Birth asphyxia: Causes, symptoms, and treatment

Birth asphyxia is a condition in which a baby does not receive enough oxygen before, during, or directly after birth.

In severe cases, it can cause serious complications and even be life threatening. Immediate treatment is necessary to ensure that the baby receives enough oxygen.

In this article, we look at the causes and symptoms of birth asphyxia, as well as the potential complications, treatment, and prevention.

Other names for birth asphyxia include perinatal asphyxia and neonatal asphyxia.

Birth asphyxia occurs when an infant does not receive enough oxygen when born, potentially leading to difficulty breathing. It can happen just before, during, or after birth.

Insufficient oxygen supply to the body can cause low levels of oxygen or a buildup of excess acid in the baby’s blood.

These effects can be life threatening and require immediate treatment.

In mild or moderate cases, babies may recover fully. However, in severe cases, birth asphyxia can cause permanent damage to the brain and organs or be fatal.

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.

A variety of factors can cause birth asphyxia. These can relate to the pregnant person or the fetus, and they include:

  • Umbilical cord prolapse: This birth complication occurs when the umbilical cord leaves the cervix before the baby.
  • Compression of the umbilical cord
  • Meconium aspiration syndrome: This syndrome occurs when a baby inhales a mixture of amniotic fluid and meconium, their first feces.
  • Premature birth: If a baby is born before 37 weeks, their lungs may not yet be fully developed, and they may be unable to breathe properly.
  • Amniotic fluid embolism: Although rare, this complication — in which amniotic fluid enters the pregnant person’s bloodstream and causes an allergic reaction — is very serious.
  • Uterine rupture: Research has shown a significant association between tears in the muscular wall of the uterus and birth asphyxia.
  • The placenta separates from the uterus: This separation can happen before the birth.
  • Infection during labor
  • Prolonged or difficult labor
  • High or low blood pressure in pregnancy
  • Anemia: In a baby with anemia, the blood cells are not carrying enough oxygen.
  • Not enough oxygen in the pregnant person’s blood: The level of oxygen may be insufficient before or during birth.

Risk factors for birth asphyxia include:

  • the pregnant person being between the ages of 20 and 25 years
  • multiple births, such as delivering twins or triplets
  • not attending prenatal care
  • low birth weight
  • abnormal position of the fetus during delivery
  • preeclampsia or eclampsia
  • history of birth asphyxia in a previous birth

Signs and symptoms of birth asphyxia can occur before, during, or just after birth. Before birth, a baby might have an abnormal fetal heart rate or low blood pH levels, which indicate excess acid.

Signs in the baby at birth can indicate a lack of oxygen or blood flow. They include:

  • unusual skin tone
  • the baby being silent and not crying
  • low heart rate
  • weak muscle tone
  • weak reflexes
  • lack of breathing or difficulty breathing
  • amniotic fluid stained with meconium
  • seizures
  • poor circulation
  • the baby being limp or lethargic
  • low blood pressure
  • lack of urination
  • abnormal blood clotting

Another indicator is a low Apgar score. Apgar is a rating system that healthcare professionals use to measure the health of a newborn. Apgar stands for:

  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respiration

Healthcare professionals will give a baby a rating from 0 to 10, depending on the health of their:

  • skin tone
  • heart rate
  • muscle tone
  • reflexes
  • breathing

A low Apgar score (between 0 and 3) that lasts for more than 5 minutes can indicate birth asphyxia.

Immediate treatment of birth asphyxia can help reduce the risk of long-term complications.

The amount of time before normal breathing resumes and the severity of the asphyxia can affect its short-term or long-term effects.

The short-term effects of birth asphyxia can include:

  • acidosis, which is when too much acid builds up in the blood
  • respiratory distress
  • high blood pressure
  • blood clotting problems
  • kidney problems

Long-term effects or complications of birth asphyxia can vary depending on the severity of the asphyxia. If a baby stops breathing for about 5 minutes, there is a risk of brain damage.

According to a 2011 review, mild-to-moderate asphyxia can cause cognitive and behavioral changes during childhood, adolescence, and adulthood. Long-term effects may include:

Severe asphyxia can cause:

The type of treatment will depend on the severity and cause of the birth asphyxia. Immediate treatments include:

  • providing extra oxygen to the pregnant person if birth asphyxia happens before delivery
  • emergency or cesarean delivery
  • suctioning fluid away from the airways in the case of meconium aspiration syndrome
  • putting the newborn on a respirator

For severe cases of birth asphyxia, treatment may include:

  • placing the baby in a hyperbaric oxygen tank, which supplies 100% oxygen to the baby
  • induced hypothermia to cool the body and help prevent brain damage
  • medication to regulate blood pressure
  • dialysis to support the kidneys and remove excess waste from the body
  • medication to help control seizures
  • intravenous (IV) nutrition
  • a breathing tube to supply nitric oxide
  • life support with a heart and lung pump

Preventing birth asphyxia can be difficult because the condition can happen suddenly and without warning.

According to a 2019 article, proper care and monitoring before and after every birth are vital, particularly in settings where fewer resources are available. Steps may include:

  • effective resuscitation
  • controlling body temperature
  • ensuring that the correct equipment is available
  • having properly trained and skilled healthcare providers present for every birth
  • pretreatment with certain medications, such as barbiturates, to reduce the risk of brain injury
  • treatments, such as body cooling, to prevent secondary complications from asphyxia due to damaged cells releasing toxins

Infants with mild-to-moderate birth asphyxia who receive prompt treatment may make a full recovery.

However, in some cases, birth asphyxia can be fatal. In infants with birth asphyxia, the death rate is 30% or more within the first few days following birth.

Birth asphyxia can also cause long-term complications and may cause mild-to-severe neurological disorders, such as seizures, cerebral palsy, or developmental delays.

Proper care and monitoring before and after the birth may help reduce the risk of birth asphyxia in some cases.

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