Neonatal Asphyxia Explained
Neonatal asphyxia occurs when blood flow is restricted or stopped, limiting oxygen and cell movement in unborn or newborn babies. Blood plays an important role in keeping the body healthy, as it carries nutrients and oxygen to organs and cells. The longer that the flow of blood and oxygen is interrupted, the more severe the impacts are on the baby.
Some cases of neonatal asphyxia are preventable with proper fetal monitoring during childbirth. If medical professionals observe fetal distress and act on it quickly, the impacts of neonatal asphyxia can be minimized or reversed.
However, if blood and oxygen flow is restricted for too long, the damage becomes permanent and can result in medical conditions, including cerebral palsy, organ failure, or even death.
Permanent damage may set in depending on:
- How long the oxygen is reduced
- How low the oxygen levels are during that time
- How quickly the distress is observed and resolved
All three of these are very important factors. Many factors in labor can lead to infant distress, but how quickly a medical team intervenes and what interventions they choose can drastically help or hurt if not done correctly.
Sometimes an infant does not respond to initial respiratory support, and NRP protocol (neonatal resuscitation program protocols) must be followed to achieve a quick increase in oxygen saturation (percentage of oxygen in the blood). Especially if there is a cause restricting blood flow, quick return of adequate perfusion (blood return) to tissue and oxygenation is vital.
Previously, doctors believed that neonatal asphyxia was responsible for all cases of cerebral palsy, but science has since proven that wrong. We now know that approximately 6% to 8% of cerebral palsy diagnoses are caused by neonatal asphyxia.
Many complications during or before birth can lead to neonatal asphyxia, including:
- Umbilical cord compression, kinks, or prolapse (cord exiting before the baby, blocking oxygenated blood flow to the infant)
- Difficulty exiting the birth canal
- Abnormal positioning of the infant during childbirth
- Maternal hemorrhaging/excessive bleeding
- Low blood pressure (causing the body to be unable to send oxygen to organs sufficiently)
- Shock (various causes can lead to a sudden decrease in blood flow)
After birth, a number of additional complications may lead to neonatal asphyxia:
- Heart, lung, or respiratory problems
- Severe anemia (iron deficiency)
- Low blood pressure
Fortunately, many of these complications can be caught early, and the severity can be minimized with proper medical monitoring and support.
What Happens During Neonatal Asphyxia?
During neonatal asphyxia, oxygen flow is restricted. This prevents blood cells from effectively transporting enough oxygen to the organs’ cells. This lack of oxygen prevents cells from functioning properly. Waste and toxic byproducts build up within the cells as a result.
This waste then damages the cells and prevents them from functioning as needed. In some cases, the damage to the cells from built-up toxins within the body leads to permanent damage to the brain, heart, lungs, kidneys, or other organs.
Cerebral palsy can result from neonatal asphyxia when it causes irreversible damage to the cerebral cortex. Cell and organ damage to the cerebral cortex can permanently impact motor function and movement.
Neonatal Asphyxia Stages
Neonatal asphyxia occurs in two stages. The first stage occurs when blood flow is reduced and blood cells do not get enough oxygen as a result.
The second stage, called reperfusion injury, occurs in the hours, days, or weeks after oxygen and blood flow are restored. Reperfusion injury is caused when damaged cells release toxins that were built up in them during the first stage of asphyxia. These toxins cause secondary damage to the patient.
Fortunately, the second stage of neonatal asphyxia doesn’t always occur, so not all patients experience reperfusion injury.
Neonatal Asphyxia Risk Factors
Certain complications or medical conditions can increase the risk of a baby suffering from neonatal asphyxia. However, these do not guarantee a baby will suffer from it. Many babies with these same risk factors do not experience neonatal asphyxia or related conditions like cerebral palsy.
Risk factors for neonatal asphyxia include:
- Premature or late-term birth
- Abnormal birth positioning (such as breech or posterior position)
- Cesarean section
- Multiple births (twins, triplets, etc.)
Additional risk factors identified in mothers include:
- Poor nutrition
- Lack of prenatal/antenatal care
- Anemia (decreased amount of cells that carry oxygen throughout the body)
- Excessive hemorrhaging or vaginal bleeding
- Statistically young or old age (under 18 and older than 40)
Neonatal Asphyxia Effects
Depending on when a baby receives medical intervention for neonatal asphyxia, the effects can range from mild to severe. Babies who receive acute or immediate injuries from neonatal asphyxia may go on to develop long-term issues, depending on the severity of the condition.
A baby born with neonatal asphyxia will have immediate symptoms, which may include:
- Pale or blue coloring
- Weak cry and decreased or absent reflexes
- Low heart rate
- Low blood pressure
- Respiratory distress
- Neurological conditions that cause poor muscle tone, seizures, or coma
In some cases, these symptoms can be reversed with proper care. Experienced medical professionals are able to identify early warning signs and prevent or lessen their impacts.
Unfortunately, sometimes the damage is too extensive or noticed too late. This can cause permanent conditions like cerebral palsy to set in. Cerebral palsy sets in if neonatal asphyxia damages the cerebral cortex.
The common symptoms of cerebral palsy include:
- Stiff muscles
- Spastic muscle movements
- Poor muscle coordination
- Involuntary movements
While the symptoms of cerebral palsy don’t worsen over time, they often become more noticeable as a child grows up and misses typical developmental milestones. Therefore, some parents don’t realize the impact that neonatal asphyxia had on their children for several years.
Neonatal Asphyxia Diagnosis
Doctors and medical professionals look for several signs and symptoms at birth to diagnose babies with neonatal asphyxia.
These signs and symptoms include:
- Respiratory distress or issues
- Weak cry
- Evidence of circulatory problems, including blue skin
When an infant is born in distress, it’s crucial to identify the cause. If the mother’s history shows little risk for infant distress, a rapid assessment of the infant’s symptoms and potential causes is essential. Understanding the cause is key to selecting appropriate and immediate interventions.
According to the neonatal resuscitation program (NRP) protocol, only respiratory resuscitation is administered if the infant’s heart rate exceeds 60 beats per minute. However, if the heart rate is below 60, compressions are initiated.
During oxygen support post-delivery, the nurse aims for a quick rise in blood oxygen levels and a normal heart rate above 110 beats per minute. Achieving an oxygen saturation of 92% or above is the goal.
Doctors also administer certain tests and standards to evaluate a baby’s health. Two common tests are the APGAR assessment and measuring acid levels in the umbilical cord.
Immediately after birth, medical professionals will perform the APGAR test, which evaluates a baby’s health based on their skin color, breathing, heart rate, reflexes, and muscle tone. If a baby scores lower than expected, the test will be repeated after 5 to 10 minutes.
A score below an 8 requires a repeat APGAR score every 5 minutes until a score of 8 has been achieved. If the infant scores a 7 or less, continued resuscitation of the infant or oxygen support is needed. This also shows that minutes of adequate resuscitation interventions are crucial after neonatal asphyxia.
A consistently low score after a second test can indicate neonatal asphyxia.
Umbilical Acid Levels
If neonatal asphyxia is suspected, the arterial blood in the umbilical cord is tested for acid levels. If their pH levels are under 7, it indicates that the baby did not get enough blood or oxygen.
Neonatal Asphyxia Treatment and Therapy
Medical professionals can proactively treat many cases of neonatal asphyxia. The exact actions performed will depend on each patient’s specific circumstance, but several treatments are relatively standard.
During birth, a mother may be treated with:
- Extra oxygen to the mother in labor
- Emergency C-section or delivery
Immediately after birth, the baby may be treated with:
- Assisted ventilation
- ECMO (artificial lung machine)
As the child grows, additional treatment may be required to treat the long-term impacts of neonatal asphyxia, such as cerebral palsy.
This treatment may include:
- Nutritional support
- Physical therapy
- Supportive braces, casts, and orthotics
- Walking aids
Legal Help for Neonatal Asphyxia and Cerebral Palsy
Cerebral palsy can be the result of neonatal asphyxia or another birth injury, which may have been preventable. People diagnosed with cerebral palsy are often eligible to file claims for financial compensation, which can help pay for medication, therapy, treatment, and other special needs costs.
If a member of your family has been diagnosed with cerebral palsy due to a birth injury, they deserve justice. Working with a law firm with experience in cerebral palsy cases can help them receive the right support.