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

Asphyxia of newborns - what is it? First of all, it should be said that this concept is not clearly delineated. In the most general sense, they denote 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 asphyxiation is a consequence of oxygen starvation during intrauterine development... Therefore, in relation to newborns, the terms and hypoxia are used interchangeably.

In contact with

Asphyxia in a newborn baby (fetus)

According to world statistics, about 20% of those born with asphyxia die after childbirth. Another 20% subsequently suffer from one or another functional disorders work-related nervous system.

Complete lack of breathing in newly born is diagnosed in 1% of children. Breathing with insufficiently effective 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 respiratory failure.

Classification of newborn asphyxia

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

Arising from prolonged hypoxia in the womb;
which is a consequence of the course of childbirth.

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

Asphyxia against the background of chronic antenatal fetal hypoxia

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

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

Acute asphyxia against the background of intrapartum hypoxia

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

Abnormal position of the fetus;
deviations during pregnancy and childbirth - premature, rapid, late;
maternal hypoxia during childbirth;
fetal aspiration of amniotic fluid;
head injury or spinal cord;
the use of pain relievers during childbirth;
C-section.

It would be wrong to believe that any hypoxia will inevitably lead to postnatal asphyxia. For example, caesarean section is becoming more common. In most cases, healthy babies are born.

The degree of asphyxia in newborns

For a more detailed understanding of what is asphyxia in a child, a special scale developed by an anesthesiologist from the United States, 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;
inability of the newborn to adapt to postnatal circulation and respiration.

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

Violation of the blood supply to the fetus through the umbilical cord (presence of nodes, mechanical compression);
placental disorders (insufficient gas exchange, decreased or high blood pressure, edema, heart attacks, inflammation, premature detachment);
pathology 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 switch to postnatal breathing is based on the following reasons:

Systemic developmental disorders, including as a result of intrauterine hypoxia;
congenital stenosis (narrowing) respiratory tract;
birth trauma to the brain;
work disruptions thyroid gland;
prematurity.

Treatment of asphyxia in newborns

newborn

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

The child is placed under a heat source;
dry the skin;
carry out tactile stimulation on the back, sole of the foot;
put the child on his back, throw his head back a little;
cleanse the mouth and nasopharynx from the contents;
suction amniotic fluid from the respiratory tract using an endotracheal tube;
in case of insufficient breathing or its complete absence, mechanical ventilation of the lungs is started;
at long-term ventilation a probe is inserted into the stomach of the lungs, through which the gas accumulating in it is sucked off.

All the above steps are carried out quickly within 2-3 minutes, periodically recording vital signs. If, after the performed manipulations, the heartbeat has reached 100 beats / min., Spontaneous breathing has appeared, and the skin has acquired a pinkish tint, artificial ventilation is stopped. If the child's condition has not improved, further resuscitation is continued.

Resuscitation of newborns with asphyxia

Resuscitation is continued with chest compressions, which are performed for 30 seconds. If the heartbeats remain at 60-80 beats / min. or absent altogether resort to medication.

Adrenalin

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

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

Infusion therapy.

In cases where there is no effect from the measures taken, blood volume supplements 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.

In case of ineffectiveness of the applied measures, it is shown intravenous administration 4% sodium bicarbonate solution at a dosage of 4 ml / kg.

If necessary, pulmonary ventilation and infusion therapy continue as part of the postresuscitation 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 the daily routine;
daily walks several times a day;
balanced diet, rich in vegetables, proteins, amino acids, vitamins and minerals;
additional vitamin support;
positive emotions and a calm, balanced state.

Caring for a child after suffering asphyxia

A child who has undergone asphyxia has a high probability of developing disorders of the nervous system. After discharge from the hospital, such a child should be under the supervision of a neurologist. No special home care 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 neonatal asphyxia are manifested, first of all, in a poor reaction to resuscitation measures. In the absence of positive dynamics in the state of the newborn at the 20th minute after childbirth, the probability of death increases and amounts to:

up to 60% - for those born at normal time;
up to 100% - in those born prematurely.

The consequences of severe birth trauma asphyxiation are reflected in the brain. For example, a baby's poor response to resuscitation within 15 minutes after delivery results in development of cerebral palsy in 10% of cases, and within 20 minutes - in 60%. But these are very difficult cases.

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

Such children, for example, are too active or, conversely, too phlegmatic. Sometimes they may not do well in school, but, on the contrary, they show themselves perfectly in creative pursuits, circles. Possible later appearance of speech was noted.

Similar variations in the development of a child can occur for other reasons unrelated to birth asphyxia. It is customary to call all this in one word - individuality, and should not cause concern for parents.

Conclusion

Though complete absence respiration at birth occurs only in 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 can be delayed later life child. Any expectant mother you should be attentive to your health, keep calm and positive mood during pregnancy.

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

The development of oxygen deficiency and shortness of breath - this is the asphyxia of newborns. This dangerous illness can occur both at the time of birth and during the first day of the baby's life. When a baby is born, it should immediately learn to breathe on its own. If in the process of adaptation to extrauterine conditions of life a failure occurs, respiratory failure occurs. Topic of the article: asphyxia during childbirth - the consequences of oxygen deficiency.

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

intracranial injury;
blockage of the respiratory tract by amniotic fluid.

Intrauterine pathology may appear due to:

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

Secondary asphyxia may appear due to a violation cerebral circulation newborn or central nervous system damage at the time of birth. Difficulty breathing a baby can get when the umbilical cord is entwined around the neck during childbirth or premature placental abruption in the mother (oligohydramnios).

Immediately after the birth of a newborn, obstetricians assess his condition on the ten-point Apgar scale. In severe asphyxia (below three points), urgent resuscitation measures are taken. From the first minutes of life, experienced specialists can determine the state of the crumbs by correct breathing, muscle contractions, heartbeats and skin.

Three degrees of the disease

The main sign of pathology in a baby is wrong breathing... In the process of intrauterine development and passage through the birth canal, the baby can get asphyxiation varying degrees severity. With mild asphyxia (6-7 points), the newborn has:

slightly reduced muscle tone;
inhibited physical activity;
poorly expressed physiological reflexes;
diffuse cyanosis in the nasolabial region;
weak intermittent breathing (shallow).

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

With pathology moderate(4-5 points) newborns have:

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

The baby sighs, but the breathing is devoid of rhythm. This degree of pathology is characterized by the presence of tachycardia in an infant (heart palpitations), and the skin on the limbs (feet and palms) and the face has a bright bluish tint.

In severe pathology (3-1 points), there is:

lack of spontaneous breathing;
blanching skin;
lack of physiological reflexes;
weak pulse and palpitations.

With a given degree of pathology, the baby can breathe, but does not scream. For muscular system characterized by atony / hypotension, no pulsation of the umbilical cord. The skin is pale, and congenital reflexes do not appear in any way.

Severe brain damage at birth may result in the absence of a congenital sucking / swallowing reflex. To an extreme degree (zero point of the Apgar scale), fetal asphyxiation can result in the death of the newborn.

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

Consequences

This pathology changes the metabolic processes in the baby's body. If asphyxia develops on the basis of 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 micro-hemorrhages can form, which destroy the tissue structure. Hypoxia lowers the pressure in the bloodstream, which affects the work of the heart - the contractions of the heart muscle slow down, their number decreases.

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

slow development of speech skills;
inhibition of mental reactions;
inadequate reaction to the situation;
poor assimilation of the school curriculum;
weakening of immunity.

The child's coordination of movements may be imbalanced, the emotional background is increased, the processes of excitation and inhibition are uncoordinated.

The most severe form of fetal asphyxiation is children cerebral paralysis(Cerebral palsy).

Cerebral palsy is not cured, the child constantly needs intensive care and attention. You need to constantly deal with the baby, and when you stop exercising, the symptoms of cerebral palsy are aggravated.

Baby care

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

Therapeutic efforts are aimed at eliminating the cause of cerebral edema, restoring metabolic processes and the function of the urinary system.

The consequences of asphyxia are difficult for a baby. The newborn needs to be disturbed less, to provide 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 can develop cerebral palsy. TO possible consequences postponed asphyxia can be attributed to:

convulsive and hydrocephalic syndromes;
diencephalic pathology;
hyperexcitability.

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

Prophylaxis

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

It is necessary to completely change the whole way of life and, above all, give up smoking and alcohol.

The mother-to-be must do daily hiking, saturating your body with oxygen. Air conditioners and room ventilation do not replace walks in the park or square. Oxygen from the mother's blood enters the fetus and prevents the onset 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 the development of pathology, future mother should:

treat even a minimal runny nose in time;
monitor changes in your hormonal levels;
go to bed not at night, but in the evening;
do not sit at a laptop for a long time without a reason;
follow the diet;
do not participate in conflict situations.

The diet involves great use fruit and vegetable dishes and a sufficient intake of low-fat dairy products. The local gynecologist will tell you about the diet in detail. For the prevention of vitamin deficiency, a special vitamin complex for pregnant. Also shown is the intake of iron and folic acid preparations.

Peace of mind - important point for a successful pregnancy and birth. Have calm moms babies are born without deviations in the psyche and health. Of course, provided that all other rules of behavior during pregnancy are observed.

Also, a woman should visit a gynecologist within the prescribed time frame. Monitoring the fetus and placenta is essential. Exactly early detection oxygen starvation of the fetus will help start timely treatment, and fetal asphyxia will not develop.

How to get rid of stretch marks after childbirth?

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

Asphyxia is observed in about 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 asphyxiation, 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 mother's blood and fetal blood;
intrauterine infections (herpes, chlamydia, toxoplasmosis, syphilis, cytomegalovirus, rubella);
aspiration asphyxia (complete or partial obstruction of the airways with mucus or amniotic fluid);
fetal malformations;
extragenital pathology ( diabetes, thyrotoxicosis, lung or heart disease, anemia);
burdened obstetric history (complicated labor, post-term pregnancy, premature placental abruption, preeclampsia);
the mother has bad habits, her use of prohibited substances.

The development of secondary asphyxia of a newborn is based on pneumopathies or cerebrovascular accidents in a child. Pneumopathies are non-infectious diseases of the lungs of the perinatal period, resulting from 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 newborn asphyxia is based on the Apgar scale.

The pathogenetic changes occurring in the child's body during asphyxia of newborns do not depend on the reasons that caused this syndrome. Against the background of hypoxia, the child develops respiratory-metabolic acidosis, which is characterized by hypoglycemia, azotemia, initial hyperkalemia, followed by hypokalemia. Violations electrolyte balance entail cellular overhydration.

With acute asphyxia in newborns, an increase in the volume of circulating blood occurs mainly due to erythrocytes. At chronic form pathology, hypovolemia is observed (a decrease in the volume of circulating blood). Such violations have a significant effect on blood rheology, impairing microcirculatory blood circulation.

Microcirculatory changes, in turn, cause hypoxia, edema, ischemia, hemorrhages in the liver, adrenal glands, heart, kidneys, but above all in the brain of the newborn.

Ultimately, disorders of not only peripheral, but also central hemodynamics develop, blood pressure drops, minute and stroke volumes of the heart decrease.

Kinds

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

Primary - arises in the first minutes of a baby's life.
Secondary - develops within the first days after birth.

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

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

Symptoms

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

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

heel reflex (reflex excitability);
breath;
palpitations;
muscle tone;
coloring of the skin.

Assessment of the condition of the newborn according to the Apgar scale:

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

With a mild degree of asphyxia, the state of newborns on the Apgar scale is estimated at 6-7 points, moderate - 4-5 points, severe - 1-3 points. At clinical death the newborn Apgar score is 0 points.

For a mild degree of asphyxia of a newborn, the following are characteristic:

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

With asphyxia of moderate newborns, the following are observed:

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

Severe asphyxia of newborns is manifested by the following symptoms:

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

Against the background of asphyxia in newborns in the first day of life, post-hypoxic syndrome may develop, which is characterized by signs of damage to the central nervous system (cerebrospinal fluid dynamics, cerebrovascular accident).

Diagnostics

Diagnosis and assessment of the severity of newborn asphyxia 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 the existing disorders of hemodynamics, electrolyte balance and metabolism.

With asphyxiation of newborns of mild to moderate severity therapeutic measures include:

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

If the above measures do not lead to the restoration of spontaneous breathing, the trachea is intubated with subsequent sanitation of the airways and the transfer of the child to artificial ventilation. For correction respiratory acidosis sodium bicarbonate is injected intravenously.

With a severe degree of asphyxia, newborns need urgent resuscitation. Tracheal intubation is performed, the child is connected to the device artificial ventilation lungs, spend outdoor massage hearts. Then carry out drug treatment of existing disorders.

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

Newborns with mild asphyxia is placed in an oxygen tent, and in case of moderate or severe asphyxia, in an incubator. These children demand to themselves special attention medical staff... Questions concerning drug treatment, feeding and caring for such children, are decided on a case-by-case basis by a neonatologist.

All children who have undergone asphyxia during the neonatal period should be kept on dispensary supervision at 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. V remote period in children who have undergone asphyxia in a neonatal state, the following disorders may occur:

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

Forecast

The prognosis depends on the form of the disease. In the mild form, it is favorable, the outcome of moderate neonatal asphyxia largely depends on the timeliness of medical care, and is generally favorable. In severe neonatal asphyxia, if the child survives, there is a high risk of serious complications.

Asphyxia is observed in about 4-6% of newborns and becomes one of the main causes of perinatal mortality.

Prophylaxis

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 case;
intrauterine monitoring of the condition of the fetus and placenta.

YouTube video related to the article:

Asphyxia of newborns is suffocation, manifested by impaired breathing, or lack of spontaneous breathing in the presence of heartbeat and other signs of life. In other words, the baby is incapable, cannot breathe on its own immediately after birth, or he breathes, but his breathing is ineffective.

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

A child born in asphyxiation is serious problem for doctors providing care 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 afterwards.

Asphyxia of the fetus and newborn proceeds with hypoxia (a decrease in oxygen concentration in tissues and blood) and hypercapnia (an increase in carbon dioxide in the body), which is manifested by severe respiratory and circulatory disorders and disorders of the child's nervous system.

Causes of newborn asphyxia

Factors contributing to the development of asphyxia

Distinguish between antenatal and intrapartum factors.

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

diseases of the mother (diabetes mellitus, hypertension, diseases and defects of the heart and blood vessels, kidneys, lungs, anemia);
problems of previous pregnancies (miscarriages, stillbirths);
complications during this pregnancy (the threat of miscarriage and bleeding, polyhydramnios, oligohydramnios, undermaturity or overmaturity, multiple pregnancies);
the mother is taking certain medications;
social factors (taking drugs, lack of medical supervision during pregnancy, pregnant women under the age of 16 and over 35).

Intranatal factors act on the baby during childbirth.

Intranatal factors include various complications that occur immediately at the time of birth (rapid or protracted labor, previa or premature placental abruption, abnormalities generic activity).

All of them lead to fetal hypoxia - a decrease in the supply of oxygen to the tissues and to oxygen starvation, which significantly increases the risk of having a baby with asphyxiation.

Causes of asphyxia

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

Insufficient clearance of toxins from the maternal part of the placenta as a result of low or high pressure from the mother, overly active contractions, or for other reasons.
A decrease in the concentration of oxygen in the blood and organs of the mother, which may be caused by severe anemia, insufficiency of the respiratory or cardiovascular system.
Various pathologies on the part of the placenta, as a result of which gas exchange through it is disrupted. These include calcifications, presentation or premature placental abruption, placental inflammation and hemorrhage.
Interruption or disruption of blood flow to the fetus through the umbilical cord. This occurs when the umbilical cord tightly wraps around the baby's neck, when the umbilical cord is squeezed during the baby's passage through the birth canal, when the umbilical cord falls out.
Insufficient breathing efforts of the newborn with the depressing effect of drugs on the nervous system (a consequence of the mother's treatment various medicines), as a result of severe malformations, with prematurity, due to 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 trauma and severe intrauterine infections.

A special risk group for the development of asphyxia is made up of premature babies, whose birth weight is extremely low, post-term and children who have intrauterine growth retardation. These children are at the highest risk of developing asphyxia.

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

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

Smoking during pregnancy causes:

constriction of the uterine vessels, which continues for another half hour after a smoked cigarette;
suppression of the respiratory activity of the fetus;
an increase in the concentration of carbon dioxide in the blood of the fetus 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 (a decrease in the level of oxygen in the blood), the fetus's body tries to compensate for the lack of oxygen. This is manifested by an increase in blood volume, increased heart rate, increased respiration, and increased fetal motor activity. The lack of oxygen is compensated for by such adaptive reactions.

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 heart rate decreases, breathing becomes less frequent, and its depth increases.

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

The lungs of a full-term fetus before childbirth secrete fluid, which enters the amniotic fluid. Respiration of the fetus is shallow and the glottis is closed, therefore, 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 the amniotic fluid enters the lungs. This is how the aspiration takes place. Substances in the amniotic fluid cause inflammation lung tissue, make it difficult for the lungs to expand on the first breath, which leads to impaired breathing. Thus, the result of aspiration by amniotic fluid is asphyxia.

Respiratory 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 respiratory distress that are not related to the lung include the following conditions:

Nervous system disorders: abnormalities in the development of the brain and spinal cord, the effects of drugs and drugs, infection.
Violation of the cardiovascular system. These include malformations of the heart and blood vessels, dropsy of the fetus.
Developmental defects gastrointestinal tract: atresia of the esophagus (blindly ending the esophagus), fistulas between the trachea and the esophagus.
Metabolic disorders.
Dysfunction of the adrenal and thyroid glands.
Blood disorders such as anemia.
Improper development of the airways.
Congenital malformations of the skeletal system: malformations of the sternum and ribs, as well as rib injuries.

Types of newborn asphyxia

Acute asphyxia caused by exposure only to intranatal factors, that is, arising during childbirth.
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 severity, they are distinguished:

slight asphyxia;
moderate asphyxia;
severe asphyxia.

Neonatologists assess the condition of a newborn child using the Apgar scale, which includes an assessment of breathing, heart rate, muscle tone, skin color and reflexes of the newborn. The assessment of the condition of the newborn is carried out at the first and fifth minute of life. Healthy children gain 7-10 points on the Apgar scale.

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

Light asphyxia

Manifested by cardiorespiratory depression. This is a depression of breathing or heartbeat as a result of stress that the child feels during the transition from intrauterine life to the outside world.

Childbirth is a tremendous stress for a child, especially if there are any complications. At the same time, in the first minute of life, the baby receives an assessment of 4-6 points according to Apgar. As a rule, for such children it is enough to create optimal conditions the surrounding world, warmth and temporary support of breathing, and after five minutes the child is recovering, he is given 7 points and higher.

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 becomes silent. The baby's skin is bluish, but turns pink quickly after inhaling oxygen through the mask. Rapid palpitations, reduced reflexes.

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

The baby's condition at birth is severe or extremely difficult.

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

In very severe asphyxia, the skin is pale or sallow. The pressure is low. The child does not breathe, does not react to examination, eyes are closed, there is no movement, reflexes are absent.

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

Asphyxia and hypoxia. Differences in manifestations in newborns

The picture of acute asphyxia and asphyxia in children who have undergone intrauterine hypoxia has some differences.

Features of children born in asphyxia who have undergone prolonged intrauterine hypoxia are presented below.

Significantly pronounced and long-lasting metabolic and hemodynamic disorders (movement of blood in the vessels of the body).
Often there are various bleeding as a result of inhibition of hematopoiesis and a decrease in the content of trace elements in the blood, which are responsible for stopping bleeding.
More often, severe lung lesions develop as a result of aspiration, surfactant deficiency (this substance prevents the lungs from collapsing) and inflammation of the lung tissue.
Metabolic disorders often occur, which is manifested by a decrease in blood sugar and important trace elements (calcium, magnesium).
Characterized by neurological disorders resulting from hypoxia and due to cerebral edema, hydrocephalus (dropsy), hemorrhages.
Often combined with intrauterine infections, bacterial complications often join.
After the postponed asphyxia, there are long-term consequences.

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

TO early complications the following conditions apply:

Brain damage, which is manifested by edema, intracranial hemorrhage, death of brain areas due to lack of oxygen.
Violation of blood flow through the vessels of the body, which is manifested by shock, pulmonary and heart failure.
Kidney damage, manifested by renal failure.
Pulmonary involvement, manifested by pulmonary edema, pulmonary hemorrhage, aspiration, and pneumonia.
The defeat of the digestive system. The intestine suffers most of all, its motility is disturbed, as a result of insufficient blood supply, some parts of the intestine die off, and inflammation develops.
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:

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

Resuscitation of newborns with asphyxia

The condition of children born in asphyxiation requires intensive care... Resuscitation is a complex of medical measures aimed at revitalizing, resuming breathing and heart contractions.

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

"A" means the provision and maintenance of an airway;
"B" stands for breath. It is necessary to restore breathing with the help of artificial or assisted ventilation;
"C" means to restore and support the contractions of the heart 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 the condition of the child.

The readiness of the medical staff. Ideally, care should be provided by two people who have the appropriate skills and know how the pregnancy and childbirth went. Before labor starts, nursing staff should check if equipment and medication are ready to help.
The readiness of the place where the child will be helped. It should be specially equipped and located directly in the delivery room or in the immediate vicinity of it.
Providing resuscitation in the first minute of life.
Stages of resuscitation according to the "ABC" -system with an assessment of the effectiveness of each stage.
Caution in infusion therapy.
Observation after relief of asphyxia.

Respiratory recovery begins as soon as birth canal a head appears, with the suction of mucus from the nose and mouth. Once the baby is fully born, it needs to be rewarmed. To do this, it is wiped off, wrapped in heated diapers and placed under radiant heat. In the delivery room there should be no leakage, the air temperature should not drop below 25 ºС.

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

If the baby cries out, they put him on his mother’s belly. If the baby is not breathing, breathing is stimulated by wiping the back and patting the baby's soles. With moderate and severe asphyxia, breathing stimulation is ineffective, so the child is quickly transferred to radiant heat and artificial ventilation (ALV) is started. After 20 - 25 seconds, they look to see if breathing has appeared. If the baby's breathing is restored and the heart rate is above 100 per minute, resuscitation is stopped and the baby's condition is monitored, trying to feed the baby with mother's milk as soon as possible.

If there is no effect of mechanical ventilation, the contents of the oral cavity are aspirated again and mechanical ventilation is resumed. In the absence of breathing on the background of mechanical ventilation for two minutes, tracheal intubation is performed. A hollow tube is inserted into the trachea, which provides air to the lungs, the child is connected to an artificial respiration apparatus.

In the absence of a heartbeat or a decrease in the heart rate of less than 60 per minute, begin indirect massage heart, 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 for the prevention of asphyxia are reduced to the timely identification and elimination of the causes of fetal hypoxia in a pregnant woman.

Every pregnant woman should be monitored by a gynecologist throughout her pregnancy. It is necessary to get registered on time, take tests, undergo medical consultations 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 asphyxiation before full recovery- quite long.

After the events held in the delivery room, the children are transferred to the children's intensive care unit or to the neonatal pathology department. In the future, if required, prescribe rehabilitation therapy in specialized departments.

The prognosis largely depends on the severity of brain damage caused by hypoxia. The more the brain suffers, the greater the likelihood of death, the risk of complications, and the longer the period of complete recovery. Premature babies have a worse prognosis than babies born on time.

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

Causes

Doctors distinguish between 2 types of asphyxia:

primary, appears at the moment the child is born;
secondary, the newborn suffocates or stops breathing several hours or days after birth.

Primary asphyxia

It appears due to chronic or acute intrauterine oxygen deficiency. We list the reasons for the development of such a condition:

failure of the child's breathing (intrauterine brain damage by infection, abnormal development of the lungs, consequence drug treatment women);
insufficient oxygen supply to the blood of a pregnant woman (thyroid disease, diabetes mellitus, illness respiratory system, cardiovascular pathology, anemia);
circulatory disorder in the placenta (dysfunction of labor, increased blood pressure in a pregnant woman);
disorder of gas exchange in the placenta (presentation or premature placental abruption);
sudden cessation of blood flow in the umbilical cord (repeated entanglement of the umbilical cord around the baby's neck, tightening of the umbilical cord).

Also, the cause of asphyxia of a newborn can be:

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

Secondary asphyxia

It can happen for the following reasons:

immaturity of the lungs in premature babies;
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 breathing disorder, which leads to impaired blood circulation and heart rate, due to which reflexes weaken, and neuromuscular conduction worsens.

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 scored on the Apgar scale, doctors distinguish 4 degrees of asphyxia.

Mild degree... According to Apgar, the child's condition is estimated at 6-7 points. The newborn takes its first spontaneous breath within the first minute after birth. But the child's breathing is weak, the cyanosis of the nasolabial triangle is visible, the muscle tone is reduced. Reflex irritability is present: the baby coughs or sneezes.
Medium degree... Apgar score 4-5 points. The newborn takes the first breath in the first minute, but breathing is irregular, very weak, the cry is weak, the heartbeat is slow. There is also a cyanosis of the face, hands, feet of the child, a grimace on his face, muscle tone is weak, the umbilical cord pulsates.
Severe degree... The Apgar state is estimated at 1-3 points. Breathing is irregular and infrequent, or none at all. The newborn does not cry, reflexes are absent, heart contractions are rare, muscle tone is weak or absent, the skin is pale, the umbilical cord does not pulsate.
Clinical death... Apgar score is 0 points. The child has no signs of life. He needs immediate resuscitation.

Treatment

Treatment for a newborn with asphyxiation begins immediately after birth. Resuscitation measures and further treatment performed by an intensive care physician 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 of the mouth and upper respiratory tract using an aspirator. If the baby's breathing is irregular or absent, an oxygen mask is put on his face for artificial lung ventilation (ALV). After 2 minutes, the cardiac activity is assessed, if the heart rate (HR) per minute is 80 or less, they begin to give the child an indirect heart massage. After 30 seconds, the condition of the newborn is again assessed, if there is no improvement, then the baby is injected into the umbilical vein medications... At the end of resuscitation, the child is transferred to the intensive care unit.

In the intensive care unit

Newborns with a mild degree of asphyxia are in the oxygen chamber, and babies with a moderate and severe degree in incubators. The child is provided with warmth and rest. Newborn do intravenous infusion the following drugs: vitamins, antibacterial agents, "Calcium gluconate" (to prevent cerebral hemorrhage), "Vikasol", "Dicinon", "ATP", "Cocarboxylase". Child with mild form asphyxia are allowed to feed 16 hours after birth. A severely ill newborn is tube fed after 24 hours. The length of a 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, since they lead to the development of complications.

Early complications:

brain necrosis;
hemorrhage in the brain;
swelling of the brain.

Late complications.