone and respiratory movements of the fetus is detected, i.e. the biophysical profile of the fetus changes;
c) biochemical testing - its data indicate antenatal problems.

Algorithm for intrapartum diagnosis:

Heart rate monitoring;
the presence of meconium in the amniotic fluid;
determination of pH and pO2 in blood taken from the skin of the fetal head;
d) determination of pH and pCO2 in arterial and venous blood from the umbilical vessels.

Postnatal diagnosis: Immediately after the birth of the baby, respiratory activity, heart rate, and skin color should be immediately assessed. If, after separation from the mother and the usual measures (drying, placing under radiant heat, drainage position, suction of secretions from the oropharynx), the child remains in a state of apnea, tactile stimulation should be performed. If there is no response, immediately begin artificial ventilation of the lungs with 100% oxygen for 15-30 s. If after this spontaneous breathing is not restored or the heart rate is less than 100 beats / min, it should be considered that the child was born in an asphyxial state.

Treatment. The only method of effective treatment that significantly improves the child’s condition and reduces the consequences of hypoxic-ischemic encephalopathy is adequate cardiopulmonary resuscitation.

The following materials are needed:

Sources of radiant heat and oxygen;
suction with pressure gauge;
breathing bag, children's face masks of different sizes;
laryngoscope with blades No. 0, 1; endotracheal tubes No. No. 2.5; 3; 3.5; 4;
umbilical cord catheters No. 8, 10;
medications: adrenaline hydrochloride, sodium bicarbonate, plasmorozshiryuvachi (5% albumin solution, isotonic sodium chloride solution, Ringeralactate solution), nalorphine.

Technique for primary neonatal resuscitation:

1. After the baby is born, to prevent hypothermia, it is necessary to place her under a source of radiant heat and dry her skin from amniotic fluid. Remove wet diapers.
2. The child's head should be slightly lowered, the neck slightly straightened. The health care worker performing resuscitation is positioned behind the child. Turn the newborn's head to one side.
3. To ensure airway patency, suck out mucus from the mouth, then from the nose (when suctioning the electrovid-smoktuvac, the negative pressure should be no more than 100 mm Hg), do not allow the catheter to be inserted deeply. The duration of suction is no more than 5-10 s. During the procedure, bring the oxygen source closer to the child’s face and monitor the heart rate (HR).
4. In case of severe asphyxia and deep aspiration of meconium, suck out the contents of the oropharynx immediately after the birth of the head. After separating the child from the mother, examine the larynx and trachea using direct laryngoscopy. If meconium is present, intubate the trachea using an endotracheal tube and suck out the contents. Start SHBL.
5. Immediately after the birth of the baby, immediately assess her respiratory activity; Heart rate (calculate in 6 s and multiply by 10); skin coloring.

If the heart rate is less than 60 beats/min, there is no breathing and the skin color is cyanotic, resuscitation should be started immediately. Dry the newborn, suck out mucus from the upper respiratory tract and begin mask ventilation using a breathing bag. If these measures are not effective, repeat suctioning of mucus from the upper respiratory tract and perform endotracheal intubation, followed by chest compressions.

When the heart rate is 60-100 beats/min, if breathing is ineffective, the skin color is cyanotic, you should wipe the newborn, suck out the mucus from the upper respiratory tract, and at the same time bring the oxygen source closer to the child’s face; if the condition does not improve, start mask ventilation using a breathing bag after 1 minute or even earlier if bradycardia persists. Begin tactile stimulation (light blows to the soles and rubbing the back), refraining from more vigorous actions. If heart rate is less than 80 beats/min, begin chest compressions.

If the heart rate is above 100 beats/min, you need to wipe the child; if there is cyanosis of the skin, bring the oxygen source closer to the face; if there is no effect, perform tactile stimulation for 2-3 s; if the heart rate drops to less than 100 beats / min - mask ventilation using a breathing bag.

When performing mask ventilation, the mask should cover the newborn's nose and mouth. The initial positive pressure on inspiration is 30-40 cm of water. Art. Pressure control is carried out with a pressure gauge (when compressing a breathing bag with a volume of up to 750 ml with one hand, the pressure created does not exceed 30 cm of water. Art.). Initial breaths should be long (0.5-1 s), the respiratory rate gradually increases to 40-60/min.

If, due to adequate ventilation, the child’s condition stabilizes and the heart rate is more than 100 beats / min, artificial ventilation can be stopped, but if, despite vigorous efforts, bradycardia persists, orotracheal intubation should be started.

Indirect cardiac massage is performed with both hands, placing the thumbs on the sternum just below the line connecting the nipples, clasping the chest with the remaining fingers. When performing chest compressions, avoid compression of the xiphoid process; the sternum should be lowered to a depth of 1.5-2 cm with a frequency of 90/min. If, despite ventilation of the lungs with 100% oxygen and chest compressions, bradycardia remains less than 80 beats/min, it is necessary to catheterize the umbilical vein and begin drug resuscitation in the following sequence:

1) if the condition does not improve, quickly administer intravenously adrenaline hydrochloride 1:10,000 at a dose of 0.1 ml/kg (0.1% solution of the drug is diluted in isotonic sodium chloride solution). An alternative may be endotracheal administration of adrenaline hydrochloride 1:10,000 dose of 0.1-0.3 ml/kg, additionally diluted in a syringe with isotonic sodium chloride solution in a 1:1 ratio;
2) if bradycardia persists below 80 beats/min, use a 5% albumin solution (plasma, Ringer-lactate solution) at a dose of up to 10 ml/kg intravenously slowly over 10 minutes;
3) sodium bicarbonate 4.2% solution at a dose of 4 ml/kg intravenously slowly at a rate of 2 ml/(kgmin), against the background of effective ventilation;
4) if the condition does not improve, repeat the administration of adrenaline hydrochloride 1:10,000 with a dose of 0.1-0.2 ml/kg. When carrying out medical resuscitation, it is necessary to monitor the adequacy of cardiac massage, the position of the endotracheal tube in the trachea, the flow of 100% oxygen into the breathing bag, the reliability of the connection of oxygen hoses, and the adequacy of pressure during ventilation of the lungs.

The newborn may be in a state of narcotic depression, in which case prolonged ventilation is necessary; administration of a 0.05% solution of nalorphine at a dose of 0.2-0.5 ml intravenously. The drug can be repeated at two-minute intervals, but the total dose should not exceed 1.6 ml.

If resuscitation measures do not lead to the appearance of spontaneous stable breathing within 30 minutes, the prognosis is always poor due to severe neurological damage. Therefore, it is justified to stop resuscitation measures after 30 minutes if there is no spontaneous breathing (provided that the child was given the opportunity to demonstrate it) and bradycardia persists.

Newborns who have suffered asphyxia require monitoring and post-resuscitation stabilization in the intensive care unit for at least 24 hours.

The main principles of treatment in the post-resuscitation period are: fluid restriction by 30-40% of physiological need; maintaining adequate perfusion and blood pressure, court treatment, ensuring adequate oxygenation (while monitoring the level of blood gases and acid-base status); correction of hypoglycemia (monitoring serum sugar levels); prevention and treatment of hemorrhagic complications.

Possible complications of asphyxia:

1) CNS: hypoxic-ischemic encephalopathy, cerebral edema, neonatal convulsions, intracranial hemorrhage (intraventricular, subarachnoid), which is most typical for premature infants, syndrome of impaired antidiuretic hormone secretion;
2) respiratory system: pulmonary hypertension, damage to the surfactant system, meconium aspiration, pulmonary hemorrhage;
3) excretory system: proteinuria, hematuria, oliguria, acute renal failure;
4) cardiovascular system: tricuspid valve insufficiency, myocardial necrosis, hypotension, left ventricular dysfunction, sinus bradycardia, rigid heart rhythm, shock;
5) metabolic disorders: metabolic acidosis, hypoglycemia, hypocalcemia, hyponatremia, hyperkalemia;
6) digestive system: necrotizing enterocolitis, liver dysfunction, gastric or intestinal bleeding, decreased tolerance to enteral load;
7) blood system: thrombocytopenia, disseminated intravascular coagulation syndrome, polycythemia.

Prevention. To prevent intrapartum asphyxia, you should:

Timely identify risk factors for the development of asphyxia;
adequately manage high-risk pregnant women;
timely diagnose and treat intrauterine fetal hypoxia;
monitor the condition of the fetus during childbirth, provide adequate management of labor

Forecast. Mortality in severe asphyxia, according to a follow-up study, reaches 10-20%, and the frequency of long-term psychoneurological complications is also high. Therefore, resuscitation measures are stopped after 15-20 minutes in the absence of spontaneous breathing and the presence of persistent bradycardia. The long-term prognosis for acute intrapartum asphyxia is better than for asphyxia of the newborn, which developed against the background of chronic intrauterine hypoxia.