What Knowledge Should Parents of Asphyxiated Newborns Possess?

What Knowledge Should Parents of Asphyxiated Newborns Possess?

Parents should learn and grasp the following knowledge related to neonatal asphyxia:

Etiology: Maternal age below 16 or above 40, maternal diabetes, hypertension, severe anemia due to Rh blood type incompatibility, severe fetal growth retardation, prenatal hypoxemia, premature birth, difficult labor, birth injuries, maternal anesthesia, and other factors.

Symptoms and Signs: When neonatal asphyxia occurs, the infant's skin may turn blue or grayish (cyanosis), heart rate slows down (bradycardia), limbs become either stiff or weak, unresponsiveness to stimuli, restlessness, excitement, reduced sensation, changes in breathing rate (apnea, rapid or slow breathing), difficulty breathing, decreased breath sounds, consciousness disorders leading to coma, seizures, and more.

Whether a neonate can survive after resuscitation from asphyxia depends on careful observation, treatment, and care. Based on our clinical experience, several key points should be taken into account in the post-resuscitation care of asphyxiated newborns: apart from monitoring the baby's skin color, respiration, and heart rate, the most crucial aspect is observing the child's consciousness, reaction to stimuli, movements, and muscle tone. Changes from agitation and restlessness to decreased movement, drowsiness, or stupor suggest possible hypoxic-ischemic encephalopathy. Increased or decreased muscle tone, as well as delayed recovery, indicate possible brain injury. If muscle tone recovery takes more than two hours, it suggests more severe brain damage, and surviving infants may suffer from neurological sequelae. Babies who experience asphyxia during delivery and subsequently develop seizures will have significantly prolonged average time for establishing regular spontaneous respiration. Infants with prolonged altered consciousness, inability to suckle, and extremely low birth weight should be fed with breast milk via nasal tube feeding, not with cow's milk or mixed feeding. For moderate to severe hypoxic-ischemic encephalopathy, infants should not be fed orally within 48 to 72 hours after birth to reduce the risk of necrotizing enterocolitis. Due to the poor swallowing and sucking abilities of moderate to severe asphyxiated infants (especially preterm and low birth weight infants), it is best to initiate feeding through nasal or oral tube feeding. Extremely low birth weight preterm infants with a history of asphyxia will require longer periods of incubation and oxygen supplementation. Sudden discontinuation of oxygen therapy may lead to refusal to eat, vomiting, recurrent cyanosis, and even electrolyte imbalances.

How to Predict the Prognosis of Neonatal Asphyxial Brain Injury? This is a medical challenge due to the many influencing factors. The Apgar scores at 1 minute or even 5 minutes after birth have limited correlation with neurological sequelae. The pH value of umbilical cord blood is also not closely related to neurological sequelae. However, preterm infants who experienced fetal distress before birth tend to have a higher risk of neurological sequelae than full-term infants.

The prognosis of neonatal asphyxia depends on the duration of time the baby failed to initiate respiration at birth. Clinical research shows that babies with low Apgar scores at 5 minutes have a better prognosis than those with similarly low Apgar scores at 10 minutes. Prolonged asphyxia causes damage to the brain, heart, kidneys, and lungs. If asphyxia lasts for more than 10 minutes, the baby may die. Neonates with low muscle tone after asphyxia and experiencing one or more episodes of apnea within the first week after birth may develop sequelae in the future.