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Birth Asphyxia

Birth asphyxia, also known as perinatal asphyxia, occurs when the baby’s brain and other organs fail to receive sufficient oxygen and nutrients before, during and after birth, according to Seattle Children’s Hospital. Without these nutrients and oxygen, the cells cannot work properly.

The damage due to birth asphyxia can occur in two stages:

  • The first stage occurs during the event itself. When blood flow is critically low and cells fail to receive enough oxygen for a period of time, immediate tissue damage can occur.
  • The second stage is called reperfusion injury, and occurs in the days or even weeks following the injury. When blood flow is restored to a tissue that was lacking it, the damaged cells release toxins that can paradoxically cause even more tissue damage.

If the asphyxia is relatively mild, the effects are short-term and the baby can recover fully. However, significant and permanent brain damage can occur if the baby’s cells lack oxygen for an extended period.

Causes of Birth Asphyxia

Birth asphyxia can occur for many reasons. These include delivery complications such as:
  • Inadequate oxygen levels in the mother’s blood before or during birth
  • Placental abruption, a condition in which the placenta separates from the uterus too soon
  • Inadequate relaxation of the uterus during labor
  • A very long or difficult delivery
  • Problems with the umbilical cord during delivery
  • A severe infection of the mother or baby
  • High or low blood pressure in the mother
  • Respiratory problems in the baby, which may be due to blockage of the baby’s airway or a birth defect in the baby’s respiratory system
  • Anemia in the baby, meaning that they don’t have enough red blood cells (the cells that carry oxygen)
  • Respiratory problems that limit oxygen intake

Signs and Symptoms

Symptoms of birth asphyxia are not always obvious, according to Johns Hopkins Medicine. Before birth, the most common symptoms are an abnormal fetal heart rate and low pH levels that indicate a high acid level in the blood. At birth, the most common symptoms include:

  • Pale, blue or bluish-gray skin color
  • Low heart rate
  • Weak muscle tone and reflexes
  • A weak cry
  • Seizures
  • Gasping or weak breathing
  • Meconium stained amniotic fluid

How is birth asphyxia diagnosed?

When your baby is born, health care providers will conduct a systematic review of the baby’s condition and assign an Apgar score. The Apgar score is based on breathing effort, heart rate, muscle tone, reflexes and skin color. Each category receives a score from 0 to 2, leading to a total Apgar score from 0 to 10. A low Apgar score can indicate birth asphyxia.

Health care providers may test the arterial blood of the umbilical cord. A very low pH means that acid levels are high, which could indicate birth asphyxia. Health care providers also look for neurological problems, such as seizures, coma and poor muscle tone. They also determine whether the baby is in respiratory distress or experiencing low blood pressure, or problems with the circulatory, digestive and respiratory systems.

How is birth asphyxia treated?

Prompt treatment is essential to prevent serious brain injury. If the baby demonstrates signs of birth asphyxia, the mother may receive additional oxygen during delivery, and her health care provider may recommend an emergency Cesarean section to deliver the baby more quickly.

Treatment options after birth depend upon the severity of the asphyxia, the overall health of the infant, and the baby’s tolerance for certain medications and therapies. If the birth asphyxia is mild, the infant will receive respiratory support until he can breathe independently. Babies with more severe asphyxia will need additional treatments. These treatments might include:

  • Machine-supported breathing or a heart-lung pump
  • Nitric oxide administered through a breathing tube to open the blood vessels in the lungs, to increase blood oxygenation
  • Therapeutic hypothermia, also known as cooling therapy
  • Blood pressure medicine
  • Kidney dialysis
  • Medicine for seizures
  • Intravenous (IV) nutrition until the bowels recover

Is birth asphyxia preventable?

Birth asphyxia sometimes can be prevented through adequate fetal monitoring, according to an Annals of Tropical Pediatrics study published by the National Library of Medicine. In that study, about one-third of the birth asphyxia cases were preventable. Proper resuscitation care also can lessen the severity of birth asphyxia and reduce or prevent long-term damage.

Long-Term Effects

Birth asphyxia can have long-term and even lifelong effects if health care practitioners cannot restore the lack of oxygen quickly.

Blindness

One common long-term effect of birth asphyxia is blindness or visual impairment. This occurs because asphyxia may affect the optic nerve (which carries signs from the eye to the brain) or the parts of the brain involved in vision. Vision aids and rehabilitation can improve outcomes in some cases.

Cerebral Palsy

The Centers for Disease Control defines cerebral palsy as a group of disorders that affect a person’s ability to move and maintain balance and posture. Symptoms of cerebral palsy can be mild or severe. In severe cases, children may be unable to walk or need special equipment to walk. In mild cases, walking may only be slightly awkward. Cerebral palsy also can cause developmental delays. Many people with cerebral palsy have speech difficulties or difficulties controlling their muscles. Some also have intellectual disabilities. Adults with cerebral palsy often develop heart and lung issues, mental health problems and severe fatigue.

Treatment for CP depends upon the symptoms and their severity, but may include medicines; surgery; assistive mobility devices; and physical, occupational and speech therapy.

Neonatal Encephalopathy

Another potential long-term effect of birth asphyxia is neonatal encephalopathy, also known as hypoxic-ischemic encephalopathy (HIE). About half of full-term infants who are born with neonatal encephalopathy die within two years, according to the Newborn Infant Nursing Review.

For those who survive, neonatal encephalopathy is often a factor in later neurodevelopmental impairment. Depending upon the severity of the encephalopathy, intelligence scores may be below their peers or below average with difficulty in reading, spelling or mathematics. They may lack full cognitive function, which means they have difficulty making decisions, interacting socially or remembering things. They also may experience visual-motor or perceptive visual dysfunction, increased hyperactivity and epilepsy. Children with neonatal encephalopathy typically require considerable behavioral monitoring, even in mild cases, and may require special education classes or a special education plan.

The lack of blood flow may also have affected other organs besides the brain, including the heart, lungs, kidneys, and liver. Children affected by HIE may have health problems related to damage to these organs.

Epilepsy or Seizure Disorders

Birth asphyxia can cause neonatal seizures. This leads to a risk of developing epilepsy, or a seizure disorder, later in life. About half of all babies who have neonatal seizures will later develop epilepsy, according to the University of California San Francisco Benioff Children’s Hospital. Doctors typically prescribe medications to help control seizures.

How do I care for a child with long-term complications from birth asphyxia?

Most of the long-term complications of birth asphyxia have no cure, but certain medicines and therapies can improve the quality of life. Those who have cerebral palsy, for example, may receive medicine to control pain, lessen muscle tightness and reduce drooling. Orthopedic surgeries or selective dorsal rhizotomy (cutting nerve fibers) may provide relief. Early intervention can help children who have developmental issues because of birth asphyxia, and home modifications may help special needs children thrive.

Many special needs children thrive with routine, so establishing a household routine is particularly important. Children with HIE and other conditions also need the opportunity to play, laugh and have fun, just as all children do. Ensuring these opportunities requires foresight and planning.

Parents can also help their children achieve by setting reasonable goals and celebrating success.

Caring for a child with long-term complications from birth asphyxia can be daunting. Providing good care is expensive, and may also require that parents take considerable time off from work. Parents also need to carefully monitor their own health, and they may need to pay for special caregivers to provide respite care from time to time.

At the Birth Injury Center, we understand that caring for a special needs child is challenging. We want to help you by assuring you have the financial and educational resources to give your child the best quality of life and help them reach their full potential.

If your family is dealing with long-term complications of birth asphyxia and you believe the asphyxia could have been prevented, contact us. We are experts in birth injuries and the laws around them. We can help you and your family move forward in hope.