Asphyxia at birth. Newborn asphyxia: a life-threatening condition

I didn’t ask her then about such a term that I didn’t understand, it was awkward after all. But such a diagnosis aroused my interest - what you don’t learn in the maternity hospital and from first-time mothers. Let's now understand together what asphyxia is.

The diagnosis of asphyxia itself is a pathology. It is caused by respiratory failure (that is, a certain oxygen deficiency appears). It usually occurs during childbirth or immediately after the birth of a child (namely: from the first minutes of a newborn’s life or in the next couple of days after birth).

Asphyxia is characterized by changes metabolic processes. These changes manifest themselves in different ways, depending on what degree of asphyxia was detected and how long it lasts.

2. What causes asphyxia

The reasons for the appearance of such pathology are not so diverse. Let's start with the fact that asphyxia can be primary and secondary.

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2.1. Primary asphyxia

This pathology occurs during the birth of a child. It is often caused by intrauterine hypoxia (lack of oxygen).

However, there is also other reasons that can cause this disease:

• skull injury (or intracranial injury);
• a defect associated with the development of the baby (a defect that has a direct connection with breathing);
• immunological “mother-baby” connection (that is, incompatibility of mother and child for medical reasons, for example, the Rh factor);
• congestion of the respiratory tract (during the birth process, the child’s respiratory tract may become clogged with amniotic fluid or mucus);

Moreover, this pathology may be due to maternal diseases:

• heart disease;
• mother's diagnosis diabetes»;
• disruption of tissue structure;
• iron deficiency in the body (here - insufficient hemoglobin level);
• toxicosis (we mean its manifestation in the last trimester, here: swelling and increased pressure);
• other reasons (placental abruption, earlier release of water, incorrect direction of the baby’s head at birth, etc.).

2.2. Secondary asphyxia

This pathology occurs immediately after the birth of the baby. Usually in the first few days of a child's life.

The most common causes secondary asphyxia it is generally accepted:

• pneumopathy (we are talking about lung diseases that are not associated with infection);
• various heart defects;
• problems with blood circulation in the brain;
• central lesion nervous system;
• other reasons (to be determined by the doctor on an individual basis).

3. What are the signs of asphyxia

The main symptom of this pathology is respiratory disorders. Moreover, this threatens serious changes in the natural functioning of the body.

Both women who have given birth and those who have not given birth know very well that immediately after birth, the child is examined by specialists. This is necessary in order to detect possible defects in the child and try to eliminate them (or, conversely, to refute the presence of pathologies in the baby).

A newborn must be checked:

• breathing (especially if the baby did not cry after birth);
• heartbeat (in beats per minute);
• complexion and body in general;
• muscle tone;
• reflexes.

4. Features of diagnosing asphyxia

The child’s condition is usually assessed on a ten-point scale. Young mothers may notice an entry in the baby’s chart: “Apgar score.”

Depending on the form of asphyxia, a certain score is assigned. There are four degrees of this disease:

4.1. Mild degree

After birth, the baby must immediately take its first breath. Often, immediately after the sigh, the baby’s cry is heard (usually it is at this moment that the mother sighs with relief and begins to cry, not believing her happiness).

At mild degree Asphyxia, the sigh may be weakened, not inspiring strong confidence. In this case, the health of the newborn is given a mark of 6-7 points on the Apgar scale.

4.2. Average degree

When a baby takes his first breath, chances are it won't happen instantly, but within one minute.

As with a mild degree, the baby’s breathing will be weak and there may be no screaming.

The baby's limbs and face will have a slightly bluish tint.

Muscle tone in the newborn and symptoms inherent in pulmonary diseases. Rating of this condition in points: 4-5.

4.3. Severe degree

After birth, the baby does not begin breathing immediately or may not be able to breathe at all. However, the child shows signs of life (not by screaming, but by weak moaning or mooing).

Also, the newborn has an infrequent heartbeat and no manifestation of unconditioned reflexes.

The body has a pale tint. There is no pulsation in the umbilical cord. This condition of the child is estimated at 1-3 points on the Apgar scale.

4.4. Critical degree

In this case, the child shows no signs of life at all. They try to “awaken” the baby already in intensive care, taking all the necessary actions. Apgar score: 0 points.

However, an initial examination is not enough to make a definitive diagnosis; therefore, other procedures are also carried out to identify pathology:

• newborn blood test;
• ultrasound examination of the brain;
• neurological examination;
• other (individual appointments for a separate child).

With the help of such diagnostics, it is possible to determine the presence (or absence) of damage to the central nervous system.

In any case, if asphyxia is noticed, the newborn needs emergency care.

5. How to treat asphyxia

I think that any mother understands that asphyxia is not a disease that can be treated without the help of a specialist. The only thing that depends on the parent is “monitoring” the child’s condition. That is, it will be necessary to pay considerable attention to the child’s breathing, heart rate and hematocrit (don’t panic, this is one of the lines in general analysis blood).

Regarding professional help:

1. At the birth of the baby (more precisely, immediately after the appearance of the head), the doctor will insert a probe (in other words, a tube) into the nasal and oral cavity. This is necessary to clear clogged Airways from mucus and amniotic fluid.
2. Next, the umbilical cord is tied.
3. After this, the baby is taken to the intensive care unit to repeat manipulations to cleanse the respiratory tract (including the nasopharynx and stomach).

Once the newborn’s breathing is established, the procedures will not end. The baby will have to undergo therapy aimed at eliminating the effects of asphyxia.

6. Is post-procedure care required?

Of course yes! How could it be different? After all measures to eliminate asphyxia have been taken, the child needs care. The newborn is transferred to the so-called “oxygen ward” and while the baby is in the maternity hospital, all procedures will be carried out by a doctor. The length of stay in such a “room” is unknown and is determined based on the condition of the newborn.

The baby is closely monitored, because it is important to monitor his body temperature, intestinal condition, and so on. Moreover, it will be possible to feed the baby no earlier than 16 hours after birth.

However, even after discharge from the maternity hospital, you should never stop monitoring the child’s health. The newborn should be under close medical supervision.

7. Consequences of asphyxia

Usually the consequences appear only after severe or critical asphyxia and the most common complications are:

• hydrocephalic syndrome (brain damage);
• diencephalic syndrome (a complex of different disorders);
• convulsive syndrome;
• motor restlessness (sleep disturbance here, etc.);
• other complications.

8. Precautions

For prevention purposes, mothers need to monitor their health not only during pregnancy, but also long before conception. It is important to register for pregnancy management at the earliest early stages and is constantly under medical supervision.

Also, it is very important for a woman to lead healthy image life, which means that being in a position to the expectant mother need to:

• spend more time outdoors;
• maintain a daily routine;
• take vitamins prescribed by your doctor;
• do not be nervous and remain calm in any situation;
• get enough sleep;
• don't get overtired.

Well, now we have dealt with such a pathology as asphyxia. But I want to reassure you right away - there is no need to panic if your newborn has been diagnosed with this. Thanks to modern medicine The disease is eliminated in the first minutes of your baby’s life and most often does not entail any complications.

You can watch a video webinar on how to reduce the risk of asphyxia in a child here:

According to medical statistics, about 10% of children need active assistance medical personnel from the very first minute of birth, in order to actively scream, breathe regularly and effectively, restore heart rate and adapt to new unusual living conditions. Among premature infants, the percentage of those in need of such help is even greater. The most a big problem– asphyxia.

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Asphyxia of newborns is suffocation, manifested by impaired breathing, or lack of spontaneous breathing in the presence of heartbeat and other signs of life. In other words, the baby is unable to breathe on its own immediately after birth, or it breathes but its breathing is ineffective.

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

A child born with asphyxia is serious problem for doctors providing assistance in maternity ward. Around the world, about a million children die each year from asphyxia, and about the same number of children experience serious complications afterwards.

Asphyxia of the fetus and newborn occurs with hypoxia (decreased oxygen concentration in tissues and blood) and hypercapnia (increased carbon dioxide content in the body), which is manifested by severe respiratory and circulatory disorders and disruption of the child’s nervous system.

Causes of newborn asphyxia

Factors contributing to the development of asphyxia

There are antenatal and intranatal factors.

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

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

Intranatal factors affect the child during childbirth.

Intranatal factors include various complications that arise immediately at the moment of birth (rapid or protracted labor, placenta previa or premature placental abruption, labor anomalies).

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

Causes of asphyxia

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

1. Insufficient cleansing of toxins from the maternal part of the placenta as a result of low or high pressure in the mother, excessively active contractions, or for other reasons.
2. A decrease in the concentration of oxygen in the blood and organs of the mother, which may be caused by severe anemia, respiratory failure or of cardio-vascular system.
3. Various pathologies of the placenta, as a result of which gas exchange through it is disrupted. These include calcifications, placental previa or premature placental abruption, inflammation of the placenta and hemorrhages into it.
4. Interruption or disruption of blood flow to the fetus through the umbilical cord. This occurs when the umbilical cord wraps tightly around the baby's neck, when the umbilical cord is compressed while the baby passes through the birth canal, or when the umbilical cord prolapses.
5. Insufficient respiratory efforts of the newborn due to the depressing effect of drugs on the nervous system (a consequence of the mother’s treatment various medications), as a result of severe malformations, in case of prematurity, due to the immaturity of the respiratory organs, due to a violation of the flow of air into the respiratory tract (blockage or compression from the outside), as a result of birth injuries and severe intrauterine infections.

A special risk group for the development of asphyxia consists of premature babies whose birth weight is extremely low, post-term babies and children who have a delay intrauterine development. These children have the highest risk of developing asphyxia.

Most children who are born with asphyxia experience a combined effect of ante- and intranatal factors.

Today, among the causes of chronic intrauterine hypoxia, maternal drug addiction, substance abuse and alcoholism are not the least important. The number of pregnant women who smoke is progressively increasing.

Smoking during pregnancy causes:

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

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

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

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

Before birth, the lungs of a full-term fetus secrete fluid that enters the amniotic fluid. Fetal breathing is shallow and the glottis is closed, so when normal development amniotic fluid cannot enter the lungs.

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

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

Causes of breathing problems not related to the lungs include the following conditions:

1. Nervous system disorders: developmental abnormalities of the brain and spinal cord, effect of drugs and drugs, infection.
2. Cardiovascular system disorders. These include malformations of the heart and blood vessels, fetal hydrops.
3. Developmental defects gastrointestinal tract: esophageal atresia (blindly ending esophagus), fistulas between the trachea and esophagus.
4. Metabolic disorders.
5. Impaired function of the adrenal glands and thyroid gland.
6. Blood disorders such as anemia.
7. Improper development of the respiratory tract.
8. Congenital malformations of the skeletal system: malformations of the sternum and ribs, as well as rib injuries.

Types of newborn asphyxia

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

According to the degree of severity, they are distinguished:

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

Neonatologists assess the condition of the newborn baby using the Apgar score, which includes assessment of breathing, heartbeat, muscle tone, skin color and reflexes of the newborn. The newborn's condition is assessed in the first and fifth minutes of life. Healthy children score 7 - 10 points on the Apgar scale.

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

Mild asphyxia

Manifests itself as cardiorespiratory depression. This is depression of breathing or heart rate as a result of the stress the baby feels during the transition from intrauterine life to the outside world.

Childbirth is a tremendous stress for a child, especially if any complications arise. At the same time, in the first minute of life, the baby receives an Apgar score of 4-6 points. As a rule, for such children it is enough to create optimal conditions environment, warmth and temporary breathing support, and within five minutes the child is restored, he is given 7 points and above.

Moderate asphyxia

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

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

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

With severe asphyxia, the child reacts poorly to examination or does not react at all, while the child’s muscle tone and movements are weak or absent at all. Skin color is bluish-pale or simply pale. It turns pink slowly after breathing oxygen, the skin takes a long time to restore its color. Heartbeat is muffled. Breathing is unrhythmic, irregular.

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

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

Asphyxia and hypoxia. Differences in manifestations in newborns

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

The characteristics of children born with asphyxia, who suffered prolonged hypoxia in utero, are presented below.

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

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

TO early complications The following conditions include:

1. Damage to the brain, which is manifested by edema, intracranial hemorrhage, and death of parts of the brain due to lack of oxygen.
2. Disruption of blood flow through the vessels of the body, which manifests itself as shock, pulmonary and heart failure.
3. Kidney damage, manifested by renal failure.
4. Lung damage, manifested by pulmonary edema, pulmonary hemorrhage, aspiration and pneumonia.
5. Damage to the digestive organs. The intestines suffer the most, their motility is impaired, as a result of insufficient blood supply, some parts of the intestines die, and inflammation develops.
6. Damage to the blood system, which is manifested by anemia, a decrease in the number of platelets and bleeding from various organs.

TO late complications The following conditions include:

1. When infections occur, meningitis (inflammation of the brain), pneumonia (pneumonia), and enterocolitis (inflammation of the intestines) develop.
2. Neurological disorders (hydrocephalus, encephalopathy). The most serious neurological complication is leukomalacia - damage (melting) and death of parts of the brain.
3. Consequences of excessive oxygen therapy: bronchopulmonary dysplasia, retinal vascular damage.

Resuscitation of newborns with asphyxia

The condition of children born with asphyxia requires resuscitation care. Resuscitation is complex medical events, aimed at reviving, resuming breathing and heart contractions.

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

• "A" means establishing and maintaining airway patency;
• "B" stands for breath. It is necessary to restore breathing using artificial or assisted ventilation;
• “C” means to restore and maintain heart contractions and blood flow through the vessels.

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

1. Readiness of medical personnel. Ideally, assistance should be provided by two people who have the appropriate skills and know how the pregnancy and childbirth proceeded. Before labor begins, nursing staff should check that equipment and medications are ready to provide care.
2. The readiness of the place where the child will receive assistance. It must be specially equipped and located directly in the delivery room or in close proximity to it.
3. Providing resuscitation in the first minute of life.
4. Stages of resuscitation according to the “ABC” system with assessment of the effectiveness of each stage.
5. Caution when administering infusion therapy.
6. Observation after relief of asphyxia.

Restoration of breathing begins as soon as birth canal the head appears, with suction of mucus from the nose and mouth. Once the baby is fully born, it needs to be warmed up. To do this, it is wiped, wrapped in heated diapers and placed under radiant heat. There should be no draft in the delivery room; the air temperature should not drop below 25 ºС.

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

If the baby screams, he is placed on his mother's stomach. If the baby is not breathing, breathing is stimulated by wiping the baby's back and patting the baby's soles. In case of moderate and severe asphyxia, breathing stimulation is ineffective, so the child is quickly transferred to radiant heat and artificial ventilation lungs (ventilator). After 20 - 25 seconds, look to see if breathing appears. If the child’s breathing has resumed and the heart rate is above 100 per minute, resuscitation is stopped and the child’s condition is monitored, trying to feed the child with breast milk as soon as possible.

If there is no effect from mechanical ventilation, the contents of the oral cavity are sucked out again and mechanical ventilation is resumed. If there is no breathing during mechanical ventilation for two minutes, tracheal intubation is performed. A hollow tube is inserted into the trachea to provide air to the lungs, and the child is connected to an artificial respiration apparatus.

If there is no heartbeat or the contraction rate decreases to less than 60 per minute, begin indirect massage hearts, continuing mechanical ventilation. The massage is stopped if the heart begins to beat on its own. If there is no heartbeat for more than 30 seconds, the heart is stimulated with drugs.

Prevention of asphyxia in newborns

All measures to prevent asphyxia come down to timely identification and elimination of the causes of fetal hypoxia in a pregnant woman.

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

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

Conclusion

Treatment of children who have suffered asphyxia, up to full recovery- quite long.

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

The prognosis largely depends on the severity of brain damage caused by hypoxia. The more the brain is affected, the more likely it is fatal outcome, the risk of complications and a longer period of complete recovery. Premature babies have a worse prognosis than babies born full term.

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 ( hypertonic disease, diseases of the heart, lungs, kidneys, 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 circulation (influence drug therapy in the mother, maternal drug addiction, birth defects development 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. The progression of hypercapnia and hypoxemia stimulates cerebral vasodilation, which initially causes an increase cerebral blood flow with its subsequent decrease. Over time, cerebral autoregulation of blood flow is lost, resulting in a decrease cardiac output and, as a consequence, arterial hypotension, which worsens tissue metabolism, and this, in turn, increases lactic acidosis. Reducing the intensity of metabolic processes allows the fetus to tolerate a long period asphyxia. Adenosine, gamma-aminobutyric acid, and opiates are released, which help reduce oxygen consumption.

Prolonged hypoxia leads to inhibition of compensation mechanisms, increased capillary permeability 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, 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

Signs	Balls
Heart rate (per 1 min)	Not defined	Less than 100	100 or more
Breathing effort	Missing	Slow, irregular
Muscle tone	Missing	Slight flexion of limbs	Active movements
Reflex reaction			Cough or sneeze
	Blue, pale	Pink body, limbs blue	Fully pink

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.

The birth of a long-awaited child is always a joyful event, but childbirth does not always have a positive outcome not only for the mother in labor, but also for the newborn itself. One common complication is fetal asphyxia during childbirth. A similar complication is recorded in 4-6% of barely born babies, and some researchers talk about 6-15% of cases.

Definition of asphyxia at birth

Asphyxia is translated from Latin as “suffocation, or lack of oxygen.” Fetal asphyxia is commonly called a pathological condition in which there is a disturbance in the process of gas exchange in the baby’s body. This process is accompanied by the accumulation of carbon dioxide and a lack of oxygen in the tissues of the newborn.

In the presence of such a complication, a child born with signs of a live birth makes isolated, convulsive, superficial and irregular respiratory movements in the presence of a heartbeat or cannot breathe independently within the first minute after birth. Such children are subject to immediate resuscitation measures, and the prognosis in this case depends on the quality and timeliness of resuscitation measures and the severity of asphyxia.

Classification of asphyxia in newborns

Depending on the time of occurrence, two forms of asphyxia are distinguished:

immediately after the birth of the baby, primary asphyxia develops;

secondary - diagnosed during the first 24 hours after birth (in other words, initially the child was breathing normally, but then asphyxia occurred).

According to the degree of clinical manifestations (severity) there are:

severe asphyxia;

asphyxia of moderate severity;

asphyxia of mild severity.

Factors that provoke the development of asphyxia

This pathological condition is usually classified not as an independent disease, but as a complication of pregnancy, diseases of the fetus and the woman. Among the causes of asphyxia are:

Fruit factors:

malformations of the brain and heart of the fetus;

airway obstruction (meconium, amniotic fluid, mucus) or aspiration asphyxia;

intrauterine growth restriction;

prematurity;

intrauterine infections;

anomalies in the development of organs of the bronchopulmonary system;

Rhesus conflict pregnancy;

birth injury in a child (traumatic brain injury).

Maternal factors:

infectious diseases;

taking medications that are contraindicated during pregnancy;

malnutrition and insufficient nutrition;

bad habits (drug use, alcohol abuse, smoking);

disturbed ecology;

shock in a woman during childbirth;

endocrine pathologies (ovarian dysfunction, thyroid diseases, diabetes mellitus);

anemia of pregnant women;

decompensated extragenital pathology (diseases of the pulmonary system, cardiovascular diseases);

severe gestosis, which occurs against a background of severe edema and high blood pressure.

Factors that contribute to the development of disorders in the uteroplacental circle:

uterine rupture;

C-section;

general anesthesia for women;

drug administration less than 4 hours before the end of labor;

anomalies of labor forces (rapid and rapid labor, incoordination and weakness of labor);

lack or excess of amniotic fluid;

multiple pregnancy;

bleeding associated with placenta previa;

constant threat of interruption;

umbilical cord pathologies (false and true nodes, umbilical cord entanglement);

premature placental abruption;

premature aging of the placenta;

post-term pregnancy.

Secondary asphyxia occurs against the background of the presence of such pathologies in a newborn:

aspiration of formula or milk after the feeding procedure, poor-quality sanitation of the stomach after birth;

heart defects that did not appear immediately and were not detected;

cerebrovascular accident due to damage to the lungs and brain during childbirth;

respiratory distress syndrome, which is caused by pneumopathy:

• atelectasis in the lungs;

  pulmonary hemorrhages;

  edematous-hemorrhagic syndrome;

  presence of hyaline membranes.

Mechanism of development of asphyxia

Regardless of what causes the lack of oxygen in the child’s body, a restructuring of microcirculation and hemodynamics occurs, as well as metabolic processes in the body.

The degree of severity depends on how intense and prolonged the fetal hypoxia was. Against the background of hemodynamic and metabolic changes, acidosis occurs, accompanied by hyperkalemia (later hypokalemia), azothermia, and lack of glucose.

In the presence of acute hypoxia, the volume of circulating blood increases, while asphyxia and chronic hypoxia develop, the blood volume decreases. This leads to blood thickening, increased aggregation of red blood cells and platelets, and increased blood viscosity.

All processes lead to disruption of microcirculation of the most important organs (liver, adrenal glands, kidneys, heart, brain). As a result of disturbances in microcirculation, ischemia, hemorrhage, and edema develop, which leads to disruption of the functioning of the cardiovascular system, disruption of hemodynamics, and as a result of malfunctions in the functioning of all other organs and systems of the body.

Clinical picture of the pathology

Grade
Color of the skin	Cyanotic
Reflexes	None	Reaction reduced	The reaction is normal
Muscle tone	Absent		Active movements
	Absent	Irregular	The baby is crying
Heartbeat	Absent	Less than 100 beats per minute	More than 100 beats per minute

The main sign of the presence of asphyxia in a newborn is respiratory failure, which leads to disruption of hemodynamics and the functioning of the cardiovascular system; there is also a disturbance in neuromuscular conduction and the severity of reflexes.

To assess the severity of pathology, neonatologists use the Apgar scale, which is used in the first and fifth minutes of a baby’s life. Each of the signs is scored 0, 1 or 2 points. A healthy child gains 8-10 points in the first minute of life.

Degrees of newborn asphyxia

Mild asphyxia

With a mild degree of asphyxia, the number of points on the Apgar scale is 6-7. The newborn takes his first breath within the first minute, but there is a decrease in muscle tone, slight acrocyanosis (bluish skin in the area of ​​the lips and nose), and weakened breathing.

Moderate asphyxia

The score is 4-5 points. Breathing is significantly weakened, irregularity and disturbances are possible. Heartbeats are quite rare, less than 100 beats per minute, there is cyanosis of the feet, hands and face. Motor activity is increased, muscular dystonia with predominant hypertonicity is present. Tremors of the legs, arms, and chin may be observed. Reflexes are either increased or decreased.

Severe asphyxia

The condition of the newborn is very serious, the number of points in the first minute on the Apgar scale is 1-3. Respiratory movements are not performed at all or there are separate breaths. The number of heartbeats is less than 100 per minute, pronounced bradycardia, arrhythmic and muffled heart sounds are observed. There is no cry, muscle atony is observed, muscle tone is significantly reduced. The umbilical cord does not pulsate, the skin is pale, reflexes are not observed. There are eye symptoms: floating eyeballs and nystagmus, convulsions, cerebral edema, DIC syndrome (increased platelet aggregation and impaired blood viscosity) may develop. Hemorrhagic syndrome (multiple hemorrhages on the skin) intensifies.

Clinical death

This diagnosis is relevant provided that all indicators on the Apgar scale are 0 points. The condition is extremely serious and requires emergency resuscitation.

Diagnostics

To make a final diagnosis of “newborn asphyxia,” obstetric history, the course of labor, assessment of the child’s condition on the Apgar scale in the first and fifth minutes, as well as clinical and laboratory tests are taken into account.

Determination of laboratory parameters:

bilirubin level, AST, ALT, blood clotting factors;

level of glucose, acid-base status, electrolytes;

level of creatinine and urea, diuresis per day and per minute (work of the urinary system);

definition of base deficiency;

level of pCO2, pO2, pH (test of blood taken from the umbilical vein).

Additional methods:

assessment of neurological status and brain (NMR, CT, encephalography, neurosonography);

assessment of the functioning of the cardiovascular system (chest X-ray, pulse, blood pressure control, ECG).

Treatment

All newborns who were born in a state of asphyxia are subject to emergency resuscitation measures. Further prognosis directly depends on the adequacy and timeliness of assistance. Resuscitation of newborns is carried out using the ABC system, developed in the USA.

Primary care for a child

Principle A

ensure the correct position for the newborn (the head is lowered and slightly thrown back with the help of a bolster);

suck out amniotic fluid and mucus from the nose and mouth, in some cases from the trachea (if amniotic fluid gets there);

examine the lower respiratory tract and intubate the trachea.

Principle B

perform tactile stimulation - slap the baby on the heels (if there is no cry within 10-15 seconds after birth, the baby is transferred to intensive care);

jet oxygen supply;

implementation of artificial or auxiliary ventilation (endotracheal tube, oxygen mask, Ambu bag).

Principle C

performing indirect cardiac massage;

administration of medications.

The decision to stop resuscitation measures in the absence of a reaction to these actions (sustained bradycardia, lack of breathing) is made after 15-20 minutes. The cessation of resuscitation measures is due to the fact that after this period of time serious brain damage occurs.

Administration of drugs

Against the background of artificial ventilation (endotracheal tube, mask), cocarboxylase is injected into the umbilical vein, which is diluted 10 ml in a 15% glucose solution. In addition, to correct metabolic acidosis, sodium bicarbonate (5% solution) is administered intravenously, and “Hydrocortisone” and “10% calcium gluconate” are administered to restore the tone of the vascular walls. When bradycardia occurs, a 0.1% atropine sulfate solution is injected into the umbilical vein.

If the heart rate is less than 80 beats per minute, chest compressions are performed and artificial ventilation should continue. 0.01% -epinephrine is injected through the endotracheal tube or umbilical vein. After the heart rate reaches 80 beats, indirect cardiac massage is stopped; when spontaneous breathing appears and the heart rate reaches 100 beats, artificial ventilation is stopped.

Observation and further treatment

After restoration of respiratory and cardiac activity with the help of resuscitation measures, the newborn is transferred to the intensive care unit. Further treatment of acute asphyxia is carried out here:

Feeding and special care

The newborn is placed in an incubator, which is constantly heated. At the same time, craniocerebral hypotremia is carried out - cooling the newborn's head in order to prevent cerebral edema. Feeding of children with moderate and mild degrees of asphyxia begins no earlier than after 16 hours; with severe degrees of asphyxia, feeding is carried out every other day. The baby is fed using a bottle or tube. Apply to the breast depending on the condition of the child.

Prevention of cerebral edema

Mannitol, Cryoplasma, plasma, and Albumin are administered intravenously through the umbilical catheter. In addition, drugs are prescribed to stimulate blood circulation in the brain (Sermion, Vinpocetine, Cinnarizine, Cavinton) and antihypoxants (ascorbic acid, vitamin E, Aevit, Cytochrome C). Hemostatic and diuretic drugs are prescribed (Vikasol, Rutin, Ditsinon).

Carrying out oxygen therapy

Warm and humidified oxygen continues to be supplied.

Symptomatic treatment

Therapy aimed at preventing hydrocephalic syndrome and seizures. Anticonvulsants are used (Relanium, Phenobarbital, GHB).

Correction of metabolic disorders

Sodium bicarbonate intravenously (continue). Infusion therapy is carried out using saline solutions (10% glucose and saline solution).

Newborn monitoring

Weighing twice a day, as well as monitoring the excreted and incoming fluid, assessing the somatic and neurological status, the presence of positive dynamics. Using devices, central venous pressure, respiratory rate, blood pressure, and heart rate are monitored. Among the laboratory tests, a complete blood count with platelets and hematocrit, electrolytes and acid-base status, and a biochemical blood test (creatinine, urea, ALT, AST, bilirubin, glucose) are performed daily. Blood clotting indicators and bacteriological cultures from the rectum and oropharynx are also performed. Ultrasound of the abdominal organs, ultrasound of the brain, and radiographic examination of the abdomen and chest are indicated.

Consequences

Asphyxia of a newborn very rarely goes away without consequences. Lack of oxygen after and during childbirth affects the vital systems and organs of the child. Particularly dangerous is severe asphyxia, occurring with multiple organ failure. In this case, the prognosis for the child’s life depends on the score on the Apgar scale. If the score increases in the fifth minute of life, then the prognosis is favorable. Also, the frequency and severity of the development of consequences largely depends on the timeliness and adequacy of resuscitation measures and subsequent therapy, as well as on the severity of asphyxia.

Frequency of complications after suffering from hypoxic encephalopathy:

in the first degree of encephalopathy due to asphyxia/hypoxia of the newborn, the development is no different from the development of a healthy baby;

in the second degree of hypoxic encephalopathy – further neurological disorders are present in 25-30% of children;

with the third degree of hypoxic encephalopathy, about 50% of children die in the first week of life. In the remaining newborns, in 75-100% of cases, severe neurological complications occur with increased muscle tone, convulsions (later mental retardation).

After suffering asphyxia during childbirth, the consequences may have late or early manifestations.

Early complications

Early complications are considered to be those that appeared during the first day of a newborn’s life and are a manifestation of a difficult birth:

gastrointestinal disorders (digestive tract dysfunction, intestinal paresis, enterocolitis);

disorders of the urinary system (swelling of the interstitium of the kidneys, thrombosis of the renal vessels, oliguria);

development of posthypoxic cardiopathy, heart rhythm disorder;

thrombosis (reduced vascular tone, blood clotting disorders);

hypoglycemia;

against the background of hypovolemic shock and as a consequence of blood thickening - polycythemic syndrome (increased number of red blood cells);

transient pulmonary hypertension;

attacks of apnea (stopping breathing);

hand tremors and increased intracranial pressure;

meconium aspiration syndrome, which causes the formation of atelectasis;

convulsions;

cerebral hemorrhages;

cerebral edema.

Late complications

Late complications include complications that are diagnosed after three days of the newborn’s life or later. They can be of neurological and infectious origin. Among the neurological ones that arose against the background of cerebral hypoxia and encephalopathy, the following are distinguished:

Hyperexcitability syndrome.

The baby has signs of increased excitability, tachycardia, dilated pupils, and pronounced reflexes (hyperreflexia). No seizures.

Reduced excitability syndrome.

Weak sucking reflex, rare pulse, periodic slowing and stopping of breathing (bradypnea and apnea), symptom of doll eyes, tendency to lethargy, dilated pupils, decreased muscle tone, the child is adynamic, lethargic, reflexes are poorly expressed.

Convulsive syndrome.

Clonic (rhythmic contractions, twitching of individual muscles of the eyes, face, legs, arms) and tonic (rigidity and tension of the muscles of the limbs and body) convulsions are characteristic. There are also guardian paroxysms, which manifest themselves in the form of floating eyeballs, protruding tongue and chewing, attacks of unmotivated sucking, gaze spasms, and grimaces. Sudden pallor, increased drooling, rare pulse, bouts of cyanosis and apnea may also be present.

Hypertensive-hydrocephalic syndrome.

Loss of cranial nerves (manifested in the form of smoothness of nasolabial folds, nystagmus, strabismus), constant convulsive readiness, increased head circumference, divergence of cranial sutures, swelling of the fontanelles, the child begins to throw back his head.

Syndrome of vegetative-visceral disorders.

Constant regurgitation and vomiting, intestinal motility disorders (diarrhea and constipation), rare breathing, bradycardia, marbling of the skin (spasms of blood vessels).

Movement disorder syndrome.

There are residual neurological disorders (muscle dystonia, paralysis and paresis).

Intraventricular hemorrhages, hemorrhages around the ventricles.

Subarachnoid hemorrhage.

Addition of infectious complications against the background of multiple organ failure and weakened immunity:

necrotizing colitis (intestinal infection);

development of sepsis;

meningitis (damage to the dura mater of the brain);

development of pneumonia.

Answers to frequently asked questions

Does a child who suffered asphyxia during childbirth need special care after discharge from the hospital?

Of course, children with a history of natural asphyxia require especially careful care and observation. In most cases, pediatricians prescribe special massages and gymnastics that prevent the development of seizures and normalize the baby’s reflexes and excitability. Also, the child should receive maximum rest. In terms of feeding, it is advisable to breastfeed.

After what time are newborns discharged from the maternity hospital after asphyxia?

There is no talk of early discharge (usually 2-3 days). The newborn must stay in the maternity ward for at least one week, as an incubator is required. If necessary, the child and mother are transferred to the children's department, where therapy can last up to a month.

Do newborns who have suffered asphyxia require clinical observation?

All children who suffered asphyxia at birth are registered with a neurologist and pediatrician without fail.

What consequences of asphyxia can develop in a child at an older age?

Children with a history of birth asphyxia are more prone to colds, there may be speech delays, delays in psychomotor development, the reaction in some situations can be unpredictable, often inadequate, school performance is reduced, and immunity is weakened. After suffering severe asphyxia, convulsive syndrome and epilepsy quite often develop; paralysis, paresis, cerebral palsy, and mental retardation are not excluded.

Asphyxia of newborns - what is it? First of all, it should be said that this concept is not clearly defined. In the most general sense, it denotes one or another degree of respiratory depression while maintaining other signs of life (heartbeat, movement of arms and legs, contraction of other muscles, etc.).

In most cases, asphyxia of newborns is a consequence of oxygen starvation during intrauterine development. Therefore, in relation to newborns, the terms and hypoxia are used interchangeably.

In contact with

Asphyxia in a newborn child (fetus)

According to world statistics, about 20% of those born with asphyxia die after childbirth. Another 20% subsequently suffer from certain functional disorders associated with the functioning of the nervous system.

Complete absence of breathing in newly born babies is diagnosed in 1% of children. Breathing with insufficiently efficient gas exchange is observed in 15% of newborns. Thus, about 16% of children are born with varying degrees of hypoxia. More often, premature babies are born with breathing problems.

Classification of newborn asphyxia

The state of suffocation in newborns is classified according to the time of occurrence and duration of oxygen deficiency. According to this principle, there are 2 types of asphyxia:

• Arising due to prolonged hypoxia in the womb;
• resulting from the course of labor.

This division is important in understanding what asphyxia in newborns is.

Asphyxia due to chronic antenatal fetal hypoxia

Insufficient oxygen supply to the fetus leads to stable hypoxia and increases the likelihood of the birth of a child with asphyxia.
Causes of antenatal fetal asphyxia:

• The presence of chronic, infectious, endocrine diseases in a woman;
• decreased hemoglobin;
• unbalanced diet during pregnancy;
• lack of vitamins and microelements (in particular iron);
• exposure to toxins during pregnancy;
• abnormalities in the development of the placenta or umbilical cord.

Acute asphyxia due to intrapartum hypoxia

The birth process is a great stress for both the woman and the child. At this stage, risk factors include:

• Abnormal fetal position;
• deviations during pregnancy and childbirth - premature, rapid, delayed;
• maternal hypoxia during childbirth;
• aspiration of amniotic fluid by the fetus;
• brain or spinal cord injury;
• use of painkillers during childbirth;
• C-section.

It would be wrong to assume that any hypoxia necessarily leads to postnatal asphyxia. For example, caesarean sections are being used more and more often. In most cases, healthy children are born.

Degrees of asphyxia in newborns

For a more detailed understanding of what asphyxia is in a child, a special scale developed by an anesthesiologist from the USA, Virginia Apgar, is used.

In accordance with the ICD, two forms of suffocation are distinguished:

• Moderate;
• heavy.

Table. Characteristics of mild (moderate) and severe asphyxia in newborns.

Causes of newborn asphyxia

There are two groups of reasons:

• Intrauterine hypoxia;
• the inability of the newborn to adapt to postnatal circulation and breathing.

Intrauterine hypoxia can occur for numerous reasons, among which the main ones include:

• Impaired blood supply to the fetus through the umbilical cord (presence of nodes, mechanical compression);
• placental disorders (insufficient gas exchange, low or high blood pressure, edema, heart attacks, inflammation, premature detachment);
• pathologies in a pregnant woman (heart, hematopoietic, pulmonary, endocrine diseases);
• smoking, alcohol abuse or systematic exposure to other toxic substances during pregnancy.

The child’s inability to transition to postnatal breathing is based on the following reasons:

• Systemic developmental disorders, including those resulting from intrauterine hypoxia;
• congenital stenosis (narrowing) of the airways;
• birth brain injuries;
• disorders of the thyroid gland;
• prematurity.

Treatment of asphyxia in newborns

newborns

First aid for asphyxia in a newborn involves the following steps:

• The child is placed under a heat source;
• dry the skin;
• tactile stimulation is carried out on the back, sole of the foot;
• put the child on his back, tilt his head back a little;
• cleanse the mouth and nasopharynx of contents;
• amniotic fluid is sucked out of the respiratory tract using an endotracheal tube;
• if breathing is insufficient or completely absent, mechanical ventilation is started;
• during prolonged ventilation of the lungs, a probe is inserted into the stomach, through which the gas accumulating in it is sucked out.

All the above steps are carried out quickly for 2-3 minutes, periodically recording vital signs. If after the manipulations the heartbeat reaches 100 beats/min, spontaneous breathing appears, and the skin acquires a pinkish tint, artificial ventilation is stopped. If the child's condition does not improve, further resuscitation is continued.

Resuscitation of newborns with asphyxia

Resuscitation is continued with indirect cardiac massage, which is carried out for 30 s. If heart rate remains at 60-80 beats/min. or absent altogether, resort to medication.

1. Adrenalin

An adrenaline solution is administered intravenously at a dosage of up to 0.3 ml/kg. It strengthens heart contractions, increases its blood supply, increases blood pressure, and has a bronchodilator effect.

If within 30 seconds after the administration of adrenaline the heartbeat does not accelerate above 80 beats/min, repeat again.

1. Infusion therapy.

In cases where there is no effect from the measures taken, blood volume replenishers are used - solutions of albumin, sodium chloride - at the rate of 10 ml/kg intravenously for 5 minutes.

In combination with other resuscitation measures, the administration of blood replenishing drugs improves blood circulation, increases blood pressure and heart rate.

If the measures taken are ineffective, intravenous administration of a 4% sodium bicarbonate solution at a dosage of 4 ml/kg is indicated.

If necessary, pulmonary ventilation and fluid therapy are continued as part of post-resuscitation intensive care.

Prevention of asphyxia in newborns

Prevention includes:

• Correct lifestyle;
• timely preparation for pregnancy, including treatment of chronic somatic and endocrine diseases;
• intensive and effective treatment of infectious diseases during pregnancy;
• observation by a gynecologist during pregnancy.

Effective measures should include:

• Quitting smoking and alcohol;
• adherence to daily routine;
• daily walks several times a day;
• a balanced diet rich in vegetables, proteins, amino acids, vitamins and microelements;
• additional vitamin support;
• positive emotions and a calm, balanced state.

Caring for a child after asphyxia

A child who has suffered asphyxia has a high likelihood of developing disorders of the nervous system. After discharge from the maternity hospital, such a child should be under the supervision of a neurologist. No special care at home is required.

Consequences of asphyxia in a newborn during childbirth

Nervous tissue is the most vulnerable to oxygen deficiency. Long periods of hypoxia during the formation of the fetal nervous system, as well as as a result of an acute lack of oxygen during childbirth, significantly increases the likelihood of developing certain disorders.

The consequences of severe asphyxia of newborns are manifested, first of all, in a poor response to resuscitation measures. In the absence of positive dynamics in the condition of the newborn at 20 minutes after birth, the probability of death increases and is:

• up to 60% – in those born at normal term;
• up to 100% - in those born prematurely.

The consequences of severe asphyxia of birth trauma are reflected in the brain. For example, a child’s weak response to resuscitation measures within 15 minutes after birth results in the development of cerebral palsy in 10% of cases, and within 20 minutes – in 60%. But these are very difficult cases.

Cases of moderate suffocation during childbirth are more common. The consequences of asphyxia in newborns at an older age manifest themselves in different ways, but all of them will be associated with the functioning of the nervous system.

Such children, for example, can be too active or, conversely, too phlegmatic. Sometimes they may not do well at school, but, on the contrary, they excel in creative activities and clubs. A possible later appearance of speech was noted.

Similar variations in the development of a child can also arise for other reasons unrelated to birth asphyxia. All this is usually called in one word - individuality, and should not cause concern to parents.

Conclusion

Despite the fact that complete absence of breathing at birth occurs in only 6% of cases of all hypoxic conditions, to varying degrees, birth asphyxia is a phenomenon that occurs much more often than many people think. The consequences of asphyxia in a newborn can last for the rest of the child’s life. Any expectant mother should be attentive to her health and maintain a calm and positive mood during pregnancy.

In the video, the doctor gives advice on behavior during childbirth, which will reduce the risk of developing newborn asphyxia.