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Perinatal Asphyxia

(Hypoxic Ischemic Encephalopathy; HIE; Cerebral Hypoxia)

Definition

Perinatal asphyxia is a condition in which a baby’s brain does not receive enough oxygen during or after birth. This results in cardiorespiratory or brain damage.
Asphyxia can be fatal. Brain cells can begin dying within as little as five minutes without oxygen. The disease can also cause long-term damage, including intellectual disability, delayed development, seizures, and cerebral palsy.

Causes

Asphyxia may be caused by:
  • The placenta separating from the uterine wall too early
  • Pressure on the umbilical cord
  • Certain medications
  • Infection
  • Breathing in meconium from the amniotic fluid
  • Birth trauma

Risk Factors

Factors that increase your baby’s risk of perinatal asphyxia include:
  • Previous still birth
  • Fetal heart rate abnormalities
  • Water breaking more than 12 hours before delivery
  • Meconium in the fluid surrounding the baby before birth
  • Hemorrhage occurring prior to childbirth
  • Fever in the mother
  • Prolonged first and second stages of labor
  • Pre-term or post-term labor
  • Delivery with forceps or a vacuum device

Symptoms

Mild asphyxia may cause:
  • Poor muscle tone
  • Irritability
  • Extreme drowsiness
  • Feeding difficulties, including poor suck
Severe asphyxia may cause:
  • Seizures
  • Poor arousal
  • Blue-colored skin or lips
  • Difficulty breathing

Diagnosis

A physical exam will be done. Typically, the history is the most important factor in making the diagnosis.
Your baby’s bodily fluids may be tested. This can be done with blood tests.
Images may need to be taken of your baby’s bodily structures. This can be done with:
Your baby’s heart and brain activity may also be tested. This can be done with:

Treatment

Life-sustaining Treatment

Life-sustaining treatment may be used if reduced brain function has happened but there is no extensive damage yet. Treatment options include mechanical ventilation to take over or support breathing and oxygen therapy. These treatments will be stooped as your baby recovers.

Medications

Medication may be needed to support heart function until your baby recovers. Medication and general anesthesia may also be given to control seizures.

Lowering Body Temperature

Your baby may be wrapped in cooling blankets within hours of birth. This will lower body temperature and reduce the risk of tissue injury and reduce the risk of long-term problems.

Prevention

In most cases, asphyxia is sudden and cannot be prevented.

RESOURCES

Brain Injury Association of America http://www.biausa.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Ontario Brain Injury Association http://www.obia.ca

References

Birth asphyxia and hypoxic ischemic encephalopathy (HIE). EBSCO PEMSoft website. Available at: http://www.ebscohost.com/dynamed. Accessed February 25, 2013.

Brain injury secondary to carotid intervention [review]. J Endovasc Ther . 2007;14:219-231.

Edwards AD. The discovery of hypothermic neural rescue therapy for peri-natal hypoxic-ischemic encephalopathy. Semin Pediatr neurol . 2009;16(4):200-206.

Harrington DJ, Redman CW, Mouldan M, Greenwood CE. The long-term outcome in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort [review]. Am J Obstet Gynecol . 2007;196:463.e1-5.

Hemphill J, Smith W. Neurologic critical care, including hypoxic-ischemic encephalopathy and subarachnoid hemorrhage. In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine . 17th ed. New York, NY: McGraw-Hill; 2005: chap 269.

Hypoxic ischemic encephalopathy (HIE). Neurographics website. Available at: http://www.neurographics.org/2/1/1/4.shtml. Accessed February 19, 2013.

Itoo BA, Al-Hawsawi ZM, Khan AH. Hypoxic ischemic encephalopathy. Incidence and risk factors in North Western Saudi Arabia. Saudi Medical Journal . 2003;24:147-153.

Puohit D, Silverstein S. Perinatal hypoxic-ischemic encephalopathy. In: Gilman S, ed. MedLink Neurology . San Diego, CA: MedLink.

Schulzke SM, Rao S, Patole SK. A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy-are we there yet? BMC Pediatr . 2007;7:30.

8/11/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Azzopardi D, Strohm B, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med. 2014;371(2):140-149.

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