In cases of birth asphyxia, a child’s body doesn’t receive enough oxygen, usually causing at least slight damage to the infant’s brain. Birth asphyxia is a major risk during the labor and delivery process, one that often has life-long consequences for the child’s health.
Some children will develop severe neurological disorders after being deprived of oxygen, even after only momentary asphyxia. Several minutes are all it takes, but the consequences of this birth complication, which is frequently caused by medical malpractice, can last a lifetime.
What Is Birth Asphyxia?
Asphyxia is the medical term for a lack of oxygen. Birth asphyxia, or perinatal asphyxia, occurs when an infant is deprived of oxygen before, during or after birth. When a child’s brain is deprived of oxygen to some extent, doctors refer to the condition as hypoxia. Another term, anoxia, is used when no oxygen reaches the brain.
Birth asphyxia is more likely to occur in premature babies than children who are carried to full-term. For full-term babies, the condition affects around four out of every 1,000 children, according to Seattle Children’s Hospital.
Birth asphyxia can be caused by a wide range of factors, from traumas suffered by the fetus in the womb to placental abruption. Some preexisting medical conditions affecting the mother, including low blood pressure, can also result in perinatal asphyxia.
Oxygen Deprivation At Birth & Brain Injury
While oxygen deprivation can harm nearly every organ in the body, brain damage is likely the most significant complication.
A form of brain damage known as hypoxic-ishemic encephalopathy is the most serious risk involved in birth asphyxia. In hypoxic-ischemic encephalopathy, or HIE, the effects of oxygen deprivation are compounded by a decrease in blood flow to the brain, ultimately killing off necessary brain cells. Without oxygen, no cell in the body can survive.
In most cases, hypoxic-ishemic brain injuries actually occur in two distinct stages. Within the first minutes of oxygen deprivation, a baby’s brain cells struggle to survive – switching over to an energy-creation process that doesn’t require oxygen. But when oxygen and blood flow return to brain cells, the cells don’t immediately switch back to using oxygen as their primary energy source. As a result, brain cells can continue to die, over the course of days or weeks, even after proper blood flow is restored. This secondary form of injury is called a “reperfusion injury.”
Symptoms & Signs
Immediately after delivery, babies who have suffered birth asphyxia may not be breathing yet, or may be breathing poorly. In the vast majority of cases, this is a medical emergency, one requiring skilled intervention. The newborn’s skin color can appear blue or abnormally pale, which is a sign that oxygen is not reaching the skin appropriately.
Reflexes are often weak, and many children will present with low muscle tone – or hypotonia – which means that their muscles will appear loose or floppy. Some babies will experience seizures, a complication that can lead to further brain damage and must be diagnosed and controlled immediately.
Meconium-stained amniotic fluid is another potential sign of perinatal asphyxia. Meconium is a child’s first stool, a greenish mix of bile, mucus and epithelial cells. The majority of babies pass their meconium after delivery, but a small portion will do so while still in the womb. This can be extremely dangerous if the infant inhales some meconium before birth. But stained meconium can also be a sign that an infant began gasping in utero, likely due to oxygen deprivation.
Additional tests may be able to confirm the fact that a child was deprived of oxygen before or during delivery. Many babies, for example, have increased levels of acid in their blood and other body tissues after suffering birth asphyxia. Carbon dioxide levels are often elevated, too.
Apgar scores – which are used to assess the health of a newborn according to basic physical functions – can bring all of these potential signs and symptoms together. An infant’s skin color, heart rate, muscle tone, reflexes and breathing patters are all taken into account in determining their Apgar score.
Long-Term Consequences Of Perinatal Asphyxia
Even minor, short spans of time without oxygen can severely damage a child’s brain, according to researchers at the European Association for Predictive, Preventive and Personalised Medicine. Mild cases of birth asphyxia often result in “minimal brain-damage disorders,” increasing the risk of attention deficit disorders like ADHD. Babies who suffer minor perinatal asphyxia during delivery are also predisposed to develop schizophrenia and psychotic syndromes later in life.
Severe episodes of oxygen deprivation during childbirth can lead to organ failure and death. When newborns survive, they often live the rest of their lives with serious developmental and neuro-muscular disorders, including:
- developmental delay
- intellectual disability
- cerebral palsy
- seizure disorders
- visual impairments
The severity of a child’s brain damage is directly linked to the amount of time they are forced to go without oxygen. But remedying the problem can have its own serious consequences. Primary treatment methods, like re-oxygenation, have themselves been linked to an increased risk for type 2 diabetes, certain cancers and neurodegenerative diseases. Thus, the main focus of a medical professional should be to prevent birth asphyxia entirely, not treat the condition adequately after the fact.
Birth Asphyxia Treatment
For children who have only been deprived of oxygen over short periods of time, breathing support and careful monitoring may be enough to avert significant brain damage. In more severe cases, infants will likely require mechanical ventilation – a breathing machine – along with extra fluids to support adequate circulation and medications to reduce blood pressure and control seizures.
To reduce the likelihood of permanent brain injury, many physicians now use hypothermic therapy, intentionally cooling a baby’s internal body temperature. Hypothermia is particularly effective in the days and weeks after a child’s delivery, when the risk of reperfusion injuries is high. Lowering the temperature of brain cells slows them down, giving each cell more time to become familiar with processing oxygen again.
Causes Of Birth Asphyxia: Was It Medical Negligence?
Sometimes children suffer perinatal asphyxia, and resulting brain damage, but it’s no one’s fault. Oxygen deprivation can occur for any number of reasons, some of which are completely unavoidable. But in other cases, birth asphyxia is entirely preventable.
- low maternal blood pressure: a condition that can be caused by the excessive use of anesthesia.
- preeclampsia: high maternal blood pressure. In some cases, preeclampsia can interfere with the delivery of oxygen and nutrients to a growing fetus.
- nuchal cord: when the umbilical cord becomes wrapped around a fetus’ neck.
- umbilical cord prolapse: when the umbilical cord drops into the birth canal before the infant does, potentially cutting of the child’s oxygen supply.
- blocked airways
- placental abruption: when the placenta peels away from the uterine wall prior to delivery.
The placenta is an organ that delivers nutrients to the developing fetus. If the placenta’s connection to the mother’s body is disrupted, a baby can be deprived of oxygen and nutrients.
- placental insufficiency: when the placenta does not deliver oxygen and nutrients to the fetus properly.
- cephalopelvic disproportion: some babies are too large to fit easily through a mother’s birth canal. During difficult labors, especially when the child becomes stuck, oxygen flow can be cut off if the umbilical cord is pinched or the placenta is detached prematurely.
- shoulder dystocia: when a baby’s child emerges from the birth canal, but it’s shoulders remain stuck.
- breech birth: when a baby is delivered in an abnormal position, usually feet or buttocks first.
- infections in the mother or child
- anemia in the infant
Some of these causal factors may be out of a doctor’s control. But it’s absolutely certain that many cases of birth asphyxia and hypoxic-ishemic encephalopathy, the brain injuries that result from oxygen deprivation, could have been prevented. Medical professionals are trained to recognize developing problems, and must act swiftly to prevent serious harm. With the appropriate prenatal monitoring and timely medical interventions, thousands of severe birth injuries could be avoided each year.