Hypoxia in newborns
The content of the article:
- Forms
- Causes
- Symptoms of hypoxia in newborns
- Diagnostics
- Treatment of hypoxia in newborns
- Complications and consequences of hypoxia in newborns
- Prevention
Hypoxia in newborns is oxygen starvation of the child's body, which can be chronic or acute. The pathology is widespread and is detected in approximately 4-6% of newborns.
Source: moirody.ru
Hypoxia in newborns is not an independent disease, but is a pathological condition that occurs against the background of an unfavorable pregnancy, childbirth, or develops as a symptom of any congenital or acquired pathology. Hypoxia is observed several times more often in premature babies. This is due to the frequent development of respiratory distress syndrome in them, caused by the immaturity of the lung tissue, one of the manifestations of which is the state of hypoxia.
Hypoxia in newborns is accompanied by systemic disorders of varying severity, primarily, damage to the central nervous system, which is manifested by its dysfunction. Severe forms of oxygen starvation pose a serious danger to a newborn, can cause disability or death.
Forms
Depending on the time of occurrence, two forms of hypoxia are distinguished in newborns:
- primary - develops at the stage of intrauterine development of the fetus or during childbirth, it can be both acute and chronic;
- secondary - occurs on the first day of a newborn's life against the background of any other pathological conditions (pneumopathy, cerebrovascular accident).
Causes
Primary hypoxia in newborns is caused by diseases of the fetus and mother, pathological course of pregnancy, complicated childbirth:
- intrauterine infections (herpes, chlamydia, toxoplasmosis, syphilis, cytomegalovirus, rubella);
- fetal malformations;
- immunological incompatibility of fetal and maternal blood;
- extragenital diseases of a pregnant woman (diabetes mellitus, thyrotoxicosis, acute and chronic lung diseases, heart defects, anemia);
- obstruction of the respiratory tract of the newborn with mucus or amniotic fluid (aspiration hypoxia);
- burdened obstetric history (prolonged pregnancy, premature placental abruption, gestosis);
- the mother has bad habits (smoking, alcohol abuse, drug addiction).
The main causes of secondary hypoxia in newborns are:
- disorders of cerebral circulation;
- pneumopathies are perinatal pathologies of the lungs of a non-infectious nature, caused by insufficient expansion of the lung tissue (disease of the hyaline membranes, edematous hemorrhagic syndrome, atelectasis).
Hypoxia in newborns leads to disorders of hemodynamics, microcirculation and metabolism, i.e. to respiratory-metabolic acidosis, which is characterized by:
- hypoglycemia;
- azotemia;
- cellular overhydration;
- hyperkalemia, followed by hypokalemia.
Against the background of hypoxia in newborns, the blood thickens, which leads to an increase in its viscosity and increased aggregation of erythrocytes and platelets. The resulting microcirculation disorders cause hemorrhages, ischemia and edema of the tissues of the brain, liver, adrenal glands, heart, kidneys. Clinically, this is manifested by the appearance of the following signs of hypoxia in newborns:
- drop in blood pressure;
- decrease in minute and stroke volume of cardiac output;
- violation of peripheral and central hemodynamics.
Symptoms of hypoxia in newborns
The main sign of hypoxia in newborns is breathing disorders, which lead to disorders of cardiac activity, hemodynamics, reflexes and muscle tone.
Immediately after birth and 5 minutes later, in order to identify possible hypoxia and determine its severity, the condition of the newborn is assessed on the Apgar scale. This technique is based on an assessment from 0 to 2 points of the following indicators:
- breath;
- skin color;
- palpitations;
- the severity of muscle tone;
- reflex excitability.
Apgar scale criteria table:
| Parameter | Score in points | ||
| 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 |
| Heart rate, beats / min | Absent | Less than 100 | Over 100 |
| Reflex excitability | Absent | The reaction is weak (grimace, movement) | Reaction in the form of movement, coughing, sneezing, loud screaming |
| Muscle tone | Missing, limbs drooping | Decreased, some flexion of the limbs | Active movements are expressed |
| Breath | Absent | Irregular, weak cry (hypoventilation) | Normal, screaming loud |
In the absence of hypoxia, newborns gain 8-10 points on the Apgar scale. With a mild degree of hypoxia, the score is 6-7 points, with an average degree - 4-5 points, with a severe degree - 0-3 points.
Symptoms of hypoxia in newborns are mild:
- the first breath occurs in the first minute of life;
- weakened breathing;
- decreased muscle tone;
- cyanosis of the nasolabial triangle.
With hypoxia of moderate severity in newborns, the following are observed:
- weakened irregular breathing;
- weak cry;
- bradycardia;
- decreased reflex excitability;
- decreased muscle tone;
- acrocyanosis.
Severe hypoxia in newborns is manifested by the following symptoms:
- lack of breathing (apnea) or single irregular breathing movements;
- severe bradycardia;
- significant hypo- or muscle atony;
- lack of reflexes;
- pallor of the skin;
- adrenal insufficiency.
In newborns with hypoxia, post-hypoxic syndrome, characterized by impaired CSF dynamics and cerebral circulation, may develop in the first day of life.
Source: uziprosto.ru
Diagnostics
The primary diagnosis of hypoxia in newborns is based on the Apgar score. To confirm the diagnosis, a study of the acid-base composition of the blood is carried out.
For differential diagnosis of traumatic and hypoxic damage to the nervous system, ultrasonography (ultrasound of the brain) and a neurological examination of the newborn are performed.
Lesions of the central nervous system caused by oxygen starvation are manifested by increased neuro-reflex excitability (against the background of severe hypoxia, suppression of reflexes is noted), the absence of focal symptoms.
Source: moirody.ru
Treatment of hypoxia in newborns
Treatment of hypoxia in newborns begins immediately from the moment the diagnosis is established, it is aimed at correcting disorders of respiratory and cardiac activity, hemodynamic disorders, water-electrolyte balance, and metabolism.
Aspiration from the oropharynx, nose and stomach of mucus and amniotic fluid is performed. If this does not lead to the restoration of breathing, then artificial ventilation of the lungs is started with a face mask. A hypertonic glucose solution, cocarboxylase is injected into the umbilical vein. The lack of spontaneous breathing after the above-described therapeutic measures is an indication for tracheal intubation, intravenous infusion of sodium bicarbonate solution.
With severe bradycardia or asystole, an external heart massage is performed. Adrenaline, corticosteroids, calcium gluconate, cocarboxylase, 10–20% glucose solution are injected intravenously.
All newborns who have undergone a state of hypoxia need careful medical supervision and continued intensive treatment, including:
- oxygen therapy;
- vitamin therapy;
- infusion therapy;
- craniocerebral hypothermia.
Questions regarding the organization of feeding a newborn are resolved in each case individually, taking into account the characteristics of the child's condition.
Complications and consequences of hypoxia in newborns
The immediate and long-term consequences of hypoxia in newborns depend on the severity and duration of violations of gas metabolism, the timeliness and completeness of the treatment. Severe hypoxia has a high risk of death, and if life is saved, disability.
In children who underwent a state of hypoxia during the neonatal period, in the first year of life, hypothalamic (diencephalic) disorders, convulsive or hypertensive-hydrocephalic form of perinatal encephalopathy, and hypo- or hyperexcitability syndrome of the central nervous system are noted.
Source: simptomer.ru
Prevention
Prevention of hypoxia in newborns consists of the following measures:
- regular intrauterine monitoring of the condition of the fetus and placenta (obstetric ultrasound, Doppler ultrasonography of the uteroplacental blood flow);
- adequate management of pregnancy, taking into account the existing risk factors;
- timely therapy of extragenital diseases in a pregnant woman;
- competent obstetric allowance in childbirth;
- the immediate release of the infant's upper respiratory tract of mucus and amniotic fluid immediately after birth.
Part of the preventive measures to reduce the risk of hypoxia in the pre- and postnatal periods should be carried out by a pregnant woman:
- rejection of bad habits;
- regular walks in the fresh air;
- sufficient physical activity;
- balanced diet;
- compliance with the daily routine;
- careful implementation of the instructions of the obstetrician-gynecologist.
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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!
