Asphyxia of a newborn - complete information. Consequences of asphyxia in newborns What is asphyxia in a newborn baby

Newborn asphyxia - 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, newborn asphyxia is a consequence oxygen starvation during intrauterine development. Therefore, in relation to newborns, the terms and hypoxia are used interchangeably.

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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 work related 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;
• head injury or spinal cord;
• 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, decreased or high blood pressure, swelling, 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) respiratory tract;
• birth brain injuries;
• malfunctions 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;
• at long-term ventilation lungs, a probe is inserted into the stomach, through which the gas that accumulates 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, it is indicated intravenous administration 4% sodium bicarbonate solution at a dosage of 4 ml/kg.

If necessary, pulmonary ventilation and infusion therapy continue during 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;
• intense and effective treatment infectious diseases during pregnancy;
• observation by a gynecologist during pregnancy.

Among effective measures should be named:

• Quitting smoking and alcohol;
• adherence to daily routine;
• daily walks several times a day;
• 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 poor response to resuscitation measures within 15 minutes after birth results in 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

Although complete absence breathing at birth occurs in only 6% of cases of all hypoxic conditions; to one degree or another, birth asphyxia is a phenomenon that occurs much more often than many people think. The consequences of asphyxia in a newborn may be delayed for later life child. Any to the expectant mother you should be attentive to your health, remain 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.

The development of oxygen deficiency and difficulty breathing is asphyxia of newborns. This dangerous illness can occur both at the time of birth and during the first days of the baby’s life. When a baby is born, it must immediately learn to breathe on its own. If there is a failure in the process of adaptation to extrauterine living conditions, breathing problems occur. Topic of the article: asphyxia during childbirth - consequences of oxygen deficiency.

Asphyxia is congenital when, during the process of formation, the fetus suffers from hypoxia due to developmental defects, lack of oxygen, as well as immunological incompatibility (Rh factor) with the mother’s body. Asphyxia can also be acquired (secondary), when during childbirth the baby receives:

• intracranial injury;
• blockage of the respiratory tract with amniotic fluid.

Intrauterine pathology may appear due to:

• chronic maternal diseases (diabetes, cardiovascular diseases, anemia);
• late toxicosis of the mother, complicated by edema and high blood pressure;
• maternal abuse of alcohol and tobacco;
• violation by the mother of the correct daily routine and increased nervous excitability.

Secondary asphyxia may occur due to a violation cerebral circulation newborn or damage to the central nervous system during birth. The baby may experience difficulty breathing when the umbilical cord is entangled around the neck during childbirth or the mother experiences premature abruption of the placenta (oligohydramnios).

Immediately after the birth of a newborn, obstetricians assess his condition using a ten-point Apgar scale. In severe cases of asphyxia (below three points), urgent resuscitation measures are carried out. From the first minutes of life, experienced specialists can determine the condition of the baby by proper breathing, muscle contraction, heartbeat and skin.

Three degrees of disease

The main sign of pathology in a baby is improper breathing. During the process of intrauterine development and passage through the birth canal, the baby may experience asphyxia varying degrees gravity. With mild asphyxia (6-7 points) the newborn experiences:

• slightly decreased muscle tone;
• inhibited motor activity;
• poorly expressed physiological reflexes;
• diffuse cyanosis in the nasolabial area;
• weak intermittent breathing (shallow).

The baby begins to breathe and cry after birth, however, his breathing is weak and his movements are devoid of activity.

For pathology moderate severity(4-5 points) in newborns the following is observed:

• sluggish reaction to irritation during examination;
• insensitivity to pain;
• partial absence of physiological reflexes;
• bluish skin tone;
• convulsive shallow breathing.

The baby takes a breath, but the breathing is devoid of rhythm. This degree of pathology is characterized by the presence of tachycardia in the baby (rapid heartbeat), and the skin on the extremities (feet and palms) and face has a bright bluish tint.

In severe forms of pathology (3-1 points) the following is observed:

• lack of spontaneous breathing;
• paleness skin;
• lack of physiological reflexes;
• weak pulse and heartbeat.

With this degree of pathology, the baby can breathe, but does not scream. For muscular system characterized by atony/hypotonia, no pulsation of the umbilical cord. The skin has a pale tint and innate reflexes do not show up at all.

Severe brain damage at birth may result in the absence of the innate sucking/swallowing reflex. In extreme cases (zero Apgar scale), fetal asphyxia can result in the death of the newborn.

Important! Fetal asphyxia does not go away without a trace: it has Negative influence to physiological and mental processes child development.

Consequences

This pathology changes metabolic processes in the baby’s body. If asphyxia develops due to intrauterine fetal hypoxia, this leads to thickening of the blood and a decrease in its volume.

Against the background of oxygen deficiency, cerebral edema and microhemorrhages can form, which destroy the tissue structure. Hypoxia reduces blood pressure, which affects the functioning of the heart - contractions of the heart muscle slow down and their number decreases.

Pathological processes also affect the area of ​​the urinary system, disrupting its functionality. As the newborn grows up, asphyxia during childbirth leads to:

• slow development of speech skills;
• inhibition of mental reactions;
• inadequate response to the situation;
• poor mastery of the school curriculum;
• weakening of the immune system.

The child may have unbalanced coordination of movements, increased emotional background, and uncoordinated processes of excitation and inhibition.

The most severe form of fetal asphyxia is childhood cerebral paralysis(cerebral palsy).

Cerebral palsy cannot be cured; the child constantly needs intensive care and attention. You need to constantly work with the baby, and when you stop exercising, the symptoms of cerebral palsy worsen.

Baby care

Immediately after identifying signs of pathology, resuscitation measures are carried out on the baby. Firstly, the oral cavity is freed from accumulation of mucus and amniotic fluid with a special probe. Secondly, they restore heart rate and respiratory function.

Therapeutic efforts are aimed at eliminating the cause of swelling of brain tissue, restoring metabolic processes and functions of the urinary system.

The consequences of asphyxia are difficult for the baby to bear. The newborn needs to be disturbed less and provided with complete rest. The head should always be raised on the pad.

After discharge, the newborn is supervised by a local pediatrician and a pediatric neurologist. Without the necessary therapy, a newborn may develop cerebral palsy. TO possible consequences Asphyxia suffered may include:

• convulsive and hydrocephalic syndromes;
• diencephalic pathology;
• hyperexcitability.

At home, the baby needs constant supervision, body temperature measurement and careful monitoring excretory system. The mother must have faith in the complete healing of the newborn baby and make every effort to form healthy body, prevent the development of cerebral palsy.

Prevention

To prevent the causes of fetal pathology, care must be taken during pregnancy.

You should completely change your entire lifestyle and, above all, give up smoking and alcohol.

The expectant mother should perform daily hiking, saturating your body with oxygen. Air conditioning and room ventilation are no substitute for walking in a park or square. Oxygen passes through the mother's blood to the fetus and prevents the occurrence and development of oxygen starvation.

If it is not possible to travel outside the city limits, you can walk in the nearest park area, where there is a lot of vegetation. Oxygen is vital for the fetus to develop properly.

To prevent the causes of pathology development, expectant mother must:

• treat even the slightest runny nose in a timely manner;
• monitor changes in your hormonal levels;
• go to bed not at night, but in the evening;
• do not sit for a long time at a laptop for no reason;
• monitor your diet;
• do not participate in conflict situations.

The diet suggests great use fruit and vegetable dishes and sufficient consumption of low-fat dairy products. Your local gynecologist will tell you about the diet in detail. To prevent vitamin deficiency, you should use a special vitamin complex for pregnant. Taking iron and folic acid supplements is also indicated.

Peace of mind - important point for a successful pregnancy and birth. U calm mothers babies are born without any mental or health problems. Of course, provided that all other rules of behavior during pregnancy are observed.

Also, a woman should visit a gynecologist at the prescribed time. Monitoring of the fetus and placenta is important. Exactly early detection oxygen starvation of the fetus will help to begin timely treatment, and fetal asphyxia will not develop.

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Newborn asphyxia is pathological condition, which occurs in a child in the early neonatal period and manifests itself as a violation respiratory function, development of hypoxic and hypercapnic syndromes.

The condition of asphyxia is observed in approximately 4-6% of newborns and becomes one of the main causes of perinatal mortality.

Causes and risk factors

Diseases of a pregnant woman can lead to fetal asphyxia, pathological development pregnancy, intrauterine infections. Primary form asphyxia is most often caused by acute or intrauterine fetal hypoxia, the causes of which are:

• immunological incompatibility of maternal blood and fetal blood;
• intrauterine infections (herpes, chlamydia, toxoplasmosis, syphilis, cytomegalovirus, rubella);
• aspiration asphyxia (complete or partial obstruction of the respiratory tract with mucus or amniotic fluid);
• fetal development abnormalities;
• extragenital pathology ( diabetes, thyrotoxicosis, lung or heart disease, anemia);
• burdened obstetric history (complicated childbirth, post-term pregnancy, premature placental abruption, gestosis);
• mother's presence bad habits, her use of prohibited substances.

The development of secondary asphyxia in a newborn is based on pneumopathy or cerebrovascular accidents in the child. Pneumopathy is a non-infectious lung disease of the perinatal period that occurs as a result of incomplete expansion of the lungs in a newborn, which leads to the development of atelectasis, hyaline membrane disease or edematous-hemorrhagic syndrome.

Diagnosis and assessment of the severity of asphyxia in newborns is based on the Apgar scale.

Pathogenetic changes occurring in the child’s body during neonatal asphyxia do not depend on the causes that caused this syndrome. Against the background of hypoxia, the child develops respiratory-metabolic acidosis, which is characterized by hypoglycemia, azotemia, and initial hyperkalemia, which is then replaced by hypokalemia. Violations electrolyte balance lead to cellular hyperhydration.

In acute asphyxia in newborns, the volume of circulating blood increases mainly due to red blood cells. At chronic form pathology, hypovolemia (decreased circulating blood volume) is observed. Such disturbances have a significant impact on blood rheology, worsening microcirculatory circulation.

Microcirculatory changes, in turn, cause hypoxia, swelling, ischemia, hemorrhages that occur in the liver, adrenal glands, heart, kidneys, but above all in the newborn’s brain.

Ultimately, disturbances of not only peripheral but also central hemodynamics develop, blood pressure drops, and cardiac output and stroke volumes decrease.

Kinds

Depending on the time of occurrence, newborn asphyxia is divided into two types:

1. Primary – occurs in the first minutes of a baby’s life.
2. Secondary – develops during the first days after birth.

In terms of severity, asphyxia of newborns is mild, medium degree and heavy.

Diseases of the pregnant woman, pathological development of pregnancy, and intrauterine infections can lead to fetal asphyxia.

Symptoms

The main signs of newborn asphyxia are breathing disorders, which subsequently lead to dysfunction of cardio-vascular system, reflexes and muscle tone.

To assess the severity of asphyxia in newborns, the Apgar method (scale) is used. It is based on a score of the following criteria:

• heel reflex (reflex excitability);
• breath;
• heartbeat;
• muscle tone;
• skin coloring.

Assessment of the newborn's condition using the Apgar scale:

Parameter	Score in points
Heart rate, beats/min	Absent
	Absent	Bradypnea, irregular	Normal, loud scream
Skin coloring	Generalized pallor or generalized cyanosis	Pink coloration of the body and bluish coloration of the limbs (acrocyanosis)	Pink coloring of the whole body and limbs
Muscle tone	Absent	Slight degree of limb flexion	Active movements
Reflex excitability (reaction to suction of mucus from the upper respiratory tract, irritation of the soles)	Absent

With a mild degree of asphyxia, the condition of newborns on the Apgar scale is assessed at 6–7 points, moderate severity – 4–5 points, severe – 1–3 points. At clinical death the newborn's Apgar score is 0.

Mild asphyxia of a newborn is characterized by:

• first breath in the first minute of life;
• decreased muscle tone;
• cyanosis of the nasolabial triangle;
• weakened breathing.

With moderate asphyxia of newborns, the following are observed:

• weakened breathing;
• bradycardia;
• faint cry;
• acrocyanosis;
• decreased muscle tone;
• pulsation of the umbilical cord vessels.

Severe asphyxia of newborns is manifested by the following symptoms:

• lack of screaming;
• apnea or irregular breathing;
• severe bradycardia;
• muscle atony;
• pale skin;
• areflexia;
• development of adrenal insufficiency;
• absence of pulsation of the umbilical cord vessels.

Against the background of asphyxia, posthypoxic syndrome may develop in newborns in the first day of life, which is characterized by signs of damage to the central nervous system (disorders of liquorodynamics, cerebrovascular accidents).

Diagnostics

Diagnosis and assessment of the severity of asphyxia in newborns is based on the Apgar scale. To confirm the diagnosis, a study of the acid-base balance of the blood is carried out.

With the aim of differential diagnosis with intraventricular, subarachnoid, subdural hemorrhages and hypoxic damage to the central nervous system, ultrasonography (ultrasound of the brain) and a complete neurological examination of the child are indicated.

Treatment

All children born in a state of asphyxia need urgent assistance medical care, aimed at restoring breathing, correcting existing hemodynamic disorders, electrolyte balance and metabolism.

For mild to moderate asphyxia of newborns therapeutic measures include:

• aspiration of contents from oral cavity and nasopharynx;
• assisted ventilation using a breathing mask;
• insertion through the umbilical vein hypertonic solution glucose and cocarboxylase.

If the measures listed above do not lead to the restoration of spontaneous breathing, tracheal intubation is performed, followed by sanitation of the respiratory tract and the child is transferred to artificial ventilation. For correction respiratory acidosis sodium bicarbonate is administered intravenously.

With severe asphyxia, newborns require urgent resuscitation. Tracheal intubation is performed, the child is connected to the apparatus artificial ventilation lungs, carry out external massage hearts. Then the existing disorders are treated with medication.

In severe neonatal asphyxia, if the baby survives, there is a high risk of developing serious complications.

Newborns with mild degree Those with asphyxia are placed in an oxygen tent, and in case of moderate or severe asphyxia, they are placed in an incubator. These children demand special attention medical personnel. Questions regarding drug treatment, feeding and caring for such children are decided on a case-by-case basis by a neonatologist.

All children who have suffered asphyxia during the neonatal period should subsequently be kept on dispensary observation from a neurologist.

Possible complications and consequences

A severe form of asphyxia can cause the death of a newborn in the first hours or days of his life. IN long term Children who have suffered asphyxia as a newborn may experience the following disorders:

• perinatal convulsive encephalopathy;
• hydrocephalus;
• hypertensive syndrome;
• hypo- or hyperexcitability syndrome.

Forecast

The prognosis depends on the form of the disease. In the case of a mild form, it is favorable; the outcome of asphyxia of moderate severity in newborns largely depends on the timeliness of medical care; in general, it is favorable. In severe neonatal asphyxia, if the baby survives, there is a high risk of developing serious complications.

The condition of asphyxia is observed in approximately 4-6% of newborns and becomes one of the main causes of perinatal mortality.

Prevention

Prevention of newborn asphyxia includes the following measures:

• active therapy extragenital pathology in pregnant women;
• rational management of pregnancy and childbirth, taking into account the risk factors available in each specific case;
• intrauterine monitoring of the condition of the fetus and placenta.

Video from YouTube on the topic of the article:

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 serious problem for doctors providing assistance in the delivery room. Every year around the world, about a million children die from asphyxia and about the same number of children develop serious complications subsequently.

Asphyxia of the fetus and newborn occurs with hypoxia (decreased oxygen concentration in tissues and blood) and hypercapnia (increased oxygen content carbon dioxide in the body), which is manifested by severe respiratory and circulatory disorders and disturbances in the functioning 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 occurring immediately at the time of birth (rapid or prolonged labor, placental previa or premature 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, failure of the respiratory or cardiovascular 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 system, 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 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. 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 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. 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 the newborn's breathing, heartbeat, muscle tone, skin coloring and reflexes. 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. Occur frequently various bleeding 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.

Late complications include the following conditions:

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 a set of medical measures 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 correct assessment 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 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 damaged, the greater the likelihood of death, the risk of complications and the longer the period of full recovery. Premature babies have a worse prognosis than babies born full term.

Asphyxia of newborns is a critical condition characterized by impaired gas exchange: an insufficient amount of oxygen reaches the child, and excess carbon dioxide accumulates in his body. Asphyxia is manifested by the absence or weakening of breathing while the heart function is preserved. In approximately 4-6% of births, newborn asphyxia is diagnosed.

Causes

Doctors distinguish 2 types of asphyxia:

1. primary, appears at the moment of birth of a child;
2. secondary, the newborn suffocates or stops breathing a few hours or days after birth.

Primary asphyxia

Appears due to chronic or acute intrauterine oxygen deficiency. Let us list the reasons for the development of this condition:

• failure of the child’s respiratory movements (intrauterine brain damage due to infection, abnormal development of the lungs, consequences drug treatment women);
• insufficient oxygen supply to the blood of a pregnant woman (thyroid disease, diabetes, respiratory system, cardiovascular pathology, anemia);
• circulatory disorder in the placenta (dysfunction of labor, increased blood pressure in a pregnant woman);
• gas exchange disorder in the placenta (placental previa or premature placental abruption);
• sudden cessation of blood flow in the umbilical cord (multiple entanglement of the umbilical cord around the child’s neck, umbilical cord constriction).

Also, the cause of newborn asphyxia can be:

• complete or partial blockage of the respiratory tract with amniotic fluid, meconium, mucus;
• Rh conflict between mother and child;
• intracranial injury of a newborn.

Secondary asphyxia

This can happen for the following reasons:

• immaturity of the lungs in premature infants;
• pneumopathy;
• congenital malformation of the brain, heart, lungs;
• aspiration of the respiratory tract with vomit;
• circulatory disorder in the brain.

Signs and degrees of asphyxia

The main sign of asphyxia in a newborn is respiratory distress, which leads to impaired circulation and heart rate, due to which reflexes weaken and neuromuscular conduction deteriorates.

To assess the severity of asphyxia, the Apgar scale is used, which takes into account the following criteria: reflex excitability, muscle tone, skin color, respiratory movements, heart rate. Depending on how many points the newborn scores on the Apgar scale, doctors distinguish 4 degrees of asphyxia.

1. Mild degree. According to Apgar, the child's condition is assessed at 6-7 points. The newborn takes his first spontaneous breath within the first minute after birth. But the child’s breathing is weak, the nasolabial triangle is visible, and the muscle tone is reduced. There is reflex excitability: the baby coughs or sneezes.
2. Average degree. Apgar score 4-5 points. The newborn takes his first breath in the first minute, but breathing is irregular, very weakened, the cry is weak, and the heartbeat is slow. There is also a cyanosis of the child’s face, hands, feet, a grimace on his face, weak muscle tone, and the umbilical cord is pulsating.
3. Severe degree. Apgar status is assessed at 1-3 points. Breathing is irregular and infrequent or absent at all. The newborn does not cry, there are no reflexes, the heart rate is rare, muscle tone is weak or absent, the skin is pale, and the umbilical cord does not pulsate.
4. Clinical death. The Apgar score is 0 points. The child does not have any signs of life. He requires immediate resuscitation.

Treatment

Treatment of a newborn with asphyxia begins immediately after birth. Resuscitation measures and further treatment carried out by a resuscitator and a neonatologist.

In the delivery room

The child is placed on a changing table, wiped dry with a diaper, and mucus is sucked out from the mouth and upper respiratory tract using an aspirator. If the baby's breathing is irregular or absent, an oxygen mask is placed on his face for artificial lung ventilation (ALV). After 2 minutes, cardiac activity is assessed, if the heart rate (HR) per minute is 80 or less, they begin to give the child an indirect cardiac massage. After 30 seconds, the newborn’s condition is assessed again; if there is no improvement, then the baby is injected into the umbilical vein medications. At the end of resuscitation measures, the child is transferred to the intensive care unit.

In the intensive care ward

Newborns with mild asphyxia are in the oxygen ward, and babies with moderate and severe asphyxia are in incubators. The child is provided with warmth and rest. A newborn is given intravenous infusion the following drugs: vitamins, antibacterial agents, “Calcium gluconate” (to prevent cerebral hemorrhage), “Vikasol”, “Dicinone”, “ATP”, “Cocarboxylase”. child with mild form Asphyxia is allowed to feed 16 hours after birth. A newborn with a severe form is tube fed after 24 hours. The duration of the baby's stay in the intensive care unit depends on his condition, in most cases it ranges from 10 to 15 days.

Consequences

The consequences of newborn asphyxia are no less dangerous than the condition itself, as they lead to the development of complications.

Early complications:

• brain necrosis;
• bleeding in the brain;
• cerebral edema.

Late complications.