Asphyxia of newborns
The content of the article:
- Causes and risk factors
- Kinds
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Asphyxia of newborns 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.
Asphyxia is observed in about 4-6% of newborns and becomes one of the main causes of perinatal mortality.
Asphyxia of newborns is manifested by impaired respiratory function
Causes and risk factors
Diseases of a pregnant woman, pathological development of pregnancy, 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 mother's blood and fetal blood;
- intrauterine infections (herpes, chlamydia, toxoplasmosis, syphilis, cytomegalovirus, rubella);
- aspiration asphyxia (complete or partial obstruction of the airways with mucus or amniotic fluid);
- fetal malformations;
- extragenital pathology (diabetes mellitus, thyrotoxicosis, lung or heart disease, anemia);
- burdened obstetric history (complicated labor, post-term pregnancy, premature placental abruption, gestosis);
- the mother has bad habits, her use of prohibited substances.
The development of secondary asphyxia of a newborn is based on pneumopathy or cerebrovascular accident in a child. Pneumopathies are non-infectious diseases of the lungs of the perinatal period, resulting from incomplete expansion of the lungs in a newborn, which leads to the development of atelectasis, hyaline membrane disease, or edematous hemorrhagic syndrome.
Pathogenetic changes occurring in the child's body during asphyxia of newborns do not depend on the causes of this syndrome. Against the background of hypoxia, the child develops respiratory-metabolic acidosis, which is characterized by hypoglycemia, azotemia, initial hyperkalemia, followed by hypokalemia. Electrolyte imbalances lead to cellular overhydration.
Asphyxia can develop at different stages of pregnancy and the birth of a baby.
With acute asphyxia in newborns, an increase in the volume of circulating blood occurs mainly due to erythrocytes. In the chronic form of pathology, hypovolemia is observed (a decrease in the volume of circulating blood). Such violations have a significant effect on blood rheology, impairing microcirculatory blood circulation.
Microcirculatory shifts, in turn, cause hypoxia, edema, ischemia, hemorrhages that occur in the liver, adrenal glands, heart, kidneys, but above all in the brain of the newborn.
Ultimately, disorders of not only peripheral, but also central hemodynamics develop, blood pressure drops, minute and stroke volumes of the heart decrease.
Kinds
Depending on the time of occurrence, newborn asphyxia is divided into two types:
- Primary - occurs in the first minutes of a baby's life.
- Secondary - develops within the first days after birth.
In terms of severity, newborn asphyxia is mild, moderate and severe.
Symptoms
The main signs of newborn asphyxia are breathing disorders, which further lead to disorders of the cardiovascular system, reflexes and muscle tone.
To assess the severity of newborn asphyxia, the Apgar method (scale) is used. It is based on a scoring of the following criteria:
- heel reflex (reflex excitability);
- breath;
- palpitations;
- muscle tone;
- coloring of the skin.
Assessment of the condition of the newborn on the Apgar scale:
| Parameter | Score in points | ||
| Heart rate, beats / min | Absent | Less than 100 | Over 100 |
| Breath | Absent | Bradypnea, irregular | Normal, loud scream |
| Skin coloration | Generalized pallor or generalized cyanosis | Pink coloration of the body and bluish coloration of the limbs (acrocyanosis) | Pink coloration of the whole body and limbs |
| Muscle tone | Absent | Mild limb flexion | Active movements |
| Reflex excitability (reaction to the suction of mucus from the upper respiratory tract, irritation of the soles) | Absent | Grimace | Cough |
With a mild degree of asphyxia, the state of newborns according to the Apgar scale is estimated at 6-7 points, moderate - 4-5 points, severe - 1-3 points. With the clinical death of a newborn, the Apgar score is 0 points.
For a mild degree of asphyxia of a newborn, the following are characteristic:
- the first breath in the first minute of life;
- decreased muscle tone;
- cyanosis of the nasolabial triangle;
- weakened breathing.
With asphyxia of moderate newborns, there are:
- weakened breathing;
- bradycardia;
- weak cry;
- acrocyanosis;
- decreased muscle tone;
- pulsation of the vessels of the umbilical cord.
Severe asphyxia of newborns is manifested by the following symptoms:
- lack of screaming;
- apnea or irregular breathing;
- severe bradycardia;
- muscle atony;
- pallor of the skin;
- areflexia;
- the development of adrenal insufficiency;
- absence of pulsation of the vessels of the umbilical cord.
Against the background of asphyxia in newborns in the first day of life, post-hypoxic syndrome may develop, which is characterized by signs of damage to the central nervous system (cerebrospinal fluid dynamics, cerebrovascular accident).
Diagnostics
Diagnosis and assessment of the severity of newborn asphyxia is based on the Apgar scale. To confirm the diagnosis, a study of the acid-base balance of the blood is carried out.
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 need urgent medical care aimed at restoring breathing, correcting existing hemodynamic, electrolyte balance and metabolic disorders.
For mild to moderate newborn asphyxia, therapeutic measures include:
- aspiration of contents from the oral cavity and nasopharynx;
- assisted ventilation of the lungs with a breathing mask;
- introduction through the umbilical cord vein of a hypertonic solution of glucose and cocarboxylase.
If the above measures do not lead to the restoration of spontaneous breathing, the trachea is intubated with subsequent sanitation of the airways and the transfer of the child to artificial ventilation. To correct respiratory acidosis, sodium bicarbonate is administered intravenously.
With a severe degree of asphyxia, newborns need urgent resuscitation. Tracheal intubation is performed, the child is connected to a ventilator, and external heart massage is performed. Then carry out drug treatment of existing disorders.
Newborns with mild asphyxia are placed in an oxygen tent, and for moderate or severe asphyxia, in an incubator. These children require special attention from medical personnel. Issues related to drug treatment, feeding and caring for such children are decided on a case-by-case basis by a neonatologist.
A newborn with severe asphyxiation is placed in an incubator
All children who have undergone 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 period, children who have undergone asphyxia in a neonatal state 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. With a mild form, it is favorable, the outcome of asphyxia of newborns of moderate severity largely depends on the timeliness of the provision of medical care, generally favorable. With severe neonatal asphyxia, if the child survives, there is a high risk of serious complications.
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 case;
- intrauterine monitoring of the condition of the fetus and placenta.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
