Birth Asphyxia

What Is Birth Asphyxia?

Asphyxia means lack of oxygen. Birth asphyxia happens when a baby's brain and other organs do not get enough oxygen before, during or right after birth. This can happen without anyone knowing. Without oxygen, cells cannot work properly. Waste products (acids) build up in the cells and cause temporary or permanent damage.

Some causes of birth asphyxia may include:

  • Too little oxygen in the mother's blood before or during birth
  • Problems with the placenta separating from the uterus too soon
  • Very long or difficult delivery
  • Problems with the umbilical cord during delivery
  • A serious infection in the mother or baby
  • High or low blood pressure in the mother
  • Baby's airway is not formed properly
  • Baby's airway is blocked
  • The baby's blood cells cannot carry enough oxygen (anemia)

Birth Asphyxia in Children

Birth asphyxia occurs in about four of every 1,000 full-term births. It may be even more common when babies are born prematurely.

The amount of harm to the newborn depends on how long and how severe the period of asphyxia is, and how quickly the right treatment is given.

Two stages of injury can happen with birth asphyxia. The first stage happens within minutes without oxygen. Cell damage occurs with the initial lack of blood flow and oxygen. The second stage of damage is called "reperfusion injury" and can last for days or even weeks. This injury occurs after restoration of normal blood flow and oxygen to the brain, and is due to toxins released from the damaged cells.

Babies with mild or moderate asphyxia may recover fully. Babies whose cells did not get enough oxygen for a longer time may have permanent injury to their brain, heart, lungs, kidneys, bowels or other organs.

When a premature baby has asphyxia, the damage may lead to cerebral palsy, developmental disabilities, attention deficit hyperactivity disorder or impaired sight. In the most severe cases, asphyxia can lead to organ failure and death.

Birth Asphyxia Symptoms and Diagnosis

Symptoms of Birth Asphyxia

Symptoms of asphyxia in a baby at the time of birth may include:

  • Baby is not breathing or breathing is very weak
  • Skin color is bluish or pale
  • Heart rate is low
  • Muscle tone is poor or reflexes are weak
  • Too much acid is in the blood (acidosis)
  • The amniotic fluid is stained with meconium (first stool)
  • The baby is experiencing seizures

Birth Asphyxia Diagnosis

At birth, doctors and nurses check your baby's condition carefully and give a number rating from 0 to 10. This number is called an Apgar score. The Apgar rates skin color, heart rate, muscle tone, reflexes and breathing effort. A very low Apgar score (0 to 3) lasting longer than five minutes may be a sign of birth asphyxia. A baby who has not had enough blood flow or oxygen to its body may have abnormal breathing, poor circulation, lethargy (lack of energy), lack of urine output and blood-clotting abnormalities.

Getting the right treatment as soon as possible can help reduce the damaging effects of an interruption to your baby's oxygen supply.

Birth Asphyxia Treatment

Birth Asphyxia Treatment Options

Babies with mild asphyxia at birth are given breathing support until they can breathe well enough on their own, and then are closely monitored.

Babies with more serious asphyxia may need mechanical ventilation (a breathing machine), respiratory therapy, fluid and medicine to control blood pressure and prevent seizures. Doctors may need to delay feedings to give the baby's bowel time to recover.

When needed, we can provide these advanced treatment options:

  • High-frequency ventilation is a form of more gentle mechanical ventilation (breathing assistance) that sends small, rapid puffs of air into your baby's lungs. It is used instead of conventional breathing machines, which sometimes need high pressure and thus may damage fragile newborn lungs.
  • Inhaled nitric oxide is used to treat respiratory failure and high blood pressure in the lungs (pulmonary hypertension). Nitric oxide is given directly through a breathing tube into the windpipe. This helps the lungs' blood vessels open (dilate) so they can carry oxygenated blood into the body.
  • Hypothermia. Research shows that cooling the baby's internal body temperature to 33.5 degrees C (about 91 degrees F) for up to 72 hours can help protect the baby's brain from damage during the second stage of asphyxia. This stage, called "reperfusion," is when normal blood flow and oxygen are restored to the brain. This treatment works best if it is started within six hours after birth and can reduce brain damage. The baby must be at least 36 weeks' gestation (not more than four weeks early) to qualify for this treatment.
  • Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support. ECMO uses a heart-lung pump to provide temporary life support when a baby's heart or lungs aren't functioning properly or need time to heal. With ECMO, oxygen-poor blood is drawn into a machine that removes excess carbon dioxide, adds oxygen and then returns the oxygen-rich blood to the baby's body. While on ECMO, your baby will be sedated and closely monitored by a nurse and an ECMO specialist.