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

Local pediatrician

Asphyxia of newborns is suffocation, manifested by respiratory failure, or lack of spontaneous breathing in the presence of a heartbeat and other signs of life. In other words, the baby is unable to breathe on its own immediately after birth, or it breathes but its breathing is ineffective.

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

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

Asphyxia of the fetus and newborn occurs with hypoxia (decreased oxygen concentration in tissues and blood) and hypercapnia (increased carbon dioxide content in the body), which is manifested by severe respiratory and circulatory disorders and disruption of the child’s nervous system.

Causes of newborn asphyxia

Factors contributing to the development of asphyxia

There are antenatal and intranatal factors.

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

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

Intranatal factors affect the child during childbirth.

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

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

Causes of asphyxia

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

1. Insufficient clearance of toxins from the maternal part of the placenta as a result of low or high maternal blood pressure, overactive contractions, or other reasons.
2. A decrease in the concentration of oxygen in the blood and organs of the mother, which may be caused by severe anemia, insufficiency of the respiratory or cardiovascular system.
3. Various pathologies of the placenta, as a result of which gas exchange through it is disrupted. These include calcifications, placental previa or premature placental abruption, inflammation of the placenta and hemorrhages into it.
4. Interruption or disruption of blood flow to the fetus through the umbilical cord. This occurs when the umbilical cord wraps tightly around the baby's neck, when the umbilical cord is compressed while the baby passes through the birth canal, or when the umbilical cord prolapses.
5. Insufficient respiratory efforts of the newborn due to the depressing effect of drugs on the nervous system (a consequence of the mother’s treatment with various drugs), as a result of severe developmental defects, in case of prematurity, due to the immaturity of the respiratory system, due to a violation of the flow of air into the respiratory tract (blockage or compression from the outside), as a consequence of birth injuries and severe intrauterine infections.

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

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

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

Smoking during pregnancy causes:

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

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

With prolonged and severe hypoxia, the fetal body cannot compensate for the lack of oxygen; tissues and organs suffer from oxygen starvation, because oxygen is delivered primarily to the brain and heart. 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 insufficient oxygen supply to the brain and disruption of its development, which can aggravate respiratory failure at birth.

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

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

Breathing disorders in newborns can be caused not only by impaired gas exchange in the lungs, but also as a result of damage to the nervous system and other organs.

Causes of breathing problems not related to the lungs include the following conditions:

1. Nervous system disorders: abnormalities in the development of the brain and spinal cord, the effects of drugs and drugs, infection.
2. Cardiovascular system disorders. These include malformations of the heart and blood vessels, fetal hydrops.
3. Malformations of the gastrointestinal tract: esophageal atresia (blindly ending esophagus), fistulas between the trachea and esophagus.
4. Metabolic disorders.
5. Impaired function of the adrenal glands and thyroid gland.
6. Blood disorders such as anemia.
7. Improper development of the respiratory tract.
8. Congenital malformations of the skeletal system: malformations of the sternum and ribs, as well as rib injuries.

Types of newborn asphyxia

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

According to the degree of severity, they are distinguished:

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

Neonatologists assess the condition of the newborn baby using the Apgar score, which includes assessment of the newborn's breathing, heartbeat, muscle tone, skin coloring and reflexes. The newborn's condition is assessed in the first and fifth minutes of life. Healthy children score 7 - 10 points on the Apgar scale.

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

Mild asphyxia

Manifests itself as cardiorespiratory depression. This is depression of breathing or heart rate as a result of the stress the baby feels during the transition from intrauterine life to the outside world.

Childbirth is a tremendous stress for a child, especially if any complications arise. At the same time, in the first minute of life, the baby receives an Apgar score of 4-6 points. As a rule, for such children it is enough to create optimal environmental conditions, warmth and temporary breathing support, and within five minutes the child is restored, he is given 7 points or higher.

Moderate asphyxia

The baby's condition at birth is assessed as moderate. The baby is lethargic, reacts poorly to examination and stimuli, but spontaneous movements of the arms and legs are observed. The child screams weakly, with little emotion and quickly falls silent. The baby's skin is bluish, but quickly turns pink after inhaling oxygen through a mask. Heart rate is rapid, reflexes are reduced.

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

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

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

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

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

Asphyxia and hypoxia. Differences in manifestations in newborns

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

The characteristics of children born with asphyxia, who suffered prolonged hypoxia in utero, are presented below.

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

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

Early complications include the following conditions:

1. Damage to the brain, which is manifested by edema, intracranial hemorrhage, and death of parts of the brain due to lack of oxygen.
2. Disruption of blood flow through the vessels of the body, which manifests itself as shock, pulmonary and heart failure.
3. Kidney damage, manifested by renal failure.
4. Lung damage, manifested by pulmonary edema, pulmonary hemorrhage, aspiration and pneumonia.
5. Damage to the digestive organs. The intestines suffer the most, their motility is impaired, as a result of insufficient blood supply, some parts of the intestines die, and inflammation develops.
6. Damage to the blood system, which is manifested by anemia, a decrease in the number of platelets and bleeding from various organs.

Late complications include the following conditions:

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

Resuscitation of newborns with asphyxia

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

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

• "A" means establishing and maintaining airway patency;
• "B" stands for breath. It is necessary to restore breathing using artificial or assisted ventilation;
• “C” means to restore and maintain heart contractions and blood flow through the vessels.

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

1. Readiness of medical personnel. Ideally, assistance should be provided by two people who have the appropriate skills and know how the pregnancy and childbirth proceeded. Before labor begins, nursing staff should check that equipment and medications are ready to provide care.
2. The readiness of the place where the child will receive assistance. It must be specially equipped and located directly in the delivery room or in close proximity to it.
3. Providing resuscitation in the first minute of life.
4. Stages of resuscitation according to the “ABC” system with assessment of the effectiveness of each stage.
5. Caution when administering infusion therapy.
6. Observation after relief of asphyxia.

Restoration of breathing begins as soon as the head appears from the birth canal, with suction of mucus from the nose and mouth. Once the baby is fully born, it needs to be warmed up. To do this, it is wiped, wrapped in heated diapers and placed under radiant heat. There should be no draft in the delivery room; the air temperature should not drop below 25 ºС.

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

If the baby screams, he is placed on his mother's stomach. If the baby is not breathing, breathing is stimulated by wiping the baby's back and patting the baby's soles. In case of moderate and severe asphyxia, respiratory stimulation is ineffective, so the child is quickly transferred to radiant heat and artificial ventilation (ALV) is started. After 20 - 25 seconds, look to see if breathing appears. If the child’s breathing has resumed and the heart rate is above 100 per minute, resuscitation is stopped and the child’s condition is monitored, trying to feed the child with breast milk as soon as possible.

If there is no effect from mechanical ventilation, the contents of the oral cavity are sucked out again and mechanical ventilation is resumed. If there is no breathing during mechanical ventilation for two minutes, tracheal intubation is performed. A hollow tube is inserted into the trachea to provide air to the lungs, and the child is connected to an artificial respiration apparatus.

If there is no heartbeat or the contraction frequency decreases to less than 60 per minute, indirect cardiac massage is started, while mechanical ventilation is continued. The massage is stopped if the heart begins to beat on its own. If there is no heartbeat for more than 30 seconds, the heart is stimulated with drugs.

Prevention of asphyxia in newborns

All measures to prevent asphyxia come down to timely identification and elimination of the causes of fetal hypoxia in a pregnant woman.

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

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

Conclusion

Treatment of children who have suffered asphyxia until complete recovery is quite lengthy.

After the activities carried out in the delivery room, children are transferred to the pediatric intensive care unit or to the neonatal pathology department. In the future, if necessary, rehabilitation therapy is prescribed in specialized departments.

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

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, the term “asphyxia” means “pulselessness,” and such children are usually stillborn.

A number of other authors consider the term newborn asphyxia as the absence of gas exchange in the lungs after the 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 is 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 severe.

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, loud scream
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 mellitus, 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 of the 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 childbirth in the mother (shock, decompensation of somatic disease, 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 in the mother.

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, the heart rate increases, and possibly 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 preferential blood supply to vital 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.

An increase in metabolic acidosis promotes the activation of plasma proteases and proinflammatory 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 of 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 gastrointestinal tract - intestinal ischemia with the possible development of necrotizing ulcerative 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 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 the enzymatic systems of the liver, low reserves of the adrenal glands 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.

With 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 severe hypoxia, the child’s condition at birth is severe or very serious, 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 consequence 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 in motor activity, respiratory movements and muscle tone of the fetus (biophysical profile).

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

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

What is newborn asphyxia?

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

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

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

Intrauterine and postpartum asphyxia and its causes

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

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

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

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

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

Secondary asphyxia occurs some time after birth due to:

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

Consequences of asphyxia of the fetus and newborn

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

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

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

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

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

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

How is asphyxia diagnosed?

Primary asphyxia is detected by visual examination of doctors present at birth. In addition to the Apgar assessment, laboratory blood tests are prescribed. The pathological condition is confirmed by test results.

Carrying out an ultrasound examination of the brain

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

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

First aid and treatment features

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

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

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

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

Rehabilitation and child care

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

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

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

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

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

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

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

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

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

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

It is very important to continue breastfeeding for as long as possible

Prevention of asphyxia

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

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

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

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

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

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

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

Throughout pregnancy, parents eagerly await the birth of their little treasure. At the same time, parents can experience a variety of emotions: fear, joy, excitement, and so on. Of course, the birth of a child is the happiest moment in the life of any family, and this joy can only be overshadowed by the news that the baby has some health problems. Recently, it is quite common to encounter cases of asphyxia in a newborn. Of course, in such a situation, parents begin to get very nervous, but in most cases this is not necessary, because modern medicine allows this complication to be cured very quickly and the child’s future development is no different from other children.

Asphyxia- this is a pathology with which a child is born, and at the same time the baby’s breathing is impaired and a lack of oxygen appears.

Causes of asphyxia in a newborn baby

It is worth noting that asphyxia cannot occur in a newborn child without obvious reasons. It is also very important to understand that today doctors note several forms of asphyxia, which parents need to become familiar with during pregnancy, so that if asphyxia occurs in the child after birth, they do not start to panic. There is primary and secondary asphyxia. Primary asphyxia in a child may occur during childbirth. This condition is caused by chronic or acute intrauterine hypoxia. In addition, this type of asphyxia can be caused by the following reasons:

• intracranial injury in a child, which he received directly during childbirth;
• congenital abnormalities that affect breathing or cause difficulty breathing;
• immunological incompatibility of a woman with her child;
• the presence of mucus or amniotic fluid in the child’s respiratory tract.

In addition, quite often the cause of primary asphyxia is the presence of a variety of extragenital diseases in a woman. These include diseases of the cardiovascular system, diabetes and others. If a woman experiences toxicosis in the second half of pregnancy, which leads to increased blood pressure and swelling of the extremities, then this can also become a prerequisite for asphyxia in the baby. Today, you can find quite a few cases where the cause of asphyxia is a pathology in the structure of the umbilical cord or placenta, or improper construction of the membranes. In some cases, asphyxia is caused by premature rupture of water, placental abruption, or directly incorrect insertion of the baby's head during labor.

Secondary asphyxia in a newborn child may appear only several hours or even days after birth. The causes of secondary asphyxia are:

• heart defects;
• problems with cerebral circulation in a child;
• serious problems with the central nervous system.

Recently, cases of secondary asphyxia due to pneumopathy have become more frequent, which can occur during pregnancy or directly during childbirth and then develops after birth and primarily affects the respiratory tract.

What changes occur in a child’s body after asphyxia?

When a child experiences asphyxia, all metabolic processes in his body begin to change. These changes will depend entirely on the duration of asphyxia, as well as on the degree of complexity and form. If this is a severe form of asphyxia, then the child’s volume of circulating blood in the body begins to decrease. In this case, the blood becomes thick and quite viscous.

You can understand that a newborn has asphyxia literally just a few seconds after birth. To do this, you need to evaluate the frequency and adequacy of the child’s breathing, the color of his skin, all indicators of muscle tone and heartbeat, as well as the presence of certain reflexes. The main signs by which one can understand the presence of asphyxia are breathing problems, which can cause serious complications in the body of a newborn baby. Therefore, immediately after the birth of the baby, doctors examine him very carefully and give an approximate estimate on the Apgar scale. There are four forms of asphyxia:

1. Lightweight;
2. Average;
3. Heavy;
4. Clinical death.

With a mild form of asphyxia, doctors can give the child a score on the Apgar scale, which will be equal to 6-7 points. Within the first minute after birth, the child must take his first breath. But at the same time, doctors note that his breathing is very weak, and the nasolabial triangle has a slightly bluish tint.

The average form of asphyxia may receive a score slightly lower - 45 points. Just as in the previous case, the child takes his first breath for a minute, but his breathing is very weak and irregular. In addition, the child may experience tachycardia and low muscle tone. The skin of the face, feet and hands will acquire a distinct bluish tint.

If there is a severe form of asphyxia, the child is given an Apgar score of no higher than 1-3 points. In this case, the child’s breathing may be very irregular or may not exist at all. The child cannot fully scream and only moans slightly or makes barely audible sounds. The heartbeat is practically inaudible, and reflexes are completely absent. Atony or hypotension may also be noted. The skin will be unnaturally pale. There will be no pulse at all in the umbilical cord. In most cases, with severe asphyxia, the baby also experiences acute adrenal insufficiency.

In the most severe form of asphyxia, namely in clinical death, the child is given the lowest score - 0 points. In this case, doctors must immediately take all necessary measures to save the child’s life.

To the above, we can add that the presence of asphyxia can be determined not only through an external primary examination of the child. Experts also determine this pathology during an ultrasound of the brain and spinal cord. Since asphyxia primarily affects the central nervous system, it will not be difficult to understand its presence. You can also examine the acid-base state of the child’s blood. This method can be used to confirm a previously made diagnosis.

How to properly treat acute asphyxia in a newborn

All children diagnosed with this condition after birth must undergo intensive therapy. Doctors provide first aid to a child right in the delivery room, immediately after the child is born. At the same time, they very carefully monitor any changes in the main parameters:

• heartbeat;
• breathing;
• hematocrit.

Based on the results of these parameters, doctors will be able to adjust the measures they have taken and will also know what needs to be done next.

What do doctors do when a child is born with asphyxia?

First of all, as soon as the baby’s head is born, a special probe must be inserted into the oral and nasal cavity. Thanks to this device, you can very easily remove remaining mucus and amniotic fluid from the upper respiratory tract and nose. Once the baby is fully born, the umbilical cord is cut, and after the baby is placed on the resuscitation table, the baby's airway must be cleared again.

After the baby’s breathing is restored, he will be transferred to a special intensive care ward.

Measures to prevent asphyxia in newborns

Asphyxia in a newborn baby can cause very serious health problems. If you follow certain tips, then the occurrence of this pathology in a child can be avoided and you can be calm. Of course, these tips do not help in absolutely all cases, but in most of them there is still a positive result.

As has been mentioned several times: the cause of asphyxia can be intrauterine hypoxia. This complication can be avoided very simply: just visit your doctor regularly. Also, during pregnancy, you need to try to eliminate all possible risks of asphyxia in the child in the future. To do this you need to do:

• avoid any infectious or somatic diseases during pregnancy;
• It is worth taking into account the age of the expectant mother; if it goes too far, then monitoring by a doctor should be strengthened;
• remove all possible disturbances in the functioning of the endocrine system;
• try to avoid stress and anxiety;
• get rid of all bad habits;
• monitor changes in a woman’s hormonal levels.

Of course, we should not forget about observing the development of the placenta and fetus in the mother’s womb. Thanks to this, you will be able to detect deviations from the norm in time, if any. By the state of the placenta, you can determine whether the fetus has oxygen starvation. A signal for concern will be the presence of meconium in the amniotic fluid. Therefore, as soon as suspicions arise about the presence of hypoxia in a child, appropriate treatment must be started immediately.

Everything that was mentioned a little above is confirmation that you need to regularly go to the doctor so that in the future you can avoid the occurrence of such a dangerous condition in your child.

The lifestyle of the expectant mother plays a very important role in the prevention of asphyxia. That is why she needs to follow simple rules and then pregnancy and childbirth will proceed without complications, and the child will be born healthy and strong.

1. Walk more in the fresh air. In this way, the woman’s blood will be maximally saturated with oxygen, which will be transferred to the child. It is worth considering that the baby really needs this element. You should not believe those women who say that walking is only useful outside the city. Go to the parks or squares that are in your city and don’t listen to anyone.
2. Maintaining a daily routine. It’s worth forgetting about the frantic pace of life. A woman who is expecting a child should sleep at least 9 hours. It is also advisable that the woman rest for several hours during the day.
3. Take vitamin complexes and eat right. A pregnant woman, like no one else, needs a large amount of vitamins and nutrients that are needed not only for her, but also for her child. Of course, a woman physically cannot take everything her body needs from food, and therefore a good vitamin and mineral complex will be very helpful. Of course, before you start taking such a drug, you need to consult a doctor, because it is he who should prescribe the required complex.
4. Don't be nervous or worry. Pregnancy is the most wonderful period in a woman’s life, and therefore you need to try to eliminate all possible stress and worries. To do this, try to distract yourself from the hustle and bustle around you as much and as often as possible, walk more, chat with friends and simply get positive emotions.

If, however, you were unable to avoid such a serious pathology as asphyxia, then you should not be very nervous, because modern medicine and timely treatment can very quickly cure your baby and give him a normal full life and proper development.

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 disrupted during the prenatal period, that is, on the ratio of the amount of oxygen and carbon dioxide in the child’s tissues and blood cells. ABOUT consequences of asphyxia We'll talk about newborns in the article.

Stages

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

Secondary asphyxia develops in the first days of a child’s life. Occurs with various types of dysfunction of the respiratory system.

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

Forecast depends on the severity of the violation, but in any case, the newborn requires urgent assistance from specialists in intensive care conditions.

What happens during asphyxia?

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

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

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

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

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

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

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

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

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

Reasons for the development of pathology

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

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

Fetal factors:

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

Mother factors:

Factors that disrupt blood circulation in the placenta:

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

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

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

Clinical manifestations

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

Mild degree characterized by:

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

Asphyxia moderate severity manifested by such symptoms as:

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

Heavy asphyxia manifests itself as:

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

You will find specialists in the treatment of bronchial asthma in children on our website.

Treatment

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

Asphyxia mild to moderate severity eliminated in several stages:

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

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

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

Newborn care

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

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

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

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

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

Consequences and complications

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

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

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

Prevention

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

During pregnancy necessary:

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

Asphyxia – 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 at the cellular level is disrupted.

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

ABOUT causes of asphyxia newborns in this video:

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