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ASPHIX OF THE NEWBORN

Definition

Asphyxia of the 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 accompanied by intrauterine asphyxia or fetal distress, which can be caused by maternal hypoxia, a decrease in placental-umbilical cord blood flow or fetal heart failure due to obstetric complications (placental abruption, placenta previa, prenatal bleeding);

maternal hypotension;

unusual conditions of childbirth and delivery (forceps, buttock presentation and childbirth, prolonged childbirth, prolapse of the umbilical cord);

chronic maternal systemic diseases (diabetes, hypertension, preeclampsia and eclampsia);

the use of drugs that inhibit the myocardial and respiratory functions of the mother:

drugs

barbiturates;

conditions such as multiple births, low birth weight, meconium contamination, acidosis and premature birth:

the presence of meconium in the amniotic fluid is the main, as well as a specific sign of fetal distress; it poses the greatest risk to the fetus when aspirated into the tracheo-bronchial tree during the transition of the fetus from intrauterine life to newborn.

Prevention

Correction of the main causes of distress of the mother, fetus or newborn.

Support for rapid delivery when the condition of the mother or fetus requires urgent or emergency delivery:

if the woman in labor is anesthetized, her condition is the primary concern of the anesthetist.

Avoid the use of respiratory and myocardial depressants, unless absolutely necessary:

use the minimum dose;

use drugs that do not cross the placental barrier. Maintain adequate maternal blood pressure:

to maintain adequate venous return, use left uterine displacement;

infusion therapy before starting regional anesthesia;

vigorously correct hypotension with fluid infusion or with the introduction of iv ephedrine, 5-10 mg.

Apgar Scale

Manifestations

Respiratory depression:

usually functional residual lung capacity is established with the first breath at birth;

regular rhythmic breathing usually sets in

the first 60-90 s. Oxygenation Reduction:

arterial p0 ^ rapidly decreases from 25-40 mm Hg. Art. in a fetus up to less than 5 mm Hg. Art.

Anaerobic metabolism with a sharp decrease in pH is quickly turned on. Brad and card.

The Apgar scale remains the most acceptable index of the condition of the newborn and the need for its resuscitation in the birth hall. Severe asphyxia develops, on the Apgar scale, 0–2 bslip in 1 min.

Situations with similar symptoms

Congenital malformations of the airways obstructing adequate ventilation and gas exchange.

Congenital cardiovascular abnormalities with right-sided bypass grafting (venous mixing).
Persistent pulmonary hypertension of the newborn. Pneumothorax.

How to act

General principles

Restoring airway patency and lung ventilation 100% 02 - the main task for asphyxiation of the newborn.

In pediatric practice, the causes of cardiac arrest and breathing in most cases are loss of airway control or inadequate ventilation and hypoxia.

To restore airway patency, use lower jaw displacement, extension of the atlanto-occipital joint or the introduction of an oral duct;

A newborn with micrognatia should be placed on its side or face down to improve airway patency. Give 100% Oh. Start controlled ventilation with a mask bag

or intubate if necessary the trachea. Conduct pharmacological and infusion therapy, being guided by the protocol of stages 2 and 3 of CPR for newborns.

In newborns with 0–2 points on the Apgar scale (severe depression).

The trachea should be intubated immediately and ventilation should begin with positive pressure.

Confirm that the position of the ETT is correct in various ways, as "breathing noises" can be heard over the entire surface of the newborn's body. The adequacy of ventilation should first be determined by an excursion of the chest wall, carefully assessing its symmetry. Most babies do not need inspiratory pressure

more than 25-30 cm Hfl.

In case of circulatory disorders, an external cardiac massage should be started according to the protocol of stages 2 and 3 of CPR.

For resuscitation, it is necessary to establish venous access, peripheral or through the umbilical artery:

if it is not possible to establish vascular access, enter the drugs used during resuscitation directly into the ETT.

For newborns with 3-4 points on the Apgar scale (moderate depression). Ventilate the patient with a 0 ^ bag and mask.

If the newborn does not breathe or does not breathe ineffectively, ETT must be administered before ventilation begins. Gas can enter the stomach, impairing ventilation; at

if necessary, decompression of the stomach should be performed.

For newborns with meconium contamination. The oropharynx suction should be performed when the fetal head is still in the perineum (vaginal birth) or in the surgical field (surgical delivery):

when removing meconium from the nasopharynx, a syringe can be used with the same success as a De Lee suction;

the application of this approach has improved outcome in meconium aspiration.

Before breathing, meconium should be sucked out of the lungs using an ETT.

The absence of meconium in the pharynx does not guarantee the absence of aspiration.

Complications

Overstretching of the stomach, causing poor ventilation and oxygenation. Throat trauma. Damage to the ligament space due to improperly selected ETT size. Pneumothorax.

Retinopathy of prematurity. Intraventricular hemorrhage.
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ASPHIX OF THE NEWBORN

  1. Diseases of the Newborn Asphyxia of the Newborn
    Asphyxia of newborns can develop both during normal childbirth with pelvic presentation of the fetus, and in the pathology of the birth process. In pigs, asphyxiation of the fetuses located in the tops of the uterine horns can occur with head presentation. A similar situation is often observed in carnivores, especially with weak contractions and attempts, when the fetus moves too slowly along the uterine horn. Asphyxia
  2. 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 by 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
  3. 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 adequate breathing Muscle tone
  4. 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
  5. 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
  6. Asphyxia of the newborn. Etiology
    Asphyxia of newborns is a pathological condition of the child due to prolonged or acute exposure to oxygen deficiency. Etiology Intrauterine acute or chronic fetal hypoxia can be caused by diseases of the mother, causing hypoxia in her and, accordingly, in the fetus (anemia, chronic diseases of the bronchopulmonary and cardiovascular system),
  7. Asphyxia of the fetus and newborn. Intracranial birth injury
    style = "background-color: #ffffff;"> Asphyxia (asphyxia, Greek - without a pulse) is an acute or sub-emerging pathological condition characterized by impaired gas exchange (hypoxia and hypercapnia) and the functions of organs and systems of the fetus or newborn. The problem of this condition has not been resolved, despite the emergence of new methods of diagnosis and treatment. According to domestic and foreign authors,
  8. Anesthesiological aid for asphyxia of newborns
    In obstetric institutions, in which there is no round-the-clock service of pediatric neonatologists, obstetricians and anesthetist provide emergency assistance to newborns born in a state of asphyxiation. Asphyxia of newborns should be understood as conditions characterized by impaired spontaneous ventilation (up to apnea), which leads to the development of oxygen deficiency with subsequent
  9. Neumann Elena Georgievna. Intrauterine hypoxia. Asphyxia and resuscitation of the newborn, 2003
    The manual reflects modern approaches to the diagnosis of asphyxia of newborn children and its early and late complications, etiology, pathogenesis, classification, asphyxia clinic in newborns are highlighted, modern approaches to providing emergency
  10. Information on the stages of resuscitation of a newborn with asphyxiation
    To correctly perform newborn resuscitation with asphyxiation, students should study the stages of resuscitation. INITIAL STAGES OF REBORNING A BABY IN ASPHYXIA 1. After giving birth to a baby, quickly clip on the umbilical cord, cut the umbilical cord, cover the cut with a sterile napkin and transfer the baby under a radiant heat source to a changing table with warm diapers. Radiant heat source
  11. TEST CONTROL ON THE TOPIC: INNERIOTIC HYPOXIA. ASPHIXIA AND RESUSCITATION OF BABIES
    Signs of live birth are considered: 1) Spontaneous breathing 2) Cardiac activity 3) Umbilical cord pulsation 4) Arbitrary muscle movements 5) At least one of the listed signs 2. A rating on which scale indicates the presence or absence of asphyxia in a child at birth: 1) Silverman 2 ) Dementieva 3) Apgar 4) Downs 3. Risk factors for birth
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