Asphyxia neonatorum is also known as perinatal asphyxia, hypoxic-ischemic encephalopathy, or birth asphyxia. These terms describe a condition that occurs when a baby does not get enough oxygen during the birth process. It can be fatal.
Anything that affects a baby’s ability to take in oxygen can be associated with asphyxia neonatorum. During birth, medical professionals must carefully manage oxygen levels for both mother and baby to reduce risks.
Causes of asphyxia neonatorum include:
- the baby’s airway becomes blocked
- the baby is anemic and his or her blood cells do not carry enough oxygen
- delivery that lasts too long or is very difficult
- the mother does not get enough oxygen before or during birth
- the mother’s blood pressure is too high or low during delivery
- an infection that affects the mother or baby
- the placenta separates from the uterus too quickly, resulting in loss of oxygen
- the umbilical cord becomes improperly wrapped around the baby
Babies who lose oxygen before, during, or after delivery can experience asphyxia neonatorum in one of two ways. The first is immediate damage due to lack of oxygen, which can happen within minutes. The second is when the cells recover from lack of oxygen and the damaged cells release toxins into the body.
Asphyxia neonatorum occurs in an estimated four out of every 1,000 live births in the United States, according to Seattle Children’s Hospital. Premature babies are at greater risk for the condition than those born to term. Babies born to mothers with conditions that affect pregnancy, such as diabetes mellitus or preeclampsia, are also at greater risk. When a baby does not grow as expected during pregnancy, he or she is at greater risk (UpToDate 2013).
The condition occurs more often in developing countries, where more mothers do not have access to proper prenatal and postnatal care.
Babies may not immediately experience symptoms of asphyxia neonatorum. An abnormal fetal heart rate prior to being born can be one indicator.
After the baby is born, he or she may experience immediate symptoms, such as:
- blue-appearing skin or very pale skin
- difficulty breathing, which may cause symptoms such as nasal flaring or belly breathing
- a slow heart rate
- a weak muscle tone
Amniotic fluid that is stained with meconium (fetal stool) can be another symptom of perinatal asphyxia. The severity of symptoms often depends on how long a baby was without oxygen. The longer a baby did not have oxygen, the more likely he or she is to experience symptoms such as failure or injury to organs, including the lungs, heart, brain, and kidneys.
When a baby is born, nurses assign a score known as an Apgar score to him or her, one and five minutes after birth. The system evaluates five factors: breathing, pulse, appearance, response to stimulus, and muscle tone. The lower the infant’s Apgar score, the more at risk he or she is for asphyxia neonatorum. A score lower than seven can indicate that a baby is experiencing difficulty with oxygenation. If a baby has an Apgar score of 0 to 3 for more than five minutes, the doctor may suspect asphyxia neonatorum.
A physician may also test a baby’s blood for high acid levels, which can indicate poor oxygenation. If a baby’s arterial blood has a pH of 7 or lower, this result can mean the baby has asphyxia neonatorum (McGuire, 2007). A physician may also order blood tests to see if a baby’s kidneys, heart, and liver are working.
Treatments for asphyxia neonatorum depend upon the severity of the baby’s condition and on when the condition was diagnosed. For example, mothers may be given additional oxygen before delivery to boost a baby’s oxygenation before birth. In prolonged or difficult deliveries, giving birth via cesarean section may be necessary.
After birth, babies with the condition may be treated with mechanical ventilation to support their breathing. Keeping babies warm has also been shown to reduce harmful effects. But babies who may have experienced brain damage may benefit from temporary lowering of brain temperature to preserve brain function (Zanelli, 2013). A baby’s blood pressure and fluid intake will also be carefully monitored to ensure that enough oxygen is being received.
Because some babies experience seizures as the result of asphyxia neonatorum, they must be carefully treated to avoid injury from seizures. Anti-inflammatory medications, magnesium, vitamins, and allopurinol (a medication that reduces acid buildup in the body) may be used to help the baby.
Asphyxia neonatorum is a leading cause of infant death and infant brain damage worldwide. The outcomes of the condition depend upon how long a baby was without oxygen. Outcomes for surviving babies range from no consequences to major long-term disabilities.
An estimated 900,000 babies die each year around the world due to asphyxia neonatorum, according to the World Health Organization. Early diagnosis and prompt treatment of the condition are vital to saving babies and minimizing complications.