What Is Asphyxia? — Definition, Causes & Symptoms
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- 0:01 What Is Asphyxia?
- 1:10 Causes of Asphyxia
- 2:05 Symptoms of Asphyxia
- 2:56 Lesson Summary
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Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences
Christianlly has taught college physics and facilitated laboratory courses. He has a master’s degree in Physics and is pursuing his doctorate study.
What Is Asphyxia?
Karen and her brother Stephen were swimming in their family’s pool. Karen was laying on a float, soaking up some sun, while Stephen was diving for toys. Suddenly, she realized Stephen had gotten awfully quiet so she sat up to see what he was doing. To her surprise, Karen saw Stephen floating off to the side of the pool! He was quiet, his eyes were closed, and his skin had a slight blue tint to it. She realized he was unconscious, so she jumped down, pulled him out of the pool, and began CPR while calling for their mom.
What happened to poor Stephen? Well, Stephen accidentally inhaled some pool water during one of his dives and was suffering from the early stages of asphyxia. Luckily, Karen’s CPR training helped her save her little brother’s life!
Asphyxia is the condition where the body either doesn’t get enough oxygen to continue normal function or has too much carbon dioxide to function properly. Without adequate oxygen, nerve cells in the brain begin to die in about 2-4 minutes, and cell death is irreversible. When Stephen inhaled water, the water in his lungs blocked the lungs’ uptake of oxygen. Drowning or near drowning can cause asphyxia, but so can a number of other conditions.
Causes of Asphyxia
Asphyxia can occur when the airway is physically blocked or as a side effect of an injury or other medical condition.
Examples of the airway being physically blocked can include:
- A foreign object lodged in the respiratory system or throat
- The tongue blocking the airway when a person is unconscious
Examples of injuries or illnesses that can cause asphyxiation can include:
- Collapsed lung
- Inhalation of toxic fumes (like carbon monoxide)
- Whooping cough
- Diptheria (bacterial infection)
- Heart failure
- Swollen veins in the head or neck
- Broken neck
- High blood pressure
- Allergic reaction
- Sleep apnea
- Drug overdose
As you can see, there are many scenarios where asphyxia can occur.
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Symptoms of Asphyxia
There are a few tell-tale signs of asphyxia. You may have found it alarming that Stephen’s skin turned blue in the scenario, but this is one symptom of asphyxia. Any time the body isn’t getting enough oxygen, affected areas may develop a blueish tint.
Other symptoms may include difficulty breathing, either decreased or increased heart rate, weakness, and seizures or convulsions. If left untreated, asphyxia can lead to coma, brain death (the brain stops functioning while the other organ systems persist), or death (organ systems fail in addition to the brain).
Treating asphyxia is pretty clear cut as it depends on clearing the airway or addressing the underlying illness or injury. In Stephen’s case, he was lucky his sister was trained in CPR because she was able to deliver much-needed oxygen to his system. Not all scenarios end so happily.
Asphyxia is a condition that occurs when the body either doesn’t get enough oxygen or there’s a build up of too much carbon dioxide. This can happen when the airway is blocked, meaning the person struggles to breathe (or can’t breathe at all), or it can happen as a result of an injury or illness that affects respiration. This can be due to choking, suffocation, drowning, paralysis, asthma, croup, or many other diseases or injuries.
Without oxygen, cell death can occur in 2-4 minutes. Symptoms of asphyxia might include difficulty breathing, inability to breathe, developing a blueish tint to the skin, irregular heart rate, weakness, and seizures. Long-term results of asphyxia include coma and death.
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Asphyxia: A Case Study
In this activity, you’ll be asked to analyze two scenarios and provide a written response to questions about each scenario.
Jared, a 25-year-old man overdosed on drugs while at a skiing event. He suffered an accident and was brought immediately by an ambulance into a nearby medical facility. Unluckily, the event fractured his knees, which required a knee replacement surgery. After the surgery, he was brought to the recovery room but failed to awaken. Two hours later, Jared remained unconscious, and later on, a generalized seizure occurred. He had an elevated breathing rate and blood pressure, with acid production occurring on his kidney. He had no other outstanding medical history, apart from a family history of addiction.
- In this scenario, is drug overdose the reason behind Jared’s unconsciousness? Support your answer.
- If so, what do you call this condition that the patient is suffering? Describe this condition.
A premature baby boy was born to a 33-year-old patient after 36 weeks of gestation. The infant was delivered via c-section due to fetal stress. A drop in maternal blood pressure during delivery with blood flow to the infant’s brain occurred. A few seconds after delivery, the baby turned pale with no heartbeat and breathing observed.
- Is the baby suffering from asphyxia? Why do you say so?
- Provide two possible treatments for this given scenario.
- Drug overdose leads to abnormally high carbon dioxide levels in the blood, depriving the body of oxygen. Such substances can cause respiratory problems that require immediate help.
- In such a case, this leads to the condition known as asphyxia. It is a condition in which an extreme decrease in the concentration of oxygen in the body leads to loss of consciousness or even death.
- Yes, the baby is suffering from asphyxia. In particular, this baby had inadequate blood circulation during delivery.
- The baby should undergo resuscitation and intubation. After this, he should be referred to the intensive care unit for diagnosis.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
Birth asphyxia occurs when a baby doesn’t receive enough oxygen before, during or just after birth. There are many reasons that birth asphyxia may occur.
Some of the causes of decreased oxygen before or during the birth process may include:
- Inadequate oxygen levels in the mother’s blood due to heart or respiratory problems or lowered respirations caused by anesthesia
- Low blood pressure in the mother
- Inadequate relaxation of the uterus during labor that prevents oxygen circulation to the placenta
- Early separation of the placenta from the uterus, called placental abruption
- Compression of the umbilical cord that decreases blood flow
- Poor placenta function that may occur with high blood pressure or in post-term pregnancies, particularly those past 42 weeks
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Factors that may lower oxygen in the baby after birth include:
- Severe anemia, or a low blood cell count, that limits the oxygen-carrying ability of the blood
- Low blood pressure or shock
- Respiratory problems that limit oxygen intake
- Heart or lung disease
Low oxygen levels may decrease a baby’s heart rate, blood pressure and blood flow out of the heart. This may limit the blood flow to organs and tissues, leading to improper cell function or damage. Organs typically affected by lowered oxygen include the brain, heart and blood vessels, gastrointestinal tract, lungs and kidneys.
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- Signs and Symptoms
Each baby may experience symptoms of birth asphyxia differently. However, the following are the most common symptoms.
Before delivery, symptoms may include:
- Abnormal heart rate or rhythm
- An increased acid level in a baby’s blood
At birth, symptoms may include:
- Bluish or pale skin color
- Low heart rate
- Weak muscle tone and reflexes
- Weak cry
- Gasping or weak breathing
- Meconium — the first stool passed by the baby — in the amniotic fluid, which can block small airways and interfere with breathing
The following test are used to diagnose birth asphyxia:
- Severe acid levels — pH less than 7.00 — in the arterial blood of the umbilical cord.
- Apgar score of zero to three for longer than five minutes. The Apgar test is used just after birth to evaluate a newborn’s color, heartbeat, reflexes, muscle tone and respiration.
- Neurological problems, such as seizures, coma and poor muscle tone.
- Respiratory distress, low blood pressure, or other signs of low blood flow to the kidneys or intestines.
Problems with a baby’s circulatory, digestive and respiratory systems may also suggest that a baby has birth asphyxia.
Birth asphyxia is a complex condition that can be difficult to predict or prevent. Prompt treatment is important to minimize the damaging effects of decreased oxygen to the baby.
Specific treatment for birth asphyxia is based on:
- The baby’s age, overall health and medical history
- Severity of the baby’s condition
- The baby’s tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
Treatment may include:
- Giving the mother extra oxygen before delivery
- Emergency delivery or Caesarean section
- Assisted ventilation and medications to support the baby’s breathing and blood pressure
- Extracorporeal membrane oxygenation (ECMO)
What is birth asphyxia?
Asphyxia (as-FIX-ee-uh) means lack of oxygen and blood flow to the brain. Birth asphyxia happens when a baby’s brain and other organs do not get enough oxygen and nutrients before, during or right after birth. This can happen without anyone knowing. Without oxygen and nutrients, cells cannot work properly. Waste products (acids) build up in the cells and cause damage.
The amount of harm depends on:
- How long your baby does not get enough oxygen
- How low the level of oxygen is
- How quickly the right treatment is given
- The first stage happens within minutes if blood flow is low and cells do not get enough oxygen.
- The second stage is called “reperfusion injury.” It can last for days or even weeks. This injury happens after the brain starts getting normal levels of blood and oxygen. Toxins released from the damaged cells cause this injury.
- Too little oxygen in the mother’s blood before or during birth
- Problems with the placenta separating from the womb too soon
- Very long or difficult delivery
- Problems with the umbilical cord during delivery
- A serious infection in the mother or baby
- High or low blood pressure in the mother
- Baby’s airway is not formed properly
- Baby’s airway is blocked
- Baby’s blood cells cannot carry enough oxygen (anemia)
- For a phone consultation with a neonatologist, call 206-987-7777 or 866-987-7777 (toll free).
- If you need neonatal emergency transport, call 206-987-8899 or 866-987-8899 (toll free).
The experts you need are here
At Seattle Children’s, your baby will get care from a whole team of experts in newborn care. In 2020, U.S. News & World Report once again named Seattle Children’s among the nation’s best pediatric hospitals. Our Neonatology Program is one of the top-ranked programs of its kind in the United States, which means your child will be cared for by the very best.
Our 32-bed Neonatal Intensive Care Unit (NICU) is the first in the state to be designated level IV. That’s the highest level possible.
We are the only hospital in the Pacific Northwest that provides 24/7 access to all the pediatric medical and surgical specialists your child may need. We stay in close communication with you – and with each other – to plan and provide the best treatment for your child.
The most advanced treatments
We provide the most advanced treatments and services in the region. Some are offered nowhere else in the Northwest. We can monitor and treat babies even when 1 or more body organs have failed.
- Body cooling (hypothermia) to reduce the risk of brain injury in babies with asphyxia.
- Extracorporeal life support (ECLS) that does the work of your baby’s heart or lungs if they are not working well and need time to heal. “Extracorporeal” means outside the body. It is also called ECMO. Our life support team has some of the nation’s best outcomes.
- State-of-the-art breathing support. As needed, we treat your newborn with breathing machines (ventilators) or inhaled nitric oxide (iNO) to open the blood vessels in the lungs.
- Neuro NICU with cutting-edge technology to keep a careful watch on your baby. Near-infrared spectroscopy ( NIRS ) measures blood flow in their brain. Video electroencephalography ( EEG ) helps us monitor brain activity. We use noninvasive MRI (magnetic resonance imaging) to make pictures of your baby’s brain without radiation.
- The largest team of anesthesiologists who specialize in treating only babies and children. Managing your baby’s pain is critical to their healing.
- Continuous dialysis to filter their blood if your baby has kidney failure.
- Mobile life support, including ECLS if needed, to bring babies to Seattle Children’s from anywhere in Washington, Alaska, Montana, Idaho, Hawaii or Oregon. We also can use body cooling during transport.
National research leaders
Our neonatologists are internationally known for their work to protect and heal the brains of babies who did not get enough oxygen at childbirth. We are committed to improving treatments for babies with asphyxia so they have the best possible chance at a healthy life.
Babies in our care can take part in research studies of promising new treatments. These are called clinical trials.
Dr. Sandra “Sunny” Juul co-leads a multicenter national study that uses high doses of the hormone erythropoietin (Epo) combined with body cooling to treat babies with asphyxia. Researchers will test the babies’ thinking and movement at age 2. The goal is to save lives and improve outcomes. The multicenter study is called HEAL (High-dose Erythropoietin for Asphyxia and Encephalopathy). This work builds on earlier research by Dr. Juul and Dr. Dennis Mayock. See Researchers Combine Therapies to Find a Better Way to Treat Brain Injury in Infants.
Our physician-scientists also:
- Study and test innovative mechanical heart devices. Our goal is to develop safer, more effective devices for children with breathing problems or very weak hearts.
- Look for the best ways to reduce stress in the NICU and relieve pain. They also study the long-term effects of stress and pain on the developing brain.
Learn more about Seattle Children’s research to improve newborn care.
Support for your whole family
- At Seattle Children’s, your family has a full team behind you. We offer a comforting environment for you and your family.
- We work with you to make decisions and treatment plans for your baby. We invite you to share your insights, questions and concerns during daily meetings of your baby’s healthcare team. The meetings are called “rounds.” Consultations are available to help you sort through confusing or difficult medical issues.
- We work with many children and families from around the Northwest and beyond. We can help with financial counseling, housing, transportation, interpreter services and spiritual care. Our goal is to get you and your baby home – or back to a hospital close to home – as soon as possible.
Symptoms of Birth Asphyxia
Symptoms of asphyxia at the time of birth may include:
- Not breathing or very weak breathing
- Skin color that is bluish, gray, or lighter than normal
- Low heart rate
- Poor muscle tone
- Weak reflexes
- Too much acid in the blood (acidosis)
- Amniotic fluid stained with meconium (first stool)
Diagnosing Birth Asphyxia
At birth, doctors and nurses check your baby’s condition carefully and give a number rating from 0 to 10. This number is called an Apgar score. The Apgar rates skin color, heart rate, muscle tone, reflexes and breathing effort. A very low Apgar score (0 to 3) lasting longer than 5 minutes may be a sign of birth asphyxia.
The doctor will check your baby for other signs of a lack of blood flow or oxygen. These include:
- Abnormal breathing
- Poor blood circulation
- Lack of energy (lethargy)
- Low blood pressure
- Not peeing
- Blood-clotting abnormalities
Treating Birth Asphyxia
If your baby has mild asphyxia at birth, they will get breathing support until they can breathe well enough on their own. We watch them closely for signs of problems.
Babies with more serious asphyxia may need:
- Breathing support from a machine that sends small, rapid puffs of air into your child’s lungs. Some babies may need nitric oxide through a breathing tube or a heart-lung pump for life support.
- Body cooling (hypothermia).
- Medicine to control blood pressure.
- Kidney support with dialysis.
- Medicine to treat seizures.
- Intravenous (IV) nutrition to give their bowel time to recover.
When needed, we provide these advanced treatment options:
High-frequency ventilation uses a breathing machine that sends small, quick puffs of air into your baby’s lungs. It is more gentle than a regular breathing machine, which sometimes uses high pressure that can damage fragile newborn lungs.
Inhaled nitric oxide
Inhaled nitric oxide is used if your baby has respiratory failure or high blood pressure in the lungs (pulmonary hypertension). Your baby will get nitric oxide through a breathing tube into their airway. This helps open (dilate) the blood vessels in their lungs so the vessels can carry oxygen-rich blood around the body.
Research shows that cooling a baby’s internal body temperature to 33.5 degrees C (about 91 degrees F) for 72 hours can help protect their brain from damage during the second stage of asphyxia. This stage (reperfusion) is when normal blood flow and oxygen are restored to the brain. This treatment works best to reduce brain damage if it is started within 6 hours after birth. This treatment is only used if babies are at least 35 weeks’ gestation (not more than 5 weeks early).
Extracorporeal life support (ECLS)
Extracorporeal life support uses a heart-lung pump to provide temporary life support when a baby’s heart or lungs are not working well or need time to heal. “Extracorporeal” means outside the body. Oxygen-poor blood is drawn into a machine that removes carbon dioxide, adds oxygen and then returns the oxygen-rich blood to the baby’s body. We will give your baby sedation while on ECLS. A nurse and an ECLS specialist will closely monitor your baby. The ECLS machine used to be called extracorporeal membrane oxygenation (ECMO).
Babies born too soon (premature) or those who did not get enough oxygen during birth may have permanent injury. This may affect their brain, heart, lungs, kidneys, bowels or other organs.
Babies with asphyxia may develop:
- Cerebral palsy
- Developmental delays
- Attention deficit hyperactivity disorder (ADHD)
- Hearing problems
- Eyesight problems
After your child receives any urgent or emergency treatment they need, the team at Seattle Children’s plans and provides ongoing care so your child has the best possible outcome. We evaluate all your child’s health needs and work with you to create a care plan that fits your child and family. Catching problems early and getting a referral to specialists may improve outcomes for your child.
Do babies recover from birth asphyxia?
Babies with mild or moderate asphyxia may recover fully. If the cells did not get enough oxygen for a longer time, a baby may have permanent injury. This could affect their brain, heart, lungs, kidneys, bowels or other organs.
Body cooling (therapeutic hypothermia) can improve outcomes for babies born at full term or near term. But babies born 5 or more weeks early cannot have body cooling. In the most severe cases, asphyxia can lead to organ failure and death.
Stages of birth asphyxia
Two stages of injury can happen with birth asphyxia:
What causes birth asphyxia?
Some causes of birth asphyxia include:
Birth Asphyxia at Seattle Children’s
We have a great deal of experience treating babies with birth asphyxia. Seattle Children’s newborn care experts treat the sickest babies. At Seattle Children’s, you are a key member of your baby’s healthcare team. Together, we work to improve your baby’s quality of life, not just meet their medical needs.