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Asphyxia

Asphyxia of newborns is a syndrome characterized by lack of breathing, irregular or ineffective respiratory movements at birth, in a child with cardiac activity. Distinguish fetal asphyxiation, which is divided into antenatal and intrapartum, and newborn asphyxiation. Asphyxia of the newborn is divided into primary, when the newborn after breathing on the umbilical cord does not breathe on its own, and secondary, which occurs in the following hours and days of the newborn’s life. Secondary asphyxia can develop due to aspiration, pneumopathy, birth injury to the brain and spinal cord, congenital heart defects, lungs, and brain. We list the factors associated with asphyxia. Antenatal factors: maternal diabetes mellitus, pregnant hypertension, maternal hypertension, chronic maternal diseases (cardiovascular, thyroid, neurological, pulmonary, renal), anemia, stillbirth or neonatal death of children during previous pregnancies, bleeding in 2-3 m trimesters, maternal infections, polyhydramnios, oligohydramnios, prematurity, premature pregnancy, multiple pregnancies, drug therapy (magnesium, lithium, adrenergic blockers), maternal addiction, fetal malformations, lower wife motor activity of the fetus, the age of the mother is less than 16 or more than 35 years. Intranatal factors: emergency cesarean section, forceps or a vacuum extractor during childbirth, gluteal and other abnormal presentations, premature, rapid delivery, anhydrous period of more than 18 hours, prolonged delivery of more than 24 hours, the second period of labor is more than 2 hours, fetal bradycardia, general anesthesia during childbirth, drugs received by the mother within 4 hours before childbirth, entanglement of the umbilical cord around the baby and her prolapse, placental abruption, placenta previa. Most children born in acute asphyxia have a combination of the above factors, but 5 leading mechanisms leading to acute asphyxia of newborns can be distinguished:

1) interruption of blood flow through the umbilical cord (true nodes of the umbilical cord, its compression, tight entanglement of the umbilical cord around the neck or other parts of the body of the child);

2) violation of the exchange of gases through the placenta (premature detachment of the placenta, placenta previa, etc.);

3) circulatory disorders in the maternal part of the placenta (overly active contractions, arterial hypotension or hypertension of any etiology in the mother);

4) deterioration of oxygenation (oxygenation) of the mother’s blood (anemia, cardiovascular disease, respiratory failure);

5) the impossibility of independent adequate breathing of the child (malformations, central nervous system lesions, medical treatment of the mother, etc.).

However, it should be noted that there is no single diagnostic feature that can confidently predict the birth of a child in a state of intranatal asphyxia. Thus, asphyxia is a suffocation, an acute pathological process caused by various reasons, which is based on a lack of oxygen in the blood (hypoxemia) and tissues (hypoxia) and the accumulation of carbon dioxide (hypercapnia) and other acidic metabolic products in the body, which leads to to the development of metabolic acidosis. Tissue hypoxia develops due to insufficient oxygen supply. Cells lose their ability to absorb oxygen. Pathological acidosis increases the permeability of the vascular wall and cell membranes, which leads to circulatory disorders, impaired blood coagulation processes, and hemorrhages in various organs. The vessels lose their tone and become full of blood, the liquid part of the blood goes into the surrounding tissues, edema and dystrophic changes in the cells of all organs and systems develop.

The final severity of asphyxia is not diagnosed in the delivery room, but at the end of the early neonatal period.

Clinic. According to the International Classification of Diseases of the IX Revision (Geneva, 1980), depending on the severity of the condition of the child at birth, moderate, or moderate, and severe asphyxia at birth are distinguished. The condition of the newborn at birth is assessed at the 1st and 5th minute of life according to the scale proposed by the American obstetrician Virginia Apgar in 1950. Medium (moderate) asphyxia is described in the ICD as follows: normal breathing did not establish within the first minute after birth, but heart rate - 100 or more per min, muscle tone is insignificant, weak reaction to irritation. The Apgar score after 1 minute is 4-6 points. In the first minutes of life, the child is often sluggish, but spontaneous motor activity is noted, the reaction to examination and irritation is weak. The physiological reflexes of the newborn are depressed. The scream is short and unemotional. The skin is cyanotic, but when oxygenated, they quickly turn pink. When auscultation of the heart reveals tachycardia, heart sounds - increased sound or muffled. Rhythmic breathing with sighs, repeated short-term apnea is characteristic. In the first hours of life, such newborns develop hyper-excitability. Characteristic manifestations are small-scale hand tremor, aggravated by screaming and anxiety, irritated screaming, sleep disturbance, frequent spitting up. Changes in the physiological reflexes of newborns and muscle tone are individual. The described disorders are transient and are functional in nature, as a result of metabolic disorders and intracranial hemodynamics. The condition of children who underwent moderate hypoxia at birth, with adequate therapy, quickly improves and becomes satisfactory by the 4th to 5th day of life. Severe asphyxia: the pulse at birth is less than 100 beats per minute, slowing or steady, breathing is absent or difficult, the skin is pale, the muscles are atonic. The Apgar score is 0–3 points. The condition of the child at birth is regarded as severe or very severe. Muscle tone, spontaneous motor activity, reaction to examination and pain irritation are reduced or absent. The physiological reflexes of newborns in the first hours of life are usually not possible to cause. The color of the skin is pale and is restored with active oxygenation to pink slowly, which indicates pronounced metabolic and microcirculation disorders.
Heart sounds are muffled or deaf. Mekonium departs before or during the birth certificate. Cardiorespiratory depression at birth is a syndrome characterized by the presence at birth and in the first minutes of life of depression of basic life functions, including bradycardia, ineffective breathing, decreased muscle tone, depression of the central nervous system, but in the absence of hypercapnia in the blood, hypoxemia. When assessed by Apgar, after 1 minute such children have 4-6 points, but 5 minutes after the optimal organization of environmental conditions and temporary respiratory or other support, the Apgar score becomes 7 points or higher. Therefore, it is generally accepted that an Apgar score alone cannot be the only criterion for asphyxiation, and a low Apgar score 1 min after birth is not always synonymous with asphyxiation.

Complications Two groups of complications are distinguished: early, developing in the first hours and days of life, and late - from the end of the first week of life onwards. Among the early complications, in addition to brain damage (edema, intracranial hemorrhage, necrosis), hemodynamic (heart failure, pulmonary hypertension), renal, pulmonary (edema, bleeding, meconium aspiration syndrome, pneumonia, etc.), gastrointestinal (paresis) are especially common. , necrotizing enterocolitis), hemorrhagic (anemia, thrombocytopenia). Among late complications, infectious (pneumonia, meningitis, sepsis, necrotizing enterocolitis, etc.) and neurological (hydrocephalic syndrome, hypoxic-ischemic encephalopathy) prevail.

Diagnostics. Asphyxia is diagnosed on the basis of clinical data, especially from the Apgar score on the 1st and 5th min of life, as well as from the main clinical and laboratory parameters.

Treatment. Asphyxia (suffocation) of newborns is a life-threatening condition, the elimination of which requires following the universal resuscitation principles set forth by P. Safar (1980) as ABC resuscitation, where: A - airway - release, maintaining the free passage of the airways; In - breath - breathing, ventilation - artificial (mechanical ventilation) or auxiliary (artificial ventilation); С - саг ^ а1 circulation - restoration or maintenance of cardiac activity and hemodynamics. Newborns have the peculiarities of providing resuscitation benefits in the maternity ward, which is due to the peculiarity of the reactivity of the organism of this period of human life. The basic principles of primary care for a newborn can be formulated as follows:

1) planned resuscitation allowance, which is ensured by the readiness of personnel, places and equipment, medicines;

2) "temperature protection" of the newborn;

3) do not expect assessment on Apgar and provide resuscitation benefits already in the first minute of life;

4) ABC resuscitation with a mandatory assessment of the effectiveness of each step;

5) asepsis during all activities;

6) minimization of drug therapy;

7) careful attitude to infusion therapy;

8) the desire to start enteral nutrition as early as possible;

9) monitor follow-up (clinical, laboratory, hardware).

In or near the delivery center, the “resuscitation island”, which consists of several blocks, should be ready to assist the newborn around the clock:

1) optimization of the environment and temperature protection - a heated table, a source of radiant heat, sterile warm diapers;

2) restoration of airway patency - electric suction, rubber pears, oral ducts, endotracheal tubes, children's laryngoscope;

3) oxygen therapy - a source of compressed air, a unit for humidification and heating of the air-oxygen mixture, a set of connecting tubes and devices for introducing oxygen;

4) mechanical ventilation (air bag type Ambu, apparatus for automatic ventilation of the lungs);

5) drug therapy - disposable syringes, gloves, sets of medicines, catheters for the umbilical vein;

6) vital functions monitoring - cardiomonitor, apparatus for measuring blood pressure, phonendoscope, stopwatch. The primary care algorithm for a newborn born in asphyxia involves several stages. Stage I resuscitation begins with a catheter suctioning the contents of the oral cavity at the time of birth of the head or immediately after the birth of the baby. If breathing is absent, it is necessary to carry out gentle, but active tactile stimulation - to click the child on the sole or vigorously wipe his back. The child is taken in sterile heated diapers, quickly transferred to the resuscitation table under a source of radiant heat. When laying the head end of the child should be slightly lowered. Amniotic fluid, mucus from the skin of the child is wiped with a warm diaper. In case of severe asphyxiation, immediate intubation is performed followed by sanitation of the respiratory tract. A full-term baby is separated from the mother immediately after birth, and a premature baby - after 1 min. At the end of stage I of resuscitation, the child’s breathing is evaluated. With adequate breathing, a heart rate above 100 per minute and a slight acrocyanosis of the skin, resuscitation is stopped, the child is monitored.

If breathing is absent, then go to the II stage of resuscitation. The task of stage II is to restore external respiration. Activities begin with ventilation of the lungs using a mask and a breathing bag. Frequency - 30-50 breaths / min. Good chest excursions indicate adequate ventilation of the alveoli, as well as the absence of serious airway obstruction.

At the III stage of resuscitation, hemodynamic and metabolic disorders are treated. In the case of a very serious condition after the initial resuscitation and the slow restoration of vital functions, it is advisable to transfer the neonates of the children's hospital to the intensive care unit. If during 15-20 minutes the child does not have independent breathing and persistent bradycardia persists, then the probability of severe brain damage is high, and it is necessary to decide on the termination of resuscitation measures.
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Asphyxia

  1. Asphyxia of the newborn
    The severity of asphyxia is estimated in points on the Apgar scale at the end of 1 and 5 minutes: moderate asphyxia - 6-4 points, severe - 3-1. Apgar scale Symptoms 0 1 2 Heart rate None Less than 100 in Over 100 in contractions 1 minute 1 minute Breathing None Weak cry, Strong cry, hypoventilation sufficient breathing Muscle tone
  2. Asphyxia
    DEFINITION In clinical practice, the term "neonatal asphyxia" refers to a clinical syndrome that manifests itself in the first minutes of life with difficulty or complete lack of breathing in the child. In addition to respiratory failure, most children born in a state of asphyxia note inhibition of unconditioned neuro-reflex activity and acute cardiovascular failure. CODE ON ICD-R21.0
  3. Asphyxia
    Physical blockage Asphyxia is an extreme difficulty in breathing, or asphyxiation, as a result of which a person may die. With asphyxiation in the body there is a lack of oxygen and an excess of carbon dioxide. Emotional blocking Asphyxia can occur in cases where a person hides for too long a fear that paralyzes him. Perhaps he has managed this fear for some time.
  4. Asphyxia of the newborn
    Scope of examination 1. Asphyxia of newborns at the prehospital stage is possible when taking birth at home or in the saloon of an ambulance. 2. The severity of asphyxia is estimated in points on the Apgar scale at the end of 1 and 5 minutes: mild asphyxia corresponds to 6-5 points, moderate severity - 4-3, severe - 2. Medical care 1. With mild asphyxia, it is necessary to restore free patency
  5. Mechanical asphyxia
    Hypoxia - oxygen starvation of organs and tissues, until the complete cessation of oxygen supply to the body. Asphyxia is the state of the body when, along with a lack of oxygen, carbon dioxide accumulates in it. Mechanical asphyxia arises from the action of an external mechanical factor. According to the pace of development, hypoxia is divided into: acute, developing and leading to
  6. ASPHIX OF THE NEWBORN
    Definition Asphyxia of a newborn is a decrease in arterial pO, and an increase in arterial pCO ^ as a result of inadequate placental or pulmonary gas exchange. Etiology Dietary insufficiency of the newborn. Heart failure of a newborn. Typical cases Asphyxia of the newborn is often associated with fetal asphyxia or fetal distress, which may be
  7. Intrauterine Hypoxia. ASPHIXIA AND RESUSCITATION OF BABIES
    Asphyxia of a newborn is the lack of effective gas exchange in the lungs immediately after birth in a child with at least one sign of live birth. Signs of life: spontaneous breathing, palpitations, umbilical cord pulsation, voluntary muscular movement. Asphyxia of newborns is the cause of death of about a million children in the world every year and about the same number of children
  8. Hypoxia and Asphyxia
    By definition, P.S. Gurevich (1989), intrauterine asphyxia is acute fetal hypoxia (anoxia) resulting from a sudden violation of the uteroplacental or placental-fetal circulation in a previously healthy fetus. However, the term “asphyxia” is recognized as very conditional, because does not quite accurately reflect the essence of pathology. In this regard, the WHO scientific team has proposed replacing
  9. Primary and resuscitation care for newborn asphyxiation
    Fetal hypoxia and asphyxia of the newborn (perinatal asphyxia) are pathological conditions that develop as a result of acute or chronic oxygen deficiency and metabolic acidosis, which are manifested by disorders of the activity of vital systems (central nervous system, circulation, respiration). Perinatal asphyxia is one of the main causes of perinatal mortality, amounting to
  10. Strangulation Asphyxia
    Strangulation asphyxia is one of the varieties of acute violation of airway patency that occurs with direct compression of the trachea, blood vessels and nerve trunks of the neck. It is characterized by rapidly onset of gas exchange disorders such as hypoxemia and hypercapnia, short-term spasm of the cerebral vessels, and then their persistent expansion with deep disturbances of cerebral circulation,
  11. Strangulation Asphyxia
    Strangulation asphyxia is one of the varieties of acute violation of airway patency that occurs with direct compression of the trachea, blood vessels and nerve trunks of the neck. It is characterized by rapidly onset of gas exchange disorders such as hypoxemia and hypercapnia, short-term spasm of the cerebral vessels, and then their persistent expansion with deep disturbances of cerebral circulation,
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