Traditional medicine

Asphyxia of newborns: a life-threatening condition. Degrees and consequences of newborn asphyxia Newborn asphyxia causes clinical manifestations

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

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Causes and risk factors

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

pregnancy disorders;
pathologies of the pregnant woman or fetus;
lack of oxygen access at the time of the newborn’s first breath (diagnosed as pulmonary asphyxia);
abnormalities in the baby's body.

There are a number of risk factors leading to asphyxia.

Placental factors

Associated with the condition of the placenta:

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

Fruit factors

Situations related to the growth and condition of the embryo:

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

Maternal factors

Pathologies associated with the mother in labor:

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 a consequence of factors such as:

brain and lung injuries during labor;
a heart defect that was not diagnosed or did not manifest itself in the first hours of life;
blockage of the respiratory tract with milk or inadequate sanitation of the stomach;
the effects of respiratory distress;
hyaline membranes;
atelectasis;
hemorrhage in the lungs;
edematous-hemorrhagic syndrome.

Development mechanism

Choking 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, the baby’s body manifests acidosis, glucose deficiency, azotemia and hyperkalemia. In the acute stage of asphyxia, the blood volume 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 pathology of microcirculation of blood with oxygen in the baby’s vital organs (heart, kidneys, brain, liver, adrenal glands). As a result of hypoxia, 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 birth using an Apgar score. The newborn's condition is recorded at the 1st and 5th minute of life. Each symptom is scored from 0 to 2 points. A healthy baby scores from 8 to 10 points at the first examination.

Mild asphyxia of newborns

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

Moderate asphyxia

Apgar score 4-5. Breathing is weak, irregular, rhythm is disturbed. There is cyanosis of the face, feet and hands, and a heart rate of up to 100 beats per minute. There may be cramps in the limbs and chin. Reflexes are either weakened or excessively strengthened. Hypertonicity appears in the muscles.

Severe asphyxia

Acute state of suffocation, Apgar from 1 to 3 at the first examination. The baby does not breathe 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 cry, the tone in the muscles is greatly reduced. The skin is bluish, there is no pulsation in the umbilical cord and no reflexes. The eyeballs float, cramps and brain swelling develop. 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 actions can lead to the appearance of breathing and heart rhythms in the newborn.

Diagnostics

Apgar scores:

presence and frequency of breathing;
heart rate;
muscle tone;
reflexes;
skin tone.

Apgar scores

In addition to external indicators, a blood test is performed to determine the acid-base status. After making the initial diagnosis, an ultrasound (ultrasound) of the brain is performed. With its help, you can 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 measures carried out by doctors in the maternity hospital. Efficiency depends on the timeliness of measures taken.

Resuscitation is carried out by monitoring basic vital parameters:

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

Resuscitation sequence

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

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

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

The baby is transferred under the lamp to the changing table.
Water and mucus are sucked out of the respiratory tract, without coming into contact with the back wall of the pharynx. The skin is wiped dry.
The newborn is placed on his back. For better airway patency, a special cushion is placed under the shoulders.
To stimulate the baby's breathing, they slap the baby's heels and massage the back along the spine with the palm of the hand.
If inspiration does not appear and the heart rate drops to 80 beats per minute, ventilation of the lungs is carried out using a mask in combination with cardiac massage.
If the measures above do not help, medications are used (0.01% adrenaline solution).

If the baby has been diagnosed with clinical death, then resuscitation is carried out for no more than 20 minutes.

In the video you will see resuscitation actions. Filmed at the 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 (incubator), equipped with heating and oxygen supply functions.

Further treatment includes:

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

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

Caring for a child after asphyxia

After an attack of suffocation and rehabilitation therapy, the baby requires special care.

Health care workers and parents should ensure:

complete rest for the newborn and mother;
correct positioning of the child in the incubator (with his head raised);
clearing the respiratory tract of mucus;
dynamic control over body temperature, bowel movements, urination, belching 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 consequences of asphyxia are related to the functioning of the nervous system. Up to a year old, a child may be overly excitable. Seizures and hypothalamic problems cannot be ruled out.

Consequences of asphyxia of newborns at an older age:

hyperactivity;
inattention;
phlegmatism;
poor learning ability.

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

In severe asphyxia, the most serious complication is cerebral palsy. 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 condition of the fetus and placenta;
monitoring pregnancy to identify possible risk factors.

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

healthy lifestyle;
strict adherence to the daily routine;
walks in the fresh air;
proper and nutritious nutrition;
taking vitamins;
calmness, absence 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 observation by a gynecologist, compliance with all doctor’s recommendations.

Video “Causes of asphyxia in a newborn”

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

Asphyxia of newborns is a pathology manifested by the child’s inability to breathe independently, as a result of which hypoxia develops, while the heart functions normally.

Lack of oxygen can lead to the most severe consequences, including the death of the baby. To eliminate the consequences, the newborn child needs urgent resuscitation. The consequences of asphyxia depend on the severity and timely provision of qualified medical care.

Asphyxia of newborns is classified according to the time of development:

primary – appears in utero;
secondary – characterized by the appearance in the first day of the baby’s life.

Also by severity:

light;
moderate;
heavy;
clinical death.

According to statistics, approximately 4–6% of all children born suffer from this pathology. The consequences of newborn asphyxia are very severe; it is one of the common causes of mortality or stillbirth.

Reasons

Primary and secondary types of asphyxia can occur for various reasons. The first is a chronic or acute condition that appears as a result of the following provoking factors:

trauma received by the child in the womb or during childbirth;
developmental defects associated with the respiratory system;
immunological incompatibility;
Rhesus conflict;
intrauterine infection;
postmaturity;
premature aging of the placenta or its detachment;
multiple pregnancy;
low or polyhydramnios;
rapid labor;
uterine rupture;
blockage of the airways with amniotic fluid, meconium or mucus.

Various pathologies during pregnancy can cause the development of asphyxia in the newborn.

In addition, extragenital diseases of the mother can also cause suffocation. For example, these may be diseases of the cardiovascular system, diabetes, anemia, increased blood pressure, swelling of the extremities.

The list continues with shock during childbirth, smoking and alcoholism, lack of nutrients, and taking medications. Other causes of fetal asphyxia are dysfunction of the placenta, umbilical cord, and premature discharge of amniotic fluid.

Secondary asphyxia is a pathology that occurs in the first days after birth. It can occur for the following reasons: heart defect, trauma at birth, disruption of the central nervous system, poor blood supply to brain cells, hemorrhage in the lungs, atelectasis in the lungs, aspiration of milk after feeding.

This pathology is not an independent disease, but is a consequence of complications during pregnancy, diseases of the mother and fetus.

Symptoms

As already mentioned, there are 4 degrees of development of asphyxia. Each is characterized by individual symptoms.

The child's condition is assessed using the Apgar score in the first minute of life

	Mild degree	Moderate	Heavy	Clinical death
Apgar score	6–7 points	4–5 points	1–3 points	0 points
Breath	First breath within the first minute of life, but weak respiratory activity.	The first breath in the first minute after birth. Breathing is weak, intermittent, the cry is quiet	Breathing is completely absent or rare, there is no cry	Absent
Muscle tone and reflexes	Muscle tone is weakened, reflexes are preserved	Weak muscle tone	Rare heartbeat, lack of reflexes, weak or absent muscle tone	Absent
Clinical picture	Blueness of the nasolabial area	Blueness of hands, face, feet, slow heartbeat	Pale skin, weak heartbeat, arrhythmia, pulsation of the umbilical cord	There are no signs of life, immediate resuscitation is required

The main symptom of asphyxia in a newborn is hypoxia, which results in a decrease in heart rate, the development of central nervous system pathology, and a decrease in reflexes and muscle tone.

Consequences

Immediately after birth, the baby is assessed on the Apgar scale - from 0 to 10 points. This procedure is repeated after 5 minutes. If improvements are detected, the prognosis for the newborn's condition is positive. If breathing does not improve, this can lead to the following consequences.

When asphyxia occurs in a newborn, metabolic processes are disrupted, which are more pronounced in severe cases of pathology.

In case of asphyxia, it is important to carry out timely medical intervention

Acute asphyxia, caused by a chronic lack of oxygen in a child, is characterized by complications such as a decrease in blood volume, it becomes thick and viscous. Hypoxia entails hemorrhages in the brain, kidneys, liver, as well as a decrease in blood pressure and a decrease in heart rate.

After asphyxia, infants should be constantly monitored by a pediatrician - this will reduce the risks of damage to health. If you suffer from a mild pathological condition, the consequences can be avoided.

Diagnostics

The diagnosis of newborn asphyxia is made in the first minute after birth. Diagnostics includes monitoring of the following basic functions:

breathing rate;
heartbeat;
muscle tone;
reflex activity;
skin coloring.

In addition to the examination and assessment of the child’s condition on the Apgar scale, a study of the acid-base state of the blood is carried out. To identify destructive processes in the brain, ultrasound and neurological examination are performed. In case of respiratory failure and hypoxia in a child, emergency care and resuscitation are required.

Resuscitation and treatment

The sooner treatment is started for a newborn with asphyxia, the fewer risks and consequences for the child in the future. For this reason, first aid to a baby is provided in the delivery room.

It goes in this order:

Clear the airways of mucus, amniotic fluid, and meconium.
Restore breathing activity.
Provide blood circulation support.

During the resuscitation process, it is necessary to monitor changes in heart rate and breathing, and changes in skin color. In the absence of meconium in the amniotic fluid, the sequence of actions is as follows:

The child is placed under infrared radiation.
All excess is sucked out from the respiratory tract and the baby’s skin is dried using a diaper.
Place the newborn on his back, placing a cushion under his shoulders.
Stimulate breathing by massaging the back along the spine and slapping the heels.

Providing assistance to the baby should occur urgently

If meconium is present in the amniotic fluid, then it is necessary to further clean the trachea, then carry out the procedure again in the respiratory tract. If the heart rate is less than 80 beats per minute, it is necessary to connect a ventilator and perform chest compressions.

If there is no improvement within 30 seconds, then a solution of adrenaline at a concentration of 0.01% is injected through the umbilical vein.

When a child is born in a state of clinical death, resuscitation lasts 20 minutes; if there are no signs of life, then doctors stop resuscitation. After resuscitation procedures, the child is placed in the intensive care unit. Vitamins, Vikasol, Cocarboxylase, ATP, calcium gluconate, and infusion therapy are prescribed.

In case of mild pathology, the newborn is placed in an oxygen ward; in severe cases, in an incubator, providing rest, warmth and antibiotic therapy. You can feed a baby with a mild degree of asphyxia after 16 hours; in case of severe pathology, feeding begins a day later using a tube.

The beginning of breastfeeding is considered individually, depending on the condition. Treatment can last from 10 to 15 days, depending on the child’s condition.

Forecast

The prognosis and consequences for a child who has suffered asphyxia depend on the severity and how correctly and timely primary care is provided. If the Apgar score increases after 5 minutes of life, a favorable prognosis is given. During the first year of life, such a child may be hyper- or hypoactive. He may suffer from seizures and hypertensive-hydrocephalic encephalopathy. Some children die after this pathology.

Caring for a child after asphyxia

After suffering from a pathology, the baby must be provided with complete rest. It must be placed in such a position that the head is raised. It is necessary to carry out oxygen therapy by placing the child in a special tent where oxygen is at a higher concentration. The length of stay in it is individual, determined by the doctor and depends on the condition of the newborn.

It is very important to provide high oxygen levels to an asphyxiated infant.

After severe asphyxia, the child is placed in an incubator, where the percentage of oxygen in the air is 40%. If this equipment is not available in the maternity hospital, a breathing mask or nasal cannulas are used to provide oxygen.

A child after pathology needs constant monitoring. It is necessary to monitor the temperature, the functioning of the gastrointestinal tract and kidneys. In most cases, the airway is cleared again.
After discharge, the newborn should be observed at the place of residence by a pediatrician and neurologist in order to exclude complications of the central nervous system.

Prevention

Conduct a timely examination of embryo development - ultrasound, observation by a gynecologist, laboratory tests, CTG;
walk in the fresh air, away from cars;
stop drinking alcoholic beverages and smoking;
take vitamin complexes;
monitor sleep and rest patterns;
eat right.

Prevention at the pregnancy planning stage consists of observation by a gynecologist, following his recommendations, and undergoing a full examination. This is especially important for women suffering from endocrine system disorders, infections and chronic diseases.

Nursing

After asphyxia, a baby requires special conditions. To do this, parents need to know the nursing process - a scientifically based technology for caring for their baby. Thanks to these activities, the correct conditions for the child’s stay are provided, which contribute to the improvement of his condition.

In the intensive care unit, child care is provided using nursing technology

In addition, nursing intervention provides support to the mother and father of the newborn. This process includes:

Awareness of parents about the factors contributing to the development of suffocation, the course of the pathology and prognosis.
Creating suitable conditions in the intensive care ward where the patient stays.
Carrying out gentle care for the child, carrying out the procedure without disturbing him or moving him from the crib.
Monitoring the baby's condition and writing down written records of breathing, heartbeat, pressure, skin color, tone and reflexes, convulsions, regurgitation, reflexes.
Monitor urine output, temperature, weight and document changes. Changing the baby's position, toileting and hygiene, ensuring oxygen saturation.
Sanitation of the trachea and cleansing of the respiratory tract.
Assessing the result of treatment, making amendments to treatment, consulting with a doctor, and fulfilling his prescription.
Collecting samples for laboratory research.
Ensuring that nutrition is provided in an appropriate manner.
Interaction with parents, explanation of the progress of therapy, notification of the manipulations performed, further observation by a pediatrician and other specialists.
Explaining to parents the importance of rehabilitation therapy, monitoring the development and abilities of the child. Conducting classes with him aimed at stimulating mental and physical activity.

After asphyxia, the child is observed by a neurologist for two years. Treatment courses are also conducted in sanatoriums and resorts. When an examination is carried out, which shows clear improvements and the absence of disturbances in development and condition, the little patient is removed from the dispensary register.

Newborn asphyxia is a pathological condition that occurs in a child in the early neonatal period and is manifested by impaired respiratory function, the development of hypoxic and hypercapnic syndromes.

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

Causes and risk factors

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

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

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

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

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

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

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

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

Species

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

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

According to the severity, asphyxia of newborns can be mild, moderate and severe.

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

Symptoms

The main signs of newborn asphyxia are breathing disorders, which subsequently lead to disruption of the functions of the cardiovascular system, reflexes and muscle tone.

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

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

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

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

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

Mild asphyxia of a newborn is characterized by:

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

With moderate asphyxia of newborns, the following are observed:

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

Severe asphyxia of newborns is manifested by the following symptoms:

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

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

Diagnostics

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

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

Treatment

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

For mild to moderate asphyxia of newborns, treatment measures include:

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

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

With severe asphyxia, newborns require urgent resuscitation. Tracheal intubation is performed, the child is connected to a ventilator, and external cardiac massage is performed. Then the existing disorders are treated with medication.

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

Newborns with mild asphyxia are placed in an oxygen tent, and with moderate or severe asphyxia, they are placed in an incubator. These children require special attention from medical personnel. Issues related to drug treatment, feeding and caring for such children are resolved on a case-by-case basis by a neonatologist.

All children who have suffered asphyxia during the neonatal period should subsequently be monitored by a neurologist.

Possible complications and consequences

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

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

Forecast

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

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

Prevention

Prevention of newborn asphyxia includes the following measures:

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

Video from YouTube on the topic of the article:

Asphyxia of the newborn(asphyxia neonatorum) is a pathological condition of a newborn caused by respiratory failure and resulting oxygen deficiency. There are primary (at birth) and secondary (in the first hours and days of life) asphyxia of the newborn.

Reasons:

The causes of primary asphyxia of a newborn are acute and chronic intrauterine oxygen deficiency - fetal hypoxia, intracranial trauma, immunological incompatibility of the blood of mother and fetus, intrauterine infection, complete or partial blockage of the respiratory tract of the fetus or newborn with mucus, amniotic fluid (aspiration asphyxia), fetal malformations.

The occurrence of asphyxia of a newborn is facilitated by extragenital diseases of the pregnant woman (cardiovascular, especially in the stage of decompensation, severe lung diseases, severe anemia, diabetes mellitus, thyrotoxicosis, infectious diseases, etc.), late toxicosis of pregnant women, post-term pregnancy, premature placental abruption, umbilical cord pathology, membranes and placenta, complications during childbirth (untimely rupture of amniotic fluid, labor anomalies, discrepancy between the sizes of the woman's pelvis and the fetal head, incorrect insertion of the fetal head, etc.). Secondary asphyxia of a newborn can be associated with impaired cerebral circulation in the newborn, pneumopathy, etc.

What happens during asphyxia?

Regardless of the causes of oxygen deficiency, a restructuring of metabolic processes, hemodynamics and microcirculation occurs in the newborn’s body. Their severity depends on the intensity and duration of hypoxia. Metabolic or respiratory-metabolic acidosis develops, accompanied by hypoglycemia, azotemia and hyperkalemia, followed by potassium deficiency. Electrolyte imbalance and metabolic acidosis lead to cellular hyperhydration. In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating red blood cells.

Asphyxia of a newborn, which develops against the background of chronic fetal hypoxia, is accompanied by hypovolemia. Blood thickens, its viscosity increases, and the aggregation ability of red blood cells and platelets increases. In the brain, heart, kidneys, adrenal glands and liver of newborns, as a result of microcirculatory disorders, edema, hemorrhages and areas of ischemia occur, and tissue hypoxia develops. Central and peripheral hemodynamics are disrupted, which is manifested by a decrease in stroke and cardiac output and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation disrupt the urinary function of the kidneys.

Symptoms:

The leading symptom of newborn asphyxia is respiratory failure, leading to changes in cardiac activity and hemodynamics, disruption of neuromuscular conduction and reflexes. The severity of newborn asphyxia is determined using the Apgar scale. In accordance with the International Classification of Diseases, IX Revision, newborn asphyxia is classified into moderate and severe (Apgar score in the first minute after birth, 7-4 and 3-0 points, respectively). In clinical practice, it is customary to distinguish three degrees of severity of asphyxia: mild (assessed on a scale

Apgar in the first minute after birth is 7-6 points), moderate (5-4 points) and severe (3-1 point). A total score of 0 points indicates clinical death. With mild asphyxia, the newborn takes his first breath within the first minute after birth, but his breathing is weakened, acrocyanosis and cyanosis of the nasolabial triangle, and a slight decrease in muscle tone are noted. With moderate asphyxia, the child takes his first breath within the first minute after birth, breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted, but there may also be tachycardia, muscle tone and reflexes are reduced, the skin is bluish, sometimes mainly in areas of the face, hands and feet, the umbilical cord is pulsating.

In severe asphyxia, breathing is irregular (individual breaths) or absent, the child does not scream, sometimes groans, the heartbeat is slow, in some cases replaced by single irregular heart contractions, muscle hypotonia or atony is observed, there are no reflexes, the skin is pale as a result of spasm of peripheral vessels, the umbilical cord is not pulsates; Adrenal insufficiency often develops.

Oxygen deficiency and disorders of the external respiration function disrupt the formation of hemodynamics and microcirculation, and therefore fetal communications are preserved: the arterial (botal) duct remains open; as a result of spasm of the pulmonary capillaries, leading to increased pressure in the pulmonary circulation and overload of the right half of the heart, the foramen ovale does not close. Atelectasis and often hyaline membranes are found in the lungs. Cardiac disturbances are noted: dullness of tones, extrasystole, arterial hypotension.

Against the background of hypoxia and reduced immune defense, microbial colonization of the intestine is often disrupted, which leads to the development of dysbiosis. During the first 5-7 days of life, metabolic disorders persist, manifested by the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance and true potassium deficiency in the child’s body. Due to impaired renal function and a sharp decrease in diuresis after the 2-3rd day of life, newborns develop edema syndrome.

A thorough neurological examination of the newborn and ultrasound examination of the brain make it possible to differentiate hypoxic and traumatic damage to the central nervous system. In the case of predominantly hypoxic damage to the central nervous system. focal neurological symptoms are not detected in most children; a syndrome of increased neuro-reflex excitability develops, in more severe cases - a syndrome of central nervous system depression. In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.) at birth, hypoxemic vascular shock is detected with spasm of peripheral vessels and pronounced pallor of the skin, hyperexcitability, focal neurological symptoms and convulsive syndrome that occurs several hours after birth are often observed. .

Treatment of asphyxia in a newborn:

Children born with asphyxia require resuscitation care. Its effectiveness largely depends on how early treatment is started. Resuscitation measures are carried out in the delivery room under the control of the basic parameters of the body’s vital activity: respiratory rate and its conductivity to the lower parts of the lungs, heart rate, blood pressure, hematocrit and acid-base status.

In case of mild asphyxia, the child is placed in a drainage (knee-elbow) position, inhalation of a 60% oxygen-air mixture is prescribed, and cocarboxylase (8 mg/kg) in 10-15 ml of a 10% glucose solution is injected into the umbilical cord vein. In case of moderate asphyxia, to normalize breathing, artificial pulmonary ventilation (ALV) is indicated using a mask until regular breathing is restored and the skin appears pink (usually within 2-3 minutes), then oxygen therapy is continued by inhalation. Oxygen must be supplied humidified and warmed with any method of oxygen therapy.

Cocarboxylase is injected into the umbilical cord vein in the same dose as for mild asphyxia. In case of severe asphyxia, immediately after crossing the umbilical cord and suctioning the contents of the upper respiratory tract and stomach, tracheal intubation is carried out under the control of direct laryngoscopy and mechanical ventilation until regular breathing is restored (if within 15-20 minutes the child has not taken a single independent breath, resuscitation measures are stopped even if heartbeat).

Simultaneously with mechanical ventilation, cocarboxylase (8-10 mg/kg in 10-15 ml of 10% glucose solution), 5% sodium bicarbonate solution (only after creating adequate ventilation of the lungs, on average 5 ml/kg), 10% solution is injected into the umbilical cord vein calcium gluconate (0.5-1 ml/kg), prednisolongemisuccinate (1 mg/kg) or hydrocortisone (5 mg/kg) to restore vascular tone. If bradycardia occurs, 0.1 ml of a 0.1% atropine sulfate solution is injected into the umbilical cord vein. If the heart rate is less than 50 beats per minute or in case of cardiac arrest, an indirect cardiac massage is performed, 0.5-1 ml of a 0.01% (1: 10000) solution of adrenaline hydrochloride is injected into the umbilical cord vein or intracardially.

Before craniocerebral hapotothermia, premedication is required (infusion of 20% sodium hydroxybutyrate solution at 100 mg/kg and 0.25% droperidol solution at 0.5 mg/kg). The scope of treatment measures is determined by the child’s condition; they are carried out under the control of hemodynamics, blood coagulation, acid-base status, protein, glucose, potassium, sodium, calcium, chloride, magnesium levels in the blood serum. To eliminate metabolic disorders, restore hemodynamics and renal function, a 10% glucose solution, rheopolyglucin is injected intravenously, and hemodez is administered from the second to third day.

The total volume of administered fluid (including feeding) on the first and second days should be 40-60 ml/kg, on the third day - 60-70 ml/kg, on the fourth - 70-80 ml/kg, on the fifth - 80-90 ml/kg, on sixths and sevenths - 100 ml/kg. From the second or third day, a 7.5% solution of potassium chloride (1 ml/kg per day) is added to the dropper. Cocarboxylase (8-10 mg/kg per day), 5% ascorbic acid solution (1-2 ml per day), 20% calcium pantothenate solution (1-2 mg/kg per day), 1% riboflavin solution are injected intravenously. mononucleotide (0.2-0.4 ml/kg per day), pyridoxal phosphate (0.5-1 mg per day), cytochrome C (1-2 ml of 0.25% solution per day for severe asphyxia), 0 is administered intramuscularly .5% solution of lipoic acid (0.2-0.4 ml/kg per day). Tocopherol acetate 5-10 mg/kg per day intramuscularly or 3-5 drops of a 5-10% solution per 1 kg of body weight orally, glutamic acid 0.1 g 3 times a day orally are also used.

In order to prevent hemorrhagic syndrome in the first hours of life, a 1% solution of Vikasol (0.1 ml/kg) is administered intramuscularly once, and rutin is prescribed orally (0.005 g 2 times a day). For severe asphyxia, a 12.5% solution of etamsylate (dicinone) 0.5 ml/kg intravenously or intramuscularly is indicated. For the syndrome of increased neuro-reflex excitability, sedative and dehydration therapy is prescribed: 25% magnesium sulfate solution 0.2-0.4 ml/kg per day intramuscularly, Seduxen (Relanium) 0.2-0.5 mg/kg per day intramuscularly or intravenously, sodium hydroxybutyrate 150-200 mg/kg per day intravenously, Lasix 2-4 mg/kg per day intramuscularly or intravenously, mannitol 0.5-1 g of dry matter per 1 kg of weight intravenously drip by 10% glucose solution, phenobarbital 5-10 mg/kg per day orally. In case of development of cardiovascular failure accompanied by tachycardia, 0.1 ml of 0.06% solution of corglycon, digoxin is administered intravenously (the saturation dose on the first day is 0.05-0.07 mg/kg, on the next day 1/5 is administered part of this dose), 2.4% aminophylline solution (0.1-0.2 ml/kg per day). To prevent dysbacteriosis, bifidumbacterin is included in the therapy complex, 2 doses 2 times a day.

It is necessary to monitor body temperature, diuresis, and bowel function. The first feeding for mild and moderate asphyxia is prescribed 12-18 hours after birth (expressed breast milk). Those born with severe asphyxia begin to be fed through a tube 24 hours after birth. The timing of breastfeeding is determined by the condition of the child. Due to the possibility of complications from the central nervous system. After discharge from the maternity hospital, children born with asphyxia are monitored by a pediatrician and a neurologist.

Forecast and prevention:

The prognosis depends on the severity of asphyxia, the completeness and timeliness of treatment measures. In case of primary asphyxia, to determine the prognosis, the condition of the newborn is re-evaluated using the Apgar scale 5 minutes after birth. If the score increases, the prognosis for life is favorable. During the first year of life, children who have suffered asphyxia may experience hypo- and hyperexcitability syndromes, hypertensive-hydrocephalic, convulsive, diencephalic disorders, etc.

Prevention includes timely detection and treatment of extragenital diseases in pregnant women, pathologies of pregnancy and childbirth, prevention of intrauterine fetal hypoxia, especially at the end of the second stage of labor, suction of mucus from the upper respiratory tract immediately after the birth of the child.

A pathological condition of a newborn caused by respiratory failure and resulting oxygen deficiency.

There are primary (at birth) and secondary (in the first hours and days of life) asphyxia of the newborn.

Etiology.

The causes of primary A. n. are acute and chronic intrauterine oxygen deficiency - fetal hypoxia, intracranial injury, immunological incompatibility of the blood of mother and fetus, intrauterine infection, complete or partial blockage of the respiratory tract of the fetus or newborn with mucus, amniotic fluid (aspiration asphyxia), defects fetal development.

The occurrence is facilitated by extragenital diseases of the pregnant woman (cardiovascular, especially in the stage of decompensation, severe lung diseases, severe anemia, diabetes mellitus, thyrotoxicosis, infectious diseases, etc.), late toxicosis of pregnant women, post-term pregnancy, premature placental abruption, pathology of the umbilical cord, fetal membranes and placenta, complications during childbirth (untimely rupture of amniotic fluid, labor anomalies, discrepancy between the sizes of the mother’s pelvis and the fetal head, incorrect insertion of the fetal head, etc.).

Secondary may be associated with impaired cerebral circulation in a newborn, pneumopathy, etc.

Pathogenesis.

Metabolic or respiratory-metabolic acidosis develops, accompanied by hypoglycemia, azotemia and hyperkalemia, followed by potassium deficiency. Electrolyte imbalance and metabolic acidosis lead to cellular hyperhydration.

In acute hypoxia, the volume of circulating blood increases mainly due to an increase in the volume of circulating red blood cells. A. n., which developed against the background of chronic fetal hypoxia, is accompanied by hypovolemia. Blood thickens, its viscosity increases, and the aggregation ability of red blood cells and platelets increases. In the brain, heart, kidneys, adrenal glands and liver of newborns, as a result of microcirculatory disorders, edema, hemorrhages and areas of ischemia occur, and tissue hypoxia develops. Central and peripheral hemodynamics are disrupted, which is manifested by a decrease in stroke and cardiac output and a drop in blood pressure. Disorders of metabolism, hemodynamics and microcirculation disrupt the urinary function of the kidneys.

Clinical picture.

The leading symptom of A. n. is a breathing disorder, leading to changes in cardiac activity and hemodynamics, disruption of neuromuscular conduction and reflexes. Severity of A. n. determined by the Apgar scale (see Apgar method). There are A. n. moderate and severe (Apgar score in the first minute after birth, 7-4 and 3-0 points, respectively). In clinical practice, it is customary to distinguish three degrees of severity of asphyxia:

mild (Apgar score in the first minute after birth 7-6 points),
moderate severity (5-4 points)
severe (3-1 points).

A total score of 0 points indicates clinical death. With mild asphyxia, the newborn takes his first breath within the first minute after birth, but his breathing is weakened, acrocyanosis and cyanosis of the nasolabial triangle, and a slight decrease in muscle tone are noted. With moderate asphyxia, the child takes his first breath within the first minute after birth, breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted, but there may also be tachycardia, muscle tone and reflexes are reduced, the skin is bluish, sometimes mainly in areas of the face, hands and feet, the umbilical cord is pulsating. In severe asphyxia, breathing is irregular (individual breaths) or absent, the child does not scream, sometimes groans, the heartbeat is slow, in some cases replaced by single irregular heart contractions, muscle hypotonia or atony is observed, there are no reflexes, the skin is pale as a result of spasm of peripheral vessels, the umbilical cord is not pulsates; Adrenal insufficiency often develops.

In the first hours and days of life, newborns who have suffered asphyxia develop posthypoxic syndrome, the main manifestation of which is damage to the central nervous system. At the same time, every third child born in a state of moderate asphyxia has a cerebral circulation disorder of the I-II degree; all children who have suffered severe asphyxia develop symptoms of impaired liquor dynamics and cerebral circulation of the II-III degree. Oxygen deficiency and disorders of the external respiration function disrupt the formation of hemodynamics and microcirculation, and therefore fetal communications are preserved: the arterial (botal) duct remains open; as a result of spasm of the pulmonary capillaries, leading to increased pressure in the pulmonary circulation and overload of the right half of the heart, the foramen ovale does not close. Atelectasis and often hyaline membranes are found in the lungs. Cardiac disturbances are noted: dullness of tones, extrasystole, arterial hypotension. Against the background of hypoxia and reduced immune defense, microbial colonization of the intestine is often disrupted, which leads to the development of dysbiosis. During the first 5-7 days of life, metabolic disorders persist, manifested by the accumulation of acidic metabolic products, urea, hypoglycemia, electrolyte imbalance and true potassium deficiency in the child’s body. Due to impaired renal function and a sharp decrease in diuresis after the 2-3rd day of life, newborns develop edema syndrome.

The diagnosis of asphyxia and its severity is established on the basis of determining in the first minute after birth the degree of respiratory impairment, changes in heart rate, muscle tone, reflexes, and skin color. The severity of asphyxia is also indicated by indicators of the acid-base state (see Acid-base balance). So, if in healthy newborns the pH of blood taken from the umbilical cord vein is 7.22-7.36, BE (base deficiency) is from - 9 to - 12 mmol/l, then with mild asphyxia and moderate asphyxia these indicators are respectively equal 7.19-7.11 and from - 13 to - 18 mmol/l, with severe asphyxia pH less than 7.1 BE from - 19 mmol/l or more. A thorough neurological examination of the newborn and ultrasound examination of the brain make it possible to differentiate hypoxic and traumatic damage to the central nervous system. In the case of predominantly hypoxic damage to the central nervous system. focal neurological symptoms are not detected in most children; a syndrome of increased neuro-reflex excitability develops, in more severe cases - a syndrome of central nervous system depression. In children with a predominance of the traumatic component (extensive subdural, subarachnoid and intraventricular hemorrhages, etc.) at birth, hypoxemic vascular shock is detected with spasm of peripheral vessels and pronounced pallor of the skin, hyperexcitability, focal neurological symptoms and convulsive syndrome that occurs several hours after birth are often observed. .

Treatment.

At the moment of birth of the fetal head and immediately after the birth of the child, the contents of the upper respiratory tract are carefully removed using a soft catheter using an electric suction (while using tees to create intermittent rarefaction of air); The umbilical cord is immediately cut and the baby is placed on a resuscitation table under a radiant heat source. Here, the contents of the nasal passages, oropharynx, and stomach contents are re-aspirated. In case of mild asphyxia, the child is placed in a drainage (knee-elbow) position, inhalation of a 60% oxygen-air mixture is prescribed, and cocarboxylase (8 mg/kg) in 10-15 ml of a 10% glucose solution is injected into the umbilical cord vein. In case of moderate asphyxia, to normalize breathing, artificial pulmonary ventilation (ALV) is indicated using a mask until regular breathing is restored and the skin appears pink (usually within 2-3 minutes), then oxygen therapy is continued by inhalation. Oxygen must be supplied humidified and warmed with any method of oxygen therapy. Cocarboxylase is injected into the umbilical cord vein in the same dose as for mild asphyxia. In case of severe asphyxia, immediately after crossing the umbilical cord and suctioning the contents of the upper respiratory tract and stomach, tracheal intubation is carried out under the control of direct laryngoscopy and mechanical ventilation until regular breathing is restored (if within 15-20 minutes the child has not taken a single independent breath, resuscitation measures are stopped even if heartbeat). Simultaneously with mechanical ventilation, cocarboxylase (8-10 mg/kg in 10-15 ml of 10% glucose solution), 5% sodium bicarbonate solution (only after creating adequate ventilation of the lungs, on average 5 ml/kg), 10% solution is injected into the umbilical cord vein calcium gluconate (0.5-1 ml/kg), prednisolongemisuccinate (1 mg/kg) or hydrocortisone (5 mg/kg) to restore vascular tone. If bradycardia occurs, 0.1 ml of a 0.1% atropine sulfate solution is injected into the umbilical cord vein. If the heart rate is less than 50 beats per minute or in case of cardiac arrest, an indirect cardiac massage is performed, 0.5-1 ml of a 0.01% (1: 10000) solution of adrenaline hydrochloride is injected into the umbilical cord vein or intracardially.

After the restoration of breathing and cardiac activity and stabilization of the child’s condition, he is transferred to the intensive care unit of the neonatal department, where measures are taken aimed at preventing and eliminating cerebral edema, restoring hemodynamic and microcirculatory disorders, normalizing metabolism and kidney function. Craniocerebral hypothermia is carried out - local cooling of the newborn's head (see Artificial hypothermia) and infusion-dehydration therapy. Before craniocerebral hapotothermia, premedication is required (infusion of 20% sodium hydroxybutyrate solution at 100 mg/kg and 0.25% droperidol solution at 0.5 mg/kg). The scope of treatment measures is determined by the child’s condition; they are carried out under the control of hemodynamics, blood coagulation, acid-base status, protein, glucose, potassium, sodium, calcium, chloride, magnesium levels in the blood serum. To eliminate metabolic disorders, restore hemodynamics and renal function, a 10% glucose solution, rheopolyglucin is injected intravenously, and hemodez is administered from the second to third day. The total volume of administered fluid (including feeding) on the first and second days should be 40-60 ml/kg, on the third day - 60-70 ml/kg, on the fourth - 70-80 ml/kg, on the fifth - 80-90 ml/kg, on sixths and sevenths - 100 ml/kg. From the second or third day, a 7.5% solution of potassium chloride (1 ml/kg per day) is added to the dropper. Cocarboxylase (8-10 mg/kg per day), 5% ascorbic acid solution (1-2 ml per day), 20% calcium pantothenate solution (1-2 mg/kg per day), 1% riboflavin solution are injected intravenously. mononucleotide (0.2-0.4 ml/kg per day), pyridoxal phosphate (0.5-1 mg per day), cytochrome C (1-2 ml of 0.25% solution per day for severe asphyxia), 0 is administered intramuscularly .5% solution of lipoic acid (0.2-0.4 ml/kg per day). Tocopherol acetate 5-10 mg/kg per day intramuscularly or 3-5 drops of a 5-10% solution per 1 kg of body weight orally, glutamic acid 0.1 g 3 times a day orally are also used. In order to prevent hemorrhagic syndrome in the first hours of life, a 1% solution of Vikasol (0.1 ml/kg) is administered intramuscularly once, and rutin is prescribed orally (0.005 g 2 times a day). For severe asphyxia, a 12.5% solution of etamsylate (dicinone) 0.5 ml/kg intravenously or intramuscularly is indicated. For the syndrome of increased neuro-reflex excitability, sedative and dehydration therapy is prescribed: 25% magnesium sulfate solution 0.2-0.4 ml/kg per day intramuscularly, Seduxen (Relanium) 0.2-0.5 mg/kg per day intramuscularly or intravenously, sodium hydroxybutyrate 150-200 mg/kg per day intravenously, Lasix 2-4 mg/kg per day intramuscularly or intravenously, mannitol 0.5-1 g of dry matter per 1 kg of weight intravenously drip by 10% glucose solution, phenobarbital 5-10 mg/kg per day orally. In case of development of cardiovascular failure accompanied by tachycardia, 0.1 ml of 0.06% solution of corglycon, digoxin is administered intravenously (the saturation dose on the first day is 0.05-0.07 mg/kg, on the next day 1/5 is administered part of this dose), 2.4% aminophylline solution (0.1-0.2 ml/kg per day). To prevent dysbacteriosis, bifidumbacterin is included in the therapy complex, 2 doses 2 times a day.

Care is important. The child should be ensured rest, the head should be placed in an elevated position. Children who have suffered mild asphyxia are placed in an oxygen tent; children who have suffered moderate to severe asphyxia are placed in an incubator. Oxygen is supplied at a rate of 4-5 l/min, which creates a concentration of 30-40%. If the necessary equipment is not available, oxygen can be supplied through a mask or nasal cannula. Repeated suction of mucus from the upper respiratory tract and stomach is often indicated. It is necessary to monitor body temperature, diuresis, and bowel function. The first feeding for mild and moderate asphyxia is prescribed 12-18 hours after birth (expressed breast milk). Those born with severe asphyxia begin to be fed through a tube 24 hours after birth. The timing of breastfeeding is determined by the condition of the child. Due to the possibility of complications from the central nervous system. After discharge from the maternity hospital, children born with asphyxia are monitored by a pediatrician and a neurologist.