The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty for more than 12 years.
neonatal hypoxia is not considered a separate disease, but refers only to pathological states, ie, is a manifestation of a congenital / acquired abnormalities or adverse pregnancy and delivery.
Hypoxia is necessarily accompanied by respiratory distress syndrome, which often develops in premature infants. Moreover, the smaller the gestational age, the harder it manifests this syndrome.
Thus, hypoxia of the newborn called oxygen starvation of the brain, which leads to its dysfunction, as well as other system disturbances. cerebral hypoxia represents a great danger to the newborn and can lead to disability and even death.
Causes
Factors that provoke the development of neonatal hypoxia, are very numerous. Conventionally, they can be divided into 4 groups:
Antenatal causes (active during pregnancy)
These include:
- severe somatic illness of the mother (cardiovascular, respiratory, endocrine pathology)
- chronic intoxication pregnancy (smoking, alcohol, drug use, occupational exposures, impaired ecology).
Also the list includes:
- premature and Prolonged pregnancy,
- gestosis,
- strong pronounced anemia,
- bleeding during pregnancy (presentation, Placental abruption)
- intrauterine infection of the fetus, and chronic maternal infections during pregnancy suffered by an acute infection,
- polyhydramnios and oligohydramnios,
- multiple pregnancy.
Additionally, hypoxia may be the fault of:
- Rh-conflict pregnancy and antiphospholipid syndrome,
- permanent threat of interruption of pregnancy and the development of placental insufficiency,
- constant stress, poor living conditions, poor nutrition.
Intranatal causes (morbidity genera)
This group includes:
- Delayed or vice versa, rapid delivery,
- fetal birth injury (damage to the brain or spinal cord),
- rodostimulyatsiya oxytocin,
- surgical delivery (forceps, Caesarean section).
Also, this group includes:
- drop in blood pressure during labor,
- preeclampsia and eclampsia during labor,
- placental abruption in labor,
- hypoxia women during general anesthesia,
- uterine rupture,
- anomalies of labor activity (discoordination tribal forces).
Pathology from the umbilical cord
- true knots and pulled the cord,
- gap umbilical vessels,
- cord entanglement,
- compression of the umbilical cord.
Fruit reasons (from the fruit).
Data are the reasons:
- hemolytic disease of the fetus and newborn (anemia due to hemolysis of erythrocytes)
- birth defects (cardiovascular abnormalities, and pulmonary systems)
- intrauterine infectious diseases,
- bleeding in the brain, adrenal glands.
asphyxia
Asphyxia, turning later to the newborn hypoxia is caused by obstruction of the respiratory tract (ingestion baby amniotic fluid and meconium, mucus blockage, taut cord entanglement, prolonged and problematic delivery of the head and others).
Signs of hypoxia. Apgar score
Evaluation of the child's condition is performed immediately after birth, in the first minute, and after 5 minutes. For this purpose, use scale developed Virginie Apgar given and summing these figures, each of which is estimated from 0 to 2 points:
- color of the skin;
- breathing rate;
- reflex activity;
- heart rate;
- muscle tone.
Points for the amount received is determined by the presence or absence of hypoxia and its degree:
- norm - 8-10 points;
- mild hypoxia - 6-7 points;
- mid-weight hypoxia - 4-5 points;
- severe hypoxia - 0-3 points.
Mild hypoxia is determined virtually all newborns in the first minute of life and disappears within 5 minutes alone.
Moderate to severe hypoxia newborn requires a certain treatment, the child comes back to normal in a few days. In severe hypoxia or asphyxia conducted immediate resuscitation is assigned to comprehensive treatment and observation of the child in the future.
Hospital neonatal hypoxia, usually yarkovyrazhena and the diagnosis is established immediately after the birth of the child. The signs of this condition include tachycardia, with the gradual replacement by bradycardia (less than 100 beats per minute) rhythm disturbance of the heart rate, auscultation of heart murmur, skin pallor and cyanosis of nasolabial triangle and limbs.
There irregular breathing or absence, reduced locomotor activity or offline (slack or child does not move), the presence of meconium into the amniotic fluid (water green). It increases the blood clotting that leads to thrombosis in the blood vessels and tissue hemorrhage.
In the future, if hypoxia was missed in the first minutes of life, joined by the following features:
- constant sleepiness;
- restless sleep, startle;
- marble limbs skin tone;
- child quickly freezes (bathing, dressing);
- restless, capricious behavior, irrational crying;
- trembling muscles of the face during crying or alone.
hypoxic encephalopathy
Hypoxia leads to the development of neonatal hypoxic encephalopathy (brain disease), which is divided into degrees of severity:
mild - drowsiness or agitation newborn disappears after 5-7 days;
mid-weight - apart from drowsiness and / or excitation is observed without cause weeping, convulsions, rejection worn on the hand, the rapid freezing;
Heavy - strong drowsiness or confusion, agitation development or persistence of coma with convulsions.
Medical tactic hypoxia
At occurrence of hypoxia in the fetus bearing-down period or during contractions (heart slowing) decide early completion of delivery: caesarean section or forceps delivery (in the case of administration of the drug oxytocin rodostimulyatsii stop). After the birth of a child starting to immediate medical attention:
- release of mucus from airways, meconium and water (special suction aspirator);
- feeding a mixture of oxygen with air or pure humidified oxygen through a mask, nasal cannula or apparatus mechanical ventilation (in the case of severe hypoxia of the newborn is placed in a incubator, intubated and start ALV);
- heating child's radiant heat (on a special changing table), and in severe hypoxia baby room in the incubator;
- administration of drugs that stimulate blood circulation and increase blood pressure (camphor, dopamine) and means excitatory respiratory center (etimizol);
- Intravenous infusions nat. solution, sodium hydrogen carbonate (neutralization of carbon dioxide in the blood), for restoring glucose decreased vascular volume;
- transfusion of blood products, if necessary (hemolytic disease of the newborn);
- antibiotics for the prevention of lung infections in case severe hypoxia and fetal intrauterine infection, as well as for respiratory distress syndrome in preterm labor;
- assignment anticonvulsants (phenobarbital, phenazepam);
- for reducing intracranial pressure is shown administering diakarba, veroshpirona (diuretic effect reduction liquor product).
Rehabilitation after discharge
Follow-up treatment after discharge from the hospital (the child's condition is satisfactory) held district neonatologist who appoints massage, medical gymnastics, feeding mode and explains the woman for child care rules have experienced hypoxia after birth.
Of the drugs are assigned improving agents and cerebral circulation power (vinpocetine, piracetam, Cerebrolysin), drugs that reduce intracranial pressure (Diacarbum, asparkam, kalisodergaszczye means), anticonvulsant drugs indications.
The child is followed up by a pediatrician should be inspected regularly and a neurologist.
Consequences and outlook
Hypoxia mild to moderate severity with timely and quality treatment does not lead to serious consequences, but the risk of developing severe hypoxia following conditions:
- anxiety, anxiety and child mental lability;
- stunted physical and mental development, and the development of headaches neuro dystonia;
- increased intracranial pressure;
- development of an epileptic syndrome, and hydrocephalus;
- the formation of brain cysts;
- the defeat of the cranial nerves and the disappearance of their functions.
Rare effects are severe hypoxia newborn child disability or death.
The prognosis depends on the degree of hypoxia. In mild and moderate hypoxia and adequate treatment the prognosis is favorable, with severe hypoxia brain doubtful prognosis.
