Asphyxia consequences for the child. What is asphyxia of newborns: pulmonary and extrapulmonary causes of development, medical tactics

Insufficient supply of oxygen to the body is very dangerous for the normal functioning of all organs, tissues and cells. human body. And than longer man experiencing a lack of oxygen, the more pronounced Negative consequences may come. This condition is considered especially dangerous if we are talking about more developing organism- fetus or newborn baby. With acute shortage Oxygen babies can encounter directly at the time of birth. Let's talk about what neonatal asphyxia is, consider the consequences of such a violation and the degree of asphyxia on the Apgar scale, and also figure out how a newborn is resuscitated during asphyxia.

The term neonatal asphyxia refers to critical situation, which develops due to impaired gas exchange: due to oxygen deficiency and carbon dioxide accumulation. Such pathological condition makes itself felt by the lack of breathing or its weakness against the background of the safe work of the heart.

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

The degree of asphyxia of newborns according to the APGAR scale

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

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

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

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

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

What threatens asphyxia during childbirth, what are its consequences

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

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

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

Resuscitation of newborns with asphyxia

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

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

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

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

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

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

At present, asphyxia of a newborn is understood as his condition when, in the presence of a heartbeat, there is no breathing or there are separate convulsive, irregular, superficial breaths.

Asphyxia is divided into:

1) fetal asphyxia , which is subdivided into antenatal and intranatal;

2) asphyxia of a newborn .

At the core intrauterine asphyxia is a circulatory disorder, and the basis asphyxia of a newborn- respiratory disorders, which are often the result of intrauterine circulation disorders.

Asphyxia of the newborn, in addition, is divided on the primary when the born baby does not breathe on its own after ligation of the umbilical cord, and secondary- arising in the following hours and days of a newborn's life.

There are 5 leading mechanisms leading to acute asphyxia of newborns:

1) interruption of blood flow through the umbilical cord ( true knots of the umbilical cord, depression of it, tight entanglement of the umbilical cord around the neck or other parts of the child's body);

2) violation of gas exchange through the placenta ( premature complete or incomplete placental abruption, placenta previa, etc.);

3) circulatory disorders in the maternal part of the placenta ( excessively active contractions, arterial hypotension or hypertension of any etiology in the mother);

4) deterioration in oxygen saturation of the mother's blood ( anemia, cardiovascular disease, respiratory failure);

5) insufficiency of extrauterine respiratory movements of the newborn ( the impact of maternal drug therapy, antenatal lesions of the fetal brain, congenital malformations of the lungs, etc.).

Secondary hypoxia can develop due to aspiration, pneumopathy, birth trauma of the head and spinal cord, congenital malformations of the heart, lungs, brain.

Therefore, asphyxia- this is suffocation, acutely arising pathological process caused by various reasons, which are based on a lack of oxygen in the blood (hypoxemia) and tissues (hypoxia) and the accumulation of carbon dioxide (hypercapnia) and other acidic metabolic products in the body, which leads to the development metabolic acidosis. Underoxidized metabolic products circulating in the blood inhibit biochemical processes in cells and cause tissue hypoxia; body cells lose their ability to absorb oxygen. Pathological acidosis increases permeability vascular wall and cell membranes, which entails a circulatory disorder, a violation of blood coagulation processes, hemorrhages in various organs.

The vessels lose their tone and overflow with blood, the liquid part of the blood goes into the surrounding tissues, edema and dystrophic changes in the cells of all organs and systems.

Asphyxia of newborns - Clinic.

Basic clinical sign asphyxia- Impaired or absent breathing. The degree of asphyxia is determined by the Apgar scale. According to the International Classification of Diseases IX Revision (Geneva 1980) distinguish asphyxia: moderate (moderate) and severe.

In the case of moderate asphyxia the total Apgar score at the 1st minute is 4-6 points, but by the 5th minute it usually reaches values characteristic of healthy children (8-10 points).

severe asphyxia is diagnosed in a child with an Apgar score of 0-3 points 1 minute after birth and less than 7 points 5 minutes after birth.

The Apgar score is performed at the end of the 1st and 5th minutes after birth. If after 5 minutes the total score has not reached 7 points, it must be done every 5 minutes until normalization or within 20 minutes.

Apgar score

Asphyxia of newborns - Treatment.

Asphyxia is a critical condition that requires urgent resuscitation. The need for these events is judged by the presence of signs of a live birth in a child:

Independent breathing.
Palpitation.
Pulsation of the umbilical cord.
active movements.

In the absence of all 4 signs of a live birth, the child is considered stillborn and is not subject to resuscitation. If there is at least 1 sign, it is necessary to provide resuscitation assistance.

Removal from asphyxia requires the use of generally accepted resuscitation principles formulated by P. Safar (1980) as ABS resuscitation, where: A - airway - release, maintaining free airway patency; B - breath - breathing, providing ventilation - artificial (IVL) or auxiliary (IVL); C- cordial circulation restoration or maintenance of cardiac activity and hemodynamics.

In the delivery room or near it around the clock should be ready to help the newborn "island of resuscitation, which consists of several blocks:

1) optimization block environment and temperature protection - a heated table, a source of radiant heat, sterile warm diapers;

2) a block for restoring airway patency - an electric suction pump, rubber bulbs, oral air ducts, endotracheal tubes, a children's laryngoscope;

3) oxygen therapy unit - a source of compressed air, an installation for humidifying and heating the air-oxygen mixture, a set of connecting tubes and devices for introducing oxygen;

4) block of artificial lung ventilation (breathing bag type Ambu, devices for automatic lung ventilation);

5) block of drug therapy - disposable syringes, gloves, sets of medicines, sets of catheters for the umbilical vein;

6) vital activity control unit - a heart monitor, a device for measuring blood pressure, stopwatch, phonendoscope.

The primary care algorithm for a newborn born in asphyxia includes several stages.

I stage of resuscitation begins with the suction of the contents of the oral cavity with a catheter at the time of the birth of the head or immediately after the birth of the child. If the child does not breathe after sucking from the oropharynx, gentle but active tactile stimulation should be performed - flick the child on the sole or vigorously wipe his back. The child is taken in sterile heated diapers, quickly transferred to the resuscitation table under a source of radiant heat. When laying down, the head end of the child should be slightly lowered (by about 15 °).

Amniotic fluid, mucus, sometimes maternal blood is wiped from the baby's skin with a warm diaper. In severe asphyxia and the presence of meconium in the amniotic fluid or oropharynx, immediate intubation is carried out, followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby after 1 minute. At the end of stage I of resuscitation, the duration of which should not exceed 20-25 seconds, the child's breathing is assessed. With adequate breathing, a heart rate above 100 per minute and a slight acrocyanosis of the skin, resuscitation is stopped, and the child is monitored. If possible, we should strive to start feeding the baby with mother's milk as early as possible.

If the heart rate is less than 100 per minute, then go to II stage of resuscitation whose task is to restore external respiration. Activities begin with ventilation with a mask and breathing bag. The respiratory rate is 30-50 per minute. More often, a 60% oxygen-air mixture is used (in premature babies, 40%). Good excursions chest indicate sufficient ventilation of the alveoli, as well as the absence of serious violations of the airway. Failure of bag and mask ventilation, suspected meconium aspiration, less than 80 h, and the need for external cardiac massage and prolonged respiratory support are indications for endotracheal intubation.

Simultaneously with ventilation stimulate breathing intravenous administration nalorphine or etimizole. 20-30 seconds after the start of mechanical ventilation, it is necessary to calculate the frequency of heart rate, if it is in the range of 80-100 per minute, continue mechanical ventilation until the frequency increases to 100 per minute.

If the heart rate is less than 80 per minute, then go to III stage of resuscitation. It is urgent to start an external heart massage against the background of mechanical ventilation with a mask with 100% oxygen concentration. If there is no effect within 20-30 seconds of massage, intubate and start mechanical ventilation in combination with massage. Press on the lower third of the sternum (but not on the xiphoid process due to the risk of liver rupture) strictly down 1.5-2.0 cm with a frequency of 100-140 times per minute.

Evaluate the effectiveness of indirect heart massage by skin color and pulse on the femoral artery.

If there is no effect within 60 seconds of cardiac massage, then cardiac activity should be stimulated with adrenaline, which is administered at a dose of 0.1 ml / kg of body weight of a 0.01% solution either endotracheally or into the umbilical cord vein. The introduction can be repeated after 5 minutes (up to 3 times). Simultaneously continue IVL and indirect massage hearts. Then evaluate the color skin and microcirculation. According to the indications, infusion therapy is carried out (albumin, native plasma, isotonic solution sodium chloride). If necessary, planned infusion therapy it starts 40-50 minutes after birth. It is very important to remember that the rate of infusion therapy is much more important than the volume. All children born with asphyxia in the delivery room are given vitamin K. In case of very serious condition after initial resuscitation and slow recovery of vital important functions transfer to the neonatal intensive care unit of the children's hospital is desirable.

If within 15-20 minutes the child does not have spontaneous breathing and persistent bradycardia persists, then there is a high probability of severe brain damage, and it is necessary to decide on the termination of resuscitation.

Neonatal asphyxia - Complications.

There are two groups of complications- early, developing in the first hours and days of life, late - from the end of the first week of life and later.

Among early complications, in addition to brain damage (edema, intracranial hemorrhage, necrosis, etc.), hemodynamic ( pulmonary hypertension, heart failure), renal, pulmonary, gastrointestinal, hemorrhagic (anemia, thrombocytopenia, DIC). Late complications are dominated by infectious (pneumonia, meningitis, sepsis) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy).

Asphyxia of newborns- a complication that develops in the early postpartum period. This pathology accompanied by a violation of the process of breathing and work of cardio-vascular system at the baby. 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 reasons causing pathology, can be directly related to the process of delivery and with the features prenatal development fetus. Among the main pathological factors that cause asphyxia, doctors distinguish:

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

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

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 violation, physicians 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, conducting tactile stimulation (stroking the back, patting the heels) and oxygen therapy through the mask, the condition of the newborn is normalized.

A child born in the state moderate asphyxia, has no further breathing problems. 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. characteristic feature This form is a change in the color of the skin, so it is often referred to as blue asphyxia of newborns. Breathing movements are isolated, 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 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 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 connects to the device artificial respiration. At the same time, drugs are injected into the umbilical cord that stimulate cardiac activity. Such babies long time are on machine breathing, and subsequently severe neurological disorders develop, a delay in neuropsychic development is possible.

Clinical death of a newborn

Clinical death of an infant occurs when doctors record complete absence 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.

At medium degree The severity of asphyxia doctors record:

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

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

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

Asphyxia of newborns - consequences

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

Asphyxia in a newborn after childbirth - consequences

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

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 his birth. Problems can appear in a few months, and sometimes even years. Late complications include:

meningitis;
pneumonia;
sepsis.

Treatment of asphyxia in newborns

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

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

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

What is it

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

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

Asphyxia may develop different forms, different conditions, as well as on different stages pregnancy and the birth of a baby.

In order to understand what measures to take, and whether it is worth fearing the consequences, you need to study all possible reasons asphyxia - it will help expectant mother behave more carefully.

Causes

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

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

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

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

Effects

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

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

There is also a group of late complications, including general brain damage, impaired blood supply, convulsive syndrome, and colds.

Signs and forms

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

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

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

Treatment and care after

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

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

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

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

Video "Asphyxia - what is it?"

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

Asphyxia of the newborn is a condition of the pathology of the newborn, which is caused by violations of the respiratory apparatus with the resulting lack of oxygen.

Primary asphyxia that occurred at the birth of a child and secondary, occurring during the first hours and days of life of newborns, is revealed.

Causes of asphyxia

The causes of primary asphyxia of the newborn are acute and chronic oxygen deficiency in the womb. It includes:

intracranial injury;
immunological incompatibility of the blood of the fetus and mother;
various intrauterine infections;
the presence of complete or partial impossibility of the functioning of the respiratory tract of the fetus or newborn due to overflow with amniotic fluid (aspiration asphyxia), as well as mucus;
the presence of fetal malformations.

Asphyxia of newborns occurs due to extragenital diseases of the pregnant woman:

cardiovascular pathologies in the stage of decompensation;
diseases of the respiratory apparatus and lungs in severe forms;
anemia;
diabetes mellitus of various types;
thyrotoxicosis;
all kinds of infectious diseases.

The causes of asphyxia in newborns are also often called late toxicosis of a pregnant woman, pregnancy in the stage of postmaturity, premature detachment of the placenta, pathology of the placenta, membranes and umbilical cord. In the presence of complications in childbirth, such as early rupture of amniotic fluid, anomalies in labor activity of a pregnant woman, incorrect positions of the fetal head, discrepancies in the size of the pelvic section of the woman in labor and the fetal head, the possibility of newborn asphyxia is not excluded. In case of violation cerebral circulation in a newborn, pneumopathy and other diseases, secondary asphyxia occurs.

The body of a newborn, despite the cause of asphyxia, will undergo a restructuring of all metabolic processes from oxygen deficiency. Hemodynamics and microcirculation are part of the restructuring in the body of the fetus. The longer and more intense the hypoxia, the more pronounced and brighter the picture of changes. There is a development of metabolic and respiratory-metabolic acidosis, which is accompanied by manifestations of hypoglycemia, azotemia and hyperkalemia, then this process is replaced by potassium deficiency. Cellular overhydration begins as a result of electrolyte imbalance and metabolic acidosis. The volume of circulating erythrocytes in the event of acute hypoxia provokes an increase in the volume of circulating blood.

Hypovolemia accompanies asphyxia of the newborn, which develops when chronic course fetal hypoxia. The ability of erythrocytes and platelets to aggregate increases, the blood gradually thickens, its viscosity increases. The brain, heart, kidneys, adrenal glands and liver of a newborn after a microcirculatory disorder suffer edema, hemorrhage and ischemia, tissue hypoxia of the newborn develops. Central and peripheral hemodynamics are accompanied by a decrease in stroke and minute volumes of the heart, sharp drop blood pressure. The urinary function of the kidneys is impaired due to disorders of metabolism, hemodynamics and microcirculation.

Symptoms of asphyxia

The main symptom of asphyxia of the newborn is a violation respiratory function, which leads to changes in cardiac activity, disorders of neuromuscular conduction and reflex activity organs. The Apgar score is an indicator of the severity of neonatal asphyxia. The International Classification of Diseases of the 9th revision provides for 2 stages of asphyxia of the newborn - the stage of moderate and severe asphyxia (the first minute after birth reveals 7-4 and 3-0 points on the Apgar scale). Clinical practice distinguishes three degrees of severity of asphyxia of the newborn:

mild (7-6 points on the Apgar scale);
asphyxia of moderate severity (5-4 points, respectively);
severe (Apgar scale has 3-1 points);

Clinical death is diagnosed with general assessment at 0 points. Light degree severity manifests itself in the first breath in the first minute of life: weakened breathing, acrocyanosis and cyanosis of the nasolabial triangle, a slight decrease in muscle tone. The average severity indicates the presence of the first breath in the first minute after birth: weakened breathing (both regular and irregular), the presence of a weak cry of the newborn, bradycardia, tachycardia are noted, muscle tone and reflexes are reduced, the skin of the newborn is cyanotic (mainly the face area , hands and feet), pulsating umbilical cord. A severe degree of asphyxia of the newborn is manifested in irregular separate breaths, or in their absence, the silence of the child (groans are possible), slow heartbeat, which may be accompanied by a single irregular contraction of the heart, muscle hypotension and atony. In this case, reflections are not observed, that is, they are absent. Spasm of peripheral vessels causes pallor of the skin, there is no pulse in the umbilical cord, the development of adrenal insufficiency occurs in most cases.

In newborns who suffered asphyxia in the first hours and days of life, the development of posthypoxic syndrome is noted, its main lesion is the central nervous system. 1-2 degree cerebrovascular accidents are detected in 1 out of 3 children who suffered asphyxia at the time of birth. Severe asphyxia suffered by children, as a rule, gives rise to the development of disorders of liquorodynamics and cerebral circulation of 2-3 degrees. The formation of hemodynamics and microcirculation is disturbed due to oxygen deficiency and in disorders of the functions of the external respiratory apparatus. As a result, fetal communications are preserved - the arterial (botallian) duct is open, spasm of the pulmonary capillaries leads to an increase in pressure in the area of the pulmonary circulation, the right region of the heart is overloaded, the foramen ovale remains open. In the lungs, atelectases and hyaline membranes are detected.

Cardiac activity also notes the following disorders: muffled tones, extrasystolic picture, detection arterial hypotension. Hypoxia and reduced immune defense cause microbial colonization of the intestine, that is, the occurrence and development of dysbacteriosis.

The first 5-7 days of a child's life show the persistence of metabolic disorders, which manifest themselves in the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance, potassium deficiency in children's body. 2-3 days of life baby is coming development of edematous syndrome due to impaired renal function and with sharp decline diuresis.

In the first minutes of a newborn's life, when determining the degree of respiratory function disorders, as well as changes in heart rate, muscle tone, reflex function, skin color, the diagnosis of asphyxia and its severity are determined. The acid-base state indicates the severity of asphyxia suffered by the child.

A healthy newborn has:

pH-blood, which is taken from the umbilical cord - 7.22-7, 36;
BE - (base deficiency) - 9-12 mmol / l;

Light asphyxia and its indicators:

pH-blood - 7.19-7.11;
BE - 13-18 mmol/l;

Severe asphyxia and its indicators:

pH-blood - less than 7.1;
BE - 19 mmol/l and more;

Hypoxic and traumatic lesions central nervous system detected during a thorough neurological examination and ultrasound examination of the brain. A hypoxic lesion of the central nervous system begins, focal neurological symptoms cannot be detected, a syndrome of increased neuro-reflex excitability develops. In severe cases, a syndrome of depression of the central nervous system is possible. In newborns with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhage, etc.), in the first moments of life, hypoxemic vascular shock occurs, accompanied by spasm of peripheral vessels, the skin is pale, hyperexcitability is also noted, often there are focal neurological disorders and convulsive syndromes which appear in the first moments after birth.

Treatment and care for asphyxia

Newborns in an asphyxial state cannot do without the help of resuscitation. Efficiency resuscitation care is the timely initiation of treatment. Resuscitation activities and assistance to newborns with asphyxia are beginning to be carried out in the maternity room. The control of the main parameters of human life must be observed: respiratory capabilities and their frequency, blood pressure indicators, hematocrit and acid-base states.

Immediately after the birth of the child, the doctor, using a soft catheter and an electric suction, carefully removes all excess from the upper respiratory tract (tees are used that create intermittent air rarefaction), the umbilical cord is cut off immediately. The child is placed under heat sources on the resuscitation table. The nasal passages, oropharynx, stomach contents are aspirated again here. In the diagnosis of mild asphyxia, the child is placed in the knee-elbow position, he is prescribed inhalation of a 60% oxygen-air mixture, cocarboxylase (8 mg / kg) and 10-15 ml of 10% glucose solution are injected into the umbilical vein. With asphyxia of moderate severity, the newborn is shown artificial ventilation of the lungs with a mask to normalize respiratory capacity. As the restored regular breathing and coloration of the skin integuments occur, pink color(duration 2-3 minutes), oxygen therapy is continued by inhalation measures. Any method of oxygen therapy involves humidified and heated oxygen. Cocarboxylase is injected into the umbilical vein at the same dose as prescribed for mild asphyxia.

With a severe degree of asphyxia, after the umbilical cord is cut off and the contents of the upper respiratory tract of the newborn are removed, tracheal intubation measures are started with the control of direct laryngoscopy and artificial ventilation of the lungs until full recovery regular breathing (resuscitation measures stop after 15-20 minutes of the child's life without a single breath and in the presence of a heartbeat).

After the restoration of breathing, the child is transferred to the ward in the neonatal unit (intensive care).

Caring for such a newborn is of particular importance. Peace is provided immediately, the head is placed on a hill. At diagnosis mild asphyxia the child is placed in an oxygen tent. In the incubator there are children diagnosed with moderate and severe asphyxia. Removal of residual mucus from the oropharynx and from the stomach is often carried out. The child's temperature, diuresis, and bowel function are monitored. After 12-18 hours, the child is prescribed the first feeding with expressed breast milk(diagnosis of mild and moderate asphyxia). In severe asphyxia of newborns, feeding occurs every other day using a probe.

Consequences of asphyxia

In the first year of life of a child who has undergone asphyxia of a newborn, the following consequences are observed:

hypo- and hyperexcitability syndrome;
hypertensive-hydrocephalic, convulsive, diencephalic disorders.