The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
neonatal asphyxia is a critical condition that occurs due to gas exchange disorder (lack of oxygen and accumulation of carbon dioxide in the body) and manifests a lack of breathing or attenuation at keeping a job heart.
neonatal asphyxia is diagnosed in about 4-6% of all births.
Kinds
There are two types of neonatal asphyxia:
- primary (occurs at the time of birth)
- secondary (child ceases to breathe or is choking in a few hours / days after birth).
Causes
neonatal asphyxia is a consequence of acute or chronic intrauterine fetal oxygen deficiency. Distinguish top 5 moments in the development of asphyxia:
- sudden cessation of blood flow in the umbilical cord (umbilical true node hauling it taut and usually repeated entanglement umbilical cord fetal neck);
- disorders of gas exchange in the placenta (premature detachment of the placenta, placenta previa etc);
- disorders of blood circulation in the placenta (increased blood pressure in the mother, dysfunction of labor);
- insufficient oxygen to the blood women (anemia, cardiovascular disease, diseases of the respiratory system, diabetes, thyroid disease, etc.);
- failure of newborn respiratory movements (the influence of medication mother, prenatal brain damage various infections, abnormal lung development, etc.).
Also cause asphyxiation of the child may be:
- newborn intracranial injury,
- Rh-conflict pregnancy,
- obturation of the complete or partial airway mucus, meconium, amniotic fluid.
Secondary asphyxia due to:
- disorders of blood circulation in the brain,
- aspirating the respiratory tract (e.g., vomitus)
- congenital malformations of the lungs, heart, brain,
- pneumopathy,
- the immaturity of the lungs (preterm).
Symptoms of neonatal asphyxia
The main symptom of asphyxia newborn is breathing disorder that causes irregular heartbeat, disruption of blood circulation in the body, as a result suffer from neuromuscular conduction and reflexes (they weakened).
To assess the degree of severity of neonatal asphyxia Apgar used. The Apgar score accounted for 5 criteria: heart rate, respiratory movements, skin color, muscle tone, and reflex irritability.
Evaluate the newborn in the first minute of life, and after 5 minutes. Depending on the number of points you scored a child, providing 4 degree of asphyxia. If the Apgar score more than 7 points, the child is considered to be satisfactory.
the degree of asphyxia
Asphyxia mild
Status Apgar child is estimated at between 6-7 points.
The newborn, who was born with mild asphyxia, during the first hours ago the first independent breath. But the child's breathing is weak, decreased muscle tone, marked cyanosis of nasolabial triangle. Preserved reflex excitability: the child sneezes or coughs.
Asphyxia average extent (moderate)
Apgar score of the child within 4-5. Newborn as well as in light of asphyxia, makes his first breath in the first minute, but very relaxed breathing, irregular, weak cry (baby squeaks or groans), slowed heartbeat. It is also noted a weak muscle tone, a grimace on his face, cyanosis (cyanosis), hands, feet, the face, the umbilical cord is pulsating.
Severe asphyxia
The child's condition Apgar scores of 1-3 matches. Breathing or not at all (apnea), or it is a rare and irregular.
The child does not cry, heartbeat rare, absent reflexes, muscle tone, or weak, or it is not (atonia), pale skin (a consequence of spasm of blood vessels), the umbilical cord is not pulsates.
When severe asphyxia, usually develops adrenal insufficiency. This form of apnea is called "white" asphyxia.
apparent death
Evaluation of the newborn Apgar scores of 0. Completely lacking all signs of life. In this case, immediate resuscitation.
Treatment of newborn asphyxia
Treatment of the newborn, who was born in a state of asphyxia, begins immediately after birth, that is, in the delivery room. Resuscitation and further therapy is a doctor neonatologist doctor-resuscitator.
First aid in the delivery room:
Immediately after birth the newborn is placed on the changing table under the heat source, and wiped dry diaper aspirated mucus from the mouth and upper airways.
If after removing mucus child is not breathing, then 1-2 times lightly slapped him on the soles of his feet. In the absence of breathing or a subpar start to ventilation - mechanical ventilation (on the face of the baby put on a mask, through which oxygen passes).
If the ventilator is continued 2 more minutes, the probe is inserted into the stomach and the gastric contents removed.
Produce an assessment of cardiac activity. If the heart rate (HR) and less than 80 per minute, start chest compressions.
Drug administration was started after 30 seconds if the heart rate of 80 or less on the background of mechanical ventilation, either immediately, in the absence of contraction of the heart.
Medications administered into the umbilical vein (sodium hydrogen carbonate solution, epinephrine solution, albumin and Ringer laktatatom saline).
In the case of birth of a child in a state of clinical death, he was immediately intubated and conduct medical therapy mentioned above. Resuscitation was stopped after 20 minutes after the start of all actions cardiac activity is not restored.
After the end of resuscitation of the newborn is transferred to the intensive care unit.
Children with mild asphyxia placed into an oxygen chamber, children with moderate to severe asphyxia in incubator. Newborn provide rest, seat heating, an antibiotic is prescribed.
In intensive care treatment continues. Showing vitamins (B group vitamins, vitamin E, glutamic acid, potassium pantothenate, rutin, nicotinic acid), menadione, Dicynonum and calcium gluconate (prevention of stroke), ATP, cocarboxylase, carried infusion therapy.
Feed the newborn with mild asphyxia begin within 16 hours, children with severe asphyxia in 24 hours through a tube.
The duration of treatment depends on the condition of the newborn and can be 10-15 days or more.
Effects
neonatal asphyxia risk of developing complications (early and late).
Early complications:
- brain edema;
- bleeding in the brain;
- brain necrosis and so on.
Late complications:
- infectious complications (pneumonia, meningitis, sepsis);
- neurological complications (hydrocephalus, encephalopathy).
Consequences after undergoing asphyxia diagnosed within the first year of life:
- hyperexcitability;
- slow reaction;
- convulsions;
- encephalopathy according to the type of hypertension-hydrocephalic;
- child deaths.
