Birth Asphyxia
Introduction
Birth asphyxia is a serious medical condition that occurs in newborn babies when there is a lack of oxygen (hypoxia) or poor blood circulation (ischemia) before, during, or immediately after birth. It is one of the major causes of neonatal morbidity and mortality worldwide. Immediate recognition and management are very important to save the life of the newborn and prevent long-term complications.
Definition
Birth asphyxia is defined as the failure of a newborn to initiate and sustain normal breathing at birth due to inadequate oxygen supply.
Causes of Birth Asphyxia
Maternal Factors Severe anemia Hypertension or eclampsia Prolonged labor Maternal shock or cardiac arrest Placental Factors Placental abruption (separation of placenta before birth) Placenta previa Reduced placental blood flow Fetal Factors Umbilical cord compression or knot Prematurity Meconium aspiration Intrauterine infections
Risk Factors
Lack of skilled birth attendants Obstructed labor Post-term pregnancy Multiple pregnancies (twins, triplets) Cesarean section delay
Pathophysiology
Reduced oxygen supply → Hypoxemia (low oxygen in blood) Inadequate blood circulation → Ischemia Accumulation of carbon dioxide → Acidosis This damages vital organs like brain, heart, lungs, and kidneys, leading to multi-organ dysfunction.
Clinical Features
Baby does not cry immediately after birth Weak or absent breathing Poor muscle tone (floppiness) Pale, bluish, or ashen skin (cyanosis) Low heart rate (<100/min) Poor reflexes
Diagnosis
APGAR Score at 1 and 5 minutes after birth (Appearance, Pulse, Grimace, Activity, Respiration). Score <7 indicates asphyxia. Blood gas analysis (low oxygen, high carbon dioxide, metabolic acidosis). Clinical observation of breathing and responsiveness.
Management
Immediate Resuscitation Clear airway (suction if needed) Provide warmth Stimulate breathing by rubbing the back or soles If no breathing → Bag and Mask ventilation Chest compressions if heart rate <60/min Medications (Adrenaline, Sodium bicarbonate if needed) Post-Resuscitation Care Maintain oxygen and glucose supply Monitor vital signs Treat seizures if present Therapeutic hypothermia (cooling therapy) in some cases to reduce brain damage
Complications
Hypoxic-Ischemic Encephalopathy (HIE) Seizures Cerebral palsy Developmental delay Organ failure (heart, kidneys, lungs) Death
Prevention
Good antenatal care (control maternal diseases) Skilled birth attendants at delivery Timely cesarean section in complicated labor Immediate neonatal resuscitation facilities Regular fetal monitoring during labor
Conclusion
Birth asphyxia is a preventable but life-threatening condition. Early recognition, quick resuscitation, and proper neonatal care can save lives and reduce complications. Improving maternal healthcare and skilled delivery services is the key to preventing birth asphyxia and ensuring a healthy start for every newborn.