Birth Asphyxia – Signs, Causes, Diagnosis and Treatment by Dr Lathiesh Kumar Kambham

Also known as perinatal asphyxia or neonatal asphyxia, this is a serious birth complication that can lead to the build-up of acids in the baby’s blood. If not attended to immediately, it can become life-threatening.
Birth asphyxia need not be severe always. In some cases, it can be just mild and the baby can recover fully with the right treatment at the right time. in some cases, when it is severe and the baby does not receive the appropriate treatment at the right time, it can cause severe or permanent damage to the brain or organs.

Signs and Symptoms of Birth Asphyxia

All babies take time to cry when they are born. Some babies cry instantly and some need a nice whack on their bottom to cry out in pain and take that big gulp of oxygen. How does a doctor know if the newborn is indeed suffering from birth asphyxia?

Signs of Asphyxia Before Delivery

Here are some tell-tale signs and symptoms of this condition.

• The Baby’s heart rate or heart rhythm will be abnormal.
• Acid levels in the baby’s blood will be high – which will happen due to the lack of oxygen supply.

These two symptoms will help the doctors diagnose birth asphyxiation before delivery.

Signs of Asphyxia After Delivery

After delivery, the following are the signs and symptoms to watch out for:

• Baby is pale or bluish in color indicating a lack of oxygen.
• Heart rate is very low.
• Muscle tone and reflex are weak.
• Baby is unable to cry as expected. They don’t cry or give out a weak cry.
• Baby is unable to breathe comfortable and gasps for breath.
• There is no urination from the baby.
• The amniotic fluid contains meconium.
• The blood does not clot properly.

Causes of Perinatal Asphyxia

There is no one reason that can cause birth asphyxia in newborns. There are many influencing factors – either related to the pregnant mother or the unborn child or both. Some of the major factors that are responsible for this condition are

1. Prolapse of Umbilical Cord

The umbilical cord is the connection between the mother and the baby. It is the passage for oxygen, food, and waste. The umbilical cord should ideally follow the baby out of the womb, which is why the umbilical cord is “cut” after birth. However, in some rare cases, this umbilical cord may leave the cervix before the baby, resulting in a prolapse. This prolapse in the umbilical cord can cause birth asphyxia.

2. Umbilical Cord Compression

As mentioned above, the baby receives oxygen through the umbilical cord, until they are out of the womb and can breathe on their own. Now, if the umbilical cord is under pressure or is compressed due to various factors including the baby’s position, there will be a disturbance in the oxygen supply to the baby.

3. Meconium Aspiration

Meconium is the baby’s first poop. Some babies can pass their first stool while still in the womb and this will mix with the amniotic fluid the baby is swimming in. As babies breathe in the amniotic fluid in the womb, when they pass meconium, they will breathe in the mixed fluid. This can affect their lungs and reduce the amount of oxygen they breathe in.

[Read : Meconium Aspiration Syndrome in Babies]

4. Premature Birth

A baby born before the completion of 37 weeks in the womb is known as a premature baby or a preterm baby. If the baby is born before the lungs are fully developed and mature enough to breathe on their own, the baby may not be able to breathe as much oxygen as required. This will in turn lead to birth asphyxiation.

5. Uterine Rupture

If the uterine wall ruptures or even has minor tears, it can affect the oxygen supply to the baby. Research shows a significant connection between birth asphyxia and tears in the uterine wall. Similarly, even if the placenta separates from the uterine wall before delivery, it can cause similar complications.

6. Embolism of Amniotic Fluid

This is a rare scenario. The amniotic fluid is not supposed to enter the mother’s bloodstream. The baby’s blood and the mother’s blood are kept separate throughout the pregnancy. Now, if the amniotic fluid leaks into the mother’s bloodstream, it can lead to severe consequences and birth asphyxia is one of them.

7. Anemia in Baby

Anemia is a condition where there are not enough red blood cells circulating in the baby’s body. Red blood cells carry oxygen around the body. Low red blood cells result in low oxygen supply.

8. Insufficient Oxygen in Mother

The mother’s body is responsible for supplying oxygen to the baby. If she does not have enough oxygen, before or during birth, it can affect the oxygen supply to the baby.

7. Mother’s Blood Pressure

If the pregnant mother is experiencing high or low blood pressure, it can affect the oxygen supply to the baby.

8. Issues During Labour

Complications during labor like infections, and prolonged or even difficult labor might interrupt the oxygen flow to the baby during labor.

Factors That Increase the Chances of Asphyxia During Birth

Complications during pregnancy or delivery are not uncommon and it is difficult to ascertain what conditions can cause asphyxiation. However, here are a few factors that can increase the chances of birth asphyxiation.

• Age of the Pregnant Woman:If it’s between 20 to 25 years.
• Number of Babies in the Womb: Twins, triplets, or more.
• Prenatal Care: If insufficient or not followed as per advice.
• Birth Weight: If the baby’s birth weight is very low.
• Position: If the baby’s position is abnormal.
• History: If the mother has a history of birth asphyxiation with previous pregnancies.
• Complications: Preeclampsia or eclampsia during pregnancy.

Complications of  Perinatal Asphyxia

Birth asphyxiation can sometimes resolve on its own after treatment. When it is not effectively treated in time, it can lead to severe complications including brain damage in the newborn.

Some of the possible complications of birth asphyxiation are as follows

• Severe hypoxic-ischemic organ damage in the newborn baby
• Organ damage leading to severe life-changing issues that can even be fatal at times
• Metabolic issues such as hypoglycemia and/or hypocalcemia
• High or quick depletion of energy
• Disturbance in the pH balance leading to acidosis
• Increase in free radicals
• Injuries to the central nervous system
• Neurodegenerative diseases
• Cerebral palsy
• Attention Deficit Hyperactivity Disorder
• Issues with vision or hearing, partial or complete loss
• Fetal distress
• Seizures
• Problem with blood clotting
• Physical disability which can sometimes even be permanent
• Paralysis in any part of the body
• Brain damage like periventricular leukomalacia
• In severe cases, even death.

[Read : Fetal Distress – Causes, Diagnosis and Treatment]

Diagnosis of Asphyxiation at Birth

Once the doctor suspects birth asphyxiation, they may confirm the diagnosis with the following details.

1. The doctor will check the blood acid levels. A lack of oxygen can lead to an increase in the blood acids. If it shows a pH of less than 7.00, in the umbilical cord or arterial blood, the doctor may diagnose birth asphyxia.
2. The APGAR score shows 0 to 3 for more than the first 5 minutes.
3. Signs of any neurological issues like coma, seizures, or poor muscle tone.
4. Signs of respiratory distress or a low blood flow to the kidneys or intestines.
5. A problem with the baby’s digestive, respiratory or circulatory system.

[Read : Know All About The Apgar Score In Newborns]

How Can Birth Asphyxia be Prevented?

Birth Asphyxia is more prevalent in certain geographic locations. Though it is not completely in our control, the following steps can help reduce the chances to a certain extent:

1. Education

Educating the pregnant mother and her family about birth asphyxiation and various signs and symptoms to watch out for. In many cases, the lack of knowledge is what prevents the mother from taking immediate steps as and when required.

2. Frequent Check-Ups

If there is a history of birth asphyxiation during previous deliveries, the pregnant woman must get checked regularly for any chances of asphyxiation in the fetus.

3. Resuscitation

If the baby suffers from birth asphyxiation during the delivery process, immediate and effective resuscitation can help the baby recover well without any lasting effects.

4. Being Prepared

A hospital must have trained staff and the right equipment to handle such emergencies in the delivery room. If they do not have the facility, they must be prepared to send the child to a hospital with the facilities, within a few minutes. Time is essential here and medical care professionals should not waste it.

5. Proper Care

The pregnant woman and the fetus must be checked regularly to ensure everything is on track. The risk can be reduced considerably with regular prenatal check-ups and scans.

Long-Term Effects of Birth Asphyxia

The body needs oxygen. The brain needs a steady flow of sufficient oxygen at all times. Even a small fluctuation can cause serious damage. When a baby does not get sufficient oxygen supply before, during, or after birth, it can have lasting effects.

The effect also depends on:

1. For how long the baby was deprived of oxygen.
2. How low the oxygen levels were.
3. How soon was the diagnosis and commencement of treatment.

If the baby is treated immediately, it can recover without any permanent damages. However, if the cells did not receive sufficient oxygen for long, then it can result in permanent damage.

Some of the possible long-term effects of birth asphyxia are:

• Neurological complications that can result in developmental delay. It can be physical, cognitive – causing learning difficulties, mental or even speech-related delays. Some of these conditions can be helped fully or to a certain extent with the right type of treatment and assistance.
• Mental disability in an otherwise healthy fetus due to insufficient oxygen supply. This disability will be long-term, in many cases even terminal.
• Visual impairment that may result in partial or even complete blindness.
• Impact on the baby’s motor skills, delaying the development or affecting their coordination while moving or running.
• Many ADHD cases have been linked to birth asphyxiation. Babies who experienced in-utero asphyxiation that leads to ischemic-hypoxic conditions were at higher risk of developing ADHD later in life. In most cases, this lack of oxygen supply happens due to complications during the delivery of the baby.
• Some babies can also develop a psychotic disorder in their adulthood. When the brain is deprived of oxygen, it can lead to behavioral issues. Some of them may not be visible right away. It will be evident only as the child grows up.
• Low attention, low intelligence, and schizophrenia are also some of the possibilities.

Treatment Options For Birth Asphyxia

If a baby is diagnosed with birth asphyxia, the following treatment options are available for the baby:

1. High-Frequency Ventilation

In this treatment, a small puff of oxygen is sent into the infant’s lungs with the help of mechanical ventilation.

2. Hypothermia

Here the baby’s internal body temperature is reduced below the normal range. It is brought down to 33.5 degrees for about 72 hours.

3. Nitric Oxide Inhalation

Here a breathing tube is placed into the baby’s windpipe and nitric oxide is sent. This tube will help reduce the blood pressure and open up the vessels in the lungs.

4. Extracorporeal Membrane Oxygenation

In this treatment, an external heart or lung pump is used. The pump will remove excess carbon dioxide and increase the oxygen supply in the baby’s body.

5. Medications

If the lack of oxygen has resulted in blood pressure variations or seizures, the doctor might prescribe blood pressure or anti-seizure medications.

6. IV Fluids

The baby might need nutritional support to compensate for all that was lost. The body needs external support to recover and recuperate. IV fluids or a nutrition supply might be given.

7. Dialysis

If the kidneys are affected due to a lack of oxygen, dialysis might be performed to remove all the waste from the bloodstream.

Can You Consider Therapeutic Hypothermia as a Treatment Option?

Yes, in some cases doctors do suggest this treatment. In this treatment, the baby’s internal organs and body temperature are deliberately brought down to 33.5 degrees for about 72 hours. Maintaining such a low temperature for so many hours can help prevent further damage to the brain.

This treatment can be used only for babies that are born after completing 35 weeks in the womb. If the baby is born 5 or more weeks early, this treatment is not a viable option.

The treatment must be started within 6 hours after the birth of the baby. Any delay beyond this can result in permanent damage to the baby.

Just like risks with every other treatment, this treatment comes with its own set of possible mistakes or risks too. Some of the common errors that arise in regard to this treatment are

• Not providing the treatment to a newborn baby within 6 hours of birth.
• Providing this treatment to an infant who may not need it in the first place.
• Not informing the parents of the affected baby about this option and robbing them of their chance of making a well-informed decision.
• Not transferring the baby to the hospital with a hypothermia treatment facility, within the stipulated time frame.
• Unavailability of set protocols and policies to carry out this treatment without any flaws or hiccups.
• Doctors or medical care professionals giving the treatment are not fully or well-trained in this treatment.

Birth asphyxia may seem like a small complication during the birth process. The severity of this complication cannot be judged unless the baby is checked thoroughly. If the doctor has even the slightest doubt regarding asphyxia, they must confirm the diagnosis and start the treatment right away. Not all cases need to be severe or cause brain damage. Do not panic, and just follow the treatment suggested, properly.

FAQ’s

1. Can Asphyxia Cause Brain Damage?

If the baby does not get a sufficient amount of oxygen, the brain will not get enough oxygen either and it also increases the chances of more carbon dioxide entering the bloodstream. It can lead to cerebral hypoxia or acidosis, which can result in brain damage.

2. Do Babies Recover From Birth Asphyxia?

Some babies do. If the birth asphyxia is not very severe, the baby will recover soon with the right treatment. However, if the asphyxia is very severe, it can result in permanent damage to the brain or other organs in the body.