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

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Neonatal asphyxia is suffocation, manifested by a violation of breathing, or the absence of spontaneous breathing in the presence of a heartbeat and other signs of life. In other words, the baby is not capable, cannot breathe on his own immediately after birth, or he breathes, but his breathing is inefficient.

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

A child born in asphyxia is a serious problem for doctors providing care in the delivery room. Around the world, about a million children die every year from asphyxia, and about the same number of children have serious complications later.

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

Causes of asphyxia in newborns

Factors contributing to the development of asphyxia

There are antenatal and intranatal factors.

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

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

Intranatal factors affect the child during childbirth.

Intranatal factors include various complications that occur immediately at the time of birth (rapid or prolonged labor, placenta previa or premature abruption, anomalies of labor activity).

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

Causes of asphyxia

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

1. Insufficient detoxification of the maternal part of the placenta as a result of low or high maternal pressure, overactive contractions, or other causes.
2. Decrease in the concentration of oxygen in the blood and organs of the mother, which can be caused by severe anemia, insufficiency of the respiratory or cardiovascular system.
3. Various pathologies from the placenta, as a result of which gas exchange through it is disturbed. Among them are calcifications, placenta previa or premature detachment, inflammation of the placenta and hemorrhages in it.
4. 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 compressed during the passage of the child through the birth canal, when the umbilical cord falls out.
5. Insufficient respiratory efforts of the newborn with a depressing effect of drugs on the nervous system (a consequence of the mother's treatment with various drugs), as a result of severe malformations, with prematurity, due to the immaturity of the respiratory organs, due to a violation of the flow of air into the respiratory tract (blockage or compression from the outside), as a result of birth trauma and severe intrauterine infections.

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

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

Today, among the causes of chronic intrauterine hypoxia, not the last place is occupied by drug addiction, substance abuse and alcoholism of the mother. The number of smoking pregnant women is progressively increasing.

Smoking during pregnancy causes:

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

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

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

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

The lungs of a full-term fetus secrete fluid before birth, which enters the amniotic fluid. Fetal breathing is shallow and the glottis is closed, so during normal development, amniotic fluid cannot enter the lungs.

However, severe and prolonged hypoxia of the fetus can cause irritation of the respiratory center, as a result of which the depth of breathing increases, the glottis opens and amniotic fluid enters the lungs. This is how aspiration happens. Substances present in the amniotic fluid cause inflammation of the lung tissue, make it difficult for the lungs to expand at the first breath, which leads to respiratory failure. Thus, the result of aspiration of 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.

Non-lung causes of respiratory problems include the following:

1. Nervous system disorders: abnormalities in the development of the brain and spinal cord, the effects of drugs and drugs, infection.
2. Violation of the cardiovascular system. These include malformations of the heart and blood vessels, dropsy of the fetus.
3. Malformations of the gastrointestinal tract: esophageal atresia (blindly ending esophagus), fistulas between the trachea and esophagus.
4. Metabolic disorders.
5. Adrenal and thyroid dysfunction.
6. Blood disorders such as anemia.
7. Improper development of the airways.
8. Congenital malformations of the skeletal system: malformations of the sternum and ribs, as well as injuries of the ribs.

Types of asphyxia in newborns

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

According to the severity are distinguished:

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

Neonatologists evaluate the condition of a newborn baby using the Apgar scale, which includes an assessment of breathing, heart rate, muscle tone, skin color and reflexes of the newborn. 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 the depression of breathing or heartbeat as a result of the stress that the child feels during the transition from intrauterine life to the outside world.

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

Asphyxia of moderate severity

The condition of the baby 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, unemotionally and quickly falls silent. The child's skin is bluish, but quickly turns pink after inhaling oxygen through the mask. Palpitation is rapid, reflexes are reduced.

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

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

In 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. The skin color is bluish-pale or just pale. It turns pink after breathing oxygen slowly, the skin restores its color for a long time. The heartbeat is muffled. Breathing irregular, irregular.

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

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

Asphyxia and hypoxia. Differences in manifestations in newborns

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

Features of children born in asphyxia who suffered prolonged hypoxia in utero are presented below.

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

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

Early complications include the following conditions:

1. Damage to the brain, which is manifested by edema, intracranial hemorrhage, death of parts of the brain due to lack of oxygen.
2. Violation of blood flow through the vessels of the body, which is manifested by shock, pulmonary and heart failure.
3. Kidney damage, manifested by renal failure.
4. Pulmonary involvement, manifested by pulmonary edema, pulmonary hemorrhage, aspiration, and pneumonia.
5. Damage to the digestive organs. The intestine suffers the most, its motility is disturbed, as a result of insufficient blood supply, some parts of the intestine die off, inflammation develops.
6. The defeat of the blood system, which is manifested by anemia, a decrease in the number of platelets and bleeding from various organs.

Late complications include the following conditions:

1. Attachment of infections, meningitis (inflammation of the brain), pneumonia (inflammation of the lungs), enterocolitis (inflammation of the intestines) develops.
2. Neurological disorders (hydrocephalus, encephalopathy). The most serious neurological complication is leukomalacia - damage (melting) and death of parts of the brain.
3. Consequences of excessive oxygen therapy: bronchopulmonary dysplasia, damage to the vessels of the retina.

Resuscitation of newborns with asphyxia

The condition of children born in asphyxia requires resuscitation. Resuscitation is a complex of medical measures aimed at reviving, resuming breathing and heart contractions.

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

• "A" means establishing and maintaining a patent airway;
• "B" means breath. It is necessary to restore breathing with the help of artificial or assisted ventilation of the lungs;
• "C" means to restore and maintain heart contractions and blood flow through the vessels.

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

1. The readiness of medical personnel. Ideally, care should be provided by two people who have the appropriate skills and know how the pregnancy and childbirth proceeded. Before the birth begins, the medical staff should check that the equipment and medicines are ready to assist.
2. The readiness of the place where the child will be assisted. It should be specially equipped and located directly in the delivery room or in close proximity to it.
3. Providing resuscitation in the first minute of life.
4. Staged resuscitation according to the "ABC" system with an assessment of the effectiveness of each stage.
5. Caution in carrying out infusion therapy.
6. Observation after relief of asphyxia.

Restoration of breathing begins as soon as the head appears from the birth canal, with the suction of mucus from the nose and mouth. Once the baby is fully born, it needs to be warmed up. To do this, it is wiped, wrapped in heated diapers and placed under radiant heat. In the delivery room should not be drafty, the air temperature should not fall below 25 ºС.

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

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

If there is no effect from mechanical ventilation, the contents of the oral cavity are sucked off 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 ensures the flow of air to the lungs, the child is connected to an artificial respiration apparatus.

In the absence of a heartbeat or a decrease in the frequency of contractions less than 60 per minute, an indirect heart massage is started, continuing mechanical ventilation. Massage is stopped if the heart begins to beat on its own. In the absence of a heartbeat lasting 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 causes in a pregnant woman that cause fetal hypoxia.

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

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

Conclusion

The treatment of children who have suffered asphyxia, until full recovery, is quite a long one.

After the activities carried out in the delivery room, the children are transferred to the pediatric intensive care unit or to the neonatal pathology department. In the future, if required, rehabilitation therapy is prescribed 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 full recovery. Premature babies have a worse prognosis than babies born at term.

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There are two types of disease: primary asphyxia occurs at the time of childbirth, secondary - during the first 24 hours of a child's life.

According to statistics, about 10% of newborns are born with manifestations of asphyxia, or during pregnancy the mother was diagnosed with fetal hypoxia. Without a doubt, the figure is quite large.

Asphyxia is a serious disease. No less terrible are the consequences to which it leads.

What damage does asphyxia cause in a child's body?

All systems and organs of the human body need oxygen, therefore, with a lack of the latter, they are damaged. The degree of damage depends on the severity of the disease, on the sensitivity of the organ to a lack of oxygen, on the speed of providing medical assistance in case of asphyxia. Changes in the body can be reversible and irreversible.

All children born in a state of asphyxia are placed in the intensive care unit, where they receive medical care.

Assessment of the severity of asphyxia is carried out according to the Apgar scale: the score is normally 8-10 points, with a mild degree of asphyxia, the condition of the newborn is estimated at 6-7 points, with moderate severity - at 4-5, with severe asphyxia, a score of 0-3 points is set.

The state of asphyxia undoubtedly causes damage of varying severity from the following systems:

• Respiratory organs


• Of cardio-vascular system


• Digestion and urinary


• endocrine system

In addition, asphyxia can cause damage to the hemostasis system and disrupt the metabolic processes of the body.
Let's take a closer look at these violations:

From the side of the brain

Violations are called hypoxic-ischemic encephalopathy. The severity of this pathology depends directly on the severity of asphyxia, which was determined by the Apgar scale. The symptoms of HIE are different and depend on the time of oxygen starvation.

A mild degree is characterized by the presence of muscle hypertonicity, especially the flexors. The child cries at any touch to him, during swaddling, examination, any medical manipulations. There are no seizures.

With an average degree of damage, on the contrary, a decrease in tone in all muscles is noted, the arms and legs are extended. The child is lethargic, lethargic, does not respond to touch. This stage is characterized by the appearance of convulsions, spontaneous breathing, slowing of the heart rate.

A severe degree of HIE is manifested by severe weakness, indifference of the child to any actions. The child has no reflexes, convulsions become rare, apnea appears (breathing stops), bradycardia persists.
Decerebration may occur (cerebrum-brain, de-negation).

From the side of the respiratory system

Violations often manifest themselves in the form of:

• Hyperventilation of the lungs - frequent shallow breathing, with difficulty inhaling.


• Pulmonary hypertension is an increase in pressure in the pulmonary circulation.


• Meconium aspiration is the entry of original feces into the respiratory tract.

From the side of the cardiovascular system

The following violations are noted:

• Decreased myocardial contractility


• Necrosis of the papillary muscles of the heart


• Lowering blood pressure


• Myocardial ischemia

From the digestive and urinary systems

Aspiration of breast milk may occur during feeding, so newborns with asphyxia are not brought to mothers for breastfeeding. In the newborns themselves, the act of sucking is disturbed, as well as intestinal motility.

In difficult cases, necrotizing enterocolitis appears. Necrosis of part of the intestine often leads to the death of the newborn.

On the part of the kidneys, functional insufficiency develops, which manifests itself in a decrease in filtration and hematuria.

From the endocrine system

There are violations in the form of hemorrhages in the adrenal glands. This is a serious condition leading to death.

It must be borne in mind that the prognosis of the consequences depends on the severity of asphyxia.
In the first degree, 98% of children develop without deviations, in the second degree - about 20% of children, and in the third - up to 80% have a disability.

Rules for caring for a child with asphyxia

In the maternity hospital, a child who has suffered asphyxia is under constant supervision. All babies are given intensive oxygen therapy. Newborns with moderate and severe forms of asphyxia are placed in a special incubator, where oxygen is supplied. The indicators of the work of the intestines, kidneys,

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

The severity of the disease depends on the extent to which the baby's gas exchange process was disturbed in the prenatal period, that is, on the ratio of the amount of oxygen and carbon dioxide in the tissues and blood cells of the child. O consequences of asphyxia newborns will talk in the article.

stages

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

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

This condition is considered very dangerous, as it is considered a common cause of stillbirth and death in children in the first days of life.

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

What happens with asphyxia?

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

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

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

At the initial stage, the volume of blood in the child's body increases, over time, when the disease becomes chronic, this volume decreases significantly. This leads to a change in the composition of the blood (an increase in the number of erythrocytes, platelets), its greater viscosity.

This condition is dangerous for the body by the possibility of the formation of blood clots, obstruction of blood vessels.

As a result of these pathological processes, there is violation of blood microcirculation in internal organs (brain, heart, etc.). Such disorders cause edema, minor hemorrhages, the development of diseases and other systems.

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

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

How to treat asthenic syndrome in children and adolescents? Learn about it from ours.

Reasons for the development of pathology

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

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

Fetal factors:

1. Traumatic brain injury of a newborn, received by him in the process of childbirth.
2. Rhesus - a conflict with the mother's body. This phenomenon is possible if the Rh status of the pregnant woman is negative, and the child is positive. In this case, the leukocytes of the expectant mother perceive the embryo as a foreign body and try to destroy it. This leads to various kinds of pathologies.
3. Violations of the functions of the respiratory system.
4. intrauterine infections.
5. premature birth.
6. Anomalies of growth and development of the child in the prenatal period.
7. Entry into the respiratory organs of amniotic fluid, mucus, feces secreted by the fetus into the amniotic fluid.
8. Violations of the development of the heart, brain.

Mother factors:

Factors that disrupt blood circulation in the placenta:

1. Postponed pregnancy.
2. Pathology of the placenta (its premature aging, detachment, presentation).
3. Entanglement of the fetus by the umbilical cord.
4. Multiple pregnancy.
5. Polyhydramnios or oligohydramnios.
6. Violations of the natural birth process (weakness of contractions, the use of drugs, caesarean section, the use of general anesthesia).

To the development of secondary asphyxia may result in the following negative factors:

1. Birth trauma to the fetus, leading to circulatory disorders in the brain.
2. Cardiac pathologies.
3. Improper feeding, when mother's milk enters the newborn's nose, making it difficult for the normal breathing process.
4. Features and pathological deviations of the structure of the lungs.

Clinical manifestations

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

Light degree characterized by:

• a slight delay in the moment of the first breath (inhalation occurs in the first minute of life);
• the cry of the child is slightly muffled;
• breathing is regular, but weakened;
• skin color in the region of the nasolabial triangle is pale or cyanotic;
• Apgar score 6-7.

Asphyxia moderate manifested by symptoms such as:

• irregular, severely weakened breathing;
• the child almost does not cry;
• reduced reflexes and heart rate;
• the skin has a bluish color in the face, hands, feet;
• Apgar score 4-5.

heavy asphyxia manifests itself in the form:

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

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Treatment

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

Asphyxia mild and moderate severity removed in several steps:

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

Treatment of severe asphyxia requires more drastic measures such as:

• hardware ventilation of the lungs;
• external heart massage;
• intravenous administration of glucose preparations, prednisolone, adrenaline, calcium gluconate.

Newborn care

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

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

It is necessary to solve the problem of feeding the baby. Of course, if there is such an opportunity, it is best improve the process of breastfeeding.

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

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

Consequences and complications

The lack of oxygen, even for a short time, negatively affects state of the brain and central nervous system. This manifests itself in the form of a violation of the processes of blood circulation, when the vessel increases in size as a result of its overfilling with blood.

This leads to the formation of blood clots, hemorrhages. If this phenomenon is observed in the area of ​​the brain, the development of necrosis (death of certain parts of the cerebral cortex) is possible.

With severe asphyxia high risk of fetal death in utero or in the first days of a child's life. Children who have had a severe degree of asphyxia develop mental and physical disorders.

Prevention

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

During pregnancy necessary:

1. Regularly visit a gynecologist who will observe the pregnancy, strictly follow all his instructions.
2. To refuse from bad habits.
3. Normalize the daily routine, relax more.
4. Healthy food.
5. Be outdoors.
6. Provide moderate physical activity (if not contraindicated).
7. Protect yourself from infectious diseases.
8. Take medications prescribed by your doctor.
9. Provide yourself with peace and positive emotions.

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

The nervous, respiratory and cardiovascular systems are especially susceptible to negative changes. The consequences of asphyxia can be very negative, up to a significant lag in mental and physical development.

O causes of asphyxia newborns in this video:

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At present, asphyxia of a newborn is understood as his condition when, in the presence of a heartbeat, there is no breathing or there are separate convulsive, irregular, superficial breaths.

Asphyxia is divided into:

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

2) asphyxia of a newborn .

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

Asphyxia of the newborn, in addition, is divided on the primary when the born baby does not breathe on its own after ligation of the umbilical cord, and secondary- arising in the following hours and days of a newborn's life.

There are 5 leading mechanisms leading to neonatal asphyxia:

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

2) violation of gas exchange through the placenta ( premature complete or incomplete placental abruption, placenta previa, etc.);

3) circulatory disorders in the maternal part of the placenta ( excessively active contractions, arterial hypotension or hypertension of any etiology in the mother);

4) deterioration of maternal oxygen saturation ( anemia, cardiovascular disease, respiratory failure);

5) insufficiency of extrauterine respiratory movements of the newborn ( the impact of maternal drug therapy, antenatal lesions of the fetal brain, congenital malformations of the lungs, etc.).

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

Therefore, asphyxia- this is suffocation, an acute pathological process caused by various reasons, which are based on a lack of oxygen in the blood (hypoxemia) and tissues (hypoxia) and the accumulation of carbon dioxide (hypercapnia) and other acidic metabolic products in the body, which leads to the development of metabolic acidosis . Underoxidized metabolic products circulating in the blood inhibit biochemical processes in cells and cause tissue hypoxia; body cells lose their ability to absorb oxygen. Pathological acidosis increases the permeability of the vascular wall and cell membranes, which leads to circulatory disorders, impaired blood coagulation processes, and hemorrhages in various organs.

The vessels lose their tone and overflow with blood, the liquid part of the blood goes into the surrounding tissues, edema and degenerative changes develop in the cells of all organs and systems.

The main clinical sign of asphyxia- Impaired or absent breathing. The degree of asphyxia is determined by the Apgar scale. According to the International Classification of Diseases IX Revision (Geneva 1980) distinguish asphyxia: moderate (moderate) and severe.

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

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

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

Apgar score

Asphyxia of newborns - Treatment.

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

1. Independent breathing.
2. Palpitation.
3. Pulsation of the umbilical cord.
4. active movements.

In the absence of all 4 signs of a live birth, the child is considered stillborn and is not subject to resuscitation. If there is at least 1 sign, it is necessary to provide resuscitation assistance.

Removal from asphyxia requires the use of generally accepted resuscitation principles formulated by P. Safar (1980) as ABS resuscitation, where: A - airway - release, maintaining free airway patency; B - breath - breathing, providing ventilation - artificial (IVL) or auxiliary (IVL); C- cordial circulation restoration or maintenance of cardiac activity and hemodynamics.

In the delivery room or near it around the clock should be ready to help the newborn "island of resuscitation, which consists of several blocks:

1) block for optimizing the environment and temperature protection - a heated table, a source of radiant heat, sterile warm diapers;

2) a block for restoring airway patency - an electric suction pump, rubber bulbs, oral air ducts, endotracheal tubes, a children's laryngoscope;

3) oxygen therapy unit - a source of compressed air, an installation for humidifying and heating the air-oxygen mixture, a set of connecting tubes and devices for introducing oxygen;

4) block of artificial lung ventilation (breathing bag type Ambu, devices for automatic lung ventilation);

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

6) a vital activity control unit - a heart monitor, an apparatus for measuring blood pressure, a stopwatch, a phonendoscope.

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

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

Amniotic fluid, mucus, sometimes maternal blood is wiped from the baby's skin with a warm diaper. In severe asphyxia and the presence of meconium in the amniotic fluid or oropharynx, immediate intubation is carried out, followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby after 1 minute. At the end of stage I of resuscitation, the duration of which should not exceed 20-25 seconds, the child's breathing is assessed. With adequate breathing, a heart rate above 100 per minute and a slight acrocyanosis of the skin, resuscitation is stopped, and the child is monitored. If possible, we should strive to start feeding the baby with mother's milk as early as possible.

If the heart rate is less than 100 per minute, then go to II stage of resuscitation whose task is to restore external respiration. Activities begin with ventilation with a mask and breathing bag. The respiratory rate is 30-50 per minute. More often, a 60% oxygen-air mixture is used (in premature babies, 40%). Good chest excursions indicate sufficient ventilation of the alveoli, as well as the absence of serious airway obstruction. Failure of bag and mask ventilation, suspected meconium aspiration, less than 80 h, and the need for external cardiac massage and prolonged respiratory support are indications for endotracheal intubation.

Simultaneously with mechanical ventilation, breathing is stimulated by intravenous administration of nalorphine or etimizole. 20-30 seconds after the start of mechanical ventilation, it is necessary to calculate the frequency of heart rate, if it is in the range of 80-100 per minute, continue mechanical ventilation until the frequency increases to 100 per minute.

If the heart rate is less than 80 per minute, then go to III stage of resuscitation. It is urgent to start an external heart massage against the background of mechanical ventilation with a mask with 100% oxygen concentration. If there is no effect within 20-30 seconds of massage, intubate and start mechanical ventilation in combination with massage. Press on the lower third of the sternum (but not on the xiphoid process due to the risk of liver rupture) strictly down 1.5-2.0 cm with a frequency of 100-140 times per minute.

Evaluate the effectiveness of indirect heart massage by skin color and pulse on the femoral artery.

If there is no effect within 60 seconds of cardiac massage, then cardiac activity should be stimulated with adrenaline, which is administered at a dose of 0.1 ml / kg of body weight of a 0.01% solution either endotracheally or into the umbilical cord vein. The introduction can be repeated after 5 minutes (up to 3 times). At the same time continue IVL and indirect heart massage. Then assess the color of the skin and the state of microcirculation. According to indications, infusion therapy is carried out (albumin, native plasma, isotonic sodium chloride solution). If necessary, planned infusion therapy is started 40-50 minutes after birth. It is very important to remember that the rate of infusion therapy is much more important than the volume. Vitamin K is administered to all children born with asphyxia in the delivery room. In case of a very serious condition, after primary resuscitation and slow recovery of vital functions, it is desirable to transfer to the neonatal intensive care unit of a children's hospital.

If within 15-20 minutes the child does not have spontaneous breathing and persistent bradycardia persists, then there is a high probability of severe brain damage, and it is necessary to decide on the termination of resuscitation.

Asphyxia of newborns - Complications.

There are two groups of complications- early, developing in the first hours and days of life, late - from the end of the first week of life and later.

Among the early complications, in addition to brain damage (edema, intracranial hemorrhages, necrosis, etc.), hemodynamic (pulmonary hypertension, heart failure), renal, pulmonary, gastrointestinal, hemorrhagic (anemia, thrombocytopenia, DIC syndrome) are especially frequent. Late complications are dominated by infectious (pneumonia, meningitis, sepsis) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy).

Pathological respiratory failure resulting from oxygen deficiency is fraught with consequences of varying severity and requires urgent resuscitation. In newborns, asphyxia can occur during childbirth or in the first few days after birth.

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Causes and risk factors

Asphyxiation is characteristic of intrauterine development and can develop due to:

• violations of the course of pregnancy;
• pathologies of the pregnant woman or fetus;
• lack of access to oxygen at the time of the first breath of the newborn (diagnosed as asphyxia of the lungs);
• deviations in the body of the infant.

There are a number of risk factors leading to asphyxia.

Placental factors

Associated with the state of the placenta:

• delayed or multiple pregnancy (oxygen deficiency is created to nourish the fetus);
• premature aging, placenta previa, or bleeding;
• placental abruption;
• pathological features of the development of the umbilical cord (formation of nodes);
• chronic threat of premature birth;
• placenta previa, bleeding;
• excess or shortage of water;
• weak or rapid labor activity;
• C-section;
• the use of general anesthesia;
• the use of pregnant drugs less than 4 hours before delivery;
• uterine rupture.

fruit factors

Situations related to the growth and condition of the embryo:

• head injury;
• Rhesus conflict;
• pathology of the development of the respiratory system of the embryo;
• infections during pregnancy (rubella, measles, chickenpox and others);
• premature birth;
• growth retardation;
• malformations of the heart or brain development;
• blockage of the respiratory organs with mucus, meconium, amniotic fluid.

maternal factors

Pathologies associated with childbirth:

• severe gestosis as a result of severe swelling and high blood pressure;
• iron deficiency (anemic disorders);
• diseases of the lungs, endocrine system (thyroid gland, diabetes, ovarian dysfunction), cardiovascular system;
• severe stress of the expectant mother;
• environmental factors;
• bad habits;
• poor nutrition;
• infections;
• taking medications with contraindications for pregnant women.

Causes of secondary asphyxia

It is the result of factors such as:

• trauma to the brain and lungs during labor;
• heart disease that was not diagnosed or did not manifest itself in the first hours of life;
• obstruction of the respiratory tract with milk or inadequate sanitation of the stomach;
• effects of respiratory distress;
• hyaline membranes;
• atelectasis;
• hemorrhage in the lungs;
• edematous-hemorrhagic syndrome.

Development mechanism

Asphyxiation leads to a restructuring of metabolic processes and microcirculation. The classification of asphyxia depends on the duration and intensity of oxygen starvation. As a result, acidosis, glucose deficiency, azotemia and hyperkalemia appear in the baby's body. In the acute degree of asphyxia, the volume of blood increases, in the chronic stage, the blood becomes thick, and its circulation decreases, which can lead to the formation of blood clots.

These processes in the body lead to the pathology of microcirculation of blood with oxygen in the vital organs of the baby (heart, kidneys, brain, liver, adrenal glands). As a result of hypoxia, a violation of the normal development of the baby's systems occurs.

Clinical picture

The degree of damage is characterized in the clinic by a doctor immediately after delivery using an Apgar score. Fixing the state of the newborn is carried out at the 1st and 5th minute of life. Each symptom is scored from 0 to 2 points. A healthy baby gains from 8 to 10 points at the first examination.

Mild neonatal asphyxia

The Apgar score is 6-7 points. The baby takes his first breath on his own in the first minute, but breathing is weakened, there is cyanosis in the nose and lips.

Asphyxia of moderate severity

4-5 points on Apgar. Breathing is weakly expressed, irregular, the rhythm is disturbed. There is cyanosis of the face, feet and hands, the heart rate is up to 100 beats per minute. Cramps in the limbs and chin may be present. Reflexes are either weakened or excessively strengthened. There is hypertonicity in the muscles.

Severe asphyxia

Acute state of suffocation, Apgar 1 to 3 on first examination. The baby is not breathing, or takes single breaths. The heart rate is less than 100 per minute, bradycardia is recorded, and the heart sounds are muffled. The newborn does not scream, greatly reduced muscle tone. The skin is cyanotic, pulsation in the umbilical cord and reflexes are absent. The eyeballs float, a spasm and swelling of the brain develops. Multiple hemorrhages on the skin, changes in blood viscosity.

With an Apgar score of 0, clinical death of the infant is observed, in rare cases, resuscitation can lead to the appearance of breathing and heart rhythms in the newborn.

Diagnostics

Apgar scores:

• the presence and frequency of breathing;
• heartbeat;
• muscle tone;
• reflexes;
• skin tone.

Apgar scores

In addition to external indicators, a blood test is carried out for the acid-base state. After the initial diagnosis is made, an ultrasound (ultrasound examination) of the brain is done. It can be used to determine the degree and type of damage to the central nervous system, that is, traumatic or hypoxic pathogenesis.

Treatment Methods

The main method of assistance for asphyxia is resuscitation carried out by doctors in the maternity hospital. Efficiency depends on the timeliness of the measures taken.

Resuscitation is carried out by monitoring the main parameters of vital activity:

• respiratory rate;
• conduction of oxygen to the lower zones of the lungs;
• heart rate;
• indicators of blood pressure, hematocrit and acid-base parameters.

The sequence of resuscitation

First aid in the form of emergency resuscitation of the baby is represented by the following scheme of actions:

1. Clear the baby's nose and mouth of meconium, mucus and amniotic fluid.
2. Restore respiratory function.
3. Support the circulatory system.

Scheme of actions in the absence of meconium in the water around the fetus:

1. The baby is transferred under the lamp to the changing table.
2. Water and mucus are sucked out of the respiratory tract, without contact with the posterior pharyngeal wall. The skin is wiped dry.
3. The newborn is laid on his back. For better airway patency, a special roller is placed under the shoulders.
4. To stimulate the baby's breathing, they clap on the heels, massage the back along the spine with the palm of your hand.
5. If the breath does not appear, and the heart rate drops to 80 beats per minute, the lungs are ventilated using a mask in combination with a heart massage.
6. If the measures above do not help, medications are used (0.01% adrenaline solution).

If the infant was diagnosed with clinical death, then resuscitation is carried out for no more than 20 minutes.

On the video you will see resuscitation actions. Photographed in GBUZ JSC "Arkhangelsk maternity hospital named after K. N. Samoilova", 2013

Further treatment and observation

After resuscitation and restoration of breathing, the baby is transferred to a special room (couveuse), equipped with a heating and oxygen supply function.

Further treatment includes:

• infusion therapy (helps restore metabolism, kidney function);
• dehydration measures (aimed at removing and preventing cerebral edema);
• the appointment of calcium gluconate to prevent cerebral hemorrhage;
• the use of sedatives with increased nervous excitability;
• feeding (begin after 16 hours, with more severe degrees of suffocation, the first day the nutrients enter the baby through the tube).

On average, the duration of treatment is from 10 to 15 days. A more accurate period is determined by the neonatologist depending on the condition of the baby.

Caring for a child after suffering asphyxia

After an asthma attack and rehabilitation therapy, the baby needs special care.

Health workers and parents should ensure:

• complete rest for the newborn and mother;
• the correct position of the child in the incubator (with a raised head);
• clearing the airways of mucus;
• dynamic control of body temperature, defecation, urination, regurgitation after feeding;
• constant monitoring of the frequency and presence of breathing during sleep.

Prognosis and consequences of the disease

Any prognosis for an infant depends on the severity of suffocation, the timeliness and effectiveness of resuscitation.

All the consequences of asphyxia are related to the functioning of the nervous system. Up to a year, a child may be overly excitable. Convulsions and hypothalamic problems are not excluded.

Consequences of asphyxia of newborns at an older age:

• hyperactivity;
• inattention;
• phlegmatism;
• poor learning.

The worst consequence of asphyxia is death. In the absence of positive dynamics in the 20th minute of the measures taken, a lethal outcome is diagnosed in up to 60% with timely births and up to 100% with premature births.

In severe asphyxia, cerebral palsy is the most serious complication. The disease develops when the newborn does not respond to resuscitation within 15 minutes - in 10% of cases, within 20 minutes - in 60%.

Prevention

On the part of doctors, preventive measures are:

• timely treatment of diseases in a woman in labor;
• Ultrasound diagnosis of the intrauterine state of the fetus and placenta;
• monitoring of pregnancy with the identification of possible risk factors.

Preventive measures to prevent asphyxia of the newborn should be observed by the mother in the prenatal period:

• healthy lifestyle;
• check adherence to the regime of the day;
• walks in the open air;
• proper and nutritious nutrition;
• taking vitamins;
• calmness, lack of stressful situations, positive emotions;
• timely diagnosis and treatment of infections both before and during pregnancy;
• preparation for conception in the form of control of chronic, especially endocrine diseases;
• constant monitoring by a gynecologist, the implementation of all the recommendations of the doctor.

Video "Causes of asphyxia in a newborn"

In the video, you will learn how to properly push during childbirth, as well as what can lead to suffocation of the baby. Author Marina Aist.