Birth Asphyxia: Causes, Symptoms, Diagnosis And Treatment

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Birth asphyxia is when the baby does not get enough oxygen before or during the birth process. The World Health Organization (WHO) defines birth asphyxia as the failure to initiate and sustain breathing at birth. According to WHO statistics, four million babies are born with birth asphyxia every year (1). This is the leading cause of perinatal and neonatal mortality and morbidity in several countries.

Read this post to know about causes, risk factors, symptoms, prevention, treatment, and long-term outlook of birth asphyxia in babies.

Signs And Symptoms Of Birth Asphyxia

The cell injury due to birth asphyxia occurs in two stages. First, there will be a lack of blood flow, and cells do not get enough oxygen during the initial stage of birth asphyxia. In the second stage, there is reperfusion injury, which is tissue damage from toxins released by damaged cells when the oxygen and blood supply return to normal. This stage often lasts for several days to weeks.

Signs and symptoms of birth asphyxia may vary in each baby and may include the following (2).

  • Pale or bluish skin
  • Weak cry
  • Weak muscles
  • Decreased heart rate
  • Gasping or weak breathing
  • Meconium-stained amniotic fluid

The following signs may indicate perinatal asphyxia (before birth) in babies.

  • Abnormal fetal heart rate patterns
  • Acid-base abnormalities and elevated creatine phosphokinase in baby’s blood

If your baby has signs and symptoms of birth asphyxia, they may be admitted into the neonatal intensive care unit (NICU) for treatment until they recover.

Risk Factors And Causes Of Birth Asphyxia

Any factors or conditions preventing adequate oxygen supply before, during delivery, and immediately after birth can cause birth asphyxia. Common causes of birth asphyxia may include (3):

  • Less oxygen in maternal blood before or during birth due to respiratory or heart problems
  • Early placental separation
  • Prolonged and difficult delivery
  • Umbilical cord problems such as umbilical cord compression during delivery, loops of cord around neck of baby
  • Severe maternal or neonatal infections
  • Increased or decreased blood pressure in mother
  • Underdeveloped or blocked airways in the baby
  • Heart or lung problems in the baby
  • Severe anemia or low blood cell count in the baby, limiting the oxygen-carrying capacity of the blood

Lack of antenatal care, multiple births, home delivery, and poor nutrition status are maternal risk factors associated with birth asphyxia. Therefore, seek adequate prenatal care and plan home deliveries only under the supervision of an expert as recommended by your doctor.

Complications Of Birth Asphyxia

Low oxygen levels during birth can reduce heart rate, blood pressure, and blood flow from the heart, resulting in reduced circulation to organs and tissues. Birth asphyxia may lead to the development of the following complications in babies (4).

  • Cerebral palsy
  • Hearing impairment
  • Vision impairment
  • Attention deficit hyperactivity disorder (ADHD)
  • Developmental delays
  • Motor impairments
  • Learning difficulties

If left untreated, birth asphyxia can be life-threatening since the newborn’s lungs may not deliver adequate oxygen to their brain and body.

Prevention Of Birth Asphyxia

Birth asphyxia is a complex problem that is difficult to predict or prevent at an early stage. Proper prenatal care and identification of risk factors may help to plan cesarean delivery to prevent complications in some cases.

Diagnosis Of Birth Asphyxia

Doctors can diagnose the presence of birth asphyxia by observing the signs and symptoms. pH levels of arterial blood from the umbilical cord, heart rate, and blood pressure help confirm the clinical diagnosis.

The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) defines birth asphyxia in hospital-based settings based on three factors. This includes metabolic or mixed academia (pH less than 7) on umbilical cord arterial blood samples, Apgar scores less than three for more than five minutes and neurologic manifestations, and multiorgan dysfunction (1).

The Apgar test is done at one minute and five minutes to help identify the newborn’s wellbeing. Apgar test evaluates a newborn’s color, heart rate, muscle tone, reflexes, and respiration.

Treatment For Birth Asphyxia

Prompt medical care helps to minimize the effects of inadequate oxygen supply to the baby. Treatment options may vary depending on the age, health status, severity, and baby’s tolerance to medications. Babies with mild asphyxia may receive breathing support until they can breathe independently.

The following treatments are often given for babies with severe birth asphyxia (2).

  • Ventilatory assistance: High-frequency ventilation, which sends small, quick puffs of air, is recommended for neonates since high pressure on regular ventilators may damage fragile newborn lungs.
  • Body cooling (hypothermia): Studies show that cooling a baby’s body to 33.5 degrees Celsius for 72 hours protects against brain injury during the second stage of asphyxia. This is best recommended for babies who are born at a minimum of 35 weeks of gestational age. Body cooling is usually started within six hours after birth in asphyxia cases.
  • Inhaled nitric oxide: Pulmonary hypertension (high blood pressure in lungs) or respiratory failure in babies with asphyxia requires treatment with inhaled nitric oxide. This reaches blood vessels in the lung through airways and dilates (open) blood vessels.
  • Extracorporeal life support (ECLS): This is called extracorporeal membrane oxygenation (ECMO), required for babies with heart and lung failure. This machine supplies oxygen to the baby’s brain and the body and removes carbon dioxide.

Besides these treatments, medications to control seizures and blood pressure are given to babies. Most babies may require intravenous (IV) nutrition until they recover. Some babies may require dialysis to support kidney function. Doctors may choose treatment options based on symptoms and complications present.

Long-term Outlook Of Birth Asphyxia

The outcome may vary depending on the duration of birth asphyxia, the oxygen levels, and the type of treatment required. Babies with mild birth asphyxia may completely recover without complications.

Babies who receive early treatment may not develop severe long-term problems. However, babies who are oxygen-deprived for a longer time may develop permanent organ damage. Organs such as the brain, heart, kidneys, lungs, and bowels are often affected. Premature babies have a higher risk of developing permanent organ damages from birth asphyxia than full-term babies.

Birth asphyxia is the major cause of prenatal and neonatal death and morbidity in many countries. It can be caused by any circumstances or conditions that impede adequate oxygen supply before, during, or soon after birth. If left untreated, it can be life-threatening; thus, early discovery and treatment are essential. While in mild cases, breathing support can be helpful to babies, babies with severe cases require ventilation, body cooling, therapy with inhaled nitric oxide or ECLS, and IV feeding. Parents are also advised to schedule follow-up consultations to monitor the baby’s health.

Key Pointers

  • Birth asphyxia occurs due to poor oxygen supply and leads to paleness, weak cry, decreased heartbeat, and gasping.
  • It increases the risk of hearing and vision impairment, cerebral palsy, and learning difficulties.
  • Birth asphyxia can be treated by high-frequency ventilation, hypothermia, and medications to control seizures.
  • The condition may be prevented through proper prenatal care and early identification of risk factors to plan delivery accordingly.


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Dr. Arva M Bhavnagarwala

Dr. Arva Bhavnagarwala has completed her post-graduation from Masina Hospital in Mumbai. She has worked at Jaslok Hospital and Research Center as a Clinical Associate. Currently, she practices Pediatrics at her private clinic in South Mumbai and is attached to Masina Hospital as a consultant pediatrician. Dr. Bhavnagarwala is a National Advisory Board Member of Indian Pediatrics, the official publication... more

Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more