Perinatal Asphyxia

Perinatal asphyxia is a condition in which an infant does not receive enough oxygen during labor and after delivery. In neonates, lack of oxygen can lead to multi-organ failure and further affect brain development. Prolonged asphyxia can also lead to an injured kidney, liver, lung and heart.

What are the symptoms of Perinatal Asphyxia?

Symptoms of perinatal asphyxia can occur before, during or after the delivery. Babies experiencing asphyxia before birth show the following symptoms.

• Abnormal fetal heart rate
• Low blood pH levels (higher acid content)

Babies experiencing asphyxia during and after labor show the following symptoms.

• Ashen skin
• Low heart rate
• Weak reflexes
• Low muscle tone
• Silent baby with no crying
• Seizures
• Low blood pressure
• Lack of breathing
• Stained amniotic fluid with meconium (first stool)
• No urination
• Blood clotting

What is the cause of Perinatal Asphyxia?

Numerous factors can cause asphyxia in infants. These factors primarily depend on the pregnant mother or the fetus, including:

• Premature birth: The infant does not breathe properly because of underdeveloped lungs in premature babies.
• Compression of umbilical cord
• Prolapsing umbilical cord, which leaves the cervix before the baby.
• Meconium aspiration: Meconium is the first stool that an infant passes. If the baby passes stool while still in the womb, the feces mix with amniotic fluid. Inhalation of this mixture causes asphyxia
• Amniotic fluid embolism, where the amniotic fluid enters the bloodstream of the mother, causing an allergic reaction
• Rupture in the uterine wall
• Placental abruption
• Infection during labor
• Difficult labor
• Anemia
• High or low blood pressure in pregnancy
• Low oxygen levels of a pregnant mother

How does the doctor diagnose Asphyxia in babies?

In cases of asphyxia before birth, the doctor generally checks for a fetal heartbeat during your regular visit. If any abnormality is detected, the doctor might conduct further tests to rule out asphyxia by determining the fetus's blood pH level. In cases of asphyxia during or after birth, the doctor and the nurse will carefully rate the baby’s breathing as per the Apgar score. Apgar stands for

• Appearance (Skin tone is observed)
• Pulse rate (Heart rate is monitored)
• Grimace (Muscle tone is determined)
• Activity (Reflexes are checked)
• Respiration (Breathing rate is evaluated)

Apgar scores lower than three and lasting longer than 5 minutes indicate asphyxia.

Doctors carry out various tests like MRI, ultrasound, CT or echocardiogram to observe the internal body organs of the infant and their proper functioning. In addition, specific tests like ECG and EEG are also carried out to determine the appropriate functioning of the heart and brain.

Risk factors and complications associated with Perinatal Asphyxia

Certain risk factors which increase the chances of perinatal asphyxia are:

• Infection in the mother such as pneumonia
• Meconium in amniotic fluid
• Water breaking more than 12 hours before delivery
• Abnormal heart rate in fetus
• Prolonged labor
• Pre- or post-term labor
• Usage of forceps or vacuum during delivery.

Depending on whether it is short-term or long-term asphyxia, certain complications are observed. Short-term effects show complications such as:

• Respiratory distress
• Acidosis
• Increased blood pressure
• Clotting of blood
• Kidney issues

Long-term effects are obtained if the baby stops breathing for more than 5 minutes. Complications observed in such infants include:

• Brain damage
• Hyperacidity
• Autism
• Attention deficit
• Schizophrenia
• Intellectual disability
• Cerebral palsy
• Vision or hearing impairment

How to prevent Perinatal Asphyxia?

There is no specific procedure to avoid asphyxia at birth, as the condition happens suddenly without any warning. However, appropriate care before and after delivery is essential. Some steps which should be taken are:

• Effective resuscitation
• Body temperature maintenance
• Trained and skilled healthcare providers present at the time of delivery
• Pretreatment with a particular medication
• All the equipment required for quick delivery should be made available

How is Perinatal Asphyxia treated?

If the infant shows mild symptoms of asphyxia at birth, breathing support is given until the baby can breathe independently. Also, the baby is closely observed for other signs of asphyxia. Immediate treatment options are:

• Cesarean delivery
• Suctioning fluid from the airway in cases of meconium aspiration

 In severe cases of asphyxia, treatment options include:

• Hypothermia (body cooling) for preventing brain damage
• Medicines to maintain blood pressure.
• Medicines to treat seizures
• Kidney support with dialysis
• Intravenous nutrition
• Breathing support with a hyperbaric oxygen tank or nitric oxide supply
• Heart-lung pump for life support

Conclusion

Most infants suffering from asphyxia at birth receiving prompt treatment recover fully.  In some instances, long-term complications are observed in the baby, such as slow development or mild to severe neurological disorders.

Request an appointment at Apollo Cradle, Amritsar - Abadi Court Road. Call 1860-500-1066 to book an appointment.