Overventilation and Hypocarbia

Many answers to a newborn’s health status can be found in their blood. A variety of cells, proteins, and gases can be found and measured within the bloodstream, including levels of oxygen, carbon dioxide, hemoglobin, red blood cell counts, white blood cell counts, and platelet counts.

When blood tests reveal low levels of any of these components in the blood, it can indicate a birth complication that needs quick treatment. When medical professionals fail to detect these abnormalities, these complications can cause or contribute to permanent birth injuries like hypoxic ischemic encephalopathy (HIE).

HIE is a severe brain injury that results from a lack of oxygenated blood flowing to the baby’s brain, resulting in neurological damage, delayed developmental milestones, vision impairments, seizures, and other complications. It is also the leading cause of cerebral palsy.

When a newborn is suspected to have HIE at birth, they may be given supplemental oxygenation through a machine in the neonatal intensive care unit (NICU). However, sometimes the breathing machine can be improperly set, removing too much carbon dioxide from the blood and creating adverse effects like hypocarbia.

When medical professionals fail to properly test a newborn’s blood or negligently contribute to a baby’s overventilation (too much oxygen during treatment), it can worsen their brain damage at birth and contribute to other complications, which can be grounds for a medical malpractice lawsuit.

Over the past three decades, the nationally recognized team of birth injury lawyers, registered nurses, and nurse-attorneys at Miller Weisbrod Olesky have established a proven track record of delivering justice for children and families across the United States who have suffered from all types of birth injuries.

We are prepared to meticulously investigate the circumstances of your case, gather crucial medical records, consult with top medical experts, and fight tirelessly to secure the compensation you deserve for your child's injury.

We represent families and their children throughout the United States. You can contact us today to schedule your free legal consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. We only receive payment once you do.

Hypocarbia (also known as hypocapnia) is a condition where the baby doesn’t have sufficient levels of carbon dioxide (CO2) in the blood.

Carbon dioxide serves two main purposes within the bloodstream: transporting waste and regulating pH levels. CO2 is a byproduct of cellular respiration; the blood transports it from the body’s tissues to the lungs for exhalation. Inside the blood it appears in the form of bicarbonate, which regulates the body’s acid-base balance.

The body needs sufficient levels of CO2 within the bloodstream to maintain this balance. The proper levels of CO2 in the blood (measured as PaCO2, or partial pressure of carbon dioxide dissolved in the blood) should fall in the range of 35-45 mmHg. When the levels fall below 35 mmHg, it can indicate the baby is in a state of hypocarbia.

Hypocarbia can stem from several different issues. One of the main causes is hyperventilation, when a baby is breathing deeper and more rapidly than normal and expelling excess amounts of CO2 with each breath.

Children and adults may hyperventilate when overexerted or anxious, but the causes are much different for newborns. One of the primary causes of rapid and shallow breathing (also known as neonatal tachypnea) is respiratory distress syndrome (RDS).

Respiratory distress syndrome is common in premature births where the baby’s lungs are not fully developed with sufficient coatings of surfactant. Surfactant is responsible for increasing airflow in the lungs and preventing the alveoli within the lungs from collapsing.

Lower levels of surfactant will force the baby to breathe harder and faster to take in oxygen. This can drive them into hyperventilation and cause them to expel more CO2 than necessary when exhaling, leading to hypocarbia.

Other pregnancy complications like meconium aspiration syndrome (when fetal waste ends up inside the lungs) can drive the baby into RDS, making it a risk factor for hypocarbia. Neonatal infections can also impact breathing, especially when they are severe and have developed into cases of neonatal sepsis (although this is a rare occurrence).

Another common cause of hypocarbia can come from neonatal breathing mismanagement at birth. Children who experience injuries during labor and delivery like hypoxia and birth asphyxia may require specialized breathing treatment after they are born. Depending on the severity of the newborn’s breathing issues, doctors may need to perform neonatal resuscitation.

In other cases, healthcare providers may transfer the infant to the neonatal intensive care unit (NICU) where they will be put on an assisted ventilation machine providing supplemental oxygen. These breathing machines can help aid babies in respiratory distress syndrome and other breathing issues, but they can also have adverse effects when improperly used.

If the ventilation machine is improperly set, the baby can receive too much oxygen and lose an excess amount of CO2 from their bloodstream. This is known as overventilation, and it can have adverse effects on blood flow within the baby’s brain and pH regulation within the body.

Overventilation can cause hypocarbia as well as lead to periventricular leukomalacia (PVL), a type of brain injury where blood flow isn’t able to reach all parts of the brain and results in the softening and damage of the white matter tissue around the ventricles.

PVL can come with symptoms of muscle spasticity and is often cited as an underlying cause of cerebral palsy. Medical professionals must be aware of this risk when administering supplemental oxygen to newborns through ventilation machines. When a child’s brain damage at birth stems from a case of hypocarbia after overventilation errors, it can constitute medical malpractice.

Unlike adults who go into hypocarbia, newborns are unable to clearly communicate their symptoms. This is why healthcare providers must be trained in how to identify signs of the condition as it develops.

One of the first signs that may point to an infant’s risk of hypocarbia is having respiratory distress syndrome. This will be characterized by rapid, shallow breathing (tachypnea) and a respiratory rate exceeding 60 respirations per minute. Nasal flaring, chest retractions, and grunting are other common signs.

Due to the electrolyte imbalances from hypocarbia, the baby may start to undergo muscle spasms and cramps. These may escalate into neonatal seizures, so doctors must keep a watchful eye and be prepared to administer anti-convulsant medications in case of an emergency.

Monitoring neonatal heart rates can also reveal signs of hypocarbia. Less carbon dioxide in the blood leads to vasoconstriction, meaning the blood vessels contract and decrease blood flow within the body.

This can be reflected by a decrease in heart rate with rapid decelerations. The same will be true in cases of fetal hypocarbia; fetal heart rate monitoring machines should show decelerations when there is a substantial decrease in CO2 within the unborn baby’s bloodstream. There will likely be other symptoms of hypocarbia that the baby will unfortunately have no way of communicating. These can include dizziness, feeling lightheaded, chest tightness, and numbness or tingling around the limbs.

With this in mind, neonatal healthcare providers must pay close attention to the observable signs and symptoms of hypocarbia through careful monitoring of the baby’s heart rates and breathing patterns, as well as any physical and behavioral concerns that may point to an issue.

Hypocarbia can lead to several different neurological, cardiovascular, and metabolic complications.

Among the most serious complications of hypocarbia are brain injuries like periventricular leukomalacia (PVL) and hypoxic ischemic encephalopathy (HIE). These injuries form as a result of vasoconstriction, preventing oxygenated blood from flowing to the head and other parts of the body.

When hypocarbia and thus vasoconstriction is prolonged, the restricted blood flow can also lead to organ dysfunction in other parts of the body, particularly to the heart. When prolonged, it can reduce the myocardial oxygen supply and lead to hypoxemia (reduction of oxygen in the blood).

Carbon dioxide is slightly acidic, so when the blood is deficient in CO2 it can throw off the body’s pH balance. This can lead to a complication known as respiratory alkalosis, when the body’s blood pH is above 7.45.

Respiratory alkalosis can affect calcium levels in the blood, leading to hypocalcemia and related muscle spasms. It can also cause lower phosphate and potassium levels, which can contribute to muscle weakness and fatigue.

When hypocarbia is suspected, the first step (following observation of physical symptoms) should be to order an arterial blood gas (ABG) test to measure CO2 levels and pH balance within the baby’s blood. A bicarbonate test (also known as a CO2 blood test) is another commonly used test to measure CO2 levels.

An arterial blood gas test will reveal the partial pressure of carbon dioxide within the arterial blood, measuring the amount of CO2 that has dissolved in the blood and is being carried to the lungs for exhalation.

A normal range for PaCO2 levels is between 35-45 mmHg (millimeters of mercury). When an infant’s readings fall below 35 mmHg, it is a sign of hypocarbia.

Additionally, using imaging tools like X-rays and CT scans can reveal any possible complications that are causing respiratory distress leading to hyperventilation and thus developing hypocarbia. Examples of conditions that may be found on these scans include pneumonia, pulmonary edema, or other diseases of the lungs.

Mechanical ventilation can be both a cause and a treatment option for hypocarbia.

When it comes to treatment, careful monitoring and management of ventilation is critical when the baby requires assisted ventilation via respiratory machines.

If the baby begins to show signs of overventilation, healthcare providers must quickly adjust the settings by either decreasing the peak pressure, modifying tidal volumes (the amount of air delivered with each breath), or changing the mode on the ventilator.

In the case of neonatal infections like pneumonia or sepsis contributing to a baby’s hypocarbia, early administration of antibiotic medications is crucial to treatment and restoring proper CO2 and oxygen levels.

Hypocarbia can lead to a brain injury relatively quickly due to its effects on restricting blood flow, so it’s important that healthcare providers quickly order blood testing and administer treatment when a case is suspected so the baby can avoid irreversible damage to their brain.

Hypocarbia cannot be prevented in all cases, but there are actions healthcare providers can take to mitigate the risk.

Like with all birth injury prevention, careful monitoring throughout the mother’s pregnancy and delivery is key to catching potential complications. This begins with proper prenatal testing and managing any of the mother’s pregnancy complications that may affect the baby’s blood CO2 levels, such as a maternal infection.

Throughout pregnancy and during labor and delivery, careful heart rate monitoring can alert medical professionals of any sudden changes in fetal status that can be treated before developing into fetal distress.

Upon birth, close physical examination of the baby’s breathing and overall appearance can indicate to doctors when neonatal resuscitation and further respiratory intervention is needed. Proper training and knowledge of how ventilation machines work can help healthcare professionals avoid errors that can lead to overventilation brain injuries.

Brain injuries like periventricular leukomalacia and hypoxic ischemic encephalopathy can permanently affect a baby’s life trajectory. When this brain damage at birth is the result of hypocarbia from overventilation or another form of neonatal breathing mismanagement, it can count as medical malpractice.

Medical negligence, such as failing to test for hypocarbia amid present physical symptoms or making errors when adjusting ventilator settings, can play a part in a child’s preventable birth injury. If a family believes medical negligence worsened their child’s injuries, legal support may be an option. A specialized birth injury attorney can review the medical records and circumstances to assess whether a claim exists.

Parents whose children suffer from the long-term effects of hypocarbia deserve to know whether it could have been prevented. Our dedicated birth injury lawyers want to help you find those answers and obtain the funds necessary to improve the quality of life for your child.

If your child has been diagnosed with hypocarbia and a resulting brain injury, and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold the responsible medical providers accountable by pursuing medical malpractice claims against them.

Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other birth complications that require long-lasting medical support.

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.

If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.

It takes a detailed expert review of the facts and circumstances of a hypocarbia case to determine whether the birth injury was caused or worsened as the result of medical malpractice.

Our Process

At Miller Weisbrod Olesky, a team of specialized birth injury malpractice attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. We then gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused you or your child's injuries.

If we feel medical negligence caused or contributed to your child's injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free legal consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form.