What is newborn asphyxia: pulmonary and extrapulmonary causes of development, medical tactics. Asphyxia of newborns during childbirth: consequences, causes, help, what will happen at an older age

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

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

Among the many factors that damage the brain of newborns, hypoxia, which can be classified as a universal damaging agent, deserves special mention. Asphyxia recorded in newborns is very often only a continuation of hypoxia that began in utero. Intrauterine hypoxia and hypoxia during childbirth are the cause of perinatal mortality in 20-50% of cases, stillbirths in 59%, and in 72.4% hypoxia and asphyxia become one of the main causes of fetal death in childbirth or the early neonatal period.

The term “asphyxia” is a relative concept and is one of the most inaccurate in neonatology. Translated from Greek language, the term “asphyxia” means “pulselessness”, and such children are usually stillborn.

A number of other authors consider the term newborn asphyxia as the lack of gas exchange in the lungs after birth of a child(suffocation) in the presence of other signs of live birth (heartbeat, pulsation of the umbilical cord, voluntary muscle movements, regardless of whether the umbilical cord has been cut and whether the placenta has separated).

In general clinical medical practice, obstetricians-gynecologists and neonatologists understand the terms “fetal hypoxia” and “newborn asphyxia” a pathological condition accompanied by a complex of biochemical, hemodynamic and clinical changes that have developed in the body under the influence of acute or chronic oxygen deficiency with the subsequent development of metabolic acidosis.

In the International Classification of Diseases and Causes of Death X (1995), intrauterine hypoxia (fetal hypoxia) and asphyxia of the newborn are identified as independent nosological forms of diseases of the perinatal period.

The incidence of births with asphyxia is 1–1.5% (ranging from 9% in children with a gestational age at birth of less than 36 weeks and up to 0.5% in children with a gestational age of more than 37 weeks).

Distinguish primary(congenital) and secondary(postnatal - occurs in the first hours of life) asphyxia of newborns.

By time of occurrence Primary asphyxia is divided into antenatal or intrapartum.

Depending on the duration primary asphyxia may be acute (intrapartum) or chronic (antenatal).

Depending on the gravity clinical manifestations, asphyxia is divided into moderate ( moderate severity) and heavy.

The severity of primary asphyxia is assessed using the Apgar scale.

APGAR SCALE

Symptoms	Score in points
Heart rate per minute	absent		100 or more
	absent	bradypnea, irregular	normal, shout
Muscle tone	limbs dangling	some flexion of the limbs	active movements
Reflex excitability (irritation of the soles, reaction to the nasal catheter)	doesn't answer		screaming, sneezing
Skin coloring	generalized pallor or generalized cyanosis	pink discoloration of the skin and bluish extremities (acrocyanosis)	pink coloration of the body and limbs

Registration of the newborn's condition on the Apgar scale is carried out at 1 and 5 minutes after birth. With scores of 7 and below at the 5th minute, the assessment is also carried out at the 10th, 15th, 20th minutes. The Apgar score at the 5th minute has a greater prognostic value in terms of predicting the further neuropsychic development of the child than the sum of the scores at the 1st minute.

It should be noted that the sensitivity of assessing the condition of a newborn using the Apgar scale is about 50%, therefore, in the presence of asphyxia, additional laboratory tests are required.

In the case of moderate asphyxia, the Apgar score at 1 minute is 4-7 points, 0-3 points indicates severe asphyxia.

High risk factors for development chronic fetal hypoxia ( antenatal) are divided into three large groups leading to development of hypoxia and hypoxemia of the pregnant woman, conditioning disorders of fetal-maternal circulation and diseases of the fetus itself.

The first includes:

anemia of pregnant women,

severe somatic pathology in a pregnant woman (cardiovascular, pulmonary),

poor nutrition, smoking, drug use, alcohol use, unfavorable environmental conditions,

endocrine diseases ( diabetes, hypothyroidism, ovarian dysfunction).

To the second:

post-term pregnancy,

long-term gestosis in pregnant women,

abnormalities in the development and attachment of the placenta,

multiple pregnancy,

umbilical cord abnormalities,

threat of miscarriage,

bleeding,

infectious diseases in the second and third trimester of pregnancy.

To the third:

fetal diseases ( intrauterine infections, malformations, fetal growth restriction, hemolytic disease fetus).

High risk factors acute hypoxia ( intrapartum) of the fetus are:

C-section,

pelvic, breech or other abnormal presentation of the fetus,

premature or delayed birth,

water-free period of more than 12 hours,

rapid and rapid birth,

placenta previa or premature abruption of the placenta,

discoordination of labor,

uterine rupture,

operative delivery.

acute hypoxia during labor in the mother (shock, decompensation somatic disease and etc.),

cessation or slowdown of blood flow in the umbilical cord (entanglement, true nodes, short or long umbilical cord, prolapse, pinched umbilical cord loops),

fetal malformations (brain, heart, lungs)

narcotic and other analgesics administered to the mother 4 hours or less before the birth of the child, general anesthesia at the mother's.

The risk of birth with asphyxia is highest among premature, post-term and children with intrauterine growth retardation. Many newborns have a combination of risk factors for the development of both antenatal and intrapartum hypoxia, although antenatal hypoxia does not necessarily lead to the birth of a child with asphyxia.

Factors in development secondary asphyxia newborn are:

residual effects of fetal asphyxia and birth damage to the brain and lungs

symptomatic asphyxia in various pathological processes (malformations, pneumonia, infections)

respiratory distress syndrome

aspiration of breast milk or formula after feeding, or poor-quality sanitation of the stomach at birth.

Pathogenesis. Short-term or moderate hypoxia and hypoxemia cause the inclusion of compensatory adaptation mechanisms of the fetus with activation of the sympathetic-adrenal system by adrenal hormones and cytokines. At the same time, the number of circulating red blood cells increases, heartbeat, perhaps a slight increase in systolic pressure without an increase in cardiac output.

Continued hypoxia, hypoxemia, is accompanied by a decrease in pO2 below 40 mmHg. promotes the inclusion of an energetically unfavorable pathway of carbohydrate metabolism - anaerobic glycolysis. The cardiovascular system responds by redistributing circulating blood with a predominant blood supply to vital important organs(brain, heart, adrenal glands, diaphragm), which in turn leads to oxygen starvation of the skin, lungs, intestines, muscle tissue, kidneys and other organs. Preservation of the fetal state of the lungs causes blood shunting from right to left, which leads to overload of the right parts of the heart with pressure, and the left parts with volume, which contributes to the development of heart failure and increased respiratory and circulatory hypoxia.

Changes in systemic hemodynamics, centralization of blood circulation, activation of anaerobic glycolysis with accumulation of lactate contribute to the development of metabolic acidosis.

In the case of severe and (or) ongoing hypoxia, a breakdown of compensation mechanisms occurs: hemodynamics, the function of the adrenal cortex, which, along with bradycardia and a decrease in cardiac output, leads to arterial hypotension up to shock.

Rise metabolic acidosis promotes the activation of plasma proteases and pro-inflammatory factors, which leads to damage to cell membranes and the development of dyselectrolythemia.

An increase in the permeability of the vascular wall leads to sludge (gluing) of red blood cells, the formation of intravascular blood clots and hemorrhages. The release of the liquid part of the blood from the vascular bed contributes to the development of cerebral edema and hypovolemia. Damage to cell membranes aggravates damage to the central nervous system, cardiovascular system, kidneys, and adrenal glands with the development of multiple organ failure. These factors lead to changes in the coagulation and platelet components of hemostasis and can provoke DIC syndrome.

Despite the fact that asphyxia and its effect on the brain are constantly in the focus of attention of researchers, nevertheless, there are still many “blank spots” in the study of the leading links of pathogenesis. But it still seems possible to identify two main hypotheses:

at the basis of hypoxic-ischemic brain damage metabolic disorders lie , the trigger mechanism of which is oxygen deficiency , and directly damaging factors to the brain - products of perverted metabolism (acidosis, increased lactate levels, accumulation fatty acids– arachidonic acid, amino acids (glutamate), oxygen radicals, prostaglandins, leukotrienes, cytokines - interleukins, etc.), which leads to hemodynamic disorders.

The basis of hypoxic-ischemic brain damage is cerebro-vascular disorders And disorders of the autoregulation mechanism cerebral circulation, advancing with oxygen deficiency.

The main pathogenetic mechanisms of the formation of clinical manifestations of hypoxia in newborns born with asphyxia can be combined into a complex of the following interrelated syndromes:

on the part of the central nervous system - impaired autoregulation of cerebral circulation, possible development of cerebral edema and excessive release of glutamate from neurons, which leads to their ischemic damage,

from the heart - ischemic cardiopathy with a possible drop in cardiac output,

from the lungs - activation of inhibitors of surfactant synthesis with the development of RDS, increased resistance of pulmonary vessels, which leads to impaired ventilation-perfusion function of the lungs, persistent fetal circulation syndrome (PFC), impaired reabsorption of intrapulmonary fluid,

from the kidneys - impaired renal perfusion with the development of acute tubular necrosis and inadequate excretion of antidiuretic hormone,

from the outside gastrointestinal tract– intestinal ischemia with possible development ulcerative necrotizing enterocolitis,

from the hemostasis and erythropoiesis system - thrombocytopenia, vitamin K deficiency, disseminated intravascular coagulation syndrome,

from the metabolic side - hyperglycemia at the time of birth and hypoglycemia in the subsequent hours of life, extra- and intracellular acidosis, hyponatremia, hypomagnesemia, hyperkalemia, increased calcium levels in the cell, increased lipid peroxidation processes,

from the outside endocrine system– adrenal insufficiency, hyper- or hypoinsulinemia, transient hypothyroidism.

The pathogenesis of asphyxia that occurs in a child with chronic antenatal hypoxia, differs significantly from that in acute asphyxia, as it develops against the background of antenatal pathology: pneumopathy, encephalopathy, immaturity of liver enzymatic systems, low adrenal reserves and thyroid gland, as well as pathological acidosis and secondary immunodeficiency. The main metabolic component of such hypoxia is a combination hypoxemia, hypercapnia and metabolic acidosis withmoment of birth. It must be remembered that perinatal hypoxia and birth stress in this situation occur in conditions of reduced or even exhausted adaptation reserves. Acidosis early causes damage to cell membranes with the development of hemodynamic, hemostatic disorders and transcapillary exchange, which determines the mechanisms of development of DN, right ventricular heart failure, collapse with a drop in blood pressure, hypovolemia against the background of insufficiency of the sympathetic-adrenal system, myocardial ischemia and phase disorders of hemostasis, which is even more impairs microcirculation.

The clinical picture of asphyxia depends on its severity. With moderate hypoxia, the child’s condition after birth is usually considered moderately severe. In the first minutes of life, the child is lethargic, motor activity and reaction to examination is reduced. The cry is unemotional. Reflexes of the newborn period are reduced or suppressed. Auscultation of the heart reveals tachycardia, sounds are increased or muffled. It is possible to expand the boundaries of relative cardiac dullness. Breathing is arrhythmic, with the participation of auxiliary muscles, the presence of wire-like wheezing of various sizes is possible. The skin is often cyanotic, but quickly turns pink when oxygenated. In this case, acrocyanosis often persists. During the first two to three days of life, these newborns are characterized by a change from the depression syndrome to the hyperexcitability syndrome, manifested by small-scale tremor of the limbs, hyperesthesia, regurgitation, sleep disturbance, spontaneous Moro reflex (phase I), decreased or suppressed reflexes of support, step, crawling, muscle hypotension, adynamia. However, changes in newborn physiological reflexes and muscle tone vary from person to person.

When conducting adequate therapy the condition of children who have suffered acute moderate asphyxia quickly improves and becomes satisfactory by the end of the early neonatal period.

In case of severe hypoxia, the child’s condition at birth is severe or very severe, up to clinical death. There may be no response to examination. Reflexes of newborns are depressed or sharply reduced, adynamia. The skin is cyanotic, pale with a “marble pattern” (impaired microcirculation). Spontaneous breathing is arrhythmic, shallow; auxiliary muscles are involved in the act of breathing, and there may be periodic absence of it (primary, secondary apnea). Auscultation of breathing is weakened. With aspiration syndrome, wheezing of various sizes is heard in the lungs. Heart sounds are muffled, bradycardia, and a systolic murmur of a hemodynamic nature is often heard. On palpation of the abdomen, a moderate enlargement of the liver is noted. Meconium often passes during labor. When prolonged acute asphyxia The clinic is close to shock. There are pronounced signs of disturbances in peripheral (the “white spot” symptom for more than 3 s) and central hemodynamics (arterial hypotension, decreased central venous pressure). The neurological status shows signs of coma or suporus (lack of response to examination and painful stimuli, adynamia, areflexia, atony, pupillary reaction to light is sluggish or absent, local ocular symptoms are possible). There may be a lack of spontaneous breathing. The heart sounds are muffled, a rough systolic murmur is heard, well transmitted to the vessels and extracardiacally. In cases of heart failure - expansion of the boundaries of relative cardiac dullness. Moist rales of various sizes may be heard in the lungs (a consequence of aspiration) against the background of weakened breathing (atelectasis). From the gastrointestinal tract, hepatomegaly is noted; there may be signs of dynamic intestinal obstruction, as a result of ischemic and metabolic disorders.

As the condition stabilizes, signs of hypertension syndrome appear; convulsions are often observed against the background of persistent muscle hypotonia and the absence of sucking and swallowing reflexes. From 2-3 days, with a favorable course, normalization of hemodynamics, respiration, neurological status (physiological reflexes, swallowing and then sucking reflexes) is noted.

The diagnosis of asphyxia is made on the basis of obstetric history, the course of labor, Apgar scores, and data from clinical and laboratory studies.

Antenatal diagnosis.

Monitoring the fetal heart rate (cardiotocography - CTG) - bradycardia and deceleration of the fetal heart rate indicate hypoxia and impaired myocardial function.

Ultrasound examination shows a decrease motor activity, respiratory movements and muscle tone of the fetus (biophysical profile).

Asphyxia of a newborn is a pathological condition of a newborn, which is caused by disorders of the respiratory apparatus with resulting oxygen deficiency.

Primary asphyxia is identified, which occurs at the birth of a child and secondary, occurring during the first hours and days of life of newborns.

Causes of asphyxia

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

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

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

1. cardiovascular pathologies in the stage of decompensation;
2. diseases of the respiratory system and lungs in severe forms;
3. anemia;
4. diabetes mellitus of various types;
5. thyrotoxicosis;
6. all kinds of infectious diseases.

The causes of asphyxia in newborns are also often called late toxicosis of the pregnant woman, pregnancy in the post-term stage, premature placental abruption, pathologies of the placenta, fetal membrane and umbilical cord. If there are complications during childbirth, such as early rupture of amniotic fluid, abnormalities in the labor of the pregnant woman, incorrect position of the fetal head, discrepancies in the size of the pelvic region of the woman in labor and the fetal head, the possibility of newborn asphyxia cannot be excluded. When cerebral circulation is impaired in a newborn, pneumopathy and other diseases, secondary asphyxia occurs.

The body of a newborn, despite the cause of asphyxia, will undergo a restructuring of all metabolic processes due to oxygen deficiency. Hemodynamics and microcirculation are part of the restructuring in the fetal body. The longer and more intense the hypoxia, the more pronounced and vivid the picture of changes. Metabolic and respiratory-metabolic acidosis develops, which is accompanied by manifestations of hypoglycemia, azotemia and hyperkalemia, then this process is replaced by potassium deficiency. Cellular hyperhydration begins as a result of electrolyte imbalance and metabolic acidosis. The volume of circulating red blood cells in the event of acute hypoxia provokes an increase in the volume of circulating blood.

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

Symptoms of asphyxia

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

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

Clinical death is detected when overall assessment in 0 points. Mild degree heaviness manifests itself in the first breath in the first minute of life: weakened breathing, acrocyanosis and cyanosis of the nasolabial triangle, a slight decrease in muscle tone. Moderate severity shows the presence of the first breath in the first minute after birth: weakened breathing (both regular and irregular), the presence of a weak cry of the newborn, bradycardia, tachycardia are noted, muscle tone and reflexes are reduced, the skin of the newborn is bluish (mainly the face area , hands and feet), pulsating umbilical cord. A severe degree of asphyxia of a newborn is manifested in irregular individual breaths, or in their absence, the child’s silence (possibly groans), slow heartbeat, which may be accompanied by a single irregular contraction of the heart, muscle hypotension and atony. In this case, reflexes are not observed, that is, absent. Peripheral vascular spasm causes pallor skin, there is no pulse in the umbilical cord, the development of adrenal insufficiency occurs in most cases.

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

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

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

In the first minutes of a newborn’s life, when establishing the degree of respiratory dysfunction, as well as changes in heart rate, muscle tone, reflex function, skin color determines the diagnosis of asphyxia and its severity. The acid-base status shows the severity of the asphyxia suffered by the child.

A healthy newborn has:

• pH of blood taken from the umbilical cord is 7.22-7.36;
• BE - (base deficiency) - 9-12 mmol/l;

Mild asphyxia and its indicators:

• Blood pH - 7.19-7.11;
• BE - 13-18 mmol/l;

Severe asphyxia and its indicators:

• Blood pH - less than 7.1;
• BE - 19 mmol/l or more;

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

Treatment and assistance for asphyxia

Newborns in an asphyxial state cannot do without the help of resuscitation. Efficiency resuscitation care lies in the timely initiation of treatment. Resuscitation measures and assistance to newborns with asphyxia begin to be carried out in the room for women in labor. Monitoring of the basic parameters of human life must be observed: respiratory capabilities and their frequency, blood pressure, hematocrit and acid-base conditions.

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

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

After breathing has been restored, the child is transferred to a ward in the neonatal unit (intensive care).

Caring for such a newborn is of particular importance. Rest is ensured immediately, the head is placed on a hill. If mild asphyxia is diagnosed, the child is placed in an oxygen tent. In the incubator there are children diagnosed with moderate and severe asphyxia. Often, mucus residues from the oropharynx and stomach are removed again. The child's temperature, diuresis, and bowel function are monitored. After 12-18 hours, the child is prescribed the first feeding with expressed breast milk(diagnosis of mild to moderate asphyxia). In case of severe asphyxia of newborns, feeding occurs every other day using a tube.

Consequences of asphyxia

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

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

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 symptom of asphyxia in a newborn is respiratory distress, which leads to impaired blood circulation and heart rhythm, due to which reflexes weaken and neuromuscular conduction deteriorates.

To assess the severity of asphyxia, the Apgar scale is used, taking into account the following criteria: reflex excitability, muscle tone, skin color, breathing 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 do the child indirect massage hearts. 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 ward intensive care.

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.

The birth of a child is definitely a joyful event for a mother. However, childbirth does not always proceed smoothly. The most common postpartum complication in a newborn is asphyxia. This diagnosis is made in 4-6% of all babies born. According to other data, suffocation occurs to one degree or another in approximately every tenth newborn. The severity of this deviation depends on the degree of lack of oxygen and accumulation of carbon dioxide in the blood and tissues of the baby. The pathology can develop inside the womb (primary) or outside it (secondary). The latter manifests itself during the first days of the baby’s life. Asphyxia – severe and dangerous condition, sometimes leading to the death of a fetus or newborn baby.

Frequently asked questions from parents

What is asphyxia?

Asphyxia is a condition of impaired breathing of a child or fetus, its oxygen starvation against the background of an excess of carbon dioxide in the blood. Most often occurring during childbirth. Sometimes reaching the development of hypoxia of the newborn. Clinically, asphyxia is manifested by the lack of breathing of a newborn baby. It may be completely absent or the baby may experience convulsive, shallow, irregular breathing movements. Pathology requires urgent resuscitation procedures, the correctness of which determines the further prognosis.

How is hypoxia different from asphyxia?

Hypoxia is oxygen starvation of the baby’s tissues and organs, which develops with a lack of oxygen. Asphyxia is a violation of the spontaneous breathing of a newborn child that occurs after his birth. Typically, hypoxia develops at the stage intrauterine development baby, sometimes becomes a consequence of suffocation.

All human tissues and organs require a constant supply of oxygen. With its deficiency, disorders arise, the severity and consequences of which depend on the degree of pathology, timeliness and correctness of first aid. In newborns, tissue damage quickly becomes irreversible. The most sensitive to oxygen deficiency are the baby’s brain, liver, kidneys, heart and adrenal glands.

How dangerous is asphyxia?

Insufficient oxygen supply, even limited in time, negatively affects the condition and functioning of the body. The brain and nervous system are especially affected. There may be disturbances in blood supply processes, manifested by an increase in the size of blood vessels due to blood overflow. Hemorrhages and blood clots form, which leads to damage to certain areas of the brain. It is also possible to develop areas of necrosis - dead brain cells.

IN severe cases suffocation leads to fetal death during childbirth or in the first few days of the baby's life. Children who have been diagnosed with severe breathing disorders have physical and mental abnormalities.

The consequences of asphyxia can be far-reaching. An infant with a history of this disorder, even to a mild degree, may experience weak immunity, tendency to catch colds, developmental delays. Schoolchildren have decreased attention, problems with memorizing material, and low academic performance. In severe forms of suffocation the following may develop: epilepsy, mental retardation, paresis, cerebral palsy, convulsive syndrome, other serious pathologies.

Why does pathology occur in newborns?

According to the time of occurrence of asphyxia, they are distinguished:

1. Primary (intrauterine), developing immediately after the birth of a child.
2. Secondary (extrauterine), which can manifest itself during the first days of a baby’s life.

Depending on the severity of the lesion

• heavy;
• average;
• light.

Causes of primary asphyxia

All reasons fit into three groups:

1. Related to the fruit:
   • intrauterine developmental delay;
   • prematurity;
   • pathologies of growth or development of the fetal heart (brain);
   • aspiration of the respiratory tract with mucus, meconium, or amniotic fluid;
   • Rhesus conflict;
   • birth traumatic brain injury;
   • pathologies of the development of the respiratory system;
   • intrauterine infection.
2. With maternal factors:
   • infectious diseases suffered during pregnancy;
   • malnutrition;
   • reception medications, contraindicated for pregnant women;
   • pathologies of the endocrine system: diseases of the thyroid gland or ovaries, diabetes mellitus;
   • anemia in a pregnant woman;
   • bad habits: alcohol, smoking, drug addiction;
   • shock during childbirth;
   • severe gestosis accompanied high blood pressure and severe swelling;
   • the presence of pathologies of the cardiovascular and respiratory systems in a pregnant woman.
3. With problems causing disturbances in the uteroplacental circle:
   • birth by cesarean section;
   • general anesthesia;
   • polyhydramnios or oligohydramnios;
   • ruptures, damage to the uterus;
   • abnormal birth: rapid, rapid labor, weak labor activity, discoordination;
   • placenta previa;
   • multiple pregnancy;
   • placental abruption or premature aging;
   • post-term pregnancy;
   • difficult pregnancy, accompanied by a constant threat of miscarriage.

Prerequisites for secondary

The following pathologies of the newborn can be the causes of the development of secondary asphyxia:

1. Undiagnosed heart defects.
2. Aspiration of milk or formula during feeding.
3. Improper sanitation of the baby's stomach after childbirth.
4. Damage to brain or heart tissue, accompanied by impaired blood circulation in the brain.
5. Respiratory syndrome, which can develop with edematous-hemorrhagic syndrome, pulmonary atelectasis, and the appearance of hyaline membranes.

Symptoms

Primary asphyxia is detected immediately after the birth of a child based on an objective assessment of its indicators:

• skin color;
• heart rate;
• breathing frequency.

The main sign of suffocation is impaired breathing, which leads to disruption of the heart and blood circulation. The severity of the newborn's condition is due to metabolic changes. In a child with impaired breathing, the concentration of red blood cells, blood viscosity increases, and platelet aggregation increases. The result of this is improper blood circulation, leading to a decrease in heart rate, disruption of the functioning of organs and systems.

With moderate severity, the child:

• lethargic;
• his reactions are reduced;
• spontaneous movements may be observed;
• reflexes are weakly expressed;
• the skin has a bluish color, which quickly changes to pink during resuscitation.

During the examination, doctors reveal:

• tachycardia;
• muffled heart sounds;
• weakened breathing;
• possible moist rales.

Condition of the newborn during rapid the right help returns to normal on days 4-6 of life.

Severe manifests itself:

• lack of physiological reflexes;
• dullness of heart sounds;
• the appearance of systolic murmur;
• hypoxic shock may develop.

Symptoms include:

• lack of response to pain and external stimuli;
• lack of breathing.

Degrees of asphyxia on the Apgar scale

The severity of suffocation is determined using the Apgar scale. It includes five criteria for which scores are given - 0, 1 or 2. Healthy baby must score at least 8 points. This assessment is carried out twice in the first minute of the child’s life and in the fifth.

Criteria

Apgar scale criteria and scores:

1. Color of the skin:
   • 0 – bluish, 1 – pale pink, 2 – pink.
2. Reflexes:
   • 0 – no, 1 – weak, 2 – normal.
3. Muscle tone:
   • 0 – absent, 1 – weak, 2 – good.
4. Heartbeat:
   • 0 – no, 1 – less than 100 beats per minute, 2 – more than 100 beats.
5. Breath:
   • 0 – no, 1 – superficial, intermittent, irregular, 2 – normal spontaneous breathing, loud crying of the child.

Degrees

Based on the results of the examination of the child and the Apgar score, the presence of asphyxia and its degree (in points) are determined:

1. 8-10 is normal.
   • The baby is healthy, there are no breathing problems.
2. 6-7 – mild degree.
   • The child has: weak, sharp breathing, decreased muscle tone, cyanosis of the nasolabial triangle.
3. 4-5 – moderate.
   • In a newborn following symptoms: irregular, intermittent breathing, bradycardia, weak first cry. Blueness of the skin of the face, feet, hands.
4. 1-3 – heavy.
   • The child has a complete absence of breathing or rare breaths, the heart rate is rare or absent, muscle tone is greatly reduced, the skin is pale or sallow.
5. 0 – clinical death.
   • A condition in which the newborn shows no signs of life. Immediate resuscitation is required.

Likely consequences

Asphyxia rarely leaves any consequences. Impaired gas exchange and lack of oxygen affects the functioning of all organs and systems of the child. Important indicator– comparison of Apgar scores made in the first and fifth minutes of the baby’s birth. As your scores increase, you can count on a favorable outcome. If the assessment does not change or even worsens, unfavorable developments are possible. The severity of the consequences of suffocation also depends on the correctness of resuscitation measures.

With a mild degree of asphyxia, especially with timely assistance, there is a high chance of avoiding consequences. In children who have had more than severe forms breathing problems, work abnormalities may develop internal organs. The most frequent consequences This condition results in neurological disorders, developmental delays, increased muscle tone, convulsions, and other pathologies. Cases of severe suffocation are often fatal. According to statistics, approximately half of these children die.

Diagnostic procedures

Diagnosing asphyxia is simple. Its main symptoms were discussed above and included breathing, heart rate, muscle reflexes and skin tone. Here we look at more specialized approaches.

Diagnosis can be made by the hydrogen index of blood, which is taken from the umbilical cord.

1. Normally, the acid-base balance is shifted towards alkali, in a newborn it is slightly higher: 7.22–7.36 BE, a deficiency of 9–12 mmol/l.
2. With mild/moderate air deficiency, pH values: 7.19–7.11 BE, deficiency 13–18 mmol/l.
3. Severe choking: less than 7.1 BE or more than 19 mmol/L.

To determine hypoxic damage to the nervous system of a newborn, neurosonography is indicated - ultrasonography brain Ultrasound, together with a neurological examination, will help distinguish traumatic disorders in the brain from disorders due to oxygen starvation.

First aid and resuscitation measures

A neonatologist administers first aid to a suffocating baby.

After a safe birth, mucus from the lungs and nasopharynx is sucked out, the condition of the newborn is assessed. The first is the presence of breathing.

If it is not there, they try to use the reflexes by slapping the baby on the heels. The breathing that appears after the procedure indicates a mild degree of suffocation, which is noted in the baby’s card. At this point the treatment stops.

If the actions taken do not help, breathing is not restored or fails, then put on an oxygen mask. The appearance of stable breathing within a minute indicates that the newborn had average degree asphyxia.

If there is no breathing for a longer period, resuscitation begins, which is carried out by a resuscitator.

Ventilation of the lungs lasts two minutes, if the patient is breathing even slightly, a probe is inserted into him, removing the contents of the stomach. The number of heartbeats is measured. If the pulse is less than 80, chest compressions begin.

Lack of improvement leads to the next stage - drug therapy. The newborn is injected into the umbilical vein with solutions of the indicated medications, continuing the massage and artificial ventilation. After 15-20 minutes, if there is no improvement in the condition, resuscitation is stopped.

Prohibited actions

In case of asphyxia you cannot:

• pat on the back or buttocks;
• blow oxygen onto the baby's face;
• press on the chest;
• Sprinkle with cold water.

Treatment

If first aid or resuscitation procedures are successful, the baby comes under special supervision. A course of activities and treatment procedures is carried out with him.

1. Special care.
2. Feeding shown.
3. Oxygen therapy.
4. Preventing cerebral edema.
5. Correction of metabolism.
6. Prevention of seizures.
7. Prevention of hydrocephalic syndrome.
8. Other types of symptomatic treatment.
9. General monitoring of the condition is carried out twice a day.

Possible complications

Lack of oxygen affects the brain the most. Changes increase in three stages, even with short-term hypoxia:

1. The blood vessels dilate and fill with blood.
2. Blood clots form, the walls of blood vessels become thinner, and hemorrhages occur.
3. Areas of the brain with microstrokes die – tissue necrosis.

The prognosis may be favorable if, after mild or moderate asphyxia, correct treatment. With a severe form it is more difficult. Normal, full-term children survive in 10-20% of cases, in 60% cases severe consequences– physical or mental disorders, pneumonia . The mortality rate for premature or low birth weight babies is close to 100%.

Prevention

Prevention of breathing problems in a newborn lies in the measures taken:

1. By doctors:
   • observation and management of the woman throughout the entire pregnancy;
   • prevention of vaginal infections;
   • timely treatment of extragenital diseases;
   • monitoring the condition of the fetus and placenta.
2. Pregnant:
   • rejection of bad habits;
   • compliance with dietary requirements;
   • feasible physical exercise, walks in the open air;
   • compliance with medical recommendations.