ASPHYXIA AND ATELECTASIS Through the diminished ventilation of the blood, a pathological oxygen-deficit en sues and an overloading with carbon dioxide, a condition of asphyxia, which seriously threatens life. If the respiration is utterly wanting one speaks of apparent death ("Scheintod").
We differentiate two forms of asphyxia: I. The congenital form, usually beginning sub partum, and which occurs as (a) asphyxia cyanotica I degree, and (b) asphyxia pallida, II degree (Runge).
II. The acquired form, which occurs after birth and which on ac count of its usual clinical and pathological findings has also been termed atelectasis.
Both forms are to be sharply differentiated in respect to etiology, occurrence and course; this however does not prevent both forms from occasionally occurring in the same child or going over into one another.
The discussion of this form in this place will be short, since it really belongs to the province of the obstetrician.
premature excitation of the respiratory centre, through which futile inspirations are elicted ante partum, can occur in many ways: I. Causes on the part of the infant: (a) Compression or twisting of the umbilical cord.
(b) Premature detachment of the placenta.
(c) Abnormal cerebral pressure in the foetus.
II. Causes on the part of the mother: (a) Insufficient maternal circulation and arterialization (espe cially with heart and lung affections).
(b) Lowering of the maternal blood pressure on account of hemorrhages, agony, death of the mother, labor.
(c) Anomalous labor pains, e.g., tetanus uteri.
With the increase in the carbon dioxide contents of the infantile blood, the irritability of the respiratory centre in the medulla decreases and severe paralysis of the respiratory function of the newborn can arise, through which the lungs can remain, even after birth, in the foetal state of atelectasis.
Symptomatology and asphyxia., arising intra utero from the above-mentioned causes, begins almost always shortly before birth, often develops rapidly and may become a serious menace to the life of the child.
Of the symptoms indicating intra-uterine asphyxia, besides the passing of meconium, the most reliable is the weakening of the foetal heart sounds. This symptom, due to irritation of the vagus, gives place, in severer stages of the asphyxia, to a consider able increase in the heart sounds (vagus paralysis) and demands the immediate end ing of the labor. The asphyc tic newborn is cyanotic, varying in color from a blu ish-red to a deep blue (as phyxia cyanotica first degree of Runge). It lies motion less with a swollen face and closed eyelids, its little legs slightly flexed. The breath ing is superficial and infre quent and is accompanied often by rattling and hic coughing. The heart's action is strong and usually infre quent. The muscular tone and also the reflex excitability are retained. Reflex choking movements are elicited on introducing the finger into the pharynx in order to aid in the removal of mucus. l3y irritating the skin, deeper inspirations are elicited which however usually soon diminish in intensity.
With the second degree (asphyxia pallida) the skin is pale, the lips alone are bluish, the muscular tone is wanting, all the extremities hang loosely relaxed, reflex irritability is lost and the heart's action is fre quent and weak. Respiration is entirely stopped, at the most one observes here and there a jerky, almost convulsive, movement of the whole child. The upper air-passages are usually totally occluded and thus the entrance of air is hindered by mucus and amniotic fluid, aspirated in consequence of premature respiratory movement.
Gradually the heart's action ceases and the body temperature sinks and thus these children usually die; others occasionally drag on for a few days, but only to die. Where the treatment avails, respira tory movement starts, the eyes are opened and the child moves with increasing liveliness. The skin becomes rosy and feels warm, the pulse strong and regular, mucus is expectorated (vomited) for days.