Cerebral Palsy and Birth Asphyxia
Birth complications and congenital issues are one of the many ways that babies can develop cerebral palsy. Birth asphyxia, or oxygen deprivation, is one such way. It’s a serious medical condition that can lead to death if not treated immediately.
Birth Asphyxia Defined
Birth asphyxia is marked by oxygen loss and blood supply loss to the baby and generally occurs shortly before or during birth. It accounts for around 6% to 8% of all cerebral palsy cases.
Birth asphyxia can be caused by:
- Umbilical cord issues, including the cord wrapping the baby’s head, a compressed or restricted cord, and similar problems
- Heavy maternal bleeding and fetal distress, leading to maternal shock
- Abnormal birth presentation, such as the baby being in the breech position, making delivery more difficult
- Large infant size, including a larger head, which may prolong delivery
- Infant and/or maternal high or low blood pressure
- Infant’s airways unformed or blocked
While a baby is still in the womb, they rely on their mother’s blood carried through the umbilical cord for oxygen. This oxygen-rich blood flows from the placenta into the umbilical cord, providing the infant with nourishment. If anything affects the oxygen-rich blood, it can negatively affect the infant’s health.
Other causes of birth asphyxia include placental issues, such as placenta previa and placental abruption. Umbilical cord problems, such as the baby getting tangled in the cord or umbilical cord compression, can also lead to birth asphyxia.
Birth Asphyxia and Brain Damage
When a baby is deprived of oxygen, the pH levels and blood gas levels are usually altered, which places the infant at a heightened risk for cerebral hypoxia and acidosis, and increased carbon dioxide entering the bloodstream. This can lead to brain damage.
During this stage, a baby can have less glucose and a number of important nutrients. This can cause waste matter to remain in the infant’s brain, creating the potential for additional medical problems.
The severity of an infant’s brain damage will depend of the how severe the birth asphyxia is, how long they’re deprived of oxygen, the age of the infant (newborns born prematurely run a much higher risk of developing brain damage if deprived of oxygen), and how the physician, nursing, and respiratory therapy staff handle the situation both during and after the baby’s birth.
If birth asphyxia causes brain damage during birth, the baby usually develops hypoxic ischemic encephalopathy (HIE) shortly after being born. HIE is a neurological impairment caused by low oxygen or lack of oxygen. HIE is one of the leading causes of infant mortality or severe impairments after birth.
For more information on HIE, refer to our article Cerebral Palsy and Hypoxic Ischemic Encephalopathy (HIE).
Birth Asphyxia and Medical Negligence
Unfortunately, a number of birth asphyxia cases could have been prevented with the proper medical measures. Medical negligence and mistakes, which usually not intentional, still happen far too often than they should, and a result, babies are left with lifelong disorders such as cerebral palsy.
For example, umbilical cord problems are one of the top reasons that birth asphyxia occurs–if a physician fails to monitor infant distress, the umbilical cord issues become worse. Failure to monitor fetal distress can also lead to doctors not knowing when to perform an emergency C-section, leaving the infant in utero for too long.
Shoulder dystocia is another common problem that leads to birth asphyxia, but in some instances, doctors fail to utilize proper maneuver methods to deliver the infant faster and safer. Essentially, failing to notice prior problems and act accordingly to prevent birth asphyxia may be seen as medical negligence and malpractice.
Birth Asphyxia Symptoms and Diagnosis
Doctors look for numerous symptoms when diagnosing birth asphyxia, including:
- Skin color may be blue and/or pale
- Low heart rate
- Poor muscle tone
- Weak reflexes
- Meconium (baby’s first stool) mixed into the amniotic fluid
- Infant seizures
- The baby may have breathing difficulties or not breathing at all
- Unalert or low level of alertness
- Hypotonia (the baby’s body is floppy and limp)
Babies born prematurely, however, have a less mature nervous system when compared to full-term babies and subsequently may not have all of the above symptoms, or any of the symptoms at all.
When diagnosing asphyxia at the time of delivery, physicians and medical staff will rate the baby’s health on a scale from 0-10. Known as the Apgar Score, it allows healthcare providers to rate the baby’s heart rate, skin color, reflexes, muscle tone, and breathing. An extremely low Apgar Score of 0 to 3 could be indicative of birth asphyxia.
Birth Asphyxia Treatment Options
The are a number of ways that birth asphyxia is treated, which sometimes can help prevent the severity of cerebral palsy. Common treatment options include:
- High-frequency Ventilation: This treatment option sends small puffs of pure oxygen into the infant’s lungs via mechanical ventilation.
- Hypothermia: Hypothermia involves reducing the baby’s internal body temperature to 33.5 degrees C for around 72 hours.
- Nitric Oxide: Inhaled nitric oxide is provided by breathing tube placed directly into the baby’s windpipe in order to help lower blood pressure and open the blood vessels in the lungs.
- Extracorporeal Membrane Oxygenation (ECMO): ECMO involves using a heart/lung pump, which provides temporary life support for the baby. It also removes excessive carbon dioxide from the infant’s body while supplying additional oxygen. Babies must be sedated while ECMO is performed.
Birth Asphyxia Long-term Outlook
Not all babies who experience birth asphyxia will develop brain damage. Brain damage can be lessoned with treatment.
Infants who have moderate to severe brain damage can develop medical conditions that require long-term treatment, such as seizures, issues with multiple organs, breathing problems, social issues, learning disabilities, cognitive dysfunctions, and behavioral issues. Again, it’s crucial that treatment begins as soon as possible which may help eliminate some of the other medical issues.