What is asphyxia in a newborn baby. What is newborn asphyxia: pulmonary and extrapulmonary causes of development, medical tactics

Currently, asphyxia of a newborn is understood as a condition when, in the presence of a heartbeat, there is no breathing or there are individual convulsive, irregular, shallow breaths.

Asphyxia is divided into:

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

2) asphyxia of the newborn .

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

Newborn asphyxia is also divided into on primary when the newborn baby does not breathe independently after ligation of the umbilical cord, and secondary- occurring in the subsequent hours and days of the newborn’s life.

There are 5 leading mechanisms leading to asphyxia of newborns:

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

2) disturbance 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 maternal oxygen saturation ( anemia, cardiovascular diseases, respiratory failure);

5) insufficiency of extrauterine breathing movements newborn ( the influence of drug therapy on the mother, antenatal brain damage to the fetus, congenital malformations of the lungs, etc.).

Secondary hypoxia can develop as a result of aspiration, pneumopathy, birth trauma of the head and spinal cord, congenital defects of the heart, lungs, and brain.

Therefore, asphyxia is suffocation, an acute pathological process caused by for various reasons, which are based on a lack of oxygen in the blood (hypoxemia) and tissues (hypoxia) and the accumulation of carbon dioxide in the body (hypercapnia) and others acidic foods metabolism, which leads to the development of metabolic acidosis. Under-oxidized 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 circulatory disorders, disruption of blood clotting processes, and hemorrhages in various organs.

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

Basic clinical sign asphyxia- disturbance or lack of breathing. The degree of asphyxia is determined using the Apgar scale. According to the International Classification of Diseases, IX revision (Geneva 1980) asphyxia is distinguished: moderate (moderate) and severe.

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

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

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

Apgar score

Asphyxia of newborns - Treatment.

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

1. Spontaneous breathing.
2. Heartbeat.
3. Pulsation of the umbilical cord.
4. Active movements.

If all 4 signs of a live birth are absent, the child is considered stillborn and cannot be resuscitated. If there is at least 1 sign, resuscitation assistance must be provided.

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 patency of the airways; B - breath - breathing, providing ventilation - artificial (IVL) or auxiliary (AVL); C - cordial circulation restoration or maintenance of cardiac activity and hemodynamics.

In or near the delivery room, a “resuscitation island”, which consists of several blocks, must be ready to assist a newborn around the clock:

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

2) patency restoration block respiratory tract— electric suction, rubber bulbs, oral air ducts, endotracheal tubes, 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) artificial lung ventilation unit (Ambu-type breathing bag, devices for automatic ventilation of the lungs);

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

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

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

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

Amniotic fluid, mucus, and sometimes maternal blood from the baby’s skin are wiped with a warm diaper. In case of severe asphyxia and the presence of meconium in the amniotic fluid or oropharynx, immediate intubation is performed, followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby is separated after 1 minute. At the end of the first stage of resuscitation, the duration of which should not exceed 20-2 5 seconds, the child’s breathing is assessed. With adequate breathing, heart rate above 100 per minute and slight acrocyanosis of the skin, resuscitation measures are 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 switch to Stage II of resuscitation, whose task is to restore external respiration. Activities begin with ventilation of the lungs using a mask and breathing bag. Respiration rate is 30-50 per minute. More often, a 60% oxygen-air mixture is used (40% for premature babies). Good excursions chest indicate sufficient ventilation of the alveoli, as well as the absence of serious airway obstructions. Ineffectiveness of bag and mask ventilation, suspicion of meconium aspiration, count less than 80 and the need for external cardiac massage and long-term respiratory support are indications for endotracheal intubation.

Breathing is stimulated simultaneously with mechanical ventilation intravenous administration nalorphine or etimizole. 20-30 seconds after the start of mechanical ventilation, it is necessary to calculate the frequency of cardiac contractions; if it is in the range of 80-100 per minute, mechanical ventilation is continued until the frequency increases to 100 per minute.

If the heart rate is less than 80 per minute, then switch to III stage of resuscitation. Need to start urgently external massage heart 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 downward by 1.5-2.0 cm with a frequency of 100-140 times per minute.

The effectiveness of chest compressions should be assessed by the color of the skin and the pulse in 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 body weight of a 0.01% solution either endotracheally or into the umbilical cord vein. Administration can be repeated after 5 minutes (up to 3 times). At the same time, mechanical ventilation and indirect cardiac massage are continued. Then the color is assessed skin and the state of microcirculation. According to indications, infusion therapy is carried out (albumin, native plasma, isotonic sodium chloride solution). If necessary, planned infusion therapy it begins 40-50 minutes after birth. It is very important to remember that the pace of infusion therapy is much more important than the volume. All children born with asphyxia in the delivery room are given vitamin K. In the case of a very severe condition after primary resuscitation and slow recovery vital important functions transfer to the neonatal intensive care unit of a children's hospital is desirable.

If within 15-20 minutes the child does not begin to breathe independently and has persistent bradycardia, then there is a high probability of severe brain damage, and it is necessary to decide on stopping resuscitation measures.

Asphyxia of newborns - 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 the early complications, in addition to brain damage (edema, intracranial hemorrhage, necrosis, etc.), hemodynamic (pulmonary hypertension, heart failure), renal, pulmonary, gastrointestinal, hemorrhagic (anemia, thrombocytopenia, disseminated intravascular coagulation syndrome) are especially common. Late complications are dominated by infectious (pneumonia, meningitis, sepsis) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy).

According to medical statistics, about 10% of children need active assistance from medical personnel from the very first minute of birth in order to actively cry, 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.

Local pediatrician

Asphyxia of newborns is suffocation, manifested by respiratory failure, or lack of spontaneous breathing in the presence of a 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 require medical attention 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 a 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 disorders, circulatory disorders and work disorders nervous system child.

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);
• reception by the mother of some medicines;
• 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, anomalies labor activity).

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 with various drugs), as a result of severe developmental defects, in case of prematurity, due to the immaturity of the respiratory system, due to a violation of the flow of air into the respiratory tract (blockage or compression from the outside), as a consequence 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 intrauterine growth retardation. 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. The fetus's breathing is shallow and the glottis is closed, so during 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: abnormalities in the development of the brain and spinal cord, the effects of drugs and drugs, infection.
2. Cardiovascular system disorders. These include malformations of the heart and blood vessels, fetal hydrops.
3. Malformations of the 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 bleeding often occurs 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.

Early complications include the following conditions:

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, respiratory stimulation is ineffective, so the child is quickly transferred to radiant heat and artificial ventilation (ALV) is started. 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 frequency decreases to less than 60 per minute, indirect cardiac massage is started, while mechanical ventilation is continued. 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 longer period full recovery. Premature babies have a worse prognosis than babies born full term.

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

The severity of the disease depends on the extent to which the baby’s gas exchange process was disrupted during the prenatal period, that is, on the ratio of the amount of oxygen and carbon dioxide in the child’s tissues and blood cells. ABOUT consequences of asphyxia We'll talk about newborns in the article.

Stages

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

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

This condition is considered very dangerous, as it is considered common cause stillbirths and infant mortality in the first days of life.

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

What happens during asphyxia?

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

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

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

At the initial stage, the volume of blood in the child’s body increases, over time, when the disease develops into chronic form, this volume is significantly reduced. This leads to a change in the composition of the blood (an increase in the number of red blood cells, platelets), and its greater viscosity.

This condition is dangerous for the body due to the possibility of blood clots and obstruction of blood vessels.

As a result of the above pathological processes observed disturbance of blood microcirculation in internal organs(brain, heart, etc.). Such disorders cause swelling, minor hemorrhages, and the development of diseases and other systems.

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

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

How to treat asthenic syndrome in children and adolescents? Find out about this from ours.

Reasons for the development of pathology

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

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

Fetal factors:

1. Cranial – brain injury newborn received during childbirth.
2. Rhesus is a conflict with the mother’s body. This phenomenon is possible if the Rhesus status of the pregnant woman is negative, and that of the child is positive. In this case, leukocytes expectant mother perceive the embryo as foreign body are trying to destroy him. This leads to various kinds of pathologies.
3. Respiratory system dysfunctions.
4. Intrauterine infections.
5. Premature birth.
6. Anomalies of growth and development of a child in the prenatal period.
7. Hitting respiratory organs amniotic fluid, mucus, feces secreted by the fetus into the amniotic fluid.
8. Developmental disorders of the heart and brain.

Mother factors:

Factors that disrupt blood circulation in the placenta:

1. Post-term pregnancy.
2. Pathology of the placenta (its premature aging, detachment, presentation).
3. Entwining the fetus with the umbilical cord.
4. Multiple pregnancy.
5. Polyhydramnios or oligohydramnios.
6. Violations of natural birth process(weakness of contractions, use of medications, caesarean section, use of general anesthesia).

Towards development secondary asphyxia The following negative factors may result:

1. Birth injuries to the fetus, leading to impaired blood circulation in the brain.
2. Cardiac pathologies.
3. Improper feeding, when mother's milk enters the newborn's nose, complicating the normal breathing process.
4. Features and pathological abnormalities lung structure.

Clinical manifestations

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

Mild degree characterized by:

• slight delay in the moment of the first inhalation (inhalation occurs in the first minute of life);
• the baby's cry is slightly muffled;
• breathing is regular but weakened;
• the color of the skin in the area of ​​the nasolabial triangle is pale or bluish;
• Apgar score 6-7.

Asphyxia moderate severity manifested by such symptoms as:

• irregular, severely weakened breathing;
• the child hardly screams;
• reflexes and heart rate are reduced;
• the skin has a bluish color in the area of ​​the face, hands, and feet;
• Apgar score 4-5.

Heavy asphyxia manifests itself as:

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

Treatment specialists bronchial asthma for the child you will find on our website.

Treatment

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

Asphyxia mild to moderate severity eliminated in several stages:

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

Treatment of severe asphyxia requires more radical measures, such as:

• mechanical ventilation;
• external cardiac massage;
• intravenous administration of glucose, prednisolone, adrenaline, calcium gluconate.

Newborn care

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

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

It is necessary to resolve the issue of feeding the baby. Of course, if possible, it is best improve breastfeeding process.

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

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

Consequences and complications

Lack of oxygen, even for a short period of time, has a negative impact on state of the brain and central nervous system. This manifests itself in the form of a violation of circulatory processes, when the vessel increases in size as a result of its overfilling with blood.

This leads to the formation of blood clots and hemorrhages. If this phenomenon is observed in the brain area, necrosis (death of certain areas of the cerebral cortex) may develop.

For severe asphyxia high risk of fetal death in utero, or in the first days of a child’s life. Children who have suffered severe asphyxia develop mental and physical disorders.

Prevention

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

During pregnancy necessary:

1. Regularly visit a gynecologist who will monitor the pregnancy and strictly follow all his instructions.
2. Refuse bad habits.
3. Normalize your daily routine, get more rest.
4. Eat properly.
5. Be in the fresh air.
6. Provide moderate physical activity(unless contraindicated).
7. Protect yourself from infectious diseases.
8. Take medications prescribed by your doctor.
9. Provide yourself with peace of mind and positive emotions.

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

The nervous, respiratory and cardiovascular systems are especially susceptible to negative changes. vascular system. The consequences of asphyxia can be very negative, including significant retardation in mental and physical development.

ABOUT causes of asphyxia newborns in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

is a pathology of the early neonatal period, caused by respiratory failure and the development of hypoxia in the newborn child. Asphyxia of a newborn is clinically manifested by the absence of spontaneous breathing of the child in the first minute after birth or the presence of isolated, superficial or convulsive irregular respiratory movements with intact cardiac activity. Newborns with asphyxia require resuscitation measures. The prognosis for asphyxia of a newborn depends on the severity of the pathology, the timeliness and completeness of the provision of therapeutic measures.

General information

From total number Newborn asphyxia is diagnosed in 4-6% of children. The severity of asphyxia is determined by the degree of gas exchange disturbance: accumulation of carbon dioxide and lack of oxygen in the tissues and blood of the newborn. According to the time of development, asphyxia of newborns can be primary (intrauterine) and secondary (extrauterine), occurring in the first days after birth. Asphyxia of newborns is a serious condition and is one of the common causes of stillbirth or neonatal mortality.

Causes

Asphyxia of newborns is a syndrome that develops as a result of disruption of pregnancy, diseases of the mother and fetus. Primary asphyxia of the newborn is usually associated with chronic or acute intrauterine oxygen deficiency caused by intracranial injuries, intrauterine infections (rubella, cytomegalovirus, syphilis, toxoplasmosis, chlamydia, herpes, etc.), immunological incompatibility of the blood of mother and fetus, fetal malformations, partial or complete obstruction of the respiratory tract of the newborn with amniotic fluid or mucus (aspiration asphyxia).

The development of asphyxia of a newborn is facilitated by the presence of extragenital pathology in a pregnant woman (anemia, heart defects, lung diseases, thyrotoxicosis, diabetes mellitus, infections), as well as a burdened obstetric history (late toxicosis, premature placental abruption, post-term pregnancy, complicated childbirth), bad habits in the mother . The causes of secondary asphyxia of the newborn, as a rule, are violations cerebral circulation child or pneumopathy. Pneumopathy is perinatal non-communicable diseases lungs caused by incomplete expansion of the lung tissue; manifested by atelectasis, edematous-hemorrhagic syndrome, hyaline membrane disease.

Pathogenesis

The woman herself should engage in prevention by giving up bad habits, following a rational regimen, and following the instructions of the obstetrician-gynecologist. Prevention of asphyxia of a newborn during childbirth requires the provision of competent obstetric care, prevention of fetal hypoxia during childbirth, and release of the child’s upper respiratory tract immediately after birth.

A diagnosis such as asphyxia occurs with alarming frequency. Children are born with signs of hypoxia, do not breathe on their own, or their breathing is weakened. At this moment, determination and professionalism are required from doctors, and faith in the best from mothers. What is happening at these moments? How to care for your baby in the future? How to avoid complications?

Asphyxia is a pathological condition of a newborn that requires immediate medical intervention

What is newborn asphyxia?

Asphyxia of newborns is a pathology in which gas exchange in the child’s body is disrupted. This condition is accompanied by an acute deficiency of oxygen and an excess of carbon dioxide. When there is a lack of air, the child is able to make only infrequent and weak attempts to breathe or does not breathe at all. In this condition, the child is immediately subjected to resuscitation.

According to the severity, asphyxia is divided into mild, moderate and severe, and clinical death is distinguished separately. Let's look at what symptoms they are characterized by.

Severity of asphyxia	Apgar scores	Breathing Features		Skin color	Heart rate	Muscle tone	Manifestation of reflexes	Additional symptoms
Lightweight	6 - 7	Weakened, but the baby can breathe on his own		Blueness of lips and nose	Normally – over 100	Demoted	No deviations	After 5 minutes the child’s condition improves independently
Moderate (average)	4 - 5	Weak with impairments		Blue	Below 100	Dystonia with hypertonicity	Reduced or increased	Tremors of the arms, legs and chin
Heavy	1 - 3	Rare breaths or no breaths at all		Pale	Below 100, in most cases below 80	Much reduced	Not observed	The child does not cry, there is no pulsation in the umbilical cord. Possible cerebral edema.
Clinical death	0	There's no breathing		Pale	None	Absent	Not visible	None

Intrauterine and postpartum asphyxia and its causes

Like any disease, newborn asphyxia has causes. Why does a lack of oxygen occur? First, let's look at the types this state. Asphyxia can be primary or secondary.

Primary (intrauterine) is a pathological condition that is diagnosed at the time of birth. It is caused by acute or chronic intrauterine lack of oxygen (hypoxia). Causes of intrauterine asphyxia also include:

• trauma to the newborn's skull;
• developmental pathologies during gestation;
• Rhesus conflict;
• blockage of the airways with mucus or amniotic fluid.

Another reason for the occurrence of intrauterine pathologies is the presence of serious illnesses. The condition of the newborn may be affected by the pregnant woman's history of heart problems, kidney problems, diabetes mellitus or iron deficiency. The occurrence of oxygen deficiency is possible against the background of late toxicosis, in which a woman’s legs swell and her blood pressure rises.

Often, asphyxia during childbirth occurs due to the abnormal structure of the placenta and amniotic membranes. Particular attention should be paid if the pregnant woman's history indicates early placental abruption and premature rupture of water.

Secondary asphyxia occurs some time after birth due to:

• heart problems in a child;
• CNS disorders;
• improper cerebral circulation in a newborn;
• pathologies in intrauterine development and during labor, which affect the respiratory system.

Consequences of asphyxia of the fetus and newborn

Consequences of newborn asphyxia almost always occur. The lack of oxygen in the baby during or after childbirth in one way or another affects the child’s organs and systems. The greatest trace is left by severe asphyxia, which is associated with multiple organ failure.

How much asphyxia will affect the child’s future life depends on the Apgar score. If at 5 minutes of life the general condition of the newborn has improved, then the chances of a successful outcome increase.

The severity of the consequences and prognosis depend on how well and on time the medical care doctors during a period of serious illness. The faster treatment was prescribed and the better resuscitation measures were carried out, the less serious complications should be expected. Special attention should be given to newborns with severe asphyxia or who have had clinical death.

The consequences of asphyxia can be very severe, so doctors carry out emergency resuscitation measures

• with hypoxia or asphyxia, which is assigned degree 1, the child’s condition is absolutely no different from healthy baby, increased drowsiness is possible;
• in the second degree, a third of children are diagnosed with neurological disorders;
• in the third degree - half of the newborns do not survive to 7 days, and the remaining half have a high probability of severe neurological diseases(mental development disorders, seizures, etc.).

Do not despair when making a diagnosis such as asphyxia. It's been happening quite often lately. The main property of a child’s body is that it can repair itself. Do not neglect the advice of doctors and maintain a positive attitude.

How is asphyxia diagnosed?

Primary asphyxia is detected by visual examination of doctors present at birth. In addition to the Apgar assessment, laboratory research blood. Pathological condition confirmed by the analysis results.

Carrying out the procedure ultrasound examination brain

The newborn should be sent for examination by a neurologist and have an ultrasound scan of the brain - this will help determine whether the baby has damage to the nervous system (more details in the article:). Using such methods, the nature of asphyxia is determined, which is divided into hypoxic and traumatic. If the lesion is associated with a lack of oxygen in the womb, then the newborn experiences neuro-reflex excitability.

If asphyxia occurs due to injury, then vascular shock and vasospasm are detected. The diagnosis depends on the presence of seizures, skin color, excitability and other factors.

First aid and treatment features

Regardless of what causes asphyxia in a child, treatment is carried out on absolutely all children from the moment of birth. If signs of a lack of oxygen are observed during contractions or pushing, then emergency delivery by cesarean section is performed immediately. Further resuscitation actions include:

• cleansing the respiratory tract of blood, mucus, water and other components that impede the flow of oxygen;
• restoring normal breathing by administering medications;
• maintaining the normal functioning of the circulatory system;
• warming a newborn;
• control of intracranial pressure.

During resuscitation measures, constant monitoring is carried out over the heart rate, respiratory rate and other vital signs of the newborn.

If the heart beats less than 80 times per minute, and independent breathing does not improve, then the baby is immediately given medication. The increase in vital signs occurs gradually. Adrenaline is used first. If there is heavy blood loss, a sodium solution is needed. If after this breathing does not return to normal, then a second injection of adrenaline is given.

Rehabilitation and child care

After removal acute condition control over the newborn's breathing should not be weakened. Further care and treatment of newborn asphyxia takes place under the constant supervision of doctors. The baby needs absolute peace. The head should always be raised.

Oxygen therapy is of no small importance. After mild asphyxia, it is important to prevent the child from being deprived of oxygen again. The baby needs increased amounts of oxygen. For this some maternity are equipped with special boxes, inside of which an increased concentration of oxygen is maintained. As prescribed by a neonatologist and neurologist, the baby should spend from several hours to several days in it.

If a child has suffered asphyxia for more than severe forms, then after resuscitation measures he is placed in special incubators. This equipment is capable of providing oxygen in the required concentration. The concentration is prescribed by doctors (usually at least 40%). If such a device is not available in the maternity hospital, then oxygen masks or special inserts for the nose are used.

After asphyxia, the child must be registered with a pediatrician and neurologist

When caring for a baby after asphyxia, regular monitoring of his condition is necessary. It is important to monitor body temperature, bowel function and genitourinary system. In some cases, it is necessary to clear the airways again.

If the newborn has suffered a lack of oxygen, then he is fed for the first time no earlier than 15-17 hours after birth. Children with severe asphyxia are fed through a feeding tube. The time when you can start breastfeeding is determined by the doctor, since the condition of each child is individual, and the time to start breastfeeding directly depends on the general condition of the baby.

After rehabilitation and discharge home, the newborn must be registered with a pediatrician and neurologist. Timely diagnosis will help prevent Negative consequences and complications.

The baby is prescribed gymnastics, massage and medications that improve blood circulation and reduce intracranial pressure.

During the first 5 years of life, the child may experience seizures and hyperexcitability (see also:). You should not neglect medical recommendations and ignore health-improving activities. General restorative massage and other procedures should be carried out only by a specialist. In the future, parents can master the basic techniques on their own. The lack of general strengthening measures can affect mental development and the child's behavior.

Children who have suffered asphyxia should not introduce complementary foods too early. Until the age of 8-10 months, the child should eat adapted infant formula or breast milk. Parents should closely monitor their child and strengthen him. You should discuss with your pediatrician the need for vitamin therapy.

It is very important to preserve it for as long as possible breast-feeding

Prevention of asphyxia

It is easier to prevent any disease than to treat it and fear complications. Measures to prevent asphyxia are very simple. Of course, prevention does not provide an absolute guarantee of the absence of breathing problems in the future, but in approximately 40% of cases a positive effect is observed.

The most important thing is medical supervision of pregnancy. A woman must register and undergo timely examinations. All risk factors must be identified and eliminated. These include:

• infection during pregnancy;
• malfunction of the thyroid gland;
• hormonal imbalance;
• severe stress;
• age over 35 years;
• bad habits (drug addiction, smoking, alcoholism).

The timing of fetal screening tests cannot be ignored. Ultrasound readings may indicate problems. Based on the condition of the placenta and amniotic fluid, the doctor can determine the development of hypoxia and prevent it in a timely manner. When the first signals of danger appear, urgent measures must be taken and the necessary therapy carried out.

You should not skip scheduled visits to the gynecologist and ignore medical recommendations. With her neglect, the expectant mother endangers not only her health, but also the condition of the fetus and its life.

When preventing oxygen starvation, the lifestyle of the expectant mother has a significant influence. Doctors recommend following these rules:

• Walks. For normal oxygen supply to the fetus, a pregnant woman must spend a sufficiently long time outdoors. Ideally, walks are held in a park or public garden. Within a few hours outside, the mother’s body is saturated with oxygen, which is supplied to the fetus. Oxygen has a positive effect on the proper formation of the organs of the future person.
• Schedule. For a woman carrying a child, correct mode day should become law. Getting up early, watching movies at night and the frantic rhythm of the day are not for her. You need to leave all the turmoil in the past and try to rest more. Night sleep should be at least 8-9 hours, and at least 1-2 hours should be devoted to it during the day.
• Taking vitamins and minerals. Even if a woman’s diet consists of the highest quality and healthy products, then taking vitamins is still necessary. Unfortunately, modern products do not have such quantities useful substances which are necessary for women and children. That is why every pregnant woman should take vitamin complexes that can meet her needs and the needs of the child. The choice of vitamin and mineral complex is carried out independently or together with a gynecologist. The most popular are Femibion ​​and Elevit Pronatal (we recommend reading:).
• You can't lift weights.
• It is important to maintain inner peace and a positive attitude.