Birth asphyxia is a decrease in blood flow to a newborn's tissues or a decrease in oxygen in a newborn's blood before, during, or just after delivery.
When a baby is born, the doctor or midwife examines the newborn for any obvious abnormalities or signs of distress. The newborn's condition immediately after birth is recorded at 1 minute and at 5 minutes after birth using the Apgar score. The Apgar score is used to assign points for heart rate, effort to breathe, muscle tone, reflexes, and color. A score of 7 to 10 is considered normal, 4 to 6 is intermediate, and 0 to 3 is low. A low Apgar score is a sign that the newborn is having difficulty and may need extra assistance with breathing or blood circulation. The Apgar score does not predict anything about the baby's health after the first few minutes of life.
Apgar Score
Characteristic | Acronym* | Score† | ||
|---|---|---|---|---|
0 | 1 | 2 | ||
Color of skin | Appearance | All blue, pale | Pink body, blue hands and feet | All pink |
Heart rate | Pulse | No pulse | Less than 100 beats per minute | More than 100 beats per minute |
Reflex response to stimulation of the nose (by touching it with a finger or a catheter) | Grimace | No response to stimulation | Grimace | Sneeze, cough |
Muscle tone | Activity | Limp, no movement | Some bending of arms and legs | Active movement |
Breathing | Respiration | No breathing | Irregular, slow | Good cry |
* The word "Apgar" is also an acronym. The letters A, P, G, A, and R correspond to the bold letters in this column. | ||||
† The baby is given a score from 0 to 2 for each of 5 characteristics. A total score of 7 to 10 at 5 minutes is considered normal, 4 to 6 is intermediate, and 0 to 3 is low. | ||||
Babies with a low Apgar score may be having trouble with breathing or blood flow. Birth asphyxia (also called perinatal asphyxia) is a decrease in blood flow to the newborn's tissues or a decrease in oxygen in the newborn's blood before, during, or just after delivery. Some potential causes include the following:
Separation of the placenta from the uterus before delivery (placental abruption)
Obstruction of umbilical cord blood flow
Abnormal development of the fetus (for example, when there is a genetic anomaly)
Severe infection in the fetus
Exposure to certain drugs or medications before birth
Severe maternal hemorrhage
Severe maternal illness
Sometimes the exact cause of birth asphyxia cannot be identified.
Regardless of the cause, affected newborns appear pale and lifeless at birth. They breathe weakly or not at all and have a very slow heart rate. The doctors and nurses provide care to revive (resuscitate) the newborn. Resuscitation may include use of a resuscitation bag and mask to push air into the lungs or insertion of a breathing tube in the newborn's throat (endotracheal intubation). If asphyxia resulted from rapid blood loss, the newborn may be in shock. They are immediately given fluids by vein, and sometimes a blood transfusion or plasma.
Newborns may require care in the neonatal intensive care unit (NICU).
Newborns with asphyxia may show signs of injury to one or more organ systems, including the following:
Heart: Poor color, low blood pressure
Lungs: Difficulty breathing and low oxygen levels
Brain: Lethargy, seizures, or even coma
Kidneys: Reduced output of urine
Liver: Difficulty making proteins that are needed for blood to clot normally
Intestines: Difficulty digesting milk
Blood forming system: Low platelet count and bleeding
Newborns may need medications to help their heart function and a mechanical ventilator to support their breathing.
Most of the organs damaged by birth asphyxia recover over a week, but brain damage may persist in some infants. Infants who have no or minimal injury to the brain may have no ongoing health problems. Those who have moderate to severe injury to the brain may have permanent developmental issues, ranging from mild learning disorders to delayed development to cerebral palsy. Some infants with severe asphyxia infants do not survive.
