Birth Asphyxia

Dr Manigandan Chandrasekaran, Dr. R. Kishore Kumar
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Introduction
KEYWORDS: Asphyxia, hypoxia, brain injury

Birth asphyxia is defined as insufficient oxygen supply to a baby at or around the time of birth. Around 25% of the 4 million annual global neonatal deaths are attributable to birth asphyxia1. In high income countries, following birth asphyxia, Hypoxic-ischemic encephalopathy (HIE) occurs in approximately 1 to 2 infants per 1000 live term births2. The incidence of HIE has been reported several times higher in low and middle income countries than in high income countries. Significant proportions of these infants die or survive with severe long-term morbidity.

There are several causes for birth asphyxia. It could be before, during or after delivery. Before delivery it could be due to hypertension, hypotension, congenital infections, intrauterine growth restriction (IUGR), placental abruption, fetal anaemia and post maturity. Intrapartum could be due to abnormal labour leading to shoulder dystocia or breech presentation and cord prolapse. After birth causes include inability of baby to cry immediately after birth and severe circulatory collapse such as in severe blood loss.

Soon after birth, respiration should occur normally along with the removal of fetal lung fluid and there should be a good oxygen/carbon dioxide exchange between the alveoli and the blood. With onset of respiration and lung expansion, pulmonary vascular resistance decreases, followed by a gradual transition from fetal to adult circulation. It is the failure of this transition from fetal to adult circulation, the birth asphyxia occurs.

In early stages of birth asphyxia, blood flow to the less important organs like liver, kidneys, intestines, muscles and lungs decreases; however the blood flow to the vital organs such as the heart and brain and adrenal glands increases. The degree of organ damage is dependent on the oxygen requirement of the organ involved and the severity of the asphyxia.

In the early phase of birth asphyxia, there is transient increase in heart rate with associated fast breathing with increase in cardiac output and peripheral constriction of blood vessels. When birth asphyxia is prolonged, it leads to a decrease in blood pressure and cardiac output. When birth asphyxia becomes ever more prolonged with no further intervention, then secondary apnea ensues with rapid gasps, hypotension and severe bradycardia. Once HIE has developed, the signs and symptoms could be low APGAR score, convulsion or unconsciousness, floppy and symptoms of multiple organ involvement.

References
Birth Asphyxia Birth Asphyxia 09/05/2018
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