Birth Asphyxia - Causes, Symptoms, Diagnosis, and Treatment

What Is Birth Asphyxia?

Asphyxia is a critical condition caused by a lack of oxygen supply and blood to the brain to maintain normal function. Asphyxia can be a present, prenatal or postnatal condition owing to insufficient oxygen and other nutrient levels in the body of an infant. There are two types of asphyxia seen in the body: one where there is a partial lack of oxygen; hypoxia, and the second is when there is a complete lack of oxygen; anoxia.

Moreover, the condition is usually seen during prenatal-placental or postnatal-pulmonary gas exchange resulting in excessive carbon dioxide levels in the bloodstream called hypercapnia and low blood oxygen levels in arteries called hypoxemia. Furthermore, the condition also damages the tissues and vital organs such as the liver, heart, muscles, and brain. The prolonged oxygen deprivation in newborns can cause fatal damage to their organs.

What Are the Stages of Birth Asphyxia?

The birth asphyxia injury is divided into two stages:

• First Stage: It is the stage that occurs during the first few minutes of the oxygen deprivation in the blood and the decrease of the blood flow, owing to which there is a deficiency of oxygen in the cells.

• Second Stage: The second stage can last for a few weeks. During this phase, the injury occurs after the cells get enough oxygen. The damaged cells release the toxins back into the body, which causes further damage to the body. So, this stage is called “reperfusion injury.”

What Are the Causes of Birth Asphyxia?

Causes of birth asphyxia can be classified as:

• Feto-Placental:

  • Umbilical Cord Prolapse: It is a fatal condition caused during labor when the cord is compressed between the cervix and the fetal presenting part. This can cause severe oxygen deprivation in the fetus.

  • Compression of Umbilical Cord: It is the external obstruction to the blood flow via the umbilical cord due to external objects or during labor.

  • Uterine Rupture: There is a relation between the muscular wall of the uterus and asphyxia which can cause its rupture.

  • Fetal Distress: In this condition, the fetus lacks oxygen in the blood.

  • Meconium Aspiration Syndrome: Meconium aspiration syndrome occurs when the fetus inhales the amniotic fluid and his first feces in the womb.

  • Amniotic Fluid Embolism: It is a very rare complication seen in the mother where the amniotic fluid enters the bloodstream of the mother, and it causes an allergic reaction in the mother. The allergic reaction in the mother can also cause complications such as asphyxia in the fetus.

  • Placenta Separates From the Uterus: It is a rare condition where the placenta separates from the uterus before the birth of the baby. This can cause a drop in the oxygen level in the blood of the fetus.

• Maternal:

  • Inadequate Maternal Oxygen: If the mother is oxygen-deprived during or before labor, there are chances of a newborn being born with the same condition.

  • High Blood Pressure of the Mother: If the mother has high blood pressure during the pregnancy, there is a chance that the baby will be born in distress.

  • Long or Difficult Birth: This can cause oxygen deprivation in the fetus.

  • Heavy Maternal Bleeding: Loss of excessive blood in the mother can also cause the lack of blood and oxygen in the child.

• Neonatal:
  • Anemia in the Baby: If the baby lacks red blood cells in the blood, it reduces the level of oxygen as the red blood cells are the carrier of the oxygen in the bloodstream.

What Are the Signs and Symptoms of Birth Asphyxia?

Symptoms of Birth asphyxia include,

• Weak breathing.

• Skin discoloration to a blue hue.

• Low heart rate.

• Weak reflexes.

• Poor muscle tone.

• Seizures.

• Amniotic fluid stained with meconium.

• Weak cry.

• Increased acid levels in the blood.

• Lack of urination.

• Abnormal blood clotting.

• Lethargic behavior.

• Poor circulation.

• High blood pressure.

• Respiratory distress.

• Kidney problems.

• Intellectual disability.

• Epilepsy.

• Hearing impairment.

• Cerebral palsy.

• Low intelligent quotient.

• Psychotic disorder.

How to Diagnose Birth Asphyxia?

The pediatrician usually takes these measures during the diagnosis of asphyxia in newborns:

• Case History: It is the very first step of a successful diagnosis. The case history in detail can reveal many hidden aspects of health. Also, during case history, the parents are asked for their medical history as well. This information can be very useful in revealing any health-related complications in newborns.

• Apgar Score: It is the rating system used for measuring the health of a newborn. The word “APGAR” stands for:

  • Appearance: The appearance of the skin tone or the activity can be useful in revealing the health-related complication. If the child has a pale blue skin appearance, there are chances of a lack of oxygen in the bloodstream.

  • Pulse: It is measured to check if the cardiac function is normal in the newborn.

  • Grimace: It is the facial expression of the child. This is checked for any distress.

  • Activity: Usually, children with asphyxia have lethargic behavior and low-tone crying.

  • Respiration: Children with asphyxia have shortness of breathing and respiration rate, which can reveal the condition and severity.

• Other Signs: Healthcare professionals also check for other signs and score them from zero to ten according to their health. These signs are:

  • Skin tone.

  • Heart rate.

  • Muscle tone.

  • Reflexes.

  • Breathing.

A score between zero to three that continuously lasts for more than five minutes can confirm the asphyxia condition in the newborn.

How to Manage Birth Asphyxia?

Birth asphyxia is a complicated condition that can cause a myriad of complications related to health. The management of the condition is as difficult and important as its prompt diagnosis. The treatment plan for asphyxia is based on the following conditions:

• The age of the child.

• Overall health or any other associated complication in the body.

• Medical history and family history.

• The severity of the condition and progress of the condition in the baby.

• Reaction to the given drug therapy and its adverse effect.

Also, the treatment plan includes the following measures for the mother and the infant both:

• The health of the mother is as important as the health of the newborn. If the mother is having any health crisis in the body, there are chances that the child is born and affected with the same. So, the mother with a low oxygen level is given extra oxygen before the delivery.

• If there are any complications related to natural childbirth, the doctors might recommend a cesarean section delivery.

• Newborns with a low oxygen level in the blood are given medications and ventilation to support normal breathing.

• Extracorporeal Membrane Oxygenation (ECMO): In the case of lung and heart failure in newborns, this is the machine that is used for maintaining the oxygen level in the blood flow to the brain and gives temporary support to the body. The machine drains the blood from the child into an artificial lung, where carbon dioxide is removed and oxygen is added to the blood. And the blood is circulated back into the body of the child.

• Inhaled Nitric Oxide: In severe cases of high blood pressure and respiratory system failure, nitric oxide is given through the breathing tube into the airway. The breathing support of the nitric oxide aids in the dilating of the blood vessels of the lungs, which in turn helps in carrying more oxygen-containing blood into the body.

• Hyperthermia: It is the treatment option used to prevent the child from a second-stage injury that can lead to brain damage. During this treatment, the internal body temperature is dropped to 33.5 degrees Celsius for 72 hours. However, this treatment works best if it is given within the first six hours of birth in almost full-term babies.

• Follow-Up: As asphyxia can cause many complications and impairments in the child, it is best if the parents can take the infant for regular checkups and follow-up visits, as recommended by the doctor.

Conclusion

Asphyxia can be a very fatal and life-threatening condition. However, if the newborn with this condition gets a prompt diagnosis and treatment, the condition can be managed. Asphyxia is also associated with many long-term and short-term complications that cause neurological and psychological conditions in children. With proper prenatal and postnatal care and regulated follow-ups, the complications associated with the condition can be managed.