How does a child behave during hypoxia? Treatment and diagnosis of fetal oxygen starvation. Drugs for oxygen deprivation

Most events that cause suffocation occur in the womb; Because of this, it is important to have good prenatal care to identify problems that may be related to choking; for example, pregnancy-related hypertension problems, intrauterine growth retardation, placental problems, etc.

Cost-effective and affordable interventions can avoid maternal and perinatal mortality. Neonatal prognosis is closely related to maternal health care, and it has been estimated that 70% of fetal and newborn deaths can be prevented by maternal intervention. Possible long-term complications range from mild motor deficits to spastic quadriplegia with or without movement disorders, seizures, cognitive changes, neurosensory changes, and feeding problems.

It is important to determine what degree of encephalopathy each strangulation patient has, since moderate scores have a normal prognosis; as opposed to those who have major changes or die or have severe serious long-term neurological complications. Other indicators of a poor neurological prognosis include: the presence of persistent or difficult to control seizures; abnormal neurological examination within a week of life; Difficulty feeding, which requires a nasogastric tube for a long time.

IN lately The role of imaging studies such as brain magnetic resonance in making long-term prognoses is being explored. Information Need Strategies need to be developed to improve neonatal and fetal prognosis. The first step to achieve this goal is "useful" information on perinatal mortality in all regions of Mexico, and this includes suffocation. It is necessary to determine which population has the best perinatal prognosis by comparing it with other populations and identifying the excess deaths that would be preventable if all pregnancies had the same opportunities as the population with the best reproductive prognosis in our country.

With this strategy, areas requiring more intervention are identified to improve reproductive prognosis. You can't create strategies if you don't know the problems. There is currently a system for registering vital statistics. This is why it is necessary to have reliable, complete and timely statistics about the births that have occurred in the country, which allows us to have data about the mother, the newborn, the place of occurrence, the person who attends the birth and who confirms it. In this sense, the initiative to create a Certificate of Birth birth.

That being said, we have made great progress and it is expected that the entire Republic will use these certificates. Unfortunately, there is currently no “link” or connection between a birth certificate and a death certificate in Mexico. This does not allow specific mortality to be determined by birth weight, which is important for understanding the problem and creating intervention strategies. This is why it is necessary to establish a reliable and systematic perinatal surveillance system, with a system for analyzing information based on weight and age at death, allowing comparisons to be made to identify areas with excess mortality.

Birth weight is an important predictor of neonatal death. It is also clear that at lower birth weights and gestational age there is a greater need for neonatal resuscitation and a greater risk of asphyxia. Age at death is very important because it determines at what point in life death occurs. If, on the other hand, it occurs in the first 7 days of life, in addition to the analysis above, you should check temperature control, infections, nutrition, etc.

Systems approach for multifactor problem. Perinatal mortality is the result of a complex interaction of medical and social factors. Formal health care system: all health care facilities, private or public. Intersectoral system: includes systems that indirectly intervene in health, such as education, transport system, etc. Informal sector and community: these are families, the population, midwives. . The informal sector and community are an important target for reducing strangulation deaths.

In Mexico, about 90% of births occur in institutions and the rest in homes. Pilot projects have shown that training midwives in neonatal resuscitation reduces deaths due to strangulation. Likewise, the meta-analysis also showed that this intervention improved perinatal survival and reduced mortality due to asphyxia. In addition, families should be trained to recognize obstetric emergencies and visit units promptly to seek care.

The formal healthcare system is basic. It is important to ensure adequate quality of medical care. Structures, processes and results must be reviewed. Currently, there are programs for neonatal resuscitation, treatment of high-risk newborns, neonatal stabilization, etc. Which should be distributed to personnel responsible for the delivery of infants. It is important that health authorities monitor such training. An obstetrician must be able to recognize and treat emergencies, and this includes performing emergency caesarean sections when indicated, the presence of blood, managing and recognizing hypertensive crises, etc. Close communication between gynecologists, pediatricians and neonatologists should be encouraged, and guidelines for perinatal management are created by consensus among them.

Also important is an intersectoral system that guarantees vehicles and roads for isolated communities will enable mothers to reach adequate care units. This system is especially needed in rural areas of Mexico. However, even in large cities, it is important to establish a transport system for high-risk mothers and newborns, allowing them to be transported to specialized centers; Without this measure, it is impossible to reduce newborn mortality.

Global efforts to prevent suffocation. A significant proportion of choking cases can be identified and treated in a timely manner. There are, however, some that are difficult to prevent or predict, such as acute umbilical cord problems. In these situations, the mother may notice decreased or absent fetal movement, which usually means that neurological damage to her baby has already occurred. These situations are currently unpredictable and difficult to prevent.

Main conclusions. It should be remembered that not all birth sites have the ability to accept gasometry to detect the acidity of the fetus or newborn. Strategies must be created to prevent intrauterine asphyxia and fetal death. It is extremely important to promptly treat injurious asphyxia. train personnel intended to participate in childbirth. Records must be implemented to “fairly” measure the problem: its prevalence, risk factors, short-term and long-term effects, etc. There is a need to maintain close communication between all health care workers, join forces and create strategies to reduce or prevent perinatal asphyxia.

• It is necessary to have a universal definition of asphyxia.
• Long-term follow-up for neurological problems with choking is necessary.

Perinatal asphyxia is a major public health problem worldwide. In Mexico, it is responsible for the majority of newborn deaths. Unfortunately, over the past three decades, we have not seen a significant reduction in mortality due to this cause in our country or in other developing countries. To reduce infant mortality, it is necessary to develop strategies to prevent perinatal asphyxia by identifying and promptly treating conditions that affect the well-being of the fetus.

Researchers, clinicians, epidemiologists, gynecological obstetricians and neonatologists from around the world must join efforts to prevent and promptly treat perinatal asphyxia, as well as to accurately record this problem and its consequences.

Neuropathy and neonatal encephalopathy in Kathmandu, Nepal: assessing the contribution of asphyxia to perinatal mortality in a low-income urban population. No more screaming at birth: Global estimates of labor and delivery of the intrauterine newborn. Essential newborn care: report of a technical working group. Promoting newborn health around the world. Maternal and child health: are you ready? South Asia to change? Designing and using qualitative research to improve newborn care practice: A guide for program managers. The continuous value of the Apgar score for the evaluation of newborns. A look through Virginia's eyes. Committee on Fetus and Newborn, American Academy of Pediatrics and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Apgar score use and abuse. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Recommendations for perinatal care. Effects of corticosteroids before preterm delivery: a review of evidence from controlled studies. Beneficial influence combined use of prenatal corticosteroids and postnatal surfactant in preterm neonates. "Newborns" of the world in the world, Hill, K. "Reducing perinatal and neonatal mortality." Special report on research in the field children's health, vol. 3, no. What supplies require the presence of pediatricians? World Health Organization, Child Health and Development: Health of the Newborn, Geneva, Switzerland: World Health Organization, Best evidence currently available: review of the literature on umbilical cord closure, immediate and delayed cord tightening in infants born between 24 and 32 weeks: a pilot randomized trial Controlled Study Placental Transfusion: Umbilical Cord Healing and Preterm Infants Delayed cord healing improves the hematologic status of Guatemalan infants at 2 months of age. Effect of cord clamping time on iron status in infants at 3 months. What can a meta-analysis reveal about traditional childbirth education and pregnancy outcomes? Thyroid responses to light are intact, spontaneous eye movements occur, and the wrist-eye maneuver is complete. Pupil size varies, although pupils tend to be dilated and reactive in less affected infants and reactive and miotic in more affected children. Most infants exhibit hypotonia at this stage. Seizures occur between 6 and 12 hours of birth in 50-60% of those affected, most of them manifesting in subtle movements, such as conjugate gaze deviation or sucking associated with altered consciousness. Premature neonates may exhibit decerebrate reactions that may mimic generalized tonic seizures. During this stage, the level of consciousness changes in a variable manner, with severely ill infants remaining dull or comatose, and less severely ill infants often demonstrating a degree of alertness that is more apparent than is actually the case and is not accompanied by fixation or visual monitoring. The attacks are intense and there are periods of apnea, agitation and weakness. Status epilepticus may occur, requiring aggressive and urgent treatment. Apnea and agitation may occur. The level of consciousness in severe cases deteriorates further and a deep stupor or coma occurs. Shields can be attached to the light in the middle position or extended. Those who die from hypoxic-ischemic encephalopathy do so more frequently during this period. Newborns who survive to this period usually improve within a few days to a few weeks; eating disorders are common and associated with problems with absorption, swallowing, and tongue movements. General hypotonia of the extremities is common, and some may exhibit hypertension, especially involving the basal ganglia. Neurological examination of a newborn differs from that performed in other age groups although it includes a detailed physical examination, it must also include analysis of primitive reflexes and requires knowledge physical changes observed in premature newborns and newborns They were exposed to asphyxia in different periods time, with their recovery and complications. The newborn examination should be done in a quiet place, with light and at an appropriate temperature to ensure that the newborn is comfortable after removal of clothing. Clothes should be removed slowly and gently, the diaper will only be removed while the area is being assessed. Ideally, the test should be carried out on the second or third day of life, a few hours after feeding and with the child not swimming or hungry. Important Steps in the study: observation. The study should begin with observation; it is a mistake to start manipulating a child without an appropriate period of observation. It is necessary to look for the presence of congenital anomalies such as defects midline skull, face, palate and spine. Abnormalities of the trunk, limbs and skin are easily detected. Changes in skin pigmentation are important because of the common ectodermal origin of the skin and nervous system. It is also important to observe limb position to assess passive muscle tone. Symmetrical movement of the limbs with slight flexion of the joints of the elbows and knees with spontaneous opening and closing of the arms is normal in newborn terms, while keeping the elbows stuck to the bed with little movement of the arms. hands may be normal until 32 weeks of pregnancy. In general, there is enough distance to go two fingers between the examination tray and the patient's neck, while larger distances may indicate hypertonicity of the cervical extensors and shorter distances may represent hypotony; the first - as chronic asphyxia, and the second - as data from acute asphyxia in the first hours. Asymmetrical mobility and asymmetrical handgrip should always be considered abnormal. Head. The head assessment includes external characteristics such as head circumference, shape and skin characteristics. Presence in the skin should be limited to the presence of masses, skin lesions such as congenital vascular malformations. It is normal to observe some bulging of the anterior fontanel with crying. The chain perimeter is a measure that informs us about the intracranial volume of both the brain and the cerebrospinal fluid; to a lesser extent, this measure depends on the subdural and subarachnoid space or intracranial blood volume. The reduced head circumference in the first days of life of a strangled child should make us suspect cerebral pathology before asphyxia. There are changes such as craniosynostosis, which is the premature closure of cranial sutures, which can affect one or more sutures, causing irregularities and asymmetries in the shape of the skull, always causing deformity and not microcephaly, in this case always the rules of cerebral and non-cranial pathology. The anterior fontanel is palpable at birth, sunken or flat; should be assessed with the child seated; bulging usually occurs during crying or when there is an abnormal increase in intracranial pressure; Its size ranges from 1 to 3 cm at its largest diameter, and its closure occurs between 10 and 20 months. The fontaneller works synchronously with the impulse. At birth, the posterior fontanel is punctate and open at birth, when intracranial pressure increases, it closes completely at 6 weeks of life. An important fact When analyzing a child with macrocephaly or microcephaly, it is to measure the cephalic perimeter of the parents, since common familial variations exist. During the first days of life, a tight fontanel, a period when the baby is choking, is usually a sign of a poor prognosis and usually represents severe cerebral edema. Warning status. Changes in consciousness are identified by analyzing periods of anxiety and sleep. When a newborn reacts to external stimuli, such as a human voice, touch, light. Babies who sleep are easily awakened by external stimuli, and those who cry are easily soothed. Warning is one of the most sensitive functions that depends on the integrity different levels central nervous system. In the newborn, the state of alertness varies and depends on several factors such as gestational age and time since the last meal. At 28 weeks' gestation, alert periods are difficult to identify, with constant stimulation, eyepiece opening, and warning periods achieved within seconds; At 32 weeks of gestation, they experience spontaneous ocular opening and may experience periods of ocular rotation and periods of sleep. Examination of cranial nerves. At 26 weeks of pregnancy, newborns often flicker in response to light; at 32 weeks, close your eyes while you present a light stimulus; and at 37 weeks, the engineer looks at the light stimulus. To evaluate this cranial nerve, the pupils must exhibit the same response to stimulation in order to be symmetrical; bright light makes newborns blink or keep their eyes closed. When assessing the fundus of the pallid optic disc, lower vascularization is also observed than in older children. The student is greyish-white. 20% of retinal hemorrhages not associated with complications during childbirth or disorders of the central nervous system or neurological complications and completely eliminated are observed in 7 to 14 days. Detailed analysis and searching for specific retinal disorders associated with asphyxia, should be specifically examined by an ophthalmologist with experience in the field of child care and asphyxia of premature infants. Lack of eye movement in the direction expected results in altered midbrain level nuclei or pathways of these nerves. In term, a large object hitting the color can also be used in the form of a red circle or browser face, the target focus moving slowly into the newborn's field of view. Pupils are difficult to assess because the eyes are closed and resist forced opening. The corneal reflex should be studied, which is when the eyes are closed when the cornea is lightly tipped with a sock. Remember that the mouth is redirected to the opposite side of the facial palsy and that when it comes to closing the peripheral palsy the eye and the affected side where the patient remains open the eye is also affected. From 28 weeks of pregnancy the auditory nerve function is evident to provide a response to sound stimuli. To the extent that maturation increases, the response is most obvious, resulting in performance motor activity, changes in breathing patterns, opening of the mouth and eyes. To test hearing function, it must be done when the child is calm, without tears, without hunger, and to ensure that the ear canals are clear. One of the most common complications in patients is asphyxia of premature hearing loss, so it is necessary to check the integrity of the auditory pathway by performing auditory evoked potentials and otoacoustic emissions. Nutrition involves proper coordination of breathing, salivation and suction. Suction and salivation are properly coordinated from the 28th week of pregnancy, but breathing is not, so food is inconsistent at this age. Delay in the acquisition of these skills in newborns with asphyxia usually determines a poor functional prognosis for food and then for the tongue, a form of pseudobulbar palsy, which are the upper control centers that cause coordination failure. Neonatal depression central nervous system has a little weakness and a tear. During vigorous crying, the symmetry of the newborn's tongue and palate can be assessed. When studying these parameters, gestational age should be taken into account and assessment should be carried out in children early age over 24 hours of life. The first thing to assess is the newborn's resting position and spontaneous limb mobility. Although the tone is assessed, the newborn should be lying on his back with his head inward, so that the tonic neck reflex does not increase the tone unilaterally. A vertical suspension should be performed to determine whether the tone of the flexor limb is adequate and symmetrical, since in the presence of hypotonia, newborns in this position tend to slide between the arms of the browser. In the ventral perspective, the newborn's pendulum acquires a vertical position between the trunk and the head, while in the presence of hypertonia of the neck extensors, the head tends to exceed the trunk. Tone assessment is also performed from the heel approach to the ear, the hand on the contralateral ear or by measuring the flexion angles of certain joints like the wrist, ankle or popliteal angle. The position and tone depends on the gestational age of the maturity of the flow towards the rostral, at 28 weeks of gestation there is minimal resistance to passive movement of all limbs, at 32 weeks the flexor tone predominates in the lower extremities and at 36 weeks the flexor tone is also evident in the upper extremities; passive mobilization of the limbs in full-term infants is an obvious tone of the limb flexors above and below; Head position also depends on gestational age; in full-term infants, it shifts steadily to the right and is often less obvious during the first 24 hours of life. In newborn asphyxia, hypotension is often initially identified, which causes spontaneous mobility; the limbs typically hang by the Landau maneuver and remain attached to the bed when the supine position is reduced. Strength assessment should be taken into account in the movements of the limbs. During the first 4 weeks of life, sinuous movements predominate, from 4 to 12 weeks are characterized by restlessness and nervousness, from 8 to 12 weeks, broad movements and strength predominate. It helps to grasp the arms or legs and pull gently to measure the force exerted to bring the newborn's arm to a normal flexed position. Muscle stretch reflexes assessed in newborns are the thoracic, biceps, brachioradialis, patella and Achilles. Reflexes cause a reflex hammer in accordance with the size of the child, increase, and sometimes may be absent in healthy newborns, although they are always symmetrical and tears often increase them. The extensor response of the plantar should be symmetrical, although sometimes it is indifferent to the flexors during crying or sleep. Persistent plantar extensors after the child reaches an abnormal rise and a violation of the corticospinal route, as a completely asymmetrical response, and especially in combination with a violation muscle strength and tone. At the 28th week of pregnancy, only the opening of the arm is present; at 32 weeks, abduction and expansion upper limbs is present and at the 37th week flexion of the limb is already obvious. The asymmetrical arm is caught in a corticospinal injury. The reflection from 35 weeks of gestation becomes increasingly obvious during the month of life and disappears between 6 and 7 months. In addition to information about clinical-electroencephalographic correlations to induce or inhibit movement of stimuli, it is important to determine information about pathophysiology. The main types of neonatal seizures are shown in Table Table.

• Best practices: identifying and treating newborn asphyxia.
• Monitoring perinatal mortality.
• Pathophysiological approach.
• Early clinical manifestations From birth to 12 hours.
• The severely affected infant is in deep stupor or coma.
• There is usually intermittent breathing or breathing problems.