Asphyxia is a dangerous pathological condition that develops in newborns in the first minutes of life (primary) or within the first few days (secondary) after birth. Pathology is characterized by respiratory failure and the development of respiratory failure. In medical practice, it is customary to divide asphyxia into moderate and severe.
Causes of asphyxia of newborns during childbirth
The causes of the development of a pathological condition are directly dependent on the type of asphyxia in a child. So, the primary develops during childbirth. This condition is usually caused by acute or chronic fetal hypoxia . In addition, the causes of asphyxia of newborns can be:
- intracranial trauma in the child, which he received during childbirth;
- malformations that have a depressing effect on the respiratory system and make breathing difficult;
- immunological incompatibility of mother and child by blood group or rhesus factor;
- obstruction of the baby's respiratory tract with mucus or amniotic fluid;
- the presence of a woman's heart and blood vessel diseases, diabetes mellitus, iron deficiency anemia;
- preeclampsia (late toxicosis) in the mother, which is accompanied by increased blood pressure and severe swelling of the limbs;
- pathological structure of the umbilical cord or placenta, its detachment, improper position of the fetal head, early discharge of amniotic fluid.
Secondary occurs within a few hours or even days after birth. The causes of asphyxia in a newborn in this case may be:
- circulatory disorders in the structures of the brain;
- damage to the central nervous system of the child;
- heart defects of varying severity;
- pneumopathy: hemorrhage in the lungs, obstruction of the respiratory tract with mucus, metabolic dysfunction.
All these conditions can begin to develop in the prenatal period.
The occurrence of a pathological condition
With various degrees of asphyxia in newborns, a pathological change in metabolic processes in the body begins. Manifestations, severity and duration of such disorders depend on the severity of asphyxiation. If the condition develops during childbirth, then there is also a decrease in blood volume, its thickening and viscosity. There may be swelling in the brain, kidneys and liver, heart, hemorrhages that occur due to insufficient oxygen are common. Pathology also leads to a decrease in blood pressure of the newborn, a decrease in heart contractions, and a violation of urinary function.
Mild asphyxia: condition of the newborn
Primary asphyxia of newborns occurs in the first minutes of life. The condition of the child is evaluated on the Apgar scale. With a mild form of respiratory failure , the baby's condition is estimated at 6-7 points. At the same time, in the first minutes of life, the newborn independently takes the first breath, but then his breathing becomes intermittent, weak. Muscle tone is usually reduced, and the nasolabial triangle acquires a bluish tint.
Signs of moderate asphyxia in newborns
Symptoms of pathology (in a moderate manifestation, that is, a moderate form of severity) are lethargy, an emotional short cry, frequent spitting up, spontaneous movements, a weak reaction to irritating factors and examination, bluish skin color, and a weak manifestation of physiological reflexes.
The condition of the newborn is generally assessed as moderate, Apgar score is 4-5. At the same time, the heart rate per minute is less than 100 (in healthy children - 100 or more), there is some flexion of the limbs (in children with a rating of 2 active movements are noted), intermittent breathing, a grimace on the face (healthy children scream, cough, sneeze) , pink body color and cyanotic - limbs.
Symptoms of severe asphyxia in children
Severe asphyxia of the newborn is manifested by such signs:
- severe or very serious condition at birth;
- almost complete absence of physiological reflexes;
- deaf heart sounds when listening, systolic murmur;
- hemorrhagic shock is possible, in which the child's eyes are closed, spontaneous breathing and no reaction to pain.
In the worst case, there may be disturbances in the normal functioning of many organs and systems, and the lack of pupil response to light. A neonatologist with such symptoms will give a rating of 1-3 points on the Apgar scale. At the same time, heart contractions may be absent, limbs hang down, breathing and reflexes are absent, skin color is pale, there may be cyanosis.
Clinical death: 0 on the Apgar scale
The most severe form of asphyxia is characterized by the clinical death of a newborn. In order to save the child’s life, in this case, doctors immediately begin resuscitation.
The main signs of secondary asphyxia
Secondary asphyxia of newborns develops several hours after childbirth or during the first few days. The condition is marked by the same symptoms. The child becomes lethargic, breathing weakens or disappears, muscle tone decreases, and may not respond to external stimuli. The skin at the same time acquires a bluish tint in the region of the nasolabial triangle.
Early and late complications of asphyxia
Early complications of respiratory failure (i.e., those observed on the first day of life) include:
- pulmonary hypertension;
- necrosis of brain tissue;
- cerebral edema;
- intracranial hemorrhage;
- acute renal necrosis;
- renal vascular thrombosis;
- convulsive syndrome;
- pathology of hematopoietic cells of the bone marrow.
Complications that can occur over the next few days in the absence of an adequate and comprehensive treatment for asphyxia of newborns are:
- meningitis - inflammation of the meninges;
- sepsis - a common infection with pathogenic bacteria that enter the bloodstream;
- pneumonia - pneumonia;
- hydrocephalic syndrome - excessive synthesis of cerebrospinal fluid.
Therapy of acute asphyxia in a child
The stages of resuscitation in asphyxiation of the newborn were systematized into a single algorithm of action in the United States. The system is called ABC steps. Firstly, neonatologists must ensure the airway of the newborn, secondly, the process of natural respiration should be stimulated, and thirdly, it is necessary to support the circulatory system.
When a child with symptoms of asphyxia appears, doctors introduce him a special probe into the nose and mouth. Often this action is performed even when the baby's head appears from the birth canal of a woman. With the help of a probe, the remnants of the mucus and amniotic fluid, which can interfere with normal breathing, are removed from the baby's respiratory tract.
After removing from the birth canal, doctors cut the umbilical cord to the newborn. After that, he will be placed on the resuscitation table, where they will re-clean the contents of the nasopharynx. This time, the stomach will also be cleaned. In this case, you can not touch the back wall of the pharynx so as not to provoke excitation of the nervous system and bradycardia.
The baby is transferred under an infrared heater, his skin is blotted with a clean diaper. To ensure maximum airway patency, doctors spread the newborn as follows: on the back, under the shoulders, a roller, the head is moderately unbent. If there is no breathing at all, then stimulation is carried out: the baby is easily clapped on the heel and sole, rubbing the skin along the spine.
During asphyxiation, it is impossible to give a child a stream of oxygen in the face, pour or spray water on it, squeeze the chest or slap on the buttocks.
The activities described above should be carried out very quickly, literally within twenty seconds. After resuscitation of the newborn with asphyxiation, his condition is again assessed, paying attention to the heart rate, respiration and skin tone.
If breathing is absent or insufficient, then the child undergoes mechanical ventilation. Help with asphyxiation of newborns involves the introduction of medicines. Among drug resuscitation agents, an adrenaline solution is effective, which is rapidly administered intravenously. A sodium chloride solution is also administered in the form of a dropper for 5-10 minutes. If necessary, at the 40-50th minute of a child’s life, they begin scheduled infusion therapy.
Newborn care after asphyxiation
After such a serious condition as asphyxia, special care for the child is necessary. He should ensure complete peace. The head should be in high condition. Doctors — neonatologists and pediatricians — often prescribe oxygen therapy to such small patients. The duration of such treatment varies in each individual case and depends on the condition of the child. After asphyxiation, the newborn is placed in a ward with a high oxygen content.
Be sure to observe the child who suffered respiratory failure during childbirth. It is necessary to systematically measure body temperature, control diuresis and intestinal functioning. Often the baby needs to re-clean the respiratory tract of foreign contents.
The first feeding of a child with mild or moderate form of respiratory failure is performed sixteen hours after birth. If the baby's condition was severe, then the first feeding is carried out only after a day and using a special probe. The start time of natural breastfeeding is determined for each case separately.
After discharge from the maternity hospital, the baby should be under the supervision of a pediatrician and a neurologist. The main goal of all therapeutic measures is to avoid (or minimize, if there is no possibility to completely eliminate) complications from the nervous system.
Prognosis of doctors and the consequences of asphyxia
The prognosis and consequences of asphyxia of newborns depend on the severity of the pathology, the adequacy of the actions of doctors and the timeliness of initiation of therapy. The prognosis directly depends on the second assessment of his health on the Apgar scale. The second assessment is made by a neonatologist five minutes after the baby is born. If the second estimate is higher than the first, then the forecast is most likely favorable.
Any consequences of asphyxia of newborns at an older age are rarely manifested if the prognosis of doctors was favorable. As a rule, if a child experienced respiratory failure during childbirth, but doctors managed to stabilize his condition and avoid complications, then at an older age there will be no other consequences of a dangerous condition.
Basic preventive measures
The consequences of asphyxia of newborns are quite serious, but they can be avoided. There are preventive measures that, of course, are not with all 100% probability to avoid respiratory failure in the fetus, but give a result in approximately 40% of cases. One of the causes of asphyxia, for example, may be fetal hypoxia. To avoid this, a pregnant woman needs to visit a doctor regularly.
Also, risk factors that can subsequently provoke respiratory failure in the fetus are:
- mother's age over 35 years old;
- the presence of bad habits in a pregnant woman;
- severe stress during pregnancy;
- malfunctioning of the endocrine system of the mother;
- changes in the hormonal background of a woman;
- infectious and other diseases that have a negative effect on the fetus.
One of the causes of asphyxia is also the detachment of the placenta or the pathology of its development. In eliminating this factor, regular monitoring by a specialist is important. The doctor will be able to identify dangerous conditions and start therapy in time so that nothing threatens the life and health of the little man.
Here are some general recommendations of gynecologists for a pregnant woman that will reduce the risk of fetal respiratory system failure:
- More walk in the fresh air. The woman’s body is saturated with the necessary amount of oxygen, which is then transferred to the fetus in need of this element.
- Take vitamins prescribed by a gynecologist. Both the most pregnant and the baby, who is still developing in close connection with the mother’s body, need vitamins and nutrients.
- Observe the daily routine. At night, the expectant mother should sleep for at least nine hours, during the day it is also recommended to allocate a couple of hours for sleep or afternoon rest (not behind the computer screen).
- Keep peace of mind and a positive attitude. Pregnancy is an unforgettable period in the life of every representative of the fair sex, but it is also associated with stresses, experiences. For the health of the child and the woman herself, it is necessary to worry less, learn how to calmly cope with life conflicts, spend more time communicating with positive people.
It is worth saying that respiratory failure, that is, asphyxia, is a serious pathology. But thanks to modern drugs and the professional actions of medical personnel, the lives of most newborns are saved and eliminated by the possible consequences of pathology.