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The person is alive until he breathes and while in his vessels circulate blood. That is why it is very important to know the features of breathing in children, as well as how and the breath of children differs from the breath of an adult.

Breathing fruit

The person begins to breathe even before his appearance, in the womb. But it is important to know the difference in the child's intrauterine breathing and his independent breathing after birth.

After fertilization of the egg, the small germ is already needed oxygen. During the first ten weeks, the fruit receives oxygen from the mother's reserves, which are in a fertilized egg. An independent full breathing of the fetus appears with the emergence of the placenta and a generic place, where almost all 9 months the baby lives. It happens about the 10-12th week of pregnancy. Oxygen is actively absorbed by the placenta vile, which are attached to the vessels of the mother, and from there are all nutrients, including oxygen.

Breathing and child's birth process

It is also interesting to know not only how the child breathes in the womb, but also how his breathing changes during birth. At the time of the child's appearance, the kid can be on double breathing - ordinary and breathing with the mother through the placenta.

Light children begin to work most often after cotton obstetrician on the ass of the baby, which makes the easy to open and fully function. At the same time, the child can also receive oxygen through the mother's umbilical umbilical, if it was not cut off (the umbilical cord is trying not to trim until it flies, that is, it still works). After cutting the uterus and reject the placenta or during the circumcision by a cord doctor, the child fully moves to self-breathing with its own lungs.

Breathing of a child in the first months of life

Often young parents can take care of the breath of the newborn baby, namely, the frequency of breathing. It is important to know the newly-made parents that the breath of the breast child differs from the breathing of an older baby and even more so by the breath of an adult.

Many parents can disturb the child's breathing rate. The fact is that the respiratory paths of the newborn baby are still undergoing the formation process, so the frequency and rhythm of the child's breathing can constantly change, not be stable. A completely normal phenomenon, if the child breathes often, takes a deep breath, as if it fits and again begins to breathe. These actions suggest that the child still learns to properly obtain oxygen, and the respiratory frequency compensates for the lack of obtaining oxygen to the baby with a normal respiratory rhythm. If the adult is about 17-20 breaths per minute, the child is 25-30, then the frequency of respiration in children of the smallest age can be up to 60 inhales per minute!

But it is necessary to remember that you need to keep track of the breath of the newborn baby. On average, the breath of infant must stabilize to the completion of the first month of life. But all individually, if the child was born premature or with pathologies, this process can be somewhat delayed.

Child breathing in a dream

It is important for parents to keep track of what breathing in a child in a dream. In a dream, the child can hide the head and not to get enough oxygen, and in order to open it yourself, it is still small. It is also important to check the child's breath in the first months of life, since the children of this age can be exposed to SVDS - a sudden child death syndrome - a stopping of breathing without visible reasons.

Retail breathing

• Young parents can also concern what the child breathes his mouth. In the first months of life, it is also normal, as the nasal passages of the child are not yet fully generated and can be completely thin. Therefore, through the nose, it may be difficult to breathe, and for this it starts to use the mouth.
• Also, the child can breathe through the mouth if his nose is scored. To facilitate the child's condition, you need to bore a nose or carefully clean it from alien bodies with a cotton wand. The reason that the baby's nose is clogged, can be dry air in the apartment, so it is very important in the first year of the baby's life to follow the humidity of the air in the house. It must be 50-60% on average.
• To breathe through the mouth, the child can also in the event that he sleeps without a pillow, and his head is a little trapped. In this case, the child is simply easier to get oxygen in this way. You can avoid this, putting a thin pad under the head.
• Also, a child can just sleep with an open mouth, but breathe with a nose. Therefore, parents before take action, you need to make sure that the child breathes at the mouth. To do this, you just need to listen carefully to the breath of the baby.

How to breathe?

Before learning a child, breathe, first you need to figure out how the child breathes. It may be chest, abdominal or mixed breathing type. With breast breathing, the chest is actively working, with an abdominal child as if breathing abdomen. Mixed type combines infant and abdominal child breathing. It is important for parents to remember that small children are almost all are on abdominal breathing, so their clothes should not be tight or stinting. This is primarily necessary for the ease of breathing the baby.

• Exercise for proper abdominal breathing. The child needs to be put on a flat surface on the back, put the handles under the head, and the knees bend a little. When inhaling you need to inflate your belly, like a ball, when you exhale - to blow it down. So repeat 10-15 times. This exercise is intended not only for breathing training, but also to strengthen the muscles of the abdominal press.
• Exercise for breast breathing. The child needs to take a sphinx pose - lie on the stomach, leans with your hands from the elbow to the brush into the floor, raise the chest. Make a deep breath, delay air a little, breathe dramatically. Exercise must be repeated several times.

The birth of the long-awaited baby is a joyful event, but not in all cases, childbirth ends successfully not only for the mother, but also for the child. One such complications is the asphyxia of the fetus, which arose in childbirth. This complication is diagnosed in 4 - 6% just that have appeared on the light of children, and according to some authors, the frequency of asphyxia of newborns is 6 - 15%.

Definition of asphyxia newborns

Translated from Latin asphyxia means choking, that is, the lack of oxygen. Asphyxia newborns is called such a pathological condition, in which gas exchange in the body of a newborn is disturbed, which is accompanied by a disadvantage of oxygen in the tissues of the child and its blood and the accumulation of carbon dioxide.

As a result, the newborn, which was born with signs of livingborn, either can not breathe independently after the first minute after the appearance of the world, or he has separate, surface, convulsive and irregular respiratory movements against the background of the healing heartbeat. Such children immediately conduct resuscitation activities, and the forecast (possible consequences) in this pathology depends on the severity of asphyxia, timeliness and quality of resuscitation.

Classification of asphyxia Newborns

By the time of occurrence, there are 2 forms of asphyxia:

• primary - develops immediately after the birth of the baby;
• secondary - diagnosed during the first day after childbirth (that is, first the child has been breathing independently and actively breathe, and then suffocate).

According to the severity (clinical manifestations) allocate:

• asphyxia is a light degree;
• asphyxia of moderate severity;
• heavy Asphyxia.

The factors provoking the development of asphyxia

This pathological condition does not apply not to independent diseases, but is only a manifestation of the complications of the course of pregnancy, diseases of women and the fetus. For the reasons of asphyxia include:

Fruit factors

• ) The child has;
• rhow-conflict pregnancy;
• anomalies of the development of the bronchopulmonary system;
• intrauterine infections;
• prematurity;
• intrauterine fetal growth delay;
• blockage of the respiratory tract (mucus, amniotic fluid, mingonium) or asphyxia;
• fliques for the development of the heart and brain of the fetus.

Maternal factors

• heavy flowing against the background of high blood pressure and severe edema;
• decompensated extragenital pathology (cardiovascular diseases, pulmonary system diseases);
• pregnant women;
• endocrine pathology (, ovarian dysfunction);
• women's shock during childbirth;
• violated ecology;
• harmful habits (smoking, alcohol abuse, drug reception);
• insufficient and defective nutrition;
• reception of drugs are contraindicated during the period of gestation;
• infectious diseases.

Factors contributing to the development of disorders in the royal and placental circle:

• transferred pregnancy;
• premature aging placenta;
• premature placental detachment;
• pupus pathology (crucial umbilical, true and false nodes);
• permanent threat of interrupt;
• and bleeding associated with it;
• multiple pregnancy;
• excess or lack of accumulating waters;
• anomalies of the generic forces (and discoordination, fast and rapid labor);
• the introduction of drugs is less than 4 hours before the completion of labor;
• general anesthesia of a woman;
• breaking the uterus;

Secondary asphyxia provoke the following diseases and pathology in a newborn

• impaired cerebral circulation in the child due to residual phenomena of brain damage and lungs in childbirth;
• not identified and not manifested at the birth of heartfalls;
• aspiration of milk or a mixture after feeding procedure or poor-quality stomach sanitation immediately after birth;
• respiratory Distress Syndrome, due to pneumopathy:
  • the presence of hyaline membranes;
  • euch-hemorrhagic syndrome;
  • pulmonary hemorrhage;
  • atelectases in the lungs.

The mechanism of development of asphyxia

It doesn't matter what the lack of oxygen in the body has just been due to the child, in any case, the exchange processes, hemodynamics and microcirculation are rebuilt.

The degree of severity of pathology depends on how long hypoxia was intense. Due to the exchange and hemodynamic rearrangements, acidosis is developing, which is accompanied by a lack of glucose, azotemia and hyperkalemia (later hypokalemia).

Under acute hypoxia, the volume of circulating blood increases, and with chronic and developed asphyxia, the volume of blood decreases. As a result, blood is condensed, its viscosity increases, the aggregation of platelets and red blood cells increases.

All these processes lead to a microcirculation disorder in vital organs (brain, heart, kidney and adrenal glands, liver). Microcirculation disorders cause swelling, hemorrhages and foci of ischemia, which leads to a violation of hemodynamics, disorder of the functioning of the cardiovascular system, and as a result of all other systems and organs.

Clinical picture

The main feature of the asphyxia of newborns is the violation of breathing, which entails the malfunction of the cardiovascular system and hemodynamics, and also disrupts the neuromuscular conductivity and the severity of reflexes.

To assess the severity of pathology, neonatologists use the evaluation of the newborn on the apgar scale, which is carried out on the first and fifth minute of the child's life. Each characteristic is estimated at 0 - 1 - 2 points. A healthy newborn in the first minute is gaining 8 - 10 points across apg.

The degrees of asphyxia of newborns

Easy asphyxia

When asphyxicia is an easy degree, the number of points in the newborn in apgar is 6 - 7. The first breath is performed throughout the first minute, but there is a weakening of respiration. Minor acrocyanosis (sinusia in the area of \u200b\u200bthe nose and lips) and a decrease in muscle tone.

Medium-heavy asphyxia

Evaluation on apgar is 4 - 5 points. There is a significant weakening of breathing, its violations and irregularity are possible. Cardiac abbreviations are rare, less than 100 per minute, there is cyanosis of face, brushes and stops. Motor activity increases, muscle dystonia is developing with a hypertonus predominance. Possible tremor chin, hands and feet. Reflexes can be both reduced and strengthened.

Heavy Asphyxia

The state of the newborn is heavy, the number of points on apgar on the first minute does not exceed 1 - 3. The child does not perform respiratory movements or produces separate breaths. Cardiac abbreviations are less than 100 per minute, pronounced, cardiac tones deaf and arrhythmical. There is no cry from a newborn, the muscular tone is significantly reduced or there is muscle atony. The skin is very pale, the umbilical cord does not pulsate, the reflexes are not defined. Eye symptoms appear: Nistagm and floating eyeballs, the development of convulsion and brain edema, DVS-syndrome (violation of blood viscosity and to increase platelet aggregation). Hemorrhagic syndrome (numerous hemorrhages on the skin) is enhanced.

Clinical death

A similar diagnosis is set to evaluate all the indicators on apgar at zero points. The state is extremely severe and requires immediate resuscitation activities.

Diagnostics

When making a diagnosis: "asphyxia of a newborn" takes into account the data of the obstetric anamnesis, as the childbirth, the assessment of the child on apgar on the first and fifth minutes and clinical laboratory research.

Definition of laboratory indicators:

• pH level, PO2, RSO2 (study of blood obtained from the umbilical veins);
• deficiency deficit;
• the level of urea and creatinine, diuresis per minute and per day (the operation of the urinary system);
• the level of electrolytes, acid-base state, blood glucose;
• alt, AST, Bilirubin level and blood coagulation factors (liver operation).

Additional methods:

• evaluation of the work of the cardiovascular system (ECG, control of blood pressure, pulse, chest x-ray);
• evaluation of neurological status and brain (neurosonography, encephalography, CT and NMR).

Treatment

All newborn born in the state of asphyxia are held immediate resuscitation activities. It is from the timeliness and adequacy of the treatment of asphyxia depends on a further forecast. Resuscitation of newborns is carried out according to the ABC system (developed in America).

Primary help newborn

Principle A.

• ensure the correct position of the child (to lift the head, laying under the shoulder belt roller and slowly throw it up);
• to suck the mucus and the oily water of the mouth and the nose, sometimes from the trachea (with aspiration by amniotic fluid);
• intubate the trachea and searches the lower respiratory tract.

Principle B.

• conduct a tactile stimulation - slaps along the heels of a child (if there is no cry for 10 to 15 seconds after the appearance of the light, the newborn is placed on the resuscitation table);
• oxygen supply inkjet;
• implementation of auxiliary or artificial ventilation of the lungs (bag of AMBU, oxygen mask or endotracheal tube).

Principle S.

• conducting indirect heart massage;
• introduction of drugs.

The solution to the issue of termination of resuscitation activities is carried out after 15 - 20 minutes, if the newborn does not respond to resuscitation actions (there is no breathing and stable bradycardia remains). The cessation of resuscitation is due to the high probability of brain lesions.

Introduction of drugs

In an umbilical vein on the background of artificial ventilation of the lungs (mask or endotracheal tube), a kocarboxylase diluted with 10 ml of 15%-glocose is injected. It is also intravenously introduced 5%-pyndocarbonate sodium for the correction of metabolic acidosis, 10% calcium-gulkonate and hydrocortisone to restore the tone of the vessels. If bradycardia appeared, 0.1% is introduced into the umbilical vein - atropine sulfate.

If the heart rate is less than 80 per minute, it is carried out indirect heart massage with a mandatory continuation of artificial ventilation of the lungs. Through the endotracheal tube, 0.01% -adrenaline is introduced (in the umbilical vein). As soon as the heart rate reached 80 strokes, the heart massage stops, the IVL continues until the achievement of CSS 100 strikes and the appearance of independent respiration.

Further treatment and observation

After providing primary resuscitation and restoration of cardiac and respiratory activities of the newborn, they are transferred to the ward of intensive therapy (PIT). Pete further therapy of asphyxia of the sharp period is carried out:

Special care and feeding

The child is placed in the kouvez, where constant heating is carried out. At the same time, craniocerebral hypothermia is carried out - the newborn head is cooled, which prevents. Feeding children with light and medium asphyxia is beginning no earlier than after 16 hours, and after severe asphyxia, feeding is allowed in a day. Feed the baby through the probe or a bottle. Applying the chest depends on the child's condition.

Warning of brain edema

Intravenously, albumin, plasma and cryoplasma, mannitol are introduced through the umbilical catheter. Preparations are also prescribed to improve the blood supply of brain (Cavinton, Cinnarizin, Vinpocetin, Sermion) and antihypoxants (vitamin E, ascorbic acid, cytochrome C, Aevit). Hemostatic preparations are appointed (ditinon, rutin, vikasol).

Oxigenotherapy

The supply of moisturized and warmed oxygen continues.

Symptomatic treatment

Therapy is carried out aimed at preventing convulsion and hydrocyphal syndrome. Anticonvulsant preparations are prescribed (GOM, Phenobarbital, Relanium).

Correction of metabolic disorders

The intravenous administration of sodium bicarbonate continues. Infusion therapy is carried out by salt solutions (Piz. Solution and 10%-glucose).

Monitoring newborns

Twice a day, the child weighed, estimate the neurological and somatic status and the presence of positive dynamics, control the received and dedicated liquid (diuresis). CSS, blood pressure, respiratory frequency, central venous pressure are recorded on the devices. From laboratory analyzes, a total analysis of blood with and platelets is determined daily, acid-base condition and electrolytes, biochemistry of blood (glucose, bilirubin, AST, Alt, urea and creatinine). The indicators of blood coagulation and tank are also evaluated. Sowing from the rotogling and rectum. The conducting of chest radiography and abdomen, ultrasound of the brain, ultrasound of the abdominal region organs is shown.

Effects

The asphyxia of newborns rarely passes without consequences. In one degree or another, the lack of oxygen in a child during and after childbirth affects all vital organs and systems. Especially dangerous is heavy asphyxia, which always flows with polyorgan deficiency. The prognosis for the life of the baby depends on the degree of evaluation on apgar. In case of an increase in the assessment on the fifth minute of life, the prediction for the child is favorable. In addition, the severity and frequency of consequences depend on the adequacy and timeliness of the provision of resuscitation activities and further therapy, as well as on the degree of asphyxia severity.

Frequency of complications after transferred hypoxic:

• when I, the degree of encephalopathy after hypoxia / asphyxia of newborns - the development of the child does not differ from the development of a healthy newborn;
• under the II degree of hypoxic encephalopathy - 25 - 30% of children in the future have neurological disorders;
• with III degree of hypoxic encephalopathy, half of children die during the first week of life, and in the rest of the 75-100%, severe neurological complications appear with convulsions and increased muscle tone (later delayed mental development).

After transferring asphyxia during childbirth, there may be an early and late.

Early complications

About the early complications they say when they appeared during the first 24 hours of life of the baby and, in fact, are manifestations of severe childbirth:

• hemorrhage into the brain;
• convulsions;
• and tremor hands (first small, then large);
• apnea attacks (respiratory stops);
• mekony aspiration syndrome and as a result of this, the formation of atelectasis;
• transient pulmonary hypertension;
• due to the development of hypovolemic shock and blood thickening, the formation of polycythymetic syndrome (a large number of erythrocytes);
• thrombosis (violation of blood coagulation, reduced tone of vessels);
• heart rate disorders, the development of postgoxic cardiopathiopathy;
• urinary system disorders (oliguria, renal vessel thrombosis, swelling interstice kidney);
• gastrointestinal disorders (and intestinal paresis, dysfunction of the digestive tract).

Late complications

Late complications are diagnosed after three days of the child's life and later. Late complications may be infectious and neurological genesis. The neurological consequences that appeared due to transferred hypoxia brain and post-epoxic encephalopathy include:

• Hypermator syndrome

The child has signs of increased excitability, bright reflexes (hyperreflexia), expanded pupils ,. A seizures are absent.

• Reduced excitability syndrome

Reflexes are poorly pronounced, the child is sluggish and the adamantic, the muscle tone is lowered, extended pupils, the tendency to lethargy, is present with a symptom of "puppet" eyes, breathing (bradypuna alternating with apnea), a rare pulse, a weak sucking reflex.

• Convulsive syndrome

Characterized with tonic (voltage and rigidity of the muscles of the body and limbs) and clonic (rhythmic cuts in the form of twitching of individual muscles and legs, face and eyes) convulsions. Operated paroxysms appear in the form of a grimace, a spasm of view, attacks of unmotivated sucking, chewing and tonging, floating eyeballs. Cyanosis attacks with apnea, rare pulse, enhanced saliva, and sudden pallor.

• Hypertension and Hydrocepal Syndrome

The child throws his head, sprouts, the cranial seams disagree, the circle of the head, the constant convulsive readiness, the fallout of the functions of the cranial nerves (the squint and nastagm is noted, the smoothness of the nasolabial folds and other).

• Vesecome-visceral disorders syndrome

It is characterized by vomiting and constant tights, disorders of the intestinal motor function (constipation and diarrhea), skin marble (spasm of blood vessels), bradycardia and rare breathing.

• Motor disorder syndrome

The residual neurological disorders are characterized (paresis and paralysis, muscle dystonia).

• Subarachnoid hemorrhage
• Outdoor hemorrhages and hemorrhages around the ventricles.

Possible infectious complications (due to weakened immunity after transferred polyorgan deficiency):

• development;
• damage to a solid cerebral shell ();
• development of sepsis;
• infectious intestinal lesion (necrotic colitis).

Question answer

Question:
Does the child who suffered asphyxia in childbirth, special care after discharge?

Answer: Yes of course. Such children need particularly careful observation and care. Pediatricians, as a rule, are prescribed a special gymnastics and massage that normalize excitability, reflexes in the baby and warn the development of convulsion. The child needs to ensure maximum peace, preference to give to breastfeeding.

Question:
When is discharged from the maternity hospital after the asphyxia of the newborn?

Answer: On early discharge (on 2 - 3 days) worth forgetting. The child will be in the maternity hospital at least a week (Kuvez is needed). If necessary, the baby and mom is transferred to the children's office where treatment can last up to a month.

Question:
Are the newborns who have undergone asphyxia, dispensary observation?

Answer: Yes, all the children who have suffered asphyxia in childbirth are mandatory put on dispensary accounting from a pediatrician (neonatologist) and a neurologist.

Question:
What are the consequences of asphyxia of the child at the older age?

Answer: Such children are prone to colds due to weakened immunity, they have reduced performance at school, the reactions to some situations are unpredictable and often inadequate, psychomotor development returned, retracting in speech. After severe asphyxia, epilepsy, convulsive syndrome often develops, is not excluded oligophrenia, and paresis and paralysis.