Neonatal asphyxia occurs when an unborn baby doesn’t get enough oxygen. This can be due to many factors, including umbilical cord compression or prolapse, excessive contractions, or issues related to medical malpractice (like a physician’s failure to appropriately handle fetal distress). Neonatal asphyxia can cause a severe lack of oxygen to the baby’s brain, which can injure brain cells and cause hypoxic-ischemic encephalopathy (HIE), cerebral palsy, seizures, and other forms of brain damage. Other terms used for neonatal asphyxia may include perinatal asphyxia, birth asphyxia, intrapartum asphyxia, neonatal encephalopathy, and hypoxic-ischemic encephalopathy; however, each term has its own unique meaning.
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What Causes Birth Asphyxia?
Inside the womb, oxygen-rich blood from the mother travels through the placenta and then to the baby through a vein in the umbilical cord. Blood vessels that run between the uterus and placenta, called the uteroplacental circulation, act in a manner similar to the lungs; gas exchange takes place in these vessels. The flow of blood to the baby moves from the maternal circulation to the uterus, then to the placenta (uteroplacental circulation), through the umbilical cord, and finally into fetal circulation.
Anything that affects this blood flow can impact the baby’s oxygenation. Thus, if the mother’s blood pressure drops or there are problems with the uterus (womb), placenta, or umbilical cord, the baby may experience birth asphyxia. In certain cases, such as a complete placental abruption or umbilical cord compression, the baby can be completely deprived of oxygen-rich blood and will then have to rely on fetal reserves. Instances such as these are obstetrical emergencies and the baby must be delivered right away before the oxygen deprivation causes brain damage.
Common causes of birth asphyxia include:
- Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord, and cord in a true knot
- Ruptured uterus
- Placental abruption
- Placenta previa
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis. This can greatly decreases the supply of oxygen-rich blood going to the baby.
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM)
- Premature birth
- Prolonged and arrested labor
- Uterine hyperstimulation caused by Pitocin and Cytotec can cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Postmaturity syndrome
- Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)
The Short-Term Effects of Birth Asphyxia
A condition known as hypoxia is an early stage of birth asphyxia. Hypoxia is characterized by insufficient oxygen levels in the blood and tissues. Carbon dioxide levels in the fetus will also increase, which is known as hypercarbia. When hypoxia occurs, the fetus begins to generate energy without oxygen, in a process known as anaerobic metabolism. This process, as well as others occurring when the baby is oxygen-deprived, cause lactic acid to build up in the baby’s blood. The high carbon dioxide level along with the lactic acid build-up cause the baby to have acidosis, a condition characterized by acidic blood. Acidosis and hypoxia can cause decreased heart function, which can cause the baby to have very low blood pressure (hypotension) and decreased blood flow to the brain (ischemia).
The insufficient oxygen level caused by the birth asphyxia causes ischemia, and the ischemia causes further hypoxia. Hypoxia and ischemia cause a series of events that disrupt the energy pathways in the cells, which leads to even further brain cell injury. When the brain is in a hypoxic-ischemic state caused by prolonged birth asphyxia, the brain is not only deprived of oxygen, it is also deprived of glucose and other nutrients.
Waste removal is also impaired. Waste remains in the cells, resulting in additional brain cell impairments. In general, the longer the brain is in a hypoxic-ischemic state, the more severe the brain injury will be.
The degree of hypoxic-ischemic brain injury in the baby depends on the following:
- The severity of the birth asphyxia
- How long the asphyxia lasts
- The baby’s age and reserves
- The medical management of the baby during and after birth
Long-Term Effects of Birth Asphyxia: The Side Effects of Hypoxic-Ischemic Encephalopathy (HIE)
If the birth asphyxia is severe enough to injure the brain, the baby will usually develop hypoxic-ischemic encephalopathy (HIE) soon after birth. HIE usually starts to occur during the birthing process, with problems such as seizures and poor feeding starting to occur shortly after delivery. HIE is a brain injury that can progress to permanent brain damage and long-term conditions, such as cerebral palsy.
Clinical signs of HIE in babies:
- Hypotonia, in which the baby is limp and floppy.
- Poor feeding
- Depressed level of consciousness, in which the baby is not alert.
- Multiple organ problems involving the lungs, liver, heart, intestines, etc.
- Poor brain stem reflexes such as breathing problems, an abnormal response to light, blood pressure and heart problems.
Hypoxic-ischemic encephalopathy is also the most common cause of neonatal seizures. Seizures must be quickly diagnosed and treated because they can advance the spread of brain injury. It is also very important that the medical team be aware of any other problems the baby is having, so that they can provide proper treatment. For example, babies experiencing heart problems often require cardiac drugs. Babies with breathing problems may need breathing tubes and breathing machines. Failure to properly manage a baby’s heart, blood pressure, and breathing can cause further brain injury and worsen the long-term effects of birth asphyxia.
Premature babies may not show any of the signs that full-term babies do. One reason for this is the fact that the nervous systems of premature and full term babies are different. Hypoxic-ischemic brain injury in a baby born preterm may be silent, with the baby having few or no obvious signs.
HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL). PVL usually occurs in premature babies, but it can also sometimes develop in term babies.
Treatment: Hypothermia Therapy Can Halt HIE and Improve the Long-Term Effects of Birth Asphyxia
It is now standard of care for babies diagnosed with HIE to receive hypothermia therapy (brain cooling). Doctors must administer hypothermia therapy within six hours of the time the birth asphyxia occurred. This means a baby with HIE must be cooled within six hours of labor and delivery.
Research shows that hypothermia therapy halts almost every injurious process that starts to occur when a baby’s brain experiences an oxygen-depriving insult. During the treatment, the baby’s body temperature is cooled to a few degrees below normal for 72 hours. Cooling the brain in this way has been shown to prevent cerebral palsy or reduce the severity of the condition. Properly administering hypothermia treatment on a baby with HIE is critical for preventing or improving the long-term effects of birth asphyxia.
For more information on hypothermia therapy, please visit our pages below:
- Hypothermia Therapy Errors
- Neonatal Requirements for Hypothermia Therapy
- Hypothermia Therapy’s Past, Present, and Future: Where is Brain Cooling Headed?
- How Does Brain Cooling Relate to Patient Safety and Medical Malpractice?
- Hypothermia Therapy May Be Effective 6-24 Hours After Birth: The study discussed here was statistically inconclusive, but warrants further research on the window of time in which hypothermia therapy can be effective.
Long-Term Effects of Birth Asphyxia
Many babies who experience birth asphyxia are diagnosed with hypoxic-ischemic encephalopathy shortly after birth. Not all children with HIE end up with permanent brain damage. Some children will not experience any long-term effects of birth asphyxia or any latent problems from HIE. Babies who have brain damage caused by birth asphyxia or HIE may develop:
- Cerebral palsy
- Epilepsy and seizure disorders
- Motor disorders
- Developmental delays
- Speech delays
- Learning disabilities
- Behavioral and emotional disorders
- Hearing impairments
- Visual impairments
- Feeding problems, nutritional concerns, and oral health issues
- Pain symptoms
- Respiratory conditions
- Skin issues
- Orthopedic issues
- Mental health conditions
The long-term effects of birth asphyxia depend on the part of the brain injured and the severity of the injury. When a baby experiences severe or total birth asphyxia, also called “acute profound asphyxia“, the part of the brain injured is typically the deep gray matter.
When asphyxia is abrupt and severe (“acute near total asphyxia“), deep brain structures are usually damaged. These include the basal ganglia, thalamus, and brain stem. The long-term effects of birth asphyxia will be more severe in these instances.
When the baby experiences asphyxia that is moderate to severe and relatively prolonged (“acute profound“), injury will usually be seen in the cerebral cortex as well as the deep brain structures, particularly the thalami, hippocampi, putamen, and dorsal part of the midbrain.
If the asphyxia is “partial and prolonged” (usually lasting for more than 30 minutes), there will mainly be cortical injury in the watershed and parasagittal regions of the brain, which are areas that do not have direct arterial blood supply. This can involve both gray and white matter. When a baby has periventricular leukomalacia (PVL), injury is often seen in the watershed zones in the periventricular region.
Babies can also experience partial prolonged asphyxia along with acute profound asphyxia, which causes a “mixed brain injury pattern“ of HIE.
When a baby has hypoxic-ischemic encephalopathy, hypoxic-ischemic lesions and other evidence of brain damage are often eventually detected with brain scans. Depending on the nature of the birth asphyxia and the condition of the baby, lesions may be on any part of the brain mentioned above (and others), such as the basal ganglia and periventricular white matter.
Predicting the Long-Term Effects of Birth Asphyxia Based on Location of Brain Damage
The extent and location of the brain damage can help doctors predict the long-term effects of birth asphyxia, as well as what types of lasting problems the child may have. Listed below are areas of the brain, and summaries of which bodily functions these areas help control. The three major parts of the brain are the cerebrum, cerebellum, and brain stem, all of which contain both gray and white matter.
The largest part of the brain, the cerebrum, contains nerve centers that control movement, cognition, reasoning, memory, perception, judgment, and decision-making. The surface of the cerebrum is called the cerebral cortex, which consists of multiple layers of neurons. Neurons are critical brain cells that process and transmit information via electrical and chemical signals, and they connect to each other and form the core of the nervous system. The neuron layers sit on top of a large portion of the brain’s white matter. White matter (along with neurons) helps transmit messages throughout the largest parts of the brain. The cerebrum includes the basal ganglia and hippocampus.
Frontal Lobe of the Cerebrum
This lobe is responsible for voluntary movement and planning. It contains the motor cortex, which controls motor function (movement). The portions of the motor cortex near the top of the head control movement of the legs and feet, and the lowest parts of the motor cortex control the muscles of the face and mouth. The frontal lobe also plays a critical role in intelligence and personality; in fact, researchers think it is the most important lobe for these functions.
Parietal Lobe of the Cerebrum
This lobe is behind the frontal lobe and contains the somatosensory cortex; it is responsible for feeling touch on certain parts of the body. For example, the part of the lobe closest to the top of the head is responsible for feeling touch on the legs and feet. Specific functions associated with the parietal lobe include comprehension of pain, pressure, heat, cold, and touch, as well as appreciation of form.
Temporal Lobe of the Cerebrum
The lobe at the side of the head is called the temporal lobe. An important region of this lobe is the auditory cortex – which is connected with the ears and plays a major role in hearing. Specific functions associated with the temporal lobe include hearing, memories, fear, and some speech and language behavior.
Occipital Lobe of the Cerebrum
The occipital lobe is at the back of the head and contains the visual cortex, which receives information from the eyes and controls vision. Specific functions associated with the occipital lobe include complex processing of vision, reading, and relating vision to other sensory experiences.
The cerebellum is a tightly folded, continuous thin layer of tissue that sits on top of a large amount of white matter. It contains a fluid-filled ventricle at the base, and at the microscopic level, there are 4 deep cerebellar nuclei embedded in the white matter. Indeed, there are many types of neurons that form a complex network with massive signal-producing capability.
The cerebellum plays a major role in motor control (muscle control). This region of the brain does not initiate movement, but it greatly contributes to coordination of muscle movement, balance, timing, and precision. The cerebellum also controls a child’s sense of position; a serious injury to the cerebellum can greatly impact a child’s ability to know where her arms and legs are in space. Damage to this part of the brain can affect a child’s ability to walk, run, maintain balance, and have normal muscle tone. It can also impact a child’s fine motor function, such as the ability to hold a piece of cereal. In addition, the cerebellum is involved in some cognitive functions, such as language and attention.
The Brain Stem
The brain stem helps regulate critical bodily functions, such as breathing, heart rate, and blood pressure. It is also involved in relaying information from the cerebrum and cerebellum to the rest of the body through the spinal cord. The nerve connections of the motor and sensory systems in the main regions of the brain travel to the rest of the body through the brain stem. Not only does the brain stem regulate heart and lung functions, it also controls the central nervous system and plays a major role maintaining consciousness and regulating the sleep cycle.
The brain stem has numerous fiber tracts that carry nerve impulses from the brain to the spinal cord. It also contains numerous areas of nuclei, which are groups of brain cells that have specialized functions. The diencephalon, pons, midbrain, and medulla oblongata make up the brainstem.
The diencephalon includes the thalamus, which relays sensory impulses from one part of the brain to another to be interpreted. Temperature, touch, and pain sensation are affected by the thalamus and cortex. The hypothalamus is also located in the diencephalon, and it plays a crucial role in regulating blood pressure, heart rate, body temperature, fluid, sleep cycle, and hormones. Optic nerves cross over in the thalamus, so injury here can cause a child to have vision problems.
The pons connects the medulla oblongata and the thalamus. It transmits information between the cerebrum, medulla oblongata, and cerebellum. The pons also plays a major role in the depth and frequency of breathing. An injury to the pons can affect a child’s breathing, ability to close the mouth and chew, vision, hearing, and ability to have coordinated motor function in the head, neck, and face.
The midbrain connects the spinal cord and brain stem to the cerebral cortex. It helps control posture, balance, hearing, visual reflexes, temperature, arousal (alertness), the sleep cycle, and coordinated movement of the head and eyes.
The medulla contains important nuclei that control essential bodily functions, and it is what connects the brain stem to the rest of the brain. Nerve impulses transmitted up and down the body go through the medulla. It has a cardiac center that controls how fast the heart beats, a respiratory center that helps control breathing, and a vasomotor center that affects the dilation or constriction of blood vessels, thereby regulating blood pressure.
These tracts connect the body to the motor cortex, conducting impulses from the brain to the spinal cord. The corticospinal tracts control the fine motor function of the limbs, such as precise movements of the fingers and toes.
Award-Winning Birth Injury Attorneys Helping Children with HIE, Cerebral Palsy, and Birth Injuries | Over 100 Years of Joint Experience
Cases involving hypoxic-ischemic encephalopathy, birth asphyxia and fetal oxygen deprivation require extensive knowledge of both law and medicine. For the best case outcomes, it’s critical to find a law firm that focuses specifically on HIE and birth injury cases. Reiter & Walsh, P.C. was established to exclusively handle HIE and birth trauma cases, and our attorneys have devoted their careers to helping victims of birth trauma receive the care they need. Reiter & Walsh ABC Law Centers is based in Michigan, but we also handle cases in Pennsylvania, Ohio, Washington D.C., Tennessee, Texas, Wisconsin, Arkansas, Mississippi, and all other U.S. states. Our legal team can handle cases involving military medical malpractice and federally-funded clinics.
Contact Reiter & Walsh, P.C. today to begin your free case review with our hypoxic-ischemic encephalopathy lawyers. Free of charge and obligations, we will answer your legal questions, determine the negligent party, and inform you of your legal options. Our team is available to speak with you to set up an appointment in any of the following ways:
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Related Reading: HIE and Birth Injury
Legal Help: Our Hypoxic Ischemic Encephalopathy Lawyers & Firm
- How to Find the Right Hypoxic Ischemic Encephalopathy Lawyers for Your Case
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- About our Hypoxic Ischemic Encephalopathy Attorneys
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Medical Information: Hypoxic Ischemic Encephalopathy
- Hypoxic Ischemic Encephalopathy (HIE) and Seizures
- Cerebral Palsy and HIE
- Hypothermia Treatment for Hypoxic Ischemic Encephalopathy
Hypoxic Ischemic Encephalopathy Resources
Video: The Long-Term Effects of Birth Asphyxia
Watch a video of birth injury attorneys Jesse Reiter and Rebecca Walsh discussing birth asphyxia long-term effects. Birth asphyxia can often be prevented if the baby is quickly delivered at the first signs of distress. Failure to quickly deliver the baby can cause prolonged oxygen deprivation, hypoxic-ischemic encephalopathy (HIE), permanent brain damage, and conditions such as cerebral palsy.
Video: How Is Birth Asphyxia Pronounced?
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- Graham EM, Ruis KA, Hartman AL, et al. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587.
- Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatr 1995; 84:927.
- Lee AC, Kozuki N, Blencowe H, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013; 74 Suppl 1:50.
- Chau V, Poskitt KJ, Miller SP. Advanced neuroimaging techniques for the term newborn with encephalopathy. Pediatr Neurol 2009; 40:181.