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What Is Birth Asphyxia? – Top 9 Questions Parents Ask About Birth Asphyxia

June 18, 2018

If your newborn baby has been diagnosed with a brain injury caused by birth asphyxia, the news is devastating and you are likely searching for answers as to how and why the injury occurred, whether it could have been prevented, and what the future holds for your child.

Below are answers to the nine most common questions asked by parents when birth asphyxia results in a brain injury to their child.

What Is Birth Asphyxia?

Birth asphyxia is a disorder characterized by a severe lack of oxygen to a baby during childbirth. This severe oxygen deficiency is also known as birth hypoxia or intrauterine hypoxia. When the infant’s body lacks oxygen, its cells cannot work properly, and therefore birth asphyxia can often result in brain damage and even death. This brain damage is called hypoxic-ischemic encephalopathy, known as HIE.

Infants who suffer from hypoxic-ischemic encephalopathy (HIE) can end up with life-altering impairments or disabilities including cerebral palsy, cognitive deficits, and hearing and/or vision loss. Even without detectable brain damage, children who’ve had birth asphyxia are at increased risk for learning disabilities, language delays and other issues later in life.

Electronic fetal heart rate monitoring (EFM) during labor can help prevent the brain damage associated with birth asphyxia. EFM allows medical professionals to assess whether a baby is receiving sufficient oxygen during labor and delivery by monitoring the baby’s heart rate. If the baby is in distress, an immediate caesarean section may be required to prevent further oxygen deprivation and to allow doctors to provide immediate medical assistance to the baby and, ideally, prevent hypoxic-ischemic encephalopathy.

Right after delivery oxygen deprivation can be detected through a quick medical assessment that all babies undergo, which is known as an Apgar score. The assessment, which is performed at 1 and 5 minutes after birth, measures a baby’s:

    • Heart rate
    • Respiration
    • Muscle tone
    • Reflex response
    • Color

A low Apgar score may mean that the baby requires medical intervention. Depending upon how low the total score is, the help can range from simply suctioning the baby’s mouth and nostrils to lifesaving resuscitation.
In cases of severe birth asphyxia or hypoxic-ischemic encephalopathy, a body cooling therapy, called Neonatal Therapeutic Hypothermia, can mitigate the effects of oxygen deprivation if administered to the baby within a few hours of birth.

What Causes Birth Asphyxia?

The causes of birth asphyxia primarily fall under three categories:

  • Medical conditions of the expectant mother
  • Complications during labor and delivery
  • Failure by doctors, nurses and other medical professionals to properly interpret and act upon fetal heart rate monitoring

What Medical Conditions of the Mother Put an Infant at Risk for Birth Asphyxia?

Some of the medical conditions of the mother that can put an infant at risk for birth asphyxia include:

  • Maternal hypertension (high blood pressure) — can cause placental infarction (lesions within the placenta that can impair the circulation to the fetus) and/or placental abruption (a premature separation of the placenta from the uterus that can cause an acute and potentially catastrophic loss of oxygen to the baby). Severe maternal hypertension associated with other findings is called pre-eclampsia and also can put the baby at risk and the mother at risk of developing seizures. HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome) is a particularly severe form of maternal hypertension that affects other organs and requires early delivery.
  • Diabetes — can cause macrosomia (an excessively large baby making delivery difficult) and/or make the baby more vulnerable during the last weeks of the pregnancy and during labor and delivery.
  • Liver problems, including cholestasis — cholestasis is generally an indication for early delivery as babies do not tolerate labor well.

What Complications during Childbirth Put an Infant at Risk for Birth Asphyxia?

Some of the complications during childbirth that will put an infant at risk of birth asphyxia include:

  • What’s known as the three P’s of labor: passageway (route the baby takes through the mother’s pelvis, cervical opening and birth canal); the baby’s size and position in the uterus and the direction the baby is facing (passenger); and strength and frequency of contractions (power)
  • Prolonged dilatation and prolonged descent during labor; arrest of dilatation and/or descent
  • Nuchal cord — the umbilical cord wraps around the newborn=s neck
  • Cord compression — the umbilical cord circulation is interrupted during the course of labor, often during the pushing phase
  • Cord prolapse — the umbilical cord leaves the uterus before the baby
  • Placental abruption — the placenta detaches prematurely from the uterus
  • Breech delivery (also known as breech birth) — the child comes out of the uterus foot-first or buttocks-first rather than head-first
  • Occiput posterior (OP) versus occiput anterior (OA) head position at delivery: “sunny side up” face instead of normal facing down
  • Shoulder dystocia — when the baby’s head has been delivered, but the baby’s shoulders get stuck behind the mother’s pelvis

Failure to Properly Interpret and Act upon Fetal Heart Rate Monitoring Can Cause Birth Asphyxia

Fetal heart rate monitoring allows healthcare providers to assess whether an unborn baby is receiving sufficient oxygen during childbirth. Fetal monitoring and monitoring of uterine contractions can be done either externally, by wrapping a pair of belts around the mother’s abdomen, or internally by attaching a small electrode to the baby’s head and inserting an
intra-uterine pressure catheter once the mother’s amniotic sac is ruptured and her cervix is dilated 2-3 centimeters.

Reassuring heart rates are within a normal range of 110-160 with accelerations and no repetitive decelerations.

If the heart rate is high, called tachycardia, the baby’s heart may be working faster than normal to compensate for low oxygen levels. If the heart rate is low, called bradycardia, the baby may not be receiving enough oxygen. Tachycardia and bradycardia are often signs that the baby is in distress and at risk for permanent brain injury due to lack of oxygen and an immediate cesarean section may be necessary.

Repetitive decelerations including variable decelerations (consistent with nuchal cord or cord compression) and late decelerations (consistent with placental dysfunction) — particularly if associated with other non-reassuring signs such as decreased variability and/or tachycardia and/or bradycardia — may be an indication for urgent/emergent delivery.

When medical professionals fail to properly interpret and act upon crucial data provided by the fetal heart rate monitor and the baby’s oxygen deprivation is severe and prolonged, permanent brain damage may occur.

What Do the Apgar Scores Mean?

At the 1 and 5 minute marks after birth, all babies undergo a quick medical assessment of their well-being, which is known as an Apgar score. The following five conditions are scored 0 to 2, with 0 signifying the worst medical state, and 2 signifying the best:

  • Heart rate
  • Respiration
  • Muscle tone
  • Reflex response
  • Color

The scores for each condition are added together. At the 1-minute mark, the total Apgar score is interpreted as follows:

  • Between 7 and 10 — the baby requires only routine post-delivery care
  • Between 4 and 6 — the baby requires breathing assistance, which can include suctioning the nostrils, massaging the baby and administering oxygen
  • 3 or less — the baby requires lifesaving measures, such as resuscitation

At the 5-minute mark, a total Apgar score between 7 and 10 is considered normal; a score of 6 or lower means further medical intervention such as admission to the neonatal intensive care unit (NICU) for further support and evaluation or hypothermia treatment may be warranted.

Low Apgar scores may be indicative of birth hypoxia or asphyxia.

What Is the Significance of a Cord Blood Gas/Cord pH?

A small sample of blood may be taken from a baby’s umbilical cord immediately following delivery. A normal cord pH ranges from 7.18 to 7.38. A more detailed study called arterial blood gases (ABG) can also be done in the hospital lab. A low cord pH and/or abnormal ABGs may be consistent with hypoxic brain injury.

Can the Severity of Brain Injury from Birth Asphyxia Be Reduced?

Yes. Body cooling therapy, called Neonatal Therapeutic Hypothermia, can reduce the risk of permanent brain injury to term newborns suffering from severe acute birth asphyxia. But body cooling therapy must be initiated shortly after birth to be effective. Failure by medical professionals to promptly initiate body cooling therapy or to transfer a baby to a hospital that is capable of providing body cooling therapy may be medical malpractice.

Body cooling therapy aims to slow or stop damaging effects of birth asphyxia by lowering the infant’s body temperature for up to 72 hours. The technique, called hypothermia treatment, involves placing the newborn on a waterproof blanket that contains cool circulating water which can reduce the infant’s temperature to as low as 91.4 degrees Fahrenheit. After three days of treatment, the caregivers allow the newborn’s temperature to return to normal.

The National Institutes of Health (NIH) found in a 2005 study that this treatment demonstrated a reduced risk of death and disability by ages 18 to 22 months as compared with routine care without the treatment. The NIH found a significantly lower mortality rate in the hypothermia group (28%) compared with the usual care group (44%). According to the NIH, researchers also calculated the number of deaths and cases of severe disability as a single combined outcome. Severe disability involved motor function, cognitive ability and vision. The combined rate was 41% for the cooling group, compared with 60% for the usual care group. Rates of cerebral palsy, blindness and epilepsy were similar between the two groups.

Following the NIH study, the internationally acclaimed Cochrane Library published a meta-analysis of cooling therapy studies, concluding, “There is evidence that induced hypothermia (cooling) of newborn babies who may have suffered from a lack of oxygen at birth reduces death or disability, without increasing disability in survivors.” Furthermore, it recommended that “parents should expect that cooling will decrease their baby’s chance of dying and that if their baby survives, cooling will decrease his/her chance of major disability.” When newborns with birth asphyxia or hypoxic-ischemic encephalopathy are not given this treatment in time or at all, the consequences, as mentioned above, are potentially devastating. This treatment has been adopted as the standard of care for newborns with oxygen deficiency due to its promising results.

What Happens If My Child Is Diagnosed with Hypoxic-Ischemic Encephalopathy?

Hypoxic-ischemic encephalopathy often results in lifelong disability requiring significant care, treatment and financial resources. If your baby has hypoxic-ischemic encephalopathy you may have a medical malpractice claim against healthcare providers whose negligence caused this brain injury or who failed to initiate body cooling therapy to reduce or prevent it. The malpractice claim is for the harm your child suffered, and for the cost of care and treatment for your child.

The lawyers at Feldman Shepherd Wohlgelernter Tanner Weinstock & Dodig LLP are pursuing medical malpractice claims for children injured by birth asphyxia. The lawsuits filed on behalf of birth asphyxia victims and families seek damages for medical bills, loss of earning potential, pain and suffering, and loss of the pleasures of life.

A sampling of recent results achieved by Feldman Shepherd attorneys Carol Nelson Shepherd, Daniel S. Weinstock, Patricia M. Giordano, G. Scott Vezina and Carolyn M. Chopko in birth asphyxia cases includes:

  • A $78.5 million verdict in Philadelphia for a child who suffered severe spastic quadriplegic cerebral palsy as a result of an 81-minute delay in performance of an emergency cesarean section delivery.
  • A $30.5 million verdict in Georgia for a child who suffered a severe hypoxic-ischemic brain injury leading her to develop spastic quadriplegic cerebral palsy, developmental delays, and a seizure disorder as a result of a delay in performance of an emergency cesarean section.
  • A $16.05 million settlement in Massachusetts for a child who suffered severe brain damage at birth following a placental abruption and delayed delivery. The neonatology team additionally failed to adequately and properly institute resuscitation procedures. Feldman Shepherd has been told that this is the largest pre-trial medical malpractice recovery in Massachusetts.
  • A $16 million settlement in Philadelphia for negligent management of labor and delivery causing cerebral palsy. The case presented a tragic example of the second-class care poorer citizens sometimes receive in the city of Philadelphia. As part of a program to supply physician coverage for “underserved” areas of the city, the United States of America (through an affiliated entity) selected and provided an obstetrician who had numerous other prior malpractice claims against him.
  • A $16 million verdict for a child with severe cerebral palsy caused by a catastrophic placental abruption that occurred at 39 ½ weeks gestation during a high-risk pregnancy. Feldman and Shepherd argued that the standard of care required the maternal fetal medicine doctor to deliver the child at 38 weeks’ gestation, or term.
  • An $11.8 million settlement for a child who suffered severe brain damage at birth following a placental abruption that occurred after nursing staff failed to recognize an emergency for more than an hour. The recovery may be the largest ever pre-trial medical malpractice recovery in the Central Florida region.
  • A $10.24 million settlement in New York for an infant who suffered severe hypoxic ischemia causing cerebral palsy and all of the other sequelae that follow such a diagnosis. Despite the fact that electronic fetal monitoring became increasingly non-reassuring, a hospital nurse and a senior resident failed to alert the mother’s obstetrician. By the time the obstetrician learned the status of his patient and came to her bedside, the fetus was severely bradycardic. The case was unique because of its qualification for involvement in the New York Medical Indemnity Fund (MIF), which provides compensation for all future medical expenses on behalf of any child injured at birth as a result of medical negligence.
  • A $10 million settlement in Arizona on behalf of a child who suffered hypoxic ischemic encephalopathy and developed cerebral palsy due to a hospital’s failure to timely treat the child’s non-reassuring fetal heart rate tracings. This settlement may be the largest ever pre-trial medical malpractice recovery in the region.
  • A $5.3 million groundbreaking settlement in favor of a child who suffered significant brain damage when doctors failed to transfer her after birth to a regional hospital where she could receive body cooling therapy to minimize the impact of birth asphyxia. Feldman Shepherd is unaware of any previous cases in the country where a recovery has been made for negligent failure to perform body cooling.

Other significant verdicts and settlements achieved by Feldman Shepherd attorneys in cases involving birth and neonatal injuries include:

  • A $20 million settlement in Central Pennsylvania for a child who suffered kernicterus and cerebral palsy as a result of the failure by healthcare providers to timely treat his hyperbilirubinemia. Feldman Shepherd is unaware of any larger pre-trial medical malpractice case recovery in the region or of any larger recovery in a kernicterus case anywhere.
  • A $12 million settlement for a child with kernicterus and cerebral palsy. The child was born completely healthy, but on the fifth day of life became severely jaundiced with an alarmingly high bilirubin level. A delay of more than 12 hours occurred before healthcare providers performed an emergency exchange blood transfusion.
  • A $10 million settlement in California for a child with kernicterus and cerebral palsy. California law imposes a general damages cap of $250,000 in medical negligence cases and applies numerous hurdles and barriers designed to prevent a medical malpractice victim from obtaining fair compensation for their injuries. Feldman Shepherd attorneys were able to prove that the hospital was providing substandard treatment and care to newborn babies if their family members spoke Spanish but not English, which was racial discrimination that rendered the cap inapplicable.

If you or a loved one has been injured and would like to speak with a Feldman Shepherd attorney, please contact us.


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