Neonatal hypoxia

"Introduction" Neonatal hypoxia refers to the hypoxic-ischemic damage to the brain caused by neonatal asphyxia in perinatal period (28 weeks of pregnancy and one week after delivery). What are the symptoms of neonatal hypoxia? Let's see mom. com。 What is neonatal hypoxia? First of all, let's understand the causes of neonatal hypoxia.

Neonatal hypoxia refers to the hypoxic-ischemic damage to the brain caused by perinatal asphyxia.

The main causes of neonatal hypoxia are maternal factors, placental abnormality, fetal factors, umbilical cord blood occlusion, labor process factors, neonatal diseases and so on.

Perinatal asphyxia is the main cause of this disease. Anyone who causes maternal and fetal blood circulation and gas exchange disorders and reduces blood oxygen concentration can cause asphyxia. 50% is caused by intrauterine asphyxia; Asphyxia during childbirth accounts for 40%; Congenital diseases account for 10%. In addition, the mother herself suffers from pregnancy-induced hypertension syndrome, massive hemorrhage, cardiopulmonary disease, severe anemia or shock; Placenta has placental abruption, placenta previa, placental dysfunction or structural abnormality; Intrauterine growth retardation, premature delivery, overdue delivery, congenital malformation, repeated apnea, respiratory distress syndrome, bradycardia, severe heart failure, shock and polycythemia; Umbilical cord occlusion, umbilical cord prolapse, compression, knotting or around the neck; Delayed delivery, urgent delivery, abnormal fetal position, surgery or application of * * * and other factors may lead to the occurrence of brain hypoxia in infants.

How to diagnose neonatal hypoxia has its typical characteristics, as follows:

1. Very sensitive or excited. Normal newborns (especially low birth weight infants) are prone to "excitement" and "sensitivity" when they are hungry, while newborns with cerebral palsy are prone to appear even if they are not hungry.

2. Excessive irritability, persistent crying, difficulty in falling asleep, general weakness, weakness or tightness of limbs. Some parents even reported that their children cried all night. About 30% children with cerebral palsy have similar severe "colic" within 3 months after birth, and suddenly they cry violently.

3. Often spit, often half-open, tongue constantly sticking out, less or more exercise, stiff exercise. The symptoms of cerebral palsy in children are often the early symptoms of hand-foot peristalsis cerebral palsy.

4. Nursing is difficult, which is manifested in that it is difficult to insert the arm into the sleeve when dressing, to abduct the thigh when changing diapers, and to break the fist when bathing. Parents often report that "children don't like to take a bath" as soon as their feet touch the edge of the bathtub or the water surface. The back immediately arched stiffly. This is also one of the characteristics of neonatal hypoxic-ischemic cerebral palsy.

5. I am sensitive to sudden sounds or changes, and it looks scary.

6. Feeding is difficult, sucking and swallowing are not coordinated, and sometimes parents report that they "flow out of their mouths when eating". It's hard to gain weight.

7. The motor development is inflexible, and children can't turn over from April to May, 9 ~ 10 can't climb, with abnormal muscle tension and posture, low muscle tension, and different sitting and crawling postures from normal children.

8. Abnormal reflex. If you put something in your hand, the child will have a grasping reaction and a sucking reaction. The innate reflex will disappear completely six months ago, and it is abnormal if it has not disappeared.

When the baby is found to have the characteristics of neonatal hypoxia, it is necessary to send a doctor to diagnose it in time, which is helpful for timely treatment.

1. Image diagnosis improves the accuracy of diagnosis.

A. B-mode ultrasound examination of skull-coronal and sagittal sector ultrasound examination with the baby's front chimney as the window. It can be operated at the bedside, not affected by radiation, and can be followed up for many times, with many advantages. Can clearly show brain edema, brain parenchymal lesions, ventricular enlargement.

B. Computerized scanning photography (CT) examination of the head-take multi-level photos of the horizontal cross section of the head. The display of subdural hemorrhage and subarachnoid hemorrhage is clearer than that of B-ultrasound, and the complementary examination of CT and B-ultrasound can improve the diagnostic rate.

2. EEG and EEG power spectrum examination-EEG can have abnormal spikes, and EEG can have power reduction or dislocation.

3. Cerebrospinal fluid examination-In order to reduce the interference to children, cerebrospinal fluid examination should be avoided, only when suppurative meningitis needs to be ruled out. It is worth noting that a very small amount of red blood cells may enter the cerebrospinal fluid of normal newborns, or the cerebrospinal fluid may be yellowish because of jaundice. Doesn't mean there's intracranial hemorrhage.

4. Blood biochemical detection-The determination of serum phosphokinase brain isoenzyme (CPK-BB) is helpful to determine the severity of brain tissue injury and judge the prognosis.

Symptoms of neonatal cerebral hypoxia can be divided into three categories according to the degree: mild, moderate and severe.

Symptoms of neonatal hypoxia The symptoms of neonatal brain hypoxia can be divided into three categories according to the degree: mild, moderate and severe, and the performance of each level is different, resulting in different degrees of harm.

1. Mild-excessive arousal, irritability, excitement and high excitability (jitter, tremor), normal muscle tone, active Moro reflex, normal sucking reflex, stable breathing and no convulsion. The symptoms gradually disappeared within 3 days and the prognosis was good.

2. Moderate inhibition, lethargy or shallow coma, low muscle tone, convulsions, apnea and hugs in 50% cases, and weakened sucking reflex. The decrease of muscle tension in the upper limbs of full-term infants is more serious than that in the lower limbs, suggesting that the lesion involves the parasagittal area. If the premature infant shows that the muscle tension of lower limbs is lower than that of upper limbs, it suggests that the lesion is periventricular leukomalacia. If the symptoms persist for more than 7 ~ 10 days, there may be sequelae.

3. Severe-the child is in a coma, with extremely low muscle tone and softness, the Moro reflex and tendon reflex disappear, the pupils are unequal, the response to light is poor, the anterior fontanelle is bulging, frequent convulsions, irregular or suspended breathing, and even respiratory failure. The mortality rate of severely ill children is high, and survivors often leave sequelae.

Newborns are generally scored twice by doctors at 1 minute and 5 minutes when apgar was born. The perfect score of a normal newborn is 10. The lower the score, the more serious the asphyxia caused by hypoxia before birth. For example, a score above 7 is mild hypoxia, which often does not affect the prognosis; 4 ~ 6 is divided into moderate asphyxia, which can often be recovered in a short time after active treatment; When the score is less than 4, it shows severe hypoxia, asphyxia and respiratory depression. At this time, it is necessary for doctors to carry out emergency rescue and resuscitation, so that it is possible to get better, otherwise it is difficult for newborns to survive. Although resuscitated by first aid, the score of 10 minutes after birth is still very low, and newborns who have not yet established normal and effective breathing may leave sequelae such as mental retardation or dyskinesia in the future due to long-term hypoxia, even if they survive. Children with low resistance are prone to aspiration pneumonia, neonatal scleredema, hypocalcemia, hypoglycemia, neonatal intracranial hemorrhage and systemic infection.

How to treat neonatal hypoxia The treatment of neonatal hypoxia can be divided into several treatment methods according to hypoxia.

The general treatment principle is: firstly, we should constantly improve obstetric techniques, deal with intrauterine distress in time, and end delivery as soon as possible. Infants with asphyxia after birth should be resuscitated in time to reduce the occurrence of neonatal hypoxic-ischemic encephalopathy (HIE). It is generally believed that if spontaneous breathing is still not restored after 20 minutes of rescue or Apgar score is still lower than 1, it means that the brain has been seriously and irreversibly damaged.

1. General treatment-keep quiet, take oxygen, keep warm, and keep the respiratory tract unobstructed. Correct acidosis. Patients with coagulation dysfunction can be given vitamin K 1.5 mg/d or blood transfusion or plasma. Correct hypoglycemia and hypocalcemia in time.

2. Intensive care-cardiopulmonary, blood pressure, intracranial pressure and EEG monitoring, closely observe body temperature, breathing, consciousness, eye impulse, pupil size, anterior fontanelle and whether there is early convulsion. Maintain blood gas and pH value in normal range. In case of cardiac insufficiency and shock, it is necessary to deal with it in time.

3. Keep the heat and properly limit the amount of liquid-generally, within 3 days after birth, the amount of liquid should be limited to 60 ~ 80 ml/kg per mouth, and the infusion speed should be 4ml/kg per hour. Intake glucose 10 ~ 20g/kg every day to keep blood sugar at 4.2 ~ 5.6 mmol/L, and give intravenous hypernutrition if necessary. Sodium bicarbonate should be used with caution to avoid aggravating brain edema.

4. Anticonvulsive therapy-The treatment of neonatal convulsion is to pay attention to the immediate treatment of metabolic disorders that may exist in HIE, such as hypoglycemia, hypocalcemia, hypomagnesemia and hyponatremia. Once it is determined that convulsions are not caused by metabolic disorders, anticonvulsants need to be used. In principle, choose a drug with sufficient dose, or use the two drugs alternately. During the medication, the blood concentration of the drug was often monitored. After the medication, the convulsion stopped, the patient fell asleep quietly, the breathing rhythm was stable, and the palms and fingers were bent to a certain degree of Zhang Liwei.

5. Treatment of brain edema

A.20% mannitol-0.25 ~ 0.5g/kg each time (1.25 ~ 2.5ml/kg), once every 6 hours. Intravenous injection or rapid intravenous drip, intracranial pressure level and conscious state can be used as indicators of whether repeated administration is needed.

B adrenocortical hormone-early application can continuously relieve brain edema and reduce the repeated use of mannitol. Dexamethasone is commonly used, 0 each time. 5 ~ lmg/kg, every 6 ~ 12 hours 1 time, mostly within 48 hours. After 48 hours, depending on the condition, stop taking medicine or reduce the dosage.

C control fluid volume —— When intracranial pressure increases due to brain edema, control fluid volume to 60 ~ 80 ml/kg every day, and adjust it according to the changes of electrolyte, plasma osmotic pressure, urine volume and body weight.

6. Restore cerebral vascular perfusion-systolic blood pressure is lower than 6 hours. Dopamine (3 ~ 5ug/kg per minute) and dobutamine (2. 5 ~ 10ug/kg), starting from a small dose and gradually increasing to a large dose.

7. Improve brain cell metabolism

One dose of cytidine diphosphate choline 100 ~ 125mg/ day was added to 100 ~ 150ml of 100% glucose solution, and it was given intravenously from the second day after birth. 1.

B cerebrolysin 1 ~ 2ml once a day, intravenous or intramuscular injection, 1 time a day, 7 ~ 10 days as a course of treatment, 2 ~ 3 courses of treatment.

C. other applicable cytochrome c, ATP, coenzyme a, etc.

8. Hyperbaric oxygen therapy-The whole hyperbaric oxygen chamber can be used to provide oxygen, the oxygen concentration is 90% ~ 100%, and the pressure is 2kPa, 2 hours each time. It can be performed continuously for 5 ~ 10 times according to the condition until the symptoms and brain edema of B-ultrasound examination disappear. The convulsive person enters the cabin after the convulsion stops and the breathing pulse is stable, and the intracranial hemorrhage person enters the cabin after the condition is stable for 6 hours.

Prevent fetal distress in the production process.

How to prevent neonatal hypoxia because there is no specific treatment for neonatal hypoxia at present, the prevention of this disease can only be to prevent fetal distress in the production process and improve the level of neonatal asphyxia resuscitation. Meanwhile, we should pay attention to the following three points:

1. During delivery, we should closely monitor the fetal heart rate, find intrauterine distress as soon as possible, and choose the best way to end the delivery as soon as possible.

2. Newborns with asphyxia after birth should race against time to establish effective breathing and perfect circulatory function, so as to minimize the damage of hypoxia to brain cells after birth.

3. Newborns after asphyxia and resuscitation should closely observe neurological symptoms and monitor all vital signs. Once the abnormal symptoms of nervous system such as disturbance of consciousness, decreased limb tension and difficulty in eliciting primitive reflex are found, the diagnosis and treatment of this disease should be considered as soon as possible to reduce the incidence of sequelae of survivors.

When the hypoxic newborn is born, the following nursing should be carried out in the hospital:

1. Ensure adequate nutrition and calories. Those who can't suck by themselves can be fed through their noses.

2. Rehabilitation exercises such as limb * * *, passive exercise and audio-visual training can be carried out in the recovery period.

3. Pay attention to children's sports and intellectual development, pay attention to whether there are abnormal muscle tension and posture, and find sequelae such as cerebral palsy and mental retardation early and intervene.

After the baby comes home from the hospital, the mother should pay attention to the following points when nursing the hypoxic newborn:

1. First of all, keep the indoor environment quiet and don't hold or move the baby often.

2. Pay attention to keep warm, overheating will easily cause the baby to lose water, dehydration and fever; Too cold can lead to hypothermia or scleredema of newborn. The ideal temperature of the baby's room in winter should be 18 ~ 22 degrees. If it is unconditional, you can put a hot water bottle around the infant of the newborn. The water temperature is 40 ~ 60 degrees, 1 ~ 2 hours, and the baby's temperature is maintained at 36 ~ 37 degrees. Also keep a certain air humidity.

3. To feed the baby carefully, you can also use the milk ratio of 1: 1, 2: 1 to 3: 1, and add 5% sugar water to feed the baby, and gradually increase the proportion of milk, mainly in small amounts for many times, not too much at a time to prevent vomiting, aspiration and aspiration. Babies who feed milk should supplement calcium and cod liver oil in time.

4. Prevent infection. The room where the newborn is located is less mobile, and relatives with infectious diseases, skin infections or colds should try to avoid contact with the baby. At the same time, we should strengthen the nursing of navel, buttocks and mouth to ensure the healthy growth of the baby.