Sequelae of severe neonatal asphyxia

If a newborn suffers from severe asphyxia, emergency treatment is required, otherwise it will directly endanger the life safety of the newborn, and even death may occur. Therefore, early treatment is very critical. In addition, if the severe asphyxia of the newborn reaches a certain level, sequelae will appear, which may have a great impact on the development of the brain and make the intellectual development very slow.

1. After the fetus is delivered, the face and skin of the whole body are bluish purple or pale, and the lips are dark purple.

2. Shallow breathing, irregular breathing, or no breathing or only weak breathing like gasping.

3. Regular heartbeat, heart rate 80￣120 times/minute or irregular heartbeat, heart rate <80 times/minute, and weak.

4. Respond to external stimuli with good muscle tone or do not respond to external stimuli with loose muscle tone.

5. Laryngeal reflex is present or absent.

When the fetus is hypoxic, the first clinical symptoms are increased fetal movement and faster fetal heart rate. The early stage of hypoxia is the excitement stage. If the hypoxia persists, it enters the inhibition stage, the fetal heart rate slows down, and finally stops beating. The anal sphincter relaxes and meconium is discharged.

The degree of asphyxia during neonatal delivery can be distinguished according to the Apgar score within 1 minute after birth. 0 to 3 points are severe, 4 to 7 points are mild. If the score is 8 to 1 point 1 minute after birth and drops to 7 points or below after a few minutes, it is also considered asphyxia.

Before starting the scoring work, medical staff should undergo training to make the scoring results as uniform as possible, and scoring should be performed by non-midwives as much as possible. The score 5 minutes after birth is particularly important for determining prognosis, and its value can be improved by continuing to score on a regular basis according to the patient's condition.

For primary-care midwives in rural mountainous areas who have difficulty in implementing the Apgar score, they can score the newborn based on two indicators: breathing and skin color. A total score of 0 to 2 points indicates severe asphyxia, 3 points indicates mild asphyxia, and a full score of 4 indicates a normal baby. In a comparison of the Apgar scores and umbilical cord blood gas of more than 500 newborns, Shanghai First Maternity and Infant Health Care Hospital found that the scores have a certain relationship with umbilical cord blood blood gas, but they cannot completely replace each other, but can complement each other.

Most choked babies can recover their breathing and their skin will turn red after timely rescue. A small number of severe cases that have not improved continue to be in shock, with gray or pale skin, low body temperature, cold limbs, shallow or irregular breathing, weak crying, and groaning. During inspiration, the xiphoid process of the sternum and the intercostals are sunken, excessive inspiration causes the anterior chest to bulge, the diaphragm to move downward, and coarse, moist rales or crackles may occasionally be heard on auscultation. Percussion is dull, and the heart sounds are mostly strong but slightly fast, and a blowing-like systolic murmur may be present.

The limbs are loose or have tremor-like movements. Chest X-rays may show partial or complete atelectasis, emphysema or pneumonia, and fluid may accumulate in the chest cavity. Some lesions disappear within 24 hours, and sometimes last for a week. Infants who survive rescue efforts are often prone to vomiting due to poor sucking ability. Body temperature rises slowly.