Asphyxia of newborns

Description:

Asphyxia of the newborn (asphyxia neonatorum) — the morbid condition of the newborn caused by disturbance of breath and arising thereof oxygen insufficiency. Distinguish primary (at the birth) and secondary (during the first hours and days of life) asphyxia of the newborn.

Symptoms of Asphyxia of newborns:

The leading symptom of asphyxia of newborns is the breath disturbance leading to change of cordial activity and a hemodynamics, disturbance of neuromuscular conductivity and reflexes. Severity determine by a scale Apgar (see Apgar a method).  According to the International classification of diseases of the IX review allocate asphyxia of moderately severe newborns and heavy (assessment on a scale Apgar in the first minute after the birth respectively 7 — 4 and 3 — 0 points). In clinical practice it is accepted to distinguish three severity of asphyxia: easy (assessment on a scale Apgar in the first minute after the birth of 7 — 6 points), moderately severe (5 — 4 points) and heavy (3 — 1 point). The general assessment of 0 points testifies to clinical death. At slight asphyxia the newborn takes the first breath within the first minute after the birth, but breath at it weakened, the Crocq's disease and cyanosis of a nasolabial triangle, some decrease in a muscle tone are noted. At moderately severe asphyxia the child takes the first breath within the first minute after the birth, breath is weakened (regular or irregular), shout weak is, as a rule, noted bradycardia, but can be and tachycardia, a muscle tone and reflexes are lowered, skin cyanotic, is sometimes preferential in a face, hands and feet, the umbilical cord pulses. At heavy asphyxia breath irregular (separate breaths) or is absent, the child does not shout, sometimes groans, heartbeat is slowed down, in some cases is replaced by single irregular reductions of heart, the hypomyotonia or an atony is observed, reflexes are absent, skin pale as a result of a spasm of peripheral vessels, the umbilical cord does not pulse; often adrenal insufficiency develops.

During the first hours and days of life at the newborns who had asphyxia the post-hypoxemic syndrome which main manifestation is defeat ц.н.с develops. At the same time at every third child who was born in a condition of moderately severe asphyxia disturbance of cerebral circulation of the I—II degree is observed, at all children who had heavy asphyxia the phenomena of disturbance of a likvorodinamika and cerebral circulation of the II—III degree develop. Oxygen insufficiency and disorders of function of external respiration break formation of a hemodynamics and microcirculation in this connection fetalis communications remain: there is open an arterial (botall) channel; as a result of the spasm of pulmonary capillaries leading to increase in pressure in a small circle of blood circulation and an overload of the right half of heart the oval opening is not closed. In lungs atelectases and quite often hyaline membranes are found. Disturbances of cordial activity are noted: dullness of tones, premature ventricular contraction, arterial hypotension. Against the background of a hypoxia and a reduced host defense microbic colonization of intestines is quite often broken that leads to development of dysbacteriosis. During the first 5 — 7 days of life the metabolic frustration which are shown accumulation in an organism of the child of acid products of exchange, urea, a hypoglycemia, an imbalance of electrolytes and true deficit of potassium remain. Owing to a renal failure and sharp decrease in a diuresis after 2 — the 3rd day of life at newborns the edematous syndrome develops.

Reasons of Asphyxia of newborns:

The reasons of primary asphyxia of newborns, are acute and chronic pre-natal oxygen insufficiency — a fruit hypoxia, an intracranial injury, immunological incompatibility of blood of mother and a fruit, a pre-natal infection, full or partial obstruction of respiratory tracts of a fruit or the newborn slime, amniotic waters (aspiration asphyxia), fruit malformations. Developing of asphyxia of newborns is promoted by extragenital diseases of the pregnant woman (cardiovascular, especially in decompensation stages, a serious illness of lungs, the expressed anemia, a diabetes mellitus, a thyrotoxicosis, infectious diseases, etc.), late toxicoses of pregnant women, perenashivany pregnancies, premature placental detachment, pathology of an umbilical cord, fetal membranes and a placenta, complication in labor (untimely izlity amniotic waters, anomalies of patrimonial activity, discrepancy of the sizes of a basin of the woman in labor and a head of a fruit, the wrong insertions of a head of a fruit, etc.). Secondary asphyxia of newborns can be connected with disturbance of cerebral circulation at the newborn, pneumopathies, etc.

Treatment of Asphyxia of newborns:

The children who were born in asphyxia need the resuscitation help. Its efficiency to a great extent depends on that how treatment is early begun. Resuscitation events are held in the delivery room under control of key parameters of life activity of an organism: a respiration rate and its conductivity in lower parts of lungs, the frequency of heartbeat, indicators of the ABP, a hematocrit and an acid-base state.