Asphyxia of newborns: severity, causes, treatment, consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

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 impaired breathing and the development of respiratory failure. In medical practice, it is customary to divide asphyxia into moderate and severe.

Causes of birth asphyxia in newborns

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 intrauterine fetal hypoxia. In addition, the causes of asphyxia in newborns can be:

• intracranial trauma in a child that 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 Rh factor;
• blockage of baby's airways with mucus or amniotic fluid;
• a woman has heart and vascular diseases, diabetes, iron deficiency anemia;
• preeclampsia (late toxicosis) in the mother, which is accompanied by high blood pressure and severe swelling of the limbs;
• pathological structure of the umbilical cord or placenta, its detachment, incorrect position of the fetal head, early discharge of amniotic fluid.

Secondary occurs within hours or even days after birth. The causes of asphyxia in a newborn in this case may be:

• circulatory disorders in brain structures;
• damage to the child's central nervous system;
• heart defects of varying severity;
• pneumopathies: hemorrhages in the lungs, blockage of the respiratory tract with mucus, dysfunction of metabolic processes.

All of these conditions can begin to develop even in the prenatal period.

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 asphyxia. If the condition develops during childbirth, then there is also a decrease in blood volume, its thickening and viscosity. Edema is possible in the brain, kidneys and liver, heart, hemorrhages are not uncommon, which appear due to insufficient oxygen. Pathology also leads to a decreaseBP of the newborn, decreased heart rate, impaired urinary function.

Mild asphyxia: newborn condition

Primary asphyxia of newborns occurs in the first minutes of life. The condition of the child is assessed 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 becomes bluish.

Signs of moderate asphyxia in newborns

Symptoms of pathology (in a moderate manifestation, that is, a moderate form of severity) are lethargy, an emotionless short cry, frequent regurgitation, spontaneous movements, a weak reaction to irritating factors and examination, bluish coloration of the skin, a weak manifestation of physiological reflexes.

The condition of the newborn is generally assessed as moderate, the Apgar score is 4-5. At the same time, the heart rate per minute is less than 100 (in he althy children - 100 or more), there is some flexion of the limbs (in babies with a score of 2, active movements are noted), intermittent breathing, a grimace on the face (he althy children scream, cough, sneeze), pink coloring of the body and bluish - limbs.

Symptoms of severe asphyxia in children

Severe asphyxia of a newborn is manifested by the following signs:

• Severe or very serious condition at birth;
• almost completelack of physiological reflexes;
• muffled heart sounds when listening, systolic murmur;
• possible hemorrhagic shock, 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, lack of pupillary response to light. A neonatologist with such symptoms will rate 1-3 points on the Apgar scale. In this case, there may be no heartbeats, limbs hang down, breathing and reflexes are absent, the skin color is pale, there may be cyanosis.

Clinical death: Apgar 0

The most severe form of asphyxia is characterized by clinical death of the newborn. To save the life of the child in this case, doctors immediately begin to carry out resuscitation.

Main signs of secondary asphyxia

Secondary asphyxia of newborns develops a few hours after birth 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, may not respond to external stimuli. The skin at the same time acquires a bluish tint in the area of the nasolabial triangle.

Early and late complications of asphyxia

Early complications of respiratory failure (i.e. those seen in the first day of life) include:

• pulmonary hypertension;
• necrosis of brain tissue;
• cerebral edema;
• intracranial hemorrhage;
• acute renal necrosis;
• thrombosis of renal vessels;
• convulsive syndrome;
• pathology of hematopoietic cells in the bone marrow.

Complications that may occur over the next few days in the absence of adequate and comprehensive treatment of newborn asphyxia are:

• meningitis - inflammation of the meninges;
• sepsis - a general infection with pathogenic bacteria that have entered the bloodstream;
• pneumonia - inflammation of the lungs;
• hydrocephalic syndrome - excessive synthesis of cerebrospinal fluid.

Therapy of acute asphyxia in a child

The stages of resuscitation in case of asphyxia of the newborn were systematized into a single algorithm of actions in the USA. The system is called ABC-steps. Firstly, neonatologists must ensure the patency of the respiratory tract 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 is born, doctors insert a special probe into his nose and mouth. Often this action is performed even when the head of the child appears from the birth canal of a woman. With the help of a probe, residual mucus and amniotic fluid, which can interfere with normal breathing, are removed from the baby's respiratory tract.

After extraction from the birth canal, doctors cut the newborn's umbilical cord. After that, he will be placed on the resuscitation table, where the contents of the nasopharynx will be re-cleaned. This timecleanse the stomach. In this case, you can not touch the back of the pharynx, so as not to provoke excitation of the nervous system and bradycardia.

The baby is carried under an infrared heater, his skin is blotted with a clean diaper. To ensure maximum airway patency, doctors lay out the newborn as follows: on the back, a roller under the shoulders, the head is moderately extended. If there is no breathing at all, then stimulation is carried out: lightly slap the baby on the heel, sole, rub the skin along the spine.

It is impossible to give a child a stream of oxygen in the face of asphyxia, pour or splash water on him, squeeze his chest or slap on the buttocks.

The activities described above should be carried out very quickly, literally within twenty seconds. After resuscitation of a newborn with asphyxia, his condition is again assessed, paying attention to heart rate, breathing and skin tone.

If breathing is absent or insufficient, then the child is artificially ventilated. Help with asphyxia of newborns involves the introduction of medications. Among medicinal resuscitation agents, an adrenaline solution is effective, which is rapidly administered intravenously. A solution of sodium chloride 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, scheduled infusion therapy begins.

Caring for a newborn after asphyxia

After such a serious condition as asphyxia, it is necessaryspecial childcare. He should be given complete rest. The head should be in an elevated position. Often, doctors - neonatologists and pediatricians - 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 asphyxia, the newborn is placed in a ward with a high oxygen content.

Be sure to monitor a child who suffered respiratory failure during childbirth. It is necessary to systematically measure body temperature, control diuresis and bowel function. Often, the baby needs to re-clean the airways from foreign content.

The first feeding of a baby with mild or moderate respiratory failure occurs sixteen hours after birth. If the baby's condition was severe, then the first feeding is carried out only after a day and with the help of a special probe. The start time for natural breastfeeding is determined on a case-by-case basis.

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 completely eliminated is not possible) complications from the nervous system.

Prognosis of doctors and consequences of asphyxia

The prognosis and consequences of asphyxia in newborns depend on the severity of the pathology, the adequacy of the actions of doctors and the timeliness of the start of therapy. The prognosis directly depends on the second assessment of his he alth 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 likely to be favorable.

Any consequences of asphyxia of newborns at an older age rarely appear 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.

Key preventive measures

The consequences of asphyxia in newborns are quite serious, but they can be avoided. There are preventive measures, which, of course, not with all 100% probability will avoid respiratory failure in the fetus, but give a result in about 40% of cases. One of the causes of asphyxia, for example, may be intrauterine fetal hypoxia. To avoid this, a pregnant woman should visit her doctor regularly.

Also, risk factors that can subsequently provoke respiratory failure in the fetus are:

• mother's age over 35;
• the presence of bad habits in a pregnant woman;
• high stress during pregnancy;
• disruption of the mother's endocrine system;
• changes in the hormonal background of a woman;
• infectious and other diseases that have a negative impact on the fetus.

One of the causes of asphyxia is alsoplacental abruption or 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 on time so that nothing threatens the life and he alth of the little man.

Here are some general recommendations from gynecologists to a pregnant woman that will reduce the risk of fetal respiratory failure:

1. More outdoor activities. The woman's body is saturated with the necessary amount of oxygen, which is then transferred to the fetus, which needs this element.
2. Take the vitamins prescribed by the gynecologist. Both the pregnant woman and the baby, who is still developing in close connection with the mother's body, need vitamins and nutrients.
3. Observe the regime of the day. At night, the expectant mother should sleep for at least nine hours, during the day it is also recommended to set aside a couple of hours for sleep or afternoon rest (not at the computer screen).
4. Keep your peace of mind and positive attitude. Pregnancy is an unforgettable period in the life of every woman, but it is also associated with stress and feelings. For the he alth of the child and the woman herself, it is necessary to worry less, learn to calmly cope with life's conflicts, devote more time to 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, lifemost newborns are saved and eliminate the possible consequences of the pathology.