ASXIS OF THE NEWBORN

Newborn's asymmetry is a complex of changes in the body of a newborn that develops under the influence of oxygen deficiency, resulting from a violation of breathing.

Depending on the cause, the following types of infantile asphyxia can be distinguished: 1) due to lack of oxygen or excess carbon dioxide in the mother's body (cardiovascular diseases, especially decompensated heart defects , severe lung diseases leading to gas exchange disturbance, severe anemia, large blood loss, shock , Severe intoxication); 2) caused by the difficulty of blood circulation in the umbilical cord or the violation of the utero-placental circulation (the true node of the umbilical cord, the tight cord with the umbilical cord, the compression of the umbilical cord by the fetal head and the walls of the birth canal during delivery in the pelvic presentation, the umbilical cord fracture under the membrane attachment, Attachment of the umbilical cord not to the placenta, but to the membranes, premature detachment of the normally located or presenting placenta, severe late toxicosis of pregnant women , pregnancy retardation , untimely outflow of amniotic fluid , anomalies of labor with frequent dis-coordinated contractions); 3) caused by the developmental defects of the central nervous system (anencephaly, hydrocephalus , spinal hernia), intracranial birth trauma, severe congenital heart disease, hemolytic disease of the newborn, congenital infections; 4) asphyxia of the newborn caused by complete or partial obstruction of the airways, for example, mucus, meconium.

The leading symptom of asphyxia is a violation of breathing, leading to a change in cardiac activity and hemodynamics, a violation of neuromuscular conduction and reflexes. Depending on the degree of severity, light and heavy asphyxia are distinguished. With mild asphyxia, the newborn takes the first breath within the first minute after birth, the breathing is weakened (regular or irregular), the cry is weak, as a rule, bradycardia is noted , but there may be tachycardia , decreased muscle tone and reflexes, bluish skin, sometimes predominantly in the area Face, hands and feet; The umbilical cord pulsates. In severe asphyxia, irregular breathing (in the form of individual breaths) or absent, the child does not cry, sometimes groans; Slow heartbeat, in some cases it is replaced by single irregular heart contractions, muscle hypotension or atony is observed, reflexes are absent; The skin of the pale umbilical cord does not pulsate.

ASSESSMENT OF THE STATE OF THE NEWBORN IN THE SCALE OF APGAR

Symptoms	Score evaluation in points
	0	1	2
Palpitation	Absent	Frequency less than 100 per minute	Frequency more than 100 per minute
Breath	Absent	Slight scream	Shout
Muscle tone	Sluggish or missing	Some degree of flexion	Active Movement
The heel reflex (reflex excitability)	Absent	Slightly expressed	Well expressed
Skin coloring	Cyanotic or pale	Pink body and cyanotic limbs	Pink

Assessment of the severity of asphyxia is carried out on the Apgar scale (see table) in the first minute after birth - a mild degree of asphyxia - 6-7 points; Asphyxia of moderate severity - 4 - 5 points; Severe asphyxia - 1-3 points.

To determine the prognosis, the child's condition is determined on a scale 5 minutes after birth. If the score increases - the forecast is favorable.

With mild asphyxia at the time of the birth of the fetal head and immediately after the birth of the child, a mild catheter is used to remove the mucus from the upper respiratory tract with a soft catheter, after giving birth, the baby is given a knee-elbow position. Using a mask all the newborns are ventilated for normalization of respiration , Cocarboxylase (8 mg / kg in 10 ml of 10% glucose solution) is injected into the vein of the umbilical cord. The cord is bandaged after the cessation of its pulsation.

In severe asphyxia, resuscitation is carried out. Immediately after birth, the baby is crossed by the umbilical cord and intubates the trachea. Through the catheter, the mucus is sucked off and artificial ventilation is performed until the recovery of independent regular breathing (no more than 15-20 minutes); If necessary, external massage of the heart is done, 1 ml of 0.01% (1:10 000) solution of epinephrine hydrochloride is injected into the skin or intracardiac. 15, 20 or 25 ml of 5% sodium hydrogen carbonate solution (depending on the weight of the baby), 8-10 ml of 10% glucose solution, and cocarboxylase (8-10 mg / kg) are poured into the vein of the umbilical cord. After recovery of respiration and cardiac activity, craniocerebral hypothermia is carried out-local cooling of the newborn's head, as well as infusion-dehydration therapy (intravenous drip infusion of 10% rheopolyglucin solution, 20% glucose solution and 10% mannitol solution at the rate of 10 ml of each drug per 1 kg of body weight ), Before the end of the infusion of liquid into the dropper, add lasix (1 mg per 1 kg of weight).

The child born in asphyxia is provided with peace, the head is given an elevated position, followed by diuresis and intestinal activity. Children born in severe asphyxia are fed through a catheter, are kept in a kuveze or are given periodic inhalations of 60% oxygen-air mixture. In connection with the possibility of complications on the part of the central nervous system for children born in asphyxia, a careful follow-up of the pediatrician and neuropathologist is established, especially during the first year of life.

Prevention includes timely detection and treatment of the pathology of pregnancy and childbirth, the prevention of intrauterine fetal hypoxia, especially at the end of the second stage of labor, sucking mucus from the upper respiratory tract of the child immediately after birth.