Perinatal asphyxia refers to the occurrence of intrauterine distress due to hypoxia of the fetus due to various causes before, during or after delivery, or respiratory and circulatory disturbances during delivery, resulting in no spontaneous breathing or failure to establish regular breathing within 1 minute after birth, a disease with hypoxemia, hypercapnia and acidosis as the main pathophysiological changes. Neonatal asphyxia is the most common emergency after birth. It must be rescued and handled correctly to reduce neonatal mortality and prevent long-term sequelae.

Differential Diagnosis of Perinatal Asphyxia

The symptoms of perinatal asphyxia are divided into the following three types:

  1. Intrauterine neonatal asphyxia (caused by intrauterine urgency)
    Our fetus is hypoxic in the mother’s womb. This situation is called intrauterine distress or intrauterine perinatal asphyxia, and most of it occurs within a few days or hours before the mother gives birth. At the beginning, the pregnant women who are going to give birth will feel that the fetal movement and the fetal heart rate increases. When the fetus has severe hypoxia in the abdomen, the fetal movement will decrease and the fetal heartbeat will slow down.
  2. Mild perinatal asphyxia (blue-violet perinatal asphyxia)
    Symptoms in children with mild perinatal asphyxia are superficial and irregular breathing or no breathing, light crying or crying only when stimulated. The skin of the child is bruised, weak but still able to maintain muscle tension, the stimulus response is poor, and the heart rate is normal or slightly slow, only about 80 to 100 times per minute.
  3. Severe perinatal asphyxia (pale perinatal asphyxia)
    In children with severe perinatal asphyxia, the symptoms are no breathing, or occasional breathing, the skin is pale or grayish-purple, the muscles are extremely loose. The baby is weak, and there is no response to stimulation. The heart rate is less than 60 beats per minute, and the heart rate can’t even be heard.

Measures to deal with perinatal asphyxia

  1. Keep warm. Place the hard paper on the far-infrared or other warming table that has been preheated.
  2. Reduce heat dissipation. Use a warm dry towel to gently wipe the newborn’s head and body to reduce heat dissipation.
  3. Position yourself well. Wrap the cloth around the baby’s shoulders to increase the height of about 2-2.5cm, so that the baby’s neck is slightly stretched.
  4. After the newborn is born, immediately clean up the mucus in the mouth, pharynx and nasal cavity. The cleaning time should not exceed 10 seconds. First, clean the oral cavity and the nasal cavity.
  5. Stimulate the sense of touch. If the baby still does not breathe after using the above four methods, you need to tap the bottom of the baby’s feet and rub the back to promote breathing.
Perinatal Asphyxia

If after the initial resuscitation, the baby is still not breathing, or the heart rate is less than 100 beats, the resuscitator needs to be used immediately for pressurized oxygen. If the heart rate is less than 80, the heart should be pressed for 30 seconds at the same time. If the situation doesn’t get better, the tracheal intubation should be performed. At the same time, 1:10000 epinephrine should be given intravenously or intratracheally.

After using the above methods, if the heart rate is still less than 100, you need to use acid correction and volume expansion agents as appropriate. If the baby has symptoms of shock, dopamine or dobutamine is needed. For those whose mother has used anesthetics within 6 hours before the baby is born, naloxone can be injected intravenously or intratracheally.

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