Asphyxia Neonatorum

[Trudi Miranda]

Bethlives in London and works as a freelance writer on a range of projects. Along with writing regular articles for Medical News Today, she writes for the Horniman Museum, an anthropology museum in South London. This involves recording minutes for conferences, blogging for their website, and documenting their process of curating art exhibitions. She loves theatre, yoga, and cycling in her spare time.

Dr. Valinda Nwadike is an ABMS board certified physician specializing in obstetrics and gynecology. She has over sixteen years of experience performing deliveries and gynecologic surgeries and currently works as a clinical instructor and supervises residents.

Birth asphyxia rates are lower in developed countries, with a rate of 2 in 1,000 births. In areas of developing countries where there is limited access to neonatal care, this rate increases up to 10 times.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Katie Lavender has over 8 years of experience as a Registered Nurse in postpartum mother/baby care. With hands-on experience in Labor and Delivery and a role as a Community Educator for newborn care, Katie is a staunch advocate for patient rights and education. As a Medical Reviewer, she is committed to ensuring accurate and trustworthy patient information.

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

Perinatal asphyxia (also known as neonatal asphyxia or birth asphyxia) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It remains a serious condition which causes significant mortality and morbidity. It is also the inability to establish and sustain adequate or spontaneous respiration upon delivery of the newborn, an emergency condition that requires adequate and quick resuscitation measures. Perinatal asphyxia is also an oxygen deficit from the 28th week of gestation to the first seven days following delivery. It is also an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs and may be associated with a lack of ventilation. In accordance with WHO, perinatal asphyxia is characterised by: profound metabolic acidosis, with a pH less than 7.20 on umbilical cord arterial blood sample, persistence of an Apgar score of 3 at the 5th minute, clinical neurologic sequelae in the immediate neonatal period, or evidence of multiorgan system dysfunction in the immediate neonatal period. Hypoxic damage can occur to most of the infant's organs (heart, lungs, liver, gut, kidneys), but brain damage is of most concern and perhaps the least likely to quickly or completely heal. In more pronounced cases, an infant will survive, but with damage to the brain manifested as either mental, such as developmental delay or intellectual disability, or physical, such as spasticity.

It results most commonly from antepartum causes like a drop in maternal blood pressure or some other substantial interference with blood flow to the infant's brain during delivery. This can occur due to inadequate circulation or perfusion, impaired respiratory effort, or inadequate ventilation. Perinatal asphyxia happens in 2 to 10 per 1000 newborns that are born at term, and more for those that are born prematurely.[1] WHO estimates that 4 million neonatal deaths occur yearly due to birth asphyxia, representing 38% of deaths of children under 5 years of age.[2]

Perinatal asphyxia can be the cause of hypoxic ischemic encephalopathy or intraventricular hemorrhage, especially in preterm births. An infant with severe perinatal asphyxia usually has poor color (cyanosis), perfusion, responsiveness, muscle tone, and respiratory effort, as reflected in a low 5 minute Apgar score. Extreme degrees of asphyxia can cause cardiac arrest and death. If resuscitation is successful, the infant is usually transferred to a neonatal intensive care unit.

There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air.[3] It has been demonstrated that high concentrations of oxygen lead to generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia.[4] Research by Ola Didrik Saugstad and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen.[5][6]

Basically, understanding of the etiology of perinatal asphyxia provides the platform on which to build on its pathophysiology. The general principles guiding the causes and the pathophysiology of perinatal asphyxia are grouped into antepartum causes and intra partum causes. As these are the various points to which insults can occur to the foetus. [citation needed]

There is current controversy regarding the medicolegal definitions and impacts of birth asphyxia. Plaintiff's attorneys often take the position that birth asphyxia is often preventable, and is often due to substandard care and human error.[13] They have utilized some studies in their favor that have demonstrated that, "... although other potential causes exist, asphyxia and hypoxic-ihy affect a substantial number of babies, and they are preventable causes of cerebral palsy."[14][15][16] The American Congress of Obstetricians and Gynecologists disputes that conditions such as cerebral palsy are usually attributable to preventable causes, instead associating them with circumstances arising prior to birth and delivery.[17]

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

Body cooling (therapeutic hypothermia) can improve outcomes for babies born at full term or near term. But babies born 5 or more weeks early cannot have body cooling. In the most severe cases, asphyxia can lead to organ failure and death.

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